Haemostatic activation in acute coronary syndrome patients in relation to physical exercise

Thrombosis is regarded to be a key factor in the development of acute coronary syndromes in patients with coronary artery disease [CAD], Platelets are known to play a fundamental role in acute coronary syndromes [ACS]. After atherosclerotic plaque rupture, platelets can form pathogenic, occlusive thrombi leading to acute ischemic events. The precise mechanisms of platelet activation in acute coronary syndromes are still under investigation. Physical activity could regulate the development of ACS via effects on platelet function. Several studies have shown that acute physical exercise increases platelet reactivity, typically assessed by aggregation assays, in both healthy individuals and in patients with cardiovascular disease. The aim of this study was to investigated the effect of moderate and strenuous exercise on arterial thrombus formation. Assay of some hemostatic marker as Platelet activation, thrombin generation [TF[pg/ml],TAT_ micro g/l and dimerand tPA concentration] von Willebrand factor, platelet aggregation tests, Coronary Angiography. haemostatic parameters in patients with ACS correlated with other clinical parameters under physical exercise Patients with ACS showed higher values for fibrinogen, tPA, TAT_, as indicators for a thrombin synthesis, and a marker for prothrombotic conditions, was elevated in patients with ACS,. Von Willebrand factor and D-dimer showed no statistical significant differences during rest., Exercise increased hemostatic parameters in an strenuous physical exercise in ACS Patients[< 0.05]. Exercise also increased plasma levels of fibrinogen and von Willebrand factor ,but there was an increase in the generation of T-AT complexes,. [P < 0.05]. Exercise did not affect platelet aggregation regardless of its intensity when triggered by the agonists ADP or collagen. Strenuous but not moderate exercise increases the thrombotic tendency in healthy sedentary male volunteers

Endocrine disorders in patients with sickle cell anemia

Red blood cell transfusions are a therapeutic mainstay in Sickle Cell Disease [SCD] and repeated transfusions can result in iron overload. Endocrine dysfunction is the most common and earliest organ toxicity seen in subjects with chronic iron-induced cellular oxidative damage. The aim of the present work is to investigate some of the endocrine functional disorders in patients with SCD. The present study consisted of 30 patients with SCD recruited from the Medical Department of King Fahd Hospital- Hofuf, Eastern Province - Saudi Arabia. Most of the patients had a history of repeated blood transfusions [5 times/year]. Patients were classified into two groups Group I [15 males] and Group 2 [15 females] with mean age for both sex [28.6 +/- 5.4 years]. Thirty age and sex matched normal subjects were, also, included in the study as a control group. Plasma level of testosterone, iron profile, FSH and LH as well as thyroid function tests were assessed. A total of 30 patients with SCD were recruited in the study [15 males and 15 females] with mean age 28.6 +/- 5.4 years. They were compared to a control group of 30 healthy subjects and showed significant difference between group 1 and the control group regarding the level of testosterone [5.03 +/- 3.37 vs 9.65 +/- 1.69; respectively, p=0.05]. Also the level of testosterone showed insignificant correlation with the serum iron level among group 1 [r=-0.18, p=0.5]. A significant lower level in T4 was detected in group 1 compared to the control group [5.17 +/- 3.41 vs 11.01 +/- 1.44; respectively, p=0.001]. There was insignificant correlation between testosterone level in group 1 and the T4 level in the same group [r=-0.01, p=0.89]. On the other hand, no significant difference was detected between group 1 and control group as regard TSH level [p=0.7]. Female patients with SCD [group 2] have a significant lower level of LH than the control group [8.7 +/- 5.44 us 16.2 +/- 2.74; respectively, p=0.001]. The present study revealed that there was no significant difference between the level of FSH among group 2 and the control group [6.19 +/- 3.60 vs 6.4 +/- 1.3; respectively, p=0.8], As regard the correlation between the LH level and the serum iron among group 2, there was no significant correlation [r= -0.35, p =0.18]. Also group 2 showed significant lower level of the T4 than the control group [6.58 +/- 6.3 vs 11.64 +/- 1.05; respectively, p= 0.005]. On the other hand no significant correlation was found between patients and control group as regard TSH level [p=0.1]. There was no significant correlation between the level of T4 and the serum iron level in both group 1 and group 2. The present study has demonstrated that SCD has a depressant effect on the hormone LH in female patients with SCD and T4 in both males and females with SCD irrespective of the serum iron level

Oxidative stress and inflammatory marker: possible pathogenic role in acute coronary syndrome

Acute coronary syndrome [ACS], which comprise unstable angina [UA] and acute myocardial infarction [AMI] are multifactor diseases involving both thrombotic and inflammatory processes. C-reactive protein [CRP] has emerged as independent risk indicator of active atherosclerosis. Reactive oxygen species [ROS] are key mediators of signaling pathways that underlie vascular inflammation in atherogenesis starting from the initiation of fatty streak development through lesion progression to ultimate plaque rupture. CRP directly up-regulate AND[P]H oxidase p22 [phox] and enhance ROS generation. Recently it has been shown that 8-iso-prostaglandin F2 alpha [8-iso-PGF2_] is a specific, chemically stable and quantitative marker of oxidative stress in vivo. It is formed in situ in cell membranes following free radical attack on the arachidonic acid. To counteract the effect of ROS, cells are endowed with a complex antioxidant network that operates to prevent or limit oxidant damage. The present study was designed to investigate the changes of 8-iso-PGF2_, total antioxidant capacity [TAC] and CRP levels in patients with acute coronary syndrome in order to evaluate the role of oxidative stress as well as inflammation in pathogenesis and consequence of the disease. The present study included 30 patients with ACS and 15 healthy, age and sex-matched controls. The patients were divided into two groups; 15 patients with UA and 15 patients with AMI. Serum leuel of 8-iso-PGF2-_ was measured using an ELISA kit Serum CRP and TAC levels was measured by turbidimetric immunoassay and colorimetric methods respectively. Serum levels of both 8-iso-PGF2- _, and CRP were significantly increased in patients compared with control [p<0.05]. TAG showed significant decrease in patients with AMI when compared to controls [p<0.05]. It could be concluded that elevated levels of 8-iso-PGF2-_ and CRP together with decreased TAC level contribute directly and actively to the pathogenesis of ACS. The oxidative stress is likely to either induce or intensify the inflammatory action, and may co-affect with inflammatory factors to accelerate plaque rupture. The evaluation of oxidative stress would enable formulation of specific antioxidant therapy as promising strategy against atherogenesis for an early intervention and better management of the disease

Levels of soluble adhesion molecule vcam-1 and icam-1 in the plasma of chronic transfused children with sickle cell disease

Increased adhesive events between the blood vessel endothelium and red and white cells play a central role in the initiation of vasoocclusive crisis. We examined endothelial functions and serum levels of inflammatory mediators in transfusion-dependent patients with sickle cell disease in stable asymptomatic stage and on crisis. The study population consisted of 40 patients with sickle cell disease [SCD] aged from 5 years to 13 years and 35 healthy normal individual with matched age and sex as control group .Serum levels of vascular cell adhesive molecules [sVCAM-1] and intercellular adhesive molecule [sICAM-1] with serum level of interleukin 6 [IL6] were determined with Enzyme -Link Immunosorbent assay [ELISA]. Asymptomatic patients with sickle cell diseases had higher sVCAM-1 levels compared to normal controls [p<0.001]. Their levels were further elevated during acute episodes. Levels were significantly lower in chronic transfused child patients compared to acute crisis p= [<0.05].The reduction of adhesive molecule levels observed in our transfused SCD patients offers insight into the mechanism of the protective effect of transfusion against acute crisis especially painful and anemic crisis. SVCAM-1 and sICAM-1 levels inversely correlated with fetal hemoglobin in SCD patients. In conclusion, adhesive molecule expression uad cytokine production may also play a role in the disease outcome