RESUMEN
Diabetes mellitus imposes a tremendous burden on health economies mainly because of its devastating complications. A long duration of metabolic disturbances can cause vascular damage leading to both macro and micro vascular complications. There is an increasing evidence that atherosclerosis is accompanied by inflammation. Our aim in this study is to prove that a low grade inflammation accompany the diabetes mellitus and this inflammatory process is correlated to diabetic control and diabetic complications. Our study was done on 100 elderly diabetic patients whose total white blood cell count was in the normal range. Their age ranged from 65-85years with mean age of them is 68.1 years, half of them were males and the other half were females. They undergo full clinical examination and laboratory investigations including total white blood cell count, serum Creatine protein level, albumin level in urine. glycosylated haemoglobin in addition to other routine laboratory investigations. The patients were divided into 5 quintiles according to the distribution of the total white blood cell count and serum C-reactive protein level. We found a highly significant positive correlation [P value <0.0001] of the total white blood cell count and serum C-reactive protein level to the diabetes duration, body mass index, systolic and diastolic blood pressure, fasting and post prandial blood glucose levels, glycosylated haemoglobin, total cholesterol, low density lipoprotein-cholesterol, serum creatinine and albuminuria and a highly significant negative Correlation with the high density Iipoprotein-cholesterol [P value<0.0001]. We found also a highly significant positive correlation of the total white blood cell Count and serum C-reactive protein level with diabetic micro and macro vascular complications [P value<0.0001]. Moreover, there is an increased risk of macro and micro vascular complications with progressive quintiles of both white blood cell count and serum C-reactive protein level. The odds ratio for the group 5 of the total white blood cell count in comparison to group 1and2 equals 7.35 [confidence Interval= 3.12-9.31] for macro vascular complications and it equals 7.19 [confidence interval= 4.12-9.19] for micro vascular complications. The odds ratio for groups 3,4and 5 of the serum C-reactive protein level equals 9.31[confidence interval= 6.19-18.1] in comparison to groups 1 and 2 for macro vascular complications and it equals 7.31 [confidence interval= 5.19-15.9] for micro vascular complications. We found also an increased risk for smokers to develop both macro and micro vascular complications of diabetes mellitus , odds ratio equals 6.87[confidence interval= 2.14-22.06] and 3 [confidence interval=1.07-8.38] respectively compared with non smokers in the lowest quintile
RESUMEN
Recent studies suggest that inflammation may play an important role in the pathogenesis of acute coronary syndromes. Several inflammav tory markers are increased in acute coronary syndromes as the nonspecific hepatically synthesized CRP, instead, several cytokines are direct inflammatory mediators as lL-6 and TNF-alpha which increase in many disease states, including the acute coronary syndromes. lL-10 is an anti-inflammatory cytokine, is produced by Th2 lymphocytes, B cells, and monocytes. It inhibits macrophagedependent cytokine synthesis by Th1 cells thus regulate balance between ceII-and humeral-mediated immune response. The proinflammatory cytokines play a role in acute coronary syndrome. however. the potential role of anti-inflammatory cytokines in the modulation of atherosclerotic process remains unknown. The objective of this study is to assess the value of pro and entiinilammatory cytokines in patients with unstable angina. The present work assessed the serum level of proinflammatory cytokines lL-6 and TNF-alpha and anti-inflammatory cytokine lL-10 in 36 patients, 20 patients had chronic stable angina, their ages ranged between 48-62 years with mean age 53 years and 16 patients with unstable angina class IIIB according to Braunwald classification, their ages ranged between 4861 years and their mean age is 54 years. All patients were diagnosed by coronary angiography. A control group comprise 10 subjects oi matched age and sex also included in this study. Serum lL-6 end TNF-alpha show a highly significant elevation in unstable angina versus the other two groups [P<0.001], these proinflammatory cytokines are positively correlated with serum cholesterol, LDL-c. TG and negatively correlated with mm in whole groups. Serum anti-inflammatory cytokine IL-10 shows a highly significant decrease in patients with unstable angina when compared to the control group [P=0.002] and also shows significant decrease when compared to patients with stable angina group [P=0.02]. Also serum lL-10 shows a negative correlation with lL-6, TNF-alpha, serum cholesterol, LDL-c, TG and PPBS in whole groups. These results indicate that the level at antiinlammatory cytokine lL-10 decrease in patients with unstable angina and this decrease may be the cause of plaque instability and rupture
RESUMEN
Insulin like growth factor-1 has incriminated as a key role in the pathogenesis of immediate and late diabetic complications. IGF-1 concentration changes either in blood or renal tissues may contribute to the pathogenesis of diabetic nephropathy. The objective of this study is to compare the level of urinary and serum IGF-1 in diabetics and non-diabetic subjects and to predict the relation between IGF-1 and development of diabetic nephropathy. It is released from various organs with the liver being the most important source. The present study assessed urinary and serum 1GF-1 in 24 patients, twelve of them are diabetics with microalbuminuria and twelve of them are diabetic with overt nephropathy and also in twelve control non-diabetic subjects of matched age and sex. Every group contain six males and six females, the differentiation between diabetic groups was based on Cambur-lll and Micral-l tests. The immunoassay of IGF-1 is a "sandwich type assay" by using mouse monoclonal antibodies directed against two different epitopes of IGF-1 which are employed in the kit. Serum IGF-1 showed statistically non-significant difference between the three test groups. Urinary IGF-1 showed marked significant difference between the three test groups. The highest value was in overt nephropa thy group [group III] [0.800:0.100 pg/ ml], then microalbuminuria diabetic group [group II] [0.408:0.007 pg/ml]. The lowest value was found in control group [group I] [0.189+0.0028 pg/ml], p value <0.01 when comparing group III with group I. Also urinary IGF-1 showed a positive correlation with the diabetic duration, mean blood pressure and serum creatinine level [P<0.001]. These results indicate that urinary 1GF-1 may reflect the important role of tissue IGF-1 in the pathogenesis and development of diabetic kidney disease