ABSTRACT
Juvenile idiopathic arthritis [JIA] is a systemic inflammatory disease with dysregulation of normal immune responses that lead to chronic tissue inflammation and damage. Synovial neoangiogenesis, one of the pathologic hallmarks of JIA, was recently found to be caused mainly by vascular endothelial cell growth factor and was associated with increased infiltration of inflammatory cells. The activation, migration and penetration of leukocytes into local inflammatory tissues are dependent on attachment to adhesion molecules on endothelial cells. For that reason, adhesion molecules are belived to play part in initiation and propagation of autoimmune diseases. So the aim of this work is to measure serum and synovial fluid [SF] concentrations of soluble adhesion molecule-1 [ICAM-1] and E-selectin in juvenile idiopathic arthritis patients and to correlate them with clinical and laboratory variables. A Sandwish ELISA technique was used to estimate the serum and synovial levels of soluble intercellular adhesion molecule-1 [ICAM-1] and E-selectin in 38 patients with JIA, 12 systemic [JIA-sys], 13 polyarticular [JIA-poly] and 13 oligoarticular [JIA-oligo.], who had active disease or were in clinical remission. Fifteen healthy subjects matched in sex and age with the patients group were studied as control group. The total leukocytic [blood and synovial] and platelet counts, erythrocyte sedimentation rate [ESR] and Creactive protein [CRP] were recorded. A significantly higher level of sICAM-1 and E-selectin [p < 0.001 and < 0.05, respectivley] were found in [JIA-sys] and [JIA-poly] than in [JIA-oligo] or in control group. The level of both molecules in the three JIA subtypes, in the active stages and clinical remission, were still higher than in control group. A significant negative correlation with age was observed for the group as a whole [p < 0.001 for both, sICAM-1: r = - 0.581 and sE- selectin: r = - 0.497] while no correlation was found with disease duration or ESR. sE-selectin was correlated with total blood leukocytic and platelet counts [p < 0.05 for both, r = 0.37 and 0.34, respectivley] and both molecules with CRP [p < 0.05, ICAM-1: r = 0.33 and E- selectin: r = 0.35] and with each other [p < 0.01, r = 0.600]. No correlation was found between serum and synovial adhesion molecules [p > 0.05] or between SF adhesion molecules concentration and total SF leukocytic count [p > 0.05]. Increased level of soluble adhesion molecules in both [JIA-sys] and [JIA-poly] may be due to endothelial cell activation which is the key to the pathogenesis of JIA especially in systemic subtype and its persistence in spite of clinical remission could be used as a marker of aggressive disease
ABSTRACT
Microbiological investigations of vitreous fluid [VF] and aqueous humour [AH] samples have often failed to detect the infecting agent in infectious endophthalmitis, resulting in a clinical dilemma regarding therapy. So in this study we aim to assess the usefulness of polymerase chain reaction in the diagnosis of acute bacterial endophthalmitis. This study included forty intraocular samples [25 vitreous fluids [VF] from 25 cases of endophthalmitis and 15 samples; 7 VF and 8 AH as control from non infective patients during vitreous and cataract surgery respectively. The samples were processed for microbiological investigation [Gram stain and periodic acid schiff and culture for aerobic, anaerobic bacteria and fungi]. Nested PCR directed at the 16S rDNA using universal primers for eubacterial genome was done. The 25 cases were divided into four groups according to the initial ophthalmic procedure. PCR for eubacterial genome showed 100% correlation with 12 [48%] bacterial culture positive samples. Two samples were positive by both direct smear and PCR but negative culture. Eubacterial genome was detected in 5 [38.4%] of 13 bacterial culture negative samples. Among the 8 eubacterial PCR negative samples, one was positive for fungus infection. Only one of 15 control samples was positive for eubacterial genome. The sensitivity and specificity of PCR in relation to culture results were 100% and 93.75%. respectively. The most common organisms recovered from patients with culture proven endophthalmitis were Coagulase Negative Staphylococci [CoNS] [41.7%], S.aureus [16.7] S. viridans [16.7%], Pneumococci [8.3%], P. aeruginosa [8.3%] and E. coli [8.3%]. The most common factors predisposing to acute bacterial endophthalmitis were intraoperative complications, use of anti-metabolite [mitomycin C] and diabetes mellitus. PCR performed on aqueous humour [AH] and vitreous fluid [VF] is a reliable tool for the diagnosis of acute bacterial endophthalmitis particularly in smear and culture negative samples