Study of serum hepcidin and reticulocyte hemoglobin content in juvenile rheumatoid arthritis patients

Objective: Juvenile Rheumatoid Arthritis [JRA] is frequently associated with different types of anemia. The effect of anemia and disease activity, on two iron status parameters; serum hepcidin and reticulocyte hemoglobin content [CHr], was investigated in JRA patients

Methods: Blood samples were obtained from 43 JRA patients and 20 ages and sex matched healthy children as control. Laboratory parameters of anemia and disease activity as well as serum hepcidin and CHr were compared between patients and control Possible correlations of hepcidin and CHr with anemia and disease activity parameters were studied

Results: All studied parameters except TIBC, serum ferritin and hepcidin showed significant differences between patients and control. Significant correlations were found between CHr and all anemia parameters except TIBC and serum ferritin while hepcidin was only correlated to serum ferritin. Both hepcidin and CHr were significantly correlated to CRP, white blood cell and neutrophil counts. Moreover, hepcidin was significantly correlated to tender joint count while CHr was significantly correlated to platelet count and swollen joint count

Conclusion: In JRA patients, serum hepcidin was primarily affected by the acute phase state rather than anemia while CHr was affected by them both with a slight predominance of anemia over inflammation

Statins ; A double weapon in treating dyslipidemic osteoporotic menopausal type 2 diabetics

Recent reports have been suggested the possible role of 3-hydroxy-3 methyl gluteryl Coenzyme A [HMG-C0A] reductase inhibitors to represent an entirely new approach in treating osteoporosis by stimulating the proliferation and differentiation of osteoblasts, the specialized cells that create new bone formation. Also, statins have been reported to prevent bone resorption through blocking an early step in mevalonate pathway and so preventing prenylation, a step that is required for osteoclasts function. The aim of the present work was to study the effect of HMG-CoA reductase inhibitors [statins]; simvastatin and pravastatin, on bone mineral density [BMD] of dyslipidemic postmenopausal females with type 2 diabetes mellitus and having osteoporosis. Thirty postmenopausal dyslipidemic type 2 diabetic females above 50 years with no history of any disease or drugs that affect bone metabolism were included in this study and classified into 2 groups; I] included 15 patients received 40mg daily of simvastatin and II] included 15 patients received 40mg daily of pravastatin both for 3 months. Each patient was subjected to full history taking, complete clinical examination, laboratory investigations including, fasting and post-prandial plasma glucose, glycosylated haemoglobin, alanine aminotransferase [ALT], serum cholesterol and triglycerides, serum calcium [total and ionized] and phosphorus. Serum osteocalcin, biochemical marker of bone formation, was measured by immunometric assay and urinary deoxypyridinoline [DPD], biochemical marker of bone resorption was measured by competitive immunoassays. Dual energy X-ray absorptiometry [DEXA] was used to assess BMD of forearm [peripheral site] and L2-L3 lumbar vertebrae [axial site]. The results of the present work can be summarized as follows; the serum levels of osteocalcin and the BMD revealed significant increase and the urinary levels of DPD revealed significant decrease after 3 months of simvastatin in group I. A mild change in osteocalcin, urinary DPD and BMD had been noticed after 3 months of pravastatin in group II, yet it did not reach a statistical significant level. Also, there was significant reduction of serum cholesterol and triglycerides levels after 3 months therapy of either simvastatin or pravastatin and none of the patients showed any abnormal change in ALT levels supporting the safety of these drugs regarding their effect on the liver. Our results suggest the beneficial unexpected role of lipophyllic statins, simvastatin, in prevention and treatment of osteoporosis. Further studies are needed to reach the best effective dose and mode of administration of statin in preventing and treating osteoporosis. Also, the possibility of using statins in combination with other currently used drugs in this domain

Study of gastric malignant neoplasms in the surgical gastroenterology unit in the Main Alexandria University Hospital

The present work included data of 42 patients with gastric malignant neoplasms that were admitted to the gastroenterology surgical unit of the main Alexandria university hospital in the period from September 2002 through December 2004 [28 months]. The highest incidence was in the age group above 50 years [61.9%]. The male to female ratio was 1.5:1. the commonest symptom was loss of weight in 23 patients [54.76%]. The main site affected was the pyloric antrum in 22patients [52.38%]. Other sites were the body [67%], cardia [14.29%], and fundus [9.52%]. Three tumors were diffuse [7.14%]. Adenocareinoma was present in 32 patients [76, 19%]; 14 patients had a poorly differentiated tumor, Il patients [34.38%] had moderately differentiated tumor, and in 7 patients [21.88%] the tumor was well-differentiated. Other microscopic types included mucoid carcinoma [11.9%], Non-Hodgkin's lymphoma [7.14%], signet ring carcinoma [2.38%] and squamous cell carcinoma [2.38%]. The diagnostic procedure included upper GIT endoscopy with biopsy taking that was diagnostic in 100% of the study group. Barium meal was done for 34 patients and was diagnostic in 29 [[85.29%]. Conventional Ultrasonography was carried out for 32 patients and was diagnostic in 18 [56.25%]. CT was done for all patients and was of diagnostic value in 92.86% [39 patients]. The major lines of treatment were gastreetomy either total or subtotal [80.95%], while palliative resection was done in three patients [7.14%]. Palliative feeding jejunostomy was done in 2 patients [4.76%]. and there was no surgical interference in one advanced ease only [2.38%]

Diagnostic and clinical significance of Argyrophilic proteins in patients with acute leukemia

The number [amount] of Argyrophilic proteins [AgNORs] were estimated in bone marrow smears of thirty-six patients with acute leukemia at initial diagnosis: 24 children [10 males 14 females] and 12 adults [6 males and 6 females] as well as 12 matched controls. The purpose of the present work was to study the possible relation of AgNORS to immunophenotypic markers and clinical outcome. Silver staining of AgNORS was applied to bone marrow smears, and immunophenotyping was done by FACS flow cytometry. Statistically significant difference in mean AgNORS count/nucleus was observed in patients versus control [p<0.05], and a different staining pattern was observed in acute lymphoblastic leukemia [ALL] [fine dots] versus acute myeloid leukemia [AML] patients [coarse dots]. Positive correlation was found between AgNORS and bone marrow blast percent, while negative correlation was found with age, hemoglobin concentration and platelet count. Strong AgNORS staining was associated with immaturity markers and poor response to treatment. Eighty percent [80%] of AML and 70% of ALL patients with mean AgNORS<2.5 achieved complete remission. Determination of AgNORS has a major predictive value and adds an additional tool to differentiate ALL from AML smear Hence, it should be included in the diagnostic and prognostic workup of patients with acute leukemia

Study of the oxidative stress in thalassemia

The objective of this study was, to evaluate the total antioxidants in thalassemic patients compared to normal controls and the correlation between this and various parameters especially splenectomy and chelation therapy. This study included 26 thalassemic patients from Alexandria University children's hospital. Their age ranged from 4-24 years. Hemoglobin electrophoresis on cellulose acetate and total antioxidant assays using a colorimetric method [Randox Laboratories UK] and serum ferritin levels were done at least three weeks from the last blood transfusion. The mean serum level of total antioxidants in thalassemic patients was significantly lower than the control group. However, there was no correlation detected between the level of antioxidants and regularity of chelation therapy. Also there was no difference between values for different thalassemic types. This work has been presented, in part, at the XXII International Congress of Pediatrics in Amsterdam 9-14 August 1998

Red blood cells superoxide dismutase activity in Iron deficiency anemia

In order to study the activity of superoxide dismutase [SOD] in red blood cells in children with iron deficiency anemia [IDA], thirty children suffering from IDA were studied. Ten matching normal healthy children served as controls. Complete blood count, iron profile, occult blood in stools and estimation of SOD activity were done. The results of this study showed that the SOD activity in anemic children was significantly higher than that of the control group [P<0.0005]. However, no significant correlation was found between SOD activity and other parameters including reticulocyte count, serum ferritin, serum iron and total iron binding capacity [TIBC]. The potential benefit of higher SOD activity in red cells from iron deficient children is to counteract the effect of oxidative stress. This work has been presented, in part, at the 25[th] Congress of the Union of Middle Eastern and Mediterranean Pediatric Societies and 2[nd] Congress of the Lebanese Pediatric Society in Beyrout-Lebanon 14-17 April 1999

Gastro-esophageal decongestion and splenectomy geodes, [Hassab], in the management of bleeding varicoses review of literature

The use of Doppler flowmetry proved the importance of hypervolemia in bleeding and showed that GEDS enhances liver perfusion confirming our findings in the sixties. Perhiatal devascularization of lower 3-4 inches of esophagus, complete separation of the stomach from its bed, ligation of left gastric artery at lesser curvature, peritonization of greater curvature, nursing the patient on his right side, suction drainage of splenic bed, and early respiratory exercises are essential technical points. Combination with sclerotherapy is useful but esophageal transection is harmful. Variceal rebleeding varied from 5.5% in 3 years to 7% in 10 years, when done properly, to 17% and 18.8% when done incompletely; higher rates include minor bleeding of gastritis. Encephalopathy varied from nil to minimal incidence of mild forms. Thus when done properly GEDS is as effective in controlling bleeding as DSRS with better liver, better heart, better life and better survival with nil or minimal encephalopathy. Combined with sclerotherapy it forms the ideal therapy for bleeding varices in all types of pathology

Neurological presentation of ten cases with disseminated intravascular coagulopathy

Cerebral involvement in DIC is rare. Ten cases of DIC, showing variable forms of central nervous system involvement, were reported. All cases showed neurological disorders plus laboratory evidence of DIC [disseminated intravascular coagulopathy]. DIC patients secondary to malignancy presented mainly with a picture of large vessel stroke. The most common neurological presentations of DIC are obtundation, coma, focal or generalized seizures, large vessel occlusion and rarely subarachnoid hemorrhage

Significance of fibronectin in diabetes mellitus with osteoarthrosis

Association of diabetes mellitus and osteoarthrosis has been discussed since quiet long time. The mechanism of osteoarthrosis in diabetes mellitus may be due to insulin deficiency which is essential for mucopolysaccharides synthesis. The ability of the fibronectin [FN] to bind to fibrinogen and collagen suggests that it may have a role in tissue response to inflammatory stimuli. The aim of this study was to estimate FN level in plasma in cases of diabetes with atherosclerosis and to show whether the diabetic state can affect plasma fibronectin level. Forty diabetic patients were the candidates of this study, 25 had the clinical and radiological evidence of osteoarthrosis and the remaining 15 had no osteoarthrosis. Plasma FN concentration was significantly elevated among diabetic patients with osteoarthrosis. No significant correlation was found between plasma FN and the age or weight of patients, duration of the diabetes and the blood glucose level neither in the osteoarthritic diabetic patients nor in the diabetic patients with no osteoarthrosis. This means that osteoarthrosis may be the causative factor for increased plasma FN. Further study comparing plasma FN and synovial FN in diabetic osteoarthrosis is recommended

Structural changes in the veins in Arterio-Venous Fistulae [AVF] and primary varicose veins of the lower extremity histological and histochemicat studies

Histological and histochemical studies were carried out on 36 specimens taken from veins of the leg: Five normal, one from chronic traumatic AVE and 30 from primary varicose veins. The study showed that the structural changes in the wall of varicose veins were not unlike those found in traumatic AVF. In addition degenerative changes in the form of accumulation of acid mucopoIysaccharides and choesterol esters were also demonstrated. These degenerative changes seem to be responsible for venosclerosis characteristic of long-standing varicose veins

Effect of gastro-oes ophageal decognestion "Hassab's operation" on liver functions in patients with hepatic schistosomiasis and ascites

A battery of liver function tests including estimations of serum bilirubin, turbidity tests, serum protein, prothrombin activity, serum alkaline phosphatase and transaminase, was done before and after Hassab's decongestion operation in twelve male hepatic schistosomiasis patients with resistant ascites. Decrease of zinc sulphate turbidity, serum enzymes, total globulins together with increase of serum albumin and prothrombin activity was recorded after operation. Improvement of hepatic and intestinal blood flow, splenectomy, amelioration of hepatic functions and renal haemodynamics are supposed to be underlying factors