Does an HbA1c level of 7% remain an appropriate goal?
The effect of glycemic control on preventing adverse cardiovascular events has been difficult to demonstrate, possibly because such effects are limited to particular patient subgroups.
To determine whether achieving glycosylated hemoglobin (HbA1c) targets of 7% versus 6.5% had differential effects by comorbidity, industry-sponsored researchers studied 2613 Italian patients with type 2 diabetes who received care from general practitioners or in diabetes clinics. Comorbidity was measured by questionnaire and was dichotomized at a level that was associated with excess mortality. Comorbidities included heart disease, lung disease, arthritis, genitourinary disease, vision loss, adverse gastrointestinal conditions, and foot disease.
Thursday 28 January 2010
More Evidence Against Too-Intensive Glucose Control in Type 2 Diabetes
The most intensive glucose control is associated with increased risk for death, according to a retrospective cohort study published online in the Lancet.
Using a U.K. general practice database, researchers identified two diabetic cohorts together comprising some 48,000 patients whose treatments had been intensified. One cohort started treatment with oral glucose-lowering monotherapy and switched to a combination therapy using a sulfonylurea plus metformin. The other cohort switched from oral agents alone to insulin with or without oral agents.
Using a U.K. general practice database, researchers identified two diabetic cohorts together comprising some 48,000 patients whose treatments had been intensified. One cohort started treatment with oral glucose-lowering monotherapy and switched to a combination therapy using a sulfonylurea plus metformin. The other cohort switched from oral agents alone to insulin with or without oral agents.
Sunday 24 January 2010
Friday 22 January 2010
Should Physicians Be 'Punished' For Not Washing Their Hands?
(original article - Medscape : http://boards.medscape.com/forums?128@659.WQ45aiaDlWk@.29f8f873!comment=1
by Leslie Kane, Other, 10:10AM Jan 14, 2010
Hospitals and healthcare organizations have made it a major goal to get physicians (and other health workers) to wash their hands more frequently, in order to prevent cross-contamination. While there are pockets of success, most efforts have been as useful as warning teenagers to put down the cell phone while driving.
by Leslie Kane, Other, 10:10AM Jan 14, 2010
Hospitals and healthcare organizations have made it a major goal to get physicians (and other health workers) to wash their hands more frequently, in order to prevent cross-contamination. While there are pockets of success, most efforts have been as useful as warning teenagers to put down the cell phone while driving.
Wednesday 13 January 2010
Interesting Article : Combined Antiplatelet and Anticoagulant Drugs Raise Bleeding Risk
Summary and Comment
Combined Antiplatelet and Anticoagulant Drugs Raise Bleeding Risk
Use of dual or triple therapy requires caution.
Aspirin and clopidogrel are recommended for patients after acute myocardial infarction (AMI), and many AMI patients also have indications for a vitamin K antagonist. But combining these drugs can elevate risk for bleeding, which in turn can lead to morbidity and mortality.
Combined Antiplatelet and Anticoagulant Drugs Raise Bleeding Risk
Use of dual or triple therapy requires caution.
Aspirin and clopidogrel are recommended for patients after acute myocardial infarction (AMI), and many AMI patients also have indications for a vitamin K antagonist. But combining these drugs can elevate risk for bleeding, which in turn can lead to morbidity and mortality.
Tuesday 12 January 2010
KMC Consultant In the Media : Dr Wan (11.01.2010)
Utusan Malaysia (Page:12) : Forum
Berita Harian - (Page 28) : Surat & E-mel
Thursday 7 January 2010
Interesting Article : Recommendations for Prescribing NSAIDs
December 28, 2009 — A review article published in the December 15 issue of the American Family Physician offers recommendations for prescribing nonsteroidal anti-inflammatory drugs (NSAIDs) in the primary care setting.
"...NSAIDs are commonly used to treat inflammation, pain, and fever by decreasing prostaglandin synthesis through blockage of the cyclooxygenase (COX) enzyme," write Amanda Risser, MD, MPH, from Oregon Health and Science University in Portland, and colleagues. "The two major isoforms of COX (COX-1 and COX-2) are inhibited by nonselective NSAIDs. COX-2 is also inhibited by selective NSAIDs. All nonselective NSAIDs inhibit platelet aggregation through inhibition of COX-1 and the thromboxane A2 (TXA2) pathway."
"...NSAIDs are commonly used to treat inflammation, pain, and fever by decreasing prostaglandin synthesis through blockage of the cyclooxygenase (COX) enzyme," write Amanda Risser, MD, MPH, from Oregon Health and Science University in Portland, and colleagues. "The two major isoforms of COX (COX-1 and COX-2) are inhibited by nonselective NSAIDs. COX-2 is also inhibited by selective NSAIDs. All nonselective NSAIDs inhibit platelet aggregation through inhibition of COX-1 and the thromboxane A2 (TXA2) pathway."
Interesting Article : Smoking Cessation Associated with Short-Term Increase in Diabetes Risk
Adults who quit smoking face increased risk for type 2 diabetes during the first several years after quitting, according to an Annals of Internal Medicine study.
Researchers followed nearly 11,000 middle-aged adults for roughly 9 years, during which about 12% developed diabetes. Compared with adults who never smoked, those who continued smoking during follow-up had a roughly 30% elevated risk for diabetes, while those who quit smoking by year 3 had almost a 75% increase in risk. The elevated risk among these new quitters seemed to be mediated by adverse metabolic changes, including weight gain and systemic inflammation.
Researchers followed nearly 11,000 middle-aged adults for roughly 9 years, during which about 12% developed diabetes. Compared with adults who never smoked, those who continued smoking during follow-up had a roughly 30% elevated risk for diabetes, while those who quit smoking by year 3 had almost a 75% increase in risk. The elevated risk among these new quitters seemed to be mediated by adverse metabolic changes, including weight gain and systemic inflammation.
Tuesday 5 January 2010
MEC Talk - January 2010 : Dr Chua May Wah
Speaker
Dr Chua May Wah (Consultant Paediatrician)
Topic
Premature Babies
Date
Thursday : 14 January 2010 (8.30 am - 9.30 am)
Location
Seminar Room, Level 8, Kedah Medical Centre
Saturday 2 January 2010
MEC KMC List of Activities for 2009
The list of activities conducted by the Medical Education Committee for the Year 2009 can be accessed at these addresses :
We would like to take this opportunity to thank all the consultants and members of the staff in KMC for their contributions and hard work. Hopefully we will be able to improve on our performance further this year.
Thank you.
MEC KMC (2009-2010)
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