Correlation of Asymmetric Dimethyl Arginine Level to Sickle Retinopathy in Children With Sickle Cell Disease.

Asymmetric dimethyl arginine (ADMA) is a competitive inhibitor of nitric oxide synthetase especially in L-arginine deficiency, which is the case in sickle cell disease (SCD). we aimed to assess the level of ADMA in children with sickle retinopathy and to correlate it to the degree of retinopathy. In this cross-sectional study 40 children with SCD were included, 20 of them with sickle cell retinopathy (SCR) (group I), 20 with normal fundus examination (group II), and another 20 healthy children served as controls (group III). We measured ADMA level by ELISA and performed fundus examination. Seventeen of the 20 children included in group I had Grade I retinopathy (85%), 2 children had Grade II retinopathy (10%), and 1 child had Grade III retinopathy (5%). ADMA was significantly higher in SCD than controls ( P -value <0.001), and it was even higher in patients with SCR compared those without retinopathy ( P -value <0.002), and there was positive linear correlation between ADMA and the grade of retinopathy. The type of retinopathy detect in the studied patients was the nonproliferative type. In conclusion, ADMA is elevated in children with SCD, and its level is even higher in those who develop SCR.

Assessment of the Role of Urinary Heparanase in Lupus Nephritis Patients and Its Correlation with Disease Activity.

Assessing the activity of lupus nephritis (LN) with novel biomarkers is a promising noninvasive diagnostic tool for managing systemic lupus erythematosus (SLE). We assessed the ability of urinary heparanase to identify LN and its relation to the disease's activity. This crosssectional study had 90 subjects: 70 patients with SLE and 20 healthy controls. A full medical history, clinical examination, and routine investigations were carried out for the patients and controls. Immunological assays and assessments of the disease's activity with the SLE Disease Activity Index (SLEDAI) and the renal SLEDAI (r-SLEDAI) were carried out for LN groups. Urinary heparanase levels were measured using an enzyme-linked immunosorbent assay for all subjects. Of our patients, 20 had active LN, 17 had nonactive LN, 18 had active lupus without renal involvement, and 15 had nonactive lupus without renal involvement. The level of urinary heparanase was significantly higher in the LN groups than in the non-LN groups and the controls and was significantly higher in those with active LN than in those with nonactive LN. There were significant positive correlations between urinary heparanase and 24-h urinary protein, total SLEDAI, and r-SLEDAI, and significant negative correlations between urinary heparanase and Complements 3 and 4. Urinary heparanase predicted the activity of LN with a sensitivity of 80% and a specificity of 91.43%. Urinary heparanase levels were higher in patients with active LN and correlated with the markers of disease activity, indicating that it can serve as a useful new biomarker for the activity of LN.

Assessment of the efficacy and safety of single platelet-rich plasma injection on different types and grades of facial wrinkles.

BACKGROUND: Platelet-rich plasma (PRP) is considered as a growing modality for tissue regeneration and a developing research area for clinicians and researchers. PRP injection treatment provides supraphysiological concentrations of growth factors that may help in accelerated tissue remodeling and regeneration. AIM OF THE STUDY: To evaluate the efficacy and safety of single autologous PRP intradermal injection for treatment of facial wrinkles and for facial rejuvenation. PATIENTS AND METHODS: A total of 20 subjects with different types of facial wrinkles were included in this study. All subjects received single PRP intradermal injection and were clinically assessed before and after treatment for a period of 8 weeks using Wrinkle Severity Rating Scale (WSRS), Skin Homogeneity and Texture (SHnT) Scale, Physician Assessment Scale, and Subject Satisfaction Scale. RESULTS: The mean value of WSRS reduced from 2.90 ± 0.91 before treatment to 2.10 ± 0.79 after 8 weeks of treatment. The most significant results were with younger subjects that have mild and moderate wrinkles of the nasolabial folds (NLFs). Fourteen of seventeen subjects with NLFs showed more than 25% improvement in their appearance. Side effects of PRP treatment were minimal to mild and with excellent tolerability. CONCLUSION: Single PRP intradermal injection is well tolerated and capable of rejuvenating the face and producing a significant correction of wrinkles especially the NLFs.

Prevalence of hepatitis C infection among children with ß-thalassaemia major in Mid Delta, Egypt: a single centre study.

BACKGROUND: Transfusion dependant patients are at a higher risk of acquiring bloodborne infections even under conditions of safe transfusion. This study was designed to determine sero-prevalence of hepatitis C infection and possible associated risk factors in thalassaemic children. METHODS: One hundred and twenty five children with ß thalassaemia major (ß-TM) were recruited from the Haematology/Oncology Unit, Paediatric Department, Tanta University Hospital, Egypt, between April 2010 and October 2011. Patients underwent history taking, full clinical examination, routine investigations and venous blood sampling. Serum was stored at -20°C till tested for hepatitis C (HCV Ab) and B (HBsAg) by ELISA. HCV Ab positive cases were confirmed by PCR. RESULTS: All patients were HBsAg negative. HCV Ab ELISA was positive in 76%, negative in 20% and equivocal in 4%. Fifty patients (40%) had positive PCR for HCV. PCR showed low viraemia in 78%, moderate viraemia in 20% and high viraemia in 2%. A positive family history of HCV, history of minor operative intervention and/or dental procedures were significantly associated with higher frequency of HCV infection in thalassaemic children, while amount and frequency of transfused blood, age at transfusion and chelation state were not. CONCLUSION: HCV infection is highly prevalent in children with ß-TM in Egypt despite strict pre-transfusion blood testing. This should arouse the attention for environmental and community acquired factors. Quality management to insure infection control in minor operative procedures and adding more sensitive tests for blood screening are recommended.

Toll-like receptor 9 in systemic lupus erythematosus, impact on glucocorticoid treatment.

AIM: To assess TLR9 expression in systemic lupus erythematosus (SLE) patients, its correlation with disease activity, and impact of TLR9 expression on the response to oral glucocorticoids. METHODS: Twenty-five active SLE, 15 inactive, and 15 control subjects were included. Anti-DNA, ANA, C3, C4, and TLR9 mRNA expressions were assessed. Active SLE patients only received oral steroid for 6 weeks. Post therapy, they were classified into steroid sensitive and steroid resistant. Data were reassessed after treatment. RESULTS: SLEDAI, anti-DNA, ANA, and TLR9 expressions were significantly higher in active SLE patients. Based on retrograde analysis, TLR9 expression was significantly higher in steroid-resistant versus steroid-sensitive group before treatment, with no significant difference between them after treatment. There was a significant positive correlation between TLR9 expression and SLEDAI score and anti-DNA and negative correlation with C3 and C4 in all patients. CONCLUSION: TLR9 may play a role in the pathogenesis of SLE and correlates with the disease activity. Corticosteroids have no effect on TLR9 expression, explaining lack of corticosteroid response in some SLE patients. TLR 9 expression can be used in predicting glucocorticoid response in active SLE patients. New treatment modalities targeting TLR9 expression may be of value in steroid-resistant patients.

Clinical and biochemical predictors of increased carotid intima-media thickness in overweight and obese adolescents with type 2 diabetes.

OBJECTIVE: To identify the clinical parameters associated with increased carotid intima-media thickness (CIMT) in overweight and obese adolescents with type 2 diabetes. METHODS: We studied 27 patients (11 males) with type 2 diabetes. Criteria for selection were age (12-19 years), body mass index above the 95th percentile for age and gender, a positive family history of diabetes, normal or high C-peptide, and negative studies for islet cell antibodies. Age- and gender-matched healthy subjects were selected as the control group. Measurements of CIMT, lipid profile, hypersensitive C-reactive protein, hemoglobin A1C (HbA1C), and insulin resistance by homeostasis model of assessment (HOMA) were obtained for all participants. RESULTS: CIMT was higher in diabetic patients than in healthy subjects (0.68 ± 0.16 vs. 0.58 ± 0.1, p < 0.01). The range of HbA1C in the 15 patients with uncontrolled diabetes was 7.6-10.4 (mean: 8.9 ± 0.9). CIMT, HbA1C, systolic blood pressure, triglycerides, HOMA, and C-reactive protein were significantly higher in patients with uncontrolled than with controlled diabetes. In diabetic patients, CIMT correlated positively with body mass index (p < 0.001), duration of diabetes (p < 0.001), systolic (p < 0.001) and diastolic blood pressure (p < 0.01), HbA1C (p < 0.001), HOMA (p < 0.01), and C-reactive protein (p < 0.01). CONCLUSIONS: CIMT is increased in adolescents with type 2 diabetes. Poor glycemic control, HOMA, increased C-reactive protein, body mass index, duration of diabetes, and elevated blood pressure are associated with early atherosclerosis in these patients.

The impact of H. pyiori eradication on response to oral iron therapy in patients with iron deficiency anemia.

Infection with Helicobacter pylori has been associated with Iron deficiency anemia (IDA). We assessed the effect of eradication of H. pylori infection on response to oral iron treatment. Twenty patients with IDA of no obvious cause, unresponsive to oral iron therapy with positive gastric biopsy for H. pyJoril infection received sequential eradication therapy for 10 days followed by oral iron therapy. Treated patients were followed up at 6 weeks and 12 weeks post eradication to assess dynamic changes in hemoglobin, serum ferritin and transferrin saturation. While 65% of anemic H. pylori infected cases had pangpstritis, 35% had antral gastritis. In the antrum severe and moderate gastritis were found in 40% and 45% of cases, respectively. Hemoglobin and serum ferritin level correlated inversely with grade of gastritis (P <0.001). Improvement in hematological parameters and serum iron profile was observed 6 weeks and 12 weeks post successful H. eradication oral iron therapy. In conclusion, eradication of H. pylori infection enhances the response to oral iron supplementation in patients with refractory IDA. Screening and eradication of H. pylori should be a standard procedure for patients with IDA.

Tissue Doppler and strain rate imaging detect improvement of myocardial function in iron deficient patients with congestive heart failure after iron replacement therapy.

BACKGROUND: Iron deficiency may contribute to diminished exercise tolerance in patients with congestive heart failure (CHF) even in absence of anemia. The aim of this study was to evaluate the effect of correction of iron deficiency on functional capacity and myocardial function in patients with CHF. METHODS: We studied 40 patients with ejection fraction <40%, hemoglobin% >12 g/dL, serum ferritin <100 ug/L, and transferrin saturation <20%. Patients received 200 mg weekly doses of iron dextran complex until serum ferritin level was between 200 and 300 ug/L or transferrin saturation level was between 30% and 40%. Transthoracic echocardiogram, tissue Doppler imaging, peak systolic strain rate, and 6 minute walk test were performed before iron therapy and at 12-week follow up. Peak early diastolic myocardial tissue velocity (E'), peak late diastolic myocardial tissue velocity (A'), and peak systolic myocardial tissue velocity (S') were measured. RESULTS: There was a significant improvement of New York Heart Association functional class (3.0 ± 0.4 vs. 2.1 ± 0.3, P < 0.05) and 6minutes walk distance (322 ± 104 vs. 377 ± 76, P < 0.01) from rest to follow up, respectively. Ejection fraction did not change significantly (32 ± 8% vs. 34 ± 9%, respectively). There was a significant improvement of S'-wave (3.0 ± 0.8 cm/sec vs. 6.0 ± 1.2 cm/sec, P < 0.05), E/E' ratio (22 ± 3 vs. 13 ± 3, P < 0.05), and peak systolic strain rate (-0.72 ± 0.11/s vs. -1.09 ± 0.37/s, P < 0.05) from baseline to follow-up, respectively. CONCLUSION: Correction of iron deficiency improves functional class and walking distance in nonanemic iron deficient patients with systolic heart failure. Tissue Doppler and strain rate demonstrated a significant improvement of diastolic and systolic function after therapy despite lack of improvement of ejection fraction. (Echocardiography 2012;29:13-18).

Cyclin dependent kinase inhibitor p27(kip1) expression and subcellular localization in relation to cell proliferation in hepatocellualr carcinoma.

Hepatocellular carcinoma (HCC) is one of the most prevalent malignancies worldwide, with a recently increased incidence in Egypt. Its prognosis is still poor although many advances in its clinical study. In this work the cell cycle regulation in relation to cell proliferation, as an important determinant of tumor behavior, was evaluated in HCC, as a new aspect of interest in cancer research. The present work involved 27 patients with hepatic focal lesions either being; HCC (group I; n=20 cases) or cirrhotic nodules (group II; n =7 cases). In addition, five controls (group III) with normal liver were studied. p27 production pattern, as an important and recently studied cell cycle regulator, both at mRNA and protein levels was studied by RT-PCR and immunohistochemistry (IHC) assay respectively. This in relation with IHC detection of proliferating cell nuclear antigen (PCNA) as a cell proliferation marker. The present work reported that hepatic tissue expression of p27 both at mRNA and protein levels was significantly decreased in HCC group compared to other groups. However there is no significant difference could be detected in between group II and III. Furthermore reduced p27 expression (mRNA and protein) was significantly related to tumor invasiveness, advanced clinical stage and poor cellular differentiation. While no relation could be detected between p27 expression and either of patient's age, gender, viral hepatitis status, alpha-fetoprotein, Child's grade or vascular invasion. In addition cytoplasmic expression of p27 was positively associated with increased tumor foci number and poor cellular differentiation with a stronger and higher incidence in HCC patients. The present work also reported increased positive rate of PCNA expression in HCC in comparison to other groups. PCNA in HCC, as a cell proliferation marker was found to be positively associated with increased number of tumor foci, advanced tumor invasiveness, stage and grade. PCNA expression was also increased with HBV and HCV/HBV coinfection with no other significant data in HCC. Interestingly and in contrary to our expectation, no significant relationship could be detected between the expression of p27 mRNA and p27 protein, as well as between the expression of p27 (both at mRNA and protein levels) and PCNA in HCC group, while these relations could be detected significantly in the other studied groups. In conclusion, reduced p27 and increased PCNA expressions may play a great role in hepatocarcinogenesis and suggested to be significant predictors of aggressive tumor behavior. p27 and PCNA may act independently with disturbed in between relationship in HCC that may be responsible for carcinogenesis. Whether the expression of p27 protein is regulated at the transcriptional level or by other mechanisms needs to be verified. Finally altered subcellular localization and cytoplasmic sequestration of p27 may be an alternative way to inactivate p27 with a possible evident role in HCC. These finding may help in planning new treatment strategies for HCC, however, large scale in vitro and in vivo studies are needed.