Association between HCV induced mixed cryoglobulinemia and pulmonary affection: the role of TNF-alpha in the pathogenesis of pulmonary changes

Chronic hepatitis C virus [HCV] infection is associated with both pulmonary involvement and cryoglobulinemia. Therefore, this study was designed to investigate the relationship between pulmonary involvement and mixed cryoglobulinemia in chronic HCV infected patients and to investigate the role of TNF-alpha in the pathogenesis of pulmonary changes. After hospital ethics committee approval and formal patient consent were obtained, 100 patients with compensated hepatitis C virus infection as confirmed by PCR were recruited in this cross sectional study. Their demographic and laboratory data, abdominal ultrasound findings, pulmonary function tests [spirometry], arterial blood gas [ABG] parameters, TNF-alpha levels, and data from high-resolution chest CT were collected and analyzed using SPSS version 16, and a serum cryoglobulin assay was performed in all of the studied patients The prevalence of mixed cryoglobulinemia was 61.7% in the studied HCV patients. Pulmonary symptoms were observed in more than half of these patients. The most common complaint among the symptomatic patients was dyspnea [51.7%], followed by cough [43.3%]. Oxygen saturation [Spo[2] and Sao[2]%], and FEVi and FVC levels, were significantly decreased in the cryoglob-ulin positive patients compared to the cryoglobulin negative patients. A statistically significant correlation was found between the presence of cryoglobulins and FEV level, FVC level, serum albumin level, viremia level, thrombocytopenia and arterial blood gas parameters. No correlation was found between cryoglobulinemia and TNF-alpha level. The results of this study suggest that pulmonary involvement is common in patients with chronic HCV infection and mixed cryoglobulinemia. Cryoglobulinemia may lead to pulmonary involvement through vascular and interstitial deposition of cryoglobulins, which results in impaired gas exchange and airway affection

Measuring the rate of therapeutic adherence among outpatients with T2DM in Egypt

The promotion of therapeutic adherence is considered as an integral component of pharmaceutical care practice and patient healthcare. It has been shown that despite effective methods of treatment, 50% of diabetic patients fail to achieve satisfactory glycemic control, which leads to accelerated development of complications and increased mortality. Clinical experience indicates that no improvement of metabolic control is possible without patients' adherence to medications. This study sought to examine the rate of medication adherence and different factors affecting it among Type 2 diabetic patients in Egypt. A total of 226 Type 2 diabetic patients who fulfilled the inclusion criteria were recruited in the current study. Adherence to the treatment was evaluated during patients' hospitalization in the Outpatient Clinics of Internal Medicine Department at University of Mansoura, Egypt. The medication adherence has been assessed during a personal interview with each patient using a multiple-choice graded questionnaire. In the study population, the adherence rates to medication, dietary/ exercise and appointment were observed to be suboptimal. The most important social factors that were significantly affecting adherence rate to the prescribed oral hypoglycemic agent[s] included marital status [P<0.001], family support [P<0.01], and socio-economical level [P<0.01]. Other patient factors that were significantly affecting therapeutic adherence were patient knowledge about the disease [P<0.01], patients' beliefs and motivation about prescribed drugs [P<0.01]. Among drug factors which found to affect significantly the rate of medication adherence are the number of drugs taken [P<0.05], complexity of drug regimen [P<0.01], and the presence of drug side effects [P<0.01]. Economical factor played an equally important role. Direct and indirect care costs in relation to patients' income were significantly affecting the rate of adherence to medication [P<0.01]. An improvement with the adherence to oral hypoglycemic agent[s] may be achieved through continuing patient education about diabetes, improvement of patients' economical levels as well as a reduction in the cost of medication. Pharmaceutical companies have to be involved and pharmacists have to be paid for helping chronically ill patients to take their medicines correctly for improving clinical outcomes

Effect of medical ozone therapy on diabetes-induced cardiac dysfunction

Diabetic metabolic dysregulation is accompanied by oxidative stress that could possibly lead to dysfunction in cardiac myocytes. The aim of this study was to elucidate the effect of controlled medical ozone therapy to diabetic rats on ischemia reperfusion insult in isolated rat hearts. Both long-term [12 weeks duration] and short-term [20 days duration] treatment were investigated. Rats of each duration were divided into non-diabetic control group and streptozotocin-induced diabetic group, the latter group being further divided into two subgroups, namely, a group receiving medical ozone and the other remaining untreated. Long-term groups were studied for the cardiac responses before and after ischemia reperfusion. Short-term groups were used to assess the degree of leukocytic adhesion to coronary endothelium. In both durations, serum levels of CPK and TNF-alpha were determined. Long-term ozone therapy to diabetic rats improved myocardial depression before and after ischemia reperfusion, with reduction in ischemia reperfusion injury. Short-term therapy resulted in an attenuating effect on leukocyte adherence to coronary vascular endothelial cells after ischemia-reperfusion. The present data show the cardioprotective effect of medical ozone therapy on ischemia reperfusion injury in diabetic rats. The reduction in TNF-alpha may represent a mechanism for such protection. Prohibiting leukocyte-endothelial adhesion and transmigration may be useful in decreasing leukocyte-dependent post-reperfusion injury

Oxidative preconditioning of medical ozone

Cardiac ischemic reperfusion injury is gaining importance due to rising of cardiac intervention procedures invoking transient ischemia, which requires trials of preconditioning strategies, A possible beneficial one could be the use of medical ozone, which is known to play a vital role in our well -being Therefore, the effect of small dose medical ozone on heart muscle and its possible protective effect on subsequent ischemia/ reperfusion injury was evaluated. Animals included in the present study were allocated into three groups: unconditioned control rats [group I], two months-ozonepreconditioned rats [group II], and three months-ozone-preconditioned rats [group III]. Rats were injected i.p. with small doses of ozone twice weekly. At the end of the experimental period, half the rats in each group were injected with heparin, a blood sample was taken for determination of plasma malondialdehyde [MDA] and the heart excised and used for isolated heart study. A blood sample was collected from the other half in each group for determination of serum glucose and the heart excised and sent for histological examination. Isolated heart study was carried out according to modified Langendorff technique. After recording basal cardiac activity, global ischemia was induced by stoppage of perfusion for 30 minutes followed by resumption of flow for another 30 minutes, and cardiac activity then recorded. The results revealed signifcant reduction in intrinsic inotropy of hearts isolated from unconditioned control rats after ischemia/ reperfusion [I/R], evidenced by significant decrease in tension generation per unit time [PT/t] after I/R in these rats, together with prolongation, of half relaxation time, insignificant change of intrinsic chronotropic activity and myocardial flow rate after I/R. Two months-medical ozone-preconditioning resulted in correction of the impaired intrinsic inotropy after I/R seen in unconditioned control rats, with enhancement of diastolic function. However, three months- medical-ozone preconditioning did not protect the hearts isolated from these rats from systolic dysfunction after I/R, though the diastolic function was significantly improved after I/R compared to unconditioned control rats. Serum glucose was decreased and plasma malondialdehyde was significantly increased in both the two-and three-months ozone-preconditioned rats. Histological examination of heart muscle revealed increased mitochondria! density in ozone preconditioned rats which was more marked in the two months-ozone-treated rats

Synthesis and hypnotic activity of some new quinazoline derivatives

Condensation of 4H-3,1-benzoxazin-4-ones [II] with p-aminobenzamides [III] 1- [p-aminobenzoylpiperidine [IV], ethy1 p-aminomethylbenzoate [V], p-aminomethy1-N- cyclohexy1-benzamide [VI] and p-aminomethy1benzoic acid hydrazide [VII] gave the corrersponding 4[3H]-quinazolinone derivatives [VIII-XIII]. The structures of the newly synthesized derivatives were confirmed by both elemental and spectral analyses. Some of the target quinazolinones showed good hypnotic action