Plasma testosterone level in male patients with metabolic syndrome

Mild hypogonadism in men have been associated with features of metabolic syndrome. The aim of the present work is to study the role of serum testosterone in middle aged men with metabolic syndrome. The study group comprised 50 middle aged men who fulfilled the definition criteria of metabolic syndrome according to WHO definition. They were divided into two groups: Group [1]: Included 19 patients with IHD [mean age 50.6 +/- 5.1 years]. Group [2] of 2]: Included 31 patients without IHD [mean age of 50.6 +/- 5.1 years]. A group of 20 age matched healthy men was used as a control group their age ranged from 41-57 years with a mean of 49.1 +/- 5.4 years. All patients and controls were subjected to thorough clinical examination including blood pressure, weight, height, BMI and WHR; investigations including ECG, CBC, fasting and postprandial blood sugar, lipid profile and serum uric acid. Total serum testosterone was measured in patients and controls by the use of enzyme chemiluminescent assay on the immulite autoanalyzer. Serum total testosterone level ranged from 0.4-7.8ng/ml in patients group with a mean of 3.8+1.8 while in the control group it ranged from 2.4-9.3ng/ml with a mean of 5.3 +/- 1.9. Comparing serum testosterone level in both groups it was found to be statistically highly significant lower in patients group than in control group p=0.003. A significant negative correlation was found between serum total testosterone .level [3.8 +/- 1.8ng/ml] and age [50.6 +/- 5.1ys] in the group of patients. r=0.32 p=0.02. A highly significant negative correlation was detected between serum total testosterone level and fasting blood sugar, serum triglycerides, serum total cholesterol, serum uric acid anddiastolic blood pressure. [r=0.728, 0.872, 0.7370, 0.990 and 0.697 respectively]. A highly significant positive correlation was detected between serum total testosterone and HDL [r=0.935] and haemoglobin [r=0.879]. Statistically insignificant negative correlation was detected between serum total testosterone level and age, WHR, postprandial blood sugar and LDL. Statistically insignificant positive correlation was detected between serum total testosterone level and BMI. Serum total testosterone level was found to be statistically insignificant lower in group [1] with evidence of IHD [3.45 +/- 1.49ng/ml] than in group [2] patients without evidence of IHD [3.97 +/- 1.99ng/ml], p=0.336. We have concluded that middle aged men with metabolic syndrome have lower testosterone level than normal population. There is a possible role of testosterone in the development or progression of metabolic syndrome and/or its components according to WHO definition

Recurrent myocardial infarction: new concepts in predisposing factors

At one end of the clinical spectrum of coronary artery disease [CAD] are subjects who have had repeated acute ischemic events [unstable angina, acute myocardial infarction or sudden death], and at the other end are those with longstanding stable angina who have never been unstable. The variability of serum level of thrombomodulin [TM] in various phases of ischemic heart disease [IHD] raised the question of variable pathphysiological role as vasoprotective, thromboresistant, and anti-inflammatory factor. To answer the question of TM variable levels in IHD, we studied 100 patients [90 males and 10 females, mean age 57 +/- 11.3 range 38 to 69 years,] with IHD including 5 groups [20 pts for each], Recurrent MI [RMI], Old stable MI [OSMI], Stable Angina [SAP], Acute MI [AMI], and a control group [normal coronary angiography]. Following clinical examination TM level was determined using ELIZA technique. Genetic studies using single strand conformation polymorphism [SSCP] method was done to determine mutation in TM gene G-33 A. Compared to control group, patients with IHD had significantly lower TM level [5.7 +/- 3.6 VS 3.06 +/- 2.8; p=0.002]. Serum TM in patients with SAP was significantly lower compared to control subjects [5.7 +/- 3.6 VS 3.92 +/- 2.8; p=0.004]. Compared to pts with OSMI., Pts with RMI had significantly higher levels of TM [4.52 +/- 4.3 VS 5.85 +/- 3.8; p=0.031]. Compared to pts with SAP, Pts with OSMI had significantly higher level of TM [3.06 +/- 2.8 VS 4.52 +/- 4.3; p=0.003]. In ischemic pts, there is a constant tendency of increased TM level from SAP to OSMI to RMI [3.06 +/- 2.8, 4.52 +/- 4.3 and 5.85 +/- 3.8, respectively]. There was no significant difference between pts with RMI and the control group [5.85 +/- 3.8 VS 5.7 +/- 3.6; p=0.93]. Compared to control group, pts with AMI had significantly lower level of TM [2.8 +/- 2.1 VS 5.7 +/- 3.6; p=0.0001] and significantly lower level of TM compared to pts with IHD not in the acute stage [p=0.026]. Regarding TM gene mutation, this study revealed that patients with a mutant TM gene have a significantly less TM level compared to patients with the mild type TM gene [2.85 +/- 2.1 vs 4.7 +/- 3.6, p=0.04] with the consequences of decreased surface expression of TM and decreased level of soluble TM in plasma. Our data point to the duality of the role of thrombomodulin in IHD as a thromboresistant and anti-inflammatory molecule. Reduced serum levels of TM could predispose to IHD and acute MI. Higher TM levels in normal population reflect activation of thrombin through protein C pathway activation [antithrombotic mechanism] whereas the lower levels of thrombomodulin in stable angina and acute MI might reflect a deficient anti thrombotic mechanism and may speak of the underestimated anti inflammatory role of thrombomodulin knocked down by inflammatory mediators released in the ischemic process. Recurrence of MI might explain the high levels of TM which serves as endothelial anti-inflammatory maker which is signaled by the continued inflammatory state caused by recurrent MI. The reduced TM expression on the coronary endothelium could facilitate thrombus formation at the site of plaque injury, highlighting the cardioprotective role played by TM at the coronary vasculature

Non-invasive assessment of skin microcirculatory changes in diabetic foot

The objective of this study was to evaluate the skin microcirculation in the lower limbs in type 2 diabetic patients for early detection of microvascular changes and prevention of its complications. This study was conducted on 30 patients with type 2 diabetes mellitus, 20 patients had clinical evidence of diabetic foot ulcers and 10 patients had no clinical evidence of foot ulcers. Ten age-matching healthy subjects were chosen as controls. Skin microcirculation was assessed by plethysmography [ankle-brachial and toe-brachial indices], laser Doppler flowmetry [LDF] and laser Doppler imaging [scanner]. It was concluded that noninvasive vascular tests, particularly toe-brachial index, measured by photoplethysmography and tissue perfusion measured by laser Doppler flowmetry are valuable in early detection of microcirculation impairment and prevention of serious complications, e.g. diabetic foot ulcers