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

occurrence of spontaneous bacterial peritonitis in patients with chronic liver disease in relation to treatment modalities of upper gastrointestinal bleeding

Patients with chronic liver disease [CLD] complicated by upper gastrointestinal [UGI] bleeding are more prone to develop spontaneous bacterial peritonitis [SBP]. SBP is defined as bacterial infection of ascitic fluid in patients with CLD in the absence of an apparent intra-abdominal source of infection. The aim of this study was to determine the incidence of developing SBP in patients with CLD suffering from UGI bleeding in relation to the mode of treatment of the bleeding episode. To fulfill this aim, we studied 50 patients [34 males and 16 females], their ages ranges from 37 to 64 years with CLD and suffering UGI bleeding. Patients were prospectively randomized according to the treatment modalities of the bleeding episodes into 3 groups: group A: 26 patients received endoscopic variceal sclerotherapy [EVS]; group B: 13 patients received endoscopic variceal ligation [EVL]; group C: 11 patients received medical treatment in the form of glypressin or somatostatin. In our study the incidence of occurrence of SBP following treatment of bleeding episodes of patients with CLD was highly significant with EVS [23%] than other modalities namely EVL [7.7%] and medical treatment [0%]. Patients with CLD receiving EVS carry a significantly higher risk for developing SBP than other modalities of treatment. EVL is safer than EVS to control UGI bleeding as regard the occurrence of postendoscopic SBP