Extended Dual Antiplatelet for Diabetic Elderly Patients After Drug-eluting Stent Implantation: an Evidence-based Clinical Review.

This article reviews the efficacy of extended (>12 months) compared to standard (12 months) DAPT for reducing myocardial infarction and stent thrombosis rates, especially in diabetic elderly patients. Literature screening was conducted at PubMed and Cochrane database using "dual antiplatelet", "duration", "adult-onset diabetes mellitus", "elderly" and, "drug-eluting stent" as keywords. Article types were limited to meta-analysis, systematic review, randomized clinical trial, or clinical trial that compared the efficacy of extended to standard duration of DAPT. Clinical outcomes used were myocardial infarction and stent thrombosis. The initial search was done to find relevant studies specifically assessing diabetic and elderly patients, then widened to diabetic and non-diabetic patients of any age above eighteen years. A total of 5 clinical trials and 1 meta-analysis were reviewed, showing an overall risk reduction of stent thrombosis and myocardial infarction. This review has several limitations, such as its potential selection bias and under-represented proportion of diabetic and elderly patients. High-risk subgroups like diabetes mellitus has a tendency of increased ischemic risk, while advanced age could have both increased ischemic risk and bleeding risk. This review suggests that it is better to reserve extended dual antiplatelet therapy for patients with high ischemic risk and low bleeding risk (tailored therapy). ...
Source: Acta medica Indonesiana - Category: Internal Medicine Tags: Acta Med Indones Source Type: research

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Patients interested in testing themselves at home for sleep apnea now have a few more options. Earlier this year Itamar Medical Ltd. introduced its third-generation WatchPAT home sleep apnea test (HSAT), the WatchPAT 300, and in June 2019, it debuted WatchPAT ONE, which the company calls the first and only disposable HSAT in the market. This month Blue Shield of California (BSC) and the Blue Cross Blue Shield Federal Employee Plan (BCBS FEP) included WatchPAT as a covered HSAT, Itamar reported in a news release. It added that changes in the U.S. Centers for Medicare &Medicaid Services (CMS) 2020 Fee Schedule are expect...
Source: MDDI - Category: Medical Devices Authors: Tags: Digital Health Source Type: news
The human genome has been proposed to contribute to interpersonal variability in the way we respond to nutritional intake. However, personalized diets solely based on gene-nutrient interactions have not lived up to their expectations to date. Advances in microbiome research have indicated that a science-based generation of a personalized diet based on a combination of clinical and microbial features may constitute a promising new approach enabling accurate prediction of dietary responses. In addition, scientific advances in our understanding of defined dietary components and their effects on human physiology led to the inc...
Source: Journal of Pediatric Gastroenterology and Nutrition - Category: Gastroenterology Tags: Invited Review Source Type: research
Authors: Sanches E, Timmermans M, Topal B, Celik A, Sundbom M, Ribeiro R, Parmar C, Ugale S, Proczko M, Stepaniak PS, Pujol Rafols J, Mahawar K, Buise MP, Neimark A, Severin R, Pouwels S Abstract Introduction: Obesity is associated with various diseases such as type 2 diabetes, hypertension, obstructive sleep apnea syndrome (OSAS), metabolic syndrome, and cardiovascular diseases. It affects several organ systems, including the pulmonary and cardiac systems. Furthermore, it induces pulmonary and cardiac changes that can result in right and/or left heart failure.Areas covered: In this review, authors provide an overv...
Source: Expert Review of Cardiovascular Therapy - Category: Cardiology Tags: Expert Rev Cardiovasc Ther Source Type: research
Publication date: Available online 20 November 2019Source: The Lancet Diabetes &EndocrinologyAuthor(s): Jane A Cauley, Lora GiangregorioSummaryThe purpose of this Review is to examine the associations between physical activity and skeletal health, with an emphasis on observational studies with fracture outcomes and randomised controlled trials (RCTs) of physical activity interventions in adults older than 40 years. In general, increased physical activity—primarily leisure time activity or moderate or vigorous physical activity—is associated with a 1–40% lower risk of hip and all fractures. The primary...
Source: The Lancet Diabetes and Endocrinology - Category: Endocrinology Source Type: research
ConclusionsHOMA-IR can further stratify diabetes risk in AA adults beyond obesity, identifying non-obese high-risk and lower-risk obese individuals. However, diabetes risk should still be carefully monitored in obese populations despite insulin sensitivity.
Source: Journal of Clinical and Translational Endocrinology - Category: Endocrinology Source Type: research
In conclusion, EMPA can trigger AMPK signaling pathways and modulate myocardial contractility and reduce myocardial infarct size caused by ischemia and reperfusion independent of hypoglycemic effect. The results for the first time demonstrate that the activation of AMPK by EMPA could one reason about EMPA's beneficial effects on heart disease.Graphical abstract
Source: Molecular and Cellular Endocrinology - Category: Endocrinology Source Type: research
ConclusionsAlong with previously recognized predictors of GDM and pre-GDM, FN ethnicity was an independent determinant of DIP in Saskatchewan from 1980 to 2013. Early maternal/child birth complications were increased in both FN and non-FN with DIP, but more so in FN. Effective DIP prevention strategies, and improvements in pre-conception, prenatal and perinatal care are required to remove ethnicity-based disparities in DIP rates and outcomes.
Source: Canadian Journal of Diabetes - Category: Endocrinology Source Type: research
What happens if you have a low blood sugar or other health issue while riding with a car service like Lyft or Uber?
Source: Diabetes Mine - Category: Endocrinology Authors: Source Type: blogs
ConclusionWe found that the risk of venous thromboembolism persisted for up to 90 days after CO poisoning. The risk was increased 22-fold for pulmonary embolism and 10-fold for deep venous thrombosis, especially in the first month after CO poisoning. Patients should be monitored for venous thromboembolism risk after CO poisoning.
Source: Annals of Emergency Medicine - Category: Emergency Medicine Source Type: research
In this study, we found that GPS significantly reversed the downregulation of TGR5 and inhibited the overproduction of fibronectin (FN), transforming growth factor β1 (TGF-β1), intercellular adhesion molecule-1 (ICAM-1) and vascular adhesion molecule-1 (VCAM-1) in glomerular mesangial cells (GMCs) exposed to high glucose (HG). Additionally, GPS prevented the phosphorylation and degradation of IκBα, and subsequently inhibited the activation of the NF-κB signalling pathway. Further investigation found that GPS enhanced the stabilization of IκBα by promoting the interaction of β-ar...
Source: Pharmacological Research - Category: Drugs & Pharmacology Source Type: research
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