Current medical research and opinion
-
Multiple pharmacologic strategies are currently available to lower blood pressure (BP). Renin-angiotensin system (RAS)-inhibitors, calcium channel blockers and diuretics are widely recommended as first line therapies. Sympathetic activation is an important contributor to BP elevation but remains unopposed or is even increased by some of these drug classes. Selective imidazoline receptor agonists (SIRAs) reduce increased central sympathetic outflow and are considered as add-on therapy in most guidelines. We conducted an international survey to evaluate contemporary hypertension management strategies in countries with high prescription rates of SIRAs to better understand the rationale and practical indications for their use in a real-world setting. ⋯ Contemporary hypertension management varies between countries and therapeutic approaches in a real-world setting are not always in line with recommendations from available guidelines. In the countries selected for this survey prescription of SIRAs was common and appeared to be guided predominantly by considerations relating to the underlying pathophysiologic mechanism of sympathetic inhibition.
-
To explore whether newly diagnosed Candida infection increases the risk of developing ankylosing spondylitis (AS). ⋯ A risk of AS was found after Candida infection, and a year of follow-up acts as an effect modifier between the Candida infection and risk of AS. Key messages What is already known on this subject? Links between spondyloarthritis and fungal infections have been found in animal studies before. What does this study add? Our study demonstrated that Candida infection is an independent risk factor for developing ankylosing spondylitis in terms of gender, age and relevant variables and comorbidities. A risk of ankylosing spondylitis was found after Candida infection, and year of follow-up acts as an effect modifier between the Candida infection and risk of AS. Clinicians should be aware of possible Candida infection in managing patients with ankylosing spondylitis. Implications: Clinicians must pay greater attention to patients with newly diagnosed Candida infection. Specifically, they should conduct tests for ankylosing spondylitis. Further research is needed to examine if and how treatment of Candida infection alleviates symptoms of AS.
-
Observational Study
Assessing Risk of Future Cardiovascular Events, Healthcare Resource Utilization and Costs in Patients with Type 2 Diabetes, Prior Cardiovascular Disease and Both.
Description of risk of cardiovascular (CV) events associated with diabetes is evolving. This US-based real-world study estimated risk of future CV events and heart failure (HF) from type 2 diabetes (T2DM) only, prior CV events only or T2DM plus prior CV events, versus controls, and evaluated healthcare resource utilization (HCRU) and costs. ⋯ In this large and geographically broad US based cohort, CV risk for T2DM patients was elevated, as was the risk for patients with prior CV events, while patients with T2DM plus prior CV events had the highest risk of future CV events. The substantial clinical and economic burden of CV events and HF in patients with both T2DM and prior CV events suggest a need for an integrated treatment and targeted intervention across both conditions.
-
To assess the use of Multivariate Index Assay (MIA OVA1) by gynecologists and determine referral practices and surgical decision making for women with adnexal masses and low-risk MIA OVA1 scores. ⋯ A high proportion of low-risk OVA1 patients were not referred to a gynecologic oncologist prior to surgery, indicating gynecologists may use MIA OVA1 along with clinical and radiographic findings to appropriately retain patients for their care. This practice is safe and may be cost-saving, with patient satisfaction implications.
-
This study aimed to establish the minimal clinically important difference (MCID) for the Fugl-Meyer Motor Scale (FMMS) and the Disability Rating Scale (DRS) to evaluate interventions in patients with motor deficits in the chronic phase after traumatic brain injury (TBI). ⋯ This study is the first to establish MCIDs for the FMMS and the DRS in the chronic phase after TBI. The results may be helpful for the design and interpretation of clinical trials of interventions.