Evaluation of plasma thrombomodulin in patients with type II diabetes mellitus

Thrombumodulin is an important endothelial anticoagulant protein that decreases thrombin activity and activates protein C. Increased plasma concentrations of various markers of endothelial damage especially thrombomodulin, have been observed in type I diabetic patients particularly in those with microangiopathy. So we aimed in this study to evaluate the significance of plasma thrombomodulin as a biochemical marker for early detection of microvascular complication such as diabetic nephropathy in patients with Type II diabetes mellitus Thirty diabetic patients fulfilled the WHO criteria for type II diabetes-were included in this study together with 10 normal volunteers as normal control.-The type II diabetic patients were classified into three groups according to the level of microalbuminuria in 24hours urine: Group I: included 10 diabetic patients [without nephropathy] microalbumin/24 hours urine<30 mg, Group II included 10 diabetic patients with [incipient diabetic nephropathy] microalbomin/24 hours urine ranged from 30 to 300 mg, and Group III included 10 diabetic patients with [overt diabetic nephropathy], microalbuminl24 hours urine>300mg. For all patients and control the following were done serum creatinine, glycated hemoglobin [HbAlc] Plasma thrombomodulin [TM] and 24 hours urinary micro-albuminuria-In this study we found that, TM were highly significantly elevated in diabetic patients with microalbominuria [group II] and with macroalbuminuria [group III] as compared to the control group [P<0.01] [Table 2]. Also group III showed highly significant elevation in TM than group II [P<0.0 1]. TM showed highly significant correlation with albumin concentration in 24 hours urine HbAlc, and duration of diabetes [P<0.01] [tables]. Because plasma TM level was strongly affected by kidney function. TM index [TM[FU/ml]/serum creatinine [mg%] was used as an endothelial marker. TM index showed a highly significant elevation in diabetic patients [p<0.01] especially in patients with macroalbuminurea [group III] as compared to normal control [p<0.01] [Table 2] also its level was significantly higher in group III than both group I and group II [p<0.01] while no significant difference was found between neither group I nor group II and control group [p>0.05]. TM index showed a highly significant positive correlation with duration of diabetes, but it showed no significant correlation with HbAlc [P>0.05] [Table 6]. These results suggested that a generalized vascular endothelial damage occurs in diabetic nephropathy including the microalbuminuric stage, and TM could be used as a marker for early detection of diabetic microvascular complications

Bronchial mucosal changes in patients with chronic hepatitis C virus infection

Hepatitis C virus [HCV], being both a hepatotropic and lymphotropic virus represents a chronic stimulus for the immune system. So, various extra hepatic immunologic abnormalities have been shown to occur frequently in patients with chronic hepatitis C virus. Among the systemic manifestations of chronic HCV infection, lung involvement has been described. Also the possibility that HCV infects extra hepatic cells has been widely discussed. So we aimed in this study to detect HCV antigen in the bronchial mucosa and broncho-alveolar lavage [BAL]. Together with, the study of histopathological changes in the bronchial biopsy and the cellular content of the BAL in patients with chronic HCV infection.Our study included 50 patients suffering from chronic liver disease due to Hepatitis C virus infection complaining of recurrent cough with negative clinical chest finding and normal X-ray chest.The patients were subdivided into: three groups according to Child-pugh classification.Bronchoalveolar lavage and bronchial biopsy were obtained through the use of fibre optic bronchoscopy. And detection of HCV antigen in the BAL and biopsy using immunohistochemistry was done. Alsostudy of the histopathological changes of bronchial biopsy and lavage were performed

In our results, HCV in bronchial biopsy and BAL fluid was detected in 42% [21/50] of our patients. And BAL showed increase in the neutrophils and lymphocytes percentage especially in patients in group II "Child B".Pulmonary permeability is mostly affected in cases of HCV infection, noticed by increase of the albumin level in the BAL of patient of Child "C" [group III]. Also Variable degrees of pathological changes have been noticed in the bronchial mucosa of the patients. These variations are affected by the severity of liver disease.So we conclude that the presence of inflammatory cell infiltration together with pathological changes of the bronchial mucosa may induce bronchial inflammation as a sequel of HCV infection which could explain the occurrence of the recurrent cough in our patients, and may lead to progressive fibrosingalveolitis