Angiotensin converting enzyme I/D polymorphism in Egyptian patients with type 2 diabetes mellitus

The deletion [D] allele of the angiotensin-I converting enzyme [ACE] is associated with higher ACE activity, it has been studied in various populations in relation lo hypertension and type 2 diabetes mellitus [DM] with contradictory results. The objective of this study was to determine the ACE insertion/deletion polymorphism, genotype distribution in Egyptian patients with type 2 DM and to evaluate the possible association of ACE insertion/deletion polymorphism with hypertension in diabetic patients. A total of 48 patients with type 2 DM, 23 of them had hypertension and 21 healthy subjects age and sex matched with the patients, as control group were included in this study. Genotyping was performed by polymerase chain reaction [PCR]. The frequency of DD genotype was significantly higher in diabetic patients compared to controls [p=0.008]. The DD genotype [Vs DI and II genotypes] was associated with increased risk of diabetes [OR: 3.647, 95% CI: 1.235-10.773, p=0.016] and the D allele was more frequent in diabetic patients and was associated with increased risk of diabetes [OR: 3.939, 95% CI: 1.782-8.709, p<0.001]. No significant difference in genotype distribution or allele frequency was detected between diabetic patients with and without hypertension. We can conclude that a significant association between ACE gene I/D polymorphism and type 2 DM is present in Egyptian patients and the D allele is associated with increased risk for type 2 DM

Anti-cyclic citrullinated peptide antibodies as a discriminating marker between rheumatoid arthritis and chronic hepatitis C-related polyarthropathy

Articular involvement is a frequent extrahepatic manifestation of hepatitis C virus infection. The distinction between HCV-related polyarthropathy and true RA may be very difficult especially with recent onset RA before articular damage and erosions develop. To assess the diagnostic utility of anti-CCP antibodies and compare it with that of rheumatoid factor in distinguishing between rheumatoid arthritis and HCV related polyarthropathy. Anti-CCP antibodies and RF were determined in the sera of 30 patients with RA and 22 patients with HCV-related polyarthropathy. Anti-CCP antibodies were positive in 83.3% of patients with RA and in 4.5% in patients with HCV and polyarthropathy. RF was positive in 90% of RA patients and in 81.1% of HCV patients with polyarthropathy. The anti-CCP antibodies showed higher specificity for RA compared to RF [95.4% Vs 18.2%]. However the sensitivity of anti-CCP was comparable to that of RF [83.3% Vs 90%]. Anti-CCP antibodies are reliable laboratory markers to differentiate between RA and HCV-related polyarthropathy

Validity of platelet count/spleen diameter ratio as a predictor of esophageal varices in patients with liver cirrhosis

Portal hypertension commonly accompanies the presence of liver cirrhosis, and the development of esophageal varices [OV] is one of the major complications of portal hypertension. To evaluate platelet count/splenic size ratio as a non-invasive parameter to predict the presence or absence of esophageal varices in patients with liver cirrhosis. Eighty-six cirrhotic patients who underwent digestive upper endoscopy, were classified into Group 1 which is formed of 60 patients who had endoscopic evidence of OV and Group 2 which is formed of 26 patients who had no endoscopic evidence of OV. All the patients underwent thorough clinical examination, laboratory and ultrasonographic evaluation. Laboratory investigations were done in the form of complete blood count including platelet count [PLT]; liver function tests [aspartate transaminase [AST], alanine aminotransferase [ALT], serum bilirubin and prothrombin time [PT]], schistosomal antibodies, hepatitis B surface antigen [HBsAg] and hepatitis C virus antibodies. Abdominal ultrasonography and upper gastrointestinal endoscopy were done for all patients. Patients with OV had lower mean platelet count and higher mean spleen diameter than patients without OV [p=0.003 and p=0.01 respectively]. The mean values of the ratio of platelet count/spleen diameter was significantly lower among OV group when compared with patients who had no endoscopic evidence of OV [p=0.002]. There was no significant difference in the platelet count/spleen diameter ratio between different grades of OV. Large OV was associated with increased portal vein diameter [p=0.05]. Lower platelet count/splenic size ratio is associated with the presence of OV yet it cannot be used as a predictor of OV and so the endoscopy remains the standard screening test for OV among patients with liver cirrhosis

Study of endothelin-1 levels in type I diabetic patients with nephropathy

Diabetic Nephropathy is a leading cause of disability in patients with type 1 diabetes mellitus [T1DM]. Recently discovered vasoconstrictors regulators, such as endothelin [ET] have been shown to have possible pathogenic roles in diabetic vascular complications. In type 1 diabetic patients will different stages of nephropathy, we investigated plasma endolhelin-1 [ET-1] levels and urinary albumin excretion to study the relationship between ET-1 and diabetic nephropathy, in addition to the effect of glycemic control on ET-1 urinary albumin excretion. Sixty patients with T1DM [38 males and 22 females] aged [20.0 +/- 4.9 years] with different stages of nephropathy were selected without renal impairment, or edema 17 patients with normal urinary albumin excretion Igp, 1 normal UAE, 21 patients with microalbuminuria [gp. 2 MAU] and 22 patients with proteinurea >lgm/day [gp. 3 PU]. In addition to 15 healthy subjects matched for sex and age acting as a control group. Plasma ET-1 levels, urinary albumin excretion, and glycosilated hemoglobin [HbAlc] were determined in all subjects. There were significant increases of ET-1 in all the diabetic groups as well as urinary albumin excretion, the highest values was found in the pro-leinuric group. Also ET-1 showed positive correlation with the severity of the renal disease as indicated by urinary albumin excretion [r=0.55 p>0.05], such results point to the possibility that ET-1 is involved in diabetic nephropathy. The normoal-buminuric group showed significant increase of ET-1 compared lo controls, this may indicate that ET-1 level may be an earlier marker of diabetic nephropathy than microalbuminuria. Classifying each group according to glycemic control of diabetes [cut point of HbAlc 7%] The subgroups of each group showed non significant change, concerning ET-1 or urinary albumin excretion, this may be due to the fact that the cut point was 7% which is initially lower than other investigators whose ail point was much higher [8.5%], they showed in contrast to that the better the control the better the effect on diabetic nephropathy. Mreviations: Finally it can be concluded that ET-1 appears to be involved in the pathogenesis of diabetic nephropathy. It may be a marker of the early stage of diabetic nephropathy as microalbminruia or may be an earlier marker than microalbuminuria that may appear in the normoproteinuric stage. Also the degree of glycemic control does not affect the ET-1 level or degree of albumin exertion in the same stage of diabetic nephropathy.

Tumor necrosis factor-alpha and insulin level in obesity

The aim of this study was to measure the plasma level of TNF-alpha in obese subjects in comparison with lean ones as well as to correlate its level with the serum insulin level. Thirty-five subjects with a wide range of values for the body mass index [BMI 18.5 +/- 63 kg/m2] were included in this study. The subjects were divided into two groups according to BMI. For all subjects, serum total cholesterol triglycerides, high density lipoprotein cholesterol [HDL- C], low density lipoprotein cholesterol [LDL-C], serum insulin and plasma level of TNF-alpha were assayed. All subjects had normal glucose tolerance as determined by WHO criteria. The study concluded that the plasma level of TNF-alpha was found elevated in obese subjects and this elevation was related to BMI and insulin resistance. So, TNF-alpha can be considered as a system regulating insulin action in obesity leading to insulin resistance with all its hazards in these patients

Enhanced anticoagulant response to activatted protein C in patients with Type 2 diabetes mellitus

Anticoagulant response to activated protein C [APC] was studied in 15 healthy subjects and 35 patients with type 2 diabetes mellitus using a modified activated thromboplastin time assay. The results were expressed in terms of the APC sensitivity ratio [APC-SR]. In addition, plasma levels of protein C, protein S and AT III were measured. APC-SR was significantly higher in diabetic patients compared to controls. AT III was significantly lower in diabetic patients compared to controls. No significant differences were observed between patients and controls as regards protein C activity and free protein S levels. In conclusion, the data suggested a role for AT III and APC cofactor activities in the regulation of the anticoagulant response in type 2 diabetic patients. The enhanced anticoagulant response to APC as well as up-regulation of the protein C/protein S system may be effective in controlling hemostatic balance type 2 diabetes