Regulatory T cells (CD4+CD25+FOXP3+) in lupus nephritis

Background: Systemic lupus erythromatosus (SLE) is an autoimmune disease with 20–65% of patients developing lupus nephritis (LN). Studies have reported 10% of LN patients will end up with end stage renal disease and their mortality rate is higher compared to patients without LN. Abnormality of regulatory T cells (Tregs) level is thought to be a potential factor for this LN development. The aim of study was to evaluate the percentage of Tregs in LN patients.Methods: This was a comparative cross sectional study involving LN patients and age and gender matched controls with a 2:1 ratio. The patients were grouped into active and inactive LN based on their lupus activity index; complement levels, ANA, dsDNA antibodies, ESR, SLE Disease Activity Index (SLEDAI2K) score and also urine PCI (uPCI>0.05 for active group). Disease history, demographic data, routine blood test, peripheral blood for differentials count were taken and recorded. Peripheral blood mononuclear cells were stained with CD4, CD25 and Foxp3 antibodies and percentage of Tregs was analysed using BD fluorescence-activated cell sorting (FACS) cytometer. We compared demographic and laboratory parameters between healthy controls and LN patients as well as active and inactive LN patients.Results: A total of 34 LN patients (32 females, 2 males) were recruited. Their mean age and disease duration were 37.97±11.14 years and 110.95±65.07 months respectively.  Thirteen matched controls with mean age 35.23±7.89 years were enrolled. There was no demographic difference between 2 groups of LN patients. Tregs were significantly lower in active LN compared to inactive LN and healthy control (0.44±0.37% vs. 1.89±0.46% vs. 3.12±0.56% of the CD4+, P<0.001). C3 and C4 complement fragments were significantly reduced in patients with active disease (C3; 50.92±28.43 vs. 76.31±25.63, P=0.011) and (C4; 11.17±8.41 vs. 16.70±6.50 P=0.044). Proteinuria was significantly higher while serum albumin levels were significantly lower in active patients compared to inactive patients and healthy control (urine PCI; 0.25(0.15-0.3) vs. 0.03(0.01-0.05) vs. 0.01, P<0.001) and (albumin; 29.89±6.87 vs. 36.87±3.58 vs. 40.62±1.89mmol/L, P<0.001). We found positive inversely correlation between Tregs with SLEDAI2K (r = -0.572, P=0.011) and proteinuria (r = -0.451, P=0.007).Conclusions: Tregs, C3 and C4 complements, and albumin were significantly lower while proteinuria was significantly higher in active LN. There was positive inversely correlation between the percentage of Tregs with SLEDAI2K score and proteinuria.

A case-control study on the association between environmental factors and the occurrence of acute leukemia among children in Klang Valley, Malaysia.

BACKGROUND: In Malaysia, acute leukemia is the most common cancer among children below the age of 15. A case-control study was here conducted for cases from the Klang Valley, Malaysia, who received treatment at the National University of Malaysia Hospital (HUKM) and Kuala Lumpur General Hospital (GHKL). The main objective was to determine any association with environmental factors. METHODS: Case subjects were children aged below 15 years and diagnosed with acute leukemia in HUKM and GHKL between January 1, 2001 and May 30, 2007. Control subjects were children aged below 15 years who were diagnosed with any non-cancerous acute illnesses in these hospitals. A total of 128 case subjects and 128 control subjects were enrolled in this study. The information was collected using a structured questionnaire and a global positioning system (GPS) device. All factors were analyzed using unmatched logistic regression. RESULTS: The analysis showed that the occurrence of acute leukemia among children was strongly determined by the following factors: family income (odds ratio (OR) 0.19, 95% confidence interval (CI): 0.09-0.42), father with higher social contact (OR 7.61, 95% CI: 3.78-15.4), number of elder siblings (OR 0.36, 95% CI: 0.18-0.77), father who smokes (OR 2.78, 95% CI: 1.49-5.16), and the distance of the house from a power line (OR 2.30, 95% CI: 1.18-4.49). CONCLUSIONS: Some socioeconomic, demographic, and environmental factors are strong predictors of the occurrence of acute leukemia among children in Klang Valley, Malaysia. In terms of environmental factors, it is recommended that future housing areas should be developed at least 200 m away from power lines.

Cluster analysis of typhoid cases in Kota Bharu, Kelantan, Malaysia.

Typhoid fever is still a major public health problem globally as well as in Malaysia. This study was done to identify the spatial epidemiology of typhoid fever in the Kota Bharu District of Malaysia as a first step to developing more advanced analysis of the whole country. The main characteristic of the epidemiological pattern that interested us was whether typhoid cases occurred in clusters or whether they were evenly distributed throughout the area. We also wanted to know at what spatial distances they were clustered. All confirmed typhoid cases that were reported to the Kota Bharu District Health Department from the year 2001 to June of 2005 were taken as the samples. From the home address of the cases, the location of the house was traced and a coordinate was taken using handheld GPS devices. Spatial statistical analysis was done to determine the distribution of typhoid cases, whether clustered, random or dispersed. The spatial statistical analysis was done using CrimeStat III software to determine whether typhoid cases occur in clusters, and later on to determine at what distances it clustered. From 736 cases involved in the study there was significant clustering for cases occurring in the years 2001, 2002, 2003 and 2005. There was no significant clustering in year 2004. Typhoid clustering also occurred strongly for distances up to 6 km. This study shows that typhoid cases occur in clusters, and this method could be applicable to describe spatial epidemiology for a specific area.

Influence of risk perception, preventive behavior, movement and environment on malaria infection in Lundu district, Sarawak, Malaysia.

The incidence of malaria in Sarawak is among the highest in Malaysia despite its downward trend since 2002. This study was conducted to identify the dominant risk factors related to malaria infection. A case-control study was conducted in Lundu District, Sarawak. Cases were 96 indigenous malaria cases registered from January to September 2005 at Lundu District Health Office. Controls were selected among those who never contracted malaria originating from the same villages as cases. Cases and control were similarly distributed with respect to age, number of household and total household income per month. Cases were more likely than controls to report high risk occupation, opened eaves, ever had movement for those aged 50 years or over and car ownership. Older age, male, lower socioeconomic level and perception of fatality toward malaria increased risk to malaria infection. Male than female had seven-fold risk to be malaria infected [adjusted odds ratio (ORa) = 7.09; 95% confidence interval (CI) = 3.21-15.65]. In term of perception of fatality toward malaria, those who did not have than did have perception of fatality toward malaria had six-fold risk to be malaria infected (ORa = 6.38; 95% CI = 1.32-30.87). On contrary, those who had lower than middle and high per capita income per month had 85% lowered risk to be malaria infected (ORa = 0.15; 95% CI = 0.03-0.72). Male, older age, lower education and socioeconomy level, lower perception towards malaria, or lower environment sanitation had increased risk to be malaria infected.

Lifestyle factors and breast cancer: a case-control study in Kuala Lumpur, Malaysia.

Breast cancer is the most common female cancer and the commonest cause of death due to cancer for women in Malaysia. This study was performed to identify the relationship with lifestyle factors. A case-control study was conducted among females with breast cancer who came for treatment to the Breast Clinic Hospital Kuala Lumpur in July until September 2004. A total of 203 female patients were recruited as cases along with 203 patients who attended the Outpatient Clinic, Hospital Kuala Lumpur during the study period as the controls. The study showed women who did not exercise regularly to have four times higher risk (adjusted odds ratio is 3.49, 95% CI is 1.84 to 6.62) compared to those who exercised regularly. Women with a high fat diet were also at elevated risk (adjusted odds ratio 3.84, 95% CI is 1.20 to 12.34) compared to those consuming a low fat diet. Women without breast cancer generally had a longer duration of lifetime lactation with a median of thirty-three months compared to women with breast cancer (twenty months, p<0.05). Women who did not take oral contraceptive pills but had breast-fed their child have a 56.0% lower risk (crude odds ratio 0.44, CI is 0.22 to 0.87) compared to women who did not take oral contraceptive pill and also did not breast-feed their child. If they had breast fed for thirteen months and above, they faced a 61.0% lower risk (crude odds ratio 0.39, 95% CI is 0.17 to 0.87). There was a significant inverse trend for lifetime lactation and breast cancer risk. In conclusion certain life styles of women are associated with a higher risk of breast cancer development. Therefore, the promotion of a healthy life style should be emphasized.