Treatment of isolated systolic hypertension in diabetes mellitus type 2

Age-related arterial stiffness is more pronounced in diabetics compared to non-diabetics, which could explain the prevalence of isolated systolic hypertension (ISH, systolic blood pressure > or =140 mmHg and diastolic blood pressure <90 mmHg) being approximately twice that of the general population without diabetes. Large-scale interventional outcome trials have also shown that diabetics usually have higher pulse pressure and higher systolic blood pressure than non-diabetics. Advanced glycation end-product formation has been implicated in vascular and cardiac complications of diabetes including loss of arterial elasticity, suggesting possibilities for new therapeutic options. With increasing age, there is a shift to from diastolic to systolic blood pressure and pulse pressure as predictors of cardiovascular disease. This may affect drug treatment as different antihypertensive drugs may have differential effects on arterial stiffness that can be dissociated from their effects on blood pressure. While thiazide diuretics are associated with little or no change in arterial stiffness despite a robust antihypertensive effect, angiotensin converting enzyme inhibitors, angiotensin II receptor blockers and calcium-channel blockers have been shown to reduce arterial stiffness. However, combination therapy is nearly always necessary to obtain adequate blood pressure control in diabetics. There are no randomized controlled trials looking specifically at treatment of ISH in diabetics. Recommendations regarding treatment of ISH in diabetes mellitus type 2 are based on extrapolation from studies in non-diabetics, post-hoc analyses and prespecified subgroup analysis in large-scale studies, and metaanalysis. These analyses have clearly demonstrated that blood pressure lowering in ISH confers improved prognosis and reduced cardiovascular and renal outcomes in both diabetics and non-diabetics.     

Psychological distress and professional help‐seeking: a prospective national study

The study focuses on use of different healthcare providers in connection with elevated levels of psychological distress. The study used a prospective design based on two waves of a national health survey. Participants were Icelandic citizens, age 18–75, randomly drawn from the National Register (N = 1592). Distressed individuals chose a wide range of providers. The choice of provider was based in part on the type of distress experienced, although most individuals turned to the general medical sector. Psychophysiological symptoms were primarily related to visiting physicians (other than psychiatrists). Depression was related to visiting psychiatrists, and anxiety was related to visiting psychiatrists, psychologists and nurses. Anger/aggression was primarily related to visiting clergy. Between 10% and 16% of distressed individuals did not receive any help from the formal healthcare system within 1 year. Studies addressing professional help‐seeking for psychological distress should closely consider the various factors facilitating and hampering use of health services for different forms of distress.     

Assessment of knowledge and attitude about basic life support among dental interns and postgraduate students in Bangalore city,India

BACKGROUND: Life-threatening emergencies can occur at anytime, at anywhere and in anyone. Effective management of an emergency situation in the dental office is ultimately the dentist's responsibility. The lack of training and inability to cope with medical emergencies can lead to tragic consequences and sometimes legal complications. Therefore, health professionals including dentists must be well prepared to deal with medical emergencies. This study was undertaken to assess the knowledge about and attitude towards basic life support(BLS) among dental interns and postgraduate students in Bangalore city, India.METHODS: A cross sectional survey was conducted among dental interns and postgraduate students from May 2014 to June 2014 since few studies have been conducted in Bangalore city. A questionnaire with 17 questions regarding the knowledge about and attitude towards BLS was distributed to 202 study participants.RESULTS: The data analyzed using the Chi-square test showed that dental interns and postgraduate students had average knowledge about BLS. In the 201 participants, 121(59.9%) had a positive attitude and 81(40.1%) had a negative attitude towards BLS.CONCLUSIONS: Cardiopulmonary resuscitation should be considered as part of the dental curriculum. Workshops on a regular basis should be focused on skills of cardiopulmonary resuscitation for dental students.     

Liver diseases in Adult Life after Childhood Cancer in Scandinavia (ALiCCS): A population‐based cohort study of 32,839 one‐year survivors

Information on late onset liver complications after childhood cancer is scarce. To ensure an appropriate follow‐up of childhood cancer survivors and reducing late liver complications, the need for comprehensive and accurate information is presented. We evaluate the risk of liver diseases in a large childhood cancer survivor cohort. We included all 1‐year survivors of childhood cancer treated in the five Nordic countries. A Cox proportional hazards model was used to estimate hospitalisation rate (hazard) ratios (HRs) for each liver outcome according to type of cancer. We used the risk among survivors of central nervous system tumour as internal reference. With a median follow‐up time of 10 years, 659 (2%) survivors had been hospitalised at least once for a liver disease. The risk for hospitalisation for any liver disease was high after hepatic tumour (HR = 6.9) and leukaemia (HR = 1.7). The Danish sub‐cohort of leukaemia treated with haematopoietic stem cell transplantation had a substantially higher risk for hospitalisation for all liver diseases combined (HR = 3.8). Viral hepatitis accounted for 286 of 659 hospitalisations corresponding to 43% of all survivors hospitalised for liver disease. The 20‐year cumulative risk of viral hepatitis was 1.8% for survivors diagnosed with cancer before 1990 but only 0.3% for those diagnosed after 1990. The risk of liver disease was low but significantly increased among survivors of hepatic tumours and leukaemia. Further studies with focus on the different treatment modalities are needed to further strengthen the prevention of treatment‐induced late liver complications.     

Mixed micropapillary–ductal carcinomas of the breast: a genomic and immunohistochemical analysis of morphologically distinct components

Micropapillary carcinomas (MPCs) can present as a rare histological special type of breast cancer; however, this histological type is more frequently found admixed with invasive ductal carcinomas of no special type (IDC‐NSTs). We have previously demonstrated that pure MPCs constitute a distinct entity at the morphological and genetic levels. Here, we sought to determine whether mixed MPCs have genomic aberrations similar to those found in pure MPCs, and to investigate whether the distinct morphological components of MPCs harbour different genetic aberrations. Using high‐resolution microarray comparative genomic hybridization (aCGH), we profiled a series of 10 MPCs of mixed histology and 20 IDC‐NSTs matched for grade and oestrogen receptor (ER) status. In addition, we generated tissue microarrays containing a series of 24 pure and 40 mixed MPCs and performed immunohistochemical analysis with ER, progesterone receptor (PR), Ki‐67, HER2, cytokeratin (CK) 5/6, CK14, CK17, EGFR, topoisomerase‐IIα, cyclin D1, caveolin‐1 and E‐cadherin antibodies. In situ hybridization was employed to evaluate the prevalence of HER2, TOP2A, EGFR, CCND1, MYC and FGFR1 gene amplification. Our results demonstrate that mixed MPCs harbour similar patterns of genomic aberrations and phenotype (82.5% luminal and 17.5% HER2) compared to pure MPCs. A comparison between the distinct morphological components of mixed MPCs in a pairwise fashion revealed that both components harbour strikingly similar genomic profiles. When compared to grade‐ and ER‐matched IDC‐NSTs, mixed MPCs significantly more frequently harboured amplification of multiple regions on 8q (adjusted Fisher's p value < 0.05). Furthermore, mixed MPCs displayed higher proliferative rates than grade‐ and ER‐matched IDC‐NSTs. Our results suggest that micropapillary differentiation in breast cancer may identify a subgroup of more aggressive ER‐positive breast carcinomas, even in those featuring a mixed histology, and that mixed MPCs are more closely related to pure MPCs than to IDC‐NSTs. Copyright © 2009 Pathological Society of Great Britain and Ireland. Published by John Wiley & Sons, Ltd.     

Association analysis of ADPRT1, AKR1B1, RAGE,GFPT2 and PAI-1 gene polymorphisms with chronic renal insufficiency among Asian Indians with type-2 diabetes

Background  

To determine association of nine single nucleotide polymorphisms (SNPs) in ADP ribosyltransferase-1 (ADPRT1), aldo-keto reductase family 1 member B1 (AKR1B1), receptor for advanced glycation end-products (RAGE), glutamine:fructose-6-phosphate amidotransferase-2 (GFPT2), and plasminogen activator inhibitor-1 (PAI-1) genes with chronic renal insufficiency (CRI) among Asian Indians with type 2 diabetes; and to identify epistatic interactionss between genes from the present study and those from renin-angiotensin-aldosterone system (RAAS), and chemokine-cytokine, dopaminergic and oxidative stress pathways (previously investigated using the same sample set).