The Relationships between CD14 and CC16 Genotypes,
Plasma Levels, and Severity in Acute Asthma Patients
Ayman H. Abd El-Zaher1, Heba Mourad 2, Amal EL-Bandary 2,
Hala M. Nagy 2 & Waleed Samy 3
Departments of Chest1, Clinical Pathology 2 and Internal Medicine 3
Faculty of Medicine, Tanta University
ABSTRACT
Background: Acute asthma is characterized by acute episodes of obstruction
relateded to airway inflammation mostly in response to respiratory tract infection.
CD14 and Clara cell protein (CC16) play a key role in inflammatory pathways.
Objective: The aim of this study is to determine the influence of CD14 and CC16
gene polymorphism and plasma levels of their products on the predisposition to
develop asthma and its severity.
Methods: This study was conducted on 40 patients during acute attack of asthma
(group I) and in convalescence (after 6 weeks of treatment of the same patients, group
II). Asthma severity scoring system was preformed to all patients according to
(Martin et al; 2006). Arterial blood gases, plasma levels of sCD14, CC16 and serum
total IgE were measured by ELISA. CD14 and CC16 gene polymorphism were
detected by restriction fragment polymorphism (RFLP).
Results: During acute asthma, plasma level of sCD14 and CC16 were significantly
higher than during convalescence: sCD14, 3.23±0.48 versus 2.64±0.24 µg/ml, (p=
0.001); CC16, 2.52±0.33/m versus 1.76±0.22 µg/ml, (p= 0.002). Higher plasma levels
of sCD14 were present during the acute attack in those with 159TT and 159TC (p=
0.002 & p= 0.001, respectively), whereas in 159CC homozygous, sCD14 levels were
insignificantly increase during the acute attacks (p= 0.119). Also higher plasma levels
of CC16 were present during the acute attack in those with 38GG and 38AG (p=
0.001 & p=0.002, respectively), whereas in 38AA homozygous, CC16 levels were
actually lower during the acute attacks than during convalescence, although this
difference was not statistically significant (p= 0.093). A significant negative
correlation was found between sCD14 and asthma score (r= 00.58, p= 0.001), while a
insignificant positive correlation was found between CC16 and asthma score (r=
0.0243, p= 0.13). There was a significant positive correlation between IgE and plasma
level of sCD14, CC16 and asthma score.
Conclusion: These results suggest that in acute asthma production of both sCD14 and
CC16 is increased in an attempt to control airway inflammation, and for subjects
whose genotype limits or prevents these increases, the ability to control airway
inflammation is impaired resulting in more severe asthma. Therefore, this study
supports the concept that sequence variations in the CD14, CC16 gene are likely to
play a role in the development of asthma.
Tanta Medical Journal Vol. (38), October 2010
Original Article
Assessment of Episodes of Sleep Apnea
in Patients with Liver Cirrhosis
Raafat A. Salah & Ayman H. Abd El Zaher *
Tropical & Chest * Departments, Faculty of Medicine -Tanta University
ABSTRACT
Background : Patients with obstructive sleep apnea (OSA) are at risk for the
development of fatty liver as a result being overweight. Several data suggest that
OSA per se could be a risk factor of liver injury. Ischemic hepatitis during OSA has
been reported. Obstructive sleep apnea has been reported to be a new complication of
liver cirrhosis with ascites. Therefore we investigated the episodes of sleep apnea as a
complication of advanced liver cirrhosis.
Methods : Sixty patients with liver cirrhosis due to chronic hepatitis C were divided
according to the child-pugh score into 3 groups: Group A (20 patients grade A
cirrhosis), Group B (20 patients grade B cirrhosis), and Group C (20 patients grade C
cirrhosis). Portable sleep polygraph (ResMed corp., CA, USA) were attached to the
subjects, and oronasal respiration, tracheal sounds, respiratory movements of the
chest, and percutaneous arterial oxygen saturation continuously were recorded. A
decrease in the mean airflow to 50% or less was defined as hypopnea, and the number
per hour of episodes of apnea and hypopnea per hour lasting 10 seconds or longer
(AHI) was counted.
Results : AHI was significantly higher in group C than in groups A and B (p<0.05).
In group C, 6 patients with 20 times or more AHI per hour, obstructive sleep apnea,
in which respiratory chest movements occur but oronasal respiration decreases or
disappears, was observed.
Conclusions : As the stage of liver cirrhosis advanced, sleep apnea appeared.
Tanta Medical Journal Vol. (39), April 2011
Original Article
Role of Granulocyte-colony Stimulating Factor in Patients
With Idiopathic Pulmonary Fibrosis
Wafaa S. El-Shimy ; Amgad A. Farhat ; Ayman H. Abd-El-Zaher
Hala M. Nagy* ; Ghada A. Attia & Ahmed M. Gamal Eldeen
Chest & Clinical Pathology * Departments, Faculty of Medicine - Tanta University
ABSTRACT
Background & Objective : Idiopathic pulmonary fibrosis (IPF) is progressive lung
disease with an associated mean survival 3-5 years. Granulocyte-colony stimulating
factor (G-CSF) is known as a potent neutrophil chemotactic glycoprotein but its
contribution to chemotactic activity in neutrophil mediated lung diseases is not yet
known. The aim of this study was to determine level of G-CSF in bronchoalveolar
lavage (BAL) fluid of patients with idiopathic pulmonary fibrosis and to correlate its
level with neutrophil count in BAL fluid and the severity of the disease.
Methods : The study was conducted on 40 subjects who classified into two groups;
10 healthy non-smokers subjects (control group) & 30 non-smokers IPF (patients
group). BAL analysis was done for measurement of neutrophil count and G-CSF level
using ELISA technique.
Results : G-CSF in BAL of IPF patients was significantly higher compared to control
group and it showed significant positive correlation with both neutrophil count in
BAL & the severity of the disease. Neutrophil count in BAL of patients was
significantly higher compared to control group.
Conclusions : G-CSF has a high level in BAL of IPF patients & it correlates
positively with severity of the disease.
Key words : G-CSF, BAL, IPF, neutrophil.
Medical Thoracoscopy Using Fibrooptic Broncoscopy
Ayman Abd El-Zaher1, Mohamed Hantera1, , Alaa Metwaly2Dina Radi3
Chest department-Tanta University1, Chest department-Zakazeek University2 & Pathology
Department3 Tanta University3
ABSTRACT
Background, Aim: Undiagnosed exudative pleural effusion remains a matter of
interest in both clinical and research fields in chest practice. the evolution in methods
of diagnosis started by Abrams closed biopsy then sonar guided closed biopsy then
rigid thoracoscopy and lastly semi-rigid thoracoscopy and VATS, but what about
centers without these facilities.
The aim of this study is to assess the ability of fiberoptic broncoscopy through chest
tube to replace rigid broncoscopy in diagnosis of undiagnosed exudative effusion.
Patient and Methods: 20 patients with undiagnosed exudative pleural effusion was
examined by fiberoptic broncoscopy through chest tube under local anesthesia and
biopsies were taken by forceps through working channels of broncoscopy.
Results: Definite diagnosis established in 16 patients and 4 patients undiagnosed due
to insufficient material, with no complications.
Conclusions: Medical thoracoscopy using fiberoptic broncoscopy is safe maneuver
and can replace rigid thoracoscopy in centers which cannot have.
Key Words: Thoracoscopy, Chest tube.
ORIGINAL ARTICLE
The role of CYFRA 21-1, nucleosome and neuron specific
enolase as early measures of chemotherapy response in nonsmall cell lung cancer
Mohamed A. Alm El-Din1, Gihan Farouk2, Hala Nagy2, Ayman Abd Elzaher3, Gehan H.
Abo El-Magd3
Departments of Clinical Oncology, Tanta University Hospitals, Tanta Faculty of Medicine, Tanta - Egypt
Departments of Clinical Patology, Tanta University Hospitals, Tanta Faculty of Medicine, Tanta - Egypt
3Departments of Chest Diseases, Tanta University Hospitals, Tanta Faculty of Medicine, Tanta - Egypt
1
2
ABSTRACT
Aim: To investigate the reduction in the levels of cytokeratin-19 fragments (CYFRA
21-1), nucleosomes and neuron-specific enolase (NSE) as early markers of the
response to chemotherapy in lung cancer.
Methods: Forty-two consecutive patients with locally advanced non-small cell lung
cancer were included. All patients received platinum-based chemotherapy. Staging
investigations and quantification of CYFRA 21-1, nucleosomes and NSE (using
enzyme-linked immunosorbent assay, ELISA) were performed before the start of
treatment and after the second cycle of chemotherapy. According to the response to
chemotherapy, patients were classified into 3 groups: (I) disease regression, (II) stable
disease, and (III) progressive disease. The reduction in the levels of tumor markers
was correlated with the response to chemotherapy.
Results: After the second cycle of chemotherapy, groups I and II had significantly
decreased levels of CYFRA 21-1 (p<0.05). Similarly, the concentration of
nucleosomes was significantly lower than the baseline levels in groups I (p=0.0008)
and II (p=0.003). The reduction of both CYFRA 21-1 and nucleosome levels was not
significant for patients in group III. In all groups the reduction of NSE levels in
response to chemotherapy was not significant. As a marker of response to
chemotherapy, CYFRA 21-1 showed the highest sensitivity (88.9%) and specificity
(77.4%) compared with nucleosomes (77.8% and 58.1% respectively) and NSE
(66.7% and 51.8% respectively).
Conclusion: The reduction in the serum levels of CYFRA 21-1 and nucleosomes may
be used for early identification of patients with good response to chemotherapy.
Key words: Lung cancer, Tumor markers, Response, Chemotherapy
Effect of a disintegrin and metalloprotease 33 (ADAM33)
gene polymorphisms and smoking in COPD
Ayman H. Abd El-Zaher a,*, Hala Nagy b, Gihan Farouk b, Ahmed Sh.
Mohamed a, Naglaa F. Ghoname c
a Department
of Chest, Faculty of Medicine, Tanta University, Egypt
of Clinical Pathology, Faculty of Medicine, Tanta University, Egypt
c Department of Microbiology & Immunology, Faculty of Medicine, Tanta University, Egypt
b Department
KEYWORDS: COPD; Disintegrin; Metalloprotease; Gene polymorphisms
ABSTRACT
Background: COPD is characterized by air flow limitation that is not fully reversed
and associated with an influx of neutrophils, macrophages and CD8 T lymphocytes in
the airways. The disease is characterized by airflow limitation and is associated with
an abnormal inflammatory response of the lungs in response to noxious particles or
gases and associated with systemic manifestation.
Methods: Sixty consecutive patients with COPD and 40 normal healthy individuals
were included. All cases and controls were subjected to detection of 2 polymorphic
loci (S1 AND Q1) of ADAM33 by PCR-RFLP technique.
Results: The percentage of S1 and Q1 AA genotype and A allele were significantly
increased in control than in COPD patients while there was significant increase in S1
and Q1 GG genotype and G allele in COPD patients than in control (p<0.001). No
significant difference was found between smoker and non-smoker among the two
studied groups in genotype and alleles distribution of ADAM33 SNPs S1 and Q1 p>
0.05, whereas there was significant increase in ADAM33 S1 G allele and Q1 G allele
in smoker and non-smoker in COPD patients as compared to their corresponding
fellows in control group (p<0.05). As regard to Pulmonary function test there was
significant decrease in % of FEV1 in COPD patients as compared to control group for
both smokers and non-smokers (p< 0.001). Within both control and COPD groups
smokers had significant decrease in FEV1 % as compared to non-smokers (p<0.001).
There was a significant decrease in FEV1 % among all genotypes in smoker as
compared to non-smoker COPD patients (p<0.001), the most prominent decrease was
found in smoker GG genotype for both ADAM33 S1 and Q1 in COPD patients.
Conclusion: In conclusion, we found that polymorphisms in the SNPs (Q1 and S1) of
ADAM33 gene are associated with COPD in the general population. In addition,
smoker patients with GG genotype in (S1 and Q1) ADAM33 will have more
pronounced decline in the pulmonary function test (FEV1).
ORIGINAL ARTICLE
Effect of obstructive sleep apnea syndrome on left
ventricular function
Mohamad G. El-Kholly a, Medhat M. Ashmawy b, Ayman H. Abd ELZaher a,*, Mahmoud EL-Shahat a,*
a Chest
Department, Faculty of Medicine, Tanta University, Egypt
Department, Faculty of Medicine, Tanta University, Egypt
Received 20 September 2012; accepted 28 September 2012
b Cardiology
KEYWORDS: OSA; AHI; ODI; LVF
ABSTRACT
Background: The link between OSAS, left ventricular dysfunction, and congestive
heart failure is less known, although OSAS is frequent in both systolic and diastolic
heart failure patients.
Aim: To study left ventricular function in patients with obstructive sleep apnea
syndrome and to assess the correlation between the severity of OSA and the degree of
ventricular dysfunction.
Subjects and methods: This study was conducted on 45 subjects (22 males and 23
females) in Chest Department, Tanta University Hospitals, they were classified into
two groups: Group A included 15 apparently healthy subjects, by sleep study they
were normal as apnea hypopnea index (AHI) < 5/h and oxygen desaturation index
(ODI) < 5/h. Group B included 30 patients with obstructive sleep apnea diagnosed by
sleep study (AHI > 5/h and ODI > 5/h).
Results: Eight (26.66%) out of the 30 OSAS patients (group B) were hypertensive and
have left ventricular dysfunction. The mean value of AHI was (2.53±1.06) and
(24.6±14.35) in groups A and B, respectively. The mean value of AHI was
significantly higher in group B than group A (p=0.001). Significant correlation was
found between AHI, diastolic and systolic dysfunctions, respectively (r= 0.324; p=
0.019 and r=0.288; p=0.049).
Conclusion: Obstructive sleep apnea syndrome may predispose in left ventricular
diastolic dysfunction, AHI is correlated with the degree of left ventricular diastolic
dysfunction.
ORIGINAL ARTICLE
SOLUBLE TRIGGERING RECEPTOR EXPRESSED ON
MYELOID CELLS -1 AS DIFFERENTIAL BIOMARKER
OF PLEURAL EFFUSION
Ayman H. Abd El-Zaher*, Ali M. Abd-Ella*, Hala Nagy** & Raba Y. Talab*
Chest* and Clinical Pathology** Departments Faculty of Medicine, Tanta University,
Egypt
ABSTRACT
Background: The currently available diagnostic markers for pleural effusion
have a limited role. The soluble triggering receptor expressed on myeloid
cells-1 (sTREM-1) is a molecule recently reported to play an important role in
the myeloid cell mediated inflammatory response, and is up regulated in the
body fluid by bacterial or fungal products.
Objective: This study aimed to investigate the value and significances of
sTREM -1 in the diagnosis of pleural effusion caused by different diseases
entities.
Patients and methods: Samples of pleural fluid from 50 patients, (10 with
empyema, 10 with parapneumonic effusions, 10 with tuberculous effusion, 10
with malignant effusion and 10 with transudative effusion). Patients were
assessed for the level of sTREM-1 by ELISA in pleural fluid. Total and
differential cell count, LDH, glucose and protein were carried out to all
studied patients.
Results: Level of sTREM-1 was highest in empyema, followed by infectious
exudates and the level of sTREM-1 were low in transudate and non-infectious
exudates and there was positive correlation between sTREM-1 and (protein,
total white blood cells and neutrophil % in pleural fluid) and serum LDH
and negative correlation between sTREM-1 and lymphocyte % in pleural
fluid.
Conclusion: Level of sTREM-1 was highest in empyema, followed by
infectious exudates and the level of sTREM-1 were low in transudate and
non-infectious exudates and there was positive correlation between sTREM-1
and (protein, total white blood cells and neutrophil % in pleural fluid) and
serum LDH and negative correlation between sTREM-1 and lymphocyte %
in pleural fluid.
Keywords: sTREM-1, PPE, tuberculous pleuritis, PE.
ORIGINAL ARTICLE
Diagnostic utility of sonar guided biopsy in tuberculous
effusion
Ayman H. Abd El-Zaher a,*, Ibrahim Salah a,1, Mohamed Hantera a,2,
Radwa Oreby b,3, Ebrahim Abaas c,4
a Faculty
of Medicine, Tanta University, Chest Department, Tanta, Egypt
of Medicine, Tanta University, Pathology Department, Tanta, Egypt
c Faculty of Medicine, Tanta University, Radiology Department, Tanta, Egypt
b Faculty
KEYWORDS: Tuberculous effusion; Tru-Cut needle; Abram’s needle
ABSTRACT
Background/aim: Tuberculous pleural effusion remains the commonest cause of
exudative effusions in areas with a high prevalence of tuberculosis and histological
examination of pleural tissue is the gold standard for its diagnosis. This study was to
assess the diagnostic utility of sonar guided biopsy in tuberculous pleural effusion.
Patients and methods: 50 patients (34 men) of mean ± SD age 38.7 ±16.7 years with
pleural effusions and a clinical suspicion of tuberculosis were enrolled in the study.
Transthoracic ultrasound was performed on all patients, who were then randomly
assigned to undergo P4 Abrams needle biopsies followed by P4 Tru-Cut needle
biopsies or vice versa.
Results: Pleural tuberculosis was diagnosed in 31 patients, alternative diagnoses were
established in 16 patients and 3 remained undiagnosed. Pleural biopsy specimens
obtained with Abrams needles contained pleural tissue in 29 patients (92.0%) and
were diagnostic for tuberculosis in 26 patients (sensitivity 82%), whereas Tru-Cut
needle biopsy specimens only contained pleural tissue in 21 patients (78%) and were
diagnostic in 21 patients (sensitivity 64%).
Conclusions: Ultrasound-assisted pleural biopsies performed with an Abrams needle
are more likely to contain pleural tissue and have a significantly higher diagnostic
sensitivity for pleural tuberculosis.