Urinary Excretion of 11 dehydrothromboxane B[2] in Diabetic Children Relation to Clinical and Biochemical Parameters

Diabetes is the 6th most important cause of disability burden in Egypt. Cardiovascular diseases are the leading cause of death in diabetics. Oxidative stress is involved in p-cell destruction and is recognized as a mediator in the development of macrovascular or cardiovascular complications in type 1 diabetes meliitus. Products of arachidonic acid metabolism elicit inflammatory responses and diseases in diabetic children such as atherosclerosis. Hyperglycemia induced activation of thromboxane pathway evidenced by increase urinary excretion of 11-dehydrothromboxane B2 [indicator of oxidative stress]. This study measured urinary excretion of 11 dehydro-thromboxane B2 in 40 type 1 diabetic children [12.38 +/- 2.75] years and 40, age and gender matched, healthy controls [10.88 + 3.23] years. Mean urinary 11 dehydrothromboxane B2 concentrations showed statistical significant difference between diabetic group [1884.8 + 826.86 pg/mg creatinine] and controls [601.95 + 229.24 pg/mg creatinine, p<0.001]. Also, total cholesterol [183.75 + 30.47 versus 112.6 + 27.07 mg/dl, p<0.001], triglycendes [147.45 + 29.91 versus 73.08 + 13.3, p<0.001], HDL [34.8 + 4.95 versus 45.6 + 8.25 mg/dl, p<0.001], LDL [120.9 + 30.5 versus 83.6 + 24.2 mg/dl, p<0.001], HbAlC [11.48 + 1.79 versus 5.37 + 0.59, p<0.001] and fasting C-peptide [0.33 + 0.14 versus 2.05 + 0.87, p<0.001] showed statistical significant difference between diabetic children and adolescents and healthy controls. Our results showed also significant positive correlation between urinary 11-dehydrothromboxane B2 and HbAlc [r= 0.627, p= 0.012], tnglycerides [r= 0.520, p= 0.047] and total cholesterol [r= 0.668, p= 0.007]. In conclusion, the increase of triglycerides and LDL-cholesterol levels in our study confirmed the dyslipidemia pattern in pediatric type 1 DM patients. Our results confirmed that hyperglycemia induced activation of thromboxane pathway in type 1 diabetic children and adolescents as evidenced by increase urinary excretion of the indicator of oxidative stress status 11-dehydrothromboxane B2. Also, we showed a significant positive correlation between the urinary excretion of 11-dehydrothromboxane B2 and the laboratory parameters of lipid metabolism. Therefore, urinary 11-dehydrothromboxane B2 can be used as a potential non invasive biomarker of dyslipidemia in type 1 diabetic children

relation between oxidative stress and adhesion molecules in Egyptian children and adolescents with type 1 diabetes mellitus

Antioxidant potential decreases while plasma lipid peroxidation products increase in type] diabetes mellitus. The vascular-endothelium is a major target of oxidative stress [OS]. Reactive oxygen species signal events leading to impairment of endothelial function and promotion of leukocyte adhesion to the vascular endothelium. To explore the relation between OS and adhesion molecules in type] diabetes and correlate it with the state of metabolic control, disease duration and microvascular complications [MVCs]. Thirty-eight type] diabetics were included: 22 patients with disease duration less than 5 years and 16 patients with duration of 5 years or more. Thirty healthy age and sex matched subjects served as controls. They were assessed clinically. Laboratory investigations included, random blood sugar [RBS], glycated hemoglobin [HbA[1]c], fasting lipid profile and measurement of serum malondialdehyde [MDA] as a marker of lipid peroxidation and serum soluble P-selectin as a marker of endothelial/platelet activation. Serum MDA and P-selectin were significantly elevated in type 1 diabetics compared to controls with the highest level in diabetics with disease duration of 5 years or more [p<0.0001]. Both MDA and P-selectin levels were significantly elevated in complicated compared to non complicated diabetics [P<0. 000] with strong relation to complication severity, Serum MDA level was positively correlated with serum P-selectin level in diabetics [p<0.000]. Serum MDA and P-selectin were positively and significantly correlated with disease duration [p<0. 0001], RBS [p<0. 0001, p-0. 00 respectively], HbA1c [p<0.000], diastolic blood pressure [p=0. 03, p-0.005 respectively], total cholesterol [p=0. 04, p-0. 02, respectively], triglycerides [p=0. 006, p<0.0001 respectively] and low density lipoproteins [p=0. 03, p=0.05 respectively] but negatively correlated with high density lipoproteins [p=0. 03]. On multiple regression analysis, HbA1c had the strongest effect on both MDA and P-selectin levels [P<0. 0001]. Cut off values for serum MDA and P-selectin equal to 8.035 nmoles/ml and 45. 15ng/dl respectively for early detection of diabetic MVCs were defined. Levels of M4D and P-selectin are elevated in type] diabetics with evident relation to disease duration, metabolic control and severity of MVCs. Hence both of them might act as good markers to identify diabetics who are more susceptible to develop vascular disease

Epidemiology and management of type 1 diabetes mellitus at the Ain Shams University pediatric hospital

Type 1 diabetes mellitus is the most common metabolic disease in childhood. An interplay between genetic susceptibility and environmental factors [triggering or suppressive] may account for the pathogenesis of type 1 diabetes The diabetes control and complications trial [DCCT] showed the importance of strict metabolic control in delaying and preventing complications. The aim of this work was to describe the epidemiological features of type 1 diabetes mellitus [the pattern of seasonality at birth and at diagnosis, the initial symptoms of presentation, and the precipitating factors] and to compare the frequency of occurrence of long term complications [as microalbuminuria, and diabetic neuropathy and retinopathy] in relation to different insulin regimens among children attending pediatric hospital at Ain Shams University. This descriptive study was conducted on 416 patients of type 1 diabetes mellitus at pediatrics hospital, Ain Shams University. For each patient a questionnaire form was filled in through an interview with the patients and/or their parents and clinical examination was performed. Also, data were collected retrospectively from the patients' medical records. There was evidence of seasonality at diagnosis with overall predominance at summer. Also, seasonality at birth was clearly evident where 48.3% of cases were delivered during summer season. Polyuria and polydepsia were the most common presenting symptoms, 90.14% and 80.04% respectively. About 60.57% of cases were presented by Diabetic Ketoacidosis [DKA]. As regards the precipitating factors, infection preceded the diagnosis of 21.9% of cases, while psychological trauma was evident in 8.7% of cases. Frequencies of occurrence of long term complications were 9.6% for microalbuminuria, 2.4% for hypertension, 1.4% for orthostatic hypotension, 4.1% for diabetic retinopathy, and 3.1% for diabetic neuropathy. These complications were more frequent with conventional insulin regimen in comparison to the intensive regimen and the difference was statistically significant. Seasonal pattern was evident at diagnosis and at birth which is more common during summer. Diabetic children on intensive insulin therapy were experienced less long term complications than those on conventional regimen. Longitudinal studies are required to confirm the presence of seasonality at birth and at diagnosis including control from normal population .Intensive diabetes therapy should be encouraged among children with type 1 diabetes mellitus to delay onset of long term complications

Bone density in survivors of childhood acute leukemia and malignant lymphomas

This study aimed to assess bone mineral density in survivors of childhood acute leukemia and malignant lymphomas to determine the prevalence of osteoporosis and identify the possible predisposing factors and patients at the greatest risk of reduced bone mineral density. The study included 41 survivors [27 patients had acute lymphoblastic leukemia and 14 patients had malignant lymphomas]. In conclusion, 60.9% of the survivors of childhood leukemias and lymphomas had decreased BMD, osteoporosis being especially severe in 17.1% of these patients. In view of the risk of fractures among patients with osteoporosis, the survivors of childhood malignancy were at an increasing risk of bone fractures later in life irrespective of the underlying cause of osteoporosis, thus the intervention should be considered for prevention and proper management

Gonadal functions in survivors of childhood malignancy

Forty youngsters [27 males and 13 females] aged 12 to 21 years [mean 15.2 +/- 3.5 years] were included in this study. All completed treatment for childhood cancer and stopped treatment for 24 -157 months [mean 47.8 +/- 35.3 months]. None had testicular or pelvic irradiation. All were pubertal at examination. The control group included 34youngsters matched in age, sex and pubertal stage to the patients' group. Thorough history and clinical examination were done as well as determination of serum LH, FSH, estrogen for females and testosterone for males, pelviabdominal sonar in females and testicular size by sonar in males and semen analysis in six patients. The study revealed that there was no significant effect of supradiaphragmatic irradiation and combination chemotherapy on gonadal functions in females. In males, serum FSH was high in 41%, FSH and LH low in 19%, testosterone low in 33% and testicular size small for pubertal stage in 50%. Semen analysis in 6 patients revealed azoospermia in 4 and severe oligospermia in 2 patients. Significant correlation was present between supradiaphragmatic irradiation in males and elevated basal FSH and small testicular size. Gonadal dysfunction in males was significantly related to longer duration of therapy and older age at evaluation