Crabtreebach5935

To access the adequacy of treatment decisions in accordance with current recommendations for individualizing glycemic targets in primary and tertiary care.

This multicenter cross-sectional study was conducted with a cohort of older type 2 diabetes patients from southern Brazil. Inclusion criteria were age over 65 years, having a previous diagnosis of type 2 diabetes (according to ADA criteria) and having at least two consultations registered in the medical records within one year. The primary outcome was the adequacy of treatment decisions according to pre-established HbA1c targets, which was compared with the complexity of care. selleck inhibitor The ideal HbA1c targets were (1) 7-7.5% for an estimated life expectancy >10 years; (2) 7.5-8% for a life expectancy of 5-10 years; (3) 8-8.5% for a life expectancy <5 years. For analysis, the chi-square test was used for categorical variables and the t-test was used for continuous variables.

Overall, 49.1% and 50.3% of the patients in the primary and tertiary care groups, respectively, received inadequate management. In patients whose HbA1c level was over target, the treatment was intensified in 46.3% and 51.2% of the primary and tertiary care groups, respectively (p = 0.57). In patients whose HbA1c level was under target, treatment was de-intensified in 5.9% and 26.2% in the primary and tertiary care groups, respectively (p <0.01).

Treatment changes based on individualized glycemic targets do occur in a minority of patients, which reflects the need for new strategies to facilitate individualized treatment targets and optimize the treatment adequacy in older adults.

Treatment changes based on individualized glycemic targets do occur in a minority of patients, which reflects the need for new strategies to facilitate individualized treatment targets and optimize the treatment adequacy in older adults.

To assess the relationship between growth differentiation factor-15 (GDF-15) levels and estimated glomerular filtration rate (eGFR) in type 2 diabetes mellitus (DM) patients with and without albuminuria.

We examined 324 patients with type 2 DM in a cross-sectional study. eGFR was determined using equations from creatinine (eGFR

) and the combination of creatinine and cystatin C (eGFR

). The patients were classified into two groups based on urinary albumin creatinine ratio (ACR) the normoalbuminuria group (urinary ACR < 30 mg/g) and the albuminuria group (urinary ACR ≥ 30 mg/g).

In individuals both with and without albuminuria, higher GDF-15 levels were associated with lower eGFR

and eGFR

. Plasma GDF-15 levels were inversely correlated with eGFR

in individuals both with and without albuminuria (γ = -0.624, p < 0.001 and γ = -0.509, p < 0.001, respectively). A multiple regression analysis showed that GDF-15 levels were significantly associated with eGFR

after adjusting for age, sex and other confounders, including urinary ACR as a continuous or categorical variable (β = -0.309, p < 0.001 and β = -0.318, p < 0.001, respectively). Similarly, these results were replicated when eGFR

was considered instead of eGFR

in correlation and regression analyses.

GDF-15 levels were inversely associated with eGFR in patients with type 2 DM. This relationship was independent of albuminuria status.

GDF-15 levels were inversely associated with eGFR in patients with type 2 DM. This relationship was independent of albuminuria status.In this multicenter study, we evaluated commonly used methods of fixation and 2 methods of joint preparation for first metatarsophalangeal joint fusion, in terms of radiological union and revision rates. Included were 409 consecutive fusions in 385 patients. The overall union rate was 91.4% (34/409). About 29.4% (10/34) of our nonunions were symptomatic. Preoperative hallux valgus showed a statistically significant relation to nonunion (odds ratio [OR] = 9.33, p = .017). Other potential contributing factors like gender (OR 1.9, p = .44), diabetes (OR = 0, p = .99), steroid use (OR = 2.07, p = .44), inflammatory arthritis (OR = 0, p = .99), and smoking (OR = 2.69, p = .34) did not attain statistical significance. Further, the methods of fixation like solid screws (OR = 0, p = .99), plate (OR = 3.6, p = .187), or cannulated screws (OR = 0.09, p = .06) showed no correlation with incidence of nonunion. We compared 2 techniques of joint preparation and found no significant difference in union rates (chi-square = 1.0426, p = .30). Our crude comparison of costs showed the average saving to the trust per year could be 33,442.50£ by choosing screws over plates. To conclude, only hallux valgus had a statistically significant relation to nonunion. All other variables had no significant impact on the union. Solid screw seems to be economically the most viable option and a valid alternative.Persistent symptomatic calcaneonavicular coalition (CNC) and too-long anterior process of the calcaneus (TLAP) are congenital disorders that can benefit from surgical treatment. The arthroscopic technique for CNC and TLAP resection has previously been described. The aim of this prospective study was to describe outcomes following arthroscopic resection of 12 (38.71%) CNC and 19 (61.29%) TLAP cases in 30 consecutive pediatric patients treated between July 2009 and March 2013. There mean age was 12.4 (range 10 to 15) years, and the mean follow-up was 55.2 (range 24 to 79) months. Radiographs, American Orthopaedic Foot and Ankle Society (AOFAS) Ankle-Hindfoot Scores, AOFAS pain scores, and patient satisfaction were assessed. All final postoperative imaging scans revealed complete synostosis resection without recurrence. The mean overall AOFAS Ankle-Hindfoot Score increased from 78.87 (95% confidence interval [CI] 76.74 to 81.01) to 93.06 (95% CI 91.10 to 95.03) (p less then .001). All patients showed pain reduction after surgery; even 1 patient (3.23%) who initially developed complex regional pain syndrome eventually had a successful outcome. The mean AOFAS pain score increased from 23.87 (95% CI 22.05 to 25.69) to 34.84 (95% CI 32.97 to 36.70) (p less then .001). All patients were either satisfied (n = 9 [30%]) or very satisfied (n = 21 [70%]) with the intervention at the final follow-up. Although both arthroscopic CNC and TLAP resection are demanding techniques, they allow for precise coalition resection through a less invasive approach, which may ultimately lead to faster recovery and improved outcomes.