Aim: To investigate the change in a serum level of copeptin, a neuroendocrine biomarker, in differentiating grades of COVID-19 severity on admission time and to find its diagnostic potential. Materials & Methods: 160 COVID-19 patients were classified according to disease severity into 80 mild to moderate and 80 severe patients. Serum copeptin level was assessed by ELISA on their admission time. Besides, serum CRP, ferritin and D-dimer were estimated. Results: Severe COVID-19 patients showed higher serum copeptin level in comparison to mild to moderate cases, with diagnostic potential to distinguish disease severity with 93.33% sensitivity and 100% specificity at cut-off value >18.5 Pmol/l. Conclusion: Serum copeptin was remarkably increased with COVID-19 severity with reasonable differentiation potential for recently admitted patients.

Background Dysregulated immunity is a hallmark of SARS-CoV-2 infection. Immune suppression is indicated by low monocyte expression of human leukocyte antigen D-related (mHLA-DR). T cells are important antiviral cells. We aimed to assess the role of mHLA-DR and T lymphocyte frequency in predicting COVID-19 severity. Patients and Methods This cross-sectional study enrolled 97 SARS-CoV-2 positive patients, including mild to moderate (n = 49) and severe cases admitted to intensive care unit (ICU) (n = 48). These ICU cases were further subdivided into survivors (n = 35) and non-survivors (n = 13). Results Severe cases had a significant decrease in the mHLA-DR mean fluorescence intensity (MFI) and T lymphocyte percentage compared to mild to moderate cases ( P <0.001). Non-survivors had a lower T lymphocyte percentage ( P =0.004) than survivors. The mHLA-DR MFI and T lymphocyte percentage correlated with oxygen saturation (r=0.632, P <0.001) and (r=0.669, P <0.001), respectively. According to the ROC curves, mHLA-DR MFI, at a cutoff of 143 and an AUC of 0.9, is a reliable biomarker for distinguishing severe COVID-19 cases, with 89.6% sensitivity and 81.6% specificity, while T lymphocyte frequency had 81.3% sensitivity and 81.6% specificity at a cutoff of 54.4% and an AUC of 0.9. The T lymphocyte percentage as a predictor of ICU survival at a cutoff of 38.995% exhibited 100% sensitivity and 57.1% specificity. According to multivariate regression analysis, reduced mHLA-DR MFI and T lymphocyte percentage are independent predictors of COVID-19 severity (OR = 0.976, 95% CI: 0.955–0.997, P = 0.025) and (OR = 0.849, 95% CI: 0.741–0.972, P = 0.018), respectively. Conclusion Reduced mHLA-DR expression and T-lymphocyte percentage are independent predictors of COVID-19 severity. Oxygen saturation percentage is correlated with mHLA-DR MFI and T lymphocyte frequency. The T lymphocyte frequency is a proposed predictor of COVID-19 survival in ICU admitted patients.

Aim We conducted the present prospective study to assess the level of microRNA (miRNA) 146a in patients with ischemic stroke and its correlation with patients’ characteristics. Methods We conducted an observational study that included adult patients (≥18 years old) who presented within 24 hrs after the onset of the symptoms of acute ischemic stroke. In addition, age- and sex-matched healthy volunteers were included as control group. The primary outcome in the present study was the difference in miRNA 146a expression between patients with ischemic stroke and control group participants. The expression of miRNA 146a was measured using quantitative real-time PCR. Quantitative real-time PCR amplification and analysis were performed using Rotor-Gene Q thermal cycler. Results The present study included 44 patients with ischemic stroke and 22 matched controls. Regarding the primary outcome of the present study, the median expression of miRNA 146a in patients with ischemic stroke was −1.98 fold (IQR −27.1–3.9) compared to 1.75 fold (IQR −2.25–5.27) in control group ( P <0.001). However, the subgroup analysis showed that the expression of miRNA 146a was significantly downregulated in comatosed patients only ( P <0.001). The expression of miRNA 146a correlated negatively with Glasgow Coma Scale score in comatose patients ( r =−0.352, P =0.022). Conclusion In conclusion, the expression of miRNA 146a is significantly downregulated in ischemic stroke patients. Further studies are needed to assess its diagnostic utility and therapeutic potentials.

Cirrhosis-associated immune dysfunction (CAID) is an immunological perturbation that develops on top of liver cirrhosis (LC). Immune perturbation directs LC progression to hepatocellular carcinoma (HCC). Innate immune cells, in particular, monocytes, play key roles in inflammation and tumorigenesis. MicroRNAs (miRs) have been regarded as master regulators of the immune networks. We aim to investigate the altered monocytes subsets distribution in LC and subsequent HCC in association with the expression level of plasma homo sapiens (hsa)-miR-21-5p and hsa-miR-155-5p. A step toward non-protein coding (nc) RNA precision medicine based on the immune perturbation, manifested as altered monocytes distribution, on top of LC and HCC. Subjects and Methods: Seventy-nine patients diagnosed with chronic hepatitis C virus (CHCV) infection with LC were enrolled in the current study. Patients were sub-classified into LC group without HCC (n=40), LC with HCC (n=39), and 15 apparently healthy controls. Monocyte subsets frequencies were assessed by flow-cytometry. Real-time quantitative PCR was used to measure plasma hsa-miR-21-5p and hsa-miR-155-5p expression. Results: hsa-miR-21-5p correlated with intermediate monocytes (r=0.30, p=0.007), while hsa-miR-155-5p negatively correlated with nonclassical monocytes (r= -0.316, p=0.005). ROC curve analysis revealed that combining intermediate monocytes frequency and hsa-miR-21 yielded sensitivity= 79.5%, specificity= 75%, and AUC= 0.84. In comparison, AFP yielded a lower sensitivity = 69% and 100% specificity with AUC= 0.85. Logistic regression analysis proved that up-regulation of intermediate monocytes frequency and hsa-miR-21-5p were independent risk factors for LC progression to HCC, after adjustment for co-founders. Conclusion: Monocyte subsets differentiation in HCC was linked to hsa-miR-21-5p and hsa-miR-155-5p. Combined up-regulation of intermediate monocytes frequency and hsa-miR-21-5p expression could be considered a sensitive indicator of LC development to HCC. Circulating intermediate monocytes and hsa-miR-21-5p were independent risk factors for HCC evolution, clinically and in silicoproofed.

Objective Musculosk eletal complications occur in patients suffering from chronic kidney diseases. The cause of destructive spondyloarthropathy (DSA) among those patients is not well known. This study aims to study the frequency of DSA among hemodialysis patients. Patients and methods The study was conducted on 75 patients known to be end-stage renal disease patients: they were divided into three groups: chronic kidney disease on regular hemodialysis for more than or equal to 5 years group (n=25), patients on regular hemodialysis for less than 5 years group (n=25), and end-stage renal disease prior to hemodialysis as a control group (n=25). All of them were subjected to: full medical history, clinical examination, and plain radiographs of the whole spine in two views. Serum beta 2-microglobulin (β2-M) levels were determined. Results A comparison of β2-M serum levels in three groups showed a highly significant difference being highest in group I and lowest in group III (P<0.001). There was high statistically significant increase in the frequency of DSA in group I compared with group II and in group II compared with group III (P<0.001). As regards the affected site among positive cases, DSA was observed to affect the cervical region in 82.35% more than the lumbar in 11.76%, and rarely to involve both cervical and lumbar in the same patient in 5.88%, DSA was observed to affect men (58.8%) more than the women (41.2 %). Comparison of age, duration of dialysis, and intact parathyroid hormone levels between positive and negative DSA cases revealed that DSA is significantly more prevalent in older age patients (P<0.05), and those with long dialysis duration (P<0.001), and those having higher intact parathyroid hormone levels (P<0.001). Conclusion DSA is the most serious spinal complication in patients on long-term hemodialysis. Serum β2-M is elevated in patients receiving long-term hemodialysis (>5 years) and is positively correlated with destructive changes (DSA).

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Background Type II diabetes is a major risk factor for cardiovascular complications. Methylglyoxal (MGO) is the most hazardous glycating agent. Objective To assess the role of MGO in diabetic patients with cardiovascular diseases (CVD). Patients and methods This is a prospective study that was conducted on 60 patients with type II diabetes mellitus, comprising 30 males and 30 females, with age ranged from 50 to 62 years. They were classified into two groups: group 1 included 30 patients with type II diabetes mellitus with CVD based on patients known to have ischemic heart disease, hypertension, pervious history of angina pectoris, or myocardial infraction, along with positive findings in ECG and echocardiography. It included 15 males and 15 females. Their age was between 51 and 62 years, with mean±SD of 55.9±5.5 years. Group 2 included 30 patients with type II diabetes mellitus without CVD, based on not being hypertensive, having no history of chest pain, along with normal ECG and echocardiography. It included 15 males and 15 females. Their age was between 50 and 61 years, with mean±SD of 55.5±5.2 years. Results There were highly significant increases in MGO in patients with type II diabetes mellitus with CVDs compared with patients with type II diabetes mellitus without CVDs, with P value less than 0.001. There was a positive correlation between MGO and indices of glycemic control (fasting blood sugar, 2 h postprandial, and glycated hemoglobin). There was a positive correlation between MGO and cholesterol, triglycerides, low-density lipoprotein, BMI, diastolic dysfunction of the heart, and diabetic retinopathy, but there was a negative correlation between MGO and high-density lipoprotein and ejection fraction of the heart, which means that MGO level is increased in heart failure. Conclusion Our study proved the importance of MGO in type II diabetic CVD in humans. We need future studies to assess the role of MGO in diabetic complications.

Background: Fibromyalgia (FM) is a chronic musculoskeletal disorder resulting in chronic widespread pain. Although it is currently believed to be the result of a central nervous system malfunction that increases pain transmission and perception. Patients with fibromyalgia frequently experience psychiatric problems. Objectives: Is to estimate the presence of fibromyalgia among Egyptian patients with rheumatoid arthritis (RA) and those with chronic depression. Patients and methods: This study was done on 277 patients; 176 patients with rheumatoid arthritis (group I), and 101 patients with chronic depression (group II). The patients were selected from Al-Zahraa University Hospital, Al-Azhar University. All patients were subjected to thorough clinical examination, laboratory investigation, calculation of disease activity score, modified Beck scale for depression. Results: Among RA patients FM diagnosis was established in 21.02% patients and 20.45% were females. Their mean age; 48.43 (±6.85) years that was significantly higher than RA patients only (29.48±8.59) years. Among (group II) patients, FM diagnosis was established in 40 (39.60%) female patients and 3(2.97%) male patients. Our results showed that depressive symptoms were more common in RA patients with fibromyalgia. DAS28 score was significantly higher in RA patients with FM mainly due to subjective component (number of tender joints and patient global assessment). Conclusion: Fibromyalgia may coexist with autoimmune inflammatory disorder like RA, commoner in older age, females and it worsens the disease activity. However, it is more common in patients with chronic depression.