Search results for: diabetic hypertension

Authors: Sogand Moshfeghi, Alireza Biglari

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Diabetes is an endocrine disorder that is commonly treated with insulin. However, long-term usage of insulin and hypoglycemic chemical drugs can result in various side effects. Therefore, it is crucial to explore effective compounds with minimal side effects for diabetes treatment. This study aimed to compare the hypoglycemic effects of hydroalcoholic extracts derived from Silybum marianum, Camellia sinensis (green tea), and Urtica dioica plants. Male Wistar rats were allocated to 5 groups. Group 1 received normal Salin. Other groups were diabetic (induced by Streptozotocin 65 mg/kg Ip), group 2 received normal Salin (Ip, qod. 21 days). Group 3 received Silybum Marianum L, hydroalcoholic extract (100 mg/kg, ip.qod, 21 days). Group 4 received Camellia sinesis L, hydroalcoholic extract (100mg/kg,ip,qod,21 days), and group 5 received Urtica dioica L. hydroalcoholic extract (100mg/kg, ip,qod,21 days). Blood samples were collected at 14 and 21 days after the initial injection to evaluate the blood glucose levels. On the fourteenth day, the blood glucose levels for the diabetic groups were as follows: Group 2: 424.7±34.5, Group 3: 390.7±10.5, Group 4: 350.4±16.9, and Group 5: 340±20.5. On the 21st day, the respective blood glucose levels were: Group 2: 432±5.0, Group 3: 410.16±5.0, Group 4: 264.3±17.5, and Group 5: 270.7±24.5. Statistical analysis using the Tukey Anova test indicated that on the fourteenth day, both the green tea and Urtica groups exhibited significant hypoglycemic effects. Furthermore, on the 21st day, Urtica dioica extract demonstrated comparable effects to Camellia Sinensis extract, while Silybum Marianum extract did not significantly lower blood glucose levels compared to the diabetic group. In conclusion, the hydroalcoholic extracts from Camellia sinensis and Urtica dioica plants exhibited promising hypoglycemic effects in diabetic rats. These findings provide valuable insights into the potential use of natural plant extracts as alternative or complementary treatments for diabetes, warranting further investigation to harness their therapeutic benefit effectively.

Keywords: Camellia sinesis, glucose, Silybum marianum, Urtica dioica

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Authors: Farah Ali, Tehreem Fayyaz, Musadiq Idris

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The present work was undertaken to investigate effects of various extracts of W. somniferafor anti-diabetic activity in alloxan induced diabetic rabbits. Rabbits were acclimatized for a week to standard laboratory temperature. Animals were fed according to a strict schedule (8 am, 3 pm and 10 pm) with green fodder (Medicago sativa) and tap water ad libitum. Animals were divided into nine groups of six rabbits each in a random manner. Body weights and physical activities of all rabbits were recorded before start of experiments. The animals of group 1 and 2 were given lactose (250 mg/kg,p.o) and Withaniasomniferaroot powder (100 mg/kg, p.o) respectively daily from day 1-20. Animals of group 3 were given alloxan (100 mg/kg,i.v) as a single dose on day 1. Powdered root of Withaniasomnifera in the doses of 100, 150, 200 mg/kg and its aqueous and ethanol extracts (equivalent to 200 mg/kg of crude drug) were given to the treated animals (groups 4-8), respectively by oral route for three weeks (day 1-20o.d), along with alloxan (100 mg/kg, i.v) as a single dose on day 1. Group 9 was treated with metformin (200 mg/kg, p.o) daily from day 1-20, along with a single dose of alloxan (100 mg/ kg, i.v) on day 1. Fasting serum glucose concentration in groups 3-9 was increased significantly (p<0.05) on day 3, with a maximum increase (215.3 mg/dl) in animals of toxic control (TC) group (3) on day 21 of the experiment as compared to normal control (NC) group (1). Effects of different doses (100, 150, 200 mg/kg, p.o) of W. somnifera root powder (WS) decreased the fasting serum glucose concentration as compared to toxic control group, with a maximum decrease (88.3 mg/dl) in group 2 (treated control) on day 21 of the experiment. Metformin (200 mg/kg, p.o) (reference control), aqueous extract (AWS) and ethanol extract (EWS) of W. somnifera (equivalent to 100 mg/kg W.somnifera root, p.o) antagonized the effects of alloxan as compared to toxic control group. These results indicate that the W. somnifera possess significant anti –diabetic activity.

Keywords: diabetes, serum, glucose, blood, sugar, rabbits

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Authors: Seyed Reza Aghili, Tahereh Shokohi, Lotfollah Davoodi, Zahra Kashi, Azam Moslemi, Mahdi Abastabar, Iman Haghani, Sabah Mayahi, Asoudeh A.

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Introduction: In diabetic foot ulcers, if fungal agents such as Candida species penetrate into the cutaneous or depth of ulcer, can increase the degree of the wound and cause Candia infection and make it more difficult to heal. Material & Methods: A cross-sectional study was performed on 100 diabetic foot ulcer patients in 2020 in Sari, Iran. patient's data and wound grade were recorded in a questionnaire. Candida infection was diagnosed with direct microscopic examination and culture of samples. Colony-PCR molecular method was used for ITS region of DNA and then PCR-RFLP with Msp1 enzyme and using HWP1 specific gene to determine species of Candida agent. Results: Of 100 patients, the mean age 62.1 ± 10.8 years, 95% type 2 diabetes, 83%>10 years duration diabetes, 59% male, 66%> poor education level, 99% married, 52% rural, 95% neuropathic symptoms, 88% using antibiotics, 69%HbA1C >9%, and mean ulcer degree 2.6±1.05 were. Candida infection was seen in 13% of the deep tissue of the wound and 7% cutaneous around the wound. The predominant Candida isolated was C. parapsilosis (71.5%), C .albicans (14.3%). Fungal infections caused by mold fungi were not detected. There was a statistically significant relationship between yeast infection and gender, rural, HbA1C and ulcer degree. Conclusion: Mycological evaluations often are ignored. Candida parapsilosis is the most common infectious agent in these patients and may require specific treatment. Therefore, more attention of physicians to Candida infections particularly, early diagnosis and effective treatment can help faster recovery and prevent amputation.

Keywords: diabetic foot ulcer, candida infection, risk factors, c. parapsilosis

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Authors: Alok Shiomurti Tripathi, Ajay Kumar Timiri, Papiya Mitra Mazumder, Anil Chandewar

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The present study evaluates the possible drug interaction between glimepiride (GLIM) and sildenafil citrate (SIL) in streptozotocin (STZ) induced in diabetic nephropathic (DN) animals and also postulates the possible mechanism of interaction by molecular modeling studies. Diabetic nephropathy was induced by single dose of STZ (60 mg/kg, ip) and confirms it by assessing the blood and urine biochemical parameters on 28th day of its induction. Selected DN animals were used for the drug interaction between GLIM (0.5mg/kg, p.o.) and SIL (2.5 mg/kg, p.o.) after 29th and 70th day of protocol. Drug interaction were assessed by evaluating the plasma drug concentration using HPLC-UV and also determine the change in the biochemical parameter in blood and urine. Mechanism of the interaction was postulated by molecular modeling study using Maestro module of Schrodinger software. DN was confirmed as there was significant alteration in the blood and urine biochemical parameter in STZ treated groups. The concentration of SIL increased significantly (p<0.001) in rat plasma when co administered with GLIM after 70th day of protocol. Molecular modelling study revealed few important interactions with rat serum albumin and CYP2C9.GLIM has strong hydrophobic interaction with binding site residues of rat serum albumin compared to SIL. Whereas, for CYP2C9, GLIM has strong hydrogen bond with polar contacts and hydrophobic interactions than SIL. Present study concludes that bioavailability of SIL increases when co-administered chronically with GLIM in the management of DN animals and mechanism has been supported by molecular modeling studies.

Keywords: diabetic nephropathy, glimepiride, sildenafil citrate, pharmacokinetics, homology modeling, schrodinger

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Authors: G. Dadashova, A. Bakhshaliyev

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Aim: Determine gender differences in the etiology and clinical outcomes, as well as in the remodeling of the left ventricle (LV) in patients with chronic heart failure (CHF), suffering from arterial hypertension (AH) and coronary heart disease (CHD). Material and methods: The study included 112 patients of both sexes; aged 45 to 60 years with postinfarction cardiosclerosis had functional class (FC) heart failure II-IV of NYHA which were examined on the basis of Azerbaijan Scientific Research Institute of Cardiology. The patients were divided into 2 groups: 1st c. 60 males, mean age 54,8 ± 3,3 years, and 2nd gr 52 women, mean age 55,8 ± 3,1 years. To assess cardiac hemodynamic all patients underwent echocardiography (B-M-modes) using ‘Vivid 3’. Thus on the basis of indicators such as the index of the relative thickness of the left ventricle wall and the index of left ventricular mass (LVMI) was identified the architectonic model of the left ventricle. Results: According to our research leading cause of heart failure in women is 50.5% of cases of hypertension, ischemic heart disease 23.7% (with 79.5% of the cases developed in patients with chronic heart failure who did not have a history of myocardial infarction). While in men is the undisputed leader of CHD, forming 78.3% of CHF (80.3% in men with CHF occurred after myocardial infarction). According to our research in women more often than men CHF develops a type of diastolic dysfunction (DD, and left ventricular ejection fraction remained unchanged. Since DD occurs in men at 65,8% vs. 76,4% of women when p < 0,05. In the group of women was more common prognostic neblagopryatnye remodeling - eccentric hypertrophy of the left ventricle: 68% vs. 54.5% among men (p < 0,05), concentric left ventricular hypertrophy: 21% in women vs 19,1% (p > 0,05 ). Conclusions: Patients with heart failure are a number of gender-specific: the prevalence of hypertension in women, and coronary heart disease in men. While in women with heart failure often recorded diastolic dysfunction and characterized by the development of prognostically unfavorable remodeling types: eccentric and concentric LV hypertrophy.

Keywords: chronic heart failure, arterial hypertension, remodeling, diastolic dysfunction, men, women, ischemic heart disease

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Authors: Hanan Badr, Fahad Manee, Rao Shashidhar, Omar Bayoumy

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Introduction: Hypertension is the major risk factor for cardiovascular diseases and stroke and a universe leading cause of disability-adjusted life years and mortality. Adopting an unhealthy lifestyle is thought to be associated with developing hypertension regardless of predisposing genetic factors. This study aimed to examine the association between recreational physical activity (RPA), and sedentary behaviors with a risk of hypertension among ministry employees, where there is no role for occupational physical activity (PA), and to scrutinize participants’ time spent in RPA and sedentary behaviors on the working and weekend days. Methods: A cross-sectional study was conducted among randomly selected 2562 employees working at ten randomly selected ministries in Kuwait. To have a representative sample, the proportional allocation technique was used to define the number of participants in each ministry. A self-administered questionnaire was used to collect data about participants' socio-demographic characteristics, health status, and their 24 hours’ time use during a regular working day and a weekend day. The time use covered a list of 20 different activities practiced by a person daily. The New Zealand Physical Activity Questionnaire-Short Form (NZPAQ-SF) was used to assess the level of RPA. The scale generates three categories according to the number of hours spent in RPA/week: relatively inactive, relatively active, and highly active. Gender-matched trained nurses performed anthropometric measurements (weight and height) and measuring blood pressure (two readings) using an automatic blood pressure monitor (95% accuracy level compared to a calibrated mercury sphygmomanometer). Results: Participants’ mean age was 35.3±8.4 years, with almost equal gender distribution. About 13% of the participants were smokers, and 75% were overweight. Almost 10% reported doctor-diagnosed hypertension. Among those who did not, the mean systolic blood pressure was 119.9±14.2 and the mean diastolic blood pressure was 80.9±7.3. Moreover, 73.9% of participants were relatively physically inactive and 18% were highly active. Mean systolic and diastolic blood pressure showed a significant inverse association with the level of RPA (means of blood pressure measures were: 123.3/82.8 among relatively inactive, 119.7/80.4 among relatively active, and 116.6/79.6 among highly active). Furthermore, RPA occupied 1.6% and 1.8% of working and weekend days, respectively, while sedentary behaviors (watching TV, using electronics for social media or entertaining, etc.) occupied 11.2% and 13.1%, respectively. Sedentary behaviors were significantly associated with high levels of systolic and diastolic blood pressure. Binary logistic regression revealed that physical inactivity (OR=3.13, 95% CI: 2.25-4.35) and sedentary behaviors (OR=2.25, CI: 1.45-3.17) were independent risk factors for high systolic and diastolic blood pressure after adjustment for other covariates. Conclusions: Physical inactivity and sedentary lifestyle were associated with a high risk of hypertension. Further research to examine the independent role of RPA in improving blood pressure levels and cultural and occupational barriers for practicing RPA are recommended. Policies should be enacted in promoting PA in the workplace that might help in decreasing the risk of hypertension among sedentary occupation workers.

Keywords: physical activity, sedentary behaviors, hypertension, workplace

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Authors: Tahmineh Hasanzadeh, Afshin Farahbakhsh

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There is some report about the hypoglycemic effect of Juglans rejia L. leaf in alloxan induced diabetic rats and hypoglycemic effect of its fruit peel administered intraperitoneally.In Iranian traditional medicine, septum of walnut shell (SWS) was recommended to reduce blood glucose. For this purpose, 41 male bulb/C mice 25-30 gm were divided into five groups. All the animals received IP injection of streptozotocin (STZ) (220 mg/kg). Two weeks later, the diabetic animals were received daily oral treatment of normal saline and aqueous extract of SWS (200, 400, 600 and 800 mg/kg) respectively for four weeks. Blood samples were taken from retro orbital sinus before the start of the experiment and repeated each two weeks. At the end of the experiment, the animals were sacrificed and the pancreatic tissues were fixed, prepared and stained by Hematoxylin-Eosin for light microscope studies. The results showed that in each group, the SWS extract reduced blood glucose in a long time (p < 0.05). metabolic extract in STZ- induced diabetic rats, which was accompanied by the hypoglycemic effect of leaf extract. However, this effect should be determined with scientific researches. Therefore, the aim of this study is to evaluate the effect of the aqueous extract of SWS on blood glucose and histopathological structure of pancreas.

Keywords: septum of walnut, blood glucose, pancreas, diabetes, walnut leaf, walnut peel, insulin

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Authors: Sourabh Jain, Vikas Jain, Dharmendar Kumar

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The present study investigated the antidiabetic potential of Cedrus deodara heart wood aqueous extract. Aqueous extract of Cedrus deodara was found to reduce blood sugar level in alloxan induced diabetic rats. Reduction in blood sugar could be seen from 5th day after continuous administration of the extract and on 21st day sugar levels were found to be reduced by 40.20%. Oxidative stress produced by alloxan was found to be significantly lowered by the administration of Cedrus deodara aqueous extract (500 mg/kg). This was evident from a significant decrease in lipid per oxidation level in liver induced by alloxan. The level of Glutathione, Catalase, Superoxide dismutase and Glutathione-S-Transferase in liver, kidney and pancreas tissue were found to be increased significantly after drug administration. The results obtained in the present study suggest that the Cedrus deodara aqueous extract effectively and significantly reduced the oxidative stress induced by alloxan and produced a reduction in blood sugar level.

Keywords: Cedrus deodara, heartwood, antioxidant, anti-diabetic, anti-inflammatory

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Authors: Djebbar Atmani, Aghiles Karim Aissat, Nadjet Debbache-Benaida, Nassima Chaher-Bazizi, Dina Atmani-Kilani, Meriem Rahmani-Berboucha, Naima Saidene, Malika Benloukil, Lila Azib

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Medicinal plants are believed to be an important source for the discovery of potential antioxidant, anti-inflammatory and anti-diabetic substances. The present study was designed to investigate the neuroprotective, anti-inflammatory, anti-diabetic and anti-hyperuricemic potential of Pistacia lentiscus, as well as the identification of active compounds. The antioxidant potential of plant extracts against known radicals was measured using various standard in vitro methods. Anti-inflammatory activity was determined using the paw edema model in mice and by measuring the secretion of the pro-inflammatory cytokine, whereas the anti-diabetic effect was assessed in vivo on streptozotocin-induced diabetic rats and in vitro by inhibition of alpha-amylase. The anti-hyperuricemic activity was evaluated using the xanthine oxidase assay, whereas neuroprotective activity was investigated using an Aluminum-induced toxicity test. Pistacia lentiscus extracts and fractions exhibited high scavenging capacity against DPPH, NO. and ABTS+ radicals in a dose-dependent manner and restored blood glucose levels, in vivo, to normal values, in agreement with the in vitro anti-diabetic effect. Oral administration of plant extracts significantly decreased carrageenan-induced mice paw oedema, similar to the standard drug, diclofenac, was effective in reducing IL-1β levels in cell culture and induced a significant increase in urinary volume in mice, associated to a promising anti-hyperuricemic activity. Plant extracts showed good neuroprotection and restoration of cognitive functions in mice. HPLC-MS and NMR analyses allowed the identification of known and new phenolic compounds that could be responsible for the observed activities. Therefore, Pistacia lentiscus could be beneficial in the treatment of inflammatory conditions and diabetes complications and the enhancement of cognitive functions.

Keywords: Pistacia lentiscus, anti-inflammatory, antidiabetic, flavanols, neuroprotective

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Authors: Mai Ali

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The abstract underscores the critical importance of junior paediatricians acquiring expertise in handling paediatric emergencies, with a particular focus on Diabetic Ketoacidosis (DKA). Existing literature reveals a wealth of research on healthcare professionals' knowledge regarding DKA, encompassing diverse cultural backgrounds and medical specialties. Consistently, challenges such as the absence of standardized protocols and inadequacies in training emerge as common issues across healthcare centres. This research proposal seeks to conduct a thematic analysis of the proficiency of paediatric trainees in the United Kingdom in managing DKA within various clinical contexts. The primary objective is to assess their level of competence and propose effective strategies to enhance DKA training comprehensively.

Keywords: DKA, knowledge, Junior paediatricians, local protocols

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Authors: Farah Ali, Tehreem Fayyaz, Musadiq Idris

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The present work was undertaken to investigate effects of various extracts of withania somnifera for anti-diabetic activity in alloxan induced diabetic rabbits. Rabbits were acclimatized for a week to standard laboratory temperature. Animals were fed according to a strict schedule (8 am, 3 pm and 10 pm) with green fodder (Medicago sativa) and tap water ad libitum. Animals were divided into nine groups of six rabbits each in a random manner. Body weights and physical activities of all rabbits were recorded before start of experiments. The animals of group 1 and 2 were given lactose (250 mg/kg, p.o) and Withania somniferaroot powder (100 mg/kg, p.o) respectively daily from day 1-20. Animals of group 3 were given alloxan (100 mg/kg, i.v) as a single dose on day 1. Powdered root of Withania somnifera in the doses of 100, 150, 200 mg/kg and its aqueous and ethanol extracts (equivalent to 200 mg/kg of crude drug) were given to the treated animals (groups 4-8), respectively by oral route for three weeks (day 1-20o.d), along with alloxan (100 mg/kg, i.v) as a single dose on day 1. Group 9 was treated with metformin (200 mg/kg, p.o) daily from day 1-20, along with a single dose of alloxan (100 mg/ kg, i.v) on day 1. Fasting serum glucose concentration in groups 3-9 was increased significantly (p<0.05) on day 3, with a maximum increase (215.3 mg/dl) in animals of toxic control (TC) group (3) on day 21 of the experiment as compared to normal control (NC) group (1). Effects of different doses (100, 150, 200 mg/kg, p.o) of W. somnifera root powder (WS) decreased the fasting serum glucose concentration as compared to toxic control group, with a maximum decrease (88.3 mg/dl) in group 2 (treated control) on day 21 of the experiment. Metformin (200 mg/kg, p.o) (reference control), aqueous extract (AWS) and ethanol extract (EWS) of W. somnifera (equivalent to 100 mg/kg W.somnifera root, p.o) antagonized the effects of alloxan as compared to toxic control group. These results indicate that the W. somnifera possess significant anti–diabetic activity.

Keywords: diabetes, serum, glucose, blood, sugar, rabbits

Procedia PDF Downloads 499

Authors: Ashish Jain, Satish Nayak

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Transdermal iontophoretic drug delivery system is viable drug delivery platform technology and has a strong market worldwide. Transdermal drug delivery system is particularly desirable for therapeutic agents that need prolonged administration at controlled plasma level. This makes appropriateness to antihypertensive and anti-diabetic agents for their transdermal development. Controlled zero order absorption, easily termination of drug delivery and easy to administration also support for popularity of transdermal delivery. In this current research iontophoretic delivery of various anti diabetic agents like glipizide, glibenclamide and glimepiride were carried out. The experiments were carried out at different drug concentrations and different current densities using cathodal iontophoresis. Diffusion cell for iontophoretic permeation study was modified according to Glikfield Design. Pig skin was used for in vitro permeation study and for the in-vivo study New Zealand rabbits were used. At all concentration level iontophoresis showed enhanced permeation rate compared to passive controls. Iontophoretic transports of selected drugs were found to be increased with the current densities. Results showed that target permeation rate for selected drugs could be achieved with the aid of iontophoresis by increasing the area in an appreciable range.

Keywords: transdermal, iontophoresis, pig skin, rabbits, glipizide, glibeclamide

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Authors: Aleksandr Nagay, Gulnoz Khamidullayeva

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It is known that an unbalanced intake of salt (NaCI), lifestyle and genetic predisposition to pathology is a key component of the risk and the development of essential hypertension (EH). Purpose: To study the relationship between salt-sensitivity and blood pressure (BP) on systolic (SBP) and diastolic (DBP) blood pressure, depending on the C825T polymorphism of GNB3 in individuals of Uzbek nationality with EH. Method: studied 148 healthy and 148 patients with EH with I-II degree (WHO/ISH, 2003) with disease duration 6,5±1,3 years. Investigation of the gene GNB3 was produced by PCR-RFLP method. Determination of salt-sensitivity was performed by the method of R. Henkin. Results: For a comparative analysis of BP, the groups with carriage of CТ and TT genotypes were combined. The analysis showed that carriers of CC genotype and low salt-sensitivity were determined by higher levels of SBP compared with carriers of CT and TT genotypes, and low salt-sensitivity of SBP: 166,2±4,3 against 158,2±9,1 mm Hg (p=0,000). A similar analysis on the values of DBP also showed significantly higher values of blood pressure in carriers of CC genotype DBP: 105,8±10,6 vs. 100,5±7,2 mm Hg, respectively (p=0,001). The average values of SBP and DBP in groups with carriers of CC genotype at medium or high salt-sensitivity in comparison with carriers of CT or TT genotype did not differ statistically SBP: 165,0±0,1 vs. 160,0±8,6 mm Hg (p=0,275) and DBP: 100,1±0,1 vs. 101,6±7,6 mm Hg (p=0,687), respectively. Conclusion: It is revealed that in patients with EH CC genotype of the gene GNB3 given salt-sensitivity has a negative effect on blood pressure profile. Since patients with EH with the CC genotype of GNB3 gene with low-salt taste sensitivity is determined by a higher level of blood pressure, both on SBP and DBP.

Keywords: salt sensitivity, essential hypertension EH, blood pressure BP, genetic predisposition

Procedia PDF Downloads 248

Authors: Sourabh Jain, Vikas Jain, Dharmendra Kumnar

Abstract:

The present study investigated the antidiabetic potential of Cedrus deodara heart wood aqueous extract and its relationship in alloxan-induced diabetic rats. Aqueous extract of Cedrus deodara was found to reduce blood sugar level in alloxan induced diabetic rats. Reduction in blood sugar could be seen from 5th day after continuous administration of the extract and on 21st day sugar levels were found to be reduced by 40.20%. Oxidative stress produced by alloxan was found to be significantly lowered by the administration of Cedrus deodara aqueous extract (500 mg/kg). This was evident from a significant decrease in lipid per oxidation level in liver induced by alloxan. The level of Glutathione, Catalase, Superoxide dismutase and Glutathione-S-Transferase in liver, kidney and pancreas tissue were found to be increased significantly after drug administration. The results obtained in the present study suggest that the Cedrus deodara aqueous extract effectively and significantly reduced the oxidative stress induced by alloxan and produced a reduction in blood sugar level.

Keywords: Cedrus deodara, heartwood, antioxidant, anti-diabetic, anti-inflammatory

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Authors: M. Khaledi Pour, P. Akbartehrani, M. Amini, M. Khani, M. Mohajeri Tehrani, R. Radi, B. Shokri

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Diabetic Foot Ulcer (DFU) is one of the costly severe complications of diabetes. Neuropathy and Peripheral Arterial Disease (PAD) due to diabetes are significant causes of this complication. In 10 years the patients with DFUs are twice as likely to die as patients without DFUs. Cold Atmospheric Plasma (CAP) is a promising tool for medical purposes. CAP generate reactive species at room temperature and are effective in killing bacteria and fibroblast proliferation. These CAP-based tools produce NO, which has bactericidal and angiogenesis properties. It also showed promising effects in the DFUs surface reduction and the time to wound closure. In this paper, we evaluated the effect of the Argon Plasma Jet (APJ) on the healing process of the Wagner Grade 2 DFUs in a randomized clinical trial. The 20 kHz sinusoidal voltage frequency derives the APJ. Patients (n=20) were randomly double-blinded assigned into two groups. These groups receive the standard care (SC, n=10) and the standard care with APJ treatment (SC+APJ, n=10) for five sessions in four weeks. The results showed that the APJ treatment along standard care could reduce the wound surface by 20 percent more than the standard care. Also, It showed a more influential role in controlling wound infection.

Keywords: argon plasma jet, cold atmospheric plasma, diabetes, diabetic foot ulcer

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Authors: P. Muñiz, R. Del Pino-García , M.D. Rivero-Pérez, J. García-Lomillo, M. L. González-SanJosé

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Grape, wine and wine pomace could improve the antioxidant status in the vasculature in terms of plasma antioxidant capacity and oxidation biomarkers, partly due to their high content in polyphenols. The current study aimed to evaluate the protection of a powdered product obtained from wine pomace (WPP) against oxidative damage associated to diabetes. Streptozotocin-induced diabetic (STZ) male Wistar rats and non-diabetic control (C) rats initially weighting 300±10 mg were supplemented with 100 mg of WPP or vehicle for 4 weeks. Blood glucose levels and body weight (BW) were measured weekly. Total antioxidant capacity (TAC) assessed using the ABTS method, and F2α-Isoprostanes (F2-IsoPs) quantified by GC-MS were measured in plasma collected at the end of this experiment. Blood glucose levels tended to increase in the STZ group along the study. Supplementation maintained relatively stable during the whole experiment the blood glucose values in STZ+WPP rats. A weight loss of BW in STZ rats respect to C rats was observed after 4 weeks, whereas the decrease in BW of STZ+WPP group showed a tendency to improve at the end of the study. TAC values significantly decreased around 11% only in plasma of STZ rats. The rest of groups showed plasma TAC values about 8 mM Trolox. Increased levels of F2-IsoPs (around 25%) were also observed in plasma of STZ rats compared to the supplemented rats, revealing a protective effect of WPP against lipid peroxidation. In conclusion, 4-week supplementation with a product derived from winery by-products improved weight loss, plasma TAC, and lipid oxidation biomarkers in Type I diabetic rats.

Keywords: blood glucose, grape polyphenols, F2α-isoprostanes, type I diabetes, oxidative stress

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Authors: S. P. Chintan, A. M. Khoja, M. Modi, R. K. Chopra, S. Garde, D. Jain, O. Kajale

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Pulmonary Hypertension is a rare but debilitating disease that affects individuals of all ages and walks of life. As recent as 15 years ago, a patient diagnosed with PH was given an average survival rate of 2.8 years. Recent advances in treatment options have allowed patients to improve quality o and quantity of life. Initial screening for PH is through echocardiography with final diagnosis confirmed through right heart catheterization. PH is now considered to have five major classifications with subgroups among each. The mild to moderate PH is common in chronic lung diseases like Chronic obstructive pulmonary diseases and Interstitial lung disease. But very severe PH is noted in few cases. In COPD patients, PH is associated with an increased risk of severe exacerbations and a reduced life expectancy. Similarly, in patients with ILD, the presence of PH correlates with a poor prognosis. Early diagnosis is essential to slow disease progression. We report here five cases of severe PH (Out of Proportion) of which four cases were of COPD and another one of IPF (UIP pattern). There echocardiography showed gross RA/RV dilatation, interventricular septum bulging to the left and mPAP of more than 100 mmHg in all the five cases. These patients were put on LTOT, pulmonary rehabilitation, combination pharmacotherapy of vasodilators and diuretics in continuation to the treatment of underlying disease. As these patients have grave prognosis close monitoring and follow up is required. Physicians associated with respiratory care and treating chronic lung disease should have knowledge in the diagnosis and management of patients with PH.

Keywords: COPD, pulmonary hypertension, chronic lung disease, India

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Authors: Yin Hua Zhang

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Cardiac metabolism is essential in myocardial contraction. In addition to glucose, fatty acids (FA) are essential in producing energy in the myocardium since FA-dependent beta-oxidation accounts for > 70-90% of cellular ATP under resting conditions. However, metabolism shifts from FAs to glucose utilization during disease progression (e.g. hypertrophy and ischemic myocardium), where glucose oxidation and glycolysis become the predominant sources of cellular ATP. At advanced failing stage, both glycolysis and beta-oxidation are dysregulated, result in insufficient supply of intracellular ATP and weakened myocardial contractility. Undeniably, our understandings of myocyte function in healthy and diseased hearts are based on glucose (10 mM)-dependent metabolism because glucose is the “sole” metabolic substrate in most of the physiological experiments. In view of the importance of FAs in cardiovascular health and diseases, we aimed to elucidate the impacts of FA supplementation on myocyte contractility and evaluate cellular mechanisms those mediate the functions in normal heart and with pathological stress. In particular, we have investigated cardiac excitation-contraction (E-C) coupling in the presence and absence of FAs in normal and hypertensive rat left ventricular (LV) myocytes. Our results reveal that FAs increase mitochondrial activity, intracellular [Ca²+]i, and LV myocyte contraction in healthy LV myocytes, whereas FA-dependent cardiac inotropyis attenuated in hypertension. FA-dependent myofilament Ca²+ desensitization could be fundamental in regulating [Ca²+]i. Collectively, FAs supplementation resets cardiac E-C coupling scheme in healthy and diseased hearts.

Keywords: hypertension, fatty acid, heart, calcium

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Authors: Rahaf Mandura

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Background: Idiopathic intracranial hypertension (IIH) is a disorder with elevated intracranial pressure (ICP) more than 250 mm H₂O, without evidence of meningeal inflammation, space-occupying lesion, or venous thrombosis. The aim of this research is to study the clinical profile, evaluation, management, and visual outcome in a hospital-based population of IIH cases in Jeddah. Methodology: This is a retrospective observational study that included the medical records of all patients referred to neuro-ophthalmology service for evaluation of papilledema. The medical records have been reviewed from October 2018 to February 2020 at Jeddah Eye Hospital (JEH), Saudi Arabia. A total of fifty-one patients presented with papilledema in the studied period. Forty-seven patients met our inclusion criteria and were included in the study. Results: Most of the patients were females (43, 91.5%) with a mean age of presentation of 30.83±11.40 years. The most common presenting symptom was headache (40 patients, 85.1%), followed by transient visual obscuration (20 patients, 42.6%), and reduced visual acuity (15 patients, 31.9%). All 47 patients were started on medical treatment with oral acetazolamide with four patients (8.5%) shifted to topiramate because of the lack of response or intolerance to acetazolamide while four patients (8.5%) underwent lumbar-peritoneal shunt because of inadequate control of the disease despite the treatment with medical therapy. For both eyes, the change in visual acuity across all assessment points was statistically significant. Nevertheless, there were no significant changes in the visual field findings among all of the compared assessment points. Conclusion: The present study has shown that IIH-related papilledema is common in young female patients with headaches, transient visual obscurations and reduced visual acuity. Those are the commonest symptoms in our IIH population. Medical treatment of IIH is significantly efficacious and should be considered in order to enhance the prognosis of IIH-related complications. Therefore, the visual status should be frequently monitored for these patients.

Keywords: idiopathic intracranial hypertension, intracranial hypertension, papilledema, headache

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Authors: Vidishaa Jali, Amit Sinha, Kameshwar Prasad

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Background and Objective: Cerebral microbleeds are frequently found in healthy elderly individuals. We performed a meta- analysis to determine the prevalence of cerebral microbleeds in apparently healthy, elderly population and to determine the effect of age, smoking and hypertension on the occurrence of cerebral microbleeds. Methods: Relevant literature was searched using electronic databases such as MEDLINE, EMBASE, PubMed, Cochrane database, Google scholar to identify studies on the prevalence of cerebral microbleeds in general elderly population till March 2016. STATA version 13 software was used for analysis. Fixed effect model was used if heterogeneity was less than 50%. Otherwise, random effect model was used. Meta- regression analysis was performed to check any effect of important variables such as age, smoking, hypertension. Selection Criteria: We included cross-sectional studies performed in apparently healthy elderly population, who had age more than 50 years. Results: The pooled proportion of cerebral microbleeds in healthy population is 12% (95% CI, 0.11 to 0.13). No significant effect of age was found on the prevalence of cerebral microbleeds (p= 0.99). A linear relationship between increase in hypertension and the prevalence of cerebral microbleeds was found, however, this linear relationship was not statistically significant (p=0.16). Similarly, A linear relationship between increase in smoking and the prevalence of cerebral microbleeds was found, however, this linear relationship was also not statistically significant (p=0.21). Conclusion: Presence of cerebral microbleeds is evident in apparently healthy, elderly population, in more than 10% of individuals.

Keywords: apparently healthy, elderly, prevalence, cerebral microbleeds

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Authors: Nditsheni Ramakuela, Sonto Maputle, Base Khoza, Augustine Tugli

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Inadequate health literacy can cause difficulties in understanding and compliance to treatment plan. With diabetic condition, self-care activities include behaviours of following a diet plan, avoiding high fat foods, increased exercise, self-glucose monitoring, and foot care. Patients with poor health literacy have difficulty interpreting medication warning labels, following directions on a prescription label and identifying their medications. Difficulties in understanding and performing self-care and health-related activities may ultimately lead to poor health outcomes. The study explored and described factors affecting health literacy and self-care to diabetic regimen by female patients at selected hospital in Limpopo Province of South Africa. Qualitative and explorative research design was used. Female patients who were admitted and diagnosed with diabetes in female medical ward constituted the study population. Non-probability, purposive sampling was used to select 20 female patients diagnosed with diabetes, who were above 18 years and admitted during April–November 2014. An in-depth face-to-face, unstructured interview was used to collect data. Data were analysed using open coding method. Measures to ensure trustworthiness and ethical considerations were adhered to. Findings revealed factors affecting health literacy for diabetic self-care activities amongst patients were; patient, family, disease and facility related. Proposed recommendations were; to strengthen diabetes education and patient-provider partnership. This is important and must be transferred to strengthen self-care activities to fully benefit the patient.

Keywords: compliance, diabetes mellitus, diabetic regimen, health literacy, self activities

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Authors: Van Truong Pham

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Background: Self-management was described as a potential strategy for blood pressure control in patients with hypertension. However, the effects of self-management interventions on blood pressure, self-efficacy, medication adherence, and body mass index (BMI) in older adults with hypertension have not been systematically evaluated. We evaluated the effects of self-management interventions on systolic blood pressure (SBP) and diastolic blood pressure (DBP), self-efficacy, medication adherence, and BMI in hypertensive older adults. Methods: We followed the recommended guidelines of preferred reporting items for systematic reviews and meta-analyses. Searches in electronic databases including CINAHL, Cochrane Library, Embase, Ovid-Medline, PubMed, Scopus, Web of Science, and other sources were performed to include all relevant studies up to April 2019. Studies selection, data extraction, and quality assessment were performed by two reviewers independently. We summarized intervention effects as Hedges' g values and 95% confidence intervals (CI) using a random-effects model. Data were analyzed using Comprehensive Meta-Analysis software 2.0. Results: Twelve randomized controlled trials met our inclusion criteria. The results revealed that self-management interventions significantly improved blood pressure control, self-efficacy, medication adherence, whereas the effect of self-management on BMI was not significant in older adult patients with hypertension. The following Hedges' g (effect size) values were obtained: SBP, -0.34 (95% CI, -0.51 to -0.17, p < 0.001); DBP, -0.18 (95% CI, -0.30 to -0.05, p < 0.001); self-efficacy, 0.93 (95%CI, 0.50 to 1.36, p < 0.001); medication adherence, 1.72 (95%CI, 0.44 to 3.00, p=0.008); and BMI, -0.57 (95%CI, -1.62 to 0.48, p = 0.286). Conclusions: Self-management interventions significantly improved blood pressure control, self-efficacy, and medication adherence. However, the effects of self-management on obesity control were not supported by the evidence. Healthcare providers should implement self-management interventions to strengthen patients' role in managing their health care.

Keywords: self-management, meta-analysis, blood pressure control, self-efficacy, medication adherence, body mass index

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Authors: Mrinal Gupta, Mohammad Rumman, Babita Singh Abbas Ali Mahdi, Shivani Pandey

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Introduction: Berberine (BBR), a bioactive compound isolated from Coptidis Rhizoma, possesses diverse pharmacological activities, including anti-bacterial, anti-inflammatory, antitumor, hypolipidemic, and anti-diabetic. However, its role as an anti-diabetic agent in animal models of dexamethasone (Dex)-induced diabetes remains unknown. Studies have shown that natural compounds, including aloe, caper, cinnamon, cocoa, green and black tea, and turmeric, can be used for treating Type 2 diabetes mellitus (DM). Compared to conventional drugs, natural compounds have fewer side effects and are easily available. Herein, we studied the anti-diabetic effects of BBR in a mice model of Dex-induced diabetes. Methods: HepG2 cell line was used for glucose release and glycogen synthesis studies. Cell proliferation was measured by methylthiotetrazole (MTT) assay. For animal studies, mice were treated with Dex (2 mg/kg, i.m.) for 30 days and the effect of BBR at the doses 100, 200, and 500 mg/kg (p.o.) was analyzed. Glucose, insulin, and pyruvate tests were performed to evaluate the development of the diabetic model. An echo MRI was performed to assess the fat mass. Further, to elucidate the mechanism of action of BBR, mRNA expression of genes regulating gluconeogenesis, glucose uptake, and glycolysis were analyzed. Results: In vitro BBR had no impact on cell viability up to a concentration of 50μM. Moreover, BBR suppressed the hepatic glucose release and improved glucose tolerance in HepG2 cells. In vivo, BBR improved glucose homeostasis in diabetic mice, as evidenced by enhanced glucose clearance, increased glycolysis, elevated glucose uptake, and decreased gluconeogenesis. Further, Dex treatment increased the total fat mass in mice, which was ameliorated by BBR treatment. Conclusion: BBR improves glucose tolerance by increasing glucose clearance, inhibiting hepatic glucose release, and decreasing obesity. Thus, BBR may become a potential therapeutic agent for treating glucocorticoid-induced diabetes and obesity in the future.

Keywords: glucocorticoid, hyperglycemia, berberine, HepG2 cells, insulin resistance, glucose

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Authors: Selena Ferrian, Erin Mccaffrey, Toshie Saito, Aiqin Cao, Noah Greenwald, Mark Robert Nicolls, Trevor Bruce, Roham T. Zamanian, Patricia Del Rosario, Marlene Rabinovitch, Michael Angelo

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Recent experimental and clinical observations are advancing immunotherapies to clinical trials in pulmonary arterial hypertension (PAH). However, comprehensive mapping of the immune landscape in pulmonary arteries (PAs) is necessary to understand how immune cell subsets interact to induce pulmonary vascular pathology. We used multiplexed ion beam imaging by time-of-flight (MIBI-TOF) to interrogate the immune landscape in PAs from idiopathic (IPAH) and hereditary (HPAH) PAH patients. Massive immune infiltration in I/HPAH was observed with intramural infiltration linked to PA occlusive changes. The spatial context of CD11c+DCs expressing SAMHD1, TIM-3 and IDO-1 within immune-enriched microenvironments and neutrophils were associated with greater immune activation in HPAH. Furthermore, CD11c-DC3s (mo-DC-like cells) within a smooth muscle cell (SMC) enriched microenvironment were linked to vessel score, proliferating SMCs, and inflamed endothelial cells. Experimental data in cultured cells reinforced a causal relationship between neutrophils and mo-DCs in mediating pulmonary arterial SMC proliferation. These findings merit consideration in developing effective immunotherapies for PAH.

Keywords: pulmonary arterial hypertension, vascular remodeling, indoleamine 2-3-dioxygenase 1 (IDO-1), neutrophils, monocyte-derived dendritic cells, BMPR2 mutation, interferon gamma (IFN-γ)

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Authors: Arielle Ferdinand

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A plant-based diet focuses on foods from plant sources, limiting or altogether omitting animal products. Some of the most common chronic illnesses seen in primary care are hypertension, hyperlipidemia, and diabetes type II. These common chronic illnesses can often be debilitating, costly, time-consuming, and, when left untreated, can lead to an early death. Treatment and maintenance of care are also labor intensive for the patient. They are often required to have at least four blood pressure checks yearly and a hemoglobin A1C checked quarterly. Though preventative interventions and prevention education should be included in patient visits in the primary care setting, education about dietary interventions, such as a plant-based diet, also yields positive outcomes for patients who already have hypertension, hyperlipidemia, and diabetes mellitus type 2. Evidence will show that incorporating a plant-based diet results in decreased blood pressure, as well as decreased levels of LDL-C, improved post-prandial glucose levels, and a reduction in HbA1C. It is cost-effective for the patient by generally lower grocery costs, and it can either reduce or prevent the need to pay for more office visits and pharmacotherapy. Incorporating this method of dietary changes is an easy intervention during a primary care office visit that would greatly benefit the patient in many ways.

Keywords: plant-based, nutrition, diabetes, hyperlipidemia

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Authors: Akwu N. A., Naidoo Y., Salau V. F., Olofinsan K. A.

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Grewia lasiocarpa E. Mey. ex Harv. (Malvaceae) is a Southern African medicinal plant indigenously used with other plants for birthing problems. The anti-diabetic properties of the hexane, chloroform, and methanol extracts of Grewia lasiocarpa stem bark were assessed using in vitro α-glucosidase enzyme inhibition assay. The predictive in silico drug-likeness and toxicity properties of the phytocompounds were conducted using the pKCSM, ADMElab, and SwissADME computer-aided online tools. The highest α-glucosidase percentage inhibition was observed in the hexane extract (86.76%, IC50= 0.24 mg/mL), followed by chloroform (63.08%, IC50= 4.87 mg/mL) and methanol (53.22%, IC50= 9.41 mg/mL); while acarbose, the standard anti-diabetic drug was (84.54%, IC50= 1.96 mg/mL). The α-glucosidase assay revealed that the hexane extract exhibited the strongest carbohydrate inhibiting capacity and is a better inhibitor than the standard reference drug-acarbose. The computational studies also affirm the results observed in the in vitroα-glucosidaseassay. Thus, the extracts of G. lasiocarpa may be considered a potential plant-sourced compound for treating type 2 diabetes mellitus. This is the first study on the anti-diabetic properties of Grewia lasiocarpa hexane, chloroform, and methanol extracts using in vitro and in silico models.

Keywords: grewia lasiocarpa, α-glucosidase inhibition, anti-diabetes, ADMET

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Authors: Mai Ali

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Advancing beyond the junior stage of a paediatrician’s career is a crucial step where they accumulate essential skills and knowledge. This process prepares them for the challenges they'll encounter throughout their profession, particularly in dealing with paediatric emergencies. This can be especially demanding for trainees specializing in fields like endocrinology, particularly in the management of Diabetic Ketoacidosis (DKA) in the UK. In different societal contexts, junior doctors, whether specializing in pediatrics or other medical fields, are generally expected to possess a fundamental level of knowledge and skills necessary for managing diabetic ketoacidosis (DKA) emergencies. These physicians consistently concurred in recognizing prevalent problems in the healthcare facilities they examined. Such issues include the lack of established guidelines for DKA treatment and the inadequate availability of comprehensive training opportunities. The abstract underscores the critical importance of junior paediatricians acquiring expertise in managing paediatric emergencies, with a specific focus on DKA. Commonly, issues like the lack of standardized protocols and training deficiencies are recurring themes across healthcare facilities. This research proposal aims to conduct a thematic analysis of the proficiency of paediatric trainees in the United Kingdom when handling DKA in various clinical contexts. The primary goal is to assess their competency and suggest effective strategies for comprehensive DKA training improvement.

Keywords: junior pediatrician, DKA, standardized protocols, level of competence

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Authors: Faiz N. K. Yusufi, Aquil Ahmed, Jamal Ahmad

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Predicting the risk of diabetic retinopathy (DR) in Indian type 2 diabetes patients is immensely necessary. India, being the second largest country after China in terms of a number of diabetic patients, to the best of our knowledge not a single risk score for complications has ever been investigated. Diabetic retinopathy is a serious complication and is the topmost reason for visual impairment across countries. Any type or form of DR has been taken as the event of interest, be it mild, back, grade I, II, III, and IV DR. A sample was determined and randomly collected from the Rajiv Gandhi Centre for Diabetes and Endocrinology, J.N.M.C., A.M.U., Aligarh, India. Collected variables include patients data such as sex, age, height, weight, body mass index (BMI), blood sugar fasting (BSF), post prandial sugar (PP), glycosylated haemoglobin (HbA1c), diastolic blood pressure (DBP), systolic blood pressure (SBP), smoking, alcohol habits, total cholesterol (TC), triglycerides (TG), high density lipoprotein (HDL), low density lipoprotein (LDL), very low density lipoprotein (VLDL), physical activity, duration of diabetes, diet control, history of antihypertensive drug treatment, family history of diabetes, waist circumference, hip circumference, medications, central obesity and history of DR. Cox proportional hazard regression is used to design risk scores for the prediction of retinopathy. Model calibration and discrimination are assessed from Hosmer Lemeshow and area under receiver operating characteristic curve (ROC). Overfitting and underfitting of the model are checked by applying regularization techniques and best method is selected between ridge, lasso and elastic net regression. Optimal cut off point is chosen by Youden’s index. Five-year probability of DR is predicted by both survival function, and Markov chain two state model and the better technique is concluded. The risk scores developed can be applied by doctors and patients themselves for self evaluation. Furthermore, the five-year probabilities can be applied as well to forecast and maintain the condition of patients. This provides immense benefit in real application of DR prediction in T2DM.

Keywords: Cox proportional hazard regression, diabetic retinopathy, ROC curve, type 2 diabetes mellitus

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Authors: J. Fernandez, N. Aguilar, R. Fernandez de Canete, J. C. Ramos-Diaz

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In this paper, a simulation model of the glucose-insulin system for a patient undergoing diabetes Type 1 is developed by using a causal modeling approach under system dynamics. The OpenModelica simulation environment has been employed to build the so called causal model, while the glucose-insulin model parameters were adjusted to fit recorded mean data of a diabetic patient database. Model results under different conditions of a three-meal glucose and exogenous insulin ingestion patterns have been obtained. This simulation model can be useful to evaluate glucose-insulin performance in several circumstances, including insulin infusion algorithms in open-loop and decision support systems in closed-loop.

Keywords: causal modeling, diabetes, glucose-insulin system, diabetes, causal modeling, OpenModelica software

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Authors: Mitakshara Sharma, S. K. Nema, Sanjeev Narang

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Diabetes mellitus (DM) is a group of metabolic disorders characterized by metabolic abnormalities, chronic hyperglycaemia and long term macrovascular & microvascular complications. Vascular complications are due to platelet hyperactivity and dysfunction, increased inflammation, altered coagulation and endothelial dysfunction. Large proportion of patients with Type II DM suffers from preventable vascular angiopathies, and there is need to develop risk factor modifications and interventions to reduce impact of complications. These complications are attributed to platelet activation, recognised by increase in Platelet Volume Indices (PVI) including Mean Platelet Volume (MPV) and Platelet Distribution Width (PDW). The current study is prospective analytical study conducted over 2 years. Out of 1100 individuals, 930 individuals fulfilled inclusion criteria and were segregated into three groups on basis of glycosylated haemoglobin (HbA1C): - (a) Diabetic, (b) Non-Diabetic and (c) Subjects with Impaired fasting glucose (IFG) with 300 individuals in IFG and non-diabetic groups & 330 individuals in diabetic group. Further, diabetic group was divided into two groups on the basis of presence or absence of known diabetes related vascular complications. Samples for HbA1c and PVI were collected using Ethylene diamine tetraacetic acid (EDTA) as anticoagulant and processed on SYSMEX-X-800i autoanalyser. The study revealed gradual increase in PVI from non-diabetics to IFG to diabetics. PVI were markedly increased in diabetic patients. MPV and PDW of diabetics, IFG and non diabetics were (17.60 ± 2.04)fl, (11.76 ± 0.73)fl, (9.93 ± 0.64)fl and (19.17 ± 1.48)fl, (15.49 ± 0.67)fl, (10.59 ± 0.67)fl respectively with a significant p value 0.00 and a significant positive correlation (MPV-HbA1c r = 0.951; PDW-HbA1c r = 0.875). MPV & PDW of subjects with diabetes related complications were higher as compared to those without them and were (17.51±0.39)fl & (15.14 ± 1.04)fl and (20.09 ± 0.98) fl & (18.96 ± 0.83)fl respectively with a significant p value 0.00. There was a significant positive correlation between PVI and duration of diabetes across the groups (MPV-HbA1c r = 0.951; PDW-HbA1c r = 0.875). However, a significant negative correlation was found between glycaemic levels and total platelet count (PC- HbA1c r =-0.164). This is multi-parameter and comprehensive study with an adequately powered study design. It can be concluded from our study that PVI are extremely useful and important indicators of impending vascular complications in all patients with deranged glycaemic control. Introduction of automated cell counters has facilitated the availability of PVI as routine parameters. PVI is a useful means for identifying larger & active platelets which play important role in development of micro and macro angiopathic complications of diabetes leading to mortality and morbidity. PVI can be used as cost effective markers to predict and prevent impending vascular events in patients with Diabetes mellitus especially in developing countries like India. PVI, if incorporated into protocols for management of diabetes, could revolutionize care and curtail the ever increasing cost of patient management.

Keywords: diabetes, IFG, HbA1C, MPV, PDW, PVI

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