Prospective evaluation of the effect of short-term oral vitamin D supplementation on peripheral neuropathy in type 2 diabetes mellitus

We aimed to assess the efficacy of short-term oral vitamin D supplementation on peripheral neuropathy in patients with type 2 diabetes. Materials and This prospective, placebo-controlled trial included 112 type 2 diabetic patients with diabetic peripheral neuropathy [DPN] and vitamin D [25[OH]D] deficiency. Patients were sequentially assigned to a treatment group [n = 57] and a placebo group [n = 55]. DPN was assessed using a neuropathy symptom score [NSS], a neuropathy disability score [NDS] and a nerve conduction study [NCS]. Vitamin D status was determined by measuring the serum total 25[OH]D concentration. Patients received either oral vitamin D[3] capsules or starch capsules once weekly for 8 weeks. The primary outcome was changes in NSS and NDS from baseline. The secondary outcome was changes in the NCS result. Serum 25[OH]D concentrations significantly improved after oral vitamin D supplementation in the treatment group when compared to the placebo group [32.8 +/- 23.7 vs. 1.1 +/- 3.6, p < 0.0001]. Similarly, the improvement in NSS values was significantly greater in the treatment group than in the placebo group [-1.49 +/- 1.37 vs. -0.20 +/- 0.59, p < 0.001]. No improvement was observed for NDS and NCS between the 2 groups after treatment. Short-term oral vitamin D[3] supplementation improved vitamin D status and the symptoms of neuropathy in patients with type 2 diabetes

Transthoracic echocardiography and 6-minute walk test in Kuwaiti sickle cell disease patients

The aim of this study was to investigate cardiac abnormalities in Kuwaiti sickle cell disease [SCD] patients using markers such as tricuspid regurgitant jet velocity [TRJV], pulmonary artery systolic pressure [PASP], and the 6-minute walk [6MW] test and correlate these findings with clinical, hematological, and biochemical parameters. Seventy-three patients with SCD and 70 matched controls were studied. The cardiac status was investigated using transthoracic echocardiography in 57 patients; the 6MW test was carried out in patients and controls. Complete blood counts and hemolytic parameters were assessed. Reticulocytes, bilirubin, and lactate dehydrogenase were significantly higher [p < 0.0001] in patients, while hemoglobin [Hb] and haptoglobin were lower [p < 0.0001] than in controls. The mean fetal Hb among patients was 15.85 +/- 8.7%. Of the 57 patients, 14 [24.5%] and 15 [26%] had mild tricuspid and mitral regurgitation, respectively. The mean ejection fraction, TRJV, and PASP were 63.9 +/- 6.3%, 1.7 +/- 0.5 m/s, and 23.0 +/- 7.3 mm Hg, respectively. Three [5.2%] patients had mildly raised TRJV [2.6-2.97 m/s, normal range <2.5 m/s] while 8 [14%] had high PASP [mean 35.3 +/- 5.1 mm Hg, normal range <30 mm Hg]. Hb, hematocrit, and reticulocytes were different [p = 0.010, p = 0.006, and p = 0.011, respectively] between patients with normal and high PASP. All 3 patients who had a high TRJV had a high PASP, and 2 of these patients died during follow-up. The systolic and diastolic blood pressure, oxygen saturation before and after the 6MW test, and distance walked were lower [p = 0.006, p = 0.000, p = 0.002, p = 0.000, and p = 0.000, respectively] in patients compared to controls. Raised PASP was common in Kuwaiti SCD patients while raised TRJV was not

Determinants and associations of homocysteine and prothrombotic risk factors in Kuwaiti patients with cerebrovascular accident

The objective ofthis study was to evaluate the determinants and associations of some prothrombotic risk factors in patients with cerebrovascular accidents [CVAs]. In this case-control study, plasma total homocysteine [tHcy], lupus anticoagulant, protein C, protein S, activated protein C resistance [APC-R] and antithrombin were measured in 102 patients [60 males and 42 females] and 167 controls [87 males, 80 females]. Serum vitamin B[12], folate, red cell folate, creatinine, lipid profile and glucose were also determined. Glomerular filtration rate [GFR] was calculated.13 [22%] of the 60 male patients, and 16 [39%] of the 42 female patients had hyperhomocysteinemia. Median [interquartile range] tHcy was higher in male patients [11.22 Mu mol/l [9.60-15.40]] than female patients [10.05 Mu mol/l [8.72-17.54]]. On binary logistic regression analysis, the significant [p < 0.05] determinants of tHcy were urea, creatinine and GFR. Comparing patients with control subjects showed that tHcy, age, fasting glucose, urea, serum creatinine, white blood cell count, protein S, APC-R and factor VIII were significantly higher, while protein C, factor II, total cholesterol, high-density lipoprotein cholesterol and low-density lipoprotein cholesterol were significantly lower in patients. Lupus anticoagulant was not associated with tHcy and not detected in patients and controls. Low concentrations of vitamins B[12] and folate were not associated with tHcy. Logistic regression analysis showed a significant association of tHcy with CVA [OR = 9.55; p = 0.047] in males in the presence of other traditional CVA risk factors but tHcy is not independently associated with CVA in females. Hyperhomocysteinemia is common in Kuwaiti patients with CVA and tHcy probably interacts with prothrombotic factors [protein C, APC-R and factor VIII] to increase CVA risk. The main determinants, age and GFR markers, should be kept in mind when determining the risk associated with tHcy

Reference intervals for important serum sex steroid hormones, prostate specific antigen, insulin like growth factor 1 and IGF binding protein 3 concentration in a normal Kuwaiti adult male population

The purpose of this study was to determine the age-specific reference ranges for some important male sex steroid hormones, prostate-specific antigen [PSA], insulin-like growth factor-1 [IGF-1], and IGF binding protein-3 [IGFBP-3], for the Kuwaiti population. Blood samples were taken from 398 consenting, fasting, healthy Kuwaiti males aged 15-80 years between 8.00 a.m. and 12.00 noon. The serum concentrations of total testosterone [TT], dehydro-epiandrosterone sulfate [DHEAS], androstenedione [ADT], sex hormone binding globulin, luteinizing hormone [LH], follicle-stimulating hormone [FSH], prolactin, PSA, IGF-1 and IGFBP-3 were determined. A distribution curve was plotted and age-specific reference levels were determined for each analyte. The reference interval for parameters with a normal distribution [Gaussian] was mean +/- 2 SD, while for the non-normal distribution [non-Gaussian], it was 2.5-97.5 percentile. The reference intervals for the analytes obtained from this study were compared with those suggested by the kit manufacturers and currently used by the Ministry of Health, Kuwait Laboratories [MOHKL]. Serum IGFBP-3 and ADT had normal distribution while other analytes had non-normal distribution. The reference intervals from this study, manufacturers kit and MOHKL were as follows: TT 3-31, 9-60, 8-35 nmol/l; DHEAS 0.9-11, 1.0-7.3, 2.2- 15.2 micro mol/l; ADT 0.5-4.3, 0.8-2.8, 2.0-9.2 nmol/l; LH 1-11, 0.8-7.6, 0.4-5.7 mIU/l; FSH 0.5-11, 0.7-11.1, 1.1-13.5 mIU/l; prolactin 42-397, 53-360, 80-230 nmol/l; IGF-1 41-542, 78-956, 71-261 ng/ml; IGFBP-3 88- 2,090, 900-4,000, 900-4,000 ng/ml, and PSA 0-3.1, 0-4, 0-4 ng/ml, respectively. These data indicate that for Kuwaitis lower reference ranges must be used for serum TT, DHEAS, ADT, IGFBP-3 and PSA. There is no need to change the currently used reference interval for FSH whereas higher values must be used for LH, prolactin, and IGF-1