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Microalgae are under research focus for the simultaneous production of biomolecules (e.g., carbohydrates, proteins, pigments and lipids) and bioremediation of toxic substances from wastewater. The current study explores the capability of indigenously isolated microalgae (Desmodesmus subspicatus) for the phycoremediation of As(III) and Cr(VI). Variation of biomolecules (carbohydrate, protein, lipid and chlorophyll) was investigated during phycoremediation. D. subspicatus survived up to the toxicity level of 10 mg/L for As(III) and 0.8 mg/L for Cr(VI). A 70% decline in carbohydrate accumulation was observed at 10 mg/L of As(III). An increased content of proteins (+ 28%) and lipids (+ 32%) within the cells was observed while growing in 0.5 and 0.2 mg/L of As(III) and Cr(VI) respectively. A decrease in carbohydrate accumulation was noted with increasing Cr(VI) concentration, and the lowest (- 44%) was recorded at 0.8 mg/L Cr(VI). D. subspicatus showed an excellent maximum removal efficiency for Cr(VI) and As(III) as 77% and 90% respectively.
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Biodegradación Ambiental , Clorofila , Cromo , Microalgas , Clorofila/metabolismo , Microalgas/metabolismo , Cromo/metabolismo , Lípidos/química , Contaminantes Químicos del Agua/metabolismo , Carbohidratos/química , Arsénico/metabolismoRESUMEN
Removing toxic Pb(II) ions from aqueous solution by the peels of citrus reticulate (mandarin orange), a fruit industry waste, presents suitable scale-up possibilities. The Scanning Electron Microscope (SEM) and Brunauer-Emmett-Teller (BET) studies reflected that the mandarin orange peel powder had a porous surface area (32.46 m2g-1), average pore size and pore volume was 38.6 Å and 0.402 cm3g-1, respectively, favorable for binding Pb(II) ions. Fourier-transform infrared spectroscopy (FTIR) showed C-Br stretching, primary alcohol (C-O), phenolic O-H, and carbodimide N = C = N bands primarily helped to bind Pb(II) ions. The study evaluated and optimized the parametric influences of pH, adsorbate and biosorbent concentration, contact time and temperature on the removal efficiency of Pb(II) ions. A maximum of 97.08% Pb(II) was removed from 20 mg L-1 solution when 2.5 g L-1 adsorbent was present. The reaction obeyed the pseudo-second-order kinetic model. The intra-particle diffusion was involved in lead sorption. The Langmuir isotherm model resulted in an adsorption capacity of 23.04 mg g-1. 35.28% Pb(II) was removed in the 3rd adsorption-desorption cycle with 0.4 M HCl. The adsorption process was natural, impulsive and endothermic. The statistical investigation used Multiple Polynomial Regression (MPR) and Genetic Algorithm (GA). The analysis effectively forecasted the percentage removal at the optimized condition.
The results of toxic Pb(II) ion removal from aqueous solution by the peels of citrus reticulate (mandarin orange), a food industry waste, are reported. The maximum Pb(II) adsorption capacity of 23.04 mg/g. This work provides a new way to realize good adsorption capacity of Pb(II) by orange peel and accelerates to utilize for small and medium-sized industries in rural areas of 3rd World Countries.
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Pseudomonas aeruginosa (P. aeruginosa) is a gram-negative biofilm-forming opportunistic human pathogen whose vital mechanism is biofilm formation for better survival. PelA and PelB proteins of the PEL operon are essential for bacterial-synthesized pellicle polysaccharide (PEL), which is a vital structural component of the biofilm. It helps in adherence of biofilm on the surface and maintenance of cell-to-cell interactions and with other matrix components. Here, in-silico molecular docking and simulation studies were performed against PelA and PelB using ten natural bioactive compounds, individually [podocarpic acids, ferruginol, scopadulcic acid B, pisiferic acid, metachromin A, Cytarabine (cytosine arabinoside; Ara-C), ursolic acid, oleanolic acid, maslinic acid, and betulinic acid], those have already been established as anti-infectious compounds. The results obtained from AutoDock and Glide-Schordinger stated that a marine-derived cytosine arabinoside (Ara-C) among the ten compounds binds active sites of PelA and PelB, exhibiting strong binding affinity [Trp224 (hydrogen), Ser219 (polar), Val234 (hydrophobic) for PelA; Leu365 and Glu389 (hydrogen), Gln366 (polar) for PelB] with high negative binding energy - 5.518 kcal/mol and - 6.056 kcal/mol, respectively. The molecular dynamic and simulation studies for 100 ns showed the MMGBSA binding energy scores are - 16.4 kcal/mol (Ara-C with PelA), and - 22.25 kcal/mol (Ara-C with PelB). Further, ADME/T studies indicate the IC50 values of AraC are 6.10 mM for PelA and 18.78 mM for PelB, which is a comparatively very low dose. The zero violation of Lipinski's Rule of Five further established that Ara-C is a good candidate for drug development. Thus, Ara-C could be considered a potent anti-biofilm compound against PEL operon-dependent biofilm formation of P. aeruginosa.
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For the past few years, microbial biofilms have been emerging as a significant threat to the modern healthcare system, and their prevalence and antibiotic resistance threat gradually increase daily among the human population. The biofilm has a remarkable impact in the field of infectious diseases, in particular healthcare-associated infections related to indwelling devices such as catheters, implants, artificial heart valves, and prosthetic joints. Bacterial biofilm potentially adheres to any biotic or abiotic surfaces that give specific shelter to the microbial community, making them less susceptible to many antimicrobial agents and even resistant to the immune cells of animal hosts. Around thirty clinical research reports available in PUBMED have been considered to establish the occurrence of biofilm-forming bacteria showing resistance against several regular antibiotics prescribed against infection by clinicians among Indian patients. After the extensive literature review, our observation exhibits a high predominance of biofilm formation among bacteria such as Escherichia sp., Streptococcus sp., Staphylococcus sp., and Pseudomonas sp., those are the most common biofilm-producing antibiotic-resistant bacteria among Indian patients with urinary tract infections and/or catheter-related infections, respiratory tract infections, dental infections, skin infections, and implant-associated infections. This review demonstrates that biofilm-associated bacterial infections constantly elevate in several pathological conditions along with the enhancement of the multi-drug resistance phenomenon.
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Antibacterianos , Infección Hospitalaria , Animales , Humanos , Antibacterianos/farmacología , Antibacterianos/uso terapéutico , Biopelículas , Bacterias , Farmacorresistencia MicrobianaRESUMEN
Cellulosic aerogels are sustainable, biodegradable, and ultra-light porous materials with three-dimensional networks having high specific surface area. Depending on the source of precursor materials, they are categorized into plant-based aerogel, bacterial cellulosic aerogel. Different types of aerogels are also produced from microcrystalline cellulose (MCC), nanocrystalline cellulose (NCC), cellulose microfibril (CMF) and cellulose nanofibril (CNF). Furthermore, inorganic and organic substances are embedded to produce hybrid aerogel or composite aerogel for the enhancement of its performance in various fields. Mixing, gelation, solvent exchange, and drying (e.g., super critical carbon dioxide or freeze drying) are the basic steps involved in cellulosic aerogel synthesis. Based on the composition of precursors during aerogel synthesis, cellulosic aerogels have broad applications in various fields such as adsorbents, electrodes, sensors, captive deionization materials, catalysts, drug delivery, thermal and sound insulating materials. This review provided consolidated information on: (i) classification of cellulosic aerogels based on the sources of raw materials, (ii) processes involved to produce the cellulosic aerogel, (iii) cellulosic aerogel synthesized from MCC, NCC, CMF and CNF, (iv) nano particle doped cellulosic aerogel, and (v) its application in various field with future perspectives.
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Dióxido de Carbono , Celulosa , Pared Celular , Desecación , Sistemas de Liberación de MedicamentosRESUMEN
Rubber processing generates a large volume of wastewater containing rubber latex residues and chemicals. Remediation of the wastewater needs a cost-effective and environment-friendly treatment method. For this study, Moringa oleifera stem bark and Pseudomonas sp. bacteria were used for adsorption and microbial treatment of the effluent. The adsorbent surface was mostly amorphous with crystallinity index 37.9% and the BET surface area was 6.622 m2/g. FTIR analysis indicated involvement of O-H stretching, ketone α, ß-unsaturated, C-H stretching, carboxylic acid and derivatives O-C stretching functional groups in the adsorption process. The assessment of the above two agents was based on their reduction capabilities of the toxic parameters, such as total suspended and dissolved solids, total solids, biological and chemical oxygen demand, sulphate, ammonium, dissolved oxygen, phosphate, pH, electrical conductivity, turbidity, and oxidation reduction potential from the wastewater. A comparative study of the present work revealed that both the agents were effective in reduction of most of the above parameters below the safe discharge limits. However, the adsorption using Moringa oleifera stem bark was better compared to the biodegradation by Pseudomonas sp. bacteria. The main challenges that typically accompany biodegradation include microbe handling and a lower removal percentage than adsorption.
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Moringa oleifera , Aguas Residuales , Moringa oleifera/química , Goma , Corteza de la Planta , Pseudomonas , AdsorciónRESUMEN
Heavy metal-contaminated water can be effectively treated using adsorbents made from abundantly available biomass. The present investigation was carried out to adsorb Cd(II) from synthetic solution by banana pseudo-stem (BP) and Moringa oleifera stem bark (MB). Adsorption efficiencies of both adsorbents were studied in the batch reactor by conducting experiments to determine the consequences of changes of pH, adsorbent dosages, initial Cd(II) concentrations, incubation time, and temperature. The process parameters were tuned to attain the highest possible removal percentage. The characterization of the adsorbents was performed by utilizing Fourier-transform infrared spectroscopy (FTIR), field emission scanning electron microscopy (FESEM), and energy-dispersive X-ray (EDX) for the fresh and metal-loaded adsorbents. Atomic absorption spectroscopy (AAS) was employed to calculate the amount of Cd(II) in an aqueous solution. The experimental data were entirely consistent with the pseudo-second-order model for BP and MB. The findings of the study illustrated the better adsorption efficiency of BP-derived adsorbent (≈ 99%) at optimum conditions over the MB (≈ 97%), and the corresponding adsorption capacities were 11.98 and 7.04 mg/g, respectively. The 4 (four) well-known isotherm models were attempted both in linear and non-linear forms. BP (R2 =0.995) and MB (R2 =0.994) were found to be best described by the Freundlich isotherm, which was selected based on the highest R2 value. In thermodynamic studies, ΔH and ΔS were calculated for both the adsorbents. Cd(II) adsorption on BP and MB was endothermic, as evidenced by the positive ΔH. Finally, the prediction of the removal percentage was made by the artificial neural network (ANN) modelling. The present work developed regionally derived waste materials which are helpful for small-scale industrial units for their waste management in an economical and sustainable way.
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Moringa , Musa , Contaminantes Químicos del Agua , Adsorción , Cadmio , Corteza de la Planta/química , Contaminantes Químicos del Agua/análisis , Cinética , Redes Neurales de la Computación , Termodinámica , Espectroscopía Infrarroja por Transformada de Fourier , Concentración de Iones de HidrógenoRESUMEN
The use of sustainable, green and biodegradable natural wastes for Cr(VI) detoxification from the contaminated wastewater is considered as a challenging issue. The present research is aimed to assess the effectiveness of seven different natural biomaterials, such as jackfruit leaf, mango leaf, onion peel, garlic peel, bamboo leaf, acid treated rubber leaf and coconut shell powder, for Cr(VI) eradication from aqueous solution by biosorption process. Characterizations were conducted using SEM, BET and FTIR spectroscopy. The effects of operating parameters, viz., pH, initial Cr(VI) ion concentration, adsorbent dosages, contact time and temperature on metal removal efficiency, were studied. The biosorption mechanism was described by the pseudo-second-order model and Langmuir isotherm model. The biosorption process was exothermic, spontaneous and chemical (except garlic peel) in nature. The sequence of adsorption capacity was mango leaf > jackfruit leaf > acid treated rubber leaf > onion peel > bamboo leaf > garlic peel > coconut shell with maximum Langmuir adsorption capacity of 35.7 mg g-1 for mango leaf. The treated effluent can be reused. Desorption study suggested effective reuse of the adsorbents up to three cycles, and safe disposal method of the used adsorbents suggested biodegradability and sustainability of the process by reapplication of the spent adsorbent and ultimately leading towards zero wastages. The performances of the adsorbents were verified with wastewater from electroplating industry. The scale-up study reported for industrial applications. ANN modelling using multilayer perception with gradient descent (GD) and Levenberg-Marquart (LM) algorithm had been successfully used for prediction of Cr(VI) removal efficiency. The study explores the undiscovered potential of the natural waste materials for sustainable existence of small and medium sector industries, especially in the third world countries by protecting the environment by eco-innovation.
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Cromo/análisis , Modelos Teóricos , Residuos Sólidos , Contaminantes Químicos del Agua/análisis , Purificación del Agua/métodos , Adsorción , Biodegradación Ambiental , Ajo/química , Cinética , Hojas de la Planta/química , Soluciones , Aguas Residuales/químicaRESUMEN
Multiple sclerosis (MS) is an inflammatory demyelinating disease of the human central nervous system (CNS). Neurotropic demyelinating strain of MHV (MHV-A59 or its isogenic recombinant strain RSA59) induces MS-like disease in mice mediated by microglia, along with a small population of T cells. The mechanism of demyelination is at least in part due to microglia-mediated myelin stripping, with some direct axonal injury. Immunization with myelin oligodendrocyte glycoprotein (MOG) induces experimental autoimmune encephalomyelitis (EAE), a mainly CD4(+) T-cell-mediated disease, although CD8(+) T cells may play a significant role in demyelination. It is possible that both autoimmune and nonimmune mechanisms such as direct viral toxicity may induce MS. Our study directly compares CNS pathology in autoimmune and viral-induced MS models. Mice with viral-induced and EAE demyelinating diseases demonstrated similar patterns and distributions of demyelination that accumulated over the course of the disease. However, significant differences in acute inflammation were noted. Inflammation was restricted mainly to white matter at all times in EAE, whereas inflammation initially largely involved gray matter in acute MHV-induced disease and then is subsequently localized only in white matter in the chronic disease phase. The presence of dual mechanisms of demyelination may be responsible for the failure of immunosuppression to promote long-term remission in many MS patients.
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Encefalomielitis Autoinmune Experimental/inmunología , Encefalomielitis Autoinmune Experimental/virología , Inflamación/patología , Esclerosis Múltiple/inmunología , Esclerosis Múltiple/virología , Virus de la Hepatitis Murina/fisiología , Animales , Encéfalo/patología , Encéfalo/virología , Enfermedades Desmielinizantes/complicaciones , Enfermedades Desmielinizantes/patología , Modelos Animales de Enfermedad , Encefalomielitis Autoinmune Experimental/patología , Femenino , Humanos , Inflamación/complicaciones , Ratones , Ratones Endogámicos C57BL , Esclerosis Múltiple/complicaciones , Esclerosis Múltiple/patología , Virus de la Hepatitis Murina/patogenicidad , Médula Espinal/patología , Virulencia , Replicación ViralRESUMEN
Microglia are the resident macrophage-like populations in the central nervous system (CNS). Microglia remain quiescent, unable to perform effector and antigen presentation (APC) functions until activated by injury or infection, and have been suggested to represent the first line of defence for the CNS. Previous studies demonstrated that microglia can be persistently infected by neurotropic mouse hepatitis virus (MHV) which causes meningoencephalitis, myelitis with subsequent axonal loss, and demyelination and serve as a virus-induced model of human neurological disease multiple sclerosis (MS). Current studies revealed that MHV infection is associated with the pronounced activation of microglia during acute inflammation, as evidenced by characteristic changes in cellular morphology and increased expression of microglia-specific proteins, Iba1 (ionized calcium-binding adaptor molecule 1), which is a macrophage/microglia-specific novel calcium-binding protein and involved in membrane ruffling and phagocytosis. During chronic inflammation (day 30 postinfection), microglia were still present within areas of demyelination. Experiments performed in ex vivo spinal cord slice culture and in vitro neonatal microglial culture confirmed direct microglial infection. Our results suggest that MHV can directly infect and activate microglia during acute inflammation, which in turn during chronic inflammation stage causes phagocytosis of myelin sheath leading to chronic inflammatory demyelination.
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Sistema Nervioso Central/patología , Enfermedades Desmielinizantes/patología , Meningoencefalitis/patología , Microglía/patología , Vaina de Mielina/patología , Mielitis Transversa/patología , Animales , Proteínas de Unión al Calcio/genética , Proteínas de Unión al Calcio/inmunología , Sistema Nervioso Central/inmunología , Sistema Nervioso Central/virología , Enfermedades Desmielinizantes/inmunología , Enfermedades Desmielinizantes/virología , Modelos Animales de Enfermedad , Expresión Génica , Humanos , Meningoencefalitis/inmunología , Meningoencefalitis/virología , Ratones , Ratones Endogámicos C57BL , Proteínas de Microfilamentos/genética , Proteínas de Microfilamentos/inmunología , Microglía/inmunología , Microglía/virología , Esclerosis Múltiple/inmunología , Esclerosis Múltiple/patología , Esclerosis Múltiple/virología , Virus de la Hepatitis Murina/inmunología , Vaina de Mielina/inmunología , Vaina de Mielina/virología , Mielitis Transversa/inmunología , Mielitis Transversa/virología , Médula Espinal/inmunología , Médula Espinal/patología , Médula Espinal/virología , Técnicas de Cultivo de TejidosRESUMEN
Spreading of different types of fluid on solids under an impressed force is an interesting problem. Here we study spreading of four fluids, having different hydrophilicity and viscosity on two substrates - glass and perspex, under an external force. The area of contact of fluid and solid is video-photographed and its increase with time is measured. The results for different external forces can be scaled onto a common curve. We try to explain the nature of this curve on the basis of existing theoretical treatment where either the no-slip condition is used or slip between fluid and substrate is introduced. We find that of the eight cases under study, in five cases quantitative agreement is obtained using a positive slip coefficient. The remaining three can be explained with a negative slip coefficient, equivalent to a sticking effect.
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Crack patterns in desiccating clay suspensions are drastically altered by the addition of polymers. In this paper we report a systematic study of the effect of varying the composition of a clay-polymer composite on the formation of crack patterns. Experiments as well as computer simulations have been done. Details of the morphology and fractal dimension of the experimental patterns are observed and the simulation is done on a two-dimensional spring network model. We find a transition from a completely fragmented fractal pattern at high clay content to a continuous film at about 50% clay content. The results of the simulation are in good qualitative agreement with the experiments. The study is expected to be of importance for clay-polymer composites. These can be designed to give improved mechanical and electrical properties for practical applications.
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We report a computer simulation study of viscous fingering patterns in a lifting Hele-Shaw cell with grooves. Here circular or square grooves concentric to the plates are etched on the lower plate. Experiments show that the presence of such grooves affect formation of viscous fingers quite strongly. We report a simulated pressure map generated in such grooved cells, when the two plates are separated with a constant force and compare the patterns with experiments. Variation in the simulated patterns for different fluid viscosity and lifting force is also studied.
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BACKGROUND: Patients beginning treatment with lipid-modifying drugs should have their serum lipid levels monitored and, if necessary, their drug therapy adjusted to reach and maintain their treatment goals. Patients with coronary heart disease or diabetes are at high risk of coronary events and are particularly important target groups for monitoring and dose adjustment of lipid-modifying drug therapy. OBJECTIVE: to determine from administrative claims the rates of lipid testing, treatment with low-density lipoprotein cholesterol (LDL-C)-lowering drug therapy, and LDL-C goal attainment defined as LDL-C < 100 mg per DL in the time period after a new diagnosis of coronary heart disease or diabetes among patients who had not previously received lipid-modifying drug therapy. METHODS: an index date was defined by a new diagnosis of coronary heart disease or diabetes between January 1, 1999 and December 31, 2000, preceded by a 12-month pre-index period without lipid-modifying drug treatment in a commercial health maintenance organization (HMO) database for the southeastern united states. coronary heart disease (CHD) was defined by a diagnosis code for myocardial infarction (International Classification of Diseases, Ninth Edition, Clinical Modification [ICD-9-CM] code 410.xx) or angina/ischemic heart disease (411.xx), or a procedural code for angioplasty (icd-9-cM 36.1x-36.3x; Current Procedural Terminology [CPT] 92980-92984, 92995-92996) or coronary artery bypass graft (icd-9-cM 36.01, 36.02, 36.05, 36.09; CPT 33510-33545). diabetes was identified either by an icd-9-cM diagnosis code 250.xx or a pharmacy claim for an antihyperglycemic medication. Patients were followed in the post-index period until loss of eligibility or a maximum of 42 months (mean = 26 months, range=12-42 months). We calculated the proportion of patients with lipids treated and at LDL-C goal (defined as V < 100 mg per DL) in months 1-6 after the index date. among those not at goal in months 1-6, we estimated the proportion treated to goal in months 7-12 and in month 7 to the end of the post-index period. Logistic regression was used to estimate the odds of goal attainment in months 7-12 and in month 7 to the end of the post-index period among patients who were not at goal in months 1-6. RESULTS: Laboratory lipid values were available for 4,676 (40.4%) of 11,552 patients who had not previously received lipid-modifying drug therapy in months 1-6 after the index date, of whom 72.7% (n = 3,400) had an LDL-C > or =100 mg per DL (63.5% for CHD and 76.7% for diabetes). Of 1,245 patients tested and treated with lipid-modifying therapy in months 1-6, 485 (39.0%) were at LDL-C goal in months 1-6 (48.2% of CHD and 28.8% of diabetes patients), and 760 (61.0%) were not at LDL-C goal (51.8% of those with CHD and 71.2% of those with diabetes). Goal attainment (cumulative) among those treated improved to 50.1% in months 7-12 and 58.4% in month 7 to the end of the post-index period. Patients not attaining goal in months 1-6, and who continued treatment in months 7-12 and month 13 to the end of the post-index period, had a 48.8% (95% confidence interval [CI], 44.0%-53.6%) predicted probability of attaining their goals. The odds of goal attainment in month 7 to the end of post-index period (among those not at goal in months 1-6) were greater for (a) age e 65 years (odds ratio [or] = 2.45, 95% CI, 1.62-3.72), (b) history of hypertension (or = 1.91, 95% CI, 1.20-3.03), (c) greater number of distinct medications (or = 1.07, 95% CI, 1.01-1.14 per additional medication), (d) months of observation post-index (or = 1.04, 95% CI = 1.01-1.08 per additional month), and (e) months supply of lipid-modifying medication (or = 1.04, 95% CI, 1.01-1.07 per additional month), and were lower for LDL-C > or = 130 mg per DL in months 1-6 (or = 0.53, 95% CI, 0.35-0.82) and a history of dyslipidemia (or = 0.54, 95% CI, 0.35-0.83). The odds of LDL-C goal attainment were not affected by diagnosis (CHD vs. diabetes), gender, statin titration (34% of patients), lipid-modifying drug switching (39% of patients), or treatment with a high-potency LDL-C-lowering drug dosage (one of sufficient strength to reduce LDL-C by > 40%). CONCLUSION: of patients receiving lipid testing and lipid drug treatment in the 6 months after an initial diagnosis of CHD or diabetes, 61% were not at the LDL-C goal of < 100 mg per DL. Among those not at LDL-C goal in the first 6 months of treatment, only about half who continued treatment subsequently attained their LDL-C goal, despite statin titration or switching of their lipid-modifying drug therapy.
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LDL-Colesterol/sangre , Enfermedad Coronaria/sangre , Diabetes Mellitus Tipo 2/sangre , Sistemas Prepagos de Salud/estadística & datos numéricos , Adulto , Estudios de Cohortes , Enfermedad Coronaria/diagnóstico , Enfermedad Coronaria/tratamiento farmacológico , Bases de Datos Factuales/estadística & datos numéricos , Diabetes Mellitus Tipo 2/diagnóstico , Diabetes Mellitus Tipo 2/tratamiento farmacológico , Femenino , Sistemas Prepagos de Salud/organización & administración , Humanos , Hipolipemiantes/uso terapéutico , Clasificación Internacional de Enfermedades/normas , Masculino , Sistemas de Registros Médicos Computarizados/estadística & datos numéricos , Persona de Mediana Edad , Análisis Multivariante , Oportunidad Relativa , Reproducibilidad de los Resultados , Estudios Retrospectivos , Factores de Tiempo , Resultado del TratamientoRESUMEN
BACKGROUND: In 2004, the Coordinating Committee of the National Cholesterol Education Program issued an update to the Adult Treatment Panel III guidelines on cholesterol management (the Update). Our objectives were to compare the proportion of elderly patients receiving intensive or minimal-guideline lipid-lowering therapy and the proportions meeting low-density lipoprotein cholesterol (LDL-C) goals before and after the update. METHODS: We used dispense records from Kaiser Permanente Northwest (Portland, OR) to identify elderly patients who received statin therapy in 2003 (n = 14425) and 2005 (n = 19422) and laboratory records to assess LDL-C goal attainment. RESULTS: Among new statin initiators, 85.4% of very-high-risk patients received minimal-guideline therapy in 2005, compared with 65.3% (P < .0001) in 2003. Of all new initiators, <1% received very aggressive therapy in either year (0.4% vs 0.3%, P = .315). Overall, 77.7% and 59.0% of ongoing users in 2005 and 2003, respectively, received minimal-guideline therapy (P < .0001). Low-density lipoprotein cholesterol goal attainment did not differ between 2003 and 2005 continuing statin users. Among very-high-risk patients who initiated statin treatment, a significantly greater proportion of patients in 2005 versus 2003 attained the optional goal of <70 mg/dL (45.5% vs 34.4% P = .014). However, there was no significant difference in the proportion attaining <100 mg/dL (77.8% vs 81.8%, P = .281). CONCLUSION: After the Update, more elderly patients were receiving intensive or minimal-guideline statin therapy. Low-density lipoprotein cholesterol goal attainment was isolated and appeared to occur by shifting already well-controlled patients to lower LDL-C levels. Although these findings may translate into less overall coronary heart disease risk, more aggressive lipid-lowering therapy would likely further reduce risk.
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LDL-Colesterol/sangre , Hipercolesterolemia/sangre , Hipercolesterolemia/tratamiento farmacológico , Hipolipemiantes/uso terapéutico , Anciano , Femenino , Humanos , MasculinoRESUMEN
PURPOSE OF REVIEW: To review recent trials and reassess cardiovascular risk in people with diabetes. RECENT FINDINGS: Recent clinical trials have tended to focus on lower-risk participants with diabetes who have had event rates considerably lower than participants in the early lipid trials. Statin studies have generally shown benefit in those without cardiovascular disease and at lower levels of low-density lipoprotein cholesterol. Results of fibrate and glitazone studies have been mixed; the question of benefit among statin-treated patients remains unanswered. Investigators failed to confirm the benefits of glucose control observed in the original Diabetes Mellitus, Insulin Glucose Infusion in Acute Myocardial Infarction study possibly due to study design issues. Epidemiologic follow-up of the Diabetes Control and Complications Trial showed sustained benefit of glucose control. A number of studies have shown the benefit of inpatient control of blood glucose. We await the results of ongoing blood pressure trials and other ongoing trials, which should provide much new information. A conceptual model of cardiovascular risk for people with diabetes mellitus based on the UK Prospective Diabetes Study outcomes model is discussed. SUMMARY: The majority of adults with diabetes have a substantially greater risk compared with those without diabetes and a small percentage has very high risk. A minority of individuals may have considerably lower 10-year risk.
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Glucemia/análisis , Enfermedades Cardiovasculares/etiología , Complicaciones de la Diabetes/complicaciones , Enfermedades Cardiovasculares/sangre , Diabetes Mellitus/sangre , Diabetes Mellitus/prevención & control , Humanos , Hipertensión/sangre , Hipertensión/etiología , Lípidos/sangre , Factores de RiesgoRESUMEN
OBJECTIVE: To examine trends in lipid management (cholesterol testing, treatment, and goal attainment) among patients with diabetes and to analyze the factors associated with initiation of lipid-lowering therapy. METHODS: We conducted a longitudinal, retrospective study of patients with diabetes identified during a 24-month baseline period (January 1, 1995, to December 31, 1996) and for whom follow-up was continued for 5 years (1997 to 2001). Generalized estimating equations were used to test for time trend effects in lipid management. We modeled the days from baseline to the first lipid-lowering prescription fill date with a multivariate Cox proportional hazards regression model. RESULTS: Rates of lipid testing, treatment, and goal attainment significantly improved (P<0.001) during the 5-year study period: from 37% to 67% for lipid testing; from 19% to 41% for treatment with a lipid-lowering agent; from 22% to 37% for achievement of low-density lipoprotein cholesterol (LDL-C) levels < 100 mg/dL; and from 54% to 75% for achievement of LDL-C levels < 130 mg/dL. The relative likelihood (hazard rate) of treatment with lipid-lowering agents was greater for patients with LDL-C levels > or = 100 mg/dL relative to patients with LDL-C concentrations < 100 mg/dL. Treatment with lipid-lowering agents of patients with a cardiovascular event during follow-up was approximately 3 times more likely relative to those without such an event. CONCLUSION: We found that rates of lipid testing, treatment, and goal attainment improved significantly between 1997 and 2001. Nevertheless, ample room for improvement of these rates continues to exist. Particular attention may be warranted to ensure that patients with diabetes receive lipid-lowering agents not only after a cardiovascular event but also before such an event occurs.
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Complicaciones de la Diabetes/sangre , Diabetes Mellitus/sangre , Hiperlipidemias/terapia , Lípidos/sangre , Adulto , Anciano , Anciano de 80 o más Años , HDL-Colesterol/sangre , LDL-Colesterol/sangre , Estudios de Cohortes , Diabetes Mellitus/terapia , Femenino , Estudios de Seguimiento , Hemoglobina Glucada/análisis , Humanos , Hiperlipidemias/complicaciones , Hipolipemiantes/uso terapéutico , Masculino , Persona de Mediana Edad , Estudios Retrospectivos , Factores de Riesgo , Gestión de Riesgos , Triglicéridos/sangreRESUMEN
OBJECTIVE: To describe current approaches used by physicians to address macrovascular risk factors among patients with diabetes and their effect on glycosylated hemoglobin (HbA1c), blood pressure, and cholesterol (low-density lipoprotein cholesterol [LDL-C]) goal attainment. METHODS: Newly referred or diagnosed patients with diabetes (N = 1,808) under the care of 133 community physicians were enrolled in a 12-month prospective multi-center observational study. The invited physicians treat a large number of patients with diabetes and included endocrinologists, internists, and primary care physicians. Patient and physician characteristics, physician ranking of treatment strategy priority, and patient ranking of diabetes-related complications of greatest concern were recorded at enrollment. Follow-up treatment rates and goal attainment rates for glucose (HbA1c <7%), cholesterol (LDL-C <100 mg/dL), and blood pressure (less than 130/80 mm Hg) were examined, both overall and for the most frequently occurring treatment strategies. RESULTS: After evaluating the metabolic profiles of patients enrolled in the study, physicians assigned the highest treatment priority to glucose control for 67.6% of patients. Treatment rates during the 12-month follow-up were highest for glycemic control (87.2%), followed by blood pressure management (77.9%), and lipid control (63.9%). Among treated patients, goal attainment for HbA1c, LDL-C, and blood pressure was 57.6%, 47.7%, and 22.8%, respectively. Regardless of treatment strategy, follow-up goal attainment was the highest for HbA1c (54.8% to 72.3%), followed by LDL-C (41.7% to 48.4%), and lowest for blood pressure (12.0% to 37.1%). CONCLUSION: These findings suggest the need for strategies that emphasize combined glucose, blood pressure, and cholesterol treatment in order to achieve more effective control of microvascular and macrovascular risk factors among patients with diabetes.
Asunto(s)
Angiopatías Diabéticas/epidemiología , Angiopatías Diabéticas/terapia , Adulto , Anciano , Anciano de 80 o más Años , Glucemia/metabolismo , Presión Sanguínea/fisiología , HDL-Colesterol/sangre , LDL-Colesterol/sangre , Recolección de Datos , Femenino , Hemoglobina Glucada/metabolismo , Humanos , Masculino , Persona de Mediana Edad , Estudios Prospectivos , Factores de RiesgoRESUMEN
This retrospective study examined lipid-lowering therapy treatment rates from 2000 to 2001 using the Ingenix LabRx Database. Patients with multiple risk factors without coronary heart disease were identified based on the presence of >/=2 of the following: men >/=45 years, women >/=55 years, hypertension, high-density lipoprotein cholesterol <40 mg/dl, total cholesterol >/=200 mg/dl, or obesity. Lipid treatment rates were estimated among those needing therapy (defined as low-density lipoprotein cholesterol >/=130 mg/dl or currently receiving lipid-lowering therapy). The overall lipid-lowering therapy treatment rate was 38% and the estimated lipid treatment gap (percent needing treatment who were not receiving it) was 62%.
Asunto(s)
Anticolesterolemiantes/uso terapéutico , Enfermedad Coronaria/prevención & control , Hipercolesterolemia/tratamiento farmacológico , LDL-Colesterol/sangre , Enfermedad Coronaria/complicaciones , Femenino , Humanos , Hipercolesterolemia/complicaciones , Masculino , Persona de Mediana Edad , Estudios Retrospectivos , Factores de RiesgoRESUMEN
OBJECTIVE: To examine the direct costs of care before and after onset of end-stage renal disease (ESRD) for patients with and without diabetes based on analyses of retrospective healthcare claims data. RESEARCH DESIGN AND METHODS: Patients with onset of ESRD between January 1998 though June 2002 were identified based on use of dialysis, renal transplantation, or other ESRD-related services. Continuous health plan enrollment > or =12 months before and > or =1 month after ESRD onset was required. The costs calculated include both observed and adjusted estimates; the latter were calculated using generalized linear models, controlling for demographic and clinical characteristics, "onset" period, and duration of follow-up. Analyses focus on the diabetic ESRD patient and include a comparison with ESRD patients without diabetes. RESULTS: The study included 2,020 patients with diabetes and 2,170 without diabetes; 63% of patients were >50 years of age. Average costs were relatively stable before ESRD ($1,535 to $4,357 for diabetes, $1,082 to $2,447 for no diabetes) but more than doubled in the month preceding onset ($9,152 and $8,211, respectively). Postonset, average monthly per-patient costs escalated sharply in the 1st month ($26,507 and $26,789), declined steadily through month 6, and remained flat but elevated thereafter. Adjusted annual costs per patient pre- and postonset of ESRD were significantly higher for diabetes (P <0.0001); annual costs were 69% ($38,041 vs. $22,538) and 79% ($96,014 vs. $53,653) higher pre- and postonset, respectively. CONCLUSIONS: The economic burden of ESRD in the year after onset is substantial, particularly among patients with diabetes.