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

Correlations between C-reactive protein as an inflammatory component of atherosclerotic process and variable lipid parameters in type 2 diabetic and hyperlipidemic patients

The study aimed to prove any correlations between CRP and different lipid parameters in patients with type 2 diabetes mellitus and hyperlipidemia. The study was conducted on 210 subjects, that were subdivided into three groups [Diabetic group, hyperlipidemic group, appearently healthy controls], each was 70 in number. Measuring of different parameters [serum concentrations of CRP, TC. HDL-C and LDL-C], were done according to standardized enzymatic assay methods. A positive correlations between CRP serum concentrations and that of TC [r = 0.37 and 0.38, P<0.05] and LDL-C [r = 0.39 and 0.35, P<0.05] respectivly in diabetic and hyperlipidemic male patients and the same results in female patients, and an inverse relationship was obtained between CRP serum levels and HDL-C serum concentrations in the diabetic and hyperlipidemic male patients, but statistically was non-significant. Serum CRP concentrations of diabetic and hyperlipidemic patients were significanty higher in both males and females than normal controls. This increase in CRP coincides a significant increase in TC, TG and LDL-C. These results may reflect that a variety of features of the metabolic syndrome are associated with a systemic inflammatory response. The higher CRP concentration in serum could reflect the inflammatory component of the atherosclerotic process that is so prelevant among patients with diabetes and hyperlipidemia

Acut organ failure in septic patients with or without shock

Sepsis and septic shock are life threatening complications of infections with a high incidence and mortality rates. Death is strongly related to types and number of systems failure, beside other risk factors. Aiming to identify the incidence of acute organ failure in relation to presence or absence of shock, retrospective evaluation was done for 170 patients admitted to Intensive Care Unit in a seven months period during 2005-2006. Patients with septic shock had a significantly higher age, APACHE II score [31.39 +/- 09.76 versus 18.6 +/- 5.73, P<0.005], SOFA score [8.42 +/- 3.70 versus 3.73 +/- 2.36, p< 0.0005], and a higher mortality rate [67.08% versus 25.27%, p< 0.0005] compared to those with severe sepsis. The percentage of acute organ failure in septic patients with shock versus those without shock was: pulmonary [86.83% versus 51.65%], renal [59.49% vr 23.07%, P<0.005], hepatic [49.37% vr 25.27%, P<0.005], haematological [54.43% vr 30.77%, P<0.005] and central nervous system [13.92% vr 10.98%, P=NS] respectively. Septic shock patients were more likely to have significantly higher mean SOFA score and a higher mortality rate than non-shocked cases. Mortality increases significantly with age, APACHE II and SOFA scores

Neurotoxicity of the commenest volatile substances abused in El-Minia Governorate: clinical and experimental study

The current study was. performed to investigate the possible neurotoxic effects of chronic solvent abuse of some of the commonest abused substances in El-Minia governorate, namely, acetone and diethyl ether, and whether these changes, if present, are reversible or not. It was carried out as 2 parts: 1[st] part; 50 male persons aging between 20-45 were divided into 5 groups of 10 subjects each: group I; a normal volunteer control group, group II exposed daily to acetone for 1-2 year[s], group III: exposed daily to acetone for 8-10 year[s], group IV: exposed daily to diethyl ether for 1-2 year[s], group IV: exposed daily to diethyl ether for 8-10 year[s]. All subjects were examined thoroughly for any neuropsychiatric disorders 3 times 3 months apart. The 2[nd] part; 180 albino rats divided into 9 groups of 20 rats each as follows: group I: a control group received a daily oral dose of 1.5 ml of physiological saline for 1 month, group II: exposed to a daily dose of acetone [1250 ppm. / 30 min.] for 1 month, then examined immediately, group III: exposed to a daily dose of acetone [1250 ppm. / 30 min.] for 1 month, left for 1 month without any medical intervention, then examined, group IV: exposed to a daily dose of acetone [1250 ppm. / 30 min.] for 3 months, then examined immediately, group V: exposed to a daily dose of acetone [1250 ppm. / 30 min.] for 3 months, left for 1 month without any medical intervention, then examined, group VI: exposed to a daily dose of diethyl ether [2000 ppm. / 30 min.] 1 month, then examined immediately, group VII: exposed to a daily dose of diethyl ether [2000 ppm. / 30 min.] 1 month, left for I month without any medical intervention, then examined, group VIII: exposed to a daily dose of diethyl ether [2000 ppm. / 30 min.] for 3 months, then examined immediately, and group IX: exposed to a daily dose of diethyl ether [2000 ppm. / 30 min.] for 3 months, left without any medical intervention for 1 month, then examined. The results of the 1[st] part of the current study revealed that persons of the groups II and IV had mild neuropsychyatric disorders and that these changes were much more severe in the persons of group III and V as well as the appearance of another serious disorders including parkinsonism, cerebellar dysfunction, and cranial nerve affection. The results of the 2[nd] part revealed that animals of groups II and VI showed profound pathological changes of the cerebral cortex and cerebellum ranging from mild to moderate degrees with higher incidence towards the mild one. In addition, the animals of groups IV and VIII showed similar changes with increased incidence of the moderate degree. Moreover, animals of groups III and VII showed a mild improvement of the reported pathological changes when compared to those examined immediately after the last dose. On the other hand, animals of groups V and IX showed no improvement and nearly were the same when compared to those of groups IV and VIII. It could be concluded that volatile substance abuse induces serious neuropsychiatric and pathological changes, and that severity of the pathological changes increases with the increase of period of abuse, while reversibility becomes less likely