Thyroid functions on hemodialyzed patients

Abnormalities in thyroid function tests are frequently encountered in uremic patients. Disturbance in endothelial dysfunction and inflammatory processes are common in individuals with chronic renal failure. This may predispose to accelerated atherosclerosis with all its complications. The study was performed to investigate relationship between thyroid function and markers of endothelium damage and inflammation in patients with regular hemodialysis [HID]. The study was performed on 50 patients with end stage renal diseases [ESRD] on regular ND for at least 10 months. All patients and control were subjected to complete history and clinical examination and measurements of thyroid function tests, marker of inflammation [CRP], marker of endothelial damage, [intracellular adhesion molecules [ICAM]], in addition to renal function, CBC, lipid profile, total protein and serum albumin. Out of 50 patients under hemodialysis, had cardiovascular events. The following parameters were significantly higher in patients under HD than control; blood urea [p < 0.001], serum creatinine [P <0.001], CRP [p <0.001], ICAM [p <0.001] and triglycerides [P <0.01]. The following parameters were significantly lower in patients under HD than controls; serum albumin [p < 0.001], FT3 [p <0.01, but still within the normal range] and hemoglobin [p < 0.01]. Using multiple regression analysis serum FT3 negatively correlated with, duration of RD [r=-0.830, p < 0.001], albumin [r=-0.770, p <0.001], CRP [r=-0.840, p < 0.001], ICAM [r=-0.500, p < 0.01], triglycerides [r=-0.540, p <0.01], and total protein [r=-0.520, P <0.01]. Logistic regression analysis and after adjusted for age, sex, BMI, hypertension, FT3 levels were independently related to CRP [OR 206, 95% CI 1.6-5.4, P < 0.001], followed by duration of dialysis [OR 2.58, 95% CI 1.7-5.2, P <0.001], lastly serum albumin [OR 2.32, 95% CI 1.6-3.9, p <0.001]. Interestingly, and serum albumin were significantly lower, while CRP and duration of dialysis were significantly higher in patients with vascular complications than the rest of patients [P < 0.01]. We can conclude that thyroid dysfunction in HID patients related to inflammation, duration of dialysis, malnutrition and to a lesser extent endothelial dysfunction. All these factors lead to accelerated atherosclerosis and cardiovascular complications and a clinical significance of these findings merits further studies

C-reactive protein an D-dimer as a prognostic factors of ischemic stroke

Inflammatory processes have a fundamental role of atherosclerotic lesion and increased risk of vascular disease especially cerebral ischemia. The study was performed to assess the prognostic influence of inflammatory markers, C - reactive protein [CRP] and D-dimer on outcome of ischemic stroke. The study includes 100 patients with first-ever ischemic stroke. The study was performed at Al-Azhar University Hospitals from May 2005 to January 2006, followed by one-year follow up. All patients were suspected to complete history and clinical examinations, CT or MRI in the first day and one week latter. CRP and D-dimer were measured within the first 24 hours of ischemic stroke. In addition to routine investigations such as; fasting and post prandial blood sugar, lipid profile, CBC, ECG, echocardiography and body mass index [BMI]. The primary end-point was either, death of any causes [vascular or non-vascular] or any non-fatal vascular events [transient ischemic attack, recurrent stroke, unstable angina, acute myocardial infarction or peripheral ischemia]. Multiple logistic regression analysis was used to evaluate the association between end-point and risk factors of stroke. The incidence of diabetes, hypertension, hypercholesterolemia and obesity were significantly higher in patients than control [p < 0.01] and in patients with fatal and non-fatal vascular events than those survival free vascular events [p <0.01]. Serum levels of CRP and D-dimer were significantly higher in patients with first-ever stroke than control [p <0.001] and in patients with fatal and non-fatal vascular events than those survival free vascular events [p < 0.01]. Kaplan-Meier analysis showed an increased incidence of new vascular events during follow-up with increased levels of CRP especially in high tertiles [64%] compared to intermediate [29%] and low tertiles [18.5%], [OR 9.1, CI 3.9-18.4; p <0.001]. Also Kaplan-Meier analysis showed an increased incidence of new vascular events during follow-up with increased levels of D-dimer especially in high tertiles [44.4%] compared to intermediate [34%] and low tertiles [30%], [OR 1.95, CI 0.95-2.1; p <0.01]. However, logistic regression analysis between, risk factors and outcome during 1-year follow-up proved that CRP is the most risk factor predictive for recurrent vascular events independent to other risk factors for stroke [OR 2.57, CI 1.34-5.10; p <0.001]. We can conclude that increased serum levels of CRP are related with a worse outcome in patients with first-ever stroke more than D-dimer independent to other risk factors of ischemic stroke. Therefore, addition of CRP to standard initial screening will generate an improved method for identifying persons at high risk of future vascular events