Long Non-coding RNA Genes Polymorphisms H19 (rs2251375) and MALAT1 (rs3200401) Association with Rheumatoid Arthritis and Their Correlation with Disease Activity in a Cohort of Egyptian Patients: A Pilot Study

Rheumatoid arthritis (RA) is a chronic, progressive, inflammatory, autoimmune disease that could be disabling throughout its course. It affects people in their most reproductive years with relatively high morbidity and mortality. Long non-coding RNAs became one of the epigenetic mechanisms to prove a link to RA pathogenesis and development, including H19 and MALAT1 genes. These two genes' expressions had proved to increase in multiple diseases, attracting attention to their polymorphisms and their possible risk role. Assess the association between H19 SNP (rs2251375) and MALAT1 SNP (rs3200401) and the susceptibility of RA and its disease activity. In this pilot study, 200 hundred subjects (100 RA patients and 100 healthy controls) were investigated for a possible link between the polymorphisms H19 SNP (rs2251375) and MALAT1 SNP (3200401) and RA susceptibility and disease activity. RA-related investigations and clinical assessment were done. Real-time PCR genotyping of both SNPs was done using TaqMan® MGB probes. There was no association between the SNPs and risk of developing RA. However, both SNPs had a significant association with high disease activity. H19 SNP (rs2251375) heterozygous genotype CA had an association with elevated levels of ESR (p = 0.04) and higher DAS28-ESR score (p = 0.03). MALAT1 (rs3200401) C allele had an association with elevated ESR (p = 0.001), DAS28-ESR (p = 0.03), and DAS28-CRP (p = 0.007), while CC genotype had an association with DAS28-CRP (p = 0.015). Linkage disequilibrium and haplotyping of the alleles of both SNPs were analyzed as both genes are present on chromosome 11, but no significant association was found between any of the combinations of the alleles (p > 0.05), denoting that (rs2251375) and (rs3200401) are not in linkage disequilibrium. There is no association between H19 SNP (rs2251375) and MALAT1 SNP (rs3200401) and the susceptibility of RA. However, there is an association between H19 SNP (rs2251375) genotype CA and MALAT1 SNP (rs3200401) genotype CC with RA high disease activity.

Effect of drilling process parameters on bearing strength of glass fiber/aluminum mesh reinforced epoxy composites

The current study attempted to evaluate the impact of drilling parameters and delamination on the bearing strength of both neat GFRP (NG) and hybrid GFRP/aluminum (Al)-wire mesh with two various configurations, first with Al-mesh in the outer surface of specimen (AG) and the other with Al-mesh in the core of specimen (GA). Drilling procedure is carried out using [Formula: see text] 6 mm carbide twist drill with three different tip angles (90°, 120° and 135°), as well as Three different speeds and feeds (1000, 2000, and 3000 rpm) and (20, 40, and 60 mm/min), respectively. Taguchi and ANOVA analyses are used to analyze the influence of processing parameters. The findings showed that AG specimen experienced the least delamination damage. The maximum bearing strength refers to NG specimen, which is 9.6% and 8.7% more than AG and GA specimens, respectively. Drill point angle has the major effect on bearing strength for both AG and GA specimens, while for NG feed rate is of the major effect. The developed regression model displayed a high level of fitness with an average prediction error of less than 3%.

Role of detection of lipoarabinomannan (LAM) in urine for diagnosis of pulmonary tuberculosis in HIV patients: Egyptian experience

Background

Tuberculosis remains a worldwide problem fueled by the HIV epidemic. TB infection impacts HIV progression and mortality even with treatment. Egypt has increasing HIV prevalence, although still in low prevalent areas.

Results

Urinary LAM was positive in 22 (95.7%) of TB patients and 1 (1.9%) of non TB group. Sensitivity was 95.7%, specificity 98.1%, positive and negative predictive values were 95.7% and 98.1% respectively, with accuracy 97.4%. Urinary LAM ELISA assay has the highest sensitivity (95.7%) in relation to other tests used for TB detection in HIV patients and its concentration was highly correlated to CD4 cell count and the extent of radiological changes.

Conclusion

The use of urinary LAM in HIV patients is rapid, safe, available, and helpful tool for ruling in TB especially for those who cannot expectorate, critically ill, with low CD4, or presented by multiple system affection.

Endoscopic management of acute oesophageal variceal bleeding within 12 hours of admission is superior to 12-24 hours

Background: Acute oesophageal variceal haemorrhage (AOVH) is a medical emergency. The American Association for the Study of Liver Diseases recommends endoscopy management as soon as possible and not more than 12 hours after presentation. The United Kingdom guidelines recommended endoscopy for unstable patients with severe acute upper gastrointestinal bleeding immediately after resuscitation and within 24 hours of admission. We aimed to evaluate the outcome of endoscopic management of AOVH in less than 12 hours compared to 12-24 hours post admission.Methods: 297 patients with AOVH were divided into groups depending on the timing of the endoscopic management: 180 within 12 h of admission and 117 patients at 12-24 hours of admission. Routine clinical and laboratory data were collected.Results: Compared to patients with endoscopic management at 12-24 hours (mean 16 hours), patients with endoscopic management within 12 hours (mean 8.3 hours) of admission had fewer hospital stay days (P = 0.001), significant reduction of ammonia levels (P < 0.0001) and significant improvement in associated hepatic encephalopathy grade 25 (p = 0.048). There were no major clinical events in the 12-hour group, but 8 events in the 12-24 hour group (p < 0.01).Conclusion: Endoscopic management of acute variceal bleeding within 12 hours of admission is superior to endoscopic management at 12-24 hours of admission regarding reduction of hospital stay, ammonia levels, correction of hepatic encephalopathy, re-bleeding and mortality rate, hence, reducing the cost of treatment benefiting patient satisfaction and improving hospital bed availability.

Non-invasive IGFBP1, IGFBP2 biomarkers as predictors and outcomes of usual interstitial pneumonia (UIP) therapeutic response

Background

Usual interstitial pneumonia (UIP) is a fatal disease that is associated with poor prognosis and survival. Several growth factors such as IGFs (insulin-like growth factors) and IGFBPs (insulin-like growth factor binding proteins) seem to take part to this pathogenesis.

Pirfenidone is an immunosuppressant drug that is thought to have anti-inflammatory and anti-fibrotic effects both in vitro and in vivo.

Objective

To assess IGFBP1 and IGFBP2 as non-invasive biomarkers for prediction and outcomes of UIP clinical activity and therapeutic response to the anti-fibrotic pirfenidone.

Results

Serum levels of IGFBP1 and IGFBP2 were significantly higher in the UIP group than in the healthy subjects (p ≤ 0.005). After 6 months therapy, UIP patients were divided into 2 groups according to improvement in MRC dyspnea grading into clinically improved and non-improved groups. 6MWT and SPaO2 were significantly improved in the clinically improved group compared to the non-improved one with no differences as regards other parameters (p < 0.0001). Both IGFBP1 and IGFBP2 were significantly decreased in serum while only IGFBP2 was decreased in BAL of all UIP after completing 12 months therapy.

Conclusion

IGFBP1 and IGFBP2 were increased in active UIP patients and reduced after 12 months anti-fibrosing therapy. IGFBPs may be promising biomarkers and predictors of response to therapy in UIP.

Interleukin 17 receptor A haplotype analysis in chronic spontaneous urticaria: A preliminary study

BACKGROUND

Chronic spontaneous urticaria (CSU) is a distressing skin disease. Family clustering and heterogeneity in the onset and progression indicate that susceptibility to CSU is a complex trait. In this study, we performed haplotype analysis for one of the key player gene, IL17RA, for CSU to test the association with disease susceptibility and severity.

METHODOLOGY

The study included 70 CSU patients and 30 healthy controls. The severity of the disease was evaluated by autologous serum skin test (ASST) and urticaria activity score (UAS). ASST test was done and quality of life was assessed using a questionnaire. Allelic discrimination analysis for rs4819554 and rs879577 was performed using real-time polymerase chain reaction technology.

RESULTS

Carriers of rs4819554*G were more prone to develop CSU than its counterpart (P = .039), while rs4819554*A allele displayed more severe phenotype in the form of more prolonged disease duration (P = .040), concurrent angioedema (P < .001), higher level of treatment (P < .001), and higher score of quality of life (P < .001). Additionally, homozygote patients with rs879577*CC were associated with angioedema (P < .001). Haplotype analysis revealed that cohorts with both rs4819554*A and rs879577*T conferred protection against developing CSU (OR = 0.07, 95% CI = 0.01-0.32, P = .001).

CONCLUSION

Our results showed that IL17RA gene polymorphisms might contribute to the increased susceptibility to CSU.

Interleukin 17 Receptor a Haplotype Analysis in Chronic Spontaneous Urticaria.. [DOI: 10.21203/rs.3.rs-36841/v1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0]

Background: Chronic spontaneous urticaria (CSU) is a distressing skin disease. Family clustering and heterogeneity in the onset and progression indicate that susceptibility to CSU is a complex trait. In this study, we performed haplotype analysis for one of the key player gene, IL17RA, for CSU to test the association with disease susceptibility and severity.MethodsThe study included 70 CSU patients and 30 healthy controls. The severity of the disease was evaluated by autologous serum skin test (ASST) and urticaria activity score (UAS). ASST test was done and quality of life was assessed using a questionnaire. Allelic discrimination analysis for rs4819554 and rs879577 was performed using Real-Time Polymerase Chain Reaction technology.Results: Carriers of rs4819554*G were more prone to develop CSU than its counterpart (p = 0.039), while rs4819554*A allele displayed more severe phenotype in the form of more prolonged disease duration (p = 0.040), concurrent angioedema (p < 0.001), higher level of treatment (p < 0.001), and higher score of quality of life (p < 0.001). Additionally, homozygote patients with rs879577*CC were associated with angioedema (p < 0.001). Haplotype analysis revealed that cohorts with both rs4819554*A and rs879577*T conferred protection against developing CSU (OR = 0.07, 95%CI = 0.01 - 0.32, p = 0.001).Conclusions: Our results showed that IL17RA gene polymorphisms might contribute to the increased susceptibility to CSU.

Prevalence and risk factors for Enterobacteriaceae in patients hospitalized with community‐acquired pneumonia

BACKGROUND AND OBJECTIVE

Enterobacteriaceae (EB) spp. family is known to include potentially multidrug-resistant (MDR) microorganisms, and remains as an important cause of community-acquired pneumonia (CAP) associated with high mortality. The aim of this study was to determine the prevalence and specific risk factors associated with EB and MDR-EB in a cohort of hospitalized adults with CAP.

METHODS

We performed a multinational, point-prevalence study of adult patients hospitalized with CAP. MDR-EB was defined when ≥3 antimicrobial classes were identified as non-susceptible. Risk factors assessment was also performed for patients with EB and MDR-EB infection.

RESULTS

Of the 3193 patients enrolled with CAP, 197 (6%) had a positive culture with EB. Fifty-one percent (n = 100) of EB were resistant to at least one antibiotic and 19% (n = 38) had MDR-EB. The most commonly EB identified were Klebsiella pneumoniae (n = 111, 56%) and Escherichia coli (n = 56, 28%). The risk factors that were independently associated with EB CAP were male gender, severe CAP, underweight (body mass index (BMI) < 18.5) and prior extended-spectrum beta-lactamase (ESBL) infection. Additionally, prior ESBL infection, being underweight, cardiovascular diseases and hospitalization in the last 12 months were independently associated with MDR-EB CAP.

CONCLUSION

This study of adults hospitalized with CAP found a prevalence of EB of 6% and MDR-EB of 1.2%, respectively. The presence of specific risk factors, such as prior ESBL infection and being underweight, should raise the clinical suspicion for EB and MDR-EB in patients hospitalized with CAP.

IL-37 gene variant (rs3811047): A marker of disease activity in rheumatoid arthritis: A pilot study

BACKGROUND

Rheumatoid arthritis (RA) is a joint destructive disorder with great morbidity. Unraveling genetic determinants causing the disease would pave the road towards early detection and precise medicine. Interleukin 37 (IL-37), a natural inhibitor of innate immunity, was shown to be a key modulator in RA. Plasma levels were deregulated and correlated with disease activity. Therefore, we hypothesized the IL-37 gene variants could influence the clinical characteristics of RA patients.

OBJECTIVE

This is a pilot study to assess the association of rs3811047 variant of IL-37 gene with RA development and disease activity in an Egyptian population.

METHODS

A total of 100 individuals (50 RA patients and 50 healthy individuals) were enrolled in the study. Disease activity score of 28 joints (DAS28) was estimated for RA patients. Genotyping was performed using Real-Time PCR technology.

RESULTS

There was no statistically significant association between genotype frequencies of rs3811047 and RA risk. However, there was a significant relationship between the studied single nucleotide polymorphism (SNP) and disease activity. Patients carrying the GG genotype had higher DAS28 score than patients with AA or AG genotypes (p = .041).

CONCLUSION

IL-37 gene rs3811047 SNP was associated with more severe RA disease activity in the current population. Larger epidemiological study is warranted to validate our results.

Ropporin gene expression in infertile asthenozoospermic men with varicocele before and after repair

OBJECTIVE

To assess Ropporin gene expression in the sperm of infertile asthenozoospermic men with varicocele (Vx) before and after repair.

METHODS

This study included 24 infertile asthenozoospermic men with Vx. They were subjected to history taking, clinical examination, scrotal color Doppler, and semen analysis with sperm separation. Three months after varicocelectomy, they were subjected to postoperative color Doppler, semen analysis, and sperm semiquantitative Reverse Transcription-Polymerase Chain Reaction assay for Ropporin gene expression levels.

RESULTS

Ropporin gene expression is significantly associated with different types of sperm motility, except for nonprogressive sperm motility. There was significant Ropporin gene overexpression postvaricocelectomy that was correlated with improved sperm count, sperm motility, and abnormal sperm morphology with decreased veins diameters.

CONCLUSION

Ropporin gene expression is related to the sperm motility. Its abnormal expression in the sperm of asthenozoospermic men with Vx is associated with impaired sperm motility that is improved after varicocelectomy.

The burden of anti-HCV genotye-4 positivity in renal transplant recipients: 8 years follow-up

Whether renal transplant recipients with anti-HCV antibodies positivity and normal liver function tests within the first year after transplantation have different morbidity and mortality and graft failure compared to anti-HCV-negative recipients remains controversial. In this retrospective study, on 411 renal transplant recipients, we analyzed grafts morbidity, survival, and liver function tests over a period of 8 years. Patients were stratified according to their anti-HCV antibody status 1 year after transplantation into anti-HCV-positive and HCV-negative patients. The presence of normal liver function tests was mandatory at inclusion. All patients received the same immunosuppressive protocol consisting of cyclosporine A, mycophenolate mofetil and steroids. One year after transplantation, 137 patients were anti-HCV negative (33 %) while the rest 274 (67 %) were positive. At 5 years of follow-up, the study population consisted of 205 patients (71 patients, 35 % with anti-HCV negativity, and 134, 65 % with positivity). At the end of the study, only 144 patients were followed up (43 patients, 30 % with negative anti-HCV and 101 patients, 70 %, with positivity). We found that graft survival was not different between both groups. Moreover, serum creatinine showed a trend to be lower in HCV-positive patients compared to negative group although difference was not statistically significant. The number of graft loss was not different between both groups. Moreover, there was no difference between both groups as regards prevalence of acute rejection, diabetes mellitus, hypertension, CMV disease and proteinuria. We can conclude that anti-HCV positivity for 8 years in patients with normal liver function tests at 1 year does not impact graft morbidity and patient survival.

Distance from treatment facility and risk of death from cardiovascular and infectious causes in renal transplant patients

We investigated whether patients receiving RTx who live farther from their attending nephrologist are more likely to die than those who live closer. A random sample of 167 patients who undergone RTx between 1996 and 2004 was examined. We calculated the distance between each patient's residence and the practice location of their attending nephrologist. We used Cox proportional hazards models to examine the adjusted relation between distance and clinical outcomes (death from all causes, rejection episodes, infectious causes, and cardiovascular complications) over a follow-up period of upto 6 years. During the follow-up period (median: 3.3, range: 1.0-6.5 years), 22% of patients died. Compared with patients who lived within 50 km of their nephrologist, the adjusted hazard ratio of death was 1.04 among those who lived 50.1-150 km away, 1.16 for those who lived 150.1-300 km away, and 1.19 for those who lived more than 300 km (P for trend <0.001). The risk of death from infectious causes increased with greater distance from the attending nephrologist (P for trend <0.001). The risk of developing acute rejection episodes did not increase with distance from the attending nephrologist (P for trend = 0.2). The risk of death from cardiovascular causes increased with distance from the attending nephrologist (P for trend <0.05). Compared with patients who lived within 50 km of their nephrologist, the adjusted hazard ratio of death among those who lived >300 km away was 1.75 for infectious causes and 1.39 for cardiovascular causes. We conclude that mortality and morbidity associated with RTx was greater among patients who lived farther from their attending nephrologist, as compared with those who lived closer.

Semen quality and reproductive endocrinal function related to blood lead levels in infertile painters

Lead causes male reproductive impairment among painters, but information is still limited. Therefore, the effect of lead on semen quality and reproductive endocrinal function in those patients was investigated. A case series of 27 infertile painters were subjected to semen analysis, measuring of blood lead level (PbB) and serum levels of endocrinal parameters including follicle-stimulating hormone (FSH), luteinising hormone (LH), testosterone (T) and prolactin (PRL). Significantly lower sperm count and motility were found in those with duration of exposure (≥ 15 years), but no significant difference was found for PbB and serum levels of FSH, LH, PRL and T. A significant negative correlation between PbB and spermatic count and motility was observed, while there was no significant correlation between PbB and all endocrinal parameters. Patients with PbB ≥ 20 μg dl(-1) showed a significant decrease in sperm motility and increase in testosterone alone among all measured hormones. But the observed decrease in sperm count did not reach a significant level. It is concluded that infertile painters are at risk of lead-related influence on semen quality, especially sperm motility and increased testosterone level without significant affection of other reproductive endocrinal parameters.

T helper type 1/T helper type 17-related cytokines in chronic hepatitis C patients before and after interferon and ribavirin therapy

OBJECTIVE

This study examined the T helper (Th) 1/Th17-related cytokines, interferon (IFN)-γ and interleukin (IL)-17 in the serum of biopsy-proven chronic hepatitis C patients before and after IFN and ribavirin therapy to address whether or not viral clearance is related to Th1/Th17 cytokines.

SUBJECTS AND METHODS

The serum levels of IFN-γ and IL-17 were assayed by ELISA on 26 patients with chronic hepatitic C virus (HCV) infection before the start and 3 months after treatment with pegylated IFN-α plus ribavirin and compared with sera from 15 normal control subjects.

RESULTS

IFN-γ and IL-17 levels are higher in the serum of patients with chronic hepatitis than in normal controls and these elevated levels were not directly correlated (r = -0.01, p = 0.96 for IFN-γ and r = -0.08, p = 0.66 for IL-17) to the viremic state of the HCV infection. In contrast to IL-17, IFN-γ showed significant reduction after 12 weeks of treatment with pegylated IFN plus ribavirin. However, IFN-γ and IL-17 serum levels were not significantly (p = 0.19 and = 0.70, respectively) different among responders and nonresponders for pegylated IFN plus ribavirin therapy.

CONCLUSION

Our findings suggest that the combined treatment with pegylated IFN-α and ribavirin downmodulates the secretion of key cytokine IFN-γ as early as 12 weeks after treatment in infected patients. These findings could encourage new exciting possibilities for immune-based interventions with the aim of restoring functional antiviral T cell responses combined with improved viral clearance.

Interferon therapy shifts natural killer subsets among Egyptian patients with chronic hepatitis C

Natural killer cells can be divided into five subpopulations based on the relative expression of CD16 and CD56 markers. The majority of natural killer cells are CD56(dim), which are considered to be the main cytotoxic effectors. A minority of the natural killer cells are CD56(bright), and function as an important source of immune-regulatory cytokines. Shifts of these subsets have been reported in patients with chronic hepatitis C virus infection. We sought to investigate the shift of natural killer subsets among Egyptian patients with chronic HCV and to analyze the influence of interferon therapy on this shift. We applied a flow cytometric analysis of peripheral blood natural killer subsets for 12 interferon-untreated and 12 interferon-treated patients with chronic HCV, in comparison to 10 control subjects. Among interferon-untreated patients, there was a significant reduction of CD56⁻16(+) (immature natural killer) cells. Among interferon-treated patients, the absolute count of natural killer cells was reduced, with expansion of the CD56(bright) subset and reduction of the CD56(dim)16(+) subset. Natural killer subset counts were not significantly correlated to HCV viral load and were not significantly different among interferon responders and non-responders. In conclusion, HCV infection in Egyptian patients has been observed to be statistically and significantly associated with reduction of the CD56⁻16(+)NK subset, while a statistically significant expansion of CD56(bright) and reduction of CD56(dim)16(+) subsets were observed after interferon therapy. Further studies are required to delineate the molecular basis of interferon-induced shift of natural killer subsets among patients with HCV.

Comparison of inguinal approach, scrotal sclerotherapy and subinguinal antegrade sclerotherapy in varicocele treatment: a randomized prospective study

We compared outcome and complications of three simple varicocelectomy techniques. Groups were divided according to whether they would receive the Ivanissevich technique (n = 55), Tauber's technique (n = 51) or subinguinal sclerotherapy (n = 49). Selection criteria were: infertility >1 year, subnormal semen, sonographic diameter of veins >3 mm and time of regurge >2 s. Patients were randomly assigned to the groups of treatment, with follow-up every 3 months for 1 year. Improvement was only in sperm count and total motility for all groups. Pregnancy rates were 20, 13.73 and 12.24%, respectively, with no significant difference between groups. Hydrocele occurred only in the group which received the Ivanissevich technique (5.5%). Tauber's technique is simple; however, it has the disadvantage of multiple branching of small veins.

ErratumTo: Genotypic detection of rifampicin and isoniazid resistant Mycobacterium tuberculosis strains by DNA sequencing: a randomized trial

Correction to Genotypic detection of rifampicin and isoniazid resistant Mycobacterium tuberculosis strains by DNA sequencing: a randomized trial Amina Abdelaal, Hassan Abd El-Ghaffar, Mohammad Hosam Eldeen Zaghloul, Noha El mashad, Ehab Badran, Amal Fathy Annals of Clinical Microbiology and Antimicrobials 2009, 8:4 (30 January 2009)

Genotypic detection of rifampicin and isoniazid resistant Mycobacterium tuberculosis strains by DNA sequencing: a randomized trial

BACKGROUND

Tuberculosis is a growing international health concern. It is the biggest killer among the infectious diseases in the world today. Early detection of drug resistance allows starting of an appropriate treatment. Resistance to drugs is due to particular genomic mutations in specific genes of Mycobacterium tuberculosis(MTB). The aim of this study was to identify the presence of Isoniazid (INH) and Rifampicin(RIF) drug resistance in new and previously treated tuberculosis (TB) cases using DNA sequencing.

METHODS

This study was carried out on 153 tuberculous patients with positive Bactec 460 culture for acid fast bacilli.

RESULTS

Of the 153 patients, 105 (68.6%) were new cases and 48 (31.4%) were previously treated cases. Drug susceptibility testing on Bactec revealed 50 resistant cases for one or more of the first line antituberculous. Genotypic analysis was done only for rifampicin resistant specimens (23 cases) and INH resistant specimens (26 cases) to detect mutations responsible for drug resistance by PCR amplification of rpoB gene for rifampicin resistant cases and KatG gene for isoniazid resistant cases. Finally, DNA sequencing was done for detection of mutation within rpoB and KatG genes. Genotypic analysis of RIF resistant cases revealed that 20/23 cases (86.9%) of RIF resistance were having rpoB gene mutation versus 3 cases (13.1%) having no mutation with a high statistical significant difference between them (P < 0.001). Direct sequencing of Kat G gene revealed point mutation in 24/26 (92.3%) and the remaining 2/26 (7.7%) had wild type KatG i.e. no evidence of mutation with a high statistical significant difference between them (P < 0.001).

CONCLUSION

We can conclude that rifampicin resistance could be used as a useful surrogate marker for estimation of multidrug resistance. In addition, Genotypic method was superior to that of the traditional phenotypic method which is time-consuming taking several weeks or longer.

Expression of toll-like receptor 2 on peripheral blood monocytes of patients with inflammatory and noninflammatory acne vulgaris

The pathogenesis of acne vulgaris is multifactorial and entails the interplay of hormonal, microbial and immunological events. The bacterium Propionibacterium acnes is involved in the induction of comedogenesis and maintenance of the inflammatory phase of acne. Toll-like Receptor 2 (TLR2) expressed on mononuclear inflammatory cells and possibly on keratinocytes and sebocytes is thought to be of vital importance in mediating P. acnes-induced inflammatory response in acne vulgaris. This work aimed to study the degree of expression of TLR2 on peripheral blood monocytes (PBM) from patients with non-inflammatory and inflammatory acne and to investigate the influence of systemic isotretinoin therapy on TLR2 expression. Sixteen patients with predominantly non-inflammatory acne, 16 patients with predominantly inflammatory acne and 16 age and sex matched healthy subjects were involved in this study. Cell surface expression of CD14 and TLR2 were determined by cell surface staining and flowcytometry. TLR2 expression was analyzed for 12 patients with severe and/or scaring inflammatory acne after oral isotretinoin therapy for two months. The mean fluorescence intensity (MFI) of TLR2 on PBM reported a statistically significant difference between patients with non-inflammatory acne, patients with inflammatory acne and control subjects. MFI of TLR was significantly lower for patients with inflammatory acne after systemic isotretinoin therapy. Data obtained suggest that TLR2 expression on PBM is an important event in acne pathogenesis and targeting this molecule might be a useful therapeutic goal in the future.

Diminished absolute counts of CD56dim and CD56bright natural killer cells in peripheral blood from Egyptian patients with hepatocellular carcinoma

Natural killer cells (NK) as components of the innate immunity substantially contribute to anti-tumor immune responses, NK cell subpopulations can be defined on the basis of the relative expression of CD16 and CD56 markers. Earlier research demonstrated a dramatic reduction in the frequency of peripheral blood CD56dimCD16+ NK subsets in hepatocellular carcinoma (HCC) patients compared with healthy subjects. We aim to assess the relative and absolute counts of natural killer cells subsets in hepatitis C-related HCC among Egyptian patients. Flowcytometric analysis of peripheral blood NK subsets was performed for HCV with HCC patients (n=20) and HCV without HCC patients (n=14) as compared to healthy control subjects (n=152). We found that HCC patients displayed a marked reduction in the relative frequency of peripheral CD56im subsets compared with healthy subjects. Moreover, there was a significant reduction in the absolute counts of CD56dim16+, CD56dim16- and CD56bright. In conclusion, this study demonstrated that the absolute counts of dim and bright NK cell subsets were decreased in different proportions in patients with HCV-related HCC that refers to a possible role for these cells, particularly CD 56 bright cells, in the immune response to HCC. This might aid in developing new therapeutic strategies targeting both NK subsets for HCC.

First aid for obstetric haemorrhage: the pilot study of the non-pneumatic anti-shock garment in Egypt

OBJECTIVE

To compare the effect of non-pneumatic anti-shock garment (NASG) on blood loss from obstetric haemorrhage with standard management of obstetric haemorrhage.

DESIGN

Observational study of consecutive obstetric haemorrhage cases before and after introduction of the NASG.

SETTING

Four tertiary care maternity facilities in Egypt.

SAMPLE

The sample consisted of women with obstetric haemorrhage and signs of shock and the entry criteria were: >750 mL of blood loss and either pulse of >100 beats per minute or systolic blood pressure of <100 mmHg. A total of 158 women were in the preintervention group and 206 in the postintervention group.

METHODS

All the women with haemorrhage meeting the eligibility criteria were treated according to the standard protocol for 4 months (May-August 2004); blood loss was measured and recorded. The NASG was then introduced, and all the women meeting the eligibility criteria were treated according to the standard haemorrhage protocol plus the NASG for 4 months (September-December 2004).

MAIN OUTCOME MEASURES

Measured blood loss collected in a closed-end, graduated, plastic, under buttocks collection drape.

RESULTS

Median measured blood loss in the drape following study entry was 50% lower in those treated with the NASG (250 versus 500 mL, P < 0.001). There was also a non-statistically significant decrease in morbidity and mortality.

CONCLUSIONS

This is the first comparative study of the NASG with a standard obstetric haemorrhage treatment protocol. The NASG shows promise for management of obstetric haemorrhage, particularly in lower resource settings. Larger studies will be needed to determine if the NASG contributes to statistically significant decreases in morbidity and mortality.

Automation of semen analysis using flow cytometer in comparison with manual methods

In order to standardize techniques and limit the effect of human factors on the results of analyses of biological fluids, automation seems to be mandatory. In an attempt to automate semen analysis, computer assisted sperm analysis (CASA) system has been developed, however its use is still limited and its practical applications have many criticisms. In a trial to automate semen analysis, this study aimed to evaluate the usefulness of flow cytometer in the detection of some seminal parameters in comparison with the traditional manual methods. Isolated spermatogenic cells and isolated sperms from semen and EDTA blood of volunteers were analyzed by flow cytometer in order to define their respective regions. Ejaculates of 28 male patients were subjected to routine semen analyses, leucocytes detection by peroxidase test and monoclonal antibody CD53 using flow cytometer after preparation of the patients' semen samples for flow cytometeric analysis. A highly significant correlation (r=0.96, p= 0.001) of absolute neutrophils (pus cells) detected by peroxidase versus flow cytometer using CD53 monoclonal antibody. A poor correlation (r=0.39, p=0.035) of sperm counts assessed by manual technique and flow cytometer and a spurious sperm counts of 1.08 million/ml detected by flow cytometery in azoospermic patients. Flow cytometer could be used for the assessment of pus cells in semen but seems to be non reliable for the assessment of sperm count if gating depend on sperm size and granularity alone.

Diminished CD4+CD25+ T-lymphocytes in peripheral blood of patients with systemic lupus erythematosus

The exact aetio-pathogenesis of systemic lupus erythematosus (SLE) is still speculative, where dysregulation or depletion of CD4+CD25+ T lymphocytes is among the supposed mechanisms. In this study, we thought to investigate patients with SLE for percentages of CD4+CD25+ T cells in their peripheral blood and to correlate this with their disease activity scores. Twenty-five patients with SLE who fulfilled, at least, four of the revised Criteria of the American College of Rheumatology (ACR) and twenty healthy volunteers participated in this study. Activity of SLE was assessed by SLE disease activity index (SLEDAI) score. Percentages of CD4+CD25+ T-cells were determined by a flowcytometric technique, while recently activated T-cells were analysed by assaying the expression of the T-cell activation marker, CD69. A statistically significant (p = 0.003) reduction of percentage of CD4+CD25+ T cells was observed among patients (mean 7.16+/-4.53 %) when compared with control subjects (mean 11.36+/-4.50 %), while a non-significant (p = 0.475) low expression of CD69 on CD4+ T cells was observed between patients (mean 0.32+/-0.28 %) and control subjects (mean 0.32+/-0.38 %). In addition, no correlation could be detected between percentages of CD4+CD25+ T cells and SLEDAI scores among SLE patients (p=0.079). In conclusion, this study adds some evidence for the role of CD4+CD25+ T cells in the pathogenesis of SLE that may have some future therapeutic applications.

TT virus infection among Egyptian patients with hepatocellular carcinoma

Hepatitis B and C viruses (HBV and HCV) have been associated with hepatocellular carcinoma (HCC). Recently, a novel DNA virus was isolated from a patient with posttransfusion hepatitis of unknown etiology and designated TT virus (TTV). To examine whether this virus is associated with HCC, we investigated sera from 82 Egyptian patients with histopathologically-diagnosed HCC. All subjects underwent serological investigations for detection of hepatitis B surface antigen (HbsAg), hepatitis B core antibody (HbcAb) and anti-HCV. Detection of TTV-DNA was performed by semi-nested polymerase chain reaction (PCR) using TTV-specific primers. TTV-DNA was detected in 28% of the patients. Age, gender, risk factors and biochemical liver functions did not significantly differ between TTV-DNA positive and negative patients. TTV was detected in 27.1% of patients with HCV-HCC, 25% of HBV-HCC, 66.7% of dual HCV and HBV infection and 40% of those with non-B, non-C-HCC (NBNC-HCC). It is concluded that, in this the cohort of Egyptian patients with HCC, TTV infection is common and is not associated with HCV, HBV, NBNC-HCC, history of schistosomiasis or blood transfusion.