Expression of pro-inflammatory cytokines (IL-6 & IL-18) exacerbate the risk of diabetic nephropathy in the Pakistani population.

BACKGROUND: Diabetic nephropathy (DN) is a micro-chronic diabetic consequence induced by metabolic and hemodynamic abnormalities. Free radicals react with other critical cellular components, causing progression of aberrant renal function. OBJECTIVE: This case control study was aimed to determine the role of IL-6 and IL-18 in diabetic nephropathy in Pakistani population. METHODS AND MATERIALS: The study's subjects (n = 180 from Lahore, Gujranwala, and Karachi) were divided into control, diabetes mellitus (DM) and diabetic nephropathy (DN) groups. The serum concentration of IL-6 & IL-18 were determined by enzyme-linked immunosorbent assay (ELISA). The expression analysis of IL-6 & IL-18 were performed by Real Time PCR. RESULTS: The significant increase in serum levels of IL-6 were observed among the control, DM and DN groups (15.3 ± 24.1 pg/ml, 34.7 ± 24.0 pg/ml, 52.6 ± 33.2 pg/ml) whereas no significant difference was observed in serum levels of IL-18. The expression analysis of IL-6 was increased by more than forty three fold in DN group (n-fold = ~43.6) as compared to DM & control whereas the expression profile of IL-18 decreased in DN group (n-fold = ~0.89). In DN group the correlation analysis revealed direct association of GFR with serum IL-6 (r = 0.1114) & inverse relationship with serum IL-18 (r = - 0.097). In multiple regression analysis using GFR as the dependent variable, BMI and expression of IL-18 were determinants in DM subjects, but only uric acid in DN subjects. CONCLUSION: The present study implicates that increased expression of IL-6 and decreased of IL-18 was associated with development of DN in Pakistani population.

Expression of Gstt1 in Type 2 Diabetic Retinopathy Patients.

Type 2 diabetes mellitus (T2DM) is the most common metabolic and multifactorial disease in which both genetic and environmental factors are involved. In diabetes, the defects in the cellular metabolism result in higher levels of free radicals. These radicals react with other vital cellular molecules, which are responsible in diabetes side effects and known as diabetic retinopathy (DR), a disease of the retina that results in impairment or loss of vision. In the present study, we investigated the expression of glutathione S-transferases class theta 1 (GSTT1) in type 2 DR subjects. Highly significant differences (P ≤ 0.05) were observed in GSST1 expression in DR patients compared with diabetic and control groups.

Significant association of serum creatinine with HbA1C in impaired glucose tolerant Pakistani subjects.

OBJECTIVE: The present study was conducted to assess the serum concentration of creatinine and determine its relationship with potential risk factors of diabetes in Impaired Glucose tolerance subjects. METHODS: This cross sectional study was conducted on 100 IGT patients who attended Amin Hayat diabetic center in Lahore from January 2011- June 2011. Patients with age group 34-67 years, (both sexes) were included in the study. Different demographic parameters as age, BMI, WHR, B.P, personal history and socioeconomic status were recorded. Oral Glucose Tolerance Test was performed. The biochemical parameters including HbA1c, lipid profile, urea, uric acid, creatinine and bilirubin level were measured by chemistry analyzer. RESULTS: A strong correlation between creatinine and HbA1c was observed. The level of creatinine was also significantly associated with age in IGT subjects. Creatinine is non-significantly correlated with Cholesterol, LDL-Chol and TG while negatively significantly associated with BMI, fasting blood glucose and HDL-Chol. CONCLUSION: The present study concluded significant association of serum creatinine with HbA1c, BMI and HDL cholesterol.

ABO blood group frequency in Ischemic heart disease patients in Pakistani population.

OBJECTIVES: To determine if there is any significant association between ABO blood groups and ischemic heart disease (IHD). METHODS: The study was performed at Punjab Institute of Cardiology (PIC), Lahore. Study duration was from January 2012 to September 2012. This study included 200 IHD patients and 230 control individuals. Self design questionnaire was used to collect information regarding risk factors. Standard agglutination test was performed to determine the blood groups. Data was analyzed on SPSS 16. RESULTS: The prevalence of blood groups in IHD group was 34% in blood group A, 29% in blood group B, 14% in blood group AB and 23% in blood group O. In control group the distribution of B, A, AB and O blood groups were 34.4%, 20.9%, 12.6%, 32.2% respectively. Rh+ve factor was prevalent in 90.5% among IHD group and 92.6% in control subjects. The prevalence of IHD was more in males (63.5%) as compared to females (36.5%). Mean age was 56.4±0.86 (yrs) and BMI was 26.4±0.33 (kg/m(2)). The prevalence of hypertension was 58.5%, diabetes was 53%, family history of cardiac disease was 45%, 35.5% of patients were doing exercise regularly, 58.5% used ghee, and 58% were smokers. C onclusion: Subjects with blood group A had significantly (p< 0.05) higher risk of developing IHD as compare to other blood groups.

Vitamin D levels among pregnant and lactating women.

OBJECTIVE: To assess the serum level of vitamin D in pregnant and lactating women. STUDY DESIGN: Case-control study. PLACE AND DURATION OF STUDY: Gynaecological Unit 1 of Jinnah Hospital, Lahore, from December 2010 to May 2011. METHODOLOGY: A total of 100 women comprised of three groups: pregnant (n = 40), lactating (n = 40) and control (n = 20) groups. The information regarding age, educational level, socioeconomic status, exposure to sunlight and dietary vitamin D intake were collected through self-structured questionnaire. Serum concentration of vitamin D was measured by ELISA and serum calcium and phosphate levels were measured by chemistry analyzer. Statistical analysis was done using SPSS (version 13). The values were considered significant at 0.05 level of significance. RESULTS: The mean serum vitamin D level in the pregnant and lactating mothers was 26.5 ± 17.1 nmol/L and 21.4 ± 16.3 nmol/L respectively and in control group was 33.8 ± 21.1 nmol/L. The mean calcium level in the pregnant, lactating and control group was 10.3 ± 1.2 mg/dL, 9.7 ± 1.3 mg/dL and 9.7 ± 1.3 mg/dL respectively. The mean phosphate in pregnant was 3.2 ± 0.76 mg/dl, in lactating was 3.3 ± 0.76 mg/dl and in control was 3.5 ± 0.92 mg/dl. Significant difference (p = 0.041 and p = 0.037 respectively) in the serum levels of vitamin D and calcium was observed among the pregnant and lactating women as compared to control group. CONCLUSION: Low serum vitamin D concentration was observed in lactating women and pregnant women as compared to control group.

Hyperinsulinemia and insulin resistance is associated with low T3/T4 ratio in pre diabetic euthyroid Pakistani subjects.

OBJECTIVE: To investigate the relationship of thyroid hormones in glucose homeostasis in impaired glucose-tolerant subjects with normal thyroid functions. METHODS: Cross-sectional analysis was carried out in (n=260) impaired glucose-tolerant (IGT) and normal glucose-tolerant (NGT) subjects. Thyrotropin (TSH), total triiodothyronine (TT3), total thyroxin (TT4) free T3 (fT3), free T4 (fT4), and insulin were assessed by enzyme-linked immunoassays (ELISA). Fasting plasma glucose (FPG) and HbA1c were measured by glucose oxidase and low-pressure cation exchange chromatography. Homeostasis model of assessment (HOMA-IR) was employed to assess the level of insulin resistance; fT3/fT4 ratio was calculated. Anthropometric measurement and habits were recorded. RESULTS: Marked hyperinsulinemia and insulin resistance were observed in IGT subjects. Serum TT3 and fT3 levels were significantly low in the IGT as compared to normal glucose-tolerant (NGT) controls. TT4 and TSH were higher in IGT subjects as compared to control subjects. There was a significant positive correlation of TSH with BMI only in the control group (r=0.351; P<0.05). Correlation of insulin with TT3, fT3,and TSH was significant (P<0.05) in IGT subjects. A significant low fT3/fT4 ratio was observed in IGT subjects as compared to NGT subjects (P<0.01). In multiple regression analysis, TSH, TT4 and fT3 contributed significantly to the variance of fasting insulin and insulin resistance in IGT subjects. CONCLUSION: Hyperinsulinemia and insulin resistance are associated with low T3/T4 ratio in pre-diabetic euthyroid Pakistani subjects.