Relationship of arterial compliance and glycosylated haemoglobin as a predictor of vascular damage in diabetic patients

Accelerated arterial stiffness has been linked in diabetes to hyperglycaemia, hyperinsulinaemia, and impaired glucose tolerance. In this work, we studied two groups: Normotensive diabetic patients Group [A] and non diabetic age and gender matched controls group Group [B]. We excluded those with hypertension, hypercholesterolemia, smokers or ex-smokers and patients with history of or complaining of peripheral vascular disease or coronary artery disease. The aim of work was to study the relationship between arterial compliance and diabetic status in normotensive diabetic patients. The two groups [A and B] were compared as regards the clinical data, laboratory investigations, echocardiographic studies, carotid duplex evaluation [intima-media thickness and incidence of atherosclerotic plaques], pulse wave velocity measurements. On comparing both groups we found that diabetic patients had average pulse wave velocity, higher incidence of diastolic dysfunction and had lower fractional shortening values and E/A ratio on echocardiographic evaluation. Correlation of glycosylated haemoglobin with the other study parameters showed a significantly positive correlation with pulse wave velocity [PWV] among the whole population and with mean intima-media thickness [Mean IMT] among the whole population and in diabetics. Correlation of pulse wave velocity with the study parameters revealed a statistically significant positive correlation with mean-intima media thickness among the total population as well as in diabetics. In this study we concluded that early vascular damage and arterial stiffness is independently related to glycaemic status in diabetic patients even before evident clinical manifestations of macrovascular affection such as hypertension, increase in intima-media thickness, development of atherosclerotic plaques, symptoms or signs of peripheral vascular disease or coronary artery disease. We don't know if tight glycaemic control could reverse these early changes of vascular compliance or not and that needs further investigation. Pulse wave velocity is a non invasive, inexpensive and feasible method for early detection of vascular damage and impaired arterial function, so that therapeutic interventions can be evaluated, in order to reduce future cardiovascular complications and thereby increase both duration and quality of life.

Evaluation of different biochemical markers of bone turnover as a diagnostic tool for osteoporosis in postmenopausal women

Osteoporosis is a major global health problem affects mainly elderly and postmenopausal women with increased risk of bone fractures. The value of different biochemical markers of bone turnover as diagnostic tool for osteoporosis is still debated. The aim of this study is to assess the value of different biochemical markers of bone turnover as a diagnostic tool for osteoporosis in postmenopausal women. We measured fasting urinary calcium [Uca], total ALP, inorganic phosphorus [Pi], urinary deoxypyridino-line [DPD], carboxyterminal telopeptide of collagen type I [ICTP] and serum N-terminal telopeptide [NTX] in 40 postmenopausal females [diagnosed by DEXA as osteoporotic, | mean age, 60.2 years], 16 preimenopausal non-osteoporotic females [mean age, 39.1 years] and 24 healthy controls [mean; age, 29.2 years]. The postmenopausal osteoporotic group showed significantly higher levels of ALP, DPD, NTX and ICTP compared to controls [p<0.001] and only ALP was significantly higher in preimenopausal group compared to controls [p<0.001]. However, there was no significant difference of Uca and Pi among the three groups. On comparing peri and postmenopausal groups together, DPD, NTX and ICTP were the only markers that clearly discriminate the two groups being higher in the osteoporotic postmenopausal group. There were significant negative correlations between bone mineral density [BMD] and each of ALP, DPD, NTx, and ICTP. The clinical utility of DPD, NTx and ICTP in identifying patients with osteoporosis was assessed by ROC [receiver operating characteristic] curve analysis. This revealed that the best diagnostic cut-off level for DPD was 6.8nM DPD/mM creatinine. This gave a diagnostic sensitivity of 100% and specifity 100%, whereas NTx at a level 17.0 nM BCE had a diagnostic sensitivity of 100% and specifity of 98%. Regarding ICTP at cut-off level of 3.6 microg/L its sensitivity was 88% and specifity was 65% which considered the lesser better sensitivity and specifity among the three studied parameters

presence of multiple autoantibodies and its relation to the control of diabetic patients under therapy

The presence of multiple autoantibodies to different islet cell antigen including those to insulin autoantibodies [IAA] islet cell cytoplasm [ICA] and glutamic acid decarboxylase [GAD-Ab] were studied in 70 diabetic patients [30 cases of type I diabetes [IDDM], 30 cases of type II [NIDDM], 10 cases shifted from oral hypoglycemic therapy to insulin, in addition to 20 normal healthy controls]. All were subjected to fasting and postprandial plasma glucose, C-peptide level, glycosylated hemoglobin, insulin antibodies, islet cell cytoplasmic antibodies and glutamic acid decarboxylase antibodies. The obtained results showed that in IDDM group, 23.3% were positive for ICA, 40% were positive for GAD-Ab and 60% were positive for IAA. In NIDDM group, 23.7% were positive for ICA, 36.7% positive for GAD-Ab and 50% were positive for IAA. In the group of patients who shifted recently to insulin therapy, 30% were positive for ICA, 30% positive for GAD-Ab and 90% were positive for IAA. There was a positive correlation between glycosylated hemoglobin with the number of positive antibodies. Cases with no positive antibodies had a significant lower glycosylated hemoglobin level than those with one or more positive antibodies. It was concluded that the presence of both ICA and GAD-Ab was a stronger predictor of rapid B cell loss; hence, there was a more need for insulin therapy

Free radicals and hyaluronic acid relationship in rheumatoid arthritis and the effect of corticosteroid therapy

Oxygen-derived free radicals [ODFRs] are important inflammatory mediators. Evidence of ODFRs contribute to rheumatoid disease, include changes in the activities of antioxidant compounds. In the present study, acute phase proteins concentrations; C-reactive protein [CRP], haptoglobin alpha 1-antitrypsin and alpha 1-acid glycoprotein [AGP] were estimated as indicators for inflammation. Antioxidant activities, ferroxidase activity of caeruloplasmin and iron-binding of transferrin against organic oxygen radicals, iron-binding and iron-oxidizing proteins, chain-breaking substances and superoxide dismutase against inorganic oxygen radicals were measured as the protective response to tissue injury. Hyaluronic, uronic acids and mucin-clot test were also determined in the synovial fluid of rheumatoid arthritis [RA] and osteoarthritis [OA] patients. These parameters were measured in blood and synovial fluid of four groups: normal subjects, OA and RA patients treated with non-steroidal anti-inflammatory drugs [NSAIDs] or steroid drug in an attempt to explain the cause of inflammation which which might account for disease activity of RA. Serum increase of CRP, AGP and haptoglobin levels can serve as an indicator of increase RA disease activity. Corticosteroid treatment may suppress inflammation, where their effects include inhibition of lysosomal proteinase enzyme release, which indicated by lowering alpha1-antitrypsin level in the steroid treated RA patients than in NSAIDs treated ones. The serum antioxidant activity against organic oxygen radicals was significantly higher in the OA and RA patients than that in the normal subjects. This may be a part of the inflammatory response of the body and may also involve protection against lipid peroxidation. Red blood cells [RBCs] superoxide dismutase [SOD] activity was significantly lower in the RA patients than that in the normal subjects or OA patients. Therefore, it would seem that the red blood cells in patients with active RA were easily damaged by exposure to oxidative stress. The increase of iron-binding, iron-oxidizing proteins and chain-breaking substances as antioxidant activities against inorganic oxygen radicals in the RA synovial fluid than OA may be indicator of oxidative damage and reflect major differences in the synovial fluid of patients with RA and those with OA. However, it would appear, that these defense mechanisms are inadequate in fully protection of hyaluronic acid [HA] in the synovial fluid, which was manifested by HA in RA was fragmented and depolymerized than that in the OA synovial fluid. Absence of SOD activity in the synovial fluid RA and OA patients indicated that these patients have less protection against O[2]

Apo-lipoproteins A-I and B and lipoprotein [A] in recent myocardial infarction with and without diabetes

In this study, the plasma lipids [total cholesterol [TC], low density lipoprotein cholesterol [LDLc], high density lipoprotein cholesterol [HDLc] and triglycerides]], apo A-1, apo B, Lp[a], TC/HDLc, LDLc/HDLc and apo B/apo A-1 ratios were measured in 120 males, aged 25-65 years, 40 normal controls and 80 patients with recent MI [45% of them had non-insulin-dependent diabetes mellitus]. Each group was divided into four subgroups according to age: Group 1 [>25-35 years], group 2 [>35-45 years], group 3 [>45- 55 years] and group 4 [55-65 years]. From the results obtained, it was concluded that lipid abnormalities might be considered an independent risk factor for development of MI. Apo-B, Lp[a] and the ratio apo-B/apo-A may be better predictors to the risk of atherosclerosis than other lipid abnormalities, especially when total cholesterol level is within normal Lp[a]

comparative study of lipoproteins, apolipoprotein A-I and B and lipoprotein [A] between Egyptian males and females in different age groups

Eighty normolipidemic healthy normal persons aged 25-65 years were chosen and divided into two groups, a male group [n=40] and a female group [n=40]. Each group was subdivided according to age into four subgroups: Group 1 [>25-35 years], group 2 [>35-45 years], group 3 [>45-55 years] and group 4 [>55-65 years]. For all cases, total cholesterol [TC], low-density lipoprotein [LDLc], high-density lipoprotein [HDLc], triglycerides [TG], apolipoproteins A-1 and B [Apo-A-1 and Apo-B] and lipoprotein [a] [Lp[a]] were measured. It was concluded that age and sex dependent reference normal range is important when assessing atherosclerotic risk by lipoprotein assay and it must be followed, better for each community separately