Laboratory screening for rhabdomyolysis among beginners practicing vigorous exercises

The objectives of this study were: screening for cases of exertional rhabdomyolysis among beginners in practicing vigorous exercises, and finding out reference laboratory values for the students who will exercise for the first time. The study was conducted in Assuit university hospital on 222 male students of first year of faculty of sports, who practiced vigorous exercises for one hour with maximal load, for the first time, and 20 apparently healthy subjects as a control group [GI]. Twenty four hours after vigorous exercise [24hs AVE], blood samples were collected and the students were classified according to [CK] levels into two groups, group II [GII] :125 students, with total CK<183U/L[cut off value] and group III [GIII]: 97 students, with total CK>183U/L. One month after vigorous exercises [I m AVE], blood samples were collected from [GIII] which represent the follow up group [GIV, baseline]. All participants were subjected to medical history, clinical examination including body mass index [BMI], and quadriceps circumferences. Laboratory investigations included peripheral haemogram, kidney and liver function tests, blood minerals, and specific tests including: total CK, CK-MB and CK-MM isoenzymes, LDH, and serum myoglobin. This study revealed statistically highly significant elevation of total CK, CK-MM, CK-MB, AST and serum myoglobin when comparing [GIII] with each of [GI] and [GII] while a high significant reduction was found when comparing [GIV] with [GIII]. No significant difference could be detected when [GIV] compared with [GI] and [GII] compared with [GI]. There was a significant reduction in serum Na+ and serum Ca+ + level and highly significant elevation in serum K+ and phosphorus in GIII when compared with GI. No statistical significance in [BMI] was detected. Twenty four hours after vigorous exercises, 16 students [7.2%] showed total CK level more than 5 times the cut off value [183 U/L]. These students showed no signs and symptoms of rhabdomyolysis except muscle pain. The participant students who showed total CK values five times or more than the cut off value [183 U/L], are considered by some authors to be suspicious of having rhabdomyolysis. Laboratory values of the students who did not show rhabdomyolysis, could be taken as reference values for students and untrained persons who will practice exercise vigorously for the first time

Significance of calcium pyrophosphate dihydrate and monosodium urate crystal identification in synovial fluid of arthritic patients

Diagnosis of joint arthritis usually depends upon certain clinico-investigatory criteria settled by international organizations. These criteria do not reveal a solid diagnosis in many occasions, also sometimes coexistence of more than one type of arthritis results in poor management and worsen the prognosis of the case. This descriptive study aimed to evaluate the role of synovial fluid crystal identification in reaching a final diagnosis of undiagnosed effusion - associated arthritis, also, to assess the value of crystal identification in diagnosis of coexistence of two or more types of arthropathies. Sixty-one patients with established joint effusion due to arthritis [acute or chronic] were included in the study. The patients were grouped into six groups according to the type of rheumatological disease after careful clinical, laboratory and radiological evaluation. Twelve cases were diagnosed as rheumatoid arthritis [RA], sixteen as osteoarthritis [OA], nine as gout, one as pseudogout, four as systemic lupus erythematosus [SLE], and four as spondyloarthropathies [SPA]. The seventh group was the undiagnosed group. All patients had subjected to synovial fluid [SF] aspiration by arthrocentesis. The aspirated samples were examined macroscopically, and microscopically for leucocytic count and crystals using polarized light microscopy [PLM]. Two types of crystals were specifically looked for: monosodium uratre [MSU] crystals that cause gout and calcium pyrophosphate dihydrate [CPPD] crystals that cause calcium pyrophosphate deposition disease. Other laboratory investigations included C- reactive protein, serum uric acid, and rheumatoid factor. After using [PLM] we found that, out of 61 cases examined, twenty samples [32.8%] showed crystals[six[9.8%] were MSU, nine[14.8%] CPPD, and five[8.2%] showed both MSU and CPPD crystals], Examination of SF for MSU and CPPD crystals showed significant changes in the diagnosis of arthritis. Out of 61 examined cases, combined arthritis was diagnosed in ten cases [16.4%] [combined OA and CPPD in five cases, combined RA and CPPD in two cases, and combined RA, MSU and CPPD in one case, combined SLE and CPPD was diagnosed in one case and combined SPA and MSU in another one]. Consequently, PLM examination allowed us to reduce the undiagnosed cases from 24.6% to 16.4%. In conclusion: Examination of SF for MSU and CPPD crystals is worth looking and can change the management strategy. It allowed us to reach a definite diagnosis in undiagnosed arthritis,and to identify the coexistence of two or more types of arthropathies. Polarized light microscopy remains the only practical way for identifying SF crystals

Role of IL-6, sIL-6R, IL-1 beta, TNF-alpha, and B2M in pathophysiology and prognosis of multiple myeloma

Cytokines control myeloma cell proliferation, differentiation, apoptosis and tumor-induced bone marrow destruction. The present study was designed to estimate the serum levels of interleukin-6 [IL-6], soluble IL-6 receptor [sIL-6R], IL-1 beta, tumor necrosis factor-alpha [TNF-alpha], and beta-2 microglobulin [beta 2M] in multiple myeloma [MM] in an attempt to elucidate their role in the disease, to study their levels in different immunologic types of MM, and to evaluate the effect of therapy on these levels. The study included 40 patients with MM, 20 newly diagnosed [group I] and 20 patients receiving treatment [group II]. Ten patients received therapy for one year [group IIb]. Patients were subclassified according to beta 2M level into [patients with beta 2M < 6 mg/L and patients with beta 2M >/= 6 mg/L]. Fifteen healthy individuals were included as controls. Samples of all patients and controls were subjected to serum protein electrophoresis, immunofixation, serum cytokines [IL-6, IL-1 beta, TNF-alpha], sIL-6R, and beta 2-microglobulin estimation. Bone marrow aspiration [for patients only] and other laboratory chemical investigations were also performed. Serum immunofixation electrophoresis revealed that out of 40 patients, 25 were IgG myeloma, 12 were IgA myeloma, one case was light chain myeloma and 2 cases had biclonal gammopathy. Serum IL-6, sIL-6R, IL-1 beta, TNF-alpha and beta 2M showed significant increase in patient groups compared to controls, with no significant difference between groups I and II in both [IgG] and [IgA] myeloma. On the other hand, IL-6, sIL-6R, and beta 2M were significantly decreased in group IIb when compared with group I and group IIa. When beta 2M level was used for subgrouping, IL-6, sIL-6R, IL-1 beta, and TNF-alpha were significantly higher in group II patients with beta 2M >/= 6 mg/L than those with beta 2M < 6 mg/L. As IL-6, sIL-6R, IL-1 beta TNF-alpha, and beta 2M were elevated in all the studied myeloma patients, they might be involved in the pathophysiology of the disease irrespective of its immunologic type. IL-6 and sIL-6R could be used in monitoring the effect of therapy in MM especially in patients with impaired renal function. In addition of being known as a good prognostic marker, beta 2M could be used to monitor the response to therapy in MM

Significance of antikeratin antibodies in discrimination between rheumatoid arthritis and polyarthritis associated with hepatitis C infection

Hepatitis C virus [HCV] injection is often associated with extrahepatic manifestations among which arthropathy is common. HCV-related arthritis commonly present as rheumatoid-like arthritis, with positive rheumatoid factor [RF]. In this study, we try to distinguish between rheumatoid arthritis [RA] and polyarthritis associated with HCV infection using a marker more specific to RA than the rheumatoid factor [RF] namely anitkeratin antibody [AKA]. Serum AKAs were evaluated [by indirect immunofluorescence technique] in two groups of patients ,all were RF seropositive. Group I. 25 patients with HCV associated polyarthralgia or arthritis. Group II: 25 patients with RA fulfilling the American college of Rheumatology [ACR] revised criteria. In addition 15 healthy individuals served as controls. All patients of group II as well as healthy controls were HCV seronegative. Other investigations were done for all groups such as erythrocyte sedimentation rate [ESR], C reactive protein [CRP] and antinuclear antibody [ANA]. Plain X ray of both hands were done for all patients to exclude the patients with bone erosion. The study revealed that anitkeratin antibodies were detected in 15/25 [60%] patients with true RA and only 3/25[12%] patients with HCV-related arthritis. AKA were not found in the sera of the healthy controls. The specificity and sensitivity of AKA in RA group were 88% and 60% respectively. Anitkeratin antibody is highly specific for RA and its estimation may increase the diagnostic performance of RA. AKA is a useful marker in discrimination between patients with true RA and those with HCV-associated arthritis

Peritoneal fluid and serum concentrations of interleukine-6, interleukin-15 and tumor necrosis factor-alpha in women with endometriosis

The objective of this prospective controlled study was to investigate the ability of a group of serum and peritoneal fluid [PF] markers to predict non-surgical endometriosis. The study was conducted in Assiut University hospital, serum and PF samples were obtained from 40 women at the reproductive age, while undergoing laparoscopy for infertility or suspicious qf endometriosis. Concentrations of interleukin [IL] 6, IL-15 and tumor necrosis factor [TNF]-alpha were measured in serum and PF, by sandwich ELISA technique, and levels were compared among women who were allocated to groups according to post-surgical diagnosis, group I [endometriosis], included 24 patients, group II [non-endometriosis], included 7 women with peritoneal adhesions not related to endometriosis, and group III [control group], included 9 women without pelvic pathology. The endometriotic group was classified into 3 stages according to the revised American Fertility Society [I985] classification: Stage I, 11 patient, stage II, 8 patients and stage III, 5 patients. Results of this study revealed that serum IL-6 was significantly higher in endometriosis than in non-endometriosis and controls, serum TNF-alpha was significantly higher in endometriosis than controls with no significant difference with nonendometriosis. Serum IL- 15 was undetectable in all controls as well as about half of the endomoetriotic and non-endometriotic groups. As regards PF-IL-6, it showed no significant difference in comparing the 3 groups with each other. Both PF-TNF-alpha and PF-IL-15 were significantly higher in endometriosis than in non-endometriosis and controls and in non-endometriosis than controls. PF-IL- 15 levels were significantly higher in late stages of endometriosis and positively correlated with the stage of endometriosis. In conclusion only serum IL-6, PF-IL-15 and PF-TNF-alpha could be used to discriminate between patients with and without endometriosis. Before these markers can be used as a non-surgical diagnostic tool, these data should be verified in a larger study PF-IL-15 is the only marker that is affected by the stage of endometriosis and so, it can be used us a quantitative rest for severity of the disease

Vascular cell adhesion molecule-1, E-selectin and von willebrand factor: Role as surrogate markers of angiogenesis in breast cancer

Angiogenesis, the development of new blood vessels from pre-existing vasculature, is a prerequisite for tumor growth and metastasis in breast cancer. Surrogate markers for angiogenesis would be useful for studying the effectiveness of antiangiogenesis drugs. We examined the potential of three glycoproteins: vascular cell adhesion molecule-1 [VCAM-1], endothelial selectin [E-Selectin], and von Will brand factor [vWF], to serve as markers for angiogenesis. Serum levels of VCAM-1, E-selectin and plasma vWF levels were measured by enzyme-linked immunosorbent assay in 54 women with different stages [1-IV] of breast cancer [12 women in stage 1, 16 in stage 11, I4 in stage III and 12 in stage IV]. Their ages ranged from 25-70 years. To investigate whether the concentration of these activated endothelial cell molecules are associated with breast cancer, the serum levels of soluble VCAM-1, E-selectin and plasma levels of vWF in women with breast cancer were compared with those of22 healthy age-matched control women, we also examined whether levels of VCAM-1, E-selectin or vWF are associated with tumor progression and stage of breast cancer [early and advanced breast cancer]. The results revealed that levels of VCAM-1, E-selectin and vWF are elevated in breast cancer women, even in early stages when compared with control women. Although plasma vWF and serum VCAM-1 levels were significantly elevated in advanced stages than early stages of breast cancer with a positive correlation with disease stage, E-selectin did not show a statistical difference between different stages of breast cancer. vWF, which is released by all endothelial cells, would be a pan-endothelial marker that would not accurately report angiogenesis and Serum soluble VCAM-1 can, be considered as an accurate marker of tumor angiogenesis in breast cancer