Study of neutrophil lymphocyte ratio [NLR] and platelet lymphocyte ratio [PLR] as a predictor inflammatory marker for diabetic nephropathy in type 2 diabetic patients

Background: Diabetes mellitus [DM] is a systemic disease having serious microvascular and macrovascular complications. DN in T2DM has an inflammatory pathology. Many inflammatory markers have been found to be related to DN, such as interleukin1 [IL1], IL6, IL8, transforming growth factor beta 1[TGF-Beta1] and tumor necrosis factor alpha [TNF Alpha]. However, their measurement is not used routinely as it is not easy to do it, in this respect. Search for inflammatory markers for the disease is a continuous process to enhance the diagnostic and treatment process

Aim of the Work: To assess neutrophil lymphocyte ratio [NLR] and platelet lymphocyte ratio [PLR] as a predictor inflammatory markers for diabetic nephropathy in type 2 diabetic patients

Patients and Methods: This study is a prospective one that was carried out on one hundred [100] type 2 Diabetes mellitus [T2DM] patients attending to internal medicine outpatient clinic and inpatient department of internal medicine at Al-Azhar university hospital, Damietta and twenty five [25] apparently healthy volunteers as a control. The populations of the study were classified into three groups according to their level of albuminuria. All were subjected tofull history and Clinical examination, Laboratory tests include Fasting mid-stream urine samples were obtained and examined for complete urine analysis and albumin/creatinine ratio [UACR],Complete blood count [CBC], HbA1c,Fasting blood sugar, Renal Function Tests,eGFR and Abdominal ultrasonography, Fundus examination and ECG and Assessment of NLR and PLR

Results: Our study showed that there was high statistically significant increased NLR, PLR and UACR in group IB when compared to group IA, II and III. Also there was statistically significant increased NLR,PLR and UACR in group IA in comparison to group II and also there was statistically significant increased NLR,PLR and UACR in group II in comparison to group III

Conclusion: Neutrophil lymphocyte ratio [NLR] and Platelet lymphocyte ratio [PLR] was significantly associated with diabetic nephropathy [DN] and high Neutrophil lymphocyte ratio [NLR] and Platelet lymphocyte ratio [PLR] values may be considered as a predictor and a prognostic risk markers of diabetic nephropathy [DN]

Rheumatic heart disease associated with secondary renal amyloidosis

Amyloidosis is a disorder of protein folding in which normally soluble proteins undergo conformational changes and are deposited in the extracellular space in an abnormal fibrillar form. Accumulation of these fibrils causes progressive disruption of the structure and function of tissues and organs, and the systemic forms of amyloidosis are frequently fatal. The conditions that underlie amyloid deposition may be either acquired or hereditary. Amyloid-A [AA] amyloidosis is the most common form of systemic amyloidosis worldwide, AA amyloidosis occurs in the course of chronic inflammatory diseases, hereditary periodic fevers, and with certain neoplasms such as Hodgkin disease and renal cell carcinoma. Amyloidosis due to rheumatic heart disease [RHD] is not common but can be seen. We report here a patient with RHD and AA renal amyloidosis. We present a 30 year-old Egyptian male with a history of RHD, accidently discovered to have nephrotic range proteinuria and rising serum creatinine. Serology studies were negative or normal, including antinuclear antibody [ANA] and antineutrophil cytoplasmic antibody [ANCA]. C3 and C4 complement levels were normal. Kidney biopsy revealed AA renal amyloidosis. CT chest and abdomen revealed bilateral hilar and mediastinal lymphadenopathy and para-aortic lymph nodes. Endobronchial biopsy and bronchoalveolar lavage revealed non-specific chronic inflammatory changes. The patient's secondary amyloidosis was presumed to be related to the long standing RHD after exclusion of other causes of secondary amyloidosis. The patient finally died due to heart failure and acute pulmonary edema. Long standing RHD can lead to secondary AA amyloidosis

Effects of tonsillar infiltration on intra-and post-tonsillectomy pain in children

The aim of this study was to test the hypothesis that blockade of nociceptive input with lidocaine 1%, bupivacaine 0.5% and ropivacaine 0.5% during tonsillectomy could decrease both the dose of inhalational anesthetic intraoperatively and the pain beyond the immediate postoperative period. Sixty patients between the ages of 6 and 12 years scheduled for tonsillectomy with or without adenoidectomy were randomly divided into four groups. Anesthesia was induced in all groups with 7 mg/kg thiopentone and 1.5 mg/kg succinyl choline. The results showed that after the preincisional infiltration with ropivacaine 0.5%, bupivacaine 0.5% and lidocaine 1%, the operation could be achieved under light general anesthesia using only halothane 0.5% concentration in oxygen with reduced recovery times