[Influence of diabetes on mechanics efficiency of pregnant women's feet end risk of diabetic foot]. / Cukrzyca i ciaza--wplyw na mechanike stóp i ryzyko rozwoju stopy cukrzycowej.

UNLABELLED: A foot is a complicated osteoarticular system. The complex structure and variability predispose it to the formation of foot deformity. The cause deformities of the feet are weakened muscle tissue and ligaments, systemic diseases: obesity, musculoskeletal defects, neurological diseases, rheumatism, diabetes, pregnancy, improper shoes or socks. They interfere with the function of the foot and are reflected in the distribution of support points. The aim of this study was to assess the impact of diabetes on pregnancy and the mechanics of the foot and the risk of developing diabetic foot. MATERIAL AND METHODS: The study took part in healthy and diseased women with type 1 diabetes in pregnancy. Evaluation of static foot was performed using podoscope, made up of mirrors, lights and camera. The camera described the distribution of the pressure on the glass plate, which the person being investigated was standing on. It recorded the reflection of feet and transmit them to a computer. Description the results consisted of defining relevant indicators. The evaluation was performed using the dynamic pressure Parotec system, the measuring cylinder placed inside the patient's shoe provided with sensors recording the foot pressure distribution on the ground while standing and walking. The data were stored on a memory card loaded into the computer, where the analysis took place. It has been calculated the average values of pressures exerted on the various zones of the foot. RESULTS: It was found that the increase in body weight resulting from the advancement of women pregnancy increases the load exerted on the foot. Forces are growing in subsequent trimesters of pregnancy reaching a maximum at the end of the third trimester. The longitudinal and transverse arches of the foot are reducing. After the birth, the pressure exerted on each area of the foot decreases, arches of the foot are getting back to starting position. CONCLUSIONS: Number of foot deformities is higher in women with type 1 diabetes. It grow the risk of developing diabetic foot syndrome.

Salivary exoglycosidases in gestational diabetes .

INTRODUCTION: As exoglycosidases have been described as potential markers of salivary gland pathology, we decided to check the possibility of the use of these enzymes in the detection of salivary gland involvement in gestational diabetes. MATERIALS AND METHODS: For this purpose diabetic pregnant women were compared to pregnant and non-pregnant healthy women. The activities of total HEX as well as GLU in the saliva were determined in duplicate according to Marciniak et al. The activities of GAL, FUC, and MAN in the saliva were determined in duplicate according to Zwierz et al. RESULTS: It was found that the specific activities of exoglycosidases in the saliva of diabetic pregnant women significantly increased in comparison to healthy pregnant and non-pregnant women. CONCLUSION: Increased specific activity of exoglycosidases suggests that gestational diabetes provokes structural/functional alterations in salivary glands and changes in the salivary glycoconjugates metabolism.

[The influence of pregnancy on progression of diabetic retinopathy]. / Wplyw ciazy na progresje retinopatii cukrzycowej.

PURPOSE: Pregnancy is considered an important risk factor of the development and progression of diabetic retinopathy (DR). The aim of the study was to assess whether retinal changes tend to progress during pregnancy in women with type 1 diabetes. MATERIAL AND METHODS: 136 women with type 1 diabetes were enrolled to this 3 years prospective study. The patients were divided according to White's scale into the following classes: B (n=76), C (n=34), D (n=24), R (n=2). Before conception and during pregnancy the patients were treated with intensive insulin therapy to achieve optimal metabolic control. Ophthalmic examination was performed before planned conception, in each trimester of the pregnancy and after delivery. RESULTS: No pathologies were discovered with fundoscopy in all the women belonging to class B, in 22 women from class C and in 4 women from class D. No progression of diabetic retinopathy was observed during the entire period of observation in 12 women from class C and in 20 from class D with nonproliferative DR in the first examination. In 3 women from class C progression of DR were observed in the second trimester with partial improvement after delivery. Visual acuity in these patients also deteriorated. Proliferative DR diagnosed in 2 patients from class R at the beginning of the observation, progressed during the pregnancy to diminish after delivery. CONCLUSIONS: Pregnancy does not influence significantly the progression of pre-existing diabetic retinopathy, provided that proper metabolic control is achieved and patients are subject to systematic ophthalmological control.

Clinical usefulness of videocapillaroscopy and selected endothelial cell activation markers in people with Type 1 diabetes mellitus complicated by microangiopathy.

PURPOSE: Microvascular abnormalities are one of the most important causes of persistent diabetic complications. The aim of our study was to compare microvascular changes examined by nailfold videocapillaroscopy (NVC) examination with serum concentrations of vascular endothelial growth factor (VEGF), soluble thrombomodulin (sTM) and endothelin-1 (ET-1) in people with Type 1 diabetes with and without microangiopathy. MATERIAL/METHODS: The study included 106 people with Type 1 diabetes and 40 healthy controls. All participants were evaluated by extensive clinical, laboratory and capillaroscopic studies. NVC was performed using a stereomicroscope SZ 4045 (Olympus, Germany). The intensity of morphological changes was graded from 0 to 3. Serum levels of VEGF, sTM and ET-1 were determined by an enzyme-linked immunosorbent assay (ELISA). RESULTS: Morphological changes were observed by NVC in 86 out of 106 (81%) people with Type 1 diabetes mellitus. Severe capillaroscopic changes (score 3) were seen in 32 out of 54 (59%) people with microangiopathy, but in only seven out of 52 (13%) individuals without microangiopathy. Higher serum concentration of VEGF (p<0.001), ET-1 (p<0.001) and sTM (p<0.05) were demonstrated in people with diabetes complicated with microangiopathy compared to healthy controls. Moreover, comparison between people with and without microangiopathic complications showed a significantly higher capillaroscopic score and sTM serum concentration in the group with retinopathy (p<0.001) nephropathy (p<0.001) and neuropathy (p<0.01). CONCLUSIONS: Our results suggest that abnormalities in NVC may reflect the extent of microvascular involvement and associated with higher VEGF, sTM and ET-1 serum levels, as well as with microangiopathic complications in diabetic people.

GC-MS based Gestational Diabetes Mellitus longitudinal study: Identification of 2-and 3-hydroxybutyrate as potential prognostic biomarkers.

Gestational Diabetes Mellitus (GDM) causes severe short- and long-term complications for the mother, fetus and neonate, including type 2-diabetes (T2DM) later in life. In this pilot study, GC-Q/MS analysis was applied for plasma metabolomics fingerprinting of 24 healthy and 24 women with GDM at different stages of gestation (second and third trimester) and postpartum (one and three months). Multivariate (unsupervised and supervised) statistical analysis was performed to investigate variance in the data, identify outliers and for unbiased assessment of data quality. Plasma fingerprints allowed for the discrimination of GDM pregnant women from controls both in the 2nd and 3rd trimesters of gestation. However, metabolic profiles tended to be similar after delivery. Follow up of these women revealed that 4 of them developed T2DM within 2 years postpartum. Multivariate PLS-DA models limited to women with GDM showed clear separation 3 months postpartum. In the 2nd trimester of gestation there was also a clear separation between GDM women that were normoglycemic after pregnancy and those with recognized postpartum T2DM. Metabolites that had the strongest discriminative power between these groups in the 2nd trimester of gestation were 2-hydroxybutyrate, 3-hydroxybutyrate, and stearic acid. We have described, that early GDM comprises metabotypes that are associated with the risk of future complications, including postpartum T2DM. In this pilot study, we provide evidence that 2-hydroxybutyrate and 3-hydroxybutyrate may be considered as future prognostic biomarkers to predict the onset of diabetic complications in women with gestational diabetes after delivery.

[The effect of Chernobyl accident on the development of malignant diseases--situation after 20 years]. / Wplyw awarii w Czarnobylu na wystepowanie nowotworów tarczycy--stan po 20 latach.

The accident that occurred at the Chernobyl Nuclear Power Plant in 1986, released large quantities of radionuclides--among them radioiodine--into the atmosphere, thereby raising public concerns about its influence on thyroid structure and function, especially the development of malignancy. There were even reports about 700 deaths due to thyroid carcinoma in Russian Federation, Ukraine and Belarus, resulting from the accident. In this review we discussed the incidence of thyroid cancer in different parts of the world, especially in heavily contaminated countries, as Ukraine and Belarus, and the possible link between radioisotope activity in the thyroid and the development of malignancy. The study carried out in Minsk showed 40-fold increase of the incidence of thyroid cancer in the years 1986-1994, in comparison to the period 1977-1985. An increase of the incidence of thyroid cancer has generally been observed in many countries after the Chernobyl accident. We focused on the factors that may have an influence on this phenomenon, especially diagnostic tests, health care, social and environmental factors, like iodine level in water and soil. The results of molecular biology studies, e.g. RET translocation in carcinoma type RET/PTC1 in elderly and RET/PTC3 in children, and expression Ax1 and Gas6 in children were reviewed as well. We also mentioned other thyroid diseases, like nodular goitre, cysts, the disturbance of thyroid function and autoimmunity, possibly linked to the radiation after Chernobyl accident. Data obtained from the regions near Chernobyl showed no increased risk of other types of malignancy (leukaemia, Hodgkin's and non Hodgkin's lymphoma) in 1986-1996. In this article the epidemiology of thyroid diseases in Poland was also reviewed.

[The effect of Chernobyl accident on the development of non malignant diseases]. / Wplyw awaarii w Czarnobylu na rozwój schorzen nienowotworowych.

The early medical complications of Chernobyl accident include post radiation disease, which were diagnosed in 134 subjects affected by ionizing radiation. 28 persons died during the first 100 days after the event. The increase occurrence of coronary heart disease, endocrine, haematological, dermatological and other diseases were observed after disaster in the contaminated territories. We also discussed the impact of ionizing radiation from Chernobyl accident on pregnancy and congenital defects occurrence. Changes following the Chernobyl accident, as the inhabitants migration from contaminated regions, political and economic conversions, led to depression, anxiety, and even to "epidemic" of mental diseases. Increased suicide rate, car accidents, alcohol and drug abuse have been observed in this population. Nowadays vegetative neurosis is more often diagnosed in Ukrainian children. Epidemiological studies were conducted on the ionising radiation effect on the health and on the dose of received radiation after Chernobyl accident face numerous problems as the absence of reliable data regarding diseases in the contaminated territories.

[The radiological situation before and after Chernobyl disaster]. / Sytuacja radiologiczna w czasie i po awarii w Czarnobylu.

The nuclear reactor accident, which occurred on 26 April 1986 at Chernobyl, has been one of the greatest ecological disasters in human history. In our study we discussed the most recent data on the accident, and the natural and synthetic sources of radiation. According to the recent data, the air at Chernobyl had been contaminated with about 5300 PBq radionuclide activity (excluding rare gases), including 1760 PBq (131)I and 85 PBq (137)Cs. The highest radiation received by the liquidators (0.8-16 Gy), lower doses were received by the population which was evacuated or inhabited the contaminated areas (in which the level of (137)Cs activity deposited in the earth was 37 kBq/m(2)). In the European countries the highest mean radiation dose per year for the whole body in the first year after the accident was in Bulgaria (760 microSv), Austria (670 microSv) and Greece (590 microSv), while the lowest radiation dose was observed in Portugal (1.8 microSv) and Spain (4.2 microSv). In Poland the mean effective equivalent dose resulting from Chernobyl accident was 932 microSv and is close to the limited dose permitted in Poland, equalling 1 mSv/year. The highest radiation dose to thyroid was received by inhabitants of the states previously known as Bielskopodlaskie, Nowosadeckie and the north-east region of Poland. Lowest dose was received by inhabitants of the areas previously known as Slupski and Rzeszowski.

Reproductive disturbances in type 1 diabetic women.

Among young type 1 diabetic women disturbances of reproductive system and other related disorders are often present. The present paper, which reviews the literature of the part several years aims to present some of those disorders. Special attention is focused on menstrual irregularities, fertility and sexual problems. Type 1 diabetic women usually have a delayed menarche and an early onset of menopause than nondiabetic women. They are also at higher risk of having menstrual disturbances, such as amenorrhea and oligomenorrhea. It has been suggested that the GnRH pulse-generator in the hypothalamus is responsible for diabetic menstrual dysfunction. The risk of sexual and gestational problems is higher in type 1 diabetes than in the general population, but fertility in diabetic women seems to be similar to nondiabetics.

Optimization and validation of a chiral GC-MS method for the determination of free D-amino acids ratio in human urine: application to a gestational diabetes mellitus study.

Gestational Diabetes Mellitus (GDM) is defined as glucose intolerance with onset or first recognition during pregnancy. It is affecting approximately up to 14% of all pregnancies with an increasing tendency. GDM has been related to relevant short-term and long-term health complications for both mother and offspring. Recent studies strongly emphasized the role of several essential amino acids in the pathogenesis of obesity and highlighted their strong correlation with insulin resistance, but there are no references related to modifications in D-AAs in biological fluids. As D-AA elimination proceeds mainly by renal excretion, urine was the selected sample to evaluate the alterations in free D-AAs ratio in a GDM study. Only 1 mL of first void urine or standard solution was required for purification, by using a Discovery DSC-SCX SPE cartridge (500 mg/3 mL) and derivatization into their N(O)-pentafluoropropionyl amino acid 2-propyl esters. Enantiomeric separation was carried out by GC-MS on a Chirasil-L-Val N-propionyl-L-valine-tert-butylamide polysiloxane fused-silica capillary column (25 m×0.25 mm I.D., 0.12 µm film thickness, Agilent Technologies, Waldbronn, Germany), under programmed temperature elution. Detection was performed with an ion trap mass analyzer, operating in the full scan mode in the m/z 50-350 range. 14 pairs of derivatives of D-and L-AAs were separated. The steps of sample preparation, derivatization and GC-MS conditions were optimized for both urine and standards. Several conditions affecting the SPE procedure, such as sorbent mass/volume ratio of the cartridge, sample dilution and pH, were optimized. Volume of reagents and solvents and reaction temperature and time were also tested for the derivatization. Regarding the GC-MS parameters, split ratio, temperature program and mass range were optimized. The final method was validated in terms of linearity, sensitivity, accuracy and precision for D-Ala, D-Pro, D-Ser, D-Met, D-Phe, D-Glu, D-Orn and D-Lys. Identification of AAs in urine samples was based on retention time and mass spectra. Urine from 20 women with GDM and 20 pregnant women with normal glucose tolerance (after 2-h 75-g oral glucose tolerance test), matched according to the week of gestation and age (22-28 week of gestation and age 24-37 years), were enrolled into the study. %D-Relative amounts were determined for Ala, Val, Thr, Ser, Leu, Asx (Asp+Asn), Glx (Glu+Gln), Met, Phe, Tyr, Orn and Lys. Statistically significant differences (p<0.05) were observed only for D-Phe and higher values were found in the GDM group. It is possible that D-Phe could be involved in metabolic/signaling pathways to compensate early stages of insulin resistance, although further work is necessary to confirm this hypothesis.

Metabolic fingerprint of Gestational Diabetes Mellitus.

Gestational Diabetes (GDM) is causing severe short- and long-term complications for mother, fetus or neonate. As yet, the metabolic alterations that are specific for the development of GDM have not been fully determined, which also precludes the early diagnosis and prognosis of this pathology. In this pilot study, we determine the metabolic fingerprint, using a multiplatform LC-QTOF/MS, GC-Q/MS and CE-TOF/MS system, of plasma and urine samples of 20 women with GDM and 20 with normal glucose tolerance in the second trimester of pregnancy. Plasma fingerprints allowed for the discrimination of GDM pregnant women from controls. In particular, lysoglycerophospholipids showed a close association with the glycemic state of the women. In addition, we identified some metabolites with a strong discriminative power, such as LPE(20:1), (20:2), (22:4); LPC(18:2), (20:4), (20:5); LPI(18:2), (20:4); LPS(20:0) and LPA(18:2), as well as taurine-bile acids and long-chain polyunsaturated fatty acid derivatives. Finally, we provide evidence for the implication of these compounds in metabolic routes, indicative of low-grade inflammation and altered redox-balance, that may be related with the specific pathophysiological context of the genesis of GDM. This highlights their potential use as prognostic markers for the identification of women at risk to develop severe glucose intolerance during pregnancy. BIOLOGICAL SIGNIFICANCE: Gestational Diabetes Mellitus (GDM) is increasing worldwide and, although diabetes usually remits after pregnancy, women with GDM have a high risk of developing postpartum type 2-diabetes, particularly when accompanied by obesity. Therefore, understanding the pathophysiology of GDM, as well as the identification of potentially modifiable risk factors and early diagnostic markers for GDM are relevant issues. In the present study, we devised a multiplatform metabolic fingerprinting approach to obtain a comprehensive picture of the early metabolic alternations that occur in GDM, and may reflect on the specific pathophysiological context of the disease. Future studies at later stages of gestation will allow us to validate the discriminant power of the identified metabolites.

Median nerve conduction impairment in patients with diabetes and its impact on patients' perception of health condition: a quantitative study.

INTRODUCTION: Impaired mobility and compromised manual dexterity leading to difficulties with the activities of daily living (ADL) are an inherent part of the clinical picture in diabetes. Hand function in diabetes is influenced by a variety of pathologies: the median nerve, the most important nerve of the hand, can suffer from metabolic disturbances, ischemia and/or entrapment neuropathies. The resulting deterioration in functional capacity is likely to have significant consequences for the ability to perform ADL, influencing adjustment to diabetes and affecting quality of life. The aim of the present study was to examine the influence of hand function as measured by median motor nerve conduction on quality of life, taking into account various aspects of functioning in patients with diabetes, including activities of daily living, psychological status and acceptance of illness. PATIENTS AND METHODS: Seventy one hospital patients with diabetes participated in the study. Electrophysiological recordings of conductance in the median nerve were obtained for both hands and the relationship between hand function and functional status (BI), depression and anxiety (HADS), adjustment to illness (AIS) and their effect on quality of life (SF-36v2 and QLI) was studied. RESULTS: Damage to the median nerve of the left hand was associated with significant differences in functioning in the physical, but not the mental component of the SF-36v2, p = 0.03 and in functional status (p = 0.006). QOL was associated with depression, patient age, acceptance of illness, functional ability and to a small, but significant extent with median nerve damage to the right hand on the measure of conduction velocities (R2 =0.726). CONCLUSIONS: Nerve conductance studies demonstrated a small, but significant effect of hand function on quality of life. Impairment of the median nerve in the left hand was associated with functional difficulties in the activities of daily living and a diminished quality of life in the area of physical functioning. No dependencies of this kind were found for the right hand, which may reflect the greater compensatory capacity of the right hand resulting from improved efficiency due to practice.

Salivary lysosomal exoglycosidases profiles in patients with insulin-dependent and noninsulin-dependent diabetes mellitus.

BACKGROUND: In this study we have investigated the effects of type I (insulin-dependent) and II (non-insulin dependent) diabetes mellitus on the specific activity and the output of salivary exoglycosidases: N-acetyl-ß-hexosoaminidase (HEX), and its isoenzymes A and B (HEX A, HEX B), and ß-glucuronidase (GLU) in well controlled diabetic patients compared to healthy age-matched controls. MATERIAL AND METHODS: In the saliva HEX, HEX A, HEX B and GLU were determined according to Marciniak et al. Protein was determined by the Lowry et al. method. RESULTS: Our results show that in the case of type I diabetes, the significantly increased activity of salivary total HEX is mainly due to the significantly increased HEX A specific activity. Significantly increased HEX specific activity in DM II is an outcome of significantly increased HEX A as well as HEX B specific activities in comparison to the appropriate healthy control. Our results showed a significant increase in the specific activity of GLU in saliva of type II diabetes patients. The output of lysosomal exoglycosidases showed a similar significant increase compared to the healthy control, in both groups of diabetes mellitus patients. CONCLUSIONS: This study has demonstrated that non-insulin dependent diabetes mellitus more strongly modify salivary glands glycoconjugates catabolism, which can be attributed to functional and morphological changes. A significant increase in the outputs of exoglycosidases in saliva of both type diabetes patients once more indicates that special attention should be paid to the oral health of these patients.

Relationship between the occurrence of symptoms of anxiety and depression, quality of life, and level of acceptance of illness in patients with type 2 diabetes.

OBJECTIVES: To determine the occurrence of symptoms of anxiety and depression in patients with type 2 diabetes, as well as to assess the relationship between the occurrence of symptoms of anxiety and depression, quality of life, and level of acceptance of illness of patients in northeastern Poland. METHODS: A cross-sectional study was conducted on 126 patients with type 2 diabetes in the Department of Endocrinology, Diabetes and Internal Diseases, Medical University of Bialystok, Bialystok, Poland from February 2010 to March 2011. Three questionnaires were administered: Hospital Anxiety and Depression Scale, Acceptance of Illness Scale, and SF-36v2 Scale. RESULTS: Symptoms of anxiety were found in 30.4% of patients and depression in 32%, more often in women than men (20.6% versus 10.3% for anxiety and 22.2% versus 10.3% for depression). Multiple regression analysis revealed that 50% of variance on the illness acceptance scale affected the quality of life in relation to the general health PCS and MCS. CONCLUSION: Symptoms of anxiety and depression adversely affect the degree of acceptance of illness and significantly lower the quality of life in patients with diabetes. Lowered quality of life is an important predictor of worse acceptance of illness by patients.

Poor hand function in diabetics. Its causes and effects on the quality of life.

OBJECTIVE: To find the possible causes of limited hand functions, and to investigate the subjective evaluation of hand functioning in patients with diabetes and its impact on the quality of life (QoL) in the physical and mental dimensions. METHODS: This study was conducted on 71 patients with type 1 and type 2 diabetes attending the Department of Endocrinology, Diabetes and Internal Diseases, Medical University of Bialystok, Poland from March to December 2009. Median nerve conduction and a questionnaire survey (Acceptance of Illness Scale, Hospital Anxiety and Depression Scale, functional capacity, and QoL SF-36v2 and Quality of Life Index) were employed for this study. RESULTS: Patients with damaged distal latency in the right (p=0.05) and left hand (p=0.004) had difficulty lifting objects. The QoL in relation to health (SF-36v2) and Quality of Life Index in patients with hand dysfunctions were significantly statistically lower compared with patients not experiencing these symptoms. These disorders also had a significant negative impact on Acceptance of Illness Scale, the incidence of depressive symptoms (p=0.001), and the patient's functional status (p=0.001). CONCLUSION: Impaired hand function affects lower acceptance of the disease, the occurrence of depression, and reduces patient's QoL.

Microvascular abnormalities in capillaroscopy correlate with higher serum IL-18 and sE-selectin levels in patients with type 1 diabetes complicated by microangiopathy.

Microvascular abnormalities are one of the most important causes of persistent diabetic complications. The aim of this study was to compare microvascular changes examined by nailfold capillaroscopy with serum concentrations of soluble E-selectin (sE-selectin) and IL-18 in type 1 diabetic patients with and without microangiopathy. Serum levels of sE-selectin and IL-18 were determined by an enzyme-linked immunosorbent assay in 106 patients with type 1 diabetes and in 40 healthy controls. All diabetic patients were evaluated by extensive clinical, laboratory and capillaroscopic studies. Morphological changes were observed by nailfold capillaroscopy in 86 out of 106 (81%) diabetic patients. Severe capillaroscopic changes were seen in 32 out of 54 (59%) patients with microangiopathy, but in only seven out of 52 (13%) patients without microangiopathy. Higher serum levels of sE-selectin (p < 0.001) and IL-18 (p < 0.05) were demonstrated in diabetic patients compared to controls. Significant differences of sE-selectin (p , 0.001) and IL-18 (p < 0.01) serum concentrations were observed between diabetic patients with microangiopathy and controls. Moreover, comparison between patients with and without microangiopathic complications showed a significantly higher capillaroscopic score and sE-selectin serum concentration in the group with microangiopathy (p < 0.001). Furthermore, diabetic patients with severe microvascular changes in capillaroscopy showed significantly higher IL-18 (p < 0.001) and sE-selectin (p < 0.05) serum levels than subgroups without changes or with mild abnormalities. Our findings suggest that abnormalities in nailfold capillaroscopy may reflect the extent of microvascular involvement and are associated with higher sE-selectin and IL-18 serum levels, as well as with microangiopathic complications in diabetic patients.