Effect of Insulin Degludec Versus Insulin Glargine on Glycemic Variability in Patients With Renal Transplantation with Pre-existing Type 2 Diabetes Mellitus; A 1-year, Randomized, Treat-to-Target Pilot Trial.

INTRODUCTION: This study hypothesized that the insulin Degludec may have benefit if used in management of diabetes mellitus after renal transplantation to achieve better control at the critical time of adjustment of immunosuppressive regimens during the first year post transplant. METHODS: Fifty patients with Type 2 diabetes Mellitus after renal transplantation with stable serum creatinine with glycosylated hemoglobin (HbA1C) 7 to 11% were included in the study to receive either Insulin Degludec or Insulin Glargine. Fasting blood glucose, 2 hour post-prandial levels and (HbA1c), were measured at 12, 16, 26, 40, and 52 weeks after renal transplantation also hypoglycemic episodes were documented all through the study. RESULTS: Despite both groups are matched as regards demographic and metabolic data, FPG, and 2h PPG were lower in insulin Degludec group all through the study. HbA1c most pronounced decline, occurred at 52th week of treatment in both groups. The most important clinically relevant finding in our study was that; the overall confirmed hypoglycemia rates and the rate of nocturnal confirmed hypoglycemia was significantly lower with Degludec treated group (P < .001). CONCLUSION: Insulin Degludec provides optimum glycemic control in in the first year post-renal transplant patients with significantly lower rate of hypoglycemia. DOI: 10.52547/ijkd.6131.

Steroid resistant focal segmental glomerulosclerosis: effect of arterial hyalinosis on outcome: single center study.

Background. Few data with adequate evidence exists as regards the effect of Cyclosporine (CsA) and mycophenolate mofetil (MMF) on pathological prognostic parameters in patients with steroid resistant focal segmental glomerulosclerosis (FSGS). The purpose of the present study is to compare the effect of cyclosporin and mycophenolate mofetil in addition to steroids on functional and histopathologic renal parameters in patients with steroid resistant FSGS one year after treatment.Material and methods. Thirty-seven adults with primary FSGS patients resistant to steroid therapy consecutively randomized to treatment with either MMF or cyclosporine. Low dose prednisolone added to both groups. Glomerular filtration rate (GFR) and blood pressure (BP) were determined at all examinations and a second renal biopsy was taken 12 months after treatment with either of cyclosporin and mycophenolate mofetil.Results. GFR significantly increased in MMF group p < 0.01 after 6 months and unchanged after 12 months. On the other hand, GFR significantly decrease in CsA group p < 0.001 after 6 months and reduced more after 12 months p < 0.001 compared to base line levels. There was a significant difference of GFR between the 2 groups at 6 months p < 0.001. The extent of proteinuria decreased significantly in CsA group after 12 months p < 0.001. The extent of arteriolar hyalinosis increased significantly in CsA group (0.78 to 1.81 score, p < 0.001) but was unchanged in MMF group (0.93 to 0.96 score), whereas interstitial fibrosis increased to same level in both groups (grade 3).Conclusion. Conversion to MMF in those patients may be superior to CsA as regards GFR after 12 months after treatment in spite of the presence of greater level of protein excretion. The increased arteriolar hyalinosis during CsA treatment most likely results in higher BP compared to MMF treatment in patients with FSGS resistant to steroids.

Early severe coronary artery disease and aortic coarctation in a child with familial hypercholesterolaemia.

An 11-year-old boy presented with easy fatigability, multiple xanthomas, and absent pedal pulsations. Laboratory workup showed severe hypercholesterolaemia and non-invasive imaging revealed 'normally functioning' bicuspid aortic valve and tight aortic coarctation. Coronary angiography showed severe right coronary artery (RCA) stenosis. Medical treatment resulted in significant improvement of dyslipidaemia. We successfully performed balloon dilation and stenting of his coarctation, as well as percutaneous coronary intervention for RCA lesion.

Adult congenital heart disease registry at Cairo University: a report of the first 100 patients.

AIMS: To establish a clinical registry for adult patients with congenital heart disease (CHD) managed in Cairo University Hospitals, aiming at description of the pattern and clinical profile of such patients. METHODS: Patients were recruited from both Cardiovascular Medicine Department Outpatient Clinic and inpatient wards of Cairo University Hospitals. Clinical data were collected from hospital records and directly from patients by treating cardiologists. Collected data were then registered in a dedicated database system and subsequently analyzed. RESULTS: Patients (49% males) ranged in age from 16 to 63 years, with a median of 25 years. Fifty-one patients were in the age-group from 20 to 30 years, with only 9% aged 50 years or older. Seventy-eight patients had acyanotic lesions, with atrial septal defect being the most common primary diagnosis (20% of total lesions). The remaining 22 patients had cyanotic heart disease, with tetralogy of Fallot being the predominant diagnosis (45% of cyanotic lesions). Six patients presented with infective endocarditis in the setting of CHD. Four women (8% of females) presented during pregnancy. Forty-six patients were sent for surgical correction/repair, while percutaneous intervention was planned in 20 patients. CONCLUSIONS: A new registry of adult patients with CHD managed in Cairo University Hospitals provides useful information, including the extent to which congenital heart defects are underdiagnosed and undertreated during infancy and childhood. In addition, those who were previously treated early in life require long-term follow-up in specialized centers. Establishment of a multidisciplinary team with expert physicians (cardiologists, dentists, obstetricians, and psychiatrists), cardiac surgeons, and nurses may be facilitated by development of a dedicated database system. Continuous financial support is a major challenge.