Alaa Dawood

Study of risk factors of diabetic foot ulcers

Objective To study the risk factors for diabetic foot ulcers (DFUs) in Menoufia University Hospitals. Background Problems associated with the diabetic foot are prevalent worldwide. DFUs contribute significantly toward the morbidity and mortality of patients with diabetes mellitus. This study was carried out to evaluate the risk factors for DFUs. Patients and methods One hundred patients with diabetic foot were enrolled and 50 patients had foot ulcers. All were subjected to the following: assessment of full history, physical examination including foot examination through peripheral pulses including Doppler examination of dorsalis pedis and posterior tibial arteries, sensations, reflexes and callus, and routine investigations including HbA1c, fasting, and 2 h postprandial blood glucose. Results DFUs occurred mostly in patients who had had diabetes for a long duration more than 10 years (94%), smokers (50%), those with diabetic retinopathy (92%), those with previous ulcers (74%), those who had a previous amputation (42%), those with peripheral neuropathy assessed by [lost monofilament (100%), lost vibration sensation (100%), lost pinprick sensation (100%)], peripheral vascular disease assessed by [ankle brachial index≤0.9 (84%), Doppler examination detected ischemia (84%)], foot fissures (12%), foot callus (24%), foot deformities (36%), limited joint mobility (26%), dyslipidemia on the basis of elevated total cholesterol greater than 200 mg/dl (40%), and poor glycemic control on the basis of (hemoglobin A1C>7.5%). The types of ulcers were neuropathic (16%) and neuroischemic (84%). Age, sex, diabetic nephropathy, obesity detected by BMI, abnormal ankle reflexes, and elevated serum creatinine were not risk factors for DFUs. Conclusion Peripheral neuropathy, duration of diabetes, peripheral vascular disease, and poor glycemic control were significant predictors of DFUs.

Retinopathy in type 2 diabetes mellitus patients with and without chronic hepatitis C virus infection

Objective The aim of the study was to evaluate the effect of chronic hepatitis C virus (HCV) infection in the prevalence of diabetic retinopathy. Background Diabetes mellitus (DM) is associated with significant morbidity and mortality as a result of both microvascular and macrovascular complications. Type 2 diabetes mellitus (T2DM) and HCV infection are two major public health problems worldwide. Patients and methods In this study, we examined 70 patients with T2DM who were selected for this prospective study from the outpatient clinics of Internal Medicine and Ophthalmology Departments. Patients were classified into two groups: group I and group II: group I comprised 38 patients with T2DM without HCV infection. Group II comprised 32 patients with T2DM with positive HCV infection. All patients were subjected to detailed history taking, clinical examination, and laboratory investigations including complete blood picture, glycosylated hemoglobin (HbA1C) level, PCR test to prove the presence of HCV infection, prothrombin time, international normalized ratio, fibrinogen, platelet count and mean platelet volume, liver function tests including aspartate aminotransferase, alanine aminotransferase, serum albumin, and total serum bilirubin, and ophthalmoscopic examinations for diagnosis of diabetic retinopathy. Results Retinopathy was higher in T2DM patients: 27 (71.1%) patients were positive for retinopathy and 11 (28.9%) patients were negative, compared with chronic HCV-DM patients, among whom 13 (40.6%) were positive for retinopathy and 19 (59.4%) were negative. This difference is high enough to produce significant statistical difference (P = 0.014). Platelet count, fibrinogen concentration, and mean platelet volume were increased in diabetic retinopathy patients. International normalized ratio and prothrombin time levels were significantly higher in diabetic patients with chronic HCV infection than in diabetic patients without HCV infection. Conclusion Diabetic retinopathy was significantly higher in diabetic patients without chronic HCV infection than in diabetic patients with chronic HCV infection.

Prevalence of urinary tract infection in Damietta diabetic patients

Aim of the work The aim of this observational study was to quantify the incidence of urinary tract infections (UTI) among diabetic patients and to compare this risk to patients without diabetes in Damietta hospital. Patients and methods This study included one thousand individuals (500 diabetic and 500 nondiabetic) examined for potential infections; assessment of history including age, sex, duration of diabetes, and treatment of diabetes, urine analysis and culture, total leukocyte count, blood sugar, serum creatinine, and glycated hemoglobin A1c was performed for each patient. Results The prevalence of UTI was 52.2%/500 diabetic patients, which was significantly higher than the prevalence of UTI in nondiabetic patients (22.4%/500 nondiabetic patients) (P < 0.001). There was a significant difference in the distribution of UTI in the diabetic and the nondiabetic group according to the history of previous UTI and total leukocytic count as diabetic patients had more previous UTI and increased total leukocytic count compared with nondiabetic patients (P < 0.001). In terms of the distribution of uropathogens in diabetic and nondiabetic patients with UTI, Escherichia coli was the most prominent uropathogen in both the diabetic and the nondiabetic group. Conclusion UTIs are more prevalent in individuals with diabetes mellitus (DM). The main risk factors for UTI in DM are inadequate glycemic control, duration of DM, diabetic microangiopathy, impaired leukocyte function, and anatomical and functional abnormalities of the urinary tract.

Study of insulin resistance in patients with systemic lupus erythematosus and rheumatoid arthritis

Objective The aim of the study was to study insulin resistance (IR) and pancreatic b-cell function in patients with systemic lupus erythematosus (SLE) and rheumatoid arthritis (RA) and their relationship with disease activity. Background IR is an important contributor to the increased cardiovascular risk attributed to the metabolic syndrome, a constellation of cardiovascular risk factors that includes central obesity, dyslipidemia, hypertension, and disturbed glucose metabolism, in patients with RA or SLE. Patients and methods The study included 35 SLE and 35 RA patients and 20 controls. Disease activity was assessed by Systemic Lupus Activity Measure score and Disease Activity Score-28. BMI, C-reactive protein, erythrocyte sedimentation rate, lipid profile, fasting glucose and insulin, and c-peptide were determined. The homeostasis model of assessment (HOMA) was used to evaluate IR and secretion. Results SLE patients had high-grade systemic inflammation, IR, and secretion compared with controls ( P P Conclusion The present study demonstrated that both SLE and RA patients had a higher IR and abnormal insulin secretion than age-matched apparently healthy controls. This conclusion was based on the measurement of fasting insulin concentration, HOMA IR, and HOMA b-cells. IR and abnormal insulin secretion were associated with markers for inflammation (erythrocyte sedimentation rate and C-reactive protein) and disease activity indices (Systemic Lupus Activity Measure and Disease Activity Score-28). Higher IR and abnormal insulin secretion were found in RA patients in comparison with SLE patients.