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BackgroundIn β-thalassemia, profound anemia and severe hemosiderosis cause functional and physiological abnormalities in various organ systems. In recent years, there have been few published studies mainly in adult demonstrating renal involvement in β-thalassemia. This prospective study was aimed to investigate renal involvement in pediatric patients with transfusion dependant beta-thalassemia major (TD-βTM), using both conventional and early markers of glomerular and tubular dysfunctions, and to correlate findings to oxidative stress and iron chelation therapy.MethodsSixty-nine TD-βTM patients (aged 1-16 years) and 15 healthy controls (aged 3-14 years) were enrolled in this study. Based on receiving chelation therapy (deferoxamine, DFO), patients were divided into two groups: group [I] with chelation (n = 34) and group [II] without chelation (n = 35). Levels of creatinine (Cr), calcium (Ca), inorganic phosphorus (PO4), uric acid (UA) and albumin were measured by spectrophotometer. Serum (S) levels of cystatin-C (SCysC) and total antioxidant capacity (STAC) and urinary (U) levels of β2-microglobulin (Uβ2MG) were measured by immunosorbent assay (ELISA). Urinary N-acetyl-beta-D-glucosaminidase (UNAG) activity and malondialdehyde (UMDA) were measured by chemical methods. Estimated glomerular filtration rate (eGFR) was determined from serum creatinine.ResultsIn patient with and without chelation, glomerular [elevated SCysC, SCr, Ualbumin/Cr and diminished eGFR]; and tubular dysfunctions [elevated SUA, SPO4, UNAG/Cr, Uβ2MG/Cr] and oxidative stress marker disturbances [diminished STAC and elevated UMDA/Cr] were reported than controls. In patients with chelation, SCysC was significantly higher while, STAC was significantly lower than those without chelation. In all patients, SCysC showed significant positive correlation with SCr and negative correlation with eGFR; STAC showed significant positive correlation with eGFR and negative correlation with SCysC, SCr, UNAG/Cr; UMDA/Cr showed significant positive correlation with Ualbumin/Cr, Uβ2MG/Cr, UNAG/Cr.ConclusionsOur data confirm high frequency of glomerular and tubular dysfunctions in TD-βTM pediatric patients which could be attributed to oxidative stress and DFO therapy.

In patients with malignant pleural effusions, levels of VEGF were significantly higher, while levels of TNF-alpha were significantly lower, than in patients with tuberculous effusions. In malignant pleural effusions, the elevated pleural fluid levels of VEGF and TNF-alpha are noteworthy. Our data support the hypothesis that blockade of VEGF, might benefit cancer patients with recurrent ascites or pleural fluid accumulation.

Repetitive transcranial magnetic stimulation (rTMS) induces lateralized speech arrest consistent with cerebral dominance for language. Studies of language cerebral dominance in differently handed healthy subjects have been limited. Using a focal magnetic coil, we examined the degree of consistency between handedness as evaluated by the Stanley Coren Score and hemispheric dominance for language as determined by rTMS in 25 right- and 25 left-handed medical students. They were categorized according to the score into 24 strongly right-handed, 1 moderately right-handed, 19 strongly left-handed, 3 moderately left-handed and 3 ambidextrous (equally-handed). In the strongly right-handed subjects, left-sided language cerebral dominance was recorded in 87.5% of the subjects, and bilateral cerebral representation in 8.2%, and right-sided language cerebral dominance in 4.2%. In the strongly left-handed subjects, 73.7% had left-side language cerebral dominance, 15.8% had bilateral cerebral representation and 10.5% had right-side cerebral language dominance. In mixed handed subjects (moderately right, left and ambidextrous), bilateral cerebral representation was observed in 57% and left-side cerebral language dominance in 43%. There were 27 subjects who developed speech arrest at 140% of motor threshold, the others developed speech arrest at lower intensities. Speech lateralized to the left-side cerebral dominance in strongly right- and left-handed subjects, but bilateral cerebral representation was frequent in mixed handedness and right-sided cerebral dominance rarely occurred.