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Background: Type-1 diabetes mellitus (DM) is a lifelong serious condition which often renders the application of standard treatment options for patients' comorbid conditions, such as bipolar disorder I, risky - especially for acute manic episodes. We present such a case whereby the application of standard anti-manic treatments would have jeopardized a patient whose physical condition was already compromised by DM. Methods: We report the case of a 55-year-old female with a history of type-1 DM since the age of 11, and severe ocular and renal vascular complications thereof. While on the waiting list for pancreatic islet cell transplantation, she developed a manic episode that proved recalcitrant to a treatment with gabapentin, lorazepam and quetiapine. Moreover, her mental state affected adversely her already compromised glycemic control, requiring her psychiatric hospitalization. Her psychotropic medication was almost discontinued and replaced by oxcarbazepine (OXC) up to 1800 mg/day for 10 days. Results: The patient's mental state improved steadily and on discharge, 3 weeks later, she showed an impressive improvement rate of over 70% on the YMRS. Moreover, she remains normothymic 6 months after discharge, with OXC at 1200 mg/day. Conclusion: Standard prescribing guidelines for acute mania recommend a combination of an antipsychotic with lithium or, alternatively, a combination of an antipsychotic with valproate or carbamazepine. However, in our case, administration of lithium was at least relatively contra-indicated because of patient's already compromised renal function. Furthermore, antipsychotics increase glucose levels and thus were also relatively contra-indicated. Moreover, the imminent post-transpantation immunosupressant treatment with immuno-modulating medicines also contra-indicated both valproate and carbamazepine. Despite the severe methodological limitations of case reports in general, the present one suggests that OXC as monotherapy might be both safe and efficacious in the treatment of acute mania in patients with early-onset type-1 DM, whose already compromised physical condition constitutes an absolute or relative contraindication for the administration of standard treatments, though there are no, as yet, randomized clinical trials attesting to its efficacy unambiguously. [ABSTRACT FROM AUTHOR]

Ketone bodies are low chain organic substances with four carbon atoms, with β-hydroxybutyric acid and acetone being the main ketone bodies in blood circulation. Under physiological conditions their levels are low while during conditions of oxidative stress, such as exercise, fasting state and acute illness, ketone body levels are increased. Recent findings have shown that in patients with heart failure their plasma concentration is increased. There is a positive correlation between increased energy metabolism of myocardial cells and the levels of β-hydroxybutyric acid and acetone. Furthermore, it has been hypothesized that the mild ketosis caused by sodium glucose cotransporter 2 inhibitors is one of the possible pathogenetic mechanisms explaining the significant cardiovascular and renal benefits observed in patients with type 2 diabetes treated with these agents. The aim of the present review is to summarize the role of ketone bodies in both normal and pathological conditions, such as heart failure., Competing Interests: The authors declare no conflict of interest., (Copyright: © 2021 Termedia & Banach.)

Aim: The aim of the study was to investigate: a) the differential effect of the three main macronutrients on food intake, fat depots and serum leptin levels and b) the impact of sibutramine on the above parameters in rats fed ad libitum with three isocaloric diets., Methods: Three groups of male Wistar rats (n = 63) were fed with a high fat diet (HFD), a high carbohydrate diet (HCD) or a high protein diet (HPD) for 13 weeks. In the last three weeks, each group was divided into three subgroups and received sibutramine (S) either at 5 mg/kg or 10 mg/kg, or vehicle. Food intake was measured daily during the last week of the experiment; perirenal and epididymal fat and fat/lean ratio were calculated and serum leptin was assayed., Results: HFD-fed rats demonstrated elevated food intake and higher regional fat depots. S at 10 mg/kg decreased food intake in the HFD and epididymal fat in the HCD group. S also reduced perirenal fat in the HCD and HPD groups. Leptin levels were higher in rats fed with either the HFD or the HPD compared to those fed with the HCD. Moreover, S at 10 mg/kg decreased serum leptin levels in the HPD group., Conclusions: Results suggest a preferential effect of S on perirenal visceral fat and support the view that body fat loss is greater when its administration is accompanied by a HCD diet. No effect of S on leptin levels was found, besides that expected as a result of the decrease in body fat.

Introduction: The QT interval on the resting electrocardiogram (ECG) expresses the myocardial depolarisation and repolarisation time. Elevated values of QT dispersion (QTd) are associated with cardiovascular mortality in diabetics. Cardiac autonomic neuropathy (CAN) is a common complication of diabetes that is also associated with increased morbidity and mortality. However, there are no data in the literature concerning the relation between CAN and QTd in diabetics. The aim of this study was to investigate: 1) the differences in QTd between diabetics and non-diabetics; 2) the differences in QTd between those with type 1 and type 2 diabetes; 3) the relation between QTd and CAN., Methods: The study population included 184 diabetics (63 type 1, group D1; 121 type 2, group D2) and 100 healthy controls who had similar age and sex distribution to D1 (n=44) and D2 (n=56) subjects. CAN assessment was made using the standard Ewing and Clarke tests. The QT interval was measured on the 12-lead resting ECG. QTd was calculated automatically using special software., Results: QTd values did not differ significantly between controls and D1 (p=0.15) or D2 (p=0.27). QTd was significantly greater in D2 than in D1 (p=0.02). There was no significant difference in QTd between those with and without CAN in either group of diabetics., Conclusions: QTd values do not differ between individuals with and without diabetes. Type 2 diabetes is associated with higher QTd values than is type 1 diabetes. CAN does not affect QTd in diabetics.

The development of obesity is caused by a disturbance of energy balance, with energy intake exceeding energy expenditure. As the autonomic nervous system (ANS) has a role in the regulation of both these variables, it has become a major focus of investigation in the fields of obesity pathogenesis. The enhanced cardiac sympathetic drive shown in most of the studies in obese persons might be due to an increase in their levels of circulating insulin. The role of leptin needs further investigation with studies in humans. There is a blunted response of the cardiac sympathetic nervous system (SNS) activity in obese subjects after consumption of a carbohydrate-rich meal as well as after insulin administration. This might be due to insulin resistance. It is speculated that increased SNS activity in obesity may contribute to the development of hypertension in genetically susceptible individuals. It is also speculated that the increase in cardiac SNS activity under fasting conditions in obesity may be associated with high cardiovascular morbidity and mortality.

Background/aims: Based on former studies in experimental animals on the effect of octreotide on serum and ascitic levels of tumor necrosis factor-alpha and interleukin-6 in the field of necrotizing pancreatitis, the present study was designed to investigate the effect of octreotide on serum interleukin-6 of patients with acute edematous pancreatitis., Methodology: A total of 36 patients with acute edematous pancreatitis and initiation of symptoms 12 hours before their admission were enrolled in the study; 20 were treated with octreotide 200 microg tid and 16 with octreotide 500 microg tid for five days. Blood was sampled at regular time intervals. Interleukin-6 was determined by an enzyme-immunoassay and C-reactive protein by nephelometry., Results: Mean concentrations of interleukin-6 of patients treated with octreotide 200 microg tid were 59.52 pg/mL before and 94.08, 46.25, 49.94, 58.16 and 26.08 pg/mL at 3, 6, 24, 48 and 72 hours after the start of therapy respectively. Respective values of patients treated with octreotide 500 microg tid were 57.19, 53.07, 57.83, 36.06, 54.29 and 65.49 pg/mL. Mean C-reactive protein of patients treated with octreotide 200 microg tid were 67.37 mg/L before and 48.51, 106.08 and 95.58 mg/L at 24, 48 and 72 hours after the start of therapy respectively. Respective values of patients treated with octreotide 500 microg tid were 65.51, 60.56, 90.68 and 64.22 mg/L., Conclusions: A transient, but not statistically significant, decrease of serum interleukin-6 levels was documented after administration of octreotide in the field of acute edematous pancreatitis. That decrease was earlier after the application of the 500 microg tid dose than the 200 microg tid dose. Studies with a greater number of patients are mandatory to fully clarify the effect of octreotide, if any, on acute pancreatitis.

Background/aims: Acute pancreatitis may be accompanied by alterations of the secretion of pancreatic and gastrointestinal peptides as a result of pancreatic inflammation. These changes, that may constitute targets of therapeutic manipulation, led to the study of the serum levels of various pancreatic and gastrointestinal peptides over the course of acute pancreatitis before and after the administration of octreotide and ranitidine., Methodology: Concentrations of gastrin, glucagon, vasoactive intestinal peptide, neurotensin and pancreatic polypeptide were determined by radioimmunoassay in the plasma of 22 patients with acute pancreatitis on the first, sixth and 11th day of the disease. All patients were treated with octreotide s.c. while 14 of them were also administered ranitidine i.v. Treatment was initiated after taking the first blood sample., Results: Mean gastrin levels in patients receiving ranitidine was 56.76 ng/L and in patients not receiving ranitidine 47.16 ng/L on the first day (pNS) remaining stable throughout the course of acute pancreatitis. Mean glucagon, vasoactive intestinal peptide, neurotensin and pancreatic polypeptide levels on the first day were 52.05 pmol/L, 8.90 pmol/L, 9.80 pmol/L and 22.06 pmol/L, respectively, and no changes were found through the course of acute pancreatitis., Conclusions: Plasma levels of gastrointestinal peptides remain constant over time and they are not significantly affected by the administration of octreotide or ranitidine. However more studies are necessary to document the significance of these findings.