common mutation in methylene tetrahydrofolate reductase gene, inflammation and atherosclerosis in chronic renal failure

Accelerated atherosclerosis is the major cause of mortality in patients on chronic haemodialysis [HD]. Inflammation and endothelial activation or dysfunction might be the major factors leading to high cardiovascular mortality rate in HD patients. Also, C667T mutation of methyltetrahydrofolate reductase [MTHFR] might be associated with accelerated athcrosclerosis. The present study was designed to clarify the role of inflammation, endothelial activation or dysfunction and genotyping of MTHFR enzyme which affect the level or homocysteine and their relation to carotid artery intima-media thickness [CIMT] as an indicator of atherosclerosis. Forty four [44] chronic haemodialysis [HD] patients and 40 healthy subjects were included in the study. Serum highly sensitive C reactive protein [hs-CRP] and IL-6 were measured as inflammatory markers, soluble vascular cell adhesion molecule-1 [sVCAM-1] was measured as a marker of endothelial activation and dysfunction. Common carotid intimal media thickness [CC-IMT] was assessed by carotid artery ultrasonography. genotyping of MTHFR enzyme which affect the level of homocysteine was analyzed by PCR RFLIP technique. Chronic HD patients had elevated levels of inflammatory markers [hs-CRP and IL-6], enhanced endothelial activation or dysfunction demonstrated by elevated VCAM-1 as compared by healthy controls. Haemodialysis patients had significantly higher CC-IMT levels. There is a significant positive correlation between inflammatory cytokines [hs-CRP and IL-6], and each with VCAM-1 and CC-IMT There is no difference in the genotype of C667T MTHFR found between patients and controls, but this mutation especially the TT genotype is associated with development of atherosclerosis as indicated by the increase of CC-IMT

Can serum fibrosis markers predict medium/large oesophageal varices in patients with liver cirrhosis?

Non-invasive predictors of medium/large oesophageal varices [LOVs] could reduce the number of screening endoscopies. As portal hypertension is a consequence of liver fibrosis, serum fibrosis markers were evaluated together with other variables as possible non-invasive predictors of medium OV/LOV. A total of 154 cirrhotic patients with splenomegaly and 30 healthy control subjects were recruited in a prospective study in two gastroenterology centres in Upper Egypt. Clinical parameters assessed included Child-Pugh class, liver size and ascites. Laboratory parameters included complete blood count, liver function tests, and aspartate aminotransferase [AST]/platelet ratio. Transforming growth factor-p! [TGF-beta [1]], alpha2 macro globulin [A[2]M] and hyaluronic acid [HA] were assayed. Ultraso-nographic examination was done for assessment of liver span, portal vein diameter and detection of minimal ascites. Oesophageal varices were diagnosed and graded by oesophagogastroduodenoscopy. Fifty-four patients [35%] had no or small varices and 100 [65%] patients had medium OV/LOV by endoscopy. On multivariate analysis, the independent predictors of medium OV/LOV were the presence of ascites [beta = 0.258, p = 0.047] and serum HA [beta = 0.449, p = 0.009]. The receiver operating characteristic curve for HA showed the area under the curve to be 0.916. The sensitivity, specificity, positive and negative predictive values and diagnostic accuracy of HA at a cut-off value of 207 micro g T[1] were 94%, 77.8%, 88.7%, 87.5% and 88.3%, respectively. The presence of ascites and serum HA level higher than 207 micro g T[1] can predict the presence of medium OV/LOV in cirrhotic patients. This would help physicians to identify patients who would most likely benefit from screening endoscopy and thus, reduce costs and discomfort from unnecessary endoscopic procedures

Adipocytokines in pre-pubertal children with type 1 diabetes: relation to some risk factors

Adipose tissue represents an active endocrine organ secreting a variety of factors that regulate energy metabolism and insulin sensitivity. The aim of this study is to evaluate adipocytokines in pre-pubertal children with type I diabetes mellitus and its relation to some risk factors. The study included 20 cases newly diagnosed with type 1 diabetes, 30 cases with long duration of diabetes, and 20 healthy matching children as controls. Cases and controls were subjected to full history taking and physical examination, estimation of BMI, blood glucose level and glycated hemoglobin. Non fasting blood samples were withdrawn from all cases and controls for estimation of serum adiponectin, resistin, leptin, TNF-alpha and IL-6. Results showed that newly diagnosed cases with type I diabetes had significantly lower BMI, serum adiponectin, and serum leptin levels and had significantly higher levels of TNf-alpha and lL-6 than cases with long duration of diabetes. No significant difference in resistin levels was observed between either studied cases or controls. Significant negative correlations were found between adiponectin with both lL-6 and TNF alpha serum levels in the whole studied cases. Also a positive correlation was found between resistin levels and duration of illness. In conclusion adipocytokines may play a role in metabolic adaptation of type I diabetes

Pro-inflammatory cytokines, oxidative stress and intelligent quotient [IQ] in malnourished pediatric patients

Protein energy malnutrition [PEM] is one of the most common health problems among children of developing countries. Children with PEM lose their resistance to infection because of a disordered immune system. Protein energy malnutrition produces changes in inflammation related proteins characteristic off a low grade systemic inflammatory response and, thus, can serve as an inflammatory stimulus. Antioxidant status of PEM patients is significantly reduced. An increasing body of evidence indicates a link between malnutrition and poor cognitive ability in children [in particularly in early onset malnutrition]. This study included 28 children having malnutrition [17 patients had marasmus [loss of subcutaneous fat over the thigh or over the abdomen or loss the buccal bad of fat] and 11 patients had kwashiorkor[presented by generalized edema, sparse easily detachable hair, flag sign, cracky paint dermatosis and apathy], 15 males 13 females, their ages ranged from 4 months to 24 months, admitted to Gastroenterology Unit, Assuit University Children Hospital from April 2007 to December 2007 as well as 15 apparently healthy children of matchable ageand sex. All patients subjected to full history, complete clinical examination and the following investigations: serum levels of TNF-alpha, lL-6, nitric oxide [NO], lipid peroxide and zinc as well as Intelligent Quotient [IQ] were done. Serum levels TNF-alpha, lL-6, NO were significantly higher in patients with kwashiorkor and in patients with marasmus than in controls as well as higher in patient with kwashiorkor than in patients with marasmus. Serum levels of peroxide, was only significantly higher in patients with kwashiorkor and in patients with marasmus than in control. Also serum zinc level and I.Q were significantly lower in patients with kwashiorkor and in patients with marasmus than in controls as well as in patients with kwashiothor than in patients with marasmus. There are negative correlations between serum levels of TNF-alpha, lL-6 and lipid peroxide with I.Q in patients with marasums and patients with kwashiorkor. Also there is a positive correlation between serum level of zinc with IQ in patients with marasmus and in patients with kwashiorkor. in conclusion, oxidative stress imbalance and zinc deficiency in children with PEM play an important role in their neurocognitive development