4 research outputs found
Relating circulating thyroid hormone concentrations to serum interleukins-6 and -10 in association with non-thyroidal illnesses including chronic renal insufficiency
<p>Abstract</p> <p>Background</p> <p>Because of the possible role of cytokines including interleukins (IL) in systemic non-thyroidal illnesses' (NTI) pathogenesis and consequently the frequently associated alterations in thyroid hormone (TH) concentrations constituting the euthyroid sick syndrome (ESS), we aimed in this research to elucidate the possible relation between IL-6 & IL-10 and any documented ESS in a cohort of patients with NTI.</p> <p>Methods</p> <p>Sixty patients and twenty healthy volunteers were recruited. The patients were subdivided into three subgroups depending on their underlying NTI and included 20 patients with chronic renal insufficiency (CRI), congestive heart failure (CHF), and ICU patients with myocardial infarction (MI). Determination of the circulating serum levels of IL-6 and IL-10, thyroid stimulating hormone (TSH), as well as total T4 and T3 was carried out.</p> <p>Results</p> <p>In the whole group of patients, we detected a significantly lower T3 and T4 levels compared to control subjects (0.938 ± 0.477 vs 1.345 ± 0.44 nmol/L, p = 0.001 and 47.9 ± 28.41 vs 108 ± 19.49 nmol/L, p < 0.0001 respectively) while the TSH level was normal (1.08+0.518 μIU/L). Further, IL-6 was substantially higher above controls' levels (105.18 ± 72.01 vs 3.35 ± 1.18 ng/L, p < 0.00001) and correlated negatively with both T3 and T4 (r = -0.620, p < 0.0001 & -0.267, p < 0.001, respectively). Similarly was IL-10 level (74.13 ± 52.99 vs 2.64 ± 0.92 ng/ml, p < 0.00001) that correlated negatively with T3 (r = -0.512, p < 0.0001) but not T4. Interestingly, both interleukins correlated positively (r = 0.770, p = <0.001). Moreover, IL-6 (R<sup>2 </sup>= 0.338, p = 0.001) and not IL-10 was a predictor of low T3 levels with only a borderline significance for T4 (R<sup>2 </sup>= 0.082, p = 0.071).</p> <p>By subgroup analysis, the proportion of patients with subnormal T3, T4, and TSH levels was highest in the MI patients (70%, 70%, and 72%, respectively) who displayed the greatest IL-6 and IL-10 concentrations (192.5 ± 45.1 ng/L & 122.95 ± 46.1 ng/L, respectively) compared with CHF (82.95 ± 28.9 ng/L & 69.05 ± 44.0 ng/L, respectively) and CRI patients (40.05 ± 28.9 ng/L & 30.4 ± 10.6 ng/L, respectively). Surprisingly, CRI patients showed the least disturbance in IL-6 and IL-10 despite the lower levels of T3, T4, and TSH in a higher proportion of them compared to CHF patients (40%, 45%, & 26% vs 35%, 25%, & 18%, respectively).</p> <p>Conclusion</p> <p>the high prevalence of ESS we detected in NTI including CRI may be linked to IL-6 and IL-10 alterations. Further, perturbation of IL-6 and not IL-10 might be involved in ESS pathogenesis although it is not the only key player as suggested by our findings in CRI.</p
Generalized Vascular Damage Including Glomerular Dysfunction In Newly-Detected Type 2 Diabetic Patients
Aim: Diabetes mellitus (DM) is considered a vascular disease, we
intended to determine prevalence and nature of generalized and
glomerular vascular abnormalities the moment it is diagnosed (ND-DM) in
a cohort of patients with Arabic descent. Over 9 months, 216 out of
1208 asymptomatic Saudies were referred by the Primary Care Physicians
on having risk factors for future development of DM for DM screening.
Methods: For the 54 ND-DM patients and 18 non-diabetic controls,
clinical examination including body mass index (BMI) and waist:hip
ratio (WHR), ultrasound determination of common carotid artery (CCA)
intimal-medial thickness (IMT), hemoglobin A1c (A1c), total cholesterol
(TC), triglycerides (TG), high-density lipoprotein cholesterol (HDL-C),
CRP, albuminuria, serum creatinine (sCr), and glomerular filtration
rate (eGFR) were done. Results: About 4.5% were unaware of their
diabetes and they had significant (35/54 vs 5/18 p=0.01) preclinical
atherosclerosis (increased IMT and/or atheromatous plaques) with
similar age, HDL-C, CRP and eGFR compared to controls. Also, they had
pathologic microalbuminuria ([μA] 145.4±201.4 vs
18.9±7.1, p=0.013) with higher BMI (29.5±3.6 vs
27.2±1.8, p=0.043), WHR (0.94±0.12 vs 0.79±0.1,
p=0.001), TC (5.1±0.9 vs 3.8±0.6, p=0.001) and TG
(2.3±0.9 vs 1.2±0.4, p=0.001) compared to controls. Diabetic
nephropathy (DN), as inferred from glomerular damage marker μA was
significantly prevalent (17/54, p=0.014) in ND-DM patients. Those with
DN had more IMT (0.96±0.1 vs 0.77±0.1, p=0.0001), WHR
(0.98±0.1 vs 0.91±0.13, p=0.037), TC (5.4±0.7 vs
4.9±0.9, p=0.049) and TG (2.7±0.4 vs 2.02±0.4, p=0.012),
lower eGFR (86.4±12 vs 104.1±13, p=0.0001), older age
(40.9±5 vs 37.9±4, p=0.028) and worse glycamic control
(A1c=8.1±1.6 vs 7.3±1.5, p=0.048). Also, diabetic retinopathy
(DR) was significantly prevalent (n=19) in ND-DM patients (p=0.047).
Interestingly, DN and DR, were significantly correlated with each other
(r=0.841, p=0.0001) and with IMT (r=0.38, p=0.005 and r=0.35, p=0.009,
respectively). Conclusion: The newly-detected Saudi diabetics already
had more vascular changes including glomerular damage than normal
glucose-tolerant subjects with clustering of risk factors in particular
abdominal obesity, and dyslipidaemia
Effect Of Hepatitis C Virus Infection On Haematocrit And Haemoglobin Levels In Egyptian Hemodialysis Patients
Aim: Hepatitis C virus (HCV) infection is common among the Egyptians.
This prevalence is higher among hemodialysis (HD) patients in whom
anemia is a common finding. Recently, some case reports and few studies
indicated that red cell status increased after hepatitis C viral
infection among HD patients. The aim of our study is to investigate
whether HCV-positive HD patients have higher hemoglobin (Hb) and
hematocrit (HCT) values compared to HCV-negative patients. Methods:
Ninety-nine chronic (HD) patients were the subject of this study. Their
HCV status was determined by anti-HCV antibodies and confirmed with RNA
polymerase chain reaction (PCR). Those with a history of blood
transfusion or massive blood loss during the last 6 months were
excluded from the study. Results: 70.7% of our patients tested positive
for anti-HCV antibody (56.9 % were male). The mean age for HCV positive
group was (40.41±14.17 years) while it was (47.35±19.18
years) for HCV negative group (P=0.08). HCV positive group has a longer
hemodialysis duration (66.54 ± 43.92 months) compared to HCV
negative patients (30.96±23.17 months, P=0.006). Mean Hb was
similar in HCV-positive compared to HCV negative group (10.32±2.03
versus 10.22±1.52 gm/dl respectively) (P=0.63). Mean HCT values
were also similar in both groups being 30.94± 6.089% in HCV
positive versus 30.77± 4.53% in HCV negative group, respectively
(P= 0.094). Fifty-five patients (39 HCV positive and 16 were HCV
negative) received erythropoietin (EPO) therapy whilst only twenty
patients received IV iron. Mean Erythropoietin dose was
5000±2236.06 Units/week in HCV- positive patients versus
6250±2720.29 Units /week in HCV - negative group (P=0.09). Liver
function tests were normal except for alanine aminotransferase (ALT)
that was significantly higher among HCV-positive compared to
HCV-negative patients (31.75±36.4 vs 15.1±7.21 U/L, P=0.05).
Conclusion: HCV-positive and HCV-negative Egyptian chronic hemodialysis
patients have comparable hemoglobin as well as hematocrit levels and
the erythropoietin dose was not influential as its lower value in
HCV-positive patients did not reach a statistically significant level
Sleep disorders in hemodialysis patients
The prevalence of sleep disorders is higher in patients with kidney failure than the general population. We studied the prevalence of sleep disorders in 88 (mean age; 41.59 ± 16.3 years) chronic hemodialysis (HD) patients at the Urology and Nephrology Center, Mansoura Uni-versity, Egypt over 4-month period. The investigated sleep disorders included insomnia, restless leg syndrome (RLS), obstructive sleep apnea syndrome (OSAS), excessive daytime sleepiness (EDS), narcolepsy and sleep walking, and we used a questionnaire in accordance with those of the International Restless Legs Syndrome Study Group, the Berlin questionnaire, Italian version of Epworth Sleepiness Scale, International Classification of Sleep Disorders, and the specific ques-tions of Hatoum′s sleep questionnaire. The prevalence of sleep disorders was 79.5% in our pa-tients, and the most common sleep abnormality was insomnia (65.9%), followed by RLS (42%), OSAS (31.8%), snoring (27.3%), EDS (27.3%), narcolepsy (15.9%), and sleep walking (3.4%). Insomnia correlated with anemia (r=0.31, P= 0.003), anxiety (r=0.279, P= 0.042), depression (r=0.298, P= 0.24) and RLS (r=0.327, P= 0.002). Also, RLS correlated with hypoalbuminemia (r=0.41, P= < 0.0001), anemia (r=0.301 and P= 0.046), hyperphosphatemia (r=0.343 and P= 0.001). EDS correlated with OSAS (r=0.5, P= < 0.0001), snoring (r=0.341, P= 0.001), and social worry (r=0.27, P= 0.011). Sleep disorders are quite common in the HD patients, especially those who are anemic and hypoalbuminemic. Assessment of sleep quality, preferably with polysomno-graphy, is necessary to confirm our results. Interventional studies for management of sleep disor-ders in HD patients are warranted