EFFECT OF METABOLIC SURGERY ON TYPE 2 DIABETES REMISSION: A MATCHED GROUP ANALYSIS

Objectives: In this study it is proposed to analyse the effect of bariatric metabolic surgery on diabetes remission in obese type 2 diabetic patients compared to conventionally treated similar patients.Methods: A retrospective review, of prospectively collected data base of conventionally treated group and metabolic group were screened from the year 2010-2013 at the study centre for patients satisfying the inclusion criteria. Three follow up data at an interval of three months and a base line value for both group were collected. Primary outcome measures the percentage of patient achieved diabetes remission, i.e. glycosylated haemoglobin (HbA1c)<6 % without active pharmacological therapy at one year and percentage of patients who achieved excess weight loss more than 60 % at one year.Secondary outcome includes percentage reduction in medication use. Statistics used in the study is student‘t' test, Chi-square and ANOA (Analysis of Variance). The treatment effects were found to be significant to the least significant difference (LSD) at 5% level of significance.Results: The patients underwent bariatric surgery had a significant improvement in glycemic status (HbA1c<6 %). In conventionally treated group less than 5% achieved HbA1c less than 6.5 % level with active pharmacological therapy. There was an increased use of antidiabetic medication with 2-5% increase in mean body weight in conventional group.Conclusion: Compared to conventional therapy bariatric surgery markedly improves diabetes and results in discontinuation or marked reduction of anti-diabetic medications in majority of patients treated. So bariatric surgery seems to be a better option for the obese diabetic patients.Â

METABOLIC EFFECTS OF THREE DIFFERENT BARIATRIC PROCEDURES-A RETROSPECTIVE STUDY

Objective: In this study it is proposed to compare the effect of three different bariatric metabolic procedures such as Laparoscopic Roux-en-Y gastric bypass (RYGB) Laparoscopic Mini gastric bypass (MGB) and Laparoscopic sleeve gastrectomy (SG) on diabetes remission and reduction in co-morbidities.Methods: A retrospective analysis of prospectively collected data base of three bariatric metabolic surgery groups were screened from the year 2010-2014 at the study centre for patients satisfying the inclusion criteria. Three follow up data at an interval of three months and a base line value for all the three groups were collected. Outcome measure the percentage of patients achieved diabetes remission according to American Diabetes Association Criteria (ADA)/International Diabetic Federation (IDF) criteria i.e. Glycosylated haemoglobin (HbA1c)<6 % or<6.5 % without active pharmacological therapy at least I year post surgically and percentage patients lost>60% excess body weight. Secondary outcome includes the percentage reduction in cardiovascular risk factors, changes in medication associated with diabetes and cardiovascular diseases and immediate and later complications of the three different procedures of surgery. All calculations were performed using SPSS Version 18 statistical software. Descriptive statistics included are calculation of mean and standard deviation. Chi–square test and two factor ANOVA for comparison of means between groups under study.Results: All the three surgical groups were comparable in reducing the excess body weight, HbA1c and cardiovascular complications. Highest response to weight reduction at 9 to 12 mo was reported from MGB group which was statistically significant between groups. Percentage of patients achieved diabetes remission according to ADA/IDF criteria was not statistically significant between groups but within group it was highly significant. Hypercholestremia reduction between MGB and GB was highly significant P value is **0.002. The lowest percentage of complications after surgery was reported by MGB group followed by SG.Conclusion: MGB relatively a new surgical procedure seems to be a better option for treating, obesity, uncontrolled diabetes and related co-morbidities

S100A4 overexpression proves to be independent marker for breast cancer progression

<p>Abstract</p> <p>Background</p> <p>Breast cancer is the most common cancer and cause of deaths in women around the world. Oncogene amplification usually occurs late in tumor progression and correlates well with aggressiveness of tumor. In fact the function of the S100A4 protein and its role in metastasis is unclear at present. The purpose of the study was to determine the expression of S100A4 protein in the invasion status and metastatic potential of breast cancer by using tissue microarray and to determine its role in breast cancer based on the expression of S100A4 gene product.</p> <p>Methods</p> <p>S100A4 protein expression was examined by immunohistochemistry (IHC) using commercially available tissue microarray containing malignant and normal breast tissue cores from 216 patients.</p> <p>Results</p> <p>S100A4 was absent in normal breast tissues while positive in 45.1% of infiltrating ductal carcinoma (IDC) node negative and 48.8% of infiltrating lobular carcinoma node negative. In paired samples, S100A4 protein was expressed in 13.5% of IDC node positive cases and 35.1% of matched lymph node metastasis.</p> <p>Conclusion</p> <p>S100A4 protein expression appears widely expressed in early and advanced breast cancer stages compared with normal breast. Our study suggests S100A4 may play a role in breast cancer progression and may prove to be an independent marker of breast cancer which appears to be down regulated in more advanced stages of breast cancer.</p

Modulatory effects of perindopril on cisplatin-induced nephrotoxicity in mice: Implication of inflammatory cytokines and caspase-3 mediated apoptosis

Cisplatin-induced nephrotoxicity limits its anticancer effectiveness, thus this study’s aim was to assess the potential modulatory effect of perindopril on cisplatin-induced nephrotoxicity and to elucidate the possible underlying mechanisms. Renal dysfunction was induced in mice by a single injection of cisplatin (10 mg kg–1, i.p.) and perindopril was administered orally (2 mg kg–1, once daily) for 5 days. Perindopril remarkably ameliorated cisplatin-induced perturbations in renal histology, renal levels of tumor necrosis factor-alpha, interleukin-6 and interleukin-10, apoptosis-regulating protein expressions (Bax and Bcl2), and partially normalized Bax to Bcl2 ratio and active caspase 3 protein expression. Conversely, perindopril had no significant effect on cisplatin-induced elevations in serum creatinine and urea, microalbuminuria, kidney to body weight ratio, lipid peroxidation marker, superoxide dismutase and catalase activities and reduced glutathione content. In conclusion, perindopril may be safely used with cisplatin in mice since it ameliorated cisplatin-induced histopathological changes, inflammation and apoptosis without affecting renal biomarkers or oxidative stress

Cost-effectiveness of malaria diagnosis using rapid diagnostic tests compared to microscopy or clinical symptoms alone in Afghanistan

Background Improving access to parasitological diagnosis of malaria is a central strategy for control and elimination of the disease. Malaria rapid diagnostic tests (RDTs) are relatively easy to perform and could be used in primary level clinics to increase coverage of diagnostics and improve treatment of malaria.&lt;p&gt;&lt;/p&gt; Methods A cost-effectiveness analysis was undertaken of RDT-based diagnosis in public health sector facilities in Afghanistan comparing the societal and health sector costs of RDTs versus microscopy and RDTs versus clinical diagnosis in low and moderate transmission areas. The effect measure was ‘appropriate treatment for malaria’ defined using a reference diagnosis. Effects were obtained from a recent trial of RDTs in 22 public health centres with cost data collected directly from health centres and from patients enrolled in the trial. Decision models were used to compare the cost of RDT diagnosis versus the current diagnostic method in use at the clinic per appropriately treated case (incremental cost-effectiveness ratio, ICER).&lt;p&gt;&lt;/p&gt; Results RDT diagnosis of Plasmodium vivax and Plasmodium falciparum malaria in patients with uncomplicated febrile illness had higher effectiveness and lower cost compared to microscopy and was cost-effective across the moderate and low transmission settings. RDTs remained cost-effective when microscopy was used for other clinical purposes. In the low transmission setting, RDTs were much more effective than clinical diagnosis (65.2% (212/325) vs 12.5% (40/321)) but at an additional cost (ICER) of US$4.5 per appropriately treated patient including a health sector cost (ICER) of US$2.5 and household cost of US$2.0. Sensitivity analysis, which varied drug costs, indicated that RDTs would remain cost-effective if artemisinin combination therapy was used for treating both P. vivax and P. falciparum. Cost-effectiveness of microscopy relative to RDT is further reduced if the former is used exclusively for malaria diagnosis. In the health service setting of Afghanistan, RDTs are a cost-effective intervention compared to microscopy.&lt;p&gt;&lt;/p&gt; Conclusions RDTs remain cost-effective across a range of drug costs and if microscopy is used for a range of diagnostic services. RDTs have significant advantages over clinical diagnosis with minor increases in the cost of service provision.&lt;p&gt;&lt;/p&gt

Effect of Microporous Layer Ink Homogenisation on the Through-Plane Gas Permeability of PEFC Porous Media

The through-plane gas permeability and morphology of PEFC gas diffusion media (GDM) is investigated for different microporous layer (MPL) ink homogenisation techniques (bath sonication and magnetic stirring) for low- (Vulcan XC-72R) and high (Ketjenblack EC-300J)-surface-area carbon powders. The MPL composition is held constant at 80 wt.% carbon powder and 20 wt.% PTFE for a carbon loading of 1.0 mg cm−2. The MPL ink homogenisation time is held constant at two hours for both techniques and increased by one hour for bath sonication to compare with previous investigations. The results show that the through-plane gas permeability of the GDM is approximately doubled using magnetic stirring when compared with bath sonication for MPLs composed of Vulcan XC-72R, with a negligible change in surface morphology between the structures produced from either homogenisation technique. The variation in through-plane gas permeability is almost negligible for MPLs composed of Ketjenblack EC-300J compared with Vulcan XC-72R; however, MPL surface morphology changes considerably with bath sonication, producing smoother, less cracked surfaces compared to the large cracks produced via magnetic stirring for a large-surface-area carbon powder. An MPL ink sonication time of three hours results in a percentage reduction in through-plane gas permeability from the GDL substrate permeability by ~72% for Ketjenblack EC-300J compared to ~47% for two hours

Factors associated with emergency department green zone utilization in hospital

Introduction: In hospital, emergency departments are highly utilized by patients. Overcrowding, congestion and long waiting time were among the issues highlighted resulting from it. In Selangor, there has been a steady increase in utilization of emergency department of government hospitals over the past five (5) years. Utilization of green zone was the highest in these hospitals. Being a department that provides a comprehensive emergency service and provides easy access for the community, issues of appropriateness utilization arise. This study aims to determine the level of appropriateness of green zone utilization by patients attending Emergency Department in Serdang Hospital and factors influencing its utilization. Methodology: A cross-sectional study was conducted in Emergency Department of Serdang Hospital. Sample sizes of green zone adult patients were obtained by systematic random sampling. Emergency Medicine and Trauma Services Policy Malaysia 2012 were used to classify patients to appropriate and inappropriate utilization of green zone. Pre-tested self-administered questionnaire were used to interview patients. Descriptive statistics, chi-square test and logistic regression used to analyse the data collected. Data analysis conducted using IBM SPSS Statistics version 22 and p value significant at <0.05. Result: There were 793 (90.7%) patients in this study. It was found that level of appropriateness utilization in green zone emergency department was 83.6% appropriate and 16.4% was inappropriate. Median age of patients were 29 years old (IQR ± 25th, 75th; 23, 40). Majority were Malays (74%). The results of chi-square test indicated that there were significant association between marital status (p=0.032), patients attending emergency department because treatment cost is cheap (p=0.025), emergency department operates 24 hours (p=0.045) and time of patient presentation to emergency department (p=0.001). From the study, the multivariate results revealed that the odds of married patients (AOR=1.481, 95% CI: 1.008, 2.174) to utilize the emergency department were higher than not married patients, the odds of patients utilize emergency department not because of the cheap treatment (AOR=1.614, 95% CI: 1.073, 2.469) was almost two times more and lastly the odds of utilization after office hours were two times more than during office hours (AOR=2.117, 95% CI: 1.388, 3.227). Conclusion: The study revealed majority of patients utilized green zone appropriately. Married patient, patient attend emergency department not because treatment cost is cheap and patient attending after office hour were significantly associated with appropriateness utilization of emergency department. Further study needed to determine the cause and effect relationship

Screening of electrocoagulation process parameters for treated palm oil mill effluent using minimum-runs resolution IV design

The present study aimed at the screening of parameters for electrocoagulation treatment of treated palm oil mill efuent using minimum-runs resolution IV design. The responses examined include: chemical oxygen demand removal (%), total suspended solids removal (%) and turbidity reduction (%), and the varied dependent factors comprise: electrical current density (mA/cm2), time (min), pH, electrolyte concentration (g/L), stirring speed (rpm), electrode spacing (mm) and electrode confguration (monopolar or dipolar). The statistical results revealed that the current density has a signifcant infuence on the treatment performance at two-level interactions with pH, electrode spacing and electrode concentration and at three-level correlations with time and pH. Thus, the most important factors afecting the removal efciency of the organic compounds were found to be pH, time, electrode spacing, electrolyte concentration and electrode confguration at a P value less than 0.05, respectively, in the descending order of signifcance. Therefore, the optimized electrocoagulation process could be reached with current density equal to 5 mA/cm2, electrolysis time of 5 min, electrode spacing of 5 mm and using monopolar electrode confguration. This combination provided the maximum ability of the process for chemical oxygen demand (68.84%), total suspended solids (93.27%) and turbidity reduction (92.88%) predictions, with the corresponding experimental values of 69.27, 97.59 and 96.91%, respectively