Oral Carbohydrate Administration in Patients Undergoing Cephalomedullary Nailing for Proximal Femur Fractures: An Analysis of Clinical Outcomes and Patient Satisfaction

Purpose: The purpose of this study was to investigate the clinical effects of oral carbohydrate intake for cephalomedullary nailing on proximal femoral fractures and patient satisfaction. Subjects and Methods: 88 patients were admitted to our hospital with proximal femoral fracture from July 2019 to December 2019. All patients were treated with closed reduction and internal fixation (CR&IF, Cephalomedullary nailing) under spinal anesthesia. The exclusion criteria included the presence of endocrine disorders including diabetes mellitus (DM), patients treated with steroids, and cognitive impairment. Additionally, those with fasting blood glucose levels above 126 mg / dl or HbA1C> 6.5% were considered as having undiagnosed DM. After obtaining informed consent, the subjects were randomized into either the preoperative oral carbohydrate (POC) group or control group. Patients who were assembled into the control group fasted including water from midnight of the day of the surgical procedure according to the conventional method. Patients assembled into the POC group received 400 ml of oral carbohydrate solution (Nucare NONPO, DAESANG, 12.8%, 1 kcal/ml)) between 21-24 hours on the day before operation and 400 ml oral carbohydrate solution 2 hours before the administration of anesthesia. Serum glucose on the day before operation at 7 am (before breakfast, baseline), immediately before anesthesia, at skin incision, 1 hour, 4 hours, 6 hours, 24 hours after anesthesia, and 3 days after surgery (before breakfast) was measured, and insulin, cortisol, and IL-6 were measured at baseline 7 am at day before operation, immediately before anesthesia, 4 hours and 24 hours after anesthesia, and 3 days after surgery (before breakfast). The patients completed questionnaires about their satisfaction (thirst, hunger, nausea and vomiting, and anxiety) in the morning (before the surgery) on the day of the surgery. Additionally, the length of hospital stay (LOS) and preoperative opioid usage was also investigated. Results: The operative characteristics of the patients did not differ between the groups except for the actual fasting time. The glucose levels were higher in the control group at skin incision; however, there were no significant differences in both groups at other time points. Additionally, insulin, insulin resistance, cortisol, and IL-6 also did not differ significantly between the 2 groups at all time-points. Among the factors related to patient satisfaction, the POC group showed significantly higher scores for thirst and hunger factors and shorter LOS than the control group. Conclusion: The intake of oral carbohydrates in patients treated with closed reduction and internal fixation for proximal femoral fractures does not affect the improvement of post-operative insulin resistance. However, there was significant improvement in patients’ thirst and hunger before surgery and LOS.

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Effect of a Polyphenol-Rich Extract from Aloe vera Gel on Experimentally Induced Insulin Resistance in Mice

The American Journal of Chinese Medicine ◽

10.1142/s0192415x07005491 ◽

2007 ◽

Vol 35 (06) ◽

pp. 1037-1046 ◽

Cited By ~ 39

Author(s):

Yolanda Y. Pérez ◽

Enrique Jiménez-Ferrer ◽

Alejandro Zamilpa ◽

Marcelino Hernández-Valencia ◽

Francisco J. Alarcón-Aguilar ◽

...

Keyword(s):

Insulin Resistance ◽

Body Weight ◽

Aloe Vera ◽

Negative Control Group ◽

Negative Control ◽

Control Group ◽

Glucose Levels ◽

Insulin Tolerance ◽

Aloe Vera Gel ◽

Experimentally Induced

Insulin resistance, which precedes type 2 diabetes mellitus (T2DM), is a widespread pathology associated with the metabolic syndrome, myocardial ischemia, and hypertension. Finding an adequate treatment for this pathology is an important goal in medicine. The purpose of the present research was to investigate the effect of an extract from Aloe vera gel containing a high concentration of polyphenols on experimentally induced insulin resistance in mice. A polyphenol-rich Aloe vera extract (350 mg/kg) with known concentrations of aloin (181.7 mg/g) and aloe-emodin (3.6 mg/g) was administered orally for a period of 4 weeks to insulin resistant ICR mice. Pioglitazone (50 mg/kg) and bi-distilled water were used as positive and negative controls respectively. Body weight, food intake, and plasma concentrations of insulin and glucose were measured and insulin tolerance tests were performed. The insulin resistance value was calculated using the homeostasis model assessment for insulin resistance (HOMA-IR) formula. Results showed that the polyphenol-rich extract from Aloe vera was able to decrease significantly both body weight ( p < 0.008) and blood glucose levels ( p < 0.005) and to protect animals against unfavorable results on HOMA-IR, which was observed in the negative control group. The highest glucose levels during the insulin tolerance curve test were in the negative control group when compared to the Aloe vera extract and pioglitazone treated mice ( p < 0.05). In conclusion, Aloe vera gel could be effective for the control of insulin resistance.

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Endothelial dysfunction precedes hypertension in diet-induced insulin resistance

AJP Regulatory Integrative and Comparative Physiology ◽

10.1152/ajpregu.1998.275.3.r788 ◽

1998 ◽

Vol 275 (3) ◽

pp. R788-R792 ◽

Cited By ~ 34

Author(s):

Prasad V. G. Katakam ◽

Michael R. Ujhelyi ◽

Margarethe E. Hoenig ◽

Allison Winecoff Miller

Keyword(s):

Insulin Resistance ◽

Endothelial Dysfunction ◽

Serum Insulin ◽

Serum Glucose ◽

Mesenteric Arteries ◽

Control Group ◽

Sprague Dawley ◽

Insulin Resistant ◽

Glucose Levels

The insulin-resistant (IR) syndrome may be an impetus for the development of hypertension (HTN). Unfortunately, the mechanism by which this could occur is unclear. Our laboratory and others have described impaired endothelium-mediated relaxation in IR, mildly hypertensive rats. The purpose of the current study is to determine if HTN is most likely a cause or result of impaired endothelial function. Sprague-Dawley rats were randomized to receive a fructose-rich diet for 3, 7, 10, 14, 18, or 28 days or were placed in a control group. The control group received rat chow. After diet treatment, animals were instrumented with arterial cannulas, and while awake and unrestrained, their blood pressure (BP) was measured. Subsequently, endothelium-mediated relaxation to acetylcholine was determined (in vitro) by measuring intraluminal diameter of phenylephrine-preconstricted mesenteric arteries (∼250 μM). Serum insulin levels were significantly elevated in all groups receiving fructose feeding compared with control, whereas there were no differences in serum glucose levels between groups. Impairment of endothelium-mediated relaxation starts by day 14 [mean percent maximal relaxation (Emax): 69 ± 10% of baseline] and becomes significant by day 18 (Emax: 52 ± 11% of baseline; P < 0.01). However, the mean BP (mmHg) does not become significantly elevated until day 28 [BP: 132 ± 1 ( day 28) vs. 116 ± 3 (control); P < 0.05]. These findings demonstrate that both IR and endothelial dysfunction occur before HTN in this model and suggest that endothelial dysfunction may be a mechanism linking insulin resistance and essential HTN.

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Efek Hipoglikemik Kecambah Beras Merah pada Tikus yang Diinduksi STZ-NA dengan Parameter Kadar Insulin, Indeks HOMA-IR dan HOMA β (Hypoglycemic Effect of Red Rice Germ on Insulin Levels, HOMA-IR, and HOMA β Index of STZ-NA Induced Rats)

Jurnal Agritech ◽

10.22146/agritech.16767 ◽

2017 ◽

Vol 36 (4) ◽

pp. 433

Author(s):

Nurhidajah Nurhidajah ◽

Nurrahman Nurrahman

Keyword(s):

Insulin Resistance ◽

Blood Glucose ◽

Insulin Level ◽

Control Group ◽

Standard Diet ◽

Red Rice ◽

Glucose Levels ◽

Blood Glucose Levels ◽

Post Test ◽

Decrease Blood Glucose

The process of germination of grains such as rice, could increase some nutritional values of amino acids and dietary fiber. Red rice and its sprouts are believed to be able to decrease blood glucose in patients with diabetes mellitus (DM). The aim of this study was to evaluate the hypoglycemic effect of red rice sprouts in STZ-NA induced diabetic rats on blood glucose level, insulin level, and HOMA-IR and HOMA-β index. This experimental study was conducted based on randomized post test only control group design using 24 male Wistar rats aged 2.5 months. Rats were divided into 4 groups, one group without induction of STZ-NA fed with a standard diet (control) and three groups of STZ- NA induced with a standard diet, red rice and red rice germ. Experiments were conducted for 6 weeks. The results showed that sprouted red rice lowered blood glucose levels by 61.88 % and the value of HOMA-IR (insulin resistance parameters) by 56.82%. Insulin level increased by 16.35 % and HOMA-β by 763.6 %. This study showed that red rice germ was able to decrease blood glucose levels and increase insulin resistance of DM rats and the strength of the pancreatic beta cells. ABSTRAKProses perkecambahan biji-bijian seperti beras, dapat meningkatkan beberapa nilai gizi seperti asam amino dan serat pangan. Beras merah dan kecambahnya diyakini mampu menurunkan glukosa darah pada penderita diabetes melitus (DM). Tujuan penelitian ini adalah mengevaluasi efek hipoglikemik kecambah beras merah pada tikus diabetes yang diinduksi STZ-NA terhadap kadar glukosa darah, insulin, serta indeks HOMA-IR dan HOMA β. Penelitian ini bersifat eksperimental in vivo pada hewan coba tikus Wistar jantan usia 2,5 bulan sebanyak 24 ekor dengan desain penelitian randomized post test only control group. Tikus dibagi menjadi 4 kelompok, masing-masing 1 kelompok tanpa induksi STZ-NA dengan diet standar dan 3 kelompok diinduksi STZ-NA dengan diet standar, beras merah dan kecambah beras merah. Percobaan dilakukan selama 6 minggu. Hasil penelitian menunjukkan kecambah beras merah mampu menurunkan kadar glukosa darah sebesar 61,88 % dan nilai HOMA-IR (parameter resistensi insulin) 56,82 %. Kadar insulin meningkat 16,35 % dan HOMA β 763,6 %. Disimpulkan, kecambah beras merah mampu menurunkan kadar glukosa darah dan memperbaiki kondisi resistensi insulin tikus DM, dan kekuatan sel beta pankreas.

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Infection Versus Hematoma Following Surgical Treatment of Proximal Femoral Fractures in Geriatric Patients

Geriatric Orthopaedic Surgery & Rehabilitation ◽

10.1177/2151458517750515 ◽

2018 ◽

Vol 9 ◽

pp. 215145851775051 ◽

Cited By ~ 2

Author(s):

Franz Müller ◽

Michael Galler ◽

Christina Roll ◽

Bernd Füchtmeier

Keyword(s):

Staphylococcus Aureus ◽

Surgical Treatment ◽

Geriatric Patients ◽

Femoral Fractures ◽

Morbidity And Mortality ◽

Control Group ◽

Postoperative Phase ◽

High Morbidity ◽

Proximal Femoral Fractures

Introduction: The surgical treatment of proximal femoral fractures predominantly involves geriatric patients and is associated with high morbidity and mortality. However, analyses on postoperative infections or hematoma are rare. Methods: Patients requiring surgical revision due to infection (n = 90) or hematoma (n = 77) in the postoperative phase were identified from an electronic database of 2000 consecutive patients surgically treated for proximal femoral fractures between 2006 and 2014. Demographic and clinical data were retrieved, including information on the pathogens in patients with infection. A follow-up on morbidity and mortality was conducted via telephone for at least 2 years postsurgery. Results: The follow-up rate was 100%, and the mean age was 81.9 years. The incidence rate of infection was 4.1% (90/2000), and women were commonly affected. Staphylococcus aureus and Staphylococcus epidermidis were the most commonly detected pathogens (35.5% and 25.5%, respectively). Mixed infections were observed in 15 patients, and Methicillin-resistant Staphylococcus aureus infections were observed in only 4 patients. A total of 77 (85.6%) infections occurred within 30 days postsurgery. The implant was preserved in 76 (84.4%) patients, and resection arthroplasty was required in 14 patients. Dementia and pertrochanteric fractures were significantly more common in the infection than in the hematoma group. Although infections were associated with high mortality rates for up to 2 years postsurgery, the rates did not significantly differ from those in the hematoma control group. Conclusion: One of every 2 patients who developed an infection following the surgical treatment of a proximal femoral fracture died within 2 years postsurgery. In addition, infections were significantly associated with dementia. Avoiding postoperative infection should be a high priority in the surgical treatment of proximal femoral fractures.

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Cephalomedullary nailing for proximal femoral fractures

International Orthopaedics ◽

10.1007/s00264-004-0624-4 ◽

2005 ◽

Vol 29 (1) ◽

pp. 21-24 ◽

Cited By ~ 5

Author(s):

Rahul Kakkar ◽

S. Kumar ◽

A. K. Singh

Keyword(s):

Femoral Fractures ◽

Proximal Femoral Fractures ◽

Cephalomedullary Nailing

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Long-term AT1 receptor blockade improves metabolic function and provides renoprotection in Fischer-344 rats

AJP Heart and Circulatory Physiology ◽

10.1152/ajpheart.00457.2007 ◽

2007 ◽

Vol 293 (3) ◽

pp. H1327-H1333 ◽

Cited By ~ 33

Author(s):

Shea Gilliam-Davis ◽

Valerie S. Payne ◽

Sherry O. Kasper ◽

Ellen N. Tommasi ◽

Michael E. Robbins ◽

...

Keyword(s):

Insulin Resistance ◽

Control Group ◽

Receptor Blockade ◽

Ang Ii ◽

Glucose Levels ◽

Fischer 344 ◽

Young Rats ◽

Age Related ◽

F344 Rats

Fischer-344 (F344) rats exhibit proteinuria and insulin resistance in the absence of hypertension as they age. We determined the effects of long-term (1 yr) treatment with the angiotensin (ANG) II type 1 (AT1) receptor blocker L-158,809 on plasma and urinary ANG peptide levels, systolic blood pressure (SBP), and indexes of glucose metabolism in 15-mo-old male F344 rats. Young rats at 3 mo of age ( n = 8) were compared with two separate groups of older rats: one control group ( n = 7) and one group treated with L-158,809 ( n = 6) orally (20 mg/l) for 1 yr. SBP was not different between control and treated rats but was higher in young rats. Serum leptin, insulin, and glucose levels were comparable between treated and young rats, whereas controls had higher glucose and leptin with a similar trend for insulin. Plasma ANG I and ANG II were higher in treated than untreated young or older rats, as evidence of effective AT1 receptor blockade. Urinary ANG II and ANG-(1-7) were higher in controls compared with young animals, and treated rats failed to show age-related increases. Protein excretion was markedly lower in treated and young rats compared with control rats (young: 8 ± 2 mg/day vs. control: 129 ± 51 mg/day vs. treated: 9 ± 3 mg/day, P < 0.05). Long-term AT1 receptor blockade improves metabolic parameters and provides renoprotection. Differential regulation of systemic and intrarenal (urinary) ANG systems occurs during blockade, and suppression of the intrarenal system may contribute to reduced proteinuria. Thus, insulin resistance, renal injury, and activation of the intrarenal ANG system during early aging in normotensive animals can be averted by renin-ANG system blockade.

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Functional evaluation of proximal femoral fractures managed with cephalomedullary nailing by oxford hip score - A prospective study

International Journal of Orthopaedics Sciences ◽

10.22271/ortho.2017.v3.i3n.143 ◽

2017 ◽

Vol 3 (3n) ◽

pp. 980-985 ◽

Cited By ~ 1

Author(s):

Pranav Kothiyal ◽

Kunal Vij ◽

Puneet Gupta ◽

Pawan Rawat ◽

Nitin Sharma

Keyword(s):

Prospective Study ◽

Femoral Fractures ◽

Functional Evaluation ◽

Proximal Femoral Fractures ◽

Cephalomedullary Nailing ◽

Oxford Hip Score ◽

A Prospective Study

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The Role of Pulsatile Cold Compression in Edema Resolution Following Ankle Fractures: A Randomized Clinical Trial

Foot & Ankle International ◽

10.1177/107110070202301105 ◽

2002 ◽

Vol 23 (11) ◽

pp. 999-1002 ◽

Cited By ~ 21

Author(s):

Steve Mora ◽

Charalampos G. Zalavras ◽

Lingjun Wang ◽

David B. Thordarson

Keyword(s):

Clinical Trial ◽

Patient Satisfaction ◽

Randomized Clinical Trial ◽

Bed Rest ◽

Ankle Fractures ◽

Control Group ◽

Study Group ◽

Time Points ◽

Cold Compression

Twenty-four patients with displaced ankle fractures awaiting surgery were randomized to a study (n = 11) or a control group (n = 13). In the study group, patients had a pulsatile cold compression (PCC) device applied to their ankle, and remained at bed rest with the extremity elevated while awaiting surgery. In the control group patients remained in a posterior molded splint instead of the PCC device. Baseline circumferential measurements of the ankle were obtained, followed by measurements at 24-hour increments to evaluate edema resolution. In addition, patient satisfaction with use of the PCC device was evaluated with a scale ranging from 1 to 4. The median decrease of circumference in the study group compared to the control group was 0.5 cm vs. 0.1 cm at 24 hours (p=0.005), 0.9 cm vs. 0.4 cm at 48 hours (p<0.001), and 1.2 cm vs. 0.5 cm at 72 hours (p=0.009). The ratio of the decrease in circumference relative to the circumference of the normal ankle was significantly higher in the PCC group compared to the control group at all time points. All patients in the PCC group were satisfied with the device (median satisfaction score = 4). The PCC device was well tolerated and resulted in a significantly greater reduction of ankle circumference at 24, 48, and 72 hours after its application, compared to splinting and elevation alone. The PCC device facilitates edema resolution following ankle fractures.

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COMPARISON OF THE EFFECT OF PTEROCARPUS MARSUPIUM WITH PIOGLITAZONE IN DEXAMETHASONE-INDUCED INSULIN RESISTANCE

Asian Journal of Pharmaceutical and Clinical Research ◽

10.22159/ajpcr.2016.v9s2.13592 ◽

2016 ◽

pp. 211

Author(s):

Narendar Koyagura ◽

I M Nagendra Nayak ◽

M G Jamadar ◽

Ashok M Patil ◽

Sanjit Anand

Keyword(s):

Insulin Resistance ◽

Serum Insulin ◽

Ethanolic Extract ◽

Control Group ◽

Model Assessment ◽

Pterocarpus Marsupium ◽

Glucose Levels ◽

Gum Acacia ◽

Insulin Sensitizing Activity ◽

D 12

ABSTRACT Objective: This study was undertaken to evaluate the preventive effect of heartwood of P. marsupium in dexamethasone-induced hyperinsulinemia and hyperglycemia and compare it with that of pioglitazone. Methods: Male albino wistar rats were divided into five groups (n=6). Plain control group received gum acacia (2%) orally from d 1 to d 12. Dexa control group received gum acacia (2%) orally for d 1 to d 12 and Dexa (8 mg/kg) intraperitoneal (i.p.) from d 7 to d 12, during the study period. Two test groups received ethanolic extract of Pterocarpus marsupium heartwood (PME) (1 and 2 g/kg/) per oral (PO), and standard control group received pioglitazone (60 mg/kg/PO) from d 1 to d 12. During the 12-d study period, the two test groups and standard control group received Dexa (8 mg/kg/i.p.) from d 7 to d 12. On last day of the study, the blood samples were collected by retro-orbital sinus punctureand used for estimation of serum insulin and glucose levels. Homeostatic Model Assessment (HOMA) method was employed to calculate the degree of insulin resistance(IR). Results were analyzed by using one-way analysis of variance followed by Scheffe’s multiple comparison test (p<0.05). Results: Treatment with ethanolic extract of P. marsupium and pioglitazone significantly (p<0.05) reduced the elevated insulin and glucose levels as well as HOMA-IR and HOMA-IS values in dexa treated animals. Conclusion: Ethanolic extract of P. marsupium heartwood effectively countered dexamethasone-induced hyperinsulinemia and hyperglycemia. Insulin-sensitizing activity of P. marsupium heartwood was found to be more effective than pioglitazone. Keywords: Pterocarpus marsupium, Insulin resistance, Hyperinsulinemia, Hyperglycemia.

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