Showing papers by "Bethesda Hospital published in 2005"

Effects of short-term treatment with metformin on markers of endothelial function and inflammatory activity in type 2 diabetes mellitus: a randomized, placebo-controlled trial.

Abstract: metformin may improve endothelial function and chronic, low-grade inflammation. All patients were randomized to receive either metformin or placebo in addition to insulin therapy. A total of 390 patients were randomized (196 metformin, 194 placebo). Metformin treatment was associated with an increase in urinary albumin excretion of 21% (−1 to +48; P = 0.06); a decrease in plasma von Willebrand factor of 6% (−10 to −2; P = 0.0007); a decrease in soluble vascular cell adhesion molecule-1 of 4% (−7 to −2; P = 0.0002); a decrease in soluble E-selectin of 6% (−10 to −2; P = 0.008); a decrease in tissue-type plasminogen activator of 16% (−20 to −12; P < 0.0001); and a decrease in plasminogen activator inhibitor-1 of 20% (−27 to −10; P = 0.0001). Metformin treatment was associated with improvement of endothelial function, which was largely unrelated to changes in glycaemic control, but not with improvement of chronic, low-grade inflammation

Genetic factors influencing pyrimidine-antagonist chemotherapy.

Abstract: Pyrimidine antagonists, for example, 5-fluorouracil (5-FU), cytarabine (ara-C) and gemcitabine (dFdC), are widely used in chemotherapy regimes for colorectal, breast, head and neck, non-small-cell lung cancer, pancreatic cancer and leukaemias. Extensive metabolism is a prerequisite for conversion of these pyrimidine prodrugs into active compounds. Interindividual variation in the activity of metabolising enzymes can affect the extent of prodrug activation and, as a result, act on the efficacy of chemotherapy treatment. Genetic factors at least partly explain interindividual variation in antitumour efficacy and toxicity of pyrimidine antagonists. In this review, proteins relevant for the efficacy and toxicity of pyrimidine antagonists will be summarised. In addition, the role of germline polymorphisms, tumour-specific somatic mutations and protein expression levels in the metabolic pathways and clinical pharmacology of these drugs are described. Germline polymorphisms of uridine monophosphate kinase (UMPK), orotate phosphoribosyl transferase (OPRT), thymidylate synthase (TS), dihydropyrimidine dehydrogenase (DPD) and methylene tetrahydrofolate reductase (MTHFR) and gene expression levels of OPRT, UMPK, TS, DPD, uridine phosphorylase, uridine kinase, thymidine phosphorylase, thymidine kinase, deoxyuridine triphosphate nucleotide hydrolase are discussed in relation to 5-FU efficacy. Cytidine deaminase (CDD) and 5'-nucleotidase (5NT) gene polymorphisms and CDD, 5NT, deoxycytidine kinase and MRP5 gene expression levels and their potential relation to dFdC and ara-C cytotoxicity are reviewed.

Does metformin decrease blood pressure in patients with Type 2 diabetes intensively treated with insulin

Abstract: We investigated in a double-blind study whether metformin reduces blood pressure (BP) in patients with Type 2 diabetes intensively treated with insulin. 220 patients with Type 2 diabetes were asked to undergo 24-h ambulatory BP monitoring (24-h ABPM). Systolic BP (SBP), diastolic BP (DBP), pulse BP (PP), mean BP (MP) and heart rate (HR) were measured as office BP measurements and as 24-h ABPM for 24-h, day and night. Office BP measurements did not differ significantly between the placebo- and metformin-treated groups for any BP measure, but showed a non-significant trend for SBP reduction with metformin use (mean baseline-adjusted difference, metformin minus placebo: -4.2 mmHg, 95% CI, -9.9 to +1.5; P = 0.15).Conclusion: Metformin does not significantly affect BP in patients with Type 2 diabetes intensively treated with insulin

Autologous blood transfusion in elective cardiac valve operations.

Abstract: Background and Aim of Study: The aim of this study was to detect any outcome differences between patients who donated autologous blood versus nondonors undergoing nonemergent cardiac valve surgery. Of further interest was whether autologous donors required less allogeneic blood products overall than patients who did not donate. Methods: We conducted a nested case-control study in which data were collected prospectively on 225 variables. Cases underwent nonemergent, cardiac valve surgery and donated autologous blood products (n = 40). Controls also had nonemergent, cardiac valve surgery but did not donate autologous blood products (n = 120). Cases were matched to controls 1:3 on age (±3 years), gender, and New York Heart Association Functional Classification. We controlled for 12 potential confounding variables and examined 17 outcomes of interest. To generate the unadjusted risks of each outcome, chi-square and t-tests were performed comparing cases and controls to each outcome of interest. Then logistic regression analysis investigated the adjusted risk between cases and controls and for the outcomes of interest, each controlling for the potential confounding variables. Results: There were no significant differences between the cases and controls for 11 of the 12 possible confounding variables. Controls had significantly more chronic obstructive pulmonary disorder. There were no significant differences between cases and controls for 13 of the 17 outcomes of interest. Autologous blood donors received more total packed red blood cells (PRBCs) (p = 0.0373) and more total fresh frozen plasma than controls (p = 0.0002). Fewer autologous blood donors required allogeneic packed red blood cell transfusion (p = 0.0134), and the total length of stay was shorter for autologous donors (p = 0.0782). Conclusion: Four of the 17 outcomes of interest were different for patients who donated autologous blood versus those who did not. Our experience demonstrated that elective cardiac valve surgery can safely reduce (by 18.3%) the need for allogeneic PRBCs by utilizing preoperative autologous blood donation.

The management of univestigated dyspepsia in primary care.

Abstract: Dyspepsia is very common in western countries, where 10-40% of the population experience upper abdominal pain or discomfort over the course of one year. Mostly it is a chronic relapsing problem. Prompt endoscopy is imperative in all patients with sinister symptoms (including the first appearance of symptoms after the age of 50-55). In other patients endoscopy is unlikely to contribute to medical management. In those a ''test and treat'' strategy implying non invasive testing for Helicobacter pylori (H. pylori) and treatment of the infection if present seems to be the best approach under current conditions (H. pylori prevalence among dyspeptics 28-61% in recent studies). If the patient is H. pylori-negative and in case of persisting symptoms after successful H. pylori eradication, empirical treatment with an antisecretory drug is justified. Endoscopy is reserved for those patients in whom this approach fails. With a continuing decrease in H. pylori prevalence the accuracy of the used non-invasive H. pylori test needs to be high and urea breath tests are to be preferred, the faecal antigen test being a reasonable alternative. At a very low prevalence of H. pylori in the dyspeptic population (below 10%) non invasive testing for H. pylori loses its significance and empirical treatment with an antisecretory drug becomes a rational first step. The physician involved in the care for dyspeptic patients needs to be aware of the current H. pylori prevalence.

Helping Arthritis Patients in Northern KwaZuluNatal

Abstract: The South African Academy of Family Practice's Rural Health Initiative (RHI) is proud to be able to bring you the following section of the journal, that will concentrate on issues pertaining to rural health in South Africa. We hope to provoke discussion on these issues and would encourage anyone interested in rural health to offer contributions to future issues.