Ambient conditions of the operating theatre and its correlation with fatigue and sleep quality of operating room workers: a cross-sectional survey.

Background: Anesthesia providers face numerous occupational hazards, including exposure to anesthesia gases, which can lead to fatigue. These professionals face challenges such as night shifts, OR stress, limited mobility and sunlight access, high workload, inadequate rest breaks. Health-related sociodemographic variables, such as smoking, sleep patterns, and obesity. Our research aims to explore various risk factors associated with fatigue among operating theatre workers including sleep quality. Methods: A cross-sectional study was conducted on 227 of operating room healthcare professionals from five tertiary hospitals in Saudi Arabia, for a period of 6 months, between January 1, 2023 to June 1, 2023. The study used a five-point Likert scale sheet and the FSS "fatigue severity scale" to analyze and measure fatigue and sleep quality. The questionnaire included all socio-demographic variables, work conditions, and fatigue severity scale items. Results: The major findings revealed a significant correlation between fatigue severity scores and exposure to anesthesia gases. Socio-demographic variables such as smoking have showed major relevance to fatigue in the sample size, as (76.6%) of the participants that answered as regular smokers have showed result of positive correlation to fatigue and with a significant of (0.034). Out of the total sample, 76.1% were exposed to anesthesia gases once daily, showing a positive association with fatigue severity scores. Work-related factors like job experience and position also had a lower association with fatigue severity. p (0.031) Univariate logistic regression p (0.035). Conclusion: The study found that the work-related conditions like workload on Anesthesia technicians and technologists over 44 h per week and gas exposure is directly linked to fatigue severity and sleep quality so is the socio-demographic considerations. With poor sleep quality in younger staff which is documented in the study result a large-scale prospective analysis to understand the factors affecting OR staff's sleep quality and fatigue severity and what can be done to regulate working hours and break time and incorporate naps in to enhance patient safety and well-being for anesthesia providers in Saudi Arabia.

Correction: Novel and pragmatic exploration of variation in glottic parameters in non-parallel versus parallel vocal cord CT planes with potential reporting pitfalls.

[This corrects the article DOI: 10.1371/journal.pone.0293659.].

Novel and pragmatic exploration of variation in glottic parameters in non-parallel versus parallel vocal cord CT planes with potential reporting pitfalls.

Oblique orientation of vocal cord demands strict compliance, by technicians and clinicians, to the recommended parallel plane CT scan of larynx. Repercussions of non-compliance has never been investigated before. We aimed to observe influence of non-parallel vocal cord plane CT scan on qualitative and quantitative glottic parameters, keeping parallel plane CT as a standard for comparison. Simultaneous identification of potential suboptimal imaging sequelae as a result of unformatted CT plane was also identified. In this study we included 95 normal adult glottides and retrospectively analyzed their anatomy in two axial planes, non-parallel plane ① and parallel to vocal cord plane ②. Qualitative (shape, structures at glottic level) and quantitative (anterior commissure ACom, vocal cord width VCw, anteroposterior AP, transverse Tr, cross-sectional area CSA) glottic variables were recorded. Multivariate statistical analysis was used to predict pattern and their impact on glottic anatomy. Plane ① displayed supraglottic features in glottis; adipose (90.5%) and split thyroid laminae (70.6%). Other categorical variables: atypical shape, submental structures and multilevel vertebral crossing were also in majority. All glottic dimensions varied significantly between two planes with most in ACom (-5.8mm) and CSA (-15.0 mm2). In contrast, plane ② manifested higher VCw (>73%), Tr (66.3%), CSA (64.2%) and AP (44.2%) measurements. On correlation analysis, variation in ACom, CSA, Tr was positively associated with VC or plane obliquity (p<0.05). This variability was more in obese and short necked subjects. Change in one parameter also modified other significantly i.e., ACom versus AP and CSA versus Tr. Results indicated statistically significant change in subjective and objective anatomical parameters of glottis on non-application of appropriate CT larynx protocol for image analysis hence highlighting importance of image reformation.

Novel Adiponectin-Resistin Indices and Ratios Predict Increased Cardiovascular Risk in Patients with Type 2 Diabetes Mellitus.

Objectives: Adiponectin and resistin are adipokines involved in insulin resistance, glucometabolic control and adiposity. There is evidence that hypoadiponectinemia and hyperresistinemia are associated with cardiovascular disease. Whether the ratio of Adiponectin-Resistin (AR) and Insulin Resistance Adiponectin-Resistin (IRAR) indices can be used as non-invasive biomarker of cardiovascular disease needs more attention. Therefore, the aim of this study was to assess the relationships of AR and IRAR indices with adiposity, glucometabolic control and cardiovascular risk incurred by high-sensitivity C-reactive protein (hsCRP) in healthy subjects and patients with Type 2 Diabetes Mellitus. Methods: This observational case control study was conducted in the Department of Physiology and Medicine, King Saud University, Riyadh. A total of 191 (control = 84 and diabetic = 107) subjects were recruited. Body composition was assessed by bioelectrical impendence analyzer (BIA). Fasting blood samples were analyzed for glucose, glycosylated hemoglobin (HbA1c), high-sensitivity C-reactive protein (hsCRP), lipid profile, adiponectin, and resistin levels. The AR and IRAR indices were determined by formulas. Results: Serum adiponectin levels were significantly lower in diabetics compared to control (95.45 ± 39.27 ng/ml vs 146.64 ± 56.36 ng/ml, p < .001) while serum resistin was significantly higher in diabetic when compared to control (2.94 ± 1.30 ng/ml vs 2.40 ± 1.09 ng/ml, p = .003). Furthermore, AR and IRAR indices were significantly increased in diabetic subjects when compared to control (.82 ± .29 vs .48 ± .35, p < .001) and (.30 ± .10 vs .17 ± .12, p < .001) respectively. ROC analysis revealed that these indices predicted increased cardiovascular risk with area under the curve (AUC) for adiponectin = .717 ( p = .001), resistin = .635 ( p = .002), AR index = .740 ( p < .001), and IRAR index = .737 ( p < .001) respectively. AR index correlated positively with Triglycerides (r = .354, p < .01), hsCRP (r = .264, p < .01), HbA1c (r = .425, p < .01), fat mass (r = .164, p < .05), Waist/Hip Ratio (WHR) (r = .248, p < .01), and negatively with high density lipoprotein (r=-.327, p < .01). Furthermore, IRAR index more strongly correlated with Triglycerides (r = .409, p < .01), hsCRP (r = .268, p < .01), HbA1c (r = .508, p < .01), fat mass (r = .152, p < .05), WHR (r = .256, p < .01), and negatively with high density lipoprotein (r = -.340, p < .01). Conclusions: AR and IRAR indices correlate significantly with adiposity, glucometabolic control and cardiovascular risk in type 2 diabetic patients and non-diabetic individuals. They may prove to be useful integrated biomarkers to predict metabolic dysregulation and cardiovascular risk.

Relationship of Body Adiposity with Platelet Function in Obese and Non-obese Individuals.

Background Adiposity is firmly linked to a higher incidence of various cardiovascular and metabolic morbidities, including diabetes, hypertension, and thromboembolism. This research study was aimed to verify the association of increased adiposity and hyperreactivity of platelets in obese and non-obese individuals. Methods This cross-sectional study was conducted on 42 subjects aged 18 years and above. Subjects were divided into obese and non-obese groups based on their body mass index (BMI). The data was collected through self-administered questionnaires. All participants underwent body composition analysis. Blood samples were collected from all subjects and taken to the Pharmacology Department for the preparation of platelet-rich plasma (PRP) and poor platelet plasma (PPP). Platelet aggregation was induced by arachidonic acid and was monitored with a Bio/Data multichannel aggregation profiler (Bio/Data Corp., Horsham, PA, USA). Results Significant differences were observed in most parameters, such as fat mass, body fat percentage, free fat mass (FFM), the percentage of trunk fat, total body water, waist-hip ratio (WHR), and basal metabolic rate (BMR) of obese and non-obese subjects. The average percent of platelet aggregation in obese and non-obese subjects was 56.33 ± 15.62 and 59.38 ± 12.62, respectively. The average area under the curve (AUC) for platelet aggregation for both groups was 339.33 ± 191.55 and 342 ± 146.68, respectively. Platelet function was not significantly different and didn't positively correlate with most parameters of the body composition, except WHR, which positively correlated with AUC for platelet function.  Conclusion There was no significant direct correlation between adiposity and platelet activation in obese subjects. However, a significant positive correlation of AUC for platelet aggregation with WHR was observed (resistance (r)-value: 0.307, p < 0.05). These findings suggest that WHR could be an effective determinant to assess the risk of thromboembolism in obese individuals.

Cognitive function assessment during 2 mA transcranial direct current stimulation in DLPFC in healthy volunteers.

Although cognitive function has been reported to change following the anodal transcranial direct current stimulation (tDCS) but still variable results have been reported in healthy subject and there is paucity of data on the cognitive effects of online tDCS. Therefore, we aimed to assess the online effect of tDCS over the left dorsolateral prefrontal cortex (DLPFC) on cognitive function and obtain safety data in healthy adults. We recruited 36 healthy (20 male) participants for this double-blind, sham-controlled parallel design. We used Stop Signal Task (SST) Go Trial and Pattern Recognition Memory (PRM) tests to evaluate cognitive function during 2 mA (20 min) anodal or sham tDCS stimulation over the left DLPFC. In active conditions, left dorsolateral prefrontal cortex was selected for electrode placement with reference over right supraorbital cortex. All related tasks were done during the online tDCS section in both groups (active/sham). There were statistically significant differences in cognitive function according to the PRM test (P = 0.003), SST (P = 0.021), and SST correct response time on Go Trials (P = 0.02) during active stimulation compared to the sham group. Our results reveal that cognitive performance is affected by a single dose of active online tDCS over DLPFC area compared to sham stimulation. In our study, tDCS is well-tolerated and safe that further supports the safety of tDCS in local healthy population.

Relationship of the Arabic version of the asthma control test with ventilatory function tests and levels of exhaled nitric oxide in adult asthmatics.

OBJECTIVE: To determine the relationship between the asthma control test (ACT) score using the Arabic version, fractional exhaled nitric oxide (FENO), and lung functions, and to derive the cutoff points for the ACT score with the American Thoracic Society recommended FENO standard levels of inflammation control. METHODS: We recruited 59 adult asthmatics out of which 53 subjects completed the study between July 2011 and June 2012 at King Saud University, Riyadh, Saudi Arabia. The FENO levels were measured by NIOX MINO (Aerocrine AB, Solna, Sweden), and ventilatory functions were recorded by standard techniques. RESULTS: The FENO values were significantly higher in patients with an ACT score <20 (65.5+/= 35.4) compared with those patients with an ACT score >/= 20 (27.4+/=10.5, p<0.001). Among the well-controlled group based on the ACT score criteria, 6 (25%) cases had high FENO levels, while among the poorly controlled group, 23 (79.3%) cases had high FENO levels (odds ratio: 11.5; p<0.0001; confidence interval: 3.16-41.72). There was a significant negative correlation between FENO and ACT score (r=-0.581, p<0.0001). At the international cutoff point of 20, the sensitivity was 95.2, and the specificity was 68.8. The receiver operating curve (ROC) showed that maximum sensitivity and specificity were observed at an ACT score cut off point of 19 (sensitivity: 90.5, and specificity: 81.2). CONCLUSION: The FENO levels correlate negatively with ACT scores however, the relationship between FENO and lung function is not significant. A significant relationship between ACT score and FENO levels indicate that there is an ongoing inflammatory state in patients with poor asthma control.

Significance of fractional exhaled nitric oxide measurements in detecting primary ciliary dyskinesia in Saudi children.

OBJECTIVE: To examine the usefulness of fractional exhaled nitric oxide (FENO) measurements in detecting primary ciliary dyskinesia (PCD) in children. METHODS: This observational study was conducted at the Department of Pediatrics and Physiology, College of Medicine, King Khalid University Hospital, King Saud University, Riyadh, Saudi Arabia from January 2011 to December 2011. The study population consisted of 22 children with symptoms suggestive of PCD and the diagnosis was confirmed by ciliary biopsy. Using the American Thoracic Society guidelines, measurements of FENO were performed in 22 subjects with proven PCD biopsies and in 11 healthy age-matched subjects. RESULTS: No significant differences were found on the basis of age or ventilatory function tests between the PCD patients and control groups. Fractional exhaled nitric oxide values were significantly lower in children with PCD (6.19+/-1.43) compared to control group (17.00+/-6.30) (CI: -14.854 to -5.927, p<0.0001). Rhinorrhea was seen in 7 (31.8%), recurrent acute otitis media in 16 (72.7%), chronic otitis media in 5 (22.7%), recurrent sinusitis in 5 (22.7%), chronic productive cough in 8 (36.4%), bronchospasm in 11 (50%), and dextrocardia in 3 (13.6%) subjects. There was no correlation between age, FENO, and ventilatory function parameters. CONCLUSION: The measurement of FENO appears to be a useful tool for screening children for PCD. It can complement other tests such as nasal biopsy and electron microscopy studies.

Serum resistin levels in patients with type 2 diabetes mellitus and its relationship with body composition.

OBJECTIVE: To assess the relationships of resistin concentrations with body mass index (BMI), body fat mass, lean body mass, and body protein mass in patients with type 2 diabetes mellitus (DM). METHODS: This cross-sectional study was conducted in the Department of Physiology, College of Medicine, King Saud University, Riyadh, Kingdom of Saudi Arabia from April 2008 to March 2011. A total of 229 subjects were selected for the study. Body composition was assessed by bioelectrical impedance analyzer. Parameters recorded included BMI, waist hip ratio (WHR), total body water, fat, protein, and lean body masses. Blood samples were analyzed for glucose, glycosylated hemoglobin (HbA1c), and resistin levels. RESULTS: We found that BMI, WHR, fasting blood glucose, HbA1c, and resistin levels were significantly higher in diabetics compared to non-diabetic healthy individuals. Fat mass was significantly higher in diabetic patients compared with controls, while the difference for muscle mass and lean body mass was non-significant. A significant positive correlation was observed between plasma levels of resistin and fat mass in patients with DM (r=0.2824, p=0.0030). CONCLUSION: Type 2 DM patients have significantly higher resistin levels that are positively correlated with body fat mass supporting the evidence that resistin plays an important role in the pathogenesis of obesity and insulin resistance.

Reference range values of fractional exhaled nitric oxide in healthy Arab adult males.

OBJECTIVE: To determine the reference values of the fraction of exhaled nitric oxide (FENO) among healthy, non-smoking male adults and its correlation with age, height, weight, and body mass index (BMI). METHODS: This cross-sectional study was conducted at the Departments of Physiology and Medicine, College of Medicine and King Khalid University Hospital, King Saud University, Riyadh, from September 2007 to August 2008 on healthy non-atopic, non-smoking male Saudi subjects. The FENO was measured online using the single-breath technique according to recent guidelines of the American Thoracic Society (ATS). RESULTS: We studied 121 subjects with a mean age of 31.00 +/- 12.24 years, BMI of 27.23 +/- 6.64, and FEV1/FVC 85% (81-92%). The FENO ranged between 7.66 parts per billion (ppb) and 46.6 ppb (mean 22.79 +/- 8.13), with >84% of subjects recording levels <30 ppb and >95% with levels <40 ppb. The FENO negatively correlated with body weight (r=0.3888, p=0.001) and BMI (r=0.238, p=0.009). No correlation was observed between FENO, FEV1/FVC ratio, age, and height. CONCLUSION: The reference values of FENO for non-smoking, non-atopic male Saudi adults fall between 7.66 and 46.6 ppb (mean 22.79 +/- 8.13), similar to other populations. The FENO negatively correlates with body weight and BMI.

Exhaled nitric oxide in stable chronic obstructive pulmonary disease.

STUDY OBJECTIVE: The objective of the study was to test the hypothesis that fraction of exhaled nitric oxide (FENO) is elevated in nonsmoking subjects with stable chronic obstructive pulmonary disease (COPD) and compare it with the results in patients with asthma and a control population. DESIGN: Cross-sectional study. MATERIALS AND METHODS: Pulmonology Clinic at a University Hospital. Twenty five control subjects, 25 steroid naïve asthmatics and 14 COPD patients were studied. All the patients were nonsmokers and stable at the time of the study. All subjects completed a questionnaire and underwent spirometry. Exhaled nitric oxide was measured online by chemiluminescence, using single-breath technique. RESULTS: All the study subjects were males. Subjects with stable COPD had significantly higher values of FENO than controls (56.54+/-28.01 vs 22.00+/-6.69; P=0.0001) but lower than the subjects with asthma (56.54+/-28.01 vs 84.78+/-39.32 P=0.0285).The FENO values in COPD subjects were inversely related to the FEV/1FVC ratio. There was a significant overlap between the FENO values in COPD and the control subjects. CONCLUSION: There is a significant elevation in FENO in patients with stable COPD, but the elevation is less than in asthmatic subjects. Its value in clinical practice may be limited by the significant overlap with control subjects.

Lipoproteina(a) is a feature of the presence, diffuseness, and severity of coronary artery disease in Saudi population.

OBJECTIVES: To study lipoprotein(a) [Lp(a)] levels in Saudi patients with angiographically defined coronary artery disease and to see its relationship with its severity and diffuseness. METHODS: This cross sectional study was carried out at King Khalid University Hospital, Riyadh, Saudi Arabia in 2006-2007. One hundred and forty-seven individuals with coronary artery disease (CAD) and 49 healthy individuals matched for age and body mass index were studied. Among CAD patients, 133 underwent angiography. Blood samples were analyzed for total cholesterol (TC), triglycerides (TG), low density lipoprotein (LDL) and high density lipoprotein (HDL) and Lp(a). RESULTS: Coronary artery disease patients had higher Lp(a) levels than controls (25.78 +/- 25.09 mg/dl versus 14.57 +/- 11.81 mg/dl, p=0.0030). Patients without stenosis (10.97 +/- 8.06 mg/dl) and one vessel involvement (19.67 +/- 17.33 mg/dl) had significantly lower levels of Lp(a) compared to double (31.88 +/- 32.17 mg/dl) and triple (29.70 +/- 28.12 mg/dl) vessel disease. Lipoprotein(a) levels correlated significantly with coronary vessel score (r=0.234, p=0.033) and Gensini score (r=0.256, p=0.02). Smoking (odds ratio [OR]: 1.86; 95% confidence interval [CI]: 1.020-2.510; p=0.04), TG levels (OR: 2.04; 95% CI: 1.251-4.932; p=0.03) and Lp(a) levels (OR: 1.56; 95% CI: 1.033-3.687; p=0.025) significantly predicted CAD severity. High risk levels of Lp(a) >/= 30 mg/dL were present in 66.7% of CAD patients. CONCLUSION: Lipoprotein(a) levels are significantly higher in Saudi patients with CAD compared to healthy individuals, and are associated with more severe and diffuse blockage of the coronary vessels.

F-ratio, a surrogate marker of carpal tunnel syndrome.

OBJECTIVE: To explore the correlation of F-ratio and F-wave minimal latency (FWML) in carpal tunnel syndrome (CTS). METHODS: This retrospective study was conducted from January 2006 to January 2007 at the clinical physiology lab, King Abdul-Aziz University Hospital, Riyadh, Saudi Arabia. Motor and sensory nerve conduction studies, FMW latencies of median and ulnar nerves, and F-ratio were carried out in 54 CTS patients and 30 controls. RESULTS: Out of 54 CTS patients, there were 14 were males (26%), and 40 females (74%), CTS was bilateral in 32 (59%), and unilateral in 22 (41%) patients. Fifty-one patients (94.4%) had involvement of the right hand, 28 patients (51.8%) had dyslipidemia and 20 patients (37%) had hypertension. The FWML (ms) in the right median nerve was 25.46+/-2.2, and 25.79+/-1.7 in the right ulnar nerve in the control group (p=0.5224), while it was 29.1+/-3.35 in the right median nerve and 26.46+/-4.35 in the right ulnar nerve in patients with CTS (p=0.0008). A similar statistically significant increase in the median nerve latency was observed in the left hand. A statistically significant reduction in the F-ratio was found consistently in all patients with CTS in both the hands (p=0.0001). CONCLUSION: The present study reveals prolongation of FWML in the median nerve, and a statistically significant reduction of F-ratio in all CTS patients. A significant inverse correlation was found between FWML and F-ratio in CTS patients. Both FWML and F-ratio support the diagnosis of CTS.

Exhaled nitric oxide: an emerging marker of inflammation in respiratory diseases.

Fractional exhaled nitric oxide (FENO) is a recently introduced non invasive marker to measure inflammation and oxidative stress in the lung. The numerous roles of NO in respiratory pathophysiology have been extensively reviewed. There is contradictory evidence regarding the exact function of NO in lung diseases. In pathological states, the enzyme inducible NO synthase generates extraordinarily high concentrations of NO when the body faces an inflammatory response by attracting macrophages that generate NO and hence NO participate in host defense against specific organisms. Fractional exhaled nitric oxide measurements have been useful in asthma, chronic obstructive pulmonary disease, cystic fibrosis, and bronchiectasis. The technique used to measure FENO is well standardized, requires the same amount of time that spirometry takes, and is feasible to be performed in young children. Measuring FENO has added another dimension to the determination of adverse respiratory effects because it allows detection of inflammatory responses in the absence of functional impairments. This review provides an insight into measurement methods, physiological factors affecting FENO, interpretation of results and diseases related to changes in FENO levels. This will help physicians in diagnosing and monitoring their treatments for different respiratory diseases.

Assessment of lipid profile in Saudi type 2 diabetic and non-diabetic periodontal patients.

OBJECTIVE: To study the extent of periodontal disease in diabetic and non-diabetic periodontitis patients, and to investigate the relationship of dyslipidemia and periodontal disease, in diabetic and non-diabetic periodontitis patients. METHODS: This is a cross-sectional study at the Department of Preventive Dental Sciences (College of Dentistry) and Department of Physiology (College of Medicine), King Saud University, Riyadh, Kingdom of Saudi Arabia, from February 2003 to June 2004. A total of 90 patients was recruited, and divided into 3 equal groups of 30 subjects, with age and gender matched, and divided as follows: group 1 healthy group: periodontally and systemically healthy subjects, group 2 periodontitis group: chronic periodontitis patients with no systemic disease, group 3 diabetic group: chronic periodontitis patients with type 2 diabetes mellitus. Plaque index, bleeding on probing, probing pocket depth (PPD), and clinical attachment level (CAL) were measured at the time of initial examination. The glycated hemoglobin, total cholesterol, low density lipoprotein (LDL), triglyceride, high density lipoprotein were also measured. RESULTS: Periodontal parameters (PPD and CAL) were of significantly higher value in the diabetic patients, when compared to the periodontitis patients (p<0.05). The total cholesterol, LDL, and triglyceride were also found to be significantly higher among the periodontitis patients than the healthy subjects (p<0.05). CONCLUSION: This study indicated that type 2 diabetic patients had a higher risk to develop advanced periodontal disease than the non-diabetic subjects. It also highlighted the association of dyslipidemia in periodontitis patients.

Comparison of lipid profiles and lipoprotein a levels in patients with type 2 diabetes mellitus during oral hypoglycemic or insulin therapy.

OBJECTIVE: The aim of this study is to compare lipid and lipoprotein (a) profiles in patients with type 2 diabetes mellitus (DM) on insulin and oral hypoglycemic therapy. METHODS: The study took place in the Department of Physiology, Army Medical College, Rawalpindi, Pakistan, during 2002. Ninety-seven type 2 DM patients participated in the study. We divided the patients according to the type of treatment into sulphonylurea (n=40), sulphonylurea plus metformin (n=33) and insulin (n=24) therapy groups as well as 40 healthy subjects served as controls. Fasting blood samples were analyzed for lipoprotein (a) [Lp (a)], total cholesterol (TC), triglycerides (TG), low-density lipoprotein cholesterol (LDL-C), high-density lipoprotein cholesterol (HDL-C), glucose, glycosylated hemoglobin (HbA1c) and insulin. RESULTS: Different groups of diabetic patients showed elevated fasting blood glucose (FPG) levels (p<0.0001 for all), HbA1c (p<0.0001 for all) compared with controls. Meanwhile, fasting insulin levels were elevated only in insulin treated group compared with oral hypoglycemic treated groups and controls (p<0.0001 for all). Patients on sulphonylurea and on sulphonylurea plus metformin groups showed significantly elevated TC (p<0.001, p<0.0001), TG (p<0.001, p<0.01), LDL-C (p<0.01, p<0.001) and LDL-C/HDL-C (p<0.0001, p<0.0001) compared with controls. Insulin therapy group showed significantly decreased TC, TG, LDL-C, LDL-C/HDL-C levels compared with sulphonylurea and sulphonylurea plus metformin treated groups, however, no significant difference was noted in the levels of above mentioned parameters and controls. Meanwhile, HDL-C levels were significantly lower in all diabetic groups compared with controls and were higher in insulin treated group compared with sulphonylurea plus metformin therapy group (p<0.05). Lipoprotein (a) levels were significantly higher in different diabetic groups compared with controls. While there was a non-significant difference in Lp (a) levels between different diabetic groups. CONCLUSION: Patients with type 2 DM who are being treated on insulin have a better lipid profile (TC, HDL-C, LDL-C, TG) compared with those patients on oral hypoglycemic agents. Meanwhile, Lp (a) levels were raised in all diabetic patients and seem not to be affected either by insulin or by oral hypoglycemic treatment.

Lipoprotein(a). The bad cholesterol.

The aim of this review is to highlight the role of lipoprotein(a) [Lp(a)] in atherogenesis and coronary artery disease. After 40 years from discovery, Lp(a) still remains an enigma and we are still far in understanding the pathophysiological role of Lp(a). Based on its peculiar structure, Lp(a) has both atherogenic and thrombogenic potentials as it is internalized by macrophages and has structural similarity with plasminogen. The results of the prospective studies performed over the past decade have also shown that Lp(a) is a predictor of coronary artery disease (CAD), even though some of the studies have failed to show a statistically significant difference in Lp(a) levels on subjects that subsequently developed CAD and those that did not. Within the population, the plasma levels can vary from <0.5 mg/dl to >200 mg/dl. There is currently no safe drug for long term treatment of patients with high levels of Lp(a). However, it has been proposed that there is a possibility of interfering with apolipoprotein(a) (apoA) translation by using adenovirus mediated antisense RNA technology. Despite more than 3 decades of intense scientific research, the physiopathological role of Lp(a) is still poorly understood and the extent to which Lp(a) levels should be assessed in clinical practice remain controversial until now.

Risk factors, knowledge and health status in diabetic patients.

OBJECTIVE: This study aimed to assess the prevalence of risk factors, knowledge and awareness in Pakistani patients with type 2 diabetes mellitus (DM). METHODS: We studied 120 DM patients at the Diabetes Center in Rawalpindi, Pakistan, from February 2001 to July 2001. Structured questionnaires, clinical and laboratory assessments were used to determine the prevalence of dyslipidemia, glycemic control, hypertension, self monitoring of blood glucose, treatment for hyperglycemia, smoking and modes of diagnosis. The patients knowledge was assessed as regards to the laboratory investigations and treatment of DM that they are receiving. Fasting blood samples were analyzed for serum total cholesterol, triglycerides, low-density lipoprotein cholesterol (LDL-C), high-density lipoprotein cholesterol (HDL-C), glucose and glycosylated hemoglobin (HbA1c). RESULTS: It was found that 46.7% of subjects had poor glycemic control (HbA1c >7.5%). There was a higher prevalence of obesity (body mass index >30) in females (30%) as compared to males (11.4%). Approximately 56.7% of subjects had moderate to high-risk levels of serum total cholesterol, LDL-C 66.7%, HDL-C 46.7% and triglycerides 16.7%. Prevalence of hypertension was 48.3% (41.7% had systolic and 28.3% had diastolic hypertension). Approximately 46% of hypertensive subjects were unaware of their hypertension. The prevalence of hypertension was higher in patients who had a positive family history of DM. On regression analysis, poor glycemic control (raised HbA1c levels) was positively related with total cholesterol (coefficient correlation [r] = 0.24) (p<0.05) and LDL-C [r = 0.28] (p<0.05) levels and negatively related with HDL-C [r = 0.49] (p<0.0001). CONCLUSION: There is a high prevalence of poor glycemic control and atherogenic dyslipidemia in Pakistani patients with type 2 DM. Most of these diabetics have poor knowledge of their disease and are unaware of its complications.

High risk levels of lipoprotein(a) in Pakistani patients with type 2 diabetes mellitus.

OBJECTIVE: To find the prevalence of high risk levels of lipoprotein(a) [Lp(a)] and the ratio between low-density lipoprotein (LDL) and high-density lipoprotein (HDL) in patients with type 2 diabetes mellitus (DM) as evidence has been provided that Lp(a) and LDL can act additively in the development of atherogenesis. METHODS: This cross sectional study was carried out at the Department of Chemical Pathology, Armed Forces Institute of Pathology, Rawalpindi, Pakistan, from February 2001 to May 2001. The patients participating in the study were diagnosed cases of type 2 DM. Fasting blood samples were analyzed for Lp(a), low-density lipoprotein cholesterol (LDL-C), high-density lipoprotein cholesterol (HDL-C), glucose and glycosylated hemoglobin. The data was analyzed by computer software SPSS 10. RESULTS: The data was analyzed by considering Lp(a) levels <30 mg/dl as desirable level and > or =30 mg/dl as the high risk level. It was found that in the control group 73.3% of individuals had desirable levels of Lp(a) while 26.7% had high risk levels. In diabetic patients with good glycemic control 56.6% of patients had desirable levels of Lp(a) while 43.4% had high risk levels. The same data was also analyzed by taking Lp(a) levels of <20 mg/dl as desirable levels and the same pattern was observed. CONCLUSION: Diabetic patients have elevated levels of serum Lp(a) as compared to healthy subjects and the frequency of high risk levels of Lp(a) is also higher in diabetics compared to non-diabetic subjects. The increased prevalence of high risk levels in patients with type 2 DM may be due to increased prevalence of low molecular weight isoforms of apoprotein(a) [apo(a)].