Association between vascular endothelial growth factor and hypertension in children and adolescents type I diabetes mellitus

The aim of the study was to analyse the relationship between the serum level of vascular endothelial growth factor (VEGF) and the incidence of hypertension (HT) in children and adolescents with type I diabetes mellitus (T1DM). One hundred and five patients with T1DM were enrolled in the study. The control group consisted of 30 healthy controls. All the T1DM patients were subjected to biochemical analyses, ophthalmologic examination and 24-h blood pressure monitoring. Besides, all the patients and healthy controls had serum VEGF levels measured with the use of the ELISA methodology. The essence of our research is that patients with T1DM and HT and with microalbuminuria (MA) and diabetic retinopathy (DR) (MA/DR) are characterized by a significantly higher level of VEGF (340.23±93.22 pg ml–1) in blood serum in comparison with the group of T1DM patients without HT and MA/DR (183.6±96.6 pg ml–1) and with healthy controls (145.32±75.58 pg ml–1). In addition, the VEGF level was significantly higher in T1DM patients, who presented all three complications, that is HT, retinopathy and MA in comparison with T1DM patients without HT, but with MA/DR (P=0.036). On the other hand, no statistically significant differences (P=0.19) were noted in the level of VEGF in serum between T1DM patients without HT and MA/DR and the healthy control group. At a further stage of analysis, using the method of multiple regression, it was shown that systolic pressure, HbA1c and duration of disease are independent factors influencing the concentration of VEGF. Summarizing, the measurement of VEGF serum levels allows for the identification of groups of patients who have the highest risk of HT and, subsequently, progression of vascular complications

Enzymatic vitreolysis with recombinant tissue plasminogen activator for vitreomacular traction

Dorota Raczyńska,1 Paweł Lipowski,1 Katarzyna Zorena,2 Andrzej Skorek,3 Paulina Glasner1 1Department of Ophthalmology, Medical University of Gdańsk, Poland; 2Department of Immunobiology and Environment Microbiology, Medical University of Gdańsk, Poland; 3Department of Otolaryngology, Medical University of Gdańsk, Poland Aims: The aim of our research was to gain data about the efficacy of intravitreal injections of a recombinant tissue plasminogen activator (rTPA) in dissolving vitreoretinal tractions (VRTs).Materials and methods: The study group consisted of patients of our Ophthalmology Clinic who had received an injection of rTPA (TPA Group) for an existent vitreomacular traction confirmed by optical coherence tomography and stereoscopic examinations. The control group consisted of patients who had declined treatment despite the existence of a vitreomacular traction confirmed by the same diagnostic methods. Each group consisted of 30 people (30 eyes). The observation period was 6 months.Conclusion: In both groups some of the VRTs had dissolved. In the TPA group the traction dissolved in 10 patients (33.33%) and in the control group only in 5 (16.67%). It is also important to point out that the mean baseline membrane thickness was higher in the TPA group than in the control group. Observing patients in both groups we noticed that the dissolution of vitreoretinal membrane occurred most frequently in those cases where the membrane was thin. In the TPA group, the mean membrane thickness after 6 months decreased considerably. At the same time, no significant change in the membrane thickness could be observed in the control group. Observation of the retinal thickness allows us to draw the following conclusion: in the TPA group, the retinal thickness in the macular area (edema) had decreased over the study period, whereas in the control group it had increased. In those cases where the traction had dissolved, the edema of the retina decreased by the end of the 6-month period in both groups. In the TPA group, the dissolution of the membrane occurred most often within 3 months from the primary injection. Based on statistics, we can confirm that in the control group there was a decrease in visual acuity during the 6 months of the study period. At the same time, visual acuity in the TPA group underwent a small improvement. A 6-month observation had shown that in patients with strong VRTs, and in particular with VRTs accompanied by epiretinal membranes, a single intraocular injection is not enough to achieve posterior vitreous detachment. We have also shown that rTPA is a safe drug, with no adverse effects observed during the study period. Keywords: tissue plasminogen activator (rTPA), vitreous body, macular hole, vitrectomy, epiretinal membrane, diabetic retinopath

Higher diversity in fungal species discriminates children with type 1 diabetes mellitus from healthy control

Beata Kowalewska,1 Katarzyna Zorena,2 Małgorzata Szmigiero-Kawko,3 Piotr Wąż,4 Małgorzata Myśliwiec3 1Department of Tropical Medicine and Epidemiology, Institute of Maritime and Tropical Medicine, 2Department of Immunology and Environmental Microbiology, 3Clinic of Paediatrics, Diabetology and Endocrinology, 4Department of Nuclear Medicine, Medical University of Gdańsk, Gdańsk, Poland Objective: To conduct qualitative and quantitative assessment of yeast-like fungi in the feces of children and adolescents with type 1 diabetes mellitus (T1DM) with respect to their metabolic control and duration of the disease.Materials and methods: The studied materials included samples of fresh feces collected from 53 children and adolescents with T1DM. Control group included 30 age- and sex-matched healthy individuals. Medical history was taken and physical examination was conducted in the two study arms. Prevalence of the yeast-like fungi in the feces was determined as well as their amounts, species diversity, drug susceptibility, and enzymatic activity.Results: The yeast-like fungi were found in the samples of feces from 75.4% of T1DM patients and 70% controls. In the group of T1DM patients, no correlation was found between age (Rs=0.253, P=0.068), duration of diabetes (Rs=−0.038, P=0.787), or body mass index (Rs=0.150, P=0.432) and the amount of the yeast-like fungi isolated in the feces. Moreover, no correlation was seen between the amount of the yeast-like fungi and glycated hemoglobin (Rs=0.0324, P=0.823), systolic blood pressure (Rs=0.102, P=0.483), or diastolic blood pressure (Rs=0.271, P=0.345).Conclusion: Our research has shown that children and adolescents with T1DM show higher species diversity of the yeast-like fungi, with Candida albicans being significantly less prevalent versus control subjects. Moreover, fungal species in patients with T1DM turn out to be more resistant to antifungal treatment. Keywords: children, diabetes mellitus type 1, yeast-like fungi, drug susceptibility, metabolic control, duration of the diseas

Novel PCSK9 (Proprotein Convertase Subtilisin Kexin Type 9) Variants in Patients with Familial Hypercholesterolemia from Cape Town

Objective: Familial hypercholesterolemia (FH) is characterized by elevated low-density lipoprotein-cholesterol and markedly increased cardiovascular risk. In patients with a genetic diagnosis, low-density lipoprotein receptor (LDLR) mutations account for >90% of cases, apolipoprotein B (APOB) mutations for ≈5% of cases, while proprotein convertase subtilisin kexin type 9 (PCSK9) gain of function mutations are rare (T) was found in 5 index patients and cascade screening identified 15 additional carriers. Low-density lipoprotein-cholesterol levels were higher in these 15 carriers compared with the 27 noncarriers (236±73 versus 124±35 mg/dL; P<0.001). In vitro studies demonstrated the pathogenicity of the G516V variant. Conclusions: In our study, 1.14% of cases with clinical FH were clearly attributable to pathogenic variants in PCSK9. Pathogenicity is established beyond doubt for the G516V variant

Inflammatory Markers Are Increased in Youth with Type 1 Diabetes: The SEARCH Case-Control Study

Context: Increased inflammation may contribute to type 1 diabetes (T1D) complications