Evaluation of the role of CXCL8 and NOx in pediatric type 1 diabetes mellitus

Genetic and environmental factors may play a role in the etiology of type 1diabetes [T1D] but a well-accepted view is that autoimmunity is the predominant effector. The aim of this study is to investigate the profile and the relationships between interleukin [IL, CXCL] -8 and nitric oxide metabolite [NOx] in T1D and to reveal their possible role in the development and progression of the disease and its complications. Twenty children with Type 1 diabetes [T1D] were enrolled for the study and compared to twenty healthy age and gender matched non-diabetic controls. The data revealed that children with T1D established high glycated hemoglobin [HbA1c%] values versus the control group [P<0.0001]. Significantly higher serum CXCL-8 concentration [23.54 +/- 11.92pg/ml] was detected in T1D children versus the control group [5.69 +/- 1.67pg/ml]. On the other hand, serum nitric acid metabolite [NOx] showed a significant reduction in the T1D children [2.38 +/- 1.14 mmol/l] compared to the control group [4.63 +/- 1.2 mmol/l]. Correlation analysis showed positive correlation between CXCL-8 with duration of the diabetes and with HbA1c. It could be concluded that CXCL-8 and NO may play important roles in the pathophysiology and progression of T1D with increased possibility to develop premature atherosclerosis which should be considered in the development of new strategies for monitoring the disease as well as for developing effective preventive and therapeutic interventions

Prevalence, pattern of presentation, risk factors and outcome of acute mesenteric venous thrombosis in Taif province, Saudi Arabia, a single center study

Mesenteric venous thrombosis has a global incidence of 10-15% of all cases of mesenteric ischemia; however reports from high altitude provinces of Saudi Arabia as Taif and Aseer recorded an incidence above 60%. The aim of this study is to record the incidence, pattern of presentation, risk factors; diagnostic tools and outcome of treatment in a single center [King Abdul Aziz Specialist Hospital] Taif, Saudi Arabia. In this retrospective chart review study, we reviewed the records and data of all patients presented to King Abdul Aziz Specialist Hospital, Taif, Saudi Arabia from January 2009 to January 2013 and their final diagnosis were proved to be acute mesenteric venous thrombosis. Traumatic, postoperative and non occlusive cases were excluded from the study. Sixteen patients with final diagnosis of acute mesenteric venous thrombosis were included in this study, out of 26 patients [61.5%] presented and diagnosed as acute occlusive mesenteric ischemia. Males were more affected than females. The mean age of the patients was 55 +/- 13.4 years. The mean duration of symptoms was 4.9 +/- 1.4 days. The most common presenting symptoms were; abdominal pain followed by nausea, vomiting, anorexia, bloody diarrhea and fever. The most prevalent physical findings was tachycardia followed by ileus, 5 patients presented by marked peritoneal signs 3 of them were shocked. Multiple risk factors were detected in all patients. Laboratory findings were not conclusive and diagnosis was established by CT angiography in most of the patients. During operation, all patients were found to have a segment of infarction of the small intestine and in one of them the cecum was involved. Resection of the gangrenous parts was done for all patients. Second look operation was performed in 25% of patients. The total mortality was 18.75%. Acute mesenteric venous thrombosis is the most common cause of acute occlusive mesenteric ischemia in Taif province and this may be related to multiple risk factors. Being familiar with this disease is essential in making the correct diagnosis to be followed by prompt resuscitation with heparinization to be continued postoperatively to prevent recurrent thrombosis. Laparotomy should be performed as soon as metabolic and hemodynamic correction is done with resection of any infracted segment. A second look operation may be required. If these steps are followed strictly and without delay, the prognosis of mesenteric venous thrombosis is often favorable

Assessment of iron status in anemic children with chronic kidney disease

Iron deficiency is the commonest cause of resistance to erythropoiesis stimulating agents [ESAs] in dialyzed children treated from anemia of chronic kidney disease [CKD]. This study was conducted in order to evaluate the significance of different biomarkers in assessment of iron status during management of anemic children with CKD. Twenty five children with diagnosis of anemia of chronic kidney disease were enrolled for the study. They were classified into two groups according to their stage of the kidney disease. Group I; included 15 children with anemia of CKD and their Glomerular Filtration Rate [GFR] was 15.5 - 29.6 ml/min/1.73m[2] [stages; III and IV CKD] and they were managed conservatively. Group II; It included 10 anemic children with end stage renal disease [Stage V CKD, GFR was 6.1 - 13.7 ml/min/1.73m[2]] and they were under regular hemodialysis. Another 10 healthy children with matched age and gender served as control group [group III]. The study showed that the hypochromic cell percentage was significantly higher in both groups I and II before treatment when compared to controls [p <0.0001]. Serum ferritin showed very high significant elevation in all the studied groups as compared to controls, also group II was highly significant when compared with group I before treatment. Improvement of iron mobilization and metabolism after 8 weeks of therapy with intravenous iron and erythropoietin was evidenced by significant increase in hemoglobin [Hb] level, RBCs and HCT% when comparing the group II patients before and after treatment. Also significant decrease in hypochromic cell percentage and increase in serum ferritin were proved. The sTfR and sTfR/ F indices showed elevation in the post-treatment group. No single biomarker is reliable alone in the assessment and monitoring the iron status in anemic patients with CKD under ESAs therapy. Measurement of hypochromic cell percentage may be simple and reliable method, and sTfR represents a valuable quantitative assay of marrow erythropoietic activity as well as a marker of tissue iron deficiency. However, the sTfR / Ferritin index is considered to be more efficient in anemic patients with CKD for early prediction of functional iron deficiency and is a sensitive tool for follow up of iron status during ESAs therapy

Diagnostic and screening utility of biochemical markers for osteoporosis and osteopenia in Saudi women

Postmenopausal osteoporosis is a major health problem worldwide and in Saudi Arabia as it leads to bone fragility and increased liability for fragile fractures, particularly in neck of femur and vertebrae. The present study was designed to determine the value of different screening tests to find out the most sensitive serum and urinary markers of osteoporosis among Saudi women and to clarify the relationship between E[2] deficiency and these markers in peri-menopause, early or postmenopausal women without hormonal replacement therapy. This study included 37 Saudi women aged 40 to 60 years. They were categorized into 3 groups according to their bone mineral density [BMD]: Group I: 15 Normal control [T-score up to -1.5], Group II: 12 Osteopenic women [T-score between -1.5 to 2.5]and Group III:10 Osteoporotic women [T-score below 2.5]. For all subjects, dual energy X-ray absorptiometry [DEXA] was performed. Osteocalcin [OC], alkaline phosphatase [ALP], free galactosyl hydroxylysine [Gal-Hyl], calcium [Ca], inorganic phosphorus [P] and estradiol [E[2]] were measured in serum, whereas, deoxypyridinoline [Dpd] and creatinine levels were measured in urine. Simultaneously both osteopenic and osteoporotic groups showed significant decreases in BMD when compared to the controls. Osteocalcin, ALP and Gal-Hyl showed significant increase [p<0.0001] among the osteopenic and osteoporotic groups versus the control group. Significant decrease in E[2] levels were obvious among the osteopenic [p<0.0001] and osteoporotic [p<0.0001] women when judged against the controls. Urinary Dpd was significantly increased in the osteopenic and osteoporotic groups [p<0.001]. In osteoporotic group, significant negative correlations were observed between OC and BMD. Positive correlations were detected among the osteoporotic group between OC and ALP and between OC and Gal-Hyl. High significant negative correlations were confirmed between E[2] and OC among both the osteopenic and the osteoporotic groups. Also, a significant negative correlation was established between E[2] and Dpd in the osteoporotic group. In comparing between osteopenic and osteoporotic groups, significant decrease was recognized in BMD and significant increase was predicted regarding ALP, [p<0.05], Gal-Hyl [p<0.0001] and Dpd [p< 0.001]. Urinary Dpd may be a simple indicator for osteoporosis in postmenopausal women; however, screening should include the measurement of serum estradiol, galactosyl hydroxylysine, alkaline phosphatase and Osteocalcin to increase the sensitivity and specificity of primary screening to identify the groups at higher risk of osteoporosis which is the keystone in prevention of disabling fragility fractures