Neutrophil lymphocyte ratio [NLR]: a well assessment tool of glycemic control in type-2 diabetic patients

Background and Objective: Increased neutrophil lymphocyte ratio [NLR] is a marker as well as predictor of various cardiac and non cardiac disorders. Our aim was to assess the relationship between NLR and different level of glycemic control in type 2 diabetic patients

Methods: An observational study was conducted at diabetic clinic of Sheikh Zayed Medical College/ Hospital, Rahim Yar Khan from September 2016 to February 2017 in which 330 type 2 diabetic patients were randomly divided in to three groups based upon diabetes control according to ADA criteria. Patients in group A with HbA1c /= 9 %[ worst control]. Patients were assessed in terms of complete blood count and C - reactive protein

Results: As compared to excellent control [Group A] patients with worst control [Group C]showed a high leukocyte count [p .001], high neutrophil count [P .003] and lower lymphocyte count [P 0.44] while patients in poor control [Group B]did not differ significantly. Similarly value of NLR was also significantly higher in worst control [Group C] as compared to poor control[Group B] and excellent control [Group A] diabetes [4.3+/-2.8, 2.7+/-1.0 and2.0+/-0.5[p.001]. NLR were found independent predictor of worst diabetes control [OR: 1.809, 95% CI: 1.459-2.401] along with fasting blood sugar [OR: 0.938, 95% CI: 0.995-0.982] and CRP [OR: 1.020, 95% CI: 1.003-1.028]

Conclusion: Increased NLR level is associated with elevated HbA1c and poor glycemic control in patients of type 2 diabetes mellitus. It can be used as a disease monitoring tool during the follow up of diabetic patients

Therapeutic benefits of green tea extract on various parameters in non-alcoholic fatty liver disease patients

Background and Objective: NAFLD affecting up to 30% of the population globally. Drug treatment option are limited with disappointing results. The dietary supplementation in the form of green tea is another option. Our objective was to investigate the effect of Green tea extract [GTE] supplementation on varioi parameters in non-alcoholic fatty liver disease [NAFLD] patients

Methods: This study was conducted Dept. of Medicine of Sheikh Zayed Medical College/Hospital, Rahii Yar Khan from 15 April 2016 to 15 July 2016. Eighty overweight, non diabetic and dyslipidemic patients c NAFLD, diagnosed on the basis of ultrasound and aminotransferases level were randomized for treatmer with capsule GTE SOOmg [n=40] and capsule placebo [n=40] twice a day for twelve weeks. Anthropometri parameters, liver enzymes, inflammatory markers and liver ultrasound imaging were estimated by SPSS-1 pre and post treatment

Results: As compared to placebo, GTE caused a significant improvement in body weight [29.5+/-3.8 t 27.2+/-3.2 kg/m[2] p=0.03], BMI [86+/-10.5 to 80+/-12.4 kg p=0.026], HOMA-IR [4.32+/-2.25 to 3.16+/- 1.6 p=0.0081 lipid profile [i.e. TC: 242.5+/-20.5 to 215.4+/-18.6 mg/dl p=0.005; TG:175+/-22.6 to 145+/-18 mg/dlp=0.003 LDL-C: 155+/-12.5 to 140+/-16.7 mg/dl p=0.011; HDL-C: 36.8+/-6.7 to46.4+/-5.8 mg/dl p =0.001, Aminotransferase: [i.e. ALT: 70.4+/-15.8 to 52.8+/-12.2 IU/L p=0.04; AST:65.8+/-12.4 to 44.3+/- 8.5U/L p =0.002] and Inflammator] markers [hs-CRP: 3.14+/-0.58 to 2.18+/-0.32 p =0.023Adiponectin: 8.46+/-1.02 to 10.55+/-3.42microg/ml p =0.003; GTE also caused a 67.5% regression of fatty liver changes on ultrasound as compared to placebo which is 25% only

Conclusion: GTE therapy resulted in significant improvement in metabolic, chemical, inflammatory and radiological parameters of non-alcoholic fatty liver disease patients who were non-diabetic and dyslipidemic

Frequency of different congenital anomalies in prenatally valproic acid treated chick embryos

Objective: To determine the frequency of different congenital anomalies in surviving chick embryo on hatching after the prenatal administration of valproic acid by comparing with age-matched controls

Study Design: Experimental study

Place and Duration of Study: Anatomy Department, College of Physicians and Surgeons Pakistan [CPSP] Regional Centre, Islamabad, from February 2010 to February 2011

Material and Methods: Thirty fertilized chicken eggs were injected with valproic acid, incubated and then evaluated for different gross congenital anomalies, on hatching or day 22 of incubation whichever was earlier. Chicks of this group were labeled as experimental group-A. Similarly, another group of thirty fertilized chicken eggs labeled as control group-B, underwent sham treatment using normal saline. The weight and length of alive chicks, the total number of chicks with gross anomalies and the number of different types of gross anomalies in both groups were noted and statistically compared

Results: In control group-B, 28 chicks hatch out on 21 day of hatching with no visible gross deformities. Whereas in experimental group-A, 23 chicks were alive, out of which, 9 chicks were with delayed hatching on 22 days of hatching. The chicks with gross deformities were 8 [p=0.0008] which included: limb abnormalities [i.e. inverted feet] in 6 chicks [p=0.006], eye abnormality [i.e. closed palpebral fissure of both eyes] in 2 chick [p=0.2], 1 chick showed multiple deformities including gastroschisis, closed palpebral fissures and inverted foot [p=0.45]

There were behavioral changes in 10 chicks [p=0.0001]. There was statistically significant difference in their weights [p=0.03]

Conclusion: Prenatal exposure of chick embryos to valproic acid increased the incidence of different gross deformities

Vildagliptin ameliorates biochemical, metabolic and fatty changes associated with non alcoholic fatty liver disease

Objective: To determine the effect of Vildagliptin in non-alcoholic, fatty liver disease patients with dyslipidemia

Methods: A randomized placebo controlled trial was conducted at outpatient clinic of Medical Unit-I of Sheikh Zayed Medical College/Hospital, Rahim Yar Khan, in which fifty eight patients of NAFLD with dyslipidemia were divided in to two, case and control groups. The case group was given tablet Vildagliptin 50mg twice a day for twelve weeks and control group was given placebo in same way. Body weight, body mass index [BMI], lipid profile, liver enzymes and ultrasound finding of fatty liver were assayed before and after treatment

Results: After 12 weeks treatment of vildagliptin there was significant improvement in following parameters. Body weight and BMI decreased significantly from 88 +/- 11 to79 +/- 12 kg [p0.036] and 30 +/- 4 to 27 +/- 5 kg/m2 [p 0.005] respectively. Notable reduction in the value of TC, TG and LDL-C [TC: 252 +/- 24 to 220 +/- 20mg/dl [p 0.031]; TG: 190 +/- 24 to115 +/- 22 mg/dl [p 0.005]; LDL-C 160 +/- 15 to 145 +/- 13mg/dl [p 0.004]. HDL-C level increased significantly from 29 +/- 5to45 +/- 4 mg/dl [p 0.001].There was remarkable reduction in aminotransferases level [ALT: 78 +/- 17 to 48 +/- 14IU/L [p 0.036]. AST: 63.3 +/- 13 to41 +/- 11IU/L [p 0.002]. There was overall 65.5% improvement in fatty liver grading on ultrasound with vildagliptin while non significant effects were seen in placebo group in all of the above parameters

Conclusion: Vildagliptin exhibited beneficial effects in non-alcoholic fatty liver disease, Nondiabetic patients with dyslipidemia

developmental gross morphology of pancreas in chick embryo after prenatal administration of valproic acid

To determine the effects of prenatal administration of valproic acid on the developmental gross morphology of pancreas in chick embryo. Experimental study. Anatomy Department, Regional Centre, College of Physicians and Surgeons, Islamabad, from February 2010 to February 2011. An experimental group-A and control group-B, comprised of 30 eggs each. Freshly laid fertilized chicken eggs of experimental group were injected with valproic acid, incubated and hatched. Eggs of control group underwent sham treatment using normal saline. The chicks were sacrificed on hatching or day 22 of incubation, whichever was earlier. The pancreata of only alive chicks of both groups were dissected out, and evaluated for gross morphology in terms of length and weight by statistically comparing with control ones. Then pancreata were stained with aldehyde fuchsin and orange-G stain to study other obvious histological effects, if any. Chicken embryos exposed to valproic acid in ovo, showed significant decrease in length and weight of pancreata. The mean of length [cm] of pancreata in group-A was 2.208 +/- 0.166, and group-B was 2.300 +/- 0.102 [p=0.008]. The mean of weight [g] of pancreata in group-A was 0.032 +/- 0.009, and group-B was 0.048 +/- 0.005 [p=0.001]. Valproic acid exposure showed retarding effect on the gross development of pancreas as depicted by decrease in the length and weight of pancreata

effect of prenatal administration of valproic acid on the survivability and day of hatching of chick embryo

To assess the effects of prenatal administration of valproic acid on the survivability and day of hatching of chick embryo in comparison with age-matched controls. The experimental study was conducted at the Department of Anatomy, Regional Centre of College of Physicians and Surgeons Pakistan, Islamabad, from February 2010 to February 2011. Fertilised chicken eggs were divided into two groups, labelled as experimental group-A and control group-B. Group-A eggs were injected with valproic acid, incubated and hatched. Group-B eggs underwent sham treatment using normal saline. The fully hatched chicks were then evaluated for the day of hatching and survivability, on hatching or on day 22 of incubation whichever was earlier. Outcome was statistically compared with the controls using SPSS 10. The two groups had 30 eggs each. In Group-A 23[76.66%] chicks hatched out, while there were 7[23.33%] dead chicks. In Group-B, 28[93.33%] chicks hatched out and 2[6.66%] were dead. Chicken embryos exposed to valproic acid in ovo showed increased mortality [p<0.001] and delayed hatching [p<0.001]. Prenatal exposure of chick embryos to valproic acid decreased embryo survival and also delayed hatching compared to age-matched controls