Appetite Disorders Research Articles

Abnormalities in Glucose Metabolism, Appetite-Related Peptide Release, and Pro-inflammatory Cytokines Play a Central Role in Appetite Disorders in Peritoneal Dialysis.

Background: Appetite disorders are frequent and scantly studied in peritoneal dialysis (PD) patients and are associated with malnutrition and cardiovascular complications.Objective: We investigated the relationship between uremic insulin resistance, pro-inflammatory cytokines, and appetite-related peptides release (ARPr) with eating-behavior disorders in PD patients.Methods: We included 42 PD patients (12 suffering anorexia, 12 obese with high food-intake, and 18 asymptomatic) and 10 controls. We measured blood levels of ARPr including orexigens [neuropeptide-Y (NPY), ghrelin, and nitric-oxide], anorexigens [cholecystokinin, insulin, corticotropin-releasing factor, leptin, and adiponectin (Ad)], and cytokines (TNF-α, sTNFα-R2, and IL-6) both at baseline and after administering a standard-food stimulus (SFS). We also measured the expression of TNF-α, leptin and Ad-encoding mRNAs in abdominal adipose tissue. We compared these markers with eating motivation measured by a Visual Analog Scale (VAS).Results: Anorexics showed both little appetite, measured by a VAS, and low levels of orexigens that remained constant after SFS, coupled with high levels of anorexigens at baseline and after SFS. Obeses showed higher appetite, increased baseline levels of orexigens, lower baseline levels of anorexigens and cytokines and two peaks of NPY after SFS. The different patterns of ARPr and cytokines pointed to a close relationship with uremic insulin resistance. In fact, the euglycemic–hyperglycemic clamp reproduced these disorders. In anorexics, TNF-α fat expression was increased. In obese patients, leptin expression in fat tissue was down-regulated and showed correlation with the appetite.Conclusion: In PD, appetite is governed by substances that are altered at baseline and abnormally released. Such modulators are controlled by insulin metabolism and cytokines and, while anorexics display inflammatory predominance, obese patients predominantly display insulin resistance.

Pyk2 in the amygdala modulates chronic stress sequelae via PSD-95-related micro-structural changes

Major depressive disorder (MDD) is a common disorder with a variety of symptoms including mood alterations, anhedonia, sleep and appetite disorders, and cognitive disturbances. Stressful life events are among the strongest risk factors for developing MDD. At the cellular level, chronic stress results in the modification of dendritic spine morphology and density. Here, we study the role of Pyk2 in the development of depressive-like symptoms induced by a model of chronic unpredictable mild stress (CUMS). Pyk2 is a non-receptor calcium-dependent protein-tyrosine kinase highly expressed in the forebrain principal neurons and involved in spine structure and density regulation. We show that Pyk2 knockout mice are less affected to anxiety-like and anhedonia-like phenotypes induced by the CUMS paradigm. Using region-specific knockout, we demonstrate that this phenotype is fully recapitulated by selective Pyk2 inactivation in the amygdala. We also show that in the absence of Pyk2 the spine alterations, PSD-95 clustering, and NMDA receptors changes induced by the CUMS paradigm are prevented. Our results reveal a possible role for Pyk2 in the response to stress and in synaptic markers expression and spine density regulation in the amygdala. We suggest that Pyk2 contributes to stress-induced responses through micro-structural changes and that its deficit may contribute to the resilience to chronic stress.

Adverse Reactions of Drugs Containing Valeriana and Corvalol: Analysis of Spontaneous Reporting

Abstract. Valerianа officinalis rhizomes whis roots, monocomponent and complex herbal drugs based on Valerianа officinalis, and the drug Corvalol containing chemically synthesized α-bromizovalerianic acid ethyl ester (ethyl bromovalerianate) are OTC drugs and are widely used. At the same time, in the database of drug adverse effects «Pharmacovigilance» AIS Roszdravnadzor from 2009 to 2018, 147 spontaneous reports of adverse reactions were registered when taking Valeriana rhizomes whis roots and Corvalol. The aim of the study was the analisis of spontaneous reporting about adverse reactions when taking Valeriana rhizomes and roots and the multi-component drug Corvalol in the database «Pharmacovigilance» AIS Roszdravnadzor and assessment of their compliance with the information in the instructions for medical use. It was reactions from the nervous system (lethargy, drowsiness, weakness, apathy, headache, dizziness, depression of consciousness, stupor, neurotoxicity, toxic encephalopathy), from the gastrointestinal tract (nausea, bitterness in the mouth, burning of the mucous membrane, belching, heartburn, appetite disorders), cardiovascular system (tachycardia) and allergic reactions (skin itching, skin flushing, rash, maculo-papular rash, urticaria, dermatitis, cheilitis, aphthous stomatitis, angioedema) in the reports. The sedative and anxiolytic effects of the leading biologically active component of rhizomes with valerian roots, valerenic acid, are mediated through modulation of the function of type-γ-aminobutyric acid receptors A. Experimentally confirmed that the mechanism of action of valerenic acid is similar to benzodiazepine drugs, which cause of a number of reported adverse neurological reactions. However, the range of complaints from patients cited in the reports is significantly wider than in the instructions for the medical use of these drugs. There is a need for further monitoring of reports and analysis of already received data and the addition of prescribing information of Valeriana rhizomes whis roots and Corvalol for ensuring safety requirements.

Preventive effect of cyproheptadine on sleep and appetite disorders induced by methylphenidate: an exploratory randomised, double-blinded, placebo-controlled clinical trial

Objectives: Insomnia and loss of appetite are the most common side effects of methylphenidate in patients with attention deficit/hyperactivity disorder (ADHD). The adverse effects may limit optimal dosing and patients’ compliance with treatment leading to the discontinuation of treatment. This research evaluates the preventive effects of cyproheptadine on sleeping and appetite disorders induced by methylphenidate in ADHD children.Methods: During this exploratory, randomised, double-blinded, placebo-controlled clinical trial, forty patients with ADHD diagnosis who had received methylphenidate randomly were assigned to participate in the cyproheptadine or the placebo group. Patients’ weight and Pittsburgh Sleep Quality Index (PSQI) score were recorded at baseline, after four, six and eight weeks of treatment. The ADHD Parent Rating Scale-V score was also defined at the beginning and the end of study for each patient.Results: There was no significant difference between the cyproheptadine and the placebo groups regarding their weight, rate of growth and PSQI score in the monthly assessment. In addition, there was no significant difference in response to the therapy between the two groups.Conclusions: Based on our findings, cyproheptadine does not have any considerable preventive effect on sleeping and appetite disorders induced by methylphenidate in ADHD children.Trial registration: Iranian Registry of Clinical Trials identifier: IRCT2015070623099N1.

Deep brain stimulation for appetite disorders: a review.

The mechanisms of appetite disorders, such as refractory obesity and anorexia nervosa, have been vigorously studied over the last century, and these studies have shown that the central nervous system has significant involvement with, and responsibility for, the pathology associated with these diseases. Because deep brain stimulation has been shown to be a safe, efficacious, and adjustable treatment modality for a variety of other neurological disorders, it has also been studied as a possible treatment for appetite disorders. In studies of refractory obesity in animal models, the ventromedial hypothalamus, the lateral hypothalamus, and the nucleus accumbens have all demonstrated elements of success as deep brain stimulation targets. Multiple targets for deep brain stimulation have been proposed for anorexia nervosa, with research predominantly focusing on the subcallosal cingulate, the nucleus accumbens, and the stria terminalis and medial forebrain bundle. Human deep brain stimulation studies that focus specifically on refractory obesity and anorexia nervosa have been performed but with limited numbers of patients. In these studies, the target for refractory obesity has been the lateral hypothalamus, ventromedial hypothalamus, and nucleus accumbens, and the target for anorexia nervosa has been the subcallosal cingulate. These studies have shown promising findings, but further research is needed to elucidate the long-term efficacy of deep brain stimulation for the treatment of appetite disorders.

Effect of proximity to high-voltage fields: results of the neural network model and experimental model with macaques

An important biological hazard that is caused by the placement of power transmission lines in the vicinity of cities and villages is the computation of the magnetic and electric fields around these lines. Therefore, the present research objective was to study the effect of high-voltage fields on the effect of the neural network model on the brain and to compare the results of this model with the results of behavioral and biological analyses of primates. In this research, two adult male macaques were selected for the experiments. Prior to inclusion in the research, the primates were exposed to behavioral tests, hormonal assays (melatonin and cortisol), and MRI-assisted brain anatomy analyses using special kits. The monkey in the experimental group was exposed to a 3 kV/m high-voltage field for 4 h a day for a month, after applying electric field simulations. In addition, the behavioral elements of the primates in the experimental and control groups were analyzed during the treatment. Computation models were used in this research, and the results were compared to experimental data. Behavioral elements manifested in the form of changes such as reduced activity, isolation, reduced appetite, and sleep disorders during applying electric field simulations of the monkey that was exposed to the high-voltage field. Based on the results of the simulation model and the variations of the behavioral, hormonal, and anatomical elements, the decrease in the activity of the brain cortex, sleep disorders, and isolation were indicative of depression in the monkey exposed to the high-voltage field.

Effects of Bisphenol S on hypothalamic neuropeptides regulating feeding behavior and apelin/APJ system in mice

Since 2010, Bisphenol A (BPA), an endocrine disruptor has been restricted and replaced by analogues like Bisphenol S (BPS). However, little is known about BPS effects and growing concern have suspected the “BPA-free” Label. Several recent studies suggest that BPS is associated with increased risk of diabetes and obesity. However, the underlying mechanisms remain unidentified. The current study investigates investigate BPS effects on hypothalamic neuropeptides regulating feeding behavior, either orexigenic or anorexigenic in Swiss Albino mice. We also studied the effect of BPS on the apelinergic system (apelin/apelin receptor (APJ)) as an original physiological system with pleiotropic actions.Bisphenol S at 25, 50, 100 µg/kg was administered to mice in water drink for 10 weeks started after weaning. Our results showed that BPS exposure alters orexigenic hypothalamic neuropeptide (AgRP) regulating feeding behavior but not anorexigenic neuropeptides (POMC, CART). Such orexigenic alterations may underlay appetite disorders leading to a concomitant food intake and body weight gain increase. In addition, data show that BPS affects the hypothalamic apelinergic system. We found a significant decrease in APJ mRNA but not in apelin expression. Based on hypothalamic APJ distribution, we suggested a potent specific physiological alteration of this receptor in mediating neuroendocrine responses in hypothalamus.Thus, our findings provide that BPS exposure could contribute to the development of obesity and metabolic disorders.

ОПЫТ КЛИНИЧЕСКОГО ПРИМЕНЕНИЯ МЕТОДА ИНТЕГРАЛЬНОЙ ГРАФИЧЕСКОЙ ГЕОМЕТРИЧЕСКОЙ ЛОГАРИФМИЧЕСКОЙ ОЦЕНКИ КОГНИТИВНЫХ ФУНКЦИЙ

Objective: Develop and evaluate the effectiveness of the method of integrated graphical geometric logarithmic evaluation of cognitive functions. Methods: The developed method consists in evaluating three indicators of the radar chart: the risk of developing and progressing cognitive impairment, cognitive deficits and expressions emotionally behavioural disorders. The method is tested on 30 subjects of the acute cerebral circulation disturbance during the last six months. Based on the clinical picture, allocated three groups of comparison. In the first group, there were 11 people who had a left middle cerebral artery (MCA) ischemic stroke; the second group consisted of 12 people who had a right MCA ischemic stroke; in the third group, there were 7 people who had a hemorrhagic stroke. The control group was represented by 23 practically healthy young age subjects. Results: It was shown that the less contribution to the development of cognitive impairment in the early recovery period after a hemorrhagic stroke is made by postponed diseases of the musculoskeletal system and head trauma, thyroid gland pathology, and burdened patient’s history of cognitive disorders. The minimal risk from the position of cognitive impairment development in patients in the early recovery period of the right MCA ischemic stroke is the presence in the history of diseases of the musculoskeletal system and pathological conditions associated with cognitive disorders in relatives. The least risk of the developing cognitive impairment in the early recovery period in patients who have had the left MCA ischemic stroke associated with concomitant thyroid gland disease. For theese patients hallucinatory spectrum disorders, abnormal physical activity, sleep and appetite disorders were characterized in the early recovery period. For patients who have had a hemorrhagic stroke and right CMA ischemic stroke, depressive disorders were characterized. Conclusion: The developed method is a convenient and effective tool for visual diagnosis of the risk of development and progression of cognitive impairment, assessment of the severity of cognitive deficit and associated emotional-behavioural disorders. Keywords: Cognitive functions, stroke, integral assessment.

Behavioural and Psychological Symptoms of Dementia: Correlates and Impact on Caregiver Distress

Aims: To evaluate the behavioural and psychological symptoms of dementia (BPSD), to determine their correlation with types and stages of dementia and patient demographics, and to assess the impact on caregiver distress. Methods: This cross-sectional study recruited consecutive dementia patients and caregivers who attended our cognitive clinic. Standard criteria were used to classify types of dementia. BPSD were assessed with the Neuropsychiatric Inventory, and its distress scale was used for caregiver distress. Results: Of a total 107 patients, nearly all (99.1%) had at least one BPSD; 71% had ≥4 symptoms. Most frequent were apathy and agitation, followed by irritability, sleep and appetite disorders, and mood disorders; disinhibition and euphoria were least frequent. BPSD were less prominent with increasing age; males showed more agitation. Apathy and eating disorders were more prevalent in the rural community. BPSD were highest in frontotemporal dementia (FTD), followed by dementia with Lewy bodies (DLB), and least in vascular dementia. Hallucinations were more common in DLB, aberrant motor behaviour in FTD. All domains of BPSD, except for anxiety and euphoria, were more prominent with increasing severity of dementia. Increasing BPSD (except for euphoria) caused higher caregiver distress. Conclusion: BPSD are universally present, bear correlates with dementia type and severity, and cause significant caregiver distress.

Growth and sexual retardation in a boy with celiac disease

Growth and sexual retardation in boys can be caused by both endocrine and somatogenic causes. One of the somatogenic causes of growth and puberty retardation is celiac disease that is a genetic disorder of the small intestine, which is associated with deficiency of enzymes breaking down the gluten peptide. The clinical picture of celiac disease may be dominated by gastrointestinal manifestations (diarrhea, recurrent abdominal pain, nausea, constipation, appetite disorders) and nonspecific symptoms (irritability, apathy, physical and sexual retardation, impaired reproductive function, anemia, etc.). We present a case of late diagnosis of celiac disease in a 15-year-old boy with physical (height SDS, -4.1; bone age SDS, -8.2) and sexual (Tanner 1) retardation. The negative results of gonadoliberin (max LH, 2 mIU/mL) and chorionic gonadotropin (Δ-testosterone, 2,3 nmol/L) tests indicated the lack of activation of the hypothalamo-pituitary-gonadal system. However, inhibin B (29.9 pg/mL) and anti-Mullerian hormone (43.8 ng/mL) levels indicated preservation of the reserve capabilities of this system. During follow-up, after treatment with a gluten-free diet for 10 months, the patient demonstrated an improved growth rate (2.7 SDS), progression of the sexual development stage (Tanner 2), and positive results of diagnostic diphereline (max LH, 16.8 IU/mL) and chorionic gonadotropin (Δ-testosterone, 11.8 nmol/L) tests. This case demonstrates the need to exclude celiac disease in patients with growth and sexual retardation, especially when these pathologies are combined with protein-energy deficiency, gastrointestinal symptoms, and anemia, as well as the need to use additional indicators of the reproductive system condition in boys, e.g. inhibin B and anti-Mullerian hormone.

Consecuencias del Burnout de cuidadores de pacientes con demencia

El objetivo de este estudio es conocer la situación de los cuidadores de pacientes con demencia. Material: Se ha realizado una búsqueda sistemática en las bases de datos Pubmed, ScienceDirect-Journals. Resultados: Actualmente, la población sigue un proceso de envejecimiento progresivo que conlleva una mayor incidencia de enfermedades asociadas, como es el caso de las enfermedades neurodegenerativas y en el supuesto que nos ocupa, las demencias. Cada vez se diagnostican con mayor frecuencia estas enfermedades y esto conlleva también que cada vez existen más personas encargadas del cuidado de estos pacientes. En la mayoría de las ocasiones el cuidado de estos enfermos se realiza en el domicilio con la consiguiente sobrecarga del cuidador principal, a lo largo de estos últimos años se ha ido dando cada vez más importancia al conjunto de signos y síntomas que se presentan juntos en estos cuidadores hasta el punto de llamarlos “segundas víctimas” y dar nombre a una enfermedad conocida como “síndrome del cuidador” o “Burnout”. Discusión: El cuidado continuo con sobrecarga, tiene una repercusión física y psicológica en los cuidadores en forma de insomnio, aislamiento, fatiga crónica, falta de concentración, irritabilidad, cambios de humor, alteraciones en el apetito y alteraciones psiquiátricas siendo la más frecuente la depresión.

MODERN PECULIARITIES OF PEDIATRIC CHRONIC GASTRODUODENITIS COURSE

Aim. To study the modern clinicolaboratory peculiarities of chronic gastroduodenitis course in children. Materials and methods. Fifty five children aged 5-15 years with chronic gastroduodenitis were under observation. Complex clinicolaboratory study including biochemical blood analysis, ultrasonic investigation of abdominal cavity organs, pH-metry, fibrogastroduodenoscopy was carried out. Results. Chronic gastroduodenitis among the observed children was often associated with biliary dysfunction (80 %) and reactive changes in the pancreatic gland (72,7 %). Clinical picture of chronic gastroduodenitis was characterized by the predominance of abdominalgias (100 %), presence of dyspeptic syndrome in the form of nausea (78,2 %), eructation (76,4 %), appetite disorders (60,0 %). Children aged 5-9 years, more often had diarrhea ( p = 0,028) and periumbilical localization of abdominalgias ( p = 0,03), but in adolescents there was more often observed heartburn ( p = 0,047) and apigastral localization of abdominalgias ( p = 0,037). Elevated acid-forming gastric function was stated in 58,2 % of cases. Helicobacter pylori was revealed in 34,5 % of children. More frequently superficial gastroduodenitis (85,5 %) was diagnosed. Pangastritis was registered in 96,4 % of children, panduodenitis - in 98,2 %. Conclusions. Chronic gastroduodenitis extremely seldom occurs in the form of isolated disease. The whole gastrointestinal tract with manifestation of biliary dysfunctions, pancreatic reactive changes, digestive motor disorders is involved into the pathological process. Early diagnosis of this disease, followed by prophylactic measures to prevent the development of associated pathology of different parts of gastrointestinal tract is required.

Appetite disorders in cancer patients: Impact on nutritional status and quality of life

Cancer patients are at high risk of malnutrition due to several symptoms such as lack of appetite. The aim of this study was to determine the prevalence of different appetite disorders in cancer patients and their influence on dietary intake, nutritional status, and quality of life. We conducted a cross-sectional study of cancer patients at risk of malnutrition. Nutritional status was studied using Subjective Global Assessment, anthropometry, and grip strength. Dietary intake was evaluated with a 24-h recall, and patients were questioned about the presence of changes in appetite (none, anorexia, early satiety, or both). Quality of life was measured using EORTC-QLQ-C30. Multivariate analysis was performed using linear regression. 128 patients were evaluated. 61.7% experienced changes in appetite: 31% anorexia, 13.3% early satiety, and 17.2% both. Appetite disorders were more common in women and with the presence of cachexia. The combination of anorexia and satiety resulted in a lower weight and BMI. However, there were no significant effects on energy or macronutrient intake among different appetite alterations. Patients with a combination of anorexia and early satiety had worse overall health perception, role function, and fatigue. Appetite disorders are highly prevalent among cancer patients at risk of malnutrition. They have a significant impact on nutritional status and quality of life, especially when anorexia and early satiety are combined.

FRI-320 - Taste and appetite disorders in patients with non-alcoholic fatty liver disease

FRI-320 - Taste and appetite disorders in patients with non-alcoholic fatty liver disease

Serotonin and melatonin secretion in postmenopausal women with eating disorders.

Postmenopausal women manifest emotional disorders associated with an increase in appetite. The aim of the study was to assess the serotonin and melatonin secretion and metabolism in postmenopausal women in relation to eating disorders. Sixty postmenopausal women and 30 women without hormonal disturbances were enrolled into the study and divided into three groups: group I (control) - women without menstrual disorders, group II - postmenopausal women without appetite disorders and change in body weight, and group III - postmenopausal women with increased appetite and weight gain. Serum melatonin, serotonin, urinary 6-sulfatoxymelatonin (aMT6s), and 5-hydroxyindoleacetic acid (5-HIAA) excretion were measured. Serum serotonin and melatonin levels in groups II and III were lower compared to group I. Urinary 5-HIAA and aMT6s excretion was lower in overweight women. In group III the correlation between the serum level of serotonin, melatonin, and BMI was negative; a high statistical significance was found between BMI and urinary aMT6s excretion. Melatonin supplementation and use of drugs modulating the serotonin homeostasis together with female hormones have a beneficial effect in complex treatment of disorders of eating in postmenopausal women. (Endokrynol Pol 2016; 67 (3): 299-304).

Argyrophilic Grain Disease: Demographics, Clinical, and Neuropathological Features From a Large Autopsy Study.

Argyrophilic grain disease (AGD) is a frequent late-onset, 4-repeat tauopathy reported in Caucasians with high educational attainment. Little is known about AGD in non-Caucasians or in those with low educational attainment. We describe AGD demographics, clinical, and neuropathological features in a multiethnic cohort of 983 subjects ≥50 years of age from São Paulo, Brazil. Clinical data were collected through semistructured interviews with an informant and included in the Informant Questionnaire on Cognitive Decline in the Elderly, the Clinical Dementia Rating, and the Neuropsychiatric Inventory. Neuropathologic assessment relied on internationally accepted criteria. AGD was frequent (15.2%) and was the only neuropathological diagnosis in 8.9% of all cases (mean, 78.9 ± 9.4 years); it rarely occurred as an isolated neuropathological finding. AGD was associated with older age, lower socioeconomic status (SES), and appetite disorders. This is the first study of demographic, clinical, and neuropathological aspects of AGD in different ethnicities and subjects from all socioeconomic strata. The results suggest that prospective studies of AGD patients include levels of hormones related to appetite control as possible antemortem markers. Moreover, understanding the mechanisms behind higher susceptibility to AGD of low SES subjects may disclose novel environmental risk factors for AGD and other neurodegenerative diseases.

Effectiveness, safety and tolerability of a complex homeopathic medicinal product in the prevention of recurrent acute upper respiratory tract infections in children: a multicenter, open, comparative, randomized, controlled clinical trial

Background: The present study was initiated to investigate the effectiveness, safety and tolerability of complex homeopathic CalSuli-4-02 tablets on prevention of recurrent acute upper respiratory tract infections (URTIs) in children, in comparison to another complex homeopathic product. Methods: The study was designed as a prospective, multicenter, randomized, open, clinical trial with two parallel treatment groups at four outpatient pediatric clinics in Russia. Children aged ≤ 6 years with susceptibility to acute URTIs (≥ three occasions during the last 6 months) were randomized to receive either CalSuli-4-02 or a comparator homeopathic product (control group) for 3 weeks. Primary outcome was the frequency of acute URTIs after 3 and 6 months post-treatment follow-up. Secondary endpoints were changes in complaints and symptoms (total and individual scores), treatment satisfaction, antibiotic use, safety and tolerability. Results: The intention-to-treat analysis involved 200 children (CalSuli-4-02: N = 99, Control: N = 101). In both treatment groups, the median number of acute URTIs was one for 3 months and two, respectively, for the full 6 months post-treatment (Relative Risk: 0.86 (95 %-CI: 0.72–1.03), p = 0.1099). Seasons had no influence on the outcome. At the end of study, CalSuli-4-02 had overall higher odds of getting lower complaints severity total score (Odds ratio: 1.99 (95 %-CI: 1.31–3.02), p = 0.0012) and showing symptom improvement (Odds ratio: 1.93 (95 %-CI: 1.25–3.00), p = 0.0033). Specifically, the complaint “appetite disorder” and the symptom “child’s activities” significantly improved more in the CalSuli-4-02 group (p = 0.0135 and p = 0.0063, respectively). Antibiotic use was decreased in both treatment groups at the study end. Overall assessment for satisfaction with and tolerability of treatment was higher with CalSuli-4-02. A low number of non-serious adverse drug reactions was reported (CalSuli-4-02: N = 4, Control: N = 1). Conclusions: Both complex homeopathic products led to a comparable reduction of URTIs. In the CalSuli-4-02 group, significantly less URTI-related complaints and symptoms and higher treatment satisfaction and tolerability were detected. The observation that the use of antibiotics was reduced upon treatment with the complex homeopathic medications, without the occurrence of complications, is interesting and warrants further investigations on the potential of CalSuli-4-02 as an antibiotic sparing option. Clinical trial registration number: Roszdravnadzor: Study No 164–563

Effectiveness, safety and tolerability of a complex homeopathic medicinal product in the prevention of recurrent acute upper respiratory tract infections in children: a multicenter, open, comparative, randomized, controlled clinical trial.

BackgroundThe present study was initiated to investigate the effectiveness, safety and tolerability of complex homeopathic CalSuli-4-02 tablets on prevention of recurrent acute upper respiratory tract infections (URTIs) in children, in comparison to another complex homeopathic product.MethodsThe study was designed as a prospective, multicenter, randomized, open, clinical trial with two parallel treatment groups at four outpatient pediatric clinics in Russia. Children aged ≤ 6 years with susceptibility to acute URTIs (≥ three occasions during the last 6 months) were randomized to receive either CalSuli-4-02 or a comparator homeopathic product (control group) for 3 weeks. Primary outcome was the frequency of acute URTIs after 3 and 6 months post-treatment follow-up. Secondary endpoints were changes in complaints and symptoms (total and individual scores), treatment satisfaction, antibiotic use, safety and tolerability.ResultsThe intention-to-treat analysis involved 200 children (CalSuli-4-02: N = 99, Control: N = 101). In both treatment groups, the median number of acute URTIs was one for 3 months and two, respectively, for the full 6 months post-treatment (Relative Risk: 0.86 (95 %-CI: 0.72–1.03), p = 0.1099). Seasons had no influence on the outcome. At the end of study, CalSuli-4-02 had overall higher odds of getting lower complaints severity total score (Odds ratio: 1.99 (95 %-CI: 1.31–3.02), p = 0.0012) and showing symptom improvement (Odds ratio: 1.93 (95 %-CI: 1.25–3.00), p = 0.0033). Specifically, the complaint “appetite disorder” and the symptom “child’s activities” significantly improved more in the CalSuli-4-02 group (p = 0.0135 and p = 0.0063, respectively). Antibiotic use was decreased in both treatment groups at the study end. Overall assessment for satisfaction with and tolerability of treatment was higher with CalSuli-4-02. A low number of non-serious adverse drug reactions was reported (CalSuli-4-02: N = 4, Control: N = 1).ConclusionsBoth complex homeopathic products led to a comparable reduction of URTIs. In the CalSuli-4-02 group, significantly less URTI-related complaints and symptoms and higher treatment satisfaction and tolerability were detected. The observation that the use of antibiotics was reduced upon treatment with the complex homeopathic medications, without the occurrence of complications, is interesting and warrants further investigations on the potential of CalSuli-4-02 as an antibiotic sparing option.Clinical trial registration numberRoszdravnadzor: Study No 164–563

Evaluation of a mobile team dedicated to behavioural disorders as recommended by the Alzheimer Cooperative Valuation in Europe joint action: observational cohort study.

Preventing behavioural crises appears to be crucial to promote quality of life of the patient-caregiver dyad, to reduce inappropriate hospitalizations and to delay institutionalization. The Alzheimer Cooperative Valuation in Europe promotes mobile care to prevent patients from severe behavioural and psychological symptoms in dementia. This study assessed the potential efficacy of a mobile team for Alzheimer's disease on hospitalization sparing and behavioural disorder reduction. A cohort study was set up from 1 January 2012 to 31 December 2013 by the Clinical and Research Memory Centre of Lyon (France). It included patients with behavioural and psychological symptoms living at home or in a nursing home. An interview explored the alternative patient pathways used by general practitioners (GPs) if the mobile team had not existed (hospitalization sparing). The Neuropsychiatry Inventory score was assessed at inclusion and 30 days later. The sample included 424 consecutive patients with Alzheimer's disease or related disorders and behavioural disorders at any cognitive and functional stage of the disease, taken in charge by the mobile team. Amongst the 424 patients (84.0 ± 7.2 years), 220 (51.9%) hospitalizations were considered by their GPs and 181 (82.3%) were avoided. The Neuropsychiatric Inventory score declined after mobile team intervention (45.8-29.9, P < 0.001). Sleep and appetite disorders, endangered situation and caregiver burnout were associated with higher risk of hospitalization at 30 days. The mobile team for Alzheimer's disease allows a high proportion of hospitalizations related to behavioural disorders to be avoided and may help to reduce behavioural disorders.

Dietary intakes and some biochemical markers in hemodialysis patients

Purpose: Intake of energy and some nutrients is frequently inadequate in dialysis patients because of eating and appetite disorders due to uremic syndrome. Inadequate energy and protein intake cause to malnutrition. Anthropometric measurements, biochemical markers and dietary intake records have great importance in determining the nutritional status of hemodialysis (HD) patients. Therefore this study was planned to determination of daily energy, nutrient intake and some biochemical markers of adult hemodialysis patients.Method and Material: A hundred and thirty six (male = 73, female = 63) clinically stable HD patients were enrolled in this study. All patients were taken 24-hour dietary recall. The daily energy and nutrient intakes of patients were calculated by food consumption records and anthropometric measurements were taken.Results: The mean age was found 45.5±13.51 years. The ratio of patients with body mass index (BMI) below 18.5 kg/m2 was 7.4% and 25 kg/m2 or upper was 16.9%. Blood hemoglobin, hematocrit, albumin and total protein levels were below the normal levels. The daily dietary energy and protein intakes were found under the recommended level in the study period. A significant positive correlation was found between daily protein intake and serum albumin levels (r=0.210, p=0.014), daily protein intake and serum total protein levels (r=0.201, p=0.019), daily energy intake and serum total protein levels (r=0.178, p=0.039).Conclusions: HD patients often have low protein and energy intakes and most of them suffer from malnutrition. Therefore nutritional status of patients should be evaluated and periodically nutrition education should be given for improving eating habits and increasing dietary compliance is recommended.