Does oral anticoagulation improve femoropedal graft patency in diabetic patients? Lessons from the Dutch BOA Study

VASA ◽  
2001 ◽  
Vol 30 (Supplement 58) ◽  
pp. 47-49 ◽  
Author(s):  
Chantelau
Keyword(s):  
Oral Anticoagulation ◽  
Controlled Trial ◽  
Oral Anticoagulants ◽  
Graft Patency ◽  
Diabetic Patients ◽  
Graft Occlusion ◽  
Total Study Population ◽  
Diabetic Status ◽  
Significant Difference ◽  
Study Population

Graft patency rates after arterial reconstruction benefit from aspirin treatment. The Dutch Bypass Oral anticoagulant or Aspirin (BOA) Study, a randomized controlled trial, compared the use of oral anticoagulants (e.g. phenprocoumon) versus aspirin in a large sample of patients after infrainguinal arterial bypass surgery. Graft occlusion was the primary endpoint. A total of 2650 bypasses were performed, 531 of which were femorocrural or femoropedal grafts. Of the latter, 194 (37%) were carried out in the subgroup of 700 diabetic patients (i.e. 26% of the total study population). There was no significant difference in patency rates of these particular grafts with either drug. Hence, aspirin 100 mg/day is as effective as oral anticoagulation to benefit patency rates in femorocrural and femoropedal bypass grafts, irrespective of the diabetic status of the patients. Aspirin is sufficient, and oral anticoagulation is not required for this particular type of reconstruction.

The Incidence of Tinea Pedis in Diabetic versus Nondiabetic Patients with Interdigital Macerations

2008 ◽  
Vol 98 (5) ◽  
pp. 353-356 ◽  
Author(s):  
Bradford S. Legge ◽  
John F. Grady ◽  
Autum M. Lacey
Keyword(s):  
Tinea Pedis ◽  
Fungal Infections ◽  
Diabetic Group ◽  
Diabetic Patients ◽  
Fungal Culture ◽  
Total Study Population ◽  
Younger Age ◽  
Significant Difference ◽  
Study Population

Background: We sought to determine the incidence of tinea pedis in patients with otherwise asymptomatic pedal interdigital macerations. Both diabetic and nondiabetic populations were compared. Age and body mass index were also examined for their significance. Methods: Fungal cultures of skin scrapings from 80 patients (77 male and 3 female; mean age, 65 years) with interdigital macerations were performed; 40 patients had previously been diagnosed with type 2 diabetes and 40 did not have diabetes. Results: Cultures revealed a 40% prevalence of tinea pedis in the total study population. The prevalence in the nondiabetic group was 37.5% and 42.5% for the diabetic group. This was not a statistically significant difference. Among patients with interdigital macerations that yielded positive fungal cultures, those in the nondiabetic group were 6.3 years older than those in the diabetic group. It was also observed that the nondiabetic patients with interdigital macerations yielding positive fungal cultures were 9.1 years older than patients with negative fungal cultures in the nondiabetic group. Conclusion: The results of this study provide the practitioner with a guide for treating pedal interdigital macerations. Because the likelihood of a tinea pedis infection is 40%, it seems prudent to treat these macerations with an antifungal agent. In regard to age, the results suggest that as nondiabetic patients age, the likelihood of an otherwise asymptomatic interdigital maceration yielding a positive fungal culture increases, and that diabetic patients may be susceptible to interdigital fungal infections at a younger age than those without diabetes. (J Am Podiatr Med Assoc 98(5): 353–356, 2008)

Oral Anticoagulation in the Prevention of One-Year Vein Graft Occlusion after Aortocoronary Bypass Surgery: Optimal Therapeutic Range and Practical Limitations

1994 ◽  
Vol 72 (05) ◽  
pp. 676-681 ◽  
Author(s):  
J van der Meer ◽  
H L Hillege ◽  
P H J M Dunselman ◽  
B J M Mulder ◽  
H R Michels ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Major Bleeding ◽  
Oral Anticoagulation ◽  
Vein Graft ◽  
Oral Anticoagulant Therapy ◽  
Coronary Bypass ◽  
Graft Patency ◽  
Graft Occlusion ◽  
Coronary Bypass Grafts ◽  
One Year

SummaryTo assess the optimal level of oral anticoagulation to prevent occlusion of vein coronary bypass grafts, 318 patients from a graft patency trial were analysed retrospectively. Oral anticoagulant therapy was started one day before surgery and continued for one year, after which graft occlusion was assessed by angiography. The aimed level of anticoagulation was 2.8-1.8 International Normalized Ratio (INR). Clinical outcome was assessed by the incidence of myocardial infarction, thrombosis and major bleeding.The observed anticoagulation level was 2.8-4.8 INR for 54%, and 1.8-3.8 INR for 75% of time per patient. Occlusion rates in patients who spent <35, 35-70, and ≥70% of time within INR range 2.8-1.8 were 10.5%, 10.8% and 11.8%, respectively (differences not statistically significant). Patients who spent ≥70% of time within INR range 1.8-3.8 versus 2.8-4.8 showed comparable occlusion rates. The risk of graft occlusion was not related to quality of anticoagulation early (0-3 months) or late (3-12 months) after surgery. Myocardial infarction, thrombosis and major bleeding occurred in 1.3%, 2.0% and 2.9% of patients.To maintain vein graft patency in the first postoperative year by oral anticoagulation, a level within INR range 1.8-3.8 for ≥70% of time seems to be sufficient.

scholarly journals Change in corneal endothelial cell density after phacoemulsification in patients with type II diabetes mellitus

2019 ◽  
Vol 35 (5) ◽  
Author(s):  
Muhammad Khalid ◽  
Muhammad Kashif Hanif ◽  
Qamar Ul Islam ◽  
Muhammad Asim Mehboob
Keyword(s):  
Endothelial Cell ◽  
Cell Density ◽  
Type Ii Diabetes Mellitus ◽  
Corneal Endothelial Cell ◽  
Endothelial Cell Density ◽  
Diabetic Patients ◽  
Type Ii ◽  
Significant Difference ◽  
Corneal Endothelial Cell Density ◽  
Study Population

Objective: To compare the mean change in Corneal Endothelial cell Density (CED), from baseline (pre-operative value), two months after phacoemulsification cataract surgery between type II diabetic patients and non-diabetic patients. Methods: This prospective stratified controlled study was conducted at PNS Shifa Hospital, Karachi. 80 eyes of 72 type II diabetic patients and 80 eyes of 77 non diabetic controls, having Nuclear Opalescence (NO) grades 2 and 3 on slit lamp examination underwent phacoemulsification surgery. CED was measured in cells/mm2, of concerned eye of each subject preoperatively and 2 months post operatively using specular microscope. The difference in mean CED change between the two groups after surgery was analyzed. Results: Mean age of study population was 61.41± 6.76 years. Out of study population, 92 (57.5%) were males and 68 (42.5%) were females. There was a statistically significant difference between both groups in terms of mean post-operative CED, mean change in CED and mean frequency change in CED (p <0.05). There was no statistically significant difference between both groups in age, gender, laterality of eyes and mean pre-operative CED, (p >0.05). Difference of pre-operative CED from post-operative CED in each group was statistically significant. Conclusion: There is a significant difference between diabetic population and normal population in terms of corneal endothelial loss after uneventful phacoemulsification cataract surgery. doi: https://doi.org/10.12669/pjms.35.5.596 How to cite this:Khalid M, Hanif MK, Qamar ul Islam, Mehboob MA. Change in corneal endothelial cell density after phacoemulsification in patients with type II diabetes mellitus. Pak J Med Sci. 2019;35(5):---------. doi: https://doi.org/10.12669/pjms.35.5.596 This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

scholarly journals Incidence of Thyroid Diseases in Saudi Diabetic Patients by Means of Ultrasonography

2018 ◽  
Vol 5 (1) ◽  
pp. 3400-3403
Author(s):  
Naglaa Mostafa Elsayed ◽  
Amnah Hakami ◽  
Bashayer Al-Sulami ◽  
Anwar Al-Sulami
Keyword(s):  
Thyroid Function Test ◽  
Thyroid Stimulating Hormone ◽  
Thyroid Diseases ◽  
Diabetic Patients ◽  
Thyroid Disorder ◽  
Common Disorder ◽  
Uncontrolled Diabetes ◽  
Significant Difference ◽  
Study Population ◽  
Thyroid Abnormalities

Introduction: Both thyroid diseases and diabetes mellitus (DM) are common in medical practice in Saudi Arabia. This research was done to study the possible relation between these two diseases. Materials and Methods: A prospective case control study was carried out to assess thyroid abnormalities by Ultrasound (US) in diabetic patients (type 1 and type 2 ).The study population consisted of 69 diabetic patients (20 Type 1DM and 49 Type 2DM) and 111 non diabetic patients. Thyroid US was done for all participants and thyroid function test mainly thyroid stimulating hormone (TSH) was done for all cases that showed positive US changes for thyroid abnormalities. Results: Abnormal thyroid US was detected in 66.7% of diabetic and 34.2% of non diabetic participants. Multinodular goitre (MNG) was the most common disorder in both types of  DM (78.6% in DMT1 and 56.3% in DMT2), while thyroid nodules were the least common disorder. No significant difference between diabetic and non diabetic patients in TSH results. Conclusion and Recommendations: The present study showed high prevalence of thyroid disorder in diabetic patients. We recommend routine US for all diabetic patients especially those with long term diabetes, uncontrolled diabetes or complaining of symptoms of thyroid dysfunction.

Abstract 596: Platelet inhibition by Ticagrelor in African American versus Caucasian patients after Percutaneous Coronary Intervention

2015 ◽  
Vol 35 (suppl_1) ◽  
Author(s):  
Pavan K Katikaneni ◽  
Kalgi Modi
Keyword(s):  
Percutaneous Coronary Intervention ◽  
African American ◽  
Platelet Reactivity ◽  
Coronary Intervention ◽  
Platelet Inhibition ◽  
Total Study Population ◽  
Percutaneous Coronary ◽  
Significant Difference ◽  
Study Population ◽  
Caucasian Patients

PLATO study showed that in acute coronary syndromes, treatment with Ticagrelor as compared with Clopidogrel significantly reduced the rate of death, myocardial infarction or stroke. In subgroup analysis based on race, no significant difference in primary end point was noted. However, African Americans (AA) comprised only 1.1% of study population. AA have greater mortality from coronary artery disease (CAD) and more likely to have high on-treatment platelet reactivity. Aim of our study is to compare the extent of platelet inhibition achieved by Ticagrelor and Clopidogrel in AA versus Caucasian patients undergoing percutaneous coronary intervention (PCI). Methods: 72 patients undergoing PCI during September to November 2014 were included in this study. All received Aspirin 325mg loading dose (LD) followed by 81mg maintenance dose, along with either Ticagrelor 180 mg LD followed by 90 mg twice-daily MD or Clopidogrel 600 mg LD followed by 75 mg once-daily MD. Platelet reactivity (PRU) was measured using the VerifyNow P2Y12 function assay 12-24h following MD and the average values calculated for each group. Results: 40 African American (55%) and 32 Caucasian (45%) patients were included. Ticagrelor was used in 45 (62.5%) and Clopidogrel was used in 27 patients (37.5%). Among Caucasians, 16 (50%) received Ticagrelor and 16 (50%) received Clopidogrel. Among AA, 27 patients (67%) received Ticagrelor, 13 patients (33%) received Clopidogrel. In the total study population, the average PRU achieved was lower for Ticagrelor (44) compared with Clopidogrel (183). Among patients who received Ticagrelor, significantly lower average PRU was seen in AA (33) compared to Caucasians (63). Among patients who received Clopidogrel, similar average PRU was seen in AA (181) and Caucasian (185) groups. After combining Ticagrelor and Clopidogrel groups, lower average PRU was achieved in AA (76) compared to Caucasians (126), the difference primarily attributable to Ticagrelor. Conclusion: Ticagrelor achieved greater platelet inhibition in AAs compared to Caucasians, while Clopidogrel achieved similar platelet inhibition in both racial groups. This potentially greater platelet inhibition by Ticagrelor in high risk AA group merits investigation in large-scale studies.

scholarly journals Impact of Admission Glycated Hemoglobin on Angiographic Characteristics and Short Term Clinical Outcomes of Non-diabetic patients with Acute ST Elevation Myocardial Infarction

QJM ◽  
2020 ◽  
Vol 113 (Supplement_1) ◽  
Author(s):  
A A I Elabd ◽  
H G M Helmi ◽  
E M A Alfiky ◽  
R A Y Bassily
Keyword(s):  
Myocardial Infarction ◽  
Coronary Artery Disease ◽  
Coronary Artery ◽  
Diabetic Patients ◽  
Cardiac Events ◽  
Adverse Cardiac Events ◽  
Significant Difference ◽  
Study Population ◽  
St Elevation ◽  
Artery Disease

Abstract Background Coronary artery disease is the most important cause of death in industrialized countries. Diabetes mellitus is one of the most important modifiable risk factors of coronary artery disease. It increases the risk of coronary artery disease by 2 to 4-fold. Interestingly, this increased risk is not confined to patients with DM, but non-diabetic patients with impaired glucose tolerance (IGT) also may have an increased incidence of cardiovascular complications. Moreover, increased admission glucose levels may be related to a higher mortality rates in patients with acute myocardial infarction (AMI), regardless of diabetic status. Objective To assess the prognostic impact of admission HbA1c in patients without known diabetes mellitus who were admitted with acute ST elevation myocardial infarction, on outcome of 1ry PCI and short-term outcome of adverse cardiac events. Material and Methods This is an observational, this study was conducted at Coronary care unit & coronary catheterization lab unit of cardiology department in Ain Shams University & specialized hospitals. The study period was 6 months (From 1-9-2018 till 1-3-2019). Results 100 patients without prior diagnosis of DM were included in our study population Three categories of patients were created according to HbA1c level: Group 1 (&lt; 5.7%): 46 patients (46%); Group 2 (5.5 to 6.4%): 38patients (38%); Group 3 (&gt;6.5%): 16 patients (16%). Baseline characteristics of the study population are shown in Table 1. The mean age of our sample was 55.06 ± 11.73 years and 96% were males. There was highly statistically significant difference found between DM groups regarding SYNTAX score with P-value (0.002) & another highly significant difference in EF between the 3 groups. Conclusion The present study showed that admission higher HbA1c level in non-diabetic patients presented by acute STEMI is associated with more severe CAD, lower rate of complete revascularization TIMI 3, and higher incidence of adverse cardiac events and mortality. Introducing measurement of HbA1c in the CCU seems to be a simple method to obtain important information on mortality risk.

Coronary Artery Bypass Surgery in Diffuse Advanced Coronary Artery Disease: 1-Year Clinical and Angiographic Results

2017 ◽  
Vol 66 (06) ◽  
pp. 477-482 ◽  
Author(s):  
Marcio Bittencourt ◽  
Alexandre Pereira ◽  
Nilson Poppi ◽  
Luis Dallan ◽  
José Krieger ◽  
...  
Keyword(s):  
Coronary Artery Disease ◽  
Coronary Artery ◽  
Coronary Artery Bypass ◽  
Artery Bypass ◽  
Graft Patency ◽  
Graft Occlusion ◽  
Significant Difference ◽  
Occlusion Rate ◽  
Artery Disease ◽  
The Impact

Background Proper treatment of patients with diffuse, severe coronary artery disease (CAD) is a challenge due to its complexity. Thus, data on the outcomes after coronary artery bypass graft (CABG) in this population is scarce. In this study, we aimed to determine the impact of CABG on the clinical and functional status, as well as graft patency in those individuals. Methods Patients with severe and diffuse CAD who underwent incomplete CABG due to complex anatomy or extensive distal coronary involvement were evaluated preoperatively and 1 year after surgery. Postoperative coronary angiography was performed to evaluate graft patency. Graft occlusion was defined as the complete absence of opacification of the target vessel. Stratified analysis of graft occlusion was performed by graft type and territories, defined as left anterior descending artery (LAD), the left circumflex branch, and the right coronary artery territories; the latter two, grouped, were further classified as non-LAD territory. Results A total of 57 patients were included, in whom 131 grafts were placed. There was a significant improvement in Canadian Cardiovascular Society angina symptom severity (Z = –6.1; p < 0.001) and maximum oxygen uptake (p < 0.001), with a corresponding decrease in the use of long-acting nitrates (p < 0.001). The overall graft occlusion rate was 19.1%, with no significant difference between LAD and non-LAD territories (p = 0.08). However, a significantly lower occlusion rate was noted for the internal mammary artery (IMA) grafts when compared with saphenous vein grafts (p = 0.01), though this difference was only significant in the LAD territory (p = 0.04). Overall, the use of venous graft was the only predictor occlusion at 1 year (odds ratio: 4.03; p = 0.016). Conclusion In patients with diffuse CAD, incomplete CABG surgery resulted in a significant clinical improvement, with acceptable graft occlusion rates at 1 year, particularly for IMA grafts to the LAD territory.

scholarly journals Effects of Local Use of Insulin on Wound Healing in Non-diabetic Patients

2017 ◽  
Vol 26 (2) ◽  
pp. 75-79 ◽  
Author(s):  
Mario Aurelio Martínez-Jiménez ◽  
Francisco Javier Valadez-Castillo ◽  
Jorge Aguilar-García ◽  
José Luis Ramírez-GarciaLuna ◽  
Francisco Israel Gaitán-Gaona ◽  
...  
Keyword(s):  
Wound Healing ◽  
Standard Care ◽  
Therapeutic Option ◽  
Controlled Trial ◽  
Diabetic Patients ◽  
Double Blind ◽  
Positive Effects ◽  
Significant Difference ◽  
Vessel Growth ◽  
Local Use

Background: Clinical trials have shown the positive effects of local insulin therapy in the formation of new vessels and fibrosis in acute and chronic diabetic wounds without major adverse effects. Objective: The aim of this study was to investigate the effects of local insulin use on wound healing in non-diabetic patients. Methods: A randomized, split-plot, double-blind, placebo-controlled trial was conducted. Ten non-diabetic patients with full-thickness acute wounds were recruited (5 due to trauma, 3 to burns, and 2 to pressure). All wounds received standard bedside treatment. Each wound was divided into 2 zones. One side received a standard care plus insulin, while the other received standard care plus injection of saline solution. A biopsy specimen was taken from both sites on days 0 and 14. The amount of blood vessel growth and the percentage of fibrosis were evaluated. Results: A significant difference in the number of new vessels was observed on the insulin-treated site (70.6 [29.21]) compared to saline only (26.5 [34.3]; P < .04). The percentage of fibrosis (insulin 34.7 [28.02] vs saline 27.8 [29.9]) showed no significant difference. No adverse events related to the study occurred. The clinical implications of this study are considerable in terms of the formation of blood vessels but not fibrosis. Conclusion: We suggest that local insulin administration is a safe therapeutic option for angiogenesis in wounds of non-diabetic patients.

scholarly journals Analysis of CYP2C9*2, CYP2C19*2, and CYP2D6*4 polymorphisms in patients with type 2 diabetes mellitus

2010 ◽  
Vol 10 (4) ◽  
pp. 287-291 ◽  
Author(s):  
Sabina Semiz ◽  
Tanja Dujic ◽  
Barbara Ostanek ◽  
Besim Prnjavorac ◽  
Tamer Bego ◽  
...  
Keyword(s):  
Type 2 Diabetes ◽  
Genetic Variations ◽  
Adverse Outcomes ◽  
Allele Frequencies ◽  
Diabetic Patients ◽  
Cyp2d6 Genotype ◽  
Significant Difference ◽  
Study Population ◽  
Polymerase Chain

This is the first study performed in population from Bosnia & Herzegovina (BH), in which we analysed a significance of genetic variations in drug-metabolising enzyme, cytochrome P450 (CYP), in pathogenesis of Type 2 diabetes. We have determined allele frequencies for CYP2C9*2, CYP2C19*2, and CYP2D6*4 in diabetic patients and nondiabetic controls. Genomic DNA was extracted from blood samples collected from 37 diabetic and 44 nondiabetic subjects. A real-time polymerase chain reaction was used for the detection of specific CYP polymorphisms, with the application of the specific TaqMan’ SNP genotyping tests (AppliedBiosystems). Interestingly, results from this study have demonstrated that frequencies of CYP2C19*2 and CYP2D6*4 variants were in line, while frequency of CYP2C9*2 polymorphism seemed to be lower in this sample of BH population as compared to the Caucasians genotype data. Furthermore, no significant difference in allele frequencies for CYP2C9*2, CYP2C19*2, and CYP2D6*4 was demonstrated between diabetic and nondiabetic subjects. Thus, results form this study seem to indicate no relationship between CYP2C9, CYP2C19, and CYP2D6 genotype and diabetes susceptibility in Bosnian population. This in part may reflect a limited study population included in our study and would require larger cohorts to reveal potential relationships between analysed CYP genetic variants and diabetes risk. In addition, it would be pertinent to further explore possible effects of CYP genetic variations on therapeutic and adverse outcomes of oral antidiabetics, which might be the key in optimising therapy for individual patient with Type 2 diabetes.

Metabolic side effects of atypical antipsychotics in older adults

2018 ◽  
Vol 30 (10) ◽  
pp. 1557-1566
Author(s):  
Emme Chacko ◽  
Stephen Boyd ◽  
Rinki Murphy
Keyword(s):  
Elderly Patients ◽  
Atypical Antipsychotics ◽  
Linear Regression Models ◽  
Total Study Population ◽  
Cholesterol Ratio ◽  
Significant Difference ◽  
Metabolic Outcome ◽  
Study Population ◽  
Significant Change ◽  
Clinically Significant

ABSTRACTBackground:The atypical antipsychotics (AAPs) are associated with a recognized class effect of glucose and lipid dysregulation. The use of these medications is rapidly increasing in elderly patients with, and without, dementia. However, the metabolic risks specific to elderly remain poorly studied.Methods:Design: A case-control study.Setting: Psychogeriatric service in Auckland, New Zealand.Participants: Elderly patients either receiving AAP treatment (cases) or not (controls) between 1 Jan 2008 and 1 Jan 2014.Main outcome measures: metabolic data of glucose, HbA1c, lipids, and cardiovascular events and death. The data were analyzed using t-tests and linear regression models for each metabolic outcome.Results:There were 330 eligible cases and 301 controls from a total study population of 5,307. There was a statistically significant change in the HbA1c over time, within the cases group of −1.14 mmol/mol (p = 0.018, 95% CI −0.19 to −2.09). Also statistically significant was the reduction in total cholesterol of −0.13 mmol/L (p = 0.036, 95% CI −0.008 to −0.245). The only significant difference found between cases and controls was in the change in cholesterol ratio of 0.16 mmol/L between groups (95%CI 0.01–0.31, p = 0.036).Conclusions:AAP use was not associated with any clinically significant change in metabolic outcomes in this study population.

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