Impact of maternal gestational diabetes on neutrophil functions of full term neonates

Background: Maternal gestational diabetes is associated with an inflammatory environment that may contribute to fetal and placental inflammatory profile changes. Few studies investigated the effect of maternal gestational diabetes on neonatal innate immunity

Objectives: Our objective was to study neutrophil number and function in neonates born to mothers with gestational diabetes

Methods: Neutrophil number [complete blood count] and functions [CD11b, CD62L and Dihydrorhodamine 123 [DHR] by flow cytometry] were assessed in the cord blood of 30 full term neonates born to gestational diabetic mothers on insulin during pregnancy and another 15 born to healthy mothers as controls

Results: The mean total leucocytic and absolute neutrophil count were significantly lower in neonates of diabetics than in normal neonates [13.55 +/- 2.51 and 17.89 +/- 3.66 p> 0.001; 9.01 +/- 1.59 and 14.18 +/- 3.44 p>0.001 respectively]. Mean CD11b, CD62L and DHR were lower among neonates of diabetic mothers than normal neonates [82.48 +/- 8.09 and 87.85 +/- 4.87 p < 0.05; 8.63 +/- 4.41 and 24.98 +/- 10.47 p <0.001; 68.71 +/- 10.24 and 79.57 +/- 8.64 p< 0.001 respectively]. Unlike the control neonates, neonates of gestational diabetic mothers had positive correlation between the functional neutrophil parameters [r0.39 p<0.05]

Conclusion: Gestational diabetes affects cord blood neutrophil count and functions leading to high susceptibility to infection

Renal expression of vascular endothelial growth factor in lupus nephritis the pediatric age groupin

Vascular endothelial growth factor [VEGF] plays a crucial role in preservation of renal functions and may also serve as a useful biomarker in monitoring the progression of lupus nephritis [LN]]. We thought to correlate VEGF expression in the kidney with renal histopathology in lupus nephritis to unveil its possible relation to disease activity and severity. We consecutively enrolled 15 patients with lupus nephritis and ten renal biopsy specimens from patients with cystic renal diseases as controls. The study measurements included SLEDAI, SLICC/ ACR damage index and BILAG renal score. Paraffin sections from renal biopsies were subjected to routine haematoxylin and eosin staining and Immunohistochemical staining for VEGF. Results: Among SLE patients, 7 [46.7%] showed mild expression of VEGF, 5 [33.3%] showed moderate while 3 [20%] had strong expression of the marker. On the contrary, the control samples [100%] revealed strong marker expression. All subjects with class IV and V lupus nephritis had mild renal expression of VEGF. Renal expression of VEGF had a significant positive correlation with serum creatinine and complement C3 levels. The 24 hours' excretion of urinary proteins had a significant negative correlation with the renal expression of the marker. On the other hand, the activity indices and therapeutic modalities did not correlate with VEGF expression. Conclusion: This pilot study among pediatric cases of SLE revealed mild to moderate VEGF expression in most cases of proliferative LN. Further longitudinal studies are needed to investigate the consequences of this finding on the prognosis of the disease

Serum interleukin 27: a possible biomarker of pediatric systemic lupus erythematosus

Systemic lupus erythematosus [SLE] is a complex autoimmune disease; different cytokines play a role in the immunopathogenesis of SLE. IL-27 has both immunosuppressive and pro-inflammatory roles and its role is unclear in SLE. To measure serum interleukin [IL]-27 among a group of patients with pediatric SLE [pSLE] and whether it varies with SLE clinical and laboratory features or with therapy. Fifty patients with pSLE and 25 healthy subjects were included. Routine laboratory and immunological markers of SLE were done. Serum IL-27 was measured by enzyme linked immunosorbent assay for both patients and healthy subjects. Serum IL-27 was significantly lower in patients when compared to healthy subjects [p< 0.001]; 17 patients [34%] had low serum IL-27 [serum IL-27 < 160 pg/ml]. Patients in lupus flare and those in remission had comparable levels [p> 0.05]. Serum IL-27 did not vary significantly between patients with lupus nephritis [LN] and those without evident LN, moreover, it was comparable among different histological classes of LN [p> 0.05]. The disease status in terms of SLE disease activity index was comparable among lupus patients with normal serum IL-27 and those with decreased serum IL-27 [p> 0.05]. Serum IL-27 was not affected significantly with the cumulative doses and the types of the immunosuppressive drugs used [p> 0.05]. Decreased serum IL-27 in SLE might support its involvement in the immune alteration underlying SLE but its exact role remains unclear

Monocyte chemotactic protein-4 [MCP-4/CCL-13] and CC chemokine receptor 3 [CCR3] in the sputum of asthmatic children

Monocyte chemotactic protein-4 [MCP-4/CCL-13] is a potent chemoattractant to eosinophils, monocytes and lymphocytes. We aimed to investigate MCP-4 and its CC chemokine receptor 3 [CCR3] expression on cells of induced sputum during acute asthma exacerbation. Immunohistochemistry was used to assess MCP-4 and CCR3 expression on induced sputum cells of 30 children during asthma exacerbation and 20 healthy matched controls. Patients were divided into three groups according to exacerbation severity; mild, moderate and severe [n = 10 for each]. Patients were followed until quiescence, when sputum was re-examined. MCP-4 and CCR3 were expressed on eosinophils and monocytes. Lymphocytes expressed only MCP-4. The percentages of sputum total cells, eosinophils and lymphocytes expressing MCP-4 and/or CCR3 were significantly higher during asthma exacerbation than in controls and negatively correlated with peak expiratory flow rate, whereas that of monocytes was not. The percentages of sputum total cells, eosinophils, monocytes and lymphocytes expressing MCP-4; and total cells and eosinophils expressing CCR3 were significantly higher in patients with severe than those with mild and moderate exacerbations. When patients were followed till remission, the percentages of sputum cells expressing MCP-4 and CCR3 decreased. Sputum eosinophil percentage correlated positively with the percentage of eosinophils expressing MCP-4 and CCR3 [r = 0.69, p < 0.0001; r = 0.62, p < 0.001, respectively]. The percentage of sputum eosinophils expressing MCP-4 correlated positively with that of cells expressing CCR3 [r = 0.95, p < 0.0001]. The expression of MCP-4 and CCR3 on sputum cells increases during acute asthma exacerbation and this increase correlates with exacerbation severity, and it decreases during remission. Modification of their expression could be a potential target for asthma therapy

Immunocytochemical localization of cytokine-induced neutrophil chemoattractant-2 and macrophage inflammatory protein-2 in neutrophils of patients with or without urinary tract disease

Polymorphonuclear leucocyte neutrophils [PMN] migrate to infected mucosal sites to protect the injured tissue from invading pathogens. Their interaction with the epithelial barrier is controlled by chemokines. Also, chemokines are involved in the pathogenesis of renal disease such as systemic lupus erythematosus [SLE]. Therefore, the present study examined the immunocytochemical localization of cytokine-induced neutrophil chemoattractant-2 [CINC-2] and macrophage inflammatory protein-2 [MIP-2] in PMN of patients with urinary tract disease; SLE, urinary tract infection [UTI], renal transplanted recipients and bladder cancer patients in comparison with normal and patients without renal disease; hepatitis C virus [HCV] and diabetes mellitus [DM]. The obtained results showed that CINC-2 and MIP-2 immunoreactivity was weak in PMN from normal and patients without urinary tract disease. However, patients with SLE, UTI and bladder cancer exhibited an upregulation in CINC-2 or MIP-2 as reflected by strong immunoreactivity and significant increase in number of positive PMN. In contrast, CINC-2 and MIP-2 immunoreactivity and number of positive PMN was slightly increased after kidney transplantation especially in case of normal graft function. However during episodes of rejection, the immunoreactivity of CINC-2 and MIP-2 as well as number of positive PMN was augmented. Additionally, there was a positive correlation between the CINC-2 and MIP-2 immunoreactivity of PMN in all groups. Taken together, the upregulation of CINC-2 and MIP-2 in patients with urinary tract disease suggest that the defect in urinary tract function leads to accumulation of CINC-2 and MIP-2 as a defect in their clearance. Thus, CINC-2 and MIP-2 can be used as an additional marker for renal rejection

Genetic polymorphism of glutathione-S- transferase [GST-M1 and GST-T1] in schistosomiasis -associated bladder cancer in Egyptian patients

This work was carried out on three groups, 30 Egyptian patients with Schistosoma haematobium [S. haematobium] with bladder cancer [15], and without bladder cancer [15], as well as 15 normal individuals as a control. All the individuals were subjected to measurement of serum level of GST by using ELISA technique and genotyping for GST-M1 and GST-T1 using PCR technique. The results proved that GST serum level was significantly deceased in S. haematobium patients with bladder cancer as compared to the other groups. The PCR results for the GST-M1 and GST-T1 genotyping showed 4 categories, [M1+ve/T1+ve, M1+ve/T1-ve, M1-ve/T1+ve, M1-ve/T1/-ve]. There was a significant decrease in enzyme levels in patients with GST-M1-ve/T1-ve as compared to the other categories. Besides, there was a significant increased risk for bladder cancer development in patients with combined gene deletion [OR = 40] which represented mainly in S. haematobium patients with bladder cancer [53.3% = M1-ve/T1-ve]

Genetic polymorphism of glutathione-s-transferase [GST-M1 and GST-T1] in Egyptian schistosomiasis -associated bladder cancer

Bladder cancer is a common neoplasm around the world. In Egypt, the majority of bladder cancer is associated with Schistosoma haematobium [S. haematobium]. Glutathione-s-transferase [GST] represents an important family of metabolizing enzymes that catalyzes the conjugation of large variety of endogenous and exogenous compounds including carcinogens and anti cancer drugs and their metabolites with reduced glutathione. Individuals with very low levels of GSTs are at increased risk for the development of carcinoma and inflammatory diseases. The potential role of GST gene polymorphism on bladder cancer susceptibility is less certain. So, the aim of this work was to study GST-M1 and GST-T1 genes polymorphism in Egyptian patients with S. haematobium to clarify its role on bladder cancer susceptibility in those patients. This was carried out on three groups, 15 Egyptian patients with S. haematobium with bladder cancer, 15 Egyptian patients with S. haematobium without bladder cancer and 10 normal individual as a control group. All individuals were subjected to measurement of serum level of GST using ELISA technique and genotyping for GST-M1 and GST-T1 using PCR technique. The results proved that GST serum level in Schistosoma patients without bladder cancer was decreased but not statistically significant if compared to control group, in contrast it was significantly deceased in Schistosoma patients with bladder cancer if compared to the other groups. PCR results for GST-M1 and GST-T1 genotyping had shown 4 categories, in control group [M1+ve/T1+ve [80%], M1+ve/T1-ve[10%], M1-ve/T1+ve[10%], M1-ve/T1/-ve[0%]], in Schistosoma without bladder cancer [M1+ve/T1+ve[66.7%], M1+ve /T1-ve[13.3%], M1-ve/T1+ve[13.3%], M1 -ve/T1-ve[6.7%]], while in Schistosoma patients with bladder cancer [M1+ve/T1+ve[13.3%], M1+ve/T1-ve[13.3%], M1-ve/T1+ve[20%] and M1-ve/T1-ve [53.3%]]. It was demonstrated a significant decrease in enzyme levels in patients with homozygous deletions of both GST-M1 and GST-T1 genes [GST-M1-ve/T1-ve] if compared to the other three categories of genotyping. Moreover, there was a significant increased risk for development of bladder cancer in patients with combined gene deletion [OR=40] which represented mainly in Schistosoma patients with bladder cancer [53.3% were M1-ve/T1-ve]. Bladder cancer is a common multifactorial disease, and genetic polymorphism especially in GST-M1 and GST-T1 could play an important role as a risk factors in development of urinary bladder cancer among Egyptian with Schistosoma haematobium. So, it could be used for early prediction of risk group in order to help them by follow up for early diagnosis or by cancer chemoprotection

Management of acute traumatic diaphragmatic rupture

The aim of this work is to describe the diagnostic and therapeutic work-up for the management of 13 blunt trauma cases with acute traumatic diaphragmatic rupture [TDR] in a single institution. This study was conducted at King Saud Hospital [350 beds], Al-Qassim Region, Saudia Arabia. All patients were resuscitated and underwent emergency chest x-ray examination, abdominal ultrasonography [US] and thoraco-abdominal CT. After hemodynamic stabilization, patients underwent exploratory lap-arotomy; through a midline incision to deal with injuries including repair of the diaphragmatic rupture. The study included 13 patients; 11 males and 2 females with a mean age of 38.6 +/- 7.6 years. Admission chest x-ray defined 5 cases with TDR; 4 left and one right rapture with a sensitivity rate o/38.5%. Preoperative CT scan was conclusive in 10 cases [including the five cases suggested by chest X-ray] with a sensitivity rate of 76.9%. There was a significant increase [X[2]=3.26, p<0.05] of diagnostic sensitivity with CT in comparison to chest x-ray. Concomitant injuries included liver laceration [n=2], splenic rupture [n=3], bowel injury [n=2], pelvic fractures [a = 4], rupture bladder [n=2], intracerebral hemorrhage [n=2]; and traumatic left below knee amputation in one case, either as a solitary injury or in combination. In all cases the diaphragmatic defect was identifed, herniated organs were gently reduced and the diaphragmatic defect was repaired using monofilament non-absorbable sutures and chest cavity was drained. Abdominal exploration showed isolated diaphragmatic tear without herniating viscera in 3 [23.1%] cases, herniated stomach in 6 [46.2%] cases, herniated omentam in 3 [23.1%] cases, herniated dome of the right lobe of the liver in one [7.7%] case, herniated spleen in 3 [23.1%] cases and herniated colon in one [7.7%] case, either alone or in combination. Nine cases had linear diaphragmatic defect, 2 cases had a V-shaped defect, one case had irregular laceration of the diaphragmatic copula and one case had a Y-shaped defect. Two patients died throughout the postoperative follow-up period with a mortality rate of 15.4%. It could be concluded that TDR should be suspected in all thoraco abdominal trauma and to be looked for during surgical exploration irrespective of the results of preoperative investigations. Chest radiographs and helical CT are the best screening tests for diagnosis of TDR

Mirizzi syndrome : a diagnostic and surgical problem

This study was conducted at King Saud Hospital [350 beds], Al-Qassim Region, Saudia Arabia; between December 2000 till May 2005. The aim of this work is to describe a series of 13 patients presented with obstructive jaundice and proved to have Mirizzi syndrome, at a single institution, submitted to surgical treatment and to comment on their aspects with emphasis on the diagnosis and treatment The following items were evaluated: clinical presentation, laboratory results, preoperative evaluation, operative findings, type of Mirizzi syndrome according to the classification of Csendes et al, 1989, choice of operative procedures, and complications. The study comprised 13 patients [5 males and 8 females with mean age 58.2+9.3 years] with MS detected out of 1834 patients [0.7%] treated for cholelithiasis during the period of the study. Preoperative radiological examination succeeded in the diagnosis of MS in 6 cases; 2 cases by ultrasonography [15.4%], 4 cases by ERCP [30.8%], one out of 4 cases by CT [25%] and one out of 4 cases by MRCP [25%] and failed to diagnose 7 cases with a success rate of 46.2%. Surgical exploration through a right subcostal incision detected the presence of impacted stone in the infundibulum of the gallbladder or in the cystic duct of the all patients; there were 4 patients [30.8%] with MS type I, 3 patients [23.1%] had MS type II, 2 patients [15.4%] had MS type III and 4 patients [30.8%] had MS type IV. The surgical procedure done was cholecystectomy for patients with type I MS, Cholecystectomy, primary closure of the cholecysto biliary fistula and T- tube drainage of CHD for patients with MS type II. Patients with MS type III underwent cholecystectomy and choledochoduo denostomy, while cholecystectomy and Roux-en-Y hepatic jejunostomy were done for patients with MS type IV. Liver function tests returned to normal values in all patients within 43.8+20.7 days [range 30-70 days postoperatively] and the mean duration of post-operative and follow-up was 20.7+12.8 months [range: 6-48 months] with no postoperative major procedure-related complications or mortality. It could be concluded that MS is an uncommon form of benign obstructive jaundice identified with a frequency of 0.7% of patients with cholelithiasis. The preoperative diagnosis of Mirizzi syndrome is difficult and an awarded suspicion is necessary to avoid injuries of the biliary tree. The problem may only become evident during the operation due to firm adhesions around Calot's triangle. The success of the treatment is relate precocious recognition of the condition during surgery, and adapting the. management according to the individual characteristics of each case

Predictors of re-admission of schizophrenic patients

Psychiatric re-admission is frequently used as a measure of adverse outcome, as it occurs when the relapse to illness is so severe that less restrictive treatment is insufficient. Investigating factors that may cause readmission of schizophrenic patients. The study composed of two parts; Part I: collecting data from data base about re-hospitalization of psychiatric patients during the year 2004, their diagnosis, socio-demographics and mean of hospital stay. Part II: prospective study throughout year 2005 for schizophrenic patients with repeated hospitalization for two times or more through this particular year. A total number of 1094 patients were re-hospitalized during the year 2004. Schizophrenic patients represented [n=373, 34%] of them. Significant correlation had been found with advanced age, being single, lower education level, increased duration of illness and with positive family history of psychiatric illness. Using the multivariate logistic regression, it had and en found that patients above 36 years of age, sex, family history, patient's compliance and stigma were independently associated with frequent hospitalization. Patients with negative family history of psychosis were less prone to have frequent hospitalization. Positive family history of psychosis and the progress of age [>36 years] were the main significant predictors for frequent hospitalization

Sexual experiences in depressed patients treated with antidepressants

Sexual dysfunction is the most challenging problem when investigating patients with Major depression in whom the illness itself and the medications used in its treatment are both known to have effects on sexual function. Assess sexual dysfunction in treated versus untreated depressed patients and possible correlation with gender and severity of depression. Forty depressed patients were assessed using Arizona Sexual Experience Scale [ASEX] and Clinical and Global impression [CGI] applied to patients before introducing an antidepressant then 8 weeks after starting treatment. Patients with untreated depression had a variety of sexual dysfunctions. Decreased arousal and/or sex drive were mentioned by half of them. Orgasmic difficulties and erectile dysfunction were significantly worse after treatment. No significant difference was detected between TCA and SSRI regarding sexual dysfunction. Depression was significantly improved in females compared to males. Worse sexual experiences were more encountered by older patients

Markers of cardiovascular disease in women with subclinical hypothyroidism

The relationship between sublinical hypothyroidism and astherogenic lipid profile is still controversial. This study evaluate some of the risk markers of cardiovascular disease in a group of women with subclinical hypothroidism, including biochemical and inflammatory markers as well as echocardiographic study. Twenty-three patients were compared with thirteen euothyriod. TSH, FT4, FT3, total cholesterol, low- density lipoprotein, high- density lipoprotein, triglycerides, CRP and IL-6 were done as well as echocardiographic examination.Significant increase in total cholesterol [P < 0.01], LDL-c [P < 0.01] and TG [P=0.0025] in subclinical hypothyroidism [SCH] patients versus control group. CRP and IL-6 were positively correlated with abnor malities in LV morphology and mass in SCH versus control group. A significant, diastolic dysfunction indicated by Significant. Prolongation of the isovolumic relaxation time [P < 0.001] and Significant. Reduction of the early diastolic mitral flow velocity/ late diastolic mitral flow velocity ratio [P < 0.001]. Serum total cholesterol, low- density liporpotein cholesterol, triglycerides, CRP and IL-6 are increase in women with subclinical hypothyroidism. Echocardiographic findings suggest that subclinical hypothyrodism causes diastolic dysfunction

Immunological and pathological prognostic markers of relapse in ulcerative colitis

Patients with quiescent ulcerative colitis [UC] need satisfactory biochemical, immunological and pathological markers to detect relapse which may influence optimal mangment and to detect relation of these markers to the degree and extent of the disease. Patients and twenty eight patients with UC in remission, were followed for 12 months, we had done:ESR, CRP, microalbuminuria, interleukin 1-B [IL-B], Interleukin 2[IL-2], and colonic mucosal biopsies at the start of the study, at the time of clinical relapse and at the end of the study. Results Patients with active UC had higher microalbuminuria compared with those in remission [p<0.001], also, significantly higher concentration of microalbuminuria were detected in extensive disease compared with left sided disease [p<0.05]. In relapsing UC there are significant increase in IL-1B and in IL-2, also there is a significant correlation between IL-1B and CRP. Over the period of the study 38% relapsed, the relapse was not related to the duration or extent of the disease. In relapse acute inflammatory infiltrate was present in 40% and crypt abscesses in 60%. Microalbuminuria as well IL-1B and IL-2 are prognostic indicators of activity in UC. Also acute inflammatory infiltrate and crypt abscesses are considered indices of active colonic inflammation

Predicting ulcer disease in dyspeptic patients by H. Pylori testing rather than endoscopy

To validate accuracy of the Rapid Blood Test [RBT] in predicting peptic ulcer disease in dyspeptic patients. Rationale: Most patients with dyspepsia have no pathology at endoscopy, thus are exposed to unjustified risk, cost, and inconvenience associated with this invasive assessment. Setting: Medical World Polyclinic and Dar Al-Shefa Hospital, Riyadh, KSA. Patients: One hundred patients with ulcer- like dyspepsia. All patients underwent a RBT followed by endoscopy with antral biopsies for histology and urease slide test [CLO test]. Sixty-five% of the patients were "gold standard" H. pylori positive [positive CLO test, positive histology], 30% were "gold standard" negative [negative CLO test, negative histology], and 5% had conflicting CLO test and histology results. Patients with peptic ulcer disease included 31% of all dyspeptic patients, 42% of H pylori-infected patients, and 7% of non-infected individuals. RBT could determine H. pylori status with a sensitivity of 91% and specificity of 77%. Positive and negative predictive values of the test were 89% and 79% respectively. In predicting peptic ulcer disease, RBT was sensitive in 93% of patients and specific in 41%. Positive and negative predictive values of the test were 41% and 93% respectively. Conclusions: RBT is reliable in determining H. pylori status. However, we cannot predict the development of peptic ulcer disease merely on the presence or absence of H. pylori

Low-pressure pneumoperitoneum improves the outcome of laparoscopic cholecystectomy

Laparoscopic cholecystectomy [LC] is an advantageous procedure that widely replaced the traditional open cholecystectomy. However, highpressure pneumoperitoneum was accused for precipitating some intraoperative hemodynamic effects and postoperative shoulder-tip pain [STP]. The objectives of this study were to determine the influence of lowpressure pneumoperitoneum on the frequency and intensity of shouldertip pain and body hemodynamics in patients undergoing laparoscopic cholecystectomy. The study comprised 70 chronic calcular cholecystitis patients [25 men and 45 women]. Thirty-three patients [Group I] were assigned to undergo LC under high-pressure [13-15 mmHg] and 37 patients under low-pressure [7-9 mmHg] [Group II]. Intraoperative monitoring included measurement of heart rate [HR], systolic, diastolic blood pressure, and mean arterial blood pressure [MAP] was calculated. The frequency of postoperative STP was determined and its intensity was determined using visual analogue scale charts [VAS]. There was a significant [P<0.05] increase in MAP in both groups at 5 mm. after insufflation and after tilting the patient to reversed Trendelenberg position [RTP], but there was a significant decrease of MAP in Group II as compared to Group I [X[2]= 7.716, P<0.05]. There was a significant reduction of both frequency [13.5% vs. 33.3%] and intensity of STP in low-pressure group compared to high-pressure group. This difference was especially significant 6, 12, 24 hours postoperatively. Moreover there was a positive significant correlation between the insufflated pressure and the frequency [r=0.691. P<0.05] and intensity [r=0.612, P<0.05] of STP. There was a significant reduction of the amount consumed analgesic [declphenac potassium 75 mg/cc, amp.] in low-pressure group compared to high-pressure group. We can conclude that reduction of the pressure of the pneumoperitoneum to 7-9 mmHg results in a significant reduction of both the frequency and intensity of shoulder-tip pain and allows more stable hemodynamics of the patients through the duration of laparoscopic cholecystectomy. On the basis of these results, the widespread use of low-pressure pneumoperitoneum throughout most of a laparoscopic cholecystectomy procedure is recommended

Prevalence and predictors of bone mineral density in inflammatory bowel disease

Osteoporosis is established in inflammatory bowel disease [IBD] but the mechanisms underlying this disorder has not been well defined. The aim of this study was to assess bone mineral density [BMD] in inflammatory bowel disease [IBD] and evaluate any potential differences between crohn s disease [CD] and ulcerative colitis [UC]. Also we will try to define biochemical markers that predict the changes in BMD. Twenty six patients with recently diagnosed [3-6 months] crohn s disease [9 patients] and ulcerative colitis [17 patients] and 15 age and gender matched healthy controls were enrolled in the study. IBD is diagnosed on clinical, radiological and colonoscopic basis. BMD of lumbar spines, femur and radius were assessed using dual energy x-ray absorptiometry within 3 months after establishing the diagnosis. Laboratory work included: serum calcium, phosphate, alkaline phosphatase and free osteocalcin. Results showed that, BMD is significantly decreased in IBD in comparison to control group [P- value <0.001], with femur more affected than vertebra [P<0.05]. BMD is more affected in CD patients than those with UC: 65% [CD]. 55% [UC] ate osteopenic and 35% [CD], 17% [UC] are osteoporotic. In CD femur T-score shows significant inverse correlation to the-disease duration [r= - 0.72] and in UC patients spine T- score is inversely related to the age [r= - 0.58] and femur T-score is significantly related to sex [more negative in males]. Serum calcium, phosphorous and alkaline phosphatase are not associated with significant difference between patients and control group [P<0.05] and there is an inverse correlation between osteocalcin and lumbar spine BMD [r=0.37, P<0.05]. In conclusion, IBD patients have significant lower BMD value and BMD is more affected in CD patients than those with UC. Osteopenia is related to disease duration in CD, while it is related to age and male sex in UC. Free osteocalcin is an independent risk factor for low BMD of lumbar spines

Management of lumbosacral instability using oswestry pedicle screw system [OPSS]

The main presenting symptom in patients with lumbosacral instability was low back pain with or without leg pain. Fifty cases were prospectively studied after failure of significant improvement with medical treatment for a minimum period of six months in 25 cases with spondylolisthesis and three months in 25 cases with failed back surgery. The standard surgical procedure consisted of transpedicular fixation using Oswestry pedicular screw system and in situ posterolateral graft using autogenous iliac bone with or without decompression. After an average follow up of twenty months, the results obtained were quite satisfactory with an overall fusion rate of 74% and excellent or good clinical results of 82% including back and leg pain and spinal mobility. The results of the present study support the reliability of the segmental pedicular fixation of the Oswestry type combined with decompression and posterolateral grafting as a safe technique for management of cases with lumbosacral instability resulting in a satisfactory outcome without significant complications

Prevalence of food allergy in asthmatic patients

This study was conducted to assess the role of clinical sensitivity to food on the pattern of bronchial asthma. A total of 1341 patients with asthma were included in the present study. The clinical sensitivity to food and its relation to respiratory symptoms were assessed cross-sectionally [using detailed questionnaires], and longitudinally during their regular visits to the asthma clinic using diet diary. Total IgE was determined for a subsample of the patients [No = 392]. The prevalence of clinical sensitivity to food was 29%; about 2 thirds of the patients had high total IgE level. Asthmatic patients with clinical sensitivity to food present with some particular features which are considered risk factors that determine the occurrence and clinical pattern of asthma. In addition, some personal characteristics in the asthmatic patients make them at increased risk to have clinical sensitivity to food. From the clinical experience of asthma management in our clinic, the authors believe and emphasize that elimination of food items from the diet of an asthmatic patient should be considered after careful investigation and observation of the patient. In addition, some personal characteristics in the asthmatic patients make them at increased risk to have clinical sensitivity to food. Early detection of food allergy is an important preventive factor for food related respiratory symptoms. The natural course of food allergy is of resolution over time although this may differ between foodstuffs and may be variably affected by avoidance of the offending allergen

Serum adenosine deaminase and cytidine deaminase as markers of active disease in childhood rheumatic disorders

Serum cytidine deaminase [CD] and adenosine deaminase [AD] activities were measured in 21 children with juvenile rheumatoid arthritis [JRA], 21 with SLE and other rheumatic diseases and 11 with active rheumatic fever [RF] in comparison with 19 healthy controls aiming at assessing their activities in such diseases and their relation in clinical and laboratory markers of the disease activity. The mean serum CD and AD activities were significantly higher in patients' groups than in controls. The increase in CD activity was more prominent in JRA and RF, while AD was highest in SLE. Patients with active JRA had higher CD activity than that with quiescent disease. AD was insignificantly higher in quiescent disease. The activity of both enzymes was insignificantly higher in active as compared to quiescent SLE. Although paired observations of eight patients revealed a drop in the activity of both enzymes with a disease remission, yet the levels remained significantly higher than in controls indicating an ongoing subclinical inflammation. The activity of both enzymes did not correlate significantly neither with ESR nor with serum complement C3 activity. No significant differences were observed with various modes of therapy [steroids, NSAIDs] of JRA. Cytotoxic drugs for SLE were accompanied by a significantly higher CD than steroid therapy