Plasma level of Von willebrand factor in type 2 diabetics with cerebrovascular stroke, with and without microalbuminuria

The risk of cerebrovascular stroke is known to be markedly elevated in patients with long duration of type 2 diabetes mellitus[1] . Diabetes mellitus is a risk factor for ischemic stroke, and is assosciated with higher mortality and worse functional outcome[2]. Microalbuminuria is associated with cardiovascular morbidity and mortality in patients with type 2 diabetes mellitus[3] Links between endothelial dysfunction [elevated level of Von Willebrand Factor], atherosclerosis and diabetes mellitus have been increasingly recognized. One of the earliest discernible atherogenic changes in diabetes is endothelial dysfunction. The aim of the present study is to examine the concept suggesting that microaluminuria in combination with high level of plasma Von Willebrand factor [as a marker of endothelial dysfunction] is a strong predictor for macrovascular disease [evidence by stroke] than microalbuminuria alone in type 2 diabetic patients. The study group consisted of thirty normotensive, non smoking diabetic patients with normal renal function selected from the internal medicine outpatient clinic of Kasr El A ini hospital. They were divided into two groups: group [l] included 10 type 2 diabetic patients with cerebrovascular stroke [6 males and 4 females], with a mean age 56 +/- 8.39 years [range 43-69 years],mean diabetic duration 11.6 +/- 3.7 years . Group [2] included 20 type 2 diabetic patients without cerebrovascular stroke [9 males and 11 females] with a mean age 55.5 +/- 8.57 years [range 43-69 years], mean diabetic duration 5.7 +/- 2.6years .Ten age, sex and weight matched healthy subjects [4male and 6 female] with a mean age 52 +/- 7.1 years [range 43-62 years] were included as a control group. Urinary albumin excretion, was assessed qualitatively using the micral test [Boehringer Manheim, Germany] and quantitatively using double antibody albumin procedure.Plasma level of von- Willebrand factor using ELISA procedures to measure vWf:Ag generally expressed in relative percent [%] as compared to pooled normal plasma . Carotid IMT was evaluated using high resolution B-modeUltrasonography. Ten diabetic patients with cerebrovascular stroke had a significant higher fasting [p= 0.0001], postprandial blood glucose [p=0.0001], cholesterol [0.001], triglycerides [p-0.02], low denisty lipoprotein [p=0.01], microalbuminuria [74.689 +/- 66.24 vs 4.166 +/- 5.6 U gm /min, p=0.003], plasma level of vWf [190.0 +/- 22.60 vs 85.50 +/- 23.74%, p=0.002] and carotid artery IMT [1.14 +/- 0.388 vs 0.4 +/- 0.06 mm, p=0.001] compared to the control group [10 subjects]. Diabetic patients with cerebrovascular-stroke [group 1] had significantly higher vWF [190.0 +/- 22.60 vs 153.35 +/- 22.7%,p=0.05], carotid IMT [1.14 +/- 0.388 vs 0.9 +/- 0.45 mm, p= p=0.04], low density lipoprotein [79.1 +/- 53.19 vs 53 .05 +/- 23.11 mg/dl, p=0.002] as well as fasting [p=0.05] and post prandial blood glucose [p=0.009], compared to twenty uncomplicated diabetic patients [group 2].Six diabetic patients with stroke and microaluminuria had a significant higher level of vWf [190.83 +/- 21.07 vs 93.750 +/- 14.36, p= 0.003], carotid IMT [p=0.009] low density lipoprotein [p=0.001], as well as fasting [p= 0.008], post prandial blood glucose [p=0.001], Cholesterol [p=0.03] and triglyceride level [p=0.04] compared to four diabetic patients with stroke but without microalbumiuria .Diabetic patients with stroke and microalbuminuria [6 patients] had a significant higher vWf level [190.83 +/- 21.07 vs 102.45 +/- 17.8%, p=0.04], low dinesty lipoprotiens [114.67 +/- 35.66 vs 67.64 +/- 13.17 mg/dl, p=0.002] fasting [0.008] and post prandial blood glucose [0.003] compared to 11 microalbuminuric type 2 diabetic patients. Diabetic patients with stroke and microalbuminuria [6 patients] had a significant higher vWf [190.83 +/- 21.07 vs 98.55 +/- 19.6% p=0.027], low dinesty lipoproteins [114.67 +/- 35.66 vs 35.22 +/- 20 mg/dl, p=0.0001], fasting, post prandial blood glucose, cholesterol and triglycerides levels compared to type 2 diabetic patients without stroke or microalbuminuria [9 patients]. Correltion between vWf and other risk factors in type 2 diabetic patients showed a positive correlation to Fasting, posprandial blood glucose, low denidty lipoprotein, microalbuminuria and intima media thickness. The results of this study indicate that among type 2 diabetic patients with MA, those with higher plasma levels of vWf have greater risk of macrovascular disease, so the risk of cerebrovascular stroke among microalbuminuric type 2 diabetic patients is much higher in association with high level of plasma Von Willebrand factor and low denisty lipoprotein than when these factors are absent, and we recommend measurement of plasma Von Willebrand factor in type 2 diabetic patients as a predictor of macrovascular complication . We also recommend mandatory measurement of low density lipoprotein cholesterol level in type 2 diabetic patients to help in prevention of cerebrovascular stroke

Elevated plasma level of von wbllebrand factor and the risk of macrovascular disease in type 2 diabetics with microalbuminuria

Microalbuminuria [MA] is indicative of generalized vascular disease and is related to carotid intima-media thickness [IMT] -which is a marker of macrovascular disease[1]. In this study, we investigated the role of high plasma level of von Mile brand factor [vWJ], as a marker of endothelial dysfunction, in predicting macrovascular disease in type 2 diabetic patients with microalbuminuria. The study group consisted of 30 non- smoking, normotensive type 2 diabetic patients with normal renal function. They were all recruited from the medical outpatient clinic at Kasr El Aini hospital, Cairo University. They were divided into two groups: Group [1]: included 17 [10 male and 7 female] patients with MA[mean age of 56 +/- 8.4, mean diabetes duration 11.6 +/- 3.7 years, mean body mass index " BMI" 30.2 +/- 5.4kg/m[2]], Group[2]: included 13 [5 male and 8 female] patients without MA [mean age 55.5 +/- 8.6years, mean diabetes duration 5.7 +/- 2.6years, mean BMI 29.6 +/- 6.7 kg/m[2]]. Urinary albumin excretion was assessed both qualitatively and quantitatively .Plasma level of vWf was expressed in relative percent [%] as compared to pooled normal plasma. Carotid IMT was evaluated using high resolution B-mode Ultrasonography. Ten age, sex and weight matched normal subjects were included in the study as a control group. Plasma level of vWf was significantly elevated in the study group compared to the control one [182.2 +/- 22.4 vs 85.5 +/- 23.7%, P=0.0001]. Carotid IMT was also significantly higher in type 2 diabetic patients compared to the control group [0.724 +/- 0.421 vs 0.40 +/- 0.06 mm, P=0.0001]. Among the study group, plasma level of vWf was higher in group [1] compared to group [2] [198.5 +/- 23.5 vs 106.0 +/- 20.0%, p=0.001] .Also, carotid IMT was higher in group [1] compared to group [2][0.975 +/- 0.338 vs 0.580 +/- 0.103 mm, p=0.001] .In group [1], there was a positive correlation between plasma level of vWf and fasting blood glucose [r=0.47, p=0.01], post prandial blood glucose [r=0.51, p= 0.01], glycated haemoglobin [r=0.49, p=0.01] .total cholesterol [r= 0.42, p=0.04], triglycerides [r=0.41,p=0.04], MA[r=0.52,p=0.001] and carotid IMT [r=0.61, p=0.0001]. Patients with retinopathy [18 patients] had a significantly higher age, duration of the disease, fasting and post prandial blood glucose, microalbuminuria, intima media thickness [0.8 +/- 0.5 vs 0.2 +/- 0.3mm, P=0.01] and von Willebrand factor [199.8 +/- 2 3.7vs 105.8 +/- 20.65, P=0.04], and a significant lower level of high density lipoprotein[37.055 + 8.814 vs 43.91 +/- 8.106 mg/dl, p= .039], compared to the diabetic group with normal fundi [12 patients].Multiple regression analysis showed that the determinants of carotid IMT in the study group were disease duration [p=0.01], triglycerides [p=0.01], MA[P=0.001], plasma level of vWf [P=0.001] and retinopathy [p=0.01]. The results of this study indicate that among type 2 diabetic patients with MA, those with higher plasma levels of vWf have greater risk of macrovascular disease. Analysis of the results also proves that plasma level of vWf is an independent risk factor for macrovascular disease in type 2 diabetic patients. Measurement of plasma level of vWf would be helpful in assessing the risk of macrovascular disease in those patients

Thrombin-antithrombin complex in normal pregnancy and pre-eclampsia

Normal pregnancy has a remarkable influence on coagulation and fibrinolytic systems. It leads to a state of hypercoagulability and thrombophilia. Moreover, this work was a trial to access the state of hypercoagulability and thrombophilia faced with pregnancy and compare the degree of this state with that found in preeclampsia using the assay of thrombin antithrombin [TAT] complex level. This complex is considered as one of the most sensitive, reliable and accurate parameter that gives an early, specific monitor for coagulation activation. Forty females were included [10 controls, 15 normal pregnants and 15 preeclamptic], TAT level was assayed for all females. All pregnants showed a hypercoagulable state associating the enhanced thrombin generation and high TAT complex level. This increase occurred in late normal pregnancy and became more evident in preeclamptics with a higher risk of thrombosis. This risk was positively correlated to the severity of the disease as monitored by the arterial blood pressure

HBV and HCV among volunteer blood donors

During the period between April 1992 and May 1995, 3576 volunteer blood donors had their sera tested for: HBsAg, HCV [antibodies] by ELISA II and ALT. Sera with high ALT were retested for: ASA, AMA and Anti Bilharzial Antibodies. 80 volunteers were HBsAg positive [2.2%], among them only 3 cases [3.8%] had their ALT elevated. HCV antibodies were +ve in 312 [8.7%] volunteers, among them 39 cases had elevated ALT [12.6%]. 28 cases had their sera positive for both HBsAg and HCV Ab [0.8%], among them 4 cases had elevated ALT [14.3%]. 6 cases had their ALT elevated with all other tests -ve [HBsAg, HCV Ab, ASA, AMA and Anti Bilharzial Ab]. 1. There is significant reduction in the prevalence rate of HBV among Egyptians reflecting a significant increase in the health services. 2. Prevalence rate of HCV among the tested sample is much lower than previously recorded rates and this clarify the urgent need for a national project to estimate the true prevalence of HCV among different communities as it looks that the differences in the prevalence rate of HCV are due to the difference in the tested samples. 3. Most of HCV antibodies positive cases might be either: inactive cases or carriers. 4. ALT testing should not be used as a lone test for blood transfusion safety as most cases with HCV +ve antibodies had their ALT normal. 5. There is a possibility of the presence of Non -B Non-C virus among Egyptian blood donors. HBsAg = Hepatitis B Surface Antigen. HCV = Hepatitis C Virus. ALT = Alanine Amino-Transferase. ASA= Anti-Smooth Muscle Antibodies. AMA = Anti-Mitochondrial Antibodies. Ab = Antibody

effects of acute smoking on plasminogen activators and plasminogen activator inhibitors in habitual smokers

There is increased drequency of arterial thrombosic in cigarette smokers. The relation between making and thrombosis has studied by many authors. The changes in the fibrinolytic system seen in our subjects have been studied by many authors but the results are not always in agreement. We wished to study some the effect of acute smoking on the activity of plasminogen activity [PA] and plasminogen activator inhibitor [PAI]. Ten apparently healthy male smoking volunteers were investigated together with 10 non-smoking controls matched for sex and age. All smoking subjects had smoked 15-20 cigarettes per day for at least the previous four years. They had abstained from smoking in the 10 hours preceding the test. Each subject had smoked 3 cigarettes over 3 minules. Immediately before and after smoking, body was sampled for evaluation of both PA and PAI. The baseline salute obtained before smoking were compared with values obtained after smoking and with values of non smokers. Comparison between smokers before smoking and in smokers showed non significant different in PAA and PAI. Comparison between smokers before and after smoking of 3 cigarettes [i.e. effect] of acute smoking], showed a significant decrease n PA, but a non difference in PAI. Comparison between smokers after smoking with non-smokers showed a decrease in PA, though insignificant, and a non significant difference in PAI. We can conclude that this acute decrease of PA may be a serious cause inducing thrombosis events, and this decrease may cause endothelial damage secondary to smoking

Plasma fibrinogen and factor XIII in chronic renal failure

The study was conducted on 40 individual: ten patients with chronic renal failure [CRF] on conservative treatment [group I], 20 patients with end stage renal disease [E.S.R.D] undergoing regular hemodialysis [group II], and 10 normal contorls. All subjects were subjected to estimation of serum creatinine, plasma fibrinogen level and assay of plasma factor XIII activity. Comparison between control group and each of group I and II have shown significant increase in plasma fibrinogen and significant decrease in plasma factor XIII activitiy in both groups of patients [I and II]. Comparison between both groups of patients [I and II] has shown that there was no significant change in all parameters studied between them. The increased plasma fibrinogen level found in our work may be due to the fact that it is an acute phase reactant protein, while the decreased factor XIII activity may be due to consumption destruction, diminished synthesis or the presence of circulating uremic inhibitor