Study of serum osteoprotegrin [OPG], tumor necrosis factor-related apoptosis-inducing ligand [Trail] and fetuin-A in patients with chronic renal failure

Vascular and valvular calcifications are strong prognostic markers of cardiovascular disease mortality in chronic kidney disease [CKD] patients especially those on hemodialysis. It has been demonstrated that CKD patients with osteodystrophy have increased atherosclerosis and, more recently, increased coronary artery calcification. Was to evaluate the link between renal failure, atherosclerosis, vascular calcification and inflammation by determining the role of serum osteoprotegrin [OPG], tumor necrosis factor-related apoptosis-inducing ligand [TRAIL], and Fetuin A in the development of vascular calcification in patients with End stage renal failure disease [ESRD]. The study included, thirty patients on maintenance hemodialysis [HD] and fifteen patients with conservatively managed chronic renal failure [CRF] for whom dialysis was not performed. Both groups were compared to fifteen age and sex matched healthy individuals who constituted the control group. To all the subjects clinical examination, and 12 lead electro-cardiography were done. To all subjects the following investigations were performed: routine biochemical analysis, serum OPG, Fetuin A and plasma TRAIL Also serum parathyroid hormone [PTH], Calcium [total and ionized], phosphorus [Ph], and C- reactive protein [CRP] were measured. Finaly carotid ultra sonography of the pelvis and hand, and calculation of vascular calcification score were done. Carotid intima media thickness [CIMT] was found to be significantly higher in both undialyzed [CRF] patients and dialyzed [HD] patients when compared to controls [p<0.001 leach]. Also the difference between both groups of patients was statistically significant [p: 0.014]. Calcification score was found to be significantly higher in CRF and HD patients when compared to controls [p: 0.047 and < 0.001 respectively] Serum OPG level was significantly higher in both undialyzed CRF and dialyzed HD patients when compared to the control group [p: 0.041 and < 0.001 respectively].The level was also found to be significantly higher in the HD group when compared to CRF patients [p< 0.001]. Serum fetuin A level was found to be significantly lower in both CRF and HD patients when compared to the control group [p: 0.02, 0.05 respectively]. As regards TRAIL levels, no significant difference was found between the three studied groups. The level of the PTH was significantly higher in CRF undialyzed and HD patients when compared to control group [p: 0.021 and < 0.001 respectively]. CRP level was significantly higher in both patients groups when compared to controls [p< 0.001, 0.04 respectively].In the total patients group: there was a positive significant correlation between VC score and both PTH and AP. There was a positive significant correlation between OPG and [CIMT, Fetuin, AP and total Ca]. There was also a positive significant correlation between Fetuin A and both TRAIL and Albumin. By performing multiple logistic regression, only serum PTH was significant independent predictor of vascular calcification [p=0.006] and serum OPG was significant independent predictor of inflammation. [p=0.029]. The only parameter with significant ROC curve was PTH. It could be finally concluded that the increased level of OPG in CRF and HD patients might be a compensatory self defensive response against other factors that promote vascular calcification, or may possess potentially damaging properties, while the decreased level of Fetuin A reflects an inadequate response against the development of VC. Also the increase level of CRP denotes an ongoing inflammatory state and this causes down regulation of fetuin A which may represent the essential link between chronic inflammation and vascular calcification. PTH was found to be the best diagnostic marker of VC of all studied parameters, and was also the most independent predictor of VC, while OPG was the most independent predictor of inflammation

Immunological evaluation of the role of some anti-viral antibodies in pathogenesis of rheumatoid arthritis

The aetiology of rheumatoid arthritis [RA] is largely unknown, however, a viral infective theory is becoming popular as a possible underlying cause. In the present study sera from twenty five patients with RA, eight osteoarthritis and sixteen health control subjects were examined for the presence of anti-rubella, anti-Epstein-Barr [EB] and antibodies to hepatitis B core [anti HBc] using haemagglutination-inhibition, direct haemagglutination and enzyme- linked immunosorbent assay [ELISA] respectively. Also, the level of circulating immune complex [CIC] was measured by the polyethylene glycol precipitation method. The aim of the present study is to assess the relationship between some antiviral antibodies and the clinical types and activity states of the rheumatoid disease. The data showed that anti-rubella antibodies were significantly higher in RA patients than control group, the higher the titre the more active is RA as evidenced from the positive correlation with the erythrocyte sedimentation rate [ESR]. No such findings were observed with neither ED or anti HBc antibodies. Interestingly, all seronegative patients were also negative for anti HBc antigen as well. The level of CIC was higher in RA patients than in control group with a positive significant correlation with the rheumatoid factor level. Anti-rubella antibodies seem to play a pathogenetic role in RA. The exact nature of which needs to be elucidated

Evaluation of liver functions in combined infection with fasciola and schistosoma mansoni

In Egypt, it was reported that Fasciola and Schistosoma mansoni occasionally co-exist in the same patients. The present work was designed to evaluate some liver function tests in cases with fascioliasis acute and chronic [single or combined with S. Mansoni infection]. The total serum proteins and electrophoretic pattern were also studied. Indirect hemagglutination test was carried out for diagnosis of fascioliasis and to determine if there is cross-reaction with S. mansoni infection. It could be concluded that liver affection resulting from fascioliasis is aggravated by a-concomitant hepatic schistosomiasis

study on hepatitis B surface [Bs] antigen and auto-antibodies in patients with fascioliasis

A considerable, unexplained liver damage was reported in human fascioliasis. The present work explored the probability of adjoined hepatitis B surface [HB[S]] antigen and auto immunity in intensification of this pathological state. Nineteen patients with chronic infection were examined clinically. The intensity of infection and specific antibody level determined. The haematological parameters and liver functions were studied. Search for HB[S] antigen, anti nuclear and anti mitochondrial antibodies was undertaken. Hepatitis B surface [HB[S]] antigen and antimitochondrial antibodies were not detected in any case. Antinuclear antibodies were observed in cases with relatively high infection intensity. It was concluded that an auto immune process might intensify the liver injury initiated by fasciola infection