RESUMO
Background Cardiovascular autonomic neuropathy (CAN), an important form of DAN is caused by the impairment of the autonomic nerve fibers that innervate the heart and blood vessels and leads to abnormalities in cardiovascular dynamics. The earliest finding of CAN, even at the subclinical stage, is a decrease in heart rate variability (HRV). Objective The objective is to assess the effect of ramipril 2.5mg once daily on cardiac autonomic neuropathy in type II DM patients as an add-on to a standard antidiabetic regimen for a duration of 12 months. Materials and methods A prospective, open-label, randomized, parallel-group study was conducted on type II DM with autonomic dysfunction. Patients in Group A received tablet ramipril 2.5mg daily along with the standard antidiabetic regimen which consist of Tab Metformin 500mg twice a day and Tab Vildagliptin 50mg twice a day and group B received only the standard antidiabetic regimen for 12 months. Results Among 26 patients with CAN, 18 patients completed the study. After one year in group A, Delta HR value increases from 9.77±1.71 to 21.44±8.44 and the E:I ratio (ratio of the longest R-R interval during expiration and shortest R-R interval during inspiration) improved from 1.23±0.35 to 1.29±0.23 signifying significant improvement in parasympathetic tone. Results of the postural test showed significant improvement in SBP. Analysis of HRV by time domain method showed that the standard deviation of RR (SDRR) interval and Standard deviation of differences between adjacent RR interval (SDSD) value increased significantly in group A. Analysis of HRV frequency domain indices showed that LFP:HFP ratio improved after treatment in ramipril group indicating improvement in sympatho-vagal balance. Conclusion Ramipril improves parasympathetic component more as compared to sympathetic component of DCAN in type II DM. Ramipril could be a promising option having favorable long-term outcomes in diabetic patients especially when treatment begins at subclinical stage.
RESUMO
CONTEXT: With the increasing use of electronic devices and social media, the duration of sleep has consistently reduced in adolescents. Sleep restriction eventually leads to cognitive performance declines. Poor sleep and working memory difficulties are both associated with learning difficulties leading to poor academic performance. AIMS: We postulated that decreased sleep duration decreases the working memory of adolescents and eventually their academic performance. SETTINGS AND DESIGN: Cross-sectional Study. METHODS AND MATERIAL: The study was conducted on 114 school students; 62 boys and 52 girls (age 13.8 ± 0.91 and 13.65 ± 0.88 years, respectively). Sleep was monitored by self-reported diary. Working memory was tested by the n-back task. The students were given 1-back and 2-back visual tasks in two blocks and accuracy of each of the tests was calculated. STATISTICAL ANALYSIS USED: Prism software was used and Mann-Whitney-U test and Spearman Correlation tests were employed. RESULTS: Sleep duration range was 4.15-12 hours with a mean of 7.63 ± 1.35 hours. The sleep duration in males and females, respectively was 6.94 ± 0.94 hrs. and 8.5 ± 1.31 hrs.; significant (p = 0.0001). The total n-back score accuracy (1-back and 2-back) was 52.11 ± 17.32% in males and 52.24 ± 17.40% in females (p = 0.976). Spearman Correlation between sleep-duration and total n-back score was not found to be statistically significant (p = 0.611). However, the correlation of total n-back score with academic performance was statistically significant. CONCLUSIONS: The working memory was not statistically different in males and females, and was not significantly correlated with sleep duration, though it was significantly associated with the academic performance.