Translational research : the journal of laboratory and clinical medicine
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Hemoglobin A1c (HbA1c) has been widely used as a measure of glycemic control in patients with diabetes mellitus. However, the role of HbA1c in the prediabetic stage has received little attention, although the effectiveness of early intensive intervention for the prediabetic patients defined by plasma glucose is well documented. In this study, routine clinical data in a Japanese university hospital were used to address whether the level of HbA1c predicted drug treatment for diabetes mellitus. ⋯ The rate (95% confidence interval; CI) of beginning anti-diabetic drug therapy was 1.5 (0.9-2.5)/1000 patient-years in patients with a normal level of HbA1c (<5.6%), which is similar to 2.1 (1.8-2.5)/1000 patient-years in patients with no HbA1c data, but lower than the value of 23.0 (18.6-28.6) and 161.8 (144.8-180.7)/1000 patient-years in those with borderline and high levels of HbA1c, respectively (P < 0.001). In a small group of 513 middle-aged patients, the rates of initial drug treatment for type 2 diabetes mellitus were 39.4 (28.1-55.1)/1000 patient-years and 270.4 (209.4-349.0)/1000 patient-years in those with borderline and high levels of HbA1c, respectively. A borderline (5.6-6.4%) or high (>or=6.5%) level of HbA1c was found to strongly predict future drug treatment for diabetes mellitus.
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A significant proportion of patients with ventricular fibrillation (VF) can only be defibrillated after a period of chest compressions and ventilation before the defibrillation attempt. In these patients, unsuccessful defibrillations increase the duration of heart arrest and reduce the possibility of a successful resuscitation, which could be avoided if a reliable prediction for the success of defibrillation could be made. ⋯ A slight modification shows that the method can be used to determine relative differences in irregularity of the studied signals. In particular, ECG recordings of VF from patients who could be successfully defibrillated are characterized by a higher level of irregularity, indicating a chaotic nature of the dynamics of the heart, which is in agreement with previous studies on long ECG recordings showing that cardiac chaos was prevalent in healthy heart, whereas in severe congestive heart failure, a decrease in the chaotic behavior was observed.
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Ethnic neutropenia is common in people of African descent. As interleukin-8 (IL-8) and granulocyte colony stimulating factor (G-CSF) bind to receptors on neutrophils, ethnic differences in neutrophil counts are hypothesized to result in different plasma levels of these cytokines. A prospective study was conducted in 72 healthy young volunteers. ⋯ Average IL-8 and G-CSF levels were about 50% and 70% higher in African volunteers compared with Caucasian volunteers (P=0.0008 and P=0.00005, respectively). Additionally, oxidative burst capacity in stimulated neutrophils was significantly lower in volunteers of African descent (P=0.03 between both groups). In sum, lower neutrophil counts are associated with higher levels of IL-8 and G-CSF in Africans.
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A newly developed rapid immunoassay method for plasma soluble E-selectin (sES) was examined to determine whether it can predict the development of acute respiratory distress syndrome (ARDS) in critically ill patients with systemic inflammatory response syndrome (SIRS). Plasma levels of sES were measured on admission (day 1) to the emergency unit. Development of various types of organ failures including ARDS was compared in the first 5 days of admission (from day 1 to day 5) between patients with normal plasma levels of sES and those with elevated plasma levels of sES. ⋯ Development of ARDS was significantly higher in the D(A)E group (15/22, 68.2%) than in the D(A)N group (4/28, 14.3%) (P < 0.001) and that of cardiovascular system failure, renal failure, and coagulation system failure was also significantly higher in the D(A)E group than in the D(A)N group. The mortality rate at 28 days after admission was higher in the D(A)E group (27.3%) than in the D(A)N group (0%) (P < 0.05). Determination of sES levels by this new rapid assay method might be useful for prediction of the development of ARDS in critically ill patients with SIRS, a pathologic condition that has the potential risk for development of multiple organ failure.
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Comparative Study
Micronutrients in African-Americans with decompensated and compensated heart failure.
Heart failure is thought to be more common and of greater severity in African-Americans (AAs). Potential mechanisms remain uncertain. The importance of micronutrient deficiencies in the pathophysiologic expression of congestive heart failure (CHF) in AAs remains to be explored, including hypovitaminosis D, which can promote secondary hyperparathyroidism (SHPT), together with hypozincemia and hyposelenemia, the 2 most crucial trace minerals integral to diverse biologic functions. ⋯ Serum Zn was below normal in 11 of 15 patients with protracted CHF, in 8 of 15 patients with shorter duration CHF, and in 5 of 10 patients with compensated failure. Serum Se was reduced in all patients with >or=4 weeks, 60% with short-term CHF, and 90% of compensated patients. Concomitant to hypovitaminosis D, hypozincemia, and hyposelenemia, SHPT is a covariant of CHF in housebound AAs.