Rana El-Hilaly

Is exercise a therapeutic tool for improvement of cardiovascular risk factors in adolescents with type 1 diabetes mellitus? A randomised controlled trial

BackgroundType 1 diabetes mellitus (T1DM) is associated with a high risk for early atherosclerotic complications especially risk of coronary heart disease.ObjectiveTo evaluate the impact of six months exercise prgram on glycemic control, plasma lipids values, blood pressure, severity and frequency of hypoglycemia, anthropometric measurements and insulin dose in a sample of adolescents with T1DM.Research design and methodsA total of 196 type 1 diabetic patients participated in the study. They were classified into three groups: Group (A) did not join the exercise program(n = 48), group (B) attended the exercise sessions once/week (n = 75), group (C) attended the exercise sessions three times/week (n = 73). Studied parameters were evaluated before and six months after exercise programe.ResultsExercise improved glycemic control by reducing HbA1c values in exercise groups (P = 0.03, P = 0.01 respectively) and no change in those who were not physically active (P = 0.2). Higher levels of HbA1c were associated with higher levels of cholesterol, LDL-c, and triglycerides (P = 0.000 each). In both groups, B and C, frequent exercise improved dyslipidemia and reduced insulin requirements significantly (P = 0.00 both), as well as a reduction in BMI (P = 0.05, P = 0.00 respectively) and waist circumference(P = 0.02, P = 0.00 respectively). The frequency of hypoglycemic attacks were not statistically different between the control group and both intervention groups (4.7 ± 3.56 and 4.82 ± 4.23, P = 0.888 respectively). Reduction of blood pressure was statistically insignificant apart from the diastolic blood presure in group C (P = 0.04).ConclusionExercise is an indispensable component in the medical treatment of patients with T1DM as it improves glycemic control and decreases cardiovascular risk factors among them.

The role of a total contact insole in diminishing foot pressures following partial first ray amputation in diabetic patients

BACKGROUND In diabetic subjects, reulcerations following first ray amputations are particularly frequent. Treatment usually includes an in-shoe intervention to reduce plantar pressure. OBJECTIVE To investigate the effects of a total contact insole on the plantar pressure reduction in patients with partial first ray amputations. MATERIAL AND METHODS Twenty diabetic subjects (mean age 60 years, mean body mass index 27kg/m(2)) with partial first ray amputation of one foot. Plantar pressure data was recorded using Matscan system (Tekscan vers. 6.34, Boston, USA) while standing and taking a step for three conditions (shoe, shoe with total contact insole, and shoe with flat insole). Plantar pressures were determined at the five metatarsal areas, mid foot area and medial and lateral heel areas. RESULTS Pressures diminished significantly (P<0.05) in tested areas using the total contact insole while standing and walking. While using the flat insole, significant pressure changes were only seen while walking (P<0.05) (P<0.05). A highly significant change in pressures with the total contact insoles during walking in all areas except for the M1 area (P<0.001) as compared to that of flat insole. CONCLUSION The conforming total contact insole showed significant reduction in plantar pressures in patients with first ray amputation.

Diagnostic Ultrasound of the Vagus Nerve in Patients with Diabetes

Autonomic neuropathy is a serious and common complication of diabetes mellitus. The vagus nerve is the longest autonomic nerve, and may be affected in diabetes as a part of generalized neuropathy. Our objective was to assess for possible sonographic changes of the vagus nerve in diabetic patients.

Role of neopterin as a biochemical marker for peripheral neuropathy in pediatric patients with type 1 diabetes: Relation to nerve conduction studies

Background: Neopterin, a marker of inflammation and cellular immune response, is elevated in conditions of T‐cell or macrophages activation. Diabetic peripheral neuropathy (DPN) is associated with inflammatory/immune processes and therefore, we hypothesized that neopterin could be used as a marker of neuropathy in type 1 diabetes mellitus (T1DM). Aim: To measure neopterin levels in children and adolescents with T1DM and assess its possible relation to DPN and nerve conduction studies (NCS). Methods: Sixty patients aged ≤18years and >5years disease duration were subjected to neurological assessment by neuropathy disability score (NDS) and NCS for median, ulnar, posterior tibial and common peroneal nerves. Mean fasting blood glucose, lipid profile, HbA1c, high sensitivity C‐reactive protein (hs‐CRP) and serum neopterin levels were assessed. Patients were compared with 30 age‐ and sex‐matched healthy controls. Results: The frequency of DPN according to NDS was 40 (66.7%) patients out of 60 while NCS confirmed that only 30 of those 40 patients had this complication (i.e. 50% out of the total studied patients). Neopterin levels were significantly higher in patients with DPN than those without (median [IQR], 53.5 [35–60] nmol/L versus 17 [13−32] nmol/L) and healthy controls (5.0 [3.2–7.0] nmol/L) (p<0.001). Significant positive correlations were found between neopterin levels and HbA1c (r=0.560, p=0.005), serum creatinine (r=0.376, p=0.003), total cholesterol (r=0.405, p=0.026) and hs‐CRP (r=0.425, p=0.012) among patients with DPN. Neopterin levels were positively correlated to motor latency of tibial and common peroneal nerves as well as motor and sensory latencies of median and ulnar nerves. Logistic regression analysis revealed that neopterin was a significant independent variable related to DPN (Odds ratio, 2.976). Neopterin cutoff value 32nmol/L could differentiate patients with and without DPN with 100% sensitivity and 96.7% specificity. Conclusions: Neopterin could be used as an early reliable serum biomarker for DPN in pediatric patients with T1DM. HIGHLIGHTSFirst study to determine neopterin in pediatric patients with type 1 diabetesBoth sensory and motor conduction changes occur in pediatric type 1 diabetesNeopterin was higher in patients with peripheral neuropathy than those without.Neopterin was correlated with motor and sensory nerve conduction parameters.Neopterin is a promising marker of peripheral neuropathy in T1DM.

Radiological outcome of calcaneo-cuboid-cuneiform osteotomies for planovalgus feet in cerebral palsy children: Relationship with pedobarography

BACKGROUND Calcaneo-cuboid-cuneiform (triple C) osteotomies correct all levels of deformity of flexible planovalgus feet (PVF) in patients with cerebral palsy (CP). The objective was assessing short term results and the hypothesis was that static pedobarography correlates with radiological parameters as outcome measures. METHODS A prospective case series of consecutive skeletally immature ambulatory spastic CP patients above the age of 4 years who underwent triple C for PVF. Assessment was done using static pedobarography and standing dorsoplantar (DP) and lateral radiographs. The calcaneal pitch, lateral talocalcaneal, lateral and DP talo-first metatarsal, and DP talonavicular coverage angles were measured. RESULTS Eighteen feet (12 patients) were analyzed. Postoperative changes in lateral and DP talo-first metatarsal, and DP talonavicular coverage angles were statistically significant (P-value=0 with paired T-test). Post operative foot pressure changes were significant and highest in mid-foot. Both outcomes were related together with a p-value of 1 using McNemar test. CONCLUSIONS The triple C and associated soft tissue procedures reliably corrected PVF deformities. Static pedobarography can be used for postoperative assessment of adequate correction.

Relationship of planter pressure and glycemic control in type 2 diabetic patients with and without neuropathy

INTRODUCTION Foot disease is a common complication of type 2 diabetes that can have tragic consequences. Abnormal plantar pressures are considered to play a major role in the pathologies of neuropathic ulcers in the diabetic foot. AIM To examine Relationship of Planter Pressure and Glycemic Control in Type 2 Diabetic Patients with and without Neuropathy. MATERIALS AND METHODS The study was conducted on 50 type 2 diabetic patients and 30 healthy volunteers. BMI calculation, disease duration, Hemoglobin A1c and presence of neuropathy (by history, foot examination and DN4 questionnaire) were recorded. Plantar pressure was recorded for all patients using the Mat-scan (Tekscan, Inc.vers. 6.34 Boston USA) in static conditions (standing) and dynamic conditions (taking a step on the Mat-scan). Plantar pressures (kPa) were determined at the five metatarsal areas, mid foot area, medial and lateral heel areas and medial three toes. RESULTS Static and dynamic plantar pressures in both right and left feet were significantly higher in diabetic with neuropathy group than in control group in measured areas (P<0.05). Static and dynamic pressures in right and left feet were significantly higher in diabetic with neuropathy group than in diabetic without neuropathy group in measured areas (P<0.05). On comparison between controls and diabetic without neuropathy group there was a significant difference in plantar pressures especially in metatarsal areas (P<0.05). No significant correlations were present between the studied variables age, disease duration, BMI and HbA1c and plantar pressures in all studied areas. CONCLUSION Persons with diabetic neuropathy have elevated peak plantar pressure (PPP) compared to patients without neuropathy and control group. HbA1c% as a surrogate for glycemic control had no direct impact on peak planter pressure, yet it indirectly impacts neuropathy evolution through out disease duration eventually leading to the drastic planter pressure and gait biomechanics changes.

Evaluation of endothelial protein C receptor in patients with systemic lupus erythematosus: correlation with disease activity and lupus nephritis

Introduction Systemic lupus erythematous (SLE) is a systemic, multifaceted inflammatory disease with clinical manifestations is protean and follows a relapsing and remitting course. Lupus Nephritis (LN) is one of the most frequent and serious manifestation. Endothelial protein C receptor (EPCR) is a transmembrane receptor that is shed into soluble form (sEPCR) in inflammatory status. It is demonstrated as a part of the pathobiology of the SLE disease. Aim of the work To assess correlation of sEPCR level in SLE patients to the disease activity in these patients and to relate sEPCR to LN. Patients and methods Serum level of sEPCR using enzyme-linked immunosorbent assay (ELISA), chemical and immunological markers of SLE were measured in 30 SLE patients and 30 age and sex matched apparently healthy controls. SLE patients were subgrouped into 20 patients without LN and 10 with LN. Disease activity was assessed using SLE Disease Activity Index (SLEDAI). Results A significantly higher sEPCR level was found on comparing SLE patients to controls with statistically highly significant difference (z = 4.8, P < 0.001). Moreover, there was a significantly higher sEPCR level on comparing SLE patients with LN to those without LN with statistically highly significant difference (z = 3.9, P < 0.001). Serum sEPCR had a highly significant positive correlation with SLEDAI in SLE patients (r = 0.66, P < 0.01). Conclusion sEPCR has a possible role in the pathogenesis of SLE and particularly LN diseases, reflecting disease activity in SLE patients.