Increased frequency of CD4 + CD25 + FoxP3 + circulating regulatory T cells [Treg] in tuberculous patients

CD4 + CD25 + FoxP3 + circulating regulatory T cells [Treg] play a fundamental role in the control of immune responses by down-regulating the function of effector CD4 + or CDS + T cells. Active suppression by Treg might be important in controlling immune responses against Mycobacterium tuberculosis [Mtb]. This study was conducted to evaluate the cellular immune response to Mtb, by evaluation of Treg cells in peripheral blood mononuclear cells [PBMCs] from patients with active pulmonary tuberculosis [PTB], patients with tuberculous pleurisy [TP] and healthy positive PPD persons as control, then evaluation after 6 months of anti-TB therapy, also evaluation of Treg cells in pleural fluid mononuclear cells [PFMCs] from patients with tuberculous pleurisy [TP]. We compared the frequency of CD4 + CD25 + FoxP3 + circulating regulatory T cells [Treg] in 20 patients with active pulmonary TB [PTB], 15 tuberculous pleurisy [TP] and 20 control latent tuberculosis. Treg frequencies in peripheral blood were significantly higher in patients with PTB and TP than in the control group [p < 0.001]. Treg frequencies were significantly higher in pleural effusions than in peripheral blood in the same group [p < 0.001]. Treg frequencies in peripheral blood were significantly decreased after 6 months of anti-TB treatment [p < 0.001]. Immune regulatory mechanisms may limit the immunopathologic condition of infection with M. tuberculosis and suppress cellular immune responses in the host. We investigated the CD4 + CD25 + FoxP3 + circulating regulatory T cells [Treg] in patients with pulmonary tuberculosis, tuberculous pleurisy and latent TB, and the frequencies of CD4 + CD25 + FoxP3 + T-cells after anti-TB therapy. MTB infection is associated with an increase in the frequency of CD4 + CD25 + FoxP3 + Treg in the blood of PTB and TP, in the pleural fluid of TP, decrease in the frequency after anti-TB therapy

Value of cardiac biomarkers in patients with acute pulmonary embolism

Prognostic stratification of patients with PE is important in management and potentially improve clinical outcome. Cardiac biomarkers are used as an adjunct to clinical and echocardiographic risk stratification in a variety of circumstances, [Creatine-kinase-MB [CK-MB]] and cardiac troponin I [cTnl] are most widely used because of their high sensitivities, and very high specificity of troponin for heart muscle injury. Evidence is mounting that myoglobin's sensitivity for myocardial necrosis combined with its unique release and clearance properties may render it particularly attractive as a risk marker either alone or in combination with other markers. The aim of the current study is to assess the levels of cardiac specific biomarkers in relation to different clinical, ECG and echocardiogrphic findings in patients with acute PE, as well as evaluating the prognostic value of these biomarkers for inhospital mortality and adverse clinical events. This study comprised 40 patients with proved PE [22 males and 18 females], their mean age was 50.05 +/- 13.09 years [range 22-70 years]. The following investigations were performed for all patients; 12-leads ECG, Full echo Doppler study, spiral CT of the chest, and laboratory testing: arterial blood gas, serum myoglobin, serum troponin, total CK and CK-MB, kidney and liver function tests. Significant elevation of CK-MB [> 10 micro/L] was noted only in 7.5% of patients, while cardiac cTnl was elevated [>/= 0.07 ng/ml] in 45% of patients and elevated serum myoglobin was found very early after symptoms [<4 h] in 55% of patients. Elevated serum cTnl and myoglobin were significantly associated with ECG signs of right ventricular strain and echocardiographic evidence of right ventricular dysfunction. The results of the present study demonstrate the prognostic value of cardiac specific biomarkers, cardiac troponin I and myoglobin in acute pulmonary embolism. Thus, the current data combined with the results of previous studies strongly support the integration of troponin and myoglobin testing into the risk stratification and management of patients with established acute PE

Asthma is inversely associated with Helicobacter pylori status

The increase in asthma rates has been linked epidemiologically to the rapid disappearance of Helicobacter pylori, a bacterial pathogen that persistently colonizes the human stomach. Recent evidence indicates that, H. pylori may have protective effects on allergic diseases. The aim of this study was to explore the relationship between asthma and H. pylori infection in a population with high prevalence of H. pyloriinfection. One hundred and seventeen asthma cases were eligible for the study in addition to 86 non asthma cases as control. Pre and post - bronchodilator spirometry, assay of Total serum immunoglobulin E [IgE] by enzyme immunoassay technique [ELISA] and [14]C Urea Breath Test [UBT] were done. Out of 41 asthmatic cases with positive H. pylori were 22 patients had mild asthma, 14 had moderate asthma, and 5 only had severe asthma with statistically significant difference between them. The mean serum level of Total IgE was significantly higher [190.04 +/- 111.9] in patients group than control group [94.13 +/- 46.49] with p-value 0.000, while the mean UBT was significantly lower [325.85 +/- 261.35] in patients group than control group [1068.67 +/- 680.7] with p-value 0.000. AS regard pulmonary function tests [FEV1 and FVC], there was statistically significant difference between positive H. pylori asthmatic and negative H. pylori asthmatic. We demonstrate an inverse association between H. pylori and asthma in a population with a high prevalence of H. pylori

Bronchiectasis in COPD patients

COPD and brochiectasis are characterized by fixed airway obstruction and chronic cough. The finding of bronchiectasis on HRCT scan in the patient with COPD may indicate the presence of more advanced airway dysfunction, frequent exacerbation and bacterial colonization. The aim of this study to evaluate the incidence of bronchiectasis on high resolution computed tomography [HRCT] scanning in patients with moderate and severe COPD, and to relate this with the presence of lower airway bacterial colonization, exacerbation frequency, severity. This study was carried out on 69 patients diagnosed with COPD. All cases were subjected to through history taking, lung function test, sputum culture, HRCT scan of the chest to diagnose bronchiectasis, All the test were performed in a stable phase. 69 COPD patients, 32 patients had moderate COPD, 37 patients had severe COPD, 33 patients [47, 8%] presented with brochiectasis, [31.3%] of the patients with moderate COPD and 62.2% of the patients with severe COPD with statistically significant difference, the more severe functional impairment [FEV1

High dose versus low dose streptokinase infusion in patients with submassive pulmonary embolism and echocardiographic right ventricular dysfunction

Pulmonary embolism [PE] remains a major cause of morbidity and mortality in the general population, the established treatment for PE is anticoagulation. It has previously been demonstrated that thrombolytic therapy can be lifesaving in patients with massive PE [haemodynamic instability and right heart failure]. However, the use of thrombolytic therapy in patients with submassive PE [haemodynamically stable] remains a controversial topic. Recent clinical studies, however, support evidence that thrombolysis may favorably affect the outcomes in a wider spectrum of high risk PE patients presenting with right ventricular dysfunction [RVD] as evidenced by decreased right ventricular end diastolic diameter [RVEDD], disappearance of paradoxical septal motion [PSM], and tricuspid regurge [TR] as well as decrease in the pulmonary artery pressure. The aim of this study was to evaluate the effect high dose streptokinase [SK] in 1 hour versus low dose SK in 24 hours in patients with submassive PE and RVD. The study included 50 patients [25 males and 25 females, mean age 45.5 y] with submassive PE [positive spiral CT chest] and RVD [proved by echocardiography]. Those without contraindications to SK were randomly assigned to receive either high dose [group 1] or low dose [group 2] of SK. Those with contraindication [s] to SK received anticoagulation [group 3]. Echocardiography was done before and 72 h after treatment. Right ventricular dysfunction [RVEDD, PSM, and TR] and mean pulmonary artery pressure [PAP] improved significantly 72 h after treatment in group 1 and 2, while a slight improvement in PAP was observed after treatment in group 3. No significant difference was noticed between group 1 and 2 regarding the effect of treatment on RVD or PAP. No significant difference was found between group 1 and 2 regarding the complications of SK. No significant difference was found between the 3 groups regarding the mortality. These data suggest that SK can rapidly reverse the pulmonary hypertension and RVD in contrast to anticoagulation. Both protocols of SK are equieffective in rapid reversal of RVD and pulmonary hypertension. Both protocols were safe as proved by absence of difference in mortality over anticoagulant group