Introduction: A large number of patients with diabetes mellitus do not want to take insulin or any injectable medication. Carvedilol can replace insulin in the treatment of T2 diabetes mellitus. Carvedilol alone or with oral anti-diabetic drugs (OAD) can replace the entire dose of insulin for patients with T2 diabetes (T2D). Carvedilol can replace insulin in patients on OAD who need insulin. Glycemic control was achieved in patients with T2D. This study was based on the hypothesis that carvedilol decreases insulin resistance, eliminates glucotoxicity and lipotoxicty and improves the function of beta-cell while reducing their apotosis.Method: In this study, 48 patients with T2D were treated with carvedilol, which was an "off-label" use of carvedilol, for the treatment of diabetes mellitus. Twenty-nine patients with T2D were on OAD, and nineteen patients were taking insulin. Both groups had high HbA1c. Carvedilol was given with or without OAD to both groups, and glycemic control was achieved. OAD included metformin and/or glimepiride or glyburide and/or sitagliptin.Results: Glycemic control was achieved using carvedilol with or without OAD in both groups. Conclusion:1. Carvedilol can reduce insulin resistance. 2. Carvedilol can replace insulin in patients with diabetes mellitus. 3. Carvedilol and metformin can prevent the progression of pre-diabetes to diabetes. 4. Patients who are on a very high dose of insulin can decrease that dose using carvedilol and metformin.
To cure coronary artery disease, complete removal of atheroma from coronary arteries is necessary and may be achieved using pharmacological intervention. This hypothesis requires verification by a trial.The conditions that lead to the formation of atheroma are as follows:Insulin resistance and vascular endothelial dysfunction, Atherogenic dyslipidemia, Risk factors for coronary artery disease, Inflammation of coronary arteries, Drugs that increase insulin resistance.Atheroma formation begins with the formation of fatty streaks on the endothelium, which progress into stable or unstable atheromatous plaques. The unstable plaque has a thin fibrous cap that is prone to rupture. Unstable plaques contain a large lipid pool consisting of oxidized low-density lipoprotein (LDL), apoB and cholesterol that can grow; they are also have heavy inflammatory cell infiltration, including monocytes, macrophages and T cell lymphocytes. Moreover, debris from ruptured macrophages that were overloaded with lipids attracts more macrophages.The plaque can grow and protrude into the coronary artery lumen. Plaques exhibit overgrowth of vasa vasorum and they can rupture, leading to the formation of a large thrombus that may severely or completely obstruct the coronary artery. Hemorrhage may also occur in the plaque.Carvedilol and metformin promote plaque stability. The supply of lipids to the lipid pool in the plaque is reduced by statins and evolocumab, and lipids are removed from the lipid pool by apoA-1 and high-density lipoprotein (HDL) as their levels in the blood are increased. Severe inflammation is treated with carvedilol, metformin, statins and apoA.Growth of vasa vasorum is attributed to insulin resistance and can be reversed by carvedilol and metformin, thereby preventing hemorrhage. The size of the thrombus on a ruptured plaque can also be reduced by carvedilol, metformin and apoA-1, as these three agents prevent platelet aggregation. Thrombi are removed by endothelial thrombolysis. A thrombus may also form in the plaque from intraplaque hemorrhage; if present, the size of this type of thrombus will be small, as vasa vasorum are atrophic. In both cases, thrombi are removed by endothelial thrombolysis. Subsequently, healthy macrophages infiltrate and remove debris, after which the plaque changes to a fibrous nodule that can be removed by endothelial fibrinolysis. The plaque is then completely removed.
Standing for long periods of time has been recognized as a potential contributor to muscle fatigue. When a person is performing activities in prolonged standing and wearing ineffective material of shoe insole, not only lead to muscle fatigue but can even cause injuries in the long term. The objective of this study is to determine the effects of two types of shoe insole materials; Ethylene Vinyl Acetate (EVA) and a combination of polyurethane (PU) and poron on muscle activity and foot pressure. The analysis of muscle fatigue was performed using surface electromyography (sEMG) while pressure under the foot was measured using FScan device. Results of comparison found that the two types of shoe insole materials showed significant difference (p-value < 0.05) in electromyography signals (µV) in the left and right gastrocnemius muscle while there are significant reductions on the peak pressure measured from the foot pressure measurement. It can be concluded that the combination of PU and poron is an effective material to be used a shoe insole for a person who is exposed to prolonged periods of standing.
Laminography is a technique used to determine the depth of a defect in Radiographic Testing (RT). It enables RT operators to accurately locate the defect from the object’s surface especially for welded components. The technique will ensure the quality of weld components meets the standard requirement for reliability and safety purposes. This paper intends to study the exposure parameters of laminography technique on carbon steel plate by using Radiographic Testing – Digital. (RT-D). The important exposure parameters that are considered in this preliminary study are voltage, current, and frame time. The radiography images with achievable level of contrast sensitivity and image quality are analyzed according to the ISO 17636-2. Discussion on correlation between the normalized Signal to Noise ratio (SNRN) and the exposure parameters are done based on the plotting graphs. The results show the exposure parameters has significantly influenced the value of SNRN. Further experimental works are performed using triangulation technique on welded sample. The deviation between the calculated depth of defects and actual results is less than 1.0mm.
Objective: A cure for coronary artery disease is desperately needed as more people die of this disease. The coronary disease can be cured by removal of all atheromatous plaques by pharmacological intervention. This pharmacological treatment can also prevent acute myocardial infarction, unstable angina, chronic stable angina, CABG, PTCA and cardiac death. Case presentation:The patient is 75 years old, who had CABG and PTCA and suffered from daily chest pain which was relieved with nitroglycerin. Also had pain in both upper arms and both forearm several hours a day and this arm pain did not respond to nitroglycerin. She suffered with coughing wheezing and shortness of breath. No treatment helped her. Chest X-Ray showed cardiomegaly. EKG showed right bundle branch block. The coronary angiogram of 2013 showed advanced obstructive disease involving LAD and left circumflex artery with disease of the grafts. The right coronary artery was completely blocked with partially blocked graft. The patient was given standard treatment of coronary artery disease and for other conditions she suffered. The medications given for the removal of atheroma from coronary arteries were Carvedilol, Metformin, statin and Evolocumab. The patient was symptom free in 3 months. A repeat coronary angiogram in 2018 showed that LAD, left circumflex and right coronary arteries and their branches had no disease and no obstructive lesion. The graft to right to the right coronary artery was open and other grafts remained unchanged. Conclusions:1) The atherosclerotic coronary artery disease can be cured. 2) Primary and secondary prevention of coronary artery disease can be achieved. 3) Intractable angina can be cured. 4) Stroke and TIA can be prevented. 5) Totally occluded coronary arteries can be opened.
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