scholarly journals The method of loci as a mnemonic device to facilitate learning in endocrinology leads to improvement in student performance as measured by assessments

2014 ◽  
Vol 38 (2) ◽  
pp. 140-144 ◽  
Author(s):  
Ayisha Qureshi ◽  
Farwa Rizvi ◽  
Anjum Syed ◽  
Aqueel Shahid ◽  
Hana Manzoor

Cognitive psychology has demonstrated that the way knowledge is structured in memory determines the ability to retain, recall, and use it to solve problems. The method of loci (MOL) is a mnemonic device that relies on spatial relationships between “loci” (e.g., locations on a familiar route or rooms in a familiar building) to arrange and recollect memorial content. In the present study, we hypothesized that the use of MOL leads to better understanding of the topic among students, which can be observed through better student performance on assessments. Students were divided into two groups: group 1 was taught insulin and diabetes mellitus through didactic lectures and a self-directed learning session, whereas group 2 was taught insulin and diabetes mellitus through didactic lectures and MOL. Memory palaces for insulin and diabetes mellitus were generated by students under supervision of the teacher and taught by students as well. A questionnaire survey and open-ended questions were given to the participants. Group 2, which underwent didactic lectures followed by a MOL interactive session, showed significantly improved performance on the assessments compared with group 1, which had been taught through didactic lectures and a self-directed learning session. Descriptive analysis showed that all students found MOL to be a helpful technique.

2017 ◽  
Vol 4 (1) ◽  
pp. 1
Author(s):  
Tan Yin Peen ◽  
Mohammad Yusof Arshad

Problem-based learning (PBL) provides students with the opportunity to conduct self-directed learning in collaborative groups, which are essential skills to meet challenges in the 21st century. This study aims to investigate the occurrence and types of collaborative and self-directed processes during problem analysis phase utilizing the FILA-MMS chart in Malaysia secondary school. Two out of five groups of students taught by a teacher in one PBL chemistry lesson was observed, audio-recorded and the verbatim were analyzed. The findings show that collaborative process and self-directed process occur in both groups. Collaborative processes occur by 79.1% and 78.9% in group 1 and group 2 respectively. Major collaborative processes observed in both groups are „question and answer‟, „co-construction‟ and „sharing of ideas or information‟. Self-directed processes occur by 18.3% and 12.9%. The main self-directed processes observed are „monitoring‟ and „directing‟. This study shows that there is a lack of self- directed learning skills among students, such as planning, reflection, evaluation of understanding, and managing information and resources. To enhance these skills among students, future PBL teachers are suggested to emphasize and model planning, reflection and evaluation processes in their lessons.


Author(s):  
М.А. Быковская ◽  
А.А. Раскуражев ◽  
А.А. Шабалина ◽  
К.В. Антонова ◽  
М.М. Танашян

Введение. Сосудистые осложнения сахарного диабета (СД) являются одной из ведущих причин повышения смертности пациентов трудоспособного возраста. Предполагается, что индуцированный гипергликемией окислительный стресс и нарушение антиоксидантной защиты играют роль в патологическом механизме повреждения сосудов, частично за счет влияния оксида азота (NО). Цель исследования: уточнение взаимосвязей в системах асимметричного диметиларгинина (АДМА) и NO у пациентов с цереброваскулярными заболеваниями (ЦВЗ) на фоне СД 2-го типа (СД-2). Материалы и методы. Обследованы 72 пациента с ЦВЗ со стенозирующим поражением внутренней сонной артерии вне острого периода: группу 1 составили 39 пациентов (18 мужчин и 21 женщина) с СД-2 в возрасте 65 [58; 72] лет; в группу 2 вошли 33 больных (15 мужчин и 18 женщин) без СД-2 в возрасте 66 [56; 74] лет. Контрольную группу составили 30 добровольцев (16 мужчин и 14 женщин) без проявлений церебральной ишемии и нарушений углеводного обмена, с нормальными значениями индекса массы тела, некурящие, в возрасте 62 [50; 66] лет. Проводилось клиническое обследование, нейро- и ангиовизуализационное исследование, спектр биохимических исследований крови, в том числе определение содержания АДМА и показателей системы NO. Результаты. В группе 1 содержание нитрата, нитрита и NO составило 62,1 [56; 68] мкмоль/л, 48,5 [26; 52] мкмоль/л и 13,6 [9; 23] мкмоль/л соответственно, что достоверно отличалось от значений этих показателей в группе 2 — 58,3 [45; 64] мкмоль/л, 39,6 [26,0; 42,3] мкмоль/л и 18,7 [16,1; 24,7] мкмоль/л соответственно. Отмечен также более высокий уровень AДМА в крови у пациентов с ЦВЗ в сочетании с СД-2 — 0,42 [0,21; 0,53] ммоль/л. Заключение. Обнаружена взаимосвязь между уровнями AДМА и NO при ЦВЗ на фоне СД-2. Это требует продолжения исследований биомаркеров повреждения сосудистой стенки для определения их места в патогенезе ишемических церебральных осложнений СД-2. Background. Vascular complications of diabetes mellitus (DM) are one of the leading causes of increased mortality in patients of employable age. Hyperglycemia-induced oxidative stress and impaired antioxidant protection have been suggested to play a role in the pathological mechanism of vascular damage, in part due to the effects of nitric oxide (NO). Objectives: clarification of relationships in the systems of asymmetric dimethylarginine (ADMA) and NO in patients with cerebrovascular diseases (CVD) and type 2 diabetes (DM-2). Patients/Methods. We examined 72 CVD patients with stenosing lesions of the internal carotid artery outside the acute period: group 1 consisted of 39 patients (18 men and 21 women; 65 [58; 72] years old) with DM-2; group 2 consisted of 33 patients (15 men and 18 women; 66 [56; 74] years old) without DM-2. The control group consisted of 30 volunteers (16 men and 14 women; 62 [50; 66] years old) without manifestations of cerebral ischemia and carbohydrate metabolism disorders, with normal body mass index, non-smokers. A clinical examination, neuro- and angio-imaging study, a spectrum of biochemical blood tests, including the concentration of asymmetric dimethylarginine (ADMA) and indicators of NO system were carried out. Results. In group 1, the content of nitrate, nitrite and NO was 62.1 [56; 68] μmol/l, 48.5 [26; 52] μmol/l and 13.6 [9; 23] μmol/l, respectively, that significantly differed from the content of these parameters in group 2 — 58.3 [45; 64] μmol/l, 39.6 [26.0; 42.3] μmol/l and 18.7 [16.1; 24.7] μmol/l, respectively. Noted also a higher blood level of ADMA in patients with CVD combined with DM-2 — 0.42 [0.21; 0.53] mmol/l. Conclusions. A relationship was found between ADMA and NO levels in CVD patients with DM-2. This requires further studies of biomarkers of vascular wall damage to determine their place in the pathogenesis of ischemic cerebral complications of DM-2.


2019 ◽  
Vol 6 (3) ◽  
pp. 132-136
Author(s):  
O. Bilovol ◽  
V. Nemtsova ◽  
I. Ilchenko ◽  
V. Zlatkina

Abstract. INFLUENCE OF HORMONAL DISORDERS ON ENDOTHELIAL DYSFUNCTION IN PATIENTS WITH ARTERIAL HYPERTENSION AND COMORBIDE ENDOCRINOPATHIES Bilovol O.M., Nemtsova V.D., Ilchenko I.A., Zlatkina V.V. Purpose: to investigate the effect of hormonal changes on endothelial dysfunction (ED) in patients with a comorbid course of hypertension (H), type 2 diabetes mellitus (T2DM) and subclinical hypothyroidism (SHT). Methods: 183 patients with  H stage II were divided into 3 groups: Group 1 (n=50) - with isolated H (comparison group); Group 2 (n=63) - with a combined course of H and T2DM; Group 3 (n=70) - with comorbidity of H, T2DM and SHT. Blood pressure levels, carbohydrate, lipid and thyroid metabolism, plasma insulin concentration, insulin resistance (IR) the HOMA-IR index, vascular endothelial growth factor (VEGF-A) plasma levels were investigated. Results: Dyslipidemia was more pronounced in group 2 than in group 1. The addition of SHT was accompanied by a tendency to increase all the atherogenic lipids. IR was observed in all patients groups and was significantly higher than in control group (p<0.05). Significant increase of VEGF-A levels in all patients groups in comparison with the control (p<0.05) was found. In group 2 VEGF-A was lower than in group 1, which is probably due to the protective effect of metformin. Analysis  of the influence of thyroid dysfunction degree on ED revealed significant increase of VEGF-A levels in TSH>6.0 μMU/ml subgroup (352.55±17.64 pg/ml vs 461.74±20.13 pg/ml (p<0.05)). Conclusion: Hormonal disorders contribute to aggravation of endothelial dysfunction in patients with hypertension and comorbid endocrinopathies - type 2 diabetes mellitus and subclinical hypothyroidism. Even minor decrease in thyroid function lead to the progression of endothelial dysfunction. Key words: hypertension, type 2 diabetes mellitus, subclinical hypothyroidism, endothelial dysfunction   Резюме. ВПЛИВ ГОРМОНАЛЬНИХ ПОРУШЕНЬ НА ЕНДОТЕЛІАЛЬНУ ДИСФУНКЦІЮ УПАЦІЄНТІВ З АРТЕРІАЛЬНОЮ ГІПЕРТЕНЗІЄЮ ТА КОМОРБІДНИМИ ЕНДОКРИНОПАТІЯМИ Біловол О.М., Немцова В.Д., Ільченко І.А., Златкіна В.В. Мета: дослідити вплив гормональних змін на ендотеліальну дисфункцію (ЕД) у пацієнтів з коморбідним перебігом артеріальної гіпертензії (АГ), цукрового діабету 2 типу (ЦД2Т) тасубклінічного гіпотиреозу (СГТ). Матеріали та методи: 183 пацієнта з АГ II стадії були розділені на 3 групи: 1-а група (n=50) - з ізольованою АГ (група порівняння); Група 2 (n=63) - з поєднаним перебігом АГ та ЦД2Т; Група 3 (n 70) – з комбінованим перебігом АГ, ЦД2Т і СГТ. Вивчали рівні артеріального тиску, показники вуглеводного, ліпідного і тиреоїдного обміну, концентрацію інсуліну в плазмі, індекс інсулінорезистентності (ІР) - HOMA-IR, рівні васкулоендотеліального фактора росту (VEGF-A) в плазмі. Результати. Ступінь дисліпідемії у 2-й групі була більш вираженою, ніж в 1-й. Приєднання СГТ супроводжувалося тенденцією до збільшення всіх атерогенних фракцій ліпідів. ІР спостерігалася у всіх групах пацієнтів і була достовірно більше, ніж у контрольній групі (р<0,05). Виявлено достовірне підвищення рівнів VEGF-A у всіх групах пацієнтів в порівнянні з контролем (р<0,05). В 2-й групі рівні VEGF-A були нижче, ніж в 1-й групі, що, ймовірно, пов'язано з протективним ефектом метформіну. Аналіз впливу ступеня гіпофункції щитовидної залози на ЕД виявив значне збільшення рівнів VEGF-A в підгрупі TSH> 6,0 мкМ / мл (352,55 ± 17,64 пг / мл і 461,74 ± 20,13 пг / мл відповідно, р <0,05). Висновки. Гормональні порушення сприяють погіршенню ендотеліальної дисфункції у пацієнтів з артеріальною гіпертензією та супутніми ендокринопатіями - цукровим діабетом 2 типу та субклінічним гіпотиреозом. Навіть незначне зниження функції щитовидної залози призводить до прогресування ендотеліальної дисфункції. Ключові слова:  гіпертензія, цукровий діабет 2 тип, субклінічний гіпотиреоз, ендотеліальна дисфункція    Резюме. ВЛИЯНИЕ ГОРМОНАЛЬНЫХ НАРУШЕНИЙ НА ЭНДОТЕЛИАЛЬНУЮ ДИСФУНКЦИЮ У ПАЦИЕНТОВ С АРТЕРИАЛЬНОЙ ГИПЕРТЕНЗИЕЙ И КОМОРБИДНЫМИ ЭНДОКРИНОПАТИЯМИ Беловол О.М., Немцова В.Д., Ильченко И.А., Златкина В.В. Цель: исследовать влияние гормональных изменений на эндотелиальную дисфункцию (ЭД) у пациентов с коморбидным течением артериальной гипертензии (АГ), сахарного диабета 2 типа (СД2Т) и субклинического гипотиреоза (СГТ). Материалы и методы: 183 пациента с АГ IIстадии были разделены на 3 группы: 1-я группа (n = 50) - с изолированной АГ (группа сравнения); Группа 2 (n = 63) - с сочетанным течением АГ и СД2Т; Группа 3 (n = 70) - комбинированное течение АГ, СД2Т и СГТ. Изучали уровни артериального давления,  показатели  углеводного, липидного и тиреоидного обмена, концентрацию инсулина в плазме, индекс инсулинорезистентности (ИР)- HOMA-IR, уровни васкулоэндотелиального фактора роста(VEGF-A) в плазме. Результаты. Степень дислипидемии во 2-й группе была более выраженной, чем в 1-й.  Присоединение СГТ сопровождалось тенденцией к увеличению всех атерогенных фракций липидов. ИР наблюдалась во всех группах пациентов и была достоверно больше, чем в контрольной группе (р<0,05). Выявлено достоверное повышение уровней VEGF-A во всех группах пациентов по сравнению с контролем (р <0,05). Во 2-й группе уровни VEGF-A были ниже, чем в 1-й группе, что, вероятно, связано с протективным эффектом метформина. Анализ влияния степени дисфункции щитовидной железы на ЭД выявил значительное увеличение уровней VEGF-A в подгруппе TSH> 6,0 мкМ/мл (352,55 ± 17,64 пг / мл и 461,74 ± 20,13 пг / мл соответственно, р<0,05). Заключение. Гормональные нарушения способствуют ухудшению эндотелиальной дисфункции у пациентов с артериальной гипертензией и сопутствующими эндокринопатиями - сахарным диабетом 2 типа и субклиническим гипотиреозом. Даже незначительное снижение функции щитовидной железы приводит к прогрессированию эндотелиальной дисфункции. Ключевые слова: гипертензия, сахарный диабет 2 тип, субклинический гипотиреоз, эндотелиальная дисфункция     


Author(s):  
Donna Marie Velliaris

As part of an intervention and support strategy, this chapter discusses the evidence-based merits of a tertiary skills development (TSD) course delivered at the Eynesbury Institute of Business and Technology (EIBT) to “students at risk” (STAR). The effectiveness of the TSD course was measured via quantitative means by comparing students' academic performance before, during, and after TSD intervention. It was found that student performance analysed over three consecutive trimesters underwent a significant improvement when the support strategy was provided, followed by a small downturn in performance when the support was removed and students were again relying solely on their independent study skills and self-directed learning.


2020 ◽  
Vol 9 (6) ◽  
pp. 1899 ◽  
Author(s):  
Robert Schönbauer ◽  
Michael Lichtenauer ◽  
Vera Paar ◽  
Michael Emich ◽  
Monika Fritzer-Szekeres ◽  
...  

Background: Low levels of soluble tumor necrosis factor-like weak inducer of apoptosis (sTWEAK) were reported in patients with coronary artery disease, heart failure, chronic kidney disease and diabetes mellitus. Soluble cluster differentiation 163 (sCD163) serum levels are related to M2 macrophages, having anti-inflammatory attributes. As sport is well-known for its anti-inflammatory and cardioprotective effects we aimed to investigate the influence of eight months of physical activity on serum sCD163 and sTWEAK levels. Methods: In total, 109 subjects with at least one cardiovascular risk factor were asked to perform endurance training within the calculated training pulse for eight months. Overall, 98 finished the study. The performance gain was measured/quantified by bicycle stress tests at the beginning and end of the observation period. The cohort was divided into four groups, dependent on their baseline performance and performance gain. sCD163 and sTWEAK were measured at baseline and after two, six and eight months by ELISA. Results: Those participants who had a performance gain of ≤2.9% (mean gain 12%) within eight months showed a significant increase in sTWEAK (group 2: from 133 to 200 pg/mL, p = 0.002 and group 4: from 166 to 212 pg/mL, p = 0.031) and sCD163 levels (group 2: from 255 to 348 ng/mL, p = 0.035 and group 4: from 247 to 288 ng/mL, p = 0.025) in contrast to subjects without performance gain (sTWEAK: group 1: from 161 to 177 pg/mL, p = 0.953 and group 3: from 153 to 176 pg/mL, p = 0.744; sCD163: group 1: from 289 to 256 ng/mL, p = 0.374 and group 4: from 291 to 271 ng/mL, p = 0.913). Baseline sCD163 correlated with erythrocyte count, hematocrit, ASAT and lipoprotein a, the presence of hypertension and a BMI > 30 kg/m2. Conclusion: Regular physical activity leads to a significant increase in sCD163 and sTWEAK levels of up to 37% and 50%, respectively. It is well-known that physical activity prevents or retards the onset and genesis of chronic inflammatory disease. One possible way of how training evolves its beneficial effect might be by modifying the inflammation status using the sTWEAK–sCD163 axis. Brief Summary: Regular physical activity leads to a significant increase in sTWEAK and sCD163 levels. Both factors are diminished in patients with chronic (inflammation-based) diseases, such as coronary artery disease, heart failure, pulmonary artery hypertension, chronic kidney disease and diabetes mellitus. It seems that the amounts of soluble TWEAK and CD163 are essential for a healthy balance and modulation between pro- and anti-inflammatory processes, and regular physical training could use the sCD163–sTWEAK axis to unfold its beneficial effect.


2016 ◽  
Vol 15 (1) ◽  
pp. 84-89 ◽  
Author(s):  
Ishtpreet Mann ◽  
Manisha Khubber ◽  
Ashwani K Gupta ◽  
Prithpal Singh Matreja ◽  
Harbir K Rao

Background: Diabetes mellitus and hypertension are chronic disorders, inadequate management of these two disorders leads to several complications and end organ damage that can impair health related quality of life (HRQoL) in these individuals. Several studies in hypertensive patients concluded that hypertension reduced HRQoL and participants with diabetes also reported comparably decreased HRQoL. The data on HRQoL in patients suffering from both hypertension and diabetes is limited hence we designed this study to assess health related quality of life in patients suffering from hypertension and diabetes mellitus.Methodology: This single centre, cross-sectional study was conducted for 2 months between April and August 2013 in patients with hypertension and diabetes mellitus. Patients suffering from hypertension were recruited in study and were divided into two groups, Group 1 consisted of patient suffering from hypertension and diabetes mellitus whereas Group 2 consisted of patients suffering from hypertension. Patients were assessed on Short form health Survey (SF-36) and the WHOQOL – Bref scores. Results: A total of 85 patients were screened out of which 41 patients were enrolled in the study, 21 patients in Group 1 and 20 patients in group 2. The SF-36 Scores showed significantly (p<0.05) worse pain scores in patients in Group 2. Patients in Group 1 had a better quality of life as compared to other group as evident by higher scores in most of the parameters of SF-36 and WHO-QOL Bref Score, though it was not statistically significant. Conclusion: Both groups had compromised quality of life; patients with hypertension and diabetes had a better quality of life.Bangladesh Journal of Medical Science Vol.15(1) 2016 p.84-89


2020 ◽  
Vol 26 (10) ◽  
pp. 1125-1130
Author(s):  
Khawla F. Ali ◽  
Alexandra Mikhael ◽  
Christine Zayouna ◽  
Omar A. Barakat ◽  
James Bena ◽  
...  

Objective: Medical tourism, a form of patient mobility across international borders to seek medical services, has gained significant momentum. We aimed to assess the outcomes of medical tourism consultations on chronic diseases, more specifically diabetes mellitus, amongst a cohort of international patients, originating from different healthcare systems, and referred to the United States for medical care. Methods: We identified international adults with established diabetes mellitus, referred globally from 6 countries to the United States between 2010 and 2016 for medical care, and were seen at the Cleveland Clinic Foundation (CCF). Group 1 included adults seen by an endocrinology provider during their CCF medical stay, whilst group 2 included those not seen by an endocrinology provider. To assess the impact of our consultations, changes in hemoglobin A1c (HbA1c) were assessed between visit(s). Results: Our study included 1,108 subjects (771 in group 1, 337 in group 2), with a mean age (± SD) of 61.3 ± 12.7 years, 62% male, and a median medical stay of 136 days (interquartile range: 57, 660). Compared to group 2, group 1 had a higher baseline mean HbA1c (8.0 ± 1.8% [63.9 mmol/mol] vs. 7.1 ± 1.4% [54.1 mmol/mol]; P<.001). After 1 visit with endocrinology, there was a significant decrease in mean HbA1c from 8.44 ± 1.98% (68.3 mmol/mol) to 7.51 ± 1.57% (58.5 mmol/mol) ( P<.001). Greatest reductions in mean HbA1c were −1.47% (95% CI: −2.21, −0.74) and −1.27% (95% CI: −1.89, −0.66) after 3 and 4 visits, respectively ( P<.001). Conclusion: Short-term diabetes mellitus consultations, in the context of medical tourism, are effective. Abbreviations: CCF = Cleveland Clinic Foundation; GCC = Gulf Cooperation Council; HbA1c = hemoglobin A1c; IQR = interquartile range; U.S. = United States


2019 ◽  
Vol 9 (1) ◽  
Author(s):  
Juliana de Fatima Pedroso ◽  
Zahra Lotfollahi ◽  
Ghadeer Albattarni ◽  
Maiara Arrruda Schulz ◽  
Andrea Monteiro ◽  
...  

Abstract The objective of the present study was to establish if individuals with Diabetes Mellitus (DM2) and periodontal diseases (gingivitis or periodontitis) presented an increase in the concentration of modified LDL (moLDL) and what is the influence of periodontal treatment on the decrease of moLDL particles with consequent improvement in the parameters of DM2. Twenty-four diabetic patients with periodontitis (Group 1) and twenty-four diabetic patients with gingivitis (Group 2) were followed up for a period of 12 months. Group 1 was treated with periodontal debridement, and Group 2 received supra-gingival scaling and prophylaxis. In both groups, periodontal clinical parameters: probing depth (PD), clinical attachment level (CAL), gingival resection (GR), bleeding on probing index (BOP) and plaque index; inflammatory serum markers (glycemia, A1c, total cholesterol, HDL-cholesterol (HDL-c), LDL-cholesterol (LDL-c), triglycerides and hs-CRP) and oxidized LDL (oxLDL) were measured at baseline, t = 6 and t = 12 months after treatment. Solutions of LDL were analyzed using the nonlinear optical Z-Scan and optical absorption techniques. The periodontal clinical parameters showed significant improvement (p < 0.05) in both Group after 12 months. For both groups, total cholesterol, HDL-c, LDL-c, triglycerides and A1c levels did not show significant reductions after periodontal therapy. hs-CRP levels in Group 1 presented a significant reduction after 12 months. The glycemic rate and the oxLDL concentrations did not show significant differences as a function of time. The optical measurements of LDL solutions revealed an improvement of the LDL-c quality in both groups. Periodontal debridement was able to improve periodontal parameters and the quality of LDL-c in diabetic patients but without changes in the oxLDL concentration in both groups. Considering the clinical relevance, the reduction of infectious and inflammatory sites present in the oral cavity through periodontal therapy may help with the control and prevention of hyperglycemia and precursors of cardiovascular diseases.


2017 ◽  
Vol 2017 ◽  
pp. 1-11 ◽  
Author(s):  
Rong Zhang ◽  
Keran Cheng ◽  
Shizan Xu ◽  
Sainan Li ◽  
Yuqing Zhou ◽  
...  

Objective. The present study was conducted to compare the efficacy of metformin combined with diammonium glycyrrhizinate enteric-coated capsule (DGEC) versus metformin alone versus DGEC alone for the treatment of nonalcoholic fatty liver disease (NAFLD) in patients with type 2 diabetes mellitus (T2DM). Subjects and Methods. 163 patients with NAFLD and T2DM were enrolled in this 24-week study and were randomized to one of three groups: group 1 was treated with metformin alone; group 2 was treated with DGEC alone; group 3 received metformin plus DGEC combination therapy. Anthropometric parameters, liver function, lipid profile, serum ferritin (SF), metabolic parameters, liver/spleen computed tomography (CT) ratio, and fibroscan value were evaluated at baseline and after 8, 16, and 24 weeks of treatment. Results. After 24 weeks, significant improvements in all measured parameters were observed in three groups (P<0.05) except for the improvements in low density lipoprotein cholesterol (LDL-C) and metabolic parameters in group 2 which did not reach statistical significance (P>0.05). Compared with group 1 and group 2, the patients in group 3 had greater reductions in observed parameters apart from CB and TB (P<0.05). Conclusions. This study showed that metformin plus DGEC was more effective than metformin alone or DGEC alone in reducing liver enzymes, lipid levels, and metabolic parameters and ameliorating the degree of hepatic fibrosis in patients with NAFLD and T2DM.


2018 ◽  
Vol 7 (3) ◽  
pp. 24-32
Author(s):  
E. A. Archakov ◽  
R. E. Batalov ◽  
S. Yu. Usenkov ◽  
M. S. Khlynin ◽  
A. V. Smorgon ◽  
...  

Aim. To estimate the efficacy of catheter ablation in patients with type 2 diabetes mellitus (T2D) present with atrial fibrillation and sick sinus syndrome (SSS) undergoing permanent pacemaker implantation.Methods. 56 patients (34 females) with persistent AF and SSS were enrolled in the study. The mean age of patients was 67.7±10.7 years. Dual chamber cardiac pacemaker with remote monitoring function were implanted in all patients. All the patients were assigned to two groups: Group 1 comprised 31 patients aged 67.3±9.6 years, and Group 2 comprised 25 patients aged 72.6±9.9 years, including 22 (39.2%) diabetic patients. 2-3 days after pacemaker implantation, group 1 patients underwent intracardiac electrophysiology study and RFA of the pulmonary vein ostia, mitral isthmus and the left atrial posterior wall. Group 2 patients received antiarrhythmic drug therapy. Results. 3 patients (9%) in Group 1 had recurrent AF within the 6-month follow-up. The efficacy of the RFA for AF was 55% (n = 17) 1 year after the indexed hospitalization. 8 patients had short paroxysmal attacks which gradually lessened and stopped after. 5 patients (21%) in Group 2 did not have any AF paroxysms within the 1-year follow-up (Х2 = 5.52, р = 0.02). All these patients received amiodarone as antiarrhythmic drug therapy, whereas the others had paroxysmal attacks. Frequent attacks in 10 patients (40%) led to a change in antiarrhythmic drug use. Hospital readmission rates for AF were 16% and 52%, respectively (Х2 = 4.15, р = 0.04). The impact of atrial and ventricular stimulation on the development of recurrent AF was statistically insignificant (atrial stimulation – X2 = 0.01, cc = 1, p = 0.90; ventricular stimulation – X2 = 0.15, cc = 1, p = 0.69). None paroxysmal attacks were recorded in 10 diabetic patients (45%) after the RFA within the 1-year follow-up.Conclusion. Catheter ablation for persistent AF and SSS treated with permanent pacemakers is highly effective and safe method. In addition, it is superior to pharmacological approach. The presence of T2D likely did not significantly affect the efficacy of RFA for persistent form of AF. 


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