Plasma adrenomedullin level in systemic lupus erythematosus patients and its relation to disease activity and lupus nephritis

To study the plasma adrenomedullin [AM] level in systemic lupus erythematosus [SLE] patients and investigate its relation to disease activity and lap us nephritis. Taking, thorough clinical examination, laboratory investigations, disease activity assessment using SLE Disease Activity Index [SLEDAI] and plasma AM assay. Renal histopathology was done for the patients with overt renal involvement. Patients were divided into two subgroups: subgroup [1a] included patients with a history of renal involvement, and subgroup [1b] included patients without renal involvement. Ten age and sex-matched healthy subjects were included as a control group. SLE patients had highly significant higher plasma AM concentration than controls. In SLE patients, there was significant positive correlation between plasma AM concentration and each of SLEDAI and prednisolone dose. On the other hand, plasma AM concentration didn't show significant correlation with age, SLE disease duration, creatinine, proteinuria, C3 and C4. Subgroup [1a] had statistically significant higher plasma AM concentration and higher SLEDAI with increased proteinuria and creatinine than subgroup [1b]. SLE patients had higher plasma AM concentration than controls. SLE patients with a history of renal involvement had significant higher plasma AM concentration than those without renal involvement. These results suggest that AM has a role in the pathogenesis of SLE and lupus nephritis

Correlation of serum VEGF levels with clinical, laboratory and MRI findings in patients with ankylosing spondylitis

To investigate serum VEGF levels as an objective activity parameter and its relationship with clinical and laboratory parameters as well as MRI findings in ankylosing spondylitis [AS]. Twenty four patients with AS and 8 healthy matched individuals were recruited in this study consecutively. Cross-sectional study was planned and demographic, clinical, functional, MRI findings, and laboratory data of patients were evaluated. Disease activity, functional status, and quality of life were also assessed respectively, with Bath Ankylosing Spondylitis Disease Activity Index [BASDAI], Bath Ankylosing Spondylitis Functional Index [BASFI], and Short-Form 36 [SF-36]. Mander Enthesis Index [MEI] was used for evaluation of enthesis involvement. We examined serum concentrations of serum VEGF levels pg/ml in patients with AS and controls. The mean value of serum VEGF levels in patients and controls were 316.4 pg/ml and 117.3 pg/ml, respectively. This difference was meaningful [p=0.04]. There was a significant correlation between VEGF level and C reactive protein level, albumin, C3, and IgA levels. MRI sacroiliitis grading showed significant correlation between VEGF levels and grades 1, 2, 3 and 4. A significant correlation between VEGF levels and distance of hand-floor, modified lumbar Schober's test, distance of chin to chest and extra-articular manifestations was found. However, there was no significant correlation between VEGF levels with MEI, BASFI, BASDAI, and SF-36 [p >/= 0.05]. Serum VEGF levels were significantly higher in AS patients than controls. Serum VEGF levels may be a potential biomarker of axial inflammation and disease activity in AS

Evaluation of parenteral nutrition on the immune system of patients with polytrauma

Nutritional support for trauma and critically ill patients has been advocated to promote immune system recovery and to prevent as much tissue break down and nutritional deficit. The present study aiming to assessment of the parenteral nutrition on the immune system of patient with multiple trauma. Compare the effect of early parenteral nutritional and conventional hospital diet on the nutrition and immunology markers in trauma patients. A convenient sample of 40 severely traumatized patients within 8 hours after trauma they were enrolled sequentially into conventional [n = 20] and total parenteral nutrition [n = 20] groups [TPN]. Criteria for subject inclusion were, age 18-<45 years, Injury severity score [ISS] 20-40 score. Tools of data collection, four tools were utilized to collect data pertinent to the study. These tools were, nutritional assessment sheet, trauma scales and [APACHE] score [checklist], parenteral nutrition plans, evaluation tool which includes [Anthropometric measurement, Laboratory studies Immunological parameters]. Total parenteral nutritional has positive impact for trauma patients on anthropometric measurement, [weight loss, TSF and MAC] which was observed at the end of therapy [7th day.] for the conventional group while there were no changes for the same parameters in TPN group. As regard, laboratory tests, there were significantly increase in the values of total serum protein and albumin among patients of the TPN group after the end of therapy at [7th day] .As regard immune function, it was found that the mean values of [IL-10, IL-6, CD8] were significantly dropped in the TPN group after the end of therapy as compared to the admission. Also there were significantly increase in the values of complement C3, IGA, CD4, and CD4/CD8 ratio among patient of the TPN group at [7th day]. Establishment and implement of standardized protocol of parenteral nutrition support using nutritional screening and physical assessment forms, for the critically ill patients

C3 and C4 complement components in autoimmune hepatitis

Autoimmune hepatitis [AIH] is an unresolving inflammation of the liver of unknown cause associated with interface hepatitis on histological examination, hypergammaglobulinemia and presence of circulating autoantibodies. Antibody-mediated tissue injury might be responsible for tissue injury in AIH therefore; a number of studies have been focused on the complement system in these patients. The aim of the study is to estimate the level of complement [C3 and C4] in different types of Autoimmune hepatitis [AIH]. The study was performed on 73 Iraqi patients with autoimmune hepatitis [AIH], attending the teaching hospital for gastroenterology and liver disease in a period between November 2003 and July 2004: Anti- soluble liver ANA, SMA.LKM-1, and LC-1 Abs were detected using Enzyme-Linked Immunosorbent Assay [ELISA] technique. Anti-SLA/LP was detected using the Euroline method. Quantitation of serum C3 and C4 of the study groups were carried by single radial immudiffusion [SRID] test. Equal volume. Significant differences was observed between AIH patients and healthy control group in the mean level of C3 and C4. In addition, level of C4 in the sera of patients with type 2 was lower than those of type 1 and 3. It was concluded that patients with AIH do not have abnormal catabolism of complement or increased level of cleavage products of C3, whereas, the depression of complement level may reflect decreased hepatic synthesis

Some immunological studies and HLA-DRB1 in hepatitis C virus-related necrolytic acral erythema

Necrolytic acral erythema [NAE] is unique in its acral location and strong association with hepatitis C virus [HCV] and altered immunological junctions. The aim of the present work was to evaluate HLA DRB1 alleles and association of some parameter of immune system functions [complements C3 and C4, antismooth muscle antibody [ASMA] and antinuclear antibody [ANA] in NAE. Response of cutaneous lesion to low dose interferon alpha [3 million unit [MU] / week] and hydroxychloroquine was also evaluated. This study included 22 patients with HCV- related NAE [group I], 45 chronic hepatitis C without NAE [group II as pathological controls] and 45 healthy subjects [group III, normal controls]. ANA was positive more in patients than normal controls [18.2% vs 0%, P <0.003], however no significant difference was seen between patients groups. ASMA was positive significantly more in patients with NAE than HCV patients, and in both patients groups than normal controls 59.1%, 17.3% and 0%; P<0.001 and 0.0001 respectively]. A significant decrease in C3 and C4 was found in NAE patients than HCV patients without NAE, [P<0.01] and in both patients groups than normal controls [P<0.001]. NAE was associated with HLA -DRB1 03, [77.7%, 16 of 22 vs 24.2%, 11 of 45 of normal controls, Pc <0.0009 and 35.6% 16 of 45 HCV patients without NAE, Pc=0.03. Clinical improvement and significant decrease in ALT [P<0.001] was observed in NAE patients after two months of interferon alpha and hydroxychloroquine therapy. Necrolytic acral erythema [NAE] appears to be an immune mediated response in chronic HCV patients, associated with, lower C3 and C4 and higher frequency of positive ASMA. The results suggest that the development of HCV related ANE is associated with HLA-DRB1 03 marker. And low dose interferon alpha [3 MU per week] and hydroxychloroquine are good treatment modalities for NAE

Continuous renal replacement therapies in ICU patients with septic shock: impact on inflammatory mediators removal

Continuous renal replacement therapies are widely used for patients with acute renal failure specially in critically ill patients in ICU. It has been suggested that hemofiltration may also eliminate toxic mediators thought to be important in the pathophysiology of sepsis. The present study examined whether hemofiltration can eliminate inflammatory mediators in patients with sepsis. A total of 28 consecutive patients with septic shock, as defined by the American College of Chest Physicians/Society of Critical Care Medicine Consensus Conference. All patients had renal affection. Patients were randomly assigned to receive hemofiltration in addition to usual ICU care [n = 17] [group 1], or to usual care plus hemodiafiltration [n =11 [group 2]. We measured the plasma concentrations of complement fraction C3a, IL-6 and TNF -a at baseline, 2 hours and 24 hours after these procedures. C3a showed a fall in concentration between baseline and 2 hrs, which not reached statistical significance during hemofiltration [from median 495.5 to 363 ng/ml, P =.48] and statistical significance during hemodiafiltration [from median 524 to 379.7 ng/ml, P = <0.05]. Furthermore, during HF C3a showed a significant fall in concentration during the interval between 2 hrs and 24hrs [from median, 363 to 274.6 ng/mL, p<0.05], HDF [from median, 379.7 to 215.8 ng/mL, p<0.05]. TNF showed a fall in concentration between baseline and 2 hrs, which reached statistical significance during hemofiltration [from median 397.9 to 332.8 pg/ml, P =0.035] and statistical significance during hemodiaflltration [from median 430.7 to 347.2 pg/ml, P 0.02]. However, during HF TNF showed a non significant change in concentration during the interval between baseline and 24hrs [from median, 397.9 to 410.4 pg/mL, p = 0.6], HDF [from median, 430.7 to 405.6 pg/mL, p = 0.5]. IL-6 showed a fall in concentration between baseline and 2 hrs, which reached statistical significance during hemofiltratio in [from median 1051 to 843.6 pg/ml, P =0.03] and statistical significant during hemodiaflltration [from median 1111.3 to 859 pg/ml, P 0.025]. However, during HFJL-6 showed a non significant change in concentration during the interval between baseline and 24hrs [from median, 1051 to 905 pg/ml, p = 0.13], HDF [from median, 1111.3 to 901.9pg/mL, p = 0.07]. No correlation were detected between inflammatory mediators removal and changing the size of hemofilter [surface area 0.7 and 1.35 square meter] p>0.05. or changing hemofiltration rate [from 1 to 2 liters/hour]. p>0.05. In conclusion, short-term hemofiltration with a highly biocompatible membrane in patients with septic multiple organ dysfunction syndrome and renal failure may even eliminate some of the mediators from septic plasma like C 3a. Filtration of the classic cytokines IL-6 and TNF-a is presumably of minor importance, but clearance of the first few hours may occur so we cannot advocate the use of continuous therapies as a treatment in sepsis for removal of inflammatory mediators only, but in presence of renal affection, these slow renal replacement therapies results in fewer cardiovascular side effects than intermittent techniques, Furthermore, continuous hemofiltration allows better control of fluid balance and simultaneous continuation of total parenteral nutrition in addition to reduction of anaphylatoxin concentrations which could be of clinical importance, since beneficial therapeutic effects in sepsis have been correlated with a fall of anaphylatoxin concentrations

Predictors of vascular endothelial dysfunction in systemic lupus erythematosus

Vascular endothelium of patients with systemic lupus erythematosus [SLE] after prolonged exposure to circulating immune complexes shows generative changes, which are significant source of mortality and morbidity. To access the endothelial function in patients with SLE and to find the risk factors that may deteriorate that function, three indices of endothelial function were studied including: carotid artery intima/ media thickness, brachial artery diameter and endothelial dependent [EDD] and independent dilatation [EID] of the brachial artery by measuring flow mediated dilatation of the artery before and after sublingual glyceryl trinitrate. Risk factors including: SLE-dependent [disease duration. steroid use, C-reactive protein, double stranded DNA antibody [anti-dsDNA], complement [C3,C4],antibody to Sjogrens syndrome A [SSA[Ro]] and SLE independent [blood pressure, cholesterol, triglycerides, fasting blood sugar, body mass index] were also studied. Thirty women were selected with mean SLE duration was 7.1 +/- 2.6 years, the mean brachial artery diameter was 0.50 +/- 0.03 cm. and the mean carotid artery intima/media thickness was 0.8 +/- 0.03 mm. Our patients with SLE had significantly impaired endothelial dependent dilatation compared with controls. SLE patients show higher incidence of hypertension, hyperlipidemia, thicker carotid intima media thickness and brachial artery diameter. Hypertriglyceridemia, higher levels of C-reactive protein, Anti-dsDNA, SSA [Ro] antibody and lower levels of C3, C4 all are associated with thicker carotid intima/media. Severe degree of SLE is associated with significant decrease in EDD and EID of brachial artery. In conclusion SLE patients are more liable to hypertension, hypertriglyceridemia and hyperglycemia that predisposed to degenerative vascular changes. Longer SLE duration, prolonged steroid use, high fasting blood sugar, high triglycerides, C-reactive protein, antidsDNA, antiSSA [Ro] are strong predictors of endothelial dysfunction. Severe degree of SLE is associated with more impairment in endothelial dependent dilatation and endothelial independent dilatation of brachial artery

value of estimation of procalcitonin and complement levels in neonatal sepsis

Neonatal sepsis is a serious problem with high morbidity and mortality. Serum Procalcitonin, C[3] and C[4] levels were estimated in 30 neonates suffering from neonatal sepsis. Further investigations were done including: Complete blood picture, blood culture, CRP, ESR, CSF examination and chest X-ray. Eighteen matched healthy neonates were included as a control group. Serum procalcitonin level was significantly elevated in neonates suffering from septicemia [p<0. 001] and its level was significantly related to the severely affected cases suffering from meningitis, [p<0. 05] and those with poor outcome [P<0.01]. The mean levels of C[3] and C[4] in the study group were lower than controls but these differences were not statistically significant [P>0.05]. Also, there was no significant relationship between the level of C[3] and C[4] and severity of the cases or outcome. We can conclude that procalcitonin can be considered as an interesting diagnostic and prognostic marker of neonatal sepsis

Evaluation of serum immunoglobulins and their relevance to chronic lung disease in mustard gas victims

Despite the fact that 8 years has elapsed since the end of the imposed war, chemically injured victims are still suffering from various long-term complications, most of them respiratory in nature. The progressive nature of respiratory problems in these patients suggests that the immune system must be involved to initiate a cascade which ends up causing lung injuries. To evaluate this, humoral immunity was assessed in 179 mustard gas victims in 1992. The patients were followed up for the next 4 years. These included 172 male and 7 female patients with a mean age of 33 years and an average of 6.1 years post-exposure to mustard gas. After physical examination and spirometric evaluation, these patients were divided into 3 groups based on the severity of their respiratory problems, i.e. "severe" [group 1], "moderate" [group 2] and "mild" [group 3]. IgG, IgA, C3 and C4 were measured using SRID technique and IgE by ELISA. The results in each group were compared with the control group consisting of 49 healthy, randomly selected volunteers. Mean age was 32 years in this group. The results indicate that there is a significant fall in IgG, IgA, C3 and C4 levels in group 3 [p=0.009, 0.01, 0.004, and 0.002, respectively] as compared to the control group. IgG had also dropped significantly in groups 2 and 1. On the other hand in group 3.19.6% and 15.2% of patients had lower than normal IgG and IgA levels, respectively. In group 2, 7.7% of patients had low IgG and 5.8% had low IgA levels. These figures were 10% and 3.8% for IgG and IgA in group 1. Of a total of 7 patients in group 3 with low IgA levels, four patients also had low IgG levels. Two of these patients gradually developed more serious respiratory problems and were classified as group 1 after two years. We concluded that: 1] mildly injured patients [group 3] have lower IgG and IgA as well as C3 and C4 levels, and 2]among these patients those who demonstrate low IgG levels are more prone to develop progressive respiratory problems in the future

Immunologic and biochemical factors in hyperemesis gravidarum

The relationship of Immune process, human chorionic gonadotropin-[beta hCG] and thyroid function in forty pregnant cases of hyperemesi; gravidarum [HG] have been studied. They were divided into two groups: Group [I]: Control group: Ten normal pregnant women and. Group [II]: Study group: Thirty pregnant women with hyperemesis gravidarum [15 cases diagnosed as hyperthyroxinemic and 15 cases without hyperthyroxinemic]. Serum Beta hCG, immune parameters and thyroid related hormones were assayed in all cases Mean serum Beta hCG, T4 [p< 0.01], IgG, IgM, C3, C4 and lymphocyte count [p < 0.05] were significantly higher in the study than control group. In hyperemesis patients with hyperthyroxinemic, mean serum Beta hCG, IgG,and IgM were significantly higher than in hyperemesis women without hyperthyroxinemic [p < 0.01]. Beta hCG was positively correlated with T4 [r =0.31], lymphocyte count [r =0.36], IgG [r=0.70], IgM [r = 0.67] and with C4 [r = 0.39] in hyperemesis patients. A negative correlation between Beta hCG and TSH [r = -0.80 p < 0.01] was noted in hyperemesis group Free T4 showed a positive association to IgM, IgG and lymphocyte count. Immunologic activity in pregnancy may have a role on the stimulatory mechanism of Beta hCG in hyperemesis patients. The relationship between T4 and immunoglobulins in HG may be indirect and may be dependent on high levels of serum Beta hCG with higher thyrotropic activity

Antibody mediated immune response in sickle disease variants

Sickle cell anemia, a hemoglobinopathy with serious impacts, represents a health challenge in the developing world. Patients are particularly susceptible to repeated infection that may endanger their lives. In this study, 83 adults and 30 children were included. Cross-sectionally, serum immunoglobulins [IgG, IgA, IgM] and complement factors [C3 and C4] were assessed. All subjects prospectively were immunized by hepatitis B vaccine [recombinant hepatitis B virus surface antigen]. The immune response was evaluated and followed up by antibodies to the selected antigen. IgA was significantly elevated in sickle disease patients and serum IgM was significantly lower in sickle disease children, while C3 and C4 did not show significant differences between groups. The immune response to immunization did no show difference in rate of response between various age matched groups, responders were over 80% in all groups after seven months from the first dose of vaccination in those who completed the study. However, the results denoted a quantitative difference in the level of hepatitis B surface antibody. Further studies to delineate the implicated mechanisms in the immunodeficiency are suggested. Meanwhile, chemoprophylaxis and immunoprophylaxis are recommended in sickle cell anemia

Plasma fibronectin and serum complement c3 levels in chronic active hepatitis following virus B versus virus C infection

Plasma fibronectin and serum complement C3 levels were estimated in 30 patients with chronic active hepatitis [CAH] post virus B and another 30 patients with CAH post virus C as well as 20 normal healthy subjects. Fibronectin level was significantly increased in CAH when compared to normal controls. Moreover, fibronectin level was significantly increased in CAH following virus C when compared to CAH following virus B hepatitis. Concerning complement C3 there was no significant changes in the different groups studied. It is concluded that CHA following virus C may lead to vigorous inflammatory damage than CAH following virus B infection

Prognostic value of activated complement 3 and oestrogen receptors in cases of cancer breast

Despite the classic prognostic factors for evaluation of cancer breast cases were used for longterm, but still insufficient and less reliable for this evaluation. Use of oestrogen receptor [ER] and complement 3 [C[3]] gave a good prognostic indicator for different cases of cancer breast

clinical, pathological and imunological study of osteoarthrosis affecting diabetic patients

This work was planned to test a possible immunological background for the observed increased incidence and severity of osteoarthrosis in diabetes mellitus. Two matched groups of patients, a diabetic and non-diabetic control, with osteoarthrosis were studied. Each group included 15 patients. All patients were subjected to arthroscopic examination of the knee joint. The grade of osteoarthrosis was recorded and biopsies were taken from the synovial membrane and articular cartilage for immunofluorescent examination. Results showed earlier age of onset of osteoarthrosis among diabetics. The severity of osteoarthrosis was found to be related to the state of diabetic control, duration of diabetes and the presence of other microvascular complications. The study revealed significantly increased deposition of immunoglobulins IgG, IgM, IgA and C3 component in the articular cartilage in diabetics. This supports the theory of enhanced immunogenicity in diabetic osteoarthrosis through a proposed immunogenic effect of the glycosylated collagen

Immunological profile during diabetic ketoacidosis with follow - up study

Eighteen patients with classical diabetic ketoacidosis were included in the present study. Serum immunoglobulins IgG, IgA, IgM and complement C[3] were estimated during diabetic ketosis [D.K.] and after correction of D.K. Ten healthy persons were taken as controls. There was significant elevation of the serum IgG, IgA and hypercompelementemia during D.K. that decreased after correction of the ketosis but was still higher than normal. The serum IgM was significantly increased in those ketotics in whom severe infections predominated as a precipitating factor of D.K. A causal and effective relationship for such enhanced humoral immune parameters during DK is present. Several mechanisms are suggested to operate: haemoconcentration during DK, acute stressfull situations insulin resistance and antinsulin antibodies and decreased clearance of complement and antibodies due to defective host defence mechanism during D.K.