Increased circulating FcepsilonRII-bearing B-lymphocytes and serum levels of IL-4 in non-autoreactive chronic idiopathic urticaria

The exact pathophysiology of chronic idiopathic urticaria (CIU) is not well understood. The concept of autoreactivity has evolved to explain the disease in up to 50% of cases, while the search for other mechanisms is still needed to explain the disease, at least among the remaining subpopulation of non-autoreactive CIU. Therefore, we thought to investigate some aspects of the IgE-dependent, lymphocyte-mediated late-phase response (LPR) of anaphylaxis. We searched for percentages of FcepsilonRII-bearing (CD23+) B and T lymphocytes and correlated this with total IgE serum levels, IL-4 serum levels and the disease severity scores. Twenty-five patients with non-autoreactive CIU and ten healthy control subjects participated in this study. CD23+ B- and T-cells were assessed by flow cytometry, total IgE serum levels were estimated by enzyme linked fluorescent assay (ELFA), IL-4 serum levels were estimated by Enzyme Amplified Sensitivity Immunoassay (EASIA), while disease severity was determined by a daily self-assessment urticaria activity and itching score. Our results showed that the mean values for percentages of CD23+ B-cells (6.7 +/- 2.3%), total IgE serum levels (139.6 +/- 103.9 microg/dl) and IL-4 serum levels (18.3 +/- 14.7 ng/ml) for patients were statistically significant (p = 0.002, 0.013 and 0.008, respectively), when compared with the corresponding values for controls (4.0 +/- 1.7%, 51.5 +/- 25.1 microg/dl, and 5.1 +/- 4.1 ng/ml, respectively), while the difference between the mean percentage of CD23+ T-cells for patients (2.8 +/- 2%) and that for controls (2.1 +/- 0.6%) was non-significant (p = 0.267). Strong positive correlations were detected between percentages of CD23+ B-cells and severity scores (r = 0.678, p = 0.0001), total IgE serum levels (r = 0.756, p = 0.0001) and IL-4 serum levels (r = 0.709, p = 0.0001), while no correlation was detected between CD23+ B-cells and CD23+ T-cells (r= 0.188, p= 0.368). It is concluded, that CD23+ B-cells, regulated by IL-4, may contribute in the pathogenesis of non-autoreactive CIU, by producing high levels of IgE and possibly lymphokines, while CD23+ T-cells may be involved in early antigen recognition. This may have a future therapeutic ramification in this distinct subset of CIU by targeting low-affinity IgE receptors.

IL-10 and IL-12p40 in Egyptian patients with HCV-related chronic liver disease

Hepatitis C virus (HCV) is the leading cause of chronic liver disease worldwide with a prevalence of approximately 14% in Egypt. IL-10 is a cytokine produced by Th2 cells. It down-regulates the proinflammatory response and modulates hepatic fibrogenesis. IL-12 is produced by antigen presenting cells. It promotes Th1 cell response and has many antiviral properties. Data concerning the Th-1/Th-2 balance in chronic hepatitis C (CH-C) are rather conflicting. Using ELISA, we assessed serum IL-10 and IL-12p40 levels in 66 Egyptian patients with HCV-related liver illness (CH-C, cirrhosis, and HCC), and their relationship to disease activity. Our results showed that spontaneous IL-10 was undetectable in patients with CH-C, HCC or controls. Only 5/22 (23%) of patients with cirrhosis showed detectable levels of IL-10. IL-12p40 was elevated in the patient groups compared to controls (p= 0.01, p= 0.01, p= 0.05 in CH-C, cirrhosis and HCC, respectively). The presence of IL-12p40 was associated with HCV level of viremia and serum AST. Serum ALT level was significantly associated with the level of IL-12p40. IL-12p40 was unrelated to liver histology or fibrosis. We concluded that in the Egyptian patients an augmentation of IL-12p40 and a suppression of IL-10 are both found. Whether this pattern is related to HCV genotype 4, or to the presence of schistosomiasis would need to be further investigated.

Heterochromia iridis in water buffaloes (Bubalus bubalis)

This study included 45 unaffected animals and 593 animals affected with heterochromia irides, and 85 enucleated eyeballs with heterochromia irides. The classification of heterochromia irides, morphology of normal and heterochromic irides, and the histology, ultrastructure, and scanning electron microscopy are presented. The incidence of heterochromia irides in water buffaloes was 7.62% affecting either one or both eyes. Both complete and partial heterochromia irides occurred. Complete heterochromia iridis is more frequent than the partial form in either bilateral or unilateral cases. The pupil has a dumb-bell-shape appearance. Granula iridica occurred at the upper (100%) and lower (30%) pupillary margins and originated from the posterior pigmented epithelium. In heterochromia irides, the melanocytes is absent in the anterior border and stromal layers, and iridal thickness appeared thinner than that of normal eyes.

Effect of i.v. tenoxicam during caesarean delivery on platelet activity

BACKGROUND

Non-steroidal anti-inflammatory drugs inhibit platelet aggregation and prolong bleeding time in healthy subjects. We have studied the effect of i.v. tenoxicam during caesarean delivery on skin bleeding time, operative, and postoperative blood loss, and beta-thromboglobulin and platelet factor 4 as specific molecular markers for platelet activity.

METHODS

Fifty women were studied. Twenty-five were given tenoxicam 20 mg i.v. 10 min before induction of general anaesthesia, and 25 formed a control group. Skin bleeding time and platelet markers were determined the day before and 1 h after induction of anaesthesia.

RESULTS

In the tenoxicam group, there was an slight increase in skin bleeding time with no statistically significant changes in platelet marker levels. In the control group, platelet markers increased 1 h after surgery. The surgeon's assessment of uterine relaxation, using a visual analogue score, operating theatre blood loss, and the frequency of bleeding over 24 h after operation, showed no significant difference between the two groups.

CONCLUSION

During caesarean delivery i.v. tenoxicam causes a slight increase in bleeding time with no significant changes in platelet marker levels.

Intra-articular tenoxicam relieves post-arthroscopy pain

BACKGROUND

Nonsteroidal anti-inflammatory drugs have been documented to be effective in the treatment of postoperative pain. The aim of this study was to evaluate the analgesic effect of local intra-articular injection of tenoxicam compared with intravenous injection on postoperative pain after arthroscopy.

METHODS

After day-case arthroscopy, 60 patients were randomized to receive either tenoxicam 20 mg in 20 ml of normal saline intra-articularly and 2 ml of normal saline i.v., or 20 ml of normal saline intra-articularly and 2 ml tenoxicam 20 mg i.v. Postoperative pain was assessed using a visual analogue scale and measuring analgesic requirements.

RESULTS

Pain scores were significantly lower in the intra-articular group at rest and during active flexion of the knee at 1, 2 and 4 hours postoperatively and during walking at 6 hours postoperatively (P < 0.05). Significantly more patients in the intravenous group required supplemental opioid analgesia within the first 4 hours postoperatively (P < 0.05).

CONCLUSION

Intra-articular tenoxicam 20 mg provided better analgesia and decreased the requirements for postoperative analgesic compared with i.v. tenoxicam 20 mg.