Prediabetes

The burden of diabetes is expected to rise from 415 million individuals in 2015 to 642 million individuals by 2040. Most individuals pass through a phase of prediabetes before developing full-blown diabetes. Insulin resistance, impaired incretin action, and insulin hypersecretion are central to the pathophysiology of prediabetes. Individuals older than 40 years of age and other high-risk individuals should be screened for diabetes with fasting plasma glucose and/or hemoglobin A1c. For those diagnosed with prediabetes, the goal of treatment should be restoring euglycemia, because there are data showing that restoring normoglycemia during prediabetes and early diabetes can produce lasting remission. The preferred approach for this is intensive lifestyle intervention, which besides reducing progression to diabetes, has also been shown to reduce all-cause mortality in a long-term follow-up study. The best evidence for a pharmacological approach is with metformin. Other drugs that have shown efficacy include thiazolidinediones, alpha-glucosidase inhibitors, orlistat, basal insulin, and valsartan. However, except for metformin, none of these drugs are currently recommended for this purpose. Newer agents such as glucagon-like peptide-1 agonists and dipeptidyl peptidase 4 (DPP-4) inhibitors also have considerable promise in this area. Bariatric surgery can be offered to patients with metabolic syndrome and body mass index of 30-35.     

Evaluating the quality of rosacea studies: implications for the patient and physician

BACKGROUND: Patients suffering from rosacea may experience frequent blushing and flushing, erythema, telangiectasia, and/or rhinophyma. In an attempt to find effective treatments, many studies have been performed. OBJECTIVE: It is important to be able to evaluate the quality of clinical trials where agents have been used to treat rosacea, and to compare the effectiveness of the different therapies used for this indication. METHODS: The reports on the efficacy and safety of the different drug therapies were evaluated using predetermined criteria. We searched MEDLINE (1966-2002) for studies where rosacea was treated with the various therapies. The criteria used to assess the quality of the studies were: randomization, blinding (double, single, or open), aims clearly defined, prior sample size calculation, whether inclusion and/or exclusion criteria were outlined, baseline comparison of patient characteristics and demographics, interventions and efficacy parameters defined, compliance assessed, statistical analysis performed including intention-to-treat evaluation of efficacy of therapy. RESULTS: Using the above-mentioned criteria, each study was rated in order to determine the quality of the clinical trial. The maximum score a study could attain was 20. To determine if high-quality studies are cited more often than the lower-quality papers, the number of times a study had been cited since its publication was measured. We found 13 of the 42 studies scored greater than 14; these studies were rated as high-quality studies. There was no significant association between high-quality papers and the number of times they had been cited, suggesting that other factors are also taken into consideration when a given study is cited. CONCLUSION: It is important for investigators and clinicians to be aware of the parameters that count towards designing a high-quality protocol since such studies are more likely to reflect efficacy rates that are accurate. Furthermore, it is essential that when a study is written up, the pertinent information regarding the design of the trial and the manner in which it was conducted are conveyed to the reader.     

A Review on Joint Carotid Intima-Media Thickness and Plaque Area Measurement in Ultrasound for Cardiovascular/Stroke Risk Monitoring: Artificial Intelligence Framework

Journal of Digital Imaging - Cardiovascular diseases (CVDs) are the top ten leading causes of death worldwide. Atherosclerosis disease in the arteries is the main cause of the CVD, leading to...     

Efficacy and safety of beating heart coronary revascularization coupled with ascending aorta-bifemoral grafting: Analysis of short term results

Introduction  

Coronary Artery Disease (CAD) frequently coexists with Peripheral Vascular Disease (PVD) and poses management issues. When there is a concomitant infrarenal aortic occlusive disease, abdominal aorta is the traditional donor of bypass inflow to the lower limbs. However, the ascending aorta may also be used as the source of inflow to both the femoral and coronary arteries in patients who present with combined CAD and PVD. Here, 5 year follow up results of simultaneous off-pump coronary artery bypass grafting (OPCAB) and Ascending Aorto-Bifemoral Grafting [AABG] are presented and merits of the procedure are discussed.     

Comparison of non-synchronized nasal intermittent positive pressure ventilation versus nasal continuous positive airway pressure as post-extubation respiratory support in preterm infants with respiratory distress syndrome: a randomized controlled trial

Objective: To determine whether post-extubation respiratory support via nsNIPPV decreases the need for mechanical ventilation (MV) compared to nasal continuous positive airway pressure (NCPAP) in preterm infants with respiratory distress syndrome (RDS).

Methods: In this randomized, controlled, open, prospective, single-center clinical trial, we randomly assigned preterm ventilated infants with RDS to either nsNIPPV or NCPAP after extubation. The primary outcome, extubation failure, was defined by pre-specified failure criteria in the 72 hours after extubation.

Results: A total of 63 preterm ventilated infants were randomized to receive either nsNIPPV (n?=?31) or NCPAP (n?=?32). Extubation failure occurred in six (19.3%) of nsNIPPV group compared with nine (28.12%) of NCPAP group and was statistically not significant (p?=?0.55). The duration of NIV was significantly lower in nsNIPPV group as compared to NCPAP group (40.4?±?39.3 hours versus 111.8?±?116.4 hours, p?=?0.003). The duration of supplementary oxygen was significantly lower in nsNIPPV versus NCPAP group (84.9?±?92.1 hours versus 190.1?±?140.5 hours, p?=?0.002). The rates of BPD in nsNIPPV group (2/29, 6.9%) were significantly lower than in NCPAP group (9/28, 32.14%) (p?=?0.02).

Conclusions: Compared to NCPAP, nsNIPPV appears to be a feasible mode of extubation in preterm infants with significant beneficial effects of reduced duration of NIV support, supplementary oxygen and decreased rates of BPD.