Pharmacogenetic-guided psychiatric intervention associated with increased adherence and cost savings.

Objectives: Pharmacogenetic testing as a means of guiding treatment decisions is beginning to see wider clinical use in psychiatry. The utility of this genetic information as it pertains to clinical decision making, treatment effectiveness, cost savings, and patient perception has not been fully characterized.

Study Design: In this retrospective study, we examined health claims data in order to assess medication adherence rates and healthcare costs for psychiatric patients.

A single naive CD8+ T cell precursor can develop into diverse effector and memory subsets.

Upon first antigen encounter, naive CD8(+) T cells get activated, clonally expand, and can develop into very distinct subsets, such as short-living effector cells or different memory subpopulations. The origin of subset diversification is currently unknown, but qualitative and quantitative differences in early signals received by individual precursor cells have been suggested as a major determinant. We show that transfer of a single antigen-specific naive T cell into a normal recipient mouse allowed recovery of clonally expanded daughter cells upon immunization.

Prevalence of hypertension in type 2 diabetes mellitus: impact of the tightening definition of high blood pressure and association with confounding risk factors.

The Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure (JNC 7) has recommended a downward shift in target blood pressure to <130/80 mm Hg in diabetic patients, thus operatively setting a new threshold level for the definition of hypertension at 130/80 mm Hg. The authors performed a retrospective chart analysis of 2227 type 2 diabetes patients treated in one hospital-based and two community-based clinics in central Israel to determine the prevalence of hypertension as a function of three diagnostic threshold levels. The prevalence of hypertension in this cohort was 60.

Immunostimulatory RNA is a potent inducer of antigen-specific cytotoxic and humoral immune response in vivo.

Single-stranded RNA stimulates immune cells and induces the secretion of pro-inflammatory cytokines and type I IFN. As adjuvant RNA can induce a T(h)2 type of humoral response, however, its potency in the induction of cytotoxic T cells in vivo has not been analyzed. Here we show that immunization with the antigen ovalbumin (OVA) and the adjuvant phosphodiester RNA complexed to the cationic lipid N-[1-(2,3-dioleoyloxy)propyl]-N,N,N-trimethylammonium methylsulfate (DOTAP) induced a Toll-like receptor-7-dependent cytotoxic T cell and humoral response.

Unidirectional development of CD8+ central memory T cells into protective Listeria-specific effector memory T cells.

Three distinct subsets of antigen-experienced CD8(+) T cells have been identified so far: short-living effector T cells (T(EC)) and two long-living subsets, described as central (T(CM)) and effector memory (T(EM)) T cells. The lineage relationships of these subpopulations as well as their involvement in protection have not yet been conclusively determined. We recently described a novel marker combination (CD127 and CD62L) to identify all three major CD8(+) T cell subsets in mice infected with Listeria monocytogenes (L.

Attempted forced titration of blood pressure to <130/85 mm Hg in type 2 diabetic hypertensive patients in clinical practice: the diastolic cost.

The authors assessed the practicality and results of forced titrating of blood pressure to <130/85 mm Hg based on guidelines of the sixth Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure in the setting of a clinical practice in 257 diabetic, hypertensive patients. Goal diastolic pressure was achieved in 90% of the patients, but goal systolic pressure was achieved in only 33%. In 57% of the patients, the attained diastolic pressure was < or =70 mm Hg, and in 20% of the cohort diastolic pressure was reduced to <70 mm Hg (mean, 60+/-1 mm Hg).

Fibromyalgia in diabetes mellitus.

Objective: The aim of this study was to evaluate the prevalence of fibromyalgia (FM) in patients with diabetes mellitus (DM).

Subjects: The study included 100 consecutive unselected patients with DM attending our diabetes clinic. Patients were divided into two groups: 45 patients with type 1 diabetes and 55 patients with type 2 diabetes.

The erythrocyte adhesiveness/aggregation test (EAAT). A new biomarker to reveal the presence of low grade subclinical smoldering inflammation in individuals with atherosclerotic risk factors.

Background: Multiple acute phase proteins and atherosclerotic risk factors increase the aggregability of erythrocytes.

Methods And Results: We used a simple slide test and image analysis to determine the degree of erythrocyte adhesiveness/aggregation in the peripheral blood of 222 women and 221 men with no, one, two or more atherosclerotic risk factors. The degree of erythrocyte adhesiveness/aggregation correlated significantly with the concentration of commonly used variables of the acute phase response.

Rheological determinants of red blood cell aggregation in diabetic patients in relation to their metabolic control.

Aims: To determine whether increased red blood cell adhesiveness/aggregation in diabetic patients is related to the extent of their metabolic control.

Methods: We measured erythrocyte adhesiveness/aggregation in a group of 85 adult patients with diabetes mellitus by using citrated venous whole blood and a simple slide test. The erythrocyte adhesiveness/aggregation was determined by measuring the size of the spaces that are formed between the aggregated erythrocytes.

The multiplicity of atherosclerotic risk factors corresponds to the appearance of increased leukocyte count in the peripheral blood: relevance to the pathogenesis of the disease.

White blood cells may have a role in the aetiopathogenesis of atherosclerosis disease in patients with risk factors for this disease. We examined the white blood cell count in a group of 331 patients and controls of the same age group (139 women and 192 men), the numbers of individuals with no, one, two or more atherosclerotic risk factors being 29, 47, 35 and 28 for women and 50, 45, 68 and 29 for men, respectively. The risk factors included were hypertension, hyperlipidaemia, current smoking and diabetes mellitus.

Starvation diet and very-low-calorie diets may induce insulin resistance and overt diabetes mellitus.

We have observed seven initially obese individuals who, during the course of a strenuous weight-reduction program, developed diabetes mellitus: non-insulin-dependent diabetes mellitus in five cases and insulin-dependent diabetes mellitus in two cases. None had any sign of prior diabetic symptoms. Although weight reduction is encouraged in obesity, crash diets without proper medical surveillance may have deleterious effects.

The Gulf War and diabetes mellitus.

The Gulf war was a traumatic and stressful event for the inhabitants of Tel-Aviv and vicinity. The entire population changed its way-of-life. In order to evaluate the influence of the war stress on glucose control, we reviewed the charts of all diabetic patients attending the outpatient clinics at the Tel-Aviv Medical Centre, whose weight and glycated haemoglobin was determined between 15.

Effect of high carbohydrate intake on hyperglycemia, islet function, and plasma lipoproteins in NIDDM.

Objective: To study effects of high carbohydrate intake on hyperglycemia, islet functions, and plasma lipoproteins in patients with NIDDM.

Research Design And Methods: An attempt was made to induce hyperglycemia in 10 men with NIDDM by feeding them an isocaloric high-carbohydrate diet (65% of energy as simple carbohydrates [31% as glucose] and 20% as fat) for 28 days in a metabolic ward. Response to the high-carbohydrate diet was compared with that of feeding a diet rich in monounsaturated fat (45% of energy as fat [31% as monounsaturated fat] and 38% as carbohydrates) for 28 days in a cross-over manner.

Does adequate control of diabetes in the preinfarction period improve the short-term postinfarction course?

It is uncertain whether adequate preinfarction diabetes control would alter the clinical outcome in diabetic patients once myocardial infarction has occurred. This study attempts an evaluation. Diabetic patients admitted successively to the cardiac intensive care unit with their first acute myocardial infarction were enrolled and followed throughout hospitalization.

Immunobiological consequence of regulation of insulin receptor on alloactivated lymphocytes in normal and obese subjects.

Acute manipulations of insulin in vivo regulate the display of insulin receptors induced on activated T lymphocytes after presentation of alloantigen. This study explored the immunobiological consequences of regulation of insulin-receptor display by acute manipulations of insulin achieved during the hyperinsulinemic-euglycemic clamp in healthy normal individuals and obese subjects. T lymphocytes were isolated at 0, 1, and 4 h of hyperinsulinemia from seven normal volunteers and seven obese individuals and studied for their capacity to 1) synthesize a complement of insulin receptors on cell membrane, 2) respond to alloantigen in the mixed-lymphocyte culture (an immunologic activity unrelated to manipulations in insulin concentrations in complete medium), and 3) respond to the lymphocyte-mediated cytotoxicity reaction (an immunologic activity known to be modulated by insulin).

Blurred vision: an overlooked initial presenting symptom of insulin-dependent diabetes mellitus.

Blurred vision, a well-known complication of uncontrolled diabetes mellitus, is occasionally overlooked as the first and only presenting symptom of type I diabetes mellitus. In this report we describe six type I diabetic patients whose first and only symptom of the disease was blurred vision, as documented by increased glycosylated hemoglobin. Institution of therapy was delayed until the classical symptoms of diabetes mellitus appeared.

Isolated symptomatic peripheral neuropathy in type 1 insulin-dependent diabetes mellitus.

Diabetic neuropathy is probably the most frequent of the chronic complications of diabetes, and is usually found in association with diabetic retinopathy and/or nephropathy. We report seven patients with long-standing insulin-dependent diabetes mellitus in whom symptomatic peripheral neuropathy was the first and only documented complication. The diagnosis of peripheral symmetrical neuropathy was based on the presence of symptoms and abnormal physical findings, confirmed with abnormal electrophysiological and/or vibratory and thermal threshold measurements.

Insulin resistance and diabetes, mechanism and possible intervention.

The issue of the peripheral resistance to insulin action has been getting a lot of attention over the last decade. The reason for this is that insulin is a major regulatory hormone and is involved in the metabolism of carbohydrates, lipids, protein and ions. To understand the pathophysiology of insulin resistance it is necessary to elucidate the methods for the assessment of insulin resistance and the molecular mechanism of insulin action.