Non-alcoholic fatty liver disease (NAFLD) is associated with metabolic comorbidities like type 2 diabetes mellitus (T2DM). The aim of this study was to determine the proportion of simple steatosis and non-alcoholic steatohepatitis, which are components of NAFLD, among newly diagnosed T2DM patients. This cross-sectional study was undertaken at the Central Hospital, Cameroon from March 2020 to September 2020 and it included all recently diagnosed T2DM patients, who had an alcohol consumption <140g (14 drinks/week) for women and <210g (21 drinks/week) for men, and without any signs of liver cirrhosis on abdominal ultrasound. All patients underwent a clinical examination with blood samples taken for lipid profile and transaminases measurements and an abdominal ultrasound assessment using a LOGIQ V5 Expert ultrasound machine. A total of 98 (53 males and 45 females) out of 128 eligible patients consented to participate in the study. The mean age was 50.31±10.51. NAFLD was present in 56.1% (55/98) patients; with mild and homogeneously diffused in 92.7% (51/55) and 94.5% (52/55) respectively. There were no significant differences in lipids profiles and transaminases between those with or without steatosis. Factors associated with fatty liver disease were body mass index ≥ 30 kg / m2 (P = 0.0002), waist circumference ≥ 94 cm for men or ≥ 80cm for women (P = 0.004). In conclusion, NAFLD is a common feature in newly diagnosed T2DM in our setting. There is a need for more attention towards NAFLD by primary care physicians, specialists and health policy makers
Aim This is an investigator initiated observational comparative medical program, to test the efficacy of Cerebrolysin® intake for 1 month versus 2 months, in patients clinically diagnosed with type 2 diabetes mellitus (T2DM) and suffering from peripheral neuropathy. Methods Patients aged ≥ 18 years old, clinically diagnosed with mild or moderate painful diabetic polyneuropathy, received Cerebrolysin® for 1 or 2 months according to investigators’ decision. Demographic data, detailed medical history, and laboratory results were collected at baseline. All enrolled patients were evaluated for Toronto Clinical Scoring System (TCSS), Visual Analogue Scale (VAS) and Leeds Assessment of Neuropathic Symptoms and Signs Pain Scale (LANSS) at baseline and end of the program (1 month/2 month). Results VAS, TCSS, and LANSS were significantly improved for all 136 enrolled patients at the end of their treatment with Cerebrolysin® for 1 or 2 months, regarding gender, duration since diagnosis of T2DM (more than or less than 10 years) and HbA1c ≤ 9% or ˃ 9%, with a very highly statistically significant difference (p-value ˂ 0.001). They were slightly improved more in patients received Cerebrolysin® for 1 month more than for 2 months. There was no statistically significant difference for gender, duration of diagnosis with diabetes mellitus less or more than 10 years, and HbA1c ≤ 9% & ˃ 9% regarding the change of VAS, TCSS, and LANSS as dependent variables, using Linear stepwise regression. While there was noticed improvement in VAS, TCSS, and LANSS with use of Cerebrolysin® for 1 month more than 2 months, Regression Coefficient (B (95% of Confidence interval)) B=0.794 (0.29-1.29), B=1.472 (0.87-2.074), B=2.143 (0.45-3.83) and p-value = 0.002, p-value ˂ 0.001, p-value = 0.13 respectively. There was no adverse event (AE) or serious adverse event (SAE) reported during the program. Conclusion: Cerebrolysin® is considered effective in the management of peripheral neuropathy in patients with T2DM Abbreviations: Adverse Event (AE), Advanced Glycation End products (AGE), Contract Research Organization (CRO), Diabetic Peripheral Neuropathy (DPN), Diacylglycerol (DAG), estimated Glomerular Filtration (eGFR), Fasting Blood Sugar (FBS), Leeds Assessment of Neuropathic Symptoms and Signs Pain Scale (LANSS), Peripheral Vascular Disease (PVD), Pin- Prick Threshold (PPT), Protein Kinase C (PKC), Statistical Analysis Plan (SAP), Serious Adverse Event (SAE), Standard Deviation (SD), Type 1 Diabetes Mellitus (T1DM), Type 2 Diabetes Mellitus (T2DM), Toronto Clinical Scoring System (TCSS), Traumatic Brain Injury (TBI), Visual Analogue Scale (VAS).
Introduction: The occurrence of an adrenal insufficiency post adrenalectomy usually attests of the success of the operative act. After the adrenalectomy, we could expect a compensatory secretion by the controlateral adrenal gland. However, the integrity of the residual function of the remaining gland depends on the initial secretory character of the mass and on its length. The aim of this study was to evaluate the residual function of the controlateral gland after a unilateral adrenalectomy. Method: This was a 13-month prospective study in Yaoundé Central Hospital. We included in the study, all patients who underwent an adrenalectomy. The adrenal function was assessed in preoperative by the measurement of 8am plasmatic cortisol after a dexamethasone suppression test, while in postoperative periods it was the measure of the baseline plasmatic cortisol at 8am. The latter was possibly completed with a stimulation test with Synacthene 0.25μg. The association between the variables was searched using the Fischer test. A significance threshold of 0.05 was adopted. Results: Seven patients (4 women and 3 men) underwent surgery indicated for an adrenal mass. Median age was 44,7 years [17 – 69 years]. The discovery mode was mainly weight gain (28.6 %) or unexplained weight loss (28.6 %). The median delay to diagnosis was 8months [8 days – 24 months]. In the preoperative period, the median cortisol level after dexamethasone suppression test was 329.9 ng/ml, amongst which 2/7 patients had hypercortisolism. The median values of normetanephrines and metanephrines were 7nmol/L and 71.4 nmol/L, respectively. Pathology described: corticosurrenalomas (2), adrenal adenomas (2), pheochromocytomas (2) and adrenalitis (1). In early postoperative, the median 8 h cortisol was 45.5 ng/ml [34.5-167.1ng/ml]. In late postoperative, the median cortisol value was 95 ng/ml, and strictly normal in 3/6 patients. There was no association between recovery of residual adrenal function and age, tumor size, initial preoperative cortisol value, treatment received preoperatively, and postoperative complications. Conclusion Adrenal insufficiency persists in almost half of the patients in late postoperative. Thus, hydrocortisone supplementation should be maintained as long as possible.
Background: Despite the high prevalence of diabetes mellitus in Egypt, the real prevalence and epidemiology of gestational diabetes mellitus (GDM) in Upper Egypt is still lacking. Objective: This study aims to determine the prevalence and risk factors of GDM among pregnant women in Upper Egypt and to evaluate the foetal and maternal outcomes of this disease. Methods: This prospective cohort study was conducted between July 2014 and July 2018. Universal screening for GDM among all pregnant women attending primary health care clinics was done using Diabetes in Pregnancy Study Group of India (DIPSI) criteria. Those with GDM were followed up until the end of purpureum. Maternal and foetal outcomes were recorded. Results: GDM was diagnosed in 956 out of 7141 pregnant women (13.4%). Previous history of GDM, macrosomic babies, and family history of diabetes were all significantly higher in GDM women (P<0.001 each). However, no definite risk factors were observed in about half of the GDM women. 29% of GDM women responded to medical nutrition therapy (MNT) alone. When the oral glucose tolerance test (OGTT) was repeated Postpartum, diagnosis of DM was established in 14.3% of the cohort, while 25.7% had impaired glucose tolerance. Conclusions: The prevalence of GDM is relatively high in Upper Egypt. Half of GDM cases lack risk factors. Universal screening using OGTT should be routinely performed to all attendant pregnant ladies. Discrete MNT is not an enough management in most of GDM cases. Keywords: GDM; Postpartum OGTT; diabetes; MNT; foetal outcome; maternal outcome.
Background: Diabetes mellitus is a chronic metabolic disorder characterized by hyperglycemia resulting from insulin resistance and/or deficiency. It is associated with numerous complications, including microvascular and macrovascular complications. Micronutrient deficiencies are commonly observed in individuals with diabetes due to the metabolic changes that occur in the body and the increased renal excretion. Several studies have shown that diabetes patients are at an increased risk of developing micronutrient deficiencies such as vitamin D, thiamine, vitamin B12, folate, magnesium, and zinc. The consequences of micronutrient deficiencies in diabetic patients can be significant. The aim of this study was to achieve a consensus on the use of complementary pharmacological therapies in the management of diabetic complications, through a modified Delphi methodology. Methods: A three-round modified Delphi Procedure was conducted to define recommendations regarding the role of Pharmaco-Complementary medicine in the management of Diabetic complications using a web-based questionnaire. The questionnaire included a set of 65 questions. The level of Consensus was defined based on the level of agreement among the panelists on specific scientific statements. Strong Consensus was defined as ≥80% agreement, Moderate Consensus with Agreement between 65% and up to 79%, and Low Consensus level with statements below 65% agreement. Results: Eighteen experts in the field of diabetes participated in the development of this consensus. Three rounds of voting were held, followed by data analysis and consensus level calculation. Out of 47 statements, a total of 33 statements achieved moderate – strong consensus (moderate: 65% - 79% agreement, strong: ≥80% agreement). Conclusion: Experts concluded that the use of pharmaco-complementary medications such as CoQ10, Benfotiamine, Magnesium, and EPA can potentially improve glycemic control, insulin sensitivity, and manage diabetic complications. This consensus can serve as a valuable tool for clinicians in managing diabetes, and its complications, and can provide direction for future research. Keywords: Diabetes, Consensus; Pharmaco-complementary, Delphi, Complications
Background The Children HospitalDr.Robert Reid Cabral, the principal children hospital in the Dominican Republic has no recent data on type 1 diabetes (T1D) incidence in children, therefore a study was undertaken to determine this in people aged <15 years (y). Methods Data were collected on all new T1D diagnoses between 2010-2019 from the The Children Hospital Dr. Robert Reid Cabral that care for children with T1D. Diagnosis was made according to standard American Diabetes Association criteria. No secondary ascertainment source was available. Significances around sex, age and incidence were assessed using the Chi-square (X2) and Pairwise Pearson Correlations tests. Results There were 513 new cases of T1D diagnosed in children aged < 15 y; a mean of 51.3 per year. Mean ± standard deviation age of T1D diagnosis was 8.5 ± 3.8 y, and there was also a not significant female preponderance ( p< 0.35). New cases were consistently highest in the 10-14 y (48.5%), and lowest in the 0-4 y age group (18.6%). Overall, mean crude annual incidence was 1.73 per 100,000 population, with no significant trend of increase or decrease.
Aim: This is a prospective, pilot, open-label, interventional, comparative, randomized study, enrolled 60 patients with type 2 diabetes mellitus (T2DM) to assess the effect of different doses of oral vitamin B containing Benfotiamine 300 mg versus intramuscular B vitamins containing watersoluble Thiamine HCl. Methods Patients ≥ 18 years with T2DM with Peripheral Neuropathy, divided into 3 groups; A & B (Benfotiamine 300 mg) and group C (Thiamine HCl), which were sub-divided to include patients with HbA1c less or more than 8 %. Patients were evaluated at baseline, after 2.5 hours, six days, and two weeks. Results Blood vitamin B1 increased from baseline to after 2.5 hours (T2) by 57%, 79% and 33% in group A, B and C respectively, with statistically significant difference in each group (p value < 0.001). Vitamin B1 continued to increase after six days (T6) in patients of groups A & B by 98% and 165% respectively, while dropped in patients of group C from 33% at T2 to 6% at T6, with p-value ≤ 0.001 between the three groups. Diabetic Neuropathic Symptom Score (DNS) decreased in mean value in all groups after 14 days of treatment by 64.4%, 53.7% and 48.6% in group A, B and C respectively, indicating improvement of peripheral neuropathy. Safety: There was no AE or SAE reported during the study. Conclusion: Oral Benfotiamine 300 mg is safe and more effective than intramuscular Thiamine HCl, in increasing vitamin B1 blood level in patients with diabetic peripheral neuropathy, which in turn relieves peripheral neuropathy. Clinical Trial Registration Number: NA Keywords: Benfotiamine, Bioavailability, Thiamine, Diabetic Peripheral Neuropathy Abbreviations : Adverse Event (AE), Advanced Glycation End products (AGE), Analysis of Variance (ANOVA), Alanine Transaminase (ALT), Body Mass Index (BMI), Case Report Form (CRF), Diabetic Neuropathic Symptom score (DNSS), Diacylglycerol (DAG), Dipeptidyl Peptidase 4 Inhibitor (DPP-4 I), Good Clinical Practice (GCP), Informed Consent Form (ICF), Intent to Treat (ITT), Institutional Review Board (IRB), Ministry of Health (MOH), National Institute of Diabetes and endocrinology (NIDE), Nuclear Factor kappaB (NF-κB), Per Protocol (PP), Protein Kinase C (PKC), Research and health Development (RHD), Serious Adverse Event (SAE), Serotonin and Norepinephrine Reuptake Inhibitors (SNRIs), Transient Ischemic Stroke (TIA)
Dapagliflozin is a selective sodium-glucose cotransporter 2 inhibitor (SGLT2i) indicated for the treatment of type 2 diabetes mellitus (T2DM), heart failure with reduced ejection fraction and chronic kidney disease. In all indications, treatment can be initiated in adults with estimated glomerular filtration rate of at least 25 mL/min/1.73 m(2). As monotherapy or as an additive therapy, dapagliflozin has been shown to promote better glycaemic control, associated with a reduction in body weight and blood pressure in a wide range of patients. In addition, dapagliflozin has a positive impact on arterial stiffness, helps to control the lipid profile and contributes to a reduced risk of cardiovascular complications. This article reviews the current scientific evidence on the role of dapagliflozin in cardiovascular risk factors including arterial stiffness, cardiovascular disease and heart failure in patients with T2DM, with the aim of helping to translate this evidence into clinical practice. The underuse of SGLT2i in actual clinical practice is also discussed.
Aims The aim was to examine whether the Prognostic Nutritional Index (PNI) and Controlling Nutritional Status (CONUT) score are predictors of wound healing in patients with diabetic foot ulcers (DFUs). Materials and Methods This was a hospital-based, single-center, observational, longitudinal cohort study of 349 Japanese patients (84 women, 265 men; mean (standard deviation) age 62.8 (12.8) years) with DFUs. The endpoint was complete wound healing. The classical Cox proportional model and competing-risks model were used to calculate the hazard ratios (HRs) and the 95% confidence interval (CI) for reaching the endpoint. Results During a median (range) follow-up of 2.3 (0.03-62.3) months, 220 patients (63.0%) reached the endpoint. In the multivariate Cox proportional hazards model, higher PNI was identified as an independent predictor for the endpoint (HRs 1.22, 95% CI 1.01-1.48, p=0.038). In the multivariate competing-risks model analysis, both higher PNI (HRs 1.26, 95% CI 1.03-1.53, p=0.024) and lower CONUT score (HRs 0.80, 95% CI 0.65-0.99, p=0.045) were identified as independent predictors for the endpoint. Similar results were obtained when the PNI and the CONUT score were treated as categorical variables (≥ median or less). Conclusions Nutritional status, as assessed using the PNI and CONUT score, is a novel clinical predictor for wound healing in patients with DFUs. Keywords: Diabetic foot ulcer; Nutritional assessment; Prognostic nutritional index; Controlling Nutritional Status.
Autoimmune Polyendocrinopathy-Candidiasis-Ectodermal Dystrophy (APECED) is a rare condition that diffusely affects many organ systems. Chronic mucocutaneous candidiasis is one of the features of APECED, which needs to be treated and monitored to prevent severe complications. This case demonstrates esophageal structuring and resultant esophageal perforation, in the setting of chronic mucocutaneous candidiasis. Learning Points • Chronic mucocutaneous candidiasis (CMC) can be present without overt esophageal thrush • CMC can result in esophageal lesions causing significant morbidity. • APECED patients with dysphagia should be assessed for chronic candida esophagitis and treated accordingly. • Patients with recurrent candida esophagitis should be considered for intermittent topical and systemic antifungal prophylactic therapy. • Esophageal perforation due to candidiasis is most often seen in the setting of immunocompromised states. Background Autoimmune polyendocrinopathy-candidiasis-ectodermal dystrophy (APECED) is a rare autosomal recessive disease caused by mutations of the AIRE (autoimmune regulator) genes [1, 2, 6, 7]. It is characterized by the clinical trial of chronic mucocutaneous candidiasis (CMC), hypoparathyroidism, and adrenal insufficiency [7]. APECED has been reported worldwide, but is more prevalent in some historically- isolated homogeneous populations in Finland (1/25000), Sardinia, and Iranian Jews (1/9000) [7]. APECED is also seen at a lower incidence in Norway, Sweden, Slovenia, Great Britain, Italy, Ireland, and North America [7]. Most patients have CMC from early childhood [2, 3]. Rarely, untreated esophageal candidiasis may lead to complications such as esophageal stricture, rupture and or fistula formation [4, 5].
Aims The study aimed to assess the effectiveness of the Flash Glucose Monitor (FGM) in empowering patients with Type 1 Diabetes Mellitus (T1DM) to fast safely during the month of Ramadan. Methods In this prospective interventional study, eligible adult patients with T1DM were monitored with FGM and completed a survey after Ramadan. Time in range, glucose variability, changes in HbA1c, and renal function was evaluated. IRB approval and informed consent were acquired prior to the study. For data analysis (SPSS) Version 25 was used. Results The study included 8 adults (5 females, 3 males). The use of FGM enabled 25% of patients who were not able to fast in the previous year to fast in the current year.The median frequency of hypoglycemic episodes increased during Ramadan from 8 to 24 (p-value 0.049), however. Glucose variability during Ramadan was reduced by 4.05 ± 7.00 % but was not significant (p-value 0.17). The time in range before Ramadan was 51.00% ±10.75, during Ramadan was 53.42% ±14.83,and post-Ramadan was 55.85%± 10. HbA1cand creatinine did not change before and after Ramadan, (p-values of 0.465 and 0.315 respectively) indicating that glycemic control and renal function were maintained. Conclusion Active glucose monitoring using FGM coupled withstructured pre-Ramadan counseling and patient education aids in empowering patient to fast safely and maintain glycemic control during month of Ramadan and avoid complications including DKA and severe hypoglycemia. Keywords: Diabetes Mellitus; Flash glucose monitoring; Fasting, Ramadan; Time in Range.
The ventromedial hypothalamic nucleus (VMN) glucoregulatory neurotransmitters γ-aminobutyric acid (GABA) and nitric oxide (NO) signal adjustments in glycogen mobilization. Glucocorticoids control astrocyte glycogen metabolism in vitro. The classical (type II) glucocorticoid receptor (GR) is expressed in key brain structures that govern glucostasis, including the VMN. Current research addressed the hypothesis that forebrain GR regulation of VMN glycogen synthase (GS) and phosphorylase (GP) protein expression correlates with control of glucoregulatory transmission. Groups of male rats were pretreated by intracerebroventricular (icv) delivery of the GR antagonist RU486 or vehicle prior to insulin-induced hypoglycemia (IIH), or were pretreated icv with dexamethasone (DEX) or vehicle before subcutaneous insulin diluent injection. DEX increased VMN GS and norepinephrine-sensitive GP-muscle type (GPmm), but did not alter metabolic deficit-sensitive GP-brain type (GPbb) expression. RU486 enhanced GS and GPbb profiles during IIH. VMN astrocyte (MCT1) and neuronal (MCT2) monocarboxylate transporter profiles were up-regulated in euglycemic and hypoglycemic animals by DEX or RU486, respectively. Glutamate decarboxylase65/67 and neuronal nitric oxide synthase (nNOS) proteins were both increased by DEX, yet RU486 augmented hypoglycemic nNOS expression patterns. Results show that GR exert divergent effects on VMN GS, MCT1/2, and nNOS proteins during eu- (stimulatory) versus hypoglycemia (inhibitory); these findings imply that up-regulated NO transmission may reflect, in part, augmented glucose incorporation into glycogen and/or increased tissue lactate requirements. Data also provide novel evidence for metabolic state-dependent GR regulation of VMN GPmm and GPbb profiles; thus, GABA signaling of metabolic stability may reflect, in part, stimulus-specific glycogen breakdown during eu- versus hypoglycemia.
Public health has never been a subject of such focus. Although critical in the dynamics of every country and society, it is witnessing the change it has never thought it would in this century! However “Change”, which is the only constant, is being radically changing „health systems‟ due to SARS-CoV-2. And the change is extra-ordinary! COVID-19, a novel strain of beta corona virus related to SARS and MERS, has caused more than twenty three million people affected worldwide till date. First reported from Wuhan in China in December 2019, “COVID-19‟ is testing the health infrastructure and societal response capabilities reminiscent of the 1918 global pandemic of Influenza that probably resulted in ~ 50 million deaths worldwide. The WHO declared a Public Health Emergency of International Concern on 30 January 2020 [1].
Background Clinicians lack tools to determine a patient’s risk for diabetic peripheral neuropathy (DPN). This study examined the relationship between severity of DPN and family history of diabetes and DPN. Methods The Michigan Neuropathy Screening Instrument (MNSI) was used to collect symptom and physical exam data from consenting diabetic and control (n=293) patients. Family history of diabetes, DPN and major complications were collected going back two generations. Relevant additional characteristics were mined from patient medical records. Results Between patients who did and did not meet MNSI criteria for neuropathy, there were significant differences in comorbidities, including cardiac ( P <.0001), renal (P =.006), PVD (P<.0001), and thyroid (P =.027). Patients with history of diabetes on both sides (P=.032) or siblings (P<.0001); history of neuropathy on their maternal (P=.026), paternal (P=.002), both sides (P=.002) or siblings (P=.002); history of amputations on their maternal (P=.039) or paternal side (P=.162); or a history of ulcers on their maternal side (P=.030), paternal side (P=.005) or both sides (P=.046) were more likely to meet MNSI criteria for neuropathy. MNSI criteria for neuropathy was independently associated with history of cardiac or PVD comorbidities, and an MNSI score in the upper quartile was associated with diabetic siblings (OR=10.96). Conclusion: Family history of diabetes, DPN, and major complications was associated with neuropathy and also stronger degree of neuropathy. Family history, specifically diabetic siblings, cardiac and PVD comorbidities are independent risk factors for developing DPN. Clinicians should gather detailed family history and relevant comorbidities to optimize prevention of severe DPN in diabetics. Keywords:Type 2; Diabetic peripheral neuropathy; Family history of diabetes; MNSI; Complications
Introduction The main hormonal treatment of estrogen sensitive breast cancer includes the use of selective estrogen receptor modulators, aromatase inhibitors and GnRH-Analogs. It has been observed that administering aromatase inhibitor to breast cancer patients not only impairs their glucose metabolism but it can even cause frank diabetes mellitus. Moreover, it has been hypothesized that aromatase inhibitors may have an impact on glucose metabolism by their effect on estrogen levels. Therefore, we designed an experiment in order to assess the effect of estrogens on insulin secretion from rat beta pancreatic insulinoma INS-1 cells. Methods Experiments were conducted on an INS-1 cell line, a rodent beta cell line derived from a rat insulinoma induced by X-ray irradiation, which displays high insulin content, production of both proinsulin I and II and responsiveness to glucose and hormones. INS-1 cells were routinely cultured in 75cm2 flasks (T75) containing 10ml of appropriate culture media and then were transferred into 6-well plates and treated with 17β-E2. Proliferation, as well as insulin expression in the 17β-E2 treated cells in mRNA and protein level was then investigated. Cell cultures were treated with 12.5mM, 25mM, 50mM, 100mM and 200mM estradiol. After 24 hours, RNA as well as protein extraction was carried out. Gene expression was examined in mRNA and protein level, by real time quantitative reverse transcriptase PCR and by western blotting, respectively. Extraction of total RNA was achieved with the use of NucleoZOL (Macherey-Nagel, Duren, Germany). Protein concentration of samples was measured by using the bicinchoninic acid (BCA) assay and bovine serum albumin (BSA) as the standard (Thermo Scientific TM Pierce TM BCA Protein Assay Kit, USA). Results Real time PCR showed a dose-dependent up regulation of insulin gene expression by estradiol. The findings were consistent with the results from western blot, although the estradiol dose-dependent increase in gene expression was not so clear. Finally, both protein and mRNA expression of insulin increased in a dose dependent manner, with mRNA reaching a plateau at 100nM estradiol treatment. Conclusion The experimental data suggest that there might be a direct effect of estrogen on beta cells and insulin secretion.
Prevalence of Type 2 Diabetes Mellitus (T2DM) is increasing along with obesity rates.Novel approaches are necessary to prevent this deadly pathology and its associated morbidity & mortality.Recent evidence suggests that very low calorie diet (VLCD) in selective adult T2DM patients, under close supervision, reaps benefits.In this minireview, we have discussed the relevant literature on VLCD in the context of T2DM.
Background Coronary Artery Disease (CAD) is a common cause of premature morbidity and mortality in diabetics and is often asymptomatic because of silent myocardial ischemia (SMI). Early detection of SMI may prevent catastrophic cardiac events. Objective To study the prevalence of SMI in patients of type 2 diabetes mellitus (Type 2 DM), asymptomatic for CAD and to assess the role of conventional CAD risk factors in diabetic patients asymptomatic for CAD in the development of SMI. Methodology 102 cases of Type 2 DM without any clinical and electrocardiographic evidence of CAD, who attended a tertiary care hospital in North Delhi, over a period of one year, were studied for the present cross-sectional study. Detailed history, general physical examination, BMI, systemic examination and investigations like glycosylated hemoglobin (HbA1c), lipid profile, resting 12-leads electrocardiography (ECG) and treadmill test (TMT) were carried out. Results Out of 102 patients, TMT was found positive in 23 patients. It was positive in 12% among diabetic patients with duration of diabetes ≤5 years, 14.8% in patients with duration 6-10 years, 37.5% in patients with duration 10-15 years and 77.7% in patients with duration 16-20 years, respectively with p<0.001. Conclusion The prevalence of SMI in asymptomatic Type 2 DM without history of CAD is 22.54%. Duration of diabetes, presence of autonomic neuropathy (AN), dyslipidemia and HbA1c level are strong clinical predictors of SMI in asymptomatic Type 2 DM. Keywords: Silent myocardial ischemia; Type 2 Diabetes mellitus; Coronary artery Disease; Treadmill test Asymptomatic; Autonomic Neuropathy.
Objective Traumatic brain injury (TBI) is associated with an increased risk of late neurodegenerative complications via unknown mechanisms. Circulating neurotoxic 5-hydroxytryptamine 2A receptor (5-HT2AR) autoantibodies were reported to increase in subsets of obese type 2 diabetes having microvascular complications. We tested whether 5-HT2AR autoantibodies increase in adults following traumatic brain injury in association with neurodegenerative complications. Methods Plasma from thirty-five middle-aged and older adult veterans (mean 65 years old) who had suffered traumatic brain injury was subjected to protein-A affinity chromatography. The resulting immunoglobulin (Ig) G fraction was tested for neurotoxicity (acute neurite retraction, and accelerated cell death) in mouse N2A neuroblastoma cells or for binding to a linear synthetic peptide corresponding to the second extracellular loopregion of the human 5-HT2A receptor. Results Nearly two-thirds of traumatic brain injured-patients harbored 5-HT2AR autoantibodies in their circulation. Active TBI autoantibodies caused neurite retraction in mouse N2A neuroblastoma cells and accelerated N2A cell loss which was substantially prevented by co-incubation with a two hundred and fifty nanomolar concentration of M100907, a highly selective 5-HT2AR antagonist. Antagonists of RhoA/Rho kinase and Gq11/ phospholipase C/inositol triphosphate receptor signaling pathways blocked TBI autoantibody-induced neurite retraction. Following traumatic brain injury, autoantibody binding to a 5-HT2A receptor peptide was significantly increased in patients having co-morbid Parkinson’s disease (n=3), dementia (n=5), and painful neuropathy (n=8) compared to TBI subsets without neurologic or microvascular complication (n=20). Autoantibody titer was significantly elevated in TBI subsets experiencing multiple neurotraumatic exposures vs. single TBI. Plasma white blood cell, a marker of systemic inflammation, correlated significantly (correlation coefficient r =0.52; P < 0.01) with, 5-HT2A receptor peptide binding of the TBIautoantibody. Conclusion These data suggest that circulating neurotoxic 5-hydroxytryptamine 2A receptor agonist autoantibodies increase in adults following traumatic brain injury in association with late neurodegenerative complications.
A investigation was established to locate the association of regular blood glucose level with the shape of mouth. Approximately 200 persons were partook in the current survey. For the measurement of blood glucose level, we took digital glucometer then we took the blood of 200 subjects for the measurement of fasting blood glucose level. We took drop of blood from 200 persons with the glucometer which gave us their blood sugar level It was obvious that the regular level of blood glucose had scientific interaction with the shape of mouth because the value of p is lower than 0.05 that’s why the result was significant.
Background: Thalassemia are a heterogeneous collection of genetic disorders categorized by decreased or absent production of one or more globin chains that make up a hemoglobin molecule. Objective: The main aim of the present study was to evaluate the growth pattern and growth failure rate in children with hyper transfused β thalassemia major those on chelating therapy in comparison with serum ferritin level in the Yemeni society for thalassemia and genetic blood disorder. Methods: In this comparative descriptive study, the growth parameters (height, weight) and serum ferritin of 109 patients aged 2-18 years (52 males 47 females) with β-thalassemia major in The Yemeni society for thalassemia and genetic blood disorder Sana`a, were taken, In which the growth was compared with normal growth charts for the same age and gender according to WHO then the growth pattern is camper with serum ferritin and degree of hemosiderosis. Results: Growth retardation below 5 centiles were found in (67.889%) of total surveyed Patients for both height and weight in both gender, in details there are (71.60%) are short and under 5th centile in compare with height of normal children at same age and gender (38.46% is female patients and 61.53% is male patients) and there are (67.9%) are underweight and under 5th centile in compare with weight of normal children at same age and gender (37.83% is female patient and 62.16% is male patients). Conclusion: Growth failure (underweight and short stature) significantly occurs in thalassemia patients compared to normal children of the same age and sex, and such growth retardation was more in Yemeni patients compared with same studies on other countries than Yemen.
