Relation between insulin level and bone mineral density in patients with type 2 diabetes mellitus

The aim of this work is to measure BMD in patients with type 2 diabetes mellitus and to correlate it with insulin level and insulin resistance. This study comprised 50 premenopausal women 40 type 2 diabetic patients [20 on insulin therapy and 20 or oral hypoglycemic drugs], 10, as a control group, which were healthy non diabetic women matched for age. All studied subjects were subjected to history taking, clinical examination, including weight, height, BMI and waist/hip ratio. Laboratory investigations including fasting and post prandial blood glucose levels, HbA1c, kidney functions, liver functions, urine analysis, lipid profile, serum calcium, phosphorus, alkaline phosphatase, and fasting insulin level. Bone mineral density [BMD] was measured using DEXA on left fore-arm using Lunar PIXI densitometer. Subjects with other diseases or using drugs that affect BMD were excluded. We found that there was no statistically significant difference in BMD between patients with type 2 diabetes mellitus and the control group [T-score was -0.3 in the diabetic group and T-score was -0.2 in the control group]. In patients with type 2 diabetes mellitus, there was a significant positive correlation between BMD and both insulin level [p value <0.05] and insulin resistance [p value <0.05]. There was no difference in BMD between type 2 diabetic patients and control group. There was a significant positive correlation between BMD with both insulin level and insulin resistance [HOMA] in patients with type 2 DM

Cystatine C biochemical marker for renal dysfunction in coronary artery bypass randomized double blinded comparison between the effects of sevoflurane and isoflurane

Volatile anesthetics exert significant protection against myocardial ischemia and excitotoxic cardiomyocyte death. One of the mechanisms by which volatile anesthetics induce protection in myocytes is pharmacological preconditioning, the activation of a potent endogenous protective mechanism in cardiac tissue against a variety of important stressors. Laboratory investigations further stress the concept that volatile anesthetics may protect endothelial and smooth muscle cells, implying that anesthetic protection might beneficially affect a much wider variety of tissues including the brain, spinal cord, liver, and kidneys. After written informed consents were obtained from all patients, 40 patients scheduled for elective CABG, they were divided into 2 groups, 20 patients each group, group I [isoflurane group], group II [sevoflurane group]. All patients received midazolam for premedication. Anesthesia was induced in all patients with propofol, fentanyl and the muscle relaxant vecuronium. Blood samples were obtained preoperatively, at arrival in the intensive care unit, and 24, 48, and 72h after surgery; they were stored at -20°C until analysis. Creatinine level and Cystatine C [CysC] assays were used as markers for renal dysfunction. Sevoflurane-treated patients required significantly more phenylephrine than did isoflurane-treated patients to maintain blood pressure above 50mmHg. However, there was no difference in mean arterial blood pressure between both groups. CysC concentrations significantly increased immediately postoperatively and peaked at 48 h after surgery for both groups [time effect, p<0.001]. Cystatine C concentrations were markedly higher for isoflurane-treated patients than for sevoflurane-treated patients. Plasma creatinine concentrations were slightly, but not significantly, increased in isoflurane-treated patients. The study concluded that, sevoflurane could be administered safely during CABG without affecting renal function. Because this study only evaluated immediate perioperativc effects of sevoflurane, we can only speculate on potential beneficial long-term effects of this treatment. Future studies should address this important issue

Lipid profiles in early untreated rheumatoid arthritis: relation to disease activity

Rheumatoid arthritis [RA] is a chronic, systemic inflammatory disorder of unknown etiology that primarily targets the synovium. Cardiovascular morbidity and mortality appear to be increased in rheumatoid arthritis which might be due to increased prevalence of risk factors for disease such as an accelerated progression of atherosclerosis. Patients with active rheumatoid arthritis show an atherogenic lipid profile, which has been linked with the inflammatory reaction. The effect of treatment of RA on the adverse lipid profile is the subject of intensive research. We investigated lipid profile in newly diagnosed untreated RA patients, compared it with matched control and determined the relation of these lipid profiles to disease activity. Fifty three patients with early RA who met the American College of Rheumatology criteria were included in this study. They had disease duration of less than one year and had not had prior treatment for it. Thirty healthy volunteers [controls] were also included. Serum lipid profile including total cholesterol [TC], low density lipoprotein cholesterol [LDL-C], high density lipoprotein cholesterol [HDL-C], triglyceride [TG], apolipoprotein A-l [apo-A], apolipoprotein B [apo-B] and lipoprotein [a] were measured in the controls and in patients with RA at baseline and 6 months after treatment. Patients with RA exhibited higher serum levels of TC, LDL-C, and TG compared to controls whereas their serum HDL-C and apo-A levels were significantly lower compared to controls. As a consequence, the atherogenic ratio of TC/HDL-C as well as that of LDL-C/HDL-C was significantly higher in RA patients compared to controls. From the included 53 patients with RA, 39 patients [73.6%] met the improvement criteria in RA after 6 months of treatment with DMARDs. Those responders showed a significant reduction of atherogenic ratio of TC/HDL-C as well as that of LDL-C/HDL-C [p value 0.008 and 0.02 respectively], a finding that was primarily due to the increase of serum HDL-C levels [p. value 0.0004]. Patients with early untreated RA are characterized by an atherogenic lipid profile, which improves after therapy. Thus, early immunointervention to control disease activity may reduce the risk of atherosclerotic process and cardiovascular events in RA patients

Comparative study between the perioperative and catabolic effects of epidural levobupivacaine and ropivacaine

Increased whole body protein breakdown and amino acid oxidation resulting in nitrogen loss, are typical features of altered protein homeostasis after surgery. Because protein represents both structural and functional components extensive loss of lean and tissue mass may cause delayed wound healing, compromised immune function and muscle weakness leading to prolonged convalescence and morbidity, neuro-axial blockade with epidural local anesthetics has been demonstrated to attenuate catabolic response to major abdominal surgery. The aim of this study is to compare the ant catabolic affect of levobupivacaine, ropivacaine and general anesthesia by the perioperative kinetics of blood ureaglucose, and hormones as glucagons, insulin, cortisol, and metabolites as lactate. Thirty patients with bladder cancer, scheduled for elective cyst prostatectomy followed by elective reconstruction of the bladder with small bowel after informed consent, patients were divided into 3 groups, each 10 patients, the first group was received general anesthesia, group II epidurally levobupivacaine was used, group III ropivacaine was used epidurals. Levobopivacaine was 0-5%, while ropivacaine was used, postoperative infusion epidurally was prepared as 5ml/hour and with 2ml increment a lockout time of 20 minutes, and levobupivacaine group was received 0.125% solution concentration, while ropivacaine was received at a higher concentration 0.2%. Blood samples were taken one before induction of general anesthesia or injection of local anesthetic, the second intraoperatively and 3 blood samples at the 3days postoperatively. All sample [5ml each were immediately centrifuged at 4 C and the plasma stored at -70Co until analysis. Ureaglucose, lactate, hormones [insulin, glucagons, cortisol] were determined, plasma concentrations of glucose, lactate were determined enzymatically. Insulin, glucagons and cortisol were quantified with radioimmunoassay. There was significant increase in blood sugar in group I in the first and second day postoperatively it was 150 +/- 20, 150 +/- 30respectively, there was significant in crease in insulin concentration in group II, III in the second day postoperatively it was 57 +/- 20, 80 +/- 15 respectively, and in the third day postoperatively, it was 90 +/- 25, 95 +/- 20respectively. There was significant decrease in insulin level in group I during surgery and in the first, second day postoperatively. It was 29 +/- 18, 30 +/- 30, 30 +/- 20 respectively. There was significant increase in glucagons level in group I in the third day postoperatively; it was 10 +/- 3. Blood urea level was significantly lower in group II and III in third day postoperatively. Blood cortisol was significantly increased in the 1st and second day postoperatively in group I. The study concluded that postoperative epidural levobupivacaine or ropivacaine have nearly equally attenuate the catabolic response after major abdominal surgery, by preventing postoperative protein breakdown with out affecting glucose metabolism

S [+] Ketamine suppresses TNF-alpha, IL-6 and IL-8 production in blood in major abominal surgery under combined epidural general anestesia

Cytokines are essential for hematopoiesis and immune responses, and they play a key role in the defense against infection. It has been demonstrated that proinflammatory cytokines such as [TNF-alpha], interleukin [IL] 6 and IL-8 increase in patients with trauma, surgical trauma, sepsis burns. 40 patients scheduled for major abdominal surgery under combined epidural general anaesthesia in Kasr, EI-Aini Hospital were included in this study. Patients age was ranged between 18-50 years, patients were ASA I and II. The patients were divided into 2 groups each group 20 patients, group I was received S [+] Ketamine as a single preincision dose, while in II S [+] Ketamine was received preincision and as a repeated doses, S [+] ketamine was injected as a single IV dose 0.5 mg/kg before incision in both groups, and repeated 0.2 mg/kg doses at 20 minutes interval until 30 minutes before the end of the operation [In group II, 20 patients only]. This study reported that S [+] ketamine suppressed TNF-alpha production IL-6, IL-8. The study also reported that a single S [+] ketamine preincision dose decreased IL-6 to 550 +/- 20 at 30 minutes before end of operation while the repeated 20 minutes doses decreased IL-6 to 440 +/- 20 minutes. IL-8 when single dose of S [+] ketamine was given decreased to 850 +/- 50 at 30 minutes before end of the operation, while after repeated S [+] ketamine it was 600'40 at 30 minutes before operation, about TNF-a. It decreased to reach 1110 +/- 180 in a single dose ofS [+] ketamine while it decreased to 1000 +/- 120 in repeated dose of S [+] ketamine. The total dose of S [+] ketamine was 35+30 in single dose group, while it was 80 +/- 40 in repeated dose group, the dose ofropivacaine given epidurally was 148 +/- 20 in single group while it was 130 +/- 15 in repeated group. This mean the anesthetics required in repeated doses of S [+] group was lower, indicated that S [+] ketamine decreased the anesthetics requirement. The conclusion of the study was S [+] ketamine directly suppresses proinflammatory cytokines production when given in repeated doses, it also decreased the ropivacaine dose needed more in repeated doses of S [+] ketamine. A larger study is also needed to assess whether the favorable postoperative effect of S [+] ketamine make differ

Assessment of serum adiponectin and leptin levels in lean and overweight type 2 diabetes mellitus and their relation to insulin level

The purpose of this study was to assess the serum adiponectin and leptin levels in type 2 diabetic and to clarify the degree of association of adiponectin with insulin levels and diabetes mellitus independent of its association to obesity. A total of 169 type 2 diabetics [103 females and 66 males, mean age 51 +/- 10 years] and 85 healthy adults matching the same age with the patient group [43 females and 42 males, mean age 48 +/- 6.7 years] were enrolled in the study. The studied subjects were classified according to their BMI into; lean [BMI < 25 kg/m[2]] and overweight-obese group [BMI > 25 Kg/m[2]]. Accordingly, there were 4 groups group 1; lean diabetic [67 subjects], group 2; overweight-obese diabetic [102 subject], group 3; lean non-diabetic [36 subjects], group 4; overweight-obese non-diabetic [49 subjects]. Fasting insulin was assayed using RIA technique of DPC Diagnostics. Fasting serum leptin was measured by RIA using Kits purchased from Linco Research. Adiponectin was assayed using Elisa kit purchased from Quantikine [Catalog Number DRP300]. Adiponectin concentrations were lower in the overweight-obese non diabetic group compared to the lean non diabetic group [p value < 0.05], and the diabetic group compared to the non-diabetic group [p value < 0.001]. The same pattern was observed when we compared obese diabetics to obese non-diabetic groups [p value < 0.05], and lean diabetic and lean non-diabetic groups [p value < 0.001]. There was no significant difference of adiponectin levels between overweight-obese and lean diabetic groups [p value > 0.05]. Adiponectin was found to be positively correlated to FBS, PPS, and HDL and negatively correlated to BMI, total cholesterol, triglycerides, LDL, fasting insulin and leptin concentrations. Serum leptin concentrations are higher in both obese diabetic and non-diabetic groups compared to lean diabetic and non-diabetic groups [p value < 0.05, and < 0.05 respectively]. Leptin was positively correlated to BMI [p value < 0.001] and fasting insulin concentrations [p value < 0.001], and negatively correlated to adiponectin concentrations [p value < 0.01]. Serum adiponectin level is low in obese subjects and is consistently lower in diabetic patients in comparison to non diabetic subjects independent to BMI. The data suggest that serum adiponectin level is more related to insulin level than to the body weight

Effect of inhaled stroids in patients with stable chronic obstructive pulmonary disease [COPD] and eosinophilic bronchitis

Chronic obstructive pulmonary disease [COPD] constitutes an enormous, and growing health problem, the treatment of which has been less than satisfactory till now. Because of the chronic inflammation in the walls of large and peripheral airways as well as in the parenchyma, and as steroids are known for their anti-inflammatory effects, the latter had been investigated in more than 100 studies, however, the results are controversial. Recently, a group of COPD patients with high sputum eosinophilic count showed improvements clinically, functionally and in health status, following high dose of inhaled steroids. Thus the aim of the current study was to determine whether sputum eosinophilia [sputum eosinophils >3%]; in stable COPD patients can predict clinical benefits from treatment by high dose of inhaled steroids. Out of the 80 COPD patients who fulfilled the inclusion criteria and agreed to participate on this study, only 14 cases [Group I] showed evidence of high eosinophilic count in induced sputum, they received no oral steroids 2 months preceding the study and they had had no exacerbation one month before the study. They were given high dose of inhaled steroids [fluticasone propionate 500 microgram twice per day by Diskus] for one month. Another 14 patients [without sputum eosinophila] were also included in this study as Group II. They received inhaled steroids at a dose similar to those of group I. Patients of Group I showed decrease in sputum eosinophilia, accompanied by marked clinical improvement however, there was no detectable statistical difference in functional improvement. Those patients of Group II showed no improvement neither clinically nor functionally denoting lack of beneficial effect of inhaled steroids in COPD patients with no sputum eosinophilia.

role of eosinophilic count in induced sputum in the determination of asthma severity, control and in the adjustment of drugs dosage

Asthma is a chronic inflammatory disease of the airways, and long-term therapy for it is therefore directed towards the suppression of airway inflammation. Assessment of asthma severity and the effectiveness of therapy should be guided by the degree of airway inflammation. This is currently guided by indirect markers, such as lung function and existing asthma symptoms. Unfortunately, their uncertain relationship with the degree of airway inflammation and their temporarily improvement under bronchodilator therapy without controlling airway inflammation are considered major drawbacks. Moreover, the use of bronchoscopy for sampling of the lower airway tissue is inappropriate for clinical practice, and thus this is only reserved for research purposes. Recently, interest has been directed towards developing relatively less invasive markers for monitoring the airway inflammation more directly. These markers had proved their ability to reflect airway inflammation, moreover, their change are in agreement with the findings in airway biopsies. They are useful in monitoring treatment effectiveness and are sensitive enough to reflect worsening of airway inflammation. Among various newer methods being developed for monitoring airway inflammation, sputum induction seem to be very promising, being reproducible and less invasive, and thus could be applied for sequential measurements. Thus this study aimed at revealing the role of induced sputum [by means of the determination of sputum eosinophilic percentage] in determining asthma severity, guiding the physicians in controlling asthma, and in the adjustment of drugs dosage. This study included 27 asthmatic patients who approved to participate in this study and who fulfilled the inclusion criteria. This study showed the presence of correlation between sputum eosinophilia and asthma severity, moreover it revealed the ability of sputum eosinophilia to reveal asthma control and to help in drug adjustment

Comparison of pharmacokinetics and pharmacodynamics of rocuronium infusion in adults and children

This study compared the pharmacokinetics and pharmacokinetic-dynamic relationship of rocuronium in children and adults, we studied 10 children [4-8 years] and 10 adults [20-40 years] ASA I and II underwent surgical operation in Kasr-El-Aini hospital. After induction with thiopentone [2-6 mg/kg], fentanyl 5-10 Hg/kg, infusion of rocuronium 0.09 mg/kg/min. in children group and 0.1 mg/kg/min. in the adults group. The infusion was given over +/- 5 minutes. The patients were monitored with the EMG of the adductor pollicis muscle. When neuromuscular block reached 85% endotracheal intubation, and then mechanical ventilation was started Maintenance of anesthesia with isoflurane 0.5- 1%, O[2]/NO[2] 50% in both groups. Arterial sample were obtained over 240 min./ Plasma concentrations were measured by HpLc. pharmacokinetic-dynamic variables were calculated using sheiner model, and the Hill equation. Statistical analysis was performed using the Mann-Whitney U test [p < 0.05]. The mean administered dose of rocuronium infusion was 0.65 +/- 0.09 mg/kg/hour in adults group and 0.35 +/- 0.1 mg/kg/hour in children group. Children differed from adults in plasma clearance 5.2 +/- 0.043 versus 7.65 +/- 1.05 ml/min./kg in adults group, distribution volume at steady state 220 +/- 20 ml/kg in children group and 168+50 ml/kg in adults group, mean residence time 50.5 +/- 9.0 [min.] in children group and 26 +/- 9.0 [min.] in adults group, concentration in effect compartment at 50% block 1.19 +/- 0.4 mg/liter in children group and 1.3 +/- 0.3 mg/liter in adults group, calculated mean ED[90] values were 0.345 +/- 0.077 in adults group, 0.25 +/- 0.067 in children group. The time course of neuromuscular block did not differ. The study concluded that infusion of rocuronium has different pharmacokinetic-dynamic in both adults and children, but it can be safely used in children especially when the infused dose adjusted by using the EMG