Amira Shoukry

Mean platelet volume and its relation to insulin resistance in non-diabetic patients with slow coronary flow

BACKGROUND Increased mean platelet volume is a central process in the pathophysiology of coronary heart disease. Insulin resistance contributes to increased platelet activation. AIM To assess the mean platelet volume and its possible relationship with insulin resistance in non-diabetic patients with slow coronary flow. METHODS AND SUBJECTS The study included 60 patients with slow coronary flow and 20 subjects (controls) with normal coronary arteries. Slow coronary flow patients were divided into 2 groups, insulin resistant (32 patients) and insulin sensitive (28 patients) according to the homeostasis model assessment of insulin resistance index (HOMA-IR). RESULTS Patients with slow coronary flow had significantly higher mean platelet volume values (7.9±0.47 vs. 7.1±0.5, p<0.01), insulin level (10.8±3.2 vs. 8.2±1.4, p<0.01), and HOMA-IR scores (2.72±0.85 vs. 1.84±0.19, p<0.01). These parameters were significantly higher in insulin-resistant patients than in insulin-sensitive ones. The mean platelet volume was correlated with HOMA-IR (r=0.52, p<0.01) and insulin level (r=0.58, p<0.01). In multivariate analysis, mean platelet volume and HOMA-IR were independent predictors of mean TIMI frame count {(B±SE=0.562±2.95, p<0.01) and (B±SE=0.538±2.46, p<0.01), respectively}. CONCLUSION Patients with slow coronary flow have increased mean platelet volume which was associated with insulin resistance in non-diabetic slow coronary flow patients. TIMI frame counts correlated with mean platelet volume and increased insulin resistance. Thus, insulin resistance and platelet activity may have a role in the pathogenesis of slow coronary flow. Also, they may have a possible benefit as follow-up markers in non-diabetic patients with slow coronary flow.

Endothelial Nitric Oxide Synthase Gene Polymorphisms and the Risk of Diabetic Nephropathy in Type 2 Diabetes Mellitus

Endothelial dysfunction plays an important role in the pathogenesis of diabetic vascular disease, including diabetic nephropathy (DN). Endothelial nitric oxide synthase (eNOS) gene polymorphisms that affect eNOS activity are associated with endothelial dysfunction. The aim of this study was to evaluate the association of three polymorphisms of the eNOS gene (894G>T, -786T>C, and 27-bp-VNTR) with the risk of DN among type 2 diabetic patients. A total of 400 type 2 diabetic patients were enrolled in this study. The DN group comprised 200 patients; the group of diabetics without nephropathy comprised another 200 patients. Genetic analysis for eNOS gene polymorphisms was done in all subjects. Measurement of nitric oxide levels was estimated. The C allele for -786T>C and the T allele for 894G>T were significantly more frequent in diabetics with nephropathy than in diabetics without nephropathy (p<0.001; odds ratio [OR] and 95% confidence interval [CI] for the C allele=1.64 [1.24-2.17] and p<0.001; OR and 95% CI=1.7 [1.27-2.26] for the T allele). The haplotypes CTa (with all the mutant alleles) and CTb were significantly more common in patients with DN (p=0.01 and 0.003, respectively). These results suggested that the eNOS polymorphisms might represent genetic determinants for developing DN in type 2 diabetic Egyptians.

Circulating serum irisin levels in obesity and type 2 diabetes mellitus.

Irisin is an exercise‐regulated myokine inducing browning of white adipose tissue and has gained interest as a potential new strategy to combat obesity and its associated disorders, such as type 2 diabetes mellitus (T2DM). The aim of this study is to evaluate the circulating serum irisin levels in obesity and T2DM and also to elucidate possible relationships between serum irisin levels with anthropometric and metabolic parameters of obesity and T2DM. One hundred fifty newly diagnosed T2DM patients as well as 150 nondiabetic control subjects were enrolled in this study. Nondiabetic controls were then stratified according to their body mass index (BMI) into three subgroups; lean, overweight, and obese. Serum irisin levels were evaluated by enzyme‐linked immunosorbent assay. Serum irisin levels were significantly decreased in T2DM patients compared with nondiabetic controls. Obese nondiabetic controls had significantly higher serum irisin levels compared with lean nondiabetic controls. In both nondiabetic controls and T2DM patients, serum irisin was significantly positively correlated with BMI (r = 0.985, P < 0.001 and r = 0.218, P = 0.007, respectively), fat mass (r = 0.959, P < 0.001 and r = 0.202, P = 0.013, respectively), fat‐free mass (r = 0.606, P < 0.001 and r = 0.194, P = 0.017, respectively), fat‐free mass index (r = 0.820, P < 0.001 and r = 0.179, P = 0.028, respectively), waist‐to‐hip ratio (r = 0.880, P < 0.001 and r = 0.194, P = 0.017, respectively), fasting insulin (r = 0.989, P < 0.001 and r = 0.207, P = 0.011, respectively), and HOMA‐IR (r = 0.989, P < 0.001 and r = 0.185, P = 0.023, respectively), whereas; significantly negatively correlated with insulin sensitivity (r = −0.992, P < 0.001 and r = −0.187, P = 0.022, respectively). In this study, we demonstrated that circulating serum irisin levels were increased in obese nondiabetic subjects, while decreased in T2DM patients. Moreover, serum irisin levels were correlated with anthropometric and metabolic markers of obesity and T2DM.

Surgery for hemoptysis in various pulmonary tuberculous lesions: a prospective study

Hemoptysis due to pulmonary tuberculous lesions is a common cause of morbidity, and occasionally mortality. The aim of this study is to evaluate the surgical outcome of hemoptysis in patients with various tuberculous pulmonary lesions. A total of 45 cases who underwent surgical procedures for various pulmonary tuberculous lesions with hemoptysis were included in this study. Sixteen patients underwent surgical management within one week of the attack of hemoptysis (group A), the other 29 patients underwent surgery one week after the attack (group B). Hemoptysis was classified into minor, major and massive hemoptysis. Major and massive hemoptysis were the common presentation of group A and tuberculous cavities were the most common lung lesions in both groups (37.7%). Lobectomy was the main surgical procedure performed in both groups (51.1%). Bronchopleural fistula occurred in one case in each group after right pneumonectomy. There was one case (6.2%) of mortality in group A. Tuberculous cavity is the common pulmonary lesion which can result in major and massive hemoptysis, therefore, we recommend early surgical resection of tuberculous cavities to avoid life-threatening hemoptysis. Limited resection should be avoided to prevent recurrence.

Serum miRNA‐499 and miRNA‐210: A potential role in early diagnosis of acute coronary syndrome

In clinical practice, there is still a need for novel biomarkers, which can reliably rule in or rule out acute coronary syndrome (ACS) immediately on admission. This is of particular interest in patients with unstable angina (UA) and non‐ST‐segment elevation myocardial infarction (NSTEMI) in whom diagnostic uncertainty is high. The aim of the present study is to evaluate the potential role of miRNA‐499 and miRNA‐210 as novel molecular biomarkers for early diagnosis of UA and NSTEMI suspected patients presented at the emergency unit. A total of 110 patients presenting to the intensive care unit (ICU) within 24 h of onset of chest pain suggestive of ACS were enrolled in the study. They included 37 UA, 48 NSTEMI and 25 noncardiac chest pain (NCCP) patients. Immediately at enrollment, blood samples were taken for estimation of serum miRNA‐499 and miRNA‐210 expression levels by real time PCR. miRNA‐499 and miRNA‐210 expression levels were significantly increased in UA and NSTEMI patients compared with NCCP patients (P < 0.001). Receiver operating characteristic (ROC) curve analysis revealed that the area under curve (AUC) of miR‐499 for the diagnosis of UA and NSTEMI was 0.98 and 0.97, respectively; while the AUC of miRNA‐210 was 0.84 and 0.90, respectively. The important finding of our study was that the AUC of miRNA‐499 for the diagnosis of ACS patients with symptoms onset <3 h was 0.89, while the AUC of miRNA‐210 was 0.86. Interestingly, combining miRNA‐499 and miRNA‐210 significantly improved the diagnostic value by increasing the AUC to 0.96, P < 0.001. In conclusion, serum miRNA‐499 and miRNA‐210 are associated with UA and NSTEMI and with those presenting within 3 h of symptom onset. Both miRNAs might be potentially novel biomarkers for accelerating the diagnosis of ACS patients in emergency unit.

Association of adiponectin with cardiovascular events in diabetic and non-diabetic hemodialysis patients

Adiponectin is a novel collagen-like protein synthesized by white adipose tissue. Its levels are decreased in obesity, type-2 diabetes and insulin-resistant states, and are increased in chronic renal failure. It has anti-inflammatory and anti-atherogenic properties. This study was planned to evaluate the levels of adiponectin in uremic patients with and without diabetes and to find any relationship between adiponectin levels and some cardiovascular risk factors, and to determine the possible predictive value of adiponectin for cardiovascular complications (CVC). The study included 100 subjects, 20 of them were healthy subjects and served as the control group (group I), 40 were uremic non-diabetic patients (group II) (half of them were without CVC, group IIA, and the other half were patients with CVC, group IIB) and, lastly, 40 uremic diabetic patients (group III) (half of them were without CVC, group IIIA, and the other half were patients with CVC, group IIIB). All subjects were subjected to complete clinical examination, including determination of mean arterial blood pressure (MABP), body mass index (BMI), waist to hip ratio, routine laboratory investigations, fasting plasma glucose, fasting plasma insulin, lipid profile (cholesterol, TG, LDL, HDL), determination of insulin resistance by homeostasis model assessment index (HOMA-IR) and estimation of serum levels of adiponectin. There was a significant increase in serum adiponectin levels in all the uremic patients (group II and group III) when compared with the control (group I) group, P <0.01; also, serum adiponectin levels were significantly decreased in uremic diabetic patients (group III) when compared with uremic non-diabetic patients (group II), P <0.01; but this was still higher than in the controls. The patients with CVC, whether uremic non-diabetic (group IIB) or uremic diabetic (group IIIB), had a significant decrease in serum adiponectin levels when compared with patients without CVC (group IIA and group IIIA), P <0.01. Serum adiponectin has a significant positive correlation with HDL and a significant negative correlation with MABP, BMI, plasma insulin, HOMA-IR, LDL, TG and cholesterol in all the patients. Therefore, it can be concluded that adiponectin levels in uremic patients, whether diabetic or non-diabetic, may be a good indicator of cardiovascular disease risk.

Lipid peroxidationand antioxidant statusin overt and subclinical hypothyroidism

Amira Shoukry. Background: Oxidative stress, caused by an imbalance in reactive oxygen species produced during normal cell metabolism and/or deficiency of scavenger antioxidant defense, has been implicated in the pathology of several human diseases, including endocrine diseases of thyroid gland. Aim of the work: The aim of this study is to evaluate the serum levels of malondialdehyde (MDA), a product of lipid peroxidation, and the antioxidant enzymatic activities of superoxide dismutase (SOD) and catalase (CAT) as well as the total antioxidant capacity (TAC) in overt and subclinical hypothyroidism. Subjects and methods: Forty eight newly diagnosed hypothyroid patients, 24 patients of them have subclinical hypothyroidism (SHT) while the other 24 patients have overt hypothyroidism (OHT), as well as 24 healthy euthyroid control subjects were enrolled in this cross sectional study. Laboratory investigations including lipid profile, thyroid functions as well as levels of serum MDA, SOD, catalase and TAC were estimated. Results: Both OHT and SHT patients had significantly higher serum TSH, total cholesterol (TC), triglycerides (TGs), LDL-C, catalase, SOD and MDA levels as well as significantly lower serum HDL-C and TAC levels when compared to euthyroid control subjects. The correlation study revealed that serum TSH levels were significantly positively correlated with TC, LDL-C and TGs serum levels and significantly negatively correlated with HDL-C levels. Moreover, serumMDA, CAT and SOD levels showed significantly positive correlation with TSH, TC, LDL-C and TGs serum levels and a significant negative correlation with free T4, free T3 and HDL-C serum levels.Furthermore, TAC levels showed a significant positive correlation with free T4, free T3 and HDL-C serum levels and a negative correlation with TSH, TC, TGs and LDLC serum levels. Conclusions: The present study demonstrated that patients with both OHT and SHT showed increased lipid peroxidation and oxidative stress which was evidenced by the increased levels of MDA, a lipid peroxidation product, and the induction of SOD and CAT antioxidantenzymatic activities. Increased MDA and other free radical production could overload the antioxidant system resulting in consumption and severe depletion of antioxidants with concomitant reduction in total antioxidant capacity.