Serum and synovial neopterin, a marker for rheumatoid arthritis activity

Rheumatoid arthritis [RA] is a chronic inflammatory disease of unknown etiology characterized by an erosive proliferative synovitis. Since the etiology of RA remains obscure, rheumatoid disease activity can only be evaluated by indirect laboratory measures. Despite the intensive efforts to make the clinical assessment more objective by applying numerical grades and indices, a relevant, reliable and reproducible method to quantitate rheumatoid activity is still needed. The pathogenesis of RA is complex involving many cells and cytokines. Neopterin, a pyrazino-pyrimidine derivative from gua-nosine triphosphate, was found to be an excellent biochemical marker for the invivo activation state of cell-mediated immunity. The aim of the present work was to study the monocyte/macrophage activation in RA patients by measuring neopterin concentration in serum and synovial fluid to test the efficacy of this new biochemical parameter in reflecting rheumatoid disease activity. 47 RA patients and 25 controls were included in this study Neopterin as well as other routine laboratory investigations were performed on the serum and synovial fluid [when applicable]. The results of this work showed that serum neopterin is significantly higher in RA patients than normal controls. Both serum and synovial fluid neopterin correlated strongly with the activity of the disease. Serum levels increased significantly as the disease becomes more active. If has been concluded that neopterin measurement can be used as a parameter of rheumatoid disease activity

Autoantibodies against glutamic acid decarboxylase and insulin: role of immunological markers in type 1 diabetes mellitus and their relatives

This study was performed on 180 child classified into three groups. Group I, consisted of 50 newly diagnosed type 1 diabetes mellitus [DM], group II included 65 non-diabetic child with a positive family history of type 1 DM and group III contained 65 non diabetic child with negative family history for type 1 DM. All individuals were subjected to routine blood investigations for diabetes [fasting and post-load serum glucose and HbAlc] in addition to the measurement of insulin autoantibodies [IAA] and glutamic acid decarboxylase autoantibodies [GADA]. The aim of this work was to assess the sensitivity and specificity of IAA and GADA as immune markers in type 1 DM as well as their role in the prediction of the disease among individuals with positive family history for type 1 DM. Results of this study showed significant positive correlation between IAA against fasting serum glucose, post-load serum glucose and HbAlc. Stronger positive correlation was found between GADA and the same parameters. GADA showed better sensitivity, specificity, positive and negative predictive values and test efficiency when compared to IAA. Combined assay [GADA and IAA] gave the same sensitivity, specificity, positive and negative predictive values and test efficiency when compared to GADA alone. It may be concluded from the present study that GADA has more significant role than IAA in predicting the risk of developing DM in individuals with positive family history of type 1 DM

Evaluation of serum and urinary myoglobin assay for the early diagnosis of acute myocardial infarction

Myoglobin is one of the new markers for the diagnosis of acute myocardial infarction [AMI]. Serum and urine myoglobin as well as cardiac enzymes were serially measured in a group of 22 patients with AMI to establish the time-frame sensitivity of individual markers. Serum myoglobin was elevated in 21 patients on admission. Sensitivity of 100% for serum myoglobin was achieved at 6 hours after admission predating that for creatine kinase enzyme [CK] and its cardiac isoenzyme [CK-MB] by six hours. However, urine myoglobin assay did not seem promising as a diagnostic tool for AMI since it showed a maximum sensitivity of 50% at 24 hours after admission. It can be concluded that serum myoglobin assay is an effective additional tool to satisfy the recent enthusiasm for an early sensitive diagnostic marker for AMI aiming for early intervention with thrombolytic therapy

Serum transferrin receptors/ferritin index, a discriminative parameter for iron deficiency anemia versus anemia of chronic disorder and B-thalassemia minor

Differentiation between iron deficiency anemia [IDA], anemia of chronic disorders [ACD] and beta-thalassemia minor is usually made definite by examining the bone marrow for iron stores. The aim of this study was to evaluate a new noninvasive parameter, serum transferrin receptors [TfR], in discriminating IDA versus ACD and beta-thalassemia minor. The subjects involved in this study consisted of IDA group [65 cases], ACD group [64 cases] and beta-thalassemia minor group [61 cases]. For the three groups, complete blood count [CBC], serum iron, total iron binding capacity [TIBC], iron stain for bone marrow smears, hemoglobin electrophoresis, serum transferrin, ferritin and transferrin receptors were assayed in addition to the calculation of the TfR/ferritin index. The results of this study showed that transferrin ferritin and TfR had better sensitivity and specificity when compared with serum iron, MCV and TIBC. However, the best sensitivity and specificity were encountered with TfR/ferritin index. Receiver operating characteristics [ROC] analysis for the different studied parameters revealed similar findings. It may be concluded that the combination between TfR and ferritin in one index can maximize the sensitivity and the specificity in the recognition of IDA