Evaluation of haemostatic mechanisms in the elderly

Aging is associated with changes in the haemostatic balance including coagulation, flbrinolytic and/or platelet activity. Adverse changes in coagulation and flbrinolytic factors are thought to contribute to the increased risk of cardio-vascular disease and atherothrombosis with age. In this study the aim was to determine how the biological factor of age affected coagulation, flbrinolytic factors and platelet glycoprotein receptors levels. In so doing the effect of age on the two important systems in the body involved in haemostasis namely, the coagulation and flbrinolytic systems was studied. The population studied consisted of ten young healthy controls aged 20 - 30 years representing [group I], twenty subjects aged 60 - 70 years [group II], twenty subjects aged 70 - 80 years [group III] and ten subjects above 80 years [group IV]. All groups were subjected to thorough history taking, complete clinical examination and routine investigations excluding obeses, hypertensives, diabetics, patients with chronic obstructive pulmonary disease [COPD] or ischemic heart disease and patients with peripheral vascular disease. Investigations of coagulation parameters [procoagulant markers] included prothrombin activity, estimation of flbrinogen level, Factor VII assay, Thrombin antithrombin [TAT] complex, Prothrombin fragment 1+2 [PF1+2]. Investigations of flbrinolytic system [flbrinolytic markers] included Tissue plasminogen activator [TPA] and tissue plasminogen activator- inhibitor [TPA-I], Flow cytometric investigation of platelet receptors, including platelet membrane glycoprotein GPIIb, Ilia, and GPIb. Prothrombin activity and TAT complex were found to increase with age but their differences between the aged groups and group I did not attain a statistical significance. Serum flbrinogen, factor VII and PF 1+2 were rising with the advancement of age and their means were significantly higher in all aged group in comparison with the young group.Serum TPA and TPA-I showed a progressive increase with age and their means were significantly higher in all aged group in comparison to the young group. Platelet glycoprotein receptors IIb, IIIa and Ib levels were found statistically significant higher in all aged groups in relation to group I. The maximum increase was found in group IV. The age-dependency of these markers has to be taken into account in respect to their clinical use in order to characterize patients with suspected risk of atherosclerotic events. In future, one should consider routinely screening for these markers in those above the age of 60 years and, if found to be high consider giving flbrinolytic and antithrombotic agents prophylactically

Serum levels of soluble receptor activator of nuclear factors-KB ligand [sRANKL], osteoprotegerin [OPG] and bone mineral density in Egyptian osteoporotic elderly women

The aim of this study was to determnine the state of the OPG/RANKL system and its possible role in osteoporotic elderly women. The present study included 40 apparently healthy old osteoporotic women aged 64.5 +/- 4.5 years as group I,[GI] and 30 healthy women of matched age as group II [GII]. The two groups were subjected to complete history taking, thorough clinical examination, routine laboratory investigations, measurement of bone formation markers as serum alkaline phosphatase, serum calcium and serum osteocalcin and measurement of bone resorptiomz markers including: hydroxyproline in urine, serum OPG and serum RANKL CT Bone Density was done as well. In the current study, non significant differences were noted between the 2 studied groups as regard fasting blood glucose, renal amid hepatic function tests. A significant increase in serum alkaline phosphatase and urinary hydroxyproline and a significant decrease in serum calcium and serum osteocalcin was noted in group I compared to group Ii. Serum levels of RANKL were significantly elevated while serum OPG levels were significantly decreased in osteoporotic women compared to healthy controls. Changes in circulating OPG-RANKL correlates with serum osteocalcin and BMD changes. RANKL is an essential cytokine for the formation and activation of osteoclasts and promotes bone resorption, while OPG antagonizes these effects. Estrogen deficiency tilts the RANKL/OPG balance to favor osteoclastic activation and bone loss. RANKL blockade may emerge as a novel therapeutic option for human bone diseases. Further studies are necessary to elucidate the causes of osteoporosis and low bone mass in old women

Physiopathologic role of plasma homocysteine concentration, folic acid and vitamin B[12] levels in patients with thrombotic stroke: relation to helicobacter pylori infection

To establish the link between serum homocysteine [Hcyst], folic acid and vitamin B[12] levels and Helicobacter pylori [H pylori] infection in the pathogenesis of thrombotic cerebrovascular stroke [CVS]. Subjects and Fourty patients with thrombotic CVS were selected at the Main Alexandria Hospital compared with 10 healthy subjects of matched age as a control group. Serum folate, vitamin B[12] and total Hcyst levels were determined. Also, serum anti-H pylori IgG was estimated in all included subjects. in thrombotic stroke patients; both serum folic acid and B[12] levels were significantly decreased while serum Hcyst level was significantly elevated compared to controls. Patients with hyper homocysteinemia [> 15 micro mol/l] had significantly lower levels of serum folate and vitamin B[12] and significantly higher levels of H pylori IgG than patients with normal serum Hcyst level. Serum Hcyst in stroke patients was significantly positively correlated to H pylori IgG levels and inversely correlated to serum folate and vitamin B[12]. Also, H pylori IgG level was significantly inversely correlated to serum folate and vitamin B[12]. H pylori infection may decrease serum folate and vitamin B[12] levels possibly through impairment of their absorption. This could lead to hyperhomocysteinemia due to abnormal Hcyst metabolism. Hcyst is toxic to endothelial cells and results in atherothrombosis and its sequelae

Autoimmune Thyroiditis is in type I versus type 2 diabetics

to determine the prevalence of autoimmune thyroiditis [AIT] as evidenced by thyroid peroxidase antibodies [TPO-ABs] in both types of diabetes Seventy five subjects from the Main Alexandria University Hospital were selected and divided into 3 groups. Group I included 30 type 1 diabetics. Group II included 30 type 2 diabetics, while group III included 15 healthy subjects of matched age and sex. Thorough history taking and physical examination were done. Fasting plasma glucose [FPG] and glycated haemoglobin [HbA1c] were estimated the following parameters were measured in serum: TPO-ABs, tyrosine phosphate-like proteins antibodies [IA2-ABs] and glutamic acid decarboxylase antibodies [GAD-ABs], Also, thyroid stimulating hormone [TSH] and free thyroxine [FT4 levels were measured in all subjects. Type l diabetics had the highest frequency of TPO-ABs positivity [26.7%], while in type 2, it was 10% vs control 6.7%, but it did not reach significant levels. TPO-ABs positivity was significantly associated with higher levels of IA2-ABs and GAD-ABs. It was also significantly associated with elevated TSH levels and insignificantly related to low free T4 levels. Conclusions: AIT, as evidenced by TPO-Abs, was present in type 1 diabetics and some type 2 with late life onset [LADA], a/though it did not reach significant levels. Results obtained were encouraging for diabetes and AIT prediction and for immunointervention measures to be used in high risk subjects

Leptin and Andropause

To determine whether circulating leptin levels change in andropausal Egyptian men. Subjects and Forty elderly nondiabetic nonobese Egyptian men [aged 65 to 75 years] [group I] were included. Subjects were non obese with BMI <25 kg/m2. Twenty healthy adult men served as controls [group II]. Estimation of fasting serum level of leptin, DHEAS and free testosterone were done using ELISA technique. Mean fasting serum leptin was significantly higher in elderly and ropause men when compared to adult men [P<0.001]. Mean fasting serum free testosterone and DHEAS ware significantly lower in group I when compared to group II [t = 18.15, P < 0.001, and t = 25 - 16, P < 0.001, respectively]. Significant negative correlation was found between serum free testosterone and serum leptin in group I [r=-0.692, P < 0.001]. Our data confirmed increased serum leptin concentration in andropausal elderly Egyptian men. An inverse correlation between serum leptin and testosterone was illustrated. Testosterone replacement therapy may be of benefit in suppressing hyperleptinemia in elderly men with subsequent break of hypogonadal-obesity cycle and prevention of development of CHAOS Complex. Further studies examining the effect of other hormonal changes during aging on serum leptin are recommended

Study of bone turnover in elder men

To evaluate the correlation of serum testosterone with the markers of bone turnover: serum alkaline phosphatase and serum osteocalcin as markers of bone formation and urinary deoxypyridinoline to creatinine ratio [DPD/Cr] as a marker of bone resorption in elderly men. Subjects and To achieve this goal, we selected 20 healthy men aged from 60 to70 years [M1], and 10 aged above 70 [M2]. All were with body mass index [BMI] of less than 25 kg/m2 to exclude the effect of increased BMI on bone turnover. Any subject with a systemic disease or on a drug that could affect bone metabolism was excluded. Ten healthy young men served as controls [C], All subjects were subjected to thorough history taking, thorough clinical examination and laboratory investigations in addition to some bone remodeling markers [serum ALP, serum osteocalcin, and urinary DPD/Cr ratio] and serum testosterone, The mean level of serum total alkaline phosphatase was significantly higher in the elderly groups, although it did not exceed the normal range [P<0.001]. Mean serum osteocalcin level was significantly higher in both elderly groups than that in the young group, and its mean level was also significantly higher in M2 group as compared to that in Ml group [P<0.001]. Mean urinary DPD/Cr levels were significantly higher in M1 and M2 groups as compared to those in group C [P<0.001]. Again, its mean level in M2 group was still significantly higher than that in M1 group [P <0.001]. Mean serum testosterone levels in both elderly groups were significantly lower than those in the young group [P< 0.001]. Its mean level in M2 group was also significantly lower than that in M1 group [P <0.005]. A significant negative correlation was found between serum testosterone and all markers of bone turnover under study in M2 group [P<0.05]. However, in M1 group, there was a significant negative correlation between serum testosterone and both urinary DPD/Cr ratio [P<0.001] and serum ALP [P<0.05], but not with serum osteocalcin [P>0.05]. This indicates that the correlation between serum testosterone and osteocalcin attains a significant level with advancement of age. Again, a significant positive correlation was displayed between urinary DPD/CR ratio and both serum ALP and serum osteocalcin [P<0.001] in M1 group. In M2 group, this positive correlation attained a statistical significance with serum ALP [P<0.05], but not with serum osteocalcin [P>0.05]. Conclusions: Serum ALP, serum osteocalcin and urinary DPD/Cr ratio are increased in elderly men above the age of 60 and become higher with advancement of age indicating that bone turnover is a progressive process with aging. Serum testosterone is significantly lower in elderly men. A significant negative correlation was observed between serum testosterone and bone turnover markers in elderly men. Correction of testosterone deficiency may have an important role in prevention of osteoporosis in men

morphometric analysis of the rectal mucosa in untreated coeliac sprue

Rectal mucosal biopsies from 27 subjects with untreated coeliac sprue and 34 subjects with irritable bowel syndrome were studied. The comparison included intraepithelial lymphocytes [IEL], immunoglobin. [Ig] containing cells, mucosal mast cells and eosinophils. subjects with coeliac sprue showed significantly increased number of intraepithelial lymphocytes, while other cell counts were only slightly increased, It is concluded that proctitis in untreated coeliacs is minimal, the increased intraepithelial lymphocyte counts may provide a diagnostic implication if the rectal biopsies looked otherwise normal