Introduction: Insulin resistance in obesity and type 2 diabetes mellitus (T2DM) is associated with cardiovascular complications such as atherosclerosis. On the other hand, the reduction of apoptosis in macrophages has been linked with accelerated atherosclerosis. Apoptosis is controlled by a different family of proteins including Bcl-2 and caspases. Methods: To examine apoptosis in insulin resistance, we assessed the mRNA expression by qRT-PCR of several Bcl-2 family members, as well as caspase-3, −7, −8, and −9 in peripheral blood mononuclear cells (PBMCs) isolated from lean, obese, diabetic, and diabetic on metformin individuals. Results: PBMCs of diabetic individuals exhibited reduced expression of caspase-7 and increased expression of Bcl-10, Bad, Bax, Bid, and caspase-3. T2DM on metformin group had significantly higher Bad, Bax, and caspase-7 expression. Discussion: The moderate up-regulation of pro-apoptotic Bcl-10, Bax, Bad, Bid, and the effector caspase-3 coupled with inhibition of caspase-7 in circulating PBMCs of T2DM could be the result of increased inflammation in T2DM. Metformin treatment significantly inhibited the expression of Bcl-10, Bid, and caspase-3 and upregulated Bad/Bax/caspase-7 pathway suggesting the activation of Bad/Bax/caspase-7 apoptotic pathway. Further studies are warranted to elicit the underlying apoptotic pathways of PBMCs in T2DM and following metformin treatment.
Objectives: To investigate the impact and predictors of tympanostomy tube )TT( extrusion.Methods: A retrospective study on 258 ears underwent TT insertion during 2016-2018 at King Abdullah Specialized Children's Hospital, Riyadh, Saudi Arabia. Patients were followed for 36-48 months postoperatively to detect the recurrence rate. The sample was divided into 2 groups based on extrusion time and were compared to determine the predictors of TT extrusion.Results: Otitis media with effusion )OME( recurrence after TT insertion was detected in 28.7%. A shorter TT extrusion time was associated with a higher recurrence )p=0.002(. Small TTs increased the probability of early TT extrusion )odds ratio = 5.144; 95% confidence interval: [1.602-16.519](.
Conclusion:More than one-fourth of the patients who underwent TT insertion for OME developed
Original Articlerecurrence. Tympanostomy tube extrusion earlier than 12 months was associated with a higher recurrence rate. Small TTs increased the probability of early TT extrusion.
The simultaneous management of tibial shaft fractures and post-traumatic ankle arthritis with ankle pain as the chief complaint can be challenging. Herein, we present a case managed with closed reduction, internal fixation, and tibiotalocalcaneal arthrodesis using a retrograde femoral nail. The patient was able to actively ambulate with full weight bearing and no pain approximately three months after the procedure. Patient consent for this case report was obtained.
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