Endothelial cell dysfunction and inflammatory process in type 1 diabetic patients with-and without micro vascular disease

Endothelial cell dysfunction results in altered production of cell adhesion molecules [CAMs] that may be involved in the pathogenesis of diabetic microvascular disease. Increased circulating cytokines may also be involved in this process. The aim of the present study was to evaluate levels of some CAMs and cytokines in children and adolescents with type 1 diabetes. It was also aimed to assess these parameters in relation to microvascular complications and certain risk factors. The study included 45 cases with type 1 diabetes aged 8-22 years of whom, 30 cases had evidence of microangiopathy [retinopathy or nephropathy] and 15 cases had not. Fifteen apparently healthy matchable subjects were included as controls. Cases were subjected to full history taking and physical examination. Direct ophthalmoscopy and fluorescein angiography were used to diagnose retinopathy, while nephropathy was diagnosed by detection of microalbuminuria. Level of glycated hemoglobin [HbA[1c]] and serum levels of sVCAM-1 and sE-selectin as well as IL-6 and TNF alpha were assessed for all patients and controls. The results showed that diabetic patients as a whole had significantly higher serum levels of sVCAM-lt sE-selectin, IL-6 and TNF alpha than controls. Post pubertal age, long duration of illness, obesity and high HbA[1c] level were significant risk factors for higher levels of CAMs. Significant positive correlations were found between levels of HbA[1c] and each of serum levels of sE-selectin and IL-6. Also significant positive correlations were found between each of serum levels of sVCAM-1 and sE-selectin, and IL-6 and TNF alpha. Patients with evidence of microangiopathy had significantly higher level of sVCAM-1 than cases without, and the latter group had significantly higher level of sE-selectin than controls. It is concluded that young patients with type 1 diabetes had significant markers of endothelial cell dysfunction particularly in those with microvascular disease. Screening of diabetic patients with E-selectin may help early diagnosis of endothelial dysfunction. Strict glycemic control and new therapeutic targets are mandatory to improve diabetic outcome in such cases

Factors associated with gallstones in patients with chronic renal failure treated by haemodialysis in upper Egypt

Studies performed to date on the prevalence of gallstones in chronic renal failure [CRF] on haemodialysis [HD] have given contradictory results. to evaluate the frequency and percentage of gallstones and its main associated risk factors in a group of Egyptian haemodialysis patients. The study included 147 patients with CRF on HD randomly selected from Assiut and Sohag University renal dialysis units in Upper Egypt [102 males, 45 females]. The screening protocol included complete medical history, female parity, as well as, use of estrogen therapy by females. History of diabetes mellitus and duration of haemodialysis were also recorded. Body mass index [BMI] was calculated and a number of biochemical parameters [total cholesterol and triglycerides, serum calcium, phosphorus and uric acid] were estimated in fasting serum. An ultrasound scan of the gall bladder and biliary tract was performed with a 3.5 MHz linear probe after at least 12 h fasting. In addition, the prevalence of gallstones in the general population of the same geographical region was calculated after revising available data in ultrasonography reports. The mean age of CRF patients was 43 +/- 14.2 years and mean duration of dialysis was 30 +/- 30.5 months. Gallstones were diagnosed in 22.4% of HD patients and this was mildly significantly higher in women than men [31.1% in women vs 18.6% in men, P=0.05] and this percentage was significantly higher than that of the general population in the same geograbical region [1.6% of the total examined] [P=0.001]. The percentage of gallstones didnt increase significantly with increasing age or duration of dialysis. We noticed an insignificantly raised risk for gallstones with use of estrogen by females, diabetes mellitus and smoking in males [OR=3.2, 1.6, 1.2 respectively; P >0.05 for all of them]. No significant difference was noted between CRF patients with and without gallstones in the studied biochemical parameters except for mean serum calcium that was significantly higher in patients with gallstones [9.8 +/- 1.3 vs 8.1 +/- 1.1; P=0.04]. The percentage of gallstones in a group of Egyptian patients on HD is higher than that of the general population of the same area. Apart from female sex, the traditional risk factors associated with gallstones in the non-uraemic general population appear not to play a significant role in gallstone formation in HD patients. Estrogen use in females, presence of diabetes mellitus and smoking in males, have insignificantly raised the risk for gallstones in these patients. Changes in serum calcium appear to play a role. Our results suggest that other factors inherent to kidney pathology may contribute to this high percentage of gallstones in CRF patients on haemodialysis