Gene/Protein Disease Symptom Drug Enzyme Compound
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Query: UMLS:C0011849 (diabetes)
 277,896 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Insulin-like growth factor-1 (IGF-1) and its receptors share considerable homology with insulin and insulin receptors, and their respective signaling pathways interact at the post receptor level. While the growth hormone (GH)-IGF-1 axis principally regulates tissue growth and differentiation, insulin exerts it primary effects on fuel metabolism. However, these two endocrine systems interact at multiple levels and in diabetes mellitus the GH-IGF-1 axis is grossly disturbed, with increased secretion of GH, reduced plasma levels of IGF-1, and complex tissue-specific changes in IGF binding proteins (IGFBPs). These observations have given rise to the view that GH-IGF-1 axis dysfunction, particularly low plasma levels of circulating IGF-1, probably play a significant role in several aspects of the pathophysiology of diabetes mellitus, including insulin resistance and poor glycemic control, and may also influence the development of microvascular complications. The availability of recombinant human IGF-1 (rhIGF-1; mecasermin), used either alone or in combination with insulin, has led to experimental studies and clinical trials in humans testing these hypotheses. These studies have examined the impact of subcutaneous rhIGF-1 injections on sensitivity and metabolic parameters. In patients with type 1 and 2 diabetes mellitus, insulin sensitivity is significantly improved, insulin requirements are reduced, and glycemic control of dyslipidemia is generally improved in short-term studies. rhIGF-1 is a particularly attractive possibility in patients with type 2 diabetes mellitus, where insulin resistance is the fundamental problem. Some patients with genetic syndromes of severe insulin resistance also benefit from treatment with rhIGF-1, which can bypass blocks in the insulin signaling pathway. The common adverse effects reported for rhIGF-1 are dose-related and include edema, jaw pain, arthralgia, myalgia, hypotension, injection site pain, and less commonly, Bell's palsy and raised intracranial pressure. Although disturbance of the GH-IGF-1 axis participates in the development of diabetic complications, the functional consequences of the complex changes in IGFBP expression at the tissue level are uncertain, and it is not known whether systemic IGF-1 therapy or other manipulations of the GH-IGF-1 axis would be helpful or harmful. Experimentally, IGF-1 has a protective effect on neuropathy, and could find an application in the healing of neuropathic ulcers. The potential benefits of IGF-1 therapy in diabetes mellitus have yet to be realised.
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PMID:Therapeutic potential of insulin-like growth factor-1 in patients with diabetes mellitus. 1583 92

Isolated facial weakness suggests either a contralateral hemispheric lesion or a disease of the facial nerve per se. The presence of sensory symptoms usually indicates a central facial weakness, which characteristically involves the lower part of the face. In contrast, the absence of sensory disturbances suggests a peripheral nerve lesion, some system diseases such as amyotrophic lateral sclerosis, or a stroke sparing the sensory cortex. Sporadic cases of Bell's palsy rank the first in incidence. Although its exact etiology remains unknown, accumulating evidence suggests reactivation of herpes simplex virus type I. A facial palsy that develops in patients with diabetes mellitus tends to show a more severe involvement with substantial denervation. Acoustic neuroma, strategically located at the cerebellopontine angle, may compress the facial nerve. Peripheral facial palsy may herald other symptoms of multiple sclerosis in young adults. Serial electrodiagnostic studies help delineate the course of the illness. The amplitude of the direct response elicited by stimulation of the facial nerve after the fourth to fifth day of onset serves as the best means predicting the eventual outcome of recovery. Blink reflex studies usually show an absent or delayed R1, implicating the central reflex arc, which includes the intrapontine portion of the facial nerve.
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PMID:Electrodiagnosis of the cranial nerves. 1659 78

Bell's palsy is one of the most common neurologic disorders affecting the seventh cranial nerve. Several disease states have been associated with facial paralysis. Drugs, however, have been rarely implicated as an etiology. We describe a 49-year-old man who developed peripheral facial paralysis after 3 weeks of linezolid therapy, along with recurrence of symptoms on rechallenge. He had insulin-dependent diabetes mellitus and a longstanding history of bilateral diabetes-related foot problems. After hospitalization, debridement, and vancomycin therapy for methicillin-resistant Staphylococcus aureus osteomyelitis, the patient was discharged to home with oral linezolid therapy. On day 23 of linezolid therapy, he developed signs and symptoms that were consistent with Bell's palsy. Linezolid was discontinued; the Bell's palsy gradually improved, with complete resolution occurring at month 3. On rechallenge with linezolid for recurrent osteomyelitis, the patient developed a second episode of Bell's palsy within a similar time frame as in the first episode. Assessment of causality using the Naranjo adverse drug reaction probability scale revealed a probable relationship between this adverse drug event and linezolid therapy. Clinicians should be aware that Bell's palsy may be another neuropathic adverse effect associated with linezolid.
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PMID:Bell's palsy associated with linezolid therapy: case report and review of neuropathic adverse events. 1686 96

We encountered 185 patients with Bell's palsy at our hospital between January 2003 and December 2005. Of these patients, 60% visited our department within 3 days of the onset, and 90% within 7 days of the onset; the interval from onset to hospital visit showed no relation with the severity of the paralysis. Complete recovery was obtained in 85.0% of the patients with steroid or steroid + antiviral treatment. Preservation of the stapedius reflex was a statistically significant predictor of good prognosis, with a high positive predictive value (95.5%). Several factors influencing the prognosis were examined with a Cox's proportional hazards model. The factors considered were the sex of the patients, left / right localization, age, postauricular pain, eye symptoms, taste disorder, underlying diabetes, the Yanagihara facial grading system score, and use of antiviral drugs. The analysis revealed only the Yanagihara score and antiviral drug use as statistically important, with hazard ratios of 1.101 and 1.586, respectively. Although this study had several limitations, steroid + antiviral treatment could yield a better prognosis as compared to steroid treatment alone.
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PMID:[A clinical study of Bell's palsy and factors influencing its prognosis]. 1787 41

Bell's palsy is a peripheral palsy of the facial nerve that results in muscle weakness on one side of the face. Affected patients develop unilateral facial paralysis over one to three days with forehead involvement and no other neurologic abnormalities. Symptoms typically peak in the first week and then gradually resolve over three weeks to three months. Bell's palsy is more common in patients with diabetes, and although it can affect persons of any age, incidence peaks in the 40s. Bell's palsy has been traditionally defined as idiopathic; however, one possible etiology is infection with herpes simplex virus type 1. Laboratory evaluation, when indicated by history or risk factors, may include testing for diabetes mellitus and Lyme disease. A common short-term complication of Bell's palsy is incomplete eyelid closure with resultant dry eye. A less common long-term complication is permanent facial weakness with muscle contractures. Approximately 70 to 80 percent of patients will recover spontaneously; however, treatment with a seven-day course of acyclovir or valacyclovir and a tapering course of prednisone, initiated within three days of the onset of symptoms, is recommended to reduce the time to full recovery and increase the likelihood of complete recuperation.
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PMID:Bell's palsy: diagnosis and management. 1871 57

Peripheral facial nerve palsy (FNP) may (secondary FNP) or may not have a detectable cause (Bell's palsy). Three quarters of peripheral FNP are primary and one quarter secondary. The most prevalent causes of secondary FNP are systemic viral infections, trauma, surgery, diabetes, local infections, tumor, immunological disorders, or drugs. The diagnosis of FNP relies upon the presence of typical symptoms and signs, blood chemical investigations, cerebro-spinal-fluid-investigations, X-ray of the scull and mastoid, cerebral MRI, or nerve conduction studies. Bell's palsy may be diagnosed after exclusion of all secondary causes, but causes of secondary FNP and Bell's palsy may coexist. Treatment of secondary FNP is based on the therapy of the underlying disorder. Treatment of Bell's palsy is controversial due to the lack of large, randomized, controlled, prospective studies. There are indications that steroids or antiviral agents are beneficial but also studies, which show no beneficial effect. Additional measures include eye protection, physiotherapy, acupuncture, botulinum toxin, or possibly surgery. Prognosis of Bell's palsy is fair with complete recovery in about 80% of the cases, 15% experience some kind of permanent nerve damage and 5% remain with severe sequelae.
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PMID:Management of peripheral facial nerve palsy. 1870 76

Bell's palsy is the most common acute facial paralysis with its causes still unclear. At present, the most widely accepted causes are viral infections, trauma, surgery, diabetes, local infections, tumor, immunological disorders, or drugs. Unclear causes lead to unidentified treatments. Most therapeutic methods are simply symptomatic treatment. Fortunately, the pathomechanism of Bell's palsy is relative clear, involving herpes simplex virus (HSV) reactivation within the geniculate ganglion, followed by inflammation and entrapment of the nerve in the bony foramen. This makes symptomatic treatment possible. But the therapeutic effects are not quite satisfactory. Therefore, novel etiological and therapeutic concepts are urgently needed. According to our clinical observation and some facts that do not favor the viral infections theory, we can conclude that all Bell's palsy is not related to viral infections, some even may have relations to bacterial infection. As far as blood routine examination is concerned, though lymphocyte increasing can be seen in most patients with Bell's palsy, there are cases with normal lymphocyte but increased neutrophil. Also, antibiotic treatment in these patients could accelerate recovery to some extent. These results indicate that Bell's palsy in these patients may be caused by bacterial infection.
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PMID:Bell's palsy may have relations to bacterial infection. 1895 23

The incidence of Bell's palsy has been estimated in a health district of a major Italian city, taking also into consideration the potential risk factors that might influence the occurrence of Bell's palsy. A matched case-control was therefore designed, by collecting data from the Emergency Departments of four Hospitals belonging to the same Health District in Rome (Italy), coordinated by a tertiary referral centre University Hospital. All patients affected by Bell's palsy within the health district and four controls for each case were included. Controls were selected from other ENT patients, and were matched for hospital admission, week of disease onset, and climate conditions. Information regarding possible risk factors was collected using standardized telephone interviews. The resulting dataset was analyzed using multiple conditional logistic regression. The study group comprised 381 patients with acute, unilateral, peripheral facial palsy, clinically diagnosed as Bell's palsy observed between 1st January 2006 and 31st December 2008. The cumulative incidence of Bell's palsy was found to be 53.3/100.000/year. Among the risk factors, age was found to influence onset of Bell's palsy, with an odds ratio of 2% for each one-year increase in age, with a linear trend (95% CI = 1-3%; p = 0.005). Bell's palsy was found to occur with an annual incidence close to previous reports. Among the possible known risk factors (diabetes, pregnancy, etc.), only aging was found to play a significant role.
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PMID:Epidemiology of Bell's palsy in an Italian Health District: incidence and case-control study. 2125 85

Serratia marcescens has been reported to cause infective endocarditis among intravenous drug users, but it is extremely rare in non-intravenous drug users in Japan. In this article, we report an 85-year-old woman with diabetes mellitus who presented with low-grade fever and general fatigue. She was administered intravenous prednisolone under a diagnosis of right Bell's palsy before this admission. Blood cultures revealed positive Serratia marcescens, which was complicated by multiple cerebral infarctions after admission. Transthoracic echocardiography on day 5 revealed vegetation on the mitral valve, which was diagnosed as infective endocarditis. An operation could not be performed because of the presence of multiple cerebral infarctions. She died on day 65 because of uncontrolled heart failure.
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PMID:A fatal case of infective endocarditis caused by an unusual suspect: Serratia marcescens. 2268 55

Reactivation of latent herpes simplex virus (HSV) type I or varicella-zoster virus (VZV) has been recognized as the most common pathomechanism underlying Bell's palsy. There is also increased reactivation of HSV or VZV in patients with immunosuppressed states and in cancer patients. The purpose of this study was to investigate the risk for cancer during a 5-year follow-up period after diagnosis of Bell's palsy by using a population-based dataset in Taiwan. We used data from the "Longitudinal Health Insurance Database". We identified 2,618 patients with Bell's palsy as the study cohort and randomly selected 13,090 patients to be used as a comparison cohort. Cox proportional hazards regression was performed to compare the 5-year risk of subsequent cancer between the study and comparison cohorts. We found that the incidence of cancer was 1.55 (95 % CI 1.35-1.78) per 100 person-years for patients with Bell's palsy and 1.09 (95 % CI 1.02-1.18) per 100 person-years for comparison patients. After censoring cases that died from non-cancer causes during the follow-up period and adjusting for urbanization, monthly income, geographic region, and diabetes, the hazard ratio (HR) for cancer during the 5-year follow-up period for patients with Bell's palsy was 1.43 times that for comparison patients (95 % CI 1.22-1.73). There was a particularly increased risk of oral cancer (HR = 2.49; 95 % CI 1.54-4.03) for patients with Bell's palsy compared with the other patients. We conclude that patients with Bell's palsy were at significant risk of cancer during a 5-year follow-up period after diagnosis.
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PMID:Increased risk of cancer after Bell's palsy: a 5-year follow-up study. 2289 Sep 70


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