Risk factors and long-term complications in insulin-dependent diabetic patients.
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Albuminuria↗
Biomedical subjects
T Jensen
Publications and source records attributed to T Jensen.
Hypertension in the course of insulin dependent diabetes mellitus and its pathogenetic mechanisms.
All IDDM patients without late complications have blood pressures similar to the nondiabetic background population, and those who develop clinical nephropathy in Denmark have no familial predisposition to hypertension. Blood pressure remains normal until after development of microalbuminuria, indicating no primary role for hypertension in the pathogenesis of nephropathy. When microalbuminuria is present it does, however, play a crucial role in the progression of nephropathy. Sodium retention, possibly induced by hyperinsulinemia, and perhaps glucose-coupled sodium reabsorption in insulin treated patients, seem to play a central role in elevating the blood pressure, but this needs further clarification.
Causality↗
Experience with fish oil treatment with special emphasis on diabetic nephropathy.
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Albumins↗
Diabetic late complications: will aldose reductase inhibitors or inhibitors of advanced glycosylation endproduct formation hold promise?
Patients suffering from the severe complications associated with both insulin- (IDDM) and non-insulin-dependent diabetes mellitus (NIDDM): nephropathy, retinopathy, neuropathy, and atherosclerosis are still largely left without a prospect of an efficient treatment. This is the case even if it has been assumed for decades and now finally proved by the results from the Diabetes Control and Complications Trial (DCCT) that hyperglycemia is the single main cause of these complications. Improved glycemic control as a result of intensive insulin treatment has the potential to reduce the incidence and progression of complications, but implementation and monitoring of improved glycemic control in all groups of IDDM and NIDDM patients in different communities will be difficult and expensive. Results from the recently terminated DCCT have shown that even with intensive insulin treatment, there will be a significant burden of complications on the diabetic population. It will, therefore, still be of immense importance for the long-term quality of life for the diabetic patient that additional possibilities are developed for prevention and intervention against diabetic complications. Almost two decades of research, animal model testing, and clinical trials have been conducted on various efficient aldose reductase inhibitors. Now the concept of inhibition of formation of advanced glycosylation endproducts on proteins and lipids resulting from extra- and intracellular hyperglycemia is entering the scene as an alternative or perhaps supplementary approach to reduce the occurrence of diabetic complications. An overview of the results from these two fields of research and associated drug-development programs will be presented along with thoughts on possible future developments.
Aldehyde Reductase↗
Incidence of retinopathy in type I (insulin-dependent) diabetes: association with clinical nephropathy.
The association between the incidence of diabetic retinopathy and the development of diabetic nephropathy was studied in 110 Type I (insulin-dependent) diabetic patients during a period from 10 years before to 5 years after the onset of persistent proteinuria. This group of patients was compared with 110 diabetic patients, who were matched according to sex, age, and diabetes duration, but who were without proteinuria during the observation period. The cumulative incidence of proliferative retinopathy was 74% in patients with clinical nephropathy and 14% in patients free of proteinuria. The incidence of background retinopathy was 93% and 37%, respectively, and the incidence of retinopathy increased dramatically 5 years before the onset of proteinuria. Neither gender, age at onset of diabetes, nor blood pressure seemed to have much influence on the incidence of severe retinopathy. It is concluded that development of clinical diabetic nephropathy implies an extremely high risk of developing severe retinopathy. A common pathogenetic link may be suspected.
Adolescent↗
Skeletal muscle lipoprotein-lipase activity in insulin-dependent diabetic patients with and without albuminuria.
In patients with insulin-dependent diabetes mellitus (IDDM), albuminuria reflects widespread vascular dysfunction. Albuminuria has been associated to defects of heparan sulfate proteoglycan (HSPG) within the extracellular matrix. Our hypothesis is that loss of HSPG in vascular walls reduces the HSPG-bound lipoprotein-lipase activity (LPLA), thereby causing elevated levels of plasma triglyceride (TG) seen in IDDM patients with albuminuria. The aim of the present study was to evaluate whether LPLA in muscle capillaries could be related to TG in IDDM patients with and without albuminuria. This is a cross-sectional study including ten healthy control subjects (group C), nine patients with IDDM and urinary albumin excretion rate (AER) of 30 mg/24 h or less (group D0) and 20 patients with IDDM and AER greater than 30 mg/24 h (group DA). Muscle LPLA, plasma TG, total cholesterol, high-density lipoprotein cholesterol (HDL), low-density lipoprotein cholesterol (LDL), and very-low-density lipoprotein cholesterol (VLDL) were measured. Between groups no difference in total cholesterol, TG, VLDL, and LDL was found. In patients with albuminuria, LPLA was reduced compared to controls, however, the difference between the groups was not statistically significant [median (range)] 35.9 mU/g (20.4-103) versus 44.6 mU/g (28.2-57.2) and 40.9 mU/g (21.7-53.5) in group DA, C, and D0, respectively, p = 0.76. AER was not correlated to LPLA. An overall negative correlation between TG and LPLA was found; r = -0.33, p = 0.04, supported by an overall significant positive correlation between LPLA and HDL; r = 0.32, p = 0.045. We conclude that, in insulin-dependent diabetes mellitus, skeletal muscle lipoprotein-lipase activity is associated with plasma triglyceride, while an association between lipoprotein-lipase activity and urinary albumin excretion is questionable.
Adult↗
Safety of aztreonam in patients with cystic fibrosis and allergy to beta-lactam antibiotics.
In an open clinical trial, aztreonam was administered repeatedly to 15 cystic fibrosis patients who were chronically infected with Pseudomonas aeruginosa and had previously had severe hypersensitivity reactions to other beta-lactam antibiotics, including anaphylactic shock, generalized urticaria, and drug-associated fever. After negative results in a skin-prick test and a lack of reaction to an intravenous test dose of aztreonam, the patients were treated with aztreonam (150 mg/[kg.d]) in combination with tobramycin (10-20 mg/[kg.d]) for 14-day periods at 3- to 4-month intervals. To date, a total of 56 course of aztreonam have been administered to these patients (three to six courses per patient), and no type 1 hypersensitivity reactions have occurred. However, as a result of drug-associated fever, the administration of aztreonam had to be discontinued in two of 15 cases. The remaining 13 patients have tolerated treatment well.
Adolescent↗
Retrospective clinical study of hypersensitivity reactions to aztreonam and six other beta-lactam antibiotics in cystic fibrosis patients receiving multiple treatment courses.
A total of 2,793 courses of treatment with seven beta-lactam antibiotics were administered to 121 cystic fibrosis patients chronically infected with Pseudomonas aeruginosa, and the patients were evaluated with respect to clinical hypersensitivity reactions. Seventy-five patients (62%) experienced 125 reactions, for an overall frequency (based on the number of courses) of 4.5%. Immediate reactions occurred in 34 patients (28.1%) during 53 courses (1.9%). The highest rate of reactions involved piperacillin (50.9% of patients), and the lowest rate involved imipenem and aztreonam (4.0% and 6.5% of patients, respectively); intermediate reaction rates were noted for carbenicillin (23.6% of patients), azlocillin (20.8%), cefsulodin (17.1%), and ceftazidime (13.0%). Cross-reactivity did not appear to be a major problem. Reactions to aztreonam seemed to be restricted to a small group of patients with a high propensity for beta-lactam hypersensitivity.
Anti-Bacterial Agents↗
Cultured rat and purified human Pneumocystis carinii stimulate intra- but not extracellular free radical production in human neutrophils.
The production of free radicals in human neutrophils was studied in both Pneumocystis carinii derived from cultures of L2 rat lung epithelial-like cells and Pneumocystis carinii purified from human lung. Using the cytochrome C technique, which selectively measured extracellular superoxide generation, hardly any free radical production was observed after stimulation with cultured rat-derived P. carinii. A chemiluminescence technique, which separately measured intra- and extracellular free radical production, was subsequently employed to differentiate the free radical generation. It was established that 1) P. carinii stimulated intra- but not extracellular free radical production in human neutrophils, 2) opsonized cultured rat-derived P. carinii stimulated human neutrophils to a strong intracellular response of superoxide production, and 3) opsonized P. carinii, purified from human lung also stimulated human neutrophils to produce intracellular free radicals.
Animals↗
Preserved neutrophil response to Candida albicans stimulation in AIDS patients with candida esophagitis.
Polymorphonuclear neutrophils (PMNs) and their interaction with immunoglobulins constitute a major line of defence against invading Candida albicans. The function of neutrophils, assessed by superoxide production, and the opsonizing efficacy of sera from 15 AIDS patients with esophageal candidiasis and 15 healthy control subjects were studied. When stimulated with opsonized C. albicans the superoxide generation of PMNs from AIDS patients did not differ from the response observed in healthy subjects. However, a significant depression was demonstrated when PMNs were maximally stimulated by phorbol-12-myristate-13-acetate (PMA). A reduction in opsonizing capability of serum from AIDS patients was detected when tested with zymosan particles. However, the opsonizing capacities of serum from AIDS patients and control subjects were comparable in anticandidal activity, a result that may be explained by a compensatory stimulation of the specific humoral anticandidal response due to perpetual mucous candidiasis in the AIDS patients. These results suggest that anticandidal activity of PMNs and sera from AIDS patients with esophageal candidiasis is preserved, matching the clinical evidence that systemic candidiasis is seldom seen in non-neutropenic AIDS patients.
Acquired Immunodeficiency Syndrome↗
Rapid enzyme-linked immunoassay for detection of Salmonella in food and feed products: performance testing program.
The BIOLINE Salmonella ELISA Test for Salmonella spp., which is a rapid, easy, and convenient assay was evaluated for use in detecting Salmonella in foods and feeds. Each food matrix or feed was artificially contaminated with low levels of Salmonella. Twenty different matrixes were studied and 20 different Salmonella strains from a broad variety of serogroups (B, C, D, E, F, G, H, I, M, O, P, and U) were used. The EUSA Test kit detected levels as low as 1 cfu/25 g sample with at least 4 of the 20 matrixes tested. The test kit is applicable to all sample types tested. The BIOLINE Salmonella ELISA Test kit has been granted AOAC-RI performance tested status.
Animal Feed↗