Preliminary cardiac changes in the prediabetic state by aid of echocardiography and doppler

Epidemiological data have long demonstrated a correlation between diabetes and cardiovascular disease which accounts for up to 80% of deaths in patients with diabetes [1]. To elucidate the cardiac structure and function in normotensive patients with type 2 diabetes and impaired glucose tolerant patients in order to assess the effect of diabetes mellitus itself on cardiac function. In addition, to show the relation between the insulin level and sensitivity, and the presence of associated peripheral vascular disease. 15 healthy control subjects; 15 patients with type 2 DM on oral hypoglycemic drugs, and 15 patients with impaired glucose tolerance were randomized from outpatient clinics of Cairo University Hospitals. They were subjected to the following: Thorough clinical examination. Serum samples for measurements of: Fasting and two hours postprandial blood glucose, fasting serum insulin, glycated hemoglobin [HbA1c], serum creatinine, urea, cholesterol, triglycerides, LDL and HDL cholesterol. Calculation of insulin sensitivity and resistance, electrocardiogram [ECG], resting echocardiography, carotid duplex and ankle brachial indices were performed. There were echocardiographic abnormalities in patients with type 2 DM. These include: a- Systolic and diastolic left ventricular function abnormalities, b- Abnormal dimensions of left ventricular mass, aortic root and left atrium. Echocardiographic abnormalities in patients with impaired glucose tolerance include: a- Diastolic left ventricular function abnormalities, b- Abnormal dimensions of left ventricular mass, aortic root and left atrium. In type 2 diabetic patients there was a negative correlation between insulin sensitivity measured by HOMA-B and LVDD and IVSD. On the other hand, there was positive correlation between HOMA-R and IVSD and E/A ratio. In patients with impaired glucose tolerance there was a negative correlation between LVDS and insulin sensitivity by HOMA-B method. Insulin resistance is positively correlated with diastolic and systolic left ventricular function abnormalities even in the prediabetic stage. This may represent the first stage of diabetic cardiomyophathy and may contribute to the increased rate of cardiovascular events that has been associated with the cardiovascular metabolic syndrome

Assessment of the role of some haemostatic parameters in patients with cryptogenic stroke

Cryptogenic stroke [CS] is a stroke of unexplained aetiology, in 1/3 the of cases, the cause of stroke remains undetermined inspite of full investigations. Patient with CS are thought to have a state of hypercoagulablity. To unmask some of the pathogenic mechanisms underlying cryptogenic stroke through assessment of some genetic disorders including C6[77]T mutation methyl-enetetrahydrofolate reductase gene, activated protein C [APC] resistance and role of thrombin anti-thrombin complex concentration [TAT] in plasma as indicators of hypecoagulable state. The study was conducted on 20 Egyptian patients divided into 2 groups, group I included 10 patients [6 males and 4 females] with cryptogenic stroke aged less than 50 years and group II included 10 age and sex matched patients with non-cryptogenic stroke. All of the 20 cases studied were subjected to panel of investigations including routine laboratory tests and imaging studies in orders to exclude any risk factors for stroke in group I patients and to determine risk factor of stroke in group II. Both groups were investigated for C6[77]T mutation in methylenetetrahydrofolate reductase gene, activated protein C [APC] resistance and thrombin anti-thrombin complex concentration [TAT] in plasma. No statistical significant difference was found between the two groups as regard C6[77]T mutation in methylenetetrahydrofolate reductase gene, [APC] resistance and TAT concentration in plasma [p value >0.05]. However, TAT level was found to be positively correlated with the clinical severity in non-cryptogenic stroke [p value <0.05]. C6[77]T mutation in methylenetetrahydrofolate gene, [APC] resistance and TAT concentration in plasma are not independent risk factors for cryptogenic stroke. TAT could be used as indicator of clinical severity and prognosis in patient with non-cryptogenic stroke