Hyperuricemia and its association with carotid intima-media thickness in hypertensive and non hypertensive patients

Carotid intima-media thickness [C-IMT] measured noninvasively by ultrasonography is widely used as a marker for increased risk of cardiovascular disease. Also hyperuricemia [HU] is a well recognized risk factor for cardiovascular diseases. The study was designed to assess the relation between hyperuricemia and carotid intima-media thickness C-IMT in patients with and without hypertension [HTN]. This study included 126 patients divided into four groups: [1] Group A, included 59 hypertensive patients with hyperuricemia. [2] Group B, included 29 hypertensive patients without hyperuricemia. [3] Group C, included 17 patients with hyperuricemia and normal blood pressure without history of hypertension. [4] Group D, included 21 control subjects. We measured carotid intima-media thickness by B-mode ultrasound in the common carotid and internal carotid artery. Routine echocardiography and uric acid level was assessed for all patients. We found that C-IMT was significantly higher in group A, B and C than group D; and it was significantly higher in group A than B. This means that C-IMT is significantly higher in all hypertensive groups than control group but it was significantly higher in hypertensive hyperuricemia [group A] than those hypertensives without hyperuricemia. We also observed a higher C-IMT in hyperuricemic non hypertensive patients than control group this means that hyperuricemia per se could be a risk factor for atherosclerosis. Uric acid levels among the whole number of patients included in the study and among the groups with hyperuricemia [group A and group C] were positively correlated with the intimal-media thickness [IMT] while there were no correlations in the other two groups without hyperuricemia. We found that left ventricular hypertrophy [LVH] was significantly higher in hypertensive patients [group A and B] than normotensives [group C and D] either with or without hyperuricemia and this was evident in the hypertensive hyperuricemic patients [group A]; but unexpectedly we observed the presence of LVH in the hyperuricemic non hypertensive patients [group C] which was significantly higher than the control group [group D]. This means that hyperuricemia is a risk factor for development of LVH hypertrophy independently of hypertension. Therefore, higher serum uric acid levels are associated with increased C-IMT and left ventricular hypertrophy in hypertensive and even non hypertensive patients. So, early screening for hyperuricemia and lowering serum uric acid levels might be beneficial in slowing progression of atherogenesis

Alterations in colonic mucosal lesions in patients with portal hypertension

Portal hypertensive colopathy [PHC] is a clinical entity in liver cirrhosis. The frequency and profile of colonic mucosal lesions of this entity are not well studied. The aim of this study is to evaluate the prevalence of colonic mucosal changes in patients with liver cirrhosis and their clinical significance. Forty patients with post-viral liver cirrhosis and portal hypertension [PHT] underwent upper gastrointestinal endoscopy as well as a full length colonoscopy to detect changes in colonic mucosa. PHC was diagnosed endoscopically by the presence of vascular ectasia, diffuse hyperaemic mucosa and rectal varices. Biopsies were obtained from the recto-sigmoid area as well as from any abnormal mucosal lesions apart from angiodysplastic areas. Diffuse hyperaemia, angiodysplasia and rectal varices were found in 40%, 32.5% and 17.5% of patients while haemorrhoids in 42.5%, respectively. The prevalence of PHC increased with worsening Child-Pugh class, the mere presence of oesophageal varices while platelet count was significantly associated with angiodysplastic lesions only. None of other upper endoscopic features of PHT was significantly related to PHC. Moreover, history of lower gastrointestinal [GI] bleeding was significantly associated with the presence of rectal varices and haemorrhoids. Colonoscopic features of PHC were significantly associated with the histopathological diagnosis revealing 79% sensitivity and 66.6% specificity. Conclusion: PHC is a frequent finding in patients with PHT. Colonoscopic features suggestive of PHC were in concordance with the histopathological evidence. Although the presence of haemorrhoids is not a feature of colopathy, yet it should be considered together with anorectal varices as a cause of lower GI bleeding

Intravitreal bevacizumab [avastin] versus triamcinolone acetonide for treatment of diffuse diabetic macular edema

To evaluate and compare the anatomical [central macular thickness] and the functional [visual acuity] outcomes associated with a single intravitreal injection of bevacizumab [Avastin] versus triamcinolone acetonide for the treatment of diffuse diabetic macular edema. The study included 74 eyes [56 patients] with diffuse diabetic macular edema, which were randomized into 2 groups according to the line of treatment used; bevacizumab group [group B] and triamcinolone group [group T]. The inclusion criteria are diffuse diabetic macular edema with fluorescein angiography evidence and central macular thickness [CMT] of at least 400u as measured by OCT. All eyes were subjected to complete ophthalmic examination, including best corrected visual acuity [BCVA] with the logarithm of minimal angle of resolution [log MAR], lOP and fundus biomicroscopy. Fundus photography of the macular region, fundus fluorescein angiography and OCT were performed for all eyes at baseline. 1.SmgIO.6m1 of bevacizumab or 4mgIO.lml of triamcinolone acetonide was injected into the vitreous cavity using a 27-gauge needle inserted through the inferotemporal pars plana 3.5mm from the limbus Patients were scheduled for follow-up examinations at 1, 4, 8, 12 and 24 weeks postoperatively. The outcome measures are the changes in CMT, changes in BCVA and any reported complication. There was no significant difference between the baseline mean CMT and mean BCVA [log MAR] of both groups [p>0.05]. Four weeks following the intravitreal injecthin, there was significant improvement in the mean CMT of both groups, but the difference between both groups was not statistically significant. The mean BCVA [log MAR] was significantly improved in both groups [p<0.05]. At 12 weeks, the mean CMT was still better than baseline in both groups, but this improvement was significant in group T only. The difference between both groups was statistically significant [p < 0.05]. The mean BCVA [log MAR] was significantly better in both groups and this improvement was significantly better in group T also. At 24 weeks, the mean CMT has increased to approximate the baseline again with a corresponding deterioration in the mean BCVA in both groups. In group T, the mean TOP was increased throughout the study and the maximum increase was reported at the 4th week [p < 0.05]. In group B, no significant change in the mean TOP was reported during the follow-up period. A single intravitreal injection of triamcinolone acetonide may be associated with greater beneficial effects on vision and central macular thickness than a single intravitreal injection of bevacizumab for the short-term management of diffuse diabetic macular edema. However, careful monitoring of the TOP should be done in eyes receiving triamcinolone acetonide

Diagnosis of renal osteodystrophy in children with chronic renal failure

This study aimed to evaluate the potential of determining bone density using digital radiography in the detection of the bone changes of renal osteodystrophy as compared to biochemical findings [serum calcium, phosphorous and alkaline phosphatase]. This study included twenty five children with CRF aged 6 to 12 years of variable etiology; 14 of them were on dialysis and compared with 10 age and sex matched healthy controls. They were examined using digital radiography together with blood samples to measure serum calcium, phosphorous and alkaline phosphatase. 3 aluminium step wedges were attached to the film cassette to give a reference image on the radiograph. Panoramic radiographs were digitalized, stored and processed by a computer. A geometrically standardized rectangular area of interest was measured for each radiograph. Bone density using digital radiography adequately demonstrated bone status by determining bone density more conspicuously than do the biochemical findings. There were no significant differences detected between dialyzed and non-dialyzed patients so they were poured as one group. While, there was significant decrease in serum calcium and significant increase in serum phosphorous and alkaline phosphatase in patients group compared to controls group. Also, reduction of bone mineral density was detected in patients group compared to controls group and positive correlation was found between bone density of the whole sample and their serum calcium levels. No meaningful correlation could be established between bone mineral density and duration of dialysis. The study concluded that bone density using digital radiography is a potentially useful tool for evaluating the hone density and consequently the bone status of renal osteodystrophy