Fawaz Azizieh

Scopus Publications

High protein diet increases the risk of allergic sensitization but not asthma in mice through modulation of the cytokine milieu toward Th2 bias
Waleed Al-Herz, Fawaz Azizieh, and Raj Raghupathy
Elsevier BV

Quantitative analyses of cytokine profiles reveal hormone-mediated modulation of cytokine profiles in recurrent spontaneous miscarriage
Kamaludin Dingle, Osama M. Kassem, Fawaz Azizieh, Ghadeer AbdulHussain, and Raj Raghupathy
Elsevier BV

Effects of Progesterone, Dydrogesterone and Estrogen on the Production of Th1/Th2/Th17 Cytokines by Lymphocytes from Women with Recurrent Spontaneous Miscarriage
Ghadeer AbdulHussain, Fawaz Azizieh, Ma’asoumah Makhseed, and Raj Raghupathy
Elsevier BV

Cytokineexplore: An online tool for statistical analysis of cytokine concentration datasets
Osama Kassem, Abdulwahab Al-Saleh, Fawaz Azizieh, and Kamaludin Dingle
Informa UK Limited
Purpose Cytokine data sets are increasing both in the number of different cytokines measured and the number of samples assayed. Further, typically data from different groups may be contrasted, eg, normal vs complication subjects. Many univariate and multivariate statistical techniques exist to study such cytokine datasets, but the ability to implement these techniques may be lacking for some practitioners, or may not be available quickly and conveniently. Here, we introduce CytokineExplore, an online tool for multi-cytokine and multi-group data analysis of user-provided Microsoft Excel data files. Materials and Methods In order to illustrate the tool features, we use data from intrauterine growth retardation (IUGR), a pregnancy complication, and normal healthy subjects as a control. The dataset contains levels for 10 cytokines, namely: IL-4, IL-6, IL-8, IL-10, IL-12, IL-13, IL-18, IL-23, interferon-gamma (IFN-γ) and tumour necrosis-alpha (TNF-α), obtained from 34 women with IUGR (further divided into 17 symmetric and 17 asymmetric cases) and 24 gestationally age-matched normal controls. Results The online tool automatically generates box-plots, histograms, PCA and PLSDA plots, t-tests and Mann–Whitney statistical tests, cytokine importance values for separating two groups, heatmaps for comparing multiple groups, and other functionalities. Figures generated can be directly downloaded for use in presentations or journal articles. Conclusion The tool facilitates quick and easy numerical exploration and multivariate analysis of cytokine datasets, to aid basic understanding and hypothesis generation.

Multivariate comparison of cytokine profiles for normal- And low-bone-density subjects
Kamaludin Dingle and Fawaz Azizieh
MDPI AG
Osteoporosis is a serious worldwide public health concern. The role of the immune system in the onset of osteoporosis in postmenopausal women is an area of current research. Here we study data from a panel of 10 cytokines obtained from postmenopausal women, with both normal and low bone mineral density (BMD). Normal- and low-BMD groups are compared and contrasted, and further low-BMD participants are sub-classified into osteopenic and osteoporotic based on BMD levels, and compared to each other. Via the use of multivariate statistical tools, we examine contrasting groups in relation to: (a) the presence of subgroups/clusters; (b) whether groups have statistically different multivariate distributions; (c) how strongly groups differ (if at all), which relates to the practical/clinical significant of any differences; and (d) which cytokines contribute most to any differences between groups. We find that the normal- vs. low-BMD groups are markedly different (p-value = 0.00013), with IL-23, IL-12, TNF-α, IL-4 and IL-6 being the most important differentiating cytokines. No significant difference between the osteopenic and osteoporotic groups is found (p-value = 0.81). These findings may aid the development of cytokine therapies for osteoporosis, and suggest the use of certain cytokine profiles as biomarkers for osteoporosis risk factors, and ways to quantify the progress of treatment therapies.

In vitro spleen cell cytokine responses of adult mice immunized with a recombinant PorA (major outer membrane protein [MOMP]) from Campylobacter jejuni
M. John Albert, Raj Raghupathy, Islam Khan, and Fawaz Y. Azizieh
Springer Science and Business Media LLC
AbstractThere is no information on cytokine profiles for use as markers of protection in Campylobacter jejuni infection. To study this, we used outer membrane protein (MOMP [PorA]) as the vaccine for protection and spleen cell cytokines as markers of protection. We cloned and expressed porA from C. jejuni111 and immunized mice by the intraperitoneal route. Subsequently, mice were orally challenged with live C. jejuni 111. The vaccine induced protection as evidenced by reduced fecal excretion of C. jejuni111. Cytokines were measured in vitro after stimulation of spleen cells with MOMP. The levels of pro-inflammatory cytokines, IL-12, TNF-α, IL-17A and IL-17F were similar in control and test mice. The levels of pro-inflammatory cytokines, IL-2 and IFN-γ were higher in control mice than in test mice, and the levels of pro-inflammatory cytokines, IL-8 and IL-1β were higher in test mice than in control mice. Among the two anti-inflammatory cytokines, the levels were similar for IL-10 but higher for IL-4 in test mice than in control mice. Ratios of pro-inflammatory to anti-inflammatory cytokines showed a bias towards an anti-inflammatory response in favor of antibody production reflecting the role of antibodies in immunity. Cytokine production patterns by spleen cells may be used as markers of protection in the mouse model.

Establishing a many-cytokine signature via multivariate anomaly detection
K. Dingle, A. Zimek, F. Azizieh, and A. R. Ansari
Springer Science and Business Media LLC
AbstractEstablishing a cytokine signature associated to some medical condition is an important task in immunology. Increasingly, large numbers of cytokines are used for signatures, via lists of reference ranges for each individual cytokine or ratios of cytokines. Here we argue that this common approach has weaknesses, especially when many different cytokines are analysed. Instead, we propose that establishing signatures can be framed as a multivariate anomaly detection problem, and hence exploit the many statistical methods available for this. In this framework, whether or not a given subject’s profile matches the cytokine signature of some condition is determined by whether or not the profile is typical of reference samples of that condition, as judged by an anomaly detection algorithm. We examine previously published cytokine data sets associated to pregnancy complications, brain tumours, and rheumatoid arthritis, as well as normal healthy control samples, and test the performance of a range of anomaly detection algorithms on these data, identifying the best performing methods. Finally, we suggest that this anomaly detection approach could be adopted more widely for general multi-biomarker signatures.

Circulatory Levels of RANKL, OPG, and Oxidative Stress Markers in Postmenopausal Women With Normal or Low Bone Mineral Density
Fawaz Y Azizieh, Diaa Shehab, Khaled Al Jarallah, Renu Gupta, and Raj Raghupathy
SAGE Publications
Introduction: Receptor activator of nuclear factor κB ligand (RANKL), osteoprotegerin (OPG), and oxidative stress markers are suggested to contribute to bone loss in osteoporosis that occurs in menopause. However, the association between these markers and bone mineral density (BMD) is controversial. The aim of this study was to measure circulatory levels of these parameters in postmenopausal women with normal or low BMD. Methods: The study population included 71 postmenopausal women, of whom 25 had normal BMD, 31 had osteopenia, and 15 had osteoporosis. Serum levels of RANKL, OPG, and 5 oxidative stress markers (catalase, peroxiredoxin 2 [PRX2], superoxide dismutase 1 [SOD1], superoxide dismutase 2 [SOD2], and thioredoxin [TRx1]) were measured using the Multiplex system. Results: As compared with subjects having normal BMD, subjects with low BMD had significantly lower median serum levels of OPG, catalase, SOD2, and PRX2 ( P = .004, .031, .044, and .041 respectively). Although levels of RANKL were not different between the 2 groups, the RANKL/OPG ratio was higher in women with low BMD ( P = .027). Conclusions: These data provide insights into the possible roles of OPG, RANKL, and oxidative stress in the pathogenesis of postmenopausal osteoporosis. However, the lack of association between these markers and BMD indicates that osteoporosis is complex and multivariate.

Circulatory pattern of cytokines, adipokines and bone markers in postmenopausal women with low BMD
Fawaz Y. Azizieh, Dia Shehab, Khaled Al Jarallah, Olusegun Mojiminiyi, Renu Gupta, and Raj Raghupathy
Informa UK Limited
Objective: In addition to some well-characterized bone turnover markers (BTMs), cytokines and adipokines have also been suggested to be linked to osteoporosis seen in menopause. However, there is much controversy on the possible association between these markers and bone mineral density (BMD). This study was aimed at measuring circulatory levels of selected cytokines, adipokines and BTMs in postmenopausal women with normal and low BMD. Methods: The study population included 71 post-menopausal women, of whom 25 had normal BMD, 31 had osteopenia and 13 had osteoporosis. Circulatory levels of selected pro-resorptive (TNF-α, IL-1β, IL-6, IL-8, IL-12, IL-17), anti-resorptive (IFN-γ, IL-4, IL-10, IL-13, TGF-β) and five adipokine markers (adiponectin, adipsin, lipocalin-2/NGAL, PAI-1 and resistin) were measured using the Multiplex system and read on the Magpix ELISA platform. Further, two bone turnover markers (PINP, CTX) as well as estradiol levels were assayed from the same samples. Results: While circulatory levels of cytokines were comparable between groups, women with low BMD had statistically significantly higher median circulatory levels of adipokines as compared to those with normal BMD. Further, while levels of CTX were not different between the two groups; PINP, PINP/CTX ratio and estradiol levels were significantly lower in women with low BMD. Levels of adiponectin, PINP, PINP/CTX ratio and estradiol correlated significantly with BMD of the hip and spine. Conclusion: The associations between various markers and BMD are complex and multivariate. Our data provide insights into the possible use of circulatory levels of cytokines, adipokines and bone turnover markers on the pathogenesis of postmenopausal osteoporosis because of the well-documented effects of these molecules on bone tissue and their relevance to osteoporosis.

Multivariate analysis of cytokine profiles in pregnancy complications
Fawaz Azizieh, Kamaludin Dingle, Raj Raghupathy, Kjell Johnson, Jacob VanderPlas, and Ali Ansari
Wiley
ProblemThe immunoregulation to tolerate the semiallogeneic fetus during pregnancy includes a harmonious dynamic balance between anti‐ and pro‐inflammatory cytokines. Several earlier studies reported significantly different levels and/or ratios of several cytokines in complicated pregnancy as compared to normal pregnancy. However, as cytokines operate in networks with potentially complex interactions, it is also interesting to compare groups with multi‐cytokine data sets, with multivariate analysis. Such analysis will further examine how great the differences are, and which cytokines are more different than others.MethodsVarious multivariate statistical tools, such as Cramer test, classification and regression trees, partial least squares regression figures, 2‐dimensional Kolmogorov‐Smirmov test, principal component analysis and gap statistic, were used to compare cytokine data of normal vs anomalous groups of different pregnancy complications.ResultsMultivariate analysis assisted in examining if the groups were different, how strongly they differed, in what ways they differed and further reported evidence for subgroups in 1 group (pregnancy‐induced hypertension), possibly indicating multiple causes for the complication.ConclusionThis work contributes to a better understanding of cytokines interaction and may have important implications on targeting cytokine balance modulation or design of future medications or interventions that best direct management or prevention from an immunological approach.

FRAX- vs. T-score-based intervention thresholds for osteoporosis
H. Johansson, F. Azizieh, N. al Ali, T. Alessa, N. C. Harvey, E. McCloskey, and J. A. Kanis
Springer Science and Business Media LLC

Patterns of circulatory and peripheral blood mononuclear cytokines in rheumatoid arthritis
Fawaz Y. Azizieh, Khaled Al Jarallah, Diaa Shehab, Renu Gupta, Kamaludin Dingle, and Raj Raghupathy
Springer Science and Business Media LLC

Cytokine profiles in osteoporosis suggest a proresorptive bias
Fawaz Azizieh, Raj Raghupathy, Diaa Shehab, Khaled Al-Jarallah, and Renu Gupta
Ovid Technologies (Wolters Kluwer Health)
Abstract Objective: As the immune system is suggested to contribute to the pathophysiology of osteoporosis in menopause, we compared the levels of proresorptive and antiresorptive cytokines produced by peripheral blood mononuclear cells (PBMCs) from postmenopausal women with normal and low bone mineral density (BMD). Methods: Seventy-one postmenopausal women were studied; 25 had normal BMD and 46 had low BMD. Participants were categorized as normal (n = 25), osteopenic (n = 31), and osteoporotic (n = 15) based on T-scores. Levels of 10 cytokines produced by mitogen-stimulated PBMCs were measured by Multiplex ELISA. Results: PBMCs from women with low BMD produced higher levels of the proresorptive cytokines tumor necrosis factor-alpha, interleukin (IL)-6, IL-12, and IL-17 (P = 0.014, 0.012, 0.011, and 0.049), and lower levels of the antiresorptive cytokines IL-4, IL-10, and IL-23 (P = 0.003, 0.018, and 0.025) compared with women with normal BMD. Proresorptive cytokines were similar in osteopenic and osteoporotic women, but both had higher levels than women with normal BMD. Osteoporotic women produced lower levels of the antiresorptive cytokines IL-4, IL-10, IL-13, and IL-23 compared with the normal BMD group (P = 0.001, 0.05, 0.05, and 0.026), and lower levels of IL-4 as compared with osteopenic women (P = 0.05). Osteopenic women produced lower levels of IL-4 and IL-10 compared with the normal BMD group (P = 0.025 and 0.038). Ratios of proresorptive to antiresorptive cytokines suggest a stronger proresorptive cytokine bias in women with low BMD. Most of the ratios are lowest in the normal BMD group, modest in osteopenic women, and highest in the osteoporotic group. Conclusions: Women with low BMD have a proresorptive cytokine bias.

Fractures in Kuwait: Incidence and distribution
Fawaz Azizieh
Informa UK Limited
The absence of descriptive epidemiological data on the frequency and distribution of fractures in a population is serious and may underestimate the actual importance of this public health problem. In this study, we report the crude and standardized incidence rates of fractures in the population of Kuwait during the period 2009–2012. Using the Ministry of Public Health’s national registry, demographic data of all fracture cases between 2009 and 2012 were retrieved. These were further categorized into fractures at the hip or any other sites. Average annual incidence rates were calculated and standardized using the world’s population in 2010 as a reference. Thus, 18,119 fractures among males and 6,362 among females were recorded. The overall estimated annual incidence rates of fractures per 100,000 person-years were 207 for males and 111.8 for females. Moreover, 13.3% of all fractures were in the hip, with incidence rates of 24.8 for males and 18.9 for females; while 86.7% were in other sites, with corresponding incidence rates of 182.2 and 92.8, respectively. The age-specific fracture incidence rates in females remained below the corresponding rates of males until ≥50 years of age, after which the female age groups showed successively higher rates. The age-standardized incidence rates for all fractures (hip and other sites) were 247.4 for males, 175.4 for females, and 216.2 for both sexes. The burden of this major public health challenge is set to rise, and such population-based incidence data call for an urgent need for action to reduce the projected human impact and socioeconomic costs of fracture.

Association of self-reported symptoms with serum levels of vitamin D and multivariate cytokine profile in healthy women
Fawaz Azizieh, Khulood Alyahya, and Kamaludin Dingle
Informa UK Limited
Background Although a large number of studies have investigated possible relationships among serum levels of vitamin D or cytokines with disease progress and prognosis, similar studies on self-reported symptoms are still controversial. The overall objective of this study was to look into the association between serum levels of vitamin D or cytokines with self-reported symptoms related to musculoskeletal pain, sleep disorders, and premenstrual syndrome (PMS) in healthy adult women. Subjects and methods Venous blood samples were collected from 117 healthy adult women, and serum levels of vitamin D, pro-inflammatory cytokines (IL-1β, IL-6, IL-8, IL-17, IFN-γ, and TNF-α) and anti-inflammatory cytokines (IL-4, IL-10, and IL-13) were measured. Groups were tested for differences in single parameters, pro-:anti-inflammatory cytokine ratios, and differences in multivariate patterns. Results There were no significant associations between serum levels of vitamin D and any of the self-reported symptoms studied. However, serum levels of certain pro-inflammatory cytokines were significantly higher in subjects with musculoskeletal pain (IL-8, P=0.008), sleep disorders (IFN-γ, P=0.02), and PMS (IL-8 and TNF-α, P=0.009 and 0.002, respectively) compared to subjects who reported no symptoms. The pro-:anti-inflammatory cytokine ratios showed pro-inflammatory cytokine dominance in subjects with self-reported symptoms, particularly in the groups with deficient levels of vitamin D. However, the multivariate cytokine-pattern analysis was significantly different between PMS groups only. Conclusion These data point to a possible role of pro-inflammatory cytokines as a contributing factor in self-reported symptoms related to musculoskeletal pain, sleep disorders, and PMS.

IL-10 & pregnancy complications
F.Y. Azizieh and R. Raghupathy
IMR Press
PURPOSE OF INVESTIGATION Successful pregnancy depends on the ability of the mother's immune system to undergo a process of immunoregulation in order to tolerate the fetus, and also to create and sustain a nurturing environment during all the stages of pregnancy. Several reports point to interleukin 10 (IL-10) as being vital for normal pregnancy, and low IL-10 levels as being associated with preg- nancy complications. This study aimed to compare IL-10 levels in normal and complicated pregnancy conditions. MATERIAL AND METHODS The authors compared levels of IL-10 produced upon stimulation of maternal peripheral blood mononuclear cells (PBMC) from women at different stages of normal gestation with those produced by women with pregnancy complications, such as recurrent spontaneous miscarriage (RSM), preterm delivery (PTD), premature rupture of fetal membranes (PROM), pre-eclampsia, and intrauterine fetal growth retardation (IUGR). RESULTS Median levels of IL-10 are statistically significantly lower in pathological conditions as com- pared to matching gestational ages of normal pregnancy. CONCLUSION Healthy pregnancy is associated with higher levels of IL-10, while pathologic pregnancies are associated with lower levels of IL-10.

Pro-inflammatory and anti-inflammatory cytokine profiles in fetal growth restriction
M. Al-Azemi, R. Raghupathy, and F. Azizieh
IMR Press
The purpose of this investigation was to measure cytokine production by maternal peripheral blood lymphocytes from women with intrauterine growth restriction (IUGR) and from healthy pregnant women, and to investigate the relationship between cytokine profiles and IUGR. Thirty-six women with IUGR and 22 control healthy pregnant women with normal fetal growth were studied. Levels of pro-inflammatory cytokines (IFNy, TNFa, IL-8, IL-12, IL-18, IL-23) and anti-inflammatory cytokines (IL-4, IL- 10, IL-13) produced by mitogen-stimulated peripheral blood mononuclear cells were measured by ELISA. Levels of the anti-inflammatory cytokine IL-4 were higher in normal pregnancy compared to IUGR, indicating an anti-inflammatory bias. Levels of the pro-inflammatory cytokines IL-6, TNFα, and IL-12 were significantly higher and levels of the anti-inflammatory cytokine IL- 10 lower in IUGR with placental insufficiency than in IUGR without placental insufficiency, suggesting a stronger pro-inflammatory bias in IUGR with placental insufficiency. Ratios of pro- to anti-inflammatory cytokines suggest a dominance of pro-inflammatory cytokines. The authors conclude that an increased pro-inflammatory cytokine bias is observed in IUGR compared to normal pregnancy, and an increased pro-inflammatory cytokine dominance is seen in IUGR with placental insufficiency compared to IUGR without placental insufficiency.

Association between levels of vitamin D and inflammatory markers in healthy women
Fawaz Azizieh, Khulood Alyahya, and Raj Raghupathy
Informa UK Limited
Background No one can deny that the biological importance of vitamin D is much beyond its classical role in bone metabolism. Several recent publications have highlighted its potential role in the functioning of the immune system. The overall objective of this study was to look into possible correlations between levels of vitamin D and inflammatory markers in sera of healthy adult women. These markers included proinflammatory cytokines (interleukin [IL]-1β, IL-6, IL-8, IL-17, interferon [IFN]-γ, and tumor necrosis factor [TNF]-α), anti-inflammatory cytokines (IL-4, IL-10, and IL-13), as well as C-reactive protein (CRP) as a general indicator of inflammation. Methods Venous blood samples were collected from 118 healthy adult women and serum levels of vitamin D, CRP, proinflammatory cytokines (IL-1β, IL-6, IL-8, IL-17, IFN-γ, and TNF-α), and anti-inflammatory cytokines (IL-4, IL-10, and IL-13) were measured. Results There were no significant direct correlations between serum levels of vitamin D and any of the inflammatory markers measured. However, subjects with deficient levels of vitamin D and high CRP produced significantly higher levels of the proinflammatory cytokines (TNF-α and IL-8) as compared to subjects with low CRP levels with nondeficient and deficient levels of vitamin D. Further, the anti-inflammatory/proinflammatory ratios suggest a role of vitamin D in maintaining an anti-inflammatory environment at low levels of CRP, an association that is weaker at high CRP levels in subjects with subclinical inflammatory situations. Conclusion These data point to a possible role of vitamin D as a contributing factor in balancing cytokines toward an anti-inflammatory role in inflammatory situations.

Tumor necrosis factor-α and pregnancy complications: A prospective study
Fawaz Y. Azizieh and Raj G. Raghupathy
S. Karger AG
Objective: The aim of this study was to compare the levels of tumor necrosis factor-α (TNF-α) produced by peripheral blood mononuclear cells in normal pregnancies and pregnancies with complications. Materials and Methods: Maternal peripheral blood mononuclear cells from women with a recurrent spontaneous miscarriage (n = 35), premature rupture of fetal membranes (n = 30), preeclampsia (n = 27) and intrauterine fetal growth retardation (IUGR; n = 36) were stimulated with mitogen or antigen, and the levels of TNF-α produced were compared to those produced by peripheral blood mononuclear cells from a normal pregnancy (n = 35). Results: The median levels of mitogen-induced TNF-α at the 1st, 2nd and 3rd trimester, and at normal delivery were 1,176.4, 4,320.9, 7,307.4 and 2,463.0 pg/ml, respectively, while those produced in the recurrent spontaneous miscarriage, premature rupture of membranes and preeclampsia cases were 4,159.8, 3,489.5 and 4,149.2 pg/ml, respectively. The differences were statistically significantly higher in these pregnancy complications (p = 0.04, 0.024 and 0.014) as compared to the levels in normal pregnancy. Furthermore, antigen-induced TNF-α levels were produced at statistically significantly higher levels by women with IUGR (120.4 pg/ml) compared to women with normal pregnancies (17.9 pg/ml; p = 0.041). Conclusion: Higher levels of TNF-α seem to play a role in these pregnancy complications, suggesting its pathogenesis in such conditions.

Incidence of hip fracture in Kuwait: a national registry-based study
Fawaz Y. Azizieh
Springer Science and Business Media LLC

Evaluation of bone mineral density in patients with chronic low back pain
Osama Al-Saeed, Ahmed Mohammed, Fawaz Azizieh, and Renu Gupta
Asian Spine Journal (ASJ)
Study Design This was designed as a retrospective study. Purpose We investigated the relationship between bone mineral density (BMD) and chronic lower back pain (LBP). Overview of Literature In spite of a large number of epidemiological surveys on the prevalence of LBP and BMD measurements completed separately in the general population, the relationship between the two has not been well documented. Methods The study included 171 patients with chronic LBP who underwent the BMD study. The control group was selected from our database regarding BMD without LBP. Results A total of 678 subjects, aged 18 to 100 years (mean, 49.9±12.9 years) were included in the study, 25% (n=171) of the subjects had LBP. Compared to those patients without LBP, patients exhibiting LBP had statistically significant lower mean weight, hip and spine BMD and T-score. Lower BMD and T-scores were significant regardless of the age group, gender, menopausal status, and obesity classification. Conclusions Chronic LBP has a negative correlation with hip and spine bone mineral density.

Cytokines as diagnostic markers of pulpal inflammation
M. ElSalhy, F. Azizieh, and R. Raghupathy
Wiley
AbstractAimTo measure and compare the levels of the cytokines IL‐2, IL‐6, IL‐8, IL‐10, TNF‐α and IFN‐γ in pulpal blood from irreversible pulpitis, asymptomatic caries exposure and normal pulps.MethodologyBlood was obtained from pulp exposure sites using cotton pellets. Twenty‐five samples were obtained from normal teeth, 40 from asymptomatic caries‐exposed pulps and 43 from irreversible pulpitis teeth. Cytokine levels were determined by high‐sensitivity ELISA. Data were statistically analysed using Kruskal–Wallis and Mann–Whitney U‐tests.ResultsSignificantly higher levels (P < 0.05) of IL‐6, IL‐8, IL‐10, TNF‐α and IFN‐γ were detected in caries‐exposed pulps and irreversible pulpitis as compared to normal teeth. IL‐2 and IL‐10 levels were significantly higher (P < 0.05) in caries‐exposed pulps as compared to irreversible pulpitis, whilst IL‐8 was significantly higher (P < 0.001) in irreversible pulpitis as compared to caries‐exposed teeth. Most interestingly, IL‐6/IL‐10 and IL‐8/IL‐10 ratios were significantly higher (P < 0.001) in irreversible pulpitis compared with both caries‐exposed and normal teeth.ConclusionLevels of IL‐8 and the ratios of IL‐6/IL‐10 and IL‐8/IL‐10 have the potential to be indicators of pulpal inflammation in caries exposure cases. Cytokine estimation in pulpal blood may help in the diagnosis of pulpal inflammation.

Relationship between leptin levels and suppressed CD4 counts in HIV patients
Mariam Al-Fadhli, Mohammad Saraya, Jafar Qasem, Fawaz Azizieh, Shahab Shahab, and Raj Raghupathy
S. Karger AG
Objective: To examine the relationship between serum leptin levels and suppression of CD4 count in HIV-infected individuals with highly active antiretroviral therapy (HAART). Subjects and Methods: Thirty seropositive HIV male patients selected from the Infectious Disease Hospital were classified into two groups according to their immunological and virological response to HAART. The first group included 15 male patients with low viral load and low CD4 counts; the second included 15 male patients with low viral load and high CD4 counts. Morning serum leptin and tumor necrosis factor-α levels of HIV patients were measured and correlated with fasting serum insulin, Homeostasis Model Assessment for Insulin Resistance (HOMA-IR), HIV viral load and CD4 count. Results: Serum leptin levels were significantly higher in patients with high CD4 counts than in patients with low CD4 counts (mean serum leptin level 47.3 vs. 10.9 ng/ml, respectively; p < 0.0001). A positive correlation was observed between serum leptin levels and CD4 counts (r = 0.697; p < 0.0001); positive correlations were also seen between leptin levels and fasting serum insulin and HOMA-IR (r = 0.633, p < 0.0001, and r = 0.537, p < 0.003, respectively). Conclusion: Serum leptin level was higher in HIV patients with high CD4 count and correlated with fasting serum insulin and HOMA-IR, thereby indicating that HAART treatment could lead to decreased levels of leptin in HIV patients, which might lead to impaired immunological recovery.

Asthma during pregnancy: An immunologic perspective

Evaluation of Bone Mineral Density in Postmenopausal Women in Kuwait
Renu Gupta, Osama Al-saeed, Fawaz Azizieh, Abdullatif Albusairi, Pushpak Gupta, and Ahmed Mohammed
Elsevier BV

Fawaz Azizieh

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