Diabetes Treatments

For induction of diabetes, STZ was used at a single dose. Insulinopenic diabetes was induced by STZ, two weeks later, 30 minutes of …

Op1 The Effect of Metformin on serum Homocysteine, Vitamin B12 and Folic
acid in NIDDM Saudi patients
Duaa Hammoda
dhammoda@yahoocom
Objective: to determine the effect of metformin on the levels of serum
homocysteine Hcy, serum vitamin B12 and folic acid in non insulin
dependent diabetics and the relationship between the metformin
exposureduration and dosage and serum Hcy and vitamin B12
Materials and methods: the cross sectional study was conducted to assess
the effect of metformin treatment on serum Hcy, vitamin B12 and folic acid
in 99 non insulin dependent diabetics, aged between 33-79 years, at Om
Alhamam clinics, National Guard hospital, Riyadh, Saudi Arabia Among
those, 35 and 64 patients were assigned to metformin and non metformin
groups based on their records of receiving metformin, minimum of 6 months
before commencing the study Fasting blood was drown and analyzed for serum
Hcy, using the Fluorescence Polarization Immunoassay technology and vitamin
B12 and folic acid using
the Immunoassay method
Results: Serum Hcy showed no significant difference p025 among the non
metformin group compared with the metformin group731 185 vs793289
Umol/L There was a significant difference p002 in the serum vitamin
B12 among the patients in the non metformin compared with the metformin
group 3668611415 vs31016118 Pmol/L However, there was no
significant difference p 078 in folic acid between patients in the non
metformin and those in the metformin group 25741215vs2508 1031
Nmol/L There was very weak, not significant correlation between serum
Hcy and the duration of metformin intake and the amount of metformin taken
Conclusion: Although the direct effect of metformin treatment on the serum
Hcy couldnt be concluded, it was found that there was a significant
depletion of serum vitamin B12 among patients who had been on specific
dosage of metformin Thus vitamin B12 supplements are recommended
OP2 The hypoglycemic effect of oral administration of
allium ampeloprasum in streptozotocin induced diabetic rats

Mahbubeh Aghaei
Department of Physiology, School of Medicine,
Shahed University, Tehran,
Iran
mahbub2006aghaei@yahoocom

Objective and backgrounds: Allium ampeloprasum the Wild Leek or Broadleaf
Wild Leek is a member of the onion family, Alliaceae It is native to
Southern Europe and Western Asia Due to anti-diabetic effect of Allium
ampeloprasum AA, its hypoglycemic effect was investigated in
streptozotocin-diabetic rats

Methods and materials: For this purpose, rats n 36 were randomly
divided into control, AA-treated control, diabetic, and AA-treated diabetic
groups For induction of diabetes, STZ was used at a single dose The
treatment groups received oral administration of AA-mixed pelleted food
625 for one month

Results: Statistical analysis of the data showed that serum glucose level
in diabetic group increases 4 weeks after the experiment as compared to
data one week before the study P0001 and AA treatment of diabetic rats
reduced serum glucose level as compared to untreated diabetic group
p005 Meanwhile, AA-treated control group did not show any significant
reduction in this parameter as compared to
untreated control group To
conclude, these results showed that oral administration of Allium
ampeloprasum in long-term could significantly reduce serum glucose level in
diabetic rats

Key words: Allium ampeloprasum, Diabetes Mellitus, Serum Glucose level, Rat

OP3 Effect of Some Calcium Channels Blockers in Experimentally Induced
Diabetic Nephropathy in Rats

Wael MYousef1; Adel H Omar1; Mohamed D Morsy2; Moshira M Abd El-
Wahed3; Naglaa M Ghanayem4

1Department of Clinical Pharmacology, Faculty of Medicine, Menoufiya
University, Egypt
2Department Physiology, Faculty of Medicine, Menoufiya University, Egypt
3Department of Pathology, Faculty of Medicine, Menoufiya
University, Egypt
4Department of Biochemistry, Faculty of Medicine, Menoufiya
University, Egypt

1Corresponding author address: Wael Mohamed Yousef, Department
of Clinical Pharmacology, Faculty of Medicine, Menoufiya
University, Egypt E-mail address: waelpharma@yahoocouk

Introduction Aim: Diabetic nephropathy
DNP is considered a CRD Chronic
Renal Disease; it is a major cause of illness and premature death in
people with DM Furthermore, it is considered the single most important
cause of end stage renal disease in the western world and accounts for more
than a quarter of all end stage renal diseases The present study was
designed to illustrate the role of CCBs amlodipine and diltiazem in
prevention and treatment of DNP in rats

Materials Methods: Eighty male albino rats weighing 130-180gm were used
in this study These animals were subdivided into five equal groups
Insulinopenic diabetes was induced by STZ, two weeks later, 30 minutes of
complete ischaemia was induced in the left kidney to induce diabetic
nephropathy then treatment was started for 12 weeks At the end of
experiment urine samples and blood samples were taken for biochemical
analysis and kidneys were taken after scarification for histopathological
evaluation

Results: Combination of renal ischaemia with DM produced a significant
increase in rat weight, rat kidney weight, BUN Blood Urea Nitrogen level,
K/B Kidney/Body weight ratio, random blood
glucose, 24 hrs urine
proteins, and 24 hrs urine volumes and creatinine clearance Treatment with
diltiazem or amlodipine significantly lowered elevated SBP and elevated 24
hrs urine volumes Furthermore, treatment with captopril produced a highly
significant lowering of elevated SBP and elevated serum creatinine; and a
significant reduction in elevated K/B ratio and proteinuria Light
microscopic examination of diabetic kidneys revealed glomerulopathy
characterized by thickening of the glomerular basement membrane, mesangial
matrix expansion, arteriolar hyalinosis and large proteinaceous deposits
occluding some capillary loops and hyaline droplets within the glomeruli
Moreover, examination of kidneys of ischaemic animals by light microscope
revealed focal tubular necrosis at multiple points along the nephron,
interstitial edema and accumulation of leucocytes within dilated vasa
recta

Conclusion: It can be concluded that, renal ischaemia hasten the
progression of DNP, diltiazem and amlodipine have a tendency to reverse of
changed parameters toward normal values except biochemical parameters,
generally
speaking, diltiazem is better than amlodipine in reversing
biochemical and histopathological changes produced by DNP, and captopril
reversed most of changed parameters except histopathological changes

Recommendations: Based on the obtained results from the present study, one
can recommend that; 1 Diltiazem and amlodipine have a nephroprotective
effect in DNP, therefore, they should be used in diabetic patients to
protect and/or slow progression of DNP 2 Captopril might be considered
the first therapy for DNP Moreover, combination of captopril with CCBs
could be a more effective tool got protection and/or slow progression of
DNP
Key words: Diabetic Nephropathy, Diltiazem, Amlodipine, Calcium Channel
Blockers, Diabetes Mellitus, Ischaemia
OP4 The Effect Of Self Management On Type2 Diabetes Self Care,
Psychological Adjustment And Blood Glucose Control

Dr Hanan Abdel-Aziz, Cairo University
OP5 Role of copper in diabetes and cardiovascular
Disease: Is there a future

Bashir Rezk
Cardiovascular Pathology

Institution Organization LSU Health Sciences Center
Department of Pharmacology Experimental Therapeutics
brezka@lsuhscedu
USA

Bashir M Rezk, Ryan Reed, Kurt Varner, Pamela A Lucchesi

Department of Pharmacology Experimental Therapeutics, Louisiana State
University Health Sciences Center, 1901 Perdido St, Suite 701, New
Orleans, LA 70112-1393,

In diabetic patients, homocysteine and oxidative stress are increased
Collectively, hyperglycemia, hyperhomocysteinemia and oxidative stress
are believed to play major roles in the development of diabetic vascular
disease which is a major cause of morbidity and mortality in diabetics
Recently, the potential therapeutic effect of copper, a redox active
essential nutrient metal, in treating vascular disease has received a
great deal of attention The mechanism by which copper induces its
therapeutic effect, however, is not fully understood We investigated the
effect of copper on hyperhomocysteinemia and/or hyperglycemia in cultured
rat aortic smooth muscle cells
VSMC TUNEL assay showed that
homocysteine 150 M induced apoptosis in VSMC This apoptotic activity
was enhanced under hyperglycemic conditions Paradoxically, homocysteine
increased intracellular glutathione GSH levels on the one hand, and
markedly elevated the concentrations of glutathione disulphide GSSG on
the other hand Surprisingly, copper II sulfate 50 M abolished the
apoptotic activity of hyperhomocysteinemia and/or hyperglycemia Our
results indicate that the apoptotic activity of hyperhomocysteinemia
and/or hyperglycemia might be due to production of superoxide anion,
reduction of GSH/GSSG ratio and activation of caspase-3 The
antiapoptotic activity of copper seems to be due to its reaction with
homocysteine, quenching of superoxide anions and reduction of caspase-3
activity This remarkable effect of copper might strengthen our
therapeutic arsenal against different diseases

OP6 Preoperative Management of the Diabetic Patient

DR A ALI SHER
aalisher@hotmailcom

Alisher I Agzamov, A M Al
Qattan

Department of Anaesthesioligy, Al Sabah Hospital, Kuwait City, Kuwait

The diabetic patient has major surgery more frequently than nondiabetic
patients Although many of these operations are done on an elective basis,
desirable preoperative control of blood glucose ranging from 120-180
mg/dL remains a therapeutic challenge In planning the management, the
type of diabetes, current treatment, the degree of recent control, the
presence of complications, and the type of surgical procedure must all be
considered

All insulin-dependent patients and many non-insulin-dependent patients need
insulin therapy preoperatively

The variable stress associated with major procedures makes a flexible
insulin regimen desirable This can be provided using a continuous insulin
regular infusion system and frequent bedside blood glucose monitoring
OP7 Correction of Hyperglycemia using autologous bone marrow-derived stem
cells transdifferentiated into islet cells
Hala Gabr M Ahmed
hlahmed@yahoocom
H Gabr1, S Nasr2, H Mostafa2, M Awn2
1 Department of Clinical
Pathology, Faculty of Medicine, Cairo University,
Egypt
2 Department of Internal Medicine, Faculty of Medicine, Cairo University,
Egypt
Introduction: The beta islet cells of the pancreas are the only cells that
exhibit appropriate glucose-responsive insulin secretion Transplantation
of these cells can establish exogenous insulin independence Toxic effects
of lifelong immunosuppression needed to prevent graft rejection, and
shortage of organs available for transplantation have restricted the number
of patients who receive pancreatic transplants
Adding this information to the new data of stem cell plasticity lead to the
assumption that autologous bone marrow stem cells BMSCs or umbilical cord
blood stem cells UCBSCs can be driven to transdifferentiate into insulin-
producing cells

Methods: After informed consent, 10 adult BM samples and 5 full term cord
blood samples were taken After mononuclear cell separation, adherent stem
cells were derived from cultures of unsorted BM and UCB cells The
unattached cells were removed after 2-7 days of culture, with spindle-
shaped
adherent cells cultured for an additional 2-3 weeks in low
55mmol/l and high 23mmol/l glucose medium Cells were then released
from surface with trypsin-EDTA and cultured with the addition of exendin-4
for 7-10 days Total mRNA was extracted and insulin mRNA detected using
pancreatic biopsy as control

Results: CD34 cell fell from 803 in BM and 118 in UCB samples to
105 and 144 respectively after primary culture Insulin mRNA was found
in five samples 50 of BM cultures in high glucose medium and none in
samples cultured in low glucose medium; and was found in 2samples 40 of
UCB samples cultured in high glucose medium and none of samples cultured in
low glucose medium

Conclusion: Adult bone marrow and UCB stem cells can be a valuable source
of beta islet cells under proper conditions High glucose medium is more
effective in stimulating insulin secretion than low glucose medium
Manipulation of the culture conditions to reach more efficient Trans
differentiation is essential

OP8 Determination of asymptomatic intracranial arteries stenosis in
diabetic patients with hypertension older than 50 years by

transcranial doppler sonography

Farzaneh Sarvghadi
fsarvghadi@yahoocom
Sarvghadi F Karimi M Azizi F
Endocrine research center, Shaheed Beheshti University of Medical Sciences

Introduction: Stroke is one of the most common causes of mortality and
morbidity Old age, diabetes, hypertension and hyperlipidemia are strong
risk factors The aim of this study was determination of cranial arteries
stenosis in old diabetic patients with hypertension by Transcranial Doppler
Sonography TCD

Methods: For this survey June 2003 -Dec2004 all diabetic patients older
than 50 years with hypertension and no previous history of cerebrovascular
problems were invited, and after completion of a questionnaire, evaluation
of peak systolic flow velocity PSV was done in middle cerebral MCA,
internal carotid ICA and vertebral arteries VA by TCD, PSV 120 cm/sec
for MCA and ICA and PSV 100 cm/sec for VA was defined as significant
steno se Results: 108 patients 51 female, 57 male aged 6251 790
years were studied 22 203 patients 11male, 11 female had stenosis
and 34 314 stenotic
arteries were also detected 8 were in VA, 8 in ICA
and 18 in MCA 7out of 22 patients 32 had multiple stenosis Mean age of
22 patients with and 86 without stenosis were 6209 671 and 6250 823
years respectively, P NS Mean duration of hypertension between these two
groups were 536 8oo and 307 339 years respectively P NS, also
duration of diabetes was1409 842 and 832 690 years respectively P
001

Discussion 20 of our patients had significant stenosis that increases risk
of stroke due to hemodynamic changes One third of them had multiple
arteries involvement Also half of the stenosis was in MCA There was a
strong correlation between duration of diabetes and occurrence of stenosis,
so periodically evaluation of old diabetic patients with hypertension for
early detection of cranial vessel involvement is recommended by TCD

Op9 Role of Community Health Nurse in Prevention and Early Detection of
Diabetes mellitus

Dr Mona Shnoda , Cairo University

OP10 The effects of coadministration of testosterone or Progesterone and
verapamil on serum insulin level

Rahim
Ahmadi, Islamic Azad University, Hamedan Branch, Iran

Laszlo Rosival, Semelweis International University,Hungary

Shahrbanoo Oryan,Teacher Training University ,Tehran,Iran

Kazem Parivar, Teacher Training University, Tehran, Iran
Rahahmadi2001@yahoocom

Background and Aims: Verapamil raises insulin secretion by direct
inhibiting of KATP channels in pancreatic B-cells On the other hand, the
hormones testosterone and progesterone can influence insulin secretion,
however, the results in this field are some conflicting and confusing This
study was done to know whether testosterone or
Progesterone can influence verapamil effects on insulin secretion in rats

Materials and Methods: Verapamil 100 mg/kg/day was administered in
drinking water Testosterone enantate 10 mg/kg/day or progesterone 20
mg/kg/day were injected intraperiotenally or subcutaneously, respectively
After 4 weeks, blood samples were collected and serum insulin was measured

Results: In male rats, varapamil, testosterone or \verapamil
testosterone\ administration resulted in increasing of insulin secretion
P001,
P005 and P0001, respectively; however, there was no
significant difference between serum insulin level of these 3 groups In
female rats, verapamil caused to increasing P001 and progesterone or
\progesterone verapamil\ resulted in decreasing of
Serum insulin P0001

Conclusion: The findings of our study indicate that the effect of verapamil
on insulin secretion is not influenced by testosterone 10 mg/kg/day for 4
weeks However, progesterone 20 mg/kg /day for 4 weeks can prohibit
the verapamil effect on insulin secretion

Key words: Serum Insulin, Verapamil, Testosterone, Progesterone

OP11 The effect of educational intervention and change in
Lifestyle on cardiovascular risk factors
Reza Rikhtegar
rrmediran@yahoocom

Background: Cardiovascular disease CVDs is one of the major causes of
death in the world Obesity and related factors play important Role in
vulnerability to CVDs Chang in lifestyle and an increase in Knowledge can
prevent or reduce CVDs development

Objective: To assess the effect of educational program and lifestyle
Change on
CVD-related risk factors

Method: One hundred patients with CVDs referred to Shahid Madani Hospital
were selected and randomly divided in two group as intervention n50 and
control n50 Blood pressure, biochemical parameters inc fasting serum
glucose, Triglyceride TAG, Total cholesterol TC, HDL and LDL
cholesterol were assessed at baseline BMI and waist to hip ratio WHR
were estimated

A face to Face continuous educational program was preformed for
intervention group over nine months, compared with controls without any
intervention All parameters were assessed at the end of study Data were
analyzed using SPSS ver115 software

Results: results showed a reduction in BMI 2727kg/m2 vs 2632 kg/m2 and
WHR 101 vs 098 in intervention group wherever no change was found in
controls Serum glucose decreased 1281 mg/dl vs 1158 mg/dl in
intervention group compared with 1349 mg/dl vs 1347 mg/dl in control
group However, these reductions were not statistically significant Not
only in intervention group but also between the two groups

Conclusion: our finding showed decreases but not significant in CVDS risk
factors follow
in the educational intervention however, future
investigation is required

Key word: CVDs, risk factors, lifestyle, educational intervention

OP12 Preparation and in vitro evaluation of linear and
Star-shaped PLGA nanoparticles for insulin delivery
Soodabeh Davaran
davaran@tbzmedacir

The bioavailability of peptide and protein drugs after oral administration
is very low because of their instability in the gastrointestinal tract and
low permeability through the intestinal mucosa

Development of a dosage form that improves the absorption of peptide and
protein drugs via the gastrointestinal tract is one the greatest
challenges in the pharmaceutical field Several approaches such as
chemical modification of peptide drugs, the use of an absorption enhancer,
the use of a protease inhibitor to protect drugs against degradation by
enzymes, the use of colon delivery,and the use of liposomes, have been
investigated in order to achieve oral peptide delivery

There is an increased interest in developing biodegradable nanoparticles
since they offer a
suitable means of delivering small molecular weight
drugs, proteins, peptides or genes by either localized or targeted
delivery to the tissue of interest Recently it
was shown that oral application of polymeric nanoparticles containing
insulin is useful in prolonging the duration of drug effect Enhancement
of oral insulin absorption in polymeric nanocapsules was reported

In present article we have reported the synthesis and characterization of
linear , poly D, L- lactide-co-glycolide PLGA- poly ethylene glycol
PEG-PLGA and star-shaped 946;- cyclodextrin- PLGA 946;-CD-PLGA and
glucose- PLGA Glu-PLGA copolymers containing insulin as a model peptide
drug

Bovine insulin was successfully encapsulated into the linear and star-
branched PLGA nanoparticles with retention of insulin stability and the
nanoparticles preparation process was optimized to reduce the burst effect
and provide in-vitro sustained release The average particle size of
samples was 120- 355 nm The cumulative amount of 65-84 insulin was
released from the samples after 24 days The yield of encapsulation of
insulin was superior to 95 The
in-vitro results suggest that the novel
PLGA nanoparticles could be used as a carrier for prolonged delivery of
protein-peptide drugs

OP13 Celiac Disease and Type1 Diabetes

DR SOHAIR ABDEL RAHMAN
sabdelrahman@kfmcmedsa

1-incidence prevelance of celiac disease among diabetics

2-presentation of celiac disease at different ages

3-diagnosis of celiac disease

4-management difficulty in third world

5-need for awareness campaign among health professionals the public

OP14 Bladder control problems in women

With type 2 diabetes

ABEER WILLIAM
JAKLEEN FAHIM
Ain Shams University

The chance of having urinary incontinence, or poor bladder control, is
much higher in women who have diabetes than in women who dont have
diabetes

The researchers found that women with diabetes and women with impaired
fasting glucose had bladder control problems more often One out of three
women reported having urinary incontinence at least
once a week

Having diabetes and being overweight or obese has been shown to be
connected to loss of bladder control for a number of reasons First, being
overweight or obese means that there is more fat in the body that can put
pressure on the bladder Second, people who are overweight or obese are
more likely to develop type 2 diabetes and, in turn, nerve problems and
infections that can cause the muscles of the bladder to weaken Third,
people with diabetes, especially those taking insulin, are more likely to
get urinary tract infections, which can also lead to the loss of bladder
control

Treatments for bladder control problem vary from learning special
exercises and diet to taking medications or to having surgery

OP15 Primary care and type 2 diabetes mellitus
Carlos Sánchez Fernández De La Vega
Health center fingoy Sergas Lugo Spain

camesues@mixmailcom

Introduction: The proportion of type 2 diabetesmellitus increases
progressively and we could possibly consider it together with arterial
hypertension and dyslipidaemias as the great
epidemy in the 21st century

Aims: This is a clinical methodology to use in primary care to detect,
evaluate, and follow the patients affected of type 2 diabetes mellitus It
is very single and we give the patients information about their risk
profile, trying to involve them in a personalized health care plan

Method: It is used in the patients with any of three major cardiovascular
risk factors Its based on formulating 5 questions and the order in which
these questions have to be formulated for attain answers

A/ It is a true diabetes mellitus? first step

B/ Its essential or secondary diabetes? second step

C/ Which is the systemic and organic damage at the time of diagnostic?
third step

D/ What diagnostic test have we used to value the damage? fourth step

E/ Which is the optimal treatment for each patient ? fith step

Each question 5 questions has a step to follow 5 steps and so we
obtain an answer These steps are constituted by specific items, that will
improve the ability of the professionals physicians and nurses in the
management of these patientsThe answers will be obtained during the
clinical evaluation of the patient and
following 5
consecutive steps This procedure is also used for the evaluation of any
cardiovascular risk factors Diabetes mellitus/ Dyslipidaemia with little
variations

Results: Using this methodology, it is possible to define an
individualized clinical profile related with:

1 Type of prevention that is carried out primary /secondary
2 Degree of metabolic control
3 Measures therapies employees according to the organic and systemic
affectation

Conclusions: The main difference concerning a standardized protocol and
guides, it is the flexibility to apply in the daily clinical practice
Applying this method we can improve:
1 The efficacy and efficiency
2 The collaboration and coordination between family physicians and
medical staff from the hospital
OP16 Affection of the Big Toe in Patients with Diabetic Foot

Dr Abdulhakim Omer Al-tamimi MD
Assis prof Surgical department Faculty of medicine Aden university
,Yemen
Mohmed Almakki Ahmed, MD ,PhD prof of surgery University of Khartoum

abotammam11@yahoocom

Objectives: The aim of this study is to assess the risk factors
precipitating to
big toe ulcer in diabetic foot, healing time, the impact
of this problem on the forefoot, rear foot and whole limb and to estimate
the incidence of amputation and the influence of initial management on the
outcome of the ulcer

Methods: This is a prospective study performed in the period between
September 2004 and March 2005 One hundred twenty two patients 92 males
and 30 females presenting to Gabir-Abuliz diabetic center in Khartoum
city, complaining of diabetic foot affecting the big toe were the base of
this study

Results: There is a significant association between the big toe ulcer in
diabetic patients and the following risk factors: Age more than50 years
844,P003,males 75,P002, occupation were retired group and
housewives 82,8,P002, eye diseases 279 , P004 and family
history positive in 74,P0004

The right big toe was affected in 549, the left in 426 and
bilateral in 25Ninety patients 74,P0003 had blister appeared
after wearing new or tight shoes n41, 336 or spontaneous n38 ,
311 Complete healing within 8 weeks occurred in 533, P004, healing
between 10-20 weeks 435 and more than 30 weeks
in 32
Ostemyelitis 262 were treated by removal of the bones, resulting in
boneless big toe and amputation performed for the distal phalanx 42,
big toe 139, forefoot 16 and below knee amputation 56, and
there is relationship between amputation and the size of the ulcer
P0001

Conclusion: Diabetic foot ulcer affecting the big toe is usually preceded
by blisters which can be prevented Good debridement, control blood
glucose, proper dressing and removal of dead bones can lead to early and
complete healing in most of the ulcers

OP17 Role of free radical in mitochondrial pathway mediated
Apoptosis in human diabetic skin wound

Ghulam Mohammad1, Varun Kesherwani4,YBTripathi2, HPPandey1,
KKTripathi3, J K chaurasia2, Nidhi Pandey2

1 Department of Biochemistry 2 Department of medicinal chemistry,
Institute of medical science 3 Department of medicine, Institute of
medical science 4 School of Biotechnology, Banaras Hindu University
Varanasi 221 005 INDIA

Email: gmk_20@rediffmailcom

In the present study, we have investigated
the role of free radical in
relation to diabetic skin wound healing In our study, we have collected 8
human skin wound sample of late stage 2 human samples are of accidental
case, 2 of chronic untreated diabetic case, 2 from oral hypoglycemic drug
and 2 from insulin treated human We have observed increased free radical
production and decrease antioxidant enzyme activity in chronic diabetic
case as compared to normal accidental case that suggests wound tissue are
in oxidative stress Increase in free radical and lipid peroxidation was
seen in oral hypoglycemic and insulin treated and untreated diabetic
patient as compared with non-diabetic wound Increased free radical
production leads to increase DNA cleavage that results in increased
apoptosis diabetic wound leads to, which resulted in impaired wound
healing

This resulted in mitochondrial pathway of apoptosis as revealed by
increased expression of p53, Bax and down regulation of antiapoptotic
molecule Bcl2, and cleavage of caspase 3 molecules

OP18 Globally Diabetes Is On Rise and Higest among Indians

DrRajendra Gadhavi
drrgadhavi@yahoocom

Introduction: Globally diabetes is on rise and higest among Indians A
Prevalance of diabetes in India is 10 - 15

Objective: The study was done to know the prevalence of diabetes and its
risk factors in urban government officials

Study Design: Cross sectional study

Setting: Sachivalaya of Gandhinagar city, Gujarat, India

Sample Size 590

Method: A pre-tested semi structured proforma administered to the
participants Investigation was done for diagnosing diabetes using FBS
PP2BS

Results: Prevalence of diabetes was highest 19 in class I cadre and
lowest 82 in lower most cadres Overall prevalence rate of diabetes
among study population was 134 with higher rate in males 137 than
females 111 The association between WHR and diabetes prevalence among
male employees was found statically significant in cadre I, cadre III,
cadre IV and all cadre combined Prevalence rate of diabetes in low
income group was found to be 1060 , in middle-income group to be 1469
and in high-income group to be 1504 The family history was positive in
4936 among diabetic compare to
1761 among non-diabetic and the
difference was statistically significant The prevalence of hypertension
was 481 in diabetic compare to 307 in non-diabetic and the
association between hypertension and diabetes has been found statically
highly significant

Conclusion: Overall prevalence of diabetes is high overall particularly in
males High income group, positive family history, hypertension, BMI and
sedentary life style were contributing factor for it

OP19 Insulin resistance

Dr, Ahmed Atwaa
Lecturer Asuit University

OP20 Methodologie to Use in Type 2 Diabetic Patients

Sadique Ahmed Bugti, Perwaiz Ahmed Patoli,Jan Muhammad,
Aftab Ahmed Shaikh
Viena

bugtisadique@yahoocom,perwaizpatoli@gmailcom,janmuhd@yahoocom,
aftabshaikhs@hotmailcom

Knowledge based systems have clearly demonstrated the potential for
substantial impact in a number of diverse areas The successful
construction of such knowledge based systems has required
that it be
possible to encode sufficient domain expertise within a machine maniputable
form to support intelligent problem solving behaviour We have focused our
consultation on acceleration of the correct diagnosis statement, early
commencement of sufficient treatment and at last but not atleast, on
providing of qualified evaluation of treatment by the specialized center
To develop a medical data warehouse and to devise a medical system programs
that reason for the doctor Specialized areas we may be content to
compartmentalize the knowledge and embed it in a machine that provides
doctor with high quality solution as long as the machine can explain
those solution to doctors satisfaction To describe knowledge
discovery in telemedicine database with inference To organize the medical
data warehouse and apply some rules to extract data
OP21 Musculoskeletal Complaints among Nursing Personnel In Shiraz
University

GholamzadehSakineh
sakinghsir@yahoocom
Introduction: Work related musculoskeletal disorders have been described as
one of the main health
problems among healthcare workers

Objective: To investigate the relationships between physical, psychosocial,
and individual characteristics and musculoskeletal complaints among nursing
personnel in Shiraz University Medical Science hospital -Iran

Methods In this study a questionnaire survey was carried out among 467
nursing personnel response 80 in 3 teaching hospitals in Shiraz, Iran
Self-administered questionnaire was distributed by the researchers The
questionnaire involved information on the respondent\s job and employment
history, weekly working hours, individual characteristics, physical and
psychosocial risk factors at work, and the occurrence of musculoskeletal
complaints in the past 12 months

Results: The subjects consisted predominantly of women 80, with ages
less than 35 years 81A high proportion of nurses 95 reported MSD at
some body site ,with low back pain being the most common condition 775
This was followed by MSD of the knee 656, upper back 558, Tibia
554, neck 528, wrist 470 MSD in these area was significantly
correlate with psychological risk factors P0001BMI in majority of
persons 657 was normal between
185-249 and MSD in some area same
low back pain, shoulder, neck was significantly correlate with
BMp005also we determined correlation between other physical and
individual characteristics with MSD

Conclusion: this investigation suggests that MSD is more frequent among
nursing personnel in Shiraz university Medical science hospital in Iran,
when compared to around the world

OP21 Psychosocial aspects of juvenile diabetes in the UAE: a
Controlled study

Valsamma Eapen UAE
veapen@uaeuacae

Objectives: Psychological well being and coping in the context of chronic
physical illness is a challenge for children as well as their families
However, in the era of increasingly sophisticated and high technological
medicine and surgery, it is all too easy to overlook the
Emotional needs of the child and the family In this study, parental
attitudes, childs self-perceptions, and familys coping were studied in 30
children with Juvenile Diabetes and 30 control subjects

Methods: The above subjects, ascertained through the Central School
Health
Clinic in Al Ain, UAE, were evaluated using Harters Self Perception Profile
for Children SPPC, and the parallel parent version Other relevant
Individual, Family and Psychosocial variables were also explored

Results: On Harters Self Perception Profile for Children SPPC, children
with Diabetes scored themselves more negatively than their parents on all
the sub-scales Social Acceptance, Athletic Competence, Physical
Appearance, and Behavioral Conduct except Scholastic Competence On the
sub-scales, children with Diabetes showed significantly lower scores in the
areas of Physical Appearance P0022 and Athletic Competence P0023
when compared to control subjects Age was significant only for the
Behavioral Conduct subscale, with the older children scoring themselves
more negatively than their younger counterparts P0037 There were
significant differences between girls and boys in their scores in the areas
of Global Self Worth P0007, Athletic Competence P0005, Physical
Appearance P0002, and Behavioral Conduct P0023, with boys showing a
more positive perception of themselves as compared to girls With regard to
family
variables, we found that maternal education and availability of
social support were the most important determinants for the young person
with Diabetes in maintaining a positive self- image
Furthermore, there was an association between children exhibiting
behavioral/emotional problems and a higher score on the parental General
Health Questionnaire Family income was found to be a significant factor
for having a positive score on the Social Acceptance domain but this was
not
important for the other domains

Conclusion: Awareness of significant family factors and understanding the
domains of self-competence and self-worth which are vulnerable in children
with Diabetes can help health care providers to target these issues and to
offer the appropriate psychosocial intervention

OP22 Coping with Diabetes in Children
Dr Naglaa Grgis, Banha University
Lecturer of community health nursing

Diabetes is a chronic illness that causes an of abnormal rise in the
level of sugar in the blood, due to the inability of the pancreas to
secrete insulin the hormone responsible for regulating sugar
level in the
blood When the child develops with diabetes it will stay with him for the
rest of his life and the child becomes a special child, one who changes the
perspective of the whole family and its entire way of life Adjusting to
diabetes takes time, and dealing with it is a daily challenge Coping with
diabetes in children act as behavior that protects them from being
psychologically harmed by problematic social experience Coping serves a
protective function that can help the child through some strategies as
encourage the child to be a team captain, learn about diabetes, share with
family and friends, talk to others with diabetes, talk about feelings, try
to re-focus, adapting to change and stress relievers So in diabetes, the
stressor is usually assumed to be the chronic demands of having diabetes
with which one most cope and that coping leads to certain metabolic and
psychosocial outcomes
OP23 Strategies for Life Style Modification in prevention of Diabetes

DrHanan Ebrahim Abd El Aziz
Lecturer of psychiatric
Mental Health Nursing

Adult
lifestyles are laid down in childhood and adolescence It is
difficult to change social patterns encompassing diet, physical
activity and risk taking behavior like smoking, and alcohol
consumption Passive entertainment exemplified by television viewing
and computer games, along with intake of meals being isolated rather
than social events all contribute to disorders of lifestyle Modern
man prefers to rely more on pills than life style changes in order to
manage his health These human tendencies must be considered in
planning future health maintaining strategies

Viewed from a wider perspective, the objectives of health policy,
ie health, healthy lifestyle and risk-taking behavior depend on what
the public perceives as the most acceptable pattern of life It is
essentially a political decision to which doctors make small if any
contribution There is little purpose in detecting the disease,
stratifying the risk and attempting to promote change in behavior, if
ultimately medical advise is not followed It is essential that the
doctor, who knows more about the clinical
situation, should
communicate with the patient, in order to allow her a reasonable
choice of participating in treatment Ultimately, implementing
prevention and treatment measures needs sustained confidence of the
public and the individual patients The management approach to
diabetes must be from a proactive public health perspective, rather
than a reactive, traditional medical perspective Using the Social
Cognitive Theory it is possible to identify risk factors, how people
acquire and maintain behavioural patterns, and intervention models
that preclude the need for costly pharmacological and medical
intervention

OP24 Patient information: Preventing complications in diabetes mellitus

Dr Inass Helmy Hassan

Lecture in Community health nursing
INTRODUCTION: Diabetes mellitus is a chronic condition that can lead to
complications over time These complications include:
Coronary heart disease, which can lead to a heart attack
Cerebrovascular disease, which can lead to stroke
Retinopathy disease of the eye, which can lead to blindness

Nephropathy disease of the kidney, which can lead to kidney failure
and the need for dialysis
Neuropathy disease of the nerves, which can lead to, among other
things, ulceration of the foot requiring amputation
Many of these complications produce no symptoms in the early stages, and
most can be prevented or minimized with a combination of regular medical
care and blood glucose monitoring
CONTROLLING BLOOD SUGAR - the long-term complications of diabetes result
from the effects of hyperglycemia elevated blood glucose levels on blood
vessels Two important studies, the Diabetes Control and Complications
Trial DCCT in patients with type 1 diabetes and the United Kingdom
Prospective Diabetes Study UKPDS in patients with type 2 diabetes, found
that patients with lower blood glucose values had fewer complications than
those with higher values
Thus, keeping blood sugars close to normal can help prevent the long-term
complications of diabetes mellitus However, there are some risks
associated with tight control, particularly an increased risk of
hypoglycemia low blood sugar
Monitoring blood sugar levels -
Monitoring blood sugars with finger sticks
at home can indicate how well diabetes is controlled and serves as a guide
to adjusting therapy See Patient information: Self-blood glucose
monitoring For most patients, a target for fasting blood glucose and for
blood glucose levels before each meal is 80-120 mg/dl; however, these
targets may need to be individualized for a patient by their doctor or
health care team
A blood test called A1C is also used to monitor blood sugar control; the
result provides an average of blood glucose levels during the previous one
to three months An A1C of 7 percent or less is recommended; this
corresponds to average blood glucose of 150 The target may be somewhat
higher in patients who are older or who have other conditions that increase
the risks associated with hypoglycemia Patients who are unable to reach
this goal can be reassured that even small decreases in A1C lowers the risk
of diabetes-related complications to some degree
The combination of A1C and finger stick blood sugars provides information
about the average blood sugar as well as daily fluctuations in blood sugar
Type 1 diabetes -
Blood sugar control in type 1 diabetes requires some form
of insulin, which can be given with insulin injections, an insulin pump, or
a combination of inhaled insulin and insulin
During a foot examination, the clinician will look for changes such as
ulcers, cold feet, thin skin, bluish skin color, and skin breaks associated
with athletes foot The clinician will also test the sensation in the feet
to determine if it is normal or diminished Patients with decreased
sensation are at risk for foot injuries that are unnoticed due to lack of
pain
KIDNEY COMPLICATIONS - Diabetes can alter the normal function of the
kidneys A urine test which measures the amount of protein albumin in the
urine can alert a healthcare provider that diabetes is affecting the
kidneys filtering action Microscopic amounts of albumin in the urine
microalbuminuria can be an early indicator of diabetes-related kidney
complications called nephropathy The amount of albumin in the urine can
also help the provider determine if nephropathy is worsening See Patient
information: Protein in the urine proteinuria
Urine screening tests should begin in people with type 1
diabetes about
five years after diagnosis, and in people with type 2 diabetes at the time
of diagnosis If the test shows that there is protein in the urine, tight
blood glucose and lipid control are recommended; a medication may be
recommended if albuminuria does not improve
A blood pressure medication an ACE inhibitor or angiotension receptor
blocker [ARB] is generally recommended for patients with albuminuria that
does not improve, even if blood pressures are normal Patients with
elevated blood pressures and albuminuria are also treated with an ACE
inhibitor or ARB These medications decrease the amount of protein in the
urine and can prevent or slow the progression of diabetes-related kidney
disease
HYPERTENSION AND RELATED COMPLICATIONS - Many people with diabetes have
hypertension high blood pressure Although hypertension produces few
symptoms, it has two negative effects: hypertension stresses the
cardiovascular system and increases the progression of diabetic
complications of the kidney and eye A healthcare provider can diagnose
hypertension by taking regular blood pressure measurements
See Patient
information: Overview of Hypertension
A blood pressure reading below 130/80 is an ideal goal for most people with
diabetes who do not have kidney complications; a lower blood pressure goal
120/75 may be recommended for people with diabetes who have kidney
complications
If a patient is diagnosed with prehypertension 120/80, the healthcare
provider may recommend weight loss, exercise, decreasing the amount of salt
in the diet, quitting smoking, and decreasing alcohol intake These
measures can sometimes reduce blood pressure to normal See Patient
information: Hypertension; diet and weight
If these measures are not effective or the blood pressure must be lowered
quickly, the provider will likely recommend one of several antihypertensive
medications The provider can discuss the pros and cons of each medication
and the goals of treatment
CARDIOVASCULAR COMPLICATIONS - In addition to lowering blood glucose
levels, a number of other measures are important to reduce the risk of
cardiac disease
Quit smoking
Manage high blood pressure with lifestyle modifications and/or
medications
Patients should
have a fasting lipid test to measure cholesterol and
triglycerides, and modify their diets Some patients may need
medication to lower their LDL bad cholesterol or trigylcerides, if
they are high
If medication is needed, a statin drug should be included whenever
possible The statin drugs have been shown to decrease the future risk of
heart attacks, strokes, and death in people with diabetes who are over age
40, even when cholesterol levels are normal The American Diabetes
Association recommends that patients with diabetes have a low density
lipoprotein LDL cholesterol level less than 100 mg/dL Some studies
suggest lowering LDL to 70 to 80 mg/dL See Patient information:
Hyperlipidemia High blood cholesterol
Aspirin 81 to 162 mg per day is recommended for all persons with
diabetes over the age of 40 years See Patient information: Aspirin
and cardiovascular disease
PREGNANCY AND DIABETES - Control of diabetes and its potential
complications is especially important in women planning to become pregnant,
as well as in those who already are pregnant Controlling blood
glucose
levels before and during pregnancy decreases the risk of a number of
complications in both the mother and the baby A separate topic review is
available on this subject See Patient information: Care during pregnancy
for women with type 1 or 2 diabetes
Pregnancy can cause a worsening of diabetic retinopathy Thus, women with
type 1 or 2 diabetes who become pregnant should have an eye examination by
an ophthalmologist or optometrist during the first trimester three months
of their pregnancy The frequency of subsequent eye exams during pregnancy
will depend upon the results of the initial examination In most cases,
doctors recommend eye exams every three months until delivery
These guidelines do not apply to women who have gestational diabetes — a
form of diabetes that develops during pregnancy and usually resolves after
delivery These women are not at risk for diabetic retinopathy
THE IMPORTANCE OF REGULAR MEDICAL CARE - Regular medical care is critical
to long-term health for people with diabetes, particularly when it comes to
preventing, detecting, and slowing the progression of complications A
healthcare provider can recommend a
regular schedule for visits, screening,
and monitoring tests based upon a patients type of diabetes 1 or 2, the
duration of the disease, the presence of any complications, and the
presence of other underlying medical problems

In addition to diabetes care, patients also need to be sure they have
regular screening for other health problems For women, this may includes a
cervical cancer screening, mammogram and clinical breast exam, and bone
density testing For men, prostate cancer screening is recommended after
age 40 For both men and women, colon cancer screening is recommended after
age 50

OP25 The Benefit Effect of Vitamin E on Zinc Deficiency in IDDM
Kechrid Zine
zinekechrid@yahoofr
Department of Biochemistry, Faculty of
Sciences, University of Annab
Algeria

OP26 Prevalence of diabetes and its risk factors among urban
Government officials
Rajendra Gadhavi
INDIA, WHO

drrgadhavi@yahoocom

OP27 The impacts of dietary supplements of Iron and vitamin C on dependent
Blood Indices in women referring to health care center of shiraz Iran
Monireh Alighanbari
mahtabirs@yahoo,com
Iran
OP28 The effect of Benson relaxation therapy on the anxiety
Level and severity of the symptoms in patients
With irritable bowel syndrome
Maryam Hazrati
maryamhazratyshir@yahoocom
Iran

This investigation is carried out to determine the effect of Benson
relaxation therapy on the anxiety level and severity of the symptoms in
patients with irritable bowel syndrome

METHOD MATERIAL: 30 patients with irritable bowel syndrome were randomly
divided into case and control groups The control group was treated by only
usual medical therapy but the case group was treated by combined medical-
relaxational therapy The two groups continued therapy for three monthsThe
anxiety level and gastrointestinal symptoms
of case and control groups were
compared at three different times two weeks before intervention, one week
and three months after intervention Also, The patients were asked to
determine 6 common gastrointestinal symptoms, in their daily symptom
diaries

RESULTS: State and trait anxiety mean of the case and control groups two
weeks before and one week after intervention didnt show significant
difference But the results after 3 months showed a significant difference
between the two groups p0001

The comparison of gastrointestinal symptoms severity means, 2 week before
intervention, showed more symptom severity in the case group rather than
the control group The results of the comparison of gastrointestinal
symptoms severity, 1 week after the intervention, didnt show any
significant difference between the two groups But the 3 months after
intervention a significant difference observed in the two case and control
groups

CONCLUSION: 3 months Benson relaxation therapy decreased significantly the
state and trait anxiety level and severity of the symptoms in patients with
irritable bowel syndrome

OP29
Is sleep a risk factor for type 2

Diabetes

JAKLEEN FAHIM
ABEER WILLIAM
Ain Shams University

A 15 year study on more than one thousand men found that the ideal
amount of sleep is seven to eight hours nightly, those with less had a
twofold - increased risk for diabetes , and those with more sleep had a
threefold higher risk

Yale university researchers say this U - shaped distribution of risk
with respect to sleep has previously been reported for coronary heart
disease , all cause mortality , and diabetes in women

Researchers at the university of Chicago have found that sleep loss
boosts appetite , my encourage weight gain , sleep deprivation alters the
circulating levels of the hormones that regulate hunger , causing an
increase in appetite and a preference for calorie - dense , high -
carbohydrate foods provides a mechanism linking sleep loss to the epidemic
of obesity , leptin , a hormone that tells the brain there is no need for
more food , and ghrelin , a hormone that triggers
hungers , sleep is a
major regular of these two hormones and to correlate the extent of the
hormonal changes with the magnitude of the hunger change ,

It provides biochemical evidence connecting the trend toward chronic
sleep curtailment to obesity and its consequence, including metabolic
syndrome and diabetes

OP30 Knowledge based systems have clearly demonstrated the
potential for substantial impact in a number of diverse areas

Sadique Ahmed Bugti, Perwaiz Ahmed Patoli,Jan Muhammad, Aftab Ahmed Shaikh
bugtisadique@yahoocom,perwaizpatoli@gmailcom,janmuhd@yahoocom,aftabshaik
hs@hotmailcom
Knowledge based systems have clearly demonstrated the potential for
substantial impact in a number of diverse areas Thesuccessful construction
of such knowledge based systems has required that it be possible to encode
sufficient domain expertise within a machinemaniputable form to support
intelligent problem solving behaviour We have focused our consultation on
acceleration of the correct diagnosis statement, early commencement of
sufficient treatment and at last but not atleast, on providing of qualified
evaluation of treatment by
the specialized center To develop a medical
data warehouse and to devise a medical system programs that reason for the
doctor Specialized areas we may be content to compartmentalize the
knowledge and embed it in a machine that provides doctor with high quality
solution as long as the machine can explain those solution to doctors
satisfaction To describe knowledge discovery in telemedicine database
with inference To organize the medical data warehouse and apply some rules
to extract data

OP31 Treatment with melatonin throughout pregnancy
prevents lipid peroxidation in fetal rat brain

Giyasettin Baydas Faculty of Medicine
baydas@hotmailcom
Turkey
OP32 Developmental effect of diabetes on children
Dr Fatin Shafek
Lecturer of pediatric nursing

Faculty of Nursing - Benha University

Children with diabetes type I juvenile-onset or insulin dependent
diabetes have a neuropsychologyical deficits and it may affect academic
performance of
children as; days absent from school, school years repeated,
grade point averages for math and reading in addition to behavioral
problems The poorer the childs diabetic control, the lower the childs
academic performance So careful monitoring is still needed to ensure that
the episodes of hypoglycemia associated with seizures and may affect
learning

OP33 Twice-daily eventide and biphasic insulin as part in patients with
type 2 diabetes

Santiago Duran Garcia
HOSPITAL UNIVERSITARIO DE VALME
sduran@duransanzcom
SPAIN

OP43 Ethical Principles and Implications in nursing practice
for diabetic elderly patient

Howyida Sadek Abd El-Hameed
Assistant professor of community health nursing faculty of nursing -
Benha university
Aging is a process-that converts healthy adults into frail ones It
diminishes reserves in most body systems and increases vulnerability to
most diseases and to
death Finch, 2006 Elderly aged people constitute
a vulnerable group that needs special care In Egypt retirement begins at
the age of 60 years in governmental and public and private sector jobs, 60
years is considered the age of retirement, which is reached by about 10 of
the population Some consider the geriatric age group as that group of
people who passed the retirement age Ibrahim, 2000

Aging is associated with a progressive increase in fasting plasma
glucose levels, and a pogressive decline in insulin sensitivity is thought
to contribute to the physiologic deterioration of glucose homeostasis Age
is an independent risk factor that interacts with diabetes to accelerate
the development of complications About 50 of those older than 60 have
abnormal glucose tolerance tests Prato, 1998

The nurse is a vital member of the comprehensive diabetes care program
and educates the diabetic elderly and their care givers about a number of
issues important for optimal diabetes care, including monitoring of blood
glucose, urine analysis for sugar, insulin administration, guidelines for
diabetes management during illness, suitable diet for DM,
management of
hypoglycemia and hyperglycemia, foot and skin care, diabetes management
before, during, and after exercise, and risk factormodifying activities
Brawunwald et al, 2001

When the community health nurse, the family care givers and other
involved health care professionals work collaboratively to facilitate a
diabetic elderly personis learning, the chances of success will be
maximized The nurse must equipped diabetic elderly and their care givers
by giving them knowledge bout nutrition, medication, effect and side
effect, exercise, disease progression, prevention strategies, monitoring
techniques and medication adjustment Smeltzer Bare, 2000

Ethical principles are guidelines that can apply to situations to
decide whether they are morals or immoral in nursing practice It is not
always practical to refer to the entire ethical theories for decision-
making Nurses often look toward narrower, more specific ethical principles
to guide their judgment and decisions making
Autonomy
Informed consent
Veracity
Confidentiality
Beneficence and Non-maleficence
Justice

Paternalism
Fidelity
Respect the others

PP1 Prevalence of thyroid autoimmunity in patients with type 1
diabetes , their first degree relatives and healthy control subjects
and its relation to islet cell autoantibody
Soha M Abd Eldayem, Nahed A Emara, Enas Abd El Rashed Hasan
Pediatric, Clinical pathology Clinical Medical Science Department,
National Research Center
Objective: To determine the prevalence of both thyroid dysfunction and
thyroid autoantibody positivity in type 1 diabetic patients and their first
degree relatives, relate biochemical findings to clinical features and anti-
islet antibodies Patients: The study included 43 patients with type 1
diabetes and 136 of their first degree relatives Forty eight healthy
children with age and sex matched with patients and who had negative family
history of autoimmune diseases, including type 1 or type 2 diabetes were
also included
Methods: Serum samples from patients, their relatives and controls were
analyzed for: 1-Anti Glutamic acid decarboxylase GAD- 65,
anti protein
tyrosin phosphatase antibodies IA2 and anti insulin antibodies IAA 2
- Thyroid function, Antithyroglobulin ATg and antithyroid peroxidase
TPO antibodies
Results: Frequency of thyroglobulin antibodies Tgab is significantly
higher in patients with type 1 diabetes and their first degree relative
than controls P 00001 and P 0002 respectively Frequency of
positive thyroglobulin , thyroid peroxidase and anti GAD antibodies is
statistically significant higher in patients with thyroid autoimmunity
Thyroid autoimmunity showed a significant positive correlation with anti
GAD antibodies in patients with type 1 diabetes mellitus r 05 and P
0001 A significant positive correlation was found between anti thyroid
peroxidase and anti GAD antibodies in first degree relatives of type 1
diabetic patients A significant positive correlation was found between age
of sibs of first degree relatives of type 1 diabetic patients , anti
thyroglobulin and anti thyroid peroxidase antibodies r 03 and P
001 , r 03 and P 004
Conclusion: Determination of thyroid antibodies by a highly sensitive
method allows
identifying diabetic patients and their first degree
relatives with thyroid autoimmunity and at risk of subsequent impaired
thyroid function, whatever age at diagnosis and diabetes duration, age of
onset of diabetes, glycemic control and family history of other autoimmune
disease A higher Prevalence of thyroid autoimmunity was found in the
presence of islet cell antibodies in patients with type 1 diabetes and
their first degree relatives

Key words: Thyroglobulin antibodies - Thyroid peroxidase antibodies - IDDM-
Relatives
PP2 Serum osteoprotegerin as an early marker for prediction
of macroangiopathy in Type 2 diabetic patients

By

Sahar Saad El-Din Bessa , RAGHDA GHONIMY

EL-SHEIKH AND AMAL HELMY ABD EL-HAMED

Internal Medicine, Cardiology and Clinical Pathology
Departments, Faculty of Medicine , Tanta University, Egypt
besa_samer@yahoocom

The detection of early atherosclerosis, accelerated by the presence
of diabetes mellitus, is of major importance for improving the prediction
and the prevention
of subsequent clinical events Osteoprotegerin OPG;
a bone-related protein, is a newly identified
inhibitor of osteoclast formation and bone resorption Recent studies
indicate that OPG also acts as an important regulatory molecule in the
vasculature and may be involved in the pathogenesis of
atherosclerosisThe aim of the present study was to investigate the
association of OPG serum levels with the presence of angiographically
documented asymptomatic coronary artery disease CAD in patients with
high risk type 2 diabetes and to evaluate its relationship with plasma
thrombomodulin TM, as a marker of endothelial dysfunction and with
carotid artery intima media thickness IMT, as a marker of
atherosclerosis The study included 40 high risk type 2 diabetic patients
with no history or symptoms of coronary events and with normal resting
electrocardiography ECG They were divided into 20 diabetics without
CAD negative results on exercise ECG stress test and 20 diabetics with
CAD positive results on exercise ECG stress test and confirmed by
coronary angiography In addition, 20 age and sex matched normal control
subjects were studied
Serum osteoprotegerin and plasma thrombomodulin
levels were measured and carotid artery IMT was determinedThe study
revealed that serum OPG levels were significantly higher in diabetics
with and without CAD than in controls p 0001 p 001;
respectively and were positively correlated with age, duration of
diabetes, HbA1c and carotid IMT in diabetics with and without CAD Serum
OPG level was correlated significantly with plasma TM only in diabetics
with CAD p 0001 Moreover, serum OPG levels were independently
associated with the presence of asymptomatic CAD in type 2 diabetics [OR,
44;95 CI, 14 to 81] In conclusion, osteoprotegerin is a clinically
important molecule independently associated with the presence of coronary
artery disease and may be a good indicator of atherosclerotic vascular
damage and macroangiopathy in asymptomatic high risk type 2 diabetics
Hence, measurement of serum OPG merits further investigation as a simple
test for improving early diagnosis of silent CAD in asymptomatic diabetic
subjects, which is usually diagnosed at an advanced stage Further
larger, prospective studies are required to analyze the role
of OPG as a
marker for diabetic macroangiopathy and to assess its therapeutic
potential as a new vasculoprotegerin
Future research on OPG gene polymorphisms could play a role in the
development, progression and response to therapy in diabetic vascular
complications
PP3 Effect Of Khat Chewing On The Levels Of Insulin And Total-
Cholesterol,Lipoprotien In Healthy Khat Chewres

Ahmed A Al-Akwa

Department of Biochemistry, Faculty of Medicine
AAL_AKWA@YAHOOCOM

Effect of khat chewing on the levels of insulin and total- cholesterol, and
lipoproteins in healthy khat chewers were studied in fifty healthy male
adults The serums of these parameters concentration were determined after
12 hours fasting after they have started to chew khat

The serum level of insulin was increased, but the serum level of HDL-
cholesterol was decreased p-value005 Non significant changes in total
cholesterol other lipoproteins, as compared to the control group Non
khat chewers

PP4
pp5 Alternative / Complementary Medicine
In Diabetes Mellitus

DrHanan Said Ali
Assistant ProfMedical surgical Nursing

Optimal treatment for type 2 diabetes incorporates a multiple risk factor
approach including self-management counseling, medical nutrition therapy,
physical activity, weight reduction if appropriate, and the use of oral
glucose lowering agents or insulin if necessary Careful consideration
needs to be given to ameliorating associated cardiovascular risk factors
such as hypertension, smoking, and dyslipidemiaWhen setting treatment
goals for individuals with type 2 diabetes, it is important to assess the
risk for severe hypoglycemia and consider the persons ability to
comprehend the regimen Consider as well other factors that may optimize
or minimize the treatments benefit including: advanced age, end-stage
renal disease ESRD, advanced cardio0vascular or cerebrovascular disease,
or other comorbidities that may lead to reduced life spanPeople with
diabetes should use the following therapies to help manage their blood
glucose levels and to prevent complications associated with the condition:

Lifestyle
changes, particularly in diet and exercise habits
Medications, particularly insulin for individuals with type 1 diabetes
and some people with type 2 diabetes
Supplements, including fiber and chromium
Relaxation techniques
Acupuncture for pain from nerve damage
Herbs in the Treatment of Diabetes
PP6 Management of Diabetes Mellitus: The Role of Care across the Life Span

DrHanan shehata ?
Lecturer of Medical surgical Nursing

PP7 Clinical Investigation of Silybum Marianum Seed Extract Silymarin
Treatment in Type-Ii Diabetic Patients

H Fallah Huseini1, B Larijani2, Wael M Yousef3, H Fakhrzadeh2, S B
Radjabipour2, R Heshmat4, R Heydari2

1Department of Pharmacology, Institute of Medicinal Plants, No 97,
Bozorgmehr St Ghods St Enghelab Ave Tehran Iran
2Endocrinology Metabolism Research Center, Tehran University of Medical
Sciences Tehran Iran
3Department of Clinical Pharmacology, Faculty of Medicine, Menoufiya
University, Egypt
4Department of Epidemiology and Biostatistics,
Tehran University of
Medical Sciences Tehran, Iran

3Corresponding author address: Wael Mohamed Yousef, Departmen of Clinical
Pharmacology, Faculty of Medicine, Menoufiya University, Egypt E-mail
address: waelpharma@yahoocouk

Introduction: The free radical production and consequently metabolic
oxidative stress disorder is hallmark of chronic disease particularly
in uncontrolled hyperinsulinemic type II diabetic patients Inhibition
of free radical production, its neutralization or correction of
oxidative metabolic abnormality in diabetic patients following
antioxidant therapy may influence the glycemic control

Aim: The present study was designed to investigate the efficacy of
silymarin treatment with known antioxidant property on glycemic control
in type II diabetic patients

Methods: A 12 month randomized double blind clinical trial was
conducted in 80 non-insulin dependent diabetic patients in two well -
matched groups One group n48 received 200mg silymarin tablet 3
times a day plus standard therapy, while the control group n32
received placebo plus standard therapy The
patients were visited every
two month and glycosylated hemoglobin HbA1c, fasting blood glucose,
total cholesterol, LDL and HDL, triglyceride, SGOT and SGPT levels were
determined at the beginning, after four month and at the end of the
study

Results: There were significant decrease in HbA1c, fasting blood
glucose, total cholesterol, LDL, SGOT and SGPT levels in silymarin
treated patients as compared to placebo group

Conclusion: In present study the silymarin treatment to hyperglycemic
type II diabetic patients for twelve months improved glycemic as well
as lipid profile

Key words: Silymarin, Herbal medicine, Antioxidant, Type II diabetes

PP8 Haptoglobin Gene Polymorphism in Type 2
Diabetic Patients With and Without Nephropathy:
Egyptian Study

Sahar S Bessa , MD ; Soha M Hamdy , PhD and
Ehab MM Ali , PhD
Internal Medicine Department , Faculty of Medicine , Tanta University ,
Chemistry Department , Division of Biochemistry , Faculty of Science,
Fayoum University and Tanta University , Egypt

besa_samer@yahoocom

The development and progression of diabetic microvascular
complications including nephropathy are related to the degree of glycemic
control and oxidative stress and may be influenced by genetic factors
The aim of the present study has been to investigate the association
between haptoglobin Hp gene polymorphism and the occurrence of diabetic
nephropathy in patients with type 2 diabetes mellitus and to find a
possible link between haptoglobin phenotypes and inflammatory parameters;
serum C - reactive protein CRP, interleukin- 6 IL - 6 and haptoglobin
The study included 60 normotensive type 2 diabetic patients of more than
5 years duration categorized in 3 equal groups according to urinary
albumin excretion UAE
into normo, micro and macroalbuminuric In addition, 20 individuals of
matched age and sex were selected to serve as a control group Serum CRP,
IL - 6 and haptoglobin concentrations were measured and haptoglobin
phenotyping was conducted using polyacrylamide gel electrophoresis The
frequency of haptoglobin phenotype 1-1 Hp 1-1 in diabetic patients
with
normoalbuminuria was 7 of 20 35 as compared with diabetics with
macroalbuminuria, 1 of 20 5 { p 002 } however, the frequency of Hp
2-2 was greater in diabetics with macroalbuminuria, 12 of 20 60 as
compared with those with normoalbuminuria or controls, 5 of 20 25 { p
003 } Patients with diabetic nephropathy micro- or macroalbuminuria
had higher levels of serum CRP, IL-6 and haptoglobin than those without
nephropathy normoalbuminuria Serum haptoglobin levels in type 2
diabetics were higher in Hp phenotype 2-2 as compared with Hp 1-1 however,
serum CRP and IL - 6 levels did not differ significantly between
haptoglobin phenotype groups Moreover, there were significant positive
correlations between urinary albumin excretion and serum levels of CRP, IL-
6 and haptoglobin in diabetic patients From this study, it could be
concluded that haptoglobin phenotype 2-2 is considered as a major
susceptibility gene for the development of nephropathy in type 2 diabetic
patients and this might be due to the low antioxidative potential of Hp 2
compared with Hp 1 The results of this study provide a
rationale for
further prospective trials of vigorous antioxidant therapy to prevent the
development of diabetic nephropathy In addition, the significant
association between inflammatory parameters and UAE indicates that
inflammation may be a pathogenic mechanism of renal injury in type 2
diabetics Moreover, serum interleukin - 6 and haptoglobin may be good
prognostic factors for the development of nephropathy in the course of
diabetes mellitus Future research on the use of anti-inflammatory therapy
may result in a new approach to treatment and prevention of diabetic
nephropathy

PP9 Renoprotective Effect of Ace Inhibitors and Calcium Channel Blockers in
Diabetic Hypertensive Nephropathy in Rats

Wael MYousef1; Adel H Omar1; Mohamed D Morsy2; Moshira M Abd El-
Wahed3; Naglaa M Ghanayem4

1Department of Clinical Pharmacology, Faculty of Medicine, Menoufiya
University, Egypt
2Department Physiology, Faculty of Medicine, Menoufiya University, Egypt
3Department of Pathology, Faculty of Medicine, Menoufiya
University,
Egypt
4Department of Biochemistry, Faculty of Medicine, Menoufiya
University, Egypt

1Corresponding author address: Wael Mohamed Yousef, Department
of Clinical Pharmacology, Faculty of Medicine, Menoufiya
University, Egypt E-mail address: waelpharma@yahoocouk

Introduction Aim: Diabetic hypertensive nephropathy DHNP is considered
a major cause of illness and premature death in people with DM largely
through accompanying cardiovascular diseases and end stage renal failure
Approximately 40 of the patient with type II diabetes will develop
diabetic kidney disease while 30 insulin dependent diabetic patients are
prone to DHNP after 25 years of the disease The present study was designed
to illustrate the role of ACE-I Captopril and CCBs amlodipine and
diltiazem in prevention and treatment of DHNP in rats
Materials Methods: Sixty male albino rats weighing 130-180gm were used
in this study These animals were subdivided into four equal groups
Insulinopenic diabetes was induced by STZ, three weeks later, animals with
systolic blood pressure of 140 mmHg or more were considered
hypertensive
Nephropathy was confirmed by elevation of serum creatinine above 12mg and
reduction of creatinine clearance below 1ml/min then treatment was started
for 12 weeks At the end of experiment urine samples and blood samples were
taken for biochemical analysis and kidneys were taken after scarification
for histopathological evaluation
Results: DHNP produced a significant increase in rat weight, rat kidney
weight, SBP, BUN Blood Urea Nitrogen level, K/B Kidney/Body weight
ratio, random blood glucose, 24 hrs urine proteins, and 24 hrs urine
volumes and creatinine clearance Treatment by either ACE-I or CCBs
significantly lowered elevated SBP and elevated 24 hrs urine volumes
Furthermore, treatment with captopril produced a highly significant
lowering of elevated SBP and elevated serum creatinine; and a significant
reduction in elevated K/B ratio and proteinuria Light microscopic
examination of diabetic kidneys revealed glomerulopathy characterized by
thickening of the glomerular basement membrane, mesangial matrix expansion,
arteriolar hyalinosis and large proteinaceous deposits occluding some
capillary
loops and hyaline droplets within the glomeruli Moreover,
examination of kidneys of DHNP animals by light microscope revealed focal
tubular necrosis at multiple points along the nephron, interstitial edema
and accumulation of leucocytes within dilated vasa recta
Conclusion: It can be concluded that, hypertension together with
nephropathy that occur in DM could be controlled by using of ACE-I
Captopril and CCBs Amlodipine and Diltiazem as they had a
nephroprotective values that preserve or at least slow down the progression
of DHNP
Recommendations: Based on the obtained results from the present study, one
can recommend that; ACE-I might be considered the first line therapy for
DHNP as its therapeutic and nephroprotective effects is still more obvious
than calcium channel blockers

Key words: Diabetic Hypertensive Nephropathy, ACE-I, Calcium Channel
Blockers, Diabetes Mellitus

PP10 Assessment of intracranial stenotic arteries in diabetic patients
older than 50 years with hypertension by transcranial doppler sonography
and determination of its risk factorsTehranIRIran

Farzaneh Sarvghadi
fsarvghadi@yahoocom
Sarvghadi F Karimi M Azizi F
Endocrine research center Shaheed Beheshti University of Medical
SciencesTehranIRIran

Background: Ischemic stroke is a major complication of diabetes mellitus,
besides old age, hypertension and hyperlipidemia are strong risk factors
for it This survey was design to detect asymptomatic intracranial stenosis
and determine its risk factors in diabetic patients older than 50 years
with hypertension by Transcranial Doppler Sonography TCD

Material and methods: Between June 2003 to December 2004 all diabetic
patients older than 50 years with hypertension and no previous history of
cerebrovascular problems, who were under observe of diabetes clinic in
Loqman general hospital were selected After completion a questionnaire
contains: demographic information, age, sex, duration of
diabetes, hypertension and hyperlipidemia , evaluation of peak systolic
flow velocity PSV in middle cerebral MCA internal carotid ICA and
vertebral arteries VA was done by TCD explorer - DMS - France ,
PSV
120 cm/sec for MCA and ICA and PSV 100 cm/sec for VA was defined as
significant stenosis, that means more than 50 stenosis of arterial wall
diameter Statistical analyses of results were done by student t test and
ANOVA

Results: 108 patient 51 female, 57 male aged 6251 790 50-85 years
were invited 22 203 patients 11 male, 11 female had stenosis, 34
314 stenotic arteries were also determined 8 stenosis in ICA, 8 inVA ,
18 in MCA Mean age of 22 patients with and 86 without stenosis were 6209
671 and 6250 823 years respectively, P NS Mean duration of
hypertension between these two groups were 536 8oo and 307 339 years
respectively P NS, also for mean duration of diabetes it was 1409 842
and 832 690 years respectively P 001 9 out of 22 41 had
hyperlipidemia and 6 of them had multiple involvement, but only 1 out of
13 patients without hyperlipidemia had multiple stenosis

Discussion: More than 20 of our patients had significant stenosis, which
are at risk for stroke due to hemodynamic changes MCA was the most common
involved artery There wasnt any relationship between occurrence of
stenosis with age, sex and
duration of hypertension but a significant
correlation was observed between prevalence and severity of stenosis with
duration of diabetes and also hyperlipidemia So periodic evaluation of old
patients with long standing diabetes for cranial vessel involvement is
recommended

Key word:Diabetes mellitus-Transcranial sonography-Arterial stenosis -
Hyperlipidemia

PP11 Effect of 30 min strenuous exercises on uric acid,
Creatine kinase and leukocyte subpopulations

Babak Nakhostin Roohi
1 Islamic Azad University of Iran Ardebil branch

The purpose of this study was evaluation of creatine kinase, uric acid and
total and differential white blood cell count WBC before and after 30 min
running at 75 Vo2max 7 physically active volunteer age: 2485 641,
weight: 6714 698, height: 17471 398, fat: 1516 484 and
Vo2max: 5485 432, unfamiliar with exercise protocol were selected and
creatine kinase as a muscle damage biomarker, uric acid as an antioxidant
and WBC as an inflammation biomarker, before and after 30 min running at
75 Vo2max were measured Creatine kinase, uric acid and,
Lymphocytes,
Neutrophils and total WBC levels increased after exercise compared to
before exercise significantly p005, but there was no difference in
monocytes and
eosinophils after exercise compared with before exercise In conclusion, 30
min running at 75 Vo2max can increase uric acid as an antioxidant and
cause cellular damage and inflammation

Key words: Muscle damage, Antioxidant, Inflammation
PP12 Sources of occupational stress and coping
Strategies among emergency department
Nurses in shiraz-Iran
GholamzadehSakineh
Iran
sakinghsir@yahoocom

Introduce: Numerous studies have indicated that job stress is significant
in nursing This will seriously impair the provision of quality care and
the efficacy of health services delivery Therefore, there is a need to
generate information about sources of job stress, and the adopted coping
strategies used by nurses in emergency department

Method: A descriptive survey was conducted and 90 emergency ward nurses
from three large teaching
hospitals in Shiraz City, Iran were involved in
the study The data were collected through a self-administered
questionnaire to identify the sources of job stress and nurses profile and
lazarous standard questionnaires to determine the types of coping
strategies

Results: The greatest proportion of respondents was women 867, range 23-
50 years, we identified the following stressors: problem related to
physical environment,dealing with patients or their relatives,Not enough
staff, Work load ,Lack of support by nursing administrators, being exposed
to health and safety hazards, The most common strategy used by nurses
was Self Controlling Mean1292,SD 43 and Positive
ReappraisalMean1292,SD039 and the strategy least used was a Accepting
ResponsibilityMean588,SD029, In our study large proportional of
nurses used an emotion-focussed strategy such as attempts to suppress
upsetting emotions and remove oneself from the stressful situation but
Problem-focused approaches were generally less used

Conclusions of the Study: It was concluded that principals used a number of
coping mechanisms during the
performance of their duties The coping
scales, Positive Reappraisal and Self-Controlling, are extremely important
in emergency department nurses
PP13 Effect of Health Education Intervention on Diabetic Control among
Elderly Diabetics in Zagazig City

Dr Eman Shokry Abd Allah
Lecturer of Community, Zagazig University
PP14 Teaching plan of diabetic patients how and why?

Nadia Hamed Farahat

Lecturer in Community Health Nursing Department
Faculty of Nursing -Ain Shams University

What is easy and what is difficult to understand in managing diabetes?

Diabetes mellitus can be significantly influenced by daily self-care No
other disease demands so much of the patients own self-knowledge and
skills

The diabetic patients are not always able to mobilize their knowledge in
order to put it into practice, this the professional nurse patients gain
the knowledge, skills, and attitudes necessary for self-care

Knowledge is an essential element of disease management
Achievement and maintenance of metabolic control requires the judicious use
of
medication, diet, activity, monitoring and education
PP15 Effect of phytoestrogn on diabetic postmenopasual women

Dr Hanan Sobeh, Medical surgical Nursing, Ain Shams University
Diabetic and non diabetic postmemoposaual women currently taking HRT
[hormonal replacement tyrapy] had better lipoprotein profile an never or
previous Users of HRt diabetic women currently taking HRT had better
glycemic control than never or previous users of RtDietary
supplementation with soy phytoestrogen favorably alters Insulin resistance
;glycemic control ,and serum lipoprotein in Postmenposaual women with type2
diabetes ,thereby improving Their cardiovascular risk profile This effect
need further follow up for more long time to see if its temporally effect
or not
PP16 Guidelines in Sick Days Management of an adult diabetic patient

Dr Manal Salah, Medical surgical Nursing, Ain Shams University

Lecturer of Medical Surgical Department

Faculty of Nursing-Ain Shams University

For prevention of DKA related to illness, patients must be taught
Sick Days Rules for managing their
diabetes when ill The most
important issues is to teach patients not to eliminate insulin doses when
nausea and vomiting occur Rather, they should take their usual insulin
dose or previously prescribed special sick day doses and then attempt
to consume frequent small portions of carbohydrates including foods
usually avoided, such as juices, and regular sodas Drinking fluids
every hour is important to avoid dehydration Blood glucose and urine
ketons must be checked every 3-4 hours If the patient is unable to take
fluids without vomiting or if elevated glucose or ketone levels persist,
the physician must be contacted Patients are taught to plan ahead and
have foods available for use on sick days In addition, a supply of urine
test strips for ketone testing should be available Patients must know
how to contact their physician 24 hours a day

Fortunately, most diabetics give some indication of their underlying
condition, such as drinking and urinating excessively, before they develop
ketoacidosis Treating diabetics before they become ketotic is
considerably more straightforward, safer, and of
course less expensive
than taking a wait-and-see approach to changes in drinking behavior
Equally important, diagnostic testing may reveal other serious conditions
which can cause excessive urination and drinking, such as kidney or liver
disease, adrenal hormone or electrolyte imbalances and uterus infections

Diabetes mellitus is a metabolic disorder characterized by a
congenital similar to juvenile-onset or Type I diabetes mellitus in
people or acquired similar to adult-onset or Type II diabetes mellitus
in people inability to transport sugar from the bloodstream into cells
Once inside cells, sugar glucose is used to generate the energy that is
essential for normal cellular function Diabetes in animals is most
commonly the acquired form and typically occurs in middle-aged to older
pets The disease results when glucose transport channels on cell
membranes are insensitive to the effects of insulin or when there are too
few channels or when the quantity of insulin produced by the pancreas is
inadequate to activate the number of glucose channels needed to maintain
normal cellular metabolism In
other words, insulin is the key that
allows special gates for sugar transport across cell membranes to be
opened A diabetic, therefore, has too much glucose in the bloodstream
where most of it cannot be utilized, and not enough glucose within the
cells themselves, where it is most needed for energy As a result, cells
attempt to derive energy from alternate metabolic pathways, such as fat
breakdown Excessive use of these alternate energy pathways culminates in
production of harmful by-products called ketones The accumulation of
ketones causes the bodys pH to become acidic ketoacidosis which makes
the cellular environment inhospitable for normal metabolic functions This
condition can ultimately become life-threatening and requires aggressive
medical therapy

Fortunately, most diabetics give some indication of their underlying
condition, such as drinking and urinating excessively, before they develop
ketoacidosis Treating diabetics before they become ketotic is
considerably more straightforward, safer, and of course less expensive
than taking a wait-and-see approach to changes in drinking
behavior
Equally important, diagnostic testing may reveal other serious conditions
which can cause excessive urination and drinking, such as kidney or liver
disease, adrenal hormone or electrolyte imbalances and uterus infections

PP17 Diabetic Update: The 4ms Of Diabetes Management
Dr Mahboba Sobhy, Banha University
Lecturer of Community Health Nursing
Faculty of Nursing - Benha University

Diabetes is a complex disease that requires a comprehensive management
plan A comprehensive management plan for the individual with diabetes
includes an emphasis on the 4Ms of Motivation, Meals / exercise,
Monitoring of blood sugars, and Medications Nursing has played a pivotal
role in the diabetes team management
PP18 the diabetic child in the school
Dr Safaa Fouad, Ain Shams University

Source:arab-diabetes.com