Hemodynamic effects of dexmedetomidine--fentanyl vs. nalbuphine--propofol in plastic surgery.

UNLABELLED: Dexmedetomidine has demonstrated to be useful in several clinical fields due to its respiratory safety and cardiovascular stability. We undertook this study to determine its usefulness in plastic surgery. Sixty patients were divided into two parallel groups. A group received dexmedetomidine--fentanyl and the comparison group received nalbuphine--propofol, both with same dose of midazolam. Blood pressure, heart rate and oxygen saturation were determined during the preoperative, intraoperative and recuperation periods. RESULTS: In both groups, hemodynamic constants decreased intraoperatively. Dexmedetomidine--fentanyl decreased more than in the nalbuphine--propofol (systolic blood pressure, p = 0.006; diastolic blood pressure, p = 0.01 and heart rate, p = 0.007). Comparatively, oxygen saturation was greater in the dexmedetomidine--fentanyl group vs. nalbuphine--propofol (p = 0.0001). Recovery time for the nalbuphine--propofol group was shorter than in the dexmedetomidine--fentanyl group (p = 0.0001). CONCLUSIONS: Dexmedetomidine shows the same cardiovascular stability but with absence of respiratory depression.

Effect of thiamine administration on metabolic profile, cytokines and inflammatory markers in drug-naïve patients with type 2 diabetes.

PURPOSE: To evaluate the effect of thiamine administration on metabolic profile, cytokines and inflammatory markers in drug-naïve patients with type 2 diabetes mellitus (T2DM). METHODS: A randomized, double-blind, placebo-controlled, pilot-scale clinical trial was carried out in 24 patients with T2DM. Twelve subjects received thiamine orally (150 mg), once daily during a fasting state for 1 month. An additional 12 patients (control group) were given placebo for the same period of time. Before and after the intervention, fasting glucose, A1C, creatinine, total cholesterol, high-density lipoprotein cholesterol, low-density lipoprotein cholesterol, triglycerides, very low-density lipoprotein, high-sensitive C-reactive protein, interleukin 6, tumor necrosis factor-alpha, leptin and adiponectin levels were estimated. Wilcoxon's signed-rank and Mann-Whitney U test were used for statistical analyses. RESULTS: There were significant decreases in glucose (6.7 ± 1.0 mmol/l vs. 6.0 ± 1.0 mmol/l, p = 0.024) before and after the intervention, respectively, and leptin concentrations (32.9 ± 13.3 ng/ml vs. 26.9 ± 12.8 ng/ml, p = 0.027) before and after the intervention, respectively, with thiamine administration. There were no changes with the rest of the measurements. CONCLUSIONS: Thiamine administration for 1 month decreased glucose and leptin concentrations in drug-naïve patients with T2DM.

Effect of 2 liquid nutritional supplements for diabetes patients on postprandial glucose, insulin secretion, and insulin sensitivity in healthy individuals.

AIM: To compare the effect of 2 liquid nutritional supplements (Enterex Diabetic and Glucerna SR) designed for the patient with diabetes mellitus on postprandial glucose, insulin secretion, and insulin sensitivity in healthy individuals. PATIENTS AND METHODS: A randomized, double-blind, crossover clinical trial was carried out in 14 healthy, young (average age 21.7+/-2.8 years) volunteers. Each individual received a single administration of 232 kcal in 232 mL of Enterex Diabetic or in 237 mL of Glucerna SR. Three days later, the intervention was crossed using the opposite supplement. At the beginning of each administration and later at 30, 60, 90, and 120 minutes, glucose and insulin concentrations were measured. Triglyceride concentrations were measured at the beginning and at 120 minutes. Area under the curve of glucose and insulin was calculated. First-phase and total insulin secretion, as well as insulin sensitivity, were assessed. RESULTS: Glucose concentration at 120 minutes was significantly lower after the administration of Enterex Diabetic in comparison with Glucerna SR (4.3+/-0.6 vs 4.7+/-0.4 mmol/L; P=.012). Enterex Diabetic compared with Glucerna SR showed a greater change of the glucose concentration from 0 to 120 minutes (-0.7+/-0.6 vs -0.0+/-0.4 mmol/L; P=.002). Administration of Enterex Diabetic decreased insulin concentrations at 120 minutes (60+/-18 vs 48+/-19 pmol/L; P=.013). Administration of Glucerna SR increased triglyceride concentration at 120 minutes (1.0+/-0.3 vs 1.1+/-0.4 mmol/L; P=.026). CONCLUSION: A single administration of Enterex Diabetic in healthy individuals decreased glucose and insulin concentrations at 120 minutes without any modification in triglyceride levels.

Obesity and dyslipidaemia in primary care physicians.

OBJECTIVE: The objective of the study was to identify the prevalence of obesity and dyslipidaemia in primary care physicians. METHODS: A cross-sectional study was carried out in 775 primary care physicians (301 men and 474 women), self-described as healthy. Waist circumference was measured and body mass index was calculated. Glucose concentration and lipid profile (total, low-density lipoprotein and high-density lipoprotein cholesterol levels and triglycerides) were measured. RESULTS: Of 775 physicians, 63.3% were overweight or obese. There were significant differences in waist circumference (P < 0.001), high-density lipoprotein cholesterol (P < 0.001) and triglyceride concentrations (P < 0.001) when the population of physicians was divided in accordance with the body mass index categories. Waist circumference was considered as a risk in 78.9% of physicians. At least one abnormality in the lipid profile was observed in 90.9% of the total subjects studied. Impaired fasting glucose was found in 2.1% of the population. CONCLUSION: In Mexico the prevalence of obesity and dyslipidaemia in primary care physicians was higher than expected.

The Effect of Agave tequilana Weber Inulin on Postprandial Ghrelin Concentration in Obese Patients.

This study was performed to investigate the effect of Agave tequilana Weber inulin on postprandial ghrelin levels in obese patients. A randomized, double-blind, cross-over design was performed. A total of 14 patients were allocated into two groups: one group received a drink that contained 500 mL lemon water, 24 g of A. tequilana Weber inulin, and 75 g glucose and the other group received a placebo drink with 500 mL lemon drink and 75 g of glucose. After a 7-day washout period, the groups were crossed. The primary outcome measure was postprandial ghrelin levels between minute 240 and minute 270. A. tequilana Weber inulin did not change postprandial ghrelin concentration in obese patients.

Effect of berberine administration on metabolic syndrome, insulin sensitivity, and insulin secretion.

BACKGROUND: The aim of this study was to evaluate the effect of berberine administration on metabolic syndrome, insulin sensitivity, and insulin secretion. METHODS: A randomized, double-blind, placebo-controlled clinical trial was carried out in 24 patients with a diagnosis of metabolic syndrome. Glucose and insulin levels after a dextrose load were measured. Triglycerides and high-density lipoprotein cholesterol concentrations at baseline were also measured. Twelve patients received berberine hydrochloride (500 mg) three times daily before meals for 3 months. The remaining 12 patients received placebo. Area under the curve (AUC) of glucose and insulin, total insulin secretion, first-phase of insulin secretion, and insulin sensitivity were assessed. RESULTS: After berberine administration, patients had a remission of 36% (P=0.037) in the presence of metabolic syndrome and a significant decrease in waist circumference in females (106±4 vs. 103±3 cm, P<0.05), systolic blood pressure (SBP) (123±7 vs. 115±9 mmHg, P<0.01), triglycerides (2.4±0.7 vs. 1.4±0.5 mmol/L, P<0.01), area under the curve (AUC) of glucose (1182.1±253.6 vs. 1069.5±172.4 mmol/l, P<0.05), AUC of insulin (92,056±72,148 vs. 67,407±46,441 pmol/L, P<0.01), and insulinogenic index (0.78±0.69 vs. 0.62±0.46, P<0.05), as well as an increase in the Matsuda index (2.1±1.0 vs. 3.1±1.6, P<0.01). CONCLUSIONS: Administration of berberine leads to remission of metabolic syndrome and decreases in waist circumference, SBP, triglycerides, and total insulin secretion, with an increase in insulin sensitivity.

Effect of vildagliptin on glucose and insulin concentrations during a 24-hour period in type 2 diabetes patients with different ranges of baseline hemoglobin A1c levels.

BACKGROUND: Currently, it is still unknown whether differences in glycemic control have any effect on glucose and insulin kinetics after vildagliptin administration. The aim of this study was to evaluate the effect of vildagliptin on glucose and insulin concentrations during a 24-h period in type 2 diabetes patients with different ranges of baseline hemoglobin A1c (A1C) levels. PATIENTS AND METHODS: A randomized, double-blind, crossover, placebo-controlled clinical trial was carried out in 12 drug-naive adult volunteers with type 2 diabetes and overweight or obesity. Subjects had fasting glucose values between 7.2 and 13.3 mmol/L. Six patients had A1C between 7.0% and 8.4% (Group A), and the remaining subjects had A1C between 8.5% and 10.0% (Group B). Patients received oral administration of vildagliptin (50 mg twice daily) or placebo in a crossover manner for two consecutive days. Until the second day of the interventions, glucose and insulin concentrations were measured every hour during a 24-h period, and areas under the curve (AUCs) were calculated. Statistical analyses were evaluated with Wilcoxon and Mann-Whitney U tests. RESULTS: There were significant decreases in glucose concentrations after vildagliptin administration in both groups when comparing placebo in all measurements throughout the 24-h period and in the AUC. There were no significant changes in insulin concentration in both groups after vildagliptin administration when comparing placebo in all measurements throughout the 24-h period and in the AUC. CONCLUSIONS: Vildagliptin administration improved glucose control during a 24-h period in type 2 diabetes patients, independent of the basal A1C level, without changes in insulin levels.

Effect of metformin glycinate on glycated hemoglobin A1C concentration and insulin sensitivity in drug-naive adult patients with type 2 diabetes mellitus.

AIM: This study evaluated the effect of metformin glycinate on glycated hemoglobin A1c (A1C) concentration and insulin sensitivity in drug-naive adult patients with type 2 diabetes mellitus (T2DM). SUBJECTS AND METHODS: A randomized, double-blind, placebo-controlled clinical trial was carried out in 20 patients with drug-naive T2DM. Ten subjects received metformin glycinate (1,050.6 mg) once daily during the first month and force-titrated twice daily during the second month. Ten additional patients received placebo as the control group. Before and after the intervention, metabolic profile including A1C and insulin sensitivity (euglycemic-hyperinsulinemic clamp technique) was estimated. RESULTS: A1C concentrations decreased significantly with metformin glycinate administration (8.0 ± 0.7% vs. 7.1 ± 0.9%, P = 0.008) before and after the intervention, respectively. There were significant differences in changes from baseline of A1C between groups (0.0 ± 0.7% vs. -1.0 ± 0.5% for placebo and metformin glycinate groups, respectively; P = 0.004). A reduction of ≥1% in A1C levels was reached in 60.0% of patients with metformin glycinate administration (P = 0.02). Insulin sensitivity was not modified by the intervention. CONCLUSIONS: Administration of metformin glycinate during a 2-month period showed a greater decrease in A1C concentrations than placebo in a selected group of drug-naive adult patients with T2DM.

Association between the Xba I polymorphism of APOB gene and plasma lipid level in Mexican patients with coronary artery disease.

Some studies, that consider polymorphisms of the apolipoprotein B (APOB) gene as risk factors for coronary artery disease (CAD), have reported discordant results. The aim of the present study was to search for associations between plasma lipid profiles with the DNA Xba I polymorphism of the APOB gene in CAD patients diagnosed by angiography (CAD+). In the present study we compared 114 Mexican patients (80 men and 34 women) with CAD+ and 132 control patients (59 men and 73 women) without evidence of ischemia or arterial damage (CAD-). The frequency of X+/X+ genotype of Xba I polymorphism, in CAD+ group, was 23% (26/114) compared with 8% (11/132) in the CAD- (OR 3.25, p = 0.002). The patients with X+/X+ for the Xba I genotype APOB gene had higher concentration of triglycerides (TG) and VLDL in plasma than CAD- (p< 0.05). The genotype X+/X+ in the CAD had an effect increasing the TG and VLDL plasma levels when compared with individuals with X-/X- and X-/X+ genotypes. The present study indicated that the X+X+ genotype of Xba I polymorphism is associated with CAD+ patients and high plasma levels of TG and VLDL, in the Mexican population.

Effect of exenatide on fat deposition and a metabolic profile in patients with metabolic syndrome.

BACKGROUND: The aim of this study was to evaluate the effect of exenatide on fat deposition and a metabolic profile in patients with metabolic syndrome. METHODS: An uncontrolled, open clinical study was carried out in 10 patients with metabolic syndrome and without pharmacological treatment. Patients received exenatide (5 µg) subcutaneously twice daily for 1 month. Before and after the intervention, metabolic profile and phases of insulin secretion and insulin sensitivity were estimated. To assess insulin secretion and sensitivity, the hyperglycemic-hyperinsulinemic clamp technique was performed. Computed tomography was performed to evaluate both subcutaneous and visceral fat. The Wilcoxon signed-rank test and Mann-Whitney U-test were used for statistical analyses. RESULTS: Weight, body mass index, waist circumference, and systolic blood pressure were decreased by exenatide. Subcutaneous fat deposition decreased by 4.4% compared to the basal value. There were significant decreases in total cholesterol and low-density lipoprotein cholesterol, as well as an increment in the first phase of insulin secretion after the intervention. CONCLUSION: One-month administration of exenatide significantly decreased subcutaneous fat deposition by 4.4%, improving the metabolic profile in patients with metabolic syndrome.

Effect of diacerein on insulin secretion and metabolic control in drug-naive patients with type 2 diabetes: a randomized clinical trial.

OBJECTIVE: To assess the effect of diacerein on insulin secretion and metabolic control in drug-naïve patients with type 2 diabetes. RESEARCH DESIGN AND METHODS: A randomized, double-blind, placebo-controlled clinical trial was carried out in 40 drug-naïve adult patients with type 2 diabetes. A metabolic profile including interleukin (IL)-1ß, tumor necrosis factor-α, IL-6, and fasting insulin levels was carried out before the intervention and 2 months afterward. A hyperglycemic-hyperinsulinemic clamp technique was performed to assess the phases of insulin secretion and insulin sensitivity. After randomization, 20 patients received diacerein (50 mg once daily) for the first 15 days and twice daily for 45 additional days. The remaining patients received placebo. Intra- and intergroup differences were calculated by Wilcoxon signed rank and Mann-Whitney U tests. RESULTS: There were significant increases in first (102±63 vs. 130±75 pmol/L; P<0.01), late (219±111 vs. 280±135 pmol/L; P<0.01), and total insulin (178±91 vs. 216±99 pmol/L; P<0.01) secretions without changes in insulin sensitivity after diacerein administration. There were significant decreases in fasting glucose (7.9±1.4 vs. 6.8±1.0 mmol/L; P<0.01) and in A1C levels (8.3±1.0 vs. 7.0±0.8%; P<0.001) after diacerein administration. There were no significant changes after placebo administration in the above-mentioned evaluations. CONCLUSIONS: Insulin secretion increased and metabolic control improved after diacerein administration in drug-naïve patients with type 2 diabetes.

Chitosan improves insulin sensitivity as determined by the euglycemic-hyperinsulinemic clamp technique in obese subjects.

In accordance with obesity is associated with insulin resistance and dyslipidemia and chitosan decrease weight and lipids, but its effect on insulin sensitivity is unknown. Our hypothesis for the research was that chitosan improves insulin sensitivity estimated with the euglycemic-hyperinsulinemic clamp technique in obesity. We undertook this study with the objective to determine the effect of chitosan on insulin sensitivity using the euglycemic-hyperinsulinemic clamp technique in obese patients during a 3-month period. A randomized, double-blind clinical trial was carried out in 12 obese adults without diabetes mellitus. During a 3-month period, 6 patients received chitosan (750 mg, 3 times per day) 30 minutes before meals, and the other 6 subjects received placebo. Serum glucose, total cholesterol, high-density lipoprotein cholesterol, and triglycerides (TG) were measured. Insulin sensitivity was estimated with the euglycemic-hyperinsulinemic clamp technique before and after the intervention. Insulin sensitivity increased significantly with the administration of chitosan (2.4 +/- 1.4 vs 3.6 +/- 1.4 mg kg(-1) min(-1); P = .043). In addition, there was a decrease in weight (90.7 +/- 14.2 vs 84.7 +/- 13.7 kg; P = .027), body mass index (34.3 +/- 2.7 vs 31.6 +/- 2.2 kg/m(2); P = .028), waist circumference (106 +/- 12 vs 99 +/- 9 cm; P = .028) and TG (2.4 +/- 0.9 vs 1.6 +/- 0.9 mmol/L; P = .028) in the chitosan group. In conclusion, 3-month administration of chitosan increased insulin sensitivity in obese patients and demonstrated a decrease in weight, body mass index, waist circumference, and TG.