state of the major circulating apolipoprotein B100-containing lipoproteins in patients with chronic renal failure and/or ischemic heart disease

The present study aimed at determining the major apolipoprotein B100 containing lipoproteins in CRF patients. These LDL subspecies are markers to lipid peroxidation, the key stone of atherosclerosis. Subjects and circulating levels of LDL-C/ HDL-C ratio, IDL [by sequential ultracentrifugation], Lp[a] [by ELISA] and MDA [by colorimetric method] were assessed in patients with CRF singly [30 cases] or combined with ischemic heart disease [15 cases] and in patients with sole IHD [15 cases]. Patients with CRF showed a significant increase in serum LDL-C concentrations and a significant decrease in HDL-C concentrations as compared with normals. Plasma IDL, Lp[a] and MDA median values were significantly higher than normal in the sole CRF, sole IHD and combined CRF with IHD. Serum TG and TC concentrations were significantly higher in patients with IHD singly than in sole CRF while HDL-C and LDL-C concentrations were similar in them. The serum levels of TC, TG, HDL-C and LDL-C in either IHD group and CRF+IHD group showed no significant differences in these groups. Also plasma Lp[a] and MDA concentrations were significantly higher in IHD patients than in controls. By multiple linear regression analysis, LDL-C/HDL-C ratio in all investigated cases was predictive indicator of abnormal IDL and Lp[a]. Conversely, Lp [a] value anticipated MDA concentrations. Although LDL-C/HDL-C ratio is known to influence atherogenesis, an avid relationship in between them is arguable due to different extrinsic and intrinsic confounding factors. However, measurement of LDL-C IHDL-C has been proposed as an appropriate first line investigations for diagnosis and therapeutic monitoring of IHD. Uremic dyslipidemia is not a simple association but promotes progression of CRF and accelerates atherosclerosis. High triglyceride-rich, apo B-containing lipoproteins [IDL and Lp[a]] may contribute avidly and independently to atheromatous process in chronic renal failure patients

state of plasma nitric oxide metabolites [NO-2 and NO-3] and endothelin-1 in patients with chronic renal failure and/or ischemic heart disease

the present study was designed to evaluate the endothelium potential vasodilatation and vasoconstriction major factors in groups of patients with CRF or IHD singly or combined. Patients and Cases eligible for inclusion in the present study were those with CRF solely [30 patients], IHD singly [15 patients] or combination of CRF with IHD simultaneously [15 patients]. The included controls [15 cases] were clinically healthy subjects who were highly matched to cases for age, gender and body weight. The designed biochemical analyses included: Plasma endothelin- 1 [ET-1] using enzyme immunometric assay [EIA] and plasma nitric oxide metabolites [NO[-2]/NO[-3] by photometric assay. The median plasma NO[-2] concentrations among single CRF, single IHD or combined CRF with IHD were not significantly different from those observed in controls. Alternatively the median concentration of plasma total NO[-3]] [NO[x]] and the ratio of NO[-3] to NO[-2] among CRF with or without IHD groups were significantly higher than controls. With regard plasma NO[x], its median concentration in IHD patients showed no significant difference from controls, but there was a significant decrease compared with single CRF or combined CRF with IHD. At the same time, statistically significant differences in the median plasma concentrations of ET- 1 between cases allocated in the three different diseased groups and control group were observed. Moreover, statistically significant higher median plasma concentrations of NO[x] and lower ET- 1 were noted in noncardiac CRF cases as compared with the nonuremic IHD patients. There was a positive relation between the plasma concentrations of NO[-2] and NO[x] in all, -studied groups and between plasma concentrations of NO[x] and ET- 1 in CRF patients whether single or combined with IHD. High ET- 1 and NO[x] levels were found in patients with advanced chronic renal failure with or without IHD, a feature that was not noted in uncomplicated IHD. Whether plasma NO[x] concentrations necessarily reflect production of the hemodynamically active component, NO is not yet settled. Therefore, plasma NOx levels, even when obtained under conditions of dietary NO[x] control, do not give stand-alone information about NO production, particularly when renal function is impaired. Although definitive proof that ET- 1 as a primary inducer of atherosclerosis is still elusive, it is likely that ET- 1- is at least an important contributor to the atherogenic process. Vascular endothelial cells in atherosclerosis may synthesize greater quantities of nitric oxide than nondiseased cells, but it is rapidly inactivated by oxidative reaction or converted to the toxic peroxynitrite

Significance of circulating levels of N-Terminal pro-brain natriuretic peptide and cyclic guanosine monophosphate as prognostic markers of congestive heart failure

Brain natriuretic peptide [BNP] represents a new biochemical marker for left ventricular systolic dysfunction [LVSD], especially the amino terminal fragment of its prohormone; NT-proBNP. In this study, plasma levels of NT-proBNP, as well as its second messenger cyclic guanosine monophosphate [cGMP], were evaluated for their diagnostic and prognostic potential and their impact on treatment strategies in patients with congestive heart failure [CHF]. Patients and Eighty patients with CHF [Class II-III] were included in the study in addition to ten healthy subjects [control group]. Ten of the patients were treated with standard therapy [ST] of digoxin and furosemide. Other patients were receiving one or more of the following treatments in addition to the ST; angiotensin-converting enzyme inhibitor [captopril], aldosterone antagonist [spironolactone] and vasodilator [isosorbide dinitrate]. Plasma level of NT-proBNP showed a highly significant increase in all CHF patients with LVSD, compared to normal controls. Poor prognosis was obtained in patients treated with ST alone assuming insufficient effect of ST to improve cardiac remodeling. Treatment with either captopril or spironolactone, together with ST, were nearly equally effective in ameliorating LVSD, as reflected by the significant decrease in NT-proBNP, compared to ST alone. The combination of captopril with spironolactone and/or isosorbide dinitrate exhibited a more powerful effect in lowering NT-proBNP, indicating relief of the ventricular overload in CHF patients. The vasodilator isosorbide dinitrate was one of the most promising drugs in improving cardiac function and reducing NT-proBNP and hence improving prognosis. Cyclic GMP showed no correlation with plasma NT-proBNP, although it was significantly increased in patients treated with isosorbide dinitrate in combination with captopril and spironolactone, compared to ST group. Moreover, plasma NT-proBNP showed no correlation with the ejection fraction, the measurable value of echocardiography. These results suggest the use of NT-proBNP as a prognostic marker in development of strategies of therapy for CHF. However, the link between neurohormonal activation and homodynamic approaches requires further investigations

Thyroxin binding globulin [TBG] and prealbumin [TBPA] levels in healthy subjects

This study was carried out on 120 carefully selected normal healthy subjects [56 males and 49 females in addition to 15 newborns]. Their ages ranged from newborn to Geriatric. Estimation of plasma TBG and prealbumin by RIA and immunoturbidimetric methods respectively was performed. Plasma TBG levels were nearly constant in females up to the age of 7.5 years and then showed progressive decrease, together with that of the male group, till the age of 16 years and then showed a slight gradual increase till the age of 65 years. The highest levels of TBG were observed at birth and at the age of 65 years and the lowest one was at age group of 15-18 years [about two thirds the highest levels]. No significant sex difference was encountered in TBC levels among all age groups. Pre albumin levels were nearly constant till the age of 8 years in males and decrease slightly in females. In both sexes, a marked increase was noted from 8-14 years, then the increase was much slower till the age of 24 years. The level started to decline slightly from age 24 to 40 years and markedly till age of 65 years. The highest level of prealbumin was in age of 15-35 years which was two and half folds that obtained for newborns and old age [65 years]. Prealbumin was significantly higher in male than females at the age range 15-50 years. Significant negative correlation was demonstrated between plasma TBC and prealbumin levels in all age groups

Transeferrin and haptoglobin, age and sex variations

Immunoturbidimetric technique was used to measure serum transferrin and haptoglobin levels in 120 subjects representing different age groups starting from birth till 80 years. Both sexes were represented almost equaly Plasma transferrin levels showed a gradual rise from birth till the age of 15 years and then dropped sharply at the age of 20 years. A slight decrease was then observed starting from the age of 24 to reach its lowest level at the age of 65 years. The highest level of transferrin was observed at 15 years which was significantly higher than in older age groups. Serum haptoglobin was absent in the newborn and started to appear at the age of one month. Then it showed marked increase from age of one month to the age of 30 Years, remaining relatively constant between 30 and 40 years then gradually increased to reach the highest level at the age of 65 years which was significantly different from other age groups. No sex difference was shown for either transferrin or haptoglobin at all age groups. So-age variations need more focusing to standardize normal levels which requires large number of cases, since it is limited by the high cost of kits in the present study

Concentration of some trace element in the serum, hair and nail of alopecia areata patients

Fifty three subjects [41 patients with alopecia areata and 12 matched controls] were selected for this study. The alopecia group comprised 25 males and 16 females with age varying from 10 to 40 years. Thirty one patients had alopecia areata and 10 patients had alopecia totalis. Fifteen patients had nail changes. Zinc, iron, copper and magnesium were estimated in the serum samples of all individuals of the study [41 patients and 12 controls] and the hair and nail samples of 42 subjects [30 patients and 12 controls] by the use of atomic absorption spectrophotometry. No statistically significant differences were found between trace elements concentrations in patients compared to controls except for low hair and nail zinc. Also patient with nail changes have a significant nail zinc as compared to those nail changes. According to these results we can speculate that trace elements have no proven role in the pathogenesis alopecia areata except for zinc which may be involved in the pathogenesis of this disease

Evaluation of spironolactone treatment in acne vulgaris in females

Acne vulgaris is very common multifactorial disorder involving the pilosebaceous follicles occurring mainly in pubertal and postpubertal period until now it represents a clinical problem in its treatment inspite of recent and different modalities of therapy. Twenty females with acne vulgaris were treated with 100 mg spironolactone per day. Estimation of total serum testosterone [t[and sex hormone binding globulin [SHBG]was done by radioimmunoassay before and after 3 months of spironolactone. Ovarian ultrasound showed polycystic ovaries in 50%of cases 14 patients [70%] showed mild to marked response while 6 patients only showed no response to spironolactone treatment. After spironolactone therapy it was observed that mean serum T level of 14 patients significantly decreased while SHBG and free testosterone index were insignificantly changed after treatment it is concluded that this form of therapy for acne vulgaris, up to the dose used is safe, reliable, and accepted by the patient

Validity of salivary testosterone measurements in hirsute women before and after spironolactone therapy

This study was conducted on twenty-one hirsute females and ten normal controls. Serum free testosterone[FT] and salivary total testosterone [SaT] were measured by radioimmunoassay [RIA] before and after a course of spironolactone therapy starting from the 4[th] to the 22[nd] days of the menstrual cycle. Salivary testosterone paralleled the changes in serum free testosterone with a significant positive correlation in all circumstances studied, suggesting that SaT measurements could be used as a safe alternative to serum sampling with the added advantages of being simple, non-invasive and avoiding undue disturbances of endocrine system