ABSTRACT
Experimental and clinical studies have recently demonstrated that growth hormone-insulin like growth factor-1 [GH/lGF-1] system is involved in the regulation of cardiac structure and function. lGF-1 promotes favourable cardiac remodelling in heart failure. The aim of this study was to detect changes in lGF-1 levels in various grades of heart failure. The study included 59 patients with heart failure with different etiologies [rheumatic heart disease, dilated cardiomyopathy and ischemic heart disease]. Patients having endocrinai disorders have been excluded. The patients as well as a control group of 10 subjects were evaluated with history, clinical examination, laboratory routine investigations, ECG, chest X-ray, transthoracic echocardiography as well as determination of serum IGF-1 and IGFBPS levels. It was found that serum lGF-1 levels were reduced in patients with heart failure in comparison to control. There was significant negative correlation between lGF-1 levels and the severity of heart failure and the impairment of systolic function. The lGF-1 levels were not influenced by the aetiology of heart failure. It is suggested that the reduction of lGF-1 in patients with severe heart failure. might be a contributing factor to systolic dysfunction in those patients and could have potential therapeutic implications in those group of patients
ABSTRACT
Nitric oxide [No] is a messenger molecule involved in pathogen suppression. Liver cirrhosis is characterized by an increased risk for infections, including Spontaneous Bacterial Peritonitis [SBP]. The role of NO in infections that develop in cirrhosis has not been fully investigated. The present study has aimed at investigation of the status of serum and ascites NO in cirrhotic patients with and without SBP and its relation, if any, with the parameters of liver function. The study was carried out on 56 patients suffering from liver cirrhosis and ascites with and without SBP. Their ages ranging from 35-70 years [mean 53.55 +/- 9.5yeat-s]. Thorough history taking, complete clinical examination, and routine investigations including complete blood picture, serum creatinine, liver function tests [serum albumin, bilirubin, SGOT, SGPT and prothrombin activity], hepatitis B surface antigen, Hepatitis C antibodies, blood culture, ascetic fluid cytology and culture for aerobic organisms, anaerobic organisms, and culture for rare organisms, besides serum and ascites NO assay, were all undertaken. The study revealed a significant elevation of serum and ascites NO in SBP groups than non-SBP group [P=0.009, 0.001, 0.0001 -0.001, 0.003, and 0.001]. Moreover, their levels have been reduced significantly after treatment of SBP [P=0.0001, 0.0001, 0.0001, -0.0.009, 0.04, and 0.001 respectively]. Although, serum NO showed no correlation with serum bilirubin, albumin, or prothrombin activity, it was found to be positively correlated with the Child-Pugh class of the studied patients [P0.045, 0.013, 0.001, and 0.045 respectively], however, ascites NO was not. In addition, ascites NO level was not correlated with any of the laboratory parameters of acetic fluid among the studied patients. The present study have shown also that; serum and ascites NO levels were found to be significantly higher in SBP patients with functional renal failure than those without. It is to be noted that; serum and ascites NO were correlated with each other [P = 0.045, 0.005, 0.004, respectively]. It can be concluded that; both serum and ascites NO level exhibited a significant elevation in cirrhotic patients especially those with SBP. Rather, ascites NO levels reflect serum levels, being higher in cirrhotic patients with more severe liver disease, and might be a useful prognostic marker