다중혈관 관상동맥 환자에서 y-문합을 이용하여 양쪽 내흉동맥만을 사용한 우회술의 조기 성적

XI. STRATEGIES FOR IMPROVING DIABETES CARE D iabetes is a chronic illness that requires continuing medical care and patient self-management education to prevent acute complications and to reduce the risk of long-term complications. Diabetes care is complex and requires that many issues, beyond glycemic control, be addressed. A large body of evidence exists that supports a range of interventions to improve diabetes outcomes. These standards of care are intended to provide clinicians, patients, researchers, payors, and other interested individuals with the components of diabetes care, treatment goals, and tools to evaluate the quality of care. While individual preferences, comorbidities, and other patient factors may require modification of goals, targets that are desirable for most patients with diabetes are provided. These standards are not intended to preclude more extensive evaluation and management of the patient by other specialists as needed. For more detailed information, refer to Bode (Ed.): Medical Management of Type 1 Diabetes (1), Burant (Ed): Medical Management of Type 2 Diabetes (2), and Klingensmith (Ed): Intensive Diabetes Management (3). The recommendations included are diagnostic and therapeutic actions that are known or believed to favorably affect health outcomes of patients with diabetes. A grading system (Table 1), developed by the American Diabetes Association (ADA) and modeled after existing methods, was utilized to clarify and codify the evidence that forms the basis for the recommendations. The level of evidence that supports each recommendation is listed after each recommendation using the letters A, B, C, or E.

Standards of Medical Care in Diabetes

Secret History: Return of the Black Death Channel 4, 7-8pm In 1348 the Black Death swept through London, killing people within days of the appearance of their first symptoms. Exactly how many died, and why, has long been a mystery. This Secret History documentary follows experts as they pick through the evidence and reveal why the plague killed on such a scale. And they ask, what might be coming next?

Medscape

Summary Background Since December, 2019, Wuhan, China, has experienced an outbreak of coronavirus disease 2019 (COVID-19), caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Epidemiological and clinical characteristics of patients with COVID-19 have been reported but risk factors for mortality and a detailed clinical course of illness, including viral shedding, have not been well described. Methods In this retrospective, multicentre cohort study, we included all adult inpatients (≥18 years old) with laboratory-confirmed COVID-19 from Jinyintan Hospital and Wuhan Pulmonary Hospital (Wuhan, China) who had been discharged or had died by Jan 31, 2020. Demographic, clinical, treatment, and laboratory data, including serial samples for viral RNA detection, were extracted from electronic medical records and compared between survivors and non-survivors. We used univariable and multivariable logistic regression methods to explore the risk factors associated with in-hospital death. Findings 191 patients (135 from Jinyintan Hospital and 56 from Wuhan Pulmonary Hospital) were included in this study, of whom 137 were discharged and 54 died in hospital. 91 (48%) patients had a comorbidity, with hypertension being the most common (58 [30%] patients), followed by diabetes (36 [19%] patients) and coronary heart disease (15 [8%] patients). Multivariable regression showed increasing odds of in-hospital death associated with older age (odds ratio 1·10, 95% CI 1·03–1·17, per year increase; p=0·0043), higher Sequential Organ Failure Assessment (SOFA) score (5·65, 2·61–12·23; p Interpretation The potential risk factors of older age, high SOFA score, and d-dimer greater than 1 μg/mL could help clinicians to identify patients with poor prognosis at an early stage. Prolonged viral shedding provides the rationale for a strategy of isolation of infected patients and optimal antiviral interventions in the future. Funding Chinese Academy of Medical Sciences Innovation Fund for Medical Sciences; National Science Grant for Distinguished Young Scholars; National Key Research and Development Program of China; The Beijing Science and Technology Project; and Major Projects of National Science and Technology on New Drug Creation and Development.

Clinical course and risk factors for mortality of adult inpatients with COVID-19 in Wuhan, China: a retrospective cohort study

Hydroxychloroquine and azithromycin as a treatment of COVID-19: results of an open-label non-randomized clinical trial.

A.F., a 61-year-old man, was admitted to our department for severe and persistent fever [body temperature(BT) 40.0 C] with chills, associated with sore throat and cough. The patient had a history of arterial hypertension, mixed dyslipidemia and hyperuricemia, treated respectively with ramipril plus hydrochlorothiazide, rosuvastatin, n-PUFAs and allopurinol. Ten years before admission, he underwent cardiac surgery with aortic valve replacement (mechanical prosthesis Sorin Carbomedics Orbis 25) for severe valvular stenosis. Six years later he again underwent cardiovascular surgery for a thoracic aortic aneurysm with implantation of a prosthetic tube (Vascutek-28). After these procedures, he received permanent oral anticoagulation (warfarin). Blood tests performed at hospital admission showed ESR 102 mm/h, neutrophilic leukocytosis, hypoalbuminemia with polyclonal hypergammaglobulinemia, and severe hypoxaemia with hypercapnia. Blood and urine cultures were obtained (several consecutive collections performed before the start of antibiotic therapy), chest X-ray study, 12-lead electrocardiogram (ECG), abdominal and pelvic ultrasonography, pharyngeal tampons, and the analysis of antiviral antibodies showed no clinically significant findings. Despite these results, considering the life-threatening condition, we decided to start oxygen therapy and antibiotic therapy. During the first days of hospitalization, the patient continued to show severe intermittent fever (B.T. max 40.5 C), despite the introduction of two consecutive i.v. broad spectrum antibiotic therapies (initially ceftriaxone, followed by piperacillin plus tazobactam i.v.).

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Guidelines enforcement and clinical outcome

Effectiveness of Dutch lipid score (modified for Italy) in a cohort of subjects aged > 18 years and comparison with the subpopulation between 18-45 years

Higher oral porphyromonas gingivalis abundance is associated with the presence of atherosclerotic cardiovascular disease in high-risk patients and in patients with Heterozygous Familial Hypercholesterolemia

Francesco Cipollone

Papers

Guidelines enforcement and clinical outcome

Effectiveness of Dutch lipid score (modified for Italy) in a cohort of subjects aged > 18 years and comparison with the subpopulation between 18-45 years

Higher oral porphyromonas gingivalis abundance is associated with the presence of atherosclerotic cardiovascular disease in high-risk patients and in patients with Heterozygous Familial Hypercholesterolemia