Effect of Leaf Aqueous Extract of Manilkara hexandra on Digestive and Glucose Metabolic Enzymes, and Serum Glucose Level in Labeo rohita Fingerlings

Manilkara hexandra (Roxb.) Dubard (common name Khirni, family: Sapotaceae) is an evergreen traditionally used medicinal plant. The present study aimed to see the effects of leaf aqueous extract of M. hexandra (LAEMH) on digestive and glucose metabolic enzyme action and serum glucose level in rohu, Labeo rohita, fingerlings. Experimental fish were fed a basal diet (Group I), and diets supplemented with LAEMH at 300 mg (Group II) and 600 mg (Group III) kg−1 body weight. A significant reduction in serum glucose was noticed in the treated groups when compared with the control group. The reduced amylase activity was noticed in the treated fingerlings in a dose-dependent manner. However, lipase and protease activities didn’t differ significantly among the experimental groups. Reduced serum glucose level might be correlated with the decline in the activity of digestive amylase in fish. Group II (3.35±0.19U) and Group III (3.49±0.13 U) were recorded with reduced glucose-6-phosphatase activities than the control group (4.4±0.39 U). Moreover, the study revealed a decline in fructose-1,6-phosphatase activities in the treated groups in comparison to the control group. The decline in the activities of the metabolic enzymes might be associated with the non-availability of glucose owing to reduced activity of the digestive amylase in the treated groups. In conclusion, the present study established the hypoglycaemic effect of the leaf aqueous extract of M. hexandra in a fish model.

Which Factors Affect Ankle Joint Swelling in Ankle Fracture Patients? - Radiological Measurement Method

Background: Ankle joint swelling (AJS) in fracture patients is important for predicting soft tissue complications and deciding urgent surgery. Most surgeons still predict the progression of AJS based on their extensive experience. This study was conducted to identify factors that may affect the progression of AJS.Methods: The clinical data and radiographic images of 120 patients who have undergone surgical treatment for ankle fracture were obtained. The immediate radiographs after surgery were representative of the swelling of the ankle joint, and the radiographs 2 weeks after device removal were representative of the normal ankle joint. We defined AJS as the sum of the ankle joint skin contour diameters in the anteroposterior and lateral views. We performed multivariate regression analysis to compare the correlation between variables and AJS.Results: A total of 90 patients were included and followed up for an average of 18.1 months (range, 14–20). Three significant factors (preoperative serum glucose level, injury mechanism, and duration of surgery) were identified to affect AJS.Conclusion: Elevated preoperative serum glucose level, high-energy injury, and extended duration of surgery were more likely to aggravate AJS. These findings will help surgeons to predict the prognosis of patients with AJS and to provide proper management for patients with an ankle fracture.Level of Evidence: Retrospective cohort study, III

Can seizures cause glycemic disorder in children with epilepsy? a cross-sectional study

Background: Aim of this study is to investigate the serum glucose level in children with epilepsy.Methods: A cross-sectional study was conducted at Pediatric Centre of Hue Central Hospital between June 2017 and June 2019. A serum glucose level test was performed after the seizure.Results: In total, 144 patients were included in the study. Of these, the most age group was 0 - <5 years (accounted for 59.7%), followed by group 5-10 years (24.3%) and 11-15 years (16%). Female was more likely than male (52.8% vs 47.2%). The most common type was generalized epilepsy (accounted for 72.2%), and the least was un-classified epilepsy (6.3%). The blood test investigated 19 (13.2%) of patients with hyperglycemia and 1 (1.4%) with hypoglycemia.Conclusions: The present study highlights that seizure can cause glycemic disorder in children with epilepsy.

Abstract 256: Length of Stay, Type of Stroke and NIHSS Score in Persons With Self-reported Diabetes

In the U.S., diabetes is the 7th leading cause of death and 65% of these deaths are attributable to cardiovascular disease or stroke or to both. Among patients admitted for acute stroke, diabetes was associated with a higher risk of death, functional dependency and stroke recurrence. The purpose of this investigation was to examine the relationship between length of stay (LOS), type of stroke [ischemic stroke (IS), Transient Ischemic Attack (TIA), Subarachnoid Hemorrhage (SAH), Intracerebral Hemorrhage (ICH)] and the NIH Stroke Scale (NIHSS) in patients admitted to the hospital with an initial diagnosis of stroke or TIA and self-reported diabetes. There were N=5105 subjects (2448 males and 2657 females) in our center’s Get With The Guidelines-Stroke (GWTG-S) database from April 2014 to March 2019. Age, race, sex, insurance type, lipids and lipoproteins, initial serum glucose on admission, blood pressure, stroke type, and initial stroke severity (NIHSS) were the variables analyzed in a multiple regression analysis, with p <0.05 considered statistically significant. Mean LOS was 7.4 days (d) (range 0-119 d). LOS was negatively associated with age (as age (years) increased, the length of stay decreased by 0.05 d). We found that LOS to be positively associated with NIHSS score. Compared to those with mild NIHSS (0-5), those with severe NIHSS (>10) had LOS increased by 4.3 d, whereas moderate NIHSS (6-10) had LOS increased by 1.9 d. When compared with IS, we found that TIA was associated with a 2.6 d decrease in LOS whereas SAH and ICH were associated with a 6.7 and 3 d increase, respectively. Insurance type also was associated with LOS. Those on Medicaid had a 2.7 d increase in LOS compared to those who had Medicare. No statistically significant difference was found between Medicare and private insurance. There was no difference between ethnicities and LOS among our subjects. As expected, higher initial serum glucose level was positively associated with increased LOS. Specifically, for every 1 unit increase in initial serum glucose level was an associated 0.01 d increase in LOS. Thus, in the current study, we demonstrated that diabetes and initial serum glucose level continue to be important criteria in estimating the LOS in person admitted with a stroke. We recommend that these variables be considered for discharge planning and length of stay benchmarks in persons with history of diabetes.

Comorbidity of sleep disorders in children with cardiomyopathies

Objective. To analyze clinical and instrumental characteristics of sleep disorders in children with cardiomyopathies (CMPs). Patients and methods. We performed retrospective analysis of clinical, laboratory, and instrumental parameters in 107 children with CMPs aged 2 to 17 years treated in the National Medical Research Center of Children's Health in 2018–2019. The study sample was formed in accordance with inclusion criteria (confirmed diagnosis of CMP with functional class I or II, NYHA or Ross R.D.) and exclusion criteria (age <2 years, other heart and vascular diseases). We enrolled 26 children with hypertrophic CMP, 63 children with dilated CMP, and 18 children with unclassified CMP. According to the signs of sleep disorders (from sleep questionnaires filled in by parents), we formed 3 groups: patients with no sleep disorders (n = 40), patients with symptoms of insomnia/parasomnia (n = 26), and patients with indirect and/or direct signs of sleep apnea syndrome (SAS). We analyzed patients’ complaints, as well as clinical, instrumental (liver ultrasound, echocardiography, Holter ECG), and laboratory (glucose, cholesterol, alanine aminotransferase, and aspartate aminotransferase in serum) parameters. Results. Sleep disorders were identified in 63% of children: 58% had signs of insomnia/parasomnia and 38% had signs of SAS. In contrast to the questionnaires, medical records had information about sleep disorders only in two cases. Medical records primarily contained complaints of fatigue and reduced tolerance to physical activity (73%), excessive sweating (23%), and shortness of breath (17%). Patients with SAS usually had more complaints (according to their medical records), and their complaints were more diverse, including abnormal blood pressure, cephalgia, palpitations, and syncope. Body mass index (BMI) (p = 0.001) and serum glucose (p = 0.001) were higher in children with SAS than in children with normal sleep. Even after the exclusion of BMI, glucose levels (although being within the reference range) were still significantly higher in the SAS group (p = 0.020). The QTc interval at the maximum heart rate (HR) (p = 0.018) in children with sleep disorders was longer and had a positive correlation with serum glucose level (r = 0.195, p = 0.052). The analysis of echocardiography parameters (excluding the diagnosis factor) showed a smaller diameter of the pulmonary artery (p = 0.058) in children with SAS and correlation between right atrial remodeling and the factor of sleep disorder in children with various forms of CMP (p = 0.040). Conclusion. The analysis of sleep questionnaires revealed sleep disorders in 63% of children with CMP, including insomnia/parasomnia (24%) and/or SAS (38%). The presence of SAS was associated with a substantial number and variety of subjective complaints. The signs of myocardial electrical instability (longer QTc interval at maximum heart rate), association between QTc and serum glucose level, specific features of remodeling of the heart and blood vessels in patients with sleep disorders, and, most importantly, SAS in children indicate the need for early detection and correction of sleep disorders (insomnia, parasomnia) and main causes of SAS, such as chronic diseases of the ENT organs, overweight, and obesity. Treatment of sleep disorders is very important in terms of prevention of complications, treatment and prognosis of cardiomyopathy in children, which will help to increase therapeutic efficacy. Key words: children, cardiomyopathy, comorbidity, sleep disorders, sleep apnea, sleep questionnaires

Clinical significance of serum amylase and glucose level in organophosphorus poisoning

Background: Organophosphorous (OP) poisoning is a common problem in country like Nepal where agriculture is the backbone of the economy. The primary mechanism of action is inhibition of acetylcholinesterase (ACHE). Organophosphorus poisoning is a possible cause of acute pancreatitis along with alternation of glucose metabolism. Materials and Method: This was a hospital based cross-sectional comparative study. The level of serum amylase and glucose were measured in thirty-eight OP poisoned patients at the time of admission, before discharge and were compared. Results: Amongst 38 patients, Majority had mild OP poisoning 27(71.1%) as per Peradeniya Organophosphorus Poisoning (POP) score whereas 9(23.7%) had moderate and 2(5.2%) had severe poisoning. The mean initial serum amylase level in patients with mild poisoning was 152±73.92 (IU/L)(p=0.000), in moderate poisoning was 213.38±69.39 (IU/L) (p=0.223) and in severe poisoning was 171.33±107.22(IU/L) (p=0.259). There was increase in serum amylase level in all patients with poisoning but level did not increase in proportion to increase with severity of POP score. The mean initial serum glucose level in mild poisoning was 132.48±37.73 (Mg/dl) (p=0.024), in moderate poisoning was 139±44.59 (Mg/dl) (p=0.033) and in severe poisoning was 174±23.38 (Mg/dl) (p=0.22). The serum glucose level increased as the severity of POP score increased. The serum amylase and glucose levels in recovering patients showed a tendency to decrease to their normal values. No patient had developed acute symptomatic pancreatitis. Conclusion: Serum amylase and glucose level were increased in all patients with OP poisoning but didn’t correlate with the clinical severity. Routine measurement of serum amylase in patients of OP poisoning has little value in the absence of clinical acute pancreatitis.

A Cross Sectional Clinical Analysis of Hemiplegia (Pakkavatham) Related to Diabetes Mellitus (Mathumeham) and Hypertension (Erathakothippu)

Background: Stroke (Pakkavatham) is the second leading mortality cause in global and death occurrence rates, rising in middle to older aged people. This condition is increased due to the dietary pattern and lifestyle modifications. Aim: To determine about the interrelationship of Type II Diabetes Mellitus DM) and Systemic Hypertension (SHT) associated with hemiplegia. Study Design: Cross Sectional Descriptive Observational Study. Place and Duration of Study: This study work was carried out in 50 patients in Government Siddha Medical College and Hospital, Palayamkottai, Tirunelveli, Tamil Nadu from April 2019 to September 2019. Materials and Methods: This study was carried in 50 subjects (30 subjects in Out Patient Department (OPD) and 20 subjects in In Patient Department (IPD) were randomly selected and the data were collected by interviewing with a structured questionnaire. The ethical clearance was attained from the Institutional Ethical Committee. Results: The highest incidence was male patients (38%) than female patients, the affected age group was 51-60 years. The prevalence was seen in male alcoholic consumers (46%), chronic smokers (44%) respectively. The incidence was mostly seen in hypertensive (70%) and non-diabetic (46%) male patients. Among the 50 patients, 14 patients (28%) had both SHT and DM. The most prevalence was seen in hypertensive patients than DM or SHT combined with DM patients. The moderate improvement was seen in the patients (32%) of control blood pressure and serum glucose level. Conclusion: The SHT may influence in the prevalence of Pakkavatham and control blood pressure and serum glucose level may be improved the good prognosis in Pakkavatham patients.