Objective: To identify whether ischemia modified albumin (IMA) is non traditional risk marker for peripheral arterial disease, and to determine whether there is an association between serum rschemia-modified albumin and the risk factor profile in type 2 diabetic patients with peripheral arterial disease. Methods: 30 patients with type 2 diabetes mellitus (15 patients with peripheral arterial disease (PAD), and 15 patients without peripheral arterial disease), beside 15 healthy subjects, age and sex matched as a control group were enrolled in the study. The basal ischemia-modified albumin (IMA) levels, clinical parameters and risk factors for peripheral arterial disease were measured and analyzed by multiple logistic analysis. Exclusion Criteria: Patients with liver, kidney diseases, ischemic events (CVS and IHD), infection, corticosteroid therapy or malignancy. Diagnoses of peripheral arterial disease were confirmed by measuring ankle-brachial pressure index (AB1), diagnosis of peripheral arterial disease was based on an ankle-brachial pressure index 0.9 or >1.3 in cither leg. Results: There were significant increases in the duration of diabetes mellitus, random blood sugar (RBS), total choles¬terol, triglycerides, low density lipoprotein and IMA in diabetic patients with PAD than without PAD. While ABI was signif¬icantly decreased (p0.001) in diabetic patients with PAD than without PAD. Multiple logistic analysis indicated that increase duration of diabetes, random blood sugar (RBS), ischemia modified albumin, and decrease ABI were independent risk factors for peripheral arterial disease in diabetic subjects. Conclusion: The baseline ischemia-modified albumin levels were significantly higher and positively correlated with HbAlc and RBS level, duration of the disease and ABI in type 2 diabetic patients with peripheral arterial disease. Ischemia-modified albumin was a risk marker for peripheral arterial disease. Taken together, these results might be helpful for monitoring diabetic peripheral arterial disease.

Objective: To identify whether ischemia modified albumin (IMA) is non traditional risk marker for peripheral arterial disease, and to determine whether there is an association between serum rschemia-modified albumin and the risk factor profile in type 2 diabetic patients with peripheral arterial disease. Methods: 30 patients with type 2 diabetes mellitus (15 patients with peripheral arterial disease (PAD), and 15 patients without peripheral arterial disease), beside 15 healthy subjects, age and sex matched as a control group were enrolled in the study. The basal ischemia-modified albumin (IMA) levels, clinical parameters and risk factors for peripheral arterial disease were measured and analyzed by multiple logistic analysis. Exclusion Criteria: Patients with liver, kidney diseases, ischemic events (CVS and IHD), infection, corticosteroid therapy or malignancy. Diagnoses of peripheral arterial disease were confirmed by measuring ankle-brachial pressure index (AB1), diagnosis of peripheral arterial disease was based on an ankle-brachial pressure index 0.9 or >1.3 in cither leg. Results: There were significant increases in the duration of diabetes mellitus, random blood sugar (RBS), total choles¬terol, triglycerides, low density lipoprotein and IMA in diabetic patients with PAD than without PAD. While ABI was signif¬icantly decreased (p0.001) in diabetic patients with PAD than without PAD. Multiple logistic analysis indicated that increase duration of diabetes, random blood sugar (RBS), ischemia modified albumin, and decrease ABI were independent risk factors for peripheral arterial disease in diabetic subjects. Conclusion: The baseline ischemia-modified albumin levels were significantly higher and positively correlated with HbAlc and RBS level, duration of the disease and ABI in type 2 diabetic patients with peripheral arterial disease. Ischemia-modified albumin was a risk marker for peripheral arterial disease. Taken together, these results might be helpful for monitoring diabetic peripheral arterial disease.

Several studies were done investigating thyroid function in patients with epilepsy. However the results of different studies were conflicting or controversial. This study aimed to evaluate thyroid hormonal changes and their relationship to thyroid volume in epileptic adults on long-term treatment with antiepileptic drugs (AEDs). This study included 135 adults with idiopathic epilepsy with mean age of 32.32پ}4.34years, duration of illness of 10.52پ}5.08 years and on treatment with carbamazepine (CBZ), valproate (VPA) or CBZ+VPA for a mean duration of 8.66پ}3.32years. The serum levels of free thyroxine (fT4), triiodothyronine (fT3), and thyroid-stimulating hormone (TSH) were assessed. Thyroid volume was measured using ultrasonography. Compared to control subjects, patients had significant lower fT4 (p0.01) and fT3 (p0.01) and higher levels of TSH (p0.0001). The majority of patients with reduced fT4 also had reduced fT3 and increased TSH levels. Nearly 26% of the patients had enlargement of the thyroid gland (p0.001). Patients on polytherapy had more thyroid volume compared to patients on monotherapy (p0.05) and patients on VPA had more thyroid volume compared to patients on CBZ (p0.03). All patients were clinically euthyroid. Significant correlations were identified between fT4 concentrations and duration of illness, dose, serum level and duration of AEDs treatment, fT3 and TSH concentrations and between thyroid volume and fT4, fT3 and TSH concentrations. In conclusion, CBZ and VPA as mono- or polytherapies may cause thyroid hormonal and structural abnormalities. Thyroid enlargement is due to associated subclinical hypothyroidsm. This data have implications suggesting prevention strategies. Abbreviations: AEDs, Antiepileptic drugs; CBZ, carbamazepine; VPA, valproate; fT3, free triiodothyronine; fT4, free thyroxine; TSH, thyroid stimulating hormone; SCH, subclinical hypothyroidism

Several studies were done investigating thyroid function in patients with epilepsy. However the results of different studies were conflicting or controversial. This study aimed to evaluate thyroid hormonal changes and their relationship to thyroid volume in epileptic adults on long-term treatment with antiepileptic drugs (AEDs). This study included 135 adults with idiopathic epilepsy with mean age of 32.32پ}4.34years, duration of illness of 10.52پ}5.08 years and on treatment with carbamazepine (CBZ), valproate (VPA) or CBZ+VPA for a mean duration of 8.66پ}3.32years. The serum levels of free thyroxine (fT4), triiodothyronine (fT3), and thyroid-stimulating hormone (TSH) were assessed. Thyroid volume was measured using ultrasonography. Compared to control subjects, patients had significant lower fT4 (p0.01) and fT3 (p0.01) and higher levels of TSH (p0.0001). The majority of patients with reduced fT4 also had reduced fT3 and increased TSH levels. Nearly 26% of the patients had enlargement of the thyroid gland (p0.001). Patients on polytherapy had more thyroid volume compared to patients on monotherapy (p0.05) and patients on VPA had more thyroid volume compared to patients on CBZ (p0.03). All patients were clinically euthyroid. Significant correlations were identified between fT4 concentrations and duration of illness, dose, serum level and duration of AEDs treatment, fT3 and TSH concentrations and between thyroid volume and fT4, fT3 and TSH concentrations. In conclusion, CBZ and VPA as mono- or polytherapies may cause thyroid hormonal and structural abnormalities. Thyroid enlargement is due to associated subclinical hypothyroidsm. This data have implications suggesting prevention strategies. Abbreviations: AEDs, Antiepileptic drugs; CBZ, carbamazepine; VPA, valproate; fT3, free triiodothyronine; fT4, free thyroxine; TSH, thyroid stimulating hormone; SCH, subclinical hypothyroidism

Several studies were done investigating thyroid function in patients with epilepsy. However the results of different studies were conflicting or controversial. This study aimed to evaluate thyroid hormonal changes and their relationship to thyroid volume in epileptic adults on long-term treatment with antiepileptic drugs (AEDs). This study included 135 adults with idiopathic epilepsy with mean age of 32.32پ}4.34years, duration of illness of 10.52پ}5.08 years and on treatment with carbamazepine (CBZ), valproate (VPA) or CBZ+VPA for a mean duration of 8.66پ}3.32years. The serum levels of free thyroxine (fT4), triiodothyronine (fT3), and thyroid-stimulating hormone (TSH) were assessed. Thyroid volume was measured using ultrasonography. Compared to control subjects, patients had significant lower fT4 (p0.01) and fT3 (p0.01) and higher levels of TSH (p0.0001). The majority of patients with reduced fT4 also had reduced fT3 and increased TSH levels. Nearly 26% of the patients had enlargement of the thyroid gland (p0.001). Patients on polytherapy had more thyroid volume compared to patients on monotherapy (p0.05) and patients on VPA had more thyroid volume compared to patients on CBZ (p0.03). All patients were clinically euthyroid. Significant correlations were identified between fT4 concentrations and duration of illness, dose, serum level and duration of AEDs treatment, fT3 and TSH concentrations and between thyroid volume and fT4, fT3 and TSH concentrations. In conclusion, CBZ and VPA as mono- or polytherapies may cause thyroid hormonal and structural abnormalities. Thyroid enlargement is due to associated subclinical hypothyroidsm. This data have implications suggesting prevention strategies. Abbreviations: AEDs, Antiepileptic drugs; CBZ, carbamazepine; VPA, valproate; fT3, free triiodothyronine; fT4, free thyroxine; TSH, thyroid stimulating hormone; SCH, subclinical hypothyroidism

This work aimed to investigate peripheral and central hearing function (auditory pathways) in patients with diabetes mellitus (DM). This study included 60 patients with mean age of 39.57±13.89 years and dura¬tion of illness of 7.37±5.15 years. We did routine pure tone audiometry (PTA) along with Auditory-Brainstem Response (ABR) at low and high repetition rate frequencies and Event-Related Potentials (ERPs). Four¬teen patients (23.33%) had tinnitus and 18 patients (30%) had subjec¬tive hearing impairment. PTA reported peripheral auditory neuropathy in 30% (18/60) or (30/120) of ears examined [versus 8.75% (7/80) for control subjects] (P=0.001). Of them, bilateral sensorineural hearing impairment (SNHI) was reported in (72.22%; n=13). The latency of wave I was prolonged in 36.67% indicating auditory neuropathy. The latency of wave III and I-III and III-V inter peak latencies (IPLs) were delayed in 46.67% indicating impairment in the cochlear nucleus. The latency of wave V and III-V and I-V IPLs were delayed in 30% without impairment in wave I or III, indicating impairment in the activity in the nuclei of lateral lemniscus. Compared to control subjects, patients had higher hearing threshold at different frequencies (250-8000 Hz) (P = 0.0001), prolonged absolute latencies of waves I, III and V and I-III, III-V and I-V IPLs at 90dBHL low and high repetition frequencies and N100, N200, P200 and P300 components of ERPs (P = 0.0001) and reduced amplitudes of P200 and P300 (P = 0.0001). No significant differences were identified among different audiologic variables between patients with type 1 (T1DM) and type 2 (T2DM) diabetes mellitus. Patients who were uncontrolled on anti-diabetic medications had prolonged I-V IPLs at 90dBHL low (right: P=0.025; left: P=0.041) and high (right: P=0.047; left: P=0.036) repetition frequencies and reduced amplitudes of P300 (right: P=0.050; left: P=0.052). significant correlations were identified between many audiologic variables and demographic- clini¬cal- and laboratory- variables In multivariate analysis and after adjust¬ment of other risk factors, there were increase in the odds for latency of wave III (OR 1.90; 95% Cl 1.02 to 3.55, P = 0.044); I-III (OR 2.36; 95% Cl 0.95 to 5.81; P = 0.06) and III-V (OR 2.36; 95% Cl 0.95 to 5.81; P = 0.06) IPLs and amplitude of P300 (OR 2.36; 95% Cl 0.95 to 5.81; P = 0.06) in relationship to the degree hyperglycemia. We conclude that, patients with DM have higher frequency of peripheral and central hearing impairment (i.e. acoustic nerve, auditory pathway throughout the brainstem till the auditory cortex). The degree of hear¬ing impairment was significantly correlated with glycemic control. This knowledge is important for specialists serving those patients.

This work aimed to investigate peripheral and central hearing function (auditory pathways) in patients with diabetes mellitus (DM). This study included 60 patients with mean age of 39.57±13.89 years and dura¬tion of illness of 7.37±5.15 years. We did routine pure tone audiometry (PTA) along with Auditory-Brainstem Response (ABR) at low and high repetition rate frequencies and Event-Related Potentials (ERPs). Four¬teen patients (23.33%) had tinnitus and 18 patients (30%) had subjec¬tive hearing impairment. PTA reported peripheral auditory neuropathy in 30% (18/60) or (30/120) of ears examined [versus 8.75% (7/80) for control subjects] (P=0.001). Of them, bilateral sensorineural hearing impairment (SNHI) was reported in (72.22%; n=13). The latency of wave I was prolonged in 36.67% indicating auditory neuropathy. The latency of wave III and I-III and III-V inter peak latencies (IPLs) were delayed in 46.67% indicating impairment in the cochlear nucleus. The latency of wave V and III-V and I-V IPLs were delayed in 30% without impairment in wave I or III, indicating impairment in the activity in the nuclei of lateral lemniscus. Compared to control subjects, patients had higher hearing threshold at different frequencies (250-8000 Hz) (P = 0.0001), prolonged absolute latencies of waves I, III and V and I-III, III-V and I-V IPLs at 90dBHL low and high repetition frequencies and N100, N200, P200 and P300 components of ERPs (P = 0.0001) and reduced amplitudes of P200 and P300 (P = 0.0001). No significant differences were identified among different audiologic variables between patients with type 1 (T1DM) and type 2 (T2DM) diabetes mellitus. Patients who were uncontrolled on anti-diabetic medications had prolonged I-V IPLs at 90dBHL low (right: P=0.025; left: P=0.041) and high (right: P=0.047; left: P=0.036) repetition frequencies and reduced amplitudes of P300 (right: P=0.050; left: P=0.052). significant correlations were identified between many audiologic variables and demographic- clini¬cal- and laboratory- variables In multivariate analysis and after adjust¬ment of other risk factors, there were increase in the odds for latency of wave III (OR 1.90; 95% Cl 1.02 to 3.55, P = 0.044); I-III (OR 2.36; 95% Cl 0.95 to 5.81; P = 0.06) and III-V (OR 2.36; 95% Cl 0.95 to 5.81; P = 0.06) IPLs and amplitude of P300 (OR 2.36; 95% Cl 0.95 to 5.81; P = 0.06) in relationship to the degree hyperglycemia. We conclude that, patients with DM have higher frequency of peripheral and central hearing impairment (i.e. acoustic nerve, auditory pathway throughout the brainstem till the auditory cortex). The degree of hear¬ing impairment was significantly correlated with glycemic control. This knowledge is important for specialists serving those patients.

This work aimed to investigate peripheral and central hearing function (auditory pathways) in patients with diabetes mellitus (DM). This study included 60 patients with mean age of 39.57±13.89 years and dura¬tion of illness of 7.37±5.15 years. We did routine pure tone audiometry (PTA) along with Auditory-Brainstem Response (ABR) at low and high repetition rate frequencies and Event-Related Potentials (ERPs). Four¬teen patients (23.33%) had tinnitus and 18 patients (30%) had subjec¬tive hearing impairment. PTA reported peripheral auditory neuropathy in 30% (18/60) or (30/120) of ears examined [versus 8.75% (7/80) for control subjects] (P=0.001). Of them, bilateral sensorineural hearing impairment (SNHI) was reported in (72.22%; n=13). The latency of wave I was prolonged in 36.67% indicating auditory neuropathy. The latency of wave III and I-III and III-V inter peak latencies (IPLs) were delayed in 46.67% indicating impairment in the cochlear nucleus. The latency of wave V and III-V and I-V IPLs were delayed in 30% without impairment in wave I or III, indicating impairment in the activity in the nuclei of lateral lemniscus. Compared to control subjects, patients had higher hearing threshold at different frequencies (250-8000 Hz) (P = 0.0001), prolonged absolute latencies of waves I, III and V and I-III, III-V and I-V IPLs at 90dBHL low and high repetition frequencies and N100, N200, P200 and P300 components of ERPs (P = 0.0001) and reduced amplitudes of P200 and P300 (P = 0.0001). No significant differences were identified among different audiologic variables between patients with type 1 (T1DM) and type 2 (T2DM) diabetes mellitus. Patients who were uncontrolled on anti-diabetic medications had prolonged I-V IPLs at 90dBHL low (right: P=0.025; left: P=0.041) and high (right: P=0.047; left: P=0.036) repetition frequencies and reduced amplitudes of P300 (right: P=0.050; left: P=0.052). significant correlations were identified between many audiologic variables and demographic- clini¬cal- and laboratory- variables In multivariate analysis and after adjust¬ment of other risk factors, there were increase in the odds for latency of wave III (OR 1.90; 95% Cl 1.02 to 3.55, P = 0.044); I-III (OR 2.36; 95% Cl 0.95 to 5.81; P = 0.06) and III-V (OR 2.36; 95% Cl 0.95 to 5.81; P = 0.06) IPLs and amplitude of P300 (OR 2.36; 95% Cl 0.95 to 5.81; P = 0.06) in relationship to the degree hyperglycemia. We conclude that, patients with DM have higher frequency of peripheral and central hearing impairment (i.e. acoustic nerve, auditory pathway throughout the brainstem till the auditory cortex). The degree of hear¬ing impairment was significantly correlated with glycemic control. This knowledge is important for specialists serving those patients.

Introduction: Gastrointestinal bleeding (GIB) is more common in patients with end stage renal disease (ESRD) and is associated with higher mortality than in the general population. There are limited data regarding the occurrence of upper GIB in dialysis patients in our locality. So, we aimed to identify upper GIT lesions by endoscopy in ESRD patients with occult GIT bleeding. Patients and methods: Highly sensitive guaiac-based faecal occult blood Hemoccult SENSA test (FOBT) was performed on stool specimens of 100 ESRD patients with upper GI symptoms; 36 with advanced renal failure prior to dialysis (CRF), 64 on maintenance hemodialysis (HD). None of the patients had overt gastrointestinal bleeding prior to participation in the study. Patients with positive FOBT underwent diagnostic upper GI endoscopy. Results: Twenty eight patients had positive guaiac-based FOBT where the majority was HD patients (71.4%). 26 patients with positive FOBT had UGI lesions with positive predictive value of 92.8%. Gastric lesions (42.9%) were the most common lesions followed by duodenal lesions and angiodysplasia (21.3% for each). Conclusion: Fecal occult blood test can be used routinely as a simple and non-invasive screening tool for early detection of UGIB in ESRD patients. The positive test should be followed by additional diagnostic procedures to identify the cause of occult bleeding. Keywords: Upper gastrointestinal bleeding; End stage renal disease; fecal occult blood; Hemoccult Sensa

Introduction: Gastrointestinal bleeding (GIB) is more common in patients with end stage renal disease (ESRD) and is associated with higher mortality than in the general population. There are limited data regarding the occurrence of upper GIB in dialysis patients in our locality. So, we aimed to identify upper GIT lesions by endoscopy in ESRD patients with occult GIT bleeding. Patients and methods: Highly sensitive guaiac-based faecal occult blood Hemoccult SENSA test (FOBT) was performed on stool specimens of 100 ESRD patients with upper GI symptoms; 36 with advanced renal failure prior to dialysis (CRF), 64 on maintenance hemodialysis (HD). None of the patients had overt gastrointestinal bleeding prior to participation in the study. Patients with positive FOBT underwent diagnostic upper GI endoscopy. Results: Twenty eight patients had positive guaiac-based FOBT where the majority was HD patients (71.4%). 26 patients with positive FOBT had UGI lesions with positive predictive value of 92.8%. Gastric lesions (42.9%) were the most common lesions followed by duodenal lesions and angiodysplasia (21.3% for each). Conclusion: Fecal occult blood test can be used routinely as a simple and non-invasive screening tool for early detection of UGIB in ESRD patients. The positive test should be followed by additional diagnostic procedures to identify the cause of occult bleeding. Keywords: Upper gastrointestinal bleeding; End stage renal disease; fecal occult blood; Hemoccult Sensa