Hala Mourad Demerdash

Delta neutrophil index versus lactate clearance: Early markers for outcome prediction in septic shock patients

Abstract Background This study was carried out to evaluate, compare the clinical utility of delta neutrophil index (DNI) values and lactate-6h-clearance as early indicators for outcome prediction in septic shock patients and to find out and correlate the specificity and sensitivity of each to the patients mortality. Methods The study was carried out in Alexandria Main University Hospital on 53 adult patients with severe sepsis/septic shock after taking an informed written consent and approval of the ethics committee. All patients received all standard therapy and resuscitation measures. Arterial blood samples were obtained for measurement of DNI using an ADVIA 2120 automated cell analyzer. Initial arterial serum lactate level and arterial lactate after 6 h from admission were measured for lactate-6h-clearance calculation. Primary outcome measures were hospital mortality (non-survivors) and discharge or transfer to a general medical ward (survivors). Data were analyzed by SPSS® software using (“t” test and chi-square χ2) P < 0.05 was considered significant. Results A total of 53 severe sepsis/septic shock patients were enrolled in the study, patients were (36) survivors and (17) non-survivors. This study demonstrated the reliability of DNI and lactate-6h-clearance as predictors of negative outcome. Variables identified by the backward logistic regression model as significantly correlated with negative outcome were lactate-6h-clearance <15%; (sensitivity, 92.5%; specificity, 85.0%; positive predictive value, 90.0%; and negative predictive value, 88.0%) and DNI value >5.2; (sensitivity, 95.0%; specificity, 90.0%; positive predictive value, 92.0%; and negative predictive value, 95.0%). Conclusion Monitoring of lactate-6h-clearance can be used to identify patients with severe sepsis/septic shock at high risk of mortality. DNI may serve as a more useful diagnostic and prognostic marker for early diagnosis of disease severity in patients with severe sepsis/septic shock, it is suggested that, increased DNI value should alert clinicians to apply more aggressive therapy.

Occupational stress of anesthesia: Effects on aging

BACKGROUNDnAnesthesiology has been identified as a stressful specialty. Chronic psychological stress may lead to biological aging and skin aging.nnnSTUDY OBJECTIVEnThe primary outcome was to measure physical health and emotional well-being. Secondary outcomes include skin aging analysis, telomere shortening in anesthetists.nnnDESIGNnThis is a prospective observational study.nnnSETTINGSnUniversity of Alexandria.nnnPATIENTSnStudy was carried out on 366 ASA I-II physicians 30-50yr.nnnINTERVENTIONSnPhysicians were categorized into two equal groups, Group A (183) were anesthesia physicians and Group B (183) were physicians in less stressful specialties (laboratory specialties). Subgroup analysis was performed comparing 10years intervals from (30-40) and from (40-50).nnnMEASUREMENTSnPhysical health and emotional well-being were evaluated. All physicians were exposed to validated assessment scales for the upper face and the lower face for skin aging analysis. Blood sampling were drowned from all physicians during their working hours for analysis of telomere length, markers of oxidative stress.nnnRESULTSnThe two studied groups showed comparable demographic data and years of work. Physical health score and emotional health score showed higher values in Group A than Group B. Upper and lower face aesthetic unit summary score showed higher values in Group A than Group B. Telomere (TTAGGG) repeats for terminal restriction fragments (TRF) of Group A individuals revealed a significant decrease of TRF compared to Group B (p=0.001*).nnnCONCLUSIONnBiological and skin aging is evident in anesthetists who are chronically exposed to occupational stress, with obvious shorter telomere length, higher lower and upper face scores, and free radicals.

Detection of MicroRNA in Hepatic Cirrhosis and Hepatocellular Carcinoma in Hepatitis C Genotype-4 in Egyptian Patients

Background In Egypt, the prevalence of chronic hepatitis C (CHC) infection is 13.8% of whole population and about 80% of the patients with hepatocellular carcinoma have underling hepatitis C. Aim This study was designed to assess the diagnostic value of plasma miR-122 and miR-21 in patients with CHC, genotype-4, to detect fibrosis progression versus noninvasive indices and their diagnostic value in detection of early stages of hepatocellular carcinoma (HCC). Methodology A prospective study that included 180 patients, divided into 3 groups: healthy controls (group I), CHC patients (group II), and hepatitis C patients with HCC (group III); all cases were subjected to thorough clinical, radiological, and laboratory investigations. Selected biomarkers were evaluated and correlated with degree of liver damage. Results revealed that miR-122 followed by miR-21 had the highest efficiency in prediction of liver cell damage. Also, miR-21 was strongly correlated with vascular endothelial growth factor (VEGF) and alpha fetoprotein (α-FP) in HCC patients. Conclusions Plasma miR-122 and miR-21 had strong correlation with degree fibrosis in HCV genotype-4 patients; consequently they can be considered as potential biomarker for early detection of hepatic fibrosis. Moreover, miR-21 can be used as a potential biomarker, for early detection of HCC combined with VEGF and α-FP.

Differential effects of gastric bypass and banding on the cardiovascular risk profile in morbidly obese subjects: The correlation with plasma apolipoprotein A-IV concentration

Abstract Background Weight loss (5–10%) improves obesity-associated cardiovascular risk factors. The aim of this work was to study the effect of 2 commonly performed bariatric surgical procedures; laparoscopic Roux-en-Y gastric bypass (RYGBP) and laparoscopic gastric band (BAND), on the cardiovascular risk profile in morbidly obese patients and its correlation with the plasma apolipoprotein (apo) A-IV level. Patient and method This study was carried prospectively on 34 patients scheduled for bariatric surgery. They were randomly assigned into two groups; group 1 = BAND (18 cases), group 2 = gastric bypass RYGBP (16 cases). Both groups were studied preoperatively and twelve months after surgery. Data collected included changes of body mass index (BMI), blood pressure, fasting blood sugar, fasting serum insulin, insulin resistance (HOMA-IR) and lipid profile. In addition, apo A-IV was determined by the Western blot technique. Results The results demonstrated a highly significant reduction in body weight as determined by reduction in the BMI in both groups I & II compared to preoperative measurements. Moreover, both groups had a significantly lower systolic blood pressure, fasting blood glucose (FBG), fasting serum insulin and HOMA-IR twelve months after operation. The changes in BMI, systolic blood pressure; FBG and HOMA-IR were significantly more in group II than in group I. The lipid profiles in group I & II before surgery were similar. The HDL-cholesterol was significantly higher in both groups I & II 12 months after surgery. In addition, apo A-IV levels increased after surgery in both groups. Conclusion Both gastric band and gastric bypass are associated with significant improvement of the cardiovascular risk profile, although it is more pronounced after gastric bypass. The improvement correlates well with the increase of apo A-IV in both groups. Thus Apo A-IV may play a positive role in improving the cardiovascular risk profile after bariatric surgery.

Role of serotonin hormone in weight regain after sleeve gastrectomy

Abstract Laparoscopic sleeve gastrectomy (LSG) is gaining popularity as bariatric surgery, a small percentage of subjects regain weight after surgery. This study was designed to evaluate body weight changes over a period of two years after LSG and investigate the role of serotonin in regulating energy balance. This is a prospective cohort study. A total of 92 patients with morbid obesity (64 women and 28 men) underwent LSG. All the participants were subjected to physical examination and detailed medical history. Anthropometric measurements were accomplished pre-operative and post-operatively at a frequency of four times per year for two years follow-up. Laboratory investigations were performed pre-operatively, and one and two years post-operatively. Blood samples were collected in the fasting state; for glucose, lipid profile and hormonal assays. Hormones measured were plasma insulin, leptin, serotonin and ghrelin. Results revealed that 35.7% weight loss occurred after one year. However, there was variability in the individual weight loss curve during the period between the first and second post-operative years. Thus, patients were divided into two groups: group I included 78 patients (84%) who maintained the lost weight, and group II included 14 patients (16.0%) who regained weight within 24u2009months post-operatively. Correlation with BMI revealed positive correlation with leptin and serotonin, whilst negative correlation with ghrelin in group II patients. Mechanisms of weight loss after LSG are not only attributable to gastric restriction but also to the neurohormonal changes. In addition, serotonin may possibly contribute to the interplay of regulatory systems of energy homeostasis

Chitotriosidase Enzyme Activity and miRNA-146a expression and their value as potential Biomarkers of subclinical Atherosclerosis in type 2 Diabetes Mellitus

Background: Type 2 diabetes T2DM is a common disease with increased mortality and morbidity due to vascular complications. Carotid Intimal-Medial Thickness (CIMT) is being used as a marker to assess subclinical atherosclerosis.MicroRNA (miR-146a) is a new discoveredbiomarker that regulates endothelial cell function and vascular inflammation, together with Chitotriosidase (CHIT1)enzyme being involved mainly in the immune and inflammatory responses. This study aimed to investigate an assumed association between CHIT1 activity and miR-146a gene expression in type 2 diabetes patients for detection of endothelial dysfunction and subclinical atherosclerosis, in association with CIMT. Material and methods: 30 control subjects (group I) and 100 patients diagnosed as T2DMclassified according to CIMT results; group II (38 patient) with CIMT value less than 0.7mm and group III (62patients) with CIMT value more than 0.7mm. Plasma CHIT1 activity was measured fluorometricallyand quantitative Real Time PCR (qPCR) for miR-146a. Routine laboratory parameters such as blood glucose, lipid profile, glycated hemoglobin were also measured. Results revealedCHIT1activity was significant high( p < 0.001) in group II and III diabetic patients compared to group I, also it waspositively correlated with CIMT and other parameters as glycemic control, lipid profile, duration of disease and blood pressure. On the other hand, plasma miR-146a was significantly reduced ( p < 0.001) in group III and was negatively correlated with CIMT and other parameters. Conclusion: IncreasedCHIT1activity may be due to the associated changes in the relative gene expression of miRNA 146a in patients with increased CIMT above 1mm. Moreover, evaluation of microRNA 146a gene expression can be used as useful biomarker for detection of endothelial dysfunction and development of atherosclerosis in T2DM. DOI:xa010.21276/APALM.1346

Importance of ferritin in sera and cerebrospinal fluid as both a predictive and an etiodiagnostic biomarker in ischemic stroke: a single-center prospective study

Background and aim Trace metals such as iron and its storage protein ferritin are known to play an important role in stroke and other neurologic disorders. This prospective study was designed to determine whether cerebrospinal fluid (CSF) ferritin levels aid in evaluation of stroke severity and its prognosis. Patients and methods Thirty-two patients with a diagnosis of acute stroke due to intrinsic or atherosclerotic vessel pathology were included in the study within 24u2009h from onset of symptoms. Immediately after admission, the clinical condition of the patient was evaluated using the Canadian Stroke Scale and was determined periodically during follow-up. Serum and CSF ferritin levels were assayed and correlated with the known biomarker amyloid β protein 1-42. Results Serum ferritin level revealed significantly greater values in patients with larger-sized lesions (P<0.01) and deteriorated neurologic condition during clinical follow-up. CSF and serum ferritin levels were correlated with neurologic deficit (r=0.50, P<0.001). There was no significant correlation between amyloid β protein 1-42 and ferritin levels (r=0.07, P=0.7). Serum ferritin level and large-sized lesions were independently associated with stroke due to Intracranial atherosclerotic disease pathology. Increased serum ferritin levels correlated with severity of stroke and the size of the lesion. Conclusion Our results revealed that elevated values of CSF and serum ferritin may indicate a poor prognosis in terms of neurologic deterioration in intracranial atherosclerotic (ICAD)-induced stroke patients.

Obesity and Trace Elements

Page 98 Obesity has been identified as a medical problem. Obesity may be associated with abnormal metabolism and micronutrient deficiencies. Thus, obesity and malnutrition at the same time is a reality. However, in the past it was unusual to say that people who eat much were liable to be malnourished. Now-a-days, eating too much does not mean meeting nutritional requirements. This is due to the fact that several factors affect those requirements; as nature of diet, dietary habits, food preparation and host-related factors as intestinal absorption.

Can Hormones Regulating Appetite be a Major Factor Contributing to Obesity

Page 39 Obesity is a growing problem throughout the whole world; it is a complex condition that causes much suffering. There are many factors associated with obesity. Those factors include; individual genetics, increased food intake, and/or a lack of physical exercise. In addition hormonal balance plays a very critical role in weight control. There are a number of established hormonal disorders that is associated with obesity. The most common syndromes include Cushing’s syndrome and Hypothyroidism.1,2