Left ventricular diastolic dysfunctions in chronic renal failure patients on healmoodilysis

Left ventricular structure and function abnormalities are frequent in individuals with chronic uremia. This disorders are frequent in patients who has increased risk of cardiovascular diseases. The aim of this study is to study the leading alteration in left ventricular diastolic function and factors related to it, using simple indices of diastolic function obtained with pulsed Doppler studies. This study was conducted on -40 patients who had end stage renal disease. They were on regular maintenance haemodialysis 3 times / week compared to 29 age and sex matched healthy subject, served as control group. All of them were subjected to the following:- full history and clinical examination including age, sex, duration of dialysis, causes of renal failure laboratory investigations were done and include: renal functions [urea, creatinine], full blood, picture blood, sugar, serum inorganic phosphorous, parathyroid hormone [PTH], alkaline phosphatase, serum albumin and total protein. Echo cardiography for assessment of left ventricular end diastolic dimension [LVEDD], left ventricular end systolic dimension [LVESD], posterior wall thickness in diastole [PWT], inter ventricular wall thickness in diastole [IVS], fraction shortening [FS%], ejection fraction [EF%]. Echo doppler examination including peak flow velocity in early diastole [E-wave], peak flow velocity in late systole [A-wave] E/A ratio, acceleration time [AT], deceleration time [D.T], and isovolumic relaxation time. Result showed that: there were a significant increase in left atrial diameter [P<0.01], left ventricular posterior wall thickness, [p <0.01] interventricular septum thickness, [p<0.001] left ventricular mass [p<0.001] in ESRD patients when compared with control group. There were highly significant increase in A-wave [p<0.01] deceleration time [p<0.05] and isovolumic relaxation time [p<0.01] while there were no significant difference in aortic root diameter, left ventricular end systolic dimension, E wave, fractional shortening and ejection fraction, in patients compared with control group. There were significant positive correlation between left atrial diameter and systolic blood pressure, positive correlation between left ventricular mass and both systolic and diastolic blood pressure, positive correlation between parathyroid hormone level and E-wave, negative correlation between left vetricular end diastolic dimension and hemoglobin concentration, negative correlation between left ventricular posterior wall thickness and hemoglobin concentration and negative correlation between parathyroid hormone level and ejection fraction. Cardio vascular complications are frequent in patients with ESRD. Echo cardiography and echo doppler cardiography are recommended in all patients with ESRD

Study of thrombomdulin, cytokines and adhesion molecules as a marker of disease activity in systemic lupus erythematosus

Twenty-four female patients with SLE compared with ten normal females as control subjects were included in this study. They were classified into 3 groups: Group I: 10 patients with SLAM score < 9 [low activity], Group II: 14 patients with SLAM score > 9 [high activity], Group III: 10 normal control subjects. All groups were subjected for specific laboratory investigations including: Thrombornodulin [TM mg/dl] Adhesion molecules: soluble intercellular adhesion molecule -1 [ICAM- 1], soluble vascular cell adhesion molecule [VCAM -1] and soluble E- selectin [ng/ ml] Cytokines: Interleukin 6 [IL-6] and Interleukin - 10 [IL- 10][pg/ml]. The result showed: Significant increase of TM, IL-6, IL-10, ICAM, VCAM, and E-selectin in group II compared with group III [p<0.01 and <0.05].Significant increase of VCAM level in group I compared with group III [p<0.001], but insignificant difference of TM, IL-6, IL- 10, ICAM and E-selectin between both groups.There were significant increase of TM, IL-6 and IL- 10 in group II [highly active] when compared with group I [low active] patients [p<0.01, <0.01 and <0.01] respectively, but insignificant difference of VCAM, ICAM, and E- selectin between both groups. There was significant correlation between TM, IL-6, IL-10,VCAM, E Selectin levels and disease activity in SLE patients [r= 0.701, 0.769, 0.696, 0.624, 0.904]respectively,and [p

Impact of the presence of intrapulmonary shunt on cardiac output and echoardiographic criteria of patients with advanced liver disease

The aim of this work was to study the impact of the presence of intrapulmonary shunt [IPSH] on cardiac output and echocardiographic criteria of two groups of patients having Child class C chronic liver cirrhosis. Sixty-eight patients having advanced liver disease [ALD] were included in this study. The results indicated that 35 patients showed an evidence of IPSH [group I], while the other 33 cases showed no evidence [group II]. There was no significant difference in sex distribution, mean age or incidence of diabetes mellitus and hypertension between both groups. There was no significant difference in the alveolo-arterial O2 gradient between both groups. But, patients with IPSH had significantly a less PaO2 than those without

Laboratory method predicting the maximal effective NSAID's in management of rheumatoid arthritis

Macrophages were isolated from 32 patients with acute rheumatoid arthritis [RA]. Macrophages of each patient were separately treated in-vitro with different NSAID's in the presence of immune complex [IC]. Cells inhibition was determined by measuring intracellular enzymes and number of FC receptors before and after treating the cell with NSAID's. Drug that caused maximal inhibition of FC receptors of the macrophages in-vitro was given to the patient for two weeks. Clinical assessment was done for each patient before and after treatment. The same previous procedures were followed for another 15 patients with acute RA as a control group. That group of patients were treated for two weeks by the drug that showed minimal FC receptors inhibition, It was found that the percentage of FC receptors inhibition is proportional to the clinical improvement of the disease parameters. Accordingly, this method can be used to predict the optimal effective NSAIDs for each patient before starting treatment