The relation between IL-10 gene (-1082G/A) and VEGF gene 936 C/T polymorphism and diabetic polyneuropathy in a cohort of Egyptian patients with type 2 diabetes

Background: Polymorphisms have been described to correlate with T2DM and its complications including diabetic polyneuropathy (DPN). The aim of this study was to investigate the relation between interleukin (IL)-10-1082 G/A and vascular endothelial growth factor (VEGF)-936 C/T polymorphism and DPN in type 2 diabetes mellitus (T2DM) patients. Methods: This cross-sectional study included 50 T2DM patients and 40 controls. Clinical and electrophysiological assessments for DPN, fasting blood glucose level (FBS) and glycosylated haemoglobin (Hb A1C) were recorded. VEGF-936 C/T polymorphism was carried out by polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP) technique. Genotyping for IL-10 promotor gene (-1082 G/A) polymorphism was performed using Real-time PCR. Results: Sixty percent of patients had confirmed DPN, while none were considered normal. IL-10 (genotype -1082G/G) was statistically higher among controls compared to patients (p=0.008). VEGF-936-CT genotype was statistically higher among patients compared to controls (p=0.033), but there was no significant relation between IL-10-1082 G/A or VEGF-936 C/T polymorphism genotypes and DPN. IL-10 (genotype -1082A/G) had higher HbA1C levels (p=0.041) and a lower albumin/creatinine ratio, while IL-10 (genotype -1082G/G) had a higher albumin/creatinine ratio (p=0.024). DPN had a significant correlation with duration of diabetes, FBS and HbA1C. Conclusion: The VEGF-936 C/T genotype may be associated with T2DM, while the IL-10 (genotype -1082G/G) may be less likely to be associated with it; however there was no association between VEGF-936 or IL-10-1082 genotypes and DPN

Involvement of the wrist and hand joints and tendons in an Egyptian systemic lupus erythematosus cohort

Abstract Background Systemic lupus erythematosus (SLE) patients often suffer hand function limitations even in the absence of symptoms related to joint or tendon disorders. Recent researches reported the presence of ultrasonographic (US) subclinical synovitis and tendon involvement in asymptomatic patients. We aimed to assess US patterns in SLE patients and determine their relationship with clinical assessment, disease activity and hand functional status using handheld dynamometry. Results We assessed 30 SLE patients (60 hands) using US; 21 (70%) patient had synovial hypertrophy, 8 (26%) showed a power Doppler (PD) activity, 6 (20%) had erosions and 11 (36.6%) had tendon US abnormality. Both patients with hand arthralgia/arthritis (symptomatic) and patients without arthralgia/arthritis (asymptomatic) had a statistically insignificant difference regarding the global synovitis score (p = 0.2) and disease activity (p = 0.3). However, the symptomatic group had a significantly increased number of joints with effusion (p = 0.04) and tendons involved (p = 0.04). The mean grip strength had a significant negative correlation with SLEDAI-2 K score (rs = − 0.4, p = 0.02) in the total patient group. In the asymptomatic group, a negative correlation was found between both mean grip (rs = − 0.5, p = 0.04) and pinch strength (rs = − 0.6, p = 0.01) with PD index, and mean pinch strength with the Jaccoud’s arthropathy index (rs = − 0.49, p = 0.05). Conclusions SLE patients may have higher subclinical synovitis, erosions and tendon involvement than expected, which may in turn reduce hand grip and pinch strength. Disease activity may also have a negative impact on the hand grip functional strength

Global economic burden of unmet surgical need for appendicitis

Background There is a substantial gap in provision of adequate surgical care in many low- and middle-income countries. This study aimed to identify the economic burden of unmet surgical need for the common condition of appendicitis. Methods Data on the incidence of appendicitis from 170 countries and two different approaches were used to estimate numbers of patients who do not receive surgery: as a fixed proportion of the total unmet surgical need per country (approach 1); and based on country income status (approach 2). Indirect costs with current levels of access and local quality, and those if quality were at the standards of high-income countries, were estimated. A human capital approach was applied, focusing on the economic burden resulting from premature death and absenteeism. Results Excess mortality was 4185 per 100 000 cases of appendicitis using approach 1 and 3448 per 100 000 using approach 2. The economic burden of continuing current levels of access and local quality was US $92 492 million using approach 1 and$73 141 million using approach 2. The economic burden of not providing surgical care to the standards of high-income countries was $95 004 million using approach 1 and$75 666 million using approach 2. The largest share of these costs resulted from premature death (97.7 per cent) and lack of access (97.0 per cent) in contrast to lack of quality. Conclusion For a comparatively non-complex emergency condition such as appendicitis, increasing access to care should be prioritized. Although improving quality of care should not be neglected, increasing provision of care at current standards could reduce societal costs substantially

Global economic burden of unmet surgical need for appendicitis

Background There is a substantial gap in provision of adequate surgical care in many low- and middle-income countries. This study aimed to identify the economic burden of unmet surgical need for the common condition of appendicitis. Methods Data on the incidence of appendicitis from 170 countries and two different approaches were used to estimate numbers of patients who do not receive surgery: as a fixed proportion of the total unmet surgical need per country (approach 1); and based on country income status (approach 2). Indirect costs with current levels of access and local quality, and those if quality were at the standards of high-income countries, were estimated. A human capital approach was applied, focusing on the economic burden resulting from premature death and absenteeism. Results Excess mortality was 4185 per 100 000 cases of appendicitis using approach 1 and 3448 per 100 000 using approach 2. The economic burden of continuing current levels of access and local quality was US $92 492 million using approach 1 and$73 141 million using approach 2. The economic burden of not providing surgical care to the standards of high-income countries was $95 004 million using approach 1 and$75 666 million using approach 2. The largest share of these costs resulted from premature death (97.7 per cent) and lack of access (97.0 per cent) in contrast to lack of quality. Conclusion For a comparatively non-complex emergency condition such as appendicitis, increasing access to care should be prioritized. Although improving quality of care should not be neglected, increasing provision of care at current standards could reduce societal costs substantially