Brain-stem auditory evoked responses in COPD patients

COPD is a multi-system disorder. It appears to be associated with the presence of systemic inflammatory markers as C reactive protein. The present study aimed to evaluate the brain-stem auditory evoked potentials [BAEP] abnormalities in stable COPD patient and its correlation with high sensitivity C reactive protein [hs-CRP] as a part of multi-system disorder. This case control study was carried out at Mansoura University Hospital Egypt from October 2009 to February 2010. The study comprised 40 stable COPD patients and 15 healthy controls with no risk that may lead to neuropathy. All the patients and controls were subjected to the following: I-Thorough history taking and clinical examination. II-Pulmonary function tests including: 1-Spirometry 2-Body plethsymography 3-Arterial blood gases analysis. III- Record of brain-stem auditory evoked potentials [BAEP] including: latencies of waves I, II, III, IV and V together with interpeak latencies [IPLs] of I-III, I-V and III-V and amplitudes of waves I-Ia and V-Va. IV - Measurement of serum high sensitivity C reactive protein [hs-CRP] by ELISA technique. V - Statistical analysis. The level of hs-CRP reactive protein in COPD was significantly elevated and correlated with spirometric, blood gases parameters and GOLD stage. The BAEP latencies of waves I, II, III, IV and V, together with interpeak latencies and amplitudes of waves I-Ia and V-Va measured on both ears were significantly different in COPD patients than controls. The prevalence of brain-stem auditory evoked potentials abnormalities was higher among very severe group of COPD. Most of BAEP wave latencies together with interpeak latencies and wave amplitudes on both ears were significantly correlated with the spirometric and blood gases parameters. The level of hs-CRP was correlated significantly with abnormalities of BAEP variables. This study showed significant subclinical BAEP abnormalities in studied stable COPD male patients. This indicates conductive defect of auditory nerve, cochlea and even hearing pathway in the brain as a part of systemic inflammation. Theses BAEP abnormalities were significantly correlated with GOLD classification, hs-CRP and PaO[2]

Allergic bronchopulmonary aspergillosis in patients with bronchial asthma

The aim of the work was to assess prevalence of allergic bronchopulmonary aspergillosis ABPA in bronchial asthma in outpatient clinic of Mansoura university hospital-Egypt and to detect the predictors for diagnosis of ABPA in bronchial asthma patients. This study comprised 210 patients with bronchial asthma. All patients were subjected to thorough histoiy taking and clinical examination, grading of severity of bronchial asthma was done according to GINA guideline 2006, chest X-ray, computerized spirometry, Aspergillin skin test. For the aspergillin skin test positive patients, the following tests were done: complete blood count, total IgE, specific IgE and IgG for Aspergillus fumigatus and chest high resolution CT. Aspergillin skin test positivity was found in 22.86% [48 out of 210] of cases of bronchial asthma [BA]. ABPA was diagnosed in 3.81% of cases of BA [8 out of 210]. While among Aspergillin skin test positive cases, the prevalence of ABPA was 16.6% [8 out of 48]. The degree of severity of BA with ABPA was higher than in BA without ABPA [87.5% versus 17.33% for severe persistent BA]. There were significantly higher percentage of cases on systemic steroid in BA with ABPA versus BA without ABPA [100% versus 42.08%. p=0.001]. There were significant higher scoring of severity of bronchiectasis and bronchial wall thickening in Aspergillin skin test positive with ABPA versus Aspergillin skin test positive without ABPA [1.87 versus 0.68 and 1.75 versus 0.6, p=0.006, 0.004 respectively]. The scoring of extent of bronchiectasis, mucus plugging and consolidation/atelectasis were significantly higher in Aspergillin skin test positive with ABPA versus aspergillin skin test positive without ABPA [1.5, 0.85, 0.50 versus 0.65, 0.18, and 0.15 respectively] [p=0.035, 0.001 and 0.048 respectively]. Aspergillin skin test positivity is high in patients with BA [22.86%] and is associated with a higher prevalence of ABPA [16.6%]. ABPA is not a rare disease in BA, as it occurs in 3.8% of cases of BA [8 out of 210]. ABPA can be predicted in patients with BA especially if they have: higher grade of BA [severe persistent BA], systemic' corticosteroids for control of BA, higher degree of severity and extent of bronchiectasis [+3 and +2], higher severity of bronchial wall thickening [+3],higher degree of extent of mucus plugging [+2] and consolidation/atelectasis [+1]

Expression of interleukin-2 receptors [IL-2R] and intracellular adhesion molecules-1 [ICAM-1] after allogeneic bone marrow transplantation

There is no specific diagnostic laboratory test for diagnosis of acute graft versus host disease [aGVHD] and sometimes it is a clinical diagnosis. Most investigators studying the relationship between IL-2 and aGVHD have obtained disappointing results. The expression and function of IL-2R and ICAM-1 are critical components in the initiation and elicitation of many T cell-mediated responses. This work was designed to investigate whether the observed phenotype pattern of IL-2R and ICAM-l may be useful for early diagnosis of aGVHD, in patients undergoing allogeneic peripheral blood stem cells transplantation [PBSCT]. Patients and Peripheral blood samples were obtained from 25 patients who underwent allogeneic PBSCT, and 13 patients with autologous PBSCT and 10 normal donors as control group. The expression of IL-2R and ICAM-1 were analyzed by flowcytometry using monoclonal antibodies against CD25 and CD54. There is statistically significant increase in the mean CD25 expression in patients with aGVHD [21.17 +/- 11.48] than patients with autologous PBSCT [5.01 +/- 2.62] or control group [1.4 +/- 0.51]. There was non significant difference [p > 0.05] in the CD 25 expression in patients with aGVHD grade I [15.11 +/- 13.9] and patients with grade 2-4 [mean 23.3 +/- 5.49]. There was significant increase [p < 0.01] in the number of patients with positive CD 25 expression with aGVHD grade 2-4 [3/3, 100%] than grade 1 [0%]. The percentage of CD54 was statistically significant higher [p < 0.05] in patients with allogeneic PBSCT [11.29 +/- 9.08] than in control group [1.34 +/- 0.47] and it was non significant with patients with autologous PBSCT [4.34 +/- 1.57]. There was non significant difference in the CD 54 expression in patients with aGVHD grade 1 [9.1 +/- 6.8] and patients with grade 2-4 [mean 16.3 +/- 12.2] [p > 0.05]. One patient 1/3 [33.3%] with positive expression of CD54 has aGVHD grade 1 and 2/3 [66.7%] have aGVHD grade 2-4 and this difference was statistically non significant [p < 0.2]. The increased level of CD25 in patients with allogeneic PBSCT is a useful marker for anticipating aGVHD and grade 2-4. CD54 is not a useful indicator for aGVHD or its grade

Aetiologic and diagnostic study of thyroid opthalomopathy

This study included 17 patients with an age ranged 17-42 years. They have thyroid eye disease. MR images of the thyroid gland and orbits were performed on 1.5 Tesla machine. TI weighted images were obtained with repetition time [TR] of about 500 ms and echo time [ET] of 20-25 ms. T2 weighted images were obtained with TR of 2000-2500 ms and TE of 30-80 ms. Excess fat deposition in the retro-bulbar space was reported in 9 cases and muscle involvement was reported in 11 cases. Five cases showed symmetrical enlargement of extra ocular muscles, while 5 cases were asymmetrical and one case was unilateral. The distribution of muscle involvement was in the following order: Inferior rectus 64.7%, medial rectus 52.9%, superior rectus 29.4% and least frequency was in the lateral rectus 17.6%. The enlarged muscles have fusiform expansion with tapering towards muscle tendon. They have signal intensity similar to normal signal intensity of the muscle on TI weighted images. On T2 weighted images, they were hypointense in 10 cases and hyperintense in one case. Lacrimal gland involvement was recorded in 2 cases