Intensive Control of Diabetes in the Hospital: Why,How, and What Is in the Future?

Intensive management of diabetes is identified as a critical component of inpatient care. However, the fundamental question that remains is whether controlling glycemia in noncritically ill diabetes patients at the lower end of the current guidelines improves outcomes of hospitalization, long-term outcomes of the primary condition, and long-term outcomes of diabetes compared with average glycemia greater than 180 mg/dl. A group of clinical investigators--Planning Research in Inpatient Diabetes (PRIDE)--is preparing randomized controlled trials with the hope of defining optimal glycemic targets for hospitalized patients with diabetes. Given the variety of clinical situations that can occur in the inpatient setting, many medical centers have established dedicated inpatient diabetes teams. There is ample evidence, albeit retrospective, that these teams improve inpatient glucose control and reduce lengths of hospital stays. Using hospitalization as an opportunity to educate patients about diabetes and to optimize their treatment regimen may improve long-term outpatient glycemic control.     

Are the 50’s,the transition decade,in choroid plexus aging?

GeroScience - The choroid plexus (CP) is an important structure for the brain. Besides its major role in the production of cerebrospinal fluid (CSF), it conveys signals originating from the brain,...     

HDL cholesterol in cardiovascular diseases: The good,the bad,and the ugly?

Atherosclerotic cardiovascular diseases are the leading cause of death in developed and developing countries. HDL-raising therapeutic modalities (such as cholesterol ester transferase protein (CETP) inhibitors) are being developed to combat these diseases. However, recent setback of two CETP inhibitors (Torcetrapib and Dalcetrapib) has highlighted the importance of measuring qualitative functionality of HDL particles, rather than focusing quantitatively on HDL cholesterol serum concentrations. It has been known that, HDL from patients with coronary artery disease (CAD) (i.e., HDL^CAD) limits the anti-inflammatory and endothelial repair properties of normal HDL, due to the activation of lectin-like oxidized LDL receptor-1 (LOX-1), thereby causing failure in endothelial nitric oxide (NO) production. A more recent study (Immunity 2013; 38: 754–768) also demonstrates that HDL from patients with chronic kidney dysfunction (CKD) (i.e., HDL^CKD), unlike its healthy counterpart (i.e., HDL^Healthy), promotes superoxide production, reduces NO bioavailability and raises blood pressure via toll-like receptor-2 (TLR-2) activation. This study provides novel insights into understanding why HDL-raising agents failed to demonstrate beneficial effects on cardiovascular mortality in large clinical trials and why CKD accelerates the development of atherosclerosis in CAD patients. Further research is warranted to elucidate whether HDL^CKD and HDL^CAD participate in other cellular processes in atherosclerosis, such as foam cell formation, the proliferation and migration of smooth muscle cells, and most importantly, plaque destabilization.     

Malaria epidemiology in low-endemicity areas of the Atlantic Forest in the Vale do Ribeira, São Paulo, Brazil

We describe a seroepidemiological survey of malaria prevalence in two areas of low endemicity: Intervales State Park and Alto Ribeira State Tourist Park (PETAR). Both are located in the Vale do Ribeira in the state of S?o Paulo, Brazil. In this study, 318 subjects from both areas had their blood analyzed for the presence of malaria parasites by thin and thick blood smears. One hundred and sixty-three (51.2%) of the subjects were from Intervales State Park and 155 (48.7%) were from PETAR. We analyzed all the samples by indirect immunofluorescent assay (IFA) to detect antibodies against asexual forms of Plasmodium vivax and Plasmodium malariae and enzyme immunosorbent assay (ELISA) to detect the presence of antibodies against circumsporozoite proteins (CSP) from P. vivax VK210, human P. vivax-like/Plasmodium simiovale, P. vivax VK247 and Plasmodium brasilianum/P. malariae. The presence of Plasmodium species was detected by polymerase chain reaction (PCR). Eighteen of the subjects analyzed had positive IFA results for IgM against P. malariae antigens, and three others were positive for P. vivax antigens. Positivity of IgG antibodies against P. vivax detected by IFA was high in samples from both Intervales State Park and PETAR (32.0% and 49.0%, respectively), while positivity for P. malariae was lower (16.0% and 19.3% in Intervales State Park and PETAR, respectively). ELISA tests showed a higher prevalence of antibodies against P. vivax VK210 (35.0%) in samples from Intervales State Park and against human P. vivax-like (29.7%) in samples from PETAR. PCR reactions revealed the presence of parasites in several of the samples analyzed. In Intervales State Park, one subject was infected by P. malariae and two by Plasmodium falciparum, while in PETAR, one subject was positive for P. falciparum and three for both P. falciparum and P. vivax parasites. The areas where these parks are located belong to the Atlantic Forest habitat, and inhabitants frequently, see monkeys. Our data suggest that monkeys may constitute a natural reservoir for malaria in both areas.     

Cholesterol in end-stage renal disease: the good, the bad or the ugly?

The incidence of cardiovascular disease is markedly increased in patients with end-stage renal disease (ESRD). High serum cholesterol is widely recognised as a cardiovascular risk factor in the general population. However, in patients with ESRD high concentrations of cholesterol are associated with a better survival. This reverse epidemiology is, amongst others, caused by confounding due to malnutrition and chronic inflammation. In this population, treatment with statins to lower the serum cholesterol remains a matter of debate. In ESRD, LDL cholesterol is modified by increased oxidative stress. These altered LDL particles play a pivotal role in the development of atherosclerosis. Treatment with the antioxidant vitamin E has not equivocally been shown to be beneficial in this population. This review tries to put data from literature on dyslipidaemia and oxidative stress in ESRD in perspective.     

Do we know the cause of the highest colorectal cancer incidence, the changes in the mortality trends and the clinical stages in the Slovak and Czech Republic, the representatives of the Central European region?

Slovak (SR) and Czech (CR) Republics reach up the highest recorded incidence rates of colorectal cancer. In analysis of the development and changes in colorectal cancer incidence in the above-mentioned countries, it was reported the most considerable incidence increase of the disease in males in the SR, then in males in the CR, subsequently in females in the SR and the slowest incidence rate was reported in females in the CR. Colorectal cancer mortality increased most rapidly in males in the SR, then in males in the CR, slower increase was reported in females in the SR and in females in the CR the mortality was in the long term stabilized. In both countries and both sexes clinical stage II is noted most frequently, also the decrease of the disease number in the clinical stage I and in undefined stage, and a slight decrease in other clinical stages. The trends in risk factors of colorectal cancer in the SR and CR would support the hypotheses of the later culmination of incidence and on the higher levels than in other developed countries. The purpose of this study is to analyse the character and changes in development of incidence, mortality and clinical stages of colorectal cancer (1980-2005) and to assess the influence of selected risk factors on the highest disease incidence in above-mentioned two Central European countries.     

What are the influences of salt, potassium, the sympathetic nervous system, and the renin-angiotensin system on the circadian variation in blood pressure?

Nocturnal blood pressure patterns are expressed as a consequence of both intrinsic circadian rhythms and the quantity and quality of sleep. A range of neurohumoral factors have been either inferred or definitively proven to influence the circadian blood pressure pattern. In this regard, changes in atrial natriuretic peptide, plasma renin activity and plasma aldosterone have been evaluated as to the influence each might have in determining diurnal blood pressure patterns. As an example, a clear pattern of nocturnal increase in plasma renin activity has been observed; however, the relationship between this change and nocturnal blood pressure remains vague. In contrast, change in sympathetic nervous system activity has most commonly been associated with the conversion of a pattern of nocturnal dips in blood pressure to one of non-dipping. Increasingly, dietary intake patterns, characterized by high sodium or low potassium content, or both, are recognized as modifiers of the normal decrease in nocturnal blood pressure, again in favor of producing a non-dipping pattern. The impact of these nutritional patterns on nocturnal blood pressure change is recognized to be most prominent in salt-sensitive individuals. Modifications of dietary sodium intake, such that it is decreased or potassium intake is increased, or both, are now recognized as means by which a nocturnal non-dipping pattern can be converted to a dipping pattern. Additional studies of an integrative nature will be necessary to obtain more complete definition of the dynamic interplay between nutrition and various neurohumoral axes in determining how nocturnal blood pressure patterns are expressed.     

Lead levels in high-risk populations and the surrounding environment in San Ignacio, Fresnillo, Zacatecas, México

OBJECTIVE: To determine the lead concentration in the blood of children and nursing or pregnant women from San Ignacio, Fresnillo, in Zacatecas, Mexico as well as in soil, plants, ash and lead-glazed pottery, in order to determine exposure due to a metal-recycling facility. MATERIAL AND METHODS: The study was carried out from December 2004 to April 2005. Lead in blood was measured with anodic stripping voltammetry, while dispersive energy X-ray fluorescence was used in the other matrices. RESULTS: Based upon the criteria outlined in the Official Mexican Standards, 90% of the children was identified as category 1, 5% as category II and another 5% as category III. The soil in the land near the facility contained from 73 to 84,238 microg/g, with an average of 4940 microg/g. Larger lead concentrations were found on sites located closer to the facility. San Ignacio's soil contained, on average, 109 microg/g. High lead levels were found in glazed pottery and the concentration in agricultural crops was greater than 300 microg/g. CONCLUSIONS: Although the majority of children in San Ignacio have blood lead concentrations considered to be acceptable according to the Official Mexican Standards, several studies indicate that deleterious effects on children's health exist even at low concentrations.The land around the metal recycling facility is contaminated with lead, and to that extent, the crops that are produced there, once ingested, are a source of contamination, which is compounded by the use of glazed pottery.     

Cysticercosis-Related Hospitalizations in the United States, 1998–2011

Cysticercosis has become increasingly recognized as an important infection in the United States in recent decades. Despite its potential impact, there is a lack of comprehensive information on the nationwide burden of disease. To better define the burden of cysticercosis in the United States, we analyzed in-patient records using the Nationwide Inpatient Sample for 1998–2011 to estimate cysticercosis-related hospitalizations and patient/institutional characteristics. There were an estimated 33,060 (95% confidence interval [95% CI] = 29,610.5–36,510.3) cysticercosis-related hospitalizations nationwide, representing a hospitalization rate of 8.03 per million population. The highest proportion of cases were male (54.8%), Hispanic (62.0%), aged 18–44 (58.8%), and occurred in the West (45.1%). An estimated 459 deaths occurred, representing an in-hospital case-fatality rate of 1.4%. These findings indicate the burden of cysticercosis-related hospitalizations in the United States is considerable and may be greater than currently appreciated. Cysticercosis should be a nationally reportable disease.