| |
N Engl J Med In New England Journal of Medicine, Vol. 366, No. 18. (2 May 2012), pp. 1657-1659, doi:10.1056/nejmp1202451
Abstract
The last substantive reform in medical student education followed the Flexner Report, which was written in 1910. In the ensuing 100 years, the volume of medical knowledge has exploded, the complexity of the health care system has grown, pedagogical methods have evolved, and unprecedented opportunities for technological support of learners have become available. Yet students are being taught roughly the same way they were taught when the Wright brothers were tinkering at Kitty Hawk. It's time to change the way we ...
|
| |
Abstract
The aim of our study was to compare the effect of simvastatin and fenofibrate treatment on the secretory function of human monocytes and lymphocytes and on systemic inflammation in type 2 diabetes and to assess whether their coadministration is superior to treatment with only 1 of these drugs. One hundred ninety-six adult patients with recently diagnosed and previously untreated type 2 diabetes and mixed dyslipidemia, complying throughout the study with lifestyle intervention and treated with metformin, were randomized in a double-blind ...
|
| |
Abstract
There may be a protective effect of nonaspirin nonsteroidal anti-inflammatory drug use on risk of Parkinson disease (PD) consistent with a possible neuroinflammatory pathway in PD pathogenesis. ...
|
| |
posted to parkinson women
by boylucas
on 2011-06-13 20:25:31
Abstract
The incidence of prevalence of Parkinson's disease (PD) is expected to rise precipitously over the next several decades, as will the associated healthcare related costs. The epidemiology and disease manifestations of PD may differ when comparing women to men. Women are for example less likely to acquire PD, and in several studies have demonstrated a delayed onset of motor symptoms. Women, however, are more likely to experience PD-related complications that may lead to disability (e.g. depression and medication-associated dyskinesia). Further, there ...
|
| |
posted to parkinson
by boylucas
on 2011-06-13 19:56:00
|
| |
Alzheimer's and Dementia, Vol. 7, No. 3. (2011), pp. 280-292
by Reisa A. Sperling, Paul S. Aisen, Laurel A. Beckett, et al.David A. Bennett, Suzanne Craft, Anne M. Fagan, Takeshi Iwatsubo, Clifford R. Jack, Jeffrey Kaye, Thomas J. Montine, Denise C. Park, Eric M. Reiman, Christopher C. Rowe, Eric Siemers, Yaakov Stern, Kristine Yaffe, Maria C. Carrillo, Bill Thies, Marcelle Morrison-Bogorad, Molly V. Wagster, Creighton H. Phelps
posted to alzheimer dementia diagnosis
by boylucas
on 2011-05-25 15:10:31
|
| |
Alzheimer's and Dementia, Vol. 7, No. 3. (2011), pp. 270-279
by Marilyn S. Albert, Steven T. DeKosky, Dennis Dickson, et al.Bruno Dubois, Howard H. Feldman, Nick C. Fox, Anthony Gamst, David M. Holtzman, William J. Jagust, Ronald C. Petersen, Peter J. Snyder, Maria C. Carrillo, Bill Thies, Creighton H. Phelps
posted to alzheimer dementia diagnosis
by boylucas
on 2011-05-25 15:03:49
|
| |
Alzheimer's and Dementia, Vol. 7, No. 3., pp. 257-262
posted to alzheimer dementia diagnosis
by boylucas
on 2011-05-25 14:57:51
|
| |
Alzheimer's and Dementia, Vol. 7, No. 3. (2011), pp. 263-269
by Guy M. McKhann, David S. Knopman, Howard Chertkowd, et al.Bradley T. Hymanf, Clifford R. Jack, Claudia H. Kawashi, William E. Klunk, Walter J. Koroshetz, Jennifer J. Manlymn, Richard Mayeuxmn, Richard C. Mohs, John C. Morris, Martin N. Rossor, Philip Scheltens, Maria C. Carrillo, Bill Thies, Sandra Weintraubu, Creighton H. Phelps
posted to alzheimer dementia diagnosis
by boylucas
on 2011-05-25 14:54:45
|
| |
Journal of musculoskeletal & neuronal interactions, Vol. 10, No. 2. (June 2010), pp. 142-150
posted to aged falls predictive
by boylucas
on 2011-03-16 04:40:10
Abstract
Timed rise was the single most important test that was able to predict both a first time faller and recurrent faller. Timed up and go was the most significant test to predict recurrent fallers. ...
|
| |
Abstract
BACKGROUND: Evaluation and treatment of major depression (MDD) in elderly patients is frequently complicated by the presence of comorbid medical conditions, which can reduce the effect of depression treatment, leading to lower rates of depressive-symptom improvement and higher rates of relapse. OBJECTIVE: The authors investigated results of antidepressant concurrent with arthritis pain treatment in elderly patients. METHOD: Patients age 65 and over with recurrent MDD were stratified by arthritis status and randomized to duloxetine (a dual reuptake-inhibitor of serotonin and norepinephrine) ...
|
| |
The Indian journal of medical research, Vol. 125, No. 3. (March 2007), pp. 231-250
posted to child diabetes
by boylucas
on 2011-03-14 21:12:03
Abstract
Diabetes mellitus (DM) is a metabolic disease characterized by absolute or relative insulin deficiency. Absolute deficiency of insulin most commonly results from an autoimmune destruction of insulin producing cells in the pancreas and in general, the term Type 1 DM (T1DM) is used to denote childhood diabetes associated with autoimmunity and absolute insulin deficiency. The term Type 2 DM (T2DM) is used to denote diabetes resulting from a relative deficiency of insulin when insulin secretion is inadequate to overcome co-existent resistance ...
|
| |
Arquivos brasileiros de endocrinologia e metabologia, Vol. 53, No. 2. (March 2009), pp. 165-174
Abstract
Type 2 diabetes mellitus (T2DM) in children and adolescents is an important Public Health problem against the backdrop of the epidemic of childhood obesity. The clinical presentation of T2DM in youth is heterogeneous from minimal symptomatology to diabetic ketoacidosis. The increasing rates of youth T2DM have paralleled the escalating rates of obesity, which is the major risk factor impacting insulin sensitivity. Additional risk factors include minority race, family history of diabetes mellitus, maternal diabetes during pregnancy, pubertal age group and conditions ...
|
| |
|
| |
European journal of endocrinology / European Federation of Endocrine Societies, Vol. 159 Suppl 1 (December 2008), doi:10.1530/eje-08-0245
posted to child insulin obesity resistence
by boylucas
on 2011-03-14 20:51:07
Abstract
Childhood obesity is a significant health problem that has reached epidemic proportions around the world and is associated with several metabolic and cardiovascular complications. Insulin resistance is a common feature of childhood obesity and is considered to be an important link between adiposity and the associated risk of type 2 diabetes and cardiovascular disease. Insulin resistance is also a key component of the metabolic syndrome, and its prevalence in the paediatric population is increasing, particularly among obese children and adolescents. Several ...
|
| |
Abstract
Objective: Emerging data indicate that insulin resistance is common among children and adolescents and is related to cardiometabolic risk, therefore requiring consideration early in life. However, there is still confusion on how to define insulin resistance, how to measure it, what its risk factors are, and whether there are effective strategies to prevent and treat it. A consensus conference was organized in order to clarify these points. Participants: The consensus was internationally supported by all the major scientific societies in ...
|
| |
Abstract
OBJECTIVE—To determine whether adults diagnosed with type 2 diabetes from age 18 to 44 years more aggressively develop clinical complications after diagnosis than adults diagnosed at ≥45 years of age.RESEARCH DESIGN AND METHODS—We compared outcomes among 7,844 adults in a health maintenance organization who were newly diagnosed with type 2 diabetes between 1996 and 1998. We abstracted clinical data from electronic medical, laboratory, and pharmacy records. To adjust for length of follow-up and sex, we used proportional hazards models to compare ...
|
| |
by Robert Sladek, Ghislain Rocheleau, Johan Rung, et al.Christian Dina, Lishuang Shen, David Serre, Philippe Boutin, Daniel Vincent, Alexandre Belisle, Samy Hadjadj, Beverley Balkau, Barbara Heude, Guillaume Charpentier, Thomas J. Hudson, Alexandre Montpetit, Alexey V. Pshezhetsky, Marc Prentki, Barry I. Posner, David J. Balding, David Meyre, Constantin Polychronakos, Philippe Froguel
Abstract
Type 2 diabetes mellitus results from the interaction of environmental factors with a combination of genetic variants, most of which were hitherto unknown. A systematic search for these variants was recently made possible by the development of high-density arrays that permit the genotyping of hundreds of thousands of polymorphisms. We tested 392,935 single-nucleotide polymorphisms in a French case–control cohort. Markers with the most significant difference in genotype frequencies between cases of type 2 diabetes and controls were fast-tracked for testing in ...
|
| |
by Wendy Winckler, Michael N. Weedon, Robert R. Graham, et al.Steven A. McCarroll, Shaun Purcell, Peter Almgren, Tiinamaija Tuomi, Daniel Gaudet, Kristina B. Boström, Mark Walker, Graham Hitman, Andrew T. Hattersley, Mark I. McCarthy, Kristin G. Ardlie, Joel N. Hirschhorn, Mark J. Daly, Timothy M. Frayling, Leif Groop, David Altshuler
Abstract
An important question in human genetics is the extent to which genes causing monogenic forms of disease harbor common variants that may contribute to the more typical form of that disease. We aimed to comprehensively evaluate the extent to which common variation in the six known maturity-onset diabetes of the young (MODY) genes, which cause a monogenic form of type 2 diabetes, is associated with type 2 diabetes. Specifically, we determined patterns of common sequence variation in the genes encoding Gck, ...
|
| |
posted to 2 child diabetes mellitus type uk
by boylucas
on 2011-03-12 00:48:48
Abstract
SUMMARY Aims Type 2 diabetes mellitus has never previously been described in UK children, although an increasing incidence in childhood is recognized in international studies. The prevalence of obesity in UK children is increasing and is a recognized risk factor for the development of diabetes. The aim of this study was to identify and characterize children with Type 2 diabetes in the West Midlands and Leicester. Methods Children were identified by contacting paediatricians responsible for diabetes in five hospitals. Details were ...
|
| |
Abstract
Context Data on the incidence of diabetes mellitus (DM) among US youth according to racial/ethnic background and DM type are limited.Objective To estimate DM incidence in youth aged younger than 20 years according to race/ethnicity and DM type.Design, Setting, and Participants A multiethnic, population-based study (The SEARCH for Diabetes in Youth Study) of 2435 youth with newly diagnosed, nonsecondary DM in 2002 and 2003, ascertained at 10 study locations in the United States, covering a population of more than 10 million ...
|
| |
Abstract
OBJECTIVE—To estimate the incidence of type 2 diabetes in children <17 years of age and to investigate the relationship of diabetes with increasing childhood obesity in the U.K. and the Republic of Ireland (ROI).RESEARCH DESIGN AND METHODS—Active monthly reporting of cases by consultant pediatricians occurred through the framework of the British Pediatric Surveillance Unit, with additional reports from specialist diabetes nurses. All children <17 years of age and diagnosed by their clinician as having non–type 1 diabetes from 1 October 2004 ...
|
| |
Abstract
The prevalence of both type 1 and type 2 diabetes among children and adolescents has been steadily increasing over the last few decades. However, as the general pediatric population becomes more obese and more ethnically diverse, reliance on phenotypic characteristics for distinguishing between these types of diabetes is becoming increasingly untenable. Yet, the recognition of differences in treatment strategies, associated disorders, and both short- and long-term diabetes and cardiovascular outcomes supports the importance of diagnostic efforts to make a distinction between ...
|
| |
by Georgeanna J. Klingensmith, Laura Pyle, Silva Arslanian, et al.Kenneth C. Copeland, Leona Cuttler, Francine Kaufman, Lori Laffel, Santica Marcovina, Sherida E. Tollefsen, Ruth S. Weinstock, Barbara Linder, for the TODAY Study Group
Abstract
OBJECTIVE To determine the frequency of islet cell autoimmunity in youth clinically diagnosed with type 2 diabetes and describe associated clinical and laboratory findings.RESEARCH DESIGN AND METHODS Children (10–17 years) diagnosed with type 2 diabetes were screened for participation in the Treatment Options for Type 2 Diabetes in Adolescents and Youth (TODAY) study. Measurements included GAD-65 and insulinoma-associated protein 2 autoantibodies using the new National Institute of Diabetes and Digestive and Kidney Diseases/National Institutes of Health (NIDDK/NIH) standardized assays, a physical ...
|
| |
Pediatrics, Vol. 114, No. 1. (July 2004), pp. 259-263
by Nichole Bobo, Alison Evert, Joanne Gallivan, et al.Giuseppina Imperatore, Jane Kelly, Barbara Linder, Rodney Lorenz, Saul Malozowski, Catherine Marschilok, Regan Minners, Kelly Moore, Adolpho Perez Comas, Dawn Satterfield, Janet Silverstein, Gladys Gary G. Vaughn, Elizabeth Warren-Boulton, Diabetes in Children Adolescents Work Group of the National Diabetes Education Program
|
| |
Abstract
The alarming increase in the prevalence of obesity in children in the United States and globally raises major concerns about its future adverse impact on public health. One outcome of this disturbing trend that is already evident is the rapidly increasing incidence of type 2 diabetes at all ages. This disease, once thought to be nonexistent in children, is increasing coincident with obesity. This article addresses the role that obesity plays in type 2 diabetes and also explores its effects on ...
|
| |
Abstract
Patients are not being transitioned to additional OADs in a stepwise fashion and/or are receiving inadequate titration on current OAD regimens. The low rate of HbA(1c) testing and rates of control are contributing factors. ...
|
| |
Abstract
Glimepiride reduced A1C similarly to metformin with greater weight gain, and there was comparable safety over 24 weeks in the treatment of pediatric subjects with type 2 diabetes. ...
|
| |
Abstract
Recognition of the primary pathophysiologic mechanism of the form of diabetes presented can guide specific treatment, optimizing metabolic control and minimizing complications over the long term. ...
|
| |
Australian family physician, Vol. 38, No. 9. (September 2009), pp. 699-703
Abstract
Type 2 diabetes is the consequence of a complex interaction between genes and the environment in a susceptible individual. Children with T2DM are generally overweight, often with central adiposity. Having one or more parents with T2DM gives offspring up to an 80% chance of developing T2DM. At risk children and adolescents should be screened for T2DM. It is important to check the glutamic acid decarboxylase (GAD) antibody to exclude type 1 diabetes. Symptoms and signs of the metabolic syndrome should be ...
|
| |
The American journal of managed care, Vol. 16 Suppl Treating (March 2010)
|
| |
Health technology assessment (Winchester, England), Vol. 11, No. 7. (March 2007)
Abstract
Cost-effective scenarios for risedronate in the management of GIO were identified, but only at the extremes of age and T-score, such that less than 10% of patients aged 50 years or more would be eligible for treatment. Greater cost-effectiveness was observed assuming that the effects of bisphosphonate in GIO were similar to those observed in postmenopausal osteoporosis, an assumption tested by meta-analysis. An assessment algorithm is proposed based on age, the presence of a prior fragility fracture and BMD tests in ...
|
| |
Abstract
Context: High-dose glucocorticoids cause acute protein loss by increasing protein breakdown and oxidation. Whether lower glucocorticoid doses, typical of therapeutic use, induce sustained catabolism has not been studied. Objective: Our objective was to assess the effect of acute and chronic therapeutic glucocorticoid doses on protein metabolism. Design and Setting: We conducted an open longitudinal and a cross-sectional study at a clinical research facility. Patients and Intervention: Ten healthy subjects were studied before and after a short course of ...
|
| |
Abstract
Conditions with chronically elevated glucocorticoid levels are usually associated with declarative memory deficits. Considerable evidence suggests that long-term glucocorticoid exposure may cause cognitive impairment via cumulative and long-lasting influences on hippocampal function and morphology. However, because elevated glucocorticoid levels at the time of retention testing are also known to have direct impairing effects on memory retrieval, it is possible that such acute hormonal influences on retrieval processes contribute to the memory deficits found with chronic glucocorticoid exposure. To investigate this issue, ...
|
| |
Skin therapy letter, Vol. 15, No. 8. (September 2010), pp. 5-9
posted to aged chronic pruritus therapy
by boylucas
on 2011-03-03 22:49:47
Abstract
The elderly in North America represent the fastest growing segment of the population and the most common skin complaint in this age group is pruritus. The multitude of variables that come with advanced age means that the management of pruritus in the elderly poses a particular therapeutic challenge. Pruritus in advanced age may result from a variety of etiologies, although xerosis is the most common. In addition, certain cutaneous and systemic diseases that are associated with pruritus are more prevalent in ...
|
| |
Abstract
This review should help dermatologists optimally manage and prevent glucocorticoid-induced side effects. ...
|
| |
Drugs & aging, Vol. 24, No. 3. (2007), pp. 239-254
Abstract
Rheumatoid arthritis (RA), ankylosing spondylitis (AS) and psoriatic arthritis (PsA) are commonly thought of as inflammatory diseases that affect younger individuals. Although the initial presentation of these diseases is commonly in a patient's twenties or thirties, they usually persist for the duration of the patient's life. In addition, up to one-third of patients with RA have disease onset after 60 years of age. Older patients with any of these three diseases are more likely to have more severe disease with significant ...
|
| |
International journal of immunopathology and pharmacology, Vol. 22, No. 2. (n 2009), pp. 415-426
by A. Migliore, E. Bizzi, B. Laganà, et al.L. Altomonte, G. Zaccari, M. Granata, M. Canzoni, B. Marasini, M. Massarotti, U. Massafra, M. Ranieri, R. Pilla, L. S. Martin, M. Pezza, F. Vacca, A. Galluccio
Abstract
Rheumatoid arthritis, ankylosing spondylitis and psoriatic arthritis are commonly thought of as inflammatory diseases that affect younger individuals. Although the initial presentation of these diseases is common in a patients twenties or thirties, they usually persist for the duration of the patients life. In addition, up to one-third of patients with RA have disease onset after 60 years of age. Anti-TNF-a therapies now have well-recognized safety profiles that have been demonstrated in the usual clinical trial populations for these diseases, but ...
|
| |
posted to aged arthritis rheumatoid therapy
by boylucas
on 2011-03-02 23:44:23
Abstract
The treatment armamentarium in rheumatic inflammatory diseases has drastically increased in the last years. Earlier uses of conventional disease-modifying antirheumatic drugs (DMARDs), along with the arrival of newer therapies including the so-called "biologic" agents, have provided better long-term outcomes for patients suffering from these illnesses. Biologic agents have shown efficacy for several diseases and failed in others. Due to a high prevalence of some of these diseases in the elderly population, this age group may also benefit, although treatment will have ...
|
| |
posted to aged arthritis elderly rheumatic
by boylucas ✚
on 2011-03-02 22:47:37
Abstract
This article summarizes the different aspects of rheumatoid arthritis and the spectrum of diseases that can present as rheumatoid arthritis in the elderly population. With the ageing of the western population, different forms of inflammatory arthritis' prevalence and incidence are increasing in elderly persons. Difficulties in establishing the diagnosis and introducing new treatment modalities in this patient group pose a great challenge for clinicians. The management of inflammatory arthritis in the elderly requires special consideration in regard to the comorbidities and ...
|
| |
Abstract
Rheumatoid arthritis is an inflammatory disease of the joints causing pain and stiffness, pathologically characterized by chronic synovitis. Without proper treatment, it progresses to cause joint deformity that results in significant loss of function. Extra-articular disease can also occur, which exacerbates morbidity and mortality associated with the disease. Patients from all age groups can acquire the disease, hence the additional categories of juvenile onset and elderly onset rheumatoid arthritis. Disease-modifying antirheumatic drugs are the mainstay of therapy, and should be initiated ...
|
| |
posted to aged arthritis rheumatoid therapy
by boylucas
on 2011-03-02 22:39:01
Abstract
During the 10-year period since the last review was done by Gardner and Furst, studies have furthered the knowledge of the use of disease-modifying antirheumatic drugs (DMARDs) in the elderly rheumatoid arthritis (RA) patient. This article briefly reviews the clinical pharmacology of humans as they age, and details the effects of aging on the specific pharmacokinetics and responses to commonly used DMARDs. There has been some progress in understanding the elderly RA patient; however, data are insufficient to provide much confidence ...
|
| |
Drugs & aging, Vol. 26, No. 4. (2009), pp. 273-293
posted to aged arthritis rheumatoid therapy
by boylucas
on 2011-03-02 19:58:13
Abstract
Treatment strategies in the management of rheumatoid arthritis (RA) have significantly changed in the past decade. The early use of disease-modifying antirheumatic drugs (DMARDs) is the basis of this new treatment strategy. Because these agents alter the natural disease course of RA, early aggressive intervention results in better outcomes with respect to future structural damage and disability. The arrival of the 'biologic agents' era in rheumatology has further improved the therapeutic options in patients with RA. A significant portion of individuals ...
|
| |
Abstract
Elderly onset rheumatoid arthritis (EORA) has been considered a benign form of rheumatoid arthritis (RA). However, it most probably encompasses different subsets of patients with distinct outcomes. According to data reported in the most recent studies directly comparing older and younger RA patients, it seems that, overall, the prognosis of EORA patients is not very different from that of other patients with this disease. However, some cases with negative rheumatoid factor and polymyalgia-like symptoms appear to be a distinct subset with ...
|
| |
posted to aged arthritis rheumatoid
by boylucas
on 2011-03-02 18:45:24
Abstract
The treatment of elderly-onset rheumatoid arthritis pursues the same objectives as in younger patients: to control the clinical manifestations, to prevent structural damage, to preserve function, and to decrease excess mortality. In the elderly, the presence of co-morbidities and increased rate of drug-related adverse effects raise specific therapeutic challenges. Nonsteroidal anti-inflammatory drugs are associated with cardiovascular, gastrointestinal, and renal adverse events. The role for corticosteroid therapy remains controversial. Although glucocorticoids provide a short-term decrease in clinical activity and probably a medium-term ...
|
| |
posted to aged health musculoskeletal oral
by boylucas
on 2011-03-02 18:00:36
Abstract
Both musculoskeletal disorders and diseases of the oral cavity are common and potentially serious problems among older persons, yet little attention has been given to the links between them. Several musculoskeletal diseases, including osteoporosis, Paget's disease, and arthritic disorders, may directly involve the oral cavity and contiguous structures. Drugs used to treat musculoskeletal diseases, including corticosteroids and bisphosphonates, increase the risk of suppression of the immune system and osteonecrosis of the jaw, respectively. Many people with disabling osteoarthritis, rheumatoid arthritis, and ...
|
| |
Reumatismo, Vol. 61, No. 2. (n 2009), pp. 107-117
posted to arthritis rheuma rheumatoid therapy
by boylucas
on 2011-03-02 16:40:29
Abstract
The findings of this study suggest that RA patients may be successfully treated with another TNFalpha antagonist, especially those withdrawing for LoE or AEs. ...
|
| |
Abstract
Objective There are limited data suggesting that methotrexate polyglutamate (MTXGlu) concentrations can guide MTX dosing in patients with rheumatoid arthritis (RA). The aim of this study was to define a therapeutic range of red blood cell (RBC) MTXGlun concentrations (where n refers to the number of glutamate groups), including threshold values for efficacy and adverse effects in patients receiving long-term oral MTX treatment. Methods A cross-sectional study of 192 patients receiving oral MTX was undertaken. Disease activity was assessed by the ...
|
| |
Abstract
Inappropriate prescribing (IP) is a common and serious global healthcare problem in elderly people, leading to increased risk of adverse drug reactions (ADRs), polypharmacy being the main risk factor for both IP and ADRs. IP in older people is highly prevalent but preventable; hence screening tools for IP have been devised, principally Beers' Criteria and the Inappropriate Prescribing in the Elderly Tool (IPET). Although Beers' Criteria have become the most widely cited IP criteria in the literature, nevertheless, they have serious ...
|
| |
posted to geriatric geriatrics pharmacology
by boylucas
on 2011-03-02 14:24:25
Abstract
Clinicians are becoming more reliant on their interpretation of clinical trial information to guide prescribing rather than their clinical skills. Thus to improve prescribing, it is increasingly important for clinicians to have an appreciation of epistemology (the science of knowledge and its interpretation) and the broader social context of knowledge. The insights of epistemologists can be useful in understanding the different ways in which clinical trials data are interpreted. ...
|
Search
