[Fetuin-A and high sensitivity-CRP in children with chronic kidney diseases]

Background: Fetuin-A is a circulating calcium- regulatory glycoprotein that inhibits vascular calcification. In end stage renal disease [ESRD], fetuin -A has been demonstrated to be reduced and inversely related to cardiovascular mortality. The present study aimed to determine the effect of renal function on serum levels of fetuin-A in patients with chronic kidney disease [CKD] and to investigate the relationship between fetuin-A serum level and vascular calcification which represents a risk factor for the development of endothelial dysfunction[ED]

Methods: 20 CKD patients on conservative treatment, 20 ESRD patients on regular hemodialysis [HD] treatment, as well as 40 apparently healthy controls of matchable age and sex were enrolled in the study. All the patients and controls were subjected to the following investigations: estimation of serum levels of fetuin-A, high sensitivity-CRP [hs-CRP], creatinine, calcium [Ca], phosphorus [Po4], alkaline phosphatase [ALP], and parathormone [PTH]. In addition, glomerular filtration rate was estimated for cases and controls

Results: There was significant reduction in fetuin-A serum levels in CKD and ESRD patients compared to controls. A significant decrease was also detected in ESRD group when compared to CKD group. The inflammation marker hs-CRP was significantly increased in CKD and ESRD patients in comparison to controls. The increase was also significant on comparing ESRD group with CKD group. A strong inverse correlation was found between serum fetuin-A and hs-CRP, Significantly increased serum levels of ALP and PTH were found in CKD and ESRD patients compared with controls. The increase was also significant in ESRD patients compared with CKD patients. In ESRD patients, Serum levels of fetuin-A showed significant inverse correlations with each of: duration of igalysis, ALP and PTH serum levels, while hs-CRP serum levels showed significant positive corelations with CaxPo4 ratio and PTH serum levels

Conclusion: Results of the present study demonstrate that inflammatory processes are increased among CKD and ESRD patients and linked to low fetuin-A serum levels and vascular calcification which represents a risk factor for the development of ED. The interaction of these incidents may be responsible for the development and progression of thrombogenesis in such cases

Real-time PCR versus phenotypic diagnostic methods in detection of methicillin and vancomycin resistant staphylococci

Staphylococci are the most frequently isolated bacteria from blood. The prevalence of antibiotic resistance has dramatically increased. Real-time PCR offers rapid, accurate, and sensitive method to detect the presence of antimicrobial resistance. This study is mainly aimed to detect uethicillin [oxacillin] and vancomycin resistant staphylococci isolated from blood of patients with significant bacteremia in Assiut University Hospital using both real-time PCR and phenotypic agnostic methods. Sixty Staphylococcal isolates were included. These isolates were collected from positive blood culture bottles [BACTEC 9050 System] of patients with significant bacteremia in Assiut University Hospital. Identification of staphylococcal species was performed by subculture on Mannitol Salt Agar [MSA] and by Microscan system, while antibiotic sensitivity testing was performed by Microscan system, Epsilometer test [E- test], Disc diffusion [DD] method, Oxacillin Resistance Screening Agar Base [ORSAB] and by real-time PCR for mec A and van A genes. Seven S. aureus isolates and fifty three Coagulase-negative staphylococci [CoNS] were detected by both MSA and Microscan system. The most effective antibiotics for staphylococcal isolates were in order. Vancomycin, Linezolid, Synercid, Rifampicin, Chloramphenicol, Gentamycin, Tetracycline, Trimethoprim/Sulphamethoxazole, Clindamycin, Ofloxacin, Ciprofloxacin, Azithromycin and Erythromycin. Concerning methicillin resistance, Real-time PCR which is the gold standard method detected mecA gene in 57 isolates. Accordingly, sensitivity and specificity of E-test were 964% and 100% respectively, DD method showed 87.7% sensitivity and 100% specificity, ORSAB media showed 92.9% sensitivity and 100% specificity while Microscan showed 100.0% sensitivity and 100.0% specificity. Concerning vancomycin resistance, E-test which is the gold standard method detected vancomycin resistance in 6 staphylococcal isolates. Therefore, the DD method showed 66.7% sensitivity and 100.0% specificity while Microscan showed 83.3% sensitivity and 100.0% specificity. Real-time PCR detected van A gene in only one staphylococcal isolate. CoNS organisms are more implicating than S. aureus in bloodstream infections [BSIs]. About 95% of staphylococcal isolates were resistant to methicillin and 10% were resistant to vancomycin. Real-time PCR was more accurate and rapid method for detection of methicillin resistance than phenotypic methods and it could be considered a confirmatory method for detection of vancomycin resistance in staphylococcal isolates suspected to have the van A gene

Prognostic value of [BCLI/IGH] genes juxtaposition and MDRI gene expression in treatment resistant B-NHL

The translocation t[11;14] [q13; q32,] has been known neoplasia for many years found in a variety of B cell malignancies. Through this rearrangement, CCND1/PRAD-1/BCL1 on chromosome 11 becomes juxtaposition to the active immunoglobulin heavy chain [IgH] enhancer on chromosome. MDR1 gene expression lead to overproduction P-gp which leads to chemotherapy resistance caused poor prognosis and short survival [OS and DFS] in B-NHL. To evaluate BCL1/ IgH juxtaposition by FISH and mdr-1 protein expression by immunohistochemistry in B-NHL. To clarify if these genes have some relevance to developing treatment resistance of B-NHL and their correlation with clinical outcome. This is a retrospective study of fifty three bone marrow biopsy samples [fixed and paraffin embedded bone marrow biopsy] for patients with BNHL. In this study t[11;14] detected by FISH was positive in [64.2%] and it was [66. 7%], [64.3%] and [60%] in Mantle cell lymphoma [MCL], Small cell lymphoma [SCL], and Large cell lymphoma [LCL] respectively. The detection frequency of MDR1/ P- glycoprotein [P-gp] by immnunohistochemistry in MCL, SCL and LCL, is [80%], [82%] and [80%] respectively. In this study the frequency of t[11;14] detection by FISH and MDR1/P-gp expression by immnunohistochemistry in our study was consistent with other studies and considered as a marker of diagnostic and poor prognostic for chemotherapy resistance in B-NHL. Presence of both expressions in a patients means very bad prognosis and resistant to chemotherapy. Determining MDR-1/P-gp and t[11;14] in B-NHL is important prior to treatment to allow the design of novel drug regimens containing agent that reverse MDR function

Cord blood ghrelin, leptin, and IGF-1: their inter-relations and relationships to gestational age, gender and anthropometrics

The main purposes of this study was to: 1] compare cord blood ghrelin, leptin and IGF-1 concentrations in PT-AGA and FT-SGA infants to that of FT-AGA. 2] determine the independent contributions of these metabolic hormones to intrauterine fetal growth and infant birth size. 3] investigate their inter-relations and relationships to anthropometric parameters. 4] determine the effect of gender on cord blood hormone concentrations. We studied 75 newborns [45 males, 30 females], classified into 3 sub-groups: Group A: included 45 infants [25 males, 20 females], FT-AGA as controls. Their gestational ages ranged from 37-42 weeks and birth weights ranged from 2575-3930 gm. Group B: included 19 infants [12 males, 7 females], PT-AGA. Their gestational ages ranged from 28-36 weeks and birth weights ranged from 1855-2350 gm. Group C: included 11 infants [7 males, 4 females], FT-SGA. Their gestational ages ranged from 37-41 weeks and birth weights ranged from 2080-2650 gm. All studied newborns were subjected to a detailed history and clinical evaluation. Demographic and anthropometric characteristics, including body weight, length, HC and BMI were registered immediately after birth. At delivery, cord blood sample was collected from all studied newborns for hormonal assay of ghrelin, leptin and IGF-1. A comparative statistical analysis and correlation studies were done for anthropometric and laboratory data within and between studied groups. Ghrelin, leptin and IGF1 were detectable in cord blood of all newborns. Cord blood ghrelin concentration of group A was significantly lower than that of group B and C, while that of group B was significantly lower than that of group C. Cord blood leptin concentration of group A was significantly higher than that of group B and C, while that of group B was significantly higher than that of group C. Cord blood IGF-1 concentration of group A was significantly higher than that of group B and C, while that of group B was significantly higher than that of group C. Cord blood ghrelin, leptin and IGF-1 were significantly higher in female than in male infants. Cord blood leptin correlated positively with gestational age, birth weight, BMI and cord blood IGF-1. Cord blood ghrelin correlated negatively with birth weight, BMI and cord blood IGF-1. IGF-1 correlated positively with birth weight and BMI. Metabolic hormones, ghreiln, leptin and IGF-1 were detectable in cord blood of all newborns, even at early gestation [as early as 28 weeks gestation] Their interrelations and correlations with gestational age and anthropometric parameters suggest that these hormones are gestation related and may play an important role in energy balance and homeostasis and regulating growth in utero

Biochemical markers of hypoxic myocardial injury in asphyxiated term neonates with hypoxic ischemic encephalopathy

Perinatal asphyxia is a common cause of neonatal morbidity and mortality and neurologic disabilities among survivors. However, no clear-cut physiologic parameters exist which enable an early identification of neonatal infants who are either at risk to develop brain damage or post-hypoxic heart failure. The main problem related to outcome is cerebral damage. 1] Assess the effect of perinatal asphyxia on the cardiac muscle function as reflected by changes in serum levels of CK, CK-MB, cTnl and cTnT. 2] Investigate the diagnostic value of these markers, their sensitivity, specificity, PPV and NPV as early predictors of the severity of cerebral damage and mortality in infants with HIE. 3] Correlate serum levels of CK, CK-MB, cTnl and cTnT in asphyxiated infants to the other markers of perinatal asphyxia. The study included 68 term newborns, 33 were asphyxiated [group I] and 35 were healthy non-asphyxiated as controls [group II]. Group I infants were considered eligible for the study when their Apgar score was

Osteopenia in patients with type 1 diabetes: prevalence and some aspects of pathophysiology

To evaluate the prevalence of osteopenia in patients with type 1 diabetes and its relationship to the metabolic control of diabetes. Also, to study if there is any changes in the biochemical markers of bone formation in type 1 diabetics. This study included 50 male patients with uncomplicated type 1 diabetes, their ages ranged from 18 to 33 years with mean +/- SD [25.3 +/- 5.4 years] and also, sex and aged matched 20 healthy subjects were included as control group. The bone mineral density was measured at the calcaneal bone for all participants using quantitative ultrasonometry. Laboratory evaluation also was done, including glycosylated hemoglobin, serum levels of calcium, phosphate, alkaline phosphatase and osteocalcin. The prevalence of osteopenia in patients with type 1 diabetes was 62% and 8% of type 1 diabetics met the criteria of osteoporosis. Type 1 diabetic patients had significantly lower levels of mean serum osteocalcin than the control group. Also, type 1 diabetic patients with calcaneal osteopenia had significantly higher levels of mean serum glycosylated hemoglobin and sign significantly lower levels of mean serum osteocalcin than those diabetics without calcaneal osteopenia. Osteopenia is frequent in patients with type 1 diabetes with prevalence of 62% and 8% of type 1 diabetics met criteria of osteoporosis. This diabetic osteopenia results mainly from decreased bone formation and the poor metabolic control. We recommend screening of type 1 diabetics for osteopenia and optimization of metabolic control to prevent osteoporosis

study of some oxidant products and antioxidants in children with acute respiratory distress

The present study included sixty pediatric patients with acute respiratory distress, their age ranged from 2 months to 13 years. They were 42 males and 18 females, in addition to twenty apparently healthy children of matchable age, sex and socioeconomic status as control group. All patients were selected from the Intensive care and emergency unit of pediatric department, Assiut University Hospitals. Patients with sepsis or suspected metabolic disease were excluded. Thorough clinical history, examination and chest x-ray were conducted. Laboratory assessments included a peripheral hemogram, serum electrolytes, urea, creatinine, arterial blood gases and estimation of some products of oxidant stress and antioxidants including nitric oxide [s. nitrite], lipid peroxides [LPER], total thiols [glutathione], ceruloplasmin and vitamin E. Out of the 60 patients, 5 cases had viral croup [8.33%], 11 cases had acute viral bronchiolitis [18.33%], 14 children had bronchial asthma [23.33%], 26 cases were diagnosed as bronchopneumonia [43.33%] and 4 cases had lobar pneumonia [6.67%]. No significant difference in arterial blood gases was found between the 5 groups except for PaO[2] which was significantly lower in asthmatic children than in those with bronchopneumonia [P<0.01]. Hemoglobin value was significantly lower and total WBC count was significantly higher in all patients with respiratory distress than controls [P<0.001 for each]. Regarding serum electrolytes, only serum calcium was significantly lower in patients with respiratory distress than controls [P<0.001]. The levels of serum nitrite, lipid peroxides and ceruloplasmin were significantly higher in patients than in controls [P<0.001 for each]. However, serum SOD, total thiols and vitamin E were significantly lower in patients than in controls [P<0.001 for each]. Patients with bronchial asthma showed significantly higher serum nitrite, lipid peroxides and ceruloplasmin and significantly lower total thiols and vitamin E than those with viral croup. Significant positive correlations were noticed between arterial oxygen pressure [PaO[2]] and serum nitrite level and between lipid peroxides and respiratory distress score [P<0.001 for each]. Significant negative correlations were observed between SOD levels fraction of inspired oxygen, between total thiols and either respiratory distress score or Fio2 and between serum vitamin E levels and either respiratory distress score or Fio2 [P<0.001 for each]. Imbalance between endogenous antioxidant systems and oxidant stress with shifting toward oxidant stress may be an underlying pathophysiologic mechanism leading to or aggravating the severity of respiratory distress in airway diseases. Further studies are recommended to delineate the effect of exogenous therapeutic augmentation of antioxidant defenses

Delayed gastric emptying in children with type I diabetes mellitus

Diabetes mellitus is considered a cause of gastroparesis in 30-50% of children and it Is presented with various gastrointestinal symptoms. Erythromycin has a variable effect in treating gastroparesis and the increase in blood sugar can affect its effect. The aim of the work is to assess gastroparesis in diabetic children and to evaluate its relation to gastrointestinal symptoms and also to study the role of erythromycin in the treatment of gastroparesis. The study included 67 children suffered type I diabetes mellitus of moro than 5 years duration. Their ages ranged from 7-11 years. Ten children of matchable age and sex were taken as controls. Clinical history and examination were done with the measurement of glycosylated hemoglobin% and gastric emptying time by scintigraphy. Glycosylated hemoglobin% [HbA1c%] was significantly high in the diabetic patients in comparison to that of the controls [8.02 +/- 1.77 and 4.92 +/- 1.64 respectively]. Out of the 67 patients 31[46.26%] showed delayed gastric emptying time and 18 of them were with gastrointestinal symptoms. HbA1c% was significantly high in those patients with delayed gastric emptying time in comparison to those with normal gastric emptying time [8.48 +/- 1.92 and 7.06 +/- 0.81 respectively]. Also it is higher in those with symptoms than those without symptoms [9.64 +/- 1.75 and 6.89 +/- 0.39 respectively]. As regards the other possible complications that are found in diabetes, patients with neurological type showed significant higher HbA1c%and more delayed gastric emptying time than those without neurological complications [8.31 +/- 2.13 and 6.92 +/- 1.39 and 236.21 +/- 79.12 and 102.1 +/- 43.21 respectively]. By giving erythromycin to the symptomatized patients in a dose of 250, mg 3 times daily for 3 months, 8 out of 18 showed improvement. A positive correlation was found between HbA1c% and GET. In conclusion, gastroparesis could be found in diabetic patients even without symptoms. The presence of other complications especially the neurological type and the uncontrolled blood sugar augment gastroparesis. Therefore, the variable response to erythromycin in gastroparesis is multifactorial

Leptin in patients with thyroid disorder

Leptin is an adipocyte-secreted protein, which functions as a metabolic, neuroendocrine hormone beside its role in regulation of food intake and energy balance. The aim of this study was to assess the influence of hypo and hyperthyroidism on plasma leptin levels. Also, we studied some biochemical changes and its relation to serum leptin. This study was done on patients with newly discovered thyroid disorders [17 cases with hypothyroidism and 19 cases with hyperthyroidism] and 19 lean euthyroid subjects as a control group. We measured the plasma leptin levels, thyroid hormones, and different biochemical variables "serum calcium [Ca], phosphorus [P], alkaline phosphatase [ALP], uric acid, serum urea, creatinine, and complete lipogram and their relation to plasma leptin. The mean leptin levels were higher in hypothyroid patients [9.5 ng/ml in males and 11.9 ng/ml in females] and lower in hyperthyroid patients [1.2 ng/ml in males and 2.8 ng/ml in females] compared with controls [2.4 ng/ml in male and 6.6 ng/ml in female]. Leptin was significantly negatively correlated with thyroxine [T[4]] [r = -0.74 P < 0.0001], triiodothyronine [T[3]] [r = -0.57,]P <0.005] and positively correlated with thyroid stimulating hormone [TSH] [r = 0.78 P <0.0001] after adjusting for body mass index [BMI] and Lipids, Also, plasma leptin significantly positively correlated with BMI = [r = 0.45, P < 0.005]. No significant correlation was observed between plasma leptin and lipids after adjusting for BM1 and thyroid hormones. Their was no significant correlation between leptin and Ca,k ALP, P, uric acid or creatinine. Plasma leptin was significantly elevated in hypothyroidism and decreased in hyperthyroidism, compared with controls. T[4], T[3] and TSH area potent regulator of plasma leptin independent of BMI

Von Willebrand factor, thrombomodulin and nitric oxide in Behcet's disease

Twenty-six patients with Behcet's disease [BD] [15 patients with active disease and 11 with inactive disease] and 20 healthy subjects, as a control group, were included in this study. All patients and controls were subjected to measurement of plasma levels of von Willebrand factor [vWF] and thrombomodulin [TM] as well as serum NO, in addition to complete blood picture, erythrocyte sedimentation rate [ESR] and C-reactive protein [CRP]. The results showed that, means of vWF, TM and NO levels were significantly higher in BD patients than controls. Mean levels of vWF were high in patients with recurrent oral ulcer [ROU] and those with arthritis/arthralgia. Mean values of NO were significantly high in patients with ROU, RGU, patients with arthritis/arthralgia and thrombosis. Mean levels of vWF, TM and NO were significantly higher in active group than inactive group. Positive correlations were found between vWF with ESR2, CRP, TM and NO. Also, positive correlations were found between TM with ESR1 and ESR2. Also, positive correlations were found between NO with ESR1, ESR2 and CRP

impact of CD34 cell dose and T lymphocyte subsets on the incidence of acute and chronic graft-versus-host disease [GVHD] following allogeneic peripheral blood stem cell transplantation

A prospective study of 50 patients of different hematological disorders allografted with peripheral blood stem cells from HLA matched siblings [group I] and 100 recipients of allogeneic peripheral blood stem cell [PBSC] transplantation were reviewed retrospectively [group II]. Patients were classified into two subgroups, subgroup A, patients who did not develop GVHD, while subgroup B were those who developed GVHD either acute or chronic. Acute GVHD was graded according to Settle criteria [1995]. Patients were followed up to two years. From the results obtained, it was concluded that acute and chronic GVHD remains an important factor affecting morbidity and mortality after allogeneic PBSCT. The higher the number of infused CD34+ cells, CD4+ cells, CD8+ cells, the severer the form of acute GVHD. Patients, who developed gastrointestinal GVHD received higher numbers of these cells than those who developed skin or hepatic GVHD. While, patients who developed chronic GVHD either de-novo or on top of acute GVHD received lower numbers of infused CD34+ cells

Adenoids in adult: Clinical and serological study, and endoscopic management

In this study, 49 adult patients with adenoid, proved endoscopically, were recorded. Clinical evaluation was done to detect any associated otorhinologic pathology. Serological tests for HIV, Epstein-Barr virus and cytomegalovirus was studied in the serum of these patients before surgery. Also, serial CT scan on the paranasal sinuses, tympanometry and acoustic nasometric analysis were done to all patients. A safe and more effective technique was proposed to be performed using endoscopic direct visualization during adenoidectomy in adults using 4.0 mm 0, 30 and 70 endoscopes. The adenoid curette was applied transorally to the nasopharynx to remove the main bulk of the adenoids. To remove the peritubal residual adenoid tissue or any residual adenoid tissue obstructing the choanae, a transnasal approach with a straight Blakesley forceps or diode laser was adopted. This study showed that in our locality, adenoid in adults is not uncommon problem, especially in females. Endoscopically, the adenoid was seen to be located on the posterior wall of the nasopharynx or as entopic adenoid tissue in the choanae. Associated nasal pathology [e.g. septal deviation, hypertrophy mucosa on the turbinated] was present in cases with nasopharyngeal and choanal adenoid, while the associated aural complication did not recorded with choanal adenoid. Serological findings revealed that most cases showed positive cytomegalovirus IgG [86.8%] indicating old infection. HIV and infectious mononucleosis spot test were negative in all cases. The combined method of a transoral and transnasal 0 or 30 and 70 endoscopic approach offered a clear operative field. The surgical procedures were all performed under direct visualization. None of the 49 patients had complications, such as postoperative nasopharyngeal hemorrhage or injury to the Eustachian tube of choanae. This method has the potential to become the procedure of choice for adenoidectomy

Follow-up of the effects of splenic irradiation on some splenic and peripheral blood cells measurements: a contreolled study in patients with hypersplenism secondary to periportal fibrosis

Nineteen patients with hypersplenism secondary to compensated periportal fibrosis [ten patients received splenic irradiation [SI], group 1 and nine patients on supportive therapy [ST] group 2]] were included in this study. The follow up period was 9-18 months in group 1 and 4-6 months in group 2. SI course was administrated twice weekly for three weeks to a total dose of 9 Gy. Initial and follow up blood counts and peripheral hemogram including red cell and platelet indices were measured in each visit; while, spleen size, splenic vein diameter were measured by duplex Doppler ultrasound initially and after three and six months. The study concluded that SI is a promising new low toxic type of treatment for patients with hypersplenism. Dose and schedule of SI should be modified according to the patients clinical condition. Changes in splenic vein diameter are correlated with the degree of platelet and red cell turnover. Its predictive value for hypersplenism should be studied

study of serum magnesium, zinc, copper and glycohemoglobin in children with type 1 diabetes mellitus

Magnesium and some trace elements known to act as antioxidants or to be related directly to glucose metabolism may be altered in diabetes mellitus. The aim of the present work is to study the state of these elements in relation to disease duration, control and complications. The study included 25 children with type 1 diabetes and 13 apparently healthy controls studied for serum magnesium, zinc, copper and blood HbA1c. Serum magnesium, zinc and copper were significantly lower in diabetic children than in controls. Serum magnesium was significantly lower in cases with longer duration of disease [>/= 5 years]. Serum magnesium level negatively correlated with the duration of diabetes. Serum zinc was significantly lower in uncontrolled than in controlled and in complicated than in uncomplicated cases. Serum zinc level correlated negatively with the degree of disease control [HbA1c]. It is to be concluded that serum magnesium, zinc and copper are deficient in diabetic children. This deficiency may be related to disease control and/or complications. Supplementation of diabetic children with these nutrients may help in control of the disease and its complications

Relation of spontaneous echocontrast to prethrombotic state in patients with dilated cardiomyopathy

This study investigates the occurrence rate and the association of intracardiac spontaneous echocontrast [SEC] to the hemostatic state and also examines whether the presence of mitral regurgitation [MR] affects SEC and/or thrombus formation in patients with dilated cardiomyopathy [DCM]. Transthoracic and transesophageal echocardiographic studies were performed in 61 hospitalized patients with DCM. Platelet aggregability, prothrombin time [PT], prothrombin concentration, international normalized ratio [INR], activated partial thromboplastin time [PTT], protein C and protein S were estimated in all patients and in 20 healthy control subjects. SEC was observed in 64% [39/61] of patients. Intracardiac thrombi were detected in 8% [5/61], all of them had SEC. Systemic embolism occurred in 13% [5/39] of patients with SEC. SEC showed correlation with increased platelet aggregability and reduced protein C and protein S [P<0.01 for each]. MR jet area and the ratio between MR jet area and left atrial area [which signifies severity of MR] were significantly lower in patients with SEC [P<0.04 and P<0.02 respectively]. In conclusion, among patients with DCM, SEC is a common echocardiographic phenomenon and associated with a hypercoagulable state, thus assessment of hemostate may be useful for evaluating the risk of thromboembolism. Also the presence of significant MR may be protective against SEC and/or thrombus formation in patients with DCM