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Assessment of Long Term Metabolic Effects of Atypical Antipsychotics in Schizophrenia Patients

Abstract

Background and aims. Patients with schizophrenia have a shorter life expectancy than normal population partially due to the metabolic side effects of antipsychotic treatment. The aim of this study is to evaluate the long-term evolution of the metabolic syndrome in chronic schizophrenia patients on fixed second generation antipsychotics (SGA).

Material and method. The components of metabolic syndrome were evaluated repeatedly in a minimum 6 months and maximum 2 years follow-up period. The presence of metabolic syndrome (MetS) and metabolic risk scores (cMetS) according to National Cholesterol Education Program Adult Treatment Panel III were calculated and compared in time. In the prevalence, incidence and normalization logistic regression studies included all the known risk factors together with the follow-up period. Finally, all these rates were compared depending on the type of SGA.

Results. Only cMetS, waist circumference and diastolic blood pressure presented significant increase in the follow-up period which was in average 385.5 days. The prevalence of MetS at base-line was 39.4%, which increased to 48.5% after the follow-up period. The calculated incidence of 30% was associated with a 23.1% rate of normalization. Logistic regression studies revealed as independent risk factors the age and base-line cMetS/weight for incidence and for normalization. In the aripiprazole group the normalization rate exceeded the incidence rate (33.3% vs 20%).

Conclusions. The results emphasize the highly dynamic character of the metabolic syndrome even in chronic schizophrenia patients with fixed SGA regimen. The normalization of MetS is a possibility that should not ignored. The age and weight continue to remain independent risk factors, thus close monitoring in elderly and strict weight control plan are necessary. Aripiprazole showed better safety profile, but more extensive studies are required for definitive conclusions.

Open access
Complexity of Cardiac Autonomic Modulation in Diabetes Mellitus: A New Technique to Perceive Autonomic Dysfunction

Abstract

Backgound and aims. In this study we analyzed heart rate variability (HRV) via chaotic global techniques so as to discriminate diabetics from control subjects. Matherial and method. Chaotic global analysis of the RR-intervals from the electrocardiogram and preprocessing adjustments were undertaken. The effect of varying two parameters to adjust the Multi-Taper Method (MTM) power spectrum were evaluated. Then, cubic spline interpolations from 1Hz to 13Hz were applied whilst the spectral parameters were fixed. Precisely 1000 RR-intervals of data were recorded. Results. CFP1 and CFP3 are the only significant combinations of chaotic globals when the default standard conditions are enforced. MTM spectral adjustments and cubic spline interpolation are trivial at effecting the outcome between the two datasets. The most influencial constraint on the outcome is data length. Conclusion. Chaotic global analysis was offered as a reliable, low-cost and robust technique to detect autonomic dysfunction in subjects with diabetes mellitus.

Open access
A Different View to Older Diabetics: Management of Treatment According to Cognitive Functions

Abstract

Background and aims. Diabetes Mellitus is a chronic systemic disease which has multiple complications and the presence of these complications affects the management of disease. It is also important to consider cognitive functions when managing the treatment of older diabetics. In this study, we aimed to make proposals for the appropriate drug choice to preserve cognitive functions in elderly diabetics.

Matherial and methods. A total of 270 older diabetic patients were reviewed. Possible risk factors of cognitive impairment were investigated. Correlation analysis was performed between MMSE and GDS, age, HbA1c, duration of diabetes.

Results. Sulfonylurea (adj. OR: 2.33, %95 CI: 1.11-4.90) and insulin treatment (adj. OR: 3.79, %95 CI: 1.56-9.21) were found associated with increased risk of cognitive impairment. In addition, there was a negative correlation between MMSE and GDS (r: -.129, p<0.05).

Conclusion. We suggest that insulin and sulfonylureas should be used with caution in those with cognitive impairment.

Open access
Early Renal Dysfunction in Obese Patients with Insulin Resistance

Abstract

Background and aims. Obese individuals have insulin resistance status assessed in the present study by the HOMA index (“Homeostasis model assessment”). This prospective study assessed renal disorders in the insulin resistance in obese patients.

Material and Methods. The study included 73 young obese patients. The assessment included the HOMA index before meal and parameters of renal function (glomerular filtration rate, albuminuria, β2-microglobulinuria).

Results. In young obese, insulin-resistance patients, glomerular hyperfiltration and β2-microglobulinuria are found in 77.0 and 93.4% of cases respectively. The albuminuria is noted in some cases, which reduces diagnostic value.

Conclusions. In young obese patients with insulin resistance, glomerular hyperfiltration and β2-microglobulinuria are main diagnostic markers of renal dysfunction.

Open access
The Effect of Thymoquinone Toward Tooth Disorder Prevention in Postnatal Rat offspring Born from Hyperglycemia Pregnant Rats

Abstract

Background and aims. Hyperglycemia in pregnancy was caused by reduced insulin production that led to tooth germ growth disorder. Thymoquinone could increase insulin production through pancreatic β-cells regeneration. The purpose of this study was to determine the effect of thymoquinone to prevent tooth disorder in rat offspring born from hyperglycemia pregnant rat.

Material and method. Wistar rat offspring used in this research taken from pregnant rat induced hyperglycemia with streptozotocin 40 mg/kgBW divided into four groups. Rat offspring observation had been done on 3rd, 5th, and 7th day postnatal. The histological image of first maxillary molar tooth germ stained with Haematoxilin Eosin and Mallory’s Trichrome. The parameters of rat offspring were body weight, blood glucose levels, tooth growth stages, tooth dimension width, and tooth germ enamel matrix.

Results. Thymoquinone group had the widest tooth germ dimension compare to other groups. All rat offspring tooth germs were at the appositioncalcification stage in matrix enamel (pre-enamel). The analysis showed that no statistical differences between thymoquinone group and metformin group (p>0.05).

Conclusions. Thymoquinone has same function with metformin to prevent tooth disorder in rat offspring born from pregnant rat induced hyperglycemia.

Open access
Euglycemic Ketoacidosis Diagnosis and Treatment Protocol in Type 1 Diabetes Patient

Abstract

Introduction. The introduction of sodium glucose cotransporter 2 inhibitors in the management of diabetes was an innovation in the treatment of this disease, considering the protective cardiovascular effect not only the ability of decreasing the plasma glucose. In Europe, this class of medication is approved for the treatment of type 2 diabetes and some of them (dapagliflozin and sotagliflozin) are also approved for use in certain patients with type 1 diabetes mellitus. These patients must have inadequate control of their blood glucose levels despite optimal insulin therapy. One of the adverse effects is diabetic ketoacidosis.

Case report. This case report presents a diabetic patient whose treatment was changed from insulin therapy to oral therapy. Within 10 days after the initiation of the new treatment her condition gradually worsened and she arrived at the emergency room with nausea, vomiting and altered general condition. She was admitted for euglycemic ketoacidosis and treated according to the protocol.

Conclusions. This case reveals the importance of continuing the insulin therapy when adding a sodium glucose cotransporter 2 inhibitor in type 1 diabetes patients.

Open access
Highlighted of Ramadan Fasting on Diabetes-Study of Complications, Biochemical Aspects and Anthropometry

Abstract

Background and aims: The diabetic exempted from fasting by religion, wishing or not to observe the fast, is exposed like any other during Ramadan to a change in lifestyle. The objective of this study was to highlight the effects of Ramadan fasting on diabetes.

Material and methods: Multicentre study on 899 diabetics was carried to collect data on the behaviour of diabetics with regard to the fast of Ramadan, biochemicals and anthropometry parameters.

Results. The sample consists of 541 diabetic fasters (DTMF) and 358 no fasters. The causes of interruption of fasting were: hypoglycemia (82.4%), dehydration (44.5%), hyperglycemia (12.6%), high blood pressure (13.7%), loss of consciousness (8.3%). The risk factors related to fasting for DTMF were the type of diabetes and gender. Discussion and modifications about dietary, blood glucose monitoring and nutritional education sessions showed a protective effect against the occurrence of hypo and hyperglycemia and loss of consciousness. Decreasing differences were noted for Hb1Ac, LDL and Total-Cholesterol between before and after Ramadan. The weight of DTMF decreased in post-Ramadan (p=0.0000).

Conclusion. There is a need to consider regular preventive measures based on public information on the effects of diabetes related complications and the benefits of a balanced diet combined with regular physical activity in nutrition education sessions.

Open access
Lifestyle Medicine – New Concept, Innovative Discipline

Abstract

A large percentage 63% of premature deaths and chronic diseases could be prevented by adhering to healthy dietary patterns, being physically active and avoid smoking. The concept of lifestyle medicine introduced 20 years ago by Rippe is defined as the integration of modern lifestyle practices into evidence-based medicine, in order to lower risk factors or to be support for chronic therapies. A new taxonomy is proposed in lifestyle medicine, with determinants, as drivers for chronic diseases, anthropogens and metaflammation, the metabolic inflammatory state. Other possible determinants are proposed for lack os scope in life, estrangement and lost identity. Despite all health messages, healthy behaviors are exceptions, not the rule. It will be important in the future to change how practitioners will support individuals in their efforts to live healthier. More psychological and social factors should be analyzed. Many doctors are not self-confident with prescribing healthy lifestyle or nutritional recommendations. Creating a new discipline should foster development of preventive recommendations. General practitioners will need specific academic trainings to learn how to promote recommendations for lifestyle changes for health, for prevention and for diseases management, starting by adopting themselves healthy lifestyles.

Open access
Micronutrients and Oral Health an Opportunity to Prevent Oral Diseases

Abstract

Nutrition plays an important role in oral health as it affects the growth of craniofacial, dental and periodontal structures. When adequate food is not unavailable, oral health may be impaired, and even overexposure to the diet may also inversely affect. Therefore, there is interdependency between nutrition and oral health. The importance of Micronutrients in normal function is becoming increasingly apparent and insufficient micronutrient intake has both short term and long-term consequences. Micronutrient assessment of suspected individual and appropriate supplement therapy may assist in dental disease prevention.

Open access