Gallic acid and p-coumaric acid attenuate type 2 diabetes-induced neurodegeneration in rats

The brain of diabetics revealed deterioration in many regions, especially the hippocampus. Hence, the present study aimed to evaluate the effects of gallic acid and p-coumaric acid against the hippocampal neurodegeneration in type 2 diabetic rats. Adult male albino rats were randomly allocated into four groups: Group 1 served as control ones and others were induced with diabetes. Group 2 considered as diabetic, and groups 3 and 4 were further orally treated with gallic acid (20 mg/kg b.wt./day) and p-coumaric acid (40 mg/kg b.wt./day) for six weeks. Diabetic rats revealed significant elevation in the levels of serum glucose, blood glycosylated hemoglobin and serum tumor necrosis factor-α, while the level of serum insulin was significantly declined. Furthermore, the brain of diabetic rats showed a marked increase in oxidative stress and a decrease of antioxidant parameters as well as upregulation the protein expression of Bax and downregulation the protein expression of Bcl-2 in the hippocampus. Treatment of diabetic rats with gallic acid and p-coumaric acid significantly ameliorated glucose tolerance, diminished the brain oxidative stress and improved antioxidant status, declined inflammation and inhibited apoptosis in the hippocampus. The overall results suggested that gallic acid and p-coumaric acid may inhibit hippocampal neurodegeneration via their potent antioxidant, anti-inflammatory and anti-apoptotic properties. Therefore, both compounds can be recommended as hopeful adjuvant agents against brain neurodegeneration in diabetics.

     

A successful chronic care program in Al Ain-United Arab Emirates

Background

The cost effective provision of quality care for chronic diseases is a major challenge for health care systems. We describe a project to improve the care of patients with the highly prevalent disorders of diabetes and hypertension, conducted in one of the major cities of the United Arab Emirates.

Settings and Methods

The project, using the principles of quality assurance cycles, was conducted in 4 stages. The assessment stage consisted of a community survey and an audit of the health care system, with particular emphasis on chronic disease care. The information gleaned from this stage provided feedback to the staff of participating health centers. In the second stage, deficiencies in health care were identified and interventions were developed for improvements, including topics for continuing professional development. In the third stage, these strategies were piloted in a single health centre for one year and the outcomes evaluated. In the still ongoing fourth stage, the project was rolled out to all the health centers in the area, with continuing evaluation. The intervention consisted of changes to establish a structured care model based on the predicted needs of this group of patients utilizing dedicated chronic disease clinics inside the existing primary health care system. These clinics incorporated decision-making tools, including evidence-based guidelines, patient education and ongoing professional education.

Results

The intervention was successfully implemented in all the health centers. The health care quality indicators that showed the greatest improvement were the documentation of patient history (e.g. smoking status and physical activity); improvement in recording physical signs (e.g. body mass index (BMI)); and an improvement in the requesting of appropriate investigations, such as HbA1c and microalbuminurea. There was also improvement in those parameters reflecting outcomes of care, which included HbA1c, blood pressure and lipid profiles. Indicators related to lifestyle changes, such as smoking cessation and BMI, failed to improve.

Conclusion

Chronic disease care is a joint commitment by health care providers and patients. This combined approach proved successful in most areas of the project, but the area of patient self management requires further improvement.     

Liraglutide acutely suppresses glucagon,lipolysis and ketogenesis in type 1 diabetes

In view of the occurrence of diabetic ketoacidosis associated with the use of sodium‐glucose transport protein‐2 inhibitors in patients with type 1 diabetes (T1DM) and the relative absence of this complication in patients treated with liraglutide in spite of reductions in insulin doses, we investigated the effect of liraglutide on ketogenesis. Twenty‐six patients with inadequately controlled T1DM were randomly divided into 2 groups of 13 patients each. After an overnight fast, patients were injected, subcutaneously, with either liraglutide 1.8 mg or with placebo. They were maintained on their basal insulin infusion and were followed up in our clinical research unit for 5 hours. The patients injected with placebo maintained their glucose and glucagon concentrations without an increase, but there was a significant increase in free fatty acids (FFA), acetoacetate and β‐hydoxybutyrate concentrations. In contrast, liraglutide significantly reduced the increase in FFA, and totally prevented the increase in acetoacetate and β‐hydroxybutyrate concentrations while suppressing glucagon and ghrelin concentrations. Thus, a single dose of liraglutide is acutely inhibitory to ketogenesis.     

Exenatide induces an increase in vasodilatory and a decrease in vasoconstrictive mediators

In view of the known vasodilatory effects of glucagon‐like peptide‐1 and exenatide, we investigated the effects of exenatide on vasoactive factors. We analysed blood samples and mononuclear cells (MNCs) from a previous study, collected after a single dose and 12 weeks of exenatide or placebo treatment in a series of 24 patients with type 2 diabetes mellitus. After exenatide treatment, plasma concentrations of atrial natriuretic peptide, cyclic guanyl monophosphate (cGMP) and cyclic adenyl monophosphate increased significantly at 12 weeks. Plasma cGMP and adenylate cyclase expression in MNCs increased significantly after a single dose. Angiotensinogen concentration fell significantly 2 hours after a single dose and at 12 weeks, while renin and angiotensin II levels fell significantly only after a single dose and not after 12 weeks of treatment. Exenatide also suppressed the plasma concentration of transforming growth factor‐β and the expression of P311 in MNCs at 12 weeks. Thus, exenatide induces an increase in a series of vasodilators, while suppressing the renin‐angiotensin system. These changes may contribute to the overall vasodilatory effect of exenatide.     

The impact of a planned health educational program on the compliance and knowledge of Jordanian pregnant women with anemia

Iron deficiency anemia is a major public health problem among pregnant women in developing countries. This study aimed to use a randomized controlled trial to evaluate the effectiveness of a health information package in Jordanian anemic pregnant women’s knowledge regarding anemia, compliance with iron supplementation, and hemoglobin level. Two hundred pregnant anemic women were recruited and randomly assigned into intervention or control group from April to July 2016. The intervention group received a video presentation of the Health Information Package Program (HIPP), narrated by a midwife, combined with PowerPoint slides to educate women about anemia in pregnancy. The participants in the control group received standard care in antenatal clinics, including iron supplementation. No significant differences were observed between the groups in age, gestational age, health problems, and total income. Only education and source of information differed significantly between the groups. Women in the intervention group had higher scores on the compliance checklist, knowledge, food selection ability, and hemoglobin level than women in the control group. The health information package program was effective. Policymakers should adopt a health information package program and apply it as a comprehensive national strategy for the prevention of anemia during pregnancy.     

Entamoeba histolytica pleuropulmonary infection. Case report and review of the literature

Pleuropulmonary amebiasis is the 2nd most common extraintestinal site of amebiasis after liver abscess. We describe a man with pleuropulmonary amebiasis presenting with pulmonary consolidation and pleural effusion. In patients with pneumonia coming from endemic countries such as Lebanon, pleuropulmonary amebiasis should be considered in the setting of chocolate-colored sputum, negative respiratory cultures, and failure of antibacterial therapy.     

Language skills and intelligence quotient of protein energy malnutrition survivors

The study was conducted on 33 children aged 3-6 years who suffered from protein energy malnutrition (PEM) during infancy in comparison to 30 matching children to assess the long-term deficits in cognition and language skills. The patients' files were revised to record their admission and follow-up data and history, clinical examination, intelligence quotient and language assessment were done. The study revealed that 2-5 years from the acute attack the PEM patients were still shorter than the controls and their cognitive abilities were poorer. Their mental ages and language skills were mostly determined by their height and the duration of follow-up during their acute illness. Additionally their diet after the 3-5 years is still defective and does not meet their recommended daily allowance. These observations urge us to continue following these patients for longer durations to make sure no permanent damage occurs due to the PEM insult to the growing brain.