Evaluation of serum cystatin C and chromogranin A as markers of nephropathy in patients with Type 2 diabetes mellitus

Abstract

The chronic joint inflammation in axial spondyloarthritis (axSpA) is characterized by infiltration of activated macrophages. The haptoglobin–hemoglobin receptor CD163 and the mannose receptor CD206 are strongly expressed on M2c and M2a macrophages, respectively. We measured the soluble forms of the receptors (sCD163 and sCD206) in plasma (PL) in two axSpA cohorts. All patients fulfil the 2009 Assessment of SpondyloArthritis International Society (ASAS) classification criteria for axSpA and/or the 1984 modified New York criteria for ankylosing spondylitis. The first cohort included anti-TNF-α treated patients with active axSpA (n?=?30); the second cohort included patients in early disease stages (n?=?38). Plasma sCD163 and sCD206 were both within the reference interval of healthy controls (HC), but sCD163 decreased slightly during anti-TNF-α treatment [baseline: 1.49?mg/L (IQR: 1.22–1.77?mg/L, 12?weeks: 1.29 (IQR: 1.09–1.57) mg/L, 20?weeks: 1.25 (IQR: 0.99–1.75) mg/L, 52?weeks: 1.39 (IQR: 1.15–1.78) mg/L], while sCD206 increased [baseline: 0.17 (IQR: 0.13–0.21) mg/L, 12?weeks: 0.19 (0.16–0.23) mg/L, 20?weeks: 0.20 (0.14–0.24) mg/L, 52: 0.19 (IQR: 0.14–0.23) mg/L], pointing toward a shift in polarization of involved macrophages. Plasma levels of sCD206 proved significantly higher in patients with early disease stages and definite radiological sacroiliitis (n?=?10). This was not the case for sCD163. A significant increase in response to anti-TNF-α treatment, could suggest sCD206 as a marker of response to anti-TNF-α treatment, however, the potential for the two macrophage markers as diagnostic and prognostic indicators of disease in axSpA is weak.     

Review on the Integration of Microelectronics for E-Textile

Modern electronic textiles are moving towards flexible wearable textiles, so-called e-textiles that have micro-electronic elements embedded onto the textile fabric that can be used for varied classes of functionalities. There are different methods of integrating rigid microelectronic components into/onto textiles for the development of smart textiles, which include, but are not limited to, physical, mechanical, and chemical approaches. The integration systems must satisfy being flexible, lightweight, stretchable, and washable to offer a superior usability, comfortability, and non-intrusiveness. Furthermore, the resulting wearable garment needs to be breathable. In this review work, three levels of integration of the microelectronics into/onto the textile structures are discussed, the textile-adapted, the textile-integrated, and the textile-based integration. The textile-integrated and the textile-adapted e-textiles have failed to efficiently meet being flexible and washable. To overcome the above problems, researchers studied the integration of microelectronics into/onto textile at fiber or yarn level applying various mechanisms. Hence, a new method of integration, textile-based, has risen to the challenge due to the flexibility and washability advantages of the ultimate product. In general, the aim of this review is to provide a complete overview of the different interconnection methods of electronic components into/onto textile substrate.     

Comparison of renal function markers in Kuwaiti patients with sickle cell disease

BACKGROUND: Proteinuria is a common manifestation of renal disease which is a significant cause of morbidity in patients with sickle cell disease (SCD). OBJECTIVE: To evaluate and compare cystatin C, beta(2)-microglobulin, and creatinine as markers of renal disease in relation to the degree of proteinuria and other complications of SCD. METHODS: 24 h urine collections were used for estimation of urine protein and creatinine clearance in 59 patients with SCD. Results were correlated with plasma cystatin C, beta(2)-microglobulin, creatinine, glomerular filtration rate (GFR; derived from plasma creatinine by Cockcroft-Gault, MDRD formulae, and calculated cystatin C clearance), and clinical and haematological variables. RESULTS: Comparing the different methods of GFR, the proportion of patients with hyperfiltration (GFR >140 ml/min) were 30.5% (MDRD), 44.1% (Cockcroft-Gault), and 10.2 % (calculated cystatin C clearance). Cystatin C was the most consistent marker of hyperfiltration. The endogenous markers of GFR showed an increasing trend with increasing proteinuria, but haematological variables were not correlated with cystatin C, beta(2)-microglobulin, or plasma creatinine. Urine protein excretion was correlated with age (r = 0.33) and significant proteinuria was present in 13.6% of patients. Patients with proteinuria had lower haemoglobin concentration (p = 0.027) than those without proteinuria but HbF was not related to the degree of proteinuria or to markers of GFR. CONCLUSIONS: Markers of GFR show variable ability to identify hyperfiltration in patients with SCD, but cystatin C is the best endogenous marker. Proteinuria is associated with age, haemoglobin, and abnormalities of GFR. Routine screening is recommended to allow for early detection and intervention.     

Chlamydia trachomatis infection in pregnancy and effect of treatment on outcome

The effect of Chlamydia trachomatis on pregnancy outcome and the effect of treatment of positive cervical cultures was studied by culturing 11,544 women for chlamydia at their first prenatal visit. Chlamydia culture was positive in 2433 (21.08%) and prevalence was related to age and race. Of the positive cultures, 1110 were classified as untreated. The untreated group demonstrated a significant increase in the incidence of premature rupture of the membranes and low birth weight and a decrease in survival when compared with either those with positive cultures who received treatment (N = 1323) or those with negative cultures (N = 9111). Screening of populations at high risk of chlamydia is recommended and treatment of chlamydia-positive patients may improve pregnancy outcome.     

Asthma in Tanta, Egypt: serologic analysis of total and specific IgE antibody levels and their relationship to parasite infection.

The relationship between asthma, IgE and parasite infection was compared in 68 randomly selected patients with asthma and 37 nonasthmatic controls living in Tanta, Egypt. Sera were assayed for total IgE and for IgE antibodies to inhaled allergens (mite, cat, cockroach, ryegrass, ragweed and 3 fungi) and to parasite antigens (Schistosoma mansoni and Brugia malayi). Parasite infection was determined by microscopic examination of stool specimens. Total IgE levels were significantly higher in patients with asthma (geometric mean 909 IU/ml), than in controls (geometric mean 145 IU/ml, p less than 0.001). The high IgE levels correlated with parasite infection and the presence of IgE antibodies to S. mansoni antigens, which were also elevated compared to controls. The prevalence of allergen-specific IgE antibodies among Egyptian asthmatics was low by comparison with 'Western' asthmatics, but nonetheless higher than among Egyptian controls. A radioallergosorbent test (RAST) values of greater than 40 U/ml to any allergen was found in 19/68 (28%) sera from the asthma group, as compared to only 1/37 (3%) sera from controls (p less than 0.001). The highest RAST values were to dust mite (Dermatophagoides pteronyssinus and D. farinae) allergens, followed by rye grass and ragweed allergens. The results suggest that in this area of Egypt, several factors may influence the development of asthma, including nonspecific activation of IgE and/or inflammatory mechanisms by helminth parasites and sensitisation to environmental allergens.     

Lipoprotein(a) and other cardiovascular metabolic risk factors in Kuwaiti children with type-1 diabetes

BACKGROUND/AIMS: Lipoprotein(a) synthesis and catabolism could be influenced by insulin or by diabetes metabolic complications in patients with type-1 diabetes. The aim of the study was to investigate the relation of plasma lipoprotein(a) concentrations with metabolic cardiovascular risk factors in Kuwaiti children with uncomplicated type-1 diabetes. METHODS: This case-control study included 115 (44 males and 71 females) diabetic children aged 6-18 years matched by age and sex to 115 non-diabetic children as controls. RESULTS: There was no significant difference between the mean lipoprotein(a) concentrations in type-1 diabetic children (27.34 mg/dl) and their controls (22.80 mg/dl). Total cholesterol, apolipoprotein A1 and B levels were significantly higher in diabetic children than controls. In diabetic children, significant correlations were found between lipoprotein(a) levels and glycated hemoglobin (r = 0.249, p = 0.011), total cholesterol (r = 0.208, p = 0.025), and apolipoprotein B (r = 0.349, p < 0.001). The proportion of diabetic children with lipoprotein(a) >30 mg/dl was significantly higher in those having poor glycemic control (glycated hemoglobin >9.0%, p = 0.013), raised total cholesterol (p = 0.033), or with a family history of cardiovascular disease (p = 0.006). CONCLUSION: Plasma lipoprotein(a) levels were not elevated in young type-1 diabetic children compared to non-diabetic controls; however, lipoprotein(a) levels were significantly higher in diabetic children with poor glycemic control. Moreover, there were significant correlations between lipoprotein(a) and the metabolic cardiovascular risk factors total cholesterol, atherogenic index, apolipoprotein B and apolipoprotein B/A1 ratio.     

Strongyloidiasis: challenges in diagnosis and management in non-endemic Kuwait

Among immunocompromised individuals, hyper-infection with Strongyloides stercoralis may occur and lead to fatal strongyloidiasis. To clinicians and laboratory diagnosticians in non-endemic countries such as Kuwait, this severe infection poses a particular problem. The clinical histories and signs and symptoms of four Kuwaiti cases of S. stercoralis hyper-infection were reviewed. Each of the four was found not only to have lived in an area where S. stercoralis was endemic but also to have been treated with immunosuppressive steroids (for medical problems unrelated to the nematode infection). When they presented with undiagnosed hyper-infections their clinical features were confusing. Three of the cases, all with low eosinophil counts, died but the other, who was treated with thiabendazole, survived. In the light of these observations, healthy medical examinees who had recently moved from endemic zones were checked for asymptomatic S. stercoralis infection, both by stool examination and ELISA-based serology. Of 381 stool samples investigated over a 3-month period, 183 (48%) were found positive for helminths, 7% for S. stercoralis. Of 198 individuals from endemic zones who were screened after another medical examination, 71 (35.8%) were found positive for intestinal helminth parasites, including one (1.45%) infected with S. stercoralis. Although ELISA appear reliable in making a presumptive diagnosis of strongylodiasis, the results of such assays are not very specific and are best interpreted in conjunction with the patient's clinical status. The concurrent administration of anthelminthics to patients prescribed steroids who, because they live or have lived in an area where S. stercoralis is endemic, are at risk of infection with the nematode, should be considered.     

Impaired growth, delayed ossification, and reduced osteoclastic activity in the growth plate of calcium-supplemented rats with renal failure

Linear growth is reduced in prepubertal children with adynamic renal osteodystrophy, suggesting that the proliferation and/or differentiation of epiphyseal growth plate chondrocytes is abnormal in this disorder. To examine this issue, in situ hybridization and histochemistry were used to measure selected markers of endochondral bone formation and bone resorption in the proximal tibia of subtotally nephrectomized rats fed a high calcium diet to induce biochemical changes consistent with adynamic osteodystrophy. Blood ionized calcium concentrations were higher and serum PTH levels were lower in nephrectomized, calcium-supplemented rats than in either intact or nephrectomized control animals. Linear growth and tibial length were reduced, but messenger RNA levels for type II collagen, type X collagen, and the PTH/PTHrP receptor did not differ from control values in nephrectomized rats given supplemental calcium. In contrast, both the width of epiphyseal cartilage and the height of the zone of hypertrophic chondrocytes were greater in calcium-supplemented nephrectomized rats. These morphological changes were associated with decreases in histochemical staining for tartrate-resistant acid phosphatase and lower levels of messenger RNA expression for the matrix metalloproteinase MMP-9/gelatinase B immediately adjacent to the epiphyseal growth plate. Diminished chondroclastic/osteoclastic activity alters growth plate morphology and adversely affects linear bone growth in calcium-supplemented, nephrectomized rats.     

Homocysteine and endogenous markers of renal function in type 2 diabetic patients without coronary heart disease

The aim of this study was to assess parameters of renal function and other determinants of plasma homocysteine in type 2 diabetic patients without coronary heart disease (CHD). Fasting plasma homocysteine, serum cystatin C and serum creatinine were determined in 183 (75 men, 108 women) Type 2 diabetic patients without clinical evidence of CHD. Creatinine clearance was calculated and parameters such as blood pressure, body mass index (BMI), and glycated haemoglobin (HbA_1c) were assessed. The urine albumin:creatinine ratio was used to classify patients as normo-, micro- or macroalbuminuric. One hundred and ten patients were normoalbuminuric, 67 patients were microalbuminuric and six patients were macroalbuminuric. There was no statistically significant difference in plasma homocysteine concentration between patients with normoalbuminuria and microalbuminuria. There was a trend towards increasing plasma homocysteine with decreasing glomerular filtration rate (GFR) (r=−0.46; P<0.0001). There was statistically significant correlation between plasma homocysteine and age (r=0.37), serum cystatin C (r=0.47), and serum creatinine (r=0.56). Plasma homocysteine concentration was significantly higher in patients with BMI<30 kg/m² and showed significant inverse correlation with weight (r=−0.16; P=0.03) and body mass index (r=−0.24; P=0.001). Homocysteine and serum creatinine were significantly higher in males than females and higher in smokers than non smokers but was not associated with glycemic control and duration of diabetes. In conclusion, elevated homocysteine concentration in patients with type 2 DM without CHD is related to age, gender, smoking, BMI and GFR. Follow up studies will provide further information on the association between hyperhomocysteinemia and the development of cardiovascular disease.