Nagwa Ramadan

Background There is an established relationship between liver disease and hepatogenous diabetes mellitus, and a growing evidence for the role of vitamin D deficiency in the pathogenesis of type 1 and type 2 diabetes mellitus. However, data on the impact of vitamin D serum level on insulin resistance among liver cirrhosis patients are lacking. Objectives of the study The primary objective of the current study was to investigate the relationship between vitamin D status and insulin resistance among hepatitis C virus (HCV)-induced liver cirrhosis patients using a homeostasis model for assessment of insulin resistance (HOMA-IR). The secondary objectives were to assess the association between deterioration of liver function on the one hand and insulin resistance and vitamin D deficiency on the other. Participants and methods Fifty patients with biopsy-proved HCV-induced liver cirrhosis were enrolled in this cross-sectional study. Routine clinical, laboratory, and imaging workout was performed to assess the degree of liver decompensation using the model of end-stage liver disease (MELD) score and the Child–Turcotte–Pugh Score (CTPS). Serum level of 25-hydroxy-vitamin D 3 [25(OH)D 3 ] was estimated. Fasting plasma glucose and fasting insulin were also measured to calculate HOMA-IR as an indicator of insulin resistance. Patients were subclassified according to serum 25(OH)D 3 levels into tertiles, according to the MELD score into three groups, and according to CTPS into Child A, B, and C. Results A significant inverse correlation was found between serum 25(OH)D 3 level and insulin resistance as assessed by HOMA-IR, whether using one-by-one correlation (r = – 0.976, P = 0.000) or using 25(OH)D 3 tertiles' correlation (r = – 0.830, P = 0.000). Linear multiple regression analysis determined low serum 25(OH)D 3 level as an independent predictor for increase in HOMA-IR among HCV-induced liver cirrhosis patients. No significant association was identified between low serum 25(OH)D 3 level and the severity of liver dysfunction as assessed by the MELD score or CTPS. Conclusion The present study showed that low serum 25(OH)D 3 level was an independent predictor for insulin resistance among patients with HCV-induced liver cirrhosis.

Systemic lupus erythematosus (SLE) is an inflammatory autoimmune disease targets the vascular system
resulting in vasculitis, vasculopathy, and premature atherosclerosis. Vascular affection is one of the proposed pathogenic
mechanisms for neuropsychiatric lupus.
Objective:
The purpose of this study was to measure the total cerebral blood flow
volume (TCBFV) in patients with SLE using Doppler ultrasonography and to determine whether a relationship exists
between cerebral perfusion changes with disease activity and cognitive screening tests.
Subjects and Methods:
This study
was conducted on twenty-one SLE female patients diagnosed according to the modified American College of Rheumatology
revised criteria of SLE. Ten age-matched female volunteers served as the control group. All subjects were assessed using
Modified Mini-Mental State as a neuropsychological screening test. Cerebral blood flow was assessed by extra- cranial
Doppler ultrasonography to calculate TCBFV.
Results:
TCBFV was lower in patients’ than in the control group but not
statistically significant. A significant lower CBFV in Left Internal Carotid Artery in patients’ group compared to the control
group (p 0.05). The cerebral perfusion was significantly lower in patients with active disease (p 0.01). There was no
statistically significant difference between patients with neuropsychiatric lupus (NPSLE) compared to Non NPSLE or
between patients with antiphospholipid syndrome (APS) and without APS; regarding their TCBV. SLE patients had
subcortical pattern of cognitive impairment.
Conclusion:
Using ultrasound for measuring TCBFV cannot detect evident
cerebral hypoperfusion. However, lower TCBFV in SLE patients is associated with more disease activity, but not related to
the cognitive dysfunction.

Abstract: Background: Foot problems are common complications in diabetics; fortunately they can be prevented. Aim of the study: to detect prevalence and categorization of diabetic foot in diabetics in Beni Suif, Egypt from 2010 to 2012. Subjects and methods: A cross-sectional study of 1000 diabetics who underwent
through history and examination. Results: Peripheral neuropathy (PN), was found in 73.7% of patients. High levels of HbA1c, creatinine, cholesterol, triglycerides, FBS, 2hPPS, BMI, SBP, albumin and insulin therapy
were predictors of PN. Peripheral arterial disease (PAD) was found in 49.3% of patients. Duration of DM, HbA1c, creatinine, cholesterol, FBS, 2hPPS, BMI, BP, albumin and insulin therapy were predictors of PAD.
Foot ulcers were found in 4.1%, while only one case had amputation. 19% of cases were categorized as high, 20% as moderate, and 11% as low risk while 50% had no risk. High risk cases had more advanced age, higher BMI, higher BP. Neuropathy, age > 55, insulin therapy and high HBA1c, creatinine, cholesterol and TGs were considered the most significant predictor of risk to diabetic foot ulcer. Conclusion: About fifth of cases had high risk for development of diabetic foot ulcers in Beni Suif hospital from 2010-2012. PN is the major cause, while PAD was found in minority.

Red cell distribution width (RDW) is considered a p
rognostic marker which may reflect an
underlying inflammatory process. This marker can be
used as a predictor for macrovascular and microvas
cular
complications of diabetes mellitus.
Aim of the study:
was to investigate the relation between RDW and va
scular
complications in patients with type 2 diabetes and
it is relation to other inflammatory marker high se
nsitivity C-
reactive protein (hs-CRP).
Subjects and methods:
This study is
a cross-sectional study
of
75 subjects with type 2
diabetes mellitus and 15 healthy controls. All subj
ects underwent thorough history, clinical examinati
on and
investigations including measurement of hs-CRP and
calculation of RDW.
Results:
In the present study RDW was
found to be elevated in diabetic patients with macr
ovascular complications (15.251±1.77) as compared t
o those
without macrovascular complications with statistica
lly significant difference (
p
=0.04). Also RDW was found to be
elevated in diabetic patients with microvascular co
mplications but this was not statistically signific
ant (
p
= 0.87). Hs-
CRP was elevated in diabetic patients with macro- a
nd microvascular complications (3.12±4.06) with sta
tistically
significant difference as compared to control group
(
p
=0.02). There was significant positive correlation
between hs-
CRP and HbA1c. Also positive correlations were foun
d between RDW and hs-CRP.
Conclusion:
High levels of
RDW are associated with increase risk of macrovascu
lar complications in type 2 diabetes mellitus.