Mismatch between ADA and AGS recommendations for glycated hemoglobin targets for older adults

In recent years, modified glycemic targets have been defined for older adults with diabetes mellitus. In a sample of elderly patients, we have identified several inconsistencies between the real life applicability of glycated hemoglobin goals recommended by the American Diabetes Association and the American Geriatrics Society.     

The effect of a grief support program on Turkish parents whose babies have died

The purpose of this study was to determine the effect of the Grief Support Program on the bereavement of parents whose babies had died. The sample consisted of 77 couples. The data was collected by the Texas Revised Inventory of Grief and the Coping Strategies Inventory. The intervention group was offered before, immediately after, and a month after death of their baby in accordance with the Grief Support Program guideline. The Grief Support Program did not affect grief intensity in the short term but had a positive effect 1 year later.     

Impact of Myocardial Acceleration during Isovolumic Contraction in Evaluating Subclinical Right Ventricular Systolic Dysfunction in Type 2 Diabetes Mellitus Patients

Aim: In diabetes mellitus (DM) patients, left ventricular dysfunction is widely evaluated and established by conventional diagnostic methods, whereas right ventricular (RV) function is not as sufficiently evaluated. The aim of this study is to assess the preclinical effects of DM on RV function by using novel Tissue Doppler Imaging (TDI)‐derived indices. Methods: The study included 96 patients with type II DM [60 with DM only and 36 patients with coexisting DM and hypertension (DMHT)] and 40 healthy controls. Conventional parameters and TDI‐derived systolic velocities of tricuspid annulus [isovolumic myocardial acceleration (IVA), peak myocardial velocity during isovolumic contraction (IVV), peak systolic velocity during ejection period (Sa), RV Tei index] were measured. Results: TDI‐derived RV IVA was significantly lower in both DM and DMHT patients compared to controls indicating subclinical impairment in RV systolic function in the study patients (P = 0,0001). However RV IVA was similar in DM and DMHT subgroup supporting RV systolic impairment in DM was independent from HT. In correlation analysis, RV IVA was significantly correlated with the existence of diabetic nephropathy (r =?0,38; P = 0,003), retinopathy (r =?0,35; P = 0,006), insulin resistance (r =?0,52; P = 0,0001). Conclusions: Diabetes is associated with subclinical RV systolic dysfunction, regardless of coexisting hypertension. Tissue Doppler‐derived IVA; is a novel, non‐invasive parameter which may be used in early detection of RV systolic dysfunction in patients with DM. (Echocardiography 2010;27:1211‐1218)     

Protective effects of resveratrol on small intestines against intestinal ischemia–reperfusion injury in rats

Background and Aim:  The aim of this study was to determine whether resveratrol could prevent intestinal tissue injury induced by ischemia–reperfusion (I/R).
Methods:  Intestinal I/R was induced in rats' intestines by 60-min occlusion of the superior mesenteric artery, followed by a 60-min reperfusion. Thirty rats were divided into three groups as follows: sham (group 1), control (group 2), and the treatment groups (group 3). The rats in the treatment group received resveratrol both before ischemia and before reperfusion. In all groups, serum aspartate aminotransferase, alanine aminotransferase, and lactate dehydrogenase levels were determined. Total antioxidant capacity (TAC), catalase, total oxidative status (TOS), oxidative stress index (OSI), and myeloperoxidase (MPO) in the intestinal tissue were measured. Intestinal tissue histopathology was also evaluated by light microscopy.
Results:  The levels of liver enzymes in group 3 were significantly lower than those in group 2 ( P  < 0.05). TAC in the intestinal tissue was significantly higher in group 3 than in group 2 ( P  < 0.05). TOS, OSI, and MPO in the intestinal tissue were significantly lower in group 3 than in group 2 ( P  < 0.05 for all). Histological tissue damage was milder in the resveratrol treatment group than in the control group.
Conclusions:  The results of this study indicated that resveratrol treatment limits the oxidative injury of the small intestine induced by I/R in rats. However, more precise investigations are required to evaluate the antioxidative effect of resveratrol on small intestine tissue damage in clinical and experimental models.     

Obstructive sleep apnea as a risk marker in coronary artery disease

STUDY OBJECTIVES: Obstructive sleep apnea (OSA) is associated with a range of cardiovascular sequelae and increased cardiovascular mortality. The aim of our study was to assess the prevalence of OSA in patients with symptomatic angina and angiographically verified coronary artery disease (CAD). In addition, we analyzed the association of OSA and other coronary risk factors with CAD and myocardial infarction. METHODS: Overnight non-laboratory-monitoring-system recordings for detection of OSA was performed in 223 male patients with angiographically verified CAD and in 66 male patients with exclusion of CAD. A logistic regression analysis was performed to assess associations between risk factors and CAD and myocardial infarction. RESULTS: CAD patients were found to have OSA in 30.5%, whereas OSA was found in control subjects in 19.7%. The mean apnea/hypopnea index (AHI) was significantly higher (p < 0.01) in CAD patients (9.9 +/- 11.8) than in control subjects (6.7 +/- 7.3). Body-mass-index (BMI) was significantly higher in patients with CAD and OSA than in patients with CAD without OSA (28. 1 vs. 26.7 kg/m(2); p < 0.001). No significant difference was found with regard to other risk factors and left ventricular ejection fraction (LVEF) between both groups. Hyperlipidemia (OR 2.3; CI 1. 3-3.9; p < 0.005) and OSA defined as AHI >/=20 (OR 2.0; CI 1.0-3.8, p < 0.05) were independently associated with myocardial infarction. CONCLUSIONS: There is a high prevalence of OSA among patients with angiographically proven CAD. OSA of moderate severity (AHI >/=20) is independently associated with myocardial infarction. Thus, in the care of patients with CAD, particular vigilance for OSA is important.     

Vasodilating mechanisms of testosterone.

The increased incidence of cardiovascular disease in man compared with premenopausal women suggests an unfavourable effect of male sex hormone testosterone on the cardiovascular system. However, numerous clinical and epidemiological studies reported a controversial relationship between testosterone and cardiovascular disease. Furthermore, an increasing amount of evidence indicate that testosterone can exert acute vasorelaxing effects, VIA non-genomic mechanisms. These effects involve primarily the vascular smooth muscle, without requiring the presence of endothelium, although an endothelial contribution is apparent in some studies. To date, the mechanism behind the vasodilatory action of testosterone is still under debate and might be through either activation of K (+) channels or blockade of Ca (2+) channels in vascular muscle cells. The purpose of this article is to review the evidence regarding the vasodilating effect of testosterone as well as its mechanism of action.     

A rare case of synchronous leiomyosarcoma and urothelial cancer of the bladder

We report a case of a 44-year-old woman who had coexisting distinct and separate primary tumors of the bladder: a leiomyosarcoma and a transitional cell carcinoma (urothelial cancer). The patient presented with macroscopic hematuria. A computed tomography scan of the pelvis showed a bladder mass along the left anterolateral wall. A transurethral resection of the bladder was performed. A pathological examination revealed that the mass was leiomyosarcoma. The patient underwent radical cystectomy with ileal conduit diversion. The urinary cystectomy specimen revealed an 11 cm x 6 cm x 5 cm solid mass on the left anterolateral wall and two 1-cm papillary tumors with different localization on the right and left lateral walls of the urinary bladder. Pathological examination revealed that the masses were high-grade leiomyosarcoma and urothelial cancer. Because of the differences in the histogenesis and prognosis, such cases should be differentiated from cases of carcinosarcoma of the urinary bladder. Synchronous occurrence of urothelial cancer and sarcoma as two separate primary tumors in the bladder is very rare. To our knowledge, seven cases of coexisting sarcoma and transitional cell carcinoma of the urinary bladder have been reported in the literature.