Modern management of insulin-dependent diabetes mellitus

Currently available treatment methods, albeit improved, remain less than totally satisfactory. New developments such as improved viability of whole organ pancreatic transplants, islet cell transplantation, immunosuppression in the treatment of new-onset diabetes, development of reliable glucose sensors to provide continuous feedback for insulin delivery devices, and alternate routes for insulin administration may drastically change diabetes treatment in the future. For now, physicians must carefully consider the risks and benefits associated with available treatments when discussing therapeutic options with patients and their families. The wide range of therapies available provides the opportunity for patient and physician to select the most appropriate treatment regimen.     

Glomerular filtration rate in adults estimated from 123iodine-hippuran and 99mtechnetium-diethylenetriaminepenta-acetic acid gamma camera renography

Summary. In a retrospective study a close relationship was found between the rate constant for renal clearance of the radioactive indicator (λ_pk) and the glomerular filtration rate (GFR) measured by ⁵¹Cr-EDTA plasma clearance. The material comprised eighteen adult subjects submitted to ¹²³I-hippuran gamma camera renography (IHGR) and twenty-two adult subjects to ^99mTc-DTPA gamma camera renography (TDGR). The rate constant was calculated from a bi-exponential decomposition of the activity-time curve recorded within a small region of interest over the left ventricle. The total cleared renal fraction (TCRF) of the cardiac output with respect to the radioactive indicator has previously been shown to be closely related to GFR. A pooled estimate of GFR (GFR_p) was calculated from the stochastically independent estimates of GFR based on λ_pk and TCRF. The comparison of GFR_p with measured GFR was satisfactory and yielded substantially smaller standard deviations (SD) of GFR_p than estimates based on λ_pk and TCRF separately. The standard deviations of GFR_p were about 7 and 12 ml/min/1·73 m² in IHGR for GFR equal to 50 and 100 ml/min/1·73 m², respectively. The corresponding SD in TDGR were about 7 and 11 ml/min/1·73 m². These standard deviations are sufficiently small for many clinical purposes and the method requires no blood samples or urine collections.     

How social media,training, and demographics influence online reviews across three leading review websites for spine surgeons

Background Context

The future of health care is consumer driven with a focus on outcome metrics and patient feedback. Physician review websites have grown in popularity and are guiding patients to certain health-care providers, for better or worse. No prior study has specifically evaluated Internet reviews of spine surgeons, determined if social media (SM) correlates with patient reviews, or evaluated Google as a physician review website.

Cardiovascular disease in U.S. patients with metabolic syndrome, diabetes, and elevated C-reactive protein

OBJECTIVE: C-reactive protein (CRP) independently predicts cardiovascular disease (CVD); whether it can stratify risk in those with metabolic syndrome and diabetes is not well documented. We evaluated whether elevated CRP levels modify the relationship of metabolic syndrome and diabetes with CVD in U.S. adults. RESEARCH DESIGN AND METHODS: In a cross-sectional study of 3,873 subjects (weighted to 156 million) aged >/=18 years participating in the National Health and Nutrition Examination Survey 1999-2000, subjects were classified as having diabetes, metabolic syndrome according to modified National Cholesterol Education Program criteria, or neither condition by low (<1 mg/l), intermediate (1-3 mg/l), or high (>3 mg/l) CRP levels. Logistic regression examined the odds of CVD by disease condition and CRP group. RESULTS: After adjusting for age, sex, smoking, and total cholesterol, compared with those with neither metabolic syndrome nor diabetes and low CRP levels, the odds of CVD were 1.99 (95% CI 1.10-3.59) for those with no disease and high CRP levels and 2.67 (1.30-5.48) for those with metabolic syndrome and intermediate CRP. Persons with metabolic syndrome but high CRP had an odds ratio (OR) of 3.33 (1.80-6.16), similar to those with diabetes and low CRP (3.21 [1.27-8.09]). The likelihood of CVD was highest in those with diabetes who had intermediate CRP levels (6.01 [2.54-14.20]) and in those with diabetes and high CRP (7.73 [3.99-14.95]). CONCLUSIONS: In this cross-sectional analysis, CVD is more common in those with metabolic syndrome or diabetes who have elevated CRP. Stratification by CRP may add prognostic information in patients with metabolic syndrome or diabetes.     

Magnetic resonance imaging of the lumbar spine: determining clinical impact and potential harm from overuse

Background

Lumbar spine magnetic resonance imaging is frequently said to be “overused” in the evaluation of low back pain, yet data concerning the extent of overuse and the potential harmful effects are lacking.