Plasma adrenomedullin, a new predictor of prognosis and severity in patients with dilated cardiomyopathy and heart failure

Adrenomedullin, a potent endogenous vasodilating and natriuretic peptide, may play an important role in the pathophysiology of chronic heart failure associated with dilated cardiomyopathy. To determine the changes of plasma adrenomedullin [AM] in patients with heart failure due to dilated cardiomyopathy of ischemic and idiopathic etiology before and after treatment and the relations between plasma AM and some hormones involved in the pathophysiology of heart failure as plasma renin activity [PRA], atrial natriuretic peptide [ANP] and aldosterone as well as some echocardiographic parameters. Also, the predictive value of AM in assessment of severity of heart failure was evaluated. Design 44 patients with symptomatic dilated cardiomyopathy due to is chemic and idiopathic etiology [24 females and 20 males], aged 53.37 +/- 9.38 years and matched to 13 healthy volunteers [8 females and 5 males] aged 54.3 +/- 8.6 years. Cases were classified according to the New York Heart Association [NYHA] functional classification into: 12 cases class 1, 10 cases class 11, 13 cases class III and 9 cases class IV Cases were subjected to thorough history, clinical and laboratory investigations with special stress on plain x-ray chest, ECG, and echocardiography to exclude other etiologies of heart failure. Assay of plasma AM, PRA, ANP and aldosterone was done. Plasma AM, PRA, ANP and aldosterone were significantly higher in patients compared to controls [27.91 +/- 15.19 Vs 11.1 7 +/- 1.55 pmol/L 2.20 +/- 1.48 Vs 0.35 +/- 0.10 ng/L/s; 16.61 +/- 61 Vs 5.57 +/- 1.16fmol/ml, 686.81 +/- 442.78 Vs 176 +/- 18.5 pmol/L respectively] and plasma levels of these hormones increased with the severity of heart failure. There was significant correlation between AM and both PRA, ANP and aldosterone [r=0.650, P<0.001; r=0.612, P<0.001; r=0.677, P<0.001 respectively]. Also there was significant correlation between plasma AM and both ejection fraction [EF] and fractional shortening percentage [FS%] [r=-0.781, P<0.001; r=-863, P<0.001 respectively], Plasma AM decreased in response to treatment of heart failure. Class of heart failure could be predicted in 82.5% of cases by assessment of plasma AM. Plasma AM increases in patients with heart failure due to dilated cardiomyopathy in proportion to the severity of heart failure along with some hormones known to modulate the development of heart failure. AM has a high predictive value in the assessment of the severity of heart failure, Stratification of patients regarding severity of heart failure can be facilitated by plasma AM measurements which could reasonably included in the routine clinical workup of patients with CHF

Chemicopathologic findings in bilharzial portal gastropathy, correlation between serum gastrin, gastric acid output, histopathologic findings and antral agyrophil cells

This study attempted to correlate the changes in serum gastrin, basal gastric acid output, histopathologic findings in the antral gastric mucosa and its G cells in patients with bilharzial portal gastropathy. Forty patients with hepatosplenic schistosomiasis recovered from ruptured esophageal varices were selected in addition to ten healthy control persons of matched age and sex. All patients and controls were subjected to thorough clinical examination, endoscopy with antral punch biopsy for histopathologic examination and histochemical staining of antral G cells. There was a significant positive correlation between serum gastrin and the number of G cells and a significant negative correlation between basal gastric acid output and the number of G cells. However, a nonsignificant correlation was found between serum gastrin, histopathologic changes, portal vein diameter and degree of liver damage denoting that hypergastrinemia was due to the overproduction and impaired feedback inhibition by gastric acid output

Subclinical cardiac dysfunction in children with vitamin D deficiency rickets: biochemical and echocardiographic study

Twenty-four children with a clinical evidence of moderately severe vitamin D deficiency rickets and ten healthy children of matched age and sex, as a control group, were included in this study. Serum profile of vitamin D status was studied. Echocardiographic assay of fractional shortening [FS] and right ventricular systolic time interval [RPEP/RVET] were done for all cases and controls. Regression analysis revealed that low serum magnesium and high LDH were the predictors of decreased left ventricular systolic function

effects of different environmental conditions on the stability of the immuno-reactive triiodothyronine [T3], thyroxine [T4] and thyrotropin [TSH] in human sera

It is frequently obligatory to expose samples for hormonal assay to different environmental and other processing factors. On the other hand, it is mandatory to identify border-line cases and avoid false results of thyroid dysfunction. These different environmental factors are focused on in this work. Endogenous T3, T4 and TSH were measured by the most convenient ELISA technique in human sera samples exposed to different temperature gradients for different periods. Aliquots of different samples were also exposed to freezing thawing cycles, delayed separation and hemolysis. T3, T4 and TSH assay showed nonsignificant difference in their concentrations when stored for up to 7 days in the refrigerator [4C] and at room temperature. The same results were reported for samples stored frozen at 20C for up to one month. Surprisingly, the 3 hormones were stable also after 5 cycles freezing and thawing, apparent hemolysis and delayed separation for up to 8 hours. These data clarify the degree of stability of the hormones responsible for the diagnosis of thyroid disorders

significance of bile acid determination in latent hyperbilirubinaemia

This work was conducted on 1540 apparently healthy personels and blood donors. Individuals with total serum bilirubin 1.4 mg/dl or more were subjected to haematological investigations to exclude haemolysis, biochemical investigations including conjugated and unconjugated bilirubin, serum transaminases [AST and ALT], alkaline, phosphatase [ALP], albumin and prothrombin time and post prandial serum bile acids as well as serological markers for viral hepatitis. Liver biopsy was performed in selected cases. Serum bilirubin was found to be elevated [1.9 mg/dl] in 56 cases [3.63%]. 39 of these cases were found to be positive for serological markers of viral hepatitis [11 HBV and 28 HCV] and 17 cases were seronegative. The latter group had no evidence of haemolysis with normal hepatic enzymes as well as normal serum bile acid level. In HBV positive cases, 4 of them had elevated hepatic enzymes and 7 had elevated serum bile acids while in HCV positive cases there were 6 cases with elevated hepatic enzymes and 23 cases had elevated serum bile acids. Abnormal histopathological changes in liver structure were reported in seropositive cases. Serum bile asid determination should join the common liver function tests, its level correlates with liver histopathological findings better than aminotransferases

Pituitary adrenal axis status in children with protein calorie malnutrition [PCM]

Thirty six children suffering from various forms of protein calorie ma1nutrition [PCM] [15 with marasmus, 9 with kwashiorkor and 12 with marasmic kwashiorkor] Their ages ranged in between 4 to 20 months, beside 10 healthy children of matched age and sex were similarly taken as a control group. The following investigations [serum Na and K. plasma ACTH, serum cortisol and aldosterone] were performed. There were: [1] Increased serum cortisol levels with loss of diurnal variation in all groups of PCM [2] Increased plasma ACTH levels in all groups of PCM. [3] Incomplete dexamethasone suppression [4] variable changes in the levels of serum aldosterone among various forms of PCM. In marasmic group mean serum aldosterone level was within normal, but the mean levels were significantly higher in both kwashiorkor and marasmic kwashiorkor groups. After nutritional rehabilitation the levels of these hormones returned to normal indicating that these changes are protective mechanisms as well as easy reversibility of the axis