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Background Abnormal extracellular matrix (ECM) turnover is linked to liver fibrosis as it reflects an imbalance between repair and progressive substitution of the liver parenchyma by scar tissue. Matrix metalloproteinases (MMPs) are the primary enzymes involved in ECM breakdown. So, this study aims to measure the value of serum matrix metalloproteinase-1 (MMP-1) in children with chronic liver diseases (CLD) in comparison with liver biopsy and serum biomarkers. A hundred twenty children with chronic liver diseases and sixty healthy children as a control group were included in this study. Both groups were evaluated via medical history, clinical, radiological, laboratory investigations, and serum MMP-1 level was measured by ELISA. Liver biopsy was performed for studied patients only. Results The mean MMP-1 was 15.2 ± 5.1 ng/ml in children with CLD, and 64.7 ± 27.4 ng/ml in the control group. MMP-1 was statistically lower in the children with CLD than controls (p < 0.001). The mean ± SD of aspartate aminotransferase to platelet ratio index (APRI) and fibrosis-4 (FIB-4) scores in all studied cases showed a significant trend of increase with progressive fibrosis stage evident with histological METAVIR scoring system, while serum MMP-1 concentration was decreased significantly with increasing the degree of fibrosis in CLD group (P 0.001). Serum MMP-1 was indirectly correlated with serum biomarkers and the degree of fibrosis in patients. Conclusions MMP-1 is a useful non-invasive marker for detection of the stage of liver fibrosis in children with chronic liver diseases.

Background: Chronic liver disorders in children constitute an increasing concern with major public health impacts, the MMP is degrading diverse extracellular matrix macromolecules and involves tissue reshaping and repair in physiological processes. The purpose of this research was to assess the diagnostic usefulness of MMP-1 in children with chronic liver disorders. Methods: 60 children undertook this research; Group I (hepatic group): 60 children with chronic liver disease, Group II (control group): 20 seemingly healthy youngsters, The entire history of taking, comprehensive clinical examination, abdominal US and laboratory testing like a complete blood count and liver function tests have been performed for all children (Alt, AST, Albumin, PT, PTT, INR, Total and direct bilirubin), Liver biopsy was conducted in all patients, with human enzyme-connected immunosorbent testing measuring Serum MMP-1 levels (ELISA). Results: the mean MMP-1 in hepatic group was 11.2±2.1 ng/ml and in control group 32.7±17.4 ng/ml. In the hepatic group controlled, p F1), AUC was 0.872 (95 percent confidence interval: 0.709-0.487), p F3); AUC p < 0.001. The sensitivity was 90% at cutoff point < 4.5 ng/ml and the specificity was 80%. Conclusion: Fibrosis identification in children with chronic liver disorders might benefit from MMP-1.

Background and Objective Hepcidin is the key regulator of iron metabolism and is a significant biomarker for systemic inflammatory states. Vitamin D is a powerful immunomodulator and plays a significant role in the inflammatory responses and fibrosis occurring due to hepatitis C virus (HCV) infection. This study assessed the level of vitamin D and serum hepcidin and its expression in peripheral blood of children with chronic hepatitis C (CHC) and correlated them with other serum markers to reflect iron metabolism and liver disease severity. Methods A total of 100 children were included in this study: 50 with HCV infection and 50 healthy controls. Biochemical parameters together with vitamin D, hepcidin, and its expression were all measured. Results The level of hepcidin and its expression together with vitamin D and hepcidin-to-ferritin (H/F) ratios were significantly reduced in patients, but the iron and ferritin levels were higher (Pr = 0.43, 0.31, 0.34, 0.28, and 0.91, respectively) but significant negative correlation with vitamin D (r = −0.37). Both hepcidin and ferritin were higher in patients with Child Pugh scores B and C than those with score A (P Conclusion Measuring serum hepcidin and its expression together with vitamin D levels in patients may have a prognostic value and is promising in the follow-up of the severity of liver disease.

BACKGROUND: Asymmetric Dimethyl Arginine (ADMA) is an endogenous inhibitor of nitric oxide synthase (NOS) is important in different diseases characterized by decreased nitric oxide (NO) availability. We aimed to assess the serum ADMA level in preterm infants suffering from respiratory distress syndrome (RDS) and its relationship with pulmonary outcomes. METHODS: This prospective study included 50 preterm neonates suffering from RDS aging≤32 weeks and weighing≤1500 gm. Serum ADMA levels were estimated in the 1st and 28th day of life by ELISA, and its correlation with surfactant requirement, duration of ventilation, and development of BPD was assessed. RESULTS: Fifty preterm infants with RDS were included, 30 infants were treated with surfactant within 12 hours after birth, the 1stday ADMA level was higher significantly in infants who required surfactant treatment than infants without surfactant treatment, At 36 weeks postmenstrual age, 16 infants were diagnosed with BPD, the 28th day ADMA level was significantly higher in infants with BPD than others without BPD. 1st-day ADMA level was significantly correlated with days on mechanical ventilation but there were no significant correlations between 1st day ADMA and days on CPAP and days on supplemental O2. CONCLUSION: Elevated serum ADMA level in preterm neonates with RDS estimated in the 1st and 28th day of life is a good predictor for pulmonary morbidities such as surfactant requirement, duration of mechanical ventilation, and development of BPD.

AIM This study is aimed to measure the value of serum Mac-2 binding protein glycan isomer (M2BPGI) in children with chronic liver diseases in comparison with liver biopsy and serum biomarkers. METHODS Comparative cross-sectional study included 100 children with chronic liver diseases and 50 healthy age/sex-matched control group. All subjects were evaluated via medical history, clinical, radiological and laboratory examinations. Liver biopsy was performed for studied patients and serum M2BPGI level was measured by Enzyme Linked Immune Sorbent Assay (ELISA) in all studied subjects. RESULTS Serum M2BPGI level increased more significantly in chronic liver disease patients (6.04 ± 2.72 ng/ml) than in healthy controls (1.12 ± 0.83 ng/ml) (P

Background Male androgenetic alopecia (MAGA) is caused by the conversion of the terminal to vellus hair. Zinc is one of the most studied trace elements in hair disorders and biotin is one of the most prescribed supplement for its treatment. Objectives The study aimed to evaluate serum zinc and biotin levels in MAGA patients to answer the question if there is a value to add zinc or biotin as a supplements in the MAGA treatment. Patients and methods Sixty MAGA patients and 60 age, sex, and body mass index-matched healthy volunteers were included. We measured serum biotin and zinc in all participants. Results Zinc (µg/dL) was lower significantly in patients compared to controls (P = 0.01), suboptimal biotin (ng/L) levels were in patients, and within normal values in controls (P = 0.01). A positive significant correlation was found between serum zinc and serum biotin (r = 0.489, P = 0.001). Serum zinc and biotin showed a nonsignificant correlation with age and disease duration. A non-significant relation was obtained between the MAGA grades, and zinc (P = 0.485) and biotin levels (P = 0.367). Conclusions Serum zinc showed subnormal value and adding zinc supplement in MAGA treatment is recommended. Serum biotin showed a suboptimal level in MAGA patients that is not correlated with patients' age or disease severity. Biotin supplement in MAGA treatment may add value to hair quality and texture. We recommend future biotin evaluation in serum combined with its metabolites in MAGA patients' urine.

Background Neutrophil/lymphocyte percentage is a helpful test for evaluation of systemic inflammation. This study aimed to investigate neutrophil/lymphocyte percentage as an evidence of control status in bronchial asthma. Patients and methods The study included 45 (20 males and 25 females) patients and 45 apparently healthy subjects. Full clinical evaluation, complete blood count (CBC) with differential white blood cell count, Erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), and total IgE measurement were done for participants. Results Neutrophil/lymphocyte percentage and CRP were higher in asthmatics than controls (statistically significant difference), and they were significantly increased with uncontrolled asthma. Neutrophil/lymphocyte percentage could predict uncontrolled asthma with a sensitivity of 66.7%, specificity of 75.6%, positive predictive value of 73.2%, negative predictive value of 69.4% and accuracy of 71.1%. Neutrophil/lymphocyte percentage increased in asthmatics with asthma control test (ACT) less than 20 versus patients with ACT of at least 20 (statistically significant difference), whereas neutrophil/lymphocyte percentage did not differ significantly among the patients with asthma regarding sex and smoking. Neutrophil/lymphocyte percentage had direct proportional relation with CRP and ACT, whereas the relations between neutrophil/lymphocyte percentage and age, eosinophils, IgE, Forced expiratory volume in first second (FEV1%), duration of the disease, or number of attacks per year were nonsignificant. No significant correlation was found between controlled and uncontrolled cases regarding total leukocyte count (TLC), duration, and onset of the disease. The number of attacks was significantly higher in uncontrolled cases than controlled ones. Conclusion Neutrophil/lymphocyte percentage could predict uncontrolled asthma with high sensitivity and specificity. Neutrophil/lymphocyte percentage is a rapid, inexpensive method with routine CBC analysis and could be a useful predictor of asthma control.

Background Increased cardiovascular morbidity in type 1 diabetes mellitus (T1DM) may be due to vascular endothelial dysfunction, accelerated thickening of arterial intima, and changes in the ventricular functions. Aim The study aimed to describe the frequency and the pattern of dyslipidemia in children and adolescents with T1DM, and its relation to the degree of glycemic control, regular activities, and the duration of diabetes. Patients and methods This case–control study included 50 patients with T1DM, aged more than or equal to 9 years, with more than 1-year duration of diabetes, and 39 healthy age-matched and sex-matched children as controls. All participants were subjected to the following: full history taking, full clinical examination, and investigations including glycated hemoglobin, total cholesterol, low-density lipoprotein-cholesterol (LDL-C), high-density lipoprotein-cholesterol (HDL-C), and triglycerides. Results There was a high statistically significant increase in the frequency of dyslipidemia in diabetic patients (64.0%). Twenty (50%) patients had elevated LDL-C, with a mean of 102.0±34.4 mg/dl; the most common type of dyslipidemia was high LDL-C and low HDL-C in eight (25.0%) patients followed by isolated high LDL-C in six (18.75%) patients, isolated low HDL-C in five (15.63%) patients, and hypercholesterolemia and high LDL-C in four (12.50%) patients. There was no statistically significant difference between the dyslipidemia group and the normolipidemic group regarding BMI (P=0.070), but waist circumference showed statistically significant increase in the dyslipidemic group compared with the normolipidemic group (P=0.045). As regards the degree of activity affecting the lipid profile, as in the normolipidemic group, 94.4% were practising mild regular activities, whereas in the dyslipidemic group, only 62.5% were practicing mild regular activities (P=0.041). Conclusion Our study support the hypothesis that LDL-C is the ‘cornerstone’ for assessment of lipoprotein-related cardiovascular risk. In addition, activity is important for the prevention of dyslipidemia, and waist circumference is an easily obtainable measure of abdominal adiposity.

Aim of the work To study the relation between neutrophil-lymphocyte ratio (NLR) with disease activity indices and with musculoskeletal ultrasonographic findings in recent onset rheumatoid arthritis (RA) patients. Patients and methods The study consisted of 40 recently diagnosed RA patients and 40 matched control. Patients’ disease activity was assessed clinically by the disease activity score (DAS-28). Musculoskeletal ultrasound was performed to detect synovitis by Power-Doppler ultrasound (PDUS). The association of NLR with the disease activity indices and the PDUS score were analyzed. Results The mean age of the patients was 44.5 ± 2.7 years, disease duration 9.4 ± 4.5 months and the female:male ratio was 2.3:1. Their disease activity was 4.7 ± 1.33 and the PDUS score was 10.24 ± 4.56. The NLR was significantly increased in the RA patients (3.28 ± 0.59) compared to the control (1.7 ± 0.23) (p 0.0002 ). There was a significant correlation between NLR with the disease duration (p 0.015 ), tender joint count (p 0.022 ), swollen joint count (p 0.018 ), morning stiffness (p 0.045 ), visual analogue scale (p 0.026 ), DAS-28 (p 0.049 ), erythrocyte sedimentation rate (p 0.032 ), C-reactive protein (p 0.017 ) and PDUS score (p 0.037 ). NLR was significantly elevated in highly active RA patients compared to patients with moderate and low disease activity (p 0.014 ). Conclusion NLR significantly correlated with disease activity indices in recent onset RA patients thus reflecting systemic inflammation with its advantages of being available, easy and cost accessible being as reliable as the DAS-28 hence it could be used as a marker of disease activity.

Ola Galal Behairy,1 Eman Rateb Abd Almonaem,1 Neveen Tawfik Abed,1 Omima M Abdel Haiea,1 Rasha M Zakaria,1 Rania I AbdEllaty,1 Effat H Asr,1 Amira Ibrahim Mansour,2 Amira MN Abdelrahman,2 Hoda A Elhady3 1Pediatric Department, Benha Faculty of Medicine, Benha University, 2Clinical and Chemical Pathology Department, Benha Faculty of Medicine, Benha University, Benha, 3Clinical Pathology Department, General Organization of Teaching Hospitals and Institutes, Egypt Background: Although advancements have been made in the management of thalassemic patients, many unrecognized complications have emerged, such as renal abnormalities.Aim: To measure serum levels of cystatin-C and β-2 microglobulin in children with beta-thalassemia major (β-TM) and investigate their significance as early markers of glomerular and tubular dysfunctions.Subjects and methods: The study was performed on 70 children with (β-TM) and 20 apparently healthy children matched for age and sex as a control group. For all the enrolled children, a comprehensive medical history was obtained and complete physical examination was performed, blood urea, serum creatinine, serum ferritin, estimated glomerular filtration rate (eGFR) by Schwartz formula and creatinine clearance, albumin/creatinine ratio in urine, serum cystatin-C levels and β-2 microglobulin were measured.Results: Thalassemic children had significantly higher cystatin-C and β-2 microglobulin levels compared with control. In addition, serum cystatin-C and β-2 microglobulin were positively correlated with urea, creatinine, serum ferritin, albumin/creatinine ratio, duration of chelation therapy and frequency of blood transfusion/year and negatively correlated with creatinine clearance, hemoglobin, and eGFR. Our data demonstrated that cystatin-C and β-2 microglobulin had higher sensitivity and specificity (91.4%, 90.0%, and 85.7%, 100%, respectively) than serum creatinine and creatinine clearance (83.0%, 100% and 81.4%, 100%, respectively) for small changes in GFR.Conclusion: Cystatin-C and β-2 microglobulin are specific and sensitive early biomarkers for monitoring glomerular and tubular dysfunction in children with β-TM. Keywords: beta thalassemia, creatinine, sensitivity, specificity

Introduction: It has long been known that COPD causes elevation in BNP level caused by hypoxia present in cases of pulmonary hypertension in COPD. The aim of this study: This study was carried out to evaluate the changes in BNP level in COPD patients without pulmonary hypertension or cor pulmonale during exacerbation and after remission. Subjects and methods: This study was created on 50 subjects, 30 COPD patients according to inclusion and exclusion criteria (BNP level will be measured during exacerbation and after remission) plus 20 age matched apparently healthy control subjects, ten of them are non smokers and ten are asymptomatic smokers. For all subjects, history taking, full clinical exam done. PFT (spirometry), BNP level measurement on human serum by ELIZA, routine labs (CBC, liver and renal function). ECG. echocardiography. Results: Levels of BNP were significantly higher in COPD patients with mean (60.52 ± 30.98 pg/mL) than control with mean (21.13 ± 4.61 pg/mL) and higher during exacerbation (60.52 ± 30.9 pg/mL) than during remission (35.65 ± 16.54 pg/mL), BNP was significantly higher in grade (III, IV) with mean (86.94 ± 40.19, pg/mL) than grade (II) (56.76 ± 6.2 pg/mL) and grade (II) was significantly higher than grade (I) with mean (37.86 ± 8.81 pg/mL) and it was a significantly inversely related to post FEV1% and post FEF 25–75% and significantly direct correlated to paco2 and non significant negative correlation to pao2. Conclusion: Plasma BNP can be used as a useful prognostic biomarker of COPD and a good predictor of exacerbation, As BNP level was significantly higher in COPD patients than in control groups, (p

Background Calprotectin is a protein released during the activation and turnover of leukocytes. It can be used as a biomarker of inflammatory diseases such as rheumatoid arthritis (RA). Aim The current study aimed to measure the serum level of calprotectin in RA patients, recently diagnosed and after initiation of treatment, to determine its association with clinical disease, synovial inflammation determined by Ultrasound (US), and its relation to therapy when compared with other inflammatory markers. Patients and methods A total of 32 patients with recent RA and 20 healthy individuals were assessed for serum calprotectin level (enzyme-linked immunosorbent assay). C-reactive protein (CRP) and erythrocyte sedimentation rate (ESR) were also measured in patients who were reassessed 4 months after initiation of therapy. Disease activity was evaluated by the disease activity score of 28 joints (DAS28), and US assessment was performed. Results The mean level of serum calprotectin was significantly higher (P

Objective Autoimmune hepatitis (AIH) is a chronic inflammatory liver disease mediated by an autoimmune reaction to hepatocytes, the present study aimed to assess the possible associations between interleukin-4 (IL-4) variable number of tandem repeats (VNTRs) and IL-4-590 promoter polymorphisms and susceptibility to autoimmune hepatitis type 1 in children. Subjects and methods The study was performed on 101 children diagnosed with AIH and 104 apparently healthy, age and sex-matched control children, diagnosis of AIH was based on the simplified score for the diagnosis of AIH. Genotyping for the IL-4 VNTR and IL-4-590 were performed using PCR-RFLP. Results The distribution of genotype frequencies of IL-4 gene intron 3 VNTR polymorphism were not significantly different between AIH patients and controls for 3R/2R and 2R/2R genotypes, while the 2R allele distribution was significantly higher among AIH patients than the control group. The frequency of IL-4-590 single nucleotide polymorphism (SNP) CT and TT genotypes was statistically higher among AIH patients than controls. Conclusion This study revealed the presence of an association between IL-4 -590 TT genotype and T alleles with increased AIH risk in pediatric patients, also assess its severity as they were detected with Child Plugh scores B and C.

This study aimed to evaluate the correlation between serum levels of IL-17 and IL-35 and the presence and severity of childhood asthma. The study was performed on 60 diagnosed asthmatic children, who were further classified into four groups according to the Global Initiative for Asthma Guidelines for Asthma Severity and Control (GINA) 2016, plus 30 age- and sex-matched apparently healthy children. All participants were subjected to full medical history, clinical examination, pulmonary function tests and laboratory evaluation in the form of complete blood count (CBC), serum total IgE, IL-17 and IL-35 by ELISA. Our results revealed that eosinophils count, IgE and IL-17 were significantly higher in the asthmatic group than the control group (p .001), while IL-35 levels were significantly lower in asthmatics than control (p .001). A strong negative correlation was found between serum IL-17 and serum IL-35; a positive correlation was found between serum IL-17 and both of serum total IgE and eosinophils counts in atopic asthmatic patients, and serum IL-35 showed significant negative correlations with both. ROC analysis of the data showed that the cut-off value of IL-35 level was189.5 pg/mL and for IL-17 level, it was13.1 pg/mL; this value could predict childhood asthma with sensitivity of 81.7% and 83.3%, and specificity of 76.7% and 70%, respectively. A combination of both cytokines yielded an increase in sensitivity to 95%. In conclusion, in the current study, IL-17 is upregulated while IL-35 is downregulated in childhood asthma with a significant negative correlation between both. These results suggest that both may play an important role in the pathogenesis of childhood asthma.

Anti-C1q autoantibodies have been proposed as a useful marker in SLE. This study aimed at measuring serum levels of anti-C1q antibodies in patients with SLE and investigates correlations of this level with the histopathological classes of renal biopsies and disease activity. The anti-C1q antibody level was measured in 30 females SLE patients and 20 controls. The activity of SLE disease was calculated according to the SLE disease activity index. A renal biopsy from patients with clinical manifestations of renal disease was obtained. There was a significant increase in the level of anti-C1q antibodies in SLE patients than controls and in patients with active LN than inactive LN (P0.05). There were significant positive correlations between anti-C1q antibody level and SLEDAIrSLEDAI scores and activity index score of renal biopsies. Anti-C1q antibodies showed higher diagnostic sensitivity and specificity than anti-dsDNA antibodies. In conclusion, anti-C1q antibodies are useful and sensitive non-invasive biomarker with high specificity in combination with anti-dsDNA antibodies for the diagnosis of renal disease activity.

Objective Osteoarthritis (OA) is a multifactorial, degenerative, and inflammatory disorder of joints causing damage of the articular cartilage, formation of osteophytes, and eburination of the subchondral bone. Matrilin-3 (MATN-3) is a non-collagenous oligomeric extracellular matrix protein (ECM), which is the smallest member of the matrilin family. This study was conducted to identify the potential association and clinical significance of MATN-3 rs8176070 (SNP6) polymorphism in a series of Egyptian patients with primary knee OA. Material and methods Polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP) was used to determine genotypes of MATN-3 SNP6 for 50 primary knee OA patients in addition to 50 healthy subjects of the same sex and age range. Full history was obtained from OA patients, followed by clinical examination, together with clinical assessment of the severity of knee OA using Lequesne Algofunctional Index score and radiological grading using the Kellgren-Lawrence grade scale (KL). Results With regard to genotypes of MATN-3 gene SNP6 (rs8176070), a statistically significant difference between OA patients and healthy control subjects was found for the B\b genotype and b allele (p=0.046 and 0.042 respectively), with the prevalence being higher in OA patients with a high risk to develop OA (Odds Ratio [OR]=2.250, 95% CI=1.011-5.008). Patients with the B\b genotype had worse clinical and radiological findings than those with B\B and b\b genotypes. Conclusion The investigated polymorphism in the MATN-3 gene may reflect the risk and severity of knee OA in Egyptian patients, particularly with the B\b genotype.

OBJECTIVE This study aimed to evaluate the effect of one dose of intra-articular injection of (PRP) in the knee joint on a specific osteoarthritis (OA) serum biomarker of cartilage degeneration, Collagen 2-1 (Coll2-1), over a short period of 3 months. The aim extended to clarify the effect of PRP on the functional status of the osteoarthritic knee joint. MATERIAL AND METHODS Sixty patients with primary unilateral knee OA were enrolled in this study. They were subdivided according to Kellgren-Lawrence grading scale (KL) into (Group I): including patients with KL grade < 3 and (Group II): including patients with KL grade ≥3. Patients were asked to complete the Western Ontario and McMaster Universities Arthritis Index (WOMAC) Score. PRP was prepared and injected immediately into the affected knee. Serum Coll2-1 (S.Coll2-1) concentration was measured by enzyme-linked immunosorbent assay (ELISA) kit pre and 3 months after PRP injection. RESULTS Significant reduction in S.Coll2-1 concentration in primary knee OA patients; (p

PROBLEM Little is known about how preeclampsia affects regulatory T-cell count and functions in umbilical cord blood of babies born to preeclamptic mothers. Here, we analyze the percentage of CD4+ CD25high FOXP3+ , CD4+ CD25low FOXP3+ , and CD4+ FOXP3+ Tregs, in the umbilical cord blood of babies born to mothers with and without preeclampsia. METHOD OF STUDY The percentage of umbilical cord blood CD4+ CD25high FOXP3+ , CD4+ CD25low FOXP3+ , and CD4+ FOXP3+ Tregs were analyzed by flow cytometry. RESULTS CD4+ CD25high FOXP3+ Treg (%) and CD4+ FOXP3+ Treg (%) were significantly lower, while CD4+ CD25low (%) was significantly higher in umbilical cord blood of babies born to preeclamptic mothers. CONCLUSION Preeclampsia is associated with immune dysregulation which leads to a deficiency in Treg (CD4+ CD25high FOXP3+ ) in the umbilical cord blood of babies born to preeclamptic mothers.

Preeclampsia is a multisystem disorder of unknown cause that is unique to human pregnancy affecting about 7-10% of pregnant women. CD4+CD25(bright) regulatory T (Treg) cells have been identified as a principle regulator of tolerance during pregnancy. The aim of this study was to demonstrate the change of peripheral CD4+CD25(bright) regulatory T lymphocytes in normal pregnancy and preeclampsia, and to explore its role in the pathogenesis of preeclampsia. We determined CD4+CD25(bright) Treg cells in the peripheral blood using flow cytometry and forkhead box P3 (FoxP3+) cells at the peripheral blood using real time PCR. 30 preeclamptic cases (group 1), 10 normal pregnancy subjects (group 2) and 10 non-pregnant healthy controls (group 3) were included. There was a highly significant decrease as regards Treg count and percentage in preeclamptic cases compared to normal pregnancy subjects (P0.001), decrease in preeclamptic cases compared to non-pregnant healthy controls (P0.001) and a significant increase in normal pregnancy subjects compared to non-pregnant healthy controls (P0.05). There was a statistically significant decrease as regards RQ of foxp3 gene expression in preeclamptic cases compared to normal pregnancy subjects (P0.001). There was no significant correlation between RQ and studied variables in preeclamptic cases (P0.05). These findings suggest that the number of Treg cells are decreased in preeclampsia, and this decrease may break the maternal tolerance to the fetus.

SLE is a heterogeneous disease, characterized by variation in clinical and serological manifestations. This study intended to verify the role of anti-nucleosome (anti-NCS) antibodies in diagnosis of SLE and lupus nephritis and to establish the correlation between antibody reactivity and disease activity. Study subjects included 35 patients diagnosed as SLE and two control groups. While the first is a group with other collagen diseases (n = 80), the second included 50 matched apparently healthy subjects. Serum IgG anti-NCS antibodies in all subjects were detected by ELISA. Serum anti-NCS were higher in SLE than in the two control groups (P0.001). Serum anti-NCS antibody levels were higher in SLE patients with renal affection (P0.001), malar rash and with hematological disorders (P0.05). Anti-NCS antibodies showed a higher diagnostic sensitivity (74.7%) and specificity (96%) than anti-dsDNA. Combining data of anti-NCS and anti-dsDNA antibodies increased the diagnostic specificity to 97.3%. In conclusion, serum anti-NCS antibodies have diagnostic value and play role in the assessment of disease activity especially active renal disease and may predict disease outcome.

This is a review of 80 patients with neuroblastoma managed at the American University of Beirut Medical Center between 1963 and 1983. Three patients had ganglioneuroblastoma of whom one showed histologic evidence of maturation into a ganglioneuroma. Four patients were less than 1 month of age and 33 were less than 2 years of age. The site of origin was intra-abdominal in 56 patients of whom 34 were intra-adrenal. Intraspinal involvement was noted in 12 patients, of whom one was a newborn. Treatment and adequate follow-up were possible in 63 patients. Total excision of the tumor was performed in 17 patients, and partial excision in 14. The 2-year and 5-year survival rates were 36% and 25%, respectively. Age, site of the tumor, and degree of cellular differentiation were the only independent variables affecting survival. Eleven of 14 patients younger than 1 year were alive 5 or more years after diagnosis. Cervical, thoracic, and pelvic tumors had a better prognosis than abdominal tumors. Other factors affecting survival were the stage and the mode of therapy. Infants with stage IV-S congenital neuroblastoma had a very poor prognosis. The initial urinary VMA level as well as the presence or absence of calcifications within the tumor had no bearing on prognosis.

The histopathological and clinical management of two children, 7 and 14 years of age, with bronchial mucoepidermoid tumor are reported. One had regional lymphatic involvement. Pneumonectomy was carried out for both because of local spread of the disease in one and extensive pneumonia in the other, which was followed by a smooth postoperative course. Both are asymptomatic and free of disease after a follow-up of 1.5 and 5 years, respectively. A review of the English literature revealed 17 other cases, the youngest being 4 years old. The low-grade malignant potential of this tumor in children is stressed.

Twelve of 80 patients suffering from neuroblastoma who were treated during a 21-year period had intraspinal involvement. Mediastinal tumors have a greater tendency to extend to the spinal canal; however, distant spread of the tumor is rare in patients presenting with intraspinal extension. Patients with intraspinal extension also survive longer than those without. Other factors affecting survival are age, stage of disease, duration of neurological symptoms, degree of histologic differentiation, and mode of therapy. In the absence of osseous metastasis, total excision of the primary lesion and its intraspinal components is usually followed by a favorable outcome; residual neurological deficits among survivors, however, are relatively common.

A case of acquired neurogenic megacolon in a child is reported. The condition resulted after a Soave endorectal pull-through procedure for Hirschsprung's disease and was secondary to hypoganglionosis which developed in the pulled-through segment. The clinical, radiological, and pathologic features as well as the successful surgical management of this case are described.