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  Citation statistics : Table of Contents
   2013| October-December  | Volume 25 | Issue 4  
    Online since January 27, 2014

 
 
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ORIGINAL ARTICLES
Zinc level and obesity
Doaa S.E. Zaky, Eman A Sultan, Mahmoud F Salim, Rana S Dawod
October-December 2013, 25(4):209-212
DOI:10.4103/1110-7782.124985  
Background Obesity is a chronic condition that is associated with disturbances in the metabolism of zinc. Therefore, the aim of this study was to investigate the relationship between serum zinc level and different clinical and biochemical parameters in obese individuals. Patients and methods Twenty-four individuals with BMI more than 30 kg/m 2 and 14 healthy controls (BMI < 24 kg/m 2 ) were assessed for BMI and waist circumference using anthropometric measurements. Colorimetric tests were carried out for the determination of zinc in serum. Results In this study, BMI and waist circumference were higher in the obese group than in the control group (P < 0.05). The mean serum zinc levels were 92 ± 31.1 and 101 ± 70 μg/dl in the obese group and control group (P > 0.05), respectively. There was a significant negative correlation between the serum zinc level and BMI, waist circumference and low-density lipoprotein (P < 0.05). Conclusion Plasma zinc concentration in obese individuals showed an inverse relationship with the waist circumference and BMI as well as serum low-density lipoprotein-cholesterol and correlated positively with high-density lipoprotein.
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Associations of fetuin-A level with vascular disease in hemodialysis patients with or without type II diabetes mellitus
Amani K Mohamed, Amany M Abdallah, Maha A Hassan, Nagwa A Mohammed, Solaf A Kamel
October-December 2013, 25(4):218-224
DOI:10.4103/1110-7782.124996  
Introduction Fetuin-A is a circulating inhibitor of calcium deposition in the vasculature and may be involved in the pathogenesis of cardiovascular disease. Low plasma fetuin-A level is independently associated with increased risk for cardiovascular disease mortality among men and women without diabetes; in addition, low level of fetuin-A is linked to mortality in patients on dialysis. Aim of the study The aim of the study was to investigate the role of fetuin-A as a marker for microvascular and macrovascular diseases in a high-risk population of end-stage renal disease patients on dialysis, with and without diabetes mellitus. Patients and methods This study included 30 end-stage renal disease patients on regular hemodialysis, with and without diabetes and 10 age-matched and sex-matched apparently healthy controls. All patients were subjected to careful history-taking, including history of strokes and acute myocardial infarction and thorough physical examinations, and cardiac assessment was performed using ECG and ECHO. Routine laboratory tests were performed, such as hemoglobin, fasting blood glucose, serum creatinine, serum urea, serum Na, serum K, uric acid, serum cholesterol, serum triglycerides, serum aspartate aminotransferase, serum alanine aminotransferase, serum albumin, serum calcium, serum phosphorus, intact parathyroid hormone (iPTH), serum iron, total iron binding capacity (TIBC), and serum fetuin-A. Results The study showed significant statistical decrease in serum fetuin-A level in chronic renal failure (CRF) and diabetes patients with vascular strokes when compared with CRF patients and CRF patients with diabetes without history of vascular strokes. There was significant positive correlation between fetuin-A and hemoglobin, serum Ca, serum albumin, TIBC, and total protein (TP), whereas there was significant negative correlation between fetuin-A and serum cholesterol, serum triglyceride (TG), fasting blood glucose (FBG), serum urea, serum creatinine, serum uric acis (UA), iPTH, serum Na, and serum K. No correlation was found between fetuin-A and age or BMI. Conclusion Our findings suggest a unique role for fetuin-A deficiency as a biomarker of vascular diseases in the setting of CRF and type 2 diabetes mellitus.
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CME
Questions and guide to answers
Hoda Atya
October-December 2013, 25(4):232-236
DOI:10.4103/1110-7782.125010  
  - 1,863 155
ORIGINAL ARTICLES
Angiopoietin-2 in chronic renal failure patients on hemodialysis: Relationship with glomerular filtration rate in the predialysis stages
Fatma A Attia, Nagwa A Mohammed, Al-Shymaa A Ibrahim
October-December 2013, 25(4):225-231
DOI:10.4103/1110-7782.125003  
Introduction Cardiovascular disease has increased as a complication of chronic kidney disease even in the absence of diabetes or hypertension. Angiopoietin-1 and 2 are 55 kDa antagonistic nonredundant gatekeepers of endothelial activation and thus are potential important factors in accelerated atherosclerosis. Aim of the study The aim of the study was to determine angiopoietin-2 level in patients on hemodialysis (stage 5) and in the predialytic stages (stages 3 and 4) and to find the relationship between angiopoietin-2 levels and glomerular filtration rate in the predialytic stages. Patient and methods We prospectively studied 75 patients divided into three groups and 12 healthy controls. Group 1 included 33 patients on maintenance hemodialysis three times a week; group 2 included 21 patients with stage 3 chronic kidney disease; and group 3 included 21 patients with stage 4 chronic kidney disease. Results We found highly significant (P < 0.01) increase in mean serum angiopoietin-2 levels in all three groups compared with the control. The mean angiopoietin-2 in group 1 was 1669.09 ± 472.64 pg/ml, in group 2 was 1206.91 ± 154.26 pg/ml, in group 3 was 1642.24 ± 113.01 pg/ml, and in control was 476.29 ± 150.37 pg/ml. Furthermore, we found highly significant (P < 0.01) increase in group 1 compared with group 2 and group 3, and in group 3 compared with group 2. Our result revealed significant negative correlation of angiopoietin-2 level with estimated glomerular filtration rate in group 2 (r - 0.858, P < 0.01) and group 3 (r - 0.825, P < 0.01), with hemoglobin in group 1 (r - 0.438, P < 0.01), and with BMI (r − 0.468, P < 0.05) and cholesterol (r − 0.503, P<0.05) in group 3; significant positive correlation was observed with uric acid (r 0.456, P < 0.05) in group 3. Conclusion Circulating angiopoietin-2 is a putative marker and potential mediator of atherosclerosis, is inversely related to glomerular filtration rate, and is increased with advanced chronic kidney disease. Normolipidemia in chronic kidney disease patients does not prevent atherosclerotic burden; this is because of the presence of other markers such as angiopoietin-2.
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Association between insulin resistance, metabolic syndrome, and duration of hepatitis C in Egyptian patients
Ebtissam Zakaria, Tarek Fayad, Mary N Rizk, Nashwa S Ghanem, Maisa Kamal
October-December 2013, 25(4):213-217
DOI:10.4103/1110-7782.124987  
Background Chronic hepatitis C virus (HCV) infection affects around 170 million individuals worldwide. Egypt has one of the highest prevalence of patients with HCV worldwide. A higher prevalence of insulin resistance (IR) is found in this population. Aim The aim of this work was to study the relation between IR, metabolic syndrome (MS), and hepatitis C in nondiabetic patients and to assess their relation to the duration of HCV infection. Patients and methods This was a cross-sectional study of 50 participants matched for age (49 ± 7.6 years), sex, and BMI. These participants were divided into three groups: 20 controls, 15 patients with HCV for less than 10 years' duration, and 15 patients with HCV for more than 10 years. We assessed patients for MS according to the AACE diagnostic criteria. Fasting and postprandial insulin levels were also assessed. IR was evaluated using the homeostasis model assessment-insulin resistance (HOMA-IR) equation. Results There was a statistically significant difference in HOMA-IR levels between controls (median 0.43 μU/ml) and those with HCV for more than 10 years (median 0.75 μU/ml; P = 0.001) as well as those with HCV for less than 10 years (median 0.89 μU/ml; P = 0.001). There was no significant difference in HOMA-IR levels between both groups of HCV (P = 0.8). The increase in the HOMA-IR test values was mainly because of increased fasting insulin levels in both groups because of the significant positive correlation between HOMA-IR and fasting insulin in patients with chronic HCV less than and those more 10 years' duration (r = 0.902, r = 1, respectively; P = 0.001 in both groups). MS was found in four of 15 patients in each group of patients; yet, none of the controls fulfilled the diagnosis criteria. Conclusion MS and IR are significantly higher in Egyptian HCV patients when compared with normal controls irrespective of the duration of HCV.
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Assessment of immunoglobulin G antibodies against oxidized low-density lipoproteins in patients with acute coronary syndrome
Mohamed S Mokhtar, Hanan Zaghla, Wael Samy, Abdou Mahmoud
October-December 2013, 25(4):177-184
DOI:10.4103/1110-7782.124976  
Background Oxidative modification of low-density lipoproteins (LDLs) induces formation of immunogenic epitopes in the LDL molecule, which leads to the formation of antibodies against oxidized low-density lipoprotein (OxLDL) that can be detected in serum. Aim of the study The objective of this study was to evaluate the association between autoantibodies against OxLDL and acute coronary syndrome (ACS). Patients and methods A total of 50 patients diagnosed as having ACS (37 male patients and 13 female patients), age ranging between 19 and 82 years and admitted to the critical care department, Cairo University, and 19 matched healthy controls were enrolled in our study. All patients were subjected to detailed medical history-taking and physical examination, serial 12-lead ECGs, serial cardiac biomarkers on admission and 24 h later, echocardiography, coronary angiography and assessement of severity using the Gensini score, and IgG anti-OxLDL antibodies measurement. Results We found significant difference in the level of antibody between patients with ACS and matched healthy controls (P < 0.001). With respect to the correlation of anti-OxLDL antibodies and the severity of ACS, we found significant correlation between the level of antibodies in patients with ACS as assessed by the Gensini score (r = 0.709) as well as between the echocardiographic findings as assessed by the wall motion score index (r = 0.589). During hospitalization, there was significant correlation of the antibody level with mechanical complications (P = 0.047) and needed immediate intervention (P < 0.001). However, the antibody level was correlated with malignant arrhythmias but P value (0.219) was insignificant because of high SD, and there was no correlation with ischemic complications (P = 0.798). Conclusion With respect to the correlation of anti-OxLDL antibodies and ACS, the patients with ACS had higher anti-OxLDL antibodies level. In addition, anti-OxLDL antibodies level was correlated with the Gensini score, wall motion score index, and major adverse cardiovascular events during hospitalization.
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Outcome of critically ill hyperglycemic stroke patients admitted to the intensive care unit
Kamel Abdelaziz Mohamed, Ahmad Saad
October-December 2013, 25(4):185-190
DOI:10.4103/1110-7782.124979  
Introduction It has been suggested that admission hyperglycemia is a marker of extensive brain damage. Despite these observations, studies that have examined the relationship between glucose levels and the outcome after stroke in diabetic and nondiabetic patients have reported conflicting results. Aim We evaluated data on stroke patients admitted to the intensive care department to estimate the influence of hyperglycemia on the short-term mortality in both diabetic and nondiabetic patients. Patients and methods A total of 100 consecutive adult patients with stroke admitted to the ICU were studied over a period of 28 months. The patients were followed up for 28 days until discharge from the hospital or until death, whichever occurred first. The patients were divided into three broad groups, on the basis of fasting blood glucose or random sugar and HbA1c to rule out undetected diabetes patients. Results There were no significant differences in the stroke subtype or the baseline stroke severity between diabetic (group 3) and hyperglycemic (group 2) patients. Also, there was no significant association between the stroke severity and the glycosylated hemoglobin level in group 2 and group 3 (r = 0.26, P = 0.4; r = 0.19, P = 0.31; respectively). With regard to an excellent outcome of stroke, which was measured by the modified Rankin scale (0-1), there was no significant difference between group 2 and group 3. The unadjusted risk ratio was 1.85 (95% confidence interval 0.52-4.41) for group 2, whereas it was 1.25 (95% confidence interval 0.7 6-4.3) in group 3. Nondiabetic patients with hyperglycemia had a 1.6 times higher relative risk of in-hospital 28-day mortality than diabetic patients. There were four nonsurvivors (11%) out of 36 patients in the control nondiabetic (group 1), whereas eight (26%) of 31 patients died in group 2, which was statistically significant when compared with group 1 (P = 0.02). However, six nonsurvivors (18%) of 33 in group 3 when compared with group 2 was statistically significant (P = 0.04). Conclusion Our current study showed that nondiabetic patients with hyperglycemia had a 1.6 times higher relative risk of in-hospital 28-day mortality than diabetic patients. Stress hyperglycemia predicts an increased risk of in-hospital mortality after ischemic stroke; thus, we should not underestimate the potential harm, as patients with the highest admission glucose levels would have most likely been treated earlier and more aggressively.
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New insight into the pathogenesis of insulin resistance in hyperthyroidism and hypothyroidism
Heba H El Demellawy, Mohamed A El Feky, Rania A Shoier, Olfat G Shaker
October-December 2013, 25(4):191-195
DOI:10.4103/1110-7782.124980  
Background and aim Thyroid hormones are linked to the different metabolic processes in the body.We evaluated the association of metabolic syndrome and different thyroid diseases. Patients and methods Eighty female patients were enrolled in this study; 40 hypothyroid (group I) and 40 hyperthyroid (group II) as well as 40 healthy females as control group. Waist circumference, BMI, fasting blood glucose, fasting insulin, HOMAIR index, adiponectin, free T3, freeT4, TSH, total cholesterol and HDL were measured in all patients. Results Adiponectin was lower in hypothyroid group (3.68 ± 0.63 ng/dl) and higher in hyperthyroid group (7.52 ± 0.68 ng/dl) than the control group (5.11 ± 0.67 ng/dl) P = 0.0001. The HOMAIR was higher in both hypothyroid (3.56 ± 0.57 ng/dl) and hyperthyroid groups (1.68 ± 0.27) compared to control group (1.33 ± 0.25) P = 0.0001. The cholesterol was also higher in both hypothyroid (161.22 ± 12.98 mg/dl) and hyperthyroid (147.02 ± 8.7 mg/dl) compared to control group (134.74 ± 6.34 mg/dl) P = 0.0001. The HDL was low in both hypothyroid group (35.86 ± 3.55 mg/dl) and hyperthyroid group (40.34 ± 3.17 mg/dl) compared with the control group (41.64 ± 3.12 mg/dl) P = 0.04. The adiponectin was positively correlated to free T3, free T4 and negatively correlated to TSH (r = 0.8, P = 0.0001; r = 0.9, P = 0.000; r = -0.9, P = 0.0001) respectively. HOMAIR was significantly correlated to the thyroid parameters (r = -0.8, P = 0.0001; r = -0.9, P = 0.0001; r = 0.8, P = 0.0001) respectively. The total cholesterol was negatively correlated with the free T3 and T4 (r = -0.5, P = 0.0001; r = -0.5, P = 0.0001) and positively correlated with the TSH (r = 0.5, P = 0.0001), It was also negatively correlated with adiponectin (r = -0.5, P = 0.0001), and positively correlated with HOMAIR (r = 0.5, P = 0.0001). The HDL was negatively correlated with TSH (r = -0.5, P = 0.000) and HOMAIR (r = -0.5, P = 0.0001), it was positively correlated with free T3, T4 (r = 0.6, P = 0.000; r = 0.5, P = 0.000) and adiponectin (r = 0.5, P = 0.0001). Conclusion Both hypo and hyperthyroidism were associated with insulin resistance and disturbances in lipid profiles.
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Colonic mucosal changes in Egyptian patients with liver cirrhosis and portal hypertension
Zakaria A Salama, Ahmad N Hassan, Samar K Darweesh
October-December 2013, 25(4):196-201
DOI:10.4103/1110-7782.124981  
Background and aims In patients with liver cirrhosis and portal hypertension (PHT), portal hypertensive colopathy (PHC) is thought to be an important cause of lower gastrointestinal bleeding. This study aimed at evaluating the prevalence and clinical significance of colonic mucosal changes in Egyptian patients with liver cirrhosis and PHT. Patients and methods A prospective study was conducted on 35 patients with liver cirrhosis and PHT (proved by upper endoscopy and/or abdominal ultrasonography). They were evaluated using full colonoscopy to detect changes in colonic mucosa and using gastroscopy to detect the presence of both gastroesophageal varices and portal hypertensive gastropathy. Results Colonic lesions were found in 27 patients (77.1%), including haemorrhoids in 20 patients (57.1%), diffuse hyperaemic mucosa in 16 patients (45.7%), angiodysplastic lesions in 12 patients (34.3%) and rectal varices in five patients (14.3%). Bleeding per rectum was detected in seven patients (20%), and it significantly correlated with the presence of haemorrhoids (P = 0.02). The prevalence of PHC and the presence of haemorrhoids increased with the worsening Child-Pugh class (P = 0.01 and 0.02, respectively). Conclusion The prevalence of PHC and haemorrhoids increases with the progression of liver disease and worsening of the Child-Pugh grading in cirrhotic patients. However, haemorrhoids, rectal varices, hyperaemia and colonic angiodysplasia are not affected by the presence of portal hypertensive gastropathy.
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Serum visfatin in chronic renal failure patients on maintenance hemodialysis: A correlation study
Abdel Wahab M Lotfy, Nagwa A Mohammed, Hanan M El-Tokhy, Fatma A Attia
October-December 2013, 25(4):202-208
DOI:10.4103/1110-7782.124982  
Background and aim of work Endothelial dysfunction, atherosclerosis, and cardiovascular disease are strongly linked to chronic kidney disease. It has been hypothesized that visfatin may play an important role in uremia-related atherosclerosis and the relation between visfatin and endothelial dysfunction has been proved. We aimed to study and characterize the relation of visfatin to some clinical and biochemical parameters among chronic renal failure (CRF) patients on regular hemodialysis. Patients and methods This study was carried out on a total of 90 individuals, divided into two groups: group A included 68 patients with CRF on regular hemodialysis (44 men and 24 women) and group B included 22 healthy individuals as controls (four men and 18 women). All participants were subjected to the following: full clinical assessment, BMI assessment, FBS (Fasting blood sugar), PPBS (postprandial blood sugar), Hb level, lipid profile, serum urea, creatinine, potassium, phosphorus, and serum visfatin. Results Serum visfatin concentration was significantly high in group A (uremic on hemodialysis) compared with group B (control) (48.95 ng/ml ±11.62 compared with 22.65 ng/ml ± 5.24; P < 0.001); a highly significant positive correlation was found between serum visfatin and serum low-density lipoprotein (r = 0.39; P < 0.001) and a significant positive correlation between serum visfatin and serum triglycerides and serum uric acid (r = 0.28; P < 0.05 and r = −0.24; P < 0.05), respectively, whereas a highly significant negative correlation between serum visfatin and Hb (r = −0.43; P < 0.001) and a significant negative correlation between serum visfatin and serum urea (r = −0.25; P < 0.05), blood sugar, both fasting and postprandial (r = −0.34; P < 0.001 and r = −0.39; P < 0.001), respectively, were found in the patients in group A, without a significant correlation either to high-density lipoprotein, serum creatinine, the etiology of CRF, or to the duration of dialysis in the patients in group A. Conclusion This study proves the association of serum visfatin with CRF, unrelated to the biochemical parameter of kidney functions; however, further studies to examine visfatin expression within renal tissue may clarify its definitive role in CRF.
  - 1,735 242
REVIEW ARTICLE
Thyroxine mimetics
Randa F Salam
October-December 2013, 25(4):171-176
DOI:10.4103/1110-7782.124969  
Thyroid hormones influence heart rate, serum lipids, metabolic rate, body weight, and multiple aspects of lipid, carbohydrate, protein, and mineral metabolism. Although increased thyroid hormone levels can improve serum lipid profiles and reduce fat, these positive effects are counterbalanced by the harmful effects on the heart, muscle, and bone. Thus, attempts to use thyroid hormones for cholesterol-lowering and weight loss purposes have so far been limited. However, over the past decade, thyroid hormone analogs that are capable of uncoupling the beneficial effects from the deleterious effects have been developed. Such drugs could serve as powerful new tools to address two of the largest medical problems, namely atherosclerosis and obesity. Aggressive reduction in LDL-cholesterol by the use of statins is a cornerstone of preventive cardiovascular risk, but additional therapies to prevent atherosclerosis and its clinical sequelae are still needed. Thyromimetics selective for the liver or the thyroid hormone receptor isoform β1 constitute a novel approach to treat dyslipidemia. In preclinical studies, selective thyromimetics were clearly shown to reduce plasma cholesterol and protect from atherosclerosis through the upregulation of hepatic LDL receptor and promotion of the so-called reverse cholesterol transport. Notably, there is the first evidence from on-going clinical trials that selective thyromimetics may reduce plasma cholesterol in humans also. Most importantly, thyromimetics has a synergistic action when used in combination with 3-hydroxy-3-methylglutaryl CoA reductase inhibitors. Animal data have further suggested that thyromimetics might be useful in the treatment of obesity, hepatic steatosis, and atherosclerosis.
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