Treatment of high blood pressure in diabetic patients and risk of undernutrition in a population in extreme Western Algeria

Introduction: Assessing the risk of undernutrition in hypertensive diabetics is essential. It makes it possible to detect undernutrition for better care. The objective of our study is to describe the factors influencing this undernutrition. Methods: A descriptive study was conducted on a sample of 366 diabetics with hypertension and 326 with normo-glycemic hypertension aged 50 years and over. Patients were enrolled at the University Hospital in Tlemcen from January to June 2018. The data collection was carried out using a questionnaire: The MNA (The Mini Nutritional Assessment). Results: The study made it possible to establish the profile of subjects at high risk of undernutrition. In our sample, age was not correlated with risk of malnutrition in diabetic hypertensives and normo-glycemic hypertensives respectively (p = 0.304 and p = 0.444). The linear regression model uses gender as an age-independent factor that affects the risk of undernutrition (p = 0.001). BMI was one of the most relevant variables for predicting the occurrence of undernutrition (p = 0.000). Thus, diabetic hypertensive patients in our study who were treated with an Angiotensin II receptor blockers , an angiotensin converting enzyme inhibition or an ARB/diuretic combination were more at risk of undernutrition (p = 0.009, p = 0.026 and p = 0.013). Conclusion: Particular attention should be paid to diabetic hypertensive subject. The treatment of hypertension in diabetics aggravates this malnutrition. Thus, a nutritional status assessment should be established in any diabetic hypertensive patient allowing appropriate therapeutic management to avoid all complications associated with undernutrition.

PRONIOSOMAL GEL MEDIATED TRANSDERMAL DELIVERY OF GLIBENCLAMIDE AND ATENOLOL COMBINATION: EXVIVO AND PHARMACODYNAMIC STUDIES

Objective: The objective of the present work was to develop an optimized dosage form for treating comorbidity in combination and evaluate it for its pharmacodynamic performance in male Wistar albino rats. Methods: Transdermal proniosomal gel for Combination of Glibenclamide (GLB) and Atenolol (ATN) was developed and optimized by Box Behnken design. This optimized combinational proniosomal gel (OCPG), which was selected by a point prediction method, was evaluated for its ex vivo, skin irritation studies and pharmacodynamic activities of both drugs in rats in comparison with its oral therapy. Results: The ex-vivo permeation behavior through different skins was studied and the findings were also confirmed by the values of the steady-state flux (Jss). The OCPG observed an increase of more than twice in the cumulative amount of impregnated drugs compared to pure drug films. The study on skin irritation revealed the non-irritability of the developed OCPG applied. OCPG significantly showed sustained hypoglycemic activity in rats (p<0.001), when compared to orally treat animals up to 24 h. Systolic blood pressure (SBP) lowering effect of OCPG was found to be significant (p<0.02), when compared to orally treat rats up to 24 h. However, the reduction was slow and sustained in the case of OPCG where a significant response was observed in the performed studies. Conclusion: Overall, the results show that controlled release GLB and ATN proniosomes offer a useful and promising transdermal delivery system. Henceforth this may be an achievement in treating the diabetic hypertensive patient.

A tale of an unfortunate outcome in COVID-era

Autosomal dominant polycystic kidney disease (ADPKD) primarily affects the kidneys; cysts can develop in other organs like liver and pancreas and sometimes complicated with formation of arterial aneurysms, brain being the commonest site. Aortic aneurysms can lead to thromboembolic events. Thromboembolism is also a recognized complication of coronavirus disease 2019 (COVID-19). Here, we present case history of an elderly diabetic, hypertensive patient with bilateral renal stones, who presented with gangrene of the left 5th toe and raised serum creatinine. He was later diagnosed as a case of COVID-19, ADPKD with aortic aneurysm, which was complicated with intraluminal thrombus formation and unfortunately, he died in course of treatment. Birdem Med J 2020; 10, COVID Supplement: 115-119