ஜர்னல் ஆஃப் மெட்டபாலிக் சிண்ட்ரோம்

Geriatric population is a special subset of adult population with different needs as there are physiological changes that occur with aging, that lead to a decline in patient’s overall performance functional disabilities and, cognitive impairment, We reviewed the various anti diabetic regimes in Emirati geriatric patients with type 2 diabetes following outpatient medical clinics. In a view to find optimum anti-diabetic regime which is more suitable and acceptable to the patients with minimum side effects. We believe that patients following in government hospitals would be a true representation of whole subset of Emirati geriatric population and hence any results obtained could be a reflection of entire Emirati geriatric population. Medical records of 350 Emirati type 2 diabetic patients age above 65 were reviewed. HBAIC at the clinic visit was noted and they were retrospectively followed up as to see which anti diabetic regime these patients were on for the preceding 3 months. Patients were divided accordingly into 4 groups namely. a) Those on oral hypoglycemic, b) oral hypoglycemic plus basal insulin, c) premix insulin and d) basal insulin bolus. Mean HBAIC was compared amongst the various age groups. Conclusion 350 patients were following medical clinics, 16 patients were excluded. Out of the remaining 334 patients 224 were females and 110 were males. Patients were divided into 2 groups according to age. Patients less than 70 years of age were 121 (36.2%) and patients greater than 70 years of age were 213 (63.8%). Patients in both these age groups had uncontrolled blood sugars. HBAIC 8.1% vs. HBAIC 7.76% in patients less than 70 year’s vs. patients greater than 70 years age). In higher age groups HBAIC was better controlled as compared to lesser age groups reflecting better care of elderly in the Emirati society. Most patients were on oral hypoglycemic as compared to insulin (60.5% vs. 21.6%). Both males and females were better controlled on oral medication as compared to insulin (HBAIC 7.58% males and HBAIC 7.69% in females on oral medications). Sulfonyl urea and metformin being the most popular oral medications used. Only 21.6% were on insulin reflecting increase needle phobia in the elderly age groups.

Human suicide is affected by a great variety of causality. Due to diversities of suicide causalities, suicide predictions and prevention are no easy tasks. This article outlines the history of suicide study, current diagnostic and therapeutic routine, pathogenesis study, new therapeutic models and future directions. This introduction aims to update human suicide study and future aspects of clinical interventions in suicide risk predictions and prevention.

Objective: The objective was to determine changes in heart rate variability (HRV) in response to orthostatic challenge in a convenience sample of patients with anorexia nervosa compared to age-matched controls. A decrease in HRV has been shown to correlate with an increased risk of heart attack in coronary artery disease and heart failure patients.

Method: Clinical data and ECG recordings were collected from 37 patients with eating disorders of which 16 had a diagnosis of anorexia nervosa and 42 controls. HRV was analyzed using linear and nonlinear methods during rest and orthostatic challenge from sitting to standing.

Results: Significant sympathovagal changes were identified in the anorexia nervosa group, especially with nonlinear HRV parameters and orthostatic challenge. Sample entropy, a nonlinear measure provided the best discrimination between the two groups on standing (1.58 ± 0.42 vs. 1.19 ± 0.4; p<0.0001) and when the change in HRV was measured from sitting to standing (-0.06 ± 0.36 vs. -0.42 ± 0.34; p<0.0001). The anorexia nervosa group had a significantly larger response to orthostatic challenge compared to the control group suggesting sympathetic dysfunction. Discussion: Including nonlinear measures and orthostatic challenge from an ECG recording of anorexia nervosa patients at initial clinical assessment on admission to hospital provides a noninvasive, sensitive tool to determine loss of normal physiological autonomic control of heart rate that may be related to an increased risk of arrhythmic events that requires further monitoring.

Conclusion: Nonlinear HRV measures are more sensitive in identifying sympathetic and parasympathetic changes associated with orthostatic challenge in patients with anorexia nervosa.

Low levels of testosterone are related with metabolic syndrome and type 2 diabetes mellitus. Testosterone levels are considered to be negatively correlated with insulin resistance and HbA1c levels. There are also reports that testosterone replacement therapy reduces insulin resistance or improves glycemic control.

Transdermal administration of testosterone ointment (Glowmin) is a method of drug administration that keeps blood concentrations stable and constant. In this study, testosterone ointment (Glowmin) was administrated as a testosterone supplement to male metabolic syndrome with low free testosterone levels. This study included 5 male metabolic syndrome with low free testosterone levels (mean age, 50.6 ± 8.8 years; mean BMI, 29.5 ± 3.1 kg/m2; mean waist circumference, 97 ± 7 cm; free testosterone levels, <8.5 pg/ml; values indicate means ± SD). Glowmin was administrated to the submandibular area at a dose of 0.3 g twice a day for 6 months. Three months after administration, a significant decrease was observed in fasting immunoreactive insulin levels, homeostasis model assessment for insulin resistance, total cholesterol and LDL-C. Six-months after administration, each of these parameter estimates remained steady.

In conclusion, transdermal administration of testosterone ointment (Glowmin) gradually reduced insulin resistance in male metabolic syndrome with low free testosterone levels.

Diagnostic criteria for metabolic syndrome in Japan are different from other countries. In this paper, we outline the diagnostic criteria and problems that the authors consider these criteria to have, as well as explain content to be changed in 2018.