Progress toward molecular therapy for diabetes mellitus: A focus on targeting inflammatory factors

Diabetes mellitus (DM) has been the most prevalent global metabolic disease, turning into a serious risk for human health. Several researches have recorded a role for inflammation and immunity in the pathogenesis of both in T1DM and in T2DM. Lots of chemical agents are available to control and to cure diabetic patients, which are not always sufficient for euglycemia maintenance and late stage diabetic complications avoidance. Therefore, newborn therapeutic methods to refine clinical outcomes in DM are required. Nucleic-acid-based therapy also known as gene expression level regulator within the target cells has been calculated to be promising in various diseases. Thus, pronounced attempts have been dedicated to develop new targeted molecular therapy aimed at improving insulin resistance in DM. This review mainly focuses on recent progress in DM molecular therapy and whether, has potential efficacy against inflammatory mediators involved in DM.

Review of pharmaceutical and therapeutic approaches for type 2 diabetes and related disorders

One of the essential diseases that are increasing in the world is type 2 diabetes (T2D), which many people around the world live with this disease. Various studies have revealed that insulin resistance, lessened insulin production has been associated with T2D, and they also show that this disease can have a genetic origin and is associated with different genes such as KCNQ1, PPAR-γ, calpain-10, ADIPOR2, TCF7L2 that can be utilized as a therapeutic target. Different therapeutic approaches and strategies such as exercise and diet, pharmacological approaches, and utilization of nanoparticles in drug delivery and gene therapy can be effective in the treatment and control of T2D. Glucagon-like peptide 1 (GLP-1) and sodium glucose cotransporter-2 (SGLT2) have both been considered as drug classes in the treatment of T2D and T2D-related diseases such as cardiovascular disease and renal disease, and have considerable influences such as diminished cardiovascular mortality in individuals with T2D, ameliorate postprandial glycaemia, ameliorate fasting glycaemia, and diminish body weight on disease treatment and improvement process. In the present review article, we have made an attempt to explore the risk factors, Genes, and diseases associated with T2D, therapeutic approaches in T2D, the influences of drugs such as Dapagliflozin, Metformin, Acarbose, Januvia (Sitagliptin), and Ertugliflozin on T2D in clinical trials and animal model studies. Research in clinical trials has promising results that support the role of these drug approaches in T2D prophylaxis and ameliorate safety even though additional clinical research is still obligatory.

The antibacterial effect of Magnolia mouthwash on the levels of salivary Streptococcus mutans in dental plaque: a randomized, single-blind, placebo-controlled trial

Background and Objectives:

Dental caries is one of the most common chronic diseases around the world. Inhibitory effects of Magnolia Grandiflora bark extract has been proved on tooth decay both in vitro and by using free sugar chewing gum. This research aimed to examine the effect of Magnolia Grandiflora bark mouth-wash on the prevalence of Streptococcus mutans in dental plaque.

Materials and Methods:

This crossover, placebo-controlled, clinical trial study, was performed on a total of twenty participants (aged 18 to 35 years) in both control and intervention groups and four phases. The prevalence of S. mutans was measured in a certain volume of volunteer’s dental plaque at the beginning of the project (phase 1), after the first prescription (phase 2), following the washout period (phase 3) and finally after the second prescription (phase 4) by culture on bacteriology medium. Plaque index and saliva sampling were carried out in follow-up visits by a dentist. The data were analyzed using T-Test (paired and independent) quantitatively.

Results:

There was a significant difference in S. mutans frequency in dental plaque between when the participants used Magnolia mouthwash and when they washed out or used a placebo (p<0.005). Results also showed a significant difference between Magnolia and Placebo groups in the mean count of saliva bacterial colony counts after oral administration in the first and second time (P<0.001 and P<0.004, respectively).

Conclusion:

The current trial showed that Magnolia Grandiflora %0.3 mouthwash tends to decrease the number of S. mutans in dental plaque significantly. Therefore, its mass production and release to the oral health community are suggested. However, further studies with larger sample sizes and varying treatment are required to substantiate the findings of this study.

Deceased Organ Donation From Pediatric Donors: Does the Literature Really Help Us? Implication for More Powerful Guidelines

BACKGROUND

Brain-dead pediatric donors have always been the focus of attention because of the higher quality, utility, and possibility of their organ donation. However, donors under the age of 5 years always necessitate making more challenging management efforts, which are not clearly implied in most parts of the guidelines.

METHODS

The data obtained from 79 brain-dead pediatric donors of the Organ Procurement Unit of Masih Daneshvari Hospital, Tehran, Iran, were assessed. The donors were divided into 2 groups, including donors under 5 years of age (group A) and those between 5 and 12 years of age (group B). Metabolic, hemodynamic, hematologic, and electrolyte status as well as the suitability for donation were compared in the study groups.

RESULTS

Of 1252 donors, 6.3% were under 12 years of age. Trauma and drug toxicity were the two primary causes of brain death in group A. In comparison, trauma and brain tumor were the leading causes of brain death in group B. The prevalence of both hyperglycemia and respiratory acidosis was significantly higher in group A (P < .05). However, severe anemia and coagulopathy were more prevalent in group B (P < .05). The high-dose inotropic administration was used for 42.4% of the donors in group A, whereas only 26% of the donors in group B needed a high dose of inotropes (P < .05). The mean quantity of organ harvested per donor was 2.1 and 2.25 in groups A and B, respectively. Furthermore, donor loss was not significantly different in both groups.

CONCLUSIONS

The occurrence of different complications in donors under the age of 5 years requires special treatment considerations that should be the center of attention in the related guidelines. Organ donation per donor indicates that donors under the age of 5 years are a valuable resource for organ procurement.

The impact of Multimedia Software Support on the Knowledge and Self-Care Behaviors of Patients with Type 2 Diabetes: a Randomized Clinical Trial

Introduction: Education is the most effective and economical part of diabetes treatment. The purpose of this study was to investigate the effect of a training program with multimedia software on the knowledge and self-care behaviors of patients with type 2 diabetes.

Methods: This study was a randomized controlled clinical trial in which 60 patients referred to diabetes clinic at Arak city were divided randomly into experimental (n=30) and control (n=30) groups. The instruments for collecting data were "Summary of Diabetes self-care activities questionnaire" and "knowledge of self-care in patients with diabetes". Data were collected before and 2 months after the intervention in the both groups. Educational program with equal content was applied for both experimental group (self-care program with multimedia software support) & control group (lecture and presentation with PowerPoint). Data analysis was done using SPSS Ver.13.

Results: Implementation of the self-care program with multimedia software support resulted in improvements in patients’ self-care behaviors in the experimental group, whereas these behaviors had not significant changes in the control group after eight weeks. There was a significant difference in the mean score of knowledge in both the experiment and control groups before and after the intervention.

Conclusion: Considering beneficial effects of training program with multimedia software support on the knowledge and self-care behaviors and the importance of this issue, suggested that the patients preferably provide terms of use of educational software for themselves.

Polymorphic GT dinucleotide repeat in the PIK3CA gene and risk of colorectal cancer

BACKGROUND

Activated PI3K generate PIP3 to trigger different signaling pathways which regulate a number of cellular functions including cell survival, apoptosis, proliferation and motility. Mutations in many cancers were discovered in the gene encoding the PI3K catalytic subunit, PIK3CA.

OBJECTIVE

To date, there has been no report on the association between polymorphism of PIK3CA gene microsatellites and risk of colorectal cancer. In this study, we investigate the relation between the GT dinucleotide repeat in intron 1 of the PIK3CA gene and colorectal cancer risk.

METHODS

A case-control study of 103 colorectal cancer patients and 150 controls was conducted in Iranian people.

RESULTS

The results of our study demonstrate that PIK3CA gene allele distribution in Iranian population varies between 13 and 20 repeats. Here we demonstrate that individuals who carry alleles shorter than 17 GT repeat are at higher risk of developing colorectal cancer (OR = 4.0, p= 0), by contrast, those individuals with two alleles longer than 16 GT repeats are at a significantly lower risk of developing colorectal cancer (OR = 0.12, p= 0).

CONCLUSION

This result suggests polymorphic GT repeat of PIK3CA gene may be a potential predictive marker of colorectal cancer risk in Iranian population.

Efficacy of recruitment maneuver for improving the brain dead marginal lungs to ideal

BACKGROUND

Because of the shortage of lungs for transplantation, finding the suitable lungs in brain-dead donors is an important issue. Recruitment maneuver is a strategy aimed at re-expanding collapsed and edematous lung tissue. The aim of this study was to assess the efficacy of this maneuver on improving marginal lungs for transplantation.

METHODS

From 127 brain-dead potential donor which were evaluated for lung donation in Masih Daneshvari Organ Procurement Unit of Tehran, Iran, 31 (25%) had marginal lungs for transplantation. These donors had normal chest X ray or bilateral infiltration and had PaO2 200-300 mm Hg with FIO2 100%. The recruitment maneuver was performed and arterial blood gas was obtained before and after maneuver. The maneuver lasts for 2 hours with continuous check of O2 saturation and patient's hemodynamic during. Finally, patients with normal bronchoscopy and PaO2/FIO2 >300 mm Hg were considered good candidates for lung transplantation. The frequency (%) and mean ± SD were used for description of variables and the Wilcoxon test was used for comparison between pre- and post-maneuver PaO2 with FIO2 100%.

RESULTS

The mean ± SD of PaO2/FIO2 with 100% FIO2 of patients before and after recruitment were 239 ± 62 and 269 ± 91, respectively. Recruitment maneuver could convert 10 marginal lungs (32%) to appropriate ones (PaO2 > 300) and finally 8 lungs were transplanted.

CONCLUSIONS

Findings of this study showed that recruitment maneuver could convert inappropriate lungs to appropriate ones in one third of brain-dead patients who had marginal lung condition. So, it is recommended that this maneuver is considered in the assessment protocol of lungs for donation.

The effect of six-week aerobic training program on cardiovascular fitness, body composition and mental health among female students

BACKGROUND

The purpose of the present study was to evaluate the effects of six-week aerobic training program including running and rope skipping on cardiovascular fitness, body mass index (BMI), and mental health among female students at the University of Isfahan, Iran.

METHODS

In this interventional study we included 30 female students in academic year 2011-12. The participants were randomly assigned in experimental group (n=15, mean±SD for age=26.06±1.18, weight (kg)=57.43±5.67, height (cm)=160.06±4.16) and control group (n=15, mean±SD for age=26.33±1.30, weight=57.66±5.08, height=161.86±3.29). Pre-test and post-test measurements include VO2 max with Queen Step test; BMI and General Health Questionnaire-28 as a measure of mental health were done. Analysis of covariance (ANCOVA) was used to test the effects of aerobic training as intervention (P<0.05).

RESULTS

There was statistically significance difference between experimental and control groups after adjustment for their own baseline values concerning cardiovascular fitness (P=0.004), BMI (P<0.001) and mental health indices (P<0.001).

CONCLUSIONS

A six-week aerobic practice improves cardiovascular strength, mental health and BMI considerably and could be more encouraged at universities.

Effects of sulfur water extraction on anthocyanins properties of tepals in flower of saffron (Crocus sativus L)

A sulfur solution with different metabisulfite concentrations (100, 400, 700, 1,000 and 2,000 ppm) was used to extract anthocyanins from saffron tepals. The extraction process was compared with acidified ethanol solution at similar extraction times of 20, 40, 60, 120, and 180 min at 40 °C. The recovery of anthocyanins with sulfur solution was higher than ethanol extraction and reached to 700 mg anthocyanins/100 g, when the sulfur concentration and extraction time were 700 ppm and 60 min, respectively. HPLC analysis showed that anthocyanins extracted with sulfur solution followed by partial desulfurization and reducing sulfur content (to less than 250 ppm) had around 100 % more cyanidin 3 glucosides and 100 % less pelargonidin 3,5 glucosides in comparison with ethanol extraction. Additionally, the color of low-sulfured anthocyanins had more saturation (chroma), less lightness, and more stability than the one extracted with ethanol solution. While monomeric and polymeric anthocyanins extracted with sulfur solution had less than 1 % changes after 3 h extraction time, they had more than 12 % changes when they extracted with alcoholic solution at similar conditions. Overall, the sulfur method had a potential to extract stable anthocyanins from waste and discarded saffron tepals in aqueous solvent, and with higher quantity and quality (more attractive color) than conventional ethanol extraction method.

Microbial pattern of bronchoalveolar lavage in brain dead donors

BACKGROUND

We assessed bronchoalveolar lavage (BAL) cultures of brain dead donors seeking to achieve better donor management and decrease transplant complications. Determining the most common source of some postoperative infections causing morbidity and mortality among lung recipients would help to reach this goal.

MATERIALS AND METHODS

This prospective study was performed on 80 brain dead donors from August 2008 to August 2009. Donors with partial pressure of arterial O2 to the fraction of inspired O2 (PaO2/FIO2)>300 mm Hg and a normal chest x-ray underwent bronchoscopy to obtain a BAL.

FINDINGS

The mean donor age was 30±14 years and 50 (63%) were males with 21 (26%) showing a positive history for smoking and 32 (40%) with turbid tracheal secretions. Chest x-ray was abnormal in 49 (61%). Positive culture BAL results were observed among 30 (38%) patients: there were 17 (90%) bacterial and 6 (22%) fungal. Finally, 16 donors (20%) were considered suitable lung donors, allowing 10 lung transplantations.

CONCLUSION

Only 20% of donors had acceptable lungs for transplantation. The high rates of positive bacterial and fungal BAL cultures in donors suggest the need for more aggressive critical care management and antibiotic therapy which may be beneficial to prevent future infections in recipients. Further prospective studies are needed to assess the correlation between donor BAL results and posttransplant morbidity and mortality.

Causes of family refusal for organ donation

INTRODUCTION

Family refusal represents a barrier for organ donation together with other cultural and religious factors possible ignorance and clinical obstacles.

METHODS

We performed this retrospective study by phone employing our organ procurement unit database, using a list of families of potential organ donors who had refused organ donation.

RESULTS

In 2009, 146 potential organ donor families refused donation. We contacted 81 families. The main reason expressed by there families to justify the refusal to donate the deceased's organs was denial and rejection of brain-death criteria (44.4%). Other causes were believing in a miracle (13.6%); fear about organ trade and unknown organ destination (9.9%); religious beliefs (8.6%); insecutrity about the brain-death diagnosis (6.2%); unstable family mood (6.2%); unknown donor wishes about donation (4.9%); belief in body integrity after death (3.7%); and fear of objection by other family members (2.5%).

CONCLUSION

Our findings showed several reasons for family refusal for organ donation; among the main cause is poor acceptance of brain death. It seems that increasing the knowledge of people about brain death and organizing strategies to confirm brain death for families are necessary to meet the organ shortage.

Eight years of lung transplantation: experience of the National Research Institute of Tuberculosis and Lung Diseases

BACKGROUND

Lung transplantation has evolved from an experimental procedure to a viable therapeutic option in many countries. In Iran, the first single-lung transplantation was performed in the year 2000, more than 3 decades after the first successful procedure in the world, and the first double-lung transplantation was performed in the year 2006.

OBJECTIVE

To describe our 8-year experience in lung transplantation.

PATIENTS AND METHODS

During 8 years, we performed 24 lung transplantation procedures. Underlying lung diseases were pulmonary fibrosis in 16 patients (66.6%); chronic obstructive pulmonary disease in 2 (8.3%); bronchiectasis in 5, including 2 patients with cystic fibrosis (20.8%), and alveolar microlithiasis in 1 (4.16%). Data for all patients were collected and analyzed. Procedures were carried out using standardized methods. The induction suppression regimen consisted of cyclosporine and methylprednisolone. Maintenance immunosuppression drugs were cyclosporine and mycophenolate mofetil, and tapering dosage of prednisolone. Patients were followed up with physical examinations, 3 times a week, as well as and cycle ergometry 3 times a week and spirometry and laboratory tests once a week and chest radiography per needed for up to 3 months posttransplantation.

RESULTS

The longest survival time was 7.2 years, in a 60-year-old patient with idiopathic pulmonary fibrosis. Fourteen patients died, 8 as a result of hemodynamic instability and/or hemorrhage, 1 as a result of bone and fat emboli, 3 after cessation of drug and 2 of them after infection.

CONCLUSION

Although lung transplantation is a complex procedure it can be performed in developing countries such as Iran.

Organ retrieval from brain-dead patients by a single organ procurement center in Iran

INTRODUCTION

The majority of transplantations depend solely on cadaveric organs. In recent years, special focus has been directed toward brain-dead patients in Iran, but it seems that there is limited information regarding the characteristics of cadaveric organ donation in our country.

MATERIALS AND METHODS

This is a retrospective analysis of data of our Organ Procurement Unit (OPU), which is one of the most active organ procurement units in Iran. We incorporated the data on all organ donations from brain-dead patients between 2004 and 2008 into the present study. Demographic characteristics of the patients along with data regarding brain death and organ donation were extracted from already registered data on patients.

RESULTS

Among 93 brain-dead patients registered in the database of the OPU, organs were retrieved from 85% (n = 79). Out of the 14 patients from whom no organ was retrieved, the cause for this failure was death before donation in 85% (n = 12). The numbers of donated organs varied between zero and six (mean +/- standard deviation = 3.1 +/- 1.7). The most donated organs in terms of frequency and count were: right kidney (n = 68; 73.1%), left kidney (n = 67; 72%), liver (n = 63; 67.7%), heart (n = 40; 43%), pancreas (n = 5; 5.4%), and lung (n = 4; 4.3%).

DISCUSSION

The overall organ retrieval rate from brain-dead patients by this OPU was comparable to that of developed countries; however, we still believe we can improve this rate/scale.

Spoligotyping of Mycobacterium tuberculosis in anthracotic bronchitis

BACKGROUND

Mycobacterium tuberculosis infection has been shown to be associated with anthracotic bronchitis. However, the typical manifestation of infection is not usually present in infected patients, which raises the question of whether a particular strain of M. tuberculosis is associated with this group of patients.

OBJECTIVE

To determine whether a particular strain of M. tuberculosis is associated with anthracotic bronchitis.

DESIGN

We assessed the predominant space oligonucleotide (spoligotype) patterns of M. tuberculosis complex isolated from patients with anthracotic bronchitis and compared the results with tuberculosis (TB) subtype patterns in Iran and other countries.

RESULTS

During a 7-month period (April--October 2006), we enrolled 87 patients (30 men and 57 women) with anthracotic bronchitis, 26% (n = 23) of whom had TB. Spoligotyping of M. tuberculosis among these 23 patients showed four distinct patterns: East-African-Indian (11, 47.8%) and Central-Asian (7, 30.4%), Haarlem I (4, 17.4%) and T-1 (1, 4.3%). When compared with spoligotype patterns of M. tuberculosis in Middle Eastern countries, including Iran, anthracotic bronchitis had similar patterns.

CONCLUSION

Our results indicate that the atypical manifestations of TB in anthracotic patients are not caused by any particular subtypes of M. tuberculosis. We conclude that anthracotic bronchitis is actually an atypical presentation of tuberculous infection with common subtypes inside the bronchial mucosa.

Deoxynivalenol and other Fusarium toxins in wheat and rye flours on the Danish market

Information on the contamination of Danish cereals and cereal products with Fusarium toxins is limited and the last survey is from 1984/1985. In the present study, the occurrence of deoxynivalenol (DON), nivalenol (NIV), HT-2 toxin, T-2 toxin and zearalenone (ZON) was investigated in flour of common wheat, durum wheat and rye. The samples were collected from 1998 to 2001 from both mills and the retail market in Denmark. A total of 190 flour samples were analysed for DON and NIV and about 60 samples for HT-2, T-2 toxin and ZON. DON was most frequently detected with an incidence rate of 78% over all samples for all years. The contamination level varied considerably from year to year, and for wheat and rye the highest incidence and DON concentrations were found in samples from the 1998 harvest. There were regular and heavy rainfalls in Denmark during the flowering period of the crops that year, and DON was found in all samples, with mean concentrations in wheat and rye flour of 191 microg kg(-1) (n=14) and 99 microg kg(-1) (n=16), respectively. Comparison of data from each harvest year showed higher contents of DON in samples of wheat (range 20-527 microg kg(-1)) than in rye (20-257 microg kg(-1)). Contents of NIV, HT-2 toxin and ZON in samples of wheat and rye were generally low, and even in positive samples the contents were close to the detection limit of the methods. The T-2 toxin was detected in only a few of the wheat samples and in low amounts. However, the toxin was found in about 50% of the rye samples collected during 1998-2000, with a mean content of 49 microg kg(-1) (n=25). Durum wheat flour showed the highest DON contamination level, and all samples (n=33) collected during 2000 and 2001 contained DON with means and medians above 1100 microg kg(-1). Over 70% of the samples contained more than 500 microg kg(-1) DON, and the highest observed concentration was 2591 microg kg(-1). The concentration of T-2 toxin in durum wheat flour was also high with five of the 10 analysed samples containing more than 100 g kg(-1).