[Computers in medicine].
Explore the source record for details and available documents.
Internal Medicine↗
Biomedical subjects
S Svacina
Publications and source records attributed to S Svacina.
[The effect of Proglicem in patients with an organic hyperinsulinism syndrome].
BACKGROUND: Organic hyperinsulinism is treated as a rule conservatively with diazoxide (Proglicem) which has a hyperglycaemic effect. In some patients, however, treatment fails and severe hypoglycaemia persists. The objective of the present investigation was to find simple criteria for evaluation of the aptness (effectiveness) of this treatment. METHODS AND RESULTS: In 11 patients with a confirmed insulinoma Proglicem was administered for five days (3 mg/kg body weight) and serum insulin and the blood sugar level as well as their ratio (IRI:G) were followed-up. In eight patients the IRI/G coefficient declined from 10.5 +/- 7.7 to 5.8 +/- 2.9 (p < 0.001); only in three patients the coefficient increased from 4.6 +/- 2.9 to 14.9 +/- 12.3 (p < 0.001). Coefficient "k" from the modified Bergman model for the intravenous glucose tolerance test had identical results; there was statistically significant agreement between the two examinations. CONCLUSIONS: To assess the effectiveness of diazoxide treatment (Proglicem) on hypoglycaemia in nesidiomas it is sufficient to evaluate the IRI/G coefficient (on fasting) before and during diazoxide treatment (Proglicem, Schering Corp.).
Adult↗
Risk calculation of type 2 diabetes.
The paper presents an analysis of the risk of developing Type 2 diabetes according to family history and anthropometric variables. The age of diabetes onset was analysed in 2024 diabetics. We obtained several groups according to family history. In each group taken separately, the data describing the cumulative percentage of diabetes onset was fitted by logistic curve F(x) = p1/(1 + p2*p3((x/10)-p4)). Comparing these curves we see that cumulative age-dependent risk increases from the group of randomly chosen persons through the group of first degree relatives to the children of diabetics. The highest risk of diabetes onset is determined by the curve representing the group of known diabetics. Another analysis was performed in a different group of 390 obese subjects (34 diabetics among them). Male diabetics had significantly higher body mass index (BMI) and weight than male non-diabetics. Female diabetics showed significantly higher weight, body mass index, waist to hip ratio (WHR) and age than female non-diabetics. Elimination of factors with randomization and matching showed a complicated relationship between diabetes, age and anthropometric variables. Using stepwise logistic regression we obtained the model for prediction of diabetes risk based on age, BMI, WHR: probability of diabetes = exp(u)/(1 + exp(u)), where u = -13.9 + 0.05431*age + 6.789*WHR + 0.07881*BMI for obese women, u = -11.84 + 10.01*WHR for obese men. In conclusion, genetic factors are the most important and can be exactly quantified in Type 2 diabetes. The importance of anthropometric variables for prediction of diabetes risk is also presented.
Adult↗
[Informatics education in undergraduate study at the 1st Medical School of Charles University].
History of medical informatics at the 1st Medical Faculty goes to 25 years back. Currently curriculum is divided in two parts. In the first year of studies and obligatory course of computer technique is organized including: computer functions, communications with computers, database systems and text editors. In the 4th year of studies a course in clinical informatics is realized including: principles of computer science, statistical software, artificial intelligence, computer in pedagogy, scientific information, classification in medicine, biological signal and picture analysis, hospital information systems, computer in outpatient ward, clinical decision support, computer simulation in clinical medicine, computers in pharmacology, computer in metabolic care, computers in medical devices. In this way medical students are prepared to be able to use technical means in scientific information management.
Czech Republic↗
Prolonged oral glucose tolerance test combined with indirect calorimetry and estimation of several substrates and hormones in obese subjects.
OGTT prolonged to 4 hours was performed in untreated 50 obese outpatients (mean age 37.9 years and BMI 37.2). Parallel to glucose, insulin, growth hormone (GH), cortisol, beta-hydroxybutyrate (BOHB), nonesterified fatty acids (NEFA) and indirect calorimetry (RQ) were estimated at hourly intervals. Basal values of thyroxine (T4), triiodothyronine (T3), total cholesterol and triacylglycerols were also obtained. Mean glycemia after overnight fasting as well as after 75 g glucose reached upper limits of the normal range. The subsequent decrease was slower. Insulinemia followed a similar trend. The initial drop of GH after the glucose load reverted to an increase above the basal value. A similar pattern was observed with cortisolemia, but the decrease and increase were less important. The basal value of RQ was rather low and glucose ingestion produced only a small increase, followed by a greater decrease. Serum levels of NEFA and BOHB sharply decreased one hour after glucose intake and afterwards regained the initial values. The mean basal values of T4 and T3 were within the normal range--the low T3 syndrome was not involved in the large majority of cases. Cholesterol and triacylglycerols approached the upper normal limit. The correlations brought additional information. Insulinemia increased parallel with the amount of body fat. The basal level was decisive for most hormones and substrates--the high or low set level could be followed in the course of the whole test. Increased insulinemia and increased glycemia suggested the presence of a mild insulin resistance with the participation of GH and cortisol. Increased levels of fasting insulinemia and glycemia were present also in obese subjects with a normal OGTT. The correlations permitted to disclose insulin-like effects of GH on basal conditions. Increased BOHB was responsible for a high cholesterol. It is suggested that even small fluctuations of glycemia related to food intake may produce a substantial modification of the hormonal status in obese subjects and initiate or support the metabolic disorders in obesity. In this respect a greater role is ascribed to the phase of decreasing glycemia in comparison to the increasing phase. Lipids are the prevailing source of energy in insulin resistant subjects. The rather stable values of indirect calorimetry indicate that energy metabolism of obese subject works on a low, pre-set level-independently on the supply of some relevant hormones and substrates.
3-Hydroxybutyric Acid↗
[Variations in the dietary regimen in type I diabetes mellitus. I. Short-term use of a high-carbohydrate diet].
For a period of two days, while maintaining compensation of diabetes mellitus type I (treated by insulin pump), the authors replaced the usual diabetic diet by a bland carbohydrate diet (2.6 +/- 0.6 MJ/24 h, practically without amino nitrogen). This resulted in a negative energy and nitrogen balance with an indicated adaptation reaction on the second day of administration--reduced amount of catabolic urinary nitrogen, concentration of non-esterified serum fatty acids suggested a slightly increased lipolysis. The insulin consumption per 24 h was significantly reduced, as compared with the control day. A low energy carbohydrate diet is, when administered for a short period under careful control of compensation of diabetes type I, relatively safe and can be used e. g. during intercurrent digestive diseases.
Adult↗
[Changes in the dietary regimen during treatment of type I diabetes mellitus with continuous insulin infusion. II. Omitting food].
UNLABELLED: The authors investigated in 11 type diabetics the effect of omission of a meal on the compensation of diabetes during treatment with an insulin pump IP 1003. After stabilization of treatment by the pump, the patients were left on the 5th day without breakfast, while the basal operation of the pump was maintained and the patient received their insulin bolus in the morning. The test was terminated as planned after 180 mins. in 6 patients, in 5 it was terminated early because of typical signs of clinical hypoglycaemia. The course of the blood sugar curves revealed differences between patients from abrupt drops of hyperglycaemic values to hypoglycaemia to balanced low blood sugar levels. For the rest of the day till the following morning after the test the blood sugar was elevated, as compared with the control level of the 4th day. CONCLUSIONS: the tests revealed the relatively small drop of the blood sugar level after omission of the meal, hypoglycaemia develops in the majority of diabetics only after 120 to 180 mins. The danger of early hypoglycaemia within 60 minutes was recorded only in patients with a known history of severe hypoglycaemic states. Posthypoglycaemic hyperglycaemia influences the compensation of diabetics during the rest of the day.
Adult↗
[Experience with a computer database in a cytogenetic laboratory].
The paper describes a computer system to support the data management in cytogenetics. Two major objectives are considered: the improvement of the quality and consistency of laboratory data and the support of data management in a large data set for research purposes. The entire system is divided into two logical parts. Firstly, a data collection module reads data from keyboard in an user-friendly way and checks for consistency including syntactic analysis of karyotype description. Secondly, the data are manipulated by a professional database system where three hierarchical data structures are introduced: 1. identification data, 2. investigation data and 3. karyotype description. Since 1984 we collected 1820 patients, 2800 investigations and 2760 karyotypes in the system. Currently, the system is reimplemented on IBM compatible machine using "dBase" database system in order to increase the operational speed and enhance the transportability of the system.
Chromosome Aberrations↗
[Compensation in diabetes and serum insulin levels in type I diabetics during insulin pump therapy and after changing to treatment with a combination of short- and long-acting insulin].
Twenty-one type diabetics previously treated in the conventional way with insulin with unsatisfactory results were admitted to hospital. The blood sugar level, serum insulin and non-esterified fatty acids in serum (NEFA) were assessed from 6 a.m. to 2 a.m. during treatment with an insulin pump and after changing the patients to insulins with varying length of action. Patients in the following groups were followed up separately: a) patients with antibodies against insulin treated either by two (n = 4) or three (n = 12) injections; b) patients with antibodies (n = 16) and without antibodies (n = 5), regardless of the number of insulin injections. Changes from the insulin pump regime implied an increased insulin requirement, (significant only in group b) and deteriorated compensation of diabetes which was more markedly manifested when evaluated by index M according to Schlichkrull with the exception of the group without antibodies, where M remained despite the increase in the range of satisfactory compensation. The NEFA profile behaved in a reversed manner, as compared with the serum insulin level. The results confirm the greater success of insulin pump treatment when attempting to maintain the blood sugar level as close as possible to normal values. From the analysis of the blood sugar and serum insulin profile recommendations for the tactics of treatment are derived, when the use of an insulin pump is not possible.
Adult↗
[A low-energy protein diet and complete fasting in obese patients. Effect on energy metabolism].
The authors investigated 38 obese patients with a BMI above 35. The patients were divided into four groups. The first three groups were on a strict reducing diet, which differed as to the energy values (1.38 MJ to 2.75 MJ) and the amount of protein (5.58 g N to 17.91 g N) per 24 hours. The fourth group fasted. In the course of 16 days metabolic balances were made and the energy output at rest was assessed by indirect calorimetry. In all groups the body weight declined markedly on average by 8.2 to 10.5 kg. The energy consumption at rest declined only during the complete fast. The fasting patients were in a negative nitrogen balance. The nitrogen balance was positive in the patients who were given 11.2 g N and 17.91 g N/24 hours. In all groups the fat utilization increased and the sugar utilization declined. The protein catabolism declined markedly only in the fasting patients. It may be summarized that the low-energy protein diet is, as compared with the fast, a more physiological way to achieve weight reduction, in particular because despite weight reduction a positive nitrogen balance is achieved.
Adult↗
[A consulting system for insulin therapy in diabetes].
The authors describe a computer system which provides consultations on insulin treatment of diabetes. The intentions and aims of computer consultation and means for their implementation are described. The basic element of the system is the model of insulin pharmacodynamics. Two concepts are used to differentiate individual characteristics of the patient: the basal need and insulin sensitivity. The basal need is the amount of insulin which maintains the blood sugar level at the desired level in the course of the day, provided the subject adheres to a standard regime. The insulin sensitivity represents the sensitivity of the glucose metabolism to deviations from the basal requirement. These purely individual parameters are currently adapted by the "learning" module. The module compares the assessed and predicted blood sugar levels and corrects the parameters to achieve a minimum difference. The accuracy of approximation depends on the number of assessed blood sugar levels. The system foresees a minimum of two assessments per day. Individualized parameters are used for the prediction of the blood sugar level. The system visualizes predicted blood sugar levels for manually administered alternative insulin doses. The module of the automatic therapeutic plan is part of the module. The system recommends treatment with an "optimal" development of the predicted blood sugar level. As a criterium of the optimal profile of the blood sugar level the M-value was selected which is used for the evaluation of the daily blood sugar profile. The predictive capacity of the system was evaluated on the basis of retrospective data.(ABSTRACT TRUNCATED AT 250 WORDS)
Diabetes Mellitus↗
[Fructosamine--a dynamic indicator of compensation in diabetes].
The serum fructosamine concentration was evaluated in 22 diabetics on admission to hospital and after intensified treatment with an insulin pump which was indicated on account of decompensation of diabetes. The drop of the mean glucose concentration in blood after 12 days of treatment correlated with the statistically significant drop of the serum fructose concentration (r = 0.69, p less than 0.001). Between the glucose and fructosamine serum concentration no relationship was observed, as long as the mean glucose concentration was calculated for a period shorter than the previous seven days. A highly significant correlation was observed between the rate of fructosamine decline and the mean blood sugar level (r = 0.94, p less than 0.001). From the dynamic changes ensues that when the mean blood sugar level declined by 1 mmol/l, the fructosamine level declined on average by 0.13 mmol/l. The results suggest a more rapid turnover of glycosylated proteins, as compared with data in the literature pertaining to non-glycosylated proteins.
Adult↗
[Analysis of dynamic changes in glycosylated blood proteins using a computer model].
UNLABELLED: The authors elaborated a computer model of albumin glycosylation based on the irreversible glycosylation reaction with first order kinetics. The dynamics of changes of glycosylated albumin in relation to the glycaemic profile was confirmed with an older model of haemoglobin glycosylation. By means of regression analysis parameters of the model in three groups of patients were calculated. CONCLUSION: 1. Stratification of the red cell pool is the reason why there is a smaller clinical difference between glycosylated protein and haemoglobin than corresponds to their half-times. 2. Glycosylated proteins are probably eliminated more rapidly than non-glycosylated ones. 3. Higher levels of glycosylated proteins sometimes do not correspond to model calculations are probably due to other factors.
Computer Simulation↗
Glucose metabolism in a patient with insulinoma complicated by hyperosmolar non-ketotic state.
A case of a patient with organic hyperinsulinism complicated by the development of hyperosmolar state is described. The hyperosmolar state was induced by vomiting and dehydration during an acute urinary tract infection. Impairment of glucose metabolism was confirmed by the finding of reduced tissue sensitivity to insulin during a euglycaemic clamp.
Adenoma, Islet Cell↗
Analysis of glycosylated serum protein changes using a computer model.
UNLABELLED: The authors devised a computer model of albumin glycosylation based on irreversible glycosylation reaction of first-order kinetics. The dynamism of glycosylated albumin changes in relation to glycaemic profiles was compared with an earlier model of haemoglobin glycosylation. A non-linear regression analysis was employed to calculate the parameters of the model in three groups of patients. CONCLUSIONS: 1. Erythrocyte pool stratification accounts for the smaller clinical difference between glycosylated protein and haemoglobin than would correspond to their respective half-life values. 2. Glycosylated proteins are probably eliminated more rapidly than non-glycosylated proteins. 3. Higher levels of glycosylated proteins are occasionally at variance with model calculations, a fact which is probably due to other factors.
Computer Simulation↗
Low-energy protein diet and starvation diet in the obese--effect on energy metabolism.
38 obese patients with BMI in excess of 35 were monitored, the patients were divided into four groups. The first three were on a strict slimming diet which different as to the energy values (1.38 MJ--2.75 MJ) and the amount of protein (5.58 g N--17.91 g N) per 24 hours. The fourth group was on a starvation diet. Metabolic balance values and resting energy cut put were measured by indirect calorimetry during 16 days of monitoring. In all groups the body weight declined markedly by an average of 8.2-10.5 kg. Resting energy consumption dropped only during absolute fasting. The starvation diet patients exhibited a negative nitrogen balance. Positive nitrogen balance was found in groups on 11.2 g N and 17.91 g N/24 hours. Fat utilization increased and sugar utilization declined in all groups. Protein catabolism declined markedly only in the fasting patients. Summed up, the low-energy protein diet is--in comparison with absolute diet--a more physiological way to achieving weight reduction, in particular, because, despite the loss of weight, a positive weight balance is achieved, too.
Adult↗
[The Biostator in the diagnosis and therapy of organic hyperinsulinism].
In 12 patients with the diagnosis of organic hyperinsulinism the authors examined the carbohydrate metabolism on a Biostator, using the method of stabilized glycaemia. They found a highly significantly reduced tissue sensitivity to insulin at the same time a reduced metabolic insulin turnover as compared with healthy subjects (p less than 0.001). Simultaneously they examined the acute action of diazoxide (Proglicem) treatment to which the patients responded in two ways. In one group a decline of the insulin level occurred and the tissue sensitivity to insulin rose, while patients in the second group responded by a rise of serum insulin but there was no response in the insulin sensitivity. In this second group diazoxide treatment obviously does not eliminate hypoglycaemic attacks. Examination on the Biostator thus makes it possible to decide whether conservative treatment is indicated in organic hyperinsulinism.
Adult↗