Juvenile and adult onset systemic lupus erythematosus outcome in Egyptian patients

The aim was to study the outcome characteristics of systemic lupus erythematosus [SLE] in Egyptians according to the age at disease onset and gender. We studied 239 SLE patients [185 adult and 54 Juvenile onset] with a female to male ratio of 9.39-1 and a mean age of 28.23 +/- 8.91 years and disease duration of 5.45 +/- 4.25 years. Full history taking, thorough clinical examination, laboratory and relevant radiological investigations were performed. Disease activity was assessed using SLEDAI and damage by SLICC. Renal biopsies were done in those with renal involvement. The clinical manifestations, disease activity and damage and laboratory investigations of the SLE patients varied according to the age at disease onset and gender. The prevalence of damage was obviously increased in juvenile patients and higher in males. Growth failure, delayed puberty and fibromyalgia were present more in Juvenile-onset patients. Adult onset SLE patients had a significantly higher secondary Sjogren syndrome especially in females. In the present study, there was a 2.5% mortality and the commonly involved kidneys were an important cause of death. Measuring organ damage in SLE is important with special concern to juvenile-onset patients to allow for designing new treatments that improve control of disease activity and minimize the development of irreversible damage. The kidney appeared to be commonly involved, especially in males, indicating the importance of regular screening for early and appropriate management

Parathyroid hormone [PTH] and markers of calcium metabolism in children with congestive heart failure

Parathyroid hormone [PTH] regulates the content of calcium and exerts an effect on myocardial function. Abnormal secretion of PTH has been sporadically reported to be associated with depressed mechanical performance of the heart muscle. The aim of this study is to evaluate parathyroid function in patients with CHF due to dilated cardiomyopathy [DCM], measuring some different parameters of calcium metabolism This work was carried on 30 cases [20 males and 10 females] with congestive heart failure [CHF] having a mean age of 6.69 +/- 3.94 years. They were recruited from Cardiomyopathy Clinic at Cairo University Children Hospital [Abou El Riche], All our patients were subjected to full history taking, general examination and echo-cardiographic examinations. Thirty normal healthy children of matched age and sex were included to serve as control. Cases were further classified into[i] Decompensated HF[n=18] [NYHA III, IV] who were admitted to in patient units and[ii] Compensated HF[n=12] [NYHA II]. The following laboratory parameters were measured and compared. Osteocalcin[OC] and Parathyroid hormone[PTH], in addition to total serum calcium, phosphorus, creatinine, urea, alkaline phosphatase, sodium and potassium. The results of our work revealed statistically significant lower serum calcium, higher serum phosphorus levels and lower serum osteocalcin in DCM cases compared to controls [p=0.0001,0.002 and 0.0001 respectively].There was no statistically significant difference between cases and controls regarding serum PTH. l.e. normal PTH, however the calcium is depressed in DCM. Parathyroid hormone level was normal in patients with CHF, however three cases of the decompenstated group showed non-significant elevated levels. Significant hypocalcaemia, hyperphosphatemia and reduction in serum OC levels were noted in our CHF patients. Further studies of these factorscontributing to the associated morbidity of patients with decompensated CHF-should be well traced