Pub Date : 2022-12-13DOI: 10.21608/mjmu.2022.171412.1147
M. AbdelFatah, Ibrahim Abdelmohsen, Sherif Bahaa, Mohamed Elwardany, Sameh Hefny
Background: The use of suction in the subgaleal drainage system after the burr-hole evacuation of chronic subdural hematoma (CSDH) is still debatable. This study aimed to investigate the value of adding suction to the drainage system of CSDH in elderly patients. Methods: This cohort study retrospectively reviewed the data of the CSDH patients operated on at our university hospital in the last eight years. The inclusion criteria were elderly patients who underwent evacuation of a unilateral CSDH through two burr holes followed by placing a subgaleal drainage tube. Two hundred seventy-three consecutive patients met the inclusion criteria. Seventy-six patients (27.8%) received suction drainage. The comparison between groups with qualitative data was done using the chi-square test. The comparison between groups with quantitative data was done using the t-test. The statistical analyses were conducted using SPSS software version 21 (IBM Corp., Armonk, New York, USA). Results: There were no statistically significant differences between the suction and the nonsuction drainage groups regarding the hospitalization period, the postoperative seizures, or the recurrence rate. However, the postoperative pneumocephalus volume in the suction drainage group was significantly lower than in the non-suction drainage group. None of the patients developed acute subdural or intracerebral hemorrhage. Conclusions: Suction drainage did not add statistically significant value to the closed drainage system regarding the hospitalization period, postoperative seizures, or recurrence rate of the CSDH. A prospective controlled study is needed to increase the evidence for this finding.
背景:慢性硬膜下血肿(CSDH)钻孔引流后硬膜下引流系统中吸力的应用仍有争议。本研究旨在探讨老年CSDH患者在引流系统中增加吸力的价值。方法:回顾性分析我院近8年来收治的CSDH患者的资料。纳入标准是通过两个钻孔对单侧CSDH进行引流，随后置入galeal下引流管的老年患者。273例连续患者符合纳入标准。76例(27.8%)采用吸引引流。定性资料组间比较采用卡方检验。有定量资料的组间比较采用t检验。采用SPSS软件21版(IBM Corp.， Armonk, New York, USA)进行统计分析。结果:抽吸组与非抽吸组住院时间、术后癫痫发作、复发率比较，差异均无统计学意义。然而，术后吸液引流组的肺水肿体积明显低于非吸液引流组。没有患者出现急性硬膜下出血或脑出血。结论:在CSDH的住院时间、术后癫痫发作、复发率方面，封闭引流系统与吸引引流没有统计学意义的增加。需要一项前瞻性对照研究来增加这一发现的证据。
{"title":"The Value of Suction Drainage for a Chronic Subdural Hematoma in Elderly Patients: A Retrospective Cohort study","authors":"M. AbdelFatah, Ibrahim Abdelmohsen, Sherif Bahaa, Mohamed Elwardany, Sameh Hefny","doi":"10.21608/mjmu.2022.171412.1147","DOIUrl":"https://doi.org/10.21608/mjmu.2022.171412.1147","url":null,"abstract":"Background: The use of suction in the subgaleal drainage system after the burr-hole evacuation of chronic subdural hematoma (CSDH) is still debatable. This study aimed to investigate the value of adding suction to the drainage system of CSDH in elderly patients. Methods: This cohort study retrospectively reviewed the data of the CSDH patients operated on at our university hospital in the last eight years. The inclusion criteria were elderly patients who underwent evacuation of a unilateral CSDH through two burr holes followed by placing a subgaleal drainage tube. Two hundred seventy-three consecutive patients met the inclusion criteria. Seventy-six patients (27.8%) received suction drainage. The comparison between groups with qualitative data was done using the chi-square test. The comparison between groups with quantitative data was done using the t-test. The statistical analyses were conducted using SPSS software version 21 (IBM Corp., Armonk, New York, USA). Results: There were no statistically significant differences between the suction and the nonsuction drainage groups regarding the hospitalization period, the postoperative seizures, or the recurrence rate. However, the postoperative pneumocephalus volume in the suction drainage group was significantly lower than in the non-suction drainage group. None of the patients developed acute subdural or intracerebral hemorrhage. Conclusions: Suction drainage did not add statistically significant value to the closed drainage system regarding the hospitalization period, postoperative seizures, or recurrence rate of the CSDH. A prospective controlled study is needed to increase the evidence for this finding.","PeriodicalId":18173,"journal":{"name":"Mansoura Veterinary Medical Journal","volume":"65 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-12-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"85399485","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2022-12-01DOI: 10.21608/mjmu.2022.169866.1146
Hoda M. Sobh, insaf elnady, Mohamed Eladalany, Hend Abdelhady
Objectives: To study the prevalence of increased CIMT (carotid intima media thickness) among NVAF (non-valvular atrial fibrillation) patients compared to healthy population and to assess the CIMT measurements in different progressive stages of AF (atrial fibrillation). Background : Progression of NVAF is characterized by switch from paroxysmal to persistent/permanent AF. Better understanding of AF progression is clinically important. NVAF is frequently associated with high number of atherosclerotic risk factors. CIMT is a good marker of subclinical atherosclerosis. Increased CIMT is an independent predictor of new onset atrial fibrillation. Higher values of CIMT is expected to be found among more progressive types of AF. Patients and methods: The study included 100 patients with NVAF and 50 healthy control subjects. Patients with AF were sub-divided into 2 groups according to AF type (paroxysmal and non- paroxysmal). Carotid ultrasound including CIMT was assessed in both AF patients subgroups and in control group and findings were compared. Results: CIMT was significantly higher in the case group compared with the control group, CIMT was significantly higher in the non-paroxysmal AF group compared to the paroxysmal AF group. There was a significant correlation between the CIMT and the duration of the AF episodes. Conclusion: Progressive types of AF (persistent and permanent) are associated with higher measurements of CIMT compared to less progressive type (paroxysmal) AF.
{"title":"Carotid Intima Media Thickness in Different Progressive Stages of Atrial Fibrillation","authors":"Hoda M. Sobh, insaf elnady, Mohamed Eladalany, Hend Abdelhady","doi":"10.21608/mjmu.2022.169866.1146","DOIUrl":"https://doi.org/10.21608/mjmu.2022.169866.1146","url":null,"abstract":"Objectives: To study the prevalence of increased CIMT (carotid intima media thickness) among NVAF (non-valvular atrial fibrillation) patients compared to healthy population and to assess the CIMT measurements in different progressive stages of AF (atrial fibrillation). Background : Progression of NVAF is characterized by switch from paroxysmal to persistent/permanent AF. Better understanding of AF progression is clinically important. NVAF is frequently associated with high number of atherosclerotic risk factors. CIMT is a good marker of subclinical atherosclerosis. Increased CIMT is an independent predictor of new onset atrial fibrillation. Higher values of CIMT is expected to be found among more progressive types of AF. Patients and methods: The study included 100 patients with NVAF and 50 healthy control subjects. Patients with AF were sub-divided into 2 groups according to AF type (paroxysmal and non- paroxysmal). Carotid ultrasound including CIMT was assessed in both AF patients subgroups and in control group and findings were compared. Results: CIMT was significantly higher in the case group compared with the control group, CIMT was significantly higher in the non-paroxysmal AF group compared to the paroxysmal AF group. There was a significant correlation between the CIMT and the duration of the AF episodes. Conclusion: Progressive types of AF (persistent and permanent) are associated with higher measurements of CIMT compared to less progressive type (paroxysmal) AF.","PeriodicalId":18173,"journal":{"name":"Mansoura Veterinary Medical Journal","volume":"23 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"74001053","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2022-12-01DOI: 10.21608/mvmj.2022.277108
A. Hafez, M. Ragab, Marwa A. Fawzy, A. El-Kattan, A. Elsayed
.
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{"title":"Molecular characterization of some pathogenic bacterial strains and hematobiochemical profile in Barki sheep with diarrhea in Siwa Oasis","authors":"A. Hafez, M. Ragab, Marwa A. Fawzy, A. El-Kattan, A. Elsayed","doi":"10.21608/mvmj.2022.277108","DOIUrl":"https://doi.org/10.21608/mvmj.2022.277108","url":null,"abstract":".","PeriodicalId":18173,"journal":{"name":"Mansoura Veterinary Medical Journal","volume":"6 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"81360261","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2022-12-01DOI: 10.21608/mjmu.2022.157523.1136
A. Ismael, Amaal H. Hassan, A. Hasan, Y. Youssef
.
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{"title":"Assessment of Serum Levels of Interleukin-27 and Interleukin-37 in Patients with Non-Segmental Vitiligo","authors":"A. Ismael, Amaal H. Hassan, A. Hasan, Y. Youssef","doi":"10.21608/mjmu.2022.157523.1136","DOIUrl":"https://doi.org/10.21608/mjmu.2022.157523.1136","url":null,"abstract":".","PeriodicalId":18173,"journal":{"name":"Mansoura Veterinary Medical Journal","volume":"29 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"81385125","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2022-12-01DOI: 10.21608/mjmu.2022.156664.1139
dalia eita, N. Omar, D. Nosseir, M. Abdelrahman, S. Gawish
Background: BRCA1-associated protein 1 (BAP1) is a nuclear-localized deubiquitylase (DUB) that belongs to the ubiquitin carboxy terminal hydrolase family of DUBs. BAP1 acts as a tumor suppressor inactivated in various cancers. Several studies in cancer cells containing BAP1 mutations indicated that BAP1 nuclear localization and catalytic activity are required for its growth and suppressive properties. Methods: Subcellular localization of BAP1 was studied in B-16 cells (WT BAP1), as well as 15 fresh frozen samples of Uveal Melanoma (UM) cases using immunofluorescence staining and confocal microscopy imaging. Wound Healing Assay was used to evaluate the role of BAP1 in the regulation of cell migration in B-16 cells. Clonogenic Assay was used to assess cell proliferation and the effect of BAP1 on DNA repair after irradiation (IR). Results: WT BAP1 was mostly nuclear and small amount was cytoplasmic. Among 15 UM samples 2 showed nuclear localization, while 4 showed only extranuclear BAP1. In 3 samples BAP1 was both nuclear and extranuclear, while 6 specimens appeared with no BAP1. In wound healing assay, BAP1 stimulated cell migration, while BAP1 knock-out slowed it down. In clonogenic Assay, more proliferation rate was detected in B-16 cells colonies with WT BAP1 even after IR confirming the role of BAP1 in cell proliferation and DNA repair. Conclusion: Mutant BAP1 is localized in a different way in the same type of cells (nuclear or cytoplasmic or absent). BAP1 is important for cell proliferation, migration
{"title":"Subcellular Localization of BRCA1-Associated Protein (BAP1) in Uveal Melanoma Cases and Assessment of Its Functions","authors":"dalia eita, N. Omar, D. Nosseir, M. Abdelrahman, S. Gawish","doi":"10.21608/mjmu.2022.156664.1139","DOIUrl":"https://doi.org/10.21608/mjmu.2022.156664.1139","url":null,"abstract":"Background: BRCA1-associated protein 1 (BAP1) is a nuclear-localized deubiquitylase (DUB) that belongs to the ubiquitin carboxy terminal hydrolase family of DUBs. BAP1 acts as a tumor suppressor inactivated in various cancers. Several studies in cancer cells containing BAP1 mutations indicated that BAP1 nuclear localization and catalytic activity are required for its growth and suppressive properties. Methods: Subcellular localization of BAP1 was studied in B-16 cells (WT BAP1), as well as 15 fresh frozen samples of Uveal Melanoma (UM) cases using immunofluorescence staining and confocal microscopy imaging. Wound Healing Assay was used to evaluate the role of BAP1 in the regulation of cell migration in B-16 cells. Clonogenic Assay was used to assess cell proliferation and the effect of BAP1 on DNA repair after irradiation (IR). Results: WT BAP1 was mostly nuclear and small amount was cytoplasmic. Among 15 UM samples 2 showed nuclear localization, while 4 showed only extranuclear BAP1. In 3 samples BAP1 was both nuclear and extranuclear, while 6 specimens appeared with no BAP1. In wound healing assay, BAP1 stimulated cell migration, while BAP1 knock-out slowed it down. In clonogenic Assay, more proliferation rate was detected in B-16 cells colonies with WT BAP1 even after IR confirming the role of BAP1 in cell proliferation and DNA repair. Conclusion: Mutant BAP1 is localized in a different way in the same type of cells (nuclear or cytoplasmic or absent). BAP1 is important for cell proliferation, migration","PeriodicalId":18173,"journal":{"name":"Mansoura Veterinary Medical Journal","volume":"1 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"78582988","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2022-12-01DOI: 10.21608/mjmu.2022.128620.1091
Jalila Ahmed, Hanan Abdlhay
Many drugs are used in treatment of cancer. Including chemotherapy, hormonal therapy and immunotherapy. The investment of immunotherapy has improve the procedure for treating cancer by utilizing the immune system to identify and attack cancer cells through immune checkpoint inhibitors. This is done by two major mechanisms, the first is CTLA-4 inhibitors like ipilimumab, and the second pathways is PD-1/PD- L1 inhibitors like nivolumab. However many adverse effects have aroused as a consequence of immunotherapy usage. Including non-endocrinal adverse effects like colitis and dermatitis, and endocrinal side effects predominantly involving pituitary and thyroid gland plus the endocrine pancreas. Pituitary gland involvement is potentially life threatening and is mainly due to CTLA-4 inhibitors, leading to multiple pituitary hormone deficiencies. It mainly present with headache, and pituitary enlargement is reported in MRI. Which is treated by high dose glucocorticoids to prevent chiasmal compression. Hormone replacement therapy is required according to the deficient hormone. Thyroid gland is one of the most commonly involved glands. Predominately by a combination of both PD-1 and CTLA-4 inhibitors. It mainly present with transient hyperthyroidism followed by hypothyroidism, which is treated by levothyroxine replacement therapy. Immunotherapy will result in both endocrine and exocrine dysfunction. ICIs associated DM is classified into four different types according to the pathology. It includes all of Acute autoimmune insulin-dependent diabetes, type 2 diabetes-like phenotype, autoimmune pancreatitis-induced diabetes, and diabetes after autoimmune lipoatrophy. Patients presented with d ketoacidosis are treated with standard approach while stable patient will be subjected to a regular insulin regimen.
{"title":"Endocrinopathies as a price of cancer treatment","authors":"Jalila Ahmed, Hanan Abdlhay","doi":"10.21608/mjmu.2022.128620.1091","DOIUrl":"https://doi.org/10.21608/mjmu.2022.128620.1091","url":null,"abstract":"Many drugs are used in treatment of cancer. Including chemotherapy, hormonal therapy and immunotherapy. The investment of immunotherapy has improve the procedure for treating cancer by utilizing the immune system to identify and attack cancer cells through immune checkpoint inhibitors. This is done by two major mechanisms, the first is CTLA-4 inhibitors like ipilimumab, and the second pathways is PD-1/PD- L1 inhibitors like nivolumab. However many adverse effects have aroused as a consequence of immunotherapy usage. Including non-endocrinal adverse effects like colitis and dermatitis, and endocrinal side effects predominantly involving pituitary and thyroid gland plus the endocrine pancreas. Pituitary gland involvement is potentially life threatening and is mainly due to CTLA-4 inhibitors, leading to multiple pituitary hormone deficiencies. It mainly present with headache, and pituitary enlargement is reported in MRI. Which is treated by high dose glucocorticoids to prevent chiasmal compression. Hormone replacement therapy is required according to the deficient hormone. Thyroid gland is one of the most commonly involved glands. Predominately by a combination of both PD-1 and CTLA-4 inhibitors. It mainly present with transient hyperthyroidism followed by hypothyroidism, which is treated by levothyroxine replacement therapy. Immunotherapy will result in both endocrine and exocrine dysfunction. ICIs associated DM is classified into four different types according to the pathology. It includes all of Acute autoimmune insulin-dependent diabetes, type 2 diabetes-like phenotype, autoimmune pancreatitis-induced diabetes, and diabetes after autoimmune lipoatrophy. Patients presented with d ketoacidosis are treated with standard approach while stable patient will be subjected to a regular insulin regimen.","PeriodicalId":18173,"journal":{"name":"Mansoura Veterinary Medical Journal","volume":"114 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"79398748","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2022-12-01DOI: 10.21608/mjmu.2022.128599.1071
Salma Elsharkawy, Ahmed M. Zeina
Almost two decades after the first face transplant, facial allotransplantation (FAT) had emerged from being considered science fiction to occupy the highest rung on the reconstructive ladder for patients with extensive facial disfigurement when autologous approaches fail or are inappropriate in restoring optimal facial form and function. FAT had piqued the interest of the medical community and the general public, as well as strong support from multiple disciplines, as a solution for reconstructing complex facial defects that are unresponsive to conventional methods. The procedure had pushed the boundaries of reconstructive microsurgery, immunology, and transplantation, establishing itself at the crossroads of multiple disciplines. The procedure raised difficult scientific, ethical, and societal issues. Patients and physicians were called upon to deal with a variety of lifelong hurdles, such as immunosuppression management and psychosocial challenges
{"title":"Impact of reconstructive facial transplantation on future of plastic surgery","authors":"Salma Elsharkawy, Ahmed M. Zeina","doi":"10.21608/mjmu.2022.128599.1071","DOIUrl":"https://doi.org/10.21608/mjmu.2022.128599.1071","url":null,"abstract":"Almost two decades after the first face transplant, facial allotransplantation (FAT) had emerged from being considered science fiction to occupy the highest rung on the reconstructive ladder for patients with extensive facial disfigurement when autologous approaches fail or are inappropriate in restoring optimal facial form and function. FAT had piqued the interest of the medical community and the general public, as well as strong support from multiple disciplines, as a solution for reconstructing complex facial defects that are unresponsive to conventional methods. The procedure had pushed the boundaries of reconstructive microsurgery, immunology, and transplantation, establishing itself at the crossroads of multiple disciplines. The procedure raised difficult scientific, ethical, and societal issues. Patients and physicians were called upon to deal with a variety of lifelong hurdles, such as immunosuppression management and psychosocial challenges","PeriodicalId":18173,"journal":{"name":"Mansoura Veterinary Medical Journal","volume":"70 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"86761851","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2022-12-01DOI: 10.21608/mjmu.2022.167378.1145
Nabil Aladeeb, Marwan Harb, Abdul Rahman Yassin, Abdulmotal Fouda, Ahmad Alsaied
{"title":"The beneficial Antifibrotic effect of Rosuvastatin on experimental Pulmonary Fibrosis induced by Bleomycin","authors":"Nabil Aladeeb, Marwan Harb, Abdul Rahman Yassin, Abdulmotal Fouda, Ahmad Alsaied","doi":"10.21608/mjmu.2022.167378.1145","DOIUrl":"https://doi.org/10.21608/mjmu.2022.167378.1145","url":null,"abstract":"","PeriodicalId":18173,"journal":{"name":"Mansoura Veterinary Medical Journal","volume":"218 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"85823182","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2022-12-01DOI: 10.21608/mjmu.2022.156569.1135
Doaa Saad, Abdelmoneum Afifi, M. Mortada, Y. Adel
Background Methotrexate has been predominantly used for more than 20 years as first-line therapy for improving the clinical course and quality of life in rheumatoid arthritis (RA) patients. Although this drug is available and effective, however some of the patients may fail to respond to it, making a special challenge to Rheumatologists. Objectives This work aimed to assess the use of elevated serum P-gp as a risk marker of therapeutic failure in RA patients treated with methotrexate and to correlate its level with the disease activity score (DAS 28). Subject and methods eighty RA patients were recruited from Outpatient Rheumatology Clinic at Mansoura University Hospital. All patients were on methotrexate therapy at a stable dosage at least 6 months prior to study onset. Disease activity was evaluated using DAS 28-ESR score. Out of the recruited patients, 25 responders to MTX with DAS 28 <3.2 (Group I) and 25 non-responders with DAS 28 > 3.2 (Group II), who met the inclusion criteria were admitted to the study. Serum levels of P-glycoprotein were estimated by ELISA. P-gp was compared in both groups and correlated with clinical factors, DAS 28 score and laboratory parameters. Multivariate analysis was performed using the Cox proportional hazards model to determine whether high serum P-gp has an independent prognostic value for poor response to methotrexate therapy. Results RA patients responding to MTX had significant lower serum P-glycoprotein compared to patients with MTX failure (p=0.041). Significant positive correlations were observed between serum P-gp levels and number of swollen joints ( p=0.001 ), number of tender joints ( P=0.003 ), deteriorated patient global health score ( p=0.002 ), DAS 28, ESR (P = 0.01), rheumatoid factor ( p < 0.001), and anti CCP (P = 0.002). No significant correlations were found between serum P-gp levels and age, disease duration, and duration of methotrexate therapy. After adjusting for confounding variables, elevated P-gp remained associated with MTX failure (Hazard Ratio 2.78, 95% CI 1.37 ─ 5.64, P =0.035). Conclusions Elevated serum P- gp results in resistance to methotrexate therapy in RA patients. High serum P-gp in association with high DAS 28 score can be used as a marker to assess the risk of MTX failure in RA.. So, assessment of P-gp level may facilitate clinical decision-making, allowing improving the ability to tailor treatment for each RA patient.
{"title":"Relationship of serum P_glycoprotein to failure of methotrexate therapy in Egyptian rheumatoid arthritis patients","authors":"Doaa Saad, Abdelmoneum Afifi, M. Mortada, Y. Adel","doi":"10.21608/mjmu.2022.156569.1135","DOIUrl":"https://doi.org/10.21608/mjmu.2022.156569.1135","url":null,"abstract":"Background Methotrexate has been predominantly used for more than 20 years as first-line therapy for improving the clinical course and quality of life in rheumatoid arthritis (RA) patients. Although this drug is available and effective, however some of the patients may fail to respond to it, making a special challenge to Rheumatologists. Objectives This work aimed to assess the use of elevated serum P-gp as a risk marker of therapeutic failure in RA patients treated with methotrexate and to correlate its level with the disease activity score (DAS 28). Subject and methods eighty RA patients were recruited from Outpatient Rheumatology Clinic at Mansoura University Hospital. All patients were on methotrexate therapy at a stable dosage at least 6 months prior to study onset. Disease activity was evaluated using DAS 28-ESR score. Out of the recruited patients, 25 responders to MTX with DAS 28 <3.2 (Group I) and 25 non-responders with DAS 28 > 3.2 (Group II), who met the inclusion criteria were admitted to the study. Serum levels of P-glycoprotein were estimated by ELISA. P-gp was compared in both groups and correlated with clinical factors, DAS 28 score and laboratory parameters. Multivariate analysis was performed using the Cox proportional hazards model to determine whether high serum P-gp has an independent prognostic value for poor response to methotrexate therapy. Results RA patients responding to MTX had significant lower serum P-glycoprotein compared to patients with MTX failure (p=0.041). Significant positive correlations were observed between serum P-gp levels and number of swollen joints ( p=0.001 ), number of tender joints ( P=0.003 ), deteriorated patient global health score ( p=0.002 ), DAS 28, ESR (P = 0.01), rheumatoid factor ( p < 0.001), and anti CCP (P = 0.002). No significant correlations were found between serum P-gp levels and age, disease duration, and duration of methotrexate therapy. After adjusting for confounding variables, elevated P-gp remained associated with MTX failure (Hazard Ratio 2.78, 95% CI 1.37 ─ 5.64, P =0.035). Conclusions Elevated serum P- gp results in resistance to methotrexate therapy in RA patients. High serum P-gp in association with high DAS 28 score can be used as a marker to assess the risk of MTX failure in RA.. So, assessment of P-gp level may facilitate clinical decision-making, allowing improving the ability to tailor treatment for each RA patient.","PeriodicalId":18173,"journal":{"name":"Mansoura Veterinary Medical Journal","volume":"41 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"73405183","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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