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Vuorlaakso M, Karèn V, Kiiski J, Lahtela J, Kaartinen I. Multidisciplinary management of diabetic foot infection associated with improved 8-year overall survival. J Diabetes Complications 2024; 38:108719. [PMID: 38574694 DOI: 10.1016/j.jdiacomp.2024.108719] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2023] [Revised: 02/05/2024] [Accepted: 02/29/2024] [Indexed: 04/06/2024]
Abstract
AIMS Diabetic foot syndrome is a global challenge best managed through multidisciplinary collaboration. This study aimed to investigate the effect of a systematic multidisciplinary team (MDT) on the overall survival and major amputation-free survival of hospitalized patients with diabetic foot infection (DFI). METHODS This retrospective cohort study was conducted at Tampere University Hospital. Cohorts of hospitalized patients with DFI before and after the initiation of multidisciplinary wound ward were compared after an 8-year follow-up. RESULTS Kaplan-Meier analysis revealed significantly higher overall survival in the post-MDT cohort (37.8 % vs 22.6 %, p < 0.05) in 8-year follow-up. Similarly, major amputation-free survival was superior in this cohort (31.8 % vs 16.9 %, p < 0.05). Additionally, early major amputation was associated with inferior overall survival (35.1 % vs 12.0 %, p < 0.05). In a multivariable Cox-regression analysis cohort (hazard ratio [HR] 1.38, 95 % confidence interval [CI95%] 1.01-1.87), early amputation (HR 1.64, CI95% 1.14-2.34) and diagnosed peripheral artery disease (HR 2.23, CI95% 1.61-3.09), congestive heart failure (HR 2.13, CI95% 1.47-3.08), or moderate kidney disease (HR 1.95, CI95% 1.34-2.84) were identified as significant risk factors affecting overall survival. CONCLUSIONS After systematic MDT approach we found improved long-term overall and major amputation-free survival. Multidisciplinary approach is therefore highly recommended for managing patients hospitalized for DFI.
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Affiliation(s)
- Miska Vuorlaakso
- Department of Musculoskeletal Surgery and Diseases, Clinic of Plastic and Reconstructive Surgery, Tampere University Hospital, Pirkanmaa Hospital District, PO Box 2000, FI-33521 Tampere, Finland.
| | - Verna Karèn
- Department of Musculoskeletal Surgery and Diseases, Clinic of Plastic and Reconstructive Surgery, Tampere University Hospital, Pirkanmaa Hospital District, PO Box 2000, FI-33521 Tampere, Finland.
| | - Juha Kiiski
- Department of Musculoskeletal Surgery and Diseases, Clinic of Plastic and Reconstructive Surgery, Tampere University Hospital, Pirkanmaa Hospital District, PO Box 2000, FI-33521 Tampere, Finland.
| | - Jorma Lahtela
- Department of Internal Medicine, Tampere University Hospital, Pirkanmaa Hospital District, PO Box 2000, FI-33521 Tampere, Finland.
| | - Ilkka Kaartinen
- Department of Musculoskeletal Surgery and Diseases, Clinic of Plastic and Reconstructive Surgery, Tampere University Hospital, Pirkanmaa Hospital District, PO Box 2000, FI-33521 Tampere, Finland.
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Saarinen HJ, Lahtela J, Mähönen P, Palomäki A. The association between inflammation, arterial stiffness, oxidized LDL and cardiovascular disease in Finnish men with metabolic syndrome - a 15-year follow-up study. BMC Cardiovasc Disord 2024; 24:162. [PMID: 38491429 PMCID: PMC10941448 DOI: 10.1186/s12872-024-03818-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2024] [Accepted: 02/27/2024] [Indexed: 03/18/2024] Open
Abstract
BACKGROUND All-cause mortality and cardiovascular disease are increased in subjects with metabolic syndrome (MetS). Risk scores are used to predict individual risk of heart disease. We performed a long-term follow-up study to investigate whether risk scores and cardiovascular risk factors such as arterial stiffness, high-sensitive C-reactive protein (hs-CRP) and oxidized LDL (OxLDL) can be used to predict cardiovascular events in Finnish men with MetS. METHODS After baseline measurements we followed 105 Finnish men aged 30 to 65 years with MetS for a mean period of 16.4 years. The primary outcome of the study was a composite of myocardial infarction, stroke, symptomatic vascular disease diagnosed with invasive angiography, coronary or peripheral revascularization, amputation due to peripheral vascular disease, cardiovascular death and non-cardiovascular death. The endpoints were retrieved from electronic medical records. RESULTS The number of acute myocardial infarctions and strokes during the first 10 years was lower than estimated by FINRISK score but SCORE predicted cardiovascular death correctly. During the whole follow-up period, 27 of 105 participants (25.8%) had 30 endpoint events. The incidence of the primary composite outcome was significantly lower in subjects with hs-CRP < 1.0 mg/L than in subjects with hs-CRP ≥ 1.0 mg/L (6 of 41 subjects [14.6%] vs. 21 of 64 subjects [32.8%]; p = 0.036). The incidence of the primary composite outcome was higher among subjects with large artery elasticity classified as borderline compared to subjects with normal large artery elasticity (5 of 10 subjects [50%] vs. 22 of 93 subjects [24%]; p = 0.05). There was no difference in the incidence of primary composite outcome in groups with different degrees of small artery elasticity or different level of oxLDL. CONCLUSIONS Men with MetS who had hs-CRP ≥ 1.0 mg/L had higher risk for CVD and all-cause mortality than those with hs-CRP of < 1.0 mg/L. This also applies to subjects with borderline decreased large artery elasticity. The amount of OxLDL had no predictive value on the incidence of CVD and all-cause mortality. Men with MetS participating in the Hämeenlinna Metabolic Syndrome Research Program without lifestyle or drug intervention had better outcome for myocardial infarction or stroke than estimated by the FINRISK score. TRIAL REGISTRATION ClinicalTrials.gov NCT01119404 retrospectively registered 07/05/2010.
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Affiliation(s)
| | - Jorma Lahtela
- Tampere University Central Hospital, Teiskontie 35, Tampere, FI-33521, Finland
| | - Päivi Mähönen
- Vita Laboratories, Laivakatu 5 F, Helsinki, FI-00150, Finland
- Department of Bacteriology & Immunology, University of Helsinki, Yliopistonkatu 4, Helsinki, FI-00100, Finland
| | - Ari Palomäki
- Department of Emergency Medicine, Kanta-Häme Central Hospital, Ahvenistontie 20, Hämeenlinna, FI-13530, Finland
- Cardiometabolic Unit, Linnan Klinikka, Raatihuoneenkatu 10, Hämeenlinna, FI-13100, Finland
- Faculty of Medicine and Health Technology, Tampere University, Tampereen Yliopisto, FI-33014, Finland
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Sola T, Pimiä E, Lahti E, Lahtela J, Jehkonen M. Type 2 diabetes and cognitive performance in middle age: a cross-sectional study. J Clin Exp Neuropsychol 2023; 45:423-432. [PMID: 37642462 DOI: 10.1080/13803395.2023.2246668] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2022] [Accepted: 08/03/2023] [Indexed: 08/31/2023]
Abstract
INTRODUCTION Type 2 diabetes has been associated with cognitive decrements already in middle-age. However, the sample sizes of the studies have been small and the neuropsychological tests used have been heterogeneous. In addition, only a few studies have matched the groups in terms of age, education and gender. In this cross-sectional matched pairs study, we investigated the cognitive performance of Finnish middle-aged type 2 diabetes patients compared to healthy individuals. METHOD A neuropsychological test battery consisting of 16 tests and 21 outcome measures was applied to 28 patients and 28 age-, education- and gender-matched healthy individuals. Various exclusion criteria were applied to minimize the risk of cognitive dysfunction due to factors other than diabetes. RESULTS We did not find between-group differences in any of the neuropsychological tests measuring attention, concept formation and reasoning, construction and motor performance, executive functions, memory, processing speed or working memory. In addition, there were no group differences in the frequency or severity of subjective cognitive symptoms, or in anxiety, depression, burnout, fatigue or alcohol use disorder symptoms. The effect sizes in this study were mostly negligible or small, with the mean effect size being -0.12. CONCLUSIONS In a carefully matched sample of middle-aged type 2 diabetes patients and healthy individuals, we found no significant effects and no meaningful evidence of cognitive differences between the groups.
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Affiliation(s)
- Teppo Sola
- Faculty of Social Sciences, Tampere University, Tampere, Finland
- Tays Research Services, Wellbeing Services County of Pirkanmaa, Tampere University Hospital, Tampere, Finland
| | - Elina Pimiä
- Tays Research Services, Wellbeing Services County of Pirkanmaa, Tampere University Hospital, Tampere, Finland
- Diabetes Outpatient Clinic, Wellbeing Services County of Pirkanmaa, City of Tampere Diabetes Outpatient Clinic, Tampere, Finland
| | - Elina Lahti
- Tays Research Services, Wellbeing Services County of Pirkanmaa, Tampere University Hospital, Tampere, Finland
| | - Jorma Lahtela
- Tays Research Services, Wellbeing Services County of Pirkanmaa, Tampere University Hospital, Tampere, Finland
- Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
| | - Mervi Jehkonen
- Faculty of Social Sciences, Tampere University, Tampere, Finland
- Tays Research Services, Wellbeing Services County of Pirkanmaa, Tampere University Hospital, Tampere, Finland
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Ainasoja O, Bishwa G, Lahtela J, Syrjälä S, Lemström K, Hurskainen M. Single Cell Transcriptomic Analysis of Acute Heart Rejection in a Rat Model. J Heart Lung Transplant 2023. [DOI: 10.1016/j.healun.2023.02.1663] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/05/2023] Open
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Kurkela O, Lahtela J, Arffman M, Forma L. Infrared Thermography Compared to Standard Care in the Prevention and Care of Diabetic Foot: A Cost Analysis Utilizing Real-World Data and an Expert Panel. Clinicoecon Outcomes Res 2023; 15:111-123. [PMID: 36855751 PMCID: PMC9968423 DOI: 10.2147/ceor.s396137] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2022] [Accepted: 01/12/2023] [Indexed: 02/24/2023] Open
Abstract
Aim Infrared thermography (IRT) is a non-invasive technology for screening and early detection of diabetic foot. Real-world data and the Delphi technique were used to assess IRT's potential effect on typical care pathways of diabetic foot and their costs in the Finnish healthcare setting. Methods The most typical care pathways of diabetic foot were identified from national healthcare registers from 2011 to 2017. The effect of IRT in terms of avoidable care episodes was assessed by a Delphi panel including Finnish diabetic foot specialists (n=13). By combining a series of decision-analytic models, the IRT's potential effect on the costs of each pathway and their sensitivity to model assumptions were estimated. Results Hypothetical annual savings were estimated to be EUR ~1.7 million (EUR ~1.3 million-EUR ~2.5 million), constituting approximately 20% of the total annual care pathway costs examined. In the longer and more complex pathways, the application of IRT was estimated to result in notable savings while in the shorter pathways, IRT could increase costs. Conclusion Our modeling suggests that IRT could potentially reduce costs in a Finnish healthcare setting. Given our analysis, generation of robust evidence on the effectiveness of recent IRT technologies with up-to-date protocols seems appropriate.
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Affiliation(s)
- Olli Kurkela
- Faculty of Social Sciences, Tampere University, Tampere, 30014, Finland,Department of Public Health and Welfare, Finnish Institute for Health and Welfare (THL), Helsinki, 00271, Finland,Laurea University of Applied Sciences, Vantaa, 01300, Finland,Correspondence: Olli Kurkela, Health Sciences, Faculty of Social Sciences, Tampere University, P.O. Box 100, Tampere, 33014, Finland, Tel +358 50 5099170, Email
| | - Jorma Lahtela
- Tampere University Hospital, Tampere, 33520, Finland
| | - Martti Arffman
- Faculty of Social Sciences, Tampere University, Tampere, 30014, Finland,Department of Public Health and Welfare, Finnish Institute for Health and Welfare (THL), Helsinki, 00271, Finland
| | - Leena Forma
- Faculty of Social Sciences, Tampere University, Tampere, 30014, Finland,Laurea University of Applied Sciences, Vantaa, 01300, Finland
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Kurkela O, Nevalainen J, Arffman M, Lahtela J, Forma L. Foot-related diabetes complications: care pathways, patient profiles and costs. BMC Health Serv Res 2022; 22:559. [PMID: 35473691 PMCID: PMC9040351 DOI: 10.1186/s12913-022-07853-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2021] [Accepted: 03/25/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Foot-related diabetes complications reduce individual well-being, increase mortality and results in increased healthcare costs. Despite their notable stress on health services, studies examining the foot complication care pathways, especially from the viewpoint of health services, are limited. We aimed to identify the most typical care pathways following an initial foot-related diabetes complication, to characterize the patients on each pathway and calculate the related healthcare costs. METHODS The identification of pathways was based on population-wide register-based data including all persons diagnosed with diabetes in Finland from 1964 to 2017. For each patient, initial foot-related complication from 2011-2016 was identified using the ICD-10 codes and related healthcare episodes were followed for two years until the end of 2017 or death. A sequence analysis was conducted on care episodes resulting in groups of typical care pathways, as well as their patient profiles. The costs of pathways resulting from the care episodes were calculated based on the data and the reported national unit costs and analyzed using linear models. RESULTS We identified six groups of typical pathways each comprising mainly single type of care episodes. Three of the groups comprised over 10 000 patients while the remaining groups ranged from a few hundred to a few thousand. Majority of pathways consisted only single care episode. However, among the rest of the care pathways variability in length of care pathways was observed between and within group of pathways. On average, the patients were over 65 years of age and were diagnosed with diabetes for over a decade. The pathways resulted in an annual cost of EUR 13 million. The mean costs were nearly 20-fold higher in the group with the highest costs (EUR 11 917) compared to the group with the lowest costs (EUR 609). CONCLUSIONS We identified groups of typical care pathways for diabetic foot and discovered notable heterogeneity in the resource use within the groups. This information is valuable in guiding the development of diabetes care to meet the growing need. Nevertheless, reasons underlying the observed heterogeneity requires further examination. Since foot complications are largely preventable, substantial savings could be achieved using cost-effective technologies and more efficient organization of care.
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Affiliation(s)
- Olli Kurkela
- Faculty of Social Sciences, Tampere University, P.O Box 100, 30014, Tampere, Finland. .,Welfare State Research and Reform Unit, Finnish Institute for Health and Welfare (THL), P.O. Box 30, 00271, Helsinki, Finland.
| | - Jaakko Nevalainen
- Faculty of Social Sciences, Tampere University, P.O Box 100, 30014, Tampere, Finland
| | - Martti Arffman
- Faculty of Social Sciences, Tampere University, P.O Box 100, 30014, Tampere, Finland.,Welfare State Research and Reform Unit, Finnish Institute for Health and Welfare (THL), P.O. Box 30, 00271, Helsinki, Finland
| | - Jorma Lahtela
- Tampere University Hospital, Teiskontie 35, P.O. Box 2000, 33520, Tampere, Finland
| | - Leena Forma
- Faculty of Social Sciences, Tampere University, P.O Box 100, 30014, Tampere, Finland.,Faculty of Social Sciences, University of Helsinki, PO 54, 00014, Helsinki, Finland.,Laurea University of Applied Sciences, Ratatie 22, 01300, Vantaa, Finland
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Ainasoja O, Hurskainen M, Ghimire B, Lahtela J, Syrjälä S, Lemström K. Spatial Transcriptomic Analysis of Acute Heart Rejection Model. J Heart Lung Transplant 2022. [DOI: 10.1016/j.healun.2022.01.746] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
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Ylikoski M, Immonen H, Tiihonen R, Kauppi MJ, Huhtala H, Jokinen JJ, Lahtela J. Glucose management team significantly improves glycaemic care and commitment to in-hospital guidelines within arthroplastic patients. Acta Anaesthesiol Scand 2022; 66:326-336. [PMID: 34870851 DOI: 10.1111/aas.14012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2021] [Revised: 10/18/2021] [Accepted: 11/09/2021] [Indexed: 11/30/2022]
Abstract
BACKGROUND Perioperative dysglycaemias are a risk for harm but guidelines to improve glucose management are poorly adhered to. AIM To determine whether a specialized team and diabetes education improves the implementation of guidelines and glucose values. METHODS We conducted a prospective study of 611 nonselected, consecutive patients attending for elective hip or knee arthroplasty. The first 209 patients received conventional care and the following 402 patients received intervention (Acute Glucose Service, AGS) in two chronological groups; either perioperatively (AGS1) or also preoperatively (AGS2). The AGS-team provided diabetes education, identified the patients with diabetes risk and adjusted the medication when needed. Capillary plasma glucose (CPG) was repeatedly measured and glycated haemoglobin (HbA1c) obtained before and after the surgery. The study objectives were to evaluate the staff actions when hyperglycaemia was severe (CPG >10 mmol/L), and to assess improvement of the glycaemic values and the complication rate within 3 months. RESULTS None of the severely hyperglycaemic events in the reference group were treated according to guidelines. In the AGS 1 group, 50% and in the AGS2 group, 53% were appropriately managed (p < .001). The events of hyperglycaemia (CPG >7.8 mmol/L at least twice) and of severe hyperglycaemia (CPG >10 mmol/L) decreased in all patient groups. The medians of the highest, mean and variability of CPG values improved. The mean HbA1c improved significantly within AGS 2. There was no association between improved glycaemic care and early complications. CONCLUSIONS AGS intervention significantly improves adherence to guidelines and glucose values.
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Affiliation(s)
- Marianne Ylikoski
- Department of Anaesthesiology Päijät‐Häme Central Hospital Lahti Finland
- Department of Internal Medicine Päijät‐Häme Central Hospital Lahti Finland
| | - Heidi Immonen
- Department of Medicine Turku University Hospital Turku Finland
| | - Raine Tiihonen
- Department of Orthopaedics and Traumatology Päijät‐Häme Central Hospital Lahti Finland
| | - Markku J. Kauppi
- Department of Internal Medicine Päijät‐Häme Central Hospital Lahti Finland
- Clinicum Faculty of Medicine Helsinki University Helsinki Finland
| | - Heini Huhtala
- Faculty of Social Sciences Tampere University Tampere Finland
| | - Janne J. Jokinen
- Department of Thoracic and Vascular Surgery Päijät‐Häme Central Hospital Lahti Finland
| | - Jorma Lahtela
- Faculty of Medicine Tampere University Tampere Finland
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Ylikoski M, Lahtela J, J Jokinen J, Kauppi MJ, Huhtala H, Tiihonen R, Immonen H. New technology may help perioperative glucose management but not without a dedicated team? Acta Anaesthesiol Scand 2021; 65:564-565. [PMID: 33316837 DOI: 10.1111/aas.13762] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2020] [Accepted: 11/26/2020] [Indexed: 11/28/2022]
Affiliation(s)
- Marianne Ylikoski
- Department of Anaesthesiology, Päijät-Häme Central Hospital, Lahti, Finland
- Department of Internal Medicine, Päijät-Häme Central Hospital, Lahti, Finland
| | - Jorma Lahtela
- Faculty of Medicine, Tampere University, Tampere, Finland
| | - Janne J Jokinen
- Faculty of Medicine, Tampere University, Tampere, Finland
- Department of Thoracic and Vascular Surgery, Päijät-Häme Central Hospital, Lahti, Finland
| | - Markku J Kauppi
- Department of Internal Medicine, Päijät-Häme Central Hospital, Lahti, Finland
| | - Heini Huhtala
- Faculty of Social Sciences, Tampere University, Tampere, Finland
| | - Raine Tiihonen
- Department of Orthopaedics and Traumatology, Päijät-Häme Central Hospital, Lahti, Finland
- Department of Medicine, Turku University Hospital, Turku, Finland
| | - Heidi Immonen
- Department of Medicine, Turku University Hospital, Turku, Finland
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Vihervuori VJ, Talala K, Taari K, Lahtela J, Tammela TLJ, Auvinen A, Raittinen P, Murtola TJ. Antidiabetic Drugs and Prostate Cancer Prognosis in a Finnish Population-Based Cohort. Cancer Epidemiol Biomarkers Prev 2021; 30:982-989. [PMID: 33653815 DOI: 10.1158/1055-9965.epi-19-0580] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2019] [Revised: 11/01/2020] [Accepted: 02/22/2021] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Hyperinsulemia and glycemic control may play a role as prostate cancer prognostic factors, whereas use of certain antidiabetic drugs, that is metformin, could improve the prognosis. We examined the link between antidiabetic medication use and prostate cancer survival taking into account simultaneous use of multiple drugs. METHODS The study cohort composed of 6,537 men in The Finnish Randomized Study of Screening for Prostate Cancer with prostate cancer diagnosed 1996 to 2009. Use of medication was attained from the nationwide prescription database of the Social Insurance Institution of Finland. Median follow-up was 9.2 years postdiagnosis. A total of 1,603 (24,5%) men had used antidiabetic medication. A total of 771 men died of prostate cancer during the follow-up. We used multivariable-adjusted Cox regression to evaluate the risk of prostate cancer death and onset of androgen deprivation therapy (ADT) with adjustment for prostate cancer clinical characteristics, comorbidities and use of other drugs. Separate analyses were further adjusted for blood glucose. RESULTS Risk of prostate cancer death was higher among antidiabetic drug users overall (HR = 1.42; 95% CI, 1.18-1.70) compared with nonusers, separately among insulin and metformin users. Adjustment for blood glucose level abolished the risk increase. Risk of ADT initiation was increased among the medication users (HR = 1.26; 95% CI, 1.05-1.49). CONCLUSIONS Men with prostate cancer using antidiabetic medication are generally at increased risk of dying from prostate cancer compared with nonusers. The risk association is driven by underlying diabetes, as adjustment for blood glucose level ameliorates the risk increase. IMPACT Type 2 diabetes should be considered as a risk factor when considering prostate cancer prognosis.
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Affiliation(s)
- Ville J Vihervuori
- Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland.
| | | | - Kimmo Taari
- Department of Urology, Helsinki University and Helsinki University Hospital, Helsinki, Finland
| | - Jorma Lahtela
- Department of Internal Medicine, Tampere University Hospital, Tampere, Finland
| | - Teuvo L J Tammela
- Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland.,Department of Urology, Tampere University Hospital, Tampere, Finland
| | - Anssi Auvinen
- Faculty of Social Sciences, Tampere University, Tampere, Finland
| | | | - Teemu J Murtola
- Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland.,Department of Urology, Tampere University Hospital, Tampere, Finland.,Department of Surgery, Seinäjoki Central Hospital, Seinäjoki, Finland
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Ylikoski M, Jokinen JJ, Lahtela J, Kauppi MJ, Huhtala H, Immonen H, Tiihonen R. Perioperative hyperglycaemia in elective arthroplasties. Should we do better? Acta Anaesthesiol Scand 2020; 64:1253-1261. [PMID: 32615649 DOI: 10.1111/aas.13666] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2020] [Revised: 06/10/2020] [Accepted: 06/11/2020] [Indexed: 12/17/2022]
Abstract
BACKGROUND Perioperative dysglycaemia is associated with deleterious outcomes but guidelines to improve glucose management are poorly or inconsistently adhered to. We evaluated glucose management among diabetic and non-diabetic patients undergoing elective hip or knee arthroplasty. METHODS Capillary plasma glucose (CPG) was measured prospectively four times daily of 209 patients undergoing elective hip or knee surgery. Actions of the attending teams to CPG values and detection of patients at risk were analysed. RESULTS A total of 209 patients were enrolled. All diabetic patients on insulin (6/6) had hyperglycaemia (≥7.8 mmol/l) more than twice and severe hyperglycaemia (>10 mmol/l) at least once. Of the 27 diabetic patients not on insulin 26 (96.3%) had CPG ≥ 7.8 mmol/l ≥ 2 times and 17 (63%) >10 mmol/l. The corresponding figures of the 176 non-diabetic patients were 137 (77.8%) and 61 (34.7%). Severe hyperglycaemia occurred in 54/176 (30.1%) of the non-diabetic patients with pre-operative HbA1c < 42 mmol/mol and random plasma glucose < 7.8 mmol/l. Of the 84 hyperglycaemic episodes > 10 mmol/l, none was treated. Patients with a FINDRISC score ≥ 12 (corresponding to moderate to high risk of diabetes) and hyperglycaemia went unnoticed. CONCLUSIONS Hyperglycaemia is common among elective orthopaedic surgery patients with or without diabetes. More than 80% of the 209 patients had hyperglycaemia and 40% had severe hyperglycaemia. None of the patients was treated according to guidelines and none of the patients at risk of hyperglycaemia or diabetes was noticed. There is an obvious need for further education and support by diabetes specialists. CLINICAL TRIAL REGISTRATION Clinical trials, gov. NCT03306810.
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Affiliation(s)
- Marianne Ylikoski
- Department of Anaesthesiology Päijät‐Häme Central Hospital Lahti Finland
- Department of Internal Medicine Päijät‐Häme Central Hospital Lahti Finland
| | - Janne J. Jokinen
- Department of Thoracic and Vascular Surgery Päijät‐Häme Central Hospital Lahti Finland
| | - Jorma Lahtela
- Faculty of Medicine Tampere University Tampere Finland
| | - Markku J. Kauppi
- Department of Internal Medicine Päijät‐Häme Central Hospital Lahti Finland
| | - Heini Huhtala
- Faculty of Social Sciences Tampere University Tampere Finland
| | - Heidi Immonen
- Department of Medicine Turku University Hospital Turku Finland
| | - Raine Tiihonen
- Department of Orthopaedics and Traumatology Päijät‐Häme Central Hospital Lahti Finland
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12
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Laakso M, Honkasalo M, Kiiski J, Ala-Houhala M, Haapasalo H, Laine HJ, Luukkaala T, Lahtela J, Kaartinen I. Re-organizing inpatient care saves legs in patients with diabetic foot infections. Diabetes Res Clin Pract 2017; 125:39-46. [PMID: 28167324 DOI: 10.1016/j.diabres.2017.01.007] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2016] [Revised: 12/20/2016] [Accepted: 01/02/2017] [Indexed: 11/19/2022]
Abstract
AIMS In this study, we evaluated the effects of the re-organization of inpatient care for patients with a diabetic foot infection, and the implementation of a specialized multi-disciplinary wound department at an academic tertiary hospital. METHODS This was a retrospective cohort study, comprising 272 patients treated for diabetic foot infections in 2006-2007 (Group 1, n=124) and 2013-2014 (Group 2, n=148). In 2012, inpatient care of all chronic wounds was centralized at a single wound department with a multi-disciplinary team. We assessed group outcome before and after the re-organization. RESULTS During the 7-year study period, the incidence of hospitalized patients with a diabetic foot infection increased 19%. After initiating the re-organization, the below-the-knee amputation rate was significantly reduced (25.8% vs. 9.5%, p<0.001). The median time from admission to surgical intervention decreased from 5days to 2days, p<0.001. The length of hospitalization also tended to decrease after the reorganization. CONCLUSIONS The findings of this study demonstrate the benefits of treating diabetic foot infections at a specialized wound department with a multi-disciplinary team. The benefits were achieved by simply distributing the workload and organizing schedules, without new investments or additional personnel. The findings of this study indicate that patients with diabetic foot infections present a challenge that is beyond the expertise of a single field of medicine. A working collaboration between disciplines and a specialized wound department are central in achieving better results.
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Affiliation(s)
- Miska Laakso
- Tampere University Hospital, Department of Musculoskeletal Diseases, Finland.
| | - Mikael Honkasalo
- Tampere University Hospital, Department of Musculoskeletal Diseases, Finland
| | - Juha Kiiski
- Tampere University Hospital, Department of Musculoskeletal Diseases, Finland
| | - Meri Ala-Houhala
- Tampere University Hospital, Department of Dermatology and Allergology, Finland
| | - Heidi Haapasalo
- Tampere University Hospital, Department of Musculoskeletal Diseases, Finland
| | - Heikki-Jussi Laine
- Tampere University Hospital, Department of Musculoskeletal Diseases, Finland
| | - Tiina Luukkaala
- Tampere University Hospital, Research and Innovation Center and University of Tampere, School of Health Sciences, Finland
| | - Jorma Lahtela
- Tampere University Hospital, Department of Internal Medicine, Finland
| | - Ilkka Kaartinen
- Tampere University Hospital, Department of Musculoskeletal Diseases, Finland
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Nagaraj A, Lahtela J, Hemmes A, Mäyränpää M, Salmenkivi K, Närhi K, Verschuren E. Cell-of-origin links histotype spectrum to immune microenvironment diversity in non-small cell lung cancer driven by mutant Kras and loss of Lkb1. Eur J Cancer 2016. [DOI: 10.1016/s0959-8049(16)61312-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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14
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Hällberg V, Kataja M, Lahtela J, Tarkka M, Inamaa T, Palomäki A. Obesity paradox disappears in coronary artery bypass graft patients during 20-year follow-up. European Heart Journal: Acute Cardiovascular Care 2016; 6:771-777. [DOI: 10.1177/2048872616633844] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Affiliation(s)
- Ville Hällberg
- Kanta-Häme Central Hospital, Finland
- Medical School, University of Tampere, Finland
| | - Matti Kataja
- National Institute for Health and Welfare, Finland
| | - Jorma Lahtela
- Medical School, University of Tampere, Finland
- Tampere University Hospital, Finland
| | | | | | - Ari Palomäki
- Kanta-Häme Central Hospital, Finland
- Medical School, University of Tampere, Finland
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15
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Nauck M, Lahtela J, Ahmann A, Rodbard H, Rosenstock J, de Loredo L, Kienhöfer J, Kretzschmar Y, Tornøe K. Wirksamkeit und Sicherheit von Liraglutid im Vergleich zu Placebo bei additiver Anwendung zu bestehenden Therapien mit Basalinsulinanaloga bei Patienten mit Typ 2 Diabetes (LIRA-ADD2BASAL): eine randomisierte, placebokontrollierte Studie. DIABETOL STOFFWECHS 2015. [DOI: 10.1055/s-0035-1549542] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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16
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Hällberg V, Palomäki A, Lahtela J, Voutilainen S, Tarkka M, Kataja M. Associations of metabolic syndrome and diabetes mellitus with 16-year survival after CABG. Cardiovasc Diabetol 2014; 13:25. [PMID: 24447406 PMCID: PMC3914357 DOI: 10.1186/1475-2840-13-25] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2013] [Accepted: 01/03/2014] [Indexed: 12/11/2022] Open
Abstract
Background The associations of metabolic syndrome (MetS) or diabetes mellitus (DM) on long-term survival after coronary artery bypass grafting (CABG) have not been extensively evaluated. The aim of the present study was to assess the impact of MetS and DM on the 16-year survival after CABG. Methods Diabetic and metabolic status together with relevant cardiovascular data was established in 910 CABG patients operated in 1993-94. They were divided in three groups as follows: neither DM nor MetS (375 patients), MetS alone (279 patients) and DM with or without MetS (256 patients). The 16-year follow-up of patient survival was carried out using national health databases. The relative survival rates were analyzed using the Life Table method comparing the observed survival rates of three patient groups to the rates based on age-, sex- and time-specific life tables for the whole population in Finland. To study the independent significance of MetS and DM for clinical outcome, multivariate analysis was made using an optimizing stepwise procedure based on the Bayesian approach. Results Bayesian multivariate analysis revealed together six variables to predict clinical outcome (2 months to 16 years) in relation to the national background population, i.e. age, diabetes, left ventricular ejection fraction, BMI, perfusion time during the CABG and peripheral arterial disease. Our principal finding was that after postoperative period the 16-year prognosis of patients with neither DM nor MetS was better than that of the age-, sex-and time-matched background population (relative survival against background population 1.037, p < 0.0001). The overall survival of MetS patients resembled that of the matched background population (relative survival 0.998, NS). DM was associated with significantly increased mortality (relative survival 0.86, p < 0.0001). Additionally, mortality was even higher in patients receiving insulin treatment than in those without. Excess death rate of DM patients was predominantly caused by cardiovascular causes. Conclusion In this long-term follow-up study patient groups without diabetes had at least equal 16 years’ survival after CABG than their matched background populations. Survival of DM patients started to deteriorate already few years after the operation.
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17
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Östenson CG, Geelhoed-Duijvestijn P, Lahtela J, Weitgasser R, Markert Jensen M, Pedersen-Bjergaard U. Self-reported non-severe hypoglycaemic events in Europe. Diabet Med 2014; 31:92-101. [PMID: 23796113 PMCID: PMC4232857 DOI: 10.1111/dme.12261] [Citation(s) in RCA: 129] [Impact Index Per Article: 12.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/18/2013] [Indexed: 11/29/2022]
Abstract
AIMS Hypoglycaemia presents a barrier to optimum diabetes management but data are limited on the frequency of hypoglycaemia incidents outside of clinical trials. The present study investigated the rates of self-reported non-severe hypoglycaemic events, hypoglycaemia awareness and physician discussion of events in people with Type 1 diabetes mellitus or insulin-treated Type 2 diabetes mellitus. METHODS People in seven European countries aged >15 years with Type 1 diabetes or insulin-treated Type 2 diabetes (basal-only, basal-bolus and other insulin regimens) were recruited via consumer panels, nurses, telephone recruitment and family referrals. Respondents completed four online questionnaires. The first questionnaire collected background information on demographics and hypoglycaemia-related behaviour, whilst all four questionnaires collected data on non-severe hypoglycaemic events in the preceding 7 days. RESULTS Analysis was based on 11 440 respondent-weeks from 3827 respondents. All participants completed the first questionnaire and 57% completed all four. The mean number of events/respondent-week was 1.8 (Type 1 diabetes) and 0.4-0.7 (Type 2 diabetes, with different insulin treatments) corresponding to annual event rates of 94 and 21-36, respectively. A total of 63% of respondents with Type 1 diabetes and 49-64% of respondents with Type 2 diabetes, treated with different insulin regimens, who experienced hypoglycaemic events, reported impaired hypoglycaemia awareness or unawareness. A high proportion of respondents rarely or never informed their general practitioner/specialist about hypoglycaemia: 65% (Type 1 diabetes) and 50-59% (Type 2 diabetes). Overall, 16% of respondents with Type 1 diabetes and 26% of respondents with Type 2 diabetes reported not being asked about hypoglycaemia during routine appointments. CONCLUSION Non-severe hypoglycaemic events are common amongst people with Type 1 diabetes and insulin-treated Type 2 diabetes in real-world settings. Many rarely or never inform their general practitioner/specialist about their hypoglycaemia and the real burden of hypoglycaemia may be underestimated.
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Affiliation(s)
- C G Östenson
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
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18
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Geelhoed-Duijvestijn PH, Pedersen-Bjergaard U, Weitgasser R, Lahtela J, Jensen MM, Östenson CG. Effects of patient-reported non-severe hypoglycemia on healthcare resource use, work-time loss, and wellbeing in insulin-treated patients with diabetes in seven European countries. J Med Econ 2013; 16:1453-61. [PMID: 24144009 DOI: 10.3111/13696998.2013.852098] [Citation(s) in RCA: 47] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
PURPOSE Hypoglycemia is a frequent side effect induced by insulin treatment of type 1 (T1DM) and type 2 diabetes (T2DM). Limited data exist on the associated healthcare resource use and patient impact of hypoglycemia, particularly at a country-specific level. This study investigated the effects of self-reported non-severe hypoglycemic events (NSHE) on use of healthcare resources and patient wellbeing. METHODS Patients with T1DM or insulin-treated T2DM diabetes from seven European countries were invited to complete four weekly questionnaires. Data were collected on patient demographics, NSHE occurrence in the last 7 days, hypoglycemia-related resource use, and patient impact. NSHE were defined as events with hypoglycemia symptoms, with or without blood glucose measurement, or low blood glucose measurement without symptoms, which the patient could manage without third-party assistance. RESULTS Three thousand, nine hundred and fifty-nine respondents completed at least one wave of the survey, with 57% completing all four questionnaires; 3827 respondents were used for data analyses. Overall, 2.3% and 8.9% of NSHE in patients with T1DM and T2DM, respectively, resulted in healthcare professional contact. Across countries, there was a mean increase in blood glucose test use of 3.0 tests in the week following a NSHE. Among respondents who were employed (48%), loss of work-time after the last hypoglycemic event was reported for 9.7% of NSHE. Overall, 10.2% (daytime) and 8.0% (nocturnal) NSHE led to work-time loss, with a mean loss of 84.3 (daytime) and 169.6 (nocturnal) minutes among patients reporting work-time loss. Additionally, patients reported feeling tired, irritable, and having negative feelings following hypoglycemia. LIMITATIONS Direct comparisons between studies must be interpreted with caution because of different definitions of hypoglycemia severity, duration of the studies, and methods of data collection. CONCLUSIONS NSHE were associated with use of extra healthcare resources and work-time loss in all countries studied, suggesting that NSHE have considerable impact on patients/society.
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Lahtela J, Hunsaker T, Brauer M, Lee J, Hemmes A, Koopal S, Corson L, Jackson P, Verschuren E. 242 Identification of EPHA3 as a Candidate Tumor Suppressor in a Screen for Cellular Senescence. Eur J Cancer 2012. [DOI: 10.1016/s0959-8049(12)70937-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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20
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Pakarinen TK, Laine HJ, Mäenpää H, Mattila P, Lahtela J. The effect of zoledronic acid on the clinical resolution of Charcot neuroarthropathy: a pilot randomized controlled trial. Diabetes Care 2011; 34:1514-6. [PMID: 21593295 PMCID: PMC3120211 DOI: 10.2337/dc11-0396] [Citation(s) in RCA: 51] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
OBJECTIVE To investigate the clinical efficacy of zoledronic acid in patients with diabetes and acute Charcot neuroarthropathy. RESEARCH DESIGN AND METHODS Thirty-nine consecutive patients were randomly assigned to placebo or three intravenous infusions of 4 mg zoledronic acid. The primary outcome was clinical resolution of acute Charcot neuroarthropathy determined by total immobilization time (casting plus orthosis). RESULTS At baseline, there was no significant difference between the randomly assigned groups with respect to Charcot disease activity or other baseline values. In the zoledronic acid group, the median time for total immobilization was 27 weeks (range 10-62), and in the placebo group it was 20 weeks (20-52) (P=0.02). CONCLUSIONS Zoledronic acid had no beneficial effect on the clinical resolution of acute Charcot neuroarthropathy in terms of total immobilization time. It is possible that it may prolong the time to clinical resolution of Charcot neuroarthropathy.
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Affiliation(s)
- Toni-Karri Pakarinen
- Department of Orthopaedics and Traumatology, Tampere University Hospital, and Medical School, University of Tampere, Tampere, Finland.
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21
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Belengeanu V, Viskari H, Tallila J, Lahtela J, Farcas S, Andreescu N, Stoian M, Bohiltea CL, Fryns JP. Lethal evolution of a newborn with consistent features of hydrolethalus syndrome--Romanian patient. Genet Couns 2011; 22:293-304. [PMID: 22029171] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
Hydrolethalus syndrome is a severe lethal disorder most commonly found in Finland. We present a lethal case of complex congenital malformation in a Romanian family who showed multiple signs described in hydrolethalus syndrome. Our case presented the specific characteristics: macrocephaly, midline cleft-lip, cleft palate, polydactyly of both hands and feet but without occipitoschisis, considered as the pathognomonic sign of the syndrome. Sequencing analysis of HYLS1 did not identify the point mutation present in the Finnish cases or other mutations in this gene.
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Affiliation(s)
- V Belengeanu
- Department of Medical Genetics, University of Medicine and Pharmacy "Victor Babes", Timisoara, Romania.
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22
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Alanen HM, Lahtela J, Leinonen E. [Hyponatremia due to psychoactive drugs is common in the elderly]. Duodecim 2011; 127:406-413. [PMID: 21442861] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
Hyponatremia due to psychoactive drugs commonly used in the treatment of elderly patients appears usually during the first weeks of treatment. Blood sodium level should be measured before the initiation of medication and checked after a few weeks. Symptoms suggesting hyponatremia in a patient under psychoactive medication are always an indication for checking the sodium level. Restriction of fluid intake to one and a half liters per day may correct mild hyponatremia. First-line treatment is always cessation of drug therapy. If the psychoactive drug is essential for the patient's disease, it will be changed to a different one.
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Verschuren E, Lahtela J, Hunsaker T, Brauer M, Corson L, Jackson P. 644 A screen for cellular senescence reveals candidate tumour suppressor genes. EJC Suppl 2010. [DOI: 10.1016/s1359-6349(10)71444-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
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Pakarinen TK, Laine HJ, Mäenpää H, Mattila P, Lahtela J. Long-term outcome and quality of life in patients with Charcot foot. Foot Ankle Surg 2010; 15:187-91. [PMID: 19840750 DOI: 10.1016/j.fas.2009.02.005] [Citation(s) in RCA: 67] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2008] [Revised: 01/24/2009] [Accepted: 02/13/2009] [Indexed: 02/04/2023]
Abstract
BACKGROUND There is only sparse scientific data about the long-term effects of the Charcot foot on patients' lives and the clinical outcome. This study evaluates the long-term effects of diabetic Charcot foot. METHODS A cross-sectional follow-up study of consecutive series of patients with Charcot foot referred to the University Hospital Diabetic Foot and Ankle Clinic between 1991 and 2002. RESULTS Forty-one patients were referred with Charcot foot between 1991 and 2002. After an average follow-up of 8 years their overall mortality rate was 29% (12/41) and 29 patients (30 Charcot feet) have been followed more than 5 years. Sixty-seven percent of Charcot feet suffered at least one episode of ulceration and 50% (15/30) of affected feet had surgical treatment resulting in 29 operations. Simple exostectomy was successful in 62% of cases. The need for surgical management increased markedly 4 years after the diagnosis. Correct diagnosis within 3 months resulted in better functional outcome (AOFAS) and walking distance (p=0.006 and p=0.008, respectively). Lower SF-36 component scores in physical functioning, social functioning and general health perceptions were found when the study population was compared to the general population and chronically ill control subjects. CONCLUSIONS Diabetic Charcot foot decreases patient's physical functioning and general health but does not usually affect mental health. Surgical management is often required with an increase 4 years post-diagnosis. A delay of diagnosis of more than 3 months was found to adversely affect the quality of life and functional outcome.
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Affiliation(s)
- Toni-Karri Pakarinen
- Department of Orthopaedics and Traumatology, Tampere University Hospital, Tampere, Finland.
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Tahvanainen A, Koskela J, Tikkakoski A, Lahtela J, Leskinen M, Kähönen M, Nieminen T, Kööbi T, Mustonen J, Pörsti I. Analysis of cardiovascular responses to passive head‐up tilt using continuous pulse wave analysis and impedance cardiography. Scandinavian Journal of Clinical and Laboratory Investigation 2009; 69:128-37. [DOI: 10.1080/00365510802439098] [Citation(s) in RCA: 53] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Murtola TJ, Tammela TLJ, Lahtela J, Auvinen A. Antidiabetic medication and prostate cancer risk: a population-based case-control study. Am J Epidemiol 2008; 168:925-31. [PMID: 18700234 DOI: 10.1093/aje/kwn190] [Citation(s) in RCA: 84] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023] Open
Abstract
Decreased risk of prostate cancer in diabetic men has been reported. The authors evaluated the association between antidiabetic medication use and prostate cancer at the population level. All incident prostate cancer cases in Finland during 1995-2002 were identified from the Finnish Cancer Registry. Matched controls were provided by the Population Register Center (24,723 case-control pairs). Information on medication use was obtained from a comprehensive prescription database. Multivariable-adjusted odds ratios were computed by using conditional logistic regression. The authors found that prostate cancer risk was decreased for antidiabetic medication users (odds ratio = 0.87, 95% confidence interval: 0.82, 0.92). The decrease was observed for most drug groups. The odds ratio decreased in a dose-dependent fashion by quantity of use. Duration of antidiabetic treatment was inversely associated with overall prostate cancer risk and risk of advanced cancer. Similar risk reduction for users of different antidiabetic drugs suggests that diabetes, instead of the medication itself, is behind the association. This finding is unlikely to be secondary because of differential uptake of the prostate-specific antigen test or different prostate-specific antigen levels between medication users and nonusers; prevalence of testing in Finland is low. Dose and time dependency of the relation probably indicates that duration of diabetes is negatively associated with risk.
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Affiliation(s)
- Teemu J Murtola
- School of Public Health, University of Tampere, Medisiinarinkatu 3, 33520 Tampere, Finland.
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Murtola TJ, Visakorpi T, Lahtela J, Syvälä H, Tammela TL. Statins and prostate cancer prevention: where we are now, and future directions. ACTA ACUST UNITED AC 2008; 5:376-87. [PMID: 18542103 DOI: 10.1038/ncpuro1146] [Citation(s) in RCA: 56] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2007] [Accepted: 04/22/2008] [Indexed: 12/31/2022]
Abstract
Statins are cholesterol-lowering drugs that are widely used to prevent and treat atherosclerotic cardiovascular disease. Recent research from both in vitro and in vivo studies suggests that there is an association between the use of statins and a reduction in the incidence of and mortality from prostate cancer. Several mechanisms of action that might bring about these beneficial effects of statins have been proposed, most of which include direct effects of statins on intracellular signaling. In this Review we discuss the current knowledge on the use of statins to prevent prostate cancer. We will also look at future directions for clinical research on this topic.
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Affiliation(s)
- Teemu J Murtola
- Department of Epidemiology, School of Public Health, University of Tampere, Tampere, Finland.
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Murtola TJ, Tammela TLJ, Lahtela J, Auvinen A. Cholesterol-lowering drugs and prostate cancer risk: a population-based case-control study. Cancer Epidemiol Biomarkers Prev 2008; 16:2226-32. [PMID: 18006910 DOI: 10.1158/1055-9965.epi-07-0599] [Citation(s) in RCA: 149] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Previous studies have shown that statin use may reduce prostate cancer risk. In the current study, we evaluated the association between serum cholesterol-lowering medication use and prostate cancer risk at the population level. MATERIALS AND METHODS All newly diagnosed prostate cancer cases in Finland during 1995 to 2002 and matched controls (24,723 case control pairs) were identified from the Finnish Cancer Registry and the Population Register Center, respectively. Detailed information on cholesterol-lowering drug purchases during the study period was obtained from the prescription database of the Social Insurance Institution of Finland. RESULTS After adjustment for potential confounders, having ever-use of any statin was associated with marginally elevated overall prostate cancer risk [odds ratio (OR), 1.07; 95% confidence interval (95% CI), 1.00-1.16]. However, none of the statins was associated with the overall prostate cancer risk when analyzed separately. On the other hand, the risk of advanced prostate cancer was decreased among users of atorvastatin, lovastatin, and simvastatin (OR 0.61, 95% CI 0.37-0.98; OR 0.61, 95% CI 0.43-0.85; and OR 0.78, 95% CI 0.61-1.01, respectively). The risk was not affected among users of other cholesterol drug groups. CONCLUSIONS Our large population-based study showed no evidence for reduced overall prostate cancer risk among users of cholesterol-lowering drugs, whereas the risk of advanced cancer was decreased among statin users.
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Affiliation(s)
- Teemu J Murtola
- School of Public Health, University of Tampere, Tampere, FIN-33014, Finland.
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29
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Ilanne-Parikka P, Eriksson JG, Lindström J, Peltonen M, Aunola S, Hämäläinen H, Keinänen-Kiukaanniemi S, Laakso M, Valle TT, Lahtela J, Uusitupa M, Tuomilehto J. Effect of lifestyle intervention on the occurrence of metabolic syndrome and its components in the Finnish Diabetes Prevention Study. Diabetes Care 2008; 31:805-7. [PMID: 18184907 DOI: 10.2337/dc07-1117] [Citation(s) in RCA: 124] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
OBJECTIVE The aim of this secondary analysis of the Finnish Diabetes Prevention Study was to assess the effects of lifestyle intervention on metabolic syndrome and its components. RESEARCH DESIGN AND METHODS A total of 522 middle-aged overweight men and women with impaired glucose tolerance were randomized into an individualized lifestyle intervention group or a standard care control group. National Cholesterol Education Program criteria were used for the definition of metabolic syndrome. RESULTS At the end of the study, with a mean follow-up of 3.9 years, we found a significant reduction in the prevalence of metabolic syndrome in the intervention group compared with the control group (odds ratio [OR] 0.62 [95% CI 0.40-0.95]) and in the prevalence of abdominal obesity (0.48 [0.28-0.81]). CONCLUSIONS The results suggest that lifestyle intervention may also reduce risk of cardiovascular disease in the long run.
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Mäkinen T, Karhunen P, Aro J, Lahtela J, Määttänen L, Auvinen A. Assessment of causes of death in a prostate cancer screening trial. Int J Cancer 2008; 122:413-7. [PMID: 17935123 DOI: 10.1002/ijc.23126] [Citation(s) in RCA: 42] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Accurate assessment of the causes of death is crucial for a conclusive evaluation of the ongoing prostate cancer screening trials. Here, we report the validity of the official causes of death as compared with an independent expert review in the Finnish prostate cancer screening trial. Because nearly 80,000 men were involved, death-cause evaluation was restricted to men diagnosed for prostate cancer. Medical charts were retrieved and the cause of death was assigned by an expert review panel for all deaths among men with prostate cancer during the study period, 1996-2003. The panel decision was compared with both death certificates and the official causes of death as assigned by Statistics Finland. Of a total of 315 deaths, the review panel attributed 127 (41%) to prostate cancer and 184 (59%) to other causes, the corresponding figures in death certificates being 124 (40%) and 187 (60%). Four cases were excluded because of insufficient information. The death-certificate data were in agreement with the panel's assessment in 305 out of 311 cases (overall agreement 97.7%, kappa = 0.95). The overall agreement between the official causes of death and the panel's decision was 97.4% (304/311, kappa = 0.95). The sensitivity of the certificates in identifying prostate cancer deaths was 96.1% (panel as golden standard). Correspondingly, specificity was 98.9%. The official causes of death thus provide an accurate means for evaluating disease-specific mortality in a large population-based prostate-cancer screening trial in Finland.
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Affiliation(s)
- Tuukka Mäkinen
- Department of Surgery, Tampere University Hospital, Tampere, Finland.
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Murtola TJ, Tammela TL, Lahtela J, Auvinen A. 462: Antidiabetic Medication and Prostate Cancer Risk - A Population-Based Case-Control Study. J Urol 2007. [DOI: 10.1016/s0022-5347(18)30715-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
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Ilanne-Parikka P, Eriksson JG, Lindström J, Hämäläinen H, Keinänen-Kiukaanniemi S, Laakso M, Louheranta A, Mannelin M, Rastas M, Salminen V, Aunola S, Sundvall J, Valle T, Lahtela J, Uusitupa M, Tuomilehto J. Prevalence of the metabolic syndrome and its components: findings from a Finnish general population sample and the Diabetes Prevention Study cohort. Diabetes Care 2004; 27:2135-40. [PMID: 15333474 DOI: 10.2337/diacare.27.9.2135] [Citation(s) in RCA: 136] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
OBJECTIVE To assess the prevalence of the metabolic syndrome (MetS) in two independent Finnish study cohorts. RESEARCH DESIGN AND METHODS The prevalence of the MetS by modified World Health Organization criteria was analyzed in different categories of glucose tolerance in a cross-sectional, population-based sample of 2,049 individuals (FINRISK) aged 45-64 years and in 522 participants of the Finnish Diabetes Prevention Study (DPS) with impaired glucose tolerance (IGT). RESULTS In the FINRISK cohort, the MetS was present in 38.8% of the men and 22.2% of the women. The prevalence was 14.4 and 10.1% in subjects with normal glucose tolerance, 74.0 and 52.2% in subjects with impaired fasting glucose, 84.8 and 65.4% in subjects with IGT, and 91.5 and 82.7% in subjects with type 2 diabetes in men and women, respectively. Among women, the prevalence of the MetS increased with increasing age. In the DPS cohort, the MetS was present in 78.4% of the men and 72.2% of the women with IGT. CONCLUSIONS The MetS was extremely common in middle-aged subjects The high prevalence in men was mostly due to their high waist-to-hip ratio. The prevalence of the MetS increased in both sexes with deterioration in glucose regulation. Approximately 75% of the subjects with IGT had the MetS. Because the syndrome includes the major risk factors for atherosclerotic vascular diseases and is the major antecedent for type 2 diabetes, concerted preventive action should be targeted to control all the features of the MetS.
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Finne P, Stenman UH, Määttänen L, Mäkinen T, Tammela TLJ, Martikainen P, Ruutu M, Ala-Opas M, Aro J, Karhunen PJ, Lahtela J, Rissanen P, Juusela H, Hakama M, Auvinen A. The Finnish trial of prostate cancer screening: where are we now? BJU Int 2003; 92 Suppl 2:22-6. [PMID: 14983949 DOI: 10.1111/j.1465-5101.2003.04397.x] [Citation(s) in RCA: 34] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- P Finne
- Department of Clinical Chemistry, University of Helsinki, Helsinki, Finland.
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Pakarinen TK, Laine HJ, Honkonen SE, Peltonen J, Oksala H, Lahtela J. Charcot arthropathy of the diabetic foot. Current concepts and review of 36 cases. Scand J Surg 2003; 91:195-201. [PMID: 12164523 DOI: 10.1177/145749690209100212] [Citation(s) in RCA: 79] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
BACKGROUND AND AIMS The incidence of diabetic Charcot neuroarthropathy has increased. The purpose here was to study the current diagnostics and treatment of the Charcot foot. MATERIALS AND METHODS During a time period from 1994 to 2000, a total of 36 feet were diagnosed as cases of diabetic Charcot neuroarthropathies. A retrospective analysis of patient records and radiographs was undertaken. A review of the recent literature is presented. RESULTS 29 cases were diagnosed in the dissolution stage, 2 in coalascence, and 5 in the resolution stage. The diagnostic delay averaged 29 weeks. Treatment with cast immobilisation ranged from 4 to 37 weeks (mean 11 weeks). A total of 14 surgical procedures were carried out on 10 patients: six exostectomies, four midfoot arthrodeses, one triple arthrodesis, one tibiocalcaneal arthrodesis and two below-knee amputations. A radiological fusion was achieved in two thirds of the attempted arthrodeses. CONCLUSIONS A physician should always consider the Charcot neuroarthropathy when a diabetic patient has an inflamed foot. In the absence of fever, elevated CRP or ESR, infection is a highly unlikely diagnosis, and a Charcot process should primarily be considered. The initial treatment of an inflamed Charcot foot consists in sufficiently long non-weightbearing with a cast, which should start immediately after the diagnosis. The prerequisites of successful reconstructive surgery are correct timing, adequate fixation and a long postoperative non-weightbearing period. In the resolution stage most Charcot foot patients need custom-molded footwear.
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Lahtela J, Nevalainen P. [Multi-injection insulin therapy using two basic insulin components--an alternative towards a better glycemic control]. Duodecim 2002; 114:1949-53. [PMID: 11717748] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/22/2023]
Affiliation(s)
- J Lahtela
- Tampereen yliopiston lääketieteen laitos, TAYS:n sisätautien klinikka PL 607, 33101 Tampere.
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Lahtela J, Tuomi ML, Karvonen AL. [Ill from eating salad]. Duodecim 2002; 114:551-3. [PMID: 11466918] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/20/2023]
Affiliation(s)
- J Lahtela
- Valkeakosken aluesairaala ja Tampereen yliopiston lääketieteen laitos PL 607, 33101 Tampere
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Nevalainen P, Lahtela J, Mustonen J, Pasternack A. [Intraperitoneal insulin therapy combined with continuous ambulatory peritoneal dialysis (CAPD)]. Duodecim 2000; 112:89-94. [PMID: 10590611] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/14/2023]
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Kaukinen K, Salmi J, Lahtela J, Siljamäki-Ojansuu U, Koivisto AM, Oksa H, Collin P. No effect of gluten-free diet on the metabolic control of type 1 diabetes in patients with diabetes and celiac disease. Retrospective and controlled prospective survey. Diabetes Care 1999; 22:1747-8. [PMID: 10526749 DOI: 10.2337/diacare.22.10.1747a] [Citation(s) in RCA: 44] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
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Malminiemi K, Lahtela J, Malminiemi O, Ala-Kaila K, Huupponen R. Insulin sensitivity in a long-term crossover trial with celiprolol and other antihypertensive agents. J Cardiovasc Pharmacol 1998; 31:140-5. [PMID: 9456288 DOI: 10.1097/00005344-199801000-00019] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
The effects of a vasodilating beta-blocker, celiprolol, on insulin sensitivity and cardiovascular risk factors were compared with those of another beta1-selective adrenoceptor blocker, calcium channel blockers, and angiotensin-converting enzyme (ACE) inhibitors. A randomized 21-month crossover trial was carried out with 25 patients with dyslipidemia receiving antihypertensive monotherapy. The study consisted of a 3-month active run-in period and two treatment periods, during which the patients received celiprolol (200-400 mg daily) or the control drug for 12 and 6 months in a crossover manner. A hyperinsulinemic euglycemic clamp and an oral glucose tolerance test (OGTT) were performed every 6 months. According to the clamp tests, the insulin-sensitivity index increased on average by 32% (p < 0.0001) during celiprolol treatment compared with that with the other antihypertensive agents, including ACE inhibitors. In OGTT, area under the incremental glucose curve decreased by 36% (p = 0.002) during celiprolol treatment, whereas insulin secretion diminished on average by 26% (p = 0.006). The mean decrease in fasting serum triglycerides was 11% (NS), whereas the high-density lipoprotein to low-density lipoprotein (HDL/LDL) ratio increased by 15% (p = 0.012). The results suggest that celiprolol improves insulin sensitivity of hypertensive patients with dyslipidemia in long-term therapy.
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Affiliation(s)
- K Malminiemi
- Department of Clinical Chemistry, Tampere University Hospital, University of Tampere, Finland
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Kanerva M, Paakkala A, Mustonen J, Paakkala T, Lahtela J, Pasternack A. Pulmonary involvement in nephropathia epidemica: radiological findings and their clinical correlations. Clin Nephrol 1996; 46:369-78. [PMID: 8982552] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
Abstract
Nephropathia epidemica (NE) is a hemorrhagic fever with renal syndrome (HFRS) normally taking a benign clinical course. The etiologic agent, Puumala hantavirus is genetically closely related to Sin Nombre virus, which causes a frequently lethal febrile syndrome with pulmonary involvement (hantavirus pulmonary syndrome, HPS). HPS is characterized by acute respiratory distress, non-cardiogenic pulmonary edema and severe and hypotension, but usually no significant renal involvement. Pulmonary involvement and respiratory symptoms also occur in NE. To understand the mechanisms of pulmonary involvement in NE, we studied the clinical records and chest X-rays of 125 hospital-treated acutely ill NE patients. Twenty-eight percent of the patients had disease-related changes in their chest radiographs. Pleural effusion and atelectasis were the most common X-ray findings, whereas frank pulmonary edema was rare. The patients with pathologic X-ray findings had a more marked hypoproteinemia (lowest measured serum protein concentration 54 +/- 1 g/l) than those with normal X-ray (62.1 +/- 0.9 g/l, p < 0.001) and leukocytosis (highest measured blood leukocyte count 14.1 +/- 0.9 x 10(9)/l vs. 10.6 +/- 0.6 x 10(9)/l, p < 0.001) and more severe renal insufficiency (highest measured serum creatinine 590 +/- 60 mumol/l vs. 356 +/- 29 mumol/l, p < 0.05). Hypoproteinemia best predicted the occurrence of abnormal chest X-ray findings in NE. This suggests, that capillary leakage and inflammation may play a role in the pathogenesis of NE lung involvement, similarly as in HPS. Differently from HPS, the fluid volume overload associated with renal insufficiency seemed to contribute strongly to the chest X-ray changes in NE.
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Affiliation(s)
- M Kanerva
- Department of Virology, University of Helsinki, Finland
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Räsänen L, Tuomi ML, Lahtela J, Knip M. [Hypersensitization to protamine-containing insulin]. Duodecim 1995; 111:914-8. [PMID: 9081826] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
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