Insulin resistance, the metabolic syndrome and global right and left myocardial performance index

Cardiovascular dysmetabolic syndrome [CDS], dysmetabolic syndrome, syndrome X, DROP syndrome [dyslipidemia, insulin resistance [IR], obesity, and high blood pressure] and IR syndrome are all synonymies for the syndrome characterized by four critical elements: atherogenic dyshpidemia, IR, central obesity, and high blood pressure. The aim of the study was to describe the global right and left myocardial function, in patients with metabolic syndrome [MS], defined according to the criteria proposed by NCEP-ATP III. A descriptive, cross-sectional, hospital based study in which, 730 patients, mean age [54 years + 6], [430 men and 300 women] who attended Suez Canal university [SCU] outpatient, clinic of cardiology and diabetes were screened for CDS criteria of whom 150 were diagnosed [63 men and 87 women]. Those who met the dysmetabolic syndrome criteria were subjected to careful history taking, blood pressure measurement anthropometric measures [Height and weight, body mass index, waist circumference], ECG and blood samples: [Na and K, Fasting blood sugar [FBS], fasting plasma insulin [FPI] [normal values from 5-15 micro IU/ml], serum creatinine [S.Cr.], serum uric acid and Lipids were measured. HOMA-IR was assessed according to the level of FBS and which was measured with electrochemiluminescence immunoassay method Serum intact pro-insulin was measured by using a highly specific solid phase enzyme linked immunosorbant assay based on sandwich principle. All participants were subjected to full echocardiographic study including right and left ventricular diastolic and systolic ftmction, and the combined index of myocardial performance [Tei index = IRT + ICT/ET]. Most of parameters of insulin resistance [IR] were higher in females than males, fasting plasma insulin, PPBS and HOMA-IR [27 vs. 21 micro IU/mL]. [162 vs. 151 mg/dl], and [10 vs. 8.5] respectively, [P value < 0.05]. In addition, waist circumference and BMI were higher in females than males, [130 vs. 127 cm] and [44 vs. 39 kg/m2] respectively, [P value < 0.05]. HDL were higher in females than males [43 vs. 39 mg/dl] respectively, with statistical significant difference [P value < 0.05]. Total body obesity [[BMI] and central obesity [waist circumference] had a statistically significant direct correlation relation with fasting plasma insulin, HOMA-IR, HDL, TG, FBS and PPBS. Central obesity alone had a statistically significant direct correlation relation with serum uric acid. Participants with the MS had greater left ventricular [LV] dimension, mass, and relative wall thickness, and left atrial diameter [all p < 0.01]. and a higher prevalence of LV hypertrophy [p <0.001], with lower ejection fraction [p <0.05], and mitral E/A ratio [p < 0.05] than participants who did not have the MS. Regarding the left ventricular global function there was significant difference between the groups. On the other hand there is non significant difference regarding right ventricular function between them. HOMA-IR was a predictor of incident global myocardial left ventricular dysfunction. The metabolic syndrome is associated with a global left rather than right ventricular dysfunction and HOMA-IR is a predictor. There is a pressing need for a national preventive program to combat obesity, diabetes and related comorbidities by general practitioners and diabetologists

Interleukin-1 receptor antagonist and c-reactive protein as predictors for prognosis of acute myocardial infarction

The aim of this study was to estimate interleukin-1 receptor antagonist [IL-1Ra] and C-reactive protein [CRP] blood levels in patients with acute myocardial infarction [AMI] on admission to correlate their concentrations with the short-term prognosis and to other risk factors of coronary heart disease [CHD]. IL-1Ra and CRP were measured in the sera of 69 patients with recent AMI. They were classified into three groups [18 good, 33 fair and 18 bad outcomes] according to their left ventricular ejection fraction [EF%]. Receiver operating characteristics [ROC] plots were used to find out the maximum efficiency of the test. CRP and IL-1Ra levels correlated with the prognosis of AMI. When applying the ROC plots, CRP showed a high sensitivity [100%] and specificity [89%] at a cutoff point of 46.5 mug/ml; while, for IL-1Ra, the sensitivity was 100% and the specificity was 59% at cutoff point of 310 pg/ml to discriminate between bad and both fair and good prognosis in AMI patients

influence of DDE residue level in human blood serum and some other environmental factors on the occurrence of breast cancer at Port Said [Egypt]

The present study was conducted to ascertain the relationship between DDE [Dichloro Diphenyl Ethan] residue level in blood serum and the occurrence of breast cancer. The influence of some other blood constituents, such as cholesterol, triglycerides on the occurrence of the disease was also looked at. The implication of some relevant risk factors such as smoking, stress and some other environmental factors in the occurrence of the disease was also investigated. The study was performed on a group of 430 local women from Port Said city, North of Egypt, mainly married with an average age of 45 years. The study group included 210 cancer patients, 110 benign breast disease patients [BBD] and a group of 110 normal women. Blood samples were collected from fasting women, and serum was separated within an hour by centrifugation. Lipid profile analysis was performed immediately after separation on one portion of the separated serum. Residues of DDE were separated from the other remaining portion of serum end detected using an ECD-gas chromatograph. A questionnaire was designed to ascertain the influence of some risk factors on the occurrence of the disease. Residue level of DDE detected in breast cancer patients, BBD patients and normal women had an average of 0.052 mg/litre, 0.062 mg/litre and 0.025mg/litre, respectively. Triglyceride level in breast cancer patients BBD patients and normal women had an average of 171, 156, and 81 mg respectively. Some of the risk factors studied have shown direct link with the occurrence of the disease, e.g. previous BBD, smoking and frequent use of insecticides. The present results revealed some statistically significant differences in the levels of DDE in serum samples of the three tested groups of women, indicating a likely involvement of DDE in the occurrence of breast cancer. Also the role of smoking, stress and other environmental risk factors is evident in Port Said city. A country wise plan has to be conducted in order to face this major health problem

Risk factors of micro-albuminuria in patients with non-insulin dependent diabetes mellitus

Micro-albuminuria is an indicator of early diabetic nephropathy [DN]. The trends towards increased end stage renal disease [ESRD] secondary to DN are expected to contiue in developing countries. An understanding of the risk factors, which lead to the development of micro-albuminuria in non-insulin dependent diabetes mellitus [NIDDM], is required to develop strategies for primary prevention of DN. A case-control design was used to determine the risk factors of early DN in 184 patients with NLDDM [48 with micro-albuminuria and 136 with normo-albuminuria]. We defined micro-albuminuria where the ratio of urine albumin in micrograms [mcg] urine creatinine in milligrams [mg] was in the range of 17-299 for males and 25-299 for females. The glycosylated hemoglobin [HbAlc] of >/= 8.1%. was used to define the poor glycemic control. Patients were examined for retinopathy, peripheral neuropathy, coronary artery disease [CAD] and peripheral vascular disease [PVD]. We measured fasting serum triglyceride, cholesterol, low-density lipoprotein [LDL], high-density lipoprotein [HDL], lipoprotein [a] [Lp[a]], C-peptide of insulin, transforming growth factor beta [TGF beta] and e-selectin. HbAlc, duration of diabetes mellitus, systolic blood pressure [SBP], diastolic blood pressure [DBP] and serum C-peptide of insulin, triglyceride, LDL and Lp[a] were positively correlated with micro-albuminuria, while HDL was inversely correlated with it. The TGF beta and e-selectin did not significantly correlated with micro-albuminuria [P>0,05]. After adjustments for the effects of covariates with logistic regression [LR] analysis, the odds ratio [OR] and 95% confidence interval [CI] of micro-albuminuria for the potential risk factors were estimated, LR revealed a significant association between micro-albuminuria and male gender [OR = 5.1], poor glycemic control [OR = 4.7], young age at onset of diabetes [OR = 4.1], dyslipidemia [OR = 3.8], hypertension [OR = 3.1], and the longer duration of diabetes mellitus [OR=2.6]. Male gender, poor glycemic control, young age at onset of diabetes, long duration of diabetes, hypertension and disturbed lipid profile especially triglyceride, LDL and Lp[a] are significant risk factors for development of DN. The possible mediators of progression of nephropathy [serum TGF beta, e-selectin and insulin] are not found to be significant markers of micro-albuminuria stage of DN