Serum ferritin level as a marker of disease activity and renal involvement in Egyptian children with juvenile systemic lupus erythematosus

Introduction: Ferritin is an acute-phase reactant that is elevated in several autoimmune disorders. Serum ferritin levels have been correlated with disease activity scores of juvenile systemic lupus erythematosus (JSLE). Furthermore, enhanced levels of ferritin have also been described in lupus nephritis (LN). Aim of the work: To evaluate serum ferritin as a cheap and available marker of disease activity and renal involvement in Egyptian children with JSLE. Patients and methods: Forty-eight JSLE cases recruited from the Pediatric Rheumatology Clinic in Cairo University Specialized Children’s Hospital and 43 matched healthy children were enrolled in the study. SLE disease activity score-2000 (SLEDAI-2K) and renal activity score were assessed. Serum levels of ferritin, was quantified by enzyme-linked immunosorbent assay. Results: The mean age of the patients was 12.6 ± 3.02 years and disease duration 3.4 ± 2.5 years. Serum ferritin significantly higher in patients (416.1 ± 1022.9 ng/ml) compared with control (36.1 ± 18.2 ng/ml) (p < 0.001). Serum ferritin was significantly higher in active (n = 20) (890.4 ± 1474.8 ng/ml) compared to inactive (n = 28) (77.4 ± 74.1 ng/ml) patients (p < 0.001). A significant correlation was found between serum ferritin with SLEDAI-2K (r = 0.35, p = 0.014), renal-SLEDAI-2K (r = 0.49, p < 0.001) and with renal activity score (r = 0.38, p = 0.008). A significant correlation was found between serum ferritin and anti-double stranded-DNA (r = 0.44, p = 0.002) and complement 3 (r = −0.42, p = 0.003). Conclusion: Serum ferritin level can be considered a reliable biomarker for monitoring disease and renal activity in children with JSLE and LN. This may lead to improvement of management and consequently prognosis of JSLE patients as serum ferritin is an available and relatively cheap marker. Keywords: Juvenile systemic lupus erythematosus, Ferritin, SLEDAI, Lupus nephriti

Clinical and histochemical response to automated microneedling therapy in treatment of traumatic scars

Background: Post traumatic skin injuries are challenging to manage. Patients may have erythematous, hypertrophic, or atrophic scars. Microneedling therapy is minimally invasive non-surgical and non-ablative procedure used for skin rejuvenation that relies on the principle of neocollagenesis. Aim: We aimed to assess the clinical and histochemical response to automated microneedling therapy in treatment of traumatic scars. Methods: This prospective study included twenty patients with traumatic scars. All patients received 4 monthly sessions of automated microneedling therapy. Outcome assessment included modified Vancouver Scar Scale, digital photographic documentation and patient's satisfaction. Histochemical evaluation by quantitative morphometric assessment for collagen and elastic fibers using image analyzer performed before and 3 months after treatment for Masson’s trichrome and Orcein stained sections respectively.&nbsp; Results: There was statistically significant improvement in scar vascularity (p= 0.018), scar pigmentation (p= 0.008), and scar pliability (p= 0.002) and sum of mVSS (P=0.000002). Histochemically, there was significant increase in collagen content, (p= 0.023), and elastin content (p= 0.003) as quantified by image analyzer. There was no significant correlations (r: 0.158 and -0.259; p-values: 0.55 and 0.34) between micro-needling therapy and scar type (atrophic versus hypertrophic)