Self-regulatory process among non-insulin dependent diabetes mellitus patients

Diabetes mellitus has been recognized as a disease for centuries. Non-insulin dependent diabetes mellitus [NIDDM] is becoming one of the main health problems in developing countries. Diabetes is a prime example of a chronic disease that requires patients to play an active role in daily self-management. This study aims to [1] describe the specific self-regulatory measures that individuals with non Insulin-Dependent Diabetes Mellitus perform to promote diabetic control, [2] identify the factors affecting the self care measures among Non-Insulin-Dependent Diabetes Mellitus patients. One hundred patients with NIDDM were randomly selected from diabetic clinics of both Ain Shams University Hospital and El-Sahel Educational Hospital. Tools of data collection, were [1] a patient self care rating scales sheet concerned with socio-demographic data, self care activities, a self dietary care, exercises, patient compliance with medication and foot care, etc. [2] a withdrawal venous blood sample for measuring the level of hemoglobin and HbAlc. Approximately one third of the patients [30%] able to describe 5 foods to be avoided, [33%] aware of symptoms of hypoglycemic attack and [50%] able to inspect foot daily, correctly. The majority of the patients have a knowledge deficit regarding self-care activities. There is a positive significant correlation between levels of HbAlc, and BMI, also between HbAlc, and socioeconomic level. Develop a patient educational program using different teaching strategies aims to promote and maintaining an independent self care level for a diabetic patient with non-insulin dependent diabetes mellitus

Cardiovascular autonomic dysfunction in multiple sclerosis: correlations with clinical, brainstem auditory evoked potential and magnetic resonance imaging

Multiple sclerosis [MS] is one of the most disabling neurological disorders, in which autonomic impairment is not rare. The aim of the current study was to assess the frequency of cardiovascular [CV] autonomic dysfunction in MS patients. We also related these autonomic abnormalities to the brainstem dysfunctions in those patients evidenced by brainstem auditor evoked potential [BAEP] and magnetic resonance imaging [MRI] studies. We studied 20 patients with clinically definite relapsing remitting MS and 20 sex and age matched healthy control. The patients were evaluated clinically using expanded disability status scale [EDSS]. Autonomic functions were evaluated with blood pressure response to both standing and static exercise [sympathetic], and 24-hour electrocardiographic [ECG] recording, time domain [parasympathetic]. Brainstem auditory evoked potential and MRI were performed to all patients. The MS patients included 11 [55%] males and nine [45%] females with a mean age of 29.8 +/- 8.4 years, whereas control group was composed of five [50%] males and five [50%] females with a mean age of 34.2 +/- 13.4 years. Regarding tests of CV autonomic functions, 13 [65%] patients had at least one abnormal test. The results showed statistically significant differences in all CV autonomic tests when comparing MS patients to controls. We found significant correlations between autonomic tests with duration of the disease. Significant correlations were detected between autonomic tests and brainstem lesions as well as periventricular parameters of MRI. BAEP findings were indicative of brainstem affection and there was a significant correlation between autonomic tests and I-V interpeak latency. These results suggest that a significant number of patients with MS show evidence of CV autonomic dysfunction, which is correlated with brainstem function

Can lidocaine protect against cerebral dysfunction of patients with cardiopulmonary bypass surgery?

The objective of this study was to investigate whether intraoperative administration of lidocaine can reduce the incidence of cerebral dysfunction in patients undergoing cardiac surgery with cardiopulmonary bypass [CPB]. 60 patients scheduled for cardiac surgery with CPB enrolled randomly into 2 groups: control group and lidocaine group. They were subjected to the same methods of anesthesia, monitoring process and CPB, and myocardial preservation techniques, lidocaine group received of 2 mg/kg bolus over 5 minutes and then infusion of 4 mg/min until the end of operation. The control group received normal saline at the same volume, rate and time. A brief battery of neuropsychologic tests was obtained preoperatively and on the tenth postoperative day. Jugular bulb oxygen [SJVO[2]] and S100beta protein were determined at different measuring points. The incidence of postoperative cognitive decline was significantly less in lidocaine group. SJVO[2] was significantly reduced during rewarming, only in the control group. S100beta was significantly elevated 24hs after CPB in both groups. The elevation was more significant in the control group. The cognitively declined patients tended to have significant fewer years of education, significant longer cross clamp time, longer CPB time, longer time to recovery and to extubation and higher S100beta. S100beta 24 hours after the bypass, was found in significant correlation with aortic cross clamp time, CPB time, time to recovery and to extubation, besides performance in Rey AVLT and Trial Making tests. We can conclude that lidocaine has a protective effect against cerebral insult of CPB

Early predictors of malignant course of middle cerebral artery infarction: clinical, laboratory and radiological study

Early predictors of deterioration may improve therapeutic decision in patients with acute cerebral ischemia. This study investigated whether measurement of serum protein S100B, beside other clinical and radiological determinants can predict a malignant course of infarction in acute middle cerebral artery [MCA] occlusion. The study included 24 stroke patients admitted within 24 hours after the symptoms onset. In all patients, the stroke was caused by middle cerebral artery infarction as proved by transcranial Doppler [TCD] or computed tomography [CT]. Patients of this study were divided into two groups: group I: included 17 patients with non malignant middle cerebral artery infarction [MCAI]. Group II: included 7 patients with malignant MCAI [mMCAI]. All patients were subjected to complete history taking and thorough neuroglical examination using National Institutes of Health Stroke Scale [NIHSS], brain imaging by computed tomography, transcranial Doppler examination and routine laboratory studies. S100B serum levels were determined in all patients [on admission and 24 hours later] and in 15 age and sex matched control subjects. The functional state of patients was evaluated on discharge by Barthel index [BI] and after 2 months by modified Ranken Scale [MRS]. Patients with mMCAI had significantly higher S100 serum level after 24 hours, and higher NIHSS after 48 hours. These patients had higher incidence of poor outcome both early on discharge [lower BI] and after 2 months [MRS > 3]. On CT examination patients with mMCAI had significantly higher frequency of early hypodensity, large sized infarction, with more severe mass effect. Regarding S100B protein: it could not be detected in any one of the control group. While no significant difference could be found between the two patients' groups on admission, its levels were significantly higher in patients with mMCAI after 24 hours. At that time, levels of S100 were significantly correlated to NIHSS at 48 hours, the infarct volume and the severity of mass effect. Again S100B protein could be correlated to functional outcome of the patients both on discharge and after 2 months. In this study predictors of stroke poor outcome were increased mean age of the patients, presence of diabetes, hypertensions, rapid deterioration in the first 48 hours, and significantly higher S100B after 24 hours from admission. Beside those clinical and laboratory data, neuroradiologic features such as the presence of early hypodenisty, large sized infarction [more than one lobe] and marked mass effect were good predictors of poor functional outcome. Serum S100B concentration 24 to 48 hours after the onset can predict a malignant course of infarction after MCA occlusion and may provide a valuable information for both neurological status and functional impairment on discharge and on long term outcome. Other predictors of the malignant course are early clinical deterioration of the patients, early hypodensity on CT with large sized infarction and severe mass effect. All of these factors beside old age and diabetes can also predict poor outcome after MCAI

Effect of spinal versus general anesthesia on the postoperative cognitive function in elderly patients

The objective of this prospective randomized study was to compare the effect of general and spinal anesthesia on the cognitive function in elderly patients. Forty-two patients [male: female 18 : 24] between the ages of 60 and 73 yr old undergoing knee arthroplasty were randomly allocated into one of two groups: group I [n=20] received general anesthesia, and all of them receive the same anesthetic technique, and group II [n=22] received spinal anesthesia. Initially, all patients were assessed by Blessed dementia scale and Hamilton Depression Rating Scale. A battery of neuropsychological measures including Circle Connection, Benton visual Retention Memory, Digit Span and Controlled Word Association, were carried out before surgery and again one and seven days after surgery, then 3 months later. Analysis of data revealed that the two groups were similar in terms of demographic data, baseline cognitive function scores, duration of surgery and intraoperative mean arterial blood pressure [MAP], oxygen saturation [SpO[2]%], and the amount of fluid needed. The results indicated that there were an early postoperative cognitive dysfunction [POCD] at one day after surgery in both study groups. One week later the cognitive function returned to baseline scores. At the 3rd month follow up, the cognitive measures were normal and even showed a statistically non significant improvement in both groups. We can conclude that PO CD after general or regional anesthesia was transient and there were no POCD after 3 months in elderly patients undergoing knee arthroplasty under general or regional anesthesia