Research advances in role of angiogenesis in diabetic ulcer and traditional Chinese medicine intervention / 中国中药杂志

Diabetic ulcer(DU) is one of the common complications of diabetes often occurring in the peripheral blood vessels of lower limbs or feet with a certain degree of damage. It has high morbidity and mortality, a long treatment cycle, and high cost. DU is often clinically manifested as skin ulcers or infections in the lower limbs or feet. In severe cases, it can ulcerate to the surface of tendons, bones or joint capsules, and even bone marrow. Without timely and correct treatment, most of the patients will have ulceration and blackening of the extremities. These patients will not be able to preserve the affected limbs through conservative treatment, and amputation must be performed. The etiology and pathogenesis of DU patients with the above condition are complex, which involves blood circulation interruption of DU wound, poor nutrition supply, and failure in discharge of metabolic waste. Relevant studies have also confirmed that promoting DU wound angiogenesis and restoring blood supply can effectively delay the occurrence and development of wound ulcers and provide nutritional support for wound healing, which is of great significance in the treatment of DU. There are many factors related to angiogenesis, including pro-angiogenic factors and anti-angiogenic factors. The dynamic balance between them plays a key role in angiogenesis. Meanwhile, previous studies have also confirmed that traditional Chinese medicine can enhance pro-angiogenic factors and down-regulate anti-angiogenic factors to promote angiogenesis. In addition, many experts and scholars have proposed that traditional Chinese medicine regulation of DU wound angiogenesis in the treatment of DU has broad prospects. Therefore, by consulting a large number of studies available, this paper expounded on the role of angiogenesis in DU wound and summarized the research advance in traditional Chinese medicine intervention in promoting the expression of angiogenic factors [vascular endothelial growth factor(VEGF), fibroblast growth factor(FGF), and angiopoietin(Ang)] which played a major role in promoting wound angiogenesis in the treatment of DU to provide ideas for further research and new methods for clinical treatment of DU.

Gold nanoparticles as a promising treatment for diabetes and its complications: Current and future potentials

Diabetes and its complications represent a major cause of morbidity and mortality in diabetes patients. This review is aimed to find the potential of gold nanoparticles (AuNPs) to act as therapeutic agents for diabetes and its complications. Here, we outline the literature related to the self-therapeutic effects of AuNPs. The first goal of this review is to highlight and summarize some of the existing studies (10 years ago) in terms of several parameters such as the size of AuNPs, dose, administration route, experimental model, experimental analysis, and findings. The second goal is to describe the self-therapeutic effects of AuNPs against the pathogenesis determinants of diabetic complications. AuNPs have been found to have inhibitory effects on transforming growth factor-ß, antiglycation, antiangiogenic, anti-hyperglycemic, anti-inflammatory, and antioxidant effects. AuNPs treatment effectively disrupts multiple pathogenesis determinants in an animal model of diabetes and diabetic complications. The present review provides insight into the potential applications of AuNPs, which may help reduce the incidence of diabetes and its complications

Angiotensin-converting enzyme inhibitors from plants: A review of their diversity, modes of action, prospects, and concerns in the management of diabetes-centric complications / 中西医结合学报

Angiotensin-converting enzyme (ACE) inhibitors are antihypertensive medications often used in the treatment of diabetes-related complications. Synthetic ACE inhibitors are known to cause serious side effects like hypotension, renal insufficiency, and hyperkalaemia. Therefore, there has been an intensifying search for natural ACE inhibitors. Many plants or plant-based extracts are known to possess ACE-inhibitory activity. In this review, articles focusing on the natural ACE inhibitors extracted from plants were retrieved from databases like Google Scholar, PubMed, Scopus, and Web of Science. We have found more than 50 plant species with ACE-inhibitory activity. Among them, Angelica keiskei, Momordica charantia, Muntingia calabura, Prunus domestica, and Peperomia pellucida were the most potent, showing comparatively lower half-maximal inhibitory concentration values. Among the bioactive metabolites, peptides (e.g., Tyr-Glu-Pro, Met-Arg-Trp, and Gln-Phe-Tyr-Ala-Val), phenolics (e.g., cyanidin-3-O-sambubioside and delphinidin-3-O-sambubioside), flavonoids ([-]-epicatechin, astilbin, and eupatorin), terpenoids (ursolic acid and oleanolic acid) and alkaloids (berberine and harmaline) isolated from several plant and fungus species were found to possess significant ACE-inhibitory activity. These were also known to possess promising antioxidant, antidiabetic, antihyperlipidemic and anti-inflammatory activities. Considering the minimal side effects and lower toxicity of herbal compounds, development of antihypertensive drugs from these plant extracts or phytocompounds for the treatment of diabetes-associated complications is an important endeavour. This review, therefore, focuses on the ACE inhibitors extracted from different plant sources, their possible mechanisms of action, present status, and any safety concerns.

Real-world evidence of health outcomes and medication use 24 months after bariatric surgery in the public healthcare system in Brazil: a retrospective, single-center study

OBJECTIVES: The number of bariatric procedures has significantly increased in Brazil, especially in the public Unified Health System. The present study describes health outcomes and medication use in obese patients treated in a major hospital that performs publicly funded surgery in Brazil. METHODS: A retrospective, single center study was conducted to collect real-world evidence of health outcomes and medication use in 247 obese patients (female, 82.2%) who underwent open Roux-en-Y gastric bypass. Changes in weight and body mass index (BMI), presence of apnea, hypertension, and type 2 diabetes (T2D), and medication use (hypertension, diabetes, and dyslipidemia) were assessed preoperatively and up to 24 months postoperatively. The mean cost of medications was calculated for the 12-month preoperative and 24-month postoperative periods. RESULTS: During the surgery, the mean age of patients was 43.42 years (standard deviation [SD], 10.9 years), and mean BMI was 46.7 kg/m2 (SD, 6.7 kg/m2). At 24 months, significant declines were noted in weight (mean, -37.6 kg), BMI (mean, -14.3 kg/m2); presence of T2D, hypertension, and apnea (-29.6%, -50.6%, and -20.9%, respectively); and number of patients using medications (-66.67% for diabetes, -41.86% for hypertension, and -55.26% for dyslipidemia). The mean cost of medications (total costs for all medications) decreased by >50% in 12-24 postoperative months compared to that in 12 preoperative months. CONCLUSION: Roux-en-Y gastric bypass successfully reduced weight, BMI, and comorbidities and medication use and cost at 24 months in Brazilian patients treated in the public Unified Health System.

Diabetes mellitus asociada a pancreatitis autoinmune: caso clínico / Autoimmune pancreatitis associated with diabetes mellitus: report of one case

Autoimmune pancreatitis is uncommon, responds to steroids and is usually associated with diabetes mellitus. We report a 73 year-old male who, two months after a diagnosis of diabetes mellitus, presented with obstructive jaundice and weight loss. Abdominal magnetic resonance imaging was suggestive of an autoimmune pancreatitis and serum IgG4 was 339 mg/dl (normal range 3-201). The patient was treated with prednisone 40 mg/day with a good clinical and laboratory response. During outpatient care, the dose of prednisone was tapered.

The Effects of Trimetazidine on QT-interval Prolongation and Cardiac Hypertrophy in Diabetic Rats / Os Efeitos da Trimetazidina no Prolongamento do Intervalo QT e na Hipertrofia Cardíaca em Ratos Diabéticos

Abstract Background: Trimetazidine (TMZ) is an anti-ischemic drug. In spite of its protective effects on cardiovascular system, there is no scientific study on the usefulness of TMZ treatment for prolonged QT interval and cardiac hypertrophy induced by diabetes. Objectives: To evaluate the effects of TMZ on QT interval prolongation and cardiac hypertrophy in the diabetic rats. Methods: Twenty-four male Sprague-Dawley rats (200-250 g) were randomly assigned into three groups (n = 8) by simple random sampling method. Control (C), diabetic (D), and diabetic administrated with TMZ at 10 mg/kg (T10). TMZ was administrated for 8 weeks. The echocardiogram was recorded before isolating the hearts and transfer to a Langendorff apparatus. Hemodynamic parameters, QT and corrected QT interval (QTc) intervals, heart rate and antioxidant enzymes were measured. The hypertrophy index was calculated. The results were evaluated by one-way ANOVA and paired t-test using SPSS (version 16) and p < 0.05 was regarded as significant. Results: The diabetic rats significantly indicated increased hypertrophy, QT and QTc intervals and decreased Left ventricular systolic pressure (LVSP), Left ventricular developed pressure (LVDP), rate pressure product (RPP), Max dp/dt, and min dp/dt (±dp/dt max), heart rate, superoxide dismutase (SOD), glutathione peroxidase (GPx) and catalase in the heart. Treatment with TMZ in the diabetic animals was significantly improved these parameters in comparison to the untreated diabetic group. Conclusions: TMZ improves QTc interval prolongation and cardiac hypertrophy in diabetes.

Resumo Fundamento: A trimetazidina (TMZ) é uma droga anti-isquêmica. Apesar de seus efeitos protetores sobre o sistema cardiovascular, não há estudos científicos sobre a utilidade do tratamento com TMZ para o intervalo QT prolongado e a hipertrofia cardíaca induzida pelo diabetes. Objetivo: Avaliar os efeitos da TMZ no prolongamento do intervalo QT e na hipertrofia cardíaca em ratos diabéticos. Métodos: Vinte e quatro ratos machos Sprague-Dawley (200-250 g) foram distribuídos aleatoriamente em três grupos (n = 8) pelo método de amostragem aleatória simples. Controle (C), diabético (D) e diabético administrado com TMZ a 10 mg/kg (T10). A TMZ foi administrada por 8 semanas. O ecocardiograma foi registrado antes de isolar os corações e transferir para um aparelho de Langendorff. Foram medidos os parâmetros hemodinâmicos, intervalo QT e intervalo QT corrigido (QTc), frequência cardíaca e enzimas antioxidantes. O índice de hipertrofia foi calculado. Os resultados foram avaliados pelo one-way ANOVA e pelo teste t pareado pelo SPSS (versão 16) e p < 0,05 foi considerado significativo. Resultados: Os ratos diabéticos indicaram hipertrofia aumentada, intervalos QT e QTc e diminuição da pressão sistólica no ventrículo esquerdo (PSVE), pressão desenvolvida no ventrículo esquerdo (PDVE), duplo produto (DP), Max dp/dt e min dp/dt (± dp/dt max), frequência cardíaca, superóxido dismutase (SOD), glutationa peroxidase (GPx) e catalase no coração. O tratamento com TMZ nos animais diabéticos melhorou significativamente esses parâmetros em comparação com o grupo diabético não tratado. Conclusões: A TMZ melhora o prolongamento do intervalo QTc e a hipertrofia cardíaca no diabetes.

Living under treatment for Systemic Hypertension and Diabetes Mellitus: Feelings and behaviors / Vidas en Tratamiento de la Hipertensión Arterial Sistémica y Diabetes Mellitus: sentimientos, comportamientos / Vidas em tratamento para Hipertensão Arterial Sistêmica e Diabetes Mellitus: sentimentos e comportamentos

ABSTRACT Objective: To understand the feelings and behaviors of people being treated for Systemic Hypertension (SH) and Diabetes Mellitus (DM). Method: A qualitative study based on Grounded Theory and Symbolic Interactionism, with 27 participants in treatment for SH and DM followed up by the Family Health Strategy team. Open, axial and selective coding was performed, giving rise to three theoretical categories and the central category. Results: The daily life is explicit in the (lack of)care of the self with the chronic disease and feelings of sadness and anxiety are expressed as reasons for the lack of control of the disease. It points out that people take care of themselves because of fear of complications, reinforced the need for guidance on the use of medication and the empowerment of the chronic patient for self-care and care for the other. Final considerations: Knowing behaviors and feelings of people with SH and/or DM allows a professional performance beyond the chronic condition.

RESUMEN Objetivo: Comprender los sentimientos y comportamientos de personas en tratamiento de la hipertensión arterial sistémica (HAS) y la diabetes mellitus (DM). Método: Estudio cualitativo basado en la Teoría Fundamentada en los Datos y en el Interaccionismo Simbólico, con 27 participantes en tratamiento de la HAS y DM, y acompañados por el equipo Estrategia Salud de la Familia. Se procedió a la codificación abierta, axial y selectiva que originó las tres categorías teóricas y la categoría central. Resultados: El cotidiano de la vida está explícito en el (des) cuidado de sí con una enfermedad crónica. Los sentimientos de tristeza y ansiedad se expresan como motivos condicionantes para el descontrol de la enfermedad. Se señala que las personas se cuidan movidas por el miedo a las complicaciones. Se reforzó la necesidad de orientación sobre el uso de la medicación y del empoderamiento del paciente crónico para el autocuidado y cuidado del otro. Consideraciones finales: Conocer los comportamientos y sentimientos de las personas con HAS y/o DM permite una actuación profesional más allá de la condición crónica.

RESUMO Objetivo: Compreender os sentimentos e comportamentos de pessoas em tratamento para a Hipertensão Arterial Sistêmica (HAS) e Diabetes Mellitus (DM). Método: Estudo qualitativo embasado na Teoria Fundamentada nos Dados e no Interacionismo Simbólico, com 27 participantes em tratamento para HAS e DM acompanhados pela equipe Estratégia Saúde da Família. Procedeu-se a codificação aberta, axial e seletiva que originaram três categorias teóricas e a categoria central. Resultados: O cotidiano de vida está explícito no (des)cuidado de si com a doença crônica e sentimentos de tristeza e ansiedade são expressos como motivos condicionantes para o descontrole da doença. Aponta que as pessoas se cuidam movidas pelo medo das complicações, reforçou a necessidade de orientação sobre o uso da medicação e do empoderamento do doente crônico para o autocuidado e cuidado do outro. Considerações finais: Conhecer comportamentos e sentimentos das pessoas com HAS e/ou DM permite uma atuação profissional além da condição crônica.

Anti-hyperglycemic activity of Rutin in streptozotocin-induced diabetic rats: An effect mediated through cytokines, antioxidants and lipid biomarkers.

Administration of rutin (50 and 100 mg/kg) and pioglitazone (10 mg/kg) orally for 3 weeks treatment significantly improved body weight, reduced plasma glucose and glycosylated hemoglobin, pro-inflammatory cytokines (IL-6 and TNF-α), restored the depleted liver antioxidant status and serum lipid profile in high fat diet + streptozotocin induced type 2 diabetic rats. Rutin treatment also improved histo-architecture of ß islets and reversed hypertrophy of hepatocytes. Rutin exhibited significant antidiabetic activity, presumably by inhibiting inflammatory cytokines, improving antioxidant and plasma lipid profiles in High fat diet + streptozotocin induced type 2 diabetic model and may be useful as a diabetic modulator along with standard antidiabetic drugs. However, such effects need to be confirmed on human subjects in clinical condition.

Control moderado de hiperglucemia luego de infarto cerebral agudo en unidad de cuidados intensivos / Moderate control of hyperglycemia after acute stroke in the intensive care unit

La hiperglucemia después de un accidente cerebrovascular isquémico (ACVi) se asocia con peor pronóstico. Se compararon retrospectivamente los efectos entre el control de la glucemia moderado (corrección a partir de 135 mg/dl) y el conservador (a partir de 200 mg/dl) en evolución neurológica, tiempo de internación y complicaciones asociadas al tratamiento de pacientes con ACVi internados en unidad de cuidados intensivos, al alta y 30 días post-egreso. Se estudiaron 208 pacientes, 103 (24% diabéticos) con tratamiento moderado y 105 (23% diabéticos) con tratamiento conservador. La glucemia media a lo largo de la internación tendió a ser menor con el tratamiento moderado sin significancia estadística (129 ± 30 vs. 138 ± 31 mg/dl; p = 0.06). La diferencia fue significativa en los no diabéticos (119 ± 24 vs. 128 ± 24 mg/dl; p < 0.05), siendo más pronunciada en aquellos no diabéticos con déficit neurológico moderado a grave al ingreso (116 ± 23 vs. 130 ± 23 mg/dl; p < 0.01). Los pacientes que ingresaron con déficit neurológico moderado a grave tuvieron mejor evolución al alta y a 30 días bajo tratamiento moderado (variación de NIHSS: alta 2.1 ± 2.6 vs. 3.4 ± 3; 30 días: 3.2 ± 3 vs. 4.8 ± 3; p < 0.01). La duración de la internación fue menor con tratamiento moderado (6 ± 5 vs. 9 ± 5 días; p < 0.05). No hubo diferencias significativas en la incidencia de hipoglucemias. En conclusión, el control moderado de la glucemia en pacientes con ACVi se asoció con mejor evolución neurológica en aquellos que ingresaban con déficit neurológico moderado a grave (escala de NIH = 4), y una hospitalización más corta, sin un aumento sustancial de episodios de hipoglucemia.

Hyperglycemia following an ischemic stroke has been associated with poor clinical outcome. We retrospectively assessed the effect of moderately controlled plasma glucose (correction from 135mg/dl) compared to conservative treatment (correction from 200 mg/dl), as regards neurological evolution, duration of hospitalization, at discharge and at 30 days post-discharge, also complications associated with the treatment in patients admitted to the intensive care unit. We studied 208 patients, 103 (24% diabetics) with moderate therapy and 105 (23% diabetics) with conservative treatment. The average blood glucose during hospitalization tended to be lower with the moderate treatment with no statistic significance (129 ± 30 vs. 138 ± 31 mg/dl; p = 0.06). The difference was significant in non-diabetics (119 ± 24 vs. 128 ± 24 mg/dl; p < 0.05), being even more pronounced in those non-diabetics with moderate to severe neurological deficit on admission (116 ± 23 vs. 130±23 mg/dl; p < 0.01). Patients admitted with moderate to severe neurological deficit and treated with moderate regime had a better outcome at discharge and at 30 days (NIHSS variation: high 2.1 ± 2.6 vs. 3.4 ± 3; 30 days: 3.2 ± 3 vs. 4.8 ± 3; p < 0.01). The duration of hospitalization was lower in the moderate treatment group (5.7 vs. 9.2 days, p < 0.05), with no significant difference showing in the incidence of hypoglycemia in either group. In conclusion, moderate control of blood glucose in ACVi patients relates to an improved neurological outcome in those admitted with moderate to severe neurological deficits (NIH scale = 4), with a reduced hospital stay, and no substantial increase of hypoglycemia episodes.

[Palmatine hydrochloride improves motor dysfunction in streptozotocin-induced diabetic rats]

Diabetes induces motor dysfunctions, Palmatine is an isoquinoline alkaloid, with anti-diabetic and antioxidant activities. This study was conducted to evaluate the effect of Palmatine on motor dysfunction in STZ-induced diabetic rats. In this experimental study, 32 male wistar rats were randomly allocated into control, Palmatine-treated non-diabetic, diabetic and Palmatine-treated diabetic groups. Diabetes was induced by STZ administration at the dose of 55 mg/kg/bw, intraperitoneally. Palmatine hydrochloride was administered subcutaneous at doses of 10 mg/kg/bw per day for a period of 6 weeks, one week after induction of diabetes. Blood glucose level was measured 1, 3, 5, 7 weeks after STZ injection. Locomotor activity tests including Y maze, grip-traction and inclined plane tests were performed to determining locomotor activity. In Y maze test, the number of arms entered significantly increased in Palmatine-treated diabetic group compared to diabetic group [P<0.05]. Grip traction and inclined plane tests significantly increased in Palmatine-treated diabetic group compared to diabetics animals [P<0.05]. Palmatine hydrochloride administration for 6 weeks improves motor dysfunctions in streptozotocin-induced diabetic rats

Retrograde Venous Perfusion in Chronic Ulcers of Lower Limb.

Chronic foot ulcers are difficult to treat. These patients need prolong treatment which is costly and often associated with non-compliance. These patients are vulnerable to develop gangrene leading to amputation. Retrograde venous perfusion (RVP) is a new therapeutic approach which was recently introduced to the treatment of diabetic foot as an adjunctive line to systemic therapy and local therapy. It is based on principle of regional anesthesia. Recently, Latin American investigators, applied this approach to local therapy of pedal ischemia. Since then this approach was mainly employed for therapy of diabetic neuropathic pedal ulcers. In this work, the efficacy of this approach was explored in 5 group of chronic foot disorder – 1) Diabetic foot presenting as foot infection, 2) Dibetic neuropathic pedal ulcers, 3) Diabetic pedal ischemia and infection, 4) Nondiabetic post traumatic foot ulcers, 5) Non-diabetic ischemic ulcer and pre-gangrene or gangrene. The present study was conducted on 56 patients having non healing ulcer of lower limb. Regular dressing and debridment and retrograde venous perfusion therapy was done in all patients. Results were assessed after completion of therapy. The following conclusions are drawn from the present study. Out of all diabetic patients, 23.7% of cases presented as diabetic foot. The incidence of diabetic foot patients was 64.29% out of all studied patients with ulcer foot. Maximum number of patients, 28.57% were in 31-40 years age group. The mean age of the patients was 44.4 years. There was male predominance with male and female ratio being 1.55:1. Mean reduction of ulcer size after RVP therapy was 63.89%. Maximum improvement was found in patients with diabetic pedal ischemia and infection i.e. 70% where as patients with non diabetic post traumatic foot ulcers had minimum improvement i.e. 52.22%. Whole foot or more than 4 toe amputation was not required in any patient in therapy group. After RVP therapy gangrene or pre-gangrene was prevented in 72.73% of patients. Minimum days of stay was 11-15 days in 32.14% of patients. Average duration of hospital stay was 18 days. Patients with foot ulcer in whom RVP therapy was not done, average duration of hospital stay was 31 days. This denotes that RVP reduces the time of therapy an avoids prolonged treatment. The ratio of diabetic and non-diabetic patients with neuropathy was 2.5:1. In Doppler ultrasound study, patients with sign of ischemia, ankle-brachial pressure index was less than 0.6 in 22 patients, out of them 16 patients were diabetic. After RVP therapy 93.33% of diabetic foot patients and 80% of non-diabetic foot ulcer patients ankle-brachial ratio became more then 0.8 denoting that after RVP therapy the blood flow in lower limb was increased. The present study confirms the good result in respect to decrease in ulcer size, overcome critical complications which are threatening the foot, early healing of ulcer, increase blood flow in ischemic foot, check progression of gangrene and pre-gangrene and to conserve the foot to avoid amputation. This study entailed expansion of the application of RVP to intractable post-traumatic ulcers of the foot and lower leg, as well as, to critical pedal ischemia in diabetic and non-diabetic patients.

Effects of Beraprost Sodium on Subjective Symptoms in Diabetic Patients with Peripheral Arterial Disease

BACKGROUND: This study evaluated the effects of Beraprost sodium (Berasil) on subjective leg symptoms in patients with peripheral arterial disease caused by diabetes mellitus. METHODS: Ninety-four diabetic patients with peripheral arterial disease were treated with Beraprost in a fixed-dose, prospective, multicenter, cohort study. Beraprost (40 microg) was administered orally 3 times daily (120 microg/day) for 12 weeks. We developed a new disease-specific symptom questionnaire, which evaluated the effect of peripheral arterial disease on leg discomfort in daily life and assessed therapeutic responses to treatment. Patients were asked for their subjective assessment of symptoms on a written questionnaire before treatment and after 12 weeks of therapy. RESULTS: There was significant improvement in all estimated subjective symptoms (burning, coldness, edema, exertional pain, stabbing, and paresthesias) in the lower extremities at 12 weeks (p < 0.001). There were 18 patients with neuropathy in whom significant improvement was noted for 6 subjective symptoms at 12 weeks (p < 0.05). Adverse events considered to be drug-related were observed in 4 patients (4.3%), all of which were mild and resolved with discontinuation of the medication. CONCLUSIONS: Beraprost is effective as a treatment for improving various subjective symptoms in the lower extremities, such as burning, coldness, edema, exertional pain, stabbing, and paresthesias, in diabetic patients with peripheral arterial disease.

Efecto del extracto acuoso de la raíz de Ruellia Tuberosa L. sobre el daño renal en la diabetes. Papel del estrés oxidativo / Effect of the aqueous extract of the root of Ruellia Tuberosa L. on kidney damage in diabetes. Role of oxidative stress

La diabetes es una de los principales problemas de la salud pública mundial, en parte debido a su asociación con otras enfermedades cardiometabólicas. Las complicaciones tisulares de la diabetes es su principal causa de muerte, siendo la nefropatía diabética la que lidera la lista de daños inducidos por la hiperglicemia crónica. Se conocen varios mediadores celulares de la nefropatía: la angiotensina II, los productos de glicosilación avanzada, las kinasas activadas por mitógenos, las especies reactivas de oxígeno y nitrógeno, entre otras, cuya activación traen como consecuencia el aumento de la síntesis de proteínas de la matriz extracelular, el ensanchamiento del glomérulo, el daño tubular y la fibrosis. Esto se traduce en insuficiencia renal crónica, caracterizada por la proteinuria, el aumento de la diuresis, el desequilibrio electrolítico, el incremento de creatinina plasmática y del nitrógeno ureico en sangre (BUN), los cuales son considerados marcadores clínicos del daño renal en la diabetes. Muchos grupos de investigación están enfocados en la búsqueda de fármacos que sean capaces de abolir, disminuir o prevenir la nefropatía diabética. En el campo de la etnobotánica, la etnomedicina y la etnofarmacología existen diversos estudios que han aportado nuevas especies, fitofármacos y productos naturales para el tratamiento no sólo de la diabetes, sino también de sus complicaciones. Existen alrededor de 1200 plantas antidiabéticas en el mundo. En Venezuela son muy pocas las especies que han sido estudiadas, a pesar que goza de gran biodiversidad vegetal. Ruellia tuberosa L. (yuquilla) es una de estas plantas de uso etnomédico, la cual pertenece a la familia Acanthaceae y está distribuida en todo el país. Las partes aéreas de esta especie han sido estudiadas de manera exhaustiva, encontrándose actividad: antidiabética, antioxidante, antiinflamatoria y analgésica. Sin embargo, su raíz ha sido muy poco estudiada. Recientemente, reportamos la actividad analgésica y antiinflamatoria del extracto acuoso de la raíz de R. tuberosa (RT) en animales de experimentación. Con el fin de validar su uso tradicional como antidiabético y de conocer la capacidad protectora ante las complicaciones de la diabetes, en este trabajo se evaluó el efecto del RT sobre el daño renal en un modelo de ratas con diabetes inducida por la estreptozotocina (ETZ) e in vitro en células de epitelio renal (células Vero) sometidas a altas concentraciones de glucosa. Asimismo, se evaluó la relación de la actividad protectora del RT con su potencial antioxidante y con la inhibición de la vía de señalización de la PKC-NF-κB. Para ello fueron evaluadas las modificaciones de la glicemia, de los marcadores de daño renal, el daño oxidativo renal, el sistema antioxidante renal, la proliferación y muerte de las células de epitelio renal, en los modelos experimentales bajo diferentes condiciones de estrés. Asimismo la expresión del NF-κB inducida por un activador de la PKC (PMA) en células de cáncer de cuello uterino (HeLa), la actividad antioxidante y el contenido de polifenoles del extracto. Los resultados muestran que el RT contiene compuestos polifenólicos y que produce un efecto atrapador del anión superóxido, estableciéndose así su capacidad antioxidante. El RT disminuyó la glicemia, la proteinuria, la diuresis, el BUN la creatinina plasmática y la pérdida de peso en los animales diabéticos; disminuyó el contenido de grupos carbonilos en las proteínas, de malonildialdehido, de proteínas totales en la corteza renal y suprimió el incremento del peso del riñón en las ratas con diabetes inducida por la ETZ; contrarrestó el decremento de la actividad de la CAT, SOD total, CuZn-SOD, GPx y GR inducida por la glucosa in vivo e in vitro; protegió a las células Vero de la glucotoxicidad, del estrés oxidativo y del estrés nitrosativo, inducido por la alta glucosa, por el peróxido de hidrógeno y por el nitroprusiato de sodio respectivamente. Sin embargo, el peróxido, el nitroprusiato así como el PMA disminuyeron el efecto protector del RT sobre la glucotoxicidad. Este extracto previno el incremento de la actividad del NF-κB inducido por el PMA en las células HeLa. Todos estos hallazgos establecen al RT como un antioxidante con efecto protector sobre el daño renal en la diabetes, tanto in vivo como in vitro, a través de un mecanismo que involucra la disminución de la glicemia, del estrés oxidativo, del estrés nitrosativo, y de la vía de señalización de la PKC-NF-kB. Esto aporta, por primera vez, información acerca de los efectos farmacológicos de la especie, a la vez que contribuye tanto a la validación de su uso tradicional como a la caracterización farmacológica de su género, sentado así las bases para el estudio fitoquímico y tecnológico de este potencial fitofármaco.

study of the microbiology of diabetic foot infections in a teaching hospital in Kuwait

The purpose of this study was to determine the microbiological profile of diabetic foot infections [DFIs] and assess the antibiotic susceptibility of the causative agents. Data were obtained from a retrospective analysis of DPI samples collected from June 2007 to July 2008. Specimens were cultured using optimal aerobic and anaerobic microbiological techniques, and antibiotic susceptibility testing was performed according to the methods recommended by the Clinical and Laboratory Standards Institute [CLSI]. Extended-spectrum beta-lactamase [ESBL] production was measured using the double disk synergy test and the ESBL Etest. A total of 440 patients were diagnosed with DFIs during this period, and a total of 777 pathogens were isolated from these patients with an average of 1.8 pathogens per lesion. We isolated more Gram-negative pathogens [51.2%] than Gram-positive pathogens [32.3%] or anaerobes [15.3%]. Polymicrobial infection was identified in 75% of the patients. The predominant organisms isolated were members of the Enterobateriaceae family [28.5%], Pseudomonas aeruginosa [17.4%], Staphylococcus aureus [11.8%], methicillin-resistant S. aureus [7.7%], anaerobic Gram-negative organisms [10.8%], and Enterococcus spp. [7%]. Vancomycin was the most effective treatment for Gram-positive bacteria, and imipenem, piperacillin-tazobactam and amikacin were the most effective treatments for the Gram-negative bacteria. In conclusion, DFI is common among diabetic patients in Kuwait, and most of the cases evaluated in this study displayed polymicrobial etiology. The majority of isolates were multi-drug resistant. The data gathered in this study will be beneficial for future determinations of empirical therapy policies for the management of DFIs. 2011 King Saud Bin Abdulaziz University for Health Sciences. Published by Elsevier Ltd. All rights reserved

Diabetes mellitus and spinal epidural abscess: clinical or surgical treatment? / Diabetes melito e abscesso epidural espinhal: tratamento clínico ou cirúrgico?

Spinal epidural abscess (SEA) is an uncommon condition and its most important predisposing factor is diabetes mellitus. Although the treatment of choice is prompt surgical abscess evacuation, followed by antibiotic therapy, successful conservative treatment of SEA has been reported in some cases. We describe a SEA case in a 23-year old white woman with diabetes for 14 years, who was successfully treated only with antibiotics, and achieved full recovery at the fourth month of follow-up.

O abscesso epidural espinhal (AEE) é uma doença incomum e o diabetes melito é o seu fator predisponente mais importante. O tratamento de escolha é a imediata drenagem cirúrgica, seguida de antibioticoterapia, entretanto, casos já foram relatados em que o AEE foi tratado clinicamente com sucesso. Descrevemos um caso de AEE em um paciente diabético tratado satisfatoriamente com uso isolado de antibióticos e que evoluiu com recuperação total no quarto mês de seguimento.

[Topical estrogen accelerates wound healing in diabetic rats]

Diabetic ulcers especially foot ulcers and the delay in their healing is a major problem faced by most diabetic patients. Based on data available on the positive role of estrogen in accelerating wound healing, this research aimed at assessing the possible effect of topical estrogen on wound healing in diabetic rats. Sixty-six male wistar rats were divided into two groups [normal and diabetic] and each group was divided into 3 subgroups [control, sham and test]. A circular full- thickness wound with a diameter of 1.5 cm was created on the backs of streptozotocin [stz]- induced diabetic and intact rats. In the test subgroup, the wounds were treated with a daily topical dose of 0.5 mg estrogen and in the sham subgroup, gentamicin ointment [dose 0.5 g] was used. The process of wound healing was assessed by macroscopic and microscopic studies on days 3, 5, 7, 14, 21, and 28. The macroscopic study, showed delays in healing of the diabetic group in comparison with the normal group and after the seventh day, wound healing showed considerable change in the test subgroup in both normal and diabetic rats [p<0.05]. In the normal group microscopic study, the only parameter which did not show any differerence was granulation tissue organization; however increasing of neoangiogenesis and re-epithelization was observed in the test subgroup. Also, in the diabetic group, the estrogen receiving subgroup showed impressive improvement compared to the sham subgroup. Topical that estrogen can accelerate the process healing of diabetic wounds

[Effect of calcitriol on glycemic and lipid control in type 2 diabetes]

Vitamin D deficiency is prevalent worldwide. Low 25 hydroxyvitamin D3 concentrations inversely associated with type 2 diabetes, metabolic syndrome and insulin resistance. The aim of this study was the evaluation of effects of oral 1, 25 [OH] 2D3[calcitriol] treatments on glycemic control and lipid profiles in patients with type 2 diabetes. This was an interventional study, conducted in Ghaem Hospital, Mashhad, Iran on 58 type 2 diabetic patients. Patients underwent calcitriol treatment with 0.5 microgram per day for 8 weeks. In all cases, clinical parameters including weight, systolic and diastolic blood pressure and laboratory parameters including levels of fasting blood glucose, insulin, lipid profile, calcium, phosphorous, HbA1C and insulin resistance [HOMA-IR] were measured, before and after the treatment period. The two sets of results were then compared with one another. Following treatment with calcitriol, FBS, HbA1C, Cholesterol, triglycerides and insulin resistance decreased but the changes were not significant [p>0.05]. LDL and diastolic blood pressure decreased significantly after treatment with calcitriol. [p=0.02 and 0.04 respectively]. Supplementation with active form of vitamin D did not have a significant effect on glycemic control but may be effective in control of hyperlipidemia and blood pressure in type 2 diabetic patients, findings which need to be confirmed in large randomized trials

Hypoglycemic and hypolipidemic effects of an aqueous extract of chamaerops humilis leaves in obese, hyperglycemic and hyperlipidemic meriones SHAWI rats

Ethnopharmacological relevance: An aqueous concoction made from the leaves of Chamaerops humilis [L.] [dwarf fan palm], is used in the Moroccan traditional medicine for the treatment of diabetes, as well as a number of other diseases. The aim of the study was to experimentally validate the use of C. humilis in the folk treatment of diabetes as well as to determine if the aqueous leaf extract of this plant has hypolipidemic properties in an animal model of obesity, hyperglycemia and hyperlipidemia. The animal model consisted of experimentally induced obesity, hyperglycemia and hyperlidemia [OHH] in Meriones shawi rats. In the acute study, OHH M. shawi rats [n = 8] were given a single oral dose [10 mg/kg] of an aqueous extract of C. Humilis leaves [plant-extract]; taurine [8 mg/kg] was used as the positive control. Plasma glucose levels were determined at 2-, 4- and 6-hr after the dose. In the sub-chronic study, groups of OHH rats [n = 8 for each group] were given daily oral doses of the plant-extract and taurine [at the above doses] for 30 days. Body weight [BW], plasma glucose, total cholesterol and triglycerides were measured at 15 and 30 days of dosing. The M. shawi rats developed OHH when maintained on a hypercaloric diet and forced physical inactivity for 90 days. A single oral dose of the plant-extract decreased plasma glucose levels with the maximum effect occurring at 4-hr after the dose [6.88 +/- 1.38 mmol/L compared to baseline 12.04 +/- 0.94 mmol/L; P<0.01]. Taurine also decreased plasma glucose [from 12.26 +/- 1.27 mmol/L to 9.15 +/- 1.27 mmol/L; P<0.05]; water treated control group did not show any effect. In normal M. shawi [normal] rats, none of the treatments had significant effect on glucose levels. In the sub-chronic study, daily oral administration of the plant-extract or taurine for 30 days to the OHH rats resulted in a significant decrease in BW [from 241 +/- 8 g to 165 +/- 11 g; P<0.001 for the extract, and from 221 +/- 13 g to 189 +/- 11 g; P<0.05 for taurine]; water treated control rats showed no effect. In normal rats, administration of the plant-extract or taurine for 30 days resulted in an insignificant decrease in BW, while water administration caused a small [normal] increase in the weight Plasma glucose levels of the OHH rats decreased significantly with daily dosing with the plant-extract [from baseline 12.04 +/- 0.94 mmol/L to 6.10 +/- 0.27 mmol/L [P<0.05] after 15 days, and to 4.84 +/- 0.22 mmol/L [P<0.001] after 30 days]. Taurine was less effective [P<0.05], while water treated control group did not show any effect. In the normal rats, administration of the plant-extract or taurine for 30 days resulted in a small decrease in glycemia. Administration of plant-extract caused a significant decrease in plasma levels of total cholesterol [from baseline of 3.46 +/- 0.21 mmol/L to 1.05 +/- 0.06 mmol/L [p<0.0l] after 15 days and to 0.62 +/- 0.02 mmol/L [p<0.00l]] after 30 days, and triglycerides [from baseline of 1.15 +/- 0.17 mmol/L to 0.47 +/- 0.04 mmol/L [p<0.00l] after 15 days and to 0.37 +/- 0.03 mmol/L [p<0.001] after 30 days]. Taurine was less effective, while water treated control group did not show any effect. There was no effect of these treatments on lipid levels in normal rats. The results of this study validate the traditional use of the leaves of C. humilis in the treatment of diabetes in Morocco. Since, the aqueous leaf extract also decreased total cholesterol and triglycerides, the plant may also be useful in the management of secondary complications of diabetes [dyslipidemia] Furthermore, the plant may become a good source of antidiabetic medication

Changing profile of prostatic abscess

PURPOSE: To compare the clinical presentation of prostatic abscess and treatment outcome in two different time frames with regards to etiologies, co-morbid factors and the impact of multidrug resistant organism. MATERIALS AND METHODS: We retrospectively assessed the charts of 48 patients with the diagnosis of prostatic abscess from 1991 to 2005. The period was divided arbitrarily into two different time frames; phase I (1991-1997) and phase II (1998-2005). Factors analyzed included presenting features, predisposing factors, imaging, bacteriological and antibiotic susceptibility profile, treatment and its outcome. RESULTS: The mean patient age in phase I (n = 18) and phase II (n = 30) were 59.22 ± 11.02 yrs and 49.14 ± 15.67 respectively (p = 0.013). Diabetes mellitus was most common predisposing factor in both phases. Eleven patients in phase II had no co-morbid factor, of which nine were in the younger age group (22 - 44 years). Of these eleven patients, five presented with pyrexia of unknown origin and had no lower urinary tract symptoms LUTS Two patients with HIV had tuberculous prostatic abscess along with cryptococcal abscess in one in phase II. Two patients had melioidotic prostatic abscess in phase II. The organisms cultured were predominantly susceptible to first line antibiotics in phase I whereas second or third line in phase II. CONCLUSION: The incidence of prostatic abscess is increasing in younger patients without co-morbid factors. The bacteriological profile remained generally unchanged, but recently multi drug resistant organisms have emerged. A worrying trend of HIV infection with tuberculous prostatic abscess and other rare organism is also emerging.