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Nervana Samy, Mie Afify, Nabila Abd El Maksoud, Magda Sayed and Azza Imam

Abstract

Background: Progressive nephropathy represents a substantial source of morbidity and mortality in type 2 diabetes. Increasing albuminuria is a strong predictor of progressive renal dysfunction and heightened cardiovascular risk. Endothelial damage is associated with albuminuria. VonWillebrand factor (vWf) and Thrombomodulin (TM) are possible markers of endothelial dysfunction and damage.

Objectives: We studied the relationship between plasma vWf, TM, and urinary albumin excretion.

Methods: We conducted on 90 diabetic patients fulfilled the WHO criteria for type 2 diabetes. Diabetic patients were placed into three groups according to urinary albumin concentration (UAC) in a 24-hour urine collection. Group I: included 30 patients with normal urinary albumin concentration (without nephropathy); microalbumin/24 hour urine less than 30 mg. Group II: included 30 patients with microalbuminuria (incipient diabetic nephropathy), microalbumin/24 hour urine from 30 to 299 mg. Group III: included 30 patients with macroalbuminuria (overt diabetic nephropathy); microalbumin/24 hour urine greater than 300 mg. We measured plasma levels of vonWillebrand factor (vWf) and Thrombomodulin (TM) as markers of endothelial dysfunction, to evaluate their relationship to urinary albumin excretion in patients with type 2 diabetes mellitus.

Results: There were significant increase in the levels of cholesterol and triglyceride, and significant decrease in HDL in group III compared to the control group, while it was highly significant with group II and III. TM levels showed no significant difference between control group and group I while it was highly significant with group II and III (p <0.01), also there was highly significant difference between group I and III (p <0.01). TM index showed no significant difference between control group and group I and II, while there was highly significant difference between control group and group III (p <0.01) and highly significant difference between group II and III (p <0.01). Albumin concentration in 24 hours urine showed no significant difference between control group and group I, while there were highly significant difference between control group and group II and III (p <0.01), also there was significant difference between group II and III (p <0.01). There were highly significant positive correlation between vWF, TM levels and all studied variables. Multivariate analysis which showed that total cholesterol, urinary albumin and age retained significant influence on the plasma vWF and TM.

Conclusions: These results suggested that generalized vascular endothelial damage occurs in diabetic nephropathy including the microalbuminuric stage. Hence, plasma vWF and TM represents valuable markers of endothelial dysfunction that could be used for early detection of diabetic microvascular complications.

Open access

Mie Afify, Nervana Samy, Mohamed Abd El-Maksoud, Maha Hasheim, Omnia Saleh and M. Elnemr

Abstract

Background: Obesity is a condition that results from chronic disruption of energy balance where energy intake continuously exceeds energy expenditure and accumulation of body fat results

Objective: We evaluated the relationships between ghrelin and leptin with the metabolic state of normal weight, overweight, and obese Egyptian women.

Methods: We studied 82 subjects with ages from 43 to 65. They were free of endocrine-related disease and divided into three groups according to their body mass index (BMI), group 1 with BMI less than 25 kg/m2, group 2 with BMI between 25 to 30 kg/m2, and group 3 with BMI more than 30 kg/m2. Ghrelin and leptin were determined by ELISA technique. Insulin resistance was measured by homeostasis model assessment. Lipid profile was determined in all groups.

Results: Fasting plasma levels of ghrelin were lower in overweight and obese groups compared to normal weight control group. There was statistically significant negative correlation of ghrelin levels with leptin, BMI and HOMA. Results showed that higher concentrations of fasting leptin were found in overweight and obese groups compared with the normal weight control group. There was statistically significant positive correlation between leptin and other biochemical parameters, insulin, BMI, and HOMA.

Conclusion: Ghrelin and leptin may be associated with obesity. These markers can be of value when assessing management.