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Abstract Background Diabetes mellitus is a common systemic disease that affects the kidneys and could eventually develop an end-stage renal failure. Renal biopsy is considered a gold standard for histological characterization of diabetic nephropathy, of which renal fibrosis is a dominant component, affecting its stiffness. The objective of this study is to investigate a correlation between renal stiffness obtained by shear wave elastography, renal Doppler resistivity indices, laboratory findings, and the histological characterization depicted by renal biopsies (if feasible) in diabetic nephropathy patients and to compare their results with those obtained from normal population to explore the diagnostic efficacy of shear wave elastography. Shear wave elastography and color duplex US were performed in twenty-six diabetic nephropathy patients and twenty-six healthy (age and sex-matched) control subjects. The shear wave elastography-derived mean value of the renal tissue stiffness was measured (in kilopascals) as well as the resistivity indices of segmental renal arteries, and then the mean values were correlated to patients' clinical-laboratory data (serum creatinine and albumin/ creatinine ratio) and the biopsy results, if feasible. Results A significant positive correlation was found between the mean resistivity indices and the mean renal cortical stiffness at one hand and the patients' clinical-laboratory data with statistically significant differences found between the control, early, and late stages of diabetic nephropathy. Conclusions Shear wave elastography is a promising, non-invasive, and accurate diagnostic tool for assessment and differentiation between early and late stages of diabetic nephropathy with a significant positive correlation to the clinical-laboratory and renal Doppler findings.

ABSTRACTIntroduction The elderly patients are at a greater risk for hypotension after induction of anesthesia. Perfusion index (PI) predicted patients vascular responses in many situations. This study hypothesized that baseline value of PI would predict hypotension in geriatric patients after anesthetic induction as population at risk for postinduction hypotension.Methods This observational, prospective study involved 30 patients aged >65 years who were scheduled for elective procedures under general anesthesia. From baseline to 15 min after propofol induction of anesthesia, the PI, heart rate, and blood pressure (BP) were recorded every minute. Hypotension was defined as a decrease greater than 30% in systolic BP from baseline.Results Early hypotension within 3 min after induction was experienced in 53.3%, while 36.7% had late hypotension within 15 min. Receiver operating characteristic (ROC) curves for PI as a predictive test of hypotension at 3 min showed good predictability of the baseline PI for early postinduction hypotension with area under receiver operating characteristic curve (AUC) 0.97, sensitivity 88%, specificity 93%, positive predictive value (PPV) 93%, negative predictive value (NPV) 87%, and a cutoff value of ≤1.3. After intubation, the predictive value decreased, with PI > 0.91 to predict late hypotension with sensitivity 91%, specificity 58%, PPV 56%, NPV 92%, and AUC 0.66.Conclusions PI could predict early hypotension following propofol induction in the geriatric population. So, it can be considered a valuable tool in monitoring this vulnerable population after induction of anesthesia.

Objectives: The target of this work was to investigate vitamin K2 level link to glycaemic status in type 2 diabetes mellitus (T2DM) patients. Methodology: Sixty T2DM patients were divided into 30 uncontrolled T2DM (group I), 30 controlled T2DM (group II) patients and 30 non-diabetic subjects as the control group. Vitamin K2 level, fasting insulin, homeostasis model assessment insulin resistance (HOMA-IR), fasting blood glucose (FBG), 2-h postprandial blood glucose (PPG), glycosylated haemoglobin (HbA1c) and fasting lipids were documented. Waist circumference (WC) was measured and body mass index (BMI) was calculated. Results: A highly significant difference between groups was observed in vitamin K2 level (P < 0.001) being 1.61 ± 0.56 ng/ml, 2.04 ± 0.59 ng/ml and 2.96 ± 0.82 ng/ml for groups I, II and III, respectively. Among diabetics, a negative correlation was reported between serum vitamin K2 and FBG (r -0.428), 2-h PPBG (r -0.319), HbA1c (r -0.268), fasting insulin (r -0.49), HOMA-IR (r -0.5), total cholesterol (T-cholesterol) (r -0.335) and LDL-C (r -0.296) with P < 0.05. The receiver operating characteristic (ROC) curve emphasized the utility of the discriminated potentiality of serum vitamin K2 as a biomarker for uncontrolled hyperglycaemia in T2DM. The multivariate linear regression has shown that FBG is the only significant independent predictor of serum levels of vitamin K2. Conclusions: In T2DM patients, serum vitamin K2 level was significantly lower, especially with uncontrolled hyperglycaemia. This suggests that vitamin K2 level has an association with the glycaemic status in T2DM.

Introduction: The elderly patients are at a greater risk for hypotension after induction of anesthesia. Perfusion index (PI) predicted patients vascular responses in many situations. This study hypothesized that baseline value of PI would predict hypotension in geriatric patients after anesthetic induction as population at risk for postinduction hypotension. Methods: This observational, prospective study involved 30 patients aged >65 years who were scheduled for elective procedures under general anesthesia. From baseline to 15 min after propofol induction of anesthesia, the PI, heart rate, and blood pressure (BP) were recorded every minute. Hypotension was defined as a decrease greater than 30% in systolic BP from baseline. Results: Early hypotension within 3 min after induction was experienced in 53.3%, while 36.7% had late hypotension within 15 min. Receiver operating characteristic (ROC) curves for PI as a predictive test of hypotension at 3 min showed good predictability of the baseline PI for early postinduction hypotension with area under receiver operating characteristic curve (AUC) 0.97, sensitivity 88%, specificity 93%, positive predictive value (PPV) 93%, negative predictive value (NPV) 87%, and a cutoff value of =1.3. After intubation, the predictive value decreased, with PI > 0.91 to predict late hypotension with sensitivity 91%, specificity 58%, PPV 56%, NPV 92%, and AUC 0.66. Conclusions: PI could predict early hypotension following propofol induction in the geriatric population. So, it can be considered a valuable tool in monitoring this vulnerable population after induction of anesthesia. [ABSTRACT FROM AUTHOR]

Objectives: The target of this work was to investigate vitamin K2 level link to glycaemic status in type 2 diabetes mellitus (T2DM) patients., Methodology: Sixty T2DM patients were divided into 30 uncontrolled T2DM (group I), 30 controlled T2DM (group II) patients and 30 non-diabetic subjects as the control group. Vitamin K2 level, fasting insulin, homeostasis model assessment insulin resistance (HOMA-IR), fasting blood glucose (FBG), 2-h postprandial blood glucose (PPG), glycosylated haemoglobin (HbA1c) and fasting lipids were documented. Waist circumference (WC) was measured and body mass index (BMI) was calculated., Results: A highly significant difference between groups was observed in vitamin K2 level ( P < 0.001) being 1.61 ± 0.56 ng/ml, 2.04 ± 0.59 ng/ml and 2.96 ± 0.82 ng/ml for groups I, II and III, respectively. Among diabetics, a negative correlation was reported between serum vitamin K2 and FBG ( r -0.428), 2-h PPBG ( r -0.319), HbA1c ( r -0.268), fasting insulin ( r -0.49), HOMA-IR ( r -0.5), total cholesterol (T-cholesterol) ( r -0.335) and LDL-C ( r -0.296) with P < 0.05. The receiver operating characteristic (ROC) curve emphasized the utility of the discriminated potentiality of serum vitamin K2 as a biomarker for uncontrolled hyperglycaemia in T2DM. The multivariate linear regression has shown that FBG is the only significant independent predictor of serum levels of vitamin K2., Conclusions: In T2DM patients, serum vitamin K2 level was significantly lower, especially with uncontrolled hyperglycaemia. This suggests that vitamin K2 level has an association with the glycaemic status in T2DM., Competing Interests: The author notes that there is no contradiction of interest in stating that the impartiality of the study published may be prejudicing it., (Copyright: © 2022 Indian Journal of Endocrinology and Metabolism.)

Background: Apelin is an adipokine that may have an advantageous role in the prediction of early diabetic nephropathy. A few studies on apelin in diabetes have been performed and this research was performed to establish the connection between the apelinergic system and diabetic nephropathy., Materials and Methods: The research included 60 patients with type 2 diabetes mellitus (T2DM) who were equally divided into Group-I (diabetic nephropathy) and Group-II (non-diabetic nephropathy), and 30 healthy subjects in the control group (Group-III). Body mass index (BMI) and waist circumference were calculated. FBG, 2 h-PPG, HbA1c, fasting lipids, urea, creatinine, eGFR, urine analysis, A/C ratio, and apelin levels were assessed., Results: A statistically significant between-group difference in plasma apelin levels was found ( P < 0.001). Apelin was the highest in Group-I than in Group-II relative to Group-III (325.79 ± 59.42 pg/mL, 162.83 ± 29.88 pg/mL, and 77.43 ± 8.44 pg/mL, respectively). Among diabetic patients, plasma apelin had a significantly positive correlation with disease duration ( r = 0.612), SBP ( r = 0.427), DBP ( r = 0.466), weight ( r = 0.372), and height ( r = 0.372), FBG ( r = 0.684), 2 h-PPG ( r = 0.744), HbA1C ( r = 0.890), total (T)-cholesterol ( r = 0.316), low density lipoprotein (LDL)-C ( r = 0.397), urea ( r = 0.575), and creatinine ( r = 0.591). A significantly negative correlation was observed between plasma apelin and HDL-C ( r = -0.303), and eGFR ( r = -0.566)., Conclusion: Apelin levels in diabetics were elevated in the case of nephropathy, impaired glucose tolerance, and dyslipidemia. This supports the relationship between the apelinergic system and diabetic nephropathy., Competing Interests: There are no conflicts of interest., (Copyright: © 2022 Indian Journal of Endocrinology and Metabolism.)