The effect of obesity and Insulin Resistance on Liver Enzymes in Type2 Diabetes Mellitus

Diabetes mellitus (DM) has been defined as a clinical syndrome that is characterized by abnormal carbohydrate metabolism. The chronic hyperglycemia of diabetes is associated with long term damage, dysfunction, and failure of different organs, especially the liver .This study was conducted to assess the effect obesity and insulin resistance on liver enzymes in diabetic Iraqi patients.A comparative study of (90) Iraqi adults divided to three subgroup(30) obese ,(30) nonobese diabetic patients and(30)person had used as control. The analysis included Liver enzyme ALP,ALT,AST,GGT ,Fasting Plasma Glucose (FBG) , Lipid Profile , Hemoglobin A1C , insulin and homeostasis model assessment of insulin resistance (HOMA IR) were measured. Subjects were excluded from this study if they had liver disease, alcohol intake, medications for lowering lipid, insulin treatment, pregnant women and women taking contraceptive pills . The study shows significantly higher of liver enzymes level ( gamma glutamyl transpeptidase (GGT), alkaline phosphatase, Aspartate Amino Transferase , Alanine Transaminase) in obese diabetic patients compared with non-obese diabetic patients and control subject and HOMA IR showed significantly higher in obese diabetic patients compared with non-obese with diabetic patients and control (P < 0.05). The lipids level showed significantly higher in obese diabetic patients compared with non-obese diabetic patients and control.The HbA1c level showed higher significantly in obese diabetic patients compared with control and ther is a posative correlation between insulin and HOMA IR , ALP in obeses diabetic patients while there was negative correlation between ALT and cholesterol in obese group and with HbA1c in control group. The liver enzymes level of(alkaline phosphatase, alanine transaminase, aspartate transaminase gama glutaminase transferase ) is significantly higher in obese diabetic patients than non –obese diabetic patients and control group , also There was posative correlation between ALP and HOMA IR while there was negative correlation between ALT and cholesterol in obese group and with HbA1c in control group

Evaluation of Electrolytes Disturbances in Iraqi Chronic Myeloid Leukemia Patients treated with Nilotinib with Monitoring of Response by FISH Study

Chronic myeloid leukemia (CML) is a myeloproliferative disorder characterized by the presence Philadelphia chromosome (Ph) which was created by a reciprocal translocation between chromosomes 9 and 22 (t [9;22] [q34;q11]. The approval of the 2nd generation TKI ( Nilotinib) takes the treatment of CML patients into new erea with more efficiency and mild to moderate adverse effects. This study was aimed at evaluation of molecular cytogenetic response by (FISH) for Nilotinib in Iraqi patients with assessment for electrolytes disturbances of Nilotinb by measuring a panel of electrolyte (Na+, K+, Ca++, PO4--- and Mg++) , where thirty Iraqi patients with CML who have resistance or no response to Imatinib treatment, attending to Baghdad Teaching Hospital/Hematology Department, have been submitted to this study. Blood samples have been taken pre and post starting treatment with Nilotinib, FISH study was done only for CML patients, while 30 normal healthy control volunteers submitted to the same panel of electrolytes measurements (Na+, K+, Ca++, PO4--- and Mg++) in addition to pre and post treatment Nilotinib patients. The results show out of 30 patients (17) males and (13) females with male to female ratio 1.3:1, FISH results for patients (pre and post) treatment mean±SD were(58.7%±26.2 % and 45.7%±29.9%) obviously significant with good cytogenetic response in resistance CML for Imatinib. Sodium levels in mmol/L pre, post treatment and control mean±SD were (139.2±6.9 , 142.4±9.2 and 140.4±2.52) respectively, with no significant difference between each other with P value > 0.05 in all comparisons. Potassium levels mean±SD in mmol/L results for patients (pre, post) and control were (4.6±0.69, 4.3±0.68 and 4.46±0.76) respectively, with no significant difference between each other with P value > 0.05 in all comparisons. Calcium levels in mg/dL results for patients (pre, post) and control as mean±SD were (8.68 ±1.68, 8.1±1.72 and 9.12±0.38) respectively with no significant differences except between post treatment and control group with P value > 0.05 in all comparisons. Phosphate levels in mg/dL results for patients (pre, post) and control as mean±SD were (2.5±0.84, 2.95±1.04 and 3.4±0.49) respectively with significant difference with P value 0.05 in all comparisons. This study sheds a light on the molecular cytogenetic response for CML patients who have already resistance to Imatinib and Nilotinib that has much more potent effect as approved by studies and this study has used FISH technique. This study emphasizes on the importance of evaluation of electrolyte panel for CML patients before starting Nilotinib study taking in to consideration if these patients are already receiving Imatinib which can also affect bone metabolism and calcium and phosphate levels

Medical Ozone Treatment Alleviate Blood Oxidative Stress And Pancreas Damage In an Alloxan-Induced Diabetes Model in Rats

Diabetic mellitus (DM ) is a prevalent systemic disease affecting a human and animals. The effects of diabetes are devastating and well documented. The increased production and/or ineffective scavenging of reactive oxygen species (ROS) may play a critical role in the development of diabetic complications. Therefore, it seems reasonable that antioxidants can play an important role in the improvement of diabetes. So, use medical ozone to study if it can regulate the oxidative complications of DM .The study was carried out on forty eight  albino females rats included six groups Group I (Control) : 8 female rats were  injected  IP  with  citrate buffer (0.1 M, pH 5) daily for 6 weeks ,Group II (MO ): 8 female rats were  injected  IP 1.1 mg/kg  b.w of MO daily for 6 weeks ,Group III (DM): 8 female rats induce diabetes by injection IP with  freshly prepared alloxan 150 mg/kg b.w in citrate buffer (pH 5), Group IV(DM+MO): 8 diabetic female rats were injected  IP 1.1 mg/kg  b.w of MO daily for 6 weeks,  group V(DM + Insulin): 8 diabetic female rats were injected subcutaneously 0.75 IU/100 g b.w. of Insulin daily for 6 weeks ,Group VI(DM +MO +Insulin):8diabetic female rats were injected IP 1.1 mg/kg  b.w of MO and Insulin  injected subcutaneously at a dose of 0.75 IU/100 g b.w , respectively daily for 6 weeks. experimental study parameters include  antioxidant enzymes assay and histology the study for pancreas

Determination of Testosterone level as predictor for insulin resistance in young men with family history of type2 diabetes and hypertension.

Background: Insulin resistance is associated with metabolic syndrome , type 2 diabetes and representing a risk factor for cardiovascular disease . This relationship may be modulated to some extent by age related changes in sex hormone status.. In particular, reduced total testosterone (TT) levels have been associated with insulin resistance and subsequent risk for developing type 2 diabetes. Aim of study: we examined whether low total testosterone level were associated with insulin resistance in young adult men. Methods: a total of 83 men (young adult men) divided into 2 group : (group1 ) 49 men with a risk factor for insulin resistance(with a family history of type2 diabetes and hypertension) and (group2) 34 men without any risk factor aged (20-40) years. Age, body mass index (BMI) and waist circumference were measured. Early morning, they were assayed for total testosterone, and insulin levels. Insulin resistance was assessed using a homeostatic model (HOMA-IR). Results: Total testosterone, declined progressively across increasing quintiles of HOMA-IR as a mean of(4.49±1.87) ng/ml in group1 compared mean (7.82±2.21) ng/ml in group 2 and correlated inversely with HOMA-IR( r = -0.424 , p = 002) also with insulin (r= -0.541) (p< 0.0001) in group1 . Total testosterone correlated inversely with BMI (r=-0.471 , p=0.001) in group1. There is a significant positive correlation between HOMA- IR of group1 and BMI (r= 0.472) (

Metabolic Disturbances of Phosphate in Metabolic Syndrome

Background: Metabolic syndrome MS a cluster of disorders comprising obesity (central and abdominal), dyslipidaemias, glucose intolerance, insulin resistance (or hyperinsulinaemia) and hypertension – is highly predictive of type 2 diabetes mellitus and cardiovascular disease. It should be emphasized that the metabolic syndrome is a syndrome and not a disease. The aim of this study is to evaluate the levels of serum phosphate in different levels in subjects with metabolic syndrome MS and Correlation between serum phosphate levels with metabolic syndrome components. The study was carried out at the National diabetes Center (NDC) /AL-Mustansiryia University ,the period from (Desmber.2011 – May 2012) One hundred forty (140) Iraqi individuals enrolled in the study (100 subject diagnosed as having metabolic syndrome and 40 as control group). The diagnosis of metabolic syndrome was based on Adult Treatment Panel III guidelines. The results of the serum phosphate concentrations in both groups showed that subjects with metabolic syndrome had significantly lower phosphate concentrations 1.52 mg/dl compared with that of control 2.29 mg/dl P?0.0001. The clinical significance of these electrolyte disturbances, as one of the diagnostic criteria of metabolic syndrome. In addition this electrolyte imbalance may have a role in prevention and or treatment of the metabolic syndrome

The Effect of Ursolic Acid and Hyperinsulinemia on the Liver and Kidney Function of Alloxan-Induced Diabetic Male Rabbits

The study aimed to examine the effect of extracted and standard ursolic acid in addition to hyperinsulinemia compared to vitamin B complex on the liver and kidney function of alloxan-induced diabetic male rabbits. The liver and kidney functions were determined and analyzed by one–way of a NOVA at variance software at a P-Value of 0.05. The result showed a significant decrease in aspartate aminotransferase (AST), alanine aminotransferase (ALT), alkaline phosphatase (ALP), and uric acid values in the groups treated with standard and extraction ursolic acid(UA) compared to the diabetic group. The rabbit group that was treated with vitamin B complex recorded a significant decrease in the three liver enzymes, uric acid, and creatinine values than the diabetic group. In addition, the rabbit group that was treated with hyperinsulinemia recorded a significant increase in aspartate aminotransferase (AST) and creatinine values than the diabetic rabbit group. While the histological results in the groups treated with standard and extraction ursolic acid had a clear ameliorative effect in liver and kidney function tests better than hyperinsulinemia, also vitamin B complex caused some good effects

Correlation of Insulin Like Growth Factor-1 and Insulin-Like Growth Factor Binding Protein with LH, FSH and Testosterone in Iraqi Children with Growth Hormone Deficiency

Insulin like growth factor-1 has metabolic and growth-related roles all over the body and is strongly associated and regulated by growth hormone. It is produced by almost any type of tissue, especially the liver. The study aimed to measure insulin like growth factor in growth hormone deficient patients and find its relation with other studied parameters. The Subjects in the study were 180 studied in the National Diabetic Center for Treatment and Research/Al-Mustansiriya University in Baghdad/Iraq for the period from November 2021 to April 2022. Blood was drawn and investigated for the levels of IGF-1, IGFBP-3, LH, and FSH. Also testosterone and statistical analysis was carried out to find the potential correlations. The results relived that the gender was not affect the levels of either parameter, IGF-1 was found to be positively correlated with age, BMI, and IGFBP-3. While IGFBP-3 was found to be positively correlated with the levels of IGF-1, LH, FSH and testosterone. From the results of the current study, it can be concluded that the levels of GH as well as the levels of IGF-1 and IGFBP-3, have significant difference between the NGHD and the patients’ group

Cytokine Gene Polymorphisms across Tuberculosis Clinical Spectrum in Pakistani Patients

BACKGROUND: Pakistan ranks 7(th) globally in terms of tuberculosis (TB) disease burden (incidence 181/100000 pop./yr; prevalence of 329/pop./yr). Reports from different populations show variable associations of TB susceptibility and severity with cytokine gene polymorphisms. Tuberculosis clinical severity is multi-factorial and cytokines play a pivotal role in the modulation of disease severity. We have recently reported that the ratio of two key cytokines (IFNgamma and IL10) show significant correlation with the severity spectrum of tuberculosis. The objective of the current study was to analyze the frequency of cytokine gene polymorphisms linked to high and low responder phenotypes (IFNgamma +874 T(hi)-->A(lo) and IL10 -1082 G(lo)-->A(hi)) in tuberculosis patients. METHODS AND FINDINGS: STUDY GROUPS WERE STRATIFIED ACCORDING TO DISEASE SITE AS WELL AS DISEASE SEVERITY: Pulmonary N = 111 (Minimal, PMN = 19; Moderate, PMD = 63; Advance, PAD = 29); Extra-pulmonary N = 67 (Disseminated DTB = 20, Localized LTB = 47) and compared with healthy controls (TBNA = 188). Genotype analyses were carried out using amplification refractory mutation system-PCR (ARMS-PCR) and stimulated whole blood (WB) culture assay was used for assessing cytokine profiles. Our results suggest that the IFNgamma +874 TT genotype and T allele was overrepresented in PMN (p = 0.01) and PMD (p = 0.02). IFNgamma +874 TT in combination with IL10 GG(lo) genotypes showed the highest association (chi(2) = 6.66, OR = 6.06, 95% CI = 1.31-28.07, p = 0.01). IFNgamma AA(lo) on the other hand in combination with IL10 GG(lo) increased the risk of PAD (OR = 5.26; p = 0.005) and DTB (OR = 3.59; p = 0.045). CONCLUSION: These findings are consistent with the role of IL10 in reducing collateral tissue damage and the protective role of IFNgamma in limiting disease in the lung

Impact of opioid-free analgesia on pain severity and patient satisfaction after discharge from surgery: multispecialty, prospective cohort study in 25 countries

Background: Balancing opioid stewardship and the need for adequate analgesia following discharge after surgery is challenging. This study aimed to compare the outcomes for patients discharged with opioid versus opioid-free analgesia after common surgical procedures.Methods: This international, multicentre, prospective cohort study collected data from patients undergoing common acute and elective general surgical, urological, gynaecological, and orthopaedic procedures. The primary outcomes were patient-reported time in severe pain measured on a numerical analogue scale from 0 to 100% and patient-reported satisfaction with pain relief during the first week following discharge. Data were collected by in-hospital chart review and patient telephone interview 1 week after discharge.Results: The study recruited 4273 patients from 144 centres in 25 countries; 1311 patients (30.7%) were prescribed opioid analgesia at discharge. Patients reported being in severe pain for 10 (i.q.r. 1-30)% of the first week after discharge and rated satisfaction with analgesia as 90 (i.q.r. 80-100) of 100. After adjustment for confounders, opioid analgesia on discharge was independently associated with increased pain severity (risk ratio 1.52, 95% c.i. 1.31 to 1.76; P &lt; 0.001) and re-presentation to healthcare providers owing to side-effects of medication (OR 2.38, 95% c.i. 1.36 to 4.17; P = 0.004), but not with satisfaction with analgesia (beta coefficient 0.92, 95% c.i. -1.52 to 3.36; P = 0.468) compared with opioid-free analgesia. Although opioid prescribing varied greatly between high-income and low- and middle-income countries, patient-reported outcomes did not.Conclusion: Opioid analgesia prescription on surgical discharge is associated with a higher risk of re-presentation owing to side-effects of medication and increased patient-reported pain, but not with changes in patient-reported satisfaction. Opioid-free discharge analgesia should be adopted routinely