ABSTRACT
Dipeptidyl peptidase-4 inhibitors (DPP-4i), or gliptins, are a widely used glucose-lowering agents. A growing amount of evidence pointed to a possible role of DPP-4i in the induction of bullous pemphigoid (BP), which is an auto-immune skin blistering disease that mainly affects the elderly. In this article we discuss a case of DPP-4i associated BP and we provide an updated review of the current knowledge regarding this emerging entity. Use of DPP-4i, particularly vildagliptin, was found to significantly increase the risk of BP. BP180 would be in the center of the aberrant immune response. DPP-4i induced BP is thought to be associated with male gender, mucosal involvement, and milder inflammatory phenotype especially in Asian population. Generally, patients may not remit fully after DPP-4i withdrawal only and require either topical or systemic glucocorticoid courses.
ABSTRACT
BACKGROUND: There has been increasing evidence and support for the use of digital technology in the cognitive health field. Despite the growing use of innovative digital technology to assess cognitive function, such technology remains scarce in Arabic countries, particularly in Tunisia. OBJECTIVE: To investigate the effectiveness of a digitally delivered cognitive assessment battery in differentiating varying degrees of cognitive function in older Tunisian adults. METHODS: One hundred fifty-five Tunisian older adults (age: 62.24±7.52 years) were assigned to one of four groups: healthy controls (HC), at-risk (AR), mild cognitive impairment (MCI), and Alzheimer's disease (AD). Participants completed a translated version of the Neurotrack digital cognitive battery. RESULTS: The AD group performed significantly lower on the associative learning (pâ=â0.01) and associative memory assessments (pâ=â0.002), than the HC and AR groups. The AD group also performed worse on the inhibition measure (pâ=â0.008) than the HC, AR, and MCI groups. For recognition memory, the was a significant difference between all four groups (pâ<â0.0005), with AD having the lowest scores followed by the MCI, AR, and HC groups, respectively. There were no significant differences observed on attention, executive function and processing speed performance between the four groups (pâ>â0.05). CONCLUSION: The use of digital technology appears to be a viable solution to current cognitive assessment challenges for assessing cognitive function in a Tunisian population. These findings provide further support for the use of digital technology in cognitive assessment, particularly in understudied populations.
Subject(s)
Alzheimer Disease , Cognitive Dysfunction , Aged , Alzheimer Disease/psychology , Cognition , Cognitive Dysfunction/psychology , Digital Technology , Humans , Neuropsychological TestsABSTRACT
PROBLEMATIC AND OBJECTIVE: Masked arterial hypertension (MHTN) is a recently described entity that is associated with the same cardiovascular risk as permanent hypertension. Its prevalence is more frequent in patients with diabetes. The objective of this study is to assess the value of systematic screening for MHTN by 24-hour blood pressure monitoring in a population of type 2 diabetic patients by estimating its prevalence and looking for predictive factors of MHTN in this population. METHODS: Through a prospective study, we recruited normotensive type 2 diabetics for clinical measurement, in whom we systematically searched for MHTN by performing an ambulatory blood pressure measurement (ABPM). The diagnosis of MHTN is established if: mean daytime BP ≥ 135/85 mmHg and / or, mean nighttime BP ≥ 120/70 mmHg and / or, mean 24 hour BP ≥ 130/80 mmHg. We then compared the two populations of MHTN (G1) and normotensive (G2) on clinical and laboratory parameters and we assessed end-organ damage in order to identify the predictive factors of MHTN. RESULTS: We recruited 53 patients whose mean age was 55.3 ± 8.4 years (range 35-72 years) with a female predominance (53%). The duration of diabetes was on average 8.7 ± 3.9 years with extremes between 2 and 17 years. The average BMI of our patients was 28.2 ± 5.3 Kg/m2. Overweight was found in almost half of our patients (47.2%). Obesity was found in 32.1% of cases. Metabolic syndrome was found in 64.2% of patients. In our study, the prevalence of HTAM in type 2 diabetics was 64%. We also found that MHTN was more often nocturnal (58.5%) and occurred mainly in non-dipper patients. Left ventricular hypertrophy, microalbuminuria and arterial stiffness evidenced by pulse pressure greater than 60mmHg were more common in the MHTN group. For the predictive factors of MHTN, we were able to collect in univariate analysis the following factors: duration of diabetes, fasting blood sugar, weight and microalbuminuria. In multivariate analysis, the predictive factors that emerged in our study are poor glycemic control (HbA1c ≥7%), high BMI and duration of diabetes. CONCLUSION: MHTN should be sought in diabetics because it allows a better assessment of the cardiovascular risk, in particular by identifying end-organ damage.
