relation between noneacterial thrombotic endocarditis and thromboembolism in patients with cancer

Patients with cancer are in hypercoagulable state. Nonbacterial thrombotic endocarditis [NBTE] can complicate any cancer. The major clinical manifestations of NBTE result from systemic emboli rather than valvular dysfunction. To assess the frequency and echocardiographic characteristics and to determine whether the presence of valvular lesions correlate with thrombo-embolic manifestations [TEM]. A prospective study conducted on 60 patients with different histopathological types of cancer and 10 healthy volunteers. A full medical history taking and physical examination were done and according to the performance status using the WHO score, the patients were classified into two groups of patients; group one, patients with good performance [grade I and II] and group two those with poor performance [III and IV]. Doppler echocardiography, chest-x-ray, abdominal sonography, and laboratory study including complete blood count [CBC]; bleeding time [BT]; prothrombin time and concentration [PT and PC]; Activated partial thromboplastin time [APTT] and serum level of both fibrinogen and D-dimer were done for all participants. Blood culture was done only for patients with NBTE. Doppler study of extremities and computed tomography [CT] of the brain were done for suspected patients with deep venous thrombosis [DVT] and cerebrovascular [CV] stroke respectively, NBTE was detected in 16 out of 60 patients [26.66%]. 22valve lesions were found; the aortic and mitral valves were the commonest sites [12 and 7 lesions respectively]. Valvular regurgitation was found in 12/60 patients [20%]; tricuspid regurgitation [TR] was the commonest lesion [42%]. The incidence of NBTE was higher in patients with poor performance than in those with good performance [p<0.001], and the highest incidence was in patients with adenocarcinoma of pancreas [50%]. Serum level of D-dimer ms higher in patients with NBTE than in those without NBTE [p<0.001]. The incidence of TEM was higher in patients with NBTE than in those without [62.5% versus 6.8%, p<0.001]. NBTE is not uncommon in patients with cancer. Aortic valve was the most commonly affected. Adenocarcinoma was the most frequent histologic type of related cancer. The major clinical manifestations of NBTE result from systemic emboli rather than valvular dysfunction. NBTE should be suspected in any stroke patient with a known or suspected malignancy and anticoagulation with unfractionated or low molecular weight heparin should be used in cancer patients with NBTE

Serum vascular endothelial growth factor in rheumatoid arthritis: a relationship to disease activity and pathogenesis

This study aims to determine the serum level of vascular endothelial growth factor [VEGF] in rheumatoid arthritis [RA] patients and to search for a relationship between serum VEGF level and clinical, laboratory, and radiological variables of the disease in an attempt to provide more insight regarding its role in disease activity and pathogenesis. 75 RA patients, diagnosed according to the American College of Rheumatology [ACR] criteria and 20 control subjects were included in this study. RA patients were divided into active group [38 patients] and non-active group [37 patients] as assessed clinically by using modified disease activity score [DAS-28] and laboratory by using erythrocyte sedimentation rate [ESR] and C-reactive protein [CRP]. All patients included in this study were subjected to full history taking, thorough clinical examination and laboratory investigations including ESR, CRP, complete blood picture, rheumatoid factor, and serum VEGF assay using ELISA technique. Assessment of radiological severity by Larsen's score was done by using plain X-ray for both hands and wrists joints. We found that serum VEGF level was higher in RA patients group than control subjects and in the active group than non-active one. In RA patients, the serum level of VEGF was positively correlated to DAS-28, ESR and CRP. Also, the levels of serum VEGF were higher in patients with early grades of Larsen's score than those with late grades. Also, RA patients with early disease duration [<2 years] had higher serum VEGF levels than those of late disease duration [>3 years]. We suggest that VEGF may be involved in the pathogenesis of RA, and serum VEGF is a non-invasive useful method for monitoring the disease activity of RA, although this is not a specific marker for RA. Anti-VEGF strategies should largely be confined to modulating angiogenesis in RA

Apolipoprotein E 3/4 genotype as a cardiac risk marker

Atherosclerosis is a complex disease caused by both genetic and environmental factors. Apolipoprotein E polymorphism is believed to confer substantial susceptibility to coronary heart disease risk. This study was performed on sixty five males selected with normal serum glucose, kidney function, liver function and thyroid function tests. They were classified into: Group A: Apparently healthy individuals [40 subjects], with normal blood pressure and ECG. Group B: Patients with atherosclerotic coronary artery disease [CAD] diagnosed by coronary angiography [25 cases]. All the studied persons were subjected to: serum lipogram, apolipoprotems A-I, B and E concentration and apolipoprotein E genotyping. In CAD group, the mean values of serum total cholesterol triglycerides, LDL-c, TC / HDL-c ratio, LDL-c / HDL-c ratio, apolipoprotein B concentration and apo B /A-I showed significant elevation while HDL-c levels revealed significant reduction compared to apparently healthy group. In CAD group, apo E 3/3 represented 68% of cases, followed by apo E 3/4 genotype 24%, apo E 3/2 genotype 4% and the homozygous apo E 2/2 genotype 4%. In apparently healthy group, apo E 3/3 genotype represented 70%, apo E 3/4; 12.5% and apo E 3/2; 17.5% of the studied individuals. CAD patients carrying apo E 3/3 genotype, had elevations of serum triglycerides, total cholesterol, LDL-c apo B and apo B/A-I ratio in 6%, 47%. 71%, 35% and 12% of cases [respectively] while HDL-c was reduced in 65% of cases carrying this genotype compared to the levels in apparently healthy group. Average risk values of TC/HDL-c ratio were found in 65% of cases and moderate risk values in 35% of cases. High risk values of LDL-c/HDL-c ratio were found in 18% of cases and moderate values in 82% of cases. But carriers of apo E 3/4 genotype in CAD patients had elevated triglycerides, total cholesterol in 33%, 67% of cases respectively and in LDL-c, apo B and apo B/A-I ratio in 83% of cases while HDL-c and apo A-I were reduced in 83% and 67% of cases carrying this genotype respectively. High risk values of TC/HDL-c and LDL-c/HDL-c ratios were observed in 17% and 18% of cases respectively. Other genotype carriers [E3/2 and E2/2] showed no difference when compared to the levels in apparently healthy subjects. In apparently healthy group, apo E 3/4 genotype carriers had significant elevation of serum TC, TG, LDL-c, TC/HDL-c ratio, LDL-c/HDL-c ratio, apo B and apo B/A-I ratio and significant reduction of apo A-I and E concentration than apo E 3/3 genotype carriers. Carriers of E 3/4 genotype also had significant elevation of TC, LDL-c, apo B and apo B/A-I ratio and significant reduction of apo E concentration compared to those carrying apo E 3/2 genotype. 1-Apo E 3/3 is the most common genotype in both apparently healthy subjects and atherosclerotic CAD patients. If is followed by apo E 3/2, then apo E 3/4 genotypes in apparently healthy group, and followed by apo E 3/4, then apo E 3/2 and apo E 2/2 in CAD group. None of the studied individuals had either apo E 4/4 or apo E 2/4 genotypes. 2 -Apolipoprotein E 3/4 genotype carriers had elevated levels of serum total cholesterol triglycerides, LDL-c, apolipoprotein B A apo B/A-I ratio, and reduced levels of HDL-c and apo A-I.So, they are susceptible to more atherogenic lipid profile than other genotype carriers, which is considered a predisposing factor for atherosclerotic coronary artery disease. As regard TC/HDL-c and LDL-c/HDL-c ratios, most of the patients carrying apo E3/4 genotype had high and moderate risk values while patients carrying apo E 3/3 genotype had average and moderate risk values

Value of serum prolactin in epileptic and some non-epileptic events

A seizure or convulsion is a common problem in pediatric age group. Other events such as breath holding attacks and syncope may simulate seizures. A thorough history and accurate description by the parents or eye witness is necessary for making diagnosis of seizures. When the description is unreliable, the diagnosis becomes difficult. The adverse effects of long term antiepileptic drugs, cost of therapy as well as social implications make it essential to build a solid diagnosis before the decision of therapy. Electroencephalography [EEG] which is the common tool to confirm the diagnosis of epilepsy, could be normal in up to 40% of patients in the inter-ictal period Twenty-four hours EEG monitoring, ambulatory EEG are used in cases with diagnostic uncertainly. Such modalities are not easily available in our locality as well as our country and so, available cheaper and easily accessible alternatives are required. The aim of the study is to evaluate the diagnostic value of post-ictal serum prolactin in the diagnosis of epilepsy and its specificity to differentiate epileptic from non-epileptic events in our locality where EEG monitoring is not available. The study included sixty eight patients and twenty one healthy controls of matched age and sex. Patients were divided into two groups: 45 epileptic patients and 23 non-epileptic patients [15 patients with breath-holding spells and 8 with syncope]. A thorough history, full neurological examination as well as general examination were done. Conventional EEG was carried out in the awake state. Serum urea, creatinine calcium, sodium and potassium were performed. Serum prolactin was performed by enzyme immunoassay. Two samples for prolactin assay, the first within one hour in attack and the second After 24 hours. Generalized tonic-clonic [G. T.C.] convulsions were the commonest type [57.7%], complex partial type of convulsion were the 2[nd] in frequency [17.8%], generalized tonic [G.T], atonic and partial with secondary generalization were 6.7% for each, and lastly simple partial were 4.4%. The serum level of prolactin of the epileptic patients [21.7 +/- 2.5 ng/ml] was significantly higher than that of each of the non-epileptics group [9.4 +/- 2.3 ng/ml], [p<0.0001], as well as the control group [7.2 +/- 1.6 ng/ml], [p<0.0001]. Furthermore, the serum level of prolactin was significantly higher among the non-epileptics than the control group [p<0.05]. Significant differences were also reported between first and second samples in the epileptic group [p<0.001]; while the difference was insignificant between the first and second samples in non-epileptic group. A significant negative linear correlation [r=-0.8] and [P<0.01] was detected between the serum prolactin and time lapsed after the fit in the first sample. Taking mean +/- 2SD as a cut off value, sensitivity of serum prolactin for diagnosing epileptic fits was 93.3% and specificity was 65.2%. Post-ictal serum prolactin in the first hour after the fit is a sensitive parameter for diagnosis of epileptic patients and highly specific parameter to differentiate between epileptic patients and patients with syndrome that mimic epilepsy and could build a solid diagnosis for doubtful cases of epilepsy