Pregnancy Ketonemia and Development of the Fetal Central Nervous System.

Glucose is the major source of energy for the human brain which in turn uses ketone bodies as a supplement for energy deficit in glucose cell deficiency conditions. Pregnancy complicated by gestational diabetes is a condition associated with significantly increased risk of ketonemia development. The data available proves a changing influence of ketones on the central nervous system during fetal life and in adults as well. Ketone bodies freely pass through the placenta. They can affect fetal growth and organ damage development, especially the central nervous system. As agreed in the current recommendation of the diabetes associations, it is not obligatory for the attending doctor to conduct a routine inspection of ketone bodies during diabetes treatment in pregnancy. This article is a literature review of ketones' effect on the central nervous system and an attempt to initiate discussion whether we should consider including ketonemia assessment into the standard care package for pregnant women with diabetes and begin some research on the explanation of its influence on fetal development.

The influence of a ten-week Nordic walking training-rehabilitation program on the level of lipids in blood in overweight and obese postmenopausal women.

[Purpose] The aim of this study was to evaluate the effect of a ten-week Nordic Walking (NW) rehabilitation program on chosen anthropometric parameters and the level of basic lipids in overweight and obese postmenopausal women's blood. [Subjects and Methods] The subjects were 32 women aged 50-68 (average: 59.7 ± 5.9 years). The study was carried out following a non-randomized model and entailed NW rehabilitation 5 times a week, which lasted for 10 weeks, as well as a low-calorie 1,500 kcal diet. The therapeutic results of the study were measured through changes in anthropometric and biochemical parameters. The results were subjected to a statistical analysis. [Results] After 10 weeks of NW rehabilitation it was observed that participants lost weight and their body mass index dropped. Additionally, whereas levels of total cholesterol, LDL and triglycerides dropped, and the level of HDL increased. [Conclusion] Rehabilitation carried out according to the NW model resulted in statistically significant changes in basic lipids in blood which, considerably increased the percentage of persons who achieved the recommended level of blood lipids. Obese persons were characterised by a smaller rehabilitation weight loss. More intense workouts and cooperation with a dietician are required.

Lactic acidosis occurrence during exercises in the smoke chamber in a 53-year-old firefighter with no significant medical history.

Lactic acidosis is a form of metabolic acidosis with a high anion gap, reduced rate of arterial blood pH under 7.35 mmol/l, and lactic acid concentration over 7 mmol/l. In the literature we can find some descriptions of the cases of lactic acidosis in patients with severe systemic diseases (cancer, acquired immunodeficiency syndrome, sepsis, diabetes with cardiovascular disease and after organ transplantations). We present the case of lactic acidosis in a patient with no chronic disease--a firefighter in whom lactic acidosis has developed during standard exercises in the smoke chamber.

Self-monitoring of blood glucose in diabetes: from evidence to clinical reality in Central and Eastern Europe--recommendations from the international Central-Eastern European expert group.

Self-monitoring of blood glucose (SMBG) is universally considered to be an integral part of type 1 diabetes management and crucial for optimizing the safety and efficacy of complex insulin regimens. This extends to type 2 diabetes patients on intensive insulin therapy, and there is also a growing body of evidence suggesting that structured SMBG is beneficial for all type 2 diabetes patients, regardless of therapy. However, access to SMBG can be limited in many countries in Central and Eastern Europe. A consensus group of diabetes experts from 10 countries in this region (with overlapping historical, political, and social environments)--Bulgaria, Croatia, Czech Republic, Hungary, Poland, Romania, Serbia, Slovakia, Slovenia, and Ukraine--was formed to discuss the role of SMBG across the spectrum of patients with diabetes. The group considered SMBG to be an essential tool that should be accessible to all patients with diabetes, including those with non-insulin-treated type 2 diabetes. The current article summarizes the evidence put forward by the consensus group and provides their recommendations for the appropriate use of SMBG as part of individualized patient management. The ultimate goal of these evidence-based recommendations is to help patients and providers in Central and Eastern Europe to make optimal use of SMBG in order to maximize the efficacy and safety of glucose-lowering therapies, to prevent complications, and to empower the patient to play a more active role in the management of their diabetes.

Pathomechanisms of the development of obesity in some endocrinopathies - an overview.

Obesity is a disease in which the excess of accumulated body fat has an adverse effect on health and consequently leads to a reduced life expectancy. It is a typical 'disease of civilisation', and is a serious public health problem because of a significant increase in its prevalance. It is also a common symptom in a variety of endocrine disorders, but the factors responsible for the development of obesity in endocrinopathies have not been clearly identified. It is not known whether a common factor responsible for the development of obesity occurs in a number of endocrine diseases. On the other hand, adipose tissue is an important endocrine organ producing biologically active substances with local or systemic action that can lead to severe disorders of the endocrine system. This study presents data on the mechanisms of the development of obesity in the thyroid diseases, polycystic ovary syndrome, hypercortisolism and pituitary insufficiency.

Occurrence and predictors of left ventricular systolic dysfunction at hospital discharge and in long-term follow-up after acute myocardial infarction treated with primary percutaneous coronary intervention.

BACKGROUND: Post-ST-segment elevation myocardial infarction (STEMI) left ventricular systolic dysfunction (LVSD) has been identified as an important marker of poor prognosis. AIM: To assess the prevalence and course of LVSD at hospital discharge and in long-term follow-up in STEMI patients treated with primary percutaneous coronary intervention (pPCI). METHODS: We enrolled 205 patients (157 male, 48 female) with a first STEMI. Echocardiography was performed before hospital discharge and 12 months after STEMI. Left ventricular systolic function (LVSF) parameters were assessed: left ventricular ejection fraction (LVEF), wall motion score index (WMSI), and average peak systolic mitral annular velocity (S') by tissue Doppler echocardiography (TDE). B-type natriuretic peptide plasma concentration was measured at admission (BNP(admission)) and at discharge (BNP(discharge)). RESULTS: We found moderate LVSD, both at hospital discharge and after 12 months. Significant global LVSD (LVEF ≤ 40%) was observed in 34% of patients at discharge, and 21% after 12 months (p 〈 0.001). Significant regional LVSD (WMSI ≥ 1.7) after 12 months was less frequent than at discharge (21% vs 33%; p 〈 0.001). More patients had significant longitudinal LVSD (S' ≤ 6.0 cm/s) after 12 months compared to discharge (28% vs 23%; p 〈 0.001). Severe global LVSD (LVEF ≤ 30%) was rare. Univariate logistic regression analysis revealed the predictors of significant global LVSD at 12 months after STEMI to be: anterior location of STEMI; pre-discharge echocardiographic parameters of LVSF and left ventricle size and mass; prepPCI angiographic indices; ratio of the difference of BNP(discharge) and BNPa(dmission) to BNP(admission) expressed as % (BNP(delta) %); time from onset of pain to balloon, and the use of abciximab. Multivariate logistic regression analysis found independent predictors of significant global LVSD at 12 months to be: BNP(delta) % and LVEF at discharge with optimal cut-off values of 728.2% for BNP(delta) % and 37% for LVEF. CONCLUSIONS: Patients with a first STEMI treated with pPCI present moderate LVSD, both at hospital discharge and after 12 months. In long-term follow-up, we found an improvement in global LVSF, and, albeit a smaller, improvement in regional LVSF. No improvement in longitudinal LVSF was observed. The increase of BNP during hospitalisation, and LVEF at discharge, are independent predictors of significant global LVSD at 12 months after a first STEMI treated with pPCI. Pre-discharge peak systolic mitral annular velocity obtained by TDE may be useful in predicting LVEF in long-term follow-up in this group of patients.

Value of oral glucose tolerance test in the acute phase of myocardial infarction.

BACKGROUND: Although European guidelines advise oral glucose tolerance test (OGTT) in patients with acute myocardial infarction (AMI) before or shortly after hospital discharge, data supporting this recommendation are inconclusive. We aimed to analyze whether disturbances in glucose metabolism diagnosed before hospital discharge in AMI patients represents a latent pre-existing condition or rather temporary finding. Additionally, we planned to investigate the value of pre-selected glycemic control parameters as predictors of long-term glucometabolic state. METHODS: We assessed admission glycemia, glycated hemoglobin, mean blood glucose concentration on days 1 and 2 in 200 patients with a first AMI but without overt disturbances of glucose metabolism. We also performed OGTT at discharge and 3 months after discharge. RESULTS: The prevalence of disturbances in glucose metabolism (as assessed by OGTT) at 3 months was significantly lower than at discharge (29% vs. 48%, p = 0.0001). Disturbances in glucose metabolism were not confirmed in 63% of patients with impaired glucose tolerance and in 36% of patients with diabetes mellitus diagnosed during the acute phase of AMI. Age >77 years, glucose ≥ 12.06 mmol/l at 120 minutes during OGTT before discharge and mean blood glucose level on day 2 >7.5 mmol/l were identified as independent predictors of disturbances in glucose metabolism at the 3-month follow-up. CONCLUSIONS: Disturbances in glucose metabolism observed in patients with a first AMI are predominantly transient. Elderly age, high plasma glucose concentration at 120 minutes during OGTT at discharge and elevated mean blood glucose level on day 2 were associated with sustained disturbances in glucose metabolism.

An evaluation of visfatin levels in obese subjects.

INTRODUCTION: Visfatin is a protein secreted by adipose tissue, which shows insulin mimetic properties. The role of visfatin in the development of obesity, diabetes mellitus, and metabolic syndrome continues to raise controversy. The aim of the study was to evaluate visfatin levels and to attempt to establish the relationship between visfatin and selected anthropometric and biochemical parameters in obese individuals. MATERIAL AND METHODS: The study included 68 obese subjects (15 men and 53 women) aged 37.8 +/- 13.2 years with body mass index (BMI) values of 39.4 +/- 6.4 kg/m(2) without a previous diagnosis of abnormal glucose metabolism. The control group comprised 30 healthy nonobese volunteers (6 men and 24 women) with normal glucose metabolism, aged 38.2 +/- 14.9 years with BMI values of 22.8 +/- 3.0 kg/m(2). RESULTS: We found significantly higher visfatin levels in the obese subjects compared to the control group (median visfatin level of 39.6 v. 17.3 ng/ml, p = 0.0006). In the obese group there was a statistically significant negative correlation between visfatin levels and age (r = -0.26, p = 0.034), waist-to-hip ratio (WHR) (r = -0.28, p = 0.031) and glycated haemoglobin (HbA(1c)) (r = -0.36, p = 0.0037). No statistically significant correlations were found between visfatin levels and the remaining parameters under study. In the control group, visfatin levels did not show any significant correlation with any of the parameters under study. CONCLUSIONS: We found elevated levels of visfatin in obese subjects, which did not correlate with the majority of anthropometric parameters with the exception of WHR (negative correlation). This correlation may suggest that elevated visfatin levels are associated with the distribution of adipose tissue characteristic of gynoid rather than visceral obesity. In the group of obese subjects, visfatin levels decreased with age and glycated haemoglobin levels.

Spontaneous baroreflex sensitivity in subjects with type 1 diabetes with and without cardiovascular autonomic neuropathy.

INTRODUCTION: The clinical usefulness of baroreflex sensitivity (BRS) in the early detection of autonomic dysfunction in patients with diabetes is not well established. The aim of the study was the evaluation of BRS in subjects with type 1 diabetes with and without cardiovascular autonomic neuropathy (CAN). MATERIAL AND METHODS: The group examined consisted of 39 patients with type 1 diabetes (mean age 30.5 +/- 8.8 years; diabetes duration 12.1 +/- 6.9 years; BMI 23.7 +/- 2.8 kg/m2; HbA(1c) 7.6 +/- 1.9%). The control group consisted of 18 sex and age-matched healthy adults. Blood pressure, heart rate and chest respiratory movements were monitored continuously by non-invasive means (Portapres). In order to recognise CAN standard Ewing tests were performed. BRS was assessed in the lying (L-BRS) and standing (S-BRS) positions by the frequency domain technique. RESULTS: Ten patients (25.6%) had CAN (the CAN(+) group). In the CAN(+) group BRS was significantly lower than in the CAN(-) group in the lying and standing positions (respectively L-BRS 4.4 +/- 2.1 vs. 10.0 +/- 4.9 ms/mm Hg; p < 0.05; S-BRS 3.3 +/- 1.6 vs. 7.0 +/- 2.2 ms/mm Hg p < 0.001). BRS did not differ significantly between the CAN(-) and control group (respectively L-BRS 10.0 +/- 4.9 vs. 13.1 +/- 5.5 ms/mm Hg p = NS; S-BRS 7.0 +/- 2.2 vs. 7.9 +/- 4.0 ms/mm Hg p = NS). CONCLUSIONS: BRS differentiated well the subjects with CAN from the group without CAN. However, the study did not enable us to confirm the value of BRS in the early detection of autonomic dysfunction among patients with type 1 diabetes who showed no abnormalities in standard cardiovascular tests.

Coagulation and fibrinolysis variables in pregnant women with type 1 diabetes mellitus.

BACKGROUND: Many studies have reported changes in the hemostatic system in patients with type 1 diabetes in whom coagulation processes predominate over fibrinolytic activity. The aim of this study was to assess some of the hemostatic variables during pregnancy women with in type 1 diabetes. MATERIAL/METHODS: The current study included 31 pregnant diabetic women and 24 healthy pregnant women. At 12, 24, and 36 weeks of gestation, we determined blood concentrations of the following: platelet count, fibrinogen, tissue plasminogen activator antigen, and plasminogen activator inhibitor-1. RESULTS: When we compared pregnant diabetic women in the third trimester with those in the first trimester, we observed a statistically significant decrease in the platelet count (172.0+/-9.0 vs 200.6+/-9.8 G/L, P<0.05) and a statistically significant increase in the levels of fibrinogen (3.5+/-0.2 vs 2.9+/-0.2 g/L, P<0.05), tissue plasminogen activator antigen (14.9+/-2.2 vs 4.7+/-0.6 ng/mL, P<0.001), and plasminogen activator inhibitor-1 (17.2+/-2.8 vs 4.0+/-1.0 IU/mL, P<0.001). Similar fibrinogen, tissue plasminogen activator: A, and plasminogen activator inhibitor-1 changes were observed in pregnant women (3.8+/-0.3 vs 2.9+/-0.2 g/L, P<0.05; 7.7+/-0.9 vs 5.2+/-0.3 ng/mL, P<0.05; and 17.6+/-2.1 vs 5.1+/-1.1 IU/mL, P<0.05, respectively). Tissue plasminogen activator antigen was the only variable to significantly increase during the third trimester in pregnant diabetic women with microangiopathy compared with women without microangiopathy (21.0+/-3.2 vs 8.4+/-1.7 ng/mL, P<0.01). CONCLUSIONS: (1) In patients with type 1 diabetes without microangiopathy and with good metabolic control, fibrinogen and tissue plasminogen activator antigen concentrations and changes in the activity of plasminogen activator inhibitor-1 are similar to those found in patients with a normal pregnancy; (2) the marked decrease in platelet count in patients with type 1 diabetes during pregnancy may be an additional source of plasminogen activator inhibitor-1; and (3) during pregnancy, diabetic microangiopathy leads to a greater increase of tissue plasminogen activator antigen concentration as a marker of endothelial cell injury.

[Assessment of selected factors influencing birthweight in pregnant women with gestational diabetes mellitus]. / Analiza wybranych parametrów wplywajacych na mase ciala noworodka u kobiet z cukrzyca ciezarnych.

OBJECTIVES: Giving birth to a chi;d with an excessive brithweight is one of the most common neonate complications observed in the pregnant women with gestation diabetes (GDM). DESIGN: The aim of the study was an evaluation of selected factors affecting birthweight in the GDM. MATERIALS AND METHODS: Data from 867 pregnant women were analysed. The influence of: age, height, place of living and mother's educational background and BMI before pregnancy and weight gain during pregnancy and also HbA1c, triglycerides (TG) and total cholesterol (TC) values in the 3rd term of pregnancy (T3) were determined. The TC and TG were assessed by the enzymatic method by means of the Bio Merieux firm set--France, HbA1c by means of the immunoturbidimetric method using the Roche firm sets--France. RESULTS: Statistically significant birthweight differences were affirmed according to: mother's height (respectively the groups: < or = 155 vs 156-169 vs > or = 170 cm), BMI before pregnancy (< 25 vs 25-29.9 vs > or = 30 kg/m2), weight gain in pregnancy (< 12 vs > or = 12 kg), TG (< 2.7 vs > 2.7 mmol/l) and HbA1c in T3. No influence of mother's age, her place of living, educational background, HbA1c at admission and TC values in T3 on the neonates birthweight was observed. CONCLUSIONS: The anthropometric and environmental factors (mother's height, weight, weight gain in pregnancy) have a more significant influence on the neonates birthweight of the mothers with GDM, than social-demographic factors (age, educational background, place of living), the way of treatment of GDM and TC in T3. The TG level in T3, beside HbA1c is an independent, prognostic factor of birthweight in GDM.

[Early development of Charcot neuroarthropathy in the course of compensated diabetes mellitus--case report]. / Wczesny rozwój neuroartropatii Charcota w przebiegu dobrze wyrównanej cukrzycy--opis przypadku.

Charcot neuroarthropathy (CN)--chronic and progressive, destructive disease of bones and joints, which develops on the background of neuropathy, is late and uncommon complication of diabetes. It occurs almost exclusively in patients with a mean duration of diabetes at least 10 years. We report the case of woman, who developed an acute phase of CN 11 months after recognition of diabetes. Because of recent recognition of diabetes and good glycaemic control, CN wasn't considered in the differential diagnosis of swelling, pain and warmth of feet. The initial diagnosis was missed, leading in few months, to development of irreversible deformity of both feet.

The role of intrinsic fibrinolytic system activation in pathogenesis of hemostasis disturbances in hemodialyzed patients with chronic renal failure.

In the hemodialysis patient, hemostasis changes may occur. The contribution of fibrinolysis in pathogenesis of these disorders is unclear. The aim of the study was to estimate intrinsic fibrinolysis pathway in patients treated with hemodialysis (HD) because of chronic renal failure caused by chronic glomerulonephritis. The study was performed with 43 patients; the control group consisted of 51 healthy volunteers chosen by sex and age. The following parameters were determined: concentration of the urokinase plasminogen activator antigen (uPA:Ag), plasmin--antiplasmin complexes (PAP), fibrin and fibrinogen degradation products (FDP), activity of prekallikrein (PK) and C1-inhibitor (C1-INH) and also euglobulin clot lysis time (ELT). The above parameters were assessed in the patients before and after HD and were compared with the control group. In the HD patients, in comparison with the control group, prolonged statistically ELT [153 (125;215) vs. 105 (75;142) min.; p<0.001], with increase of PAP (508.6 +/- 274.7 vs. 184.7 +/- 69.4 microg/L; p<0.001) and FDP concentrations [5 (5;15) vs. 2.5 (0;0.3) microg/mL; p<0.05] before the procedure were determined. It suggests increased plasmin production and fibrin digestion despite determination of decreased general fibrinolytic activity. The C1-INH activity before HD was also significantly increased as compared with the control group [157 (136;171) vs. 107 (100;124)%; p<0.001], and its significant decreased after the HD is 157.7 +/- 23.9 vs. 122.3 +/- 20.3%; p<0.001, as it seems to be a nondirect proof of intrinsic pathway contribution in fibrinolysis activation in the HD patients. The remaining examined parameters did not change significantly after the dialysis procedure.