Background Telomeres are hexameric nucleotide sequences. The biological role of telomeres is to prevent shortening of DNA to preserve integrity of the genome. Length of telomeres is determined by age, sex, and environmental exposures. Telomeres are vulnerable to injury by oxidative stress. Telomere length is sustained by telomerase, a ribonucleoprotein telomerase reverse transcriptase (TERT). Telomerase may help cell growth and secure against cell death. ‘Telomeropathy’ is associated with genetic mutations. The most common phenotype related to telomerase mutation is pulmonary fibrosis. Objective To investigate the associations of both TERT and telomerase RNA component C with disease progression in patients with interstitial lung diseases (ILDs), which include idiopathic pulmonary fibrosis (IPF), and to compare results between patients with ILD and control. Patients and methods A total of 46 patients with different types of ILDs were enrolled as well as 15 healthy persons as control. Whole blood sample was obtained from both patients and healthy control for detection of expression of telomerase gene by quantitative real-time PCR. Results There was a significant negative correlation between telomerase reverse transcriptase (h-TERT) and partial pressure of oxygen (r=−23, P=0.03). Both h-TERT and telomerase reverse transcriptaseRNA component (h-TERC) were relatively more expressed in patients with IPF with pulmonary hypertension, whereas there was a significant elevation of h-TERT relative expression in patients with IPF with honeycombing high-resolution computed tomography pattern in comparison with those with reticulonodular pattern, with median of 0.85 versus 0.29, respectively. Conclusion Hypoxia may affect DNA damage in the telomere region. Expression of telomerase may take part in pulmonary fibrosis. Exposure to hypoxia or growth factors can stimulate the expression of telomerase on cells of vascular smooth muscle.
Objectives To study the effect of direct-acting antivirals (DAAs) on platelet-to-lymphocyte ratio (PLR) and neutrophil-to-lymphocyte ratio (NLR) in patients with hepatitis C virus (HCV)-related thrombocytopenia. Background PLR and NLR are correlated with HCV infection, HCV-related liver cirrhosis, HCV-related atherosclerosis and cardiovascular diseases. Patients and methods In the current study, we studied 100 patients with HCV-related thrombocytopenia. All patients were subjected to anti-HCV antibody, HBsAg, liver profile, blood urea, serum creatinine, fasting and postprandial blood glucose, complete blood count, iron profile, direct anti-globulin test, rheumatoid factor, antinuclear antibody, and alpha fetoprotein. Abdominal ultrasound, FibroScan, echocardiography, and electrocardiography were done for all patients. Thrombocytopenia was defined as platelets count less than 150.000/mm. The used DAAs were sofosbuvir and daclatasvir, and duration of treatment was 12 weeks. All patients were followed up during antiviral therapy (for 12 weeks) and had extended follow-up for 24 weeks after the end of therapy with DDAs. Quantitative PCR for HCV RNA was done at the start of therapy and at 12 weeks (end of treatment response). PCR for HCV was repeated at 12 weeks after the end of treatment to assess the sustained viral response at 12 weeks after end of treatment (SVR-12) and at 24 weeks after the end of treatment to assess the sustained viral response at 24 weeks after end of treatment (SVR-24). PLR and NLR were calculated by dividing platelet and neutrophil counts, respectively, by lymphocyte count at the start of treatment, then at 4 weeks, at 12 weeks (end of treatment), at 24 weeks (SVR-12), and at 36 weeks (SVR-24). Results The mean age of patients was 49.55±7.79 years, with a range of 33–64 years. They showed female predominance, with females constituting 58.7%. Patients were all Child A status. Liver fibrosis stage was either stages I, II, or III (45, 30, and 25%, respectively). Mean platelet count was 82.25±23.64, 77.01±18.58, 90.84±18.86, 85.02±18.79, and 80.26±18.67 before starting treatment with DAAs, at 4 weeks, at 12 weeks (end or treatment), at 24 weeks (SVR-12), and at 36 weeks (SVR-24), respectively. PLR mean±SD was 74.07±12.76, 76.01±13.58, 65.84±13.86, 62.02±12.79, and 60.26±12.67 before starting treatment with DAAs, at 4 weeks, at 12 weeks (end or treatment), 24 weeks (SVR-12), and at 36 weeks (SVR-24), respectively. NLR mean±SD was 1.61±0.24, 1.64±0.23, 1.50±0.24, 1.45±0.23, and 1.33±0.24 before starting treatment with DAAs, at 4 weeks, 12 weeks (end or treatment), 24 weeks (SVR-12), and at 36 weeks (SVR-24), respectively. Both PLR and NLR initially increased at 4 weeks after the start of treatment and then both significantly decreased to reach lowest level at 36 weeks (SVR-24). Conclusion PLR and NLR are both decreased after HCV eradication by DDAs in HCV-infected patients with thrombocytopenia suggesting improvement of HCV-associated systemic inflammation.
Objective The aim was to study bone marrow (BM) cellularity, morphological characteristics, and types of cellular infiltrates in rheumatoid arthritis (RA) patients associated with peripheral cytopenias. Background RA is a systemic, autoimmune disease leading to joint destruction. BM is an important compartment in RA, where there are autoreactive lymphocytes, abnormal production of cytokines, and abnormal BM microenvironment, which may affect the integrity of the BM and accordingly may require specific modalities in treatment. Patients and methods In the current study, we examined 60 RA patients with cytopenias (defined according to WHO as hemoglobin level below 12 g/dl (woman), 13 g/dl (man), platelet count below 150×109/l, absolute neutrophil count below 1.8×109/l, and lymphocytes below 1.0×109/l. The diagnosis of RA was made according to the American College of Rheumatology (2010) criteria. All patients were subjected to thorough history taking, physical examination, imaging studies including abdominal ultrasound, and chest radiography and laboratory investigations including routine investigations, blood film, antinuclear antibody, antidouble stranded DNA antibody, rheumatoid factor, anticyclic citrullinated peptide (anti-CCP) antibody, and BM aspiration and biopsy. Flow cytometry immunophenotyping was performed to detect lymphocytic infiltration in the BM and its subtypes. Results The patients were predominantly women (91.7%); 40 (66.6%) patients had normocellular BM, 16 (26.6%) patients had hypercellular and four (6.6%) patients had hypocellular BM. Dysmyelopoiesis was present in five (8.3%) patients; dyserythropoietic and megaloblastoid changes were present in 26 (43.3%) patients whereas dysmegakaryopoiesis was present in six (10%) patients. BM eosinophils mean±SD was 2.95±1.51%. BM plasma cell mean±SD was 4.0±2.35. BM lymphocytes mean±SD was 15.65±6.75% and was predominantly T-lymphocytes (mean±SD: 61.63±8.69%). BM-activated (CD25+) T-lymphocytes mean±SD was 23.8±11.5. Higher BM lymphocytes, T-cells, and plasma cell percentages were statistically associated with increased frequencies of positive anti-CCP, neutropenia, thrombocytopenia, and arthritis and were positively correlated to inflammatory markers (erythrocyte sedimentation rate, C-reactive protein, and ferritin).The percentage of activated (CD25+) BM T-lymphocytes was higher in RA patients with either positive C-reactive protein, positive anti-CCP, elevated ferritin, or pancytopenia. There was no significant relation between lymphocytic infiltration (either B-lymphocyte or T-lymphocyte) and type of BM cellularity. Conclusion Lymphocytic infiltration, especially T-lymphocytes is closely related to the activity markers in RA and to the type and degree of cytopenia in RA patients.
Necrotizing fasciitis is a sever and potentially fatal soft tissue infection, but its presentation in head and neck region is rare. Few reported cases of cervical necrotizing fasciitis secondary to tonsil infection were found in literature, which were proven to be dangerous life threatening condition. In this short communication, we are presenting a 35-year-old, immune-competent Saudi female patient. She was presented to our hospital with ill looking picture of right peritonsillar abscess with mild degree of trismus. Patient was admitted, IV antibiotic was started and CT scan neck showed pus in the left tonsil parenchyma and in right peritonsillar region, with cellulitis in right parapharyngeal region with no clear collection noticed within the neck spaces. Patient was taken to OR where pus in the left tonsil surface was noted and cleaned, and incision and drainage of right peritonsillar fossae was done, pus came out and gas bubbles noted along with necrotic fleshy tissue in the lower pole of the right tonsil from which multiple biopsies were taken. Patient had postoperative bleeding after 24 hours. CT scan was repeated and patient was taken for OR for debridement of necrotic tissue from right tonsil, and right neck exploration and debridement. Necrotic tissues medial to the right submandibular gland was seen and removed. The cultured swab and aspirated pus showed coagulase-negative staphylococcus, antibiotic was changed based on sensitivity results and she responded very well. She was discharged home post operatively in stable condition and was followed up for 18 months with no history of recurrent tonsillitis.
Aim This study aimed to detect atherosclerotic changes in the carotid arteries of systemic lupus erythematous (SLE) patients as an indicator of cardiovascular risk factors and to correlate the findings with disease severity and activity parameters as well as to study specific ECG changes in these patients to elucidate possible associations between these variables. Patients and methods This study included 30 SLE patients who met the Systemic Lupus International Collaborating Clinics (SLICC) criteria (group I), 30 rheumatoid arthritis (RA) patients diagnosed according to the American College of Rheumatology/European league against rheumatism (EULAR) 2010 criteria (group II), and 30 apparently healthy volunteers age and sex matched to the SLE patients’ group (group III). All patients were subjected to full history taking, thorough clinical examination, assessment of disease activity using the Systemic Lupus Erythematous Disease Activity Index (2 K) score and assessment of damage by the SLICC/American College of Rheumatology Damage Index (SDI). Laboratory investigations included: complete blood count, erythrocyte sedimentation rate, lipid profile, immunological profile (antinuclear antibodies, anti-double-stranded DNA antibody, anticardiolipin antibody, and complements C3 and C4). The right common carotid artery was scanned by ultrasound and the average of carotid intima media thickness (CIMT) was calculated (mean of four readings) for all participants participating in the study. ECG was also done for all participants. Results The mean CIMT was higher in RA patients (0.71±0.194 mm) with a nonsignificant difference compared with SLE patients (0.68±0.197 mm) and a high statistically significant difference (P0.05). Abnormal ECG findings were observed in 3/30 SLE patients (10%), 10/30 RA patients (33.3%), and one/30 healthy control (3.3%), with statistically significant difference (P<0.03) among groups. The presence or absence of abnormal ECG findings showed statistically insignificant differences regarding patients’ disease activity and mean CIMT. Conclusion Although ECG changes were present in 10% of our SLE patients, association of specific ECG changes could not be confirmed. A greater prevalence of increased CIMT was observed in SLE patients, emphasizing the important role of this disease in the development of premature atherosclerosis which did not correlate with disease activity or severity parameters.
Childbearing is an important phenomenon among adolescents. Studies that have evaluated teenagers' reproductive patterns have found that many adolescents are ambivalent regarding sexual activity and childbearing. In order to assess the patterns of adolescents' reproductive health and pregnancy to conduct interventions, every country needs to collect specific data about childbearing intentions. This study was conducted to determine the factors that may affect the childbearing intentions of adolescents.
As a common debilitating illness, cancer is among the leading causes of child mortality in developed and developing countries. Cancer diagnosis for children is considerably stressful for their parents. Resilience is a key factor behind effective coping with cancer-related problems. This study evaluated resilience and its predictors among the parents of children with cancer.