Anorectal dysfunctions in diabetic autonomic neuropathy and microangiopathy

Disturbed motility may explain gastrointestinal symptoms of patients with diabetic neuropathy. This study investigates the anorectal dysfunctions in diabetic autonomic neuropathy [DAN] and microangiopathy. The study includes 47 diabetic patients [group 1: 30 non-complicated; group 2: 17 complicated by DAN and microangiopathy] and 10 healthy non-diabetic volunteers as control subjects. Following medical history, clinical examination and laboratory investigations, the included patients were subjected to sigmoidoscopy with mucosal biopsy and anorectal manometry. The lower gastrointestinal symptoms [e.g., constipation, diarrhoea or faecal incontinence] were reported more in group 2 [complicated diabetic patients] than in group 1 [non-complicated diabetic patients] [p=0.003]. Group 2 patients had significantly higher fasting blood glucose, serum uric acid, serum creatinine and triglycerides than group 1 patients [p=0.001, 0.03, 0.04,<0.001, respectively]. Overall, diabetic patients had lower resting anal pressure [p=0.004], squeeze pressure [p=0.007], and higher thresholds of minimal rectal sensation and sense of desire for defaecation [all p<0.001] when compared to control subjects. Group 2 patients had lower resting anal pressure [p<0.001], squeeze pressure [p=0.02], and higher thresholds of minimal rectal sensation [p<0.001], sense of desire for defaecation [p=0.009] and maximum tolerable volume [p=0.002] than group 1 patients. Group 2b [patients with DAN and microaniopathy] had significantly lower resting anal pressure than group 2a [patients with DAN] [p=0.001]. Anorectal dysfunctions occur in diabetic patients particularly when complicated by autonomic neuropathy and microangiopathy

Hematological changes in malaria: relation to plasmodium species

To evaluate different hematological changes in patients with malaria and to establish a possible role of Plasmodium species in the pathogenesis of these changes. Hematological changes were prospectively studied in randomly selected patients, immediately on admission and on a daily basis after starting anti-malarial treatment. Infectious Diseases Hospital, Kuwait, during the year 2004. The study enrolled 103 patients with malaria, [37 infected with Plasmodium falciparum, 34 infected with Plasmodium vivax, and 32 infected with both species i.e., mixed infections]. Antimalarial drugs Beside history taking, clinical examination, and routine laboratory work, thick and thin blood films were prepared and examined from all patients for defining the species involved. In addition, blood picture [red and white blood cells, platelets, and reticulocytes] was studied in all patients. Anemia and thrombocytopenia were the two most important hematological abnormalities seen in cases of acute malaria infection. The degree of anemia was related more to P. falciparum infection, while, thrombocytopenia was associated with P. vivax infection and mixed infections. Hematological changes were mild in the first 24 hours, but continued to deteriorate for few days after anti-malarial therapy. One P. falciparum infection was associated with severe hematologic abnormalities, disseminated intravascular coagulopathy [DIC], and acute respiratory distress syndrome [ARDS]. We recommend that subsequent checkup of blood cells and platelets are of utmost importance particularly in cases infected with P. falciparum or mixed infections

Role of the size of circulating immune complexes in pathogensis of hepatitis C virus infection

For assessing the role of the size of circulating immune complexes [ClC] in the pathogenesis of hepatitis C virus infection [HCV],immunoglobulin-specific CICs were determined in 32 patients and 10 healthy control.Group [l]: 10 patients with chronic hepatitis C, group [2]: formed of 7 patients with schistosomiasis alone,and group [3]: included 15 patients with dual HCV and schistosomiasis.Clq-CIC, IgA, IgG, and IgM containing CIC were studied using radial immunodiffusion technique after precipitating the immune complexes with polyethylene glycol [Medic assay].Our results showed that all types of the studied CIC were significantly higher in the three patients groups than control [p=0.000].On comparing the CIC in the three groups,both IgG-CIC and IgM-CIC were predominant,and highest in those affected by mixed HCV and schistosomiasis.Further analysis demonstrated that lgG-CIC correlates with liver aminotransferases in patients with hepatitis C infection.Thus, we concluded that an immune-mediated mechanism related to the small sized IgG-CIC might have a role in the pathogenesis of hepatitis C virus infection