Neutrophil-to-monocyte ratio is the better new inflammatory marker associated with rheumatoid arthritis activity.

Background: Rheumatoid arthritis (RA) is a systemic autoimmune disease that chronically affects patients with episodes of inflammation. New inflammatory hematological markers were investigated for follow-up, such as the neutrophil-monocyte ratio (NMR), lymphocyte monocyte ratio (LMR), and neutrophil-lymphocyte ratio (NLR). This study was conducted to determine the most useful marker based on studies of association with RA disease activity and correlation with the classical markers C-reactive protein (CRP), erythrocyte sedimentation rate (ESR), and rheumatoid factor (RF). Methods: This case-control study included 62 chronic RA patients who had previously been diagnosed and experienced episodes of symptoms while attending a variety of public and private rheumatology clinics in Ibb City, Republic of Yemen, for the period of September 1 to November 30, 2021. Twenty healthy volunteers were included in this study. Complete blood count, CRP, ESR, and RF levels were measured in all participants. Results: The total leukocyte count, neutrophil count, platelet count, NMR, LMR, and NLR were positively correlated with CRP and ESR, but the monocyte count was reversed. The area under the curve (AUC = 0.861, 95% confidence interval [CI] = 0.769-0.948) for the NMR cutoff value of 4.7 was equal to that of CRP and close to that of ESR. This NMR cutoff value had 87% sensitivity and 80% specificity. LMR and NLR cutoff values of 4.35 and 1.35, respectively, resulted in AUCs of (AUC = 0.807, 95% CI, 0.708-0.905) and (AUC = 0.699, 95% CI, 0.571-0.819); their sensitivity and specificity were 62.3%, 90%, 57.4%, and 80%, respectively. Conclusions: As a convenient and low-cost inflammatory marker of RA activity, NMR outperformed LMR and NLR.

Early infant feeding and allergic respiratory diseases in Ibb city, Yemen.

BACKGROUND: Allergic respiratory diseases (ARD) are a highly prevalent health problem affecting infants and children in Yemen. Early infant feeding predisposition to the development of ARD has been a controversial question. The aim of this study is to investigate the association between early feeding before 6 months of age and the development of ARD among children attending Childhood and Maternity Public Hospital (CMPH), Ibb, Yemen Republic. SUBJECTS AND METHODS: The study population included 151 child patients attending the pediatric clinic at CMPH. Upon clinical and laboratory examinations, 72 out of 151 patients had ARD, while the other 79 had diseases other than ARD; all of them were used in risk assessment. Fifteen blood samples from healthy volunteers were used in laboratory investigations as a control. Complete blood count and IgE level were investigated for all participants. Children's parents were requested to give an informed consent and fill questionnaire about demography and history details. RESULTS: Early infant feeding was a significant risk factor for the development of ARD with an odds ratio (OR) of 6.8 and 95% confidence interval (CI) 3.0 to 15.3. Artificial milk particularly was risk factor with an OR of 6.1 and 95% confidence interval 2.7 to 13.5. Artificial milk exhibited more wheezing and asthma attack than others (OR 4.3, 95% CI 1.9 to 9.4 and OR 7.6, 95% CI 3.5 to 16.3, respectively). The risk of wheezing and asthma attack also increase with early feeding generally (OR 3.0, 95% CI 1.3 to 7.2 and OR 4.8, 95% CI 2.2 to 8.1, respectively). The patients had a higher sensitization markers than the control, such as eosinophil count and total serum IgE. The highest levels of IgE ever reported existed among early fed patients with artificial milk. CONCLUSIONS: Early infant feeding, particularly with artificial milk, is a risk factor predisposing infants to the development of allergic respiratory disease presented with more clinical features of wheezing and asthma attack.

Evaluation of antibody immunochromatography testing for diagnosis of current Helicobacter pylori infection.

BACKGROUND: Helicobacter pylori infection represents a major gastrointestinal complaint associated with gastritis, gastric ulcer and stomach tumors. It is present in 90 % of developing countries population. H. pylori diagnosis in these countries, where resources are limited, is accomplished with simple non-invasive tests such as stool antigen and serum antibody tests. The aim of this study was to evaluate the serum antibody test in the diagnosis of current H. pylori infection. SUBJECT AND METHODS: A total of 117 patients were included in this prospective diagnosis accuracy testing study, who clinically presented with dyspepsia, heartburn, abdominal pain, diarrhea, or halitosis. A stool sample was collected from each patient and tested for H. pylori antigen using immunochromatographic method.Blood sample was also collected, half of which was EDTA-sampled and analyzed for complete blood count, while the remaining half was left to clot, the separated serum was tested for antibodies against H. pylori with immunochromatographic cassette. RESULTS: About 35 % of sixty six patients who were positive for stool antigen test gave a negative for serum antibodies test. Meanwhile, the non-consistent results within 51 negative stool antigen test patients was exhibited by 47 % of them. The discrepancies were not affected by age or disease duration. The calculated sensitivity, specificity, positive predictive value and negative predictive values were 50 %, 65 %, 65 % and 50 % respectively. CONCLUSION: The serum antibody test is not reliable in the diagnosis of current H. pylori infection. In developing countries, with limited facilities and primary care units, stool antigen test diagnosis is useful for diagnosis.

Compensation of CD55 Underexpression on Red Blood Cells of ß-Thalassemia Major Patients.

ß-Thalassemia (ß-thal), is an autosomal recessive disorder caused by mutations at the ß gene locus. ß-Thalassemia major (ß-TM) is a severe form of the disease, characterized by severe hypochromic and hemolytic anemia with an increased need for transfusion. Hemolysis is caused by intoxication, whereas mechanical removal of the affected cells caused by macrophage. Immunological implications are also reported and occur via antibodies and complement. We found previously that complement inhibitor receptor CD55 is underexpressed in these patients. This study concerns the compensatory mechanisms of this diminished expression upon flow cytometry analysis of CD55 and CD59 on the red blood cells (RBCs) of ß-thal patients. This study was conducted on 24 patients and 10 healthy controls. Full history and transfusion data was obtained, then a complete blood count (CBC) and flow cytometry analysis of CD55 and CD59 on erythrocytes were carried out. Within our 24 patients, we found a diminished expression of CD55 with a normal expression of CD59. The percentage of cells that express CD55 was significantly different from that of the controls. The mean fluorescence intensity (MFI) of CD55 and CD59 with correlation studies reveals that different factors affect the underexpression of CD55 and also revealed compensatory changes of the defect to minimize the hemolysis occurring in ß-thal patients. Compensation of CD55 underexpression in the deficient patients occurred when an increase in the MFI of both the receptor CD55, on the positive cells, and another complement inhibitor receptor CD59.

Red blood cells alloimmunization and autoimmunization among transfusion-dependent beta-thalassemia patients in Alexandria province, Egypt.

BACKGROUND: Beta thalassemia is considered a severe, progressive anemia, which needs regular transfusions for life expectancy. One of the most important complications of regular blood transfusions is autoimmunization and alloimmunization, which increases the need for transfusion. This study was performed to investigate the frequency of auto- and allo-antibodies in beta thalassemia patients in Alexandria, Egypt. MATERIALS AND METHODS: Blood samples of fourteen beta thalassemia patients were collected and tested for autosensitization with direct antiglobulin test (DAT). The positive DAT blood sample undergone antibody elution then identification. Plasma of the patients were also investigated for allosensitization by testing against cell panel reagents. RESULTS: DAT was positive in 45% of the patients. Eluted antibodies were identified in 6 cases of 10, they were Kp(b) and Lu(b), and one positive test was unidentified. Alloantibodies were detected in 42.5% of the cases. The identified antibodies were anti-D (4.76%), anti-c (4.76%), anti-K (4.76%), anti-Kp(a) (9.52%), anti-Kp(b) (19.05%), anti-Lu(a) (9.52%), anti-Lu(b) (19.05%), and anti-Bg(a) (4.76%). A total 23.81% of the alloantibodies were unidentified. DISCUSSION: This study observes that autoimmunization and alloimmunization were more frequent among poly transfused beta thalassemia Egyptian patients. The presence of these clinically significant alloantibodies is a bad indicator for situation of blood transfusion. There is need for use an effective strategies to provide a safe blood for those patients by using leukodepleted blood and more compatible blood with extended phenotyping.

Uropathogenic Escherichia coli isolates with different virulence genes content exhibit similar pathologic influence on Vero cells.

Uropathogenic Escherichia coli are the major causative agent of urinary tract infection--they may simultaneously express a number of virulence factors to cause disease. The aim of this study was to investigate the relation between virulence factors content of fifteen UPEC isolates and their pathogenic potential. The isolates belonged to the five serotypes O78:K80, O114:K90, O142:K86, O164 and O157. Nine of the virulence factors have been explored, ibeA, pap, sfa/foc, cnfl, hly, fyuA, pil, ompT and traT. Virulence factors profiling of the isolates revealed a different content ranging from 22% to 100% of the virulence genes explored. The pathogenic capacity of all fifteen isolates when tested on Vero cells showed that the cytotoxicity for all tested strains on Vero cells was approximately equal and enhanced after growth in syncase broth, leading mainly to cell lysis. The toxic effects reduced slightly after heat treatment of the toxin, and greatly after formalin detoxification, but not all the deleterious effect was abolished. Endotoxin also has cytotoxic effects on Vero cells, but longer time is needed for cytolysis which is greatly diminished with formalin treatment. In conclusion, our study revealed that pathogenic strains of UPEC can exert their pathogenic effect on live cells or system with limited virulence factors gene content.

Expression of CD55 on red blood cells of ß-thalassemia patients.

CD55 is a complement regulatory protein expressed by cells to protect them from bystander lysis by complement. It prevents the formation of C3/C5 convertase. In ß-thalassemia (ß-thal), the defective hemoglobin (Hb) production makes red blood cells (RBCs) lyse early and frequently. Loss of CD55 expression in those patients compromises the complement regulatory function, thereby accelerating RBC lysis. In this study, we aimed to evaluate the expression of CD55 on erythrocytes of ß-thal patients. Flow cytometry analysis of CD55 was conducted on RBCs of 21 ß-thalassemia major (ß-TM) patients, 11 ß-thalassemia intermedia (ß-TI) patients and 10 healthy volunteers. The results showed a significant decrease in CD55 expression in ß-TM (57.5 ± 16.7%), while there was a slight decrease in ß-TI patients (81.8 ± 3.8%) in comparison with that of the normal controls (88.7 ± 0.8%). The diminished expression of CD55 was not accompanied by decrease in CD59 expression in ß-thal patients (97.2 ± 2.3%). This could suggest a mechanism (could be genetic) responsible for low CD55 expression. It may be related to defective Hb genes in thalassemia, but it does not relate to cell membrane changes.