Effect of simvastatin on insulin sensitivity in type 2 diabetic subjects

To study the effect of Simvastatin therapy on insulin sensitivity in type 2 Diabetes mellitus subjects. This is a randomized case control study, conducted at Baqai Institute of Diabetology and Endocrinology, Karachi, Pakistan. The study was conducted in 100 type 2 diabetes subjects of both sexes. Patients were randomized into two groups. Fifty patients were given Simvastatin 40mg/day for three months while 50 patients were used as controls. Both groups had similar anthropometric [age, duration of diabetes, BMI and Blood pressure] and biochemical [serum creatinine, fasting plasma glucose, fasting insulin level and lipid profile] characteristics. Insulin resistance was assessed by calculating homeostasis model assessment for insulin resistance [HOMA-IR] before and after 3 months of simvastatin treatment [40mg/day]. Simvastatin [40mg/day] markedly decreased cholesterol, triglycerides and LDL levels but did not significantly affect insulin sensitivity as determined by HOMA-IR. However it improved insulin sensitivity in subjects having insulin resistance.[HOMA IR reduction 1.92; p=0.001] Short term simvastatin therapy [3 months] had no effect on insulin sensitivity, but had a significant lipid lowering effect in all the subjects

Endoscopic evalution of acute dysphagia due to mechanical obstruction

To find out the common causes of mechanical dysphagia in South Punjab and determine the endoscopic features of benign and malignant stricture to decide for either therapeutic intervention [endoscopic dilatation/stunting] or biopsy. This descriptive study was conducted in Medical Unit-1, Gastroenterlogy Nishtar Hospital Multan Pakistan during the period from September 2004 to December 2005. A total 50 patients were included in the study. Foreign body in esophagus, was seen in 3 patients [6%] 2 female and one male. Two patients [4%] had esophageal web, both patients were female and upper part of oesophagus was involved in both of them. Benign stricture was the commonest abnormality. Lower third of oesophagus was the commonest site of involvement [62.5%], middle one third was involved in 31.25% of cases while upper third was involved in only 1 patient [6.25%]. Carcinoma oesophagus was predominantly found in males and lower one third was the commonest site [71.4%]. No patient had involvement of upper third while middle third was involved in 28.6%. Mean age of the patients was 42; age range was 14 to 63. Duration of dysphagia ranged from one day to 35 days; mean duration was 18 days. Upper gastrointestinal endoscopy is a safe and valuable procedure in individuals of all age groups with dysphagia and often leads to positive therapeutic intervention even in quite frail subjects. Benign esophageal stricture, esophagitis and esophageal carcinoma, are the commonest causes of dysphagia in South Punjab

Relationship among fatness, blood lipids, and insulin resistance in Pakistani children.

Observations on associations between fatness and metabolic risks among South-East Asian adults have resulted in devising lower thresholds of body mass index (BMI) for them. Metabolic abnormalities, including type 2 diabetes, are now also appearing in children and are associated with obesity. There has not been much work done to identify indicators of metabolic risks among South Asian children. This study was undertaken to observe the relationship among fatness, blood lipids, and insulin resistance in Pakistani children. Fatness, lipids, and insulin resistance were assessed in 92 middle-class Pakistani school children aged 8-10 years. Height, weight, waist, hips, mid-arm circumference, and triceps skin-fold, measured in school, were used for calculating various indicators of fatness, i.e. BMI, waist hip ratio (WHR), and arm-fat percentage. Fasting blood samples were analyzed for total lipids, triglycerides (TG), total cholesterol (TC), high density lipoprotein (HDL), low density lipoprotein (LDL), glucose and insulin levels. Homeostasis model assessment (HOMA) index was calculated to assess insulin resistance. Two separate multiple regression models of various risk indicators (family history, sex, BMI, WHR, arm-fat percentage) showed that only arm-fat percentage had a significant positive association both with insulin levels (b = 2.04, p = 0.044) and LDL (b = 2.11, p = 0.037). Only five children were overweight (BMI-for-age > 85th percentile according to National Center for Health Statistics 2000 reference). Neither overweight children nor those who were in the uppermost tercile of BMI-for-age differed significantly from other children in terms of presence of higher-than-desirable values of lipids or insulin. However, compared to those in the lowest tercile, children who were in the uppermost tercile of armfat percentage had a significantly higher frequency of high blood cholesterol (40% vs 67%, p = 0.027), high LDL (33.3% vs 61.3%, p = 0.026), and markedly higher proportion above average insulin levels (16.7% vs 35.5%, p = 0.083). Arm-fat percentage could be developed as a practical tool for determining the risk status of children. However, further cross-sectional assessments are needed to ascertain accurate relationships among arm-fat percentage, lipid profiles, and insulin resistance in larger and varied groups of children.

Fatness, Lipids, Insulin sensitvity, and life style of children from high and low risk families

Children show variation in certain diabetes related risk factors according to the family history. Early detection of high risk groups could prevent or delay the onset of diabetes. Insulin level and fatness of Pakistani children has never been compared according to family history. This study was designed to observe the differences in insulin sensitivity, lipids and fatness in children from high and low risk families. Two groups of 8-10 year old school children were assessed for the differences in insulin sensitivity, lipids, fatness, food and activity habits. The first group had no family history for diabetes [low risk group, n=40] in any first or second degree relative. The second group had positive family history of diabetes [high risk group n=40] Data were collected through questionnaire sent to parents and children's interview. Blood test and anthropometric assessments were done at the schools by a physician. The two groups of children had similar level of insulin sensitivity. Children having positive family history for diabetes had markedly higher mean values for BMI, and arm fat% as compared to the controls. Though the low risk group had markedly higher level of total lipids and triglycerides the high risk group had markedly lower HDL and significantly higher LDL [p=0.008] and HDL-LDL [p=0.009] ratio than the low risk group. There was no significant difference in food and activity habits of the two groups. Marked variations in lipid profile of children from high and low risk families are evident at an early age. Presence of these differences in the absence of differences in food and activity habits and insulin sensitivity suggests that variation in lipid storage and metabolism could precede the appearance of reduced insulin sensitivity in children from high-risk families. Measures to control excessive fat deposition in childhood could be an initial step towards the prevention of diabetes and heart disease in adult life