Mohamed Y. Elsammak

Diagnostic value of serum procalcitonin and c-reactive protein in egyptian children with streptococcal tonsillopharyngitis

We investigated serum procalcitonin (PCT) and C-reactive protein (CRP) in children with streptococcal tonsillopharyngitis or nonstreptococcal tonsillopharyngitis and in healthy children. The median (range) for PCT was 0.374 (0.11–6.5), 0.105 (0.01–0.53) and 0.02 (0.01–0.08) ng/mL in the streptococcal, nonbacterial tonsillopharyngitis and control groups, respectively. PCT had a greater specificity than CRP for detection of bacterial tonsillopharyngitis.

Fibroblast Growth Factor-23 and Hypophosphatemia in Chronic Obstructive Pulmonary Disease Patients

Fibroblast Growth Factor-23 and Hypophosphatemia in Chronic Obstructive Pulmonary Disease Patients Impaired serum phosphate levels may contribute to respiratory muscle weakness that further negatively impacts Chronic Obstructive Pulmonary Disease (COPD) patients. Recently, Fibroblast Growth Factor 23 (FGF-23) has been shown to play an important role in the regulation of body phosphate. The current study includes 2 groups: 70 COPD patients and 34 control subjects. Blood samples were taken for a panel of routine lab tests. FGF-23 was measured using a commercially available ELISA kit. Plasma FGF-23 levels were significantly higher in the patient group compared to the control group (P=0.000). Tubular maximum absorption of phosphate was significantly reduced in COPD patients compared to the control group (P=0.04). Plasma FGF-23 negatively correlated with FEV1 and serum albumin. Elevated plasma FGF-23 levels found in COPD patients correlated with disease severity and may represent an additional factor causing low serum phosphate. Faktor Rasta Fibroblasta 23 i Hipofosfatemija Kod Pacijenata sa Hroničnom Opstruktivnom Bolešću Pluća Poremećeni nivoi fosfata u serumu mogu dodatno oslabiti respiratorne mišiće, što negativno utiče na pacijente sa hroničnom opstruktivnom bolešću pluća (HOBP). Nedavno je pokazano da faktor rasta fibroblasta 23 (FGF-23) ima važnu ulogu u regulisanju nivoa fosfata u telu. Ova studija obuhvatila je dve grupe: 70 pacijenata sa HOBP i 34 kontrolna subjekta. Uzeti su uzorci krvi za panel rutinskih laboratorijskih testova. FGF-23 meren je pomoću komercijalnih ELISA testova. Nivoi FGF-23 u plazmi bili su značajno viši u grupi pacijenata nego u kontrolnoj grupi (P=0,000). Maksimalna tubularna apsorpcija fosfata bila je značajno snižena kod pacijenata sa HOBP u poređenju sa kontrolnom grupom (P=0,04). FGF-23 u plazmi bio je u negativnoj korelaciji sa FEV1 i albuminom u serumu. Povišeni nivoi FGF-23 u plazmi kod obolelih od HOBP u korelaciji su sa stadijumom oboljenja i možda predstavljaju dodatni faktor odgovoran za nizak nivo fosfata u serumu.

In Egyptians, a mutation in the lymphotoxin-α gene may increase susceptibility to hepatitis C virus but not that to schistosomal infection

Abstract In Egypt, human schistosomiasis is a chronic endemic disease that can produce portal hypertension and occasionally death. Curiously, most Egyptian cases of the disease are complicated by co-infection with hepatitis C virus (HCV), the co-infection generally resulting in more severe liver disease than seen in those only infected with HCV. The high frequency of co-infection may be the result of transmission of the virus during parental schistosomal therapy or schistosomiasis-related surgery but it also seems possible that certain individuals are particularly susceptible to both schistosome and HCV infection. Lymphotoxin-α (LTα) participates in inflammatory responses, and single-nucleotide polymorphisms (SNP) in the human LTα gene have recently been found to have profound effects on individual susceptibility to various diseases, including some of those caused by parasitic infection. The possibility that the SNP that create an NcoI restriction site in the gene are associated with increased susceptibility to schistosomal and/or HCV infection has now been investigated in the Egyptian city of Alexandria. The subjects investigated were 22 patients infected only with HCV, 44 cases of schistosomal hepatic fibrosis (SHF) who were either co-infected with HCV (22) or HCV-free (22), and 22 apparently healthy, schistosome-free and HCV-free controls. When each of these subjects was tested for the NcoI polymorphism in their LTα gene, by PCR–RFLP, those with isolated HCV infection and those co-infected with Schistosoma and HCV (but not those infected with Schistosoma alone) were found significantly more likely to carry the mutation than the control subjects (P<0.05). When the cases of SHF were pooled together (irrespective of HCV-infection status), they were not found significantly more likely to have the mutation than the controls. At least in Egypt, therefore, the LTα mutation may have a role in susceptibility to HCV infection (and the subsequent development of clinical manifestations) but appears to have little if any effect on susceptibility to schistosome infection. Larger studies are now needed to confirm these results.

Taq 1B polymorphism of cholesteryl ester transfer protein (CETP) in Egyptian patients with metabolic syndrome

AIM We aimed at evaluation of the possible association of cholesteryl ester transfer protein (CETP) Taq1B polymorphism with the components of metabolic syndrome in a cohort of Egyptian patients compared to their healthy counterparts. PATIENTS AND METHODS Blood samples were collected for lipid profile, fasting glucose, insulin and routine biochemical tests. The Taq1B genotypes of CETP were determined using RFLP-PCR technique. RESULTS The patients group showed a significantly higher B1B1 genotype and lower B2B2 genotype compared to the controls group. Serum HDL-C level was significantly higher in all subjects with the B2B2 genotype compared to those with B1B1 genotype. In the patients group, age positively correlated with cholesterol level, triglycerides, BMI and waist circumference. CONCLUSION Egyptian patients affected with metabolic syndrome have a higher prevalence of B1B1 genotype that is associated with lower serum HDL-C levels.

Serum sFas and Tumor Tissue FasL Negatively Correlated with Survival in Egyptian Patients Suffering from Breast Ductal Carcinoma

Fas (CD95-APO-1), a member of tumor necrosis factor receptor super-family, exists in two forms, transmembrane and soluble (sFas). It had been suggested that circulating sFas levels and/or tissue FasL may reflect the severity of invasive breast ductal carcinoma. Few studies showed that neither DNA-index nor ploidy is an independent prognostic indicator, and there is no correlation with clinical outcome. The S-phase fraction (SPF) has been shown to be useful prognostic factor in both node-negative and node-positive tumors. The present work was done to find a correlation between sFas, tissue FasL, ploidy and SPF with prognostic factors and survival of breast ductal carcinoma patients. The present study included two groups; a patients group comprised 30 patients with breast ductal carcinoma and a control group that comprised 15 patients with benign breast swellings. Serum sFas was measured using commercially available ELISA kit and tissue FasL expression was studied using avidin–biotine immunohistochemical staining technique. Cell cycle studies were performed using flow cytometry. Serum sFas was significantly higher in breast ductal carcinoma group than in the benign breast swelling control group. A significant negative correlation between serum sFas and overall survival was found. Tissue FasL expression was directly correlated with distant metastasis and poor overall survival. A significant direct correlation was found between moderate and high SPF with worse pathologic parameters. Serum sFas level, tissue FasL immuno-expression and S-phase fraction are independent prognostic factors in breast ductal carcinoma cases.

HCV Core Antigen Testing versus HCV PCR Testing for Early Detection of HCV Infection

HCV core antigen is detectable in serum several weeks earlier than anti-HCV antibodies. Variability in early detection time is even more pronounced in certain groups of patients such as the hemodialysis and immunocompromised where the antibody response may take between 45-68 days to develop. Early detection of HCV core Ag in serum may represent an attractive, cost effective screening tool for such high risk patients. The current study aimed at evaluation of the analytical performance of the Abbott Architect HCV Chemiluminescenat Microparticle Immunoassay (CMIA) in comparison to the standard PCR detection of HCV RNA. In addition, the current study evaluated the possible clinical utility of HCV Ag kit in testing pooled samples from several patients. Samples from 44 HCV patients and 15 controls were analyzed using the CMIA HCV core Ag assay and quantitative PCR. Samples from positive HCV patients were pooled and analyzed using the HCV core Ag assay. The current study demonstrated a sensitivity of 81.0% and specificity of 97.0% for the ABBOTT HCV core Ag kit assay in detecting HCV positive cases compared to quantitative PCR assay. The most important finding of the current study is that HCV core Ag assays may have false negative results at low level viremia (low HCV copy numbers). The current study does not support using HCV core Ag as a single test for screening possible HCV cases or using HCV core Ag assays on pooled samples. Bigger studies may be needed to strengthen the findings of the current study

Prognostic value of urokinase plasminogen activator receptor (uPAR) and neutrophil CD64 expression in acute respiratory distress syndrome patients

The outcome of acute respiratory distress syndrome (ARDS) may vary from complete recovery to multiorgan failure and death. The current study evaluates the prognostic performance of plasma uPAR and Neutrophil expression of CD64 in patients with ARDS of different etiologies and tests the possible correlation with other prognostic markers, namely APACHE-II score and serum CRP. The current study included 2 groups: 68 patients with ARDS and 25 age- and sex-matched, randomly selected, healthy control subjects. Blood samples were taken for routine laboratory tests on admission to ICU. Plasma uPAR was measured using a commercially available ELISA kit, and neutrophil CD64 expression was measured using flow cytometry. Plasma uPar was significantly higher in bacteremic ARDS patients than those without bacteremia. There was also a significant increase in plasma uPAR in ARDS survivors than in those who died. CD64 expression showed a similar pattern of increase in bacteremic ARDS. Using ROC curves plasma uPAR outperformed CD64 expression and CRP as a prognostic indicator in the studied ARDS patients. A cut-off value for plasma uPAR which almost always predicted mortality was 15.1 ng/ml with PPV of 100% and NPV 97%. Plasma uPAR is significantly elevated in ARDS patients and has a superior prognostic value to both neutrophil CD64 expression and scrum CRP in ARDS patients. A plasma uPAR cutoff value of 15.1 ng/ml has a PPV of 100% and NPV of 97% in predicting mortality in the ARDS patient included in the current study.