30 research outputs found
Precision Medicine in Patients with Differential Diabetic Phenotypes: Novel Opportunities from Network Medicine
No full textIntroduction: Diabetes mellitus (DM) comprises differential clinical phenotypes ranging from rare monogenic to common polygenic forms, such as type 1 (T1DM), type 2 (T2DM), and gestational diabetes, which are associated with cardiovascular complications. Also, the high-risk prediabetic state is rising worldwide, suggesting the urgent need for early personalized strategies to prevent and treat a hyperglycemic state.Objective: We aim to discuss the advantages and challenges of Network Medicine approaches in clarifying disease-specific molecular pathways, which may open novel ways for repurposing approved drugs to reach diabetes precision medicine and personalized therapy.Conclusion: The interactome or protein-protein interactions (PPIs) is a useful tool to identify subtle molecular differences between precise diabetic phenotypes and predict putative novel drugs. Despite being previously unappreciated as T2DM determinants, the growth factor receptor-bound protein 14 (GRB14), calmodulin 2 (CALM2), and protein kinase C-alpha (PRKCA) might have a relevant role in disease pathogenesis. Besides, in silico platforms have suggested that diflunisal, nabumetone, niflumic acid, and valdecoxib may be suitable for the treatment of T1DM; phenoxybenzamine and idazoxan for the treatment of T2DM by improving insulin secretion; and hydroxychloroquine reduce the risk of coronary heart disease (CHD) by counteracting inflammation. Network medicine has the potential to improve precision medicine in diabetes care and enhance personalized therapy. However, only randomized clinical trials will confirm the clinical utility of network-oriented biomarkers and drugs in the management of DM
Molecular mechanisms of hyperglycemia and cardiovascular-related events in critically ill patients: rationale for the clinical benefits of insulin therapy
No full textSamer EllahhamParagon Cardiovascular Foundation, Falls Church, VA, USAAbstract: Newly recognized hyperglycemia frequently occurs with acute medical illness, especially among patients with cardiovascular disease (CVD). Hyperglycemia has been linked to increased morbidity and mortality in critically ill patients, especially when it is newly recognized. Increased rates of reinfarction, rehospitalization, major cardiovascular events, and death in CVD patients have also been found. An expanding body of literature describes the benefits of normalizing hyperglycemia with insulin therapy in hospitalized patients. This article reviews several underlying mechanisms thought to be responsible for the association between hyperglycemia and poor outcomes in critically ill patients and those with cardiovascular events, as well as the biologic rationale for the benefits of insulin therapy in these patients.Keywords: hyperglycemia, diabetes, cardiovascular disease, critical illness, insuli
Role of Antiplatelet Agents in the Primary and Secondary Prevention of Atherothrombotic Events in High Risk-Patients
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Impact of repeated hospital accreditation surveys on quality and reliability, an 8-year interrupted time series analysis
No full textOBJECTIVE: To evaluate whether hospital re-accreditation improves quality, patient safety and reliability over three accreditation cycles by testing the accreditation life cycle model on quality measures.DESIGN: The validity of the life cycle model was tested by calibrating interrupted time series (ITS) regression equations for 27 quality measures. The change in the variation of quality over the three accreditation cycles was evaluated using the Levene's test.SETTING: A 650-bed tertiary academic hospital in Abu Dhabi, UAE.PARTICIPANTS: Each month (over 96 months), a simple random sample of 10% of patient records was selected and audited resulting in a total of 388 800 observations from 14 500 records.INTERVENTIONS: The impact of hospital accreditation on the 27 quality measures was observed for 96 months, 1-year preaccreditation (2007) and 3 years postaccreditation for each of the three accreditation cycles (2008, 2011 and 2014).MAIN OUTCOME MEASURES: The life cycle model was evaluated by aggregating the data for 27 quality measures to produce a composite score (YC) and to fit an ITS regression equation to the unweighted monthly mean of the series.RESULTS: The results provide some evidence for the validity of the four phases of the life cycle namely, the initiation phase, the presurvey phase, the postaccreditation slump and the stagnation phase. Furthermore, the life cycle model explains 87% of the variation in quality compliance measures (R2=0.87). The best-fit ITS model contains two significant variables (β1 and β3) (p≤0.001). The Levene's test (p≤0.05) demonstrated a significant reduction in variation of the quality measures (YC) with subsequent accreditation cycles.CONCLUSION: The study demonstrates that accreditation has the capacity to sustain improvements over the accreditation cycle. The significant reduction in the variation of the quality measures (YC) with subsequent accreditation cycles indicates that accreditation supports the goal of high reliability.</p
Exploring the impact of compassion and leadership on patient safety and quality in healthcare systems: a narrative review
No full textThe Intrarenal Endothelin System and Hypertension
No full text The kidney is both a source of endothelin (ET) generation and an important target organ of this peptide. The highest concentrations of ET-1 in the body exist in the renal medulla, where it mediates natriuretic and diuretic effects through the ETB receptor subtype. It is proposed that aberrations in the renal ET system may lead to sodium and water retention and subsequently to the development of hypertension. </jats:p
