Association of ficolin-2 gene polymorphisms and susceptibility to systemic lupus erythematosus in Egyptian children and adolescents: a multicenter study.

BACKGROUND: Pediatric-onset SLE (pSLE) is a multisystem autoimmune disease. Recently, the ficolin-2 (FCN2) gene has emerged as a potential candidate gene for susceptibility to SLE. OBJECTIVES: The objective of this study was to evaluate the association of the FCN2 gene polymorphisms at positions -986 (G/A), -602 (G/A), -4 (A/G) and SNP C/T (rs3124954) located in intron 1, with susceptibility to pSLE in Egyptian children and adolescents. METHODS: This was a multicenter study of 280 patients diagnosed with pSLE, and 280 well-matched healthy controls. The FCN2 promoter polymorphisms at -986 G/A (rs3124952), -602 G/A (rs3124953), -4 A/G (rs17514136) and SNP C/T (rs3124954) located in intron 1 were genotyped by polymerase chain reaction, while serum ficolin-2 levels were assessed using enzyme-linked immunosorbent assay. RESULTS: The frequencies of the FCN2 GG genotype and G allele at -986 and -602 positions were significantly more represented in patients with pSLE than in controls (p < 0.001). Conversely, the FCN2 AA genotype and A allele at position -4 were more common in patients than in controls (p < 0.001). Moreover, patients carrying the FCN2 GG genotype in -986 position were more likely to develop lupus nephritis (odds ratio: 2.6 (95% confidence interval: 1.4-4.78); p = 0.006). The FCN2 AA genotype at position -4 was also identified as a possible risk factor for lupus nephritis (odds ratio: 3.12 (95% confidence interval: 1.25-7.84); p = 0.024). CONCLUSION: The FCN2 promoter polymorphisms may contribute to susceptibility to pSLE in Egyptian children and adolescents. Moreover, the FCN2 GG genotype at position -986 and AA genotype at position -4 were associated with low serum ficolin-2 levels and may constitute risk factors for lupus nephritis in pSLE.

Susceptibility of Biomphalaria alexandrina to the plant Azolla pinnata and some herbicides in relation to infection with Schistosoma mansoni miracidia.

Molluscicidal activity of the herebicides 2,4-D and Graminol, as well as both extracts and dry powder of the plant Azolla pinnata were evaluated against B. alexandrina snails. It was observed that 2,4-D proved to be the most toxic compound among he tested ones, showing LC90 of 52 ppm after 24 h of exposure. Ethanol extract of Azolla showed the highest molluscicidal activity against the tested snails compared with the other extracts and dry powder (LC90 = 3300 ppm). Ethanol extract at 6600 ppm after 3 h of exposure killed 100% and 19.4% of S. mansoni miracidia and cercariae, respectively. The molluscicidal activity of 2,4-D was not influenced by the presence of Azolla (900 plants/liter) for 7 days, while Graminol effect was significantly reduced. However, the infectivity of S. mansoni miracidia to B. alexandrina snails was not affected by Azolla existence.

Effect of the plant Azolla pinnata on survival, growth rate, fecundity and hatchability of egg-masses of Biomphalaria alexandrina snails.

Data indicated that Azolla pinnata plants variously reduce the growth rate of Biomphalaria alexandrina snails expressed as net increase in shell diameter (direct or indirect exposure). The plant density played an important role in this respect. The higher the plant density was the lower the growth rate and vice versa. Too, indirect exposure of newly hatched B. alexandrina resulted from exposed treated eggs reduced the growth rate of these snails. Data revealed that direct and/or indirect exposure to the abnormal high density (50,000 plants/L) resulted in complete kill of B. alexandrina snails after two weeks from continuous exposure. Snails exposed directly to Azolla at 50,000 and 25,000 plants/L failed to lay eggs. On the other hand, sanils exposed to 10,000 plants/L laid few eggs, resulted in low reproductive rate (57.94) compared with unexposed ones (110.6). The same trend of results was recorded with hatchability of Biomphalaria eggs.

Mitral balloon valvotomy in children with Inoue balloon technique: immediate and intermediate-term result.

Percutaneous mitral balloon valvotomy (PMV) using the Inoue balloon technique was attempted in 170 patients. Of these, 30 patients were children aged 10 to 18 years (mean 15.9 +/- 2.7 years). There were 16 female and 14 male patients. All were in sinus rhythm. The procedure was successful in 28 patients (93%). PMV was performed using 20 to 28 mm (mean 25 mm) diameter balloon catheters with an echo-Doppler guided stepwise mitral dilation technique. After PMV, the mean left atrial pressure decreased from 25 +/- 5 to 14 +/- 4 mm Hg (p < 0.001). The mean mitral valve gradient (MVG) decreased from 16 +/- 4 to 6 +/- 3 mm Hg (p < 0.001). The mitral valve area (MVA) by catheter increased from 0.7 +/- 0.2 to 1.7 +/- 0.5 cm2 (p < 0.001), and MVA as determined by echocardiography (2DE) increased from 0.8 +/- 0.1 to 1.9 +/- 0.3 cm2 (p < 0.01). There were no deaths or thromboembolic complications; cardiac tamponade developed in one patient, mild mitral regurgitation (MR) developed in three patients (10%) and increased by one grade from (1+ to 2+) in another two patients (8%). A small atrial septal defect (ASD) assessed by color flow mapping developed in seven patients (25%); 90% were closed at 3 months. The Doppler and 2DE MVAs were maintained at 1.8 +/- 0.4 cm2 at 17 months' mean follow-up; one patient developed restenosis. We conclude the PMV using the Inoue balloon catheter is safe and effective in the treatment of severe mitral stenosis in children, with a low complication rate.

Magnetic resonance imaging compared with angiography in the evaluation of intermediate-term result of coarctation balloon angioplasty.

Between July 1986 and December 1990, 24 consecutive adult patients with native coarctation of the aorta underwent balloon dilatation. Their ages ranged from 15 to 55 (mean 25) years. Dissection of the aorta developed in one patient. The remaining 23 patients were restudied by catheterization and magnetic resonance imaging (MRI) 8 to 60 (mean 21) months after dilatation. Both studies were performed between 1 and 180 (mean 40) days of each other. The diameter of the aorta at the site of previous coarctation was measured on angiogram and MRI by two independent observers. The data were compared by means of linear regression analysis. The gradient across the previous coarctation site ranged from 0 to 20 (mean 7 +/- 7.3) mm Hg. The diameter of the aorta at the site of previous coarctation measured on angiogram was 13.7 +/- 3.7 mm and on MRI it measured 13.5 +/- 3.7 mm, with excellent correlation (r = 0.96, SEE = 0.92, p < 0.001). Two patients had small aneurysms 2 cm in diameter demonstrated by angiography and MRI, and two patients developed restenosis, diagnosed correctly by both cardiac catheterization and MRI. This study demonstrates that MRI provides excellent visualization of the anatomy of the aorta and is a good noninvasive method for follow-up of patients undergoing balloon coarctation angioplasty.

Endomyocardial fibrosis: Clinical, echocardiographic and hemodynamic findings.

Endomyocardial fibrosis (EMF) is a disease of unknown origin. It was first described by Davies in Uganda in 1948. The clinical enchocardiographic, and hemodynamic findings in 18 patients are presented. Six patients had right-sided involvement, four had left-sided involvement and eight had biventricular involvement. The presence of a small ventricle with obliteration of the apex and a large atrium, diagnosed by two-dimensional echocardiography, is highly suggestive of endomyocardial fibrosis. Ventricular angiography was diagnostic in 17 out of 18 cases. Endomyocardial biopsy yielded positive findings in three out of seven patients and is not essential for diagnosis. Two patients suffered a cerebral embolism. Six patients underwent surgery with good results in three patients.

Value of immediate angioplasty after intravenous streptokinase in acute myocardial infarction.

To improve reperfusion, immediate percutaneous transluminal coronary angioplasty (PTCA) was considered after intravenous streptokinase (0.75 to 1.5 million U) was administered to 98 patients with acute myocardial infarction less than 4 hours after the onset of chest pain. Thirty-four culprit arteries were occluded (group A); 42 arteries were patent with residual stenosis of more than 70% (group B). Twenty-two patients had residual stenosis of less than 70% (group C); eight of these had severe disease of the remaining vessels. Group C patients were either treated conservatively or underwent bypass surgery. Immediate PTCA was attempted in 74 patients (32 in group A, 42 in group B) and was successful in 68 (92%). Emergency bypass surgery for acute occlusion after PTCA was required in two patients. Follow-up averaged 23 months (range, 16 to 47 months). Asymptomatic occlusion recurred in three patients. Restenosis occurred in five patients: four had early restenosis (one in group A, three in group B) and one had late restenosis (group B). These arteries were successfully redilated. Late reinfarction occurred in two patients. They were treated with intravenous urokinase and repeat PTCA. Elective bypass surgery was performed in three patients because of recurrent angina. They had severe three-vessel disease as revealed by control angiography. The mortality rate was 2.7% (two patients; one in group B had early reinfarction, and one patient in group A died suddenly after 17 months). Eighty-five percent of patients treated with PTCA alone remain free of symptoms. This approach has a high success rate and low morbidity and mortality rates. Long-term results are superior to thrombolysis alone.

Percutaneous transluminal coronary angioplasty more than twice for the same coronary lesion.

To determine outcome and predictors of restenosis after three or more PTCAs for the same coronary lesion we studied 23 patients (17 patients three PTCAs; five patients four PTCAs; one patient six PTCAs). The primary success rate was 100%. Myocardial infarction was seen in one patient; there was no emergency surgery or mortality. Duration of follow-up after the last PTCA was 11-58 months (mean 26 months). Restenosis occurred in 6 of 23 patients (26.1%) after the last PTCA. The symptom-free interval before the last PTCA was less than or equal to 3 months in five of these six patients, a larger balloon for the last PTCA was used in two patients. After the last PTCA 17 of the 23 patients (73.9%) were asymptomatic; repeat angiography in seven of them revealed no restenosis. The symptom-free interval before the last PTCA was less than 3 months in eight patients, and a larger balloon was used in six of these. In nine patients the interval was greater than 3 months, and a larger balloon was used in two. When the symptom-free interval before the last PTCA was less than or equal to 3 months, restenosis occurred in two of eight patients (25%) in whom a larger balloon was used, but in three of five patients (60%) in whom a larger balloon was not used. When the interval before the last PTCA was less than or equal to 3 months five of 13 patients (38.5%) developed restenosis, but when it was greater than 3 months only one of 10 patients did so.