Preliminary evidence supports circulating microRNAs as prognostic biomarkers for type 2 diabetes

Background

Circulating microRNAs are emerging as potential prognostic biomarkers for the development of type 2 diabetes. However, microRNAs are also associated with complications from impaired glucose metabolism (e.g. endothelial cell function). Prior studies have not evaluated for associations between trajectories of circulating microRNAs with trajectories of fasting blood glucose over time and the responses to behavioral interventions to reduce risk. This study performed longitudinal assessment of microRNAs and fasting blood glucose and identified relationships between microRNAs and behavioral risk reduction interventions.

Methods

MicroRNAs (n = 353) were measured in subsets (n = 10, n = 8) of participants from previously completed clinical trials that studied behavioral risk reduction interventions. Fasting blood glucose trajectories were associated with changes in 45 microRNAs over 12 months.

Results

Following a 3‐month physical activity and dietary intervention compared with baseline, 13 microRNAs were differentially expressed. Seven microRNAs (i.e. miR‐106b, miR‐20b, miR‐363, miR‐486, miR‐532, miR‐92a and miR‐93) were commonly identified between the two analyses.

Conclusions

Further studies are needed to determine which microRNAs are prognostic biomarkers of risk for type 2 diabetes versus consequences of impaired glucose metabolism. Additional future directions of this research are to differentiate whether microRNAs are prognostic and/or diagnostic biomarkers for risk for type 2 diabetes and predictive biomarkers of responses to risk reduction interventions.

Clozapine: nursing care considerations

Since its release for clinical use in February of 1990, an ever-growing number of psychiatrists are beginning to use clozapine to treat clients whose psychoses have been refractory to conventional measures. While clozapine has been shown to have superior antipsychotic efficacy without the standard extrapyramidal side effects, it also has some potentially fatal side effects. The unpredictability in client response poses a number of issues for nursing, which has an essential role in assuring that treatment occurs accurately and safely. The authors share their experience in working with clients, families, and staff over the past two years who have been actively involved with clozapine.

Parenteral lorazepam versus parenteral haloperidol for the control of psychotic disruptive behavior

In a double-blind, prospective study, 2 mg of intramuscular lorazepam and 5 mg of intramuscular haloperidol were equally effective in controlling aggression, agitation, and assaultive behavior. Although lorazepam and haloperidol produced an equivalent mean decrease in aggression, significantly more subjects who received lorazepam had a greater decrease in aggression ratings than haloperidol recipients; this effect was independent of sedation. Lorazepam produced significantly fewer extrapyramidal symptoms. These data support the current clinical practice of using lorazepam (alone, or in combination with a neuroleptic) for control of acute aggressive and assaultive behavior.

Sickle cell anemia in the home environment. Observations on the natural history of the disease in Tennessee children

Because the natural history of sickle cell disease and of its variant forms has not been fully studied, because the disease is associated with ma jor socioeconomic problems and with poverty, and because sickle cell anemia and related hemoglobinopathies are frequent, reports of ob servations made in the home environment seem justified and necessary.