Hepatitis C virus Infection and Diabetic microvascular complications

The microvascular complications are the important cause of mortality and morbidity of either type 1 or 2 DM. Great efforts have been made to recognize the possible susceptibility or etiologic factors of these complications; whether genetic or environmental. Hepatitis C virus infection is another prevalent problem in our community. The present work aimed to study the possible impact, if any of HCV infection on microvascular complications. A total 70 diabetic patients 17 type 1 and 53 type 2, were included [20 males and 50 females] with age ranging from 13 to 72 years and 30 healthy volunteers with matched age and sex were taken as a control group. Complete history taking and full clinical examination were done. Laboratory work up was done for patients and control including urinalysis, blood sugar, serum creatinine, urinary albumin excretion, lipogram, liver function tests, HbAlc and HCV antibodies. Fundus examination was done for patients and control. Diabetics were found to have a prevalence rate of HCV infection of 32%. Prevalence of microvascular complication, nephropathy, retinopathy and neuropathy were found to be relatively higher in diabetics with HCV infection. Advanced grades of microvascular complication were more prevalent in HCV-positive diabetics. It was concluded that HCV infection is possibly a potential aggravating factor for microvascualr complications

Vascular endothelial growth factor [VEGF]: an association with diabetic microvascular complications

Type 2 diabetes mellitus [DM] and hyperhomocysteinaemia are both associated with premature vascular disease. This study aimed to assess plasma total homocysteine [P tHcy] level in type 2DM and its relation to nephropathy and retinopathy. P tHcy level was estimated in 20 type 2 diabetic patients with retinopathy and microalbuminuria and 20 patients with retinopathy and macroalbuminuria versus 20 type 2 diabetics with no retinopathy nor nephropathy and 20 healthy controls matched for age, sex and race. Other assessment included funduscopic examination, complete urine analysis, estimation of urinary albumin excretion rate, blood urea, serum creatinine, crentinine clearance, fasting plasma glucose, glycosylated haemoglobin [HbA[IC]]. serum lipid profile. as well as ultrasonographic examination of the kidneys and renal arteries. Mean P tHcy concentration was significantly higher in both the albuminuric groups than in normal albuminuric. group and controls, however mean P tHcy was inversely correlated with creatinine clearance versus no correlation with the other studied parameters, and no relation to retinopathy. Creatinine clearance is the only parameter associated with P tHcy, denoting that the degree of renal functional impairment is the determinant of its plasma concentration in patients with type 2 DM

Vascular endotheliaf growtli factor [VEGF]: an association with diabetic microvascular complications

The mediators of diabetic microvascular complications remain largely unknown. As diabetic stinopathy is associated with ischaemic changes followed by neovascularization, a role has been proposed for vascular endothelial growth factor [VEGF] its pathogenesis. Subjects and Serum EGF levels were studied in 55 diabetic patients at ferent stages of their disease and microvascular mplications. It was first noted that ciculating VEGF levels were significantly higher in betic patients [421 +/- 309 pg/ml, mean +/- SD] npared to controls [188 +/- 145 pg/ml], P < 0.05. ther analysis showed VEGF levels to be highest in] etic patients with proliferate retinopathy 1 +/- 376 pg/ml]. The level in those with and without background retinopathy was comparable to that of controls [379 +/- 250 pg/ml]. A significant rise in serum VEGF was also detected in patients with significant proteinuria [662 +/- 276 pg/ml]. The level in those with icroalbuminuria was comparable to that of controls [375 +/- 273 pg/ml]. A positive, albeit weak, correlation was noted between serum VEGF and urinary albumin excretion [r= 0.27, P < 0.05]. This study confirms raised circulating level of VEGF in diabetic patients with advanced microvascular disease [proliferate retinopathy and established nephropathy]

Pulmonary microangiopathy and its association with retinopathy and nephropathy in type 2 diabetes mellitus: role of ACE and ET-1

Aim: The microvascular complications in type 2 diabetes mellitus are associated with high morbidity mortality. Their pathogenesis is not fully understood in spite of recent advances. Although some authors have reported normal pulmonary function in diabetics, others found abnormalities including impaired diffusing capacity. The aim of this study was to assess the presence of pulmonary microangiopathy [as determined by lung diffusing capacity for carbon monoxide, DLco] in type 2 diabetic patients and to analyze the correlation between DLco and various diabetic factors. We also aimed to association between DLco and serum levels of ACE and ET-1 [markers of endothelial damage in various diabetic microangiopathies]. Subjects and Thirty-eight type 2 diabetic patients without over lung disease and 20 age and sex-matched :ontrols were enrolled in the study. All patients ontrols were non-smokers. Glycosylated haemoglobin [HbA-1c] was measured as an indicator of control. The presence of diabetic retinopathy was detected by ophthalmoscopic examination and the presence of diabetic nephropathy was determined by measuring the 24-hour urinary albumin excretion [UAE]. A global spirometry was performed and DLco was measured by the single-breath method corrected by alveolar volume [DLcoA/VA]. Forced vital capacity [FVC], forced expiratory volume in 1 second [FEV1] and FEV1/FVC were within normal in diabetics. Diabetic patients showed a significant reduction of% DLcoA/VA that was greater in those not receiving insulin and those with diabetic microangiopathy. The serum levels of ACE and ET-1 were significantly higher in diabetics [ACE and ET-1 level were more elevated in those with diabetic microangiopathy]. Percent DLcoA/VA was negatively correlated with serum ACE, ET-1 and UAE values. Conclusions: These data suggest the existence of microangiopathic involvement of pulmonary vessels in type 2 diabetic patients particularly in presence of retinopathy and/or nephropathy. Elevated serum levels of ACE and ET-1 as well as microalbuminuria are significant independent predictors of the existence of pulmonary microangiopathy. Insulin resistance may be central to the pathogenesis of pulmonary microangiopathy. Exogenous insulin administration, e.g. via the inhaled route, may be used in diabetics to improve their DLco

Re-appraisial of the prevalence of obesity, glucose intolerance and hypertension in an Egyptian village in Dakahlia province

Obesity is becoming a world - wide problem associated with a multitude of potential risks and complications was to study the prevalence of obesity, glucose intolerance and hypertension and their interaction in a rural community and to compare the rates with those reported in previous studies in / 985 and / 989, all carried out in a El Hasina village in Dakahlia province. 500 individuals, were subjected to thorough history taking and clinical examination. Blood pressure was measured with standard sphygmomanometer and hypertension was diagnosed according to the JNC VI criteria. Body mass index [BMI] was considered as an index of obesity. Fasting and postprandial blood glucose were assayed utilizing a portable reflectance apparatus. The prevalence of obesity in 2002 was found to be 56.2%: of them 28.8% were overweight, 26% were obese and 1.4% had morbid obesity. These figures are higher than those reported in the previous study carried out during 1985 [21.45%]. The increased prevalence of obesity from 1985 to 2002 denotes that obesity is becoming an over-endemic diseases in Egypt and a great challenge to health authorities. The prevalence of DM increased from 5.2% in 1989 to 1/6% in 2002, and the prevalence of IGT increased fro 6.2% in 1989 to 7.4% in 2002: probably indicating that JGT and DM are becoming an endemic problem in Egypt. Both DM and IGT were more common among obese [15.3% and 11.4%, respectively,] than non-obese [6.8% and 2.3%, respectively]. In our study. the total prevalence of HTN among the studied individuals was / 6.4%. Hypertension was found to be more prevalent among obese [24.9%] than non-obese [5.5%] individuals. and Increasing the degree of obesity was associated with an increased prevalence of hypertension