The prevalence of impaired fasting glucose and type 2 diabetes in a population‐based sample of overweight/obese children in the Middle East

Moadab MH, Kelishadi R, Hashemipour M, Amini M, Poursafa P. The prevalence of impaired fasting glucose and type 2 diabetes in a population‐based sample of overweight/obese children in the Middle East. Background: Type 2 diabetes mellitus (T2DM) and impaired fasting glucose (IFG) are increasing in young population who are facing an escalating trend of overweight. The aim of this study was to determine the prevalence of IFG and T2DM for the first time in a population‐based sample of Iranian obese children. Methods: This cross‐sectional, population‐based study was conducted in Isfahan, the second large city of Iran. Overall, 672 overweight and obese school students, selected from 7554 students, aged 6–19 yr, were screened for IFG and T2DM. Fasting plasma glucose (FPG) and lipid profile were measured in all participants. Oral glucose tolerance test and insulin level were measured in those children with IFG. Insulin resistance was defined as homeostasis model assessment for insulin resistance (HOMA‐IR) > 3.10. Results: Among the7554 students (48.7% boys and 51.3% girls) studied, 9.34% (n = 706) were overweight and 5.3% (n = 403) were obese. A number of 672 overweight and obese students including 302 (44.9%) boys and 370 (55.1%) girls, with a mean age of 12.8 ± 3.10 yr underwent biochemical work up. Overall, the prevalence of IFG was 4.61% (n = 31), the corresponding figure was 2% (n = 4) in the 6–10 yr age group, and 5% (n = 27) in those aged 10.1–19 yr. The prevalence of T2DM was 0.1% (n = 1; age, 18.00 yr). Impaired glucose tolerance and insulin resistance were detected in three and six participants with IFG, who consisted 0.4 and 0.8% of total obese and overweight students, respectively. Conclusions: Although the prevalence of T2DM is low in Iranian obese children, IFG is not uncommon. Preventive measures and screening of FPG should be considered for these children.     

Air pollution, platelet activation and atherosclerosis

Atherosclerosis begins in early life. The role of platelets is well-documented from its early stages. A wealth of evidence associates atherosclerotic cardiovascular disease with inflammatory diseases. The role of environmental factors, including air pollution, remains overlooked. Some studies have documented the effect of air pollution on inflammatory and pro-thrombotic factors implicated in the progression of cardiovascular diseases. In particular, the increase of platelet count and platelet hyper-reactivity towards agonists are emerging as markers of hematologic and hemostatic changes in response to the exposure to air pollutants. The systemic pro-inflammatory and pro-thrombotic response to the inhalation of fine and ultrafine particulate matters is seemingly associated with platelet activation. This association may have a clinical significance, particularly in the presence of cardiometabolic risk factors, and may indicate the need for anti-platelet treatment. It is of particular relevance to further study the significance of platelet activation and anti-platelet therapies in primordial/primary preventive measures in children and adolescents at risk of accelerated atherosclerosis.     

Foot gangrene in patients with end-stage renal disease: a case control study

The prevalence of peripheral arterial disease (PAD) in patients with end-stage renal disease (ESRD) is high, with an annual risk of amputation estimated at 13%, and indications for limb revascularization in patients combining ESRD with stage IV PAD (foot gangrene) are still controversial. This case-controlled study compared survival, limb salvage, and quality of life in a group of patients hospitalized for foot gangrene according to their renal status (ESRD versus no renal insufficiency). All patients with ESRD hospitalized for foot gangrene (n = 16) from 1996 to 2002 were compared with a control group with normal creatininemia (n = 24) hospitalized for foot gangrene due to peripheral atherosclerotic arterial disease. The 2 groups were matched for age, sex ratio, and number with diabetes mellitus. After a mean follow-up of 467 +/-410 days, patients with ESRD had a more severe prognosis as regards mortality (68.7% vs 12.5%, p = 0.0005) and major amputation (31% versus 8%, p = 0.09). The ESRD group was characterized by more frequent extensive arterial calcifications (16/16 vs 13/24, p = 0.002), owing to a higher level of the calcium phosphorus product (3.54 +/-1.2 vs 2.4 +/-0.6, p = 0.0023), and by impaired microcirculatory perfusion, as indicated by a lower oxygen pressure (TcPO(2)) (15.6 +/-12 mm Hg vs 26 +/-16, p = 0.07). ESRD implies a poor prognosis in patients with stage IV peripheral arterial disease.     

Efficacy of duloxetine and gabapentin in pain reduction in patients with knee osteoarthritis

Clinical Rheumatology - Knee osteoarthritis (OA) is a common form of arthritis in elders which can lead to reduced daily activity and quality of life. It is important to administer a proper...     

Growth Ring Orientation Effects in Transverse Softwood Fracture

In this study, the fracture mechanics of eastern spruce were characterized in relation to end-grain orientation. Compact tension-type specimens with small pre-formed cracks were prepared such that grain angle varied relative to the load axis. Specimens were loaded under crack mouth opening displacement (CMOD) control as to maintain stable crack growth. Specimen fracture was characterized using both R-curve and bulk fracture energy approaches. The results showed that under a RT grain orientation, as well as grain deviations up to about 40∘, cracks will follow a path of least resistance in an earlywood region. As the grain angle exceeds 40∘, the crack will initially move macroscopically in the direction of maximum strain energy release rate, which extends in the direction of the pre-crack, but locally meanders through earlywood and latewood regions before settling once again in an earlywood region. At 45∘, however, the macroscopic crack takes a turn and follows a straight radial path. The results further show that RT fracture is macroscopically stable, while TR fracture is unstable. None of the end-grain fracture orientations showed rising R-curve behavior, suggesting that there is not a traditional fracture process zone in this orientation.     

Air pollution and non-respiratory health hazards for children

Air pollution is a global health issue with serious public health implications, particularly for children. Usually respiratory effects of air pollutants are considered, but this review highlights the importance of non-respiratory health hazards. In addition to short-term effects, exposure to criteria air pollutants from early life might be associated with low birth weight, increase in oxidative stress and endothelial dysfunction, which in turn might have long-term effects on chronic non-communicable diseases. In view of the emerging epidemic of chronic disease in low- and middle- income countries, the vicious cycle of rapid urbanization and increasing levels of air pollution, public health and regulatory policies for air quality protection should be integrated into the main priorities of the primary health care system and into the educational curriculum of health professionals.     

The effect of nutraceuticals on multiple signaling pathways in cardiac fibrosis injury and repair

Heart Failure Reviews - Cardiac fibrosis is one of the most common pathological conditions caused by different heart diseases, including myocardial infarction and diabetic cardiomyopathy....     

The Inclusion of a Matrix Metalloproteinase-9 Responsive Sequence in Self-assembled Peptide-based Brain-Targeting Nanoparticles Improves the Efficiency of Nanoparticles Crossing the Blood-Brain Barrier at Elevated MMP-9 Levels

This study investigated whether the inclusion of a matrix metalloproteinase-9 (MMP-9) responsive sequence in self-assembled peptide-based brain-targeting nanoparticles (NPs) would enhance the blood-brain barrier (BBB) penetration when MMP-9 levels are elevated both in the brain and blood circulation. Brain-targeting peptides were conjugated at the N-terminus to MMP-9-responsive peptides, and these were conjugated at the N-terminus to lipid moiety (cholesteryl chloroformate or palmitic acid). Two constructs did not have MMP-9-responsive peptides. NPs were characterised for size, charge, critical micelle concentration, toxicity, blood compatibility, neural cell uptake, release profiles, and in vitro BBB permeability simulating normal or elevated MMP-9 levels. The inclusion of MMP-9-sensitive sequences did not improve the release of a model drug in the presence of active MMP-9 from NPs compared to distilled water. ¹⁹F NMR studies suggested the burial of MMP-9-sensitive sequences inside the NPs making them inaccessible to MMP-9. Only cholesterol-GGGCKAPETALC (responsive to MMP-9) NPs showed <5% haemolysis, <1 pg/mL release of IL-1β at 500 μg/mL from THP1 cells, with 70.75 ± 5.78% of NPs crossing the BBB at 24 h in presence of active MMP-9. In conclusion, brain-targeting NPs showed higher transport across the BBB model when MMP-9 levels were elevated and the brain-targeting ligand was responsive to MMP-9.     

Swellable elementary osmotic pump (SEOP): an effective device for delivery of poorly water-soluble drugs.

A new type of elementary osmotic pump (EOP) tablet for efficient delivery of poorly water-soluble/practically insoluble drugs has been designed. Drug release from the system, called swellable elementary osmotic pump (SEOP), is through a delivery orifice in the form of a very fine dispersion ready for dissolution and absorption. SEOP tablets were prepared by compressing the mixture of micronized drug and excipients into convex tablets. Factors affecting the release of drug from the SEOP tablets containing a poorly water-soluble drug, indomethacin, have been explored. The release behaviour of indomethacin from different formulations of this dosage form was studied at pH 6.8 for a period of 24h. The formulations were compared based on four comparative parameters, namely, D(24h) (total release after 24h), t(L) (lag time), RSQ(zero) (R square of zero order equation) and D%(zero) (percentage deviation from zero order kinetics). The drug release profile from osmotic devices showed that the type of polymer in the core formulation can markedly affect the drug release. The results showed that concentration of wetting agent in the core formulation was a very important parameter in D(24h) and release pattern of indomethacin from SEOP system. Increasing the amount of wetting agent to an optimum level (60mg) significantly increased D(24h) and improved zero order release pattern of indomethacin. Increasing concentration of caster oil (hydrophobic) in the semipermeable membrane of the device or hydrophilic plasticizer (glycerin) in coating formulation markedly increased t(L) and decreased D(24h). The results also demonstrated that aperture size is a critical parameter and should be optimized for each SEOP system. Optimum aperture diameter for the formulations studied here was determined to be 650microm for zero order release pattern. t(L) and D%(zero) were dramatically decreased whereas D(24h) and RSQ(zero) increased with increasing the aperture size to optimum level. This study also revealed that optimization of semipermeable membrane thickness is very important for approaching zero order kinetics.