Parathyroid hormone: effects on glucose homeostasis and insulin sensitivity in chronic renal failure patients on regular hemodialysis

To look into the relation between parathyroid hormone and abnormal glucose homeostasis in chronic renal failure patients on regular hemodialysis. 41 subjects, with chronic renal failure, and on regular hemodialysis [28 male, 13 female; age range 19-64 years]. Full history and clinical examination were taken for every patient. In addition, ten age and sex matched healthy persons were selected randomly as control group. Informed consent was obtained. All patients were investigated to determine serum creatinine, calcium, phosphorus, alkaline phosphatase, parathyroid hormone, fasting glucose, and fasting insulin. Homeostasis module assessment of insulin resistance was calculated as a measure of insulin resistance. Homeostasis module assessment of beta cell was calculated as a measure of pancreatic beta cell function. The uremic patients were classified into two groups: group A included 24 patients with plasma parathyroid hormone levels < 450 pg/ml and group B included 17 patients with plasma parathyroid hormone level >450 pg/ml. There is a marked increase in fasting insulin level in all patients versus control associated with increased homeostasis module assessment of insulin resistance, an index for insulin resistance. Significant negative correlation is found between parathyroid hormone and fasting insulin and homeostasis module assessment of insulin resistance in uremic patients. Patients with severe hyperparathyroidism have relatively more impaired pancreatic beta cell function in comparison to those with mild hyperparathyroidism. The pulsed dose of intravenous 1-cholecalciferol is associated with low parathormone level and high serum calcium. Insulin resistance is a constant feature of chronic renal failure patients under hemodialysis therapy, while secondary hyperparathyroidism is linked negatively to beta cell function. Intermittent pulsed intravenous alphacalcidol is an effective method of lowering high serum parathyroid hormone and is associated with improvement of beta cell function without significant effect on insulin resistance

Using blood pressure and urine output as a guide for the duration of magnesium sulphate therapy as a prophylaxis against seizures among patients with severe preeclampsia

To assess whether we can use blood pressure and urine output to adjust the duration at postpartum magnesium sulphate as a prophylaxis against seizures in patients with severe preeclampsia. This is a randomized control single blinded clinical trial held in Suez canal University hospital, Obstetrics and Gynecology Department. The study was carried on 150 of pregnant women attending the emergency delivery ward and are diagnosed as cases of severe preeclampsia distributed in three groups. The first group received magnesium sulphate as a 6 gm intravenous bolus loading dose then 1 gm/hour as a maintenance dose until the delivery time, then the regimen will be continued after delivery spontaneous onset of diuresis and, greater than 50% of the hourly postpartum blood pressures less than 150 mm Hg systolic and, less than 100 mm Hg diastolic [including the hour immediately before medication discontinuation], the second group received magnesium sulphate as a 6 gm intravenous bolus loading dose then 1 gm/hour as a maintenance dose until the delivery time then the regimen continued after delivery until the onset of diuresis only and the third group received a 48 gm of magnesuim sulphate. The results showed that no cases exposed to fits in group 1 and also no cases exposed to fits in group 2;: versus one case [3.3%] exposed to fits in group 3. There was only one as only one case that needed to reinitiate therapy in group 2 versus two cases needed to reinitiate therapy in group which is statistically insignificant. In group 2 there was one case needed to reinitiate therapy, so no effect on blood pressure or the need to reinitiate therapy by increasing the total dose as magnesium sulfate. There were no side effects at all from magnesium sulfate in group 1 and group 2, versus nine cases [30%] suffered from oliguria, two cases [6. 7%] suffered from hyporeflexia and three cases [10%] suffered from arrythmias in group 3. We can depend on diuresis alone as a dependable clinical parameter to withdraw magnesium sulphate safely without giving the patient unnecessary doses of the unsafe magnesium sulfate and without affecting the maternal outcome as no cases had postpartum fits and only one case needed to reinitiate therapy, although depending on diuresis and blood pressure to determine the duration of the therapy carries the same safety margin as diuresis alone and carries no more benefit over diuresis alone as magnesium sulfate not mainly an antihypertensive drug

Vascular endothelial growth factor [VEGF]: an association with diabetic microvascular complications

Type 2 diabetes mellitus [DM] and hyperhomocysteinaemia are both associated with premature vascular disease. This study aimed to assess plasma total homocysteine [P tHcy] level in type 2DM and its relation to nephropathy and retinopathy. P tHcy level was estimated in 20 type 2 diabetic patients with retinopathy and microalbuminuria and 20 patients with retinopathy and macroalbuminuria versus 20 type 2 diabetics with no retinopathy nor nephropathy and 20 healthy controls matched for age, sex and race. Other assessment included funduscopic examination, complete urine analysis, estimation of urinary albumin excretion rate, blood urea, serum creatinine, crentinine clearance, fasting plasma glucose, glycosylated haemoglobin [HbA[IC]]. serum lipid profile. as well as ultrasonographic examination of the kidneys and renal arteries. Mean P tHcy concentration was significantly higher in both the albuminuric groups than in normal albuminuric. group and controls, however mean P tHcy was inversely correlated with creatinine clearance versus no correlation with the other studied parameters, and no relation to retinopathy. Creatinine clearance is the only parameter associated with P tHcy, denoting that the degree of renal functional impairment is the determinant of its plasma concentration in patients with type 2 DM

Vascular endotheliaf growtli factor [VEGF]: an association with diabetic microvascular complications

The mediators of diabetic microvascular complications remain largely unknown. As diabetic stinopathy is associated with ischaemic changes followed by neovascularization, a role has been proposed for vascular endothelial growth factor [VEGF] its pathogenesis. Subjects and Serum EGF levels were studied in 55 diabetic patients at ferent stages of their disease and microvascular mplications. It was first noted that ciculating VEGF levels were significantly higher in betic patients [421 +/- 309 pg/ml, mean +/- SD] npared to controls [188 +/- 145 pg/ml], P < 0.05. ther analysis showed VEGF levels to be highest in] etic patients with proliferate retinopathy 1 +/- 376 pg/ml]. The level in those with and without background retinopathy was comparable to that of controls [379 +/- 250 pg/ml]. A significant rise in serum VEGF was also detected in patients with significant proteinuria [662 +/- 276 pg/ml]. The level in those with icroalbuminuria was comparable to that of controls [375 +/- 273 pg/ml]. A positive, albeit weak, correlation was noted between serum VEGF and urinary albumin excretion [r= 0.27, P < 0.05]. This study confirms raised circulating level of VEGF in diabetic patients with advanced microvascular disease [proliferate retinopathy and established nephropathy]

In vivo effect of [50Hz] magnetic Filed on concentration of trace elements concerned with hemoglobin formation

The present in vivo experiment was designed to establish whether the exposure to 50 Hz magnetic field induces changes in blood and organs store of trace elements concentrations possibly associated with changes in hemoglobin level and induction of anemia. Rats were exposed to a high magnetic field strength of 0.5 T for one hour daily, the experiment was conducted for 30 days. Thirty-six rats were divided into control and magnetic field exposed rats. Iron, copper and zinc concentrations in blood, liver, kidney and spleen were estimated to assess the magnetic field effect on trace element storage in these tissues. MF exposure resulted in a depletion of the organs store of trace elements. A highly significant increase in blood copper and a decrease in zinc and iron levels were detected. A significant decrease was found in the hematological parameters, ceruloplasmin and ferritin [iron metabolism parameters]. The changes observed were associated with anemia during the first 14 days of MF exposure. The magnitude of anemia increased with increasing the exposure time