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The Influence of Hyperglycemia on the Outcome of Diabetic Pregnancies

Abstract

At the beginning of the last century, the association between diabetes mellitus and pregnancy was credited with a high risk of complications and mortality. However, nowadays, such issue no longer bears such a pessimistic approach. Planning the pregnancy during a period of optimal metabolic control and careful monitoring of the pregnant woman significantly reduces maternal and fetal mortality. The most important aspects of fetal pathology are: intrauterine fetal death, congenital malformations, growing disorders (macrosomia or delays in growing), neonatal hypoglycemia, respiratory distress syndrome, hypertrophic cardiomyopathy etc. The fetus’s viability is significantly impacted if a quality maternal glycemic control is not obtained at least 3 months prior to birth, as well as throughout the entire pregnancy term (particularly during the first 10 weeks, term during which organogenesis is completed). This systematic review of scientific literature aims to summarize the pathogenic ways in which hyperglycemia may influence the fetus of women with Diabetes Mellitus.

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Macrosomia. A Systematic Review of Recent Literature

Abstract

Background and aims: The obesity and overweight rate among women of childbearing age and fetal macrosomia associated with different birth injuries are very frequent all over the world and with an increasing incidence. The huge amount of published literature on this topic in the last decade is putting the practioners in a very challenging position. Material and method: We have done a systematic review on the recent literature (last five years) based on science direct database. Results: A total of 5990 articles were identified and after successive exclusion of some of them, 48 were deeply analyzed. The results were grouped in following topics: risk factors for fetal macrosomia, the pathophysiology of macrosomia, prenatal clinical and lab diagnosis and prevention of macrosomia. Conclusions: Considering the maternal, fetal and neonatal complications of macrosomia, the counseling, and monitoring of the pregnant women risk group are of particular importance for adopting a low calorie / low glycemic diet and avoiding a sedentary behaviour. Long-term follow-up of the mother and the macrosomic baby is required because of the risk of obesity, diabetes, hypertension, and metabolic syndrome later in life.

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Maturity Onset Diabetes of the Young – An Overview of Common Types. A Review

Abstract

Background and aims: Maturity Onset diabetes in Young (MODY) is an autosomal dominant disease and according to an estimate, the MODY cases are 2% of all the diabetic cases. The objective was to review the common types of MODY reported in literature in context to their geographical areas. Material and method: For literature search, PubMed data base was used. The key word was “Maturity onset diabetes of the young”. The articles were reviewed by titles and if found relevant, the abstract and full article (if available) were retrieved. The studies that were published in English, presented original data and describe type of MODY were included. The information related to author, year of publication and type of MODY was extracted in excel sheet. Results: A total of 1135 studies resulted which were reviewed, and 206 articles were finally selected. The studies were grouped according to the regions i.e. Asia, Europe, America, Africa and Australia & Oceania. The MODY 2 was most prevalent in regions i.e. Asia, Europe, America and Australia & Oceania followed by MODY 3. When analysed according to countries, MODY 2 was found prevalent in India, Korea, UK, Italy, Spain, Czech Republic, Canada and Brazil while MODY 3 was common in Japan, China, France Norway and Germany. Conclusion: The MODY 2 was most common. The data from south Asian countries including Pakistan is lacking. As there is a huge burden of diabetes in the country so there is a dire need to do large scale studies on MODY in the country.

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Subclinical Diastolic Dysfunction and Its Correlation with Laboratory Parameters in Type 2 Diabetes Mellitus in India: A Case Control Study

Abstract

Background: This study was conducted to evaluate left ventricular dysfunction in diabetics and to find correlation with glycemic control and biochemical parameters compared to non-diabetic population. Methods: Thirty type 2 diabetics and thirty nondiabetic controls were recruited. Age, sex, body mass index of the controls were matched. Results: Mean duration of diabetes mellitus in study population was 10.97± 4.01years. Among study population both cases and controls had ejection fraction >55%( no systolic dysfunction). Among cases(n=16) 53.3% were having mean E/A ratio <1 and(n=14) 46.67% were had mean E/A ratio >1. In controls all of them had mean E/A ratio above 1. This difference of mean E/A ratio among cases and controls was statistically significant (p<0.001). Among patients with diabetes, 9.09% cases with a HbA1cbetween 6-7%, 33.33% between 7.1-8%, respectively 100% of cases with HbA1c>8.1% had diastolic dysfunction the differences between groups being statistically significant (p<0.001). Low density lipoprotein( LDL) was weakly and negative correlated with E/A ratio (r = - 0.38) while fasting blood sugar (r = -0.53) respectively Hemoglobin A1c (r = -0.66) were moderately and negatively correlated. All these correlations were statistically significant. Conclusion: Subclinical diastolic dysfunction is prevalent among diabetic population. Diastolic dysfunction in patients with diabetes was correlated with FBS, HbA1C and LDL.

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Age Dependent Effects of Metformin in Wistar Albino Male Rats with Metabolic Syndrome

Abstract

Background and aims: Comparative estimation of metformin treatment effectiveness in adult and young rats with metabolic syndrome (MS).

Materials and methods: A metabolic syndrome model was induced by full replacement of drinking water with 20% fructose solution in Wistar albino male rats of two age categories (young animals of 21 days age (50-70g) and adults (160-180g)). After 60 days of MS modelling and metformin treatment, hematological, biochemical, blood pressure, chromatin DNA fragmentation investigations, as well as morphological macroscopic and microscopic studies were carried out.

Results: In young rats, effects of metformin on blood clotting time, lipid metabolism and DNA fragmentation were more pronounced. Mature rats showed greater susceptibility to this drug as for influence on pancreas and visceral fat relative weights.

Conclusions: In our experiment with young and adult rats with MS and metformin treatment we showed that this preparation effect was age-dependent for lipid metabolism indices, blood clotting time, nuclear DNA fragmentation parameters, as well as for changes of relative organs weights and target organs morphological structure. Metformin treatment allowed a partial normalization of serum levels of lowdensity lipoproteins (LDLP) and ratio high lowdensity lipoproteins / lowdensity lipoproteins (HDLP/LDLP), hemoglobin contents, hematocrit percentage, DNA fragmentation rates, with simultaneous worsening in blood clotting time, blood pressure levels, liver and pancreas relative organs weights (of young rats).

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Carcinogenic Substances Naturrally Occuring in the Human Diet

Abstract

Oncogenesis is a result of the combined action of numerous factors peculiar to the body and the environment (the latter are more effective). Among dietary factors directly implied in the occurrence of malignant tumors we can mention: food additives, contaminated food, polycyclic aromatic hydrocarbons, nitrosamines and some components which are naturally present in food. Moreover, food-related malignancies are a consequence of the increased consumption of fats, proteins, alcohol in parallel with decreases in the consumption of dietary fibers and some micronutrients. Carcinogenic substances naturally present in food are of a particular interest for both nutritionist’s and patient’s, usually not being perceived as being harmful.

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The Effect of Tempeh Gembus Variations to Serum Levels of High Sensitivity C-Reactive Protein (hsCRP) and Serum Levels of Fibrinogen of Sprague Dawley Rats with Aterogenic Diet

Abstract

Background and aims: Cardiovascular diseases are widespread and causes many deaths in the world. The concentration of acute phase protein: C-reactive protein (CRP) and fibrinogen will rise dramatically when inflammation happens, which that can be used as an early marker of cardiovascular disease risk. Tempeh gembus contains fiber, unsaturated fatty acids and isoflavones are believed to reduce the inflammatory reaction. The aim of the study was to determinate the effect of tempeh gembus variations to levels of hcCRP and levels of fibrinogen of Sprague Dawley rats with atherogenic diet.

Material and methods: This study was quasi-experimental with posttest only randomized control group design using 35 Sprague Dawley mice. The rats were randomized into 5 groups: negative control group given the standard diet, the positive control group given standard diet and atherogenic diet, and three treatment groups were given the standard diet, atherogenic diet and variation of tempeh gembus (tempeh gembus, heated tempeh gembus and tempeh gembus with bromelain enzyme) for 28 days. Serum levels of hsCRP and fibrinogen examined using ELISA (Enzyme-linked Immunosorbent Assay).

Results and conclusions: The administration of tempeh gembus with bromelain enzyme is the most effective treatment for hsCRP serum level indicated a significant difference (p=0.028) between the negative control group, positive control group and first group with the third group. Fibrinogen serum levels showed significant differences in all treatment groups (p =0.042), administration of tempeh gembus with bromelain enzyme is the most effective treatment is shown by a significant difference between the negative control group and the positive control group with third group. The administration of tempeh gembus with bromelain enzyme for 28 days can reduce the serum levels of hsCRP and fibrinogen on rats significantly.

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Evaluation of Cognitive Function in Patients with Type 2 Diabetes and Overt Hypothyroidism

Abstract

Background and Aims. Previous studies report the presence of cognitive impairment in patients with overt hypothyroidism. The thyroid hormones are essential for neurological and intellectual functions. Type 2 diabetes mellitus (T2DM) subjects are exposed to higher risk of cognitive function alteration compared to nondiabetic subjects. The aim of the present study was to analyze the cognitive function of T2DM subjects with overt hypothyroidism.

Materials and Methods. We performed an observational study between 2015-2017. A total of 12 patients (11 women and 1 men) with overt hypothyroidism and T2DM were recruited for this study. Their cognitive function was compared with that of subjects of a control group (16 patients - 12 women and 4 men with T2DM but without overt hypothyroidism). Cognitive function was evaluated using the Mini Mental State Examination (MMSE) test. Serum thyroid stimulating hormone (TSH) levels were measured by immunoradiometric assay, free thyroxine (FT4) by radioimmunoassay while fasting plasma glucose (FPG) levels were evaluated using automated devices.

Results. There were no significant differences between the two groups in respect of age and FPG. In the study group, mean TSH and FT4 levels were 11.76±4.43 mIU/L, resepectively 0.53±0.08 ng/dL while in the control group these were 2.60±0.40 mIU/L, respectively 1.12±0.19 ng/dL (p<0.001). Moderate cognitive impairment was present in 3 patients of the study group (25.00%) and in 2 subjects from the control group (12.50%). Mild cognitive impairment was present in 4 patients (33.33%) of the study group and in 2 subjects from the control group (12.50%).

Conclusion. This study showed that MMSE scores are significantly reduced in subjects with T2DM and hypothyroidism compared to subjects with T2DM without hypothyroidism (p<0.004). The study revealed a negative correlation between TSH and MMSE score in the study group.

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Goat Milk Kefir Supplemented with Porang Glucomannan Improves Lipid Profile and Haematological Parameter in Rat Fed High Fat and High Fructose Diet

Abstract

Background and Aims: Diet with a high fat and high sugar is associated with an increased incindence of the metabolic syndrome. Kefir has been known as a natural probiotic, while glucomannan from porang (Amorphophallus oncophyllus) tuber was demonstrated as prebiotic in vivo. Probiotics and prebiotics can be used adjuvant nutritional therapy for metabolic syndrome. The aim of this study was to evaluate the effect of goat milk kefir supplemented with porang glucomannan on the lipid profile and haematological parameters in rats fed with a high-fat/high-fructose (HFHF) diet.

Materials and methods: Rats were divided into 5 groups: normal diet; HFHF; HFHF + kefir; HFHF + kefir + glucomannan; and HFHF + simvastatin.

Results: There were significant differences before and after treatment in triglycerides and total cholesterol in HFHF + kefir+glucomannan group. The HFHF rats administered kefir with or without glucomannan had higher levels of lymphocytes and lower neutrophils compared to HFHF group (p<0.05). Only goat milk kefir without glucomannan proved to reduce platelets number.

Conclusion: Goat milk kefir supplemented with porang glucomannan could improve the health of rats fed high-fat/high-fructose, by decreasing plasma triglycerides, total cholesterol, and their immunomodulatory effect by decreasing number of neutrophils and increasing the lymphocytes. Especially for goat milk kefir had antithrombotic activity which important to prevent cardiovascular diseases.

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Impact of Dietary, Socioeconomic, and Physical Factors on Obese and Overweight Schoolchildren Living in Sidi-Bel-Abbes (West of Algeria) and Ain Defla (Centre)

Abstract

Background and aims: The aim of the current study was to assess the impact of environmental factors; food, socio-economic, and physical activity, on a group of obese children living in Ain-Defla (Center Algeria) and Sidi-Bel-Abbes (West Algeria).

Material and methods: The protocol was carried out on a cohort of 125 school children aged of 5 to 11 years, including 64 boys and 61 girls, and 139 school children, including 93 boys and 46 girls in Ain Defla and Sidi-Bel-Abbes respectively. Concerning the classification of obesity and overweight, we referred to the International Obesity Task Force and the French References' curves.

Results: Regarding dietary intake our results showed that 34% of students from both regions took their breakfast, compared to 66% who did not take. Furthermore, 73% of students skipped at least one meal, however 23% respected meals frequency i.e. 4 meals a day. Regarding socio-economic factors and physical activity, our findings showed that obesity rates were high (36%) among children whose fathers are workers. However, for mothers who are housewives, obesity increases among their children (88%). The relationship was reversed between the parents' education level and the Body Mass Index. We found an opposite relationship between Body Mass Index and physical activity, and investigated children use screen devices for long time periods.

Conclusions: Our study showed a positive relationship between obesity and overweight and environmental factors.

Open access