Anemia in systemic lupus erythematosus [SLE] patients; types, simple diagnosis and role of erythropoietin [EPO]

Anemia is a common hematological abnormality in Systemic lupus erythematosus and can easily be categorized with simple laboratory tests; the aim of this study was to investigate types and causes of anemia in SLE patients and to evaluate the role of EPO in different types of SLE anemia. Patients and methods; forty three male and female patients with SLE were investigated for types and possible causes of anemia among the follow up patients of the rheumatology outpatient clinic of Sohag university hospital in one year, blood and urine samples were obtained for laboratory investigations, patients with hemoglobin level less than 14 gm/dl for male and 12.3 gm/dl for female were consider anemic and enrolled in the study. Thirty nine patients [90.7%- 1 male and 38 females] were anemic, with mean age of 31 +/- 10 years, the types and incidence of anemia were; iron deficiency anemia [IDA] n = 22 [56.4%], anemia of chronic disease [ACD] n = 12 [30.8%] and autoimmune hemolytic anemia [AIHA] n=5 [12.8%], mean levels of hemoglobin were 10.4 +/- 1.3, 9.6 +/- 1.1 and 7.7 +/- 0.8, in the three groups respectively, low levels of complement C3 and C4 were observed in AIHA, and ACD, but not in patients with IdA. Anti-dsDNA antibodies were seen in all patients with AIHA, and in 10 patients with IDA, CRP concentrations were not related to severity of anemia in the three groups, higher levels of serum creatinine and proteinuria were detected in the three was no difference in the mean levels of EPO among different groups. Anemia in SLE can be easily diagnosed by simple methods, IDA is very common among SLE patients in our community, Erythropoietin [EPO] may have no role in SLE anemia and the presence of Anti Erythropoietin antibodies [AEA] and its role can not be ruled out

Tenosynovitis and rheumatoid nodules in tendons of hands and feet using high frequency ultrasonography and ower doppler sonography

Evaluation of disease activity and therapeutic response in patients with rheumatoid arthritis [RA] was based largely on the clinical findings. Conventional sonography provides accurate method for identification of the tendons changes with RA. The study included 69 patients with RA. Sonographic examination of the tendons in both hands and feet was performed by using B-mode real-time machines [ACUSON SEQUOIA 512, probe 7.5 MHZ]. Rheumatoid nodu1es were detected in 15 patients [21.7%]. The flexor tendons were affected mainly by tenosynovitis and nodules. The ultrasonography identified the RA tendon nodules that can not be detected by clinical examination. Ultrasonography shou1d be considered the screening procedure of choice for the diagnosis of rheumatoid inpalpable nodules in the tendons of hands and feet. It gives good information about the inflammatory synovitis and general idea about the tendon texture, that provides an objective assessment of the treatment efficacy

Seropositivity to sarcocystis antigens, in attendants of rheumatology clinic in Sohag, University Hospital

Human sarcocystosis is a zoonotic dead end infection. Many cases have been reported recently after muscle biopsy and some were diagnosed clinically as eosinophilic myositis. Cases were chosen randomly among attendants of Sohag University Rheumatology Clinic, 45 were having rheumatoid arthritis and 46 diagnosed as chronic myositis. 10 apparently healthy persons were enrolled as control. Records of the patients gave information about R.F., CRP, ANA and eosinophilic count. Using Sarcocystis of Fusiformis cystozoites as antigen, ELISA was performed for all patients, while Western Blot test was performed for 32 patients chosen randomly among them as 14 rheumatoid and 18 chronic myositis. Seropositivity by ELISA was 18.7% of patients, while that by immunoblotting was 31.2% among chosen cases. Most seropositive patients range between 30-40 years old. Comparison of ELISA and immunoblotting results revealed that all seronegative cases were negative by both tests, and that 9.4% of cases tested by both tests were positive only by ELISA, and they were of the rheumatoid arthritis group. Eosinophilia was more prevalent among seropositive cases, and was absent in the cases which were positive by ELISA and negative by immunoblotting. The conclusion is that Western Blot is more sensitive than ELISA. The latter is a good negative test. As immunoblotting is costy and tideous, ELISA when combined with eosinophilic count is a good indicative of sarcocystosis

value of adriamycin [or mitoxantrone] in the treatment of adult intermediate and high grade Non-Hodgkin's Lymphoma long term survival of randomized trial

This prospective study included 74 adult patients with intermediate and high grade non-Hodgkin's lymphoma treated in NEMROCK between December 1987 and May 1990. The patients were randomized into three treatment arms: Arm I [27 cases] received COOP/Ara-C-VP16 regimen, arm II [25 cases] received COPP/Ara-C-VP16 alternating with CHOP, while arm III [22 cases] received COPP/Ara-C-VP16 alternating with CNOP. This study aimed to determine whether the addition of adriamycin of mitoxantrone was critical in improving the response rate and long term curability of aggressive NHL in adults. At a median follow up period of 81 months [range 67-96 months], the five-year- survival figures were significantly superior in arms II and III compared with arm I. No significant difference was observed in response rate and five-year-survival figures between arm II [adriamycin based] or arm III [mitoxantrone based]. Treatment related toxicities, especially grades III and IV myelosuppression were significantly higher in arms II and III. Also, one event of treatment related mortality was recorded in arm II and arm III. In spite of its relatively satisfactory complete response rate [44%] and its acceptable toxicity profile, the five-year-disease-survival obtained in arm I by the COPP/Ara-C-VP16 regimen was extremely disappointing [13%]. These results indicated the importance of including anthracyclines or anthracenedione in any chemotherapy regimen designed for the treatment of aggressive NHL in adults

Results of treatment and survival of 231 patients with stage III bronchogenic carcinoma

Two hundred and thirty one patients with stage III Bronchogenic Carcinoma had been studied at NEMROCK [1974 1985]. 82% of patients had non small cell lung cancer, while 18% of patients had small cell lung cancer. 29% of patients received radiation therapy alone and 30% of patients received chemotherapy, while 41% of patients received combination of chemo and radiotherapy complete remission after treatment was obtained in 19.5% of patients, all of them received combined modality of treatment with a mean duration of response 10.5 +/- 11 months. There was a better 18 months survival for the patients received combined treatment modality as compared with other groups, and the difference was significant P < 0. 05]