Early detection of diabetic nephropathy in children and adolescents with type 1 diabetes mellitus

Recent studies have demonstrated that the onset and course of diabetic nephropathy can be ameliorated to a very significant degree by several interventions but these interventions would have their greatest impact if instituted at a point very early in the course of development of this complication. This study has been designed to explore the problem of diabetic nephropathy in type 1 Diabetes Mellitus particularly its early detection in a sample of children and adolescent patients up to 18 yrs of age. Estimating the prevalence of microalbuminuria and hyperfiltration, and assessing the relationship between microalbuminuria and GFR in type 1 diabetic children and adolescents. A cross-sectional design and a consecutive sampling procedure were adopted to enroll 115 patients [59 males and 56 females] who met the inclusion criteria, from those attending the National Diabetic Center of AL Mustansiriyah University / Baghdad during the period from the 1st of August 2005 to the end of July 2006. Micral test II was used to screen early morning [spot] urine samples for increased albumin excretion rate while the novel use [in Iraq] of Schwartz formula made possible estimating the GFR from serum creatinine and demographic characteristics. The results were used for assessing the relationship between microalbuminuria and GFR. Important risk factors including patients age and disease duration, have also been evaluated. The mean patients age was 14.05 [ +/- 2.95] years, and the mean disease duration was 6.52 [ +/- 2.85] years. The prevalence of microalbuminuria in the study sample was [48.70%] estimated as increased urinary albumin excretion [20-200mg/l]. Statistically significant associations were found between microalbuminuria and longer duration of diabetes [p value = 0.017], and older age of diabetic patients [p value = 0.031]. The overall prevalence of hyperfiltration [estimated as GFR of >/= 130ml/min/1.73m2] was [16.52%], comprising [63%] normoalbuminuric and [37%] exhibiting microalbuminuria. Male preponderance was evident [89.48%]. Factors showing significant association with hyperfiltration state were: male gender [p value = 0.013], and older age of diabetic patients [p value = 0.031]. There was a statistically significant inverse correlation between the different levels of albumin excretion rate and the levels of estimated GFR. [r = - 0.79 p value =0.024]

Prevalence of metabolic syndrome in patients with ischemic heart disease

Metabolic syndrome is a combination of medical disorders that increase one's risk for cardiovascular disease and diabetes. Whereas the syndrome is under scrutiny and extensive investigations worldwide, it has been very little investigated in Iraq with a considerable lack of local pertinent data. Estimation of the prevalence of metabolic syndrome in patients with ischemic heart disease and assessing the severity of coronary artery disease in patients who meet the criteria of metabolic syndrome. The study was carried out at Ibn Albitar hospital, a tertiary center for cardiovascular surgery/Baghdad/Iraq from 1st Oct. 2005 to 30th Dec. 2006. A cross sectional design and consecutive sampling procedure were adopted to enroll 300 patients comprising 226 males and 74 females who met the eligibility criteria and were assigned to undergo coronary angiography. Documentation of data regarding medical history, the required measurements, and investigations was accomplished in accordance with a specially designed data sheet that included all relevant information. The overall prevalence of metabolic syndrome in the study sample was 69.33%. Differentially, the prevalence was very much higher among patients with ischemic heart disease 84% than those without ischemic heart disease 10%. The estimated difference was statistically highly significant [p=0.01]. Only 240 patients showed angiocardiographic evidence of ischemic heart disease; [single vessel disease 24.2%, two vessels disease 35.8%, triple vessels disease 23.3%, and left main stem disease 16.7%]. There was no significant difference in the prevalence of metabolic syndrome among different subgroups of patients with ischemic heart disease classified by the results of coronary angiography. There is a need for having a unified definition of the metabolic syndrome to allow for proper assessment and valid comparison between prevalence data in different populations. Highlighted the need for wider analytical studies enrolling bigger samples with the aim of obtaining a more valid inference, in addition to community based surveys to help early recognition of metabolic syndrome, identify patients at risk of ischemic heart disease, and reduce the impact of ischemic heart disease on the community