Leptin, osteocalcin, and bone mineral density in post-hepatitic liver cirrhosis

The pathophysiology of osteoporosis complicating chronic liver disease is unknown. Some studies have found leptin to be a potent inhibitor of bone formation. The aim of this study is to investigate the relationship between leptin, osteocalcin and bone mineral density [BMD] in liver cirrhosis. Sixty patients with post-hepatitic liver cirrhosis were classified into three groups: group I, 20 pre-menopausal females; group II, 20 post-menopausal females; and group III, 20 males. In addition, 21 age- and sex-matched healthy subjects [seven for each group] were included as control subjects. Patients were classified according to Child-Pugh classification into grade A [n = 0], grade B [n = 38] and grade C [n = 22]. Serum osteocalcin, leptin and parathyroid hormone [PTH], in addition to liver functions test, hepatitis B surface antigen [HBsAg], anti-hepatitis C virus [HCV], serum phosphorus and calcium were measured. Bone mineral density [BMD] was measured by calcaneal ultrasound. Leptin was elevated in all groups [I, II and III] when compared with their control groups [p < 0.01, p < 0.001 and p < 0.01, respectively]. Further, it was high in female groups [I and II] compared to males [group III], [p < 0.01 each]. BMD and serum osteocalcin decreased in each group compared with the respective control [p < 0.001; p < 0.01 in group I, p < 0.05; p < 0.001 in group II and p < 0.001; p < 0.001 in group III, respectively]. In the Child-Pugh grade C group, BMD and osteocalcin were low [p < 0.001, p < 0.05, respectively], while serum leptin was elevated [p < 0.05], when compared with grade B group. Leptin correlated negatively with serum osteocalcin [r = -0.553; p < 0.001], BMD [r = -0.229; p < 0.05], albumin [r = -0.449; p < 0.001] and albumin/globulin [A/G] ratio [r = -0.661; p < 0.001], while positively correlated with both aspartate transaminase [AST] [r = 0.462; p < 0.001], and alanine transaminase [ALT] [r = 0.483; p < 0.001]. Osteocalcin negatively correlated with intact iPTH [r = -0.370, p < 0.001], while positively correlated with BMD [r = 0.418; p < 0.001], albumin [r = 0.659; p < 0.001] and A/G ratio [r = 0.444; p < 0.001]. Serum leptin was elevated in cirrhotic patients and may have a role in the pathogenesis of osteoporosis in liver cirrhosis

Value of the terminal QRS distortion in the admission electrocardiogram compared to several clinical and electrocardiographs parameters in predicting myocardial infarction size, and final scar size

The major determinants of short and long-term prognosis after myocardial infarction [MI] are MI size as well as the final scar size. Clinical and electrocardiographic [ECG], admission variables were studied in 60 consecutive patients admitted with their first acute anterior ST-segment elevation MI of <6 hours duration. Predischarge low-dose dobutamine stress echo was done to the patients unless contraindicated to measure MI size [Resting wall motion score index; WMSI] and final scar size [low-dose WMSI]. Out of the 19 variables studied only 4 variables were significant univariate predictors of both MI size and scar size; QRS distortion, higher Killip class, number of leads with ST segment elevation and Selvester score. Other 3 variables predicted only MI size; history of chronic stable angina, sum of ST elevation, and maximum creatinine kinase level. Of the admission variables, the multivariate predictors of larger MI size were QRS distortion and higher baseline Killip class. For scar size the only multivariate predictor was Killip class. The pre-discharge multivariate model added Selvester score to the above admission variables as a significant multivariable predictor to both MI and scar sizes. The presence of QRS distortion in the admission ECG can independently predict large MI ALT but not essentially a large final scar size. Both can be independently predicted by the admission Killip class as well as by Selvester score in the predischarge ECG

Value of serum and synovial fluid activin A and inhibin A in some rheumatic diseases

Activin is a growth and differentiation factor of many cell types and has recently been implanted in inflammatory processes. Clinical data demonstrating roles of activin and its antagonist inhibin in inflammatory arthropathies, are lacking. The Study is to measure serum and synovial fluid levels of activin A and inhibin A in patients with rheumatoid arthritis [RA] systemic lupus erythematosus [SLE] and osteoarthritis [OA] and correlate them with disease activity parameters. This study included 60 patients with three rheumatic diseases [20 with RA, 20 with SLE and 20 with OA], as well as ten healthy subjects as a control group. All of them were subjected to complete history, physical and musculoskeletal examination and estimation of disease activity index [DAS- 28] for RA and [SLEDAI] for SLE. The following investigations were done for all subjects; serum and synovial activin A and inhibin A; in addition to complete blood picture, erythrocyte sedimentation rate [ESR], C-reactive protein [CRP],rheumatoid factor [RF], antinuclear antibodies [ANA],anti-dsDNA, serum complement [C 3, 4] and Xrays on affected joints. The mean values of serum activin A were significantly higher in RA, SLE and OA than controls [P<0.001] also in RA and SLE versus OA [P<0.05 for both]. The mean values of serum inhibin A were significantly higher in all studied groups than controls [P<0.05 for RA and OA and P<0.001 for SLE]. Also serum inhibin levels were significantly higher in SLE versus OA P<0.001, but there was no significant differences between RA and SLE. Synovial fluid activin and inhibin A were significantly higher in RA than OA [P<0.05 for both]. Positive correlations were found between serum activin A and disease activity parameters of RA morning stiffness [MS], Ritchie index [RI], ESR, CRP and DAS 28] P<0.05, for all. Also positive correlation was found between serum inhibin A and RI in RA patient [P<0.05]. In SLE, positive correlations were found between serum activin A and inhibin A with ESR [P<0.001 for activin and P<0.05 for inhibin A and SLEDAI [P<0.001 for both activin and inhibin]. No correlation were found between synovial activin and disease activity and negative correlation between synovial inhibin and ESR. The significant increase of serum and synovial activin A and inhibin A in RA and SLE and their positive correlations with disease activity parameters of RA and SLE suggest pro-inflammatory action. However the lack of correlations or negative correlation of their synovial levels with disease activity may indicate their anti inflammatory action, We recommended further studies to detect the exact role of activin A and inhibin A

value of lipoprotein [a], homocysteine and doppler of carotid and femoral arteries in assessment of atherosclerosis in asymptomatic cardiovascular risk patients

Atherosclerosis is a major health problem and a common cause of death in our locality. Traditional cardiovascular risk factors do not predict most future cardiovascular events. The aim of this study is to evaluate role of non traditional biochemical markers, carotid and femoral doppler in early detection of atherosclerosis in asymptomatic cardiovascular risk patients. This study was conducted on seventy two patients with various cardiovascular risk factors [22 diabetic. 15 hypertensive, 20 smokers and 15 obese], in addition to eighteen apparently healthy subjects as a control group. All patients and controls were subjected to complete history, physical examination anthropometric measurements, calculation of Framingham risk score [FS]. Measurement of serum levels of lipoproteln [a] [Lp[a]], homocysteine, insulin and C-reactive protein [CRP] as well as microalbumin in urine [UAER], in addition to lipid profile, serum glucose and calculation of insulin sensitivity [QUICKI] were done for all subjects. Also intinia-media thickness [IMT] and plaque formation were assessed in both carotid and femoral arteries using high resolution ultrasound [B mode]. According to FS patients were classified into 3 groups: group [A] 40 patients FS< 10, group [B] 25 patients FS 10-<20% and group [C] 7 patients FS >/= 20%. Also according to presence of atheroma patients were classified into two groups, group I patients without atheroma [62 patients] and group II patients with atheroma [10 patients]. Mean values of serum insulin, homocysteine, CRP, UAER and left common carotid IMT revealed significant elevation in diabetic, hypertensive, obese and smoker groups compared to controls [P<0.01 for all and P <0.05 for CRP in smoker group]. Insulin sensitivity [QUICKI] showed significant reduction in all studied groups compared to controls [P<0.01 for all]. Mean value of Lp[a] showed significant elevation in smoker group compared to controls [P<0.01], but in other groups the mean values of Lp[a] were higher but statistically insignificant. In group C [FS >/= 20%] the mean values of triglycerides, Lp[a] and IMT of both right femoral and right carotid showed significant elevation compared to group [A] FS < 10% [P<0.01 for all]. In group II [patients with atheroma] mean values of systolic blood pressure, serum insulin, triglycerides and CRP revealed significant elevation compared to patients group I [without atheroma] [P< 0.05 for all], while insulin sensitivity showed significant reduction [P<0.05]. Univariate analysis showed significant positive correlations between IMT of left carotid artery and BMI, systolic and diastolic blood pressure, cholesterol, LDL-c., triglycerides, CRP, homocysteine and FS and negative correlation with HDL-c, Also there were positive correlations between triglycerides with CRP and between Lp [a] with homocysteine. Age, waist circumference, waist/hip ratio, homocysteine, triglycerides and CRP were predictors of IMT of carotid artery: while age, CRP and triglycerides were predictors of atheroma. Non traditional biochemical markers were elevated in all cardiovascular risk groups. IMT of carotid artery correlated positively with traditional risk factors [systolic and diastolic blood pressure, BMI lipogram and FS] and negatively with HDL-c. Also it correlated positively with non traditional risk factors [CRP and homocysteine]

Clinical and biochemical assessment of nutritional status in patients with chronic renal failure on regular haemodialysis

Malnutrition is common in patients with chronic renal failure [CRF] on regular haemodialysis [HD]. The aim of this study is to evaluate the extent of this problem in haemodialysis unit in Assiut University Hospitals. Sixty male patients with CRF on regular HD and 20 age and sex matched controls were enrolled in this study. All patients and controls were subjected to complete history, physical examination and estimation of anthropometric measurements [body weight [wt], body mass index [BMI], midarm circumference [MAC] and triceps skin fold [TSF]. The following investigations were done for all subjects including; peripheral hemogram, kidney functions, lipid profile, serum phosphorus [P], calcium [Ca], albumin, transferrin and ferritin, in addition to serum leptin and C-reactive protein [CRP]. The patients were classified according to uraemic score into 3 groups [A; 13 patients, B; 34 patients and C; 13 patients]. Cases were also classified, according to subjective global assessment score [SGA] of nutritional status into group A [no malnutrition, 6 patients], group B [mild to moderate malnutrition, 35 patients] and group C [severe malnutrition; 19 patients]. According to serum albumin level also patients were classified into group A [serum albumin> 40 g/L; 27 patients], group B [serum albumin 30-40 g/L; 30 patients] and group C [serum albumin< 30 g/L, 3 patients]. The mean values of wt, BMI, TSF, MAC, albumin and transferrin were significantly lower in patients than controls [P<0.001, 0.001, 0.001, 0.001, 0.01 and 0.001 respectively]. Mean levels of serum P, leptin and ferritin were significantly higher in patients than controls [P<0.001 for all]. Mean values of wt, BMI, TSF, MAC and Hb were significantly lower in group B and C than group A when patients were classified according to SGA score [P< 0.05 for B vs A and P<0. 001, 0.00!, 0.001, 0.01 and 0.05 for C vs A]. The mean values of wt, BMI, TSF, MAC, Hb and serum leptin were also significantly lower in group C than B [P<0. 001, 0.01, 0.01, 0.05 and 0.05 respectively] but mean values of ferritin were significantly higher in malnourished patients group B and C than group A [P<0.001 for each]. Mean values of TSF were significantly lower in group C than A [P<0. 05] and mean values of wt, BMI, and TSF were significantly lower in group C versus B [P<0.05 for all] when patients were classified according to uraemic score. 75% of patients had positive CRP and 20% had lymphopenia. Positive correlations were found between Hb and wt, BMI and MAC [F<0.05 for all]. Positive correlation was found between ferritin and CRP [P<0. 05] and negative correlations with BMI, TSF and MAC [P<0. 01, 0.05 and 0.05 respectively]. Malnutrition was common in patients with CRP on regular HD. Anthropometric measurements were lower in malnourished patients than well-nourished patients. Hyperleptinaemia may participate in the pathogenesis of uraemic anorexia. Inflammation may play a role in occurrence of malnutrition in CRF patients. We recommended dietary education of patients with CRF and follow up patients with anthropometric measurements. Further studies are needed to substantiate role of leptin in the development of malnutrition

use of gated cardiac single photon emission computed tomography [SPECT] in healthy smokers

As cigarette smoking is a major cardiovascular risk factor, this study was designed to find the effect of chronic cigarette smoking on cardiovascular system of apparently healthy subjects by using gated SPECT. This study included 20 healthy young males heavy smokers with smoking index 379 +/- 193.4. Also 10 age and sex matched non smokers volunteers served as controls. Smokers and non smokers persons were subjected to complete history taking, thorough clinical examination, X-ray chest, resting ECG and resting echocardiography to exclude any abnormalities. In addition the following laboratory investigations were done; blood urea, serum creatinine, serum glucose, lipogram and C-reactive protein. Also, stress gated cardiac SPECT using Tc99m MIBI was performed for all subjects. Mean values of serum cholesterol and LDL-c were significantly higher in smokers than non smokers [p <0.001, p <0.05 respectively]. Mean values of HDL-c were significantly lower in smokers than controls [p<0.05]. The percentages of positive CRP were significantly higher in smokers versus non smokers [p<0.05]. The mean values of EF% and SV were insignificantly lower in smokers versus controls at post-stress SPECT. Also, 50% of smokers had diminished myocardial perfusion versus 0% of non smokers [p<0.01] at post stress SPECT. There were also abnormal wall motion and thickness at post stress SPECT. Cigarette smoking is a major risk factor for atherosclerosis in young adult male. Post stress cardiac SPECT may be useful for early detection of cardiovascular events of smoking

Serum leptin, insulin and parathyroid hormone levels in chronic renal failure patients

Chronic renal failure patients whether they are treated with hemodialysis or on conservative treatment frequently suffer uremic anorexia and malnutrition, which is associated with increased morbidity and mortality. In this study we have measured serum leptin, serum insulin and parathyroid hormone in addition to routine kidney function tests, serum glucose, total protein, albumin, lipogram, total serum calcium and inorganic phosphorus. This study was conducted on forty five male patients with chronic renal failure and ten healthy male subjects as control group [Group I.]. According to management of chronic renal failure the patients were divided into two groups: 22 patients on conservative treatment [Group II] and 23 patients on hemodialysis [Group III]. Serum levels of both leptin and insulin revealed significant elevation in patient groups [either on conservative or on hemodialysis,] compared to controls, also in hemodialysis group compared to group on conservative treatment. Serum level of intact parathyroid hormone, also showed significant elevation in groups II and III compared to controls with no difference in comparing group Ill versus group II. Correlation study in whole patients group revealed significant negative correlations between creatinine clearance with both leptin and insulin. Also significant positive correlations were found between leptin and insulin and between leptin and intact parathyroid hormone [iPTH]. Anorexia was found in both patient groups II and III [90.9% and 91.3% respectively,]. Chronic renal failure patients have hyperleptinemia and hyperinsulinemia and there are important interactions between leptin and insulin in which each hormone may be involved in regulating the function of the other. Excess parathyroid hormone may play a role in the pathogenesis of both hyperleptinemia and hyperinsulinemia. Hyperleptinemia may be an important contributing factor for uremic anorexia

Von Willebrand factor, thrombomodulin and nitric oxide in Behcet's disease

Twenty-six patients with Behcet's disease [BD] [15 patients with active disease and 11 with inactive disease] and 20 healthy subjects, as a control group, were included in this study. All patients and controls were subjected to measurement of plasma levels of von Willebrand factor [vWF] and thrombomodulin [TM] as well as serum NO, in addition to complete blood picture, erythrocyte sedimentation rate [ESR] and C-reactive protein [CRP]. The results showed that, means of vWF, TM and NO levels were significantly higher in BD patients than controls. Mean levels of vWF were high in patients with recurrent oral ulcer [ROU] and those with arthritis/arthralgia. Mean values of NO were significantly high in patients with ROU, RGU, patients with arthritis/arthralgia and thrombosis. Mean levels of vWF, TM and NO were significantly higher in active group than inactive group. Positive correlations were found between vWF with ESR2, CRP, TM and NO. Also, positive correlations were found between TM with ESR1 and ESR2. Also, positive correlations were found between NO with ESR1, ESR2 and CRP

Thyroid disorders in systemic lupus erythematosus and rheumatoid arthritis

Aim: Thyroid disorders are not uncommon in systemic lupus erythematosus [SLE] and rheumatoid arthritis [RA]. However, the association between SLE and RA with autoimmune thyroid diseases is conflicting. This study was designed to determine the patterns of thyroid dysfunction in SLE and RA in Assiut University Hospital. Subjects and Twenty patients with SLE and another twenty with RA were studied in addition to 20 healthy age- and sex-matched controls. All patients were subjected to complete history taking, thorough clinical examination and joint examination. All patients and controls were subjected to the following investigations: serum T3, T4, TSH, antithyroglobulin antibodies [ATGAb] and thyroid peroxidase antibodies [TPOAb]. Also, complete blood picture, ESR, RF, ANA, CRP and LE cells were determined. Fifty percent of SLE patients showed thyroid dysfunction compared to 15% of RA [P<0.05]. In SLE group, 20% had euthyroid sick syndrome, 20% had hypothyroidisrn [10% subclinical and 10% overt], and 10% had hyperthyroidism [5% subclinical and 5% overt]. However in RA, 10% had hypothyroidisrn [subclinical] and 5% had subclinical hyperthyroidism. TPOAb was found in 15% of SLE and 5% of RA patients and 10% of controls, but the titre was higher in SLE and RA patients. Also ATGAb was found in 5% of SLE and 30% of RA patients and 10% of controls, but the titre was higher in SLE and RA patients. Conclusions: Thyroid dysfunction was common in SLE [in particular] and RA. Euthyroid sick syndrome and hypothyroidism were the most common thyroid disorders in SLE. In RA hypothyroidism was more common than hyperthyroidism. SLE and RA were associated with antithyroid antibodies [TPOAb in SLE and ATGAb in RA]. We recommend the performance of thyroid function tests in patients with SLE [in particular] and RA as a part of biochemical and immunological profile

Tumor necrosis factor alpha, interleukin-10 and nitric oxide in patients with type 1 diabetes mellitus and their association with glycemic control an dsome complications of the disease

Type-1 diabetes mellitus is a disease that results from autoimmune destruction of insulin producing beta-cells. The autoimmune response against beta-cells is believed to result from a disorder of immune regulation. According to this concept tumor necrosis factor alpha [TNF-alpha], interleukin-10 [IL-10], nitric oxide [NO], urinary albumin excretion rate [UAER] and HbAIc in addition to serum glucose, kidney and liver function tests as well as lipogram were studied in sixty eight type-1 diabetic patients. Twelve healthy subjects were included as a control group According to disease duration patients were classified into three groups: group I [30 cases] patients with disease duration less than 5 years, group II [22 cases] patients with disease duration 5-10 years and group III [16 cases] patients with disease duration > 10 years. Also patients were classified according to UAER into 3 groups: group A [30 cases] normoalbuminuric patients UAER < 20 micro g/min. group B [35 cases] microalbuminuric patients UAER 20-200 micro g/min. group C [3 cases] macroalbuminuric patients UAER > 200 micro g/min. According to HbAIc levels, patients were classified into controlled group [HbALc < 6%] 20 patients and uncontrolled group [HbAIc > 6%] 48 patients. In whole patients group mean values of HbAIc, TNF-alpha and UAER showed significant elevations compared to controls [P <0.001, 0.001 and 0.05 respectively], while IL-10 revealed significant reduction. [P < 0.001]: NO mean value showed statistically insignificant elevation. Mean values of HbAIc in groups I, II, III, A, B revealed significant elevations compared to controls [P < 0.001 for all] also in group III versus group I [P < 0.05] and in group B versus A [P<0.05]. TNF-alpha showed significant elevation in groups I, II, III in comparison with controls [P < 0.001 for all]. While mean value of IL-10 showed significant reduction in groups I, III compared to controls [P < 0.01, P < 0.001 respectively] also in group III versus group I, II [P < 0.01 for both]. NO and UAER showed significant elevations in group III compared to controls [P < 0.05 and P < 0.01 respectively]. NO levels showed significant elevation in groups I and III compared to group II [P < 0.05 for both]. UAER in group III revealed significant elevation versus groups I and ii [P < 0.01, P < 0.001 respectively]. In normoalbuminuric and microalbuminuric groups [A, B] TNF-alpha showed significant elevation compared to controls [P < 0.001 for both]. IL-10 mean value showed significant reduction in groups A and B compared to controls [P < 0.001 for both]. NO levels revealed no significant differences. In uncontrolled group, level of IL-10 was significantly low, while UAER was significantly high [p < 0.05 for both]. TNF-alpha and NO showed no signifigant difference between controlled and uncontrolled groups. Positive correlations were found between TNF-alpha and serum glucose and HbAIc, also negative correlations were found between IL-10 and serum glucose, HBAIc, cholesterol, triglycerides and LDL-c. NO showed positive correlation with UAER level. From this study we concluded that increased TNF-a [proinflammatory cytokine of Th1] and decreased IL-10 levels [type 2 cytokine of Th2] may play a role in the pathogenesis of type-1 diabetes mellitus. TNF-alpha and IL-10 may be a predictor of glycemic control. Increased NO level may play a role in the pathogenesis and complications of diabetes