Some predictors of diabetic complications. are they related to the severity of these complications or the duration of diabetes mellitus?

Diabetic [DM] patient is susceptible to a series of complications, which cause morbidity and premature mortality. Predictors of diabetic complications include Hemoglobin A1c [HbAlc], Erythrocyte sorbitol [ER-SOR], fibronectin and collagen W. The aim of the present study is to determine if these predictors of diabetic complications are related to the severity of these complications or the duration of DM. Sixty patients with DM [31 males and 29 females, age from 16 to 65 years] and 10 control non-diabetics with same age. Patients were classified according to absence or presence of complications into two groups: non complicated group [30 patients, age from 25 to 65 years, 17 males and 13 females, 15 IDDM, and 15 NIDDM] and complicated group [30 patients, age from 16 to 65 years, 14 males and 16 females, and 15 IDDM, and 15 NIDDM]. Complicated group was either one [17 patients], two [8 patients] or three [6 patients] complications. Through history taking, clinical examination, and routine laboratory examinations were done in addition to Doppler echocardiography, and plasma levels of HBAIc, ER-SOR, Fibronectin, and Collagen IV. Complicated NIDDM showed significant [P<0.05] Left ventricular diastolic dysfunction and higher [P<0.05] left ventricular mass versus complicated IDDM. HbAlc, ER-SOR, Fibronectin, and collagen IV were significantly [p <0.001] increased in diabetic patients, either complicated or non complicated. However, no added significant [P>0.05] effect of severity of complications on level of these predictors. There was excellent [P<0.001] correlation between HbAlc level and duration of DM particularly in complicated NIDDM, and good correlation [P< 0.05] between levels of ER-SOR, and collagen IV and duration of DM. We conclude that the predictors of diabetic complications [HbAlc, ER SOR, fibronectin, and collagen IV] are elevated in diabetic patients. However, the severity of the complications has no evident added effect on the level of these predictors. Meanwhile, there was good relation between the duration of DM and some of these predictors [HbAlc, ER-SOR, and collagen IV. In addition, follow up Doppler echocardiography is recommended for early detection of left ventricular dysfunction in diabetic patients

Right sided restrictive cardiomyopathy in Egyptian peasants with hepatosplenic schistosomiasis: a Retrospective 5- year study

Endomyocardial Fibrosis [EMF] is a common disease in the humid zones of tropical Africa- Recognition of cases outside the tropical zone has been reported with increasing Interest. We report our experience with 30 Egyptian peasants who all had infection with schistosoma. Laboratory investigations, 12-lead electrocardiography and pericardiocentesis were performed in all patients. Pericardial biopsy was performed in some patients. All patients had evidence of infection with schistosoma mansoni, schistosomal hepatic fibrosis. splenomegaly and ascites. All patients had markedly congested neck veins with positive kussmaul's sign in some patients. All patients had no eosinophilia. Atrial fibrillation was detected in 24 patients. Detailed echocardiographic study showed obliteration of the right ventricle [RV], apical RV firbrosis, varying degrees of exudative pericardial effusion in all patients. No extension of fibrosis into RV outflow tract. No fibrosis in left side of heart. Hugely dilated right atrium [RA] with RA spontaneous echo contrast detected in all patients and FM thrombi in only 10 patients. Normal size pulmonary artery without pulmonary hypertension. Minimal to mild tricuspid regurgitation was detected in all patients by Doppler echocardiography. In conclusion, right-sided restrictive card iomyopathy is a special form of EMF detected only in Egyptian peasants without eosinophilia. It always, involved the right side of the heart. Calcification extended to the RV outflow tract in some cases