Obese Diabetic Women Research Articles

Postpartum cardiac reverse remodeling is reflected in urine proteome

Abstract Background The impact of postpartum cardiac reverse remodeling (RR) on urinary proteome, particularly in pregnant women with cardiovascular risk (CVR) factors who show long-term increased risk of cardiovascular disease and mortality is unknown. Purpose To profile the urinary proteome in pregnant women with/without CVR factors to identify proteins associated with postpartum RR. Methods Our study included a prospective cohort of 32 healthy and 27 obese and/or hypertensive and/or diabetic pregnant women who underwent transthoracic echocardiography, pulse-wave-velocity, and urine collection at the 3rd trimester and 6-months postpartum. Shotgun HPLC-MS/MS profiled proteins. Generalized linear mixed-effects models were used to identify associations between urinary proteins and left ventricle mass (LVM), a surrogate of RR. Results The presence of at least one CVR factor was associated with worse LVM RR. We identify 6 (alpha-galactosidase A [GLA], sialate O-acetylesterase [SIAE], trans-golgi network integral membrane protein 2 [TGOLN2], sortilin [SORT1], desmoglein-2 [DSG2] and neuroblast differentiation-associated protein [AHNAK]) and 11 (serotransferrin [TF], inter-α-trypsin inhibitor heavy chain 4 [ITIH4], complement C3 [C3], transketolase [TKT], fibronectin [FN1], ubiquitin-like modifier-activating enzyme 1 [UBA1], cell division control protein 42 homolog [CDC42], glutathione s-transferase P1 [GSTP1], sodium/potassium-transporting ATPase subunit alpha-1 [ATP1A1], ADP-ribosylation factor 1 [ARF1] and pro-cathepsin H [CTSH]) proteins associated with high and low LVM regression, respectively. These proteins were functionally linked with insulin-like growth factor (IGF) transport and uptake regulation by IGF binding-proteins, platelet activation, signaling and aggregation and the immune system’s activity. The concentration of IGF-1 in urine samples was associated with low LVM regression after delivery. Conclusions Urine proteome reflects postpartum cardiac RR. Specifically, eight urine proteins (GSTP1, ARF1, FN1, SORT1, SIAE, GLA, ITIH4 and DGS2) show clinical value in identifying women at higher risk for incomplete postpartum RR. In addition, the association between IGF and postpartum LVM regression was validated.

The effect of MIND diet on sleep status, anxiety, depression, and cardiometabolic indices in obese diabetic women with insomnia: study protocol for a randomized controlled clinical trial {1}

BackgroundThe Mediterranean-DASH Intervention for Neurodegenerative Delay (MIND) diet is a plant-based and anti-inflammatory diet that has the ability to protect and manage cardiovascular and nervous system diseases. Regarding that insomnia and cardiovascular problems are x`common in type 2 diabetes mellitus (T2DM), the present study will assess the effectiveness of the MIND dietary pattern on sleep quality, cardiometabolic indicators, and other psychological indicators.MethodsForty-four overweight/obese T2DM women with insomnia, aged 30–65 years, will voluntarily participate in this randomized controlled trial and will be randomized to receive either a MIND low-calorie diet (MLCD) or a low-calorie diet (LCD) over a 3-month period. Before and after the study, sleep quality, some biochemical and cardiometabolic indices, cortisol, brain-derived neurotrophic factor (BDNF), high-sensitivity C-reactive protein (hs-CRP), and oxidative stress indicators will be assessed.DiscussionThe use of dietary interventions in the management of T2DM complications is practical and safe. This research seeks to investigate the capacity of the MIND diet in the management of insomnia and cardiovascular problems of DM. It is expected that the results of this research will provide new perspectives on using an ideal dietary regimen to treat these health conditions.Trial registrationIRCT20181111041611N8. Registered on August 7, 2023. https://www.irct.ir/trial/71772

The extent of postpartum cardiac reverse remodeling is reflected in urine proteome

The association of postpartum cardiac reverse remodeling (RR) with urinary proteome, particularly in pregnant women with cardiovascular (CV) risk factors who show long-term increased risk of cardiovascular disease and mortality is unknown. We aim to profile the urinary proteome in pregnant women with/without CV risk factors to identify proteins associated with postpartum RR. Our study included a prospective cohort of 32 healthy and 27 obese and/or hypertensive and/or diabetic pregnant women who underwent transthoracic echocardiography, pulse-wave-velocity, and urine collection at the 3rd trimester and 6 months postpartum. Shotgun HPLC–MS/MS profiled proteins. Generalized linear mixed-effects models were used to identify associations between urinary proteins and left ventricle mass (LVM), a surrogate of RR. An increase in arterial stiffness was documented from 3rd trimester to 6 months after delivery, being significantly elevated in women with CV risk factors. In addition, the presence of at least one CV risk factor was associated with worse LVM RR. We identified 6 and 11 proteins associated with high and low LVM regression, respectively. These proteins were functionally linked with insulin-like growth factor (IGF) transport and uptake regulation by IGF binding-proteins, platelet activation, signaling and aggregation and the immune system’s activity. The concentration of IGF-1 in urine samples was associated with low LVM regression after delivery. Urinary proteome showed a predicting potential for identifying pregnant women with incomplete postpartum RR.

Ghrelin and resistin status in obese diabetic women with metabolic syndrome

Ghrelin and resistin status in obese diabetic women with metabolic syndrome

Laparoscopic cholecystectomy in obese diabetic women

Background: Diabetes mellitus is associated with an increased risk of complications after abdominal surgery. We evaluated retrospectively the impact of preoperative risk factors and outcome of diabetic patients after laparoscopic cholecystectomy (LC) compared with open cholecystectomy (OC) for symptomatic gallstones. Objective: To determine Laparoscopic cholecystectomy in obese diabetic women Methods: A cross-sectional study was conducted at Shifa International hospital Islamabad Pakistan, which was performed between April 2020 and March 2022. The total number of patients in our study were 100. The number of female patients were 95 and male were 5. In 100 consecutive patients who underwent for blood tests and some diagnostic tests too. We included only old age people in our study age above than 40 years. We took BMI for every patients. Data was tabulated and analyzed by SPSS. Results: In a current study total 100 patients were enrolled. The minimum age of patients were 40 and the maximum age of the patients were 80. The mean age were 11.81±10.2 years. The minimum BMI were 30 and maximum BMI were 40. The mean BMI were 3.041±13.5. The minimum Operation hours were 1 and maximum Operation hours were 2. The mean of the operation hours were 1.045±3.76. Fig 1, shows us gender distribution, in which 95 were female patients while 5 were male patients. The frequency of male patients were 95 and the percentage were 95. The frequency of female patients were 5 and its percentage were 5. The frequency of nausea patients were 16 and its percentage were 16. The frequency of vomiting patients were 84 and its percentage were 84. The frequency of sever right abdominal patients was present in 97 patients and was not present in 3 patients. The frequency of diabetes mellitus 97 and its percentage were 97 while the frequency of diabetes mellitus were not present in 3 patients. 75% of patients were cholelithiasis while 25% of patients were not affected by cholelithiasis. The second figure shows 18 % of patients have choledocholithiasis and 82 % of patients were not affected by this disease. The third figure shows that 3% of patients have cholecystitis while 97% of patients were not affected by this type of disease. The fourth figure shows that type 2 Diabetes mellitus were present in 97% of patients while were not present in 3% of patients. Conclusion: Laparoscopic cholecystectomy as a new technique for the treatment of cholecystectomy. The main benefit of laparoscopic cholecystectomy for diabetic patients is that the wound recovers fast and its no major complications. In our study females were as compared to males. The operation time is from 1 to 2 hours on laparoscopic Cholecystectomy.

A case-control regression analysis of liver enzymes in obesity-induced metabolic disorders in South Asian females.

Excessive body weight may disrupt hepatic enzymes that may be aggravated by obesity-related comorbidities. The current case-control study was designed to evaluate the extent of liver enzyme alteration in obesity-related metabolic disorders. Obese females with BMI ≥ 30 suffering from metabolic disorders were grouped according to existing co-morbidity and their hepatic enzymes were compared with non-obese healthy females. The resultant data was subjected to analysis of variance and mean difference in liver enzymes were calculated at P = 0.05. Analysis of variance indicated that obese diabetic and obese hypertensive females had almost 96% and 67% increase in the concentration of gamma-glutamyl transferase than control, respectively (P<0.0001). The obese females suffering from diabetes and hypertension exhibited nearly 54% enhancement in alanine transaminase level (P<0.0001) and a 17% increase in aspartate aminotransferase concentration (P = 0.0028). Obesity along with infertility decline liver enzyme production and a 31% significant decline in aspartate aminotransferase was observed while other enzyme concentrations were not significantly altered. Regression analysis was performed on the resultant data to understand the association between liver enzyme alteration and the development of metabolic diseases. Regression analysis indicated that obese diabetic and obese diabetic hypertensive women had 20% production of normal liver enzymes and 80% enzymes produced abnormally. Obese hypertensive and obese infertile females had only 5% and 6% normal production of liver enzymes, respectively. This research leads to the conclusion that the ability of the liver to function normally is reduced in obesity-related diabetes and hypertension. This may be due to inflamed and injured liver and poses a serious threat to developing fatty liver disease and ultimately liver cirrhosis.

Association between Nesfatin-1 Levels and C-Peptide in Sera of Obese / Non-Obese Type 2 Diabetic Women

Objective: The aim of the presented word was to assess the diagnostic accuracy of serum Nesfatin-1 in type 2 diabetes mellitus and its relationship with C-peptide level in obese and non-obese type-2 diabetic women of Iraqi population.&#x0D; Methods: A case-control study was performed on 50 type 2 diabetic patients admitted in Al-Hussein Teaching Hospital and Al-Hassan center of diabetes and endocrinology unit / Kerbala health directorate – Iraq and another 50 control individuals, during the period from April, 2022 – Jan. 2023). The T2DM groups were divided into two groups 25 obese and 25 non-obese; also the control group was divided into 25 obese and 25 non-obese as apparently healthy groups. The ELISA Kit was used to measure serum Nesfatin-1 and C-peptide, and random serum glucose was measured by enzymatic colorimetric method, and lipid profile test were measured through spectrophotometric technique, instead of HbA1c% was determined using HPLC method.&#x0D; Results: The results observed indicated that Nesfatin-1 levels shown a non-significant decrease in all of type 2 diabetic groups as compared with apparently healthy control group, while the C-peptide were significantly decreased in type 2 diabetic patients when compared with apparently control group. In addition, the random blood glucose and HbA1c% were shown significant elevation in type 2 diabetic patients as compared with apparently healthy control groups. The observed data indicated that Nesfatin-1 and C-peptide levels when comparing between type 2 diabetic patients and control in obese groups shown a risk factors depending upon the odd ratio observed (OR = 1.064 (1.011-1.119), 1.0200 (0.992-1.08)) respectively, but only Nesfatin-1 was shown to be significant. In BMI the levels of Nesfatin-1 and C-peptide, as shown the Nesfatin-1 was significant in obese groups, while the C-peptide as shown significant in normal weight groups. The optimal diagnostic points for Nesfatin-1 were (sensitivity = 98%, specificity = 90%) at a level (Cut-off points) = 39.13, while C-Peptide levels: (sensitivity = 98%, specificity = 94%) at a level (Cut-off points) = 15.99. Both markers have p-values of the AUC were &lt;0.001 and statistically significant.&#x0D; Conclusion: Accordingly, it was concluded that a significant relationship between circulating Nesfatin-1 levels and type 2 diabetes. Nesfatin-1 appears to be able to contribute to the treatment of obesity and diabetes because of its anorexigenic and antihyperglycemic effects. In addition, C-peptide is a known biomarker of insulin resistance and beta-cell function. High specificity and sensitivity analyzed results were obtained by ROC analysis for both markers in T2DM.

Dysregulation of Lipid Droplet Protein Expression in Adipose Tissues and Association with Metabolic Risk Factors in Adult Females with Obesity and Type 2 Diabetes

BackgroundAdipocyte dysregulation of lipid droplet (LD) metabolism caused by altered expression of LD proteins contributes to obesity-related metabolic diseases. ObjectivesWe aimed to investigate whether expression levels of PLIN1, CIDEA, and CIDEC were altered in adipose tissues of women with obesity and type 2 diabetes and whether their alterations were associated with metabolic risk factors. MethodsNormal-weight (NW; 18.5 kg/m2 < BMI ≤ 25 kg/m2; n = 43), nondiabetic obese (OB; BMI > 30 kg/m2; n = 38), and diabetic obese (OB/DM; BMI > 30 kg/m2, fasting glucose ≥ 126 mg/dL, HbA1c ≥ 6.5%; n = 22) women were recruited. Metabolic parameters were measured, and expressions of PLIN1, CIDEA, CIDEC, and obesity-related genes were quantified in abdominal subcutaneous (SAT) and visceral adipose tissues (VAT). Effects of proinflammatory cytokines, endoplasmic reticulum (ER) stress inducers, and metabolic improvement agents on LD protein gene expressions were investigated in human adipocytes. ResultsPLIN1, CIDEA, and CIDEC expressions were lower in SAT and higher in VAT in OB subjects relative to NW subjects; however, they were suppressed in both fat depots in OB/DM subjects relative to OB (P < 0.05). Across the entire cohort, whereas VAT PLIN1 (r = 0.349) and CIDEC expressions (r = 0.282) were positively associated with BMI (P < 0.05), SAT PLIN1 (r = −0.390) and CIDEA expressions (r = −0.565) were inversely associated. After adjustment for BMI, some or all of the adipose LD protein gene expressions were negatively associated with fasting glucose (r = −0.259 or higher) and triglyceride levels (r = −0.284 or higher) and positively associated with UCP1 expression (r = 0.353 or higher) (P < 0.05). In adipocytes, LD protein gene expressions were 55–70% downregulated by increased proinflammatory cytokines and ER stress but 2–4-fold upregulated by the metabolic improvement agents exendin-4 and dapagliflozin (P < 0.05). ConclusionsThe findings suggest that reduction of adipose LD protein expression is involved in the pathogenesis of metabolic disorders in women with obesity and type 2 diabetes and that increasing LD protein expression in adipocytes could control development of metabolic disorders.

The effect of a period of Pilates and the supplementation of Royal Jelly on inflammatory indexes of diabetic obese women

Background: The use of supplements, herbal extracts, and exercise training for the treatment of diseases and metabolic disorders has increased among people. Thus, the aim of this study was the study of The effect of a period of Pilates and the supplementation of Royal Jelly on inflammatory indexes of diabetic obese women. Materials and Methods: In this quasi-experimental study 44 volunteer diabetic obese women participated and They were randomly divided into Four groups of 11 controls, Royal Jelly, Pilates, Pilates + Royal Jelly. Pilates exercise training was performed during 8 weeks (3 sessions per week, 60 min per session). The subjects consumed a supplement group of 1000 mg of royal Jelly daily for 8 weeks. covariance analysis test were used to examine the in-group differences and between the research groups. Results: The results showed that eight weeks of Pilates and Royal Jelly Supplements significantly reduced the TNF-α, CRP and IL-6 diabetic women(P=0.001). In addition, serum glucose and serum insulin also decreased significantly in during eight weeks of Pilates and supplementation of the royal Jelly(P=0.001). Vo2max significantly Increase in training, training + supplement groups (P=0.001). Conclusion: According to obtained results, it appears that Pilates training plus Royal Jelly extract consumption have better effect on serum inflammatory factors in obsess women with diabetes type 2

Effect of obesity on fragility fractures, BMD and vitamin D levels in postmenopausal women. Influence of type 2 diabetes mellitus

AimsTo see the effects of obesity on risk fracture, bone density (BMD), and vitamin D levels in a group of postmenopausal women, and consider how comorbid type 2 diabetes mellitus (T2DM) modifies them.Methods679 postmenopausal women were grouped into obese and non-obese. Obese women were grouped into those with T2DM and those without. 25(OH)-vitamin D, PTH and BMD were measured, and prevalent fragility fractures were gathered.ResultsObese women had higher prevalence of T2DM, than non-obese women. Levels of 25(OH)-vitamin D were lower and those of PTH higher in obese women, BMD values were higher in obese women. Diabetic-obese women had a higher prevalence of non-vertebral fractures than non-diabetic-obese. Multivariate logistic regression model showed association of fragility fractures with age, total hip BMD, BMI and T2DM. Obese women have higher BMD and lower 25(OH)-vitamin D values (and higher PTH) than non-obese, without diabetes.ConclusionsT2DM confers an increased risk of non-vertebral fractures in postmenopausal obese women.

How safe is Contraception use among Obese Diabetic Women?

Incidence of diabetes mellitus is increasing is worldwide. The incidence of obesity is also increasing among the diabetic people. Sexually active obese women are commonly encountered nowadays due to increase in the global burden of obesity and diabetes mellitus Obesity and diabetes mellitus is associated with many health risks and a pregnant obese diabetic woman has health risks not only for herself but also to the foetus she carries. Thus, an effective birth control method is important to reduce pregnancy related complications. Though most of us are aware of management of diabetes and obesity, we may not be aware of the contraceptive usage among premenopausal women and HRT [hormone replacement therapy] use among perimenopausal women. A study was conducted to find the incidence of obese diabetics among the women attending a religious function. Later the study was extended to find the contraceptive use among the obese diabetic women and HRT usage among obese perimenopausal diabetic women. It has been found that 16/84 are prediabetic 25/84 are diabetic and 35/84 are overweight and 22/84 are obese. Follow up study was done to find out what contraceptive method was used by them and their knowledge about the contraceptive use. 77% (n=364) of the sexually active obese women are using contraception, with most of them using hormonal contraception. We are aware that some of the oral contraceptives will aggravate diabetes and obesity. Introduction: There is global increase in diabetes mellitus together with increasing incidence of obesity among women. This increase in obese diabetic women includes increasing numbers of women of a reproductive age whose reproductive health and contraception need careful consideration. We have conducted a study among obese diabetic women and their contraceptive usage. This study explored the level of knowledge, attitude, and practice of contraception usage of the sexually active obese women. Among the respondents (25.6%) were not aware of the best contraceptive for sexually active obese women. It is noted that 32.1% of obese women with underlying medical illness were still on hormonal contraception. The awareness of health risk associated with hormonal contraceptive usage of the amongst the obese diabetic women is less. This study has revealed that there is a lack of education and counselling with regards to safe and appropriate use of contraceptive to the women who need it for family planning. Objective: This study aims to look at the knowledge, attitude and practice (KAP) in the choice of contraceptives among obese and sexually active women. Methods: This study was conducted at Ministry of Health, health facilities and Private General Practitioners’ Clinics inPeninsular Malaysia. A self-designed questionnaire was used to assess KAP of the participants. A total of 473 respondents participated in the survey. Results: 77% (n=364) of the sexually active obese women are using contraceptives. Majority used hormonal contraceptives (n=204, 56%) and barrier method was the preferred method (39%, n=142) among the others. Women with Hypertension and Type II Diabetes Mellitus have the highest rate of using hormonal contraception (51.6%, n=32, 52.6%, n=30) respectively. Both groups have low awareness on the health risk associated with hormonal contraception which was 69% and 83% respectively. Most of the respondents were satisfied with the method of contraception they use, and majority mentioned ‘Easy to take’ as the reason for using it. 32%(n=152) of the respondents have underlying medical illnesses. 24.5% thought that hormonal contraception is the best. 23.5% choose IUCD as the method of choice. Conclusion: In the first part of the study the incidence of diabetes mellitus and obesity among the women was done. In the second part the study explored the level of knowledge, attitude, and practice, of the sexually active obese women based on their sociodemographic data in the choice of the appropriate contraceptive considering their existing medical conditions and sources of procurement. Majority of obese women used non hormonal contraception and almost half of the rest chose hormonal contraception. A quarter of the respondents claimed that hormonal contraception was the best choice. Many obese women with underlying medical illnesses were on hormonal contraception. It is noted that 32.1% of obese women with underlying medical illness were still on hormonal contraception. The awareness amongst the diabetic and hypertensive respondents on health risk associated with hormonal contraceptive used was noted to be poor, being 38.7% and 42.9% respectively. The use of IUCD as the preferred and appropriate choice for those with medical conditions is very discouraging (less than 3%).

Irisin Levels Related to Glycosylated Hemoglobin in Type 2 Diabetic Obese Women

The aim of the preset study is to explain the role of irisin hormone levels in type-2 obese diabetic women and compare these levels with those in obese nondiabetic women. In addition, we investigated the relation of irisin levels with those of glycated hemoglobin (HbA1c) and body mass index (BMI) in the patients.&#x0D; Eighty eight subjects were included in this study, including 44 type-2 Iraqi obese diabetic women as a patients group, and 44 obese nondiabetic women as a control group. Serum irisin was measured by Enzyme-linked Immune-Sorbent assay (ELISA), while determination of glycosylated Hemoglobin was carried out by The SD A1c CareTM system. Diabetic type-2 obese women showed a highly significant decrease in the levels of serum irisin when compared to levels in obese non-diabetic women, while no significant changes were observed in the mean±SD values when comparing age and duration of DM. In the patients, a negative correlation was found between serum irisin and HbA1c while no significant correlation was recorded between the hormone levels and BMI.

Ghrelin, resistin and insulin in obese diabetic women in Wad-Madani, Sudan

Obesity in the Sudan is increasing at alarming rate with the tendency of reaching an epidemic proportion in women. It is commonly associated with type 2 diabetes (T2D). Some adipokine hormones such as resistin are associated with obesity. To study how the levels of resistin, ghrelin and insulin are associated with obesity,fat distribution and (T2D) and to ascertain any interrelationships between them. 150 women, age ≥18 years old, resident in Wad-Madani town, Sudan were participated in the study. They were divided into 3 groups according to body mass index (BMI) value: I (normal weight), II (overweight) and III (obese diabetic). Fasting serum resistin and ghrelin concentrations were measured using ELISA method. Insulin levels were determined by radioimmunoassay(RIA). The mean±SD levels of resistin 5.80±4.91ng/mL,Ghrelin107.60±26.67pg/M and Insulin 11.92±8.54mLU/ml in obese diabetic were found to be greater than in normal or overweight women. In normal weight values were 3.07±2.15 ng/mL 83.30±13.38pg/mL, and 6.62±6.77mLU/ml for resistini, ghrelin and Insulin, respectively. Values for overweight women 3.64±2.63 pg/mL 90±17.35 pg/mL and 8.13±7.54 mLU/ml for resistin, ghrelin and insulin respectively. Increased BMI, waist circumference (WC) and hormones (ghrelin and resistin) were associated with insulin resistance. Further studies are needed to accept or refute these findings.

The rectus femoris muscle flap is an underused tool in the vascular surgeon's armamentarium

Mrs Havercamp aFictitious.aFictitious. presents to clinic at 4:00 pm today for an unscheduled appointment. She is a 67-year-old obese diabetic woman who is 10 days status post right common femoral endarterectomy with Dacron patch angioplasty and retrograde iliac stenting for rest pain. Today, she reports increasing pain and drainage from the groin wound. On examination, there is erythema and dehiscence of the skin edges. Cloudy fluid emanates from the wound. I sigh. “Mrs Havercamp, when was the last time you had anything to eat or drink?” Groin wound complications—alarmingly common, occasionally lethal. Amputation may result, but regardless of the outcome, a significant commitment of time, effort, and cost ensues for the patient and the surgeon. That muscle flaps are a valuable adjunct in the treatment of groin wound complications is incontrovertible. Virtually every vascular surgeon has rotated a sartorius flap, usually with success. But what if the sartorius flap fails? or is unavailable? Most of us will have exhausted our toolbox and require the assistance of a plastic surgeon colleague. Indeed, there are myriad reports of other types of muscle flaps used in the management of groin wounds—tensor fascia lata, gracilis, anterolateral thigh myocutaneous, rectus femoris, rectus abdominis, and others. Common among these reports is that they are performed by plastic surgeons in the majority of cases. This study by Ryer and colleagues1Ryer E.J. Garvin R.P. Kapadia R.N. Jorgensen B.D. Green J.O. Fluck M. et al.Outcome of rectus femoris muscle flaps performed by vascular surgeons for the management of complex groin wounds after femoral artery reconstructions.J Vasc Surg. 2020; 71: 905-911Abstract Full Text Full Text PDF PubMed Scopus (3) Google Scholar describes 24 rectus femoris flaps performed exclusively by vascular surgeons for treatment of complex groin wounds after femoral artery reconstruction. As expected, obesity, diabetes, and chronic real disease were common in this cohort of patients, and more than half of the surgical procedures were performed in fields previously operated on. Outcomes were largely favorable and comparable to other publications for patient survival and limb salvage. There were no instances of flap necrosis, nor were any complications related to flap rotation identified. The technique for creation of these flaps is described and is straightforward. The authors acknowledge a potential disadvantage of the rectus femoris flap: a decrement in knee extension strength. The authors did not attempt to quantify it, and they appear to dismiss its importance among chronically ill patients who engage in little strenuous activity. On the contrary, maintaining all residual strength among these patients whose reserve is marginal may be critically important to maintaining mobility. This study sheds no light on this issue. In addition, harvesting and rotating this flap almost certainly take more time than creating a sartorius flap and do involve a fairly generous counterincision in the thigh. Nevertheless, I suspect that these potential downsides practically have little impact. Will I abandon the sartorius flap? Certainly not, and I suspect the authors will not either. There is clearly a role for this simple flap under the right circumstances. Will I add the rectus femoris flap into my own armamentarium? Absolutely. The opinions or views expressed in this commentary are those of the author and do not necessarily reflect the opinions or recommendations of the Journal of Vascular Surgery or the Society for Vascular Surgery. Outcome of rectus femoris muscle flaps performed by vascular surgeons for the management of complex groin wounds after femoral artery reconstructionsJournal of Vascular SurgeryVol. 71Issue 3PreviewGroin wound complications after femoral artery reconstructions are highly morbid and notoriously difficult to treat. Successful techniques include long-term antibiotic therapy, operative débridement, and muscle flap coverage. Historically, more complex muscle flap coverage, such as a rectus femoris muscle flap (RFF), has been performed by plastic and reconstructive surgeons. In this study, the experience of vascular surgeons performing RFF in the management of wound complications after femoral artery reconstructions is reported. Full-Text PDF

Association of Body Mass Index with Activin-A and Inhibin-A in Gestational Diabetic Women

Objective: The objective of the study was to assess the association of body mass index (BMI) with Activin-A and Inhibin-A (biomarkers) irrespective to age in women with gestational diabetes mellitus (GDM).Methods: This study was a case-controlled study, in which sixty (60) diagnosed cases of gestational diabetic women with and without obesity and thirty (30) pregnant women without diabetes or any other complications were included in the study after taking informed written consent. The duration of the study was from January 2018 to June 2018. The enrolled participants were ninety (90) who were fulfilling the criteria in the duration of the study. Participants were placed into three groups A, B and C. In group A, thirty (30) pregnant females without complications, in group B thirty (30) non-obese pregnant women with gestationaldiabetes and in group C thirty (30) obese pregnant females with gestational diabetes mellitus (GDM). The biophysical parameters including weight, height and blood pressure were measured through standard protocols. Blood tests for biomarkers Activin-A and Inhibin-A levels were measured through Human Activin-A enzyme-linked immunosorbent assay(ELISA) kit and Human Inhibin-A ELISA kit respectively.Results: The results of the study revealed that the biophysical markers Actin-A and Inhibin-A had associations with gestational diabetes, the significant (p-value&lt;0.05) association was observed between Activin-A and body mass index but Inhibin-A had an insignificant association with it. However, the levels of bothbiomarkers (Activin-A and Inhibin-A) were found to be raised in both obese and non-obese gestational diabetic women when compared with normal pregnant women. The secondary outcome of the study is, there is significant (p-value&gt;0.05) relation between age and body mass index of obese GDM.Conclusion: The study concluded that the level of Activin-A was raised significantly (p-value&gt;0.05) in obese and non-obese gestational diabetic women as compared to normal pregnant women and non-significant increases in inhibin-A were observed in obese and non-obese gestational diabetic women as compared to normal pregnant women. A secondary outcome was, that there is significant (p-value&gt;0.05) association found between body mass index and age of the pregnant women.

Depot-specific UCP1 expression in human white adipose tissue and its association with obesity-related markers.

This study investigated depot-specific mRNA expression of uncoupling protein 1 (UCP1) in human white adipose tissue (WAT) and its association with obesity-related markers. We recruited 39 normal-weight, 41 nondiabetic obese, and 22 diabetic obese women. We measured UCP1 mRNA expression in abdominal visceral adipose tissue (VAT) and subcutaneous adipose tissue (SAT), and investigated the associations between UCP1 mRNA expression in VAT and SAT, and obesity-related markers including mRNA expression of leptin, adiponectin, CCAAT-enhancer-binding protein homologous protein (CHOP), and positive regulatory domain-containing protein 16 (PRDM16). We also evaluated UCP1 mRNA expression in differentiated human white adipocytes after treatment with various stressors and metabolic improvement agents in vitro. UCP1 mRNA in VAT was significantly higher than in SAT in all groups. UCP1 mRNA in SAT was negatively correlated with BMI, total abdominal fat area, visceral fat area, blood pressure, fasting glucose, insulin, HOMA-IR score, triglyceride, hsCRP, fasting leptin levels, and adipocyte size. UCP1 mRNA in SAT was positively correlated with fasting adiponectin levels. UCP1 mRNA in VAT was negatively correlated with visceral-to-subcutaneous fat ratio (VSR), fasting glucose, and triglyceride levels. In SAT, UCP1 mRNA was negatively correlated with mRNA expression of leptin and CHOP, and positively correlated with mRNA expression of adiponectin. The expression of PRDM16 was positively correlated with UCP1 mRNA in both VAT and SAT. UCP1 mRNA expression in differentiated human white adipocytes was significantly reduced after incubation with thapsigargin, tunicamycin, homocysteine, TNF-α, or IL-β, and significantly increased after incubation with exendin 4, dapagliflozin, and telmisartan. This study demonstrated depot-specific mRNA expression of UCP1 and its association with obesity-related markers in human WAT. UCP1 mRNA in human white adipocytes was suppressed by inflammatory agents and enhanced by metabolic improvement agents. UCP1 in human WAT might participate in the pathogenesis of obesity-related metabolic diseases.

Early gestational diabetes screening in obese women: a randomized controlled trial

Although in 2013 the American College of Obstetricians and Gynecologists recommended early screening for gestational diabetes in obese women, no studies demonstrate an improvement in perinatal outcomes with this strategy. We sought to determine whether early screening for gestational diabetes improves perinatal outcomes in obese women. Randomized controlled trial comparing early gestational diabetes screening (14-20 weeks) to routine screening (24-28 weeks) in obese women (body mass index ≥30 kg/m2) at 2 tertiary care centers in the United States. Screening was performed using a 50-g, 1-hour glucose challenge test followedby a 100-g, 3-hour glucose tolerance test if the initial screen was ≥135 mg/dL. Gestational diabetes was diagnosed usingCarpenter-Coustan criteria. Women not diagnosed at 14 to 20weeks were rescreened at 24 to 28 weeks. Exclusion criteria werepre-existing diabetes, major medical illness, bariatric surgery, andprior cesarean delivery. The primary outcome was a compositeofmacrosomia (>4000 g), primary cesarean delivery, hypertensive disease of pregnancy, shoulder dystocia, neonatal hyperbilirubinemia, and neonatal hypoglycemia (assessed within 48 hours of birth). A total of 962 women were randomized, and outcomes were available for 922. Of these 922 women, 459 (49.8%) were assigned to early screen and 463 (50.2%) to routine screen. Baseline characteristics were balanced between groups. In the early screening group, 69 (15.0%; 95% confidence interval, 11.9-18.6%) were diagnosed with gestational diabetes: 29 (6.3%; 95% confidence interval, 4.3-8.9%) at <20 weeks and 40 (8.7%; 95% confidence interval, 6.3-11.7%) at >24 weeks. Of those randomized to routine screening, 56 (12.1%; 95% confidence interval, 9.3-15.4%) had gestational diabetes. Early screening did not reduce the incidence of the primary outcome (56.9% in the early screen versus 50.8% in the routine screen, P= .07; relative risk, 1.12; 95% confidence interval, 0.99-1.26). Early screening for gestational diabetes in obese women did not reduce the composite perinatal outcome.

Effect of Aerobic Training on Blood Viscosity in Hypertensive Women

Abstract Background: Blood viscosity level increases in hyperten-sive patients. Objective of this study was to determine the effect of aerobic training on blood viscosity in hypertensive women. Aim of Study: To investigate effect of aerobic training on blood viscosity in hypertensive women. Material and Methods: Thirty obese diabetic women participated in this study chosen from Al-Bagour public hospital in 2018. The patients were assigned into two equal groups. Each group included 15 patients. The patients in both groups were matched in age ranged from (50-65 years old) and body mass index ranged from (25 to 29.9Kg/m2), with mild to moderate hypertension and had high blood viscosity >4.5 relative to water. All patientsreceived medications ac-cording to physician prescription, Group A received a program of aerobic training using treadmill 3 days/week for 8 weeks with intensity 60-80% MHR started with 20 minutes and increased by 5 minutes every two weeks till reaching 40 minutes at 8th week. Warm up phase 5-10 minutes, cool down phase 5-10 minutes in form of walking on treadmill at low speed.while group B acted as control group. Results: The data revealed a statistically decrease in blood viscosity level in group A than in group B after treatment (p<0.05). The percentage of improvement in group A was 20% while it was 7.2% in group B. Conclusion: Aerobic training had valuable effect on blood viscosity level in women with hypertension.

Interrelations Between Inflammatory and Oxidative Stress Biomarkers in Obese Women with Two Complications (Hypertension, Diabetes)

Abstract Background and aims: Interaction between oxidative stress and inflammation has not been comprehensively investigated in the association obesity – diabetes - hypertension. Our aim was to investigate interrelations between inflammatory and oxidative stress biomarkers in obese women with two complications (hypertension, type 2 diabetes). Material and Methods: 54 obese patients without complications, 46 diabetic patients with obesity, 48 hypertensive diabetic obese women, and 120 healthy controls were recruited from the department of nuclear medicine (Algeria). Inflammatory and oxidative stress biomarkers were assayed by appropriate methods. Results: Inflammatory markers were significantly higher in all obese groups compared to controls. Elevated pro-oxidants and decreased antioxidant markers were noted in obese women. These alterations were accentuated when obesity was associated with hypertension and diabetes. A positive interrelationship between inflammatory mediators and oxidative status, and a negative one with antioxidants were noted during obesity. Hypertension and diabetes enhanced these correlations. Leptin, C-reactive protein, catalase, superoxide dismutase, ion superoxide, peroxynitrite were found to be the best inflammatory and oxidative stress biomarkers that can predict diabetes and hypertension in obese women. Conclusions: oxidative stress and inflammation were intimately interconnected in women obesity associated with diabetes and hypertension.

Prediction of Endometrial Hyperplasia and Cancer among Premenopausal Women with Abnormal Uterine Bleeding.

Objective To create a prediction model including clinical variables for the prediction of premalignant/malignant endometrial pathology in premenopausal women with abnormal uterine bleeding (AUB). Methods This is an observational retrospective study including 240 premenopausal women with AUB referred to diagnostic hysteroscopy. Based on the presence of endometrial hyperplasia (EH) or cancer (EC), the women were divided into cases (EH/EC) and controls (no EH/EC). Univariate, stepwise logistic regression and ROC curve analysis were performed. Results 12 women had EH/EC (5%). Stepwise logistic regression analysis showed that EH/EC associated significantly with BMI ≥ 30 (OR=7.70, 95% CI 1.90 to 31.17), diabetes (OR=9.71, 95% CI 1.63 to 57.81), and a thickened endometrium (OR=1.20, 95% CI 1.08 to 1.34, criterion > 11 mm). The AUC was 0.854 (95% confidence intervals 0.803 to 0.896, p<0.0001). Considering the pretest probability for EH/EC of 5%, the prediction model with a positive likelihood ratio of 8.14 showed a posttest probability of 30%. The simultaneous presence of two or three risk factors was significantly more common in women with EH/EC than controls (50% vs. 6.6 and 25% vs. 0%, respectively, p<0.0001). Conclusion When premenopausal vaginal bleeding occurs in diabetic obese women with ET > 11 mm, the percentage of premalignant/malignant endometrial pathology increases by 25%. It is likely that the simultaneous presence of several risk factors is necessary to significantly increase the probability of endometrial pathology.