Insulin resistance as a predictor of restenosis in patients with type II diabetes mellitus undergoing coronary angioplasty and stent implantation

Hyperinsulinaemia is an independent risk factor for ischemic heart disease and induces greater vascular smooth muscle cell proliferation in experimental models. Restenosis after coronary stenting is neointimal tissue proliferation. The rationale of this study is to asses the predictive value of insulin resistance for in-stent restenosis in patients with type II diabetes mellitus. The study population included forty patients [20 diabetic and 20 non diabetic] undergoing percutaneous coronary intervention PCI with stenting and all patients were followed up for 6 months and Homeostasis model assessment insulin resistance [HOMA-IR] were done for assessment of insulin resistance. All clinical, angiographic, procedural, Doppler echocardiographic and laboratory variables were analyzed for all patients in multivariate analysis. Angiographic in-stent restenosis occurred in 14/20 [70%] diabetic patients with no significant difference compared to 13/20 [65%] non-diabetic patients. Multivariate regression analysis showed that HOMA-IR were an independent predictor for restenosis after coronary stenting [HOMA IR p=0.001 for non-diabetic and p=0.025 for diabetics]. HOMA-IR and fasting insulin can be used as a predictor for in stent restenosis in both diabetic and non-diabetic patients

Evaluation of the role of lipase activity on cholecystokinin release, gastric emptying and pancreatic secretion

These studies shown that lipase plays an important nutrient specific regulatory role on upper gastrointestinal functions which is dependent on the hydrolysis of fat into free fatty acids, thus stimulating the release of CCK. The studies showed also the high potency and specificity of THL as a lipase blocker. Since pancreatic lipase is the first enzyme to show a decrease in activity in patients with pancreatic insufficiency, the results of our study are important for evaluating some pathophysiological aspects of this disease. In the current study can be used in the pharmacotherapy of diseases related to dietary fat intake such as obesity, hypercholesterolemia, and their sequelae

Rehabilitation in coronary artery disease: assessment and outcome

This study included 69 male patients with corollary artery disease [CAD] of whom 47 were in stable angina pectoris and 22 had myocardial infarction. Thirty matched normal subjects were considered as controls. All the patients were subjected to complete clinical examination and maximal exercise performance was determined using maximum symptom limited progressive exercise test according to Burce et al., [6]. The parameters of VO2 max., HR max., treadmill duration, systolic B.P max., double product of maximal HR and functional aerobic impairment were assessed. The patients were trained on treadmill 3 times per week for 3 months at 70% of predetermined maximal heart rate. The patients were encouraged to do their daily activities and aerobic maintenance activities during the follow up period. The results of this study lead to the conclusion that the 3 months' physical training program prescribed on the basis of symptom limited graded exercise test and maintenance activities led to significant maintained improvement of maximal exercise performance inpatients with CAD. So the use of physical training call be considered as a valuable component in management of these patients