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https://www.readbyqxmd.com/read/28289965/novel-insights-into-the-pathophysiology-and-clinical-aspects-of-diabetic-nephropathy
#1
REVIEW
Zubair Ilyas, Joumana T Chaiban, Armand Krikorian
Diabetic nephropathy (DN) is a well-described complication of diabetes mellitus and the leading cause of end stage renal disease (ESRD). Although increased albuminuria has been the gold standard for screening, data suggests that renal damage starts long before the onset of clinically apparent increases in macro and even micro-albuminuria. Clinical practice guidelines for the prevention of DN have been traditionally focused on the control of serum glucose, blood pressure and dyslipidemia, with some focus on the renin-angiotensin-aldosterone system (RAAS) as a main target for successful therapy...
March 13, 2017: Reviews in Endocrine & Metabolic Disorders
https://www.readbyqxmd.com/read/28285069/sacubitril-valsartan-the-newest-addition-to-the-toolbox-for-guideline-directed-medical-therapy-of-heart-failure
#2
REVIEW
Jo E Rodgers
Sacubitril/valsartan combines a neprilysin inhibitor with an angiotensin receptor blocker. As an inhibitor of neprilysin, an enzyme that degrade biologically active natriuretic peptides, this first-in-class therapy increases levels of circulating natriuretic peptides resulting in natriuretic, diuretic, and vasodilatory effects. In patients chronic New York Heart Association class II-IV heart failure with reduced ejection fraction, the PARADIGM-HF trial demonstrated that sacubitril/valsartan significantly reduced the primary endpoint of cardiovascular mortality and HF hospitalization compared to enalapril...
March 8, 2017: American Journal of Medicine
https://www.readbyqxmd.com/read/28275938/role-of-coronary-calcium-for-risk-stratification-and-prognostication
#3
REVIEW
Negin Nezarat, Michael Kim, Matthew Budoff
A multitude of studies now support the understanding that an increased coronary artery calcium (CAC) score represents advanced atherosclerosis and high risk for cardiovascular disease (CVD) and, as such, should be treated with conventional therapies for those considered high risk. Data is now available to guide treatment with aspirin, statins, and lifestyle management. The new ACC/AHA 2013 guidelines support intensifying statin therapy when the CAC is ≥75th percentile for age, sex, and ethnicity/race or when the calcium score is ≥300 Agatston units...
February 2017: Current Treatment Options in Cardiovascular Medicine
https://www.readbyqxmd.com/read/28237685/evaluation-of-a-new-handheld-point-of-care-blood-gas-analyser-using-100-equine-blood-samples
#4
David Bardell, Eleanor West, J Mark Senior
OBJECTIVES: To determine whether the Enterprise point-of-care blood analysis system (EPOC) produces results in agreement with two other blood gas analysers in regular clinical use (i-STAT and Radiometer ABL77) and to investigate the precision of the new machine when used with equine whole blood. STUDY DESIGN: Prospective, randomized, non-blinded, comparative laboratory analyser study. ANIMALS: Horses admitted to a university teaching hospital requiring arterial or venous blood gas analysis as part of their routine clinical management...
February 22, 2017: Veterinary Anaesthesia and Analgesia
https://www.readbyqxmd.com/read/28178413/spontaneous-intracerebral-hemorrhage-management
#5
REVIEW
Jun Yup Kim, Hee-Joon Bae
Spontaneous non-traumatic intracerebral hemorrhage (ICH) remains a significant cause of mortality and morbidity throughout the world. To improve the devastating course of ICH, various clinical trials for medical and surgical interventions have been conducted in the last 10 years. Recent large-scale clinical trials have reported that early intensive blood pressure reduction can be a safe and feasible strategy for ICH, and have suggested a safe target range for systolic blood pressure. While new medical therapies associated with warfarin and non-vitamin K antagonist oral anticoagulants have been developed to treat ICH, recent trials have not been able to demonstrate the overall beneficial effects of surgical intervention on mortality and functional outcomes...
January 2017: Journal of Stroke
https://www.readbyqxmd.com/read/28161697/in-the-wake-of-systolic-blood-pressure-intervention-trial-new-targets-for-improving-hypertension-management-in-chronic-kidney-disease
#6
Crystal C Tyson, Thomas M Coffman
Systolic Blood Pressure Intervention Trial (SPRINT) was a multicenter randomized controlled trial showing the significant benefit of intensive reduction of blood pressure to a target of 120 mm Hg in individuals with hypertension and elevated cardiovascular risk. Because SPRINT includes the largest cohort of adults with chronic kidney disease (CKD) to be prospectively studied in a hypertension intervention trial, it has particular relevance to the field of nephrology. Here, we review the findings of SPRINT and assess their potential impact on guidelines for treatment of hypertension in patients with CKD...
February 4, 2017: Nephron
https://www.readbyqxmd.com/read/28157742/stroke-epidemiology-and-risk-factor-management
#7
Amy Guzik, Cheryl Bushnell
PURPOSE OF REVIEW: Death from stroke has decreased over the past decade, with stroke now the fifth leading cause of death in the United States. In addition, the incidence of new and recurrent stroke is declining, likely because of the increased use of specific prevention medications, such as statins and antihypertensives. Despite these positive trends in incidence and mortality, many strokes remain preventable. The major modifiable risk factors are hypertension, diabetes mellitus, tobacco smoking, and hyperlipidemia, as well as lifestyle factors, such as obesity, poor diet/nutrition, and physical inactivity...
February 2017: Continuum: Lifelong Learning in Neurology
https://www.readbyqxmd.com/read/28107274/the-sluscore-a-novel-method-for-detecting-hazardous-hypotension-in-adult-patients-undergoing-noncardiac-surgical-procedures
#8
Wolf H Stapelfeldt, Hui Yuan, Jefferson K Dryden, Kristen E Strehl, Jacek B Cywinski, Jesse M Ehrenfeld, Pamela Bromley
BACKGROUND: It has been suggested that longer-term postsurgical outcome may be adversely affected by less than severe hypotension under anesthesia. However, evidence-based guidelines are unavailable. The present study was designed to develop a method for identifying patients at increased risk of death within 30 days in association with the severity and duration of intraoperative hypotension. METHODS: Intraoperative mean arterial blood pressure recordings of 152,445 adult patients undergoing noncardiac surgery were analyzed for periods of time accumulated below each one of the 31 thresholds between 75 and 45 mm Hg (hypotensive exposure times)...
April 2017: Anesthesia and Analgesia
https://www.readbyqxmd.com/read/28095040/consensus-statement-by-the-american-association-of-clinical-endocrinologists-and-american-college-of-endocrinology-on-the-comprehensive-type-2-diabetes-management-algorithm-2017-executive-summary
#9
Alan J Garber, Martin J Abrahamson, Joshua I Barzilay, Lawrence Blonde, Zachary T Bloomgarden, Michael A Bush, Samuel Dagogo-Jack, Ralph A DeFronzo, Daniel Einhorn, Vivian A Fonseca, Jeffrey R Garber, W Timothy Garvey, George Grunberger, Yehuda Handelsman, Irl B Hirsch, Paul S Jellinger, Janet B McGill, Jeffrey I Mechanick, Paul D Rosenblit, Guillermo E Umpierrez
A1C = hemoglobin A1C AACE = American Association of Clinical Endocrinologists ACCORD = Action to Control Cardiovascular Risk in Diabetes ACCORD BP = Action to Control Cardiovascular Risk in Diabetes Blood Pressure ACEI = angiotensin-converting enzyme inhibitor ADVANCE = Action in Diabetes and Vascular Disease: Preterax and Diamicron MR Controlled Evaluation AGI = alpha-glucosidase inhibitor apo B = apolipoprotein B ASCVD = atherosclerotic cardiovascular disease BAS = bile acid sequestrant BMI = body mass index BP = blood pressure CHD = coronary heart disease CKD = chronic kidney disease CVD = cardiovascular disease DASH = Dietary Approaches to Stop Hypertension DPP-4 = dipeptidyl peptidase 4 eGFR = estimated glomerular filtration rate FDA = Food and Drug Administration GLP-1 = glucagon-like peptide 1 HDL-C = high-density lipoprotein cholesterol IMPROVE-IT = Improved Reduction of Outcomes: Vytorin Efficacy International Trial LDL-C = low-density lipoprotein cholesterol LDL-P = low-density lipoprotein particle Look AHEAD = Look Action for Health in Diabetes NPH = neutral protamine Hagedorn OSA = obstructive sleep apnea SFU = sulfonylurea SGLT-2 = sodium glucose cotransporter-2 SMBG = self-monitoring of blood glucose T2D = type 2 diabetes TZD = thiazolidinedione VADT = Veterans Affairs Diabetes Trial...
February 2017: Endocrine Practice
https://www.readbyqxmd.com/read/28071865/the-impact-of-evidence-based-sepsis-guidelines-on-emergency-department-clinical-practice-a-pre-post-medical-record-audit
#10
Bernadine Romero, Margaret Fry, Michael Roche
AIMS AND OBJECTIVES: The aim of this study was to explore the number of patients presenting with sepsis before and after guideline implementation; the impact of sepsis guidelines on triage assessment, Emergency Department management and time to antibiotics. BACKGROUND: Sepsis remains one of the leading causes of mortality and morbidity within hospitals. Globally, strategies have been implemented to reduce morbidity and mortality rates, which rely on the early recognition and management of sepsis...
January 10, 2017: Journal of Clinical Nursing
https://www.readbyqxmd.com/read/28056987/blood-pressure-control-in-type-2-diabetic-patients
#11
REVIEW
Alon Grossman, Ehud Grossman
Diabetes mellitus (DM) and essential hypertension are common conditions that are frequently present together. Both are considered risk factors for cardiovascular disease and microvascular complications and therefore treatment of both conditions is essential. Many papers were published on blood pressure (BP) targets in diabetic patients, including several works published in the last 2 years. As a result, guidelines differ in their recommendations on BP targets in diabetic patients. The method by which to control hypertension, whether pharmacological or non-pharmacological, is also a matter of debate and has been extensively studied in the literature...
January 6, 2017: Cardiovascular Diabetology
https://www.readbyqxmd.com/read/28011188/mid-range-ejection-fraction-does-not-permit-risk-stratification-among-patients-hospitalized-for-heart-failure
#12
Inés Gómez-Otero, Andreu Ferrero-Gregori, Alfonso Varela Román, José Seijas Amigo, Domingo A Pascual-Figal, Juan Delgado Jiménez, Jesús Álvarez-García, Francisco Fernández-Avilés, Fernando Worner Diz, Luis Alonso-Pulpón, Juan Cinca, José Ramón Gónzalez-Juanatey
INTRODUCTION AND OBJECTIVES: European Society of Cardiology heart failure guidelines include a new patient category with mid-range (40%-49%) left ventricular ejection fraction (HFmrEF). HFmrEF patient characteristics and prognosis are poorly defined. The aim of this study was to analyze the HFmrEF category in a cohort of hospitalized heart failure patients (REDINSCOR II Registry). METHODS: A prospective observational study was conducted with 1420 patients classified according to ejection fraction as follows: HFrEF, < 40%; HFmrEF, 40%-49%; and HFpEF, ≥ 50%...
December 20, 2016: Revista Española de Cardiología
https://www.readbyqxmd.com/read/27968771/treatment-of-acute-cardiac-failure-in-the-emergency-department-improve-our-practices-data-from-the-resurcor-network
#13
L Belle, G Courtiol, L Lamboley, P Debax, P Pili, G Deschane, M Latappy, J Oberlin, A Drouet, C Ricard, C Morvan, F-X Ageron
BACKGROUND: In 2015, the European Society of cardiology published guidelines on the pre-hospital and early hospital management of acute cardiac failure (ACF), which included: - use of intravenous vasodilators (nitrates) when systolic blood pressure is>110mmHg; - non-invasive ventilation if oxygen saturation is<90% and/or respiratory rate is>25/min despite nasal oxygen; - using a reduced dose of intravenous furosemide (20-40mg or equivalent of the oral morning dose if already on chronic diuretic therapy) and; - early performance of echocardiography...
November 2016: Annales de Cardiologie et D'angéiologie
https://www.readbyqxmd.com/read/27955682/health-effectiveness-and-cost-effectiveness-of-telehealthcare-for-heart-failure-study-protocol-for-a-randomized-controlled-trial
#14
Simon Lebech Cichosz, Lars Holger Ehlers, Ole Hejlesen
BACKGROUND: Several heart failure studies have shown promising results for implementing telehealthcare. These studies have led to clinical and political interest in telehealthcare as a way to improve heart failure outcomes and lower costs. However, there is a need for large-scale clinical trials with cost-effectiveness assessments. METHODS/DESIGN: The present study is known as the TeleCare North Heart Failure Trial in Denmark. We are studying the health effectiveness and cost-effectiveness of a telehealth (Telekit) solution compared with usual care for patients with heart failure...
December 12, 2016: Trials
https://www.readbyqxmd.com/read/27927632/associations-between-blood-pressure-and-outcomes-among-blacks-in-the-jackson-heart-study
#15
Tiffany C Randolph, Melissa A Greiner, Chidiebube Egwim, Adrian F Hernandez, Kevin L Thomas, Lesley H Curtis, Paul Muntner, Wei Wang, Robert J Mentz, Emily C O'Brien
BACKGROUND: In 2014, new hypertension guidelines liberalized blood pressure goals for persons 60 years and older. Little is known about the implications for blacks. METHODS AND RESULTS: Using data from 2000 through 2011 for 5280 participants in the Jackson Heart Study, a community-based black cohort in Jackson, Mississippi, we examined whether higher blood pressure was associated with greater risk of mortality and heart failure hospitalization, and whether the risk was the same across age groups...
December 7, 2016: Journal of the American Heart Association
https://www.readbyqxmd.com/read/27923668/health-associations-with-meeting-new-24-hour-movement-guidelines-for-canadian-children-and-youth
#16
Valerie Carson, Jean-Philippe Chaput, Ian Janssen, Mark S Tremblay
The study objective was to examine whether meeting the new Canadian 24-hour movement guidelines was associated with health indicators in a representative sample of Canadian children and youth. Cross-sectional findings are based on 4157 (1239 fasting subsample) children and youth aged 6-17years from cycles 1-3 of the Canadian Health Measures Survey (CHMS). Sleep and screen time were subjectively measured while moderate- to vigorous-intensity physical activity (MVPA) was accelerometer-determined. Health indicators in the full sample (body mass index (BMI) z-scores, waist circumference, blood pressure, behavioral strengths and difficulties score (lower=better), and aerobic fitness) and fasting subsample (triglycerides, high-density lipoprotein (HDL)-cholesterol, C-reactive protein, and insulin) were measured...
December 5, 2016: Preventive Medicine
https://www.readbyqxmd.com/read/27900971/chronic-kidney-disease-stages-among-diabetes-patients-in-the-cape-coast-metropolis
#17
Richard K D Ephraim, Eric Arthur, W K B A Owiredu, Prince Adoba, Hope Agbodzakey, Ben A Eghan
Diabetes patients worldwide are at a high risk of chronic kidney disease (CKD) which affects their quality of life and increases the risk of early death. This study used the new kidney disease improving global outcomes (KDIGO) guidelines to establish the prevalence and also identify the factors associated with CKD among diabetes patients in the Cape Coast Metropolis. Two hundred (200) diabetes patients were randomly recruited from the diabetic clinic of the Cape Coast Teaching Hospital from January to April 2014...
November 2016: Saudi Journal of Kidney Diseases and Transplantation
https://www.readbyqxmd.com/read/27887644/copenhagen-comorbidity-in-hiv-infection-cocomo-study-a-study-protocol-for-a-longitudinal-non-interventional-assessment-of-non-aids-comorbidity-in-hiv-infection-in-denmark
#18
Andreas Ronit, Judith Haissman, Ditte Marie Kirkegaard-Klitbo, Thomas Skårup Kristensen, Anne-Mette Lebech, Thomas Benfield, Jan Gerstoft, Henrik Ullum, Lars Køber, Andreas Kjær, Klaus Kofoed, Jørgen Vestbo, Børge Nordestgaard, Jens Lundgren, Susanne Dam Nielsen
BACKGROUND: Modern combination antiretroviral therapy (cART) has improved survival for people living with HIV (PLWHIV). Non-AIDS comorbidities have replaced opportunistic infections as leading causes of mortality and morbidity, and are becoming a key health concern as this population continues to age. The aim of this study is to estimate the prevalence and incidence of non-AIDS comorbidity among PLWHIV in Denmark in the cART era and to determine risk factors contributing to the pathogenesis...
November 26, 2016: BMC Infectious Diseases
https://www.readbyqxmd.com/read/27884231/guidelines-for-the-management-of-hypertension
#19
REVIEW
Aram V Chobanian
This article summarizes pertinent data from clinical trials on the effects of antihypertensive therapy on cardiovascular complications. Prior definitions of hypertension and blood pressure goals of therapy are discussed, and differences between national and international guidelines on such goals are summarized. The results of the SPRINT study are summarized, and the impact of this study on future goals of treatment is discussed. New recommendations are provided on blood pressure goals, and the effects such goals might have on clinical practice are discussed...
January 2017: Medical Clinics of North America
https://www.readbyqxmd.com/read/27855640/long-term-secondary-prevention-of-acute-myocardial-infarction-sepat-guidelines-adherence-and-outcome
#20
Constantinos Ergatoudes, Erik Thunström, Annika Rosengren, Lena Björck, Kristina Bengtsson Boström, Kristin Falk, Michael Fu
BACKGROUND: A number of registry studies have reported suboptimal adherence to guidelines for cardiovascular prevention during the first year after acute myocardial infarction (AMI). However, only a few studies have addressed long-term secondary prevention after AMI. This study evaluates prevention guideline adherence and outcome of guideline-directed secondary prevention in patients surviving 2 years after AMI. METHODS: Patients aged 18-85 years at the time of their index AMI were consecutively identified from hospital discharge records between July 2010 and December 2011 in Gothenburg, Sweden...
November 17, 2016: BMC Cardiovascular Disorders
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