Test accuracy was assessed by

the degree of misclassification (both under- and over-diagnosis) of patients into normal glycaemic control, impaired glucose tolerance and diabetes mellitus based on OGTT data using WHO criteria. A predictive index (PI) was generated using stepwise ordinal regression models (incorporating FPG, HbA1c, HDL-C, triglycerides, age and gender). HbA1c alone, using the International Expert Committee cut-off values, had unacceptably high misclassification rates (49.0% under- and 2.5% Veliparib over-diagnosed). This did not improve when ADA criteria were examined, despite their lower cut-off values for normoglycaemia (44.4% under- and 7.1% over-diagnosed). FPG was marginally better, misclassifying 44.4% (mostly under-diagnosis; 41.4%). The PI had the lowest misclassification rate (35.9%; with 22.7% under- and 13.1% over-diagnosed). In conclusion, our data suggest that HbA1c alone offers little advantage over FPG in detecting dysglycaemia in this high risk population. Our approach using a predictive

index to combine HbA1c with other test data will enhance its performance. Copyright © 2012 John Wiley & Sons. “
“The objective of this audit was to compare treatment outcomes in patients on dipeptidyl peptidase (DPP)-4 inhibitors and glucagon-like 17-AAG purchase peptide-1 receptor (GLP-1R) agonists within a hospital clinic setting, and to identify factors that might influence their response to treatment. We undertook ADP ribosylation factor a retrospective audit of 118 consecutive patients who received either a DPP-4 inhibitor or a GLP-1R agonist as add-on to existing oral hypoglycaemic agent therapy. Primary clinical outcomes compared were change in HbA1c and weight. The clinical characteristics of patients who responded with both weight loss and improvement in HbA1c were compared to those who did not. The results showed that more patients (73.6%) were on a GLP-1R agonist;

57% of patients on a GLP-1R agonist lost weight and had improved HbA1c compared to 40% of patients on a DPP-4 inhibitor. The mean reduction in HbA1c was 8.4mmol/mol with a mean weight loss of 2.6kg. There were good correlations between the initial HbA1c and decline in HbA1c in both treatment groups. In all, 68.3% of patients on additional insulin treatment improved HbA1c while 46.3% improved in terms of both weight and HbA1c. Patients not on insulin responded better to treatment (OR 1.96; p=0.047) with these agents. It was concluded that good metabolic control can be achieved if these agents are used judiciously. The DPP-4 inhibitors improve HbA1c but are weight neutral, while the GLP-1R agonists cause both weight loss and improvements in HbA1c. The addition of insulin under specialist supervision can be beneficial. Copyright © 2013 John Wiley & Sons. Practical Diabetes 2013; 30(4): 159–162 “
“Diabetes is a global epidemic and the highest prevalence rates in the world are found in Gulf Corporation Council countries, including Qatar.

43 Glycoconjugate vaccines are particularly beneficial considering that the aim of immunization in travelers is to reduce the risk of disease in the individual as well as reduce the likelihood of transmission to others and the international spread of infection. At present, there are two glycoconjugate multivalent meningococcal vaccines available that protect against disease caused by serogroups A, C, W-135, and Y for use in individuals aged 11 to 55 years; one also includes 2- to 10-year-olds. Although Selleckchem EPZ015666 these vaccines are effective and well tolerated, gaps remain in our

arsenal against meningococcal disease. There currently is no vaccine available that offers broad protection against multiple strains of N meningitidis serogroup B, which is Ruxolitinib in vitro a major cause of meningococcal disease outbreaks and epidemics in many regions in the world. Moreover, the emergence of the new serogroup X in recent years, mainly in Niger, must be closely monitored, as there is no vaccine available for it.49 Finally, there is no vaccine currently indicated for protection against meningococcal disease in infants under 2 years of age. However, there is hope for the future. A glycoconjugate meningococcal ACWY-CRM vaccine is now licensed in various countries that can be used from the age of 2 months. Vaccines against serogroup B are in advanced

development. Furthermore, updated national travel

recommendations may provide travel aminophylline medicine providers with an effective tool to evaluate meningococcal vaccination as a means to help prevent contagion and spread of infectious disease globally. Editorial assistance by International Meetings & Science, Inc. is gratefully acknowledged. R. S. has accepted fee for speaking, organizing and chairing education, consulting and/or serving on advisory boards, reimbursement for attending meetings, and/or funds for research from Baxter, GlaxoSmithKline, Novartis Vaccines, and Sanofi Pasteur MSD. “
“Background. Previous studies investigating the travelers’ knowledge, attitudes, and practices (KAP) profile indicated an important educational need among those traveling to risk destinations. Initiatives to improve such education should target all groups of travelers, including business travelers, those visiting friends and relatives (VFR), and older adult travelers. Methods. In the years 2002 to 2009, a longitudinal questionnaire-based survey was conducted at the Dutch Schiphol Airport with the aim to study trends in KAP of travel risk groups toward prevention of hepatitis A. The risk groups last-minute travelers, solo travelers, business travelers, travelers VFR, and older adult travelers were specifically studied. Results. A total of 3,045 respondents were included in the survey.

43 Glycoconjugate vaccines are particularly beneficial considering that the aim of immunization in travelers is to reduce the risk of disease in the individual as well as reduce the likelihood of transmission to others and the international spread of infection. At present, there are two glycoconjugate multivalent meningococcal vaccines available that protect against disease caused by serogroups A, C, W-135, and Y for use in individuals aged 11 to 55 years; one also includes 2- to 10-year-olds. Although Dabrafenib order these vaccines are effective and well tolerated, gaps remain in our

arsenal against meningococcal disease. There currently is no vaccine available that offers broad protection against multiple strains of N meningitidis serogroup B, which is Selleck SCH772984 a major cause of meningococcal disease outbreaks and epidemics in many regions in the world. Moreover, the emergence of the new serogroup X in recent years, mainly in Niger, must be closely monitored, as there is no vaccine available for it.49 Finally, there is no vaccine currently indicated for protection against meningococcal disease in infants under 2 years of age. However, there is hope for the future. A glycoconjugate meningococcal ACWY-CRM vaccine is now licensed in various countries that can be used from the age of 2 months. Vaccines against serogroup B are in advanced

development. Furthermore, updated national travel

recommendations may provide travel Vildagliptin medicine providers with an effective tool to evaluate meningococcal vaccination as a means to help prevent contagion and spread of infectious disease globally. Editorial assistance by International Meetings & Science, Inc. is gratefully acknowledged. R. S. has accepted fee for speaking, organizing and chairing education, consulting and/or serving on advisory boards, reimbursement for attending meetings, and/or funds for research from Baxter, GlaxoSmithKline, Novartis Vaccines, and Sanofi Pasteur MSD. “
“Background. Previous studies investigating the travelers’ knowledge, attitudes, and practices (KAP) profile indicated an important educational need among those traveling to risk destinations. Initiatives to improve such education should target all groups of travelers, including business travelers, those visiting friends and relatives (VFR), and older adult travelers. Methods. In the years 2002 to 2009, a longitudinal questionnaire-based survey was conducted at the Dutch Schiphol Airport with the aim to study trends in KAP of travel risk groups toward prevention of hepatitis A. The risk groups last-minute travelers, solo travelers, business travelers, travelers VFR, and older adult travelers were specifically studied. Results. A total of 3,045 respondents were included in the survey.

The diagnostic yield improved in the subgroup with LB lengths >15 mm. This result is in agreement with that of a previous validation study in HIV/HCV-coinfected patients [9]. Analyses of discordant results between LB and noninvasive techniques for diagnosing fibrosis have also shown a reduction in discordance for larger

biopsy samples [22]. The patients included in LB studies are usually regarded as not representative of the general HIV/HCV-infected population. The selection of patients takes into consideration factors such as adherence to HAART, number of clinical visits missed, control of HIV disease, and abstinence from drug or alcohol abuse. Thus, the indexes evaluated in validation studies may perform less well in unselected patients. Tanespimycin cost The GRAFIHCO study included a large group of patients with HIV/HCV coinfection and availability Selleck PLX3397 of current simple blood tests from a wide variety of health care facilities in Spain, including nonreferral centres and prisons. We compared the subgroup of patients selected for the present analysis with the whole study group. We found some expected differences between the two groups. Alcohol use was less frequent in the patients selected for this subanalysis.

HIV disease control was better in the study patients, as reflected by a higher CD4 cell count and more frequent undetectable HIV RNA, in spite of similar rates of antiretroviral therapy prescription in the two groups. All of these characteristics are consistent with the profile of a typical candidate to undergo LB, i.e. a patient who is abstinent from alcohol, does not miss clinical visits and is adherent to antiretroviral therapy. However, the magnitude of the differences between groups in alcohol intake, HIV RNA and CD4 cell counts was small. In addition, these variables did not significantly affect the performance of the indexes. These suggest that the degree of selection in this population was not high. Finally, the APRI and the FI showed similar values in both the GRAFIHCO population and the patients selected for this analysis.

To our knowledge, this is the first study that attempts to validate simple indexes Thalidomide for the prediction of liver fibrosis in patients that could be regarded as fairly representative of a large population with HIV/HCV coinfection in a Western country. In conclusion, the APRI and the FI can be used to predict clinically relevant liver fibrosis in HIV/HCV-coinfected patients in nonreferral health care facilities. The simplicity and wide availability of the tests involved in the calculation of these indexes, coupled with their low cost, makes them attractive as elective techniques for the diagnosis of fibrosis in low-resource settings. This study was supported by a grant from Abbott Laboratories. The authors wish to thank the Spanish Health Ministry (ISCIII-RETIC RD06/006) for financial support. Members of the GRAFIHCO Study Team were: R. Fernández, R.