Complete Blood Picture Research Articles

Frequency inborn error of mitochondrial function in Mosul and Kurdistan region

This work aimed to estimate the frequency of mitochondrial inborn errors of metabolism (MIEMs) in patients presenting with family history and IEM-picture who referred for advance IEM assay in Mosul province and Kurdistan region. This study was observational study conducted on 364 cases referred from different general /or private pediatric clinics with unexplained sign and symptoms and suspension of mitochondrial dysfunction. The study included 364 children with an age ranging from 1 month to 1 year. Started from January 2018 to January 2020. All patients referred with their full history review, notes about their clinical examination, and laboratory investigations including blood ammonia, serum lactate/ pyruvate, arterial blood gases. In addition to the standard laboratory-tests (kidney and liver functions, blood glucose, and complete blood picture) carried out in Sorain private Laboratory. The results of this work show that sixteen (4.4%) of cases were positive in the IEM screening test

2020 Hong Kong College of Obstetricians and Gynaecologists guideline on investigations of premenopausal women with abnormal uterine bleeding.

Abnormal uterine bleeding in premenopausal women is a common gynaecological symptom and composes of abnormality in the frequency, duration, regularity, and flow volume of menstruation. It could constitute the presentation of various gynaecological malignancies. An appropriate history and physical examination are mandatory to ascertain the diagnosis. Depending on the clinical condition, a complete blood picture, thyroid function test, clotting profile, chlamydia test, cervical smear, and pregnancy test can be performed. Ultrasound should be performed in cases with a pelvic mass, unsatisfactory physical examination, persistent symptoms, or no response to medical treatment. In women aged ≥40 years, an out-patient endometrial biopsy with Pipelle should be performed. In women aged <40 years with risk factors for endometrial cancer, persistent symptoms, or no response to medical treatment, an endometrial biopsy should be performed to rule out endometrial cancer. Hysteroscopy or saline infusion sonohysterography is more sensitive than ultrasound for diagnosing endometrial pathology. Details of the above recommendations are presented.

Efficacy of Inhaled Salbutamol in the Management of Transient Tachypnoea of Newborn

Objective: To compare the outcome of salbutamol nebulization with controls (normal saline) in transient tachypnea of newborn. Methods: In this randomized controlled trial 284 (142 in each group) neonates were included with gestational age above 35 weeks of any gender. Study was conducted in Department of Pediatrics Holy Family Hospital Rawalpindi. Sampling technique was consecutive non probability sampling. Duration of study was 6 months. Sample size had been calculated using WHO calculator; Significance level 5%, Power of test 80%, Population mean 5.4, Test value of population mean 4.8, Standard Deviation 1.8. At admission complete blood picture, C-reactive protein and chest x-ray were done. Group-1 received salbutamol nebulization at a dose of 0.15mg / kg / dose for 10 minutes in 2ml normal saline QID while Group-2 received only normal saline nebulization 2ml QID in 24 hours. Double blinding was ensured and in case of any side effects of salbutamol (tachycardia, arrhythmias and hypoglycemia) treatment was stopped immediately and managed accordingly. Results: In this study, comparison of outcome of inhaled salbutamol with controls in transient tachypnea of newborn shows that respiratory rate per minute was 50.15+2.34 in Group-1 and 64.92+2.70 in Group-2, p value was 0.0001, heart rate per minute in Group-1 was recorded as 120.08+2.36 and 134.79+3.27 in Group- 2, p value was 0.0001, oxygen saturation(%) was 97.27+0.92 in Group-1 and 83.28+1.81 in Group-2, p value was 0.0001, duration of oxygen therapy(hours) was recorded as 15.49+1.84 in Group-1 and 27.78+5.57 in Group-2, value of p was 0.0001, duration of hospitalization(days) was recorded as 2.03+0.45 in Group-1 and 5.07+0.72 in Group-2 while value of P was 0.0001 Conclusion: Salbutamol Nebulization is more effective than normal saline in TTN. Key Words: Transient Tachypnea of newborn, management, inhaled salbutamol, outcome.

Feasibility and accuracy of cord blood sampling for admission laboratory investigations: A pilot trial.

Phlebotomy losses greatly contribute to anaemia following preterm birth. Therefore, the possibility of drawing initial tests from the placenta seems attractive. There is a lack of literature regarding the feasibility and accuracy of pathology tests taken from umbilical arterial and venous (UAB/UVB) compared to blood collected from the newborn. UAB and UVB complete blood pictures were compared with the initial neonatal blood test. The relationship between UAB, UVB and neonatal complete blood picture values was determined by Spearman's Rho correlation with absolute values compared by Kruskal-Wallis. P < 0.05 was considered significant. Neonatal haemoglobin, white cell count, immature/total ratio and platelets were significantly correlated to the corresponding values in the UAB and UVB (all P < 0.001). While UAB and UVB haemoglobin and white cell count were similar, both were significantly lower than the neonatal values (P < 0.001 and P = 0.014, respectively). No difference was seen for immature/total ratio and platelet concentrations. UVB blood culture (BC) was feasible (90%), even with delayed cord clamping, and the UVB BC volume was significantly higher (P < 0.001), with a low rate of BC contamination (1.5%). Our findings support the feasibility and accuracy of umbilical blood in place of blood collected from the newborn. This reduces the phlebotomy losses and allows higher blood volume collection which may increase the sensitivity of BC collection.

Serum Markers as a Predictor of Hepatic Fibrosis Compared to Fibroscan in chronic hepatitis B Infected Egyptian patients: A Cross-sectional Study

Background &amp; Aims: The gamma-glutamyl transpeptidase (GGT) to platelet ratio (GPR), the gamma-glutamyl transpeptidase to albumin (GAR) and S-index are novel biomarkers suggested to assess liver fibrosis. The aim of the work was to assess the correlation between GGT and other related markers as GAR and GPR among other previous documented markers and the degree of fibrosis and steatosis in chronic HBV Egyptian patients as measured by fibroscan. Materials And Methods: After ethical approval of the protocol, a total of 170 chronic HBV patients were recruited from tropical medicine department, Tanta University. They underwent fibroscan examination for fibrosis and steatosis measurement with concomitant testing of liver functions and complete blood picture. Proposed serum markers were calculated. The relation between these ratios with the fibrosis and steatosis measured by fibroscan were tested using Pearson rank correlation. Results: There was a highly significant positive correlation between gamma-glutamyl transpeptidase and platelet ratio (GPR), GAR, GGT, Fib4, APRI and fibrosis (p=&lt;0.001, &lt;0.001,&lt;0.001,&lt;0.001,0.011 and &lt;0.001 respectively), while there was no correlation with the degree of steatosis (p=0.922,0.66,0.936,0.214,0.591 and 0.760 respectively). Also these markers were significantly higher in patients with higher grades of fibrosis (f2-4) (p= 0.007,0.013,&lt;0.001,0.018,0.029,and 0.002 respectively), they also showed high sensitivity and low specificity in detecting higher grades of fibrosis with no statistically significant difference between the AUC of GPR and GAR (p=0.89). Conclusion: Noninvasive serum markers including GGT, GPR, GAR, Fib4, APRI, and S-index are positively correlated to the degree of fibrosis in CHB patients with high sensitivity and low specificity. They were good negative tests for diagnosis of significant fibrosis.

Gall Bladder Wall Thickening in Dengue Fever - Aid in Labelling Dengue Hemorrhagic Fever and a Marker of Severity.

IntroductionDengue fever is a mosquito-borne viral disease spread by the bite of the Aedes aegypti mosquito. Dengue epidemics have contributed to a great economic burden, especially in South-East Asia. This study aimed to determine gall bladder wall thickness (GBWT) in patients with dengue fever, assess its sensitivity and specificity to identify dengue hemorrhagic fever, and also compare gall bladder wall thickening (GWBT) with platelets, hematocrit, and leucocyte count.Materials and methodsThis prospective observational study was conducted in the dengue ward of Benazir Bhutto Hospital, Rawalpindi, Pakistan, from September 2019 to January 2020, i.e., four months. Patients admitted to the dengue ward diagnosed as seropositive and provided consent were enrolled into the study. Laboratory investigations (blood complete picture, liver function tests, renal function tests) were collected and recorded. Ultrasonography was performed on admission and subsequently during a hospital stay. Patients were divided into two groups: those with gall bladder wall thickness ≤ 3mm and ˃3mm. All data were entered and analyzed on SPSS version 24 (IBM Inc., Armonk, USA).ResultsOut of 180 patients, 122 (67.8%) were male, and 58 (32.2%) female. The mean age was 33 ± 13 years. One hundred and six patients (58.9%) were diagnosed with dengue fever, 68 (37.8%) - dengue hemorrhagic fever, and six (3.3%) - dengue shock syndrome. The most common finding was gall bladder wall thickness ˃3mm (69/180; 38.3%) followed by ascites (38.1%). Sixty-two patients out of 69 (89.9%) with GBWT ˃3mm were managed as dengue hemorrhagic fever (p=0.000). Alanine transaminase (ALT), platelet, and total leukocyte count (TLC) were associated positively with an edematous gall bladder wall (p<0.005). The mean gall bladder wall thickness for dengue hemorrhagic fever was 6.4mm ± 2.5 mm. A GBWT value of 3.5mm was found to have 94.6% specificity and 91.2% sensitivity.ConclusionGall bladder wall edema is strongly correlated with dengue hemorrhagic fever. Hence it should be assessed in all patients with dengue fever.

HAEMATOETIOLOGICAL EVALUATION OF SPLENOMEGALY

BACKGROUND: Splenomegaly is usually the result of an underlying disorder.Causes ranging from infections to haematological malignancies. AIMS AND OBJECTIVES : Present study aims to find out the frequency of various haematological causes of splenomegaly and to study its haematological parameters . MATERIAL AND METHODS: This descriptive case series study was carried out at Department of Medicine at Nri General Hospital from 1st March 2019 to 31st August 2019,over a period of six months. 100 patients older than 13 years of age with clinically enlarged spleen were selected for this study. Sampling technique is Non propability convinient sampling. After getting informed consent from the patients proforma filled elaborating history, important clinical findings and investigations like abdominal ultrasound , complete blood picture , liver function tests , virals were performed. RESULTS: Males (57%) are most commonly affected than females (43%). The most common age group in males was 41-50 yrs and females was 21-30 yrs. The maximum cases were identified with moderate splenomegaly.Among the haematological causes 57% were leukemias,of which 30% were chronic and 27% were acute . CONCLUSION : Splenomegaly in a symptomatic person should always be investigated thoroughly as most of the cases are treatable. Haematological parameters with enlarged spleen is utmost important as an additional tool in evaluating the etiopathogenesis of splenomegaly.

Prevalence of Bronchial Asthma among Patients attending Tertiary Allergy center /Kirkuk / Iraq

Background: The prevalence of asthma worldwide increased last three decades, according to the world health organization estimate in 2005, around 300 million people affected with asthma, little data for its prevalence at Middle East. Objective: To evaluate the prevalence of asthma among patients attending tertiary allergy center in Kirkuk. Patients and Methods: The study included 1840 patients of different age groups from 1-4 years to age group 65 and above and deferent gender male and female, attending to allergy center from first of January to 30th of December 2017. They are diagnosed by clinical examination, spirometer, complete blood picture including eosinophil count and for certain patient’s chest x rays and sputum culture for suspect fungal infections like aspergilloses. Results: The study shows an increase prevalence of asthma at Kirkuk tertiary allergy center the prevalence was 6.94% and it is prevalence significant higher in adults than children, study shows at age group 20-44 year was 37.5% and age group45-65 years total number was 528 percentage 28.7%. Seasonal changes was clear there is an increase asthma cases at spring months from April to May the prevalence was 29.83% and an increase in autumn months from September to November the prevalence was 30.05%. According to gender the study shows the females little higher than males in the females was 5053%,in males49.47% .Conclusion: The prevalence of asthma is high in these locality and need more longitudinal data studies at the level of government to discover seasonal environmental factors play role in provoking asthmatic attack and need to be observed and studied which is important in prevention of asthma in our locality.

Effect of tranexamic acid in reducing blood loss during and after cesarean delivery

Objective The aim was to evaluate the effect of tranexamic acid (TA) in reducing blood loss during and after elective cesarean delivery (CS). Background Postpartum hemorrhage is an obstetrical emergency that can follow delivery. It is a major cause of maternal sickness and maternal death. Patients and methods In all, 74 full-term pregnant primigravida with singleton pregnancy aged between 20 and 35 years, scheduled for elective CS were enrolled at a prospective study. The patients were divided into two groups. Group I: patients received a bolus injection of 1 g of intravenous TA diluted in 20 ml of 5% dextrose solution slowly over 5 min at 10 min before skin incision. Oxytocin 10 units in 500 ml normal saline (9% saline) intravenous drip (8 ml/min) were administrated after fetal delivery. Group II: no TA was given; oxytocin was administered as in group I. Preoperatively, complete blood picture and coagulation profile were done. Result Hemoglobin and hematocrit levels decreased significantly in group II than in group I (P = 0.007; 0.005) consecutively. On comparing the two studied groups, there was a significant decrease in the amount of blood loss in group I than in group II (P = 0.001). More cases in group II than in the TA group required further ecbolic treatment during the postoperative period (P = 0.018). Conclusion A safe dose of TA plays an effective role in reducing blood loss during lower segment CS without causing complications.

Neutrophil and Platelet to Lymphocyte Ratio for Detecting Early-onset Neonatal Sepsis

Background: Neonatal sepsis [NS] is associated with severe morbidity and mortality. Clinical manifestations range from subclinical infection to severe local or systemic infection. The diagnosis of NS remains a challenge as it has subtle and distinct signs and symptoms. Although blood culture is the gold standard in the diagnosis of NS, the search for high-sensitivity NS markers continues to overcome the drawbacks of blood cultures. The aim of the work: This study aimed to investigate the effectiveness of the neutrophil to lymphocyte ratio and platelet to lymphocyte ratio in predicting early onset sepsis in neonates.Patients and Methods: A case control study, comprised 120 newborns [60 newborns with neonatal sepsis as a case group and 60 healthy newborns as a control group], based on patient records at neonatal intensive care unit [NICU] of Al-Azhar University Hospital [Damietta], from January 2018 to January 2019. All were subjected to adequate history taking, full clinical examination, complete blood picture, C-reactive protein and blood culture. After that, neutrophil to lymphocyte ratio [NLR] and platelet to lymphocyte ratio [PLR] were calculated. Results: NLR was significantly higher in neonates with sepsis. However, there were no association between PLR and early onset sepsis [EOS]. Although, the diagnostic cutoff value for NLR was 1.0 with 72% sensitivity, 100% specificity, there was no association between PLR and EOS.Conclusion: NLR increases significantly in neonatal sepsis, and can be used as a marker for detection of early onset neonatal sepsis.

The validity of myocardial perfusion using 99mTc-Tetrofosmin gated single-photon emission tomography (gSPECT) in the detection of coronary artery disease in different stages of chronic kidney disease

Background: Patients with advanced chronic kidney disease (CKD), subjected to hemodialysis (H.D.), May not manifest chest pain with severe coronary artery disease (CAD). Aim of the study: Study the value of radionuclide myocardial perfusion using gated single-photon emission tomography (gSPECT) in recognition of the frequency and risk factors of CAD in different stages of CKD patients. Patients and Methods: the current study divided 133 CKD patients (pts) into three groups according to CKD stage: 43 cases in stage 3, 43 in stage 4, and 47 in stage 5. Each stage included asymptomatic and symptomatic subgroups. The present study recorded the clinical evaluation, laboratory data (in the form of complete blood picture, fasting blood glucose and glycosylated hemoglobin (HbA1c), lipid profile, serum calcium and phosphorus, C-reactive protein [CRP]), together with imaging tests (Dipyridamole stress-rest gSPECT/C.T., coronary C.T. angiography and LVM index by echocardiography) for all patients. Results: the study included ninety-nine asymptomatic and 34 symptomatic patients. CKD 3 included 33 asymptomatic and ten symptomatic, CKD 4 included 33, and 10, while CKD5 included 33 and 14, respectively. The asymptomatic group presented forty-eight cases (48.5%) abnormal gSPECT (19 fixed and 29 reversible defects). Eleven of this abnormal gSPECT were in CKD3, thirteen in CKD 4, and twenty-four in CKD 5, with a statistically higher prevalence of abnormality in CKD5 (P&lt;0.0001). On the contrary, thirty cases of the symptomatic group had abnormal gSPECT (12 fixed and 18 reversible defects) seven in CKD 3, nine in CKD 4, and all the fourteen of CKD5. We Compared both groups concerning risk factors, age (senior in asymptomatic), blood pressure (greater in symptomatic), serum creatinine (higher in symptomatic), duration of hemodialysis (longer in symptomatic), cholesterol (more elevated in symptomatic) and HDL (more elevated in asymptomatic). The symptomatic group had a statistically more abundant perfusion defects size compared to the asymptomatic group. Stepwise regression discovered that the abnormal myocardium (SSS score &gt; 4) was dependent first of all on age, which consequently revealed the substantial role of D.M., LVH, and elevated CRP. Conclusion: stress-rest gSPECT is essential in the revealing of CAD in different stages of CKD, even in low-risk patients. High-risk CKD patients for CAD are those with D.M., LVH, and high CRP.

Correlation of some Immunological Markers with Systemic Lupus Erythematosus disease

SLE (Systemic Lupus Erythematosus) is, a heterogeneous disease, with ,diverse clinical manifestation disorder characterized by hyperactivity of B and T cell, creation of auto, antibodies, and, deposition, of antibody- containing immune complexes in blood vessels, during body. This study aims to investigation some immunological markers related to patients with SLE. It includes the study of the level, of Interleukin, (IL.17), antinuclear antibody (ANA), anti dsDNA, antiphospholipid and, complement, C3, C4, In addition to study the complete blood picture including hemoglobin, red blood cell monocytes, white blood cells, platelets and lymphocytes, they belong to factors that may interfere with the disease. Current study included 110 patients with SLE, and 106 (96.36%) were female and 4 (3.64%) were male. Patients with an average age of 31.61 ± 8.60 years. This work also includes 70 blood specimens as control group. Our study illustrated that most infections were on Village 71.82 % compared with the City 28.18 , and patients without history disease 57.27 % while patients with history disease42.73%. The results also showed that the concentration of IL.17 was significantly higher than p ≤ 0.05 in serum patients with lupus erythematosus (469 ± 2.25 g / ml) comparison with healthy individuals (107.39 ± 0.41 pg / ml). ELISA was used to measure some types of autoantibodies, and showed an increase in ANA and dsDNA Ab levels in SLE patients compared with healthy individuals. The results also prone that the antiphospholipid is significantly increase (P ≤ 0.05) in patients with SLE compared to controls.Evaluating serum complement level C3, C4 in the total study, our results observed significant decrease (p ≤ 0.05) in serum of patients with SLE (0.62 ± 0.01,0.13 ± 0.01g/l) respectively, compared with controls ,(1.74 ± 0.01,0.28 ± 0.01g/l) respectively.The results of the study also showed a significant decrease in hemoglobin, red blood cell monocytes, white blood cells, platelets and the number of lymphocytes for SLE patients compared with healthy individuals.The relationship between antibodies to ANA and IL-17, antibodies to dsDNA and C3, C4 and lymphocytes was identified, as well as the relationship between APA, C3 and C4 antibodies. Inconclusion ,peoples with SLE have a positive ANA, High concentration of, ds DNA Ab and anti-phospholipid which plays an important role in pathogenesis and complement C3 and C4 in patients with SLE is decreased. An increased inflammatory concentration of interleukin (IL.17) can play a critical role in the pathogenesis of SLE which leads to disease progression.

Serum Sclerostin Level in Relation to Bone Status in Children with Chronic Kidney Disease

Abstract Background: To assess the serum level of sclerostin as a bone marker in children with different stages of Chronic Kidney Disease and its relation to bone status in children with CKD. Aime of Study: Is to assess the serum level of sclerostin in children with different stages of CKD and its relation to bone status in those children. Patients and Methods: The study was conducted on total of 90 children, 60 children of them were followed-up for diagnosis of CKD stages from II to V at Mansoura University Children Hospital (MUCH) Nephrology Unit. This study was done from March 2015 to March 2016. They were 34 (56.7%) males and 26 (43.3%) females with mean age SD of 11.06±3.4. Control group of 30 healthy children and were 18 male (60%) and 12 (40%) female with mean age SD of 9.6±2.3. Age ranges from three to seventeen years, complete blood picture, serum creatinine, parathyroid hormone, alkaline phosphatase, calcium, phosphorous and sclerostin serum level and also DEXA scan were measured in both groups. All patients were free from acute illness or symptoms suggestive of a urinary infection in the previous 3 months and none of them were receiving corticosteroids. Children with CKD who have diabetes, vascular calcifications or had undergone renal transplantation were excluded. Results: Elevated serum sclerostin in CKD & ESRD groups compared to control. Non-significant correlation between serum sclerostin level, biochemical bone markers and different anthropometeric measures. Conclusions: Serum sclerostin was elevated in CKD & ESRD suggesting as an indicator of bone mineral density in CKD patients but it is level didn't correlate as expected with observed BMD or bone turnover markers, suggesting presence of confounding variables that must be taken into account before routine clinical implementation. Non-significant cor-relation between serum sclerostin level and other biochemical bone markers as regard Calcium, phosphate, alkaline phos-phatase and patathemone hormone. Non-significant correlation was also detected between sclerostin, bone mineral density and body composition.

A Case Report on Iactrogenic Cushing Syndrome with Scabies and Oral Candidiasis

Cushing syndrome is a condition characterized by high blood levels of cortisol or other exogenous compounds of glucocorticoids. This can be iatrogenic or endogenous cortisol secretion, due to the either an adrenal tumor or hyper secretion of adrenotropic hormone by the pituitary gland. Due immunosuppression patient are prone to more infectious diseases. Here the patient is diagnoses with oral candidiasis and scabies. Clinical investigation was carried out and laboratory investigations like Cortisol level in morning and evening, complete blood picture. He was provided with treatment of hydrocortisone, anti-fungal agents, anti-parasitic agents and skin moisturizer.&#x0D; Keywords: Iactrogenic Cushing syndrome, Candidiasis, Scabies, Cortisol, Corticosteroid.

Evaluation of Methotrexate toxicity among patients presented to the Poison Control Center of Ain Shams University Hospitals, Egypt: A Prospective Study

Background: toxicity following acute ingestion of large amount of methotrexate is rarely reported, yet accidental daily dosing of methotrexate can result in life-threatening toxicity. Objective: This study aims to evaluate the outcome of cases of methotrexate toxicity reported to the Poison Control Center of Ain Shams University Hospitals, Egypt with highlight on causes of mortality, frequency of adverse effect and treatment offered. Methods: A prospective study conducted on patients suffering from methotrexate toxicity admitted to the Poison Control Center from January 2015 till December 2018. Twenty-seven patients were included and were classified into two groups: Survivors and Non-survivors. The following variables were studied: presence or absence of vomiting, diarrhea, stomatitis, dysphagia, melena, rash, respiratory distress and treatment given to the patients. Venous samples were drawn for complete blood picture, renal function test and liver enzymes. Electrocardiogram and chest X- ray were performed for all patients on admission and repeated if needed. Results: Our results revealed that 41% of patients had no effect, minor effect (7%), moderate effect (4%), major manifestation (22%). Death was reported in 26% of the cases. The majority of patients (63%) were due to therapeutic errors. Accidental and suicidal patients were asymptomatic. Major manifestations and death were reported in cases of therapeutic error. Death was mainly due to respiratory complications. Conclusion: Errors with methotrexate treatment was the main cause of toxicity and respiratory complication was the most common cause of mortality. Strategies to reduce these harms are highly required.

3064 – PREDICTIVE VALUE OF MIRNA 181A IN PEDIATRIC ACUTE LYMPHOBLASTIC LEUKEMIA

<h3>Context</h3> Acute lymphoblastic leukemia (ALL) represents the most common type of pediatric malignant neoplasm. The miRNAs play an important role in the regulation of normal hematopoiesis and their disruption contributes to leukemogenesis and considered novel candidates with diagnostic, predictive and prognostic potential value. Recently, specific miRNAs have been discovered to be involved in the pathogenesis of ALL serving as a biomarker for detection of leukemia at diagnosis and relapse. <h3>Objective</h3> To study the associations between miR181a expression and the outcome after induction so the possibility of using miR-181a expression as a predictive marker for children with ALL. <h3>Methods</h3> This study was carried out in Oncological Clinical Pathology Department, South Egypt Cancer Institute and included 40 newly diagnosed pediatric ALL. MiR-181a expression was assessed at diagnosis and before start of treatment. MiR-181a was extracted from peripheral blood or bone marrow sample by miRNeasy Mini kit, then revers transcription of miRNA to cDNA using TaqMan® MicroRNA Reverse Transcription (RT) Kit, and finally, real-time PCR(q-PCR) using 7500 Fast Real-Time PCR System by TaqMan® Universal Master Mix. Patients have been evaluated for the response after induction therapy clinically, by complete blood picture and bone marrow aspirate examination. <h3>Results</h3> The expression level of miR-181a was significantly higher in remission group than in non-remission group. (P< 0.001). <h3>Conclusions</h3> High expression of miRNA-181a is associated with remission and good outcome after induction therapy in pediatric ALL. So miR-181a could be considered as a predictive marker in pediatric ALL. We recommended further studies to work on the use of miR-181a as a prognostic and predictive non-invasive marker in childhood ALL.

HIV-associated thrombocytopenia: Profiling hematological changes in the HIV infected and AIDS patients

Background and Aim: The first Acquired Immune Deficiency Syndrome (AIDS) case in India was detected in the year 1986. Seldom studies have been conducted correlating Cluster of Differentiation-4 cell counts (CD4 cell counts) and complete blood picture including platelet counts in the Human Immunodeficiency Virus (HIV) infected and AIDS patients in the Indian population. The present study was carried-out with the same intent to evaluate the CD4 cell counts and complete blood picture including platelet counts in the HIV infected and AIDS patients and correlate them with the sero-negative controls. Materials and Methods: The present study was a cross-sectional, hospital-based study on the HIV infected and AIDS patients. Evaluation of complete blood picture including platelet counts was done using Sysmex XP 100- (Sysmex Corp., Hyogo, Japan), a fully automated analyzer while CD4 cell counts were evaluated using Partec Cyflow Counter- (Partec GmbH, Munster, Germany). Statistical Analysis Used: The data was analyzed using SPSS version 15.0 (SPSS Inc., Chicago, IL, USA). Comparison of the said parameters was done using Analysis of Variance (ANOVA) and post-hoc Games-Howell test. p-value of <0.05 was considered statistically significant. Results: The levels of hemoglobin (Hb), white cell counts (WBCs) and platelet counts showed statistically significant results (p <0.001) with the levels of Hb and platelet counts significantly decreased and levels of WBCs significantly increased in the HIV infected and AIDS groups as against the sero-negative controls. Conclusion: Hb, WBCs and platelet counts were significantly altered in the HIV infected and AIDS groups when compared with the sero-negative controls.

OSTEOPROTEGERIN (OPG) AND SOLUBLE RECEPTOR ACTIVATOR OF NUCLEAR FACTOR KAPPA B LIGAND (S-RANKL) IN PATIENTS WITH RHEUMATOID ARTHRITIS

Background: Rheumatoid arthritis (RA) is a chronic inflammatory disease that may result in debilitating joint deformities with destruction of bone and cartilage. Inflammation is still considered the pivotal inducer of both components of joint damage. A mechanism of bone destruction that could be dissociated from inflammation was proposed in which osteoclasts activation play a prominent role in bone resorption. RANKL and its natural decoy receptor, osteoprotegerin (OPG), play key roles in osteoclast activation. Objective: To evaluate osteoprotegrin (OPG) and soluble RANKL (s-RANKL) level in serum of rheumatoid arthritis patients, and to correlate their levels in serum to disease activity and radiological findings (bone loss). Patients and methods: Fifty five rheumatoid arthritis patients were included in the study. They were classified according to disease activity into 2 groups: The first group was active RA group, and the second was inactive RA group. In addition, RA group was classified according to bone erosions into 2 groups: The first group was RA group with bone erosions and the second group was RA group without bone erosions. The study included 25 healthy individuals of matched age and sex as a control group. All participants were exposed to complete clinical examination, radiological examination, and full laboratory evaluation including osteoclast activity markers (OPG/ RANKL ratio), inflammation markers (ESR, CRP and DAS-28 score), immunological markers (RF and anti-CCP), biochemical markers (calcium, phosphorus and alkaline phosphatase) and complete blood picture (CBC). Results: OPG/ RANKL ratio was significantly lower in RA group compared to control group. OPG/RANKL ratio was significantly lower in active RA group compared to inactive RA group. OPG/ RANKL ratio was significantly lower in RA group with bone erosion compared to RA group without bone erosions. OPG/ RANKL ratio showed significant negative correlation with both disease duration (in all RA groups) and inflammatory markers (in some not all RA groups). OPG/ RANKL ratio did not correlate with biochemical markers in all RA groups. Conclusion: OPG/ RANKL ratio could be used to monitor joint damage (bone erosions) progression in patients with RA. Progression of joint damage (bone erosions) due to osteoclast over activity could, at least in part, be dissociated from inflammation. Therefore, targeting OPG/ RANKL ratio may be effective in preventing bone damage in RA patients.

Relationship of methylenetetrahydrofolate reductase C677T genetic polymorphism and oxidative changes in Egyptian patients with β-thalassemia major

Objectives To evaluate the genetic polymorphism of methylenetetrahydrofolate reductase (MTHFR) C677T among patients with beta-thalassemia major and its related oxidative changes. Background Accelerated oxidative damage is one of the hallmarks in beta-thalassemia major. Genetic polymorphism of MTHFR C677T has been shown to cause hyperhomocysteinemia, which acts as a prooxidant. Material and methods Genotyping for MTHFR C677T was evaluated by PCR-restriction fragment length polymorphism technique. Complete blood picture, hemoglobin electrophoresis, serum ferritin, and total antioxidant capacity (TAC) were determined in 60 patients with beta-thalassemia major and 20 controls of matched age and sex. Results MTHFR 677TT genotype was significantly higher among patients with beta-thalassemia major (23.3%) compared with controls (5%). There was significant decrease in TAC in thalassemic patients as compared with controls. TAC was significantly lower in TT group than both of CC and CT groups. Ferritin level was significantly higher in thalassemic group than controls. Conclusion Detection of MTHFR (C6777T) genetic polymorphism among thalassemic patients could be helpful in assessment of oxidative stress among these patients.

Ameliorative effect of kefir against γ-irradiation induced liver injury in male rats: impact on oxidative stress and inflammation.

Ionizing radiation is a double-edged sword because of its benefits and risks to human health. Therefore, protecting human organs from harmful effects of radiation is an important concern of researchers. Kefir, as a good source of probiotics, received growing interest in protective medicine owing to its antioxidant, anti-inflammatory, and immunomodulatory properties. Thus, this study was planned to investigate the protective role of kefir against γ-radiation-induced hepatotoxicity. Thirty-two male rats were distributed in four groups: (I) control, (II) received Kefir orally (5ml/kg body weight) for 28days, (III) exposed to whole body γ-irradiation (6.5Gy) to induce hepatotoxicity, and (IV) was pretreated with kefir for 21days then exposed to γ-irradiation followed by 7days of kefir treatment. At the end of the experiment, complete blood picture (CBC), liver function, and lipid profile were estimated. Furthermore, levels of lipid peroxidation, nitric oxide content, and endogenous antioxidants, in addition to concentrations of copper, iron, and calcium were measured in liver tissue. Furthermore, monocyte chemoattractant protein-1 (MCP-1) and relative gene expression of nuclear factor kappa (NF-κB) were assessed. The results revealed that oral administration of kefir significantly reduced the radiation-induced hepatic histological alterations, hepatic function impairment, and dyslipidemia. Moreover, kefir notably ameliorated the state of oxidative stress and appeared to inhibit the induced inflammation. This study provides a possible counteracting role of kefir against hepatotoxicity induced γ-radiation. This can focus the benefit of kefir application as a prophylactic treatment to limit hepatic inflammation during radiotherapy.