Significance of antikeratin antibodies in discrimination between rheumatoid arthritis and polyarthritis associated with hepatitis C infection

Hepatitis C virus [HCV] injection is often associated with extrahepatic manifestations among which arthropathy is common. HCV-related arthritis commonly present as rheumatoid-like arthritis, with positive rheumatoid factor [RF]. In this study, we try to distinguish between rheumatoid arthritis [RA] and polyarthritis associated with HCV infection using a marker more specific to RA than the rheumatoid factor [RF] namely anitkeratin antibody [AKA]. Serum AKAs were evaluated [by indirect immunofluorescence technique] in two groups of patients ,all were RF seropositive. Group I. 25 patients with HCV associated polyarthralgia or arthritis. Group II: 25 patients with RA fulfilling the American college of Rheumatology [ACR] revised criteria. In addition 15 healthy individuals served as controls. All patients of group II as well as healthy controls were HCV seronegative. Other investigations were done for all groups such as erythrocyte sedimentation rate [ESR], C reactive protein [CRP] and antinuclear antibody [ANA]. Plain X ray of both hands were done for all patients to exclude the patients with bone erosion. The study revealed that anitkeratin antibodies were detected in 15/25 [60%] patients with true RA and only 3/25[12%] patients with HCV-related arthritis. AKA were not found in the sera of the healthy controls. The specificity and sensitivity of AKA in RA group were 88% and 60% respectively. Anitkeratin antibody is highly specific for RA and its estimation may increase the diagnostic performance of RA. AKA is a useful marker in discrimination between patients with true RA and those with HCV-associated arthritis

Role of IL-6, sIL-6R, IL-1 beta, TNF-alpha, and B2M in pathophysiology and prognosis of multiple myeloma

Cytokines control myeloma cell proliferation, differentiation, apoptosis and tumor-induced bone marrow destruction. The present study was designed to estimate the serum levels of interleukin-6 [IL-6], soluble IL-6 receptor [sIL-6R], IL-1 beta, tumor necrosis factor-alpha [TNF-alpha], and beta-2 microglobulin [beta 2M] in multiple myeloma [MM] in an attempt to elucidate their role in the disease, to study their levels in different immunologic types of MM, and to evaluate the effect of therapy on these levels. The study included 40 patients with MM, 20 newly diagnosed [group I] and 20 patients receiving treatment [group II]. Ten patients received therapy for one year [group IIb]. Patients were subclassified according to beta 2M level into [patients with beta 2M < 6 mg/L and patients with beta 2M >/= 6 mg/L]. Fifteen healthy individuals were included as controls. Samples of all patients and controls were subjected to serum protein electrophoresis, immunofixation, serum cytokines [IL-6, IL-1 beta, TNF-alpha], sIL-6R, and beta 2-microglobulin estimation. Bone marrow aspiration [for patients only] and other laboratory chemical investigations were also performed. Serum immunofixation electrophoresis revealed that out of 40 patients, 25 were IgG myeloma, 12 were IgA myeloma, one case was light chain myeloma and 2 cases had biclonal gammopathy. Serum IL-6, sIL-6R, IL-1 beta, TNF-alpha and beta 2M showed significant increase in patient groups compared to controls, with no significant difference between groups I and II in both [IgG] and [IgA] myeloma. On the other hand, IL-6, sIL-6R, and beta 2M were significantly decreased in group IIb when compared with group I and group IIa. When beta 2M level was used for subgrouping, IL-6, sIL-6R, IL-1 beta, and TNF-alpha were significantly higher in group II patients with beta 2M >/= 6 mg/L than those with beta 2M < 6 mg/L. As IL-6, sIL-6R, IL-1 beta TNF-alpha, and beta 2M were elevated in all the studied myeloma patients, they might be involved in the pathophysiology of the disease irrespective of its immunologic type. IL-6 and sIL-6R could be used in monitoring the effect of therapy in MM especially in patients with impaired renal function. In addition of being known as a good prognostic marker, beta 2M could be used to monitor the response to therapy in MM

value of soluble transferrin receptor in early diagnosis of iron deficiency anemia in chronic renal failure

Decreased erythropoietin [EPO] production is the main pathogenic factor of anemia in chronic renal failure [CRF]. Iron deficiency is the most common cause of EPO resistance in dialyzed patients with renal failure. Subclinical or functional iron deficiency is difficult to diagnose in these patients. Aim: This study was designed to determine the sensitivity and specificity of serum iron, transferring, ferritin and soluble serum transferrin receptor [sTFR] in diagnosis of iron deficiency in chronic renal failure and the efficacy of recombinant human EPO [rHuEPO] treatment. Patients: This study was conducted on 70 patients with CRF divided into three groups: group [A] CRF patients predialysis [30 cases], group [B] CRF patients on regular dialysis > 5 years [30 cases], and group [C] CRF patients on dialysis and rHuEPO treatment with parentral iron supplementation [10 cases].Twenty healthy individuals age and sex matched were included as controls. Peripheral hemogram, serum urea and creatinine, serum iron [SI] and total iron binding capacity [TIBC], serum ferritin, serum transferring and [sTFR] were done for both patients and control group. There was highly significant reduction of RBCs, hemoglobin [Hb] and hematocrit [Hct] in different patients groups compared to controls; [P < 0.001] for each Serum iron [SI] was insignificantly reduced in groups A and B compared to controls while it was significantly increased in group C [P < 0.05]. Serw transferrin was significantly reduced in all patients groups compared to controls [P < 0.001] for each. Serum ferritin and sTFR were significantly increased in both group, A and B [P < 0.001] for each, while in group C, there was significant increase in serum ferritin [P < 0.01] and no significant difference in sTFR level compared to controls. sTFR is a sensitive [sensitivity 93%] and specific [specificity 100%] indicator for identifying iron deficiency and assessing the effect of rHuEPO treatment in CRF patients

Renal responses to halogenated anaesthetics

Creatinine, urea, sodium potassium, sugar and blood osmolality were determined in sixty patients under anaesthesia [halothane group: 20 cases; enflurane group: 20 cases and methoxyflurane: 20 cases]. The significant results obtained were: in halothane group, there were increase in excretion of creatinine; sodium and potassium in urine; blood urea and urine volume in the first postoperative period. In the group of enflurane, sodium and potassium excretion in urine in the first day were decreased. Blood urea increased at the operative and third postoperative days. With methoxyflurane, the excretion of creatinine in urine was much reduced at the third and seventh postoperative days. Serum sodium decreased, while blood urea increased in the day of operation

Fluoride formation and excretion following halothane, enflurane and methoxyflurane anesthesia

Serum and urine fluoride and serum uric acid were determined in sixty patients receiving halothane, enflurane and methoxyflurane [20 in each group]. On the day of operation, there was significant increase in serum uric acid and fluoride concentration with methoxyflurane, while in halothane and enflurane groups fluoride in serum and urine were significantly elevated. Serum uric acid decreased to preoperative level, in the three anaesthetics at the third and seventh postoperative days. The increased level of fluoride with the three anaesthetics still persisted in methoxyflurane group, while it was disappeared at the seventh postoperative day in the other two groups. Regression analysis revealed no correlation between serum uric concentration and level of fluoride in the blood with methoxyflurane

Serum lipoprotein-cholesterol in hypertensive patients

A study was performed on a group of 38 hypertensive subjects [25 Females and 13 males] and compared the results to another group of 17 matched controls [6 females and 11 males] for assessment of the hazards of lipoproteins cholesterol in hypertensive patients. Hypertensive patients studied showed significant elevation of serum triglycerides, VLDL-C. Significant elevation of total serum cholesterol and LDL-C. in moderate hypertensive patients. Significant reduction of HDL-C. in severe hypertensive patients as compared to the control group. Significant reduction in the ratio of total serum cholesterol to serum triglycerides, and in the ratio of HDL-C. to total serum cholesterol in moderate hypertension. Significant reduction in severe hypertensive patients in the ratio of total serum cholesterol to serum triglycerides. This effect of hypertension was similar to other vascular diseases [coronary, cerebral and peripheral]