Study of tumor necrosis factor-alpha, leptin, plasminogen activator inhibitor-1 and oxidative stress in obese type 2 diabetic patients: Relation to insulin resistance

Great evidence indicates that some factors secreted by adipocytes are directly involved in the pathogenesis of obesity diabetes syndrome. This work was designed to study the role of tumor necrosis factor-alpha [TNF-alpha], leptin, plasminogen activator inhibitor-1 [PAI-1] and oxidative stress in relation to insulin resistance in obese type 2 diabetic patients. The study included 60 premenopausal women, classified into 4 groups; I] included 15 obese type 2 diabetics II] included 15 lean type 2 diabetics III] included 15 obese non diabetics and IV] included 15 lean non diabetics. All subjects were subjected to complete history taking, thorough clinical examination, anthropometric measurements and laboratory investigations including fasting and 2-hour post load glucose levels, fasting and 2-hour post load insulin levels, lipid profile, plasma TNF-alpha levels, leptin levels, PAI-1 levels and measurement of malondialdehyde [MDA] levels. The present study showed a significant positive correlation between leptin and body mass index [BMI], waist circumference, fasting insulin level and homeostasis model assessment insulin resistance index [HOMA IR], cholesterol and TNF-alpha. The statistical significance of association between leptin in one hand and waist circumference, HOMA, and cholesterol in the other hand was abolished when data were adjusted for BMI. The statistical significance between leptin and fasting insulin and TNF-alpha persisted after adjustment of data for BMI, indicating an independent association between leptin and both fasting insulin and TNF-alpha. There was an independent association between TNF-alpha and fasting glucose, 2-hour post load glucose, leptin and PAI-1. There was independent association between PAI-1 and fasting insulin, 2-hour post load insulin, triglycerides, high density lipoprotein-cholesterol [HDL-C] and TNF-alpha. MDA level was significantly higher in diabetic groups in comparison to the non-diabetic groups. However, there was no correlation between MDA and other parameters. We conclude that leptin, TNF-alpha, PAI-1 and increased oxidative stress may play a role in insulin resistance in obese type 2 diabetic patients

Impact of diagnostic laparoscopy on the management of gastric cancer

In this study, 50 patients with endosmotically proven gastric adencarcinoma were included. Ages of our patients ranged from 35 to 72 years [mean 54 years], with male predominance [male to female = 2.8:1]. The site of the tumours were in the antrum, body of the stomach, proximal 1/3 [20%],5 [10%], 4 [8%] and 2 [4%] cases, respectively. Ultrasonograhy, CT scan and laparoscopy were performed to patients. The sensitivity of the 3 modalities in detection of hepatic metastases were 26.7%, 46.7% and 86.7%, respectively, Also, the sensitivity of the 3 modalities in detection of peritoneal metastases were 33.3%, 16.7% and 83.3%, respectively. Laparoscopy avoided laparatomy in 18 [36%] of our patients We concluded that diagnostic laparasocopy is more accurate than other tests under investigations. It is of increasing imkportance in planning patient management with the use of non-operative methods of tumour palliation in patients with intraabdominal metastases

Levels of circulating soluble cell adhesion molecules in diabetics and in impaired glucose tolerance patients: correlation to stiffness index beta of the common carotid and femoral arteries

The current work was conducted to study the possible relationship between endothelial activation as assessed by the level of circulating soluble VCAM-1, ICAM-1, and E-selectin concentrations and atherosclerotic disease as assessed by the stiffness index 13 of the common carotid and femoral arteries in type 2 diabetic patients and patients with impaired glucose tolerance and the correlation of stiffness index beta of the common carotid artery and femoral artery with the degree of insulin resistance. Subjects and This study entailed 20 patients with type 2 diabetes meilitus, representing group I [GI], and 20 patients with impaired glucose tolerance, representing group II [GII] and 20 healthy subjects of matched age and sex as a control group, III [GIII]. All subjects were subjected to complete history taking and thorough clinical examination including body mass index [BMI]. Routine Laboratory investigations included oral glucose tolerance test [OGTT], glycosylated hemoglobin [HbA[1c]], serum uric acid, serum triglycerides, total serum cholesterol, high-density lipoprotein cholesterol [HDL-C], low-density lipoprotein cholesterol [LDL-C], as well as liver and renal function tests were carried out by using standard commercial methods. The level of urinary microalbumin in GI, and insulin sensitivity assessment through OGTT, in all groups were carried out. Serum levels of the circulating adhesion molecules ICAM-1, VCAM-1 and E-selectin were measured in GI, II, and III by an enzyme-linked immunosorbent assay. All subjects were subjected also to radiological measurement of stiffness indexes beta of the common carotid and femoral arteries by high-resolution ultrasonography. sVCAM was found to be 681.2 +/- 81.8, 551.7 +/- 33.5, 453.4 +/- 28.4 ng/ml in GI, GII, and GIII, respectively. sICAM was found to be 339.4 +/- 18.8, 301 +/- 19.3, 197.8 +/- 9.2 ng/ml in GI, GII, and GIII, respectively. E-selectin was found to be 90.4 +/- 5.7, 69.8 +/- 6.8, 51.1 +/- 6.6 ng/ml in GI, GII, and GIII, respectively. Using LSD, sVCAM, sICAM, and E-selectin were found to be significantly increased in GI when compared to GII and GIII and to be significantly increased in GII when compared to Gill. Concerning stiffness index of carotid artery, it was found to be 28.7 +/- 8.3, 14.7 +/- 1.4, 12.1 +/- 1.6 in GI, GII, and GIII respectively. Using LSD, stiffness index of carotid artery was found to be significantly increased in GI when compared to GII and controls. With reference to stiffness index of femoral artery, it was found to be 30.3 +/- 7.1, 15.4 +/- 1.4, 12.7 +/- 2.4 in GI, GII, and GIII, respectively. Using LSD, stiffness index of the femoral artery, it was found to be significantly increased in GI when compared to GII and controls. It could be concluded that cAMs can be used as a marker of the stiffness index beta of both common carotid and femoral arteries due to the noted significant positive association. Stiffness index beta of both common carotid and femorai arteries are exacerbated in type 2 diabetic patients than in patients with impaired glucose tolerance and controls. The stiffness index beta of both common carotid and femorai arteries are associated with insulin resistance in type 2 diabetes meilitus. Further prospective studies should be carried to ascertain whether insulin resistance may induce the early changes of atherosclerosis in diabetes

Stiffness index beta of the common carotid and femoral arteries: relation to insulin resistance

This work was intended to study the association between arterial wall stiffness indexes beta of the common carotid and femoral arteries and insulin resistance in type 2 diabetic patients as well as patients with imparied glucose tolerance compared with age and sex matched control subjects. The study included 60 subjects classified into 3 groups; I] included 20 patients with type 2 diabetes, II] included 20 patients with IGT and III] included 20 matched controls. All patients and controls were subjected to the followings: complete history taking, thorough clinical examination, laboratory investigations including HBA1C, uric acid, complete lipid profile, microalbumin assay, renal and liver function tests. Measurement of insulin sensitivity by oral glucose tolerance test. Stiffness indexes beta of the common carotid and femoral arteries were measured by high resolution ultrasonography. The results of the present work can be summarized as follows: the stiffenss index beta [SI] of the common carotid and femoral arteries was significantly higher in diabetic group than those with IGT and controls [P< 0.001] for each], still those with IGT was insignificantly higher than controls [P < 0.05]. Also, stiffness index [SI] of the common carotid and femoral arteries was positively and significantly correlated with relative insulin resistance, total cholesterolm serum tryglycerides, LDL-C, uric acid, age and the duration of diabetes [P < 0.05]. Our results suggest that the stiffness indexes beta of the common carotid and femoral arteries were associated with insulin resistance in type 2 diabetic patients and such insulin resistance plays an important role in the pathogenesis of these sclerotic changes