Autonomic dysfunction in cardiovascular system of type 2 diabetic mellitus A bedside evaluation

Introduction: In 20 to 40% of all diabetes mellitus patients some abnormalities of autonomic function is present. Diabetic autonomic neuropathy can involve both sympathetic and parasympathetic nervous system. Parasympathetic abnormalities appear earlier and sympathetic innervations may remain intact even in presence of severe Parasympathetic damage. The aim of the study: To determine the various aspect of autonomic neuropathy in the diabetic population using series of standardized test, to interpret the different type of presentation of autonomic neuropathy in diabetes mellitus. Materials and methods: Sixty patients with mean age of 57.7% who had non-insulin dependent diabetes mellitus, varying from one year to fifteen years duration with normal 12 lead electrocardiograph were selected for the study. With standard autonomic function test procedures for both sympathetic and parasympathetic were done with suitable inclusion criteria. Results: Peripheral neuropathy was observed in 40% (24/60) of patients. In 46.6% (28/60) patients Pupillary changes were observed. In patients with peripheral neuropathy, 95.8% (23/24) had Pupillary changes. Postural hypotension was observed in 36.7% (22/60). The results of various tests of autonomic function are as follows. While interpreting the results all borderline cases were considered as normal. The rise of heart rate less than ten was observed in 40% of study group with mean of6.94.Among the patients, 36.7% (22/60) had fallen in blood pressure of more than 30millimeter of mercury. Conclusion: Newer drugs have to be tried for comforting many diabetics with clinical autonomic neuropathy afflicted with this condition in that at least the quality of life of with diabetic neuropathy will improve

Correlation of sleep quality, anxiety, depression and sympathetic skin response in chronic insomnia / 中华神经科杂志

Objective To investigate the correlation between chronic insomniacs' sleep quality and age,gender,education level,anxiety,depression and sympathetic skin response (SSR) in chronic insomniacs.Methods General information of 197 outpatients with chronic insomnia was recorded,including age,gender and education,etc.They were tested by Pittsburgh's Sleep Quality Index (PSQI),Hamilton's Anxiety Scale (14 item version) (HAMA14),Hamilton's Depression Scale (24 item version)(HAMD24) and Sympathetic Skin Response (SSR).Distribution properties of different age,gender and education groups were studied.Chronic insomniacs were divided into mild insomnia group (7 ≤ PSQI ＜ 14)and moderate-severe insomnia group (PSQI ≥ 14).Dependency relation analysis and stepwise linear regression analysis were conducted among indices of PSQI scores,HAMA14 scores and total score,HAMD24 scores and total score,SSR positive incidence.Results Among 197 chronic insomniacs (male,50 cases,25.4％;female,147 cases,74.6％),insomniacs aged over 40 accounted for 77.2％.Female patients were older than male patients with statistical significance,of whom those aged 40-60 years accounted for the highest proportion of 37.1％.Female patients with less education (junior high school and below)accounted for the highest proportion of 50.3％ (73/197),whose education level was generally lower than male patients.Among 197 chronic insomniacs,104 cases (52.8％,99/197) had mild insomnia and 93cases (47.2％) had moderate-severe insomnia.Total score of HAMA14 of patients with moderate-severe insomnia was significantly higher than that of patients with mild insomnia (16.47 ± 5.40 vs 12.51 ± 4.53;t =5.552,P＜0.01).There was statistically significanct difference in subitem HAMA14 scores of anxiety somatization factor (4.31 ± 2.26 vs 5.90-3.10,t =5.600,P ＜ 0.01) and spiritualized anxiety factor (10.5 ± 72.97 vs 8.20 ± 3.00,t =4.157,P ＜ 0.01) between mild and moderate-severe groups with insomnia.Total score of HAMD24 of patients with moderate-severe insomnia was significantly higher than that of patients with mild insomnia (18.04 ± 5.91 vs 13.41 ± 5.05;t=3.931,P＜ 0.01).There was statistically significanct difference in scores of most HAMD24 subitems including anxiety/somatization (3.56 ± 1.51 vs 2.94 ± 1.28;t =3.110,P =0.002),cognitive dysfunction (2.91 ± 1.68 vs 2.17 ± 1.57;t=3.191,P=0.002),retardation (2.331 ±1.31 vs 1.72 ±1.22;t=3.939,P=0.01),dyssomnia (4.51 ± 1.54 vs 3.01 ± 1.80;t =6.228,P ＜0.01) and hopelessness factor (2.29 ± 1.46 vs 1.66 ± 1.07,t =3.459,P =0.001;except body weight and diurnal variation factor) between groups with different degrees of insomnia.SSR abnormal incidences of moderate-severe insomniacs were significantly higher than that of mild insomniacs.The proportion of poorly differentiated waveform and not elicited waveform in SSR abnormal groups had statistically significant difference.The Pearson correlation analysis showed that PSQI scores in chronic insomnia patients and HAMA14,HAMD24 score as well as abnormal rate of SSR were positively correlated (r =0.439,0.465,0.249,all P ＜ 0.01).Conclusions Chronic insomnia was commonly seen in middle-aged women with education level of junor high school and below.The degree of sleep quality and anxiety,depression as well as the abnormal rate of SSR was positively correlated in patients with chronic insomnia.

Clinical features of paroxysmal autonomic nerve dysfunction after brain injury / 临床神经病学杂志

Objective To explore the clinical features of paroxysmal autonomic nerve dysfunction after brain injury.Methods The clinical data of 22 patients with paroxysmal autonomic never dysfunction after brain injury were analysed retrospectively.Results The 22 patients were in vegetative state.The primary injury in 14 cases were severe traumatic brain injury,2 cases were cerebral or cerebellar hemorrhage and received evacution of hematoma,1 case was heroin toxic encephalopathy,2 cases were severe carbon monoxide poisoning,3 cases were hypoxic-ischemic encephalopathy after cardiopulmonary resuscitation(1 case with electrical injury,1case with coronary angiography and coronary stent implantation and 1 case with cardiac arrest due to anaesthetic accident).They had most of the symptoms such as paroxysmal agitation,hyperthemia,diaphoresis,tachypnea,tachycardia,hypertension,myodystonia and convulsion.No epileptic wave was found on EEG in the stage of attact.Latent period of physiological waves were prolonged and amplitudes were fallen down on brain auditory evoked potential(BAEP) and somatosensory evoked potential(SEP).The lesions in varied degrees were found in the cortex,subcortex,or brainstem by neuroimaging.The medicion such as dopamine agonist or antagonist,benzodiazepines and muscle relaxants were just focused on symptoms.There were 10 cases who got out of vegetative state eventually during 1 to 13 months after onset.Conclusions The clinical features of paroxysmal autonomic nerve dysfunction after brain injury are paroxysmal autonomic nerve dysfunction combining myodystony.The most of the severe patients are in vegetative state.The therapy is only focused on symptoms.