共查询到20条相似文献，搜索用时 31 毫秒
1.
Siyu Chen Xuhong Hou Yu Sun Gang Hu Xiaoyan Zhou Huijuan Xue Peizhu Chen Jingzhu Wu Yuqian Bao Weiping Jia 《Primary Care Diabetes》2018,12(3):231-237
Aims
To assess whether an integrated hospital-community diabetes management program could improve major cardiovascular risk factor control among patients with diabetes in real-world clinical settings.Methods
985 adults with diabetes in the Shanghai Taopu community health service center were enrolled at baseline and 907 subjects completed the follow-up. The follow-up levels of the metabolic profiles were assessed by their averages during the follow up period.Results
After a mean 7-year follow-up period, heamoglobin A1c, systolic and diastolic blood pressure levels decreased by 0.6%, 5.7 mmHg, and 1.5 mmHg, respectively (all P < 0.001). There was a non-significant difference in low-density lipoprotein cholesterol, while high-density lipoprotein cholesterol increased 1.9 mg/dL and triglycerides decreased 28.3 mg/dL, respectively (all P < 0.001). The percentage of patients with diabetes who met any one of three Chinese Diabetes Society goals (heamoglobin A1c <7.0%, blood pressure <140/80 mmHg, and low-density lipoprotein cholesterol <100 mg/dL) increased from 58.2% to 70.1%. The chronic diabetes complication screening rates (diabetic retinopathy, diabetic neuropathy, diabetic nephropathy) have significantly increased, from almost zero to 12–78%.Conclusions
This long-term program has increased the proportions of attaining major cardiovascular risk factors control goals and diabetic chronic complication screening rates among patients with diabetes. 相似文献2.
T.G. Kebede C. Pink W. Rathmann B. Kowall H. Völzke A. Petersmann P. Meisel T. Dietrich T. Kocher B. Holtfreter 《Diabetes & metabolism》2018,44(3):243-249
Aim
As periodontitis may contribute to the pathogenesis of diabetes, the effects of periodontitis on diabetes incidence and HbA1c change was quantified in a prospective cohort.Methods
Data from an 11-year follow-up of the Study of Health in Pomerania were analyzed to evaluate the effects of periodontitis on incident diabetes and long-term HbA1c changes in 2047 subjects aged 20–81 years. Diabetes was based on self-reported physician diagnoses, antidiabetic medication use, or HbA1c ≥ 6.5% or non-fasting blood glucose levels ≥ 11.1 mmol/L. To assess periodontal status, periodontal pockets were probed, and their depth and clinical attachment levels measured. For both measures, means and percentages of sites ≥ 3 mm were calculated. In addition, all probing depths ≥ 4 mm were summed (cumulative probing depth). Modified Poisson and multivariable linear models were applied, adjusted for age, gender, highest level of general education, marital status, waist circumference, physical activity, smoking status and follow-up time.Results
Over a mean follow-up period of 11.1 years, 207 subjects developed diabetes. Baseline mean clinical attachment levels (CAL) and probing depths (PPD) were not significantly associated with either diabetes incidence [mean CALs, fourth quartile, incidence rate ratio = 0.819, 95% confidence interval (CI): 0.489–1.370; P = 0.446] or long-term changes in HbA1c (mean CAL, fourth quartile, β = ?0.086, 95% CI: ?0.187, ?0.016; P = 0.098). Sensitivity analyses using alternative exposure definitions confirmed these results.Conclusion
Contrary to the currently available literature, no convincing evidence was found of any potential association between periodontitis and diabetes incidence or HbA1c change. 相似文献3.
Sharon H. Saydah Edward W. Gregg Henry S. Kahn Mohammed K. Ali 《Primary Care Diabetes》2018,12(1):3-12
Aims
Determine the mortality experience among adults with diabetes in meeting and not meeting less intense control for glycated hemoglobin (HbA1c), blood pressure (BP), and cholesterol.Methods
National Health and Nutrition Examination Survey 1999–2010 participants with self-report of diagnosed diabetes (N = 3335), measured HbA1c, BP and non-HDL cholesterol were linked to the National Death Index through December 31, 2011. Proportional hazards models were used to estimate hazard ratios (HR) of meeting HbA1c < 9% and BP < 160/110, and non-HDL cholesterol < 190 mg/dL. Models used age as the time scale and adjusted for demographics (sex, race/ethnicity, education), diabetes duration, history of cardiovascular and chronic kidney disease, and treatments for elevated glucose, BP, and cholesterol.Results
Over a mean 5.4 person-years of follow-up, participants meeting all less intense control had a 37% lower mortality (HR = 0.63, 95% CI 0.54, 0.74) relative to those who did not meet the goals. Of approximately 306,000 deaths per year that occur among Americans with diabetes, we estimate 39,400 might have been averted by improving the care of those who have not met these less intense control goals.Conclusions
Meeting the less intense control goals is associated with 37% reduction in mortality and could lead to 39,400 fewer deaths per year. 相似文献4.
T.-T. Li A.-P. Wang J.-X. Lu M.-Y. Chen C.-C. Zhao Z.-H. Tang L.-X. Li W.-P. Jia 《Diabetes & metabolism》2018,44(5):437-443
Aim
As the prevalence and clinical characteristics of non-alcoholic fatty liver disease (NAFLD) are still unknown in ketosis-onset diabetes, the present study compared the characteristics of NAFLD in type 1 diabetes (T1D), ketosis-onset and non-ketotic type 2 diabetes (T2D) patients.Methods
This cross-sectional study was performed with newly diagnosed Chinese patients with diabetes, including 39 T1D, 165 ketosis-onset and 173 non-ketotic T2D, with 30 non-diabetics included as controls. NAFLD was determined by hepatic ultrasonography, then its clinical features were analyzed and its associated risk factors evaluated.Results
NAFLD prevalence in patients with ketosis-onset diabetes (61.8%) was significantly higher than in controls (23.3%; P = 0.003) and in T1D patients (15.4%; P < 0.001). However, there was no difference in prevalence between ketosis-onset and non-ketotic T2D patients (52.6%; P = 0.229), although BMI and alanine aminotransferase (ALT) proved to be independent risk factors for the presence of NAFLD in both these groups whereas, in T1D patients, serum uric acid levels were independent risk factors.Conclusion
NAFLD prevalence and risk factors in ketosis-onset diabetes were similar to those in non-ketotic T2D, but different from those in T1D. These data provide further evidence that ketosis-onset diabetes should be classified as a subtype of T2D rather than idiopathic T1D. 相似文献5.
S. Kralisch A. Hoffmann J. Kratzsch M. Blüher M. Stumvoll M. Fasshauer T. Ebert 《Diabetes & metabolism》2018,44(2):150-154
Aims
Neuregulin 4 has recently been recognized as a novel adipokine secreted by brown adipose tissue (BAT), with beneficial effects on murine insulin resistance and hepatic steatosis. Yet, thus far, neither regulation of neuregulin 4 in gestational diabetes mellitus (GDM) nor its longitudinal changes in the peripartum period have been elucidated.Methods
Circulating neuregulin 4 levels were measured by ELISA in 74 women with GDM and 74 healthy, gestational-age-matched controls. Also, neuregulin 4 was quantified during pregnancy and compared with postpartum levels in a follow-up study of 25 women with previous GDM and 25 healthy control women.Results
Women with GDM had lower median serum levels of the novel BAT-secreted adipokine neuregulin 4 (3.0 μg/L) compared with healthy (non-GDM) pregnant controls (3.5 μg/L; P = 0.020), and the area under the glucose curve (AUCGlucose) was an independent and negative predictor of circulating neuregulin 4 (P = 0.033). Also, median postpartum serum concentrations of neuregulin 4 (3.2 μg/L) were not significantly different from prepartum levels (2.8 μg/L; P = 0.328). In addition, neuregulin 4 was positively and independently associated with irisin (P = 0.009), but not other BAT-secreted adipokines.Conclusion/interpretation
Women with GDM have significantly lower circulating neuregulin 4 levels compared with healthy pregnant controls, and the AUCGlucose is negatively and independently associated with neuregulin 4 during pregnancy. Neuregulin 4 is positively correlated with irisin during pregnancy, as well as in a longitudinal fashion. Future studies are now needed to better elucidate the precise pathomechanisms of the regulation of BAT-secreted adipokines during pregnancy. 相似文献6.
Xianfeng Zhou Xiaonan Ruan Lipeng Hao Yi Zhou Jianjun Gu Hua Qiu Kang Wu Siyu Yu Xinyi Rui Xiaonan Wang Xiaolin Liu Juzhong Ke Genming Zhao Qiao Sun 《Primary Care Diabetes》2018,12(3):238-244
Aims
Due to the diversity of the Chinese population, it requires considerable research to evaluate HbA1c diagnostic threshold for diagnosis of hyperglycemia.Methods
We included 7909 subjects aged ≥15 without known diabetes from the baseline of Pudong community cohort in 2013. Participants took oral glucose tolerance test (OGTT) and HbA1c assay. Receiver operating characteristic curve determined the HbA1c threshold in the diagnosis of hyperglycemia.Results
The optimal HbA1C threshold for diagnosing newly diagnosed diabetes (NDD) and pre-diabetes in this population was 6.0% (AUC = 0.798, 95%CI: 0.779–0.818) and 5.6% (AUC = 0.655, 95%CI: 0.638–0.671). When compared with elderly age group (≥70 years), HbA1c for detecting NDD performed better in youth (15–39 years: P = 0.003, 40–49 years: P < 0.001). There were 13.81% and 13.34% of participants would be newly detected as NDD and pre-diabetes via HbA1c criteria; meanwhile 3.20% and 15.52% diagnosed as NDD and pre-diabetes by OGTT criteria would be missed diagnosis.Conclusions
The optimal HbA1c thresholds for NDD and pre-diabetes were lower than ADA criteria. It is necessary to carefully consider whether choose HbA1c as a diagnostic criterion or combine two diagnostic standards. Age-specific diagnostic thresholds should be considered when HbA1c was recommended as diagnostic standard. 相似文献7.
Antonio V.C. Coelho Ronald R. de Moura Rafael L. Guimarães Lucas A.C. Brandão Sergio Crovella 《The Brazilian journal of infectious diseases》2018,22(5)
Background
Antiretroviral therapy (ART) saved millions from HIV-1 infection and AIDS, but some patients do not experience adequate CD4+ T cells gain despite achieving viral suppression. The genetic component of this condition is not yet completely elucidated.Objective
To identify predictive genetic markers of immune response to ART.Methods
Case–control study. Out of 176 HIV-infected patients recruited in the city of Recife, Northeast Brazil, 67 patients with no immunologic response were the cases and the remaining 109 patients who responded were the controls. A set of 94 selected single nucleotide polymorphisms (SNPs) involved in antiretroviral drugs pharmacodynamic pathways and immune system homeostasis were genotyped, while the remaining 48 were ancestry informative markers (AIMs) for controlling for eventual hidden population structure.Results
Male patients were overrepresented in non-responder group (p = 0.01). Non-responders also started with lower absolute CD4+ T cell counts (p < 0.001). We found five SNPs significantly associated with the outcome, being three more frequent in non-responders than responders: rs2243250 (IL4) A allele (p = 0.04), rs1128503 (ABCB1) A allele (p = 0.03) and rs707265 (CYP2B6) A allele (p = 0.02), whereas the other two were less frequent in non-responders: rs2069762 (IL2) C allele (p = 0.004) and rs4646437 (CYP3A4) A allele (p = 0.04).Conclusion
Some significant univariate associations remained independently associated at multivariate survival analysis modeling, such as pre-treatment CD4+ T cells counts, IL2 and ABCB1 genotypes, and use of protease inhibitors, yielding a predictive model for the probability for immune response. More studies are needed to unravel the genetic basis of ART immunological non-response. 相似文献8.
A. Jayedi K. Djafarian F. Rezagholizadeh A. Mirzababaei M. Hajimohammadi S. Shab-Bidar 《Diabetes & metabolism》2018,44(4):320-327
Aim
This study aimed to test the dose-response relationship between fasting blood glucose (FBG) levels and risk of prostate cancer.Methods
A systematic search was done of PubMed and Scopus from their inception up to January 2017. Prospective and retrospective studies reporting risk estimates of prostate cancer for two or more categories of blood glucose levels were identified, and two independent authors extracted the information. Relative risk (RR) was calculated using random-effects models and pooled.Results
Ten prospective cohort studies, one nested case-control study, one case-cohort study and three case-control studies (total n = 1,214,947) involving 12,494 cases of prostate cancer were reviewed. The pooled RR of prostate cancer for the highest vs. lowest category of FBG was 0.88 (95% CI: 0.78–0.98, I2 = 25.5%, n = 15 studies). A 10 mg/dL increment in FBG level was not associated with risk of prostate cancer (0.98, 95% CI: 0.96–1.00, I2 = 45.4%, n = 11 studies). Subgroup analyses yielded a significant inverse association only in the subgroup of cohort studies. Non-linear dose-response meta-analysis showed a very slight decrement in risk with increasing FBG levels. Sensitivity analyses using cohort studies showed a steep decrease in risk along with an increase in FBG from baseline levels of ≈ 70 mg/dL across prediabetes and diabetes ranges.Conclusion
Higher FBG levels are associated with lower risk of prostate cancer in cohort studies, but not in case-control studies, findings that limit interpretation of our present results. 相似文献9.
Ken Yan Thong Mahender Yadagiri Dennis Joseph Barnes David Stuart Morris Tahseen Ahmad Chowdhury Ling Ling Chuah Anthony Michael Robinson Stephen Charles Bain Karen Ann Adamson Robert Elford John Ryder 《Primary Care Diabetes》2018,12(1):45-50
Introduction
Treatment of type 2 diabetes with sodium–glucose cotransporter 2 (SGLT2) inhibitors may result in genital fungal infections. We investigated possible risk factors for developing such infections among patients treated with the SGLT2 inhibitor dapagliflozin.Methods
The Association of British Clinical Diabetologists (ABCD) collected data on patients treated with dapagliflozin in routine clinical practice from 59 diabetes centres. We assessed possible associations of patient’s age, diabetes duration, body mass index, glycated haemoglobin, renal function, patient sex, ethnicity and prior genital fungal infection, urinary tract infection, urinary incontinence or nocturia, with the occurrence of ≥1 genital fungal infection within 26 weeks of treatment.Results
1049 out of 1116 patients (476 women, 573 men) were analysed. Baseline characteristics were, mean ± SD, age 56.7 ± 10.2 years, BMI 35.5 ± 6.9 kg/m2 and HbA1c 9.4 ± 1.5%. Only patient sex (13.2% women vs 3.3% men) and prior history of genital fungal infection (21.6% vs 7.3%) were found to be associated with occurrence of genital fungal infections after dapagliflozin treatment, adjusted OR 4.22 [95%CI 2.48,7.19], P < 0.001 and adjusted OR 2.41 [95% CI 1.04,5.57], P = 0.039, respectively.Conclusion
Women and patients with previous genital fungal infections had higher risks of developing genital fungal infections with dapagliflozin treatment. 相似文献10.
11.
Sunday Adeola Emaleku Olusola D. Omueti Godsent Oluwakemi Emaleku 《Diabetes & Metabolic Syndrome: Clinical Research & Reviews》2018,12(6):831-837
Aim
Cardiovascular diseases (CVDs) and diabetes mellitus (DM) are some of the leading causes of death in the world, and diet has roles in their etiology. This research study therefore investigates the glycemic index (GI) of soy flour fortified whole wheat meal (SFFWWM) consumed with Talinum triangulare (gbure) soup and the effects of the meal on the lipid profiles of the test human subjects.Methods
The control human subjects and test human subjects were fed D-glucose (DG) and whole wheat meal (WWM) with Talinum triangulare soup respectively on the first day of the experiment, and SFFWWM with the same soup the next day (for test subjects only) after 10–12 h overnight fasting. Blood glucose levels of the subjects were taken before and 2 h after meals’ consumption at 30 min interval and blood samples collected for lipid profiles evaluations.Results
The result of the study showed that; SFFWWM consumed with Talinum trianguilare soup has a non-significant lower GI than WWM consumed with the same soup, but a significant lower GI than DG at (P < 0.05). Furthermore, there was no significant difference in lipid profiles of the test human subjects between when they consumed WWM and SFFWWM with the soup however, SFFWWM reduced TC, TG, LDL-C and VDL-C and increased HDL-C and TP than WMM at (P < 0.05). In addition, GI is positively correlated with TC, TG, LDL-C and VLDL-C, but is negatively correlated with TP and HDL-C.Conclusion
It can therefore be concluded that; fortifying WWM with soy flour would reduce the risk factors of CVDs and DM, the diseases recently claiming thousands of today. 相似文献12.
Osama B. Albasheer Mohammed S. Mahfouz Yahia Solan Duaa A. Khan Mohammed A. Muqri Haneen A. Almutairi Ali M. Alelyani Hussain A. Alahmed 《Diabetes & Metabolic Syndrome: Clinical Research & Reviews》2018,12(2):117-121
Purpose
To determine the prevalence of depression and related risk factors among type 2 diabetes mellitus patients (T2DM) in Jazan area, Saudi Arabia.Method
A cross sectional, self-administered questionnaire study was conducted among T2DM patients in Jazan area, Saudi Arabia. A total of 385 patients were selected at randomly. The Patient Health Questionnaire (PHQ-9) was utilized to measure symptoms and signs of depression.Results
The overall prevalence of depression among T2DM patients was 37.6%. Of them, 24.2% were mildly depressed, 9.6% were moderately severely depressed, and 4.2% were severely depression. Significant predictors of depression include the presence of diabetic foot (P = 0.000), cardio-vascular diseases (P = 0.000), eye complication (P = 0.073), and erectile dysfunction (P = 0.090). The prevalence of depression was not significantly associated with the age (P = 0.375) and gender (P = 0.374). Similarly no association was found with duration of diabetes (P = 0.475) and HbA1c (P = 0.555).Conclusion
The study revealed that diabetes complications are strong predictors of the rate of depression among T2DM patients. Therefore, early depression screening is needed to improve the quality of life of diabetic patients. 相似文献13.
Abdul Hakeem Alrawahi Patricia Lee Zaher A.M. Al-Anqoudi Muna Alrabaani Ahmed Al-Busaidi Faisal Almahrouqi Ahmed M. Albusaidi 《Diabetes & Metabolic Syndrome: Clinical Research & Reviews》2018,12(2):105-110
Aim
To date, no cardiovascular risk assessment tool has been developed specifically for any Arabian population including Omanis. This study aims to develop a suitable cardiovascular risk prediction model in the form of a statistical equation, for Omanis with type 2 diabetes.Materials and methods
A sample of 2039 patients with type 2 diabetes selected from primary care settings in the Aldakhiliyah Province of Oman were involved in a retrospective cohort study. All patients were free of cardiovascular disease at baseline (in 2009–2010) and were followed up until: 1) their first cardiovascular event occurred; 2) the patient died, or 3) the end of the data collection in December 2015.Results
Among the total sample, 192 cardiovascular disease events were recorded within a mean follow-up period of 5.3-year. The 5-year probability of a cardiovascular event was given as 1 ? 0.9991Exp∑XiBi, where Exp ∑XiBi (hazard ratio) = Exp (0.038 age + 0.052 DM duration + 0.102 HbA1c + 0.201 total cholesterol + 0.912 albuminuria [1 if present] + 0.166 hypertension [1 if present] + 0.005 BMI).Conclusion
The first cardiovascular risk prediction tool in the Arab world was developed in this study. It may be used to estimate the 5-year cardiovascular risk among Omanis with type 2 diabetes in order to plan patient management and preventive measures. However, further validation studies are required to determine the accuracy of the model. 相似文献14.
H.S. Bajaj R.E. Brown L. Bhullar N. Sohi S. Kalra R. Aronson 《Diabetes & metabolism》2018,44(6):493-499
Aim
The impact of new classes of glucose lowering medications on markers of non-alcoholic fatty liver disease (NAFLD) associated with type 2 diabetes (T2D) have been inconsistent in their magnitude and independence. This large retrospective study investigates changes in alanine aminotransferase (ALT) levels among subjects initiated on newer classes of T2D medications in comparison to a reference control group.Methods
We studied people with T2D from a large Canadian diabetes register, who had canagliflozin, dapagliflozin, liraglutide, sitagliptin or no further treatment added to their diabetes treatments. Stepwise multiple regression was used to determine the association of A1c and weight change on ALT. Propensity score weighting was used to balance baseline characteristics between treatment groups.Results
A total of 3667 subjects met study criteria. ALT levels (mean follow-up 4.8 months) were lower after treatment with sodium glucose co-transporter 2 (SGLT2) inhibitors, canagliflozin (?4.3 U/L, P < 0.01) and dapagliflozin (?3.5 U/L, P < 0.01), compared to incretin agents, liraglutide (?2.1 U/L, P < 0.01) and sitagliptin (?1.8 U/L, P < 0.01), each greater than the control group. Only the SGLT2 inhibitor treatment groups maintained a significant ALT reduction vs. control following multivariable adjustment and propensity score weighting. Greater ALT reductions were seen with higher baseline ALT for both the SGLT2 inhibitor treatment groups.Conclusion
SGLT2 inhibitors canagliflozin and dapagliflozin resulted in a weight and A1c-independent reduction of ALT levels compared to incretin agents, with a dose-response observed at higher baseline ALT levels. Further studies investigating the differential effects of these drug classes on NAFLD, and insulin/glucagon levels as potential mechanism explaining these differences, should be performed. 相似文献15.
Y. Mori F. Okazaki C. Inuo Y. Yamaguchi S. Masuda S. Sugiura T. Fukuie M. Nagao I. Tsuge T. Yosikawa A. Yagami K. Matsunaga T. Fujisawa K. Ito H. Narita Y. Kondo 《Allergologia et immunopathologia》2018,46(5):482-490
Background
Lipid transfer protein (LTP) is a major fruit allergen. It has, however, recently been revealed that the systemic reaction in peach-allergic patients is related not only to LTP (Pru p 3) but also to gibberellin-regulated protein (Pru p 7). We investigated recombinant Pru p 7 (rPru p 7) for its potential use in worldwide standardization for the diagnosis of peach allergy.Methods
Natural Pru p 7 (nPru p 7) was purified from peach crude extract using a monoclonal antibody affinity column. Complementary DNA for Pru p 7 was cloned and expressed in Escherichia coli and Pichia pastoris. Serum immunoglobulin (Ig) E in peach-allergic patients was examined by enzyme-linked immunosorbent assay (ELISA) using nPru p 7 and rPru p 7 (E. coli product: erPru p 7 and P. pastoris product: prPru p 7).Results
Peach-allergic patients (n = 27) were diagnosed and categorized into oral reaction (n = 10) or systemic reaction (n = 17). The nPru p 7 positivity based on serum IgE levels was 52% in the systemic-reaction group and 0% in the oral-reaction group (P < 0.05). In the systemic-reaction group, there was no significant difference in reactivity between nPru p 7 and prPru p 7, but the reactivity of erPru p 7 was significantly lower than those of nPru p 7 and prPru p 7 (P < 0.05).Conclusions
We found that prPru p 7 exhibited reactivity in ELISA comparable to that of nPru p 7 for the diagnosis of peach allergy with systemic reaction. 相似文献16.
Joseph Jonathan Lee Matthew James Thompson Juliet Alexandra Usher-Smith Constantinos Koshiaris Ann Van den Bruel 《Primary Care Diabetes》2018,12(3):254-264
Background
The epidemiology of type 1 diabetes mellitus (T1DM) suggests diagnostic delays may contribute to children developing diabetic ketoacidosis at diagnosis. We sought to quantify opportunities for earlier diagnosis of T1DM in primary care.Methods
A matched case-control study of children (0–16 years) presenting to UK primary care, examining routinely collected primary care consultation types and National Institute for Health and Care Excellence (NICE) warning signs in the 13 weeks before diagnosis.Results
Our primary analysis included 1920 new T1DM cases and 7680 controls. In the week prior to diagnosis more cases than controls had medical record entries (663, 34.5% vs 1014, 13.6%, odds ratio 3.46, 95% CI 3.07–3.89; p < 0.0001) and the incidence rate of face-to-face consultations was higher in cases (mean 0.32 vs 0.11, incidence rate ratio 2.90, 2.61–3.21; p < 0.0001). The preceding week entries were found in 330 cases and 943 controls (17.2% vs 12.3%, OR 1.49, 1.3–1.7, p < 0.0001), but face-to-face consultations were no different (IRR 1.08 (0.9–1.29, p = 0.42)).Interpretation
There may be opportunities to reduce time to diagnosis for up to one third of cases, by up to two weeks. Diagnostic opportunities might be maximised by measures that improve access to primary care, and public awareness of T1DM. 相似文献17.
Rolando Paternina-de la Ossa Seila Israel do Prado Maria Célia Cervi Denissani Aparecida Ferrari dos Santos Lima Roberto Martinez Fernando Bellissimo-Rodrigues 《The Brazilian journal of infectious diseases》2018,22(5)
Background
Community-associated methicillin-resistant Staphylococcus aureus (CA-MRSA) is spreading worldwide, but little is known about the epidemiology of this pathogen in Brazil.Objective
To evaluate clinical and microbiological features of children with S. aureus infections admitted to a university hospital.Methods
This was a cross-sectional study evaluating the potential risk factors for CA-MRSA, and a retrospective cohort evaluating in-hospital clinical outcomes. To include patients with both community and hospital-associated infections, we screened the results of the microbiological laboratory tests from January 1, 2012, to December 31, 2016. According to the phenotype, we classified the isolates in Methicillin-Susceptible S. aureus (MSSA), Hospital-Associated Methicillin-Resistant S. aureus (HA-MRSA), and CA-MRSA. Clinical data were collected from the patients’ medical records.Results
We identified 279 cases of S. aureus infections (MSSA = 163, CA-MRSA = 69, HA-MRSA = 41). Overall, the incidence density of CA-MRSA and MSSA infections increased while the HA-MRSA incidence density decreased over the study period. CA-MRSA infected patients were more likely to present with skin and soft tissue infections (OR: 2.83, 95%CI: 1.54–5.33, p < 0.001) and osteomyelitis (OR: 4.76; 95%CI: 1.16–22.71, p = 0.014) when compared to MSSA and HA-MRSA infections. Unadjusted case fatality rates were similar between MSSA-infected patients (3.14%, 5/159) and CA-MRSA infected patients (3.80%, 3/79, p = 0.792), while HA-MRSA infected patients were more likely to die in the hospital (12.20%, 5/41, p = 0.013).Conclusions
CA-MRSA is an emergent pediatric pathogen in Brazil. Our results highlight the relevance of choosing an appropriate initial antimicrobial drug for treating children with severe S. aureus infections. 相似文献18.
Thorsten Siegmund Martin Pfohl Thomas Forst Stefan Pscherer Peter Bramlage Johannes Foersch Anja Borck Jochen Seufert 《Diabetes & Metabolic Syndrome: Clinical Research & Reviews》2017,11(1):51-57
Aim
Optimal treatment intensification strategies in patients with type-2 diabetes mellitus (T2DM) receiving basal insulin supported oral antidiabetic therapy (BOT) remain controversial. The objective of the present study was to compare outcomes of BOT-intensification by either the uptitration of long-acting insulin glargine or by the immediate addition of a rapid acting insulin analogue (RAIA).Methods
This was a prospective, observational, 24-week study in T2DM patients with BOT using insulin glargine and baseline glycated hemoglobin (HbA1c) between 7.0 and 8.5%. Patients were stratified by their physicians to one of the following treatment intensification strategies: Basal insulin titration to target with discretionary subsequent addition of RAIA at weeks 12 or 24 (GLAR), or immediate addition of RAIA at baseline (GLARplus).Results
A total of 3266 patients were prescreened of whom 2202 fulfilled the selection criteria. Of these, 1684 patients were documented in the GLAR group and 518 in the GLARplus group. In the GLAR group, in 91 (5.5%) and 21 patients (1.3%) RAIA was added at weeks 12 and 24, respectively. The groups displayed similar baseline characteristics; except, mean diabetes duration was slightly shorter in the GLAR group (8.7 vs. 9.4 years). During the study, insulin glargine dose was increased from 18.7 to 26.4 U (plus 7.7 U) in GLAR and from 24.9 to 27.3 U (plus 2.4 U) in GLARplus patients. Mean RAIA dose was 9.6 ± 4.7 U at the final visit. After 24 weeks, HbA1c was reduced by 0.8 and 0.9% in the GLAR and GLARplus groups, respectively (both p < 0.001). An HbA1c of ≤7.0% was achieved in 49.2% of GLAR and 48.5% of GLARplus patients. In both groups, we observed improvements in cardiovascular risk factors such as lipids and blood pressure. The rates of symptomatic (1.6 vs. 1.7%) and severe (0.18 vs. 0.19%) hypoglycemic episodes were low and comparable in both groups.Conclusion
These findings provide evidence that treatment intensification in patients with type 2 diabetes not at glycemic target on BOT with insulin glargine is equally safe and effective using either long-acting insulin titration alone or the addition of a rapid-acting insulin analogue. 相似文献19.
H. Kahal A. Aburima B. Spurgeon K.S. Wraith A.S. Rigby T. Sathyapalan E.S. Kilpatrick K.M. Naseem S.L. Atkin 《Diabetes & metabolism》2018,44(5):431-436
Aim
Strict glycaemic control has been associated with an increased mortality rate in subjects with type 2 diabetes (T2DM). Here we examined platelet function immediately and 24 hours following induced hypoglycaemia in people with type 2 diabetes compared to healthy age-matched controls.Methods
Hyperinsulinaemic clamps reduced blood glucose to 2.8 mmol/L (50 mg/dl) for 1 hour. Sampling at baseline; euglycaemia 5 mmol/L (90 mg/dl); hypoglycaemia; and at 24 post clamp were undertaken. Platelet function was measured by whole blood flow cytometry.Results
10 subjects with T2DM and 8 controls were recruited. Platelets from people with T2DM showed reduced sensitivity to prostacyclin (PGI2, 1 nM) following hypoglycaemia. The ability of PGI2 to inhibit platelet activation was significantly impaired at 24 hours compared to baseline in the T2DM group. Here, inhibition of fibrinogen binding was 29.5% (10.3–43.8) compared to 50.8% (36.8–61.1), (P < 0.05), while inhibition of P-selectin expression was 32% (16.1–47.6) vs. 54.4% (42.5–67.5) (P < 0.05). No significant changes in platelet function were noted in controls.Conclusion
Induced hypoglycaemia in T2DM enhances platelet hyperactivity through impaired sensitivity to prostacyclin at 24 hours. 相似文献20.
Katja Vince Tamara Poljičanin Marko Brkić Urelija Rodin Ratko Matijević 《Primary Care Diabetes》2018,12(4):325-330