Aim: To determine periodontitis in obese and Non-obese subjects of DM type 2. Methods: 280 subjects were included from January, 2006 to June 2007. These were divided into groups I to VI with 40 controls. Both sexes were included with age ranges 31 to 70 years. Blood samples for fasting and random glucose were taken. Periodontal pocket depth was recorded in these patients. Results: Significant difference was observed in blood sugar level. Fasting and random sugar shows significant difference in control subjects as well as diabetic patients with periodontitis periodontal depth was highly significant in DM as compared to control group. Periodontal pocket depth was more significant in obese diabetic when comparing with non-obese patients. Conclusion: Periodontal pocket depth was significant in obese diabetic when comparing with nonobese.

Liraglutide exert favorable effects on most of the diabetes associated cardiovascular (CV) risk factors and this study was designed to further explore the benefits of liraglutide by observing its effect on plasma sialic acid (PSA) in diabetic rats. A total of 30 streptozotocin induced (50 mg/Kg; i.p.) diabetic rats were randomized into vehicle treated (1 ml/Kg s.c, twice daily) group I, liraglutide treated groups II and III (30 μg/Kg and 150 μg/Kg, twice daily respectively) and studied for 6 weeks. Liraglutide treated groups showed significant reductions in fructosamine levels (p≤0.05) from baseline. Between groups comparison revealed significant difference (p≤.05) at the end point. Similarly, at week 6, liraglutide treated groups showed significantly low levels of PSA compared to baseline (p<0.03 and p<0.005 for group II and III respectively) and control group I (p<0.002 and p<0.001 for group II and III respectively). However, the difference was non-significant between groups II and III (p<0.09). Other parameters including glucose tolerance, fasting plasma glucose (FPG), blood lipids, systolic blood pressure (SBP) and body weight also improved by liraglutide with the group III showing greater improvement. The study concludes that liraglutide produce favourable effects on PSA and may bea useful choice in protecting against diabetes associated CV complications.

Protection against diabetic nephropathy (DN) is one of the main targets in diabetes treatment and present study evaluates the nephroprotective effect of Carica papaya L. in streptozotocin (STZ) induced diabetic rats. DN rats were treated with 1.5 and 2.5 gm/dl C. papaya leaf extract for 6 weeks to determine its nephroprotective effect with different parameters. Pimagedine (1 ml/mg) served as a reference drug. Compared to diabetic control group, C. papaya (1.5 and 2.5 gm/dl) treatment significantly decreased some important parameters including plasma glucose, HbA1-c, urinary AER and albumin/creatinine ratio. Improvement in GFR was also significant by C. papaya. However, the decrease in blood urea nitrogen (BUN), plasma creatinine, blood pressure (B.P), total cholesterol and serum albumin levels were significant only in diabetic group treated with 2.5 gm/dl of C. papaya leaf extract. Serum triglyceride and urine volume decreased with both low and high doses of C. papaya. Histological examination revealed marked improvement in glomerular morphology after C. papaya treatment. The study concludes that C. papaya leaf extract may exert ameliorative effect on DN.

To determine the effect of Zubex (aqueous extract of Curcuma longa linn, Iron murakab, Eugenia jambolana, Lin seed or flflax seed, processed egg shell calcium and Asphaltum) on plasma sialic acid (PSA) along with cardiovascular (CV) risk factors in streptozotocin-induced diabetic rats.

Since antiquity bitter melon has been in use for treating diabetes but clinical trials show conflicting results about its usefulness. The present study aims to asses and compare the hypoglycemic and antiatherogenic effects as well as the safety of two different doses of bitter melon with glibenclamide.

In a randomised, comparative, parallel group study overweight diet-treated type 2 diabetic patients attending a teaching hospital in Peshawar, Pakistan, were assigned to 12 months of monotherapy with metformin (n=102) or glibenclamide (n=102) to investigate the effects of these agents on serum sialic acid (SSA). Drug treatment significantly improved glycaemic control and metformin treatment also appeared beneficial to other parameters monitored, significantly reducing triglycerides. Throughout the study SSA decreased in both treatment groups and there were no statistically significant differences between the groups. However, in the metformin-treated group SSA at 12 months was significantly lower than at baseline.

More than 1000 herbal products have been used by diverse cultures of the world to treat hyperglycemia and among them bitter melon (Momordica charantia) is one of the most popular herbal resource. The beneficial effects of bitter melon is not limited to hypoglycaemia only, but it also ameliorates diet induced obesity, insulin resistance and exhibit cardioprotective effects. The present study attempts to investigate the effect of bitter melon fruit juice on a newly investigated risk factor, sialic acid in type2 diabetics. A total of 40 type2 diabetic patients, divided into group A (n = 20) and group B (n = 20) were investigated during the present study. The patients of group A were following bitter melon fruit juice treatment along with diet control, whereas the patients of group B were on diet control only. Serum sialic acid (SSA) decreased in group A from 66.20 ± 2.30 mg/dl to 63.50 ± 2.10 mg/dl (<0.11) but, increased in group B from 66.50 ± 1.70 mg/dl to 68.20 ± 2.50 mg/dl (<0.12), compared to baseline. Post-treatment between group comparison revealed a significant difference (<0.05). The beneficial effects on fasting plasma glucose (FPG) and glycohemoglobin (HbA1-c) were also greater in group A compared to group B as was the case with blood lipids, weight and blood pressure. The study provides another mechanism for the cardioprotective effect of bitter melon and further strengthens its value in the management of type2 diabetes.

Diabetes mellitus is associated with an increase in sialic acid concentration along with other complications. Sialic acid changes in NIDDM patients were investigated following bitter melon (55ml/24h) and rosiglitazone (4mg/24h) treatment. A total of 25 patients of both sexes were used in each experimental group. Patients following bitter melon treatment showed no significant difference of serum sialic acid (57.95±4.90 vs. 57.6±5.56mg/dl, p=0.17) and serum glucose concentration (93.7±9.63 vs. 88.35±6.31mg/dl, p=0.78) as compared to control subjects. However, the concentration of total cholesterol was significantly high in these patients as compared to control subjects (192±14.23 vs. 170.6±15.1mg/dl, p<0.03) but within normal range (160–200mg/dl), suggesting the significant hypoglycemic and lipid-lowering properties of bitter melon. The patients following rosiglitazone treatment showed a significant increase of serum sialic acid concentration (60.2±5.80 vs. 57.6±5.56mg/dl, p=0.01) along with glucose (112±6.2 vs. 88.35±6.31mg/dl, p<0.04) and total cholesterol concentration (216.45±20.2 vs. 170.6±15.1mg/dl, p<0.01) as compared to control subjects. In addition six of the patients had retinopathy, two of whom were suffering also from myocardial infarction and they still had a higher serum sialic acid (61.05±1.20mg/dl), glucose (187±2.11mg/dl), total cholesterol (239.10±5.04mg/dl) and triglyceride (183±4.14mg/dl) concentration, indicating a poor response of these patients to rosiglitazone. Comparison of serum sialic acid concentration of patients, following bitter melon and rosiglitazone treatment revealed no significant difference but the study showed that bitter melon could be more effective in the management of diabetes and its related complications as compared to rosiglitazone.

PURPOSE: To assess whether there is survival benefit for patients with mild or moderate aortic stenosis if they undergo aortic valve replacement at the time of coronary artery bypass surgery.METHODS: From 1985 to 1995 we evaluated all patients at our institution who underwent coronary artery bypass surgery and who had the echocardiographic diagnosis of mild (mean gradient < 0 mm Hg and/or valve area > 1.5 cm(2)) or moderate (mean gradient >= 30 and <= 40 mm Hg and/or valve area > 1.0 <= 1.5cm(2)) aortic stenosis. Using propensity analysis, survival was compared between 129 patients who underwent coronary artery bypass surgery alone and 78 patients who underwent concomitant coronary artery bypass surgery and aortic valve replacement.RESULTS: Perioperative mortality was similar among patients who underwent coronary artery bypass surgery alone compared with patients who underwent concomitant coronary artery bypass surgery and aortic valve replacement. By Kaplan-Meier analysis, 1-year and 8-year survival were better at 90% and 55% for patients who underwent concomitant coronary artery bypass surgery and aortic valve replacement compared with 85% and 39% for patients who underwent coronary artery bypass surgery alone (P < 0.001). This benefit was limited to patients with moderate aortic stenosis (propensity-adjusted relative risk = 0.43; 95% confidence interval: 0.20 to 0.96; P = 0.04).CONCLUSION: Concomitant aortic valve replacement at the time of coronary artery bypass surgery for mild or moderate aortic stenosis appears to convey a survival advantage for patients with moderate aortic stenosis but not for those with mild aortic stenosis. (c) 2005 Elsevier Inc. All rights reserved.

OBJECTIVE:We sought to assess whether aortic valve replacement (AVR) among patients with severe aortic stenosis (AS), severe left ventricular (LV) dysfunction and a low transvalvular gradient (TVG) is associated with improved survival. BACKGROUND:The optimal management of patients with severe AS with severe LV dysfunction and a low TVG remains controversial. METHODS:Between 1990 and 1998, we evaluated 68 patients who underwent AVR at our institution (AVR group) and 89 patients who did not undergo AVR (control group), with an aortic valve area < or = 0.75 cm(2), LV ejection fraction < or = 35% and mean gradient < or = 30 mm Hg. Using propensity analysis, survival was compared between a cohort of 39 patients in the AVR group and 56 patients in the control group. RESULTS:Despite well-matched baseline characteristics among propensity-matched patients, the one- and four-year survival rates were markedly improved in patients in the AVR group (82% and 78%), as compared with patients in the control group (41% and 15%; p < 0.0001). By multivariable analysis, the main predictor of improved survival was AVR (adjusted risk ratio 0.19, 95% confidence interval 0.09 to 0.39; p < 0.0001). The only other predictors of mortality were age and the serum creatinine level. CONCLUSIONS:Among select patients with severe AS, severe LV dysfunction and a low TVG, AVR was associated with significantly improved survival.

Background: Previous studies have reported the clinical and echocardiographic findings of patients with left atrial spontaneous echo contrast (SEC) and thrombi. We sought to study these characteristics in patients with right atrial SEC and thrombi. Methods: We reviewed 580 consecutive patients from the ACUTE (Assessment of Cardioversion Using Transesophageal Echocardiography) Registry and found 79 patients (14%, aged 67 ±; 13 years, 67 male) with transesophageal echocardiography (TEE) findings of right atrial SEC or thrombi (group 1). This group was compared with a control group of 75 consecutive patients (group 2) (aged 68 ± 13 years, P = not significant; 49 male, P <.005) from the registry with no TEE findings of SEC or thrombi in the left or right atrium. Results: Atrial fibrillation was present in 60 of 79 group 1 patients (76%). Five right atrial (6%) and 11 left atrial (14%) thrombi were identified. Both left ventricular ejection fraction (39% ±; 16% versus 47% ±; 14%; P =.0005) and presence of right ventricular dysfunction (n = 44 versus 18; P =.0001) differed significantly between groups 1 and 2, respectively. Right atrial area (24 ±; 6 cm2 versus 22 ±; 6 cm2; P =.02) was larger in patients in group 1. Left atrial SEC was present in 68 of 79 group 1 patients (86%). Patients with right atrial thrombi and right atrial SEC had a longer duration of arrhythmia (524 ±; 812 days versus 147 ±; 368 days, P <.05) than patients with right atrial SEC only. Conclusions: Right atrial SEC has a prevalence of 14% in patients with atrial arrhythmia who undergo TEE-guided cardioversion. Right atrial thrombi are a rare finding and were seen in fewer than 1% (5/580) of patients with atrial arrhythmia. Right atrial thrombi among patients on anticoagulation therapy were not associated with clinically significant pulmonary embolism. (J Am Soc Echocardiogr 2001;14:122-7.)

Integrated backscatter (IBS) imaging technology has been used in a wide range of clinical conditions to help characterize tissue abnormalities including myocardial diseases(1-5) and thrombi.(6-8) Previously, we and others(9-11) reported quantitative assessment of left atrial (LA) cavity spontaneous echo contrast (SEC) using IBS. However, it is not known whether LA appendage (LAA) SEC can also be measured quantitatively, and if there exists a relation between LAA Doppler flow velocities and a quantitative measure of SEC. Use of IBS in assessing the severity of SEC may reduce errors resulting from human subjectivity. SEC assessment is highly influenced by the experience level of the operator in the use of transesophageal echocardiography. Inexperienced observers may either under- or overestimate the presence and severity of SEC, leading to a possible change in the clinical management of the patient. A quantitative IBS evaluation may provide an additional objective tool, if not a replacement, for qualitative assessment of SEC, especially in situations in which an observer may not be comfortable in visually grading the presence or severity of SEC. The present study assessed LAA SEC in patients with atrial arrhythmia using IBS and its correlation with qualitative grades of SEC and clinical and echocardiographic predictors of thromboembolism.

An alternative clinical management strategy and cost analysis model is presented for patients with atrial fibrillation of >2 days' duration who may benefit from immediate cardioversion with self-administered low-molecular-weight heparin (enoxaparin) as a bridge antithrombotic therapy to warfarin, after a negative transesophageal echo-cardiography (TEE) screening for thrombus. Assuming no difference in stroke or bleeding rates, our cost minimization model shows that the TEE-guided enoxaparin treatment costs are $1353 lower per patient than an intravenous unfractionated heparin approach. Sensitivity analyses for stroke and bleeding reveal that the treatment-cost economic dominance of the TEE-guided enoxaparin approach may be enhanced by an expected improvement in clinical outcome.