Serum Levels of Zinc and Copper in Cases of Juvenile Idiopathic Arthritis

Background:Juvenile idiopathic arthritis (JIA) represents a heterogeneous group of autoimmune diseases that arises before the age of 16 years and lasts more than 6 months. During acute inflammation of the disease, serum copper concentration increases and zinc decreases, that could point to the possible pharmacological properties of these trace elements. Aim:To measure the serum level of zinc and copper in patients with juvenile idiopathic arthritis (JIA) with different subtypes and correlate the levels of zinc and copper with the disease activity. Methods:This cross-sectional study was done on 40 patients already diagnosed clinically with JIA; patients were followed-up at the Rheumatology Outpatient Clinic, Children's Hospital, Cairo University. Results:Out of forty patients, 16were males (40%) and 24 were females (60%) with a male to female ratio (M: F) of 1:1.5. Out of the forty patients 17 were in activity and 23 were without activity. Thirty age and sex matched controls were included for comparison. Serum copper level was significantly higher in patients with JIA than those of the controls (P= 0.017) while there were no significant difference in serum level of zinc between JIA patients and that of the controls. Conclusion:Alteration of serum copper and zinc probably is a defense response against JIA; increased copper may be due to inflammation associated, these elements could serve as biomarkers for the disease activity.

Reverse transcription PCR assays for detection of borna disease virus in psychiatric patients

Borna disease virus [BDV] is a virus that naturally infects the central nervous system [CNS] of broad range of warm-blooded animals. BDV is an enveloped virus, non- segmented, negativestranded RNA genome and has an organization characteristic of a member of Bornaviridae. It may persists in the central nervous system [CNS] of infected individuals for their entire life span. In the present work the presence of BDV p24 RNA in peripheral blood cells was detected from 37 psychiatric patients [15 patients diagnosed as schizophrenia, 10 as Major depressive disorder and 12 as mood disorder bipolar I most recent episode mania]. Patients were selected from the outpatient as well as the inpatient units of Psychiatric Department in Mansoura University hospital and 37 healthy volunteers as the control group. All subjects were interviewed by structured diagnostic criteria categorized according to the Diagnostic and Statistical Manual of Mental Disorders DSM-IV. The presence of BDV p24 RNA was investigated by nested reverse transcriptase PCR [RT-PCR] using specific primers to p24 from BDV. The median duration of illness was 6, 4 and 10 years in depressive disorder, mood disorder and schizophrenia respectively. The mean age was 40.7, 30.1 and 36.1 in depressive disorder, mood disorder and schizophrenia respectively. There were no significant differences in age and duration of illness among patients groups with psychotic disorders in the presence or absence of p24 RNA of BDV. Frequency of BDV- RNA on patient's groups was 10.8% [4/37]. The detection of BDV-RNA in the peripheral blood cells of patients but not on control group should help our understanding of the pathogenesis in the disease

Treatment Strategies for Childhood Steroid-Resistant Nephrotic Syndrome.

Background: Nephrotic syndrome (NS) is a common childhood kidney disease caused by impaired glomerular function, characterized by protein leakage from the blood to the urine through the glomeruli, resulting in proteinuria, hypoalbuminemia, hypercholesterolemia and generalized edema. NS is descriptively classified upon the patients’ response to steroid treatment as steroid-sensitive NS (SSNS) or steroidresistant NS (SRNS). Aim: describe and compare different management strategies for SRNS. Methods: This retrospective study included 53 SRNS who were attending the Nephrology Outpatient Clinic, Children's Hospital, and Cairo University for follow-up. Results: out of 53 SRNS patients, 29 (54.72%) patients showed complete response to immunosuppressive therapy, while 14 (25.42%) showed partial response and the remaining 10 (18.87%) showed no response. Conclusion: Partial response to steroids or to first line of immunosuppressive therapy predicts better response to further immunosuppressives in SRNS patient. Cyclophosphamide is a preferable line in MCNS as it gives good results (50% complete response) with the advantage of lower cost and shorter duration of use. In patients with non-minimal change lesions or those who failed to respond to cyclophosphamide, cyclosporine is used.

Immunohis1ochemical cyclooxygenase-2 [COX-2] and cd31 expression in breast carcinoma with correlation to clinico-pathological parameters

Breast cancer is the most'common cancer in Egyptian women. COX-2 seems to be involved in malignant transformation and tumor progression by affecting cell proliferation, mitosis, cell adhesion, apoptosis, immune surveillance, and angiogenesis. Angiogenesis is an important key step in tumor progression. Microvascular density [MVD], a surrogate marker of angiogenesis can be assessed by CD31 staining. This study aims to: 1. Evaluate COX-2 and CD31 expressions in breast cancer. 2. Determine the correlation between COX-2 and CD31 with the clinico-pathological parameters in ductal breast carcinoma. This study included 74 specimens of breast lesions. Patient's age, tumor size and local aggressive changes, history of recurrence and/or presence of distant metastasis were obtained. Hematoxylin and Eosin [HandE] stained sections were evaluated for histopathological tumor type, tumor grade, presence or absence of normal hyperplastic, in situ component, lymphocytic infiltration, lymphovascular invasion, and axillary lymph node status. COX-2 and CD31 immunostaining was done to detect their expression using the avidin-biotin peroxidase method. COX-2 increased with increasing grade of ductal carcinoma in situ [DC1S] and invasive ductal carcinomas [IDC] [P< 0.05 and P< 0.002 respectively]. COX-2 expression increased progressively along the continuum of neoplastic changes from normal breast epithelium to IDC [P< 0.01]. There was significant correlation between COX-2 and tumor size [P< 0.05], tumor grade [P< 0.002], lymphovascular invasion [P< 0.03] and lymph node metastasis [P< 0.02]. CD31 staining was observed along the cell membrane of endothelial cells of microvessels in all breast specimens. The median CD31 MVD count was 10 for normal breast, increased insignificantly to 17 in hyperplastic lesions, and reached 19 for DCIS, and 66.5 in IDC [P < 0.000]. There was significant increase in MVD between different grades of IDC [P < 0.01] but not in DCIS. Positive correlation was present between COX-2 and CD31 in DCIS and in IDC [P< 0.000 for each]. COX-2 was increased with poor prognostic parameters; tumor size, tumor grade, lymphovascular invasion and lymph node metastasis. CD31 increases with increasing grade of IDC. These findings might imply for new therapeutic strategies in order to prevent progression of DCIS to IDC and to improve cancer therapy

Reduced Fertility and Fecundity among Patients with Bipolar I Disorder and Schizophrenia in Egypt

OBJECTIVE: To evaluate reproduction among patients with bipolar I disorder (BP1) or schizophrenia (SZ) in Egypt. METHODS: BP1 patients (n=113) were compared with community based, demographically balanced controls (n=124) and SZ patients (n=79, DSM-IV). All participants were evaluated using structured interviews and corroborative data were obtained from relatives. Standard indices of procreation were included in multivariate analyses that incorporated key demographic variables. RESULTS: Control individuals were significantly more likely to have children than BP1 or SZ patients (controls 46.8%, BP1 15.9%, SZ 17.7%), but the BP1-SZ differences were non-significant. The average number of children for BP1 patients (0.37+/-0.9) and SZ patients (0.38+/-0.9) was significantly lower than for controls (1.04+/-1.48) (BP1 vs controls, p<0.001; SZ vs controls, p<0.001). The frequency of marriages among BP1 patients was nominally higher than the SZ group, but was significantly lower than controls (BP1: 31.9% SZ: 27.8% control: 57.3%). Even among married individuals, BP1 (but not SZ) patients were childless more often than controls (p=0.001). The marital fertility, i.e., the average number of children among patients with conjugal relationships for controls (1.8+/-1.57) was significantly higher than BP1 patients (1.14+/-1.31, p=0.02), but not significantly different from SZ patients (1.36+/-1.32, p=0.2). CONCLUSION: Selected reproductive measures are significantly and substantially reduced among Egyptian BP1 patients. The reproductive indices are similar among BP1 and SZ patients, suggesting a role for general illness related variables. Regardless of the cause/s, the impairment constitutes important, under-investigated disability.

effect of hemodialysis on Q-T interval on children with chronic renal failure

The hemodialysis patients have a wide variety of electrocardiographic [ECG] abnormalities and, in certain instances; hemodialysis itself seems to be a cause of ECG changes and different kinds of dysrhythmias. The purpose of the study was to assess the effect of hemodialysis on QT and corrected QT [QTc] interval and QTc interval dispersion in patients with end-stage renal failure 10 min before [pre-HD] and 10 min after each hemodialysis [post-HD]. An observational cross-section study was conducted on 30 patients 'admitted to the dialysis unit in Abou El Ressh pediatric hospital along a period of 6 months starting from October 2008. The total number of cases on regular hemodialysis throughout the year was: 60 cases. 30 cases were picked at random to be included in the present work. Clinical examination, history taking and laboratory analysis were offered to all patients, 12 lead ECG was done before and after hemodialysis. The results showed that after hemodialysis there were significant changes for the QTc and QT dispersion with 3.3% of cases had prolonged QT interval after hemodialysis and 43.3% had prolonged QTc after dialysis and 50% had abnormal QTd after dialysis. After dialysis there was significant negative correlation between Na level and QTc, also between K level and QTc

Chromium picolinate inhibits cholesterol induced stimulation of platelet aggregation in hypercholesterolemic rats

Hypercholesterolemia indirectly increases the risk of myocardial infarction by enhancing platelet aggregation. Chromium, has been shown to lower plasma lipids. The objective of this study was to investigate whether chromium inhibits platelet aggregation under normal and hypercholesterolemic conditions. White albino rats were divided into four groups: control rats fed with a normolipemic diet [NLD group], chromium supplemented rats fed with NLD [NLD+Cr group], rats fed with a high fat diet [HF group], and chromium supplemented rats fed with HF [HF+Cr group]. After 10 weeks, blood was collected to determine ADP and collagen-induced platelet aggregation and plasma levels of total cholesterol, triglycerides [TG], HDL-C, apolipoprotein Al [Apo-A1], apolipoprotein B [Apo-B], and thromboxane B2 [TX B2]. LDL-C was calculated by Friedewald Formula. High fat diet animals [HF group] displayed significant elevation of plasma lipids and platelet aggregation which were normalized to control levels by chromium supplementation. Chromium supplementation in normolipemic [NLD+Cr] rats didn't produce significant changes in either plasma lipids or platelet activity. The results of the present study demonstrate that chromium supplementation to hypercholesterolemic rats returns cholesterol induced platelet aggregation to control levels. This normalization is mostly due to a reduction in plasma cholesterol level

Anticonvulsant effects of 1, alpha-hydroxy-vitamin D in comparison to the conventional antiepileptic drug phenytoin in the pilocarpine model of epilepsy in rats

Conventional antiepileptic drugs fail to adequately control seizures and exhibit unfavorable side effects. Vitamin D3 [Cholecalciferol], has its essential role in calcium and phosphorus metabolism, and is involved in regulating the functions of the central nervous system. Moreover, it has long been known that chronic treatment with antiepileptic drugs impairs mineral homeostasis in epileptic patients, leading to marked hypocalcaeinia and reduced plasma levels of vitamin D which in turn may increase seizure]. to test the possible role of the neurosteroid hormone 1, alpha-hydroxy vitamin D3 [1, alpha vit. D3], an active form of Vitamin D3 in epilepsy and its interactions with the conventional antiepileptic drug phenytoin in the pilocarpine induced seizures in rats two experiments were performed. Experiment 1 was conducted to measure seizures severity, oxidative markers and calcium level in the pilocarpine model of epilepsy: live groups of rats were used. 1-Control group received saline intraperitoneal [i.p.] only, 2-control epileptic group received pilocarpine 320 mg/kg i.p., 3-vitamine D3 treated group received 1, alpha-H vit. D3 40 ng/kg i.p. one hour before pilocarpine, 4-Phenytoin treated group received 11.2mg/kg phenytoin i.p., 2 hours before pilocarpine and 5-both 1, alpha-H vit. D3 and phenytoin treated group in the same doses mentioned before. Experiment 2 was conducted to test the effect of chronic treatment for one week with 1, alpha-H vit. D3, phenytoin or both on oxidative markers, calcium level and behavioral tests in rats. Overall, compared to the saline-treated control animals, the 1, alpha-H vit. D3 -treated rats demonstrated reduced severity of pilocarpine induced seizures, with decreased levels of oxidative markers. Co-administration of 1, alpha-H vit. D3 with phenytoin resulted in a significant reduction of seizure severity and duration. Furthermore, 1.alpha-H vit. D3 potentiated the anticonvulsant activity of phenytoin and reduced its undesirable effects as regard increase in oxidative markers and memory impairment that were induced by phenytoin. These findings show that Vitamin 0 plays a direct anticonvulsant role in the brain and suggest that the Vitamin D may represent a new anticonvulsant drug increasing the efficacy of conventional antiepileptic drugs

comparative study between influence of rosiglitazone; a peroxisome proliferator-activated receptor gamma [PPARS] agonist, and corticosteroids on experimentally induced asthma in guinea pigs

Dugs used currently to treat asthma have limitations partly due to their undesired effects. PPARgamma agonists including rosiglitazone may offer additional therapeutic advantages to current treatment. The aim of the present study was to assess the anti-inflammatory potential of a PPARi agonist, rosiglitazone, locally delivered by means of nebulization in a guinea pig model of asthma, in comparison with that of the corticosteroid budesonide. Five groups of guinea pigs were used, five animals each. The first group was Sham -sensitized guinea pigs; the other four groups were sensitized by ovalbumin [OVA] by allergen solution containing 100 micrograms OVA and 100 mg Al [OH]3 per ml saline. 0.5 ml was injected intraperitoneally, while another 0.5 ml of the solution was divided over seven intracutaneous injection sites. The second group was OVA-sensitized and exposed to inhalation of saline. The third, fourth and fifth group were OVA albumin-sensetized. The third group was treated with vehicle inhalation, The fourth group was treated with rosiglitazone and the fifth group was treated with budesonide. Animals in the last 3 groups were exposed to allergen provocation procedure [Ag challenge] from weeks 4 to 5 after OVA sensitization. Assessment of asthma was done by studying the effect of rosiglitazone and budesonide on airway hyper responsiveness [AHR] to acetylcholine [Ach], inflammatory cellular changes in bronchoalveolar lavage and histopathological changes. The effect of rosiglitazone and budesonide pretreatment on histamine induced contraction of isolated OVA sensitized guinea pig tracheal spiral strips was also investigated. In addition, the direct effect of rosiglitazone and budesonide incubation on histamine induced contraction of isolated guinea pig tracheal spiral strips was examined. The results revealed that one week pre-treatment with rosiglitazone [20 minutes inhalation in a dose of 300 microg/ Kg/ day] and budesonide [20 minutes inhalation in a dose of 2mg/ Kg/ day] resulted in significant reduction in airway hyperreactivity to inhaled Ach, inflammatory cellular content in bronchoalveolar lavage fluid [BALF] and improvement in histopathological changes of asthmatic lung. There was no significant difference between both drugs as regard improvement of AHR, reduction in thickness of the interalveolar septum, decrease in total leucocytic count [TLC], count of lymphocytes and macrophages. However, budesonide caused significant reduction in eosinophils and macrophages count in comparison to rosiglitazone. In addition, rosiglitazone had a direct relaxant effect on airway smooth muscle. The results provided evidence for the therapeutic potential of inhaled PPARi agonist, rosiglitazone, in the treatment of airway asthmatic inflammation. In addition PPARgamma agonists had a direct relaxant effect on the isolated tracheal smooth muscle

Factor VIII related antigen in childhood vascular disease

To evaluate the Role of VWF factor VIII related Ag as a marker of activity in different childhood collagen vascular disorders, to study the relation between factor VIII and vasculitic manifestations in different collagen vascular disorders and to emphasise the relation between VWF and different clinicolaboratory manifestations in collagen diseases. Factor VIII Related Ag [VWF] is produced in megakaryocytes and endothelial cells, and present in plasma vascular subendothelium. It is stored in the alpha - granules of platelets and the Weibel-Palade body of the endothelial cells, it plays a pivotal role in hemostasis and pathological intravascular thrombosis: Patients with Henoch-Schonlein purpura [HSP], SLE, JRA and Juvenile dermatomyositis [JDM] had significantly high levels of VWF, indicating that high level may reflect the presence of vascular especially endothelial damage in patients with connective tissue diseases. The study included 65 patients attending the rheumatology clinic at Cairo University Pediatric Hospital aged from 4 to 10 years with different collagen disorders together with 20 age and sex matched controls. All patients and controls were subjected to full history taking, laboratory investingations including complete blood picture, ESR, CRP, ASOT, Renal function tests, C[3], C[4], 24 hour protein in urine, ANA and measuring serum levels VWF by ELISA. VWF was significantly higher in the four groups of patients with collagen vascular disease than in the control groups. The highest level of VWF was in HSP patients. The VWF showed higher levels in SLE patients with severe rash and renal involvement. It was also higher in JRA and dermatomyositis patients with vasculitic manifestations. The VWF levels were directly related to disease activity in both SLE and RA patients. The elevated level of VWF are most likely a reflection of the existence of outgoing vascular damage [Active vasculitis]. The VWF can be particularly helpful in assessing degree of systemic involvement as well as disease activity in patients with severe vasculitic form of JRA

Propofol - ketamine anesthesia versus sevoflurane anesthesia in pediatric patients undergoing cardiac catheterization for balloon valvotomy

Objective: To evaluate the homodynamic and oxygenation parameters and recovery profile of propofol-ketamine anesthesia versus sevoflurane inhalationl anesthesia, during cardiac catheterization in infants and children. Design: prospective clinical study Setting: Children Hospital, Mansoura University

Participants: Infants and children [n = 30] undergoing cardiac catheterization

Intervention: group I: anesthesia was induced with ketamine 1 mg/kg followed by a bolus of propofol 1 mg/kg. thereafter initial rate of infusion 50 micro/kg/min propofol and 20 micro/kg/min ketamine. group II: induction by sevoflurane by steadily increasing inspired concentration in increments of 1.5-2% every 3 breaths until the onset of rhythmic breathing and loss of eye lash reflex occurred. Heart rate, mean arterial blood pressure and non invasive oxygen saturation was monitored throughout the procedure

Results : Heart rate, mean arterial blood pressure and non invasive arterial oxygen saturation showed no significant differences between both groups during studied periods, The induction was significantly [P= 0.0001] shorter in propofol-ketamine group when compared with sevoflurane group. However, the extubation time [P=0.001], time to eye opening [P=0.0023] and discharge time [P= 0.01] were significantly shorter in sevoflurane group than propofol-ketamine group

Conclusion: propofol-ketamine anesthesia or sevoflurane anesthesia was associated with stable haemodynamic and oxygenation profile with more rapid induction with propofol-ketamine group but more rapid recovery with sevoflurane group

role of serum transferrin receptors in the assessment of body iron stores and iron - deficient erythropoiesis in children

The present work studied the role of serum transferrin receptors in the differentiation between iron deficiency anemia and anemia of chronic disorders based on the presence or absence of iron stores. The study included 40 children, in the age range of 5-15 years. They were divided into 3 groups: control group of 10 healthy children, iron deficiency group of 15 patients, and 15 patients with anemia of chronic disease. The following laboratory tests were done for both cases and controls: complete blood picture, serum iron, total iron binding capacity [TIBC], serum ferritin and serum transferrin receptors. Percent transferrin saturation and serum transferrin receptor-ferritin index [sTfR- F index] were calculated. Hemoglobin concentration, red blood cell [RBC] indices and serum iron behaved similarly in patients with iron deficiency anemia [IDA] and those with anemia of chronic diseases [ACD]. Total iron binding capacity was significantly increased in IDA and decreased in ACD. The percent transferrin saturation decreased in IDA patients to less than 16%, it was significantly higher in ACD than IDA patients. Serum ferritin was significantly higher in ACD than in IDA group. The serum transferrin receptor [sTfR] was found to be significantly higher in IDA than in patients with ACD. The serum transferrin receptor [sTfR] was the best discriminatory power of all parameters used in the study for distinguishing between IDA and ACD

Intercellular adhesion molecule-1 [ICAM-1] in neonatal sepsis

Neonatal sepsis is a significant cause of morbidity and mortality in preterms. The signs of neonatal sepsis are clinically non-specific. ICAM-1 is one of the group of intercellular adhesion molecules. It has an important role in the early recognition of inflammation. So, this study was performed to find out any relation between neonatal sepsis and serum ICAM-1 for possible use as a diagnostic or prognostic parameter in such cases. This study comprised 28 neonate, admitted to the NICU of Maternity Hospital of Ain Shams University due to neonatal sepsis. They were 10 males and 18 females. Their ages ranged between 2-23 days. mean 7.57 +/- 5.54 days at the time of sampling. Their gestational ages ranged between 30-42 weeks, mean was 37.07 +/- 3.15 weeks. Fourteen were pretems [less than 37 weeks of gestation], 13 were fullterms [37-40 weeks of gestation] and one was post-term [42 weeks of gestation]. Their birth weights ranged between 1100-4115 g mean was 2795.1 +/- 820.39 g. Twenty-four were delivered by normal vaginal delivery, 3 by caesarian section and one by ventouse extraction. Eighteen cases were diagnosed as neonatal sepsis within the first week of life and 10 cases beyond the first week of life. Fifteen cases had risk factors predisposing to sepsis. Thirteen healthy normal neonates, age and sex matched were also included in this study, serving as control group. They were selected from neonates of normal deliveries accompanying their mothers during their follow up visits to maternity Hospital of Ain Shams University. They were 5 males and 8 females. Their ages ranged between 2-24 ways, mean 6.62 +/- 6.02 days at sampling time. Their gestational ages ranged between 37-40 weeks, mean was 39.2 +/- 12 weeks. Their birth weights ranged between 2600 - 4100 g, mean was 3338.5 +/- 524.1 g. Cases and control were subjected to medical history, clinical examination, complete blood count, quantitative C-reactive protein, blood culture and sensitivity test, estimation of serum ICAM-1 level by ELISA. As regards the group of cases, the clinical manifestations were, in descending order of frequency, lethargy, sluggish Moro's reflex, poor suckling, hypothermia, bleeding tendency, tachypnea, organomegaly, abdominal distension and fits. Haemoglobin% and RBCs count of cases were not significantly different from control [P>0.05]. Total leucocytic count of cases was highly significantly higher than control [P>0.01], 71,43% of cases had neutrophilia, 3.57% were neutropenic and 25% of cases had normal absolute neutrophil count, 85.71% of cases had bandaemia and 89.29% of cases were thrombocytopenic. Serum ICAM-1 was highly significantly higher in cases than control group, i.e., mean was 959.36 +/- 415.19 and 381.54 +/- 173.05 ng/ml respectively and P<0.001. It was significantly positively correlated with total leucocytic count among patient's group [r = 0.5655 and P<0.05]. Mean serum ICAM-1 of fullterms was 900.71 +/- 408.26 ng/ml, while for preterms, it was 1018.00 +/- 428.97, P>0.05 [non-significant]. As regards comparison to control, p was <0.001 for fullterms and p was <0.001 for preterms [both are highly significant]. Mean serum C-reactive protein [CRP] of cases was 39.86 +/- 49.45 mg/l and mean serum CRP of control was below 6 mg/l [P<0.01]. The serum CRP was not correlated with serum ICAM-1. The blood culture was positive in all cases, 14 klebsiella, 5 beta- Streptococci, 3 Staph aureus, 3 E. coli, 2 Staph. epidermidis and one Pseudomonas. No correlation was found between serum ICAM-1 and type of organism. Serum ICAM-1 is a very useful tool in diagnosis of neonatal sepsis in fullterms and preterms

effect of food deprivation and refeeding on some renal functions and renal NA+-K+ ATPase activity in rats

Starvation is considered as a safety manner for reduction of weight in obesity taking into consideration the time factor and the ample supply of water. Results of the study proved that the metabolic responses and the changes in renal functions during starvation are reversible. This work was conducted on 28 rats divided into four groups, one control group and three fasted groups for three days with free access to water, two of the fasted groups were refed for two and five days. The body weight, the water intake and urinary output were decreased during starvation then normalized after refeeding. Significant decrease in creatinine clearance, urea excretion, blood bicarbonate and blood pH were observed during starvation, then returned to normal at the end of the fifth day of refeeding. Significant increase in serum sodium was reported while serum potassium was not affected; urinary excretion of sodium and potassium were decreased but all normalized on refeeding. Starvation did not alter serum chloride. Renal Na+ - K+ ATPase activity was significantly increased during starvation and normalized on refeeding