Azerbaijan Medical Journal

The risk of hypoglycemia with anti-hyperglycemic agents is an important limiting factor in the management of type 1 (T1DM) and type 2 (T2DM) diabetes mellitus. While hypoglycemia is more common in T1DM, the incidence is high in T2DM patients who use insulin or secretagogues, particularly patients with longer duration of diabetes. The underlying cause of hypoglycemia in diabetes is a complex interaction between hyperinsulinemia and compromised physiologic and behavioral responses to falling glucose levels. Pancreatic dysfunction also causes loss of normal therapeutic response to hypoglycemia—a reduction in circulating insulin (in T2DM only) and an increase in glucagon secretion. In T1DM and advanced T2DM, the third defense against hypoglycemia is increase in adrenomedullary sympathoadrenal epinephrine secretion, which is also compromised, causing the syndrome of defective glucose counterregulation. Diminished increase in epinephrine, also called hypoglycemia-associated autonomic failure (HAAF), is largely responsible for defective glucose counterregulation. HAAF can result in recurrent hypoglycemia and lowering of glycemic threshold that typically triggers sympathoadrenal response to hypoglycemia. This results in hypoglycemia without warning symptoms, or “hypoglycemia unawareness,” which increases the risk of severe hypoglycemia associated with substantial morbidity and mortality. Long-term effects of severe hypoglycemia, aside from causing accidents, may include adverse cardiovascular outcomes and cognitive impairment. To reduce the impact of hypoglycemia, it is important to identify patients at risk and use careful consideration when choosing antidiabetes medications. Newer insulin analogs that more accurately replicate endogenous insulin secretion and incretin therapies that cause glucose-sensitive insulin secretion may ultimately reduce the risk of hypoglycemia.

Migraine is a common disabling brain disorder. Approximately 1% of the world’s population may have chronic migraine. Cerebral hemodynamics during different phases of the migraine attack demonstrate alterations in cerebral blood flow and perfusion, vessel caliber, cortical and sub-cortical function, underscoring that migraine pathophysiology is highly complex. Transcranial dopplerography assessment of blood flow parameters in patients with migraine. A retrospective analysis of the results of TransCranial Dopplerography (TCD) of the middle cerebral artery and main cerebral veins was performed in 117 patients with migraine-54 with aura and 63 without aura. The age of the subjects was 18-43 years, among them 53 (45.3%) men and 64 (54.7%) women. The maximum Systolic Velocity (Vs), the Resistance and Pulsativity Indexes (RI, PI) in Middle Cerebral Artery (MCA) the maximum systolic velocity in Basal Vein of Rosenthal (BVR) and in the Direct Sinus (DS) were determined. According to MRI data, structural changes in white matter of the brain were detected in 19 (30.2%) patients with migraine without aura (1st group) and 28 (51.9%) patients with migraine with aura (2nd group). The Vs in MCA among patients of 1st group averaged 127.9±6.8cm/c, in the patients of 2nd group - 61.7±5.7cm/c, in the control group - 108.4±6.1cm/c respectively. The Vs in a patient of 1st group were significantly higher than in patients of 2nd group and control group (P1-2<0.001, P1-2<0.001). The value of Vs was significantly lower than in the control group (P2-3 <0.001). In the first group, the value of RI was significantly (P1-2<0.05) less than in the second group. The value of PI in patients with migraine with aura was significantly higher (P<0.05) than in the group with migraine without an aura and a control group. The highest systolic blood flow velocity and asymmetry in the basal vein of Rosenthal was noted in patients of 1st group and amounted to 46.4±5.7cm/s, in the 2nd group - 27.8±4.6cm/s, in the control group - 21.4±3.8cm/c, respectively. The value of Vs among patients of 2nd group with high reliability (P 2-1<0.01, P 2-3<0.001) exceeded the rate in patients of 1st group and control group. In patients with migraine without an aura in the fetal period, the systolic blood flow velocity in the middle cerebral artery increases, the resistance index decreases. In patients with migraine with aura, the greatest increase in systolic blood flow velocity in the direct sinus is observed.

Around 10% of newborn infants require assistance during transition after birth. Heart rate (HR) is the most important clinical indicator to evaluate the clinical status of a newborn. Our study aimed to review all established and novel methods to detect HR in babies giving special consideration to non-invasive techniques. We performed a systematic literature search on the following databases MEDLINE, Embase, Cochrane Central Register of Controlled Trials (CENTRAL), and CINAHL. The inclusion criteria were studies on methods to detect HR in both term and preterm infants in comparison to one of the current gold standards: pulse oximetry (PO) or electrocardiography (ECG) published in the last 15 years. Two independent reviewers screened titles and abstracts for eligibility. Data extracted in an Excel table were analysed to produce a narrative review structured around the type of monitoring, identified obstacles in use, as well as methods to overcome these limitations. The search revealed 649 studies after duplicates were removed. Full article analysis was performed on 26 studies of which 25 met the inclusion criteria. Well established methods such as auscultation and palpation, although rapid and easily available, have been shown to be inaccurate. ECG and PO were both more precise but the delay in obtaining a reliable HR signal from birth often exceeded 1–2 min. Novel sensors offered the advantages of minimally obtrusive technologies but have limitations mainly due to movement artefact, bad sensor coupling, intermittent measurement, and poor-quality recordings. The limitations of existing methods have a potential impact on short- and long-term morbidity and mortality outcomes. The development of a technological solution to determine HR accurately and quickly in babies at birth has immense implications for further research and can guide interventions, such as placental transfusion and resuscitation

Preterm birth is a major risk factor for neurodevelopmental delays and disorders. This study aimed to identify genomic biomarkers of intrauterine inflammation in umbilical cord tissue in preterm neonates that predict cognitive impairment at 10 years of age. Genome-wide messenger RNA (mRNA) levels from umbilical cord tissue were obtained from 43 neonates born before 28 weeks of gestation. Genes that were differentially expressed across four indicators of intrauterine inflammation were identified and their functions examined. Exact logistic regression was used to test whether expression levels in umbilical cord tissue predicted neurocognitive function at 10 years of age. Placental indicators of inflammation were associated with changes in the mRNA expression of 445 genes in umbilical cord tissue. Transcripts with decreased expression showed significant enrichment for biological signaling processes related to neuronal development and growth. The altered expression of six genes was found to predict neurocognitive impairment when children were 10 years old These genes include two that encode for proteins involved in neuronal development. Prenatal intrauterine inflammation is associated with altered gene expression in umbilical cord tissue. A set of six of the differentially expressed genes predict cognitive impairment later in life, suggesting that the fetal environment is associated with significant adverse effects on neurodevelopment that persist into later childhood.

Cervical cancer can infiltrate locally and directly spread to adjacent organs including the vagina, peritoneum, urinary bladder, ureters, rectum, and paracervical tissue, but the intestine metastasis from cervical cancer is extremely rare, which can easily be misdiagnosed. Case presentation: Here, we report a case about a 45-year-old postoperative cervical cancer patient with metastases to small intestine and sigmoid colon who presented abdominal distention and dull pain due to intestinal obstruction. The patient underwent exploratory laparotomy, and two intestinal segments including the tumors were resected. The postoperative pathological diagnosis illustrated sigmoid colon and terminal ileum metastatic squamous cell carcinoma. Conclusions: This case demonstrates that intestine metastasis must be considered in the differential diagnosis of acute abdomen in patients with cervical cancer even at an early tumor stage