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Background: Sickle cell disease (SCD) consists of a group of hemoglobinopathies in which individuals inherit hemoglobin variants derived from single point mutations. Asymmetric dimethylarginine (ADMA) contributes to limiting Nitric Oxide (NO) bioavailability in SCD. The aim of the present study was to assess the level of the Asymmetric Dimethyl Arginine in children with sickle cell. Methods: This cohort cross-sectional study was carried out on 60 children which were divided in to 3 equal groups. Group I: SCD children with sickle retinopathy. Group II: SCD children without retinopathy. Group III: healthy control children who were selected from the outpatient clinic. Results: There was a significant increase in ADMA level among participants withSCD. There was a positive significant correlation between ADMA level and family history as well as the incidence of hepatomegaly. There was no significant correlation between ADMA level and demographic and laboratory parameters except LDH. Conclusions: The level of ADMA is elevated in children with sickle cell anemia. High plasma ADMA level is a risk for hepatomegaly in children with sickle cell anemia.

Asymmetric dimethylarginine (ADMA) level may play a role in the pathogenesis of cerebrovascular stroke in Children with Sickle Cell Anemia (SCA). To assess the plasma level of ADMA in children with SCA and its correlation to cerebral blood flow. This is a cross sectional study was carried out on 30 children with homozygous SCA under follow up in the Out Patients Clinic, Pediatric Department at Tanta University Hospital and 30 healthy children as a control group. Both groups had undergone the following investigations: Complete blood count, lactate dehydrogenase enzyme, and plasma level of ADMA by a commercial ADMA ELISA Kit. Trans-cranial Doppler were done for both groups. ADMA plasma level was significantly higher in-patient group in comparison to the control group (p

Background: The Interleukin (IL)-37 is a member of IL-1 cytokines and reported to down-regulate inflammation as a natural suppressor of innate immune responses. We measured serum IL-37 concentration in Rheumatoid Arthritis (RA) patients and analyzed clinical disease activity and radio-graphic erosion in RA.Aim of the Study: To throw some light on Interleukin-37 (IL-37) in patients with rheumatoid arthritis and its impact on disease activity and joint damage.Subject and Methods: 30 patients diagnosed to had Rheu-matoid Arthritis (RA) selected from Outpatient Clinic of Physical Medicine, Rheumatology and Rehabilitation Depart-ment, Tanta University Hospitals fulfilling the American College of Rheumatology (ACR)/European League Against Rheumatism (EULAR) 2010 criteria for diagnosis of RA, and 20 apparently healthy individuals matched in age and sex participated as controls. Patients with other autoimmune diseases, acute coronary syndrome or any current infections were excluded. Disease Activity Score in 28 joints (DAS 28) was assessed for all patients; routine laboratory investigations (rheumatoid factor RF, anti-cyclic citrullinated peptide anti CCP, complete blood count CBC, Erythrocyte Sedimentation Rate ESR & C Reactive Protein CRP) and serum level of IL 37 measured by Enzyme-Linked Immunosorbent Assay ELISA were evaluated. Degree of joint destruction was assessed by Larsen score.Results: Serum IL-37 level was significantly higher in RA patients than control and positively correlated with level of disease activity assessed by DAS-28 score, also with clinical and laboratory indicators of disease activity as well as degree of bone erosion measured by Larsen score.Conclusion: IL-37 was increased in RA patients and its level was increased with disease activity, so it could prove to be potential biomarker for RA diagnosis, disease activity assessment and curative effect observation.

Background Lupus nephritis (LN) is one of the most common and serious complication of Systemic Lupus Erythrematosus (SLE) and assessment of its activity is crucial. Heparanase has been proposed to be important in the pathogenesis of proteinuria in various forms of glomerulonephritis. Objectives To assess the ability of urinary heparanase to identify SLE with nephritis and the relation of this marker to lupus activity. Methods This cross sectional study was carried out on 90 subjects; 70 patients with SLE and 20 healthy volunteers as a control. All patients and controls were subjected to full history taking and complete clinical examination, routine investigations. Immunological assay and assessment of disease activity by systemic lupus erythematosus disease activity index (SLEDAI) score, renal SLEDAI (r-SLEDAI) were done for lupus nephritis group. The lupus patients were divided according to SLEDAI score into 4 groups; 20 with active lupus nephritis, 17 with non-active LN, 18 with active lupus without renal involvement, 15 with non-active lupus without renal involvement. Urinary Heparanase levels were measured by using ELISA for all groups. Results The level of urinary heparanase was significantly higher in LN groups than non-LN groups and control. It was also significantly higher in active LN than non-active LN patients. There was a significant positive correlation between urinary heparanase and 24 hours urinary proteins, total SLEDAI, and r-SLEDAI, and significant negative correlation between urinary heparanase and C3 & C4. ROC curve analysis revealed that urinary heparanase predicted presence of lupus nephritis activity with a sensitivity of 80%, and a specificity of 91.43%. Conclusion Urinary heparanase levels are increased in patients with active LN and correlate with disease activity markers, indicating that it can serve as a new useful biomarker for lupus nephritis activity. References [1] Kim K-J, Kim J-Y, Park S-J, Baek I-W, Yoon C-H, Kim W-U, et al. SAT0227 Urinary heparanase activity is elevated in patients with lupus nephritis and correlate with protein excretion. Annals of the Rheumatic Diseases. 2013;71(Suppl 3):548-9. [2] Cho C, Kim K, In-Woon B. 206 Increased urinary heparanase levels are associated with active lupus nephritis. Archives of Disease in childhood; 2017. F: F for ANOVA test, Pairwise comparison bet. each 2 groups was done using Post Hoc Test (Tukey) − p: p value for comparing between the different groups − p1: p value for comparing between group V and each other group − p2: p value for comparing between group I and group II − p3: p value for comparing between group III and group IV − p4: p value for comparing between group I and group III − p5: p value for comparing between group II and group IV − p6: p value for comparing between group I and group IV − p7: p value for comparing between group II and group III Disclosure of Interests None declared

SummaryBackground Platelet-rich plasma (PRP) is considered as a growing modality for tissue regeneration and a developing research area for clinicians and researchers. PRP injection treatment provides supraphysiological concentrations of growth factors that may help in accelerated tissue remodeling and regeneration. Aim of the study To evaluate the efficacy and safety of single autologous PRP intradermal injection for treatment of facial wrinkles and for facial rejuvenation. Patients and methods A total of 20 subjects with different types of facial wrinkles were included in this study. All subjects received single PRP intradermal injection and were clinically assessed before and after treatment for a period of 8 weeks using Wrinkle Severity Rating Scale (WSRS), Skin Homogeneity and Texture (SHnT) Scale, Physician Assessment Scale, and Subject Satisfaction Scale. Results The mean value of WSRS reduced from 2.90 ± 0.91 before treatment to 2.10 ± 0.79 after 8 weeks of treatment. The most significant results were with younger subjects that have mild and moderate wrinkles of the nasolabial folds (NLFs). Fourteen of seventeen subjects with NLFs showed more than 25% improvement in their appearance. Side effects of PRP treatment were minimal to mild and with excellent tolerability. Conclusion Single PRP intradermal injection is well tolerated and capable of rejuvenating the face and producing a significant correction of wrinkles especially the NLFs.

To assess the diagnostic value of interleukin 6 (IL-6), IL-8 and tumor necrosis factor-α (TNF-α) as inflammatory markers in chronic obstructive pulmonary disease (COPD) patients. IL-6, IL-8 and TNF-α levels were measured by ELISA in the serum and the bronchoalveolar lavage (BAL) in 10 control participants and 25 mild and moderate COPD patients, whereas 25 patients with severe COPD were studied for the serum level of these inflammatory biomarkers. The mean value and SD of BAL and serum IL-6, IL-8 and TNF-α levels were significantly higher in COPD patients when compared with control participants; the serum level of these biomarkers were also significantly higher in severe compared with mild and moderate COPD patients. Increased srum and/or BAL IL-6, IL-8 and TNF-α can be used as biomarkers of the systemic inflammatory response in COPD patients, and their levels are correlated with the severity of COPD. Egypt J Broncho 2014 8:91–99

Background and study aims This study aimed to find out non-invasive markers for the assessment of severity of non-alcoholic steatohepatitis (NASH) in an attempt to decrease the need for liver biopsy. It also aimed to evaluate the key role of apoptosis in the pathogenesis of the disease and the suggested role of anti-apoptotic factors in therapeutic modalities and disease prognosis. Patients and methods The serum levels of soluble Fas (s. Fas), s. Fas ligand, cytokeratin 18 (CK-18) fragment and Bcl-2 were measured in 80 patients and 15 non-hepatic subjects as control. The patients were divided based on histological examination of liver biopsy into three groups. Group I included 40 patients with NASH, group II had 40 patients with non-alcoholic fatty liver disease (NAFLD) non-NASH and group III had 15 non-hepatic subjects as control. Apoptosis of hepatocytes was assessed by morphological examination using a light microscope and expressed as number per square millimetre. Results There was a significant increase in the serum levels of s. Fas, s. Fas ligand and CK-18 fragments in the NASH group. The anti-apoptotic protein Bcl-2 showed significantly low levels in NASH patients. Apoptosis of hepatocytes was significantly higher in the NASH group. The degree of apoptosis was inversely correlated with the level of Bcl-2. A significant correlation between both s. Fas and CK-18 fragment with liver histology with regard to lobular inflammation and ballooning was found. Conclusions Increased serum levels of s. Fas and CK-18 fragment in the NASH group and its correlation with the severity of disease suggested the key role of apoptosis in NASH pathogenesis which can be used for the assessment of the severity of NASH. A high level of anti-apoptotic Bcl-2 in NAFLD suggests its protective role in disease progress.

Background: COPD is characterized by air flow limitation that is not fully reversed and associated with an influx of neutrophils, macrophages and CD8 T lymphocytes in the airways. The disease is characterized by airflow limitation and is associated with an abnormal inflammatory response of the lungs in response to noxious particles or gases and associated with systemic manifestation. Methods: Sixty consecutive patients with COPD and 40 normal healthy individuals were included. All cases and controls were subjected to detection of 2 polymorphic loci (S1 AND Q1) of ADAM33 by PCR-RFLP technique. Results: The percentage of S1 and Q1 AA genotype and A allele were significantly increased in control than in COPD patients while there was significant increase in S1 and Q1 GG genotype and G allele in COPD patients than in control (p 0.05, whereas there was significant increase in ADAM33 S1 G allele and Q1 G allele in smoker and non-smoker in COPD patients as compared to their corresponding fellows in control group (p

Aim To investigate the reduction in the serum level of cytokeratin-19 fragments (CYFRA 21–1), nucleosomes and neuron-specific enolase (NSE) as early measures of the response to chemotherapy in non-small cell lung cancer (NSCLC). Methods Forty-two consecutive patients with locally advanced NSCLC were included. All patients received platinum-based chemotherapy. Staging investigations and quantification of CYFRA 21–1, nucleosomes and NSE (using enzyme-linked immunosorbent assay, ELISA) were performed before the start of treatment and after the second cycle of chemotherapy. According to the response to chemotherapy, patients were classified into 3 groups: (I) disease regression, (II) stable disease, and (III) progressive disease. The reduction in the levels of tumor markers was correlated with the response to chemotherapy. Results After the second cycle of chemotherapy, groups I and II had significantly decreased serum levels of CYFRA 21–1 (pConclusion The reduction in the serum level of CYFRA 21–1 and nucleosomes may be used for early identification of NSCLC patients with good response to chemotherapy.

Background: Iron deficiency may contribute to diminished exercise tolerance in patients with congestive heart failure (CHF) even in absence of anemia. The aim of this study was to evaluate the effect of correction of iron deficiency on functional capacity and myocardial function in patients with CHF. Methods: We studied 40 patients with ejection fraction 12 g/dL, serum ferritin

Objectives: Thalassemic children with repeated blood transfusion are at higher risk of suffering transfusion relatedinfections including hepatitis B virus (HBV). HBV vaccine immunogenicity in several studies showed variable responserates. The aim of this study is to evaluate the immunogenic effect of hepatitis B vaccine in thalassemic children at differentage groups.Materials and methods: After ethical approval and informed parent consent, 125 diagnosed thalassemic patients wererecruited from the Hematology/Oncology Unit, Pediatric Department, Tanta University Hospital. Patient’s transfusion,and vaccination history, clinical data, and blood samples were obtained. Patient’s sera were stored at -20°C till tested forAnti-hepatitis B surface (anti-HBs) by ELISA. Patients with titers 10IU/L). Significantly higher percentage of protected patients (40.1%) were younger than 3 years of age, while age groupsabove 3years showed a significant trend towards having non protective titers (p=0.003). Anti-HBs titers weren’t correlatedto age, ferritin, liver enzymes, and duration of transfusion or number of transfused packs.Conclusion: Protective Anti-HBs titer was reduced after age of 3 years in our patients. So, we recommend screeningof thalassemic patients at age of 3 years to evaluate the need of a booster dose. J Microbiol Infect Dis 2012; 2(2): 44-49Key words: Thalassemia, HBV, vaccination, immunogenicity

Objectives The aim of this study was to identify clinical parameters associated with increased carotid intima media thickness (CIMT) in adolescents with type 2 diabetes. Background Overweight children and adolescents are at increased risk of type 2 diabetes and early development of atherosclerotic lesions and cardiovascular complications. Methods Patients were selected among diabetics who presented to diabetes out patients’ clinic. Criteria for selection were age (12–19 years), being overweight (BMI above the 95th percentile for age and gender), normal or high C-peptide, and negative studies for islet cell antibodies. Age and gender matched healthy subjects, were enrolled as a control group. Laboratory investigations included lipid profile, hypersensitive C-reactive protein (hs-CRP), HbA1c and assessment of insulin resistance by HOMA. According to HbA1c, patients were divided into, uncontrolled group (with HbA1c >6.5) and controlled group (with HbA1c ⩽ 6.5). Ultrasonographic analysis of CIMT was performed for all participants and its association with risk variables was analyzed. Results BMI, triglycerides, C-reactive protein, HbA1c and HOMA were significantly higher in diabetic patients than the controls. CIMT, HbA1c, systolic blood pressure, triglycerides, HOMA and C-reactive protein were significantly higher in uncontrolled than controlled diabetics, while there was no significant difference between the two groups as regard BMI, total cholesterol, LDL, HDL and C-peptide. In diabetic patients, CIMT correlated positively with BMI, duration of diabetes, systolic and diastolic blood pressure, HbA1c, HOMA, and C reactive protein. Conclusion CIMT is increased in adolescents with type 2 diabetes as compared to control subjects. Poor glycemic control, HOMA, increased C reactive protein, BMI, duration of diabetes and elevated blood pressure are associated with early atherosclerosis in these patients.

Background Fetuin-A is a multifunctional hepatic secretory protein that is involved in the pathology of many disorders. Recent epidemiological studies showed that serum Fetuin-A was associated with insulin resistance and its comorbidities, such as metabolic syndrome and type 2 diabetes. Hyperthyroidism involves a significant increase in the level of tissue metabolism and is often accompanied by abnormal glucose tolerance and insulin resistance. Aim The aim of this work is to study the relationship between serum Fetuin-A and insulin resistance in patients with hyperthyroidism. Participants and methods Our study was carried out on 35 newly diagnosed patients with hyperthyroidism (group I) and 20 healthy individuals matched for age and sex as controls (group II). Fetuin-A, fasting insulin, fasting blood glucose, free T3, free T4, thyroid stimulating hormone, total serum calcium, and high-sensitivity C-reactive protein were measured before and after euthyroidism was established. Results Significantly higher levels of serum Fetuin-A were noted in the patient group before treatment compared with the control group. There was a significant decrease in serum Fetuin-A in the patients after treatment in comparison with before treatment. There was an insignificant difference between the patients after treatment and the control group in terms of serum Fetuin-A. Fetuin-A was correlated positively with Homeostasis Model of Assessment-Insulin Resistance, High-sensitivity C-reactive protein, fT3, and fT4, whereas there was a negative correlation between thyroid stimulating hormone and Fetuin-A. Conclusion This study provides direct evidence for a relationship between serum Fetuin-A and insulin resistance in patients with hyperthyroidism.

Background: Transfusion dependant patients are at a higher risk of acquiring bloodborne infections even under conditions of safe transfusion. This study was designed to determine sero-prevalence of hepatitis C infection and possible associated risk factors in thalassaemic children. Methods: One hundred and twenty five children with b thalassaemia major (b-TM) were recruited from the Haematology/Oncology Unit, Paediatric Department, Tanta University Hospital, Egypt, between April 2010 and October 2011. Patients underwent history taking, full clinical examination, routine investigations and venous blood sampling. Serum was stored at 2208C till tested for hepatitis C (HCV Ab) and B (HBsAg) by ELISA. HCV Ab positive cases were confirmed by PCR. Results: All patients were HBsAg negative. HCVAb ELISA was positive in 76%, negative in 20% and equivocal in 4%. Fifty patients (40%) had positive PCR for HCV. PCR showed low viraemia in 78%, moderate viraemia in 20% and high viraemia in 2%. A positive family history of HCV, history of minor operative intervention and/or dental procedures were significantly associated with higher frequency of HCV infection in thalassaemic children, while amount and frequency of transfused blood, age at transfusion and chelation state were not. Conclusion: HCV infection is highly prevalent in children with b-TM in Egypt despite strict pre-transfusion blood testing. This should arouse the attention for environmental and community acquired factors. Quality management to insure infection control in minor operative procedures and adding more sensitive tests for blood screening are recommended.

To assess TLR9 expression in systemic lupus erythematosus (SLE) patients, its correlation with disease activity, and impact of TLR9 expression on the response to oral glucocorticoids.Twenty-five active SLE, 15 inactive, and 15 control subjects were included. Anti-DNA, ANA, C3, C4, and TLR9 mRNA expressions were assessed. Active SLE patients only received oral steroid for 6 weeks. Post therapy, they were classified into steroid sensitive and steroid resistant. Data were reassessed after treatment.SLEDAI, anti-DNA, ANA, and TLR9 expressions were significantly higher in active SLE patients. Based on retrograde analysis, TLR9 expression was significantly higher in steroid-resistant versus steroid-sensitive group before treatment, with no significant difference between them after treatment. There was a significant positive correlation between TLR9 expression and SLEDAI score and anti-DNA and negative correlation with C3 and C4 in all patients.TLR9 may play a role in the pathogenesis of SLE and correlates with the disease activity. Corticosteroids have no effect on TLR9 expression, explaining lack of corticosteroid response in some SLE patients. TLR 9 expression can be used in predicting glucocorticoid response in active SLE patients. New treatment modalities targeting TLR9 expression may be of value in steroid-resistant patients.

Objective: To identify the clinical parameters associated with increased carotid intima-media thickness (CIMT) in overweight and obese adolescents with type 2 diabetes. Methods: We studied 27 patients (11 males) with type 2 diabetes. Criteria for selection were age (12–19 years), body mass index above the 95th percentile for age and gender, a positive family history of diabetes, normal or high C-peptide, and negative studies for islet cell antibodies. Age- and gender-matched healthy subjects were selected as the control group. Measurements of CIMT, lipid profile, hypersensitive C-reactive protein, hemoglobin A1C (HbA1C), and insulin resistance by homeostasis model of assessment (HOMA) were obtained for all participants. Results: CIMT was higher in diabetic patients than in healthy subjects (0.68 ± 0.16 vs. 0.58 ± 0.1, p < 0.01). The range of HbA1C in the 15 patients with uncontrolled diabetes was 7.6–10.4 (mean: 8.9 ± 0.9). CIMT, HbA1C, systolic blood pressure, triglycerides, HOMA, and C-reactive protein were significantly higher in patients with uncontrolled than with controlled diabetes. In diabetic patients, CIMT correlated positively with body mass index ( p < 0.001), duration of diabetes ( p < 0.001), systolic ( p < 0.001) and diastolic blood pressure ( p < 0.01), HbA1C ( p < 0.001), HOMA ( p < 0.01), and C-reactive protein ( p < 0.01). Conclusions: CIMT is increased in adolescents with type 2 diabetes. Poor glycemic control, HOMA, increased C-reactive protein, body mass index, duration of diabetes, and elevated blood pressure are associated with early atherosclerosis in these patients.

Background and aim To evaluate the role of chemokine CC ligand 20 (CCL20) as a biomarker for hepatocellular carcinoma (HCC). Patients and methods Ninety patients in four groups were enrolled in this prospective cross-sectional study: 30 with HCC (group I), 30 with liver cirrhosis (group II), 15 with hepatitis C virus infection (group III), and 15 healthy blood donors as controls. Alpha fetoprotein (AFP), CCL20 and vascular endothelial growth factor (VEGF) were measured in all groups. Results Serum levels of CCL20 were significantly different among the study groups (F=230.979, pConclusion CCL20 may be used for the detection of HCC in HCV-infected patients with comparable specificity and higher sensitivity than AFP.

Diabetes is now the major cause of end-stage kidney failure, both in developing and developed nations. It is the primary diagnosis causing kidney diseases in 20-40% of patients starting treatment for end-stage renal diseases worldwide. The aim of the study was to evaluate the urinary level of vitamin D-binding protein (UVDBP) as a new biomarker for diabetic nephropathy (DN). Urine samples were obtained from 45 patients with type 2 diabetes mellitus and were classified into three groups (normoalbuminuric, microalbuminuric, and macroalbuminuric). Fifteen healthy participants served as the control group. The excretion levels of UVDBP were quantified with enzyme-linked immunosorbent assay. The results showed that UVDBP levels were significantly elevated in patients of the DN3 and DN4 groups compared with those of the DN2 group and normal controls. In conclusion, the current study demonstrated that UVDBP levels were significantly elevated in patients with DN. Moreover, a strong positive correlation was observed between the expression level of UVDBP and the development of DN. Thus, the findings indicate that UVDBP levels are a potential biomarker for the early detection of DN.

Background Helicobacter pylori is a pathogenic bacterium that has been linked to many disorders such as cardiovascular diseases, diabetes mellitus, and dyslipidemia. However, whether it is associated with insulin resistance still needs to be evaluated. In this work we aimed to delineate the possible relation of H. pylori infection with insulin resistance in nonobese nondiabetic patients. Patients and methods The study was carried out on 80 individuals who were divided into two groups. Forty patients were diagnosed to have H. pylori and 40 healthy volunteers formed the control group. All were subjected to history taking, clinical examination, routine laboratory investigations, evaluation of H. pylori immunoglobulin G level, and assessment of fasting blood glucose and fasting insulin level to calculate homeostasis model assessment of insulin resistance. Results There was a significant increase in C-reactive protein in H. pylori-positive patients when compared with H. pylori-negative controls. Also a significant positive correlation was found between homeostasis model assessment of insulin resistance and each of fasting blood glucose, fasting insulin, and C-reactive protein in both groups. Conclusion H. pylori infection was strongly associated with insulin resistance in nonobese, nondiabetic patients.