Value of screening colonoscopy in the diagnosis of Egyptian patients with lower gastrointestinal symptoms

Colorectal cancer is a major cause of mortality allover the world. Fecal occult blood testing, flexible sigmoidoscopy and total colonoscopy are the most commonly recommended screening tests for colorectal cancer, yet screening rates are still below target levels. To fully realize the benefits of early detection of colorectal cancer, screening rates must be improved. The current study has been conducted to study the current pattern of colorectal lesions from endoscopic and histopathologic perspectives in relation to clinical and laboratory aspects in Egyptian patients with different lower gastrointestinal symptoms. 165 cases with different lower gastrointestinal symptoms presented to Gastroenterology and Endoscopy Unit, Specialized Medical Hospital, Mansoura University. Clinical, laboratory, colonoscopic and histopathological examination of colonoscopic samples were done during the period from October 2005 to July 2006. The main lower gastrointestinal symptoms were abdominal pain, distension, altered bowel habits, dysentery and rectal bleeding. Ulcerative colitis represented 9.1% while colorectal carcinoma represented 4.1% of cases. The commonest symptoms and laboratory findings associated with colorectal carcinoma group were constitutional symptoms, constipation, rectal bleeding, fecal occult blood and iron-deficiency anemia. The colonoscopic examination is safe, accurate and cost-effective means of the screening for colorectal carcinoma

elevated plasma homocysteine and fibrinogen be predictors for non-alcoholic steatohepatitis in patients with metabolic syndrome? A cross sectional study

Metabolic syndrome is highly prevalent among population nowadays. Non-alcoholic steatohepatitis is so common in the cases of metabolic syndrome to the extent that it is considered one of its criteria. Elevated Homocysteine and fibrinogen levels can increase blood coagulability, and they are considered as minor risk factors for coronary artery disease. Recent studies have suggested that they may also have a role in the pathogenesis of non-alcoholic steatohepatitis as well. is to detect the state of the plasma homocysteine and fibrinogen in cases of metabolic syndrome with non-alcoholic steatohepatitis and their correlation with the grade of non-alcoholic steatohepatitis. This study was done on 70 patients with metabolic syndrome their age 36-64 years, in addition to 50 healthy control subjects. They have undergone thorough history taking, clinical examination, routine investigations, liver biopsy [only in patients] and detection of plasma homocysteine and fibrinogen. 44 cases [62.9%] were found to have non-alcoholic steatohepatitis who hade also a significantly higher level of plasma homocysteine, fibrinogen and C-reactive protein [P < 0.0001] in comparison to those had no non-alcoholic steatohepatitis. Moreover, the grade of non-alcoholic steatohepatitis had a significant positive correlation with homocysteine and C-reactive protein [P < 0.0001]. The level of plasma homocysteine, fibrinogen and C-reactive protein is higher in cases with non-alcoholic steatohepatitis than in those without it suggesting that they can be predictors for the disease, but this needs further confirmation by large prospective studies

Sex hormones and oxidant- antioxidant status in post-menopausal women with coronary artery disease

The strikingly lower prevalence of acute coronary syndromes in pre-menopausal women than in men of similar age, then the progressive narrowing of that difference with age after menopause, suggests an important role for sex hormones and probably oxidative stress in the development of coronary artery disease. The aim of this study is to evaluate the sex hormones and oxidant stress [malondialdehyde, which is a metabolite of lipid peroxidation] and anti-oxidants [vitamin C and E] status in postmenopausal women with stable coronary artery disease and in those with acute coronary syndromes. This study was conducted on 40 non-hormone user postmenopausal women with coronary artery disease. They were divided into 3 groups: the 1[st] group [17 patients] who had an acute myocardial infarction, the 2[nd] group [10 patients] had unstable angina and the 3[rd] one [13 patients] had stable angina. This is an addition to 20 apparently healthy postmenopausal women of similar age. All cases and control subjects were subjected to thorough history taking, full clinical examination, routine laboratory investigations, resting echocardiography and special laboratory investigations including detection of serum level of; total and free testosterone, total estradiol, morning and nocturnal serum cortisol, malondialdehyde and plasma levels of alpha-tocopherol and vitamin-C. We found a higher serum level of total and free testosterone in cases than control subjects [P-value 0.016 and 0.031 respectively] and the serum free testosterone was significantly higher in the group of acute myocardial infarction than the group of stable angina [P-value 0.008]. The serum level of total estradiol was significantly lower in cases than in control group [P value 0.0001]. Serum malondialdehyde was significantly higher in cases than control subjects [P<0.0001], and it was significantly higher in cases of acute myocardial infarction in comparison to stable angina cases [P-value 0.005]. Vitamin E [[alpha]-tocopherol] and vitamin C were significantly lower in cases than control group [P 0.0001 and 0.048 respectively]. The serum levels of free testosterone as well as malondi-aldehyde were higher in postmenopausal women with coronary artery disease. However, serum level of estradiol, vitamin E and C were lower in them in comparison to control subjects

Relations of serum aldosterone and microalbuminuria to left ventricular hypertrophy in patients with essential hypertension

Left ventricular hypertrophy [LVH] is an independent risk factor for cardiovascular morbidity and mortality in hypertensive patients. The identification of risk factors for the initiation of LVH in patients with hypertension [HTN] is important including microalbuminunuria [MAU] and hyperaldosteronism. Evaluation of the relationship of MAU and plasma aldosterone to blood pressure [BP] and LVH in patients with essential HTN. Thirty male patients with essential HTN and 15 healthy subjects as a control group were subjected to thorough clinical examination, transthoracic echocardiography, lipid profile, serum potassium, and serum aldosterone estimation. MAU was evaluated with dipstick Micral-II Test of fasting midstream morning urine on two successive days. Left ventricular mass index [LVMI] was calculated and values >134gm/m[2] were considered as LVH. Patients with LVMI >134 gm/m[2] had higher serum aldosterone, BMI, Interventricular septal thickness [IVST], Posterior wall thickness [PWT] and Relative wall thickness [RWT]. Serum aldosterone was significantly higher among the test hypertensive group and was positively correlated correlated with LVMI, RWT, PWT, IVST, LVM and negatively correlated with LV diastolic dimensions. MAU was positively correlated with systolic BP, Pulse pressure, BMI and LVMI and a strong relationship between MAU and serum aldosterone was detected. Aldosterone is an important contributor to the development of LVH and hypertensive nephropathy and strong relation between microalbuminuria and aldosterone is detected. The Value of selective aldosterone blockers in preventing target organ damage [TOD] awaits further investigation

Glucagon like peptide-I [GLP-I] and type 2 diabetes mellitus in the elderly

The most common type of diabetes in the elderly is type 2 diabetes which has a hereditary association and is aggravated by obesity and diabetogenic drugs; its prevalence increase with aging from 6% among those aged 45-54 years to more than 20% among those aged 75 years or older. Glucagon like peptide-I [GLP-I] is a hormone secreted from gut endocrine cells in response to nutrient ingestion and plays multiple roles in metabolic homeostasis as stimulation of glucose-dependent insulin secretion and insulin biosynthesis, inhibition of glucagon secretion and gastric emptying and inhibition of food intake. The objective of this study is to compare between the levels of GLP-I in diabetics and non diabetic elderly and to predict the possible role of GLP-I in the development of type 2 diabetes mellitus in the elderly. The presentawork assessed the postprandial serum level of GLP=I in 30 elderly patients with type 2 diabetes mellitus 15 males and 15 females Their age'ranged between 65-74 years. Their mean age is 68.27 years in comparison to 30 control non-diabetic elderly of matched age and sex. The radioimmunoassay of GLP-I is based upon the competition between labeled I 125 peptide and unlabeled peptide binding to a limited quantity of GLP-I antibody, as the concentration of standard or unknown in the reaction increases the amount of I 125 peptide able to bind to the antibody decrease. By measuring the amount of I 125 peptide bound as a fraction of the concentration of the unlabeled peptide in standard reaction mixture the standard curve is constructed and from which the concentration of the peptide in the samples can be determined. Serum GLP-I shows a statistically marked significant decrease in diabetic elderly group when compared to the control group with mean value of [7.56 ng/ml] in diabetic group versus [16.99 ng/ml] in control group P value <0.001 with no gender difference in the diabetic group with mean value of [8.24 ng/ml] in males diabetic versus [6.88 ng/ml] in females diabetic with P value 0.20. Also there is a highly significant negative correlation between GLP-I and insulin and glucagon levels in diabetic group with P value <0.001. These results indicate that GLP-I decrease in elderly type 2 diabetics and this decrease may be a cause of the high prevalence of type 2 diabetes in the elderly population

Some absorptive functions in protein energy malnutrition

Sixty malnourished children versus 30 sex and age matched nourished children were studied for absorptive functions of the upper small intestine, using glucose tolerance test, D-xylose test and serum folic acid level. A marked impairment of glucose tolerance test, a marked impairment of xylose absorption, a highly significantly low mean serum folate level and insignificantly high level of mean serum vitamin B[12] were observed in children with PEM. On the other hand, mean serum folate level obtained for malnourished children after 5 days folate therapy showed insignificant change from that of control subjects. Accordingly we can conclude that there is defective absorption, particularly for sugars [glucose and xylose], and there is no malabsorption of folic acid in PEM patients and the low folate level in their sera is mainly due to decreased intake