29 research outputs found
Rationale and methods of the multicenter randomised trial of a heart failure management programme among geriatric patients (HF-Geriatrics)
<p>Abstract</p> <p>Background</p> <p>Disease management programmes (DMPs) have been shown to reduce hospital readmissions and mortality in adults with heart failure (HF), but their effectiveness in elderly patients or in those with major comorbidity is unknown. The Multicenter Randomised Trial of a Heart Failure Management Programme among Geriatric Patients (HF-Geriatrics) assesses the effectiveness of a DMP in elderly patients with HF and major comorbidity.</p> <p>Methods/Design</p> <p>Clinical trial in 700 patients aged â„ 75 years admitted with a primary diagnosis of HF in the acute care unit of eight geriatric services in Spain. Each patient should meet at least one of the following comorbidty criteria: Charlson index â„ 3, dependence in â„ 2 activities of daily living, treatment with â„ 5 drugs, active treatment for â„ 3 diseases, recent emergency hospitalization, severe visual or hearing loss, cognitive impairment, Parkinson's disease, diabetes mellitus, chronic obstructive pulmonary disease (COPD), anaemia, or constitutional syndrome. Half of the patients will be randomly assigned to a 1-year DMP led by a case manager and the other half to usual care. The DMP consists of an educational programme for patients and caregivers on the management of HF, COPD (knowledge of the disease, smoking cessation, immunizations, use of inhaled medication, recognition of exacerbations), diabetes (knowledge of the disease, symptoms of hyperglycaemia and hypoglycaemia, self-adjustment of insulin, foot care) and depression (knowledge of the disease, diagnosis and treatment). It also includes close monitoring of the symptoms of decompensation and optimisation of treatment compliance. The main outcome variables are quality of life, hospital readmissions, and overall mortality during a 12-month follow-up.</p> <p>Discussion</p> <p>The physiological changes, lower life expectancy, comorbidity and low health literacy associated with aging may influence the effectiveness of DMPs in HF. The HF-Geriatrics study will provide direct evidence on the effect of a DMP in elderly patients with HF and high comorbidty, and will reduce the need to extrapolate the results of clinical trials in adults to elderly patients.</p> <p>Trial registration</p> <p>(ClinicalTrials.gov number, <a href="http://www.clinicaltrials.gov/ct2/show/NCT01076465">NCT01076465</a>).</p
Scleredema Diabeticorum in a Patient with Type 2 Diabetes Mellitus
Background. Scleredema adultorum, a connective tissue
disorder of unknown aetiology, is characterized by a thickening of the
reticular dermis in the upper back of the body that may decrease the
mobility of the affected tissues. It has been reported in diabetic
patients with poor metabolic control. Therapeutic options are limited
with generally poor results. Case Report. 53-year-old
white male with type 2 diabetes mellitus was referred to our
department for evaluation of incipient nephropathy and retinopathy. On
examination, he presented erythematous, indurated, painless and
ill-defined plaque on the skin of the upper back with limited movement
of shoulders. A biopsy was done revealing scleredema. PUVA treatment
and physiotherapy were started with the amelioration of mobility and
acquiring some elasticity of the upper back. Discussion.
The development of scleredema in diabetic patients has been
related to prolonged exposure to chronic hyperglycaemia. Our patient
has had diabetes for 20 years with an acceptable glucose control,
however he developed the scleredema 10 years ago. Conclusions.
Scleredema is a rare connective disorder that seems to appear
most frequently in diabetic subjects. Good metabolic control seems not
to preclude its development. PUVA treatment and physiotherapy are
therapeutic options that seem to be of some help
Ribavirin/interferon-alpha sequential treatment of recurrent hepatitis C after liver transplantation
Receptor activator of nuclear factor-kB ligand -RANKL- as a novel prognostic marker in prostate carcinoma
Combined immunodetection of parathyroid
hormone-related protein (PTHrP) and receptor activator
of NF-kB ligand (RANKL) has shown to successfully
distinguish poorly- and well-differentiated prostate
carcinoma (PCa). In the present study, we aimed to
assess whether immunohistochemical evaluation of these
factors, and also osteoprotegerin (OPG) and Ki67, in
radical prostatectomy specimens can predict biochemical
recurrence. Fifty nine PCa cases undergoing radical
prostatectomy between 1995 and 1998, without history
of neoadjuvant hormonal therapy, were studied.
Preoperative serum prostate-specific antigen (PSA),
Gleason-sum score, pathologic stage, perineural
invasion, seminal vesicle involvement, and positive
surgical margins were assessed in these patients.
Biochemical recurrence, defined by PSA > 0.4 ng/mL at
90 days or later after prostatectomy, occurred in 32/59
patients. In these patients, positivity for OPG and
RANKL in the tumoral epithelium was higher than in
those patients with no biochemical recurrence. Using
univariate analysis, Gleason-sum score, surgical
margins, and seminal vesicle involvement, as well as
OPG and RANKL immunostaining (using a score value
corresponding to moderate staining as cut-off) were significant predictors of biochemical recurrence
(p<0.05). Using the multivariate Cox model, among the
evaluated factors only RANKL expression (hazard ratio
11.6; p <0.001) was an independent prognostic indicator.
Our findings suggest that immunohistochemical
evaluation of RANKL in the primary tumor is a potential
risk factor in PCa patients
Immunohistochemical analysis of lowâgrade and highâgrade prostate carcinoma: relative changes of parathyroid hormoneârelated protein and its parathyroid hormone 1 receptor, osteoprotegerin and receptor activator of nuclear factorâkB ligand
AIM: To investigate multiple bone cytokines produced by prostate carcinoma (PCa) as a novel strategy to differentiate potential aggressiveness in localised PCa using immunohistochemical analysis. METHODS: A total of 47 cases of PCa undergoing radical prostatectomy or transurethral prostatic resection at our institution (FundaciĂłn JimĂ©nez DĂaz (Grupo Capio), Madrid, Spain) between January 1991 and June 1998 were identified as lowâgrade (â©œ4; nâ=â22) or highâgrade (â©Ÿ7, excluding 7 (3+4) cases; nâ=â25) PCa according to Gleason grade. PCa specimens were immunostained for: parathyroid hormone (PTH)ârelated protein (PTHrP), the PTH1 receptor, osteoprotegerin and receptor activator of nuclear factorâÎș B ligand (RANKL), as well as Ki67 (a proliferation marker) and CD34 (an angiogenesis marker). RESULTS: PCa samples showed an increased immunostaining for both osteoprotegerin and RANKL, associated with tumour grade and PTHrP positivity, in the tumoral epithelium. Using a score value of 4âcorresponding to moderate stainingâas cutâoff, the best sensitivity value was for PTHrP (with Câterminal antiserum C6; 100 %); wheras the best specificity value was for RANKL (95 %). CONCLUSIONS: All the evaluated factors are overexpressed mainly in the highâgrade tumours. Our findings indicate that, in most patients with PCa (with Ki67 values between 1% and 9%), sequential determination of Câterminal PTHrP and RANKL immunoreactivities is a useful approach to discriminate lowâgrade and highâgrade tumours