Evaluation of the role of presepsin [soluble cd 14 subtype] in the diagnosis of neonatal sepsis in preterm newborns

Objective: The present study was conducted to evaluate the role of presepsin as an early and rapid predictor of bacterial infection in newborn infants

Methods: This study was carried out on 50 preterm newborn infants with clinically suspected early onset sepsis admitted to the neonatal intensive care unit at Alexandria University Maternity Hospital, All studied newborns were subjected to History taking, detailed physical examination and sepsis work -up, including complete blood count, blood culture, CRP, CSF analysis if indicated and quantitative measurement of preseason

Results: The mean birth weight of the studied newborn infants was 1520 g and the mean gestational age was 32.7 weeks with no statistically significant difference as regard the preseason results. Virginities was the main maternal risk factor for EOS, present in 80 % of the studied newborn infants. The majority of cases of positive culture for Klebsiella were negative for preseason, and this was statistically significant, Presence of toxic granules had the highest incidence among laboratory markers in the CBC in the studied group, Preseason was positive in 48% of newborns and the mean value of preseason was 1397.6 ng/L, Most cases with positive initial CRP readings were positive for preseason and this was statistically significant. There was no significant difference in preseason results as regard clinical score, total laboratory score and both laboratory and clinical scores. All cases that had meningitis were positive for preseason, and most cases that didn't have meningitis were negative for preseason and this was statistically significant. There was no statistically significant difference between preseason results and duration till admission, Apgar score or hospital stay

Conclusion: We concluded that preseason is a useful, quickly and easily performed marker for diagnosis of neonatal, sepsis. Its results are comparable to the CRP and seemed to be superior to conventional CBC tests. Furthermore, presepsin is a promising prognostic marker that could identify high risk newborns to severe sepsis, but it may not be elevated in response to infections caused by organisms like Klebsiella

Evaluation of haemostatic mechanisms in the elderly

Aging is associated with changes in the haemostatic balance including coagulation, flbrinolytic and/or platelet activity. Adverse changes in coagulation and flbrinolytic factors are thought to contribute to the increased risk of cardio-vascular disease and atherothrombosis with age. In this study the aim was to determine how the biological factor of age affected coagulation, flbrinolytic factors and platelet glycoprotein receptors levels. In so doing the effect of age on the two important systems in the body involved in haemostasis namely, the coagulation and flbrinolytic systems was studied. The population studied consisted of ten young healthy controls aged 20 - 30 years representing [group I], twenty subjects aged 60 - 70 years [group II], twenty subjects aged 70 - 80 years [group III] and ten subjects above 80 years [group IV]. All groups were subjected to thorough history taking, complete clinical examination and routine investigations excluding obeses, hypertensives, diabetics, patients with chronic obstructive pulmonary disease [COPD] or ischemic heart disease and patients with peripheral vascular disease. Investigations of coagulation parameters [procoagulant markers] included prothrombin activity, estimation of flbrinogen level, Factor VII assay, Thrombin antithrombin [TAT] complex, Prothrombin fragment 1+2 [PF1+2]. Investigations of flbrinolytic system [flbrinolytic markers] included Tissue plasminogen activator [TPA] and tissue plasminogen activator- inhibitor [TPA-I], Flow cytometric investigation of platelet receptors, including platelet membrane glycoprotein GPIIb, Ilia, and GPIb. Prothrombin activity and TAT complex were found to increase with age but their differences between the aged groups and group I did not attain a statistical significance. Serum flbrinogen, factor VII and PF 1+2 were rising with the advancement of age and their means were significantly higher in all aged group in comparison with the young group.Serum TPA and TPA-I showed a progressive increase with age and their means were significantly higher in all aged group in comparison to the young group. Platelet glycoprotein receptors IIb, IIIa and Ib levels were found statistically significant higher in all aged groups in relation to group I. The maximum increase was found in group IV. The age-dependency of these markers has to be taken into account in respect to their clinical use in order to characterize patients with suspected risk of atherosclerotic events. In future, one should consider routinely screening for these markers in those above the age of 60 years and, if found to be high consider giving flbrinolytic and antithrombotic agents prophylactically

Expression of CD 117 antigen [C-KIT] in multiple myeloma patients and its clinical value in correlation with other prognostic factors

Angiogenesis is increased in multiple myeloma [MM], Vascular endothelial growth factor [VEGF] is associated with progression of haematological malignancies and plays a role in increased angiogenesis seen in MM. CD117 [c-kit] is expressed in cells committed to myeloid lineage. Evaluation of the expression of CD 117 in bone marrow myeloma cells and its correlation with other laboratory data and the level of VEGF. Forty patients diagnosed as MM were included in this study. Ten healthy controls of matched age and sex. Patients and controls were subjected to complete blood picture, serum protein electrophoresis, serum level of beta 2 micro globulin and VEGF by Elisa technique. Study the expression of CD38/CD117 in double color by Facscalibur from BD company. In MM cases VEGF was significantly higher than normal controls. It was positively correlated with monoclonal protein and beta 2 microglobulin which is established to be a good prognostic indicator in MM. Co-expression of CD38/CD117 was higher in myeloma cells and showed a positive significant correlation with monoclonal protein, bone marrow myeloma cells, beta 2 microglobulin and VEGF level in serum. Study the co-expression of CD38/CD117and serum level of VEGF are beneficial in MM patients and can used as a good associated markers in MM. Also further studies on the role of c-kit in MM as a prognostic indicator would be of great benefit in raising the possibility of using tyrosine kinase inhibitors as a target therapy in MM patients

Study of plasma adiponectin in type 2 diabetes mellitus ; relation to non-alcoholic fatty liver disease

Subdying possible link between adiponectin, plasma insulin and biochemical parameters of liver injury in type 2 Diabetic patients with and without non-alcoholic fatty liver disease [NAFLD]. Thirty type 2 diabetics [group I], 30 type 2 diabetics with NAFLD [group II] and 30 healthy controls [group III] were subjected to complete clinical examination, anthropometric measurements, determination of fasting plasma insulin and fasting adiponectin, fasting and 2-hours postprandial plasma glucose, glycated hemoglobin [HbA[1c]%] lipid profile, liver enzymes and abdominal ultrasound examination. Diabetic patients had significantly increased mean fasting plasma insulin and decreased mean fasting plasma adiponectin values compared with the controls, especially group II with NAFLD [p < 0.001]. There was a significantly negative correlation between fasting adiponectin and insulin values in both diabetic groups [p < 0.001]. Adiponectin did not correlate with lipid parameters nor liver enzyme in diabetics with and without NAFLD. In conclusion, this study demonstrated a low plasma adiponectin level in type 2 diabetes especially those with NAFLD that is inversely correlated with hyperinsulinemia. These data support a role for .adiponectin in protection against liver injury, in keeping with the hypothesis that an imbalance between proinflammatory and antiinflammatory cytokines may have a pathogenic role in the development of liver damage in diabetics with NAFLD. Finally, a novel cross-talk between the adipose tissue and liver is emerging that may act as a major player in the link between the metabolic syndrome and non alcoholic fatty liver disease [NAFLD].Future studies are recommended to evaluate the role of adiponectin in the management of patients with type 2 diabetes and those with NAFLD

Study of P-glycoprotein [multi-drug resistance gene] expression in acute lymphoblastic leukemia in the elderly: correlation with cytogenetics and response to induction chemotherapy

Elderly patients with acute lymphoblastic leukemia [ALL] have only rarely been included in clinical trials. The aim of this work was to investigate some of the biologic characteristics of ALL in the elderly by cytogenetic analysis and by studying of P-glycoprotein [P-gp] or multidrug resistance [MDR-1] protein expression at initial presentation. Twenty patients with newly-diagnosed beta-lineage ALL were accrued to the study. They were divided into two groups; group I: ten patients aged <60 years, and group II: ten patients aged >/= 60 years. They were subjected to history taking, clinical examination, complete blood count [CBC] and bone marrow [BM] aspiration with immunophenotyping to establish the diagnosis. Cytogenetic analysis was done by the G-banding technique and estimation of P-gp in ALL blast cells was performed by flow cytometry. All patients were in a good performance status and induction chemotherapy was instituted according to standard protocol for ALL. Complete remission [CR] was achieved in 50% of patients in group I and 40% in group II. No significant difference was found between the two groups regarding P-gp expression in pretreatment samples. However, a highly significant difference was noted on comparing CR and non-CR patients in both groups as regards P-gp expression [t=20.89, p=0.00]. Cytogenetic analysis revealed that 20% of patients in group I and 60% of cases in group II had cytogenetic abnormalities. No significant difference was found between CR and non-CR patients as regards the cytogenetic status. Also, there was no significant difference between patients with normal and those with abnormal karyotypes as regards P-gp expression. Failure to respond to chemotherapeutic drugs in ALL in the elderly seems to be a multifactorial phenomenon. Further clinical trials evaluating the disease features, outcome, and new therapeutic approaches are warranted