Glycemic control effect on diabetic neuropathy and antioxidants in type 2 diabetes mellitus

To assess the relationship between glycemic control, the oxidative stress and antioxidant vitamin status and their influence on diabetic neuropathy. Thirty six type 2 diabetic patients with diabetic neuropathy were included in this study. They were classified into good and poor glycemic controlled groups [12 and 24 patients respectively]. All patients underwent multiple nerve conduction parameters including F wave latencies. Fasting serum glucose and glycosylated hemoglobin [HbAcl%], Lipogram, malondialdehyde [MDA], nitric oxide [NO] and antioxidants vitamin C and E plasma levels were determined. Poor glycemic controlled group recorded significant longer F wave latency of ulnar nerve, slower sensory conduction velocities of median nerve [P<0.05] and segmental motor conduction velocities of ulnar and median nerves [P <0.05; 0.01; 0.001], compared with that of good glycemic controlled group. Poor glycemic controlled group had significant rising oxidative stress markers [MDA] and reducing NO and vitamins [E and C] plasma level compared to that of good glycemic controlled group [P<0.001]. HbAlc% is significantly correlated with plasma MDA, vitamin C and E levels and segmental conduction velocities [P<0.001; 0.05]. Poor glycemic control is associated with high oxidative stress, lipid peroxidation and depletion of vitamins C and E plasma levels, that may be contributing to diabetic neuropathy progress

Short term effect of glycemic and dyslipidemia control on nerve conduction study and antioxidants status in type 2 DM

The importance of glycemic control in patients with diabetes is well known, but neurological studies suggest that dyslipidemia is actually a more significant contributor to diabetic neuropathy. Is to study the relationship between the degree of hyper glycemic and hyperlipidemic control on one hand and the degree of improvement in clinical, neurophysiological parameters, and level of oxidative stress markers and antioxidants in type 2 DM. Twenty four type 2 diabetics with hyperglycemia, dyslipidemia and diabetic neuropathy were included in this study. They received treatment for control of hyperglycemia and dyslipidemia for 3 months. Clinical assessment, nerve conduction, F-wave studies, lipid profile, oxidative stress markers as Plasma malondialdehyde [MDA] and antioxidant status [Nitric Oxide and vitamin C and E] were measured for each patient before, one and 3 months after beginning of treatment. They were classified according to percentage changes [PC] of glucosylated heamoglobin level [HbAlc%] into 2 groups. The first group had low PC of HbAlc% [< 25%] and the second group had high PC of HbAlc%[> 25%][n=11 and 13 respectively]. There were no significant differences in demographic and clinical data between both groups. Higher PC group had significant greater improvement compared to lower PC group in motor conduction velocity of median nerve [p = 0.017], serum triglyceride [p= 0.005], lipidperoxidation [MDA] and antioxidants levels [p= 0.0001 for each]. Efficient glycemic and dyslipidemia control significantly improved peripheral nerves function and antioxidant status

Complications of acute myocardial infarction in relation to the site of infarction

It has been suggested that infarction site may be significant determinant of clinical course and outcome after acute myocardial infarction [AMI].We aimed To assess the incidence of different sites of myocardial infarction [MI] and the different complications recorded according to the site of infarction, also to assess in-hospital mortality and its relation to age, sex, site of MI and other complications in patients with AMI. This study included all patients admitted to coronary care units of internal medicine and cardiology departments of Assiut university hospitals, Assiut government, Egypt, in the period from May 2007 to May 2008 with first AMI throughout one year [No=485 patients]. All patients were subjected to: careful history and clinical examination, electrocardiography [ECG], laboratory investigations, echocardiography and hemodynamic monitoring. In addition, 50 age and sex matched controls were included in this study. The incidence of AMI was higher in the old age group >/= 60 years [59.38%] with a higher percentage in men than women [71.75% vs 28.25%] in all age groups. Extensive anterior location of MI had the highest incidence among our patients [44.7%] while the inferopostenior location had the lowest incidence [4.1%] in both genders. Then the overall, inferior [26.2%], antroseptal [10.1%], extensive [9.3%] and lateral location [5.6%] came in between the two sites. Patients with extensive MI experienced the highest incidence of serious complications as cardiogenic shock [13.3%], left ventricular [LV] aneurysm [35.5%], LV thrombus [35.5%], stroke [2.2%], atrial fibrillation [AF] [13.3%], premature ventricular ectopics [PVCs] [100%] and they also had the highest incidence of in-hospital mortality [17.7%].The incidence of the various sites of MI as well as the complications recorded in these patients are near to that recorded in other studies all over the world. Patients with anterior and extensive infarction experienced the highest incidence of complications and mortality than those with inferior and inferoposterior locations

Hyperhomocysteinemia in chronic renal failure and its role in repeated vascular access thrombosis in patients on regular hemodialysis

This study was performed on 79 patients with chronic renal failure [CRF] in Assiut University Hospital through the year 2006-2007 in the dialysis unit and 20 apparently healthy subjects as a reference group, they were classified as following: Group I; 20 healthy subjects, Group II; 24 patients who will start dialysis for the first time, Group III; 55 patients on maintenance hemodialysis for more than 3 years. Group III was sub-classified according to the presence of repeated arterio-venous fistula occlusion and thrombosis into: Group III a; 25 patients without repeated arterio-venous fistula occlusion and, Group III b; 30 patients with repeated [3 or more] fistula occlusion. After careful history and clinical examination, the following was done: A] Routine investigations: Peripheral hemogram, serum glucose, urea and creatinine and creatinine clearance, total serum protein and serum albumin as well as serum lipidprofile. B] Special investigations: total plasma homocysteine. The results of this study showed no significant difference when comparing group IIlb with group IlIa regarding kidney function [serum urea, creatinine and creatinine clearance], serum total protein and albumin as well as all components of the lipid profile. Homocysteine showed highly statistically significant elevation when comparing each of groups II, IIIa and Illb with group I, but there was no statistically significant difference when comparing group II with group III. However, there was highly statistically significant elevation when comparing group III b with group III a. We concluded that hyper-homocysteinmia in patients with end stage renal disease could be considered a risk factor for the development of repeated vascular access thrombosis [VAT] or occlusion

Hypermethylation of the PAX 5 gene promoter and its implication in the pathogenesis of multiple myeloma

This study aimed to clarify the mechanism of silencing of the PAX5 gene. The genetic analysis of the coding region and promoter by southern blot analysis did not show growth structural abnormalities in human multiple myeloma [MM] cell lines when compared with PAX5 expressing B cells. Several transcription factors like Ikaros-1 [IK-1] and SRY-related high mobility group [HMG] box [SOX4 and SOX5] showed a similar expression pattern in B cells and MM cells. Therefore, it was suggested that epigenetic factors could be involved in PAX5 silencing. The examination of the methylation pattern in PAX5 promoter revealed some areas of hypermethylation in methylation sensitive Southern blot analysis. Moreover, the treatment of MM cell lines by methylation blocking cytidine analogue 5-aza-2 deoxycytidine [5-aza-2dC] could restore the expression of PAX5 gene. It was postulated that hypermethylation of the PAX5 gene promoter may be responsible for its silencing in human MM. It was proposed that PAX5 gene silencing could be related to the oncogenesis of human MM

Assessment of total plasma homocysteine and nitric oxide levels as a risk factors in coronary heart disease

This study was performed on 40 patients suffering from Coronary heart disease [CHD] and 20 primary asymptomatic hyperlipidemia subjects compared with 20 age and sex matched healthy persons as a control group [group I]. Patients were classified into three groups: Group III: Twenty patients with acute myocardial infarction [AMI]. Group II: Twenty patients [6 with stable angina [group III[a]], and 14 with unstable angina [group III[b]] Group IV: Twenty patients with primary hyperlipidemia, without clinical and ECG evidences of ischaemic heart disease [IHD]. All patients and control groups were subjected to clinical examination, ECG: serum glucose level, Kidney, liver function tests, lipogram, CK, CK-MB and C-reactive protein, nitric oxide, [NO] and Total plasma homocysteine [tHcy] Serum total cholesterol and LDL-c levels showed statistically significant elevation in groups II, III and IV when compared with the control group. Also, serum CH, LDL-c and Triglyceride [TG] showed highly significant elevation in group IV when compared with group II and III while 9 TG was signficantly elevated only in group III compared with control Serum HDL-c revealed statistically significant reduction in all patient groups when compared to the control group, but no significant difference was observed on comparing different patient groups together. CK, CK-MB and CRP levels revealed highly significant elevation in group II and group III[b], and group IV when compared with the control group. No significance difference was observed on comparing group III[a] with the control group. Also the same parameters showed significant elevation in group II when compared with groups III[a] III[b] and IV. Also there was highly significant elevation in group III[b] when compared with group IV. But no significant difference was observed on comparing group III[a] with group IV. Serum nitric oxide [NO] revealed highly significant elevations in groups III[a], III[b] and IV when compared with the control group, while no significant difference was observed between group II and the control group. Serum NO level showed no significant difference in other patient groups when compared with each other. Homocysteine showed highly significant elevation in all patient groups when compared with the control group. In group II plasma tHcy levels showed significant elevation when compared with groups III[a],III[b] and IV. Moreover patients in group III[b] showed significant elevation when compared to group IV. Hyperhomocysteinemia is found in most of the patients with CHD and in cases of primary hyperlipidemia. So tHcy can be used as a risk factor for prediction of CHD. Also it is related to severity of CHD as it showed the highest sensitivity in AMI

Survey study of microalbuminuria in diabetic patients attending out-patient clinic of diabetes in Assiut University Hospital

Micro albuminuria is the earliest sign of diabetic nephropathy [DNP] and it is an indicator for the presence of the characteristic glomerular lesion. This study was conducted on the adult diabetic patients of both types I and II of diabetes mellitus [DM] attending the out -patient clinic of Assiut University Hospital throughout the year 2002. Patients with hypertension, congestive heart failure or those with urinary tract infection albuminuria were excluded. Five hundred patients were subjected to full history taking and clinical examination as well as the following investigations; [I] complete urine analysis [2] screening for micro albuminuria [3] fasting serum glucose [FSG]] and glycosylated hemoglobin [HbAlc] [4] serum urea and creatinine and creatinine clearance. Out of 500 patients 213 [42.6%] were positive for micro albuminuria which was more prevalent among type I DM, male sex, extreems of age, urbans, over-weight and obese patients and those with low physical activities as well as patients with non renal complications. Significant direct proportions were found between level of micro albuminuria, on one hand, and level of FSG and HbAlc and serum urea and creatinine on the other hand, while inverse proportion was found with creatinine clearance. We have concluded that, micro albuminuria is a simple detectable marker for screening incipient DNP. Micralbuminuria was prevalent among considerable percentage [42.6%] of our diabetic patients. It was found to be more prevalent among different studied categories of patients which could be considered as possible risk factors for developing DNP in our locality. Apart from hypertension, these factors are [1] type I DM [2] male sex [3] extreems of age [4] urbans [5] low physical activities [6] obesity [7] long duration of DM [8] bad control of hyperglycaemia [9] presence of non renal complications [10] renal insufficiency

Thyroid and pancreatic islet cell antibodies in chronic hepatitis c [HCV] infection with and without diabetes

The prevalence and the clinical relevance of thyroid and pancreatic beta cell immunity in HCV +ve patients with and without diabetes before interferon [IFN-alpha] therapy remain controversial. So, the aim of the present study was : 1-To determine the prevalence of organ specific Pancreatic beta cell and thyroid autoantibodies and organ non-specific antibodies [Anti Neutrophil Cytoplasmic Antibodies [ANCA], Anti Smooth Muscle Antibodies [ASMA] and Liver Kidney Microsomal Antibodies [LKMA] in HCV+ve patients with and without diabetes. 2- To evaluate whether autoimmune beta cell damage could be involved in the development of diabetes in HCV +ve patients. 3- To assess the clinical value and the relationship between such autoantibodies. Research design and Methods: The evidence of clinical autoimmune diseases and the presence of autoantibodies were assessed in 56 HCV+ve patients before INF-alpha therapy. Autoantibodies to Islet Cells [ICA], Thyroglobulin [TGAs]. Thyroid Peroxidase [TPAs] were tested by ELISA and immunometric assay, in addition to ANCA, ASMA and LKMA were tested by ELISA and immunoflorescence assay in 30 patients with diabetes [Group I], 26 patients without diabetes [Group II], in addition to 14 sex and age matched controls. Correlating these antibodies with age, sex, body mass index [BMI], presence of liver cirrhosis and its staging. It was found that age, BMI, family history of diabetes, and insulin levels were significantly higher in the diabetic group than in non diabetic HCV+ve patients. None of the 56 patients studied showed evidence of clinical autoimmune diseases. However, 5.4% of patients were positive for ICA[3/56], 10.7% [6/56] were positive for TGAs, 8.9% [5/56] were positive for TPAs. The coexistence of ICA and thyroid antibodies were found in only 3.6% of patients [2/56]. Furthermore, 71.4% of patients [40/56] were positive for ANCA, 35. 7% [20 /56] were positive for ASMA, 12.5% [7/56] were positive for LKMA. The frequencies of these autoantibodies were not significantly different in the presence- or absence of diabetes or when compared with controls except in ANCA +ve group in which antibodies were significantly higher [p<0.05] in the diabetic group. Moreover, ICA +ve patients were all diabetics. The ICA, TGAs and TPAs were more frequent among HCV+ ve female patients although most of our patients [75%,] were men. The presence of liver cirrhosis or / is staging according to Child Pugh score had no relation to the presence of such antibodies. Our study indicated a low prevalence of beta cell immunity and thyroid autoantibodies in HCV +ve patients. The level of such autoantibodies whether organ specific or non organ specific had no relation to the presence of diabetes or liver cirrhosis complicating or associated with HCV infection. Old age, high BMI, and family history of diabetes are risk factors for diabetes in HCV patients. Furthermore, the role of NCV in the development of diabetes was unlikely to be mediated by autoimmune mechanism. However, hyperinsulinemia and insulin resistance may play a role