Gene/Protein Disease Symptom Drug Enzyme Compound
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Query: UMLS:C0018799 (heart disease)
 34,133 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Diabetes mellitus is a disease with major long-term implications, not only for the health and well-being of affected individuals, but also for costs to the National Health Service. Treatment of the disease and its complications takes up 4-5% of total health care expenditure in the U.K. These costs are dominated by in-patient care for the complications arising from diabetes. This paper presents a review of studies which have been carried out on the costs of diabetes and its complications. For such a chronic and potentially disabling disease with numerous complications it is surprising that costs have not been more extensively researched. A large amount of data are available about the implications of diabetes in terms of incidence and prevalence, but few costs have been collected, particularly indirect and marginal costs. Both insulin dependent (IDDM) and non-insulin dependent (NIDDM) diabetic patients exhibit similar complications so that the cost of treatment may be comparable, but further studies are needed to establish this. In addition, few studies have included diabetes as a secondary diagnosis. The studies which are available have tended to focus on direct costs, for example, the costs of hospital care, consultations and drugs, because they are the easiest to measure. Fewer studies have included indirect costs, such as the effect of time lost from work, early retirement and premature death, because of the difficulties in assigning monetary values to these factors. The most important contributors to the costs of diabetes are those of treating complications such as eye and limb disease, heart disease, neuropathy and nephropathy.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:The costs of diabetes and its complications. 143 13

Growth hormone (GH)-cell adenomas are benign pituitary tumors which present with chronic high GH output. Hereditary GH-cell adenomas are rare and include MEN I, McCune Albright Syndrome, Carney complex and familial acromegaly. Most of the tumors causing acromegaly are sporadic. Acromegaly is a disfiguring and disabling disease and, if untreated, life expectancy is reduced by a decade. Elevated GH levels, hypertension and heart disease are major negative survival determinants in these patients. Current treatments for acromegaly attempt to control the disease by reducing growth hormone secretion from the tumor either by surgery, radiotherapy or medical therapy. The choice of therapy depends on age, general health, the severity and complications of the disease and dangers associated with each treatment. Assessment of disease activity in patients with acromegaly following treatment is a problem because no sensitive clinical parameters are available and there is no well-defined clinical endpoint that defines cure. Cure in acromegaly has been defined therefore as normalization of biochemical parameters. A consensus publication recommended biochemical cure be considered as nadir GH of less than 1 microm g/L after OGTT and a normal circulating IGF-I. In optimizing the control of acromegaly new therapeutic strategies are evolving (growth hormone receptor antagonist - pegvisomant, potent dopamine agonists, universal somatostatin receptor ligands, chimeric molecules). The aim of the evolving therapeutic strategies is to produce a normal life expectancy in patients with acromegaly.
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PMID:Acromegaly - evolving strategies. 1644 81

Chronic obstructive pulmonary disease (COPD) can be a disabling disease, and the impact on older adults is particularly evident in the nursing home setting. Chronic obstructive pulmonary disease is present in about 20% of nursing home residents, most often in women, and accounts for significant healthcare utilization including acute care visits for exacerbations and pneumonia, as well as worsening heart disease and diabetes mellitus. The emphasis on hospital readmissions is particularly important in nursing homes where institutions have quality measures that have financial implications. Optimizing drug therapies in individuals with COPD involves choosing medications that not only improve symptoms, but also decrease the risk of exacerbations. Optimizing the treatment of comorbidities such as heart disease, infections, and diabetes that may affect COPD outcomes is also an important consideration. Depending on the nursing home setting and the patient, the options for optimizing COPD drug therapies may be limited owing to patient-related factors such as cognition and physical impairment or available resources, primarily reimbursement-related issues. Choosing the best drug therapy for COPD in older adults is limited by the difficulty in assessing respiratory symptoms using standardized assessment tools and potentially decreased inspiratory ability of frail individuals. Because of cognitive and physical impediments, ensuring optimal delivery of inhaled medications into the lungs has significant challenges. Long-acting bronchodilators, inhaled corticosteroids, and roflumilast decrease the risk of exacerbations, although inhaled corticosteroids should be used judiciously in this population because of the risk of pneumonia and oropharyngeal side effects. Treatment of COPD exacerbations should occur early and consideration should be made to the benefits and risks of systemic corticosteroids and antibiotics. Clinical research in the COPD population in nursing homes is clearly lacking, and ripe for discovery of effective management strategies.
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PMID:Optimizing Drug Therapies in Patients with COPD in the US Nursing Home Setting. 3117 22