Retrospective study of infections in Egyptian patients with systemic lupus erythematosus [SLE]

Infections are one of the leading causes of morbidity and mortality in patients with systemic lupus erythematosus [SLE], therapeutic, dose-related and genetic factors all contribute to a lupus patient's increased susceptibility to infections. Although bacterial pathogens are the most common cause of infections, a wide variety of pathogens have been reported. Multiple risk factors for infection in SLE have been reported. These include disease activity, renal disease, gluco-corticoid use and cytotoxic therapies. The objective was to analyze infection risk factors in Egyptian lupus patients; the influence of these factors on disease activity, organ damage, disease development and the type of micro-organisms involved. The study included forty patients with SLE [37 females and 3 males] They were selected from those attending the SLE clinic in Ain Shams University hospital outpatient. Lupus disease activity had been established according to SLAM score. They were subjected to a retrospective study to : Complete medical history with special interest on duration of the disease, current treatment for lupus and dosage of prednisone, antimalarial drugs and immunosuppressive agents, number of infections whatever the cause during One year and number of admission due to episodes of infection whatever the cause. It included also symptoms of urinary tract infection [UTI] upper respiratory tract infection [URTT] as well as any complaint of the patient proved to be due to infection Laboratory assays included: CBC, ESR, serum creatinine, urine analysis, 24 hours protein in urine and culture when necessary. Increased incidence of infection in lupus patients which was 83 infections during the one year study. the incidence of Upper Respiratory Tract Infections was 8 infections [9.64%], Urinary Tract Infections 70 infections [84.34%], and Skin Infections 5 infections [6.02%] 83% of the cultures had had obtained from lupus patients. 83% of the urine were G- ve organisms. E. coli was the most common uropathogen encountered in this study [47%] which was resistant to most antibiotics but was sensitive to aminoglycosides. Skin infections were presented by abscesses 4 times [80%] -with predominance of staphylococci- and Herpes Zoster once [20%] There was a significant increase in the number of infection in relation to corticosteroids dose. There was a statistical significance between incidence of infection and addition of immunosupressive drugs to corticosteroids. There was a strong relation between incidence of infection and disease activity. SLE itself, increased dose of corticosteroids, use of immunosuppressive drugs and activity of the disease all are risk factors in incidence of infection in patients with SLE. UTI followed by URTI and skin infections including HZ were the most frequent infections in Egyptian SLE patients

Serum and synovial fluid levels of vascular endothelial growth factor in patients with inflammatory and degenerative arthritis

This work conducted to evaluate the clinical utility of measuring vascular endothelial growth factor [VEGF] by enzyme-linked immunosorbent assay in serum and synovial fluid [SF] samples from patients with early rheumatoid arthritis [RA], other recent-onset inflammatory arthritides, established RA and osteoarthritis [OA], as well as non-arthritic healthy controls. The study, also, investigated whether serum and SF VEGF had any relation with the standard clinical, laboratory and radiological markers of RA disease. The results showed that serum VEGF levels were elevated in patients with RA, inflammatory arthritis and OA in comparison with non-arthritic controls. Patients with recent-onset RA had the highest VEGF values both in serum and SF. In early and established RA groups, VEGF levels were higher in SF than in the serum. In the early inflammatory arthritides and the OA groups, the opposite occurred. Serum and SF VEGF were higher in active than inactive RA disease, with a positive correlation between their levels and each of ESR and disease activity grade. Moreover, values of VEGF in SF, but not in serum correlated well with the development of radiological damage in the established RA group

Study of acute phase reactants in diabetic retinopathy

This work included thirty patients with diabetes and fifteen normal control subjects. The diabetic group was divided into two subgroups according to the presence or absence of diabetic retinopathy, each subgroup comprised fifteen patients. For all subjects the following were done; history and clinical examination, measurement of the following acute phase reactants alpha -1 -antitrypsin, alpha-2-macroglobulin, haptoglobin and C-reactive protein. This study revealed that acute phase reactants are significantly higher in diabetic patients compared to control subjects [P<0.005] and significantly high in diabetics with retinopathy compared to diabetics without retinopathy [P<0.05]. We conclude that these changes are the result of hormonal imbalance in diabetics and are not related to the development of microangiopathy

Searching for a corrective factor in hepatic encephalopathy [serum calcium and phosphorus]

This study was conducted on 20 patients with different grades of hepatic encephalopathy to estimate serum phosphorous and calcium in this particular neuropsychiatric syndrome. The results of those patients were compared to 10 normal subjects. 16 patients [80%] with hepatic encephalopathy showed hypophosphatemia with a mean of 2.64 +/- 47 mg/dl. There was mild hypocalcemia in all patients with a mean of 8.9 +/- mg/dl. It was found that the grade of hepatic encephalopathy was inversely proportional to be serum phosphorous level. Correction of this hypophosphatemia to improve the clinical condition of those patients, avoiding the use of the antacid aluminium hydroxide as it lowers phosphorous absorption and the use of biological active metabolites of vitamin D to correct these metabolic abnormalities were recommended

Female sex hormones in hepatosplenic bilharziasis

The effect of hepatosplenic bilharziasis on female sex hormones has been investigated in twenty women. The patients were segregated into two equal groups according to the presence or absence of ascites. The result were compared with ten healthy women. The study revealed that in early non ascitic stage there was concomitant rise in estradiol and prolactin level with reduction in the gonadotropins level and testosterone and insignificant changes in progosterone. After developing ascites all hormones including progesterone were much lowered with infertility