Altered BANKL/OPG system in hepatic osteodystrophy

The coexistence of liver disease and metabolic bone disease has been recognized for many years and is now the subject of increasing attention. Hepatic Osteodystrophy was established in patients with cholestatic liver disease, but new research suggests that it is prevalent in patients with other chronic liver diseases. Its etiology is complex and multifactorial. Receptor activator of nuclear factor Kb ligand [RANKL] plays a role in the differentiation and activation of bone resorbing osteoclasts by binding to its high affinity receptor [RANK] located on the surface of osteoclasts. This effect is counterbalanced by osteoprotegren [OPG], which acts as a decoy receptor competing with RANKL for RANK. To evaluate bone mineral density [BMD] and OPG/RANKL system in cirrhotic patients with backache. This study included 50 subjects suffering from backache, divided into 4 groups as follows: Group I: 10 subjects with normal BMD, Group II: 10 patients with pathological BMD but otherwise healthy considered as control, Group III: 15 patients with cirrhosis and normal BMD, Group IV: 15 patients with cirrhosis and pathological BMD. All patients underwent clinical examination, routine liver function tests, alkaline phosphatase, total calcium, serum OPG, serum RANKL, added to BMD. The lowest BMD values are estimated at the lumber spine, femoral neck, and lastly lower end of radius. There was a significant decrease in OPG in osteopenic/ osteoporotic non cirrhotic patients compared to control group, while it is significantly higher than control in both osteopenic/osteoporotic and patients with normal BMD of cirrhotic groups. RANKL, was significantly higher in non cirrhotic patients with pathological BMD compared to control group, but lower than control in cirrhotic groups both with normal and pathological BMD, with significant difference in cirrhotic with pathological BMD and non significant in those with normal BMD compared to controls. Serum OPG was negatively correlated to serum calcium, albumin, and International Normalized Ratio [INR], but positively correlated to bone alkaline phosphatase, and AST in cirrhotic patients of both groups. In cirrhotic patients, low BMD has tendency to affect axial bone early, which is similar to postmenopausal osteoporosis. On the contrary, higher OPG and lower RANKL levels are opposite to postmenopausal osteoporosis. This difference indicates that: OPG/RANKL system is activated in a different way in cirrhosis, suggesting a role for OPG/RANKL system in pathogenesis of hepatic osteodystrophy

prospective and year study of risk factors for adverse events associated with pediatric cardiac catheterization in Tanta university hospital

The role of the pediatric cardiac catheterization laboratory has evolved in the last decade as a therapeutic modality, although remaining an important tool for anatomic and hemodynamic diagnosis. The aim of this study was to determine the relative risks of pediatric diagnostic and interventional cardiac catheterizations in a prospective study of suitable duration [5 years]. A study of 760 consecutive pediatric cardiac catheterization procedures was undertaken according to standard techniques. All necessary laboratory investigations, imaging or life support measures required for diagnosis, treatment or follow up of patients were done according to the situation. The results demonstrated that patients' age, ranged from 20 days to 15 years [mean 2.5 years]. One or more complications occurred in 68 studies, [8.9%] and were classified as major in 14 [1.8% of procedures] and minor in 54 [7.1% of procedures], with 1 interventional procedure associated complications [n=21; 2.7% of procedures] the most common adverse I, event. Arrhythmic complications [n=17; 2.3% of procedures] were the second most common I complication. Vascular related complications occurred in 73 cases [7.7%] bleeding in 12 cases [1.6%] while catheter manipulation caused complications in 5 cases [0.66%]. Death occurred in one case aged 20 days [0.13%] due to uncontrollable arrhythmia. Patient weight <5 kg, age<2 years and interventional studies were the independent risk factors for morbidity

Conclusions and Recommendations: complications continue to be associated with pediatric cardiac catheterization. Their incidence in Tanta University Cardiac Catheter Laboratory parallels that achieved elsewhere in the world nowadays. The most frequent and serious categories of complications we have encountered are those related to interventional procedure followed by arrhythmias, Independent risk factors for complications included a young patient age, with a lower body weight and undergoing an interventional procedure. Efforts should be directed to improving equipment for flexibility and size, raising operator experience. Patient selection and preparation as well as the per catheterization intensive medical care should be improved