Homocysteine in type 2 diabetes mellitus: relation to diabetic vascular complications

Hyperhomocysteinemia has recently been recognized as an independent risk factor for cardiovascular disease. Diabetes mellitus [DM] is know to increase the risk of atherosclerotic vascular diseases. Insulin resistance syndrome is characterized by clustering of cardiovascular risk factors like hyperinsulinemia, hypertension .etc, that has been hypothesized to play an important role in atherosclerosis. The reason for the high susceptibility of diabetic patients to atherosclerosis remain incompletely understood. Plasma homocysteine [HCY] status in diabetics is still a matter of controversy. The aim of our work .was to study plasma level of HCY in type 2 diabetic patients and to study the relation of plasma HCY level to different diabetic vascular complications. The study included 40 patients with type 2 [DM] [aged 52.9 +/- 6.3 years]. and 25 apparently healthy controls matched in age and sex with the patients. Both groups were evaluated thoroughly and the following parameters were assessed, fasting blood post prandial blood glucose [PPBG], uric acid, serum creatinine, lipid fasting plasma insulin [FPI], homeostasis model assessment of insulin resistance [HOMA-IR] and plasma HCY level. Our study revealed significant increase in systolic blood pressure [SBP], diastolic blood pressure [DBP], FBG, PPBG, plasma cholesterol, triglycerides [TG] and low density lipoprotein cholesterol [LDL-c] but significant decrease in high density lipoprotein cholesterol [HDL-c] in diabetic patients vs control group. We found also significant increase in plasma HCY, FPI and HOMA-IR in diabetic patients vs control group, all [p<0,001].Thestudy also showed highly significant increase in plasma HCY in patients with macrovascular complications vs those with microvascular complications [31 +/- 1.69 vs 22.3 +/- 226, p<0.001]. In patients with type 2 DM there were significant positive correlation between HCY level and age, SBP, DBP, FBG, PPBG, serum creatinine, total cholesterol TG, LDL-c, FPI, proteinuria and HOMA-IR but significant negative correlation with HDL-c [all p<0.001]. From this study, it is concluded that hyperhomocysteinemia is present in type 2 DM especially in patients with concomitant macrovascular complications, and it can be considered as a definite risk factor for vascular complications in those patients

Health assessment for chronic liver disease

Assessment of health related quality of life [HRQOL] is not routinely reported in the literature on chronic liver disease [CLD]. Few studies have examined quality of life [QOL] in those patients despite its significant functional impact. The aim of this work is to evaluate HRQOL in patients with chronic liver disease and to examine the correlation between chronic liver disease questionnaire [CLDQ] and the severity of liver disease, and their impact on the well being of these patients with the chronic illness. Subject and methods:-Th study included 75 patients having CLD [aged 45.18 +/- 6.5 years 40 male and 35 female] and 20 apparently healthy subjects as a control group [aged 42.11 +/- 5.2 ,12 male and 8 female]. Both groups were evaluated thoroughly and were asked to complete the CLD] questionnaire which is designed to assess HRQOL in CLD patients. We found significant impairment of HRQOL in patients versus controls. The study also showed significant decrease in HRQOL in patients with higher Child Pugh [CP] class. We also found significant impairment in HRQOL in patients more than 50 years old compared to those younger than 50 years for all grades of CP classification. The study also revealed significant-ye correlation between HRQOL and clinical manifestation of liver decompensation, bilirubin and prothrombin time. There was significant+ve correlation between HRQOL And plasma albumin. As regard hepatic transaminases we found significant ve correlation between AST and worry domain and significant-ve correlation between ALT and activity domain of CLD questionnaire. From the previous results, it appears that chronic liver diseases substantially reduce HRQOL. Further, this impairment increases with disease severity. The ability of the CLDQ to detect associations with disease severity and its applicability to all types of liver diseases that it can be an additional, important outcome in clinical trials designed suggest to evaluate health changes due to disease progression and provide therapeutic measures suitable for patients