Study of silent myocardial ischemia in type 2 diabetic males

Patients with diabetes have two to four folds greater risk of death from coronary artery disease than age-matched non diabetic individuals. Accelerated coronary and peripheral vascular atherosclerosis is one of the most common and chronic complications of diabetes mellitus. A recent aspect of coronary artery disease in this condition is its silent nature. Is to detect the prevalence of silent myocardial ischemia [SMI] in type 2 diabetic males in our locality and to select male diabetic population who should be screened for SMI. This study included 100 type 2 diabetic male patients with negative history of angina or anginal equivalent symptoms and thirty apparently healthy males as a control group. All subjects were studied as regard age, duration of DM, type of diabetic therapy, smoking, family history of IHD, blood pressure estimation, body mass index [BMI], fundus examination and presence of peripheral arterial disease. Laboratory estimation of fasting and post prandial blood glucose level, lipid profile, glycated hemoglobin [HbA[1c]], microalbuminurea, and C-reactive protein was done for all participants. Non invasive tests [NITs] including 12 leads resting ECG, trans-thoracic echocardiography, treadmill exercise ECG, myocardial perfusion imaging were done for all participants and patients positive for one or more N1Ts were subjected for coronary angiography. Twenty nine patients [29%] were positive for one or more NITs in the patients group compared to only one case [3.3%] in the control group. After the results of coronary angiography, 20 patients were positive for significant coronary artery stenosis in one or more vessels in the patients group while it was refused to be done by the patient in the control group. There was statistically significant difference as regard family history of DM and IHD, hypertension, and obesity with higher levels of microalbuminurea, C-reactive protein, total cholesterol, and triglycerides in the patients group than in the control. The patient group was subdivided into two subgroups according to the results of coronary angiography, 20 patients positive for SMI [positive for coronary angiography] and 80 patients negative for SMI [negative for coronary angiography]. Smoking, hypertension, obesity, hyperlipidemia, and family history of IHD were significantly higher in the diabetic subgroup positive for SMI compared to those negative for SMI. Most of the patients positive for SMI had have DM for more than 5 years duration. Type 2 diabetic male patients should be screened for detection of SMI when age above 50 years old, diabetes duration is more than 5 years [particularly if uncontrolled], presence of two or more cardiac risk factors and/or patients suffering from one or more of the chronic diabetic complications

Platelet aggregation abnormalities in end-stage renal disease; a possible cause of hemorrhagic diathesis

End-stage renal disease patients [ESRD] are at risk of hematological complications. Hypercoagulability and paradoxically hemorrhagic tendency have been described in uremic patients. Hemorrhagic complications are primarily due to uremic platelet dysfunction and intermittent anticoagulation therapy used in hemodialysis. The aim of this study was to investigate the effect of hemodialysis [HDD] on platelet aggregation abnormalities and hence its role in bleeding in ESRD patients on maintenance hemodialysis. Forty two patients with ESRD on maintenance HD, in the hemodialysis unit at Sohag University Hospital utilizing polysulphon memrance and using Fresenius machines 94008 B] were included in this study and compared with a control group; of fourteen healthy adult volunteers. Blood samples were obtained for laboratory investigations form patients and controls before HD session and after the session from patients only the following laboratory investigations were performed; Complete blood cont [CBC]. serum urea, creatinine, Bilirubin, AST, ALT and hepatitis markers [HBsAg and anti HCV antibody]. tests for coagulation screening; PT and PTT, Study of platelet aggregation with ADP and Ristocetin. For all patients and controls bleeding time [BT] was performed at the time of sample taking. Bleeding time is significantly prolonged after the HD session comparing to results before the HD session and that of controls, platelet aggregation with ADDP and Ristocetin were significantly decreased in HD patients before and after session comparing to controls and also statistically significant comparing the results of patients before and after HD session. There is no statistically significant difference in the results of INR and PTT when comparing results of patients before and after sessions and when comparing the results of patients to controls, HD sessions in ESRD patients lead to platelet aggregation abnormalities which may resulted in hemorrhagic disorders in HD dependent patients

Factors associated with gallstones in patients with chronic renal failure treated by haemodialysis in upper Egypt

Studies performed to date on the prevalence of gallstones in chronic renal failure [CRF] on haemodialysis [HD] have given contradictory results. to evaluate the frequency and percentage of gallstones and its main associated risk factors in a group of Egyptian haemodialysis patients. The study included 147 patients with CRF on HD randomly selected from Assiut and Sohag University renal dialysis units in Upper Egypt [102 males, 45 females]. The screening protocol included complete medical history, female parity, as well as, use of estrogen therapy by females. History of diabetes mellitus and duration of haemodialysis were also recorded. Body mass index [BMI] was calculated and a number of biochemical parameters [total cholesterol and triglycerides, serum calcium, phosphorus and uric acid] were estimated in fasting serum. An ultrasound scan of the gall bladder and biliary tract was performed with a 3.5 MHz linear probe after at least 12 h fasting. In addition, the prevalence of gallstones in the general population of the same geographical region was calculated after revising available data in ultrasonography reports. The mean age of CRF patients was 43 +/- 14.2 years and mean duration of dialysis was 30 +/- 30.5 months. Gallstones were diagnosed in 22.4% of HD patients and this was mildly significantly higher in women than men [31.1% in women vs 18.6% in men, P=0.05] and this percentage was significantly higher than that of the general population in the same geograbical region [1.6% of the total examined] [P=0.001]. The percentage of gallstones didnt increase significantly with increasing age or duration of dialysis. We noticed an insignificantly raised risk for gallstones with use of estrogen by females, diabetes mellitus and smoking in males [OR=3.2, 1.6, 1.2 respectively; P >0.05 for all of them]. No significant difference was noted between CRF patients with and without gallstones in the studied biochemical parameters except for mean serum calcium that was significantly higher in patients with gallstones [9.8 +/- 1.3 vs 8.1 +/- 1.1; P=0.04]. The percentage of gallstones in a group of Egyptian patients on HD is higher than that of the general population of the same area. Apart from female sex, the traditional risk factors associated with gallstones in the non-uraemic general population appear not to play a significant role in gallstone formation in HD patients. Estrogen use in females, presence of diabetes mellitus and smoking in males, have insignificantly raised the risk for gallstones in these patients. Changes in serum calcium appear to play a role. Our results suggest that other factors inherent to kidney pathology may contribute to this high percentage of gallstones in CRF patients on haemodialysis

Prognostic value of cardiac troponin T [CTnT] elevation in chronic renal failure patients on haemodialysis

Increased plasma treponin T [CTnT] is frequently observed in end-stage renal failure patients. patients with end-stage renal disease have a high risk of premature death, mainly as a result of cardiovascular disease [CVD], which is not sufficiently explained. The objective of this study was to study the extent and pattern of increased cardiac treponin T [CTnT] in end stage renal failure patients on regular hemodialysis and to evaluate the usefulness and the prognostic value of CTnT as a predictor of subsequent cardiac events in those patients. This study was carried on [80] patients on regular hemodialysis [50] of them have no evidence of ischemic heart disease and [30] proved to have cardiac diseases, patients were followed up for 6 months and one year for any cardiac events. a] There is no correlation between CTnT level and blood urea, serum creatinine and blood sugar. b] CTnT levels are higher in ischemic group [mean level 0.11 microg/L] than in non ischemic group [mean level 0.08 microg/L]. c] More cardiac complications were observed in the cardiac group versus non cardiac patients. These complications were associated with higher levels of CTnT, in the cardiac group during the period of follow up 6 patients [20%] died, 3 [10%] suffer frequent anginal attacks, 4 [13.3%] suffer heart failure and 3 [10%] suffer myocardial infarction. In the non cardiac group during the period of follow up 9 patients [18%] died, 7 [14%] patients show ischemic changes in E-C-G follow up, 8 [l6%]suffer heart failure and 1 [2%] patients suffer myocardial infarction. Increased plasma cardiac treponin T [CTnT] is frequently observed in end stage renal disease patients without acute coronary disease. Increased [CTnT] appears to predict cardiac complications and predicts long and short term all cause mortality in hemodialysis patients. The CTnT predicts death and cardiovascular outcomes in clinically stable patients with end-stage renal disease. Because this protein is synthesized exclusively in myocardial cells, its predictive power for these outcomes may be because it reflects, besides cardiac ischemia, left ventricular [LV] mass, which is a strong predictor of cardiovascular death in this population per se

Functional cardiac abnormalities in cirrhotic patients with and without ascitis

Abnormalities in cardiac function have been reported in patients with liver cirrhosis, suggesting latent cardiomyopathic changes in these patients. In this study we investigated cardiac function and morphology in patients with liver cirrhosis with and without ascites. A total of 60 patients with liver cirrhosis [divided into three groups each with 20 patient; group I without ascitis, group II with mild and moderate ascitis and group III with tense ascitis] and 20 normal healthy control subjects were studied by two dimensional Doppler echocardiography. Cardiac dimensions and left and right ventricular systolic [ejection fraction, isovolumic contraction time and peak flow velocity of the aortic and pulmonary flow] and diastolic [the peak flow velocity in early diastole E cm/sec, the peak flow velocity in late diastole A cm/sec, and the E/A ratio and the deceleration time of the E wave, the isovolume relaxation time of the left ventricle] functions were evaluated. Our study showed that the EF is significantly low in all patient groups versus the control subjects and in the ascitic patients versus the non-ascitic group [P<0.01] but no significant difference between the patients with mild and moderate ascitis versus the nonascitic patients. The LVET was significantly shorter in patients with tense ascitis [G.3] as compared to non-ascitic patients[G.1] [P0.04]. also the IVCTL/LVET was significantly lower in all patient groups compared to the controls [P<0.006], and in ascitic patients versus non-ascitics[P<0.02]. For the right ventricular systolic function; the VmaxR was significantly decreased in nonascitic patients compared to controls [P<0.03], the RVET was significantly shorter in all patients groups compared to controls [P<0.004]. The E/A ratio was significantly decreased in ascitic patients versus controls [P<0.001 and in ascitics versus nonascitics [P<0.002]. The deceleration time of the E wave was significantly prolonged in ascitic versus controls [P<0.001] and in ascitics versus non-ascitics [P<0.01]. Also, the IVRT was significantly prolonged in all patient groups versus the controls. Both atria and right ventricle were significantly enlarged in cirrhotic patients versus controls and in cirrhotics with ascitis versus those without ascitis. Liver cirrhosis is associated with enlarged right cardiac chambers. Systolic and diastolic dysfunction were evident in cirrhotic patients and more in those with ascites. Our data confirm the presence of cirrhotic cardiomyopathy rather than secondary cardiac adaptation to circulatory changes in liver cirrhosis

Cardiac arrhythmias and silent myocardial ischemia in chronic renal failure patients on hemodialysis

Cardiovascular diseases are the most common cause of death in patients with End Stage Renal Disease [ESRD] on renal replacement therapy. Cardiac arrhythmias are frequent cardiovascular complication during dialysis session. ST segment depression on ambulatory ECG without patient awareness is a marker of what has been termed "silent ischemia". It has been suggested that in patient with ESRD transient ST segment depressions are associated with increased cardiovascular mortality. The objective of this study is to evaluate and to detect the effect of hemodialysis on cardiac rhythm in ESRD patients on regular hemodialysis by using Holler's monitor [24 hours. ambulatory electrocardiogram] and also to detect prevalence of silent myocardial ischemia among these patients. This study was conducted in the Dialysis Unit, Sohag University Hospital, Sohag Faculty of Medicine. It included 40 adult patients [29 males and 11 females] with ESRD on regular hemodialysis. Their ages ranged from 18-50 years with a mean age of [35 +/- 2.36] years. Results of this study showed that there is runs of ventricular and supraventricular arrhythmia in dialysis patients and the occurrence of this arrhythmia in the form of insignificant ventricular runs which occurred in 2 [5%] out of 40 patients studied. However there is a significant prevalence of total ventricular arrhythmia which occurred in 80% of the patients. There is significant occurrence of supraveniricular arrhythmia which occurred in 62.5%, 42.5% and 40% [predialysis, during dialysis and postdialysis respectively]. Ventricular tachycardia was not seen, and supraventricular was observed in 5 patients [12.5%]. The total number of these arrhythmias [both ventricular and supraventricular] were improved by hemodialysis. The present study showed that there is a high incidence of myocardial ischemic episodes in relation to hemodialysis. 29 [72.5%] out of 40 patients showed ischemic episodes of whether 24 [83%] patients showed asymptomatic ischemic episodes. The study also showed that most ischemic episodes whether painful or silent were recorded during hemodialysis session [72.8%]. Dialysis per se is not arrhythmogenic. The isolated ventricular and atrial arrhythmias occurred in patients with ESRD cluster before next hemodialysis sitting are assumed to be due to disturbances of both serum phosphorus and serum potassium levels. On the other hand myocardial ischemic episodes frequently occurred during hemodialysis

Epidemiology of end stage renal diseased patients on hemodialysis in Sohag Governorate, Upper Egypt

End-stage renal disease [ESRD] has various causes that differ according to the country. Egypt is a country with high mortality from ESRD, Sohag governorate is one of the South Egypt governorates. To study the prevalence and incidence rates and its health burden and to allocate the etiology and possible contributing factors and other epidemiologic factors for ESRD in Upper Egypt. The primary study tool was a structured questionnaire that focused on variables suspected as an etiological factor for ESRD in addition to the past history of risk factors exposure. One thousand and fifty four [1054] patients on hemodialysis were interviewed for collecting the data, in the period starting on the first of January 2003 till the end of December 2003. They were distributed in 17 centers with variable capacities for hemodialysis all over Sohag eleven districts. All were subjected to history taking, thorough medical examination, abdominopelvic ultrasonographic examination in the equipped centers and laboratory investigations of blood and urine. The estimated prevalence of ESRD at Sohag is 276.44 per million populations, the new cases constituted 22.27% of the patients along the year of the study. All patients were undergoing intermittent hemodialysis treatment, mostly thrice weekly. Distribution of patients by residence showed that most patients were living in rural areas [77%] whereas [23%] were urban residents. Males constituted 60% while females were 40% of the dialysis patients. Etiology of ESRD was unknown in about 9% of the cases while hypertension was responsible for 27.6% of the cases and diabetic nephropathy was responsible for 7%. Chronic pyelonephritis constituted 14.1% of the contributing causes for ESRD in Sohag and chronic glomerulonephritis was the cause in about 11.2% cases. Obstructive uropathy was detected in 22.7% of the cases; more than half of it was due to schistosomiasis. Other causes for ESRD were associated in smaller percentages. The number of deaths among the ESRD patients in Sohag governorate during the year 2003 is 180 / 1054 [8%] of the cases. The causes of deaths include cardiovascular diseases in 60% of the deaths, cerebrovascular accidents in 15%, infections in 5% and the rest was due to various diseases. These data will he hopefully contributed to the development of the national health care policies appropriate to the epidemiology of the disease in Upper Egypt. More attention should be paid not only to the recurrent renal infections and urolithiasis but also to hypertensive and diabetic patients to prevent the ESRD development as a consequence of their illness. Also, preventive programs against shistosomiasis should be continued in Upper Egypt