Oxidative stress markers as early predictors of diabetes complications in Type 2 diabetic patients

Objectives: Type 2 diabetes mellitus (T2DM) is a complex disease that affects many organs. Oxidative stress plays a key role in the pathogenesis of insulin resistance and ?-cell dysfunction. Thus, the present study aimed to use oxidative stress markers as early predictors for the progression of diabetic complications. Materials and Methods: The study sample included 400 individuals (300 T2DM and 100 non-diabetic controls) aged from 35 to 59 years randomly selected from the outpatient clinic of the National Institute for Diabetes and Endocrinology. T2DM patients were divided into subgroups: Subgroup (1) patients without any complications, Subgroup (2) patients with diabetic nephropathy(DN) and Subgroup (3) patients with cardiovascular disorders (CVD). Biochemical markers of fasting blood glucose, glycated haemoglobin (HbA1C), glucose-6-phosphate dehydrogenase (G6PD), lactate, arginase, heme oxygenase-1 (HO-1), haemoglobin (Hb), triglycerides (TG), cholesterol, low-density lipoprotein (LDL-C), high-density lipoprotein (HDL-C), urea, creatinine, malondialdehyde (MDA), reduced glutathione (GSH), catalase (CAT) and nitric oxide (NO) were performed. Results: DM patients showed significant increases in body mass index, systolic blood pressure, diastolic blood pressure, FBS, HbA1C, cholesterol, TG, LDL-C and glomerular filtration rate, while HDL-C decreased. Significant increases were observed in HO-1, MDA and NO, while G6PD/lactate, GSH and CAT decreased in DM patients. The DN and CVD patients exhibited a significant increase in HO-1, MDA and NO; while G6PD/lactate, GSH and CAT decreased compared with DM patients. Receiver operating characteristic analysis showed that the sensitivity and specificity of oxidative stress markers were 66.67–100%. Conclusion: Hexose monophosphate (HMP)/glycolysis pathways are shifted during DM near glycolysis rather than HMP pathway to produce energy where the amount of glucose enters the cells is low, causing oxidative stress. Oxidative stress markers could be used as early predictors of diabetes complications.

Khat-induced liver injuries: a report of two cases

Khat is consumed for recreational purposes in many countries, including Yemen, where >50% of adults chew khat leaves regularly. A wide spectrum of khat-induced liver injuries has been reported in the literature. Herein, we report two patients with khat-induced liver injury. Both patients clinically presented with acute hepatitis, one of whom showed radiological evidence of hepatic outflow obstruction. Based on the histological tests, both patients had acute hepatitis, which indicated drug-induced liver injury [DILI] on a background of chronic hepatitis and portal fibrosis; of the two, one presented with symptoms of immune-mediated liver injury

Laparoscopic treatment of common bile duct stones: [single stage] laparoscopic approach to cholelithiasis and choledocholithiasis

Treatment options of CBD stones include selective pre or postoperative ERCP, open choledochotomy and one-stage laparoscopic clearance. There are several disadvantages to ERCP including the additional invasiveness of endoscopic procedures, moreover large and/or multiple stones, or impacted stones in CBD may be difficult or impossible to retrieve at ERCP even with ES [endoscopic sphincterotomy]. Peroperative real time cholangiography has the advantage of addressing choledocholithiasis with a single procedure LCBDE [Laparoscopic Common Bile Duct Exploration] while leaving the sphincter of Oddi anatomically intact without added morbidity. The choice of treatment between immediate laparoscopic common bile duct exploration, open exploration of CBD and transsphincteric endoscopic retrieval depends on many factors. A prospective study was designed to visualize and examine the biliary ductal system by laparoscopic intra-operative cholangiography [IOC] during laparoscopic cholecystectomy [LC]. The aim was to visualize the ductal anatomy and any anomalies on filling with contrast [to avoid biliary injury], detect any CBD stones and assess the ductal emptying and patency of ampulla of Vater by immediate contrast flow through the papilla into the duodenum. Intraoperative cholangiography was performed for 302 patients underwent LC for chronic calcular cholecystitis [CCC] in Benha University Hospital from Dec. 1999 to Jan 2004. Among 302 patients underwent LC and intraoperative real-time cholangiography, 31 patients [11.3%] were harbouring silent CBD stones managed immediately for CBD clearance. LCBDE was feasible in 23/31 cases who had choledecholithiasis [74.2%], while 8 patients needed conversion to open choledochotomy. 28 patients [9.3%] had preoperative ERCP, endoscopic sphincterotomy [ES], stone retrieval Operative cholangiography during LC proved residual stones in CBD in 2 of them [7.1%] and were treated by open choledochotomy. LCBDE approach is safe, feasible and effective in management of CBD stones and carries low morbidity and mortality. It has the advantage of intraoperative diagnosis and treatment of choledocholithiasis as a [one step] procedure

Anterior endoscopic spine surgery. A new technique and early results

Endoscopic procedures have been widely used in general surgery for appendicectomy, cholecystectomy and hernia repairs. Video-assisted thoracic surgery is widely applied for pleural biopsy, lung resections and sympathectomy. From the beginning of the last decade endoscopic techniques started to be applied to spine surgery. Indications are increasing, instrumentations and techniques are rapidly refined. This study includes our early experience using these techniques. The study includes 6 cases of anterior spinal release for scoliosis, 2 cases of drainage of tuberculous thoracic cold abscesses, 2 cases of laparoscopic L[5]-S[1] fusion by bone grafts for non-specific discitis and 6 cases of complementary anterior fusion [4 cases for spondylolisthesis and 2 cases for post-laminectomy instability] by threaded cages. The techniques are briefly described; difficulties and complications and early results are discussed

Kaposi's sarcoma: a frequent cause of refractory blood diarrhea in Ugandan patients with AIDS

Between 1990-1992 we performed colonoscopy and biopsy on 123 sequential patients with CDC Group IVC AIDS seen at Mulago Hospital, Kampala, who had persistent bloody diarrhea in excess on one month despite antibiotic treatment. Kaposi's sarcoma-like lesions were noted in 69 [56%]. The lesions were predominantly macular in morphology, localized to the rectosigmoid and ascending colon, and bled easily. Kaposi's sarcoma [KS] was confirmed histologically in 56 [81%] of these patients. Inability to confirm the histology in the remaining 13 patients was attributed to the submucosal location of KS, inaccessible to the biopsy forcepsd. All patients with colonic Kaposi's sarcoma also had KS in the lesions in the skin and/or mouth. Inflammatory and granulomatous abnormalities were noted in 103 patients, accompanied by non-specific histological changes. Stool pathogenes were identified as follows: Cryptosporidium 65 patients; Strongy-Ioides stercoralis 37 patients; Giardia lamblia 8 patients; Entameba histolytica 6 patients; and Ancylostoma 5 patients. Multiple pathogens were seen in some patients. There were no correlations between the individual pathogens, gross or microscopic abnormalities, and the Kaposi's sarcoma-like lesions. Colonic Kaposi's sarcoma was strongly associated with bloody diarrhea in AIDS patients in Uganda

Adult cerebral malaria and HIV infection

In Mulago Hospital, Kampala, Uganda, 73 adult patients with cerebral malaria were screened for HIV antibodies. Thirteen patients were HIV seropositive and 60 patients were HIV negative. There were no significant differences between HIV positive and negative cases concerning depth and duration of coma, response to treatment and neurological outcome. However, HIV positive patients with cerebral malaria run a different clinical course. They showed significantly more recurrent short febrile illnesses before admission in coma and longer duration of fever before presentation. HIV positive patients had significantly more convulsive episodes during coma than HIV negative patients [OR = 4.4 [10.09 - 13.6], P < 0.0051]. Oral candidiasis was only reported in 6 [46%] patients. All were HIV positive. At time of recovery from coma, HIV patients had significantly lower total white cell count [p < 0.005]. We believe that these differences reflect the impact of each infection on the other. We think that frequent malaria attacks in an adult living in endemic area should rise the suspicion of underlying HIV infection