Evaluation of subclinical atherosclerosis in Egyptian psoriatic patients

Psoriasis [Ps] is a common, relapsing, immune-mediated, inflammatory skin disorder of unknown etiology. Ps is not single organ disease confined to the skin but it is systematic inflammatory condition analogous to other inflammatory immune disorders which are known to have increased risk of heart disease. On other hand, inflammation plays also an important role in the pathogenesis of atherosclerosis. So, there is striking similarity between molecular and inflammatory pathway in Ps and atherosclerosis. Was to assess the presence of subclinical atherosclerosis in patients with Ps by using carotid ultrasonography. 60 patients with Ps were enrolled in this study after exclusion of traditional cardiovascular risk factors and cardiovascular diseases [CVD]. In addition, 20 age and gender matched healthy persons served as controls. Patients were classified according to Ps area and severity index [PASI] score into group I [20 mild patients], group II [20 moderate] and group III [20 severe]. The average common carotid artery [CCA] intima media thickness [IMT], internal diameter [ID] and arterial wall mass index [AWMI] were measured using high resolution B- mode ultrasound. Psoriatic patients showed statistically significant increase in CCA-IMT [P value 0.001], AWMI [P value 0.010] and significant decrease in ID [P value 0.001], as compared to controls. Psoriasis patients could be suggested as a group with an increased atherosclerotic risk especially in older ages with longer duration of Ps. The carotid IMT, ID and AWMI can identify patients with subclinical atherosclerosis who need special follow up to reduce cardiovascular morbidity and mortality

Relationship between overall and abdominal obesity and periodontal disease among young adults

To assess overall and abdominal obesity and their relation to periodontal disease among young adults, body mass index [BMI] and waist circumference [WC] were measured and clinical attachment loss [CAL], gingival index [GI] and Community Periodontal Index [CPI] were estimated. The sample comprised 380 adults [170 males and 210 females] aged 20-26 years. There was a significant correlation between both BMI and WC and CAL, GI and CPI in females. In males, a significant correlation was only recorded between WC and GI and CPI. Overall and abdominal obesity in young adult females and abdominal obesity in males were significantly associated with periodontal disease

Urinary S-100B protein as an early biochemical indicator of hypoxic-ischemic encephalopathy after birth asphyxia in term newborn infants

Measurements of serum and cerebrospinal fluid concentrations of S-100B protein has been used to detect brain distress, and in the perinatal period are correlated with brain maturation and are used to assess cerebral damage after perinatal asphyxia. As S-100B protein is eliminated by the kidneys, and because collecting urine is a simpler procedure than collecting cerebrospinal fluid or blood, especially in high-risk infants in whom anemia attributable to repeated blood sampling is common, we aimed to investigate the relation of urinary S-100B protein to the severity of hypoxic-ischemic encephalopathy [HIE] and to the neurological outcome in full-term newborns with HIE. Routine laboratory variables neurologic patterns, ultrasound imaging, and urine concentrations of S-100B protein were determined at first urination and at 24 hours after birth in 34 infants with perinatal asphyxia and in 25 control subjects. The concentrations of S-100B protein in urine were measured using an immunoluminometric assay. Neurological examination and Denver Developmental Screening Test [DDST] were performed at 12 months in the survivors. The results were correlated with the degree of HIE, and the presence or absence of neurologic abnormalities at age 12 months. Urinary levels of S-100 protein [micro g/L] were significantly higher in asphyxiated infants with favorable outcome [group I] [0.93 +/- 0.31 at 2 hours, and 1.05 +/- 0.30 at 24 hours] and in asphyxiated infants with adverse outcome [group II] [2.62 +/- 0.92 at 2 hours and 4.78 +/- 2.11 at 24 hours] compared to controls [0.18 +/- 0.04 at 2 hours and 0.24 +/- 0.08 at 24 hours, P=0.001 for all]. Also, these levels were significantly higher in asphyxiated infants with severe HIE than infants with moderate HIE, and those with no or mild HIE, with P <0.001 [at 2 hr] and P <0.003 [at 24 hr]. S-100 levels were negatively correlated with perinatal pH in the infants and associated with abnormal CTG at admission to the labor ward. For prediction of neonatal outcome measured as severe HIE, the sensitivity of S100 >0.32 micro g/L [at 2 hours] was 100%, and the specificity was 92.3%. At 24 hours, the sensitivity of S100 >0.58 micro g/L was 100%, and the specificity was 97.4%. For prediction, of adverse outcome at 12 months, the sensitivity of S100 >0.32 micro g/L [at 2 hours] was 100%, and the specificity was 92%. At 24 hours, the sensitivity of S100 >0.58 micro g/L was 100%, and the specificity was 97%. The use of S-100B as a pathologic marker in urine offers a tool to identify which asphyxiated infants are at risk of hypoxic-ischemic encephalopathy and its possible neurologic sequelae, and provide a new perspective for improving the monitoring and care of newborns

prevalence of atrial fibrillation among acute medical admissions in Kuwait

To establish the prevalence of atrial fibrillation [AF] among acute medical admissions to the Adan Hospital, Kuwait, and to evaluate the clinical features of the patients. Subjects and Of 2,833 acute medical admissions to the Adan Hospital from January 1 to May 31, 2003, 120 patients with AF were included in the study. The patients were divided into paroxysmal or persistent [PPAF], and chronic atrial fibrillation [CAF]. The prevalence of stroke and clinical features of the CAF patients with and without strokes were studied. All the patients with AF underwent echocardiography to evaluate left ventricular ejection fraction [LVEF] and left atrial dimension [LAD]. The prevalence of AF in the study period was 4.24%, of which 68.3% had CAF and 31.7% had PPAF. The prevalence of heart failure, ischemic heart disease, systemic hypertension, and diabetes mellitus was 27.5, 55.8, 65.8, and 53.3%, respectively. Patients with CAF were older and had a higher prevalence of heart failure compared to PPAF patients. Of the patients with CAF, 26.8% had at least one episode of stroke. The CAF patients had lower LVEF and larger LAD than PPAF patients. Stroke patients with CAF had lower LVEF and larger LAD as compared to those without stroke. Atrial fibrillation is a common admission diagnosis in our hospital. Patients with AF commonly suffer from heart failure, hypertension, diabetes mellitus, and ischemic heart disease. There was a high prevalence of stroke among CAF patients

Soluble thrombomodulin and protein c plasma levels in neonatal sepsis

Sepsis is a systemic response to infection, and it constitutes a major cause of morbidity and mortality in Intensive Care Nursery Unit. Sepsis is associated with endothelial cell activation, a hemostatic profile characterized by activation of the coagulation pathway, and subsequent activation of the fibrinolytic system, which is then followed by the inhibition of the fibrinolytic system. Thrombomodulin [TM] is a membrane glycoprotein in the vascular endothelium and it plays an important physiological role as a cofactor in the thrombin catalyzed activation of protein C [PC]. It is also a specific parameter of endothelial cell injury. The aim of this study was to assess the plasma levels of soluble TM and PC and to clarify their relationships with the severity and outcome of neonatal sepsis. This study was carried out on 40 preterm neonates [20 septic and 20 controls] and 40 fullterm neonates [20 sepstic and 20 controls]. It was done in the Neonatal Intensive Care Unit at El-Minia University Hospital and Biochemistry Department, from December 2001 to May 2002. All neonates were subjected to full history taking stressing upon the risk factors for infection and thorough clinical examination for assessment of gestational age and detection of the clinical signs and severity of sepsis. The laboratory investigations included CBC, CRP, blood cultures and estimation of TM and PC in the plasma by ELISA technique. In this study, plasma levels of TM were significantly higher and plasma levels of PC were significantly lower in neonates with sepsis than those in the controls, in preterm than fullterm both septic and controls, in preterm cases than preterm controls and in fullterm cases than fullterm controls [all p<0.05], but no significant differences of both markers were reported between positive and negative cases of blood cultures [all p >0.5]. There was also a significant increase of TM and decreased PC plasma levels in survivors rather than non survivors both fullterm and preterm cases and in severe, complicated rather than non severe, non complicated septic cases [all p<0.05]. Significant negative correlations were reported between TM and PC in both preterm and full term cases [r=-0.46, p<0.03 and r=-0.51, p <0.02 respectively]; also between TM levels and platelet numbers in both preterm and fullterm cases [r=-0.53, p< 0.01 and r=-0.42, p<0.04 respectively]. The correlations between PC levels and platelet count were significant [r=0.5, p<0.02 for preterm cases and r=0.56, p<0.01 for fullterm cases respectively]; but there were no significant correlations between both TM and PC levels with Hb % and Ieucocytic count [all p>0.05]

Conclusion: The elevation of plasma TM is frequently seen in neonatal sepsis and circulating TM is a useful marker for evaluating endothelial tissue damage. Protein C serves as an early and highly sensitive marker for hypercoagulable state of sepsis.Both markers are useful indicators for detecting the severity and outcome of neonatal sepsis