Impact of leptin levels upon left ventricular structural abnormalities in non-insulin-dependent diabetics

Non-insulin-dependent diabetes mellitus adversely affects left ventricular [LV] structure. ri.ecent studies have shown that leptin increases in insulin-resistant states, such as obesity and hypertension. The levels of plasma leptin have been found to be associated with LV myocardial growth.To assess fasting serum leptin concentrations in the type 2 diabetic patients and to correlate its level with the LV structural changes. Patients and Twenty four type 2 diabetic patients with LV structural changes and twenty four type 2 diabetic patients without LV structural changes [controls] participated in this study. The following LV structural parameters were assessed by Two-dimensional echocardiography: left ventricular end-diastolic diameter [LVEDD], left ventricular end-systolic diameter [LVESD], interventricular septal thickness [IVST], left ventricular posterioi wall thickness [PWT], relative wall thickness [RWT] and left ventricular mass index [LVMI]. left atrium [LA] and aortic root [Ao] dimensions were also assessed. Fasting serum leptin, insulin, glucose and glycosylated hemoglobin [HbAlc] were determined. The correlations of eptin to LV structural parameters were statistically analyzed. Body mass index [BMI], FBG and fasting serum concentrations of leptin and insulin were significantly greater in patients than controls. There were statistically significant differences between the two groups in all echocardiographic parameters apart from LVEDD, LVESD, RWT, LA and AO In the case group, leptin was positively correlated with FBG and insulin. A significant correlation was also found between serum leptin and echocardiographic parameters; PWT. IVST, SWI and LVMI. Hyperleptinemia in type 2 diabetic patients with LV structural changes and the association of leptin with indexes of LV structure may reflect its role in the development of myocardial wall thickening in non-insulin dependent diabetes mellitus

Dexamethasone with either granisetron or ondansetron for postoperative nausea and vomiting in laparoscopic surgery

In a prospective randomized double-blind study, we compared the effectiveness of dexamethasone 8 mg with either granisetron 1 mg or ondansetron 4 mg in the prevention of postoperative nausea and vomiting in patients undergoing laparoscopic surgery. Hundred ASA I and II patients scheduled for laparoscopic surgery were enrolled in the study and 84 patients completed it. Following induction of anesthesia, group I [n = 42] received granisetron 1 mg and dexamethasone 8 mg, group II [n = 42] received ondansetron 4 mg and dexamethasone 8 mg. Nausea and vomiting episodes, pain scores as well as side effects were recorded during the first hour and subsequently during the first 6 and 24 hours postoperatively. Satisfaction scores were obtained at discharge. There was no statistically significant difference between the 2 groups during the 1[st] 24 hours following surgery in regards to pain scores, satisfaction and side effects manifestations. At 0-1 hour interval, 100% of patients in group I and 97.6% in group II had no vomiting. Total response [no moderate or severe nausea and no rescue antiemetics] was 83.3% in group I and 80.95% in group II, and metoclopramide was used in 7.1% of patients in both groups. At 1-6 hours interval, 97.6% of patients in group I and 100% in group II had no vomiting. Total response was 92.8% in group I and 90.9% in group II, and metoclopramide was used in 4.76% of patients in group I and 2.38% in group II. At 6-24 hours no vomiting occurred in 97.6% of patients in group I and 100% in group II. Total response was 95.2% in both groups, and metoclopramide was used in 2.38% of patients in both groups. In conclusion, the combination of dexamethasone 8 mg with either granisetron 1 mg or ondansetron 4 mg following induction of anesthesia in patients undergoing laparoscopic surgery showed no statistically significant difference in antiemetic efficacy with minimal side effects and excellent patient satisfaction

Does pancuronium or cisatracurium delay the rate of arousal following rmifentanil-based anesthesia?

The present report investigates the rate of arousal following remifentanil-based anesthesia associated with the coadministration of pancuronium, which inhibits butyrylcholinesterase, or cisatracurium, which is partially metabolized by nonspecific esterases, versus vecuronium that is eliminated independently of ester hydrolysis. Sixty patients, ASA I-II, scheduled for elective abdominal surgeries were enrolled in a double-blinded prospective study. In fact, patients were equally divided into three Groups with each Group receiving remifentanil and either one of the following three muscle relaxants: pancuronium, vecuronium or cisatracurium. The rate of arousal following discontinuation of anesthesia was assessed by Modified Aldrete Score. Time to eye opening on verbal command, tracheal extubation, Modified Aldrete Score >9, and time to discharge from the recovery room were recorded. Time to eye opening on verbal command, tracheal extubation, Modified Aldrete Score >9, and time to discharge from the recovery room were not significantly different between the three groups. The results suggest that recovery following remifentanil-based anesthesia is not delayed by the coadministration of pancuronium, cisatracurium versus vecuronium; and by the use of neostigmine for reversal of neuromuscular blockade

Muallem endo - tracheal tube introducer: [METTI] an aid for the difficulty airway.

This is a brief report evaluating a new single use endotracheal tube introducer [METTI] which has a soft curved atraumatic tip. The introducer was tried in 44 patients, whose direct laryngoscopic view was simulated to Cormack IIIb score, and in six patients with real Cormack III score. The overall success rate of railroading of the tracheal tube over the introducer was 94% from the first attempt

Role of clinical hematological, biochemical and serological assays in management of brucellosis

Brucellosis is an infectious disease. Brucellosis can be suspected by clinical presentation and may produce hematological and biochemical changes of liver function. Ninety nine patients of brucellosis and twenty normal individuals were included in this study. The cases were classified into 4 subgroups [1, 2, 3 and 4] according to the regimen of therapy applied. The brucella organisms were isolated, and were presented by blood culture in 60 cases and were negative in 39 cases. The clinical, hematological, liver function and serological tests were investigated before and two weeks following treatment. The main symptoms of brucella patients were fever 100%, headache 68.6%, arthralgia 66.7%, myalgia 68.7%, anorexia 25.3%, sweating 58.6%, rigors 51.5%, abdominal discomfort 17.2%, cough 9.1% and dysuria in 31.3%. The main signs include fever with mean of 38.9C, hepatomegaly 31.3% and splenomegaly in 49.5%. Before treatment, anemia was presented in 63.6%, leucopenia in 58.6%, monocytosis 61.6%, and ESR was high in 97.9% of cases. Liver function tests were affected in brucellosis in which hyperbilirubinemia in 34.3%, alkaline phosphatase enzyme was raised in 30.3%, aspartate transaminase enzyme was high in 27.3% and alanine transaminase enzyme was elevated in 33.3%. There were significant difference in the blood picture and liver function tests between the cases of brucella and the normal control [P <0.0001]. Two weeks after treatment all symptoms and signs were improved and disappeared

Recent therapeutic studies on human brucellosis

The present study included ninety nine cases. They were diagnosed by clinical examination, serological estimation of both IgG and IgM antibodies against brucella antigen and /or positive blood culture specific for brucellosis. In addition, there were twenty normal subjects [control group]. The studied individuals divided into four groups according to the regimen of drug used. Rifampicin was considered the best monotherapy, by the data revealed that combination of two drugs, namely tetracycline orally and streptomycin by intramuscular injection was better than monotherapy