Background/Aims: Non-alcoholic fatty liver disease is a spectrum of clinical conditions, including simple steatosis and non-alcoholic steatohepatitis (NASH). The aim of the study is to evaluate the tissue inhibitors of metalloproteinase-1 and 2 (TIMPs) as noninvasive predictors of NASH. Methods: Three groups were included in the study. Obese patients (n = 30) with normal liver enzymes were included in group I and obese patients (n = 30) with elevated liver enzymes with liver biopsy-based diagnosis of NASH were included in group II. Age-matched subjects (n = 30) formed the control as group III. The lipid profile, liver enzyme levels and levels of TIMPs were compared among all the patients and subjects. Results: Comparison of groups I and II showed significantly elevated levels of TIMP-1 and TIMP-2 in group II as compared to group I (p < 0.05). Similarly, comparison between groups II and III showed significantly increased levels of TIMP-1 and TIMP-2 in group II as compared to group III (p < 0.05). TIMP-1 (sensitivity 96.7%, specificity 100%) and TIMP-2 (sensitivity 93.3%, specificity 100%) showed high accuracy in NASH diagnosis. Conclusion: TIMP-1 and TIMP-2 may be considered noninvasive markers for the diagnosis of NASH.
Background Liver cirrhosis is a condition that destroys the normal function of the liver, leading to hepatic encephalopathy, which is associated with impairment in postural control and disturbance in balance. Aim of the study The aim of this study was to detect the disturbances in balance and postural control because of hepatic encephalopathy as a result of liver cirrhosis using dynamic posturography. Participants and methods Individuals were divided into two groups: 45 patients with liver cirrhosis and 45 controls. Both groups underwent dynamic posturography to evaluate balance control, number connection test-type A, line tracing test, and serum ammonia (NH3) level to assess encephalopathy. Results Dynamic posturography findings were significantly weaker in patients with liver cirrhosis than in the controls. They were also weaker in patients with high NH3 than in patients with low NH3. There were significant negative correlations between dynamic posturography findings and number connection test-type A, line tracing test, and NH3 levels. Conclusion Hepatic encephalopathy because if liver cirrhosis affects balance control and the degree of affection is related to the degree of encephalopathy.
BackgroundSystemic lupus erythematosus (SLE) is a typical systemic autoimmune disease associated with endothelial dysfunction that leads to accelerated atherosclerosis. Endothelial progenitor cells (EPCs) responsible for vascular regeneration were shown to have reduced number and impaired function in SLE. Abnormalities of left ventricular (LV) systolic and diastolic function and increased LV mass have been described in SLE patients. Endothelial dysfunction and EPCs mobilization abnormalities in SLE contribution to this LV dysfunction is uncertain.ObjectivesThe aim of this study was to assess left ventricular (LV) diastolic and systolic function of SLE patients using the relatively new speckle tracking echocardiography (STE) and examine whether any detected abnormalities of LV function have any relation with peripheral circulating EPCs count.Methods50 SLE patients without clinical evidence of cardiac involvement or cardiovascular risk factors and 25 healthy age and sex matched controls were subjected to quantification of peripheral circulating VEGFR2+/CD133+ and VEGFR2+/CD34+ EPCs using flow cytometry technique, conventional transthoracic echocardiography (TTE), tissue Doppler imaging (TDI) and STE.ResultsPatients showed a significantly lower CD133+/VEGFR2+ EPCs (p=0.009) and CD34+/VEGFR2+ EPCs counts (p=0.0001) compared to controls. TTE/TDI revealed a significantly lower LV ejection fraction (LVEF) (p=0.007), higher LV end systolic dimensions (p=0.02), myocardial performance index (p=0.0001) and mitral flow E/lateral annulus E' ratio (p=0.002) in patients compared to controls. STE showed a significantly lower global longitudinal strain (p value <0.001), global circumferential strain (GCS) (p<0.001) and global strain rate during isovolumic relaxation period (GSRIVR) (p=0.01) in patients compared to controls. By multiple logistic regression analysis, the independent variables affecting GCS and GSRivr were the prednisolone dose and the LVEF respectively. (95% CI = -0.465 to -0.027; p=0.028 and 95% CI =0.001 to 0.01; p=0.021; respectively).ConclusionsTDI and STE detected subclinical systolic and diastolic abnormalities of LV function in SLE patients. The significantly lower EPCs count detected in patients did not however have any impact on these abnormalities of LV function.ReferencesUrowitz MB, Bookman AA, Koehler BE, et al. the bimodal mortality pattern of systemic lupus erythematosus. Am J Med 1976; 60:221-5.Ebner P, Picard F, Richter J, et al. accumulation of VEGFR2+/CD133+ cells and decreased number and impaired functionality of VEGFR2+/CD34+ cells in patients with SLE. Rheumatology 2010; 49:63-72.Paran D, Caspi D, Levartovsky D, et al. cardiac dysfunction in patients with systemic lupus erythematosus and antiphospholipid syndrome. Ann Rheum Dis 2007; 66: 506-10.Geyer H, Caracciolo G, Abe H, et al. assessment of myocardial mechanics using speckle tracking echocardiography: fundamentals and clinical applications. J Am Soc Echocardiogr 2010; 23: 351-69.Disclosure of InterestNone declared
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