Proteinurea and cerebrovascular stroke in type 2 diabetic patients

Proteinuria is an independent risk factor for cardiovascular disease in patients with NIDDM. The aim of this study was to assess the relationship between proteinuria and ischemic stroke in subjects with NIDDM, and to determine whether proteiuria is an independent risk factor for cerebrovascular stroke also. We performed a study on 20 diabetic patients with first-ever ischemic stroke due to thrombotic arterial occlusion, who were considered cases, and 10 diabetic patients without stroke, matched by gender. age, and diabetes duration, as a control group. WHO criteria for verified definite or possible stroke were used to ascertain the diagnosis of stroke. Proteinuria was higher in diabetics with stroke compared to those without stroke [P < 0.00]. Diabetic patients with stroke and proteinuria compared to those without proteinurea had significantly high duration of diabetes, systolic and diastolic blood pressure. fasting blood glucose, serum cholesterol and triglycerides[P < 0.05, 0.05, 0.001, 0.05, 0.05 and 0.01 respectively. However, proteinurea was not correlated to site, size or severity of stroke. In conclusion proteinurea was strongly associated with stroke in diabetic patients, may be through the presence of associated risk factors mainly hypertension. dyslipidemia and uncontrolled diabetes mellitus

Effect of exchange transfusion on oxygen free radicals and some antioxidants in newborn infants

Exchange transfusion rapidly produces variable changes in pro-oxidants and antioxidants plasma concentrations in neonates which may be responsible for free radical metabolism. So our study aimed to evaluate the effect of exchange transfusion on some pro-oxidants [iron, and ferritin] and primary antioxidants [ceruloplasmin and transferrin] in newborn infants. The study included 25 neonates [16 males and 9 females] with mean gestational age of 34.4 +/- 3.9 weeks. They were divided into 2 groups according to clinical presentation, 17 with hyperbilirubinemia [6 haemolytic and 11 non haemolytic] and 8 hyperbilirubinemia with sepsis. All neonates were subjected to full clinical history, Gestational age assessment, thorough clinical examinations for all systems and laboratory investigations [before and after exchange transfusion] in the form of complete blood count, serum levels of total and direct bilirubin, serum levels of ferritin, Iron and T.I.B.C., serum level of malondialdehyde and serum levels of ceruloplasmin and transferrin.Regarding to our results, serum level of total bilirubin showed statistically highly significant decrease after exchange transfusion [E.T.] and primary antioxidant [ceruloplasmin and transferrin] were significantly elevated after E.T. As regard pro oxidants, there was highly significant decrease in serum levels of ferritin, iron and malondialdehyde after E.T. and highly significant rise in serum level of T.I.B.C. after E.T. The differences between the mean values of serum ferritin, iron, T.I.B.C., transferrin and - ceruloplasmin before and after exchange transfusion were statistically significant in preterm and neonates with birth weight less than 2kg. Transferrin showed positive correlation with gestational age.After exchange transfusion there was significant decrease in serum levels of ferritin and iron and significant increase in T.I.B.C. in both groups of neonataI hyperbilirubinemia and neonatal hyperbilirubinemia with septicemia. Serum levels of transferrin and ceruloplasmin were also increased after exchange transfusion in both groups but without significant statistical difference. Finally we can conclude that elevation of serum levels of primary antioxidants [ceruloplasmin and transferrin] and lowering serum levels of oxygen free radicals [MDA as an index] after exchange transfusion indicate its important role not only in decreasing the serum bilirubin level but also in improving the defence mechanism against oxygen free radical injury especially in preterm neonates. Preterm and neonates with low birth weight are more vulnerable to neonatal oxygen radical diseases because of their developmentally low iron associated antioxidant proteins [transferrin]

Role of anaesthesia on cytokine responses to major surgery: inhalational versus intravenous

The aim of this study was to investigate the effects of inhalational vs intravenous anaesthesia on cytokines and hormones production in response to major surgery. Twenty patients ASA I and II were randomly allocated to receive either halothane-N0[2] [Inhalation group] or propofol-fentanyl [I.V. group]. Blood samples for cytokines include interleukin-1 beta [IL-1 beta], interleukin-2 [IL-2], interleukin-6 [IL-6] and interferon-lamda [IFN-lamda] and for hormones, cortisol and prolactin concentrations were obtained at intervals; before induction, end of surgery and 24 hours postoperatively. No significant changes were observed in interleukins or hormones concentrations between the two groups before induction of anaesthesia IL-1 beta increased by the end of surgery with no difference between both groups. IL-2 decreased significantly in I.V. group by end of surgery as compared with inhalational group. lL-6 increased significantly in inhalational group and still high 24 h. postoperatively. IFN-lamda decreased significantly by end of surgery in both groups. Cortisol level increased significantly in inhalational group more than in I.V. group by the end of surgery and no significant difference 24 h. postoperatively. Prolactin concentration increased but no significant difference between the two groups throughout the study period. We concluded that I.V. anaesthesia with propofol-fentanyl minimise rise of IL-6 and suppresses release of IL-2 and plasma concentration of cortisol as compared with halothaneNO[2] anaesthesia which increase secretion of IL-2, IL-6 and cortisol concentrations