Long Term Evaluation of Glycemic Control in Patients with Type 2 Diabetes Receiving Either Alogliptin and Lansoprazole or Alogliptin Mono-therapy for 3 Months Followed by Alogliptin Mono-therapy:A Retrospective Analysis

Aims:This study was the retrospective analysis of the previous study named as APPLE study( study of combination effect of AlogliPtin and lansoPrazoLE on glycemic control in patients with type 2 diabetes), in which the effect of the combination therapy of alogliptin (a dipeptidyl peptidase-4 inhibitor, DPP4-I) and lansoprazole (a proton pump inhibitor, PPI) was compared with alogliptin mono-therapy without PPI on glycemic control in a randomized open-label study design. The aim of this study was to investigate whether so called legacy effect of proton pump inhibitor on glycemic control is observed. Patients and Methods:In the patients that participated in the APPLE study( 3 months observation;total: 100 patients), the patients who continued the intake of alogliptin at least more than 1 year after the registration(enrollment)in APPLE study was evaluated on glycemic control retrospectively. As a rule, the administration of lansoprazole in combination group was discontinued after the finish of 3 months- of the APPLE study. Twenty-six patients in the alogliptin mono-therapy group and 26 patients in combination group met the requirement in this analysis. Mean observation periods were respectively 16 months. In these patients, the number of patients in whom all diabetic drugs were not changed in observation-period was respectively 18 in alogliptin mono-therapy group and 17 in combination group.Results:The decrease of HbA1c was maintained also after long term observation (16 months) in both alogliptin mono-therapy and combination groups (the decrease was respectively -1.054±0.548 and - 1.123±0.723%), which was similar compared with that observed in 3 months-APPLE study. There were no significant differences in change of HbA1c and fasting plasma glucose (FPG) at the time in enrollment of APPLE study and at final visit( approximately 16 weeks) between these groups. The significant difference in change of HbA1c and FPG was not found also between alogliptin mono-therapy and combination group in the subgroup of patients where all diabetic drugs were unchanged during observation period.Conclusion:This study found that the legacy effect of PPI on glycemic control was not apparent more than 9 months after the APPLE study. Based on the results in the previous APPLE study and in this current retrospective study, we concluded that the add-on effect of PPI for DPP4-I on glycemic control in patients with type 2 diabetes is not clinically apparent

The Effect of Switching from Either Mitiglinide or Glimepiride to Repaglinide on Both Glycemic Control and Oxidative Stress in Patients with Type 2 Diabetes

Aims:The goal of this study was to investigate the effect of switching from either the low dose sulfonylurea glimepiride(1?mg once daily)or the glinide mitiglinide(10?mg three times daily)to repaglinide(0.5?mg three times daily)on both glycemic control and oxidative stress in patients with type 2 diabetes.Patients and Methods:Finally 17 patients(patients treated with either glimepiride:n=11 or mitiglinide:n=6)completed the study. The type and dose of all drugs, including the anti-diabetic treatments, were not changed for at least 1?month prior to the study.Results:Both groups showed a significant decrease in HbA1c levels. FPG showed a tendency(not significant)toward a decrease in the mitiglinide-treated group, while no change was found in the glimepiride-treated group. A significant decrease in 8-iso-PGF2α levels was found only in the glimepiride-treated group. There was a significant correlation between the difference in 8-iso-PGF2α levels and that in either FPG or HbA1c before and after the switch only in the mitiglinide-treated group.Conclusions:Repaglinide may have an anti-oxidative effect probably due to the strong postprandial glucose lowering observed in patients with type 2 diabetes

Association Between Nerve Conduction Velocity and Clinical Parameters Related to Diabetic Complications inPatients with Type 2 Diabetes

The main purpose of the study was to investigate the association of median motor nerve conduction velocity(MCV) and sural sensory nerve conduction velocity( SCV) with parameters related to diabetic complicationsin patients with type 2 diabetes. A total of 263 patients hospitalized for glycemic control from 1999to 2006 who underwent single or multiple nerve conduction velocity tests (at least a right median MCVtest) were enrolled in the study retrospectively. Right median MCV showed a significant negative correlationwith age and diabetic duration, and was also significantly negatively correlated with systolic blood pressure(SBP) and log urinary albumin excretion (UAE). Right median MCV showed strong positive correlationswith left median MCV and right median SCV, and significant but relatively mild positive correlationswith right peroneal MCV and right sural SCV. In multiple regression analysis, only SBP and diabetic durationshowed a significant association with right median MCV. Although right sural SCV showed significantnegative correlations with SBP and log UAE, the correlations were relatively weak compared with those forright median MCV. Of 215 patients who underwent complete sural SCV measurements, right and left suralSCV were detected in 159( 74%) and 163 patients( 76%), respectively. In conclusion, these results suggestthat median MCV is more closely associated with markers related to diabetic complications such as SBP orUAE, compared with sural SCV, but that sural SCV is more sensitive than median MCV for detection of diabeticneuropathy

SIADH induced by pneumonia in a patient with Shy-Drager syndrome

Patients with Shy-Drager syndrome have impaired baroreceptor-mediated vasopressin release when inan upright position. We report a case of Shy-Drager syndrome in which the syndrome of inappropriate secretionof antidiuretic hormone (SIADH) developed with pneumonia. It has been speculated that pneumonia-induced SIADH is caused by baroreceptor-mediated vasopressin release. Our case presents the possibilitythat pneumonia-induced SIADH is caused by non-baroreceptor-mediated ADH release

THE CLINICAL BENEFIT OF SERUM PROCALCITONIN LEVELAS COMPARED TO BISAP SCORING SYSTEM FOR PREDICTINGTHE SEVERITY AND PROGNOSIS OF ACUTE PANCREATITIS

Background: Early accurate severity assessment of patients with acute pancreatitis (AP) is cruicial to decide on the acute management and predict outcomes and prognosis.This is done through multiple scoring systems of which serum procalcitonin (PCT) and BISAP has shown promising results. However,data comparing these methods is still conflicting. Objectives: we aim to assess the role of PCT as a sole indicator and compare it to BISAP in determining severity and prognosis of AP. Methods: Retrospective chart review of all AP cases between June 2012 and February 2017 at Makassed General Hospital, with at least one reading of PCT documented in records. Data regarding patients’ demographics and outcomes were collected. Procalcitonin levels and trends were compared to severity classes and BISAP scores regarding various outcomes of AP. Results: Forty-four patients met our inclusion criteria. Based on the revised Atlanta classification, 26 patients had mild, four moderate and 14 severe AP. Mean serum PCT levels were found to correlate with severity classes (1.28 with mild versus 4.81 with moderate-severe AP; P \u3c 0 .0001). This was even more prominent on follow-up testing after 48hours (1.67 vs 12.89 respectively; P=0.01). This proportional relation was again noted with BISAP scores of 0,1 and 2 where the mean PCT was 0.1,5.0 and 19.1 respectively. A trend of decrease in serial PCT was also noted with mild as compared to a trend of rising PCT in moderate-severe AP. Conclusion: Initial and serial PCT levels directly correlated with disease severity and might offer significant additional prognostic value in AP

PERCEPTION OF LEBANESE WOMEN ON PREFERRED MODE OFDELIVERY AND ITS ASSOCIATED COMPLICATIONS

Cesarean section, since ancient times, has been known to be an alternative mode to normal vaginal delivery. It is clinically indicated in certain situations. However, nowadays, Cesarean section rates are increased worldwide and in Lebanon, and instead of being an alternative, it has become the primary choice for certain women and physicians, who decide that their patients should go for that option. The purpose of our study was to investigate the perception of Lebanese women towards different modes of delivery in Lebanon. A cross- sectional study was conducted, where participants, aged 18 to 55, were selected in different regions across Lebanon, and were asked to fill a questionnaire with regards to their perception. Data were collected about preferred modes of delivery, women’s awareness towards vaginal and caesarean deliveries and their associated complications. 388 women agreed to participate. The majority were less than 25 years old (around 40%). The majority preferred vaginal delivery (79.5%) over Cesarean section. No significant association was found between age and preferred modes of delivery. The main reasons for preferring vaginal delivery were shorter hospital stay and faster postpartum recovery. 96.3% who underwent C-section stated that it was emergent rather than planned. Of those who preferred Caesarean delivery, main reasons were the fear of pain and believing that it is a safe procedure. As for perception on complications, 50% believed that neither vaginal delivery nor cesarean section increased maternal death. Short term fetal respiratory distress was believed to be less after vaginal delivery than after cesarean section

A case in which water intoxication due to excessive water ingestion did not inhibit the secretion of arginine vasopressin

We experienced a case of water intoxication due to excessive water ingestion that was complicated by the syndrome of inappropriate secretion of antidiuretic hormone (SIADH). A 60-year-old Japanese woman with nervous depression drank too much lemon tea within several hours, vomited ten times, and developed disturbed consciousness and dysarthria. Her plasma arginine vasopressin (AVP) concentration was not inhibited,although her plasma osmolality was low. Nausea and/or stress may stimulate AVP secretion regardless of the hypo-osmolality. We believe that dilatation of her stomach due to excessive liquid ingestion and cerebral edema due to hypo-osmolality brought on her nausea. Stress induced by a psychiatric problem and/or admission to a hospital may also stimulate AVP secretion by the central nervous system. Treatingnausea and stress may help reduce AVP secretion and resolve hyponatremia

Validation of Pyrosequencing for the Analysis of KRAS Mutations in Colorectal Cancer

The use of antibodies against epidermal growth factor receptor( EGFR) in conjunction with conventionalchemotherapy for metastatic colorectal cancer (CRC) in patients with KRAS wild-type tumors has beenproven to be efficacious. Recently, KRAS testing prior to anti-EGFR therapy has become mandatory formetastatic CRC patients. Although newly developed pyrosequencing is expected to be one of the highthroughput procedures detecting such mutations, the accuracy of the procedure has not been well evaluated.In the present study, we aimed to validate the accuracy, especially the potential for a false-negative result,in detecting KRAS mutations by pyrosequencing using cultured tumor cells. DNA extracted from culturedìNOZî gallbladder cancer cells( known to contain KRAS mutation G12V) at concentrations of 1%, 5%, 10%, and 25%, as well as 2 DNA samples extracted from a resected CRC specimen( known to contain anotherKRAS mutation, G12C) at concentrations of 5% and 25%, were prepared. We analyzed KRAS mutationalstatus and nonexistent and/or nonfunctional mutations of these 6 samples using pyrosequencing. TheKRAS mutation detection rates in the 4 NOZ samples( 1%, 5%, 10%, and 25%) were 0.37%, 2.79%, 5.28%,and 13.85%, respectively. Some artifacts of KRAS mutations unlikely to be present were detected in 1%samples of NOZ at a rate similar to that of the G12V mutation( G12C, 0.29%;G13C, 0.42%). Although theKRAS mutation G12C was detected at rates of 1.26% and 6.49% in samples with 5% and 25% DNA extractedfrom resected CRC specimen, respectively, no other type of KRAS mutation was detected in suchsamples. Pyrosequencing could not detect KRAS mutations correctly in the sample containing 1% DNA.This might cause false negatives. A sample mutated DNA concentration of at least 5% was necessary forprecise analyses by this procedure