Plasma endothelin-1 levels in children with sickle cell anemia

The abnormal interaction between sickle cells and vascular endothelium may be of greater relevance for vaso-occlusive events than are alteration of red cell morphology or viscosity. One endothelial cell derived component extremely sensitive to cell injury is the vasoconstrictor peptide; endothelin-1 [ET-1] which has been found to be increased in patients with ischemic manifestations. Plasma ET-1 was assessed in this work to mirror endothelial cell interactions and to clarify its role in sickle cell anemia as a co-factor in the pathogenesis of vaso-occlusive events. According to their clinical presentation, patients were divided into two groups: Group I [n=18] were in steady state of sickle cell anemia, 12 of them [Group II] presented with acute painful crisis during the study period. Both groups were subjected to full clinical examination, routine hematological evaluation and measurement of plasma ET-1 level using ELISA technique. Our results were compared to a reference group of 15 age- and sex-matched normal controls. A statistically significant increase of levels of plasma ET-1 was demonstrated in patients during crisis compared to those during the steady state of their disease [p<0.05]. Similarly, ET-1 level was higher in both groups than the controls [p<0.05]. There was a significantly higher level of ET-1 in patients with hepatomegaly versus those without enlarged liver [p<0.05]. A significant negative correlation between ET-1 and frequency of blood transfusion was detected in this study, while a significant positive correlation between it and hemoglobin S was also found. However, no correlation was present between ET-1 and frequency of previous vaso-occlusive crises. ET-1 could contribute to both the prolonged vasospasm and inflammation mediating painful crisis in sickle cell anemia. Endothelin antagonist strategies might have good utility in the treatment of this complex clinical disorder

Effect of vitamin A and zinc deficiency on T-lymphocytes and natural killer cells in malnourished children

Serum vitamin A and zinc were estimated in 50 children with protein- energy malnutrition aged six months to three years and 20 health children with the same age classified into two subgroups according to their ages. The effect of their levels on natural killer cells [NK] and T- lymphocytes [cell mediated immunity] as well as anthropometric measurements and clinical features were also studied. Patients were classified into marasmic group and two Kwashiorkor groups according to their age. Clinical manifestations of vitamin A and zinc deficiencies were more evident in Kwashiorkor group [KWO]. Anthropometric measurements were significantly lower in marasmic group than control group. No significant difference was observed between both the Kwashiorkor groups. Vitamin A, zinc, CD3 [T-lymphocytes] and CD16 [NK] were significantly lower in all patients groups than control groups. A positive correlation was also found between zinc and CD3 in marasmus and KWO-group II [elderly gp] indicating the importance of zinc in normal maturation of T- lymphocytes responsible for cell mediated immunity. Also, a positive correlation was found between vitamin A and NK cells [CD16] in control group II and in marasmic group I indicating the importance of vit A for NK. Also, a good correlation was found between vitamin A and zinc in control group I and KWO-group I indicating that both zinc and vit A are essential nutrients for the proper functioning of the immune system

C-reactive protein in pregnancy, labor, in the post partum period and in premature rupture of membranes

The changes in the serum level of the C-reactive protein [CRP] over the course of normal pregnancy, labor, in premature rupture of membranes [PROM] and also in the postpartum period, were evaluated in 80 cases using turbidimetric system. Also, the efficiency of CRP determination versus ESR, total leucocytic count and differential blood count in detecting PROM was evaluated. The study revealed that CRP levels did not show a significant difference in pregnancy compared with the control group. However, CRP level was more sensitive and specific than the other parameters in detecting subclinical chorioamnionitis. It has added the advantage of being an easy, accurate, rapid diagnostic method

study of factor VIII: coagulant and Von Willebrand activities in diabetic retinopathy

The relation between factor VIII coagulant [F VIII:C], Von Willebrand Factor [vWF] and diabetic retinopathy was studied in this work. The study was conducted upon 38 insulin dependent diabetics, 14 without retinopathy, 13 with background retinopathy and 11 with proliferative retinopathy. They were matched to 10 non-diabetic controls. The study revealed that vWF activity increases significantly in diabetics in general. This increase tended to go in parallel with the increase in the severity of retinopathy. However, no significant difference in vWF activity was found between diabetics with and without retinopathy. This means that vWF has no role in the pathogenesis of retinopathy. On the other hand, F VIII:C showed marked increase in the diabetics in general. This increase was more prominent with proliferative retinopathy than background retinopathy. However, no difference was found between existence of absence of retinopathy. In conclusion, both F VIII:C and vWF levels are increased in diabetics, but their relation to the process of vascular endothelium damage are merely a sequence of vascular damage in case of vWF, while F VIII:C increase represents activation of the hemostatic system in diabetic patients

correlation study between 2,3-diphosphoglycerate [2,3-DPG] and platelet aggregation on congenital heart diseases

This study was conducted upon 30 individuals, 20 patients having congenital heart diseases [CHD], 10 cyanotic and 10 acyanotic patients, and 10 healthy controls. All subjects were investigated for 2, 3-diphosphoglycerate [2, 3-DPG] in blood and ADP induced platelet aggregation to clarify any relationship between these two parameters. Also platelet aggregation to clarify any relationship between these two parameters. Also platelets count, hematocrit value, [HCT], O2 saturation, PO2 and blood pH were determined. The results revealed that platelet did not differ in patient groups compared to control group. In the cyanotic group ADP-induced platelet aggregation showed a marked impairment compared to control group. In addition 2, 3-DPG enzyme was significantly increased in both cyanotic and acyanotic groups, but this increase was much higher in the cyanotic group. Correlation study between 2, 3-DPG level in blood and platelet aggregation induced by revealed that there was an inverse relationship between 2, 3-DPG enzyme level in blood and ADP induced platelet aggregation in patients with cyanotic CHD. Thus, it could be concluded that the glycolytic pathway of red blood cells interact with the prostaglandin pathway of platelets in order to maintain blood flow homeostasis in hypoxic patients. If this is proved to be correct, then, there is another good reason apart from altering hemoglobin oxygen affinity, for elevated 2, 3-DPG concentration in erythrocytes in cyanotic patients. Such an enzyme could be of great clinical usefulness in the treatment of thromboembolic disease

In vitro effect of insulin on neutrophil phagocytic and chemotactic functions in insulin dependent and non insulin dependent diabetics [IDDM and NIDDM]

Neutrophil phagocytic and chemotactic activities were measured in vitro in 40 subjects: 10 normal controls, 20 patients with insulin dependent diabetes mellitus [IDDM] and 10 patients with non insulin dependent diabetes mellitus [NIDDM]. Phagocytic and chemotactic activities were measured twice: first, before adding insulin and secondly, 30 minutes for the chemotactic activity, to determine the direct effect of insulin on neutrophil function. A significant impairment of phagocytosis in both IDDM and NIDDM patients was observed. Phagocytosis was not altered by the in vitro addition of insulin. It is explained by the fact that insulin does not act directly on the cells but by regulating the blood glucose level through inhibiting glycogenesis and lipolysis. Patients with IDDM showed no significant correlation between fasting blood glucose and the phagocytic index, but a significant correlation was observed between the glucose and the phagocytic index, but a significant index. However, patients with NIDDM showed no significant correlation between fasting blood glucose and phagocytic index and no correlation between the duration of the disease and the phagocytic index. Also no impairment of PMN chemotaxis in vitro was observed in either IDDM or NIDDM patients before or after insulin addition

Plasma fibronectin concentration in normal pregnancy and pre-eclampsia

Twenty pregnant females and ten non pregnant healthy females were studied in this work. All cases were subjected to careful clinical examination, plasma fibronectin estimation and serum FDPs concentration. Fibronectin concentrations were measured by Behring radial immunodiffusion while quantitative determination of FDPs level was measured by Behring staphylococcal clumping method. Fibronectin concentrations were significantly increased during pregnancy and pre- eclampsia. This increase was attributed to a hypercoagulable state which occurs late in pregnancy in normotensives and in preeclampsia to direct release of converted tissue fibronectin into the plasma by damaged vascular endothelium. FDPs levels were also significantly increased in both groups. This is mostly due to secondary fibrinolysis. There was a significant increase of FDPs levels in pre- eclamptic females when compared to the normotensive group. No correlation was observed in the pre-eclamptic groups. A pronounced decrease in plasma fibronectin level was found during labor and was attributed to localization of fibronectin around the fetal vessels and in the stroma of the villi. At onset of labor and at the puerperium, the pregnant loses fibronectin with the start of separation of the placenta and delivery of the fetus. During labor, FDPs levels were significantly raised. The increase of fibronectin in pre-eclamptic pregnant which was accompanied by a rise of FDPs is explained by the assumption that intravascular coagulation in pre-eclampsia is low grade, or localized to small areas

Antithrombin III[AT III] and fibrinogen degradation products [FDP] in nephrotic syndrome [NS] and diabetic nephropathy

AT III is a normal anticoagulant whose loss with proteinuria may be responsible for thrombotic complications in nephritic syndrome. Diseases with a primary coagulation disorder, as diabetes mellitus, may stimulate the production of AT III as a protective mechanism. There is still debate about the level of AT III in NS and diabetic neprop[athy. In this stud plasma AT III together with serum and urinary FDP were measured in 30 cases, who were 10 normal controls, 10 with NS and 10 with diabetic nephropathy. The latter 2 groups had comparable proteinuria 3.3 +/- 1.52 and 3.4 +/- 1.68 g/day respectively. Serum and urinary FDP were significantly high; with comparable values; in both patients groups, indicating a coagulation disorder. The plasma AT III of the NS [26.58 +/- 6.9 m%] was significantly lower than controls [33.2 +/- 4mg% p< 0.001], while the level in diabertec patients near the value of controls [31.68 +/- 3.1 mg%] with the difference from that of NS still significant p < 0.001. The apparently normal values of AT II in patients with diabetic nephropathy may actually represent a higher level tending to correct a primary coagulation disorder, if compared to the low level found in NS with comparable proteinuria