ABSTRACT
Background & objectives: Type 2 diabetes mellitus (T2DM) is known to induce inflammation and activation of neutrophils causing the release of neutrophil elastase (NE), a pro-inflammatory proteinase. The activity of NE is regulated by endogenous inhibitors alpha1-antitrypsin (?1-AT) and alpha2- macroglobulin (?2-MG). Disrupted proteolytic homeostasis in T2DM patients is one of the causes for vascular complications. This study was carried out for evaluating the levels of plasma NE, ?1-AT, ?2-MG and NE-?1-AT complex to understand their roles in the pathophysiology of diabetic nephropathy (DN) and diabetic retinopathy (DR). Methods: A total of 240 participants (Control, n=60; T2DM, n=60; DN, n=60; and DR, n=60) were recruited after recording history, clinical examination and laboratory investigations. Retinopathy was confirmed by fundoscopy and nephropathy by urinary albumin excretion and serum creatinine levels. NE was measured using STANA. ?1-AT, ?2-MG and NE-?1-AT complex were estimated by ELISA. Results: Baseline clinical and laboratory findings were confirmatory to the study groups. The mean elastase activity was higher (P<0.0005) in diabetes groups (T2DM=0.73±0.31, DN=0.87±0.35, DR=0.76±0.41) than controls (0.35±0.20). The levels of ?1-AT were lower in DR (8.77±2.85) than DN (26.26±6.16) and T2DM (41.13±14.06) when juxtaposed with controls (122.95±25.71). The approximate fold decrease of ?1-AT levels was 15 for DR and four for DN compared to controls. The levels of ?2-MG were lowered in T2DM (167.29±30.45), DN (144.66±13.72), and DR (104.67±11.47) than controls (208.87±31.16). The NE-?1-AT complex levels were: controls (215.83±13.61), T2DM (98.85±23.85), DN (129.26±20.40) and DR (153.25±17.11). Interpretation & conclusions: Homeostasis of NE, ?1-AT and ?2-MG is disrupted in T2DM, DN and DR. Strikingly reduced levels of ?1-AT observed in DR are indicative of its possible role in the pathophysiology of retinopathy and emphasizes ?1-AT as a plausible therapeutic target.
ABSTRACT
Background: Diabetes Mellitus is reported to increase the risk of Urinary Tract Infection (UTI) with higher probability of drug resistant organisms. Understanding the burden, microbiological profile and antibiotic sensitivity pattern is vital for effective prevention and management. To assess the microbiological profile and antibiotic sensitivity pattern of Urinary Tract infections among type 2 diabetes mellitus patients.Methods: The study was A prospective observational study done on 117 type 2 diabetic subjects aged above 18 years presenting with symptoms of UTI in a tertiary care hospital Urine was analyzed for urine routine examination, culture and antibiotic sensitivity using standard testing methods on a midstream urine sample. Descriptive analysis was carried out by mean and standard deviation for quantitative variables, frequency and proportion for categorical variables.Results: The mean age of the study population was 57 years. Females constituted 62.39% of participants. Burning micturition (52.99%) was the most common presenting symptom. The prevalence of culture positive UTI was 51.28%. Among gram-negative bacilli, Escherichia coli (20.51%), Klebsiella (6.85%) dominated the culture reports. Enterococcus (4.27%) and Staphylococcus aureus (2.6%) were the common gram-positive organisms isolated. Meropenem was the most effective antibiotic against E. coli (87.5%) and Klebsiella (95%) Vancomycin had 100% sensitivity against Enterococci and S. aureus.Conclusions: More than half of diabetic patients presenting with symptoms of UTI had culture positive UTI, predominantly caused by gram negative organisms. There is a need for comparative studies of Diabetes and controls to explore the key differences in the pattern of UTI.