value of pulsed tissue doppler study in the early diagnosis of diastolic dysfunction in type 2 diabetes mellitus

Cardiovascular disease is the most important cause of mortality and morbidity among patients with type 2 diabetes. Diastolic dysfunction represents the earliest preclinical manifiestataion of diabetic cardiomyopatahy that can progress to sympotomatic heart failure. Transmitral flow Doppler echocardiography is widely used to non-invasively evaluate diastolic function in type 2 diabetic patients, however, this method may give misleading results. Recently, Pulsed Tissue Doppler Imaging [TDIK] has emerged as a new non invasive imaging modality that allows direct online measurement of myocardial velocities throughout the cardiac cycle. The aim of this work is to evaluate the usefulness of pulsed tissue Doppler study of mitral annulus versus transmitral flow Doppler in assessing the diastolic function in type 2 diabetic patients. This study included 4 subjects divided into: 15 patients with type 2 DM having diastolic dysfunction diagnosed by conventional Doppler [group I], and another 15 diabetic patients with normal diastolic function by conventional Doppler [group II], in addition to 10 normal controls [GROUP III]. All patients were subjected to clinical evaluation, laboratory investigations, ECG, echocardiographic assessment and Pulsed Tissue Doppler Imaging of the mitral inflow and mitral annulus with assessment of the transmitral flow veloctities. All partients with diastolic dysfunction diagnosed by conventiaonal Deoppler showed the same abnormality on using TDI, moreover the use of the ratio E[TDI]/A[TDI] by TDI diagnosed 33.33% of group 2 patients to have diastolic dysfunction while they were having normal patterns by conventional Doppler. There were no values in the control group of E[TDI]/A[TDI]<1. Higher values of FBS, PP, HbA1c and triglycerides were associated with impaired LV diastolic performance. Diastolic dysfunction is common in type 2 DM patients specially those with worse glycaemic control. Pulsed TDI of the mitral annulus is more sensitive than conventional Doppler in identifying early LV diastolic dysfunction in type 2 DM patients

Comparison of different methods of urine sampling to estimate bacteriuria in male patients

This work was done to elicit the validity of different urine specimens taken by both clean and unclean methods on the culture of organisms in male patients with pyuria; thus trying to facilitate the methods of sampling. Urine samples from 25 patients complaining of acute dysuria or other irritative genito-urinary symptoms were collected by different methods [unclean urine sample, mid-stream clean catch urine sample, urethral catheterization and suprapubic aspiration]. Culture interpretation was done for these specimens. In our study we found that all patients [100%] who showed a positive culture by unclean first void urine sample gave identical results as those taken by clean catch midstrean urine, urethral catheterizalion and suprapubic aspiration. Thus, the first void urine is an easy and accurate method for taking samples from men. As most previous studies, we demonstrated that the common organism causing urinary tract infection in men is E. Choli followed by Staphylococci and to a lesser extent Klebsiella, Proteus and Pseudomonas organisms

Effects of smoking on the serum levels of dehydroepiandrosterone sulphate

Cigarette smoking has been incriminated in the development of many medical disorders, namely coronary heart disease and lung cancer. Low levels of dehydroepiandrosterone sulphate "DHEAS" Has been found in patients with coronary heart disease, hypertension, obesity, atherosclerosis and malignancy. To detect the effect of cigarette smoking on the serum levels of DHEA S we have examined a group of subjects, namely 76 males and 40 females aged 40-49 years. Half of them beeing smoking 20 cigarettes daily for at least 20 years and the other half were never smokers. All subjects were chosen not to be hypertensive, diabetic, hyperlipedemic or obese and not having any significant disorder. Analysis of our results revealed significant lower levels of DHEA S in the smoker subgroup compared with the non smoker group with a P value < 0.05 in males and < 0.01 in females. We concluded that low serum levels of DHEA S may be associated with cigarette smoking in both sexes provided that conditions are the same. This may explain the liability of the smokers to develop coronary heart disease and malignancy. We recommend estimation of DHEA S serum levels in smokers to detect those with higher risk to develop coronary heart disease and malignancy. Also estimation of DHEA S levels in ex- smokers is recommended to detect the effect of cessation of cigarette smoking

Insulin resistance in essential hypertension

The study was conducted on a total number of 31 non obese adults of both sexes. They were divided into 2 groups: 21 otherwise healthy, untreated hypertensive patients and 10 normal controls. All the subjects were tested by routine investigations; including liver and kidney function tests. They were exposed to an oral glucose insulin tolerance test extended for two hours with simultaneous serum potassium assessment. We restricted our study on those with a normal glucose tolerance test. Our patients showed significant hyperinsulinemia of all the samples of the curve, and in spite of this, relative hyperglycemia. Insulin sensitivity was studied by the [A] value, the insulin area and lastly the glucose/insulin ratio. In all the patients, we found statistically significant insulin resistance as compared to the control subjects by the 3 equations, with a P value < 0.001. The degree of this resistance was not found to be in concordance with the degree of hypertension, thus pointing to other factors; e.g. dietary factors, degree of physical activity or the duration of hypertension as related to the degree of this resistance. The potassium levels were normally responsive to the released insulin thus excluding it as a parameter of insulin resistance

Changes of phagocytic and bactericidal activities of neutrophils in relation to age

In the present study, we estimated phagocytic activity and bactericidal activity of neutrophils in a number of healthy persons representing a wide range of ages from 21 to 92 years. Individuals suffering from any disorders known to compromise host defense system were excluded from the study. To confirm the normality of different biologic systems, each individual was subjected to thorough clinical examination and laboratory investigations. The individuals were classified according to age into three groups. Group I from 21 to 39 years, group II from 40 to 58 years and group III from 62-92 years. We demonstrated a highly significant age-related decline of the phagocytic and bactericidal activities of neutrophils. A significant negative correlation was detected between age and phagocytic function in group II only, and a significant positive correlation was demonstrated between phagocytic power and bactericidal activity in the same group. It could be concluded that some of the functional abilities of neutrophils including phagocytic and bactericidal activities, do decline with age. This finding could result in decreased effectiveness of non specific defense system in the aged population. Such in age-associated effect may explain at least partially, the increased liability of old persons to infectious diseases

Leukocytic phagocytosis and random migration during the normal menstrual cycle

In this work we studied some functions of the leucocytes in normal menstruating females, and we tried to correlate the abnormalities that might be found with the normal hormonal changes that accompany menstrual cycle. Eighteen normal females came as volunteers. We studied random leucocytic migration with and without the addition of antigen, we also studied the leucocytic phagocytosis. Estrogen and progesterone were measured using radioisotopic kits,blood sugar was measured using enzymatic method. The leucocytic migration after addition of antigen was significantly lower in the follicular phase as compared with that in the luteal phase, these changes were strongly correlated with estrogen level and E/P ratio but not with the progesterone level. These changes in migration may explain the tendency of menstruating females with low estrogen and progesterone levels to toxic-shock syndrome, acne, gonorrhea and other infections