Elevated serum tumor necrosis factor alpha and ferritin may contribute to the insulin resistance found in HCV positive Egyptian patients.

OBJECTIVE: There is evidence of an increased incidence of insulin resistance and diabetes mellitus (DM) in patients with hepatitis C virus (HCV) infection. Several mechanisms have been proposed, including inadequate insulin secretion or interference with signaling within the insulin receptor. We assessed serum tumor necrosis factor alpha (TNFalpha) and ferritin levels as potential mediators of insulin resistance in HCV positive Egyptian patients. PATIENTS AND RESULTS: Patients (n = 27) with HCV infection, patients (n = 23) with hepatitis C and DM (HCV + DM), patients (n = 22) with DM, and sex- and age-matched controls (n = 18) were included in this study. The degree of insulin resistance (HOMA index) was significantly higher in the HCV, HCV + DM and DM groups compared to the controls. The mean +/- SD of the HOMA index was 4.53 +/- 2.84, 6.1 +/- 2.36, 3.69 +/- 2.2 and 1.32 +/- 0.49, in HCV, HCV + DM, DM and controls, respectively. Serum TNFalpha levels were significantly higher in the HCV, HCV + DM groups compared with the healthy controls and DM patients (p < 0.001). The median (range) values of TNFalpha in HCV, HCV + DM, DM patients and controls subjects were 25.5 (0.43-124.0), 19.8 (0.51-139), 0.85 (0-10.5) and 0.32 (0-5.8) pg/mL, respectively. There was a significant positive correlation between the HCV load and both HOMA index and TNF alpha level. HCV and HCV + DM patients also had significantly higher serum ferritin levels compared with healthy controls and patients with DM. The mean +/- SD of serum ferritin in HCV, HCV + DM, DM patients and controls subjects was 258.1 +/- 116.2, 285.8 +/- 124.3, 86.9 +/- 41.8 and 159.9 +/- 76.9 ng/mL, respectively. CONCLUSION: Patients with HCV infection had a significantly higher level of TNFalpha and ferritin which may explain their insulin resistance. HOMA index and serum TNFalpha levels correlated positively with the HCV load.

[Coronary angiography: 1st or 2nd-line test?]. / La coronarographie: examen de premiére ou de deuxième intention?

Coronary angiography, although now performed extremely frequently, remains an invasive and expensive examination, whose place, as first-line diagnostic method, must be discussed; Its main advantage is to provide a definitive diagnosis of coronary atherosclerosis as well as simple prognostic indicators (single vessel, two-vessel or three-vessel disease; concomitant evaluation of left ventricular function by associated radiological ventriculography). However, it is unable to precisely assess the degree of coronary wall disease and, more importantly, cannot evaluate the functional repercussions of stenosis. Under these conditions, only cases in which myocardial revascularization is expected to provide a definite clinical benefit (presence of frank angina symptoms) probably justify first-line coronary angiography. In all other cases, coronary angiography is a useful examination to provide reference "mapping" of the coronary lesions, but an obvious clinical benefit for the patient cannot be expected from systematic use of this technique. In particular, in such situations, coronary angiography should not be the only element on which the decision to perform myocardial revascularization should be based: the "oculostenotic reflex" must always be avoided.