Evaluation of glucose tolerance in cystic fibrosis: Comparison of 50-g and 75-g tests

AbstractBackgroundThe recommended tests for evaluation of glucose tolerance in cystic fibrosis are the fasting blood glucose (FBG) and the 75-g, fasting, 2-h oral glucose tolerance test (OGTT). We compared a 50 g, non-fasting, 1-h glucose challenge test (GCT) to the standard OGTT.MethodsDuring their regularly scheduled visit to the cystic fibrosis clinic, patients underwent a 50-g, non-fasting 1-h GCT and were asked to complete a standard 75-g, fasting, 2-h OGTT within one week of their clinic visit.ResultsFifty-seven patients underwent glucose tolerance testing. Of these, 31/57 (54%) completed both tests. Hyperglycemia was detected on both tests in 9/31 (29%) patients, 11/31 (35%) tested positive only on the GCT, while all those with positive OGTTs had positive GCTs (p<0.01).ConclusionsIn this study, the GCT identified all patients who meet the criteria for abnormal glucose tolerance on an OGTT. There was a large subgroup that was positive for glucose intolerance only on the GCT. These individuals represent a distinct biochemical subgroup of uncertain significance that warrants closer evaluation. Although the GCT can be completed in a non-fasting state and in conjunction with regular blood work or clinic visits, the anticipated greater compliance was not seen

Competition and Combative Advertising: An Historical Analysis

Fred K. Beard (PhD, University of Oklahoma) is a professor of advertising in the Gaylord College of Journalism and Mass Communication, University of Oklahoma. His research interests include comparative advertising, advertising humor, and advertising history. His work has appeared in the Journal of Advertising, the Journal of Advertising Research, the Journal of Business Ethics, the Journal of Business Research, Journalism History, the Journal of Historical Research in Marketing, the Journal of Macromarketing, and the Journal of Marketing Communications, among others.Yeshttps://us.sagepub.com/en-us/nam/manuscript-submission-guideline

Gender differences in glucoregulatory responses to intense exercise

Trabalho final de mestrado integrado em Medicina (Cardiologia), apresentado á Faculdade de medicina da Universidade de CoimbraIntrodução: A angioplastia primária (ICPp) é considerada internacionalmente como o gold-standard no tratamento de doentes diagnosticados com enfarte agudo do miocárdio com supradesnivelamento do segmento ST (EAMST). Estudos prévios mostram resultados até então contraditórios, relativamente ao prognóstico dos doentes que realizaram a ICPp em horário laboral (L) comparativamente aos que a realizaram em horário não laboral (NL). O objectivo deste estudo é comparar, em termos clínicos e prognósticos, os doentes com EAMST submetidos a ICPp de acordo com o horário de realização da sua realização (laboral versus não laboral). Materiais e métodos: Estudou-se 341 doentes com EAMST submetidos a ICPp ao longo de 3 anos, num centro de elevado volume com serviço 24horas/7dias. Dividiuse os doentes em dois grupos, consoante o horário de realização da ICPp: horário laboral (L (n=167): dias da semana das 8h-18h) e não laboral (NL (n=174): dias da semana das 18h-8h e fins de semana). Os doentes foram comparados em termos clínicos, analíticos, angiográficos e prognósticos. O seguimento médio foi de 24,1 ± 9,2 meses. Resultados: O grupo L apresentou, mais frequentemente, antecedentes de doença coronária (15,6% versus 5,2%, p=0,002) e angioplastia prévia (14,6% versus 4,0%, p=0,004). Os doentes do grupo NL tinham mais frequentemente oclusão da artéria culprit (87,4% versus 68,3%, p<0,001) assim como a valores de troponina I máxima mais elevados (137,9 ± 167,0 versus 102,4 ± 163,3, p=0,001). Não se encontraram outras diferenças a nível da evolução clínica, duração do internamento ou mortalidade intra-hospitalar (grupo NL: 8,6% versus grupo L: 4,2%, p=0,123). Durante o seguimento, não foram encontradas diferenças quanto à incidência de eventos cardíacos e cerebrovasculares major entre os dois grupos. 5 Conclusão: O prognóstico a curto e a longo prazo dos doentes com EAMST admitidos num centro de elevado volume é independente do horário da realização da ICPp.Introduction: Primary percutaneous coronary intervention (pPCI) is considered the gold-standard in the treatment of patients diagnosed with ST-segment elevation myocardial infarction (STEMI). Previous studies have shown contradictory results in the outcome of patients who underwent pPCI during regular working hours versus those who underwent pPCI during off-hours. This study’s aim is to compare clinically and in terms of outcome, the patients who were admitted with STEMI that underwent pPCI according to the schedule of the procedure. Methods: We studied 341 patients that underwent pPCI during a 3 years period in a high-volume centre with 24/7 service. The patients were divided in two groups according the schedule of the pPCI’s realization: regular hours (RH: days of the week from 8:00 to 18:00) and off-hours (OH: days of the week from 18:00 to 8:00 and weekends). The groups were compared clinically, analytically, angiographically and in terms of the outcome during a 24,1 ± 9,2 months follow-up. Results: The RH group was more commonly associated with previous history of coronary disease (15,6% versus 5,2%, p=0,002) and previous PCI (14,6% versus 4,0%, p=0,004). The patients in the OH group presented more frequently a culprit artery’s occlusion (87,4% versus 68,3%, p=0,000) and a significant superior value of maximum troponin I (137,9 ± 167,0 versus 102,4 ± 163,3, p=0,001). Differences were not found in either clinical evolution, length of stay nor in-hospital mortality (group NL: 8,6% versus group L: 4,2%, p=0,123). Also, during the follow-up, major adverse cardiac and cerebrovascular events (MACCE) have shown similar outcomes in both groups. 7 Conclusion: This study showed that the short and long term outcomes of the STEMI patients who underwent pPCI in a high-volume centre with 24/7 service is independent of the procedure’s schedule

Cost-effectiveness of the ACR TIRADS compared to the ATA 2015 risk stratification systems in the evaluation of incidental thyroid nodules

Rationale and Objectives: Thyroid nodules are a common incidental imaging finding and prone to overdiagnosis. Several risk stratification systems have been developed to reduce unnecessary work-up, with two of the most utilized including the American Thyroid Association 2015 (ATA2015) and the newer American College of Radiology Thyroid Imaging, Reporting and Data System (TIRADS) guidelines. The purpose of this study is to evaluate the cost-effectiveness of the ATA2015 versus the TIRADS guidelines in the management of incidental thyroid nodules. Methods: A cost-utility analysis was conducted using decision tree modeling, evaluating adult patients with incidental thyroid nodules < 4 cm. Model inputs were populated using published literature, observational data, and expert opinion. Single-payer perspective, Canadian dollar currency, five-year time horizon, willingness to pay (WTP) threshold of $50,000, and discount rate of 1.5$25 less cost. Results were sensitive to the malignancy rate of biopsy and the utilities of a patient with a benign nodule/subclinical malignancy or under surveillance. Probabilistic sensitivity analysis showed that TIRADS was the more cost-effective option 79.7% of the time. Conclusion: The TIRADS guidelines may be the more cost-effective strategy by a small margin compared to ATA2015 in most scenarios when used to risk stratify incidental thyroid nodules

Sex disparities in effects of cystic fibrosis-related diabetes on clinical outcomes: A matched study

BACKGROUND: Cystic fibrosis-related diabetes (CFRD) is an increasingly prevalent comorbidity factor for patients with cystic fibrosis (CF). CFRD has been associated with an accelerated decline in clinical parameters and an increased mortality rate