Associations between Human Aldosterone Synthase (CYP11B2) and Angiotensin II type 1 Receptor (ATR1) Gene Polymorphisms with End Stage Renal Disease In hypertensive Egyptian Patients on Maintenance Hemodialysis

Many people with an advanced form of kidney disease do not know they have weak or failing kidneys, but early detection and treatment can help prevent the progression of kidney disease to kidney failure. The resulting costs of treatment of ESRD are enormous. ESRD is a complex phenotype, which results from the presence of underlying kidney disease, and superimposing inherited and environmental factors. Among the predisposing genetic factors, renin-angiotensin-aldosterone system (RAAS) disruption is clearly involved in ESRD development. The aim of this study is to evaluate the association between CYP11B2 C-344T and ATR1 A1166C gene polymorphisms with increased risk for ESRD in hypertensive Egyptian patients on maintenance hemodialysis.This study included 70 ESRD patients on maintenance hemodialysis (32 males and 28 females, mean age 54.5± 9.5 years, recruited from El Doaah and El Rayan hospitals, Cairo, Egypt. 70 healthy individuals, of matching age and sex (30 males and 40 females, mean age 50.2 ± 13.1 years), were also included in the study. All subjects were genotyped for both CYP11B2 C-344T and ATR1 A1166C gene polymorphisms. Serum aldosterone was also measured for all subjects. Concerning the CYP11B2 gene, HD patients showed increased frequency of the TT genotype (68.57%) as compared to controls (only 12.85%), with no significant differences in T allele distribution between the 2 groups. In contrast, HD patients had low frequency of the CC genotype (5.71%) as compared to controls (32.85%), with a significant difference in C allele distribution between the HD patients (28.56%) and controls (70.7%). Comparing serum aldosterone levels in various CYP11B2 genotypes in HD patients revealed that patients with TT genotype had statistically higher aldosterone levels (121.583 ± 43.311) than those with the TC (72.055 ± 11.709) or CC genotype (68.75 ± 13.145). On the other hand, for AT1R A1166C genotype frequency, HD patients showed significantly (p˂0.05) higher frequency of CC genotype (70%) than controls (7.1%), with lower AA genotype frequency (5.71%) compared to controls (57%). Moreover, there was significant differences in A allele distribution between the HD patients (27.13%) and controls (64.25%).  The same was true for the C allele, with a frequency of (59.28%) in HD patients compared to a frequency of (39.25%) in controls. On the other hand, studying ATR1 A1166C gene polymorphisms revealed that patients with the CC genotype had significantly higher aldosterone levels (121.25 ± 43.006) than those with AA (87.6 ± 25.4) genotype.

Dietary Behaviour Pattern and Physical Activity in Overweight and Obese Egyptian Mothers: Relationships with Their Children's Body Mass Index

BACKGROUND: Obesity and related morbidity increase in Egyptian women and their children. A better understanding of dietary and activity patterns is needed to reduce obesity prevalence.AIM: The present study aimed to assess dietary patterns and physical activity in Egyptian overweight and obese mothers and to explore its relationships with their children's body mass index (BMI).SUBJECTS AND METHODS: This descriptive case-control study was conducted at the National Research Center. The study included a sample of 64 overweight and obese mothers and 75 children, compared with apparently healthy non-obese mothers and their children of matched age and social class. Tested questionnaires were used to collect information of the studied subjects.RESULTS: A statistically significantly higher incidence of unemployment, large family size was observed in overweight & obese women compared to controls (P < 0.05). Those women who consumed vegetables more than 3 times a week were less likely to be overweight or obese (P < 0.05). No significant association were detected between mothers' physical activity, dietary behaviour variables and children’s BMI except for consuming beverages with added sugar (95%CI = 0.074-0.985, P<0.05).CONCLUSION: Improper dietary patterns, nonworking mothers and big family size are associated with obesity among Egyptian women. Emphasis should be given to increasing physical activity and encourage healthier diets among Egyptian mothers and their children

Impact of opioid-free analgesia on pain severity and patient satisfaction after discharge from surgery: multispecialty, prospective cohort study in 25 countries

Background: Balancing opioid stewardship and the need for adequate analgesia following discharge after surgery is challenging. This study aimed to compare the outcomes for patients discharged with opioid versus opioid-free analgesia after common surgical procedures.Methods: This international, multicentre, prospective cohort study collected data from patients undergoing common acute and elective general surgical, urological, gynaecological, and orthopaedic procedures. The primary outcomes were patient-reported time in severe pain measured on a numerical analogue scale from 0 to 100% and patient-reported satisfaction with pain relief during the first week following discharge. Data were collected by in-hospital chart review and patient telephone interview 1 week after discharge.Results: The study recruited 4273 patients from 144 centres in 25 countries; 1311 patients (30.7%) were prescribed opioid analgesia at discharge. Patients reported being in severe pain for 10 (i.q.r. 1-30)% of the first week after discharge and rated satisfaction with analgesia as 90 (i.q.r. 80-100) of 100. After adjustment for confounders, opioid analgesia on discharge was independently associated with increased pain severity (risk ratio 1.52, 95% c.i. 1.31 to 1.76; P < 0.001) and re-presentation to healthcare providers owing to side-effects of medication (OR 2.38, 95% c.i. 1.36 to 4.17; P = 0.004), but not with satisfaction with analgesia (beta coefficient 0.92, 95% c.i. -1.52 to 3.36; P = 0.468) compared with opioid-free analgesia. Although opioid prescribing varied greatly between high-income and low- and middle-income countries, patient-reported outcomes did not.Conclusion: Opioid analgesia prescription on surgical discharge is associated with a higher risk of re-presentation owing to side-effects of medication and increased patient-reported pain, but not with changes in patient-reported satisfaction. Opioid-free discharge analgesia should be adopted routinely

Association of insertion–deletion polymorphism of ACE gene and Alzheimer’s disease in Egyptian patients

Introduction: Alzheimer’s disease (AD) is a progressive, neurodegenerative disease. Many studies proposed an association of the insertion (I)/deletion (D) polymorphism (indel) in intron 16 of the gene for angiotensin I-converting enzyme (ACE) on chromosome 17q23 with Alzheimer’s disease. ACE indel and related haplotypes associated with AD risk have reduced plasma ACE whereas protective genotypes have elevated ACE. Object: To investigate whether there is a correlation between polymorphisms of the ACE I/D locus gene and AD in Egyptian patients and to determine whether there is a difference in ACE activity in the plasma of clinically diagnosed AD patients. Methods: Subjects of this study are 84 dementia patients diagnosed as having Alzheimer’s disease, 45 males and 39 females aged 65 ± 7 years from the Geriatric Department at Ain-Shams University Hospitals and 86 individuals as non dementia controls, 44 males and 42 females aged 63 ± 6 years. All subjects were genotyped for the common insertion/deletion polymorphisms for ACE gene locus, and ACE plasma activity assay was measured for AD patients. Results: There was statistically significant difference in the frequency of the ACE insertion/deletion alleles between the cases and controls where the I allele distribution in AD cases and controls was 74% vs. 15%, and the I/I genotype frequency was 60% vs. 5%, respectively. They both reached a statistical significance range (I allele frequency: OR = 3.714, 95% CI 1.311–10.523, p < 0.01; I/I genotype frequency: OR = 3.18 95% CI 2.33–4.33, p < 0.01). But no significant difference in ACE plasma level was found between different genotypes in our AD patients. Conclusions: Our present study supports the hypothesis of implication (I allele) of ACE gene polymorphism in the development of AD. On the other hand, we did not find significant difference in plasma ACE activities when compared with different studied genotypes

Manganese Superoxide Dismutase Alanine to Valine Polymorphism and Risk of Neuropathy and Nephropathy in Egyptian Type 1 Diabetic Patients

Oxidative stress, characterized by a marked increase in the level of oxygen free radicals (OFR), has been implicated in the development of diabetic microangiopathic complications, such as diabetic neuropathy (DN) and nephropathy (DP). Antioxidant enzymes may protect against the rapid onset and progression of microangiopathy, by reducing the excess of OFR and peroxides. Mutations and polymorphisms in genes encoding such enzymes may therefore result in a predisposition to this disorder. AIM: we investigated the role of genes encoding the antioxidant enzyme, mitochondrial superoxide dismutase (Mn-SOD2), in DN and DP pathogenesis in an Egyptian population. We studied Ala(-9)Val polymorphism of the Mn-SOD2 gene in type 1 diabetic patients (n = 65) with DN (n = 40) or DP (n = 45). METHODS: we used polymerase chain reaction (PCR) assays with restriction fragment length polymorphism for rapid detection of polymorphisms. These assays involved the use of mismatch PCR primers to create restriction sites in the amplified product only in presence of the polymorphic base. The PCR product was then digested with AgeI restriction enzyme to detect Ala(-9)Val polymorphic sites. RESULTS: the frequencies of the Ala allele (odds ratio (OR) = 0.438, 95% CI of 0.247 - 0.778) and the Ala/Ala genotype (OR = 0.26, 95% CI of 1.39 - 10.266) were significantly lower in diabetic neuropathy patients. In contrast, the frequencies of the Val allele (OR = 2.282, 95% CI of 1.286 - 4.05) and the homozygous Val/Val genotype (OR = 6.68, 95% CI of 0.3 - 0.76) were significantly higher in patients with DN than diabetics without neuropathy. Although the Val allele was more frequently detected in DP patients than diabetics without nephropathy (OR = 3.2), this difference was statistically non-significant. In conclusion, Ala(-9)Val substitution in the Mn-SOD2 gene was associated with DN in Egyptian diabetic children but not a significant factor in diabetic patients with nephropathy