Analysis of arterial hypertension pharmacotherapy in patients with obstructive sleep apnea syndrome

IntroductionObstructive sleep apnea (OSA) is often connected with arterial hypertension and it could also be a cause of secondary hypertension. Treatment of arterial hypertension and optimal blood pressure level are important for prevention of cardiovascular complications. It is not well known how to treat patients with OSA and arterial hypertension. Also many patients with OSA suffer from metabolic syndrome which worsen their prognosis.AimThe aim of our study was to assess arterial hypertension compensation in patients with metabolic syndrome and moderate to severe OSA and to analyze used pharmacotherapy.Materials and methods85 hypertensive patients (75 men) with metabolic syndrome, average age 53.6 ± 9.3 years, were evaluated using overnight sleep study with diagnosis of OSA, average apnea–hypopnea index (AHI) 56.3 ± 23. Patients underwent 24 h ambulatory blood pressure monitoring (ABPM) and their current pharmacotherapy data were obtained. Appropriate combinations of antihypertensive drugs (patients with metabolic syndrome) were derived from ESH/ESC 2013 guidelines.ResultsArterial hypertension was well compensated in only 11.8% of the patients. 24.7% patients were treated according to current guidelines. Fisher's exact test with analysis of adjusted residues has found higher rate of blood pressure subcompensation in patients treated with triple+ combination of drugs (p = 0.035, 51.4% vs 10%).ConclusionOnly a small number of patients had optimal blood pressure level and were treated according to current ESH/ESC guidelines. We have to constantly appeal to all physicians to perform ABPM in patients with OSA.     

中药治疗口腔扁平苔藓的免疫调节作用

目的探讨中药治疗对口腔扁平苔藓患者免疫状况的影响。方法对３０例口腔扁平苔藓患者应用中药治疗，检查了患者治疗前后Ｔ淋巴细胞亚群的变化。结果患者治疗前ＣＤ３、ＣＤ４以及ＣＤ４／ＣＤ８比率显著低于健康人（Ｐ＜０．０１）；中药治疗后患者ＣＤ３、ＣＤ４以及ＣＤ４／ＣＤ８比率显著提高（Ｐ＜０．０１），ＣＤ４／ＣＤ８比率恢复正常。３０例中，痊愈８例，显效１４例，好转８例。结论提示口腔扁平苔藓患者Ｔ淋巴细胞功能减弱，Ｔ细胞亚群平衡失调，中药治疗对患者机体免疫有双向调节作用，免疫平衡得以恢复，并取得较好的临床疗效。     

Treating aggression in persons with autism spectrum disorders: A review

Aggression is one of the most frequent and debilitating problems observed among persons with autism spectrum disorders (ASD). It is common and can be more problematic than many core symptoms of ASD. Thus, treating the behavior is a high priority. A surprisingly limited number of studies have addressed treatment when taken in the context of the vast ASD literature. This paper reviews many of these papers and describes the types of interventions that have been used and the characteristics of the people who have been studied.     

The Effectiveness of Cross-Tapering Switching to Ziprasidone in Patients with Schizophrenia or Schizoaffective Disorder

Objective

Switching antipsychotics is one useful therapeutic option when the treatment of schizophrenia encounters suboptimal efficacy and intolerability issues. This study aimed to investigate the efficacy and tolerability of cross-tapering switching to ziprasidone from other antipsychotics.

Methods

A total of 67 patients with schizophrenia or schizoaffective disorder were recruited in this 12-week, multicenter, non-comparative, open-label trial. Prior antipsychotics were allowed to be maintained for up to 4 weeks during the titration of ziprasidone. Efficacy was primarily measured using the 18-item Brief Psychotic Rating Scale (BPRS) at baseline, 4 weeks, 8 weeks, and 12 weeks. Efficacy was secondarily measured by the Clinical Global Impression-Severity (CGI-S) scale and the Global Assessment of Functioning (GAF) scale at each visit. Regarding the metabolic effects of switching to ziprasidone, weight, body mass index (BMI), waist-to-hip ratio (WHR), and lipid profile-including triglyceride (TG), high-density lipoprotein (HDL), low-density lipoprotein (LDL), and total cholesterol levels-were measured at each follow-up visit.

Results

The BPRS scores were significantly improved at 12 weeks after switching to ziprasidone (F=5.96, df=2.11, p=0.003), whereas the CGI-S and GAF scores were not significantly changed. BMIs, WHRs, and TG levels were significantly decreased, with no significant changes in other lipid profiles.

Conclusion

Cross-tapering switching to ziprasidone is effective for patients with schizophrenia spectrum disorders. Beyond the efficacy of the procedure, favorable metabolic profiles show that switching to ziprasidone may be helpful for maintenance therapy over an extended period.     

Exploring beliefs on diabetes treatment adherence among Dutch type 2 diabetes patients and healthcare providers

Objective

Despite well-known beneficial effects, adherence to core elements of diabetes treatment is suboptimal. This study, conducted in the Netherlands, aimed to explore if and how treatment adherence success factors are applied in diabetes consultations, and to explore salient personal beliefs about type 2 diabetes treatment including both healthy lifestyle adaptations and pharmacotherapy.

Fluoxetine Treatment Seems to Reduce the Beneficial Effects of Cognitive-Behavioral Therapy in Type B Alcoholics

Objective : The aim of this study was to test the hypothesis that, because of abnormalities in serotonergic neurotransmission that may underlie craving and impulsive behavior, fluoxetine treatment differentially affects drinking among type B alcoholics, who are characterized by high levels of both premorbid vulnerability and alcohol-related problems. Methods : Using a k -means clustering procedure, alcohol-dependent subjects from a placebo-controlled trial of fluoxetine were grouped into low-risk/severity (type A n = 60) and highrisk/severity (type B: n = 35) groups. Multivariate analysis of covariance (with pretreatment measures as covariates) evaluated the effects of Alcoholic Subtype, Medication Group, Treatment Completion, and their interactions on measures of drinking, both during the 12-week treatment period and a 6-month follow-up period. Results : Although there were no main effects of Alcoholic Subtype or Medication Group, subjects who completed the treatment trial showed significantly better drinking-related outcomes. There was also an interaction of Alcoholic Subtype by Medication Group during treatment. Among type B subjects, fluoxetine treatment resulted in poorer drinking-related outcomes than placebo treatment. Among type A subjects, there was no effect of Medication Group. This interactive effect did not persist during the 6-month follow-up period. Conclusions : Alcoholic subtypes identified by cluster analysis seem to be differentially responsive to the effects of fluoxetine treatment on drinking-related outcomes. Serotonergic abnormalities previously identified among a subgroup of alcoholics who are also characterized by impulsivity and severity of alcohol dependence may help to explain the differential medication effect. Based on these findings, it is recommended that, in the absence of a comorbid mood or anxiety disorder, fluoxetine not be used to maintain abstinence or reduce drinking in high-risk/severity alcoholics.     

Hypertension and chronic kidney diseases

Chronic kidney diseases – arising from inborn or acquired renal disorders – are one of the most common causes of secondary hypertension. Renal parenchymatous hypertension accompanying bilateral or unilateral kidney diseases is more prevalent than renovascular hypertension. The prevalence and severity of hypertension are influenced by age, weight, type of renal affliction, and depth of renal dysfunction. In multifactorial pathogenesis, sodium retention plays the crucial role together with dysbalance concerning effects of different vasoactive substances; however, unequivocal distinction between volume- and renin-type hypertension is difficult. The treatment of renal hypertension includes appropriate lifestyle changes, pharmacotherapy, hemoelimination methods and radiological or urological invasive procedures. In chronic kidney diseases with increased albuminuria or proteinuria, ACE inhibitors and AT1-blockers are preferred. Combination of several antihypertensives is often required to achieve the target blood pressure. Increased blood pressure represents not only the manifestation of chronic kidney diseases but also an important factor concerning the renal and cardiovascular risk.     

Combining ECT with pharmacological treatment of depressed inpatients in a naturalistic study is not associated with serum BDNF level increase

BackgroundBDNF blood levels are reduced in MDD. They can be increased with pharmacologic treatment and ECT, but it is not clear whether the combination of treatments promotes an additional increase. The present study aims to evaluate whether combined treatment promotes an increase in BDNF, restoring the level to that of non-depressed controls.MethodsNinety-nine adult inpatients were invited to participate in this naturalistic prospective cohort study between May 2011 and April 2013. Diagnosis was made by MINI, and the symptoms were evaluated at admission and at discharge by HDRS-17. Those inpatients with a diagnosis of depression were included and divided into two groups: those who underwent combined ECT and medication (31 subjects) and those who used only pharmacotherapy (68 subjects). Serum BDNF was measured in blood samples collected at admission and discharge. One hundred healthy blood donors without any psychiatric diagnosis were included as a control group.ResultsThere were no significant differences in serum BDNF levels between the combined and pharmacological groups at admission and at discharge, and no significant variation in BDNF occurred in any group during the treatment. There were no interactions between time and treatment groups nor significant time effects or treatment group effects for BDNF in the Generalized Estimating Equation Model (GEE). The control group had significantly higher serum BDNF levels in comparison with each of the treatment groups at admission and discharge (p = 0.00).ConclusionCombination of ECT with pharmacological treatment did not result in increased serum BDNF levels and did not restore levels to that of controls.