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Objective: Early Childhood Caries (ECC) considers a multifactorial disease. Vitamin D, calcium, and phosphorus have a crucial role in mineralized tissue formation and mineralization. The purpose of this study was to evaluate the association between the serum level of vitamin D, calcium, and phosphorus, and ECC in healthy preschool children. Subject and methods: A 36 preschool children with age from 1 to 6 years old were selected for this clinical study. Enrolled children were randomly divided into two equal groups (n=18); group I; children with ECC, group II; children with caries-free. Clinical examination was carried out to assess decay, missing, filled teeth (dmft) caries index using World Health Organization (WHO) criteria. 25-hydroxyvitamin D “25(OH)D”, calcium, and phosphorus in serum had been measured for all enrolled children. Data were analyzed using paired t-test, and chi-square test at a p Results: The results of this study showed a significant decrease in serum level of vitamin D, calcium, and phosphorus in children with ECC when compared to children with caries-free. However, the result of the dmft index revealed that the filled tooth due to caries showed a higher mean followed by decay and missing teeth. Conclusion: There is a relation between the deficiency in serum level of vitamin D, calcium, and phosphorus and the incidence of ECC.

Background: Deflation of the pneumatic tourniquet after orthopedic surgery is associated with multiple cardiovascular adverse effects [hypotension and tachycardia]. Trendelenburg position or passive leg raising [PLR] are commonly used as the initial treatment of shock and hypotension Aim of the work: To compare between Trendelenburg position 20˚ and passive leg raising 45° regarding the incidence of post-tourniquet deflation cardiovascular adverse effects in patients undergoing unilateral knee arthroscopy. Patients and methods: This prospective study included 98 cases that underwent unilateral knee arthroscopy. Patients were randomly allocated into two groups; group [1] included 49 cases who were exposed to the Trendelenburg position after deflation, and group [2] included the remaining cases who had the straight leg raising test after deflation. Mean arterial pressure, heart rate, and need for vasoactive substances were recorded. Results: No significant difference was noticed between the two groups regarding demographic variables, heart rate before tourniquet deflation, and one-minute after its deflation. However, there was a significant difference between the same groups on the subsequent readings apart from the last one. Also, group [1] showed significantly higher mean arterial pressure [MAP] compared to group [2] after deflation. Hypotension was more significantly encountered in group [2], and thus ephedrine requirements were increased. Conclusion: Trendelenburg position appears to be more efficacious when compared to the straight leg raising, regarding the prevention of cardiovascular adverse effects associated with deflation.

Background: During liposuction procedures, injection of wetting solution containing epinephrine is performed. This may increase the risk of cardiovascular side effects in large volume cases. Magnesium sulfate has cardioprotective effects, and can prevent complications related to epinephrine. The aim of the work: To assess the effect of adding intravenous magnesium sulfate, during the administration of epinephrine containing wetting solution, on the incidence of epinephrine-mediated cardiovascular side effects during liposuction surgery. Patients and Methods: This was a prospective randomized study comprised a total of 94 cases into two equal groups. The epinephrine group included 47 cases that had epinephrine in their wetting solution, and epinephrine-Mg group included the remaining cases that had adrenaline in the wetting solution along with intra venous. administration of MgSO4. Heart rate, blood pressure, arrhythmia incidence, isoflurane, and morphine consumption were recorded. Results: No significant difference was noticed as regard basal and induction heart rate and mean arterial pressure [MAP]. However, the epinephrine-Mg group showed significantly lower readings on subsequent assessment. There was no significant difference among both groups regarding the incidence of arrhythmia; the epinephrine group had more cases with arrhythmia. Isoflurane consumption decreased significantly in the epinephrine-Mg group in comparison with the epinephrine group, while morphine consumption did not significantly differ between them. Conclusion: Based on our findings, intravenous administration of magnesium sulfate decreases heart rate, blood pressure, and inhalational anesthesia consumption during liposuction. However, it has no significant impact neither on the incidence of arrhythmia, nor morphine consumption.

Background Systemic lupus erythematosus (SLE) is a complex autoimmune disease with activation of the innate and adaptive immune systems. Vitamin A deficiency causes imbalance of T helper 17 (Th17) and regulatory T cell (Treg), deteriorating the progression of SLE. Aim To determine the relationship between vitamin A levels and Th17 and Treg level in patients with SLE and its relation to disease activity. Patients and methods A total of 45 female patients with SLE diagnosed according to the American College of Rheumatology criteria and 45 healthy age-matched and sex-matched patients as control group were included. Full assessment was done including medications, clinical examination (pain evaluation by visual analogue scale and assessment of disease activity by SLE disease activity index), laboratory investigations, and albumin–creatinine ratio. Serum levels of vitamin A were measured by a human KAMIYA kits, and flow cytometry was used for measuring Th17 and Treg percentages. Results There was a significant deficiency of vitamin A level in patients with SLE compared with controls (P=0.001). There was a significant negative correlation between vitamin A and Th17 (P=0.001) and positive correlation between vitamin A and Treg percentages (P=0.001). There was a negative correlation between vitamin A levels and albumin–creatinine ratio in patients with SLE (R=−0.255). A positive correlation between serum levels of vitamin A and C3 and C4 was found (P=0.001). Conclusion Vitamin A deficiency is a bad prognostic factor in patients with SLE, affecting Th17/Treg balance. Routine use of retinoic acid may be a promising supplementary agent in patients with SLE, improving its prognosis.

Aim of the work: To evaluate three subtypes of CD4+Foxp3+ T cells, interleukin-35 (IL-35) and IL-10 in systemic lupus eryhtematosus (SLE) patients and study their relation to disease activity. Patients and methods: Fifty SLE patients were included and divided according to the SLE disease activity index (SLEDAI) into 2 equal groups with activity or in remission. Twenty healthy subjects were included as controls. All subjects underwent flow cytometric analysis of CD4, CD25, CXCR5 and Foxp3 expression on T cells. Serum IL-35 and IL-10 levels were measured by ELISA. Results: Patients were 46 females and 4 males with a mean age of 38.0 ± 10.0 years, disease duration of 9.2 ± 6.0 years. The mean SLEDAI was 6.8 ± 3.7 in active ones. SLE patients especially those with activity had significantly reduced percents of CD4+CD25+Foxp3+ and CD4+CXCR5+Foxp3+ T cells, but increased percents of CD4+CD25−Foxp3+ T cells. This was accompanied by significant higher levels of serum IL-35 and IL-10 (p

Background Diabetic retinopathy (DR) is one of the most common and serious micro vascular complication affecting type 2 diabetic patients. The literature on adipokines as a possible mechanism in the pathogenesis of DR is contradictory. We are in need for more explanation about the pathogenesis of DR and also in need for reliable biomarker for early diagnosis of such complication. The aim of this work was to study the serum level of omentin-1 and its relation to diabetic retinopathy in type 2 diabetes mellitus (type 2 DM). Patients and methods This study was conducted on 75 type 2 DM patients; 20 healthy subjects served as a control group. All participants were classified into 4 groups: • Group1: Included 25 type 2 diabetics without retinopathy. • Group2: Included 25 type 2 diabetics with non proliferative diabetic retinopathy (NDPR). • Group 3: Included 25 type 2 diabetics with proliferative diabetic retinopathy (PDR). • Group 4: Included 20 healthy subjects as a control group. Thorough history taking and physical examination with calculation of body mass index (BMI), investigations were done including serum creatinine, lipid profile, glycosylated haemoglobin (HbAIc), C-reactive protein (CRP), urine albumin creatinine ratio (UACR) and serum omentin-1. Fundus examination was carried out by an expert ophthalmologist. Results Serum omentin-1 level was significantly lower in diabetic patients compared with the control, and in DR compared with diabetics without DR and in PDR compared with NPDR. There was a negative significant correlation between serum omentin-1 level and BMI, HbA1c, CRP, total cholesterol, low density lipoprotein (LDL) and Serum triglycerides (TG) and positive significant correlation with high density lipoprotein (HDL). Conclusions From this study we can conclude that serum omentin-1 is significantly lower in patients with DR compared with diabetics without retinopathy and in PDR patients compared with NPDR patients. Also, there is a negative significant correlation between serum omentin-1 and HbAIc, BMI, CRP and some lipid parameters.

Background Glucagon-like peptide-1 (GLP-1) is a peptide formed of 30 amino acids. It is synthesized in and released from the enteroendocrine L cells that are present throughout the small and the large intestine. Because of the important physiological role of GLP-1 in augmenting insulin secretion, it is generally believed that GLP-1 release is deficient in type 2 diabetes mellitus (T2DM) patients. However, studies in adults have yielded conflicting results showing decreased, normal, or increased GLP-1 concentrations in prediabetics or T2DM after oral glucose or mixed meal. The aim of this work was to study the level of fasting total GLP-1 in T2DM patients and its relation to the glycemic profile. Patients and methods This study included 60 T2DM patients and 40 participants matched for age and sex as a control group, selected from the inpatient and outpatient clinics of the Internal Medicine Department in Menoufia University Hospital. After obtaining their informed consent, all participants were subjected to a full assessment of history and physical examination with estimation of BMI, insulin resistance with homeostasis model assessment-2, and investigations including fasting blood glucose (FBG), glycated hemoglobin (HbAIc), and the total fasting levels of GLP-1. Results There was no significant difference in the level of GLP-1 between T2DM patients and the controls. There were significant negative correlations between the fasting total GLP-1 and FBG, HbAIc, serum insulin, and homeostasis model assessment-2 in both the total sample and the T2DM patients. Conclusion Fasting total levels of GLP-1 are not reduced in T2DM patients and are negatively correlated with FBG, HbAIc, and insulin resistance.

Background Diabetic kidney disease (DKD) is the leading cause of renal failure. Diabetic patients with microalbuminuria typically progress to proteinuria and overt diabetic nephropathy. Nesfatin-1 is an anoretic polypeptide with potent metabolic regulatory effects and its circulating levels are shown to be elevated in type 2 diabetes mellitus (T2 DM). Nesfatin-1 may be involved in the pathogenesis of DKD through inflammatory mechanisms. The aim of the work was to study the relation between plasma nesfatin-1 levels and different grades of DKD in patients with T2 DM. Patients and methods This study was conducted on 120 patients with T2 DM and 20 controls selected from the inpatient department and outpatient clinics of the Internal Medicine Department in Menoufia University Hospital. The selected individuals were grouped into four groups: group 1 included 20 healthy individuals, group 2 included 40 patients with T2 DM with normoalbuminuria, group 3 included 40 patients with T2 DM with microalbuminuria, and group 4 included 40 patients with T2 DM with macroalbuminuria. Members of the study were subjected to thorough history with special emphasis on age, sex, and duration of the DM. Investigations included fasting blood glucose, glycosylated hemoglobin, complete urine analysis, serum creatinine, urine albumin–creatinine ratio, estimated glomerular filtration rate, and plasma nesfatin-1. Results Plasma nesfatin-1 was significantly higher in group 4 compared with other groups, in group 3 compared with groups 1 and 2, and in group 2 compared with group 1. There was a positive significant correlation between plasma nesfatin-1 and serum creatinine, urine albumin–creatinine ratio, and glycosylated hemoglobin and negative significant correlation between plasma nesfatin-1 and estimated glomerular filtration rate in the studied diabetic patients. There was no correlation between plasma nesfatin-1 and BMI and duration of diabetes in the diabetic patients. Conclusion From this study, we can conclude that plasma nesfatin-1 is significantly higher in patients with DKD, and there is a positive correlation between plasma nefatin-1 level and the grades of DKD. So, plasma nesfatin-1 may be considered for prediction of developing DKD in a previously unaffected patients with DM.

Background: Diabetes mellitus (DM) is one of the most frequent etiologies of erectile dysfunction (ED). Risk factors of ED in type 2 diabetes mellitus (T2 DM) include patient age, disease duration, sedentary life and glycemic control. Subnormal testosterone concentrations contribute to ED as testosterone regulates nearly every component of erectile function.The aim of the work was to study the age of the patient, duration of diabetes mellitus, body mass index (BMI), glycosylated hemoglobin (HbAIc) and urinary albumin creatinine ratio (uACR) in type 2 male diabetic patients as risk factors for erectile dysfunction and their relation to serum testosterone level. Patients and methods: This study was conducted on 100 male type 2 diabetics selected from inpatient department and out patient clinics of the Internal Medicine Department in Menoufia University Hospital. The patients were divided into two groups: Group 1: 50 patients with type 2 DM with erectile dysfunction and Group 2: 50 patientswith type 2 DM without erectile dysfunction. The study groups were subjected to thorough history with special emphasis on age of the patients, disease duration and investigations including testosterone level, glycosylated hemoglobin, and uACR. The patients answered the abridged 5-item version of the International Index of Eectile Function (IIEF-5) questionnaire. Results: Total serum testosterone was significantly lower in diabetics with ED compared to those without ED. HbAIc, diabetes duration and uACR were independently negatively correlated with testosterone level. Conclusion: The diabetes duration, glycemic control and uACR contribute to erectile dysfunction in type 2 diabetics, and they were independently and negatively correlated with total serum testosterone level. Keywords: Type 2 diabetes mellitus, Erectile dysfunction, Serum testosterone

Objective The aim of the present work is to investigate the expression of Golgi protein 73 (GP73) in serum in patients with hepatocellular carcinoma (HCC) and determine its efficacy as a screening test in early detection of HCC. Background Serum GP73 is a promising biomarker for detection of HCC. Patients and methods This case–control study involved 30 patients with HCC, 30 patients with liver cirrhosis, and 15 healthy controls. Clinical examination, abdominal ultrasonography, and triphasic computed tomography for focal lesion were performed. Liver function tests were performed using clinical autoanalyzer, serum α-fetoprotein (AFP) was measured using enzyme-linked immune-sorbent assay method, and GP73 was determined by enzyme-linked immune-sorbent assay kit for GP73. Data were collected and statistically analyzed. Results GP73 was highly significantly higher in HCC group than cirrhotic and control groups. The sensitivity of GP73 in diagnosis of HCC was 83% and the specificity was 74%, at a cutoff point of 111 ng/ml, elicited from the receiver operator characteristic curve, with very good area under curve of 0.909, whereas that the sensitivity of AFP was 36.7% and the specificity was 100% at a cutoff point of 400 ng/ml, elicited from the receiver operator characteristic curve, with very good area under curve of 0.903. Conclusion GP73 is highly associated with HCC and is more sensitive than AFP for early detection of HCC.

To evaluate the value of soluble urokinase plasminogen activator receptor (suPAR) in diagnosing sepsis and predicting mortality in critically ill children. In a prospective cohort study, 69 critically ill children admitted into the pediatric intensive care unit (PICU) were randomly enrolled in addition to 15 healthy children as a control group. Clinical examination was performed, including calculation of the Pediatric Risk of Mortality (PRISM) and Pediatric Index of Mortality2 (PIM2). suPAR was measured in patients at admission as well as in the controls. Patients were followed up for 30 d. suPAR level was significantly higher among the total patient cohort compared to controls (p

Background:Matricellular protein Cysteine-rich protein 61 (Cyr61) is involved in chronic inflammatory disorders like rheumatoid arthritis (RA) and atherosclerosis.Objectives:This study aimed to assess the value of serum Cyr61 in diagnosis of rheumatoid arthritis, evaluating its correlation with disease activity and its relation to atherosclerosis.Methods:Cross-sectional study included 105 RA patients classified into active and inactive groups according to disease activity score (DAS28) with 50 healthy age and gender-matched controls. Full clinical and laboratory assessment was done including enzyme-linked immunosorbent assay (ELISA) measurement of Cyr61. Bilateral assessment of carotid intima-media thickness (CIMT) was done using high resolution-ultrasonography. Comparison of Cyr61 between RA patients and controls, correlation between Cyr61 and disease activity and CIMT were analyzed with appropriate statistical analyses.Results:Significant elevation of Cyr61 in RA patients compared to controls (235.62±62.5 vs. 73.11±18.2) respectively. The cut off value of Cyr61 was 99.25 pg/ml, with area under the curve (AUC) =0.995, P Conclusion:Serum Cyr61 as a potential diagnostic biomarker in RA is inversely correlated with disease activity. High Cyr61 in RA is a risk factor for atherosclerosis. Disruption of serum Cyr61 is engaged in the pathogenesis of both rheumatoid arthritis and atherosclerosis which is a clue for a future treatment strategy of RA.References:[1]Smolen JS, Aletaha D, Barton A, Burmester GR, Emery P, Firestein GS, Kavanaugh A, McInnes IB, Solomon DH, Strand V, Yamamoto K (2018) Rheumatoid arthritis. Nature reviews Disease primers 4:18001. doi:10.1038/nrdp.2018.1[2]Pelechas E, Kaltsonoudis E, Voulgari PV, Drosos AA (2019) Rheumatoid Arthritis. In: Pelechas E, Kaltsonoudis E, Voulgari PV, Drosos AA (eds) Illustrated Handbook of Rheumatic and Musculo-Skeletal Diseases. Springer International Publishing, Cham, pp 45-76. doi:10.1007/978-3-030-03664-5_3[3]Sparks JA (2019) Rheumatoid Arthritis. Annals of Internal Medicine 170 (1):ITC1-ITC16. doi:10.7326/aitc201901010[4]Abd El-Monem S, Ali A, Hashaad N, Bendary A, Abd El-Aziz H (2019) Association of rheumatoid arthritis disease activity, severity with electrocardiographic findings, and carotid artery atherosclerosis. Egyptian Rheumatology and Rehabilitation 46 (1):11-20. doi:10.4103/err.err_36_18[5]Rawla P (2019) Cardiac and vascular complications in rheumatoid arthritis. Reumatologia 57 (1):27-36. doi:10.5114/reum.2019.83236[6]de Brito Rocha S, Baldo DC, Andrade LEC (2019) Clinical and pathophysiologic relevance of autoantibodies in rheumatoid arthritis. Advances in Rheumatology 59 (1):2. doi:10.1186/s42358-018-0042-8Disclosure of Interests:None declared

Background Insulin resistance (IR) is a characteristic feature of uremia. Both IR and metabolic syndrome are considered independent predictors for cardiovascular events and mortality in patients with chronic kidney disease. Few studies have shown a favorable effect of erythropoietin (EPO) in decreasing IR. We hypothesized that short-term treatment with EPO can lead to improvement of IR in patients with chronic kidney disease. Patients and methods Patients were categorized into two groups: 20 hemodialysis patients (HDP) not receiving EPO (control) compared with other 40 HDP divided into two subgroups (20 diabetics and 20 nondiabetic), both receiving EPO (intervention group) all over the duration of the study, which extended for 6 months. All patients were subjected to history taking, full clinical examination, as well as laboratory investigations. Results All baseline results of parameters of glycemic control showed significant stepwise increase from nondiabetic intervention group, to control group, and then to diabetic intervention group. homeostatic model assessment of insulin resistance (HOMA-IR) was 1.64±0.88, 6.14±0.46, and then 10.78±2.84, respectively. On comparing the results before and after EPO therapy in both intervention groups, there was a significant improvement in IR in both groups. HOMA-IR was 10.78±2.84 and 5.52±161 (P Conclusion EPO treatment in HDPs is followed by improvement of IR in diabetic as well as nondiabetic patients with end-stage kidney disease and on hemodialysis.

Background: Becoming shorter by each cell division, telomere length (TL) is regarded as a marker of cellular aging. Relative TL (T/S) depends on the quantitation of telomere hexamer repeat copy number normalized to autosomal single-copy gene copy number. TL is influenced by several factors, including oxidative stress (OS) and inflammation. This study aimed to investigate the possible role of TL and OS as markers for Alzheimer's disease (AD). Materials and Methods: One hundred and eighty participants were categorized into three groups. Group 1: Included 60 patients with AD. Group II: included 60 age-matched nondemented subjects. Group III (pregeriatric group): included 60 healthy controls with their ages ranging between 30 and 60 years. TL was determined by the quantitative Real time-PCR method, plasma levels of 8-OHdG by enzyme-linked immunosorbent assay, and total antioxidant capacity (TAC) by colorimetery. Results: In comparison to the other two groups, patients with AD showed shortened TL, increased plasma 8-OHdG concentration, and decreased TAC. The sensitivity of T/S ratio to predict AD was 86.67%, whereas the specificity was 96.67%. The sensitivity of 8-OHdG to predict AD was 96.67%, whereas the specificity was 86.67%. Conclusion: AD is associated with shortened TL and increased OS as manifested by decreased TAC and increased serum 8-OHdG. T/S and 8-OHdG could be used as early predictors for AD.

Background and study aim : Portal hypertension leads to formation of portosystemic collateral veins as oesophageal varices in patients with liver cirrhosis. Several studies have shown that blood ammonia is a vauable non invasive marker of oesophageal varices. This study is designed to evaluate the possible relation between blood ammonia level and oesophageal varices in patients with liver cirrhosis. . Patients and Methods: This study was conducted on three groups of patients and control subjects. Group I included 20 cirrhotic patients without evidence of oesophageal varices. Group II included 40 cirrhotic patients with evidence of varices. Group III included 20 healthy control subjects. Serum level of ammonia were done for all patients and control subjects. Results: There was a highly significant increase in the mean values of blood ammonia in cirrhotic patients with varices in comparison to other patients without varices, with highly significant positive correlation between serum ammonia and size of varices. There was a significant increase in the mean values of blood ammonia in cirrhotic patients with grade III and IV varices [large varices) in comparison to cirrhotic patients with grade I and II varices. Conclusion:Blood ammonia level is a valuable, simple non invasive marker for prediction of oesophageal varices.

Background A progressive pulmonary involvement is frequent in systemic sclerosis and it is the leading cause of morbidity and mortality. IL-6 has been implicated in the pathogenesis of systemic sclerosis via stimulation of fibroblasts to produce excess collagen and glycosaminoglycan. Specific correlation between IL-6 and lung involvement have not been found yet. Aim To study the possible correlation between lung involvement (assessed by spirometry and HRCT abnormalities) and the serum level of IL-6. Subjects and methods 20 patients with scleroderma compared with 20 matched volunteers as control group. All participants underwent spirometry, HRCT scan and serum IL-6 measurements. HRCT signs were scored according to Warrick et al. score for systemic sclerosis. Results Patients showed a statistically significant reduction in FVC%, FEF 25–75% and significantly higher ESR and IL-6 compared to control. There was a highly significant positive correlation between the total HRCT score and serum IL-6. Conclusion Serum IL-6 could be a marker of the degree of pulmonary involvement in patients with systemic sclerosis.

Plasmodium falciparum infection is associated with diffuse vascular dys-regulation. Levels of blood circulating endothelial cells (CECs; CD146+CD45−) are a marker of vascular injury. This study aimed to measure blood CECs by flow cytometery in patients with acute malaria infection before and after treatment and to evaluate the prognostic value of that measurement for that disease. The subjects were allocated into: Group I: uncomplicated malaria (UM, n = 32), Group II: severe malaria (SM, n = 12), Group III: the treated UM (TUM, n = 32), Group IV: the treated SM (TSM, n = 12) and Group V: healthy controls (HC, n = 25). Before treatment, SM patients showed the highest mean number of CECs (30,658.3 ± 2658.2/5 × 106 peripheral blood mononuclear cells (PBMCs)), followed by UM patients (19,481.56 ± 866.83/5x106PBMCs) and both groups were significantly higher than HC (2034 ± 300.59/5x106PBMCs, P

Objective The aim was to assess the role of the circulating endothelial progenitor cells (CEPCs) in stages of breast cancer (BC) in patients. Materials and Methods We reviewed papers on the relation between CEPCs and stages of BC from Medline databases (PubMed, Medscape, Science Direct, and EMF-Portal) and all materials available on the internet from 1994 to 2016. The initial search presented 100 articles, of which, 30 met the inclusion criteria. The articles studied the relation between endothelial progenitor cells and stages of BC. If the studies did not fulfill the inclusion criteria, they were excluded. Study quality assessment included whether ethical approval was gained, eligibility criteria specified, appropriate controls, adequate information, and defined assessment measures. Comparisons were made by structured review with the results tabulated. Findings Endothelial progenitor cells counts were significantly higher in advanced stages of BC compared with those with early stages and controls in almost all the studied publications. Conclusion Our review concludes CEPCs elevation in the blood of patients is a useful marker of tumor angiogenesis and progression and early predictor of metastasis in patients with BC.

Objective The aim of this work was to study the role of interleukin-6 (IL-6) in hepatic encephalopathy (HE) in patients with liver cirrhosis. Background IL-6 is an interleukin that acts as both proinflammatory response and anti-immune response. Patients and methods This study included 80 patients divided into three groups: group I represents the control group (20 healthy individuals), group II included patients with liver cirrhosis 'without HE' (30 patients), and group III included patients with liver cirrhosis and HE of different grades (30 patients). Full history taking, clinical examination, and investigations for all cases were done. Results There was significant difference in serum IL-6 level among the three groups: normal, liver cirrhosis, and HE groups (44.63 ± 43.08, 85.57 ± 54.24, and 156.5 ± 93.90, respectively; P ≤ 0.0001). There was a significance difference when comparing the mean values of serum IL- 6 in HE group according to Child classification (P Conclusion IL-6 serum level is increased significantly in patients with 'liver cirrhosis and HE' and may be used as a confirmatory diagnostic marker of overt HE.

Objective This study aimed to investigate the enhanced frequencies of CD14++ CD16 + peripheral blood monocytes in asthmatic patients. Background CD16 + monocytes are increased in inflammatory conditions. It was reported that CD16 + monocytes can be divided into two subsets with different potential of modulating inflammatory responses: CD14++ CD16 + and CD14 + CD16 + monocytes. CD14++ CD16 + and CD14 + CD16 + monocyte subsets are quantified in asthmatic patients regarding severity of disease and glucocorticoids treatment options. Patients and methods CD14++ CD16 + was examined in 20 cases of completely controlled asthma, 20 cases of partly controlled asthma, 20 cases of uncontrolled asthma, and 25 healthy controls using flow cytometry. Results The results showed highly significant difference among the controlled asthma, partly controlled asthma, uncontrolled asthma, and control groups regarding pulmonary function tests and also showed highly significant difference among controlled asthma, partly controlled asthma, uncontrolled asthma, and control groups regarding percentage of CD14++ CD16 + cells. Moreover, the results showed highly significant correlation between CD14++ CD16 + cells and percentage of forced expiratory volume in 1 s, forced expiratory volume in 1 s/forced vital capacity, C-reactive protein, erythrocyte sedimentation rate, immunoglobulin E, neutrophils, and eosinophils (laboratory investigations) of controlled asthma, partly controlled asthma, uncontrolled asthma, and control groups. Conclusion CD14++ CD16 + monocytes showed the highest levels of expression in uncontrolled asthmatic cases as compared with other monocyte subsets. CD14++ CD16 + monocytes showed higher levels of expression in uncontrolled asthma cases than other asthmatic cases.

Background Psoriasis is a common chronic, recurrent, and immune-mediated disease of the skin and joints that follows a relapsing and remitting course. Psoriasis represents a T-cell-mediated inflammatory skin disease that includes the activation of both Th1, which produces interferon-g (IFN-γ), tumor necrosis factor-α, and interleukin-2 (IL-2), and Th17, which produces IL-17, tumor necrosis factor-α, IL-6, and IL-22. Objective We planned this study to determine probable associations between IFN-γ, Th1 cytokine, in the sera of psoriatic patients and the possible correlation to disease severity. Materials and methods We studied the level of serum IFN-γ in 40 cases of plaque psoriasis, erythrodermic, and guttatepsoriasis using PASI score for assessing the severity, and in the serum of healthy 40 controls. Results There was a statistically significant positive correlation between the PASI score and the level of IFN-γ in all clinical types. This can suggest that serum IFN-g is a psoriasis severity and prognostic marker. Conclusion Serum IFN-γ in psoriatic patients can be used as a severity and prognostic marker, and then anti-IFN-γ may eventually become a useful therapeutic approach in psoriasis.

Introduction: In addition to the complexity of the clinical presentation of both infections and disease activity in systemic lupus erythematosus (SLE) patients, the difficulty in making the therapeutic decision require investigations that should be of diagnostic value. Neutrophil CD64 is up regulated within few hours in patients with infection. Similarly, serum procalcitonin (PCT) levels increase rapidly following bacterial infection. Objective: The aim of this work is to study the usefulness of neutrophil CD64 expression and serum PCT as diagnostic markers to discriminate infection from disease activity in patients with systemic lupus erythematosus. Methods: This study was carried on 20 healthy females as controls (group I) and 55 female patients with SLE. Patients were distributed as following; 20 SLE patients without activity or infections (group II), 20 SLE patients with lupus activity (group III), and 15 SLE patients with infection (group IV). CBC, ANA, Anti-ds DNA, C3 and C4 were measured in all population. Serum PCT was measured by ELFA and neutrophil CD64 expression was done by flowcytometry. Results: Neutrophil CD64 expression and serum PCT levels were increased significantly in SLE patients with infection compared to those with disease activity. We demonstrated significant correlations between CD64 and markers of both activity and infection, while serum PCT levels were significantly correlated with markers of infection. The area under the ROC curves for detection of infection (AUC; 95% CI) for neutrophil CD64 expression and serum PCT were (0.90; 0.79-1.01) and (0.99; 0.95-1.01), respectively. Conclusion: Our findings can prove that both neutrophil CD64 and serum PCT are reliable markers to discriminate infection from disease activity in SLE patients. Serum PCT was more accurate than neutrophil CD64 expression.

Objectives The aims of this work were to study serum prolactin (PRL) levels in patients with primary immune thrombocytopenia (ITP) and to investigate its possible correlation with disease activity and manifestations. Background ITP is a disorder characterized by immune-mediated accelerated platelet destruction and suppressed platelet production. Hyperprolactinemia (HPRL) has been described in many autoimmune diseases such as systemic lupus erythematosus. Patients and methods The study was carried out on 40 cases of primary ITP patients (group I) and 50 healthy controls (group II). PRL was measured directly in the serum samples by VIDAS PRL kits using the ELFA technique for all patients and controls. Results Moderate HPRL (serum PRL 30-200 ng/ml) was present in eight (20%) of primary ITP patients, but was not present in any of the 50 controls. Among 22 patients with platelet count below 30 000/μl, eight (36.4%) patients had HPRL and 14 (63.6%) patients had normal PRL levels. HPRL was associated with lower platelet counts. Conclusion This study shows that HPRL is present in 20% of patients with primary ITP. Also, patients with HPRL have a lower platelet count than patients with normal PRL levels.

Objectives To determine the level of interleukin-6 (IL-6) in both serum and pleural fluid in order to evaluate the diagnostic utility of IL-6 in differentiation between different types of pleural effusion. Background Pleural effusion is a relatively common clinical condition. It is often diagnostic dilemma for the physician. Interleukin-6 (IL-6) has multiple functions on various cells and tissues. It is often used as a marker for systemic activation of pro-inflammatory cytokines. Methods This study was conducted on 40 patients of pleural effusion, they were selected from Al-Mahalla Chest Hospital in the period between October 2012 and May 2013. All patients were subjected to detailed clinical history, thorough clinical examination, plain chest-X-ray (postero-anterior and lateral views), blood sample for: Complete blood picture (CBC), erythrocyte sedimentation rate (ESR), liver functions, renal functions and serum and pleural fluid (LDH, protein and IL-6) by ELISA. Results Serum and effusion IL-6 could differentiate between exudate transudate as it increased in exudate than transudate. In the present study there was higher concentration of IL-6 in the serum and pleural effusion of parapneumonic effusion than malignant and tuberculous exudative pleural effusion and higher concentration in malignant than tuberculous effusion. Conclusion Effusion IL-6 could be used to differentiate between exudate and transudate and serum IL-6 could be used as an alternative non invasive method for differentiation between exudates and transudate as there was a significant positive correlation between serum IL-6 and effusion IL-6.

Introduction: Pleural effusion is a common clinical presentation in several diseases. Various parameters from pleural fluid have been studied to identify the cause of effusion. D-dimer is a degradation product of cross-linked fibrin and alkaline phosphatase (ALP) is one of the biochemical markers found in pleural effusion. ALP is a plasma membrane derived enzyme of uncertain physiologic function that hydrolyzes synthetic phosphate esters at pH 9. It is present in the serum in several forms, i.e., ALP-1 alpha 2, ALP-2 beta 1 and ALP-3 beta 2. Aim: The present study was carried out to evaluate the value of alkaline phosphatase and D-dimer concentration in the pleural effusions and serum as a diagnostic tool. Methods: This study was carried out on one hundred patients with pleural effusions of different aetiologies. 75 patients had exudative pleural effusions (35 patients had tuberculous effusion, 20 patients had malignant effusion, 10 had parapneumonic effusion, 5 had empyema and 5 patients had systemic lupus erythematosis) and 25 patients had transudative effusions (20 patients had hepatic and 5 patients had cardiac effusions). Serum and pleural effusion D-dimer (measured by ELISA), ALP, LDH and protein levels were measured. Results: There was a highly significant difference in the pleural fluid D-dimer and ALP levels between exudative and transudative effusions (P 0.05). Lastly there was no significant difference (P > 0.05) in the serum levels of either the ALP or the D-dimer between different types of effusions. Conclusion: Measurement of pleural fluid D-dimer and ALP levels aids in the differentiation between exudative and transudative pleural effusions. Also, both pleural fluid D Dimer and ALP are significantly higher in tuberculous pleural effusions.