Correlation of synovium osteoprotegrin with magnetic resonance imaging in rheumatoid arthritis

To demonstrate the role of Osteoprote grin [OPG] expression in the synovium in the pathogenesis of rheumatoid arthritis [RA] joint damage, and correlate it with Magnetic Resonance Imaging [MRI] finding. Twenty RA patients and five controls were included. RA disease activity was assessed by disease activity score [DAS 28]. MRI examination of knee joint, including evaluation of inflammation using synovitis score and evaluation of destruction with an erosion score, were performed. Knee joint's synovial biopsy specimens were obtained, by arthroscopy, to demonstrate the degree of expression of OPG by using immunohistochemical staining with monoclonal antibodies, and to study the histopathological activity scores by histopathological examination. The OPG expression was deficient [grade 0, 1] in 70% of synovial cells and 85% of endothelial cells lining of the synovial blood vessels, and grade I and 2 in 70% of infiltrating cells in active RA synovium. There was no significant association between OPG expression score [synovial, endothelial, infiltrating cells] and disease duration, number of tender swollen joints, ESR and Larsen score. There was a significant inverse correlation between OPG expression [synovial, infiltrating] and MRI erosion score. There was a highly significant correlation between MRI synovitis score and ESR, CRP, pain score, histopathological synovium score [p<0.01] and significant negative correlation with erosion score. We concluded that decrease in OPG expression in synovium has a role in pathogenesis of joint damage in RA patients, and MRI is considered a sensitive test to detect pathological lesion in joint damage in RA patients

Potential role of interleukins-12 and 18 as predictors in infection induced premature rupture of membranes whether full term or preterm

Acute bacterial intraamniotic infections are by far the most important cause of perinatal morbidity and death. Although early diagnosis and aggressive treatment to decrease the ill effects of intra amniotic infection, this goal is frequently difficult to achieve because the infection may not be clinically apparent before delivery in all patients. In this respect, the current study was designed to asses the potential role of interleukins [1L]-12 and or 18 as a predictor of infection induced rupture membrane whether term or preterm. 75 pregnant women at labor were the subjects of the study. 25 preterm with premature rupture of membranes [PROM] were gp 1, 25 full term PROM were gp 2 and 25 full term with intact membranes were gp 3 [controls]. Bacterial cultures, Chlamydia, Mycoplasma and Ureaplasma were detected among the high vaginal swabs taken at the time of delivery. IL-12 and 18 were quantitated by commercial enzyme linked immu-nosorbant assay [ELISA] from cell culture supernates of milogcn stimulated whole peripheral blood obtained from all subjects at time of delivery. Results revealed a significant association of bacterial infections and IL-12 and 18 with PROM deliveries [whether preterm or term] compared to the controls. A significant increase in IL-12 and 18 were observed among preterm cases than full term ones and among positive bacterial culture cases compared to negative culture ones. The highest interleukin values were with ordinary bacterial infections and the least were with mycoplasmal and ureaplasmal ones. IL-18 values were significantly higher than IL-12 levels. So, we can conclude that IL-18 measurement could be a marker of infection induced PROM

Metacarpal index phalanx versus dual-energy X-Ray absorptiometry in osteoporosis

Osteoporosis is one of the most common metabolic diseases. It is responsible for considerable morbidity, mortality and costs. Our aim was to evaluate metacarpal index as a diagnostic tool for bone mass measurement as compared with DEXA. The study included 50 males above 60 years of age with a history of osteoporotic fractures as well as 20 apparently healthy males. Their ages ranged from 20-25 years. Metacarpals index had sensitivity of 46%, specificity of 95% positive predictive value 96%, negative predictive value 41% in comparison to DEXA. Metacarpals index can be used as a routine test for exclusion of osteoporosis

Relationship of serum leptin and osteocalcin to bone mineral density in osteoarthritis

Several epidemiological studies have shown a lower prevalence of osteoporotic hip fractures in osteoarthritis patients. Other studies have demonstrated elevated bone mineral density in osteoarthritis patients [OA]. The prevailing view is that there may be an inverse relationship between osteoarthritis and osteoporosis. High leptin levels are associated with obesity, which is a risk factor for osteoarthritis. Interestingly, in osteoarthritis patients leptin is present in synovial fluid and is expressed by articular chondrocytes and normal human chondrocytes express the functional Ob-Rb leptin receptor isoform. To determine the relationship of leptin to osteoarthritis as well as osteoporosis and to assess the hypothesis that osteoarthritis is protective from the occurrence of osteoporosis. This study included sixty subjects: thirty osteoarthritis patients and thirty age and sex matched apparently healthy controls. All patients were selected from the Outpatient Clinics of the Rheumatology and Rehabilitation and Intenal Medicine Departments of Ain Shams University Hospitals. The patients were classified according to the body mass index [BMI] into two groups: Group I [BMI < 25] and Group II [BMI >25]. Group I were 13 patients with mean age +/- standard deviation [SD] 49.2 +/- 7.4 and Group II were 17 patients with mean age +/- standard deviation [SD] 49.7 +/- 8.1. Another classification was done according to the menopausal state of the patients. The patients were also classified into two groups: Premenopausal OA patients [Group A] and postmenopausal OA patients [Group B]. Group A were 16 patients with mean age +/- standard deviation [SD] 42.87 +/- 1.14, Group B were 14 patients with mean age +/- standard deviation [SD] 57.07 +/- 4.06. Patients were subjected to: 1. Detailed medical history taking. 2. Thorough clinical examination: with particular attention to Body mass index [BMI] and Local examination of the knees.3. Radiological assessment: with Plain X-rays for both knees of patients and controls. Analysis was done according to the Kellgren and Lawrence, [1957] scoring system as a radiographic grading of OA and assessment of bone mineral density [BMD, g/cm[2]] of the left femoral neck and lumbar spine [L1-L4] were measured using dual energy X-ray absorptiometry [DEXA] 4. Laboratory investigations: Assay of serum leptin, bone alkaline phosphatase [B-ALP] and serum osteocalcin [OC] was done. 6. Statistical Analysis was done for all the results. Comparative study between all OA patients and controls showed a highly significant difference as regards serum leptin, x-ray score and DEXA of the spine and hip [p<0.001]. It also showed a significant difference as regards B-ALP [p<0.05], it showed anon-significant difference as regards age, osteocalcin and BMI [p>0.05]. Comparative study between OA patients with BMI < 25 [Group I] and controls showed highly a significant difference as regard serum leptin, x- ray score and DEXA of the spine and hip [p<0.001]. It also showed a significant difference as regards B-ALP and BMI [p<0.05]. It showed a non-significant difference as regards age and osteocalcin [p>0.05]. Comparative study between OA patients with BMI > 25 [Group II] and controls showed a highly significant difference as regards x-ray score, serum leptin, BMI and BMD of the hip [p<0.001]. It also showed a significant difference as regards the BMD of the spine and it showed avnon-significant difference as regards other parameters. Comparative study between OA patients with BMI < 25 [Group I] and OA patients with BMI > 25 [Group II] showed a highly significant difference as regards x-ray score, BMI, serum leptin and BMD of the spine and hip [p<0.001]. It also showed a significant difference as regards pain score [p<0.05] and a non- significant difference as regards other parameters. All premenopausal osteoarthritis patients showed BMD within normal. As regards postmenopausal patients, 6 patients [42.8%] showed osteopenia, two patients [14.4%] showed osteoporosis and 6 patients [42.8%] showed non-significant decrease in BMD. Comparative study between pre- and post-menopausal groups showed highly significant difference as regards age, disease duration, joint pain score, B-ALP, OC and BMD of the spine and hip [p<0.001]. It also showed a significant difference as regards x-ray score [p<0.05] and a non-significant difference as regards serum leptin and BMI. In all the patients, serum leptin showed a highly significant correlation with BMI [p<0.001]. It also showed a significant correlation with joint pain score [p<0.05] and a non-significant correlation with disease duration, x-ray score and, B-ALP, OC and BMD of the spine and hip. Serum leptin level is higher in osteoarthritis patients than controls even when the BMI was insignificant indicating a possible role of leptin in the pathogenesis of this disease irrelevant to obesity. Meanwhile, it is neither correlated to the BMD nor to the biomarkers of bone formation indicating that it has no role in oteoporosis. In our study, osteoarthritis is not protective against osteoporosis since; osteopenia and osteoporosis were present in osteoarthritis patients

Role of Helicobacter pylori in refractory iron deficiency anaemia

The role of Helicobacter pylori [H. pylori] infection in the development of iron deficiency anaemia has been the focus of attention during the last decade. Confirmation of the relationship between H. pylori infections and iron deficiency anaemia has not confirmed the pathophysiologic mechanisms involved in this phenomenon was to study the levels of fasting gastric acidity [free and total] as well as the level of tumor necrosis factor alpha in refractory iron deficiency anaemic male patients seropositive for H. pylori infection versus those with seronegativity for H. pylori infection. Also, we tried to find the underlying pathophysiologic mechanism for iron deficiency anaemia observed in these patients. This study was conducted on 30 adult male patients having iron deficiency anaemia and gastroduodenitis. They were subdivided into 2 groups of matched age and haemoglobin value. Group I was seropositive for H. pylori infection and refractory to iron therapy. These patients did not receive prior treatment for eradication of H. pylori infection while group II was seronegative for H. pylori infection and was considered a control group. Patients with active bleeding or previous medical problem were excluded from the study. All patients and controls in the present study were subjected to the following at presentation: careful history taking and thorough clinical examination, complete blood picture, reticulocytes%, assessment of serum iron, total iron binding capacity, serum ferritin, IgG antihelicobacter antibody and tumor necrosis factor-alpha [TNF-alpha], stool for occult blood and measurement of gastric acidity [total and free] by chemical method. Upper endoscopy was done and multiple biopsies were taken and tested for expression of cytotoxin associated gene A [cag A] by polymerase chain reaction [PCR]. results revealed statistically significant higher values of free and total gastric acidity as well as tumor necrosis factor-alpha levels in H. pylori seropositive compared with H. pylori seronegative group. Among H. pylori seropositive group, higher value of TNF-alpha level was observed in H. pylori cagA positive [7 patients] than cagA negative patients [8 patients]. Also, haemoglobin values were inversely correlated with tumor necrosis factor-alpha levels. From this study, we can conclude that elevated serum tumor necrosis factor [TNF-alpha] in H. pylori seropositive group may be one of the underlying pathophysiologic mechanism for iron deficiency anaemia observed in these patients

nitrite/ lens crystalline reaction: the mechanism of in-vitro protein damage

Recent work has explored the potential deleterious role that nitric oxides [NO] and their derivatives may have in human diseases. The many by-products of NO include nitrite ion, which accumulates in the anterior chamber of the eye during ocular inflammation or derived from cigarette smoking. These ions may cause lens damage and leads to cataract formation. The present study aims to examine the nitrite/ lens crystalline reaction and investigate the mechanism of lens proteins damage with nitrite ion. Rabbit lenses were incubated in different concentrations [0-200 mM] of sodium nitrite in a phosphate buffer at neural pH and body temperature, for 7 days. The following measurements were carried out on lens proteins: total protein content, refractive index [RI], electrophoretic separation and amino acid separation. The results indicated a significant decrease of the total soluble lens proteins and an increase in the refractive index after incubation with nitrite. In addition, there is change in the molecular weight of lens proteins and amino acid pattern. These modifications are indicative of oxidative damage and are similar to changes seen in cataract formation. It was concluded that, nitrite accumulation within the lens environment could contribute to lens crystalline modification and cataract formation. Such changes may be due to lens protein oxidation. Nitrite has been shown to easily oxidized proteins, giving rise to disulphide bridge formation, and induces cross-linking, therefore enhancing protein aggregation and insolubolization

Environmental impact assessment for transfer of smelters outside the residential area, Alexandria, Egypt

In Egypt, it has long been realized that smelters are seriously deteriorating environmental conditions inside cities. Smelters in Alexandria City are located within the residential areas. EI-Gomrok District is particularly highly contaminated with emissions from smelters. It is suggested that the new site for smelters will be established in Amerya district, close to the Egyptian Petrochemical Company because Alexandria Governorate owns this area. This study aimed at assessing the environmental impacts for transfer of smelters to the new area. All obtained data were pulled together to assess the impacts of the smelters transfer on the physico-chemical environment, biological environment, and socioeconomic environment. Two alternatives were studied Alternative I, no action and keep the existing situation and alternative II, transfer of smelters to petrochemical site in Amerya District. Alternative II recorded +17 while alternative I recorded -29. So, it was found that application of alternative II, will result in good progress and development as regard the physico-chemical, biological, and the social environment of Alexandria City. An Environmental Management System [EMS] must be established to ensure sustainability of environmental conditions in the new area

Monitoring of the hazardous waste landfill for the mercury decontamination project of Misr Chemical Industries, Alexandria, Egypt

Misr Chemical Industries [MCI] is located in EL-Mex industrial area, to the west of Alexandria City. Chloralkali production in MCI started in 1960 using mercury-amalgam electrolysis and continued operation of the facility for over 35 years, far beyond the design service life of 20 years, has caused increased emissions and frequent leaks to air and water from the processing equipment, which posed serious occupational hazards to the exposed workers and severe environmental problems in the vicinity of MCI. A hazardous waste landfill [HWL] has been established on 1998 for containing derbies of MCI to reduce environmental and health risks to reasonable levels. The site of the HWL is approximately 80 km southwest of EI-Mex area where MCI facilities are located, at Alam EL-Afrag on the edge of the western desert. The study aimed at monitoring the HWL site for possible leakage of mercury vapour to air. Measurements were made by using the mercury vapour analyzer. The study began after five years from the final closure of the landfill on 2002 and extended for three years till the end of 2004. It was found that the HWL site selection complies with law 4/1994, Article 28.The mercury vapour readings in the site were almost not detected which assured the good performance of the mercury decontamination project of Misr Chemical Industries

Serum interleukin-18 level and natural killer cell percentage in systemic lupus erythematosus: clinical correlation

To detect serum interleukin -18 level and natural killer cell percentage in patients with systemic lupus erythematosus and to find out their correlation with disease activity and their role in lupus renal disease. The study included 30 female patients with systemic lupus erythematosus [15 patients with lupus nephritis and 15 patients without renal disease]. 10 apparently healthy females with matched age represent the control group. All patients were subjected to full history taking, thorough clinical examination, assessment of disease activity using modified systemic lupus erythematosus disease activity index [SLEDAI], laboratory investigations especially serum interleukin-18 level, natural killer [NK] cell percentage, serum urea, serum creatinine and 24 hours urinary protein. Serum level of interleukin-18 [IL-18] was significantly increased and percentage of NK cells was significantly decreased in patients with systemic lupus erythematosus [SLE] when compared to controls. In patients with SLE, increased serum IL-18 level showed significant negative correlation with NK cell percentage while this correlation was significantly positive with SLEDAI. Serum IL-18 level was significantly higher and NK cell percentage was significantly lower in SLE patients with lupus nephritis compared to those with no renal disease. In patients with lupus nephritis, increased serum IL-18 level showed significant positive correlation to serum urea, serum creatinine and 24 hours urinary protein, while reduced percentage of NK cells showed significant negative correlation with serum creatinine. The findings of this study may indicate that increased serum IL-18 levels and reduced NK cell percentage may play a role in pathogenesis and activation of SLE and renal involvement in this disease. Further studies are recommended for IL-18 as a potential target in treatment of autoimmune diseases including SLE

Prevalence of macrovascular disease in systemic sclerosis

To detect the prevalence of macrovascular disease in systemic sclerosis. Thirty patients with systemic sclerosis and ten normal controls matched in age and sex were included in the study. All subjects were screened for atherosclerosis risk factors and non-invasive vascular assessment as carotid duplex scanning and measurement of ankle brachial blood pressure index. There was no significant difference in risk factors as cigarette smoking, systolic, diastolic blood pressure, cholesterol, triglycerides and glucose levels between patients and controls groups. Twenty three out of 30 patients [76.7%] had carotid artery disease compared to [30%] of normal controls with a highly significant difference. Macrovascular disease is a common finding in systemic sclerosis. Early identification allows early intervention and treatment with better control of high rate of cardiovascular mortality

Serum chemokines in lupus nephritis and SLE disease activity

To estimate the serum macrophage inflammatory protein-1alpha [MIP-1alpha] and serum/urinary monocyte chemoattractant protein-1 [MCP-1] in systemic lupus erythematosus [SLE] patients. This is in order to highlight their possible roles in the pathogenesis of SLE, disease activity and renal involvement. Forty SLE patients [group I] and 20 apparently healthy controls [group II] were included in the study. SLE patients were subdivided into group IA patients with active lupus nephritis [13 patients] and group IB patients without nephritis [27 patients]. Nephritis was diagnosed by active urinary sediments, impaired serum creatinine or creatinine clearance and graded by renal biopsy according to the WHO classification. SLE activity was measured using SLEDAI. The serum MIP-1 and serum/urinary MCP-1 were measured in all patients and controls using the ELISA technique. SLE patients had a significantly higher level of serum MIP-1alpha in group IA [105.2 +/- 12.9 pgm/mL] and group IB [93.9 +/- 3.5 pgm/mL] when compared to the control group [69.1 +/- 4.9 pgm/mL]. Also, there was a significant positive correlation [p<0.05] between MIP-Ialpha and both clinical [SLEAI], serological [dsDNA, ESR levels] parameters of disease activity and serum/urinary MIP1alpha. There was a statistically significant difference between the means of MCP-1 [serum 16.40 +/- 5.97 and urinary 21.20 +/- 3.12] among the controls and SLE group IA [serum 488.6 + 354.61, urinary 590.3 +/- 339.54], also between the controls and SLE group IB [serum 32.20 +/- 12.65, urinary 35.5 +/- 18.55]. The serum and urinary MCP-1 showed positive correlation with disease activity [SLEDAI], serum creatinine, and creatinine clearance. Also, urinary MCP-1 had positive correlation with ESR. Again, there was a significant difference between groups IA and IB regarding serum levels of MIP-1alpha and serum/urinary MCP-1 [p < 0.05]. The levels of serum MIP-1alpha and the serum/urinary MCP-1, may be used as laboratory parameters of disease activity in SLE and may reflect its immunopathogentic role and proinflammatory activity in SLE. Also, the urinary MCP-1 may be a useful simple tool for monitoring disease activity of lupus nephritis

Angiogenesis in rheumatoid patients: clinical, radiological and histopathological study

To evaluate angiogenesis and cartilage destruction in rheumatoid arthritis [RA] patients. This was performed using power Doppler ultrasonography [PDS] and detection of vascular endothelial growth factor [VEGF] in the serum and immunohistochemically. Eighteen Rheumatoid arthritis patients [group 1] and ten apparently healthy subjects [group 2] participated in this study. Full history taking, thorough clinical examination and routine rheumatological profile investigation were done. Serum VEGF was measured in all patients and controls using ELISA technique. The knee joints were examined with ultrasound and resistance index was measured with spectral ultrasonography. Histological examination for synovial membranes was done with hematoxylin and eosin, factor VIII and VEGF with immunohistochemical staining. There was a highly significant difference between RA patients and controls as regard sVEGF [582.22 +/- 84.89, 176 +/- 20.55 pg/ml], histological score [36.94 +/- 7.83, 2.72 +/- 1.2], factor VIII [3.16 +/- 0.618, 1.2 +/- 0.41], VEGF staining [3.03 +/- 0.89, 0.5 +/- 0.32] and PDS [3.027 +/- 0.58, 0.41 +/- 0.24] [p<0.001 in all parameters]. Also, there was a significant difference between patients and control as regard resistive index [RI] [0.72 +/- 0.19, 1.07 +/- 0.1] and synovial proliferation [3.055 +/- 0.7, 0.25 +/- 0.263] [p<0.05 in both parameters]. RA patients were classified according to VEGF staining into low, moderate and intense staining. There was a highly significant difference between patient subgroups regarding serum VEGF, synovial proliferation, PDS score [p<0.001] and a significant difference regarding histopathological score, factor VIII and RI [p<0.05 in all parameters]. There was a positive correlation between sVEGF and DAS score, synovial proliferation, ESR, PDS, VEGF staining and histological score, and negative correlation with RI. Also, there was a positive correlation between VEGF staining and histological score, sVEGF, PDS, synovial proliferation and negative correlation with RI. VEGF is a potent mediator of endothelial proliferation of angiogenesis, the expression of VEGF depending on the activity and plays a part of pathogenesis of RA and synovitis. PDS is a useful method demonstrating synovial vascularization and monitoring disease activity. RI is an objective tool to estimate the degree of inflammation in RA

Evaluation of the wastewater treatment plant of the starch plant of the Egyptian starch, yeast, and detergents company, Alexandria

Starches are insoluble in water. Starch is used in cooking for thickening sauces. In industry, it is used in the manufacture of adhesives, paper, and textiles. The most promising new market for corn starches is as raw material for the production of industrial chemicals and plastics which are today made from petroleum feedstock. Wastewater effluent of starch production is characterized by high total suspended solids of high organic load. The Egyptian Starch, Yeast, and Detergents Company is one of most famous factories producing food starch. It is located in Alexandria. As its final wastewater effluent highly exceeds the permissible limits of total suspended solids [TSS] and chemical oxygen demand [COD] of Decree No. 44/2000 of Low No. 93/1962, the starch company established an anaerobic wastewater treatment plant [WWTP] since 2002. The present study aimed at evaluating the existing WWTP and the compliance of its final discharge with the regulatory limits for the disposal of final wastewater into public sewer. WWTP shows stable and controlled treatment unit with high treatment efficiency. It is fruitfull to applay the same technology in treatment of end pipe industrial wastes having similar characteristics

Endothelin-1 and ocular involvement in behcet's disease

To detect plasma Endothelin-1 [ET-1] in Behcet's disease [BD] and to assess if ET-1 is associated with ocular BD. 20 BD patients [12 with ocular and 8 without ocular disease] and 10 healthy control subjects were included in the study. The plasma level of Endothelin-1 was measured with Enzyme Immunometric Assay [EIA]. Plasma ET-1 levels were significantly higher in patients with BD than in the control subjects. Among patients with ocular BD, the mean plasma ET-1 levels were significantly increased when compared with non ocular disease and control subjects. Elevated plasma Endothelin-1 may play a role in ocular involvement of BD

Serum homocysteine level and vascular involvement in behcet's disease

To assess whether serum homocysteine level is related to vascular involvement in Behcet's disease. Twenty five patients with Behcet's disease and ten healthy subjects were included in the study. All the participants were subjected to thorough clinical assessment, radiological evaluation and laboratory investigations including serum folate, vitamin B12 and lipid profile. Total serum homocysteine level was determined by fluorescent polarization immunoassay. The patients were classified into two groups with respect to vascular involvement. Serum homocysteine level in BD patients was significantly higher than in the healthy controls [15.6 +/- 4.2 Vs 10.15 +/- 3.3 mmol /L, p <0.001]. Among BD patients with vascular involvement, total homocysteine level was significantly higher than in those without vascular involvement and healthy controls [p <0.05 and < 0.001 respectively]. On the other hand, there was no significant difference between patients without vascular involvement and healthy controls [p > 0.05]. No statistically significant difference was found between the different studied groups as regards serum folate, vitamin B12 and lipid profile [p > 0.05]. In addition, no significant correlation between total homocysteine and the other parameters investigated in BD patients. Hyperhomocysteinaemia may be a risk factor for the development of vascular involvement in Behcet's disease

association between helicobacter pylori cytotoxin associated gene A, vacuolating cytotoxin antigen, matrix metalloproteinase-9 and tissue inhibitor of metalloproteinase-1 in cancer patients

This work aimed at studying the frequency of H. pylori in various solid tumors and hematological malignancies. Also, the association between H. pylori virulence markers [cytotoxin associated gene A, cagA and vacuolating cytotoxin antigen, vacA gene] expression and the plasma level of MMP-9 and its inhibitor, tissue inhibitor of metalloproteinase-1 [TIMP-1] in advanced cancer patients was investigated. This study included 17 patients with solid tumors including 8 patients with gastric patients having H. pylori -ve gastric ulcer [served as controls]. All patients and controls complained of dyspepsia. Multiple gastric biopsy specimens from antral and body regions were taken from all cases and controls and tested by polymerase chain reaction [PCR] for the expression of cagA and vacA genes. Plasma MMP-9 and TIMP-1 were measured using ELISA technique. The frequency of H. pylori in this study was 50%, 44.44% and 6 1.54% in gastric cancer, solid tumors and hematological malignancies, respectively. Significant increase in plasma MMP-9 level was detected in solid tumors and hematological malignancies compared to controls. Plasma MMP-9 level was also significantly higher in H. pylori +ve than H. pylori -ve cases with significantly higher values in those expressing cagA than those expressing vacA gene. The highest MMP-9 was present among H. pylori +ve patients with gastroduodenitis. It was concluded that the presence of H. pylori virulence markers especially cagA gene may play a role in cancer progression in cancer patients. So, its early detection and eradication may be beneficial in these patients

role of cytomegalovirus [CMV] and cytokines in recurrent spontaneous abortions

The present study aimed at evaluating the role of CMV by polymerase chain reaction [PCR] in peripheral white blood cells and cytokines such as tumor necrosis factor alpha [TNF], interferon gamma [IFN] and interleukins [IL] IL-10 and IL-12 in cultured supernatants of nitrogen stimulated peripheral blood mononuclear cells by enzyme linked immunosorbent assay [ELISA] among cases suffering from recurrent spontaneous abortion. The study was conducted on 90 subjects who were divided into: Group 1 including 40 patients who were second trimester unexplained aborters; group 2 including 40 patients who were second trimester aborters of known gynecologic etiology and group 3 including 10 patients who were healthy pregnant controls of matched age. CMV was detected in 30% among group 1 which was significantly higher than both groups 2 and 3 [10%]. Also, CMV was highly significantly associated with the number of abortions [mean = 7.8] among group 1 than group 2 [mean = 4]. As regards the cytokines studied, TNF revealed the highest levels [mean = 2600 pg/ml] among group 1 and the least was IL-10 [mean = 30.25 pg/ml] with IFN and IL-12 in between and the difference was statistically significant. TNF, IFN and IL-12 revealed a significantly positive correlation to number of spontaneous abortions [groups 1, 2], whereas IL-10 revealed significantly negative correlation to the same groups. In conclusion, CMV should be routinely screened by PCR in peripheral white blood cells of all recurrent spontaneous abortion cases. Also, future immunotherapy by cytokines, such as IL-10 or anti-TNF or anti-IL-12, should be tried first experimentally then later on human volunteers to prevent recurrent spontaneous abortion

Melanoma inhibitory activity [MIA] and transforming growth factor- beta [TGF-beta] levels in the sera of juvenile arthritis

We measured serum levels of MIA and TGF-beta by means of ELISA and investigated whether they provide clinically relevant parameters in juvenile arthritis patients. We also evaluated their correlations with clinical and laboratory parameters. Serum was obtained from 10 poly-articular juvenile arthritis [pa-JRA [patients, 10 childhood systemic lupus erythematosus [ch-SLE] patients, 10 childhood systemic sclerosis]ch-SSC] patients and 10 apparently healthy children as a control group. Both MIA and TGF-beta serum concentrations were found to increase in both destructive [JRA] and non-destructive [ch-SLE and ch-SSc] juvenile arthritis. We found no correlation with disease activity, clinical or laboratory parameters except RF. MIA and TGF-beta are not serum markers of a specific disease. In addition, the presence of elevated MIA in the sera of juvenile arthritic patients very likely reflects passive release from necrotic or apoptotic chondrocytes and is partly due to chondrocyte activation. This is supported by the fact that MIA level was only associated with RF positivity and not with markers of inflammation

Anti-neutrophil cytoplasmic antibodies in juvenile chronic arthritis and rheumatoid arthritis

To assess the incidence and clinical significance of ANCA in RA and JCA patients, and to study the relation between ANCA and granulocyte specific ANA. Serum antineutrophil cytoplasmic antibodies were determined with indirect immunofluoresescent [IIF] technique in 20 RA and 12 JCA patients. ANCA was detected in sera from 10 RA patients [50%] and their titer ranged from 110-350 and JCA patients [25%], their titer ranged from 70-230. ANCA titer was not correlated with RF, disease duration and the presence of ANA. p-ANCA were found in 25% RA patients and 8% of JCA patients, c- ANCA were seen in 25% of RA patients and 17% of JCA patients. The laboratory and histologically proven nephropathy were seen in 25% of RA patients 8% of JCA patients, they were associated with p- ANCA. We concluded that early diagnosis of ANCA associated vasculitides is a key to prevent renal failure, and to measure the serum ANCA titer not only for the diagnosis the clinical course, but also to early treatment of renal affection

Role of ultrasonography in the diagnosis and management of plantar fasciitis

To evaluate the sonographic features of plantar fasciitis and to investigate the efficacy of ultrasound-guided local steroid injection in its management. Forty patients, aged 25-55 years who had a clinical diagnosis of plantar fasciitis, 1-3 years previously and twenty age-matched healthy volunteers [control group], were evaluated with conventional x-rays then with ultrasound using a 7.0 MHZ linear-array transducer. All patients had calcaneal spurs in their X-rays. Heel pain was unilateral in 24 patients and bilateral in 16. Sagittal sonograms were obtained, and the thickness of plantar fascia was measured at its proximal end near its insertion into the calcaneus. Other findings including hypoechoic fascia, fiber rupture, perifascial fluid collections and calcifications were searched for. Evaluations were performed before, at 2 weeks and 3 months after a single dose of ultrasound-guided local steroid [7 mg Betamethasone and 0.5ml of 1% lidocaine] injection into the inflamed plantar fascia. Pain intensity was quantified with a tenderness threshold [TT] and visual analog scale [VAS]. Plantar fascia thickness was significantly increased in heels of patients with plantar fasciitis [mean 3.91 +/- 0.53] as compared to control [mean 2.13 +/- 0.18] [p<0.0005]. The mean thickness of the plantar fascia had decreased significantly on evaluation after 2 weeks [mean 3.73 +/- 0.53] [p<0.05]. While after 3 months there was a highly significant decrease [mean 2.39 +/- 0.43] [p<0.0005]. The mean VAS score and TT showed a highly significant improvement on evaluation after 2 weeks and 3 months [mean 4.57 +/- 0.98, 1.55 +/- 0.84 and 7.12 +/- 0.75, 9.47 +/- 1.66 respectively, p<0.0005]. The comparison between the second and third evaluations of all our parameters showed a highly significant improvement [p<0.0005]. The proximal plantar fascia was diffusely hypoechoic as compared to controls. No fascial rupture, perifascial fluid collection or calcifications were identified. Increased thickness of the fascia and hypoechoic fascia are sonographic findings of plantar fasciitis. Sonography provides sufficient information for the physician to confirm an initial diagnosis of plantar fasciitis and assess individual treatment regimens