Circulating cell free DNA as a predictor of systemic lupus erythematosus severity and monitoring of therapy

Background: Systemic lupus erythematosus [SLE] is the most heterogeneous chronic autoimmune disease; it is characterized by the presence of auto reactive B and T cells, responsible for the aberrant production of a broad and heterogeneous group of autoantibodies. Recent studies using various detection methods have demonstrated the elevations of circulating DNA in SLE patients

Aim of the study: The current study aimed to measure cell-free DNA [cf-DNA] in SLE patients as a potential tool to predict disease activity and treatment follow up

Subjects and methods: 52 of SLE patients with age ranging from 10 to 48 years were randomly selected and 25 healthy subjects with age and gender matched with the patients were included as a control group. Thorough clinical examination stressing on the central nervous system, vascular, renal, rash, musculoskeletal, mucocutaneous manifestations, and fever was done for patients. The following investigations were done: Complete blood count [CBC], kidney function tests, C-reactive protein [CRP], routine autoantibodies for autoimmune diseases, complements [C3 and C4], anti-nucleosome antibodies and cf-DNA by real time PCR [RT-PCR]

Results: The levels of anti-double stranded DNA [anti-dsDNA], anti-nucleosome Ab, and cf-DNA were significantly increased in SLE patients compared to controls. The cf-DNA level was correlated to markers of disease severity namely CRP and anti-nucleosome. A significant reduction in levels of cf-DNA, anti-nucleosome Ab and anti-dsDNA was noticed after therapy

Conclusion: Our findings support that the measurement of cf-DNA appears to be a useful marker in addition to laboratory tests used in SLE diagnosis. High correlation with markers of disease severity suggesting its role in disease pathogenesis and decreasing its level after therapy makes it to be a marker of treatment follow-up

Self-medication with drugs and complementary and alternative medicines in Alexandria, Egypt: prevalence, patterns and determinants

This study aimed to describe the prevalence, pattern and reasons for self-medication among adults in Alexandria, Egypt. In a community-based survey during 2012, a representative sample of 1100 adults completed a predesigned interview questionnaire on self-medication practices by drugs and complementary or alternative medicines [CAM]. A majority of them practised self-medication [86.4%], mostly using both drugs and CAM [77.5%]. The most commonly used drugs were analgesics [96.7%], and cough and cold preparations [81.9%], but 53.9% of respondents reported self-medication with antibiotics. The most frequently used CAM were herbs [91.6%], followed by spiritual healing [9.4%] and cupping and acupuncture [6.4%]. CAM improved the condition according to 95.2% of users. Logistic regression analysis revealed that age, occupation and the presence of chronic conditions were the independent factors significantly affecting the practice of self-medication with drugs

Soluble CD14-subtype [prespsin] and hepcidin as diagnostic and prognostic markers in early onset neonatal sepsis

The clinical picture and laboratory markers of Early-onset neonatal sepsis [EONS] are nonspecific, however a variety of different molecules have been suggested as clinical biomarkers in sepsis. Presepsin [soluble CD14-subtype] has been identified as a protein whose level increases significantly in the blood of septic patients. Hepcidin, an iron homeostasis regulator, it can be used in diagnosis of neonatal sepsis. The aim of this study is to evaluate the role of new markers namely presepsin and hepcidin in diagnosis of EONS compared to CRP before and after antibiotic therapy. The study enrolled 62 neonates, 28 of them fulfilled the criteria of EONS, and 34 healthy neonates as a control group. Serum levels of presepsin, hepcidin, CRP, complete blood picture, blood gases, and serum iron parameters for all neonates and blood cultures were done for 28 of neonates with clinical picture of sepsis. Serum levels of presepsin, hepcidin, and CRP were significantly higher in neonates with sepsis than in healthy neonates. The presepsin was more sensitive and specific than hepcidin and CRP for diagnosis of EONS. After antibiotic therapy, the serum level of presepsin was dramatically decreased as compared to its pretreatment level. The same results was noted, but to a lesser degree for hepcidin and CRP. Additionally, the presepsin level was significantly correlated to blood culture results and CRP levels. Presepsin is considered a promising biomarker for early diagnosis of EONS with higher sensitivity and specificity rather than hepcidin and CRP. Its correlation to sepsis markers and response to treatment is more informative. Future large scale studies are needed to understand the role of hepcidin and presepsin in development of sepsis in other pediatric age groups

Handicapping conditions among children under six years in family medicine centers in Alexandria. Part I: screening and detection

Early identification of children with developmental delays is important in the primary health care [PHC] setting. The PHC practitioner's office is mostly the place where the majority of children younger than 5 years of age are seen and is ideal for developmental and behavioral screening by the use of age-appropriate developmental checklists to record milestones during preventive care visits as a part of developmental surveillance. The aim of the present study was to screen children under 6 years in 5 family medicine [FM] facilities in Alexandria, Egypt for the early detection of some handicapping conditions [visual, hearing, speech, and orthopedic] and to review the family files of the screened children to assess the number of suspicious cases missed by the family physicians. Data were collected using a pre-designed screening sheet for the early detection of the above mentioned handicapping conditions among 550 children attending the study FM facilities and by family file review of the screened children. Screening of children under 6 years old had yielded the following results: orthopedic abnormalities represented 14.2%, followed by visual abnormalities [9.3%], speech abnormalities [8.9%], hearing abnormalities [6.2%], and mental retardation [2%]. Risk factors found to affect the occurrence of the study handicapping conditions were found to be mostly positive family history, consanguinity between parents, maternal age at the time of pregnancy, and complications during pregnancy; labour; and in the post natal period. Recording was incomplete as only 11.6% of the screened children had both complete files including growth and development charts. Poor performance of the family physicians in the study facilities was evident regarding detection and referral of handicapped cases in children as only 75 handicapped cases [46.3%] could be detected by the family physicians in the study facilities out of the 162 handicapped cases detected by the researcher. Family physicians in the study facilities referred only 57.3% of the detected. Therefore, screening for risk factors of handicap should be performed by the family physicians during routine daily activity as well as during the well baby clinic schedules. This is best achieved by proper development and application of guidelines and protocols for screening, follow up, and management of handicapping conditions including proper recording and referral

Handicapping conditions among children under six years in family medicine centers in Alexandria. Part II: assessment of resources

Handicap means the disadvantage or restriction of activity caused by disability. It is the practical consequence of disability and impairment. It is estimated that 5% of the world's children population suffer from severe handicaps and an additional 10-15%, may need special attention to overcome less severe handicaps. The aim of the present study was to assess the quality of human and non-human resources necessary for the prevention and control of handicapping conditions among children under 6 years in 5 family medicine [FM] facilities in Alexandria, Egypt. Data were collected using 2 different questionnaires: a checklist was designed to assess the availability of resources required for the early detection of visual, hearing, speech, and orthopedic causes of handicap among children under six in the study family medicine facilities. A self-administered questionnaire was designed to assess the knowledge, attitude, and practice [KAP] of 34 family physicians working in the study FM facilities about the early detection of the previously mentioned handicapping conditions in children. The percentage of registered to the total population was highest at Gohn FM unit [68.8%] and lowest at El-Seiouf FM center [24.6%]. Most of the equipment required for handicap screening was available in the study FM facilities. Child health records, daily registration records, and well baby clinic records were available, but no specific records or reports for handicapping conditions in children were present. About half of the physicians [47%] had no postgraduate studies at all, only 23.5% and 3% of the family physicians were trained about detection of mental retardation, and genetic causes of handicap, respectively and 14.7% did not attend any training course at all. The majority of family physicians had fair knowledge [76.5%], positive attitude [61.8%], and partial practice [70.6%]. The difference in KAP levels between the different study facilities was statistically insignificant. There was a statistically significant direct proportionate relation between the knowledge of the physicians and their practice; i.e., the higher is the knowledge the better is the practice. Therefore, handicap prevention and control should be properly integrated within PHC [Family medicine] services with continuous, proper training of all health team members