All-cause mortality risk predictors in a preventive cardiology clinic cohort-examining diabetes and individual metabolic syndrome criteria: a PRECIS database study.

AIM: It is unclear if metabolic syndrome (MS) is equal to type 2 diabetes mellitus (DM) in predicting cardiovascular disease (CVD) risk and mortality, and its prognostic value compared to Framingham risk model is controversial. We assessed mortality, CVD risk and prevalence in patients with DM and those without DM who met National Cholesterol Education Program Adult Treatment Panel III (NCEP-ATP III) MS criteria compared to patients without DM or MS. We analysed which component(s) of NCEP MS criteria had greatest predictive value for mortality. METHODS: Retrospective cohort analysis of 1189 DM, 1241 MS (fasting glucose < 126 mg/dl and > or =3 components NCEP-ATP III criteria) and 3023 non-DM/non-MS patients presented for baseline visit to Preventive Cardiology clinic between 1995 and 2006, whose subsequent vital status was determined for a median of 5.2 years. The association with mortality was determined by Cox proportional hazards models. The incremental predictive value of MS components was performed by concordance indexes. RESULTS AND CONCLUSION: DM group had highest mortality and CVD prevalence vs. MS and non-DM/non-MS groups respectively (all p < or = 0.001). Patients with MS criteria had increased CVD prevalence and 1.5-fold increased mortality vs. non-DM/non-MS group (all p < 0.02). In NCEP MS criteria, only fasting glucose significantly predicted mortality in MS group (p = 0.05). MS criteria predicted CVD prevalence in a parallel manner to Framingham risk score assessment. In a cohort of patients at high risk for CVD whose risk factors are being treated, presence of diabetes in addition to plasma glucose within NCEP MS criteria strongly predicts all-cause mortality.

Serum uric acid, mortality and glucose control in patients with Type 2 diabetes mellitus: a PreCIS database study.

AIMS: To determine the association of serum uric acid with all-cause mortality and hyperglycaemia in patients with Type 2 diabetes. METHODS: Retrospective cohort analysis of 535 consecutive patients who had uric acid determinations between 1998 and 2004 and whose subsequent vital status was determined at a median of 4.5 years. The association with mortality was analysed with Cox proportional hazards models. The incremental predictive value of uric acid was examined with concordance indexes. The proportional risk of mortality was represented with the Kaplan-Meier survival curves by uric acid quartiles. RESULTS: We studied 370 men and 165 women aged 59.3 +/- 11.5 years. Mean uric acid was 371.7 +/- 106.2 micromol/l. Patients with glycated haemoglobin (HbA(1c)) > or = 9% had lower uric acid vs. the rest (342.2 +/- 112.1 vs. 383.5 +/- 106.2, P = 0.002). Overall mortality was 10.8%. For each 59 micromol/l increase in uric acid there was a 41% increase in risk of death (unadjusted analysis). The association of uric acid with mortality remained after adjustment for covariates (hazard ratio = 1.21, 95% confidence interval 1.07-1.45) and after gender subanalyses. Uric acid increased the accuracy of prediction when added to a model including Framingham risk factors, components of metabolic syndrome and fibrinogen (P = 0.03). Mortality was higher in patients taking diuretics vs. the rest (15.9 vs. 7.3%), but uric acid predicted mortality in both subgroups. CONCLUSIONS: Serum uric acid predicts mortality in Type 2 diabetic patients regardless of gender, HbA(1c), renal function and diuretic use. Intervention studies should determine whether uric acid is a potential therapeutic target or only a marker of mortality risk.

Extracardiac vascular disease and effectiveness of sustained clopidogrel treatment.

OBJECTIVE: To assess the effectiveness of long term treatment with clopidogrel of patients with extracardiac vascular disease (ECVD) (a history of either peripheral arterial disease or cerebrovascular disease). DESIGN: Subgroup analysis of a prospective randomised clinical trial. SETTING: The CREDO (clopidogrel for the reduction of events during observation) trial was a randomised, double blind, placebo controlled trial conducted at 99 centres in North America from June 1999 through April 2001. PATIENTS: 2116 patients who were to undergo elective coronary intervention or were deemed at high likelihood of undergoing percutaneous coronary intervention were enrolled in the CREDO trial. The current study sample consisted of 272 patients with ECVD. MAIN OUTCOME MEASURE: One year incidence of the composite of death, myocardial infarction, or stroke in the intent to treat population. RESULTS: Patients with ECVD had a more than twofold greater relative risk reduction with clopidogrel for the primary end point compared with patients without ECVD (47.9%, 95% confidence interval (CI) -4.2% to 73.9%, v 18.2%, 95% CI -10.5 % to 39.5%, respectively). CONCLUSIONS: Longer term clopidogrel treatment provides added protection against thrombotic events throughout the arterial vasculature, not limited to the coronary arteries, and may be especially effective for patients with more diffuse atherosclerosis such as ECVD.

Auditory hallucinations after right temporal gyri resection.

The authors present a case study on the development of auditory hallucinations secondary to right temporal lobe damage. Surgical resection in the study patient was of the right superficial middle and inferior temporal gyri. Carbamazepine at a dosage of 800 mg daily was the most effective medication used. A multidisciplinary approach involving the neurosurgeon, psychiatrist, family, and rehabilitation specialist is necessary in managing the psychiatric sequelae of brain injury.

An interactive telemedicine system for remote speech-language pathology treatment.

There is significant potential for delivering speech-language pathology services using telemedicine methods. However, current telemedicine and videoconferencing equipment has limitations that constrain the speech-language therapeutic interventions that can be delivered remotely. This work aimed to develop a telemedicine system that would extend the capabilities of existing videoconferencing equipment and integrate an array of clinically relevant and validated therapeutic tools and techniques. Through a user-centered iterative design framework, an earlier prototype system was expanded and enhanced to enable greater interaction between a speech-language clinician and client during a telemedicine session. The final system utilizes H.323 Internet-based videoconferencing with integrated T.120 data sharing features and allows for a wide range of treatment material and therapeutic interventions to be delivered to a remote client. The protocol for a case-study evaluation designed to evaluate the system as a means for providing comprehensive speech-language treatment has been developed and testing is underway. Preliminary results indicate that the system is a viable alternative to face-to-face treatment for adult clients with neurological impairments.

3-Nitrotyrosine in the proteins of human plasma determined by an ELISA method.

The modification of tyrosine residues in proteins to 3-nitrotyrosine by peroxynitrite or other potential nitrating agents has been detected in biological systems that are subject to oxidative stress. A convenient semi-quantitative method has been developed to assay nitrated proteins in biological fluids and homogenates using a competitive ELISA developed in our laboratory. This assay selectivity detected 3-nitro-l-tyrosine residues in a variety of peroxynitrite-treated proteins (BSA, human serum albumin (HSA), alpha1-antiprotease inhibitor, pepsinogen and fibrinogen) and also in a nitrated peptide, but had a low affinity for free 3-nitro-L-tyrosine and 3-chloro-L-tyrosine. The IC50 values for the inhibition of antibody binding by different nitrated proteins were in the range 5-100 nM, suggesting that the antibody discriminated between nitrotyrosine residues in different environments. The presence of nitrotyrosine in plasma proteins was detected by Western blot analysis and quantified by the ELISA. A concentration of 0. 12+/-0.01 microM nitro-BSA equivalents was measured in the proteins of normal plasma which was increased in peroxynitrite-treated plasma and was elevated in inflammatory conditions. HSA and low-density lipoprotein (LDL) isolated from plasma contained 0.085+/-0.04 and 0. 03+/-0.006 nmol nitro-BSA equivalents/mg protein, respectively. Comparison of the level of nitration in peroxynitrite-treated HSA and LDL in the presence and absence of plasma indicates that nitration and presumably oxidation is inhibited by plasma antioxidants. The presence of nitrotyrosine in LDL is consistent with previous reports implicating peroxynitrite in the oxidative modification of lipoproteins and the presence of a low concentration of oxidized LDL in the blood.