relationship between serum ferritin and glycosylated hemoglobin in adults with type 2 diabetes mellitus

Background: Serum ferritin, an acute phase reactant is a marker of iron stores in the body. Several studies concluded that, serum ferritin was found to be high in uncontrolled type 2 diabetic patients. This study was carried out to investigate serum ferritin levels in poor controlled type 2 diabetes [PCD] and well controlled type 2 diabetes [WCD]

Subjects and Methods: The study comprised of 42 apparently healthy controls and 84 type 2 diabetic patients. They were recruited from the Governmental and NGO's Hospital at Cairo, Egypt. Anthropometric measurements including: weight and height were measured and body mass index [BMI] was calculated. Fasting blood glucose [FBG]; Glycosylated hemoglobin [HbAIc] and serum ferritin were determined. Patients were subdivided into PCD and WDC according to HbAIc levels

Results: BMI; FBG; HbAIc and serum ferritin were significantly higher in in type 2 diabetics compared with apparently healthy controls. Based on glycemic control; the levels of FBG and serum ferritin were elevated in patients with HbA1c >7. Moreover, there was a positive significant correlation between serum ferritin, HbA1c and FBG that was more pronounced in PCD patients

Conclusion: The present study showed positive association of serum ferritin levels with glycemic control in Type 2 diabetic patients

Study of bone density ostocalcin level in children with acute lymphoblastic leukemia

Objective: To study Bone density and serum osteocalcin level in children with acute lymphoblastic leukemia

Methods: Serurn osteocalcin and DXA scan were evaluated in 45 children with ALL, 15 at diagnosis and before starting chemotherapy, 15 during chemotherapy and 15 after completing their treatment regimen

Results: From the total 45 patients, 23 [51.1%] had low osteocalcin level and 36 [80%] had low bone rnineral density [48% had osteopenia and 32% had osreoporosis]

Conclusion: Musculoskeletal abnormalities are present in children with ALL at diagnosis, during treatment] and persist as long-term squeal after treatment

Antibacterial effectiveness of low energy diode laser irradiation on management of periodontitis in Down syndrome

With the poor oral hygiene exhibited by patients with Down syndrome, the potential for a robust flora arises causing Periodontitis. Along with periodontal disease, the patient population has other medical conditions that limit treatment. This study was conducted to evaluate the antibacterial effectiveness of an 870-nm diode laser on periodontitis in patients with Down syndrome. Thirty five patients with Down syndrome suffering from periodontitis were included in this study and divided into two groups, Group I [25 patients] laser was applied to one half of the mouth and the other half was considered as a control and Group II included [10 patients] basic periodontal treatment was applied to evaluate the systemic effect of laser. Quantification of A. actinomycetemconcomitans, P. Gingivalis and Capnocytophaga were carried out using real-time PCR technique at baseline and at 2 weeks, at 6 weeks and at 12 weeks post periodontal and laser treatment. A. Actinmycetcomitans and P. gingivalis were the most common organisms found in the studied patients and Capnocytophaga was the least common organisms. In group I the quantitative results of A. actinomycetemconcomitans, P. Gingivalis at 2 weeks were significantly lower in both sides of mouth than that of baseline level. After 6 week, it was still significantly lower than that of the baseline in the right side of the mouth, but at 12 weeks no significant difference was observed in both sides. In group II, quantitative results of A. actinomycetemconcomitans, P. Gingivalis at 2 weeks were also significantly lower than that of baseline but not at 6 and at 12 weeks. As regards, Capnocytophaga there was no significant difference at baseline, at 2 weeks, at 6 weeks and at 12 weeks post periodontal and laser treatment in both groups I and II. Scaling and root planning plus laser therapy was better than scaling and root planning alone in the chosen patients and this antibacterial effect continues to be significant up to 6 weeks after therapy. Based upon the results of the study, it was found that Laser therapy could be used for the treatment of periodontitis as a complementary therapy not to replace mechanical intervention

Helicobacter pylori infection and vascular complications in patients with type 2 diabetes mellitus

The present work was deSigned to study H. pylori infection in type 2 DM, its relation to some clinical; metabolic and radiological markers of atherosclerosis and vascular complications in type 2DM. The study included sixty type 2 diabetic patients and fifteen healthy controls matched with age and sex. Both patients and controls were subjected to full history taking, clinical examination, estimation of BMI, resting ECG. laboratory tests including HbA1C, FBG, Serum creatinine; Lipid profile; fibrinogen assay, ESR; CRP; TNF a; IL-6; IL-1B; H. pylori IgG. 24 hours and urine collection for urinary albumin excretion. Radiological investigations include aabdominal ultrasound. Ultrasound on the carotid arteries used in measuring the intima-medial thickness [IMT]. The present study found non Significant increase in prevalence of H. pylori infection in type 2 diabetic patients in relation to controls. H. pylori infection had no relation to sex, age of the patients, duration of diabetes, BMI, type of therapy or the degree of diabetic retinopathy. H. pylori infection did not affect levels of FBG, HbA1c and microalbuminuria and caused a Significant increase in the level of triglycerides, TNFa, IL-1B, CRP and fibrinogen, decrease in the level of HDL and non Significant effect on WBCs count, the levels of total cholesterol, LDL, ESR and IL-6 in type 2 diabetic patients. H. pylori infection does not affect IMT of both Right and Left common carotid arteries. No Significant increase of the prevalence of H. pylori infection among diabetic patients with diabetic vascular complications. There is no Significant increase in prevalence of H. pylori infection among type 2 diabetic patients. H. pylori infection is not related to patient age, degree of glycaemic control, IMT or diabetic vascular complications among type 2 diabetic patients. However, H. pylori infection could affect atherosclerotic process through its effects on lipid profile [increase in TG and decrease HDL levels], increase levels of inflammatory cytokines [TNF-alpha and IL-1B] and acute phase reactants [CRP and Fibrinogen]

Phytochemical content of medicinal mushroom [Ganoderma lucidum]

Ganoderma lucidum is a functional food and a source of physiologically beneficial medicine. The Ganoderma fungi contained polyphenols, flavonoids, carotenoids, tannins, saponins and some of micro-elements [Cu, Zn, Mg, Mn and Se] as excellent antioxidants. Data showed a content of polyphenols and flavonoids fractions by HPLC. Ganoderma has a high content of kaempherol [14.43 micro g/g] then myricetin and quercetin [9.94 and 9.33 micro g/g, respectively]. The content of cinnamic acid and P-cumaric acid [9.82 and 11.53 micro g/g] were higher than cumarin, O-cumarin [8.88 and 8.44 micro g/g], respectively. Ganoderma protein is rich in cystine and methionine [0.85 and 13.53 g/100g protein], respectively compared with its level in casein [0.33 and 2.59 g/100g protein]. The ratio of arginine: lysine was higher than of methionine: glycine which is used as indication of the ability of plant proteins to lower cholesterol level in blood. The composition of Ganoderma mushroom having a relatively high content of unsaturated fatty acids [oleic, linoleic, linolenic, ecosanoic and decosahexanoic acids]. Also, the reducing power Ganoderma extract was higher compared to that for vitamin C

Study of antioxidants and anticancer activity of licorice [Glycyrrhiza glabra] extracts

Licorice root [Glycyrrhizia glabra] was analyzed for its major constant. Water and ethanolic extracts of licorice were obtained. Ethanolic extracts were analyzed for its contents of polyphenols and flavonoids and evaluated as natural antioxidant in comparison with commercial antioxidant [Rutin-BHT-BHA-TBHQ]. Also the efficiency of licorice ethanolic extract as anticancer agent for breast, colon and liver was evaluated. When licorice extracts were evaluated as natural antioxidant by microsomes, DPPH and Deoxyribose, the results showed that the ethanolic extract, was somewhat more efficient than the water extract but still it was similar to BHA and BHT at 100 ppm but was less efficient than TBHQ. Study revealed that ethanolic extract has strong antihepatic cancer activity at 16.1 micro g/ml and anti breast cancer activity at 100 micro g/ml, while it has no effect in colon cancer at 100 micro g/ml

Relation between T lymphocytes activities and the intensity of schistosoma mansoni infection

This study was done on 60 schistosome patients and 12 cross matched healthy control persons. The schistosome patients were classified on the bases of intensity of infection into: 22 patients with light infection [one to 100 eggs/gm stool], 24 patients with moderate infection [101- 400 eggs/gm stool], 14 patients with heavy infection [>400 eggs/gm stool]. All the studied cases were submitted to flow cytometric analysis of peripheral blood mononuclear cells using monoclonal antibodies against CD3, CD4, CD8, CD28, HLA-DR. It was found that there was a significant decrease in CD3, CD4 and the expression of costimulatory molecule CD28 on CD8 T lymphocytes, while CD8 T lymphocytes and the activation marker HLA-DR expression on CD4 T lymphocytes were increased. These changes were more obvious with the increase in intensity of infection

Graves'-related ophthalmopathy: [A] study of proinflammatory serum cytokines profile and peripheral blood T-cell subsets in relation to clinical status and orbital ultrasonography

Aim: Graves'-related ophthamopathy [GRO] is an organ -specific autoimmune disease passing into two stages, the stage of active inflammatory disease, which is treated conservatively by anti-inflammatory drugs or radiotherapy, and the inactive fibrotic stage, which is treated surgically. It is rather difficult to distinguish inflammatory from noninflammatory stages. The aim of the present work was to study some proinflammatory cytokines as sICAM, IL-2, and IFN-gamma serum levels, and peripheral blood T-cell subsets, together with orbital Ultrasonography in patients with GRO and their relation to clinical activity score [CAS] and relevant clinical parameters. Subjects and Fourty patients with GRO were enrolled, 30 of whom had inactive GRO and 10 cases had active GRO according to the clinical activity score, in addition to 10 healthy volunteers as a control group. Thorough clinical evaluation and orbital ulttrasonography were done for all patients. Laboratory work included measurement of sICAM, IL-2, IFN-gamma in serum and T-cell subsets in peripheral blood for patients and control. It was found that age, sex, smoking habit, or thyroid hormone status are not different in patients having active compared to inactive GRO, while the duration of the disease was significantly different, being shorter in those having active GRO. Extraocular muscle hyporeflectivity, as shown by orbital ultra-sonography, was significantly correlated with clinical activity score [P <0.01]. Serum sICAM-1, IL-2, and IFN-gamma levels were high in patients compared to controls [40.4=/=5 pg/ml versus 10.4 +/- 3.08 pg/ml, 440 +/- 187.6 pg/ml versus 65.8'24.3 pg/ml, and 479=/=160.3 pg/ml versus 116.4 +/- 24.0 pg/ml, respectively], and those having active GRO showed higher levels compared to those with inactive GRO [46.2 +/- 4.6 pg/ml versus 38.4 +/- 3.4 pg/ml, 707 +/- 149 pg/ml versus 351 +/- 87.6 pg/ml and 705.3 +/- 108.2 pg/ml versus 404.2 +/- 86.5 pg/ml, respectively]. T-cell subsets studied [CD3, CD4, and CD8] in peripheral blood were not different in patients with active GRO compared to those with inactive GRO [75.5 +/- 6.19% versus 71.8 +/- 5.53%, 58.4 +/- 4.62% versus 53.7+7.26%, and 14.8'6.05% versus 14.8 +/- 3.18%, respectively]. Conclusions: It is concluded that the duration of the eye disease and orbital utrasonography added to the clinical activity score could help distinguish patients with active Graves'-related ophthalmopathy, while serum levels of slCAM-1, IL-2, and IFN-gamma as single measurements, or peripheral blood T-cell subset pattern are of little help in this respect

Outcome of drug treatment in patients with prolactinoma

Aim: Prolactinoma is the most common pituitary adenoma, accounting for about one third of patients with pituitary tumors. Therapeutic options include drug treatment, pituitary surgery, and radiotherapy. However, medical therapy is the preferred initial therapy for most patients with prolactinoma. The aim of the present work was to study patients with prolactinoma attending the Mansoura University Hospital from the clinical, biochemical and radiologic aspects, and to assess the efficacy and outcome of drugs used [bromocriptine and quinagolide] in their treatment. Subjects and A series of 29 cases with prolactinoma attending the Endocrinology outpatient clinic and inpatient department at the Mansoura University Hospital, during the period from 1998 to 2001, were analyzed retrospectively. Patients were followed up for a mean of 6 months to one year. Diagnosis of prolactinoma was made on the basis of high serum prolactin levels with pituitary mass lesion, after exclusion of high GH and high TSH serum levels. Patients had full sheets of clinical data, together with biochemical profile including serum prolactin level, TSH, basal GH. Magnetic resonance imaging [MRI] was done at diagnosis and at follow up. Fundus examination and field of vision were done for patients with macroprolactinoma, at diagnosis and follow up. Bromocriptine [B] was given to 21 patients [15 with microprolactinoma and 6 with macroprolactinoma] in a dose of 7.5-15 mg/day in divided doses, while quinagolide [Q] was given to 8 cases [4 with micro-and 4 with macroprolctinoma] in a dose of 1.5-3 mg once a day. Follow up was made for 6-12 months with clinical, biochemical and MRI assessment. It was found that about 2/3 of prolactinoma patients were females. Microprolactinoma was more prevalent in women while macroprolactinoma was more prevalent in men, and in general, microprolactinoma was more prevalent than macroprolactinoma. The clinical presentation was mainly related to hypogonadism in the form of amenorrhea-galactorrhea in women and sexual impotence and infertility in men. Serum prolactin level was significantly higher in macroprolactinoma compared to microprolactinoma. Visual field defects were found in 5 out of 10 patients harboring macro-prolactinoma. There was no significant difference in efficacy between bromocriptine and quinagolide. Normalized serum prolactin was achieved in 14 out of 15 patients with microprolactinoma in the B treated group versus 4 out of 4 patients in the Q treated group, and 4 out of 6 patients with macroprolactinoma in the B treated group versus 3 out of 4 patients in the Q treated group. Microprolactinoma disappeared in 6 cases out of 15 patients in the B treated group versus 3 out of 4 patients in the Q treated group. More than 50% reduction in tumor dimensions was achieved in 6 out of 15 patients in the B treated group versus 3 out of 4 patients in the Q treated group, and less than 50% reduction in tumor dimensions was achieved in 3 patients in the B treated group. Response to both drugs was not statistically different. For macroprolactinomas there was also a nonsignificant difference in the response to both drugs used. More than 50% reduction in tumor dimensions was achieved in 4 out of 6 patients in the B treated group versus 2 out of 4 patients in the Q treated group, while less than 50% reduction in tumor dimensions was achieved in one patient in the B treated group versus 2 patients in the Q treated group. One patient with macroprolactinoma was resistant to bromocriptine without change in adenoma dimensions. Visual field defects improved in 4 macroprolactinoma cases with prior field defects with the exception of the failed case in the B treated group. Drug side effects were more severe in bromocriptine-treated patients than quinagolide, and three patients of the series were switched to quinagolide because of bromocriptine intolerance. Conclusions: It can be concluded that prolactinoma is more prevalent in females predominantly microprolactinoma. When males are affected macroprolactima predominates due to delayed diagnosis. Patients with prolactinoma respond well to medical treatment in terms of normalization of excess prolactin level and reduction or disappearance of the tumor mass. Both bromocriptine and quinagolide are similarly effective, but quinagolide has fewer side effects

Bone status in patients with hyperthyroidism: impact of the severity, duration, and etiology of hyperthyroidism on bone turnover markers and bone mineral density

Hyperthyroidism is accompanied by osteopenia or osteoporosis with higher incidence of fracture rates. There is paucity of data about the relation between the degree or duration of hyperthyroidism or its etiology and the resulting bone changes. The aim of the present work was to study bone status in patients with hyperthyroidism including biochemical markers of bone turnover and bone mineral density, and to elucidate the impact of severity, duration, and etiology of hyperthyroidism on biochemical markers of bone turnover and bone mineral density. Subjects and Thirty-six male patients with hyperthyroidism, 21 with Graves' disease and 15 with toxic multinodular goiter, with an age ranging from 23 to 65 years and a mean of 43 +/- 10 years, were included, together with 10 healthy men with matched age as a control group. In addition to full clinical examination, patients were subjected to radioisotope scanning and uptake of the thyroid gland with Tc 99,and DEXA scanning of the lower half of the left radius. Laboratory work up included serum free T3, free T4, TSH. Special assays done for patients and controls included serum total and B-ALP, serum OC, serum calcium, serum phosphorus urinary calcium, urinary DXP cross-links, urinary creatinine and calculated urinary DXP/urinary creatinine ratio. Biochemical markers of bone turnover were significantly higher in patients with Graves' disease compared to controls. Serum B-ALP was 9,5 +/- 5.6 KAU/I versus 2.2 +/- 0.8 KAU/I [P=0.00], serum OC was12.7 +/- 5 ng/dl versus 6.6 +/- 1.6 ng/dl [P=0.00], urinary calcium was 22.6 +/- 7.5 mg/dl versus15.5 +/- 5.1 mg/dl [P<0.05], and urinary DXP/urinary creatinine ratio was 12.6 +/- 5.5 versus 6.3 +/- 1.8 [P=0.00]. Biochemical markers of bone turnover were significantly higher in patients with toxic multinodular goiter compared to controls. Serum B-ALP was 4.3 +/- 2.6 KAU/I versus 2.2 +/- 0.8 KAU/I [P<0.05], serum OC was11.5 +/- 6.1 ng/dl versus 6.6 +/- 1.6 ng/dl [P<0.05], urinary calcium was 19.2 +/- 5 mg/dl versus15.5 +/- 5.1 mg/dl [P<0.05], and urinary DXP/urinary creatinine ratio was 13.5 +/- 7 versus 6.3 +/- 1.8 [P<0.05]. There was nonsignificant difference in the biochemical markers of turnover in patients with Graves' disease compared to those with toxic multinodualr goiter. Serum OC was 12.7 +/- 5 ng/d versus11.5 +/- 6.1 ng/dl, urinary calcium was 22.6 +/- 7.5 mg/dl versus 19.2 +/- 5 mg/dl, and urinary DXP/urinary creatinine ratio was 12.6 +/- 5.5 versus 13.5 +/- 7. However, serum B-ALP was higher in patients with Graves1 disease compared to those with multinodular goiter [9.5=/=5.6 KAU/I versus4.3 +/- 2.6 KAU/I [P< 0.05]. The Z -score at the lower half of the left radius in patients with Graves' disease [-1.7 +/- 0.5] was not significantly different from those with toxic multinodular goiter [-1.6 +/- 6]. Correlation between free T3 and biochemical markers of bone turnover revealed a significant positive correlation with all studied parameters: B-ALP [n= 0,37, P<0.05], serum OC [r= 0.62, P<0.05], urinary calcium [r=0.46, P<0.05], and urinary DXP/urinary creatinine ratio [r=0.52, P<0.05]. Correlation between free T4 and bone turnover markers revealed a significant positive correlation with B-ALP [r=0.43, P<0.05], serum OC [r=0.65, P<0.05], urinary calcium [r= 0.61, P<0.05], and urinary DXP/ urinary creatinine ratio [r=0.49, P< 0.05]. The duration of the thyrotoxic state did not correlate with the assessed bone turnover markers. However, the duration of the thyrotoxic state correlated significantly with the Z-score of the studied patients [r =0.68, P< 0.05]. The Z-score of the studied patients did not correlate with the free T3 and freeT4. Conclusions: It is concluded that men with hyperthyroidism have significant bone loss with higher biochemical markers of bone turnover. The severity of hyperthyroidism is directly related to the derangement of biochemical markers of bone turnover. Duration of the thyrotoxic state is related to the degree of bone loss. The etiology of the thyrotoxic state is not related to the degree of derangement in bone turnover markers or to the degree of bone loss

Detecting depression among open cardiac surgery patients: pre and postoperative evaluation of changes

Objectives: this study aimed at evaluation of changes in the pre- and post-operative depression by simple method among open cardiac surgery patients that may help in further psychiatric intervention to improve outcomes

Methods: it included eighty four patients of those that subjected to open cardiac surgery over one year period. They were evaluated prior to the surgery, at the tenth postoperative day and at three to four months later. Assessments were done using the WHO [Ten] Well-Being Questionnaire, the Major Depression Rating Scale [ICD-10 version], the PCASEE Quality of Life Scale, and the New York Heart Association Functional Classification [NYHA]

Results: high concordance rate in diagnosing de in pression was found in this study between the surgeon and the psychiatrist. More than one third [36%] of patients who subjected to open cardiac surgery had preoperative depression. At the follow up; there were increased levels of depression more than the preoperative stage. Low scores of the quality of life were related in the post-operative stages to the depression in spite of the marked improvement the functional disability

Conclusion: there are decrements in both the quality of life and depressive scores in open cardiac surgery patients even after surgical interference independent of the improvement in the physical functional disabilities that needs further psychiatric intervention to mini mize the further physical consequences of depression

Non thyroidal illness syndrome in patients with congestive heart failure: a novel prognostic formula

The non thyroidal illness syndrome [NTI] refers to changes in serum thyroid hormones in the absence of primary disorders of the hypothalamus, pituitary or thyroid glands and it occurs in patients with severe nonthyroidal systemic illnesses including cardiac disorders. NTI is reported to occur in patients with severe as well as compensated heart failure and it is related adverse prognosis. Aim of the present work was to elucidate the pattern of thyroid hormone abnormalities in patients with different degrees of heart failure and its relation to the patient prognosis and clarifying if the etiology of heart disease is related to the pattern or severity of NTI. This work was carried out on 50 subjects: 40 patients with congestive heart failure and 10 healthy volunteers of matched age and sex. Patients were classified according to the etiology of heart failure into 4 classes. Hypertensive group included 9 patients with hypertensive heart failure, cardiomyopathic group 11 patients with dilated cardiomyo-pathy, rheumatic group 10 patients with rheumatic heart disease, and ischemic group including 10 cases with ischemic heart failure. Patients were classified according to NYHA into grade IV of 11 patients, grade III of 15 cases, and grade II including 14 patients. After clinical evaluation, laboratory work up was carried out including serum total T3, total T4, TSH and total cortisol together with total CPK, LDH, lipogram, serum creatinine, and liver function tests and echocardiography. serum T3, T4, and TSH were proved to be low in patients compared to control and the decrease was marked in advanced stages of heart failure compared to the less severe grades. It was also proved that the etiology of heart failure is not related to the pattern or severity of NTI in these patients. Serum cortisol was found to be insignificantly high in-patients compared to control and not related to thyroid hormone abnormalities. A novel prognostic formula was suggested to predict the prognosis of patients with congestive heart failure with certainty reaching up to 98%, This formula used the discriminancy score and it revealed 3 independent factors determining the prognosis in these patients which are CPK, total T4, and aortic root dimension. patients with congestive heart failure have thyroid hormone abnormalities in the form of low T3, T4 and low TSH. The severer the grade of heart failure the lower the hormone levels. Etiology of heart failure is not related to the pattern or seventy of NTI. A novel prognostic formula was suggested to predict prognosis of patients with heart failure with certainty reaching up to 98 96. Three parameters were proved to be independent predictors namely: CPK, T4, and aortic root dimension

Prothrombotic markers in NIDDM

The present work comprised the study of 50 cases besides 10 controls. The necessary clinical and laboratory investigations had been carried out for all subjects. In addition, PC was assayed. A significant prolongation of PT, APTT has been observed in all diabetic group as compared to the control group. Insignificant decrease in fibrinogen level has been observed in all diabetic group as compared to control group. Insignificant increase in PC activity has been observed in all diabetic group as compared to control group. This may be an attempt by the body to overcome hypercoagulability [Vigano et al. 1984]. Significant decrease in PC activity has been observed in diabetic bilharzial group as compared to the diabetic non bilharzial group