Homocysteinemia Levels Research Articles

Homocysteinemia Level Determination Among Retired People in Bobo Dioulasso, Burkina Faso

Homocysteinemia Level Determination Among Retired People in Bobo Dioulasso, Burkina Faso

STUDY OF PREVALENCE OF HYPERHOMOCYSTEINEMIA IN CHRONIC KIDNEY DISEASEPATIENTS AT TERTIARY CARE HOSPITAL IN NORTHWEST MAHARASHTRA

Introduction-Chronic Kidney Disease is growing problem across all over world and India as well. Chronic kidney disease encompasses a spectrum of different pathophysiological processes associated with abnormal kidney function and a progressive decline in glomerular filtration rate(GFR).The risk for cardiovascular disease (CVD) morbidity and mortality remains high in all stages of CKD, including in patients with hemodialysis. More patients with CKD die of CVD than of the progression of kidney failure.The increase of homocysteine level, referred as hyperhomocysteinemia, is highly prevalent in CKD patients and associated with an increased risk of CVD complications. Proposed mechanisms for hyperhomocysteinemia in kidney failure is due to reduced clearance of total plasma homocysteine (tHcy) secondary to defective kidney and/or extra kidney metabolism of tHcy and deficiencies of folate, vitamin B12, and pyridoxal 5-phosphate (PLP). Aim-To study Serum Homocysteine levels in patients with Chronickidney disease and to estimate Serum Homocysteine levels in different stages of Chronic kidney disease. Materials And Methods- All the patients presenting with clinical, biochemical and ultrasound kidney evidence of chronic kidney disease in department of medicine at tertiary care centre in northern Maharashtra. Normal plasma homocysteine level was considered to bebelow 15 umol/litre. Results- A study of 54 patients with Chronic Kidney disease of both sex were taken as sample. Of the 54 patients 38 were males and 16 were females .36 patients were in age range of 41-60 . 32 patients were in stage 5 CKD , 14 were in stage 4 CKD , 8 were in stage 3 CKD. Hyperhomocysteinemia was observed in 78 % of CKD patients. Serum Homocysteinemia levels were maximum in patients with higher grade of CKD. The associationbetween decreased GFR and increase in serum homocysteine levels was found to be statistically significant. (p<0.05). Conclusion-Study concludes that hyperhomocysteinemia is highly prevalent in CKD patients. Homocysteine is commonly considered as toxicthrombogenic amino acid which causes atherosclerosis and cardiovascular diseases. Mortality due to cardiovascular diseases is high in CKD. Hence early screening and treatment for Hyperhomocysteinemia should be done in CKD to prevent cardiovascular diseases.

Evaluating Deficiency of Vitamin B12 and Risk Factors in Healthy Infants

Background: The deficiency of vitamin b12 is highly extensive within the developed countries and is often found to remain undiagnosed within these populations. the main feature within infants suffering from vitamin b12 deficiency is altered neurological development and generalized growth. Effects of vitamin b12 deficiency on the brain can be prevented. To avoid these morbidities and mortality associated with vitamin b12 deficiency it is pivotal for clinicians to understand what other risk factors are associated with a deficiency within the infant population of developing countries. Materials and methods: This cross-sectional study was conducted on 82 healthy infants for the assessment of Vitamin B12 at Pediatric Department of LGH, Lahore from March 2021 to August 2021. Participants were selected who were healthy. After recruitment, participants underwent hematological and biochemical indices analysis. Hemoglobin, serum vitamin b12, homocysteine and methylmalonic acid were different parameters measured. Maternal vitamin b12 deficiency was investigated along with risk factor vitamin b12 deficiency in healthy infants. Results: A total of 82 recruited participants were selected after screening and meeting the recruitment criteria. After assessment of hematological data, anemia was diagnosed in 67.82% of infants (n=56). The breakdown of the anemic population showed that the male population was predominant with 58.2% affected males and 41.8% affected females. Decreased levels of plasma vitamin b12 concentration were documented in 22% of the population with a total number of 18 participants (male: 11, female: 7). Increased levels of homocysteinemia were documented in 49.1% of infants with n=40. Increased levels of methylmalonic acid were appreciated in all infants. As defined by previous criteria, the diagnosis of vitamin b12 deficiency was appreciated in 30 infants with a percentage of 38%. Furthermore, an assessment of folate deficiency showed that 8 out of 82 participants had concurrent folate deficiency in red cells with a percentile prevalence of 9.7%. maternal vitamin b12 deficiency was considered as risk factor for infant vitamin b12 deficiency Conclusion: The prevalence of vitamin b12 deficiency in healthy infants is significantly high in developing and underdeveloped countries. Vitamin b12 deficiency cooccurs with anemia and other variation of biological markers. The study concluded that among the various risk factors that may predispose an infant to vitamin b12 deficiency, maternal b12 deficiency remains the highest appreciated risk factor. Keywords: Vitamin B12, Risk Factors, Vitamin B12 deficiency, Maternal B12

Significance of hyperhomocysteinaemia as an effective marker for vasculogenic erectile dysfunction: a cross-sectional study.

BackgroundThe primary objective of this cross-sectional study aimed at evaluating serum levels of homocysteinemia (Hcy) in a cohort of erectile dysfunction (ED) patients, and at assessing the correlation between Hcy and vasculogenic ED.MethodsA total of 119 Chinese patients presenting with ED [International Index of Erectile Function (IIEF)-5≤21] were enrolled in this study. The whole cohort was asked to complete the IIEF-5 questionnaire and blood analysis. A detailed medical history, physical examination, nocturnal penile tumescence (NPT) tests and penile color Doppler ultrasonography (pDUS) were performed by a urologist. Based on the pDUS result, they were further categorized into 2 main groups: non-vasculogenic ED (n=79) and vasculogenic ED (n=40).ResultsAge and Hcy levels were significantly higher in the vasculogenic ED group compared to the non-vasculogenic ED group (38.45±8.51 vs. 32.29±7.57 and 22.91±5.85 vs. 16.31±5.23 µmol/L, respectively, P<0.01). Univariate and multivariable regression analyses showed that the incidence of vasculogenic ED raised significantly with the increase of Hcy level. After multivariable adjustment, ED patients with hyperhomocysteinaemia (HHcy) had 13.42 times the odds of vasculogenic ED compared with patients without HHcy (OR: 13.42, 95% CI: 3.78 to 47.64). Moreover, the risk of vasculogenic ED was 1.24 (95% CI: 1.04 to 1.48, P=0.01) per-unit increase in Hyc concentration for ED with HHcy. In addition, the smoothing curve revealed that Hcy levels were inversely correlated with peak-systolic velocity (PSV) (β: −0.48, 95% CI: −0.91 to −0.05, P=0.04) in vasculogenic ED patients by multivariate regression analysis. Furthermore, in the analysis of receiver operating characteristic curve, the area under curve for Hcy to predict vasculogenic ED was 0.81 (95% CI: 0.73 to 89) in patients with ED.ConclusionsThese findings suggest a dose-dependent association between Hcy and vasculogenic ED. HHcy was a risk factor for vasculogenic erectile dysfunction. Therefore, HHcy is likely to be a potential indicator to predict and diagnose vasculogenic ED when using pDUS.

Combination of hyperhomocysteinemia and hypertension in patients with atherosclerosis of brachiocephalic arteries: the frequency, clinical and laboratory correlates

Combination of hypertension (HTN) and hyperhomocysteinemia &gt; 10 mсmol/l is frequently called H-type hypertension. It is associated with an increased risk of vascular events including stroke.Objective. To estimate the frequency and clinical and laboratory correlates of combination of hyperhomocysteinemia and HTN in a cohort of patients with atherosclerosis of brachiocephalic arteries (BCA).Design and methods. We recruited out-patients with confirmed atherosclerosis of BCA based on the ultrasound duplex scans. History were registered. Complete blood count, biochemical analysis (lipids, creatinine, homocysteine and C-reactive protein) and urine analysis were performed.Results. Data from 93 patients were analyzed. The frequency of combination of hyperhomocysteinemia and HTN among patients with atherosclerosis of BCA was 95%. The level of homocysteine was higher in males than in females (p = 0,001). Correlation analysis showed a direct weak association between the level of homocysteinemia and the number of white blood cells, red blood cells, monocytes, level of creatinine in the blood and microalbuminuria (p &lt; 0,05). Linear regression analysis showed that male gender along with microalbuminuria were independent predictors of the homocysteine level in these patients.Conclusions. A combination of hyperhomocysteinemia and HTN is common among patients with the atherosclerosis of BCA. Stroke prevention measures in patients with HTN and atherosclerosis of BCA should include assessment of homocysteine level and prescription of B vitamins if needed.

Influence of anti-TNF therapy and homocysteine level on carotid intima-media thickness in rheumatoid arthritis patients.

It is a well-known fact that disruptions in the immune system and systemic inflammation are associated with accelerated atherosclerosis in rheumatoid arthritis (RA) patients. Elevated levels of tumor necrosis factor α (TNF-α), a major pro-inflammatory cytokine, are involved in endothelial cell activation of medium and large arteries, leading to increased endothelial permeability, generation of superoxide anion radical and hydrogen peroxide, and decreased availability of nitric oxide (NO). The present study aims to determine the influence of anti-TNF therapy and homocysteine (Hcy) levels on the carotid intima-media thickness (IMT) in patients with RA. Assessments were performed on 115 patients diagnosed with RA on biological treatment to determine the evolution of IMT and Hcy levels. Carotid ultrasonography was used to assess the IMT, as a fast and easy tool for the prediction of cardiovascular events in patients with RA. The first measurement of IMT was noted as IMT1, followed by a second measurement after 1 year, noted as IMT2. The group of patients was divided into approximately three equal groups, each being treated with a different biological product, respectively, etanercept, adalimumab, and infliximab. In the 3 groups, after 1 year of anti-TNF-α therapy, IMT2 progression was significantly reduced compared to baseline. No significant differences were found among the three groups of treatment. A strong association was observed between IMT1-IMT2 in the etanercept group (P<0.001, r=0.758), in the adalimumab group (P<0.001, r=0.761) and in the infliximab group (P<0.001, r=0.829). The low level of Hcy2 after 12 months of anti-TNF-α therapy was significantly correlated with a decrease in IMT2 (P<0.001) in patients who had a high level of Hcy and IMT >0.9 mm at baseline. The results from the present study showed that biological treatment and the low level of homocysteinemia reduced the cardiovascular risk in RA, regardless of the treatment chosen (infliximab, adalimumab, or etanercept).

Factors associated with hyperhomocysteinemia in relatively healthy Taiwanese adults: A retrospective medical record study.

Elevated homocysteine levels have been proposed as a risk factor for cardiovascular disease. The aim of this study was to evaluate factors associated with hyperhomocysteinemia in relatively healthy Taiwanese adults.A retrospective cross-sectional study was conducted using data from the health examination database in a medical center located in southern Taiwan. Hyperhomocysteinemia was defined as a plasma homocysteinemia level >15 μmol/L. Factors associated with hyperhomocysteinemia were evaluated using univariate and multiple stepwise logistic regression analyses.A total of 817 adults with a mean age of 55.5 years were included in the present study, and of them, 67 (8.2%) had hyperhomocysteinemia. Results from multiple logistic regression analysis showed that male sex (Odd ratio [OR] = 12.28, 95% CI = 2.94–51.27, P = .001), advanced age (OR = 1.37 per 10 years, 95% CI = 1.06–1.77, P = .017), triglycerides (OR = 1.02 per 10 mg/dL, 95% CI = 1.01–1.04, P = .010), and uric acid (OR = 1.27, 95% CI = 1.09–1.49, P = .004) were significantly and independently associated with hyperhomocysteinemia.In this retrospective medical record study, male sex, advanced age, higher plasma level of triglyceride, and uric acid were significantly associated with hyperhomocysteinemia in relatively healthy Taiwanese adults.

A study to evaluate the correlation between increased homocysteine level and hyperlipidaemia: An observational study

: Numerous studies have suggested a possible relation between increased homocysteinemia level and cardiovascular diseases. This relationship is clinically important in the management of cardiac diseases specially in elderly population. However, there is limited data which suggests association between hyperhomocysteinemia and hyperlipidaemia. The aim of this study is to find a relation between hyperlipidaemia and hyperhomocysteinemia in patients who are not on lipid-lowering treatment.A total of 300 hyperlipidemic patients were enrolled who attended medicine OPD. After obtaining informed consent, data were collected by a trained technician according to a standard operating protocol of the laboratory. After an overnight fast of minimum 12 hours, 5 ml of venous blood was taken under aseptic conditions in EDTA tube. The blood was late centrifuged, plasma samples were then separated within half hour of sample collection and were stored at −80 °C in the laboratory. Total cholesterol (TC), Low Density Lipid-Cholesterol (LDL-C), High Density Lipid-Cholesterol (HDL-C) and Triglycerides (TG) were measured on Bene Spheraautoanalyzer. Homocysteine was measured on Robonic ELISA reader.Homocysteine level in blood was directly proportional to increased level of TC, TG, LDL-C and age of the patient. In the same group homocysteine level was inversely proportional to high density lipoproteins. There is strong correlation of increased homocysteine level with hyperlipidaemia.

A homocisteinemia como factor de risco de doença vascular cerebral. A importância da idade e dos nìveis de homocisteinemia.

To evaluate importance of homocysteinemia as risk factor of thrombotic cerebrovascular disease, in terms of age and homocysteinemia levels. A group of patients under 55 years old (n = 35, 21 males) that had suffered a stroke 3 months to 1 year before the study, defined by clinical criteria and the presence of cerebral infarction confirmed by tomography, without history or predisponents to embolic disease. The patients were matched with a group of controls without vascular pathology of a check-up program, in terms of age and sex. Patients and controls with history of alcoholism, signs or laboratory of renal or hepatic insufficiency or with history of recent ingestion of vitamins of the group B were excluded since these conditions could influence homocysteinemia levels. We measured to patients and controls the plasmatic basal homocysteinemia and homocysteinemia 6 hours after methionine overload of 0.1 g/Kg body weigh. We estimated case-control odds ratio of hyperhomocysteinemia globally and by age groups, and odd ratio of different levels of homocysteinemia. Hyperhomocysteinemia case-control global odds ratio was 5.7, being higher in younger patients (8.8 below and 3.5 after the age of 45 years). Homocysteinemia as a risk factor of cerebrovascular disease presented as a continuous effect: low homocysteinemia was protective, and the higher the homocysteinemia, the higher the cerebrovascular risk proved to be. In these circumstances, heterozygozyty of cysthationine beta synthase deficiency, refered as the more important cause of hyperhomocysteinemia, cannot account for most of the cases of hyperhomocysteinemia.

Hyperhomocysteinemia Associated with Low Muscle Mass, Muscle Function in Elderly Hemodialysis Patients: An Analysis of Multiple Dialysis Centers.

Background The hyperhomocysteinemia was with high prevalence and has been considered as a risk factor for cardiovascular disease in hemodialysis patients. These patients also experienced a high risk of muscle wasting caused by the comorbidity, malnutrition, and low physical activity. We investigated the associations of homocysteinemia with muscle mass, muscle function in elderly hemodialysis patients. Methods A clinical cross-sectional study was conducted on 138 hemodialysis patients aged 65 years and above in seven hospital-based hemodialysis centers in Taiwan. The data on anthropometry, laboratory, and 3-day dietary intake was examined. The skeletal muscle mass (SMM) was measured by the bioelectrical impedance analysis; the SMM was adjusted by height or weight as SMMHt2 (kg/m2) and SMMWt (%). Muscle function was defined as handgrip strength (HGS) (kg) measured by handgrip dynamometer. Statistical analyses were conducted using simple regression and multivariable stepwise regression analysis. Results In the total sample, 74.6 % of hemodialysis patients were hyperhomocysteinemia (≥ 15 μmol/L). The means of SMMHt2, SMMWt, arm lean mass, hand grip strength, and muscle quality were 8.7 ± 1.2, 37.7 ± 5.6, 1.7 ± 0.5, 21.1 ± 7.4, and 10.0 ± 3.0, respectively. The multivariable stepwise regression analysis showed that homocysteinemia level was significantly inversely associated with SMMWt (B-coeff. = -0.03, p = 0.02) in hemodialysis patients above 65 years old, but not with muscle function. ConclusionsHyperhomocysteinemia is common and associated with decreased muscle mass in the elderly hemodialysis patients. Future studies are suggested to explore the impact of the homocysteine-lowering therapy on muscle decline.

A13501 Study on correlation between plasma homocysteinemia level and target organ damage in patients with primary hypertension

A13501 Study on correlation between plasma homocysteinemia level and target organ damage in patients with primary hypertension

Therapeutic tactics with violations of the menstrual cycle caused by ovulative dysfunction

Purpose: presentation of modern data on the pathogenesis of menstrual cycle disorders (NMCs) associated with ovulatory dysfunction, and the effectiveness of their treatment with medication.Basic provisions. It is shown that NMC is the result of violations of the cyclic production of gonadotropic and sex hormones. Among the hormonal drugs for the treatment of NMCs, combined estrogen-progestational oral contraceptives (COCs), especially those with drospirenone (DRSP), are advantageous. The introduction of calcium levomefolate - biologically active form of folatein the composition of COCs containing 30 μg of ethinylestradiol and DRSP has a potentiating effect associated with their noncontraceptive effects due to antiandrogenic and antimineralocorticoid activity. It was shown that calcium levomefolate, which participates in human body metabolism, as a component of COC, has a protective effect on the cardiovascular system (due to a decrease in the level of homocysteinemia) in the syndrome of polycystic ovaries, contributes to reducing obesity.Conclusion. The combination of 30EE/DRSP promotes the normalization of the menstrual cycle and has non-contraceptive effects associated with antiandrogenic and antimineralcorticoid action, and fortification with calcium levomefolate also has a positive effect on the hormonal profile and lipid metabolism, has a protective effect on cardiovascular diseases in women with the metabolic syndrome in polycystic ovaries, contributes to the normalization of weight.

DIAGNOSTIC MEANING OF DETERMINATION OF HOMOCYSTEIN IN THE BLOOD SERUM IN CHILDREN WITH NEUROINFECTIONS

The aim of the study was to determine the serum level of homocysteine in children with neuroinfections. Mаterials and methods: A blood serum assay of 60 children with viral and bacterial neuroinfections was performed using the enzyme immunoassay to evaluate homocysteinemia as a marker of endothelial dysfunction. Results: In interpreting the results, the average level of hyperhomocysteinemia in patients with bacterial and viral neuroinfections was established. The highest homocysteine levels in serum were observed in bacterial neuroinfections, especially in the presence of signs of meningoencephalitis and pneumococcal etiology of the disease. Dependence of changes in the level of homocysteinemia from the sex of sick children was not revealed. Conclusion: Neuroinfections in children, regardless of the cause, are accompanied by hyperhomocysteinemia, indicating the presence of endothelial activation in this pathology, more pronounced in the case of a bacterial etiology of the infectious process and the combined lesion of the soft dura mater and the brain substance.

Agenesis of Internal Carotid Artery and Ischemic Stroke, One Case Report: A Review of Literature

Background: Agenesis of the internal carotid artery (ICA) is a rare anatomic variation of the cerebral circulation. A malfunction during the embryonic peri-od is at stake. It is very often asymptomatic and therefore discovered inci-dentally. Association with ischemic stroke is exceptional. Physiopathology is uncertain; the hypothesis of a blood flow reversal is reported in the literature. The diagnosis is based on the absence of a carotid canal as revealed by CT scans at skull base level with bone settings. Other non-invasive techniques, in-cluding echo-Doppler of the neck vessels, can now make the diagnosis. Objec-tive: Discuss the association between occurrence of an ischemic stroke in the left posterior sylvian territory and discovery of ipsilateral carotid agenesis. Case report: A 24-year-old female patient was prospectively recruited at DAX hospital center (France). Vascular risk factors involved active smoking of 8 pack-years and a combined estrogen/progestin contraceptive. Her family history included an uncle with heterozygote Factor V Leiden mutation. She presented a left upper limb sensorimotor deficit. Nuclear Magnetic Resonance Angiography (MRA) revealed a right superficial sylvian ischemic stroke asso-ciated with agenesis of the right internal carotid artery. CT scan at skull base level with bone settings showed absence of a right carotid canal, thus confirm-ing agenesis. An opinion was then requested for an arteriography which showed an operative polygon of Willis, a sylvian artery or middle cerebral ar-tery (MCA) irrigated by a very large right posterior communicating artery (PCOM) and the left anterior cerebral artery (ACA) supplied by the anterior communicating artery (ACOM), through the left carotid system. The right syl-vian territory where stroke occurred was therefore supplied by the functional vertebrobasilar system. ECG and four-day meticulous monitoring detected no cardiac rhythm disorders. Transesophageal echocardiography was normal. Blood tests results showed normal blood coagulation with glycohemoglobin level at 4.6%. Total cholesterol was 1.42 g/l including LDL-C at 0.82 g/l and HDL-C at 0.36 g/l; triglycerides levels were 1.23 g/l. VDRL-TPHA serodiagnosis for syphilis, and HIV serology were all negative. Thrombophilia testing was performed and showed absence of Factor V Leiden mutation. Homocyste-inemia level was normal. The patient was discharged under KARDEGIC 160 mg, one daily with home rehabilitation. Currently she’s doing well and no re-currence is observed.

Evaluation of Cardiovascular Risk Factors in a Young Adults Tunisian Group

Introduction: Cardiovascular diseases have become more common in young adults. Their emergence is due to the prevalence of cardiovascular risk factors. The aim of this study is to determine the prevalence of cardiovascular risk factors in a Tunisian young adult group. Material and methods: This is an epidemiological study of 705 Tunisians volunteers, free from any cardiovascular pathology; who are recruited at the Military Hospital of Tunis. Besides the classical cardiovascular risk factors (obesity, dyslipidemia, smoking, alcohol…), we evaluate the level of homocysteinemia and determined the C677T mutation of the methylenetetrahydrofolate reductase (MTHFR) gene by PCR-RFLP method. Results and conclusions: The mean age of our population is 28.25 ± 9.08 with a male majority (83.8%). We have 43.8% obese subject or overweight, 54.3% smokers and 12.9% alcoholics. The lipid profile showed that 12.6% of the population had hypercholesterolemia and 39.5% had hypoHDLemia, 7.9% had a high lipoprotein(a) concentration. In our study population we found that 10.9% of subjects had an hs-CRP concentration greater than 3 mg/L. Genotyping of the MTHFR gene revealed that 34% of young adults had a mutated genome (CT). The results showed a significant correlation between different factors, such as cholesterolemia and obesity. The prevalence of these risk factors showed the severity of our young people’s health status and imposes a change in the way of Tunisians life.

Homocysteine modulates 5-lipoxygenase expression level via DNA methylation.

SummaryElevated levels of homocysteinemia (Hcy), a risk factor for late‐onset Alzheimer's disease (AD), have been associated with changes in cell methylation. Alzheimer's disease is characterized by an upregulation of the 5‐lipoxygenase (5LO), whose promoter is regulated by methylation. However, whether Hcy activates 5LO enzymatic pathway by influencing the methylation status of its promoter remains unknown. Brains from mice with high Hcy were assessed for the 5LO pathway and neuronal cells exposed to Hcy implemented to study the mechanism(s) regulating 5LO expression levels and the effect on amyloid β formation. Diet‐ and genetically induced high Hcy resulted in 5LO protein and mRNA upregulation, which was associated with a significant increase of the S‐adenosylhomocysteine (SAH)/S‐adenosylmethionine ratio, and reduced DNA methyltrasferases and hypomethylation of 5‐lipoxygenase DNA. In vitro studies confirmed these results and demonstrated that the mechanism involved in the Hcy‐dependent 5LO activation and amyloid β formation is DNA hypomethylation secondary to the elevated levels of SAH. Taken together these findings represent the first demonstration that Hcy directly influences 5LO expression levels and establish a previously unknown cross talk between these two pathways, which is highly relevant for AD pathogenesis. The discovery of such a novel link not only provides new mechanistic insights in the neurobiology of Hcy, but most importantly new therapeutic opportunities for the individuals bearing this risk factor for the disease.

Correlation analysis of risk factors for atherosclerotic cerebral infarction combined with metabolic syndrome in elderly patients

Objective To analyze the clinical features of metabolic syndrome (MS) combined with and cerebral infarction (ACI) in elderly patients, and to investigate the high-risk metabolic factors for MS combined with ACI in the elderly. Methods A total of 337 elderly patients admitted to general internal medicine wards of our hospital from 2013 to 2015 were divided into MS combined with ACI group (group A), MS group (group B), ACI group (group C) and control group (group D, patients with non-MS and non-ACI). Age, smoking history and past history were recorded. The systolic blood pressure (SBP), diastolic blood pressure (DBP), levels of fasting blood glucose (FBG), total cholesterol (TC), triglyceride (TG), low density lipoprotein cholesterol (LDL-C), high density lipoprotein cholesterol (HDL-C), alanine aminotransferase (ALT), serum creatinine (CRE), glycated hemoglobin (HbA1c), glycosylated serum protein (GSP), uric acid (UA), homocysteinemia (HCY), fasting serum insulin, serum C-peptide, D-dimer (DD) were detected. Body mass index (BMI) and insulin resistance index (HOMA-IRI) were calculated. Results Age, levels of FBG, GSP, TG, systolic blood pressure, HCY, DD and HOMA-IRI were higher and the HDL-C level was lower in group A than in group B (all P <0.05). Age, levels of FBG, HbA1c, GSP, TG, TC, LDL-C, HCY, DD and HOMA-IRI were higher in group C than in group D (all P <0.05). Multivariate Logistic regression analysis showed that age (≥75 years), hypertension (blood pressure ≥140 / 90mmHg), high FBG (≥7.0 mmol/L), high TG (≥1.7 mmol/L), low HDL-C (<0.9 mmol/L), high HCY (≥20.4 μmol/L) and a history of smoking or increased carotid artery intima-media thickness (CA-IMT) were the independent risk factors for atherosclerotic cerebral infarction combined with MS (OR= 5.233, 2.870, 3.138, 5.184, 3.375, 4.545, 3.809, 3.663, respectively, all P<0.05). Conclusions Atherosclerotic cerebral infarction are affected by multiple metabolic abnormalities of MS in elderly patients. Age over 75 years, high blood pressure, high fasting glucose, hypertriglyceridemia, low high-density lipoprotein cholesterol, high homocysteine and smoking history, increased carotid artery intima-media thickness are closely related to atherosclerotic cerebral infarction combined with MS in the elderly. Key words: Metabolic syndrome×; Brain infarction; Risk factors

Functional Outcome After Lower Limb Amputation: Is Hyperhomocysteinemia a Predictive Factor?: An Observational Study.

Lower limb amputation (LLA) is the drastic stage of peripheral arterial disease (PAD) where the hyperhomocysteinemia (H-HCY) seems to be a risk factor. Surprisingly, in literature the levels and the role of homocysteinemia (HCY) in persons with LLA are understudied. This study aims to investigate the level of HCY and its correlation with the functional outcomes after LLA.A case–control study to analyze HCY levels in amputees admitted in a rehabilitation hospital during an investigation period of 1.5 years. Barthel Index was used to assess the functional outcome.We enrolled 91 dysvascular amputees and 44 amputees for other reasons than PAD (controls). The mean level of HCY was found higher in dysvascular amputees (15.2 ± 7.5) compared to controls (11.0 ± 5.0, P < 0.0001) with a risk related ratio of 4.78. Normal Gaussian distribution of HCY was observed in controls, whereas in dysvascular amputees the data follow a double Gaussian distribution. Finally, a significant negative correlation was found between HCY and the effectiveness of rehabilitation (R = −0.37, P = 0.001) only in dysvascular amputees.Dysvascular amputees had a level of HCY significantly higher than amputees without PAD. H-HCY seems to influence the functional outcomes of the rehabilitative treatment only in LLA due to PAD.

Prognostic role of metabolic risk factors (hyperhomocysteinemia) in the development of chronic heart failure

The aim of the study was to assess the relationship of homocysteine levels in the blood serum with the severity and nature of chronic heart failure (CHF) in patients with coronary heart disease. 94 patients with CHF were examined. The control group included 32 patients without cardiovascular disorders. At baseline and after 12 months of observation the homocysteine levels in the blood serum were determined by enzyme-linked immunosorbent assay. Correlative relationship of hyperhomocysteinemia with ischemic myocardial remodeling and with reduced inotropic function in CHF patients was observed. The homocysteine level in the blood serum of CHF patients significantly exceeded that of the control group and moderately increased with the progression of the disease severity of functional class. In the group with an unfavorable course of CHF the baseline homocysteine level proved to have the greatest value as compared to that in the group with a favorable course. In patients with a favorable course of CHF the homocysteinemia level tended to decrease towards the end of prospective study, whereas in patients with an unfavorable course, on the contrary, hyperhomocysteinemia persisted (p&lt;0.01). In case the hyperhomocysteinemia baseline exceeds 18.5 mkmol/L (ROC-AreaSE = 0.860.04, sensitivity 71 %, specificity 90%), the severity and characteristics of the ischemic CHF could be most likely predicted. Thus, hyperhomocysteinemia is related with the severity and nature of CHF. Determining the level of homocysteine in the blood serum can be recommended for early prediction of the severity and nature of CHF.

0273: Pulmonary embolism in Behçet's disease: a series of 10 patients

Pulmonary embolism is an unusual complication of Behçet’s disease (BD). Our aim study is to analyse epidemiological, physiopathological and evolutive aspects of this condition. From 1998 to 2013, 10 cases of pulmonary embolism were found amongst BD patients in the department of internal medicine of Hedi Chaker Hospital. All these patients fulfilled International Study Group criteria for BD. 10 patients (all men, mean aged at 29.9±9.08 years) were diagnosed as having pulmonary embolism. This was inaugural in 7 cases. Peripheral venous thrombosis was present in 50% of patients; cardiac thrombosis was presented in 2 cases and pulmonary aneurysm in 2 patients. Pulmonary infarction has been noted in 3 cases. Pulmonary artery pressure may be elevated, and may indicate a poor prognosis. Mediastinal lymphadenopathy and mild pleural and pericardial effusions was also observed in 1 case. Protein C, protein S, antithrombin III and homocysteinemia levels were normal in all cases. One patient was positive for IgG anticardiolipin antibody. All our patients were treated successfully by anticoagulation therapy combined with high dose prednisone, colchicine and intravenous cyclophosphamide in 2 patients. After a mean follow-up of 106± 49 months, 4 patients had a recurrence of pulmonary embolism and only 1 patient was dead. Pulmonary embolism is one of the severe and worst prognostic manifestations of the BD. Our knowledge about pulmonary complications of Behçet’s disease continues to evolve, but we need controlled trials for the management of the disease. The main goal should be to elucidate the pathogenesis and standardize the management according to the underlying pathologic process.