http://ccforum.com/content/13/1/R18/comments The latest comments on the article 'The effect of diabetes mellitus on organ dysfunction with sepsis: an epidemiological study' 2009-02-20T08:51:19Z http://ccforum.com/content/13/1/R18/comments#331649 <p>The increased susceptibility to generalized infections in diabetes can be compared with the increased risk for active tuberculosis in the same patients (1). <br/> <br/>As to the mechanism, it may be suggested that the downstream metabolites of the excessive glucose concentration are toxic to the immunological regulatory system. The principal intermediate methylglyoxal downregulates the Raf-1 thereby attenuating the system (2). <br/> <br/>An idea of the circulating methylglyoxal concentration can be had by the urinalysis for D-lactic acid, its eventual metabolite (3). <br/> <br/>1 Murray JCY. Diabetes mellitus increases the risk of active tuberculosis. A systematic review of 13 observational studies. PLoS Med 2008; 5: e152. <br/> <br/>2 Du J, Zen J, Ou X, et al. Methylglyoxal downregulates Raf-1 protein through a ubiquination-mediated mechanism. In J Biochem Cell Biol 2006; 38: 1084 <br/> <br/>3 Talasniemi JP, Pennanen S, Savolainen H, et al. Assay of D-lactate in diabetic plasma and urine. Clin Biochem 2008; 41: 1099</p> Heikki Savolainen 2009-02-20T08:51:19Z http://ccforum.com/content/13/1/R18 Esper et al. Critical Care 13 R18 Fri Feb 13 00:00:00 GMT 2009