Relationship between thyroid function and endothelium dysfunction in hemodialyzed patients

Chronic renal failure affects thyroid function in many ways. Disturbances in hemostasis and inflammation are common complications of kidney diseases. Endothelial dysfunction may link these two processes. The study was performed to assess thyroid hormones in relation to markers of endothelial damage and inflammation in hemodialyzed [HD] patients. Sixty patients on regular HD [40 patients treated with erythropoietin and 20 patients without erythropoietin therapy] and 30 healthy controls were studied. Thyroid hormones, markers of endotherlial damage [Von Willebrand factor [vWF], intracellular adhesion molecule [ICAM], marker of inflammation [high-sensitivity C-reactive protein [hsCRP] and tumor necrosis factor alpha [TNF alpha], hemostatic parameter [tissue plasminogen activator [tPA], kidney function tests, complete blood count, lipid profile, serum iron, serum albumin and total protein, serum calcium and phosphate were measured. The weekly erythropoietin dose and the patient demographics were recorded. Free T[3] were lower in HD patients compared with controls, markers of hemostasis, inflammation and endotherlial dysfunction were significantly higher in HD patients compared with controls. In all hemodialysis patients, free T[3] was independently related to time on dialysis, albumin, serum iron, total protein, triglycerides, total calcium, vWF, tPA and hsCRP. In the HD patients with CRP less than 6 mg/L, free T[3] was related to time on dialysis, total protein and triglycerides. While in HD patients with CRP greater than or equal to 6 mg/L, free T[3] was related to total calcium and hsCRP. Also in multiple regression analysis the predictors of free T[3] were hsCRP and dose of erythropoietin. We describe a novel relation between thyroid hormones and markers of endothelial dysfunction and inflammation in HD patients. Thyroid dysfunction is related to time on dialysis, endothelial damage, and inflammatory state, frequently encountered in uremia could be responsible for accelerated atherosclerosis and development of cardiovascular complications. Therefore, the relations between thyroid axis and endothelium in HD subjects merit additional studies

Left ventricular size and function in obese versus lean type 2 diabetes

The impact of type 2 diabetes and obesity on left ventricular size and function is not well established and still a matter of debate. The study was performed to assess LV size and function in type 2 diabetic patients obese or not. The study included 40 normotensive patients with type 2 diabetes, 20 of them were obese [group I], and the other 20 patients were lean [group II]. The control of the study included 40 healthy subjects with age and sex matched, 20 of them were obese [group III], and the other 20 subjects were lean [group IV]. The study was performed at Al-Azhar University hospitals from October 2005 to July 2006. Patients and controls were subjected to clinical evaluation, with special emphasis to measurements of body mass index [BMI], waist hip circumference ratio [WHR], ECG and standard 2-D echocardiograms. Laboratory investigations include; lipid profile, HbA1c, fasting blood sugar [FBS], fasting serum insulin and measurements of insulin resistance [IR]. LV functions [EF, FS% and E/A ratio] were significantly impaired in-group I and II when compared to controls [p<0.05] and more significantly impaired in-group I when compared to group II [p<0.05]. Left ventricular mass was significantly higher in obese groups [group I and III] when compared to lean groups [group II and IV], [p<0.01], and no significant changes were found between obese diabetic and non-diabetics. All values of LV mass, EF and FS% are still within the normal reference range and all patients had no ECG abnormalities. Hyperinsulinemia and insulin resistance were significantly higher in diabetic groups when compared to controls [p<0.01] and in-group I when compared to group II [p<0.01]. Total cholesterol, LDL-cholesterol, triglycerides, HbA1c, fasting insulin and IR were significantly higher, while HDL-cholesterol was significantly lower in-group I when compared to group II, in-group I when compared to group III, and in-group II when compared to group IV. In obese diabetic patients LV mass was correlated with BMI, waist circumference, serum insulin, and IR. EF and FS% correlated with BMI, waist circumference, triglycerides, HDL-cholesterol, disease duration, HbA1c, serum insulin, and IR. E/A ratio correlated with BMI, waist circumference, HDL-cholesterol, triglycerides, disease duration, HbA1c, serum insulin, and IR. In obese non-diabetic subjects LV mass was correlated with BMI, waist circumference, serum insulin and IR. EF and FS% correlated with BMI, waist circumference, serum insulin, and IR. E/A ratio correlated with BMI, waist circumference, serum insulin, and IR. We can claim that simple obesity has its main impaction on LV size rather than functions, while diabetes has its main impaction on the LV functions. These denoting the other mechanisms of cardiovascular affection in diabetes including endothelial dysfunction and microvascular angiopathy

Role of adhesion molecules in the pathogenes of chronic obstructive pulmonary disease

Interaction between cell adhesion molecules and their ligands are an important step of inflammatory processes and may have direct relevance to the pathology of airway inflammation in patients with COPD. To determine the possible role of adhesion molecules in increased airway inflammation in subjects with COPD. Serum levels of adhesion molecules [ICAM-1, VCAM-1 and P-Selectin] were measured in 30 patients with COPD and in 20 healthy controls, as well as in broncho-alveolar lavage [BAL] obtained from both groups [patients and controls]. In addition, pulmonary function tests [ventilatory function FEV [1], FVC, and FEV [1]/ FVC], E.C.G. and echocardiography for all studied subjects were studied. Serum adhesion molecules were significantly higher in patients than controls, p < 0.01 [in the serum as well as in BAL]. Smoking significantly increases expression of adhesion molecules in patients and controls in the serum as well as in BAL [p < 0.01]. The degree of airway obstruction was significantly higher in smoker versus non-smoker and correlated significantly with serum levels of adhesion molecules [r = 0.520, 0.560 and 0.500] for serum ICAM 1, VCAM 1 and P-selectin respectively. Increased airway inflammation and obstruction in patients with COPD is associated with an increased expression of adhesion molecules in the serum as well as in BAL, especially in smokers, where they may reflect the degree of ongoing airway inflammation in patients with COPD

Comparative analysis of the biochemical tests used to differentiate between pleural transudates and exudates

This study aimed to evaluate the diagnostic accuracies for pleural fluid tests that discriminate between transudative and exudative pleural effusion. A prospective evaluation of 78 patients with pleural effusion of different etiologies was done. The criteria showed the best results in this series, four effusions only were misclassified [three transudates and one exudate]. The number of misclassified effusions in other criteria was seven by PF cholinesterase [three transudates and four exudates], six by the P/S cholinesterase [four transudates and two exudates], six by PF cholesterol [one transudate and five exudates] and five by PF/S cholesterol ratio [two transudates and three exudates]. It was concluded that the criteria of Light et al. were the best method for distinguishing exudates from transudates