Serum inducible and endothelial nitric oxide synthase in coronary artery disease patients with Type 2 Diabetes mellitus

OBJECTIVE

Coronary artery disease (CAD) is a well-known cause of morbidity and mortality in type 2 diabetes mellitus (T2DM). The role of endothelial nitric oxide synthase (eNOS) and inducible nitric oxide synthase (iNOS) in T2DM patients in relation to CAD is not well understood. We examined serum inducible and endothelial nitric oxide synthase activities in patients with T2DM in relation to the presence of coronary artery disease.

PATIENTS AND METHODS

The present study was conducted in the Department of Physiology, King Saud University, Riyadh, Saudi Arabia. Subjects were grouped into control (Group A, n=87), T2DM without CAD (Group B, n=70), and T2DM patients with CAD (Group C, n=49). The selection of T2DM subjects was according to the American Diabetes Association (ADA). Serum iNOS, eNOS, hsCRP, nitrates and nitrites along with lipid profile were compared between different groups. Spearman's correlation and ROC analysis were also performed.

RESULTS

Serum eNOS levels were significantly high in the control group (112.38±47.16 U/ml) than in DM without CAD (81.43±49.91 U/ml) and DM with CAD (84.80±43.32 U/ml, p<.001). Serum iNOS levels were significantly higher in DM with CAD (42.87±28.83 U/ml) compared to both control (22.08±11.77 U/ml) and DM without CAD (16.24±12.30 U/ml, p<.001). Additionally, the differences in nitrite and NO were not significant between the three groups (34.06±24.75, 33.02±21.50, 38.83±24.34 uM, p = .384), and (56.51±36.78, 49.89±28.83 vs. 55.77±30.34 uM, p=.416) respectively. ROC curve analysis revealed a sensitivity and specificity of 73.5% and 68.6% of iNOS level at a cutoff point of 21.1 U/ml to predict CAD in T2DM patients. The ROC analysis for iNOS, eNOS, and hs-CRP were .782 (p<.001), .574 (p=.170), and .726 (p<.001), respectively.

CONCLUSIONS

Patients with T2DM have significantly higher levels of serum iNOS and lower levels of eNOS. However, iNOS levels were significantly higher in T2DM patients with concomitant CAD. Moreover, iNOS activity positively correlated with glycemic control and hsCRP. Therefore, iNOS could be an emerging future marker for CAD in T2DM patients and its antagonists could be useful in the management of these patients.

Reduced pulmonary functions and respiratory muscle strength in Type 2 diabetes mellitus and its association with glycemic control

OBJECTIVE

Diabetes mellitus is one of the main devastating causes of mortality and morbidity due to its detrimental complications. We aimed to evaluate the pulmonary functions and respiratory muscle strength in relationship with glycemic control and gender in type 2 Diabetes Mellitus (T2DM).

MATERIALS AND METHODS

This cross-sectional study was performed at King Saud University and King Khalid University Hospital, Riyadh, Kingdom of Saudi Arabia from June 2107 to June 2019. We evaluated pulmonary functions, respiratory muscle strength, body composition and glycemic control in T2DM (n=110) and control group (n=119). Gender differences were also evaluated in T2DM.

RESULTS

Subjects with T2DM have significantly decreased forced vital capacity (FVC) (3.6±0.7 vs 3.3±0.9, p = 0.012), forced expiratory volume in first second (FEV1) (3.3±2.2 vs 2.7±0.6, p = 0.019), peak expiratory flow (PEF) (127.4±210.9 vs. 49.2±133.6, p = 0.003), FEF25-75 (3.6±1.3 vs. 3.1±1.1, p-value = 0.025), and maximum inspiratory pressure (MIP) (99.3±26.9 vs. 87.4±19.3, p=0.001). However, no significant difference between control and diabetes was found in maximum expiratory pressure (MEP) (132.5±34.9 vs 126.2±30.0, p = 0.202). Significant reduction in FVC (male=3.7±0.8 vs female = 3.0±0.7 p = 0.000), FEV1 (3.3±1.9 vs 2.6±0.5 p = 0.000), FEF25-75 (3.6 ± 1.3 vs 2.9 ± 1.0 with p-value = 0.000), MIP (96.9±23.1 vs 87.5±27.1 with p = 0.017), and MEP (134.0±32.2 vs. 120.1±33.5 with p = .011) were observed in females compared to males in T2DM subjects.

CONCLUSIONS

Decline in the pulmonary function and inspiratory muscle strength are associated with poor glycemic control in T2DM. Moreover, there are significant differences between male and female in lung parameters and inspiratory as well as expiratory muscles strength. The exact pathophysiological mechanism to explain this association requires further investigations.

Relationship between HbA1c and Lipid Profile Seen in Bangladeshi Type 2 Diabetes Mellitus Patients Attending BIRDEM Hospital: A Cross-Sectional Study

Diabetes mellitus is one of the leading non-communicable diseases all over the world including Bangladesh. Diabetes is characterized by chronic hyperglycemia and disturbances of carbohydrate, lipid and protein metabolism. Glycated hemoglobin (HbA1c) level of ≥6.5% has been included as a criterion for diagnosis of diabetes. Impaired lipid profile is commonly present in type 2 diabetes. Aim of the study was to investigate the association between serum lipid profile and blood glucose. And hypothesizing that early detection of lipid abnormalities and treatment can minimize the risk for atherogenic cardiovascular disorder and cerebrovascular calamity in patients with type 2 diabetes mellitus (T2DM). This observational cross sectional study was carried out in the department of Biochemistry, Bangladesh Institute of Research & Rehabilitation in Diabetes, Endocrine and Metabolic Disorders (BIRDEM) hospital, Dhaka, Bangladesh from January 2016 to June 2016. A total 105 patients with T2DM of age within the range of 30-45 years were selected for the purpose. Fasting blood glucose (FBG), total cholesterol (TC), high density lipoprotein cholesterol (HDL-C), low density lipoprotein cholesterol (LDL-C), triglyceride (TG) and glycated haemoglobin (HbA1c) levels were evaluated. Test of significance was calculated by unpaired Student's 't' test. Correlation studies (Pearson's correlation) were performed between glycated haemoglobin (HbA1c) and serum lipid profile. Significance was set at p<0.05. Significantly higher mean serum levels of TC, TG and LDL-C and significantly lower mean serum levels of HDL-C were noted in patients with diabetes. Significant correlations were observed between HbA1c value and serum levels of TC, TG and HDL-C (p<0.05) but no significant correlation of HbA1c value with LDL-C in-diabetes patient. The study concluded that HbA1c value correlate well with lipid profile in-diabetes patients. So, HbA1c can be used as a predictor of dyslipidemia in type 2 diabetes.

Efficient oil palm total RNA extraction with a total RNA extraction kit

Oil palm tissues are rich in polyphenols, polysaccharides and secondary metabolites; these can co-precipitate with RNA, causing problems for downstream applications. We compared two different methods (one conventional and a kit-based method - Easy-Blue(TM) Total RNA Extraction Kit) to isolate total RNA from leaves, roots and shoot apical meristems of tissue culture derived truncated leaf syndrome somaclonal oil palm seedlings. The quality and quantity of total RNA were compared through spectrophotometry and formaldehyde gel electrophoresis. The specificity and applicability of the protocols were evaluated for downstream applications, including cDNA synthesis and RT-PCR analysis. We found that the conventional method gave higher yields of RNA but took longer, and it was contaminated with genomic DNA. This method required extra genomic DNA removal steps that further reduced the RNA yield. The kit-based method, on the other hand, produced good yields as well as well as good quality RNA, within a very short period of time from a small amount of starting material. Moreover, the RNA from the kit-based method was more suitable for synthesizing cDNA and RT-PCR amplification than the conventional method. Therefore, we conclude that the Easy-BlueTM Total RNA Extraction Kit method is suitable and superior for isolation of total RNA from oil palm leaf, root and shoot apical meristem.

Tissue polypeptide specific antigen as a marker used to determine the liver diseases

BACKGROUND

Tissue polypeptide specific antigen and its specific M3 epitope are increased in malignant as well as in some benign diseases. The level of tissue polypeptide specific antigen in serum is related mostly to proliferation capacity rather than tumor mass and cell necrosis.

OBJECTIVE

The aim of this study was to evaluate the levels of tissue polypeptide specific antigen and other tumor markers in patients with liver cirrhosis, chronic active hepatitis and hepatoma to determine if tissue polypeptide specific antigen is important to other tumor markers in hepatoma patients.

METHODS

Ninety-seven patients and 30 controls were included in the study. The patients were divided into three subgroups as cirrhosis, hepatoma and chronic active hepatitis. The levels of tissue polypeptide specific antigen, carcinoembryonic antigen, CA19.9, alpha-fetoprotein and transaminases were determined in all patients.

RESULTS

Tissue polypeptide specific antigen levels were significantly higher in all patients than in the control group (p less than 0.005) According to Kruskal-Wallis test with regard to subgroups, the differences in mean values of tissue polypeptide specific antigen and alpha-fetoprotein were significant (p less than 0.0001 for both). There was a low correlation between tissue polypeptide specific antigen and alpha-fetoprotein in the cirrhotic and hepatoma groups, but these were significantly correlated in the chronic active hepatitis group. The correlation coefficient between tissue polypeptide specific antigen and transaminases in all patients was low.

CONCLUSIONS

Tissue polypeptide specific antigen is efficient for determining primary hepatoma patients and also that this marker is specific for proliferation of cells.

The Incidence, Predisposing Factors, Complications and Outcome of Preeclampsia in Diabetic Pregnancy

Introduction: Preeclampsia is a serious complication of pregnancy and common cause of fetal and maternal morbidity as well as mortality worldwide. In diabetic women, the chance of preeclampsia is increased. The incidence of preeclampsia in diabetic pregnancy is approximately 10 to 15 percent, which is associated with poor glycaemic control. Aim: This study was carried out to find the predisposing factors related to preeclampsia and determine the complications of preeclampsia in diabetic pregnancy and also the impact of preeclampsia in infants born to diabetic mothers. Methods: This prospective study was carried out at the Bangladesh Institute of Research and Rehabilitation in Diabetes, Endocrine and Metabolic Disorders (BIRDEM), Dhaka. The Patient population consisted of 80 diabetic pregnant women who attended or admitted to BIRDEM hospital during the study period. The women were divided into groups: 50 pregnant diabetic women with preeclampsia were taken as case. 30 pregnant diabetic women without preeclampsia were taken as control. Diagnosis of preeclampsia was made on the basis of the criteria of the Committee on Terminology of the American College of Obstetrician and Gynecologist. Results: Preterm delivery (<37 weeks gestation) was higher among study group (64%) compared to control (33.3%) women. Term delivery was 36.0 vs 66.7 percent among case and control women, respectively. The distribution is statistically significant (P<0.01). 35 percent of Caesarean section was done due to fetal distress in the study group and in control group it was 20 percent. In study group, 22.5 percent Caesarean sections were done due to impending eclampsia and eclampsia, 705 percent due to accidental haemorrhage and 5 percent due to IUGR. Maternal complication in study and control subjects. In the case group, maximum number of the women (16%) showed signs of impending eclampsia, while among control women, maximum number (10%) developed postpartum haemorrhage (PPH). 48 percent neonates were of low birth weight and in controls it was 13.3 percent. Both hyperbilirubinaemia (40%) and hypoglycaemia (30%) were more in study group than controls (16.66% and 20%, respectively). Perinatal outcome among study group and controls. Neonatal survival was 82.0 percent in study group and 86.7 percent in control group. Comparison of Perinatal outcome between the groups is not statistically significant. Most of the perinatal mortality was due to prematurity (8%) and intrauterine death (6%). In control group, most of the perinatal deaths were due to congenital anomalies (6.6%). Conclusion: The higher incidence among study group may be, in part, the result of more preterm birth or shortened gestational duration because early delivery is a consequence of preeclampsia. The higher rate in associated with preeclampsia was due to increased incidence of IUD and prematurity. DOI: http://dx.doi.org/10.3329/birdem.v1i1.12379 Birdem Med J 2011; 1(1): 10-14

CO2 as a distending medium for gastric and small bowel MRI: a feasibility study

This work evaluates carbon dioxide as a contrast medium for magnetic resonance imaging of the stomach and small bowel. Twelve healthy volunteers underwent rapid magnetic resonance imaging after oral administration of a carbon dioxide generating agent using a combination of breath-hold and interactive fluoroscopic imaging during breathing. Diagnostic-quality images were obtained in 100% of cases for the stomach and in 92, 75, 67 and 42% of cases for the duodenal segments 1-4, respectively. Visualisation of the jejunum and ileum proved unacceptable for clinical use and anti-peristaltic agents did not significantly influence the results. Further development of fast imaging and magnetic resonance interactive fluoroscopic methods may allow the use of carbon dioxide as a contrast medium for clinical imaging of the stomach and duodenum.