effect of combined rheumatoid arthritis and metabolic syndrome on endothelial dysfunction and the reliability of platelet endothelial cell adhesion molecule-I and matrix metalloproteinase-8 as markers for this dysfunction

Patients with rheumatoid arthritis [RA] and patients with metabolic syndrome [MetS] both are at increased risk for cardiovascular disease [CVD]. The present study aimed to evaluate the effect of association of RA with MetS on endothelial function measured by flow mediated dilatation [FMD] in females, as well as to find the possible role of platelet endothelial cell adhesion molecule-1 [PECAM-1] and matrix metalloproteinase-8 [MMP-8] on this function. forty eight female patients with RA, 21 of them had metabolic syndrome [RAMetS]. Forty nine female cases were enrolled as control cases, 25 of them had MetS [ContMetS]. C-reactive protein [CRP], MMP-8, Cartilage oligomeric matrix protein [COMP] and PECAM-i were assayed. Measurement of brachial artery FMD was performed using ultrasonography. RAMetS group had the highest level of MMP-8, PECAM-1 and CRP but it had the lowest FMD value than the other groups. FMD was found to correlate inversely with the severity of MetS as well as homeostasis model assessment-insulin resistance [HOMA-IR], CRP, MMP8, PECAM-1, rheumatoid factor [RF] and disease activity score in 28 joints [DAS28]. Endothelial cell dysfunction [ECD] proved by FMD impairment could be considered to be a common feature of RA as well as MetS. ECD was aggravated if both conditions were associated. Elevated MMP-8, PECAM-1 and CRP in RA patients and their correlation to FMD, point them to be contributing factors in the pathogenesis of ECD and the possibility to use them as biochemical markers for assessment of ECD in RA and/or MetS

Relationship between adiponectin, resistin and visceral obesity in type 2 diabetes mellitus in female Egyptians

The aim of this work was to study the possible physiological role of adiponectin and resistin as mediators linking obesity and insulin resistance in type 2 diabetes mellitus. Seventy-five female Egyptian subjects were enrolled in this study. They were divided into four groups as follows: obese nondiabetics [ONDM], obese diabetic type 2 [0DM], nonobese nondiabetic [NONDM] and nonobese diabetic [NODM]. Anthropometric measurements were taken. Abdominal ultrasound was also done to measure visceral fat [VF], subcutaneous fat [SCF] and visceral fat index [VFI]. Fasting blood samples were taken for analysis of serum insulin, blood glucose, plasma adiponectin and resistin. In the diabetic group adiponectin had an inverse correlation with resistin,VF and VFI [P < 0.01, P < 0.05, P < 0.01]. Resistin had a weak positive correlation only with VF, [P = 0.05] and RAI [resistin /adiponectin index] showed a positive correlation with VFI and SCF. In the nondiabetics adiponectin had no correlation with resistin, but had negative correlation with HOMA, age, VF and VFI, whereas resistin had no correlation with the same variables. RAI had a positive correlation with HOMA and SCF. In conclusion it can be said that resistin has no direct relation to insulin resistance either in diabetics or non diabetics. However, it may have a weak relation to visceral obesity only in diabetics. Hypoadiponectinemia is related to visceral obesity and increased resistin level in diabetics, while in non diabetics it is related to visceral obesity, insulin resistance and age. RAI is more informative than resistin which indicates a possible interaction between resistin and adiponectin especially in diabetics. RAI correlates positively with some anthropometrics but not to insulin resistance in diabetics, while it correlates positively with both variables in non diabetics

Assessment and protection of ovarian function in young females undergoing cytotoxic chemotherapy

Infertility with its psychological and social implications is one of the side effects of chemotherapy especially in young females with various malignant diseases. This study was conducted to assess ovarian function and test the effect of oral contraceptive pills and GnRH a[gnadotrophine releasing hormone agonist] in the protection of ovarian function in cancer cases. Fifty seven young female patients with early stages of malignant diseases were enrolled in this study. Their age ranged between 20-35 years. All patients received alkylating agent based chemotherapy as a chemotherapy for their disease. They were divided into 3 groups. Group [1] included 15 patients who received GnRH agonist 3.6 mg IM monthly. Group [2] included 18 patients who received oral contraceptive pills continuously for the entire duration of the their chemotherapy cycles Group [3] included 24 cases received only chemotherapy. Pre and 6 months post chemotherapy serum hormonal assay which included FSH, estradiol [E2], anti mullerian hormones [AMH], and inhibin-B were carried out for all patients. Ultrasound ovaries was also done. Analysis of the results showed that the use of either GnRH agonist or oral contraceptive pills almost equally helps in the protection of ovarian function in young female patients receiving alkylating agent based regimen. But contraceptive pills are significantly less costly in comparison to GnRH agonists. However, in spite of the apparent short term benefits of these drugs in preserving gonadal function, the hormone derangement which was noticed post chemotherapy may cause premature ovarian failure. The hormonal study AMH and lnhibin-B as well as the ultrasound study to count the number of antral follicles pre and post chemotherapy, are very effective tools to evaluate the condition of the ovaries pre and post treatment

risk of ovarian failure in egyptian patients with lupus nephritis treated with various cytotoxic and immunosuppressive drugs

To compare the effect of various immuno-suppressive drugs on gonadal function in females with SLE. We studied 128 female patients with SLE, 68 of them had lupus nephritis [LN]. All the patients with LN received corticosteroid [CS] plus one of theses drugs: cyclophosphamide [CP] [24 cases], azathioprine [AZA] [1 6 cases], mycophenolate mofetil [MPM] [10 cases] and cyclosporine [CyA] [18 cases]. The other 60 cases received CS alone. Blood samples were taken for inhibin B,esradiol E2, LH and FSH before and six months after starting the treatment. Clomiphene test was done in some cases. Sustained amenorrhea [> 1 year] occurred in 33% of the patients in the CP group and in 5% of patients in the CyA group. After 6 months of treatment, the mean level of inhibin B, LH and FSH -in cases that received CS alone- were lower than their basal values. In the CP group, the mean values of E2 and inhibin B after treatment were lower significantly [p=0.01 and 0.001] while LH, FSH were higher significantly than before treatment after controlling the effect of the associated CS doses. Corticosteroid treatment decreased the cytotoxic effect of CP on the ovaries. In the CyA group the mean levels of inhibin B, FSH hormones were lower significantly than before treatment, in the AZA group and the MPM groups the mean values of the hormones were not different than before treatment. Activity of the disease measured by SLEDAI score [systemic lupus erythematosus activity index score], SLICC/ACR renal damage score [systemic lupus International Collaborating Clinic /Amerlcan College of Rheumatology], had no effect on the occurrence of sustained amenorrhoea Also activity and chronicity renal biopsy index had no effect on ovarian failure in these cases. CP is an effective drug for lupus nephritis but possibility of ovarian failure in the young women is a serious side effect and must be discussed clearly with the patient. Combining large maintenance daily doses of Corticosteroid > 20 mg /day did not affect the initiation of amenorrhoea but reduced the incidence of sustained amenorrhoea after the discontinuation of the treatment. CyA may affect gonadal dysfunction. Other immunosuppressive drugs had a negligible effect on ovarian function. Inhibin B is a sensitive test for detection ovarian dysfunction in these patients

Percent and risk factors of HCV infection in Egyptians attending Alexandria University Hospital

In Egypt HCV infection is a serious problem. The prevalence in 1999 was 18% according to MOHP survey. This study tried to get a clear idea about the percent of HCV in a random sample of students and employees in Alexandria University as compared to the percent of HCV infection in blood donors and to shed light on most of the risk factors. As well as to clarify the relation between DM and HCV infection. Random samples of 428 students, 479 employees and 24,064 blood bank donors were involved in this study. A standard questionnaire was issued to the students and the employees to collect data concerning age, sex, history of previous hepatitis history of blood transfusion, IV schistosomal treatment, intravenous injection [IV], intramuscular injection [IM], subcutaneous injection [SC], tattoo, circumcision, Hogamma [suction cupping], diabetes mellitus [DM] and marital state. Blood samples from the same patients were collected for HCV antibodies, alanine transferase [ALT] and fasting blood sugar levels. Cases with the risk factors were compared with those lacking them using logistic regression, odd ratios and confidence intervals. The prevalence of HCV in the whole group of students and employees was 11.6%. It was 17.2 in the age group above 30 years, and 7.6 in those below 30 years, odd ratio between the two age groups [OR= 2.5, 95% CI: 1.6-3.8, p 0.001]. Percent of HCV in males was 13.5 while in females 7%, [OR= 2.06, 95% CI: 1.2-3.5, p<0.01]. HCV infection in apparently healthy blood bank donors was 3.9% which as expected was lower significantly than the normal population even after it was adjusted for the age variable [p<0.01 vs normal population]. The adjusted OR of the studied risk factors which were statistically significant was as follows: IV schistosomal treatment [tarter emetic] [OR=53, 95% CI: 32-199, p <0.001], blood transfusion before 1994 [OR= 2.5, 95%