Study on evaluation of the persistent elevation of C-reactive protein as a predictor of cardiac hypertrophy and dysfunction in elderly patients maintained on hemodialysis

The average age of dialysis patients is increasing each year, reflecting the aging of the population in general. Hemodialysis [HD] patients suffer from a chronic inflammation. They are at increased risk of cardiovascular disease. To evaluate the persistent elevation of C reactive protein [CRP] as a predictor of cardiac hypertrophy and dysfunction in elderly patients maintained on HD. Quantitative determinations of serum high-sensitivity C reactive protein [hs-CRP] by ELISA were done in the 3 studied groups; Group A: included 30 selected end stage renal disease [ESRD] elderly patients maintained on regular HD at the Main Alexandria University Hospitals. Their mean ages were 68.50 +/- 5.20 years [15 males and 15 females]. Group B: included 20 age-matched elderly healthy individuals. Their mean ages were 69.10 +/- 6.42 years [10 males and 10 females]. Group C: included 10 healthy adult individuals. Their mean ages were 34.20 +/- 4.85 years [5 males and 5females]. Doppler Echocardiography was done to all subjects with estimation of ejection fraction [EF%], fractional shortening [FS%], and left ventricular mass index [LVMi] as well as E/A and El/Al ratios. In elderly HD patients, hs-CRP showed statistically significant higher levels than those of groups B and C with significantly higher values in group B than group C [F=19.85, p=0.001]. By using echocardiography, LVMi showed statistically significant higher values in group A than the other 2 groups with no significant difference between them [F=0.854, p=0.01], whereas FS and EF percentages showed no significant differences between the 3 studied groups. Both E/A and El/Al ratios showed statistically significant lower values in group A than groups B and C [x[2]= 13.33 and 12.38, p= 0.00] and 0.02 respectively]. Correlation study showed a significant negative correlation between serum hs-CRP levels and serum albumin, EF% and E/A ratio. On the other hand, serum hs-CRP levels had a significant positive correlation with serum urea, erythrocyte sedimentation rate [ESR] and LVMi. In elderly patients maintained on HD, the persistent elevation of CRP, which reflects chronic inflammation, had a high impact on the occurrence of left ventricular hypertrophy [LVH] and dysfunction. These data lend support to the hypothesis that inflammation plays an important role in the pathogenesis of cardiovascular diseases in these patients

Study of N-acetyl-beta-D-glucosaminidase in elderly patients with iron deficiency anaemia

Little is known about renal tubular function in elderly patients with iron deficiency anaemia. To investigate renal tubular function in these patients. To achieve this aim, we compared renal tubular function in 30 asymptomatic non smoker elderly patients [over 65 years] having iron deficiency anaemia [group I] with 15 healthy age and sex matched controls [group II]. Based on their ages, group I patients were subdivided into 2 subgroups; group Ia consisted of 15 iron deficiency anaemia patients >/= 65 - 70 years while group Ib consisted of 15 iron deficiency anaemia patients above the age of 70 years. These patients were diagnosed during routine check up. Patients with known cardiac, hepatic, or renal diseases as well as cancer or other comorbid conditions were excluded from the study. Blood and urine samples were obtained for haematological and biochemical analysis. Urinary N-acetyl-beta-D-glucosaminidase [NAG], as an index of renal tubular function, was estimated by spectrophotometry. Mean urinary NAG levels were significantly higher in iron deficiency anaemia patients of both age groups than in controls [F=85. 77, p<0.001] with significantly higher mean values observed in group Ib than in group Ia patients. No statistically significant difference was observed between mean urinary NAG values in males [19 patients] and females [11 patients] [t= 0.56, p= 0.46]. In elderly iron deficiency anaemia patients of both age groups, urinary NAG values showed statistically significant negative correlation with haemoglobin levels [r=-0.673 and -0.811 at p=0.006 and <0.001 for groups Ia and Ib respectively] and were positively correlated with age [r=0.838 and 0.780 at p<0.001 and <0.001 for groups Ia and Ib respectively]. No correlation was detected between urinary NAG and haemoglobin values in either males or females [r=-0.433, p=0.064 for males and r=-0.077, p=0.821 for females]. There was no correlation between urinary NAG and serum iron, total iron binding capacity [TIBC] or serum ferritin in elderly iron deficiency anaemia patients of both age groups [r=-0.136, 0.328 and -0.070 at p=0.63, 0.232 and 0.805 respectively for group Ia] and [r=-0.229, -0.333 and 0.107 at p=0.414, 0.225 and 0.704 respectively for group Ib]. Elderly patients even with asymptomatic iron deficiency anaemia have impaired renal tubular function. Anaemia may be a contributing factor for renal impairment in such patients that is why it should be early diagnosed and treated even if no clinical disease is immediately apparent

Evaluation of some platelet functions and platelet membrane glycoproteins in uremic, hemodialysis and renal transplant patients

The hemostatic defect of chronic renal failure [CRF] is well recognized. Increased bleeding has been attributed to platelet dysfunction. However, the available reports are controversial. To study platelet aggregation and glycoprotein receptors' [GP] expression in a well identified population with CRF. 25 patients with advanced CRF on conservative treatment [CRF group], 25 patients on regular hemodialysis [HD group], 25 renal transplant patients [Tx group], and 20 age-, race- and sex-matched healthy controls [control group] were subjected to complete physical examination, complete blood count, bleeding time [BT], renal functional parameters and other necessary laboratory tests, in addition to estimation of platelet aggregation in response to adenosine 5-diphosphate [ADP] and ristocetin as well as GPIb, GPIIb, and GPIIIa receptors' expression using fluorescein isothiocyanate-conjugated monoclonal antibodies CD42b, CD41 and CD62, respectively and a flow cytometer. BT was prolonged in both CRF and HD groups [P<0.001], and was not attributed to a decrease in platelet count. Both CRF and HD patients had similar, but significantly decreased maximum percentage of platelet aggregation induced by either ADP or ristocetin compared with Tx and healthy control groups [P<0.001]. GPIb expression was significantly decreased in the CRF group than the Tx and healthy control groups [P<0.05], while HD group showed non significant difference when compared with CRF, Tx or control groups. GPIIb and GPIIIa showed a highly significant decreased expression in both CRF and HD groups compared with Tx and healthy control groups [P<0.001], with no significant difference in between both uremic groups. An inverse correlation was observed between serum creatinine and GPIIb [r=-0.641, P=0.023] and GPIIIa [r=-0.545, P=0.031] receptors' expression in CRF patients versus no correlation in HD patients. The results of the studied parameters in Tx group were comparable to healthy controls. Uremic patients have decreased platelet aggregability and decreased GP receptors' expression [mainly GPIIb and GPIIIa], denoting that platelet dysfunction is at least partially contributing to their hemorrhagic problem. The observed defects were not corrected by regular HD. Renal transplantation seemed to be a better choice

Study of transforming growth factor-beta-1 in elderly with recent cerebrovascular stroke

To study transforming growth factor- beta 1 [TGF- beta1] in elderly subjects with recent cerebrovascular stroke [CVS]. Circulating plasma levels of TGE- beta1 were measured in the three studied groups; group I: 20 elderly subjects with CVS, attack within 24 hours, ten were males and ten were females, were compared to group II: 20 elderly age-matched healthy subjects and group III: 10 healthy adult subjects as control Lipid profile, erythrocyte sedimentation rate [ESR], high-sensitivity C-reactive protein [hs-CRP] were estimated in all studied groups, also computerized tomography [CT] of the brain was done in group I patients to diagnose the ischemic nature of stroke. TGF- beta1 levels were significantly lower in group I [elderly stroke group], than group II [elderly healthy], which were significantly lower than that in group III [healthy adults], with mean values of 22.96 +/- 8.86 ng/ml, 48A9 +/- 15.63 ng/ml and 63.93 +/- 9.54 ng/ml respectively [F = 43.3, P - 0.0001]. A significant negative correlation was found between TGF- beta1 levels and age, serum cholesterol, triglyceride [TG], ESR-I, ESR-2 and hs-CRP. On the other hand, a significant positive correlation was found between TGF- beta1 and high density lipoprotein cholesterol [HDL-C] levels. Low levels of TGF- beta1 in elderly subjects significantly influence the occurrence of ischemic CVS suggesting an important role of this cytokine in the process of protection from such strokes. Further prospective studies are needed to evaluate the use of this cytokine levels as a marker for the development of ischemic CVS and this may provide the basis for evaluation, follow-up, and novel protective therapy in elderly patients with cerebral atherosclerosis

Evaluation of polymerase chain reaction, immunocytopathology, and interferon- gamma in pleural fluid for the differential diagnosis of tuberculous pleural effusion

Pleural tuberculosis [TB] is a diagnostic challenge because of its nonspecific clinical presentation and paucibacillary nature. The inefficiency of conventional laboratory methods and the reliance on pleural biopsy have motivated the evaluation of alternative diagnostic strategies. In this study, our goal was to improve the diagnosis of tuberculous pleural effusion and to determine the most sensitive, specific, and rapid diagnostic methods. We used PCR to detect DNA [IS 6110] specific for M tuberculosis complex and IFN-gamma quantitation on pleural fluid samples and compared them to the results of immunnocytopathology staining and conventional bacteriological methods [Ziehl Neelsen stain and culture using the LJ medium]. The study population included 50 patients presented with pleural effusion at Alexandria Main University Hospital and El Maamora Chest Hospital, between June 2004 to December 2004. In addition 5 cases of malignant pleural effusion were received from Damnhour oncology center - Behira, in the period from January 2004 to December 2004. According to the clinical diagnosis, the patients were distributed into 3 groups; group I; 14 patients with confirmed old tuberculosis patients group II ; 8 patients with Probable pleural tuberculosis and group III; 33 patients with Pleural effusion due to an etiology different from tuberculosis. For each specimen of pleural fluid; Immunocytochemical staining, Ziehl- Neelsen staining, culture on Lowenstein Jensen medium, measurement of IFN-gamma level, and PCR for detection of Mycbacterium tuberculosis DNA [IS 6110] were done. No samples were positive by Ziehl-Neelsen staining or by culture for M.tuberculosis. Only one case was positive for pleural tuberculosis by PCR. IFN-gamma values were significantly higher in the pleural fluid of patients with confirmed tuberculosis than in those with probable pleural tuberculosis. Ten out of 14 patient with confirmed tuberculosis. were reactive to IFN-gamma by ELISA [mean value = 276.2 picogram/ml], while only one case out of 8 cases with probable pleural tuberculosis was reactive [mean value = 2.5 picogram/ml]. As regards the third group with etiology different from tuberculosis, all the cases were not reactive by ELISA for IFN-gamma. PCR, and measurement of IFN-g levels provide the basis for the rapid and efficient diagnosis of pleural TB in different clinical settings