Association Between Excess Iron and Type 2 Diabetes

Association Between Excess Iron and Type 2 Diabetes Diabetes is a lifelong and costly metabolic disease that could lead to several life threatening complications, such as diabetic nephropathy and cardiovascular disease (CVS). Therefore, a better understanding of its pathophysiology and identifying the possible mechanisms underlying this disease could be helpful in preventing its occurrence and complications. Obesity is found to be the major risk factor that derives type 2 diabetes (T2D). Recently several studies has demonstrated that there are other risk factors that participate in developing T2D such as iron accumulation in the liver. Studies showed that high levels of iron are associated with oxidative stress. Iron is considered a strong pro-oxidant through the production of hydroxyl radicals, powerful oxidant species. In addition, iron overload is found to be associated with lipid accumulation in the liver cells (steatosis) which leads to insulin resistance. Fatty liver, oxidative stress, obesity and other factors are considered tr iggering factors that increase the risk of developing T2D. Therefore, iron might be involved in diabetes pathophysiology. It is also anticipated to be a risk factor for developing insulin resistance and other diabetic complications. It is also important to investigate whether high iron levels could increase the risk of diabetes or having diabetes will elevate iron levels. Background Introduction Diet and lifestyle play a major role in prevention of type 2 diabetes (T2D)[2]. Macronutrients, such as carbohydrates and fat should be restricted to decrease the chance of developing T2D. However, the impact of micronutrients on the reduction of the incident of T2D is not well established [2, 3]. Several studies suggested that some micronutrients, such as calcium, magnesium, chromium and iron could cause insulin resistance and diabetes [2]. Iron is considered as an essential nutrient for humans as it is the major component of oxygen transporters in the body, and it is has a metabolic function as a cofactor for several enzymes. However, excess amount of iron is found to be harmful to the body by altering glucose metabolism and the production of reactive oxygen species that play a role in the generation of additional reactive oxidants, such as hydroxyl radicals in which iron salt plays a catalytic role in a reaction. This reaction is known as a metal catalysed Haber-Weiss reaction [4, 5]. Pancreatic islets are found to be more susceptible to oxidative stress as their defence against oxidants is weak. Mouse model with high levels of iron and oxidative stress mediates apoptosis of pancreatic islets with a subsequent decrease in insulin secretory capacity [5, 6]. Previous studies on animals showed an increase in diabetes incidence after parenteral administration of iron. Evidence on the role of iron in the pathophysiology of type 2 diabetes mellitus was first discovered in patients with classic hereditary hemochromatosis (HH). This hereditary disorder is characterised by a progressive accumulation of iron in the heart, liver, pancreas, and other parts of the body. The frequency of diabetes was found to be increased in those patients [5]. Other studies suggested that phlebotomy or iron chelation therapy will decrease iron level and thus improve insulin sensitivity in diabetic patients [7]. Other studies on thalassemic patients showed an increase in insulin resistance[5]. Although the exact mechanism on the participation of iron in the onset of diabetes is not exactly known, however, iron overload found to be associated with hepatic dysfunction, insulin deficiency and insulin resistance.[5] Previous evidence confirms the association between iron overload and insulin resistance. However, further investigation is warranted to prove the relationship between the accumulation of iron and the progression to type 2 diabetes mellitus. Recently, correlation between hepatic iron overload with chronic liver disease such as non-alcoholic fatty liver disease (NAFLD) have been considered. Like glucose, iron level is regulated by a mechanism similar to that for glucose. It is regulated by a hepatic peptide hormone called herpcidin. High levels of iron stimulate the synthesis of herpcidin, which in turn decreases the iron exporter ferroportin in macrophages and intestinal cells and thus reduce serum iron. High consumption of food that contains iron and glucose will also increase the risk of hyperglycaemia and iron overload. Males are at higher risk to develop iron overloading than females, because females lose iron from blood during menstrual cycle.[8] Kowdley et al, investigated the role of serum ferretin levels and the accumulation of iron in NAFLD [9]. An increase in ferretin levels is associated with greater accumulation of iron in hepatic cells, but even in patients without iron overload, ferretin was associated with advance stages of NAFLD. This concludes that iron overload is unrelated to advanced stages of NAFLD characterised by systemic inflammation. This study gives a contradictory role of iron overload in patients with NAFLD.[8] Insulin-resistance is found to be related to hepatic iron-overload syndrome. Typically, in NAFLD, the iron accumulation is mild and involves hepatocytes and sinusoidal Kupffer cells. Nevertheless, iron reduction treatment was found to be beneficial in the treatment of NAFLD disease activity as well as increase in insulin sensitivity.[10] Iron overload has also been found to be associated with diabetic complications, such as diabetic nephropathy and cardiovascular disease [5]. Animal studies showed an increase in the amount of iron in the kidneys. An increase in urinary iron was also found in patients with diabetic nephropathy [5]. In patients with CVD, high iron levels are associated with several complications such as myocardial infarction (MI) [5]. Diabetes is found to be associated with more than one risk factor including iron overload, fatty liver and obesity. More research is warranted to investigate the correlation between elevated iron levels and the incidence of T2D. Obesity is another detrimental factor that is found to be prevalent in diabetic patients. It is considered a major cause of inflammation, which may be responsible for developing insulin resistance leading to diabetes. High levels of C-reactive protein (CRP) have been reported in obese patients [11].Therefore, our study will also investigate the relationship between obesity, T2D and iron levels. Aims and objectives Because iron overload is found to affect major tissues involved in glucose and lipid metabolism (pancreatic B cells, liver, and adipose tissue)[12]. Iron overload is found to be related to several metabolic chronic disease, such as T2D, obesity, non-alcoholic fatty liver and other complications [12]. Our aim of the study is to investigate the association between excess iron in the body and T2D. This study also aims to elucidate how iron levels and T2D are related to obesity. Plan of investigation A cross-sectional observational study will be carried out. It will include a group of 180 participants. The study population will be categorized into four groups consisting of Group 1: Healthy individuals (controls); Group 2: Obese healthy individuals; Group 3: Normal weight diabetic patients; Group 4: Obese diabetic patients [13]. The inclusion criteria are patients aged between 40 and 70 years with a male to female ratio of 140:40; only postmenopausal women will be included to reduce possible confounding by iron deficiency. The exclusion criteria are any history of uncontrolled hypertension, cardiac, pulmonary, and neurological complications. Participants having recent infectious, inflammatory or neoplastic conditions; or with laboratory evidence of inflammation (C-reactive protein >0.5 mg/dl or white blood cell count >11,000/uL, platelet count >400,000/uL), and individuals who is anaemic will be excluded [13]. Heavy smokers and alcoholics will also be refused enrolment. Methods and materials General measurements: On the first day, every participant will be allocated to the appropriate group after conducting diferent measurements. Body mass index (BMI) will be measured for each patient by dividing their weight (in kilograms) by height (in meters) squared. Any participant with a BMI> 30 is considered to be obese. Then, the blood pressure will be taken by a standard sphygmomanometer for each patient while they are on a supine position. Patients will be asked to avoid drinking alcohol and caffeine 12 hours before the measurements.[14] Then each participant will be asked to fill in a 50-item food frequency questionnaire (FFQ) to assess their iron consumption.[2] Oral glucose tolerance test (OGTT) will be used to measure blood glucose levels for participants then results will be recorded. Before OGTT they will be asked not to eat, or drink for up to 8-12 hours. Participants will have to ingest 75 g glucose in 250-300 ml water over five minutes. Then the blood samples will be taken after 2 hrs of glucose ingestion. (Normal value less than 140 mg/dL) [15]. Iron overload will be measured by ferritin blood test; overnight blood samples will be obtained. Ferritin can be measured in serum using serum separator tubes (SST), or plasma using lithium heparin or EDTA tubes. Centrifugation and separation within 24 h of sample collection is required and ferritin is stable for 7 days at 2-8Â °C. The samples must be centrifuged to remove precipitates and fibrin [16]. Statistical methods: Statistical analyses will be performed utilising Minitab software. Descriptive statistics will be performed for each group. The mode of distribution for continuous variables will be detected according to Anderson darling test. Serum ferritin values for each group will be compared with the control group and the significant difference will be determined by Student t-test or Mann Whitney test according to the mode of distribution. A p-value lower than 0.05 will be considered significant. By comparing ferritin levels of the control group with the obese nondiabetic group, we will determine if there is a significant relationship between obesity and iron levels. On the other hand the relationship between iron levels and diabetes will be determined by comparing the group of diabetic healthy weight with the control group. We could also determine the role of obesity in T2D. The association between the serum ferritin levels, BMI and blood glucose levels will be determined by Spearman’s r ank correlation test. Higher correlation is demonstrated with Rho values close to 1. The 50-item food frequency questionnaire (FFQ) filled in by each group of participants will be analysed trough Minitab software. This will help to evaluate the association between dietary intake of iron and the risk of T2D. Fund should be allocated to purchase tools and materials to successfully conduct this project. Tools of measuring glucose level are essential during different phases of this project. These tools will estimate blood glucose levels and provide data that will enrich analysis. Serum separator is essential to estimate iron levels necessary to conduct analysis and find correlation with blood glucose level. Estimation of iron and blood glucose and their correlation is advantageous for participants. The results of this project will reflect on their diet specifications by either increasing or decreasing iron content. This project will provide insights to how much iron should be minimally consumed to reduce the incidence of diabetes. Also, many recommendations for obesity will be flagged up in this project to reduce the incidence of diabetes and raise awareness toward diabetes and its complications. This study also requires the participation of a part-time technical assistant in distributing the questionnaire, collection of data and feedback. An experienced researcher is required to guide me in the experimental part of the study as he has a broad expertise and knowledge in practical issues. Given the large sample size taken in this project, support needs to be offered by researchers and technical assistants to collect blood samples and conduct the required tests to meet the pre-determined objectives in a timely fashion The use of participants in the study helps to make a difference in care for future diabetic patients by providing information about the risk factors that will derive the disease, with the possible interventions. It will also benefit the participant themselves by gaining knowledge about the different dimensions of diabetes and through helping them to improve their quality of life by changing their lifestyle and diet modification. Of note, this study will not cause any harm for participant.

Essay About Literature Essay

Literature is timeless, it endured all the changes of the past and is still is being appreciated till the present time and will still be as time goes by.  Literature exists in every country, in every language, and in every period but each has its own uniqueness that stands out for their styles. It exceeds time; literary works of famous people regardless of what period in time they came from is still being appreciated, if not more than when the period it is from. Literary works from the early periods had undergone different adaptations by the later periods to preserve the author’s great work, the ideas, and the creativity they instil in every words to make it live through time. There is a purpose for reading literary works – to entertain and educate its readers or audience. Reading, for example, a novel is just like watching a movie in a very slow pace; reading can make you cry, laugh, smile, get angry and whatnot just like watching a movie; reading lets us imagine the characters, the settings, and what happens in the story. As it entertains us, it also educates us and teaches us about life experiences that we might encounter, and the morals that we should possess. Other literary works inform us about happenings in daily life which also falls in educating the readers. There are different types of literary works, it doesn’t just end with reading materials, and it can also be in a form of a song and a play. It can be performed in front of people or just enjoyed by oneself; it has different genres to offer to different interests of people. Literature is everywhere and in any time and it knows no bounds.

Lawrence Bittaker and Roy Norris Are the Toolbox Killers

In late October 1979, California authorities were busy hunting down and capturing The Hillside Strangler, Angelo Buono. In the meantime, two more barbaric killers had teamed up to fulfill a prison time fantasy - to kidnap, rape, torture and kill a girl for each teenage year. For two months, the duo hunted roads and beaches, looking for victims who  matched their demented fantasy. They almost met their goal, killing five young girls, ages ranging between 13 to 18. This is their story. Bittaker and Norris Meet In 1978, Lawrence Sigmund Bittaker, age 38, and Roy L. Norris, age 30, met while in the California State Prison at San Luis Obispo. Norris was labeled as a mentally disordered sex offender and previously spent four years at a state mental institution. Once released, he raped again and returned to prison. Bittaker spent most of his adult life behind bars for various offenses. As their friendship grew, so did their fantasies of raping and murdering teenage girls. The Murder Mack After their release from prison, they paired up, transformed Bittakers 1977 GMC van into what they nicknamed, Murder Mack, and began their kidnap, torture and killing spree of young girls. As is characteristic of psychopaths, the pain inflicted on their victims grew more vicious with each new captive. Cindy Schaeffer On June 24, 1979, in Redondo Beach, Cindy Schaeffer, age 16, was walking to her grandmother’s house after attending a church program. Bittaker and Norris pulled up next to her in the Murder Mack and tried to entice her to go for a ride. Her attempts to ignore the two failed. She was forced into the van and taken to a pre-selected spot in the mountains. There she was tortured and denied her requests to pray before the two beat and strangled her to death with wire coat hangers. Andrea Hall On July 8, 1979, the duo went hunting for their second victim and found 18-year-old Andrea Hall hitchhiking on the Pacific Coast Highway. With Bittaker hiding in the back, Norris stopped and offered Hall a ride. Within minutes after she entered the van, Bittaker attacked, raped and took pictures of her bound and in fear. As if playing a game, Bittaker then asked why she should be allowed to live. Not liking her answer, he stabbed her in the ear with an ice pick and choked her to death. Jackie Gilliam and Jacqueline Lamp On Sept.  3, 1979, the murderous pair picked up their youngest victims from a bus stop at Hermosa Beach. Jackie Gilliam, 15, and Jacqueline Lamp, 13, were kidnapped and taken to the mountain location where they were raped and tortured for two days. As with Hall, both girls were stabbed in each ear with an ice pick, their small bodies viciously attacked with vice grips, then strangled to death with coat hangers tightened with pliers. Lynette Ledford The killers last known victim was killed on Oct. 31, 1979. Sixteen-year-old Lynette Ledford was kidnapped and her body mutilated. The young girl was stabbed numerous times, and with pliers, Bittaker ripped at her body. During her torture, her screams and pleas were tape-recorded as Bittaker repeatedly beat the young girls elbows with a sledgehammer, all the time demanding that she not stop screaming. In the end, the pair strangled her with a coat hanger. For fun the pair decided to leave Ledfords brutalized corpse on the lawn of a suburban home in Hermosa Beach, just to see the reaction of the media. The Hillside Strangler, Angelo Buono, had been caught just a few days before the discovery of Lynette Ledfords body, although authorities were not swayed into identifying her killer as Buono. Captured Norris was the murderous pairs downfall. He bragged to an old prison friend about his crime spree. The friend tipped off police, and the story sounded much like that of the victim, Shirley Sanders. On September 30, Shirley Sanders managed to escape from two men who used chemical mace on her, then raped her inside a van. Police interviewed her again, this time armed with pictures, and Sanders was able to identify the van and Norris and Bittaker as her attackers. Norris Points the Finger at Bittaker The two were arrested for unrelated crimes and held without bail for violating their probations. During an interrogation, Norris began admitting details about the pairs murderous activities, and he pointed the finger at Bittaker for being the one who killed their victims. 500 Photos - 19 Missing Girls Norris worked out a deal with authorities in exchange for his testimony against Bittaker, as well as showing police where they hid the bodies of their victims. Overall, police found over 500 photos of teenaged girls, 19 of which were listed as missing. But Norris clammed up and would only tell investigators what happened to five of the 19 missing girls. The Sentencing During Bittakers and Norris trial, the disturbing pictures of their crimes and the tape-recording of Lynette Ledfords final painful hours were shared with the jury. The impact was substantial. Bittaker was sentenced to death, and the judge included an extra 199-year life sentence just in case his death sentence was ever commuted to life. Norris was given 45 years to life for his cooperation in the investigation. In 2009, Norris was denied parole for an additional 10 years. Sources Couples Who Kill by Carol Anne Davis

Marketing Plan for a Furniture Shop - 1626 Words

BOITHOK, an exclusive furniture and show piece outlet is ready to introduce living room furnishers and show pieces that will bring an antique and traditional look and create an artistic environment. BOITHOK occupies a specific niche within the furniture market. Its furniture’s offerings focus on traditional and old Bangladeshi look furniture products and show pieces that are exclusive in craftsmanship materials. Its market segments include the people who are highly elegant, have good interior sense and want to decorate their living room in a different way. BOTHOK does not provide comparable products for mass market .The Company wishes to target those customers who seek quality products with exclusive design and traditional look. BOITHOK†¦show more content†¦Opportunities: âž ¢ Competition is low as it involves with totally new type of product and defined customers group âž ¢ Opportunity for capturing market share through product differentiation âž ¢ New channe ls of distribution âž ¢ Specific Niche; people are ready to pay premium price as our company maintain â€Å"aura of exclusivity†. Threats: âž ¢ Growth will invite competition âž ¢ As a new start up business it lacks knowledge and experience than other companies âž ¢ It will take huge time to create brand awareness and image. 3. Objectives: BOITHOK’s financial objectives are to: ââ€" ª Earn an annual rate of return investment of 20% after taxes over five years. ââ€" ª Produce net profit of 552000 BDT next year ââ€" ª Achieve first year total sales revenue 5152000 BDT BOITHOK’s marketing objectives are to: ââ€" ª Strategically BOITHOK assumes that they need to go into specialty channels to address their target customer s needs. 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