Leptin, osteocalcin, and bone mineral density in post-hepatitic liver cirrhosis

The pathophysiology of osteoporosis complicating chronic liver disease is unknown. Some studies have found leptin to be a potent inhibitor of bone formation. The aim of this study is to investigate the relationship between leptin, osteocalcin and bone mineral density [BMD] in liver cirrhosis. Sixty patients with post-hepatitic liver cirrhosis were classified into three groups: group I, 20 pre-menopausal females; group II, 20 post-menopausal females; and group III, 20 males. In addition, 21 age- and sex-matched healthy subjects [seven for each group] were included as control subjects. Patients were classified according to Child-Pugh classification into grade A [n = 0], grade B [n = 38] and grade C [n = 22]. Serum osteocalcin, leptin and parathyroid hormone [PTH], in addition to liver functions test, hepatitis B surface antigen [HBsAg], anti-hepatitis C virus [HCV], serum phosphorus and calcium were measured. Bone mineral density [BMD] was measured by calcaneal ultrasound. Leptin was elevated in all groups [I, II and III] when compared with their control groups [p < 0.01, p < 0.001 and p < 0.01, respectively]. Further, it was high in female groups [I and II] compared to males [group III], [p < 0.01 each]. BMD and serum osteocalcin decreased in each group compared with the respective control [p < 0.001; p < 0.01 in group I, p < 0.05; p < 0.001 in group II and p < 0.001; p < 0.001 in group III, respectively]. In the Child-Pugh grade C group, BMD and osteocalcin were low [p < 0.001, p < 0.05, respectively], while serum leptin was elevated [p < 0.05], when compared with grade B group. Leptin correlated negatively with serum osteocalcin [r = -0.553; p < 0.001], BMD [r = -0.229; p < 0.05], albumin [r = -0.449; p < 0.001] and albumin/globulin [A/G] ratio [r = -0.661; p < 0.001], while positively correlated with both aspartate transaminase [AST] [r = 0.462; p < 0.001], and alanine transaminase [ALT] [r = 0.483; p < 0.001]. Osteocalcin negatively correlated with intact iPTH [r = -0.370, p < 0.001], while positively correlated with BMD [r = 0.418; p < 0.001], albumin [r = 0.659; p < 0.001] and A/G ratio [r = 0.444; p < 0.001]. Serum leptin was elevated in cirrhotic patients and may have a role in the pathogenesis of osteoporosis in liver cirrhosis

Apolipoprotein E 3/4 genotype as a cardiac risk marker

Atherosclerosis is a complex disease caused by both genetic and environmental factors. Apolipoprotein E polymorphism is believed to confer substantial susceptibility to coronary heart disease risk. This study was performed on sixty five males selected with normal serum glucose, kidney function, liver function and thyroid function tests. They were classified into: Group A: Apparently healthy individuals [40 subjects], with normal blood pressure and ECG. Group B: Patients with atherosclerotic coronary artery disease [CAD] diagnosed by coronary angiography [25 cases]. All the studied persons were subjected to: serum lipogram, apolipoprotems A-I, B and E concentration and apolipoprotein E genotyping. In CAD group, the mean values of serum total cholesterol triglycerides, LDL-c, TC / HDL-c ratio, LDL-c / HDL-c ratio, apolipoprotein B concentration and apo B /A-I showed significant elevation while HDL-c levels revealed significant reduction compared to apparently healthy group. In CAD group, apo E 3/3 represented 68% of cases, followed by apo E 3/4 genotype 24%, apo E 3/2 genotype 4% and the homozygous apo E 2/2 genotype 4%. In apparently healthy group, apo E 3/3 genotype represented 70%, apo E 3/4; 12.5% and apo E 3/2; 17.5% of the studied individuals. CAD patients carrying apo E 3/3 genotype, had elevations of serum triglycerides, total cholesterol, LDL-c apo B and apo B/A-I ratio in 6%, 47%. 71%, 35% and 12% of cases [respectively] while HDL-c was reduced in 65% of cases carrying this genotype compared to the levels in apparently healthy group. Average risk values of TC/HDL-c ratio were found in 65% of cases and moderate risk values in 35% of cases. High risk values of LDL-c/HDL-c ratio were found in 18% of cases and moderate values in 82% of cases. But carriers of apo E 3/4 genotype in CAD patients had elevated triglycerides, total cholesterol in 33%, 67% of cases respectively and in LDL-c, apo B and apo B/A-I ratio in 83% of cases while HDL-c and apo A-I were reduced in 83% and 67% of cases carrying this genotype respectively. High risk values of TC/HDL-c and LDL-c/HDL-c ratios were observed in 17% and 18% of cases respectively. Other genotype carriers [E3/2 and E2/2] showed no difference when compared to the levels in apparently healthy subjects. In apparently healthy group, apo E 3/4 genotype carriers had significant elevation of serum TC, TG, LDL-c, TC/HDL-c ratio, LDL-c/HDL-c ratio, apo B and apo B/A-I ratio and significant reduction of apo A-I and E concentration than apo E 3/3 genotype carriers. Carriers of E 3/4 genotype also had significant elevation of TC, LDL-c, apo B and apo B/A-I ratio and significant reduction of apo E concentration compared to those carrying apo E 3/2 genotype. 1-Apo E 3/3 is the most common genotype in both apparently healthy subjects and atherosclerotic CAD patients. If is followed by apo E 3/2, then apo E 3/4 genotypes in apparently healthy group, and followed by apo E 3/4, then apo E 3/2 and apo E 2/2 in CAD group. None of the studied individuals had either apo E 4/4 or apo E 2/4 genotypes. 2 -Apolipoprotein E 3/4 genotype carriers had elevated levels of serum total cholesterol triglycerides, LDL-c, apolipoprotein B A apo B/A-I ratio, and reduced levels of HDL-c and apo A-I.So, they are susceptible to more atherogenic lipid profile than other genotype carriers, which is considered a predisposing factor for atherosclerotic coronary artery disease. As regard TC/HDL-c and LDL-c/HDL-c ratios, most of the patients carrying apo E3/4 genotype had high and moderate risk values while patients carrying apo E 3/3 genotype had average and moderate risk values

Von Willebrand factor, thrombomodulin and nitric oxide in Behcet's disease

Twenty-six patients with Behcet's disease [BD] [15 patients with active disease and 11 with inactive disease] and 20 healthy subjects, as a control group, were included in this study. All patients and controls were subjected to measurement of plasma levels of von Willebrand factor [vWF] and thrombomodulin [TM] as well as serum NO, in addition to complete blood picture, erythrocyte sedimentation rate [ESR] and C-reactive protein [CRP]. The results showed that, means of vWF, TM and NO levels were significantly higher in BD patients than controls. Mean levels of vWF were high in patients with recurrent oral ulcer [ROU] and those with arthritis/arthralgia. Mean values of NO were significantly high in patients with ROU, RGU, patients with arthritis/arthralgia and thrombosis. Mean levels of vWF, TM and NO were significantly higher in active group than inactive group. Positive correlations were found between vWF with ESR2, CRP, TM and NO. Also, positive correlations were found between TM with ESR1 and ESR2. Also, positive correlations were found between NO with ESR1, ESR2 and CRP

value of soluble transferrin receptor in early diagnosis of iron deficiency anemia in chronic renal failure

Decreased erythropoietin [EPO] production is the main pathogenic factor of anemia in chronic renal failure [CRF]. Iron deficiency is the most common cause of EPO resistance in dialyzed patients with renal failure. Subclinical or functional iron deficiency is difficult to diagnose in these patients. Aim: This study was designed to determine the sensitivity and specificity of serum iron, transferring, ferritin and soluble serum transferrin receptor [sTFR] in diagnosis of iron deficiency in chronic renal failure and the efficacy of recombinant human EPO [rHuEPO] treatment. Patients: This study was conducted on 70 patients with CRF divided into three groups: group [A] CRF patients predialysis [30 cases], group [B] CRF patients on regular dialysis > 5 years [30 cases], and group [C] CRF patients on dialysis and rHuEPO treatment with parentral iron supplementation [10 cases].Twenty healthy individuals age and sex matched were included as controls. Peripheral hemogram, serum urea and creatinine, serum iron [SI] and total iron binding capacity [TIBC], serum ferritin, serum transferring and [sTFR] were done for both patients and control group. There was highly significant reduction of RBCs, hemoglobin [Hb] and hematocrit [Hct] in different patients groups compared to controls; [P < 0.001] for each Serum iron [SI] was insignificantly reduced in groups A and B compared to controls while it was significantly increased in group C [P < 0.05]. Serw transferrin was significantly reduced in all patients groups compared to controls [P < 0.001] for each. Serum ferritin and sTFR were significantly increased in both group, A and B [P < 0.001] for each, while in group C, there was significant increase in serum ferritin [P < 0.01] and no significant difference in sTFR level compared to controls. sTFR is a sensitive [sensitivity 93%] and specific [specificity 100%] indicator for identifying iron deficiency and assessing the effect of rHuEPO treatment in CRF patients