Serum 25 hydroxy vitamin D levels in adult asthmatic patients

Patients with chronic lung disease as asthma appear to be at increased risk for vitamin D deficiency for reasons that are not clear. A cross sectional study including 75 asthmatic adults aged older than 18 years and 75 adults healthy control aged older than 18 years [35 males and 40 females for both groups] assessing the relationship between serum 25 hydroxy vitamin D levels and lung function. In our study only [12.31%] of our asthmatic adults had sufficient vitamin D levels [>/=30 ng/ml], wherase [85%] of healthy control subjects expressed sufficient levels. Vitamin D deficiency [<20 ng/ml] was observed in 59 [78.66%] asthmatic patients [17.28 +/- 2.4 ng/ml]. Deficiency was not observed in controls [33.67 +/- 6.3]. In asthmatic patients Serum 25 [OH] vitamin D was positively correlated with forced expiratory volume in 1 second% [FEV1%] predicted andforced expiratory/forced vital capacity ratio [FEV1/FVC][P=<0.05 for all]. There was no significant association between serum vitamin D level and eosinophil count. Reduced vitamin D levels are highly prevalent in adult asthmatic patients and are associated with impaired pulmonary functions

Study of the cyclical citrullinated peptide antibody [Anti-Ccp] in rheumatoid arthritis patients with extra articular lung manifestations

Anti- CCP antibody has recently gained much interest as a marker for early detection and prediction of severe articular and extra-articular disease in rheumatoid arthritis. To evaluate this in patients with active rheumatoid disease and lung involvement, we studied 40 rheumatoid arthritis patients with active disease: 10 patients [6 males and 4 females] have chronic disease with joint effusion but no extra articular affection, 13 chronic patients [5 males and 8 females] with joint effusions and evidence of lung fibrosis, 9 chronic patients [4 males and 5 females] with both joint and pleural effusions but no evidence of lung fibrosis and 8 patients [4 males and 4 females] with relatively recent onset disease with only joint inflammation without effusion plus 8 normal control subjects. Blood anti- CCP was found to be significantly much elevated in all patient groups than controls [p<0.001 for all] and in patients with lung disease than those without [p < 0.001 for both] with highest levels seen in patients with lung fibrosis. In patients without lung disease, levels were slightly [but significantly] higher in those with joint effusion than in those without [p <0.01]. Joint and pleural fluids showed significantly higher anti-CCP levels than blood [p<0.001for both]. Also levels in joint fluid were significantly higher than in pleural fluid [p<0.001]. Blood anti-CCP showed a strong positive correlation with both of ESR and blood rheumatoid factor [r = 0.599, p<0.001 and r = 0.841, p< 0.001 respectively] and with joint and pleural fluid levels [r = 0.786, p<0.001 and r = 0.522, p<0.05 respectively]. A highly significant inverse relation was seen between this antibody in blood and FEV1% [r = 0.593, p <0.001]. We concluded that: anti-CCP antibody could be a good marker for diagnosis of rheumatoid arthritis that can predict patients with severe disease and the association with extra articular affection especially in the lung

Serum interleukin-1 receptor antagonist: clinicopathological correlations with lupus nephritis

To evaluate the relationship between serum interleukin-1 receptor antagonist [IL-1ra] concentrations and renal involvement in SLE and to study its impact on laboratory, immunological and renal histopathological findings in SLE patients as well as its association with disease activity. We studied 26 [23 females, 3 males] SLE patients who had distinct clinical manifestations [22 had vasculitic skin rash, 20 had photosensitivity, 13 had oral ulcerations, 8 had neuropsychiatric manifestations]. They were classified into two subgroups; group Ia included 18 patients who had impaired renal function, 14 of them were proved by renal biopsy and group Ib that included 8 patients without renal affection. Ten healthy subjects matched for age and sex with the patient group were taken as a control group [group II] All patients were subjected to full history taking with stress on clinical manifestations of renal dysfunction, serum samples were tested for interleukin-1 receptor antagonist [IL-1ra] in addition to levels of C3, C4, creatinine levels and for the presence of anti ds-DNA antibodies. Light and electron microscopic examination [LM and EM respectively] of renal biopsy samples were performed for patients of group Ia. The 14 biopsy samples were classified according to the world health organization [WHO] classification as follows: Class I and II [inactive nephritis] n=1, class III and IV [active nephritis], n=11 and class V, n=2. The activity index [AI] and chronicity index [CI] in those 14 renal biopsy specimens were also determined. This study showed that the pattern of IL-1ra in active SLE varies in a manner that is dependent on which organs are involved. Serum IL-1ra concentrations were compared to normal blood donors [t=3.28, p<0.0001 highly significant]. However, significant higher levels of IL-1ra were observed in patients with extra-renal disease group Ib as compared to other patients group Ia [mean +/- SD were 1006.3 +/- 823.9 pg/ml, range 470-3000 and 147.1 +/- 58.5 and range 53-260 pg/ml] for patients without and with renal involvement respectively]. Elevated IL-1ra concentrations in patients with renal manifestations correlated positively with C3 and C4 levels [r=0.56 and 0.36 respectively] and negatively with degree of proteinuria and serum creatinine levels [-0.44 and -0.4 respectively] but not with disease activity index score SLEDAI [r=0.16]. Moreover, there was a high significant difference between the group of patients who were negative for anti ds-DNA [n=4] and those who where positive [n=22] as regards serum IL-1ra levels, being significantly lower in the positive group who were positive for anti ds DNA [t=2.8, p <0.01]. Furthermore, the highermost level of IL-1ra in group Ia [with renal impairment] was 260 pg/ml and the lowermost level of IL-1ra in group Ib was 470 pg/ml so a cut off value was selected at 370 pg/ml and the sensitivity and specificity values for IL-1ra for detection and diagnosis of lupus nephritis were found to be 100% for both. Therefore, a relative decrease of IL-1ra response appears to be a feature characteristic of kidney involvement and IL-1ra elevation clearly correlates with SLE involving other organs. So it may be a useful marker of lupus nephritis