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   2015| January-April  | Volume 1 | Issue 1  
    Online since July 6, 2015

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Autoimmune thyroid disorders in seropositive versus seronegative rheumatoid arthritis
Mohamed K Ghitany, Eiman A Soliman, Maha E Bondok, Shahinda A Elmaadawy
January-April 2015, 1(1):53-63
Background Autoimmune diseases are chronic conditions initiated by the loss of immunological tolerance to self-antigens; they represent a heterogeneous group of disorders that afflict specific target organs or multiple organ systems. Autoimmune thyroid disease (AITD) is a common organ-specific autoimmune disorder affecting mostly middle-aged women. AITD is a term that includes various clinical forms of autoimmune thyroiditis; among these diseases, Hashimoto's thyroiditis and Graves' disease are the two most common types and share many features immunologically. Rheumatoid arthritis (RA) is a chronic inflammatory disease that leads to severe disability and premature mortality. Given the same pathogenic mechanisms, autoimmune diseases tend to cluster together, and hence this study was designed to investigate the relationship between AITD and RA, particularly seropositive versus seronegative subtypes. Patients and methods The study included 70 patients with evidence of RA. Their diagnosis was based on the 2010 American College of Rheumatology (ACR)-EULAR classification criteria, and they were subclassified into two groups: group I, comprising 35 patients with seropositive RA (positive to one or both seromarkers), and group II, comprising 35 patients with seronegative RA (negative to both seromarkers). Twenty healthy age-matched and sex-matched controls constituted group III. All of the studied participants underwent detailed history-taking and physical examination, focusing on RA duration of illness, clinical features suggestive of thyroid dysfunction, and disease activity score (DAS28). We determined the complete blood count, erythrocyte sedimentation rate, C-reactive protein, urea, creatinine, alanine aminotransferase, aspartate aminotransferase, thyroid stimulating hormone (TSH), serum total T3 (TT3), serum total T4 (TT4), rheumatoid factor (RF), anti-cyclic citrullinated peptide (anti-CCP), anti-thyroid peroxidase (anti-TPO), thyroglobulin Ab, and TSH receptor antibody (TRAb) levels, and also performed a neck ultrasound. Results It was found that erythrocyte sedimentation rate, C-reactive protein, RF, and anti-CCP were significantly higher in RA patients versus controls, particularly in seropositive versus seronegative patients. No significant difference was found between the studied groups as regards TSH, T3, and T4 levels; however, hypothyroidism was found to be more common than hyperthyroidism in RA patients (29 vs. 3% in group I and 9% in group II). Anti-TPO and antithyroglobulin were significantly higher in RA patients versus controls (P < 0.001) and specifically in seropositive (1301.9 ± 1716.0 and 1750.0 ± 1866.2, respectively) versus seronegative patients (799.4 ± 1597.7 and 898.1± 988.11, respectively). TRAbs were detectable in a small subset of RA patients (6% regardless of the serostatus) with significant difference between patients and controls (P = 0.006). Ultrasonographic features of thyroiditis were significantly evident in RA patients versus controls (P = 0.001). A positive correlation was found between RA autoantibodies (RF and anti-CCP) and thyroid autoantibodies (mainly anti-TPO and TRAbs) (P = 0.007, 0.012, 0.004, and 0.035, respectively). Conclusion Thyroid dysfunction and AITD are common in RA patients, with hypothyroidism being the most common disorder, which is prevalent in 29% of patients regardless of their serostatus. This association was independent of disease activity assessed by DAS28. Increased incidence of thyroid autoimmunity was seen in seropositive RA versus seronegative RA patients, as evidenced by higher levels of thyroid autoimmune markers in the former. TRAbs were detectable in a small subset of patients with RA.
  4,171 46 -
Study of serum apelin and its relation to obesity-associated hypertension
Samir N Assaad, Aliaa A El-Aghoury, Eman M El-Sharkawy, Eman Z Azzam, Marwa A Salah
January-April 2015, 1(1):28-35
Introduction Over the past few decades obesity has become a major burden on health worldwide. The prevalence of hypertension has increased with a significant increase in the prevalence of overweight and obesity. Recent studies indicate an important role of adipose tissue hormones called adipokines in obesity-associated complications. Apelin has recently been added to the family of adipokines. One of the physiologic functions of the apelin/APJ system is regulation of the cardiovascular function. The aim of this study was to determine the relation of serum apelin to obesity-associated hypertension as well as to myocardial performance. Patients and methods The study included 30 obese hypertensive patients, 30 obese nonhypertensive patients, and 25 age-matched and sex-matched controls. In all studied participants we determined the lipid profile, serum insulin, fasting blood glucose level, HOMA-IR, serum apelin, and echocardiographic results of left ventricular systolic and diastolic function. Results Higher levels of fasting blood glucose, fasting serum insulin, HOMA-IR, triglycerides, total cholesterol, and low-density lipoprotein were detected in obese hypertensive and nonhypertensive patients. Left ventricular mass index (LVMI) was increased in both obese hypertensive and nonhypertensive patients in comparison with healthy individuals. Left ventricular ejection fraction and E/A ratio were significantly lower in hypertensive obese versus nonhypertensive obese individuals (P = 0.004 and <0.001, respectively), whereas LVMI was higher in hypertensive versus nonhypertensive patients (P < 0.001). Apelin levels were significantly equally higher in obese hypertensive and nonhypertensive patients (6.10 ± 1.88 and 6.40 ± 1.60 ng/ml) compared with controls (4.22 ± 0.86 ng/ml, P < 0.001). In hypertensive obese individuals, serum apelin correlated negatively with left ventricular ejection fraction (P = 0.02) and directly with E/A ratio (P = 0.03). Conclusion Apelin levels are significantly higher in obese hypertensive and nonhypertensive patients. This increase might be a compensatory mechanism against myocardial dysfunction with obesity.
  3,823 63 2
Serum sclerostin levels in type 2 diabetes mellitus patients: possible correlations with bone metabolism parameters and thrombocytosis
Manal Ali Abdel Khalek, Amal Mohamad El-Barbary, Alyaa Ahmed Elsherbeny, Emad Abdel Mohsen Abdel Hadi, Mona Gameel Balata, Manal Shawky Hussein, Rasha Ahmad Gaber, Sonya Ahmed El-Gaaly
January-April 2015, 1(1):21-27
Introduction Type 2 diabetes mellitus (T2DM) is a group of pandemic debilitating metabolic diseases featuring chronic hyperglycemia that results from defective insulin secretion and/or insulin actions. Dame and Sutor reported that diabetic patients are prone to thrombocytosis through a complex interplay of mechanisms. Therefore, the aim of our work is to evaluate serum sclerostin levels in patients with T2DM and to analyze the relationships among sclerostin, bone mineral density (BMD), bone metabolism, and thrombocytosis. Objective This study aimed to evaluate serum sclerostin in T2DM and its correlations with bone metabolism and thrombocytosis. Patients and methods Fifty male T2DM patients were enrolled; they were divided into two groups according to existing thrombocytosis. Forty age-matched men were included as controls. Clinical tests of physical mobility, fasting blood glucose, glycated hemoglobin, calcium, creatinine, parathormone (PTH), 25-hydroxyvitamin D, bone-specific alkaline phosphatase (BALP), serum carboxy-terminal cross-linked telopeptide of type I collagen (sCTX-I), serum sclerostin, and BMD were performed. Results There were insignificant increases in BMD in diabetic patients versus controls. There were significantly lower levels of PTH, BALP, and sCTX-I in the diabetes mellitus (DM) patient groups compared with the controls (P < 0.001). Serum sclerostin levels were significantly higher in DM patients than the controls, with insignificantly higher sclerostin levels in group II. Serum sclerostin was correlated positively with disease duration and correlated negatively with PTH, BALP, and sCTX-I (P < 0.001). Conclusion Sclerostin plays a role in the pathogenesis of bone changes in T2DM. The interplay between vitamin D, PTH, and blood glucose highlights the possibility of an existing endocrine axis. Finally, the role of osteocytes in regulating hematopoiesis and association with DM and osteoporosis should be investigated further.
  2,111 38 -
Study evaluating testosterone deficiency as a cause of anemia and reduced responsiveness to erythropoiesis-stimulating agents in men on maintenance hemodialysis
Mohamed Magdy Abd El-Kader, Eman Ezat Al-Gohary, Mohamed Momtaz El-Sawy, Ammar Yasser Neanaa
January-April 2015, 1(1):1-6
Introduction Chronic kidney disease (CKD) is a worldwide disease that is classified into five stages according to the glomerular filtration rate and presents through a variety of symptoms and signs. Anemia is one of the first signs of kidney dysfunction. The most common causes of anemia in CKD are erythropoietin (EPO) hormone deficiency and iron deficiency. Anemia and hyporesponsiveness to erythropoietin-stimulating agents (ESAs) are commonly observed in CKD patients and are associated with increased morbidity, mortality, and a significant healthcare economic burden. Although testosterone deficiency is a prevalent condition in men with CKD, it has so far received relatively little attention in practice. Testosterone stimulates erythropoiesis through the production of hematopoietic growth factors and possible improvement of iron bioavailability. Aim The aim of this study was to evaluate serum testosterone levels in patients on maintenance hemodialysis (MHD) and correlate its level with anemia and response to ESAs therapy. Patients and methods This study included 40 male patients from dialysis units, where they were divided equally into group A, group taking ESAs, and group B, group not taking ESAs (EPO-naive group). Another 20 men were included in group C (control group). All groups were subjected to a full assessment of history, full clinical examination, and laboratory investigations to exclude all possible causes of anemia. Results This study showed that in group A, 75% of the participants were anemic, whereas in group B, 100% of the participants were anemic, with a higher degree of anemia. The testosterone level was slightly higher in group B than group A; despite being within the normal range, it was relatively deficient on the basis of the age of the participants in the control group. Conclusion Testosterone deficiency is a prevalent condition in CKD that starts at an earlier age than the normal population. It is an evident independent cause of anemia in EPO-naive CKD patients and is a possible cause of resistance of ESAs in CKD patients; still, the most important causes of anemia in CKD are EPO and iron deficiency.
  2,051 32 -
Study of vitamin D level in type 2 diabetic patients before and after treatment with pioglitazone
MR Halaw, MM Abu Shady, YM Eid, AA EL Sherbeney, WW Mohamed
January-April 2015, 1(1):43-48
Objective The aim of this study was to evaluate vitamin D level in type 2 diabetic patients before and after treatment with pioglitazone and assess any possible relationship with type 2 diabetic patients who are pioglitazone naive. Participants and Methods The study included 50 female participants; of them, 20 were healthy female participants who served as controls and 30 were pioglitazone-naive diabetic patients. All individuals were subjected to history taking and clinical examination, including fasting blood sugar, 2 h postprandial, glycosylated hemoglobin (HbA1c), lipid profile test (total cholesterol, HDL, LDL, triglycerides), kidney function tests (serum creatinine and calculated glomerular filtration rate), and evaluation of serum calcium, phosphorus, and alkaline phosphatase and serum 25-hydroxy vitamin D (by enzyme linked immunosorbant assay) before (basal) and after 3 months of treatment with pioglitazone. Results There was an nonsignificant elevation of vitamin D in group 2b (diabetic patients after using pioglitazone for 3 months), in comparison with vitamin D level in group 2a (diabetic patients before using pioglitazone) (P = 0.117). Vitamin D levels were found to be inversely associated with HbA1c levels in type 2 diabetic patients (P = 0.000 linear regression analysis); it was also found to be inversely associated with fasting and 2 h postprandial blood sugar levels (P < 0.000). Conclusion Vitamin D could impact glycemic control in terms of the inverse relation of vitamin D with HbA1c%, and at the same time poor glycemic control could impact vitamin D status in uncontrolled diabetic patients. Thiazolidinediones do not have significant effect on vitamin D level in female diabetic patients.
  1,879 29 -
Development and validation of an IGF-1-modified Child-Pugh score to risk-stratify hepatocellular carcinoma patients
Ahmed O Kaseb, Lianchun Xiao, Rania Naguib, Wafaa El-Shikh, Manal Hassan, Hesham Hassabo, Jeong-Hoon Lee, Jung-Hwan Yoon, Hyo-Suk Lee, Young Kwang Chae, James L Abbruzzese, Jeffrey Morris
January-April 2015, 1(1):14-20
Background The Child-Turcotte-Pugh (CTP) score inaccurately predicts survival in patients with chronic liver disease, including hepatocellular carcinoma (HCC), yet remains the standard tool for assessing hepatic reserve and guiding therapeutic decisions. CTP scoring relies on objective laboratory values for albumin, bilirubin, and prothrombin time and subjective clinical grading of hepatic encephalopathy and ascites. As liver production of insulin-like growth factor-1 (IGF-1) is significantly reduced in patients with cirrhosis, we hypothesized that IGF-1 could be a valid surrogate for hepatic reserve to replace the subjective parameters in CTP scores. Materials and methods We prospectively enrolled patients and collected data and retrospectively tested plasma IGF-1 levels in four independent cohorts: two HCC cohorts from the USA [n = 310 (training set) and n = 99 (validation set 1)]; one HCC cohort from Korea [n = 188 (validation set 2)]; and one cirrhosis cohort from Egypt [n = 71 (validation set 3)]. Recursive partitioning identified within the training set three optimal IGF-1 ranges that correlated with survival: >50 ng/ml = 1 point; 26-50 ng/ml = 2 points; and <26 ng/ml = 3 points. We modified the CTP score by replacing ascites and encephalopathy grading with IGF-1 values, subjected both the resulting IGF score and the CTP score to log-rank analysis, and quantified the prognostic values with C-statistics to compare the scores' performance in all cohorts. Results The IGF score was significantly more accurate in predicting survival and improved the stratification of all CTP classes in the training and validation cohorts. Conclusion The new IGF score is simple and blood-based, and validated well on multiple independent HCC cohorts. It could identify a subpopulation of patients who may benefit from active therapy because of their preserved hepatic reserve, as distinct from patients for whom therapy can be deferred or avoided.
  1,812 32 -
Study of the C-reactive protein and tumor necrosis factor-α levels in the elderly before and after resistance exercise training
Noha M El-Sabbagh, Enas M Shahin, Nany H Abo El Makarem, Rania S Swelem, Shaymaa AIM AbdElMoneim
January-April 2015, 1(1):7-13
Introduction Aging results in chronic low-grade inflammation that is associated with an increased risk for disease, poor physical functioning, and mortality. The biomarkers that are mostly related to inflammation such as tumor necrosis factor-α (TNF-α) and C-reactive protein (CRP) are created to stimulate and activate the immune system in response to inflammation. Strategies that reduce age-related inflammation may improve the quality of life in older adults. The benefits of regular exercise for the elderly are well established, whereas less is known on the impact of low-intensity resistance exercise on this chronic low-grade inflammation in the elderly. Aim of the study To study the level of TNF-α and CRP before and after programmed resistance exercise in Egyptian elderly individuals. Patients and methods Thirty healthy elderly individuals aged 60 years or older, of both sexes, participated in 4 weeks of resistance exercise training (RET). Circulating levels of TNF-α and CRP were measured before and after the exercise training. Results This study found that both inflammatory markers, TNF-α and CRP, were statistically significantly decreased (P = 0.036, 0.009), respectively, in comparison with the previous starting level measured before the exercise in the same individuals. Conclusion There was a negative correlation between TNF-α and CRP levels and the RET, which indicated that RET represents a low-cost strategy that may reduce age-related inflammation and may thus improve the quality of life in older adults.
  1,580 27 -
Clinical significance of serum adipokine visfatin/eNampt in relation to prostate cancer detection and aggressiveness
Salwa H Gomaa, Tamer M Abou Youssif, Mostafa Elmissery, Saba Elgendy
January-April 2015, 1(1):36-42
Background Prostate cancer is a common malignancy ranked as the second most common cause of cancer and the fifth cause of cancer-related mortality worldwide. The association between obesity and prostate cancer remains poorly understood, but evidence suggests that obesity may adversely affect the risk of developing high-grade disease. Adipokines may contribute toward the molecular basis for a link between obesity and prostate cancer. Several studies have shown the role of visfatin in different cancers including astrocytomas, myeloma, and male oral squamous cell; gastric, endometrial, hepatocellular, and colorectal carcinomas; and invasive breast cancer. Objective In the present study, we attempted to investigate whether a high serum level of visfatin is a good biomarker associated with prostate cancer, especially high-grade cancer, and in obese patients; then, it could be used as a biomarker for the detection of prostate cancer and to determine its aggressiveness. Participants and method The present study included 89 individuals divided as follows: 15 age-matched volunteers, control group (group I), 36 patients diagnosed with benign prostatic hyperplasia (BPH group) (group II), and 38 patients diagnosed with prostate cancer (PC group) (group III). Results There was a statistically significant increase in serum visfatin level in PC patients (group III) compared with both the controls (group I) and patients with BPH (group II) (P < 0.001, P < 0.001, respectively). In PC patients, the median value of serum visfatin was 55.36 ng/ml (44.32-94.02), whereas it was 12.06 ng/ml (10.36-17.74) in the BPH group and 14.89 ng/ml (10.68-18.62) in the control group. BMI, visfatin, and prostatic-specific antigen were found to be the major significant determinants of the tumor grade (Gleason score) of PC (with a 95% confidence interval 0.096-0.233, P < 0.001; 0.083-0.016, P = 0.005; and 0.001-0.019, P = 0.033, respectively). Conclusion In this study, we found a significant positive association between serum visfatin and PC, especially in obese individuals, and we suggest that visfatin could be used as a new promising biomarker for PC; further investigations are warranted to confirm its role in the diagnosis of PC and to assess its aggressiveness.
  1,541 23 2
The prognostic value of serum 25-hydroxyvitamin D level in patients with ST-segment elevation myocardial infarction
Hegazy S Mohammed, Hisham M El-Ashmawy, El-Sawy M Mohamed, Alkomy Mostafa
January-April 2015, 1(1):49-52
Background Low serum level of vitamin D has been shown to be associated with cardiovascular diseases as well as the presence of diabetes, dyslipidemia, and hypertension. Vitamin D deficiency is prevalent in Egypt as well as worldwide. We aimed to assess vitamin D status in patients with acute ST-segment elevation myocardial infarction (STEMI) and its correlation with hospital length of stay, in-hospital complication, in-hospital mortality, and 6-month mortality. Patients and methods In a prospective study, 53 patients with acute STEMI were included. The patients' 25-hydroxyvitamin D levels (ng/ml) were determined and the associations with clinical characteristics, laboratory data, in-hospital outcomes, and 6-month mortality were investigated. The study also included 20 healthy adult volunteers. Results Almost 70% of the patients in the STEMI group were vitamin D deficient (<30 ng/ml). Patients with a history of hypertension had significantly lower vitamin D levels (P < 0.001). Moreover, there was a significant positive relationship between hospital length of stay and levels of vitamin D (P < 0.003). Also, hospital length of stay was significantly shorter in patients who had undergone a primary percutaneous intervention (P < 0.008). Conclusion Vitamin D deficiency is highly prevalent in patients with acute STEMI. Vitamin D deficiency is highly prevalent in patients with a history of hypertension. Vitamin D deficiency is associated with longer length of hospital stay.
  1,419 16 -