Plasma fibrinogen level as a predictor of incident metabolic syndrome in a community-based prospective study in Hong Kong Chinese

BACKGROUND AND AIMS: Metabolic syndrome (MS) comprises a constellation of metabolic abnormalities associated with a high risk of developing diabetes and cardiovascular diseases. Central obesity, with related insulin resistance and inflammation are considered the core of the underlying pathogenesis of MS. Fibrinogen, an acute-phase reactant in the coagulation cascade, has been shown to play pivotal role in determining the extent of local or systemic inflammation. In this study, we examined whether plasma fibrinogen was predictive of incident MS in a community-based Chinese cohort. MATERIALS AND METHODS: Subjects were recruited from the Hong Kong Cardiovascular Risk Factors Prevalence Study (CRISPS) cohort. 2780 subjects were recruited in 1995-6 with baseline assessment performed. 1416 subjects without MS at …postprin

Prevalência e fatores associados de infecção pelo M. tuberculosis entre Agentes Comunitários de Saúde.

Introdução: A tuberculose é uma doença milenar e que, ainda hoje, constitui grave problema de saúde pública em todo o mundo. Objetivo: Estimar a prevalência e os fatores associados à infecção latente pelo MTB entre Agentes Comunitários de Saúde atuantes na rede básica de saúde de Municípios prioritários para o controle de TB Cuiabá/MT, Manaus/AM, Salvador/BA e Vitória/ES. Métodos: Estudo de corte transversal no qual os dados foram coletados através de questionário, composto de questões abertas e fechadas sobre características pessoais; informações a respeito da tuberculose; utilização de medidas preventivas, etc. Aplicou-se prova tuberculínica, com leitura após 48-72h por enfermeiros treinados, considerando como ponte de corte positivo 5 e 10 mm de enduração. A análise múltipla foi feita por meio de regressão logística hierarquica. Foram incluídas no modelo as variáveis que mostraram associação com desfecho com p<0,1. Permaneceram no modelo as variáveis independentes que mantiveram associação com desfecho após ajuste (p<0,05). Este estudo obteve aprovação do Comitê de Ética em Pesquisa com seres humanos do Centro de Ciências da Saúde da Universidade Federal do Espírito Santo, n° de registro CEP-07/2010 e das Secretarias Municipais de Saúde, por meio de uma Carta de Apresentação. Resultados: 322 Agentes Comunitários de Saúde (ACS) aceitaram participar voluntariamente do estudo por meio da assinatura do Termo de Consentimento Livre e Esclarecido. Destes, 10 não compareceram para leitura, sendo estes considerados como perdas, além do que um indivíduo foi excluído pelo fato do teste rápido para HIV ter resultado positivo, perfazendo uma amostra final de 311 participantes. Ainda em relação aos ACS triados, a positividade a Prova Tuberculínica, levando-se em consideração o ponto de corte ao teste de 10 mm e de 5 mm de enduração, foi de 37,30% (IC95%: 0,31-0,42) e de 57,88% (IC95%: 0,52-0,63), respectivamente.Conclusões: Faz-se necessário um programa de realização de Prova Tuberculínica, de rotina, combinado com intervenções para reduzir o risco de transmissão nosocomial, bem como a realização de outros estudos para avaliar a eficácia de novos testes para detecção de tuberculose latente

Simple risk assessment tools to identify post-menopausal women with fracture risk in community

Conference Theme: Osteoporosis: Ortho-Medical Integration & Allianc

Embryo cryopreservation: a local experience

Abstrac

Circulating fibroblast growth factor 21 level predicts the progression of diabetic nephropathy in patients with type 2 diabetes

Session: OR23-The Beta Cell and Diabetes Complications: Basic and Clinical Aspects Clinical/Translational: no. OR23-4Oral PresentationObjective: Fibroblast Growth Factor 21 (FGF21) is a metabolic hormone produced by the liver, but also expressed in the other tissues including the adipose tissues, pancreas and kidney. Beneficial effects on body weight, carbohydrate and lipids metabolism have been observed in animals treated with recombinant FGF21. However, paradoxical increases in circulating FGF21 levels are found in obesity and diabetes. Elevated levels are also found in patients with impaired renal function. Its correlation with urinary albumin excretion in patients with diabetic nephropathy, even in the stage of microalbuminuria, suggests it to be an early indicator of subclinical diabetic nephropathy. Here we investigate whether serum FGF21 level can be usefully employed in the prediction of disease progression in patients with diabetic nephropathy. Research Design and Methods: Baseline plasma FGF21 levels were measured with an ELISA in type 2 diabetic subjects, recruited from the Hong Kong West Diabetes Registry. The role of FGF21 in predicting chronic kidney disease (CKD) over a median follow-up of 4 years was analyzed using Cox regression analysis. CKD progression was defined as a deterioration in CKD staging and a 25% or greater drop in estimated glomerular filtration rate (eGFR) from baseline, as defined by International Society of Nephrology statements. Results: At baseline, serum FGF21 levels increased progressively with CKD staging (P for trend <0.001; n=1136). Amongst 1071 subjects with baseline CKD stage ≤ 3, serum FGF21 levels were significantly higher in those with CKD progression (n=171) during follow-up than those with no progression (n=900) (P<0.001). On multivariable Cox regression analysis, serum FG21 was independently associated with CKD progression (hazard ratio [HR]: 1.24; 95% CI: 1.05-1.47; P=0.012), after adjustment for age, duration of diabetes, hypertension, C-reactive protein and eGFR. Serum FGF21 remained an independent predictor of CKD progression in a subgroup of subjects with normoalbuminuria and CKD stage 1 or 2 at baseline (HR 1.4; 95% CI 1.04-1.88; p=0.028; n=559) Conclusions: Elevated FGF21 levels may represent a compensatory change to the metabolic derangement and renal injury in diabetic patients with renal disease and appear to be a useful biomarker for predicting disease progression in type 2 diabetic patients at early stages of diabetic nephropathy. Supported by: the Hong Kong Research Grant Council (CRF HKU 02/12R)link_to_OA_fulltex

Elevated Circulating Pigment Epithelium-Derived Factor Predicts the Progression of Diabetic Nephropathy in Patients With Type 2 Diabetes

CONTEXT: Pigment epithelium-derived factor (PEDF), a circulating glycoprotein with antiangiogenic, antioxidative, and anti-inflammatory properties, protects against diabetic nephropathy (DN) in animal models. OBJECTIVE: We investigated whether circulating PEDF predicted the progression of DN in a 4-year prospective study. DESIGN, SETTING, AND PARTICIPANTS: Baseline plasma PEDF levels were measured in type 2 diabetic subjects recruited from the Hong Kong West Diabetes Registry. The role of PEDF in predicting chronic kidney disease (CKD) and albuminuria progression was analyzed using Cox regression analysis. MAIN OUTCOME MEASURE: We evaluated CKD progression, defined as deterioration in CKD staging and a 25% or greater drop in estimated glomerular filtration rate (eGFR) according to International Society of Nephrology statements. RESULTS: At baseline, plasma PEDF levels increased progressively with CKD staging (P for trend 60 mL/min/1.73 m(2) (n = 462) at baseline (hazard ratio = 2.75; 95% confidence interval = 1.01-7.49; P < .05), even after adjustment for potential confounders. CONCLUSIONS: Elevated PEDF levels may represent a compensatory change in type 2 diabetic patients with renal disease and appear to be a useful marker for evaluating the progression of DN

Consolidating service receivers: Nurse-led Clinic in the management of osteoporosis to reinforce lifestyle modification, increase drug-adherence rate and Osteoporosis Clinic attendance rate at Queen Mary Hospital

Conference Theme: Consolidating Health Care - 固本培員, 健行不

The DIAFOOT project: improved survival of diabetic foot patients begins with increased awareness

Conference Theme: The future of diabetes: putting evidence into practic

Reverse phase protein array identifies novel anti-invasion mechanisms of YC-1

YC-1 has recently been demonstrated to have potent anti-invasion and anti-metastatic activity in several cancer models, in addition to its anti-proliferation activity. However, the mechanism underlying its anti-invasion/anti-metastatic activity is largely unknown. Nasopharyngeal carcinoma (NPC) is a highly metastatic head and neck cancer in Southeast Asia. Here, we demonstrated that YC-1 inhibited invasiveness and proliferation of NPC cells, with the latter being accompanied by PARP cleavage, S-phase arrest and activation of Chk1/Chk2. We aimed at identifying novel anti-invasion mechanisms of YC-1 in NPC by a functional proteomic platform, the reverse phase protein array (RPPA). Our study revealed for the first time that multiple invasion-related signaling proteins (β-catenin, caveolin, Src and EGFR), as well as several growth-related proteins (AMPKα, phospho-acetyl-CoA carboxylase (p-ACC), HER-2 and mTOR), which were previously un-described signaling proteins altered by YC-1, were found to be down-modulated by YC-1 in NPC cells. We hypothesized that YC-1-mediated downregulation of these invasion proteins contributed to its anti-invasion activity in NPC cells. Overexpression of EGFR, activated Src or caveolin, but not β-catenin reversed the inhibitory effects of YC-1 on NPC cell invasion, with EGFR and activated Src having additional effects on rescuing NPC cells from YC-1-mediated growth inhibition. In summary, we have identified several novel anti-invasion mechanisms of YC-1 that could impact NPC, and possibly other cancers as well. © 2009.link_to_subscribed_fulltex

Protocol driven assessment programme effectively shortens new case waiting time

Service Priorities and Programmes Free Papers: SPP4.6 Quality and Safety in Healthcare 1Conference Theme: Consolidating Health Care - 固本培員, 健行不息Introduction: The waiting time for new cases in endocrine clinic has been rising due to increasing demand. The average waiting time has increased to 26.3 ± 5.5 weeks in February 2012. To improve the situation, a protocol driven assessment (PDA) programme has been established and incorporated into the triage pathway starting from April 2012. Objectives: (1) To shorten the waiting time of new case at the Endocrine Clinic; and (2) to enhance efficient work flow of triage system and improve patient care. Methodology: Protocols for endocrine diseases including obesity, hyperprolactinaemia, hypercalcaemia, hypopituitarism and hypogonadism were developed. Patients referred for such conditions were triaged to the PDA programme in which history taking, assessments, investigations and early interventions were carried out according to the protocols set by an endocrine nurse and subsequently followed by endocrinologists. Results: 225 referrals were screened from May 2012 to December 2012. 64 patients were triaged to the programme. The referralto-nurse and referral-to-endocrinologist times for the programme were 5.9 ± 4.9 and 9.8 ± 5.3 weeks respectively. This showed a significant improvement when compared with their original referral-to-endocrinologist time (26.6 ± 5.7 weeks, p<0.05). Referral-to-endocrinologist time for patients not recruited into the programme also showed significant improvement (10.3 ± 9.0 vs. 26.2 ± 5.4 weeks, p< 0.05) and the PDA programme was one of the measures that contributed to this success. Early intervention has been initiated during the initial nursing assessment of the programme. 18 obese patients received prompt referrals to relevant allied health disciplines before assessments by specialists. Four patients, referred for hyperprolactinaemia, had normal serum prolactin level after re-checked by endocrine nurse under a controlled non-stressed condition. They could be discharged from clinic at the first specialist assessment. More urgent conditions, such as visual field defects and high blood pressure, had also been detected early in the nursing assessment stage and resulted in prompt treatment action. The establishment of PDA programme, conducted by an experienced nurse, not only shortens waiting time but also provides patients with a more streamlined, timely and efficient model of care