Hepatitis C virus genotype distribution in Egyptian diabetic patients: a preliminary study

There is controversy regarding whether a specific hepatitis C virus [HCV] genotype is associated with diabetes mellitus. This study aimed to investigate HCV genotype distribution in diabetics and its relation to some clinical and laboratory variables in HCV-positive diabetic versus non-diabetic Egyptians in East Delta. The study included 100 HCV-positive patients of which 66 were diabetic in addition to 35 healthy adults as a control group. Clinical assessment, laboratory measurements of plasma glucose, insulin, C-peptide, C-reactive protein [CRP], tumour necrosis Factor-alpha [TNF-alpha] and liver functions [alanine aminotransferase [ALT], aspartate aminotransferase [AST] and gamma-glutamyltransferase [GGT]] as well as HCV genotype determination were done, and AST/platelet ratio index [APRI] and Homoeostasis Model of Assessment-Insulin Resistance [HOMA-IR] were calculated. The main results were the presence of HCV genotype 3, in 31.8% of the diabetic group and in 26.5% of the non-diabetic group, while the remainder of cases had genotype 4, the predominant genotype in Egypt. This is the first report of the presence of HCV genotype 3 in about 30% of an Egyptian cohort. However, there was no significant difference in genotype distribution between both groups. Further, there were significantly higher values of HOMA-IR, insulin and C-peptide in HCV-positive groups in comparison to the control group, while TNF-alpha was significantly higher in the HCV-positive diabetic group. However, there were no significant differences between both genotypes regarding these parameters. Although this study reveals for the first time the presence of HCV genotype 3 in a significant percentage of a group of Egyptian patients, where the majority were diabetic, the association between diabetes and certain HCV genotypes could not be confirmed on the basis of our findings. Hence, taking into consideration the impact of such a finding on the treatment decisions of those patients, further studies are warranted to explore these findings to a greater extent

Brain natriuretic peptide [BNP] in essential hypertension: correlation with echocardiographic left ventricular mass and function

This study was conducted to determine plasma levels of brain natriuretic peptide [BNP] in hypertensive patients with and without heart failure and to correlate the findings to left ventricular systolic and diastolic functions as well as left ventricular mass. The study included 50 hypertensive patients and 10 normotensive subjects as a control group. All patients and control were subjected to clinical examination, ECG, plain X-ray chest and echocardiography. Blood samples were withdrawn for evaluation of plasma BNP levels. The study revealed marked increase in plasma BNP levels in all hypertensive patients in comparison to control. The marked elevation was noticed more in the group having left ventricular hypertrophy as evidenced by increased echocardiographically determined left ventricular mass index. Patients having symptomatic heart failure showed the highest values. Significant negative correlation was found between BNP levels and indices of LV systolic performance namely ejection fraction [EF] and fractional shortening [FS]. Also, plasma BNP levels were significantly higher among hypertensive patients having diastolic dysfunction as evidenced by decreased ratio of early versus late transmitral flow velocity [E/A ratio]. BNP values showed fairly high sensitivity in predicting ventricular hypertrophy in comparison to echocardiography. It could be concluded that BNP levels might be a biomarker of left ventricular hypertrophy, filling impairment as well as systolic dysfunction. Larger studies are required to assess serial measurements of BNP to monitor antihypertensive therapy or to detect development of heart failure in hypertensives

Insulin like growth factor-1 [lGF-1] in Egyptian patients with heart failure

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

Epicardial visceral fat in obesity

Epicardial fat, which is the fat surrounding the heart has been recently studied as a method of visceral adipose tissue prediction. The role of visceral fat has been previously linked to the insulin resistance and metabolic syndrome and its associated increased cardiovascular risk. So, the aim of this study was to determine the epicardial fat thickness in obese subjects and to correlate the findings to anthropometric and metabolic parameters of the metabolic syndrome and insulin sensitivity. The study included 38 obese [BMI

Coagulation and fibrnolytic variables in subjects with metabolic syndrome

It has been noticed that the metabolic cardiovascular risk factors associated with the metabolic syndrome do not sufficiently explain excess cardiovascular risk attributed to this syndrome. It was suggested that abnormalities in haemostatic system might contribute to this excess risk. Therefore, the aim of this study was to determine the levels of some of the haemostatic variables in subjects having metabolic syndrome and to correlate these values with the anthropometric and metabolic variables associated with this syndrome. The study included 46 obese non diabetic subjects of whom 28 subjects [group1] fulfilled the ATP III criteria of the metabolic syndrome and 18 subjects [group2] did not have metabolic syndrome as well as 14 lean subjects [group 3] of matched age and sex as a control group. Clinical and laboratory evaluation of the study groups stressed on anthropometric measurements [weight, height, body mass index, waist circumference, and sagittal abdominal diameter],blood pressure , and laboratory measurements of fasting glucose, fasting insulin, lipids, tissue plasminogen activator [t-PA] antigen, antithrombin III activity [ATIII], protein C antigen and von Willebrand factor [vWf] antigen. The main results of this study included a significant increase in the concentrations of t-PA and vWf antigens in subjects having metabolic syndrome [group 1] in comparison to the other groups while there were non-significant changes in the levels of protein C antigen and AT III activity. Both t-PA and vWf showed significant correlation with HOMA-IR as a measure of insulin sensitivity. The t-PA showed also significant correlation with most of the variables of metabolic syndrome including waist circumference, BMI, systolic blood pressure, fasting glucose, fasting insulin, and HDL cholesterol . On the other hand, vWf showed significant correlations with fasting glucose, fasting insulin and sagittal abdominal diameter, with non-significant correlations with the other variables. It was concluded that the t-PA and vWf antigens concentrations were increased in subjects with metabolic syndrome and correlated with the HOMA-IR measure of insulin sensitivity. Taking into consideration that both t-PA and vWf are mainly released from vascular endothelium, these findings could be an indicator of endothelial dysfunction in those group of subjects