Anorectal dysfunctions in diabetic autonomic neuropathy and microangiopathy

Disturbed motility may explain gastrointestinal symptoms of patients with diabetic neuropathy. This study investigates the anorectal dysfunctions in diabetic autonomic neuropathy [DAN] and microangiopathy. The study includes 47 diabetic patients [group 1: 30 non-complicated; group 2: 17 complicated by DAN and microangiopathy] and 10 healthy non-diabetic volunteers as control subjects. Following medical history, clinical examination and laboratory investigations, the included patients were subjected to sigmoidoscopy with mucosal biopsy and anorectal manometry. The lower gastrointestinal symptoms [e.g., constipation, diarrhoea or faecal incontinence] were reported more in group 2 [complicated diabetic patients] than in group 1 [non-complicated diabetic patients] [p=0.003]. Group 2 patients had significantly higher fasting blood glucose, serum uric acid, serum creatinine and triglycerides than group 1 patients [p=0.001, 0.03, 0.04,<0.001, respectively]. Overall, diabetic patients had lower resting anal pressure [p=0.004], squeeze pressure [p=0.007], and higher thresholds of minimal rectal sensation and sense of desire for defaecation [all p<0.001] when compared to control subjects. Group 2 patients had lower resting anal pressure [p<0.001], squeeze pressure [p=0.02], and higher thresholds of minimal rectal sensation [p<0.001], sense of desire for defaecation [p=0.009] and maximum tolerable volume [p=0.002] than group 1 patients. Group 2b [patients with DAN and microaniopathy] had significantly lower resting anal pressure than group 2a [patients with DAN] [p=0.001]. Anorectal dysfunctions occur in diabetic patients particularly when complicated by autonomic neuropathy and microangiopathy

Some clinicolaboratory predictors of nonalcoholic steatohepatitis

In nonalcoholic fatty liver disease [NAFLD], the high cost of undertaking histological assessment of all persons with asymptomatic elevations of liver enzymes cannot be justified in view of the risks and limited clinical benefits. As the clinicians cannot distinguish steatosis and nonalcoholic Steatohepatitis [NASH], the purpose of this work was to study some of the clinical and laboratory parameters that could be useful as noninvasive predictors of NASH in NAFLD patients. The demographics, clinical, radiological, laboratory, and histopathological features of 40 NAFLD patients with persistently elevated ALT were evaluated. Significant rise of serum glucose, ALT, AST, cholesterol, LDL and TG with significant decrease of HDL was found in NASH versus steatosis patients, and in patients with grade II NASH versus those with grade I. The number of NASH patients was higher among studied diabetic than non-diabetic group and in obese than non obese group. Grade II NASH was found only in diabetic and in obese patients. In NASH patients, the relative risk of hypertriglyceridemia was 17, of obesity 7.13, of diabetes 1.47, but with hypercholesterolemia it was only 1.1. In obese patients particularly those with diabetes, presence of hepatomegaly, sonographically bright liver, persistent rise of transaminases and hypertriglyceridemia are sufficient to diagnose Steatohepatitis and might prove useful in guiding selection of patients for liver biopsy and in targeting therapy

Anorectal dysfunction in diabetic autonomic neuropathy and microangiopathy

Diabetic autonomic neuropathy affects many physiological systems, producing a variety of important clinical manifestations. Diabetic motility disturbances are frequent and may be found within esophagus, stomach, small bowel, colon and anal sphincter. Disturbed motility may explain gastrointestinal symptoms of patients with diabetic enteropathy. The aim of this study was to investigate any possible relation between the severity of anorectal dysfunctions in diabetes mellitus and the duration of the disease and the presence of microangiopathy or neuropathy. The present study comprised 47 diabetic male patients and ten healthy male volunteers as control group. The patients and control were subjected to history taking, clinical examination [including autonomic function tests and occular fundoscopy], and a series of investigations including laboratory, sigmoidoscopy with mucosal biopsy and lastly anorectal manometry. The majority of diabetic noncomplicated patients were found to be asymptomatic [73%]. While, conistipation was the most common among symptomatic diabetic patients whether complicated [41%] or noncomplicated [20%], incontinence was frequent in autonomic neuropathy [28%]. Complicated diabetic patients exhibited decreased resting anal pressure [P=0.027], squeeze pressure [P=0.017], and higher thresholds of minimal rectal sensation [P=0.001], sense of desire for defecation [P=0.001] and maximum tolerable volume [P=0.001] when compared to diabetic non complicated cases. Diabetic patients with long history of the disease [>5years] had more worsening of the resting anal pressure [P=0.001], anal squeeze pressure [P=0.001] and more impairment of minimal rectal sensation [P=0.001], sense of desire for defecation [P=0.001] and maximum tolerable volume [P=0.001] when compared to those with short history. In patients with long history of diabetes mellitus, anorectal motility disorders were observed frequently and could be attributed to the increased incidence of microangiopathy, autonomic and peripheral neuropathy observed in this subset of patients. Constipation is the most common lower-GI symptom but can alternate with episodes of diarrhea and sometimes incontinence. Anorectal manometry and other specialized tests typically performed by the gastroenterologist may be helpful in early recognition of gastrointestinal motility disorders and subsequently better long-term management of patients with diabetes mellitus

Assessment of propertide of type III procollagen in chronic liver diseases

Sixty-three hepatic patients [38 males and 25 females] with ages ranging between 25-75 years [mean 48.49 +/- 1.72] were included in this study. For comparison, 20 healthy age and sex matched volunteers were taken as controls. Patients with chronic liver diseases including hepatic cirrhosis [23 patients], bilharzial hepatic fibrosis [10 patients], hepatic malignancy [15 patients] and chronic viral hepatitis C [15 patients] were included in this study. All patients and healthy subjects were thoroughly clinically examined. Fasting blood sample was taken from each individual, divided into aliquots and analyzed for aminoterminal propeptide of type IIII procollagen and liver function tests [including prothrombin time, serum albumin, bilirubin, ALT and AST]. The severity of liver disease was graded by Pugh-Child scoring including the assessment of ascites, encephalopathy, bilirubin, albumin and prothrombin time. It was concluded that propeptide of type III procollagen [PIIINP] measurement is a good noninvasive marker of manifest fibrosis. Cirrhotic patients had the highest serum PIIINP levels of all studied patients

Congestion index of the portal vein and other predictors of variceal bleeding in portal hypertensive patients

Rupture of esophageal varices is the most common cause of massive, life threatening hemorrhage from the esophagogastric segment and portal pressure is necessary for rupture of varices but not all patients with elevated portal pressure bleed and local factors play a role. This study was designed to clarify the possible contribution of clinical risk factors and en-doscopic findings with portal hemodynamic changes in initiation of variceal bleeding. The study comprised 50 patients with liver cirrhosis and portal hypertension, 30 of them had a history of previous variceal bleeding and the other 20 patients didn't bleed before. After through history taking and clinical examination, liver function tests and complete blood picture were done, abdominal ultrasonography and Doppler study for the portal vein were performed and the congestion index of the portal vein [CI] was calculated and then upper gastrointestinal endoscopy was done. Results showed that mild to moderate splenomegaly, presence of ascites, increase in Child-Pugh score, thrombocytopenia and low prothrombin activity were associated with more variceal bleeding. Also results showed that CI of the portal vein was highly significantly increased in bleeders when compared to non-bleeders. The endoscopic prognostic index [PI] which depends on the size of esophageal varices, presence of gastric varices and congestive gastropathy was highly significantly increased in bleeders than in non-bleeders. Correlation studies showed that CI was positively correlating with Child-Pugh score and PI and it was negatively correlating with platelets count. From the above we can conclude that, for portal hypertensive patients, Echo Doppler of the portal vein which is a cheap and non-invasive technique should be done to select those with high CI to be submitted to endo-scopic screening for large and risky varices who would benefit from the available pharmacological and endoscopic prophylactic therapies

QTc intervals in healthy weight stable obese subjects

115 healthy obese subjects [25 males and 90 females] were selected from outpatient clinics. QT intervals corrected for heart rate using Bazett and Framingham equations were measured. There was a nonsignificant correlation observed between absolute QT-interval duration and body mass index [BMI]. But significant correlations were found between Bazett-QTc [B-QTc] and Framingham-QTc [F-QTc] and BMI. The main change in obesity was a progressive shortening of the RR interval with increasing fatness, that is resting heart rate increased with increasing BMI. 18.5% of subjects had B-QTc >0.44 second, however, only 8% had F-QTc >0.44 second. These findings suggested that obesity may be one of the most common causes of prolonged QTc interval, although the actual cause is still unknown, but progressive shortening of RR duration with increasing BMI that may be due to decreased cardiac vagal activity in obese subjects could explain this prolongation of QTc but evaluation of the clinical significance of this observation may be a crucial task for further research