Value of troponin i as a marker for detection of myocardial injury in patients on regular hemodialysis

Cardiovascular disease accounts for approximately 50% of deaths in patients with end-stage renal disease [ESRD]. Identifying those ESRD patients at high risk for future events is challenging, because they often have silent ischemia or atypical expressions of angina. Use of ECG data as diagnostic and prognostic tools is also difficult in this population because of the high prevalence of left ventricular hypertrophy and electrolyte disturbarices. Renal failure is one of the conditions in which serum markers of myocardial damage are falsely elevated. It is well known that levels of creatine kinase, CK-MB and myoglobin are altered in patients with uremia. Angina may be atypical or not observed due to silent ischemia and can be caused by factors other than coronary artery disease. In addition, nonspecific electrocardiogram findings are very common in these patients due to electrolyte imbalance, left ventricular hypertrophy and drug effects. Therefore, the value of specific biochemical markers of myocardial injury is crucial to this patient population. In some studies it is demonstrated that elevated cardiac troponins are a sign of coronary artery disease when these patients were investigated invasively by angiography, or non-invasively using stress cardiac isotopic imaging. Aim of the study: Evaluation of the role of cardiac troponin I in the diagnosis of myocardial injury in patients -under regular dialysis. The Study included 69 patients were selected from dialysis unit in El Minia university hospital. They are classified into three groups. Group I 25 patients with chronic renal failure under regular dialysis and proven not to have cardiac events [myocardial infarction, unstable angina, any anginal pains, congestive heart failure]. Group II Included 19 patients with chronic renal failure under regular dialysis proven to have cardiac events and Group III Included 25 apparently healthy subjects matched for age and sex their ages All the patients and controls were subjected to the following: History taking, general examination. Laboratory investigations [Complete blood count [CBC], BUN, serum creatinine, AST, serum phosphorous and ionized calcium ,lipid profile, C-reactive protein, LDH, CK,CK- MB and cardiac troponin I. Resting 12- leads ECG, and echocardiography. There was highly significant difference between group I, II and group Ill as regards BUN, serum creatinine, phosphorous and C- reactive protein and highly significant difference between group I and group U while significant difference between group II and III as regards serum calcium. There was highly significant difference between group I, II versus group II and III as regards serum triglycerides, HDL-cholesterol and LDL-cholesterol, but significant difference between group I, Ill and highly significant difference between group II, III as regards total cholesterol. There was highly significant difference between group I, II versus III as regards AST, LDH, CK, and CK -MB also high significant difference between group1, II and control as regards troponin. Conclusions: Cardiac troponin I can predicts myocardial infarction in patients with chronic renal failure on regular hemodialysis

Heat shock protein [hsp60, hsp90] in children with autoimmune diseases

This study was designed to investigate the possible role of heat shock proteins [Hsp60, Hsp90] in different autoimmune processes, and to assess the prevalence and prognostic significance of antibodies to Hsp60, Hsp90 in different groups with autoimmune diseases. One hundred and twenty children with autoimmune diseases were chosen from the pediatric, rheumatology, and medicine clinics of EI-Minia University hospital. They were designated as five groups. The sixth group included 20 apparently healthy children were taken as a control. IgG, IgM to Hsp 60 KDa [Kilo Dalton] and Hsp 90 KDa were determined using an ELISA with purified bovine Hsp60 KDa or Hsp 90 KDa. There was an increased titers of anti Hsp60 and anti- Hsp 90 [IgG and IgM] in patients with autoimmune diseases [Juvenile rheumatoid arthritis JRA, Systemic Lupus Erythromatosis SLE, Mixed connective tissue diseases MCTD, and Diabetic group DM] serum samples compared with serum samples from healthy controls [p<0.001] for each of them. Also concentrations of IgM to Hsp 60, 90 were less frequent in recent onset JRA when compared with long standing JRA, while the concentration of IgG to Hsp 60, and Hsp 90 were less frequent in long standing JRA when compared with recent onset JRA. The highest concentration of Hsp 60, Hsp 90 IgGs were in patients with MCTD group [59.36 +/- 5.2] and [68.9 +/- 2.6] and lowest values were present in diabetic group [20.24 +/- 4.72] and [20.46 +/- 2.53] when compared with other groups with autoimmune diseases. The highest concentrations of Hsp 60, Hsp 90 IgM were present in patient with longstanding JRA [28.4 +/- 3.9 and 41.4 +/- 4.4] and lowest concentrations were present in diabetic group [6.34 +/- 0.9 and 9.84 +/- 0.57]. The type of antibodies to Hsp 60, 90 correlated with the duration of illness in patients with JRA, The highest concentration of Hsp [60,90] were present in patients with MCTD, the lowest concentration were present in DM, the high level of Hsp correlate with the type and course of illness

Carotid intimal medial thickness in children and young adolescents with nephrotic syndrome

Patients with nephrotic syndrome [NS] are assumed to be at increased risk for atherosclerosis and coronary heart diseases [CHD], probably because of NS associated with hyperlipidemia, hypertension and steroid therapy. This study was aimed at evaluation of the carotid intimal thickness as a predictor of developing atherosclerosis in children and young adolescents with nephritic syndrome. Twenty-five children and young adolescents attending the pediatric nephrology outpatient clinic of El- Minia university hospital were enrolled in this study. They were 16 males and 9 females. Their age range between 8 and 14 years with a mean of 11 +/- 2.1 years. They were subdivided into 2 subgroups; one included 15 patients [60%] having proteinuria and not responding to steroid therapy and the other included 10patients [40%] having proteinuria and responding to steroid therapy. Fifteen healthy age and sex matched young adolescent served as a control group. All patients were subjected to thorough history taking and clinical examination. All subjects in the study underwent laboratory investigations including urinalysis, 24-hour protein in urine, serum creatinine, Triglycerides [TGs], cholesterol, low and high density lipoproteins [LDL and HDL], as well as carotid duplex. The results showed that carotid intimal thickness was significantly higher in nephritic patients than the results showed that carotid intimal thickness was significantly higher in nephritic patients than controls [p<0.001]. Serum LDL and cholesterol were significantly higher in nephritic patients than controls [p<0.01, p<0.02 respectively]. Carotid intimal thickness was directly correlated to relapse rates and serum HDL, LDL and cholesterol [p<0.001 for each]. Nephrotic patients with long duration of illness. Resistant to steroid therapy, have a history of hypertension and hyperlipidemia are more susceptible to early development of atherosclerosis and subsequent cardiovascular complications so they must be properly controlled especially early use of statins in children and young adolescent in those with high risk factors. Follow up of the high-risk nephrotic adolescent for possible development of CHD in young adulthood is recommended

impact of immune response to schistosoma hematobium infection on the outcome of HCV in patients with concomitant HCV and Schistosoma hematobium infection in El-Minya governorate in Egypt

Patients with schistosoma haematobium display immune response may alter the outcome of HCV in-patients with concomitant HCV and schistosoma haematobium. This study was aimed at evaluation of the effect of immune response to schistosoma haematobium on the outcome of HCV in-patients with concomitant infection [HCV and schistosoma haematobium]. This study was conducted on 70 subjects 59 of them were infected with HCV and/or schistosomiasis selected form the outpatient clinic of El-Minya University Hospital while the remaining eleven subjects were healthy control volunteers with no history and negative serology to both HCV and schistosomiasis. The patients were grouped into three groups. Group [I] it included 24 patients with concomitant HCV and schistosomal infections. Group [II] it included 19 patients with schistosoma haematobium infection. Group [III] it included 16 patients with HCV infection alone and control group. It included 11 healthy subjects. All groups were subjected to history taking, clinical examination, abdominal ultrasonography and rectal snip were done for all groups and liver biopsy was done for HCV +ve patients. Routine laboratory investigations and ELISA assessed hepatitis markers [A, B, C] antibodies and Special investigations, CD3, CD4, CD8, and estimation of CD[4]/CD[8] ratio and detection of ant-bilharzial antibody titer. Absolute CD4 was highly significant higher in group 3 when compared to control group [p- value < 0.001] and was highly significant lower in group 1 when compared to control group [p- value < 0.001]. As regard to absolute CD4 between different groups of patient it was high in group 3 then less in group 2 and much lower in group 1 and these differences were highly significant [p- value <0.001]. Absolute CD8 was highly significant higher in group 3 when compared to control group [p- value < 0.001] and was highly significant lower in group 1 when compared to control group [p- value < 0.001]. As regard to absolute CD8 between different groups of patient it was high in group 3 then less in group 2 and much lower in group 1 and these differences were highly significant [p- value <0.001]. Absolute CD4 / CD8 ratio was highly significant lower in group 1, 2 and 3 when compared to control group [p-value < 0.001] and was highly significant lower in group 1 when compared to group 3 [p- value < 0.001]. As regard to absolute CD3, CD4, CD8 and CD4/ CD8 ratio absolute CD4 and CD4/CD8 ratio were higher in-patients treated with praziquantel versus those not receiving this medication. While CD8 was higher in-patients not received this medications versus those received the medications. This study has documented that schistosoma haematobium display a suppressive effect on the immune system so that a concomitant infection with HCV will present with a more protracted disease with severe sequel and adverse complications. Also this study has documented that CD4, CD8, and CD4/CD8 ratio may be good indicators of the disease activity. It is recommended that strict control and treatment of schistosomiasis may ameliorate the problem of HCV induced chronic liver disease in Egypt