Study of silent myocardial ischemia in type 2 diabetic males

Patients with diabetes have two to four folds greater risk of death from coronary artery disease than age-matched non diabetic individuals. Accelerated coronary and peripheral vascular atherosclerosis is one of the most common and chronic complications of diabetes mellitus. A recent aspect of coronary artery disease in this condition is its silent nature. Is to detect the prevalence of silent myocardial ischemia [SMI] in type 2 diabetic males in our locality and to select male diabetic population who should be screened for SMI. This study included 100 type 2 diabetic male patients with negative history of angina or anginal equivalent symptoms and thirty apparently healthy males as a control group. All subjects were studied as regard age, duration of DM, type of diabetic therapy, smoking, family history of IHD, blood pressure estimation, body mass index [BMI], fundus examination and presence of peripheral arterial disease. Laboratory estimation of fasting and post prandial blood glucose level, lipid profile, glycated hemoglobin [HbA[1c]], microalbuminurea, and C-reactive protein was done for all participants. Non invasive tests [NITs] including 12 leads resting ECG, trans-thoracic echocardiography, treadmill exercise ECG, myocardial perfusion imaging were done for all participants and patients positive for one or more N1Ts were subjected for coronary angiography. Twenty nine patients [29%] were positive for one or more NITs in the patients group compared to only one case [3.3%] in the control group. After the results of coronary angiography, 20 patients were positive for significant coronary artery stenosis in one or more vessels in the patients group while it was refused to be done by the patient in the control group. There was statistically significant difference as regard family history of DM and IHD, hypertension, and obesity with higher levels of microalbuminurea, C-reactive protein, total cholesterol, and triglycerides in the patients group than in the control. The patient group was subdivided into two subgroups according to the results of coronary angiography, 20 patients positive for SMI [positive for coronary angiography] and 80 patients negative for SMI [negative for coronary angiography]. Smoking, hypertension, obesity, hyperlipidemia, and family history of IHD were significantly higher in the diabetic subgroup positive for SMI compared to those negative for SMI. Most of the patients positive for SMI had have DM for more than 5 years duration. Type 2 diabetic male patients should be screened for detection of SMI when age above 50 years old, diabetes duration is more than 5 years [particularly if uncontrolled], presence of two or more cardiac risk factors and/or patients suffering from one or more of the chronic diabetic complications

Hypertension; ecological factors, control and complication in Urban Sohag, Upper Egypt

Because of the associated morbidity, mortality and the cost to societies, hypertension is an important public health challenge being the most common worldwide disease-affecting human. To study the clinical characteristics, therapeutic regimens, compliance with treatment, risk factors and target organ damage of hypertensive patients among people > 35 years old. A cross sectional study; conducted in Sohag city; it involved 520 patients; males [45.7%] and females [54.3%]. Their ages were 35 to 85 years. Hypertension presented more between non-smokers [72.55%], females [54.3%], educated patients [50.99%] and patients with low SES [54.9%]. ECG of hypertensive patients showed that ischemia presented in [51.63%] of patients, while their laboratory investigations showed that hyperglycemia presented in [28.7%], anemia in [18.3%], high serum creatinine level presented in [8.49%] and proteinuria in [10.45%] of patient. Adequate BP control was found to be achieved in [49.67%]; older patients had lower adequacy of BP control in spite of the extensive use of multiple-drug therapy and of appropriate drug choice. This is probably due to high prevalence of a difficult to control form of hypertension and poor compliance with the multiple-drug regimen. Most hypertensive patients had more than one coexistent CV risk factor. Aging, being a female [54.3%], diabetes, family history of hypertension [28.7%], smoking [27.45%], family history of coronary heart disease [25.4%], and obesity [10%] were of the contributing risk factors .About 72% had target organ damage. Heart involvement was the most frequent finding [63.39%]; coronary heart disease was the most common heart damage [51.63%]. ACE-inhibitors were prescribed in [58.16%]; mostly capotril and zestril. Beta-blockers were used in [34.64%] of the patients, Ateno is the drug mostly used in this group. Monotherapy was prescribed for [41.17%] only of the patients. Fortunately [75.81%] of patients showed regular use of their drug regimens. It was observed that [49.67%] only of patients had their condition under control, the number of drugs was inversely related to BP control. Hypertensive patients in Sohag city had a profile of high CV risks, target organs damage and poor blood pressure control particularly in the elderly. Great efforts towards improving the compliance of both service providers with guidelines and patients with treatment must be done. A multidisciplinary approach for routine clinical check up, follow-up, training, prescribing simple once-daily regimens and encourage life style modifications; all to optimize patient outcomes and prevent disease

Functional cardiac abnormalities in cirrhotic patients with and without ascitis

Abnormalities in cardiac function have been reported in patients with liver cirrhosis, suggesting latent cardiomyopathic changes in these patients. In this study we investigated cardiac function and morphology in patients with liver cirrhosis with and without ascites. A total of 60 patients with liver cirrhosis [divided into three groups each with 20 patient; group I without ascitis, group II with mild and moderate ascitis and group III with tense ascitis] and 20 normal healthy control subjects were studied by two dimensional Doppler echocardiography. Cardiac dimensions and left and right ventricular systolic [ejection fraction, isovolumic contraction time and peak flow velocity of the aortic and pulmonary flow] and diastolic [the peak flow velocity in early diastole E cm/sec, the peak flow velocity in late diastole A cm/sec, and the E/A ratio and the deceleration time of the E wave, the isovolume relaxation time of the left ventricle] functions were evaluated. Our study showed that the EF is significantly low in all patient groups versus the control subjects and in the ascitic patients versus the non-ascitic group [P<0.01] but no significant difference between the patients with mild and moderate ascitis versus the nonascitic patients. The LVET was significantly shorter in patients with tense ascitis [G.3] as compared to non-ascitic patients[G.1] [P0.04]. also the IVCTL/LVET was significantly lower in all patient groups compared to the controls [P<0.006], and in ascitic patients versus non-ascitics[P<0.02]. For the right ventricular systolic function; the VmaxR was significantly decreased in nonascitic patients compared to controls [P<0.03], the RVET was significantly shorter in all patients groups compared to controls [P<0.004]. The E/A ratio was significantly decreased in ascitic patients versus controls [P<0.001 and in ascitics versus nonascitics [P<0.002]. The deceleration time of the E wave was significantly prolonged in ascitic versus controls [P<0.001] and in ascitics versus non-ascitics [P<0.01]. Also, the IVRT was significantly prolonged in all patient groups versus the controls. Both atria and right ventricle were significantly enlarged in cirrhotic patients versus controls and in cirrhotics with ascitis versus those without ascitis. Liver cirrhosis is associated with enlarged right cardiac chambers. Systolic and diastolic dysfunction were evident in cirrhotic patients and more in those with ascites. Our data confirm the presence of cirrhotic cardiomyopathy rather than secondary cardiac adaptation to circulatory changes in liver cirrhosis

Soluble adhesive proteins L and E selectin in patients with systemic lupus erythromatosus: value in monitoring disease R mission after corticosteroid therapy

In this study, we aimed to examine circulating adhesive proteins L and E selectin levels in 33 patients with systemic lupus erythematosus SLE and to correlate levels of these proteins to disease activity parameters. L and E selectins were further investigated in a subgroup of patients with SLE who could be followed for 3 months duration and who found to be in disease remission after starting corticosteroid therapy. Results of the study showed significant decrease of L selectin and significant rise of E selectin levels in SLE patients versus healthy control subjects [720.5 +/- 213 ng/ml Vs 1008.7 +/- 237 ng/ml] and [71.5 +/- 14 ng/ml Vs 43.6 +/- 10 ng/ml], P < 0.002 and P < 0.001 respectively. E selectin was further elevated in SLE patients with organ [cardiopulmonary, renal and CNS] affection [n=15] versus those without organ affection [n=18] [78 +/- 8.2 Vs 47.6 +/- 12], P < 0.001 respectively. Correlation of L and E selectins to disease activity parameters showed significant association between L selectin and erythrocyte sedimentation rate and between E selectin and all parameters except hemoglobin. After starting corticosteroid therapy, no significant changes was observed in L selectin level within 3 months duration compared to the baseline level [708 +/- 159], [711 +/- 160] and [706 +/- 178] Vs [730 +/- 170], respectively. In contrast, significant decline of E selectin level compared to the baseline level was observed in the second and third month after starting corticosteroid therapy [59.8 +/- 9.9] and [61.9 +/- 6.8] Vs [43.6 +/- 10], P < 0.01 and P < 0.01 respectively. Results of the study indicate that L and E selectins are important contributing factors in the immunopathogenic mechanism of SLE. E selectin may be considered as a marker of disease activity and may aid in monitoring disease remission after starting corticosteroid therapy. It is justified to consider SLE as one of the disorders which could benefit from antiadbesive molecules therapy

Cognitive function in patients with non valvular atrial fibrillation: correlation to markers of thrombogenesis

There is increasing evidence that non valvular atrial fibrillation NVAF is associated with an increased risk of asymptomatic or silent cerebral infarctions. An important question is whether these infarction are truly asymptomatic and whether anti-thrombotic treatment could be beneficial in those patients. In this study we examined components of cognitive function [Event Related Potentials "ERP[s]" P300 and Wechsler Adult Intelligence Scale "WAIS"] and markers of thrombogenesis [fibrinogen, fibrinopeptide A "FPA". platelet aggregation, platelet factor 4 "PF-4" and beta-thromboglobulin "beta T.G"] in 20 neurologically asymptomatic NVAF patients comparing them to a well matched group in sinus rhythm. In addition, parameters of cognitive function components were correlated to those of thrombogenesis in the group of AF patients. NVAF patients had significantly prolonged latency and significantly reduced amplitude of P300 component of ERPs in AF Vs sinus rhythm group respectively and significantly reduced verbal intelligence quotient [VIQ] component of [WAIS] Vs sinus rhythm group P< 0.006. In addition, NVAF patients had significantly elevated levels of fibrinogen [p< 0.01], FPA [p<0.001], significant platelet aggregation is response to 2 ug/ml collagen [p< 0.001] and 1 ug/ml collagen [P< 0.001] and significantly elevated levels of PF-4 [P< 0.01] and beta T. G [P< 0.001] compared to the group in sinus rhythm respectively. In the NVAF group, there was positive association between P300 latency of ERPs components and each of FPA and PF-4 with high P< 0.1 and marginal P= 0.05 significance respectively and significant inverse correlation between all parameters of WAIS components and those of thrombogenesis except for the relation of performance intelligence quotient [PIQ] to each of FPA and beta T.G levels. These results may aid in identifying those patients at high risk of developing dementia and may help decision making when anti thrombotic therapy is being considered in NVAF patients. We recommend cognitive

Thyroid hormone in asthmatic patients

The aim of this work was to study the possible changes of thyroid hormones levels in patients with bronchial asthma. The study included 60 asthmatic patients and 15 healthy control subjects. The results show that in extrinsic and intrinsic asthma groups, there was significant increase in serum T3 and T4 levels compared with control group. In patients with chronic bronchitis associated asthma, there was significant increase in serum T4 and insignificant decrease in serum T3 level compared to control group. There was no significant difference in serum T3 and T4 levels between extrinsic and intrinsic asthma group. There was significant decrease of serum T3 level in patients with chronic bronchitis associated asthma compared with patients with asthma not associated with chronic bronchitis. These results indicated altered thyroid hormone levels in asthmatic patients