Relation Between URIC Acid Levels and Subclinical Hypothyroidism in Diabetic Patients.

BACKGROUND AND AIM: Subclinical hypothyroidism (SCH) is frequently seen in diabetic patients. Elevated levels of uric acid (UA) were also reported in diabetic patients. No study assessed the relation between SCH and UA levels in diabetic patients. We aimed to evaluate this relation and the association of both conditions with other clinical and laboratory parameters in diabetic patients. SUBJECTS AND METHODS: This cross-sectional study included 100 T2DM patients in addition to 50 age and sex matched healthy controls. Diabetic patients comprised 50 patients with SCH and 50 euthyroid patients. All participants were subjected to careful history taking, thorough clinical examination and standard laboratory work up. The performed investigations included fasting and postprandial blood sugar, fasting insulin levels, HbA1c levels, thyroid hormones (FT3, FT4 and TSH), renal profile and serum UA. RESULTS: Comparison between the studied groups regarding serum UA levels revealed significantly higher levels in the diabetic group (5.4 ± 1.9 versus 4.2 ± 1.0 mg/dl, p<0.001). SCH + DM patients had significantly higher UA levels in comparison to DM group (6.1 ± 1.8 versus 4.8 ± 1.7 mg/dl, p<0.001) and control group (6.1 ± 1.8 versus 4.2 ± 1.0 mg/dl, p<0.001). SCH + DM patients had significantly higher HbA1c levels (8.9 ± 1.1 versus 7.6 ± 1.3%, p<0.001), HOMA-IR (3.9 ± 0.8 versus 2.8 ± 1.0, p<0.001) and UA levels (6.1 ± 1.8 versus 4.8 ± 1.7, p<0.001). Correlation analysis identified a significant direct correlation between serum UA and HOMA-IR in DM + SCH patients (r=0.4,p=0.004). In univariate analysis, presence of SCH [OR (95% CI): 2.57 (1.07-6.15), p=0.034] and nephropathy [OR (95% CI): 4.57 (1.77-11.8), p=0.002] was significant predictors of higher (upper tertile) UA in the studied patients. However, in multivariate analysis, only nephropathy [OR (95% CI): 4.25 (1.62-11.17), p=0.003] continued to be significant while SCH showed a marginal trend [OR (95% CI): 0.43 (0.17-1.08), p=0.073]. CONCLUSION: The present study suggests an association between SCH and increased UA levels in diabetic patients.

Circulating cell-free DNA, peripheral lymphocyte subsets alterations and neutrophil lymphocyte ratio in assessment of COVID-19 severity.

Cell destruction results in plasma accumulation of cell-free DNA (cfDNA). Dynamic changes in circulating lymphocytes are features of COVID-19. We aimed to investigate if cfDNA level can serve in stratification of COVID-19 patients, and if cfDNA level is associated with alterations in lymphocyte subsets and neutrophil-to-lymphocyte ratio (NLR). This cross-sectional comparative study enrolled 64 SARS-CoV-2-positive patients. Patients were subdivided to severe and non-severe groups. Plasma cfDNA concentration was determined by real-time quantitative PCR. Lymphocyte subsets were assessed by flow cytometry. There was significant increase in cfDNA among severe cases when compared with non-severe cases. cfDNA showed positive correlation with NLR and inverse correlation with T cell percentage. cfDNA positively correlated with ferritin and C-reactive protein. The output data of performed ROC curves to differentiate severe from non-severe cases revealed that cfDNA at cut-off ≥17.31 ng/µl and AUC of 0.96 yielded (93%) sensitivity and (73%) specificity. In summary, excessive release of cfDNA can serve as sensitive COVID-19 severity predictor. There is an association between cfDNA up-regulation and NLR up-regulation and T cell percentage down-regulation. cfDNA level can be used in stratification and personalized monitoring strategies in COVID-19 patients.