RESUMO
Background and Objectives: diabetes and depression are highly prevalent conditions and have significant impact on health outcomes. The combination of depression with type 2 diabetes is a public health problem. Therefore, we aimed to assess some socio-demographic characteristics of type 2 diabetes and to investigate the relationship between type 2 diabetes and depression among patients aged from 40 to 60 years old
Methods: 125 patients diagnosed with type 2 diabetes attending diabetes clinics in the Al-Zahraa hospital were invited to participate in this cross-sectional study. Patients were interviewed using structured questionnaires to gather data on socio-demographics, clinical, self care compliance, medication usage, and diabetes complications. The MADRS was administered as a screening tool for depression level evaluation. Binary logistic regression model was used to examine association between predictor variables and risk of depression among diagnosed type 2 diabetes at 95% C.I. and P < 0.05
Results: one hundred and twenty five participants completed the interview. More than half of participants were females [58.4%] and the mean age was 48 [sd = 5.9], 47.2% hypertensive, and 59.2% on insulin. More than two third [74.4%] of patients were depressed; [24.8% mild, 37.6% moderate and 12% severely depressed]. Almost four out of five patients [88.8%] had diabetes complications; Depression was strongly associated with neuropathy, age, retinopathy, sex and cardiac complications. However, the likelihood of depression was not associated with nephropathy, hypertension and sexual dysfunction
Conclusion: the current study demonstrates a strong correlation between depression and diabetes particularly complications. In particular, patients who are depressed tended to have poorer self-care, more severe physical symptoms and were less likely to adhere to prescribed care regimens. These findings raise the possibility that improving the mental health as part of a comprehensive management plan for diabetes may improve the overall long term outcomes of these patients
RESUMO
Background: Metabolic brain diseases usually present with a complex neurological picture so they are often overlooked. This prospective study was undertaken to focus on the clinical aspects, biochemical abnormalities and neuroimaging of the brain in children suffering from neurometabolic disorders
Patients and methods: This study was carried out on 130 patients suspected clinically of having metabolic brain diseases and presented to the neuropediatric clinic, neonatal intensive care unit in Benha faculty of medicine and the neurometabolic specialized clinic in Abu El-Reesh hospital. The diagnosis of neurometabolic disorders was confirmed in 29 children [22%]. They were 19 males and 10 females, their age ranged from 5 days to 10 yrs with mean age 3.61 +/- 2.2 years. They presented with clinical manifestations suggestive of metabolic brain diseases. They were subjected to thorough history, clinical examination, investigations in the form of serum ammonia, serum lactate ,blood glucose, blood gases assessment, ketone bodies in urine, CPK [creatine phosphokinase],urine organic acids, plasma aminogram, enzymatic assay, EMG [Electromyography],EEG[electroencephalography], muscle biopsy, CT and MRI of the brain
Results: Patients were classified according to their clinical presentations, biochemical and radiological findings into 5 groups, Group I, Organic acidemia 10 cases [34.5%], including, Methyl malonic acidemia [4 cases], Biotinidase deficiency [3 cases], Glutaric Aciduria type 1 [2 cases] and Maple syrup urine disease [one case]. Group II, Mitochondrial disorders 9 cases [31%] including, Leigh syndrome [4 cases], Pyruvate dehydrogenase deficiency [2 cases], mitochondrial encephalomyopathy [2 cases] and MELAS syndrome[mitochondrial encephalopathy, lactic acidosis and stroke] [one case]. Group III, Urea cycle abnormalities 5 cases [17.2 %]. Group IV Aminoacidopathy 3 cases [10.4 %]in the form of Phenylketonuria. Group V Fatty acid oxidation defect 2 cases [6.9%]. The main neurological manifestations were global developmental delay [93.1%], seizures [89.7%], hypertonia [65.5%] and microcephaly [55.2%]. Biochemical abnormalities were: Group I: had acidosis in 9 cases[90%] [ketoacidosis in [4 cases],lactic acidosis in[3 cases],acidosis without ketosis in [2 cases]], ketosis only in one case [10%] and hyperammonemia in 7 cases [70%] of cases. GroupII: had mainly lactic acidosis 5 cases [55.6%] and mild hyperammonemia [11.1%]. GroupIII: had isolated hyperammonemia [100%]. Group IV: had hyperphenylalaninemia in [100%] of cases with phenylketonuria. Group V: had lactic acidosis,mild hyperammonemia, hypoglycemia and absent ketosis in [100%]of cases. Neuroimaging showed abnormal findings in the form of basal ganglia abnormalities [41.4%], brain atrophy [27.5%], diffuse demeylination and focal demeylination [6.9%]each and normal findings in [17.3%]
Conclusion: Presence of unexplained neurological symptoms whose severity is out of proportion to the inciting illness should arouse suspicion of a metabolic disease. Screening tests like blood gas analysis, blood levels of lactate, glucose and ammonia, urine examination for ketones and neuroimaging provide valuable clues to the presence of an underlying metabolic disease