Sleep disordered breathing in different endocrinal diseases

Sleep-disordered breathing [SDB] is an extremely common condition that compromises the vital functions of respiration and circulation. As currently defined, obstructive sleep apnea [OSA] is associated with considerable morbidity and mortality, whereas the currently available treatments are associated with either limited efficacy and/or poor compliance. An improvement in the understanding of the nature and pathophysiology of the disorder may lead to novel treatments. The objectives of the present study are to detect apnea /hypopnea as an indicator of SDB in patients with some endocrinal diseases, namely diabetes mellitus, hypothyroidism, acromegaly and Cushing for early management and better quality of life. We studied sixty-five patients with different endocrinal diseases [group A]. They were further subdivided into: group 1 [25 patients with diabetes mellitus], group 2 [16 patients with hypothyroidism], group 3 [12 patients with acromegaly] and group 4 [12 patients with Cushing disease]. All groups were subjected to full clinical and neurological assessment, sleep history, laboratory investigations, and an overnight polysomnographic [PSG] study. Twenty healthy subjects were selected as a control group [group B]. Respiratory disturbance index [RDI] was significantly higher in all patients groups compared to control group. HbA1c, FBS, as well as 2hr PP correlated positively with RDI in group [1]. No significant correlation was observed between RDI and serum TSH, T3 and T4 levels in group [2]. Acromegalic patients with SDB had significantly higher growth hormone [GH] level which correlated positively with RDI in group [3]. No significant correlation was observed between RDI, serum ACTH and 24 hours urinary cortisol levels in group [4]. There are complex interactions between OSA and neuroendocrine function. Understanding this complex relation may lead to more effective, better tolerated treatment for sleepiness and SDB. It is increasingly important that in patients presented to sleep laboratory, careful medical evaluation should be done to all cases presented with sleepiness and had manifestation of sleep apnea to exclude different endocrinal diseases

Stem cell transplantation in hematological disorders: a developing country experience-impact of cost considerations

To describe the experience in setting up a bone marrow transplant program at Ain Shams University, Cairo, Egypt. Sixteen patients were transplanted at Ain Shams University Bone Marrow Transplantation unit from March 2005 to January 2008. Sixteen patients were transplanted with a median age of 25 years. Indications for transplantation were chronic myeloid leukemia, acute myeloid leukemia, aplastic anemia, acute lymphoblastic leukemia, and aggressive lymphoma. Seven donors and 6 patients were positive for cytomegalovirus immunoglobulin G [IgG] antibody [Ab] pretransplant. Only one patient was positive for toxoplasma IgG Ab and another had a high titre for toxoplasma IgM Ab pretransplant. Two donors and 2 recipients were positive for hepatitis B antibody markers; however, none were positive for hepatitis B virus DNA by polymerase chain reaction [PCR]. None of the patients or donors were positive for hepatitis C virus via PCR pre-transplant. Acute graft versus host disease [GVHD] was seen in 3 patients, while chronic GVHD was seen in 5 patients. Primary cause of death was recurrence in 2 patients and graft failure in one patient. Thirteen are alive and disease free with a median follow-up of 20 months. Although our unit is a relatively new unit, these results are comparable to those achieved in the Western world and cost a mean of US$250,000