Cognitive Function in Type 2 Diabetes Mellitus Patients Taking Metformin and Metformin-Sulfonylurea

The most prescribed antidiabetic drugs in Indonesian primary health care are metformin or a combination of metformin and sulfonylurea. Studies on metformin have shown various impacts on cognitive decline in patients with type 2 diabetes mellitus, whereas sulfonylurea has been shown to reduce this impact. This study aimed to compare the impacts of metformin and metformin-sulfonylurea on cognitive function and determine what factors affected it. This cross-sectional study was conducted at Pasar Minggu Primary Health Care involving 142 type 2 diabetes mellitus patients taking metformin or metformin-sulfonylurea for > 6 months and aged > 36 years. Cognitive function was assessed using the validated Montreal Cognitive Assessment Indonesian version. The effects of metformin and metformin-sulfonylurea on cognitive decline showed no significant difference, even after controlling for covariates (aOR = 1.096; 95% CI = 0.523–2.297; p-value = 0.808). Multivariate analysis showed age (OR = 4.131; 95% CI = 1.271–13.428; p-value = 0.018) and education (OR = 2.746; 95% CI = 1.196–6.305; p-value = 0.017) affected cognitive function. Since a lower education and older age are likely to cause cognitive decline, health professionals are encouraged to work with public health experts to address these risk factors for cognitive function

Impaired Recent Verbal Memory in Pornography-Addicted Juvenile Subjects

We aimed to find the differences in memory capabilities between pornography-addicted and nonaddicted juveniles. We enrolled 30 juveniles (12–16 y) consisting of 15 pornography addiction and 15 nonaddiction subjects. We used Rey Auditory Verbal Learning Test (RAVLT) to measure verbal memory, Rey–Osterrieth Complex Figure Test (ROCFT) for visual memory, along with Trail Making Test A and B (TMT-A and TMT-B) for attention. We found a significant reduction in the RAVLT A6 result of the addiction group (nonaddiction vs addiction: 13.47 ± 2.00 vs 11.67 ± 2.44, MD � − 1.80, p � 0.04), but not in ROCFT or attention tests. Analysis in sex subgroups yielded no sex-specific difference. We concluded that pornography addiction may be associated with impaired recent verbal memory in juveniles, regardless of sex and without association to attention

Faking Good Among Porn-Addicted Adolescents

Pornography content is becoming an increasingly serious problem in Indonesia, where it is suspected that around 97% of 1,600 children and adolescents have been exposed to pornography. Various efforts have been made by the government to minimize the prevalence of pornography content, such as by blocking porn-suspected sites. It is also known that the exposure of massive and periodic pornography content to children and adolescents can result in adverse effects in the form of addiction. Research results with EEG (Edison, RE., et al) and fMRI (Prawiroharjo, P., et al) have reported changes in the brain activity of children and adolescents who were suspected as having addiction to pornography content. Interestingly, there is a tendency to a phenomenon of faking good among the subjects. This article discusses the phenomenon from the perspectives of psychology and neuroscience

High blood pressure tends to increase carotid intima-media thickness in adult females

Background Atherosclerosis is initiated by endothelial dysfunction, as a result of increasing degradation of nitrit oxide by reactive oxygen species, thereby increasing oxydative stress. Dyslipidemia is one of the risk factors of endothelial dysfunction. The aim of this study was to evaluate the relationship of blood pressure and serum lipid level with carotid intima-media thickness (CIMT) in subjects aged between 55-65 years. Methods A cross sectional study was carried out in 52 male and female subjects aged between 55-65 years. Age, gender, body mass index (BMI), blood pressure, lipid profile, and CIMT were assessed in all subjects. The independent t-test was used to to analyze the relationship between all variables and CIMT. The level of statistical significance was set at p<0.05 Results Mean age was 59.19 ± 3.68 years, prevalence of thickened CIMT was 66.5%, and plaques were found in 9 subjects. There wwre no significant differences in age, BMI, systolic and diastolic blood pressure, and lipid profile between normal and thickened CIMT (p>0.05). However, there was a significant difference in gender between the two groups (p=0.011). In females, mean systolic and diastolic blood pressure were higher in the thickened CIMT group than in the normal CIMT group, but the difference was not significant (p>0.05). Conclusions Our findings suggest that high blood pressure tends to increase CIMT in female adults. An increasing value of CIMT should be considered as a sign of cerebrovascular disease

Comparison of Effects of ACEIs and ARBs on Albuminuria and Hyperkalemia in Indonesian Hypertensive Type 2 Diabetes Mellitus Patients

Purpose. Due to economic consideration, Indonesia’s formulary restrictions are at odds with the treatment guidelines of the American Diabetes Association (ADA) and the Eighth Joint National Committee (JNC 8). ADA and JNC 8 equally recommend the prescription of an angiotensin-converting enzyme inhibitor (ACEI) or angiotensin II receptor blocker (ARB) for hypertensive patients with type 2 diabetes mellitus (T2DM) with overt proteinuria (urine albumin to creatinine ratio (UACR) ≥ 300 mg/g creatinine). However, since 1 April 2018, Indonesian formulary restricted telmisartan and valsartan only for T2DM patients with declined renal function as shown by eGFR value. There is no compelling evidence in favor of ACEI over ARB or vice versa except for data supporting the early use of both drugs in patients with overt proteinuria. However, ARB is a choice if ACEI’s side effects, that is, coughing, occurs. Therefore, it necessitates a detailed evaluation of the effects of ACEIs and ARBs on albuminuria and their side effect, hyperkalemia, specific to Indonesian T2DM patients. Methods. This cross-sectional study involved 134 T2DM patients whose treatment was restricted to either ACEIs (n = 57) or ARBs (n = 77) for at least two months before the study during May–October 2018. Patients with known end-stage renal disease and those receiving dialysis were excluded. UACR and blood potassium levels were compared between the two study groups. Also, the risk factors of albuminuria and hyperkalemia were estimated using multivariate analysis. Results. T2DM patients in the ACEI and ARB groups had similar characteristics except for a higher body mass index (p=0.008), lower glomerular filtration rate (p=0.04), and a longer duration of prior treatment (p<0.001) in the ARB group. This study showed no differences between the ACEI and ARB groups in the proportion of cases with albuminuria (p=0.97) and hyperkalemia (p=0.86), even after adjustment for confounders. In addition, uncontrolled diastolic blood pressure was a significant factor associated with albuminuria (OR: 4.897, 95% CI: 1.026–23.366; p=0.046), whereas a female was 70.1% less likely to develop hyperkalemia than a male (OR: 0.299, 95% CI: 0.102–0.877; p=0.028). Conclusion. This cross-sectional study demonstrated that ACEIs and ARBs have a similar effect on albuminuria and hyperkalemia in Indonesian hypertensive T2DM patients, even after correction for potentially confounding variables

Association between serum homocysteine level and cognitive function in middle-aged type 2 diabetes mellitus patients.

Type-2 diabetes mellitus (T2DM) is strongly associated with various complications, including cognitive impairment. Diabetic complication is related with structural and functional changes of brain. Studies investigated that homocysteine as an independent risk factor of several organ complications. This marker might have a role in pathogenesis of cognitive impairment in T2DM patients. We aimed to know the association between serum homocysteine level and cognitive impairment in middle-aged T2DM populations. The study was a cross-sectional study involving 97 T2DM patients aged <60 years old. Cognitive assessment was based on validated Indonesian version of Montreal Cognitive Assessment (MoCA-INA) test. Besides, serum homocysteine level (Hcy) was measured based on standard laboratory assay. Filling out the questionnaire of MoCA-INA was conducted when patients came to take the blood sample. This study used independent t-test, chi-square and multivariate logistic regression model to analyze the data. There were 47 subjects (48.5%) with mild cognitive impairment (MCI). Delayed recall was the most impaired domain (94.8%). There was no significant mean difference of serum Hcy level in MCI and non-MCI group (11.99±3.27 μmol/L vs 12.36±4.07 μmol/L respectively, p = 0.62). Final model of logistic regression showed no association between serum Hcy and cognitive function after adjusting confounding variables (OR: 1.778; 95%CI: 0.69-4.54). Further investigation involving slight elderly T2DM patients with larger sample size should be conducted to confirm this finding