Role of adhesion molecules in vascular complications of type 2 diabetes mellitus

The present study was undertaken to evaluate the plasma levels of soluble adhesion molecules [intercellular adhesion molecule-1 [ICAM-1] and vascular cell adhesion molecule-1 [VCAM-l] in type 2 DM to elucidate its potential involvement in pathogenesis of diabetic vascular complications and its association with other independent risk factors for diabetic atherosclerosis. The study was conducted on 60 patients with type 2 DM [27 with vascular complications Vs. 33 without vascular complications, assessed by fundus examinations] and 20 healthy controls, at Al-Azhar University Hospitals between March 2004 to August 2004. Serum levels of ICAM-l and VCAM-l in association with fasting blood sugar, fasting insulin and insulin resistance were measured, as wall as lipid profile, plasminogen activator inhibitor [PAl] and factor VII. Serum levels of ICAM-1 and VCAM-1 were significantly higher in type 2 diabetic patients with vascular complication than those without vascular complications, but no significant changes in their levels were found between patients without vascular complications and controls. Serum levels of ICAM- 1 and VCAM- I were significantly correlated with other studied parameters in patients with and without vascular complications except fasting serum insulin levels. Serum levels of insulin resistance [IR] and lipid profile were significantly higher in patients with type 2 DM than controls and in patients with vascular complications than those without vascular complications. Serum levels of fasting blood glucose, factor VII and PAl were significantly higher in diabetic patients with and without vascular complications than controls, on the other hand no significant changes was found between patients with and those without vascular complications. The present study suggested that the levels of soluble adhesion molecules in type 2 DM with dyslipidaemia, hyperinsulinemia and hypercoagulable state may be a marker of endothelial cell activation or dysfunction and may be related to the activity of multiple cell types in atherosclerotic lesion. Serum levels of ICAMs were closely related to vascular diabetic complications. Furthermore, they may serve as a tool for monitoring the impact of prevention and intervention on vascular damage

Hypothalamic pituitary thyroid axis in critically ill patients

Patient with critical illness has disturbed thyroid function tests sick euthyroid syndrome' in the form of low total and free T 3, T 4 [FT 3, PT 4] and low level of the serum TSH. We investigated the hypothalamic-pituitary-thyroid axis and its relation to the mortality and/or morbidity before and after TRH stimulation. Bas-line serum TSR, free T 3, T 4 and after 200 microgram TRH, stimulated serum TSR, free T 3,and free T 4, were measured in 17 patients presented with acute critical illness, in 24 patients with chronic illness and in 20 healthy control. The results showed significant reduction in baseline and impaired secretion of thyroid hormones [FT 4 and PT 3] as well as TSH level in patients groups compared to control group. In acutely ill patients this reduction is mainly in PT 3, while in chronic patients reduction of both FT 3 and FT 4 were evident. A bolus I.V. injection of TRH in critically ill patients leads to marked increases in the serum TSR without changes in serum FT 3 or FT 4 and outcome of patients. It was found that serum TSH, FT 4 and serum albumin were correlated significantly with the mortality and morbidity of critically ill patients than APACHE II score inspite of its long term used in the prediction of morbidity and mortality in such patients. However follow up measurements of FT 4 and TSH can take it as a marker of recovery of critical illness. The results demonstrated an impairment of the hypothalamic-pituitary-thyroid axis in patients with critical illness and serum levels of FT 4 and TSH can be used in the prediction of morbidity and mortality in such patients

Reduction in Nitric Oxide metabolites and antioxidants concentration in plasma after a single Cigarette smoking

In this study, the changes in the combined plasma concentrations of nitrate and nitrite as an index of nitric oxide [NO] concentration as well as the changes in the concentrations of major serum antioxidants [ascorbic acids and methionine] in smokers after smoking a single cigarette were measured. The effect of smoking a single cigarette was studied in 30 smokers and 15 nonsmokers [controls]. Plasma were collected before 5 and 60 minutes after smoking a single cigarette to measure the plasma levels of NO metabolites and antioxidants. Smoking a single cigarette significantly decreased NO metabolites concentrations by 10.2 +/- 1.1 mumol/L compared with the plasma concentrations at pre-smoking [13.5 +/- 1.2 mumol/L. The concentrations of ascorbic acid and methionine were also significantly lower after smoking a single cigarette [39.7 +/- 3.3 mumol/L and 8.1 +/- 0.7 mumol/L, respectively] compared with the plasma concentrations at pre-smoking [51.8 +/- 4.2 mumol/L and 10.2 +/- 0.7 mumol/L, respectively, for both]. These parameters returned to the pre-experimental levels at 60 minutes after smoking cessation. In nonsmokers, the same results were obtained, except that the impairments of NO and antioxidant release from the endothelium are less than in nonsmokers