A review of the aetiology and management of vocal behaviour in dementia

Vocal behaviour is a common form of agitation displayed by people with dementia. It refers to excessive screaming, abusive language, moaning, perseveration, and repetitive and inappropriate requests. The authors provide a literature review on this form of challenging behaviour, focusing on the aetiological factors and the available treatment options. Emphasis is put on a biopsychosocial approach. The aim of this article is to increase awareness of the condition in elderly nursing residences and hospitals, and to encourage best evidence-based practice.peer-reviewe

Relationship of hyperglycaemia, hypoglycaemia, and glucose variability to atherosclerotic disease in type 2 diabetes

Objective: Type 2 diabetes mellitus (T2DM) is known to be associated with increased cardiovascular risk. The aim of this study was therefore to investigate the independent effects of hyperglycaemia, hypoglycaemia, and glucose variability on microvascular and macrovascular disease in T2DM. Methods. Subjects with T2DM of 7.8mmol/L (β=15.83, p=0005) was the sole independent predictor of albuminuria in generalised linear regression. Conclusions. This study demonstrates that hypoglycaemia is associated with the occurrence of atherosclerotic disease while hyperglycaemia is associated with microvascular disease in a Caucasian population with T2DM of recent duration.peer-reviewe

Heart failure with preserved ejection fraction and diabetes mellitus

Heart failure with preserved ejection fraction (HFpEF) constitutes approximately 50% of heart failure patients. The prevalence of diabetes mellitus in HFpEF is high at 30-40%. The paper provides a systematic review of the pathophysiological features underlying HFpEF in diabetes mellitus. The importance of mechanisms other than left ventricular diastolic dysfunction underlying this important condition is emphasised. Thus, ventricular-arterial coupling & vascular dysfunction together with chronotropic incompetence & cardiovascular reserve dysfunction play an important role. The various morphologic and molecular features occurring in the myocardium and vasculature in diabetes secondary to hyperglycaemia and other metabolic disturbances are also discussed. These include microangiopathy, myocardial fibrosis, increased oxidative stress, impaired calcium homeostasis, activation of the cardiac renin-angiotensin system, autonomic neuropathy, endothelial dysfunction, re-expression of foetal gene response as well as stem cell involvement. Nonetheless, a lot is still unknown and further studies are needed to establish the underlying pathophysiological mechanisms with the hope that novel pharmacotherapies targeting this disease will be developed. In the meantime, cardiometabolic factors, including hyperglycaemia, hypertension and dyslipidaemia should be targeted and aggressively treated.peer-reviewe

An audit of the management of diabetic ketoacidosis at St Luke’s Hospital

Aim: To perform an audit of the protocol used in the management of patients with Diabetic Ketoacidosis, in St Lukes Hospital. Methods: Patients admitted with `Diabetes Ketoacidosis', between 14th August 2004 and 14th August 2005, were identified from the Admission book at the Accident and Emergency Department. Data obtained from patients' medical records were collected according to a preset proforma. The criteria assessed by this audit included parameter monitoring, investigations performed, the type and amount of intravenous fluids given, the insulin regime and potassium supplements used. Results: From a total of fifty six patients, forty seven files were traced, of which seventeen satisfied the criteria for Diabetic Ketoacidosis. Two were excluded and fifteen were analysed. In the population studied the mean age was 28 years with a male predominance of 60%. Ten patients suffered from Type 1 Diabetes whilst two patients had Type 2 Diabetes. Three other patients were newly diagnosed. Only one patient had all parameters checked according to protocol. In the majority of patients, fluids given in the first 22 hours, coincided with the amount of fluids stated in the protocol whilst 6/15 (40%) patients were administered the requested amount of insulin via infusion pump. With regards to potassium replacement, 13/15 (87%) patients were started on potassium supplements at a later stage. The factors influencing the total time for conversion to a fixed insulin regime and the duration of stay in hospital were also analysed. Conclusion: Deviations from the protocol were identified in parameter recording, the type of intravenous fluids given and the doses of insulin and potassium supplementation administered. New Diabetic Ketoacidosis guidelines have now been developed.peer-reviewe

Smoking ban : a long-term analysis of the Malta paradox in a population of over 400,000 subjects

Objectives: The introduction of laws that make indoor public areas and workplaces smoke-free has resulted in a significant reduction in the incidence of acute coronary syndromes (ACS). Malta was the second European country to introduce the smoking ban legislation in April 2004. The purpose of the study was to investigate the impact of the smoking ban in Malta on ACS morbidity and mortality. Methods: The number of ACS hospital admissions and the number of cardiovascular deaths were retrospectively analysed. The annual data for 5 years prior to and following the introduction of the Tobacco Act were obtained according to age-groups for both genders. Poisson regression analyses were performed to assess for decline in ACS admission and cardiovascular death. Results: The ACS admission rate increased throughout the 5 years following the introduction of the smoking ban. There was no change in mortality rate in the 5 years following the legislation, except in 2007 when a small but significant decline was noted. Conclusions: The Malta smoking ban did not have a significant impact on cardiovascular mortality and ACS admissions rates, indicating the need for proper enforcement of the public smoking ban and increase in public awareness regarding the adverse effects of smoking.peer-reviewe

Inverted takotsubo cardiomyopathy secondary to adrenaline injection

A young woman presented with severe chest pain and an inverted takotsubo cardiomyopathy following adrenaline injection for treatment of an allergic reaction. To the authors’ knowledge, this is the first reported case of inverted takotsubo cardiomyopathy following systemic adrenaline administration. The case strongly suggests a central role of catecholamines in the pathogenesis of takotsubo cardiomyopathy.peer-reviewe

A review of the aetiology and management of vocal behaviour in dementia

Abstract Vocal behaviour is a common form of agitation displayed by people with dementia. It refers to excessive screaming, abusive language, moaning, perseveration, and repetitive and inappropriate requests. The authors provide a literature review on this form of challenging behaviour, focusing on the aetiological factors and the available treatment options. Emphasis is put on a biopsychosocial approach. The aim of this article is to increase awareness of the condition in elderly nursing residences and hospitals, and to encourage best evidence-based practice