Inflammatory status in patients on chronic hemodialysis

All chronic renal failure patients show clinical and/or laboratory manifestations of inflammation. Prevalence of infection in chronic renal failure [CRF] patients is high due to immune dysfunction, also repeated cannulation and central venous catheters are probably responsible for the high incidence of infection. Detection of these pro-inflammatory cytokines in the plasma allow to detect patients with high risk of endotoxemia and also it was noticed that there is high degree of correlation between the inflammation, malnutrition and atherosclerotic process. The aim of the present study was to detect the level of plasma alpha-MSH as immunomodulator which counter acts the pro-inflammatory cytokines such as TNF-alpha, neopterin, nitric oxide [NO], C-reactive protein [CRP] and eridotoxins. This study was conducted on 40 subjects divided into three groups, 15 patients on maintenance hemodilaysis [GI], 15 patients with chronic renal failure not yet on dialysis [GII], and 10 healthy subjects as a control group [GIII]. Plasma alpha-MSH was measured using a double antibody radioimmunoassay, TNF-alpha and neopterin using specific enzyme-linked immunosorbent assays. Plasma nitrites were determined by a colorimetric method and endotoxin with the quantitative chromogenic method. The present study showed that most of the chronic renal failure patients show laboratory evidence of inflammation especially before starting dialysis. alpha-MSH was found to he elevated in both groups. Also, the levels of the proinflammatory cytokines, TNF-alpha, neopterin, nitric oxide, iNOS, C-reactive protein and plasma endotoxin were found to he elevated in both group I and group II. There was a positive correlation between alpha-MSH and endotoxemia. Also, there was a positive correlation between the level of endotoxins and the level of other pro-inflammatory cytokines suggesting the role of endotoxemia in stimulating the formation and release of the proinflammatory cytokines

Evaluation of the levels of circulating carbohydrate antigen and anti-SWAP antibodies in patients with active Schistosoma haematobium infection and its relation to morbidity changes

The immune responses of schistosomiasis and its relation to morbidity changes is important to understand the pathogenesis of this disease. The aim of this study is to evaluate the levels of circulating antigen and anti-SWAP antibodies and its relation to morbidity changes in patients with active Schistosoma haemtobium infection. An antigen enzyme-linked immunosorbent assay [ELISA] employing monoclonal [mAb] 128C3/ 3/21 was used to detect circulating parasite-derived antigen in the sera of 35 of actively infected schistosoma haematobium patients [31 males and 4 females, 5 to 25 years of age] seen in the out patient clinic of Assiut University Hospital. AntiSWAP [soluble adultworm antigen preparation] immunoglobulins IgG1. IgG4 and IgE were performed for 25 of them. Patients were treated with praziquantel [PZQ] and re-evaluated after 1, 3, and 6 months. Changes in morbidity were evaluated using ultrasonographic grading of urinary bladder lesions. It was found that all patients had significantly high levels of circulating antigens in their sera i. e. above the cut-off value. The antigen level fell significantly in the follow cup visits [p<0.001]. Although the mean antigen level was still significantly reduced [p<0.001] at 6 months visit, 16 patients had high mean antigen level and 9 had rising levels of antigenaemia, reflecting reinfection in 6 patients and persistence of infection in the others. On the other hand, all patients had positive ELISA reaction for IgG1 and IgG4, while 5 patients had negative reaction for IgE through the different visits before and after treatment. The decrease in the mean levels of IgG1 and IgG4 were statistically significant only after 6 months of treatment, but the mean levels of IgE showed significant drop at 3 and 6 months of treatment. A significant correlation was found between the circulating antigen and the anti SWAP IgE during the active infection, but no significant correlation was found between the antigen level and IgG1 and IgG4. There was a significant correlation between the level of circulating carbohydrate antigens and morbidity changes of the urinary bladder. On the other hand there was no significant correlation between the anti-SWAP antibodies and morbidity changes. We conclude that ELISA assay for detection of circulating carbohydrate antigen of S.haematobium is valuable and sensitive in diagnosis of active infection, measurement of intensity of infection and detection of reinfection as well as evaluation of the efficacy of treatment. Its level correlates with anti-SWAP IgE during active infection. In addition it correlates significantly with

Neurological presentation of ten cases with disseminated intravascular coagulopathy

Cerebral involvement in DIC is rare. Ten cases of DIC, showing variable forms of central nervous system involvement, were reported. All cases showed neurological disorders plus laboratory evidence of DIC [disseminated intravascular coagulopathy]. DIC patients secondary to malignancy presented mainly with a picture of large vessel stroke. The most common neurological presentations of DIC are obtundation, coma, focal or generalized seizures, large vessel occlusion and rarely subarachnoid hemorrhage

Psychiatric, medical and neurological study of 12 cases of anorexia nervosa

Careful evaluation for psychiatric disorders and medical illness were done for 12 cases of anorexia nervosa encountered from November 1989 through October 1990. All patients verified the diagnostic criteria of DSM III R for anorexia nervosa. Their mean age was 18.5 years. Patients were subjected to psychometric study [IQ and Beck's depression scale] as well as routine investigations. The study showed that 41.6% were severely ill, 58.3% required medical care and 50% were depressed. Persistent significant cardiac irregularities were frequent and severe in patients who had abused laxatives and diuretics. The study pointed to the increasing incidence of anorexia and the serious medical complication associated with it

dermatoglyphic index for the diagnosis of Down Syndrome

The plam and foot prints of 52 male Mongols and 100 male normal controls were examined for the pattern of 28 dermatoglyphic areas. Statistical analysis revealed significant differences between Mongols and control subjects in the pattern frequency of 15 areas; only eight pattern areas accounted for most of the total dermatoglyphic variation between the two groups. Since discriminant function analysis of these eight areas permitted accurate diagnosis of subjects with Down syndrome, a simple dermatoglyphic diagnostic index was devised to facilitate clinical application of the method

new concept in the design of an intensive care unit for haemodialysis

The intensive care units are extensively used in Egypt for haemodialysis. The paper discussed the development of the basis utilized for the design of renal intensive care units. The design should fulfill, maximum utilization of resources, area and time. The paper suggested an integrated concept for the planning of such units. The suggested design presented in the paper suits developing countries