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The prognostic significance of exercise testing was compared with clinical and electrocardiographic (ECG) variables in a prospective study of 107 patients with unstable angina discharged from the hospital on medical therapy. During a follow-up period of 12.8 +/- 1.4 months, 10 patients (9%) had a nonfatal myocardial infarction (n = 8) or died (n = 2) and 22 (20%) were readmitted with recurrent unstable angina. The relation between 20 clinical, ECG and exercise test variables and the risk of adverse outcome (death, nonfatal myocardial infarction or recurrent unstable angina) was analyzed using both univariate and multivariate (logistic regression) analysis. Univariate predictors of adverse outcome included diabetes mellitus, evolutionary T wave changes, T wave changes on the preexercise ECG and low maximal rate-pressure product during exercise. Independent predictors of adverse outcome in multivariate analysis included diabetes mellitus, evolutionary T wave changes after admission, rest pain during hospitalization, ST depression during exercise and low maximal rate-pressure product. A predictive model constructed using the regression equation and all independent predictors stratified patients into high and low risk groups (41% and 5% risk of adverse outcome, respectively). The result of a predischarge exercise test adds independent prognostic information to clinical and ECG data in medically treated patients with unstable angina and could be used in combination with clinical and ECG data to identify patients at risk of adverse events.
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PMID:Prognostic significance of a predischarge exercise test in risk stratification after unstable angina pectoris. 186 32

Many current health status instruments either are too long to use in many acquired immune deficiency syndrome (AIDS) clinical trials or omit important concepts. In this study, human immunodeficiency virus (HIV)-relevant items developed for the Medical Outcomes Study (MOS) from subscales for cognitive function, energy/fatigue, health distress, and a single quality of life item were added to a portion of the MOS Short-form General Health Survey. The resulting 30-item questionnaire reliably and distinctly measured ten aspects of health and took less than 5 minutes to complete. To test its validity, this modified measure was used to compare the health of 73 subjects with asymptomatic HIV infection and 44 with early AIDS-related complex (ARC). Compared with ARC subjects, asymptomatic individuals reported superior overall health, less pain, and better physical function, role function, cognitive function, and quality of life (rank-sum, P less than 0.02). Asymptomatic subjects' scores were higher on most subscales than the age-adjusted scores of MOS outpatients with hypertension, diabetes, recent myocardial infarction, or depression; ARC patients scored closest to hypertensive patients. This instrument, containing a subset of the MOS measures of health-related quality of life, may be a useful outcome measure for AIDS clinical trials.
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PMID:A health status questionnaire using 30 items from the Medical Outcomes Study. Preliminary validation in persons with early HIV infection. 187 45

The present study was conducted to assess the reciprocal effects between the psychosocial contexts of diabetes and older adulthood. Data were collected from 191 community-dwelling adults over the age of 60 with non-insulin-dependent diabetes mellitus. Results indicate that older adults with diabetes reported higher rates of selected chronic illnesses, lower self-rated physical health, and higher levels of depression than did comparison samples of older adults without diabetes. Compared with younger adults with NIDDM, the present sample of older adults perceived fewer impacts of diabetes, including fewer symptoms of poor metabolic control, less emotional impact, fewer barriers to adherence, and less complex regimens. Overall levels of social support and regimen adherence were high. Older adults in this sample reported wanting minimal help from their family and friends with self-management activities and receiving more help than desired with following a meal plan and taking medications. Implications of the unique context of older adulthood for diabetes self-management are discussed.
Diabetes Educ
PMID:Psychosocial contexts of diabetes and older adulthood: reciprocal effects. 187 77

Regular physical activity increases a person's ability to perform daily activities with greater vigor and may reduce the risk for specific health problems, including coronary heart disease (1), hypertension (2), noninsulin-dependent diabetes mellitus (3), colon cancer (4), and depression (5), as well as lower all-cause death rates (6). In addition to extracurricular activities (e.g., sports and recreational organizations), high school physical education (PE) classes provide an opportunity to ensure a minimal, regular amount of desirable physical activity and help establish physical activity patterns that may extend into adulthood. This report examines the prevalence of self-reported enrollment, attendance, and participation in PE classes by students in grades 9-12.
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PMID:Participation of high school students in school physical education--United States, 1990. 188 83

Patients with type II diabetes mellitus were assessed for symptoms of depression using the Zung Self-Rated Depression Scale (Zung SDS) and the Beck Depression Inventory (BDI). The patients were classified according to the presence or absence of diabetic complications, and they were compared with a group of demographically matched, nonmedically ill control subjects. The patients with diabetic complications scored significantly higher on the depression inventories than did the patients without complications and the control subjects. Factor analysis of BDI responses revealed that cognitive symptoms of depression were prominent in the diabetic patients with complications. In this group, 74% of patients scored within the range of clinical depression on the BDI; 35% scored within the range of severe depression. Symptoms of sexual dysfunction were significantly correlated with symptoms of depression in diabetic women but not in diabetic men. The findings are discussed within the context of other research in the behavioral aspects of diabetes mellitus.
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PMID:Symptoms of depression in patients with type II diabetes mellitus. 188 19

The accuracy of physicians' perceptions of their patients' emotional state and health attitudes was examined in a diabetes outpatient clinic by comparing patients' ratings of anxiety, depression and health locus of control with physicians' ratings. In 234 patients, doctors' and patients' ratings correlated significantly for depression and anxiety. The physicians rated patients with a strong belief in control of health by others as most dependent on doctors. Men but not women with external locus of control were also rated as very dependent on doctors. Anxious or depressed patients were rated by their doctors as less able to cope with diabetes. The results indicate that non-psychiatric physicians are able to assess their patients' emotions and health attitudes with greater accuracy than is usually assumed.
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PMID:Diabetologists' assessments of their outpatients' emotional state and health beliefs: accuracy and possible sources of bias. 189 64

To evaluate the significance of ischemic ST depression without anginal chest pain during exercise testing among patients with diabetes mellitus, the data on 45 such patients from the Coronary Artery Surgery Study registry were analyzed. These patients (group 1, silent ischemia) were compared with 37 diabetic patients with both ischemic ST depression and chest pain (group 2, symptomatic ischemia), with 31 diabetic patients without ischemic ST depression or chest pain (group 3, no ischemia), and with 429 patients without diabetes who had silent ischemia during exercise testing. All patients had documented coronary artery disease (CAD) (greater than 70% diameter narrowing). The 6-year survival among patients with silent ischemia was worse in diabetic than nondiabetic patients (59 vs 82%, respectively, p less than 0.001). By contrast, the 6-year survival among patients without ischemia was similar among diabetic and nondiabetic patients (93 vs 85%, respectively, p = 0.476). Among diabetic patients, survival at 6 years with medical treatment was 59% for group 1, 66% for group 2 and 93% for group 3 (p = 0.008). Survival among subsets of patients with diabetes and silent ischemia (group 1) based on the extent of CAD and left ventricular function ranged from 100 to 32% (p = 0.093). The survival of the 45 patients with diabetes mellitus and silent ischemia (group 1) treated medically was compared with that of 28 patients receiving coronary artery graft bypass surgery.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Significance of silent myocardial ischemia during exercise testing in patients with diabetes mellitus: a report from the Coronary Artery Surgery Study (CASS) Registry. 189 78

Dehydration, in childhood as in adulthood, may origin from an inadequate water ingestion or an excessive water elimination. Causes may be found in fever, vomiting, scalds, pulmonary hyperventilation, diabetes. Water loss during acute diarrhea in children can be even 6-7 times higher in comparison with an healthy child. Together with water, electrolytes are lost. We differentiate dehydration in isonatremic d. (70% of cases), hyponatremic d. (10%) and hypernatremic d. (20%) basing on Sodium loss. Important dehydration causes severe clinical symptoms as shock, renal and cardiocirculatory failure, convulsion, coma. Symptoms at the central nervous system level derivate both from hyperosmolarity in brain cells and from thrombosis or hemorrhages in subdural sites. Dehydration, following acute diarrhea, is slight when weight loss is lower than 5%. The child health conditions still remain good. Dehydration become moderate if weight loss reaches 5% and the child starts suffering. When the weight loss reaches 10%, dehydration is now severe and circulatory deficiency becomes evident. When it is higher than 10%, prognosis is very severe and shock and coma may be observed. In the present work, we illustrate the different ways of rehydration after acute diarrhea. Initially, oral rehydration must be established with one of the oral solutions, differing each other for amount of electrolytes and glucose. Recently, a new solution, "supersolution", has been presented differing from the other ones for electrolytes concentration and for the presence of rice starch instead of glucose. In most cases of diarrhea, oral rehydration appears adequate but sometimes an intravenous rehydration becomes necessary, e.g. in case of vomiting, CNS depression and in any case of severe gastroenteric symptomatology.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:[Dehydrated child]. 189 82

The gut may be a site of early diabetic neuropathy in humans and rats. The latter may provide appropriate models of these conditions. Therefore, cholinergic function was examined in two gut smooth muscle preparations from control, 30-day, and 6-month streptozotocin-diabetic and similarly diabetic rats that had received continuous treatment with an aldose reductase inhibitor, ponalrestat. Responses of terminal ileum longitudinal muscle to transmural nerve stimulation were depressed in preparations from untreated 30-day diabetic animals. Responses to exogenous acetylcholine were also depressed, by at least the same extent, in preparations from both 30-day and 6-month diabetic groups. Ponalrestat treatment prevented both changes in the 30-day study but did not prevent a depression of responses to acetylcholine in the 6-month study. Neither diabetes nor ponalrestat affected responses of esophageal muscularis mucosa to electrical stimulation or to exogenous acetylcholine. These observations suggest a change in the smooth muscle and/or noncholinergic innervation rather than in the cholinergic nerves of the ileal preparation. Cholinergic function in the ileum did not, therefore, seem to be an appropriate model of diabetic neuropathy.
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PMID:Effects of diabetes on cholinergic transmission in two rat gut preparations. 189 95

A 24-year-old newly diagnosed male patient with diabetes presented with diabetic ketoacidosis (DKA) (pH 7.16, HCO3 6.0) and extreme hypertriglyceridemia (239.35 mmol/L). The diagnosis of DKA was delayed because of the apparent depression of the true serum glucose (to 11 mmol/L). He was treated with intravenous (IV) insulin and rehydration, which normalized his pH, HCO3, and triglyceride levels. To the authors' knowledge, this is both the highest triglyceride level recorded and the first report of a high triglyceride level as the apparent cause of a factitiously low glucose level.
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PMID:Pseudonormoglycemia in diabetic ketoacidosis with elevated triglycerides. 189 2


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