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

High thoracic epidural analgesia improves postoperative cardiac outcome in ischemic patients undergoing major abdominal surgery

Postoperative cardiac morbidity and mortality continue to pose considerable risks to surgical patients. High thoracic epidural analgesia [HTEA], owing to its selective blockade of cardiac sympathetic innervation, has been used for treatment of medically or surgically refractory angina pectoris. However; its use in patients with coronary artery disease [CAD] undergoing non cardiac surgery has not been adequately investigated. The aim was to investigate the effect of HTEA on postoperative cardiac morbidity in patients with symptomatic CAD undergoing major abdominal surgery as opposed to a technique with comparable analgesic effect namely: Low thoracic epidural analgesia [LTEA]. After approval, thirty patients with symptomatic CAD undergoing major abdominal surgery were included. Before general anesthesia, they were randomly allocated to have HTEA or LTEA for both intra and postoperative pain relief. In addition to haemodynamic measurements, postoperative cardiac morbidity was investigated by comparing the preoperative ECG, echocardiography and troponin I with the postoperative ones done one the first, third and seventh days. Data were expressed as mean [SE]. Cardiac morbidity was only diagnosed in 13.3% of patients in the HTEA group. In the LTEA group, 53.3% were found to have new ischemic changes and 13.3% developed postoperative MI. No cardiac mortality was reported in either group. Absolute risk reduction was 53.3% and the number needed to treat was found to be 2. HTEA in patients with CAD undergoing non-cardiac surgery has resulted in a reduced postoperative cardiac morbidity. It may be worthwhile establishing this technique, unless contra indicated, in such patients

Anticardiolipin antibodies and left atrial thrombus as indicators for increased risk of thromboembolic events in patients with isolated mitral stenosis

The study population consisted of 113 non-anticoagulated patients with Mitral stenosis [MS] and 20 healthy control subjects. Serum levels of IgG and IgM anticardiolipin antibodies [ACLs] were determined in all patients and control subjects. Transthoracic echocardiographic [TTE] and transesophageal echocardiographic [TEE] studies were performed in all patients to measure cardiac chambers, mitral valve area [MVA] and left ventricular ejection fraction [EF%] and to examine left atrial [LA] appendage [LAa] and LA for the presence of thrombi. In conclusion, anticardiolipin antibodies either IgG or IgM was commonly detected in patients with MS. There was a significant association between +ve ACLs and LA thrombi detected by TEE. So, these antibodies could be considered as a warning tool for thrombus formation and seem to be considered an independent risk factor for thrombembolic events in patients with mitral stenosis

Survey study of microalbuminuria in diabetic patients attending out-patient clinic of diabetes in Assiut University Hospital

Micro albuminuria is the earliest sign of diabetic nephropathy [DNP] and it is an indicator for the presence of the characteristic glomerular lesion. This study was conducted on the adult diabetic patients of both types I and II of diabetes mellitus [DM] attending the out -patient clinic of Assiut University Hospital throughout the year 2002. Patients with hypertension, congestive heart failure or those with urinary tract infection albuminuria were excluded. Five hundred patients were subjected to full history taking and clinical examination as well as the following investigations; [I] complete urine analysis [2] screening for micro albuminuria [3] fasting serum glucose [FSG]] and glycosylated hemoglobin [HbAlc] [4] serum urea and creatinine and creatinine clearance. Out of 500 patients 213 [42.6%] were positive for micro albuminuria which was more prevalent among type I DM, male sex, extreems of age, urbans, over-weight and obese patients and those with low physical activities as well as patients with non renal complications. Significant direct proportions were found between level of micro albuminuria, on one hand, and level of FSG and HbAlc and serum urea and creatinine on the other hand, while inverse proportion was found with creatinine clearance. We have concluded that, micro albuminuria is a simple detectable marker for screening incipient DNP. Micralbuminuria was prevalent among considerable percentage [42.6%] of our diabetic patients. It was found to be more prevalent among different studied categories of patients which could be considered as possible risk factors for developing DNP in our locality. Apart from hypertension, these factors are [1] type I DM [2] male sex [3] extreems of age [4] urbans [5] low physical activities [6] obesity [7] long duration of DM [8] bad control of hyperglycaemia [9] presence of non renal complications [10] renal insufficiency