Clinical implications,diagnosis,and management of diabetes in patients with chronic liver diseases

Diabetes mellitus(DM) negatively affects the development and progression of chronic liver diseases(CLD) of various etiologies. Concurrent DM and CLD are also associated with worse clinical outcomes with respect to mortality, the occurrence of hepatic decompensation, and the development of hepatocellular carcinoma(HCC). Unfortunately, early diagnosis and optimal treatment of DM can be challenging, due to the lack of established clinical guidelines as well as the medical complexity of this patient population. We conducted an exploratory review of relevant literature to provide an up-to-date review for internists and hepatologists caring for this patient population. We reviewed the epidemiological and pathophysiological associations between DM and CLD, the impact of insulin resistance on the progression and manifestations of CLD, the pathogenesis of hepatogenic diabetes, as well as the practical challenges in diagnosis and monitoring of DM in this patient population. We also reviewed the latest clinical evidence on various pharmacological antihyperglycemic therapies with an emphasis on liver disease-related clinical outcomes. Finally, we proposed an algorithm for managing DM in patients with CLD and discussed the clinical and research questions that remain to be addressed.     

Race and ethnic differences and human figure drawings: clinical utility of the DAP:SPED.

This study examined race and ethnic differences on the Draw A Person: Screening Procedure for Emotional Disturbance (DAP:SPED; Naglieri, McNeish, & Bardos, 1991) for youths 6 though 17 years of age for 2 matched samples. Samples were drawn from the DAP:SPED nationally representative standardization sample and matched on gender, grade, and school classroom. No statistically significant differences were found for big figure, small figure, or shading item composites. A statistically significant difference was found between Black-White pairs on figure omissions but showed a small effect size (d value = .25). Further, no statistically significant differences were found between the DAP:SPED Total T scores for Black and White youth (M = 47.67, SD = 10.09; N =138) or Hispanic and White youth (M = 48.20, SD = 9.56; N = 59), showing very small effect sizes. In addition, equivalence testing showed similarities across race and ethnic pairs for all composites and DAP:SPED total score, lending preliminary support to the DAP:SPED's clinical utility as a measure that yields similar scores across these groups.     

PILOT PROJECTS TO STIMULATE ADVERSE DRUG REACTION REPORTING

Schemes for stimulating adverse drug reporting are described with particular emphasis on a recently introduced Mississippi Adverse Drug Reaction Reporting Programme.     

Fractal analysis of the PDL-bone interface and implications for orthodontic tooth movement

BACKGROUND: The periodontal ligament (PDL) is a soft tissue interposed between the tooth and the alveolar bone. It is responsible for transmission of forces in vivo; this promotes bone remodeling. The purpose our study was to use fractal analysis to quantify the complex morphology of the PDL-bone interface. METHODS: We used Scion Image (Scion Corp, Frederick, Md) and Benoit fractal analysis (Tru Soft International, St. Petersburg, Fla) programs to calculate the fractal dimension of the PDL-bone interface in rats via the box-counting method. Rats in the experimental groups received an initial force of 0.1N or 0.5N with customized springs for 6 hours. RESULTS: Our studies showed an increase in normal fractal dimension at the root apices of the rats' maxillary molars. We also found evidence that the fractal dimension varies along the entire root length from the apex to the cementoenamel junction. CONCLUSIONS: Mechanical loading might lead to an increase in fractal dimension at the PDL-bone interface apart from mechanisms of bone cell directed remodeling. These changes in fractal dimension are proportional to loading and could provide a new parameter for force determination in orthodontic tooth movement.