Laboratory Parameters In Patients Research Articles

Risk factors associated with clinically significant gastrointestinal bleeding in pediatric ED

IntroductionGastrointestinal bleeding is a common problem in pediatric emergency department (PED). Some of these patients can lose significant amount of blood which may lead to shock. The aim of this study is to determine the risk factors predicting clinically significant gastrointestinal (GIS) bleeding in patients presenting to PED. MethodsThis study was performed prospectively from January 1st 2013 to December 31th 2013 in patients with upper or lower GIS bleeding. Clinically significant GIS bleeding was defined as >2g/dL hemoglobin decrease at any time during observation in PED, need for erythrocyte transfusion or need for rapid endoscopic evaluation. Results105 patients were enrolled, 81 of which were eligible for the study. Twenty two patients (26,8%) had clinically significant GIS bleeding. These patients have significantly more commonly have upper GI bleeding and symptoms of melena, pallor and tachycardia. Initial laboratory findings revealed lower hemoglobin, RBC and albumin levels with higher WBC and BUN levels. They need significantly more nasogastric tube placement and PPI and H2 blocker treatment. Final diagnosis included more gastritis and peptic ulcers. These patients have less hematochezia, less lower gastrointestinal bleeding and less commonly diagnosed as acute gastroenteritis or Mallory Weiss tear as a final diagnosis. ConclusionsPediatric emergency physicians should be aware of clinical and laboratory parameters of patients with clinically significant GIS bleeding to predict which patients are under risk of life threatening blood loss. Patients who have melena, pallor, tachycardia, anemia and uremia at presentation are more prone to have significant GIS bleeding.

Up-regulation of chemokine CXCL13 in systemic candidiasis

Candida albicans is the leading cause of healthcare associated bloodstream infections. Chemokine CXCL13 is well-known involved in inflammation, but its role in candidemia has not been assessed. Our study firstly demonstrated that serum CXCL13 levels were significantly elevated in candidemic patients compared with bacteremic patients and control subjects by ELISA, and CXCL13 concentrations were positively and significantly correlated with clinical Sequential Organ Failure Assessment (SOFA) scores and several laboratory parameters in patients. Moreover, ROC curve analysis showed the diagnostic efficiency of CXCL13 was superior to CRP and PCT. To further study the role of CXCL13, a mouse model was established. Importantly, the data showed the dramatically elevated levels of CXCL13 in mice serum and infected kidney, were significantly correlated with renal fungal burden and pathology scores. In conclusion, our results indicated that CXCL13 had strong potential as a novel biomarker of diagnosis and prognosis for candidemia.

Clinical profile of patients with thrombocytopenia at tertiary health care centre

Background: In tropical countries like India thrombocytopenia is commonly encountered by clinicians in any speciality. Thrombocytopenia present as asymptomatic condition to sometimes becomes a life-threatening condition requiring blood transfusion in various etiological conditions. Infections like malaria and dengue are invariably associated to thrombocytopenia with changing trends in clinical features. Infection is the commonest cause of thrombocytopenia. The objective of study was to evaluate the different causes of thrombocytopenia along with study of clinical profile and laboratory parameters in patients with thrombocytopenia.Methods: A cross-sectional hospital based study was conducted in Department of Medicine at Indian Institute of Medical Science and Research Medical College, Badnapur, Dist. Jalna, Maharashtra, India from November 2015 to August 2017. This study comprises cases of thrombocytopenia of age more than 12 years admitted with platelet count <1 lack/mm3 was included in study, whereas patients with malignancy and chemotherapy induced thrombocytopenia, idiopathic thrombocytopenic purpura, cirrhosis of liver were excluded.Results: Study shows almost 55.83 % of total patients were below age of 30 years and 44.17% patients were above 30 years of age. The highest incidence of thrombocytopenia was seen in the age group of 21-30 years (32.50%) followed by 31-40 (25.83%) and 12-20 years (23.33%). The most common diseases that causes thrombocytopenia were infections (63.33%) [i.e. Dengue (30%), Malaria (20.83%), Enteric fever (5%), HIV (4.166%), Leptospirosis (1.66%) and DIC (1.66%)] and Megaloblastic anemia (21.66%) were common in younger population.Conclusions: Study concluded that most common causes of thrombocytopenia were infections (63.33%) and megaloblastic anemia (21.66%). Bleeding manifestations were present in 37.50% of patients and the most common site of bleeding was skin and mucous membrane. The main etiological cause of bleeding in our study was dengue hemorrhagic fever followed by megaloblastic anaemia and malaria.

Association Between IL-28B Polymorphism and Clinical Laboratory Features in Patients with Chronic Hepatitis D

Objectives: We aimed to determine an association between IL-28B rs12989760 single nucleotide polymorphism (SNP) and clinical laboratory parameters in patients with chronic hepatitis D. Methods: A total of 59 patients who were chronically infected with HDV were had their serum tested for the presence of qHBsAg, anti-HBs, HBeAg, anti-HBe, anti-HBc, anti-HCV, anti-HDV IgM, anti-HDV IgG, HDV RNA, HBV DNA and AFP. Liver function tests, coagulation tests and CBC were also performed. IL-28B polymorphism was performed using a TaqMan 5' allelic discrimination assay by real time PCR. Results: Of these 59 patients, 40 patients (67.8 %) carried the rs12979860CC homozygote genotype, 11 patients (18.6%) were rs12979860CC homozygote and 8 patients (13.6%) were rs12979860CT heterozygote. Alkaline phosphatase and direct bilirubin values were higher (p<0.05) and total protein levels were lower (p<0.05) in patients who were homozygotes for the T allele as opposed to the carriers of the C allele. AFP levels were significantly higher (p=0.02) in the rs12979860 TT genotype group. Liver enzymes including AST, ALT and GGT were significantly not higher in patients who carry C allele (p>.05). Conclusion: The most frequent genotype was IL-28B rs12979860CC among patients with chronic hepatitis D. The IL-28B rs12979860 polymorphism was associated with some abnormal liver function test parameters and AFP levels. Additional studies are necessary to understand the immune mechanisms of IL-28B polymorphism in HDV infection.

ДИНАМІКА ПОКАЗНИКІВ ЛЕПТИНУ, АДИПОНЕКТИНУ ТА ІНТЕРЛЕЙКІНУ-6 ПРИ ПРИЗНАЧЕННІ САРТАНІВ, СТАТИНІВ ТА УРСОДЕЗОКСИХОЛЕВОЇ КИСЛОТИ У ПАЦІЄНТІВ З АРТЕРІАЛЬНОЮ ГІПЕРТЕНЗІЄЮ, ПОЄДНАНОЮ З ОЖИРІННЯМ ТА НЕАЛКОГОЛЬНИМ СТЕАТОГЕПАТИТОМ

Метою роботи було оцінити динаміку клініко-лабораторних показників у пацієнтів з артеріальною гіпертензією, поєднаною з ожирінням та неалкогольним стеатогепатитом при комбінованій терапії сартанами, статинами та урсодезоксихолевою кислотою (УДХК).Матеріали та методи. Обстежено 50 пацієнтів із ІІ-ІІІ стадією артеріальної гіпертензії, яких розділено на дві групи. Хворим першої групи призначали телмісартан (20 мг), аторвастатин (20 мг) та УДХК (10 мг/кг) 1 раз на добу. Пацієнтам другої групи призначали олмесартан (10 мг), аторвастатин (20 мг) та УДХК (10 мг/кг) 1 раз на добу. Проведено оцінку клініко-гемодинамічної та лабораторної ефективності комбінації цих препаратів через 12 тижнів лікування.Результати досліджень. Призначення впродовж 12 тижнів комбінації аторвастатину та УДХК в комплексній терапії з олмесартаном або телмісартаном у пацієнтів обох груп відзначено достовірне зниження усіх гемодинамічних показників, суттєве зменшення рівнів холестерину (p<0,01), ліпопротеїдів низької щільності (p<0,05) та аланінамінотрансферази.Також така схема лікування призводила до зниження рівнів інтерлейкіну-6 та лептину в обох групах, однак, зміни рівня лептину виявилися статистично недостовірними за рахунок значного діапазону показників. Відзначено достовірне підвищення концентрації адипонектину (до 25,94±0,65 мкг/мл) у першій групі, що свідчить про прямий вплив телмісартану на рівень адипонектину.Висновки.Призначення комбінації сартанів (телмісартану або олмесартану) в поєднанні з аторвастатином та урсодезоксихолевою кислотою впродовж 12 тижнів пацієнтам з артеріальною гіпертензією, поєднаною з ожирінням та неалкогольним стеатогепатитом, має позитивний вплив на загальний стан хворих за рахунок підтримання оптимального артеріального тиску, зменшення суб'єктивних скарг та покращення гемодинаміки серця.Така комбінація лікарських препаратів покращує показники ліпідного спектру крові (за рахунок зменшення рівнів загального холестерину (p<0,01) та ліпопротеїдів низької щільності (p<0,01)), знижує рівні лептину та інтерлейкіну-6 (p<0,01)Комбінація телмісартану з аторвастатином та урсодезоксихолевою кислотою у пацієнтам з артеріальною гіпертензією, поєднаною з ожирінням та неалкогольним стеатогепатитом призводить до достовірного зростання рівня адипонектину (p<0,01).

Antioxidant status of serum bilirubin, uric acid and albumin in pemphigus vulgaris.

Oxidative stress and low antioxidant status are implicated in the pathogenesis of inflammatory and autoimmune diseases. Pemphigus vulgaris (PV) is an extremely severe autoimmune bullous dermatosis characterized by intraepithelial bullae on the skin and mucosa, and its antioxidant status is not fully understood. To assess correlations between PV and serum antioxidant levels of bilirubin, uric acid (UA) and albumin. We enrolled 116 patients newly diagnosed with PV who were admitted to the First Affiliated Hospital of Guangxi Medical University (Guangxi, China), and 108 healthy controls (HCs). Clinical characteristics and laboratory parameters of patients were retrospectively analysed. Our survey shows that compared with the HC groups, serum levels of bilirubin [total bilirubin (Tbil), direct bilirubin (Dbil) and indirect bilirubin (Ibil)], UA and albumin were significantly lower in patients with PV, regardless of sex. In all groups, serum Tbil, Dbil, Ibil, UA and albumin levels were lower for women than for men. Severity of pemphigus was slightly negatively associated with Tbil, Dbil and Ibil, but was not associated with UA or albumin. Moreover, when the data were adjusted for the covariances of age and sex separately, Tbil, Dbil, Ibil, UA and albumin were all relevant to PV. Our findings demonstrate that serum levels of bilirubin (Tbil, Dbil and Ibil), UA and albumin are reduced in patients with PV supporting the hypothesis that oxidative stress and antioxidant status are important in the pathogenic mechanism of PV.

The influence of obesity and insulin resistance on the progress of bronchial asthma

Objective – to evaluate the clinical and laboratory parameters in patients with bronchial asthma and obesity based on the distribution of adipose tissue Materials and м ethods . The study involved 78 patients with uncontrolled bronchial asthma with obesity (A + O). 2 groups were formed: Group 1 – 43 patients with gynoid type obesity and Group 2 – 35 patients with android type obesity. An anthropometric study: the hip circumference (HC), waist circumference (WC), the ratio of WC/HC, case history data analysis, Asthma Control Test (ACT). Blood glucose, total cholesterol (TC), triglycerides (TG), high-density lipoprotein (HDL), low density lipoprotein (LDL), glycated hemoglobin test (HbAlc %), index HOMA-IR Monocyte Chemoattractant Protein-1 (MCP-1), respiratory function (RF) were examined. Results . It has been revealed the reliable increase in indices in the 2 nd group: HbAlc, HOMA-IR, TG, LDL, MCP-1 p < 0.05. It has been found the decreased levels of speed indices parameters – FEV1, FEF25, FEF75 and FVC, p < 0.05. It has been found a high correlation between age and the ratio of OT/OS (r = 0.52, p < 0.05). The positive correlation between the mean force MCP-1 and TG (r = 0.56, p < 0.05) and MCP-1 and LDL (r = 0.49, p < 0.05) has been obtained. Correlation analysis of FDD and biochemical parameters: blood glucose (r = 0.26, p < 0.05), TG (r = 0.27, p < 0.051), the index NOMA-IR (r = 0.38, p <0.05), ACT (r = 0.33, p <0.05), MPC-1 (0.62, p < 0.05). Conclusions. The obtained data proves the negative impact of android type obesity on bronchial asthma course. Identified correlations between the EF and studied biochemical indicators demonstrate the carbohydrate and fat metabolism disturbances and inflammation development in patients with different types of obesity.

Autoantibodies against interleukin-21 correlate with disease activity in patients with rheumatoid arthritis.

The objective of this study is to investigate the levels of interleukin (IL)-21 and autoantibodies (AAbs) against IL-21 and their association with clinical characteristics and laboratory parameters in patients with rheumatoid arthritis (RA). One hundred twenty-six patients with RA, 69 patients with osteoarthritis (OA), and 88 healthy controls (HC) were included in this study. The levels of IL-21 and AAbs against IL-21 in the serum were measured using enzyme-linked immunosorbent assay (ELISA). The correlation between the levels of IL-21 and anti-IL-21 AAbs with clinical and laboratory parameters was evaluated. The results showed that the concentration of IL-21 was significantly higher in the serum of patients with RA (15.58±3.22ng/ml) than OA (1.80±0.99ng/ml) and HC (0.07±0.03ng/ml, p<0.01). The levels of IL-21 in the serum correlated with erythrocyte sedimentation rate (ESR) in patients with RA (r=0.435, p<0.01). Anti-IL-21 AAbs could be detected in RA patients. The median AU value of AAbs against IL-21 was significantly higher in serum of RA (47.90) than in that of OA (15.17) and HC (8.19, p<0.01). The titers of AAbs against IL-21 correlated with Disease Activity Score-28 (DAS28) (r=0.449, p<0.001), ESR (r=0.386, p<0.001), and CRP (r=0.241, p=0.03). Both IL-21 and AAbs against IL-21 are elevated in RA. The levels of AAbs against IL-21 correlate with disease activity, which suggests that anti-IL-21 AAbs may play a role in the pathogenesis of RA.

The correlation between body mass index, routine clinical and laboratory parameters and in-hospital survival in patients with acutely decompensated heart failure

Introduction: Recent studies have investigated the existence of so-called “obesity paradox” in heart failure (HF) patients, suggesting that obese patients might have a better prognosis than underweight and normal weight patients. It seems that body mass index (BMI) may be an independent prognostic factor in patients with acute and chronic HF. Patients and Methods: We investigated the correlation between BMI, in- hospital survival and routine clinical and laboratory parameters in patients hospitalized for acutely decompensated HF. Results: Total number of 145 patients (mean age 76±10.2 years) were divided in three groups: 37 with normal body weight (20-24.9 kg/m2), 64 overweight (25- 29.9 kg/m2), and 44 obese patients (≥30 kg/m2) patients. At the end of approximately 9 days of hospitalization, 24 of all patients died (16.5%). In-hospital mortality was significantly lower in obese patients (7% ; p=0.05). Patients with normal body weight were older than obese patients: 80 (75-87) compared to 72 (65-80) ; p=0.001 and significant negative correlation between BMI and patients age existed (r=-0.383 ; p<0.001). There was no significant difference in left ventricular ejection fraction between three compared groups of patients. Obese patients had significantly lower NT-proBNP (pmol/l): 319 (182-758) compared to overweight 862 (342-3013) and compared to normal body weight 1209 (616-2378) ; p=0.001, hs-cTnT (ng/l): 23 (15-57) compared to overweight 38 (27-70) and compared to normal body weight 44 (29-60) ; p=0.009 and serum urea (mmol/l) concentration: 8.1 (6.2-12.3) compared to overweight 9.7 (6.6-12.3) and compared do normal body weight 11.3 (8.2-14.7) ; p=0.039. No significant difference in serum creatinine, uric acid and hemoglobin existed, but significant negative correlation between BMI and NT-proBNP was found (r=-0.22 ; p=0.013). Conclusions: In-hospital mortality was significantly lower in obese HF patients. Obese patients had significantly lower NT-proBNP, hs- cTnT and serum urea concentrations. There was significant negative correlation between BMI and NT-proBNP.

Selenium status parameters in patients with polycystic ovary syndrome

Polycystic ovary syndrome (PCOS) is the most common endocrine disorder in women of reproductive age. To date, no systematic study of interactions between selenium status parameters (SSPs: serum selenium concentration, plasma glutathione peroxidase, GPX3, plasma selenoprotein P, SELENOP), sex hormones, thyroid function parameters, and other laboratory parameters in patients with PCOS has been undertaken. Therefore we aimed to compare such parameters in women with PCOS and in the control groups, and to investigate the multidimensional interactions between various parameters in PCOS patients and in controls. The subjects were diagnosed either with PCOS (n=28, 25.4±5.2 y) or with PCOS+Hashimoto disease (n=13, 27.3±5.6 y). Female patients having normal menses were recruited into the first control group (n=70, 26.8±7.3 y) or to the second control group comprising women only with Hashimoto disease (n=10, 26.2±6.9 y).No apparent differences in SSPs between control subjects and patients with PCOS, also complicated with Hashimoto disease, were identified, though such differences were noticeable for total testosterone (tT), sex hormone binding globulin, free androgen index, dehydroepiandrosterone sulfate (DHEAS), and insulin profile. The correlation between tT and DHEAS was found the strongest. The other group of mutually highly and positively correlated parameters consisted of GPX3, follicle stimulating hormone, free triiodothyronine and free thyroxine. All the latter parameters correlated negatively with vitamin D3. SSPs took part in interactions with thyroid hormones, sex hormones and some other parameters, but only for GPX3 such interactions were statistically significant. The significance of these findings remains open for further investigation, particularly in patients with PCOS and/or Hashimoto disease.

Anti-neutrophil cytoplasmic antibodies in new-onset systemic lupus erythematosus.

BackgroundThe clinical significance of anti-neutrophil cytoplasmic antibodies in patients with new-onset systemic lupus erythematosus, especially in systemic disease accompanied by interstitial lung disease remains to be elucidated.ObjectivesThis study was designed to investigate the role of anti-neutrophil cytoplasmic antibodies in new-onset systemic lupus erythematosus patients.MethodsA hundred and seven patients with new-onset SLE were enrolled. Presence of anti-neutrophil cytoplasmic antibodies in the sera was assessed by indirect immunofluorescence as well as enzyme linked immunosorbent assay against proteinase-3 and myeloperoxidase. Clinical features and laboratory parameters of patients were also recorded. All patients were subjected to chest X-ray, chest high-resolution computed tomography and pulmonary function test.ResultsForty-five systemic lupus erythematosus patients (45/107, 42%) were seropositive for anti-neutrophil cytoplasmic antibodies. Compared with anti-neutrophil cytoplasmic antibodies-negative patients, the anti-neutrophil cytoplasmic antibodies-positive patients had significantly higher incidence of renal involvement, anemia, and Raynaud's phenomenon as well as decreased serum level of complement 3/complement 4 and elevated erythrocyte sedimentation rate. In addition, there was a positive correlation between serum anti-neutrophil cytoplasmic antibodies level and disease activity of systemic lupus erythematosus. Furthermore, prevalence of interstitial lung disease in the anti-neutrophil cytoplasmic antibodies -positive patients (25/45, 55.6%) was obviously higher than that in the anti-neutrophil cytoplasmic antibodies-negative patients (15/62, 24.2%).Study limitationsThe sample size was limited and the criteria for screening new-onset systemic lupus erythematosus patients might produce bias.ConclusionsThe level of anti-neutrophil cytoplasmic antibodies in new-onset systemic lupus erythematosus patients correlates positively with the disease activity and the prevalence of interstitial lung disease.

Serum leptin and 25 Hydroxyvitamin D levels in patients with type II diabetes mellitus

Background: Vitamin D and Leptin appears to play a range of roles in beta cell growth and insulin secretion and most importantly interaction with other hormonal mediators and regulators of energy and metabolism. Objective: The aim of this study was to measure serum leptin and vitamin D levels and to investigate their relationships with vitamin D and other clinical laboratory parameters in patients with type II diabetes. Subjects and Methods: Blood samples were taken from 80 patients with type II diabetes mellitus encountered during their attending the Internal Medicine clinic consultancy in Ramadi Teaching Hospital and the National Diabetes Center for Treatment and Research at Al-Mustansiriya University and 60 healthy subject. From December 2014 to November 2015. Investigations included serum Leptin, 25OHD, Insulin, HbA1c using ELISA and biochemical test.Results: The median concentration of serum 25 OH vitamin D of patients (15.70 ng/ ml) was significantly lower than healthy controls (20.27 ng/ ml). The rate of vitamin D deficiency (VDD) was significantly higher in patients (82.5%) than healthy controls (48.3%). The serum insulin and HOMA-IR were significant increase in patients had vitamin D &lt; 20 ng/ml when compared with an insufficient/normal group. There were no significant differences in leptin levels between type II DM and healthy control. Conclusion: These results strongly support the role of vitamin D deficiency and serum leptin in pathogenesis of type II diabetes.

Impact of Pulmonary Embolism on Acute Chronic Obstructive Pulmonary Disease Exacerbation

Purpose: This study aims to assess effect of pulmonary embolism (PE) on clinical and laboratory parameters of patients hospitalized for acute exacerbations of chronic obstructive pulmonary disease (AECOPD). Risk factors for PE development were also evaluated. Methods: In this retrospective study, patients who were hospitalized for AECOPD and underwentcomputed tomographic pulmonary angiography scan (CTPA) between 2009 and 2011 were included. Patients with PE were evaluated separately as those diagnosed at initial examination and those suspected during exacerbation therapy since they had inadequate response. Binary logistic regression analysis was used in order to determine risk factors on PE development. Results: The study consisted of 36 patients, 13 patients (36.1%) had PE. FEV 1 and FEV 1 /FVC values were higher in PE group (53.7% vs 41.4%; 62.3% vs 52% respectively; p<0.05). There was no difference between D-dimer levels of PE and non-PE patients. Risk of PE development did not differ with analyzed variables. Those diagnosed at initial examination had significantly less number of exacerbations in the last one year than those diagnosed during therapy (1.1 vs 3.2; p<0.05). Conclusion: PE should always be considered inAECOPDetiology, particularly in patients with frequent exacerbation history and D-dimer levels may bemisleading.

Effects of postpartum uterine curettage in the recovery from Preeclampsia/Eclampsia. A randomized, controlled trial.

To evaluate if postpartum uterine curettage improved the clinical and laboratory parameters in patients with preeclampsia or eclampsia. A total of 442 patients with preeclampsia/eclampsia were randomized to postpartum curettage (223) or no procedure (219). Systolic and diastolic blood pressure were recorded and analyzed at hours 6, 12, 24 and 48. Also, several laboratory values and diuresis were evaluated. No statistical differences were found between groups (curettage vs. no procedure) in regards to systolic [155.74(15.43) vs. 156.81(15.58)] and/or diastolic blood pressure [101.51(11.44) vs. 101.70(11.20)] before and after the allocated procedure, starting at hour 6 [SBP: 134.19(13.11) vs. 136.65(15.36); DBP: 87.20(9.42) vs. 88.57(10.98)] and up to 48 h after delivery [SBP: 126.59(15.54) vs. 128.21(13.85); DBP: 81.86(9.92) vs. 81.67(11.33)]. No statistical differences between groups were found in the rate of recovery of laboratory values, as well as in the need for additional antihypertensive medications in the postpartum period. These results applied to patients with severe preeclampsia (210 patients in both arms) and eclampsia (13 vs. 9). There were no cases of postpartum eclampsia or acute renal failure after delivery in any of the groups. To perform a postpartum uterine curettage does not present an advantage in the patient with preeclampsia/eclampsia. The procedure dos not improve clinical or laboratory values.

Influence of three months therapy with L-arginine on the general clinical conditions of patients with various forms of heart failure

The objective: assessing of the impact of the 3 month course of treatment with L arginine on the clinical and functional and laboratory parameters in patients with various forms of heart failure.Patients and methods. The study included 55 patients with cardiomyopathy: 22 patients with isolated right ventricular dilated cardiomyopathy (RVDCMP) and 33 patients with dilated cardiomyopathy (DCM) with bi ventricular heart failure. The average age of patients 42,1 ± 9,0 year (from 21 to 54 years). Depending on the shape of heart failure patients were divided into two groups. The first group included 22 patients with RVDCMP (average age 45,3 ± 10,2 years), the second included 33 patients with dilated cardiomyopathy (mean age 45,3 ± 13,3 years).Results. It was noted improvement in clinical and functional and laboratory parameters in both groups of patients, but in the case of RVD CMP these changes were more pronounced in comparison with a group of DCM. Different effects of L-arginine in the analyzed group of patients was caused by the presence of irreversible changes in the state of decompensated myocardium in patients with dilated cardiomyopa thy, while in patients with RVDCMP compensatory response of the heart muscle must have been higher.Conclusion. The use of arginine in patients with dilated cardiomyopathy with right ventricular or bi-ventricular lesion improves vascular endothelial function, affecting the flow-dependent vasodilatation.

Clinical features of osteoarthritis in patients with metabolic syndrome

To estimate clinical and laboratory parameters in patients with osteoarthritis (OA) and in those with OA and metabolic syndrome (MS). 164 patients with OA were examined and divided into 2 groups of 82 people: a study group (patients with MS) and a control one (those without MS). OA was defined according to the diagnostic criteria described by R.D. Althmann (1995). MS was identified based on the criteria developed by the International Diabetes Federation (2005). The location of affected and swollen joints was determined according to the Richie index; the intensity of pain syndrome was measured by a visual analogue scale at rest and on movement; the WOMAC and Lequesne indexes were estimated in the patients. Erythrocyte sedimentation rate and C-reactive protein and tumor necrosis factor-α levels were determined from laboratory data. In the MS group, the frequency of joint injuries at various sites, the prevalence of synovitis, and the intensity of pain and inflammation were significantly higher than in the non-MS group. The negative impact of MS on the clinical picture of OA can be inferred by the findings.

The impact of educational intervention on physical activity, nutrition and laboratory parameters in type II diabetic patients.

BackgroundDiabetes is one of the most common chronic diseases that is now widely spread around the world, and day by day the number of patients is increasing. The purpose of this study was to determine the impact of educational intervention on physical activity, nutrition and laboratory parameters in type 2 diabetic patients.MethodsThis semi-experimental study was performed from March to October 2015 on 100 patients with type 2 diabetes who referred to the Niknejad health center. The type of sampling was simple random. Data were collected using a questionnaire including demographic questions, assessment of nutritional status and physical activity, history of diabetes, physical measurements and laboratory parameters of patients. Data were analyzed using SPSS 16, and descriptive and analytical tests (paired-samples t-test) and the results were significant at the level of (p<0.05).ResultsIn present study, body measurements, the mean number of units of fruit and vegetable intake per day, type of oil consumption, the mean number of days of fish intake per week or the mean number of days with intense physical activity per week, had no significant difference before and after the intervention, while the variables of FBS level (p<0.003), rate of HbA1c (p<0.027), the mean number of days of fruit intake (p<0.001) and vegetable intake (p<0.037) per week and the mean number of days with moderate physical activity (p<0.03) of patients, had significant difference before and after the intervention.ConclusionAccording to the findings of this study, to improve BMI, fish intake, type of oil consumption and also increased daily fruit and vegetable intake in these patients, a variety of educational-supportive interventions are recommended.

Importance of laboratory parameters in patients with obstructive sleep apnea and their relationship with cardiovascular diseases.

Ostructive sleep apnea (OSA) is an independent risk factor for the development of cardiovascular events. Platelet activation and inflammation are the mechanisms involved in the association between OSA and cardiovascular disease (CVD). The markers of platelet activation and inflammation are the mean platelet volume (MPV), platelet-lymphocyte ratio (PLR), red cell distribution width (RDW), neutrophil- lymphocyte ratio (NLR). We aimed to define the association of NLR, PLR, RDW, and MPV with the severity of disease and the presence of CVD. This study consisted of 300 patients who were admitted to the sleep laboratory. The patients were classified according to their apnea- hypopnea index (AHI) scores as OSA negative (Group A: AHI<5), mild (Group B: AHI: 5-15), moderate (Group C: AHI=15-30), and severe OSA (Group D: AHI >30). There were no significant differences in the NLR, PLR, and MPV among the groups (P>.05); only RDW differed significantly (P=.04). RDW was significantly higher in patients with than without risk factors for CVD [15.6% (15.4-15.7) vs 15.3% (15.1-15.3), respectively; P=.02]. NLR, PLR, MPV, and RDW are widely available and easily obtained from a routinely performed hemogram. Among these laboratory parameters, only RDW can demonstrate the reverse consequences of OSA-associated comorbidities, because vascular damage due to systemic inflammation is an important underlying mechanism in these diseases. RDW might be used as a marker of the response and patient compliance with continuous positive airway pressure treatment.

Elevated serum autoantibodies against co-inhibitory PD-1 facilitate T cell proliferation and correlate with disease activity in new-onset systemic lupus erythematosus patients

BackgroundProgrammed cell death protein 1 (PD-1) plays an important role in immune response regulation as a co-inhibitory signal during T cell activation. However, there is little known about the serum autoantibody profile of PD-1 in systemic lupus erythematosus (SLE), a disease characterized by the breakdown of immune tolerance to self-antigens and an excessive production of autoantibodies. Thus, we aim to investigate the serum levels and function of anti-PD-1 in patients with new-onset SLE.MethodsSerum levels of anti-PD-1 IgG and IgM isotypes were detected in new-onset SLE patients (n = 90), rheumatoid arthritis (n = 50), primary Sjogren’s syndrome (n = 50), ankylosing spondylitis (n = 25), and healthy controls (HC) (n = 80) using an enzyme-linked immunosorbent assay (ELISA). The correlation of anti-PD-1 with clinical characteristics and laboratory parameters of patients with new-onset SLE was analyzed. The effects of purified anti-PD-1 IgG from SLE patients on T cell proliferation were measured using flow cytometry.ResultsThe data revealed increased levels of anti-PD-1 IgG, but not IgM, especially in new-onset SLE patients, and the positive rate of anti-PD-1 IgG was 30 (33.3%). The level of anti-PD-1 IgG was closely associated with malar rash (OR = 15.773), arthritis (OR = 22.937), serositis (OR = 16.008), hematological (OR = 35.187), renal (OR = 8.306), and neurological involvement (OR = 37.282). Moreover, the serum levels of anti-PD-1 IgG were positively correlated with the SLE disease activity index (SLEDAI) score (r = 0.296, p = 0.0046) and the erythrocyte sedimentation rate (ESR) (r = 0.2446, p = 0.0201). In vitro examination showed that purified anti-PD-1 IgG obtained from SLE patients enhanced T cell proliferation when co-cultured with dendritic cells (DCs).ConclusionsThe current study indicates, for the first time, that the serum levels of co-inhibitor autoantibodies against PD-1 are elevated in new-onset SLE patients and are associated with disease activity in SLE. Autoantibodies against PD-1, facilitating T cell proliferation, revealed a new insight into the function of negative regulation signals involved in the pathogenesis of SLE.

Aortic aneurysm and chronic disseminated intravascular coagulation: a retrospective study of 235 patients

Chronic disseminated intravascular coagulation (DIC) is a rare but devastating complication of aortic aneurysm (AA). This study investigated the clinical manifestations, laboratory findings, and treatment of patients with AA-associated chronic DIC (AA-DIC) and explored the mechanisms, duration, and therapeutic response of AA-DIC. We retrospectively reviewed the medical records of 235 AA patients admitted at the Peking Union Medical College Hospital between September 2009 and January 2015. The patients were classified as those with DIC (AA-DIC) and those without DIC (non-DIC). The AA-DIC group showed a significantly higher proportion of female patients and a significantly longer AA disease course than the non-DIC group did. The AA-DIC patients presented mural thrombi, dissecting aneurysms, a family history of AA, and diabetes significantly more frequently than the non-DIC patients did. Furthermore, multiple regression analyses revealed that sex, mural thrombus, aneurysm type, diabetes, and stent surgery are possible independent risk factors for AA-DIC patients. Fifty-two (22.1%) patients presented AA-DIC. Among these patients, 43 had non-typical DIC and 9 had typical DIC; the mortality rate of the latter was 22.2%. The mean age of the patients with typical DIC was significantly higher than of that of patients with non-typical DIC. The non-typical DIC patients also presented abnormal coagulation disorders of varying degrees. Furthermore, heparin or low-molecular-weight heparin improved the clinical symptoms and laboratory parameters in patients with AA and typical DIC. Thus, chronic DIC should be considered in patients with AA.