Biomedical subjects
Publications and source records attributed to S Svacina.
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BACKGROUND: Relationship between dehydroepiandrosterone (DHEA), its sulphate (DHEAS) and various components of metabolic syndrome X have been recently discussed in several papers. Originally only DHEA or DHEAS have been considered to be responsible for all of the effects. At present mainly DHEA hydroxyderivatives (particularly 7-hydroxyisometers) are assumed to be responsible for those effects. METHODS AND RESULTS: 68 obese subjects (28 males) aged 42.6 +/- 11.1 years, with average BMI 35.7 +/- 11.6 kg/m2 were examined. Relationship between 7-alpha and 7-beta-(OH)-DHEA and various components of metabolic syndrome X have been followed in a pilot epidemiological study. Fluctuations of the hydroxyderivates level during one-day starvation test were investigated in a group of 11 obese females and compared with that of the control group (12 lean subjects with BMI 23.1 +/- 2.4 kg/m2). From the view of the metabolic syndrome X, the negative correlation between the serum levels of 7-beta-(OH)-DHEA and insulinemia (r = -0.28; p = 0.23), glycemia (r = -0.48; p < 0.001), serum level of uric acid (r = -0.35; p = 0.02) and opposite the positive correlation between the serum level of HDL-cholesterol (r = 0.42; p < 0.01) should be pointed out. The negative correlation between 7-alpha-(OH)-DHEA and age and BMI was noticed (correlation for 7-beta-(OH)-DHEA was similar). No other statistically significant correlation was found among the other monitored parameters. In 11 obese females the dynamic changes of the above-mentioned DHEA hydroxyderivatives during one-day starvation test were monitored. Changes were compared with the control group (12 lean females). Significant increases in DHEAS, 7-beta-(OH)-DHEA, and sex hormone binding globulin (SHBG) levels were observed during this test. Significant differences in dynamic changes (before and after the test) between obese and lean group have been found only in DHEAS and SHBG. CONCLUSION: We suppose that 7-beta-(OH)-DHEA (more than 7-alpha-(OH)-DHEA) is specifically related to the metabolic syndrome X and that its claimed anti-glucocorticoid effect in the immune response can play some role in its metabolic effects.
BACKGROUND: The influence of metabolic state and the presence of diabetes before surgery on the weight changes following non-adjustable gastric banding, were studied. METHODS: The total of 50 patients referred for gastric banding had the following parameters measured: insulinemia, glycemia, total cholesterol, triglycerides (TAG), dehydroepiandrostendione (DHEA) and its sulphate (DHEA-S), triiodothyronine, thyroxine, and thyroxine-stimulating hormone. We evaluated 28 of these, who completed at least 6 months of follow-up. 12 of these patients had diet-treated non-insulin dependent diabetes mellitus (NIDDM) and 16 were non-diabetics, and 9 of them had a positive family history of NIDDM (FH DM). We compared the change in weight of the diabetics, non-diabetics and those with positive FH DM, at 3, 6 and 12 months after the operation. Multiple linear regression tested the influence of the measured parameters on patients' weight. RESULTS: Weight loss was greatest in the group of patients without a positive family history of diabetes, and lowest in the diabetic group. Due to the high dispersion, differences in the t-test are not significant. When individual factors and their influence on weight development were tested by multiple linear regression, weight loss was greatest in patients with high TAG and low insulin levels and lowest in patients with diabetes or positive FH DM. CONCLUSIONS: Although post-operative weight can be influenced by other factors, eg. psychological ones, it is advisable to test each patient pre-operatively for insulin and TAG levels, and to establish family history of diabetes and presence of diabetes to give an idea of the prognosis of weight change.
We carried out statistical analysis of biochemical, anthropometric and anamnestic values at the first contact with 114 patients in the specialized obesity unit. We evaluated metabolic state of different groups varying in the presence of risk factors of atherosclerosis. We disclosed statistically significant differences between those groups, enabling evaluation of the severity of state and early decision on suitability and urgency of treatment.
Initial hormonal and metabolic investigation was performed in a group o 51 patients (mean age 41 years and body mass index--BMI 45.1 kg/m2) referred to gastric banding for morbid obesity. Patients were followed for one year period after surgery. Using multiple linear regression following parameters influencing BMI change were identified. Negative influence on BMI reduction: high insulin, presence of diabetes, low T3/T4 ratio. Positive influence on BMI reduction high triglycerides level, positive family history of diabetes. It is possible to identify patient's prognosis after gastric banding using metabolic and hormonal investigation. This investigation should be performed in every patient.
Morbid obesity (BMI over 40 kg/m2) is typically complicated by many serious diseases including early death. Using 7 case studies of morbid obese patients we are documenting severe polymorbidity of these persons including severe manifestation of metabolic syndrome. Using adequate therapy, e.g. gastric banding, risk of these patients can be reduced. Some parts of metabolic syndrome can be documented in adolescent children of these patients. The aim of this study is to show the importance of early intervention in patients with morbid obesity.
The severity of metabolic syndrome is usually determined according to static variables (blood glucose, insulin level, body mass index etc.) The most important classification is dynamic and prognostic classification which can be used to determine the ability to decrease elevated metabolite and hormone levels or to lose weight. Different mathematical approaches were used to determine these phenomena: 1. Mathematical modelling e.g. (Bergman minimal model or glycation model). 2. Predictive calculations using multiple regression (using static and dynamic parameters to determine weight loss in obesity treatment). 3. One day starvation test (finding very variable hormone and metabolic changes in obese patients). We can conclude There are 3 types of metabolic parameters: A. Static (basic) description, B. Functional (actual) description, C. Dynamic-stability describing variables. Mathematical modelling is a complicated method needing many blood samples. It is very invasive for patients and it is difficult to be repeated. Predictive importance can have also repeated measured metabolic data which are able to classify the stability (fixation) of metabolic state. Some basic parameters and simple dynamic tests like one day starvation test can be used in prognostic classification of patients who are able to change their fixed metabolic state.
Dexfenfluramine (DF) is contraindicated in severe psychiatric disorders and in depression. We used DF in 3 patients with chronic psychosis and severe overeating without changes in psychiatric pharmacotherapy. Two patients had paranoid schizophrenic psychosis with hallucinations, one patient mixed psychosis, beginning with lactation psychosis, and several attacks of hallucinations and depression later. Overeating was removed in all 3 patients without any negative effect on the psychotic state. All patients were able to maintain their body weight. Two patients with poorly controlled diabetes improved markedly their metabolic status. Doses up to 75 mg per day of DF were necessary during binge eating episodes in one patient. We conclude that DF can be used with care under close psychiatric supervision in psychotic patients with severe overeating.
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We have checked weight changes in 11 patients eight years after 2-weeks in-patient weight reduction treatment and weight changes of another group of 11 patients three years after gastric banding. Using multiple linear regression we've looked for factors which could influence the aforementioned weight changes. For weight reduction regimens we confirmed only the following connection: BMI reduction in 8 years = 12.256 - 2.827 x BMI reduction in 2 weeks. For gastric banding it was: BMI reduction in 3 years = -7.880 + 2.383 x BMI reduction in 6 months. We therefore conclude that the long term effects of reduction regimens is not influenced by any hormonal or metabolic characteristics of the patient, but can be predicted by the early weight loss of the patient. Patients who lose too much during the reduction regimen will find it more difficult to keep the weight down, whereas patients who lose weight rapidly after gastric banding have the best long term prognosis.
Teaching of medical informatics in the 1st medical faculty is compared with teaching of informatics and related curricula in European faculties. Practically in all faculties in the 1st year, a curriculum is situated with formal (mathematical, probabilistic or information and computer based) approach. From a clinical point of view there are two main reasons for situating this curriculum in the first year--it is a good basis for teaching special parts of informatics later directly in preclinical or clinical curricula and teaching informatics is a good occasion how to bring some clinical problems to the first year study and how to motivate students to the study of theoretical medicine.
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Several computer models and dynamic parameters were used to describe metabolic state of patients. We have used models to explain the process of glycation of hemoglobin and albumin, to identify insulin sensitivity, to describe individual insulin therapy needs and to predict outcome of metabolic diseases. We also compared static and dynamic description of patients with metabolic X syndrome. We can conclude that static and dynamic parameters bring different quality of information in metabolic care.
The author gives an account of the contents of medical and health informatics. Information systems are the second most important area of health informatics and their contribution to the functions of hospitals, policlinics and individual surgeries is substantial. The position in this country as regards implementation and communication of hospital information systems is not simple and the implementation of completely functional systems will still need considerable efforts. Probably it will be also essential to have a new category of university trained workers which exists in other countries, so-called health care administrators or managers.
Presented survey summarises insulin-steroid interactions. Beside the well known resistance to insulin induced by steroid hormones, also the central effect of insulin, its influence on the system hypophysis-adrenals, and its stimulatory effect on the generation of steroids in adrenals and ovaries are reviewed. Insulin-steroid interactions are further illustrated by pathogenesis of the polycystic ovary syndrome and by our study on dehydroepiandrosterone regulation. Insulin induced changes in the dehydroepiandrosterone level during the intravenous glucose tolerance test were described.
The effect of dexfenfluramine, the new serotoninergic appetite suppressor, was tested in 20 women. The drug was administered 3 months, 15 mg twice a day. A selected reduction of carbohydrate and of fat intake was observed. The body weight decreased mainly due to fat loss in the abdominal region. An important decrease of blood lipids was recorded, while insulinemia and OGTT remained unchanged. Serum alkaline phosphatase increased and ALT decreased. Other liver tests did not change. During the treatment the level of cortisol, TSH, T3 and 17-ketosteroids were not affected. T4 decreased and GH increased. These metabolic and hormonal effects were discussed. The treatment with dexfenfluramine was well tolerated and was found to have several favourable effects.
Low dehydroepiandrosterone (DHEA) and hyperinsulinaemia are assumed to be risk factors of atherosclerosis. Exogenous hyperinsulinaemia during hyperinsulinaemic clamp decreases DHEA. We have evaluated interaction of these hormones during 2 weeks of therapeutic starvation in 11 obese patients (mean BMI 41.2 kg/m2), 5 nondiabetics and 6 diabetics with diet only therapy. Comparing diabetics with normals we have found no differences in BMI and blood DHEA, DHEAS and insulin levels. We have found a light implication of negative correlation of insulin to DHEA and DHEAS level in diabetics (r = -0.71, -0.73, p = 0.16, 0.18). During starvation insulinaemia is declining, DHEA initial increase is followed by a decrease (r = 0.93, p = 0.01). We conclude that insulin decrease during starvation could be a cause of DHEA decrease. This finding is unexpected according to the potential of exogenous insulin to suppress DHEA. Further investigation of endogenous DHEA and insulin relation is necessary.
A retrospective analysis of the function of adaptive model based consultation system for insulin therapy was performed. The program proved good adaptation ability with improving blood glucose level prediction. In a group of 12 brittle type 1 diabetic patients individual analysis showed problems resulting from retrospective testing of dynamic systems, when treatment is determined only by the physician.