Syed Shahid Habib

Exhaled nitric oxide in stable chronic obstructive pulmonary disease

STUDY OBJECTIVE: The objective of the study was to test the hypothesis that fraction of exhaled nitric oxide (FENO) is elevated in nonsmoking subjects with stable chronic obstructive pulmonary disease (COPD) and compare it with the results in patients with asthma and a control population. DESIGN: Cross-sectional study. MATERIALS AND METHODS: Pulmonology Clinic at a University Hospital. Twenty five control subjects, 25 steroid naïve asthmatics and 14 COPD patients were studied. All the patients were nonsmokers and stable at the time of the study. All subjects completed a questionnaire and underwent spirometry. Exhaled nitric oxide was measured online by chemiluminescence, using single-breath technique. RESULTS: All the study subjects were males. Subjects with stable COPD had significantly higher values of FENO than controls (56.54±28.01 vs 22.00±6.69; P=0.0001) but lower than the subjects with asthma (56.54±28.01 vs 84.78±39.32 P=0.0285).The FENO values in COPD subjects were inversely related to the FEV1/FVC ratio. There was a significant overlap between the FENO values in COPD and the control subjects. CONCLUSION: There is a significant elevation in FENO in patients with stable COPD, but the elevation is less than in asthmatic subjects. Its value in clinical practice may be limited by the significant overlap with control subjects.

Body mass index and body fat percentage in assessment of obesity prevalence in saudi adults.

OBJECTIVE To assess the obesity prevalence in Saudi adults according to the international standards of body mass index (BMI) and body fat percentage (BF%). METHODS Five hundred and thirty healthy Saudi adults aged 18-72 years (mean 36.91 ± 15.22 years) were enrolled in this study. Their body composition was assessed by bioelectrical impendence analysis with a commercially available body composition analyzer. Standard BMI and BF% values were used to define obesity. RESULTS The prevalence of underweight, normal underweight, overweight and obesity in Saudi adults according to the BMI criteria (<18.5 kg/m², 18.5-24.4 kg/m², 25-29.9 kg/m², 30 kg/m² and above, respectively) was 2.5%, 30.2%, 33.6%, and 33.8%, respectively, whereas the obesity prevalence was 60% (n=318) in Saudi adults according to the BF% criteria (25% for males and 30% for females), which was significantly higher than that according to BMI criteria. However, it was 50.6% (n=268) when the BMI cutoff point was 27.5 kg/m², proposed by WHO for the Asian population. Kappa analysis showed that the obesity prevalence defined by BMI and BF% was higher in females than in males (k=0.530 vs k=0.418, P<0.0001). The sensitivity and specificity of BMI (30 kg/m² and 27.5 kg/m²) were 54.1% and 96.7% and 76.4% and 88.2%, respectively, for obesity. A lower BMI cutoff point (26.60 kg/m²) was proposed in this study, which gave the maximum sensitivity (84.3%) and specificity (85.4%), with a moderate kappa agreement (k=0.686). Moreover, the obesity prevalence at this cutoff point (56.4%) was significantly higher than that recommended by WHO. CONCLUSION The specificity of BMI for obesity is high and its sensitivity is low in both sexes. Its sensitivity can be increased by changing BMI cutoff to a lower value. The choice of BF% reference is of great influence for the assessment of obesity prevalence according to the BMI.

CRP levels are higher in patients with ST elevation than non-ST elevation acute coronary syndrome.

FUNDAMENTO: Hay gran interes en el uso de proteina C-reactiva de alta sensibilidad (PCR-as) para evaluacion de riesgo. Altos niveles de PCR-as en el comienzo del sindrome coronario agudo (SCA), antes de la necrosis tisular, puede ser un marcador sustituto para comorbilidades cardiovasculares. OBJETIVO: De esa forma, nuestro objetivo fue estudiar diferentes medidas de seguimiento de niveles de PCR-as en pacientes con SCA y comparar las diferencias entre infarto de miocardio sin elevacion del segmento ST (NSTEMI) con pacientes presentando elevacion del segmento ST (STEMI). METODOS: Este es un estudio observacional. De los 89 pacientes reclutados, 60 presentaban infarto agudo de miocardio (IAM). Tres niveles seriados de PCR-us, a nivel basal en la hospitalizacion antes de 12 horas despues del inicio de los sintomas, niveles de pico 36-48 horas despues de hospitalizacion y niveles de control despues de 4 a 6 semanas fueron analizados y comparados entre pacientes con (IAMCSST) y sin supradesnivel del segmento ST (IAMSSST). RESULTADOS: Pacientes con IAMCSST tenian IMC significativamente mas alta cuando fueron comparados con pacientes IAMSSST. Los niveles de creatinoquinasa fraccion MB (CK-MB) y aspartato aminotransferasa (AST) eran significativamente mas altos en pacientes con IAMCSST cuando fueron comparados con pacientes con IAMSSST (p<0,05). Los niveles de PCR a nivel basal y en el control no difirieron de forma significativa entre los dos grupos (p= 0,2152 y p=0,4686 respectivamente). Hubo una diferencia significativa en los niveles de pico de PCR entre los dos grupos. En el grupo de pacientes con IAMCSST los niveles fueron significativamente mas altos cuando fueron comparados a los pacientes con IAMSSST (p=0,0464). CONCLUSION: Pacientes con IAMCSST presentan picos significativamente mas elevados de PCR cuando son comparados a pacientes IAMSSST. Esos datos sugieren que el proceso inflamatorio tiene un papel independiente en la patogenesis del infarto de miocardio. De esa forma, los niveles de PCR pueden ayudar en la estratificacion de riesgo despues del infarto de miocardio.BACKGROUND There is intense interest in the use of high-sensitivity C-reactive protein (hsCRP) for risk assessment. Elevated hsCRP concentrations early in acute coronary syndrome (ACS), prior to the tissue necrosis, may be a surrogate marker for cardiovascular co-morbidities. OBJECTIVE Therefore we aimed to study different follow up measurements of hsCRP levels in acute coronary syndrome patients and to compare the difference between non-ST elevation myocardial infarction (NSTEMI) and ST myocardial infarction (STEMI) patients. METHODS This is an observational study. Of the 89 patients recruited 60 patients had acute myocardial infarction (AMI). Three serial hsCRP levels at baseline on admission to hospital before 12 hours of symptom onset, peak levels at 36-48 hours and follow up levels after 4-6 weeks were analyzed and compared between non-ST elevation AMI and ST elevation AMI. RESULTS STEMI patients had significantly higher BMI compared to NSTEMI patients. Creatine kinase myocardial bound (CKMB) and Aspartate aminotransferase (AST) levels were significantly higher in STEMI patients compared to NSTEMI patients (p<0.05). CRP levels at baseline and at follow up did not significantly differ between the two groups (p = 0.2152, p = 0.4686 respectively). There was a significant difference regarding peak CRP levels between the two groups, as STEMI patients had significantly higher peak CRP levels compared to NSTEMI patients (p = 0.0464). CONCLUSION STEMI patients have significantly higher peak CRP levels compared to NSTEMI patients. These data suggest that inflammatory processes play an independent role in the pathogenesis of myocardial infarction. Thus, CRP assessment may assist in risk stratification after myocardial infarction.

Lipids and lipoprotein(a) concentrations in Pakistani patients with type 2 diabetes mellitus

Aim:  The aim of the present study was to analyze serum lipoprotein(a) [Lp(a)] levels in Pakistani patients with type 2 diabetes mellitus (DM) and to find correlations between clinical characteristics and dyslipidaemias in these patients.

Lipoprotein (a) is associated with basal insulin levels in patients with type 2 Diabetes Mellitus

FUNDAMENTO: Ainda nao foi claramente estabelecido se a resistencia/deficiencia insulinica leva diretamente a aterogenese ou atraves de sua associacao com outros fatores de risco como os niveis de lipoproteina (a)[Lp(a)]. OBJETIVO: O objetivo do estudo foi estabelecer a relacao entre os niveis basais de insulina, lipides e lipoproteina (a) em pacientes com diabetes mellitus (DM) tipo 2. METODOS: Amostras de sangue foram colhidas em jejum e os niveis de insulina, lipoproteina (a), colesterol total (CT), triglicerides (TG), lipoproteina de baixa densidade (LDL-C), lipoproteina de alta densidade (LDL-C), glicose e hemoglobina glicada (HbA1c) foram medidos em 60 pacientes com DM tipo 2 e 28 individuos saudaveis. Nos dividimos os pacientes em dois grupos baseados nos niveis basais de insulina: > 10 µIU/ml e 10 µIU/ml comparados com aqueles que apresentavam insulina basal < 10 µIU/ml (p < 0.05). A analise de regressao mostrou uma relacao significante da Lp(a) com os niveis de insulina (r = 0,262, p < 0,05) e razao Insulina/Glicose(r = 0,257, p < 0,05). CONCLUSAO: Os niveis de Lp(a) se correlacionam inversamente com os niveis de insulina em pacientes com DM tipo 2. Os niveis de Lp(a) podem ser um dos fatores de risco cardiovascular em pacientes com DM tipo 2 com maior duracao da doenca. (Arq Bras Cardiol 2009;93(1):28-33)BACKGROUND It has not been clearly established whether insulin resistance/deficiency leads directly to atherogenesis or through its association with other risk factors such as lipoprotein(a) [Lp(a)]. OBJECTIVE This project aimed at studying the association between basal insulin, lipids and lipoprotein(a) levels in patients with type 2 diabetes mellitus. METHODS Fasting blood samples were analyzed for Insulin, Lipoprotein(a), total cholesterol (TC), triglycerides (TG), low density lipoprotein cholesterol (LDL-C), high density lipoprotein cholesterol (HDL-C), glucose and glycosylated hemoglobin (HbA1c) levels in 60 patients with type 2 Diabetes Mellitus (DM) and 28 healthy subjects. We divided patients into two groups based on basal insulin levels: > or = 10 microIU/ml and < 10 microIU/ml. RESULTS Insulin levels were higher in diabetic versus control individuals [p < 0.05]. TC (p< 0.01), LDL-C (p< 0.05), TC/HDL ratio (p< 0.01) and TG levels (p< 0.05) were higher and HDL- C levels were significantly lower (p < 0.001) in both diabetic groups as compared to control. Lp(a) levels were significantly higher in both diabetic groups, when compared to the control group. Lp(a) levels were significantly lower in diabetics with basal insulin > or =10 microIU/ml when compared to those with basal insulin < 10 microIU/ml (p < 0.05). Regression analysis revealed a significant relationship of Lp(a) with insulin levels (r = 0.262, p < 0.05) and Insulin Glucose ratio (r = 0.257, p < 0.05). CONCLUSION Lp(a) levels correlate inversely with insulin levels in Type 2 diabetic patients. Lp(a) may be one of the cardiovascular risk factor in type 2 diabetic patients with longer duration of DM.

Lipoproteína (a) está associada com níveis basais de insulina em pacientes com Diabetes Mellitus tipo 2

FUNDAMENTO: Ainda nao foi claramente estabelecido se a resistencia/deficiencia insulinica leva diretamente a aterogenese ou atraves de sua associacao com outros fatores de risco como os niveis de lipoproteina (a)[Lp(a)]. OBJETIVO: O objetivo do estudo foi estabelecer a relacao entre os niveis basais de insulina, lipides e lipoproteina (a) em pacientes com diabetes mellitus (DM) tipo 2. METODOS: Amostras de sangue foram colhidas em jejum e os niveis de insulina, lipoproteina (a), colesterol total (CT), triglicerides (TG), lipoproteina de baixa densidade (LDL-C), lipoproteina de alta densidade (LDL-C), glicose e hemoglobina glicada (HbA1c) foram medidos em 60 pacientes com DM tipo 2 e 28 individuos saudaveis. Nos dividimos os pacientes em dois grupos baseados nos niveis basais de insulina: > 10 µIU/ml e 10 µIU/ml comparados com aqueles que apresentavam insulina basal < 10 µIU/ml (p < 0.05). A analise de regressao mostrou uma relacao significante da Lp(a) com os niveis de insulina (r = 0,262, p < 0,05) e razao Insulina/Glicose(r = 0,257, p < 0,05). CONCLUSAO: Os niveis de Lp(a) se correlacionam inversamente com os niveis de insulina em pacientes com DM tipo 2. Os niveis de Lp(a) podem ser um dos fatores de risco cardiovascular em pacientes com DM tipo 2 com maior duracao da doenca. (Arq Bras Cardiol 2009;93(1):28-33)BACKGROUND It has not been clearly established whether insulin resistance/deficiency leads directly to atherogenesis or through its association with other risk factors such as lipoprotein(a) [Lp(a)]. OBJECTIVE This project aimed at studying the association between basal insulin, lipids and lipoprotein(a) levels in patients with type 2 diabetes mellitus. METHODS Fasting blood samples were analyzed for Insulin, Lipoprotein(a), total cholesterol (TC), triglycerides (TG), low density lipoprotein cholesterol (LDL-C), high density lipoprotein cholesterol (HDL-C), glucose and glycosylated hemoglobin (HbA1c) levels in 60 patients with type 2 Diabetes Mellitus (DM) and 28 healthy subjects. We divided patients into two groups based on basal insulin levels: > or = 10 microIU/ml and < 10 microIU/ml. RESULTS Insulin levels were higher in diabetic versus control individuals [p < 0.05]. TC (p< 0.01), LDL-C (p< 0.05), TC/HDL ratio (p< 0.01) and TG levels (p< 0.05) were higher and HDL- C levels were significantly lower (p < 0.001) in both diabetic groups as compared to control. Lp(a) levels were significantly higher in both diabetic groups, when compared to the control group. Lp(a) levels were significantly lower in diabetics with basal insulin > or =10 microIU/ml when compared to those with basal insulin < 10 microIU/ml (p < 0.05). Regression analysis revealed a significant relationship of Lp(a) with insulin levels (r = 0.262, p < 0.05) and Insulin Glucose ratio (r = 0.257, p < 0.05). CONCLUSION Lp(a) levels correlate inversely with insulin levels in Type 2 diabetic patients. Lp(a) may be one of the cardiovascular risk factor in type 2 diabetic patients with longer duration of DM.

Níveis de PCR são maiores em pacientes com síndrome coronariana aguda e supradesnivelamento do segmento ST do que em pacientes sem supradesnivelamento do segmento ST

FUNDAMENTO: Hay gran interes en el uso de proteina C-reactiva de alta sensibilidad (PCR-as) para evaluacion de riesgo. Altos niveles de PCR-as en el comienzo del sindrome coronario agudo (SCA), antes de la necrosis tisular, puede ser un marcador sustituto para comorbilidades cardiovasculares. OBJETIVO: De esa forma, nuestro objetivo fue estudiar diferentes medidas de seguimiento de niveles de PCR-as en pacientes con SCA y comparar las diferencias entre infarto de miocardio sin elevacion del segmento ST (NSTEMI) con pacientes presentando elevacion del segmento ST (STEMI). METODOS: Este es un estudio observacional. De los 89 pacientes reclutados, 60 presentaban infarto agudo de miocardio (IAM). Tres niveles seriados de PCR-us, a nivel basal en la hospitalizacion antes de 12 horas despues del inicio de los sintomas, niveles de pico 36-48 horas despues de hospitalizacion y niveles de control despues de 4 a 6 semanas fueron analizados y comparados entre pacientes con (IAMCSST) y sin supradesnivel del segmento ST (IAMSSST). RESULTADOS: Pacientes con IAMCSST tenian IMC significativamente mas alta cuando fueron comparados con pacientes IAMSSST. Los niveles de creatinoquinasa fraccion MB (CK-MB) y aspartato aminotransferasa (AST) eran significativamente mas altos en pacientes con IAMCSST cuando fueron comparados con pacientes con IAMSSST (p<0,05). Los niveles de PCR a nivel basal y en el control no difirieron de forma significativa entre los dos grupos (p= 0,2152 y p=0,4686 respectivamente). Hubo una diferencia significativa en los niveles de pico de PCR entre los dos grupos. En el grupo de pacientes con IAMCSST los niveles fueron significativamente mas altos cuando fueron comparados a los pacientes con IAMSSST (p=0,0464). CONCLUSION: Pacientes con IAMCSST presentan picos significativamente mas elevados de PCR cuando son comparados a pacientes IAMSSST. Esos datos sugieren que el proceso inflamatorio tiene un papel independiente en la patogenesis del infarto de miocardio. De esa forma, los niveles de PCR pueden ayudar en la estratificacion de riesgo despues del infarto de miocardio.BACKGROUND There is intense interest in the use of high-sensitivity C-reactive protein (hsCRP) for risk assessment. Elevated hsCRP concentrations early in acute coronary syndrome (ACS), prior to the tissue necrosis, may be a surrogate marker for cardiovascular co-morbidities. OBJECTIVE Therefore we aimed to study different follow up measurements of hsCRP levels in acute coronary syndrome patients and to compare the difference between non-ST elevation myocardial infarction (NSTEMI) and ST myocardial infarction (STEMI) patients. METHODS This is an observational study. Of the 89 patients recruited 60 patients had acute myocardial infarction (AMI). Three serial hsCRP levels at baseline on admission to hospital before 12 hours of symptom onset, peak levels at 36-48 hours and follow up levels after 4-6 weeks were analyzed and compared between non-ST elevation AMI and ST elevation AMI. RESULTS STEMI patients had significantly higher BMI compared to NSTEMI patients. Creatine kinase myocardial bound (CKMB) and Aspartate aminotransferase (AST) levels were significantly higher in STEMI patients compared to NSTEMI patients (p<0.05). CRP levels at baseline and at follow up did not significantly differ between the two groups (p = 0.2152, p = 0.4686 respectively). There was a significant difference regarding peak CRP levels between the two groups, as STEMI patients had significantly higher peak CRP levels compared to NSTEMI patients (p = 0.0464). CONCLUSION STEMI patients have significantly higher peak CRP levels compared to NSTEMI patients. These data suggest that inflammatory processes play an independent role in the pathogenesis of myocardial infarction. Thus, CRP assessment may assist in risk stratification after myocardial infarction.

Prognostic value of ADAMTS13 in patients with severe sepsis and septic shock

PURPOSE ADAMTS13 level was evaluated as a predictor of mortality in patients with severe sepsis and septic shock, and compared with Acute Physiology and Chronic Health Evaluation II (APACHE II) scores. METHODS This prospective observational study was conducted in the Medical and Surgical Intensive Care Units of King Khalid University Hospital. Detailed clinical evaluations were performed on 84 patients (56.08±18.18 years of age) with severe sepsis and septic shock. ADAMTS13 levels were determined (three blood samples at 24 hours intervals) and APACHE II scores, hematological profiles, indices of organ hypo-perfusion, renal functions and coagulation profiles were recorded. Primary outcome was 30 days ICU mortality and secondary outcomes were its comparison with APACHE II score, length of ICU stay and use of vasopressor agents. RESULTS Hypertension (53.6%) and diabetic mellitus (45.2%) were the commonest comorbidities. The median ADAMTS13 levels were 336.65, 339.35 and 313.9, respectively. ROC analysis showed maximum area under the curve for second ADAMTS13 (AUC=0.760) compared with first (AUC=0.660) and third samples (AUC=0.707) and APACHE II scores (AUC=0.662). Patients were divided into low and high ADAMTS13 groups according to the best cut-off point. Mortality was high in the low ADAMTS13 level group [OR=4.5]and was significantly associated with age, DBP, ADAMTS13, APACHE II score, DIC score and platelet count. ADAMTS13 (OR=5.3), APACHE II (OR=4.13) and DIC scores (OR=7.32) were significant risk factors for mortality. CONCLUSIONS Low ADAMTS13 was associated with increased mortality in patients with severe sepsis and septic shock and was comparable to APACHE II scores for predicting mortality.

Effect of drinking Arabian Qahwa on fractional exhaled nitric oxide levels in healthy nonsmoking Saudi adults.

OBJECTIVES: Fractional exhaled nitric oxide (FENO) is an emerging marker of inflammation in respiratory diseases. However, it is affected by a number of confounding factors. We aimed to study the effect of drinking Arabian Qahwa on FENO in non-smoking Saudi healthy adults. METHODS: We recruited 12 nonsmoker healthy male adults aged 36.6 ± 2.7 (21-50) years. All subjects were free from acute respiratory infections or allergies and had normal ventilatory functions and serum IgE levels. At 8 am in the morning, their baseline values of FENO were recorded. They had not taken tea or coffee in the morning and had taken similar light breakfast. They were given three cups of Arabian Qahwa to drink and then after every 30 minutes, serial levels of FENO were recorded. RESULTS: Average FENO levels at baseline were 28.73 ± 9.33 (mean ± SD) parts per billion (ppb). The mean FENO levels started to decrease significantly after 30 minutes of drinking Arabian Qahwa (P=0.002). This decrease in FENO level was further observed till two hours after Qahwa drinking and then it started to increase in next 90 minutes but still was significantly lower than the baseline (P=0.002). The mean FENO level recorded after 4 hours was 27.22 ± 10.22 (P=0.039). CONCLUSIONS: FENO levels were significantly lowered by intake of Arabian Qahwa and this effect remains for about 4 hours. Therefore, history of recent Qahwa intake and abstinence is essential before performance of FENO and its interpretation.

Effect of Smoking on Cognitive Functioning in Young Saudi Adults

Background Smoking is the predominant form of tobacco consumption and is growing worldwide, particularly in the younger generation in the Middle-East. We aimed to determine the effects of tobacco smoking on cognitive functions among young Saudi adults. Material/Methods We recruited a group of cigarette smokers (N=22) and a group of controls (non-smokers) (N=30) from apparently healthy male volunteers aged 18–29 years. Cognitive function was assessed by using the Cambridge Neuropsychological Automated Battery (CANTAB). The cognitive functions outcome variables were the response time (attention-switching task [AST]), and the percentage of correct response (pattern recognition memory [PRM] task). Clinical, demographic, blood markers (brain-derived neurotrophic factor (BDNF) and apolipoprotein E) were assessed between groups. Results The 2 groups were matched for age and educational status. In comparison to the control group, smokers showed significant cognitive impairments in AST-Latency (p=0.001), AST-Congruent (p=0.001), and AST-Incongruent condition (p=0.001). There was not significant difference in BDNF APOE serum level between the 2 groups. Conclusions These results indicate that attention and alertness were significantly impaired in smokers compared to non-smokers.