Study of prognostic markers in psoriasis

Elevated peripheral blood neutrophil counts have been reported in untreated patients with psoriasis [Ps] in absence of infection. Several studies reported high level of white blood cell [WBC] activation products including oxygen inetabolites in the peripheral blood of these patients which in turn trigger an up-regulation of antioxidant defences. The aim of this work was to determine some inflammatory and antioxidant markers which are easily evaluated and can be used as indicators of prognostic significance in Ps. The study was carried out in 40 patients with posriasis vulgaris: 20 patients with mild Ps and the other 20 patients with severe disease. Twenty normal individuals were studied as a control group. We evaluated the following: total and differential leukocytic count and elastase as markers ofneutrophil activation; erythrocyte sedimentation rate [ESR] and c-reactive protein [CRP] and fibrinogen as markers of inflammation; and ceruloplasmiri and transferrin as endogenotis antioxidant markers. The data of this work pointed to the central role of neutiophils in the inflammatory response in Ps. The worsening of the disease accompanies the increase of the inflammatory response of neutrophils. So, values of elastase, CRP and neutrophil counts can be used as parameters for prognosis and worsening of Ps

Neutrophil gelantinase associated lipocalin [NGAL] as a biomarker of painful vaso-occlusive crisis in sickle cell disease [SCD]

Chronic inflammation and hypercoagulable state contribute significantly to the occurance of vaso-occiusive complication of sickle cell diseases [SCD]. The pathogenesis determines changes in the levels of pro-inflammatory mediators such as cytokines, endothelial adhesion molecules, elevated markers of thrombin generation and group of new biochemical markers including NGAL. The aim of the present study was to evaluate levels of neutrophil gelatinase associated lipocalin [NGAL] in SCD patients during painful crises and steady state of illness. This work included 43 patients with SCD in painful crises that was severe to justify hospital admission, Nineteen samples were collected among the cases when patients came to the clinic for follow up visit in steady state. Control group included fourteen healthy ethnically matched individuals. NGAL levels were quantitated by ELISA. Other haematological and biochemical parameters such as HG, RBC, WBC, bilirubin, CRP, LDH were also determined. The results revealed that NGAL concentrations were highly significantly elevated in sickle cell painful crises compared with steady state SCD [p < 0.0001] and when compared with healthy controls. These results also showed the NGAL levels correlate with WBC, CRP and LDH. This work represents initial step to determine NGAL role as a biomarker involved in the inflammatory and immune modulatory functions reported in the pathogenesis of painful episodes in SCD and may be a valuable predictor marker in the progress to severe attaches [e.g. acute chest syndrome] or resolution of acute SCD crisis

study of some clinical and biochemical markers of epileptic seizures

The adverse effects of anticonvulsant drugs, duration and expense of therapy and social implications make it essential for accurate discrimination of epileptic from non epileptic seizures [NES]. There is still no single biochemical marker for epileptic seizures and many patients being treated as epileptics are not actually so. Moreover, the coexistence of pseudoseizures with epilepsy is high. Recently few studies had investigated the neuroprotective erythropoietin [EPO] system in the central and peripheral nervous systems. However, the clinical importance of EPO as a specific biochemical marker for epileptic fits is not yet investigated. Sixty children divided into 3 groups were studied. Group I included 20 recently diagnosed epileptics, aged 3.5-15 years. Group II involved 20 children with recent NES, aged 2-14 years. Twenty children suffering fever of unknown origin with lumbar puncture as part of its diagnostic work up, aged 3-15 years represented group III [control group]. All children were suffering no other neurological, hematological or renal diseases. Thorough history, clinical examination and routine investigations, confirmed diagnosis and established exclusion criteria. CT brain, EEG and EMG were done for all patients. Peripheral white blood cells [WBCs], serum creatine kinase [CK] and serum and CSF albumin and erythropoietin [EPO] were measured 24 hours Post-ictally for all patients and on admission of control children. Family history was positive for epilepsy in 20% of epileptic children. Post-ictal symptoms followed more than a half of epileptic seizures and less than a quarter of NES. The most common types of epileptic seizures were generalized tonic-clonic [GTC], generalized tonic [GT], myoclonic then focal seizures. CT brain was normal among most epileptic and all non epileptic patients; with hemorrhage in two epileptics and calcification in only one. EEG showed focal [FEA], generalized [GEA] and multifocal epileptogenic activities [MFEA] among our recent epileptics. Peripheral WBCs, serum CK and CSF levels of EPO showed a significant elevation 24 hours Post-ictally following generalized tonic-clonic epileptic fits and to a lower extent following focal and non epileptic fits. The 3 parameters showed a significant positive correlation with seizure duration. Serum CK levels were markedly elevated [more than 200 U/L] and CSF levels of EPO increased by more than 2 standard deviations in a high percentage of epileptic seizures especially so; GTC seizures, with this marked degree of elevation as a more sensitive factor discriminating epileptic from non epileptic seizures. Post-ictal symptoms, peripheral WBCs, serum CK and CSF levels of EPO are important discriminative factors between epileptic and non epileptic seizures before proceeding to more sophisticated and expensive investigations

Insufficiency of kerosine as solvent to pyrethroids [tetramethrih and permethrin] in the formulation of insecticides and its influence on blood parameter in adult albino rats

This investigation involved the effect of Kerosine for long time [288 days in these concentrations] as a stress hazardous influence that caused unfavorable manifestations. The direct effect was on hemobiotic system which was concluded from the MCHC and was more indicated in the females than males and that was more clear in the Neutrophiles / lymphocytic ratios. This investigation showed also the hormonal affection as for the cortisol, testosterone leading to a more hazard insufficiency of the testicular functions. Thus it is clear that this formulation has a damaging effect on the productive system as well as the haemopoetic system affecting the blood initiating cells as revealed from the peripheral blood studies. Thus it is necessary to avoid the production of this formulation due to its direct effect on the blood forming system as well as the hormonal profiles in both male and female in individual animals

Modulation of haematological and pathological changes caused by toxoplasma gondii in an experimental model of chronic infection

Wide spectrum of pathologic patterns is encountered in T. gondii infection, ranging from trivial pathology to fatal disease. The study was done to evaluate the ability of some drug groups to reverse the pathological changes caused by T. gondii infection. This evaluation was done, in vivo, in a rat model of chronic infection parallel to that in human. Lung, liver and brain specimens were taken in definite time points respecting the kinetics of infection in that model. Blood counts were done to all groups to evaluate efficacy and toxicity of drugs. A new combination of dipyridamole/ allopurinol was able to significantly reduce the pathology in all organs to almost the baseline pathology of chronic Toxoplasma infection. The relatively moderate protective effect of pyrimethamine/sulfadiazine combination was undermined by the toxic effects evidenced by pathology and haematological parameters. Spiramycin, in spite of proving safe, yet its protective effective is relatively weak in all organs especially in the brain where it seems to offer no protection

Study of the role of C reactive protein measurement in reducing the rate of negative explorations for acute appendicitis

Appendicectomy for suspected acute appendicitis is a common procedure. The rate of normal appendices unnecessarily removed remains high [15-30%] despite several techniques and investigations used to improue our diagnostic accuracy. Many studies investigated the role of raised C-reactive protein in improving the diagnosis of acute appendicitis with con-jlicting results. This study emphasizes the impact of a normal [rather than raised] serum C-reactive protein in reducing the rate of negative explorations. In a double blind study, blood for the measurement of serum C-reactive protein [CRP] was collected pre-operatively from 156 patients just before going to the operating room for appendicectomy. The histopathology of the 156 appendices were grouped into positive [acute appendicitis] and negative [normal appendix]. White blood count [WBC], CRP and the histopathology findings were correlated. In patients with histopathologically proven acute appendicitis both the WBC count and serum CRP level were significantly raised [P=0.025 and P<0.0001 respectively]. Serum CRP level was normal in 26 out of 30 negative explorations [normal appendix on histopathology]. The specificity and sensitivity of serum CRP was 86.6% and 93.6% respectively. A normal preoperative serum CRP measurement in patients with suspected acute appendicitis is most likely associated with a normal appendix Deferring surgery in this group of patients would probably reduce the rate of unnecessary appendicectomies

CD[95] as an early and sensitive marker of neonatal sepsis and disease outcome

This study was carried out on 33 neonates. They were classified into 2 groups: the first group included 18 septic neonates [9 males and 9 females] of these 11 were fullterm and 7 were perterm. The second group included 15 healthy neonates as a control group [7 males and 8 females] of these 10 were full term and 5 were preterm. All cases and controls were subjected to thorough history, clinical examination, laboratory investigation for both groups included: complete blood picture, total and differential leucocytic count, erythrocyte sedimentation rate [ESR], c-reactive protein [CRP], blood culture in septic cases and Fas /Apo 1 / CD[95]. The level of CD[95] is significantly elevated in septic full term and septic preterm compared to normal full term and normal preterm respectively [both P<0.0001]. Comparing CD[95] levels in septic neonates according to the severity of infection there was significant difference between cases who recovered and those who died [P<0.05]. There was no significant correlation between the levels of CD[95] in septic cases and the causative organism. Comparing CD[95] with other laboratory results, there was significant negative correlation between CD[95] levels and platelet count, significant positive correlation with total leucocytic count in septic full term and negative correlation in septic premature. There was also positive correlation between CD[95] level and CRP. In conclusion, soluble CD[95] can be used as an early and sensitive marker in diagnosis of neonatal sepsis

Changes in leucocytic count and serum immunoglobulins after partial hepatectomy alone and in combination with splenectomy in rats

This work was done to investigate the role of the liver and spleen in the body defense mechanism. Thirty male albino rats were prepared and divided into three groups. The first group was considered as a sham-operated group, the second group was subjected for a partial hepatectomy, and the third group was subjected for partial hepatectomy plus splenectomy. After one week and three weeks postoperatively blood samples were taken from the retroorbital vein and analyzed for total and differential leucocyytic counts and for serum g-globulin level. The results showed that, there is a significant depression in total and differential leucocytic counts and a significant elevation in serum g-globulin level after one week and after three weeks, with significant improvment in lymphocytic count and in gamma globulin level after the third weak. Spleenectomy in the third group worsen the condition and showed a significant depression in leucocytic count without a significant elevation of gamma globulin level that appeared in the second group. These results clarify the role of both liver and spleen in body defense mechanism and in protection against bacterial infection. Also, suggest to reserve the splenic tissue if it is possible and advise for subtotal splenectomy or for splenic tissue transplantation

Laparoscopic management of patients with acute biliary symptoms. Factors predictive of Failure of a laparoscopic technique

Laparoscopic cholecystectomy has become the standard elective management of cholelithiasis. Little information exists, however, regarding the appropriateness of this procedure in the setting of acute symptomatology. We reviewed our results with 26 patients with acute biliary symptoms managed laparoscopically. There were 18 females and 8 males with their ages ranging from 22 to 70 years with an average of 46 years. Laparoscopic cholecystectomy was attempted in all patients, and was successful in 22 of 26 patients, four procedures were converted to open cholecystectomy because of difficulty in dissection precluding laparoscopic cholecystectomy. Patients requiring open cholecystectomy were older, more likely to be febrile [mean temperature of 37.9 +/- 0.6 versus 37 +/- 0.7] and were more likely to have a significant leukocytosis [mean white cell Count 12.8 +/- 5.2 +/- 10[3] cells/mm[3] versus 9.2 +/- 2.8 +/- 10[3] cells/mm[3]] than were those undergoing successful laparoscopic cholecystectomy. Laparaoscopic cholecystectomy can be performed safely in the majority of patients presenting with acute biliary symptoms. Patients presenting with a triad of right upper quadrant pain, fever and elevated white cell count who are especially males, elderly and morbidly obese are more likely to require conversion to a standard cholecystectomy and should be informed accordingly