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Elevated pretransplant serum CRP level is a risk predictor for acute rejection episodes and may be a useful predictive marker in the follow-up of post-transplantation patients.

Introduction Diabetic foot problems are highly prevalent, responsible for almost 50% of all diabetes-related hospital admissions and a 10-year reduction in life expectancy. The main factors involved in the pathology of diabetic foot are neuropathy, ischemia, and infection. The comorbidities of diabetes are hypertension, obesity, and dyslipidemia. Because of the huge premature morbidity and mortality associated with diabetes, prevention of complications is a key issue and, therefore, it is essential to understand the basic mechanisms that lead to tissue damage. Aim of the work The aim of our study was to detect the association between patient comorbidities, chronic complications, and different diabetic foot types for the early detection and management of these conditions. Patients We carried out a cross-sectional study of 80 consecutive outpatient Egyptian patients with diabetic foot disease in the National Institute of Diabetes and Endocrinology. Results Sixty-three percent were purely neuropathic, followed by 19% that were neuroischemic, whereas 18% were of the ischemic type. Hypertension is the most common comorbid condition and coronary artery disease is highly prevalent in the ischemic and neuroischemic types. The coexistence of hypercholesterolemia, smoking, diabetes, and male sex appears to significantly increase the incidence of ischemic diabetic foot. Nephropathy and retinopathy are significantly associated with neuropathic foot ulcers. Hypertriglyceridemia correlates positively to ischemic and neuroischemic ulcers whereas low HDL and proteinuria correlate positively to both neuropathic and neuroischemic ulcers. Conclusion Special attention should be paid toward the identification of patients who are at risk of foot ulceration to help prevent foot problems. Comorbid conditions must also be identified early and managed aggressively.

Introduction Dyslipidemia has long been implicated in diabetic complications. However, many subgroups have been considered to be responsible. Furthermore, a cause and effect relationship has long been debated. Apolipoprotein B (Apo B) is an exact measure of the total number of very low-density lipoprotein and low-density lipoprotein particles; thus, total plasma Apo B is a reliable surrogate for actual low-density lipoprotein particle number irrespective of its size. Hence, it is a better indicator of the correlation between dyslipidemia and diabetic microvascular complications. Aim of the work Our aim is to study the correlation between Apo B and diabetic microvascular complications, namely, nephropathy and retinopathy. Materials and methods A cross sectional study was carried out of 56 diabetic patients, 36 men and 20 women, both type 1 and 2, who were chosen randomly from the outpatient Endocrinology Clinic in Cairo University. Serum creatinine, estimated glomerular filtration rate, urine albumin/ creatinine ratio (A/C ratio), and Apo B levels were determined. Groups were divided according to the A/C ratio as follows: no proteinuria (A/C ratio<30mg/g), incipient proteinuria (30–300mg/g), and overt proteinuria (>300mg/g). We performed fundus examination as well as fluorescein angiography in patients with retinopathy. Patients on dialysis, HBA1c more than 7.5, on lipid-lowering treatment, or with familial hyperlipidemia were excluded. Calculations were carried out using the SPSS v.10 statistical software. Results We found a significant positive correlation between Apo B levels and microvascular complications. Apo B was higher with overt nephropathy than incipient nephropathy (1.75 ±0.38), and higher in patients with incipient nephropathy (1.4± 0.48) than in patients without nephropathy (1.02 ± 0.34, P<0.01). A highly significant correlation was detected between the grades of retinopathy and the Apo B level. Finally, a significant positive correlation was detected between the presence of maculopathy and Apo B. Apo B levels were significantly higher in the presence of both nephropathy and retinopathy (1.26 ± 0.389) than in the absence of both complications (0.77± 0.361, P<0.05). Conclusion Apo B levels are strongly correlated to diabetic microvascular complications. The higher the degree of nephropathy, the higher the Apo B level. The presence of more than one microvascular complication correlates positively with high levels of Apo B. This suggests the possible use of Apo B as a sensitive biomarker of the presence of early diabetic microvascular complications.

Introduction As cardiovascular disease is the leading cause of mortality in type 2 diabetes mellitus, new markers for early detection and risk stratification of diabetic macroangiopathy and microangiopathy are highly desired. Adipocytokines were considered to lead to an increased risk of vascular complications in patients with type 2 diabetes by modulating vascular function and affecting the inflammatory process, thus enhancing atherosclerosis. Two of these were of particular interest, namely, visfatin and adiponectin. Aim The aim of this study was to evaluate serum visfatin, serum, and urinary adiponectin as early, sensitive surrogate markers of vascular atherosclerosis. We also correlated the levels of these markers to the degree of carotid intimal medial thickness (reflecting the atherosclerotic burden) in type 2 diabetic patients. Results Sixty diabetic patients were subdivided into two groups: group I (30 patients with carotid atherosclerosis as assessed by carotid Doppler) and group II (30 patients without carotid atherosclerosis). Twenty healthy volunteers participated as controls. Serum visfatin as well as serum and urinary adiponectin were assessed in all the study groups. We found significantly higher levels of serum visfatin among diabetics compared with the control group. Visfatin was also significantly higher in group I diabetics with atherosclerosis than those without (P<0.05). Similarly, urinary adiponectin was significantly higher in group I than in group II and in diabetics than in the control group. Serum adiponectin was higher in the control group than both the study groups. Using a regression model, visfatin proved to be the only significant predictor in the model (ß = 0.03, P<0.001). In fact, visfatin alone proved significant, explaining 63% of the variability in carotid intima-media thickness (P<0.001). Conclusion Serum visfatin is highly correlated with macrovascular complications in diabetic patients. Serum visfatin may emerge as a valuable and cheaper surrogate marker for the prediction of prevalent macrovascular complications in a type 2 diabetic population. It is a novel and easy-to-obtain method for the clinical assessment of vascular stress and cardiovascular disease risk in type 2 diabetes. Future prospective studies are needed to confirm our results.