Bone mineral density in chronic hemodialysis patients and its correlation to biochemical markers

Renal osteodystrophy may result in considerabli morbidity for patients with end-stage renal disease. Secondary hyperparathyroidism, adynamic bone disease and osteomalacia, the main bony problems in chronic renal failure, may all be responsible for a reduction in bone mineral density [BMD]. The aim of this study is to investigate the biochemical parameters and bone mineral density in patients undergoing regular hemodialysis and to assess their possible correlation to different variables, Patients and Methods: thirty nine patients with end-stage renal disease maintained on regular hemodialysis for variable intervals were participated in the study. Osteocalcin, type1-C terminal collagen propeptide [CICP], Osteoprotegrin [OPG], receptor activator of nuclear factor kB ligand [RANKL], parathyroid hormone [PTh], serum total calcium, inorganic phosphorus and alkaline phosphatase were estimated to all patients. Bone mineral density[BMD] was measured by dual energy X ray absorptiometry [DEXA] in lumbar spine and femoral neck with estimation of BMD t-score. Body mass index [BMI] was calculated. Assessment of correlation between clinical, laboratory data and BMD was done. There was a positive correlation between age, BMD and CICP, between BMI and RANKL and also between BMD hip and spine. BMD in both sites correlated inversely, with PTH [P< 0.01], there was a significant correlation between duration of dialysis and PTH [P< 0.001], calcium level and hip t-score were the most important variable for prediction of reduced BMD. Osteopenia was frequent in patients on hemodialysis and those with hyperparathyroidism and longer duration of hemodialysis were more susceptible to reduced BMD developing osteoporosis

Soluble P-selectin in systemic lupus erythematosus

The present research aimed to evaluate serum Adhesion Molecules [AMs] in patients with Juvenile Idiopathic Arthritis [JIA] to correlate their values with disease activity in different clinical subtypes. Serum levels of some soluble AMs [E-selectin, sICAM 1 and sVCAM 1] wereassayed by ELISA in 37 patients with JIA both during activity and after remission. Other activity parameters like sedimentation rate and leukocytic counts were tested as well. Twentyhealthy children of matched age and sex were taken as control. Serum E-selectin was found significantly higher in JIA compared to control [in all subtypes across all disease stages], with significant drop after remission, yet not reached the normal values. These changes were more evident in systemic JIA compared to other subtypes. Serum ICAM 1 and VCAM 1 showed the same changes in relation to control and to the disease activity. We can conclude that systemic JIA is associated with higher levels of soluble AMs thus explaining the perpetual inflammatory process and hence the remissions and exacerbations which are usually associated with higher morbidity in systemic JIA than in the other subtypes. We recommend following JIA patients until laboratory remission [normalization of serum AMs] to correlate AMs levels to clinical course aiming to put forward a therapeutic plan

Role of interferon-alpha, interleukin-1 beta and T cell activation in aplastic anemia pathogenesis

The present work was performed to clarify the role of stimulatory cytokine as IL-1 beta and inhibitory cytokine as IFN-gamma and T cell activation evidenced by CD25 expression in the pathogenesis of aplastic anemia. Twenty-eight newly diagnosed aplastic anemia patients and 15 age and sex matched healthy controls were included in this study. An estimation of IL-1 beta, IFN-gamma and the percentage of CD25 expression was done to all patients and controls. IFN-gamma was significantly higher in AA patients as compared with the age matched controls. IL-1 beta was significantly lower in AA patients as compared with the controls. The percentage of CD25 expression was significantly higher in AA patients as compared with the controls. There was a highly positive significant correlation between IFN-gamma and leucocytopenia. There was a negative significant correlation between IL-1 beta and each of age and leucocytopenia. There was a highly positive correlation between CD25 expression and Hb level of the patients

Enhanced anticoagulant response to activatted protein C in patients with Type 2 diabetes mellitus

Anticoagulant response to activated protein C [APC] was studied in 15 healthy subjects and 35 patients with type 2 diabetes mellitus using a modified activated thromboplastin time assay. The results were expressed in terms of the APC sensitivity ratio [APC-SR]. In addition, plasma levels of protein C, protein S and AT III were measured. APC-SR was significantly higher in diabetic patients compared to controls. AT III was significantly lower in diabetic patients compared to controls. No significant differences were observed between patients and controls as regards protein C activity and free protein S levels. In conclusion, the data suggested a role for AT III and APC cofactor activities in the regulation of the anticoagulant response in type 2 diabetic patients. The enhanced anticoagulant response to APC as well as up-regulation of the protein C/protein S system may be effective in controlling hemostatic balance type 2 diabetes