Evaluation of plasma thrombomodulin in patients with type II diabetes mellitus

Thrombumodulin is an important endothelial anticoagulant protein that decreases thrombin activity and activates protein C. Increased plasma concentrations of various markers of endothelial damage especially thrombomodulin, have been observed in type I diabetic patients particularly in those with microangiopathy. So we aimed in this study to evaluate the significance of plasma thrombomodulin as a biochemical marker for early detection of microvascular complication such as diabetic nephropathy in patients with Type II diabetes mellitus Thirty diabetic patients fulfilled the WHO criteria for type II diabetes-were included in this study together with 10 normal volunteers as normal control.-The type II diabetic patients were classified into three groups according to the level of microalbuminuria in 24hours urine: Group I: included 10 diabetic patients [without nephropathy] microalbumin/24 hours urine<30 mg, Group II included 10 diabetic patients with [incipient diabetic nephropathy] microalbomin/24 hours urine ranged from 30 to 300 mg, and Group III included 10 diabetic patients with [overt diabetic nephropathy], microalbuminl24 hours urine>300mg. For all patients and control the following were done serum creatinine, glycated hemoglobin [HbAlc] Plasma thrombomodulin [TM] and 24 hours urinary micro-albuminuria-In this study we found that, TM were highly significantly elevated in diabetic patients with microalbominuria [group II] and with macroalbuminuria [group III] as compared to the control group [P<0.01] [Table 2]. Also group III showed highly significant elevation in TM than group II [P<0.0 1]. TM showed highly significant correlation with albumin concentration in 24 hours urine HbAlc, and duration of diabetes [P<0.01] [tables]. Because plasma TM level was strongly affected by kidney function. TM index [TM[FU/ml]/serum creatinine [mg%] was used as an endothelial marker. TM index showed a highly significant elevation in diabetic patients [p<0.01] especially in patients with macroalbuminurea [group III] as compared to normal control [p<0.01] [Table 2] also its level was significantly higher in group III than both group I and group II [p<0.01] while no significant difference was found between neither group I nor group II and control group [p>0.05]. TM index showed a highly significant positive correlation with duration of diabetes, but it showed no significant correlation with HbAlc [P>0.05] [Table 6]. These results suggested that a generalized vascular endothelial damage occurs in diabetic nephropathy including the microalbuminuric stage, and TM could be used as a marker for early detection of diabetic microvascular complications

Cardiac troponin 1: a highly sensitive and specific cardiac marker

The aim of the present study was to evaluate the early diagnostic sensitivity and specificity of cardiac troponin I [cTnI] as compared to the routinely used cardiac enzymes [total CK and CK-MB] in acute chest pain patients presenting to the Emergency Department [ED] within the first six hours of onset of pain. This study was conducted on 17 acute myocardial infarction [AMI] patients presenting to the Emergency Department [ED] within the first six hours from onset of chest pain, in addition to 36 non-AMI patients [11 patients with unstable angina, as well as 15 patients suffering from CRF and 10 patients with traumatic muscle injury]. The results were compared with those of 10 healthy age- and sex-matched control subjects. CTnI [measured by a chemiluminescent technique on Immulite system] proved to be the superior marker for early and accurate diagnosis of AMI during the first six hours of onset of chest pain as evidence by ROC curve analysis. The area under the curve [AUC] for cTnI was 0.955, that for CK-MB was 0.925, meanwhile that for total CK was 0.769. The optimum cutoff level of cTnI was 1.6 ng/ml. At this level, cTnI showed a diagnostic efficacy of 94.1%, 95.6%, respectively, with diagnostic efficacy of 95.2%. Although CK-MB showed a similar diagnostic sensitivity [94.1%], it had a much lower specificity [77.8%], hence resulting in a much lower diagnostic efficacy [82.3%], compared to cTnI. Total CK, on the other hand, showed a very low sensitivity [70.6%] and specificity [80%] with diagnostic efficacy of 82.3%

Alpha glutathione S-transferase as a biochemical marker of hepatocellular damage in chronic hepatitis C virus infection

Alpha glutathione S-transferase [alpha GST] has been advocated as a better marker of hepatocellular damage than the transaminases in chronic hepatitis C virus infection. We have assessed the potential interest of plasma alpha GST determination in 58 patients proved to have chronic hepatitis C [HCV]. The patients were divided into two groups; Group-1, included 29 patients with chronic hepatitis C alone and group-H included 29 patients with chronic hepatitis C and liver cirrhosis. In addition to 15 healthy volunteers as a control group. Blood samples were assayed for aspartate aminotransferase [AST], alanine aminotransferase [ALT], G-glutamyltransferase [GGT] and alpha GST.The results showed that in group-I, there was a statistically significant elevation of ALT. AST, GGT and alpha GST in comparison to the control group. There was no significant correlation between alpha GST and all the studied liver enzymes. Also, there was insignificant correlation between alpha GST levels and HCV-RNA level. In group-II, alpha GST was elevated, but its elevation was insignificant in comparison with the control group.ROC curve analysis revealed alpha GST had a better diagnostic sensitivity andspecificity [68.97% and 72.41 %, respectively] and diagnostic efficacy of 70.69%. It's cutoff level was 1.7 ng/ml. Meanwhile, ALT gave a diagnostic sensitivity [58.62%], diagnostic specificity [62.07%] and a diagnostic efficacy of 60.34%. The association of alpha GST with ALT may improve the biochemical assessment of liver damage in patients with chronic hepatitis C, as it gave a similar sensitivity [62.07%] and a better specificity [82.76%], hence resulting in a better diagnostic efficacy [72.41%]

Relation of environmental occupational stress factors and lipid profile as a risk factors of ischemic heart disease

The present study analysed the relationship between some environmental occupational stress Factors in terms of decision latitude, demand context, perceived strain during work and blood lipids as a risk factor of ischaemic heart disease [IHD], in terms of cholesterol, triglycerides, HDL-C, LDL-C, Apolipoprotein, A[I], Apolipoprotein B and lipoprotein [a]. The study was carried out in one of the factories in the tenth of Ramadan and included a cross sectional samples of 105 male workers aged 35-50 years, employed in jobs with regular mental tasks and a certain degree of responsibility for more than 10 years duration. The participants were interviewed and personal, occupational and medical data were collected and biochemical blood investigations were done. The study showed significant higher serum cholesterol in the group of disturbed relations at work. Serum levels of LDL-C was significantly higher in some groups of occupational stress, while serum HDL-C was significantly lower. Serum triglycerides was significantly increased in two groups. There was a significant association between lower serum levels apo-[I] and some of the occupational stress factors. Low decision latitude was the only stress factor which showed a significant correlation with high levels of lipoprotein [a]

Lipoprotein [A] in nephrotic syndrome

Lipoprotein [a] [Lp [a]] is an independent risk factor of early atherosclerosis with atherogenic and thrombogenic properties. Several studies have described a correlation between high plasma Lp [a] level and coronary heart disease, stroke and peripheral atherosclerosis. We measured plasma Lp [a] concentration in 21 patients with primary untreated nephrotic syndrome. Lp [a] levels were determined by immunopreciptin analysis. Data were compared with a healthy control group matched for age and sex. Histological lesions were MCGN in 1 pateint, MPGN in 4 patients, membranoproliferative GN in 8 cases, memberanous GN in 4 cases, focal segmental glomerulosclerosis in 3 patients and crescntic GN in 1 patient. 57% of nephrotic patients had Lp [a] levels > 30 mg /dl compared to 20% in the control group. There was no significant difference in Lp [a] levels with respect to the underlying renal pathology, there was no significant correlation between Lp [a] and urinary protein excretion, renal functions, or with other lipid parameters including total cholesterol, triglycerides, HDL-cholesterol and LDL-cholesterol. There was however a significant inverse correlation between Lp [a] and serum albumin [r = - 0. 464, p = 0.034]. Our findings suggest that decrease in serum albumin led to increased hepatic Lp [a] synthesis