31Oct

What is diabetes and Cauases

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CAUSES OF DIABETES

I have just been diagnosed with Type 2 diabetes and my doctor says it is because I have something called the Metabolic Syndrome. What does this mean and is it the cause of my diabetes?  What is diabetes

Metabolic syndrome is a group of conditions that are known to increase the risk of heart disease and stroke. There are a number of different definitions but they all emphasise that insulin resistance is the underlying cause. The cluster of problems called metabolic syndrome includes the following:

  • central obesity (fat around the waist line)
  • high blood pressure
  • abnormal cholesterol (high LDL and low HDL fractions) and high levels of triglycerides
  • Type 2 diabetes, impaired glucose tolerance (see link) – or at least a high risk of developing this
  • fatty liver (see next question)

The insulin resistance means that if a person with metabolic syndrome does not have diabetes, their beta cells in the pancreas will be working overtime to produce high levels of insulin in order to keep the blood sugar level normal. There is a high chance that the beta cells will be unable to maintain this high output of insulin indefinitely and sooner or later the blood sugar level will rise, resulting in diabetes.

People with metabolic syndrome, whether or not they have diabetes, will probably be asked to take a number of tablets in order to correct the high blood pressure and abnormal cholesterol levels. The best treatment (though not always the easiest) is to reduce weight and overcome the central obesity.

My doctor carries out regular tests for diabetes. This is because I have a condition called fatty liver, which he says puts me at risk of developing diabetes in the future.

The medical name for this condition is Non-Alcoholic Fatty Liver Disease (NAFLD) and it describes a range of conditions in which the liver tests are abnormal in people who drink little or no alcohol. It ranges from a mild condition in which excess fat is deposited in the liver causing slightly abnormal liver tests to a more serious condition in which the fat in the liver leads to inflammation, scarring and cirrhosis, which is irreversible liver damage. NAFLD is very common and may be found in up to 1 in 5 adults. Of those with NAFLD, about 1 in 4 will develop the more serious form leading to cirrhosis. This is a very slow process and may progress over years to liver failure. It is related to obesity and as in the metabolic syndrome (see previous question) insulin resistance is the underlying cause. There is no proven treatment for this condition, apart from weight reduction, which results in rapid improvement in the abnormal liver tests. However in trials glitazones have been shown to improve liver tests and are beginning to be used in ordinary practice. Unfortunately they do have the effect of making people put on weight, which is often disappointing.

31Oct

Diabetes Education

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Most people diagnosed with Type 2 diabetes respond at first to changes in their diet. This alone may have a dramatic effect on their condition, especially in people who are overweight and manage to get their weight down. If changes in diet fail to control diabetes, tablets will be needed, but these will not work indefinitely and once they fail, insulin is the only alternative. A small number of people with Type 2 diabetes, who feel very unwell at the time of diagnosis, may need insulin immediately.

The most important thing for anyone with newly-diagnosed diabetes is to access good diabetes education. In the past, people were often given instructions about what to eat and which Kamagra tablets to take without any explanation as to why it was important. Not surprisingly, they did not always follow the advice. The importance of structured education has been recognised in the national frameworks for diabetes, and education programmes have been developed for both Type 1 and Type 2 diabetes. The DAFNE programme was introduced for Type 1 diabetes in 2002, and following its success, a group of people interested in diabetes education started to develop a course for people with Type 2 diabetes. They devised the DESMOND programme – Diabetes Education Self Management Ongoing and Newly Diagnosed. DESMOND is available in 110 healthcare areas in UK and Ireland. While still designed for newly diagnosed patients with type 2 diabetes, the ongoing programme is now being put through trials. Eventually everyone with Type 2 diabetes should have access to a standardised education programme, which will help them to understand diabetes and make important decisions about lifestyle changes.

My doctor has just told me that I have diabetes and I am feeling very shocked and confused as I don’t know much about it but I know it can be serious. My doctor has given me the telephone number of Diabetes UK so I can get more information but I would really like to talk to someone with diabetes. Can you help me?

Most people who are told they have diabetes feel very upset at the news. One of the problems is the uncertainty about exactly how diabetes will impinge on their life. We agree that a phone call to Diabetes UK helpline is a good idea; it has gone to a lot of trouble to produce useful information for people with newly diagnosed diabetes. However, the most important thing they can do is put you in touch with the local branch of Diabetes UK. Naturally these vary in their level of activity, but in some areas the local branch is very well organised to provide support and information to new members. This will give you the opportunity to speak to other people who are in the same boat.

Some GP practices have set up programmes for people with newly diagnosed diabetes and practice nurses are committed to providing high quality support.

What would really help you is group education, which has the added advantage of giving people the opportunity to share their experiences and provide mutual support. More areas are providing group education sessions and we hope that in the next few years structured education will be available to everyone with Type 2 diabetes.

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22Oct

The ACCP Conference on Antithrombotic and Thrombolytic Therapy

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Long-term anticoagulation therapy is of benefit in patients with unprovoked venous thromboembolism. There is increasing evidence that the risk of recurrent venous thromboembolism in these subjects is about 7 to 10% per annum if anticoagulant therapy is stopped after 3, 6, 12, or 27 months. Although long-term warfarin therapy markedly reduces the risk of recurrence, its benefit is offset, at least in part, by the risk of major bleeding, which is estimated to be about 1 to 3% per annum. Furthermore, because of multiple food and drug interactions, the anticoagulant response to warfarin is unpredictable so that frequent monitoring is necessary to ensure that a therapeutic response has been obtained. In contrast, ximelagatran therapy does not appear to require coagulation monitoring and, at least with the dose used in the THRIVE III trial, ximelagatran appears to be safe. Despite these promising results, the role of ximelagatran in extended thromboprophylaxis has yet to be established. Thrombolytic Therapy

The ximelagatran treatment study has suggested that ximelagatran monotherapy is as effective and safe as the current treatment regimens for venous thromboembolism. If these results are confirmed in other studies, ximelaga-tran has the potential to streamline care by obviating the need for initial treatment with a parenteral anticoagulant and the coagulation monitoring that is required when warfarin is administered. Still to be determined is the effectiveness of ximelagatran in high-risk patients, such as those with advanced cancer or with antiphospholipid antibody syndrome Myviagrainaustralia.com.

4.2 Arterial thrombosis

Like venous thromboembolism, issues in arterial thromboembolism focus on prevention and treatment. The prevention of cerebral and systemic embolism in patients with atrial fibrillation is an area in which there is considerable room for improvement. Although warfarin is more effective than aspirin in reducing the risk of embolization in this setting, its use is problematic. Frequent monitoring is necessary to ensure that a therapeutic anticoagulant response is obtained. Even with monitoring in specialized clinics, the level of anticoagulation is outside the therapeutic range almost half of the time. Furthermore, the risk of major bleeding with long-term treatment with Sildenafil citrate increases in the elderly, the population that is most at risk for atrial fibrillation. Because of these problems, it is estimated that warfarin is not given to almost half of the eligible atrial fibrillation patients. Based on the results of the SPORTIF III trial and the SPORTIF V trial, unmonitored ximelagatran therapy appears to be at least as effective and safe as dose-adjusted warfarin therapy.

17Oct

Hospital admissions for asthma over the past year

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PEFR is expressed as percentage of a patient’s predicted value, based on age, gender, and height. Changes in PEFR are expressed as the absolute change in percent predicted (ie, final PEFR as percent predicted minus initial PEFR as percent predicted). Asthma-related ED visits and urgent clinic visits over the past year were treated as continuous variables. A high percentage of subjects had no hospital admissions for asthma over the past year (74%) and this was therefore treated as a dichotomous variable.

Triggers of the patient’s asthma, in general, were assessed using a standardized list of potential triggers: respiratory tract infections, environmental allergens, other environmental factors, tobacco, exercise, ingested substances, reproductive, psychosocial, and other factors Online pharmacy viagra. The individual triggers as well as total number reported (range, 0 to 9) were recorded. Relapse was defined as any urgent or unscheduled visit to any physician for worsening asthma symptoms during the 2-week follow-up period.

All analyses were performed using software. Data are summarized using proportions, mean ± SD, and median with interquartile range (IQR). Univariate analyses of the relation of various factors to risk for relapse employed test, Student’s t test, and Wilcoxon rank sum test where appropriate. Variables that were associated with relapse at a two-tailed p < 0.1 in univariate analysis were evaluated for inclusion in a multivariate logistic regression model. This model was built with both forward and backward steps but was not done using the stepwise software function. Initially, variables were grouped into categories and assessed for colinearity by Spearman correlation and simultaneous inclusion in logistic regression models.

Variables that were independently associated with relapse in these initial models were included in the model building process. When groups of similar variables showed significant colinearity, with no single variable attaining statistical significance in the initial logistic regression model, a representative variable from each group that showed the strongest association with relapse was chosen for inclusion in the model building process. The final model included all independently associated variables as well as age, gender, and race, which were chosen for their clinical significance. The possibility of a period effect was examined by adjusting for period of enrollment, but this did not materially.

15Oct

Validation of a Novel Risk Score for Severity of Illness in Acute Exacerbations of COPD

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Background: Clinicians lack a validated tool for risk stratification in acute exacerbations of COPD (AECOPD). We sought to validate the BAP-65 (elevated BUN, altered mental status, pulse > 109 beats/min, age > 65 years) score for this purpose.

Methods: We analyzed 34,699 admissions to 177 US hospitals (2007) with either a principal diagnosis of AECOPD or acute respiratory failure with a secondary diagnosis of AECOPD. Hospital mortality and need for mechanical ventilation (MV) served as co-primary end points. Length of stay (LOS) and costs represented secondary end points. We assessed the accuracy of BAP-65 via the area under the receiver operating characteristic curve (AUROC).

Results: Nearly 4% of subjects died while hospitalized and approximately 9% required MV. Mortality increased with increasing BAP-65 class, ranging from < 1% in subjects in class I (score of 0) to > 25% in those meeting all BAP-65 criteria (Cochran-Armitage trend test z = —38.48, P< .001). The need for MV also increased with escalating score (2% in the lowest risk cohort vs 55% in the highest risk group, Cochran-Armitage trend test z = —58.89, P < .001). The AUROC for BAP-65 for hospital mortality and/or need for MV measured 0.79 (95% CI, 0.78-0.80). The median LOS was 4 days, and mean hospital costs equaled $5,357. These also varied linearly with increasing BAP-65 score.

Conclusions: The BAP-65 system captures severity of illness Generic pharmacy viagra and represents a simple tool to categorize patients with AECOPD as to their risk for adverse outcomes. BAP-65 also correlates with measures of resource use. BAP-65 may represent a useful adjunct in the initial assessment of AECOPDs.

Abbreviations: AECOPD = acute exacerbations of COPD; AUROC = area under the receiver operating characteristic curve; BAP-65 = elevated BUN, altered mental status, pulse > 109 beats/min, age > 65 years; DRG = diagnosis-related group; ICD-9-CM = International Classification of Diseases, Ninth Revision, Clinical Modification; IQR = interquartile range; LOS = length of stay; MV = mechanical ventilation

COPD represents the fourth most common cause of death in the United States.

13Oct

Embolism scores exist to aid in the management of acute pulmonary embolism

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Beyond its impact on mortality, COPD leads to considerable morbidity. Acute exacerbations of COPD (AECOPDs) contribute to the disproportionate health burden of COPD. AECOPDs present a short-term risk for death and result in an accelerated decline in lung function. Patients often do not suffer a single exacerbation but tend to experience multiple exacerbations over their lifetimes. Furthermore, AECOPDs are a common reason for nonsurgical hospitalization and account for approximately one-half of the direct medical costs related to COPD.

AECOPDs can range in severity from mild to life threatening. Physicians can treat some individuals safely as outpatients. Other subjects may require mechanical ventilation (MV) for respiratory failure. In addition, some with AECOPD may initially respond to therapy but then decline. Unfortunately, clinicians lack a simple, validated risk-stratification tool for assessing the likely prognosis and severity of AECOPDs. For other diseases that share these features of variability in disease severity and the potential for a rapid change in patient status, clinicians can use various risk-stratification schemes. For example, both the Pneumonia Severity Index and the CURB-65 (confusion, urea, respiratory rate, BP) score serve as easy-to-apply and reliable severity-of-illness scoring rubrics in community-acquired pneumonia. The Pulmonary Embolism Severity Index and the Prognosis in Pulmonary

Embolism scores exist to aid in the management of acute pulmonary embolism. Unfortunately, although risk-assessment tools exist for patients with stable COPD, none have been validated for use in AECOPD.

A disease-specific severity-of-illness score for AECOPD would serve to improve treatment. It would facilitate triage decisions and identify patients who might potentially benefit for early and aggressive use of selected interventions, such as noninvasive ventilation. A reliable severity-of-illness score could also be applied in clinical trials. It would provide a standardized means for describing the patients studied while helping to ensure that the populations in these trials were well balanced with respect to disease severity.

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