Temporomandibular Joint Manifestations in Rheumatoid Arthritis: A Case Report.

Rheumatoid arthritis (RA) is a chronic infl ammatory disease characterized by joint swelling, joint tenderness, and ravagement of synovial joints, leading to rigorous incapacitation, and premature mortality. It was fi rst described by Dr. Augustin Jacob Landr´e-Beauvais in 1800. RA aff ects about 1% population worldwide. Temporomandibular joint (TMJ) involvement is usually found along with the involvement of the joints of the hands and feet. TMJ involvement is associated with pain, infl ammation, limited joint movements, swelling, joint stiff ness, and muscle spasm. Radiological features include cortical erosion, decreased joint space, de-ossifi cation, sharpen pencil head or spiked deformity or mouthpiece of fl ute deformity of the condylar head. Clinical examination and investigations (radiographic and hematological) remain the mainstay of diagnosis. Here, we present a case of RA of TMJ along the joints of the hands and feet.

Evaluation of procalcitonin, C-reactive protein, interleukin-6 & serum amyloid A as diagnostic biomarkers of bacterial infection in febrile patients.

Background & objectives: Early identification of bacterial infection in patients with fever is important for prompt treatment. However, the available parameters such as C-reactive protein (CRP) and leukocyte counts are not very specific. This study was aimed to assess the diagnostic value of procalcitonin (PCT), CRP, interleukin-6 (IL-6) and serum amyloid A (SAA) for bacterial infection in febrile patients. Methods: Serum samples were collected from febrile patients between January and December 2012 and processed for blood cultures. PCT, IL-6, CRP and SAA levels were measured. The patients were divided into three groups according to the final diagnosis: bacteraemia group (group1), bacterial infection with negative blood culture (group 2) and non-bacterial infection group (group 3). Results: There were significant (P<0.05) difference in the levels of PCT, CRP, IL-6 and SAA among the three groups. The PCT levels of patients with gram-positive bacterial infections were lower than gram-negative bacterial infections (0.53 vs 2.13, P < 0.01). The best cut-off value to detect bacterial infections was 0.26 ng/ml for PCT. PCT, CRP, IL-6 and SAA had areas under the curve of 0.804, 0.693, 0.658 and 0.687, respectively. Interpretation & conclusions: Our results showed PCT as a valuable marker of bacterial infections in febrile patients. PCT was superior to CRP, IL-6 or SAA in the early identification of bacterial infection. More prospective and large scale studies are warranted to confirm these findings.

Serum Fetuin A, hs-CRP and Homocysteine as Biochemical Markers of Cardiovascular Complications in Chronic Dialysis Patients.

Introduction: Chronic kidney disease (CKD) patients are considered a high risk group of cardiovascular disease in which vascular calcifi cation plays central role. A pivotal role in the inhibition of calcifi cation is played by fetuin-A. Th e measurement of infl ammatory markers such as high sensitivity C-reactive protein (hs-CRP) and homocysteine which promotes atherosclerosis is helpful in predicting cardiovascular disease in ESRD patients on regular dialysis. Material and Method: Th e study included 40 adult CKD patients divided into 30 ESRD patients on conventional hemodialysis, 15 with CVD and 15 without CVD, as well as 10 CKD patients on conservative treatment. Ten healthy subjects served as a control group. Enzyme-linked immunosorbent assays were used for fetuin-A, hs-CRP and homocysteine. Results: ESRD patients showed a signifi cant increase in serum hs-CRP, homocysteine and decrease in fetuin-A compared to control group. In addition, ESRD patients with CVD and without CVD showed a signifi cant increase in hs-CRP, homocysteine and only those with CVD had signifi cantly decreased fetuin-A in relation to CKD patients. Th e study revealed increased levels of hs-CRP and decrease in fetuin-A in ESRD patients with CVD compared to ESRD patients without CVD. Fetuin-A showed a negative correlation with hs-CRP and homocysteine in ESRD patients with and without CVD. Conclusion: Th e combined use of hs-CRP at a cutoff of (10 mg/dL) with either fetuin-A at a cutoff value of (0.26 g/L) or alternatively with homocysteine at a cutoff value of (48.23 μmol/L) proved to be eff ective for discrimination of CVD patients from other ESRD or CKD patients.

Proteína C reactiva en pacientes con periodontitis crónica / C-reactive protein in patients with chronic periodontitis

La Periodontitis Crónica surge en las últimas décadas como un posible factor de riesgo para el desarrollo de eventos cardiovasculares. Bajo estas premisas, nace un nuevo paradigma que orienta el logro de diagnósticos, formas de prevención, intervención temprana y estrategias en el tratamiento de la Periodontitis Crónica. La Proteína C Reactiva (PCR) ha resultado ser un marcador de inflamación sistémica asociado a la Enfermedad Arterial Coronaria y a la Periodontitis Crónica.Objetivo del estudio: Conocer los niveles de Proteína C Reactiva en pacientes con Periodontitis Crónica Material y métodos: Se seleccionaron 80 pacientes del Postgrado de Periodoncia de la Facultad de Odontología de la Universidad Central de Venezuela. El estudio fue de tipo descriptivo, observacional, prospectivo. La data fue migrada a SPSS 17.0, para el análisis estadístico. Para las variables cuantitativas se utilizó la media y la desviación standart. Para evaluar la correlación entre variables se utilizó el coeficiente de correlación de Pearson, la prueba de Chi cuadrado de independencia y el análisis de Varianza para un solo factor. Resultados: De la muestra poblacional, El nivel sérico de Proteína C Reactiva ultrasensible resultó Factor de Riesgo Cardiovascular en 47 pacientes (58,8 por ciento). Discusión y conclusiones: No existe asociación entre los niveles de la Proteína C Reactiva ultrasensible y la presencia de Periodontitis Crónica generalizada.

Significant increases in monocyte counts and serum creatine kinase in acute myocardial infarction versus general infections.

Background: Biomarkers specificity is an important factor for their reliable utilization. Known markers for acute myocardial infarction (AMI), including creatine kinase (CK), C-reactive protein (CRP), and blood cell counts are thought to be altered in other pathologic conditions, such as infections. Aim: To compare the level of these biomarkers in AMI patients and infected controls with respect to normal subjects. Materials and Methods: We recruited 15 AMI patients, 15 patients with bacterial infections (infected control group) and 35 normal subjects. Peripheral blood samples were obtained for blood cell counts and biochemical analyses. Results: Only monocytes were significantly increased in AMI patients (0.793 × 10 9 /L) than normal controls (0.497 × 10 9 /L). Infected controls showed a significant increase in total white blood cell (11.50 × 10 9 /L versus 6.149 × 10 9 /L) and neutrophil (9.360 versus 3.223 × 10 9 /L) counts and a significant decrease in red blood cell (3.750 versus 5.105 × 10 12 /L) counts as compared with normal controls. Serum CK was significantly increased in AMI patients (313.20 ± 94.84 U/L) and decreased in infected controls (48.40 ± 10.35 U/L) as compared with normal controls (100.82 ± 8.86 U/L). The levels of CRP were significantly higher in infected controls (136.93 ± 34.83 mg/L) and nonsignificantly higher in AMI patients (38.53 ± 12.76 mg/L) than normal controls (3.48 ± 0.59 mg/L). Monocytes were significantly correlated with both CK and CRP; however, there was no correlation between CK and CRP. Conclusion: Differential trends of monocytes and CK in AMI and infective controls point toward their possible application in prognosis of AMI patients.

Brain-stem auditory evoked responses in COPD patients

COPD is a multi-system disorder. It appears to be associated with the presence of systemic inflammatory markers as C reactive protein. The present study aimed to evaluate the brain-stem auditory evoked potentials [BAEP] abnormalities in stable COPD patient and its correlation with high sensitivity C reactive protein [hs-CRP] as a part of multi-system disorder. This case control study was carried out at Mansoura University Hospital Egypt from October 2009 to February 2010. The study comprised 40 stable COPD patients and 15 healthy controls with no risk that may lead to neuropathy. All the patients and controls were subjected to the following: I-Thorough history taking and clinical examination. II-Pulmonary function tests including: 1-Spirometry 2-Body plethsymography 3-Arterial blood gases analysis. III- Record of brain-stem auditory evoked potentials [BAEP] including: latencies of waves I, II, III, IV and V together with interpeak latencies [IPLs] of I-III, I-V and III-V and amplitudes of waves I-Ia and V-Va. IV - Measurement of serum high sensitivity C reactive protein [hs-CRP] by ELISA technique. V - Statistical analysis. The level of hs-CRP reactive protein in COPD was significantly elevated and correlated with spirometric, blood gases parameters and GOLD stage. The BAEP latencies of waves I, II, III, IV and V, together with interpeak latencies and amplitudes of waves I-Ia and V-Va measured on both ears were significantly different in COPD patients than controls. The prevalence of brain-stem auditory evoked potentials abnormalities was higher among very severe group of COPD. Most of BAEP wave latencies together with interpeak latencies and wave amplitudes on both ears were significantly correlated with the spirometric and blood gases parameters. The level of hs-CRP was correlated significantly with abnormalities of BAEP variables. This study showed significant subclinical BAEP abnormalities in studied stable COPD male patients. This indicates conductive defect of auditory nerve, cochlea and even hearing pathway in the brain as a part of systemic inflammation. Theses BAEP abnormalities were significantly correlated with GOLD classification, hs-CRP and PaO[2]

Caracterización de lactantes con infección del tracto urinario:2009-2010: Hospital Regional de Antofagasta / Characterization of infants with urinary tract infection: 2009-2010: Regional Hospital of Antofagasta

INTRODUCCION: Las infecciones del tracto urinario (ITU) son una de las enfermedades bacterianas más frecuentes en pediatría. La incidencia de ITU en el paciente pediátrico no se conoce con exactitud. En recién nacidos se estima en 1 por ciento con una mayor proporción de varones, mientras que en lactantes aumenta entre 3 a 5 por ciento con igual proporción en ambos sexos. OBJETIVO: Caracterizar el perfil clínico-epidemiológico de lactantes con diagnóstico de ITU en el servicio de Pediatría del Hospital Regional de Antofagasta. PACIENTES Y METODOS: Estudio descriptivo retrospectivo de corte transversal. Se analizaron fichas clínicas de pacientes de la unidad de lactantes del Servicio de Pediatría del Hospital Regional de Antofagasta con diagnóstico de ITU al egreso del periodo Mayo 2009 - Mayo 2010. La muestra final fue 88 pacientes. Los datos fueron analizados y tabulados en una planilla Excel2007. RESULTADOS: Un 71,5 por ciento fueron sexo femenino. La edad promedio fue de 8,9 meses con rango entre 1 mes y 23 meses. Los síntomas más frecuentes fueron fiebre (97,7 por ciento), vómitos (30,7 por ciento), diarrea (23,1 por ciento), inapetencia (21.6 por ciento) y llanto/irritabilidad (16 por ciento). Las alteraciones de laboratorio fueron PCR elevada (96 por ciento), piuria (94,3 por ciento), leucocitosis (87,5 por ciento) y nitritos positivos (48 por ciento). Sólo fueron consignados el 85,2 por ciento de los urocultivos, de los cuales el patógeno más frecuente fue Escherichia coli en el 84 por ciento. DISCUSION: La ITU en lactantes en nuestro estudio fue más frecuente en el sexo femenino, teniendo como signo preponderante la fiebre. El germen más común fue Escherichia coli, correlacionándose con la literatura. Valoramos la importancia de solicitar urocultivos para la confirmación microbiológica.

INTRODUCTION: Urinary tract infections (UTI) are one of the most frequent bacterial diseases in pediatrics. The incidence of UTI in pediatric patients is not known with accuracy. In newborns is estimated in 1 percent with a larger proportion in males, while in infants increase between 3 to 5 percent with the same proportion for both sex. OBJECTIVE: Characterize clinically and epidemiologically the profile of infants diagnosed with UTI in the Pediatric service of the Regional Hospital of Antofagasta. METHODS AND MATERIALS: A descriptive retrospective cross-sectional study. Medical records of patients diagnosed with UTI by the end of the period of May 2009 - May 2010 from the unit of infants in the Pediatric Service of the Regional Hospital of Antofagasta were analyzed. The final sample was 88 patients. The data was analyzed using an Excel 2007 spreadsheet. RESULTS: 71,5 percent were women. The average age was 8,9 month in a range between 0,5 and 23 month. Most frequent symptoms were fever (97,7 percent), vomit (30,7 percent), diarrhea (23,1 percent), lack of appetite (21,6 percent) and crying/irritability (16 percent). The alterations in laboratory was CRP high (96 percent), pyuria (94,3 percent) and leukocytosis (87,5 percent). Only were record the 85, 2 percent of urine culture of which the most frequent pathogenic agent was Escherichia coli in the 84 percent of the cases. DISCUSSION: The UTI in infants in our study was more frequent in women and its predominant symptom is fever. The most common germ was Escherichia coli which agree the literature. We value the importance of ask for urine culture to microbiological confirmation.

Acute perforated appendicitis: An analysis of risk factors to guide surgical decision making.

Introduction: Acute perforated appendicitis is associated with increased post-operative morbidity and mortality. Avoiding delays in surgery in these patients may play a role in reducing observed morbidity. Objective: To analyze the clinico-pathological profile and outcomes in a cohort of patients undergoing emergency appendicectomies for suspected acute appendicitis and to determine factors influencing the risk of perforated appendicitis in order to aid better identification of such patients and develop protocols for improved management of this subset of patients. Materials and Methods: A retrospective analysis of patients undergoing emergency appendicectomies following presentation with acute appendicitis to the Modbury hospital, South Australia from March 2007 to April 2011 was conducted. Statistical analyses were performed in SAS 9.2. Results and Discussion: 506 patients underwent emergency appendectomy for acute appendicitis which included equal number of male and female patients with a median age of 25 years. Perforated appendicitis was found in 102 (20%) patients. Post-operative morbidity was significantly higher in patients with perforated appendicitis (28.4% vs 4.7%; P<0.0001). Male sex, patients older than 60 years, along with raised neutrophil counts and C-reactive protein levels were found to be significantly associated with the risk of perforation (P<0.05). Conclusions: Acute perforated appendicitis is associated with high morbidity. The increased risk of perforation in males and elderly patients appears unrelated to delays in presentation, diagnosis, or surgery. Patients with clinically diagnosed acute appendicitis and an elevation in neutrophil count and CRP level must be considered candidates for early surgery as they are likely to have an appendicular perforation.

Study of prognostic markers in psoriasis

Elevated peripheral blood neutrophil counts have been reported in untreated patients with psoriasis [Ps] in absence of infection. Several studies reported high level of white blood cell [WBC] activation products including oxygen inetabolites in the peripheral blood of these patients which in turn trigger an up-regulation of antioxidant defences. The aim of this work was to determine some inflammatory and antioxidant markers which are easily evaluated and can be used as indicators of prognostic significance in Ps. The study was carried out in 40 patients with posriasis vulgaris: 20 patients with mild Ps and the other 20 patients with severe disease. Twenty normal individuals were studied as a control group. We evaluated the following: total and differential leukocytic count and elastase as markers ofneutrophil activation; erythrocyte sedimentation rate [ESR] and c-reactive protein [CRP] and fibrinogen as markers of inflammation; and ceruloplasmiri and transferrin as endogenotis antioxidant markers. The data of this work pointed to the central role of neutiophils in the inflammatory response in Ps. The worsening of the disease accompanies the increase of the inflammatory response of neutrophils. So, values of elastase, CRP and neutrophil counts can be used as parameters for prognosis and worsening of Ps

Correlation of CRP and serum fibrinogen levels with disease severity, clinical factors and pulmonary function tests in COPD patients

Chronic obstructive pulmonary disease [COPD] is a progressive chronic disease and C-reactive protein [CRP] and fibrinogen are considered as main systemic inflammatory biomarkers. This study aimed to evaluate the alterations of CRP and serum fibrinogen levels in COPD patients and their correlation with the severity of disease, arterial O[2] saturation and opium or cigarette consumption. This was a descriptive case-control study conducted on 31 COPD patients and 29 healthy controls selected by using easy sampling method in Afzalipour Hospital. Serum levels of CRP and fibrinogen were measured by ELISA method and analyzed using SPSS software version 15. The mean serum level of CRP in the understudy patients [13.15 +/- 13.72 mg/L] was significantly higher than that of the controls [3.53 +/- 1.12 mg/L] [P=0.000]. However, no significant difference was found in the mean serum level of fibrinogen between cases [3.81 +/- 0.93 mg/dl] and controls [3.72 +/- 0.9 mg/dl] [p=0.82]. Also, no significant correlation was detected between the serum level of CRP or fibrinogen and severity of the disease [P=0.92 and P=0.58, respectively]. A statistically significant relationship was found between the serum levels of CRP and fibrinogen and arterial O[2] saturation [P=0.02]. There was no significant difference in the serum levels of CRP and fibrinogen between the opium users [p=0.19] and other patients [p=0.15]. According to our study results, COPD, per se, can increase the inflammatory biomarkers including CRP. Raised serum level of CRP is indicative of systemic inflammation which results in extra-pulmonary manifestations like cardiovascular diseases, cerebrovascular accidents, osteoporosis, and cachexia. Therefore, with routine measurement of this marker, we can evaluate the severity of systemic inflammation in these patients and choose the best treatment accordingly

Hiperbilirrubinemia en apendicitis: es un factor predictivo de perforación / Hyperbilirubinemia in appendicitis: is a predictive factor of perforation

Background: An elevated total bilirubin level can be a marker for perforated appendicitis. Aim: To assess and compare the predictive value of total bilirubin, C-reactive protein (CRP), white-blood cell count, the lapse of symptoms evolution, and systemic inflammatory response syndrome (SIRS) for the diagnosis of perforated appendicitis. Material and Methods: Prospective study of 134 consecutive patients aged 33 +/- 16 years (63 males) operated for acute appendicitis of whom 49 had a perforated appendix. A preoperative blood sample was obtained to measure total bilirubin, C reactive protein and complete blood count. A systemic inflammatory response score was calculated. Results: The lapse of symptoms before operation was higher in patients with perforated appendicitis compared with their counterparts without perforation (105.2 +/- 79.3 and 38.6 +/- 17.5 hours respectively). C reactive protein values were 176 +/- 82.6 and 80 +/- 76 mg/1 respectively, (p = 0.01). Serum bilirubin values were 0.7 +/- 0.3 and 1.0 +/- 0.5 mg/dl, respectively (p = 0.05). Sixty five percent of patients with perforated appendicitis had a SIRS score between 3 and 4 points. A C reactive protein over 76.7 mg/1, a lapse of symptoms over 34.5 hours and a SIRS score of three or more had the best performance for the prediction of perforated appendicitis. Conclusions: The diagnosis of perforated appendicitis may be suspected based on CRP, SIRS, and the lapse of symptoms before operation. We do not recommend the use of total bilirubin to predict perforation in appendicitis.

Introducción: Se ha propuesto a la hiperbilirrubinemia como un marcador específico de apendicitis perforada. El objetivo del presente estudio es el de comparar el rendimiento para la predicción de perforación de la bilirrubina total (BT) y la proteína C reactiva (PCR), leucocitosis, el tiempo de evolución del cuadro clínico y el síndrome de respuesta inflamatoria sistémica (SIRS). Métodos: Se diseñó un estudio prospectivo y observacional, en el que se aplican curvas Receiver Operating Characteristics para comparar la sensibilidad y especificidad de las variables investigadas, se determinaron los mejores puntos de corte con la mejor sensibilidad y especificidad. Resultados: El período de tiempo de evolución del cuadro clínico se encontraba prolongado en los pacientes con apendicitis perforada (105,2 +/- 79,3 h y 38,6 +/- 17,5 h) y los niveles de PCR se encontraban muy elevados (176 +/- 82,6 mg/1 y 80 +/- 76 mg/1). La mayoría de los pacientes con apendicitis perforada tuvieron una puntuación SIRS entre 3 y 4 puntos. El valor de la PCR mayor a 76,7 mg/1, el tiempo de evolución de los síntomas mayor a 34,5 h y una puntuación SIRS de 3 puntos o más obtuvieron los mejores puntos de corte con el mejor rendimiento para la predicción de apendicitis perforada. Conclusiones: El diagnóstico de apendicitis perforada puede sospecharse cuando la PCR, SIRS y el período de tiempo de evolución del cuadro clínico están elevados. No recomendamos la medición de la BT como factor predictivo de perforación en pacientes con apendicitis.

Serum risk markers as predictors of cardiac and renal complications in patients with obstructive sleep apnea

Patients with obstructive sleep apnea are at high risk to develop many complications. Increased risk to develop cardiovascular and renal morbidity and mortality are the most sinister of these complications. There are various serum markers which are known to be helpful as prognostic factors for the development of cardiac and renal complications in those patients. The aim of this study is to determine the prognostic value of certain serum cardiac and renal risk markers in OSA. The study also aims to investigate the relationship between the serum level of these markers and severity of OSA. Forty five males were included in this study, classified into two groups, the obstructive sleep agroup [n=30], this group subdivided into two subgroups with respect to apnea-hypopnea index [AHl]: subgroup A, [n=15], with AHI<5; and subgroup B [n=15], with AHI >5. The second group included [n=15] healthy control male subjects. All patients of obstructive sleep apnea group underwent overnight polysomonography after complete ENT examination. The serum level of cholesterol, triglycerides, C-reactive protein [CRP], homocysteine, creatinine, cystatin C were measured in both groups. Statistical significance was assessed with analysis of variance at p<0.05. In correlation analysis, pearson correlation was used. The results of over night polysomonography were significantly diagnostic for OSA in all patients of the OSA patients' group. There was significant difference-regarding serum levels of homocysteine, CRP and cystatin C in OSA patients' group compared to the control group. Serum homocysteine, CRP and cystatin C levels were significantly increased in subgroup B compared to subgroup A [p<0.05]. There was no significant difference between OSA patient's group and the control group and between subgroup A and subgroup B in serum creatinine, total cholesterol, LDL-C, HDL-C, triglyceride. Increased plasma concentrations of homocysteine and CRP can he useful in clinical practice as predictors for cardiovascular disease in patients with OSA. Also increased plasma level of cystatin C is a predictor of impaired renal function in OSA patients and it is more sensitive than serum creatinine

Renovascular disease and cognitive impairment in elderly: a novel risk maker

Renal artery stenosis is most commonly due to either fibromuscular dysplasia or atherosclerosis. Atherosclerosis accounts for 90 percent of cases of renal-artery stenosis. Renal-artery stenosis may occur alone [isolated anatomical renal-artery stenosis] or in association with hypertension, renal insufficiency [ischemic nephropathy], or both. The aim of the present work was to study the role of renovascular disease as a novel risk marker of cognitive impairment in elderly. The study included 80 patients divided into 4 groups: Group 1: 20 cases of elderly patients above 65 years and suffering from grade 2 or 3 CKD. Group II: 20 cases aged 20-40 years and suffering from grade 2 or 3 CKD. Group III: 20 healthy controls aged above 65 years. Group IV: 20 healthy controls aged 20-40. They had been evaluated for their: Clinical condition, including physical examination and history taking, ECG, BMI estimation, MMMS examination, Routine investigation including: complete blood picture with differential counting, bleeding and coagulation time, liver functions tests, lipid profile, fasting and post-prandial plasma glucose, renal function tests, complete urine analysis, 24-hours proteins in urine, assessment of glomerular filtration rate [GFR] by MDRD and creatinine clearance and in addition specific laboratory investigations were done including: Serum CRP using turbidimetry, Microalbuminurea using turbidimetry, v-WF Ag by ELISA, s-ICAM. By ELISA and Duplex study was performed on carotid and renal arteries. The results of the present study showed that there was a significant increase in the BMI in groups land II in comparison to group III which was higher than group IV. The MMMS test was significantly lower in group I in comparison to groups II and III which were in turn significantly lower than group IV. Hemoglobin was significantly lower in groups I and II than group III and IV. Platelets count was significantly lower in groups I and II than group III which was also significantly lower than group IV. Creatinine clearance was significantly lower in groups I and II than in groups III and IV vWF levels were significantly lower in groups land II than in groups III and IV s.ICAM I was significantly higher in groups I and II compared to groups Ill and IV. CRP was significantly increased in groups I and II in comparison to groups III and IV Carotid plaque score was significantly higher in group I than group II which was higher than groups III. Resistive index was significantly lower in groups land II than in groups III and IV Acceleration index was significantly lower in groups I and II than in groups III and IV. A significant positive correlation was found between age and urinary albumin, CRP, and s.ICAM. A significant negative correlation between age and cereatinine clearance and MDRD in groups I, II and III. Reno vascular disease is common in elderly and the most important cause is atherosclerosis in this group of patients. There are many risk factors for cognitive impairment in patients suffering from renovascular disease and most of them are correctable. Renovascular disease can be considered as a novel risk factor of cognitive impairment through many interacting mechanisms

Neutrophil gelantinase associated lipocalin [NGAL] as a biomarker of painful vaso-occlusive crisis in sickle cell disease [SCD]

Chronic inflammation and hypercoagulable state contribute significantly to the occurance of vaso-occiusive complication of sickle cell diseases [SCD]. The pathogenesis determines changes in the levels of pro-inflammatory mediators such as cytokines, endothelial adhesion molecules, elevated markers of thrombin generation and group of new biochemical markers including NGAL. The aim of the present study was to evaluate levels of neutrophil gelatinase associated lipocalin [NGAL] in SCD patients during painful crises and steady state of illness. This work included 43 patients with SCD in painful crises that was severe to justify hospital admission, Nineteen samples were collected among the cases when patients came to the clinic for follow up visit in steady state. Control group included fourteen healthy ethnically matched individuals. NGAL levels were quantitated by ELISA. Other haematological and biochemical parameters such as HG, RBC, WBC, bilirubin, CRP, LDH were also determined. The results revealed that NGAL concentrations were highly significantly elevated in sickle cell painful crises compared with steady state SCD [p < 0.0001] and when compared with healthy controls. These results also showed the NGAL levels correlate with WBC, CRP and LDH. This work represents initial step to determine NGAL role as a biomarker involved in the inflammatory and immune modulatory functions reported in the pathogenesis of painful episodes in SCD and may be a valuable predictor marker in the progress to severe attaches [e.g. acute chest syndrome] or resolution of acute SCD crisis

Value of serum and synovial fluid activin A and inhibin A in some rheumatic diseases

Activin is a growth and differentiation factor of many cell types and has recently been implanted in inflammatory processes. Clinical data demonstrating roles of activin and its antagonist inhibin in inflammatory arthropathies, are lacking. The Study is to measure serum and synovial fluid levels of activin A and inhibin A in patients with rheumatoid arthritis [RA] systemic lupus erythematosus [SLE] and osteoarthritis [OA] and correlate them with disease activity parameters. This study included 60 patients with three rheumatic diseases [20 with RA, 20 with SLE and 20 with OA], as well as ten healthy subjects as a control group. All of them were subjected to complete history, physical and musculoskeletal examination and estimation of disease activity index [DAS- 28] for RA and [SLEDAI] for SLE. The following investigations were done for all subjects; serum and synovial activin A and inhibin A; in addition to complete blood picture, erythrocyte sedimentation rate [ESR], C-reactive protein [CRP],rheumatoid factor [RF], antinuclear antibodies [ANA],anti-dsDNA, serum complement [C 3, 4] and Xrays on affected joints. The mean values of serum activin A were significantly higher in RA, SLE and OA than controls [P<0.001] also in RA and SLE versus OA [P<0.05 for both]. The mean values of serum inhibin A were significantly higher in all studied groups than controls [P<0.05 for RA and OA and P<0.001 for SLE]. Also serum inhibin levels were significantly higher in SLE versus OA P<0.001, but there was no significant differences between RA and SLE. Synovial fluid activin and inhibin A were significantly higher in RA than OA [P<0.05 for both]. Positive correlations were found between serum activin A and disease activity parameters of RA morning stiffness [MS], Ritchie index [RI], ESR, CRP and DAS 28] P<0.05, for all. Also positive correlation was found between serum inhibin A and RI in RA patient [P<0.05]. In SLE, positive correlations were found between serum activin A and inhibin A with ESR [P<0.001 for activin and P<0.05 for inhibin A and SLEDAI [P<0.001 for both activin and inhibin]. No correlation were found between synovial activin and disease activity and negative correlation between synovial inhibin and ESR. The significant increase of serum and synovial activin A and inhibin A in RA and SLE and their positive correlations with disease activity parameters of RA and SLE suggest pro-inflammatory action. However the lack of correlations or negative correlation of their synovial levels with disease activity may indicate their anti inflammatory action, We recommended further studies to detect the exact role of activin A and inhibin A

Subclinical involvement of cardiovascular system in juvenile collagen diseases

Cardiovascular lesions are commonly found in children and adolescence with different collagen diseases with relevant implication in mortality and morbidity. The purpose of the study was to verify whether there is any sign of cardiovascular involvement in juvenile collagen diseases using electrocardiography [ECG] and echocardiography [ECHO]. The study was carried out on 77 patients, 52 juvenile idiopathic arthritis [JIA], 20 systemic lupus erythematosus [SLE], 3 spondylarthropathy [SPA] and 2 juvenile dermatomyositis [JDM]. They were free of any clinically evident of cardiac manifestations. Thirty six healthy children were enrolled as control group All subjects underwent complete history and physical examinations, x ray chest, ECG and two dimensional, M mode, continuous wave [CW], pulse wave [PW] and color flow Doppler examinations. The following investigations were done erythrocyte sedimentation. rate[ESR], antistreptolysin O titre [ASOT], C reactive protein[CRP], rheumatoid factor[RF], antinuclear antibodies[ANA] and anti double stranded DNA[anti ds DNA]. Minor ECG changes were detected in 3 SLE and 2 JDM. ECHO showed pericardial effusion in 2 [3.3%] JIA and 3[15%] SLE. Aortic insufficiency was detected in 5[9.6%] JIA, 4 [20%] SLE. Mitral regurge was found in 7[13.4%] JIA, 5 [25%] SLE. Mild tricuspid regurge was detected in 3[15%] SLE. Mild pulmonary hypertension was found in 4[20%] SLE. Significant systolic dysfunction was elicited in JIA in form of increased left ventricular end diastolic diameter [LVEDD], left ventricular end systolic diameter[LVESD], left ventricular end diastolic volume[LVEDV] and left ventricular end systolic volume[LVESV] and reduction of ejection fraction [EF] and fractional shortening [FS]. In SLE .there was significant reduction, of EF and FS. Significant diastolic dysfunction was manifested in JIA by decreased peak early [E], E acceleration time [Eat], E duration [Edur], Total duration [Tdur], [E/A] ratio and A acceleration time [Aat] and increased peak atrial filling velocity [A], E deceleration time [Edt], isovolumic relaxation time [IVRT] and A deceleration time [Adt] and in SLE by decreased [E] and [E/A] ratio and increased [Edt] and in JDM by decreased [E] and [E/A] ratio and increased [IVRT]. In JIA, there was a positive correlation between age and [LVEDD] and disease duration with both [LVEDD] and [LVESD] and negative correlation between disease duration and EF. Cardiovascular involvement in juvenile collagen diseases is common. Regular cardiac evaluation using [ECG] and [ECHO] is recommended for early diagnosis of cardiac involvement. Key words: Cardiovascular-juvenile-collagen diseases

Rheumatoid Arthritis: Phenomenology, Personality Profile, Stress and their Inter-Relationship.

The purpose of this study was to study the psychiatric morbidity of Rheumatoid Arthritis and to look for an association between disease parameters and personality dimensions of Rheumatoid Arthritis patients. Methods: 40 patients were selected from Rheumatoid Clinic of P.B.M.Hospital,Bikaner as per Association of Rheumatoid Arthritis (A.R.A.) revised criteria. The ICD-10 Module of International Personality Disorder Examination (IPDE),Social And Occupational Functioning Assessment Scale (SOFAS),Hamilton’s Rating Scale for depression(HAM-D),Presumptive Stressful Life Events Scale(PSLE) were administered to these patients .Bivariate statistical methods were used to find association between illness variables and psychological dimensions. Group differences were analyzed by students T-test and ANOVA. Results: Rheumatoid Arthritis patients with psychiatric morbidity showed higher R.A. severity (p<0.02), swan neck and valgus deformity (p< 0.05), more number of joints involved (p<0.01), smaller joints (metacarpo-phalangeal and inter-phalangeal) involvement (p<0.05), presence of C - reactive protein in blood samples (p<0.01). Majority of patients who had personality psychopathology also reported stress in preceding one year period. Personality level psychopathology either alone or in combination is present in 17 patients that is 42.5 % of the sample. Patients with single personality trait psychopathology were better in comparison to severe personality psychopathology in terms of number of joints involved, joint deformities, social and occupational functioning and psychiatric morbidity. Conclusion: Preliminary findings suggest that the severity of Rheumatoid Articles correlates with psychiatric morbidity.

Basic fibrolast growth factor and vascular endothelial growth factor levels as pulmonary biomarkers of chronic obstructive pulmonary disease

There has been increasing interest in using pulmonary biomarkers to understand and monitor the inflammation in the respiratory tract of patients with chronic obstructive pulmonary disease [COPD]. The aim of this study is evaluating circulating basic fibroblast growth factor [bFGF] and vascular endothelial growth factor [VEGF] levels to determine the value of these growth factors as biomarkers of COPD and as indicators of severity of COPD in patients with chronic obstructive pulmonary disease in comparison to the inflammatory cytokines, C-reactive protein [CRP], tumor necrosis factor- alpha [TNF- alpha and interleukin-6 [IL-6]. Also, to determine if there is a correlation between circulating levels of VEGF and bFGF and pulmonary function [FEV1]. The study included 86 patients with chronic obstructive pulmonary disease [COPD], Besides 20 healthy, age matched males with normal pulmonary function were included as controls. The patients were divided into 5 stages according to lung function measured by spirometer [FEV1% predicted]. All patients were subjected to determination of FEV1 and determination of circulating bFGF, VEGF. TNF- alpha CRP and IL-6. The results showed that the concentration of circulating bFGF, VEGF, TNF- alpha, CRP and IL-6 were significantly higher in patients with CORD in comparison to the control group and their levels increased according to the stage of disease. There was a negative correlation between the blood levels of VEGF and bFGF with FEV1 in the different stages of COPD [p<0.05]. Also, there was a strong positive correlation between VEGF and bFGF [p<0.05]. In conclusion, bFGF and VEGF could play an important role in the pathogenesis of COPD and could be considered as a reliable and early biomarker in the diagnosis of COPD

Serum resistin as a biomarker for hepatic state in HCV infected patients and its relation to insulin resistance

Patients with chronic liver disease display disturbances of glucose metabolism which is more prevalent among patients with chronic HCV compared with those with other liver diseases and the general population, irrespective of whether cirrhosis is resent. Insulin resistance, a "prediabetic" abnormality of blood sugar, is a specific feature of chronic hepatitis C virus [HCV] infection. To evaluate the clinical utility of the adipokine hormone resistin a potential mediator in inflammatory processes as a biomarker of disease progression in HCV infected patients and to assess if it is involved in the pathogenesis of insulin resistance. The study included 60 HCV infected patients and 20 healthy subjects as control. All cases were recruited from Kasr El Ani Hospital. They were classified into 3 groups; group [I]: Included 20 cases of HCV infected patients with no liver cirrhosis; group [II]: Included 40 cases of HCV infected patients with liver cirrhosis, it was subdivided into three subgroups according to Child-Pugh classification which were [IIa]10 cases, [IIb] 15 cases and [IIc] 15 cases and group [III]: Control group included 20 healthy subjects who were matched with the studied patients as regard age, sex and body mass index. Abdominal ultrasonography, upper endoscopy [for patient groups only], liver function, complete blood picture, erythrocytes sedimentation rate [ESR], C-reactive protein [CRP], blood sugar, fasting insulin, fasting C-peptide with calculation of insulin sensitivity [IS] by the quantitative insulin sensitivity check index [QUICKI] and serum resistin levels were done for all participants. Serum resistin level showed statistically highly significant elevation in HCV infected patients compared with the matched control group [p<0.001] and also its level showed statistically significant differences in subgroups of group [II] being higher in patients presented with complication of liver cell failure [p<0.01]. Its serum level was inversely correlated with the hepatic synthetic function including albumin [r=-0.476, p<0.001] and prothrombin concentration [r=-0.346, p<0.001]. Also, a positive correlations between resistin and biomarkers of inflammation including CRP [r=0.305, p<0.004] and TLC [r=0.268, p<0.01] and insulin resistance parameters [C-peptide r=0.285, p<0.01] were detected, while resistin was inversely correlated with insulin sensitivity [QUICKI] [r=-0.289, p<0.05]. This study demonstrates that serum resistin level is elevated in patients with HCV related chronic liver disease and might be used as a biomarker for the clinical progression of the disease. The correlation of resistin to the insulin resistance [IR] present in such patients, may suggest its possible role in the pathogenesis of insulin resistance

Do C-reactive protein and lipoprotein [a] have different impacts on the severity of coronary artery disease in diabetic and non-diabetic patients?

The potential role of lipoprotein [a] changes and also inflammation in coronary artery disease [CAD] have rendered these processes one of the most interesting objects of study in patients affected by type 2 diabetes mellitus. The aim of the current study was to evaluate lipoprotein [a] and other lipid profiles and also C-reactive protein [CRP] as the predictors of cardiovascular disease severity in non-insulin dependent diabetic subjects in comparison with non-diabetic CAD patients. Between June and September 2004, 372 patients with CAD were enrolled at Tehran Heart Center. Non-insulin dependent diabetics accounted for 102 of the cases, and the remaining 270 were non-diabetics. The severity of CAD was evaluated using the Gensini score, and the effect of patient variables such as serum lipid concentrations and CRP on CAD severity in the diabetics was investigated and compared with that of the non-diabetics. The mean of the Gensini score, CRP, and serum concentrations of all the lipid profiles were similar between the diabetic and non-diabetic patients. In the diabetic group, a high CRP concentration [?=0.200, Rs= 0.040; P=0.046] was effective on the Gensini score, whereas lipoprotein [a] and lipid profiles did not influence CAD severity. In the non-diabetics, no significant relationships were found between the Gensini score and all the studied laboratory indices. A high CRP level is an important predictor of the severity of CAD in diabetic patients with CAD