Effect of dexamethasone on HLA-DR expression on human peripheral blood monocytes

Human peripheral blood monocytes [HPBM] express HLA-DR antigen which is involved in antigen presentation processes. HLA-DR expression on HPBM is upregulated by interferon-gamma [IFN-gamma]. We looked at the effect of the glucocorticoid dexamethasone [DEX] on HLA-DR expression by HPBM cultured in serum free media using anti-human monoclonal antibodies conjugated with phycoerythin at 48 hours and under different exposure conditions. Results were assessed by immunofluorescence microscopy and flow activated cell sorter [FACS] analysis. DEX in a concentration of 1x 10[-6]M did not significantly alter HLA-DR expression on HPBM, however in the same concentration it significantly enhanced INF-gamma induced HLA-DR upregulation. Furthermore we looked at the effect of DEX on RSV infected monocytes detected by anti-RSV monoclonal antibodies conjugated with fluorescine isothiocyanate [FITC] and analysed by two colour FACS analysis. DEX at 1x10[-6]M significantly enhanced HLA-DR expression on virus infected monocytes but not non-infected cells. These data suggest that the interactions between glucocorticoids and monocyte immunoregulatory functions are more complex than previously thought and may not always be of immunosuppressive nature

Circulating immune complexes in patients with bronchial asthma

Circulating immune complexes [CICs] are known to exist in a number of immunologic disorders. Their role in asthma is not yet defined. The study included 44 asthmatic patients aged 21 to 62 years and 22 children aged 3.5 to 12.5 years in addition to 14 adults and 14 children age and sex matched controls. We looked for CICs in all patients and controls using a solid phase C1[q] enzyme-immunoassay expressed as percent inhibition of binding. We could detect significant CICs in the sera of 72.2 percent of the asthmatic patients compared to 10.7 percent controls. In the pediatric group 59.1 percent had significant CICs compared to 7.14 percent controls, whereas 86.4 percent of adult asthmatics had significant CICs compared to 14.28 percent controls. We classified our patients into atopic and non-atopic using history, skin test and IgE determination. All non atopic children expressed significant CICs [100 percent] in their sera compared to 18.2 percent in theatopic group. In adults 81.8 percent atopic patients expressed CICs compared to 90.9 percent in the non-atopic group. CICs inversely correlated with total IgE levels. We could not find a correlation between CICs and the clinical severity or duration of asthma

Long term immunotherapy in asthma

Slow immunotherapy with aquous extracts of some important chosen inhalant allergens was given to 180 selected atopic asthmatic patients for six months as an initial course. Cases with severe steroid dependent asthma were excluded. Another 130 atopic asthmatics, age and sex matched with the first group were given placebo and symptomatic treatment only. Excellent or significant responses were obtained in 84.4% in the first group compared to 70.8% in the control group. Long-term maintenance [loses for three years were give to 95 patients among the good responders in the first group, and 52 patients of the same group were followed up after stopping the vaccine as controls. Recurrence rates were significantly lower in those who received the long-term regimen [14.7%] compared to those who stopped the vaccine after six months [69.2%] side effects were mild and controllable

Asthma in infancy and early childhood pitfalls in diagnosis

Bronchial asthma is well known to be the commonest cause of wheezing in infancy and early childhood. Over as well as under-diagnosing asthma may be hazardous. The study included 300 wheezy infants and children aged 3 months to 4 years referred by pediatricians and general practitioners for further management of asthma. From a detailed history, clinical and radiological examination and immunological investigations in some cases we could reach a provisional diagnosis. Immunological investigations included humoral immunoglobulins and T- cell functions in suspected cases of immunodeficiency. Follow up for 2-3 years showed that only 30 percent of the patients proved to be asthmatics. Wheezy bronchitis following an upper respiratory viral infection occurred in about 50 percent of cases. Acute bronchiolitis could be diagnosed in 2 percent, most of which were hospitalized. About 8 percent of the cases had foreign body inhalation which was extracted by bronchoscopy. Immunodeficiency, mainly humoral though sometimes combined, could be diagnosed in 7 percent of cases. Other less common causes as tuberculous hilar nodes, cardiomyopathy and congenital anomalies were diagnosed in about 3 percent of cases

Thyroid hormones changes in acute myocardial infarction

Disturbances in thyroid hormones following the onset of acute myocardial infarction has received much attention in the last few years. The subject and its value is still a matter of controversy. We studied 30 newly admitted cases to the Internal Medicine department of Kasr EI-Einy hospital with the diagnosis of acute myocardial infarction based on clinical presentation, ECG and cardiac enzymes. They were 21 males aged 40-70 years and 9 females aged 40-65 years. 10 healthy age and sex metched individuals were taken as controls. We found a significant reduction in T3 and T4 following myocardial infarction with the peak fall encountered on the 3[rd] day after the onset of infarction. The fall in T3 and not T4 correlated with the extent of infarction. T3 levels were significantly reduced in the complicated cases only if compared to the non complicated group. T3 and T4 levels did not correlate with the degree of cardiac enzymes elevation nor with any of the risk factors studied. We concluded that T3 and T4 hormones decrease maximally on the 3[rd] day following the onset of infarction, and that T3 alone show decreasing levels with increasing severity of the infarction as well as in the presence of complications. Hence T3 could be used as a prognostic tool regarding extensive and complicated cases

effects of asthma on the course of pregnancy and labour

Asthma is relatively a common disorder complicating pregnancy. The response of asthma to pregnancy is variable. Some women improve, others worsen and some show no change. It is known that asthma could exert a plethora of mechanical and hormonal factors that influence the respiratory system. Asthmatic patients may overreacts. We studied 40 asthmatic pregnant women aged 22 to 32 years and 40 age matched controls. Asthmatic patients were all atopic and had their symtpoms for at least 2 years before pregnancy. All cases were free of systemic diseases, infections and gynaecological probems. They were subjected to a clinical study including a 2 weekly follow-up with pulmonary function tests includind FVC, FEV, FEV1%, FEF and PEFR. Cases were also subjected to routine laboratory tests, skin tests and they were all delivered in hospital. All follow-up data and complications were recorded in diary cards. We found that 27.5% of our patients improved [group I], 30% worsend [group II] and 42.5% had their asthma unchanged during pregnancy, Their were no significant differences among the three groups in change of asthma course between 16-28 weeks. Group II showed significant progression between 14-16 weeks and more between 30-36 weeks with no decline in PFT thereafter. All group I were suffering from mild to moderate asthma whereas most group II were severely asthmatics [75%]. No significant changes in the course of astha were detected among primi and multiparous women and no significant variations in PFT were detected in the control group. We found increased incidences of emesis gravidarum, pre eclampsi, prematurity and antipartum haemorrhage in the severe asthmatic group. We also encountered one case of neonatal death from acute respiratory distress syndrome in a severely asthmatic mother, and one case of neonatal goitre with hypothyroidism in a mother receiving iodide containing remedy on her own. There was also an enhanced need for augmented uterine contractility and increased incidence of low birth weight babies in the asthmatic group particularly the severe. We concluded that applying the best medication, avoiding maternal hypoxia and follow-up would ensoure the best outcome for both mother and fetus