امنة عبد الباقي خضر الدجيلي

ackground: cisplatin is a potent chemotherapeutic agent that is currently used in management of many and various types of tumors. Cisplatin causes dose-related nephrotoxicity that significantly affects kidney function and limits cisplatin use with maximum required dose and usefulness. This study was to assess the protective and ameliorativen effect of zinc sulfate on kidney function and nephrotoxicity caused by cisplatin in cancer patients. Patients and methods: 41 patients were enrolled in the study and were randomized into two groups. Patients in group I (N=20) received cisplatin based regimen every 21 days for six consecutive cycles. Patients in group II (N=21) received zinc sulfate plus cisplatin based regimen during the six consecutive cycles of treatment. Serum urea, creatinine and magnesium levels were measured at base line and 21 days after 1, 2, 4 and 6 cycles of cisplatin based regimen. The glomerular filtration rate of patients was calculated according to updated version of the Modification of Diet in renal Diseases formula. Results: In group I, cisplatin based regimen after 6 cycles of treatment caused significant (P<0.05) increment in serum urea and creatinine and significant (P<0.05) decline in The glomerular filtration rate and magnesium in comparison to base line levels. Serum urea and creatinine levels of group II were significantly (P<0.05) lower than that of group I while glomerular filtration rate and magnesium were significantly (P<0.05) higher than that of group I. Conclusion: zinc sulfate significantly ameliorated nephrotoxicity and improving kidney function in cisplatin-treated patients. Keywords: zinc sulfate, cisplatin, kidney function, nephrotoxicity. Introduction Cisplatin is an alkylating-like agent with potent antitumor efficacy that is widely used in treatment of various types of cancers(1). Currently, cisplatin clinical use is complicated by the dose-dependent nephrotoxicity which can occure in form of acute kidney injury (AKI) in approximately 20-30% of patients(2) . Acute kidney injury accounts for increased morbidity and mortality (3) and thereby cisplatin dose should be decreased to avoid nephrotoxicity at the expense of maximum chemotherapeutic effectiveness.(1,3) .

Background: Trastuzumab therapy is effective in HER2 positive breast cancer patients, but it is highly complicated by cardiotoxicity.Objective: To elucidate the possible effects of carvedilol on echocardiographic fraction shortening, serum troponin I and serum malondialdehyde in trastuzumab treated females with HER2 positive breast cancer.Patients and Methods: A total of twenty six females with HER2 positive breast cancer were enrolled in this study. The patients were randomized into two groups, thirteen patients in each group. Group I included patients who received trastuzumab therapy for 8 cycles with 21 days apart. Group II included patients who treated with trastuzumab therapy with carvedilol 3.125 mg, orally, twice daily dose for 8 cycles. Echocardiography was used to measure fraction shortening at zero time, 4th and 8th cycles in both groups. Serum troponin I and malondialdehyde were measured at zero time, 2nd, 4th, 6th and 8th cycles in both groups.Results: Treatment with trastuzumab therapy caused a significant decrement in echocardiographic fraction shortening at an only 8th cycle in comparison to baseline readings (P < 0.05).Combined trastuzumab plus carvedilol caused a significant increase in echocardiographic fraction shortening compared with that of trastuzumab therapy group (P < 0.05). Regarding serum troponin I and malondialdehyde, trastuzumab therapy caused a significant increment in both these markers in comparison to baseline readings (P < 0.05). Combined trastuzumab plus carvedilol caused significant decrement in troponin I and malondialdehyde compared with that of trastuzumab therapy group (P < 0.05).Conclusion: Carvedilol causes significant increment in echocardiographic fraction shortening and significant decrement in serum troponin I and malondialdehyde in trastuzumab treated patients.

Abstract: Background: Left ventricular meridional end systolic stress (LVMESS) is a quantitative determinant index of LV afterload which is an essential determinant of LV performance. The key factors influencing LVMSS, notably ventricular wall thickness, chamber size and configuration are shown to be altered by both obesity and type2 diabetes mellitus (T2DM). There exist reports implicating high free insulin-like growth factor 1 (IGF-1) but not growth hormone (GH) levels, with increased left ventricular mass index (LVMI), abnormal LV geometric remodelling, and A1c levels. Objective: to explore whether a meaningful link exists between LVMESS and free IGF-1 plasma levels, in obese middle-aged and elderly individuals with or without T2DM. Subjects and methods: In this cross sectional study, a total of 145 participants Involved. Middle aged and elderly obese individuals with or without T2 DM were matched with healthy lean subjects of the same age group, with or without T2 DM. LVMESS and IGF-1 levels were compared between groups; group differences were analyzed using unpaired t test and linear correlation test. Data were expressed as the mean ± S.D, using SPSS version 18). Results: LVMESS values showed significant decrease in diabetic patients compared to control in both middle and old aged subjects. IGF-1, concentration levels were lower in the elderly obese diabetics compared to control, with significant (r=0.462; p= 0.04) negative correlation with LVMESS in healthy obese old aged, and a negative but nonsignificant correlation with LVMESS in lean old aged with or without diabetics. Conclusion: Nonlinear correlation of IGF-1 levels with LVMESS obtained. It could be hypothesized that because of its negative significant correlation with LVMESS in the elderly non diabetic obese, IGF-1 free level could be utilized to serve as a predictor of impaired LV systolic function in these subjects. In addition the results could shed some light on IGF-1- LVMESS relationship, when considering IGF-1 therapy in certain conditions. Recommendation: It is suggested that using IGF-1 plasma levels in the elderly with or without T2DM could aid as predictor for LV global systolic dysfunction .However, larger sample size are to be considered. Keywords: IGF- 1, left ventricular meridional end systolic stress, obesity, Type 2 Diabetes Mellitus.

ABSTRACT The cardio-ankle vascular index (CAVI) is a new index of arterial stiffness that can be measured with a VaSera VS-1000 device. An association between certain arterial stiffness indices and cardiac function has been found but has not yet been validated. The aim of this study was to establish whether any significant relationship exists between cardiac index (CI) and CAVI. Twenty healthy male volunteers with a mean age of 30 ± 5 years and a mean BMI of 23.1 ± 1.1 kg/m2 participated in the study. CO was estimated using a Doppler technique, and CAVI was measured with a VaSeraVS-1000 device. A motorised tilting table was used to achieve head-up tilt (HUT) angles of 0°, 30°and 60°, to modify the peripheral sympathetic outflow. We found that there was a significant inverse correlation between CI and the degree of head-up tilt, ( for 0°and 30°; for 0° and 60°, p < 0.001 for both; for 30° and 60°, ). CAVI showed a significant positive correlation relative with the degree of HUT, ( for 0° and 30°; for 0° and 60°; for 30° and 60°, for all). A significant negative correlation was found between CI and CAVI r = - 0.47, p < 0.05. Additionally, a significant p < 0.001 increase in PVR values was observed for increasing HUT values. In conclusion: An inverse relationship between CI and CAVI was shown; a decrease in cardiac output is associated with an increase in CAVI values at different degrees of HUT. This association provides further insight into the postural link between cardiac output and arterial compliance. KEYWORDS Cardiac Index; Cardio-Ankle Vascular Index;Atherosclerosis; Head-Up Tilt