ASCOT-CRP trial - Summary & Results
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http://www.theheart.org/web_slides/1185967.do A post hoc analysis of the trial's lipid-lowering arm designed to evaluate the importance of high-sensitivity C-reactive protein (hs-CRP) in measuring CV risk
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Diabetic nephropathy
The document discusses acute and late complications of diabetes mellitus. Acute complications include diabetic ketoacidosis (DKA), insulin shock, and hyperglycemic hyperosmolar nonketotic coma. Late complications involve damage to organs over time and include retinopathy, neuropathy, and nephropathy. Treatment of diabetic nephropathy focuses on blood pressure control using ACE inhibitors or ARBs to slow disease progression.
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Diabetes ketoacidosis
This document discusses diabetic ketoacidosis (DKA), providing definitions, symptoms, pathophysiology, diagnosis, treatment, and complications. DKA results from a lack of insulin and causes the body to burn fat and produce acidic ketones. It is defined by hyperglycemia, ketosis, and acidemia. Treatment involves fluid replacement, insulin therapy to lower blood glucose levels, and monitoring for complications like shock, thrombosis, pulmonary edema, and cerebral edema. The goal is to resolve the DKA and transition the patient to their usual insulin regimen and diet to prevent future occurrences.
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The document discusses acute complications of diabetes mellitus including hypoglycemia, diabetic ketoacidosis (DKA), and hyperosmolar hyperglycemic state (HHS). It provides details on the pathogenesis, clinical presentation, precipitating factors, diagnostic evaluation, and treatment of DKA and HHS, including fluid resuscitation, insulin therapy, electrolyte replacement, and criteria for resolution prior to transitioning to subcutaneous insulin therapy. Complications of treatment are also discussed.
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The document discusses acute and late complications of diabetes mellitus. Acute complications include diabetic ketoacidosis (DKA), insulin shock, and hyperglycemic hyperosmolar nonketotic coma. Late complications involve damage to organs over time and include retinopathy, neuropathy, and nephropathy. Treatment of diabetic nephropathy focuses on blood pressure control using ACE inhibitors or ARBs to slow disease progression.
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Diabetic retinopathy is a complication of diabetes that affects the tiny blood vessels in the retina. High blood glucose levels over a long period of time can damage these blood vessels. Symptoms include blurry or blocked vision that may be accompanied by spots or floaters. The condition progresses through mild, moderate, and severe non-proliferative stages and can become proliferative, potentially causing blindness if left untreated. Risk factors include diabetes, high blood pressure, high cholesterol, and pregnancy.
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Diabetic kidney disease
Diabetic kidney disease, also called diabetic nephropathy, is a type of chronic kidney disease caused by damage to the kidneys as a result of diabetes. Over time, high blood glucose levels associated with diabetes can damage the tiny filters in the kidneys called glomeruli. This can progressively reduce their ability to filter waste from the blood, potentially leading to kidney failure. Symptoms of diabetic kidney disease may include swelling, poor sleep or concentration, nausea or weakness. It can be diagnosed through urine and blood tests and managed through strict control of blood sugar and blood pressure levels.
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Chronic complications of diabetes mellitus include microvascular complications that affect the eyes (retinopathy), kidneys (nephropathy), and nerves (neuropathy), as well as macrovascular complications like coronary heart disease and cerebrovascular disease. Both microvascular and macrovascular complications can result in diabetic foot and erectile dysfunction. The mechanisms behind these complications include the formation of advanced glycosylation end products due to high blood glucose, increased activity of the sorbitol pathway, and activation of protein kinase C. Early detection and treatment of these complications can help prevent further damage.
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Diabetic retinopathy is a complication of diabetes mellitus where changes occur in the retina. It is a leading cause of vision loss among working age adults in Malaysia. The risk of retinopathy rises with longer duration of diabetes and poor blood glucose control. Annual eye screening is recommended to detect early signs and plan treatment. Laser photocoagulation is commonly used to treat early stages while vitrectomy may be used for advanced proliferative cases with vitreous hemorrhage. Anti-VEGF drugs combined with laser can also treat diabetic macular edema.
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Diabetic nephropathy is the leading cause of end-stage renal disease. About 20-30% of patients with type 1 or type 2 diabetes develop nephropathy, which involves stages of hyperfiltration, microalbuminuria, proteinuria, and finally end-stage renal disease. Risk factors include age, race, ethnicity, history of microalbuminuria, hypertension, poor glycemic control, and smoking. Treatment aims to control blood pressure and block the renin-angiotensin system using ACE inhibitors, angiotensin receptor blockers, or calcium channel blockers to slow the progression of kidney damage.
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1. Diabetic peripheral neuropathy (DPN) is damage to nerves caused by high blood sugar levels from diabetes, resulting in pain symptoms.
2. DPN is diagnosed clinically based on symptoms of numbness, tingling, and pain in a glove/stocking distribution, especially in the feet. Sensory testing and nerve conduction studies can support the diagnosis.
3. Screening tools that incorporate both patient interviews about sensory symptoms and physical exams of nerve function have high sensitivity and specificity for diagnosing neuropathic pain compared to tools relying only on interviews.
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This document provides information about diabetes and diabetic retinopathy for medical students. It outlines learning objectives related to understanding diabetes demographics, diagnosis, complications, and treatments. Key points include that diabetes affects over 29 million Americans and has significant medical costs. Diabetic retinopathy is a leading cause of blindness and its progression can be slowed by controlling blood sugar and blood pressure. The document also defines the stages of diabetic retinopathy and diabetic macular edema.
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A sufficient decrease in C-reactive protein (CRP) levels after elective colorectal surgery can predict an uneventful recovery. The study found that patients who developed early complications had higher CRP levels on the second postoperative day compared to uncomplicated patients. A decrease in CRP levels between the second and fifth postoperative days of less than 36% for open surgery and 48% for laparoscopic surgery indicated a risk of developing late complications. Monitoring CRP levels in the early postoperative period can help identify patients at risk of septic complications and guide safe discharge from the hospital.
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This document describes diabetic retinopathy (DR), its classification, pathogenesis, risk factors, screening protocols, and treatment. DR is classified as non-proliferative DR (NPDR) or proliferative DR (PDR). NPDR is further divided into mild, moderate, severe, and very severe stages based on lesions seen. PDR is characterized by new blood vessel growth. Clinically significant macular edema (CSME) can occur and cause vision loss. Screening intervals depend on DR severity. Laser treatment is used for CSME, PDR, and sometimes severe NPDR to prevent vision loss complications like vitreous hemorrhage or retinal detachment. Good glucose and blood pressure control can delay DR progression.
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Soffacation (suicidal)
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Diabetic nephropathy is a chronic kidney disease characterized by gradually increasing urinary albumin excretion, high blood pressure, declining kidney function, and presence of diabetic retinopathy. It develops in 20-40% of people with diabetes and is the leading cause of end-stage renal disease. The pathophysiology involves metabolic and hemodynamic pathways as well as genetic factors. Hyperglycemia causes kidney damage through increased polyol pathway flux, formation of advanced glycation end products, activation of protein kinase C, and other mechanisms. Hemodynamic changes from hypertension increase glomerular pressure and permeability. Genetic factors like ACE polymorphisms also influence risk. Progression is associated with proteinuria, anemia
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The document discusses diabetic retinopathy, including its definition, signs and symptoms, causes, risk factors, stages, treatments including laser photocoagulation and intravitreal injections, and importance of glycemic and blood pressure control. It emphasizes the need for regular eye exams in people with diabetes to screen for and treat diabetic eye diseases early.
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This document discusses automation in hematology. It begins by outlining the necessity for automation in cell counting, diagnosing various blood conditions, and performing multiple tests on a single platform. The document then covers the advantages and disadvantages of automation, including increased speed and accuracy versus high costs. It describes the various principles used in automated hematology analyzers, such as electrical impedance, optical light scattering, and flow cytometry. Finally, it provides details on specific analyzers like the Pentra ES 60 and Pentra DF Nexus.
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Interpretation of lab tests - CRP, TUMOR MARKERS, SERUM FERRITIN
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Lecture 1: Hematology introducion For TID and HIV Medicine MSc students
Lecture 1: Hematology introducion For TID and HIV Medicine MSc students
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One of the largest studies to examine the effect of omega-3 polyunsaturated fatty acids (PUFA) on AF
TRITON-TIMI 38 trial - Summary & Results
http://www.theheart.org/web_slides/1144191.do
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SHIFT trial - Summary & Results
http://www.theheart.org/web_slides/1425587.do
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http://www.theheart.org/web_slides/1146285.do
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http://www.theheart.org/web_slides/1242353.do
An analysis based on an Italian registry of 308 patients with Brugada syndrome who underwent programmed electrical stimulation (PES) studies according to one consistent protocol (unlike earlier multicenter studies that were based on varying PES protocols)
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- 1. ASCOT-CRP (Anglo-Scandinavian Cardiac Outcomes Trial—C-Reactive Protein)
- 2. ASCOT-CRP (Anglo-Scandinavian Cardiac Outcomes Trial—C-Reactive Protein) PS Sever (Imperial College, London, UK) American Heart Association 2010 Scientific Sessions • A post hoc analysis of the trial's lipid-lowering arm designed to evaluate the importance of high-sensitivity C-reactive protein (hs-CRP) in measuring CV risk • Included 485 patients: Who reached the composite end point (CV death, nonfatal MI, coronary revascularization, or fatal/nonfatal stroke) Were age- and sex-matched to 1367 patients in the control group who hadn't suffered one of those events Were followed for 5.5 years
- 3. ASCOT-CRP: Results Measuring hs-CRP had little to no utility in refining CV risk assessment beyond classic risk factors • Baseline levels of hs-CRP and LDL-C were significantly correlated with each other (p<0.0001) and both were predictive of the composite CV end point: OR 1.31 (95% CI 1.10–1.56; p=0.002) for LDL-C OR 1.19 (95% CI 1.05–1.34; p=0.006) for every one–standard-deviation increase in hs-CRP • Lower on-treatment LDL-C but not hs-CRP was associated with a highly significant reduction in CV events over six months: LDL-C <2.1 mmol/L (median) vs LDL-C ≥ 2.1 mmol/L predicted a reduction in the composite end point (adjusted OR=0.41, 95% CI 0.22–0.75; p=0.004) hs-CRP <1.83 mg/L (median) vs hs-CRP ≥ 1.83 mg/L showed no such predictive effect (adjusted OR=0.86, 95% CI 0.49–1.51; p=0.60)
- 4. ASCOT-CRP: Commentary* "It is clear that achievement of low LDL-cholesterol levels confers great benefit, and there's no added benefit by achieving a lower CRP level." - Dr Peter S Sever "I'm not as convinced as Dr Sever that this damages the CRP hypothesis." - Dr Roger Blumenthal "It's a post hoc analysis of a previously published trial and we must take it with a grain of salt. It was a particularly high-risk primary-prevention cohort, and it's fair to say there were a relatively small number of events." - Dr Donald Lloyd Jones *All comments from ASCOT analysis fuels debate over JUPITER-based CRP indication for statins (http://www.theheart.org/article/1153661.do)
- 5. Become a member of http://www.theheart.org Become a fan on Facebook: http://www.facebook.com/theheartorg Follow us on Twitter: http://www.twitter.com/theheartorg theheart.org is the leading online source of independent cardiology news. We are the top provider of news and opinions for over 100 000 physicians.