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Comment 2014; 35(3): 202-203 PubMed PMID: 24977968 Citation  Keywords:  Animals, Dogs, Female, Hair:chemistry, Male, Mercury:analysis, Preservatives, Pharmaceutical:adverse effects, Thimerosal:adverse effects, Vaccines:administration & dosage,.   

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Journal Article 2014; 35(3): 186-197 PubMed PMID: 24977966 Citation  Keywords:  Disorders of Excessive Somnolence:drug therapy, Drug Therapy:trends, Humans, Hypnotics and Sedatives:therapeutic use, Movement Disorders:drug therapy, Sleep Apnea Syndromes:drug therapy, Sleep Disorders, Circadian Rhythm:drug therapy, Sleep Initiation and.   

: Sleep disorders are frequent and disturbing, mostly chronic conditions. Despite the fact practice of sleep medicine is a young field. Sleep disorders were reduced to insomnia and even insomnia was not well studied until 1960ies. This article maps amazing development of sleep disorders treatment from the beginning till current date. The text covers both scientific and clinical perspectives on most frequent sleep related disorders including insomnias, hypersomnias, parasomnias, sleep related movement and breathing disorders, restless legs syndrome and circadian rhythm sleep disorders....

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Case Reports 2014; 35(3): 183-185 PubMed PMID: 24977965 Citation  Keywords:  Adult, Amines:therapeutic use, Anticonvulsants:adverse effects, Carbamazepine:adverse effects, Cyclohexanecarboxylic Acids:therapeutic use, Female, Humans, Hypothyroidism:chemically induced, Thyroxine:therapeutic use, Trigeminal Neuralgia:complications, V.   

: The question whether antiepileptic drugs alter thyroid function requires a better understanding. In our article, we report two sisters, one of whom was treated with levothyroxine because of hypothyroidism. Although both women received anticonvulsant therapy, transient hypothyroidism was observed only in the hypothyroid woman and was found after treatment with classic anticonvulsant agents (carbamazepine and sodium valproate) but not with gabapentin. Our report shows that the effect of anti-epileptic drugs on the thyroid gland depends on the patient's hormonal status and on the drug being used....

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Journal Article 2014; 35(2): 154-158 PubMed PMID: 24878981 Citation  Keywords:  Adrenomedullin:blood, Aged, Antihypertensive Agents:therapeutic use, Calcitonin Gene-Related Peptide:blood, Cardiovascular Diseases:diagnosis, Case-Control Studies, Diabetes Mellitus, Type 2:blood, Dyslipidemias:complications, Female, Humans, Hypertension.   

OBJECTIVES: To evaluate the significance of plasma adrenomedullin and calcitonin gene-related peptide (CGRP) concentration in patients with Type 2 diabetes mellitus who are treated for hypertension and dyslipidemia.

METHOD: Plasma adrenomedullin and CGRP concentration, transthoracal echocardiography and ABPM were evaluated in 82 patients with Type 2 diabetes mellitus and 41 control subjects with no previous cardiovascular disease. All the subjects had casual blood pressure ≤140/90 mmHg or received antihypertensive medication, were treated by statin if LDL cholesterol was≥3mmol/L, by fibrates if triacylglyceroles≥2 mmol/L.

RESULTS: The mean age was 61±6 in patients with diabetes mellitus and 61±5 years in control subjects (p=0.9). Plasma CGRP was 3.0±1.8 in patients with diabetes mellitus and 2.3±1.0 ng/ml in control subjects (p=0.09). Plasma adrenomedullin was 2.2±0.9 in patients with diabetes mellitus and 2.8±1.1 ng/ml in control subjects (p=0.01). In patients with diabetes mellitus mass index of the left ventricle was significantly higher and the parameters of diastolic function were more deteriorated. Plasma adrenomedullin and CGRP correlated significantly negatively with serum creatinine and positively with mean 24 hours arterial blood pressure in patients with diabetes mellitus but not in control subjects. Plasma adrenomedullin concentration in patients with diabetes mellitus treated for hypertension was significantly reduced.

CONCLUSION: Despite concentration plasma adrenomedullin and CGRP modulation by cardioprotective treatment both neuropeptides remained involved in regulation of hemodynamic and metabolic parameters in patients with Type 2 diabetes mellitus. The low plasma of adrenomedullin in patients with Type 2 diabetic may be marker of the efficient intervention on cardiovascular risk factors....

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Journal Article 2014; 35(2): 116-122 PubMed PMID: 24878980 Citation  Keywords:  Aged, Anxiety:etiology, Humans, Lower Urinary Tract Symptoms:complications, Male, Middle Aged, Multivariate Analysis, Prognosis, Prostatic Hyperplasia:complications, Research Design, Severity of Illness Index, Somatoform Disorders:etiology, Surveys and Qu.   

OBJECTIVE: This study tried to test predictors of response to routine treatment in patients with lower urinary tract symptoms suggestive of benign prostatic hyperplasia (LUTS/BPH).

METHODS: Subjects were evaluated at baseline and at week 12 following routine treatment for LUTS/BPH using the Korean version of the International Prostate Symptom Score (IPSS) to measure the severity of LUTS/BPH. Demographics and various clinical variables were analyzed by regression analysis.

RESULTS: Ninety three patients received routine treatment for LUTS/BPH for 12 weeks in a naturalistic treatment setting. None of demographics and clinical variables was different between responders and non-responders. According to multivariate regression analysis, the presence of anxiety (OR=0.203), lower improvement in the GAD-7 total score (OR=0.755) and lower improvement in the PHQ-15 total score (OR=0.811) were independent predictors of treatment response after 12 weeks routine treatment.

CONCLUSIONS: We found the positive association of improvement in anxiety and somatization with treatment response, while presence of anxiety was negatively associated with treatment response, in patients with LUTS/BPH. However, additional studies with adequate power and improved designs are necessary to support the present findings....

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Journal Article 2014; 35(2): 104-109 PubMed PMID: 24878979 Citation  Keywords:  Animals, Anti-Inflammatory Agents:therapeutic use, Antidepressive Agents:therapeutic use, Depressive Disorder:complications, Encephalitis:etiology, Glutamic Acid:physiology, Humans, Inflammation Mediators:antagonists & inhibitors, Nerve Growth Factors:phy.   

: Post-stroke depression (PSD) is a prevalent complex psychiatric disorder that causes delay to functional recovery from rehabilitation and also increases cognitive impairment. The etiology of PSD remains controversial and appears to be physical and psycho-social in origin, alone or in combination. The causes of PSD as well as the mechanisms conferring beneficial antidepressant effects in the context of ischemic brain injury are still unknown. In addition, appropriate treatment strategies for therapy to prevent stroke-induced depression-like behavior remain to be developed. This paper, therefore, proposes two hypotheses for post-stroke depression: The inflammatory hypothesis, which is the increased production of proinflammatory cytokines resulting from brain ischemia in cerebral areas causing the pathogenesis of post-stroke depression and the glutamate hypothesis, where the excess glucocorticoids released from stress-induced over-activation of hypothalamus-pituitary-adrenal (HPA) lead to dysfunction of glutamatergic transmission. Neurotrophins, especially brain-derived neurotrophic factor (BDNF) and vascular endothelial growth factor (VEGF) both play various roles in the central nervous system (CNS), attenuate apoptosis in cultured neurons, stimulate neurogenesis and increase survival and protect neuronal tissues from cell death induced by ischemia or depression. We also touch upon recent treatment strategies including inhibition of pro-inflammatory cytokines, SSRI, neurotrophins and cell-based therapies. In the present review, we provide an overview of recent evidence concerning the mechanisms of post-stroke depression and propose four prospective treatment strategies so as to provide references for clinical evidence-based medications....

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Journal Article 2014; 35(2): 142-148 PubMed PMID: 24878978 Citation  Keywords:  Adult, Baroreflex:physiology, Cardiovascular Diseases:diagnosis, Endothelium, Vascular:physiopathology, Female, Humans, Male, Middle Aged, Polysomnography, Prognosis, Risk Factors, Severity of Illness Index, Sleep Apnea, Obstructive:complications,.   

OBJECTIVES: Obstructive sleep apnea syndrome (OSA) is associated with increased cardiovascular morbidity and mortality. Endothelial dysfunction (ED), accelerated atherosclerosis and autonomic dysfunction might be the key players responsible for development of vascular diseases in patients with OSA. In a population with suspected OSA and low burden of cardiovascular risk factors, we therefore aimed to investigate the association between potential cardiovascular risk factors including OSA-specific indices, ED and autonomic activity.

METHODS: ED was investigated using reperfusion hyperaemia index (RHI). OSA was assessed using standard polysomnography, autonomic activity was assessed using baroreflex sensitivity (BRS).

RESULTS: We enrolled 31 patients (42.1±11.7 years) with OSA. Significant inverse correlation was found between RHI and apnea-hypopnea index (AHI) (r=-0.550, p=0.001) and between RHI desaturation index (r=-0.533, p=0.002). Positive correlation was found between RHI and minimal nocturnal oxygen saturation (r=0.394, p=0.028). In a multiple regression model AHI was the only significant variable to predict RHI (β=-0.522, p=0.003). We found no correlation between RHI and BRS. RHI in the population with severe OSA (AHI above 30) was significantly lower than RHI in the rest of the population (p=0.012).

CONCLUSION: AHI was the only significant independent predictor of impaired endothelial function as expressed by RHI. RHI showed no association with BRS in patients with OSA....

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Journal Article 2014; 35(2): 149-153 PubMed PMID: 24878977 Citation  Keywords:  Aged, Aged, 80 and over, Carotid Artery Diseases:complications, Carotid Artery, Internal:pathology, Cerebral Infarction:complications, Euthyroid Sick Syndromes:complications, Female, Humans, Inpatients:statistics & numerical data, Male, Middle Aged, Nervo.   

OBJECTIVES: The low triiodothyronine (T3) syndrome indicates poor prognosis for patients with cerebral infarction. It is unknown, however, whether basic conditions or severities in the patients with the low T3 syndrome are different compared to those without the low T3 syndrome.

METHODS: We compared the risk factors and the severity of the disease using the National Institutes of Health stroke scale (NIHSS) score at the worst condition for cerebral infarction in patients with or without the low T3 syndrome in order to better understand the characteristics underlying the worse prognosis in patients with the low T3 syndrome.

RESULTS: We found that cerebral infarction patients with the low T3 syndrome were significantly older (p<0.001) and significantly more likely to be female (p=0.002) and had hypertension (p=0.04) or homocystinemia (p=0.001), but less likely to smoke (p=0.008), compared to patients without the low T3 syndrome. The proportion of NIHSS score ≥8 in the patients with LAA-ICA-associated cerebral infarction accompanied by the low T3 syndrome was significantly higher than in those without the low T3 syndrome (p=0.001).

CONCLUSION: We concluded that increased numbers of risk factors for cerebral infarction and more severe neurological deficits may be important causes for worse prognosis in the patients with the low T3 syndrome which may more likely occur in patients with LAA-ICA cerebral infarction. Intense secondary prevention in cerebral infarction especially in older women are needed....

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