Variants of endothelial nitric oxide synthase gene are associated with components of metabolic syndrome in an Arab population

Genetics plays a crucial role in the development of metabolic syndrome (MetS). Here we examined the association between endothelial nitric oxide synthase (eNOS) gene polymorphisms and MetS in a Saudi Arabian cohort to extend the understanding of the genetic basis of MetS in diverse ethnic populations. Anthropometric, clinical and biochemical parameters as well as genotyping for 894G>T, -786T>C variants of eNOS gene by PCR-RFLP and 4a/b by direct PCR were performed in 886 Saudi Arabians (477 MetS and 409 Non-MetS). The genotype distribution (TT, p=0.001; TC, p=0.001; TC+CC, p=0.001) and allele (T, p=0.007; C, p=0.007) frequency of the -786T>C SNP were significantly different between Non-MetS and MetS subjects which remained significant after Bonferroni correction. Moreover: 1) the GT and GT+TT genotypes of the 894G>T SNP were associated with elevated blood pressure (p=0.017, and p=0.022, respectively); 2) the ab variant of 4a/b polymorphism was associated with decreased HDL levels (p= 0.044); and 3) the TC+CC genotype and C allele of the -786T>C SNP were associated with increased fasting glucose levels (p=0.039, and p=0.028, respectively). Also, G-a-C was identified as the risk haplotype for MetS susceptibility (p=0.034). The results suggest a significant association of 894G>T, 4a/b and -786T>C polymorphisms with MetS and its components is present in an Arab population. A genetic predisposition to develop abnormal metabolic phenotypes, consistent with an increased prevalence of metabolic phenotypes can be detected in this ethnic group.     

Differences in outcomes between cholecalciferol and ergocalciferol supplementation in veterans with inflammatory bowel disease

Aim: Vitamin D deficiency is a global health issue associated with increased health‐care costs, and could play a role in the pathogenesis and management of inflammatory bowel disease. Prior studies show a high prevalence of vitamin D deficiency in veterans with inflammatory bowel disease. We aimed to examine the outcome differences in patients with inflammatory bowel disease, comparing treatment with ergocalciferol to cholecalciferol. Methods: A retrospective review of electronic medical records of patients with inflammatory bowel disease at a Veterans Affairs Medical Facility in the Southeastern United States was carried out. Those with at least one serum 25(OH) vitamin D level were included. Initial and follow‐up vitamin D values were recorded. The type of vitamin D supplementation, whether cholecalciferol or ergocalciferol, was documented. Costs in the year after measurement of vitamin D were divided into separate inpatient and outpatient categories. Results: Veterans (n = 108) with ulcerative colitis or Crohn's disease and an available 25(OH) vitamin D level were studied. There were differences in follow‐up vitamin D levels; those who received weekly ergocalciferol had higher subsequent levels than those who received cholecalciferol, especially at a second follow up, although differences did not achieve statistical significance. However, those who received vitamin D3 were less likely to use laboratory, pharmacy, radiology and fee‐based services, and had lower laboratory and pharmacy costs. Conclusions: Our data suggest that cholecalciferol replacement might improve outcomes to a greater extent than ergocalciferol, and might be better in limiting health‐care costs and expenses in patients with inflammatory bowel disease. Geriatr Gerontol Int 2012; 12: 475–480.     

Post-remission retinal microvascular and choroidal thickness changes in eyes with Behḉet’s disease posterior uveitis: an OCTA longitudinal study

International Ophthalmology - To investigate the retinal microvascular and choroidal thickness changes in eyes with active Beh?et’s disease posterior uveitis and post-remission. A...     

Effects of aging and propofol on the cardiovascular component of the autonomic nervous system

Study ObjectivesTo determine the combined effects of aging and propofol on autonomic nervous system activity using heart rate variability (HRV) analysis.DesignProspective, two-parallel group, repeated-measures study.SettingOperating room of an academic hospital.PatientsASA physical status 1, 2, and 3 patients, including 14 young (< 65 yrs) and 14 elderly (> 65 yrs) patients. All patients were scheduled for general surgical procedures with general anesthesia.InterventionsEach patient received two successive propofol doses during induction (0.5 mg/kg and 1.5 mg/kg) with a time interval allowing the return of Bispectral Index (BIS) to awake values.MeasurementsPrimary outcomes were HRV parameters, which included normalized power spectral density at low frequency (LFnorm) and high frequency (HFnorm) bands and the ratio LF/HF. Secondary outcomes were BIS values, blood pressure, heart rate, respiratory rate, and body temperature.Main ResultsThe interaction of age and propofol dose level was significant [multivariate analysis of variance, F (3,74) = 4.72, P = 0.005], representing a combined effect of age and propofol dose level on the mean HRV parameters. Propofol induction decreased the HFnorm component and enhanced LFnorm and LF/HF in the younger group, but had no significant effect in the older group. Such an effect was not associated with a significant difference in systolic blood pressure (SBP) decrements between the younger and older groups. Within each group, propofol caused significant decreases in SBP compared with preinduction values. Heart rate did not change significantly during propofol administration between groups or within groups.ConclusionsPropofol and aging act in synergy to depress the activity of the cardiovascular component of the autonomic nervous system. However, a compensatory increase in sympathetic outflow was seen in young patients. Such counterbalance was not observed in the older group.     

Neglected neck femur fractures in adolescents and young adults: factors predicting the surgical outcome

Background

Neglected femoral neck fracture in young adults is an intriguing problem. This retrospective study tried to solve that challenge through open reduction, cannulated screw internal fixation, autogenous iliac bone and bone marrow grafting.

Methods

Thirty-six cases were studied; they were classified according to Sandhu et al.'s classification. Twenty cases were type I and 16 cases were type II fractures; the mean age was 26.8 years; fracture neglect averaged 44.6 days. Twenty cases had posterior comminution and 16 cases had anterior comminution. All cases had open reduction, cannulated screw internal fixation, autogenous iliac bone and bone marrow grafting. The Harris hip score and Matta et al. grading system were applied for functional and radiological evaluation, respectively.

Results

The average postoperative follow-up was 25.3 months; 94.4 % of the cases had solid union in a mean of 19.6 weeks. Functionally, the Harris hip score averaged 87.8 points. Nonunion, avascular necrosis and coxa vara complicated two, two and four cases, respectively. Fair and poor radiological results were related to coxa vara and avascular necrosis, respectively. Nonunion was significantly related to posterior comminution, type II neglected fracture, and a neglect of more than 45 days. Age groups more than 30 years old and postoperative neck-shaft angles <140° were significantly associated with late-onset radiological healing and nonunion.

Conclusions

Cannulated screw osteosynthesis augmented by autogenous bone and bone marrow grafting is a simple, easy-to-perform surgical procedure with encouraging clinical outcomes for selected patients complaining of that difficult problem.     

Renal impairment in children with posterior urethral valves

Background

Posterior urethral valves (PUV) are a common cause of end-stage renal failure in childhood. Our aim was to describe a cohort of patients with PUV and to investigate the predictors of renal impairment.

Methods

We performed a retrospective chart review of children with PUV who were followed at King Abdulaziz University hospital between 2002 and 2011.

Results

The cohort comprised 68 boys. There was a significant difference in the duration of follow-up (p?=?0.024), nadir serum creatinine (p?<?0.001), and last known serum creatinine level (p?=?0.001) between the patients with and without renal impairment. The duration of follow-up appeared to be a significant predictor for serum creatinine doubling (p?=?0.003; odds ratio, 1.8). There was no difference in the age of presentation, age at the time of the study, and first or last serum creatinine between children who initially had vesicostomy and children who had ablation.

Conclusions

Ablation of PUV or vesicostomy did not influence kidney function in our study cohort. Children with a normal nadir serum creatinine who presented early had a better outcome.