P-selectin in preterm infants suffering necrotizing enterocolitis

Platelet selectin [P-selectin], an adhesion molecule expressed by activated endothelial cells, mediates the early phases of leukocyte adherence to the endothelium. Expression of P-selectin has been shown to be crucial to neutrophil recruitment in many human inflammatory processes as well as in animal models of intestinal ischemia-reperfusion, intestinal transplantation, and sepsis, but its role in NEC is unknown. To study P-selectin, a possible cause of NEC, in the blood of preterm infants. Twenty-four consecutive preterms, clinically suspected or proven to have NEC, were enrolled in this pilot study. Their weight ranged from 1 to 2.3 Kg [mean +/- SD: 1.7 +/- 0.5 Kg], age ranged from 2 to 21 days [mean +/- SD: 12 +/- 3.5 days] and their gestational age [GA] ranged from 29 to 33 weeks [mean +/- SD: 31 +/- 3 weeks]. In addition, 12 age- and weight-matched apparently healthy preterm infants served as a control group. Written consents were obtained from the parents of infants included in the study. All neonates were subjected to perinatal history, clinical examination, routine investigations [CBC, plain X-ray and abdominal ultrasonography [US], arterial blood gases and serum bicarbonate, serum sodium, CRP and blood culture], and measurement of blood P-selectin by direct immunofluorescent staining. Infants with NEC clinically presented with significant PROM, gastric residual, abdominal distensions, hypoperfusion, hematochezia and evidence of NEC in abdominal X-ray and/or US, compared to control infants. Significant abnormal laboratory investigations in NEC cases included high CRP, hyponatremia, bandemia, thrombocytopenia, metabolic acidosis, and blood culture-proven neonatal sepsis. Abnormal blood P-selectin [>20 units] was detected in 21 [87.5%] infants with NEC, with a mean level of 51 +/- 12.4 units that was significantly higher than that of control infants, P<0.001. A strong significant negative correlation was observed between blood P-selectin and each of GA, body weight, platelet count, arterial blood pH and bicarbonate, while it was a significant positive correlation with each of CRP and band cell count. P-selectin may have a role in the pathogenesis of NEC in preterm infants and may be used as a diagnostic tool

Apo-1 as a marker of programmed cell death in patients with acute lymphoblastic leukaemia

We have planned this work to evaluate the significance and prognostic values of both membrane and soluble APO-1 as markers of apoptosis in patients with acme leukaemia before and alter chemotherapy. For that, 30 patients suffering from acute leukaemia [15 patients with ALL and 15 patients with AMD and 10 apparently healthy individuals serving as control group, were selected and subjected to the following: thorough history and clinical examination, routine investigations including: complete blood picture, bone marrow examination, cytochemistry, immunopheno typing of the blast cells and specific investigations including: detection of mAPO1 [CD95] on surface of blast cells by flow cytometry, detection of DNA fragmentation by agarose gel electrophoresis and measurement of soluble APO-1 by ELISA technique before and after chemotherapy. Surface membrane CD9S was found to be expressed on the majority of ALL blast cells [86.6%] and in only 60% of AML blast cells. The degree of surface membrane expression was variable ranging from 23-86% in ALL and from 43-89%; in AML. In both ALL and AML patients, a significant relationship was detected between surface CD95 expression and response to initial induction chemotherapy. Ninety-one percent of ALL patients and 84% of AML patients who had surface CD95 expression>20% on their blast cells showed complete hematological remission after initial induction chemotherapy. This was confirmed by finding that DNA extracted from patients under chemotherapy, whose blast cells CD95 expression was>20%, showed DNA fragmentation [DNA laddering] by agarose gel electrophoresis [characteristic of apoptosis]. As regards soluble CD9S [SCD95] before starting chemotherapy, no statistically significant difference was observed between the level of soluble CD9S in both ALL and AML patients and the control group [P>0.05]. But, in AML patients, the level of soluble CD95 tended to be etevated [not significantly] in comparison with normal control. After initial induction chemotherapy, the level of soluble CD95 was found to be significantly decreased in both ALL and AML patients in comparison to its level before therapy [P<0.001 and<0.01, respectively]. By following up patients who were resistant to chemotherapy, it was observed that patients who did not achieve complete remission after induction chemotherapy had relatively higher levels of sAPO-1. From these results we can conclude that, since there is a significant relationship between surface CD95 expression in both ALL and AML patients and response to chemotherapy, the expression of surface CD95 could serve as a new prognostic marker as it is helpful in predicting the outcome of therapy. In addition, because soluble APO-1 was found to be relatively high in patients resistant to anti-leukaemic therapy, so measurement of s-APO-1 in sera of acute leukaemia patients could serve as a putative marker for an active persisting leukaemia

Validity of interleukin-18 plus CRP measurement in the early diagnosis of sepsis neonatorum

Over the last decade a variety of laboratory tests have been developed to enhance the early and accurate diagnosis of sepsis neonatorum. However, non of these tests has been found to be absolutely reliable in detecting all septic neonates. To test the validity of circulating interleukin-18 [cIL-18] plus serum C-reactive protein [CRP] for the diagnosis of sepsis neonatorum, in term infants admitted to the neonatal intensive care unit [NICU] of Zagazig University Hospitals, during year 2005. Twenty - four neonates with positive blood cultures were selected from 60 neonates with clinically suspected sepsis. Their ages ranged from 0.3 to 25 days [X +/- SD: 14.2 +/- 7.1]. In addition, 14 gestational age [GA]-, chronologic age - and sex - matched healthy neonates served as a control group. Results: Forty percent of neonates with clinically suspected sepsis proved to have positive blood cultures, E. coli being the most significant isolate [62.5%]. Rise of serum CRP and cIL-18 is highly significantly associated with culture-proven neonatal sepsis. Meanwhile, other tests were nonsignificant associates. Using ROC curve analysis, cIL-18 displayed a sensitivity and a specificity of 91.7% and 85.7%, and CRP displayed a sensitivity and a specificity of 72% and 100%, respectively. When both tests were used, combined, the reported sensitivity and specificity accounted for 100%, for each. The combined use of cIL-18 and serum CRP is valuable in the early and accurate diagnosis of sepsis neonatorum