Venous thrombosis is associated with hyperglycemia at diagnosis: a case-control study.

Background: Patients with (undiagnosed) diabetes mellitus, impaired glucose tolerance or stress-induced hyperglycemia may be at greater risk for venous thrombosis and present with relative hyperglycemia during the thrombotic event.

Objectives: To assess whether venous thrombosis is associated with hyperglycemia at diagnosis.

Patients/methods: We performed a case-control study, derived from a cohort of consecutive patients referred for suspected deep vein thrombosis.

No apparent impact of increased post-operative blood glucose levels on clinical outcome in kidney transplant recipients.

Background: Our objective is to evaluate whether hyperglycemia in the first 48 h after renal transplantation is independently associated with rejection, post-operative infection and post-transplant diabetes mellitus (PTDM) in a retrospective cohort study.

Methods: Patients who received a renal transplant in our hospital in 2003 or 2004 were included. Glucose values until 48 h after surgery were retrieved from laboratory reports.

A randomized clinical trial comparing the effect of basal insulin and inhaled mealtime insulin on glucose variability and oxidative stress.

Aim: To assess the effect of three times daily mealtime inhaled insulin therapy compared with once daily basal insulin glargine therapy on 72-h glucose profiles, glucose variability and oxidative stress in type 2 diabetes patients.

Methods: In an inpatient crossover study, 40 subjects with type 2 diabetes were randomized to receive 9 days of inhaled insulin three times daily before meals or 9 days of glargine administered in the morning before breakfast in a randomized order. During the last 72 h in each phase, glucose was measured with continuous glucose monitoring.

Vascular liver disorders (II): portal vein thrombosis.

Portal vein thrombosis (PVT) is a rare disorder that is associated with a variety of underlying conditions, of which liver cirrhosis, malignancy and myeloproliferative disorders are the most common. Based on clinical presentation and results of imaging, two different entities can be identified, acute and chronic PVT. Anticoagulation therapy is recommended for all patients with acute PVT in an attempt to prevent further thrombosis and to promote recanalisation of the obstructed veins.

Advanced age, antithrombotic strategy, and bleeding in non-ST-segment elevation acute coronary syndromes: results from the ACUITY (Acute Catheterization and Urgent Intervention Triage Strategy) trial.

Objectives: This study sought to evaluate the impact of age on outcomes in patients with moderate- and high-risk non-ST-segment elevation acute coronary syndrome (NSTE-ACS) enrolled in the ACUITY (Acute Catheterization and Urgent Intervention Triage Strategy) trial.

Background: Aging-associated changes in physiology and metabolism may alter the risk and benefit of therapeutic strategies from that observed in younger people.

Methods: We performed a pre-specified analysis of 30-day and 1-year outcomes in 4 age groups, overall and among those undergoing percutaneous coronary intervention (PCI).

Individual quality improvement in acute coronary syndromes: a performance improvement initiative.

Although treatment guidelines from the American College of Cardiology (ACC) and the American Heart Association (AHA) have been published and widely accepted, barriers to the optimal management of patients with acute coronary syndromes (ACS) still exist. Adherence to guidelines has been correlated with improvements in patient outcomes in ACS, including reduced mortality, yet data demonstrate that 25% of opportunities to provide guideline-recommended care are missed. This article describes a performance improvement (PI) initiative designed to address gaps in process-related ACS care and improve patient outcomes.

Management of patients with unstable angina / non-ST-elevation myocardial infarction: a critical review of the 2007 ACC /AHA guidelines.

Background: In 2007, the American College of Cardiology/American Heart Association (ACC/AHA) published new guidelines for the diagnosis and management of patients with unstable angina/non-ST segment elevation myocardial infarction (UA/NSTEMI). These guidelines include some important updates on the use of clopidogrel, fondaparinux, bivalirudin and low-molecular-weight heparins (LMWHs) all of which have published landmark clinical trials in patients with acute coronary syndromes (ACS) since the publication of the 2002 guidelines. While these 2007 guidelines are more comprehensive and up-to-date compared with the recommendations published in 2002, they also raise many questions for practising emergency physicians and cardiologists.

Regional clustering of anthropometric dimensions of primary school children in rural and suburban Vietnam.

Nutrition transition is one of the driving forces of the upcoming global epidemic of diabetes mellitus and cardiovascular diseases. We hypothesized that in previously deprived rapidly changing regions, the progress of the obesity epidemic is clustered per community and that screening with anthropometric school surveys can detect the negative effects of the nutrition transition in its early stages. In 16 different rural and urban communities in Binh Thuan Province, southern Vietnam, anthropometric surveys were conducted in local primary schools.

[Lower incidence of type 2 diabetes mellitus with changes in lifestyle: clues from World War II].

Objective: To investigate the relation between diabetes and food consumption on a population level.

Design: Retrospective, descriptive.

Method: Data were collected from the archives of the Public Health Service of Amsterdam and the diabetes aftercare outpatient clinic ('Diabetes Nazorg') in Utrecht, the Netherlands, to determine the incidence of diabetes between 1940 and 1950.

[Intensive blood glucose-lowering therapy: to which extent?].

The excess mortality in the group of intensively treated patients in the 'Action to control cardiovascular risk in diabetes' (ACCORD) study casts doubts on the safety ofglycated haemoglobin (HbA(1C)) levels below 7%. However, comparison of the ACCORD study with the 'Action in diabetes and vascular disease: preterax and diamicron-MR controlled evaluation' (ADVANCE) trial, which showed no excess mortality, indicates that not a low HbA(1C) level per se, but the method by which it was achieved, was responsible for the adverse outcome. Although no specific cause was identified, the excessive use of rosiglitazone, and the combination of up to 5 glucose-lowering drugs, most strikingly distinguishes the ACCORD study from other studies.

The use of adjunctive anticoagulants in patients with acute coronary syndrome transitioning to percutaneous coronary intervention.

Patients presenting to the Emergency Department (ED) need to be quickly diagnosed, risk-stratified, and treated accordingly. Anticoagulants used in the ED should be easy to use and suitable for all patients with acute coronary syndromes, regardless of treatment strategy. In patients with ST-segment myocardial infarction, current guidelines recommend unfractionated heparin regardless of reperfusion strategy or low-molecular-weight heparin (LMWH) as an alternative in patients undergoing percutaneous coronary intervention (PCI).

Proteomic identification of proteins in the human brain: Towards a more comprehensive understanding of neurodegenerative disease.

Proteomics has revealed itself as a powerful tool in the identification and determination of proteins and their biological significance. More recently, several groups have taken advantage of the high-throughput nature of proteomics in order to gain a more in-depth understanding of the human brain. In turn, this information has provided researchers with invaluable insight into the potential pathways and mechanisms involved in the pathogenesis of several neurodegenerative disorders, e.

Vascular liver disorders (I): diagnosis, treatment and prognosis of Budd-Chiari syndrome.

Budd-Chiari syndrome (BCS) is a venous outflow obstruction of the liver that has a dismal outcome if left untreated. Most cases of BCS in the Western world are caused by thrombosis of the hepatic veins, sometimes in combination with thrombosis of the inferior vena cava. Typical presentation consists of abdominal pain, hepatomegaly and ascites, although symptoms may vary significantly.

Changing the glucose cut-off values that define hypoglycaemia has a major effect on reported frequencies of hypoglycaemia.

Aims/hypothesis: The aim of this analysis was to quantify the relationship between the frequency of hypoglycaemia and various glucose cut-off points for the definition of hypoglycaemia, within a range of HbA(1c) strata.

Methods: Data from two trials examining insulin glargine dose titration in 12,837 type 2 diabetic participants starting insulin therapy were combined. Curves for hypoglycaemia frequency plotted against endpoint HbA(1c) level were constructed, using a range of glucose cut-off points for hypoglycaemia.

Treatment strategies in non-ST-elevation acute coronary syndromes in patients undergoing percutaneous coronary intervention: an evidence-based review of clinical trial results and treatment guidelines: report on a roundtable discussion.

With the availability of new data and the recent release of new European and US guidelines, contemporary care paradigms for the treatment of patients with non-ST-elevation acute coronary syndromes (NSTE ACS), including those undergoing percutaneous coronary intervention, are likely to undergo substantial changes. In recognition of this shifting landscape as well as the impact of new guidelines on care models for the treatment of patients with NSTE ACS, a roundtable was convened on October 25, 2007, to discuss the implications of these changes. The purpose of this review is to summarize the presentations and subsequent discussions from the roundtable, which examined the guidelines and evidence from a variety of perspectives, and to explore the best ways to incorporate new treatment paradigms into everyday clinical care.

The strength of phenotypic selection in natural populations.

How strong is phenotypic selection on quantitative traits in the wild? We reviewed the literature from 1984 through 1997 for studies that estimated the strength of linear and quadratic selection in terms of standardized selection gradients or differentials on natural variation in quantitative traits for field populations. We tabulated 63 published studies of 62 species that reported over 2,500 estimates of linear or quadratic selection. More than 80% of the estimates were for morphological traits; there is very little data for behavioral or physiological traits.

Evaluating clinical accuracy of continuous glucose monitoring devices: other methods.

With more and more continuous glucose monitoring devices entering the market, the importance of adequate accuracy assessment grows. This review discusses pros and cons of Regression Analysis and Correlation Coefficient, Relative Difference measures, Bland Altman plot, ISO criteria, combined curve fitting, and epidemiological analyses, the latter including sensitivity, specificity and positive predictive value for hypoglycaemia. Finally, recommendations for much needed head-to-head studies are given.

Prevalence of diabetes mellitus and the performance of a risk score among Hindustani Surinamese, African Surinamese and ethnic Dutch: a cross-sectional population-based study.

Background: While the prevalence of type 2 diabetes mellitus (DM) is high, tailored risk scores for screening among South Asian and African origin populations are lacking. The aim of this study was, first, to compare the prevalence of (known and newly detected) DM among Hindustani Surinamese, African Surinamese and ethnic Dutch (Dutch). Second, to develop a new risk score for DM.

Initial risk stratification and presenting characteristics of patients with evolving myocardial infarctions.

Objectives: To describe the presenting characteristics and risk stratification of patients presenting to the emergency department with chest pain who have a normal initial troponin level followed by a raised troponin level within 12 h (evolving myocardial infarction (EMI)).

Methods: Data from the Internet Tracking Registry for Acute Coronary Syndromes (i*trACS), a registry of patients presenting with undifferentiated chest pain, were used. This analysis included patients without ST segment elevation with at least two troponin assay results < or = 12 h apart.

Continuum of care in the treatment of ST-segment elevation myocardial infarction (STEMI): importance of platelet and coagulation inhibition.

ST-segment elevation myocardial infarction (STEMI) is a serious manifestation of atherothrombosis. Platelets play an important role in the pathogenesis of atherothrombosis, and the use of antiplatelet agents is associated with substantial improvements in clinical outcome. Current guidelines for the management of patients with STEMI stress the importance of using antiplatelet agents as an integral part of acute and long-term therapy.

Hypoglycemia and strict glycemic control in critically ill patients.

Purpose Of Review: In contrast to patients with diabetes mellitus, data on consequences of hypoglycemia in critically ill patients are sparse. The purpose of this review is to summarize available data on prevalence of hypoglycemia, risk factors, and possible consequences of hypoglycemia in critically ill patients.

Recent Findings: There is strong evidence that strict glycemic control is beneficial for critically ill patients.