Assessment of serum neopterin as an inflammatory and cardiovascular marker in type 1 and 2 diabetes complicated by diabetic foot syndrome: a comparative study

  Introduction. Neopterin is a byproduct of nerve trans­mitter coenzyme that is synthesized and released by macrophages and T-lymphocytes. It is a useful inflam­matory marker of diabetes progression, as its levels increase with the progression of the disease from prediabetes to type 2 diabetes (T2D). This study aimed to compare serum neopterin levels between type-1 and type-2 diabetes patients with diabetic foot syndrome (DFS), and assess the relation between serum neopterin levels and cardiometabolic risk factors. Materials and methods. This observational cross-sec­tional study was carried out in the Centre of Diabetes Mellitus in Erbil, Iraq from 1st January to 31st December 2016. A total of 30 healthy subjects and 140 patients with DFS [70 patients with type 1 diabetes (T1D) and 70 patients with T2D] were enrolled in the study. The main outcome measurements included anthropometric measurements, blood pressure, fasting serum glucose, glycated haemoglobin, lipid profile, neopterin and high sensitivity C-reactive protein (hs-CRP). Results. Serum neopterin levels of T2D patients were significantly (p < 0.001) higher than the corresponding levels of T1D patients (18.6 ± 2.1 nmol/L vs. 12.6 ± 1.3 nmol/L). The changes in the serum neopterin levels were related to cardiometabolic risk factors. In T1D, a significant positive correlation between serum levels of neopterin and diastolic blood pressure were ob­served, while in T2D the significant positive correlation was found between fasting serum triglyceride levels and neopterin levels. Serum levels of neopterin were insignificantly correlated with hs-CRP in T1D and T2D. Conclusions. In patients with DFS, serum neopterin lev­els are significantly higher in those with T2D compared with T1D patients. Neopterin levels are not related to the grading of DFS, but are invariably related to cardio­metabolic risk factors. (Clin Diabetol 2018; 7, 2: 91–96

Ocena stężeń adiponektyny i leptyny w surowicy u pacjentów z chorobą niedokrwienną serca — związek z frakcją wyrzutową, wskaźnikiem uwapnienia tętnic i angiogramem tętnic wieńcowych

Introduction. Adiponectin is an adipose tissue-derived adipocytokine protein, while leptin is the protein that maintains the body weight in humans via its effect on the hypothalamus. These hormones interact at different levels of cardio-metabolic risk factors. This study aimed to assess the serum levels of adiponectin and leptin in patients with ischaemic heart disease and subjected to coronary calcium scoring (CCS) and coronary angiography. Material and methods. We included 59 patients with ischaemic heart disease and 20 healthy subjects served as a control in this study. The patients were assessed by electrocardiograph, echocardiograph, coronary angiogram and coronary computerised tomography (CCT) for the assessment of CCS. Serum levels of adiponectin and leptin were determined by using enzyme-linked immunosorbent assay (ELISA) technique. Results. Coronary computed tomography (CT) investigation explored, that 30.5% of patients had positive calcium score and 67.8% of patients did not show evidence of coronary changes by CT angiograph. The patients had significantly high leptin and low adiponectin levels compared with healthy subjects. Serum leptin levels were significantly low in patients with positive CCS and angiogram, compared with those who had no abnormal CCT. Significant positive correlation between ejection fraction and serum leptin (r = 0.285, p &lt; 0.05) and non-significant correlation with serum adiponectin were observed. Conclusions. Serum leptin and adiponectin levels are useful determinants in patients with ischaemic heart disease, as high serum leptin levels are associated with negative coronary CT and positively correlated with left ventricular ejection fraction.Wstęp. Adiponektyna jest adipocytokiną, białkiem produkowanym przez tkankę tłuszczową, natomiast leptyna jest białkiem przyczyniającym się u ludzi do utrzymania masy ciała przez wpływ na przysadkę mózgową. Hormony te oddziałują na siebie na różnych poziomach czynników ryzyka sercowo-naczyniowego. Badanie przeprowadzono w celu oceny stężeń adiponektyny i leptyny w surowicy pacjentów z niedokrwienną chorobą serca, których poddano koronarografii i u których określono wskaźnik uwapnienia tętnic (CCS). Materiał i metody. Do badania włączono 59 pacjentów z chorobą niedokrwienną serca i 20 zdrowych osób tworzących grupę kontrolną. U chorych wykonano badania elektrokardiograficzne, echokardiograficzne, koronarografię i tomografię tętnic wieńcowych (CCT) w celu oceny CCS. Surowicze stężenia adiponektyny i leptyny oznaczono metodą immunoenzymatyczną (ELISA). Wyniki. W ocenie uwapnienia tętnic, dokonanej za pomocą tomografii komputerowej (CT) tętnic wieńcowych, u 30,5% chorych uzyskano wynik dodatni, a u 67,8% chorych nie stwierdzono zmian w tętnicach wieńcowych w angiografii CT. U osób z chorobą niedokrwienną stężenia leptyny były istotnie wyższe, a adiponektyny — niższe niż w grupie kontrolnej. U chorych z dodatnim CCS i zmianami w angiogramie stężenie leptyny w surowicy było istotnie niższe niż u osób bez nieprawidłowości w CCT. Stwierdzono istotną dodatnią korelację frakcji wyrzutowej ze stężeniem leptyny w surowicy (r = 0,285; p < 0,05) oraz nieistotną korelację ze stężeniem adiponektyny w surowicy. Wnioski. Surowicze stężenia leptyny i adiponektyny są użytecznymi wskaźnikami u pacjentów z chorobą niedokrwienną serca, ponieważ wysokie stężenie leptyny wiązało się z ujemnym wynikiem CCT i korelowało dodatnio z frakcją wyrzutową lewej komory

Barriers to Diabetes Care during Humanitarian Crisis during 2013–2022 in Five Arabian Countries: A Systematic Review

Objective: The purpose of this systematic review is to examine the difficulty in getting diabetes care in five Arab nations that experienced conflict and humanitarian crises between 2013 and 2022. Materials and methods: Original published articles (2013–2022) reporting diabetes care challenges refugees and host community members were searched from Web of Sciences, PubMed and Europe PMC databases. Two impartial reviewers evaluated the methodological quality of the data from these studies. Results: Of 670 searched studies, 41 studies were included in this systemic review. Fourteen were published between 2013 and 2017, and 27 were published between 2018 and 2022. The main barriers to diabetes care reported were; a) refugees who lacked diabetes knowledge and information, b) community members who complained of financial shortage and insufficient drug supply, c) government health providers who expressed hostility toward the refugees, and d) humanitarian organizations that provided subpar care due to financial hardship and lack of resources. Conclusions: This review focuses on evidence of suboptimal diabetes care in humanitarian settings in five Arabic countries affected by wars and conflicts. There are numerous impediments to monitoring, investigating, and treating displaced and host community patients. These barriers can be overcome by improving the knowledge of both patients and healthcare providers, as well as overcoming the hosting communities’ economic shortage. 

Tick removal

Ticks are blood feeding external parasites which can cause local and systemic complications to human body. A lot of tick-borne human diseases include Lyme disease and virus encephalitis, can be transmitted by a tick bite. Also secondary bacterial skin infection, reactive manifestations against tick allergens, and granuloma?s formation can be occurred. Tick paralysis is a relatively rare complication but it can be fatal. Except the general rules for tick bite prevention, any tick found should be immediately and completely removed alive. Furthermore, the tick removal technique should not allow or provoke the escape of infective body fluids through the tick into the wound site, and disclose any local complication. Many methods of tick removal (a lot of them are unsatisfactory and/or dangerous) have been reported in the literature, but there is very limited experimental evidence to support these methods. No technique will remove completely every tick. So, there is not an appropriate and absolutely effective and/or safe tick removal technique. Regardless of the used tick removal technique, clinicians should be aware of the clinical signs of ticktransmitted diseases, the public should be informed about the risks and the prevention of tick borne diseases, and persons who have undergone tick removal should be monitored up to 30 days for signs and symptoms

Ocena stężenia neopteryny w surowicy jako wskaźnika zapalenia i czynnika ryzyka kardiometabolicznego u chorych na cukrzycę typu 1 i typu 2 powikłaną zespołem stopy cukrzycowej — badanie porównawcze

Introduction. Neopterin is a byproduct of nerve trans­mitter coenzyme that is synthesized and released by macrophages and T-lymphocytes. It is a useful inflam­matory marker of diabetes progression, as its levels increase with the progression of the disease from prediabetes to type 2 diabetes (T2D). This study aimed to compare serum neopterin levels between type-1 and type-2 diabetes patients with diabetic foot syndrome (DFS), and assess the relation between serum neopterin levels and cardiometabolic risk factors. Materials and methods. This observational cross-sec­tional study was carried out in the Centre of Diabetes Mellitus in Erbil, Iraq from 1st January to 31st December 2015. A total of 30 healthy subjects and 140 patients with DFS [70 patients with type 1 diabetes (T1D) and 70 patients with T2D] were enrolled in the study. The main outcome measurements included anthropometric measurements, blood pressure, fasting serum glucose, glycated haemoglobin, lipid profile, neopterin and high sensitivity C-reactive protein (hs-CRP). Results. Serum neopterin levels of T2D patients were significantly (p &lt; 0.001) higher than the correspond­ing levels of T1D patients (18.6 ± 2.1 mg/L vs. 12.6 ± 1.3 mg/L). The changes in the serum neopterin levels were related to cardiometabolic risk factors. In T1D, a significant positive correlation between serum levels of neopterin and diastolic blood pressure were ob­served, while in T2D the significant positive correlation was found between fasting serum triglyceride levels and neopterin levels. Serum levels of neopterin were insignificantly correlated with hs-CRP in T1D and T2D. Conclusions. In patients with DFS, serum neopterin lev­els are significantly higher in those with T2D compared with T1D patients. Neopterin levels are not related to the grading of DFS, but are invariably related to car­diometabolic risk factors.  Wstęp. Neopteryna jest produktem ubocznym reakcji koenzymu przekaźnika nerwowego syntetyzowanym i wydzielanym przez makrofagi i limfocyty T. Jest ona użytecznym wskaźnikiem zapalnym zaawansowania cukrzycy, ponieważ jej stężenia zwiększają się w wraz z progresją choroby od stanu przedcukrzycowego do jawnej cukrzycy typu 2 (T2D). Badanie przeprowadzo­no w celu porównania stężeń neopteryny w surowicy u chorych z zespołem stopy cukrzycowej (DFS) będącym powikłaniem cukrzycy typu 1 lub typu 2. Dodatkowo za­mierzano ocenić zależność między stężeniami neopteryny w surowicy a czynnikami ryzyka kardiometabolicznego. Materiał i metody. Badanie o charakterze obserwacyj­nym przeprowadzono w ośrodku diabetologicznym w mieście Erbil w Iraku od 1 stycznia do 31 grudnia 2016 roku. Do badania włączono 30 zdrowych osób oraz 140 chorych na cukrzycę z DFS — 70 z cukrzycą typu 1 (T1D) i 70 z T2D. Do głównych parametrów ocenianych w badaniu należały: pomiary antropometryczne, ciśnienie tętnicze, glikemia na czczo, hemoglobina glikowana, profil lipidowy, stężenie neopteryny i stężenie białka C-reaktywnego oznaczanego metodą wysokoczułą (hs-CRP). Wyniki. Stężenie neopteryny w surowicy było istotnie wyższe (p < 0,001) u chorych na T2D niż u chorych na T1D (18,6 ± 2,1 nmol/l vs. 12,6 ± 1,3 nmol/l). Zmiany wartości stężeń neopteryny w surowicy wiązały się z występowaniem czynników ryzyka kardiometabolicz­nego. U chorych na T1D zaobserwowano istotną dodat­nią korelację między stężeniem neopteryny w surowicy a ciśnieniem rozkurczowym, natomiast u chorych na T2D wykazano istotną dodatnią korelację między stę­żeniem neopteryny a stężeniem triglicerydów na czczo. Zarówno u chorych na T1D, jak i u osób z T2D stężenie neopteryny w surowicy wiązało się z hs-CRP. Wnioski. U grupie chorych z DFS stężenie neopteryny w surowicy było istotnie wyższe u osób z T2D niż u pacjentów z T1D. Nie stwierdzono zależności między stężeniem neopteryny a stopniem ciężkości DFS, wykazano natomiast związek z czynnikami kardiome­tabolicznymi

The Erythrocyte Sedimentation Rate is a Simple, Sensitive and Predictive Hematological Index for Non-Septic Diabetic Foot Syndrome: A Cross-Sectional Study

Objective: Several studies have found that the hematological index can be considered as a prognostic biomarker of diabetes mellitus. This study aimed to compare the level of the erythrocyte sedimentation rate (ESR) with other hematological indices as a predictive marker of non-infected diabetic foot syndrome (DFS). Materials and methods: A total of 137 patients with diabetes (53 males and 84 females) and another 30 healthy subjects (10 males and 20 females) were included in this study. The participants were grouped into Group I (healthy subjects, n = 30); Group II (n = 72, type 2 diabetes without clinical evidence of DFS features); and Group III (n = 65, type 2 diabetes with clinical evidence of DFS features (grade 0–2). Hematological indices were determined by a hematology autoanalyzer. Results: The serum fasting glucose levels were significantly higher among Group III patients compared with Groups I and II. The value of ESR was significantly higher among Group III patients compared with Group II. The ESR and red distribution width (RDW) values increased in tandem with the DFS upgrade. The area under the curve (AUC) of the ESR at a cutoff value of 18 mm/hour was 0.663 with 95% confidence intervals of 0.571–0.755, which was significantly (p &lt; 0.001) higher than the AUC of RDW, platelet distribution width, mean platelet volume, and plateletcrit. Also, the area under the curve of the ESR increased as the upgrading of DFS increased. Conclusions: We conclude that determination of ESR serves as a predictor and discriminator of DFS and its upgrading.

Harmful versus beneficial effects of using short-term combined oral antidiabetic therapy: ‎An open label comparative clinical trial ‎

Background: Although oral antidiabetic drugs have many beneficial pleiotropic effects, they are ‎not free from adverse reactions that may interfere with glucose homeostasis. This study aimed ‎to assess the effects of oral antidiabetic drugs as add- on-therapy to metformin, on the metabolic, ‎cardiac, and renal determinants. ‎ Material and methods: A total number of seventy-eight type 2 diabetes (T2D) patients who ‎were treated with metformin were allocated to add-on-therapy for 12 weeks, with glimepiride ‎‎(4mg/day, n=26), sitagliptin (100mg/day, n=28), and canagliflozin (300mg/day, n=24). ‎Anthropometric measurements, glycemic indices, lipid, and renal markers, were determined ‎before initiation and after the treatment. ‎ Results: All of the three treatments significantly decreased the glycemic indices, triglyceride-to-glucose index, and non-significantly altered the serum uric acid-to creatinine. Glimepiride ‎significantly increased the waist-to-height ratio (0.630±0.057 versus 0.640±0.057, p=0.040), ‎while sitagliptin and canagliflozin significantly decreased it (0.650±0.058 versus 0.640±0.054, ‎p=0.009, and 0.650±0.041 versus 0.630±0.044, p&lt;0.001). Estimated glomerular filtration index- ‎epidemiology collaboration (ml/min/1.73m2) significantly declined by using glimepiride ‎‎(109.0±10.4 versus 103.6±10.9, p=0.001), and sitagliptin (106.1±12.4 versus 103.3±15.0, ‎p=0.013). ‎ Conclusion: Careful selection of using oral antidiabetic agents can protect T2D patients from ‎harmful events, particularly those related to cardiovascular events and renal function