Insulin therapy in diabetes type 2: indications modalities and results

After several years of evolution, insulin therapy becomes necessary in type 2 diabetes mellitus. However there is still an ongoing controversy in the studies devoted to this subject. The objective of our retrospective study was to evaluate the indications, the modalities and the results of insulin treatment in 106 patients with type 2 diabetes. Insulin treatment was temporary in 20 patients [18.86%] and definitive in 86 patients [81.14%]. The therapeutic protocol used a combined treatment with oral hypoglycaemic agents in 11 cases [10.38%], a conventional treatment in 48 cases [45.28%] or an intensive therapy in 47 cases [44.34%]. The outcome could be evaluated in 86patients after 6 months and 1 year. At the first follow-up [6 months], 59 patients [68.6%] had a significant reduction in fasting glycemia [7.8 vs 15.5 mmol/l], post prandial glycemia [8.9 vs 25.8 mmol/l] and glycated haemoglobin [6.9% vs 10.2%]. 69 patients [80.24%] had a mean weight gain of 7 +/- 5 kg and 8 [7.5%] had hypoglycaemic episodes. In the total number of 59 patients who improved with the insulin treatment, 46 patients 77.96% were treated with the intensive insulin protocol. Insulin treatment in type 2 diabetic patients seems to have a limited risk of hypoglycaemia but causes an important weight gain

Is there a role for islet cell antibodies [ICA] in hepatitis C virus-diabetes mellitus mysterious link?

There is an increasing evidence of strong association between hepatitis C virus [HCV] and diabetes mellitus particularly, non-insulin dependent diabetes mellitus [NIDDM], the cause of which is still obscure. Autoantibodies of different types have been screened in-patients with HCV. The presence of islet cell antibodies was conducted to clarify the possible role of ICA in this association and to find any correlation between ICA and other autoantibodies. We studied 48 patients with HCV as diagnosed by RIBA II and PCR. Patients were divided into group I [NIDDM group] and group II [Non diabetic group]. Group I comprised 14 males and 10 females with a mean age of 39,75 +/- 6 years, group II comprised 16 males and 8 females with a mean age of 39.60 +/- 5.8 years. Non of the patients received antiviral therapy. They were tested for: Blood glucose, liver functions [ALT, AST, Alkaline Phosphatase, Albumin and Prothrombin time]. The following non organ-specific autoantibodies were screened: Anti-mitochondrial antibodies [AMA], anti-smooth muscle antibodies [ASMA], and antinuclear antibodies [ANA]. Islet cell antibodies [ICA] were screened in their sera by indirect immunoflurescence test [Inova Lite, Research kit]. The results of the study showed relatively increased prevalence of ICA in group I [33.3%] than in group II [12.5%], but the difference was statistically non significant [P > 0.05], In group I A MA, ASMA and ANA were positive in 8.3%, 41.6% and 20.8% respectively, while in group II they were positive in 8.3%, 37.5%. and 16.7% respectively, with no statistical significant difference between both groups. ICA correlated significantly with ASMA in both groups and with ANA only in group II. No correlation was detected between ICA and AMA. Neither ICA nor other studied auto-antibodies did correlate to any of the studied liver functions, in group I, ICA did not correlate to either patient's age, sex or family history of diabetes. In [1] The HCV-Diabetes Mellitus Link deserves careful evaluation, [2] ICA alone could not explain the relatively high incidence of diabetes mellitus in HCV patients, [3] ICA might be present in the sera of HCV patients as a part of immune disturbances present in the disease. [4] There is a significant correlation between ICA and ASMA, [4] HCV might trigger an autoimmune phenomena that persist even after cessation of the disease activity, [5] other possible mechanisms for HCV-diabetes mellitus link might be: iron overload, metabolic effect, receptor and /or post-receptor effect, viral pancreatitis or HLA association

Transient reversible acute drug-hepatitis and renal failure, in a peptic ulcer patient under cimetidine [Tagamet R]

Though some therapeutic drugs and alcohol are known to induce non-infectious hepatitis, yet the drug related hepatitis is not widely documented, while the role of alcohol is well known and established with many publications. In this study, an interesting case of acute drug- hepatitis and renal failure in a Saudi patient with peptic ulcer, who was under Cimetidine [Tagamet R] tablets for one year, was reported. A rapid and dramatic improvement followed the withdrawal of the drug. Clinical, laboratory findings and recommendations were discussed

Ultrastructural observations of human pulp healing following exposure

Traumatic exposures were done under local anesthesia in eight human maxillary premolars from patients [12-20 years]. The exposure was capped with calcium hydroxide, then filled with zinc oxide. Three teeth were extracted after two days and five teeth after one week. After two days the pulp showed numerous defensive pulp cells which migrated to the area with accumulation of inflammatory cells, fragments of cell organels and some aggregation of calcium hydroxide. The pulp cells showed increase in size with extensive development and proliferation of rough endoplasmic reticulum. Macrophages appeared in close contact with the fibroblasts. Irregularly arranged collagen fibrils were seen between the cells. One week following the operative procedure, the pulp showed an increase in the rough endoplasmic reticulum with marked distention of the cisternea. The mitochondria and the Golgi aparatus were well developed. Newly formed collagen fibres could be identified by the presence of active differentiated cells. Some minute foci of calcification were seen along the collagen fibres. It seems that collagen is capable to induce precipitation of calcium