South Asians have a very high incidence of ischemic heart disease and stroke. In addition, they also have a very high incidence of metabolic diseases such as prehypertension, hypertension, visceral obesity, metabolic syndrome, prediabetes, type-2 diabetes, and its clinical complications. Currently, there are over 75 million diabetic subjects in India and an equal number of prediabetics. Republic of China has taken over India as the diabetes capital of the world, with over 115 million diabetics. Modern medicine is disease focused and has failed to address the prevention of these chronic diseases. According to the reports from the United Nations (Millennium Development Goals [MDGs], the World Health Organization, Global Health Initiatives, and the non-communicable disease risk task force), obesity has increased by 2-fold and type-2 diabetes by 4-fold worldwide. Experts in this field predict that chances of meeting the MDGs set by the UN members of reducing the incidence of these diseases at 2025 to the level of 2020 are very little. Western medicine has failed to reduce or reverse the trend in the incidence of these diseases. We feel that an integrated approach to health care may be a better option, to reduce the disease burden in developing and resource-poor countries. Having said that, one cannot prevent something that one is not aware of, as such it is the need of the hour for us, to develop a robust predictive and preventive health-care platform. In an earlier article, we presented our views on reducing or reversing cardiometabolic diseases. There is great enthusiasm among the health-care providers and professional bodies that integration of emerging technologies will help develop personalized, precision medicine, as well as reduce the cost of health-care worldwide.
Non-invasive Diagnostic Tools: Cardiometabolic Risk Assessment and Predictionasclepiuspdfs
Cardiometabolic risks (CMRs) have rapidly increased to epidemic proportions worldwide in the past three decades. Cardiovascular disease (CVD) remains the number one killer. No country has reduced, reversed, or prevented the increase in the incidence or prevalence of chronic metabolic diseases. Framingham Heart Study group described the modifiable risk factors that promote the development of CVD. They also developed risk calculators, for the prediction of acute vascular events such as heart attacks and stroke. The risk predictor algorithms were fine-tuned, as and when additional risk factors were discovered. However, at the time of this writing, there is no such calculator for assessment, stratification, and management of CMRs. On the other hand, numbers of non-invasive diagnostic devices have been developed for continuous monitoring of blood pressure and glucose profiles. We have described in our earlier articles, non-invasive diagnostic platform developed by LD-Technologies,
Augmented Personalized Health: using AI techniques on semantically integrated...Amit Sheth
Keynote @ 2018 AAAI Joint Workshop on Health Intelligence (W3PHIAI 2018), 2 February 2018, New Orleans, LA [Video: https://youtu.be/GujvoWRa0O8]
Related article: https://ieeexplore.ieee.org/document/8355891/
Abstract
Healthcare as we know it is in the process of going through a massive change - from episodic to continuous, from disease-focused to wellness and quality of life focused, from clinic centric to anywhere a patient is, from clinician controlled to patient empowered, and from being driven by limited data to 360-degree, multimodal personal-public-population physical-cyber-social big data-driven. While the ability to create and capture data is already here, the upcoming innovations will be in converting this big data into smart data through contextual and personalized processing such that patients and clinicians can make better decisions and take timely actions for augmented personalized health. In this talk, we will discuss how use of AI techniques on semantically integrated patient-generated health data (PGHD), environmental data, clinical data, and public social data is exploited to achieve a range of augmented health management strategies that include self-monitoring, self-appraisal, self-management, intervention, and Disease Progression Tracking and Prediction. We will review examples and outcomes from a number of applications, some involving patient evaluations, including asthma in children, bariatric surgery/obesity, mental health/depression, that are part of the Kno.e.sis kHealth personalized digital health initiative.
Background: Background: http://bit.ly/k-APH, http://bit.ly/kAsthma, http://j.mp/PARCtalk
HealthCursor Consulting Group India- Mobile Health is going to be a 3000 crore market in India by 2017. (Source PwC). M-health (use of mobile phones) and E-health are all set to make an entry into India's primary health centres (PHCs) and sub-centres as the health ministry plans to go hi-tech. Healthcare industry is expected to show a strong growth of 23% per annum to become a US$ 77 billion industry by 2012. One of the largest sector in terms of revenue and employment has grown at 9.3% per annum between 2000-2009 with a current size at par with fastest growing developing country like China, Brazil and Mexico.Driven by various catalysts such as increasing population, rising income levels, changing demographics and illness profile with a shift from chronic to life style diseases, healthcare industry is expected to move to levels of US$ 77 billion in next 3 years. (Source: ASSOCHAM).
Empowering rural India is of utmost importance and the government needs to do so by provisioning for broadband penetration and financial inclusion. Access to quality health care is another key to achieving rural empowerment. The budget for this segment was raised marginally last year and it would be good to have an allocation for rural health care programs with provisions for technology that would help modernize this sector to expand its reach through remote healthcare solutions and telemedicine.
Furthermore, the government announced a big budget campaign 'Swabhimaan' in the budget last year to promote banking and provide services to about 20,000 villages. In order to meet this goal, the budget this year too would need to make provisions accordingly. The steering committee on health said that in the 12th plan (2012-17), all district hospitals would be linked to leading tertiary care centres through telemedicine, Skype and similar audio visual media. M-health will be used to speed up transmission of data. Disease surveillance will be put on a GIS platform.
Disease surveillance based on reporting by providers and clinical laboratories (public and private) to detect and act on disease outbreaks and epidemics would be an integral component of the system.India will also put in place a Citizen Health Information System (CHIS) - a biometric based health information system which will constantly update health record of every citizen-family. The system will incorporate registration of births, deaths and cause of death. Maternal and infant death reviews, nutrition surveillance, particularly among under-six children andwomen, service delivery in the public health system, hospital information service besides improving access of public to their own health information and medical records would be the primary function of the CHIS.
Economies of Indian states can grow 1.08 per cent faster with every 10 per cent increase in Internet and broadband connections.
Eysenbach AMIA Keynote: From Patient Needs to Personal Health ApplicationsGunther Eysenbach
AMIA Spring Conference, May 29th-31st, 2008, Phoenix/AZ. PHR Track Keynote covers: An international perspective on the importance of PHR/PHA development & research; patient needs (and other drivers of Personal Health Records); Emerging technological trends, with an emphasis on what Eysenbach calls PHR 2.0 – impact of Web 2.0 approaches e.g. to reduce attrition in ehealth applications
Eysenbach: Personal Health Applications and Personal Health RecordsGunther Eysenbach
Keynote talk at the AMIA Spring Conference in the PHR track (Personal Health Records), focussing on international develoments and a new paradigm which I call PHR 2.0
Non-invasive Diagnostic Tools: Cardiometabolic Risk Assessment and Predictionasclepiuspdfs
Cardiometabolic risks (CMRs) have rapidly increased to epidemic proportions worldwide in the past three decades. Cardiovascular disease (CVD) remains the number one killer. No country has reduced, reversed, or prevented the increase in the incidence or prevalence of chronic metabolic diseases. Framingham Heart Study group described the modifiable risk factors that promote the development of CVD. They also developed risk calculators, for the prediction of acute vascular events such as heart attacks and stroke. The risk predictor algorithms were fine-tuned, as and when additional risk factors were discovered. However, at the time of this writing, there is no such calculator for assessment, stratification, and management of CMRs. On the other hand, numbers of non-invasive diagnostic devices have been developed for continuous monitoring of blood pressure and glucose profiles. We have described in our earlier articles, non-invasive diagnostic platform developed by LD-Technologies,
Augmented Personalized Health: using AI techniques on semantically integrated...Amit Sheth
Keynote @ 2018 AAAI Joint Workshop on Health Intelligence (W3PHIAI 2018), 2 February 2018, New Orleans, LA [Video: https://youtu.be/GujvoWRa0O8]
Related article: https://ieeexplore.ieee.org/document/8355891/
Abstract
Healthcare as we know it is in the process of going through a massive change - from episodic to continuous, from disease-focused to wellness and quality of life focused, from clinic centric to anywhere a patient is, from clinician controlled to patient empowered, and from being driven by limited data to 360-degree, multimodal personal-public-population physical-cyber-social big data-driven. While the ability to create and capture data is already here, the upcoming innovations will be in converting this big data into smart data through contextual and personalized processing such that patients and clinicians can make better decisions and take timely actions for augmented personalized health. In this talk, we will discuss how use of AI techniques on semantically integrated patient-generated health data (PGHD), environmental data, clinical data, and public social data is exploited to achieve a range of augmented health management strategies that include self-monitoring, self-appraisal, self-management, intervention, and Disease Progression Tracking and Prediction. We will review examples and outcomes from a number of applications, some involving patient evaluations, including asthma in children, bariatric surgery/obesity, mental health/depression, that are part of the Kno.e.sis kHealth personalized digital health initiative.
Background: Background: http://bit.ly/k-APH, http://bit.ly/kAsthma, http://j.mp/PARCtalk
HealthCursor Consulting Group India- Mobile Health is going to be a 3000 crore market in India by 2017. (Source PwC). M-health (use of mobile phones) and E-health are all set to make an entry into India's primary health centres (PHCs) and sub-centres as the health ministry plans to go hi-tech. Healthcare industry is expected to show a strong growth of 23% per annum to become a US$ 77 billion industry by 2012. One of the largest sector in terms of revenue and employment has grown at 9.3% per annum between 2000-2009 with a current size at par with fastest growing developing country like China, Brazil and Mexico.Driven by various catalysts such as increasing population, rising income levels, changing demographics and illness profile with a shift from chronic to life style diseases, healthcare industry is expected to move to levels of US$ 77 billion in next 3 years. (Source: ASSOCHAM).
Empowering rural India is of utmost importance and the government needs to do so by provisioning for broadband penetration and financial inclusion. Access to quality health care is another key to achieving rural empowerment. The budget for this segment was raised marginally last year and it would be good to have an allocation for rural health care programs with provisions for technology that would help modernize this sector to expand its reach through remote healthcare solutions and telemedicine.
Furthermore, the government announced a big budget campaign 'Swabhimaan' in the budget last year to promote banking and provide services to about 20,000 villages. In order to meet this goal, the budget this year too would need to make provisions accordingly. The steering committee on health said that in the 12th plan (2012-17), all district hospitals would be linked to leading tertiary care centres through telemedicine, Skype and similar audio visual media. M-health will be used to speed up transmission of data. Disease surveillance will be put on a GIS platform.
Disease surveillance based on reporting by providers and clinical laboratories (public and private) to detect and act on disease outbreaks and epidemics would be an integral component of the system.India will also put in place a Citizen Health Information System (CHIS) - a biometric based health information system which will constantly update health record of every citizen-family. The system will incorporate registration of births, deaths and cause of death. Maternal and infant death reviews, nutrition surveillance, particularly among under-six children andwomen, service delivery in the public health system, hospital information service besides improving access of public to their own health information and medical records would be the primary function of the CHIS.
Economies of Indian states can grow 1.08 per cent faster with every 10 per cent increase in Internet and broadband connections.
Eysenbach AMIA Keynote: From Patient Needs to Personal Health ApplicationsGunther Eysenbach
AMIA Spring Conference, May 29th-31st, 2008, Phoenix/AZ. PHR Track Keynote covers: An international perspective on the importance of PHR/PHA development & research; patient needs (and other drivers of Personal Health Records); Emerging technological trends, with an emphasis on what Eysenbach calls PHR 2.0 – impact of Web 2.0 approaches e.g. to reduce attrition in ehealth applications
Eysenbach: Personal Health Applications and Personal Health RecordsGunther Eysenbach
Keynote talk at the AMIA Spring Conference in the PHR track (Personal Health Records), focussing on international develoments and a new paradigm which I call PHR 2.0
Early diagnosis and prevention enabled by big data geneva conference finale-Marefa
The presentation provides an overview of how digital health or use of data processing and telecommunication infrastructure can contribute to the early diagnosis and prevention of diseases.
Overview of Health Informatics: survey of fundamentals of health information technology, Identify the forces behind health informatics, educational and career opportunities in health informatics.
Big data approaches to healthcare systemsShubham Jain
The idea behind this presentation is to explore how big data will revolutionize existing healthcare system effectively by reducing healthcare concerns such as the selection of appropriate treatment paths, quality of healthcare systems and so on. Large amount of unstructured data is available in various organizations (payers, providers, pharmaceuticals). We will discuss all the intricacies involved in massive datasets of healthcare systems and how combination of VPH technologies and big data resulted into some mind-boggling consequences. Major opportunities in healthcare includes the integration of various data pools such as clinical data, pharmaceutical R&D data and patient behaviour and sentiment data. Finding potential insights from big data with the help of medical image processing techniques, predictive modelling etc. will eventually help us to leverage the ever-increasing costs of care, help providers practice more effective medicine, empower patients and caregivers, support fitness and preventive self-care, and to dream about more personalized medicine.
Reviewwww.thelancet.com Vol 395 May 16, 2020 1579Adessiechisomjj4
Review
www.thelancet.com Vol 395 May 16, 2020 1579
Artificial intelligence and the future of global health
Nina Schwalbe*, Brian Wahl*
Concurrent advances in information technology infrastructure and mobile computing power in many low and
middle-income countries (LMICs) have raised hopes that artificial intelligence (AI) might help to address challenges
unique to the field of global health and accelerate achievement of the health-related sustainable development goals. A
series of fundamental questions have been raised about AI-driven health interventions, and whether the tools,
methods, and protections traditionally used to make ethical and evidence-based decisions about new technologies can
be applied to AI. Deployment of AI has already begun for a broad range of health issues common to LMICs, with
interventions focused primarily on communicable diseases, including tuberculosis and malaria. Types of AI vary, but
most use some form of machine learning or signal processing. Several types of machine learning methods are
frequently used together, as is machine learning with other approaches, most often signal processing. AI-driven
health interventions fit into four categories relevant to global health researchers: (1) diagnosis, (2) patient morbidity
or mortality risk assessment, (3) disease outbreak prediction and surveillance, and (4) health policy and planning.
However, much of the AI-driven intervention research in global health does not describe ethical, regulatory, or
practical considerations required for widespread use or deployment at scale. Despite the field remaining nascent,
AI-driven health interventions could lead to improved health outcomes in LMICs. Although some challenges of
developing and deploying these interventions might not be unique to these settings, the global health community will
need to work quickly to establish guidelines for development, testing, and use, and develop a user-driven research
agenda to facilitate equitable and ethical use.
Introduction
AI is changing how health services are delivered in many
high-income settings, particularly in specialty care
(eg, radiology and pathology).1–3 This development has
been facilitated by the growing availability of large
datasets and novel analytical methods that rely on such
datasets. Concurrent advances in information technology
(IT) infrastructure and mobile computing power have
raised hopes that AI might also provide opportunities to
address health challenges in LMICs.4 These challenges,
including acute health workforce shortages and weak
public health surveillance systems, undermine global
progress towards achieving the health-related sustainable
development goals (SDGs).5,6 Although not unique to
such countries, these challenges are particularly relevant
given their contribution to morbidity and mortality.7,8
AI-driven health technologies could be used to address
many of these and other system-related challenges.4
For example, ...
20 tendencias digitales en salud digital_ The Medical FuturistRichard Canabate
Resaltado de las tendencias que darán forma a la atención médica post COVID19.
No se trata de enumerar estas tendencias, sino de dar una valiosa visión de los factores de conducción detrás de ellas mientras que es muy específico. Se trata de mostrar cuáles son las áreas exactas que deben destacarse entre todas las áreas en el tema "IA en la atención médica", por ejemplo.
How can the Internet of Things (IoT) help us challenge the invisible epidemic of autoimmune disease?
Learn how healthcare is evolving in the age of connected devices, and how both recent and future innovations are improving patient experience & outcomes for those with chronic and autoimmune diseases.
Click through to view the slides from DrBonnie360's recent presentation at the Healthcare IoT Summit in San Francisco!
Just as a corporation can improve its products and services by analyzing data and using relevant data points to steer future action, the healthcare industry can leverage big data in future decisions to the improvement of personalized medicine. But healthcare can use big data on more fronts than most industries, especially considering transition of healthcare into precision medicine. Visit: https://www.rockwestsolutions.com/sensors/medical-devices/
The United States government’s total public debt has risen recently. The spike is so significant that some experts are expecting a US debt ceiling breach.
Publicado originalmente en http://www.slideshare.net/EugeneBorukhovich/open-health-data-qualitative-overview
Extraordinaria presentación sobre la aplicación de Open Data en Salud ejemplos y casos de éxito en varios paises.
Convalescent Plasma and COVID-19: Ancient Therapy Re-emergedasclepiuspdfs
Convalescent plasma has again re-emerged as a therapy during coronavirus disease (COVID-19) outbreaks currently use as a prophylactic or an interventional treatment in infected patients. Convalescent plasma has been used in the 20th century confronting different infectious diseases where there was no other therapy available. Conceivably, this convalescent plasma therapy tends to be proving a game-changing treatment in some COVID-19 patients and could support treatment, in addition to the current interventions before other developed therapies are available for the population.
The Negative Clinical Consequences Due to the Lack of the Elaboration of a Sc...asclepiuspdfs
Until a few years ago, the immune system was considered as responsible for the only defense against microbial infections and other external agents. On the contrary, the immune cells have been proven to be linked not only through cell-cell contact but also by releasing proteins capable of influencing the immune-inflammatory response, the so-called cytokines or interleukins. Moreover, the cytokines have appeared to play not only immune activities but also metabolic and systemic effects influencing the overall biological systems, including the nervous, the endocrine, and the cardiovascular systems, by representing the main endogenous molecules responsible for the maintenance of the unity of the biological life. Therefore, only the systematic clinical consideration of cytokine effects may allow the generation of real future holistic medicine.
More Related Content
Similar to Predictive and Preventive Care: Metabolic Diseases
Early diagnosis and prevention enabled by big data geneva conference finale-Marefa
The presentation provides an overview of how digital health or use of data processing and telecommunication infrastructure can contribute to the early diagnosis and prevention of diseases.
Overview of Health Informatics: survey of fundamentals of health information technology, Identify the forces behind health informatics, educational and career opportunities in health informatics.
Big data approaches to healthcare systemsShubham Jain
The idea behind this presentation is to explore how big data will revolutionize existing healthcare system effectively by reducing healthcare concerns such as the selection of appropriate treatment paths, quality of healthcare systems and so on. Large amount of unstructured data is available in various organizations (payers, providers, pharmaceuticals). We will discuss all the intricacies involved in massive datasets of healthcare systems and how combination of VPH technologies and big data resulted into some mind-boggling consequences. Major opportunities in healthcare includes the integration of various data pools such as clinical data, pharmaceutical R&D data and patient behaviour and sentiment data. Finding potential insights from big data with the help of medical image processing techniques, predictive modelling etc. will eventually help us to leverage the ever-increasing costs of care, help providers practice more effective medicine, empower patients and caregivers, support fitness and preventive self-care, and to dream about more personalized medicine.
Reviewwww.thelancet.com Vol 395 May 16, 2020 1579Adessiechisomjj4
Review
www.thelancet.com Vol 395 May 16, 2020 1579
Artificial intelligence and the future of global health
Nina Schwalbe*, Brian Wahl*
Concurrent advances in information technology infrastructure and mobile computing power in many low and
middle-income countries (LMICs) have raised hopes that artificial intelligence (AI) might help to address challenges
unique to the field of global health and accelerate achievement of the health-related sustainable development goals. A
series of fundamental questions have been raised about AI-driven health interventions, and whether the tools,
methods, and protections traditionally used to make ethical and evidence-based decisions about new technologies can
be applied to AI. Deployment of AI has already begun for a broad range of health issues common to LMICs, with
interventions focused primarily on communicable diseases, including tuberculosis and malaria. Types of AI vary, but
most use some form of machine learning or signal processing. Several types of machine learning methods are
frequently used together, as is machine learning with other approaches, most often signal processing. AI-driven
health interventions fit into four categories relevant to global health researchers: (1) diagnosis, (2) patient morbidity
or mortality risk assessment, (3) disease outbreak prediction and surveillance, and (4) health policy and planning.
However, much of the AI-driven intervention research in global health does not describe ethical, regulatory, or
practical considerations required for widespread use or deployment at scale. Despite the field remaining nascent,
AI-driven health interventions could lead to improved health outcomes in LMICs. Although some challenges of
developing and deploying these interventions might not be unique to these settings, the global health community will
need to work quickly to establish guidelines for development, testing, and use, and develop a user-driven research
agenda to facilitate equitable and ethical use.
Introduction
AI is changing how health services are delivered in many
high-income settings, particularly in specialty care
(eg, radiology and pathology).1–3 This development has
been facilitated by the growing availability of large
datasets and novel analytical methods that rely on such
datasets. Concurrent advances in information technology
(IT) infrastructure and mobile computing power have
raised hopes that AI might also provide opportunities to
address health challenges in LMICs.4 These challenges,
including acute health workforce shortages and weak
public health surveillance systems, undermine global
progress towards achieving the health-related sustainable
development goals (SDGs).5,6 Although not unique to
such countries, these challenges are particularly relevant
given their contribution to morbidity and mortality.7,8
AI-driven health technologies could be used to address
many of these and other system-related challenges.4
For example, ...
20 tendencias digitales en salud digital_ The Medical FuturistRichard Canabate
Resaltado de las tendencias que darán forma a la atención médica post COVID19.
No se trata de enumerar estas tendencias, sino de dar una valiosa visión de los factores de conducción detrás de ellas mientras que es muy específico. Se trata de mostrar cuáles son las áreas exactas que deben destacarse entre todas las áreas en el tema "IA en la atención médica", por ejemplo.
How can the Internet of Things (IoT) help us challenge the invisible epidemic of autoimmune disease?
Learn how healthcare is evolving in the age of connected devices, and how both recent and future innovations are improving patient experience & outcomes for those with chronic and autoimmune diseases.
Click through to view the slides from DrBonnie360's recent presentation at the Healthcare IoT Summit in San Francisco!
Just as a corporation can improve its products and services by analyzing data and using relevant data points to steer future action, the healthcare industry can leverage big data in future decisions to the improvement of personalized medicine. But healthcare can use big data on more fronts than most industries, especially considering transition of healthcare into precision medicine. Visit: https://www.rockwestsolutions.com/sensors/medical-devices/
The United States government’s total public debt has risen recently. The spike is so significant that some experts are expecting a US debt ceiling breach.
Publicado originalmente en http://www.slideshare.net/EugeneBorukhovich/open-health-data-qualitative-overview
Extraordinaria presentación sobre la aplicación de Open Data en Salud ejemplos y casos de éxito en varios paises.
Similar to Predictive and Preventive Care: Metabolic Diseases (20)
Convalescent Plasma and COVID-19: Ancient Therapy Re-emergedasclepiuspdfs
Convalescent plasma has again re-emerged as a therapy during coronavirus disease (COVID-19) outbreaks currently use as a prophylactic or an interventional treatment in infected patients. Convalescent plasma has been used in the 20th century confronting different infectious diseases where there was no other therapy available. Conceivably, this convalescent plasma therapy tends to be proving a game-changing treatment in some COVID-19 patients and could support treatment, in addition to the current interventions before other developed therapies are available for the population.
The Negative Clinical Consequences Due to the Lack of the Elaboration of a Sc...asclepiuspdfs
Until a few years ago, the immune system was considered as responsible for the only defense against microbial infections and other external agents. On the contrary, the immune cells have been proven to be linked not only through cell-cell contact but also by releasing proteins capable of influencing the immune-inflammatory response, the so-called cytokines or interleukins. Moreover, the cytokines have appeared to play not only immune activities but also metabolic and systemic effects influencing the overall biological systems, including the nervous, the endocrine, and the cardiovascular systems, by representing the main endogenous molecules responsible for the maintenance of the unity of the biological life. Therefore, only the systematic clinical consideration of cytokine effects may allow the generation of real future holistic medicine.
The great benefit of blood/blood constitutes therapy is the ability to provide transfusion support for patients with many unique hematologic conditions. For some patients, such as patients with sickle cell disease, thalassemia major, immune hemolytic anemia, anemia of kidney disease, and aplastic anemia may need for this consolidation extends throughout their life. By knowing the alteration mechanisms of these conditions, we can appreciate the stationary, urgency, and the value of the transfused red blood cell (RBC).
Decreasing or Increasing Role of Autologous Stem Cell Transplantation in Mult...asclepiuspdfs
During the past four decades, autologous stem cell transplantation (ASCT) has been the first choice and the standard option for the treatment of newly diagnosed patients with multiple myeloma. The introduction of new agents such as thalidomide, lenalidomide, and bortezomib has led to a clear improvement in basic approach and those agents became the standard of care in the induction phase; however, they were not able to play the role of ASCT in term of progression-free survival and overall survival. Debate continues about the best induction, consolidation, and maintenance taking into account the toxicities of these new agents. The new monoclonal antibody (anti CD38) starts to take its place in the induction setting and it seems to be a promising agent in the high-risk group. Until recently, ASCT is the standard treatment for newly diagnosed patients.
Comparison of the Hypocalcemic Effects of Erythropoietin and U-74389Gasclepiuspdfs
Aim: This study calculated the effects on serum calcium (Ca) levels, after treatment with either of two drugs: The erythropoietin (Epo) and the antioxidant lazaroid (L) drug U-74389G. The calculation was based on the results of two preliminary studies, each one of which estimated the certain influence, after the respective drug usage in an induced ischemia-reperfusion animal experiment. Materials and Methods: The two main experimental endpoints at which the serum Ca levels were evaluated were the 60th reperfusion min (for the Groups A, C, and E) and the 120th reperfusion min (for the Groups B, D, and F). Especially, the Groups A and B were processed without drugs, Groups C and D after Epo administration, whereas Groups E and F after the L administration. Results: The first preliminary study of Epo presented a non-significant hypocalcemic effect by 0.34% ± 0.68% (P = 0.6095). However, the second preliminary study of U-74389G presented a non-significant hypercalcemic effect by 0.14% ± 0.66% (P = 0.8245). These two studies were coevaluated since they came from the same experimental setting. The outcome of the coevaluation was that L is 2.3623042-fold (2.3482723–2.3764196) more hypercalcemic than Epo (P = 0.0000). Conclusions: The antioxidant capacities of U-74389G ascribe 2.3623042-fold more hypercalcemic effects than Epo (P = 0.0000).
The term refractory anemia (RA) may be confusing to those who are not hematologists. RA should be well defined because it means more than what it says. RA is defined as anemia that is not responsive to therapy except transfusion.[1] The term RA is used to rule out those types of anemia with a known cause such as anemia of systemic diseases (liver and kidney) and anemia of inflammation even though they are considered refractory to therapy.[2] RA with cellular or hypercellular bone marrow was formerly used to exclude aplastic anemia.
Management of Immunogenic Heparin-induced Thrombocytopeniaasclepiuspdfs
Immunogenic heparin-induced thrombocytopenia (HIT) is an immune response to heparin associated with significant morbidity and mortality in hospitalized patients if unidentified as soon as possible, due to thromboembolic complications involving both arterial and venous systems. Early diagnoses based on a comprehensive interpretation of clinical and laboratory information improve clinical outcomes. Management principles of strongly suspected HIT should not be delayed for laboratory result confirmation. Treatment strategies have been introduced including new, safe, and effective agents. This review summarizes the clinical therapeutic options for HIT addressing the use of parenteral direct thrombin inhibitors and indirect factor Xa inhibitors as well as the potential non-Vitamin K antagonist oral anticoagulants.
73-year-old woman without any pertinent history was admitted to the hospital due to remittent fever with erythema. She showed itching and linearly arranged erythema on the chest, back, and abdomen [Figure 1a and b]. As she had been taking daily cefditoren pivoxil for the 4 days before her admission, she was diagnosed as having drug-related scratch dermatitis, and the antibiotic treatment was stopped. Her fever remained. Laboratory data showed elevated levels of white blood cells (14,800/μl, normal range 4000–7000) and liver enzymes such as aspartate aminotransferase (AST) 138 IU/L (normal range 5–40), alanine aminotransferase 97 IU/L (normal range 5–35), and ferritin (17469.5 ng/mL, normal range 5–152).
Bone Marrow Histology is a Pathognomonic Clue to Each of the JAK2V617F, MPL,5...asclepiuspdfs
According to the World Health Organization and Clinical Laboratory Molecular and Pathological criteria bone marrow pathology in JAK2V617F mutated trilinear myeloproliferative neoplasm (MPN) patients essential thrombocythemia (ET) and polycythemia vera are indistinguishably featured by clustered medium to large pleomorphic megakaryocytes and increased cellularity (60–90%) due to increased erythropoiesis and megakaryopoiesis. MPL515 mutated ET is the second distinct clonal MPN characterized by thrombocythemia in a normocellular bone marrow showing clustered increased large to giant mature megakaryocytes with staghorn-like hyperlobulated nuclei. Calreticulin (CALR) mutated hypercellular thrombocythemia associated with prefibrotic megakaryocytic, granulocytic myeloproliferation (MGM) recently became the third distinct MPN featured by dense clusters of immature megakaryocytes with cloud-like nuclei. Bone marrow pathology in newly diagnosed MPN patients appears to be a pathognomonic clue for diagnostic differentiation between JAK2V617F mutated trilinear MPN, MPL515 normocellular thrombocythemia, and CALR thrombocythemia with MGM characteristics followed by secondary reticulin fibrosis. Their natural histories clearly differ featured by an increase of erythro/granulopoiesis and cellularity in JAK2V617F, decrease of erythropoiesis and cellularity in MPL515 and increase of dual megakaryo/granulopoiesis and cellularity in CALR mutated MPN.
Helicobacter pylori Frequency in Polycythemia Vera Patients without Dyspeptic...asclepiuspdfs
Introduction: In polycythemia vera (PV) patients, peptic ulcer and gastroduodenal erosions are more common than the general population, but there are insufficient data on the frequency of Helicobacter pylori (HP) and its role in etiopathogenesis. In this study, we aimed to compare the prevalence of HP infection in PV patients without dyspeptic complaints with a healthy control group without dyspeptic complaints. Materials and Methods: Fifty patients with PV without dyspeptic complaints and 50 controls without dyspeptic complaints were enrolled in this study after informed consent obtained. Stool samples of selected patients were analyzed using HP stool antigen test (True Line®). Results: There was surprisingly striking difference between HP prevalence in PV patients without dyspeptic complaints and asymptomatic healthy controls (64% vs. 2%) (P < 0.05). There was no significant relationship found between HP presence and age, gender, treatment modalities, complete blood count, positivity of JAK2 V617F, serum erythropoietin level, and splenomegaly in PV patients (P > 0.05). Conclusion: As the susceptibility of HP infections in PV patients are higher, it is recommended to have close surveillance of these patients by screening HP presence. In addition, when HP positivity is determined, the eradication of HP is essential to prevent possible future gastrointestinal lesions in patients with PV.
Lymphoma of the Tonsil in a Developing Communityasclepiuspdfs
The lymphoma of the tonsil is a rarity. Single case reports have appeared in countries as disparate as China, Greece, India, Japan, and Turkey. Therefore, this paper presents cases found in Nigeria among the Ibo ethnic group. The epidemiological comparisons are deemed to be worthy of documentation such as age ranges and sides of involvement.
Should Metformin Be Continued after Hospital Admission in Patients with Coron...asclepiuspdfs
Background: In most patients with diabetes, guidelines recommend discontinuation of oral anti-diabetic agents. Preliminary data suggest that pre-admission metformin use may have a mortality benefit in patients with coronavirus disease (COVID)-19 admitted to the hospital. Objective: The objective of the study was to review the impact of metformin on morbidity and mortality among hospitalized patients with COVID-19. Methods: Review of English literature by PUBMED search until November 10, 2020. Search terms included diabetes, COVID-19, metformin, retrospective studies, meta-analyses, pertinent reviews, pre-print articles, and consensus guidelines are reviewed.
Clinical Significance of Hypocalcemia in COVID-19asclepiuspdfs
Background: Preliminary data suggest that hypocalcemia is common among patients with COVID-19 admitted to the hospital. Objective: The objective of the study was to examine the clinical significance of hypocalcemia in the setting of COVID-19. Methods: Literature search (PubMed) until August 5, 2020. Search terms include hypocalcemia, COVID-19, mortality, and complications. Retrospective studies are reviewed due to a lack of randomized trials. Results: Prevalence of hypocalcemia among hospitalized patients with COVID-19 ranges from 62% to 78%, depending on the definition of hypocalcemia and patients’ characteristics. In most cases, hypocalcemia is mild to moderate biochemically. Hypocalcemia is a risk factor for hospitalization of patients with COVID-19. In already hospitalized patients, hypocalcemia is significantly associated with increase severity of COVID-19 and its complications, including multiorgan failure, acute respiratory distress syndrome, and death. Hypocalcemia is significantly correlated with inflammatory markers of COVID-19. Causes of hypocalcemia in COVID-19 patients are unclear, but Vitamin D deficiency may be a contributing factor. Conclusion: Hypocalcemia is common in hospitalized patients with COVID-19 and carries unfavorable outcomes. Further studies are needed to examine the causes of hypocalcemia in COVID-19 and to see whether normalization of circulating calcium levels improves prognosis.
Excess of Maternal Transmission of Type 2 Diabetes: Is there a Role of Bioche...asclepiuspdfs
Objective: An excess of maternal transmission of Type 2 diabetes (T2D) has been reported in some populations but not confirmed in other studies. Mitochondrial inheritance has been proposed to explain such excess. In the present paper, we have considered the presence of T2D in the mother and/or in the father in relation to the risk of T2D and to age at onset of the disease in the offspring. The distribution of two genetic polymorphisms involved in glucose metabolism in relation to the presence of T2D in the mother has been also considered. Materials and Methods: Two hundred and seventy-nine participants with T2D were studied in the population of Penne, a small rural town in the eastern side of central Italy. Adenosine deaminase locus 1 (ADA1) and phosphoglucomutase locus 1 (PGM1) phenotypes were determined by starch gel electrophoresis. Statistical analyses were carried out using commercial software (SPSS). Results: The proportion of patients from T2D mothers is much greater as compared to the proportion of the patients from T2D fathers (P < 0.0001). Age at onset of the disease in patients in whom one or both parents are T2D is lower as compared to other patients. The distribution of ADA1 and PGM1 phenotypes in participants with T2D depends on the presence of diabetes in the mother. Conclusions: About the transmission of T2D, our data confirm the high proportion of maternal T2D and show the role of two common biochemical polymorphisms involved in glucose metabolism.
The Effect of Demographic Data and Hemoglobin A 1c on Treatment Outcomes in P...asclepiuspdfs
Objective: Diabetes mellitus, the most common cause of non-traumatic foot amputations, is a life-threatening condition due to its high mortality and morbidity. In our study, we retrospectively evaluated our patients with diabetic foot syndrome in our clinic. Materials and Methods: The demographic data, duration of diabetes, Wagner classification, haemoglobin A 1c (HbA1c) levels, white blood cell, C-reactive protein sedimentation levels, hospital stay, and treatment results were evaluated retrospectively in 14 patients with diabetic foot between January 2017 and December 2018. Results: The mean age of the patients was 62.43 ± 7.7 years. Of the 14 patients, 3 were females and 11 were males. All 14 patients were type 2 diabetes mellitus. When diabetic foot Wagner classification was performed, 6 patients were evaluated as Wagner 2, five patients were Wagner 3, and three patients were evaluated as Wagner 4. Nine patients had complete amputation and 3 had vascular surgery. Conclusion: Although the level of HbA1c is below the target level, the risk of diabetic foot is increased when there is no adequate diabetes mellitus foot training. Inadequate diabetic patient education and hospitalization of patients after infection progress the amputation rate.
Self-efficacy Impact Adherence in Diabetes Mellitusasclepiuspdfs
The aim of the paper is to explore how self-efficacy (SE) is associated with adherence among adults with diabetes mellitus (DM). Methods: The search of electronic databases identified 564 records from 2007 to 2017 on SE and adherence from different perspectives and its effect on adults with DM. Discussions: SE increases the confidence in adults in their self-care behaviors. Non-adherence continues to be a significant barrier to SE. SE and adherence should be informed by an understanding of theoretical frameworks and the individual characteristics. Conclusion: Adherence is likely among adults with better SE to empower them to make valid decisions about their health. Interventions to improve SE should be tailored based on different types of non-adherence such as intentional and unintentional non-adherence. Implications: An intercollaborative professional practice approach is crucial to improve SE and adherence for sound judgment and valid decision-making.
Uncoiling the Tightening Obesity Spiralasclepiuspdfs
While an underweight prevalence was once more than twice that of obesity, now more people are obese than underweight. Obesity is one of the leading causes of preventable death in the world. There are an estimated 2,100,000,000 obese people worldwide and that number is forecast to grow to 51% of the world’s population by 2030. Escalating obesity-related disease costs threaten to bankrupt the world’s health-care systems.
Prevalence of Chronic Kidney disease in Patients with Metabolic Syndrome in S...asclepiuspdfs
Background and Objective: Chronic kidney disease (CKD) which is an increasingly important clinical and public health issue is associated with cardiovascular disease. Epidemiologic studies have also linked metabolic syndrome (MetS) with an increased risk of incident CKD. Therefore, the present study was designed retrospectively to find the prevalence and potential risk factors of CKD in patients with MetS in Saudi Arabia.
Management Of Hypoglycemia In Patients With Type 2 Diabetesasclepiuspdfs
Hypoglycemia is the rate-limiting step of intensive management in patients with diabetes. Lowering one’s A1C to a prescribed target is expected to mitigate one’s risk of developing long- and short-term diabetes-related complications. Several of the less expensive and commonly prescribed glucose lowering agents favored by practitioners result in weight gain, hypoglycemia, and even an increased risk of cardiovascular (CV) mortality. Although achieving a targeted A1C of <7 % is the standard of care, clinicians often fail to evaluate patients for glycemic variability which can increase oxidative stress driving long-term diabetes-related complications including CV death. The use of concentrated insulins and glucagon-like peptide-1 receptor agonists separately or in combination with each other reduces glycemic variability and one’s risk of hypoglycemia. Pharmaceutical agents which allow patients to safely achieve their targeted A1C without weight gain and hypoglycemia should be preferred in patients with type 2 diabetes.
It is known that the cancer development process is multifactorial nowadays. The relationship between insulin and cancer has recently been gaining in importance. The number of studies between insulin resistance and thyroid cancer is very small, although the association between obesity, type 2 diabetes, and insulin resistance, particularly breast, colon, and pancreatic cancer development, is long. There are studies advocating increased growth factors with insulin resistance as well as triode cancer after thyroid angiogenesis. Insulin and insulin-like growth factors may be the primary causes of pathophysiology in many cancers, especially thyroid cancer, with mitogenic activity.
These lecture slides, by Dr Sidra Arshad, offer a quick overview of physiological basis of a normal electrocardiogram.
Learning objectives:
1. Define an electrocardiogram (ECG) and electrocardiography
2. Describe how dipoles generated by the heart produce the waveforms of the ECG
3. Describe the components of a normal electrocardiogram of a typical bipolar leads (limb II)
4. Differentiate between intervals and segments
5. Enlist some common indications for obtaining an ECG
Study Resources:
1. Chapter 11, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 9, Human Physiology - From Cells to Systems, Lauralee Sherwood, 9th edition
3. Chapter 29, Ganong’s Review of Medical Physiology, 26th edition
4. Electrocardiogram, StatPearls - https://www.ncbi.nlm.nih.gov/books/NBK549803/
5. ECG in Medical Practice by ABM Abdullah, 4th edition
6. ECG Basics, http://www.nataliescasebook.com/tag/e-c-g-basics
Ozempic: Preoperative Management of Patients on GLP-1 Receptor Agonists Saeid Safari
Preoperative Management of Patients on GLP-1 Receptor Agonists like Ozempic and Semiglutide
ASA GUIDELINE
NYSORA Guideline
2 Case Reports of Gastric Ultrasound
New Directions in Targeted Therapeutic Approaches for Older Adults With Mantl...i3 Health
i3 Health is pleased to make the speaker slides from this activity available for use as a non-accredited self-study or teaching resource.
This slide deck presented by Dr. Kami Maddocks, Professor-Clinical in the Division of Hematology and
Associate Division Director for Ambulatory Operations
The Ohio State University Comprehensive Cancer Center, will provide insight into new directions in targeted therapeutic approaches for older adults with mantle cell lymphoma.
STATEMENT OF NEED
Mantle cell lymphoma (MCL) is a rare, aggressive B-cell non-Hodgkin lymphoma (NHL) accounting for 5% to 7% of all lymphomas. Its prognosis ranges from indolent disease that does not require treatment for years to very aggressive disease, which is associated with poor survival (Silkenstedt et al, 2021). Typically, MCL is diagnosed at advanced stage and in older patients who cannot tolerate intensive therapy (NCCN, 2022). Although recent advances have slightly increased remission rates, recurrence and relapse remain very common, leading to a median overall survival between 3 and 6 years (LLS, 2021). Though there are several effective options, progress is still needed towards establishing an accepted frontline approach for MCL (Castellino et al, 2022). Treatment selection and management of MCL are complicated by the heterogeneity of prognosis, advanced age and comorbidities of patients, and lack of an established standard approach for treatment, making it vital that clinicians be familiar with the latest research and advances in this area. In this activity chaired by Michael Wang, MD, Professor in the Department of Lymphoma & Myeloma at MD Anderson Cancer Center, expert faculty will discuss prognostic factors informing treatment, the promising results of recent trials in new therapeutic approaches, and the implications of treatment resistance in therapeutic selection for MCL.
Target Audience
Hematology/oncology fellows, attending faculty, and other health care professionals involved in the treatment of patients with mantle cell lymphoma (MCL).
Learning Objectives
1.) Identify clinical and biological prognostic factors that can guide treatment decision making for older adults with MCL
2.) Evaluate emerging data on targeted therapeutic approaches for treatment-naive and relapsed/refractory MCL and their applicability to older adults
3.) Assess mechanisms of resistance to targeted therapies for MCL and their implications for treatment selection
- Video recording of this lecture in English language: https://youtu.be/lK81BzxMqdo
- Video recording of this lecture in Arabic language: https://youtu.be/Ve4P0COk9OI
- Link to download the book free: https://nephrotube.blogspot.com/p/nephrotube-nephrology-books.html
- Link to NephroTube website: www.NephroTube.com
- Link to NephroTube social media accounts: https://nephrotube.blogspot.com/p/join-nephrotube-on-social-media.html
Explore natural remedies for syphilis treatment in Singapore. Discover alternative therapies, herbal remedies, and lifestyle changes that may complement conventional treatments. Learn about holistic approaches to managing syphilis symptoms and supporting overall health.
Report Back from SGO 2024: What’s the Latest in Cervical Cancer?bkling
Are you curious about what’s new in cervical cancer research or unsure what the findings mean? Join Dr. Emily Ko, a gynecologic oncologist at Penn Medicine, to learn about the latest updates from the Society of Gynecologic Oncology (SGO) 2024 Annual Meeting on Women’s Cancer. Dr. Ko will discuss what the research presented at the conference means for you and answer your questions about the new developments.
Pulmonary Thromboembolism - etilogy, types, medical- Surgical and nursing man...VarunMahajani
Disruption of blood supply to lung alveoli due to blockage of one or more pulmonary blood vessels is called as Pulmonary thromboembolism. In this presentation we will discuss its causes, types and its management in depth.
Lung Cancer: Artificial Intelligence, Synergetics, Complex System Analysis, S...Oleg Kshivets
RESULTS: Overall life span (LS) was 2252.1±1742.5 days and cumulative 5-year survival (5YS) reached 73.2%, 10 years – 64.8%, 20 years – 42.5%. 513 LCP lived more than 5 years (LS=3124.6±1525.6 days), 148 LCP – more than 10 years (LS=5054.4±1504.1 days).199 LCP died because of LC (LS=562.7±374.5 days). 5YS of LCP after bi/lobectomies was significantly superior in comparison with LCP after pneumonectomies (78.1% vs.63.7%, P=0.00001 by log-rank test). AT significantly improved 5YS (66.3% vs. 34.8%) (P=0.00000 by log-rank test) only for LCP with N1-2. Cox modeling displayed that 5YS of LCP significantly depended on: phase transition (PT) early-invasive LC in terms of synergetics, PT N0—N12, cell ratio factors (ratio between cancer cells- CC and blood cells subpopulations), G1-3, histology, glucose, AT, blood cell circuit, prothrombin index, heparin tolerance, recalcification time (P=0.000-0.038). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and PT early-invasive LC (rank=1), PT N0—N12 (rank=2), thrombocytes/CC (3), erythrocytes/CC (4), eosinophils/CC (5), healthy cells/CC (6), lymphocytes/CC (7), segmented neutrophils/CC (8), stick neutrophils/CC (9), monocytes/CC (10); leucocytes/CC (11). Correct prediction of 5YS was 100% by neural networks computing (area under ROC curve=1.0; error=0.0).
CONCLUSIONS: 5YS of LCP after radical procedures significantly depended on: 1) PT early-invasive cancer; 2) PT N0--N12; 3) cell ratio factors; 4) blood cell circuit; 5) biochemical factors; 6) hemostasis system; 7) AT; 8) LC characteristics; 9) LC cell dynamics; 10) surgery type: lobectomy/pneumonectomy; 11) anthropometric data. Optimal diagnosis and treatment strategies for LC are: 1) screening and early detection of LC; 2) availability of experienced thoracic surgeons because of complexity of radical procedures; 3) aggressive en block surgery and adequate lymph node dissection for completeness; 4) precise prediction; 5) adjuvant chemoimmunoradiotherapy for LCP with unfavorable prognosis.
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Ve...kevinkariuki227
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
2. Rao: Metabolic disease risks
Clinical Research in Diabetes and Endocrinology • Vol 1 • Issue 1 • 2018
prevention strategies are implemented, the total cost
of
cardiovascular diseases is projected to exceed $1 trillion by
2030 in the U.S. alone. As Watson is trained on heart health
goals and measures, it aims to help employers better design,
tailor and deliver health programs, and ultimately provide
employees with more customized coaching for those wanting
to achieve ideal heart health. Yet another application is
Sugar. IQ, a new app from Medtronic Inc., that uses IBM
Watson computing power for collecting and computing real-
time data from continuous glucose monitors (CGMs) and
insulin pumps, to find patterns and then offer personalized
insights to the end users. Just recently (June 2018), Food and
Drug Administration (FDA) of the USA approved Israel’s
DreaMed Diabetes App., an Advisor Pro, for managing
diabetes treatment with CGMs for type-1 diabetics. These
are high end, high tech approaches to improve or manage the
health care.
How about the low end or run of the mill approaches to
health care? Availability of inexpensive sensors and software
analytical capabilities and smart platforms such as iPads
and smartphones has created a flurry of activities to develop
mobile health care and management applications. What
started as wellness apps have now become part of National
and International studies. One such application is the use of
Fitbit activity tracker, by the prestigious National Institutes
of Health, USA, to track sleeping patterns. Fitbit the leading
global wearables brand has been selected for use in the
National “All of Us” Research Program established by the
White House in the US. This National level research program
is aiming to get 1 million Americans, to eventually enroll
in the program. The Scripps Translational Science Institute
will be using Fitbit devices for looking into how individual
characteristics can affect health and disease treatment. The
program will collect genetic information from participants
and use wearable devices to track health-related metrics
including heart rate and sleep patterns. Recent developments
in mobile health applications, global shift toward precision
medicine, and health metrics that can be generated through
wearables have the potential to provide cost-effective,
highly personalized, sustainable health-care solutions. Smart
vascular stents with sensors that can monitor blood flow have
been developed and are under clinical evaluation for further
validation and possible replacement of the conventional bare
metal and drug-eluting stents. If these sensors are capable of
measuring the fluid dynamics of the circulating blood, then
they would be the first one of kind sensors, to monitor in real
time, the thrombotic or hemorrhagic status of the circulating
blood.
We at Bengaluru, India, the IT capital of India, have been
trying to establish a consortium of experts including
members of the academia and industries to integrate
emerging technologies for the development of affordable
and sustainable health care. In August 2015, we organized
an International workshop on, “Preventive Medicine through
Contemporary Advances in Interdisciplinary Engineering”
in Bengaluru, India, under the aegis of National Design
Research Forum (DRDO), Institutions of Engineers,
Bengaluru. We are currently working on various pieces of
this “public health puzzle.”As and when we develop new and
useful technologies, we will report our findings. Now that, we
have briefly described the role of big data, machine learning,
artificial intelligence (IBM-Watson), and the usefulness of
wearables in improving wellness and health-care delivery, we
will discuss the couple of clinical applications with “novel
methodologies,” where integration of available technology
has made a difference. We will also discuss the strengths and
weaknesses of such approaches. A report by Carolyn Johnson
in today’s issue of Washington Post (June 21, 2018) titled,
“Gawande to head health-care venture ofAmazon, Berkshire,
and JP Morgan” supports our suggestion that integration of
emerging technologies, will help to develop personalized,
precision medicine, as well as reduce the cost of health-care
worldwide. At least that is the anticipation of this powerful
team.
With the help of Dr. Pratiksha G. Gandhi, Chairperson, IPC
Heartcare Centre, Mumbai, (www.ipcheartcarecentre.com),
we developed collaboration with Dr.
Albert Maarek (LD
Technologies, Miami, Florida), who has developed a unique
platform to evaluate endothelial dysfunction, metabolic
syndrome, insulin resistance, cardiac risk assessment, and
autonomic risk factor (RF).[13-15]
It is of great interest for
those of us, who are trying to develop integrated health-care
systems, to validate and appreciate the ingenuity of this non-
invasive diagnostic platform. Basic devices integrated in
this system or systems are oximeter, blood pressure monitor,
and a galvanic skin response monitor as shown in Figure 1,
under the heading LD Products. Dr. Albert Maarek’s system
is sold by the LD Products of Miami, Florida, under the name
of TM-OXI, EC-GS, and ES-GS systems. In India, when
these systems were obtained by Mr. Ashok Jain, he put them
together on a console and established “Lifespan” diagnostic
centers. In the initial stages, Dr. Gandhi was facilitating the
distribution of this system. Currently, it is marketed by Magus
Biotech Pvt., Ltd. (www.magusbiotech.com).
As mentioned earlier, the device integrated in these various
system is standard time-tested FDA approved devices such as
oximeter, blood pressure monitor, and galvanic skin response
monitor (used for lie detection). The engineers and software
experts have used the data generated from these devices
and with the help of clinical data, come up with diagnosis
of various risks, clusters of such risks, and risk scores for
cardiometabolic disease (CMD). At personal level, I have
tested this system in the USA, as well as at our IPC clinic
in Mumbai. I
would say with certainty, it does a fairly
good job in determining the state of one’s health. What we
have to remember hear is to appreciate the ingenuity of the
3. Rao: Metabolic disease risks
Clinical Research in Diabetes and Endocrinology • Vol 1 • Issue 1 • 2018 32
developers that the data generation, algorithms, and analytics
drive the final outcome and generate the results [Figure 4].
The oximeter which is extensively used for obtaining oxygen
saturation in intensive care units is used here in this system,
to obtain pulse waveforms [Figure 2].
As shown in Figure
2, the pulse waves generated by the
oximeter provides three types of data: Heart rate variability
as a response to the autonomic nervous responses, systolic
interval time as it relates to blood pressure, and change in the
blood volume as it relates to the arterial stiffness.
Using plethysmography of the waveforms, software analytics
generate the type of information clinicians are looking for.
Similarly, plethysmography of the waveforms is used for
developing information about autonomic nervous system
imbalances [Figure 3].
Using the clinical data from various sources, they have
developed a correlation between the type of data generated
using these devices and various known risks of CMDs. What
are some concerns in using this non-invasive diagnostic
platform? By and large, clinicians, diabetologists, and
endocrinologists manage diabetes using parameters such as
fasting blood glucose, postprandial glucose, or HBA1c
. The
health-care providers are not familiar with the risk analysis
algorithms used by these kinds of platforms or with the
terminology used for risk scores and how they were derived.
Independent validation of the data generated by this system, as
well as addition of emerging technologies such as Dexcom G6
or LIfeStyle Libre Free Pro, to monitor glucose, will enhance
the acceptance and use of such devices. Having said that, we
would like to underscore the importance of this innovative
platform, as it is one of a kind non-invasive diagnostic
platform, wherein, the innovators have very cleverly used three
well-accepted devices to develop a variety of risk indicators,
Figure 1: Sudo-Path System and Tm-Oxi System Courtesy: Albert Maarek, LD Technologies.
Figure 2: Plethysmography tracings of pulse waves. Courtesy: Albert Maarek, LD Technologies
4. Rao: Metabolic disease risks
33 Clinical Research in Diabetes and Endocrinology • Vol 1 • Issue 1 • 2018
risk clusters, and risk scores for monitoring CMDs. Since we
emphasized the importance of monitoring blood glucose for
the management of the severity of the disease and to prevent
the development of clinical complications associated with the
Type-2 diabetes, we will discuss some of the options available
from the perspective of integration of emerging technologies.
Continuous monitoring of glucose has great advantages.
According to Rebecca Voelker’s report in the recent issue of
JAMA Network (May 2018), the US FDA has approved a
CGM that can work in tandem, with mobile medical apps,
and automated insulin pumps, to help people with diabetes
manage their interstitial sugar more easily. The Dexcom G6 is
the first CGM approved as both a stand-alone device and one
that can be integrated into automated insulin dosing systems.
According to the manufacturer, Dexcom Inc. of San Diego,
California, its newly approved CGM has an easy-to-use auto
applicator that inserts a small sensor just beneath the skin.
The sensor measures glucose levels and a transmitter inside
of it sends readings wirelessly every 5 min, to a receiver or
Figure 3: Autonomous nerve system responses. Courtesy: Albert Maarek, LD Technologies
Figure 4: Metabolic risk factors (RFs), RF clusters, and risk scores. Courtesy: Albert Maarek, LD Technologies
Figure 5: Mean glucose levels for 12-day period
5. Rao: Metabolic disease risks
Clinical Research in Diabetes and Endocrinology • Vol 1 • Issue 1 • 2018 34
a compatible smartphone or smartwatch. With a mobile app,
users can share readings with up to 5 people. No finger sticks
are needed for calibration or diabetes treatment decisions. In
two trials, 324 adults and children aged 2 years or older with
diabetes used the Dexcom G6 for 10 days. During multiple
clinic visits, their readings were compared with laboratory
test results that measured their blood glucose levels. An FDA
statement indicated that no adverse events were reported
during the studies. We would be glad to validate these sensors
in India, if the manufacturers provide them for our clinical
evaluation in India.
Abbott Diabetes Care has launched their Ambulatory glucose
monitor (AGM) FreeStyle Libre Pro in India. This system
Figure 6: Ambulatory glucose profiles are generated from the composite data collected several days or weeks, plotted according
to time they occurred over the 24-h period
Figure 7: Glucose profile of a patient with no medications: High HBA1c 9.8%. Courtesy: Abbott Diabetes Care
Figure 8: Glucose profile of a patient 80 years old, diabetic for 20 years, under medical care HBA1c 7.2% (personal studies).
Courtesy: Abbott Diabetes Care
Figure 9: Data plot for HBA1c
versus fasting blood sugar (n =
100,000)
6. Rao: Metabolic disease risks
35 Clinical Research in Diabetes and Endocrinology • Vol 1 • Issue 1 • 2018
also uses a transdermal sensor, which is easy to apply with an
auto applicator. Manufacturers sell a reader, which can read
the real-time data, and at the end of the study (12–15 days),
will consolidate the composite data into readable charts.
The individual mean glucose value for every reading is also
provided for developing further information.
Mean glucose values for the 12 days study period are shown
in Figure 5 these bar graphs. Mean glucose value is 156
and there is variation of a high of 29 and a low of 26. This
composite data come from over 1152 recordings (close to 100
readings per graph). In view of the fact that the mean glucose
value is a collective value of so many individual readings, this
type of data collection brings a great degree of confidence
and reliability compared, to single point measurements, by
currently used glucose monitoring methodologies. In the
area of hypertension management, importance of ambulatory
measurements was recognized much earlier. Yet the US
health-care payers do not pay for such valuable services. It
is time, the global health providers recognize the importance
of this kind of monitoring and subsidize preventive care.
Ambulatory glucose profiles are shown in Figure 6.
Figure 7 shows a glucose profile for a 12-hour period. Dark
blue line represents the mean glucose value. Hemoglobin
value is computed, and in this patient, it is 9,8%. In Figure 8
glucose profile a patient who is on medication is graphed.
HBA1c is 7.2% which is close to the recommended level for
elderly individuals.
Since software provides flexibility to look at composite data
for1-daymeasurementsand1-weekor2-weekmeasurements,
this method of monitoring glucose can be used for following
single drug treatment, combination of drugs, or the effect
of even dietary or lifestyle changes. Since this device also
is FDA approved, both the Dexcom G6 (CGM) and Abbott
flash glucose monitor (AGM) are useful tools, for monitoring
glucose in Type-1 as well as Type-2 diabetic patients.
Type-1
patients and Type-2
patients on insulin can take
advantage of hypoglycemia alerts to adjust their medications.
Similar to the Dexcom G6, if the Abbott Diabetes Care
develops connectivity to various smartphone apps, it would be
very useful. We, in India, are trying to validate the FreeStyle
Libre Pro (AMG) at two independent sites. Specific goals
are as follows: (1) To find correlation between blood glucose
levels and interstitial glucose levels, (2) to determine the
usefulness or otherwise of this methodology for managing
real-time, post-meal glucose levels, and (3) to use it as a tool
to screen indigenous drugs and their combinations, dietary
supplements, and complementary therapies for managing
post-meal glucose levels.
Manufacturers claim that HBA1c values generated using
FreeStyle Libre Pro correlates well with finger prick
measurements. Shown below in Figure 9 is a data plot of
individual values for fasting blood sugar against HBA1c
for a total of over 10,000 individuals monitored at two
independent sites (Patna, Bengaluru) in India. One can
visualize quite a scatter of the individual values (data points)
and the reasons for such deviation need explanation. This
is yet another area, where we would like to validate these
devices for their specificity and accuracy, compared to the
conventional blood glucose values. Dr. Mohan and associates
at the Madras Diabetes Research Foundation, Chennai, India,
have done a multicenter real-life study on the effect of flash
glucose monitoring on glycemic controls in patients with
type-1 (T1D) as well as type-2 (T2D) diabetes and have
demonstrated significant reduction in A1c
levels in both T1D
and T2D patients.[16]
DISCUSSION
Since I am writing this “point of view” article for the Journal
of Clinical Research in Diabetes and Endocrinology, I
would like to initiate a debate on the benefits or otherwise
of clinical studies versus clinical trials, in providing the
needed information for developing cost-effective affordable,
predictive, and preventive care. Let us examine for instance
the results of clinical trials on fish oil supplements. In April
issue of JAMA, as part of Medical News and Perspectives,
JenniferAbbasi describes findings of fish oil supplementation
as, “Another Nail in the Coffin for Fish Oil Supplements.”[17]
The findings of 10 clinical trials are at odds with the
advice from the AHA, including a 2017 science advisory
recommendation, to consider fish oil supplementation
for patients with a recent myocardial infarction or heart
attack.[18]
We and others, decades ago had demonstrated, that
fish oil supplements do not interfere with the conversion of
arachidonic acid to prostaglandins or with platelet function.[18]
Now, let us examine a few examples of clinical studies (not
clinical trials), which have demonstrated safety and efficacy
of complementary therapies. It is a well-known fact that
oxidative stress, free radicals, tissue injury, and inflammation
play a very important role in promoting metabolic diseases.
The transcription factor Nrf2 (nuclear factor erythroid-2-
related factor-2, Nrf-2), for instance, a master regulator of
detoxification, antioxidant, anti-inflammatory, and other
cytoprotective mechanisms is raised by health-promoting
factors. This transcription factor activates the transcription
of over 500 genes (so-called survival genes) in the human
genome, most of which have cytoprotective functions. The
most healthful diets such as Mediterranean and Okinawa
are rich in Nrf2 raising nutrients. Recent studies have
demonstrated that induction of Nrf2 and Ho-1 expression by
Protandim (a mixture of five phytochemicals; Ashwagandha,
Indian Bacopa, Indian Green Tea, China Milk Thistle, and
China Turmeric) is associated with a reduction in oxidative
stress and fibrosis, preservation of the RV microcirculation,
and RV function.[19]
Studies by the pioneer scientist, professor
7. Rao: Metabolic disease risks
Clinical Research in Diabetes and Endocrinology • Vol 1 • Issue 1 • 2018 36
McCord and Fridovich, on the effect of Protandim on various
pathways have shown, significant modulation by Protandim
not only of pathways involving antioxidant enzymes but also
those related to colon cancer, cardiovascular disease, and
Alzheimer’s disease.[20,21]
In a recent study, Rossman and associates have shown that
chronic supplementation with a mitochondrial oxidant
(MitoQ) improves vascular function in healthy older
adults.[22]
They studied the effect of oral supplementation of
20 Mg/day MitoQ for 6 weeks in healthy older individuals
with impaired endothelial dysfunction, as measured by the
brachial artery flow-mediated dilation. In these subjects,
post-treatment, brachial artery flow-mediated dilation was
higher; aortic stiffness was lower, and plasma oxidized low-
density lipoprotein, a marker of oxidative stress was lower,
suggesting the beneficial effects of MitoQ. In a separate study,
6 weeks of 500 mg twice daily of nicotinamide riboside (NR)
chloride (NIAGEN) seems to boost the level of nicotinamide
adenine nucleotide (NAD+) and reverses the physiological
signs of aging and kick starts the same key chemical pathways
responsible for its health benefits including the activation of
enzymes called sirtuins, which are largely credited for the
beneficial effects of calorie restriction.[23]
Studies from the
University of Minnesota have demonstrated that D-ribose, a
commonly used supplement, can indeed provide quick energy
and reduce oxidative stress at the cellular and organ levels.[24]
Several seminal studies have demonstrated that management
of modifiable risk factors (RFs) significantly reduces the
development of acute vascular events.[25,26]
In spite of this
observation, we know that there are many other metabolic
risks, if not controlled in time, contribute significantly to
the progress of these metabolic diseases, and promote acute
vascular events. Just to name a few metabolic risks, they
include oxidative stress, free radical injury, inflammation,
bloodflowalterations,hypertension,endothelialdysfunction,
hardening of the arteries, subclinical atherosclerosis, excess
weight, subcutaneous obesity, visceral obesity, metabolic
syndromes, and type-2 diabetes. It is rather time consuming
and extremely costly to do clinical trials, to find appropriate
therapeutic interventions for all of these known metabolic
risks. However, if we develop a multifunctional platform, to
validate the efficacy and safety of complementary therapy,
it is possible to screen many therapeutic modalities and
develops evidence-based data in a cost-effective manner
in a relatively short time period. For instance, we have
validated the safety and efficacy of mulberry green tea as
well as l-arginine using TM-Oxi systems at the IPC Clinic
in Mumbai, India.
We are currently facing an “epidemic or tsunamis” of
metabolic disorders and time to act is now. In view of the
time constraints and economic constraints, we suggest that
simple clinical studies should be encouraged for developing
complementary therapies to reduce, reverse, or prevent the
growing menace of metabolic diseases. In a short overview
like this, it is hard to cover all aspect of this very important
topic, but we encourage readers to refer to original articles,
reports, and reviews on the “Integration of emerging
technologies for cost-effective, affordable health care.”[3-6,27-33]
CONCLUSIONS
Metabolic diseases such as excess weight, obesity,
metabolic syndrome, and type-2 diabetes have reached
epidemic proportions worldwide. To create awareness,
develop educational and preventive strategies, we started a
professional society at the University of Minnesota, in 1993.
Since that time, we have been working on issues related, to
the early diagnosis of the risks for various metabolic diseases,
and development of novel integrated technologies, to manage
the observed risks. In spite of the fact that global organizations
such as the World Health Organization, United Nations, and
non-communicable risk task force have been developing
reports on the increase in the incidence of metabolic diseases,
no country has reduced, reversed, or prevented the increase
in the incidence of the twin epidemics, obesity, and type-2
diabetes.
On the other hand, major clinical trials have demonstrated
the beneficial effects of managing the modifiable RFs, in
reducing the incidence of acute vascular events. When it
comes to reducing or reversing the twin epidemics of obesity
and diabetes, we still have a long way to go.
Clinical trials are time consuming, expensive, and at times
unpredictive. In this review, we have raised the possibilities
of developing cost-effective clinical studies, which can
provide evidence-based information on the safety and
efficacy of complementary therapies at the shortest possible
time. We also have provided examples for developing
integrated platforms for risk assessment, risk prediction, and
risk management, using integrated emerging technologies.
We also recommend that new emerging technologies should
undergo clinical evaluation and validation by independent
sources other than manufacturer-sponsored studies.
We have discussed some examples of complementary drug
development, which may prove to be safe and effective in
reducing the impact of additional RFs, other than the known
modifiable RFs for cardiovascular disease. It is our viewpoint
that the future health-care providers will use every possible
emerging technologies, to reduce the cost of the services and
improve the quality of care. At the clinician’s level, there will
be more emphasis on personalized and precision care. The
need of the hour is in our opinion, development of a robust
predictive and preventive health-care platform.
8. Rao: Metabolic disease risks
37 Clinical Research in Diabetes and Endocrinology • Vol 1 • Issue 1 • 2018
ACKNOWLEDGMENTS
The author wishes to thank Dr. Sadhana Sharma, Professor,
Head, Department of Biochemistry, All India Institute of
Medical Sciences, Patna, and Dr. M.A. Shekar, the Director,
KarnatakaInstituteofEndocrinologyandResearch,Bengaluru,
India, for their inputs. Dr. Pratiksha Gandhi, the Director, IPC
Heartcare, Mumbai/USA, and Dr. Albert Maarek, the Director,
LD Technologies, Miami, Florida, USA, for their collaboration
in clinical studies of TM-Oxi and Sudo-Path Systems.
Dr. Navneeth Selvan (Southern Region) and Dr. Silpi Bardhan
(Eastern Region), Regional Scientific Directors (Abbott
Diabetes Care), for their help in these studies and Ms. Smitha
Bopanna, the Director, Noesys Software Pvt., Ltd., Bengaluru,
for her help in the analysis of data.
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How to cite this article: Rao GHR. Predictive and
Preventive Care: Metabolic Diseases. Clin Res Diab
Endocrinol 2018;1(1):30-37.