Type 2 diabetes patients requiring empagliflozin in Southeast of Iran: Frequency and guideline adherence (2022-2023)

INTRODUCTION

Empagliflozin plays a beneficial role in individuals with type 2 diabetes at high risk of cardiovascular complications. This study aimed to assess the prevalence of individuals with type 2 diabetes who required empagliflozin based on clinical guidelines between the years 2022 and 2023.

MATERIAL AND METHODS

This study was a descriptive-analytical cross-sectional study conducted on a target population of patients with type 2 diabetes. Patient data, including demographic characteristics, smoking status, hypertension, hyperlipidemia, renal insufficiency, retinopathy, and proteinuria, were collected. The indication for prescribing empagliflozin was determined based on the risk of cardiovascular complications.

RESULTS

A total of 398 individuals with type 2 diabetes with a mean age of 58.4 years were examined. Overall, 87.4% of the patients had an indication for empagliflozin prescription. The indication for empagliflozin prescription was significantly higher in men, individuals with hyperlipidemia, those over 55 years of age, obese individuals, and smokers. The mean age, body mass index, and triglyceride levels were higher in candidates for empagliflozin prescription. Male candidates for empagliflozin had significantly higher rates of smoking and systolic blood pressure compared to females.

CONCLUSIONS

The findings of this study demonstrated that a significant percentage of individuals with type 2 diabetes had an indication for empagliflozin prescription based on clinical and laboratory criteria.

Antibacterial activity of lactobacilli from buffalo milk and yoghurt in Bandar-e Gaz, North-West Iran

A cross-sectional study was conducted from April to June 2016 to determine the inhibitory effect of Lactobacillus strains isolated from buffalo milk and yogurt in Bandar-e Gaz, Golestan province, North-West Iran. The raw milk and yogurt samples were collected and cultivated on MRS medium by anaerobical incubation at 37 °C for 48 h. The suspected colonies were identified on the basis of Gram’s staining and conventional biochemical tests. The antibacterial activity of the cell-free supernatant extracted from Lactobacillus strains was determined using the agar well diffusion method against standard strains Escherichia coli ATCC 11303, Staphylococcus aureus ATCC 29213, Bacillus cereus ATCC 19115, Listeria monocytogenes ATCC 19111, E. coli and S. aureus isolates from local cheese samples. A total of 10 Lactobacillus spp. were isolated and identified as L. plantarum, L. casei, L. acidophilus. L. plantarum A1 and L. acidophilus R1 exhibited relatively strong inhibitory effect against S. aureus and B. cereus, respectively. Both isolates had no inhibitory effect against L. monocytogenes. L. casei B1 showed moderate inhibitory effects against L. monocytogenes. This study showed that Lactobacilli from buffalo dairy products had good inhibitory activity towards Gram-positive indicator organisms and were one of the best choices to control these pathogens in food products.

Increased super-conditioning temperature of corn grain affects performance, skeletal growth, and blood metabolites in Holstein dairy calves

We aimed to evaluate the effects of feeding super-conditioned corn at different temperatures on intake, growth performance, total-tract starch digestibility, rumen fermentation, blood metabolites, and feeding behavior of dairy calves. Thirty-six Holstein female dairy calves (40 ± 1.72 kg of body weight, ± SD) were randomly assigned to 1 of the following 3 treatments: (1) ground corn (control; CON; n = 12), (2) corn super-conditioned at 75°C (T-75; n = 12), and (3) corn super-conditioned at 95°C (T-95; n = 12). Three mash starter feeds with an identical nutritional composition were blended with 5% chopped alfalfa hay and fed to individually-housed calves from d 3 to 77 of their birth. All calves were fed 4 L/d of pasteurized whole milk twice daily since d 3 to 56, followed by 2 L/d of morning feeding from d 57 to 63 of age. Calves were weaned on d 63 and remained in the study until d 77. The T-75 and T-95 diets increased total-tract starch digestibility compared with the CON diet. Dry matter intake and weaning or final BW were not affected by treatments; however, average daily gain and feed efficiency increased in calves fed T-95 in the overall period. The T-95 diet increased withers height and tended to increase hip height compared with other diets, but feeding behavior did not change throughout the experimental period. Ruminal pH decreased in calves fed the T-95 diet compared with T-75 and CON diets. The molar proportion of ruminal propionate increased, whereas the acetate-to-propionate ratio tended to decrease in calves fed the T-95 compared with CON diet. Calves fed the T-95 diet had the highest blood glucose concentration, whereas a trend for increased insulin concentration was observed in calves fed T-95 compared with other diets. In conclusion, super-conditioning temperature of corn (T-95 vs. T-75 and CON) improved the average daily gain, feed efficiency, and skeletal growth, but did not influence dry matter intake during the first 77 d of age. Finally, the total-tract starch digestibility increased, whereas ruminal pH dropped during the postweaning period as super-conditioning temperature elevated.

Proliferation inhibition of cisplatin-resistant ovarian cancer cells using drugs screened by integrating a metabolic model and transcriptomic data

OBJECTIVES

If screening to find effective drugs is possible, the inhibition of proliferation using existing drugs can be a practical strategy to control the drug resistance of cancer. Development of a system-oriented strategy to find effective drugs was the main aim of this research.

MATERIALS AND METHODS

An algorithm (transcriptional regulated flux balance analysis [TRFBA]) integrating a generic human metabolic model with transcriptomic data was used to identify genes affecting the growth of drug-resistant cancer cells. Drugs that inhibit activation of the target genes were found and their effect on the proliferation was experimentally evaluated.

RESULTS

Experimental assessments demonstrated that TRFBA improves the prediction of cancer cell growth in comparison with previous algorithms. The algorithm was then used to propose the system-oriented strategy to search drugs effective in limiting the growth rate of the cisplatin-resistant A2780 epithelial ovarian cancer cell. Experimental evaluations resulted in the selection of azathioprine, terbinafine, hydralazine and sodium valproate that appropriately inhibit the proliferation of resistant cancer cells while minimally affecting normal cells. Furthermore, experimental data indicate that the selected drugs are synergistic and can be used in combination therapies.

CONCLUSIONS

The proposed strategy was successful to identify drugs effective on the viability of resistant cancer cells. This strategy can enhance the potency of treatments for drug-resistant cancer cells and provides the possibility of using existing drugs.

Looking beyond the cosmetic tattoo lesion near the eyebrow: Screening the lungs

Cosmetic tattooing has become a risk factor for several adverse reactions related to inks, procedures, and associated clinical conditions. Development of a sarcoid reaction to the inserted tattoo pigment in the skin is not common. We report a 45 year-old patient with history of dyspnea and mild cough since two years who had subsequently developed reddish, scaly lesions in her 15-year old tattoo done near her right eyebrow. Skin biopsy of the tattoo lesion revealed cutaneous sarcoidosis which led to further investigations and a diagnosis of pulmonary sarcoidosis. The present case highlights the fact that cutaneous sarcoidosis can develop in a long-standing tattoo. Also such a patient should be screened for systemic sarcoidosis disease.

Leishmania major: common antigen responsible for induction of delayed-type hypersensitivity response in guinea pigs

The cellular response to Leishmania major (L. major) was evaluated in vivo by delayed-type hypersensitivity (DTH) skin test reaction using leishmanin as antigen. Our previous study had shown the development of species-specific DTH reaction in sensitized guinea pigs by application of a single purified antigen from promastigotes and filtered culture supernatants of L. major. This study has shown that purified antigen is common in both stages of the life cycle and filtered culture supernatant of L. major. The common antigen was purified and analyzed from soluble Leishmania antigen (SLA) of amastigotes, promastigotes, and filtered culture supernatant of L. major by specific monoclonal antibody coupled to sepharose-4B. The purified antigen, which gave a single band of 56 kDa on sodium dodecyl sulfate polyacrylamide gel (SDS-PAGE) electrophoresis, elicited DTH response in guinea pigs sensitized with L. major. It was almost of the same degree as that produced by whole SLA. These results show that DTH inducer antigen is present in both stages of the life cycle and filtered culture supernatant of L. major.

Analysis of specific IgE and IgG subclass antibodies for diagnosis of Echinococcus granulosus

The potential roles of specific antibodies of different immunoglobulin G (IgG) subclasses and IgE in serological diagnosis of cystic echinococcosis (CE) were investigated by an enzyme linked immunosorbent assay (ELISA) based on Antigen 5 (Ag5). Presence of IgG1 was demonstrated in all sera from 58 patients with CE. The most discriminatory and specific antibodies found in this study belonged to IgG4 and IgE. Only one false-positive reaction was observed with IgG4 and no IgE cross-reactivity occurred with 40 sera from healthy controls. In 36 sera from patients infected with parasites other than CE two false-positive reactions with IgG4 were observed but none occurred with IgE. In immunoblotting, it was shown that IgG1 subclass was responsible for cross-reactivity of human antibodies that reacted with a 38 kDa subunit of Ag5. IgG4 and IgE antibodies could not recognize the 38 kDa subunit and under non-reducing conditions reacted with the 57 kDa subunit without any cross-reactivity to other parasites. The results demonstrated that IgG4 and IgE are the most important antibodies for serological diagnosis of hydatid cyst in an Ag5 based immunoassay system.

Leishmania major: Species specific delayed hypersensitivity reaction induced by exogenous secreted antigen in the guinea pig

The cellular response to Leishmania major (L. major) is usually evaluated in vivo by the delayed-type-hypersensitivity (DTH) test using leishmanin. Leishmanin can give false-positive reactions in areas where there is a background of leishmaniasis. In a previous study, it was shown that a 56 kDa antigen purified from promastigote and culture supernatant of L. major induce strong DTH reactions in sensitized guinea pigs. In this study, the species-specificity of this antigen was further investigated. Three groups of guinea pigs were sensitized with L. major, L. tropica, and L. infantum and both flanks of sensitized animal were injected intradermally with purified 56 kDa antigen or soluble leishmania antigen (SLA). The extent of indurations were measured after 24, 48, and 72 h. In animals which were sensitized with three species of leishmania, only those immunized with L. major showed skin reactions to purified antigen by an increase in skin thickness. Since complex antigen mixtures such as SLA and leishmanin show cross-reactivity and can be non-specific, the result obtained here suggest that 56 kDa antigen may be a useful diagnostic tool for species specific diagnosis in field studies of leishmaniasis.

Leishmanin skin test in guinea pig with a single purified protein of Leishmania major

A series of hybridomas was produced by fusion of SP2/0 myeloma cells with spleen cells of mice immunized with Leishmania major (L. major). The reactivity of secreted monoclonal antibodies (mAbs) was evaluated against available leishmanin antigen by enzyme linked immunosorbent assay. Only one hybridoma designated as 7F9 secreted IgG1 mAb which was shown to be reactive with leishmanin. This mAb was further tested against four species of Leishmania (L. donovani, L. tropica, L. infantum, L. major) and a recombinant gp63. Among the four species tested it was shown to be only reactive with promastigotes of L. major. The antigen recognized by this mAb was purified and analyzed from both sonicated and supernatant cultures of L. major by immunoaffinity chromatography and reverse phase high performance liquid chromatography. The purified antigen, which gave a single band of 56kDa on sodium dodecyl sulfate polyacrylamide gel electrophoresis elicited a strong delayed-type hypersensitivity (DTH) reaction in guinea pigs sensitized with L. major. It was almost of the same degree as that produced by leishmanin. These results suggest that an L. major-specific antigen is an alternative as a specific diagnostic skin test reagent, which could lead to a better understanding of the mechanism of DTH in L. major.

Compositional changes of PBL population in patients with chronic hepatitis B virus infection

In this report we have analysed the peripheral blood lymphocyte of several patients with chronic hepatitis B virus infection with flow cytometry. Based on the presence and absence of the HBeAb, patients were divided into two groups. In both, all the patients were HBsAg positive with normal range of serum alanine aminotranferase (23.9 +/- 17.8). We have found that the immunophenotypic profiles of patients were different from healthy donors with significant decrease in CD(3)(+) T cells, specially CD(8)(+) T cells and a significant increase in the CD(19)(+) B cells. The differences were seen in other subset of T cells (CD(4)(+)) or NK cells (CD(56)(+)/CD(16)(+)) and HLA-DR markers were not significant. When the phenotypic profiles of both groups were compared with each other, such changes were more dominant in group II, with HBeAb positive than in group I, with HBeAb negative. Also, we have seen a correlation between the increase of CD(19)(+) B cells and the decrease of CD CD(3)(+) T cells. No such correlation was observed with other cells.

Effect of psoas training on postmenopausal lumbar bone loss: a 3-year follow-up study

The present study completed a previous randomized trial that demonstrated the protective effect of 1-year psoas training on lumbar bone loss in postmenopausal women. Computerized tomography had been carried out at the beginning (CT1) and at the end (CT2) of this trial. In the present study, 67 women having completed the first trial were asked to practice psoas exercises (60 hip flexions in sitting position with a 5 kg weight on the knee) for 2 additional years with a third CT control at the end of this period (CT3). The aim of this complementary study was to assess the compliance rate and long-term effect on bone of daily psoas muscle training over a longer period. Twenty-one women performed this daily psoas training for 3 years from CT1 to CT3, and 14 acted as controls during the same period. Fourteen women were controls during the first year (from CT1 to CT2) but practiced psoas training during the following 2 years (from CT2 to CT3). Four women were psoas trained during the first year (from CT1 to CT2) and subsequently crossed over to the control group for the last 2 years. The compliance rate was 42%, with an attendance rate of 88%. The lumbar bone loss was lower in the 21 women trained over the 3 years (-3.26 +/- 28.45 mg/cm3) than in the 14 untrained women (-16.79 +/- 8.51 mg/cm3) (P = 0.02). The bone loss was not significantly reduced between the two periods of the study in the 12 women having been controls from CT1 to CT2 and having crossed over to the active training group from CT2 to CT3. Psoas training may be effective against lumbar bone loss. We conclude that specific training may play a contributing role in the preventive strategy to avoid osteoporosis.

Phospholipid peroxidation in tumor promoter-exposed mouse skin

We have investigated lipid peroxidation in the skin of CD1 mice following single or repeated topical applications of the tumor promoter, 12-O-tetradecanoylphorbol-13-acetate (TPA). A substantial accumulation of hydroxyphospholipids, to levels 3-5 times control values, followed exposure to two or more TPA treatments (24-72 h intervals), whereas single applications were ineffective. Sodium borohydride reduction increased the yield of product by approximately 50%, suggesting the additional presence of phospholipid hydroperoxides in the oxidized lipids. Straight phase HPLC analysis of the constituent hydroxy fatty acids, followed by gas chromatography/mass spectrometry, revealed that oxidized derivatives of linoleic acid, including 9- and 13-hydroxyoctadecadienoic acids (9- and 13-HODE), were the primary products. Stereochemical analysis showed ratios of S to R stereoisomers of 1.3 for 13-HODE and 1.27 for 9-HODE, which implied that TPA-induced peroxidation was primarily due to free radical oxidation, although a partial contribution of enzyme (lipoxygenase) activity is possible. The TPA-induced peroxidation was greater in the epidermis than in the dermis. Pre-exposure of mouse skin to the anti-inflammatory agent fluocinolone acetonide, antioxidants and enzyme (phospholipase A2 and lipoxygenase) inhibitors lowered the peroxidation response to subsequent exposure to TPA. Phospholipid peroxidation products may be useful markers of oxygen radical production in TPA-exposed mouse skin with possible relevance to tumor promotion.

One-year psoas training can prevent lumbar bone loss in postmenopausal women: a randomized controlled trial

On the premise that bone response to exercise is locally controlled, we conducted a randomized trial to evaluate the effects of a 1-year training of psoas muscles (treatment group: TG) versus a 1-year training of deltoid muscles (control group: CG) on the lumbar trabecular bone mineral density (TBMD). TBMD was measured with computed tomography scan. Seventy-eight subjects were included and 67 completed the study. Intention to treat analysis revealed no significant change in TBMD from 0 to 12 months. Data analysis in the 67 remaining women, including both assiduous and nonassiduous subjects, revealed greater bone loss in CG than in TG although the difference was not significant. Similar analysis in a subgroup of subjects who performed the exercises assiduously (TG: n = 23, CG: n = 26) showed that the mean bone loss of all four vertebrae from 0 to 12 months was significantly greater in the CG (-8.87 +/- 12.75 mg/cm3, mean +/- SD) than in the TG (0.14 +/- 11.21 mg/cm3, mean +/- SD, P = 0.01). These results suggest that continuous 1-year psoas training can prevent lumbar bone loss in postmenopausal women and support the hypothesis of local action of physical activity.

Hydatid cyst of the skull: report of four cases

Four new cases of cranial echinococcosis are presented and the literature is reviewed. Young males are most commonly affected. Early cases present as an expansile osteolytic lesion in the diploe. The more advanced forms manifest as multilocular or unilocular destructive lesions with adjacent soft-tissue masses. Two patients with unilocular hydatid cysts recovered completely after surgery. One youth with the multilocular form died four months after operation. The other patient is well two years after surgery. The location, anatomical forms of the lesion, and the importance of early diagnosis are stressed.