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1.
Purpose
Several studies have been published about the effect of garlic on lipid profile and blood glucose in diabetic patients. Which, the results mostly contradict with each other. This study aimed to investigate the effect of garlic on lipid profile and serum glucose levels in diabetic patients using a systematic review and meta-analysis.Methods
This study was a systematic review and meta-analysis of articles published between 1988 and 2016. For this purpose, two independent researchers searched SID medical information databases including MagIran, Irandoc, Medlib, Iran Medex, Science Direct, Scopus, Google and PubMed using keywords. Data were analyzed using STATA software.Results
After the initial search, 23,000 articles were found, of which 33 had the required criteria for the meta-analysis. In the present study, the total sample under review was 1273 individuals, with a mean of 39 samples per study. Overall, the garlic was more influential than placebo in reducing the levels of lipid parameters including triglycerides (TG), total cholesterol (TC), high density lipoprotein (HDL), low density lipoprotein (LDL), and fasting blood sugar (FBS) and HbA1C. In the meta-analysis, the concentration of serum TC, LDL, TG, and HDL in the group receiving garlic compared with the placebo showed a significant decreased for 16.87 mg/dl (95% CI, ?21.01, ?12.73) (P = 0.001), 9.65 mg/dl (95% CI, ?15.07, ?4.23) (P = 0.001), 12.44 mg/dl (95% CI, ?18.19, ?6.69) (P = 0.001), and increased for 3.19 mg/dl (95% CI, 1.85, 4.53) (P = 0.001), respectively. Also, the concentration of serum FBS and HbA1C serum showed a significant decreased for 10.90 mg/dl (95% CI, ?16.40, ?5.40) (P = 0.001) and 0.60 mg/dl (95% CI, ?0.98, ?0.22) (P = 0.001), respectively.Conclusion
Garlic can reduce lipid profile as well as glucose parameters and be therapeutically effective in patients suffering from cardiovascular diseases and diabetes. 相似文献2.
María José Fernández-Landa Adrián Hugo Aginagalde Eunate Arana-Arri Luis Bujanda Isabel Idígoras Isabel Bilbao Isabel Portillo Rodrigo Jover 《Gastroenterologia y hepatologia》2019,42(2):73-81
Introduction
Colonoscopy is the diagnostic/therapeutic confirmation test for colorectal cancer. The monitoring of the experience of people who have undergone the test is interesting to improve the quality of the colonoscopy. The aim of the project was to study factors affecting patients’ experience and their relationship with the quality indicators of the Clinical Practice Guidelines.Patients and methods
An observational cross-sectional study was conducted, including quality and experience indicators (adapted mGHAA-9 questionnaire and clinical history) in a sample of 432 participants aged between 40- and 75-years-old who had undergone a colonoscopy in 2015. Univariate and multivariate analysis with multiple logistic regression.Results
Satisfaction was associated in the multivariate analysis with evaluating the waiting time for the colonoscopy as short (OR = 3.80) (1.76-10.90, 95% CI), >55-years-old (OR = 2.60) (1.19-5.68, 95% CI), rating the experience with the preparation positively (OR = 7.34) (3.15-17.09, 95% CI), not reporting pain or discomfort during the procedure (OR = 3.71) (1.03-13.40, 95% CI) (P = .006) and being examined in a tertiary hospital (OR = 2.81) (1.17-6.72; 95% CI) (P = .020).Discussion
The mGHAA-9 questionnaire adapted to Spanish is useful to evaluate patient experience factors. There are aspects to improve in terms of waiting time, colon cleansing, satisfaction with preparation and post-colonoscopy problems. Interventions should be implemented to enhance patient experience and colonoscopy quality. 相似文献3.
Francisco Campos-Rodriguez Nuria Reyes-Nuñez Carlos Queipo-Corona Angeles Sanchez-Armengol Bernabe Jurado-Gamez Jose Cordero-Guevara Maria F. Troncoso Araceli Abad-Fernandez Julian Caballero-Rodriguez Mercedes Martin-Romero Ana Encabo-Motiño Lirios Sacristan-Bou Javier Navarro-Esteva Maria Somoza-Gonzalez Juan F. Masa Maria A. Sanchez-Quiroga Beatriz Jara-Chinarro Belen Orosa-Bertol Andrea Crespo Sedano 《Archivos de bronconeumología》2019,55(4):201-207
Objectives
Although an association between uric acid (UA) levels and obstructive sleep apnea (OSA) has been reported, the effect of continuous positive airway pressure (CPAP) on this measure is yet unclear. We aimed to investigate the effect of CPAP therapy on serum UA levels in patients with OSA.Methods
We conducted a multicenter, open-label, randomized controlled trial in 307 women diagnosed with moderate-to-severe OSA (apnea-hypopnea index [AHI] ≥ 15) in 19 Spanish Sleep Units. Women were randomized to CPAP (n = 151) or conservative treatment (n = 156) for 12 weeks. Changes in serum UA measures were assessed on an intention-to-treat basis. Additional analyses were conducted in the subgroup of women with CPAP adherence ≥4 h/night and those with UA levels ≥6 mg/dl.Results
Women had a mean (SD) age of 57.1 (10.1) years, median (first–third quartile) body mass index of 33.7 (29.0–38.5) mg/kg2 and AHI of 32.0 (22.6–48.5). The average serum UA measure was 5.11 (1.26) mg/dl, and 80 (26.1%) participants had UA ≥ 6 mg/dl. Compared with the control group, the CPAP group did not achieve any reduction in UA levels (non-adjusted intergroup difference ?0.03 mg/dl, 95%CI ?0.20 to 0.13; p = 0.702) after 12 weeks of follow-up. These results did not change when the analysis was restricted to women with CPAP adherence ≥4 h/night, or the subgroup of women with hyperuricemia.Conclusions
Twelve weeks of CPAP therapy does not reduce UA levels compared to conservative treatment in women with moderate-to-severe OSA. 相似文献4.
Low normal fasting glucose and risk of accidental death in Korean adults: A prospective cohort study
Aim
This study aimed to prospectively examine whether low normal glucose levels and hypoglycaemia are associated with increased mortality due to external causes, especially unintentional accidents.Methods
A total of 345,318 normoglycaemic Korean adults who had undergone health examinations during 2002–2003 were followed-up to 2013. To avoid potential biases related to glucose-lowering medication use, those with known diabetes or hyperglycaemia were excluded.Results
During 3.6 million person-years of follow-up, 1293 participants died because of unintentional accidents. Hazard ratios (HRs) for these accidental deaths were 1.26 (95% CI: 1.11–1.42), 1.60 (1.21–2.11) and 3.07 (1.37–6.85) for fasting serum glucose (FSG) levels of 70–79, 55–69 and < 55 mg/dL (3.9–4.4, 3.05–3.83 and < 3.05 mmol/L), respectively, compared with 80–99 mg/dL (4.44–5.5 mmol/L). FSG levels < 80 mg/dL were associated with an approximately 30% higher mortality due to accidents: specifically, 40% were non-fall-related injury; 50% were automobile-related; and 80% were motorcycle-related. The associations were weak (approximately 10% higher mortality, with P > 0.05 for each cause) for deaths due to traffic accidents (pedestrians, pedal cyclists), falls, intentional self-harm and physical assault. The population attributable risks for FSG levels < 80 mg/dL were 10% (95% CI: 2–18%) for non-fall-related injury, 11% (6–17%) for car accidents and 17% (6–27%) for motorcycle accidents.Conclusion
FSG levels of 70–79 mg/dL (3.9–4.4 mmol/L) as well as < 70 mg/dL are risk factors for accidental death. Appropriate management of the impact of FSG levels < 80 mg/dL might reduce unintended deaths due to non-fall-related injury, and automobile and motorcycle accidents, by ≥ 10%. 相似文献5.
Agustín Julián-Jiménez María Cecilia Yañez Juan González-del Castillo Manuel Salido-Mota Begoña Mora-Ordoñez María Jesús Arranz-Nieto Manuel R. Chanovas-Borras Ferrán Llopis-Roca Josep María Mòdol-Deltell Gema Muñoz 《Enfermedades infecciosas y microbiología clínica》2019,37(1):11-18
Objectives
To analyse and compare 30-day mortality prognostic power of several biomarkers (C-reactive protein, procalcitonin, lactate, suPAR and pro-adremomedullin) in elderly patients seen in Emergency Departments (ED) due to infections. Secondly, if these could improve the prognostic accuracy of sepsis criteria (systemic inflammatory response syndrome and quick Sepsis-related Organ Failure Assessment [qSOFA]).Methods
A prospective, observational, multicentre and analytical study. Patients aged 75 years and older who were treated for infection in the ED of 8 participating hospitals were enrolled consecutively. An assessment was made of 25 independent variables (epidemiological, comorbidity, functional, clinical and analytical variables) that could influence short-term mortality (at 30 days).Results
The study included 136 patients, 13 (9.5%) of whom died within 30 days of visiting the ED. MR-proADM is the biomarker with the best area under the curve ROC to predict 30-day mortality (0.864; 95% CI 0.775-0.997; P < .001) with a prognostic cut-off > 2.07 nmol/l, sensitivity of 77% and specificity of 96%. The qSOFA score ≥ 2 had an area under the curve ROC of 0.763 (95% CI 0.623-0.903; P = .002), sensitivity of 76% and specificity of 75%. The mixed model (MR-proADM plus qSOFA ≥ 2) improved the area under the curve ROC to 0.878 (95% CI 0.749-1; P < .001) with the best prognostic performance with sensitivity of 69% and specificity of 97%Conclusions
MR-proADM showed the best performance for 30-day mortality prognostic power compared to other biomarkers in elderly patients seen in EDs due to infections. qSOFA score achieves better results than systemic inflammatory response syndrome, and the mixed model (qSOFA ≥ 2 plus MR-proADM > 2.07 nmol/l) increased the predictive power of qSOFA. 相似文献6.
Sara Hernández Egido Ana de Luis Reboredo Alicia García Señán Ana Belén Gil González Juan Luis Muñoz Bellido José Manual González Buitrago Fernando Sánchez-Juanes 《Enfermedades infecciosas y microbiología clínica》2019,37(4):244-250
Introduction
We have developed a MALDI-TOF-mediated phenotypic method, which determines antibiotic susceptibility (AS) from positive blood cultures (BCs) in 2 h. We developed a software for process automation. We report results on Escherichia coli-positive BCs with cefotaxime (CTX) and ciprofloxacin (CIP).Methods
We studied CIP and CTX activity in 18 and 17 real E. coli-positive BCs, and in 56 and 45 spiked BCs, respectively. Positive BCs were incubated for 2 h without any antibiotics, and with 2 mg/l and 4 mg/l of CIP and CTX. The extraction was performed using ethanol/formic acid. Spectra were processed with specifically developed software which compares the peaks’ intensity and the size of specific peaks.Results
The set cut-off point was a 3-fold decrease in the summation of all peaks and/or the 5382m/z peak value (ribosomal protein L34). In simulated BCs, the correlation of CIP 2 mg/l and 4 mg/l with Etest® was 94.6% and 98.2%, respectively; for CTX 2 mg/l and 4 mg/l, this correlation was 95.6%. In real BCs, the correlations were 100% for CIP (2 mg/l and 4 mg/l) and 88.2% and 94.1% for CTX 2 mg/l and 4 mg/l, respectively. Resistant isolates were always correctly classified.Conclusion
This method provides accurate, fast and inexpensive AS information. The method can be automated, making it easier to implement in a microbiology laboratory routine. 相似文献7.
Francesco Fici Elif Ali Bakir Sengul Beyaz Wim Makel Nicolas Roberto Robles 《Primary Care Diabetes》2018,12(6):558-564
Background
Albuminuria is an early marker of kidney disease in patients with diabetes and/or hypertension undetected or untreated albuminuria is a leading cause of chronic kidney disease and cardiovascular events, The purpose of the present survey was to assess the prevalence of albuminuria in patients with diabetes and hypertension, treated with a combinations of renin angiotensin aldosterone system inhibitors and dihydropyridine calcium channel blockers.Methods
The survey was performed in 105 Primary Care Units in Turkey and involved outpatients, routinely visited by either a specialist or a non-specialist physician.Albuminuria was evaluated in a spot morning urine sample, as albumin–creatinine ratio, using the Multistic-Clinitek-device analyzer (Siemens), that has a strong correlation with 24-h urinary albumin excretion. Microalbuminuria was defined as a loss of 3.4–33.9 mg albumin/mmol creatinine and macroalbuminuria as a loss of >33.9 mg albumin/mmol creatinine. Diabetes was assessed through documented blood glucose concentration or use antidiabetic drugs, whereas hypertension through blood pressure measurement and current antihypertensive treatment.Results
The survey enrolled 1708 subjects with a prevalence of type 2 diabetes (87.6%). Albuminuria was detected in 52.0% of patients. Blood pressure was controlled in 37.0% and diabetes in 56.7%. The risk of albuminuria was significantly high in patients with uncontrolled diabetes (p < 0.001) and blood pressure (p = 0.009).Conclusions
In a large cohort of treated hypertensive patients with diabetes, albuminuria was present in about 50% and was correlated with poor diabetes and blood pressure control. Systematic screening of albuminuria, particularly in Primary Care, is an important tool for the early diagnosis of nephropathy. 相似文献8.
Florencio García-Martín Sonsoles Guadalix Fernando García-Boyano Natalia Melón Peña José Ignacio Martínez Pueyo Ramiro Callejas Martínez Manuel Praga Terente 《Nefrología : publicación oficial de la Sociedad Espa?ola Nefrologia》2019,39(2):160-167
Introduction
Primary hyperparathyroidism (PHPT) is a common endocrine disorder characterised by hypercalcaemia and parathormone increase. Decreased glomerular filtration rate (< 60 ml/min) continues to be a parathyroidectomy (PTX) criterion in asymptomatic PHPT. The influence of PTX on renal function evolution is the subject of debate.Objective
To analyse the clinical, laboratory and histological characteristics of patients undergoing PHPT, as well as renal function evolution after PTX.Material and methods
Retrospective study of 297 patients diagnosed with PHPT and referred to surgery in a single centre between 1998 and 2016. Laboratory parameters were determined at baseline, one week and one year after PTX.Results
The Incidence of PTX was 38 cases/million/year. Mean age was 60 ± 14 years and 80.5% of the patients were female. Approximately 65.3% were asymptomatic. Nephrolithiasis was the most common clinical finding (33%), followed by bone involvement (29.5%). PTX indications were: clinical symptoms (34.7%), hypercalcaemia > 11.2 mg/dl (27%), nephrolithiasis (13%), low bone mass (12%), age < 50 years (11%) and decreased glomerular filtration rate < 60 ml/min (2.3%).For diagnostic localisation, spect-MIBI had a sensitivity of 92% and cervical ultrasound of 70%. A total of 94.3% of PHPT cases were due to a parathyroid adenoma.After PTX, normalisation of PHPT-related parameters was observed. We found a significant increase in serum creatinine levels (0.81 vs 0.85 mg/dl, P < .001) from the first week post-PTX until the end of the first year. The renal function was only found to be significant in patients with glomerular filtration rate > 60 ml/min (baseline serum creatinine levels 0.77 mg/dl vs serum creatinine levels after one year 0.81 mg/dl, P < .001).Conclusions
PHPT was asymptomatic in most patients who underwent surgery. Hypercalcaemia and nephrolithiasis were the most common indications of parathyroidectomy in asymptomatic patients. MIBI scan was the most useful localisation method. Surgical treatment of PHPT is followed by renal function impairment, which persists after the first week post-PTX. 相似文献9.
K. Douros D. Kotzia C. Kottaridi A. Giotas B. Boutopoulou E. Bozas V. Matziou K. Priftis V. Papaevangelou 《Allergologia et immunopathologia》2019,47(3):260-264
Aim
To prospectively evaluate interferences between viruses of the upper respiratory tract in asymptomatic preschool children.Methods
Nasal-pharyngeal swabs from 233 preschool aged children were prospectively collected over four consecutive time periods, during one school year. The samples were tested using a RT-PCR DNA/RNA microarray system for nine respiratory viruses.Results
Respiratory syncytial virus (RSV) was a predictor of the presence of influenza virus (INFL) (OR: 9.12, CI: 1.52–54.75, p = 0.016), and similarly, INFL predicted the presence of RSV (OR: 4.01, CI: 1.14–14.16, p = 0.030). Also, rhinovirus (RV) was a predictor of adenovirus (ADV) presence (OR: 3.66, CI: 1.10–12.14, p = 0.034), and similarly, ADV predicted the presence of RV (OR: 4.05, CI: 1.02–16.05, p = 0.046). No other significant associations between viruses were observed.Conclusion
Our results indicate that respiratory viruses found in carrier stage in asymptomatic children may interact with other viruses and even facilitate their settling in the upper respiratory tract. The pathophysiological role of these interactions is not yet clear. 相似文献10.
Flaviu Bob Adalbert Schiller Romulus Timar Daniel Lighezan Oana Schiller Bogdan Timar Cristiana Georgeta Bujor Mircea Munteanu Florica Gadalean Adelina Mihaescu Iulia Grosu Andreea Hategan Lazar Chisavu Agneta-Maria Pusztai Adrian Covic 《Nefrología : publicación oficial de la Sociedad Espa?ola Nefrologia》2019,39(3):250-257
Background
Klotho is found in two forms: a transmembrane form and a soluble form (s-Klotho). In order to be excreted, s-Klotho, that is too large to be filtered, will probably reach the proximal convoluted tubule by a transcytosis process. The aim of our study was to show the relationship between the levels of s-Klotho and tubular injury in patients with diabetic kidney disease (DKD), using as tubular injury marker the kidney injury molecule-1 (KIM-1).Methods
Our study included 63 DKD patients (stages 1–5, mean eGFR 65.15 ± 32.45 ml/min) with a mean age 58.13 ± 12 years. In all patients we determined serum levels of: KIM-1 and s-Klotho using ELISA, urinary albumin/creatinine ratio (UACR) and reduction in the estimated glomerular filtration rate (eGFR) per year.Results
We found a strong statistically significant correlation of s-Klotho with the rate of reduction of eGFR/year (r = 0.714, p = 0.0004) and with the tubular injury marker KIM-1 (r = 0.758, p = 0.005) and strong correlations of UACR with the rate of reduction of eGFR/year (r = 0.53, p < 0.01), KIM-1 (r = 0.49, p < 0.05) and s-Klotho (r = 0.52, p < 0.01).Conclusion
Despite previous published data, that shows a decrease of s-Klotho in chronic kidney disease, in our study the rapid annual decline of kidney function but not the level of eGFR was associated with increased s-Klotho. A possible explanation could be a more severe proximal tubule injury that could lead to a reduction of tubular excretion of s-Klotho as suggested by the correlation of s-Klotho levels with the serum levels of KIM-1. 相似文献11.
Lucía Silva-Fernández Teresa Otón Anca Askanase Patricia Carreira Francisco Javier López-Longo Alejandro Olivé Íñigo Rúa-Figueroa Javier Narváez Esther Ruiz-Lucea Mariano Andrés Enrique Calvo Francisco Toyos Juan José Alegre-Sancho Eva Tomero Carlos Montilla Antonio Zea Esther Uriarte Jaime Calvo-Alén José Luis Andreu 《Reumatología clinica》2019,15(1):34-42
Objectives
The course and long-term outcome of pure membranous lupus nephritis (MLN) are little understood. The aims of this study are to evaluate the clinical features, course, outcome and prognostic indicators in pure MLN and to determine the impact of ethnicity and the type of health insurance on the course and prognosis of pure MLN.Methods
We conducted a retrospective review of medical records of 150 patients with pure MLN from Spain and the USA.Results
Mean age was 34.2 ± 12.5 and 80% were women. Sixty-eight percent of patients had nephrotic syndrome at diagnosis. The average serum creatinine was 0.98 ± 0.78 mg/dl. Six percent of patients died and 5.3% developed end-stage renal disease (ESRD). ESRD was predicted by male sex, hypertension, dyslipidemia, high basal 24 h-proteinuria, high basal serum creatinine and a low basal creatinine clearance. Age, cardiac insufficiency, peripheral artheriopathy, hemodialysis and not having received mycophenolate mofetil or antimalarials for MLN predicted death.Conclusions
Pure MLN frequently presents with nephrotic syndrome, high proteinuria and normal serum creatinine. Its prognosis is favourable in maintaining renal function although proteinuria usually persists over time. Baseline cardiovascular disease and not having a health insurance are related with poor prognosis. 相似文献12.
Gabriel Horta-Baas Adolfo Camargo-Coronel Dafhne Guadalupe Miranda-Hernández Leslie Gabriela Gónzalez-Parra María del Socorro Romero-Figueroa Mario Pérez-Cristóbal 《Reumatología clinica》2019,15(3):140-145
Introduction
End-stage renal disease (ESRD) due to lupus nephritis (LN) occurs in 10%-30% of patients. Initially systemic lupus erythematosus (SLE) was a contraindication for kidney transplantation (KT). Today, long-term graft survival remains controversial. Our objective was to compare the survival after KT in patients with SLE or other causes of ESRD.Methods
All SLE patients who had undergone KT in a retrospective cohort were included. Renal graft survival was compared with that of 50 controls, matched for age, sex, and year of transplantation. Survival was evaluated by the Kaplan-Meier test and the Cox proportional hazards model.Results
Twenty-five subjects with SLE were included. The estimated 1-year, 2- and 5-year survival rates for patients with SLE were 92%, 66% and 66%. Renal graft survival did not differ between patients with SLE and other causes of ESRD (P = .39). The multivariate analysis showed no significant difference in graft survival between the two groups (hazard ratio, HR = 1.95, 95% confidence interval [CI] 0.57-6.61, P = .28). The recurrence rate of LN was 8% and was not associated with graft loss. Acute rejection was the only variable associated with graft loss in patients with SLE (HR = 16.5, 95% CI 1.94-140.1, P = .01).Conclusions
Renal graft survival in SLE patients did not differ from that reported for other causes of ESRD. 相似文献13.
Aims
rs5219 is in Potassium inwardly-rectifying channel, subfamily J, member 11 (KCNJ11) E23K gene, located at 11p15.1. Researches on the association between rs5219 gene polymorphism with type 2 diabetes mellitus (T2DM) were performed extensively, but the results remain controversial. To investigate the relationship, a meta-analysis involving 21,464 individuals was conducted.Methods
Odds ratios (OR) and 95% confidence intervals (CI) were used to assess the strength of this association. Publication bias was evaluated with Begg’s test. Our research includes three gene models: allelic genetic model (K-allele vs. E-allele), recessive genetic model (KK vs. EK + EE) and dominant genetic model (EE vs. EK + KK).Results
In allelic genetic model, subgroup analysis demonstrated rs5219 K-allele was relevant to T2DM risk in Caucasian (OR: 1.16, 95% CI: 1.09–1.24, P = 0.000) and East Asian (OR: 1.19, 95% CI: 1.13–1.26, P = 0.000), recessive genetic model indicated rs5219 KK genotype was related to T2DM risk in Caucasian, East Asian, South Asian, and North African (OR: 1.27, 95% CI: 1.17–1.38, P = 0.000), dominant genetic model pointed out rs5219 EE genotype was an opposite association with T2DM risk in Caucasian (OR: 0.86, 95% CI: 0.78–0.94, P = 0.001). No obvious evidence of publication bias was found.Conclusions
There was a believable evidence to verify that rs5219 variation was associated with T2DM. 相似文献14.
Xiandong Gu Xuming Luo Xiongbiao Wang Jihong Tang Wei Yang Zhuying Cai 《Primary Care Diabetes》2018,12(5):460-466
Background
The aim of this study was to explore the correlation between obstructive sleep apnea (OSA) and diabetic neuropathy.Materials and methods
After working out searching strategy, literatures were screened from the electronic databases: PubMed, Embase, and the Cochrane library. R 3.12 was utilized to perform meta-analysis, and odds ratio (OR) and its 95% confidence interval (CI) were used to present effect size. Heterogeneity was assessed by χ2-based Q test and I2 statistics. Publication bias was estimated by Egger’s test and sensitivity was evaluated by leave one out methods.Results
According to the criteria, a total of 11 studies with 1842 patients were enrolled in this study. With a significant heterogeneity (Q = 31.83, I2 = 68.60%), the random effects model was utilized to assess the effect size of pooled data. A remarkable correlation was identified OSA and diabetic neuropathy (OR = 1.84, 95% CI: 1.18–2.87) without publication bias (t = 1.68, P = 0.13). Meanwhile, the result of leave one out performed a well sensitivity. Moreover, the subgroup analyses presented that OSA was significantly correlated with type 1 diabetic neuropathy (OR = 1.97, 95% CI: 1.19–3.25), but no remarkable correlation was identified between OSA and type 1 (OR = 1.84, 95% CI: 0.86–3.93) or 1 + 2 (OR = 1.30, 95% CI: 0.43–3.92) diabetic neuropathy.Conclusion
OSA was significantly correlated with neuropathy in type 1 diabetes, but not in type 2 and type 1 + 2 diabetes. 相似文献15.
M.M.J. Zanders H.R. Haak M.P.P. van Herk-Sukel R.M.C. Herings L.V. van de Poll-Franse J.A. Johnson 《Diabetes & metabolism》2018,44(1):22-29
Aim
This study explores the changes in glucose-lowering drug (GLD) use before and after cancer diagnosis among patients with diabetes.Methods
New GLD users (1998–2011) living in the Dutch ECR–PHARMO catchment area were selected from the PHARMO Database Network (n = 52,228). Those with a primary cancer diagnosis were considered cases (n = 3281) and matched with eligible controls (n = 12,891) without cancer during follow-up. Conditional logistic regression analysis was used to assess changes in GLD use, such as treatment add-ons, treatments drops and initiation of insulin, for cases compared with controls associated with specific cancer types in four time windows (6–3 and 0–3 months before cancer diagnosis; 0–3 and 3–6 months after cancer diagnosis).Results
In the 3 months before cancer diagnosis, patients with upper gastrointestinal (GI) cancers (oesophageal, stomach, pancreatic, liver cancers) had higher odds of initiating insulin (OR: 9.3; 95% CI: 3.6–24.1); to a lesser extent, this was also observed in the 3 months prior to that (at 6 months, OR: 3.9; 95% CI: 1.3–12.1). Diagnosis of colorectal (OR: 3.4; 95% CI: 1.4–8.4), pulmonary (OR: 2.5; 95% CI: 1.1–5.4) and upper GI (OR: 13.6; 95% CI: 5.0–36.9) cancers was associated with increased odds of initiating insulin in the 3 months after cancer diagnosis. During all study time windows, the odds of treatment drops were higher for patients with upper GI cancers whereas, for most other cancers, these odds were higher only after a diagnosis of cancer.Conclusion
The greater odds of initiating insulin during the 6 months prior to diagnosis of upper GI cancers suggest reverse causation. After cancer diagnosis, drops in use of GLDs was commonly seen. 相似文献16.
Mauricio Restrepo-Escobar Paula Andrea Granda-Carvajal Fabián Jaimes 《Reumatología clinica》2019,15(1):27-33
Objective
To develop a multivariable clinical prediction model for the requirement of aggressive immunosuppression with cytostatics, based on simple clinical record data and lab tests. The model is defined in accordance with the result of the kidney biopsies.Methods
Retrospective study conducted with data from patients 16 years and older, with SLE and nephritis with less than 6 months of evolution. An initial bivariate analysis was conducted to select the variables to be included in a multiple logistic regression model. Goodness of fit was evaluated using a Hosmer–Lemeshow test (H–L) and the discrimination capacity of the model by means of the area under the ROC (AUC) curve.Results
Data from 242 patients was gathered; of these, 18.2% (n = 44) did not need an addition of cytostatics according to the findings of their kidney biopsies. The variables included in the final model were 24-h proteinuria, diastolic blood pressure, creatinine, C3 complement and the interaction of hematuria with leukocyturia in urinary sediment. The model showed excellent discrimination (AUC = 0.929; 95% CI = 0.894–0.963) and adequate calibration (H–L, P = .959).Conclusion
In recent-onset LN patients, the decision to use or not to use intensive immunosuppressive therapy could be performed based on our prediction model as an alternative to kidney biopsies. 相似文献17.
Aim
To investigate the association between serum bilirubin and distal symmetrical polyneuropathy (DSPN) in Chinese patients with type 2 diabetes (T2D).Methods
A total of 1800 inpatients with T2D (including 68 with 1-year follow-ups) were consecutively enrolled between June 2014 and March 2017. DSPN was diagnosed according to criteria recommended by the Toronto Diabetic Neuropathy Expert Group in 2010. Clinical data were retrospectively collected.Results
Patients with vs. without DSPN had low levels of serum total bilirubin (9.9 ± 3.1 μmol/L vs. 10.7 ± 2.8 μmol/L; P < 0.01) and unconjugated bilirubin (6.7 ± 2.2 μmol/L vs. 7.3 ± 2.1 μmol/L; P < 0.01), respectively. Patients in the lowest tertiles of bilirubin had the highest rates of DSPN and slowest nerve conduction velocities (NCVs). After multivariate adjustment, low levels of unconjugated bilirubin were a risk factor (OR: 0.696, 95% CI: 0.494–0.981; P = 0.038, highest vs. lowest) for the presence of DSPN. Furthermore, in the 68 patients who had 1-year follow-ups, those with the lowest tertiles of serum bilirubin showed maximum deterioration in NCVs. These changes remained significant even after multivariate adjustment.Conclusion
Low levels of serum bilirubin, especially unconjugated bilirubin, contributed to the presence and progression of DSPN in Chinese patients with T2D. Thus, serum unconjugated bilirubin may be used as an additional indicator of risk and progression of DSPN. 相似文献18.
V. Kvedariene B. Sitkauskiene L. Tamasauskiene O. Rudzeviciene V. Kasiulevicius G. Nekrosyte E.R. Gomes P. Demoly 《Allergologia et immunopathologia》2019,47(1):32-37
Introduction and objectives
Drug hypersensitivity reactions (DHRs) are the adverse effects of drugs that, when taken at doses generally tolerated by normal subjects, clinically resemble allergy. We aimed to assess the prevalence of self-reported DHRs among Lithuanian children and adults and to identify possible risk factors.Materials and methods
A cross-sectional survey of a population visiting their general practitioners in Vilnius and Kaunas regions of Lithuania was performed. Thirty-five questions on drug allergy symptoms, in addition, food, pollen allergy and family history were included.Results
3222 (60.0%) children and 2148 (40.0%) adults were included in the study. 7.9% of children and 13.8% of adults reported a DHR for at least one drug (p < 0.001). 69.8% of children and 47.3% of adults, who indicated DHRs, had skin symptoms. Rate of anaphylaxis was similar in both groups (about 10%). 4.5% of children and 7.3% of adults had DHRs induced by antibiotics and this was the most implicated group of drugs. Significant self-reported risk factors for DHRs were family history of DHRs (OR = 6.007, 95%CI 4.756–7.587), pollen allergy (OR = 2.0, 95%CI 1.573–2.544), food allergy (OR = 1.92, 95%CI 1.505–2.448), female gender (OR = 1.439, 95%CI 1.187–1.744) and age (OR = 1.017 in favour of adults, 95%CI 1.013–1.021).Conclusions
The prevalence of self-reported DHRs in Lithuania is higher among adults than children. Drug-induced skin reactions were the predominant symptom in both groups. Besides female gender and age, a positive family history of DHR and presence of pollen or food allergy may be associated with DHR. 相似文献19.
C. Fourgeaud L. Simon B. Benoughidane S. Vignes 《La Revue de médecine interne / fondée ... par la Société nationale francaise de médecine interne》2019,40(3):151-157
Background
Sirolimus is a mammalian target of rapamycin (mTOR) inhibitor used after organ transplantation and to treat vascular malformations. Among its adverse effects, limb lymphedema has been described.Objective
The aim of this study was to analyze the clinical features, lymphoscintigraphy and lymphedema outcome in patients treated with sirolimus.Patients and methods
Monocentric retrospective study from January 2008 to September 2017 analyzing all consecutive patients having lymphedema occurring with sirolimus.Results
Fifteen patients (7 men, 8 women), mean age at the first visit, 56 years (range: 38–76), had a kidney transplant (n = 12), liver transplant (n = 1), or lymphangioleiomyomatosis (n = 2) treated with sirolimus at a mean daily dose of 1.8 mg were included. Lymphedema involved one (n = 4), or both (n = 1) lower limbs, upper limb (n = 9), lower limbs and upper limb (n = 1). Lymphedema affected the whole limb (n = 10), or the distal part (n = 5). The median time between lymphedema onset and the beginning of sirolimus was 52 weeks (range: 8–232). Lymphoscintigraphy in 7 patients (lower limb: 3, superior: 4) showed no inguinal or axillary nodal fixation (n = 6) or decreased uptake (n = 1). Sirolimus was discontinued in 7 cases without lymphedema improvement with a median follow-up of 12 months and maintained in 8 cases.Conclusion
Sirolimus is associated with upper and/or lower limb lymphedema, without predominance of sex, and without disappearance after sirolimus discontinuation. Pathophysiological mechanisms remain unclear. Lymphedema management is based on low-stretch bandages and compression. 相似文献20.
Konstantinos Douros Maria-Ioanna Thanopoulou Barbara Boutopoulou Anna Papadopoulou Anastassios Papadimitriou Andrew Fretzayas Kostas N. Priftis 《Allergologia et immunopathologia》2019,47(3):209-213