Prognostic roles and survival benefits of endoscopic resection versus surgical resection in the management of malignant colon polyps

Background: Due to few sufficient data regarding the comparison between endoscopic and surgical resection of malignant colorectal polyps regarding outcomes and survival benefits, there are no clear guidelines of management strategies of malignant colorectal polyps. The aims of the present study were to compare endoscopic resection alone and surgical resection in patients with malignant polyps in the colon (T1N0M0) readings advantages, disadvantages, recurrence risks, survival benefits, and long-term prognosis to detect how management strategy affects outcome. Patients and methods: we included 350 patients. All included patients were divided into 2 groups; the first group included 100 patients who underwent only endoscopic polypectomy and the second group included 250 patients who underwent endoscopic polypectomy followed by definitive surgical resection after histopathological diagnosis. We followed all patients for about 5 years, ranging from 18 to 55 months. The primarily evaluated parameters are surgical consequences and patients' morbidity. The secondary evaluated parameters are recurrence risks, recurrence free survival, and overall survival rates. Results: The age of patients who underwent polypectomy is usually younger than the surgical group, males have more liability to polypectomy in comparison with females. Patients with tumors in the left colon have more liability to polypectomy in comparison with the right colon (p< 0.0001). Tumor factors associated with more liability to surgical resection are presence of lymphovascular invasion, high grade, and poor tumor differentiation (p< 0.0001). The management strategy was the most significant predictor of overall and recurrence free survival rates in patients with malignant colon polyps (p< 0.001). Conclusions: We found that survival benefits and lower incidence of recurrence are detected in the surgical resection group more than in the polypectomy group. (AU)

The prognostic roles of PYCR2 and ZBTB18 expression in tissues of colorectal carcinoma and non-neoplastic tissues: an immunohistochemical study

Background: It is important to detect novel biomarkers responsible for the progression and spread of colorectal cancer (CRC) to better evaluate the prognosis of the patients, provide better management, and foster the development of therapeutic targets. In humans, pyrroline-5-carboxylate reductase 2 (PYCR2) is encoded on chromosome 1q42.12, and its metabolic activity has been linked to oncogenesis in many cancers. Zinc finger and broad-complex, tramtrack, and bric-à-brac (BTB) domain-containing protein 18 (ZBTB18), a zinc finger transcriptional repressor, has been found to have a tumor-suppressor role and to be methylated in CRCs. To date, the prognostic roles of PYCR2 and ZBTB18 in CRC patients have not been thoroughly studied. Objective: To evaluate the tissue protein expression of PYCR2 and ZBTB18 in CRC and adjacent non-neoplastic intestinal tissues, to detect their roles in CRC carcinogenesis, progression and metastases. Patients and methods: After applying the inclusion criteria, 60 CRC patients were included in the study. Tissue samples from the tumor and the adjacent non-neoplastic tissues were stained with PYCR2 and ZBTB18. The patients were followed up for about 30 months (range: 10 to 36 months). We performed a correlation regarding the expression of the markers, and clinicopathological and prognostic parameters. Results Upregulation of PYCR2 and downregulation of ZBTB18 were found to be higher in CRC tissue than in the adjacent non-neoplastic colonic mucosa (p = 0.026 and p < 0.001 respectively). High expression of PYCR2 and low expression of ZBTB18 were positively correlated with large tumor size, higher tumor grade, advanced tumor stage, presence of spread to lymph nodes, and presence of distant metastases (p < 0.001). High PYCR2 and low ZBTB18 expressions were significantly associated with poor response to therapy (p = 0.008 and 0.0.17 respectively), as well as high incidence of progression and recurrence (p = 0.005), and unfavorable overall survival (OS) rates (p = 0.001). Conclusion: High expression of PYCR2 and low expression of ZBTB18 were independent predictors of CRC, progression, poor prognosis and unfavorable patient OS and progression-free survival (PFS) rates. (AU)

Surgical roles in the management of metachronus para-aortic lymph node recurrence and synchronous para-aortic lymph node metastasis in colorectal cancer patients

Background: The relative rarity of synchronous para-aortic lymph node (PALN) metastasis (SPM) and metachronous PALN recurrence (MPR) in colorectal carcinoma (CRC) patients leads to a limited number of studies on patient management, and no treatment guidelines have been established to date. Objective: To assess the prognostic, predictive roles, and long-term outcomes of different management strategies for isolated MPR and SPM in CRC patients to establish the best one. Materials and Methods: We included 35 CRC patients with isolated MPR and 25 patients with isolated SPM who underwent curative R0 resection. We performed PALN dissection (PALND) in 15 cases in MPR group and in 10 cases in the SPM group; all remaining patients in both groups underwent chemoradiotherapy (CRT) without further surgical intervention. During the study period of about 5 years, we compared the patients who underwent PALND and those who underwent CRT. Results: The overall survival and recurrence-free survival rates were significantly longer in patients who underwent PALND (p = 0.049 and 0.036 respectively). (AU)

A comparison between different management surgical approaches in the treatment of splenic flexure colon cancer

Background: There are many surgical approaches which described extent of resection of the colon for adequate surgicalmanagement of splenic flexure cancer, but up till now there is no established surgical procedure, this is because the presence of double lymphatic drainage of themesenteric vessels. Segmental resection of the colon for the management of splenic flexure cancer was a recently accepted surgical procedure. Objective: In the present study, we aimed to compare three surgical management techniques to clarify the best management approach of Egyptian patients with splenic flexure cancer regarding operative, clinical, and oncological outcomes: segmental resection, and extended left or right hemicolectomy,. Materials and Methods In the present study, we included 90 patients with splenic flexure cancer. Cases were divided into 3 groups. Each group included 30 patients in order to compare three surgical techniques: segmental resection, extended left hemicolectomy, and extended right hemicolectomy. Results: We have found no statistically significant differences between the three included groups regarding operative findings, postoperative complications, local recurrence, distant recurrence, disease progression, recurrence-free survival rate, progression-free survival rate, and overall survival rate. The operative time was longer, and the number of lymph nodes was higher in the extended right hemicolectomy group (p<0.001). Conclusion: We have shown that segmental resection of the splenic flexure is surgically and clinically suitable for the adequate management of operable cases of carcinoma of the splenic flexure. (AU)

Subtipo Persecutorio Del Trastorno Delirante: Estudio De Series De 129 Casos / Persecutory Subtype Of Delusional Disorder. Descriptive Study Of 129 Cases

Resumen Objetivo. El objetivo de este estudio es conocer las características demográficas, factores ambientales, factores de riego psicosociales, y clínicas del subtipo persecutorio en un grupo de pacientes con trastorno delirante (TD). Metodología. Estudio epidemiológico retrospectivo sobre un Registro de Casos en el Dispensario de Psiquiatría e Higiene Mental de Córdoba sobre pacientes con TD según criterios DSM-IV-TR. Aquellos pacientes que cumplieron con los criterios de inclusión definidos constituyeron nuestra muestra final de 261 casos, de ellos 129 casos presentaban el subtipo persecutorio. Las variables sobre las que se recogió información en base a protocolos, fueron agrupadas con el orden siguiente: I. Variables de los datos sociodemográficos y generales. II. Variables de los Factores de riesgo del TD (familiares y personales). III. Variables del Cuadro Clínico y el Diagnostico del TD (Presentación, sintomatología delirante, funcionalidad y discapacidad, utilización de los recursos sanitarios, tratamiento, problemas psicosociales, evolución y curso). Resultados. La proporción hombres versus mujeres en el subtipo persecutorio fue de 1,04. Solo el 5,4% de estos pacientes tenía estudios primarios. Un 65,9%, al realizar la primera consulta psiquiátrica, se encontraba casado y el 50,4% convivían en el hogar. Un 14,7% consumió previamente alcohol y un 0,8% otras sustancias. Las ideas de referencia y de persecución se presentaron el 98,4% y en el 99,2% de los casos respectivamente. Conclusiones. Son necesarios futuros estudios prospectivos para investigar los factores de riesgo del subtipo persecutorio del TD.

Objective. The objective of this study is to investigate the demographic, environmental, psychosocial and clinical characteristics of the persecutory subtype in a group of patients with delusional disorder (DD). Methodology. Retrospective descriptive study of DD cases registered at Psychiatry and Mental Hygiene Clinic of Cordoba according to DSM-IV-TR criteria was conducted. We obtained a sample of 261 DD patients who met the inclusion criteria; of them 129 cases has persecutory subtype. Data and variables collected were divided into 4 groups: I. Socio-demographic and general data. II. DD risk factors (personal and family). III. DD clinical picture and diagnosis (presentation, symptoms, disability, use of health care resources, treatment, and evolution). Results. The proportion of males versus females of the persecutory subtype was of 1.04. Only 5.4% of patients had primary level of education. At the first visit of the psychiatry clinic, 65.9% of the patients were married and about half of them shared home. About 14.7% of patients had a past history of alcohol consumption, and only 0.8% consumed other drugs. Ideas of reference and of persecution were found in 98.4% and 99.2% respectively. Conclusions. It is necessary to conduct future prospective studies to investigate the risk factors associated with the persecutory subtype of DD.

Multidetector computed tomography evaluation of synchronous lymphoma and other solid malignancies

Objective: The objective of this study is to review the multidetector computed tomography (MDCT) findings of synchronous lymphoma and other solid malignancies. Patients and Methods: This retrospective study included 18 patients confirmed with diagnosis of lymphoma and other solid malignancies. They were 8 women and 10 men (mean age, 62.5 year; range, 44–73 years). CT scanning was performed on one of the two systems: 64 MDCT in 11 patients and 6 MDCT in 7 patients. All 36 malignancies were underwent pathological evaluation. Results: All cases were confirmed pathologically. Lymphomas were Hodgkin disease ( n = 5 patients) and non-Hodgkin lymphoma ( n = 13 patients). Hepatocellular carcinoma was detected in five patients. Bronchogenic carcinoma was detected in two patients. Renal cell carcinoma was detected in two patients. Breast carcinoma was detected in two patients. Prostatic carcinoma was detected in two patients. Gastric carcinoma was detected in two patients. Endometrial carcinoma was detected in one patient. Colonic carcinoma was detected in one patient. Thyroid carcinoma was detected in one patient. Conclusions: MDCT scanning is accurately imaging modality for the evaluation of synchronous lymphoma and other solid malignancies. More reports and accumulation of such cases should help to clarify the mechanisms, contribute to a further understanding of this phenomenon, and may lead to a new treatment strategy for synchronous lymphoma and other solid malignancies

Device associated infections among neonates in neonatal intensive care units: a single unit survey study in Cairo, Egypt

Background: Device Associated Infection (DAI) namely Ventilator Associated Pneumonia (VAP) and Central Line Associated Blood Stream Infection (CLABSI) is one of the challenges for both neonatal nurses and doctors. Aims of the study were 1) Assess the rate of DAI occurrence among neonates, 2) explore the relationship between DAI rates and certain risk factors such as nurse patient ratio, hand hygiene practice, gestational age (GA), weight, and length of hospital stay among neonates.Methods: Descriptive correlational survey research design. Sample: All neonates admitted in twelve months-duration were included (total number 1090 neonates). Nurses and doctors were observed for compliance to adequate hand hygiene technique. Tools: 1) Center for Disease Control (CDC) criteria to calculate DAI rates, 2) Hand hygiene five points checklist 3) Review of neonates charts to collect data as weight, GA 4) Ballard score and 5) nurse/patient ratio.Results: 24 neonates developed DAI, high significant negative correlations between DAI and infants' weight, GA, nurse/patient ratio and overall compliance to hand hygiene techniques were reported (p-value ?0.05). Length of hospital stay, inadequate hand hygiene technique had strong positive correlations with DAI rate (p-value ?0.05).Conclusions: Factors that could affect DAI were infant's weight, GA, length of hospital stay, inadequate hand hygiene technique and nurse/patient ratio. Recommendations: implementation of infection control programs to raise nurses as well as physicians' compliance to adequate hand hygiene technique and increase number of nurses in the Neonatal Intensive Care Unit (NICU) per shift.

Serum Levels of Zinc and Copper in Cases of Juvenile Idiopathic Arthritis

Background:Juvenile idiopathic arthritis (JIA) represents a heterogeneous group of autoimmune diseases that arises before the age of 16 years and lasts more than 6 months. During acute inflammation of the disease, serum copper concentration increases and zinc decreases, that could point to the possible pharmacological properties of these trace elements. Aim:To measure the serum level of zinc and copper in patients with juvenile idiopathic arthritis (JIA) with different subtypes and correlate the levels of zinc and copper with the disease activity. Methods:This cross-sectional study was done on 40 patients already diagnosed clinically with JIA; patients were followed-up at the Rheumatology Outpatient Clinic, Children's Hospital, Cairo University. Results:Out of forty patients, 16were males (40%) and 24 were females (60%) with a male to female ratio (M: F) of 1:1.5. Out of the forty patients 17 were in activity and 23 were without activity. Thirty age and sex matched controls were included for comparison. Serum copper level was significantly higher in patients with JIA than those of the controls (P= 0.017) while there were no significant difference in serum level of zinc between JIA patients and that of the controls. Conclusion:Alteration of serum copper and zinc probably is a defense response against JIA; increased copper may be due to inflammation associated, these elements could serve as biomarkers for the disease activity.

Factors affecting readmission for asthma exacerbation in children attending Alexandria university children-hospital

Background: The admission rate for bronchial asthma has increased dramatically all over the world. This increase in admission influences the children’s quality of life in addition to health care cost. Objective of the study was to identify the risk factors for readmission because of acute asthmatic attacks.Methods: Case control study applied on asthmatic children admitted because of acute asthma attacks attending emergency room, paediatric intensive care unit and inpatient wards of Alexandria university children's hospital, Alexandria, Egypt in the period from September 2016 to July 2017. The study group was subdivided into 2 groups; group (A) readmitted within one year from first admission and group (B) firstly admitted.Results: The mean age in group (A) and (B) was 9.09±3.98 and 8.65±4.01 respectively. Males were more than females in both groups, and no sex differentiation effects on readmission. The duration of the disease in readmitted group ranged from 1-8 years, it was a risk factor for acute asthma readmission. Viral infection, exercise and dust were risk factors for acute asthma exacerbation readmission. Disease severity was found to have a higher percentage of hospitalization; cases with severe and moderate bronchial asthma compared to mild cases. Readmitted patients had more sleep disturbance and lack of school attendance. Readmitted patients were less adherent to treatment.Conclusions: Duration of the disease, viral infections, common cold, dust and exercise are risk factors for acute asthma readmission. Severity of the disease and adherence to medications affect acute asthma readmission.

Serum 25-hydroxy vitamin D in asthmatic children and its relation to disease severity

Background: Asthma is a chronic immunological disorder of the lungs. Vitamin D has several effects on the innate and adaptive immune systems. Little is known about vitamin D level and its impact on severity of asthma in children. This study aimed to determine vitamin D levels in asthmatics versus control children; studying the relation if any between these levels and asthma severity.Methods: This cross-sectional study was conducted on 60 asthmatic children and 20 apparently healthy children as controls. Asthma patients were divided into 3 groups (mild, moderate, severe; 20 each). Asthma severity was based on GINA criteria. Vitamin D level was measured to all study group.Results: The difference between the mean values of vitamin D level in control and asthmatic patients was statistically significant (p<0.001). This difference between control group and each asthma subgroup and between asthma subgroups versus each other were statistically significant being highest in control and lowest in patients with severe asthma (p<0.001). Differences in vitamin D status in control and all asthmatic patients were statistically significant (p<0.001). The difference between control group and each asthma subgroup according to vitamin D status were statistically significant (p<0.001). Concerning asthma subgroups the difference in vitamin D status between severe versus mild and moderate asthma were statistically significant (p<0.001), while between mild and moderate asthma it was not.Conclusions: Significantly lower vitamin D level in asthmatic children compared to controls and a differential decrease in vitamin D levels in asthmatic children being lowest in severe asthma was confirmed.

Association of dopamine D4 receptor gene variants with autism.

Background: Autism spectrum disorder (ASD) is a heritable neurodevelopmental disorder with poorly understood and complex etiology. The central dopaminergic system is strongly implicated in ASD pathogenesis. Genes encoding various elements of this system have been linked to ASD. This study aimed to estimate the distribution frequency of dopamine D4 receptor-exon III repeat region polymorphic genotypes among Egyptian children with autism. Methods: This case-control study included 178 children with autism (mean age 4.46±1.72 years) (118 males and 60 females) and a normal control group (n=128) of matching age and gender. Assessments by DSMIV- TR criteria, Stanford-Binet intelligence scale and childhood autism rating scale (CARS) were done. Assay for DRD4 48 bp VNTR genotypes was performed on amplified DNA by RFLP-PCR. Results: The 4/4 allele had the highest frequency among both autistic (39.32%) and control children (62.5%), with no significant difference between them. The 7/7 allele had also a high frequency (33.7%) among autistic patients, which was significantly different (p˂0.05) from the control group (12.5%) Furthermore, 70% of the patients carrying the 7/7 allele had the lowest IQ scores (58.5±6.5). Conclusions: There is a strong evidence that the DRD4 7/7 allele might be a risk factor for autism.

Lipid-lowering and hepatoprotective effects of Vitis vinifera dried seeds on paracetamol-induced hepatotoxicity in rats

BACKGROUND/OBJECTIVES: Red grape seeds as functional food are a good source of important bioactive components such as phenolics and antioxidants, which decrease oxidative stress that contributes to the pathogenesis of hepatotoxicity. The current study was conducted in order to evaluate the protective effect of red grape dried seeds (RGDS) on antioxidant properties, lipid metabolism, and liver and kidney functions of rats with paracetamol (750 mg/kg) induced hepatotoxicity. MATERIALS/METHODS: RGDS was added to the basal diet at 5, 10, and 20%. Thirty five adult male rats were assigned to five groups (n = 7) for a six-week feeding period; group (1) normal control, group (2) induced control, groups (3, 4, and 5) fed a diet with RGPS at different levels, 5, 10, and 20%, respectively. At the end of the feeding period, animals' blood and tissues were collected for estimation of serum lipid profile, serum liver, and kidney biomarkers. The protection was measured by detecting lipid peroxidation (LPO), glutathione (GSH), superoxide dismutase (SOD), Catalase (CAT) (in liver tissues), and liver histological examination. RESULTS: The results showed a significant (P < 0.05) decrease in levels of serum cholesterol, triglycerides, low density lipoprotein (LDL-C), and very low density lipoprotein (VLDL-C), with a significant increase in level of high density lipoprotein (HDL-C) for RGDS groups compared to induced control. Rats administered a diet containing RGDS levels produced significant (P < 0.05) hepatoprotection by decreasing the activities of liver enzymes, kidney parameters, and lipid peroxidation, while levels of GSH, SOD, and CAT were increased significantly to near the normal levels. CONCLUSION: The RGDS 20% group was more effective than others against hepatotoxicity of paracetamol, which may be attributed to RGDS total phenols and antioxidant contents, which were 1.438 mg and 1.231 mg, respectively.

3DCRT for posterior fossa: sparing of surrounding organs at risk

Radiotherapy of the posterior fossa is routinely delivered using 3DCRT parallel-opposed lateral fields. However high incidence of sensorineural hearing loss, hypothalamic pituitary dysfunction, thyroid and gonadal dysfunction during radiotherapy makes the need for treatment plan which provides adequate coverage of the target volume while sparing of the cochlea and other surrounding organs at risk [OARs] at same time inevitable. To compare the coverage of posterior fossa and the dose to surrounding OARs including non-posterior fossa brain, pituitary, cochlea, eyes, optic nerves, optic chiasm, cervical spinal cord, thyroid gland, pharynx, parotid glands and mandible using three different 3DCRT plans. Ten patients underwent CT simulation for treatment planning of posterior fossa boost. The CT data were transferred to Precise Elekta treatment planning system where posterior fossa, non-posterior fossa brain, pituitary, cochlea, parotid glands, cervical spinal cord, thyroid gland, pharynx, mandible, eyes, lenses, optic nerves and optic chiasm were all contoured. For each patient, three plans were carried out; two parallel opposed open lateral photon fields, a pair of wedged posterior oblique fields, and a pair of wedged posterior oblique fields and an open vertex field

Angiogenic output in viral hepatitis, C and B, and HCV-associated hepatocellular carcinoma

Angiogenesis is known to play a pivotal role in most of malignancy, including HCC, and in chronic inflammation. To investigate the angiogenic output in HCV and HBV infection and its implication in the development of HCV associated HCC. Blood samples were collected and grouped as; HS healthy subjects control group; HCC-HCV; chronic HCV infected patient group [HCV+ve] who are positive for serum anti-HCV antibodies and HCV-RNA; anti-HCV antibody positive and HCV-RNA negative patient group [HCV-ve]; patients with positive HBsAg and HBV-DNA group [HBV+ve]; and HBsAg positive and HBV-DNA negative patient group [HBV-ve]. Serum levels of vascular endothelial growth factor, angiopoietin-2, endostatin and angiostatin were assessed in different studied groups

Prevalence of Hepatitis B Virus Infection among Egyptian Pregnant Women - A Single Center Study.

Background: Hepatitis B virus (HBV) infection still has a relatively high incidence and prevalence worldwide. In the post-vaccination era in developing countries, perinatal vertical transmission remains the most common mode of transmission. Prevention of mother-to-child transmission requires screening for HBV surface antigen (HBsAg) in pregnant women to identify which newborns that must be immunized. Aim: This study aimed to evaluate the prevalence of HBV infection among pregnant mothers who were attending outpatient clinic of the Obstetric Department, and Social and Preventive Medicine Center at Cairo University Hospital Campus, for routine antenatal care. Methods: A cross sectional study included 2,000 pregnant women. A rapid screening test for HBV “One Step HBsAg Rapid Test” was done for all women and all HBsAg-positive cases were confirmed by ELISA for HBsAg. A structured questionnaire for risk factors for HBV acquisition was filled for every pregnant mother positive for HBsAg and a control group of HBsAg negative mothers. Results: Out of 2,000 pregnant women, 35 (1.75%) were positive by the rapid test, out of whom 32/35 cases (91.43) were confirmed to be positive by the confirmatory test representing 1.6% of the study population. Family history of HBV, previous intravenous (IV) injections, medical clinic attendance, hospital admission, and surgeries were the risk factors for acquiring HBV infection (P-value=0.001, 0.003, 0.002, 0.000, and 0.011, respectively). Conclusion: HBV infection is prevalent among pregnant mothers attending our outpatient services. Therefore we recommend screening for HBV in all Egyptian pregnant mothers to prevent neonatal infection by immunoprophylaxis.

Crossed abdominal wall plication in abdominoplasty

Plication of the anterior abdominal wall musculature and the anterior rectus sheath is a common procedure during abdominoplasty. The purpose of this study was to compare a newly modified technique for oblique plication of the anterior rectus sheath with classic vertical rectus plication, on the assumption that oblique plication is more physiological and anatomical. Fifteen patients underwent oblique plication of the anterior rectus sheath to correct both vertical and transverse laxity, and the results were compared with those for an equal number of patients who underwent vertical rectus plication. The average duration of follow-up was 18 months. The comparison was made by four non-medical judges from pre- and post-operative photographs. We compared waistline contour, definition of the linea alba, hip-waist transition and anterior abdominal wall contour. The rated areas were judged on a 5-point Likert scale, and the global score was based on the average of the four scores. The results for both groups were excellent; however, the global score for oblique plication was significantly higher [4.21 versus 3.81; p = 0.0046]. Oblique plication improved the anterior abdominal contour [p = 0.0386] and definition of the linea alba [p = 0.0099] better than wide vertical rectus plication, with greater aesthetic and theoretical functional improvement. The results for the hip-waist transition and waistline contour were not significantly different. Oblique plication of the anterior rectus sheath was more effective than classic vertical rectus plication in repair of the anterior abdominal wall musculature

Ultrasonography in clinical assessment of inflammatory and destructive changes in patients with psoriatic arthritis

To investigate the presence of asymptomatic entheseal abnormalities in psoriatic patients in an attempt for preclinical detection of psoriatic arthritis before joint affection becomes established. study included 50 patients who were divided into 2 groups; group I included 20 psoriatic patients with established psoriatic arthritis [as a control group] and group II included 30 psoriatic patients who didn't have any rheumatologic manifestations. Clinical assessment, routine laboratory studies, rheumatoid factor assessment, routine X-ray, musculoskeletal ultrasound [US], and power Doppler sonography were performed to all patients. US detected changes in 53.3% of psoriatic patients. The most common was inactive synovitis [53.3%], followed by tenosynovitis of flexor and extensor tendons of the hand [33.3%], then achillis tendinitis in 20%, and active synovitis along with achillis bursitis to be 6.7% for each. It was found that the PASI score and CRP were statistically higher in psoriatic patients with US findings than those with no US findings [p<0.05]. Higher tilers of CRP were associated with more synovitis, effusion, achillis tendinitis and bursitis in psoriatic patients; yet CRP tilers did not have in effect on US findings in patients with arthritis. It was found that active joint disease was significantly associated with joint spurs. US could detect subclinical musculoskeletal changes in asymptomatic psoriatic patients, and these changes are related to active skin disease and high levels of inflammatory markers. That is why proper control of skin disease and regular US follow up may lead to early, subclinical diagnosis of psoriatic arthritis and hence, early intervention to prevent joint destruction

Plasma concentration of osteopontin [OPN] in children with systemic lupus erythematosus: relationship with disease activity

Osteopontin [OPN] is an important bone matrix mediator found to have key roles in inflammation and immunity. OPN is a cytokine which can play a number of roles in promoting activation of T lymphocyte, regulating balance between T-helper 1 and T-helper 2, participating in cell-induced immunologic response and stimulating B lymphocyte to express multi-clone antibodies. Overexpression of OPN has been associated with the development of the autoimmune/lymphoproliferative syndrome. The aim of our present study was to analyze the possible correlation between the plasma concentration of OPN and disease activity in children with Systemic Lupus Erythematosus [SLE]. We also investigated the correlation between plasma IL-18 and OPN concentrations to further confirm the association of OPN with disease activity. We measured the plasma concentration of OPN, and the plasma proinflammatory IL-18 concentration in 40 SLE patients with or without renal disease [RSLE group and SLE group, respectively] and in 30 sex-and age-matched controls using enzyme immunoassay. Plasma OPN concentrations were significantly higher in RSLE and SLE patients than in the controls [p=0.000 and p=0.002]. Increase in OPN concentration correlated positively and significantly with SLE disease activity index in all SLE patients [r=0.34; p=0.04]. In RSLE patients, plasma OPN concentration showed a significant positive correlation with proinflammatory cytokine IL-18 concentration [r=0.48; p=0.004]. In conclusion, The above results suggest that the production of OPN is associated with the inflammatory process and SLE development, and may serve as a potential disease marker of SLE

Influence of human leucocyte antigen HAL-DRB1 and anti-cyclic citrullinated peptide antibodies on rheumatoid arthritis patients

To determine whether the presence of certain Human Leukocyte Antigen [HLA]-DRB1 locus is associated with production of anti-cyclic citrullinated peptide antibodies [anti-CCPAbs] and to analyze to what extent they are associated with increased susceptibility to and severity of rheumatoid arthritis [RA] in Egyptian population. Twenty nine RA patients were included in a case control study, all gave informed consents and the study was approved by the Ain Shams university ethical committee. Assessment of RA disease activity and severity was done by simplified disease activity index [SDAI] and Larsen scores respectively. Another fifteen age and sex matched subjects were also included as a control group, concentrations of anti-ccPAbs were determined in the sera of all subjects and in the synovial fluid of RA patients. The presence of HLA-DRB1 shared epitope [SE+] alleles were also determined. The alleles most strongly associated with RA susceptibility were HLA-DRB1 [01 and 04] [41.4%]. RA patients with serum anti-ccPAb titres above 60 U/ml had a higher frequency distribution of HLA-DRB1 01 [58.3%] and DRB1 04 alleles [83.3%]. There was significant positive correlation between serum and synovial anti-CCPAb titres, also between serum anti-CCPAb titres and RA disease activity and severity. HLA-DRB 1 SE+alleles [01 and 04] were strongly expressed among Egyptian RA patients. They were associated with the production of anti-CCPAb in high titres which could be involved in the disease process of RA. The presence of anti-CCPAb in high titres was associated with more active and aggressive disease. So, early determination of HLA-DRB 1 SE+alleles and serum anti-CCPAb titre in RA patients could facilitate the prediction of disease course and prognosis at the time of initial presentation

Serum levels of ghrelin, tumor necrosis factor-A [TNF- A], and lnterleukin-6 [IL-6] in infants and children with congenital heart disease

Ghrelin increases food intake, body weight, and growth hormone secretion. The cause of growth retardation in congenital heart disease [CHD] is multifactorial. The aim of this study was to estimate serum levels of ghrelin, tumor necrosis factor-a [TNF-alpha], and interleukin-6 [IL-6] ih infants and children with CHD, compared with levels in age-matched controls, and to correlate the levels ofghrelin with TNF- alpha, and IL-6. We measured serum ghrelin, TNF- alpha and IL 6 levels using ELISA in 60 patients with CHD [40 acyanotic and 20 cyanotic] and in 20 control subjects. Our results showed that patients with CHD, whether compiled in one group or classified into acyanotic and cyanotic, had significantly higher serum ghrelin TNF- alpha, and IL-6 than controls [p = 0.000]. Serum levels of ghrelin and TNF- alpha in the acyanotic patients were significantly higher than in the cyanotic patients [p = 0.000]. On the other hand, there was no significant difference in serum levels of IL-6 between the acyanotic and the cyanotic patients [p = 0.126]. In acyanotic and cyanotic patients with CHD, there was a positive correlation between ghrelin and TNF- alpha [r = 0.424; p = 0.006 and r = 0.577; p = 0.008, resp.]. Ghrelin levels were not correlated with IL-6 in the acyanotic and cyanotic patients with CHD [r = -0.211; p = 0.216 and r = -0.341; p = 0.08, resp.]. Serum ghrelin, TNF- alpha, and IL-6 levels are elevated in patients with CHD whether acyanotic or cyanotic. Increased ghrelin levels represent malnutrition and growth retardation in these patients. The relation of ghrelin with TNF- alpha may be explained by the possible effect of chronic congestive heart failure and chronic shunt hypoxemia