PROGNOSTICATION OF COMPLICATED COURSE OF ACUTE MYOCARDIAL INFARCTION WITH CONCOMITANT TYPE 2 DIABETES MELLITUS BASED ON USE OF ENDOTHELIAL MONOCYTE ACTIVATING POLYPEPTIDE-ІІ.

OBJECTIVE: The aim: To determine the prognostic value of endothelial monocytic peptide ІІ in the course of AMI (acute myocardial infarction) in combination with type 2 diabetes mellitus (DM). PATIENTS AND METHODS: Materials and methods: The study involved 120 patients divided in 2 groups: Group 1 - patients with acute myocardial infarction (AMI) with concomitant type 2 DM (n=69); Group 2 - patients with AMI without concomitant type 2 DM (n=51). Control group was composed with 20 almost healthy persons. RESULTS: Results: It was determined that in patients with AMI in combination with type 2 diabetes, the level of endothelial monocyte-activating polypeptide II (EMAP-II) was 1.65 times higher than in patients without concomitant type 2 DM (p <0.05). The patients with AMI and type 2 DM who were included in the group of the 3rd tertile according to level of EMAR-II had the complicated course compared to patients in the groups of the 1st and 2nd tertiles. Q-positive AMI was found in 100% of patients who belonged to the group of the 3rd tertile; recurrence of AMI occurred only in patients whose EMAR-II index was included in the 3rd tertile. CONCLUSION: Conclusions: According to the results of endothelial function analysis with usу ща the marker of EMAP-II endothelial dysfunction in patients with AMI and concomitant type 2 DM, the increased level of this parameter was characteristic of pronounced violation of dilatation properties of the vascular wall and of the other indicators of complicated comorbid conditions.

Assessing Decision Making Capacity for Do Not Resuscitate Requests in Depressed Patients: How to Apply the "Communication" and "Appreciation" Criteria.

The Patient Self Determination Act (PSDA) of 1991 brought much needed attention to the importance of advance care planning and surrogate decision-making. The purpose of this law is to ensure that a patient's preferences for medical care are recognized and promoted, even if the patient loses decision-making capacity (DMC). In general, patients are presumed to have DMC. A patient's DMC may come under question when distortions in thinking and understanding due to illness, delirium, depression or other psychiatric symptoms are identified or suspected. Physicians and other healthcare professionals working in hospital settings where medical illness is frequently comorbid with depression, adjustment disorders, demoralization and suicidal ideation, can expect to encounter ethical tension when medically sick patients who are also depressed or suicidal request do not resuscitate orders.

A preliminary study of the relationship between clozapine-induced weight gain and menstrual irregularities in schizophrenic, schizoaffective, and bipolar women.

Controversy persists about links between psychotropic drug use, obesity, and consequent menstrual irregularities. Although these interrelationships have been suggested to possibly explain polycystic ovarian syndrome among women taking valproate, less is known about menstrual irregularities associated with weight gain caused by other psychotropics. Clozapine, sparing of prolactin-related menstrual effects yet often associated with weight gain, offers a model psychotropic from which to test such hypotheses. We studied outpatient premenopausal women from a clozapine clinic to preliminarily assess the association between menstrual cycle patterns and body mass index (BMI). Records were reviewed for 13 female premenopausal schizophrenic, bipolar, or schizoaffective outpatients who took clozapine with no conventional antipsychotics for >6 months. Mean 6-month menstrual cycle lengths were compared with BMIs and relative weight changes since starting clozapine. Subjects took clozapine (mean +/- SD dose 392.2 +/- 195.7 mg/day) for a mean +/- SD of 4.4 +/- 3.2 years, with a mean preclozapine weight increase of 27%. Twenty-three percent had menstrual irregularities in the preceding 6 months (mean +/- SD cycle length = 36.4 +/- 18.1 days), although no significant associations were observed between cycle length and (a) mean +/- SD BMI (32.0 +/- 8.4) (r = -0.09, p = 0.78) or (b) weight change since starting clozapine (r = -0.10, p = 0.75). The observed lack of association between clozapine-induced weight gain and menstrual disturbances would provisionally suggest that iatrogenic weight gain does not robustly explain the emergence of irregular menses among premenopausal women taking clozapine.