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Journal Article 2011; 32(2): 121-126 PubMed PMID: 21552191 Citation  Keywords:  Humans, Schizophrenia:therapy, Transcranial Magnetic Stimulation, Treatment Outcome,.   

: One of the fundamental prerequisites of the successful schizophrenia treatment is represented by an adequately significant impact on the negative symptoms of schizophrenia. Since the present pharmacotherapy has probably reached its limit in this area, there is a logical effort to utilize other, non-pharmacological methods. One of the most promising supplements that has been for a long time verified in the clinical practice is rTMS. Most of the studies have arrived at the conclusion that rTMS is an efficient method in the treatment of negative symptoms of schizophrenia. A valuable contribution to the assessment of the rTMS application in the treatment of negative symptoms is represented by meta-analyses. The meta-analyses indicate that the effect is mild to moderate (d=0.43 to 0.68). To sum it up, there will be higher probability of the rTMS effect on negative symptoms if 10 Hz stimulating frequency and a longer stimulation period in the extent at least three, ideally four to six weeks is used....

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Comparative Study 2011; 32(2): 158-163 PubMed PMID: 21552190 Citation  Keywords:  Adult, Circadian Rhythm:physiology, Computers, Humans, Light, Lighting, Melatonin:metabolism, Saliva:metabolism, Sleep:physiology, Students, Universities,.   

OBJECTIVES: Self-luminous electronic devices emit optical radiation at short wavelengths, close to the peak sensitivity of melatonin suppression. Melatonin suppression resulting from exposure to light at night has been linked to increased risk for diseases. The impact of luminous cathode ray tube (CRT) computer monitors on melatonin suppression was investigated.

DESIGN: Twenty-one participants experienced three test conditions: 1) computer monitor only, 2) computer monitor viewed through goggles providing 40 lux of short-wavelength (blue; peak λ ≈ 470 nm) light at the cornea from light emitting diodes (LEDs), and 3) computer monitor viewed through orange-tinted safety glasses (optical radiation <525 nm ≈ 0). The blue-light goggles were used as a "true-positive" experimental condition to demonstrate protocol effectiveness; the same light treatment had been shown in a previous study to suppress nocturnal melatonin. The orange-tinted glasses served as a "dark" control condition because the short-wavelength radiation necessary for nocturnal melatonin suppression was eliminated. Saliva samples were collected from subjects at 23:00, before starting computer tasks, and again at midnight and 01:00 while performing computer tasks under all three experimental conditions.

RESULTS: Melatonin concentrations after exposure to the blue-light goggle experimental condition were significantly reduced compared to the dark control and to the computer monitor only conditions. Although not statistically significant, the mean melatonin concentration after exposure to the computer monitor only was reduced slightly relative to the dark control condition.

CONCLUSIONS: Additional empirical data should be collected to test the effectiveness of different, brighter and larger screens on melatonin suppression....

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Journal Article 2011; 32(2): 148-153 PubMed PMID: 21552189 Citation  Keywords:  Aged, Biomarkers:blood, Chronic Disease, Circadian Rhythm:physiology, Erythropoietin:blood, Female, Glomerular Filtration Rate:physiology, Hemoglobins:metabolism, Humans, Insulin-Like Growth Factor I:metabolism, Interleukin-6:blood, Kidney:physiopathology.   

OBJECTIVE: Chronic inflammation plays a pivotal role in the development of renal disease. Circadian sleep-wake rhythm is disturbed in renal disease. Awareness of other disturbed rhythms, such as inflammation processes, can affect the treatment of patients with renal disease. Knowledge of possibly related circadian misalignment of the cytokines erythropoietin (EPO), Insulin Growth Factor-1 (IGF-1) and interleukins (IL) however is limited. We therefore performed an observational study. The objective of this study was to characterize levels of EPO, IGF-1 and inflammation markers IL-6 and TNF-α, related to renal function.

METHODS: The study population consisted of patients with various degrees of renal function, admitted to our hospital. During 24 hours, blood of 28 subjects with various degrees of renal function was collected every 2 hours. The patients were stable, not acutely ill and they were waiting for a procedure, such as elective surgery. Circadian parameters of EPO, IGF-1, IL-6 and TNF-α were measured in serum and were correlated with glomerular filtration rate (GFR) and Hb, using Pearson correlations.

RESULTS: Although diurnal variations in EPO level were found in 15 out of 28 patients, the curves did not show a consistent phase. The presence of an EPO rhythm was not related to GFR. No diurnal rhythm could be detected for IGF-1, IL-6 and TNF-α. Mean levels of IGF-1 were correlated inversely to mean levels of EPO (p=0.03). When divided based on GFR and Hb subjects with GFR 10-30 ml/min and lower Hb had the highest IGF-1 levels (p=0.02). A relationship between Il-6, TNF-α and EPO or GFR was not found.

CONCLUSION: The existence of a circadian (mis)alignment of EPO, IGF-1, IL-6 and TNF-α was not found. The association between high IGF-1 and low Hb suggests that EPO and IGF-1 have an alternating role, dependent on GFR, in stimulating erythropoiesis. These results could have consequences for the treatment of anemia....

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Evaluation Studies 2011; 32(2): 199-205 PubMed PMID: 21552187 Citation  Keywords:  Antipsychotic Agents:adverse effects, Feeding Behavior:psychology, Humans, Interpersonal Relations, Mental Disorders:drug therapy, Motor Activity:physiology, Obesity:epidemiology, Outcome Assessment (Health Care):methods, Predictive Value of Tests, Risk F.   

OBJECTIVES: Patients with mental illness are at risk for weight gain. Evidence-based risk assessment checklists have the potential to identify patients at risk early in treatment and improve patient outcomes.

METHODS: The 16-item Weight Gain Risk Factor (WGRF-16) checklist has been developed as a simple brief assessment of key weight gain risk factors during antipsychotic treatment. It consists of factors that were collected on the basis of published research on predictors to be assessed at initiation of, and early in treatment with antipsychotics.

RESULTS: The factors in the WGRF-16 checklist included age, sex, body mass index, race, appetite, energy intake, a diagnosis of undifferentiated schizophrenia, early clinical response, comorbiditites, social activity, patient insight, housing conditions, weight satisfaction, eating habits, and physical activity level. The WGRF-16 is designed to be repeated 2-3 weeks after initiation of treatment to help to predict an individual's risk of clinically significant weight gain (>7%) during long-term treatment. Further research is required to assess the predictive validity of the checklist.

CONCLUSIONS: The WGRF-16 checklist is not intended to replace other required monitoring of patients with severe mental disorders but is a facilitator of weight monitoring in conjunction with clinical guidelines....

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Journal Article 2011; 32(1): 7-24 PubMed PMID: 21407167 Citation  Keywords:  Animals, Comorbidity, Depression:epidemiology, Humans, Inflammation:epidemiology, Neuroimmunomodulation:physiology, Oxidative Stress:immunology, Reactive Nitrogen Species:metabolism, Signal Transduction:immunology, Stress, Psychological:epidemiology,.   

: There is now evidence that depression, as characterized by melancholic symptoms, anxiety, and fatigue and somatic (F&S) symptoms, is the clinical expression of peripheral cell-mediated activation, inflammation and induction of oxidative and nitrosative stress (IO&NS) pathways and of central microglial activation, decreased neurogenesis and increased apoptosis. This review gives an explanation for the multiple "co-morbidities" between depression and a large variety of a) brain disorders related to neurodegeneration, e.g. Alzheimer's, Parkinson's and Huntington's disease, multiple sclerosis and stroke; b) medical disorders, such as cardiovascular disorder, chronic fatigue syndrome, chronic obstructive pulmonary disease, rheumatoid arthritis, psoriasis, systemic lupus erythematosus, inflammatory bowel disease, irritable bowel syndrome, leaky gut, diabetes type 1 and 2, obesity and the metabolic syndrome, and HIV infection; and c) conditions, such as hemodialysis, interferon-α-based immunotherapy, the postnatal period and psychosocial stressors. The common denominator of all those disorders/conditions is the presence of microglial activation and/or activation of peripheral IO&NS pathways. There is evidence that shared peripheral and / or central IO&NS pathways underpin the pathophysiology of depression and the previously mentioned disorders and that activation of these IO&NS pathways contributes to shared risk. The IO&NS pathways function as a smoke sensor that detect threats in the peripheral and central parts of the body and signal these threats as melancholic, anxiety, and fatigue and somatic (F&S) symptoms. The presence of concomitant depression is strongly associated with a lower quality of life and increased morbidity and mortality in medical disorders. This may be explained since depression contributes to increased (neuro)inflammatory burden and may therefore drive the inflammatory and degenerative progression. It is concluded that the activation of peripheral and / or central IO&NS pathways may explain the co-occurrence of depression with the above disorders. This shows that depression belongs to the spectrum of inflammatory and degenerative disorders....

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Journal Article 2011; 32(1): 102-108 PubMed PMID: 21407166 Citation  Keywords:  Adult, Atherosclerosis:metabolism, Body Mass Index, Cholesterol, HDL:blood, Cholesterol, LDL:blood, Exercise:physiology, Female, Humans, Middle Aged, Obesity:metabolism, Oxygen Consumption:physiology, Physical Fitness:physiology, Sedentary Lifestyle, Trig.   

OBJECTIVE: In obese patients, we hypothesized physical exercise (PE) to affect lipids through its intrahepatic fat accumulation-lowering effect, associated with a decrease of total body fat (Fat%) and even weight (Mass).

DESIGN AND SETTING: Thirty seven sedentary, non-diabetic women (BMI median 34.8) from our out-patient department were tested. Elimination criteria: recent weight reduction, lipid-influencing or heart rate-modifying medication.

PARTICIPANTS: 50 entering, 37 finishing, 7 excluded for processing failure, 6 did not fulfill the protocol.

INTERVENTIONS: PE protocol: 60 min supervised trainings, intensity at 65% of VO2max, modified by the clamp heart rate test. Median of total training hours was 34 during 115 days (median).

MAIN OUTCOME MEASUREMENTS: an effect of PE on total cholesterol (CH), triglycerides (TG), HDL-cholesterol (HDL_C), LDL-cholesterol (LDL_C), index of atherogenity (IA), atherogenic index of plasma (AIP), maximum peak oxygen consumption (VO2max), Mass, body mass index (BMI), waist circumference (Waist) and Fat%.

RESULTS: Statistically significant differences at start (_s) and the end (_e) of PE (p<0.05): AIP -0.049, Mass -3.6 (kg), BMI -1.7 (kg/m2), Waist -2.5 (cm), Fat% -2.5, VO2max 2.92 (L.min-1kg-1). Correlation coefficients, Pearson's between Gaussian distributed (Gd-v) variables and Spearman´s (non Gd-v) statistically significant (p<0.05): IA and BMI, IA and Mass, IA and Waist, IA and Fat%, LDL and BMI, LDL and Mass, LDL and Fat%, LDL and Waist, IA and VO2max, LDL_C and VO2max.

CONCLUSIONS: PE improves lipid profile towards production of antiatherogenic particles more likely due to changes in anthropometric parameters than in improvement of physical fitness....

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Journal Article 2011; 32(1): 77-81 PubMed PMID: 21407165 Citation  Keywords:  Cholecalciferol:blood, Cholesterol, HDL:blood, Cholesterol, LDL:blood, Dehydroepiandrosterone Sulfate:blood, Estrogens:blood, Female, Hormone Replacement Therapy:methods, Hormones:blood, Humans, Hydrocortisone:blood, Hypercholesterolemia:blood, Hypogonadi.   

OBJECTIVE: In 2002 we proposed a new hypothesis of the etiology and pathogenesis of hypercholesterolemia. There is paucity of information in the literature regarding the association of steroidopenia and hypercholesterolemia. Our goal is to determine if the treatment of steroidopenia with hormonorestorative therapy (HT) to youthful levels will normalize total cholesterol (TC) levels.

MATERIAL AND METHODS: We retrospectively analyzed 43 hypercholesterolemic patients treated with HT. Laboratory workup included lipid profile, serum pregnenolone, dehydroepiandrosterone sulfate (DHEA-S), progesterone, total estrogen, cortisol, total testosterone, and vitamin D-3 levels at presentation with follow up ranging from 3 to 9 months. HT therapy included a combination of several agents such as pregnenolone, dehydroepiandrosterone (DHEA), triestrogen, progesterone, testosterone, hydrocortisone, and vitamin D-3.

RESULTS: HT lowered mean TC from 228.8 mg/dL to 183.7 mg/dL (19.7%) (p<0.05) in all patients. In 12 men of mean age 58, HT statistically significantly lowered TC from 227.9 mg/dL to 177.1 mg/dL (22.3%) (p<0.05). Apparently it did so mostly by lowering LDL and triglycerides (TRG) while HDL did not appreciably change. In 31women, mean age 57, TC declined from 229.2 mg/dL to 186.3 mg/dL (19%) (p<0.05). HDL, LDL, and TRG are also decreased to a statistically significant degree. These results were associated with statistically significant elevations in pregnenolone, DHEA Sulfate, testosterone, progesterone but not total estrogen, cortisol or vitamin D-3 changes in both men and women.

CONCLUSIONS: We conclude that correction of steroidopenia with the use of hormonorestorative therapy is an effective strategy for normalizing and maintaining cholesterol homeostasis....

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Case Reports 2011; 32(1): 4-6 PubMed PMID: 21407162 Citation  Keywords:  Adjuvants, Immunologic:administration & dosage, Adult, Female, Humans, Interferon beta-1b, Interferon-beta:administration & dosage, Lupus Erythematosus, Systemic:chemically induced, Multiple Sclerosis, Relapsing-Remitting:drug therapy, Time Factors,.   

: Drug-induced systemic lupus erythematosus (SLE) is a rare complication of therapies with some drugs. Breaking out after months or years of therapy with a certain drug, its occurrence is likely to increase with the duration of the medication and the cumulative quantity of the drug. The symptoms of this syndrome include, in particular, arthralgia, myalgia, fever, serositis, skin exanthema and production of antinuclear (ANA) antibodies. In contrast to SLE, its symptoms gradually abate after discontinuation of the inducing agent. The authors describe the case of a 43-year-old patient suffering from multiple sclerosis who experienced drug-induced SLE after 8-year application of interferon (IFN) beta-1b....

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