Plasma Insulin/Erythrocytic Aldose Reductase Ratio as a Predictor for Hepatocellular Carcinoma Among Type II Diabetics and Hepatitis C Virus-Infected Patients

Purpose Hepatocellular carcinoma (HCC) is a possible oncogenic progression during persistent hepatitis C-infection +/- type II diabetes mellitus (DM). To investigate the plasma insulin, erythrocytic aldose reductase (AR) and sorbitol dehydrogenase (SDH) as possible predictive tools for HCC in hepatitis C-infected patients (HCV) +/- DM. Erythrocytes (RBCs) were adopted as a possible vehicle for pre-malignant variations being of short life span. Methods The study included 20 healthy control and 100 patients of 48–64 years old, divided into 5 equal groups as; type II DM, HCC, HCC with DM, DM- HCV infected and non-DM HCV infected. Plasma levels of AFP and insulin were measured. Results It showed an elevated AR, significant reduction of SDH in RBCs and plasma of DM patients. These values were greatly elevated among HCV, HCC, diabetic HCV, and diabetic HCC patients. All DM patients showed elevated insulin levels than normoglycemic controls. Conclusion The study substantiated the use of RBCs as a vehicle for early diagnostic markers better than plasma. We recommend the use of insulin/ erythrocytic AR ratio as a new laboratory marker for predicting HCC among type II diabetics or non-treated HCV-infected patients with control insulin/ erythrocytic AR ratio by each laboratory.

A global analytical molecular pharmacological study of the endocrinological pharmacotherapeutic rationale of anti-diabetic prescriptions appraisal attributes for metformin and sitagliptin, with evaluation of anti-diabetic tertiary medical healthcare patient satisfaction

Background: The inhibition of dipeptidyl peptidase-4 by anti-diabetic drugs dipeptidyl peptidase-4 inhibitors enhances hormonal activity of incretins (GLP-1, GIP, GRP), stimulates insulin release and reduces glucagon secretion, producing anti-hyperglycaemic activity among type II diabetics. The objective of this study was a global analytical molecular pharmacological study of the endocrinological rationale of anti-diabetic prescriptions appraisal attributes for metformin and sitagliptin, along with anti-diabetic tertiary medical healthcare patient satisfaction evaluation.Methods: 100 new early moderate grade type II diabetics were prescribed oral metformin 500 mg or sitagliptin 25 mg once daily for 3 months, in monotherapy, or in combination therapy, or in a mixed regimen of monotherapy and combination therapy. The patients’ endocrinological pharmacotherapeutic compliance was analysed. The number of prescriptions for metformin and sitagliptin was recorded; and prescription percentages were calculated. The completeness and molecular basis of prescription content attributes were analysed. The molecular basis of anti-diabetic pharmacotherapeutics, was analysed. The anti-diabetic tertiary medical healthcare patient satisfaction was evaluated by patient response to different attributes of anti-diabetic treatment.Results: All the patients had completed the study, with no adverse effects related drop-out, lost to follow-up or voluntarily withdrawn patients. The prescription rates of metformin was 75% (75 prescriptions), followed by sitagliptin: 25% (25 prescriptions).100% prescriptions were complete for each prescription content attribute. The molecular pharmacotherapeutic response mechanisms were significantly efficacious. All the patients were satisfied with each anti-diabetic medical healthcare attribute. Conclusions: The patient endocrinological pharmacotherapeutic compliance was significantly high. Metformin was most commonly prescribed, followed by sitagliptin. The prescription content analyses showed 100% completeness, with significant pharmacotherapeutic molecular efficacy. There was ample anti-diabetic medical healthcare satisfaction.

SERUM VISFATIN, INSULIN RESISTANCE AND BETA CELL FUNCTION IN TYPE II DIABETIC PATIENTS AND NON-DIABETIC ADULT OFFSPRING WITH POSITIVE PARENTAL HISTORY OF TYPE II DIABETES MELLITUS

Introduction: Non-diabetic individuals with type II diabetic parents are more susceptible to develop Diabetes. Visfatin; an adipocytokine and an enzyme is linked with glucose metabolism and affected by obesity. It works like insulin in the human body. It serves as a key enzyme in nicotinamide adenine dinucleotide biosynthesis and plays a pivotal role in glucose mediated insulin secretion. Aims and Objectives: In this study we aimed to determine and compare serum visfatin levels, insulin resistance (HOMA-IR) and beta cell function (HOMA-%B) of type II diabetic patients and non-diabetic adult offspring of type II diabetic parents with that of non-diabetic adult offspring of non-diabetic parents. Material and methods It was a cross-sectional comparative study conducted at Diabetes clinic of Lahore General Hospital (LGH) and department of Physiology, Post Graduate Medical Institute (PGMI), Lahore in 2018. The study groups included thirty type II diabetic subjects (group III) and forty non-diabetic adult offspring of type II diabetic parents (group II). Forty non-diabetic adult offspring of non-diabetic parents served as controls (group I). The subjects were of thirty to fifty years of age. Blood pressure, BMI and waist circumference of every subject was measured. Fasting blood samples of the subjects were analyzed for serum insulin, glucose and visfatin. Insulin resistance (HOMA-IR), insulin sensitivity (HOMA-%S) and beta cell function (HOMA-%β) were also calculated. Results Type II diabetics (group III) had significantly higher serum visfatin, HOMA-IR, and lower HOMA-%S as compared to the controls (group I). No significant difference was found between HOMA-%B of group III and controls. On the contrary, non-diabetic adult offspring of type II diabetic parents (group II) had significantly lower serum visfatin and HOMA-%S while HOMA-%β, HOMA-IR was significantly higher in comparison to the control group (group I). Conclusion Visfatin production seems suppressed in non-diabetic individuals with type II diabetic parents probably due to hyperinsulinemia. Moreover, it has a little role in insulin secretion in these individuals as reflected by their higher HOMA-%B index. However, visfatin’s upregulation in chronic hyperglycemia is indicative of its restorative role in the declined beta-cell function in type II diabetics.

An assessment of depression in type-II diabetics presenting at tertiary care hospital

Objective: To assess the frequency of depression in type-II diabetics presenting at tertiary care hospital. Materials & Methods: This cross sectional study was conducted at Department of Psychiatry & Behavioral Science, Sheikh Zayed Hospital, Rahim Yar Khan from April 2020 to October 2020 over the period of 6 months. Total 200 type-II diabetics having age 20-65 years either male or female were selected for this study. Depression was assessed in selected by using DSM-IV criteria for Depression. Results: Mean age was 54.37 ± 5.88 years. Out of 200 patients of diabetes, depression was noted in 46 (23%) patients. Most (98,49%) of the patients were between 51-65 years but difference of depression with age group was not statistically significant with p value 0.8958. Total 19 (20.88%) male patients and 27 (24.77%) female patients were found with depression. But depression was insignificantly associated with gender with p value 0.6315. Total 11 (14.29%) patients found with depression having duration of diabetes mellitus ≤3 years and 35 (28.46%) patients found with depression having duration of diabetes mellitus >3 years. Depression was significantly associated with duration of diabetes mellitus with p value 0.032. Conclusion: Our study concluded that prevalence of depression in type 2 diabetes mellitus patients was much higher and have shown positive association with extremes of ages and duration of disease. Keywords: Diabetes mellitus, depression, socioeconomic status, physical recovery

Study of serum lipid profile and serum lipo-protein (a) in type II diabetes mellitus patients compared to non-diabetics

Background: This study helps us in evaluating present Indian scenario of lipid and diabetic portfolio, and advices about how aggressive treatment should be for immediate control of blood sugars and lipids are to minimize the cardiovascular risks. The objective of this study was to evaluate the serum lipid profile and lipo-protein (a) levels in comparison to patients with type II diabetics with non-diabetics.Methods:It was a hospital-based case control study conducted on patients presenting with signs and symptoms of diabetes mellitus and confirmed on doing appropriate investigation. 200 patients of which 100 were non-diabetic (control) and 100 type II diabetic patients, of which fifty were type II diabetics were on oral hypoglycemic agents (OHA) and 50 were on insulin only, were selected after matching for age and sex. Lipid profile, serum lipoprotein (a), ECG, 2D echo was studied in these patients.Results: The males were more (74%) than females (26%) among the cases. Fasting blood sugar, post prandial blood sugar and HbA1c were significantly more in cases. Triglycerides, LDL, VLDL and lipoprotein (a) were significantly more in cases. ST shift (mm) and T wave inversions were significantly more in cases compared to controls (p<0.05). Mean ejection fraction was significantly reduced in cases compared to controls. FBS and PPBS were not significantly different in two groups of OHA and insulin but HbA1c was significantly better controlled in insulin group than OHA group.Conclusions:Lipid profile and lipoprotein (a) as well as ECG and 2D echo parameters were significantly worse in diabetes patients. Hence appropriate management is important to prevent risk of complications.

Retinal Inflammation, Oxidative Stress, and Vascular Impairment Is Ablated in Diabetic Mice Receiving XMD8-92 Treatment

The global number of diabetics continues to rise annually. As diabetes progresses, almost all of Type I and more than half of Type II diabetics develop diabetic retinopathy. Diabetic retinopathy is a microvascular disease of the retina, and is the leading cause of blindness in the working-age population worldwide. With such a significant health impact, new drugs are required to halt the blinding threat posed by this visual disorder. The cause of diabetic retinopathy is multifactorial, and an optimal therapeutic would halt inflammation, cease photoreceptor cell dysfunction, and ablate vascular impairment. XMD8-92 is a small molecule inhibitor that blocks inflammatory activity downstream of ERK5 (extracellular signal-related kinase 5) and BRD4 (bromodomain 4). ERK5 elicits inflammation, is increased in Type II diabetics, and plays a pathologic role in diabetic nephropathy, while BRD4 induces retinal inflammation and plays a role in retinal degeneration. Further, we provide evidence that suggests both pERK5 and BRD4 expression are increased in the retinas of our STZ (streptozotocin)-induced diabetic mice. Taken together, we hypothesized that XMD8-92 would be a good therapeutic candidate for diabetic retinopathy, and tested XMD8-92 in a murine model of diabetic retinopathy. In the current study, we developed an in vivo treatment regimen by administering one 100 μL subcutaneous injection of saline containing 20 μM of XMD8-92 weekly, to STZ-induced diabetic mice. XMD8-92 treatments significantly decreased diabetes-mediated retinal inflammation, VEGF production, and oxidative stress. Further, XMD8-92 halted the degradation of ZO-1 (zonula occludens-1), which is a tight junction protein associated with vascular permeability in the retina. Finally, XMD8-92 treatment ablated diabetes-mediated vascular leakage and capillary degeneration, which are the clinical hallmarks of non-proliferative diabetic retinopathy. Taken together, this study provides strong evidence that XMD8-92 could be a potentially novel therapeutic for diabetic retinopathy.

An Assessment of Retinopathy in Type-II Diabetics along with Microalbuminuria

Objective: To assessment of retinopathy in type-II diabetics along with microalbuminuria at tertiary care hospital. Material and methods: This study was done at Department of Medicine, D.G Khan Hospital, D.G Khan from April 2020 to October 2020 over the period 6 months. Total 295 patients of type-II diabetes mellitus along with microalbuminuria having age between 45-80 years either male or female were selected. Diabetic retinopathy was evaluated in selected patients. Results: Total 295 patients were selected according to inclusion criteria. The mean age of patients was 58.13 ± 9.412 years. Out of 295 patients, retinopathy was noted in 67 (23%) patients. Out of 147 (49.83%) male patients, retinopathy was noted in 39 (26.5%) patients. Out of 148 (50.17%) female patients, retinopathy was noted in 28 (18.9%) patients. Statistically insignificant association of retinopathy with gender was noted with p value 0.119. Conclusion: Findings of this study showed a higher percentage of retinopathy in patients of type-II diabeties along with microalbuminuria. Most of the victims were males as compared to females and no association of development of retinopathy with gender was detected. Higher number of patients belonged to 4th and 5th decade of life. Four to five years of duration was noted among the half of the study population. Keywords: Retinopathy, Diabetes mellitus type II, Microalbuminauria

Comparison of Ultrasonographic Evaluation of Gallbladder Volume in Type II Diabetic Patients with Non-diabetic Healthy Subjects

Background: Measurement of increased gallbladder volume is necessary for the detection of pathology of gallbladder. Objective: The purpose of the present study was to find out the difference between ultrasonographically measured gall bladder volume in fasting and post prandial states of type II diabetic patients and non-diabetic control subjects. Methodology: This cross-sectional study, carried out department of Radiology and Imaging at Bangladesh Institute of Research and Rehabilitation in Diabetes, Endocrine and Metabolic Disorders (BIRDEM) Hospital, Dhaka, Bangladesh from June 2013 to July 2014. The type II diabetic patients were selected as group A and the healthy individual with age and sex matched were selected as group B. An ultrasonographic evaluation of fasting gallbladder volume and 2 hours after meal was done in all the subjects using a 3.5 MHz transducer. Information was recorded in preformed data collection sheet. Results: There was statistically significant (p<0.001) difference of mean fasting gall bladder volume between diabetic and non-diabetic subjects. The mean postprandial gall bladder volume of type II diabetic patients was significantly higher than that of the non-diabetic controls. By using Karl-Pearson coefficients of correlation it was found that gallbladder enlargement in type II diabetics, was significantly correlated with body mass index (p= 0.05) and systolic blood pressure (p= 0.05). Conclusions: Cholecystomegaly is found in type II diabetics in the present study to a significant degree which is also significantly correlated with body mass index and systolic blood pressure. Journal of Current and Advance Medical Research, July 2021;8(2):114-118

Impact of Gut Microbiome Lactobacillus spp. in Brain Function and its Medicament towards Alzheimer’s Disease Pathogenesis

Alzheimer’s disease is neurodegenerative dementia which has significant health complications in the old age group. An imbalance in gut microbiota can influence to cause several diseases like chronic disorders, depression, type II diabetics, and neurological disorders like AD. Aging is one of the major causes of the development of neurodegenerative disease due to the decreasing levels of neurotransmitters, oxidative stress, chronic inflammation, and apoptosis. These harmful effects of aging can be prevented by probiotics usage. The gut-microbiota is capable to control the brain function through the gut-brain axis. Lactobacillus strains are considered as beneficial microorganism because of its importance of the maintenance in healthy intestinal microflora, immunomodulation, and intestinal pathogenic intervention. They have diverse applications in the medical field with properties like antioxidant, anticancer, anti-inflammatory, anti-proliferative, anti-obesity, and anti-diabetic activities. Probiotic supplementation with Lactobacillus strains shows an optimistic trend to use it as a significant therapy for cognitive symptoms. This review article put forwards the significance of the gut-brain axis and the contribution of Lactobacillus strains as a probiotic supplement and its therapeutic innovations for future aspects and the limitation to treat AD-related pathogenesis are briefly elucidated.