Risk factors of micro-albuminuria in patients with non-insulin dependent diabetes mellitus

Micro-albuminuria is an indicator of early diabetic nephropathy [DN]. The trends towards increased end stage renal disease [ESRD] secondary to DN are expected to contiue in developing countries. An understanding of the risk factors, which lead to the development of micro-albuminuria in non-insulin dependent diabetes mellitus [NIDDM], is required to develop strategies for primary prevention of DN. A case-control design was used to determine the risk factors of early DN in 184 patients with NLDDM [48 with micro-albuminuria and 136 with normo-albuminuria]. We defined micro-albuminuria where the ratio of urine albumin in micrograms [mcg] urine creatinine in milligrams [mg] was in the range of 17-299 for males and 25-299 for females. The glycosylated hemoglobin [HbAlc] of >/= 8.1%. was used to define the poor glycemic control. Patients were examined for retinopathy, peripheral neuropathy, coronary artery disease [CAD] and peripheral vascular disease [PVD]. We measured fasting serum triglyceride, cholesterol, low-density lipoprotein [LDL], high-density lipoprotein [HDL], lipoprotein [a] [Lp[a]], C-peptide of insulin, transforming growth factor beta [TGF beta] and e-selectin. HbAlc, duration of diabetes mellitus, systolic blood pressure [SBP], diastolic blood pressure [DBP] and serum C-peptide of insulin, triglyceride, LDL and Lp[a] were positively correlated with micro-albuminuria, while HDL was inversely correlated with it. The TGF beta and e-selectin did not significantly correlated with micro-albuminuria [P>0,05]. After adjustments for the effects of covariates with logistic regression [LR] analysis, the odds ratio [OR] and 95% confidence interval [CI] of micro-albuminuria for the potential risk factors were estimated, LR revealed a significant association between micro-albuminuria and male gender [OR = 5.1], poor glycemic control [OR = 4.7], young age at onset of diabetes [OR = 4.1], dyslipidemia [OR = 3.8], hypertension [OR = 3.1], and the longer duration of diabetes mellitus [OR=2.6]. Male gender, poor glycemic control, young age at onset of diabetes, long duration of diabetes, hypertension and disturbed lipid profile especially triglyceride, LDL and Lp[a] are significant risk factors for development of DN. The possible mediators of progression of nephropathy [serum TGF beta, e-selectin and insulin] are not found to be significant markers of micro-albuminuria stage of DN

Electromyography as an objective index for pelvic floor damage during childbirth

Seventy nulliparous women were investigated by needle electromyography of the pelvic floor muscles to establish whether childbirth causes damage to the pelvic floor muscles and its nerve supply and to establish the neurophysiological parameters to diagnose such conditions. It was found that women with long second stage of labor and heavier babies showed definite evidence of denervation in EMG. However, forceps delivery and perineal tears did not contribute to the degree of denervation. It was concluded that labor [vaginal delivery and cesarean section after trial of labor] causes partial denervation with consequent reinnervation in most women having their first baby. In six women, the damage is serve and associated with urinary and fecal incontinence

Amniotic fluid interleukin - 6 [il-6] determination: a possible guide for management and prognosis of preterm labour

Amniotic fluid samples were collected from four carefully selected groups of pregnant women, respectively, presented as followed [but none with any evidence of intrauterine infection]: Group I, term pregnancy not in labor; group II, normal term labor; group III, preterm labor and undelivered within one week of sampling and group IV, preterm labor and delivered within one week of sampling. Amniotic fluid was obtained by amniocentesis [in undelivered women] or at the time of amniotomy [in delivered women]. The samples were cultured to detect any intrauterine infection. Interleukin-6 [IL-6] was determined by a specific enzyme-linked immunoassay. The mean [ +/- SD] amniotic fluid IL-6 levels [pg/ml] were 25.5 +/- 6.2 in group I, 504 +/- 60.6 in group II, 45 +/- 15.1 in group III and 406 +/- 100.7 in group IV. However, insignificant difference in the IL-6 levels was found between the women of group II and group IV, a significant difference was noticed in the IL-6 levels between the undelivered [groups I and III] and delivered [groups II and IV] women whether in term or preterm labor. Therefore, it was concluded that the determination of IL-6 level in amniotic fluid may help in the prognosis and management of preterm labor

Comparative study of serum gastrin levels in mothers and neonates at birth after vaginal delivery, cesarean section and fetal compromise

This study included forty-one pregnant women with various perinatal conditions divided into five groups: Group I included cases with normal pregnancy and normal vaginal delivery without induction or augmentation [n=10], group II, elective repeat cesarean section [n=10], group III, suspected fetal compromise [n =8], group IV, post-date pregnancy [n =7] and group V, preeclampsia [n =6]. For each case immediately after delivery, gastrin levels were measured by RIA in maternal sera and cord sera of the neonates. Statistical analysis was performed by Mann-Whitney U test. The study showed that gastrin levels in the cord sera of the neonates in group I were significantly higher than those in neonates in group II. Serum gastrin concentrations in women in group IV were significantly higher than women in group II. Gastrin levels in cord sera of neonates in group III and group TV were significantly higher than those observed in group II. The study concluded that vaginal delivery and perinatal pathology might induce hypergastrinemia in both mother and neonate at birth

Umbilical plasma concentration of endothelin-1 in intrapartum fetal heart rate abnormalities

The umbilical and maternal plasma concentrations of endothelin-1 [ET-1] were measured in 40 pregnant women at full-term [20 with elective cesarean section as a control group and 20 with emergency cesarean section done because of severe fetal heart rate [FHR]abnormalities. The FHR pattern was assessed, measured umbilical blood gases and investigated the relationships between the umbilical vein-artery ET-1 concentration difference and these variables. The concentration of ET-1 in the umbilical vein was higher than the umbilical artery in the all 40 women. The umbilical vein-artery ET-1 concentration difference [mean +/- standard error of the mean] was significantly greater in the emergency cesarean group [4.5 +/- 2.5 pmol/L] than those delivered by elective cesarean [1.7 +/- 1.5 pmol/L]. The umbilical vein-artery concentration difference correlated negatively with the umbilical arterial oxygen pressure. The study concluded that in cases with FHR abnormalities and with fetal hypoxia, the fetoplacental concentration of ET-1 was increased

Dialysis-induced amyloidosis in patients with end stage renal disease: an electron microscopic study of gingival biopsies

Amyloidosis has been recently recognized in uremic patients undergoing long- term dialysis. Amyloid deposits are predominantly articular or periarticular causing musculoskeletal disorders. The diagnosis of amyloidosis through gingival biopsy in these patients was attempted in this study. Both light and electron microscopic findings were significant. Amyloid deposits were detected in the biopsy specimens. The deposits were mainly composed of beta-2 microglobulin, a protein which is neither excreted nor dialyzable in end stage renal disease

Histochemical and histopathological changes in diabetic gingival tissues

120 diabetic and prediabetic gingivae were studied histopathological and histochemically and compared with non-diabetic gingivae, PAS + ve substance was deposited in the epithelial cells and the vascular wall [subendothelially] leading to narrowing and even occlusion of vascular lumen in severe diabetic cases [uncontrolled late onset diabetic] a mirror of the micro-angiopathy occuring in diabetes. Succinic dehydrogenase and acid phosphatase activities showed increase in the epithelial cells and lamina propria cells. The increase in the first enzyme might be due to the abnormal C.H.O. metabolism in diabetes; but the increase in the latter was due to the increased phagocytic function of these cells accompanying the degenerative process in the cell and also as a reaction to the inflammatory processes usually accompanying this disease. The decrease in alkaline phosphatase activity in the capillary endothelial cells might be due to disturbed active ion-transport function of these cells, a condition which usually accompany microangiopathy. From this research it was found that by gingival biopsy one could diagnose and correlate diabetes especially in its presymptomatic or preclinical stage [prediabetic] where easier treatment and control could be done