Causas precipitantes de crisis hiperglicémicas agudas en pacientes internados en el Centro Médico Nacional - Hospital Nacional / Precipiting causes of acute hyperglycemic crisis in patients in the Centro Médico Nacional - Hospital Nacional

Introducción: las crisis hiperglicémicas agudas son las emergencias endocrinológicas más frecuentes en la práctica clínica y junto a la hipoglucemia se las describe como las complicaciones metabólicas agudas graves del paciente diabético. Objetivo: identificar las causas precipitantes de crisis hiperglicémicas agudas en pacientes internados en el Centro Médico - Hospital Nacional. Metodología: estudio observacional, descriptivo, de corte transversal de pacientes internados en el Centro Médico Hospital Nacional, durante el periodo de mayo 2021 a octubre del 2023. Los datos fueron obtenidos con la revisión de las fichas clínicas. Resultados: de los 100 pacientes evaluados, la crisis hiperglicémica aguda más frecuente fue la Cetoacidosis diabética (CAD) 53 %, seguida del Estado hiperosmolar hiperglicémico (EHH) 25 % y el estado mixto 22 %. Los desencadenantes más frecuentes fueron el abandono del tratamiento, debut de la enfermedad e infecciones. La mortalidad global fue del 12 %. Conclusión: la causa más frecuente de descompensación fueron el abandono del tratamiento, la diabetes de novo y procesos infecciosos.

Introduction: hyperglycemic crises are the most frequent endocrinological emergencies in clinical practice and, along with hypoglycemia, are described as serious acute metabolic complications in diabetic patients. Objective: to identify the precipiting causes of acute hyperglycemic crisis in hospitalized patients in the Centro Médico Nacional - Hospital National. Methodology: this was an observational, descriptive, cross -sectional study of patients hospitalized at the Centro Médico Nacional - Hospital National, from May 2021 to October 2023. The data were obtained from a review of the clinical records. Results: Of the 100 patients evaluated, the most frequent acute hyperglycemic crisis was diabetic ketoacidosis (CAD) 53 %, followed by the hyperglycemic hyperosmolar state (EHH) 25 % and the mixed state 22 %. The most frequent triggers were the abandonment of treatment, disease debut and infections. Global mortality was 12 %. Conclusion: the most frequent causes of decompensations were abandoning treatment, novo diabetes and infectious processes.

Anti-hyperglycemic and anti-hyperlipidemic effects of a methanolic extract of Debregeasia salicifolia in Alloxan-induced diabetic albino mice

Abstract Diabetes mellitus (DM), an endocrine syndrome characterized by high blood glucose levels due to abrogated insulin activity. The existing treatments for DM have side effects and varying degrees of efficacy. Therefore, it is paramount that novel approaches be developed to enhance the management of DM. Therapeutic plants have been accredited as having comparatively high efficacy with fewer adverse effects. The current study aims to elucidate the phytochemical profile, anti-hyperlipidemic, and anti-diabetic effects of methanolic extract D. salicifolia (leaves) in Alloxan-induced diabetic mice. Alloxan was injected intraperitoneally (150 mg kg-1, b.w), to induced diabetes in mice. The mice were divided into three groups (n=10). Group 1 (normal control) received normal food and purified water, Group II (diabetic control) received regular feed and clean water and group III (diabetic treated) received a methanolic extract of the plant (300 mg kg-1) for 28 days with a typical diet and clean water throughout the experiment. Blood samples were collected to checked serum glucose and concentration of LDL, TC, TG. The extract demonstrated significant antihyperglycemic activity (P 0.05), whereas improvements in mice's body weight and lipid profiles were observed after treatment with the extract. This study establishes that the extract has high efficacy with comparatively less toxicity that can be used for DM management.

Resumo Diabetes mellitus (DM) é uma síndrome endócrina caracterizada por níveis elevados de glicose no sangue devido à atividade anulada da insulina. Os tratamentos existentes para o DM têm efeitos colaterais e vários graus de eficácia. Portanto, é fundamental que novas abordagens sejam desenvolvidas para aprimorar o manejo do DM. As plantas terapêuticas foram acreditadas como tendo eficácia comparativamente alta com menos efeitos adversos. O presente estudo visa elucidar o perfil fitoquímico, efeitos anti-hiperlipidêmicos e antidiabéticos do extrato metanólico de D. salicifolia (folhas) em camundongos diabéticos induzidos por aloxana. Alloxan foi injetado por via intraperitoneal (150 mg kg-1, b.w), para induzir diabetes em camundongos. Os camundongos foram divididos em três grupos (n = 10). Grupo 1 (controle normal) recebeu ração normal e água purificada, Grupo II (controle diabético) recebeu ração regular e água limpa, e o grupo III (tratamento diabético) recebeu extrato metanólico da planta (300 mg kg-1) por 28 dias com uma dieta típica e água limpa durante todo o experimento. Amostras de sangue foram coletadas para verificar a glicose sérica e a concentração de LDL, TC, TG. O extrato demonstrou atividade anti-hiperglicêmica significativa (P 0,05), enquanto melhorias no peso corporal e no perfil lipídico dos camundongos foram observadas após o tratamento com o extrato. Este estudo estabelece que o extrato tem alta eficácia com comparativamente menos toxicidade e pode ser usado para o controle do DM.

In-vitro Anti-hyperglycemic Evaluation of Hydroalcoholic Extract of Delonix regia Bark

Anti-hyperglycemic agents is a substance that helps a person with diabetes control their level of glucose (sugar) in the blood. It includes insulin and oral anti-hyperglycemic agents. Diabetes is a metabolic disorder characterized by increased blood glucose levels leading to other major complications. Thus, obtaining these anti hyperglycemic agents through easily available flora is necessary. Delonix regia , a tree cultivated worldwide, has also been used as traditional medicine in various disorders. Aim of the project work was to evaluate the anti-hyperglycemic activity in the hydroalcoholic extract of D. regia bark for the treatment of hyperglycemia. The collected bark was dried, powdered and extracted through cold maceration method. The extract was further concentrated to obtain a gummy mass of the hydroalcoholic extract. The extract was subjected to phytochemical analysis through conventional chemical tests and GC-MS. After the identification of the phytoconstituents, they were studied for their clinically proven properties. In-vitro anti-hyperglycemic studies were carried out through assays like alpha-amylase inhibition assay and alpha-glucosidase inhibition assay. The results of the extract were compared with results of standard acarbose. The IC 50 standard values in alpha-amylase inhibition assay and ?-glucosidase inhibition assay were 98.77 and 84.33 ?g/mL, respectively. The IC 50 values of hydroalcoholic extract of D. regia bark in alpha-amylase and alpha-glucosidase inhibition assay were 167 and 116.31 ?g/mL, respectively. From the study, the hydroalcoholic extract of bark of D. regia exhibit anti-hyperglycemic activity compared to standard acarbose.

Anti-hyperglycemic fraction from Alternanthera sessilis L. leaves gets elucidated following bioassay-guided isolation and mass spectrometry

Abstract The anecdotal use of Alternanthera sessilis L. as a relief for diabetes has been known in the Philippines for generations, and antidiabetic activity of similar varieties in other countries is likewise documented. However, the compounds responsible for this activity remain unclear. This study aims to isolate the anti-hyperglycemic fraction of local A. sessilis leaves and identify the compounds in this fraction. Methanol extract of A. sessilis leaves and its hexane, ethyl acetate (ASE), and water fractions were administered to alloxan-induced diabetic mice. ASE (250mg/kg) had the highest anti-hyperglycemic activity at 6-h post-treatment (25.81%±12.72%), with almost similar blood glucose reduction rate as metformin (30.13±3.75%, p=0.767). Repeated fractionation employing chromatographic separation techniques followed by in vivo anti-hyperglycemic assay yielded partially purified subfractions. A. sessilis ethyl acetate subfraction 4-2 (100mg/kg) displayed remarkable suppression of blood glucose rise in diabetic mice at 6-h post-treatment (26.45±3.75%, p<0.0001), with comparable activity with metformin (100mg/kg, 27.87±5.65%, p=0.652). Liquid chromatography/mass spectrometry showed eight distinct peaks, with four peaks annotated via the Traditional Chinese Medicine library and custom library for A. sessilis. Among these, luteolin, apigenin, ononin, and sophorabioside were identified as putative compounds responsible for the anti-hyperglycemic activity. This result provided basis for the reported anecdotal claims and potential utility of the local variety of A. sessilis leaves as sources of anti-hyperglycemic agents

Changes of 1, 5-AG in Vitreous Humor of Rabbit Cadavers with Hyperglycemic Metabolism / 法医学杂志

OBJECTIVES@#To investigate the concentration and change characteristics of 1, 5-anhydroglucitol (1, 5-AG) in the vitreous humor of rabbit cadavers with hyperglycemic metabolism, and to explore the value of 1, 5-AG in forensic pathology identification of death caused by hyperglycemic metabolism disorders.@*METHODS@#A diabetic hyperglycemic rabbit model was established by using alloxan. Eighteen rabbits with fasting glucose concentration ≥13.80 mmol/L (experimental group) and 18 healthy rabbits with fasting glucose concentration ≤6.10 mmol/L (control group) were selected. After death from air embolism. The blood samples were collected immediately, and vitreous humor samples were collected at 0 h, 12 h, 24 h and 36 h after death. The concentration of 1, 5-AG in the blood and vitreous humor of rabbits was determined.@*RESULTS@#The blood glucose concentration in the experimental group was (25.10±3.14) mmol/L. At the time of death, there was no significant difference in the concentration of 1, 5-AG in the blood [(0.94±0.20) μg/mL] and in the vitreous humor (0.99±0.05 μg/mL, P>0.05). The concentration of 1, 5-AG in the vitreous humor of the experimental group was lower than that of the corresponding control group at all time points (P<0.05), and there was no significant difference betwwen 1, 5-AG concentration in vitreous humor between earch time point in the experimental group and the control group (P>0.05). Correlation analysis showed that the concentration of 1,5-AG in blood was negatively correlated with blood glucose in both control group and experimental group (control group: r=-0.79, P<0.05; experimental group: r=-0.97, P<0.05).@*CONCLUSIONS@#Vitreous humor can replace blood as an effective test sample for 1,5-AG detection. The concentration of 1, 5-AG in rabbit vitreous humor remains stable within 36 hours after death and is not affected by the change of postmortem interval. If the concentration of 1, 5-AG decreases significantly, it indicates the existence of hyperglycemia in rabbits before death.

Research on hypoglycemic activity of Osmanthus fragrans var. thunbergii extract / 药学学报

This study aimed to assess the hypoglycemic activity, and in vitro inhibition of α-glucosidase, inhibition of the advanced glycation end products (AGEs), and total antioxidant capacity were used to clarify its bioactivity. Furthermore, the potential hypoglycemic active chemical constituents in the aqueous extract of Osmanthus fragrans var. thunbergii flower were characterized using high performance liquid chromatography-electrospray ionization-quadruple time-of-flight mass spectrometry (HPLC-ESI-QTOF-MS) method. The result showed that in vitro inhibition of α-glucosidase of the extract (IC50 = 2.11 ± 0.26 mg·mL-1) were similar to acarbose (IC50 = 2.88 ± 0.32 mg·mL-1), and it inhibited the AGEs formation and the total antioxidant capacity in a certain extent. Based on the MS fragmentation pathway analysis of reference chemical acteoside contained in this extract, and related references, 73 constituents were tentatively identified from the aqueous extract of Osmanthus fragrans var. thunbergii flower, including 58 phenylethanoids, 8 caffeoylquinic acids, 1 flavonoid vicenin-2, and 6 common organic chemicals in plant. Furthermore, 8 unknown alkaloids were characterized in this work. Among of these chemicals, 61 phenylethanoids were supposed to be detected for the first time. In conclusion, this work disclosed the potential hypoglycemic active constituents of Osmanthus fragrans var. thunbergii flower.

Presentación mixta de cetoacidosis diabética y estado hiperosmolar hiperglucémico en el embarazo: reporte de caso / Mixed presentation of diabetic ketoacidosis and hyperglycemic hyperosmolar state in pregnant woman: Case report

Resumen ANTECEDENTES: La cetoacidosis diabética y el estado hiperosmolar hiperglucémico son complicaciones agudas de la diabetes que se superponen en uno de cada cuatro casos, y cada una pone en peligro la vida de la madre y del feto. Existe poca información acerca del diagnóstico y tratamiento de las complicaciones agudas de la diabetes en el embarazo. OBJETIVO: Reportar el caso de una embarazada sin controles prenatales y sin antecedentes personales ni familiares de importancia que tuvo una crisis hiperglucémica mixta asociada con eclampsia y óbito. CASO CLÍNICO: Paciente primigesta, de 21 años, con 33 semanas de embarazo que ingresó al hospital debido a: náuseas, disnea y ausencia de movimientos fetales. Al ingreso se encontró somnolienta y con presión arterial elevada. Los exámenes de laboratorio se reportaron compatibles con cetoacidosis diabética y estado hiperosmolar hiperglucémico. A pesar del tratamiento, sobrevino la eclampsia. El embarazo finalizó mediante cesárea, con un recién nacido sin latidos cardiacos. La paciente evolucionó favorablemente con la atención multidisciplinaria. Fue dada de alta con valores de glucosa y presión arterial en límites normales. CONCLUSIÓN: Las crisis hiperglucémicas durante el embarazo se asocian con morbilidad y mortalidad materna y fetal, además de trastornos hipertensivos. El diagnóstico temprano de diabetes en los controles prenatales es fundamental para evitar este cuadro.

Abstract BACKGROUND: Diabetic ketoacidosis and hyperglycemic hyperosmolar state are acute complications of diabetes. These two overlap in one in four cases, and each endangers the life of the mother and the fetus. There is little information about the diagnosis and management of acute complications of diabetes in pregnancy. OBJECTIVE: To report the case of a pregnant woman without prenatal controls and without significant personal or family history who developed a mixed hyperglycemic crisis associated with eclampsia and death. CLINICAL CASE: 21-year-old primigravida admitted at 33 weeks' gestation due to nausea, dyspnea and absence of fetal movements. She was drowsy and had high blood pressure values. Laboratory tests were consistent with a mixed presentation of diabetic ketoacidosis and hyperosmolar hyperglycemic state. Despite treatment, the patient developed eclampsia. Cesarean delivery was performed, extracting a newborn without fetal heartbeat. The patient evolved favorably with multidisciplinary management. She was discharged with glucose and blood pressure values within normal limits. CONCLUSION: Hyperglycemic crises in pregnancy are associated with maternal-fetal morbidity and mortality and hypertensive disorders of pregnancy. Early diagnosis of diabetes in prenatal checkups is essential to avoid this condition.

Analysis of demographic and clinical characteristics of 1668 patients with different types of hyperglycemic crisis / 中华内分泌外科杂志

Objective:To analyze and compare the demographic and clinical characteristics of patients with different types of hyperglycemic crisis, so as to provide clinical basis for the prevention and treatment of hyperglycemic crisis.Methods:The data of patients with hyperglycemic crisis in six First-level general hospitals in Chongqing from Jan. 2015 to Dec. 2020 were retrospectively collected and divided into diabetic ketoacidosis (DKA) , hyperglycemic hyperosmolar state (HHS) and diabetic ketoacidosis with hyperglycemic hyperosmotic state (DKA-HHS) . The demographic and clinical characteristics of each group were analyzed by descriptive method.Results:A total of 1668 patients were collected, among whom1388 were DKA, 113 were HHS and 167 were DKA-HHS. The proportion of T2DM in DKA was 90.1%, the proportion of urban residents’ medical insurance, farmers and retirees was higher in the three groups, and the incidence of hyperglycemic crisis in patients above 60 years old was the highest in all age groups. The incidence of DKA and HHS changed little during the six years, but increased significantly in the DKA-HHS group. Shock, disturbance of consciousness, hospitalization expenses and mortality in the DKA-HHS group were higher than those in the other two groups.Conclusions:There are differences in demographic and clinical characteristics among different types of hyperglycemic crisis. Clinically, more attention should be paid to patients above 60 years old and patients with hyperglycemic crisis such as DKA-HHS. Health education and guidance for diabetic patients in high-risk groups should be strengthened in order to reduce the occurrence of diabetic hyperglycemic crisis.

Hyperglycemic memory in diabetic cardiomyopathy / 医学前沿

Cardiovascular diseases account for approximately 80% of deaths among individuals with diabetes mellitus, with diabetic cardiomyopathy as the major diabetic cardiovascular complication. Hyperglycemia is a symptom that abnormally activates multiple downstream pathways and contributes to cardiac hypertrophy, fibrosis, apoptosis, and other pathophysiological changes. Although glycemic control has long been at the center of diabetes therapy, multicenter randomized clinical studies have revealed that intensive glycemic control fails to reduce heart failure-associated hospitalization and mortality in patients with diabetes. This finding indicates that hyperglycemic stress persists in the cardiovascular system of patients with diabetes even if blood glucose level is tightly controlled to the normal level. This process is now referred to as hyperglycemic memory (HGM) phenomenon. We briefly reviewed herein the current advances that have been achieved in research on the underlying mechanisms of HGM in diabetic cardiomyopathy.

Clinical profile of adult patients with Hyperglycemic Crisis at the De La Salle University Medical Center, a ten-year retrospective study

Abstract@#This current study aims to report the clinical profiles and characteristics of diabetic patients who had been admitted for hyperglycemic crises from 2007 to 2017 at our institution. @*Methodology@#We conducted a retrospective study in a tertiary care university hospital outside Metro Manila. The data gathered were divided into three categories: clinical data, biochemical data and precipitating factors. @*Results@#A total of 3,120 adult patients with diabetes mellitus were admitted for various reasons, and 71 cases presented with DKA or HHS over the 10-year period of review which is equivalent to 2% of all diabetes mellitus cases admitted. Forty-six (64.79%) of the patients with hyperglycemic crises were known diabetics with a duration of 7-13 years. Majority of patients were not taking anti diabetic medications upon admission. Most patients with hyperglycemic crises were tachycardic and hypertensive upon admission. Majority were discharged and improved. Majority of the cases 53 (81.69%) had DKA. The most common precipitating factor in DKA and HHS was infection.@*Conclusion@#In conclusion, the biochemical profiles in our series did not significantly differ from the past study by Gatbonton et.al (1998). Despite the advent of new therapies for diabetes mellitus control, mortality among the patients with hyperglycemic crises was slightly higher in our study at 11% compared to the global reported data of 2-10%. One of the reasons could be the minimal improvements in our health care delivery system that is still unable to cater to the needs of diabetic Filipinos. Early screening programs should be done for patients beginning age 40 years and even earlier for those with risk factors for prompt detection and treatment of diabetes mellitus. Education and awareness should be strengthened for patients with diabetes mellitus to avoid the crises by emphasizing the importance of regular follow-up, monitoring and compliance with a diabetic regimen, especially with insulin and multiple OADs (oral anti- diabetic drugs) since the disease is progressive, and timely intensification of therapy is needed.

Cetoacidosis diabética: características epidemiológicas y letalidad en adultos atendidos en un hospital universitario en Colombia / Epidemiological characteristics and lethality of adults with diabetic ketoacidosis treated in a university hospital in Colombia

RESUMEN Introducción: la cetoacidosis diabética es una de las complicaciones agudas más graves de la diabetes. Pocos estudios en Latinoamérica describen el perfil clínico y los desenlaces de la población adulta con esta condición. El objetivo de este estudio es determinar las características demográficas y clínicas de los pacientes adultos con esta enfermedad. Para esto se hizo énfasis en los factores precipitantes y en la determinación del porcentaje de letalidad intrahospitalaria por cualquier causa. Métodos: estudio de cohorte retrospectivo de pacientes mayores de 18 años admitidos por cetoacidosis diabética en el Hospital Universitario San Vicente Fundación de Medellín-Colombia, entre enero de 2012 y diciembre de 2015. Resultados: se incluyeron 159 pacientes con diagnóstico de cetoacidosis diabética. La mediana de la edad fue de 46 años. 40 individuos (25,2 %) tenían diabetes tipo 1, 107 (67,3 %) diabetes tipo 2 y, 12 (7,6 %), otro tipo de diabetes. El factor precipitante de cetoacidosis diabética más común fue la suspensión del tratamiento hipoglucemiante (36 %), seguida de infección (32 %) y diabetes de novo (28 %). La mediana de la estancia hospitalaria fue de 8 días. 12 pacientes fallecieron. Conclusión: la evaluación de los casos de cetoacidosis diabética en este estudio demostró diferencias importantes en la presentación clínica de aquellos con diabetes tipo 1 y tipo 2. La suspensión del tratamiento fue el factor precipitante más frecuente, seguido por la infección. La letalidad en este estudio fue de 7,5 %, superior a la tasa de 1 % que tienen los países desarrollados, evidenciando la necesidad de mejorar la atención de estos pacientes.

SUMMARY Importance: Ketoacidosis is one of the most serious complications of diabetes. Few studies in Latin Ameri-ca describe the clinical profile and outcomes of adults with diabetic ketoacidosis. We proposed to determine demographic and clinical features, precipitating fac-tors and mortality in adults with diabetic ketoacidosis at a university hospital. Methods: A retrospective cohort study of patients older than 18 years of age admitted to the Hospital Universitario San Vicente Fundación (Medellín, Colombia) were reviewed from 2012 to 2015. Results: 159 adult patients with diabetic ketoacidosis were included. The median age was 46 years. Forty patients (25,2 %) had type 1 diabetes, 107 (67,3%) type 2 diabetes and 12 (7,6%) other types of diabetes. The most common diabetic ketoacidosis precipitating factor was suspension of medical treatment (36%), followed by infection (32%) and new diagnosis of diabetes (28%). The median hospital stay was 8 days. Twelve patients died. Conclusion: The evaluation of patients with diabetic ketoacidosis in this study showed important differences in the clinical presentation of those with type 1 and type 2 diabetes. Suspension of treatment was the most frequent precipitating factor, followed by infection. Mortality in this cohort was 7,5% compared to 1% in developed countries, showing the need to urgently improve the care of these patients.

The role of renal 5-hydroxytryptamine synthesis and degradation in hyperglycemia-induced kidney injury / 药学学报

Hyperglycemic kidney injury (HKI) is a common complication of diabetic patients. We examined the relationship between HKI and the abnormal expression of 5-hydroxytryptamine (5-HT) system induced by hyperglycemia in type 2 diabetes mellitus (T2DM). In animal experiments, a T2DM model was established in mice by feeding a high-fat diet with intraperitoneal injection of streptozotocin. The mice were treated with the 5-HT2A receptor (5-HT2AR) antagonist sarpogrelate hydrochloride (SH) and 5-HT synthesis inhibitor carbidopa (CDP) (respectively or in combination). In cell culture experiments, human glomerular mesangial cells (HMC) were stimulated with D-glucose (D-Glu), and 5-HT2AR, 5-HT synthesis, and 5-HT degradation were inhibited by SH, CDP, or monoamine oxidase A (MAO-A) inhibitor clorgyline. Periodic acid-Schiff (PAS) staining and Masson staining, immunohistochemistry and Western blot, fluorescent probe, and enzyme linked immunosorbent assay (ELISA) and enzyme reagent were respectively used to detect histopathology, protein expression, intracellular reactive oxygen species (ROS), and biochemical indexes. The animal experiments were in accordance with the regulations of the Animal Ethics Committee of China Pharmaceutical University. The results showed that 5-HT2AR, 5-HT synthases, and MAO-A were expressed in glomerular basement membrane and kidney tubular epithelial cells of mouse kidney and HMC. The expression of these proteins was significantly up-regulated in T2DM mice or when HMC cells were exposed to high concentration of D-Glu. HKI, characterized by abnormal renal function, glomerular swelling, and glomerular basement membrane thickening and fibrosis, is closely associated with an increase in kidney 5-HT2AR, 5-HT synthesis, and 5-HT degradation. Among them, 5-HT2AR can mediate the expression of 5-HT synthases and MAO-A; MAO-A can catalyze the degradation of 5-HT to increase the production of mitochondrial ROS, leading to the phosphorylation of nuclear factor kappa B (NF-κB) with the production of inflammatory cytokines, and the up-regulation of matrix metalloproteinase-2 (MMP-2) and α-smooth muscle actin (α-SMA) with the production of collagens. SH and CDP can effectively treat HKI, and the combination of SH and CDP has a clear synergistic effect.

Anti-hyperglycemic Effects of Diacerein in Alloxan-Induced Diabetes Mellitus in Wistar Albino Rats

Objective: To determine the anti-hyperglycemic effects of interleukin-1 inhibitor (diacerein) in alloxan induced diabetic albino wistar rats. This experimental study was performed at the Department of Animal Husbandry and Veterinary Sciences, Sindh Agriculture University, Tando Jam within 6 months from April 2016 to September 2016. Total of 160 adult Albino Wistar Rats having an average of 200 to 300 grams body weights were selected. Animals were categorized into 4 groups as;  Group A (n=15): Control rats – receive 0.9% normal saline as placebo Experimental Groups  Group B (n=15): Experimental Control (Diabetic rats) - Alloxan50 mg/kg body weight intraperitoneal.  Group C (n=15): Diabetic rats + Diacerein (30 mg/kg/day) orally daily.  Group D (n=15): Diabetic rats + Diacerein (50 mg/kg/day) orally daily. Animals were kept and treated as per the NIH Guideline for Use and Care of Laboratory Animals. Diabetes mellitus was induced via a single intraperitoneal injection of 50 milligram/kg alloxan monohydrated dissolved in aseptic 0.9% saline. After 72 hours, blood specimens were taken from the caudal vein of the rats and glucose level>200 mg/dL was taken as diabetes. Experimental rats were given diacerein approximately 30 and 50 mg orally for 6 weeks. At the completion of experiment the body weight was measured of each animal by electronic measuring balance and blood sample was taken from each animal of all groups to assess the blood glucose level and HbA1c level. Data were recorded via self-made proforma and analysis was done by using SPSS version 20. Results: Average body weight of Diabetic control (Group B) was 193.33±22.50 grams, which was lower in contrast to Diacerein treated group C 202.47±25.70 grams and significantly lower as compared to Diacerein treated group D as 212.6±23.43 grams. A significant increase in blood glucose levels 182.07±10.63 mg/dl was noted in the Diabetic control (Group B) compared to Diacerein treated group C (110.13± 8.54 mg/dl) and group D (85.87±8.41 mg/dl) (P=0.001). HbA1c was markedly raised in the Group B- diabetic controls, while diacerein treated diabetic rats (groups C and D) showed a significant decrease in HbA1c (P=0.001). Conclusion: It was concluded that Diacerein achieves the Euglycemic state by reducing the levels of blood glucose and glycated hemoglobin (HbA1c) in Alloxan-Induced diabetes mellitus in Wistar Albino Rats

Afasia como debut de estado hiperosmolar hiperglicémico. Caso clínico / Aphasia as the presenting symptom of a hyperglycemic hyperosmolar state. Case report

Neurological manifestations such as seizures, disorders of consciousness and abnormal movements such as hemichorea and hemiballismus can be the presenting symptoms of hyperglycemic hyperosmolar states. Exceptionally, focal signs as hemiparesis or aphasia are described. We report a 66-year-old man, presenting with nonfluent aphasia and right subtle hemiparesis. The computed tomography, computed tomography angiography and brain magnetic resonance did not show acute ischemic lesions or obstruction of arterial vessels. The initial laboratory evaluation disclosed a blood glucose of 936 mg/dL, a plasma osmolality of 331 mOsm/Kg, and positive plasma ketones. After the treatment of hyperglycemia and hyperosmolality, focal symptoms subsided.

Effects of 6-phosphofructokinase-2/fructose-2,6-bisphosphatase 3 on tubule formation of human umbilical vein endothelial cells / 中国组织工程研究

BACKGROUND: The research on neovascularization in diabetic retinopathy is mostly limited to vascular endothelial growth factor, but 6-phosphofructoklnase-2/fructose-2,6-diphosphatase (PFKFB3) also plays a certain role. OBJECTIVE: To Investigate the effect of PFKFB3-SÍRNA on human umbilical vein endothelial cells (HUVECs) In high glucose environment. METHODS: HUVECs were divided Into four groups: Normal glucose control group (5.5 mmol/L glucose), normal glucose+PFKFB3-slRNA group (5.5 mmol/L glucose+PFKFB3-siRNA), high glucose group (30 mmol/L glucose), high glucose+PFKFB3-slRNA group (30mmol/L glucose+PFKFB3-slRNA). Western blot assay was used to detect the silencing effect of PFKFB3 expression. PFKFB3 with optimal silencing effect was selected for subsequent experiments. The tubule formation was detected by in vitro tubule formation assay. The expression of PFKFB3 mRNA was detected by real-time fluorescent quantitative PCR. The expression of PFKFB3 and AKT protein was detected by western blot. RESULTS AND CONCLUSION: PFKFB3-SÍRNA significantly inhibited the expression of PFKFB3 (P 0.05). Compared with the high glucose group, the tube formation ability of the high glucose+PFKFB3-siRNA group was significantly increased (P 0.05). Compared with the high glucose group, the ratio of p-AKT/AKT protein in the high glucose+PFKFB3-siRNA group was increased (P < 0.01). To conclude, siRNA silencing of PFKFB3 gene expression can inhibit the expression of PFKFB3 and improve tube formation in HUVECs. The mechanism may be related to the down-regulation of AKT expression.

Morphological, phytochemical and anti-hyperglycemic evaluation of Brachychiton populneus

Abstract Brachychiton populneus (Schott & Endl.) R.Br., Malvaceae, is one of five Brachychiton species cultivated in Egypt. Little information was found concerning the morphological, phytochemical and biological investigations of B. populneus. Morphological investigations of B. populneus were performed on fresh and dried leaves. Air-dried, ground leafy branches were extracted with 70% methanol/water yielding B. populneus extract. Seventeen flavonoids were isolated and identified using different chromatographic and spectroscopic techniques; eleven of them were reported for the first time from this plant. Potential activity of B. populneus extract against alloxan inducing oxidative stress and diabetes in male rats was preliminary investigated (four groups of ten rats /group). B. populneus extract (500 mg/kg bw i.p.) exhibited significant acute anti-hyperglycemic activity with blood glucose levels of 227.3 and 157.6 mg/dl after 4 and 24 h, respectively, compared to alloxan and standard Diamicron (5 mg/kg bw p.o.) groups, as well as to a normoglycemic control group at p < 0.05. The extract reverted the body weight values of the alloxan-induced diabetic rats to that of control animals after 24 h. In addition, B. populneus extract counteracted the effect of the oxidative stress induced by alloxan causing significantly increase in the glutathione content level (2.35 mmol/l) and relative decrease in the malondialdehyde level (21.31 nmol/l) and nitric oxide content (1.98 µmol/l) in serum after 24 h of treatment compared to alloxan-induced diabetic rats (1.01 mmol/l, 118.9 nmol/l, 4.69 µmol/l, respectively) and to normoglycemic control at p < 0.05. These effects appear to be related to the flavonoid principles. The intergeneric relationship of the genus Brachychiton and other related genera assessed well-supported differentiation between them. Furthermore, a significant dissimilarity was observed at interspecific level.

Distúrbio de movimento por conta de estado hiperosmolar não cetótico em idosa: relato de caso / Movement disorder caused by hyperosmolar hyperglycemic state in an older adult: a case report

O diabetes e suas complicações constituem as principais causas de mortalidade precoce na maioria dos países. O envelhecimento da população e a crescente prevalência da obesidade e do sedentarismo, além dos processos de urbanização, são considerados os principais fatores responsáveis pelo aumento da incidência e da prevalência do diabetes mellitus (DM) em todo o mundo. Este relato de caso objetiva descrever a presença de distúrbio do movimento em idoso por conta do estado hiperosmolar não cetótico. A combinação de hemicoreia-hemibalismo, hiperglicemia não cetótica e envolvimento dos gânglios da base em exames de imagem é considerada uma síndrome única. Os distúrbios do movimento em estado hiperosmolar não cetótico apresentam resposta terapêutica satisfatória com o uso de neurolépticos e controle glicêmico adequado. A escassez de trabalhos publicados proporciona subdiagnósticos clínico e laboratorial, interferindo no prognóstico e no acompanhamento dos pacientes.

Diabetes mellitus (DM) and its complications constitute the leading causes of early mortality in most countries. Population aging and the growing prevalence of obesity and sedentary lifestyles, in addition to spreading urbanization, are considered the main drivers of the increasing incidence and prevalence of DM worldwide. This case report describes the acute onset of movement disorder in an older woman secondary to hyperosmolar hyperglycemic state (HHS). The combination of hemichorea­hemiballismus, HHS, and evidence of basal ganglia involvement on neuroimaging is considered a unique syndrome. Movement disorders secondary to HHS respond satisfactorily to administration of neuroleptic agents and proper glycemic control. The lack of published studies on this pathologic entity may lead to clinical and laboratory underdiagnosis, with negative impacts on patient prognosis and follow-up.

Anti-Hyperglycemic and Anti-Hyperlipidemic Potentials of Methanol Leaf Extracts of Aframomum melegueta and Piper guineense

Aim: The study investigated the anti-hyperglycemic and anti-hyperlipidemic potentials of methanol extracts of Piper guineense and Aframomum melegueta leaves with a view to utilizing the plants in the treatment and management of cardiovascular disorders. Methodology: Twenty-eight healthy albino rats were randomly divided into seven equal groups: Group I received normal saline (2 ml/kg bwt); Group II received a single dose of alloxan(150 mg/kg bwt) intraperitoneally; Group III received alloxan (150 mg/kg bwt) + glibenclamide (5 mg/kg bwt);Group IV received alloxan (150 mg/kg bwt) +PG (200 mg/kg bwt); Group V received alloxan (150 mg/kg bwt) + PG (400 mg/kg bwt); Group VI received alloxan (150 mg/kg bwt) + AM 200 (mg/kg bwt); Group VII received alloxan (150 mg/kg bwt) + AM (400 mg/kg bwt). The blood glucose level was determined before and after treatment with the extracts. The lipid: (total cholesterol (TC), triglycerides (TG), high density lipoprotein (HDL) and low density lipoprotein (LDL) were estimated using the Randox diagnostic kits. Results: The results revealed that alloxan was able to induce hyperglycemia at 150 mg/kg bwt and post-treatment with P. guineense and A. melegueta at 200 mg/kg and 400 mg/ kg bwt were able to significantly lower the blood glucose level which was quite apparent in AM treated groups. Also, the extracts at 200 mg/kg and 400 mg/kg were able to bring a significant (p < 0.05) reduction in TC, TG and LDL concentrations when compared to the alloxan treated group with the highest reduction in AM treated groups. Conclusion: These results revealed that the methanol extract of P. guineense and A. melegueta elicited anti-hyperglycemic and anti-hyperlipidemic potentials of the extracts with the highest effect observed in A. melegueta treated rats.

Bioactivity of methanolic extract of Brassica juncea in animal model of diabetes mellitus / 中草药·英文版

Objective: To study the bioactivity of methanolic extract of Brassica juncea on animal model of diabetes mellitus along with its effect on diabetic and metabolic parameters. Methods: Diabetes mellitus was induced in rats by injecting streptozotocin (60 mg/kg) intraperitonealy. Blood glucose was measured on day 3 by GOD-POD method to confirm the diabetes mellitus. Rats having fasting blood glucose > 250 mg/dL were further selected for study and they were divided into four groups, control, control + streptozotocin, streptozotocin + metformin (75 mg/kg) and streptozotocin+ extract of B. juncea (450 mg/kg). Each group consisted of six rats of either sex. Metformin and experimental extract were administered for 21 d. Triglyceride, cholesterol level were measured on day 21 by commercially available kit. Blood glucose was measured on days 7 and 21. Anti-oxidant potential was assessed by estimating extent of lipid peroxidation (LPO) by malondialdehyde (MDA), nitric oxide (NO), superoxide dismutase (SOD) and glutathione (GSH) in liver, kidney, pancreas, muscle tissues on day 21. Unpaired and paired student's t-test was applied for statistical analysis. Results: The extract of B. juncea showed significant decrease in blood glucose level on day 21. The treatment group showed significant difference in oxidative stress by increasing SOD and GSH and decreasing LPO and NO activity on day 21. The treatment did not show statistically significant difference of cholesterol, and triglycerides level on day 21. Conclusion: The study showed anti-hyperglycemic and anti-oxidative properties of methanolic extract of B. juncea.

Trends in Hyperglycemic Crisis Hospitalizations and in- and out-of-Hospital Mortality in the Last Decade Based on Korean National Health Insurance Claims Data

BACKGROUND: Hyperglycemic crisis is a metabolic emergency associated with diabetes mellitus. However, accurate epidemiologic information on cases of hyperglycemic crisis in Korea remains scarce. We evaluated trends in hyperglycemic crisis hospitalizations and in- and out-of-hospital mortality in Korea. We also predicted future trends. METHODS: We extracted claims data with hyperglycemic crisis as the principal diagnosis from the National Health Insurance Service database in Korea from January 2004 to December 2013. We investigated the numbers of claims with hyperglycemic crisis and identified trends in hyperglycemic crisis based on those claims data. We predicted future trends by statistical estimation. RESULTS: The total annual number of claims of hyperglycemic crisis increased from 2,674 in 2004 to 5,540 in 2013. Statistical analysis revealed an increasing trend in hyperglycemic crisis hospitalizations (P for trend <0.01). In contrast, the hospitalization rate per 1,000 diabetes cases showed a decreasing trend (P for trend <0.01) during this period. The mortality rate per 1,000 diabetes cases also showed a decreasing trend (P for trend <0.0001). However, no distinct linear trend in the case-related fatality rate at <60 days over the last decade was observed. The predicted number of annual claims of hyperglycemic crisis will increase by 2030. CONCLUSION: The number of hyperglycemic crisis hospitalizations in Korea increased in the last decade, although the hospitalization rate per 1,000 diabetes cases and mortality rate decreased. Also, the predicted number of annual claims will increase in the future. Thus, it is necessary to establish long-term healthcare policies to prevent hyperglycemic crisis.