Vascular endothelial growth factor as an indicator of severity of diabetic retinopathy

To evaluate vascular endothelial growth factor [VEGF] as an indicator of severity in diabetic retinopathy. The study included 120 patients divided equally into 3 groups [proliferative diabetic retinopathy [PDR] group, non proliferative diabetic retinopathy [NPDR] group and non diabetics control group]. Vitreous and blood samples were collected from all patients. VEGF concentrations were determined using enzyme linked immuno-sorbent assay and correlated with retinopathy grading. Vitreous concentrations were statistically significant higher than serum concentrations in both retinopathy groups with strong positive correlation [r = 0.927 at p < 0.001 in PDR and r = 0.646 at p < 0.001 in NPDR]. Serum and vitreous VEGF concentrations in diabetics were statistically significant higher than control group [p<0.01]. Both increased with the progression of retinopathy. Very mild NPDR patients had the lowest vitreous concentration [mean = 20.33 ng / ml] but still higher than controls [mean = 4.53 ng / ml]. PDR patients with tractional detachment had the highest vitreous concentration [mean = 225.18 ng / ml]. VEGF concentrations were statistically significant higher in NPDR patients with maculopathy than NPDR patients without maculopathy. There is a strong direct positive correlation between VEGF concentrations and retinopathy grading

Study of autonomic function in liver cirrhosis and hepatocellular carcinoma

Background and Aim: cardiovascular autonomic neuropathy is a known, but often unrecognized complication of liver cirrhosis and it can lead to many adverse effects including increased risk of mortality. However, few published studies are available about autonomic dysfunction in non alcoholic liver disease. Considering the adverse prognostic implications of autonomic neuropathy, the aim of the present study was to assess cardiovascular autonomic function in patients with liver cirrhosis and patients with hepatocellular carcinoma

Methods: The study included 60 cirrhotic patients [13 females and 47 males with mean age 53.5+/-7.6 years], 40 patients with hepatocellular carcinoma [8 females and 32 males with mean age 54.3+7.95], and 20 age and sex matched healthy controls. Clinical examination beside laboratory and radiological investigations necessary for diagnosis were done. Cardiovascular autonomic function using the standard tests was examined in patients and controls. We studied the presence and extent of autonomic dysfunction in the patients in relation to clinical and laboratory characteristics

Results: Compared to control subjects, both cirrhotics and hepatoma cases had impaired autonomic function tests, prolonged QTc [P<0.001] and higher autonomic function scores [P<0.001]. HR response to deep breathing was impaired more in hepatoma group than in cirrhotics [P<0.001]. 54 of cirrhotics [90%] and 37 of hepatoma patients [92.5%], had abnormal results of one or more autonomic function tests. No significant difference was found between cirrhosis and hepatoma groups as regard the distribution of autonomic dysfunction [P=0.245]. Parasympathetic dysfunction was more prevalent than sympathetic one in cirrhosis group [E:11.7% and D:41.7%, VS 36.7%] and also in hepatoma group [E:27.5% and D:32.5%, VS 32.5%]. Cirrhotics with autonomic neuropathy had significantly higher rate of CV autonomic neuropathy symptoms [P=0.002], higher rate of ascites [P<0.001], lower BMI [P<0.001], lower serum albumin [P<0.001] and higher INR [P=0.008] than those without neuropathy. In patient groups, combined AD increased in frequency according to child class [P<0.001 and <0.05 respectively], also the abnormal autonomic tests were significantly related to child class, serum albumin and INR. We concluded that AD, mainly parasympathetic is present with comparable frequency in liver cirrhosis and hepatoma patients and is related to the severity of liver failure. So, the standard autonomic function tests should be used during evaluation of such cases, also HR response to DB may help in screening cirrhotics for hepatoma

Abbreviation: AD: Autonomic dysfunction: AFP: alpha fetoprotein: AN: Autonomic neuropathy: BMI; body mass index; CV: cardiovascular: D: definite; DB deep breathing: DBP: diastolic blood pressure: E: early: FBS: fasting blood sugar HCC: hepatocellutar Carcinoma: HR: heart rate; HR LS: heart rate response to standing: HRV: heart rate variability; M+SD: mean + standard deviation; PH: postural hypotension; PPS: postprandial sugar: QTc: Corrected QT interval; SBP: systolic blood pressure: VR: Valsalva ratio