Preliminary cardiac changes in the prediabetic state by aid of echocardiography and doppler

Epidemiological data have long demonstrated a correlation between diabetes and cardiovascular disease which accounts for up to 80% of deaths in patients with diabetes [1]. To elucidate the cardiac structure and function in normotensive patients with type 2 diabetes and impaired glucose tolerant patients in order to assess the effect of diabetes mellitus itself on cardiac function. In addition, to show the relation between the insulin level and sensitivity, and the presence of associated peripheral vascular disease. 15 healthy control subjects; 15 patients with type 2 DM on oral hypoglycemic drugs, and 15 patients with impaired glucose tolerance were randomized from outpatient clinics of Cairo University Hospitals. They were subjected to the following: Thorough clinical examination. Serum samples for measurements of: Fasting and two hours postprandial blood glucose, fasting serum insulin, glycated hemoglobin [HbA1c], serum creatinine, urea, cholesterol, triglycerides, LDL and HDL cholesterol. Calculation of insulin sensitivity and resistance, electrocardiogram [ECG], resting echocardiography, carotid duplex and ankle brachial indices were performed. There were echocardiographic abnormalities in patients with type 2 DM. These include: a- Systolic and diastolic left ventricular function abnormalities, b- Abnormal dimensions of left ventricular mass, aortic root and left atrium. Echocardiographic abnormalities in patients with impaired glucose tolerance include: a- Diastolic left ventricular function abnormalities, b- Abnormal dimensions of left ventricular mass, aortic root and left atrium. In type 2 diabetic patients there was a negative correlation between insulin sensitivity measured by HOMA-B and LVDD and IVSD. On the other hand, there was positive correlation between HOMA-R and IVSD and E/A ratio. In patients with impaired glucose tolerance there was a negative correlation between LVDS and insulin sensitivity by HOMA-B method. Insulin resistance is positively correlated with diastolic and systolic left ventricular function abnormalities even in the prediabetic stage. This may represent the first stage of diabetic cardiomyophathy and may contribute to the increased rate of cardiovascular events that has been associated with the cardiovascular metabolic syndrome

Microalbuminuria and endothelial dysfunction in hypertensive patients with and without cerebral lacunar infarctions

This study included 14 nondiabetic persons with untreated essential hypertension and cerebral lacunar infarctions detected by MRI or CT brain scan, 12 age and sex matched untreated nondiabetic hypertensive patients without infarction and 11 normal controls. Urinary albumin excretion [UAE] was measured photometrically and von Willebrand factor [vWF] as a known marker of endothelial dysfunction was estimated by a platelet aggregation method. UAE was found to be significantly higher in hypertensives with lacunar infarctions compared with those without and to normal control. VWF concentrations were found to be significantly higher in patients with lacunar infarctions compared with those without and with the normal control, but there was no significant difference between its level in hypertensives without lacunae and the normal controls. There was a significant positive linear correlation between vWF and UAE values in hypertensive patients with lacunar infarctions. Increased systolic blood pressure and low HDL correlated with both UAE and vWF in patients with lacunar infarctions

Serum manganese in patients with hepatic encephalopathy

50 patients with chronic liver disease were studied in 3 groups: Group A [10 patients without liver cell failure], group B [10 patients with liver cell failure but without encephalopathy], and group C [30 patients with hepatocellular failure and encephalopathy]. 10 normal persons were used as controls. Serum Mn and ammonia concentrations were determined in all subjects. Serum Mn in cirrhotics without hepatocellular failure was significantly lower compared with group B [P <0.05], but it was not significantly different from that in control group. Manganese level was found to be directly correlated to the severity of hepatic encephalopathy. Serum ammonia was found to be higher in patients with encephalopathy than the other groups, however, it didn't correlate significantly with the degree of encephalopathy