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  Citation statistics : Table of Contents
   2015| September-December  | Volume 1 | Issue 3  
    Online since March 9, 2016

 
 
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ORIGINAL ARTICLES
Influence of thyroid function on the outcome of percutaneous coronary intervention in euthyroid patients with coronary artery disease
Samir N Assaad, Mohamed A Sobhy, Tamer M Elsherbiny, Rania S Swelem, Magdy M Allam
September-December 2015, 1(3):97-108
DOI:10.4103/2356-8062.178289  
Background Thyroid hormonal disturbance plays an essential role in coronary artery disease (CAD) development and progress. Few studies have detected the relation between percutaneous coronary intervention (PCI), thyroid gland function, and morphology. We aimed to assess the influence of baseline thyroid function tests on the outcome of PCI in euthyroid patients with CAD, and to detect the effect of PCI on the thyroid function and ultrasound features. Patients and methods This study included 113 clinically euthyroid patients with stable CAD. Serum free T3, serum free T4, thyroid-stimulating hormone (TSH), thyroid-stimulating hormone index, free T3/T4 ratio, anti-thyroperoxidase (TPO), and high-sensitivity C-reactive protein had been measured before, and then 24 h and 3 months after PCI. The morphology of thyroid was evaluated through thyroid ultrasound before and 3 months after PCI. Results One day after PCI, there was a significant increase in serum FT3 and serum FT4 and no significant change in the serum TSH compared with just before PCI (P < 0.001, P = 0.04, P = 0.97, respectively). In addition, there was a significant increase in serum FT3/FT4 ratio compared with just before PCI (P = 0.007). Three months after PCI, there was a significant increase in serum FT4, decrease in serum FT3 returning to baseline, and a significant increase in serum TSH compared with just before PCI (P = 0.42, P < 0.001, P < 0.001, respectively). There was a significant decrease in the serum FT3/FT4 ratio and significant increase in serum thyroid-stimulating hormone index compared with just before PCI ( P ≤ 0.001, P < 0.001, respectively). Higher TSH and measured echogenicity index were independent pre-PCI predictors of unfavorable outcomes after 24 h with cutoff values greater than 0.95 mIU/ml and greater than 1.81, respectively. Lower FT3 and higher FT4 levels were independent pre-PCI predictors of unfavorable outcomes after 3 months with cutoff values less than or equal to 2.95 pg/ml and greater than 1.3 ng/dl, respectively. Conclusion A state of euthyroid hyperthyroxinemia was detected 24 h after PCI. A state of thyroid hormone resistance was detected 3 months after PCI. Higher TSH and measured echogenicity index independently predicted unfavorable outcome after 24 h. Lower FT3 and higher FT4 levels independently predicted unfavorable outcomes after 3 months.
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Serum total osteocalcin level as a vascular marker in elderly patients with metabolic syndrome
Marwa A Saad, Nany H Al-Gaiar, Marwa H Mahmood, Amr M Al-Abd
September-December 2015, 1(3):109-114
DOI:10.4103/2356-8062.178290  
Metabolic syndrome (MetS) is a major public health problem and a clinical challenge worldwide. Several epidemiological studies have confirmed the increased risk for cardiovascular diseases (CVD) in individuals with MetS. Total osteocalcin (TOC) is a bone-derived, noncollagenous protein that was recently recognized as a hormone-regulating energy metabolism factor. Importantly, osteocalcin expression has been described as having a role in calcifying vascular smooth muscle cells. We aimed in the present study to analyze the correlation between serum levels of TOC and vascular calcification in elderly persons with MetS. Seventy-four elderly men aged 65 years or older were included in the present study and divided into two groups. Group I comprised 40 patients who satisfied at least three criteria for MetS according to the National Cholesterol Education Program Adult Treatment Panel III (NCEP-ATP III) definition, and group II comprised 34 age-matched healthy men who served as the control group. BMI was calculated, blood samples were taken for lipid profile analysis, and total osteocalcin (OCN) levels were evaluated using enzyme-linked immunosorbent assay kits. Carotid Doppler B mode ultrasonography was performed for all participants. Patients with MetS exhibited significantly higher BMIs, waist circumference, fasting blood sugar, triglycerides, blood pressure, total cholesterol, and lower high-density lipoprotein-cholesterol compared with controls. Patients with MetS had significantly lower levels of TOC compared with controls. Also, patients with MetS had significantly higher intima-media thickness and a higher number of carotid plaques compared with controls. TOC was significantly negatively correlated with parameters of carotid atherosclerosis. It is also negatively correlated with dyslipidemic parameters. Its correlation with components of MetS did not reach statistical significance. We concluded that serum osteocalcin levels were negatively correlated with carotid atherosclerosis in patients with MetS. This may reflect the role of osteocalcin as a circulating endocrine factor that regulates glucose metabolism and thereby cardiovascular risk in patients with MetS. Prospective studies are needed to assess the time course and relevance of serum osteocalcin in the development of atherosclerosis in patients with MetS.
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Study of frailty index in elderly men with type 2 diabetes mellitus
Marwa AM Saad, Samar M Abd El-Fattah, Mohamed S Gad, Akram M Deghady
September-December 2015, 1(3):115-120
DOI:10.4103/2356-8062.178291  
Introduction Frailty is a common and growing multidimensional health and social care challenge across the world. Diabetes mellitus (DM) is one of the most important causes of morbidity and mortality in Egypt. Frailty and diabetes are inter-related. In addition, diabetes causes early-onset frailty. In this study we aimed to determine the frailty index in elderly men with type 2 DM and compare it with that in pre-elderly diabetic patients and age-matched healthy controls. Materials and methods Seventy male participants were included in the present study and were divided into three groups. Group I comprised 20 healthy men aged 65-75 years who were considered the control group; group II comprised 25 patients aged 50-64 years with type 2 DM; and group III comprised 25 patients aged 65-75 years with type 2 DM. Patients on insulin therapy and those with hypogonadism or hypothyroidism were excluded from the study. Frailty index was determined for all participants using Fried's five phenotypic parameters. Patients were considered frail if they fulfilled more than or equal to three parameters, prefrail if they fulfilled one to two parameters, and nonfrail if they fulfilled none of the parameters. Data were collected, analyzed, and compared between groups I and III and between groups II and III. Further, frailty index was correlated with the duration of DM and the degree of glycemic control. Results Seventy patients were divided into three groups. The mean age in group I was 68.50 ± 1.90 years, that in group II was 58.24 ± 4.34 years, and that in group III was 68.60 ± 2.43 years. Regarding the frailty index, in group I 17 patients (85%) were nonfrail, three (15%) were prefrail, and none were frail; in group II, four patients (16%) were prefrail, 21 (84%) were frail, and none were nonfrail; and in group III, three patients (12%) were prefrail, 22 (88%) were frail, and none were nonfrail. A statistically significant difference was noted between groups I and III, whereas no significant difference was noted between groups II and III. A significant positive correlation was found between the frailty index score and duration of diabetes and degree of glycemic control in groups II and III. Conclusion Diabetes and frailty are causally related. Diabetes is associated with frailty at earlier age. The duration of diabetes and degree of glycemic control correlate with the severity of frailty in both elderly and pre-elderly diabetic patients.
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Evaluation of sex-specific association of serum testosterone and estradiol levels with frailty in elderly Egyptian men and women
Marwa AM Saad, Marwa H Mahmood
September-December 2015, 1(3):121-127
DOI:10.4103/2356-8062.178320  
Background Frailty is an age-associated syndrome characterized by a reduced functional reserve and impaired adaptive capacity. Age-ass ociated decline in sex-hormone levels represent one of the potential mechanisms involved in the development of frailty. We aimed at studying the association of serum testosterone and serum estradiol levels with frailty in elderly Egyptian men and women, and evaluating sex-specific differences in the association between testosterone and estradiol levels with frailty. Materials and methods A total of 94 elderly participants (55 men and 39 women), aged 65 years and older, were included in the present study. Participants were divided into three groups according to their frailty status, which was determined according to the Fried criteria. Total testosterone (TT), free testosterone (FT), and total estradiol (E2) were determined. Results For men, frailty was significantly correlated with TT and FT but not with E2, whereas, for women, frailty was significantly correlated with FT and E2 but not with TT. In addition, BMI was significantly correlated with frailty for both men and women. Conclusion We concluded that lower levels of FT are associated with frailty for both men and women, whereas lower levels of TT are associated with frailty in men but not in women. Estradiol (E2) is correlated with frailty in women but not in men. In light of these findings, men with low levels of testosterone are at an increased risk for physical frailty and could thus benefit from testosterone therapy. In addition, postmenopausal women might also benefit from testosterone administration and estrogen supplementation in the context of a wider hormonal care.
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Study of the relation between serum testosterone level and carotid atherosclerosis in elderly men
Nany H El Gayar, Marwa H Mahmoud, Amro M Elabd
September-December 2015, 1(3):128-136
DOI:10.4103/2356-8062.178324  
Objective The aim of the present study was to evaluate the relationship between serum testosterone concentration and carotid atherosclerosis in elderly men. Participants and methods The current study included 40 participants who were classified into two groups; the first group comprised 30 elderly healthy men (the case group) and the second group comprised 10 young males (the control group). Serum level of total testosterone was measured using a commercial immunoassay kit cobas testosterone II; sex hormone binding globulin (SHBG) was measured using a commercial immunoassay kit cobas. SHBG and free androgen index (FAI) were calculated by dividing the total testosterone value by SHBG value and then multiplying it by 100 [total testosterone (nmol/l)/SHBG (nmol/l)Χ100%]. Ultrasonographic measurement of carotid intima-media thickness (IMT) was also carried out. Results Total testosterone level was significantly lower in the case group than in the control group (t = 5.354, P < 0.001). SHBG was significantly higher in the case group than in the control group (t = 4.796, P < 0.001). FAI was significantly lower in the case group than in the control group (z = 4.686, P < 0.001). IMT was significantly higher in the case group than in the control group (t = 3.513, P = 0.001). As regards the number of plaques, 10 men participants (33.3%) from the case group did not have any plaques, 13 (43.3%) had one plaque, and seven (23.3%) had two plaques; however, in the control group, nine participants (90%) did not have any plaques and only one (10%) had one plaque; therefore, the case group had significantly higher number of plaques than did the control group (z = 3.007, P = 0.003). There was a significant negative correlation between total testosterone and SHBG (R = −0.856, P < 0.001), a significant positive correlation between total testosterone and FAI (R = 0.957, P < 0.001), and a significant negative correlation between testosterone and both IMT (R = −0.501, P = 0.005) and number of plaques (R = −0.358, P = 0.52). SHBG was negatively correlated with FAI (R = −0.845, P < 0.001) but positively correlated with both IMT (R = 0.392, P = 0353) and the number of plaques (R = 0.032, P = 0.056). There were significant negative correlations between FAI and both IMT (R = −0.601, P < 0.001) and the number of plaques (R = −0.461, P = 0.010). IMT was positively correlated with the number of plaques (R = 0.760, P < 0.001). Conclusion These findings suggest that normal physiologic testosterone levels may help to protect men from atherosclerosis. In elderly men, low plasma testosterone is associated with elevated carotid IMT. A negative correlation has been demonstrated between endogenous testosterone levels and IMT of the carotid arteries. These findings suggest that men with lower levels of endogenous testosterone may be at a higher risk for developing atherosclerosis.
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Serum leptin and multi-detector computed tomography (MDCT)-measured bone attenuation among low BMI male patients with moderate-severity chronic obstructive pulmonary disease in exacerbation and stable states
Fatma E Bukhary, Yehia Z Mahmoud, Ragaa Abdel-Shahid, Hesham KH Keryakos, Laila A Mohsen, Tamer T Ismail, Lamiaa Hamdy
September-December 2015, 1(3):137-146
DOI:10.4103/2356-8062.178331  
Introduction Several studies have shown high prevalence of osteoporosis and weight loss in patients with chronic obstructive pulmonary disease (COPD). Leptin regulates bone metabolism, body weight, and pulmonary artery pressure. The association of bone density and serum leptin with BODE score in moderate COPD patients is still unclear. Aim of the study The aim of the study was to explore the association of serum leptin with average bone attenuation assessed by routine chest MDCT, and their correlation with clinical and echocardiographic parameters. Patients and methods The study included 54 male patients with low BMI and moderate COPD severity. Patients were divided into two groups: those with COPD exacerbations (24 patients; group I) and those with stable COPD (30 patients, group II). Twenty male volunteers of matched age and BMI were included as controls (group III). Calculation of BMI and BODE score was done. Spirometry and echocardiography were performed in all participants. Average bone attenuation of the thoracic spine was estimated by MDCT. Serum leptin was estimated. Results Group I and group II had significantly lower bone attenuation and higher BODE index, pulmonary artery systolic pressure (PASP), and right ventricle diameter (RVD) as compared with healthy controls (P < 0.001). Serum leptin level and leptin/BMI ratio were significantly increased in group I than in other groups (P < 0.001). Group II had significantly lower serum leptin than did controls. Serum leptin correlated positively with age, BMI, COPD severity, and bone attenuation and showed significant negative correlation with BODE score and serum calcium in group II. Meanwhile; it showed significant positive correlation with BMI and PASP in group I. In the stable COPD group, PASP, RVD, BMI, and bone attenuation were independent predictors of serum leptin, whereas BODE score, FEV 1 , FEV 1 /FVC, PASP, RVD, BMI, and serum leptin were independent predictors of bone attenuation. Conclusion COPD patients with moderate severity and low BMI had increased circulating leptin and low calcium level during exacerbation. Serum leptin level correlated with bone attenuation in stable but not in exacerbation states.
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Study of serum monocyte chemoattractant protein-1 as a marker of disease activity in rheumatoid arthritis patients
Magdy Abd El-Aziz El-Zohairy, Anna Nashait Abou-Raya, Akram Abd El-Monem Degady, Eman Hassan El-Said, Mosab Mohammed Adel
September-December 2015, 1(3):147-152
DOI:10.4103/2356-8062.178338  
Introduction Rheumatoid arthritis (RA) is a chronic systemic disease that primarily targets the synovium, leading to synovial inflammation and proliferation, loss of articular cartilage, and erosion of juxta-articular bone. Objective The aim of the work was to assess the role of serum monocyte chemoattractant protein-1 (MCP-1) as a marker of disease activity in RA and its correlation with different disease parameters. Patients and methods We assessed serum MCP-1 level in 40 RA patients and 20 age-matched and sex-matched healthy controls. We also assessed different clinical and laboratory disease parameters in RA patients - namely, swollen joint count, tender joint count, erythrocyte sedimentation rate, C-reactive protein (CRP), rheumatoid factor, anti-cyclic citrullinated peptide (ACCP), and 28-joint Disease Activity Score (DAS-28) (CRP). We correlated serum MCP-1 with disease activity and different disease parameters. Results Serum MCP-1 was significantly higher (P = 0.001) in the patient group (mean = 414, SD = 508.97) than in the control group (mean = 77.25, SD = 16.58). Serum level also correlated significantly with rheumatoid factor (P = 0.004), swollen joint count (P = 0.004), and with DAS-28 CRP score (0.034). There was no significant correlation between MCP-1 and tender joint count, erythrocyte sedimentation rate, CRP, or radiographic changes. Conclusion Serum MCP-1 is a useful biomarker in monitoring RA activity.
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Iron status in healthy elderly people: an evaluation of the role of soluble transferrin receptors in elderly
Nany H El Gayar, Akram A Deghady
September-December 2015, 1(3):153-158
DOI:10.4103/2356-8062.178345  
Objective The aim of this study was to examine the status of iron and the significance of soluble transferrin receptors (sTfR) in healthy elderly population. Participants and methods This study was carried out on 30 healthy elderly individuals (15 men and 15 women) above 65 years of age (the elderly group); in addition, 10 young participants served as controls (the control group). Serum iron level, total capacity of iron binding (TIBC), ferritin, and hemoglobin were measured. The level of sTfR was measured with a commercial kit using BioVendor Humans sTfR ELISA. Results Significant statistical decrease in hemoglobin level (P = 0.0007), ferritin (P = 0.00001), and serum iron (P = 0.00001), and a significant statistical increase in sTfR (P = 0.0013) were found in the elderly group. There was no statistical significant difference in TIBC (P = 0.4719) and significant negative correlation between sTfR and ferritin, TIBC, hemoglobin, and serum iron. Conclusion Serum iron decreases with advancing age and sTfR level increases. sTfR is negatively correlated with serum iron level and can be used as a reliable marker for iron stores, as sTfR is not affected by acute inflammatory conditions. sTfR measurement is useful in the diagnosis of iron deficiency.
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