Plasma stable nitric oxide end products and endothelin-1 states in patients undergoing hemodialysis due to chronic end stage rena disease

In patients with end-stage renal disease [ESRD], it is essential to mandate an active screening for high risk factors of coronary atherosclerosis through periodical clinical examination and determination of the traditional and non traditional risk factors for cardiovascular disease [CVD]. Determination of two novel biochemical atherogenic risk factors: plasma nitric oxide [NO] metabolites [nitrite: NO2 and nitrate: NO3] and endothelin-1 [ET-1] concentrations in patients with end stage renal disease who were undergoing hemodialysis. The present study population was classified into: [i] A healthy reference [control] group which comprised 13 clinically healthy blood donors or patients' relatives and [ii] ESRD group which comprised 19 patients with chronic end stage renal failure [ESRD] who were undergoing intermittent hemodialysis [HD] All patients and controls were subjected for determination of plasma native NO-2/NO-3 concentrations by a colorimetric assay and plasma ET-1 concentrations using an enzyme immunometric immunoassay [EIA]. Plasma total nitrites [NO-2,+NO-3], native nitrites and calculated nitrates [umol/mi] and plasma ET-l [pg/mi] levels were significantly higher in ESRD patients both before and after dialysis sessions than their corresponding levels of healthy controls. Hemodialysis sessions induced non significant increase of NO metabolites [NOx, NO2 and NO3] and ET-1 levels above the predialysis values. However, nitrate: native nitrite ratios in the HD-patients both before and after dialysis [1.7: 1 and 1.5: 1] were significantly lower than the corresponding normal ratio [3.1:1]. Plasma total nitrites comprised 21.2% native nitrites in healthy subjects. The native nitrites fraction increased to 37.0% and 40.0% of the total nitrites in ESRF patients immediately before and after HD sessions, respectively. Patients with ESRD who were undergoing hemodialysis presented significant increase of novel vasoactive CVD risk factors [NO and PT-I] when compared with the corresponding healthy reference values. Although there was a significant correlation between No meyabolites and ET-1, plasma NO metabolites concentrations did not necessarily reflect the hemodynamically active plasma NO component

Effects of different therapeutic modalities on clinical and biochemical critieria of the metabolic syndrome in adult Egyptians

Principally there are three_ interrelated protocols used for management of metabolic syndrome. However, the outcome of management by any of these protocols is a subject of debate. This promoted interest to evaluate the beneficial effects of three interrelated therapeutic modalities [life-style modifications only, the insulin sensitizer metformin alone or both together] on the clinical and biochemical features of MS. Fifty four patients with MS were randomly obtained from the Outpatient Clinics of Mansoura University Hospitals. All patients fulfilled the criteria of AHA/NHLBI for MS. Patients were randomly divided into three equal groups. They were managed with either life-style modifications [proper nutrition regimen and adequate physical exercise] aiming an intraabdominal visceral fat loss, metformin therapy alone or life-style modifications plus metformin therapy together. Clinical and laboratory reassessments after about 6.0 months of treatment were done. For patients whom their responses to any of the above stated measures were not satisfactory, specific drug treatment of any component of the syndrome [obesity, hypertension, hyperglycemia, dyslipidemia] was prescribed. Patients gained significant benefits, but at variable degrees, in response to any of the three modalities of treatment. The combined life-style modifications with metformin intake together produced the best outcome This protocol significantly ameliorated clinical disorders of MS [abnormal BMT, waist circumference and SP]. In addition, it improved MS biochemical abnormalities, Thus it decreased fasting plasma glucose, serum triglycerides, total cholesterol, LDL-C, C peptide and insulin concentrations as well as decrease of insulin resistance index together with increment of serum HDL-C concentration. Therapeutic responses obtained after either metformin therapy or lifestyle modifications alone were less effective than after their combination Metformin [MF therapy together with life-style modifications significantly ameliorated clinical features and improved metabolic commotions of MS. Subsequently the prognosis of the syndrome became favorable. Life style modifications or metformin therapy alone were less effective than their combined therapy

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

Testosterone and luteinizing hormones in impotent and infertile diabetic patients

This study comprised 29 diabetic patients, divided into 3 groups; 12 non complicated, 5 infertile and 12 impotent diabetic patients, in addition to 5 healthy normal males of matched age. All cases were subjected to thorough clinical examination, fasting and post prandial blood sugar, semen analysis for infertile group and radio immunoassay of serum testosterone and luteinizing hormones. It was found that, neuropathy and peripheral ischaemia were more common in the impotent diabetic group. Serum testosterone was significantly subnormal in the impotent group, but the luteinizing hormone was significantly subnormal in infertile one. The emperical use of androgen and luteinizing hormone in diabetics with sexual problems is not advisable as it could further depress the hypothalamopituitary gonadal axis

study on the significance of postmortem serum electrolytes in diagnosis of drowning

Estimation of blood electrolhytes [Na, K, Ca, Mg and Cl]. Was useful to differentiate rabbits died by drowing in waters of different nature [Sea, Nile, Drainage and tap] from those of undrowned reference group. The most reliable index for differentiating sea water drowning from those drowned in fresh water was chloride followed by sodium. On the other hand, there was no mineral estimate that successfully differentiate between river, drainage and tap waters drownings

Materno-foetal plasma cortisol levels during spontaneous vaginal deliveries of normal and preeclamptic pregnancies

Plasma cortisol levels were estimated in both normal and preeclamptic pregant women during the last week of gestation as well as during spontaneous vaginal deliveries. Foetal plasma cortisol levels were also determined. The maternal plasma cortisol levels showed a signifcant increase during the process of labour in normal and preeclamptic cases. This suggests that the physical and psychological stress of labour leads to an increased activity of the anterior pitutary-adrenal axis. The significance of the changes in preeclamptic cases is discussed. The foetal plasma cortisol levels were almost always lower than their corresponding maternal levels. The decrease was however more in infants of preeclamptic cases. This denotes that the placental function partly determines the circulating foetal cortisol levels, which probably depends on the maternal cortisol passed through the placenta

Thyroid and male infertility

The functional state of the thyroid gland was evaluated clinically and by PBI for 104 infertile males and 25 normal controls. An euthyroid state was found to be fundamental for spermatogenesis. Hypothroidism was detected in 3 cases and a case record of azoospermic thyrotoxicosis is described with normalization of semen picture after medical control of the hyperthyroid state. Liothyronine therapy [20 ug/day] was very effective among infertile males with hypothyroidism and useless in euthyroidism. Study of the functional state of thyroid gland is essential before T 3 therapy