Exaggerated Liver Injury Induced by Renal Ischemia Reperfusion in Diabetes: Effect of Exenatide

Background/Aim:

This study was designed to investigate the possible effect of exenatide (Glucagon like Peptide-1 receptor agonist) on liver injury (distant organ) induced by renal ischemia reperfusion (IR) in diabetic rats.

Materials and Methods:

In vivo renal IR was performed in both type 2 diabetic and normal rats. Each protocol comprised ischemia for 30 minutes followed by reperfusion for 24 hours and a treatment period of 14 days before induction of ischemia.

Results:

Lipid peroxidation, xanthine oxidase activity, myeloperoxidase activity and nitric oxide level in liver tissue were significantly increased (P < 0.01, P < 0.001, P < 0.001, P < 0.05, respectively), after IR in diabetic rats compared to normal rats. Antioxidant enzymes like glutathione, superoxide dismutase, catalase and glutathione peroxidase were significantly reduced (P < 0.05, P < 0.05, P < 0.01, P < 0.05, respectively), after IR in diabetic rats compared to normal rats. Exenatide treatment significantly normalized (P < 0.01), these biochemical parameters in treated rats compared to diabetic IR rats. Serum creatinine phosphokinase activity and liver function enzymes were also significantly normalized (P < 0.001, P < 0.001, respectively), after administration of exenatide.

Conclusion:

Exenatide exerted protective effect on exaggerated remote organ (liver) injury induced by renal IR in diabetes.     

Implementation of diabetic foot ulcer classification system for research purposes to predict lower extremity amputation

BACKROUND:

Patients with diabetic foot ulcers are at a high risk of having both minor or major lower extremity amputations.

AIM:

To identify the extent of risk factors for major and minor amputations in patients with diabetic foot ulcers.

MATERIALS AND METHODS:

This prospective study was conducted from 2003 to 2005. Using the guidelines for wound classification developed by the International Consensus of the Diabetic Foot, patients were assessed for ischemia, neuropathy, linear measurement of wound diameters, depth of wound, and infection. In addition, end stage renal failure was added as a criterion to assess the association of all these criteria with both toe and lower extremity amputation.

RESULTS:

2,321 patients were studied and their mean age was 55 ± 12 years. Most (83.5%) of the patients presented with foot ulcers (n = 1394). Plantar ulcers were the most common (42.6%) followed by ulcers of the big toe (39%). Some (28.5%) of the patients had different types of amputations: 10% had major lower extreme amputation (MLEA) with 8.7% amputations being below the knee and minor (toe) amputations accounting for 18.5%. The most commonly amputated (9.9%) toe was the first toe.

CONCLUSION:

The guidelines for wound classification proposed by the International Consensus of the Diabetic Foot are reliable predictive factors and can determine the outcome of diabetic foot management. Significant factors associated with MLEA were ischemia, neuropathy, and end-stage renal disease and those associated with toe amputation were neuropathy, depth of wound, and grade of infection.     

Lipid abnormalities in streptozotocin-diabetes: Amelioration by Morus indica L. cv Suguna leaves

AIM:

To observe the influence of mulberry (Morus indica L. cv Suguna) leaves on lipid abnormalities in STZ-diabetic rats.

MATERIALS AND METHODS:

Treatment with dried mulberry leaf powder for a period of 8 weeks in hyperglycemic and hyperlipidemic STZ-diabetic rats.

RESULTS:

Mulberry leaves regulated fasting blood glucose, ameliorated the abnormalities in lipid profile as indicated by significant (P<0.01) decrease in serum triglycerides, phospholipids, cholesterol and plasma free fatty acids by 50, 6, 31 and 22% respectively in STZ- diabetic rats compared to diabetic control rats which had significantly (P<0.01) raised levels of triglycerides, phospholipids, cholesterol and free fatty acids than the normal control rats. A marked increase in fecal bile acids (154%) was observed in mulberry treated diabetic rats compared to the diabetic control group indicating conversion of cholesterol to bile acids. In addition, mulberry supplementation significantly lowered LDL-C (67%) and VLDL-C (44%) levels and increased HDL-C (53%) and also decreased atherogenic index (58%) significantly when compared to the diabetic control group.

CONCLUSION:

Besides the diabetic rats, mulberry leaves affected lipid profile in normal rats also indicating hypolipidemic effect as a result of the synergistic action of bioactive compounds.     

Educational program for patients with type-1 diabetes mellitus receiving free monthly supplies of insulin improves knowledge and attitude, but not adherence

BACKGROUND:

Though patients attending a diabetic clinic in a tertiary care hospital were given free monthly supplies of insulin, it was found that their glycemic control was poor.

SETTINGS AND DESIGN:

A prospective interventional study was carried out at the outpatient clinic in a tertiary care hospital.

AIMS:

To evaluate the effectiveness of a six month educational interventional program on the knowledge, attitude and practices (KAP) of type-1 diabetic patients receiving free monthly supplies of human insulin and to assess their adherence.

METHODOLOGY:

Sixty-seven type-1 diabetics, receiving free insulin vials each month, were recruited. The patients'' baseline glycemic index, plasma insulin and KAP scores were determined using a validated questionnaire. The patients were educated about the disease and use of insulin for the next six months. In the seventh month, the KAP questionnaire was readministered and blood parameters measured.

STATISTICAL ANALYSIS:

Blood glucose, glycosylated hemoglobin and plasma insulin were compared by paired t tests. Mean KAP scores by Wilcoxon matched-pairs signed-ranks test. Difference in the proportion of patients answering the items was compared using test of proportions for dependant groups.

RESULTS:

The overall mean scores (± SE) increased from 30.8 ± 0.5 to 42.2 ± 0.4 (P < 0.001). The improvement in practice scores, though significant, was marginal, that is, from 17.7 ± 0.3 to 18.8 ± 0.3. In three out of the ten items under practice domain, only the manner in which vials were being stored at home showed significant improvement (P < 0.0001). The adherence to the insulin regimen increased from 82 to 86%, but was not significant. Patients cited financial reasons for nonadherence.

CONCLUSION:

The study showed that a planned educational intervention in type-1 diabetics, receiving monthly supplies of insulin free of charge, did not improve the key aspects of the practice component, even though the knowledge and attitude improved.     

Determinants of gestational diabetes mellitus: A case control study in a district tertiary care hospital in south India

Objective:

To study the determinants of Gestational Diabetes Mellitus (GDM).

Design:

Case-control study. Setting: Sri Avittom Thirunal Hospital, Thiruvananthapuram district, Kerala, South India.

Participants:

300 GDM women as cases and 300 age-matched controls.

Study variables:

Sociodemographic characteristics, pre-pregnancy Body Mass Index (BMI), menstrual history, obstetric history, infertility history, family history of diabetes in first degree relatives, recurrent urinary tract infection (UTI), and moniliasis.

Statistical analysis:

T-test, Fishers Exact Test, Chi square test, Adjusted Odds Ratio with 95% CI. Results: Pre-pregnancy BMI ≥ 25 (P < 0.001, OR = 2.7), irregular menstrual cycle (P = 0.006), treatment for infertility (P = 0.001, OR = 3.3), family history of diabetes (P = 0.001, OR = 4.5), history of diabetes in mother (P = 0.003), previous pregnancy losses (P = 0.04), past GDM (P = 0.035), prematurity (P = 0.01), pre-eclampsia (P = 0.04), polyhydramnios (P < 0.001, OR = 6.0), UTI (P < 0.001, OR = 3.2), and moniliasis (P < 0.001, OR = 7.6) were significantly associated with present GDM.

Conclusion:

Early identification of women at risk of GDM and prompt treatment is recommended to prevent complications.     

Correlation between changes of blood pressure with insulin resistance in type 2 diabetes mellitus with 4 weeks of pioglitazone therapy

OBJECTIVE:

To examine effects of pioglitazone (PIO) on systolic, diastolic, pulse and mean blood pressures (SBP, DBP, PP and MP, respectively) in type 2 diabetes mellitus (T2DM).

MATERIALS AND METHODS:

One hundred and six normotensive patients with T2DM with mean fasting blood glucose (FBS; 183 ± 6 mg/dl) were randomly divided into two groups. Test group was treated with 15 mg of PIO in addition to metformin 500 mg three times per day in both groups. SBP, DBP, PP and MP and fasting insulin, FBS and lipid profiles were measured before and after PIO therapy.

RESULTS:

There was a significant reduction in SBP (123 ± 2 vs. 118 ± 2 mmHg, P < 0.05), PP (41 ± 1 vs. 37 ± 1 mmHg, P < 0.05), and MP (95 ± 1 vs. 91 ± 1, P < 0.05). Clinical reduction in DBP was observed but not significant (82 ± 2 vs. 81 ± 1 mmHg, P > 0.05). There was a significant correlation between decline in SBP and DBP with respective baseline values (r = 0.76, P < 0.001 and r = 0.62, P < 0.001, respectively). Changes in PP and MP strongly correlated with baseline values (r = 0.51, P < 0.05 and r = 0.56, P < 0.05, respectively). There was a parallel reduction of FBS (183 ± 2 vs. 121 ± 3, P < 0.001) but reduction in IR or lipid profiles was not significant in test group. Changes in BP were not significant in control group ( P > 0.05).

CONCLUSION:

PIO treatment of T2DM showed early reduction of SBP and MP within first 4 weeks. Results suggest that pharmacodynamic effects of PIO mainly affect the systolic component. We hereby suggest that reduction of BP by PIO is independent from mechanisms of changes in IR and dyslipidaemia in normotensive diabetic patients.     

Age and outcomes of primary percutaneous intervention for ST elevation myocardial infarction in a tertiary center—are we there yet?

Background Primary percutaneous intervention (PPCI) is the treatment of choice for ST elevation myocardial infarction (STEMI) but robust evidence in the very elderly is lacking. We compared PPCI outcomes between different age quartiles (quartile 1 < 60 years, quartile 2 ≥ 60 to < 70 years, quartile 3 ≥ 70 to < 80 years, quartile 4 ≥ 80 years). Methods Retrospective observational analysis of our Morriston Tertiary Cardiac Centre (Abertawe Bro Morgannwg University Health Board) patients from 2005 to 2010 with STEMI who underwent PPCI. Results Of 434 patients, 57 (13%) were in quartile 4 (≥ 80 years). In older age quartiles, patients were less likely to receive a drug eluting stent (DES, P = 0.001) or glycoprotein IIb/IIIa inhibitor (GPI, P < 0.0001). Increase in age was associated with reduced time to survival (β-coefficient: -0.192, t: -3.70, 95%CI: -4.91 to -1.50, P < 0.0001) as was the presence of cardiogenic shock (β-coefficient: -0.194, t = 3.77, 95%CI: -5.26 to -1.65, P < 0.0001). Use of GPI was associated with increased time to survival (β-coefficient: 0.138, t = 2.82, 95%CI: 1.58–8.58, P = 0.005) but older age quartiles were less likely to receive GPI (P < 0.0001). In-hospital mortality (1.8% quartile 1, 3.6% quartile 2, 10.9% quartile 3 and 12.3% quartile 4, P = 0.002) and 1-year mortality (5.4% quartile 1, 5.5% quartile 2, 16.8% quartile 3 and 24.6% quartile 4, P < 0.0001, respectively) was significantly higher in older age quartiles. Conclusions Increased short term and intermediate term mortality is seen in the very elderly after PPCI. Age and cardiogenic shock were prognostic factors. Intervention should not be based on age alone and awareness regarding prognostic factors can help improve management.     

Results of Short- and Long-Segment Cardioesophageal Myotomy for Achalasia

Background/Aim:

We report the results of a short- and long-segment cardiomyotomy for relief of the symptoms of achalasia.

Patients and Methods:

From 1997 to 2009, 41 patients (22 men, 19 women) with achalasia underwent cardiomyotomy. Patients were divided into 2 groups [short-segment group (SSG) and long-segment group (LSG)]. SSG include 22 patients with laparotomy and 8-cm short-segment myotomy and Dor fundoplication. LSG includes 19 patients with thoracotomy and 12-cm long-segment myotomy and Belsey partial fundoplication.

Results:

Median follow up was 48 months (range: 12–70 months). Postoperative dysphagia improved in 20 patients in SSG and in 17 patients in LSG (P < 0.001). Slow emptying sensation improved in 19 patients in SSG and in 16 patients in LSG postoperatively (P < 0.001). Heartburn was present in 2 patients in SSG and 3 patients in LSG postoperatively (P = 0.179). Radiologically, barium stasis decreased significantly from 88% to 25% in SSG and from 85% to 30% in LSG. The lower esophageal sphincter (LES) gradient decreased from 32 to 10 mmHg in SSG and from 34 to 14 mmHg in LSG (P < 0.001).

Conclusions:

Short-segment cardiomyotomy reduces the LES gradient and relieves obstructive symptoms.     

Serum Paraoxonase 1 Activity Status in Patients with Liver Disorders

Background/Aim:

Paraoxonase 1 (PON1) is an esterase, exclusively synthesized by liver. The present study has two objectives: to determine the PON1 activity status in various disorders associated with hepatocellular damage and to correlate the changes of PON1 activity with the standard liver function and fasting lipid profile tests in these disorders.

Patients and Methods:

The study groups consisted of 95 patients with liver diseases including acute viral hepatitis (14), cirrhosis with portal hypertension (33), leptospirosis (14), sepsis and multi organ failure (15), left ventricular failure (9), and falciparum malaria (10); and 53 healthy controls. Serum PON1 activity was measured manually using spectrophotometer. Liver function test parameters and fasting lipid profile were performed in clinical chemistry auto analyzer (Hitachi 912).

Results:

The serum PON1 activity in patients with acute viral hepatitis and sepsis decreased significantly (P<0.001) and moderately in falciparum malaria (P<0.05). However, in patients with cirrhosis, leptospirosis and left ventricular patients, its activity did not change significantly. On applying Pearson correlation, serum PON1 activity correlated positively with high-density lipoprotein-cholesterol (HDL-C) in patients with sepsis (r=0.633, P<0.05), left ventricular failure patients (r=0.814, P<0.05) and negatively with acute viral hepatitis patients (r=– 0.528, P<0.05).

Conclusion:

PON1 activity has decreased significantly in acute viral hepatitis, sepsis with multi organ failure and falciparum malaria patients. Determination of PON1 activity may serve as a useful additional test in assessing these conditions.     

Correlation between sudomotor function,sweat gland duct size and corneal nerve fiber pathology in patients with type 2 diabetes mellitus

Aims/Introduction

To study the correlation between sudomotor function, sweat gland duct size and corneal nerve fiber pathology in type 2 diabetes.

Materials and Methods

Sudomotor function was quantified by Neuropad test, and sweat gland duct and corneal nerve fibers were visualized by confocal microscopy in 78 patients with type 2 diabetes stratified by diabetic neuropathy and 28 control participants.

Results

In patients with diabetic neuropathy, sudomotor function, as judged by the time required for complete color change of a Neuropad, was impaired compared with that of controls (P < 0.0001), thereby showing deterioration was related to the severity of diabetic neuropathy (P < 0.0001). Sweat gland ducts were smaller in patients without neuropathy than in controls (P < 0.0001), and further shrinking was seen in patients with severe diabetic neuropathy (P < 0.05). Patients without diabetic neuropathy showed reduced density and length (P < 0.001) of corneal nerve fibers and beading frequency (P < 0.0001), and increased tortuosity (P < 0.0001) compared with controls, and these changes deteriorated in patients with severe diabetic neuropathy. Sudomotor function was negatively associated with corneal nerve fibers (P < 0.002) and branches (P < 0.01), and influenced by the severity of diabetic neuropathy (P < 0.0001); sweat gland duct size correlated with serum triglycerides (P < 0.02), uric acid (P < 0.01), corneal nerve branch (P < 0.03), sudomotor function (P < 0.03) and severity of neuropathy (P < 0.03).

Conclusions

Type 2 diabetic patients had sudomotor dysfunction and smaller sweat gland ducts compared with controls. The stage of diabetic neuropathy and corneal nerve fiber pathology were independent predictors of sudomotor dysfunction, and serum triglycerides, uric acid, corneal nerve branch, stage of diabetic neuropathy and sudomotor function were predictors of sweat gland duct size.     

Burns in diabetic patients

CONTEXT AND AIMS:

Diabetic burn patients comprise a significant population in burn centers. The purpose of this study was to determine the demographic characteristics of diabetic burn patients.

MATERIALS AND METHODS:

Prospective data were collected on 94 diabetic burn patients between March 20, 2000 and March 20, 2006. Of 3062 burns patients, 94 (3.1%) had diabetes; these patients were compared with 2968 nondiabetic patients with burns. Statistical analysis was performed using the statistical analysis software SPSS 10.05. Differences between the two groups were evaluated using Student''s t-test and the chi square test. P < 0.05 was considered as significant.

RESULTS:

The major mechanism of injury for the diabetic patients was scalding and flame burns, as was also the case in the nondiabetic burn patients. The diabetic burn patients were significantly older, with a lower percentage of total burn surface area (TBSA) than the nondiabetic burn population. There was significant difference between the diabetic and nondiabetic patients in terms of frequency of infection. No difference in mortality rate between diabetic and nondiabetic burn patients was observed. The most common organism in diabetic and nondiabetic burn patients was methicillin-resistant staphylococcus. Increasing %TBSA burn and the presence of inhalation injury are significantly associated with increased mortality following burn injury.

CONCLUSIONS:

Diabetics have a higher propensity for infection. Education for diabetic patients must include caution about potential burn mishaps and the complications that may ensue from burns.     

Depression in newly diagnosed type 2 diabetes

Objective:

To investigate the incidence of depression in newly diagnosed type 2 diabetes. Materials and

Methods:

One hundred newly diagnosed (4 – 12 weeks) T2DM participants were evaluated for depressive symptoms by using the Self-Rating Depression Scale (SDS). Blood glucose (HBA1C), urinary albumin, BMI, and blood pressure were measured. Sexual function was evaluated by a self-score on IIEF-5 Questionnaires in male participants below 60 years of age.

Results:

Twenty-eight (28%) of these had depressive scores, 18 (18%) had mild scores, six (6%) had moderate scores, and four had (4%) severe ones. In those who took oral medication, the percentage of depression was 18.5% (10/54) and in those who were treated by insulin the percentage was 39.1% (18/46). The levels of fasting blood glucose (FBG), HBA1c, and urinary albumin were higher in those with depression. The SDS score was negatively correlated with age and annual household income (r = 0.151,0.139, P < 0.05); 17% of the (8/48) males below 60 years of age was diagnosed with erectile dysfunction (ED) by II EF-5score < 20 and the severity of depressive symptoms was negatively correlated with II EF-5score (r = 0.131, P < 0.05).

Conclusion:

These findings indicated that depressive symptoms are common in newly diagnosed type 2 diabetics. A variety of factors could be influencing the severity of depressive symptoms.     

Foot Technology, Part 1 of 2: Association between Foot Temperature and Sudomotor Dysfunction in Type 2 Diabetes

Background and Aims

Increased foot skin temperature has been described as a feature of diabetic neuropathy. The aim of this present study was to investigate the association between foot temperature and sudomotor dysfunction in type 2 diabetes mellitus.

Patients and Methods

This study included 51 patients (group A: 25 men, mean age 61.14 ± 6.11 years) without sudomotor dysfunction and 52 patients (group B: 25 men, mean age 59.54 ± 6.18 years) with sudomotor dysfunction. Sudomotor dysfunction was defined as time until complete Neuropad^® color change from blue to pink exceeding 600 s in at least one foot. Time until complete color change of the test was also recorded. Foot skin temperature was measured with a handheld infrared thermometer on the plantar aspect of the foot at the level of the first metatarsal head.

Results

On both feet, temperature was significantly higher in group B than in group A (right foot, group A versus group B, 30.62 ± 1.13 °C versus 32.12 ± 1.06 °C, p < .001; left foot, group A versus group B, 30.65 ± 1.06 °C versus 32.19 ± 1.10 °C, p < .001). There was a significant positive correlation between time to complete Neuropad color change and foot skin temperature (right foot, r = 0.742, p < .001; left foot, r = 0.758, p < .001), which was confirmed in both groups.

Conclusions

Patients with sudomotor dysfunction have significantly higher foot temperature than those without sudomotor dysfunction. Foot temperature is positively correlated with severity of sudomotor dysfunction, as evaluated by the time to complete Neuropad color change.     

Clinical Relevance of Serum Vascular Endothelial Growth Factor and Interleukin-6 in Patients With Colorectal Cancer

Background/Aim:

Some biological factors play a role in stimulation of malignant growth, metastasis and angiogenesis; however, their clinical relevance has not yet been well established for most of them. This work was aimed at studying the clinical relevance of serum vascular endothelial growth factor (VEGF) and interleukin -6 (IL-6), in patients with colorectal cancer (CRC).

Materials and Methods:

Preoperative serum levels of VEGF and IL-6 were measured by enzyme -linked immuno -assay in 35 CRC patients and in 30 healthy controls.

Results:

CRC patients with or without metastasis had significantly higher VEGF and IL-6 levels than healthy controls (all P < 0.001). Patients with advanced clinical stage had significantly higher levels of VEGF and IL-6 than those with early clinical stage (all P < 0.001). Also, patients with metastatic disease had significantly higher VEGF and IL-6 levels than those with localized disease (all P < 0.001). The diagnostic accuracy for invasiveness was 83% for VEGF (cut off value = 240 pg/ml) and 66% for IL-6 (cut off value = 6.7 pg/ml), with sensitivity 79% and 74% and specificity 68% and 59%, respectively.

Conclusion:

In CRC patients, preoperative measurement of serum VEGF and Il-6 may prove useful non-invasive diagnostic indicators associated with advanced clinical stage and tumor metastasis that warrants further investigations.     

Morphological changes of the peripheral nerves evaluated by high‐resolution ultrasonography are associated with the severity of diabetic neuropathy,but not corneal nerve fiber pathology in patients with type 2 diabetes

Aims/Introduction

To evaluate the morphological changes of the median and posterior tibial nerve using high-resolution ultrasonography, and the corneal C fiber pathology by corneal confocal microscopy in type 2 diabetic patients.

Materials and Methods

The cross-sectional area, hypoechoic area and maximum thickness of the nerve fascicle of both nerves were measured by high-resolution ultrasonography in 200 type 2 diabetic patients, stratified by the severity of diabetic neuropathy, and in 40 age- and sex-matched controls. These parameters were associated with corneal C fiber pathology visualized by corneal confocal microscopy, neurophysiological tests and severity of diabetic neuropathy.

Results

The cross-sectional area, hypoechoic area and maximum thickness of the nerve fascicle of both nerves in patients without diabetic neuropathy were larger than those in control subjects (P < 0.05 to P < 0.001), and further increased relative to the severity of neuropathy (P < 0.0001). All morphological changes of both nerves were negatively associated with motor and sensory nerve conduction velocity (P = 0.01 to P < 0.0001), and directly associated with 2,000-Hz current perception threshold (P = 0.009 to P < 0.001). The significant corneal C fiber pathology occurred before developing the neuropathy, and deteriorated only in patients with the most severe neuropathy. The association between the morphological changes of both nerves and corneal C fiber pathology was poor.

Conclusions

The morphological changes in peripheral nerves of type 2 diabetic patients were found before the onset of neuropathy, and were closely correlated with the severity of diabetic neuropathy, but not with corneal C fiber pathology.     

Differentiation of Tuberculous Peritonitis from Peritonitis Carcinomatosa without Surgical Intervention

Background/Aim:

Ascites of tuberculous peritonitis (TBP) is an exudative type and may well be misdiagnosed as carcinomatous peritonitis, especially in the elderly. The aim of this study was to identify independent predictors that can differentiate TBP from peritonitis carcinomatosa without surgical intervention.

Patients and Methods:

This prospective cohort study was performed on 75 subjects in the following groups: TBP (n=27) (TBP group), ovarian cancer complicated with ascites (n=24) (Ov Ca group), and gastric cancer complicated with ascites (n=24) (Ga Ca group). The frequency of clinical symptoms, laboratory parameters, and serum tumor markers levels were compared.

Results:

In univariate analysis; fever, night sweats, and abdominal pain were significantly more frequent in the TBP group compared to those in the Ov Ca group (P < 0.001, P < 0.001, and P = 0.035, respectively) and the Ga Ca group (P < 0.001, P < 0.001, and P = 0.015, respectively). Serum CA 19-9 and carcino embryonic antigen (CEA) levels were significantly lower in the TBP and Ov Ca group compared to the Ga Ca group (P < 0.001 and P < 0.001, respectively). Elevated serum CA 125 level was found in all patients with TBP and Ov Ca and in 86.6% of patients with Ga Ca. In the multivariate analysis, presence of fever (P < 0.001), night sweats (P < 0.001), age under 40 years (P = 0.008), and normal serum CA 19-9 level (P = 0.044) were independent predictor of diagnosis of TBP.

Conclusion:

The presence of fever, elevated serum CA 125 level, normal serum CA 19-9, and CEA associated with lymphocyte predominant benign ascites may establish the diagnosis of TBP.     

Evaluation of the efficacy of pulsed electromagnetic field in the management of patients with diabetic polyneuropathy

AIM:

The study was carried out to evaluate and compare the effect of low power, low frequency pulsed electromagnetic field (PEMF) of 600 and 800 Hz, respectively, in management of patients with diabetic polyneuropathy.

SETTINGS AND DESIGNS:

The study was a randomized controlled trial performed in Guru Nanak Dev University and Medical College, Amritsar, India with different subject experimental design.

MATERIALS AND METHODS:

Thirty subjects within an age group of 40–68 years with diabetic polyneuropathy stages N1a, N1b, N2a were randomly allocated to groups 1, 2, 3 with 10 subjects in each. Group 1 and 2 were treated with low power 600 and 800-Hz PEMF for 30 min for 12 consecutive days. Group 3 served as control on usual medical treatment of diabetic polyneuropathy (DPN). The subjects with neuropathy due to any cause other than diabetes were excluded. The pain and motor nerve conduction parameters (distal latency, amplitude, nerve conduction velocity) were assessed before and after treatment.

STATISTICAL ANALYSIS:

Related t-test and unrelated t-test were used for data analysis.

RESULTS:

Significant reduction in pain and statistically significant (P<0.05) improvement in distal latency and nerve conduction velocity were seen in experimental group 1 and 2.

CONCLUSIONS:

Low-frequency PEMF can be used as an adjunct in reducing neuropathic pain as well as for retarding the progression of neuropathy in a short span of time.     

Proteolytic activity in the brain of alloxan diabetic rats: Presence of a proteolytic activator in the cerebral extract

BACKGROUND AND AIM:

Diabetes mellitus is known to cause neurological disorders due to impaired glucose metabolism involving decreased utilization of glucose by the brain tissues. The mechanisms responsible for failure of glycemic regulation in type-2 diabetes leading to neurological impairment need to be thoroughly elucidated.

MATERIALS AND METHODS:

Type-2 diabetes was induced in albino rat models with alloxan monohydrate (40 mg/kg i.v.). Cerebral cortex and medulla oblongata were investigated 48 h after alloxan administration for the alterations in proteolytic activity.

RESULTS:

Diabetes caused an elevation (P < 0.001) of blood glucose and also proteolytic activity in the brain.

CONCLUSION:

Impaired glucose metabolism in the brain was the key factor which was responsible for the elevated (P < 0.001) proteolysis leading to brain dysfunction.     

Association between erectile dysfunction and cardiovascular risk in individuals with type-2 diabetes without overt cardiovascular disease

Background:

Erectile dysfunction in type-2 diabetes may be an independent marker for coronary artery disease. Present study was undertaken to investigate whether type-2 diabetic patients with erectile dysfunction without having overt cardiovascular disease had increased cardiovascular risk.

Aim:

To find out correlation between ED and cardiovascular risk in diabetic patients.

Methods:

Fifty type-2 diabetic patients were assessed for erectile dysfunction using international index of erectile dysfunction (IIEF-5), which include questionnaire and cardiovascular risk assessment by multiparameter cardiovascular analysis device (periscope).

Results:

The prevalence of erectile dysfunction in type-2 diabetics was very high (78%), mild, moderate and severe ED was present in 6, 36 and 36%, respectively. The total cardiovascular risk was more in patients with ED in comparison to patients without ED (34.87 ± 18.82 vs 20.91 ± 11.03 p = 0.002). The mean 10-years coronary risk and cardiac risk was 12.00 + 9.60 and 22.23 + 14.14 (p = 0.029) and 13.36 ± 1.22 and 28.85 ± 4.13 (p 0.002) in patients without ED and with ED respectively. The mean vascular and atherosclerosis risk was 28.73 ± 13.94 and 39.38 ± 19.51 (p > 0.05) and 26.18 ± 10.31 and 33.92 ± 13.40 (p > 0.05) in patients without ED and with ED, respectively. Total cardiovascular risk was found to increase with age, duration of diabetes and HbA1c levels.

Conclusion:

The total cardiovascular risk increases with increasing severity of erectile dysfunction in type-2 diabetic patients without having overt cardiovascular disease.     

A comparative evaluation of safety and efficacy of rosuvastatin, simvastatin, and atorvastatin in patients of type 2 diabetes mellitus with dyslipidemia

AIM:

To evaluate and compare the safety and efficacy of rosuvastatin, simvastatin, and atorvastatin in patients of type 2 diabetes mellitus with dyslipidemia.

MATERIALS AND METHODS:

This open-label, randomized, parallel group, comparative, prospective study of 12-weeks duration included 60 patients of type-2 diabetes with dyslipidemia having good glycemic control with fixed dose combination of tablet glimepiride + metformin and divided into three groups of twenty each. Group-1 patients have received tablet rosuvastatin 10 mg once daily, group-2 received tablet atorvastatin 10 mg once daily, and group-3 received tablet simvastatin 10 mg once daily for 12 weeks each. The levels of serum cholesterol, serum triglyceride, LDL, VLDL, and HDL were assessed at baseline and at the end of 12 weeks.

RESULTS:

The mean serum cholesterol, serum triglyceride, LDLc, and VLDLc levels were significantly reduced on therapy (P<0.001). Simultaneously, the mean levels of HDL were highly significantly increased (P<0.001) after therapy for 12 weeks with rosuvastatin, atorvastatin, and simvastatin. Reduction of LDL levels in rosuvastatin group was statistically significant when compared with those of simvastatin group (P< 0.05) but was statistically nonsignificant when compared with atorvastatin group (P> 0.05). Conclusion: 10 mg of rosuvastatin was comparable to 10 mg of atorvastatin and more efficacious than 10 mg simvastatin in reducing LDL levels after 12 weeks of therapy in patients of type 2 diabetes mellitus with dyslipidemia.