Relationships between electrochemical skin conductance and kidney disease in Type 2 diabetes

BackgroundSUDOSCAN® non-invasively measures peripheral small fiber and autonomic nerve activity using electrochemical skin conductance. Since neuropathy and nephropathy are microvascular Type 2 diabetes (T2D) complications, relationships between skin conductance, estimated glomerular filtration rate (eGFR), and urine albumin:creatinine ratio (UACR) were assessed.MethodsTwo hundred five African Americans (AA) with T2D, 93 AA non-diabetic controls, 185 European Americans (EA) with T2D, and 73 EA non-diabetic controls were evaluated. Linear models were fitted stratified by population ancestry and T2D, adjusted for covariates.ResultsRelative to EA, AA had lower skin conductance (T2D cases p < 0.0001; controls p < 0.0001). Skin conductance was also lower in T2D cases vs. controls in each population (p < 0.0001, AA and EA). Global skin conductance was significantly associated with eGFR in AA and EA with T2D; adjusting for age, gender, BMI, and HbA1c, positive association was detected between skin conductance and eGFR in AA T2D cases (parameter estimate 3.38, standard error 1.2; p = 5.2E^− 3), without association in EA T2D cases (p = 0.22).ConclusionsNoninvasive measurement of skin conductance strongly associated with eGFR in AA with T2D, replicating results in Hong Kong Chinese. SUDOSCAN® may prove useful as a low cost, non-invasive screening tool to detect undiagnosed diabetic kidney disease in populations of African ancestry.     

Increased responsiveness to thrombin through protease-activated receptors (PAR)-1 and -4 in active Crohn's disease

Background and aimsPlatelets are essential in hemostasis and inflammation, thereby linking coagulation with inflammation. Abundant thrombin generation in association with inflammation is considered a major reason for the increased risk for thromboembolic events. We therefore investigated platelet responsiveness to thrombin.MethodsIn this case–control study 85 patients with Crohn's disease (active CD 42, remission 43) and 30 sex- and age-matched controls were enrolled. Clinical disease activity (Harvey–Bradshaw-Index) was assessed and CD-related data were determined by chart review. Platelets' response to protease activated receptor-1 and -4 (PAR-1, -4) was assessed by whole blood platelet aggregometry (MEA), levels of platelets adhering to monocytes (PMA), and platelet surface P-selectin.ResultsPlatelets' aggregation after activation with the specific PAR-1 agonist (SFLLRN) and PAR-4 agonist (AYPGKF) was higher in patients with active CD compared to patients in remission and controls (p = 0.0068 and p = 0.0023 for SFLLRN, p = 0.0019 and 0.0003 for AYPGKF). Likewise, levels of PMA after activation with PAR-1 and PAR-4 receptor agonists were higher in patients with active CD compared to patients in remission and controls (p = 0.0001 and p < 0.0001 for SFLLRN, p = 0.0329 and p = 0.0125 for AYPGKF). However, P-selectin expression on human platelets showed heterogeneous results. Only PAR-1 activation of platelets resulted in significant differences between CD patients and controls (p = 0.0001 and p = 0.0022 for active and inactive CD versus controls, respectively).ConclusionsOur data suggest a new mechanism of platelet activation which has the potential to increase risk for thromboembolism in patients with active CD which might be due to platelets poised for thrombin-inducible activation.     

Disordered glycemic control in women with type 2 diabetes is associated with increased TNF receptor-2 levels

BackgroundEvidence implicates tumor necrosis factor (TNF) in the pathophysiology of Type 2 Diabetes (T2D) through unclear mechanisms. We hypothesized that disordered glycemic control leads to TNF activation and increases in soluble-TNF (sTNF) and its receptors-1 (sTNFR1) and -2 (sTNFR2).MethodsWe characterized 265 T2D and non-diabetic Latin American subjects and assessed the relationship between the TNF system and fasting plasma glucose (FPG), hemoglobin-A1C (A1C), insulin (FPI), C-peptide and HOMA-Beta.ResultssTNF and sTNFR2 but not sTNFR1 levels were higher in T2D than non-diabetics (P < 0.0001). In T2D, sTNFR2 was associated with A1C and C-peptide (R² = 0.354, b = 0.504, P < 0.0001; b = 0.167, P = 0.049). Also, T2D patients with disordered glycemic control had increased sTNFR2 levels that correlated with FPG (Rho:0.393, P < 0.001), A1C (Rho:0.451, P < 0.001) and HOMA-Beta (Rho:-0.308, P = 0.005); events not observed in T2D patients with adequate glycemic control. Furthermore, sex-based comparative analyses of T2D patients showed that women compared to men had higher sTNFR2 levels (P = 0.017) that correlated with FPG, A1C, FPI and HOMA-Beta.ConclusionsDisordered glycemic control is associated with sTNF and sTNFR2. sTNFR2 levels were higher in T2D women than men. Thus, increased sTNFR2 levels may be an important biomarker for disordered glucose and inflammatory complications in T2D patients and women in particular.     

Renin angiotensin system polymorphisms in patients with metabolic syndrome (MetS)

BackgroundThe genes associated with hypertension could be genetic risk factors for metabolic syndrome (MetS).AimTo determine the frequency of M235T and T174M-AGT, I/D-ACE and A1166C-AGTR1 in hypertensive patients with MetS and to evaluate the relationship between these polymorphisms and central obesity and dyslipidemia, respectively.Materials and methodsWe performed AGT, AGTR1 and ACE genotyping in 56 hypertensive women (24 with MetS) and 71 normotensive women using PCR-RFLP methods and PCR, respectively.ResultsHypertensive patients carrying the mutated TT235, MM174 and DD genotypes had an 1.53 (p = 0.56), 1.78 (p = 0.52) and 1.28 (p = 0.78)-fold increased risk to develop MetS. Hypertensive carriers of both mutated TT235 and MM174 or TT235 and D/D or TT235 and CC + AC genotypes had an 8.15 (p = 0.04), 4.83 (p = 0.04) and 10.53 (p = 0.05)-fold increased risk to develop MetS. Hypertensive patients with MetS and TT, D/D or CC genotypes had higher body mass index compared to hypertensive patients without MetS (p ≤ 0.05 for all the genotypes). Hypertensive patients with MetS and TT235, MM174, D/D or CC1166 genotypes had higher triglyceride levels, lower HDL-cholesterol levels and higher waist circumference compared to hypertensive patients without MetS (p ≤ 0.05, except for the association between CC1166 and HDL-cholesterol level).ConclusionsThe effect of the T174M, I/D and A1166C polymorphisms on MetS may depend on the M235T polymorphism. Among hypertensive subjects with MetS, the presence of TT235, MM174, DD and CC1166 genotypes could be a risk factor for central obesity and dyslipidemia.     

Outcomes of dementia: Systematic review and meta-analysis of hospital administrative database studies

IntroductionAim of the study was to compare various outcomes of dementia patients with elderly patients without dementia by conducting a systematic review of previous population-based studies.MethodsThe relevant studies were retrieved from search of electronic databases.ResultsThe pooled data from included 11 studies consisted of outcomes of 1,044,131 dementia patients compared to 9,639,027 elderly patients without dementia. Meta-analysis showed that the mortality in dementia patients was 15.3% as compared to 8.7% in non-dementia cases (RR 1.70, CI 95%, 1.27-2.28, p 0.0004). However, there was significant heterogeneity between the studies (p < 0.00001). Dementia patients had significantly increased overall readmission rate (OR 1.18; 95% CI, 1.08-1.29, p < 0.001). They had higher complication rates for urinary tract infections (RR 2.88; 95% CI, 2.45-3.40, p < 0.0001), pressure ulcers (RR 184; 95% CI, 1.31-1.46, p < 0.0001), pneumonia (RR 1.66; 95% CI, 1.36-2.02, p < 0.0001), delirium (RR 3.10; 95% CI, 2.31-4.15, p < 0.0001), and, dehydration and electrolyte imbalance (RR 1.87; 95% CI, 1.55-2.25, p < 0.0001). Dementia patients had more acute cardiac events (HR 1.16; 95% CI, 1.06-1.28, p 0.002), while fewer revascularization procedures (HR 0.12; 95% CI, 0.08-0.20, p < 0.001). Patients with dementia had lesser use of ITU (reduction by 7.5%; 95% CI, 6.9-8.1), ventilation (reduction by 5.4%; 95% CI, 5.0-5.9), and dialysis (reduction by 0.5%; 95% CI, 0.4-0.8).DiscussionCompared to older adult population, patients with dementia had poorer outcome. Despite higher mortality rate and readmission rate, they underwent fewer interventions and procedures.     

Effects of age after laparoscopic right colectomy for cancer: Are there any specific outcomes?

BackgroundLaparoscopic approach in colorectal surgery has demonstrated to give advantages in terms of postoperative outcomes, particularly in high-risk patients. The aim was to assess the impact of patients’ age on the short-term outcomes after laparoscopic right colectomy for cancer.MethodsFrom January 2004 to September 2014, all patients who underwent laparoscopic right colectomy for cancer in a single institution were divided into four groups (A: <64 years; B: 65–74 years; C: 75–84 years; D ≥85 years). Risk factors for postoperative complications were determined on multivariable analysis.ResultsLaparoscopic right colectomy was performed in 507 patients, including 171 (33.7%) in A, 168 (33.1%) in B, 131 (25.8) in C and 37 (7.4%) in D. Patients in Group C and Group D had higher ASA score (p < 0.0001) and presented more frequently with anaemia (20.6% and 29.7%, p = 0.001). Stages III and IV were more frequently encountered in groups C and D. Overall morbidity was 27.5% without any difference in the four groups (24.5%, 29.1%, 7.5% and 18.4% respectively, p = 0.58). The rate of minor complications (such as wound infection or postoperative ileus) was higher in Group D compared to other groups (p = 0.05). The only independent variable correlated with postoperative morbidity was intraoperative blood transfusion (OR 2.82; CI 95% 1.05–4.59, p < 0.0001).ConclusionsThe present series suggests that patient’s age did not significantly jeopardize the postoperative outcomes after laparoscopic right colectomy for cancer.     

Transabdominal salvage surgery after pouch failure in a tertiary center: A case-matched study

BackgroundSalvage surgery after failure of ileal pouch–anal anastomosis (IPAA) could be offered to selected patients. However, the results vary widely in different centers.AimsTo assess the outcomes of salvage surgery by comparison with a control group matched for confounding variables.MethodsFrom a prospective database of 1286 IPAA, patients undergoing transabdominal salvage surgery were compared for perioperative and functional outcomes and quality of life (QOL) to a 1:3 control group of primary IPAA cases.ResultsSalvage surgery patients (30) had a higher rate of hand-sewn anastomoses (80 vs 20%, p < 0.0001) and reoperations (10 vs 2.2%, p 0.02) than control group (90). A higher number of daytime and nighttime bowel movements (7.4 vs 4.1, p < 0.0001, and 2.6 vs 1.8, p = 0.002), a lower median CGQL score (0.7 vs 0.8, p = 0.0001) and a higher rate of pouch fistulae (13.3 vs 1.1%, p = 0.003) were reported after salvage surgery. Pouch failure rate after salvage surgery was 10.1%, 18.7% and 26.8% at 1, 5 and 10 years (vs 0%, 3.5% and 8.4% in control group, p = 0.0085).ConclusionsAlthough worse functional outcomes and decreased QOL have to be expected, salvage surgery after pouch failure is associated with acceptable outcomes when performed in a referral center.     

Crohn's disease and smoking: Is it ever too late to quit?

BackgroundSmoking increases CD risk. The aim was to determine if smoking cessation at, prior to, or following, CD diagnosis affects medication use, disease phenotypic progression and/or surgery.MethodsData on CD patients with disease for ≥ 5 yrs were collected retrospectively including the Montreal classification, smoking history, CD-related abdominal surgeries, family history, medication use and disease behaviour at diagnosis and the time when the disease behaviour changed.Results1115 patients were included across six sites (mean follow-up—16.6 yrs). More non-smokers were male (p = 0.047) with A1 (p < 0.0001), L4 (p = 0.028) and perianal (p = 0.03) disease. Non-smokers more frequently received anti-TNF agents (p = 0.049). (p = 0.017: OR 2.5 95%CI 1.18–5.16) and those who ceased smoking prior to diagnosis (p = 0.045: OR 2.3 95%CI 1.02–5.21) progressed to complicated (B2/B3) disease as compared to those quitting at diagnosis. Patients with uncomplicated terminal ileal disease at diagnosis more frequently developed B2/B3 disease than isolated colonic CD (p < 0.0001). B2/B3 disease was more frequent with perianal disease (p < 0.0001) and if i.v. steroids (p = 0.004) or immunosuppressants (p < 0.0001) were used. 49.3% (558/1115) of patients required at least one intestinal surgery. More smokers had a 2nd surgical resection than patients who quit at, or before, the 1st resection and non-smokers (p = 0.044: HR = 1.39 95%CI 1.01–1.91). Patients smoking > 3 cigarettes/day had an increased risk of developing B2/B3 disease (p = 0.012: OR 3.8 95%CI 1.27–11.17).ConclusionProgression to B2/B3 disease and surgery is reduced by smoking cessation. All CD patients regardless of when they were diagnosed, or how many surgeries, should be strongly encouraged to cease smoking.     

Glycaemic control for painful diabetic peripheral neuropathy is more than fasting plasma glucose and glycated haemoglobin

BackgroundThe relationship between postprandial hyperglycaemia and diabetic peripheral neuropathy (DPN), whether painful or painless, has yet to be determined. Thus, the aim of this study was to investigate the relationship in patients with type 2 diabetes (T2D).MethodsThis cross-sectional study was conducted in adults with T2D between January and October 2013. Blood samples were collected after overnight fasting every 3 months prior to enrolment. For this study, increased postprandial glycaemic exposure was defined as high glycated haemoglobin (HbA_1c) and near-normal mean fasting plasma glucose (FPG) levels. Both painless and painful DPN were evaluated using two validated tools, the Michigan Neuropathy Screening Instrument (MNSI) and Douleur Neuropathique 4 (DN4) questionnaire.ResultsThis study included 1040 participants with mean FPG levels < 140 mg/dL, 535 of which were < 126 mg/dL. Of these patients, 200/1040 (19.2%) and 105/535 (19.6%) had DPN. Multivariate analysis demonstrated that higher HbA_1c levels (≥ 7%) did not increase risk of painless DPN, but did significantly increase risk of painful DPN in T2D patients with FPG < 140 mg/dL and < 126 mg/dL, with corresponding odds ratios of 2.49 and 3.77 (95% confidence intervals: 1.09–5.71 and 1.20–11.79), respectively, after adjusting for demographic factors, diabetes-related variables and comorbidities.ConclusionThis study is the first to reveal that increased postprandial glycaemic exposure, as assessed by high HbA1c and near-normal FPG levels, is associated with an increased risk of painful DPN in adults with T2D.     

Clinical,biochemical and genetic spectrum of low alkaline phosphatase levels in adults

BackgroundLow serum levels of alkaline phosphatase (ALP) are a hallmark of hypophosphatasia. However, the clinical significance and the underlying genetics of low ALP in unselected populations are unclear.MethodsIn order to clarify this issue, we performed a clinical, biochemical and genetic study of 42 individuals (age range 20–77 yr) with unexplained low ALP levels.ResultsNine had mild hyperphosphatemia and three had mild hypercalcemia. ALP levels were inversely correlated with serum calcium (r = − 0.38, p = 0.012), pyridoxal phosphate (PLP; r = − 0.51, p = 0.001) and urine phosphoethanolamine (PEA; r = − 0.49, p = 0.001). Although many subjects experienced minor complaints, such as mild musculoskeletal pain, none had major health problems. Mutations in ALPL were found in 21 subjects (50%), including six novel mutations. All but one, were heterozygous mutations. Missense mutations were the most common (present in 18 subjects; 86%) and the majority were predicted to have a damaging effect on protein activity. The presence of a mutated allele was associated with tooth loss (48% versus 12%; p = 0.04), slightly lower levels of serum ALP (p = 0.002), higher levels of PLP (p < 0.0001) and PEA (p < 0.0001), as well as mildly increased serum phosphate (p = 0.03). Ten individuals (24%) had PLP levels above the reference range; all carried a mutated allele.ConclusionOne-half of adult individuals with unexplained low serum ALP carried an ALPL mutation. Although the associated clinical manifestations are usually mild, in approximately 50% of the cases, enzyme activity is low enough to cause substrate accumulation and may predispose to defects in calcified tissues.     

Effect of maternal use of flaxseed oil during pregnancy and lactation on glucose metabolism and pancreas histomorphometry of male offspring from diabetic rats

AimInvestigate if the maternal use of flaxseed oil prevents pancreatic alterations in the offspring of diabetic mothers.MethodsDiabetes was induced in female wistar rats (n = 12) by a high-fat diet and low-dose of streptozotocin. After the confirmation of the diabetes (glucose >300 mg/dL), rats were mated and once pregnancy was confirmed, they were allocated into three groups (n = 6): high-fat group (HFG); flaxseed oil group (FOG); and control group (CG) (nondiabetic rats). At weaning, male offspring (n = 12/group) received a standard chow diet. The animals were euthanized in two phases: at 100 and at 180 days, (n = 6/group). The pancreas was collected for histomorphometric and immunohistochemistry analysis.ResultsHFG showed hypertrophy of pancreatic islets at 100 and at 180 days (p < 0.0001), while the FOG offspring had islets with smaller diameters compared to HFG at both phases of sacrifice (p < 0.0001). HFG had a lower percentage of small islets when compared to CG and FOG, which had a higher percentage when compared to HFG (p = 0.0053) at 100 days. At 180 days HFG showed higher percentage of larger islets (p = 0.00137) and lower percentage of smaller islets (p = 0.00112), when compared to FOG. HFG showed lower islet insulin immunodensity at 100 days (p < 0.0001) and 180 days (p < 0.0001), whereas FOG was similar to CG (p < 0.0001) at 100 days and higher at 180 days (p < 0.0001).ConclusionsFlaxseed oil reduced the damage caused by maternal hyperglycemia, promoting normal pancreas histomorphometry and β cell mass.     

Decreased glomerular filtration rate in patients with at least 5 years of type 2 diabetes in Ho Chi Minh City,Vietnam: Prevalence and associated factors

AimsThis study determined the prevalence and associated factors of decreased estimated glomerular filtration rate (eGFR) in patients who had type 2 diabetes for at least 5 years.MethodsA cohort study was conducted in 467 outpatients in a community-based hospital in Ho Chi Minh City, Vietnam. Serum creatinine were tested twice, at two occasions at least 3 months apart. The confirmatory eGFR was the average of the two eGFR of which the difference was ≤20%. The mean urine albumin-to-creatinine ratio was calculated from two consecutive early morning specimens.ResultsMost patients were female with a mean age of 61.7 (8.0) years. Albuminuria was found in 40% of participants, and the prevalence of decreased eGFR was 7.5% (n = 35). Individuals with declined eGFR were older (p < 0.001), had duration of diabetes longer (p = 0.025), higher systolic blood pressure (p = 0.010) and higher acid uric level (p < 0.001), increased albumin excretion (p = 0.009), and more proliferative retinopathy (p = 0.011) than those with non-declined eGFR.ConclusionsAlthough decreased eGFR in type 2 diabetes patients was not prevalent, the strategies to prevent the progressive decline of GFR should be done to prevent patients from progressing to advanced renal disease.     

Sleep-related disorders in Latin-American children with atopic dermatitis: A case control study

BackgroundAtopic dermatitis (AD) has been associated with impairment of sleep. The aim of this study was to evaluate sleep disorders in AD Latin-American children (4–10 years) from nine countries, and in normal controls (C).MethodsParents from 454 C and 340 AD children from referral clinics answered the Children Sleep Habits Questionnaire (CSHQ), a one-week retrospective 33 questions survey under seven items (bedtime resistance, sleep duration, sleep anxiety, night awakening, parasomnias, sleep-disordered breathing and daytime sleepiness). Total CSHQ score and items were analysed in both C and AD groups. Spearman's correlation coefficient between SCORAD (Scoring atopic dermatitis), all subscales and total CSHQ were also obtained.ResultsC and AD groups were similar regarding age, however, significantly higher values for total CSHQ (62.2 ± 16.1 vs 53.3 ± 12.7, respectively) and items were observed among AD children in comparison to C, and they were higher among those with moderate (54.8%) or severe (4.3%) AD. Except for sleep duration (r = −0.02, p = 0.698), there was a significant Spearman's correlation index for bedtime resistance (0.24, p < 0.0001), sleep anxiety (0.29, p < 0.0001), night awakening (0.36, p < 0.0001), parasomnias (0.54, p < 0.0001), sleep-disordered breathing (0.42, p < 0.0001), daytime sleepiness (0.26, p < 0.0001) and total CSHQ (0.46, p < 0.0001). AD patients had significantly higher elevated body mass index.ConclusionLatin-American children with AD have sleep disorders despite treatment, and those with moderate to severe forms had marked changes in CSHQ.     

Obesity and iron deficiency anemia as risk factors for asymptomatic bacteriuria

BackgroundFew studies examined the risk factors of asymptomatic bacteriuria, showing contradictory results. Our study aimed to examine the association between different clinical and laboratory parameters and asymptomatic bacteriuria in internal medicine patients.Materials and methods330 consecutive hospitalized subjects, asymptomatic for urinary tract infections (UTIs), underwent to microscopic examination of urine specimens. 100 subjects were positive for microscopic bacteriuria and were recruited into the study. At the quantitative urine culture 31 subjects of study population were positive while 69 subjects were negative for bacteriuria.ResultsThe analysis of clinical characteristics showed that the two groups of subjects (positive and negative urine culture for bacteriuria) were significant different (p < 0.05) about obesity (76.7% vs 42% respectively), metabolic syndrome (80.6% vs 44,9%), cholelithiasis (35.5% vs 13,2%) and iron deficiency anemia (80.6% vs 53,6%). The univariate analysis showed that only obesity, cholelithiasis and iron deficiency anemia were positively associated with positive urine culture for bacteriuria (Odds Ratios [OR] = 3.79, p = 0.0003; OR = 2,65, p = 0.0091; OR = 2.63, p = 0.0097; respectively). However, the multivariate analysis by logistic regression showed that only obesity and iron deficiency anemia, independently associated with positive urine culture for bacteriuria (OR = 3.9695, p = 0.0075; OR = 3.1569, p = 0.03420 respectively).ConclusionsThis study shows that obesity and iron deficiency anemia are independent risk factors for asymptomatic bacteriuria.     

Bivalirudin versus heparin for percutaneous coronary intervention: an updated meta-analysis of randomized controlled trials

AimsGiven controversy over anticoagulation regimens for percutaneous coronary intervention (PCI), we performed an updated meta-analysis of randomized controlled trials (RCTs) to compare bivalirudin versus heparin.Methods and resultsMedline/Pubmed and Cochrane CENTRAL were searched for all RCTs comparing bivalirudin with provisional glycoprotein IIb/IIIa inhibitor (GPI) use versus heparin with provisional or routine GPI use for PCI. Pooled estimates of 30 day outcomes, presented as risk ratios (RR) [95% confidence intervals], were generated with random-effect models. Our analysis included 14 studies with 30,446 patients that were randomized to bivalirudin with provisional GPI use (n = 14,869) versus heparin with provisional (n = 6451) or routine GPI use (n = 9126). There was no significant difference between anticoagulation with bivalirudin compared with heparin for death (RR 0.95 [0.78–1.14]) or myocardial infarction (RR 1.10 [0.97–1.25]). Early stent thrombosis was significantly greater with bivalirudin compared with heparin (RR 1.61 [1.18–2.20], p = 0.003), especially in patients undergoing primary PCI (2.15 [1.15–4.03], p = 0.02). However, bivalirudin reduced the risk of major bleeding (RR 0.59 [0.51–0.70], p < 0.0001) and TIMI major bleeding (RR 0.59 [0.48–0.72], p < 0.0001) compared with heparin. Meta-regression analysis demonstrated that bleeding risk with use of heparin significantly increases with increasing GPI use (p = 0.02).ConclusionMeta-analysis of 14 RCTs with 30,446 patients demonstrated that bivalirudin is associated with higher risk of stent thrombosis but lower risk of major bleeding compared with heparin.     

Effect of aerobic exercise on peripheral nerve functions of population with diabetic peripheral neuropathy in type 2 diabetes: A single blind,parallel group randomized controlled trial

ObjectiveTo evaluate the effect of moderate intensity aerobic exercise (40%–60% of Heart Rate Reserve (HRR)) on diabetic peripheral neuropathy.MethodsA parallel-group, randomized controlled trial was carried out in a tertiary health care setting, India. The study comprised of experimental (moderate intensity aerobic exercise and standard care) and control groups (standard care). Population with type 2 diabetes with clinical neuropathy, defined as a minimum score of seven on the Michigan Diabetic Neuropathy Score (MDNS), was randomly assigned to experimental and control groups by computer generated random number tables. RANOVA was used for data analysis (p < 0.05 was significant).ResultsA total of 87 patients with DPN were evaluated in the study. After randomization there were 47 patients in the control group and 40 patients in the experimental group. A comparison of two groups using RANOVA for anthropometric measures showed an insignificant change at eight weeks. For distal peroneal nerve’s conduction velocity there was a significant difference in two groups at eight weeks (p < 0.05), Degrees of freedom (Df) = 1, 62, F = 5.14, and p = 0.03. Sural sensory nerve at eight weeks showed a significant difference in two groups for conduction velocity, Df = 1, 60, F = 10.16, and p = 0.00. Significant differences in mean scores of MDNS were also observed in the two groups at eight weeks (p value significant < 0.05).ConclusionModerate intensity aerobic exercises can play a valuable role to disrupt the normal progression of DPN in type 2 diabetes.     

Metabolic syndrome enhances endoplasmic reticulum,oxidative stress and leukocyte–endothelium interactions in PCOS

ObjectivePolycystic ovary syndrome (PCOS) is associated with insulin resistance, which can lead to metabolic syndrome (MetS). Oxidative stress and leukocyte–endothelium interactions are related to PCOS. Our aim was to evaluate whether the presence of MetS in PCOS patients can influence endoplasmic reticulum (ER) and oxidative stress and leukocyte–endothelium interactions.Material and MethodsThis was a prospective controlled study conducted in an academic medical center. The study population consisted of 148 PCOS women (116 without/32 with MetS) and 112 control subjects (87 without / 25 with MetS). Metabolic parameters, reactive oxygen species (ROS) production, ER stress markers (GRP78, sXBP1, ATF6), leukocyte–endothelium interactions, adhesion molecules (VCAM-1, ICAM-1, E-Selectin), TNF-α and IL-6 were determined.ResultsTotal ROS, inflammatory parameters and adhesion molecules were enhanced in the presence of MetS (p < 0.05), and the PCOS + MetS group showed higher levels of IL-6 and ICAM-1 than controls (p < 0.05). Increased adhesion and leukocyte rolling flux were observed in PCOS and PCOS + MetS groups vs their respective controls (p < 0.05). GRP78 protein expression was higher in the PCOS groups (p < 0.05 vs controls) and sXBP1 was associated with the presence of MetS (p < 0.05 vs controls without MetS). Furthermore, PCOS + MetS patients exhibited higher GRP78 and ATF6 levels than controls and PCOS patients without MetS (p < 0.05). In PCOS women, HOMA-IR was positively correlated with ICAM-1 (r = 0.501; p < 0.01), ROS (r = 0.604; p < 0.01), rolling flux (r = 0.455;p < 0.05) and GRP78 (r = 0.574; p < 0.001).ConclusionOur findings support the hypothesis of an association between altered metabolic status, increased ROS production, ER stress and leukocyte–endothelium interactions in PCOS, all of which are related to vascular complications.     

The role of vitamin D,obesity and physical exercise in regulation of glycemia in Type 2 Diabetes Mellitus patients

AimThe aims of this study were to determine the role of vitamin D, obesity and physical exercise in the regulation of glycemia in Type 2 Diabetes Mellitus patients in a highly consanguineous population.DesignCase and control study.SettingThe survey was carried out at the Hamad General Hospital and Primary Health Care (PHC) centers in the State of Qatar.SubjectsThe study was conducted from November 2012 to June 2014 among subjects above 30 years of age. Of the 2224 registered with diagnosed diabetes and free diseases attending Hamad General Hospital and PHC centers agreed and gave their consent to study.MethodsQuestionnaire included socio-demographic variables, body mass index (BMI), consanguinity, lifestyle habits, family history of diabetes, blood pressure and development of diabetes complications such as retinopathy, nephropathy, and neuropathy were collected at regular intervals throughout the follow-up. Univariate and multivariate statistical analysis were performed.ResultsThere were statistically significant difference between patients with diabetic and control in terms of ethnicity (p = 0.012), level of education (p = 0.002), occupation (p < 0.001), monthly income (p < 0.001), BMI(p = 0.024), sport activity (p = 0.018), cigarette smoking (p < 0.001), consanguinity (p = 0.029) and family history of Diabetes Mellitus (p < 0.001) and co-morbidity hypertension (p = 0.041). Further, the biochemistry values in the studied subjects with T2DM compared to healthy controls and the study revealed that serum Vitamin D, BMI, fasting glucose level, calcium, HbA1c, total cholesterol HDL, LDL, bilirubin, triglycerides, uric acid and blood pressure systolic and diastolic were higher in T2DM compared to their counterparts. Multivariate logistic regression showed that vitamin D deficiency ng/mL, Family History of T2DM, BMI (kg/m²) hypertension, consanguinity, income, mother occupation, ethnicity, educational level and Lack of physical exercise variables were significant predictors of diabetes. In the group of Diabetes Mellitus Type 2 patients, 39.3% as opposed to 51.2% in the control group had vitamin D deficiency, 25(OH) D3 levels ≤ 10 ng/ml (p < 0.001). In the group of Diabetes Mellitus Type 2 patients, 34.6% as opposed to 37.9% in the control group had vitamin D insufficiency, 25(OH)D3 levels <20 ng/ml (p < 0.001). In the group of Diabetes Mellitus Type 2 patients, 22.8% as opposed to 14.2% in the control group had vitamin D sufficiency, 25(OH)D3 levels >30 10 ng/ml (p < 0.001).ConclusionVitamin D, family history of diabetes, consanguinity marriages’ and hereditary gene-environment interactions and physical exercise may also contribute to the current diabetes epidemic in Qatari’s Arab populations.     

Disease severity in familial cases of IBD

BackgroundPhenotypic traits of familial IBD relative to sporadic cases are controversial, probably related to limited statistical power of published evidence.AimTo know if there are phenotype differences between familial and sporadic IBD, evaluating the prospective Spanish registry (ENEIDA) with 11,983 cases.Methods5783 patients (48.3%) had ulcerative colitis (UC) and 6200 (51.7%) Crohn's disease (CD). Cases with one or more 1st, 2nd or 3rd degree relatives affected by UC/CD were defined as familial case.ResultsIn UC and CD, familial cases compared with sporadic cases had an earlier disease onset (UC: 33 years [IQR 25–44] vs 37 years [IQR 27–49]; p < 0.0001); (CD: 27 years [IQR 21–35] vs 29 years [IQR 22–40]; p < 0.0001), higher prevalence of extraintestinal immune-related manifestations (EIMs) (UC: 17.2% vs 14%; p = 0.04); (CD: 30.1% vs 23.6%; p < 0.0001). Familial CD had higher percentage of ileocolic location (42.7% vs 51.8%; p = 0.0001), penetrating behavior (21% vs 17.6%; p = 0.01) and perianal disease (32% vs 27.1%; p = 0.003). Differences are not influenced by degree of consanguinity.ConclusionWhen a sufficiently powered cohort is evaluated, familial aggregation in IBD is associated to an earlier disease onset, more EIMs and more severe phenotype in CD. This feature should be taken into account at establishing predictors of disease course.     

Association of adiponectin with peripheral muscle status in elderly patients with heart failure

BackgroundReduced peripheral muscle mass was demonstrated in patients with chronic heart failure (HF). Adipokines may have potent metabolic effects on skeletal muscle. The associations between adipokines, peripheral muscle mass, and muscle function have been poorly investigated in patients with HF.MethodsWe measured markers of fat and bone metabolism (adiponectin, leptin, 25-hydroxy vitamin D, parathyroid hormone, osteoprotegerin, RANKL), N-terminal pro B-type natriuretic peptide (NT-pro-BNP) in 73 non-cachectic, non-diabetic, male patients with chronic HF (age: 68 ± 7 years, New York Heart Association class II/III: 76/26%, left ventricular ejection fraction 29 ± 8%) and 20 healthy controls of similar age. Lean mass as a measure of skeletal muscle mass was measured by dual energy X-ray absorptiometry (DEXA), while muscle strength was assessed by hand grip strength measured by Jamar dynamometer.ResultsSerum levels of adiponectin, parathyroid hormone, osteoprotegerin, RANKL, and NT-pro-BNP were elevated in patients with chronic HF compared to healthy controls (all p < 0.0001), while no difference in serum levels of leptin, testosterone or SHBG was noted. Levels of 25-hydroxy vitamin D were reduced (p = 0.002) in HF group. Peripheral lean mass and hand grip strength were reduced in patients with HF compared to healthy subjects (p = 0.006 and p < 0.0001, respectively). Using backward selection multivariable regression, serum levels of increased adiponectin remained significantly associated with reduced arm lean mass and muscle strength.ConclusionsOur findings may indicate a cross-sectional metabolic association of increased serum adiponectin with reduced peripheral muscle mass and muscle strength in non-cachectic, non-diabetic, elderly HF patients.