Inflammation In Diabetic Patients Research Articles

DIABETES MELLITUS AND ITS IMPACT ON THE STATE OF THE ORAL CAVITY IN CHILDREN

Today, the number of people with diabetes is growing in all age groups both in our country and around the world. Diabetes is one of the most serious diseases in terms of its course and complications. It is known that diabetes destroys all types of metabolism, changes cellular and humoral immunity, is characterized by persistent hemorrhagic and neuromodulatory disorders, and slows down regenerative and reparative processes. The development of diabetic complications is associated with hyperglycemia and pathological changes in the vascular and peripheral nervous system. Studies by Ukrainian and foreign scientists have repeatedly shown that the child's body is an integral system and that endocrine disorders are accompanied by changes in various organs and systems, including the dentition. Although periodontal tissues are the main affected organ, other dental lesions, such as caries, inflammatory and infectious diseases of the oral mucosa and salivary glands. They are more common in diabetic patients than in children without somatic lesions. The first and most common symptoms in diabetic patients are dry mouth (xerostomia) and dry lips due to dehydration with polyuria, which is especially noticeable in children with worsening diabetes. Inflammatory periodontal diseases and inflammatory-dystrophic periodontal diseases occupy a special place among the symptoms of diabetes in the oral cavity in diabetic children. Vascular damage is of prime importance in the development of periodontal tissue inflammation in diabetic patients. Microangiopathy in diabetes mellitus enhances the process of bone resorption. The analysis of scientific material shows that there are significant pathological changes in the oral cavity of children with diabetes mellitus, which increase the dynamics of the disease and worsen its course. Therefore, the planning of dental treatment of patients with diabetes at each clinical stage should be based on a clear understanding of all etiological relationships, manifestations of various forms of diabetes in the oral cavity and their relationship with the corrected state of carbohydrate metabolism. A literature search was conducted using the databases Web of Science, Scopus, The Cochrane Library, MedLine, EMBASE and Global Health.

Correlation Between Hemoglobin A1c (HbA1c) and High-Sensitivity C-Reactive Protein (hs-CRP) in Myocardial Infarction Patients and Their Six-Month Mortality Follow-Up.

Background Acute coronary syndrome (ACS), encompassing unstable angina (UA), non-ST-elevation myocardial infarction (NSTEMI), and ST-elevation myocardial infarction (STEMI), poses significant global health challenges because of its associated high mortality and morbidity rates. Vascular inflammation plays a crucial role in the pathogenesis of atherosclerosis, and it is often assessed using biomarkers such as high-sensitivity C-reactive protein (hs-CRP). Hyperglycemia, common in myocardial infarction patients, is linked to increased complications and mortality, with glycosylated hemoglobin A1c (HbA1c) serving as a key indicator of long-term glycemic control. Objective This study investigates the correlation between hs-CRP and HbA1c levels in patients with acute myocardial infarction (AMI) and type 2 diabetes mellitus (T2DM) and evaluates their impact on six-monthmortality outcomes. Methods A prospective observational study was conducted with 80 patients diagnosed with AMI. Data collection included demographic information, medical history, clinical assessments, laboratory investigations (including hs-CRP and HbA1c levels), and imaging studies. Patients received standard treatment and were followed up for six months. Statistical analyses were performed to examine the relationships between hs-CRP, HbA1c, and clinical outcomes. Results Higher HbA1c levels at admission were significantly correlated with elevated hs-CRP levels (p < 0.05). Both biomarkers showed a reduction at six months, correlating with improved glycemic control and reduced inflammation. Each unit increase in HbA1c was associated with a 21% increase in the hazard of mortality, and, similarly, each unit increase in hs-CRP was associated with a 17% increase in the hazard of mortality. The positive correlation between HbA1c and hs-CRP suggests that HbA1c can serve as an independent marker for predictingmortality in this patient population. Conclusion The study demonstrates a significant correlation between hs-CRP and HbA1c levels in patients with AMI and T2DM, with both biomarkers serving as strong predictors of six-monthmortality. HbA1c, because of its positive correlation with hs-CRP, could be used as an independent marker for assessing the risk of adverse outcomes in these patients. These findings highlight the importance of managing both glycemic control and inflammation in diabetic patients with ACSs.

Effects of melatonin supplementation on markers of inflammation and oxidative stress in patients with diabetes: A systematic review and meta-analysis of randomized controlled trials

Background & aimsDiabetes mellitus is a metabolic disorder, in which chronic systemic inflammation and oxidative stress contribute to the progression of this condition and its complications. Melatonin, a hormone known for its potent antioxidant and anti-inflammatory properties, has emerged as a potential therapeutic intervention in diabetes. This review aims to evaluate the effects of melatonin supplementation on markers of oxidative stress and inflammation in diabetic patients. MethodsA thorough literature search of databases, including PubMed, Embase, Web of Science, Cochrane Central, CNKI, and Scopus, was conducted through October 2023. We included randomized controlled trials investigating the effects of melatonin on markers of inflammation and oxidative stress, compared to placebo in patients with diabetes. The data was analyzed using the random-effects model and the summary effect size was determined using the standardized mean difference (SMD) with 95% confidence interval (CI). ResultsFourteen studies with 823 participants were included. Our analysis indicates that melatonin can lead to significant reductions in levels of C-reactive protein (CRP) [SMD = -0.75; 95% CI: -1.37, -0.12; P = 0.018], tumor necrosis factor-alpha (TNF-α) [SMD = -0.40; 95% CI: -0.64, -0.15; P = 0.001], interleukin (IL)-1 [SMD = -0.75; 95% CI: -1.03, -0.47; P < 0.0001], IL-6 [SMD = -0.79; 95% CI: -1.07, -0.51; P < 0.0001], and malondialdehyde (MDA) [SMD = -0.61; 95% CI: -0.80, -0.43; P < 0.0001]. Furthermore, we found a significant increase in levels of total antioxidant capacity (TAC) [SMD = 0.81; 95% CI: 0.12, 1.51; P = 0.021], glutathione (GSH) [SMD = 0.66; 95% CI: 0.28, 1.03; P = 0.001], and superoxide dismutase (SOD) [SMD = 1.69; 95% CI: 0.80, 2.58; P < 0.0001] following melatonin consumption in patients with diabetes. ConclusionMelatonin supplementation is a promising complementary strategy to attenuate oxidative stress and inflammation in diabetic patients.

Innovative Bio-based Hydrogel Microspheres Micro-Cage for Neutrophil Extracellular Traps Scavenging in Diabetic Wound Healing.

Neutrophil extracellular traps (NETs) seriously impede diabetic wound healing. The disruption or scavenging of NETs using deoxyribonuclease (DNase) or cationic nanoparticles has been limited by liberating trapped bacteria, short half-life, or potential cytotoxicity. In this study, a positive correlation between the NETs level in diabetic wound exudation and the severity of wound inflammation in diabetic patients is established. Novel NETs scavenging bio-based hydrogel microspheres 'micro-cage', termed mPDA-PEI@GelMA, is engineered by integrating methylacrylyl gelatin (GelMA) hydrogel microspheres with cationic polyethyleneimine (PEI)-functionalized mesoporous polydopamine (mPDA). This unique 'micro-cage' construct is designed to non-contact scavenge of NETs between nanoparticles and the diabetic wound surface, minimizing biological toxicity and ensuring high biosafety. NETs are introduced into 'micro-cage' along with wound exudation, and cationic mPDA-PEI immobilizes them inside the 'micro-cage' through a strong binding affinity to the cfDNA web structure. The findings demonstrate that mPDA-PEI@GelMA effectively mitigates pro-inflammatory responses associated with diabetic wounds by scavenging NETs both in vivo and in vitro. This work introduces a novel nanoparticle non-contact NETs scavenging strategy to enhance diabetic wound healing processes, with potential benefits in clinical applications.

Relationship between Platelet Index and Lipid Metabolism, Coagulation Function, and Inflammation in Diabetic Patients.

Platelets are overactive in type 2 diabetes mellitus (T2DM). This study analyzed the relationship between platelet index and lipid metabolism, coagulation function, and inflammation in T2DM patients. This study enrolled 60 T2DM patients and 60 healthy subjects (age- and gender-matched). Mean platelet volume (MPV) and platelet distribution width (PDW) were evaluated, and their associations with lipid metabolism (TG and HDL-C), coagulation function (vWF and PAI-1), and inflammation (IL-6 and TNF-α) were analyzed. T2DM patients had increased MPV and PDW. Furthermore, the platelet index was correlated with the levels of TG, HDL-C, vWF, PAI-1, IL-6, and TNF-α. MPV and PDW are increased in T2DM patients. Moreover, platelet index was associated with lipid metabolism disorder, coagulation dysfunction, and inflammatory response in T2DM patients.

Problems of applying inflammatory markers to diagnostics of anemia of chronic disease in patients with type 1 and type 2 diabetes

The purpose of the study was to evaluate the severity of changes in the values of markers-candidates for the differential diagnosis of anemia of chronic diseases in patients with type 1 and type 2 diabetes mellitus. The total number of leukocytes, erythrocyte sedimentation rate, content of C-reactive protein, TNFa, ferritin and hepcidin were evaluated. 50 people with type 1 diabetes mellitus and 81 people with type 2 diabetes mellitus were examined. The diagnosis of anemia was established on the basis of data on the level of hemoglobin, the content of erythrocytes in the blood, ferritin and serum iron. Next, the type of anemic syndrome was determined. The patients were divided into groups: 14 patients with diabetes mellitus and anemia of chronic diseases, 15 people with diabetes mellitus and iron deficiency anemia, 38 patients with diabetes with latent iron deficiency and 64 patients with diabetes mellitus without anemia. The comparison group consisted of 17 healthy volunteers. It was shown that in the general sample of patients with diabetes mellitus anemia of chronic diseases was distinguished only by the erythrocyte sedimentation rate, which was higher than in iron deficiency anemia, latent iron deficiency and in patients without anemia. The severity of inflammation in diabetic patients was analyzed depending on its type. The concentration of hepcidin in the blood of diabetic patients, regardless of type, exceeded its content in the blood of healthy individuals. Elevated serum concentrations of TNFα were characteristic of inflammation in type 1 diabetes mellitus. Diabetes mellitus type 2 was characterized by an increase in: erythrocyte sedimentation rate - relatively healthy individuals; concentrations of C-reactive protein - in comparison with healthy volunteers and patients with type 1 diabetes mellitus; ferritin levels compared with patients with type 1 diabetes mellitus. Taking into account the type of diabetes and the type of iron metabolism disorder, it was found that in type 1 and type 2 diabetes mellitus, only the erythrocyte sedimentation rate in patients with anemia of chronic diseases was significantly higher than in patients with iron deficiency anemia and without anemia. The article discusses the reasons for the difficulties in using inflammatory markers (ferritin and hepcidin) as parameters for verifying anemia of chronic diseases in patients with diabetes mellitus. It is pointed out that it is necessary to take into account the differences in the mechanisms of inflammation development in type 1 or type 2 diabetes mellitus when trying to use cytokines and C-reactive protein as additional diagnostic markers in practice. The rationale is given for the prospects of determining the erythrocyte sedimentation rate, with the recommendation of a certain threshold value, for the detection of anemia of chronic diseases in patients with type 1 and type 2 diabetes mellitus.

Effect of empagliflozin use on monocyte high-density lipoprotein ratio and plasma atherogenic index in obese and non-obese type 2 diabetic patients.

Diabetes mellitus (DM) is a metabolic disorder marked by hyperglycemia, caused by impaired insulin secretion and activity. Chronic inflammation holds a significant role in the development, progression, and complications of DM and obesity. There are publications reporting that the monocyte/ high-density lipoprotein (HDL)-C ratio (MHR) and plasma atherogenic index (PAI) could be used as indicators of systemic inflammation. In the present study, we aimed to explore the effect of empagliflozin, an inhibitor of sodium-glucose co-transporter 2 (SGLT2), on MHR and PAI in obese and non-obese type 2 diabetes mellitus (T2DM) patients. A total of 125 patients who presented to the outpatient clinics of Tokat Gaziosmanpasa University Hospital between January 2019 and January 2023 with a diagnosis of T2DM and were started on 25 mg empagliflozin and used for a minimum of 24 weeks were included in the study. The patients' age varied between 18-75 years, were without chronic liver disease, chronic renal failure, infection, or inflammatory disease, and were not on drugs affecting bone marrow. The patients were categorized into two groups, obese and non-obese, according to their body mass index (BMI). The data obtained were statistically analyzed using the IBM SPSS Statistics 25 software package. The mean age of the patients was 57.5 ± 10.9 years. Of the patients, 59.2% (n = 74) were female, and 40.8% (n = 51) were male. The mean HbA1c percentage was 8.99 ± 2.18% prior to empagliflozin treatment and significantly decreased to 7.68 ± 1.80% after empagliflozin use (p < 0.05). The mean monocyte HDL-C ratio (MHR) pre- and post-empagliflozin treatment was 16.22 ± 6.31 and 13.77 ± 5.29, respectively, and these values significantly differed from each other (p < 0.05). The mean plasma atherogenic index (PAI) of the patients before empagliflozin treatment was 0.62 ± 0.28, whereas, after the treatment, it significantly reduced to 0.52 ± 0.27 (p < 0.05). While MHR and PAI statistically significantly decreased with the use of empagliflozin, there was no difference between the obese and non-obese patient groups in terms of MHR and PAI results. Studies in the literature show that the decrease in MHR and PAI leads to a decline in inflammation. MHR and PAI are inexpensive and practical markers to assess cardiovascular disease risk and inflammation in diabetic patients. This finding indicates that MHR and PAI can be used as inflammation markers in patients on empagliflozin treatment.

Single-Dose Treatment with Rapamycin Preserves Post-Ischemic Cardiac Function through Attenuation of Fibrosis and Inflammation in Diabetic Rabbit.

Robust activation of mTOR (mammalian target of rapamycin) signaling in diabetes exacerbates myocardial injury following lethal ischemia due to accelerated cardiomyocyte death with cardiac remodeling and inflammatory responses. We examined the effect of rapamycin (RAPA, mTOR inhibitor) on cardiac remodeling and inflammation following myocardial ischemia/reperfusion (I/R) injury in diabetic rabbits. Diabetic rabbits (DM) were subjected to 45 min of ischemia and 10 days of reperfusion by inflating/deflating a previously implanted hydraulic balloon occluder. RAPA (0.25 mg/kg, i.v.) or DMSO (vehicle) was infused 5 min before the onset of reperfusion. Post-I/R left ventricular (LV) function was assessed by echocardiography and fibrosis was evaluated by picrosirius red staining. Treatment with RAPA preserved LV ejection fraction and reduced fibrosis. Immunoblot and real-time PCR revealed that RAPA treatment inhibited several fibrosis markers (TGF-β, Galectin-3, MYH, p-SMAD). Furthermore, immunofluorescence staining revealed the attenuation of post-I/R NLRP3-inflammasome formation with RAPA treatment as shown by reduced aggregation of apoptosis speck-like protein with a caspase recruitment domain and active-form of caspase-1 in cardiomyocytes. In conclusion, our study suggests that acute reperfusion therapy with RAPA may be a viable strategy to preserve cardiac function with the alleviation of adverse post-infarct myocardial remodeling and inflammation in diabetic patients.

Correlation between Serum Vitamin D Levels, COVID-19 Severity, and Inflammation in Diabetic Patients: A Retrospective Study

Correlation between Serum Vitamin D Levels, COVID-19 Severity, and Inflammation in Diabetic Patients: A Retrospective Study

A Study of Carotid Doppler and Highly Specific C Reactive Protein in Type II Diabetes Mellitus and Its Correlation with Macrovascular Complications

Background: Diabetes has a multitude of macrovascular complications, one of them being Carotid artery Atherosclerosis leading to stenosis and predisposing patient to Stroke. A hypothesis put forward is the presence of low-grade inflammation in Diabetic patients, which may enhance atherosclerosis. A study was planned to assess Carotid artery stenosis and HsCRP levels in Diabetic patients, so as to identify at risk group and take measures to prevent complications such as stroke and ischemic heart disease.&#x0D; Aim: To study the patients by clinical parameters, ultrasound carotid doppler study, and estimation of HsCRP with patients of type II DM.&#x0D; Study Design: Cross sectional observational study.&#x0D; Place and Duration of Study: Study was conducted at Department of General Medicine, Dr D Y Patil Medical College, Pune from July 2019 – September 2021.&#x0D; Methodology: The study included 50 subjects with type 2 DM (as per inclusion and exclusion criterion). All participants were explained the nature of the study and after informed consent all subjects were clinically examined and were subjected to carotid artery doppler and HsCRP levels.&#x0D; Results: In our study 16% had carotid stenosis of &lt;50% while 8% had &gt;50%. However, 42% had increased intima-media thickness. On the other hand, 52% subjects had raised HsCRP levels.&#x0D; Conclusion: In our study, Carotid Stenosis and impending stenosis was seen in significant number of Diabetic patients of more than 5 years duration, who also had higher HsCRP levels.

Hydralazine attenuates renal inflammation in diabetic rats with ischemia/reperfusion acute kidney injury

Acute kidney injury (AKI) is one of the major complications with increased oxidative stress and inflammation in diabetic patients. Hyperglycemia stimulates the formation of advanced glycation end products (AGEs). However, hyperglycemia directly triggers the interaction between AGEs and transmembrane AGEs receptors (RAGE), which enhances oxidative stress and increases the production of inflammatory substances. Therefore, diabetes plays a pivotal role in kidney injury. Hydralazine, a vasodilator and antihypertensive drug, was found to have the ability to reduce ROS, oxidative stress, and inflammation. We applied Hydralazine co-culture with AGEs in rat mesangial cells (RMC) and to renal ischemia/reperfusion(I/R) injury models in streptozotocin-induced diabetic rats. Hydralazine significantly decreased AGEs-induced RAGE, iNOS, and COX-2 expressions in RMC. Compared to the diabetic with AKI group, hydralazine decreased inflammation-related protein, and JAK2, STAT3 signaling in rat kidney tissue. Our studies indicate that Hydralazine has the potential to become a beneficial drug in the treatment of diabetic acute kidney injury.

Effects of Non-Surgical Periodontal Treatment on Reactive Oxygen Metabolites and Glycemic Control in Diabetic Patients with Chronic Periodontitis.

Periodontal infection may contribute to poor glycemic control and systemic inflammation in diabetic patients. The aim of the present study is to evaluate the efficacy of non-surgical periodontal treatment in diabetic patients by measuring oxidative stress outcomes. Sixty diabetic patients with periodontitis were enrolled, treated with scaling and full-mouth disinfection, and randomly prescribed chlorhexidine mouthwash, antioxidant mouthwash, or ozone therapy. Reactive oxygen metabolites (ROMs), periodontal parameters, and glycated hemoglobin were measured at baseline and then at 1, 3, and 6 months after. At baseline, all patients presented with pathologic levels of plasmatic ROM (388 ± 21.36 U CARR), higher than the normal population. Probing depth, plaque index, and bleeding on probing values showed significant clinical improvements after treatment, accompanied by significant reductions of plasma ROM levels (p < 0.05). At the 6-month evaluation, the mean ROM relapsed to 332 ± 31.76 U CARR. Glycated hemoglobin decreased significantly (∆ = −0.52 units) after treatment. Both the test groups showed longer-lasting improvements of periodontal parameters. In diabetic patients, periodontal treatment was effective at reducing plasma ROM, which is an indicator of systemic oxidative stress and inflammation. The treatment of periodontal infection might facilitate glycemic control and decrease systemic inflammation.

PPAR\u03b3 activation improves the microenvironment of perivascular adipose tissue and attenuates aortic stiffening in obesity

BackgroundObesity-related cardiovascular risk, end points, and mortality are strongly related to arterial stiffening. Current therapeutic approaches for arterial stiffening are not focused on direct targeting within the vessel. Perivascular adipose tissue (PVAT) surrounding the artery has been shown to modulate vascular function and inflammation. Peroxisome proliferator-activated receptor γ (PPARγ) activation significantly decreases arterial stiffness and inflammation in diabetic patients with coronary artery disease. Thus, we hypothesized that PPARγ activation alters the PVAT microenvironment, thereby creating a favorable environment for the attenuation of arterial stiffening in obesity.MethodsObese ob/ob mice were used to investigate the effect of PPARγ activation on the attenuation of arterial stiffening. Various cell types, including macrophages, fibroblasts, adipocytes, and vascular smooth muscle cells, were used to test the inhibitory effect of pioglitazone, a PPARγ agonist, on the expression of elastolytic enzymes.ResultsPPARγ activation by pioglitazone effectively attenuated arterial stiffening in ob/ob mice. This beneficial effect was not associated with the repartitioning of fat from or changes in the browning of the PVAT depot but was strongly related to improvement of the PVAT microenvironment, as evidenced by reduction in the expression of pro-inflammatory and pro-oxidative factors. Pioglitazone treatment attenuated obesity-induced elastin fiber fragmentation and elastolytic activity and ameliorated the obesity-induced upregulation of cathepsin S and metalloproteinase 12, predominantly in the PVAT. In vitro, pioglitazone downregulated Ctss and Mmp12 in macrophages, fibroblasts, and adipocytes—cell types residing within the adventitia and PVAT. Ultimately, several PPARγ binding sites were found in Ctss and Mmp12 in Raw 264.7 and 3T3-L1 cells, suggesting a direct regulatory mechanism by which PPARγ activation repressed the expression of Ctss and Mmp-12 in macrophages and fibroblasts.ConclusionsPPARγ activation attenuated obesity-induced arterial stiffening and reduced the inflammatory and oxidative status of PVAT. The improvement of the PVAT microenvironment further contributed to the amelioration of elastin fiber fragmentation, elastolytic activity, and upregulated expression of Ctss and Mmp12. Our data highlight the PVAT microenvironment as an important target against arterial stiffening in obesity and provide a novel strategy for the potential clinical use of PPARγ agonists as a therapeutic against arterial stiffness through modulation of PVAT function.

The effect of non-surgical periodontal therapy on glycemic control and C1-reactive protein levels among type 2 diabetic patients with periodontitis: A clinical trial

It suggests that non-surgical periodontal therapy without systemic antibiotic therapy may not achieve a significant improvement in glycemic control and systemic inflammation in diabetic patients. However, it is important to highlight that the decision of whether or not to use antibiotics to treat periodontitis. Thus this study aimed to evaluate over 3 months the consequence of non-surgical periodontal treatment without systemic antibiotic therapy on serum levels of HbA1c and C-reactive protein (CRP). Forty-two participants with type 2 diabetes mellitus (DM) and moderate periodontal disease were randomized into intervention (IG) and control (CG) groups. The IG received non-surgical periodontal therapy in the form of full-mouth scaling and root planing. Participants were followed up for 3 months. The CG received non-surgical periodontal therapy after 3 months. Clinical parameters, including plaque index (PI), gingival bleeding index (GBI), probing pocket depth (PPD), clinical attachment level (CAL), and HbA1c and CRP levels, of all patients were recorded at baseline and after 3 months. A p-value less than 0.05 considered significant. At the end of 3 months, IG showed improvement in all the clinical parameters compared to CG. There were no significant differences in HbA1c and CRP after 3 months when compared to the baseline level in both groups. Clinical parameters were significantly improved by the employment of non-surgical periodontal treatment without systemic antibiotic therapy, but HbA1C and CRP levels were not significantly affected.

Anemia profile in Diabetic patients with preserved renal function

Background: Diabetes is one of the largest global health emergencies of the 21st century. Prevalence of anemia in diabetic patients is two to three times higher than for patients with comparable renal impairment and iron stores in the general population.&#x0D; Aims and Objective: This study was done to analyse the prevalence of anemia and its profile in patients with preserved renal function.&#x0D; Materials and Methods: One-hundred diabetic patients with anemia with normal renal functions were selected. Complete blood count, peripheral blood smear, iron studies, vitamin B12 levels were assessed. Diabetic control was monitored by HbA1c. Patients were identified to have specific type of anemia, based on iron profile and vitamin B12 levels. Severity of anemia was also assessed. Appropriate statistical tests were applied to analyse the results.&#x0D; Results: Mean age of subjects in the study group was 53.4±13.6 years. The mean haemoglobin level was 9.41±2.18 g/dl. Out of the 100 cases, 43 patients had iron deficiency anemia, 40 patients had anemia of inflammation, and 8 patients had vitamin B12 deficiency, 8 patients had combined iron and vitamin B12 deficiency, and 1 patient had pancytopenia. Mean HbA1c was higher in iron deficient individuals with a significant p value and mean HbA1c was lower in Vitamin B12 deficient individuals. Among the cases, 16% had mild anemia, 61% had moderate anemia, and 23% had severe anemia. Severe anemia had a significantly lower HbA1c, which was statistically significant.&#x0D; Conclusion: According to our study, iron deficiency anemia was the commonest, followed by anemia of inflammation in diabetic patients with preserved renal function. Diabetes being a pro-inflammatory state had a higher incidence of anemia of inflammation compared to general population. We have to identify and acknowledge the higher prevalence of Anemia of Inflammation in diabetic patients in the absence of renal dysfunction.

Effects of Intra-vitreal Injection of Bevacizumab as an Adjunct during Phacoemulsification in Diabetic Maculopathy

Purpose: To study the effects of Intra-vitreal injection of Bevacizumab as an adjunct during phacoemulsification in patients with diabetic retinopathy.&#x0D; Study Design: Quasi experimental study.&#x0D; Methods: Hundred diabetic patients who were scheduled to undergo phacoemulsification were included in the study. They were equally divided into two groups; Bevacizumab and control group. Complete ocular examination and macular thickness and volume were determined using an OPTOVUE-OCT machine. The patients in the Bevacizumab group were given intra-vitreal injection of 1.25 mg/0.05ml of Bevacizumab at the time of Phacoemulsification. A written ethical approval was obtained and the study was conducted according to principles of declaration of Helsinki.&#x0D; Results: The bevacizumab group manifested low value of CMT one month post-surgery as compared to the control group (262.2 ± 32.2 and 288.5 ± 54.1, respectively) with P = 0.01. The Total Macular volume, and Best-corrected visual acuity in the two groups showed no significant difference one month after surgery. Amongst the patients who developed postsurgical macular edema, four patients did not possess a positive history for diabetic retinopathy and 3 of them had Non Proliferative Diabetic Retinopathy. We found no significant relationship between the post-surgical macula edema with the presence of mild Non Proliferative Diabetic Retinopathy. (Fisher's test, P = 0.321).&#x0D; Conclusion: The ocular anti-VEGF therapy substantially reduces macular edema secondary to post-surgical inflammation in diabetic patients. It effectively reduces the central macular thickness although the results are not found to be statistically significant when compared with the control group.&#x0D; Key Words: Diabetes mellitus; diabetic macular edema; diabetic retinopathy: Bevacizumab.

The Correlation between Hemoglobin A1c (HbA1c) and Hyperreflective Dots (HRD) in Diabetic Patients.

Hyperreflective dots (HRD) are activated retinal microglial cells induced by retinal inflammation in diabetic patients. This study was conducted to compare the HRD count of normal and diabetic subjects; to determine the correlation between hemoglobin A1c (HbA1c) levels and HRD count; to determine HbA1c cut-off levels for the appearance of HRD in diabetic patients. A cross-sectional study was conducted among normal and diabetic patients. Fundus photos, SD-OCT images and HbA1c levels were taken. A total of 25 normal subjects, 32 diabetics without retinopathy and 26 mild-to-moderate nonproliferative diabetic retinopathy (NPDR) diabetics were recruited. There was a statistically significant difference between the mean count of HRD among the normal group, the diabetic without retinopathy group and the mild-to-moderate NPRD group. The mean HRD count in the inner retina layer was significantly higher compared to the outer retina layer. There was a significant linear relationship between the HbA1c levels and HRD count. Using the receiver operating curve, the HbA1c level of 5.4% was chosen as the cut-off point for the appearance of HRD. The positive linear correlation between the HbA1c levels and the appearance of HRD may indicate that hyperglycemia could activate retina microglial cells in diabetic patients.

Pre- Probiyotikler ve Diyabet

Diabetes Mellitus, son 10 yılda prevalansı dünya çapında ciddi artış gösteren bir halk sağlığı sorunudur. Çeşitli nedenlere bağlı olarak ortaya çıkan diyabetin patogenezinde yetersiz fiziksel aktivite ve yanlış beslenme alışkanlıklarını içeren olumsuz yaşam tarzı değişikliklerine bağlı olarak meydana gelen insulin direnci ile genetik faktörlerin önemli rol oynadığı kabul gören yaygın görüşler arasındadır. Ancak son yıllarda çevresel faktörlerin de diyabet patogenezindeki etkisini gösteren kanıtlar ortaya çıkmıştır. Bu faktörlerden en çok üzerinde durulan ise mikrobiyotadır. Yürütülen çalışmalarla da mikrobiyotadaki değişen bakteri dengesinin; bağırsak geçirgenliğinde artışa, kanda Glukagon Benzeri Peptid-1 ve Glukagon Benzeri Peptid-2’nin azalmasına ve endotoksin artışına neden olduğu gösterilmiştir. Bu hormonal değişiklikler ve endotoksemi ise hedef organlarda lipogenez, yağ kütlesi, inflamasyon ve makrofaj inflitrasyonunda artış; insülin duyarlılığı, beta hücre kütlesi ve plazma insülin düzeyinde ise azalmaya neden olarak diyabetin ortaya çıkmasına katkıda bulunmaktadır. Diyabetin önüne geçebilmek ya da komplikasyonlarının oluşumunu engelleyebilmek için bağırsak mikrobiyotasında meydana gelen değişikliklerin eski haline getirilmesi ise temel amaçtır. Mikrobiyotayı düzenlemek için esas olan beslenmedir ve son yıllarda yapılan çalışmalarla prebiyotik ve probiyotik müdahaleleri ile bağırsak florasının eski haline getirilebileceği belirtilmektedir. Prebiyotikler ve probiyotiklerin diyabetik hastalarda inflamasyonu azaltmada, kan lipit profilini optimal seviyelerde tutmada, kilo kontrolünü sağlamada, antioksidan savunmayı düzeltmede, insülin duyarlılığını ve pankreas β-hücre fonksiyonlarını iyileştirerek kan şekeri regülasyonunu sağlamada etkili olduğu gösterilmiştir.

Quantitative Proteomics Reveals Differences in the Response of Neutrophils Isolated from Healthy or Diabetic Subjects to Infection with Capsule-Variant Burkholderia thailandensis.

In Thailand, diabetes mellitus is the most significant risk factor for melioidosis, a severe disease caused by Burkholderia pseudomallei. In this study, neutrophils isolated from healthy or diabetic subjects were infected with B. thailandensis E555, a variant strain with a B. pseudomallei-like capsular polysaccharide used here as a surrogate micro-organism for B. pseudomallei. At 2 h post-infection, neutrophil proteins were subjected to 4-plex iTRAQ-based comparative proteomic analysis. A total of 341 proteins were identified in two or more samples, of which several proteins involved in oxidative stress and inflammation were enriched in infected diabetic neutrophils. We validated this finding by demonstrating that infected diabetic neutrophils generated significantly elevated levels of pro-inflammatory cytokines TNFα, IL-6, IL-1β, and IL-17 compared to healthy neutrophils. Our data also revealed that infected neutrophils from healthy or diabetic individuals undergo apoptotic cell death at distinctly different rates, with infected diabetic neutrophils showing a diminished ability to delay apoptosis and an increased likelihood of undergoing a lytic form of cell death, compared to infected neutrophils from healthy individuals. Increased expression of inflammatory proteins by infected neutrophils could contribute to the increased susceptibility to infection and inflammation in diabetic patients in melioidosis-endemic areas.

The Relationship Between Hematological Indices and Inflammation in Diabetic Patients

The Relationship Between Hematological Indices and Inflammation in Diabetic Patients