OUTCOMES OF APLASTIC ANEMIA PATIENTS IN ASSUIT UNIVERSITY HOSPITAL, ONE YEAR STUDY

Aplastic anemia is a disorder in which the bone marrow fails to make enough blood cells. to identify the various aetiological factors that stands behind aplastic anemia as a common hematological problem and the various outcomes of those patients along one year. The study included 80 patients with aplastic anemia who were admitted to the Clinical Hematology Unit of Assuit University Hospital from November 2011 to October 2012. All patients were recruited for careful history and meticulous investigations to detect predisposing factors. Results: 42.5% of all studied aplastic anemia patients had any definite etological or predesposing factor, so considered as idiopathic group while, 57.5% were secondry to chmicels and/or insecticides [22.5%], hepatitis C[15%], systemic lupus erythematosis[SLE] [12.5%] and rheumatoid arthritis[7.5%]. The observed outcomes showed that complete recovery in 39%t of the secondry aplastic anemia patients [P<0.001], chronicity in 22% while 39% died. However, none of the idiopathic aplastic anemia' patients reached recovry, 59% become chronic [P<0.001] and 41% died [P<0.05]. Secondary aplastic anemia patients have a chance for recovery by correcting the primary etiology that is not an option in idiopathic patients. The hope for not recovered aplastic anemia patients is dependency on transfusional support and immunosupressive therapy waiting for a chance in allogeneic stem cell transplantation. The expected outcome of most of unrecovered patients is death unless find early chance for transplantation.So, there is a very potential need for stem cell transplantation center in Assuit University as an important referral center in Upper Egypt

Platelet count, mean platelet volume and aggregation as markers of disease activity in rheumatoid arthritis

Rheumatoid arthritis [RA] is a chronic inflammatory disorder that affects small joints of hands and feet. Different forms of hematological disorders are associated with RA as anemia, neutropenia, thrombocytosis, thrombocytopenia, eosinophilia, and hematological malignancies. To correlate the value of mean platelet volume [MPV], platelet count and platelet hyperactivity with Disease Activity Score [DAS 28 score] and their reflection on cardiovascular system in RA. 50 newly diagnosed RA patients were attending the Clinical Rheumatology Unit during the year 2012 with twenty five control helthy subjects randomly selected. For all, CBC, including platelet count, MPV, platelet aggregation using ADP, echocardiography in addition to ECG, ESR, and CRP were done. MPV, Platelet count, CRP and ESR were, significantly higher in RA patients than controls, while Platelet aggregation, hemoglobin level, mean diastolic function and ejection fraction[EF] were significantly lower in RA patients than control group. Significant positive correlations were detected between DAS 28 score and both MPV and platelet count, while significant negative correlations were found with both hemoglobin and EF. Significant increase of the platelet aggregation in sero-negative compared to sero-positive rheumatoid arthritis patients was detected. Platelet count and MPV are inexpensive tests, may be useful for a rapid assessment of disease activity in patients with RA

Integral relationship of some adipocytokines with glycae.mic control and cardiovascular risk in type 2 diabetes mellitus with application of incretin enhancer

Adipocytokines achieve fundamental physiological targets with respect to energy balance, glucose homeostasis and cardiac performance. Visfatin, resistin, apelin and leptin are active adipocytokines, however their relations to diabetes mellitus [DM] and cardiovascular functions are poorly elucidated. The objectives of this study are to clarify the relation of adipocytokines in type 2 DM and cardiovascular risks [hypertension and dyslipidaemia] and their responses after application of incretin enhancer. Type 2 DM patients and fifteen healthy controls were enrolled. Patients were randomized to receive the usual regimen [metformin 850 mg three times /d orally] in group I [n-19], incretin [Vildagliptin 50 nig twice/d] in group II [n=17] or the combination of both agents in group HI [n= 17] for 14 weeks. Results: The adiposity related parameters, SBP, DBF, glycaemic control parameters increased significantly [p<0.001] in all diabetic groups relative to the controls in addition to disturbance of lipid profile. A significant increase in the level ofvisfatin, resist In, leptin and apelin in all diabetic patients was also observed. Both incretin enhancer and metformin led to significant improvement in glycaemic parameters [fasting blood glucose and glycosylated haemoglobin], lipid profile [total cholesterol and triglycerides] with more noticeable effects after incretin application. The addition of incretin enhancer seemed to confer greater benefits in amelioration of Body mass index [BMI], SBP, DBF, fasting insulin level, HDL and the measured adipocytokines levels in group II and ILL However, the advancement get more in the combination group which; suggest the complementary functions of both agents. Aforementioned changes in adipocytokines of controls were correlated positively with BMI SBP, DBF, FBG and HBAlc but they were non-significantly related to other anthropometries and laboratory parameters. At baseline, significant positive correlations between adipocytokines with BMI, FBG and HBAlc in T2 DM patients were evident. These results reflect involvement of adipocytokines in pathopkysiology of T2 DM and the associated cardiovascular risks and improvement was proved in BMI, glycaemic control and cardiovascular complications after application of incretin enhancer nevertheless, the overall clinical monitoring of incretin enhancer must he further assessed in wider scale

Hyperdynamic circulatory response to iron deficiency, thalassaemia and sickle cell a anaemias

One of the most interesting areas of research in erythrocyte physiology is the interaction of haemoglobin with nitric oxide [NO]. These two molecules independently fulfill diverse and complex physiological roles, while together they delicately modulate microvascular perfusion in response to second-by-second changes in local metabolic demand, contributing to hypoxic vasodilatation. To highlight on pathophysiological mechanisms of hyperdynamic state in anemic patients as well as to investigate the relation between haemoglobin, NO, endothelin-1 [ET-1], cyclic guanosine monophosphate [c GMP] and endotoxins with hyperdynamic circulatory states in different anaemic patients. Forty five anaemic patients categorized in three groups each fifteen [Iron Deficiency Anaemic, Thalassaemic and Sickle Cell Anaemic patients] in addition to ten healthy controls. Pulse rate, systolic and diastolic blood pressure values were recorded for all subjects. Also, Haemoglobin types and level, serum iron and TIBC, NO, ET-1, c GMP and Endotoxin levels were measured for all. Significant increase in pulse rate and pressure, decrease in diastolic pressure in addition to elevation of NO, cGMP and Endotoxins whereas ET-1 significantly decline in all anemic patients. NO levels when correlated with Hb, ET-1 levels and diastolic blood pressure showed negative significant correlation, while. It was positively correlated with c GMP, Endotoxins, systolic blood pressure and pulse pressure in different anemic groups. Vasodilatation, the main cause of hyperdynamic accompanying anemia contributed to increase NO levels joint with reduction of ET-1 which mediated through c GMP pathway. Besides, en do endotoxemia may have some role in amplifying of NO production

Importance of inflammatory cytokines and endothelial peptides in predicting hypertensive left ventricular hypertrophy

Although it has been hypothesized that hypertension in part is an inflammatory disorder, the link between inflammation and endothelial disorders with hypertensive complications as left ventricle hypertrophy [LVH] is still marginal. This study was designed to investigate the role of inflammatory markers as interleukin-6 [IL-6], high sensitivity C reactive protein [Hs-CRP], endothelial peptides as endothelin-1 [EDN -1] and nitric oxide [NO] as well as serum lipid profile in predicting LVH. It also focused on the pathophysiological responsibility of inflammation and endothelial dysfunction in developing hypertensive LYH. To examine these hypotheses forty hypertensive patients were enrolled and divided by using echocardiography into hypertensive patients with normal left ventricular mass [Group I] and hypertensive patients with LVH [Group II]. Ten normotensive subjects were also included and considered as control group [C]. ELISA technique was used for measuring plasma concentrations of IL-6, Hs-CRP, EDN-1 by special kits, while serum NO and lipid profile were measured by spectrophotometer. Both hypertensive groups were relatively matched with each other regarding age, gender, body surface area and body mass index [BMI], however they were significantly greater than control. Serum levels of IL-6, Hs-CRP and END-1, were significantly higher and those of NO were significantly lower in both hypertensive groups compared to normotensives. Moreover, these changes were more obvious in hypertensive patients with LVK Additionally, estimation of serum lipid profile showed that levels of total cholesterol triglycerides, and low density lipoproteins [LDL-C] were significantly elevated and that of high density lipoproteins [HDL-C] were significantly reduced in group [II] compared to other groups. Among both hypertensive patients, LY mass index was significantly positively correlated with serum levels of IL-6, Hs-CRP, EDN-1, cholesterol, triglyceride, LDL-C and significantly negatively correlated with HDL-C hut not with age and NO levels. However, the slope of these relations was steeper in the hypertensive group with LVH. Besides, levels of IL-6 and EDN-1 were the most predictors [r= 0.849, P<0.0001, r= 0.889, P<0.0001 respectively] for LYH. The inflammatory markers are significantly increased in hypertensive patients with LVH. Increased EDN-l and lowered NO are also concerned to a greater extent in hypertensive LYH and this confirms a key pathophysiological role of inflammation and endothelium dysfunction in developing and progression of hypertension and LVH which is vital for recommending prophylactic and therapeutic strategies

Lactate and acid base changes during laparoscopic cholecystectomy

The observation of hemodynamic and metabolic impairment related to CO2 pneumoperitoneum and postoperative mesenteric ischemia reports following laparoscopic procedures have raised concern about local and systemic effects of increase intraabdominal pressure during laparoscopic procedures. The present study aims to evaluate the metabolic and acid base responses of using high pressure versus low pressure pneumoperitonium in patients undergoing laparoscopic cholecystectomy in a prospective randomized clinical trial. 20 ASA I-II patients scheduled for elective laparoscopic cholecystectomy were randomly allocated to one of two study groups; high pressure pneumoperitoneum 12-14mmHg [HPP, n=10] versus low pressure pneumoperitoneum 6-8mmHg [LPP, n=10] undergoing laparoscopic cholecystectomy. Arterial blood gases and lactate levels were determined after induction of anesthesia [before pneumoperitonium], then after 10 min, then 30 min after insufflations and at the end of surgery and 1 hour postoperatively. Nurses in recovery unit reported pain assessment starting postoperatively until 3 hours on a 10mm VAS [0-10]. Statistical significant was established at P<0.05. Bicarbonate was significantly [P>0.0412] lower in high pressure group at 30 min and 60 min after insufflations. In high pressure group lactate levels increased significantly as compared to low pressure group, [at 30 minutes after the establishment of abdominal pneumatic inflation P