Yasser W. Darwish

Androgenetic alopecia and insulin resistance: are they truly associated?

Background  Controversies exist regarding the association of androgenetic alopecia (AGA) with insulin resistance. Are they truly associated, or is insulin resistance just related to aging, obesity, or to the presence of metabolic syndrome?

In vitro antibiotic susceptibility patterns of Propionibacterium acnes isolated from acne patients: an Egyptian university hospital-based study

Background  Antibiotics have been used for more than 40 years against Propionibacterium acnes (P. acnes), the most common agent of acne. Antibiotic resistance to this bacterium becomes a worldwide problem in recent years. No studies are available on antibiotic susceptibility patterns of P. acnes among Egyptian acne patients.

Is there a role for insulin resistance in nonobese patients with idiopathic hirsutism

Background  Hirsutism is the presence of terminal hairs in women in a male‐like pattern. It may result from various causes of androgen excess or may be idiopathic. Controversies exist concerning the presence of insulin resistance in idiopathic hirsutism (IH) or if it is a manifestation of a high body mass index (BMI).

Platelets microparticles as a link between micro- and macro-angiopathy in young patients with type 1 diabetes

Abstract The development of vasculopathies in diabetes involves multifactorial processes. Increased levels of platelets-derived microparticles (PMPs) have been reported in diseases associated with thrombotic risk, but few data are available in diabetes. We explored the level of PMPs in young patients with type 1 diabetes in relation to inflammation, glycemic control, micro-vascular complications and carotid intima media thickness (CIMT). Eighty children and adolescents with type 1 diabetes were divided into two groups according to the presence of micro-vascular complications and compared with 40 healthy controls. Patients were subjected to medical history, clinical examination and assessment of high-sensitivity C-reactive protein (hs-CRP), HbA1c, urinary albumin creatinine ratio (UACR), flow cytometric analysis for PMPs using anti-CD41b and CIMT. PMP levels were significantly increased in all patients with type 1 diabetes (2.92 ± 1.3%) whether with micro-vascular complications (3.46 ± 1.11%) or those without complications (2.37 ± 1.28%) compared with healthy controls (1.28 ± 0.64%; p < 0.001). CIMT was significantly elevated in all patients, and the highest levels were among those with micro-vascular complications (p < 0.001). Significant positive correlations were found between PMPs and body mass index, HbA1c, serum creatinine, total cholesterol, UACR, hs-CRP and CIMT (p < 0.05). Multiple linear regression analysis showed that HbA1c, UACR, hs-CRP and CIMT were independently related to PMPs levels in type 1 diabetes. According to Receiver operating characteristic curve analysis, the cutoff value of PMPs at 2.48% could differentiate patients with and without micro-vascular complications with a sensitivity of 80% and specificity of 73.3%. PMPs are elevated in patients with type 1 diabetes and can be considered as an early marker of micro-vascular complications and subclinical atherosclerosis.

Impact of CYP2C9 and VKORC1 genetic polymorphisms upon warfarin dose requirements in Egyptian patients with acute coronary syndrome.

Warfarin is the most widely prescribed anticoagulant drugs. Cytochrome P450-2C9 (CYP2C9) and vitamin K epoxide reductase-oxidaxe complex subunit 1 (VKORC1) contribute significantly to the variability of warfarin dose requirements among patients. We investigated the impact of CYP2C9 and VKORC1 polymorphisms on the variability of warfarin dosage requirements in Egyptian patients with acute coronary syndrome and their association with other nongenetic factors. Eighty participants with acute coronary syndrome were enrolled in this cross-sectional study. Associations between CYP2C9 and VKORC1 gene variants together with daily warfarin dose, demographic data, clinical status of patients and time to target international normalized ratio were assessed. Mean warfarin dose among patients with wild-type CYP2C9*1/*1 genotype was significantly higher than heterozygous CYP2C9*1/*2 and CYP2C9*1/*3 variants (P ⩽ 0.001). Patients with wild VKORC1 (G/G) genotype were treated with significantly higher daily warfarin dosages than homozygous (A/A) and heterozygous (G/A) genotypes. Patients carrying VKORC1 (G/G) genotype in combination with the CYP2C9*1/*1 type alleles had the highest daily warfarin dosage, whereas the lowest daily warfarin dosage to achieve the required clinical effect was found among patients having CYP2C9*1/*2 and CYP2C9*1/*3 genotypes combined with VKORC1 (A/A) genotype (P ⩽ 0.001). Regression analysis revealed that age, height, CYP2C9 and VKORC1 genotypes were significantly associated with warfarin dose. Genetic polymorphisms in VKORC1, CYP2C9 along with age and height are determinants of warfarin dose requirements in Egyptian population acute coronary syndrome. Higher warfarin loading dose is required for both wild CYP2C9 and VKORC1 gene variants which may contribute to warfarin-resistant cases.

Platelet Function Profile Post-Clopidogrel Therapy in Patients With Type 2 Diabetes Undergoing Coronary Stent Implantation

Platelet dysfunction contributes to the increased risk of thromboischemic complications after percutaneous coronary intervention (PCI), particularly in type 2 diabetes. Little is known about the effects of glycemic control on platelet reactivity. We assessed adenosine diphosphate-induced platelet aggregation and flow cytometric expression of P-selectin in 90 patients (56 diabetic and 34 nondiabetic patients) undergoing coronary stent implantation after administration of clopidogrel as a potential predictor of poststent complications and its relation to glycemic control. Posttreatment platelet reactivity was significantly elevated in diabetic compared with nondiabetic participants and was associated with smoking, hypercholesterolemia, overweight, and cardiovascular ischemic events. A linear relationship was found between hemoglobin A1c in diabetic patients and platelet reactivity. Both methods (standard aggregometry and P-selectin expression) used for assessment of platelet function were positively correlated. Low responsiveness to clopidogrel detected by posttreatment platelet reactivity is a risk factor for ischemic events after PCI in diabetic patients.

Renal iron deposition by magnetic resonance imaging in pediatric β-thalassemia major patients: Relation to renal biomarkers, total body iron and chelation therapy

BACKGROUND The reciprocal of multiecho gradient-echo (ME-GRE) T2* magnetic resonance imaging (MRI) R2*, rises linearly with tissue iron concentration in both heart and liver. Little is known about renal iron deposition in β-thalassemia major (β-TM). AIM To assess renal iron overload by MRI and its relation to total body iron and renal function among 50 pediatric patients with β-TM. METHODS Serum ferritin, serum cystatin C, urinary albumin creatinine ratio (UACR), and urinary β2-microglobulin (β2 M) were measured with calculation of β2 M/albumin ratio. Quantification of liver, heart and kidney iron overload was done by MRI. RESULTS Serum cystatin C, UACR and urinary β2 microglobulin as well as urinary β2m/albumin were significantly higher in β-TM patients than the control group. No significant difference was found as regards renal R2* between Patients with mean serum ferritin above 2500 μg/L and those with lower serum cutoff. Renal R2* was higher in patients with poor compliance to chelation therapy and positively correlated to indirect bilirubin, LDH, cystatin C and LIC but inversely correlated to cardiac T2*. CONCLUSION kidney iron deposition impairs renal glomerular and tubular functions in pediatric patients with β-TM and is related to hemolysis, total body iron overload and poor compliance to chelation.

Assessment of serum 25-hydroxyvitamin D levels in patients with extensive/recalcitrant alopecia areata before and after PUVA and NB-UVB therapy

BackgroundAlopecia areata (AA) is an autoimmune, inflammatory hair loss disease. Deficient vitamin D levels have been noted in different autoimmune diseases. Psoralen in conjunction with ultraviolet-A irradiation (PUVA) and narrow band ultraviolet-B (NB-UVB) are therapeutic modalities for AA, reported to improve vitamin D status. ObjectiveThe aim of the study was to assess serum 25-hydroxyvitamin D [25(OH)D] levels in patients with extensive/recalcitrant AA before and after topical PUVA, systemic PUVA and NB-UVB. Patients and methodsThis case–control study included 60 participants: 30 patients with AA divided into three equally distributed groups, treated by topical PUVA (group 1), systemic PUVA (group 2) and NB-UVB (group 3), three times/week, and 30 age-matched and sex-matched healthy controls. Serum 25(OH)D levels were measured in all participants at the initiation of the study and 3 months after treatment in patients. Extent of hair loss, assessed by the Severity of Alopecia Tool score, was determined and correlated with serum 25(OH)D levels before and after treatment. ResultsBefore treatment, significantly deficient serum 25(OH)D levels were found in patients compared with controls. Three months after treatment, serum 25(OH)D levels increased but still with significantly lower levels compared with controls. Compared with pretreatment levels, significant increase in serum 25(OH)D levels was found in all groups with significant negative correlations between serum 25(OH)D levels and Severity of Alopecia Tool scores before and after treatment. ConclusionDeficient serum 25(OH)D levels are present in patients with extensive/recalcitrant AA and increase after topical PUVA, systemic PUVA and NB-UVB.

ADAMTS13 Levels in Young Patients With β-Thalassemia Major Relation to Hepatitis C Virus Infection, Liver Cirrhosis, and Iron Overload

We measured levels of a disintegrin and metalloproteinase with a thrombospondin type 1 motif, member 13 (ADAMTS13) in 50 children and adolescents with β-thalassemia major (25 without hepatitis C virus [HCV] infection and 25 with HCV infection) compared to 25 healthy controls and assessed their relation to iron overload, HCV infection, and liver cirrhosis. Hematological and coagulation profiles, serum ferritin, and von Willebrand factor antigen were assessed. Levels of ADAMTS13 were significantly lower in β-thalassemia major with and without HCV infection compared to healthy controls, with a more significant reduction in levels among patients with HCV (P < .001). HCV-positive patients with thalassemia having liver cirrhosis had the lowest ADAMTS13 levels than those without cirrhosis (P = .012) or HCV-negative patients with thalassemia (P < .001). Levels of ADAMTS13 were positively correlated with platelet count while inversely correlated with partial thromboplastin time, serum ferritin, and VWF: Ag (P < .05). Conclusion: Patients with β-thalassemia major infected with HCV have low ADAMTS13 levels, and a marked reduction was observed among patients with liver cirrhosis and, therefore, may be liable to thromboembolic manifestations.