study of some nontraditional risk factors for the development of coronary heart disease in patients with insulin dependent diabetes mellitus

Megjor risk factors explain much of the excess risk for coronary heart disease produced by diabetes, but nontraditional factors may also relate to incident coronary heart disease. This study was conducted on 35 patients with IDDM and coronary heart disease [CHD] [10 females and 25 males, aged 45-70 years], 35 patients with IDDM and without CHD [17 females and 18 males, aged 35-65 years] as well as 20 age and sex matched apparently healthy individuals as a control group. Every individual was subjected to clinical evaluation including history taking and clinical examination with special stress on the presence of risk factors as well as measurement of: fasting and postprandial blood glucose levels, lipid profile, serum albumin level glycosylated hemoglobin [HbA[1]], C-reactive protein [CRP], fibrinogen level von Willebrand factor antigen level [vWF Ag], total leucocyte count and albumin excretion rate [AER] in urine. Insulin dependent diabetics with CHD had higher levels of total cholesterol LDL-c and triglycerides and had lower levels of HDL-c when compared with diabetics without CHD and with controls. They also showed higher levels of fibrinogen, vWFAg level, CRP and total leucocyte count and lower levels of serum albumin. Microalbuminuria was present in 71.4% of diabetics who developed CHD while it was present in 31.4% of diabetics without CHD. In diabetics with CHD, fibrinogen was correlated with vWF at r=0.52 and P< 0.05. vWF Ag level is weakly correlated to lipid parameters, being significantly correlated to triglycerides. It was also positively correlated toAER [microalbwninuria] [r=0.84, P< 0.003], while it was negatively correlated to serum albumin [r = -0.4, P< 0.05]. In the type I diabetic group with CHD C-reactive protein correlated significantly with vWF [r=0.43, P< 0.005] and with fibrinogen [r=0.60, P< 0.001]. In conclusion levels of fibrinogen, von Willebrand factor, CRP, albumin and leucocyte count were predictors of coronary heart disease among patients with IDDM. These associations may reflect the underlying inflammatory reaction or microvascular injury related to atherosclerosis and a tendency toward thrombosis

Study of intercellular adhesion molecule-I in patients with liver cirrhosis and chronic hepatitis: association with disease severity and activity

This study was carried out in Benha University hospital on 20 patients with liver cirrhosis [Group I], 25 patients with chronic hepatitis [Group II] and 20 healthy controls. Thorough history and clinical examination was done to all subjects. Abdominal ultrasonography and the following laboratory investigations were performed to every subject: AST, ALT, serum albumin, serum bilirubin, Prothrombin time [PT], HCV Ab, HBs Ag, HBc Ab [IgG]. HBe Ab and serum level of intercellular adhesion molecule- 1 "sICAM- 1". Liver biopsy was done to patients only. Assessment of disease severity was judged by Child-Pugh classification. Assessment of disease activity was done by histopathological staging and by ALT and AST levels. Our work showed that serum level of sICAM- 1 was significantly high in both patient groups compared to controls, and this elevation was attributed to both increased hepatic production and defective hepatic clearance. The serum level of sICAM-1 correlated significantly with both disease severity and activity. Our study showed that serum level of sICAM-1 can be used as a screening non-invasive test with high specificity [100%] and sensitivity [94.6%] to detect patients with chronic liver diseases. On the other hand we failed to find a significant difference in the serum level of sICAM-1 between the two patient groups. Therefore, serum level of sICAM-1 has a poor diagnostic value with low specificity [78.6%] and sensitivity [43.5%] to differentiate patients with chronic hepatitis from patients with cirrhosis

Hypothalamic-pituitary-adrenal axis function in rheumatoid arthritis

This study was conducted on 50 individuals, 35 patients suffering from rheumatoid arthritis [RA] diagnosed according to the revised American Rheumatism Association criteria and receiving nonsteroidal anti-inflammatory drugs [NSAID] and 15 apparently healthy individuals as a reference group. Each individual was subjected to full history taking, clinical examination complete blood count, erythrocyte sedimentation rate, rheumatoid factor, plasma adrenocoticotrophic hormone [ACTH], serum cortisol [AM. PM] and serum interleukin-1 B [IL-IB]. ACTH levels were significantly higher in RA patients [mean +/- SD 43.6 +/- 26.9 pg/mi] than in the reference group [mean +/- SD 30.8 +/- 19.2 pg/ml. Serum cortisol levels [both AM and PM values] were reduced in RA patients [mean +/- SD 10.3 +/- 7.6 ug/dI and 5.3 +/- 3.5 ug/d1] than in reference group [mean j SD 12.6 +/- 3.4 ug/dl and 6.2 +/- 1.7 ug/dl and this reduction was evident in patients with active RA, grade III [mean +/- SD 6.8 +/- 2.4 ug/dl and 3.8 +/- 1.5ug/dl] and grade IV [mean +/- SD 2.36 +/- 2.1 ug/dI and 1.9 +/- 2.3 ug/dl. Serum levels of IL-lB were elevated in RA patients [mean +/- SD 7.8 +/- 8.4 pg/mi] than in reference group [mean +/- SD 2.5 +/- 1.5 pg/m1]. These findings suggest that RA patients have an abnormality of the HPA axis function. This hypothalamic abnormality may be an additional unrecognized factor in the pathogenesis of RA