Possible role of leptin, and tumor necrosis factor-alpha in hypoandrogenicity in patients with early rheumatoid arthritis

Hypoandrogenicity is common in men with rheumatoid arthritis who have lower levels of sex hormones such as testosterone and dehydroepiandrosterone sulphate. The fat tissue hormone leptin is stimulated by tumor necrosis factor alpha [TNF-alpha], and was found to be associated with hypoandrogenicity. To study the inter-relation between serum levels of TNF-alpha, leptin and androgens in early diagnosed RA. Serum levels of TNF-alpha, leptin, testosterone, and [DHEAS] hormones were measured by ELISA and compared in 40 men with early RA and 30 healthy volunteers. The mean serum leptin and TNF-alpha were significantly elevated in patients with RA compared to control group, and both of them were positively correlated with the disease activity score [DAS28]. Sex hormones [testosterone and DHEAS] were significantly decreased in male patients with RA compared to control group, and they were negatively correlated with serum TNF-alpha, leptin. Our data suggest that TNF-alpha, and leptin may be involved in hypoandrogenicity in patients with RA and that strategies aimed at interfering with leptin axis could represent innovative therapeutic tool for hypoandrogenicity in RA

Angiogenic factors in Egyptian bladder cancer patients

Bladder cancer is the second most common urological cancer with an estimated 53,200 diagnosed cases and 12,100 resultant deaths in the year 2000. The incidence of bladder cancer has increased over the past two decades due to improved detection rate of the early stages of the disease i.e. superficial bladder cancer, while the decreasing mortality rate results from a decrease in the incidence of invasive and metastatic form of the disease and improvement in the therapy. Angiogenesis is a prerequisite for normal growth and development and abnormal angiogenesis is a critical feature of many diseases including cancers. The molecules that stimulate angiogenesis are called antigenic factors and are released by tumour cells or leukocytes within the turnour. This submitted work has been performed to fulfill the following objectives: 1- Determination of the angiogenic stimulators, Platelet derived growth factor [PDGF] and nitric oxide [NO] in sera as well as basic fibroblast growth factor [bFGF], hyaluronic acid [HA] and hyauronidase [HAase] in urine of patients with bladder cancer as well as reference healthy persons and patients with benign bladder lesions for comparison. 2- Matching of the assayed measures to be correlated with clinicopathological criteria of patients. The current study included 60 patients divided into two groups: I] Group 1: included 30 patients who were already diagnosed as bladder cancer by cystoscopy and biopsy, and further subdivided into 2 subgroups according to the histopathological picture of their cancer tissues into: A] Squamous cell carcinoma [76.7%] included 22 patients B] Transitional cell carcinoma [23.3%] included 8 patients II] Croup II: included 30 patients with benign bladder lesions subjected to: 1] Thorough clinical examination. 2] Urine analysis 3] complete blood picture. 4] Cystoscopy. 5] Biopsy and histopathological examination of the tissue sample. The study also included 14 reference healthy subjects. The work has concluded that serum levels of PDGF were significantly higher [p<0.0001] in patients with bladder cancer compared with both of benign -bladder diseases and the -healthy subjects. Meanwhile, serum levels of PDGF were also significantly higher in-patients with benign bladder diseases compared to healthy persons. Measured bFGF in the urine of patients with bladder cancer was significantly higher with respect to those with benign lesions as well as the reference healthy cases. [P<0.0001]. Urinary HA of bladder cancer patients was also significant higher than those with benign bladder lesion or health persons [p<0.0001]. Urinary HA ase activity was found to be significantly higher in the patients with bladder cancer compared to those with benign bladder lesions and the health pet [P<0.0001]. The serum concentrations of nitric oxide were significantly higher in-patients bladder cancer compared to those with benign with bladder diseases and the healthy group [P< 0001]. This work obviates that measured angiogenic factors [PDGF and bFGF] have a domain role in development of bladder cancer. Hence, angiogenic inhibitors and as beneficial components as adjuvant therapy with surgery, chemotherapy radiotherapy

Clinical usefulness of cystatin C concentration as a marker of early renal dysfunction in patients with cirrhosis of the liver

As preventive and renoprotective interventions are available, early identification of nephropathy is crucial, and there is a growing demand for a clinically convenient and reliable marker of renal function. Diagnosis of impaired renal function is of particular importance in patients with cirrhosis of the liver. Moderately reduced renal function may be missed by the conventional parameters. Cystatin C is an endogenous marker of glomerular filtration rate independent of muscle mass. Therefore, the aim of this study was to investigate the value of serum cystatin C concentration for the detection of moderately impaired renal function in patients with different stages of cirrhosis in comparison with the conventional methods. Eighty seven patients with cirrhosis were included in this study; All cases in this work had been examined clinically and they are scored according to Child-Pugh score. Calculation of creatinine clearance [CrCl] by determining its concentration in timed urine collections and simultaneously in blood were done for all the patients. All blood samples were obtained on the day of urine collection for CBC, LFTs, pro-thrombin time, serum electrolyte, creatinine, urea, creatinine clearance and Cystatin C concentrations. The patients then divided into two groups depending upon the results creatinine clearance: [groupl] normal creatinine clearance group [creatinine clearance >/= 70 ml/min; n=50] and [group2] reduced creatinine clearance group [creatinine clearance 40n69 ml/min; n=37]. There was no significant difference in urea concentration between the two groups [30.7] group 2 versus [28.3] mg/100 ml, group 1. While serum Cystatin C concentrations [mean [SD]: 1.32 [0.51] v 1.03 [0.34] mg/1 [p=0.008] and creatinine concentrations 1.03 [0.52] v 0.86 [0.22] mg/100 ml [p=0.03] were higher in group 2 than in group 1. To confirm the diagnostic advantage of Cystatin C over creatinine and urea. Receiver-operator characteristics [ROC] shows at equal specificity, the sensitivity of cystatin C was increased almost throughout the ROC plot. At cut off concentrations of 1.0 mg [Cystatin C], 0.8 mg/100 ml [creatinine] and 27 mg/100 ml [urea],cystatin C exhibited significantly higher sensitivity than creatinine and urea [70%, 45.2%, and 43.9%; respectively p<0.05], Specificity and efficiency were not significantly different between parameters. The sensitivity of Cystatin C [88.5%] tended to be higher than that of creatinine [62.0%] and urea [55.3%] at equal specificity of [60%] in Child-Pugh class C patients. The results demonstrated that the diagnostic accuracy of plasma Cystatin C was better than plasma creatinine in identifying liver cirrhotic patients with reduced glomerular filtration rate. particularly with Child-Pugh class C patients, for early diagnosis of renal dysfunction

relation between plasma free fatty acids [FFA], lipogram and arrhythmogenecity in patients with acute myocardial infarction

The present study comprised 45 patients with acute myocardial infarction [AMI] within 12 - 24 hours after the onset of symptoms and 10 healthy individuals as a control group. The development of various types of arrhythmias in these patients was statistically and significantly related to the rise in free fatty acids plasma level and hypokalemia. Also, the rise in free fatty acids [FFA] plasma level correlated with the size of the infarction estimated by the increase in cardiac enzymes serum level