Evaluation of serum cartilage oligomeric matrix protein [Comp], soluble tumour necrosis factor receptor-II[sTNF-RII] and interleukin-6 [IL-6] levels in relation to serum estradiol, functional and radiologic findings in postmenopausal females with knee joint osteoarthritis

To evaluate the possible relation between serum levels of cartilage oligomeric matrix protein COMP, sTNF-RII, IL-6 and estradiol in post-menopausal females with clinically and radiologically documented osteoarthritic changes in the knee joint. Twenty post-menopausal females [PMOA] -with clinically and radiologically documented knee joint osteoarthritis were compared to a control group of ten post-menopausal females [control group [I]] and ten pre-menopausal females [control group [2]] "who were clinically and radiologically free of knee joint osteoarthritis. To all the studied subjects, a complete clinical examination was performed, including body mass index calculation, as well as scoring .systems for functional assessment of joint. Plain X-ray of both knee joints was performed. Serum samples were obtained for analysis of urea, creatinine, uric acid, total calcium, inorganic phosphates, C-reactive protein, rheumatoid factor COMP, sTNF-fUI, IL-6, and estradiol levels. The mean serum estradiol values in the PMOA, and control group [I] were significantly lower than their corresponding value in control group [2], and slightly lower in the PMOA than control group [1]. The mean serum COMP value was slightly higher in the PMOA group than its corresponding value in control group [1], and both mean sera values were significantly higher than their corresponding mean value in control group [2]. The mean serum sTNF-RII value was significantly higher in the PMOA group than its corresponding values in control group [1] and control group [2]. As regards mean serum IL-6 value, it was significantly higher in control group [1] than its corresponding values in the both PMOA and control group [2]. Based on ROC curve analysis in PMOA and control group [1], both serum COMP and sTNF-RII yitld a diagnostic specificity of 90% each, while the diagnostic sensitivity was 45% and 50% respectively. By using the combined approach, we were able to increase the diagnostic sensitivity of serum COMP and sTNF-RII to 90% and 83% respectively. On the other hand, the receiver operating characteristics [ROC] curve analysis of the same parameters in PMOA and control group [2], revealed a diagnostic sensitivity of 100% for each of serum COMP and s TNF-PJI as well as a diagnostic specificity of 90% for serum COMP and 70% for sTNF-RII. The fact that radiographic evidence of OA usually appears in advanced stages of the disease led to the need of identifying possible serum biochemical markers that could reflect the joint tissue status. From the above mentioned results, it could be concluded that the combined measurement of serum levels of the biochemical markers COMP and sTNF-RII may be used in identifying osteoarthritis in post-menopausal females. Furthermore, menopausal state per-se could play a role in the limitation of the diagnostic sensitivity of either of the two parameters if one of both analytes was chosen alone for measurement

Study of serum osteoprotegrin [OPG], tumor necrosis factor-related apoptosis-inducing ligand [Trail] and fetuin-A in patients with chronic renal failure

Vascular and valvular calcifications are strong prognostic markers of cardiovascular disease mortality in chronic kidney disease [CKD] patients especially those on hemodialysis. It has been demonstrated that CKD patients with osteodystrophy have increased atherosclerosis and, more recently, increased coronary artery calcification. Was to evaluate the link between renal failure, atherosclerosis, vascular calcification and inflammation by determining the role of serum osteoprotegrin [OPG], tumor necrosis factor-related apoptosis-inducing ligand [TRAIL], and Fetuin A in the development of vascular calcification in patients with End stage renal failure disease [ESRD]. The study included, thirty patients on maintenance hemodialysis [HD] and fifteen patients with conservatively managed chronic renal failure [CRF] for whom dialysis was not performed. Both groups were compared to fifteen age and sex matched healthy individuals who constituted the control group. To all the subjects clinical examination, and 12 lead electro-cardiography were done. To all subjects the following investigations were performed: routine biochemical analysis, serum OPG, Fetuin A and plasma TRAIL Also serum parathyroid hormone [PTH], Calcium [total and ionized], phosphorus [Ph], and C- reactive protein [CRP] were measured. Finaly carotid ultra sonography of the pelvis and hand, and calculation of vascular calcification score were done. Carotid intima media thickness [CIMT] was found to be significantly higher in both undialyzed [CRF] patients and dialyzed [HD] patients when compared to controls [p<0.001 leach]. Also the difference between both groups of patients was statistically significant [p: 0.014]. Calcification score was found to be significantly higher in CRF and HD patients when compared to controls [p: 0.047 and < 0.001 respectively] Serum OPG level was significantly higher in both undialyzed CRF and dialyzed HD patients when compared to the control group [p: 0.041 and < 0.001 respectively].The level was also found to be significantly higher in the HD group when compared to CRF patients [p< 0.001]. Serum fetuin A level was found to be significantly lower in both CRF and HD patients when compared to the control group [p: 0.02, 0.05 respectively]. As regards TRAIL levels, no significant difference was found between the three studied groups. The level of the PTH was significantly higher in CRF undialyzed and HD patients when compared to control group [p: 0.021 and < 0.001 respectively]. CRP level was significantly higher in both patients groups when compared to controls [p< 0.001, 0.04 respectively].In the total patients group: there was a positive significant correlation between VC score and both PTH and AP. There was a positive significant correlation between OPG and [CIMT, Fetuin, AP and total Ca]. There was also a positive significant correlation between Fetuin A and both TRAIL and Albumin. By performing multiple logistic regression, only serum PTH was significant independent predictor of vascular calcification [p=0.006] and serum OPG was significant independent predictor of inflammation. [p=0.029]. The only parameter with significant ROC curve was PTH. It could be finally concluded that the increased level of OPG in CRF and HD patients might be a compensatory self defensive response against other factors that promote vascular calcification, or may possess potentially damaging properties, while the decreased level of Fetuin A reflects an inadequate response against the development of VC. Also the increase level of CRP denotes an ongoing inflammatory state and this causes down regulation of fetuin A which may represent the essential link between chronic inflammation and vascular calcification. PTH was found to be the best diagnostic marker of VC of all studied parameters, and was also the most independent predictor of VC, while OPG was the most independent predictor of inflammation

Evaluation of some epidemiological characteristic and biochemical parameters among Egyptian autistic children

One of the settled facts in the etiology of autism is that genetic and environmental factors play a role in its occurrence. However, the recent dramatic increase in autism prevalence world, suggests other factors to be involved in its etiology. Most of the studies reported associations but not possible risk factors in the etiology of autism. The present work aimed at determining some epidemiological characteristics of Egyptian autistic children including the study of some incriminated perinatal factors. As well as biochemical assessment of metabolic disturbances with special stress on fatty acids and trace elements in the autistic children compared to their healthy siblings. Sixty children were included in the study, divided into two groups; a group that consisted of forty children who fulfilled the criteria of pervasive developmental disorders and a group of twenty apparently healthy siblings matched by age, sex, and social status to the autistic children. All the children were subjected to a thorough history taking and clinical examination including anthropometric measurements, Laboratory investigations included the determination of some routine biochemical parameters in blood and urine, serum and blood levels of some trace elements [copper, zinc, lead, and cadmium] using the atomic absorption spectrophotometry, serum total and individual fractions of fatty acids [using gas liquid chromatography] and urinary vanillyl mandelic acid [VMA]. The present work revealed a significant increase in head circumference measurement of autistic children compared to their control group and the gestational age as the only significantly different perinatal factor between th groups. A significant lower serum zinc and higher blood lead and cadmium mean values were observed in autistic children, along with significant rise in the ratios of copper to zinc, cadmium to zinc and lead to zinc. As regards the fatty acids, the omega 3 fatty acids were significantly lower in autistic children than the corresponding siblings, along with a significantly higher omega 6 to 3 ratio in autistic children in addition, the arachidonic acid ecosapentadecanoic acid ratio was significantly higher in autistic children than the corresponding siblings. Serum stearic acid was significantly higher while serum docosanoic acid and its methyl ester were significantly lower in autistic children than their healthy siblings. The urinary VMA and uric acid to creatinine ratios were .significantly higher in autistic children when compared to their healthy siblings. Correlation studies of omega 3 fatty acids with other parameters demonstrated positive correlation with serum zinc level and inverse correlations with blood lead, autistic head circumference, as well as lead/zinc, cadmium/zinc, urine uric acid and urine VMA to creatinine ratios. From the present work, it could be concluded that head circumference is an important determinant of autistic children. The disturbance in metal metabolism noted in this study by the significantly lower serum zinc which is important as a neurotransmitter and the significantly higher blood cadmium and lead levels could denote a dysfunction in metallothionein protective detoxification of cadmium and lead resulting in increased vulnerability these toxins. Another finding is the deficiency of essential fatty acid particularly the omega3 series including Eicosapentaenoic [EPA] and Docosahexaenoic [DHA] as well as the complete absence of linolenic acid could be responsible for the suppression of brain energy metabolism, and alteration of the course of brain development. In lion, neurochemical factors could play a role in autism as demonstrated by the increased urinary VMA in autistic children that denotes frequent stressful conditions to which autistic children are subjected to