Comparison of glycosylated hemoglobin and serum fructosamine as an index of glycemic control in diabetic patients with chronic renal failure

This study aimed to compare between glycosylated hemoglobin HbA[IC] and fructosamine in diabetic patients with C.R.F. to determine which of them is more valid as an index for glycemic control. Our work was carried on five groups each consisted of twenty diabetic non-uremic [group I], diabetic uremic on regular hemodialysis [group II] diabetic uremic on conservative treatment [group III], uremic non diabetic on regular hemodialysis [group IV] and healthy control subjects [group Y]. All of them were investigated for total plasma protein, fasting and post prandial serum gluose, serum creatinine, hemoglobin content, HbA[IC] and serum fructosamine level. It was evident from his work that the level of both HbA[IC] and fructosamine was significantly higher in diabetic patients with and without uremia when compared to control group. Although HbA[IC] level was significantly low in uremic non-diabetic patients, serum fructosamine level didn't change significantly in these patients. This finding can be explained by the fact that the life span is shortened in uremic patients, while both parameters which affect serum fructosamine level [blood sugar and total protein] showed no significant alteration in these patients. A negative non-significant correlation was found between seum creanine and both HbA[IC] level and serum fuctosamine level among all studied. In all studied groups, plasma glucose [Fasting and post prandial] showed positive significant correlation with both glycosylated hemoglobin and serum fructosamine. HbA[IC] correlated significantly with Hb level, mean while serum fructosamine correlated significantly with total serum protein. We can conclude that serum fructosamine is the test of choice for judging the glycemic control in uremic patients, because it is not affected by uremia and because of its automaticity, reproducibility and cheapness

Visceral leishmaniasis among hypersplenic patients in Dakahlia governorate, Egypt

In the present study, out of 22 human cases with hypersplenism and suggesting manifestations, four gave seropositivity for VL by the indirect hemagglutination tests [128 and more]. Two of these four patients gave seropositivity by dot-ELISA [1: 8000]. Amastigotes of Leishmania parasite were demonstrated in the splenic smears obtained during splenectomy. One culture obtained from these two cases grew promastigotes. Typing is ongoing. It was concluded that visceral leishmaniasis should be considered in the differential diagnosis of patients with hepatosplenomegaly or hypersplenism in Egypt