Validity of immunoglobulin-binding protein 1 as a biomarker for lupus nephritis

BACKGROUND

Lupus nephritis (LN) is a major issue that adds a burden on patients with systemic lupus erythematosus (SLE). Immunoglobulin-binding protein 1 (IGBP1) is identified as a phosphoprotein that has been recently reported to be linked to the B-cell receptor complex and regulates differentiation, proliferation, apoptosis, and tolerance of B cells. Its diagnostic and/or prognostic role in LN has been highlighted only recently.

OBJECTIVES

This study aims to evaluate the relation between serum IGBP1 and SLE disease activity and/or renal activity and to investigate the validity of IGBP1 as a biomarker for LN.

METHODS

96 participants were enrolled and divided into three groups: nephritis, nonnephritis, and control groups. The patients with SLE were diagnosed according to the Systemic Lupus International Collaborating Clinics classification (SLICC) criteria. The serum IGBP1 level was assayed using an enzyme-linked immunosorbent assay (ELISA). Assessments were conducted using the Systemic Lupus Erythematosus Disease Activity Index 2000 (SLEDAI-2k) and renal biopsy for LN patients.

RESULTS

The nephritis and nonnephritis groups had higher IGBP1 levels than the controls; the nephritis group had the highest serum IGBP1 levels (p < .001). Significant correlations were found between IGBP1 levels and proteinuria (r = 0.568, p = .001) and renal SLEDAI (r = 0.475, p = .006) in the nephritis group; on the other hand, the correlation of serum IGBP1 levels with SLEDAI-2K was non-significant for both groups (nephritis and nonnephritis groups). The IGBP1 levels were significantly different among histopathologic classes (p < .001), with class V showing the highest level. Moreover, it showed a significant positive correlation with the pathologic activity index. Compared with renal SLEDAI for identifying active renal affection in patients with SLE, the serum IGBP1 level with a cut-off value of 547.45 ng/mL is a valid biomarker for detecting active nephritis with 93.8% sensitivity and 96.9% specificity.

CONCLUSION

The serum IGBP1 levels were high in patients with LN and were positively correlated with the pathologic activity index. The serum IGBP1 level of 547.45 ng/mL is a valid biomarker for detecting active nephritis. Thus, we recommend that clinicians monitor the serum IGBP1 level of patients with SLE to detect LN.

HLA-DRB1, IRF5, and CD28 gene polymorphisms in Egyptian patients with rheumatoid arthritis: susceptibility and disease activity

This study was established to assess the effects of IRF5 rs10488631 and CD28 rs1980422 single-nucleotide polymorphisms (SNPs) and HLA-DRB1 shared epitope (SE) allele on the prognosis and disease activity of rheumatoid arthritis (RA) patients. A total of 150 RA patients and 150 healthy controls were genotyped for the selected SNPs by real-time PCR. HLA-DRB1 SE was determined using LAB Type SSO Class II DRB1 typing. Our results suggest that HLA-DRB1, CD28, and IRF5 significantly discriminated (p < 0.001) RA patients and healthy controls (OR of single HLA-DRB1 SE allele = 2.431, CI = 1.467-4.027, OR of two SE alleles = 11.152, CI = 2.479-50.159), (OR of CD28 risk allele C = 2.794, 95% CI = 1.973-3.956) and (OR of IRF5 risk allele C = 4.925, CI = 3.26-7.439). Rheumatoid factor (RF) seropositivity was associated with HLA-DRB1 SE (p < 0.001) and IRF5 risk allele (p < 0.001). ACPA was significantly associated only with IRF5 risk allele (p < 0.001). A better response to methotrexate therapy was found in HLA-DRB1 SE non-carriers, and CD28 TT patients. This study demonstrated associations of HLA-DRB1 SE, CD28, and IRF5 with the risk of RA. HLA-DRB1 SE and CD28 rs1980422 can be used as predictors of methotrexate therapy response.

Polyneuropathy associated with chronic hemodialysis: Clinical and electrophysiological study

AIM

To estimate the frequency and pattern of peripheral polyneuropathy (PNP) that may affect patients maintained on hemodialysis.

PATIENTS AND METHODS

The study was carried out on 60 middle-aged male patients attending the Internal Medicine Department for maintenance hemodialysis. All were subjected to a complete neurological examination. Motor and sensory nerve conduction studies of both lower limbs (the tibial, peroneal and sural nerves) and both upper limbs (median and ulnar nerves), as well as F-wave measurements of both tibial and median nerves, were done. The patients were subdivided clinically into two groups, clinically apparent neuropathy and inapparent groups. Then they were divided according to the types of peripheral neuropathy detected by electrophysiological studies into axonal, demyelinated and mixed polyneuropathy. In addition, they were divided into motor, sensory and sensorimotor groups.

RESULTS

Polyneuropathy was found clinically presented in 33 (55%) cases, while evident by electrophysiological examination in 100% of the clinically apparent group (33 patients) and evident in 92.5% of the clinically inapparent group (27 patients). The frequency of pathologic electrophysiological parameters was significantly higher in patients with longer duration of hemodialysis. Axonal polyneuropathy is the most prevalent type in those patients.

CONCLUSION

Peripheral polyneuropathy is a common presentation in patients maintained on hemodialysis. The longer the duration of hemodialysis, the more liability to develop PNP that can be detected earlier by electrodiagnostic studies in the subclinical cases.

Multiple versus single ultrasound guided suprascapular nerve block in treatment of frozen shoulder in diabetic patients

BACKGROUND

Suprascapular nerve block (SSNB) is used in the management of frozen shoulder. There are no evidences from the literature that can determine how many blocks and the interval between them.

OBJECTIVE

To compare between single and multiple (nine) SSNB in the treatment of diabetic frozen shoulder.

METHODS

Ninety six patients with Type 2 diabetic and a frozen shoulder divided into 2 equal groups. Patients in group1 were subjected to single SSNB. Patients in group 2 were subjected to multiple (nine) SSNB. Participants were assessed clinically and by ultrasound at baseline and after 3 weeks and 4 months.

RESULTS

After 3 weeks, there was a significant improvement of all clinical & ultrasound parameters in both groups. But the improvement in group 2 was significantly better than the improvement in group 1. Also after 4 months, all parameters in both groups showed a further improvement in comparison with the base line parameters but still there was a highly significant improvement in group 2 versus group1.

CONCLUSION

A course of multiple (nine) injections for suprascapular nerve block gave a better outcome than a single injection for suprascapular nerve block.

Two- versus Three-Point Internal Fixation of Displaced Zygomaticomaxillary Complex Fractures

Despite the high frequency of the zygomaticomaxillary complex (ZMC) fractures, there is no consensus among facial reconstructive surgeons regarding the best surgical management; thus, surgical choice for ZMC fractures is still challenging. This study included 40 patients with displaced ZMC fracture. Twenty patients were treated with open reduction and internal fixation (OR/IF) using two-point fixation technique (at infraorbital margin and zygomaticofrontal buttress region) and the remaining 20 patients were treated with OR/IF using three-point fixation technique (at frontozygomatic suture, infraorbital margin, and zygomatico maxillary buttress). The results of both types of ZMC fractures repair were then statistically compared. No statistical differences between the two types regarding malar eminence asymmetry; projection (forward displacement) and width (medial displacement) in axial CT; inferior displacement; superior displacement and width (medial displacement) in coronal CT; angle of displacement (outward displacement) in 3D CT; masseter and temporalis muscles power electromyography; actual duration of surgery; and patient satisfaction. On the other hand, the total cost of the used plates and screws was significantly higher with three-point repair than two-point repair ( p  = 0.003). Moreover, postoperative CT lateral zygoma displacement was statistically significantly better in three-point fixation. Two-point fixation modality for displaced ZMC fractures is as effective as three-point method in fixation and prevents postreduction rotation or clinical displacement with significantly lower cost.

Reliability of a Proposed Ultrasonographic Grading Scale for Severity of Primary Knee Osteoarthritis

OBJECTIVES

The objective of this study was to examine the concordance of a grading scale (0–4) of medial femoral osteophytes in knee joint detected by ultrasound (US) compared with the corresponding grades (0–4) of Kellgren–Lawrence (K&L) scale of conventional radiography and clinical joint examination.

PATIENTS AND METHODS

A cross-sectional observational study included 160 patients with knee pain who fulfilled the American College of Rheumatology (ACR) criteria for knee osteoarthritis (KOA) and 20 patients with knee pain who have not fulfilled the ACR criteria for KOA. All patients were subjected to clinical assessment (Western Ontario and McMaster Universities Index of Osteoarthritis and global visual analog scale) and radiological assessment in the form of X-ray grading according to K&L grading scale and ultrasonographic assessment of medial femoral osteophytes according to a scale that was proposed by the first author and consisted of five grades (0–4), where grade 0 denoted no osteoarthritis and grade 4 denoted the most advanced grade of KOA. Grade 2 was divided into two subgrades A and B with grade 2B considered as a more advanced stage than grade 2A.

RESULTS

The proposed US grading scale had high sensitivity and specificity in detecting the different grades of KOA compared with K&L grading scale (a total sensitivity of 94.6% and a total specificity of 93.3%). Intra- and interreader reliability of US was excellent (kappa >0.93 and >0.85, respectively).

CONCLUSIONS

US can reliably detect the severity of KOA. Good agreement was found between the proposed US grading scale and K&L grading scale. The proposed US grading scale is simple and reliable.

Electromyography assessment in zygomaticomaxillary complex fractures

OBJECTIVE

The aim of this study was to assess the activity of the masseter and temporalis muscles using surface electromyography (EMG) in patients with zygomaticomaxillary complex (ZMC) fractures.

PATIENTS AND METHODS

This prospective study was carried out on 25 patients who had ZMC fractures. Fifteen patients were managed by open reduction and rigid fixation (ORIF) using titanium miniplates. This study, using surface electromyography, analyzed the activity of the masseter and temporalis muscles of 25 patients with ZMC fractures; 15 of them were surgically treated under general anesthesia (GA). Evaluations were made before surgery and 6 weeks after surgery by recording the mean of muscle contraction of 20 motor unit action potential (MUAP) against resistance, and statistical analyses were performed.

RESULTS

A significant EMG difference between the normal and ZMC fracture sides was found (P < 0.0001) for both masseter and temporalis muscles and was significantly improved after ORIF. However, postoperative EMV values of the repaired side was significantly less than measured postoperatively in the normal side (P < 0.0001) for both muscles.

CONCLUSION

ZMC fractures significantly diminish muscular activity of the masseter and temporalis and even though significant recovery of muscle activity was revealed after 6 weeks, it is still less than normal activity, highlighting the importance of postoperative rehabilitation.