Effect of dapagliflozin against NAFLD and dyslipidemia in type 2 diabetic albino rats: possible underlying mechanisms

OBJECTIVE

The aim was to investigate the effect of dapagliflozin on non-alcoholic fatty liver disease and dyslipidemia in type 2 diabetic rats by studying the histopathological structure of the liver and detecting possible underlying mechanisms for this impact by evaluating the potential anti-inflammatory action of dapagliflozin.

MATERIALS AND METHODS

100 albino rats were used in this work and divided into five equal groups: group I (Control group), group II (Control diabetic group), group III (was administered dapagliflozin, 0.75 mg/kg, p.o.), group IV (was administered dapagliflozin, 1.5 mg/kg, p.o.), and group V (was administered dapagliflozin, 3 mg/kg, p.o.).

RESULTS

In our study, the total body weight, liver weight, liver index, blood glucose level, insulin level, insulin resistance, total cholesterol, triglycerides, liver enzymes, IL-1 β, and MDA were significantly higher in the control diabetic group than the normal group. The dapagliflozin reduced all the above variables significantly in a dose-dependent manner compared to the control diabetic group (p-value = 0.001 for all).

CONCLUSIONS

Dapagliflozin may be a promising novel treatment strategy for treating T2DM-related non-alcoholic fatty liver disease (NAFLD), and dyslipidemia where it possesses anti-oxidative, anti-inflammatory and anti-dyslipidemic effects.

Prevalence of urinary incontinence among women in Saudi Arabia: a cross-sectional study

OBJECTIVE

Urinary incontinence is defined as involuntary loss of urine, a common health condition that is more frequent in women. It disturbs the affected individuals and interferes with their daily activities. This study aimed to estimate the prevalence of urinary incontinence among Saudi women in the western area of the Kingdom of Saudi Arabia.

SUBJECTS AND METHODS

A descriptive cross-sectional design was used for this study. A survey was administered to Saudi women in the western area of the Kingdom of Saudi Arabia ranging in age from 18 to 70 years. The data were collected using the Arabic version of the Questionnaire for Urinary Incontinence Diagnosis. Descriptive statistics were generated by calculating numbers and percentages of information on the prevalence of incontinence in women. p-values < 0.05 were considered statistically significant.

RESULTS

The prevalence of urinary incontinence was 44.2%, with the urge type being the most reported. Stress urinary incontinence was reported by 155 women (15.4%), urgency urinary incontinence by 257 women (25.6%), and mixed urinary incontinence by 102 women (10.15%).

CONCLUSIONS

Urinary incontinence is prevalent in women in Western Saudi Arabia. Age, multiparty obesity, and vaginal surgery are significant risk factors influencing its occurrence.

Incidence of Guillain-Barré Syndrome post COVID-19: a systematic review of case reports and case series

OBJECTIVE

The purpose of this systematic review was to study the incidence, risk factors and patients subjected to Guillain-Barré syndrome (GBS) after COVID-19.

MATERIALS AND METHODS

For qualitative assessment and assessing the methodological quality, the Cochrane Handbook for Systematic Reviews of Interventions and the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA 2020) checklist were utilized. Data from PubMed, Cochrane, Embase, CINAHIL, Medline, ResearchGate, and Scopus were searched. The relevant studies involved patients with confirmed COVID-19 diagnosis by RT-PCR, and GBS diagnosis based on typical clinical symptoms and/or confirmatory diagnostic results. A total of 12 English relevant articles (6 papers were case reports and 8 were case series with a total of 32 patients) published in a peer-reviewed journal from 2019 to 2021 were included. Following the review methodology, two independent raters were responsible for retrieving, extracting and checking for data eligibility. Demographic characteristics are presented as frequencies and percentages. Based on distribution of values, continuous data were expressed as median and interquartile range (IQR).

RESULTS

Out of 32 patients, 26 patients reported neurological symptoms, 6 cases went unnoticed, 7 cases showed involvement of the cranial nerves, 12 cases did not, and 13 cases went unreported.

CONCLUSIONS

It is too early to draw any conclusions concerning a potential relationship between SARS-CoV-2 infection and GBS. More large-scale observational studies are required to understand the pathogenesis of SARS-CoV-2-associated GBS and to demonstrate a definite causal relationship between GBS and SARS-CoV-2 infection.

Risk of acute pulmonary embolism in COVID-19 pneumonia compared to community-acquired pneumonia: a retrospective case-control study

AIM

To compare the incidence of pulmonary embolism (PE) in COVID-19 pneumonia and non-COVID-19-related community-acquired pneumonia (CAP) in hospitalised patients.

MATERIALS AND METHODS

A retrospective case-control study was conducted. This included patients hospitalised with pneumonia and investigated for suspected PE with computed tomography pulmonary angiogram (CTPA). Cases were defined as patients with COVID-19 pneumonia from 1 March 2020 to 17 May 2020; controls were patients with CAP from 5 July 2019 to 31 January 2020. The primary outcome was to determine the risk of developing PE in both groups. Multivariable logistic regression was used to calculate the adjusted odds ratio for PE.

RESULTS

One hundred and forty-four patients were included; 72 cases (47% male; mean age 59 (±15) years), and 72 controls (56% male; mean age 58 (±20) years). PE was diagnosed in 23.6% of the cases versus 6.9% of the controls. The adjusted odds ratio for PE in hospitalised patients with COVID-19 pneumonia compared with those with CAP was 3.23 (95% confidence interval [CI] 1.04-10.04, p=0.04).

CONCLUSION

The odds of developing PE in hospitalised patients with COVID-19 pneumonia are three-times higher than in those with CAP. The results provide a quantitative assessment of the risk of PE in COVID-19 pneumonia, a condition new to healthcare, compared to other forms of pneumonia with a well-established scientific basis.

Lipid profiles are influenced by arm cranking exercise and training in individuals with spinal cord injury

STUDY DESIGN

A prospective, two-group comparative intervention study.

OBJECTIVE

To determine the acute and training effects of arm cranking exercise on blood lipid profiles in wheel chair bound individuals with spinal cord injury (SCI) and normal able-bodied subjects.

SETTING

Faculty of Science, School of Sport and Exercise Science, Liverpool John Moores University, England.

METHODS

Total cholesterol, triglyceride and high-density lipoprotein cholesterol (HDL-C) at rest and in response to arm cranking exercise before and after 12 weeks of training were compared between individuals with SCI (N = 5) and able-bodied subjects (N = 7). Following the determination of peak oxygen consumption (VO2peak), all subjects performed a submaximal arm cranking exercise at an intensity corresponding to 60-65% VO2peak for 30 min. Venous blood samples were obtained before and after submaximal exercise and measured for total cholesterol, triglycerides and HDL-C concentrations. These lipid parameters were remeasured in all subjects at rest and in response to the same submaximal arm cranking exercise after 12 weeks of individually supervised arm cranking training programme.

RESULTS

Before training, the resting mean value of triglyceride in individuals with SCI was significantly (P < 0.05) higher than that found in able-bodied persons. Acute arm cranking exercise did not change total cholesterol or triglyceride concentrations in either the SCI or the able-bodied groups. However, HDL-C increased significantly following exercise in the able-bodied subjects. Following training, the resting mean value of total cholesterol in the group with SCI was significantly (P < 0.05) higher compared with able-bodied individuals. Furthermore, the resting and post submaximal arm cranking exercise mean values of total cholesterol in the able-bodied group, but not in the group with SCI, were significantly lower than those observed before training. While the resting mean value of HDL-C before training in the group with SCI was lower than that found in the able-bodied, this difference did not reach the designated level of significance (P > 0.05). Submaximal arm cranking exercise was followed by a significant increase in HDL-C only in the able-bodied individuals. Compared to pretraining, the resting and post arm cranking exercise levels of HDL-C in the group with SCI increased significantly (P < 0.05) after training.

CONCLUSION

It is concluded that acute arm cranking exercise and training in individuals with SCI is associated with favourable effects on HDL-C, whereas total cholesterols and triglycerides were not altered. The mechanism responsible for the increase in HDL-C with training in individuals with SCI is not known, but it is likely to be related to increased activity of cholesterol transport enzymes lipoprotein lipase and acyltransferase.

Adverse effects of alcohol ingestion post exercise on blood rheological variables during recovery

The present study examined the influence of ingesting a moderate dose of alcohol on the main determinants of blood rheology namely: plasma viscosity, plasma fibrinogen concentration, plasma total protein concentration, and haematocrit. Eleven moderately active young men were studied immediately after a standardised cycle ergometer test and during the 24 h period of recovery. Alcohol (0.7 g/kg body mass) was given 1 h after exercise on one test occasion, while an equal volume of alcohol-free solution was administered on the other. Venous blood samples were obtained at baseline, post exercise, and at 1, 5, and 22 h post alcohol ingestion. A significant reduction in plasma volume was observed immediately after exercise, but this decrease was restored 1-h post drink ingestion. Blood alcohol level increased significantly 1 h after the ingestion of alcohol, but decreased and returned to the resting baseline level at 5 h during recovery. Exercise induced significant changes (P<0.05) in blood rheology as manifested by a significant increase (P<0.05) in plasma viscosity and plasma fibrinogen. Parallel increase (P<0.05) in haematocrit and total protein was also observed after exercise. The increase in these rheological variables immediately after exercise was mainly due to exercise-induced plasma volume loss. During recovery, while the increase in haematocrit post-exercise returned to the baseline level in both control and alcohol trials, plasma viscosity and plasma fibrinogen remained significantly high during recovery in the alcohol trial compared with control condition. It is concluded that exercise induces significant changes in the main determinants of blood rheology and the consumption of alcohol after physical exercise delays the normal return of plasma viscosity, plasma fibrinogen to the resting baseline levels during recovery. Although the mechanism responsible for these findings is not, as yet known, it might be linked with alcohol induce dehydration.

Effects of alcohol ingestion following exercise on postprandial lipemia

The study determined the effect of alcohol ingestion postexercise on postprandial lipemia during recovery. The mean values were compared with those obtained in a control experiment during which no alcohol was given. Nineteen normolipidemic subjects (11 males and 8 females) performed two exercise trials at an intensity corresponding to 70% VO2max for 35 min. In a random order, alcoholic (0.7 g/kg) or alcohol-free drinks were given 1 h after the completion of exercise. Venous blood samples were obtained pre- (before breakfast) and postexercise and pre- and postprandially during recovery. Total cholesterol and high-density lipoprotein cholesterol showed no change with exercise or alcohol ingestion. In the control trial, when subjects consumed a standardized lunch, triglycerides showed no significant change, but when alcohol was consumed postexercise triglyceride concentration increased substantially 5 h during recovery in both males and females. The mechanism responsible for the rise in triglyceride concentration during recovery when alcohol was ingested following exercise is not known, but this appears to be a late phenomenon.

The effect of alcohol ingestion on the exercise-induced changes in fibrin and fibrinogen degradation products in man

The present study examined the influence of ingesting a moderate dose of alcohol on plasminogen activator activity (t-PA), plasma fibrinogen (Fb), total degradation products (TDP) and the degradation products of fibrin (FbDP) and fibrinogen (FgDP) at rest and in response to exercise. Eleven male subjects performed two separate experimental trials at an exercise intensity corresponding to 70% maximal oxygen consumption for 35 min. Prior to trials, subjects were either given 0.5 g/kg alcohol in orange-flavoured drink or an equal volume of non-caloric non-alcoholic drink 45 min before exercise. Comparison of the levels of t-PA, Fb, TDP, FbDP, and FgDP at rest, before and 45 min after the ingestion of alcohol revealed no significant differences between alcohol and control experiments. Exercise resulted in a marked increase in t-PA, TDP, and FgDP, with no appreciable change in FbDP. Although plasma fibrinogen level showed significant decrease post-exercise when subjects ingested alcohol, this difference was small and its biological significance is questionable. While t-PA level increased similarly in response to exercise during alcohol and control trials, a significantly higher response of TDP was found during the control trial compared with alcohol trial. It was concluded that exercise with and without alcohol ingestion is followed by a substantial increase in t-PA, which coincided with an increase in TDP. The increase in TDP was mainly due to an increase in FgDP, but not to FbDP. These findings support the hypothesis that a significant fibrinogenolysis occurs in response to exercise, and moderate intoxication with alcohol prior to exercise reduced this response.

Blood hemostasis in exercise and training

Formation of the blood clot is a slow but normal physiological process occurring as a result of the activation of blood coagulation pathways. Nature's guard against unwanted blood clots is the fibrinolytic enzyme system. In healthy people, there is a delicate dynamic balance between blood clot formation and blood clot dissolution. Available evidence suggests that exercise and physical training evoke multiple effects on blood hemostasis in normal healthy subjects and in patients. A single bout of exercise is usually associated with a transient increase in blood coagulation as evidenced by a shortening of activated partial thromboplastin time (APTT) and increased Factor VIII (FVIII). The rise in FVIII is intensity dependent and continues into recovery. The effects of acute exercise on plasma fibrinogen have yielded conflicting results. Thus, the issue of whether exercise-induced blood hypercoagulability in vitro mirrors an in vivo thrombin generation and fibrin formation remains disputable. Exercise-induced enhancement of fibrinolysis has been repeatedly demonstrated using a wide range of exercise protocols incorporating various exercise intensities and durations. Moderate exercise appears to enhance blood fibrinolytic activity without a concomitant activation of blood coagulation mechanisms, whereas, very heavy exercise induces simultaneous activation of blood fibrinolysis and coagulation. The increase in fibrinolysis is due to a rise in tissue-type plasminogen activator (tPA) and decrease in plasminogen activator inhibitor (PAI). The mechanism of exercise-induced hyperfibrinolysis is poorly understood, and the physiological utility of such activation remains unresolved. Strenuous exercise elicits a transient increase in platelet count, but there are conflicting results concerning the effect of exercise on platelet aggregation and activation. Few comprehensive studies exist concerning the influence of exercise training on blood hemostasis, making future investigation necessary to identify whether there are favorable effects of exercise training on blood coagulation, fibrinolysis, and platelet functions.

Exercise induces a change in plasma fibrinogen concentration: fact or fiction?

This study examined the effect of exercise on plasma fibrinogen concentrations with simultaneous measurements of plasma volume changes. Eight moderately active males aged 26.6+/-3.6 years (mean +/- SD) completed maximal (VO2max) and submaximal (75% VO2max for 30 minutes) exercise trials separated by 7 days. Venous blood samples were obtained at rest, immediately postexercise, and following 30 minutes of recovery. Whole blood was analysed for haematocrit and haemoglobin, while citrated plasma was assayed for fibrinogen levels. Values of haematocrit and haemoglobin before and after exercise were utilised for the estimation of plasma volume changes. Plasma volume decreased (p<0.05) immediately following both maximal (-17.7+/-5.1%) and submaximal (-14.3+/-4.1%) exercise. Exercise resulted in decreased plasma fibrinogen levels (maximal exercise: from 266.3+/-14.5 to 222.2+/-23.9 mg x dL(-1); submaximal exercise: from 239.5+/-45.4 to 209.7+/-42.4 mg x dL(-1)) only when postexercise raw data were corrected for the contraction of plasma volume. It is concluded therefore that changes in plasma volume in response to exercise should be taken into account when interpreting exercise effects on plasma fibrinogen concentration.

Activation and disturbance of blood haemostasis following strenuous physical exercise

Physical exercise activates blood coagulation and enhances fibrinolytic activity. To investigate whether these activations of blood coagulation and fibrinolysis are balanced post-exercise and during the period of recovery, 11 moderately active young men were examined immediately after a standardised cycle ergometer test and during the 24 h period of recovery. Blood samples were obtained at rest, immediately after exercise, and 2, 6 and 24 h after exercise. All post-exercise values were corrected for any change in plasma volume. Exercise induced a significant increase in factor VIII activity and this occurred with a significant shortening of activated partial thromboplastin time. A concomitant enhancement of tissue plasminogen activity resulted in significant increases in tissue plasminogen activity antigen and total fibrin/fibrinogen degradation products, and a significant decrease in tissue plasminogen activator inhibitor-1 activity. Increases in coagulation and fibrinolytic activity changed in parallel during exercise. However, during recovery, while the increase in factor VIII activity post-exercise persisted 2 and 6 h into recovery, fibrinolytic activity demonstrated a sharp fall. It is concluded that whereas the enhanced fibrinolytic activity during exercise appears to counterbalance the increase in blood coagulability, this haemostatic balance is not maintained during recovery. This perturbed blood haemostasis could constitute an enhanced risk for coronary artery thrombosis and may contribute to exercise-related cardiovascular events.

Effects of exercise and training on blood rheology

The effects of exercise on the rheological properties of blood have not received much research attention. Recent, limited evidence indicates that the viscosities of whole blood and plasma increase in response to a variety of exercise protocols. The increase in whole blood viscosity is mainly attributed to an increase in haematocrit and plasma viscosity, whereas the deformability and aggregability of red blood cells remain unaltered. The increases in plasma viscosity and haematocrit have been ascribed to exercise-induced haemoconcentration as a result of fluid transfer from the blood to the interstitial spaces. Although the long term effects of endurance training on blood rheology have been very briefly examined, the exact effect of training has not as yet been determined. However, available cross-sectional and longitudinal studies indicate that the blood of endurance athletes is more dilute and this has been attributed to an expansion of plasma volume as a result of training. It has been suggested that this blood dilutional effect of endurance training may be advantageous in delivering oxygen to the exercising muscles because of a reduced resistance to blood flow. The increase in plasma volume may also contribute to the body water pool and help offset dehydration. The influence of strength and power training on blood rheology is not known.

Changes in lipid profile variables in response to submaximal and maximal exercise in trained cyclists

This study examined the effect of prolonged submaximal exercise followed by a self-paced maximal performance test on cholesterol (T-Chol), triglycerides (TG), and high-density lipoprotein cholesterol (HDLC). Nine trained male athletes cycled at 70 percent of maximal oxygen consumption for 60 min, followed by a self-paced maximal ride for 10 min. Venous blood samples were obtained at rest, at 30 and 60 min during submaximal exercise, and immediately after the performance test. Lactic acid, haematocrit (Hct), haemoglobin (Hb), T-Chol and TG were measured in the blood, while plasma was assayed for HDL-C. Plasma volume changes in response to exercise were calculated from Hct and Hb values and all lipid measurements were corrected accordingly. In order to ascertain the repeatability of lipid responses to exercise, all subjects were re-tested under identical testing conditions and experimental protocols. When data obtained during the two exercise trials were analysed by two-way ANOVA no significant differences (P > 0.05) between tests were observed. Consequently the data obtained during the two testing trials were pooled and analysed by one-way ANOVA. Blood lactic acid increased nonsignificantly (P > 0.05) during the prolonged submaximal test, but rose markedly (P <0.05) following the performance ride. Lipid variables ascertained at rest were within the normal range for healthy subjects. ANOVA showed that blood T-Chol and TG were unchanged (P > 0.05), whereas HDL-C rose significantly (P <0.05) in response to exercise. Post hoc analyses indicated that the latter change was due to a significant rise in HDL-C after the performance ride. It is concluded that apparent favourable changes in lipid profile variables occur in response to prolonged submaximal exercise followed by maximal effort, and these changes showed a good level of agreement over the two testing occasions.

Blood coagulation and fibrinolysis at rest and in response to maximal exercise before and after a physical conditioning programme

Twenty-five young subjects were divided into experimental (n = 13) and control (n = 12) groups in order to examine the acute and chronic effects of exercise on blood coagulation and fibrinolysis. Blood coagulation and fibrinolysis variables were ascertained in both groups before and after a physical conditioning programme both at rest and following maximal exercise. The experimental group exercised for 12 weeks [30 min, 3 x week at 70% (6 weeks) and 80% (6 weeks) of maximum heart rate]. The control group maintained normal activity patterns. Significant activation (P < 0.05) of blood coagulation was observed in response to maximal exercise before and after the conditioning programme in both groups in activated partial thromboplastin time (APTT), thrombin clotting time (TCT), factor VIII procoagulant activity (FVIII PA) and factor VIII antigen (FVIII A). Likewise, blood plasminogen activator showed a significant increase (P < 0.05) in response to maximal exercise before and after conditioning in both groups. Although VO2 max following the conditioning programme was significantly increased in the exercise group versus control, no significant changes (P > 0.05) were observed in either group in blood coagulation and fibrinolysis parameters at rest or in response to maximal exercise. It is concluded that maximal exercise transiently accelerates blood coagulation and activates blood fibrinolytic activity, however physical conditioning appears not to influence the haemostatic and fibrinolytic systems at rest or in response to maximal exercise.

Respiratory metabolism of D[U-14C]glucose in hens and cocks during prolonged treadmill exercise

1. The specific activity of expired 14CO2 was measured at rest and during 90 min treadmill exercise following an initial intravenous injection of D[U-14C]glucose. 2. The rate of CO2 production rose 4.5-fold during exercise in cocks but only 2.5-fold in females. The mean respiratory quotient was close to unity at rest and during exercise. 3. Estimated glucose turnover rate rose approximately 3.5-fold during exercise in cocks. Turnover rate did not increase in hens but the fraction of the glucose turnover oxidized to provide energy for the working muscles was increased. 4. It is concluded that carbohydrate sources account for the major fraction of energy expenditure during exercise of this magnitude and duration.