Mechanisms of Preconditioning Exercise-Induced Neurovascular Protection in Stroke / 대한뇌졸중학회지

Ischemic stroke is a leading cause of death and disability. Tissue plasminogen activator is the only U.S. Food and Drug Administration approved thrombolytic therapy for ischemic stroke patients till date. However, its use is limited due to increased risk of bleeding and narrow therapeutic window. Most of the preclinically tested pharmacological agents failed to be translated to the clinic. This drives the need for alternative therapeutic approaches that not only provide enhanced neuroprotection, but also reduce the risk of stroke. Physical exercise is a sort of preconditioning that provides the body with brief ischemic episodes that can protect the body from subsequent severe ischemic attacks like stroke. Physical exercise is known to improve cardiovascular health. However, its role in providing neuroprotection in stroke is not clear. Clinical observational studies showed a correlation between regular physical exercise and reduced risk and severity of ischemic stroke and better outcomes after stroke. However, the underlying mechanisms through which prestroke exercise can reduce the stroke injury and improve the outcomes are not completely understood. The purpose of this review is to: demonstrate the impact of exercise on stroke outcomes and show the potential role of exercise in stroke prevention and recovery; uncover the underlying mechanisms through which exercise reduces the neurovascular injury and improves stroke outcomes aiming to develop novel therapeutic approaches.

Mechanisms of Preconditioning Exercise-Induced Neurovascular Protection in Stroke / 대한뇌졸중학회지

Ischemic stroke is a leading cause of death and disability. Tissue plasminogen activator is the only U.S. Food and Drug Administration approved thrombolytic therapy for ischemic stroke patients till date. However, its use is limited due to increased risk of bleeding and narrow therapeutic window. Most of the preclinically tested pharmacological agents failed to be translated to the clinic. This drives the need for alternative therapeutic approaches that not only provide enhanced neuroprotection, but also reduce the risk of stroke. Physical exercise is a sort of preconditioning that provides the body with brief ischemic episodes that can protect the body from subsequent severe ischemic attacks like stroke. Physical exercise is known to improve cardiovascular health. However, its role in providing neuroprotection in stroke is not clear. Clinical observational studies showed a correlation between regular physical exercise and reduced risk and severity of ischemic stroke and better outcomes after stroke. However, the underlying mechanisms through which prestroke exercise can reduce the stroke injury and improve the outcomes are not completely understood. The purpose of this review is to: demonstrate the impact of exercise on stroke outcomes and show the potential role of exercise in stroke prevention and recovery; uncover the underlying mechanisms through which exercise reduces the neurovascular injury and improves stroke outcomes aiming to develop novel therapeutic approaches.

Experimental evaluation of Candonocypris novaezelandiae (Crustacea: Ostracoda) in the biocontrol of Schistosomiasis mansoni transmission

<p><b>OBJECTIVE</b>To test Candonocypris novaezelandiae (Baird) (C. novaezelandiae), sub-class Ostracoda, obtained from the Nile, Egypt for its predatory activity on snail, Biomphalaria alexandrina (B. alexandrina), intermediate host of Schistosoma mansoni (S. mansoni) and on the free-living larval stages of this parasite (miracidia and cercariae).</p><p><b>METHODS</b>The predatory activity of C. novaezelandiae was determined on B. alexandrina snail (several densities of eggs, newly hatched and juveniles). This activity was also determined on S. mansoni miracidia and cercariae using different volumes of water and different numbers of larvae. C. novaezelandiae was also tested for its effect on infection of snails and on the cercarial production.</p><p><b>RESULTS</b>C. novaezelandiae was found to feed on the eggs, newly hatched and juvenile snails, but with significant reduction in the consumption in the presence of other diet like the blue green algae (Nostoc muscorum). This ostracod also showed considerable predatory activity on the free-living larval stages of S. mansoni which was affected by certain environmental factors such as volume of water, density of C. novaezelandiae and number of larvae of the parasite.</p><p><b>CONCLUSIONS</b>The presence of this ostracod in the aquatic habitat led to significant reduction of snail population, infection rate of snails with schistosme miracidia as well as of cercarial production from the infected snails. This may suggest that introducing C. novaezelandiae into the habitat at schistosome risky sites could suppress the transmission of the disease.</p>

Diabetes education the Arab world. A call for action

Diabetes education is effective for improving clinical outcomes and quality of life. The barriers to patient education in the Arab World include: Attitude of the administration and policy makers, the negative view of health professionals and patients towards education, lack of curriculum / programs, lack of trained/certified personnel in the field of Therapeutic Patient Education [TPE], economic barriers, misconcepts, environmental and ecological barriers, lack of legislation for food labels, lack of premises for TPE, the absence of a positive role for the patients in their therapeutic choices, unawareness of patients about their rights, lack of time for both the patient and health care providers and high prevalence of illiteracy. Strategic plans should address all these barriers. Content areas that need to be addressed are determined in collaboration with the patient. Any health care professional can provide diabetes education. The lack of trained personnel in the domain of TPE in our region dictates the need to fill this gap by adopting a strategic plan, implemented in successive steps, starting by the formation of a number of Health Care Professionals [HCPs] in short term training. This document is a call for action, inviting all who are concerned with diabetes to establish national diabetes programs in the Arab World, and to start to undertake educational initiatives

Evaluation of serum plasminogen activator inhibitor-1 [PAI-1] in type 2 diabetic patients

This study was performed on 20 nonsmoking, normotensive type 2 female diabetic patients with normal renal and hepatic functions. They were divided into two groups: Group 1 included ten controlled type 2 diabetic patients on oral hypoglycemics with a mean age of 53.9 +/- 5.23 years [range 45-60 years] and mean diabetes duration of 5.7 +/- 2.6 years and group 2 included ten uncontrolled type 2 diabetic patients on oral hypoglycemics with a mean age of 49 +/- 5.01 years [range 40-56 years] and mean diabetes duration of 11.6 +/- 3.7 years. A determination of plasma insulin level using enzyme linked immunosorbent assay [ELISA] and the plasma level of plasminogen activator inhibitor-1 [PAI-1] was done using Biopool Tint Elize test. Ten age and sex matched normal subjects were included in the study as a control group. The results of this study indicated that among type 2 diabetic patients, PAI-1 was elevated among uncontrolled diabetic patients. It proved to have an important role in the development of ischemic heart disease as an example of macrovascular diabetic complication, especially if associated with dyslipidemia

Insulin-like growth factor I and bone turnover markers in young male patients with non alcoholic chronic liver disease

Low bone mass has been described in patients with chronic liver disease. Reduced osteoblastic function with diminished bone formation has been suggested as the main factor responsible for osteoporosis in liver cirrhosis. Insulin like growth fact or 1, [IGF-1] has been linked to idiopathic osteoporosis, so this study aimed to evaluate the role of IGF-1 in bone remodeling in non alcoholic liver cirrhosis and to detect the presence of low or high bone turnover in those patients. Subjects and Thirty male patients with chronic non-alcoholic, liver disease and 10 age matched healthy male subjects as a control group, were included in this study. The patients were classified according to Child-Poitgh into 3 groups, A, B and C. Both patients and control were subjected to assessment of their liver function, fasting and postprandial blood glucose, blood urea and serum creatinine, serum levels of parathormone, insulin like growth factor, [IGF-1], osteocalcin and urinary levels of deoxypyridoline [DPD], in addition to abdominal ultra-sonography and upper gastrointestinal endoscopy for patients only. Patients showed significantly lower serum levels of both IGF-1 and osteocalcin, [the marker of bone formation] than controls and significantly higher levels of urinary deoxypyridinoline [DPD] [the marker of bone resorption]. The mean value of IGF I was 33.44 +/- 34.41 ng/dL in patients and 256.69 +/- 96.67 in control [p value=0.01]. The mean value of osteocalcin was 2.70 +/- 1.79 ng/ml in patient whereas it was 6.59 +/- 2.13 ng/ml in control subjects [p value<0.0l]. Urinary DPD was 13.52 +/- 650 NM DPD/mm in patients whereas, it was 6.75 +/- 1.47 in control subjects [p value<0.0l]. Definite osteoprosis has been found in all the examined patients [100%] mostly in the lumbar spines by dual x-ray absorptiometty [DXA] scan. No correlation has been found between IGF-1 level and severity of liver cirrhosis

Elevated plasma level of von wbllebrand factor and the risk of macrovascular disease in type 2 diabetics with microalbuminuria

Microalbuminuria [MA] is indicative of generalized vascular disease and is related to carotid intima-media thickness [IMT] -which is a marker of macrovascular disease[1]. In this study, we investigated the role of high plasma level of von Mile brand factor [vWJ], as a marker of endothelial dysfunction, in predicting macrovascular disease in type 2 diabetic patients with microalbuminuria. The study group consisted of 30 non- smoking, normotensive type 2 diabetic patients with normal renal function. They were all recruited from the medical outpatient clinic at Kasr El Aini hospital, Cairo University. They were divided into two groups: Group [1]: included 17 [10 male and 7 female] patients with MA[mean age of 56 +/- 8.4, mean diabetes duration 11.6 +/- 3.7 years, mean body mass index " BMI" 30.2 +/- 5.4kg/m[2]], Group[2]: included 13 [5 male and 8 female] patients without MA [mean age 55.5 +/- 8.6years, mean diabetes duration 5.7 +/- 2.6years, mean BMI 29.6 +/- 6.7 kg/m[2]]. Urinary albumin excretion was assessed both qualitatively and quantitatively .Plasma level of vWf was expressed in relative percent [%] as compared to pooled normal plasma. Carotid IMT was evaluated using high resolution B-mode Ultrasonography. Ten age, sex and weight matched normal subjects were included in the study as a control group. Plasma level of vWf was significantly elevated in the study group compared to the control one [182.2 +/- 22.4 vs 85.5 +/- 23.7%, P=0.0001]. Carotid IMT was also significantly higher in type 2 diabetic patients compared to the control group [0.724 +/- 0.421 vs 0.40 +/- 0.06 mm, P=0.0001]. Among the study group, plasma level of vWf was higher in group [1] compared to group [2] [198.5 +/- 23.5 vs 106.0 +/- 20.0%, p=0.001] .Also, carotid IMT was higher in group [1] compared to group [2][0.975 +/- 0.338 vs 0.580 +/- 0.103 mm, p=0.001] .In group [1], there was a positive correlation between plasma level of vWf and fasting blood glucose [r=0.47, p=0.01], post prandial blood glucose [r=0.51, p= 0.01], glycated haemoglobin [r=0.49, p=0.01] .total cholesterol [r= 0.42, p=0.04], triglycerides [r=0.41,p=0.04], MA[r=0.52,p=0.001] and carotid IMT [r=0.61, p=0.0001]. Patients with retinopathy [18 patients] had a significantly higher age, duration of the disease, fasting and post prandial blood glucose, microalbuminuria, intima media thickness [0.8 +/- 0.5 vs 0.2 +/- 0.3mm, P=0.01] and von Willebrand factor [199.8 +/- 2 3.7vs 105.8 +/- 20.65, P=0.04], and a significant lower level of high density lipoprotein[37.055 + 8.814 vs 43.91 +/- 8.106 mg/dl, p= .039], compared to the diabetic group with normal fundi [12 patients].Multiple regression analysis showed that the determinants of carotid IMT in the study group were disease duration [p=0.01], triglycerides [p=0.01], MA[P=0.001], plasma level of vWf [P=0.001] and retinopathy [p=0.01]. The results of this study indicate that among type 2 diabetic patients with MA, those with higher plasma levels of vWf have greater risk of macrovascular disease. Analysis of the results also proves that plasma level of vWf is an independent risk factor for macrovascular disease in type 2 diabetic patients. Measurement of plasma level of vWf would be helpful in assessing the risk of macrovascular disease in those patients

Some epidemmiological aspects of patients with end stage renal diseases

This study was carried out to describe the end stage renal disease [ESRD] among Egyptian patients and to identify the possible risk factors of their disease. A case-control study was conducted with two control groups [patient or hospital control group and normal community control group] compared with ESRD cases on hemodialysis. The study revealed that hypertension followed by obstructive uropathy are the leading causes of ESRD. Conducting the multiple logistic regression analysis, the following factors were found to act independently as risk factors for ESRD in the following order of importance: Past history of hypertension, family history of renal failure, past history of renal pain, smoking, urban origin of birth, past history of renal or urinary stones, past history of schistosomiasis, the presence of a near-by residential factory and past history of frequent hospitalization. A quality of life score has been invented

Gonadotrophic hypothalamic hypophyseal dysfunctions in men with liver cirrhosis

This work was carried out on 10 patients with liver cirrhosis and 4 normal controls matched for age and sex. The patients were diagnosed on the bases of clinical examination, liver function tests and abdominal ultrasonography. The results revealed higher basal levels of gonadotrophic hormones in patient group than normal controls. The level of gonadotrophic hormones measured half and one hour after stimulating with LHRH showed no significant difference between patients and controls. These data indicate that the pathophysiology of hypogonadism in men with liver cirrhosis may be a complex one

Study of some fibrinolytic activity and fibronectin in diabetes mellitus

In order to explore the disturbances in the coagulation-fibrinolytic system in diabetics with micro and macro angiopathies plasma fibronectin, Plasminogen, serum fibrin [ogen] degradation products [FDPs] were measured in eight diabetic patients without angiopathies, ten non- insulin dependent diabetics [NIDD] and nine insulin-dependent diabetics [IDD] with angiopathies. The control group comprised ten healthy volunteers. These four groups were closely matched for age, sex and smoking habit. Plasma fibronectin, Plasminogen activity and serum FDPs were not significantly different between normals and different groups of diabetics and between NIDD and IDD with and without angiopathies. In diabetics fasting blood sugar as well as the duration of the disease had no influence on plasma fibronectin, Plasminogen and FDPs levels. It is concluded that the fibrinolytic system, in diabetics in whom a hypercoagulable state is expected, was not adequately compensated by an increase in its activity as demonstrated by the absence of the FDPs and normal Plasminogen level. Also, fibronectin plays no role in diabetic micro - and macro - angiopathies

Provocation of postural hypotension by insulin in diabetic autonomic neuropathy

Twenty insulin dependent adult male diabetics with clinical features of autonomic neuropathy were the subject of this study.Blood pressure and pulse rates were measured in the supine position and on standing. Serial readings were taken before and after IV soluble insulin administration [20 - 30 units]. Blood samples for estimation of glucose sodium and potassium were withdrawn before and 15 minutes after insulin injection. In all patients, the systolic and diastolic BP fell immediately after IV insulin especially on standing which potentiated markedly the fall in BP and proved to be statistically significant.This was alsoassociatedwithastatistically significant increase in heart rate