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The Impact of Alpha-Lipoic Acid on Insulin Resistance and Inflammatory Parameters in Patients with Type 2 Diabetes Mellitus and Cardiac Autonomic Neuropathy
Victoria Serhiyenko,
Marta Hotsko,
Alexandr Serhiyenko,
Oksana Snitynska,
Ludmila Serhiyenko,
Volodymyr Segin
Issue:
Volume 8, Issue 5, September 2020
Pages:
197-203
Received:
7 July 2020
Accepted:
22 July 2020
Published:
13 August 2020
Abstract: Development of chronic complications in type 2 diabetes mellitus (T2DM), namely cardiac automonic neuropathy (CAN), had been implicated as an independent risk factor for cardiovascular mortality. This paper presents the results obtained during the study of possible alpha-lipoic acid (ALA) impact on the state of insulin resistance (IR), the content of some pro- and anti-inflammatory factors in patients with T2DM and definite stage of CAN. Our study involved 33 persons with diagnosed T2DM and definite CAN, which were allocated to one of two groups. The control group (15 patients) received standard hypoglycemic treatment, whereas the intervention group (18 patients) received ALA 600 mg in film-coated tablets/q.d. in addition to standard therapy. Treatment period was 3 months in duration. Levels of glycated hemoglobin A1c, glucose, immunoreactive insulin (IRI), leptin, interleukin (IL) IL-6 and IL-8, high sensitivity C-reactive protein (hs-CRP), tumor necrosis factor-alpha (TNF-alpha) in the blood were measured. TNF-alpha/IL-10 ratio and Homeostasis model assessment IR (HOMA-IR) were calculated. The significant reduction in glucose, IRI, leptin concentration and HOMA-IR parameters; decrease in the pro-inflammatory link activity, namely hs-CRP, TNF-alpha, IL-6 and IL-8 levels, TNF-alpha/IL-10 ratio, with no changes in IL-10 content after 3 months of treatment was found. The results of our study demonstrated the decrease in the pro-inflammatory link activity after treatment and allow us to consider ALA as one of the promising drug for complex treatment of definite stage of CAN in patients with T2DM.
Abstract: Development of chronic complications in type 2 diabetes mellitus (T2DM), namely cardiac automonic neuropathy (CAN), had been implicated as an independent risk factor for cardiovascular mortality. This paper presents the results obtained during the study of possible alpha-lipoic acid (ALA) impact on the state of insulin resistance (IR), the content ...
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Association of Use of Angiotensin-Converting Enzyme Inhibitors and Angiotensin II Receptor Blockers with Coronavirus Disease 2019 Severity and Mortality
Patricia Díaz-Guardiola,
Virginia Martín-Borge,
Cristina García-Fernández,
María Teresa Ramírez-Prieto,
Marcela Irma Ramírez-Belmar,
Gema García-Romero,
Esther de la Calle,
José Antonio Balsa
Issue:
Volume 8, Issue 5, September 2020
Pages:
204-210
Received:
21 July 2020
Accepted:
3 August 2020
Published:
18 August 2020
Abstract: Background: A potential association between use of angiotensin-converting–enzyme inhibitors (ACEI) or angiotensin-receptor blockers (ARB) and coronavirus disease 2019 (COVID-19) severity has been suggested. We conducted a retrospective study to investigate the association between ACEI/ARB use and COVID-19 severity and mortality. Methods: The first 1,000 consecutive patients with COVID-19 who were attended in the emergency department at the Infanta Sofía University Hospital were included. Clinical data was manually extracted by reviewing medical records, and the ACEI/ARB prescription was assessed from an electronic pharmacy database. The primary endpoints were critical COVID-19 and mortality. Results: A total of 241 (24.1%) patients had a critical COVID-19 and 171 (17.1%) died. ACEI use was associated with critical COVID-19 (OR 1.90, 95% CI 1.34-2.70), and with mortality (OR 1.98, 95% CI 1.35-2.91) in the unadjusted analysis, but not after adjusting by age, sex and comorbidities (OR 1.15 95% CI 0.69-1.94, and OR 1.00 95% CI 0.56-1.77, respectively). Similarly, ARB use was associated with critical COVID-19 (OR 1.58, 95% CI 1.11-2.58), although not with mortality (OR 1.47, 95% CI 0.98-2.19) in the unadjusted analysis, but not after adjusting by age, sex and comorbidities (OR 0.97, 95% CI 0.57-1.65, and OR 0.74, 95% CI 0.41-1.33, respectively). Conclusion: These results suggest that the use of ACEI/ARB is not independently associated with COVID-19 severity and mortality.
Abstract: Background: A potential association between use of angiotensin-converting–enzyme inhibitors (ACEI) or angiotensin-receptor blockers (ARB) and coronavirus disease 2019 (COVID-19) severity has been suggested. We conducted a retrospective study to investigate the association between ACEI/ARB use and COVID-19 severity and mortality. Methods: The first ...
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The Obstinate Refractory and Resistance Hypertension
Raj Kamal Choudhry,
Amrendra Kumar Singh
Issue:
Volume 8, Issue 5, September 2020
Pages:
211-214
Received:
17 April 2020
Accepted:
3 August 2020
Published:
20 August 2020
Abstract: Resistant hypertension (RHTN) is relatively common with an estimated prevalence of 10-20% of treated hypertensive patients. It is defined as blood pressure (BP) >140/90 mmHg treated with ≥3 antihypertensive medications, including a diuretic, if tolerated. Refractory hypertension is a novel phenotype of severe antihypertensive treatment failure. The proposed definition for refractory hypertension, i.e. BP >140/90 mmHg with use of ≥5 different antihypertensive medications, including a diuretic and a mineralocorticoid receptor antagonist (MRA) has been applied inconsistently. In comparison to RHTN, refractory hypertension seems to be less prevalent than RHTN. This review focuses on current knowledge about this novel phenotype compared with RHTN including definition, prevalence, mechanisms, characteristics and comorbidities, including cardiovascular risk. In patients with RHTN excess fluid retention is thought to be a common mechanism for the development of RHTN. Recently, evidence has emerged suggesting that refractory hypertension may be more of neurogenic etiology due to increased sympathetic activity as opposed to excess fluid retention. Treatment recommendations for RHTN are generally based on use and intensification of diuretic therapy, especially with the combination of a long-acting thiazide-like diuretic and an MRA. Based on findings from available studies, such an approach does not seem to be a successful strategy to control BP in patients with refractory hypertension and effective sympathetic inhibition in such patients, either with medications and/or device based approaches may be needed.
Abstract: Resistant hypertension (RHTN) is relatively common with an estimated prevalence of 10-20% of treated hypertensive patients. It is defined as blood pressure (BP) >140/90 mmHg treated with ≥3 antihypertensive medications, including a diuretic, if tolerated. Refractory hypertension is a novel phenotype of severe antihypertensive treatment failure. The...
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Lithium Poisoning Update in Diagnosis and Treatment
Jorge Rico-Fontalvo,
Rodrigo Daza-Arnedo,
Victor Leal-Martínez,
Emilio Abuabara-Franco,
Nehomar Pájaro-Galvis,
José Correa-Guerrero,
Maria Raad-Sarabia,
Alonso Pomares-Lara,
Dayana Ayola-Rosales,
Karen Mercado-Anillo,
Yamile Sepúlveda-Hernandez,
Huber Alvarado-Castell,
Christian Pérez-Calvo
Issue:
Volume 8, Issue 5, September 2020
Pages:
215-220
Received:
25 July 2020
Accepted:
6 August 2020
Published:
20 August 2020
Abstract: Introduction: Lithium has been used over time in the treatment of psychiatric pathologies, mainly the bipolar spectrum, however, the narrow therapeutic range generates a high incidence of poisoning by this metal, with a very heterogeneous clinical presentation of toxicity which will depend on two factors: the time of evolution, if it is acute or chronic, and the serum levels, ranging from gastrointestinal symptoms to severe neurological compromise. As of today, there is no specific antidote for lithium, so intermittent hemodialysis is the strategy of choice for the intoxicated patient. Objectives: To describe the available and relevant literature on the management of Lithium poisoning. Methodology: A search was performed with the MeSH terms "Lithium, Renal Dialysis, Poisoning, Toxicity, Acute kidney injury" in the ClinicalKey, PubMed and Ovid databases search engines, finding 156 results, of which 47 were used to develop this manuscript. Conclusions: Lithium poisoning is frequent due to its narrow therapeutic margin, so serum lithium levels should be monitored in patients medicated with it. Today there is no specific antidote, so renal replacement therapy is the best therapeutic option for lithium poisoning, demonstrating high efficiency, especially in cases of marked neurotoxicity. It is necessary to assess the need to initiate timely management in order to achieve a rapid clearance of the drug and decrease the rate of complications and mortality.
Abstract: Introduction: Lithium has been used over time in the treatment of psychiatric pathologies, mainly the bipolar spectrum, however, the narrow therapeutic range generates a high incidence of poisoning by this metal, with a very heterogeneous clinical presentation of toxicity which will depend on two factors: the time of evolution, if it is acute or ch...
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Value of PET/CT and MATLAB in Detection of COVID-19 in an Oncology Patient - Case Report
Michael Masoomi,
Alshaima Al-Shammeri,
Esraa Al-Qattan,
Haytham Ramzy,
Hany A Elrahman,
Aisha Al-Qattan,
Latifah Al-Kandari,
Iman Al-Shammeri
Issue:
Volume 8, Issue 5, September 2020
Pages:
221-225
Received:
24 July 2020
Accepted:
10 August 2020
Published:
25 August 2020
Abstract: The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), which causes the infectious disease COVID-19, was declared a global pandemic in March 2020. The SARS-CoV-2 infection has polymorphic clinical presentations. The real time PCR is the reference diagnostic test; however, it can only detect the presence of virus for a specific window of time and its sensitivity has been reported as low as 60–70%. Case: We report a clinical case for a 28-year-old male patient. His clinical history included known NHL (large B-cell lymphoma) that treated with chemotherapy and autologous bone marrow transplant in 2017. He initially presented with fewer, URTI (upper respiratory infection) and weight loss to have a PET/CT scan for restaging. The follow up PET/CT scan, suggested no worrisome FDG metabolic activity elsewhere to suggest disease recurrence, though, hypermetabolic mediastinal lymph nodes, which were kept with active infectious process and bilateral FDG-avid ground glass attenuation in between the consolidation patches were noted. The follow up RT-PCR post PET/CT scan was proved to be positive. A developed pixelated quantitative map of CT part of the lung using MATLAB showed clearly severity of the lung disease that strongly suggested COVID-19 lung in association with the positive RT-PCR. FDG PET/CT has the potential to add value to the challenges of diagnosing complications caused by viruses such as COVID-19.
Abstract: The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), which causes the infectious disease COVID-19, was declared a global pandemic in March 2020. The SARS-CoV-2 infection has polymorphic clinical presentations. The real time PCR is the reference diagnostic test; however, it can only detect the presence of virus for a specific window of ...
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The Cases of COVID-2019 and Changes at Autopsy
Olena Babkina,
Volodymyr Zosimenko,
Iana,
Ushko,
Olexsander Volobuev
Issue:
Volume 8, Issue 5, September 2020
Pages:
226-229
Received:
30 July 2020
Accepted:
12 August 2020
Published:
25 August 2020
Abstract: The article demonstrates data on the identification and statistical analysis of cases of 2019-nCoV coronavirus infection and changes at autopsy. Exploratory data analysis was July 29, 2020. It has been demonstrated that despite the timely adoption of measures to prevent the spread in Ukraine of acute respiratory disease caused by the 2019-nCoV coronavirus, including the introduction of an emergency regime throughout Ukraine with restrictive measures, the number of infected people is constantly increasing, there is also the number of fatal consequences was increased, causing concern. As a result of the analysis, it was revealed that, unlike other countries of the world in Ukraine, the greatest number of infected people is observed in people aged 40-60 years, among which female persons prevail. The coronavirus COVID-19 affects not only the lungs but also other human organs. The necessity of compliance by the population with the recommendations of the Ministry of Health of Ukraine and World Health Organization (WHO) in Ukraine, as in the countries of the world for COVID-19, the implementation of quarantine standards to reduce cases of infection and deaths, was emphasized.
Abstract: The article demonstrates data on the identification and statistical analysis of cases of 2019-nCoV coronavirus infection and changes at autopsy. Exploratory data analysis was July 29, 2020. It has been demonstrated that despite the timely adoption of measures to prevent the spread in Ukraine of acute respiratory disease caused by the 2019-nCoV coro...
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The Photomotor Response - Dynamic Quantification by a Portable Pupillometer
Jurij Rosen,
Claudio Privitera,
Resul Bulmus,
Makoto Nakamura,
Alexander Hartmann
Issue:
Volume 8, Issue 5, September 2020
Pages:
230-236
Received:
17 July 2020
Accepted:
12 August 2020
Published:
31 August 2020
Abstract: The pupillary light reflex (PLR) is a key component of the physical examination as it reliably tests the functional integrity of the neuromuscular loop between pupil and midbrain. Unlike the traditional manual testing the PLR with a penlight that frequently leads to incorrect interpretation due to its subjectivity, the specialized “pupillometer” tool allows objective testing and trending of pupillary data. We performed quantitative unilateral pupillometry several times in 53 healthy subjects (aged 21-74) in different background illumination levels using the NeurOptics NPi®-200 pupillometer. A number of key parameters describing the PLR were collected and analysed. We found that the individual PLR was very consistent. In general, constriction velocity (the first part of the PLR when the pupil constricts promptly after the onset of a light stimulus) was brisker than the dilation velocity (the second part of the PLR, when the pupil recovers from the constriction). Most importantly, both velocities depend on the initial pupillary resting size. We proved that pupillary parameters depend on environmental light conditions and age, but not gender, and scrutinized the nature and dynamics of anisocoric pupils. Taking together, pupillometry is becoming an important, non-invasive clinical tool for testing the autonomic nervous system. Here, we describe baseline parameters representing the physiological PLR, confirming and extending previously reported data. We thus provide the clinician important criteria to precisely assess the PLR and hence the autonomic nervous system in different pathological conditions such as diabetes, traumatic brain injury or cardiac and other autonomic neuropathies.
Abstract: The pupillary light reflex (PLR) is a key component of the physical examination as it reliably tests the functional integrity of the neuromuscular loop between pupil and midbrain. Unlike the traditional manual testing the PLR with a penlight that frequently leads to incorrect interpretation due to its subjectivity, the specialized “pupillometer” to...
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Association Between Obesity and Sarcoidosis: A Systematic Review and Meta-analysis
David Wainaina Wambui,
Ogugua Ndili Obi,
Gregory Dale Kearney
Issue:
Volume 8, Issue 5, September 2020
Pages:
237-245
Received:
7 August 2020
Accepted:
28 August 2020
Published:
7 September 2020
Abstract: Background: Sarcoidosis is a systemic inflammatory disease characterized by epithelioid granuloma formation in various organs. The etiology of sarcoidosis is unknown. Several studies report an increased risk of sarcoidosis in obese patients. The purpose of this study is to conduct a systematic review to assess the risk of sarcoidosis in obese or overweight patients, and to provide a population-based estimate of the risk of sarcoidosis in obese and overweight individuals. Methods: Using the Preferred Reporting Items for Systematic Review and Meta-analysis Protocols (PRISMA) guidelines, we conducted a comprehensive search of studies (Randomized control trial (RCT), cohort or case-control) studies that estimated the risk of sarcoidosis with body mass index (BMI) between 2009-2019 using keywords and MESH terms related to obesity and sarcoidosis. The search was conducted in MEDLINE, EBSCO, and CINAHL. Three independent investigators reviewed each article and assessed for bias. Data was extracted from each study that met inclusion criteria. Quantitative analysis was performed using Review Manager 5.3 software. Results: An initial search yielded 77 potential articles; 73 articles did not meet inclusion criteria and 4 were included in the final analysis. The pooled risk estimate for the incidence of sarcoidosis in obese and overweight individuals was 1.68 [95% confidence interval 1.5-1.87] with a significant statistical heterogeneity, I2 of 92%. Conclusion: From our systematic review, obese and overweight individuals have a 68% (RR 1.68, 95% CI 1.50 to 1.87) increased risk of developing sarcoidosis in comparison with normal or underweight individuals. More studies are needed to further evaluate the role of obesity in the etiopathogenesis of sarcoidosis.
Abstract: Background: Sarcoidosis is a systemic inflammatory disease characterized by epithelioid granuloma formation in various organs. The etiology of sarcoidosis is unknown. Several studies report an increased risk of sarcoidosis in obese patients. The purpose of this study is to conduct a systematic review to assess the risk of sarcoidosis in obese or ov...
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Evaluating Effect of Cognitive Behavioral Nursing on Quality of Life in Hemodialysis Patients
Huixia Yu,
Yu Meng,
Jian Li,
Sijing Shao,
Jinglan Luo,
Xiutin Li
Issue:
Volume 8, Issue 5, September 2020
Pages:
246-249
Received:
13 September 2020
Accepted:
22 September 2020
Published:
30 September 2020
Abstract: Objective: To assess effect of cognitive behavioral nursing on quality of life in hemodialysis patients. Methods: We invite 120 patients to join our study from January 2018 to January 2020. They were diagnosed as chronic renal failure in the hospital. In addition, the patients receive hemodialysis treatment in treatment process. In study beginning step, the participants were randomly assigned to a control group (n=60) and intervention group (n=60). For participants of control group, the patients receive the common nursing intervention in hemodialysis process. Additionally, the intervention group patients receive cognitive behavioral nursing on the basis of routine nursing. Result: In depression assessment and anxiety assessment, the control group and intervention group have similar assessment in depression status and anxiety status. In after nursing intervention part, the two groups have different assessment in research result. In health literacy assessment, the two group patients improve their health literacy in four elements. In addition, intervention group has better improvement that that of control group. In addition, the research result of coping style assessment and quality of life assessment are similar, that the two groups have different improvement in research result, that intervention group has better improvement than that of control group. Conclusion: the cognitive behavioral nursing improves some aspects of chronic renal failure patients, that include mental health, health literacy of patient, coping style level of patient and quality of life.
Abstract: Objective: To assess effect of cognitive behavioral nursing on quality of life in hemodialysis patients. Methods: We invite 120 patients to join our study from January 2018 to January 2020. They were diagnosed as chronic renal failure in the hospital. In addition, the patients receive hemodialysis treatment in treatment process. In study beginning ...
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