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Biomedical subjects

Samy I McFarlane

Publications and source records attributed to Samy I McFarlane.

At least 19 recordsLinked to original sources
PubMed2006

Antiepileptic drugs and bone metabolism.

Anti-epileptic medications encompass a wide range of drugs including anticonvulsants, benzodiazepines, enzyme inducers or inhibitors, with a variety effects, including induction of cytochrome P450 and other enzyme, which may lead to catabolism of vitamin D and hypocalcemia and other effects that may significantly effect the risk for low bone mass and fractures. With the current estimates of 50 million people worldwide with epilepsy together with the rapid increase in utilization of these medications for other indications, bone disease associated with the use of anti-epileptic medications is emerging as a serious health threat for millions of people. Nevertheless, it usually goes unrecognized and untreated. In this review we discuss the pathophysiologic mechanisms of bone disease associated with anti-epileptic use, including effect of anti-epileptic agents on bone turnover and fracture risk, highlighting various strategies for prevention of bone loss and associated fractures a rapidly increasing vulnerable population.

Journal Article↗
PubMed2006

Cardiometabolic syndrome and chronic kidney disease.

Chronic kidney disease (CKD) is increasingly recognized as a major risk factor for end-stage renal disease (ESRD), cardiovascular (CV) disease, and CV-related premature death. More than 8 million people in the United States have CKD; therefore, preventive stratiegies should be directed at identifying risk factors for this condition. There is growing evidence implicating the cardiometabolic syndrome, a clustering of CV risk factors that include obesity, insulin resistance, compensatory hyperinsulinemia, dysglycemia, atherogenic dyslipidemia, and hypertension. Factors mediating this relationship include increased glomerular filtration, increased vascular permeability, oxidative and endoplasmic reticulum stress, activation of the renin-angiotensin system, and inappropriate secretion of growth factors. The consequences are microalbuminuria, a marker of inflammation and endothelial dysfunction, renal vascular proliferation, extracellular matrix expansion, and CKD. Prevention of CKD should be directed at controlling all components of the cardiometabolic syndrome, with the ultimate goal of reducing the burden imposed by ESRD.

Albuminuria↗
PubMed2006

Anemia and cardiovascular disease in diabetic nephropathy.

Cardiovascular disease (CVD) is the major cause of morbidity and mortality in people with diabetes and in those with chronic kidney disease (CKD). Diabetes, occurring in epidemic proportions in the United States and worldwide, is also the leading cause of CKD and kidney failure. Identification of modifiable risk factors for CVD in patients with diabetes and CKD is thus of paramount importance. Anemia is increasingly recognized as a potential CVD risk factor in patients with diabetic nephropathy, in whom it is generally more severe and occurs at an earlier stage of CKD. In this review, we discuss the epidemiologic evidence, pathophysiologic mechanisms, and the current research findings, highlighting the role of anemia as a potential modifiable risk factor for CVD in patients with diabetic nephropathy, a particularly vulnerable population for CVD.

Anemia↗
PubMed2006

Gender disparity in outcomes of care and management for diabetes and the metabolic syndrome.

Although diabetes lies among the major risk factors for cardiovascular disease (CVD) in both men and women, current evidence suggests that it has a much stronger effect on the risk of coronary heart disease (CHD) in women than in men. Moreover, diabetic women have not experienced the decline in CHD mortality observed in diabetic men and individuals without diabetes over the past three decades. Apart from a more pronounced direct effect of diabetes on the vascular wall, this greater impact of diabetes on CHD risk in women could be associated with a heavier burden of other traditional cardiovascular risk factors within the context of the metabolic syndrome, a stronger effect of the metabolic syndrome on CVD, and a less aggressive management of the various risk factors in diabetic women compared with men. This article discusses the recent evidence on the gender differences in the outcomes of CVD and the management of risk factors associated with diabetes and the metabolic syndrome, highlighting the need for better treatment strategies of diabetes and the other components of the metabolic syndrome in diabetic women.

Cardiovascular Diseases↗
PubMed2006

Diabetes insipidus: diagnosis and treatment of a complex disease.

Diabetes insipidus, characterized by excretion of copious volumes of dilute urine, can be life-threatening if not properly diagnosed and managed. It can be caused by two fundamentally different defects: inadequate or impaired secretion of antidiuretic hormone (ADH) from the posterior pituitary gland (neurogenic or central diabetes insipidus) or impaired or insufficient renal response to ADH (nephrogenic diabetes insipidus). The distinction is essential for effective treatment.

Diabetes Insipidus↗
PubMed2005

The case for low carbohydrate diets in diabetes management.

A low fat, high carbohydrate diet in combination with regular exercise is the traditional recommendation for treating diabetes. Compliance with these lifestyle modifications is less than satisfactory, however, and a high carbohydrate diet raises postprandial plasma glucose and insulin secretion, thereby increasing risk of CVD, hypertension, dyslipidemia, obesity and diabetes. Moreover, the current epidemic of diabetes and obesity has been, over the past three decades, accompanied by a significant decrease in fat consumption and an increase in carbohydrate consumption. This apparent failure of the traditional diet, from a public health point of view, indicates that alternative dietary approaches are needed. Because carbohydrate is the major secretagogue of insulin, some form of carbohydrate restriction is a prima facie candidate for dietary control of diabetes. Evidence from various randomized controlled trials in recent years has convinced us that such diets are safe and effective, at least in short-term. These data show low carbohydrate diets to be comparable or better than traditional low fat high carbohydrate diets for weight reduction, improvement in the dyslipidemia of diabetes and metabolic syndrome as well as control of blood pressure, postprandial glycemia and insulin secretion. Furthermore, the ability of low carbohydrate diets to reduce triglycerides and to increase HDL is of particular importance. Resistance to such strategies has been due, in part, to equating it with the popular Atkins diet. However, there are many variations and room for individual physician planning. Some form of low carbohydrate diet, in combination with exercise, is a viable option for patients with diabetes. However, the extreme reduction of carbohydrate of popular diets (<30 g/day) cannot be recommended for a diabetic population at this time without further study. On the other hand, the dire objections continually raised in the literature appear to have very little scientific basis. Whereas it is traditional to say that more work needs to be done, the same is true of the assumed standard low fat diets which have an ambiguous record at best. We see current trends in the national dietary recommendations as a positive sign and an appropriate move in the right direction.

Journal Article↗
PubMed2005

Differential effect of obesity on bone mineral density in White, Hispanic and African American women: a cross sectional study.

Osteoporosis is a major public health problem with low bone mass affecting nearly half the women aged 50 years or older. Evidence from various studies has shown that higher body mass index (BMI) is a protective factor for bone mineral density (BMD). Most of the evidence, however, is from studies with Caucasian women and it is unclear to what extent ethnicity plays a role in modifying the effect of BMI on BMD.A cross sectional study was performed in which records of postmenopausal women who presented for screening for osteoporosis at 2 urban medical centres were reviewed. Using logistic regression, we examined the interaction of race and BMI after adjusting for age, family history of osteoporosis, maternal fracture, smoking, and sedentary lifestyle on BMD. Low BMD was defined as T-score at the lumbar spine < -1.Among 3,206 patients identified, the mean age of the study population was 58.3 +/- 0.24 (Years +/- SEM) and the BMI was 30.6 kg/m2. 2,417 (75.4%) were African Americans (AA), 441(13.6%) were Whites and 348 (10.9%) were Hispanics. The AA women had lower odds of having low BMD compared to Whites [Odds ratio (OR) = 0.079 (0.03-0.24) (95% CI), p < 0.01]. The odds ratio of low BMD was not statistically significant between White and Hispanic women. We examined the interaction between race and BMD. For White women; as the BMI increases by unity, the odds of low BMD decreases [OR = 0.9 (0.87-0.94), p < 0.01; for every unit increase in BMI]. AA women had slightly but significantly higher odds of low BMD compared to Whites [OR 1.015 (1.007-1.14), p <0.01 for every unit increase in BMI]. This effect was not observed when Hispanic women were compared to Whites.There is thus a race-dependent effect of BMI on BMD. With each unit increase in BMI, BMD increases for White women, while a slight but significant decrease in BMD occurs in African American women.

Journal Article↗
PubMed2005

Challenges in the diagnosis and management of new-onset diabetes after transplantation.

With the availability of newer and more potent immunosuppressive agents, post-transplant survival has markedly improved. However, these agents, together with the rising age of transplant recipients, have been associated with a rise in the incidence of new-onset diabetes after transplantation (NODAT). Besides the traditional risk factors for diabetes mellitus, such as age, obesity, hypertension, and family history of diabetes, additional risk factors for NODAT are identified. These include immunosuppressive therapy, hepatitis C infection, acute rejection, and deceased donor kidney transplant. In this article, we discuss the epidemiology, risk factors, pathophysiology, clinical course, and therapeutic and diagnostic challenges of this emerging disease.

Diabetes Mellitus↗
PubMed2005

Stroke prevention in diabetic and other high cardiovascular risk patients.

Diabetes is a major risk factor for stroke that is usually associated with risk factors such as hypertension, obesity, albuminuria, and dyslipidemia. Furthermore, atrial fibrillation and heart failure, two of the most important risk factors of stroke, are common in the diabetic population. With the rising epidemic of diabetes, the incidence of stroke is also on the rise. Implementations of effective stroke prevention strategies appear to be the most rational option to curb this growing epidemic. In this review, we examine the epidemiologic and the pathophysiologic association between stroke and diabetes, highlighting the population-based stroke preventive measures. These include hygienic and lifestyle changes, that if applied effectively could offer a great potential for stroke prevention and reduction of the cardiovascular burden in the diabetic populations.

Behavior Therapy↗
PubMed2005

Cardiovascular disease in diabetes and the cardiometabolic syndrome: focus on minority women.

Diabetes and the cardiometabolic syndrome (CMS) are evolving as global epidemics. In the United States, diabetes affects 20 million people, with 47 million afflicted with the CMS. These disorders have a higher propensity for women, particularly in minority populations with disproportionate increase in cardiovascular disease (CVD) morbidity and mortality. Despite the decline in CVD mortality rates in the general population over the past 35 years parallel to the advances in therapeutic interventions, these rates have increased in women with diabetes. Early preventive measures for CVD risk factor through behavioral and lifestyle modification, smoking cessation, and reduction in psychosocial stressors, as well as pharmacotherapy, are among the currently supported approaches to CVD risk reduction in this high-risk population. In this article, we discuss CVD in people with diabetes and the CMS, with emphasis on minority women, a particularly vulnerable population.

Cardiovascular Diseases↗
PubMed2005

Hypertension in patients with Cushing's disease: pathophysiology, diagnosis, and management.

Hypertension is a very common comorbidity in patients with Cushing's disease/syndrome, resulting from the interplay of several pathophysiologic mechanisms, including stimulation of mineralocorticoid and glucocorticoid receptors as well as the associated insulin resistance, sleep apnea, and overexpression of renin-angiotensin system. Although treatment of Cushing's disease results in resolution or amelioration of hypertension in these patients, a significant proportion of patients do not achieve complete cure or require a prolonged period of time for complete response to therapy. Therefore, therapeutic strategies for Cushing's-specific hypertension are necessary to decrease morbidity and mortality associated with this disease. In this review, we discuss the pathophysiology of hypertension in patients with Cushing's disease, highlighting the therapeutic options, including the exciting new developments in the role of peroxisome proliferator-activated receptor (PPAR)-g agonists in the management of this patient population.

Adrenalectomy↗
PubMed2005

Challenges in the diagnosis and management of renal artery stenosis.

Renal artery stenosis (RAS) is a common cause of secondary hypertension, with the activation of the renin-angiotensin-aldosterone system being the pathophysiologic hallmark of the disease. Renovascular hypertension, ischemic nephropathy, proteinuria, and flash pulmonary edema are the main clinical syndromes associated with RAS. The prevalence of RAS is on the rise, owing to an increasing prevalence of diabetes and atherosclerotic disease among our aging population. This rise in RAS prevalence poses major challenges for clinicians making diagnostic and treatment decisions. Although renal angioplasty is of proven benefit in fibromuscular dysplasia, randomized trials in atherosclerotic RAS have not shown any advantage for revascularization over medical therapy in terms of blood pressure control or renal function preservation. Angioplasty and surgical interventions should be reserved for patients with preserved kidney size and hemodynamically significant stenosis.

Angioplasty↗
PubMed2005

Hypertension in pregnancy.

Hypertension in pregnancy contributes significantly to both maternal and neonatal morbidity and mortality. Among different forms of pregnancy-associated hypertension, preeclampsia-eclampsia has the highest impact on morbidity and mortality. Chronic hypertension may result in preterm and small for gestational age infants, even when it is mild-to-moderate. Chronic hypertension is a risk factor for superimposed preeclampsia and results in higher rates of adverse outcome. Preeclampsia is a multisystemic disease that is thought to be initiated by abnormalities in placental perfusion and endothelial dysfunction, ultimately resulting in multiorgan failure. Preeclampsia is more common in women of minority ethnicity who are socioeconomically disadvantaged. Pharmacologic therapy for hypertensive disorders in pregnancy is limited by concerns regarding the safety of both mother and fetus. Although treatment of severe hypertension is not debated, there is no consensus on the rationale for pharmacologic therapy of mild-to-moderate hypertension in pregnancy.

Antineoplastic Agents↗