الفهرس 
Biochemistry and Metabolism of HomocysteineOnly 14 pages are availabe for public view
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Abstract
This study was conducted with the aim of assessment of depressive symptoms in patients of IHD and to detect the association between depressive symptoms and serum level of homocysteine in patients of IHD.
The work consisted of two parts: theoretical and practical.
The theoretical part:
This part consists of a review of literature on the subject of association between depressive symptoms and serum level of homocysteine in patients of IHD. It is consisted of three chapters including the following:
The first chapter: Biochemistry & Metabolism of Homocysteine. It includes definition of homocysteine as naturally occurring amino acid and concerned with metabolic regulation of homocysteine level and measurement of tHcy in addition to different methods of homocysteine assay.
The second chapter: Homocysteine a novel risk factor for ischaemic heart disease. It includes role of Hcy in vascular injury and methods of reduction of Hcy level.
The third chapter: relation between depression and IHD: it discussed the relation between depression and IHD, different methods of mood and CVD dysregulation, impact of depression on IHD and management of depression in IHD patients.
The practical part:
1-Subject & methods:
The sample consists of group of IHD patients (n=80) who attend the cardiology outpatient’s clinics and inpatients department of Kasr El Aini hospital.
They represent consecutive referrals of patients fulfilling the inclusion criteria for Ischaemic heart disease of American College of Cardiology (ACC).
IHD patients were subjected to the following assessment procedures:
1- Diagnosis of myocardial ischaemia according to (AHA) (American Heart Association, 2000).
2- Psychiatric examination : using Kasr El Aini Psychiatric sheet to diagnose psychiatric disorders according to DSMIV criteria (American Psychiatric Association, 2000)
3- Psychometric tools:
a. Beck depressive inventory scale BDI (Beck et al., 1996)
b. Present state examination depression sections PSE-10 (short English-Arabic version) (Hamdi et al., 2007).
4- Laboratory assessment of plasma homocyseine by chemmiluminescent technique.
Results:
Results obtained from the assessment procedures were subjected to thorough analysis and discussion. They can be summarized as follows:
1-In viewing demographic data of the sample, it can be noticed that there were no statistically significant differences between the two subgroups (group of patients with depressive symptoms and group of non depressive symptoms) on all of sociodemographic data including sex, education & occupation.
However, it can be noticed that the mean and SD of the age of the group of IHD about 54.19+10.85 but there were statistically significant differences between both subgroups as regards the age (P=0.046).
2- the most common medical diagnoses were detected according to ICD10 criteria were ischaemia (45%), STEMI (16.25%), ischaemia with old MI (13.75%), ischaemia with STEMI (11.25%) then unstable angina (5%) and ischaemia with NSTEMI (2.5%).
3- the most common psychiatric diagnoses were detected by psychiatric sheet examination and PSE-10 SCALE was major depressive disorder single episode (30%) and dysthymia (27.5%).
4- It can be noticed that the mean beck depression scale level and SD for the sample were about 22.94+10.5. However, the differences between the two subgroups are statistically highly significant (P=0.000).
5- It can be noticed that the mean serum homocysteine level and SD for the sample were about 14.4+7.4. However, the differences between the two subgroups are statistically significant (P=0.098).
6- The results of psychiatric tools:
b) PSE-10:
1) Prevalence of patients with depressed symptoms is 45% according to PSE-10.
2) Using PSE and according to DSMIV criteria 21.2% (N=17) of patients had MDD single episode, 15% (N= 12) had dysthymia, 8.8% (N= 7) had double depression, 33.8% (N= 27) had subclinical symptoms of depression and the remaining 21.2% (N= 17) had no mood diagnosis.
b) BDI-II:
1) The prevalence of patients with depressive symptoms is 77.5% of the sample (IHD=80 patients) according to BDI-II.
2) The mean beck scale level for the depressed patients group was 26.97 While the mean beck scale level for none depressive group was 9.06.
3) Classification of patients group according to Beck depression scale. The most frequent patients were with moderate depression 28 (35%) followed by severe depressed patients 22 (27.5%) then mild depressed patients 12 (15%). It includes non depressed patients 18 (22.5%).
7-Relation between Depression & Hcy:
1) Using PSE-10 there was no difference in the mean homocysteine level between the different types of depressive disorders. The homocysteine mean level for all depressed patients (14.838 ±9.5) is similar to non/subclinically depressed patients (14.034 ±5.2) (t=0.46, P=.65)
2) Using BDI-II the mean homocysteine level for the depressed patients group was 15.134. While the mean homocysteine level for non depressive group was 11.856
3) There are trend toward statistical significance differences between the two groups (P=0.098)
4) Classification of patients group according to homocysteine level. The most frequent were patients with normal homocysteine level 48 (60%) followed by those with moderate homocysteine level 29 (36.25%) then those with elevated homocysteine level 3 (3.75%).There is no highly elevated homocysteine level
5) There were non significant positive or negative correlation between each of beck scale level, serum Hcy level and duration of ischaemia in the patients with depressive symptoms.
6) There is significant correlation between bodily function problems (PSE-10 Section 7) and Hcy serum level, while other depressive sections show non significant correlation with serum Hcy level.
8- As regards duration of ischaemia:
There were statistically highly significant differences between the IHD patients with depressive symptoms and those without depressive symptoms as regards the duration of ischaemia (P=0.000).
9- As regards CCU admission:
There were statistically significant difference between the IHD patients with depressive symptoms and those without depressive symptoms as regards the CCU admission (P=0.03).
10- As regards Cardiac Catheterization:
There were statistically significant difference between the IHD patients with depressive symptoms and those without depressive symptoms as regards the cardiac cathetarization (P=0.03)