Rehabilitation of hypertensive patients with left ventricular diastolic dysfunction

To assess the benefits of exercise training for rehabilitation of hypertensive patients with left ventricular diastolic dysfunction. This study was conducted on 40 hypertensive male patients with left ventricular diastolic dysfunction diagnosed with Doppler echocardiography. They were subjected to full history taking with special emphasis on dyspnea, which was classified according to NYHA classification, clinical examination, and surface ECG. Exercise stress test and Echocardiographic study were done twice for all patients at the start and at the end of the training program. Patients were divided into group-A [exercise group] that included 30 male hypertensive patients who underwent an exercise training program for two months and group-B [control group] that included 10 male age matched hypertensive patients who did not undergo the exercise training program. After the exercise training program group-A achieved longer exercise duration and higher METs as compared to group-B and the pre exercise parameters. Significant reduction of resting HR, BP and DP was noticed in the exercise group. Diastolic function in the form of increased E-wave velocity and reduction ofA-wave velocity, normalization of E/A ratio with reduction of DT and IVRT were noticed in the exercise group as compared to the control group as well as the pertaining data of the exercise group. Rehabilitation training program is beneficial in increasing physical endurance of hypertensive patients and in the control of BP, Diastolic function has improved in trained persons. Exercise training should be considered an integral part of the treatment of hypertensive patients

Anti-Nucleosome antibodies as a diagnostic tool in systemic lupus erythematosus and marker of lupus nephritis

To evaluate the prevalence of anti-nucleosome antibodies [anti-NCS Abs] in systemic lupus erythematosus [SLE], their role in diagnosis, disease activity and lupus nephritis [LN]. The study was conducted on 23 SLE female patients. They were divided into two groups according to the presence or absence of LN. Ten apparently healthy individuals served as a control group. Clinical assessment was done to all patients especially for renal affection. Disease activity was scored with SLEDAI. Anti-NCS and anti-dsDNA antibodies were measured with ELISA. Renal biopsy was performed for patients with LN. The prevalence of anti-NCS Abs was [78.3%] and anti-dsDNA Abs was [56.5%] in SLE. Seventeen patients presented with LN and 6patients without. Among these patients, the prevalence of anti-NCS Abs and anti-dsDNA Abs were [88%-64.7%] and [50%-33.3%] respectively. Anti-NCS Abs were found to be positive in 21.7% of SLE patients lacking anti-dsDNA Abs. The mean anti-NCS and anti-dsDNA Abs tiler in SLE was 250.60 +/- 207.00 and 443.3 +/- 714.3 respectively, showing a highly significant increase compared with healthy controls [12.3 +/- 4.54 and 31.0 +/- 20.11] [p<0.001]. Moreover, in LN and those without LN, the mean anti-NCS Abs showed a highly significant increase [331.41 +/- 179. 73 and 21.67 +/- 8.36] [p<0.001], while there was a significant increase in the mean of anti-ds DNA Abs [574.71 +/- 794.07 and 71.17 +/- 46.99] [p<0.05] respectively. The sensitivity and specificity of anti-NCS Abs in SLE were 82.6% and 100% and in LN were 88.2% and 100% respectively. Anti-NCS Abs showed a positive significant correlation with ESR [r=0.900], SLEDAI [r=0.761] and anti-dsDNA Abs [r=0.681] in LN, but showed a negative significant correlation with disease duration [r=-0.511] and C4 [r=-0.650] in patients without LN. In LN 7 patients hadproliferative glomerular lesion [WHO class III], 6 patients class IV and 4 patients class II on renal biopsy. They were associated with a statistically significant proteinuria, anti-ds DNA and anti-NCS especially in classes II and IV, Anti-NCS Abs could be a useful parameter for diagnosis and assessment of disease activity and LN in SLE, It seems to be a more sensitive marker of SLE than anti-ds DNA especially in patients who are anti-dsDNA antibody negative

Role of anti-annexin V antibodies in peripheral vascular ischemia of systemic sclerosis patients

To evaluate the role of a-AXVAbs IgG isotype in SSc and correlate it with peripheral microvascular and macrovascular affection. This study was conducted on 20 SSc female patients and 10 healthy controls. Clinical assessment was performed especially for peripheral vascular affection. ACL [IgG, IgM], Anti Scl-70 and a-AXV Abs were measured by ELISA and AC A by IIP. NFC and Doppler U/S were done. Diffuse SSc found in 11 patients and limited in 9 patients. A-AXV Abs were +ve in 19 patients, mean +/- SD 14.6 +/- 5.2, a highly significant increase compared to controls [t=5.3p<0.001]. There was no significant difference between diffuse and limited SSc [t-1.47 and p>0.05]. Patients were classified into 2 groups according to presence or absence of peripheral vascular affection: Group I, included 12 and Group II 8 patients. There was a highly significant difference between them regarding duration of RP [p<0.001], a significant difference regarding a-AXV Abs [p<0.05], but no such regarding ACL [IgG and IgM], anti-Scl-70 or anti-ACA. Within group I, there was a significant positive correlation between a-AXV Abs and disease duration, RP and ACL [IgG and, IgM] [p<0.05]. NFC showed scleroderma pattern: early 5%, active 75% and late 20%.Comparing a-AXV Abs in them, a highly significant difference in active and late [p<0.001]. Doppler US showed irregular thickening in carotid arteries, stenosis and calcification in ulnar and calcification and irregular thickening in femoral and popliteal arteries. A highly significant increase of a-AXV Abs in ulnar artery stenosis [p<0.001]. Measurement of a-AXV Abs in SSc can discriminate patients with vascular affection from those without it, with specificity 62.5%, and sensitivity 91.7%. Peripheral micro and macrovascular affection should be assessed

Serum YKL-40 in rheumatoid arthritis and its correlation with disease activity

To determine the serum level of YKL-40 in rheumatoid arthritis [RA] patients and to find out its correlation with the disease activity. The study was conducted on 20 RA patients recruited from the Rheumatology and Rehabilitation Department of Ain Shams University Hospitals, as well as 10 apparently healthy individuals who served as a control group. Patients with liver disease, myocardial infarction or malignancies were excluded. Also patients taking slow-acting drugs or had intra-articular injections in the previous month before the study were not included. All the patients and the controls were subjected to complete history taking, thorough clinical examination, radiological and laboratory tests. Serum YKL-40 level was measured in the patients and the controls using ELISA test. Serum YKL-40 level was significantly higher in RA patients as compared to the control group. Serum YKL-40 level showed a positive significant correlation with the disease duration, the parameters of disease activity in RA patients and with the disease severity as assessed with Larsen's radiological score. Measurement of serum YKL-40 level in RA patients is a laboratory test that can be used as a new parameter other than the conventional markers of inflammation, which are ESR and serum CRP level. Also, it helps to asses the disease activity as well as the progression and the destructive effect of the disease on the joints

Tumor necrosis factor alpha expression in iliac bone biopsy and relation to bone histomorphometry in pre- and post- menopausal women

To identify TNF-alpha protein expression in iliac crest bone biopsies and their influence on trabecular microarchitecture in relation to menopausal status. Twenty-four females were classified into Group I: 10 pre-menopausal with mean age 39.9 +/- 5.06 and Group II: 14 post-menopausal with mean age 57.18 +/- 5.01. Serum estradiol and BMD [using DEXA] were assessed. Histomorphometrical study of iliac crest biopsy using H and E stain to evaluate trabecular architecture. Immunohistochemistry with TNF- alpha antibody was done to measure number of bone marrow producing cells and their area% in cells lining bone trabeculae. There was a highly significant difference between 2 groups regarding serum estradiol and BMD at all sites. Histomorphometrical parameters showed a highly significant decrement and significant decrease of Ob.S. TNF- alpha cells number and area% in bone biopsy showed a highly significant increase in group II but no correlation with age or BMI. There was a significant negative correlation of E2 in group /, highly so in group II. BMD, showed a significant negative correlation at the lumbar spine in group II. Bone histomorphometric parameters showed a significant negative correlation with T.Th in group 1 and highly one in group II, a highly significant positive correlation with T.S and with E.S in both groups and a significant positive correlation with T.S in group 1. No significant correlation regarding Ob. S in both groups. TNF- alpha has a critical role in the pathogenesis of post-menopausal osteoporosis. This may have impact on the future therapy, using anti TNF-a drugs already available

Effect of estrogen agonist antagonist on bone mineral density in postmenopausal breast cancer

Tamoxifen is an estrogen agonist/ antagonist, which has its effect not only on breast cancer cells but also on the liver and bone. In this study we tried to study the effect of long-term treatment with that drug on bone metabolism. Twenty-five postmenopausal women with stage I or II breast cancer receiving 30 mg tamoxifen daily together with twenty-five postmenopausal age-matched normal controls were included in this study. Measurements of bone mineral density using dual energy X-ray absorptiometry [DEXA] at the lumbar spine, femoral neck and forearms were done after the operation, at the start of the study and after 12 months of tamoxifen administration. They were compared with those of normal controls. Bone mineral density increased in the tamoxifen treated group as compared to the control group. A decrement in bone mineral density in the age-matched group [Z score] was statistically significant [p<0.05]. Also, there was a significant reduction in serum cholesterol in the tamoxifen treated group. These results indicate that tamoxifen has estrogen-like effects on bone metabolism in post-menopausal women. This results in an increase and stabilization of bone mineral density in the axial skeleton and a stabilization of bone mineral content in the appendicular skeleton