Ultrasonographic assessment of entheseal sites of upper and lower extremities in hemodialysis patients using Madrid Sonography Enthesitis Index.

BACKGROUND: There is no much information about the entheseal involvement among hemodialysis (HD) patients. The aim of this study was to assess the frequency and distribution of ultrasonographic (US) entheseal alterations in HD patients and to evaluate the association between US abnormalities and both clinical and laboratory data. METHODS: This study was conducted on 41 HD patients and 23 sex- and age- matched controls. All participants were evaluated clinically for any signs of enthesopathy. Six entheses sites were scanned bilaterally using grey scale (GS) and power Doppler (PD) US and were scored using Madrid Sonography Enthesitis Index (MASEI) scoring system. RESULTS: In HD patients, at least one clinical sign suggestive of enthesopathy was found in 69 (14%) of 492 entheses. HD patients had statistically significant higher scores of structural tendon abnormalities (p < 0.001), enthesis thickening (p < 0.001), bone erosions (p < 0.001) and calcification (p = 0.037) than the healthy controls. Total MASEI score was higher in HD patients than healthy controls (median;18 vs 8, p < 0.001), also, MASEI-inflammatory (median;11 vs 3, p < 0.001) and damage scores (median;6 vs 0, p < 0.001). There was a statistically significant positive association between total MASEI score and both age (p = 0.032) and duration of HD (p = 0.037). Duration of HD was predictive for both MASEI-damage component (p = 0.004) and total MASEI score (p = 0.014). CONCLUSION: There is a high prevalence of subclinical enthesopathy in HD patients. The entheseal US alterations is much higher in HD patients than in healthy subjects. The duration of HD is the significant predictor of enthesopathy in HD patients.

MiRNA -483-5p as a Potential Noninvasive Biomarker for Early Detection of Alzheimer's Disease.

Alzheimer's disease (AD) is an irreversible, progressive neurodegenerative disease that accounts for 62% of dementia cases in elderly. Early diagnosis of AD is crucial for successful treatment in order to slow disease progression and avoid deterioration. Current diagnostic tools for AD are unable to detect the disease in its early stage; in addition, they still have several limitations. Many studies have shown that microRNAs (miRNAs) are implicated in the pathogenesis of AD, and alterations of their levels in blood make them potential biomarkers for AD. We aimed to evaluate the plasma microRNA-483-5p as a non -invasive biomarker for early diagnosis of AD in mild cognitive impairment (MCI) stage in order to improve treatment outcomes. 40 patients with MCI and AD, and 20 apparently healthy controls were investigated. Plasma levels of miRNA -483-5p were measured by real time polymerase chain reaction (PCR) and expressed as fold change. Receiver operating characteristic (ROC) curve analysis was done to assess diagnostic performance of the assay. Plasma levels of miRNA-483-5p were higher in MCI and AD patients than controls (mean = 8.04, 2.84 and 0.21 respectively, P<0.001), and decreased in AD patients in comparison to MCI patients (mean = 2.84 and 8.04 respectively, P = 0.032). There were significant positive correlations between plasma levels of miRNA-483-5p and age (r = 0.338, P= 0.008) and Dementia Rating (DR) scale (r = 0.351, P = 0.026), and significant negative correlations between plasma levels of miRNA-483-5p and Functional Daily Living Activity (FDLA) scale (r = -0.441, P<0.001), Mini Mental State Examination(MMSE) (r = -0.478, P< 0.001) and Montreal Cognitive Assessment (MOCA) scale (r = -0.396, P= 0.002). ROC curves revealed that miRNA-483-5p has high diagnostic performance in differentiating MCI and AD patients from healthy controls with specificity 95%, 90% and sensitivity 85%, 90% respectively. In conclusion, miRNA-483-5p may be a promising non -invasive biomarker for early diagnosis of AD in MCI stage.

Relationship between Th1 and Th2 cytokine serum levels and immune response to Hepatitis B vaccination among Egyptian health care workers.

Hepatitis B virus (HBV) vaccination leads to both humoral and cellular immune responses and results in protecting levels of specific antibodies. The immune response to the vaccine and production of T-helper 1 (Th1) and Th2 cytokines vary among the individuals. Thus we aimed to investigate the relationship between Th1/Th2 cytokine serum levels and antibody production after HBV vaccination, hoping to improve the effectiveness of vaccination. A total of 90 health care workers had been vaccinated with triple doses of HB vaccine at 0, 1, and 6 months intervals. Two months after the third dose, anti-HBs titer, interferon gamma (INF-γ), and interleukin (IL)-13 serum levels were measured. There were 16 low-responders (anti-HBs = 10-150 IU/L), 41 moderate-responders (anti-HBs> 150< 1000 IU/L), and 33 high-responders (anti-HBs = 1000 IU/L). IFN-γ and IL-13 serum levels showed significant positive correlation with anti-HBs titer. We concluded that, decreased serum level of IFN-γ (Th1 cytokine) and IL-13 (Th2 cytokine) was associated with diminished production of anti-HBs antibodies after HB vaccination, suggesting that IFN-γ and IL-13 could play a significant role in the immune response to HB vaccination and could be used as vaccine adjuvants.

Urinary Orosomucoid - 2 and Soluble CD14 as Potential Biomarkers for Assessment of Disease Activity in Rheumatoid Arthritis.

Rheumatoid arthritis (RA) is the most common inflammatory joint disease leading to severe disability and premature mortality. Current blood biomarkers for assessing RA activity are invasive and are not highly sensitive or specific to changes in disease activity. Therefore, there is a need for new biomarkers that can accurately indicate disease activity. The present study evaluated the use of urinary orosomucoid (ORM) - 2 and soluble CD14 (sCD14) as non-invasive biomarkers for precise assessment of disease activity of RA, in order to improve treatment outcomes in RA patients. The study included 36 female patients with RA, were divided into three groups of mild, moderate and severe disease activity according to disease activity score 28 (DAS 28) based on erythrocyte sedimentation rate (ESR) and were compared to control group. Urinary levels of ORM-2 and sCD14 were measured by ELISA. All patients showed significant increase in urinary ORM-2 and sCD14 levels in comparison to controls. There were significant positive correlations of urinary ORM-2 and sCD14 levels with DAS28score and also with the conventional blood biomarkers (C- reactive protein (CRP) and ESR). The receiver operating characteristic curve analysis revealed that both urinary ORM-2 and sCD14 have higher predictive value for disease activity than CRP and ESR. In conclusion, Urinary ORM-2 and sCD14 levels were increased in patients with RA and were correlated with the disease activity. Thus, the urinary biomarkers might be able to replace blood measures for RA activity as they could provide non-invasive and precise assessment of disease activity in RA patients.