Adrenalectomy improves glycemic responses in congenic obese LA/Ntul//-cp RATS

To determine the effects of adrenalectomy on typical insulin-mediated glycemic responses in male obese rats, groups (n=6 -12 rats/phenotype) of normally reared congenic lean and obese animals were fed a Purina chow diet from 6 to 9 weeks of age, and the Chow diet plus a highly palatable cafeteria diet from 9 to 12 weeks of age. The congenic LA/Ntul//-cp rat strain is noted for its longevity and early expression of the obese trait but remains non-diabetic throughout much if not all of its normal lifespan. Subgroups of obese animals were subjected to bilateral adrenalectomy (ADX) at 6 weeks of age to remove glucocorticoid contributions to glycemic parameters. Measures of weight gain (WG )and of glucose tolerance (OGT) were obtained in the three treatment groups at 6, 9 and 12 weeks of age. WG on ADX-obese rats was similar to that of their lean littermates at 6 and 9 weeks of age on the chow diet but increased to twice that observed in their lean littermates from 9 to 12 weeks of age. OGT responses after 30 to 60 minutes and the area under the OGT curve were impaired but not diabetic in obese animals at all ages compared to lean littermates and returned toward those of normally lean rats after ADX. The Insulin to glucose ratio (I:G) was also consistent with insulin resistance in obese but not in ADX-obese or lean rats at 12 weeks of age. In conclusion, ADX resulted in normalization of OGT and glycemic parameters in the obese phenotype at 9 and 12 weeks of age. These results are consistent with normalization of typical insulin-mediated components of glycemic parameters and glucose uptake in peripheral tissues following adrenalectomy of congenic obese rats. The results further suggest that the counterregulatory effects of insulin and glucocorticoid hormones may be contributory to the impaired glycemic responses in the obese phenotype of the LA/N//-cp (corpulent) rat and are consistent with a receptor-mediated element in the development of insulin resistance and glucose uptake in peripheral tissues commonly associated with the early development of obesity in this strain.

Treatment dilemma of a depressed patient with metabolic syndrome

Background: Depression affects around 121 million people world wide according to the world health organization (WHO) and is the second leading cause of disability globally. Metabolic syndrome is defined as a combination of conditions that predispose individuals to several diseases, mainly cardiovascular diseases. The association between metabolic syndrome and depression represents a major social issue for its increasing prevalence. However, proper treatment strategies for patients who have the two overlapping conditions are not yet established. Case report: We report a challenging but successful treatment strategy of a 60 year old male, with metabolic syndrome, diagnosed with depression. Aim: The aim of the report is to highlight the need of developing evidence based treatment strategies for patients with depression overlapping with metabolic syndrome. Conclusion: Treating patients with depression and metabolic syndrome requires a multidisciplinary team, and cautious decisions as to which antidepressant to start in order to avoid deterioration in their comorbidities. More research is needed in this field as both metabolic syndrome and depression are increasing in prevalence and are among the leading causes of burden to the healthcare system.

Sudanese diabetics with hypertension are at high risk for cardiovascular disease

Objectives: To measure blood glucose, lipid profile levels, and blood pressure in diabetic hypertensive patients in order to identify the association between the parameters measured and an increased risk of cardiovascular risk in the Sudanese diabetic hypertensive patients. Material and methods: During the months of April 2012 and March 2013, a case-control study was employed in Gezira State, Sudan. The study enrolled 200 patient who met the participation criteria, with respondents divided into diabetic hypertensive and non-diabetic categories to estimate fasting blood glucose levels (FBG), Glycosylated hemoglobin (HbA1C) and lipid profile which include; total cholesterol (TC), high density lipoprotein cholesterol (HDL-C), low density lipoprotein cholesterol (LDL-C) and triglycerides (TG). The random access auto-analyzer bio system, A15 was used to test samples for various biochemical parameters. Individual information, as well as anthropometric and biochemical measurements were collected on a questionnaire. After each participant gave verbal consent, venous blood samples were drawn after an overnight fast. The statistical evaluation was achieved with the aid of a statistical package for social sciences (SPSS version 16, Chicago, IL, USA). Result: The WC and BMI both increased significantly by (p=<0.0001), according to the analysis of variance (ANOVA). FBG and HbA1C levels were significantly elevated by (p=<0.0001). The increase in systolic blood pressure (SBP) was significant by (p=<0.0001). The mean HDL-C level was at high risk (49.73) with a significant increase by (p=0.009). The mean LDL-C concentration was above the optimum level (109.03) with a non-significant increase (p=0.697). Conclusion: WC, BMI, DBP, FBG, and HDL-C all increased significantly. Diabetic- hypertensive participants were at a high risk of develops dyslipidemia and cardiovascular disease.

Generalized edema and heart failure caused from hypothyroidism and ferrous agent for hypochromic anemia

The patient was an 85-year-old female who has been treated for hypertension and atrial fibrillation (Af). She has visited outpatient clinic and has received regularly general blood tests for every six months. Hemoglobin (Hb) level was stable as 11.2-12.3 g/dL and MCV 88fL from 2017, but it decreased suddenly to 5.2 g/dL and 64 fL in Sept 2020. She did not feel any symptoms or signs. Further evaluations revealed that occult blood in stool and upper and endoscopic exams were negative. About 40 days after starting sodium ferrous citrate, she developed edema anasarca, bilateral pleural effusion and heart failure. Laboratory test showed hypothyroidism, and then the administration of thyroid hormone and diuretics brought her early improvement. As to this impressive case report, general clinical progress and some discussion of the relationship among anemia, edema anasarca, heart failure and hypothyroidism would be described.

Effective and convenient treatment of Xultophy with lower doses for elderly diabetic patient

The case is an 82-year-old female patient with Type 2 Diabetes Mellitus (T2DM) for 22 years. She developed right empyema in early January, 2021 and was treated by antibiotics and CT-guided drainage. After improving the status, she was transferred to Hayashi hospital, Tokushima, Japan. Treatment for T2DM was initially multiple daily insulin injection (MDI), but it could not continue because of injection several times a day by the family. Then, Xultophy was started once a day, which brought satisfactory glucose variability with lower doses. Consequently, Xultophy would be effective and useful agent from bio-psycho-social points of view.

Prevalence of malnutrition risk in elderly with type 2 diabetes mellitus

Introduction: Type 2 diabetes is more common in the elderly and is associated with obesity. People with diabetes are already at risk of poor health because of the disease complications. Diabetic patients often have an obese appearance and malnutrition is often unrecognized and untreated. Aim: The present study is to assess the prevalence of malnutrition risk in a sample of elderly people with type 2 diabetes. Methodology: A cross-sectional observational study was carried out on 47 elderly diabetic patients. Clinical and anthropometric data (weight and height) were obtained by consulting clinical records. To archived sociodemographic and lifestyle information it was applied a questionnaire. Waist circumference (CP), arm (PB) and leg (PP) perimeters were measured were performed according to standard procedures. The body fat percentage (BF) was calculated from the anthropometric equation of Deurenberg (1998). The Mini Nutritional Assessment (MNA®), validated for the geriatric population was used to assessment nutritional risk. The statistical analysis of the data was performed using the computer software for Windows, SPSS®, version 25.0 (SPSS INc, Chicago). Statistical significance was considered when p <0.05. Results: The average age of the participants was 74.2±5.3 years with 53.2% males and 46.8% females. The mean value of HbA1c was 8.30±1.98%. There was no statistical significance (p=0.50) between the mean BMI of men (28.9±4.8) and women (30.0±5.7). According to the evaluation of Lipschitz (1994), 51.9% of men and 68.4% of women are overweight. Results of the nutritional status assessment according to the MNA® showed that 27.7% of diabetic patients were at risk of malnutrition. Conclusion: The prevalence of the malnutrition risk in the present study is very relevant (27.7%), being crucial the nutritional monitoring of participants at nutritional risk and/or overweight, in order to avoid deterioration in their health status and promote a healthy lifestyle.

Magnesium status in a population of type 2 diabetes mellitus in Morocco

Background: Type 2 diabetes mellitus (T2DM) contributes to 90% cases of diabetes–the ninth leading cause of death. Magnesium (Mg) levels have been found consistently low in the patients with T2DM around the world. Objective: The objective of our work was to assess the Mg status in the patients with T2DM. Material and methods: A descriptive prospective study including 103 patients with type 2 diabetes mellitus (T2DM) was carried out at Avicenna Military Hospital in Marrakesh over a period of four months (October 2019 - January 2020). The patients with T2DM and age above 35years with no history of Mg supplementation, cancer or autoimmune disease were included in the study. Blood samples were analyzed for fasting glucose, lipid profile, HbA1c, and serum magnesium. The data were analyzed by SPSS version 16, Pearson correlation was performed to establish the relationship between Mg and metabolic variables in T2DM patients. Results: The study included 103 T2DM patients with 56 (54.4%) males and 47 (45.6%) females. Prevalence of hypomagnesemia was 14.56%. Mean age of the patients and duration of diabetes were 59±9 years and 9±4years, respectively. Most common antecedent conditions were dyslipidemia (43.7%), hypertension (42.7%), and retinopathy (25.2%). Hypomagnesemia was significantly associated with HbA1c (P=0.003) and arterial hypertension (P=0.002). Magnesium had negative linear relationship with increased fasting blood sugar and HbA1c. Conclusion: In Morocco, the prevalence of hypomagnesemia in T2DM patient is low, but it has negative linear relationship with fasting blood sugar and HbA1c.

Case series: COVID-19 infection causing new-onset diabetes mellitus?

Objectives: This paper seeks to explore the hypothesis of the potential diabetogenic effect of SARS-COV-2 (Severe Acute respiratory syndrome coronavirus). Case series presentation: We present a case series of observation among 8 patients of age group ranging from 34 to 74 years with a BMI range of 26.61 to 53.21 Kilogram/square meters that developed new-onset diabetes after COVID-19 infection. Severe Acute Respiratory Syndrome Coronavirus (SARS-COV-2), commonly known as Coronavirus or COVID-19(Coronavirus infectious disease), gains entry into the cells by binding to the Angiotensin-converting enzyme-2(ACE-2) receptors located in essential metabolic tissues including the pancreas, adipose tissue, small intestine, and kidneys. The evidence reviewed from the scientific literature describes how ACE 2 receptors play a role in the pathogenesis of diabetes and the plausible interaction of SARS-COV-2 with ACE 2 receptors in metabolic organs and tissues. Conclusion: The 8 patients without a past medical history of diabetes admitted with COVID-19 infection developed new-onset diabetes mellitus due to plausible interaction of SARS-COV-2 with ACE 2 receptors. The resulting downregulation of ACE-2 and ACE-2 receptors expression caused islet-cell damage resulting into diabetes. The resulting observation has the potential to adversely impact significant number of the globally affected population. Screening patients with COVID-19 for diabetes routinely can help in early detection, significantly reducing morbidity and mortality associated with diabetes. Due to limitations of observational study with a small sample size will require further investigation in the form of Clinical trial.

Diabetes potentiates ROS production in granulocytes from patients with chronic kidney disease

Background: Type 2 diabetes (DM2) and chronic kidney disease (CKD) are inflammatory pathologies. Diabetes is characterized by hyperglycemia and CKD by the gradual and irreversible loss of kidney function. Both diseases develop oxidative stress, and reactive oxygen species (ROS) play a pivotal role in the pathogenesis. This study aimed to determine ROS production by granulocytes from renal patients (CKD) with or without diabetes. Methods: Granulocytes from patients with DM2, CKD, CKD-DM2, and healthy controls were purified using the Ficoll-Hypaque gradient method. Granulocyte ROS generation in the absence or the presence of PDB (an activator of NADPH-oxidase) or Concanavalin A (Toll- receptor 3,9 activator) was evaluated in a luminol-dependent chemiluminescence method. The cell-free DNA in the serum of DM2, CKD, and CKD-DM2 patients was measured by the fluorescence method before and after hemodialysis. Results: Our results show a significant increase in ROS production by granulocytes from patients with CKD, DM2, and CKD-DM2 compared to healthy control (p<0.05). CKD-DM2 group produced the most significant ROS levels with or without NADPH-oxidase activation. ROS production showed a significant increase in the presence of ConA. In contrast, mitochondrial (internal) ROS showed a different ROS response. DNA extrusion was higher in the CKD-DM2 group after hemodialysis suggesting cell death. Conclusion: The results demonstrated that CKD-DM2 patients produced high ROS generation levels and increased DNA extrusion after hemodialysis. It may suggest that CKD-DM2 disease is more severe and has a worse clinical prognosis.

Hypophosphatasia screening in pediatric age based on records

Introduction: hypophosphatasia (HPP) is a congenital disease, characterized by a defect in bone and dentary mineralization, secondary to a deficiency in the biosynthesis of non-specific tissue isoenzyme of alkaline phosphatase (TNSALP), resulting in decreased levels of alkaline phosphatase (ALP) activity and the extracellular accumulation of its substrates. Our goal was to establish the interest of screening the hospital databases of pediatric patients with low levels of ALP for the diagnosis of HPP. Materials and methods: during the period from September 2016 to September 2017, 23231 patients were tested for ALP, 1752 of them showed low levels of ALP. Based on the clinic, basal disease and that in previous analyses they did not present ALT norm values, 14 cases were selected: 8 cases associated with early puberty, 1 case of low size, 1 case of liver disease and myasthenia and 1 case of teething problems. ALPL gene was studied in those cases. Results: the latter case was of an 8-year-old male with a pathological variant of HPP: c.343_348dupACCGCC (p.Thr115_Ala116dup) in exon 5 in dominant heterozygous, inherited from his mother. At the substrate level the levels of pyridoxal-5-phosphate were above 50μg/L. Conclusion: the diagnostic strategy with a high index of clinical suspicion of HPP should include the observation of low levels of serum ALP activity. Our study shows that HPP is an underdiagnosed disease.An appropriate protocol to detect HPP in a clinical setting in tertiary care hospitals is required.