Increased Fasting Blood Sugar Research Articles

Vitamin B12 and Holotranscobalamin Levels in Diabetic Peripheral Neuropathy Patients

ABSTRACT Diabetic neuropathy is the most common and debilitating microvascular complication leading to nontraumatic amputations. Identifying the role of vitamin B12 in the etiology of neuropathy is crucial because simple vitamin B12 replacement may reverse neurologic symptoms if confirmed. Large proportion of vegetarians and patients on metformin have been associated with lowering of vitamin B12 levels. We have undertaken study on 60 vegetarian subjects between the age of 30 and 60 years, 20 healthy controls, 20 type 2 diabetes mellitus patients who were on metformin with peripheral neuropathy (DMWN), and 20 diabetics without peripheral neuropathy (DMWON). Vitamin B12, homocysteine, and folate levels were measured, and holotranscobalamin (holoTC) is also included, to improve the diagnosis of tissue vitamin B12 status, as holoTC is the biologically active fraction and more sensitive index of vitamin B12 status than total vitamin B12 itself. Complete history and clinical evaluation for neuropathy and electroneuromyography were recorded. Results In the DMWN group, vitamin B12 levels were significantly higher than in the DMWON group and controls [1013 (564-1501) pmol/l, 387 (245-731) pmol/l, and 305 (234-472) pmol/l respectively]. Similarly, serum holoTC was also found to be significantly higher in the DMWN [203.8 (129-300) pmol/l] group compared with the DMWON [94.4 (42.2-230.6) pmol/l] group and controls [74 (40-170) pmol/l]. Whereas mean levels of homocysteine and folate did not show any significant difference between groups, significant increase in fasting blood sugar and HbA1c was seen in the DMWN group compared with DMWON group and controls. Duration of diabetes is also significantly more in DMWN group compared with DMWON group. Conclusion We found that vitamin B12 and holoTC levels were high in patients with DMWN and DMWON groups compared with controls. Our study demonstrated that peripheral neuropathy was not associated with vitamin B12 deficiency in diabetics. These findings merit further research on a larger population to investigate into the cause of diabetic neuropathy, the factors involved, and benefit of vitamin B12 supplementation in these patients. Key messages Vitamin B12 status has no association with diabetic peripheral neuropathy. How to cite this article Noorjahan M, Madhavi K, Priscilla C, Jabeen SA. Vitamin B12 and Holotranscobalamin Levels in Diabetic Peripheral Neuropathy Patients. Indian J Med Biochem 2016;20(1):16-20.

Evaluation of Biochemical Markers Serum Amylase and Serum Lipase for the Assessment of Pancreatic Exocrine Function in Diabetes Mellitus.

Diabetes mellitus (DM), a metabolic disorder characterized by hyperglycaemia, associated with deficiency or resistance to insulin indicates endocrinal abnormality of the pancreas. Amylase and lipase are enzymes secreted by the exocrine portion of the pancreas. Endocrinal derangement observed in diabetes may interfere with the exocrine function of the pancreas. To estimate the levels of fasting blood sugar, serum lipase, serum amylase in patients of type 1 and type 2 DM. Than comparing them with healthy controls and to study the effect of type 1 and type 2 DM on pancreatic exocrine function using serum levels of amylase and lipase as biochemical marker. This study was conducted at GMERS Medical College and Hospital from Dec 2015 to July 2016. Thirty patients of type 1 DM and 30 patients of type 2 DM, who were already diagnosed and taking treatment, were included in this study. A total number of 30 apparently healthy individuals were recruited as the control group in our study. Fasting venous blood samples were collected from the cases as well as the controls and they were analysed by using semi auto analyser for blood glucose, serum amylase and serum lipase. The results were analysed statistically by using SPSS software. Values were expressed as means ± SD. We found statistically significant (p<0.01) low values for serum amylase and serum lipase in patients with type 1 and type 2 DM as compared to healthy controls. Fasting blood sugar was significantly higher in cases as compared to controls. We found negative correlation of fasting blood sugar level with serum amylase and serum lipase and positive correlation of serum amylase with serum lipase in both type 1 and type 2 DM. Our study clearly demonstrated that in type 1 and type 2 DM, there was increase in fasting blood sugar with decrease in serum amylase and serum lipase which signifies the derangement of endocrine-exocrine axis of the pancreas. Serum amylase and serum lipase can be used as biochemical markers for assessment of pancreatic exocrine function.

How much excess body weight, blood sugar, or age can double the risk of hypertension?

BackgroundDespite the well-known impact of advanced age, excess body weight, and raised blood glucose on blood pressure, the level of exposure to these risk factors that is necessary to double the risk hypertension is not widely investigated, but was explored in this study. Study designCross-sectional study. MethodsThis study reports the results of a screening program conducted on a large population of adults to assess the prevalence of diabetes and hypertension and their associated risk factors. The participants were people aged 30 years or older referring to 16 health centers in Tehran. A standard questionnaire was used to collect data on blood pressure, body mass index (BMI), waist-hip ratio (WHR), fasting blood sugar (FBS), smoking status, and demographic characteristics (age and gender) based on WHO STEPS manual. ResultsOf the 7611 people who participated in the screening program, 696 (9.1%) had raised blood pressure. The level of exposure to risk factors for high blood pressure that is necessary to replicate the OR of 2.0 indicated that an OR of 2.0 corresponds to an increase in age of about 9.4 years, an increase in BMI of about 10.3 kg/m2, an increase in waist-to-hip ratio of about 0.5, and an increase in fasting blood sugar (FBS) of about 85.8 mg/dl. ConclusionsThis study indicated how much increase in age, BMI, waist-hip ratio, and FBS can double the risk of hypertension. These results may be helpful for public health policy and prioritizing effective prevention programs to reduce the burden of high blood pressure.

Cytomorphometric study of epithelial cells in normal and cataractous human lenses in relation with hyperglycemia.

The aim of the study is to evaluate and correlate the morphology and cell density of epithelial cells adhering to lens capsule surgically removed from the anterior central region with lens clarity and type of cataract present in patients with or without type 2 diabetes. Capsulorhexis specimens were obtained from patients who had undergone phacoemulsification cataract surgery. All the samples were centrifuged and stained by the aid of Papanicolaou technique and were observed under light microscope. We determinated the mean cell density, the degree of epithelial damage, and morphological indicators of cells such as cell area and the nucleus-plasma ratio. Patients with cataract demonstrated a statistical significant decrease in cell density and an heterogeneous cell picture in which enlarged cells dominated. In addition, type 2 diabetics with cataract had a significantly even lower mean epithelial cell density by the presence of larger cell area with smaller nucleus-plasma ratio. More pronounced alterations in the lens epithelium were correlated not only with the presence of cortical cataract, increased fasting blood sugar, and increased HbA1c but also with the prolonged duration of diabetes and the co-existence of diabetic retinopathy. It seems that density and morphology of the anterior lens epithelial cells determine the lens epithelium damage which is more profound in hyperglycemia and in cortical cataracts. The changes in lens epithelium seem to play an important role in cataractogenesis.

The molecular mechanisms of liver and islets of Langerhans toxicity by benzene and its metabolite hydroquinone in vivo and in vitro

Benzene (C6H6) is one of the most commonly used industrial chemicals causing environmental pollution. This study aimed to examine the effect of benzene and its metabolite hydroquinone on glucose regulating organs, liver and pancreas, and to reveal the involved toxic mechanisms, in rats. In the in vivo part, benzene was dissolved in corn oil and administered through intragastric route at doses of 200, 400 and 800 mg/kg/day, for 4 weeks. And, in the in vitro part, toxic mechanisms responsible for weakening the antioxidant system in islets of Langerhans by hydroquinone at different concentrations (0.25, 0.5 and 1 mM), were revealed. Benzene exposure raised the activity of phosphoenolpyruvate carboxykinase (PEPCK), glucose 6-phosphatase (G6Pase) enzymes and increased fasting blood sugar (FBS) in comparison to control animals. Also, the activity of hepatic glucokinase (GK) was decreased significantly. Along with, a significant increase was observed in hepatic tumor necrosis factor (TNF-α) and plasma insulin in benzene treated rats. Moreover, benzene caused a significant rise in hepatic lipid peroxidation, DNA damage and oxidation of proteins. In islets of Langerhans, hydroquinone was found to decrease the capability of antioxidant system to fight free radicals. Also, the level of death proteases (caspase 3 and caspase 9) was found higher in hydroquinone exposed islets. The current study demonstrated that benzene and hydroquinone causes toxic effects on liver and pancreatic islets by causing oxidative impairment.

Effect of Treadmill Running on Apelin and APJ Expression in Adipose Tissue and Skeletal Muscle in Rats Fed a High-fat Diet.

Apelin, an adipokine and also a myokine, is involved in glucose homeostasis. In this study we investigated the effect of insulin resistance and exercise on the regulation of apelin and APJ in adipose tissue and skeletal muscle. After 20 weeks of a high-fat diet (HFD), rats showed severe insulin resistance, with increased fasting blood sugar and plasma insulin and impaired glucose tolerance. Plasma apelin immunoreactivity as well as apelin and APJ expression in adipose tissue and gastrocnemius muscle were significantly increased, with no difference in soleus muscle. Treadmill running completely ameliorated the HFD-induced insulin resistance, decreased plasma apelin level, and downregulated apelin and APJ expression in adipose tissue. However, apelin and APJ expression was upregulated in soleus and gastrocnemius muscle with treadmill training and a HFD. Exercise had a tissue-dependent effect on apelin and APJ expression in rats fed a HFD.

A Study on Metabolic Syndrome Prevalence among Master Health Checkup Subjects

Background and Objectives: The prevalence of metabolic syndrome is increasing among Indians. Early screening is the only way to recognize metabolic syndrome. There are only few evidences available about the magnitude of metabolic syndrome among master health checkup patients. With this background the present study assess the prevalence of metabolic syndrome in master health subjects. Methods: 105 patients was undergone master health checkup at Chennai Medical College Hospital and Research Centre during the month of June 2014 and they were enrolled for this present study. Blood pressure, fasting blood glucose level, high density lipoprotein, triglycerides were measured after overnight fasting. Anthropometric measurements such as height, weight, waist circumference and hip circumference also measured. The results were analyzed statistically. Results: The prevalence of metabolic syndrome among master health checkup subjects was found 28.5%. Among 20% males (21) and 8.5% (9) were females. The most common feature of the metabolic syndrome among master health checkup subjects was abdominal obesity (30), high blood pressure (21), increased fasting blood sugar (24), low levels of high density lipoproteins (24), and high level of triglycerides (19). The prevalence among the age groups was 6.6% among 30-40years, 13.3% among 41-50years, 6.6% among 51-60 and 1.9% among 61-75years. Interpretations and Conclusions: The presentation of metabolic syndrome is asymptomatic and incidental, screening is the only way to identify the individual and address the issues. Measuring the prevalence of metabolic syndrome in general population in the form of master health checkup is one of the key to assess the early identification and also to plan for early prevention in the form of lifestyle modification, dietary intervention. Key Words: Metabolic Syndrome, Fasting blood glucose, Lipoprotein, Triglycerides, Prevalence

A Study of the Cardiovascular Risk Factor Profile in Patients with Acute Coronary Syndrome with Particular Reference to Metabolic Syndrome

Objectives: Cardiovascular risk factors for acute coronary syndrome (ACS) are on rise in people of Indian origin. Moreover, the prevalence of metabolic syndrome (MS) is higher in populations with ACS than in the general population. Thus, the aim of the study was to evaluate the cardiovascular risk factor profile of patients presenting with acute coronary syndrome and to study the prevalence and impact of metabolic syndrome in patients with acute coronary syndrome by using South Asian modified National cholesterol Education Program Adult Treatment Panel III definition. Methods: This study was conducted between October, 2010 and March, 2011 at Government General Hospital, Kurnool, India. A total of 100 patients with ST or non-ST segment elevation ACS and who had clinical, electrocardiographic and biochemical diagnosis within the first 24 hrs of clinical onset were enrolled in the study. The enrolled subjects were divided into two groups: those with MS and those without MS. Cardiovascular risk factors defined by components of MS were evaluated. Analysis was performed using SPSS software. Results: Sixty patients had MS along with ACS and 40 patients had ACS without MS. The most prevalent component of MS was increased waist circumference (83.3%), followed by increased triglycerides (78.3%) and increased fasting blood sugar (76.7%). Majority of patients (58.3%) had presence of three components of MS. Conclusion: The MS is a highly prevalent condition among the patients with ACS and is associated with severe coronary artery disease. The identification of MS imparts a high risk status to the patient in developing cardiovascular disease but at the same time provides abundant opportunities for intervention. Hence it is of paramount importance to aim for stricter goals and lower cut offs for intervention at all levels of prevention: primordial, primary and secondary.

당뇨와 지역사회치주지수의 관련성: 제5기 국민건강영양조사

Objectives: The purpose of the study was to examine the association between diabetes mellitus and community periodontal index in Korean adults. Methods: The study populations were recruited by the Fifth Korea National Health and Nutrition Examination Survey. Study subjects were 10,411 who were examined oral examination, blood test, and aged over 19 years. Using multiple logistic regression analyses, the variables were adjusted for gender, age, household income, family history of diabetes, body mess index, smoking habit, and frequency of tooth brushing. Periodontal tissue examination of the subjects was performed and scored by Community periodontal index(CPI). Using probe, six teeth were examined for hemorrhage, plaque, and pocket depth and classified into CPI0, CPI1, CPI2, CPI3 and CPI4. Healthy periodontal groups(CPI0-2) and periodontal disease groups(CPI3-4) were divided by the periodontal disease status. The definition of diabetes mellitus(DM) was decided by the diagnosis by the doctors and fasting blood sugar level. Those who were diagnosed as DM were included in DM group. The DM variables included normal blood sugar level, increased fasting blood sugar level, and DM blood sugar level. The DM variables were compared to periodontal disease blood sugar level and analyzed. Results: The periodontitis prevalence rate was 23.2%. Those who had diabetes mellitus accounted for 5.5% of the subjects. Those who had impaired fasting glucose accounted for 17.7% and 7.9% of subjects were diabetes mellitus by blood test. In the confirmed diabetes group by doctor, the periodontitis prevalence rate was significantly higher than the non-diabetic group. Diabetic group by blood test had the highest prevalence rate of periodontitis than those who had impaired fasting glucose group or normal group. After adjusting for gender, age, household income, family history of diabetes, body mass index, smoking habit, and frequency of tooth brushing, the risk of periodontitis in diagnosed diabetes mellitus was 1.57 times(95% CI; 1.27-1.94) higher than the normal group. In impaired fasting glucose group and diabetes mellitus group by blood test, the risk of periodontitis was 1.11 times(95% CI; 0.95-1.30) and 1.45 times(95% CI; 1.45-2.12) higher, respectively. Conclusions: There was a significant relationship between diabetes mellitus and periodontitis in Korean adults. These results suggest that diabetes mellitus is a risk factor for periodontitis.

Influence of one-year androgen deprivation therapy on lipid and glucose metabolism in patients with newly diagnosed prostate cancer.

87 Background: The adverse events of androgen deprivation therapy (ADT) are widely recognized, but ADT-induced alterations in lipid and glucose metabolism may be race-dependent. We prospectively recruited Japanese patients with newly diagnosed prostate cancer who underwent at least one year of ADT and examined changes in lipid and glucose metabolism in these patients. Methods: Patients with newly diagnosed prostate cancer were recruited between January 2011 and August 2012. Body weight, abdominal circumference, and blood testing results were recorded every three months, and visceral and subcutaneous fat were measured by computed tomography before and after one year of ADT. Results: One hundred three patients completed a one year course of ADT. Median age was 74 (range, 50 to 85). Thirty nine patients underwent ADT with luteinizing hormone-releasing hormone (LHRH) agonist monotherapy, while 64 patients underwent ADT with LH-RH agonist plus bicalutamide. Median prostate-specific antigen (PSA) before ADT was 16.7 ng/ml (range, 3.6-3316 ng/ml). Clinical stage was B (46.6%), C (28.2%), and D (25.2%). Mean increase in body weight, abdominal circumference and body mass index after one year of ADT was 3.8%, 4.1%, and 3.8%, respectively. Mean decrease of hemoglobin was 5.5%. Mean increase of total, low-density lipoprotein cholesterol, high-density lipoprotein cholesterol and triglycerides was 9.0%, 10.8%, 5.0%, and 21.0%, respectively. Mean increase in fasting blood sugar and HbA1c was 4.6% and 1.7%, respectively. Changes in each variable from baseline to 0, 3, 6, 9, and 12 months was as follows: body weight, 0, 0.9, 2.7, 3.3, and 3.8%; hemoglobin, 0, 4.5, 3.7, 5.5, and 5.5%; total cholesterol, 0, 12.9, 11.4, 9.7, and 9.0%; triglycerides, 18, 26, 25, 21%; and HbA1c, 0, 2.1, 1.2, 1.2, and 1.7%. Increase of visceral and subcutaneous fat measured by computed tomography before and after one year of ADT was 32.4% and 35.4%, respectively. Conclusions: One year of ADT caused significant changes, especially in lipid metabolism, in Japanese patients with prostate cancer. Visceral and subcutaneous fat increased more than 30%. These changes were noticeable in the first half of the one year course of ADT. Appropriate monitoring and management of these patients is needed, because these changes might cause critical cardiovascular events. Clinical trial information: UMIN000004709.

The Buffering Role of HDL in Balancing the Effects of Hypercoagulable State in Type 2 Diabetes

Diabetes mellitus as a heterogeneous disease along with hyperglycemia causes quite many acute and chronic complications including cardiovascular complication. Cardiovascular complications are caused because of numerous factors such as increased Fasting Blood Sugar (FBS), Triglyceride (TG), hypercholesterolemia, hypercoagulable state and a change in balancing lipoproteins including Low Density Lipoproteins (LDL) and High Density Lipoproteins (HDL). Because of probable role of HDL in prevention of cardiovascular complications and its antithrombotic role in diabetics, we have studied lipoproteins and HDL in particular, effect on coagulation parameters which may potentially lead to cardiovascular complications in type 2 diabetics. In this study, 60 type 2 diabetics in early stage of diabetes were compared statistically with 50 healthy subjects in terms of biochemical factors of: FBS, TG, VLDL, LDL, coagulation parameters of: Partial thromboplastin time (PT), Activated Partial Thromboplastin Time (APTT), specific activity of coagulation factors and then the correlation between the biochemical and coagulation parameters was measured using Pearson’s correlation coefficient. Our findings showed that FBS, TG, VLDL and coagulation factors of: II, IX, X, XI in diabetics had increased significantly compared with healthy subjects. They also indicated that APTT and therefore, the intrinsic coagulation pathway in diabetics prolonged in comparison with the healthy individuals. There were no other significant differences in the measured parameters between two groups. On the other hand, by studying biochemical and coagulation factors, it was shown that there was a positive significant correlation among FBS, cholesterol and HDL with the coagulation factors of II, V, IX, X, XI. There was, interestingly, a negative significant correlation between HDL and APTT. The observed correlation between coagulation factors and HDL, regardless of the no significant difference of HDL in the two groups, shows that probably the hypercoagulable state as a result of hyperglycemia led to plasma increase of HDL. In other words, HDL, probably, because of hypercoagulable state, intended to remove their destructive effects of hypercoagulable state and then correlated with them.

METABOLIC SYNDROME

Objective: To determine the frequency of metabolic syndrome in patients presenting with acute myocardial infarction (MI). Design: Cross –sectional, observational, multi center study. Place and duration: Allied Hospital Faisalabad from 01-01-2009 to 30-06-2010. Materials and Method: Any patient fulfilling the criteria of acute myocardial infarction were admitted and enrolled in the study during the study period. Demographic details, history and clinical examination of the patients were recorded on prescribed performa after securing an informed consent. Blood Pressure was recorded in lying posture from right arm and waist circumference measured at umbilical level in lying position. Blood sample was collected in fasting state for estimation of plasma glucose, serum HDL-cholesterol and serum triglycerides levels. Results: Out of 690 patients, 420(60.86%) were male and 270(39.14%) were females with average age 55.90±10.19. 40% males and 44% females had metabolic syndrome and incidence increased with age. Waist circumference was increased in 46.85% participants followed by increased fasting blood sugar (42%) levels. Conclusions: Frequency of metabolic syndrome was high among the patients with acute myocardial infarction. It supports the potential for preventive efforts in persons with high risk for acute myocardial infarction.

The Relationship between Psychosocial Stress, Age, BMI, CRP, Lifestyle, and the Metabolic Syndrome in Apparently Healthy Subjects

The aim of this cross-sectional study was to examine the factors which may be associated with the metabolic syndrome by exploring the relationship between psychosocial stress, age, body mass index (BMI), C-reactive protein (CRP), lifestyle factors, and the components of the metabolic syndrome, such as glycated hemoglobin (HbA1c), fasting blood sugar (FBS), body fat percentage, and triglyceride concentration, among apparently healthy subjects. Psychosocial stress was measured by the use of the inventory to measure psychosocial stress (IMPS). One thousand four hundred and ninety-nine people out of 1,941 public school workers admitted to a hospital for a medical check-up responded to the IMPS, yielding a response rate of 77.2%. A total of 1,201 workers excluding 298 who were taking medication for various diseases were analyzed with the use of hierarchical multiple regression models. It was found that IMPS-measured stress score, age, BMI, and smoking habit were associated with an increase in glycated hemoglobin among men, while alcohol consumption was associated with a decrease in glycated hemoglobin. Stress score, age, BMI, and alcohol consumption were found to be associated with an increase in FBS among men, while smoking and exercise habits were associated with a decrease in FBS. CRP was found to be associated with an increase in body fat percentage among men, though stress score was not associated with an increase in body fat percentage. Stress score, age, and BMI were associated with an increase in triglyceride concentration among women. The findings of the present study seem to be in line with the hypothesis that psychosocial stress plays an important role in developing the metabolic syndrome, which may be associated with inflammatory processes in the vascular wall, resulting in atherosclerosis and cardiovascular disease.

Haemorrheologic and fibrinolytic activities in diabetics resident in Calabar, Cross-River State, Nigeria

Diabetes mellitus is a major health problem that results in significant morbidity and mortality from such complications as neuropathy, peripheral vascular disease and macrovascular disease. Many of the previous haemostatic studies in diabetic Nigerians focused on platelet count and activity with scanty information on haemorrheologic and fibrinolytic activities. A total of 50 diabetic subjects aged between 35 - 75 years attending the diabetic clinic of University of Calabar Teaching Hospital were selected for the study. 50 age-matched non-diabetic apparently healthy volunteers were used as controls. Fasting blood sugar (FBS), relative plasma viscosity (RPV), plasma fibrinogen concentration (PFC) and euglobulin lysis times (ELT) were estimated using standard methods. There was significant increase in FBS, RPV, PFC and ELT of diabetics when compared with the non-diabetic controls (P PFC and ELT (p > 0.05). It was observed in this study that the diabetic subjects had defective fibrinolysis and hyperviscous plasma as revealed by significantly increased RPV, PFC and prolonged ELT when compared with apparently healthy controls. This shows that the diabetics are prone to developing vascular and thrombotic complications. It may be necessary to incorporate RPV, PFC and ELT as routine tests for better management of these patients.

EFFECT OF 3-HYDROXY-3-METHYLGLUTARYL-COA REDUCTASE INHIBITORS ON FASTING BLOOD SUGAR.

Background 3-Hydroxy-3-methylglutaryl-CoA reductase inhibitors (statins) reduce serum cholesterol and cardiovascular morbidity and mortality. But the effect of statins on glucose metabolism is unclear. Some studies have suggested that statins may cause hyperglycemia by increasing calcium concentration in the islet cells, leading to a decrease in insulin release, or by decreasing GLUT 4-mediated peripheral glucose uptake. Methods We analyzed data in 345,417 patients (mean age 61 ± 15 years, 94% males, 6% diabetics, 20% statin users) from the Veterans Affairs VISN 16 database. We studied change in fasting blood sugar (FBS) in this population over a mean time of 2 years between the first available measurement and the last measurement from the most recent recorded visit. Data were limited to patients who had two FBS measurements. In the diabetic group, a diagnosis of diabetes had to be present before the first FPG measurement. Results Among nondiabetics, FBS increased with statin use from 97.8 to 105.2 mg/dL, and among nonstatin users, FPG increased from 96.6 to 101.6 mg/dL over the period of observation (increase in FBS with statin use; p Conclusion Statin use increases FBS in diabetic as well as nondiabetic patients. This relationship between statin use and rise in FBS is independent of age and use of aspirin, beta-blockers, and angiotensin-converting enzyme inhibitors.

Factors Influencing Mortality in Acute Pancreatitis

Severe acture pancreatitis (SAP), a multisystem disease, is characterized by multiple organ system failure and additionally by local pancreatic complications such as necrosis, abscess, or pseudocyst. The rate of mortality in SAP, which is about 20% of all cases of acute pancreatitis (AP), may be as high as 25%, as in infected pancreatic necrosis. The factors that influence mortality in different degrees are various. Etiology for the episode, age, sex, race, ethnicity, genetic makeup, severity on admission, and the extent and nature of pancreatic necrosis (sterile vs. infected) influence the mortality. Other factors include treatment modalities such as administration of prophylactic antibiotics, the mode of feeding (TPN vs. enteral), ERCP with sphincterotomy, and surgery in selected cases. Epidemiological studies indicate that the incidence of AP is increasing along with an increase in obesity, a bad prognostic factor. Many studies have indicated a worse prognosis in idiopathic AP compared to pancreatitis induced by alcoholism or biliary stone. The risk for SAP after ERCP is the subject of extensive study. AP after trauma, organ transplant, or coronary artery bypass surgery is rare but may be serious. Since Ranson reported early prognostic criteria, a number of attempts have been made to simplify or add new clinical or laboratory studies in the early assessment of severity. Obesity, hemoconcentration on admission, presence of pleural effusion, increased fasting blood sugar, as well as creatinine, elevated CRP in serum, and urinary trypsinogen levels are some of the well-documented factors in the literature. The role of appropriate prophylactic antibiotic therapy although still is highly controversial, in properly chosen cases appears to be beneficial and well accepted in clinical practice. Early enteral nutrition has gained much support and jejunal feeding bypassing the pancreatic stimulatory effect of it in the duodenum is desirable in selected cases. The limited role for endoscopic sphincterotomy in patients with demonstrated dilated CBD with impacted stone and evidence of impending cholangitis is well documented. Surgery in AP other than for removal of the gallbladder is often limited to infected pancreatic necrosis, pseudocysts, and pancreatic abscess and in some cases of traumatic pancreatitis with a ruptured duct system. The progress in the understanding of the role of cytokines will over us opportunities to use immunomodulatory therapies to improve the outcome in SAP.

Relationships between Risk Factors for Coronary Artery Disease and Aspirin Resistance.

Aspirin prevents or delays atherogenesis and subsequent arterial occlusions. Patients who are relatively resistant to aspirin have a higher rate of vascular occlusive events. We evaluated the hypothesis that in patients with a previous myocardial infarction (MI) relative resistance to aspirin was related to risk factors for coronary heart disease (CHD). We studied 192 patients with a history of at least 1 MI including 136 males and 64 females. Mean age was 62. Compliance was assured by studying patients 2 hours after they were observed to ingest 325mg aspirin and confirmed with a qualitative assay (arachidonic acid 1.0mM stimulated light aggregometry) that detected aspirin inhibition of platelet aggregation in all of the study patients. To assess amount of aspirin inhibition of platelet aggregation (aspirin resistance) platelet prostaglandin agonist (PPA) 30mM stimulated light aggregation was performed (Schwartz J. Lab Clin Med 2002; 139:227). A CHD risk assessment score that includes diabetes, HDL, total cholesterol, high blood pressure (HBP) smoking and age was used as a measure of 10 year risk for CHD. Statistical comparisons were evaluated using a univariate general linear model. A significant relationship was observed between platelet resistance to aspirin inhibition and increased CHD risk (p=0.03). Evaluation of individual CHD risk factors showed that diabetic patients were more resistant to aspirin as demonstrated by an increased slope of aggregation (p=0.02) a decreased time to 50% aggregation (p=0.04) and a linear relationship between an increase in fasting blood sugar and an increased aggregation slope (p=0.05). A higher (BMI) (p=0.05) or a lower HDL (p=0.02) were also related to aspirin resistance. Although decreased aspirin inhibition of platelets was observed in patients who smoked or had HBP, these differences were not significant. We conclude that in patients with CHD a relative resistance to aspirin inhibition of platelet aggregation correlates with a commonly used risk assessment equation and with the presence of diabetes, increasing BMI or decreasing HDL. This suggests the hypothesis that CHD patients who have a higher risk for CHD, or those who have diabetes or obesity or a decreased HDL, may benefit from additional platelet inhibiting medications.

Macrolides in the treatment of asthma and cystic fibrosis

Asthma and cystic fibrosis are two respiratory diseases characterized by chronic inflammation, leading to remodelling of the airways. Macrolides are widely used antibiotics, with a peculiar anti-inflammatory effect. On the basis of the methodologies used by the Cochrane collaboration, this review discusses the evidence for their long-term use as anti-inflammatory agents in these two diseases. Three randomized-controlled trials (RCTs) were identified for both asthma and cystic fibrosis. A positive effect of macrolides on reducing eosinophil numbers and markers of eosinophilic inflammation was demonstrated in patients with asthma. Data on cystic fibrosis demonstrated an effect on lung function with an increase of 5.4% in forced vital capacity (FVC) in patients treated with macrolide vs. placebo, but without a significant effect on FEV1. Side-effects were rare, mild and reversible on withdrawal of treatment. Although preliminary data from small studies are promising, the role of macrolides in the treatment of these chronic disorders needs to be more firmly established with larger, well-designed trials, targeted to investigate major clinical outcomes.

PARTICIPANT AND PHYSICIAN SATISFACTION WITH A WORKSITE CARDIOVASCULAR RISK REDUCTION PROGRAM. 11

Purpose: Participant and physician satisfaction is critical to the success of worksite health promotion programs. The Health Education and Risk Reduction Training Program is a cardiovascular risk reduction program (CRR) designed to identify persons at high risk for clinical cardiac events (CCE) and provide nurse-based CRR through lifestyle modification and medical management for one year. Methods: Worksite employees, retirees, and retiree spouses were asked to complete a Cardiovascular Risk Assessment (CRA). Persons identified at increased risk for CCE were invited to a clinic screen. Those at highest risk were enrolled in the program. Participants were evaluated and counseled every 3-4 months and referred to their primary care physician (PCP) for medical management as needed. Evaluation results were sent to PCPs. 82% of participants (258) and 20% of PCPs (41) completed a satisfaction survey at one year. Results: 95% of participant responders rated overall satisfaction as satisfied or very satisfied. 180 reported confident or very confident they could maintain behavioral changes. Of 114 who reported they had been advised to see their PCP for elevated cholesterol, 43 (38%) reported a treatment change. Similarly, of 29 with increased fasting blood sugar, 13 (45%) reported a change, and of 44 with elevated blood pressure, 22 (50%) reported a change. 90% of PCP responders were satisfied or very satisfied with accuracy, clarity and timeliness of participant progress letters and reports. 74% reported they would recommend the program to other patients, 65% reported program participants had greater knowledge regarding risk factors compared to patients not in the program, and 42% reported their exposure to the program was helpful in providing preventive care to other patients. Conclusions: Overall, participant responders were satisfied and many made behavior changes as a result of the program. PCP responders found the Program beneficial to their patients and their practice.

Antihypertensive Effect and Tolerability of Perindopril in Indian Hypertensive and Type 2 Diabetic Patients

This study compared the antihypertensive effect and acceptability of a perindopril-based group with that of an atenolol-based group in Indian hypertensive type 2 (non-insulin-dependent) diabetic patients. 100 ambulant patients aged between 35 and 69 years were recruited into this monocentric, randomised, double-blind study in two parallel groups for 1 year after a 1-month washout period on placebo. The setting was a tertiary care institution. All patients had stable, essential hypertension between 95mm Hg and 115mm Hg, type 2 diabetes with glycosylated haemoglobin (HbA(1C)) <12%, and albuminuria between 300mg and 3.5g/24 hours. There were 50 patients per treatment group and two patient population groups were studied, intention-to-treat (ITT) and per-protocol (PP). The former constituted all patients, whilst the latter included those without major protocol deviation and who completed the 12-month study. The study drugs were perindopril 4 to 8mg once daily or atenolol 50 to 100mg once daily. In each group therapeutic adjustment was planned by doubling the dose and then by the addition of hydrochlorothiazide 25mg daily. Nifedipine 30 to 60mg daily was subsequently added if the desired drop in blood pressure was not obtained. The ITT group was analysed by Student's t-test, and a 2-way analysis of variance was performed for the PP population. A comparison of the control of hypertension, biochemical abnormalities, blood sugar and adverse effects was performed in the atenolol group versus the perindopril group. On single-dose therapy after 1 month 17 patients (60%) had normal blood pressure [diastolic blood pressure (DBP) </=90mm Hg] on atenolol 50mg daily, while 13% (30.23%) had normal blood pressure (DBP </=90mm Hg) on perindopril 4mg daily (p = 0.013). In the ITT group the sitting systolic blood pressure (SBP) decreased by 14.4 +/- 22.3mm Hg at the end of the treatment period on atenolol from 174.4 +/- 17.9mm Hg at the initial period, and the sitting SBP decreased by 21.6 +/- 20.3mm Hg at the end of perindopril treatment from an initial value of 172.1 +/- 20.3mm Hg (probability 0.091). The sitting DBP decreased by 18.6 +/- 8.7mm Hg on atenolol from 100.5 +/- 4.8mm Hg at the initial period and by 15.8 +/- 9.1mm Hg on perindopril from 100.6 +/- 5.2mm Hg (probability 0.112). Glycaemic control was similar for HbA(1C) fasting and postprandial glucose in the ITT population, while fasting glucose increased over time from 10.7 +/- 4.1 to 12.0 +/- 3.4 mmol/L; p < 0.001 in the PP population in the atenolol group. The percentage of normalised patients (sitting DBP </=90mm Hg) was similar in both groups. Patients on perindopril monotherapy required more additional antihypertensive drugs compared with atenolol monotherapy. There was a significant increase in fasting blood sugar in the atenolol-based group (p < 0.001).