Níveis de óxido nítrico mais elevados estão associados à atividade da doença em pacientes egípcios com artrite reumatoide / Higher nitric oxide levels are associated with disease activity in Egyptian rheumatoid arthritis patients

Introdução O estresse oxidativo produzido no interior de articulações inflamadas pode produzir fenômenos autoimunes e destruição articular. As espécies radicais com atividade oxidativa, incluindo espécies reativas de nitrogênio, representam mediadores de inflamação e de lesão cartilaginosa. Objetivos Avaliar o óxido nítrico sérico como marcador de estresse oxidativo em pacientes egípcios com artrite reumatoide e sua relação com a atividade da doença. Métodos 80 com artrite reumatoide foram divididos em dois grupos, de acordo com a pontuação DAS28: Grupo I: 42 pacientes com doença ativa, e Grupo II: 38 pacientes com doença inativa. Quarenta indivíduos equiparados por idade e gênero foram incluídos como grupo controle (Grupo III). Foram realizados exames laboratoriais de rotina e o óxido nítrico foi medido usando Elisa. Radiografias simples das mãos foram feitas para a pontuação do estado radiológico utilizando o método de Sharpe. Resultados A comparação do nível sérico de óxido nítrico entre os três grupos mostrou uma diferença altamente significativa (p < 0,001). Obtiveram-se níveis significativamente mais elevados entre os pacientes com artrite reumatoide em comparação com os controles. Os níveis mais elevados foram obtidos em pacientes com a doença ativa (média±DP 82,38±20,46) em comparação com aqueles com a doença inativa (35,53±7,15). O óxido nítrico no Grupo I exibiu uma correlação positiva significativa com a rigidez matinal (r=0,45), artrite (r=0,43), contagem de plaquetas (r=0,46), velocidade de hemossedimentação (r=0,83), proteína C-reativa (r=0,76) e Índice de Atividade de Doença (r=0,85). O óxido ...

Background Oxidative stress generated within inflammatory joints can produce autoimmune phenomena and joint destruction. Radical species with oxidative activity, including reactive nitrogen species, represent mediators of inflammation and cartilage damage. Objectives To assess serum nitric oxide as a marker of oxidative stress in Egyptian patients with rheumatoid arthritis and its relation to disease activity. Methods Eighty patients with rheumatoid arthritis were divided into 2 groups, according to the DAS-28 score: Group I: 42 patients with disease activity, and Group II: 38 patients with no disease activity. Forty age- and sex-matched individuals were included as control group (Group III). Routine laboratory investigations were done, and nitric oxide was measured using Elisa. Hand plain radiographies were done for radiological status scoring using the Sharp method. Results A comparison between nitric oxide in all three groups showed a highly significant difference (p < 0.001), significantly higher levels were obtained among rheumatoid arthritis patients in comparison to controls, and higher levels were obtained in patients with active disease (mean±SD 82.38±20.46) in comparison to patients without active disease (35.53±7.15). Nitric oxide in Group I showed a significant positive correlation with morning stiffness (r=0.45), arthritis (r=0.43), platelet count (r=0.46), erythrocyte sedimentation rate (r=0.83), C-reactive protein (r=0.76) and Disease Activity Score (r=0.85). Nitric oxide showed a significant positive correlation (r=0.43) with hand radiographies (Sharp score) in Group I. Conclusion There are increased levels of nitric oxide in the serum of patients with rheumatoid arthritis. Nitric oxide correlates significantly with disease activity, inflammatory markers and radiological joint status. .

Assessment of the environmental and operational factors affecting the bioremediation of H[2]S gas as air pollutant

This study aims at optimizing environmental and operational factors affecting the bioremediation of H[2]S as air pollutants. Sulfur gases are emitted from many industrial sources and have adverse effects on the public health and the environment. Bioremediation of waste gases represents a new treatment alternative that has been seen as a competitive to the physicochemical treatment technologies. Sulfur gases, such as H[2]S were among the inorganic gases that have been proven to be suitable candidates to Bioremediation. The process of biological treatment depends on using sulfur eating bacteria which can use the target sulfur gas or compound as energy or supplementary source converting it to another sulfur form. Sulfur bacteria are dominant microorganisms in many natural media. The bioreactor used was an aerobic reactor for oxidizing H[2]S to elemental sulfur by Sulphur Oxidizing Bacteria [SOB]. It consisted of aerobic bioreactor, a settler, and H[2]S-laden gas producing system. The microorganism used is SOB isolated from sewage sludge. Microbial activity is affected by environmental factors and operational factors. The results revealed that the optimum CO[3] concentration range for complete removal and conversion, i.e. 100% recovery of H[2]S is 61.5 to 615 g/m[3]. The SOB was highly preferment within a nitrogen concentration range of 30.8 to 123.1 g/m[3], achieving 100% removal or conversion efficiency. The minimum P concentration that maintained maximum activity of the resident SOB was about 24.6 g/m[3]. The mesophilic range was the optimum for the SOB used in this study [38-43 C°]. The highest performance of the bioreactor was attained at pH range from 7.5 to 9 with optimum operation at pH 8. Results explained that the resident SOB at pH 8 tolerated total sulfide concentrations higher than at pH 7. 100% removal efficiency of the bioreactor reaching at O[2]/H[2]S range 0.5- 1.5. The maximum elemental sulfur yield obtained was 92.4%. The increase of H[2]S inlet concentration required increase of contact time. The measurements of SOB concentration in the suspension reported average about 3.56x10[8] cells/ml [range from 3.5 to 3.62x10[8] cells/ml]. This implies that the maximum cell capacity was about 1.23x10[-12] g H[2]S/cell.h. The activity of the SOB was not affected at SO[4] concentrations below 20,000 g/m[3]. The removal efficiency was 100% below this concentration. The S[2]O[3] concentrations higher than 10,000 to 15,000 g/m[3] may be inhibitive to the SOB. This study recommended encourages the using of air pollutant gases bioremediation in industries scale

Retrospective study of infections in Egyptian patients with systemic lupus erythematosus [SLE]

Infections are one of the leading causes of morbidity and mortality in patients with systemic lupus erythematosus [SLE], therapeutic, dose-related and genetic factors all contribute to a lupus patient's increased susceptibility to infections. Although bacterial pathogens are the most common cause of infections, a wide variety of pathogens have been reported. Multiple risk factors for infection in SLE have been reported. These include disease activity, renal disease, gluco-corticoid use and cytotoxic therapies. The objective was to analyze infection risk factors in Egyptian lupus patients; the influence of these factors on disease activity, organ damage, disease development and the type of micro-organisms involved. The study included forty patients with SLE [37 females and 3 males] They were selected from those attending the SLE clinic in Ain Shams University hospital outpatient. Lupus disease activity had been established according to SLAM score. They were subjected to a retrospective study to : Complete medical history with special interest on duration of the disease, current treatment for lupus and dosage of prednisone, antimalarial drugs and immunosuppressive agents, number of infections whatever the cause during One year and number of admission due to episodes of infection whatever the cause. It included also symptoms of urinary tract infection [UTI] upper respiratory tract infection [URTT] as well as any complaint of the patient proved to be due to infection Laboratory assays included: CBC, ESR, serum creatinine, urine analysis, 24 hours protein in urine and culture when necessary. Increased incidence of infection in lupus patients which was 83 infections during the one year study. the incidence of Upper Respiratory Tract Infections was 8 infections [9.64%], Urinary Tract Infections 70 infections [84.34%], and Skin Infections 5 infections [6.02%] 83% of the cultures had had obtained from lupus patients. 83% of the urine were G- ve organisms. E. coli was the most common uropathogen encountered in this study [47%] which was resistant to most antibiotics but was sensitive to aminoglycosides. Skin infections were presented by abscesses 4 times [80%] -with predominance of staphylococci- and Herpes Zoster once [20%] There was a significant increase in the number of infection in relation to corticosteroids dose. There was a statistical significance between incidence of infection and addition of immunosupressive drugs to corticosteroids. There was a strong relation between incidence of infection and disease activity. SLE itself, increased dose of corticosteroids, use of immunosuppressive drugs and activity of the disease all are risk factors in incidence of infection in patients with SLE. UTI followed by URTI and skin infections including HZ were the most frequent infections in Egyptian SLE patients

Effects of circadian blood pressure variability on aortic distensibility in untreated and treated hypertensive individuals

Background: Blood Pressure [BP] exhibits a circadian periodic variation with lower values during the night and higher values during the day. Blunted BP decline during nighttime, which is called non-dipping pattern, in hypertension [HTN], is associated with higher cardiovascular [CV] morbidity and mortality, however, this association has not gone undisputed. Furthermore, the influences of non-dipper BP on aortic elastic properties have not yet been widely studied

Objectives: the aim was to evaluate the effect of circadian BP changes [dipping and non-dipping state] on aortic dispensability in untreated and treated hypertensive subjects using standard Doppler echocardiography

Patients and Methods: this study included 87 out of 180 subjects classified according to their BP profile and clinical status into 3 groups. Group [1]: 28 patients with untreated HTN, Group [2]: 34 patients with treated HTN, and Group [3]: 25 normal controls. Each group was further classified into 2 subgroups: [a: dippers and b: non-dippers]. We excluded every patient with any systemic disease or CV risk factor that may affect aortic structural and/or functional characteristics apart from HTN. All study populations were subjected to thorough history taking, clinical examination, laboratory work up, ECG, 24h ABPM, standard echo Doppler

Results: the study included 44 [51%] males and 43 [49%] females; their mean age was 42 +/- 8, and ranging between 29-55 years. In untreated hypertensives, systolic and diastolic aortic diameters [SAD, DAD] [aortic anatomical parameters] were similar in both dippers and non dippers, while functional parameters [aortic strain distensibility and stiffness index] [AS, AD, and ASI] showed only trends for more impairment in non dippers than dippers, however, these did not reach statistical significance. In treated hypertensives, also aortic anatomical parameters were similar in both dippers and non dippers, while aortic functional parameters were significantly more impaired in non-dippers than in both dippers and controls. We also found that both aortic anatomical and functional parameters and so elastic properties showed significant correlations mainly with systolic load in untreated hypertensives, while correlated mainly with nighttime ABP measurements in treated hypertensives

Conclusion: this study confirmed that, in untreated hypertensive, aortic distensibility was slightly more impaired in non-dippers compared to dipper ones, but this difference did not reach statistical significance and it correlated positively mainly with systolic load. While in treated hypertensives, AD was significantly more impaired in non-dippers compared to dippers and it correlated positively mainly with nighttime measurements

Neopterin as an immunological marker

To compare between serum neopterin level in rheumatoid arthritis [RA] patients [active and nonactive], patients with some parasitic intestinal nematodes infestation and with normal controls. The patient groups were chosen to represent diseases in which cell mediated immunity is involved in the disease process. Also, to correlate changes in serum neopterin level with status of disease activity in patients with rheumatoid arthritis [RA] and with the load of some intestinal nematodes infestation. This study was done on the following groups. Group I included 20 inactive RA patients [8 males and l2females, 18-50 years old], Group II which included 20 active RA patients [7 males and 13 fema1es, 18-60 years old], Group III included 16 patients with enterobiasis [6 males and 10 females, 5-35 years old], group IV included 12 patients with ascariasis [8 males and 4 females, 4-30 years old], group V included 12 patients with ancylostomiasis [10 males and 2 females, 12-50 years old] and group VI which included 10 normal subjects [5 males and 5 females, 10-35 years old] with no evidence of any rheumatological disorder or parasitic infestation as a control group. RA disease activity was assessed according to the presence or absence of morning stiffness, pain, grip strength, and articular index. Group I, II and VI were subjected to full medical history and clinical examination, CBC and ESR, assay of rheumatoid factor [RF] by Rose-Waaler test, and X-ray on the affected joints and graded by modified Larsen et al. [1977] index .Group III, IV, V, and VI were subjected to full medical history and clinical examination, repeated stool analysis, perianal swab for suspected cases of pinworm infestation, and estimation of parasitic load. Quantitative measurement of serum neopterin was done for all persons included in the study. In RA patients both groups [I and II] were matched regarding age and disease duration. ESR and serum neopterin levels were higher in active disease group [highly significant difference]. In all RA patients there was a positive correlation between ESR and serum neopterin, and between ESR and serum RF levels. In group I, a positive correlation was found between ESR and serum neopterin levels. In group II, a positive correlation was found between age and disease duration, ESR and serum neopterin levels, ESR and serum RF levels, and between serum neopterin and serum RF levels. Also, serum neopterin was significantly elevated in groups III, IV, and V when compared to group VI. A highly significant difference was found on comparing serum neopterin level between patients with active RA and all parasitic patients, active RA and controls, inactive RA and controls, and all parasitic patients and controls [being higher in the former groups], while it was insignificant on comparing inactive RA and all parasitic patients. Furthermore, serum neopterin was significantly increased with increased parasitic load. Serum neopterin is significantly higher in sera of active RA patients and correlates with disease activity and also it is significantly higher in sera of patients with intestinal nematodes infestation and its level progressively rises with the increase in the parasitic load