RESUMO
In diabetic patients, cardiovascular disease remains the leading cause of death, and myocardial infarctions tend to be more extensive and have a poorer outcome than in age, weight and sex matched individuals without diabetes. Diabetes mellitus, which is one of the major risk factors for ischemic heart disease [IHD], is increasing all over the world especially in developing countries, raising with it the incidence of IHD. Most of the ischemic burden on the myocardium is silent, especially in diabetics, due to the presence of autonomic neuropathy. The aim of this study is to evaluate the relative incidence of silent ischemic episodes and the total ischemic burden in diabetic and non diabetic patients, whether known to be ischemic or not, in Mataria district. This study includes four groups of male individuals, aged 45 to 60 years, attending the outpatient clinic of Mataria Teaching Hospital. Group I includes 20 diabetic patients known to be ischemic; group II includes 20 diabetic patients clinically free from IHD; group III includes 20 non diabetic patients known to be ischemic and group IV includes 20 non diabetic non ischemic individuals. A 24-hours ambulatory ECG recording was done for all individuals and analyzed for significant ST-segment deviation. The results of this study show that ischemic patients whether diabetic or not, are significantly more hypercholesterolemic than non ischemic individuals. The number of patients showing ischemic episodes are greater in the diabetic ischemic group than in the ischemic non diabetic group [60% versus 45%], and the total number of episodes, whether manifest or silent was also greater in the former than in the latter group [71: 49]. The study confirms also the fact that the number of silent ST shifts is much more than the symptomatic ones [81.7% versus 18.3% in diabetic ischemic patients, and 65.3% versus 34.7% in ischemic non diabetic patients]. Moreover, diabetic patients who are not known to be ischemic show more silent episodes than the control group. These findings confirm that episodes of silent ischemia are present in a good percentage of patients with angina and a higher prevalence of these episodes is present in diabetic patients. This should urge us to give more care to the diabetic patients, whether already diagnosed as ischemic or not. The proper and early detection of diabetic patients with silent ischemia will result in a more rapid initiation of appropriate treatment and a much more favorable outcome
RESUMO
Chronic liver diseases are often characterized by portal hypertension an important component is increased intrahepatic vascular resistance. It is now established that nitric oxide is a key factor in the hemodynamic abnormalities associated with liver cirrhosis and chronic portal hypertension. The aim of this work is to measure plasma levels of nitric oxide in patients with liver cirrhosis and portal hypertension and to find out the correlation between nitric oxide levels and stage and severity of cirrhosis and between nitric oxide levels and parameters of hyperdynamic circulation. The study included 45 patients with cirrhosis which were divided into 3 groups. The first group included 15 cirrhotic patients Child class A, the second group included 15 cirrhotic patients Child class B and the third group included 15 cirrhotic patients Child class C. A control group included 12 healthy subjects. This study showed that nitric oxide levels determined as the stable end product nitrate, measured by photometric means, are highly significantly increased among cirrhotic patients Child class A, or class B, or class C groups compared to the healthy controls [p<0.01]. Furthermore, nitric oxide levels are highly significantly increased in cirrhotic patients with ascites [Child class B or class C groups] compared to those without ascites [Child class A group] [p<0.01]. Moreover, there was significant difference of Nitric oxide between child class B and class C groups which means that Nitric Oxide level increases proportionally with the severity of cirrhosis. Also cirrhotic patients [Child class A, or class B, or class C] have highly significantly increased cardiac index [p<0.01] and decreased mean arterial pressure [p<0.01] compared to healthy controls. Moreover, there is highly significant negative correlation between nitric oxide levels and mean arterial pressure and highly significant positive correlation between nitric oxide levels and cardiac index