ABSTRACT
AIMS: To estimate the incidence of death and macrovascular complications after a first myocardial infarction for patients with Type 2 diabetes. RESEARCH DESIGN: In a retrospective, incidence cohort study in the Tayside Region of Scotland we studied all patients hospitalized with a diagnosis of first acute myocardial infarction from 1 April 1993 to 31 December 1994. The primary endpoint was time to death. Secondary endpoints were 2-year incidence of hospital admission for angina, myocardial infarction, stroke, heart failure, coronary angiography, coronary artery bypass graft (CABG) and percutaneous transluminal coronary angioplasty (PTCA). RESULTS: The 147 patients with Type 2 diabetes had significantly worse survival with an increase in relative hazard of 67% compared with non-diabetic patients. After adjustment for age, sex, smoking status, prior heart failure, prior angina, delay to hospitalization, site of infarction, drug therapy with aspirin, beta-blockers, streptokinase and hyperlipidaemia and treated hypertension, Type 2 diabetes was still associated with a 40% higher death rate compared with people without diabetes (P < 0.05) There was no significant difference in death rates in those aged over 70 years, but an indication of a trend in younger individuals with a four-fold increase in death rate in those with diabetes aged < 60 years, compared with a rate ratio of 2.6 in those with diabetes aged 61-70 years. CONCLUSIONS: Among hospitalized patients with first acute myocardial infarction, Type 2 diabetes mellitus is consistently associated with increased mortality and increased hospital admission for heart failure. The estimated 4-year survival rate is only 50%. Our results indicate that younger subjects with Type 2 diabetes and acute myocardial infarction are a high-risk group deserving of special study, and support the argument for aggressive targeting of coronary risk factors among patients with Type 2 diabetes.
Subject(s)
Diabetes Mellitus, Type 2/complications , Myocardial Infarction/epidemiology , Aged , Cohort Studies , Female , Humans , Hypertension/complications , Incidence , Male , Middle Aged , Myocardial Infarction/diagnosis , Myocardial Infarction/mortality , Prognosis , Recurrence , Retrospective Studies , Risk Factors , Scotland/epidemiology , Smoking , Survival AnalysisABSTRACT
OBJECTIVE: To examine whether allopurinol is associated with any alteration in mortality and hospitalisations in patients with chronic heart failure (CHF). This hypothesis is based on previous data that a high urate concentration is independently associated with mortality with a risk ratio of 4.23 in CHF. DESIGN: Retrospective cohort study. SETTING: Medicines Monitoring Unit, Ninewells Hospital, Dundee, UK. PATIENTS: 1760 CHF patients divided into four groups: those on no allopurinol, those on long term low dose allopurinol, those on short term low dose allopurinol, and those on long term high dose allopurinol. MAIN OUTCOME MEASURES: Total mortality, cardiovascular mortality, cardiovascular hospitalisations, cardiovascular mortality or hospitalisations. RESULTS: Long term low dose allopurinol was associated with a significant worsening in mortality over those who never received allopurinol (relative risk 2.04, 95% confidence interval (CI) 1.48 to 2.81). This may be because low dose allopurinol is insufficient to negate the adverse effect of a high urate concentration. However, long term high dose (> or = 300 mg/day) allopurinol was associated with a significantly better mortality than longstanding low dose allopurinol (relative risk 0.59, 95% CI 0.37 to 0.95). This may mean that high dose allopurinol can fully negate the adverse effect of urate and return the mortality to normal. CONCLUSIONS: Long term high dose allopurinol may be associated with a better mortality than long term low dose allopurinol in patients with CHF because of a dose related beneficial effect of allopurinol against the well described adverse effect of urate. Further work is required to substantiate or refute this finding.
Subject(s)
Allopurinol/administration & dosage , Cardiac Output, Low/prevention & control , Free Radical Scavengers/administration & dosage , Gout Suppressants/administration & dosage , Aged , Chronic Disease , Cohort Studies , Female , Hospitalization/statistics & numerical data , Humans , Male , Mortality , Proportional Hazards Models , Regression Analysis , Retrospective Studies , Survival Analysis , Treatment OutcomeABSTRACT
AIMS: A study was carried out to compare the visual abilities of prematurely born children with those of matched full term controls. METHODS: The vision of 68 children born at less than 32 weeks' gestation and aged between 5 and 7 1/2 years at the time of testing was compared with that of a control group of children born at full term, and matched for sex and age from due date. RESULTS: The premature children had significantly poorer distance and near visual acuity, contrast sensitivity and stereopsis, and a high incidence of colour vision defects (predominantly tritan type). These differences were associated with the high incidence of ocular pathology experienced by 31 (45%) of the premature children compared with only nine (13%) of the controls. When excluding children with ocular and cerebral pathology, 32 matched pairs of premature and control children remained. The 32 premature children did not differ from their controls in terms of distance and near acuities or stereopsis, but they did have significantly poor contrast sensitivity in both their 'best' and 'worst' eyes. None of the 32 control children had colour vision defects, compared with seven of the matched premature children. CONCLUSION: This adds support to previous speculation that the preterm eye is at risk of subtle visual impairment independent of the occurrence of refractive error, manifest squint, disorders of the fundus and media, and cerebral damage.
Subject(s)
Infant, Premature , Vision Disorders/diagnosis , Cerebral Palsy/complications , Child , Child, Preschool , Color Vision Defects , Contrast Sensitivity , Depth Perception , Eye Diseases/complications , Humans , Infant, Newborn , Vision Disorders/complications , Visual AcuitySubject(s)
Fetus/abnormalities , Kidney/abnormalities , Kidney/diagnostic imaging , Ultrasonography, Prenatal , Female , Humans , PregnancyABSTRACT
Effective care for patients with diabetes and other chronic conditions can be achieved in general practice if goals are set and outcome measured. Clinical audit is a useful method of gathering the necessary information.
Subject(s)
Diabetes Mellitus/therapy , Medical Audit , Diabetes Mellitus/diet therapy , Diabetes Mellitus/drug therapy , Female , Humans , Male , Middle AgedSubject(s)
Automobiles , Restraint, Physical/methods , Child , Child, Preschool , Humans , Infant , Infant, Newborn , Seat BeltsABSTRACT
We report on a 5-month-old female twin who presented with urinary tract infection and was found to have a horseshoe kidney. Her identical twin had a normal renal anatomy. There have been only 2 other reports of a horseshoe kidney in monozygotic twins: in 1 instance both twins were affected, while in the other there was discordance.
Subject(s)
Diseases in Twins , Kidney/abnormalities , Female , Humans , Infant , Pregnancy , Twins, Monozygotic , Urinary Tract Infections/geneticsABSTRACT
Two hundred and thirty six children with untreated lymphoblastic leukaemia were compared for height with the normal population by calculation of their mean standard deviation score. As a group, they proved to be significantly taller (P less than 0.0001), which gives support to the theory that growth hormone or a somatomedin may be involved in the development of the disease.
