A new study has based on surveillance data has reported that the prevalence of diabetes among US adults grew by 45% over the past 20 years.

The study has been published online May 1 in Diabetes Care.

This study included 22,586 adults sampled in three periods of the National Health and Nutrition Examination Survey  from 3 periods:

• 1988 – 1994 (7950 participants).
• 1999 – 2004 (6756 participants).
• 2005 – 2010 (7880 participants).

Diabetes was defined as having self-reported diagnosed diabetes or having a fasting plasma glucose level ≥126 mg/dL or HbA1c ≥6.5% (48 mmol/mol).

The researchers looked at the prevalence of diabetes as well as body mass index (BMI), waist-to-hip ratio, waist circumference, and other measures in 3 age groups:

• Younger adults (aged 20 to 34).
• Middle-aged adults (aged 35 to 64).
• Older adults (aged 65 and older).

The authors found that number of adults with diabetes increased by 75% from 1988–1994 to 2005–2010 and  the prevalence of diabetes increased over the two decades across all age-groups.

Younger adults had the lowest absolute increase in diabetes prevalence of 1.0%, followed by middle-aged adults (2.7%) and older adults (10.0%).

The authors concluded that during the past two decades, the prevalence of diabetes increased across all age-groups, but adults ≥65 years of age experienced the largest increase in absolute change.

Obesity was strongly associated with the increase in diabetes prevalence, especially in adults <65.
The limitation of the study was study were

• Cross-sectional study
• Did not distinguish between type 1 and type 2 diabetes
•  One time measurement to establish undiagnosed diabetes.

Source

• Diabetes Care. Published online May 1, 2013. Abstract

Microalbuminuria is defined as excretion of between 30 mg and 300 mg of albumin a day  [24 hoursin the urine.

• Less than 30 mg is insignificant.
• Over 300 mg is albuminuria or macroalbuminuria.

Patients should be tested for proteinuria if they have any of the following risk factors:

• Glomerular Filtration Rate ≤60 ml/min/1.73 m2.

• Diabetes
• Hypertension.
• Cardiovascular disease.
• Renal tract disease
• Renal Stones
• Prostatic hypertrophy.
• Family history of chronic kidney disease (CKD)
• Haematuria

The study is based on data from the Japan Diabetes Complications Study and was published online April 25 in Diabetes Care.

Diabetic retinopathy is a known risk factor for microalbuminuria, and microalbuminuria is a risk factor for macroalbuminuria, but authors wanted to find if  diabetic retinopathy predicts poor renal function.

For the study, 1475 patients in the Japan Diabetes Complications Study were divided into 4 groups:

• Normal urine albumin, no diabetic retinopathy ( 773)
• Normal urine albumin, with diabetic retinopathy (279)
• Microalbuminuria, no diabetic retinopathy (277)
• Microalbuminuria, with diabetic retinopathy (146)

The authors found that, after a  a median follow-up of 8 years, patients who either had microalbuminuria or diabetic retinopathy or both at baseline, were much more likely to progress to macroalbuminuria.

The annual decline in the estimated glomerular filtration rate (eGFR) was 2 to 3 times faster in the group with both risk factors than in the other groups.

Microalbuminuria and diabetic retinopathy appear to be markers for decline i kidney function.

Source

1. Diabetes Care, Published online before print April 25, 2013, doi: 10.2337/dc12-2327 

For the study, the authors tracked the health of 6500 Danish 22 year old men, all born in 1955, for 33 years up to the age of 55.

Normal weight was classified as a body mass index (BMI) of between 18.5 and 25; obesity is classified as a BMI of 30 or more.

Half of those classified as obese at the age of 22 were diagnosed with diabetes, high blood pressure, heart attack, stroke, blood clots in the legs or lungs, or had died before reaching the age of 55.

Source

1. BMJ News 
2. M. Schmidt, S. A. Johannesdottir, S. Lemeshow, T. L. Lash, S. P. Ulrichsen, H. E. Botker, H. Toft Sorensen. Obesity in young men, and individual and combined risks of type 2 diabetes, cardiovascular morbidity and death before 55 years of age: a Danish 33-year follow-up study. BMJ Open, 2013; 3 (4): e002698   DOI: 10.1136/bmjopen-2013-002698

The 2012 study found that about 68 percent of physicians were using their smartphones at work and 64 percent were in 2011.

About 38 percent of those physicians surveyed said they use both their smartphone and tablet for their jobs, too.

Kantar found that 43 percent of all physicians surveyed reported that they look up reference drug data on their smartphones, which marks a 13 percent increase over last year’s survey results. The survey also found that 39 percent of all physicians surveyed said they use their smartphones to find and perform clinical calculations, which marked a 4 percent increase over last year. Finally, about 31 percent of all physicians said they made prescribing decisions from their smartphones, up from about 21 percent last year.

Source
Mobihealth

This recommendation would also dramatically reduce transmission of the virus, and markedly curtail infected patients’ progression to AIDS and death.

In 2005, screening of only at risk patients were recommended.

Key Findings

Three key research findings drove the task force to update HIV screening guidelines.

• 20% of people infected with HIV are not aware that they are infected.
• Initiation of antiretroviral therapy before carriers become symptomatic markedly reduces progression to AIDS and death.
• the overall harms of screening the general population and treating those who are found to be HIV-positive are now considered “small.”

The USPSTF also recommended that all pregnant women should be screened for HIV, because identification and treatment “dramatically reduces the rate of mother-to-child transmission.”

Women screened during a previous pregnancy should be rescreened with every subsequent pregnancy.

The evidence is insufficient to establish what the optimal interval should be between screenings. However, it is “reasonable” to rescreen at-risk people at 1-year intervals.

Source

Ann Int Med. Published online April 29, 2013.

Triple therapy with one of these drugs plus ribavirin and pegylated interferon is now the standard of care for HCV genotype 1.

Of the 1,082 patients in the study taking telaprevir, 27 showed severe anemia, compared with five patients developing severe rash.

Among 344 patients on boceprevir, six developed severe anemia.

These data were collected by a consortium of 44 academic centers and 59 community-based clinics in the U.S., which have sought to enroll all patients receiving these drugs.

The only exclusion criteria were consent refusal or participation in another study of HCV therapies.

Anemia in most patients was treated mainly by reducing ribavirin dosages, giving erythropoietin type drugs  and transfusions

Baseline cirrhosis was a significant risk factor for severe anemia .

The study was done by Fried and colleagues.

Authors found that  about one-quarter of patients in the study stopped all therapy prematurely.

The study was funded by Vertex, Merck, Kadmon, and Genentech.

Source

1. Fried M, et al “HCV-TARGET: a longitudinal, observational study of North American patients with chronic hepatitis C (HCV) treated with boceprevir or telaprevir” EASL 2013; Abstract 818.
2. Medpage Today

The research, led by the University of Warwick and published in the journal Child Abuse & Neglect, found the effects of poor parenting were stronger for children who are both a victim and perpetrator of bulling (bully-victims) than children who were solely victims.

It found that negative or harsh parenting was linked to a moderate increase in the risk of being a ‘bully-victim’ and a small increase in the risk of being a victim of bullying. In contrast, warm but firm parenting reduced the risk of being bullied by peers.

The study categorised behaviours such as abuse/neglect, maladaptive parenting and overprotection as negative parenting behaviour.

It categorised authoritative parenting, parent-child communication, parental involvement and support, supervision and warmth and affection as positive parenting behaviours.

Source

1. Science Daily

Photo: Morgue File

Vomiting can occur due to a number of reasons which include following

Digestive Tract

• Gastritis and Gastroenteritis
• Pyloric stenosis (Results in a very forceful projectile vomiting)
• Bowel obstruction
• Overeating especially in children
• Peritonitis
• Food allergies
• Cholecystitis, pancreatitis, appendicitis, hepatitis
• Food poisoning

Sensorineural Causes

• Motion sickness
• Meniere’s  disease
• Concussion
• Cerebral hemorrhage
• Migraine
• Brain tumors
• Benign intracranial hypertension and hydrocephalus

Metabolic Causes

•     Hypercalcemia
•     Uremia
•     Adrenal insufficiency
•     Hypoglycemia
•     Hyperglycemia

Pregnancy

• Morning sickness
• Hyperemesis

Drugs

•  Alcohol
• Opioids
• Selective serotonin reuptake inhibitors
• Chemotherapy drugs

Miscellaneous

• Self-induced
• Postoperative nausea and vomiting
• Extreme pain or agony or distasteful sensation
• Overexertion

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