Unrecognized dyslipidemia among patients presented with first attack of acute coronary syndrome [ACS] in a multiethnic population in GMC hospital, Ajman, UAE [Dyslipidemia-ACS UAE Study]

Introduction: Acute coronary syndrome [ACS] is a major reason for hospitalization in our country. Dyslipidemia has been identified as one of the major modifiable risk factors for Coronary Artery Disease [CAD]. Our clinical observation was that many patients presenting with first ACS in Ajman, had no known risk factors, yet their routine investigations revealed lipid derangements. The aim of this study was to determine the prevalence of unrecognized dyslipidemia and its relation to other modifiable risk factors in an Ajman cohort of patients with first ACS

Materials and methods: All patients who visited the Department of Cardiology during the period of January 2006 to December 2012 with first attack of ACS without history of previous coronary artery disease or dyslipidemia were studied through a descriptive epidemiological approach. Case records of these were first reviewed, data collected and questionnaires were filled. From this, data was entered into excel spread sheet and was transformed to SPSS 21 version for statistical analysis

Results: A total of 438 case records were studied and 169 patients met inclusion criteria. Out of these, 141 patients [83.4%] were unrecognized dyslipidemics and 28 patients [16.6%] were non-dyslipidemics. We documented the demographic and clinical characteristics of the 141 unrecognized dyslipidemics along with other comorbid conditions. We found that most of the patients [54/141, 38.3%] were less than 40 years, 40/141 [28.4%] were between 41-50 years, and 47/141 [33.4%] were above 50 years. Majority of our patients were males [109/141, 77.3%], and Asians [74/141, 54%] were the major ethnic group being affected, followed by the Arabs [52/141, 38%]. We also found that smoking was the most common risk factor encountered in our population [57/141, 40.4%], followed by family history of early coronary artery disease [40/141, 36.7%], hypertension [47/141, 33.3%] and diabetes [29/141, 20.6.%]. 82 patients out of the 141 patients presented with high systolic and diastolic BP. During presentation non ST-segment elevation-ACS was a more frequent diagnosis [120/141, 85.1%] than ST-segment elevation myocardial infarction [13/141, 9.2%] or unstable angina [8/141, 5.7%]. The LDL levels >100 mg/dl in majority [123/141, 88.6%] of the patients

Conclusion: Dyslipidemia was one the major risk factors which was widely prevalent and it went unrecognized until being detected during the first presentation with ACS. There were also other risk factors which contributed to the presentation of ACS at a young age, especially in males. This research implied the importance of creating more awareness and maintaining strict control of lipid levels in at risk patients. It provides useful information to health authorities, to design locally relevant interventions

Tobacco use among patients with cardio-vascular diseases: a hospital based study, Ajman, UAE

Background: The proportion of deaths from coronary heart disease varied from 25 to 45% in the Eastern Mediterranean region and has become a major public health threat in the region

Objectives: The use of tobacco among patients with cardiovascular diseases reporting to the departments of Cardiology and Internal Medicine at GMC Hospital Ajman, UAE and the attitude of patients with cardiovascular diseases towards use after diagnosis was assessed

Materials and Methods: This cross-sectional study was conducted amongst 300 patients with cardiovascular diseases reporting to the Out-patient and In-Patient of departments of Cardiology and Internal Medicine of GMC Hospital Ajman, UAE. An interviewer-administered questionnaire was used for data collection. SPSS-21 version was used to perform statistical analysis. The proportion of tobacco users was estimated. The participants were divided into smokers and non-smokers and the association between smoking habits and sociodemographic variables, and clinical conditions were assessed

Results: Out of 300 participants, 194[64.7%] were between age 30 and 50 years, and 225[75%] were males. The Highest number 146[48.7%] was found to be from the Eastern Mediterranean region. Among the 300 participants, 142[47%] used tobacco. Amongst the 142 tobacco users, 40[28.2%] of them consumed shisha with an average age of initiation being 25 years and the average consumption before and after CVD being once daily. For cigarette smoking, there were 125[88%] participants with an average age of initiation of 20 years, while the average quantity before CVD being fifteen in a day, which decreased to five in a day after CVD. Of the participants, 1[0.7%] was found to use Dokha, starting after CVD at the age of 45, consuming five in a day. The most consumed type of tobacco among males is cigarette as nearly 120 participants smoked. Males accounted for almost 96% of total smokers. On the other hand, the most consumed type of tobacco among females is shisha; nearly 15% of shisha smokers were female, whereas males accounted for 85%. Eight participants were found to have only arrhythmias and 4 [50%] were consumers of tobacco products. Four participants had only angina pectoris and 3 [75%] out of those 4 consumed tobacco. Ninety eight participants had dyslipidemia alone, out of which, 42 [42.9%] were tobacco users. Ninety-five participants had combined disease effect, of those, 50 [52.6%] were found to consume tobacco products. There was a significant association between tobacco use in patients with cardiovascular diseases and gender

Conclusion: The proportion of tobacco use among the participants with cardiovascular disease was 47.3%. Cigarette had the highest consumption rate out of all the other forms of tobacco. There was a significant association between tobacco use in patients with cardiovascular diseases and gender. Smoking was found to be more prevalent among males than females. Among males, cigarette smoking was more common while in females the use of shisha was more common

[Effectiveness of group cognitive-behavioral training on physiological indicators and communication skills in the hospital staffs]

Introduction: high levels of stress in the health professionals and deficit in communication skills of this group can endanger their mental health and reduce their job efficacy. Current study aimed to identify the effectiveness of the group cognitive-behavioral training on physiological indicators and communication skills of the hospital staff

Method: this was a semi-experimental study using pre-test-post-test design. The sample group consisted of 32 people [16 experimental and 16 control groups] in one of the randomly selected Tehran hospitals. Intervention program was conducted weekly in 4 sessions each 4 hours on the subjects of the experimental group. Data were collected using Physiological Reactions to Stress [PRS] and Communication Skills Test-Revised [CSTR] before and after the intervention from both groups and was analyzed by analysis of covariance using SPSS software [v. 19]

Results: the results showed that the cognitive-behavioral training significantly increased the mean of communication skills and a significant reduction of physiological indicators in the experimental group compared with the control group

Conclusion: group cognitive-behavioral training is an effective way to improve mental health of health staff. Therefore, more attention from the health managers and clinical health researchers is needed in this field

Apoptosis and oxidative stress in b thalassemia major in children

In B thalassemia the synthesis of beta globin chains is decreased .This interferes with the assembly of normal Hb A,. Recently apoptosis has been noted to play a central role in regulation of hemopieosis. Excess iron could generate reactive oxygen species [ROS] that may be involved in turn in lie damage of cellular compartment adding to apoptosis . The aim of this work is to study apoptosis and oxidative stress in B thalassemia major in children and their relationship to the severity of the disease and to the use of chelation . A cross sectional study of 56 patients with B thalassemia major aged 8 M -13 y as well as 10 apparently healthy age and sex- matched control . Beside full history and examination all patients and controls had the following investigations done Hb, serum ferritin, ALT, AST, ALP, FAS, TBARS and DNA damage measurement. Correlation studies showed that fas and TBARS showed significant negative correlation with Hb and significant positive correlation with ferritin . Newly diagnosed patients [First admission] showed significantly less severe DNA damage than recurrent cases . Chelated patients scored significantly better lhan non chelated patients . Patients on chelation showed significant better outcome regarding apoptosis and oxidative stress, therefore we must be ready with early chelation in all B thalassemia cases

Molecular fingerprinting of the Egyptian medicinal plant Cocculus pendulus

The genus Cocculus belongs to the family Menispermaceae which comprises about 35 species of shrubs or woody climbers. Only one species, Cocculus pendulus is found in Egypt. This plant is reported to have good medicinal values in traditional system of medicine. Despite the wide occurrence of C. pendulus in the Egyptian deserts, attention was paid only to its distribution and morphological description ignoring the biochemical constitution, the genome makeup and environmental aspects which are not given due consideration. Since no information about the genome of C. pendulus is available, the current study deals with molecular investigation of C. pendulus expressed by DNA fingerprinting of the young leaves of this plant using amplified fragment length polymorphism [AFLP] technique with four primer combinations. The obtained results revealed a total of 228 bands with an average of 57 bands for each primer combination, of which 61 bands were polymorphic [26.8%] ranging in size from 59 to 570 bp. The number of amplicons/primer pairs ranged from 48 [E-AGG/M-CAC] to 72 [E-AAC/M-CAG] while the number of polymorphic amplicons varied from 13 to 21 with polymorphism percentage of 22.03-29.17%. Thus the average number of polymorphic fragments/combinations was 15. In this regard, the combination E-AGG/M-CAC was more efficient as confirmed by computing the discriminating power [D] of all primer combinations. Also, the AFLP marker gives a complete informative and highly discriminative picture about C. pendulus as shown by [PIC = 0.99]

Antioxidant activity of satureja hortensis L. essential oil and its application in safflower oil

It has been considered by researchers to study the possibility of replacing chemical food additives [synthetic antioxidants] by natural products [medicinal plants]. This study investigated the antioxidant properties of Satureja hortensis L. essential oil [SHEO] on safflower oil oxidation. Different assays have been used to evaluate the antioxidant activity of SHEO: total phenol content [TPC], DPPH, ABTS+, ferric thiocyanate [FTC], beta - carotene bleaching. For evaluation of SHEO effect on safflower oil oxidation, peroxide value [PV], conjugated dienes [CD], and tiobarbituric acid [TBA] indices were compared with BHT [a synthetic antioxidant]. TPC of SHEO was determined to be 293.7 mg gallic acid equivalent in 1 ml of sample and IC[50] was 0.71 mg/ml in DPPH. 0.4 and 0.1 mg/ml of SHEO at all time [1, 5, 10, 15 min] showed the highest and lowest antiradical ABTS+ activity [118.2 and 26.6 microg/ml AscAE =Ascorbic acid equivalent] in 15 min. In FTC and FTC-TBA, 8 mg/ml SHEO showed the highest activity. In beta-carotene bleaching of 0.1-2 mg/ml SHEO, 0.1 has the minimum [%9.02], and 1 and 2 has the maximum inhibitory effects [%34.33 and%36.86 inhibitions]. 4 mg/ml of SHEO had the highest inhibitory effect in the safflower oil test and that peroxide does not have significant difference with 0.1 mg/ml BHT. Antioxidant activities of SHEO concentrations increased in all indices [pandamp; lt; 0.05] and various concentrations were able to slow down the oxidation process

Application of satureja hortensis l. and zataria multiflora boiss. Essential oils as two natural antioxidants in soybean oil during microwave heating

Autoxidation is considered to be the main route of edible oil deterioration, which produces undesirable odors and flavors during storage and heating. The unpleasant flavor of oxidized oil has been attributed to primary and secondary products of unsaturated fatty acids. The microwave heating is a rapid method when compared with other methods of heating. In this research, the effect of microwave heating on the oxidative stability of soybean oil amended with either of Satureja hortensis L. [SHEO] and Zataria multiflora Boiss [ZMEO] essential oils was evaluated and compared with synthetic antioxidant [butylated hydroxyl toluene= BHT; 200 ppm]. Soybean oil containing with SHEO [200 and 1000 ppm], ZMEO [200 and 1000 ppm] and BHT [200 ppm] were heated using microwave oven [600 W] for 25 min and spectrophotometer was used to determine UV absorption. Peroxide value [PV], conjugated dienes [CD] and conjugated trienes [CT] indices were measured. Statistical results showed that PV after 25 min were increased in all treatments and the stability of soybean oil treated with synthetic antioxidant [BHT, 200 ppm] was higher than oil treated with the studied essential oils [SHEO and ZMEO, 200 and 1000 ppm]. Diene and triene indices increased during the heating. There was a positive correlation between PV, diene and triene indices during the process of microwave heating. The two essential oils [SHEO and ZMEO, in concentrations of 200 and 1000 ppm] showed fairly good antioxidant activities as compared with BHT [200 ppm] in soybean oil control sample [refined- bleached- deodorized soybean oil without any additives]

Determination of serum C and S protein and factor V leiden in sickle cell disorder in Khozestan province

Sickle cell disease [SCO] is due to beta chain mutation and substitution of valine for glutamic acid in sixth position,that is cause increasing polymerization and vaso-occlusion. Decrease of protein C, protein S and increase in factor V leiden activity contribute to hypercoagulation state in SCO, recently.The aim of this study was to determinate the differences of serum C and S protein and factor V leiden between sickle cell patients and control subjects. In this randomized case-control study, protein C, protein S and factor V leiden activity were measured in 100 SCO patients in crisis phase. And were compared between 50 age- gender -race- matched controls and SCD patients in, hydroxyurea intake, blood transfusion, levels of HbF, age and gender by Chi-Square and Anova statistical tests in SPSS software. In 100 patients 47 were males and 53 females, mean age was20.2 [range 3-58, 1SD +/- 1.03]. Protein C and protein S levels were significantly low [both P<0.0001] in 35% and 24% patient; respectively. But in controls it was not like this. Factor V leiden was increased significantly [P<0.00l] in 27% of patient and 4% of controls. A significant [P=0.02] correlation was detected between protein S levels and age groups. Protein C and protein S levels reduced and factor V leiden activity increased in SCD patients and cause hypercoagulable state in these patients

longitudinal study to investigate the role of IL-6 and IL-7 in the pathologenesis of early rheumatoid arthritis

Previous researches indicate that IL-6 is a pro-inflammatory cytokine in RA that can drive Th17 cell development in mice and humans. Data from experimental arthritis models suggest that Th17 cells are pathogenic via production of the pro-inflammatory cytokines IL-17 and TNF alpha, leading to monocyte and fiboblast activation, and involvement in osteoclastogeneis and joint damage. The aim of this study is to investigate if interleukin-6 [IL-6] and/or interleukin-17 [IL-17] and Th17 cells are biomarkers for disease progression and severity in early Undifferentiated Arthritis [UA] and/Rheumatoid Arthritis [RA] patients. We performed a longitudinal study recruiting 20 patients with either undifferentiated inflammatory arthritis or early rheumatoid arthritis. We also recruited 30 age [mean = 46] and sex-matched healthy controls. The patients were assessed at baseline, 6 and 12 months for the American College of Rheumatology [ACR] criteria, Rheumatoid factor [RF], Anti Citrullinated Peptides [Anti-CCP], ESR, CRP, X-Ray of the hands and feet, joint count, patient global assessment, DAS28 and Quality of Life [HAQ] measurements. Peripheral blood and serum samples were taken and PBMC isolated. Cell subset analysis [CD3, CD4/CD8, and CD14] was performed ex vivo. Peripheral blood monocytes in RA and UDA showed the proportion of IL6 CD14+Monocytes significantly higher in RA patients at base line than the UDA. Sero-positive patients were higher in the proportion of [Total IL17 CD3 +CD4+Tcells, IFNgamma+IL17+CD3+CD4+Tcells, IL6 CD14+Monocytes] than the sero-negative patients but that differences did not reach statistical significance. The longitudinal follow up for the early arthritis group, showed a significant change in the%IL6 Monocytes. The proportion of IL6 and IL17 in peripheral blood of early rheumatoid arthritis shows a weak correlation with disease activity which could not be an ideal biomarker for disease activity in comparison to synovial level of these cytokines

Results of chemotherapy by UKCCSG protocol in children with acute lymphoblastic leukemia: clinical characteristics and outcome

Acute lymphoblastic leukemia [ALL] represents a clonal expansion and arrest of normal lymphoid hematopoiesis. ALL remains the most common malignancy in children. The survival rate of the patients is significantly increased since the 1960s. This study was undertaken to evaluate the 5- year overall survival [OS] rates of patients with ALL in a single center in Iran. A total of 220 children with ALL up to 15 years old who had been treated by UKCCSG protocol at the Oncology Department in Shafa Hospital from March 1997 to October 2004 were evaluated for their age, gender, as well as FAB types, presenting features, outcomes of therapy and relapse. The mean age of the patients was 6.69 years [SD= 3.8, median 6 years]. In this series, 123 patients [55.9%] were male. There was a complete remission induction rate of 85.5% during first induction course of therapy. Five-year overall survival was 60.9% and it was better [p=0.006] in standard risk group. Relapse rate after first remission was 23.6% and death due to relapse was more in high risk group, but it was not significant [p=0.053]. There were 59[68.6%] of total deaths in induction period and 18[20.9%] after relapse. Overall infections [69.4%] were major cause of deaths in induction period. OS was better in boys, age group between [1-10 yo] and initial white blood cells count [10,000-50,000x10[3]/mm[3]] but there were not significant [p=0.39, p=0.30, p=0.202, respectively]. Five-year overall survival was 60.9% of the children with new ALL who were undergoing chemotherapy by UKCCSG protocol. High mortality rate in induction period was mainly due to infections which decreased five-year overall survival in this study

[Successful treatment of refractory thrombotic thrombocytopenic purpura with rituximab, a monoclonal antibody: a case report]

Thrombotic thrombocytopenic purpura [TTP] is mostly attributed to the presence of an autoantibody against ADAMTS-13, a metalloprotease that degrades ultralarge von Willebrand protein multimers. Accumulation of vWF multimers and systemic platelet aggregation lead to microangiopathic thrombosis, hemolytic anemia, and end-organ ischemia. Most patients respond to therapeutic plasma exchange [TPE], which replaces the missing protease and removes the circulating inhibitor. However, some cases [10%-20%] might not respond to TPE alone, and, therefore, interest has been aroused to use the novel immunosuppressive anti-B-cell antibody, rituximab. We report a 12-year old male patient with severeTTP refractory to multiple courses of plasmapheresis and high-dose steroid treatment in whom the combined use of daily plasma exchange and rituximab was associated with clinical resolution of active TTP, and we discuss the benefits and possible timing of combined therapy. Retuximeb used with plasma exchange can lead to sustained clinical remission in patients with refractory autoimmune TTP

[Identifing relationships among acute phase proteins [Hp and Fb], albumin and clinical findings in dairy calf pneumonia]

Enzootic calf bronchopneumonia is a multyfactorial disease that occurs in association whit the in telaction of various infectious agenes, and colf susceptibility. The economic losses is associated with death loss and treatment costs, reduction of live weight gain and reduced of productive life span, whith mey be considevable. The aim of this study was to examine the acute phase response in calves with enzootic pneumonia. We measured acute phase proteins [App] and identified some potential markers useful for evaluation of calve's health status. Sixty Holstein calves within two weeks to six months old were divided into two groups. Clinical findings of individual were recorded after the physical examination. Blood samples were taken from the calves and were used for Complete blood count [CBC] and serum biochemical evaluation. Clinical findings including body temperature, pulsation, and respiratory rate were significant between two groups. Hematological parameters showed no significant differences between two groups as well as some biochemical profiles [albumin and globulin]. The results of this study indicated a significant increase in Haptoglobin [Hp] and Fibrinogen [p<0.05]. Our results showed the application of Haptoglobin and fibrinogen measurements as indicators of health in calf herds, thereby facilitating treatment decisions

[Effects of eucalyptus globules labill essential oil on some immunological variables of common carp [cyprinus carpio]]

Influence of both dietary and bath administration of Eucalyptus globules labill was evaluated on some immunological variables of common carp [Cyprinus carpio] under temperature less than optimum in order to determine stimulatory effect of the essential oils. Fish weighing 30-35 g were bathed or fed with different doses of 30, 60 and 120 micro/L or mg/kg feed for a period of 8 days. Serum lysozyme activity, bactericidal activity, total white blood cells, total protein, globulin and albumin were measured on days 1, 2, 8, 15 and 23 after the essential oils administration. On day 23 post administration the remaining fish from each group were intraperitonealy injected with killed Aeromonas hydrophila [6x10[8] cells/ml] and antibody titer was measured 3 weeks later. The obtained results showed that Eucalyptus globules had a limited immunostimulatory effect on these immunological variables although antibody titers and total white blood cells in some test groups were significantly [p<0.05] higher than the control one. The reduction of the immunological factors is probably related to the lower water temperature, inappropriate administrating dose and duration of essential oils administration

Autologous bone marrow-derived stem cell therapy in patients with Buerger's disease

Patients suffering from Thrornboangiitis Obliterans [TAO] or Buerger's disease have endothelial cell dysfunction and the severity of the disease lies in the need for amputation in more than a quarter of all sufferers. The aim of present study was to determine whether granulocyte colony-stimulating factor mobilized autologous bone-marrow derived mononuclear cells transplantation improves endothelial dysfunction in these patients. Circulating mononuclear cells containing endothelial progenitor cells were obtained from patients following bone-marrow mobilization with granulocyte colony stimulating factor. Mononuclear cells and CD34+ cells were enumerated prior to intramuscular injection into the affected limbs. In this pilot study, autologous bone-marrow derived mononuclear cell therapy collected from peripheral blood following granulocytes colony stimulating factor [G-CSF] mobilization was effective, safe and resulted in sustained clinical results for patients with severe peripheral occlusive arterial diseases

[Autologous transplantation of peripheral blood mononuclear stem cells in patients with buerger's disease following stem cell mobilization with granulocyte-colony stimulating factor: a report of three cases]

Treatment with autologous peripheral blood mononuclear stem cells [PB-MNCs] has shown benefits in patients with Buerger's disease. The purpose of this study was to evaluate the feasibility, safety and efficacy of PB-MNCs transplantation in patients with Buerger's disease. Three patients were treated by PB-MNCs transplantation. The patients received G-CSF at a dose of 5 ug/kg/day prior to the treatment. Stem cells were harvested from peripheral blood and injected directly into the muscle of the affected limbs. Patients reported pain relief after approximately one month. Venous oxygen saturation in the affected lower limb increased and clinical symptoms showed improvement. Angiographic scores were significantly improved in the transplanted patients. Satisfactory clinical improvements were observed by injecting PB-MNCs after G-CSF mobilization, suggesting that this novel cell therapy method is feasible, safe and efficient. No adverse effects were observed following the intramuscular administration of stem cells

Alterations of serum levels of zinc, copper and selenium trace elements in juvenile idiopathic arthritis and acute rheumatic fever: preliminary findings

Some trace elements such as zinc, copper and selenium [Zn, Cu and Se] are catalytic, structural and regulatory ions for enzymes, proteins and transcription factors, and is thus are critical in many homeostatic mechanisms of the body, including immune responses. Our knowledge about changes in Zn, Cu and Se elements in juvenile idiopathic arthritis [JIA] and acute rheumatic fever [ARF] is incomplete. We hypothesize that "development of JIA and ARF is associated with alterations of Zn, Cu and Se trace elements". To test this hypothesis and to fill this existing gap in literature. Serum level of Zn, Cu and Se was examined in healthy individuals [10.0 control cases], JIA and ARF [23 and 19 cases, respectively] using atomic spectrophotometric assays. Compared to the control group, there were a reduction of serum Se levels and Zn levels and elevation of Cu levels in JIA and ARF. These changes were more obvious with disease activity, polyarticular involvement [JIA] and presence of cardiac affection [ARF]. Meanwhile, there was a significant direct correlation among the activity indices and both serum Zn and Se levels. The significant alterations of some serum trace elements in JIA and ARF suggest possible roles for these elements in the development of these lesions. The diagnostic and prognostic ramifications of these findings are open for further investigations

study of demand of military staff and their family members on counseling and psychotherapy

Counseling and psychotherapy are essential for today life. Military staffs and their families are exposed to stresses of military environment along with their common life stressors. Therefore, their demand of counseling service is more. This was a descriptive study performed on 1892 selected subjects in 2003 to recognize the demands of Sepah personnel and their family members for counseling and psychotherapy. The sampling method was double-cluster and the selected data were obtained by questionnaire and analyzed by statistical mean, percentage and Chi-Square tests. Results revealed that counselors and psychotherapies are secondary source for counseling life problems and the major life problems of subjects in order were as follow: family relationship, parenting or child rearing and psychological problems. Most subjects asked for establishment of counseling centers to be accessible and application of specialized counselors.The counseling services in military organization have to be adjusted with clients neediness.

[ study of demand of military staff and their family members on counseling and psychotherapy]

Background: Counseling and psychotherapy are essential for today life. Military staffs and their families are exposed to stresses of military environment along with their common life stressors. Therefore, their demand of counseling service is more

Materials and methods: This was a descriptive study performed on 1892 selected subjects in 2003 to recognize the demands of Sepah personnel and their family members for counseling and psychotherapy. The sampling method was double-cluster and the selected data were obtained by questionnaire and analyzed by statistical mean, percentage and Chi-Square tests

Results: Results revealed that counselors and psychotherapies are secondary source for counseling life problems and the major life problems of subjects in order were as follow: family relationship, parenting or child rearing and psychological problems. Most subjects asked for establishment of counseling centers to be accessible and application of specialized counselors

Conclusions: The counseling services in military organization have to be adjusted with clients' neediness

Plasma endothelin-1 and nitric oxide in children with insulin-dependent diabetes mellitus

Dysfunction of vascular endothelium is considered an early step in the development of diabetic complications. To assess plasma endothelin-1 [ET-1] and nitric oxide [NO] levels in children with insulin-dependent diabetes mellitus [IDDM] and their relation to the degree of metabolic control and disease duration. Plasma ET-1 and NO levels were assessed-by enzyme immunoassay-in 34 children with IDDM and compared to 17 healthy controls of matched age and sex. Diabetic patients had higher plasma ET-1 levels compared to controls [median [IQR]=5.9 [4.9-39.2] Vs 4.9 [4.4-6.1] pg/mI, P=0.02]. ET-1 levels were higher in patients with poor and moderate metabolic control when compared to those with ideal control [p=0.004 and 0.001; respectively]. ET-1 levels were positively correlated with NO levels [r=0.48, p=0.004]; HblAc level [r=0.57, P=0,001]; and disease duration [r=0.39, p=0.02]. Although, plasma NO levels in diabetic patients were not significantly different from controls [median [IQR]=24.6 [21.9-30.2] Vs 22.0 [21.0-26.5] umol/L, P 0.09]; NO levels were significantly higher in patients with poor metabolic control when compared to those with ideal control [p<0.001]. In children with IDDM, poor metabolic control and increased disease duration are associated with increased ET-1 production, which may be related to future diabetic complications. The elevated plasma NO levels in poorly controlled patients might mean a compensatory protective response towards increased ET-1 production

Frequency of pulmonary tuberculosis in cirrhotic patients with resistant chest infection

24 cirrhotic patients with resistant chest infection were selected for this study. Full clinical assessment, liver function tests, abdominal ultrasonography, and tuberculin skin test were done for all patients. Also, bacteriological examination of sputum for acid fast bacilli [AFB] by direct stained film and cultured on Lowenstein-Jensen [L-J] medium for mycobacteria PCR to search for mycobacterium tuberculosis complex DNA using primer set for DNA segment of the IS 6110 was performed for all cases. The prevalence of tuberculosis among the 24 patients was 29.2% by one or more employed technique. Direct microscopy alone showed 2 positive cases [8.3%] for AFB, and L-J cultures were positive in 5 cases [20.8%] whereas PCR revealed 5 [20.8%] patients, 2 of them were negative by direct microscopy and L-J culture. The sensitivity and specificity of direct stained film were 40% and 100% respectively. Whereas the sensitivity and specificity of PCR in diagnosing tuberculosis were 100% and 89.5%. There were significant difference between tuberculous and non tuberculous patients as regard prolonged fever and elevated enzymes whereas no significant difference as regard other studied parameters. In pulmonary tuberculosis is not uncommon cause of resistant chest infection in cirrhotic patients and should be considered as an important cause of such resistance. PCR is rapid, sensitive, specific and valuable tool for diagnosing pulmonary tuberculosis especially in immunocompromised patients