Sjögren-like syndrome after bone marrow transplantation.

OBJECTIVE: To study the incidence of dry eye in Sjögren-like syndrome, graft-versus-host disease (GVHD) in hematological patients undergoing bone marrow transplantation (BMT). MATERIAL AND METHOD: Prospective, cross-sectional study in twenty-six patients that were planned for BMT (group I). Twenty-nine patients undergoing BMT before study were classified as group II no GVHD (9), and group III with GVHD (20). Thirty-two normal subjects were controls. All subjects were examined by slit lamp biomicroscopy and had their tear samples analyzed about tear osmolarity. They were also evaluated for aqueous tear production by phenol red thread test, Schirmer test without anesthesia, tear film stability by tear break-up time (TBUT), and rose bengal staining 2 weeks before BMT (for group I) as well as 6 weeks, 3 months, and 6 months after BMT. The patients with GVHD were followed up 1 month later. Main outcome measures were amount of tear production, tear film stability, and dry eye symptoms. RESULTS: Average aqueous tear production in group III was less than control and group II (p < 0.001). Mean TBUT in group III was faster than control (p < 0.001) and group I before BMT (p = 0.001). Mean score of rose bengal staining in group III was more than control and group I before BMT (p < 0.001). Keratoconjunctivitis sicca and red eye developed in 27.5%, and 20% of group III, with incidence of dry eye by Schirmer test without anesthesia (67.5%). This compares with group II having incidence of dry eye of 16.7%. However, 42.3% of group I before BMT had dry eye compared with 9.4% in the controls (p < 0.001). CONCLUSION: Trend of dry eye in patients with BMT and GVHD were higher than no-GVHD group. Doctors should be aware of ocular symptoms and signs of dry eye in patients with BMT and follow-up for proper management.

Von willebrand factor levels in patients with diabetic retinopathy.

Plasma levels of von Willebrand factor (vWF), an indicator for endothelial injury, were measured in type II diabetic patients with or without retinopathy and 20 normal control subjects. Patients were grouped according to their degree of retinopathy, 12 patients with no evidence of retinopathy, 19 patients with background retinopathy and 23 patients with proliferative retinopathy. All groups of diabetic patients had significantly higher vWF levels when compared to normal controls. But the levels of vWF did not correlate with the severity of retinopathy. The data suggested that diabetic patients had some degree of endothelial injury that might not relate to the development of retinopathy.

Fibrinolytic activity in patients with diabetic retinopathy.

Tissue plasminogen activator (t-PA), plasminogen activator inhibitor (PAI-1) and plasminogen concentrations were measured in 62 patients with non-insulin dependent (type II) diabetes mellitus. Patients were grouped according to their degree of retinopathy; 13 patients with no evidence of retionpathy (BDR) and 26 patients with proliferative retinopathy (PDR). Twenty healthy individuals served as normal controls. PAI-1 levels of all diabetic groups were found to be lower than control group. But the difference was statistically significant only between PDR and controls. Plasminogen levels in diabetic groups were higher than in the control group, especially in the PDR group. There was no difference in t-PA levels between diabetics and the control group. It is concludedthat PAI is closely related with the development of retinopathy in diabetic patients.

Prothrombin fragment 1+2 and fibrinogen in Thai type 2 diabetic patients.

Since the evidence for the hypercoagulable state in terms of prothrombin fragment 1+2 (F1+2) in Thai diabetic patients has never been reported, we studied plasma F1+2 levels in 68 type 2 diabetic patients and in 20 normal age-matched volunteers. Fibrinogen, D- dimer, glucose, HbA1C, cholesteroi, triglyceride, HDL-cholesterol and creatinine were also determined. It was found that the levels of F1+2 and fibrinogen in the diabetic patients were significantly higher than in the controls (p<0.001 and p<0.01 respectively), while D-dimer was detected positively in 17 out of 64 patients whereas none could be detected in the 20 healthy volunteers. A total of 23 out of 68 patients had higher levels of F1+2 than the normal range. When we compared the clinical characteristics, blood chemistry analysis and hypercoagulable markers of the diabetic patients between the groups of high F1+2 and normal F1+2, there were significantly higher numbers of positive D-dimer cases in the high F1+2 group compared with the normal F1+2 group (p=1.01). The correlation between F1+2 vs diabetic duration was 0.29 with p value less than 0.05. This study suggests that there are hypercogulable states in Thai diabetic patients.

Plasma viscosity in healthy Thais.

Plasma viscosity estimation is the test which reflects the progress of various certain diseases. This test is more sensitive and more reliable than the erythrocyte sedimentation rate. In this study, plasma viscosity was determined in 175 health subjects with the ages ranging from 15 to 70 years. Ninety-two subjects were males and 83 females. The normal range of plasma viscosity was 1.51-1.79 mPa.S at 25 oC (mean = 1.65 mPa.S). The mean values of plasma viscosity in male and female were 1.64 and 1.67 mPa.S respectively. There was no statistical significant difference in plasma viscosity among both sex.