Marwan S. M. Al-Nimer

Role of nitrosative and oxidative stress in neuropathy in patients with type 2 diabetes mellitus.

Objectives: Evidences of oxidative and/or nitrosative stress in type 2 diabetes mellitus were demonstrated in experimental and human studies. This study is aimed to assess the serum peroxynitrite and oxidized lipoproteins in patients with type 2 diabetes mellitus presented with clinical and laboratory evidences of peripheral neuropathy. Materials and Methods: Eighty four patients with type 2 diabetes mellitus (51 of them had neuropathy) and 31 apparent healthy subjects were studied in the unit of neurophysiology at the University Hospital of Medical College, Al-Nahrin University in Baghdad, Iraq. Neuropathy total symptom score (NTSS), neuropathy impairment score in the lower leg (NIS-LL), and nerve conduction velocity of sensory (ulnar and sural) and motor (ulnar and common peroneal) nerves were used to assess the neuropathy. Fasting venous blood was obtained from each participant for the determination of serum glucose and oxidized lipoproteins. Results: The electrophysiology study revealed significant decrease in conduction velocity of ulnar (sensory and motor components), sural, and common peroneal nerves in diabetic neuropathy compared to diabetics without neuropathy and healthy subjects. Significant high level of serum peroxynitrite was found in diabetic patients with or without neuropathy compared with non-diabetics. The changes in serum-oxidized lipoproteins in patients with diabetics with or without neuropathy were non-significantly differed from healthy subjects. Neither nitrosative stress nor oxidative stress indices correlated with the variables that are related to the neuropathy. Conclusion: It concludes that evidence of nitrosative and to less extent the oxidative stress is associated with neuropathy in type 2 diabetes mellitus and their indices not correlated with variables related to neuropathy.

Saliva α-Synuclein and A High Extinction Coefficient Protein: A Novel Approach in Assessment Biomarkers of Parkinson's Disease

Background: The pathological hallmark of Parkinsons disease (PD) is the appearance of intracytoplasmic inclusions known as Lewy bodies in which its principal component is α-synuclein. Aim: This study aimed to determine salivary α-synuclein and the extinction coefficient of the saliva protein as biomarkers of PD. Materials and Methods: This observational study was done in Department of Pharmacology, College of Medicine in cooperation with Department of Oral Medicine, College of Dentistry at Al-Mustansiriya University in Baghdad, Iraq from September 2013 to March 2014. A total number of 20 PD patients and 20 healthy subjects were enrolled in the study. Unstimulated saliva obtained from each participant obtained for determination of salivary flow rate, saliva protein and α-synuclein using enzyme linked immune sorbent assay (ELISA) technique. Results: Total saliva protein and uncontaminated protein with nucleic acids are significantly higher in PD compared with healthy subjects. The mean extinction coefficient of that protein is 27.25 M.cm-1 which significantly (P < 0.001) less than corresponding value of healthy subjects (33.48 M.cm−1 ). Saliva α-synuclein level is significantly less in PD (65 ± 52.2 pg/ml) than healthy subjects (314.01 ± 435.9 pg/ml). Conclusions: We conclude that saliva α-synuclein serves as a biomarker for PD if its level compared with healthy subjects, and a specific protein with extinction coefficient 27.25 M.cm-1 is detected in saliva of Parkinsons patients.

Antiproliferative effects of aspirin and diclofenac against the growth of cancer and fibroblast cells: In vitro comparative study

Non-steroidal anti-inflammatory drugs (NSAIDs) inhibit the growth of several cancer cell lines. The aim of this study is to compare the cytotoxic effect of aspirin with diclofenac on the growth of HeLa cell, mammary cell carcinoma, rhabdomyosarcoma and fibroblast cell lines in the culture media. The cells are cultured in RPMI-1640 culture media supplemented with 5% fetal calf serum and antibiotics. Aspirin (5 mg/well) and diclofenac (0.625 mg/well) significantly inhibit the growth of HeLa, rhabdomyosarcoma and fibroblast cells. The cytotoxic effect of aspirin against rhabdomyosarcoma is significantly (p < 0.001) higher than that of diclofenac with a potency approximated 2.6. It concludes that aspirin and diclofenac inhibit the growth of fibroblast and cancer cell by inhibiting the up-regulation of cyclooxygenases enzymes in cancer cells. Aspirin is more effective than diclofenac against the growth of rhabdomyosarcoma cell line.

Increased mean carotid intima media thickness in type 2 diabetes mellitus patients with non-blood pressure component metabolic syndrome: A preliminary report.

AIMS: Patients with type-2 diabetes mellitus have greater carotid intima media thickness and they are at risk for generalized atherosclerosis. This study aimed to compare the thickness of carotid artery intima media in type-2 diabetes mellitus patients with and without nonblood pressure component metabolic syndrome. SETTINGS AND DESIGN: This was a comparative observational study conducted in the Departments of Pharmacology and Physiology in the College of Medicine, Al-Mustansiriyia University in cooperation with Baghdad Teaching Hospital. MATERIALS AND METHODS: Forty-six diabetic patients of both sexes with systolic blood pressure < 130 mm Hg and diastolic blood pressure < 85 mm Hg were subjected to high resolution B-mode ultrasonography of the common and internal carotid arteries. Patients were grouped into those without metabolic syndrome (Group I) and with nonblood pressure component metabolic syndrome (Group II). STATISTICAL ANALYSIS: The two-tailed unpaired Students t-test was used in this study. RESULTS: Significantly high mean thickness was observed in the common carotid intima media (0.824 ± 0.155 mm) but not in the internal carotid arteries in group II patients compared to group I patients (0.708 ± 0.113 mm). Group II also had a significant number of patients with increased lesion intima media thickness (≥ 1.1 mm). Conclusion: The greater carotid intima media thickness observed in type 2 diabetes mellitus patients is related to the metabolic syndrome even in the absence of the blood pressure component.

Assessment of nitrosative stress and lipid peroxidation activity in asymptomatic exposures to medical radiation: The bystander effect of ionizing radiation

Background: Adaptive response and bystander effect are two important phenomena involved in biological responses to ionizing radiation. Aims: To determine the bystander effect of ionizing radiation in medical exposures by measuring the serum nitric oxide (NO•), peroxynitrite (ONOO•), and malondialdehyde (MDA) levels. Materials and Methods: Twenty-five medical staff working in the Unit of Radiology and 15 medical staff working in other departments at the Al-Yarmouk teaching hospital in Baghdad, Iraq, were enrolled in the study. Venous blood was obtained from each subject for determination of NO•, ONOO•, and MDA levels. Results: Significantly higher serum NO•, ONOO•, and MDA levels were observed in participants working in the radiology unit as compared with serum levels in those working elsewhere. There was no correlation between the lipid peroxidation activity and ONOO•/NO• ratio. The serum NO• level in subjects working in the x-ray services was significantly higher than that in subjects working in the CT and MRI services. Conclusions: The bystander effect of radiation could be observed in asymptomatic individuals working in the radiology unit and it was particularly well observed in people working in the X-ray services as opposed to CT and MRI services. Determination of serum nitrogen species could be a useful laboratory investigation for assessment of the bystander effect of radiation.

Dyslipidemia as a contributory factor in etiopathogenesis of diabetic neuropathy

Objectives: The pathogenesis of neuropathy in type 2 diabetes mellitus is multifactorial.Dyslipidemia may contribute to the development of diabetic neuropathy. This study aimed to assess the atherogenic lipid indices in type 2 diabetic patients with neuropathy. Material and Methods: Fifty-one patients with type 2 diabetes mellitus and 31 healthy subjects were studied in the Unit of Neurophysiology at the University Hospital of Medical College, Al-Nahrin University in Baghdad, Iraq, from January 2002 to January 2003. Neuropathy total symptom score (NTSS), neuropathy impairment score in the lower leg (NIS-LL), and electrophysiological study of sensory (ulnar and sural) and motor (ulnar and common peroneal) nerves were used to assess nerve function. Fasting venous blood was obtained from each participant for determination of lipid profile and atherogenic lipid ratios. Results: The frequency of high blood pressure was significantly higher in neuropathic patients. The electrophysiology study revealed significant decrease in conduction velocity of ulnar (sensory and motor components), sural, and common peroneal nerves. The minimum F-wave latency of motor nerve was significantly prolonged. Among the lipid fractions, only high-density lipoprotein–cholesterol was significantly reduced by 14% of healthy participants value. Atherogenic lipid ratios were significantly higher in diabetic patients than corresponding healthy ratios. Conclusion: Metabolic lipid disturbances in terms of atherogenicity co-existwith neuropathy in type 2 diabetes mellitus, irrespective of duration of disease.

Effects of meloxicam and rofecoxib on psychomotor performance: A randomized, double-blind, placebo-controlled cross-over study

Objectives: To investigate the effects of meloxicam and rofecoxib on psychomotor performance in young, healthy volunteers. Materials and Methods: This study was conducted in Department of Pharmacology, College of Medicine, Al-Mustansiriya University, Baghdad, Iraq in 2003. Twelve healthy, young males were allocated randomly from college students and participated in a balanced one-period cross-over investigation, with each period separated by a 7-day washed-out period. Participants were asked to perform psychomotor performance (choice reaction time and critical flicker-fusion threshold tests) before and after 2 h of receiving single oral dose of either meloxicam (7.5 mg) or rofecoxib (25 mg). Results: Meloxicam and rofecoxib were statistically significant, differing from placebo in reducing motor and recognition reaction times, respectively, of the objective test used. Both drugs were not significantly different from placebo in critical flicker-fusion frequency thresholds. Conclusion: These results allow the conclusion that the effects of preferential (meloxicam) and highly selective (rofecoxib) cyclo-oxygenase-2 inhibitors showed central effect by improving psychomotor performance, but in different directions.

Epileptic patients are at risk of cardiac arrhythmias: A novel approach using QT-nomogram, tachogram, and cardiac restitution plots

Background: Sudden death is reported in patients who had a history of epilepsy and some authors believed that is due to cardiac arrhythmias. Objectives: This study aimed to predict that the epileptic patients are at risk of serious cardiac arrhythmias by QT-nomogram, tachogram (Lorenz), and cardiac restitution plots. Methods: A total number of 71 healthy subjects (Group I) and 64 newly diagnosed epileptic patients (Group II) were recruited from Al-Yarmouk and Baghdad Teaching hospitals in Baghdad from March 2015 to July 2015 and included in this study. The diagnosis of epilepsy achieved clinically, electroencephalograph record and radio-images including computerized tomography and magnetic image resonance. At the time of entry into the study, an electrocardiography (ECG) was done, and the determinants of each ECG record were calculated. The QT-nomogram, tachogram, and cardiac restitution plots were used to identify the patients at risk of cardiac arrhythmias. Results: Significant prolonged corrected QT corrected (QTc) and JT corrected intervals were observed in female compared with male at age ≥50 years while the TQ interval was significantly prolonged in males of Group II. Eight patients of Group II had a significant pathological prolonged QTc interval compared with undetectable finding in Group I. QT nomogram did not disclose significant findings while the plots of Lorenz and restitution steepness disclose that the patients of Group II were vulnerable to cardiac arrhythmias. Abnormal ECG findings were observed in the age extremities (≤18 years and ≥50 years) in Group II compared with Group I. Conclusion: Utilization of QT-nomogram, restitution steepness, and tachogram plots is useful tools for detection subclinical vulnerable epileptic patient with cardiac arrhythmias.

Concomitant measurements of serum annexin A5 levels and hematological indices as markers in recent and old myocardial infarction with low ejection fraction: A preliminary study.

BACKGROUND Serum annexin A5 (anxA5) level is significantly increased in patients with acute coronary syndrome. Hematological indices are significantly increased in patients with ischemic heart disease. This study aimed to demonstrate the changes in the distribution of blood cells and the levels of anxA5 in patients presented with significant low ejection fraction ST-elevation acute myocardial infarction (STEMI) in comparison with corresponding patients with ischemic heart disease. METHODS Patients with low ejection fraction presenting at Hospital of Diyala University of Iraq were enrolled. Electrocardiograph (ECG), echocardiograph, hematological indices, serum annexin V (anxV) levels and the determinants of the cardio-metabolic risk factors were performed. Based on clinical examination, ECG findings and laboratory tests, patients were divided into healthy subjects (n=20); patients with acute MI (n=40) and with chronic MI (n=12). RESULTS Acute MI has significant high levels of serum triglyceride, uric acid and high mean value of red cell distribution width (RDW) compared with healthy subjects and chronic MI. Platelet distribution width (PDW) is significantly reduced in patients of acute MI and chronic MI compared with healthy subjects, whereas the plateletcrit (PCT) is significantly higher in acute MI compared with healthy subjects. There is an insignificant difference between the means of serum anxA5 levels of acute MI (35.6±7.2ng/ml) and chronic MI (32.4±8.9ng/ml), but significantly higher than the cutoff level of the healthy subjects (5ng/ml). CONCLUSIONS Measurement of serum annexin level is a useful diagnostic marker of acute or chronic MI with low ejection fraction.

Saliva C-reactive protein as a biomarker of metabolic syndrome in diabetic patients

Background: Human C-reactive protein (CRP) has been used in the risk assessment of coronary events. Human saliva mirrors the body′s health and well-being and is noninvasive, easy to collect, and ideal for third-world countries as well as for large patient screening. Aims: This study aimed to screen the saliva CRP qualitatively in patients with diabetes (Type 1 and 2) taking in considerations, the diagnostic criteria of metabolic syndrome. Setting and Design: Center for diabetes mellitus, prospective study. Materials and Methods: A total number of 50 Type 2 diabetes (T2D) patients, 25 Type 1 diabetes (T1D) patients, and 25 healthy subjects were recruited from the center for diabetes mellitus. Each patient was assessed clinically, and the anthropometric measures, glycemic status, and lipid profiles were determined. Stimulated salivary flow rate and saliva CRP were determined. Statistical Analysis: All calculations analysis was made using Excel 2003 program for Windows. Results: The results showed that the salivary flow rate in T1D was less than healthy subjects and T2D and CRP was found positive (6 mg/L) in 36% and 56% of patients with T1D and T2D, respectively. Saliva CRP was found to be related to the anthropometric measurement, blood pressure, and glycemic control. Conclusions: We conclude that saliva CRP may be used as a biomarker for metabolic syndrome and its value is obvious in T2D rather than in T1D.