CD144+ endothelial microparticles as a marker of endothelial injury in neonatal ABO blood group incompatibility

Background

ABO antigens are expressed on the surfaces of red blood cells and the vascular endothelium. We studied circulating endothelial microparticles (EMP) in ABO haemolytic disease of the newborn (ABO HDN) as a marker of endothelial activation to test a hypothesis of possible endothelial injury in neonates with ABO HDN, and its relation with the occurrence and severity of haemolysis.

Material and methods

Forty-five neonates with ABO HDN were compared with 20 neonates with Rhesus incompatibility (Rh HDN; haemolytic controls) and 20 healthy neonates with matched mother and infant blood groups (healthy controls). Laboratory investigations were done for markers of haemolysis and von Willebrand factor antigen (vWF Ag). EMP (CD144⁺) levels were measured before and after therapy (exchange transfusion and/or phototherapy).

Results

vWF Ag and pre-therapy EMP levels were higher in infants with ABO HDN or Rh HDN than in healthy controls, and were significantly higher in babies with ABO HDN than in those with Rh HDN (p<0.05). In ABO HDN, pre-therapy EMP levels were higher in patients with severe hyperbilirubinaemia than in those with mild and moderate disease or those with Rh HDN (p<0.001). Post-therapy EMP levels were lower than pre-therapy levels in both the ABO HDN and Rh HDN groups; however, the decline in EMP levels was particularly evident after exchange transfusion in ABO neonates with severe hyperbilirubinaemia (p<0.001). Multiple regression analysis revealed that the concentrations of haemoglobin, lactate dehydrogenase and indirect bilirubin were independently correlated with pre-therapy EMP levels in ABO HDN.

Discussion

Elevated EMP levels in ABO HDN may reflect an IgG-mediated endothelial injury parallel to the IgG-mediated erythrocyte destruction and could serve as a surrogate marker of vascular dysfunction and disease severity in neonates with this condition.     

Coalition resection and medial displacement calcaneal osteotomy for treatment of symptomatic talocalcaneal coalition: functional and clinical outcome

Purpose

The purpose of this study was to evaluate the functional and clinical outcome of combined TCC resection and medial displacement calcaneal osteotomy for treatment of symptomatic talocalcaneal coalition.

Method

This is a prospective case series study on 27 patients (30 feet) who had symptomatic rigid pes planovalgus due to talocalcaneal coalition. All patients were treated by coalition resection and medial displacement calcaneal osteotomy. Pre-operative clinical and radiological assessment was done. Pain was assessed by visual analogue scale (VAS) and the functional assessment was done by the American Foot and Ankle Society score (AOFAS) for the hind foot. Pre-operative and postoperative plantar pressure assessment was done for all patients barefoot using the mat scan (Tekscan, Inc., vs. 6.34, Boston, USA).

Results

The mean follow-up period was 27.44 months (±2.47, range 23–33). Heel valgus improved from 15.03 (±6.9) degrees pre-operative to 3.09 (±2.3) degrees postoperatively. There was a statistically significant improvement in the VAS from 8.48 (±0.70) pre-operative to 3.70 (±1.13) postoperative. The mean AOFAS score showed statistically significant improvement from 39.88 (±6.09) pre-operative to 84.37 (±7.06) postoperative. There was a statistically significant decrease in mid foot pressure during standing from 48.05 kPa pre-operative to 35.30 kPa postoperative, and during walking from 148.08 kPa pre-operative to 90.22 kPa postoperative.

Conclusion

A combination of medial displacement calcaneal osteotomy with TCC resection showed statistically significant improvement in VAS and AOFAS scores, as well as decreasing the plantar pressure on the mid foot during standing and walking.     

Clinical characteristics and in-hospital mortality of COVID-19 adult patients in Saudi Arabia

Objectives:To provide a detailed study of demographic, baseline comorbidities, clinical features, and outcome for Coronavirus disease 2019 (COVID-19) patients.Methods:A record-based case-series study conducted from March 23 to June 15, 2020 in King Saud Medical City, Riyadh, Saudi Arabia. Demographic data, clinical presentation, laboratory investigations, complications, and in-hospital outcome of COVID-19 patients collected with analysis of the clinical characteristics for survivors and deceased.Results:A total of 768 patients were included. The mean age was 46.36±13.7 years and 76.7% were men. Approximately 96.3% reported more than one comorbidity; diabetes mellitus was the most frequent (46.4%). Fever (84.5%), cough (82.3%), and shortness of breath (79.8%) were the main presenting symptoms. During the follow-up, pneumonia reported in 68.6%, acute respiratory distress syndrome in 32.7%, septic shock in 20.7%, respiratory failure in 20.3%, and acute kidney injury in 19.3%. Approximately 45.8% of enrolled patients required intensive care unit admission. Lung disease (odd ratio [OR]=3.862 with 95% confident interval [CI] (2.455-6.074), obesity (OR=3.732, CI=2.511-5.546), smoking (OR=2.991, CI=2.072-4.317), chronic kidney disease (OR=2.296. CI=1.497-3.521), and diabetes mellitus (OR=2.291, CI=1.714-3.063) are predictors of ICU admission. Fatality ratio was 89/2084 (4.27%). Men were more prevalent in dead group.Conclusion:Coronavirus disease 2019 places a huge burden on healthcare facilities, particularly in patients with comorbidity. Coronavirus disease 2019 patients who are obese and smokers with history of diabetes mellitus have a high risk of death.     

COVID-19 and liver dysfunction: A systematic review and meta-analysis of retrospective studies

Recently, Coronavirus Disease 2019 (COVID-19) pandemic is the most significant global health crisis. In this study, we conducted a meta-analysis to find the association between liver injuries and the severity of COVID-19 disease. Online databases, including PubMed, Web of Science, Scopus, and Science direct, were searched to detect relevant publications up to 16 April 2020. Depending on the heterogeneity between studies, a fixed- or random-effects model was applied to pool data. Publication bias Egger's test was also performed. Meta-analysis of 20 retrospective studies (3428 patients), identified that patients with a severe manifestation of COVID-19 exhibited significantly higher levels of alanine aminotransferase, aspartate aminotransferase, and bilirubin values with prolonged prothrombin time. Furthermore, lower albumin level was associated with a severe presentation of COVID-19. Liver dysfunction was associated with a severe outcome of COVID-19 disease. Close monitoring of the occurrence of liver dysfunction is beneficial in early warning of unfavorable outcomes.     

Impact of cytotoxic T‐lymphocyte‐associated protein 4 codon 17 variant and expression on vitiligo risk

BackgroundCytotoxic T‐lymphocyte‐associated protein 4 (CTLA‐4) is one of the essential brakes expressed on T cells that prevent T‐cell hyperactivation‐associated autoimmune disorders. Several CTLA4 polymorphisms were implicated in the regulation of gene expression. We aimed to explore the association of CTLA4 expression and rs231775 (c.49A>G) variant with vitiligo risk and severity of the disease in a sample of the Middle Eastern population.MethodsThe CTLA4 gene expression and genotyping for rs231775 (A/G) variant were assessed in 161 vitiligo patients and 165 controls using a real‐time polymerase chain reaction. Vitiligo Area Severity Index (VASI) and Vitiligo Disease Activity score (VIDA) were evaluated.ResultsA higher frequency of rs231775 G allele was observed in vitiligo cases than controls (45% vs. 33%, p = 0.002). After adjustment of age, sex, family history of vitiligo, and CTLA expression level, using multivariate analysis, G/G carriers were associated with a higher risk of vitiligo under recessive (OR = 2.94, 95% CI = 1.61–5.35, p < 0.001), dominant (OR = 1.87, 95% CI = 1.14–3.06, p = 0.013), and homozygote comparison (OR = 3.34, 95% CI = 1.73–6.42, p = 0.001) models. Although the CTLA4 relative expression levels were comparable to that of controls, G/G carriers exhibited a significantly lower expression profile (median = 0.63, IQR = 0.34–1.75) than A/A (median = 1.43, IQR = 0.39–4.25, p = 0.018) and A/G carriers (median = 1.68, IQR = 0.49–3.92, p = 0.007). No significant associations of CTLA4 variant/expression with disease severity and/or activity were observed.ConclusionThe CTLA4 rs231775 variant was associated with vitiligo susceptibility and gene expression; the risky genotype (GG) was associated with lower CTLA4 relative expression levels than the other genotypes. Further large‐scale studies in different populations are warranted.     

Fabrication of UiO-66/MIL-101(Fe) binary MOF/carboxylated-GO composite for adsorptive removal of methylene blue dye from aqueous solutions

This study provides a novel composite as an efficient adsorbent of cationic methylene blue dye. UiO-66/MIL-101(Fe) binary metal organic framework (MOF) was fabricated using a solvothermal technique. Additionally, the developed binary MOF was modified with carboxylated graphene oxide (GOCOOH) using a post-synthetic technique. The as-fabricated UiO-66/MIL-101(Fe)-GOCOOH composite was analyzed by FTIR, XRD, SEM, BET, TGA, XPS and zeta potential analysis. The adsorption performance of UiO-66/MIL-101(Fe)-GOCOOH composite was examined for its aptitude to adsorb cationic MB dye using a batch technique. The obtained data revealed that, the developed UiO-66/MIL-101(Fe)-GOCOOH composite exhibited higher adsorption capacity compared to UiO-66/MIL-101(Fe) binary MOF. Adsorption isotherms and kinetic studies revealed that MB dye adsorption onto UiO-66/MIL-101(Fe)-GOCOOH composite fitted a Langmuir isotherm model (q_m = 448.71 mg g⁻¹) and both pseudo 1^st order and pseudo 2^nd order kinetic models. An intra-particle diffusion model showed that the adsorption process occurs through three steps. Besides, thermodynamic data reflected that the adsorption of MB onto UiO-66/MIL-101(Fe)-GOCOOH composite is an endothermic and spontaneous process and the adsorption involves both physisorption and chemisorption interactions. The as-fabricated UiO-66/MIL-101(Fe)-GOCOOH composite exhibited good reusability and can be considered as a promising reusable adsorbent for the treatment of dye-containing industrial effluents with high efficiency.

This study provides a novel composite as an efficient adsorbent of cationic methylene blue dye.