Levels In Non-diabetic Patients Research Articles

Vitamin D level is associated with severity of coronary artery atherosclerosis and incidence of acute coronary syndromes in non-diabetic cardiac patients

IntroductionIschaemic heart disease is the main cause of death in developed countries. There are many modifiable risk factors associated with coronary heart disease (CAD). A growing number of studies point to vitamin D deficiency as a risk factor for heart attacks and the conditions associated with cardiovascular disease. This study aimed to analyse the relationship between the level of 25-hydroxyvitamin D (25(OH)D) and the severity of coronary artery atherosclerosis and to study 25(OH)D levels in non-diabetic patients hospitalised due to acute coronary syndrome and those diagnosed with stable CAD.Material and methodsoronary angiography was performed prospectively in 410 successive cardiac patients. The severity of coronary artery atherosclerosis was assessed according to the Coronary Artery Surgery Study Score (CASSS). The plasma 25(OH)D level was assessed with the electrochemiluminescence method.ResultsThe 25(OH)D level proved to be one of the significant determinants of the CASSS (p < 0.05). In subjects without significant lesions in the coronary arteries the 25(OH)D level was significantly higher compared to patients with one- to three-vessel coronary atherosclerosis (p < 0.05). A significantly higher 25(OH)D level was noted in patients diagnosed with stable CAD compared to patients hospitalised due to acute coronary syndrome (p < 0.01).ConclusionsPatients with one- to three-vessel atherosclerosis have a significantly lower 25(OH)D level compared to patients without significant lesions in the coronary arteries. A lower 25(OH)D level was observed in patients hospitalised due to acute coronary syndrome compared to patients diagnosed with stable CAD.

General Lack of Correlations between Age and Signs of the Metabolic Syndrome in Subjects with Non-diabetic Fasting Glucose Values

ABSTRACTBackground: Insulin resistance and advancing age are well-recognized risk factors for metabolic syndrome. Recent reports indicate that fasting glucose levels in non-diabetic patients correlate appropriately with the development of certain elements in metabolic syndrome, which suggest a cause–effect relationship with insulin resistance.Objective: The present investigation assessed whether a significant association exists between chronological age and various elements of metabolic syndrome in this same group of subjects possessing non-diabetic fasting glucose levels.Methods: Baseline data were taken from 288 subjects (age 17–87 years) with fasting glucose levels ≤ 125 mg/dl. Correlations between chronological age and different metabolic parameters were assessed to determine any statistically significant relationships and compare these with previously demonstrated metabolic parameters.Results: With the exception of systolic blood pressure, the following correlations between age and components of metabolic syndrome were not significant or even significant in the opposite direction compared to those found in the same population using fasting glucose as the independent variable: body weight, body fat, diastolic blood pressure, white blood cell count (WBC)/neutrophil count, and circulating levels of insulin, high-density lipoprotein (HDL) cholesterol, triglycerides, high-sensitivity C-reactive protein (hs-CRP), alanine aminotransferase (ALT), and aspartate aminotransferase (AST). Although systolic blood pressure still increased, it was to a lesser extent than might be expected.Conclusions: In the present investigation, a cross-sectional analysis was carried out over a wide age range of subjects. It is noteworthy that fasting glucose levels and the other major elements of metabolic syndrome did not change significantly with advancing age. These results demonstrate that decreasing insulin resistance and fasting glucose levels may be an important way to overcome the adverse effects and perturbations of advancing age-induced consequences of metabolic syndrome.

The Role of Sleeve Gastrectomy on Preventing Type 2 Diabetes Mellitus.

AIM:To investigate the effect of bariatric surgery on HbA1c and serum cortisol levels in morbidly obese patients without type 2 diabetes mellitus.MATERIALS AND METHODS:Twenty-nine patients who underwent sleeve gastrectomy and whose body mass index was> 40 were included in the present study. Patients’ files were reviewed retrospectively. Those with diabetes mellitus and those with age <18 were excluded from the study. Pre-operative and 1-year post operative data were documented. The obtained data were analysed by SPSS statistical program.RESULTS:The mean age of the patients was 27.4 ± 8.4. 5 of the patients were male, and 24 were female. The mean body mass index of the patients was 44 ± 2.3. 1 patient [3.4%] had hypertension. Four patients [13.7%] had gastroesophageal reflux disease. The number of smokers was 7 [24.1%], and the number of alcohol users was 3 [10.3%]. There was a statistically significant decrease in HbA1c, body mass index values after operation [p value <0.01], but cortisol was not different [p value = 0.72].CONCLUSION:In this present study we found that bariatric surgery caused a significant decrease in HbA1c levels in non-diabetic patients, suggesting that bariatric surgery may prevent Type 2 Diabetes Mellitus in obese patients.

A Cross-sectional Observational Analysis of Preoperative Blood Glucose Levels in Nondiabetic Patients presenting for Surgery

ABSTRACT Introduction Abnormal blood glucose levels alter the course and result of surgery. This study aims to quantify the incidence of hypoglycemia or hyperglycemia in the preoperative period and to assess the impact of duration of nil per os (NPO), age, intravenous fluids (IVFs), blood transfusion, severity of pain and anxiety, and steroid or antibiotic administration on preoperative blood glucose levels in nondiabetic patients. Materials and methods The NPO duration, age, IVF, blood transfusion, pain and anxiety score, steroid and antibiotic administration were noted in 1,000 nondiabetic patients presenting for both elective and emergency surgery. Blood glucose level was measured before induction of anesthesia by capillary finger-prick method. The values of blood glucose levels were analyzed for correlation with above-mentioned parameters. Results Overall incidence of hypoglycemia was found to be 23.3%. About 27.2% of patients including 34.95% children posted for elective surgery and 33.37% of patients including 8.73% children posted for emergency surgery group were hypoglycemic. The incidence of hyperglycemia was 1.51 and 1.08% for adults in elective and emergency category respectively. Age showed widely varied association to preoperative blood glucose levels; blood glucose levels increased with age in male patients, with patients aged between 18 and 40 years admitted for emergency surgery (p = 0.006), but decreased with age in patients older than 60 years irrespective of gender and type of surgery (p = 0.014). The preoperative blood glucose levels increased with higher preoperative pain and anxiety (p = 0.05) and administration of steroids (p = 0.00043). Similarly, with increase in duration of NPO, preoperative blood glucose levels decreased in adult females (p = 0.000) and males over 40 years (p = 0.049), both admitted for emergency surgery. Only preoperative normal saline (NS; p = 0.001), 6% hydroxyethyl starch (HES; p = 0.043), Isolyte P (p = 0.000), and blood transfusion (p = 0.05) showed significant correlation. Conclusion Preoperative blood glucose monitoring is recommended mandatorily for all patients posted for emergency surgery. It is also recommended for elective pediatric and geriatric surgery patients, patients with high anxiety and/or pain, increased NPO duration, and preoperative administration of steroid, NS, 6% HES, or blood. How to cite this article Pattajoshi S, Nerurkar AA, Tendolkar BA. A Cross-sectional Observational Analysis of Preoperative Blood Glucose Levels in Nondiabetic Patients presenting for Surgery. Res Inno in Anesth 2017;2(2):29-33.

Impact of different intravenous fluids on blood glucose levels in nondiabetic patients undergoing elective major noncardiac surgeries.

Background:Intravenous (IV) fluids are an integral part of perioperative management. Intraoperative hyperglycemia is associated with poor clinical outcomes in patients undergoing major surgeries even in nondiabetics.Aim:This study was conducted to observe the effect of different maintenance fluid regimens on intraoperative blood glucose levels in nondiabetic patients undergoing major surgeries under general anesthesia.Settings and Design:Randomized double-blind study.Materials and Methods:One hundred nondiabetic patients of either sex were divided randomly into two Groups I and II of 50 each undergoing elective major surgeries of more than 90 min duration under general anesthesia. Both groups were given calculated dosage of IV fluids accordingly 4-2-1 formula while Group I was given Ringer lactate (RL) and Group II was given 0.45% dextrose normal saline and potassium chloride 20 mmol/L. Changes in vital parameters, % oxygen saturation, and urine output were monitored at regular intervals. Capillary blood glucose (CBG) was measured half-hourly until end of surgery. If CBG level was more than 150 mg%, then calculated dose of human insulin (CBG/100) was given as IV bolus dose.Statistical Analysis:Statistical analysis was done using SPSS 22.0 software (IBM Corporation, Armonk, New York, USA), paired t-test and Chi-square test.Results:A significant increase of CBG level and was observed during intraoperative and immediate postoperative period (P < 0.001) in Group II.Conclusion:RL solution is probably the alternative choice of IV fluid for perioperative maintenance and can be used as replacement fluid in nondiabetic patients undergoing major surgeries.

Effect of hydroxyethyl starch on blood glucose levels.

BackgroundHydroxyethyl starch (HES), a commonly used resuscitation fluid, has the property to induce hyperglycemia as it contains large ethyl starch, which can be metabolized to produce glucose. We evaluated the effect of 6% HES-130 on the blood glucose levels in non-diabetic patients undergoing surgery under spinal anesthesia.MethodsPatients scheduled to undergo elective lower limb surgery were enrolled. Fifty-eight patients were divided into two groups according to the type of the main intravascular fluid used before spinal anesthesia (Group LR: lactated Ringer's solution, n = 30 vs. Group HES: 6% hydroxyethyl starch 130/0.4, n = 28). Blood glucose levels were measured at the following time points: 0 (baseline), 20 min (T1), 1 h (T2), 2 h (T3), 4 h (T4), and 6 h (T6).ResultsMean blood glucose levels at T5 in the LR group and T4, T5 in the HES group, increased significantly compared to baseline. There were no significant changes in the serial differences of mean blood glucose levels from baseline between the two groups.ConclusionsAdministration of 6% HES-130 increased blood glucose levels within the physiologic limits, but the degree of glucose increase was not greater than that caused by administration of lactated Ringer's solution. In conclusion, we did not find evidence that 6% HES-130 induces hyperglycemia in non-diabetic patients.

Distinct roles of urinary liver-type fatty acid-binding protein in non-diabetic patients with anemia.

BackgroundVarious stresses including ischemia are known to up-regulate renal L-FABP gene expression and increase the urinary excretion of L-FABP. In diabetic patients with anemia, the urinary excretion of L-FABP is significantly increased. We studied the clinical significance of urinary L-FABP and its relationship with anemia in non-diabetic patients.Subjects and MethodsA total of 156 patients were studied in this retrospective cross-sectional analysis. The associations between anemia and urinary L-FABP levels, and the predictors of urinary L-FABP levels in non-diabetic patients were evaluated.ResultsUrinary L-FABP levels were significantly higher in patients with anemia compared to those in patients without anemia. Similarly, the urinary L-FABP levels were significantly higher in patients with albuminuria compared to those in patients without albuminuria. Urinary L-FABP levels correlated with urinary albumin-to-creatinine ratios, estimated glomerular filtration rates, body mass index, and hemoglobin levels. Multivariate linear regression analysis determined that hemoglobin levels (β = -0.249, P = 0.001) and urinary albumin-to-creatinine ratios (β = 0.349, P < 0.001) were significant predictors of urinary L-FABP levels.ConclusionsUrinary L-FABP is strongly associated with anemia in non-diabetic patients.

Comparative Effect of Atorvastatin and Rosuvastatin on 25-hydroxy-Vitamin D Levels in Non-diabetic Patients with Dyslipidaemia: A Prospective Randomized Open-label Pilot Study.

Aims: Low 25-hydroxy-vitamin D [25(ΟΗ)D] levels have been associated with increased risk for cardiovascular disease. Conflicting data exist regarding the effect of statins on [25(OH)D] levels. The aim of this study was to compare the effect of atorvastatin and rosuvastatin on 25(OH)D levels in non-diabetic patients with dyslipidaemia.Methods: This was a prospective randomized open-label study. Patients were assigned to atorvastatin 20 mg⁄day (n=28, age: 56.1±2.2 years, 22 females) or rosuvastatin 10 mg⁄day (n=24, age: 57.4±1.9 years, 20 females). Total cholesterol (TC), low- (LDL-C) and high-density lipoprotein cholesterol (HDL-C), triglycerides (TG), fasting plasma glucose, insulin, glycosylated haemoglobin A1c (HbA1c) and high sensitivity C-reactive protein (hsCRP) levels were measured, and homeostatic model of assessment insulin resistance (HOMA-IR) was calculated at baseline and 12 weeks post-treatment. Results: There were no within or between group significant differences in 25(OH)D levels (atorvastatin: 21.7±1.9 ng/ml at baseline and 23.5±2.3 ng/ml at week 12; rosuvastatin: 25.3±1.8 and 27.0±2.4 ng/ml, respectively; p=0.172 and p=0.306 for between groups, respectively). Both statins significantly reduced TC, TG and LDL-C levels, with a greater LDL-C reduction being observed by rosuvastatin. Conclusion: Atorvastatin and rosuvastatin did not significantly affect 25(OH)D levels in this study.

Distribution of morbidity in diabetic and non-diabetic patients according to intraoperative blood glucose levels in coronary artery bypass greft surgery: our single-center experience of 267 patients

Background: This study aims to investigate the distribution of morbidity in diabetic and non-diabetic patients who were subjected to conservative glycemic control during coronary artery bypass graft (CABG) surgery and to determine the efficacy of this strategy according to currently recommended target intraoperative blood glucose value. Methods: Between April 2009 and April 2011, consecutive 267 CABG patients who were subjected to intraoperative conservative glycemic control with intermittent boluses of insulin during surgery were retrospectively analyzed. The patients were classified as diabetic (n=118) and non-diabetic (n=149) patients. Then, the patients were divided into three subgroups as intraoperative mean blood glucose (MBG) concentration 180 mg/dL (group 3). All recorded perioperative, intraoperative, and postoperative data were compared between diabetic and non-diabetic patients according to their intraoperative blood glucose levels. Results: Among patients enrolled in the study, 44% were diabetic and 51.7% of diabetics and 11.3% of non-diabetics were in group 3. Of all patients, 29% had an intraoperative MBG of >180 mg/dL. Non-diabetic patients in group 3 had higher lactate levels (p=0.005), renal impairment (p=0.04), and mortality rates (p=0.03), compared to other groups and with diabetic patients in same group. The incidence of infectious events was higher in diabetic patients with MBG >180 mg/dL (p=0.037). A low positive correlation between MBG and lactate levels in non-diabetic patients (r=0.20), and between MBG and the length of stay in the intensive care unit in diabetic patients (r=0.25) was found. Conclusion: Our study results demonstrate that intraoperative conservative glycemic control with intermittent boluses of insulin seems not to be sufficient in diabetic patients. Non-diabetic patients with higher lactate levels, renal impairment and mortality rates also necessitate effective glycemic control. Therefore, simple, safe and effective algorithms should be developed for intraoperative glycemic control.

Nutrition-related status and granulation tissue colour of pressure ulcers evaluated by digital image analysis in older patients.

Granulation tissue colour may be an indicator for nutritional assessment in pressure ulcer (PU) care. This study evaluated the relationship between nutritional status, anaemia and diabetes, and granulation tissue colour of PUs by colour analysis of digital photographs in the clinical setting. The cross-sectional study included 42 older patients with 51 full-thickness PUs from 10 institutions. Patient demographics, wound status, nutritional status and dietary intakes were obtained from medical charts. From a wound image, the granulation red index was processed by computer software and the proportion of pixels exceeding the threshold intensity of 80 for the granulation tissue surface (%GRI80) was calculated. Haemoglobin levels were positively associated with %GRI80 levels (p=0.007) in the crude model, but not in the adjusted model (p=0.260). The interaction term between diabetes and protein intake was significantly associated with %GRI80 levels in the adjusted models (p=0.010). At protein intakes of 0.95 g/kg or higher, diabetic wounds exhibited lower %GRI80 levels than non-diabetic wounds (p=0.002). At protein intakes of less than 0.95 g/kg, %GRI80 levels did not differ between diabetic and non-diabetic patients (p=0.247). Protein intakes of 0.95 g/kg or higher were associated with higher %GRI80 levels in non-diabetic patients (p=0.015), but not in diabetic patients (p=0.127). Granulation tissue colour, evaluated by the objective and quantitative analysis of digital photography, is related to haemoglobin level, diabetes and dietary intakes in clinical settings.

The Relationship of the Glycosylated Hemoglobin A1c Levels with the Severity of the Coronary Artery Disease in Non-diabetic Stable Angina Patients

PP-325 We sought to determine the relationship between the severity of the coronary artery disease measured with the Gensini score and the hemoglobin A1c (HbA1c) levels in non-diabetic patients with stable angina pectoris. A total of 93 patients undergoing coronary angiography were included in the

Serum pigment epithelium derived factor levels in non-diabetic patients with acute myocardial infarction

Purpose: Inflammation plays a central role in coronary artery disease. Pigment epithelium derived factor (PEDF), which has been studied widely in ischemia induced retinal neovascularization, demonstrates antiinflammatory and antioxidant properties. PEDF's protective action against atherosclerosis has been demonstrated, however PEDF levels in patients with acute myocardial infarction remain unknown. Methods: The study population consisted of 84 non-diabetic patients who underwent coronary angiography with a clinical diagnosis of coronary artery disease. Of the 84 patients included in the study, diagnosis was ST segment elevation myocardial infarction (STEMI) in 28 patients, nonST segment elevation myocardial infarction (NSTEMI) in 28 patients and stable angina pectoris (SAP) in 28 patients. Serum levels of PEDF were measured with enzyme linked immunosorbant assay method and levels were compared among study groups. Results: Serum levels of PEDF (μg/ml) were significantly lower in patients with acute myocardial infarction compared to SAP patients (19.9±6.3 vs 25.4±7.3, p=0.002). In patients with STEMI, PEDF levels were lower compared to patients with NSTEMI, however there was no statistical significance in the levels of PEDF between STEMI and NSTEMI groups (18.9± vs 20.9±, p=not significant, Figure 1). In logistic regression, current smoking (p=0.03) and lower PEDF levels were independently related to acute myocardial infarction (p=0.02, OR:0.88, 95% confidence interval: 0.81-0.95). ![Figure][1] Figure 1 Conclusion: Compared with patients with SAP, serum levels of PEDF was lower in patients with acute myocardial infarction. Decreased PEDF levels in patients with coronary artery disease, may play a role in the development of an acute myocardial infarction. [1]: pending:yes

Intraoperative blood glucose levels in nondiabetic patients undergoing elective major surgery under general anaesthesia receiving different crystalloid solutions for maintenance fluid.

Context:The study was undertaken to observe the effect of different maintenance-fluid regimen on intraoperative blood glucose levels in non-diabetic patients undergoing elective major non-cardiac surgery under general anesthesia.Aims:To know the intraoperative blood glucose levels.Settings and Design:Prospective randomized parallel group study.Subjects and Methods:Two hundred non-diabetic patients (100 in each group) aged between 18 years and 60 years were enrolled for this prospective randomized parallel group study. Group A patients received Ringer's lactate solution and Group B patients received 0.45% sodium chloride with 5% dextrose and 20 mmol/L potassium chloride as maintenance fluid. Capillary blood glucose (CBG) level was measured immediately before initiation of intravenous fluid therapy and thereafter hourly till the end of surgery. If at any time intraoperative CBG was found to be more than or equal to 150 mg/dL calculated dose of human soluble insulin was given as intravenous bolus equal to the amount of CBG/100 units.Statistical Analysis Used:For comparison of normally distributed variables independent sample t test was done. For rest of the data, i.e., CBG_0, CBG_4 and insulin consumption Mann-Whitney U test was employed.Results:63% patients in group B developed at least one episode of hyperglycemia CBG ≥ 150 mg/dL) but only 29% in the Group A did so. Insulin consumption was significantly higher in Group B than in Group A to maintain normoglycemia. The relative risk of becoming hyperglycemic in Group B patients is 2.172 (95% CI 1.544 to 3.057). Number needed to harm, i.e., hyperglycemia, in Group B is 2.941 (95% CI 2 to 5).Conclusions:We conclude that stress induced-hyperglycemic response in patients undergoing major non-cardiac surgery is common in non-diabetic population. Maintenance-fluid therapy by dextrose containing solution as opposed to Ringer's lactate solution increases the incidence of hyperglycemia. To achieve normoglycemia by intravenous bolus dose of human regular insulin, significantly higher doses are required in patients receiving dextrose containing saline as maintenance fluid.

Effect of Iron Deficiency on Glycation of Haemoglobin in Nondiabetics

Protein glycation is a spontaneous reaction that is believed to play a key role in the pathogenesis of many clinical disorders. The glycation of proteins is enhanced by elevated glucose concentrations. The major form of protein glycation with a clinical consideration is glycated haemoglobin (HbA1c). The HbA1c fraction is abnormally elevated in chronic hyperglycaemic diabetic patients and it correlates positively with the glycaemic control. However, increased glycated haemoglobin levels have been documented in iron de.ciency anaemic patients without any history of diabetes. The aim of this study was to determine the effect of IDA on the HbA1c levels in nondiabetic patients, so as to consider IDA as an important factor which influenced the HbA1c levels, while monitoring the glycaemic status of diabetics. Fifty non-diabetic, anaemic patients and 50 age-matched healthy subjects were enrolled in this study. The patients who had glucose tolerance abnormalities (impaired glucose tolerance or diabetes mellitus), haemoglobinopathies, haemolytic anaemia, infestation, chronic alcohol ingestion and chronic renal failure were excluded from the study. Haematologic investigations were done and the fasting and postprandial glucose and HbA1c levels were measured in all the subjects. The mean HbA1c (7.6 ± 0.5%) level in the patients with IDA was higher than that in the control group (5.5% ± 0.8) (p < 0.001). There were no differences in the levels of fasting and postprandial glucose between the IDA and the control groups (p > 0.05). The haemoglobin, serum ferritin, fasting and postprandial glucose, and the HbA1c levels were normal in the control group (p > 0.05). HbA1c is not affected by the blood sugar levels alone, and there are various confounding factors when HbA1c is measured, especially that of iron de.ciency, which is the commonest of the de.ciency diseases worldwide. It is hence prudent to rule out IDA before making a therapeutic decision, based on the HbA1c levels.

Factors Associated with Increases in Glucose Levels in the Perioperative Period in Non-Diabetic Patients

Background: Blood glucose levels are elevated during the perioperative period as a result of the neuro-endocrine response to the stress of surgery. In nondiabetic patients, blood glucose levels are not a part of routine preoperative testing nor are they monitored during surgery or in the post anesthesia care unit (PACU). We measured blood glucose levels in nondiabetic patients during the perioperative period to identify how many patients had high glucose levels and what factors were associated with increases in blood glucose levels. Methods: This prospective observational study included two hundred and ninety five nondiabetic patients between the ages of 18 and 80 years, undergoing elective noncardiac surgery. Blood glucose levels were measured preoperatively and at frequent, predetermined intervals during surgery and in the PACU. Patient characteristics, surgical and anesthetic factors, and pain scores in the PACU were recorded, as were postoperative complications. Results: Forty nine percent (49%) of the patients had maximum intraoperative glucose levels of 126 mg/dl or higher and fifty three percent (53%) had maximum postoperative glucose levels of 126 mg/dl or higher. Preoperative glucose levels, family history of diabetes and amount of blood loss were statistically significantly associated with both max-intra-op and max-post-op glucose levels. Additionally, blood administration, surgery duration and race were significantly associated with max-intra-op glucose levels, while amount of intravenous fluids and sex were significantly associated with max-post-op glucose levels. Conclusion: A large number of nondiabetic patients in our study had maximum glucose levels >126 mg/dl in the perioperative period. Certain patient characteristics, as well as surgical/anesthetic factors, were associated with increases in the glucose levels. More studies are indicated to determine which patients may benefit from glucose monitoring in the perioperative period.

Diastolic Dysfunction of Aging Is Independent of Myocardial Structure but Associated with Plasma Advanced Glycation End-Product Levels

BackgroundHeart failure is associated with abnormalities of myocardial structure, and plasma levels of the advanced glycation end-product (AGE) Nε-(carboxymethyl)lysine (CML) correlate with the severity and prognosis of heart failure. Aging is associated with diastolic dysfunction and increased risk of heart failure, and we investigated the hypothesis that diastolic dysfunction of aging humans is associated with altered myocardial structure and plasma AGE levels.MethodsWe performed histological analysis of non-ischemic left ventricular myocardial biopsies and measured plasma levels of the AGEs CML and low molecular weight fluorophores (LMWFs) in 26 men undergoing coronary artery bypass graft surgery who had transthoracic echocardiography before surgery. None had previous cardiac surgery, myocardial infarction, atrial fibrillation, or heart failure.ResultsThe patients were aged 43–78 years and increasing age was associated with echocardiographic indices of diastolic dysfunction, with higher mitral Doppler flow velocity A wave (r = 0.50, P = 0.02), lower mitral E/A wave ratio (r = 0.64, P = 0.001), longer mitral valve deceleration time (r = 0.42, P = 0.03) and lower early diastolic peak velocity of the mitral septal annulus, e’ (r = 0.55, P = 0.008). However, neither mitral E/A ratio nor mitral septal e’ was correlated with myocardial total, interstitial or perivascular fibrosis (picrosirius red), immunostaining for collagens I and III, CML, and receptor for AGEs (RAGE), cardiomyocyte width, capillary length density, diffusion radius or arteriolar dimensions. Plasma AGE levels were not associated with age. However, plasma CML levels were associated with E/A ratio (r = 0.44, P = 0.04) and e’ (r = 0.51, P = 0.02) and LMWF levels were associated with E/A ratio (r = 0.49, P = 0.02). Moreover, the mitral E/A ratio remained correlated with plasma LMWF levels in all patients (P = 0.04) and the mitral septal e’ remained correlated with plasma CML levels in non-diabetic patients (P = 0.007) when age was a covariate.ConclusionsDiastolic dysfunction of aging was independent of myocardial structure but was associated with plasma AGE levels.

Glucose disturbances in non-diabetic patients receiving acute treatment with methylprednisolone pulses

Methylprednisolone pulses are used in a variety of disease conditions, both for acute and chronic therapy. Although well tolerated, they increase glucose levels in both non-diabetic and diabetic patients. They may also be considered a significant risk for acute metabolic alterations. The purpose of this report is to determine the metabolic changes in blood glucose levels in non-diabetic patients receiving methylprednisolone pulses and identify the presence of predictive factors for its development. Observational, prospective study in 50 non-diabetic patients receiving 1 g intravenous methylprednisolone pulses for three consecutive days as an indication for diverse autoimmune disorders. Demographic, anthropometric, and metabolic variables were analyzed, and glucose, insulin and C-peptide levels after each steroid pulse were identified. Different variables and the magnitude of hyperglycemia were analyzed using Pearson's correlation. 50 patients were included, predominantly women (66%, n = 33). The average age was 41 ± 14 years with a BMI of 26 ± 3 kg/m². Baseline glucose was 83 ± 10 mg/dL. After each steroid pulse, glucose increased to 140 ± 28, 160 ± 38 and 183 ± 44, respectively (p < 0.001). C-peptide and insulin concentrations increased significantly (p < 0.001). The prevalence of fasting hyperglycemia after each pulse was 68%, 94% and 98%, respectively. We found no correlation between the magnitude of hyperglycemia and the studied variables. Methylprednisolone pulses produced significant increases in fasting glucose in most patients without diabetes. Further studies are needed to define its role in long-term consequences.

Effect of soy protein supplementation in patients with chronic hepatitis C: a randomized clinical trial.

To evaluate the effects of soy supplementation on insulin resistance, fatty liver and alanine aminotransferase (ALT) levels in non-diabetic patients with chronic hepatitis C (CHC). In a prospective, randomized and single-blinded clinical trial, we compared patients with CHC who had casein as a supplement (n = 80) (control group), with patients who consumed a soy supplement diet (n = 80) [intervention group (IG)]. Both groups received 32 g/d of protein for 12 wk. Patients' baseline features showed that 48.1% were overweight, 43.7% had abdominal fat accumulation, 34.7% had hepatic steatosis and 36.3% had an homeostasis model assessment index of insulin resistance (HOMA-IR) ≥ 3.0. Descriptive analysis showed that protein supplementation diet reduced hepatic steatosis in both groups; however, significant reductions in ALT levels occurred in the soy group. Multiple regression modeling indicated that in the presence of severe fibrosis (F3/F4), γ glutamyl transferase elevation and high density lipoprotein (HDL) reduction, the intervention group had 75% less chance of developing hepatic steatosis (OR= 0.25; 95% CI: 0.06-0.82) and 55% less chance of presenting with an ALT level ≥ 1.5 × the upper limit of normal (ULN) (OR = 0.45, 95% CI: 0.22-0.89). Soy treatment did not have any effect on insulin resistance (OR = 1.92; 95% CI: 0.80-4.83), which might be attributed to the fact that the HOMA-IR values at baseline in most of our patients were in the normal range. Advanced hepatic fibrosis, an ALT level > 1.5 × ULN and visceral fat were predictors of an HOMA-IR ≥ 3. The IG group had a reduced risk of an ALT level > 1.5 × ULN. An HOMA-IR ≥ 3.0 and HDL < 35 mg/dL were also risk factors for increased ALT. Soy supplementation decreased ALT levels and thus may improve liver inflammation in hepatitis C virus (HCV) patients; it also reduced hepatic steatosis in a subgroup of patients but did not change insulin resistance. It should be considered in the nutritional care of HCV patients.

The Relationship between the Antioxidant System and Anaemia in Haemodialysis Patients

Anaemia and oxidative stress are common features of chronic kidney disease, and both are associated with an increase in morbidity and mortality. There is growing evidence, from experimental and clinical studies, that oxidative stress may be implicated in the pathogenesis of anaemia. This study investigated the relationship between total antioxidant capacity, anaemia and serum albumin levels in 127 non-diabetic patients requiring haemodialysis. Total serum antioxidant capacity levels were determined and were found to be significantly correlated with levels of haemoglobin, haematocrit, serum albumin, serum total protein, malondialdehyde (a product of lipid peroxidation), potassium, phosphorus and alanine transaminase. There was also a significant correlation between serum albumin levels and haemoglobin and haematocrit levels. In conclusion, total antioxidant capacity was found to be inversely correlated with malondialdehyde levels and positively correlated with haemoglobin and haematocrit levels in non-diabetic patients requiring haemodialysis. Patients with high serum albumin concentrations and high total antioxidant capacity may also have high (i.e. normal) levels of haemoglobin.

Comparative effects of rosuvastatin and atorvastatin on glucose metabolism and adipokine levels in non-diabetic patients with dyslipidaemia: a prospective randomised open-label study

The impact of statins on glucose metabolism and adipokines remains controversial. We compared the effects of rosuvastatin and atorvastatin on glucose homeostasis, insulin sensitivity (IS), adiponectin and leptin levels as well as systemic inflammation in non-diabetic patients with dyslipidaemia. Thirty-six patients were randomly assigned to 10 mg/day of rosuvastatin (n = 18) or 20 mg/day of atorvastatin (n = 18) for 12 weeks. Total cholesterol (TC), low-density lipoprotein cholesterol (LDL-C), high-density lipoprotein cholesterol (HDL-C), non-HDL-C, triglycerides (TG), fasting plasma glucose, insulin, homeostasis model assessment-insulin resistance (HOMA-IR), quantitative IS check index (QUICKI), adiponectin, leptin and high-sensitivity C-reactive protein (hsCRP) were measured at baseline and after 4 and 12 weeks. Both statins significantly lowered TC, LDL-C, non-HDL-C and TG compared with baseline. Only rosuvastatin caused a significant reduction in insulin and HOMA-IR levels (-35%, p = 0.005 and -33%, p = 0.011 respectively) and a significant increase in QUICKI (+11%, p = 0.003) at 12 weeks. In terms of adipokines and hsCRP, no difference was observed after 4 and 12 weeks of treatment with either statin. Rosuvastatin compared with atorvastatin resulted in significant improvements in IS indices. No significant changes in adiponectin, leptin or hsCRP levels were observed at 4 and 12 weeks of treatment with either statin.