Serum neopterin level in children with juvenile idiopathic arthritis

Background: Juvenile idiopathic arthritis [JIA] is generally considered a clinical syndrome involving several disease subsets, with a number of inflammatory flows, leading to an eventual common pathway in which persistent synovial inflammation and associated damage to articular cartilage and underlying bone are present. Neoptrin is a reliable marker in the assessment of the rate of IFN-gamma production. Levels of neoptrin increase in direct proportion with the level of interferon. Measurement of neopterin level is useful because of its relative stability also it is a prognostic indicator for cell-mediated immunity

Aims: This study aims to assess serum level of neopterin in patients with Juvenile Idiopathic Arthritis [JIA] in relation to the disease activity, severity and response to conventional and biological therapy

Methodology: The study was conducted on 30 patients [Group A] previously diagnosed as SoJIA, they were divided into two subgroups according to their therapy into Group AI on biological therapy [15 patients] and Group AII on conventional therapy [15 patients]. These in addition to 20 healthy controls [Group B]

Results: Basic clinical evaluation and laboratory investigations were done. We found that JIA patients had significantly higher levels of serum neopterin than healthy controls. We also found a highly significant difference between neopterin levels in the activity and remission states among all patients [Group AI and Group AII]

Conclusion: We concluded that serum neopterin is a useful marker for cellular immune activation and also indicative of the activity of JIA. Our findings are supported by positive correlations between serum neopterin levels and other markers of activity as TLC, PLT counts, ESR, and CRP. We also concluded that serum neopterin is a sensitive and accurate predictor of disease activity where sensitivity of that test was 93.3% and accuracy was 72.5%

Recommendations: Investigating the serum neopterin measurement in other autoimmune collagen diseases. Assessment the influence of biological therapy on neopterin levels in relation to disease progression

Prognostic impact of factor V leiden in systemic lupus erythematosus pediatric patients

Objective: This research aimed to study the presence of factor V gene G1691A mutation [Factor V Leiden] in SLE pediatric patients with and without complications and to investigate the association between the presence of Factor V Leiden and lupus complications mainly lupus nephiritis in these patients

Subjects and Methods: This study was conducted on 50 Egyptian pediatric patients [48 females and 2 males] who were all diagnosed as SLE according to the American College of Rheumatology criteria. They were enrolled from the Immunological Clinics at Ain shams University Pediatric Hospital and were divided into two groups: Group 1 [control group] of matched age and sex: Including 25 newly diagnosed uncomplicated SLE patients e.g.: arthritis, musculoskeletal and cutaneous lupus. Group 2 [patients group]: Including 25 SLE complicated patient e.g.: nephritis, neurolupus, thrombotic manifestation, cardities and antiphospholipid antibody syndrome. The complications observed in patient group was further classified into lupus nephritis alone or lupus nephritis with other complications [21 patients] or patients with complications other than lupus nephritis [4 patients]

Results: All patients included in this study were subjected after taking their parents' consent to full history taking laying stress on history of complications mainly lupus nephritis. In addition, laboratory investigations which include CBC, tests for confirmation of SLE as ANA, anti dsDNA, C3, lupus anticoagulant, anticardiolipin IgG and IgM and renal function tests as serum creatinine and 24 hrs urinary proteinsm were done. The Factor V gene mutation was determined by the method of PCR-based DNA analysis in both control and patient groups. In control group, there was 1 out of 25 patients having the Factor V Leiden mutation; who had a heterozygous pattern. The prevalence of Factor V Leiden in patients group showed 2 out of 25 patients, both of them had a heterozygous pattern of the gene mutation

Conclusion: This study couldn't demonstrate any correlation between the presence of Factor V Leiden mutation and the presence of complications in SLE patients as there was no statistical significant difference [P >0.05]

Timothy grass pollen sensitization in asthmatic egyptian children

Background: Allergic diseases are considered a major problem for healthcare systems in both developed and developing countries. Longitudinal epidemiologic studies have shown an increased prevalence of sensitization to common allergens, and increased prevalence of asthma, atopic dermatitis, food allergy, and allergic rhinitis in children. The increase in allergies is a phenomenon that is being observed in all fast-developing countries. For a long time, science has taken as a starting point that solely a genetic predisposition is a precondition for the development of an allergy. Today, knowledge of environmental factors that can alter genes or the transcription of genes in the cells, has improved

Aim of the Work: We aimed to investigate the rate of sensitization to Timothy grass pollen in a group of asthmatic Egyptian children in relation to other markers of disease expression. Our ultimate objective was to add information to the map of aeroallergen sensitization in our country

Patients and Methods: This analytical cross sectional study was conducted on children with bronchial asthma following up at the Pediatric Allergy and Immunology Clinic, Children's Hospital, Ain Shams University in the period from September 2017 to March 2018. The sample included 100 asthmatic patients who were enrolled consecutively. Patients were classified into intermittent and persistent Asthma according to the 2009 VA/DoD asthma management guidelines

Results: The current study revealed a high frequency of Timothy grass pollen [TGP] sensitization representing 61% of the studied sample. The diameter of wheal in sensitized children ranged between 3-7 mm with a median [IQR] of 4 [3- 4]. None of our subjects had wheal diameter >/= 8 mm, which denotes severe reaction. In our study, Patients with persistent asthma were more prone to be TGP sensitized [80.3%] than those with intermittent asthma [19.7%]. Sensitized children with persistent asthma showed larger wheal diameter [median= 4 mm, range: 4-7 mm] than those with intermittent asthma who showed smaller diameter [median= 3.5 mm, range: 3-4 mm]

Conclusion: Sensitization to TGP might point a persistent phenotype of pediatric asthma and may be linked to severity and need to step up and/or add on therapeutic options