Value of tumor necrosis factor-like weak inducer of apoptosis and chemokine CXC ligand 13 as biomarkers for disease activity in systemic lupus Erythematosus

Tumor necrosis factor -like weak inducer of apoptosis [TWEAK] triggers multiple cellular activities in a wide variety of cells, ranging from proliferation to cell death. It also causes upregulation of chemokine [C-X-C motif] receptor 5, and its ligand, chemokine [C-XC motif] ligand 13 [CXCL13]. However, the precise roles of TWEAK and CXCL13 in the pathogenesis of SLE and their association with disease activity still obscure. The study included forty SLE patients and twenty control subjects. SLE disease activity was evaluated by Systemic Lupus Erythematosus Disease Activity Index [SLEDAI] 2000 score. Anti-dsDNA antibodies, serum complement C3, high sensitivity CRP [hsCRP] concentrations, TWEAK and CXCL 13 serum concentrations were detected by ELISA. TWEAK mRNA expression in peripheral blood mononuclear cells was estimated by relative quantitative Real Time-PCR. Serum concentrations of TWEAK and CXCL13 were significantly elevated in SLE patients compared to controls [p < 0.05] with significant increase in patients with active SLE compared to those with inactive disease [p< 0.05], they also significantly correlated with SLEDAI score and anti-dsDNA antibodies. TWEAK mRNA levels increased significantly in active lupus compared to inactive disease. It can be concluded that TWEAK serum and expression levels together with its inducible chemokine CXCL13 serum levels may benefit as biomarkers for prediction of SLE disease activity, as well as possible targets for personalized therapies due to their involvement in the pathogenesis of SLE

Prevalence of peripheral neuropathy in Egyptian hepatitis C virus patients: correlation to some clinical and laboratory parameters

The present study was undertaken to assess prevalence and characteristics of peripheral neuropathy [PN] in Egyptian hepatitis C virus [HCV] patients. Eighty newly diagnosed HCV patients were enrolled, with 20 healthy volunteers. All were subjected to: full clinical examination, neurological examination, laboratory assessment including; routine blood tests, ESR, CRP, RF, ANA, C4, cryoglobulins [CGs], anti-GM1 antibodies, HCV antibodies, Quantitative PCR, abdominal ultrasonography, liver biopsy, and electrophysiological assessment. Thirty-six patients [45%] had clinical neuropathy, 18 patients [22.5%] had subclinical neuropathy. Thirty-eight out of the 54 PN patients [70.3%] showed axonal neuropathy which is mainly sensory affecting lower limbs. Twelve patients showed +ve cryoglobulinemia, all of them had neuropathy [10 clinical, 2 subclinical]. Abnormal titers of anti-neuronal antibodies were associated with electrophysiological abnormalities in 50 out of the 54 PN patients. PN correlated with age, disease duration, ESR, CRP, RF, HCV viraemia, CGs, anti-GM1 and hypocomplementinemia. PN exists in high prevalence among Egyptian HCV patients, and is associated with CG. It is mainly of axonal sensory type more affecting lower limbs. HCV patients should be investigated for the presence of CGs even in the absence of clinical manifestations

Assessment of lipid peroxidation and antioxidant status in rheumatoid arthritis and osteoarthritis patients

The aim of the present study was to assess the lipid peroxidation [LPO] and antioxidant status of patients with rheumatoid arthritis compared with osteoarthritis. This study included 30 RA, 30 OA patients and 15 healthy subjects. Parameters of activity of RA patients and clinical parameters of OA patients were assessed. Erythrocyte sedimentation rate [ESR], C reactive protein [CRP], serum malondialdehyde [MDA], the activities of erythrocyte superoxide dismutase [SOD] and catalase [CAT], glutathione [GSH] level, plasma glutathione-S-transferase [GST] activity and ceruloplasmin [Cp] level were measured. Increased MDA, plasma GST activity and Cp levels with reduction of the activities of SOD, CAT and GSH levels were demonstrated in RA and OA patients. A positive correlation was detected between the clinical and laboratory parameters in both RA and OA patients with GST and Cp. A direct correlation was found between previous parameters and serum MDA in RA. Meanwhile, a negative correlation was observed between these parameters with erythrocyte SOD, CAT activities and GSH level. Direct correlation also existed between MDA and GST with Cp, between erythrocyte SOD with CAT activities and negative correlations of GST activity with GSH level. Increased oxidative stress in RA and OA patients have led to compensatory changes in the levels of antioxidants. These changes provide additional protection against LPO. These findings confirm the role of oxidative stress in the pathogenesis of RA and OA, and that LPO markers and antioxidants can serve as surrogate markers for disease activity

Genetic polymorphism, tissue expression of macrophage migration inhibitory factor versus serum cortisol levels in children with early onest atopic dermatitis

Background: macrophage migration inhibitory factor [MIF] has a regulator role of host responses to infection and stress. It is now emerging as a key integrator of the immunoneuroendocrine interface and has capacity to counter-regulate the effects of glucocorticoids on immune cells. Functional promoter polymorphisms of the human A4IF gene single-nucleotide polymorphism [SNP] at position 173 *G/C altered level of MIF gene transcription and contribute to increase susceptibility for early onset, severity and poor outcome of Atopic Dermatitis [AD]

Objective: to evaluate values of human MIF gene single nucleotide polymorphism [SNP], immunohistochemically study of MIF expression in biopsies from the skin lesions [as it mirrors serum MIF levels] versus serum cortisol levels and their relation to different degrees of severity in early onset AD

Patients and Method: this study was carried out on twenty four Participants. Fourteen with AD, 11 females and 3 males, their ages ranged from 3-12ys with mean+/- sd [7.6+/-3.03] [group l]. Ten healthy participant's age and sex matched were taken as controls, their ages ranged from 4-llys with mean+/-sd [6.15+1.53] [group2].Group 1 after that were subdivided for immunohistochemically staining into group A and Group B. They were selected from dermatology outpatient clinic at Al-Zahraa University Hospital after taking informed consent from their parents, and they were subjected to full history, clinical and dermatological examinations; measuring CEC, ESR, morning serum cortisol levels; Genetic study for human MIF gene single-nucleotide polymorphism [SNP] [MIF-173*G/C], and immunohistochemically study of MIF expression in skin biopsies

Results: five out of Fourteen patients were moderate AD [Objective SCORAD index]. They had been associated with SNP of human MIF at 173 *C [35.71%]. There was strong and moderate positive expressions of MIF in skin biopsies from moderate AD patients with SNP, while mild or no expressions of MlF in mild AD skin lesions by immunohistochemically staining. No significant difference in morning serum cortisol in group1 and 2; mean +/- SD was [10.67+/-3.73], [12.34+/-3.58], and also between cases with MIF gene SNP [group B] and without [group A], mean +/- SD was [11.64+/-2.68]. [10.13+/-4.26] respectively p>0.05

Concision: potent association was found between human MIF gene [SNP], Tissue expression of MIF and severity of AD. Anti MIF antibodies can be used in management of different forms of AD. Higher doses of steroid therapy may be required in some cases to antagonize elevated MIF level and possibility of subclinical hypo function of adrenal gland

Ultrastructure and types of fimbriae in uropathogenic E-coli among bilharzial patients

The aim of this work was to study the association of different types of fimbriae of urinary E coli isolates with different disease entities. We collected a total of 57 urinary E. coli isolates from 3 groups of bilharrzial patients: group 1: with cystitis [21 isolates]; group 2: with pyelonephritis [18 isolates] and group 3: with urinary bladder carcinoma [18 isolates]. Each isolate was studied for: I. Fimbrial expression and type determination by haemagglutination [HA] of human and guinea pig erythrocytes. II. Electron microscopic [E/M] structure using negative staining, standard transmission and scanning electron microscopy. It was found that infection with mannose sensitive type 1 fimbriated E. coli dominated in group 1 and 3 [80.95% and 77.78% respectively]. In group2 [55.56%] were caused by mannose resistant P fimbriated E. coli. Although there was a perfect correlation between HA and the presence of fimbiriae by E/M [P< 0.01], yet E/M detected other types of fimibriae which could-have been missed by HA alone. Negative staining was the best technique in electron microscopy. We concluded that detection of P flimbriae in urinay E. coli strains may justify a vigorous antibiotic treatment to prevent development of pyelonephritis. Although type 1 fimbriae was associated with simple cystitis, yet follow up and complete investigations are recommended to detect an associated carcinoma

Treatment outcome of smear positive pulmonary tuberculosis patients

The prime goals of tuberculosis treatment are to cure diseased individuals and minimizing transmissibility of Mycobacterium tuberculosis within the community. Tuberculosis treatment imposing many challenges for patients, health care providers and control program and non adherence to this regimen increases the risk of treatment failure, relapse, emergence of drug resistance and prolonged infectivity. Directly observed treatment short course [DOTS] had been evolved as the standard care to improve treatment compliance. Despite the free availability of these medications, many patients are not successfully treated. To evaluate the treatment outcome among patients with smear positive pulmonary Tuberculosis. To identify factors that may be associated with non-successful treatment. A multi stage sample consisted of about 849 smear positive TB patients new and previously treated pulmonary cases selected from 14 Governorates. They were submitted to sputum culture and sensitivity to determine the pattern of resistance to the first line anti TB drugs. All the included subjects were followed using a special data collection form to determine the treatment outcome among them. Treatment outcome was reported in 776 patients, successful treatment occurred in about 87% among new patients vs. 47% in the previously treated group, non-successful treatment in the form of failure [11%], default [3.6%], transferred out [4.7%], and death in [3.4%]. Treatment outcome was favorable among females compared to male patients [83.3% vs. 75.5%]. Drug resistance was significantly higher among previously treated males. Successful treatment outcome was dependent on the gender, type of the patients, and the presence of multi-drug resistance using the logistic regression model. Treatment outcome is highly dependent on the pattern of drug resistance, type of the patient, and the gender

Evaluation of growth hormone in polytransfused thalassemic patients with short stature and effect of L - carnitine treatment

Objective: Evaluation of growth hormone in poly- transfused thalassemic patients with short stature and effect of L-carnitine therapy in patients with growth hormone deficiency

Method: The study included. 30 beta-thalassemic patients with mean age 13.8 +/-1.7 yr and 30 children with constitutional short stature as a control. Anthropometric measurements, thyroid profile, insulin like growth factor -1 [IGF-1] and growth hormone [GH] provocation by 2 tests were done at the beginning of the study. Anthropometric measurements and pubertal assessment were done for all patients after 6 months. Eight patients with inadequate GH response to both clonidine and ITT were given L-Carnitine treatment at a dose of 50 mg/kg/day divided into three doses for 6 months. They were reevaluated after 6 months of therapy

Results: Twelve [40%] patients had sub-clinical hypothyroidism [diagnosed by normal free thyroxin level and elevated thyroid stimulating hormone], 10 [33.3%] patients had growth hormone deficiency. Peak GH and growth velocity /{cm and Standard Deviation Score [SDS]] were significantly lower while weight [SDS] and weight / height SDS were significantly higher than patients with constitutional short stature [P < 0.05]. A significant positive correlation was found between height and target height [cm]. Eight patients with growth hormone deficiency were given L-carnitine for 6 months [50 mg/Kg/day]. After L-carnitine treatment hemoglobin level, peak GH, IGF-1 and growth velocity [cm and SDS] were significantly increase and the number of blood transfusions was significantly decrease [p<0.05]. Delta changes were higher in height [cm and SDS], estimated mature height, sitting height and lower in target height - height [SDS and cm] six months after L-carnitine treatment in beta-thalassemic patients with growth hormone deficiency [p <0.05]

Conclusion: Growth hormone[GH] deficiency is an etiologic factor in beta-thalassemia patients with short stature. L-Carnitine can promote GH secretion and growth