الفهرس 
Introduction & Aim of the WorkOnly 14 pages are availabe for public view
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Abstract
Spontaneous bacterial peritonitis (SBP) is an infection of ascetic fluid The incidence ranges19.6 % in Egyptian cirrhotic patients and mortality rate of 33% . Homocysteine, a nonessential sulfhydryl-containing amino. It is synthesized during a multistage process of metabolism of another essential amino acid, methionine. Homocysteine is one of systemic inflammatory markers. It is considered as a proinflammatory molecule that activates synthesis of several cytokines and increases production of reactive oxygen species ,and resultant oxidative stress . Objectives The aim of the present study is to measure serum and ascetic homocysteine level in ascetic patients and detect its role in diagnosis of SBP. Subjects and methods Cross sectional comparative study . Forty five patients were cirrhotic with spontaneous bacterial peritonitis (SBP) and divided clinically to symptomatic (28) and non-symptomatic (17 ). The other 45 patients were cirrhotic with non infected ascites as a control group. After full history taking and general examination, patients were subjected to ultrasonography. Ascetic fluid and blood sample were collected from all patients in the study .Routine investigations { Liver function tests LFT (ALT, AST, S. albumin, S. total bilirubin , alkaline phosphatase, AFP and prothrombin time) ,Renal function tests RFT ( S. creatinine), fasting blood sugar , CBC and CRP } were done for all patients.Also ascetic fluid subjected to dipstick strip test screening to detect leucocyte esterase , PMN leukocytic count, CRP, albumin assay for SAAG calculation and homocysteine assay. Results • TLC regarding complete blood count in the studied patients, was significantly higher in both symptomatic and asymptomatic SBP patients compared to non infected ascites Also, TLC was significantly higher in symptomatic compared to asymptomatic SBP .INR was significantly higher in symptomatic SBP compared to non infected ascetic patients. Ascetic fluid TLC was significantly higher in patients with SBP versus non infected ascetic patients ,also in symptomatic SBP versus asymptomatic SBP. • Aerobic culture for peritoneal fluid belong asymptomatic SBP patients yield no bacterial growth ,while 8 out of 28 peritoneal fluid samples belong the symptomatic SBP patients yield significant bacterial growth revealed five(5) E-coli and three(3) S-aureus • Serum and ascetic homocysteine levels was significantly higher in SBP patients compared to non infected patients .Also significantly higher levels of both serum and ascetic homocysteine in symptomatic versus asymptomatic SBP patient. Serum and ascetic homocysteine level assay in SBP before and 4-5 days after antibiotic therapy revealed significantly lower in homocysteine level after antibiotic therapy . The best discriminators between patients with non infected ascites and those with SBP were ascetic TLC, serum CRP, serum homocysteine with non significant differences between their AUCs, followed by ascetic Hcy. Serum homocysteine was the best discriminator than others between negative and positive culture results in SBP cases followed by ascetic Hcy, then ascetic TLC. Serum and ascetic homocysteine showed significant positive correlation with serum and ascetic TLC, ascetic CRP, positive ascetic fluid culture results, SBP and symptomatic SBP. Serum and ascetic homocysteine were significantly positively correlated. Otherwise, no significant correlations were found between serum and ascetic homocysteine and other parameters in all the studied patients. Conclusion: Serum homocysteine was more reliable than ascetic Hcy but less sensitive than ascetic TLC and serum CRP when discriminate between patients with non infected ascites and those with SBP. Serum homocysteine was the best discriminator between negative and positive culture results in SBP cases followed by ascetic Hcy, then ascetic TLC. Serum and ascetic homocysteine have significant positive correlation with serum and ascetic TLC, ascetic CRP, positive ascetic fluid culture results, SBP and symptomatic SBP. - Ascetic LE, using “ Medi-Test combi 10, cannot be used as a bedside test for rapid diagnosis of SBP - So, serum homocystiene levels could serve as a promising, noninvasive, and easy method that may help physician in detection spontaneous bacterial peritonitis. Also it is a reliable marker for the resolution of the infection, avoiding the potential need for the second paracentesis.