Gihane I. Khalil

Electronic noses for monitoring benzene occupational exposure in biological samples of Egyptian workers

ObjectivesBenzene is commonly emitted in several industries, leading to widespread environmental and occupational exposure hazards. While less toxic solvents have been substituted for benzene, it is still a component of petroleum products and is a trace impurity in industrial products resulting in continued higher occupational exposures in industrial settings in developing countries.Materials and MethodsWe investigated the potential use of an electronic nose (e-nose) to monitor the headspace volatiles in biological samples from benzene-exposed Egyptian workers and non-exposed controls. The study population comprised 150 non-smoking male workers exposed to benzene and an equal number of matching non-exposed controls. We determined biomarkers of benzene used to estimate exposure and risk including: benzene in exhaled air and blood; and its urinary metabolites such as phenol and muconic acid using gas chromatography technique and a portable e-nose.ResultsThe average benzene concentration measured in the ambient air of the workplace of all studied industrial settings in Alexandria, Egypt; was 97.56±88.12 μg/m3 (range: 4.69–260.86 μg/m3). Levels of phenol and muconic acid were significantly (p < 0.001) higher in both blood and urine of benzene-exposed workers as compared to non-exposed controls.ConclusionsThe e-nose technology has successfully classified and distinguished benzene-exposed workers from non-exposed controls for all measured samples of blood, urine and the exhaled air with a very high degree of precision. Thus, it will be a very useful tool for the low-cost mass screening and early detection of health hazards associated with the exposure to benzene in the industry.

Serum chemerin and high-sensitivity C reactive protein as markers of subclinical atherosclerosis in Egyptian patients with type 2 diabetes

Context: Chemerin is one of the adipokines that regulate fat metabolism. High-sensitivity C-reactive protein (hs-CRP) may be considered as a cardiovascular risk predictor. Measuring intima-media thickness of the CCA (C-IMT) is a well-evidenced tool for the detection of early stages of atherosclerosis. We aimed here to study both serum chemerin and hs-CRP as markers of subclinical atherosclerosis in Egyptian patients with type 2 diabetes, who are angiographically free of coronary artery disease (CAD). Subjects and methods: This cross-sectional study was conducted on 180 subjects divided into two groups: Group A included 90 type 2 diabetic patients without CAD and group B including 90 nondiabetic control subjects. All study subjects were having normal coronary angiography. Serum chemerin, homeostasis model assessment for insulin resistance (HOMA-IR), glycated haemoglobin (HbA1c), lipid profile, hs-CRP as well as C-IMT were assessed in all study subjects. Results: There was a statistically significant difference between the 2 groups regarding serum chemerin level, HOMA-IR, hs-CRP and C-IMT; being higher in the diabetic patients than in the control group (p = 0.006, 0.024, 0.040 and <0.001, respectively). There was positive correlation between serum chemerin level and waist-to-hip ratio (WHR), HOMA-IR, hs-CRP and C-IMT. Carotid intima-media thickness was positively correlated with patients’ WHR, blood pressure, HbA1c, diabetes duration as well as hs-CRP, and negatively correlated with ankle-brachial index (ABI). Linear regression analysis showed that HbA1c, serum chemerin and hs-CRP were independently affecting C-IMT. Serum hs-CRP was positively correlated with HbA1c and HOMA-IR (p = 0.006 and 0.032, respectively), and negatively correlated with HDL-cholesterol level (p = 0.018). Conclusion: Both serum chemerin and hs-CRP could be considered as markers of subclinical atherosclerosis, and hence, may be utilized for the early detection of macrovascular disease, in Egyptian patients with type 2 diabetes.

Effects of sleep disordered breathing on functional capacity and quality of life in chronic kidney disease Egyptian patients

PurposeWe assessed the prevalence of sleep disordered breathing (SDB) and investigated its effects on the muscle functional capacity and quality of life (QoL) among chronic kidney disease (CKD) Egyptian patients, either maintained or not maintained on hemodialysis (HD).MethodsThe study population comprised 100 CKD patients who were divided into patients maintained on HD (n = 60; M/F = 28:32) and patients not maintained on HD (n = 40; M/F = 24:16). Patients were observed overnight using the pulse-oximetry technique and further subdivided into patients with SDB and patients without SDB, according to their calculated oxygen desaturation index (cutoff 5). All patients were subjected also to estimation of Kt/V ratio (which is a measure for the efficiency of HD), body-composition analysis, biochemical analysis, muscle functional capacity, and QoL measurements using standard methods and questionnaires, respectively.ResultsPrimary outcomes were intergroup differences regarding physical capacity and muscle performance, QoL, and body-composition measurements. CKD patients in general, either maintained on HD or not, suffer from SDB, and the levels of urea and creatinine may increase the incidence of SDB in CKD patients not maintained on HD. CKD patients maintained on HD with SDB had poorer functional capacity, physical performance, and muscle composition, in comparison with those without SDB.ConclusionsOverall, SDB appears to partly contribute to the total diminished functional capacity of HD patients. Thus, CKD patients maintained on HD with SDB had significantly lower sleep quality and QoL as compared to those not maintained on HD with or without SDB.

Hypogonadism in patients with chronic obstructive pulmonary disease: relationship with airflow limitation, muscle weakness and systemic inflammation

Abstract Objectives To determine the prevalence of hypogonadism in male patients with Chronic obstructive pulmonary diseases (COPD), and to study its impact on skeletal muscle dysfunction and assess the effect of systemic markers of inflammation on testosterone level and muscle function. The study included 50 stable male COPD patients and 30 controls. Methods Both groups were subjected to the following measurements; inflammatory markers levels (high-sensitivity C-reactive protein (hs-CRP) and interleukin – 6 (IL-6)), sex hormones including; serum total (T) and free testosterone (FT), sex hormone binding globulins (SHBG), luteinizing hormone (LH), follicle-stimulating hormone (FSH) and 17β estradiol levels (E2), the exercise capacity (6-minute walk distance (6MWT)) and quadriceps muscle force (One repetition maximum (1RM) and EMG). COPD patients underwent spirometry. Results There was a higher prevalence of hypogonadism in COPD patients than the controls (62% versus 17%). There was a significant negative correlation between serum testosterone levels (T and FT) and the severity of airway obstruction. Quadriceps muscle force and the exercise capacity were significantly lower in COPD patients than controls but they showed no correlation with the testosterone level. Inflammatory markers were significantly higher in COPD patients compared to controls and showed a significant correlation with the severity of airflow obstruction. The higher inflammatory markers levels were related to more muscle weakness as hs-CRP was inversely correlated with the quadriceps strength and exercise capacity, while IL-6 was inversely correlated to quadriceps strength only. Conclusion Hypogonadism is highly prevalent in clinically stable COPD patients and is particularly related to the severity of the airway obstruction. Systemic inflammation is present in stable COPD patients and its intensity is related to the severity of the underlying disease and it predisposes to skeletal muscle weakness and exercise intolerance. However, we failed to find a significant association between hypogonadism and muscle weakness or systemic inflammation.

Accuracy of heparin binding protein: as a new marker in prediction of acute bacterial meningitis

Background Cerebrospinal fluid bacterial culture is the gold-standard for confirmation of acute bacterial meningitis, but many cases are not culture confirmed. Antibiotics reduce the chance of a microbiological diagnosis. Objective to evaluate efficacy of Heparin-binding protein in diagnosis of bacterial meningitis. Patients 30 patients diagnosed with acute bacterial meningitis, 30 viral meningitis, and 30 subjects with normal CSF findings. Design Diagnosis was based on history, clinical criteria, CSF examination, latex agglutination & culture, and sensitivities and response to therapy. HBP was measured using enzyme-linked immunosorbent technique in both serum & CSF. Results Cerebrospinal fluid HBP levels averaged 0.82 ± 0.3 ng/mL in controls, 3.3 ± 1.7 ng/mL in viral and 174.8 ± 46.7 ng/mL in bacterial meningitis. Mean serum level was 0.84 ± 0.3 ng/mL in the controls, 3.7 ± 1.9 ng/mL in viral, and 192.2 ± 56.6 ng/mL in bacterial meningitis. Both HBP levels were significantly higher in patients with bacterial meningitis. Cut-offs of 56.7 ng/ml and 45.3 ng/ml in cerebrospinal fluid & serum showed 100% overall accuracy. Even in patients who received prior antibiotics, remained elevated. Conclusion Serum Heparin-binding protein serves as a non-invasive potential marker of acute bacterial meningitis even in partially treated cases.

Accuracy of combined maternal serum interleukin-8 and salivary estriol in prediction of preterm labor.

Aim: To assess the accuracy of combined maternal serum interleukin and maternal salivary estriol levels in prediction of preterm labor in Egyptian pregnant females. Study Design: Case control study. Place and Duration of Study: It was conducted in El-Shatby University Hospital of Gynecology and Obstetrics, Alexandria, Egypt between 1 Jan to 30 September in the year 2012. Methodology: We included 80 pregnant females of gestational age 28-36 weeks (40 females with preterm labor and 40 pregnant not in labor). Both groups were matched for the womens age and the gestational age. A questionnaire was completed; abdominal and vaginal examinations were done. Maternal serum and saliva were collected for measuring the serum interleukin-8 and salivary estriol levels using ELISA technique. Original Research Article Shehata et al.; BJMMR, 6(10): 978-986, 2015; Article no.BJMMR.2015.274 979 Results: Using ROC curve analysis, the overall diagnostic accuracy of Salivary Estriol alone at cut off point 200 pg/ml in prediction of preterm labor was 58% (0.46-0.71). Sensitivity and specificity were 82.5% and 32.5% respectively. The diagnostic accuracy of combined Salivary Estriol and serum interleukin-8 in prediction of preterm labor was 68% (0.56-0.79). Sensitivity and specificity were 75%% and 60% respectively. Lastly, the maternal serum interleukin-8 had the following accuracy measures for prediction of preterm labor at cut off point 965 pg/ml. (Overall accuracy: 79% (0.69-0.89), sensitivity 92.5% and specificity 42.5%). Conclusion: The maternal serum interleukin-8 is an effective and relatively non invasive and more accurate strategy for prediction of preterm labor at cut off point 965 pg/ml than salivary estriol. (Overall accuracy: 79%, sensitivity 92.5% and specificity 42.5%).

Estradiol Testosterone Ratio, Serum Retinol Binding Protein 4 and Insulin Resistance in Overweight and Obese Egyptian Men

Overweight and obesity are the leading causes for the development of multiple adverse metabolic effects. Retinol Binding Protein 4 (RBP4), a peptide secreted from adipocytes and hepatocytes, provides a new link between obesity and insulin resistance. The objective of this work is to determine RBP4 serum levels and evaluate its relationship with serum testosterone (T), serum estradiol (E2), E2/T ratio and insulin resistance in overweight and obese Egyptian men. The study included 65 men which were subdivided into (20 normal weight, 20overweight and 25 obese). Their mean age was (43.88±5.52). Serum RBP4 was measured by the enzyme linked immunosorbent assay. Serum RBP4 and E2/T ratio were significantly higher, while serum T was significantly lower in overweight and obese groups as compared with normal weight group. In all subjects, serum RBP4 correlated positively with BMI, waist circumference, waist-to-hip ratio (WHR), HOMA-IR, serum E2 and E2/T ratio. In contrast, it correlated negatively with quantitative insulin sensitivity check index (QUICKI) and serum T. In multiple linear regression analysis serum RBP4 was independently associated with E2/T ratio. It could be concluded that serum RBP4 is elevated in overweight and obese as compared with normal weight subjects, and that the disturbance in E2/T ratio seem to affect RBP4 serum levels and insulin sensitivity in obese men.

Effect of adjuvant chemotherapy on carboxytelopeptide of cross-linked type I collagen of egyptian women with non-metastatic breast cancer

Abstract Background: Women with breast cancer are at increased risk for the development of osteoporosis and skeletal fractures, as consequences of aromatase inhibition or chemotherapy-induced ovarian failure. We

Relationship between testosterone, sex hormone binding globulin, angiopoietin related growth factor and insulin resistance in normal weight and obese men

Abstract Background Angiopoietin related growth factor (AGF) is a liver derived factor that potently antagonizes obesity and insulin resistance (IR). Aim The objective of this work is to determine AGF serum levels and evaluate its relationship with total testosterone (TT), calculated free testosterone (cFT), sex hormone binding globulin (SHBG), insulin and IR in normal weight and obese men. Subjects A total of 60 men were included: twenty normal weight subjects with body mass index (18.5–24.7 kg/m2) and 40 obese men with BMI (30–39.5 kg/m2). Methods Serum AGF was measured by enzyme linked immunosorbent assay. Serum TT, SHBG, and insulin were analyzed by chemiluminescent immunoassay. Results Angiopoietin related growth factor was significantly lower in the obese group as compared with normal weight group. In all subjects, AGF correlated positively with TT and SHBG and negatively with 2 h oral glucose tolerance test (OGTT) glucose and fatty liver index (FLI). In normal weight group, AGF correlated positively with age, SHBG, fasting insulin, HOMA-IR, AST and ALT and negatively with BMI, TC and LDL-C. In the obese group, it correlated positively with BMI and negatively with TG. Multiple linear regression analysis revealed that SHBG and fasting glucose were positive predictors of AGF serum levels. In the total sample, SHBG correlated negatively with BMI, fasting glucose, fasting insulin, HOMA-IR, FLI and positively with AGF, QUICKI and HDL-C. Conclusion The present results revealed for the first time an association between SHBG and AGF serum levels. It could be suggested that they overlap to regulate metabolic homeostasis in normal weight men and that the disturbed inter-relationship could contribute to the pathogenesis of insulin resistance and obesity. Moreover, the observed relationship between SHBG and AGF in the present study could clarify the unresolved controversies regarding specific mechanistic relationships between SHBG abnormalities and abnormalities in glucose homeostasis.