A Study on the Relationship between Subclinical Hypothyroidism
and Diabetic Retinopathy in Type 2
Diabetic Patients
Khodeir, S. A.1; Abd E l Raouf, Y. M1; Farouk, G.2and Allam, W. A.3
Departments of Internal Medicine1 Clinical Pathology2 and
Ophthalmology3 Faculty of Medicine, Tanta
University, Egypt. masyasser@yahoo.com
Abstract: Diabetic retinopathy is one of the most common microvascular
complications and the leading cause of blindness in adults between 30
and 65 years of age worldwide. Also, unrecognized thyroid dysfunction
may impair metabolic control and add to cardiovascular, and other
chronic complication risk in diabetic patients. This study aimed to
investigate the relationship between subclinical hypothyroidism and the
development of retinopathy. The study was carried on 75 patients of
newly diagnosed type 2 diabetes mellitus, normotensive, without any
apparent vascular complications. Our patients were divided into two
groups. Group Ι included 48 patients who were euthyroid (futher divided
int sub-groups Ιa with TSH level ≥2<4 μIu/ml and Ιb with TSH
≥0.4<2 μIu/ml. , while group ΙΙ included 27 patients who were found to
have subclinical hypothyroidism. Fasting and postprandial plasma
glucose, lipid profile, HBA1c, free T4, TSH and fundus examination
were done to all patients. The obtained results revealed that diabetic
retinopathy was associated with sub-clinical hypothyroidism, with
statistical significant difference between group Ι and group ΙΙ. When
group Ι and group ΙΙ compared, it was found that there had been
significant difference in TSH level in different stages of diabetic
retinopathy. In conclusion subclinical hypothyroidism is associated with
diabetic retinopathy in type 2 diabetic patients. There is a positive
correlation between level of TSH and stage of diabetic retinopathy in type
2 diabetics with subclinical hypothyroidism.
[Khodeir, S. A; Abd E l Raouf, Y. M; Farouk, G. and Allam, W. A. A
Study on the Relationship between
Subclinical Hypothyroidism and Diabetic Retinopathy in Type 2
Diabetic Patients] Journal of American
Science 2012; 8(1):525-530]. (ISSN: 1545-1003).
http://www.americanscience.org. 72
Key words: Diabetic retinopathy, subclinical hypothyroidism, endothelial
dysfunction.
145
Arab Journal of Nephrology and Transplantation
Arab Journal of Nephrology and Transplantation. 2012 Sep;5(3):145-7
Country Data AJNT
Prevalence of HCV Infections Among Hemodialysis Patients in Al
Gharbiyah Governorate, Egypt
Samy A. Khodir1, Mervt Alghateb1, Kamal M Okasha*1, and Safenaz
El-Saed Shalaby2
(1) Internal Medicine and (2) Public Health Departments of Tanta
University, Tanta, Egypt.
Abstract
Introduction: Hepatitis C virus (HCV) is a significant problem for
patients undergoing hemodialysis (HD) treatment. This medical problem
has never been studied in Al Gharbiyah Governorate; this study was
conducted aiming to estimate the prevalence of anti-HCV positive
patients and the incidence of seroconversion in its different HD units.
Methods: All 2351 patients maintained on HD in the eight towns of Al
Gharbiyah Governorate were interviewed and their anti-HCV status was
tested by a third-generation enzyme immunoassay. Patients who
tested negative for anti-HCV at the start of the study were re-assessed
monthly for HCV seroconversion and at the end of the study all patients
were screened for HCV antibodies.
Results: At the start of our study in March 2011, we found that 824 out
of 2351 patients (35%) were anti-HCV reactive. At the end of study in
November 2011, we found that HCV seroconversion occurred in 168 out
of 1527 patients (11%) who were HCV free at the start of the study. By
the end of the study, a total of 42.2% were found to be anti-HCV reactive.
Conclusion: The study demonstrated high prevalence of anti-HCV in HD
units in Al Gharbiyah Governorate. Similar studies must be conducted in
all Egyptian governorates’ HD units to evaluate this major health problem
all over Egypt. We also encourage strict application of preventive
strategies for HCV infection in all health institutes, especially HD units
Keywords: Egypt; HCV; Hemodialysis; Seroconversion
Paraoxonase Gene Polymorphism and Activity in Type 2 Diabetes
Mellitus with Microvascular
Complications
Khodeir, S. A.1; Abd El Raouf, Y. M 1; Amer, A. EMAN2; El Fadaly, N.
H. 2and Abd El Latif, E. Aml3
1Internal Medicine Department, Faculty of Medicine, Tanta University.
2Biochemistry Department, Faculty of
Pharmacy, Alahram Canadian University (acu), 6th October City and
3Clinical Pathology Department,
Faculty of Medicine, Tanta University, Egypt.
masyasser@yahoo.com
Abstract: Paraoxonase (PON1) is an antioxidant enzyme closely
associated with HDL – cholesterol that protects LDL – cholesterol against
oxidation. Less protection may therefore be supposed by decreased PON1
activity in diabetes mellitus (DM) patients. This study was undertaken to
evaluate the association of PON1 gene polymorphism with diabetic
nephropathy and the relationship of allelic polymorphism with PON1
activity in DM patients. The study was conducted on 36 patients with
type 2 DM complicated with nephropathy, 24 patients without
nephropathy, and 20 healthy subjects of matched age and sex to serve as
control. Eight ml over night fasting venous blood were collected from
every patient and control, distributed as such ; 5 ml in plain tube to
separate serum for estimation of total cholesterol, triglyceride , LDL ,
HDL , glucose and PON1 activity, and 3 ml on EDTA vacutainer tube for
estimation of glycated Hb (HbA1c) and PON1genotyping. Obtained
Results revealed that no gender or age influence was found on PON1
activity. Serum PON1 activity was significantly decreased in diabetic
patients as compared with control. Also PON1 activity was significantly
decreased in diabetic patients with nephropathy as compared with
diabetic patients without nephropathy. The PON1 (55) LL genotype was
the most frequent in healthy subjects, followed by the MM genotype, and
then the LM genotype. In diabetic patients with nephropathy, the MM
genotype was the most common, followed by the LL genotype, and then
the LM genotype. In diabetic patients without nephropathy, the LL, MM,
LM genotypes frequencies were 37.5%, 37.5%, and 25% respectively.
The PON1 (192) QQ genotype was the most frequent in healthy subjects,
followed by the RR genotype, and then the QR genotype. In diabetic
patients with nephropathy, the RR genotype was the most common,
followed by the QR genotype, and lastly the QQ genotype. In diabetic
patients without nephropathy, the RR genotype was the most common,
followed by the QQ genotype, and lastly the QR genotype. The PON1
activity in relation to genotyping showed insignificant difference in
genotype LL, MM, LM, QQ, QR, and RR. Higher PON1
activity was found in diabetic patients with nephropathy, genotype LL
than LM, and MM. In diabetic patients without nephropathy, the
PON1(55)LL genotype showed significant increase in PON1 activity than
MM and LM genotype. In diabetic patients without nephropathy, PON1
(192) higher activity was found in QQ, followed by RR, and lastly QR
genotypes. In diabetic patients with nephropathy significant higher
activity of PON1 was found in genotypes RR as compared with QQ, and
QR genotypes.
[Khodeir, S. A.; Abd E l Raouf, Y. M; Amer, A. EMAN; El Fadaly, N.
H.and Abd El Latif, E. Aml Paraoxonase
Gene Polymorphism and Activity in Type 2 Diabetes Mellitus with
Microvascular Complications. Journal of
American Science 2012; 8(4):303-309]. (ISSN: 1545-1003).
http://www.americanscience.org. 41.
Key words: Paraoxonase, type 2 diabetes mellitus, microangiopathy..
Detection of Circulating Microparticles in Patients with Proliferative
Diabetic Retinopathy
Samy A Khodeir 1, Y M Abd El Raouf 1, Gihan Farouk2 and
Mohammed EL-Bradey3
Departments of 1Internal Medicine 2Clinical Pathology and
3Ophthalmology, Faculty of Medicine, Tanta University
masyasser@yahoo.com
Abstract: Background: The development of vasculopathies in diabetes
involves multifactorial processes including pathological activation of
vascular cells. Release of microparticles by activated cells has been
reported in diseases associated with thrombotic risk, but few data are
available in diabetes. Diabetic retinopathy is associated with increased
local activation or apoptosis of retinal, neural, and vascular `endothelial
cells in the eye which indicate that microparticles (MPs) of different
cellular origin might be locally generated in the eye of diabetic patients.
Aim: The aim of this study is to investigate the presence of endothelial,
platelet, and retinal-derived microparticles both in the vitreous and in the
plasma of diabetic patients compared with that of non diabetic ones.
Subjects and methods: In a case-control study, this study included 45
patients: 25 diabetic patients with non proliferative diabetic retinopathy
(NPDR), and 20 diabetic patients with proliferative diabetic retinopathy
(PDR) compared with control group consists of non diabetic 10 subjects.
Blood samples were analyzed by flow cytometry. Microparticles present
in plasma and vitreous were analyzed according to their parameters of
size and fluorescence. Results: As regard plasma samples, there was
significant increase in CD144 and CD41 in groups II, III as compared
with control group (p = 0.001). Peanut agglutinin PNA was not detected
in plasma sample among all studied groups. Whereas, as regard to the
vitreous sample, there was significant increase in CD144, CD41 and PNA
in groups II,III as compared with control group (p= 0.048, 0.009, 0.048 ),
(P = 0.001) respectively. Conclusion: microparticles appear as a new
prognostic potential of type 2 diabetes in the early detection of vascular
complications. Moreover significant increase of different types of
microparticles in vitreous fluid of membrane in patients with PDR, may
contribute to disease progression.
[Samy A Khodeir, Y M Abd El Raouf, Gihan Farouk and Mohammed
EL-Bradey Detection of Circulating
Microparticles in Patients with Proliferative Diabetic Retinopathy.
Life Science Journal, 2012; 9(1): 204-209]
(ISSN: 1097-8135). http://www.lifesciencesite.com. 29
Key words: Microparticles, diabetic retinopathy, endothelial cell
dysfunction.
Assessment the Role of L-Carnitine in Improving Hepatic
Encephalopathy Using MR Spectroscopy
Hanan H. Soliman1, Dina H. Ziada1, Mohamed Hefeda2, Manal Hamisa2
and Samy A. Khodeir3
Tropical Medicine and Infectious Diseases1, Radiology2, Internal
Medicine3, Departments, Faculty of Medicine
Tanta University-Egypt
dhz646@hotmail.com
Abstract: Background and aim: Hepatic encephalopathy (HE) is related
to abnormal cerebral metabolites. MR Spectroscopy (MRS) can
demonstrate neurometabolites changes associated with therapy. The aim
was to evaluate the influence of L-carnitine on mental Conditions, serum
ammonia and neurometabolites on patients with HE using MRS. Patients
and methods: Ten control subjects and 54 patients with grades II to III
HE, were randomized into (GI) receiving lactulose 30ml/t.d.s as standard
therapy and( GII) receiving L-Carnitine1000mg/twice in addition.
Clinical assessment, fasting Ammonia level, and nuerometabolites using
proton MRS were calculated and compared at base line and after one
week. RESULTS: After one week, 25% of HE patients were reversed in
group I versus 42.3% in group II. fasting ammonia levels were
significantly decreased in both groups compared to pretreatment
levels and significantly lower in L-carnitine group compared to lactulose
group(P=0.041). neurometabolites mI/Cre, Cho/Cre, Gx/Cre, and
(Cho+mI)/Gx ratios were significantly improved in both groups
compared to pre treatment levels, but L Carnitine added group(II),
showed a significant increase in mI/Cre, and (Cho+mI)/Glx ratios and
decrease in Glx/Cre ratio in comparison to lactulose group(p=0.002p=0.003-p=0.002 respectively).
CONCLUSION: Adding L Carnitine to (lactulose) therapy for treatment
HE hastened the clinical improvement and was associated with
significant improvement in serum ammonia and neurometabolites
specially mI/Cre, and (Cho+ mI)/Glx and Glx/Cre ratios .
[Hanan H. Soliman, Dina H. Ziada, Mohamed Hefeda, Manal Hamisa
and Samy A. Khodeir Assessment the Role
of L-Carnitine in Improving Hepatic Encephalopathy Using MR
Spectroscopy]J ournal of American Science
2012; 8(1): 715-721]. (ISSN: 1545-1003).
http://www.americanscience.org. 97
Key words: Magnetic Resonance Spectroscopy (MRS), L-Carnitine,
hepatic encephalopathy (HE),
neurometabolite.
Str.Ionel Perlea nr.10, sector 1, Bucuresti
E-mail: office@srmi.ro, www.srmi.ro
Revista Societatii de Medicina Interna
Articolul face parte din revista:
Nr.6 din luna 2012
Descarca varianta pdf
Autor S. Khoder1, M. Assem2 and G.Attia3
titlu articol: INSULIN RESISTANCE AND CHRONIC KIDNEY DISEASE. WHAT IS THE ROLE OF
VITAMIN D?
cuvinte cheie: INSULIN RESISTANCE, CHRONIC KIDNEY DISEASE, VITAMIN D
ARTICOL
S. Khoder1, M. Assem2 and G.Attia3
1. Internal Medicine department, Tanta Faculty of Medicine, Tanta University, EGYPT
2. Department of Hepatology, National Liver Institute, MenoufiyaUniversity, EGYPT
3. Clinical Pathology department, Tanta Faculty of Medicine, Tanta University, EGYPT
Corresponding author:
Sami Khoder, MD.
Department of Internal Medicine.
Tanta Faculty of Medicine
Tanta University
Tanta
EGYPT
Telephone: 0020403335010
Fax: 0020403335010
Email: Abdsamy@yahoo.com
Post code: Tanta University: 31527
Competing Interest: Authors declare no competing interest, either financial or non-financial.
Funding: All sharing centers, participate in the fund.
Received15 October 2011
Accepted in 29 March 2012
ABSTRACT
Background&Aim: Chronic kidney disease (CKD) is a major risk factor for cardiovascular
disease and premature death. Patients with CKD have insulin resistance (IR) early in the
course of the disease and exceptionally high rate of severe vitamin D deficiency. Emerging
evidence suggests that the progression of CKD and many of the cardiovascular complications
may be linked to hypovitaminosis D. This study aimed to investigate the relationship of
between vitamin D and IR in CKD patients, and assessment the effect of vitamin D on glucose
metabolism. Patients &Methods: Fifty-two patients who had CKD were included in the
study; all underwent assessment of vitamin D 3, and IR status by measuring fasting serum
glucose, insulin, C-peptide, and Homeostasis Model Assessment (HOMA-1) and (HOMA-2) –
IR. Results: Significant improvement was seen in HOMA1-IR with supplementation of vitamin
D3 compared with that prior to administration of vitamin D3 (P<0.05). There were also
significant increase in HOMA2% - S, HOMA2% -B, and significant decrease in HOMA2-IR
compared with baseline values (P P<0.05). Conclusions: Supplementation with vitamin D in
CKD who are both vitamin D deficient and insulin resistant can enhance insulin sensitivity
and B-cell activity if the dose is large enough and continued over a sufficient length of time.
Comparison of Partial Splenic Chemoembolisation
versus Splenic Irradiation as Treatment of
Hypersplenism in Advanced Cirrhosis
Dina H. Ziada1, Hanan H. Soliman1, Amr Al-Badery2, Nehal El
Mashd3, Samy A. Khodeir4
Tropical Medicine and Infectious
Diseases1, Radiology2, Oncology and
Nuclear Medicine3, Internal medicine 4 ,
Departments- Tanta University-Egypt.
The Corresponding Author: Dina Hazem
Ziada
Address: Algeash street, Tanta university
hospitals, tropical medicine department,
Tanta, Gharbia, Egypt.
Tel: 040-3310133
Mobile: 01117109990
E-mail:DHZ646@hotmail.com
List of abbreviations:
LDSI : low dose splenic irradiation
OPSS : overwhelming post-splenectomy
sepsis
PSE: Partial splenic embolization .
Financial support: Nil
Received 3 September 2011
Accepted 15 February 2012
Egyptian Liver Journal
Word count of abstract:242
Word count of text:2557
Number of tables:7
Number of figures: 5
Abstract:
Hypersplenism in advanced cirrhotic patient is a
conflicting issue as surgical splenectomy carries high
perioperative morbidity and mortality rates. Partial splenic
embolization (PSE) and low dose splenic irradiation
(LDSI) are alternative procedures available in Egypt. The
aim of this prospective controlled study was to compare
(PSE) versus (LDSI) for ablation of spleen as treatment of
hypersplenism in advanced cirrhosis.
Patients and methods: Seventy one cirrhotic patients
suffering
hypersplenism
underwent
abdominal
ultrasonography, liver functions, INR and bone marrow
examination to confirm the diagnosis. They were enrolled
in 3 groups. Group (I):26patients treated by (LDSI),
Group
(II):25patients treated by (PSE) and GroupIII:20 patients
received conventional therapy as control group then we
followed up these patients for 6months.
Results: LDSI group showed steady progressive increase
in all CBC elements. A significant increase in platelets
started by week 2 While that of Hb and WBCs started by
first month. While these increases started by the first week
in PSE group which reached its peak in second week then
gradually decreased but still significantly higher than pre
treatment and control levels. Both procedures were well
tolerated by the patients but more complications were
reported with PSE. Both LDSI and PSE didn't affect liver
functions.
Conclusion: Both LDSI and PSE are safe and effective in
treating hypersplenism in decompensated cirrhosis. They
induce improvement of cytopenia and splenomegaly. The
rapid onset and higher efficacy of PSE should be weighed
against the wide safety and moderate efficacy of radiation.
Keywards: hypersplenism, advanced cirrhosis, Partial
splenic embolization (PSE) and low dose splenic
irradiation (LDSI).
Right Ventricular Function in Patients with Cor-Pulmonale: A Three-Dimensional
Echocardiographic Study
Inas Deraz , Samy Khodier , Ghada Abd Elmoamen
Tanta Med. Sc. J 2011; 6(2):64-71
ICID: 992750 Background/Aim: Right ventricular function is an important determinant of
morbidity and mortality in patients with cor-pulmonale. The first derivative of right ventricular
(RV) pressure (dp/dt) is a good index of contractility, but it depends on preload. On the other
hand, dp/dt divided by end-diastolic volume (EDV) is a good index of contractility and
independent of preload. The measurement of RV EDV is difficult because of RV complex
geometry. Real-time three dimensional (3D) echocardiography allows measurement of
ventricular volume irrespective of its shape. The Aim of the work is to investigate the value of
3D echocardiography in evaluating RV function in patient with cor-pulmonale by measuring RV
EDV and dp/dt/EDV.
Patient & Methods: 19 patients with cor-pulmonale, five females and fourteen males (mean age
55.6+11.41 years) underwent echocardiography, blood sampling of N-terminal pro brain
natriuretic peptide (NT-pro-BNP) and 6 minute walking distance (6 min. WD). RV dp/dt and
mean pulmonary artery pressure were estimated from continuous wave Doppler determined
tricuspid regurgitant velocity. RV EDV was measured by both two-dimensional (2D) Simpson’s
method (EDV2D) and real-time 3D echocardiography (EDV3D).
Results: RV dp/dt/EDV was calculated using EDV2D and EDV3D. RVdp/dt/EDV3D showed better
correlation than RVdp/dt/EDV2D with the non-invasive parameters of RV function including
mean pulmonary artery pressure (mPAP) and NT pro BNP (P< 0.05). So, RVdp/dt/EDV3D
correlated well with disease severity, whereas RV dp/dt/EDV2D did not.
Conclusion: In patient with cor-pulmonale, 3D echocardiographically measured RV EDV and
RVdp/dt/ EDV3D correlated with the non invasive parameters of RV function including mPAP,
which is measured by echocardiography, and NT- pro- BNP. So, RV dp/dt/EDV3D seems to be a
potential marker of disease severity and is useful in assessing the prognosis.
Value of Real-Time Three-Dimensional Echocardiography in Diagnosis of Native Valve
Infective Endocarditis: Comparison with Transesophegeal Echocardiography
Aim: To determine the diagnostic accuracy of detecting vegetations using transthoracic realtime three-dimensional echocardiography (RT-3DE) as compared to transesophygeal
echocardiography (TEE) in patients with clinically suspected native valve infective endocarditis
(IE).
Patients &Methods: 34 patients with clinically suspected native valve infective endocarditis
were evaluated by transthoracic two dimensional, real-time three dimensional and
transesophygeal echocardiography. TEE was performed within 24 hours after RT-3DE. The
diagnosis of IE was made according to Duke Criteria. Criteria suggestive of vegetation for RT3DE included mobile nodules, focal thickness and uneven surface.
Results: Of 34 patients (18 males, 16 females, their age ranged from 21 to 56 years with a mean
age 39+ 16 years), RT-3DE was diagnostic in 28 patients (82%); positive in 15 patients and
negative in 13 patients using TEE as the reference standard. The remaining 6 patients (18%)
were in determined for vegetation detection by RT-3DE. OF the positive 15 patients by RT-3DE,
mobile nodule was detected in 13 patients (86.7%) and focal thickness was detected in 2
patients (13.3%), uneven surface was not detected in any patients. Of 34 patients, TEE was
diagnostic in 33 patients (97%); positive in 18 patients, negative in 15 patients and in
determined in one due to complex valvular anatomy. The sensitivity for the detection of
vegetations by RT-3DE was 86%, the specificity of 89%, positive predictive value (PPV) of 88%,
negative predictive value of (NPV) of 80%.
Conclusion: In patients with clinically suspected native valve infective endocarditis, RT-3DE is a
good diagnostic tool as it has an excellent concordance with TEE. So, it should be recommended
as the first line noninvasive diagnostic imaging.
A Study On The Relationship Between The Abnormalities
Of Liver Transaminase Enzymes And Coronary
Atherosclerotic Disease
Samy Khodeir ; Sabry A. Abousaif * ; Enas Draz ** & Eman A Amer ***
Departments of Internal Medicine ; Tropical Medicine & Infectious Diseases * and Cardiology
**
,
Faculty of Medicine -Tanta University
Biochemistry Department ***, Faculty of Pharmacy - Alahram Canadian University (ACU),
6th October City, Egypt
ABSTRACT
Liver function tests (LFTS) are commonly used in clinical practice to screen for liver disease,
monitor the progression of known disease. Association of liver transaminases and metabolic
syndrome raised the possibility of relationship between liver enzymes and cardiovascular risk
associated with metabolic syndrome. In the present study we explored the possible relation
between ALT and AST serum levels and coronary atherosclerosis. 320 patients with no history of
documented viral hepatitis or excessive alcohol intake were included. Serum ALT and AST were
checked for all patients as well as coronary angiography and liver ultrasonography. Patients
were divided into group I (146/320) with fatty liver on ultrasonography and over weight or
obesity and group II (174/320) with no fatty liver and with average BMI. We found that AST and
ALT levels were significantly higher in group I than group II and there was a positive
correlation between ALT and AST level and coronary atherosclerosis in both groups. In
conclusion, liver transaminases (ALT, AST) in the absence of viral hepatitis or excessive alcohol
consumption, are associated with metabolic syndrome and they have positive correlation with
coronary atherosclerosis.