Insulin-like growth factor [IGF] -1, IGF-II, IGF-binding protein -1 [IGFBP-1] and IGFBP-3 in children with insulin dependent diabetes mellitus

The existing literature on serum insulin like growth factors [IGFs] and their binding proteins [IGFBPs] levels in insulin dependent diabetes mellitus [IDDM] is conflicting. In the present study, 44 children and adolescents with IDDM [22 newly diagnosed and 22 old known cases] aged from 5 to 14 years, 18 girls and 26 boys, together with 18 apparently healthy control children of matchable age and sex were subjected to estimation of serum levels of IGF-I, IGF II, IGFBP-1, IGFBP-3 and fasting serum glucose. Glycemic control was assessed by glycosylated hemoglobin [HbA[1C]]. Diabetic children showed significantly lower serum levels of IGF-I, IGF-II and IGFBP-3 [p<0.01, p<0.01 and p<0.001 respectively] and significantly higher levels of IGFBP-1 [p<0.05] than controls. This was true for the diabetic cases in general, for newly diagnosed cases and for those with poor metabolic control. Old diabetic cases and patients with average glycemic control differed from the control children only regarding IGF-II [p<0.001 for both] and regarding IGFBP-3 [p<0.001] and p<0.05 respectively]. While prepubertal cases showed significantly lower IGF-I than controls [p<0.05], pubertal cases lacked this difference. IGF-I levels were negatively correlated with each of HbA[1C] [r=-0.52, p<0.001] and IGFBP-1 [r=-0.45, p<0.002], and were positively correlated with each of IGFBP 3 [r=0.31, p<0.05] and body mass index [BMI] [r=0.43, p<0.004]. IGFBP-1 levels were positively correlated with fasting serum glucose [r=0.46, p<0.002]. In conclusion, alterations in the IGF/IGFBP system are observed in children with IDDM in the present study. Improvement of glycemic control may help to decrease this alteration. The impact of these alterations on the health of diabetic children is still unsettled

Vaso-active mediators and doppler indices in maternal and fetal vessels in pre-eclampsia

Pre-eclampsia is associated with increased vascular reactivity and vasoconstriction. Forty six women whose pregnancy were complicated with pre-eclampsia and twenty six normotensive pregnant women all at the same duration of pregnancy were studied. Pre-eclampsia occurred in the 2nd trimester only in two patients, in the sometime it occurred in 28 patients before the 37th weeks and 16 after the 37th weeks. Only eight patients were with moderate hypertension, while 38 patients were with severe disease. Blood flow velocity waveforms in both right and left uterine arteries, fetal umbilical artery and fetal descending aorta was done for both patients and controls. Serum levels of endothelin-I [ET1], prostaglandin E2 [PGE2], nitric oxide [NO], Von Willebrand factor [vWF] and angiotensin converting enzyme activities [ACE], were determined for both patients and controls. Serum levels of ET-1, ACE and vWF were higher, while serum levels of NO and PGE2 were lower to statistically significant levels [p<0.001] in pre-eclamptic women in all instances. Also, all Doppler indices were significantly higher in patients with pre-eclampsia than in normotensive women [p<0.001]. There was strong positive correlation between Doppler indices and serum levels of ET-1, ACE and vWP and strong negative correlation with NO and PGE2 in both patients with pre-eclampsia and in normotensive women [r<0.05]. These changes confirm the presence of highlight vascular reactivity and endothelial damage in cases of pre-eclampsia. The resulting endothelial damage and dysfunction may underlay the pathologic features of this disorder