multidimensional evaluation of two cardiac rehabilitation programs in patients with coronary artery disease

This study was performed to study the impact of two different cardiac rehabilitation programs [high frequency versus low frequency exercises] on the cardiopulmonary outcome of patients with stable coronary artery disease. Relation of these exercise programs on the recurrence of myocardial morbidity was also defined. Fifty patients with stable ischemic heart disease were divided into two groups: Group 1: including 25 patients who were subjected to a six-week high frequency exercise training and Group 2: including 25 patients who were subjected to a six-week low frequency exercise training. All the patients were subjected to full clinical assessment, laboratory investigations and Doppler echo cardio graphic studies. A statistically significant difference [p<0.05] was found after both the cardiac rehabilitation programs were instituted regarding all the exercise test characteristics studied. As regards quality of life [Qol] questionnaire there was also a highly statistical significant difference p<0.001]. Exercise training has a well-documented efficacy in the overall rehabilitation of patients with coronary artery disease. Beneficial effects of exercise training are evident along the different parameters of cardiac functions i.e. exercise capacity, exercise tolerance, cardiac hemodynamics as well as the patient's QoL

Estimation of soluble L- selectin and plasma fibronectin in patients with rheumatoid arthritis

This study was done to detect the serum level of soluble L-selectin [sL-selectin] and plasma level of fibronectin [pFN] in patients with rheumatoid arthritis [RA] and compare these levels to normal healthy controls. The aim extends to determine the relation of these levels to clinical parameters of disease activity. Fifty patients with RA as well as twenty healthy persons- as a control group- were included into this study. All patients were subjected to full clinical assessment and laboratory investigations. sL-selectin and pFN were measured in patients and controls using the enzyme-linked immunosorbent assay technique, and their correlations with disease activity parameters were studied. Serum levels of sL-selectin and pFN were highly significantly increased in RA patients as compared to healthy controls [p<0.001]. These levels also showed a highly statistically significant correlation with some parameters of RA disease activity [p<0.001]. This rise was more evident in patients with severe disease activity sL-selectin and pFN levels are elevated in RA patients especially in those with a severely active disease. The might reflect their role in the pathogenesis of RA. The correlation of sL-selectin and pFN with clinical parameters of RA patients may help in evaluation of progression or remission of the disease

Risk factors and magnitude of osteoporosis among attendants at Banha university hospital

This work was conducted among three hundred and twenty attendants of the outpatient clinics in Banha University Hospital, with ages >/= 40 years, they were selected by systematic random sampling to clarify the magnitude of osteoporosis and its associated risk factors. Anthropometric measurements were done for each subject including. weight, height and BMI [Wt [Kg] / ht [m[2]]]. Also, bone density was measured using the densitometry, Dual energy X-ray absorptiometry [DEXA] scan for spines, hip and forearm at wrist joint was done for each subject. This research revealed that the prevalence of osteoporosis was 69.4% among the attendants and it increased significantly with increasing age [p<0,001]. Osteoporosis was significantly more prevalent among females [81.2%] than males [45.8%] [p<0.001]. Also, it was more encountered among subjects with low-weight [<60 Kg], height [>170cm] and low BMI [<25 Kg/m[2]]. The results illustrated that the significant life style and dietary risk factors of osteoporosis were: sedentary life, smoking, excessive tea and coffee intake and low milk consumption. Hypertension rheumatoid arthritis, calcium and vitamin D deficiency and using corticosteroids were the medical risk factors associated significantly with osteoporosis [p<0.001]. Late menarche, postmenopausal >/= 5 years and never using hormonal contraceptive or replacement therapy were the significant evident reproductive risk factors among females in this study. There is an association between the prevalence of osteoporosis and sedentary life style, dietary risk factors, medical risk factors and reproductive risk factors. Integrated health education programs with primary health care activities were recommended to increase awareness of adults about the major risk factors of osteoporosis and its important preventive measures

Cortisol and parathormone levels in juvenile rheumatoid arthritis: relation to interleukin-1 beta and interleukin-6

This study was designed to define the levels of cortisol and parathormone in children with juvenile rheumatoid arthritis [JRA] in relation to disease activity as well as to the levels of the proinflammatory cytokines interleukin-1 beta [IL-l, beta] and interleukin-6 [IL-6]. Thirty six patients [26 females and 10 males; aged 6-12 years; mean 7.3 +/- 1.6 yr] as well as 18 apparently healthy controls were recruited into the study. Patients and controls were subjected to clinical examination and a comprehensive battery of investigations including a complete blood picture, ESR, CRP, serum levels of calcium. phosphorus, alkaline phosphatase, IL-I beta, IL-6 as well as cortisol and parathyroid hormone [PTH]. Serum levels of IL-I, beta and IL-6 were significantly higher in JRA patients than those of the controls [p<0.001]. This rise was more evident in patients with an active disease. On the other hand, serum levels of both cortisol and FTH were significantly lower in patients compared to the controls [p<0.001]. Moreover, there were significant negative correlations between serum levels of both cortisol and PTH with IL-i, 6 and IL-6 as well as other parameters of disease activity [ESR and CRP] [p<0.05 and p<0.001, respectively]. There was also a significant negative correlation between FTH only and serum calcium p<0.05]. Decreased serum values of both cortisol and FTH were demonstrated in the children suffering from JRA, especially those with a high disease activity. This hormonal status may indicate a disturbed homeostasis contributing to a more active disease

Anti-cardiolipin antibodies and cardiac involvement in systemic lupus erythematosus

To study anticardiolipin antibodies [aCL] in blood and clarify their possible relation to cardiac involvement in patients with systemic lupus erythematosus [SLE]. Twenty SLE patients and twelve healthy persons, as a control group, were included into this study. All patients were subjected to full clinical assessment and laboratory investigations. aCL antibodies IgG were measured in patients and controls using the enzyme-linked immunosorbent assay [ELISA] technique and their correlations with disease activity parameters were studied. SLE patients were divided according to the presence of aCL antibodies into two groups: first group of 9 patients with negative aCL antibodies and second of 11 patients with positive aCL antibodies. A highly statistically significant difference [p<0.001] was found between aCL antibodies IgG level in SLE patients vs. control group, A statistical significant difference was also observed [p<0.05] in aCL antibodies between both groups of SLE patients in relation to clinical data, laboratory data and disease activity. On echocardiography, there was a significant correlation [p<0.05] between the presence of aCL antibodies and the occurrence of mitral regurge in aCL positive patients, while there was no significant correlation with other echo parameters. There was an association between the presence of aCL antibodies and cardiac abnormalities in SLE patients on echocardiographic examination especially valvular lesions [regurgitation more than stenosis]. This suggests that aCL antibodies may play a role in the pathogenesis and the severity of cardiac lesions. Also; there was an association between echocardiographic changes as well as high serum levels of aCL antibodies with SLE disease activity

Evaluation of transcranial doppler in neuro-Behcet's disease patients

To study the value of transcranial Doppler [TCD] in patients with neuro-Behcet's disease [Neuro-BD] and to correlate the findings with the MRI results. This study included 15 patients fulfilling the diagnostic criteria of international study group for Behcet's disease. MRI brain was done and evaluated for the presence of parenchymal lesions. Bilateral transcranial Doppler ultrasound of the middle [MCA], anterior [ACA] and posterior [PCA] cerebral arteries were performed in patient and control groups. TCD parameters were compared between 15 patients and age and sex matched control subjects. We found 12 [80%] patients had single or multiple brain lesions on MRI. Most of these lesions were of high signal intensity on T2-weighted images and located in the brainstem, basal ganglia and deep white matter region. TCD findings were abnormal in 5 [33.3%] patients. Pulsatility and resistivity indices of the MCA were significantly higher in patients than in normal control [p<0.001]. The mean blood flow velocity of the MCA and ACA was marginally reduced in patients with neuro-BD than in healthy controls, but did not reach a statistical significance [p>0.05]. No significant relation was found between abnormal MRI lesions and TCD parameters. Cerebral hemodynamics might be affected in patients with Behcet's disease compared with healthy controls. TCD may be a useful tool in the evaluation of patients with neuro-Behcet's disease

Correlation of plasma osteopontin and interleukin-18 concentrations with systemic lupus erythematosus disease activity

Osteopontin [OPN] is an extracellular matrix protein of pleotropic properties that has been recognized as a potential inflammatory cytokine. Also it has immunological activities including stimulation of T-helper type 1 lymphocyte response and B-cell antibody synthesis. IL-18 has multiple biological activities that are important in generating Th1 responses and inflammatory tissue damage. We measured the plasma concentration of OPN and the plasma IL-18 concentration in 24 SLE patients and 20 sex and age matched control subjects using an enzyme- linked immunosorbent assay. Plasma OPN concentrations and plasma IL-18 concentrations were significantly higher in SLE patients than in the control group [both p<0.001]. The increase in OPN and IL-18 concentrations correlated positively and significantly with SLE activity [r= 0.831, p<0.001] and [r = 0.826, p<0.001] respectively. Also, there was a highly significant positive correlation between OPN and IL-18 [r=0.75, p<0.001]

Undifferentiated polyarthritis: is it a hiddrn form of RA? The value of anticyclic citrullinated peptide antibodies as a diagnostic and prognostic marker for rheumatoid arthritis

The study was undertaken to assess the value of anti-cyclic citrullinated peptide antibodies [anti-CCP] in comparison to anti-perinuclear factor [APF] and IgM rheumatoid factor [IgM RF] in the early diagnosis of rheumatoid arthritis [RA] in patients with undifferentiated polyarthritis [UPA]. Serum samples of sixty patients with UPA [not fulfilling any of the ACR criteria for the diagnosis of any of the connective tissue diseases] and of other twenty age and sex matched healthy volunteers act as a control group was tested for IgM RF, APF and anti-CCP antibodies at first visit. Follow-up and reassessment of all patients was done monthly till the end of the study after one year. Measurement of APF was done by indirect immunofluorescence [IIF] and anti-CCP was done by enzyme linked immunosorbent assay [ELISA]. Forty two [70%] out of 60 UPA patients met the revised criteria of diagnosis of RA after one year of follow-up. A positive anti-CCP test was highly specific for RA [specificity 88.8%] being found in 30 [71.5%] out of 42 RA patients and its sensitivity was [71.4%]. IgM RF had the highest sensitivity [76%] and it was less specific for RA [66.6%] while the specificity and the sensitivity of APF were 77.7% and 52.38%, respectively. There was a highly significant association between anti-CCP antibodies positive RA patients and high disease activity score as well as disease severity score [p<0.001] while there was significant association between IgM RF and APF positive RA patients separately and high disease activity score [p<0.02 and 0.01, respectively] as well as disease severity score [p<0.05 and 0.01, respectively]. These results suggest that anti-CCP antibody is a highly specific serologic marker for RA and its determination is of value in the diagnosis of early cases of RA. Furthermore, anti-CCP may have prognostic significance because of their association with more severe and active form of RA