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Elevated depressive affect is associated with adverse cardiovascular outcomes among African Americans with chronic kidney disease  

PubMed Central

This study was designed to examine the impact of elevated depressive affect on health outcomes among participants with hypertensive chronic kidney disease in the African-American Study of Kidney Disease and Hypertension (AASK) Cohort Study. Elevated depressive affect was defined by Beck Depression Inventory II (BDI-II) thresholds of 11 or more, above 14, and by 5-Unit increments in the score. Cox regression analyses were used to relate cardiovascular death/hospitalization, doubling of serum creatinine/end-stage renal disease, overall hospitalization, and all-cause death to depressive affect evaluated at baseline, the most recent annual visit (time-varying), or average from baseline to the most recent visit (cumulative). Among 628 participants at baseline, 42% had BDI-II scores of 11 or more and 26% had a score above 14. During a 5-year follow-up, the cumulative incidence of cardiovascular death/hospitalization was significantly greater for participants with baseline BDI-II scores of 11 or more compared with those with scores <11. The baseline, time-varying, and cumulative elevated depressive affect were each associated with a significant higher risk of cardiovascular death/hospitalization, especially with a time-varying BDI-II score over 14 (adjusted HR 1.63) but not with the other outcomes. Thus, elevated depressive affect is associated with unfavorable cardiovascular outcomes in African Americans with hypertensive chronic kidney disease.

Fischer, Michael J.; Kimmel, Paul L.; Greene, Tom; Gassman, Jennifer J.; Wang, Xuelei; Brooks, Deborah H.; Charleston, Jeanne; Dowie, Donna; Thornley-Brown, Denyse; Cooper, Lisa A.; Bruce, Marino A.; Kusek, John W.; Norris, Keith C.; Lash, James P.



Sociodemographic factors contribute to the depressive affect among African Americans with chronic kidney disease  

PubMed Central

Depression is common in end-stage renal disease and is associated with poor quality of life and higher mortality; however, little is known about depressive affect in earlier stages of chronic kidney disease. To measure this in a risk group burdened with hypertension and kidney disease, we conducted a cross-sectional analysis of individuals at enrollment in the African American Study of Kidney Disease and Hypertension Cohort Study. Depressive affect was assessed by the Beck Depression Inventory II and quality of life by the Medical Outcomes Study-Short Form and the Satisfaction with Life Scale. Beck Depression scores over 14 were deemed consistent with an increased depressive affect and linear regression analysis was used to identify factors associated with these scores. Among 628 subjects, 166 had scores over 14 but only 34 were prescribed antidepressants. The mean Beck Depression score of 11.0 varied with the estimated glomerular filtration rate (eGFR) from 10.7 (eGFR 50–60) to 16.0 (eGFR stage 5); however, there was no significant independent association between these. Unemployment, low income, and lower quality and satisfaction with life scale scores were independently and significantly associated with a higher Beck Depression score. Thus, our study shows that an increased depressive affect is highly prevalent in African Americans with chronic kidney disease, is infrequently treated with antidepressants, and is associated with poorer quality of life. Sociodemographic factors have especially strong associations with this increased depressive affect. Because this study was conducted in an African-American cohort, its findings may not be generalized to other ethnic groups.

Fischer, Michael J.; Kimmel, Paul L.; Greene, Tom; Gassman, Jennifer J.; Wang, Xuelei; Brooks, Deborah H.; Charleston, Jeanne; Dowie, Donna; Thornley-Brown, Denyse; Cooper, Lisa A.; Bruce, Marino A.; Kusek, John W.; Norris, Keith C.; Lash, James P.



Chronic Diseases  

Microsoft Academic Search

Although diabetes mellitus, cardiovascular disease, and human immunodeficiency virus infection are three separate entities,\\u000a each has causal and non-causal risk factors that are common in the stage 5 chronic kidney disease population. The medical\\u000a nutrition therapies are similar, which emphasize adequate protein and energy intakes, fluid control, and possibly carbohydrate\\u000a and fat modifications. Each patient requires an individualized evaluation, taking

Sharon R. Schatz


Host and disease-specific factors affecting steatosis in chronic hepatitis C  

Microsoft Academic Search

Background\\/Aim: Steatosis is commonly present in chronic hepatitis C. Our aim was to evaluate host- and disease-specific factors associated with its occurrence.Methods: Histologic findings in 60 patients were correlated with body mass index, human leukocyte antigens, and other conventional parameters. Comparisons were made with 41 patients who had nonalcoholic steatohepatitis and 18 patients who had chronic hepatitis B.Results: Patients with

Albert J. Czaja; Herschel A. Carpenter; Paula J. Santrach; S. Breanndan Moore



-374 T/A RAGE Polymorphism Is Associated with Chronic Kidney Disease Progression in Subjects Affected by Nephrocardiovascular Disease  

PubMed Central

Background Chronic kidney disease (CKD) patients present elevated advanced glycation end products (AGEs) blood levels. AGEs promote inflammation through binding to their receptor (RAGE), located on the membrane of mesangial cells, endothelial cells and macrophages. Several genetic polymorphisms influence RAGE transcription, expression and activity, including the substitution of a thymine with an adenine (T/A) in the position -374 of the gene promoter of RAGE. Our study investigates the role of -374 T/A RAGE polymorphism in CKD progression in subjects affected by nephrocardiovascular disease. Methods 174 patients (119 males (68.4%) mean age 67.2±0.88 years; 55 females (31.6%): mean age 65.4±1.50 years) affected by mild to moderate nephrocardiovascular CKD were studied. Each subject was prospectively followed for 84 months, every 6–9 months. The primary endpoint of the study was a rise of serum creatinine concentrations above 50% of basal values or end stage renal disease. Results Carriers of the A/A and T/A genotype presented higher plasma levels of interleukin 6 (A/A 29.5±15.83; T/A 30.0±7.89, vs T/T 12.3±5.04 p?=?0.01 for both) and Macrophages chemoattractant protein 1 (A/A 347.1±39.87; T/A 411.8±48.41, vs T/T 293.5±36.20, p?=?0.04 for both) than T/T subjects. Carriers of the A allele presented a faster CKD progression than wild type patients (Log-Rank test: Chi square?=?6.84, p?=?0,03). Cox regression showed that -374 T/A RAGE polymorphism (p?=?0.037), albuminuria (p?=?0.01) and LDL cholesterol (p?=?0.038) were directly associated with CKD progression. HDL cholesterol (p?=?0.022) and BMI (p?=?0.04) were inversely related to it. No relationship was found between circulating RAGE and renal function decline. Conclusions -374 T/A RAGE polymorphism could be associated with CKD progression and inflammation. Further studies should confirm this finding and address whether inhibiting RAGE downstream signalling would be beneficial for CKD progression.

Baragetti, Ivano; Norata, Giuseppe Danilo; Sarcina, Cristina; Baragetti, Andrea; Rastelli, Francesco; Buzzi, Laura; Grigore, Liliana; Garlaschelli, Katia; Pozzi, Claudio; Catapano, Alberico Luigi



IL-1 signal affects both protection and pathogenesis of virus-induced chronic CNS demyelinating disease  

PubMed Central

Background Theiler’s virus infection induces chronic demyelinating disease in mice and has been investigated as an infectious model for multiple sclerosis (MS). IL-1 plays an important role in the pathogenesis of both the autoimmune disease model (EAE) and this viral model for MS. However, IL-1 is known to play an important protective role against certain viral infections. Therefore, it is unclear whether IL-1-mediated signaling plays a protective or pathogenic role in the development of TMEV-induced demyelinating disease. Methods Female C57BL/6 mice and B6.129S7-Il1r1tm1Imx/J mice (IL-1R KO) were infected with Theiler’s murine encephalomyelitis virus (1 x 106 PFU). Differences in the development of demyelinating disease and changes in the histopathology were compared. Viral persistence, cytokine production, and immune responses in the CNS of infected mice were analyzed using quantitative PCR, ELISA, and flow cytometry. Results Administration of IL-1?, thereby rending resistant B6 mice susceptible to TMEV-induced demyelinating disease, induced a high level of Th17 response. Interestingly, infection of TMEV into IL-1R-deficient resistant C57BL/6 (B6) mice also induced TMEV-induced demyelinating disease. High viral persistence was found in the late stage of viral infection in IL-1R-deficient mice, although there were few differences in the initial anti-viral immune responses and viral persistent levels between the WT B6 and IL-1R-deficiecent mice. The initial type I IFN responses and the expression of PDL-1 and Tim-3 were higher in the CNS of TMEV-infected IL-1R-deficient mice, leading to deficiencies in T cell function that permit viral persistence. Conclusions These results suggest that the presence of high IL-1 level exerts the pathogenic role by elevating pathogenic Th17 responses, whereas the lack of IL-1 signals promotes viral persistence in the spinal cord due to insufficient T cell activation by elevating the production of inhibitory cytokines and regulatory molecules. Therefore, the balance of IL-1 signaling appears to be extremely important for the protection from TMEV-induced demyelinating disease, and either too much or too little signaling promotes the development of disease.



Does lobectomy for lung cancer in patients with chronic obstructive pulmonary disease affect lung function? A multicenter national study  

Microsoft Academic Search

Objective: The purpose of this study was to evaluate the effect of lobectomy on pulmonary function in patients with chronic obstructive pulmonary disease. Methods: One hundred thirty-seven patients were analyzed; 49 had normal pulmo- nary function tests, and 88 had chronic obstructive pulmonary disease. Different functional parameter groups were identified: obstructive (forced expiratory volume in 1 second (FEV1), forced expiratory

Sergio Baldi; Enrico Ruffini; Sergio Harari; Gian Carlo Roviaro; Mario Nosotti; Nadia Bellaviti; Federico Venuta; Daniele Diso; Federico Rea; Claudio Schiraldi; Alberto Durigato; Maurizio Pavanello; Angelo Carretta; Piero Zannini



Environmental and Occupational Exposures: Do They Affect Chronic Obstructive Pulmonary Disease Differently in Women and Men?  

Microsoft Academic Search

chronicobstructivepulmonarydiseasemortalityinrelationtotraffic among elderly women compared with men, the other finding no gender difference). Two other environmental studies suggested small gender differences with slightly greater effect of biomass or traffic-related pollution among women. Four of five occupational studiesalsofoundincreasedeffectsofworkplacepollutantexposure on measures of chronic airflow obstruction or bronchitis symptoms in women; again the differences were small. Preliminary findings from analysis of pooled data

Susan M. Kennedy; Reid Chambers; Weiwei Du; Helen Dimich-Ward



Clinical Factors Affecting the Direct Cost of Patients Hospitalized with Acute Exacerbation of Chronic Obstructive Pulmonary Disease  

PubMed Central

Background: Chronic obstructive pulmonary disease (COPD) is a disease of increasing significance in terms of economic and social burden due to its increasing prevalence and high costs. Direct costs of COPD are mostly associated with hospitalization expenditures. In this study, our objective was to investigate the costs of hospitalization and factors affecting these costs in patients hospitalized due to acute exacerbation of COPD (AECOPD). Methods: A total of 284 patients hospitalized AECOPD were included in the study. Data were examined retrospectively using the electronic hospital charts. Results: Mean duration of hospitalization was 11.38 ± 6.94 days among study patients. Rates of admission to the intensive care unit, initiation of non-invasive mechanical ventilation (NIMV) and invasive mechanical ventilation (MIV) were 37.3% (n=106), 44.4% (n=126) and 18.3% (n=52) respectively. The rate of mortality was 14.8% (n=42). Mean cost of a single patient hospitalized for an AECOPD was calculated as $1765 ± 2139. Mean cost of admission was $889 ± 533 in standard ward, and $2508 ± 2857 in intensive care unit (ICU). The duration of hospitalization, a FEV1% predicted value below 30%, having smoked 40 package-years or more, the number of co-morbidities, NIMV, IMV, ICU, exitus and the number of hospitalizations in the past year were among the factors that increased costs significantly. Hospital acquired pneumonia, chronic renal failure and anemia also increased the costs of COPD significantly. Conclusion: The costs of treatment increase with the severity of COPD or with progression to a higher stage. Efforts and expenditures aimed at preventing COPD exacerbations might decrease the costs in COPD.

Ornek, Tacettin; Tor, Meltem; Alt?n, Remzi; Atalay, Figen; Geredeli, Elif; Soylu, Omer; Erboy, Fatma



Chronic wasting disease  

PubMed Central

Until recently, chronic wasting disease of cervids, the only wildlife prion disease, was believed to be geographically concentrated to Colorado and Wyoming within the United States. However, increased surveillance has unveiled several additional pockets of CWD-infected deer and elk in 12 additional states and 2 Canadian provinces. Deer and elk with CWD have extensive aggregates of PrPSc not only in the central nervous system, but also in peripheral lymphoid tissues, skeletal muscle, and other organs, perhaps influencing prion shedding. Indeed, CWD is transmitted efficiently among animals by horizontal routes, although the mechanism of spread is unknown. Genetic polymorphisms in the Prnp gene may affect CWD susceptibility, particularly at codon 225 (S/F) in deer and codon 132 (M/L) in elk. Since CWD infects free-ranging animals and is efficiently spread, disease management will be a challenge.

Sigurdson, Christina J.; Aguzzi, Adriano



Children, Sports, and Chronic Disease.  

ERIC Educational Resources Information Center

Discusses four chronic diseases (cystic fibrosis, congenital heart disease, rheumatoid arthritis, and asthma) that affect American children. Many have their physical activities unnecessarily restricted, though sports and exercise can actually alleviate symptoms and improve their psychosocial development. Physicians are encouraged to prescribe…

Goldberg, Barry



Children, Sports, and Chronic Disease.  

ERIC Educational Resources Information Center

|Discusses four chronic diseases (cystic fibrosis, congenital heart disease, rheumatoid arthritis, and asthma) that affect American children. Many have their physical activities unnecessarily restricted, though sports and exercise can actually alleviate symptoms and improve their psychosocial development. Physicians are encouraged to prescribe…

Goldberg, Barry



Micellar electrokinetic chromatography for the determination of urinary desmosine and isodesmosine in patients affected by chronic obstructive pulmonary disease  

Microsoft Academic Search

The presence in urine of desmosine (DES) and isodesmosine (IDES), two crosslinked amino acids unique to the elastic fiber network, can be used as a specific indicator of degradation of mature elastin. Compared to methodologies so far available, the capillary electrophoretic technique reported here seems to be suitable and convenient for determining desmosines in urine of patients affected by chronic

Simona Viglio; Giuseppe Zanaboni; Maurizio Luisetti; Rocco Trisolini; Rudi Grimm; Giuseppe Cetta; Paolo Iadarola



Chronic Disease Indicators  

NSDL National Science Digital Library

The Chronic Disease Indicators (CDI) is a cross-cutting set of 97 indicators that were developed by consensus and that allows states and territories and large metropolitan areas to uniformly define, collect, and report chronic disease data that are important to public health practice and available for states, territories and large metropolitan areas. 

Control, Center F.


Chronic wasting disease  

Technology Transfer Automated Retrieval System (TEKTRAN)

Chronic wasting disease (CWD) is an emerging prion disease of deer, elk, and moose in North America. This fatal neurodegenerative disease was first recognized 50 years ago and its distribution was limited to the Rocky Mountains for several decades. In the past few years, CWD has been found in the ea...


Chronic granulomatous disease  


CGD; Fatal granulomatosis of childhood; Chronic granulomatous disease of childhood; Progressive septic granulomatosis ... The condition is often discovered in very early childhood. Milder forms may be diagnosed during the teen ...


Chronic Kidney Disease  


You have two kidneys, each about the size of your fist. Their main job is to filter wastes and excess water out of ... help control blood pressure, and make hormones. Chronic kidney disease (CKD) means that your kidneys are damaged ...


Chronic Granulomatous Disease  

Microsoft Academic Search

Chronic granulomatous disease (CGD) was first described in the 1950s and has become a paradigm for genetic neutrophil diseases.\\u000a It is characterized by recurrent infections with a narrow spectrum of bacteria and fungi as well as a common set of inflammatory\\u000a complications most notably including inflammatory bowel disease. Over the last half century major advances in management have\\u000a profoundly altered

Steven M. Holland



Chronic obstructive pulmonary disease  

PubMed Central

The global prevalence of physiologically defined chronic obstructive pulmonary disease (COPD) in adults aged >40 yr is approximately 9-10 per cent. Recently, the Indian Study on Epidemiology of Asthma, Respiratory Symptoms and Chronic Bronchitis in Adults had shown that the overall prevalence of chronic bronchitis in adults >35 yr is 3.49 per cent. The development of COPD is multifactorial and the risk factors of COPD include genetic and environmental factors. Pathological changes in COPD are observed in central airways, small airways and alveolar space. The proposed pathogenesis of COPD includes proteinase-antiproteinase hypothesis, immunological mechanisms, oxidant-antioxidant balance, systemic inflammation, apoptosis and ineffective repair. Airflow limitation in COPD is defined as a postbronchodilator FEV1 (forced expiratory volume in 1 sec) to FVC (forced vital capacity) ratio <0.70. COPD is characterized by an accelerated decline in FEV1. Co morbidities associated with COPD are cardiovascular disorders (coronary artery disease and chronic heart failure), hypertension, metabolic diseases (diabetes mellitus, metabolic syndrome and obesity), bone disease (osteoporosis and osteopenia), stroke, lung cancer, cachexia, skeletal muscle weakness, anaemia, depression and cognitive decline. The assessment of COPD is required to determine the severity of the disease, its impact on the health status and the risk of future events (e.g., exacerbations, hospital admissions or death) and this is essential to guide therapy. COPD is treated with inhaled bronchodilators, inhaled corticosteroids, oral theophylline and oral phosphodiesterase-4 inhibitor. Non pharmacological treatment of COPD includes smoking cessation, pulmonary rehabilitation and nutritional support. Lung volume reduction surgery and lung transplantation are advised in selected severe patients. Global strategy for the diagnosis, management and prevention of Chronic Obstructive Pulmonary Disease guidelines recommend influenza and pneumococcal vaccinations.

Vijayan, V.K.



Sleep and Chronic Disease  


... found at . Sleep and Sleep Disorders ? Sleep About Us About Sleep Key Sleep Disorders Sleep and Chronic Disease How Much Sleep Do ... of depression be monitored among persons with a sleep disorder. 4, 5 References Knutson KL, Ryden AM, Mander ...


Chronic Wasting Disease  

Microsoft Academic Search

Chronic wasting disease (CWD) is a unique transmissible spongiform encephalopathy (TSE) of mule deer (Odocoileus hemionus), white-tailed deer (O. virginianus), and Rocky Mountain elk (Cervus elaphus nelsoni). The natural history of CWD is incompletely understood, but it differs from scrapie and bovine spon- giform encephalopathy (BSE) by virtue of its occurrence in nondomestic and free-ranging species. CWD has many features

E. S. Williams



Chronic obstructive pulmonary disease  

Microsoft Academic Search

Chronic Obstructive Pulmonary disease (COPD), characterized by poorly reversible airflow limitation, and strongly associated with tobacco smoking, is estimated to cause >2.5 million deaths per year worldwide. Active smokers have more acute exacerbations, which correlate with long-term decline in lung function. The diagnosis, severity assessment and monitoring of COPD rely heavily but not exclusively on spirometry. Smoking cessation reduces exacerbation

S Singh



Chronic Wasting Disease  

USGS Publications Warehouse

Chronic wasting disease (CWD) is an always-fatal, neurological illness occurring in North American cervids (members of the deer family), including white-tailed deer, mule deer, elk and moose. Since its discovery in 1967, CWD has spread geographically and increased in prevalence locally. CWD is contagious; it can be transmitted freely within and among free-ranging populations. It is likely that diseased animals can transmit CWD to healthy animals long before they become clinically ill. Managing CWD in free-ranging populations is extremely difficult, therefore preventative measures designed to reduce the chance for disease spread are critically important.

Richards, Bryan



Chronic Obstructive Pulmonary Disease: A Chronic Systemic Inflammatory Disease  

Microsoft Academic Search

Chronic obstructive pulmonary disease (COPD) is characterized by chronic inflammation in both the airways causing airway obstruction and the lung tissues causing emphysema. The disease is induced by inhalation of noxious gasses and particulate matter resulting in a chronic persistent inflammatory response in the lung, and the extent of the inflammatory reaction correlates with the severity of the disease. This

Stephan F. van Eeden; Don D. Sin



Evaluation of the effect of vincamine teprosilate on behavioural performances of patients affected with chronic cerebrovascular disease.  


With a view to determining the efficacy of Teproside versus placebo in patients affected with cerebrovascular disease, 30 subjects, selected at the Montescano Medical Rehabilitation Centre, were randomly divided into two groups of 15 subjects each. After a two-week wash-out period, the first group was treated with placebo and the second with vincamine teprosilate (Teproside) at 120 mg daily, both for a period of 90 days. The assessment of each patient took place in two stages, one at the beginning and one at the end of treatment. It was performed according to both clinical criteria (including an interview with the patient and his family) and neuro-psychological criteria (memory tests, perceptive-spatial and logical functions tests). The data obtained showed a significant improvement of the behavioural performance, the mnemonic ability and the perceptive-motor activity in the Teproside group treated. PMID:6500778

Casale, R; Giorgi, I; Guarnaschelli, C



Anemia of chronic disease.  


Anemia of chronic disease (ACD) or inflammation may be secondary to infections, autoimmune disorders, chronic renal failure, or malignancies. It is characterized by an immune activation with an increase in inflammatory cytokines and resultant increase in hepcidin levels. In addition, inappropriate erythropoietin levels or hyporesponsiveness to erythropoietin and reduced red blood cell survival contribute to the anemia. Hepcidin being the central regulator of iron metabolism plays a key role in the pathophysiology of ACD. Hepcidin binds to the iron export protein, ferroportin, present on macrophages, hepatocytes, and enterocytes, causing degradation of the latter. This leads to iron trapping within the macrophages and hepatocytes, resulting in functional iron deficiency. Production of hepcidin is in turn regulated by iron stores, inflammation, and erythropoiesis via the BMP-SMAD and JAK-STAT signaling pathways. Treatment of anemia should primarily be directed at the underlying disease, and conventional therapy such as red blood cell transfusions, iron, erythropoietin, and novel agents targeting the hepcidin-ferroportin axis and signaling pathways (BMP-SMAD, JAK-STAT) involved in hepcidin production also may be considered. PMID:23953340

Gangat, Naseema; Wolanskyj, Alexandra P



Heritability of chronic venous disease  

PubMed Central

Varicose veins without skin changes have a prevalence of approximately 20% in Northern and Western Europe whereas advanced chronic venous insufficiency affects about 3% of the population. Genetic risk factors are thought to play an important role in the aetiology of both these chronic venous diseases (CVD). We evaluated the relative genetic and environmental impact upon CVD risk by estimating the heritability of the disease in 4,033 nuclear families, comprising 16,434 individuals from all over Germany. Upon clinical examination, patients were classified according to the CEAP guidelines as either C2 (simple varicose veins), C3 (oedema), C4 (skin changes without ulceration), C5 (healed ulceration), or C6 (active ulcers). The narrow-sense heritability (h2) of CVD equals 17.3% (standard error 2.5%, likelihood ratio test P = 1.4 × 10?13). The proportion of disease risk attributable to age (at ascertainment) and sex, the two main risk factors for CVD, was estimated as 10.7% (Kullback–Leibler deviance R2). The heritability of CVD is high, thereby suggesting a notable genetic component in the aetiology of the disease. Systematic population-based searches for CVD susceptibility genes are therefore warranted.

Krusche, Petra; Wolf, Andreas; Krawczak, Michael; Timm, Birgitt; Nikolaus, Susanna; Frings, Norbert; Schreiber, Stefan



Systemic Effects of Chronic Obstructive Pulmonary Disease  

Microsoft Academic Search

Chronic obstructive pulmonary disease (COPD) affects various struc- tural and functional domains in the lungs. It also has significant extrapulmonary effects, the so-called systemic effects of COPD. Weight loss, nutritional abnormalities, and skeletal muscle dysfunc- tion are well-recognized systemic effects of COPD. Other less well- known but potentially important systemic effects include an in- creased risk of cardiovascular disease and

Alvar G. N. Agusti



Chronic liver disease in Aboriginal North Americans  

Microsoft Academic Search

A structured literature review was performed to detail the frequency and etiology of chronic liver disease (CLD) in Aboriginal North Americans. CLD affects Aboriginal North Americans disproportionately and is now one of the most common causes of death. Alcoholic liver disease is the leading etiology of CLD, but viral hepatitis, particularly hepatitis C, is an important and growing cause of

John D Scott; Naomi Garland



Chronic granulomatous disease mimicking Crohn's disease.  


A 34-month-old boy with intermittent diarrhoea and abdominal distension from 2 months of age, a chronic microabscess of the cheek, gastric antral narrowing, and perianal abscesses containing granulomata was found at colonscopy to have extensive, noncaseating, submucosal ileal and colonic granulomata. He was initially thought to have Crohn's disease, but then developed a cervical abscess, and a diagnosis of chronic granulomatous disease was established. This is an important, although rare, differential diagnosis of chronic inflammatory bowel disease in childhood. PMID:3894611

Isaacs, D; Wright, V M; Shaw, D G; Raafat, F; Walker-Smith, J A



Adolescents' Perception of Epilepsy Compared With Other Chronic Diseases: “Through a Teenager's Eyes”  

Microsoft Academic Search

Adolescent perception of physical and social impact of chronic illness was assessed to determine (1) if there is greater prejudice toward epilepsy than other chronic disease and (2) if adolescents with chronic disease have less prejudice toward similarly affected peers with all types of chronic disease or just their specific chronic disease. Cognitively normal teens aged 13 to 18 years

Christina Cheung; Elaine Wirrell



Antiproteinuric treatment reduces urinary loss of vitamin D-binding protein but does not affect vitamin D status in patients with chronic kidney disease.  


Vitamin D deficiency is common in chronic kidney disease (CKD). Increased urinary loss of vitamin D binding protein (VDBP), the main transporter of 25-hydroxyvitamin D(3) in the circulation, has been postulated to contribute to vitamin D deficiency in proteinuria. To test this hypothesis we analyzed urinary and plasma levels of VDBP, 25-hydroxyvitamin D(3) and 1,25-dihydroxyvitamin D(3) from proteinuric patients, before and after antiproteinuric interventions. We performed a post-hoc analysis of a clinical trial in CKD patients (n=13, creatinine clearance median 60 (range 25-177) ml/min) subjected to the following study periods: washout (no antiproteinuric treatment, 4 weeks), lisinopril 40mg QD (ACEi, 6 weeks), or indomethacin 75mg BID (NSAID, 4 weeks) in randomized sequence. Healthy subjects screened for donation (n=10) served as controls. Plasma and urine VDBP levels were measured by ELISA, 25-hydroxyvitamin D(3) levels by LC-MS and 1,25-dihydroxyvitamin D(3) levels by radioimmunoassay. In CKD patients urinary VDBP excretion was strongly increased (median (range) 5413 (155-211,027) ?g/24h) as compared to healthy controls (64 (23-111) ?g/24h, p<0.001). Both NSAID and ACEi significantly decreased urinary VDBP excretion, in proportion to proteinuria reduction. Plasma VDBP, 25-hydroxyvitamin D(3) and 1,25-dihydroxyvitamin D(3) levels, however, were similar between patients and controls and not affected by antiproteinuric intervention. Urinary VDBP excretion is markedly increased in proteinuria and responds to antiproteinuric treatment. Urinary VDBP loss is not associated with plasma VDBP or vitamin D(3) levels, suggesting that urinary loss of VDBP does not affect vitamin D status. PMID:21958677

Doorenbos, Carolina R C; de Cuba, Milton M; Vogt, Liffert; Kema, Ido P; van den Born, Jacob; Gans, Reinold O B; Navis, Gerjan; de Borst, Martin H



COPD (Chronic Obstructive Pulmonary Disease)  


Chronic Obstructive Pulmonary Disease (COPD) makes it hard for you to breathe. Coughing up mucus is often the first sign of ... common COPDs. Your airways branch out inside your lungs like an upside-down tree. At the end ...


New treatments for chronic obstructive pulmonary disease using ergogenic aids  

Microsoft Academic Search

Chronic obstructive pulmonary disease is currently considered a systemic disease, presenting structural and metabolic alterations that can lead to skeletal muscle dysfunction. This negatively affects the performance of respiratory and peripheral muscles, functional capacity, health-related quality of life and even survival. The decision to prescribe ergogenic aids for patients with chronic obstructive pulmonary disease is based on the fact that




Chronic Kidney Diseases  


... pressure at a healthy level. Continue Kinds of Kidney Diseases Like any complicated machine, not all kidneys work ... to work the way they should. How Are Kidney Diseases Diagnosed? Kidney problems are often not noticed at ...


Anemia of Chronic Disease (Anemia of Inflammation)  

Microsoft Academic Search

Mild-to-moderate anemia often develops in the setting of acute or chronic immune activation and is termed anemia of chronic disease (ACD) or anemia of inflammation. Anemia of chronic disease is the second most common type of anemia (after anemia of iron deficiency) and results in increased morbidity and mortality of the underlying disease. Anemia of chronic disease is mediated by

Neeraj Agarwal; Josef T. Prchal



Chronic Disease and the Environment  

NSDL National Science Digital Library

This site provides an overview of chronic diseases such as asthma, cancer and birth defects (with respect to infant mortality) and their environmental causes. Special topics include disease tracking, biomonitoring, Hispanic Americans and environmental health, public health infrastructure, and bioterrorism. The site also features links to current news and related resources.

Responsibility, Physicians F.; Envirohealthaction


Treatment of chronic kidney disease  

Microsoft Academic Search

Treatment of chronic kidney disease (CKD) can slow its progression to end-stage renal disease (ESRD). However, the therapies remain limited. Blood pressure control using angiotensin-converting enzyme (ACE) inhibitors or angiotensin II receptor blockers (ARBs) has the greatest weight of evidence. Glycemic control in diabetes seems likely to retard progression. Several metabolic disturbances of CKD may prove to be useful therapeutic

Jeffrey M Turner; Carolyn Bauer; Matthew K Abramowitz; Michal L Melamed; Thomas H Hostetter



Uromodulin and Chronic Kidney Disease  

Microsoft Academic Search

Uromodulin (Tamm-Horsfall protein) is produced in the kidney by cells of the thick ascending limb and distal tubule. Recent genetic studies suggest a role of uromodulin in chronic kidney disease. Mutations in the UMOD gene cause uromodulin storage disease. They code for amino acid substitutions that lead to misfolding of the molecule and its retention in the endoplasmic reticulum. Single

Karl Lhotta



Rethinking chronic obstructive pulmonary disease  

Microsoft Academic Search

Chronic obstructive pulmonary disease (COPD) is a complex polygenic disease characterized by an abnormal inflammatory response to smoke, and results in a progressive and debilitating condition with declining lung function. The reasons why some smokers get COPD are not known.We suggest that corticosteroid resistance, which derives from oxidative stress, might actually be the cause of COPD and represent the starting

Antonella Tonello; Giovanni Poli



Genetics of Chronic Kidney Disease  

Microsoft Academic Search

The current review collates what is already known of the genetics of chronic kidney disease (CKD), and focuses on new trends in genome-wide assessment of the inherited component of susceptibility to this condition. Early efforts to identify kidney disease susceptibility genetic loci using linkage and candidate gene strategies proved disappointing. More recently, genome-wide association studies have yielded highly promising results

Conall M. O’Seaghdha; Caroline S. Fox



Framing international trade and chronic disease.  


There is an emerging evidence base that global trade is linked with the rise of chronic disease in many low and middle-income countries (LMICs). This linkage is associated, in part, with the global diffusion of unhealthy lifestyles and health damaging products posing a particular challenge to countries still facing high burdens of communicable disease. We developed a generic framework which depicts the determinants and pathways connecting global trade with chronic disease. We then applied this framework to three key risk factors for chronic disease: unhealthy diets, alcohol, and tobacco. This led to specific 'product pathways', which can be further refined and used by health policy-makers to engage with their country's trade policy-makers around health impacts of ongoing trade treaty negotiations, and by researchers to continue refining an evidence base on how global trade is affecting patterns of chronic disease. The prevention and treatment of chronic diseases is now rising on global policy agendas, highlighted by the UN Summit on Noncommunicable Diseases (September 2011). Briefs and declarations leading up to this Summit reference the role of globalization and trade in the spread of risk factors for these diseases, but emphasis is placed on interventions to change health behaviours and on voluntary corporate responsibility. The findings summarized in this article imply the need for a more concerted approach to regulate trade-related risk factors and thus more engagement between health and trade policy sectors within and between nations. An explicit recognition of the role of trade policies in the spread of noncommunicable disease risk factors should be a minimum outcome of the September 2011 Summit, with a commitment to ensure that future trade treaties do not increase such risks. PMID:21726434

Labonté, Ronald; Mohindra, Katia S; Lencucha, Raphael



Framing international trade and chronic disease  

PubMed Central

There is an emerging evidence base that global trade is linked with the rise of chronic disease in many low and middle-income countries (LMICs). This linkage is associated, in part, with the global diffusion of unhealthy lifestyles and health damaging products posing a particular challenge to countries still facing high burdens of communicable disease. We developed a generic framework which depicts the determinants and pathways connecting global trade with chronic disease. We then applied this framework to three key risk factors for chronic disease: unhealthy diets, alcohol, and tobacco. This led to specific 'product pathways', which can be further refined and used by health policy-makers to engage with their country's trade policy-makers around health impacts of ongoing trade treaty negotiations, and by researchers to continue refining an evidence base on how global trade is affecting patterns of chronic disease. The prevention and treatment of chronic diseases is now rising on global policy agendas, highlighted by the UN Summit on Noncommunicable Diseases (September 2011). Briefs and declarations leading up to this Summit reference the role of globalization and trade in the spread of risk factors for these diseases, but emphasis is placed on interventions to change health behaviours and on voluntary corporate responsibility. The findings summarized in this article imply the need for a more concerted approach to regulate trade-related risk factors and thus more engagement between health and trade policy sectors within and between nations. An explicit recognition of the role of trade policies in the spread of noncommunicable disease risk factors should be a minimum outcome of the September 2011 Summit, with a commitment to ensure that future trade treaties do not increase such risks.



Chronic diseases among older cancer patients  

Microsoft Academic Search

Introduction: With the growing number of older cancer patients, the burden of chronic diseases among older cancer patients will become increasingly important. Chronic diseases often interfere with treatment decisions and prognosis for cancer patients. However, little is known about the occurrence of chronic diseases among older cancer patients. Aim: We aim to examine the frequency of pre-existing and subsequent chronic

L. D. Deckx; M. A. van der Akker; J. M. Metsemakers; A. K. Knottnerus; F. G. Schellevis; F. B. Buntinx



HHS and NCI Launch National Campaign to Address Diet-Related Diseases Affecting African-American Men: Major Campaign Urges Men to Eat 9 Servings of Fruits and Vegetables a Day to Reduce Chronic Disease Risk

U.S. Department of Health and Human Services (HHS) Secretary Tommy G. Thompson and National Cancer Institute (NCI) Director Andrew von Eschenbach today announced a national campaign to reduce the risk of chronic diseases among African-American men.


Nutrition and chronic kidney disease  

Microsoft Academic Search

The incidence of malnutrition disorders in chronic kidney disease (CKD) appears unchanged over time, whereas patient-care and dialysis techniques continue to progress. Despite some evidence for cost-effective treatments, there are numerous caveats to applying these research findings on a daily care basis. There is a sustained generation of data confirming metabolic improvement when patients control their protein intake, even at

Denis Fouque; Solenne Pelletier; Denise Mafra; Philippe Chauveau



Mechanisms of progression of chronic kidney disease  

Microsoft Academic Search

Chronic kidney disease (CKD) occurs in all age groups, including children. Regardless of the underlying cause, CKD is characterized\\u000a by progressive scarring that ultimately affects all structures of the kidney. The relentless progression of CKD is postulated\\u000a to result from a self-perpetuating vicious cycle of fibrosis activated after initial injury. We will review possible mechanisms\\u000a of progressive renal damage, including

Agnes B. Fogo




PubMed Central

Glomerulonephritis, often accompanied by the nephrotic syndrome, developed in CAF1 mice following the administration of spleen cells from normal BALB/c mice. The renal lesion was membranous glomerulonephritis. When studied with fluorescein-conjugated antisera to either mouse gamma globulin or ?1C-globulin, the glomeruli contained beaded and irregular deposits of these immunoproteins. The ultrastructure of the lesion was characterized by thickening of the glomerular basement membranes and the presence of electron-dense subepithelial deposits. Acid eluates of the diseased kidneys contained gamma globulin that failed to bind to sections of normal kidneys. These findings conform to the type of nephritis provoked by immune complexes. They indicate that this type of immune injury can be based on the reaction of intolerant immunocytes to normal antigens.

Lewis, Robert M.; Armstrong, Martine Y. K.; Andre-Schwartz, Janine; Muftuoglu, Asuman; Beldotti, Lorraine; Schwartz, Robert S.



Food insecurity and chronic disease.  


Household food insecurity has been previously hypothesized to promote dependence on inexpensive, highly palatable foods that are energy dense. Such dependence, and the cyclical nature of having enough food in the beginning of the month followed by food scarcity at the end of the month, could lead to weight gain over a short period of time. Such dependence on energy-dense foods and weight gain may play a direct role in the development of chronic conditions. Other compounding factors that result from exposure to household food insecurity have been well described, including pathways by which stress promotes visceral fat accumulation and chronic disease. This symposium review paper summarizes the literature on the link between food insecurity and the following: 1) diet, 2) weight gain, and 3) chronic disease, especially among women. This paper also proposes a framework for considering how the lived experience of household food insecurity may potentiate the development of chronic disease by activating the stress response among individuals at critical developmental periods in a food-impoverished environment. PMID:23493536

Laraia, Barbara A



Corticosteroids in infant chronic lung disease  

Microsoft Academic Search

Corticosteroids in infant chronic lung disease. C. May, A. Greenough. Chronic lung disease (CLD), defined as chronic oxygen dependency at 36 weeks postmenstrual age, is increasing and associated with chronic respiratory morbidity and high health care utilisation at follow up. Many strategies, tested in randomised trials, have failed to reduce CLD. In contrast, corticosteroids if given systemically within the first

A. Greenough; Lung Biology; Anne Greenough


Chronic pain: a non-use disease.  


One of the major problems in modern medicine is to find remedies for the group of people with chronic pain syndromes. Low back pain is one of the most frequent syndromes and perhaps the most invalidating of all of them. Chronic pain seems to develop through several pathways affecting the spinal cord and the brain: (1) neuro-anatomical reorganisation, (2) neuro-physiological changes, and (3) activation of glia cells (immune reaction in the central nervous system). Although all of these pathways seem to provide a (partial) plausible explanation for chronic pain, treatments influencing these pathways often fail to alleviate chronic pain patients. This could be because of the probability that chronic pain develops by all three mechanisms of disease. A treatment influencing just one of these mechanisms can only be partially successful. Other factors that seem to contribute to the development of chronic pain are psychosocial. Fear, attention and anxiety are part of the chronic pain syndrome being cause or consequence. The three pathways and the psycho-emotional factors constitute a psycho-neuro-immunological substrate for chronic pain syndromes; a substrate which resembles the substrate for phantom pain and functional invalidity after stroke. Both phantom pain and functional invalidity are considered non-use syndromes. The similarity of the substrate of both these two neurological disorders and chronic pain makes it reasonable to consider chronic pain a non-use disease (the hypothesis). To test this hypothesis, we developed a "paradoxal pain therapy". A therapy which combines the constraint induced movement therapy and strategies to dissociate pain from conditioning factors like fear, anxiety and attention. The aim of the therapy is to establish a behaviour perpendicular on the pathological pain-behaviour. Clinically, the treatment seems promising, although we just have preliminary results. Further clinical and laboratory studies are needed to measure eventual changes at neuro-anatomical and neuro-psychological level using modern neuro-imaging instruments (PET, SPECT, fMRI). Randomised clinical trials should be carried out to test our hypothesis for all-day use in clinical practice. The hypothesis: chronic pain is a non-use disease produced by psycho-emotional factors like fear, attention and anxiety. Optimal treatment should be based on physiological use, and dissociation of pain and the mentioned psycho-emotional factors. Paradoxal pain therapy could serve these treatment conditions. PMID:17071012

Pruimboom, L; van Dam, A C



Osteodystrophy in chronic liver diseases.  


Osteoporosis and osteomalacia are, to date, among the most common metabolic diseases in the world. Lately, an association between metabolic bone diseases and chronic liver disease has been increasingly reported, inducing many authors to create a new nosographic entity known as 'hepatic osteodystrophy.' The importance of such a condition is further increased by the morbidity of these two diseases, which greatly reduce the quality of life because of frequent fractures, especially vertebral and femoral neck ones. For this reason, early identification of high-risk patients should be routinely performed by measuring bone mass density. The explanation for the association between bone diseases and chronic liver disease is still uncertain, and involves many factors: from hypogonadism to use of corticosteroid drugs, from genetic factors to interferon therapy. To date, few studies have been conducted, and all with a small number of patients to establish definitive conclusions about the possible treatment, but some evidence is beginning to emerge about the safety and efficacy of bisphosphonates. PMID:22241574

Mansueto, Pasquale; Carroccio, Antonio; Seidita, Aurelio; Di Fede, Gaetana; Craxì, Antonio



Nursing management of chronic obstructive pulmonary disease.  


Chronic obstructive pulmonary disease (COPD) is a major cause of chronic morbidity and mortality, which imposes a major burden on both society and the health service. It is a common condition that is on the increase and predominantly caused by smoking. Progressive damage to the lung tissue renders the patient increasingly breathless resulting in a frightening existence causing varying degrees of disability and handicap. It is therefore essential that healthcare professionals understand how this condition affects patients not only from a physical perspective, but also from a psychological and social perspective to provide effective nursing management. Nursing management of patients suffering from this disease is aimed at helping to control individual patient's symptoms and improve their quality of life. PMID:19060812

Barnett, Margaret


Utilization of Telehealth Technology to Develop and Implement a Comprehensive Management Initiative for Chronic Diseases.  

National Technical Information Service (NTIS)

Chronic diseases affect over 90 million Americans and result in high health care costs and tremendous personal and societal burden. Diabetes is, arguably, among the most pervasive and researched chronic diseases. Research shows that much of the costs and ...

R. A. Vigersky



Calciphylaxis presenting in early chronic kidney disease with mixed hyperparathyroidism  

Microsoft Academic Search

Calciphylaxis is a disabling and life-threatening complication that primarily affects patients who are dialysis dependent. Reports have grown in the literature of cases occurring in those who have advanced chronic kidney disease (pre-end-stage renal disease) or in the setting of transplantation. There are also a few reports of cases occurring in those without any form of chronic kidney disease but

Michael Brucculeri; Allan H Haydon



Cardiac Disease in Chronic Obstructive Pulmonary Disease  

PubMed Central

The cardiac manifestations of chronic obstructive pulmonary disease (COPD) are numerous. Impairments of right ventricular dysfunction and pulmonary vascular disease are well known to complicate the clinical course of COPD and correlate inversely with survival. The pathogenesis of pulmonary vascular disease in COPD is likely multifactorial and related to alterations in gas exchange and vascular biology, as well as structural changes of the pulmonary vasculature and mechanical factors. Several modalities currently exist for the assessment of pulmonary vascular disease in COPD, but right heart catheterization remains the gold standard. Although no specific therapy other than oxygen has been generally accepted for the treatment of pulmonary hypertension in this population, there has been renewed interest in specific pulmonary vasodilators. The coexistence of COPD and coronary artery disease occurs frequently. This association is likely related to shared risk factors as well as similar pathogenic mechanisms, such as systemic inflammation. Management strategies for the care of patients with COPD and coronary artery disease are similar to those without COPD, but care must be given to address their respiratory limitations. Arrhythmias occur frequently in patients with COPD, but are rarely fatal and can generally be treated medically. Use of ?-blockers in the management of cardiac disease, while a theoretical concern in patients with increased airway resistance, is generally safe with the use of cardioselective agents.

Falk, Jeremy A.; Kadiev, Steven; Criner, Gerard J.; Scharf, Steven M.; Minai, Omar A.; Diaz, Philip



Caloric restriction and chronic inflammatory diseases.  


A reduction in calorie intake [caloric restriction (CR)] appears to consistently decrease the biological rate of aging in a variety of organisms as well as protect against age-associated diseases including chronic inflammatory disorders such as cardiovascular disease and diabetes. Although the mechanisms behind this observation are not fully understood, identification of the main metabolic pathways affected by CR has generated interest in finding molecular targets that could be modulated by CR mimetics. This review describes the general concepts of CR and CR mimetics as well as discusses evidence related to their effects on inflammation and chronic inflammatory disorders. Additionally, emerging evidence related to the effects of CR on periodontal disease in non-human primates is presented. While the implementation of this type of dietary intervention appears to be challenging in our modern society where obesity is a major public health problem, CR mimetics could offer a promising alternative to control and perhaps prevent several chronic inflammatory disorders including periodontal disease. PMID:21749581

González, O A; Tobia, C; Ebersole, J L; Novak, M J



Bisalbuminemia in chronic kidney disease.  


Hereditary and acquired bisalbuminemia, in which the serum contains an albumin variant differing from albumin A by single amino-acid substitutions, have been reported in different races or ethnic groups and in association with various pathologic states. The importance of this rare condition in the pathophysiology of established diseases is uncertain. We evaluated a 68-year-old woman with chronic kidney disease who presented with worsened serum creatinine concentration despite lack of dietary or medical changes. Serum protein electrophoresis was performed with an automated rapid electrophoresis system. Bisalbuminemia was noted as an incidental finding on serum protein electrophoresis. The serum creatinine level stabilized with dietary protein restriction and a beta-blocking agent/diuretic combination for blood pressure control. Although the possibility that some physiologic or pharmacologic substances may not bind to abnormal albumin variants as well as they bind to normal albumin should not be discounted, the finding of bisalbuminemia did not influence the diagnosis, management, course, or prognosis of chronic kidney disease. The role of persistent bisalbuminemia in renal disease is uncertain. PMID:15480907

Ejaz, A Ahsan; Krishna, Murli; Wasiluk, Andrew; Knight, Janice D



Mediterranean dietary pattern and chronic diseases.  


The study of the relationship between the Mediterranean way of eating and the occurrence of diseases typical of the economically developed countries has been considered the starting point of nutritional epidemiology. From the Seven Countries Study in the 1950s to the recent European EPIC collaboration, the evaluation of the components of diet-affecting chronic diseases such as cardiovascular disease and cancer has been crucially based on the analysis of foods and nutrients characterizing the Mediterranean dietary habits. This long research history has been marked by a consistency of data over time when either single nutrients/food groups or more complex dietary patterns have been analyzed: The Mediterranean way of eating is a protective tool from cardiovascular diseases and many cancers. Italy has been a natural point of observation, starting from cardiovascular disease in the mid-1950s and continuing with major cancers. In spite of unfavorable lifestyle changes in the Italian population mostly due to globalization of unhealthy habits (richer diet and lower levels of physical activity), those individuals still close to the Mediterranean style are significantly protected. The very recent Italian data derived from the observation of about 50,000 individuals, participating in the Italian cohorts of the EPIC study, confirm these findings and are consistent with results from other European populations and in some cases also from North American populations. Moreover, several dietary trials suggest that such a way of eating improves both the metabolic risk condition for chronic disease and the occurrence of those diseases. In conclusion, a way of eating inspired by a Mediterranean dietary pattern is not only based on evidence but is also a palatable style that has contributed to protection from the epidemic of chronic diseases. PMID:24114475

Panico, Salvatore; Mattiello, Amalia; Panico, Camilla; Chiodini, Paolo



[Disorders of the larynx and chronic inflammatory diseases].  


Chronic inflammatory diseases including tuberculosis, rheumatic disorders (rheumatoid arthritis, sarcoidosis, systemic lupus erythematosus, Wegeners's granulomatosis, relapsing polychondritis) and reflux disease are considered as systemic diseases, and may affect the larynx. The clinical symptoms are often unspecific, leading to prolonged intervals to diagnosis. Solid and haematological tumours should be considered in differential diagnosis and may require bioptic sampling. Treatment may require interdisciplinary approach. PMID:23044789

Pickhard, A; Smith, E; Rottscholl, R; Brosch, S; Reiter, R



Chronic Granulomatous Disease; fundamental stages in our understanding of CGD  

Microsoft Academic Search

It has been 50 years since chronic granulomatous disease was first reported as a disease which fatally affected the ability of children to survive infections. Various milestone discoveries from the insufficient ability of patients' leucocytes to destroy microbial particles to the underlying genetic predispositions through which the disease is inherited have had important consequences. Longterm antibiotic prophylaxis has helped to

Tracy Assari



Ghrelin in Chronic Kidney Disease  

PubMed Central

Patients with chronic kidney disease (CKD) often exhibit symptoms of anorexia and cachexia, which are associated with decreased quality of life and increased mortality. Chronic inflammation may be an important mechanism for the development of anorexia, cachexia, renal osteodystrophy, and increased cardiovascular risk in CKD. Ghrelin is a gastric hormone. The biological effects of ghrelin are mediated through the growth hormone secretagogue receptor (GHSR). The salutary effects of ghrelin on food intake and meal appreciation suggest that ghrelin could be an effective treatment for anorexic CKD patients. In addition to its appetite-stimulating effects, ghrelin has been shown to possess anti-inflammatory properties. The known metabolic effects of ghrelin and the potential implications in CKD will be discussed in this review. The strength, shortcomings, and unanswered questions related to ghrelin treatment in CKD will be addressed.

Cheung, Wai W.; Mak, Robert H.



Neuropsychological Functioning in Chronic Lyme Disease  

Microsoft Academic Search

Lyme disease is currently the most common vector-borne illness in the United States. The disease is multisystemic, and chronic disease, in particular, may be associated with neuropsychological deficits. However, to date, only a few empirical studies exist, which examine the neuropsychological sequelae associated with chronic Lyme disease. A review of the literature shows that the deficits observed in adults with

Holly James Westervelt; Robert J. McCaffrey



Neuropsychological functioning in chronic Lyme disease.  


Lyme disease is currently the most common vector-borne illness in the United States. The disease is multisystemic, and chronic disease, in particular, may be associated with neuropsychological deficits. However, to date, only a few empirical studies exist, which examine the neuropsychological sequelae associated with chronic Lyme disease. A review of the literature shows that the deficits observed in adults with chronic Lyme disease are generally consistent with the deficits that can be seen in processes with primarily frontal systems involvement. These observations are generally consistent with neuroradiologic findings. The clinical presentation in chronic Lyme disease and the nature of the neuropsychological deficits are discussed, as are several central issues in understanding neuropsychological functioning in chronic Lyme disease, such as the impact of chronic illness, response to treatment, and the relationship between neuropsychological performance and depression, fatigue, and neurological indicators of disease. PMID:12428915

Westervelt, Holly James; McCaffrey, Robert J



Chronic Disease and Childhood Development: Kidney Disease and Transplantation.  

ERIC Educational Resources Information Center

|As part of a larger study of transplantation and chronic disease and the family, 124 children (10-18 years old) who were chronically ill with kidney disease (n=72) or were a year or more post-transplant (n=52) were included in a study focusing on the effects of chronic kidney disease and transplantation on children's psychosocial development. Ss…

Klein, Susan D.; Simmons, Roberta G.


Optimizing Disease Management of Chronic Obstructive Pulmonary Disease  

Microsoft Academic Search

Chronic obstructive pulmonary disease (COPD) is a major public health problem worldwide. It is the fourth leading cause of chronic morbidity and mortality in the US, and is projected to rank seventh in burden of disease worldwide by 2020. In contrast with a number of chronic diseases, COPD is most often associated with one or more co-morbid conditions, and this

Philip Corsello; David Tinkelman



Chronic thyroiditis (Hashimoto’s disease)  


Hashimoto's thyroiditis; Chronic lymphocytic thyroiditis; Autoimmune thyroiditis ... Chronic thyroiditis or Hashimoto's disease is a common thyroid gland disorder. It can occur at any age, but is most often seen in middle- ...


Rethinking chronic obstructive pulmonary disease.  


Chronic obstructive pulmonary disease (COPD) is a complex polygenic disease characterized by an abnormal inflammatory response to smoke, and results in a progressive and debilitating condition with declining lung function. The reasons why some smokers get COPD are not known. We suggest that corticosteroid resistance, which derives from oxidative stress, might actually be the cause of COPD and represent the starting point of the pathology. The absence of response to corticosteroids would let the disease develop, impairing the organism capacity to suppress any kind of inflammatory process. Corticosteroid resistance may derive from smoke induced oxidative stress and plausibly impairs the organism capacity to suppress inflammation. Many factors may contribute to the development and persistence of corticosteroid resistance: inefficient antioxidant defences, a corticosteroid response less efficient or more sensitive to oxidative conditions, and also any other concomitant factor, environmental, genetic or intercurrent, which would contribute to amplify inflammation and hence oxidative stress. One or more of these factors might represent the variable component of the disease, which gives origin to COPD heterogeneity. This hypotheses may also explain why the disease persists after quitting smoking, as an inflammatory process severe enough to generate a strong oxidative stress may support itself by maintenance of corticosteroid resistance. PMID:21075542

Tonello, Antonella; Poli, Giovanni



GARD (Global Alliance against chronic Respiratory Diseases)  

Microsoft Academic Search

ABSTRACT: Hundreds,of millions,of people,of all ages,suffer from,chronic,respiratory,diseases which include asthma and respiratory allergies, chronic obstructive pulmonary disease, occupational,lung,diseases,and,pulmonary,hypertension.,More than,500 million patients,live in developing,countries,or in deprived,populations.,Chronic,respiratory,diseases,are increasing,in prevalence. Although the cost of inaction is clear and unacceptable, chronic respiratory diseases and their risk factors receive insufficient attention from the healthcare community, government officials, media, patients and families. The Fifty-Third World Health

J. Bousquet; R. Dahl; N. Khaltaev



Impact of chronic hypercortisolemia on affective processing.  


Cushing syndrome (CS) is the classic condition of cortisol dysregulation, and cortisol dysregulation is the prototypic finding in Major Depressive Disorder (MDD). We hypothesized that subjects with active CS would show dysfunction in frontal and limbic structures relevant to affective networks, and also manifest poorer facial affect identification accuracy, a finding reported in MDD. Twenty-one patients with confirmed CS (20 ACTH-dependent and 1 ACTH-independent) were compared to 21 healthy control subjects. Identification of affective facial expressions (Facial Emotion Perception Test) was conducted in a 3 Tesla GE fMRI scanner using BOLD fMRI signal. The impact of disease (illness duration, current hormone elevation and degree of disruption of circadian rhythm), performance, and comorbid conditions secondary to hypercortisolemia were evaluated. CS patients made more errors in categorizing facial expressions and had less activation in left anterior superior temporal gyrus, a region important in emotion processing. CS patients showed higher activation in frontal, medial, and subcortical regions relative to controls. Two regions of elevated activation in CS, left middle frontal and lateral posterior/pulvinar areas, were positively correlated with accuracy in emotion identification in the CS group, reflecting compensatory recruitment. In addition, within the CS group, greater activation in left dorsal anterior cingulate was related to greater severity of hormone dysregulation. In conclusion, cortisol dysregulation in CS patients is associated with problems in accuracy of affective discrimination and altered activation of brain structures relevant to emotion perception, processing and regulation, similar to the performance decrements and brain regions shown to be dysfunctional in MDD. This article is part of a Special Issue entitled 'Anxiety and Depression'. PMID:21787793

Langenecker, Scott A; Weisenbach, Sara L; Giordani, Bruno; Briceño, Emily M; Guidotti Breting, Leslie M; Schallmo, Michael-Paul; Leon, Hadia M; Noll, Douglas C; Zubieta, Jon-Kar; Schteingart, David E; Starkman, Monica N



Impact of Chronic Hypercortisolemia on Affective Processing  

PubMed Central

Cushing syndrome (CS) is the classic condition of cortisol dysregulation, and cortisol dysregulation is the prototypic finding in Major Depressive Disorder (MDD). We hypothesized that subjects with active CS would show dysfunction in frontal and limbic structures relevant to affective networks, and also manifest poorer facial affect identification accuracy, a finding reported in MDD.Twenty-one patients with confirmed CS (20 ACTH-dependent and 1 ACTH-independent) were compared to 21 healthy controlsubjects. Identification of affective facial expressions (Facial Emotion Perception Test) was conducted in a 3 Tesla GE fMRI scanner using BOLD fMRI signal. The impact of disease (illness duration, current hormone elevation and degree of disruption of circadian rhythm), performance, and comorbid conditions secondary to hypercortisolemia were evaluated.CS patients made more errors in categorizing facial expressions and had less activation in left anterior superior temporal gyrus, a region important in emotion processing. CS patients showed higher activation in frontal, medial, and subcortical regions relative to controls. Two regions of elevated activation in CS, left middle frontal and lateral posterior/pulvinar areas, were positively correlated with accuracy in emotion identification in the CS group, reflecting compensatory recruitment. In addition, within the CSgroup, greater activation in left dorsal anterior cingulatewas related to greater severity of hormone dysregulation. In conclusion, cortisol dysregulation in CS patients is associated with problems in accuracy of affective discrimination and altered activation of brain structures relevant to emotion perception, processing and regulation, similar to the performance decrements and brain regions shown to be dysfunctional in MDD.

Langenecker, Scott A.; Weisenbach, Sara L.; Giordani, Bruno; Briceno, Emily M.; GuidottiBreting, Leslie M.; Schallmo, Michael-Paul; Leon, Hadia M.; Noll, Douglas C.; Zubieta, Jon-Kar; Schteingart, David E.; Starkman, Monica N.



Kidneys in chronic liver diseases  

PubMed Central

Acute kidney injury (AKI), defined as an abrupt increase in the serum creatinine level by at least 0.3 mg/dL, occurs in about 20% of patients hospitalized for decompensating liver cirrhosis. Patients with cirrhosis are susceptible to developing AKI because of the progressive vasodilatory state, reduced effective blood volume and stimulation of vasoconstrictor hormones. The most common causes of AKI in cirrhosis are pre-renal azotemia, hepatorenal syndrome and acute tubular necrosis. Differential diagnosis is based on analysis of circumstances of AKI development, natriuresis, urine osmolality, response to withdrawal of diuretics and volume repletion, and rarely on renal biopsy. Chronic glomerulonephritis and obstructive uropathy are rare causes of azotemia in cirrhotic patients. AKI is one of the last events in the natural history of chronic liver disease, therefore, such patients should have an expedited referral for liver transplantation. Hepatorenal syndrome (HRS) is initiated by progressive portal hypertension, and may be prematurely triggered by bacterial infections, nonbacterial systemic inflammatory reactions, excessive diuresis, gastrointestinal hemorrhage, diarrhea or nephrotoxic agents. Each type of renal disease has a specific treatment approach ranging from repletion of the vascular system to renal replacement therapy. The treatment of choice in type 1 hepatorenal syndrome is a combination of vasoconstrictor with albumin infusion, which is effective in about 50% of patients. The second-line treatment of HRS involves a transjugular intrahepatic portosystemic shunt, renal vasoprotection or systems of artificial liver support.

Hartleb, Marek; Gutkowski, Krzysztof



Hypertrophic osteoarthropathy of chronic inflammatory bowel disease  

SciTech Connect

The case of a 14-year old girl with painful periostitis and ulcerative colitis is reported. The association of chronic inflammatory bowel disease with osteoarthropathy is rare and has previously been reported in eight patients. The periosteal reaction found in association with inflammatory bowel disease is apparently related to a chronic disease course and may cause extreme localized pain.

Oppenheimer, D.A.; Jones, H.H.



Health literacy and knowledge of chronic disease  

Microsoft Academic Search

We sought to examine the relationship between health literacy and knowledge of disease among patients with a chronic disease. A total of 653 new Medicare enrollees aged 65 years or older who had at least one chronic disease (115 asthma, 266 diabetes, 166 congestive heart failure, 214 hypertension), completed both the in-person and telephone survey. Health literacy measured by the

Julie A Gazmararian; Mark V Williams; Jennifer Peel; David W Baker



Angiogenesis and chronic kidney disease  

PubMed Central

The number of patients requiring renal replacement therapy due to end-stage renal disease (ESRD) is increasing worldwide. The prevalence of chronic kidney disease (CKD), and the importance of CKD as a risk factor in development of ESRD and in complicating cardiovascular disease (CVD) have been confirmed. In recent years, the involvement of angiogenesis-related factors in the progression of CKD has been studied, and the potential therapeutic effects on CKD of modulating these factors have been identified. Vascular endothelial growth factor (VEGF)-A, a potent pro-angiogenic factor, is involved in the development of the kidney, in maintenance of the glomerular capillary structure and filtration barrier, and in the renal repair process after injury. VEGF-A is also involved in the development of early diabetic nephropathy, demonstrated by the therapeutic effects of anti-VEGF-A antibody. Angiopoietin (Ang)-1 induces the maturation of newly formed blood vessels, and the therapeutic effects of Ang-1 in diabetic nephropathy have been described. In experimental models of diabetic nephropathy, the therapeutic effects of angiogenesis inhibitors, including angiostatin, endostatin and tumstatin peptides, the isocoumarin NM-3, and vasohibin-1, have been reported. Further analysis of the involvement of angiogenesis-related factors in the development of CKD is required. Determining the disease stage at which therapy is most effective and developing an effective drug delivery system targeting the kidney will be essential for pro-or anti-angiogenic strategies for patients with CKD.



Nutrition and Chronic Kidney Disease  

Microsoft Academic Search

\\u000a \\u000a \\u000a \\u000a \\u000a • \\u000a \\u000a \\u000a The development and progression of chronic kidney disease (CKD) is influenced by a number of dietary factors, including salt\\u000a and protein intake and energy balance (obesity).\\u000a \\u000a \\u000a \\u000a \\u000a • \\u000a \\u000a \\u000a While the benefits of a low-protein intake in preventing the development of CKD are not firmly established, it is likely that\\u000a a high-protein intake is detrimental to individuals with even mild impairment

Srinivasan Beddhu


Defective tryptophan catabolism underlies inflammation in mouse chronic granulomatous disease  

Microsoft Academic Search

Half a century ago, chronic granulomatous disease (CGD) was first described as a disease fatally affecting the ability of children to survive infections. Various milestone discoveries have since been made, from an insufficient ability of patients' leucocytes to kill microbes to the underlying genetic abnormalities. In this inherited disorder, phagocytes lack NADPH oxidase activity and do not generate reactive oxygen

Luigina Romani; Francesca Fallarino; Antonella de Luca; Claudia Montagnoli; Carmen D'Angelo; Teresa Zelante; Carmine Vacca; Francesco Bistoni; Maria C. Fioretti; Ursula Grohmann; Brahm H. Segal



The Neglected Global Burden of Chronic Oral Diseases  

Microsoft Academic Search

The global burden of oral diseases, in fact, has been outlined in a very recent Bulletin of the World Health Organization: The vast majority of diseases affecting the soft and hard tissues of the oral cavity, in fact, have a chronic nature, are strongly associated with socio-behavioral risk factors, and represent a larger problem in underprivileged groups in both developing

M. D. Mignogna; S. Fedele



Chronic kidney disease and cardiovascular disease in the Medicare population  

Microsoft Academic Search

Chronic kidney disease and cardiovascular disease in the Medicare population.BackgroundThe extent of diabetes, chronic kidney disease (CKD), and cardiovascular disease (CVD) in the Medicare population is relatively unknown. Also unknown is the effect of these diseases on patient survival before end-stage renal disease (ESRD).MethodsPrevalent cohorts of Medicare enrollees from 1996 to 2000 were assessed for diabetes and CKD, presence of

Allan J. Collins; Shuling Li; David T. Gilbertson; Jiannong Liu; Shu-Cheng Chen; Charles A. Herzog



68 FR 3326 - Chronic Disease Prevention and Health Promotion Programs  

Federal Register 2010, 2011, 2012, 2013

...Chronic Disease Prevention and Health Promotion Programs; Notice Federal Register...Chronic Disease Prevention and Health Promotion Programs The Centers for Disease...Chronic Disease Prevention and Health Promotion Programs. Table of...



Measurement of renal function in patients with chronic kidney disease.  


Chronic kidney disease affects millions of people worldwide and is associated with an increased morbidity and mortality as a result of kidney failure and cardiovascular disease. Accurate assessment of kidney function is important in the clinical setting as a screening tool and for monitoring disease progression and guiding prognosis. In clinical research, the development of new methods to measure kidney function accurately is important in the search for new therapeutic targets and the discovery of novel biomarkers to aid early identification of kidney injury. This review considers different methods for measuring kidney function and their contribution to the improvement of detection, monitoring and treatment of chronic kidney disease. PMID:23802624

Sandilands, Euan A; Dhaun, Neeraj; Dear, James W; Webb, David J



The burden of chronic obstructive pulmonary disease  

Microsoft Academic Search

Chronic obstructive pulmonary disease (COPD) is a disease state characterized by chronic airflow limitation that is not fully reversible, with a precise definition varying between different management guidelines.The burden of COPD is considerable from all relevant viewpoints. From the perspective of society, the mortality is already considerable, and it is likely to increase from the sixth to the third most

P. Vermeire



Pulmonary hypertension in chronic obstructive pulmonary disease  

Microsoft Academic Search

Pulmonary hypertension in chronic obstructive pulmonary disease. J.A. Barbera `, V.I. Peinado, S. Santos. #ERS Journals Ltd 2003. ABSTRACT: Pulmonary hypertension is a common complication of chronic obstructive pulmonary disease (COPD). Its presence is associated with shorter survival and worse clinical evolution. In COPD, pulmonary hypertension tends to be of moderate severity and progresses slowly. However, transitory increases of pulmonary

J. A. Barbera; V. I. Peinado; S. Santos



Chronic Obstructive Pulmonary Disease (COPD)  


... available for COPD patients for education and opportunities to share experience with other patients and families. Will COPD ever go away? The term chronic in chronic ...


Chronic Kidney Disease in Octogenarians  

PubMed Central

Summary Background and objectives There are limited data on the prevalence of chronic kidney disease (CKD) and its clinical importance in the very old. We examined the prevalence of CKD in octogenarians and its association with cardiovascular disease (CVD). Design, setting, participants, & measurements In a cross-sectional analysis of 1028 participants from the Cardiovascular Health Study All Stars, we evaluated association of prevalent CKD with CVD using multivariable logistic regression. CKD was defined as eGFR of <60 ml/min per 1.73 m2. GFR was estimated using CKD-Epi creatinine and cystatin C equations that incorporate coefficients for age, gender, and race (eGFREPI, eGFRCYS3var) and the one-variable cystatin C equation (eGFRCYS1var). Prevalent CVD was defined as a composite of coronary heart disease, heart failure, and stroke. Results Mean age was 86 years, 64% were women, 86% were Caucasians, 14% had diabetes, and 39% had prevalent CVD. Mean eGFREPI, eGFRCYS3var, and eGFRCYS1var were 59, 62, and 70 ml/min per 1.73 m2, and 51%, 46%, and 33% had CKD, respectively. Associations of CKD with CVD varied by equation in adjusted analyses: CKDEPI (OR, 1.53; 95% CI, 1.15 to 2.03), CKDCYS3var (OR, 1.67; 95% CI, 1.25, 2.23), and CKDCYS1var (OR, 2.09; 95% CI, 1.55, 2.83). Conclusions Reduced eGFR is highly prevalent in octogenarians, and the eGFRCYS1var equation yielded the lowest prevalence of CKD but the strongest association with prevalent CVD. Because there are no validated estimating equations in the elderly, estimation of kidney function on the basis of on any one equation should be interpreted with caution.

Shastri, Shani; Tighiouart, Hocine; Katz, Ronit; Rifkin, Dena E.; Fried, Linda F.; Shlipak, Michael G.; Newman, Anne B.



Diarrheal Diseases - Acute and Chronic  


... doctor if you have a family history of celiac disease, inflammatory bowel disease (IBD), have unintentional weight loss, ... common small bowel disease in the U.S. is celiac disease, also called celiac sprue. Crohn’s disease can also ...


An NMR Metabolomics Study of Elk Inoculated with Chronic Wasting Disease  

Microsoft Academic Search

Chronic wasting disease (CWD) is a fatal neurodegenerative disease affecting both farmed and wild cervids, specifically deer and elk, and is a member of the larger family of prion diseases. Prion disease transmission is believed to occur through exposure to infectious prion material—a misfolded and infectious form of the prion protein that is normally present in the host. Chronic wasting

M. Jake Pushie; Rustem Shaykhutdinov; Alsu Nazyrova; Catherine Graham; Hans J. Vogel



28 CFR 79.57 - Proof of chronic renal disease.  

Code of Federal Regulations, 2010 CFR

...2010-07-01 false Proof of chronic renal disease. 79.57 Section 79.57...Millers § 79.57 Proof of chronic renal disease. (a) In determining whether a claimant developed chronic renal disease following pertinent...



Genomic Biomarkers for Chronic Kidney Disease  

PubMed Central

Chronic kidney disease (CKD) remains a major challenge in nephrology and for public health care, affecting 14–15% of the adult U.S. population and consuming significant health care resources. In the next 20 years, the number of patients with end stage renal disease is projected to increase by 50%. Ideal biomarkers that allow early identification of CKD patients at high risk of progression are urgently needed for early and targeted treatment to improve patient care. Recent success of integrating molecular approaches for personalized management of neoplastic diseases, including diagnosis, staging, prognosis, treatment selection and monitoring, has strongly encouraged kidney researchers to pursue molecular definitions of patients with kidney disease. Challenges for molecular marker identification in CKD are a high degree of cellular heterogeneity of the kidney and the paucity of human tissue availability for molecular studies. Despite these limitations potential molecular biomarker candidates have been uncovered at multiple levels along the genome – phenome continuum. Here we will review the identification and validation of potential genomic biomarker candidates of CKD and CKD progression in clinical studies. The challenges in predicting CKD progression, as well as the promises and opportunities resulting from a molecular definition of CKD will be discussed.

Ju, Wenjun; Smith, Shahaan; Kretzler, Matthias



[Chronic obstructive pulmonary disease and heart failure].  


Chronic obstructive pulmonary disease (COPD) is commonly associated with heart failure. Individuals with COPD have a 4.5-fold greater risk of developing heart failure than those without. The sensitivity and specificity of clinical judgment in the diagnosis of heart failure in patients with COPD can be enhanced by biological markers such as B-type natriuretic peptide and N-terminal pro-B-type natriuretic peptide. Correct interpretation of imaging results (mainly echocardiographic findings) and lung function tests can also help establish the co-occurrence of both conditions. There is little evidence on the management of patients with COPD and heart failure, although treatment of COPD undeniably affects the clinical course of patients with heart failure and viceversa. PMID:19595494

Villar Alvarez, Felipe; Méndez Bailón, Manuel; de Miguel Díez, Javier



Total body irradiation correlates with chronic graft versus host disease and affects prognosis of patients with acute lymphoblastic leukemia receiving an HLA identical allogeneic bone marrow transplant  

Microsoft Academic Search

Purpose: To investigate whether different procedure variables involved in the delivery of fractionated total body irradiation (TBI) impact on prognosis of patients affected by acute lymphoblastic leukemia (ALL) receiving allogeneic bone marrow transplant (BMT).Methods and Materials: Ninety-three consecutive patients with ALL receiving a human leukocyte antigen (HLA) identical allogeneic BMT between 1 August 1983 and 30 September 1995 were conditioned

Renzo Corvò; Gabriella Paoli; Salvina Barra; Almalina Bacigalupo; Maria Teresa Van Lint; Paola Franzone; Francesco Frassoni; Daniele Scarpati; Andrea Bacigalupo; Vito Vitale



HIV/AIDS, chronic diseases and globalisation  

PubMed Central

HIV/AIDS has always been one of the most thoroughly global of diseases. In the era of widely available anti-retroviral therapy (ART), it is also commonly recognised as a chronic disease that can be successfully managed on a long-term basis. This article examines the chronic character of the HIV/AIDS pandemic and highlights some of the changes we might expect to see at the global level as HIV is increasingly normalised as "just another chronic disease". The article also addresses the use of this language of chronicity to interpret the HIV/AIDS pandemic and calls into question some of the consequences of an uncritical acceptance of concepts of chronicity.



Decrease in Irisin in Patients with Chronic Kidney Disease  

PubMed Central

Patients with chronic kidney disease have abnormal energy expenditure and metabolism. The mechanisms underlying altered energy expenditure in uremia are unknown and remain to be elucidated. Irisin is a peroxisome proliferator-activated receptor ? coactivator 1-?–dependent myokine, and it increases energy expenditure in the absence of changes in food intake or activity. We hypothesize that chronic kidney disease patients have altered irisin levels. We measured resting irisin levels in 38 patients with stage 5 chronic kidney disease and in 19 age- and sex-matched normal subjects. Plasma irisin levels were significantly decreased in chronic kidney disease patients (58.59%; 95% CI 47.9%–69.2%, p<0.0001). The decrease in irisin levels was inversely correlated with the levels of blood urea nitrogen and creatinine. Further association analysis revealed that irisin level is independently associated with high-density lipoprotein cholesterol level. Our results suggest that chronic kidney disease patients have lower than normal irisin levels at rest. Furthermore, irisin may play a major role in affecting high-density lipoprotein cholesterol levels and abnormal energy expenditure in chronic kidney disease patients.

Wen, Ming-Shien; Wang, Chao-Yung; Lin, Shuei-Liong; Hung, Kuo-Chun



Cardiovascular complications of pediatric chronic kidney disease  

PubMed Central

Cardiovascular disease (CVD) mortality is a leading cause of death in adult chronic kidney disease (CKD), with exceptionally high rates in young adults, according to the Task Force on Cardiovascular Disease. Recent data indicate that cardiovascular complications are already present in children with CKD. This review summarizes the current literature on cardiac risk factors, mortality and morbidity in children with CKD.



Non-Hormonal Medications and Chronic Diseases  

Microsoft Academic Search

\\u000a This chapter explores the relation between breast cancer risk and the use of non-hormonal medications and chronic diseases.\\u000a Many drugs and diseases have been linked with breast cancer in case reports and epidemiologic studies. This chapter covers\\u000a those major medications and diseases where there is adequate epidemiologic evidence for evaluation.

Patricia F. Coogan


Natural Histories of Chronic Obstructive Pulmonary Disease  

Microsoft Academic Search

Concepts relating to the natural history of chronic obstructive pulmonary disease (COPD) arise most importantly from the classic study of Fletcher and colleagues (The Natural History of Chronic Bronchitis and Emphysema, Oxford University Press, New York, 1976). This study, which evaluated working English men over 8 years, was used to construct a proposed life-long natural history. Although this is a

Stephen I. Rennard; Jørgen Vestbo



Chronic Diseases and Health Promotion  


... chronic conditions have one or more daily activity limitations. 5 Arthritis is the most common cause of disability, with nearly 19 million Americans reporting activity limitations. 6 Diabetes continues to be the leading cause ...


Neuromotor control in chronic obstructive pulmonary disease.  


Neuromotor control of skeletal muscles, including respiratory muscles, is ultimately dependent on the structure and function of the motor units (motoneurons and the muscle fibers they innervate) comprising the muscle. In most muscles, considerable diversity of contractile and fatigue properties exists across motor units, allowing a range of motor behaviors. In diseases such as chronic obstructive pulmonary disease (COPD), there may be disproportional primary (disease related) or secondary effects (related to treatment or other concomitant factors) on the size and contractility of specific muscle fiber types that would influence the relative contribution of different motor units. For example, with COPD there is a disproportionate atrophy of type IIx and/or IIb fibers that comprise more fatigable motor units. Thus fatigue resistance may appear to improve, while overall motor performance (e.g., 6-min walk test) and endurance (e.g., reduced aerobic exercise capacity) are diminished. There are many coexisting factors that might also influence motor performance. For example, in COPD patients, there may be concomitant hypoxia and/or hypercapnia, physical inactivity and unloading of muscles, and corticosteroid treatment, all of which may disproportionately affect specific muscle fiber types, thereby influencing neuromotor control. Future studies should address how plasticity in motor units can be harnessed to mitigate the functional impact of COPD-induced changes. PMID:23329816

Mantilla, Carlos B; Sieck, Gary C



Serum elastase 1 in chronic pancreatic disease  

Microsoft Academic Search

Summary Elastase 1 and immunoreactive trypsin were assessed by a RIA technique in the sera of 29 control subjects, 24 pancreatic cancer patients, 22 patients with chronic pancreatitis and 31 with extra-pancreatic diseases to ascertain and compare their usefulness in chronic pancreatic disease diagnosis. Increased levels of elastase 1 were detected in 60.9% of pancreatic cancer and in 61.1% of

G. Del Favero; C. Fabris; M. Plebani; A. Panucci; A. Piccoli; L. Perobelli; A. Burlina; R. Naccarato



Exacerbation phenotyping in chronic obstructive pulmonary disease.  


Acute exacerbations of chronic obstructive pulmonary disease (AECOPD) are crucial events but causes remain poorly defined. A method to clinically 'phenotype' AECOPD have been proposed, and 52 hospitalized chronic obstructive pulmonary disease exacerbations according to underlying aetiology have now been prospectively phenotyped. Multiple exacerbation phenotypes were identified. A subpopulation coinfected with virus and bacteria had a significantly longer length of hospital stay, and this pilot study indicates that exacerbation phenotyping may be advantageous. PMID:24164687

Macdonald, Martin; Korman, Tony; King, Paul; Hamza, Kais; Bardin, Philip



Controversies in Chronic Kidney Disease Staging  

PubMed Central

In 2002, a new chronic kidney disease staging system was developed by the US National Kidney Foundation. The classification system represented a new conceptual framework for the diagnosis of chronic kidney disease (moving to a schema based on disease severity defined by the glomerular filtration rate). While the introduction of the staging system stimulated significant clinical and research interest in kidney disease, there has been vigorous debate on its merits. This mini-review aims to summarise the recent controversies that have been raised since the introduction of the new classification.

Polkinghorne, Kevan R



Lung Compliance and Chronic Obstructive Pulmonary Disease  

PubMed Central

Chronic obstructive pulmonary disease, namely, pulmonary emphysema and chronic bronchitis, is a chronic inflammatory response of the airways to noxious particles or gases, with resulting pathological and pathophysiological changes in the lung. The main pathophysiological aspects of the disease are airflow obstruction and hyperinflation. The mechanical properties of the respiratory system and its component parts are studied by determining the corresponding volume-pressure (P-V) relationships. The consequences of the inflammatory response on the lung structure and function are depicted on the volume-pressure relationships.

Papandrinopoulou, D.; Tzouda, V.; Tsoukalas, G.



Affective and Psychiatric Disorders in Celiac Disease  

Microsoft Academic Search

Several extraintestinal clinical manifestations have been reported in celiac disease (CD). Among them, growing evidence suggests the association between CD and affective and psychiatric disorders. In this review the most frequent affective and psychiatric disorders associated with CD and the possible mechanisms involved in these associations were analyzed. The available data suggest that screening for CD in patients with affective

Giovanni Addolorato; Lorenzo Leggio; Cristina D’Angelo; Antonio Mirijello; Anna Ferrulli; Silvia Cardone; Luisa Vonghia; Ludovico Abenavoli; Veruscka Leso; Antonio Nesci; Salvatore Piano; Esmeralda Capristo; Giovanni Gasbarrini



Chronic Kidney Disease and Its Complications  

PubMed Central

Chronic kidney disease (CKD) is a complex disease impacting more than twenty million individuals in the United States. Progression of CKD is associated with a number of serious complications, including increased incidence of cardiovascular disease, hyperlipidemia, anemia and metabolic bone disease. CKD patients should be assessed for the presence of these complications and receive optimal treatment to reduce their morbidity and mortality. A multidisciplinary approach is required to accomplish this goal.

Thomas, Robert; Kanso, Abbas; Sedor, John R.



The Causes of Skin Damage and Leg Ulceration in Chronic Venous Disease  

Microsoft Academic Search

Chronic venous disease with skin changes of the leg is a common condition affecting up to 1 in 20 people in westernized countries. The causes of this problem are not fully understood, although research in recent years has revealed a number of important mechanisms that contribute to the disease process. Patients with chronic venous disease suffer persistently raised pressures in

Philip Coleridge Smith



Application of biomedical informatics to chronic pediatric diseases: a systematic review  

Microsoft Academic Search

BACKGROUND: Chronic diseases affect millions of children worldwide leading to substantial disease burden to the children and their families as well as escalating health care costs. The increasing trend in the prevalence of complex pediatric chronic diseases requires innovative and optimal delivery of care. Biomedical informatics applications play an important role in improving health outcomes while being cost-effective. However, their

Fatemeh Moeinedin; Rahim Moineddin; Alejandro R Jadad; Jemila S Hamid; Teresa To; Joseph Beyene



Drug dosing adjustments in patients with chronic kidney disease.  


Chronic kidney disease affects renal drug elimination and other pharmacokinetic processes involved in drug disposition (e.g., absorption, drug distribution, nonrenal clearance [metabolism]). Drug dosing errors are common in patients with renal impairment and can cause adverse effects and poor outcomes. Dosages of drugs cleared renally should be adjusted according to creatinine clearance or glomerular filtration rate and should be calculated using online or electronic calculators. Recommended methods for maintenance dosing adjustments are dose reductions, lengthening the dosing interval, or both. Physicians should be familiar with commonly used medications that require dosage adjustments. Resources are available to assist in dosing decisions for patients with chronic kidney disease. PMID:17555141

Munar, Myrna Y; Singh, Harleen



Screening and Management of Depression for Adults With Chronic Diseases  

PubMed Central

Background Depression is the leading cause of disability and the fourth leading contributor to the global burden of disease. In Canada, the 1-year prevalence of major depressive disorder was approximately 6% in Canadians 18 and older. A large prospective Canadian study reported an increased risk of developing depression in people with chronic diseases compared with those without such diseases. Objectives To systematically review the literature regarding the effectiveness of screening for depression and/or anxiety in adults with chronic diseases in the community setting. To conduct a non-systematic, post-hoc analysis to evaluate whether a screen-and-treat strategy for depression is associated with an improvement in chronic disease outcomes. Data Sources A literature search was performed on January 29, 2012, using OVID MEDLINE, OVID MEDLINE In-Process and Other Non-Indexed Citations, OVID EMBASE, OVID PsycINFO, EBSCO Cumulative Index to Nursing & Allied Health Literature (CINAHL), the Wiley Cochrane Library, and the Centre for Reviews and Dissemination database, for studies published from January 1, 2002 until January 29, 2012. Review Methods No citations were identified for the first objective. For the second, systematic reviews and randomized controlled trials that compared depression management for adults with chronic disease with usual care/placebo were included. Where possible, the results of randomized controlled trials were pooled using a random-effects model. Results Eight primary randomized controlled trials and 1 systematic review were included in the post-hoc analysis (objective 2)—1 in people with diabetes, 2 in people with heart failure, and 5 in people with coronary artery disease. Across all studies, there was no evidence that managing depression improved chronic disease outcomes. The quality of evidence (GRADE) ranged from low to moderate. Some of the study results (specifically in coronary artery disease populations) were suggestive of benefit, but the differences were not significant. Limitations The included studies varied in duration of treatment and follow-up, as well as in included forms of depression. In most of the trials, the authors noted a significant placebo response rate that could be attributed to spontaneous resolution of depression or mild disease. In some studies, placebo groups may have had access to care as a result of screening, since it would be unethical to withhold all care. Conclusions There was no evidence to suggest that a screen-and-treat strategy for depression among adults with chronic diseases resulted in improved chronic disease outcomes. Plain Language Summary People with chronic diseases are more likely to have depression than people without chronic diseases. This is a problem because depression may make the chronic disease worse or affect how a person manages it. Discovering depression earlier may make it easier for people to cope with their condition, leading to better health and quality of life. We reviewed studies that looked at screening and treating for depression in people with chronic diseases. In people with diabetes, treatment of depression did not affect clinical measures of diabetes management. In people with heart failure and coronary artery disease, treatment of depression did not improve heart failure management or reduce rates of heart attacks or death. At present, there is no evidence that screening and treating for depression improves the symptoms of chronic diseases or lead to use of fewer health care services.



Comorbidities in Chronic Obstructive Pulmonary Disease  

Microsoft Academic Search

Comorbidities such as cardiac disease, diabetes mellitus, hyper- tension, osteoporosis, and psychological disorders are commonly reported in patients with chronic obstructive pulmonary disease (COPD) but with great variability in reported prevalence. Tobacco smokingis a risk factorfor many of these comorbidities as well as for COPD,makingit difficultto draw conclusions aboutthe relationship between COPD and these comorbidities. However, recent large epi- demiologic

Wissam M. Chatila; Byron M. Thomashow; Omar A. Minai; Gerard J. Criner; Barry J. Make



Updated guidelines for managing chronic kidney disease.  


Chronic kidney disease (CKD) is the most costly disease covered by Medicare, and two common causes of CKD, diabetes and hypertension, are increasing worldwide. More than 60% of Americans will develop CKD in their lifetimes. This article reviews updated guidelines for managing CKD in primary care. PMID:24103894

Dobkowski, Darlene; Zuber, Kim; Davis, Jane



Glycemic index in chronic disease: a review  

Microsoft Academic Search

Aim: The intent of this review is to critically analyze the scientific evidence on the role of the glycemic index in chronic Western disease and to discuss the utility of the glycemic index in the prevention and management of these disease states. Background: The glycemic index ranks foods based on their postprandial blood glucose response. Hyperinsulinemia and insulin resistance, as

LS Augustin; S Franceschi; DJA Jenkins; CWC Kendall; C La Vecchia


Respiratory failure in chronic obstructive pulmonary disease  

Microsoft Academic Search

Respiratory failure is still an important complication of chronic obstructive pulmonary disease (COPD) and hospitalisation with an acute episode being a poor prognostic marker. However, other comorbid conditions, especially cardiovascular disease, are equally powerful predictors of mortality. The physiological basis of acute respiratory failure in COPD is now clear. Significant ventilation\\/perfusion mismatching with a relative increase in the physiolo- gical

P. M. A. Calverley



Glycemic index in chronic disease: a review  

Microsoft Academic Search

Aim: The intent of this review is to critically analyze the scientific evidence on the role of the glycemic index in chronic Western disease and to discuss the utility of the glycemic index in the prevention and management of these disease states.Background: The glycemic index ranks foods based on their postprandial blood glucose response. Hyperinsulinemia and insulin resistance, as well

LS Augustin; S Franceschi; DJA Jenkins; CWC Kendall; C La Vecchia



Nutrition for Chronic Kidney Disease in Children.  

National Technical Information Service (NTIS)

Chronic kidney disease (CKD) is any disease that causes the kidneys to function less efficiently over a long period of time. In the early stages of CKD, the kidneys continue to work. They just dont do their job as well as healthy kidneys. Because the decl...



Asthma, chronic obstructive pulmonary disease (COPD), and the overlap syndrome.  


Asthma and chronic obstructive pulmonary disease (COPD) are highly prevalent chronic diseases in the general population. Both are characterized by heterogeneous chronic airway inflammation and airway obstruction. In both conditions, chronic inflammation affects the whole respiratory tract, from central to peripheral airways, with different inflammatory cells recruited, different mediators produced, and thus differing responses to therapy. Airway obstruction is typically intermittent and reversible in asthma but is progressive and largely irreversible in COPD. However, there is a considerable pathologic and functional overlap between these 2 heterogeneous disorders, particularly among the elderly, who may have components of both diseases (asthma-COPD overlap syndrome). The definitions for asthma and COPD recommended by current guidelines are useful but limited because they do not illustrate the full spectrum of obstructive airway diseases that is encountered in clinical practice. Defining asthma and COPD as separate entities neglects a considerable proportion of patients with overlapping features and is largely based on expert opinion rather than on the best current evidence. The presence of different phenotypes or components of obstructive airway diseases, therefore, needs to be addressed to individualize and optimize treatment to achieve the best effect with the fewest side effects for the patient. Although specific interventions vary by disease, the treatment goals of obstructive airway diseases are similar and driven primarily by the need to control symptoms, optimize health status, and prevent exacerbations. PMID:23833163

Nakawah, Mohammad Obadah; Hawkins, Clare; Barbandi, Farouk


Aetiology of chronic suppurative lung disease.  

PubMed Central

Forty one (1%) of 4000 children referred for respiratory disease had chronic suppurative lung disease not due to cystic fibrosis. Further investigations showed congenital malformations in six (15%), primary ciliary dyskinesia syndrome in seven (17%), 11 had immunological abnormalities (27%), and two bronchiectasis due to aspiration (5%). Therefore the underlying cause for the disease was found in 63%. Identification of predisposing causes may facilitate prevention of further bronchial damage.

Nikolaizik, W H; Warner, J O



Major and chronic diseases, report 2007  

Microsoft Academic Search

Blind spots in European health information\\u000aOn June 6th 2008 the European Commission has published the Major and Chronic Diseases Report 2007. This report describes the state of the art of health information in Europe on 13 prevalent chronic conditions. Large differences between the Member States of the European Union became apparent. \\u000a\\u000aFor example, as compared to the old Member

S. Giampaoli; H. van Oyen; W. Devillé; M. Verschuuren



Systemic effects of chronic obstructive pulmonary disease  

Microsoft Academic Search

ABSTRACT: Chronic obstructive pulmonary,disease (COPD) is characterised by an inappropriate\\/excessive inflammatory response of the lungs to respiratory pollutants, mainly tobacco smoking. Recently, besides the typical pulmonary pathology of COPD (i.e. chronic bronchitis and emphysema), several effects occurring outside the lungs have been described, the so- called systemic effects of COPD. These effects are clinically relevant because they modify,and can help

A. G. N. Agusti; A. Noguera; J. Sauleda; E. Sala; J. Pons; X. Busquets



Chronic myelogenous leukemia: mechanisms underlying disease progression  

Microsoft Academic Search

Chronic myelogenous leukemia (CML), characterized by the BCR-ABL gene rearrangement, has been extensively studied. Significant progress has been made in the area of BCR-ABL-mediated intracellular signaling, which has led to a better understanding of BCR-ABL-mediated clinical features in chronic phase CML. Disease progression and blast crisis CML is associated with characteristic non-random cytogenetic and molecular events. These can be viewed

AS Shet; BN Jahagirdar; CM Verfaillie



Systemic Diseases and Chronic Rhinosinusitis  

Microsoft Academic Search

Many systemic diseases can cause nasal symptoms, either as an initial presentation or a manifestation later in the disease process. When patients present with nasal symptoms resembling infection—such as purulent nasal discharge, crusting, and congestion—acute rhinosinusitis is likely to be diagnosed. However, when these symptoms persist despite appropriate medical therapy, other etiologies should be considered. In some cases, underlying inflammation

Christine Reger; Christina F. Herrera; Megan Abbott; Alexander G. Chiu



PubMed Central

Soluble Klotho (sKl) in the circulation can be generated directly by alterative splicing of the Klotho transcript or the extracellular domain of membrane Klotho can be released from membrane-anchored Klotho on the cell surface. Unlike membrane Klotho which functions as a coreceptor for fibroblast growth factor-23 (FGF23), sKl, acts as hormonal factor and plays important roles in anti-aging, anti-oxidation, modulation of ion transport, and Wnt signaling. Emerging evidence reveals that Klotho deficiency is an early biomarker for chronic kidney diseases as well as a pathogenic factor. Klotho deficiency is associated with progression and chronic complications in chronic kidney disease including vascular calcification, cardiac hypertrophy, and secondary hyperparathyroidism. In multiple experimental models, replacement of sKl, or manipulated up-regulation of endogenous Klotho protect the kidney from renal insults, preserve kidney function, and suppress renal fibrosis, in chronic kidney disease. Klotho is a highly promising candidate on the horizon as an early biomarker, and as a novel therapeutic agent for chronic kidney disease.

Hu, Ming Chang; Kuro-o, Makoto; Moe, Orson W.



COPD (Chronic Obstructive Pulmonary Disease)  

MedlinePLUS Videos and Cool Tools

... COPD and emphysema. Exposure to other irritants and pollution can also harm the lungs. There are also ... associated with these diseases. Avoiding other irritants and pollution is also important. Likewise, repairing lung damage is ...


Chronic Kidney Disease-Mineral and Bone Disorder  


... Disease-Mineral and Bone Disorder Chronic Kidney Disease-Mineral and Bone Disorder On this page: What is ... More Information Acknowledgments What is chronic kidney disease-mineral and bone disorder (CKD-MBD)? CKD-MBD occurs ...


Child's Chronic Illness Can Affect the Whole Family  


... News) -- Parenting a chronically ill child can cause stress that affects the whole family. That's the finding of researchers who reviewed 96 studies conducted in 12 countries between 1980 and 2012. ... sometimes created greater stress for parents than the severity or length of ...


The potential impact of anaemia of chronic disease in COPD  

Microsoft Academic Search

Anaemia of chronic disease (ACD), with chronically low levels of circulating haemoglobin, is an immune driven abnormality that occurs in many inflammatory diseases, and also in chronic heart failure. Although chronic obstructive pulmonary disease (COPD) is ''traditionally'' associated with polycythaemia, the systemic inflammation that is now recognised as a feature of COPD makes it a possible cause of ACD. If

T. Similowski; A. Agusti; W. MacNee; B. Schonhofer



Pulmonary epithelium, cigarette smoke, and chronic obstructive pulmonary disease  

PubMed Central

Chronic obstructive pulmonary disease (COPD) is a complex chronic inflammatory disease involving a wide variety of cells and inflammatory mediators. The most important etiological factor in the development of this disease is cigarette smoking. Much of the research into the mechanisms of COPD has been concerned with the induction of inflammation and the role of neutrophils and macrophages in the pathophysiology of the disease. The possible contribution of the epithelium to the development of COPD has only recently become apparent and remains unclear. In this article we review research into the effect of cigarette smoke on the pulmonary epithelium with particular emphasis on oxidative stress, proteolytic load, pro-inflammatory cytokine and chemokine profile and epithelial secretions. In addition, we have also reviewed how cigarette smoke may affect epithelial damage and repair processes.

Thorley, Andrew J; Tetley, Teresa D



Kimura's disease in a chronic hemodialysis patient.  


Eosinophilia is not an uncommon finding in chronic dialysis patients. It is usually benign in nature although definite pathogenesis is unknown. We have encountered a young uremic Chinese adult who developed Kimura's disease after being on maintenance hemodialysis for about 3 years. Asymptomatic eosinophilia had been noted for 1 year and 8 months prior to the development of progressively enlarged neck masses, which leads to the diagnosis of Kimura's disease. In contrast to most cases, eosinophilia was first noticed before the neck masses appeared. There is often a close correlation between Kimura's disease and glomerular disease, where renal involvement is considered as a systemic manifestation. However, we do not have strong evidence to support this relationship between terminal renal failure and Kimura's disease in this patient. To our knowledge, our patient is the first reported case of Kimura's disease occurring in chronic hemodialysis patients. Eosinophilia persisted for nearly 2 years before the neck mass developed and recurred after the excision. Besides, our patient also demonstrated a chronic and recurrent course typical of Kimura's disease. PMID:11275632

Lee, C T; Huang, C C; Lam, K K; Chen, J B


Chronic Kidney Disease Is Associated with Angiographic Coronary Artery Disease  

Microsoft Academic Search

Background\\/Aims: Patients with chronic kidney disease (CKD) have a dramatically increased risk for cardiovascular mortality. Few prior studies have examined the independent association of CKD with coronary anatomy. Methods: We evaluated the relationship between CKD and severe coronary artery disease (CAD) in 261 male veterans with nuclear perfusion imaging tests suggesting coronary ischemia. We used chart review and patient and

Michel Chonchol; Jeff Whittle; Angela Desbien; Michelle B. Orner; Laura A. Petersen; Nancy R. Kressin



Gender and human chronic renal disease  

Microsoft Academic Search

Background: Gender affects the incidence, prevalence, and progression of renal disease. In animal models of the disease, female sex appears to modify the course of progression. Hormonal manipulation by male or female castration also changes the course of renal disease progression, suggesting direct effects of sex hormones in influencing the course of these maladies.Objective: This review examines the pertinent animal

Sharon Silbiger; Joel Neugarten



Antioxidants and prevention of chronic disease.  


The generation of reactive oxygen species (ROS) and other free radicals (R) during metabolism is a necessary and normal process that ideally is compensated for by an elaborate endogenous antioxidant system. However, due to many environmental, lifestyle, and pathological situations, excess radicals can accumulate, resulting in oxidative stress. Oxidative stress has been related to cardiovascular disease, cancer, and other chronic diseases that account for a major portion of deaths today. Antioxidants are compounds that hinder the oxidative processes and thereby delay or prevent oxidative stress. This article examines the process of oxidative stress and the pathways by which it relates to many chronic diseases. We also discuss the role that endogenous and exogenous antioxidants may play in controlling oxidation and review the evidence of their roles in preventing disease. PMID:15462130

Willcox, Joye K; Ash, Sarah L; Catignani, George L



Cognitive impairment in chronic kidney disease  

Microsoft Academic Search

Background. Although end-stage renal disease (ESRD) has been associated with cognitive impairment, the relation between lesser degrees of chronic kidney disease (CKD) and cognitive impairment is less well understood. The objective of this study was to assess the cognitive function in patients with varying severity of CKD using P3 event-related potentials (P3ERPs). Methods. In this cross-sectional study, 15 neuro- logically

Pankaj Madan; Om P. Kalra; Sunil Agarwal; Om P. Tandon


Anemia in children with chronic kidney disease  

PubMed Central

Anemia is a common feature of chronic kidney disease, but the management of anemia in children is complex. Erythropoietin and supplemental iron are used to maintain hemoglobin levels. The National Kidney Foundation-Kidney Disease Outcomes Quality Initiative (NKF-KDOQI) clinical practice guidelines for the management of anemia specifically in children were recently published. Pediatric nephrologists are encouraged to use current clinical practice guidelines and best evidence in conjunction with their clinical experience to optimally manage patients with anemia.

Koshy, Susan M.



Chronic Graft-Versus-Host Disease  

Microsoft Academic Search

\\u000a Chronic graft-versus-host disease (cGVHD) is a complex, immune phenomenon that occurs after allogeneic stem cell transplant\\u000a (SCT) and resembles a plethora of autoimmune diseases [1]. It can have minimal features like a dry eye or can be disabling\\u000a with sclerodermatous fascitis and bronchiolitis obliterans. The incidence and time course is variable. Despite improvement\\u000a in other areas of SCT, little significant

Madan Jagasia; Steven Pavletic


Epidemiology of chronic kidney disease in children  

Microsoft Academic Search

In the past 30 years there have been major improvements in the care of children with chronic kidney disease (CKD). However,\\u000a most of the available epidemiological data stem from end-stage renal disease (ESRD) registries and information on the earlier\\u000a stages of pediatric CKD is still limited. The median reported incidence of renal replacement therapy (RRT) in children aged\\u000a 0–19 years

Jérôme Harambat; Karlijn J. van Stralen; Jon Jin Kim; E. Jane Tizard


New Therapies for Chronic Obstructive Pulmonary Disease  

Microsoft Academic Search

Chronic obstructive pulmonary disease (COPD) is a major global health problem which is increasing throughout the world and a major cause of death. However, current therapies fail to prevent disease progression or mortality. The mainstay of current drug therapy are long-acting bronchodilators; several longer-acting inhaled ?2-agonists and muscarinic antagonists (and combinations) are now in development. No treatments have so far

Peter J. Barnes



Framing international trade and chronic disease  

Microsoft Academic Search

There is an emerging evidence base that global trade is linked with the rise of chronic disease in many low and middle-income\\u000a countries (LMICs). This linkage is associated, in part, with the global diffusion of unhealthy lifestyles and health damaging\\u000a products posing a particular challenge to countries still facing high burdens of communicable disease. We developed a generic\\u000a framework which

Ronald Labonté; Katia S Mohindra; Raphael Lencucha



End stage chronic obstructive pulmonary disease.  


Many patients with chronic obstructive pulmonary disease (COPD) die each year as those with lung cancer but current guidelines make few recommendations on the care for the most severe patients i.e. those with Global Initiative for Chronic Obstructive Lung Disease (GOLD) stages III and IV with chronic respiratory failure. Only smoking cessation and long term oxygen therapy (LTOT) improve survival in COPD. Although non invasive positive pressure ventilation (NPPV) may have an adjunctive role in the management of chronic respiratory insufficiency there is little evidence for its use in the routine management of stable hypercapnic COPD patients. At difference, several prospective, randomised, controlled studies, systematic reviews and meta-analyses show good level of evidence for clinical efficacy of NPPV in the treatment of acute on chronic respiratory failure due to acute exacerbations of COPD. NPPV is also alternative to invasive ventilation for symptom relief in end stage COPD. Surgical interventions for end stage COPD like bullectomy, different modalities of lung volume reduction surgery and lung transplantation are likely to be of value to only a small percentage of patients. Nevertheless, there are specific indications, which, when added to pulmonary rehabilitation will further advance exercise capacity and quality of life. As in other chronic diseases when severity of disease increases along the natural history, therapy aimed to prolong life becomes less and less important in comparison to palliative therapy aimed to relieve symptoms. The most effective treatments for dyspnoea are bronchodilators, although also opiates may improve dyspnoea. Supplemental oxygen reduce exertional breathlessness and improve exercise tolerance in hypoxaemic COPD patients. There are difficulties in treating with antidepressant the frail and elderly COPD patients. Good clinical care can prevent or alleviate suffering by assessing symptoms and providing psychological and social support to the patients and their families. PMID:19462352

Ambrosino, Nicolino; Gherardi, Marco; Carpenè, Nicoletta



Magnesium in Chronic Kidney Disease: Unanswered Questions  

Microsoft Academic Search

Background: Magnesium ion is critical for life and is integrally involved in cellular function and a key component of normal bone mineral. In health, the kidneys, gastrointestinal tract and bone are responsible for maintaining serum magnesium concentrations in the normal range and magnesium balance. Most clinical disorders involving magnesium, other than chronic kidney disease (CKD), result in hypomagnesemia, either from

David M. Spiegel



Dental disease in children with chronic illness  

PubMed Central

We focus on the role of the general paediatrician in promoting the importance of good dental health for all children and in particular those children "at risk". We present preventive measures, evidence based where available, that may improve dental care and promote the role of paediatric dental services in the multidisciplinary management of chronic disease.

Foster, H; Fitzgerald, J



Theophylline in Chronic Obstructive Pulmonary Disease  

Microsoft Academic Search

Although theophylline has side effects when used in bronchodilator doses, increasing evidence shows that it has significant antiinflam- matory effects in chronic obstructive pulmonary disease at lower plasma concentrations. These antiinflammatory effects are unlikely to be accounted for by phosphodiesterase inhibition or adenosine receptor antagonism, which require higher concentrations. There isnowevidencethattheophyllineatlowtherapeuticconcentrations is an activator of histone deacetylases and that this

Peter J. Barnes



Update on Pregnancy in Chronic Kidney Disease  

Microsoft Academic Search

The occurrence of pregnancy in patients with chronic kidney disease (CKD) has been considered a dangerous event both for the mother and for the fetus. However, increasing evidence shows that the stage of CKD is the leading factor that can predict possible acceleration in the declining of renal function and complications of pregnancy. This review summarizes recent data on pregnancy

Giuseppe Castellano; Vincenzo Losappio; Loreto Gesualdo



Chronic beryllium disease: Diagnosis and management  

Microsoft Academic Search

Chronic beryllium disease is predominantly a pulmonary granulomatosis that was originally described in 1946. Symptoms usually include dyspnea and cough. Fever, anorexia, and weight loss are common. Skin lesions are the most common extrathoracic manifestation. Granulomatous hepatitis, hypercalcemia, and kidney stones can also occur. Radiographic and physiologic abnormalities are similar to those in sarcoidosis. While traditionally the pathologic changes included




Gene Therapy for Chronic Granulomatous Disease  

Microsoft Academic Search

Identification of gene mutations responsible for leukocyte dysfunction along with the application of gene transfer technology has made genetic correction of such disorders possible. Much of the research into molecular therapy for inherited disorders of phagocytes has been focused on chronic granulomatous disease (CGD). CGD results from mutations in any one of the four genes encoding essential subunits of respiratory

W. Scott Goebel; Mary C. Dinauer



Fluid homeostasis in chronic obstructive lung disease  

Microsoft Academic Search

Chronic obstructive pulmonary disease (COPD) often leads to massive oedema and the development of what is usually called cor pulmonale. The mechanisms by which patients with COPD retain salt and water are not completely understood. Several abnormalities have been found including reduced renal blood flow with relatively preserved glomerular filtration rate and elevated levels of renin, aldosterone, arginine vasopressin and

P. W. de Leeuw; A. Dees



MicroRNAs: new insights into chronic childhood diseases.  


Chronic diseases are the major cause of morbidity and mortality worldwide and have shown increasing incidence rates among children in the last decades. Chronic illnesses in the pediatric population, even if well managed, affect social, psychological, and physical development and often limit education and active participation and increase the risk for health complications. The significant pediatric morbidity and mortality rates caused by chronic illnesses call for serious efforts toward better understanding of the pathogenesis of these disorders. Recent studies have shown the involvement of microRNAs (miRNAs) in various aspects of major pediatric chronic non-neoplastic diseases. This review focuses on the role of miRNAs in four major pediatric chronic diseases including bronchial asthma, diabetes mellitus, epilepsy and cystic fibrosis. We intend to emphasize the importance of miRNA-based research in combating these major disorders, as we believe this approach will result in novel therapies to aid securing normal development and to prevent disabilities in the pediatric population. PMID:23878802

Omran, Ahmed; Elimam, Dalia; Yin, Fei



Dietary Fiber and the Relationship to Chronic Diseases  

Microsoft Academic Search

Preventative medicine is targeting chronic diseases such as heart disease, cancer, diabetes, and obesity. Populations that consume more dietary fiber have less chronic disease. Intake of dietary fiber has beneficial effects on the risk factors for developing several chronic diseases. Dietary reference intakes recommend the consumption of 14 g of dietary fiber per 1000 kcal, or 25 g for women

Derek A. Timm; Joanne L. Slavin



Bone health and vascular calcification relationships in chronic kidney disease  

Microsoft Academic Search

Abnormal bone in chronic kidney disease (CKD) may adversely affect vascular calcification via disordered calcium and phosphate\\u000a metabolism. In this context, bone health should be viewed as a prerequisite for the successful prevention\\/treatment of vascular\\u000a calcification (VC) along with controlled parathyroid hormone (PTH) secretion, the use of calcium-based phosphate binders and\\u000a vitamin D therapy. In CKD patients, VC occurs more

Goce B. Spasovski



Future Treatments for Chronic Obstructive Pulmonary Disease and Its Comorbidities  

Microsoft Academic Search

The recognition that patients with chronic obstructive pulmonary disease (COPD) may have systemic manifestations and often suffer from comorbid conditions has important implications for therapy thatrequirefurtherresearch.ThemostlikelylinkbetweenCOPDand extrapulmonary effects is that inflammation in the lung periphery ''spillsover''intothesystemiccirculationandeffectsonotherorgans that may also be affected by the systemic effects of cigarette smoking. The peripheral lung inflammation of COPD and systemic inflammatory effectscouldbetreatedbysystemicantiinflammatory treatments, but

Peter J. Barnes



Chronic kidney disease after hematopoietic stem cell transplantation  

PubMed Central

Acute and chronic kidney diseases occur after hematopoietic stem cell transplantation. These are caused by the transplant itself, and the complications of transplant. Recent estimates show that near 15% of subjects undergoing HSCT will develop CKD, which is a complication rate that can affect outcome and reduce survival. Investigation of the causes of CKD is needed, as are ways to prevent, mitigate and treat it.

Cohen, Eric P; Pais, Priya; Moulder, John E



Chronic obstructive pulmonary disease: a novel risk factor for cardiovascular disease  

Microsoft Academic Search

Chronic obstructive pulmonary disease (COPD) is one of the leading causes of morbidity and mortality in Canada and elsewhere. It affects 5% of all adult Canadians and is the fourth leading cause of death. Interestingly, the leading causes of hospitalizations and mortality among COPD patients are cardiovascular events. In the Lung Health Study, over 5 800 patients with mild to

Don D. Sin; S. F. Paul Man



Exacerbations and Progression of Disease in Asthma and Chronic Obstructive Pulmonary Disease  

Microsoft Academic Search

Exacerbations, characterized by an increase in patients' symptoms above baseline, are characteristic of both chronic obstructive pul- monary disease (COPD) and asthma. Prevention of exacerbations and their expedient treatment are major goals for reducing the morbidity and cost of both conditions. Exacerbations, however, may also adversely affect the natural history of these disorders, perhaps by contributing to increased rates of

Stephen I. Rennard; Stephen G. Farmer



Future of chronic obstructive pulmonary disease management.  


Bronchodilators play a pivotal role in the management of symptomatic chronic obstructive pulmonary disease. Inhaled short-acting bronchodilators are used for all stages of chronic obstructive pulmonary disease, primarily for the immediate relief of symptoms; inhaled long-acting bronchodilators are recommended for maintenance therapy in patients with moderate-to-very severe disease and those with daily symptoms. When symptoms are not adequately controlled by a single bronchodilator, combining bronchodilators of different classes may prove effective. Several long-acting ?(2)-agonists and long-acting muscarinic antagonists with 24-h duration of action and inhalers combining different classes of long-acting, once-daily bronchodilators are in development. The place of these agents in the treatment algorithm will be determined by their efficacy and safety profiles and their long-term impact on relevant clinical outcomes. PMID:22788943

D'Urzo, Anthony; Vogelmeier, Claus



Metabolic Syndrome, Chronic Kidney, and Cardiovascular Diseases: Role of Adipokines  

PubMed Central

Obesity is a chronic disease, whose incidence is alarmingly growing. It is associated with metabolic abnormalities and cardiovascular complications. These complications are clustered in the metabolic syndrome (MetS) leading to high cardiovascular morbidity and mortality. Obesity predisposes to diabetic nephropathy, hypertensive nephrosclerosis, and focal and segmental glomerular sclerosis and represents an independent risk factor for the development and progression of chronic kidney disease (CKD). Albuminuria is a major risk factor for cardiovascular diseases (CVDs). Microalbuminuria has been described as early manifestation of MetS-associated kidney damage and diabetic nephropathy. Obesity and MetS affect renal physiology and metabolism through mechanisms which include altered levels of adipokines such as leptin and adiponectin, oxidative stress, and inflammation. Secretory products of adipose tissue also deeply and negatively influence endothelial function. A better understanding of these interactions will help in designing more effective treatments aimed to protect both renal and cardiovascular systems.

Tesauro, Manfredi; Canale, Maria Paola; Rodia, Giuseppe; Di Daniele, Nicola; Lauro, Davide; Scuteri, Angelo; Cardillo, Carmine



Chronic quercetin exposure affects fatty acid catabolism in rat lung.  


Dietary quercetin intake is suggested to be health promoting, but this assumption is mainly based on mechanistic studies performed in vitro. Previously, we identified rat lung as a quercetin target tissue. To assess relevant in vivo health effects of quercetin, we analyzed mechanisms of effect in rat lungs of a chronic (41 weeks) 1% quercetin diet using whole genome microarrays. We show here that fatty acid catabolism pathways, like beta-oxidation and ketogenesis, are up-regulated by the long-term quercetin intervention. Up-regulation of genes (Hmgcs2, Ech1, Acox1, Pcca, Lpl and Acaa2) was verified and confirmed by quantitative real time PCR. In addition, free fatty acid levels were decreased in rats fed the quercetin diet, confirming that quercetin affects fatty acid catabolism. This in vivo study demonstrates for the first time that fatty acid catabolism is a relevant process that is affected in rats by chronic dietary quercetin. PMID:17103110

de Boer, V C J; van Schothorst, E M; Dihal, A A; van der Woude, H; Arts, I C W; Rietjens, I M C M; Hollman, P C H; Keijer, J



Pathophysiology of Exacerbations of Chronic Obstructive Pulmonary Disease  

Microsoft Academic Search

Smokers with stable chronic obstructive pulmonary disease have a chronic inflammation of the entire tracheobronchial tree character- ized by an increased number of macrophages and CD8 T lympho- cytes in the airway wall and of neutrophils in the airway lumen. Exacerbations of chronic obstructive pulmonary disease are consid- ered to reflect worsening of the underlying chronic inflammation ofthe airways,causedmainlybyviralandbacterialinfections andair

Alberto Papi; Fabrizio Luppi; Francesca Franco; Leonardo M. Fabbri



Cardiorenal Syndrome Type 4--Cardiovascular Disease in Patients with Chronic Kidney Disease: Epidemiology, Pathogenesis, and Management  

PubMed Central

The term cardiorenal syndrome refers to the interaction between the heart and the kidney in disease and encompasses five distinct types according to the initial site affected and the acute or chronic nature of the injury. Type 4, or chronic renocardiac syndrome, involves the features of chronic renal disease (CKD) leading to cardiovascular injury. There is sufficient epidemiologic evidence linking CKD with increased cardiovascular morbidity and mortality. The underlying pathophysiology goes beyond the highly prevalent traditional cardiovascular risk burden affecting renal patients. It involves CKD-related factors, which lead to cardiac and vascular pathology, mainly left ventricular hypertrophy, myocardial fibrosis, and vascular calcification. Risk management should consider both traditional and CKD-related factors, while therapeutic interventions, apart from appearing underutilized, still await further confirmation from large trials.

Pateinakis, Panagiotis; Papagianni, Aikaterini



FastStats: Chronic Liver Disease/Cirrhosis  


... Related Links Accessibility NCHS Home FastStats Home Chronic Liver Disease and Cirrhosis (Data are for the U.S.) ... Hospital Inpatient Care Number of discharges with chronic liver disease and cirrhosis as the first-listed diagnosis: ...


Coexistence of chronic calcific pancreatitis and celiac disease.  


Coexistence of celiac disease with chronic calcific pancreatitis is rare. We describe a 26-year-old woman with chronic calcific pancreatitis in whom non-response to treatment was due to celiac disease. PMID:17401240

Sood, Ajit; Midha, Vandana; Sood, Neena; Bansal, Manu; Kaur, Manpreet; Goyal, Anuza; Sharma, Nidhi


64 FR 11915 - National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control...  

Federal Register 2010, 2011, 2012, 2013

...Chronic Disease Prevention and Health Promotion, Centers for Disease Control...Chronic Disease Prevention and Health Promotion's pending funding committed to achieving the health promotion and disease prevention...



Analgesic use and chronic renal disease.  


To examine the use of analgesics as a cause of chronic renal disease, we performed a multicenter case-control study of 554 adults with newly diagnosed kidney disease (serum creatinine, greater than or equal to 130 mumol per liter [1.5 mg per deciliter]) and 516 matched control subjects selected randomly from the same area of North Carolina. Histories of use of analgesics (phenacetin, acetaminophen, and aspirin) were obtained by telephone interview with the patients or their proxies. Daily users of analgesics had significantly more renal disease than infrequent users (odds ratio, 2.79; 95 percent confidence interval, 1.85 to 4.21). The risk of renal disease was highest in daily users of phenacetin (odds ratio, 5.11; confidence interval, 1.76 to 14.9, after adjustment for the effects of other analgesics). The risk of renal disease was also increased in daily users of acetaminophen; after adjustment for the use of aspirin and phenacetin, the odds ratio was 3.21 (confidence interval, 1.05 to 9.80). There was no increased risk in daily aspirin users (adjusted odds ratio, 1.32; confidence interval, 0.69 to 2.51). The risks with daily use of either phenacetin or acetaminophen changed little after adjustment for diabetes, hypertension, and the indication for analgesic use. We conclude that the long-term, regular use of phenacetin may increase the risk of chronic renal disease. The long-term, daily use of acetaminophen, the major metabolite of phenacetin, is associated independently with an increased risk of chronic renal disease. We could find no increased risk in daily users of aspirin. PMID:2651928

Sandler, D P; Smith, J C; Weinberg, C R; Buckalew, V M; Dennis, V W; Blythe, W B; Burgess, W P



Chronic wasting disease in Canada: Part 1  

PubMed Central

Abstract The purpose of part 1 is to provide an overview of published literature (1980–2002) on chronic wasting disease (CWD) to inform Canadian readers about the disease and to explain Canadian regulatory approaches to the surveillance and control of CWD. Much of the scientific information is drawn from American publications obtained from internet searches in PubMed and Medline databases. The following keywords were used: chronic wasting disease, prion, diagnosis, transmissible spongiform encephalopathies, CWD and deer, CWD and elk, and CWD and environment. The article also presents information from Canadian publications and unpublished observations, Canadian Food Inspection Agency (CFIA) documents, and both government and nongovernment internet Web sites. The article highlights some different features of CWD in Canada, as compared with the situation in the United States, and mentions public health implications of the disease. It also describes the basis for development of Canada’s surveillance and control program. Part 2 will detail the activities and results of the surveillance and control program during 2000 to 2002 and discuss factors that will influence the feasibility of eradicating CWD. Chronic wasting disease appears to have been introduced into Canada through the importation of infected farmed elk from the United States in the late 1980s and early 1990s, at a time when little was known about the disease. Since then, eradication efforts in Canada have led to the control of the spread of CWD in the farmed elk industry. Still, management of this disease, especially in free-ranging cervids, is a challenge.



Age-associated chronic diseases require age-old medicine: role of chronic inflammation.  


Most chronic diseases--such as cancer, cardiovascular disease (CVD), Alzheimer disease, Parkinson disease, arthritis, diabetes and obesity--are becoming leading causes of disability and death all over the world. Some of the most common causes of these age-associated chronic diseases are lack of physical activity, poor nutrition, tobacco use, and excessive alcohol consumption. All the risk factors linked to these chronic diseases have been shown to up-regulate inflammation. Therefore, downregulation of inflammation-associated risk factors could prevent or delay these age-associated diseases. Although modern science has developed several drugs for treating chronic diseases, most of these drugs are enormously expensive and are associated with serious side effects and morbidity. In this review, we present evidence on how chronic inflammation leads to age-associated chronic disease. Furthermore, we discuss diet and lifestyle as solutions for age-associated chronic disease. PMID:22178471

Prasad, Sahdeo; Sung, Bokyung; Aggarwal, Bharat B



Chronic inflammatory rheumatic diseases in black Zimbabweans.  

PubMed Central

The pattern of chronic inflammatory rheumatic diseases seen in 52 black Zimbabweans was determined. These diseases constituted 2% of all treatable chronic endemic medical diseases registered around Gweru City. Rheumatoid arthritis (RA) and gout were the commonest, 38.8% and 28.8% of the total respectively. Systemic lupus erythematosus (SLE), polymyositis, progressive systemic sclerosis, mixed connective tissue disease, ankylosing spondylitis, and Reiter's diseases were seen less frequently. While the rarity of ankylosing spondylitis was not surprising, that of SLE was striking. RA seen in Zimbabwe was as severe as in East Africa, with a mean age of onset of 43.6 (SD 9.6) years, mean ESR 67 (SD 33) mm/h, seropositivity 78%, subcutaneous nodules 10%, and overall deformities in 35% of all cases. Gout was as seen elsewhere, with a mean age of onset 41.5 (SD 7.95) years, M:F ratio 6.5:1, mean male serum uric acid 10.8 (SD 2.69) mg/dl (0.64 +/- 0.16 mmol/l). Alcohol as a precipitating and aggravating factor was supported by a high mean drunkenness score of 10.3 (SD 3.89) out of a maximum of 17. Unawareness and underdiagnosis of these diseases are still likely problems in this part of the world.

Lutalo, S K



[Vaccination scheme in advanced chronic kidney disease].  


1. VACCINATION AGAINST HEPATITIS B a) All patients with chronic advanced renal disease and negative serology for HBsAg and antiHBs are to be vaccinated against hepatitis B (Evidence level: B). b) For classic vaccines (Engerix B and HBVAxpro) the adult vaccine dose is 40 mcg (20 mcg in the paediatric population). There are two dose regimens based on the medicinal product used: 0, 1 and 6 months with HBVAxpro and 0, 1, 2 and 6 months with Engerix B. With the new vaccine Fendrix, the dose is 20 mcg and the schedule 0, 1, 2 and 6 months (Evidence level: C). c) The antiHBs titre is to be measured 1-2 months after administration of the last dose. In patients whose antibody titres are below 10 mIU/mL, a booster may be administered, checking the response or administering a second full vaccination (Evidence level: B). d) In responders, antibody levels are to be tested at least once a year. If the antiHBs titre is below 10 mIU/mL, a booster is to be administered (Evidence level: C). 2. VACCINATION AGAINST INFLUENZA a) All patients with chronic advanced renal disease are to be vaccinated every year against influenza (Evidence level: B). b) The vaccination dose and regimen are the same as recommended for the general population (Evidence level: C) 3. VACCINATION AGAINST PNEUMOCOCCUS a) Vaccination against pneumococcus is recommended in patients with chronic renal disease associated with nephrotic syndrome or who may be future candidates for renal transplant (Evidence level: B). b) There is no evidence of the clinical value of the pneumococcal vaccine in adult patients with chronic renal failure, not transplanted. However, some regions are recommending routine vaccination in the population aged >or= 60 years, the age of a high percentage of our patients. c) To maintain immunisation, revaccination is required every 3- 5 years. 4. OTHER VACCINES a) Vaccination against hepatitis A is recommended in patients with renal failure associated with chronic liver disease or who are candidates for renal transplant (Evidence level: C). b) The recommendations for vaccination against tetanus and diphtheria are the same as for the general population (Evidence level: C). c) Chickenpox vaccine is indicated in children with chronic renal disease, particularly if they are candidates for transplant (Evidence level: B). Although there is no evidence of the value of this vaccine in adults, it is advisable to perform it in those who may be candidates for renal transplant with no protecting antibodies. d) There is no evidence of the clinical value of the vaccine against Staphylococcus aureus. PMID:19018745

Barril, G; Teruel, J L



The nervous system and chronic kidney disease in children  

PubMed Central

This paper provides a review of the literature on the nervous system involvement incurred by children and adolescents with chronic kidney disease (CKD), with a particular focus on neuropsychological functioning. In addition to an historical overview of earlier literature, published studies from the past 14 years that address both central and peripheral nervous system function in children with CKD are reviewed (1990–2003). These studies span work in neuroimaging, electrophysiology, and neuropsychology. A key focus for this review is on variables that might affect neurodevelopmental status in these children. The paper concludes with suggestions for achieving progress in the understanding of this complication of kidney disease in children.

Wetherington, Crista E.; Duquette, Peter J.; Hooper, Stephen R.



Chronic recurrent multifocal osteomyelitis associated with Crohn's disease.  


Chronic recurrent multifocal osteomyelitis (CRMO) was first described by Giedion in 1972 as a self-limited relapsing noninfectious inflammatory condition usually affecting children and adolescents. The association of CRMO with psoriasis, palmoplantar pustulosis, and SAPHO syndrome (synovitis, acne, pustulosis, hyperostosis, and osteitis) has been described. In this case report, we present a 49-year-old man with CRMO coexisting with Crohn's disease. To our knowledge, this is the first report of CRMO with Crohn's disease without the presence of pustular skin lesions or other features of SAPHO syndrome. PMID:9472913

Bognar, M; Blake, W; Agudelo, C



Diseases of the parathyroid gland in chronic kidney disease  

Microsoft Academic Search

During the past few years, remarkable advances have been made in the understanding and the management of parathyroid diseases\\u000a in patients with chronic kidney disease (CKD). One of the important insights is the identification of fibroblastic growth\\u000a factor 23, which has greatly reshaped our understanding of secondary hyperparathyroidism (SHPT). The recent introduction of\\u000a calcimimetic cinacalcet hydrochloride has led to a

Hirotaka Komaba; Takatoshi Kakuta; Masafumi Fukagawa


Chronic GVHD as an autoimmune disease.  


Many of the clinical, histological and serological manifestations of chronic graft-versus-host disease (GVHD) resemble autoimmune disease (AD), and although the differences are significant, they may be more semantic than biological. Indeed, studies suggest that some ADs may represent a fetal-versus-maternal chronic GVHD. Both conditions involve dysregulated immune responses resulting in tissue inflammation, damage, scarring and organ dysfunction, and both may be associated with a genetic predisposition. Epitope-specific autoaggressive phenomena such as immune thrombocytopenic purpura (ITP) are often seen following allogeneic hematopoietic stem-cell transplantation (HCT), implying a loss of specific tolerance to self structures. However, the more widespread manifestations of GVHD such as the well-known scleroderma-like symptoms differ in many fundamental respects from de-novo scleroderma, and other multisystem ADs such as systemic lupus erythematosus (SLE) or rheumatoid arthritis (RA). PMID:18503993

Tyndall, Alan; Dazzi, Francesco



Calciphylaxis presenting in early chronic kidney disease with mixed hyperparathyroidism.  


Calciphylaxis is a disabling and life-threatening complication that primarily affects patients who are dialysis dependent. Reports have grown in the literature of cases occurring in those who have advanced chronic kidney disease (pre-end-stage renal disease) or in the setting of transplantation. There are also a few reports of cases occurring in those without any form of chronic kidney disease but with primary hyperparathyroidism. This disease entity is characterized by calcification, intimal hypertrophy, and thrombosis of small vessels that result in necrotizing, nonhealing ulcers - many of which are life threatening. Although several strategies aimed at treating and preventing this affliction have been reported in the literature, the outcome for most patients with calciphylaxis remains quite poor. We describe a patient with comparatively early stage-3 chronic kidney disease who developed calciphylaxis in the setting of both primary and secondary hyperparathyroidism. Predictably, after subtotal parathyroidectomy, her wounds did not completely heal and her biochemical markers of hyperparathyroidism did not completely normalize until her underlying secondary hyperparathyroidism was treated medically. It was only after initiating cinacalcet that the patient experienced complete wound healing and resolution of her calciphylaxis. It also supports other authors' findings that cinacalcet may be an important adjunct in the treatment of calciphylaxis. PMID:22259253

Brucculeri, Michael; Haydon, Allan H



Calciphylaxis presenting in early chronic kidney disease with mixed hyperparathyroidism  

PubMed Central

Calciphylaxis is a disabling and life-threatening complication that primarily affects patients who are dialysis dependent. Reports have grown in the literature of cases occurring in those who have advanced chronic kidney disease (pre-end-stage renal disease) or in the setting of transplantation. There are also a few reports of cases occurring in those without any form of chronic kidney disease but with primary hyperparathyroidism. This disease entity is characterized by calcification, intimal hypertrophy, and thrombosis of small vessels that result in necrotizing, nonhealing ulcers – many of which are life threatening. Although several strategies aimed at treating and preventing this affliction have been reported in the literature, the outcome for most patients with calciphylaxis remains quite poor. We describe a patient with comparatively early stage-3 chronic kidney disease who developed calciphylaxis in the setting of both primary and secondary hyperparathyroidism. Predictably, after subtotal parathyroidectomy, her wounds did not completely heal and her biochemical markers of hyperparathyroidism did not completely normalize until her underlying secondary hyperparathyroidism was treated medically. It was only after initiating cinacalcet that the patient experienced complete wound healing and resolution of her calciphylaxis. It also supports other authors’ findings that cinacalcet may be an important adjunct in the treatment of calciphylaxis.

Brucculeri, Michael; Haydon, Allan H



The genetics of chronic obstructive pulmonary disease  

PubMed Central

Chronic obstructive pulmonary disease (COPD) is a significant cause of global morbidity and mortality. Previous studies have shown that COPD aggregates in families, suggesting a genetic predisposition to airflow obstruction. Many candidate genes have been assessed, but the data are often conflicting. We review the genetic factors that predispose smokers to COPD and highlight the future role of genomic scans in identifying novel susceptibility genes.

Lomas, David A; Silverman, Edwin K



Anemia management in chronic kidney disease  

Microsoft Academic Search

Anemia is one of the most common and morbid complications of chronic kidney disease, causing unpleasant symptoms and reducing the quality of life. The availability of recombinant human erythropoietin (rHuEPO) in 1989 has been one of the most important developments in the care of this population in the past several decades. Treatment with erythropoiesis-stimulating agents (ESAs) has improved patients’ lives,

Steven Fishbane; Allen R Nissenson



Preventive care in chronic liver disease  

Microsoft Academic Search

OBJECTIVE: To identify preventive care measures that are appropriate for and specific to patients with chronic liver disease and to\\u000a provide recommendations and information that can be shared with patients.\\u000a \\u000a \\u000a MEASUREMENTS: A review of the literature was undertaken using MEDLINE from 1970 to present. Priority was given to randomized controlled studies, but case reports, case-control studies, and reviews\\u000a were included.

Thomas R. Riley; Jill P. Smith



Endocrinological disturbances in chronic obstructive pulmonary disease  

Microsoft Academic Search

ABSTRACT: In this overview, the available literature on endocrinological disturbances in chronic obstructive pulmonary disease (COPD) is reviewed, with stress on growth hormone\\/insulin-like growth factor I (IGF-I), thyroid hormone and the anabolic steroids. In COPD, little is known about circulating growth hormone or IGF-I concentrations. Some authors find a decrease in growth hormone or IGF-I, others an increase. An increase

E. C. Creutzberg; R. Casaburi



Biodiversity Loss Affects Global Disease Ecology  

NSDL National Science Digital Library

Changes in the type and prevalence of human diseases have occurred during shifts in human social organization, for example, from hunting and gathering to agriculture and with urbanization during the Industrial Revolution. The recent emergence and reemergence of infectious diseases appears to be driven by globalization and ecological disruption. We propose that habitat destruction and biodiversity loss associated with biotic homogenization can increase the incidence and distribution of infectious diseases affecting humans. The clearest connection between biotic homogenization and infectious disease is the spread of nonindigenous vectors and pathogens. The loss of predators and hosts that dilute pathogen transmission can also increase the incidence of vectorborne illnesses. Other mechanisms include enhanced abiotic conditions for pathogens and vectors and higher host-pathogen encounter rates. Improved understanding of these causal mechanisms can inform decisionmaking on biodiversity conservation as an effective way to protect human health.

Montira Pongsiri (US Environmental Protection Agency;Office of the Science Adviser); Joe Roman (University of Vermont;Gund Institute for Ecological Economics)



Chronic beryllium disease: Diagnosis and management  

SciTech Connect

Chronic beryllium disease is predominantly a pulmonary granulomatosis that was originally described in 1946. Symptoms usually include dyspnea and cough. Fever, anorexia, and weight loss are common. Skin lesions are the most common extrathoracic manifestation. Granulomatous hepatitis, hypercalcemia, and kidney stones can also occur. Radiographic and physiologic abnormalities are similar to those in sarcoidosis. While traditionally the pathologic changes included granulomas and cellular interstitial changes, the hallmark of the disease today is the well-formed granuloma. Immunologic studies have demonstrated a cell-mediated response to beryllium that is due to an accumulation of CD4{sup +} T cells at the site of disease activity. Diagnosis depends on the demonstration of pathologic changes (i.e., granuloma) and evidence that the granuloma was caused by a hypersensitivity to beryllium (i.e., positive lung proliferative response to beryllium). Using these criteria, the diagnosis of chronic beryllium disease can now be made before the onset of clinical symptoms. Whether, with early diagnosis, the natural course of this condition will be the same as when it was traditionally diagnosed is not known. Currently, corticosteroids are used to treat patients with significant symptoms or evidence of progressive disease. 21 refs.

Rossman, M.D. [Hospital of the Univ. of Pennsylvania, Philadelphia, PA (United States)



Interstitial Lung Disease in a Patient with Chronic Granulomatous Disease  

PubMed Central

Background Chronic granulomatous disease (CGD) is an inherited phagocytes defect, characterized by defects of NADPH-oxidase and inability of bacterial killing, which leads to recurrent life-threatening infections. Respiratory problems, which are the major cause of morbidity in CGD, usually result from recurrent severe infections; however, vigorous inflammatory response could also cause respiratory diseases. Case Presentation Herein, an 11 year-old patient with CGD is presented who suffered from chronic cough and dyspnea for 7 years. Considering the results of chest X-ray, high-resolution computed tomography, and pulmonary function test, the diagnosis of interstitial lung disease was made. Conclusion Early recognition of manifestations associated with CGD and appropriate treatment could prevent further complications and reduce morbidity and mortality in this group of patients.

Moghtaderi, Mozhgan; Kashef, Sara; Rezaei, Nima



Chronic granulomatous disease as a risk factor for autoimmune disease.  


Chronic granulomatous disease (CGD) is characterized by recurrent infections and granuloma formation. In addition, we have observed a number of diverse autoimmune conditions in our CGD population, suggesting that patients with CGD are at an elevated risk for development of autoimmune disorders. In this report, we describe antiphospholipid syndrome, recurrent pericardial effusion, juvenile idiopathic arthritis, IgA nephropathy, cutaneous lupus erythematosus, and autoimmune pulmonary disease in the setting of CGD. The presence and type of autoimmune disease have important treatment implications for patients with CGD. PMID:18823651

De Ravin, Suk See; Naumann, Nora; Cowen, Edward W; Friend, Julia; Hilligoss, Dianne; Marquesen, Martha; Balow, James E; Barron, Karyl S; Turner, Maria L; Gallin, John I; Malech, Harry L



The end of AIDS: HIV infection as a chronic disease.  


The success of antiretroviral therapy has led some people to now ask whether the end of AIDS is possible. For patients who are motivated to take therapy and who have access to lifelong treatment, AIDS-related illnesses are no longer the primary threat, but a new set of HIV-associated complications have emerged, resulting in a novel chronic disease that for many will span several decades of life. Treatment does not fully restore immune health; as a result, several inflammation-associated or immunodeficiency complications such as cardiovascular disease and cancer are increasing in importance. Cumulative toxic effects from exposure to antiretroviral drugs for decades can cause clinically-relevant metabolic disturbances and end-organ damage. Concerns are growing that the multimorbidity associated with HIV disease could affect healthy ageing and overwhelm some health-care systems, particularly those in resource-limited regions that have yet to develop a chronic care model fully. In view of the problems inherent in the treatment and care for patients with a chronic disease that might persist for several decades, a global effort to identify a cure is now underway. PMID:24152939

Deeks, Steven G; Lewin, Sharon R; Havlir, Diane V



Household Food Insecurity and Obesity, Chronic Disease, and Chronic Disease Risk Factors  

Microsoft Academic Search

Context. Studies examining the association between food insecurity and obesity in adults have produced conflicting results, and information is limited on the relationship between food insecurity and adult chronic health conditions, particularly in a high-risk population.Objective. To examine the association between household food insecurity and self-reported weight status and chronic disease in the Lower Mississippi Delta.Design. A two-stage stratified cluster

Patrick H. Casey; Carol L. Connell; Catherine M. Champagne; Jeffrey M. Gossett; David Harsha; Beverly McCabe-Sellers; James M. Robbins; Pippa M. Simpson; Kitty L. Szeto; Judith L. Weber; Margaret L. Bogle



[Cardiovascular diseases in patients with chronic renal diseases].  


The risk of cardiovascular disease in patients with chronic renal disease appears to be far greater than in the general population and the risk of cardiovascular death is much higher than the risk of eventually requiring renal replacement therapy. Heart failure is important finding and it is evident even before the initiation of dialysis; the frequency of heart failure is 10 to 30 times higher in patients on dialysis than in the general population. Left ventricular hypertrophy has incidence of nearly 75-80% and is closely related to heart failure, ventricular arrhythmias, fatal myocardial infarction, aortic root dilatation and cerebrovascular event. Ischaemic heart disease is usually the consequence of coronary artery disease, but 27% of haemodialysis patients may have symptoms without atherosclerotic changes in coronary arteries. Silent myocardial ischemia is more frequent in dialysis population. Hypertension is present in 80-85% of patients and its prevalence is linearly related to glomerular filtration rate. Patients with end-stage renal disease are more likely to have an increase in pulse pressure and isolated systolic hypertension and they may not demonstrate the normal nocturnal decline in blood pressure. Patients on dialysis are prone to calcification of media and intima due to disbalance of promoters and inhibitors of calcification process. Now, there are no valid data about the privilege of one dialysis method over another in cardiovascular morbidity and mortality. Numerous traditional and non-traditional risk factors urge for preventive measures for cardiovascular diseases in patients with chronic renal diseases. PMID:18924484

Dimkovi?, Nada



The spectrum of disease in chronic traumatic encephalopathy.  


Chronic traumatic encephalopathy is a progressive tauopathy that occurs as a consequence of repetitive mild traumatic brain injury. We analysed post-mortem brains obtained from a cohort of 85 subjects with histories of repetitive mild traumatic brain injury and found evidence of chronic traumatic encephalopathy in 68 subjects: all males, ranging in age from 17 to 98 years (mean 59.5 years), including 64 athletes, 21 military veterans (86% of whom were also athletes) and one individual who engaged in self-injurious head banging behaviour. Eighteen age- and gender-matched individuals without a history of repetitive mild traumatic brain injury served as control subjects. In chronic traumatic encephalopathy, the spectrum of hyperphosphorylated tau pathology ranged in severity from focal perivascular epicentres of neurofibrillary tangles in the frontal neocortex to severe tauopathy affecting widespread brain regions, including the medial temporal lobe, thereby allowing a progressive staging of pathology from stages I-IV. Multifocal axonal varicosities and axonal loss were found in deep cortex and subcortical white matter at all stages of chronic traumatic encephalopathy. TAR DNA-binding protein 43 immunoreactive inclusions and neurites were also found in 85% of cases, ranging from focal pathology in stages I-III to widespread inclusions and neurites in stage IV. Symptoms in stage I chronic traumatic encephalopathy included headache and loss of attention and concentration. Additional symptoms in stage II included depression, explosivity and short-term memory loss. In stage III, executive dysfunction and cognitive impairment were found, and in stage IV, dementia, word-finding difficulty and aggression were characteristic. Data on athletic exposure were available for 34 American football players; the stage of chronic traumatic encephalopathy correlated with increased duration of football play, survival after football and age at death. Chronic traumatic encephalopathy was the sole diagnosis in 43 cases (63%); eight were also diagnosed with motor neuron disease (12%), seven with Alzheimer's disease (11%), 11 with Lewy body disease (16%) and four with frontotemporal lobar degeneration (6%). There is an ordered and predictable progression of hyperphosphorylated tau abnormalities through the nervous system in chronic traumatic encephalopathy that occurs in conjunction with widespread axonal disruption and loss. The frequent association of chronic traumatic encephalopathy with other neurodegenerative disorders suggests that repetitive brain trauma and hyperphosphorylated tau protein deposition promote the accumulation of other abnormally aggregated proteins including TAR DNA-binding protein 43, amyloid beta protein and alpha-synuclein. PMID:23208308

McKee, Ann C; Stein, Thor D; Nowinski, Christopher J; Stern, Robert A; Daneshvar, Daniel H; Alvarez, Victor E; Lee, Hyo-Soon; Hall, Garth; Wojtowicz, Sydney M; Baugh, Christine M; Riley, David O; Kubilus, Caroline A; Cormier, Kerry A; Jacobs, Matthew A; Martin, Brett R; Abraham, Carmela R; Ikezu, Tsuneya; Reichard, Robert Ross; Wolozin, Benjamin L; Budson, Andrew E; Goldstein, Lee E; Kowall, Neil W; Cantu, Robert C



The Indiana Chronic Disease Management Program  

PubMed Central

The Indiana Chronic Disease Management Program (ICDMP) is intended to improve the quality and cost-effectiveness of care for Medicaid members with congestive heart failure (chronic heart failure), diabetes, asthma, and other conditions. The ICDMP is being assembled by Indiana Medicaid primarily from state and local resources and has seven components: (1) identification of eligible participants to create regional registries, (2) risk stratification of eligible participants, (3) nurse care management for high-risk participants, (4) telephonic intervention for all participants, (5) an Internet-based information system, (6) quality improvement collaboratives for primary care practices, and (7) program evaluation. The evaluation involves a randomized controlled trial in two inner-city group practices, as well as a statewide observational design. This article describes the ICDMP, highlights challenges, and discusses approaches to its evaluation.

Rosenman, Marc B; Holmes, Ann M; Ackermann, Ronald T; Murray, Michael D; Doebbeling, Caroline Carney; Katz, Barry; Li, Jingjin; Zillich, Alan; Prescott, Victoria M; Downs, Stephen M; Inui, Thomas S



An Informatics-based Chronic Disease Practice  

PubMed Central

The authors present the case study of a 35-year informatics-based single subspecialty practice for the management of patients with chronic thyroid disease. This extensive experience provides a paradigm for the organization of longitudinal medical information by integrating individual patient care with clinical research and education. The kernel of the process is a set of worksheets easily completed by the physician during the patient encounter. It is a structured medical record that has been computerized since 1972, enabling analysis of different groups of patients to answer questions about chronic conditions and the effects of therapeutic interventions. The recording process and resulting studies severe as an important vehicle for medical education about the nuances of clinical practice. The authors suggest ways in which computerized medical records can become an integral part of medical practice, rather than a luxury or novelty.

Nordyke, Robert A.; Kulikowski, Casimir A.



The Relationship Between Chronic Kidney Disease and SYNTAX Score  

Microsoft Academic Search

Chronic kidney disease (CKD) is associated with increased risk of cardiovascular disease and death. We evaluated the association between CKD and severity of coronary artery stenosis by calculating SYNTAX Score in patients with left main coronary artery and\\/or 3-vessel coronary artery disease. Coronary angiograms of 217 patients were assessed. Chronic kidney disease was staged using the estimated glomerular filtration rate

Ugur Coskun; Kadriye Orta Kilickesmez; Okay Abaci; Cuneyt Kocas; Cem Bostan; Ahmet Yildiz; Murat Baskurt; Alev Arat; Murat Ersanli; Tevfik Gurmen



Disturbances of rhythm in chronic lung disease.  


Patients with chronic obstructive lung disease have a high incidence and wide variety of cardiac arrhythmias. These arrhythmias are often clinically significant and may be life threatening. Although they occur particularly in the context of acute respiratory failure, arrhythmias are not infrequent in clinically stable patients. The relatively high incidence of sudden arrhythmias seen in acute respiratory failure are associated with a very poor prognosis, in particular, ventricular premature beats and multifocal atrial tachycardia. Long-term electrocardiographic monitoring is valuable in increasing the detection of these arrhythmias and in assessing their clinical significance and response to therapy. The mechanisms producing these arrhythmias are poorly understood and probably multiple. However, disturbances of blood gases, blood pH, and electrolytes or the presence of cor pulmonale or associated coronary artery disease is probably important. The therapy of these arrhythmias must include efforts to improve the patient's ventilatory status as well as careful use of standard antiarrhythmic drugs. Further investigation is needed to define the mechanisms, determine the prognosis, and improve the therapy of the arrhythmias found in chronic obstructive lung disease. PMID:584715

Biggs, F D; Lefrak, S S; Kleiger, R E; Senior, R M; Oliver, G C


[Chronic obstructive pulmonary disease in women].  


For the past several years the number of women suffering from chronic obstructive pulmonary disease (COPD) has been steadily increasing. This fact prompts the debate which factors, in addition to considerably increasing prevalence of cigarette smoking among young women, are responsible for these epidemiologic changes. Differences in the natural history and prognosis of COPD in females and males are presented in the paper, as well as the number of potential ethiopathogenetic and pathophysiologic factors influencing these variations. Among them, differences in the COPD risk factors spectrum in both genders and in airways anatomy are pointed out, and the mechanisms responsible for greater women's susceptibility to components of cigarette smoke, which reflect genetic (enzyme polymorphisms), epigenetic (diminished DNA methylation) and hormonal (estrogens) influences on xenobiotics metabolism. Further, sex-related differences regarding COPD phenotypes (chronic bronchitis vs. emphysema), immunological markers and clinical manifestation of disease are underlined in the paper. More frequent coexistence of anxiety and depression, COPD exacerbations and worse quality of life in women are also emphasized. Other differences, pointed out by authors include autoimmunological conception of pathogenesis of COPD (greater female susceptibility to produce autoantibodies), risk factors of disease exacerbation and, at last, response to certain forms of COPD treatment (nicotine replacement therapy, long-term oxygen therapy). PMID:22370982

Uci?ska, Romana; Damps-Konsta?ska, Iwona; Siemi?ska, Alicja; Jassem, Ewa



Novas terapias ergogênicas no tratamento da doença pulmonar obstrutiva crônica* New treatments for chronic obstructive pulmonary disease using ergogenic aids  

Microsoft Academic Search

Chronic obstructive pulmonary disease is currently considered a systemic disease, presenting structural and metabolic alterations that can lead to skeletal muscle dysfunction. This negatively affects the performance of respiratory and peripheral muscles, functional capacity, health-related quality of life and even survival. The decision to prescribe ergogenic aids for patients with chronic obstructive pulmonary disease is based on the fact that



Activity Monitoring in Chronic Obstructive Pulmonary Disease  

PubMed Central

The measurement of daily physical activity (PA) has become a significant outcome in patients with chronic obstructive pulmonary disease (COPD). Recent data have shown the independent association between PA markers, hospitalizations, and mortality. Daily PA can be quantified by direct observation, assessment of energy expenditure, questionnaires, and activity monitors (motion sensors). This review aims to describe the methods used to quantify daily PA in COPD on the basis of the published literature and to suggest potential applications of activity monitoring methods in clinical research and daily care of COPD patients.

Benzo, Roberto



Oral corticosteroids for stable chronic obstructive pulmonary disease  

Microsoft Academic Search

Background: Chronic obstructive pulmonary disease (COPD) is a common chronic lung disorder, usually related to cigarette smoking, representing a major and increasing cause of morbidity and mortality. It is defined \\

Julia A E Walters; Haydn Walters; Richard Wood-Baker



Achieving Salt Restriction in Chronic Kidney Disease  

PubMed Central

There is consistent evidence linking excessive dietary sodium intake to risk factors for cardiovascular disease and chronic kidney disease (CKD) progression in CKD patients; however, additional research is needed. In research trials and clinical practice, implementing and monitoring sodium intake present significant challenges. Epidemiological studies have shown that sodium intake remains high, and intervention studies have reported varied success with participant adherence to a sodium-restricted diet. Examining barriers to sodium restriction, as well as factors that predict adherence to a low sodium diet, can aid researchers and clinicians in implementing a sodium-restricted diet. In this paper, we critically review methods for measuring sodium intake with a specific focus on CKD patients, appraise dietary adherence, and factors that have optimized sodium restriction in key research trials and discuss barriers to sodium restriction and factors that must be considered when recommending a sodium-restricted diet.

McMahon, Emma J.; Campbell, Katrina L.; Mudge, David W.; Bauer, Judith D.



Achieving salt restriction in chronic kidney disease.  


There is consistent evidence linking excessive dietary sodium intake to risk factors for cardiovascular disease and chronic kidney disease (CKD) progression in CKD patients; however, additional research is needed. In research trials and clinical practice, implementing and monitoring sodium intake present significant challenges. Epidemiological studies have shown that sodium intake remains high, and intervention studies have reported varied success with participant adherence to a sodium-restricted diet. Examining barriers to sodium restriction, as well as factors that predict adherence to a low sodium diet, can aid researchers and clinicians in implementing a sodium-restricted diet. In this paper, we critically review methods for measuring sodium intake with a specific focus on CKD patients, appraise dietary adherence, and factors that have optimized sodium restriction in key research trials and discuss barriers to sodium restriction and factors that must be considered when recommending a sodium-restricted diet. PMID:23320173

McMahon, Emma J; Campbell, Katrina L; Mudge, David W; Bauer, Judith D



Epidemiology of Chronic Kidney Disease in Heart Failure  

PubMed Central

Synopsis Heart failure is common and is associated with poor prognosis. Chronic kidney disease is common in heart failure, and shares many risk factors with heart failure such as age, hypertension, diabetes, and coronary artery disease. Over half of all heart failure patients may have moderate to severe chronic kidney disease. The presence of chronic kidney disease is associated with increased morbidity and mortality, yet it is also associated with underutilization of evidence-based heart failure therapy that may reduce morbidity and mortality. Understanding the epidemiology and outcomes of chronic kidney disease in heart failure is essential to ensure proper management of these patients.

Ahmed, Ali; Campbell, Ruth C.



Insulin resistance and chronic liver disease  

PubMed Central

Increased insulin resistance is frequently associated with chronic liver disease and is a pathophysiological feature of hepatogenous diabetes. Distinctive factors including hepatic parenchymal cell damage, portal-systemic shunting and hepatitis C virus are responsible for the development of hepatogenous insulin resistance/diabetes. Although it remains unclear whether insulin secretion from pancreatic beta cells is impaired as it is in type 2 diabetes, retinopathic and cardiovascular risk is low and major causes of death in cirrhotic patients with diabetes are liver failure, hepatocellular carcinoma and gastrointestinal hemorrhage. Hemoglobin A1c is an inaccurate marker for the assessment and management of hepatogenous diabetes. Moreover, exogenous insulin or sulfonylureas may be harmful because these agents may promote hepatocarcinogenesis. Thus, pathogenesis, cause of death, assessment and therapeutic strategy for hepatogenous insulin resistance/diabetes differ from those for lifestyle-related type 2 diabetes. In this article, we review features of insulin resistance in relationship to chronic liver disease. We also discuss the impact of anti-diabetic agents on interferon treatment and hepatocarcinogenesis.

Kawaguchi, Takumi; Taniguchi, Eitaro; Itou, Minoru; Sakata, Masahiro; Sumie, Shuji; Sata, Michio



Experimental Chronic Wasting Disease in Wild Type VM Mice.  


Chronic wasting disease (CWD) is a naturally occurring prion disease in North American deer (Odocoileus species), Rocky mountain elk (Cervus elaphus nelsoni) and moose (Alces alces). The disease was first confirmed in the Republic of Korea in 2001, and subsequent cases were diagnosed in 2004, 2005 and 2010. The experimental host range of CWD includes ferrets, several species of voles, white-footed mice, deer mice and Syrian golden hamsters. In addition, CWD was transmitted to the transgenic mouse over-expressing elk or deer prion protein efficiently, but not to wild type mouse. Here, we report the experimental transmission of elk CWD to conventional VM/Dk mice reaching 100% attack rate after second passage. The CWD-prion-affected wild type mice will be a useful model for future CWD studies. PMID:23708962

Lee, Yoon-Hee; Sohn, Hyun-Joo; Kim, Min-Jeong; Kim, Hyo-Jin; Park, Kyung-Je; Lee, Won-Yong; Yun, Eun-Im; Tark, Dong-Seob; Choi, Young-Pyo; Cho, In-Soo; Balachandran, Aru



Immunology of asthma and chronic obstructive pulmonary disease  

Microsoft Academic Search

Asthma and chronic obstructive pulmonary disease (COPD) are both obstructive airway diseases that involve chronic inflammation of the respiratory tract, but the type of inflammation is markedly different between these diseases, with different patterns of inflammatory cells and mediators being involved. As described in this Review, these inflammatory profiles are largely determined by the involvement of different immune cells, which

Peter J. Barnes



Early cardiovascular involvement in Chronic Obstructive Pulmonary Disease  

Microsoft Academic Search

Early cardiovascular involvement in Chronic Obstructive Pulmonary Disease. M. Malerba, G. Romanelli. Cardiovascular (CV) disease represents a consider- able risk factor in terms of both morbidity and mortality in elderly patients with chronic obstructive pulmonary disease (COPD). In fact, there is a considerable evidence of this association: for only 20 years forced expiratory vol- ume in 1 second (FEV1) has

M. Malerba; G. Romanelli



Treatment of mild chronic obstructive pulmonary disease  

PubMed Central

Chronic obstructive pulmonary disease (COPD) is an epidemic in many parts of the world. Most patients with COPD demonstrate mild disease. The cornerstone of management of mild disease is smoking cessation, which is the only proven intervention to relieve symptoms, modify its natural history and reduce mortality. For asymptomatic patients, it is the only required therapy. Short-acting bronchodilators can be added on an as needed basis for those with intermittent symptoms and regularly for those with persistent symptoms. Long-acting bronchodilators can be substituted for those who remain symptomatic despite regular use of short-acting bronchodilators. Inhaled corticosteroids do not modify the natural history of COPD and as such cannot be recommended as standalone therapy for mild COPD. However, for patients with refractory and intractable symptoms, they may be used in combination with long-acting beta-2 agonists. Influenza and pneumococcal vaccination and pulmonary rehabilitation are other therapies that may be considered for select patients with mild disease. In this paper, we summarize the current standard of care for patients with mild COPD.

Chee, Alex; Sin, Don D



[Wilson disease - factors affecting clinical presentation].  


Wilson disease (WD) is a genetic disorder with copper metabolism disturbances leading to copper accumulation in many organs with their secondary damage. It is caused by mutation in the ATP7B gene on chromosome 13, which encodes ATP-ase 7B involved in copper transport. The age of neurologic symptom onset in WD is 20-30 years, but there is a wide spectrum of disease including: age at onset, clinical signs and treatment efficacy. More than 500 mutations of ATP7B have been described so far, but the WD genotype does not explain the disease variability. Several other factors are suspected to influence WD presentation, including polymorphisms in the genes encoding: apolipoprotein E, prion-related protein, methyltenetetrahydrofolate reductase, Murr1, antioxidant-1, X-linked inhibitor of apoptosis as well as iron metabolism disturbances, gender impact, inflammatory reactions and oxidative stress. The explanation of their significance can change the therapy of WD. The aim of our study was to review and assess the clinical significance of the factors affecting WD presentation. PMID:23650006

Litwin, Tomasz; Cz?onkowska, Anna


Iron sucrose causes greater proteinuria than ferric gluconate in non-dialysis chronic kidney disease  

Microsoft Academic Search

Non-dextran intravenous (i.v.) iron preparations seem to differentially affect proteinuria in patients with chronic kidney disease. To study effects of ferric gluconate and iron sucrose on proteinuria, we conducted a crossover trial in 12 patients with stage 3–4 chronic kidney disease. These patients were randomized to receive the same dose of either drug 1 week apart. Urine samples were obtained

R Agarwal; A R Rizkala; M O Kaskas; R Minasian; J R Trout



Application of Direct Renin Inhibition to Chronic Kidney Disease  

Microsoft Academic Search

Purpose  Chronic kidney disease has serious implications with a high risk for progressive loss of renal function, increased cardiovascular\\u000a events as well as a substantial financial burden. The renin-angiotensin-aldosterone system (RAAS) is activated in chronic\\u000a kidney disease, especially in diabetes and hypertension, which are the leading causes of chronic kidney disease. Angiotensin\\u000a converting enzyme (ACE) inhibitors and angiotensin receptor blockers (ARBs)

Christian W. Mende



Hypertension in chronic kidney disease: navigating the evidence.  


Hypertension is both an important cause and consequence of chronic kidney disease. Evidence from numerous clinical trials has demonstrated the benefit of blood pressure control. However, it remains unclear whether available results could be extrapolated to patients with chronic kidney diseases because most studies on hypertension have excluded patients with kidney failure. In addition, chronic kidney disease encompasses a large group of clinical disorders with heterogeneous natural history and pathogenesis. In this paper, we review current evidence supporting treatment of hypertension in various forms of chronic kidney disease and highlight some of the gaps in the extant literature. PMID:21747971

Tedla, F M; Brar, A; Browne, R; Brown, C



Natriuretic Peptides in Chronic Kidney Disease  

PubMed Central

Background and objectives: B-type natriuretic peptide (BNP) and amino-terminal pro-B-type natriuretic peptide (NT-proBNP) are biomarkers of cardiovascular disease that is common in patients with chronic kidney disease (CKD). Conflicting data on the influence of glomerular filtration rate (GFR) on BNP and NT-proBNP levels in CKD may stem from failure to account fully for the effects of coexistent cardiac disease, dysfunction, and volume overload. Design, setting, participants, & measurements: Prospective head-to-head comparison of plasma BNP and NT-proBNP in ambulatory euvolemic CKD patients with normal LV ejection fraction and no manifest cardiac or vascular disease. GFR was estimated by the Modification of Diet in Renal Disease formula, BNP and NT-proBNP measured using Abbott AxSYM and Roche Elecsys assays, respectively, and cardiac morphology and function assessed by transthoracic echocardiography. Results: In 142 patients (42% female) of mean age 60 ± 11 yr, mean left ventricular ejection fraction was 71% ± 6%, GFR 38 ± 14 ml/min per 1.73 m2, and median BNP and NT-proBNP level 59 and 311 pg/ml, respectively. Multivariate predictors of NT-proBNP level were GFR, ?-blocker usage, LV mass index, and hemoglobin level. Plasma BNP was independently predicted by LV mass index and ?-blocker usage but not GFR. In the 74 patients without diastolic dysfunction, there was a significant rise in NT-proBNP but not BNP as GFR declined. Conclusions: Unlike NT-proBNP, plasma BNP level is relatively independent of GFR. BNP may therefore be the more appropriate biomarker to screen for cardiac dysfunction in CKD.

Tagore, Rajat; Ling, Lieng H.; Yang, Hong; Daw, Hla-Yee; Chan, Yiong-Huak; Sethi, Sunil K.



Exploring metabolic dysfunction in chronic kidney disease.  


Impaired kidney function and chronic kidney disease (CKD) leading to kidney failure and end-stage renal disease (ESRD) is a serious medical condition associated with increased morbidity, mortality, and in particular cardiovascular disease (CVD) risk. CKD is associated with multiple physiological and metabolic disturbances, including hypertension, dyslipidemia and the anorexia-cachexia syndrome which are linked to poor outcomes. Specific hormonal, inflammatory, and nutritional-metabolic factors may play key roles in CKD development and pathogenesis. These include raised proinflammatory cytokines, such as interleukin-1 and -6, tumor necrosis factor, altered hepatic acute phase proteins, including reduced albumin, increased C-reactive protein, and perturbations in normal anabolic hormone responses with reduced growth hormone-insulin-like growth factor-1 axis activity. Others include hyperactivation of the renin-angiotensin aldosterone system (RAAS), with angiotensin II and aldosterone implicated in hypertension and the promotion of insulin resistance, and subsequent pharmacological blockade shown to improve blood pressure, metabolic control and offer reno-protective effects. Abnormal adipocytokine levels including leptin and adiponectin may further promote the insulin resistant, and proinflammatory state in CKD. Ghrelin may be also implicated and controversial studies suggest activities may be reduced in human CKD, and may provide a rationale for administration of acyl-ghrelin. Poor vitamin D status has also been associated with patient outcome and CVD risk and may indicate a role for supplementation. Glucocorticoid activities traditionally known for their involvement in the pathogenesis of a number of disease states are increased and may be implicated in CKD-associated hypertension, insulin resistance, diabetes risk and cachexia, both directly and indirectly through effects on other systems including activation of the mineralcorticoid receptor. Insight into the multiple factors altered in CKD may provide useful information on disease pathogenesis, clinical assessment and treatment rationale such as potential pharmacological, nutritional and exercise therapies. PMID:22537670

Slee, Adrian D



Chronic Beryllium Disease Prevention Program Report  

SciTech Connect

This document describes how Lawrence Livermore National Laboratory (LLNL) meets the requirements and management practices of federal regulation 10 CFR 850, 'Chronic Beryllium Disease Prevention Program (CBDPP).' This revision of the LLNL CBDPP incorporates clarification and editorial changes based on lessons learned from employee discussions, observations and reviews of Department of Energy (DOE) Complex and commercial industry beryllium (Be) safety programs. The information is used to strengthen beryllium safety practices at LLNL, particularly in the areas of: (1) Management of small parts and components; and (2) Communication of program status to employees. Future changes to LLNL beryllium activities and on-going operating experience will be incorporated into the program as described in Section S, 'Performance Feedback.'

Lee, S



Chronic caffeine consumption exacerbates hypertension in rats with polycystic kidney disease  

Microsoft Academic Search

Autosomal dominant polycystic kidney disease (ADPKD) is a common inherited disorder frequently associated with renal failure, hypertension, and other abnormalities. The present study determined whether chronic caffeine intake in an animal model of this disease would affect renal structure and function and blood pressure. Heterozygous male Han:Sprague-Dawley rats with ADPKD and normal littermates were provided with either tap water or

George A. Tanner; Judith A. Tanner



Beryllium Sensitization Progresses to Chronic Beryllium Disease A Longitudinal Study of Disease Risk  

Microsoft Academic Search

The blood beryllium lymphocyte proliferation test is used in medical surveillance to identify both beryllium sensitization and chronic beryllium disease. Approximately 50% of individuals with beryllium sensitization have chronic beryllium disease at the time of their initial clinical evaluation; however, the rate of progression from beryllium sensitization to chronic beryllium disease is unknown. We monitored a cohort of beryllium-sensitized patients

Lee S. Newman; Margaret M. Mroz; Ronald Balkissoon; Lisa A. Maier



Skeletal muscle response to inflammation--lessons for chronic obstructive pulmonary disease.  


To describe how inflammation affects muscle adaptation and performance in people with chronic obstructive pulmonary disease. In chronic obstructive pulmonary disease, an increasingly sedentary lifestyle is a primary contributor to muscle dysfunction that results in a loss of mobility and independence and, ultimately, mortality. Given the systemic chronic inflammation and profound limb muscle atrophy in chronic obstructive pulmonary disease, it is tempting to speculate that the inflammatory process is deleterious to skeletal muscle. In healthy people, however, the inflammatory process initially is dominated by a destructive phase that is tightly regulated and modulates a reparative, regenerative phase. Although the inflammatory process and associated oxidative stress is more closely connected to muscle wasting in animal models of chronic obstructive pulmonary disease, the causative role of inflammation toward muscle atrophy and weakness in people with chronic obstructive pulmonary disease has not been definitively shown. Anti-inflammatory interventions aimed toward tempering muscle wasting and weakness in chronic obstructive pulmonary disease may not prove to be beneficial because of longer-term disruption of the regeneration of muscle tissue. Temporally and spatially targeted interventions aimed toward ameliorating oxidative stress, such as antioxidants, nutritional supplements, and chronic exercise training, may optimize outcomes toward maintaining muscle mass and performance. PMID:20046123

Reid, W Darlene; Rurak, Jennifer; Harris, R Luke



Diseases of the parathyroid gland in chronic kidney disease.  


During the past few years, remarkable advances have been made in the understanding and the management of parathyroid diseases in patients with chronic kidney disease (CKD). One of the important insights is the identification of fibroblastic growth factor 23, which has greatly reshaped our understanding of secondary hyperparathyroidism (SHPT). The recent introduction of calcimimetic cinacalcet hydrochloride has led to a major breakthrough in the management of SHPT. Recognition of circulating molecular forms of parathyroid hormone (PTH) is also a major milestone in the accurate assessment of parathyroid function in CKD. Primary hyperparathyroidism should also be considered in patients with CKD, because it can cause various renal manifestations and can also occur as a sporadic disease in these patients. Hypoparathyroidism is occasionally seen in dialysis patients in the setting of diabetes mellitus and malnutrition-inflammation complex syndrome, as well as after parathyroidectomy for advanced SHPT. For patients with adynamic bone disease due to hypoparathyroidism and/or skeletal resistance to PTH, teriparatide, a PTH analog, may have potential for improving bone metabolism and reducing the risk of fracture. In this review, we summarize our current knowledge on diseases of the parathyroid gland in CKD patients, with a particular focus on recent work in the field. PMID:21818548

Komaba, Hirotaka; Kakuta, Takatoshi; Fukagawa, Masafumi



[Chronic diseases and quality of life in primary health care].  


The aim of this cross-sectional study was to evaluate quality of life in chronic patients treated at primary care services associated with the Catholic University of Pelotas, Rio Grande do Sul State, Brazil. Quality of life was assessed by WHOQOL-Bref, and data on chronic diseases were obtained from patients' medical records and categorized as cardiovascular diseases, respiratory diseases, endocrine diseases, mental illness, and other musculoskeletal diseases. A total of 920 subjects were interviewed. Low self-rated quality of life was associated with female gender, older age, low socioeconomic status, single conjugal status, and chronic disease. In all domains of quality of life, mean levels were lower in patients with diseases of the nervous system, except in the environmental domains, which were lower in patients with mental illness. The results corroborate that quality of life in patients with chronic diseases is a priority for public health policies. PMID:24068223

Azevedo, Ana Lucia Soares de; Silva, Ricardo Azevedo da; Tomasi, Elaine; Quevedo, Luciana de Ávila



Hormones and arterial stiffness in patients with chronic kidney disease.  


Cardiovascular disease constitutes the major cause of mortality in patients with chronic kidney disease. Arterial stiffness is an important contributor to the occurrence and progression of cardiovascular disease. Various risk factors, including altered hormone levels, have been suggested to be associated with arterial stiffness. Based on the background that chronic kidney disease predisposes individuals to a wide range of hormonal changes, we herein review the available data on the association between arterial stiffness and hormones in patients with chronic kidney disease and summarize the data for the general population. PMID:23911970

Gungor, Ozkan; Kircelli, Fatih; Voroneanu, Luminita; Covic, Adrian; Ok, Ercan



Preventing chronic diseases by promoting healthy diet and lifestyle: public policy implications for China.  


Fuelled by rapid urbanization and changes in dietary and lifestyle choices, chronic diseases have emerged as a critical public health issue in China. The Healthy China 2020 programme recently announced by the Chinese government has set an overarching goal of promoting public health and making health care accessible and affordable for all Chinese citizens by year 2020. One of important components of the programme is to reduce chronic diseases by promoting healthy eating and active lifestyles. Chronic diseases not only affect health and quality of life, but also have economical and social consequences. With a limited infrastructure for chronic disease care, China is ill-equipped to deal with the escalating chronic disease epidemic, which threatens to reverse the gains of economic development in recent decades. Population-based intervention studies conducted in China and elsewhere have demonstrated the efficacy and effectiveness of several preventive strategies to reduce risk of chronic diseases in high-risk individuals and the general population. However, translating these findings into practice requires changes in health systems and public policies. To achieve the goals set by the Healthy China 2020 programme, prevention of chronic diseases should be elevated to a national public policy priority. PMID:21366840

Hu, F B; Liu, Y; Willett, W C



Chronic kidney disease in acute coronary syndromes  

PubMed Central

Chronic kidney disease (CKD) is associated with a high burden of coronary artery disease. In patients with acute coronary syndromes (ACS), CKD is highly prevalent and associated with poor short- and long-term outcomes. Management of patients with CKD presenting with ACS is more complex than in the general population because of the lack of well-designed randomized trials assessing therapeutic strategies in such patients. The almost uniform exclusion of patients with CKD from randomized studies evaluating new targeted therapies for ACS, coupled with concerns about further deterioration of renal function and therapy-related toxic effects, may explain the less frequent use of proven medical therapies in this subgroup of high-risk patients. However, these patients potentially have much to gain from conventional revascularization strategies used in the general population. The objective of this review is to summarize the current evidence regarding the epidemiology and the clinical and prognostic relevance of CKD in ACS patients, in particular with respect to unresolved issues and uncertainties regarding recommended medical therapies and coronary revascularization strategies.

Marenzi, Giancarlo; Cabiati, Angelo; Assanelli, Emilio



Epidemiology of chronic kidney disease in children.  


In the past 30 years there have been major improvements in the care of children with chronic kidney disease (CKD). However, most of the available epidemiological data stem from end-stage renal disease (ESRD) registries and information on the earlier stages of pediatric CKD is still limited. The median reported incidence of renal replacement therapy (RRT) in children aged 0-19 years across the world in 2008 was 9 (range: 4-18) [corrected] per million of the age-related population). [corrected] The prevalence of RRT in 2008 ranged from 18 to 100 per million of the age-related population. Congenital disorders, including congenital anomalies of the kidney and urinary tract (CAKUT) and hereditary nephropathies, are responsible for about two thirds of all cases of CKD in developed countries, while acquired causes predominate in developing countries. Children with congenital disorders experience a slower progression of CKD than those with glomerulonephritis, resulting in a lower proportion of CAKUT in the ESRD population compared with less advanced stages of CKD. Most children with ESRD start on dialysis and then receive a transplant. While the survival rate of children with ERSD has improved, it remains about 30 times lower than that of healthy peers. Children now mainly die of cardiovascular causes and infection rather than from renal failure. PMID:21713524

Harambat, Jérôme; van Stralen, Karlijn J; Kim, Jon Jin; Tizard, E Jane



Bioecological control of chronic liver disease and encephalopathy  

Microsoft Academic Search

Minimal encephalopathy was originally associated with chronic liver disease but is increasingly associated with most other\\u000a chronic diseases and particularly with diabetes and also chronic disorders in other organs: kidneys, lungs, thyroid and with\\u000a obesity. It is increasingly with dramatically increased and more or less permanent increase in systemic inflammation, most\\u000a likely a result of Western lifestyle. Frequent physical exercise

Stig Bengmark



Prevalence of Chronic Diseases in Adolescents with Intellectual Disability  

ERIC Educational Resources Information Center

|Valid community-based data on the prevalence of chronic diseases in adolescents (12-18 years) with intellectual disability (ID-adolescents) are scarce. The aim of this study was to assess the prevalence rates and the nature of chronic diseases in a population of ID-adolescents and to compare them with the rates among adolescents in the general…

Oeseburg, B.; Jansen, D. E. M. C.; Dijkstra, G. J.; Groothoff, J. W.; Reijneveld, S. A.



Workplace problems and solutions for employees with chronic diseases  

Microsoft Academic Search

Background While many employees who have a chronic disease manage their jobs well, others are hampered in work performance, experience work-related problems and are at risk for job loss. Aims To identify the practical and psychosocial barriers recognized by employees with chronic disease who experience work-related problems and to examine preferred work accommodations. Methods A questionnaire was sent by mail

I. Varekamp; Dijk van F. J. H



Chronic Disease Health Beliefs and Lifestyle Practices Among Vietnamese Adults  

Microsoft Academic Search

There is growing alarm about the dramatic increase of chronic diseases among more acculturated Vietnamese (Yee, 1999). There were 180 Vietnamese adults, stratified by gender and age: 93 males and 87 females; young (ages 18–34), middle aged (ages 35–58), and older (ages 59+). A MANOVA was performed with nine Chronic Diseases Risk subscales, health behaviors, acculturation, depression, and health locus

Barbara W. K. Yee; Ha T. Nguyen; Martin Ha



Oxygen therapy during exacerbations of chronic obstructive pulmonary disease  

Microsoft Academic Search

Oxygen therapy during exacerbations of chronic obstructive pulmonary disease. A.G.N. Agusti´, M. Carrera, F. Barbe ´, A. Munoz, B. Togores. #ERS Journals Ltd 1999. ABSTRACT: Venturi masks (VMs) and nasal prongs (NPs) are widely used to treat acute respiratory failure (ARF) in chronic obstructive pulmonary disease (COPD). In this study, these devices were compared in terms of their potentiality to

A. G. N. Agusti; M. Carrera; F. Barbe; A. Munoz; B. Togores


Amenorrhoea in women with non-alcoholic chronic liver disease  

Microsoft Academic Search

Amenorrhoea is common in women with non-alcoholic chronic liver disease, but little is known about its causes or consequences. We investigated 12 young women with non-alcoholic chronic liver disease and amenorrhoea and compared them with 11 healthy age matched controls studied in the follicular phase of the menstrual cycle. None of the patients had raised serum concentrations of follicle stimulating

T F Cundy; J Butler; R M Pope; A K Saggar-Malik; M J Wheeler; R Williams



Flavonoid intake and risk of chronic diseases1,2  

Microsoft Academic Search

Background: Flavonoids are effective antioxidants and may pro- tect against several chronic diseases. Objective: The association between flavonoid intake and risk of several chronic diseases was studied. Design: The total dietary intakes of 10 054 men and women dur- ing the year preceding the baseline examination were determined with a dietary history method. Flavonoid intakes were estimated, mainly on the

Paul Knekt; Jorma Kumpulainen; Ritva Järvinen; Harri Rissanen; Markku Heliövaara; Antti Reunanen; Timo Hakulinen; Arpo Aromaa


Vitamin D and Chronic Kidney Disease  

PubMed Central

Chronic kidney disease (CKD) is an emerging public health problem and one of the most powerful predictors of premature cardiovascular disease. Emerging evidence suggests that the progression of CKD and many of the cardiovascular complications may be linked to hypovitaminosis D. Patients with CKD have an exceptionally high rate of severe vitamin D deficiency that is further exacerbated by the reduced ability to convert 25-(OH)vitamin D into the active form, 1,25 dihydroxy-vitamin D. As new evidence has improved our understanding of classical, as well as the non-classical, functions for vitamin D, it has become apparent that the autocrine role of vitamin D is an important modulator of several systems including the immune, renal and cardiovascular systems. In addition to the traditional supplementation of 1,25-vitamin D to CKD patients, by assessing and repleting 25-(OH)vitamin D deficiency, physicians will adequately fuel both the renal and extra-renal pathways of calcitriol synthesis maintaining the classical, as well as the non-classical, functions of vitamin D that ultimately influence clinical outcomes in this high-risk group of patients. Because of the high rates of hypovitaminosis D and progression of CKD to end-stage renal disease in minority populations, these findings are highly relevant to the national efforts to reduce health disparities. Healthcare providers are called to join the intensified efforts of public health officials to disseminate and implement updated guidelines and recommendations to halt the growing epidemic of vitamin D deficiency, particularly in high-risk populations.

Williams, Sandra; Malatesta, Karla; Norris, Keith



Common lung conditions: chronic obstructive pulmonary disease.  


The etiology of chronic obstructive pulmonary disease (COPD) is chronic lung inflammation. In the United States, this inflammation most commonly is caused by smoking. COPD is diagnosed when an at-risk patient presents with respiratory symptoms and has irreversible airway obstruction indicated by a forced expiratory volume in 1 second/forced vital capacity ratio of less than 0.7. Management goals for COPD include smoking cessation, symptom reduction, exacerbation reduction, hospitalization avoidance, and improvement of quality of life. Stable patients with COPD who remain symptomatic despite using short-acting bronchodilators should start inhaled maintenance drugs to reduce symptoms and exacerbations, avoid hospitalizations, and improve quality of life. A long-acting anticholinergic or a long-acting beta2-agonist (LABA) can be used for initial therapy; these drugs have fewer adverse effects than inhaled corticosteroids (ICS). If patients remain symptomatic despite monotherapy, dual therapy with a long-acting anticholinergic and a LABA, or a LABA and an ICS, may be beneficial. Triple therapy (ie, a long-acting anticholinergic, a LABA, and an ICS) also is used, but it is unclear if triple therapy is superior to dual therapy. Roflumilast, an oral selective inhibitor of phosphodiesterase 4, is used to manage moderate to severe COPD. Continuous oxygen therapy is indicated for patients with COPD who have severe hypoxemia (ie, PaO2 less than 55 mm Hg or an oxygen saturation less than 88% on room air). Nonpharmacologic strategies also are useful to improve patient outcomes. Pulmonary rehabilitation improves dyspnea and quality of life. Pulmonary rehabilitation after an acute exacerbation reduces hospitalizations and mortality, and improves quality of life and exercise capacity. Smoking cessation is the most effective management strategy for reducing morbidity and mortality in patients with COPD. Lung volume reduction surgery, bullectomy, and lung transplantation are surgical interventions that are appropriate for some patients with COPD. PMID:23767419

Delzell, John E



Therapeutic vaccines for chronic diseases: successes and technical challenges  

PubMed Central

Chronic, non-communicable diseases are the major cause of death and disability worldwide and have replaced infectious diseases as the major burden of society in large parts of the world. Despite the complexity of chronic diseases, relatively few predisposing risk factors have been identified by the World Health Organization. Those include smoking, alcohol abuse, obesity, high cholesterol and high blood pressure as the cause of many of these chronic conditions. Here, we discuss several examples of vaccines that target these risk factors with the aim of preventing the associated diseases and some of the challenges they face.

Bachmann, Martin F.; Jennings, Gary T.



Hemoglobin Decline in Children with Chronic Kidney Disease: Baseline Results from the Chronic Kidney Disease in Children Prospective Cohort Study  

Microsoft Academic Search

Background and objectives: The level of glomerular filtration rate at which hemoglobin declines in chronic kidney disease is poorly described in the pediatric population. Design, setting, participants, & measurements: This cross-sectional study of North American children with chronic kidney disease examined the association of glomerular filtration rate, determined by the plasma disappearance of iohexol, and hemoglobin concentration. Results: Of the

Jeffrey J. Fadrowski; Christopher B. Pierce; Stephen R. Cole; Marva Moxey-Mims; Bradley A. Warady; Susan L. Furth


Effectiveness of innovations in nurse led chronic disease management for patients with chronic obstructive pulmonary disease: systematic review of evidence  

Microsoft Academic Search

Objective To determine the effectiveness of innovations in management of chronic disease involving nurses for patients with chronic obstructive pulmonary disease (COPD). Design Systematic review of randomised controlled trials. Data sources 24 electronic databases searched for English or Dutch language studies published between January 1980 and January 2005. Review methods Included studies described inpatient, outpatient, and community based interventions for

Stephanie J. C. Taylor; Bridget Candy; Rosamund M. Bryar; Jean Ramsay; Hubertus J. M. Vrijhoef; Glenda Esmond; Jadwiga A. Wedzicha; Chris J. Griffiths



Chronic metabolic acidosis in azotemic rats on a high-phosphate diet halts the progression of renal disease  

Microsoft Academic Search

Chronic metabolic acidosis in azotemic rats on a high-phosphate diet halts the progression of renal disease.BackgroundHyperphosphatemia and metabolic acidosis are general features of advanced chronic renal failure (RF), and each may affect mineral metabolism. The goal of the present study was to evaluate the effect of chronic metabolic acidosis on the development of hyperparathyroidism and bone disease in normal and

Aquiles Jara; Arnold J Felsenfeld; Jordi Bover; Charles R Kleeman



Genetics of Sputum Gene Expression in Chronic Obstructive Pulmonary Disease  

Microsoft Academic Search

Previous expression quantitative trait loci (eQTL) studies have performed genetic association studies for gene expression, but most of these studies examined lymphoblastoid cell lines from non-diseased individuals. We examined the genetics of gene expression in a relevant disease tissue from chronic obstructive pulmonary disease (COPD) patients to identify functional effects of known susceptibility genes and to find novel disease genes.

Weiliang Qiu; Michael H. Cho; John H. Riley; Wayne H. Anderson; Dave Singh; Per Bakke; Amund Gulsvik; Augusto A. Litonjua; David A. Lomas; James D. Crapo; Terri H. Beaty; Bartolome R. Celli; Stephen Rennard; Ruth Tal-Singer; Steven M. Fox; Edwin K. Silverman; Craig P. Hersh; Mark M. Wurfel



Chronic obstructive pulmonary disease as a systemic disease: an epidemiological perspective  

Microsoft Academic Search

Chronic obstructive pulmonary disease as a systemic disease: an epidemiological perspective. H. Andreassen, J. Vestbo. #ERS Journals Ltd 2003. ABSTRACT: Chronic obstructive pulmonary disease (COPD) has been increasingly recognised as a systemic disease. The hormonal, metabolic and musculoskeletal implications of the generalised processes involving oxidative stress, inflammatory mediators, cytokines, and endocrine hormones have only begun to be understood. Only a

H. Andreassen; J. Vestbo



The Microvasculature in Chronic Kidney Disease  

PubMed Central

Summary Background and objectives Individuals with chronic kidney disease (CKD) stages 3 to 5 have an increased risk of cardiac and other vascular disease. Here we examined the association of CKD 3 to 5 with small vessel caliber. Design, setting, participants, & measurements This was a cross-sectional observational study of 126 patients with CKD stages 3 to 5 (estimated GFR [eGFR] <60 ml/min per 1.73 m2) and 126 age- and gender-matched hospital patients with CKD 1 or 2. Retinal vessel diameters were measured from digital fundus images by a trained grader using a computer-assisted method and summarized as the central retinal artery equivalent (CRAE) and central retinal vein equivalent (CRVE). Results Patients with CKD 3 to 5 had a smaller mean CRAE and CRVE than hospital controls (139.4 ± 17.8 ?m versus 148.5 ± 16.0 ?m, P < 0.001; and 205.0 ± 30.7 ?m versus 217.4 ± 25.8 ?m, respectively; P = 0.001). CRAE and CRVE decreased progressively with each stage of renal failure CKD1–2 to 5 (P for trend = 0.08 and 0.04, respectively). CKD and hypertension were independent determinants of arteriolar narrowing after adjusting for age, gender, diabetes, dyslipidemia, and smoking history. Patients with CKD 5 and diabetes had a larger mean CRAE and CRVE than nondiabetics (141.4 ± 14.9 ?m versus 132.9 ± 14.2 ?m; 211.1 ± 34.4 ?m versus 194.8 ± 23.8 ?m). Conclusions The microvasculature is narrowed in patients with reduced eGFR.

Ooi, Qi Lun; Tow, Foong Kien Newk-Fon Hey; Deva, Raj; Alias, Mohamad Afzal; Kawasaki, Ryo; Wong, Tien Y.; Mohamad, Nor; Colville, Deb; Hutchinson, Anastasia



Circulating Adipocytokines and Chronic Kidney Disease  

PubMed Central

Background Adipokines have been associated with atherosclerotic heart disease, which shares many common risk factors with chronic kidney disease (CKD), but their relationship with CKD has not been well characterized. Methods We investigated the association of plasma leptin, resistin and adiponectin with CKD in 201 patients with CKD and 201 controls without. CKD was defined as estimated glomerular filtration rate (eGFR) <60 mL/min/1.73 m2 or presence of albuminuria. Quantile regression and logistic regression models were used to examine the association between adipokines and CKD adjusting for multiple confounding factors. Results Compared to controls, adjusted median leptin (38.2 vs. 17.2 ng/mL, p<0.0001) and adjusted mean resistin (16.2 vs 9.0 ng/mL, p<0.0001) were significantly higher in CKD cases. The multiple-adjusted odds ratio (95% confidence interval) of CKD comparing the highest tertile to the lower two tertiles was 2.3 (1.1, 4.9) for leptin and 12.7 (6.5, 24.6) for resistin. Median adiponectin was not significantly different in cases and controls, but the odds ratio comparing the highest tertile to the lower two tertiles was significant (1.9; 95% CI, 1.1, 3.6). In addition, higher leptin, resistin, and adiponectin were independently associated with lower eGFR and higher urinary albumin levels. Conclusions These findings suggest that adipocytokines are independently and significantly associated with the risk and severity of CKD. Longitudinal studies are warranted to evaluate the prospective relationship of adipocytokines to the development and progression of CKD.

Mills, Katherine T.; Hamm, L. Lee; Alper, A. Brent; Miller, Chad; Hudaihed, Alhakam; Balamuthusamy, Saravanan; Chen, Chung-Shiuan; Liu, Yanxi; Tarsia, Joseph; Rifai, Nader; Kleinpeter, Myra; He, Jiang; Chen, Jing



Resistant Hypertension in Nondialysis Chronic Kidney Disease  

PubMed Central

Resistant hypertension (RH) is defined as blood pressure (BP) that remains above the target of less than 140/90?mmHg in the general population and 130/80?mmHg in people with diabetes mellitus or chronic kidney disease (CKD) in spite of the use of at least three full-dose antihypertensive drugs including a diuretic or as BP that reaches the target by means of four or more drugs. In CKD, RH is a common condition due to a combination of factors including sodium retention, increased activity of the renin-angiotensin system, and enhanced activity of the sympathetic nervous system. Before defining the hypertensive patient as resistant it is mandatory to exclude the so-called “pseudoresistance.” This condition, which refers to the apparent failure to reach BP target in spite of an appropriate antihypertensive treatment, is mainly caused by white coat hypertension that is prevalent (30%) in CKD patients. Recently we have demonstrated that “true” RH represents an independent risk factor for renal and cardiovascular outcomes in CKD patients.

Stanzione, Giovanna; Conte, Giuseppe



[Chronic inflammatory intestinal diseases. Pathophysiology and therapy].  


The pathogenesis and therapy of chronic inflammatory intestinal diseases are characterized by an obvious discrepancy. There is extensive agreement that the pathogenesis is substantially based on a disruption of the barrier of the intestinal mucous membrane against luminal bacteria. This has been demonstrated in recent years by evidence from various disciplines, in particular from genetics, microbiology, morphology and innate immunology. However, there is also the evidence-based therapy which, as in the past, is aimed against the effectors of the adaptive immune system. In this case the therapy with biologicals is more aggressive and takes the risk of a series of undesired side-effects. This dichotomy of pathological knowledge and therapeutic innovation is not only medically unsatisfactory but also makes it difficult to present a consistent picture of these symptoms. Despite this an attempt will be made to bridge these inconsistencies and to demonstrate possible future developments which will lead to a final causal therapy. An extended version of this article appears in our newly published book "Colitis ulcerosa und Morbus Crohn". PMID:19777197

Herrlinger, K; Wittig, B; Stange, E F



Atherosclerotic cardiovascular disease risks in chronic hemodialysis patients  

Microsoft Academic Search

Atherosclerotic cardiovascular disease risks in chronic hemodialysis patients.BackgroundCardiovascular diseases are the most common causes of death among chronic hemodialysis patients, yet the risk factors for these events have not been well established.MethodsIn this cross-sectional study, we examined the relationship between several traditional cardiovascular disease risk factors and the presence or history of cardiovascular events in 936 hemodialysis patients enrolled in

Alfred K. Cheung; Mark J. Sarnak; Guofen Yan; Johanna T. Dwyer; Robert J. Heyka; Michael V. Rocco; Brendan P. Teehan; Andrew S. Levey



Chronic Kidney Disease in India: Challenges and Solutions  

Microsoft Academic Search

Chronic diseases have become a major cause of global morbidity and mortality even in developing countries. The burden of chronic kidney disease (CKD) in India cannot be assessed accurately. The approximate prevalence of CKD is 800 per million population (pmp), and the incidence of end-stage renal disease (ESRD) is 150–200 pmp. The most common cause of CKD in population-based studies

S. K. Agarwal; R. K. Srivastava



Fundamental questions about genes, inactivity, and chronic diseases  

Microsoft Academic Search

Booth FW, Lees SJ. Fundamental questions about genes, inactivity, and chronic diseases. Physiol Genomics 28: 146-157, 2007. First pub- lished October 10, 2006; doi:10.1152\\/physiolgenomics.00174.2006.— Currently our society is faced with the challenge of understanding the biological basis for the epidemics of obesity and many chronic diseases, including Type 2 diabetes. Physical inactivity increases the relative risk of coronary artery disease

Frank W. Booth; Simon J. Lees




Microsoft Academic Search

Abstract ,Chronic wasting disease (CWD) is a transmissible spongiformencephalopathy (TSE) of deer (Odocoileusspp.) and RockyMountain,elk (Cervus elaphus nelsoni). Other TSEs include important diseases of domestic animals (scrapie, bovine spongiformencephalopathy )and rare fatal diseases of humans (Creutzfeldt-Jakob disease and variant Creutzfeldt-Jakob disease); the bovine spongiform encephalopathyagent apparentlycauses variant Creutzfeldt-Jakob disease. In recent years intense interest in CWD has developed because of

Elizabeth S. Williams; Michael W. Miller; E. Tomthorne


Nutrition Support for the Chronically Wasted or Acutely Catabolic Chronic Kidney Disease Patient  

PubMed Central

Summary Because of the number of factors affecting the nutritional and metabolic status in patients with advanced chronic kidney disease or who are on maintenance dialysis, the prevention and treatment of protein-energy wasting (PEW) of chronic kidney disease should involve a comprehensive combination of maneuvers to diminish protein and energy depletion, in addition to therapies that will avoid further losses. The available evidence suggests that nutritional supplementation, administered orally or parenterally, is effective in the treatment of maintenance dialysis patients with PEW in whom oral dietary intake from regular meals cannot maintain adequate nutritional status. Increased oral nutrient intake during dialysis and at home is the ideal choice for this intervention. In clinical practice, the advantages of intradialytic oral nutritional supplements include proven efficacy and compliance. Therefore, at a minimum, oral nutritional supplementation given intradialytically should be attempted in maintenance dialysis patients with PEW, accompanied by individualized dietary advice for appropriate intake at home. In ones who cannot tolerate oral feeding, other forms of nutritional supplementation including intradialytic parenteral nutritional are a reasonable strategy. Although not proven conclusively, nutritional interventions in the form of supplementation may lead to considerable improvements in mortality, hospitalization, and treatment costs.

Ikizler, T. Alp



Metabolic derangements seen in chronic kidney disease and end-stage renal disease patients.  


The National Health and Nutrition Examination Survey (NHANES) shows increasing trends in the prevalence of chronic kidney disease (CKD) and end-stage renal disease (ESRD) in the US population. There is an inverse relationship between a declining glomerular filtration rate and mortality and morbidity. A wide spectrum of complex metabolic derangements contributes to a large extent for this increased mortality and morbidity. An overview of some of these metabolic derangements--like uremic dyslipidemia, uremic inflammation, and endocrine abnormalities affecting thyroid and sexual functioning of CKD patients--is provided. Understanding some of these metabolic derangements may help develop new and affective strategies to help reduce mortality and morbidity among CKD patients. PMID:21625099

Gupta, Diptesh; Misra, Madhukar



Nitric Oxide and Exhaled Breath Nitrite\\/Nitrates in Chronic Obstructive Pulmonary Disease Patients  

Microsoft Academic Search

Background: Measurement of nitric oxide (NO) and nitrite\\/nitrates (NOx) levels in exhaled breath condensate (EBC) are non-invasive techniques, which can be used to monitor airway inflammatory diseases. Production of NO is often increased in inflammatory diseases of the airways, including exacerbations of chronic obstructive pulmonary disease (COPD). COPD-associated airway inflammation may be affected by multiple factors, including cigarette smoking and

Jia Liu; Alessandra Sandrini; Michelle C. Thurston; Deborah H. Yates; Paul S. Thomas



Prevention of progressive fibrosis in chronic renal diseases: antifibrotic agents.  


Renal fibrogenesis can be induced by several injury mechanisms in different renal diseases, but ultimately produces identical fibrotic changes in the kidney. Recently, a number of agents that can inhibit extracellular matrix (ECM) accumulation have been studied, suggesting a therapeutic utility in the treatment of fibrotic renal disease. Pirfenidone (PFD) is a small molecule that has shown efficacy in various models of renal damage with progressive disease. The apparent absence of toxicity in PFD suggests that it does not affect the normal ECM turnover. Relaxin, a hormone belonging to the insulin-like growth factor (IGF) family, has antifibrotic properties and has been used for a long time to induce transient remissions in patients with scleroderma. Only recently it has been shown to drastically reduce corticomedular scarring in animal models. Bone morphogenetic protein 7 (BMP-7), a member of the transforming growth factor beta (TGF-beta) superfamily, has been shown to reduce glomerular and interstitial area, and prevent glomerular sclerosis even more effectively than enalapril. Finally, hepatocyte growth factor (HGF), with its multiple biological activities on a wide variety of cells, has an organotrophic role in the regeneration and protection of various organs including the kidney. Both endogenous and exogenous HGF have shown suppressive effects on renal fibrosis and chronic renal damage in various animal models. The inhibition of pathological ECM accumulation and the modulation of fibrotic mechanisms with these new antifibrotic agents is an achievable goal and could confer further benefits beyond the current therapies used in the treatment of chronic renal diseases. PMID:15372410

Negri, Armando Luis


Factors associated with chronic lung disease in preterm infants.  

PubMed Central

Among 659 infants of 30 weeks' gestation or less born in a regional perinatal centre between 1983 and 1989, 195 were ventilated for four days or more and survived to 28 days, and 87 of these developed chronic lung disease. There was a sevenfold increase in the annual incidence of chronic lung disease over time. During the same period there were significant increases in the number of infants who survived, the incidence of septicaemia, and the use of parenteral lipid emulsions. Chronic lung disease was significantly associated with low birth weight, shorter gestation, duration of ventilation, vaginal delivery, sepsis, and the use of lipid. Respiratory and physiological measurements at 96 hours were significantly worse in infants who subsequently developed chronic lung disease. Initial logistic regression showed that gestation, arterial carbon dioxide tension (PaCO2), and ventilation rate at 96 hours; and birth in 1988 or 1989, were independently associated with chronic lung disease, but when septicaemia and use of lipid during the first 21 days were included, only gestational age (odds ratio 0.64, 95% confidence interval (CI), 0.49 to 0.81 for each week) and use of lipid (odds ratio 8.1, 95% CI, 2.32 to 28.0) remained significantly associated with chronic lung disease. The observed increase in incidence of chronic lung disease in this population was associated with earlier use of parenteral lipids in infants of very low gestation rather than with changes in population, survival, or ventilator treatment of respiratory distress syndrome.

Cooke, R W



Pesticides and human chronic diseases: evidences, mechanisms, and perspectives.  


Along with the wide use of pesticides in the world, the concerns over their health impacts are rapidly growing. There is a huge body of evidence on the relation between exposure to pesticides and elevated rate of chronic diseases such as different types of cancers, diabetes, neurodegenerative disorders like Parkinson, Alzheimer, and amyotrophic lateral sclerosis (ALS), birth defects, and reproductive disorders. There is also circumstantial evidence on the association of exposure to pesticides with some other chronic diseases like respiratory problems, particularly asthma and chronic obstructive pulmonary disease (COPD), cardiovascular disease such as atherosclerosis and coronary artery disease, chronic nephropathies, autoimmune diseases like systemic lupus erythematous and rheumatoid arthritis, chronic fatigue syndrome, and aging. The common feature of chronic disorders is a disturbance in cellular homeostasis, which can be induced via pesticides' primary action like perturbation of ion channels, enzymes, receptors, etc., or can as well be mediated via pathways other than the main mechanism. In this review, we present the highlighted evidence on the association of pesticide's exposure with the incidence of chronic diseases and introduce genetic damages, epigenetic modifications, endocrine disruption, mitochondrial dysfunction, oxidative stress, endoplasmic reticulum stress and unfolded protein response (UPR), impairment of ubiquitin proteasome system, and defective autophagy as the effective mechanisms of action. PMID:23402800

Mostafalou, Sara; Abdollahi, Mohammad



77 FR 43092 - Agency Information Collection Activities; Proposed Collection; Comment Request; Chronic Disease...  

Federal Register 2010, 2011, 2012, 2013

...Comment Request; Chronic Disease Self-Management Education Program Standardized...relating to the Chronic Disease Self-Management Education Program. DATES...Disabilities through Chronic Disease Self-Management Education (CDSME)...



62 FR 28042 - Development of State Health Promotion and Chronic Disease Prevention Databases/Clearinghouses  

Federal Register 2010, 2011, 2012, 2013

...Number 766] Development of State Health Promotion and Chronic Disease Prevention...program for development of State health promotion and chronic disease prevention...bibliographies, literature, and health promotion and chronic disease...



64 FR 28000 - The National Center for Chronic Disease Prevention and Health Promotion (NCCDPHP); Meeting  

Federal Register 2010, 2011, 2012, 2013

...Chronic Disease Prevention and Health Promotion (NCCDPHP); Meeting The National...Chronic Disease Prevention and Health Promotion (NCCDPHP) of the Centers for...Chronic Disease Prevention and Health Promotion's funding announcement...



Dermatologic complications of chronic venous disease: medical management and beyond.  


Patients with venous insufficiency commonly develop complications which can result in significant morbidity and occasional mortality. Venous leg ulcers, the most prevalent type of lower extremity ulcer, are the most frequent sequela of venous insufficiency and negatively affect quality of life for the patient. Most have focused on venous ulceration, but other complications may arise including dermatitis, atrophie blanche, lipodermatosclerosis, and malignancy. Contact dermatitis is a common complication seen in the treatment of venous disease. Patients with venous insufficiency have a disrupted epidermal barrier, making them more susceptible than the general population to contact sensitization and subsequent dermatitis. Venous dermatitis is often the first manifestation of venous insufficiency and needs to be addressed promptly. Atrophie blanche, an end point of a variety of conditions, appears as atrophic plaques of ivory white skin with telangiectasias. Lipodermatosclerosis is an indurated plaque in the medial malleolus which can, at times, be quite tender and painful. Malignant degeneration is a rare but important complication of venous disease since tumors which develop in the setting of an ulcer tend to be more aggressive. Pain is a feature of venous disease often overlooked and commonly undertreated. Finally, psychosocial issues such as anxiety and depression are more common in patients with venous disease and should be adequately addressed. Recognizing these complications of chronic venous insufficiency is important as early intervention is the key to preventing unnecessary patient suffering and discomfort. PMID:17823046

Barron, Gregory S; Jacob, Sharon E; Kirsner, Robert S



66 FR 8405 - Health Promotion and Disease Prevention Initiatives Related to Chronic Disease Prevention and...  

Federal Register 2010, 2011, 2012, 2013

...Program Announcement 01018] Health Promotion and Disease Prevention Initiatives...Chronic Disease Prevention and Health Promotion World Health Organization...a cooperative agreement for Health Promotion and Disease Prevention...



Venous thromboembolism in patients with chronic obstructive pulmonary disease  

PubMed Central

Purpose Our aim was to compare clinical characteristics, prophylaxis, treatment, and outcomes of venous thromboembolism in patients with and without previously diagnosed chronic obstructive pulmonary disease. Methods We analyzed the population-based Worcester Venous Thromboembolism Study of 2,488 consecutive patients with validated venous thromboembolism to compare clinical characteristics, prophylaxis, treatment, and outcomes in patients with and without chronic obstructive pulmonary disease. Results Of 2,488 venous thromboembolism patients, 484 (19.5%) had a history of clinical chronic obstructive pulmonary disease and 2,004 (80.5%) did not. Chronic obstructive pulmonary disease patients were older (mean age 68 years vs. 63 years) and had a higher frequency of heart failure (35.5% vs. 12.9%) and immobility (53.5% vs. 43.3%) than patients without chronic obstructive pulmonary disease (all p<0.0001). Chronic obstructive pulmonary disease patients were more likely to suffer in-hospital death (6.8% vs. 4%, p=0.01) and death within 30 days of venous thromboembolism diagnosis (12.6% vs. 6.5%, p<0.0001). Chronic obstructive pulmonary disease patients demonstrated increased mortality despite a higher frequency of venous thromboembolism prophylaxis. Immobility doubled the risk of in-hospital death (adjusted odds ratio 2.21; 95% confidence interval 1.35–3.62) and death within 30 days of venous thromboembolism diagnosis (adjusted odds ratio 2.04; 95% confidence interval 1.43–2.91). Conclusion Patients with chronic obstructive pulmonary disease have an increased risk of dying during hospitalization and within 30 days of venous thromboembolism diagnosis. Immobility in chronic obstructive pulmonary disease patients is an ominous risk factor for adverse outcomes.

Piazza, Gregory; Goldhaber, Samuel Z.; Kroll, Aimee; Goldberg, Robert J.; Emery, Catherine; Spencer, Frederick A.



Corynebacterium aquaticum infection in a patient with chronic granulomatous disease.  


Patients with chronic granulomatous disease are uniquely susceptible to infection with catalase-producing bacteria. Staphylococcus aureus, Klebsiella, Escherichia coli and Serratia marcescans are common infecting organisms. A 17-month-old boy with Corynebacterium aquaticum bacteremia is reported. This is only the third documented infection with this non-JK diphtheroid and the first case infection in a patient with chronic granulomatous disease. It is likely that our patient's underlying immune defect predisposed him to infection with this unusual, catalase-producing organism. Although these bacteria are common contaminants and rarely infecting agents, true infection should be considered in patients with chronic granulomatous disease from whom a diphtheroid is isolated. PMID:3407679

Kaplan, A; Israel, F



Stories of chronic kidney disease: listening for the unsayable.  


AIMS: To explore individuals' stories of chronic kidney disease, particularly those aspects of experience that are difficult to discuss using language (i.e. unsayable). BACKGROUND: Chronic kidney disease is continuous, but it is also life-threatening and sometimes people ask difficult questions about life and death that can be challenging and for some, impossible to discuss. These 'unsayables' are the focus of this article. The unsayable may reside both within and beyond language. Careful analysis of narratives of illness for sayable and unsayable aspects of the experience can help illuminate new areas of concern for people with chronic kidney disease. DESIGN: Narrative inquiry, located in a social constructionist framework, guided this study. METHODS: Secondary data analysis was conducted with 46 in-depth interviews (collected between 2008-2011) with 14 people living with chronic kidney disease. FINDINGS: Through narrative thematic analysis, we identify that the unsayable includes the following five themes: living with death, embodied experiences that were difficult to language, that which was unthinkable, unknowable mystery and that which was untold/unheard. Whereas the first four themes attend to that which is unsayable for people living with chronic kidney disease, the last theme acknowledges that which is unsayable to people living with chronic kidney disease. CONCLUSION: Not all experiences of illness can be explicitly articulated in language. Listening for both the sayable and unsayable aspects of life with chronic and life-threatening illness is an important nursing role. PMID:23594086

Makaroff, Kara L Schick; Sheilds, Laurene; Molzahn, Anita




PubMed Central

Introduction Occupational exposure to silica may be associated with chronic kidney disease (CKD). Most studies have been conducted in occupational cohorts with high levels of exposure but small numbers of cases. We analyzed data from a population-based case-control study of occupational silica exposure and CKD. Methods Cases were hospital patients with newly diagnosed CKD and community controls were selected using random digit dialing and frequency matched by age, gender, race and proximity to the hospital. Silica exposure estimates were assigned by industrial hygiene review of lifetime job history data and weighted for certainty and intensity. Conditional logistic regression was used to estimate the odds ratios (ORs) for CKD conditioned on demographic, lifestyle and clinical variables. Results The mean age of participants was 62 years (range, 30-83 years), 56% were male and 54% were white. Any silica exposure (compared to none) was associated with a 40% increased risk of CKD (OR=1.40, 95% confidence interval [CI]: 1.04, 1.89) in a multivariable adjusted model. The mean cumulative duration of silica exposure was significantly higher in exposed cases than in exposed controls (33.4 vs. 24.8 years, respectively). Overall, compared to non-exposed participants, the ORs (95% CI) for those below and above the median duration of silica exposure were 1.20 (95% CI: 0.77, 1.86) and 1.76 (95% CI: 1.14, 2.71), respectively. Conclusions We found a positive relationship between occupational silica exposure and CKD. A dose-response trend of increasing CKD risk with increasing duration of silica exposure was observed and was particularly strong among non-whites.

Vupputuri, Suma; Parks, Christine G.; Nylander-French, Leena A.; Owen-Smith, Ashli; Hogan, Susan L.; Sandler, Dale P.



Substance P at the Nexus of Mind and Body in Chronic Inflammation and Affective Disorders  

ERIC Educational Resources Information Center

|For decades, research has demonstrated that chronic diseases characterized by dysregulation of inflammation are particularly susceptible to exacerbation by stress and emotion. Likewise, rates of depression and anxiety are overrepresented in individuals suffering from chronic inflammatory disease. In recent years, substance P has been implicated…

Rosenkranz, Melissa A.



Management of Chronic Infectious Diseases in School Children.  

ERIC Educational Resources Information Center

This document contains guidelines for developing policies and procedures related to chronic infectious diseases, as recommended by the Illinois Task Force on School Management of Infectious Disease. It is designed to help school personnel understand how infectious diseases can be transmitted, and to assist school districts in the development and…

Illinois State Board of Education, Springfield.


A systems view of genetics in chronic kidney disease  

Microsoft Academic Search

A tight interplay of genetic predisposition and environmental factors define the onset and the rate of progression of chronic renal disease. We are seeing a rapid expansion of information about genetic loci associated with kidney function and complex renal disease. However, discovering the functional links that bridge the gap from genetic risk loci to disease phenotype is one of the

Benjamin J Keller; Sebastian Martini; John R Sedor; Matthias Kretzler



Epidemiology of cardiovascular risk in patients with chronic kidney disease  

Microsoft Academic Search

Background. Chronic kidney disease (CKD) patients are highly prone to cardiovascular disease for a number of reasons. At the time of starting renal replacement treatment, their cardiovascular condition is already severely compromised, suggesting that cardiovascular risk factors begin to operate very early in the progression of CKD. Moreover, those patients reaching end-stage renal disease without cardiovascular abnormalities have a high

Francesco Locatelli; Pietro Pozzoni; Francesca Tentori; Lucia Del Vecchio



Chronic obstructive pulmonary disease and asthma in the ICU  

Microsoft Academic Search

Chronic obstructive pulmonary disease (COPD) and asthma are both common respiratory problems that can present acutely with severe respiratory failure. Both are characterized by the presence of air flow limitation, which is variable in asthma and usually fixed in COPD. Chronic respiratory failure usually develops in COPD once FEV1 falls to less than 30% of predicted. Patients are often hospitalized

Simon Baudouin



Serum Pancreatic Enzyme Concentrations in Chronic Viral Liver Diseases  

Microsoft Academic Search

Serum amylase and lipase concentrations weredetermined in 78 patients with chronic liver diseases[26 chronic active hepatitis (CAH) and 52 livercirrhosis] and in 15 healthy subjects. Pancreaticisoamylase concentrations and macroamylase complexes wereassayed in hyperamylasemic sera. Serum amylase levelswere abnormally elevated in 27 patients (35%; 22 livercirrhosis, 5 CAH), whereas serum lipase levels were elevated in 16 patients (21%; 15 livercirrhosis, 1

Raffaele Pezzilli; Pietro Andreone; Antonio Maria Morselli-Labate; Claudia Sama; Paola Billi; Carmela Cursaro; Bahjat Barakat; Annagiulia Gramenzi; Manuela Fiocchi; Federico Miglio; Mauro Bernardi



Chronic Diseases in the Pediatric Age Group. Matrix No. 7.  

ERIC Educational Resources Information Center

|This paper briefly outlines current problems associated with chronic diseases in children and youth and provides indications for the types of future research and analysis needed to facilitate the development of solutions. In general, these problems are associated with the following: malignancies, hereditary anemias, cystic fibrosis, other chronic

Katz, Michael


Chronic unexplained hypertransaminasemia may be caused by occult celiac disease  

Microsoft Academic Search

In a subset of patients attending liver units, a chronic increase in serum transaminases may remain of undeter- mined cause despite thorough investigations. On the other hand, elevated levels of serum transaminases have been reported in about 40% of adult celiac patients. To evaluate the prevalence of subclinical celiac disease in patients with chronic unexplained hypertransaminasemia in comparison with that

Maria Teresa Bardella; Maurizio Vecchi; Dario Conte; Ersilio Del Ninno; Mirella Fraquelli; Stefania Pacchetti; Eliseo Minola; Marina Landoni; Bruno Mario Cesana; Roberto De Franchis



Prevalence of comorbidity of chronic diseases in Australia  

Microsoft Academic Search

BACKGROUND: The prevalence of comorbidity is high, with 80% of the elderly population having three or more chronic conditions. Comorbidity is associated with a decline in many health outcomes and increases in mortality and use of health care resources. The aim of this study was to identify, review and summarise studies reporting the prevalence of comorbidity of chronic diseases in

Gillian E Caughey; Agnes I Vitry; Andrew L Gilbert; Elizabeth E Roughead




Microsoft Academic Search

SUMMARY: Familial benign chronic pemphigus (Hailey-Hailey disease) is a blistering dermatosis, which is inherited as an autosomal dominant trait and usually presents around the third and fourth decades. Painful erosions, vesico-pustules and scaly erythematous plaques appear at sites of friction such as the sides of the neck, the axillae, the groins and the perineum. A case of familial benign chronic

Ivelina Yordanova; Dimitar Gospodinov; Valentina Chavdarova; Savelina Popovska



Patient-Centered Medical Home in chronic obstructive pulmonary disease  

PubMed Central

Chronic obstructive pulmonary disease (COPD) is a progressive and debilitating but preventable and treatable disease characterized by cough, phlegm, dyspnea, and fixed or incompletely reversible airway obstruction. Most patients with COPD rely on primary care practices for COPD management. Unfortunately, only about 55% of US outpatients with COPD receive all guideline-recommended care. Proactive and consistent primary care for COPD, as for many other chronic diseases, can reduce hospitalizations. Optimal chronic disease management requires focusing on maintenance rather than merely acute rescue. The Patient-Centered Medical Home (PCMH), which implements the chronic care model, is a promising framework for primary care transformation. This review presents core PCMH concepts and proposes multidisciplinary team-based PCMH care strategies for COPD.

Ortiz, Gabriel; Fromer, Len



COPD (Chronic Obstructive Pulmonary Disease) - Multiple Languages: MedlinePlus  


... Hindi (??????) Japanese (???) Korean (???) Portuguese (português) Russian (???????) Somali (af Soomaali) Spanish (español) Tagalog ( ... PDF Health Information Translations Return to top Portuguese (português) Chronic Obstructive Pulmonary Disease (COPD) Doença Pulmonar Obstrutiva ...


Enzymes in feces: Useful markers of chronic inflammatory bowel disease  

Microsoft Academic Search

BackgroundUlcerative colitis and Crohn's disease are characterized by a chronic intestinal inflammation. Since the precise etiology is still unknown, current therapies are aimed at reducing or eliminating inflammation.

Imerio Angriman; Marco Scarpa; Renata D'Incà; Daniela Basso; Cesare Ruffolo; Lino Polese; Giacomo C. Sturniolo; Davide F. D'Amico; Mario Plebani



Complications of Chronic Kidney Disease Occur Earlier in Children  


... lead to a shift in treatment, the largest prospective study of children with chronic kidney disease (CKD) has ... from these findings.” CKiD is a multi-center, prospective study of children and teenagers ages 1 to 16 ...


Bio-ecological control of chronic liver disease and encephalopathy.  


Minimal encephalopathy was originally associated with chronic liver disease but is increasingly associated with most other chronic diseases and particularly with diabetes and also chronic disorders in other organs: kidneys, lungs, thyroid and with obesity. It is increasingly with dramatically increased and more or less permanent increase in systemic inflammation, most likely a result of Western lifestyle. Frequent physical exercise and intake of foods rich in vitamins, antioxidants, fibres, lactic acid bacteria etc in combination with reduction in intake of refined and processed foods is known to reduce systemic inflammation and prevent chronic diseases. Some lactic acid bacteria, especially Lb paracasei, lb plantarum and pediococcus pentosaceus have proven effective to reduce inflammation and eliminate encephalopathy. Significant reduction in blood ammonia levels and endotoxin levels were reported in parallel to improvement of liver disease. Subsequent studies with other lactic acid bacteria seem to demonstrate suppression of inflammation and in one study also evidence of clinical improvement. PMID:19104922

Bengmark, Stig



Research involving participants with chronic diseases: overcoming recruitment obstacles.  


Chronic diseases are rampant in the United States and account for the majority of healthcare costs in this country. The implementation of research studies involving members of chronic disease populations is necessary to the development of interventions aimed at preventing these conditions and improving outcomes. The implementation of such studies hinges on the successful recruitment of an adequate number of study participants. Difficulties surrounding participant recruitment in behavioral studies are well documented and present a barrier to researchers aiming to conduct research involving persons with chronic diseases. Common recruitment challenges associated with recruiting chronic disease participants are reviewed, and a highly effective, alternative recruitment strategy used by the authors in a qualitative study involving persons with epilepsy is discussed in detail. PMID:24107754

Miller, Wendy R; Bakas, Tamilyn; Buelow, Janice M; Habermann, Barbara


Hyperuricemia and Urate Excretion in Chronic Renal Disease.  

National Technical Information Service (NTIS)

Standard renal clearances were performed in 92 subjects, comparing uric acid excretion, glomerular filtration and renal plasma flow in normal people and people with proven chronic renal disease with normal and sub-normal glomerular filtration. Despite com...

J. J. McPhaul



Pulmonary Rehabilitation for Patients With Chronic Pulmonary Disease (COPD)  

PubMed Central

Executive Summary In July 2010, the Medical Advisory Secretariat (MAS) began work on a Chronic Obstructive Pulmonary Disease (COPD) evidentiary framework, an evidence-based review of the literature surrounding treatment strategies for patients with COPD. This project emerged from a request by the Health System Strategy Division of the Ministry of Health and Long-Term Care that MAS provide them with an evidentiary platform on the effectiveness and cost-effectiveness of COPD interventions. After an initial review of health technology assessments and systematic reviews of COPD literature, and consultation with experts, MAS identified the following topics for analysis: vaccinations (influenza and pneumococcal), smoking cessation, multidisciplinary care, pulmonary rehabilitation, long-term oxygen therapy, noninvasive positive pressure ventilation for acute and chronic respiratory failure, hospital-at-home for acute exacerbations of COPD, and telehealth (including telemonitoring and telephone support). Evidence-based analyses were prepared for each of these topics. For each technology, an economic analysis was also completed where appropriate. In addition, a review of the qualitative literature on patient, caregiver, and provider perspectives on living and dying with COPD was conducted, as were reviews of the qualitative literature on each of the technologies included in these analyses. The Chronic Obstructive Pulmonary Disease Mega-Analysis series is made up of the following reports, which can be publicly accessed at the MAS website at: Chronic Obstructive Pulmonary Disease (COPD) Evidentiary Framework Influenza and Pneumococcal Vaccinations for Patients With Chronic Obstructive Pulmonary Disease (COPD): An Evidence-Based Analysis Smoking Cessation for Patients With Chronic Obstructive Pulmonary Disease (COPD): An Evidence-Based Analysis Community-Based Multidisciplinary Care for Patients With Stable Chronic Obstructive Pulmonary Disease (COPD): An Evidence-Based Analysis Pulmonary Rehabilitation for Patients With Chronic Obstructive Pulmonary Disease (COPD): An Evidence-Based Analysis Long-term Oxygen Therapy for Patients With Chronic Obstructive Pulmonary Disease (COPD): An Evidence-Based Analysis Noninvasive Positive Pressure Ventilation for Acute Respiratory Failure Patients With Chronic Obstructive Pulmonary Disease (COPD): An Evidence-Based Analysis Noninvasive Positive Pressure Ventilation for Chronic Respiratory Failure Patients With Stable Chronic Obstructive Pulmonary Disease (COPD): An Evidence-Based Analysis Hospital-at-Home Programs for Patients With Acute Exacerbations of Chronic Obstructive Pulmonary Disease (COPD): An Evidence-Based Analysis Home Telehealth for Patients With Chronic Obstructive Pulmonary Disease (COPD): An Evidence-Based Analysis Cost-Effectiveness of Interventions for Chronic Obstructive Pulmonary Disease Using an Ontario Policy Model Experiences of Living and Dying With COPD: A Systematic Review and Synthesis of the Qualitative Empirical Literature For more information on the qualitative review, please contact Mita Giacomini at: member_giacomini.htm. For more information on the economic analysis, please visit the PATH website: The Toronto Health Economics and Technology Assessment (THETA) collaborative has produced an associated report on patient preference for mechanical ventilation. For more information, please visit the THETA website: Objective The objective of this evidence-based review was to determine the effectiveness and cost-effectiveness of pulmonary rehabilitation in the management of chronic obstructive pulmonary disease (COPD). Technology Pulmonary rehabilitation refers to a multidisciplinary program of care for patients with chronic respiratory impairment that is individually tailored and designed to optimize physical and social performance and autonomy. Exercise training is the cornerstone of pulmonary re



CFTR gene mutations in isolated chronic obstructive pulmonary disease  

SciTech Connect

In order to identify a possible hereditary predisposition to the development of chronic obstructive pulmonary disease (COPD), we have looked for the presence of cystic fibrosis transmembrane regulator (CFTR) gene DNA sequence modifications in 28 unrelated patients with no signs of cystic fibrosis. The known mutations in Italian CF patients, as well as the most frequent worldwide CF mutations, were investigated. In addition, a denaturing gradient gel electrophoresis analysis of about half of the coding sequence of the gene in 56 chromosomes from the patients and in 102 chromosomes from control individuals affected by other pulmonary diseases and from normal controls was performed. Nine different CFTR gene mutations and polymorphisms were found in seven patients, a highly significant increase over controls. Two of the patients were compound heterozygotes. Two frequent CF mutations were detected: deletion F508 and R117H; two rare CF mutations: R1066C and 3667ins4; and five CF sequence variants: R75Q (which was also described as a disease-causing mutation in male sterility cases due to the absence of the vasa deferentia), G576A, 2736 A{r_arrow}G, L997F, and 3271+18C{r_arrow}T. Seven (78%) of the mutations are localized in transmembrane domains. Six (86%) of the patients with defined mutations and polymorphisms had bronchiectasis. These results indicate that CFTR gene mutations and sequence alterations may be involved in the etiopathogenesis of some cases of COPD.

Pignatti, P.F.; Bombien, C.; Marigo, C. [and others



[Heart failure in chronic kidney disease: from epidemiology to therapy].  


Many patients affected by chronic kidney disease (CKD) die before reaching endstage renal disease because of cardiovascular disease (CVD). Recent guidelines and position statements have therefore defined CKD as a cardiovascular risk equivalent, and patients in all stages of CKD are considered in the highest risk group for development of CVD. Heart failure (HF) is the main cardiovascular complication that occurs in renal patients and its incidence increases proportionally with the reduction of glomerular filtration rate. In fact, pressure and volume overload, that are inherent to the abnormalities of homeostasis typical of CKD, lead to concentric/eccentric left ventricular hypertrophy (LVH). Initially, LVH is adaptative because energy is spared by maintaining stable wall stress. However, in the long term, LVH becomes maladaptative, inducing systolic and/or diastolic dysfunction that, in turn, lead to symptomatic left ventricular failure. Nowadays, it is well established that several classes of drugs, including reninangiotensin system antagonists, beta blockers and aldosterone antagonists, improve survival in patients with HF. In fact, all major guidelines on HF recommend such drugs as standard therapy. The problem for nephrologists is that the general approach and recommendations for the management of HF in the general population may not be completely safe in renal patients with HF. This review is conducted with the purpose to provide more information on the efficacy and safety of HF therapy in renal patients. PMID:18278761

Zamboli, P; De Nicola, L; Minutolo, R; Stanzione, G; Bertino, V; Sosio, R; De Luca, A; Crivaro, M; Tassinario, S; Conte, G


Alteration of the platelet transcriptome in chronic kidney disease  

PubMed Central

SUMMARY Bleeding and thrombotic disorders are major complications affecting patients with chronic kidney disease (CKD). Exposure of circulating platelets to uremic toxins and contact with artificial surfaces during dialysis induce platelet abnormalities and alter the platelet proteome. We hypothesized that these changes may be subsequent to changes in the composition and/or regulation of the platelet transcriptome. In this study, we investigated the circulating platelets of 10 CKD patients (i.e. 5 chronic hemodialysis patients and 5 stage 4 CKD uremic patients) and 5 age- and sex-matched healthy subjects. We observed an alteration of the platelet messenger RNA (mRNA) and microRNA transcriptome in CKD patients. Impaired in uremic platelets, the levels of some mRNAs and of most microRNAs appeared to be corrected by dialysis, which is consistent with a beneficial effect of dialysis and a mRNA regulatory role of platelet microRNAs. Reduced in platelets of uremic patients, phosphatidylcholine transfer protein (PCTP) and WD repeat-containing protein 1 (WDR1) were found to be regulated by microRNAs, the latter of which involving hsa-miR-19b, a microRNA increased in platelets of uremic patients and involved in platelet reactivity. These results suggest that an alteration of microRNA-based mRNA regulatory mechanisms may underlie the platelet response to uremia and entail the development of platelet-related complications in CKD.

Ple, Helene; Maltais, Manon; Corduan, Aurelie; Rousseau, Guy; Madore, Francois; Provost, Patrick



Common gene polymorphisms and nutrition: emerging links with pathogenesis of multifactorial chronic diseases (review)  

Microsoft Academic Search

Rapid progress in human genome decoding has accelerated search for the role of gene polymorphisms in the pathogenesis of complex multifactorial diseases. This review summarizes the results of recent studies on the associations of common gene variants with multifactorial chronic conditions strongly affected by nutritional factors. Three main individual sections discuss genes related to energy homeostasis regulation and obesity, cardiovascular

Alexandre Loktionov



Chronic liver disease and transplantation — uncovering the role of the liver in ingestive behaviour  

Microsoft Academic Search

The liver is an important metabolic sensor relaying humoral and neural signalling via the brain stem to the hypothalamus. The integration of this information in the higher centres ultimately controls the composition, duration and frequency of nutritional intake. In chronic liver disease, alterations in oxidative metabolism and impairment of the liver's metabolic role may affect changes in ingestive behaviour and

R. A. Richardson; O. J. Garden; H. I. Davidson



Spirometry Utilization After Hospitalization for Patients With Chronic Obstructive Pulmonary Disease Exacerbations  

Microsoft Academic Search

Chronic obstructive pulmonary disease (COPD) is a leading cause of morbidity and mortality in the US population. An area of improvement hinges on early detection and proper monitoring. Spirometry is an important interventional tool; its underuse among hospitalized patients with COPD could affect quality of care. This study evaluates spirometry use at the Community Medical Center—Sierra in hospitalized patients with

Natalia B. Volkova; Ann Kodani; Dahlia Hilario; Sipho M. Munyaradzi; Michael W. Peterson



Effect of Exacerbation on Quality of Life in Patients with Chronic Obstructive Pulmonary Disease  

Microsoft Academic Search

Exacerbations occur commonly in patients with moderate or severe chronic obstructive pulmonary disease (COPD) but factors affecting their severity and frequency or effects on quality of life are un- known. We measured daily peak expiratory flow rate (PEFR) and daily respiratory symptoms for 1 yr in 70 COPD patients (52 male, 18 female, mean age ( 6 SD) 67.5 6




Efficacy of nutritional aupplementation therapy in depleted patients with chronic obstructive pulmonary disease  

Microsoft Academic Search

ObjectiveWeight loss and muscle wasting adversely affect morbidity and mortality in patients with chronic obstructive pulmonary disease (COPD). Maintenance systemic glucocorticosteroids, prescribed in a substantial number of patients, further contribute to muscle weakness. We investigated the efficacy of oral nutritional supplementation therapy in depleted patients with COPD.

Eva C Creutzberg; Emiel F. M Wouters; Rob Mostert; Clarie A. P. M Weling-Scheepers; Annemie M. W. J Schols



The Potential Anti-Inflammatory Effect of Exercise in Chronic Obstructive Pulmonary Disease  

Microsoft Academic Search

People with chronic obstructive pulmonary disease (COPD) suffer from muscle dysfunction which seems to be partly caused by systemic inflammation. Muscle protein breakdown as well as synthesis might be affected by this systemic inflammation. Additionally, it seems to induce excessive oxidative stress and reduce the level of growth-stimulating factors. As exercise training can have an anti-inflammatory effect in healthy people,

Jantine van der Vlist; Thomas W. J. Janssen



Orofacial findings in chronic granulomatous disease: report of twelve patients and review of the literature  

Microsoft Academic Search

BACKGROUND: Chronic granulomatous disease is an extremely rare primary immunodeficiency syndrome that can be associated with various oral complications. This can affect high number of patients. However, data on oral complications is sparse. Here we will review the literature and describe the orofacial findings in 12 patients. FINDINGS: The age range was 5-31 years. Oral findings were variable, and reflected

Najla S Dar-Odeh; Wail A Hayajneh; Osama A Abu-Hammad; Huda M Hammad; Adel M Al-Wahadneh; Najwa K Bulos; Azmi M Mahafzah; Maha S Shomaf; Mohammed A El-Maaytah; Faris G Bakri



Beryllium copper alloy (2%) causes chronic beryllium disease.  


We describe two newly confirmed cases of chronic beryllium disease who presented to our clinic from a facility that only used 2% beryllium copper alloy. These cases illustrate that the 2% beryllium copper alloy continues to cause chronic beryllium disease and that appropriate preventive measures must be taken to control exposures and educate industries and their workers about the hazards of beryllium alloys. PMID:10224597

Balkissoon, R C; Newman, L S



Urinary phospholipase A2 excretion in chronic pancreatic diseases  

Microsoft Academic Search

Summary  This study was performed to investigate the behavior of phospholipase A2 (PLA2) in serum and urine of patients with chronic\\u000a pancreatic diseases and to ascertain whether any factors influenced the results. In 30 controls, 45 patients with pancreatic\\u000a cancer, 54 with chronic pancreatitis, and 64 with extrapancreatic diseases, serum and urinary PLA2, pancreatic isoamylase\\u000a and RNase, and urinary N-acetylglucosaminidase (NAG)

C. Fabris; D. Basso; M. P. Panozzo; G. Del Favero; T. Meggiato; M. Plebani; C. Ferrara; P. Fogar; M. Zaninotto; R. Naccarato



Physical activity, genes, and lifetime predisposition to chronic disease  

Microsoft Academic Search

This mini-review summarizes the main associations between physical activity and chronic diseases and discusses the basic concepts\\u000a related to the role of genetic factors in studies evaluating the effects of physical activity\\/exercise therapy on chronic\\u000a disease prevention\\/treatment during the life course. Many observational cohort studies have shown that high physical activity\\u000a during young adulthood or middle age is associated with

Urho M. Kujala



Increased Serum Angiotensin-Converting Enzyme in Chronic Renal Disease  

Microsoft Academic Search

Serum angiotensin-converting enzyme (SACE) was significantly elevated in 16 of 48 patients with various types of chronic renal disease not on hemodialysis [45.6 ± (SD)16.7 nmol\\/min\\/ml, p < 0.001] and in 17 of 52 patients with chronic renal disease on maintenance hemodialysis (43.2 ± 13.8, p < 0.001) in comparison with 58 healthy adult controls (32.2 ± 9.8). There was

Emanuel Silverstein; John Brunswick; Sreepada Rao; Joan Friedland



Metagenomic Applications and the Potential for Understanding Chronic Liver Disease  

Microsoft Academic Search

\\u000a Liver fibrosis is characterized by an excessive deposition of extracellular matrix proteins that occurs in chronic liver disease\\u000a of any origin. Cirrhosis occurs with the development of regenerating nodules of hepatocytes. Patients with decompensated liver\\u000a cirrhosis have a poor prognosis, and liver transplantation is often necessary. There are no effective antifibrotic treatments\\u000a for patients with chronic liver diseases. Intestinal dysbiosis

Bernd Schnabl


Exercise in chronic pulmonary disease: aerobic exercise prescription  

Microsoft Academic Search

ABSTRACT COOPER, C. B. Exercise in chronic pulmonary disease: aerobic exercise prescription. Med. Sci. Sports Exerc.,Vol. 33, No. 7, Suppl., pp. S671?S679, 2001. Endurance exercise training (EXT) is singly the most important aspect of rehabilitation for patients with chronic pulmonary disease. When effective, this modality of physical reconditioning leads to improved functional exercise capacity and reduced breathlessness. Early implementation is




Anemia and pregnancy: a link to maternal chronic diseases.  


Anemia is a global public health problem. It has serious short- and long-term consequences during pregnancy and beyond. The anemic condition is often worsened by the presence of other chronic diseases such as malaria, tuberculosis, HIV, and diabetes. Untreated anemia also leads to increased morbidity and mortality from these chronic conditions as well. It is surprising that despite these chronic conditions (such as malaria, tuberculosis, and HIV) often being preventable, they still pose a real threat to public health. This article aims to review the current understanding of the pathophysiology, risks, prevention, and treatment of anemia in the light of these chronic conditions. PMID:22099433

Gangopadhyay, Raja; Karoshi, Mahantesh; Keith, Louis




Microsoft Academic Search

Chronic wasting disease (CWD) is a fatal disease of North American cervids that was first detected in a wild, hunter-shot deer in Saskatchewan along the border with Alberta in Canada in 2000. Spatially explicit models for assessing factors affecting disease detection are needed to guide surveillance and control programs. Spatio-temporal patterns in CWD prevalence can be complicated by variation in

Erin E. Rees; Evelyn H. Merrill; Trent K. Bollingertrent K. Bollinger; Yeen Ten Hwang; Margo J. Pybus; Dave W. Coltman


Fish consumption and risk of major chronic disease in men  

PubMed Central

Background Although fish consumption may reduce specific disease endpoints, such as sudden cardiac death and prostate cancer, the effects on total burden of major chronic disease, reflecting sums of effects on a variety of endpoints and risk pathways, are not well established. Higher n-6 fatty acid consumption has also been hypothesized to reduce the health benefits of n-3 fatty acids in fish. Objective The aim was to study associations of fish and n-3 fatty acid consumption with risk of total major chronic disease (cardiovascular disease, cancer, and death), and to determine whether a high n-6 intake modifies the associations. Design Lifestyle and other risk factors were assessed every 2 y and diet every 4 y in 40,230 U.S. male health professionals aged 40–75 years and free of major chronic disease at baseline in 1986. During 18 y follow-up, 9715 major chronic disease events occurred, including 3639 cardiovascular disease events, 4690 cancers, and 1386 deaths from other causes. Results After multivariable adjustment, neither fish nor dietary n-3 fatty acid consumption was significantly associated with risk of total major chronic disease. Compared with fish consumption of <1 serving/mo, consumption of 1 serving/wk and 2–4 servings/wk was associated with a lower risk of total cardiovascular disease of ~15%. No significant associations were seen with cancer risk. Higher or lower n-6 fatty acid intake did not significantly modify the results (P for interaction >0.10). Conclusions Modest fish consumption was associated with a lower risk of total cardiovascular disease, consistent with cardiac mortality benefits, but not with total cancer or overall major chronic disease; n-6 fatty acid consumption did not influence these relations.

Virtanen, Jyrki K.; Mozaffarian, Dariush; Chiuve, Stephanie E.; Rimm, Eric B.



Peripheral arterial disease affects kinematics during walking  

Microsoft Academic Search

Objective: Claudication is the most common manifestation of peripheral arterial disease (PAD) producing significant ambulatory compromise. The purpose of this study was to use advanced biomechanical analysis to characterize the kinematic ambulatory pattern of claudicating patients. We hypothesized that compared with control subjects, claudicat- ing patients have altered kinematic gait patterns that can be fully characterized utilizing advanced biomechanical analysis.

Rolando Celis; Iraklis I. Pipinos; Melissa M. Scott-Pandorf; Sara A. Myers; Jason M. Johanning



Effect of pregnancy on pre-existing liver disease: chronic viral hepatitis.  


Women with viral chronic hepatitis generally do quite well during pregnancy, providing that they have not progressed to decompensated cirrhosis. As a general rule, a stable liver equals a safe pregnancy. However, concern is about how pre-existing chronic liver disease may affect the pregnancy and the unborn baby. This review plans to answer some key questions regarding this issue in order to provide to healthcare professionals updated information of the current knowledge in this field. Besides, a synopsis of the following subject matters are reviewed, for instance, the main risk factors associated with vertical transmission of HBV and HCV in pregnant women chronically infected, the influence of pregnancy on HBV and HCV viral load and the effect of pregnancy on the clinical course of chronic hepatitis. Lastly, it is included a list of recommendations to decrease vertical transmission rates of chronic viral hepatitis as well as some information for the reproduction team. PMID:17060881

Sookoian, Silvia


Susceptibility of Domestic Cats to Chronic Wasting Disease  

PubMed Central

Domestic and nondomestic cats have been shown to be susceptible to feline spongiform encephalopathy (FSE), almost certainly caused by consumption of bovine spongiform encephalopathy (BSE)-contaminated meat. Because domestic and free-ranging nondomestic felids scavenge cervid carcasses, including those in areas affected by chronic wasting disease (CWD), we evaluated the susceptibility of the domestic cat (Felis catus) to CWD infection experimentally. Cohorts of 5 cats each were inoculated intracerebrally (i.c.) or orally (p.o.) with CWD-infected deer brain. At 40 and 42 months postinoculation, two i.c.-inoculated cats developed signs consistent with prion disease, including a stilted gait, weight loss, anorexia, polydipsia, patterned motor behaviors, head and tail tremors, and ataxia, and the cats progressed to terminal disease within 5 months. Brains from these two cats were pooled and inoculated into cohorts of cats by the i.c., p.o., and intraperitoneal and subcutaneous (i.p./s.c.) routes. Upon subpassage, feline CWD was transmitted to all i.c.-inoculated cats with a decreased incubation period of 23 to 27 months. Feline-adapted CWD (FelCWD) was demonstrated in the brains of all of the affected cats by Western blotting and immunohistochemical analysis. Magnetic resonance imaging revealed abnormalities in clinically ill cats, which included multifocal T2 fluid attenuated inversion recovery (FLAIR) signal hyperintensities, ventricular size increases, prominent sulci, and white matter tract cavitation. Currently, 3 of 4 i.p./s.c.- and 2 of 4 p.o. secondary passage-inoculated cats have developed abnormal behavior patterns consistent with the early stage of feline CWD. These results demonstrate that CWD can be transmitted and adapted to the domestic cat, thus raising the issue of potential cervid-to-feline transmission in nature.

Nalls, Amy V.; Seelig, Davis M.; Kraft, Susan L.; Carnes, Kevin; Anderson, Kelly R.; Hayes-Klug, Jeanette; Hoover, Edward A.



Factors affecting recurrence after surgery for Crohn's disease  

Microsoft Academic Search

Abstract Abstract Abstract Abstract Although in Crohn's disease post-operative recurrence is common, the determinants of disease recurrence remain speculative. The aim of this study was to examine factors affecting post-operative recurrence of Crohn's disease. A Medline-based literature review was carried out. The following factors were investigated: age at onset of disease, sex, family history of Crohn's disease, smoking, duration of

Takayuki Yamamoto


Cardiovascular risk factors in patients with chronic kidney disease  

Microsoft Academic Search

Patients with chronic kidney disease have a higher burden of cardiovascular disease, which increases in a dose-dependent fashion with worsening kidney function. Traditional cardiovascular risk factors, including advanced age, diabetes mellitus, hypertension and dyslipidemia, have an important role in the progression of cardiovascular disease in patients who have a reduced glomerular filtration rate, especially in those with mild-to-moderate kidney disease.

Sarina van der Zee; Usman Baber; Sammy Elmariah; Jonathan Winston; Valentin Fuster



Magnesium in Chronic Kidney Disease: Challenges and Opportunities  

Microsoft Academic Search

Cardiovascular disease is the leading cause of mortality and morbidity in patients with chronic kidney disease, which is partly explained by the fact that 40–70% of patients receiving dialysis have significant coronary artery disease. Recent clinical studies have shown that lower serum magnesium (Mg) levels are associated with vascular calcification and cardiovascular mortality among patients with end-stage renal disease (ESRD).

Mehmet Kanbay; David Goldsmith; Mehtap Erkmen Uyar; Faruk Turgut; Adrian Covic



A life course approach to chronic disease epidemiology.  


A life course approach to chronic disease epidemiology uses a multidisciplinary framework to understand the importance of time and timing in associations between exposures and outcomes at the individual and population levels. Such an approach to chronic diseases is enriched by specification of the particular way that time and timing in relation to physical growth, reproduction, infection, social mobility, and behavioral transitions, etc., influence various adult chronic diseases in different ways, and more ambitiously, by how these temporal processes are interconnected and manifested in population-level disease trends. In this review, we discuss some historical background to life course epidemiology and theoretical models of life course processes, and we review some of the empirical evidence linking life course processes to coronary heart disease, hemorrhagic stroke, type II diabetes, breast cancer, and chronic obstructive pulmonary disease. We also underscore that a life course approach offers a way to conceptualize how underlying socio-environmental determinants of health, experienced at different life course stages, can differentially influence the development of chronic diseases, as mediated through proximal specific biological processes. PMID:15760279

Lynch, John; Smith, George Davey



Infectious causes of chronic inflammatory diseases and cancer.  

PubMed Central

Powerful diagnostic technology, plus the realization that organisms of otherwise unimpressive virulence can produce slowly progressive chronic disease with a wide spectrum of clinical manifestations and disease outcomes, has resulted in the discovery of new infectious agents and new concepts of infectious diseases. The demonstration that final outcome of infection is as much determined by the genetic background of the patient as by the genetic makeup of the infecting agent is indicating that a number of chronic diseases of unknown etiology are caused by one or more infectious agents. One well-known example is the discovery that stomach ulcers are due to Helicobacter pylori. Mycoplasmas may cause chronic lung disease in newborns and chronic asthma in adults, and Chlamydia pneumoniae, a recently identified common cause of acute respiratory infection, has been associated with atherosclerosis. A number of infectious agents that cause or contribute to neoplastic diseases in humans have been documented in the past 6 years. The association and causal role of infectious agents in chronic inflammatory diseases and cancer have major implications for public health, treatment, and prevention.

Cassell, G. H.



Chronic renal disease progression: treatment strategies and potassium intake.  


Disordered potassium homeostasis is a common complication of chronic kidney disease and traditional management focuses on restricting potassium intake to avoid hyperkalemia. Permissive potassium intake carries the risk of hyperkalemia and hyperphosphatemia, and possibly may contribute to the development of uremic neuropathy. Excessive potassium restriction and removal by dialysis carries the risk of worsened chronic hypertension, intradialytic hypotension, renal fibrosis and cyst formation, and ventricular arrhythmias. Cohort studies have associated both hypokalemia and hyperkalemia with increased mortality in CKD. A single study of potassium intake in hemodialysis patients found increased intake associated with increased mortality despite adjustment for serum potassium concentration. We recommend avoiding mandatory potassium restriction in early chronic kidney disease. We endorse routine potassium restriction in advanced chronic kidney disease requiring hemodialysis and close monitoring of serum potassium concentration in any patients receiving renin-angiotensin-aldosterone system blockers. PMID:23953806

Sinha, Arjun D; Agarwal, Rajiv



Chronic pediatric pulmonary disease and primary humoral antibody based immune disease.  


Chronic inflammation of the larger airways is a common occurrence in children. A number of factors such as younger age, premature birth, male gender, exposure to environmental smoke or pollution, and crowded housing can increase a child's susceptibility to chronic lung disease. Chronic bronchitis may be caused by an underlying humoral immunodeficiency if the clinical course is recurrent or prolonged. Primary humoral immunodeficiency accounts for approximately 70% of all immunodeficiencies. The differential of chronic bronchitis also includes Cystic Fibrosis, ciliary defects and immune cellular and phagocytic defects. This review will summarize the most common humoral antibody based immune based deficiencies associated with chronic pulmonary disease. PMID:21144721

Dosanjh, A



Care for chronic illness in Australian general practice – focus groups of chronic disease self-help groups over 10 years: implications for chronic care systems reforms  

Microsoft Academic Search

BACKGROUND: Chronic disease is a major global challenge. However, chronic illness and its care, when intruding into everyday life, has received less attention in Asia Pacific countries, including Australia, who are in the process of transitioning to chronic disease orientated health systems. AIM: The study aims to examine experiences of chronic illness before and after the introduction of Australian Medicare

Carmel M Martin; Chris Peterson; Rowena Robinson; Joachim P Sturmberg



Evaluation of the chronic disease self-management program (CDSMP) among chronically ill older people in the Netherlands  

Microsoft Academic Search

Many chronically ill older patients in the Netherlands have a combination of more than one chronic disease. There is therefore a need for self-management programs that address general management problems, rather than the problems related to a specific disease. The Chronic Disease Self-Management Program (CDSMP) seems to be very suitable for this purpose. In evaluations of the program that have

Henrike Elzen; Joris P. J. Slaets; Tom A. B. Snijders; Nardi Steverink



Bipolar Affective Disorder and Parkinson's Disease  

PubMed Central

Little is known about comorbidities of bipolar disorder such as Parkinson's disease. A case history and a literature survey indicate that bipolar disorder is linked with or influences Parkinson's disease and vice versa. Underlying mechanisms are poorly understood, and, more importantly, no treatment options are established in such double diagnoses. The few data in comorbid Parkinson cases seem to point to a rapid cycling pattern of bipolar symptoms. With regard to therapeutic intervention, the literature supports pramipexole for treatment of both Parkinson and depressive symptoms in bipolar depression. Lithium, the mood stabilizer of choice for treating manic states, is problematical for use in Parkinson patients because of its side effects. Valproate might be an alternative, especially for treatment of rapid cycling.

Engmann, Birk



Action plans with limited patient education only for exacerbations of chronic obstructive pulmonary disease  

Microsoft Academic Search

Background: Chronic obstructive pulmonary disease (COPD) is a progressive disease characterised by exacerbations, usually infective in origin, which affect symptoms and quality of life. Action plans may help individuals recognise a deterioration in their symptoms and initiate changes to treatment early, thereby reducing the impact of the exacerbation.\\u000aObjectives: To assess the efficacy of action plans in the management of

Julia A E Walters; Allison C Turnock; E Hayden Walters; Richard Wood-Baker



Affect School for chronic benign pain patients showed improved alexithymia assessments with TAS20  

Microsoft Academic Search

BACKGROUND: Alexithymia is a disturbance associated with psychosomatic disorders, pain syndromes, and a variety of psychiatric disorders. The Affect School (AS) based on Tomkins Affect Theory is a therapy focusing on innate affects and their physiological expressions, feelings, emotions and scripts. In this pilot study we tried the AS-intervention method in patients with chronic benign pain. METHODS: The AS-intervention, with

Eva O Melin; Hans O Thulesius; Bengt A Persson



Hydrocarbon exposure and chronic renal disease  

Microsoft Academic Search

The study objective was to investigate further the potential role of long-term exposure to hydrocarbons (HCs) in the development of idiopathic chronic glomerulopathy (ICG) using a more refined measurement of HC exposure. A total of 321 pairs of cases and controls, matched by age, gender, and geographical area, were assembled. A detailed questionnaire was blindly administered to cases and controls

Nabih R. Asal; Harold L. Cleveland; Christian Kaufman; Wato Nsa; Deborah I. Nelson; Robert Y. Nelson; Elisa T. Lee; Beverly Kingsley



Evaluating bone quality in patients with chronic kidney disease.  


Bone of normal quality and quantity can successfully endure physiologically imposed mechanical loads. Chronic kidney disease-mineral and bone disorder (CKD-MBD) adversely affects bone quality through alterations in bone turnover and mineralization, whereas bone quantity is affected through changes in bone volume. Changes in bone quality can be associated with altered bone material, structure, or microdamage, which can result in an elevated rate of fracture in patients with CKD-MBD. Fractures cannot always be explained by reduced bone quantity and, therefore, bone quality should be assessed with a variety of techniques from the macro-organ level to the nanoscale level. In this Review, we demonstrate the importance of evaluating bone from multiple perspectives and hierarchical levels to understand CKD-MBD-related abnormalities in bone quality. Understanding the relationships between variations in material, structure, microdamage, and mechanical properties of bone in patients with CKD-MBD should aid in the development of new modalities to prevent, or treat, these abnormalities. PMID:24100399

Malluche, Hartmut H; Porter, Daniel S; Pienkowski, David



New loci associated with kidney function and chronic kidney disease.  


Chronic kidney disease (CKD) is a significant public health problem, and recent genetic studies have identified common CKD susceptibility variants. The CKDGen consortium performed a meta-analysis of genome-wide association data in 67,093 individuals of European ancestry from 20 predominantly population-based studies in order to identify new susceptibility loci for reduced renal function as estimated by serum creatinine (eGFRcrea), serum cystatin c (eGFRcys) and CKD (eGFRcrea < 60 ml/min/1.73 m(2); n = 5,807 individuals with CKD (cases)). Follow-up of the 23 new genome-wide-significant loci (P < 5 x 10(-8)) in 22,982 replication samples identified 13 new loci affecting renal function and CKD (in or near LASS2, GCKR, ALMS1, TFDP2, DAB2, SLC34A1, VEGFA, PRKAG2, PIP5K1B, ATXN2, DACH1, UBE2Q2 and SLC7A9) and 7 loci suspected to affect creatinine production and secretion (CPS1, SLC22A2, TMEM60, WDR37, SLC6A13, WDR72 and BCAS3). These results further our understanding of the biologic mechanisms of kidney function by identifying loci that potentially influence nephrogenesis, podocyte function, angiogenesis, solute transport and metabolic functions of the kidney. PMID:20383146

Köttgen, Anna; Pattaro, Cristian; Böger, Carsten A; Fuchsberger, Christian; Olden, Matthias; Glazer, Nicole L; Parsa, Afshin; Gao, Xiaoyi; Yang, Qiong; Smith, Albert V; O'Connell, Jeffrey R; Li, Man; Schmidt, Helena; Tanaka, Toshiko; Isaacs, Aaron; Ketkar, Shamika; Hwang, Shih-Jen; Johnson, Andrew D; Dehghan, Abbas; Teumer, Alexander; Paré, Guillaume; Atkinson, Elizabeth J; Zeller, Tanja; Lohman, Kurt; Cornelis, Marilyn C; Probst-Hensch, Nicole M; Kronenberg, Florian; Tönjes, Anke; Hayward, Caroline; Aspelund, Thor; Eiriksdottir, Gudny; Launer, Lenore J; Harris, Tamara B; Rampersaud, Evadnie; Mitchell, Braxton D; Arking, Dan E; Boerwinkle, Eric; Struchalin, Maksim; Cavalieri, Margherita; Singleton, Andrew; Giallauria, Francesco; Metter, Jeffrey; de Boer, Ian H; Haritunians, Talin; Lumley, Thomas; Siscovick, David; Psaty, Bruce M; Zillikens, M Carola; Oostra, Ben A; Feitosa, Mary; Province, Michael; de Andrade, Mariza; Turner, Stephen T; Schillert, Arne; Ziegler, Andreas; Wild, Philipp S; Schnabel, Renate B; Wilde, Sandra; Munzel, Thomas F; Leak, Tennille S; Illig, Thomas; Klopp, Norman; Meisinger, Christa; Wichmann, H-Erich; Koenig, Wolfgang; Zgaga, Lina; Zemunik, Tatijana; Kolcic, Ivana; Minelli, Cosetta; Hu, Frank B; Johansson, Asa; Igl, Wilmar; Zaboli, Ghazal; Wild, Sarah H; Wright, Alan F; Campbell, Harry; Ellinghaus, David; Schreiber, Stefan; Aulchenko, Yurii S; Felix, Janine F; Rivadeneira, Fernando; Uitterlinden, Andre G; Hofman, Albert; Imboden, Medea; Nitsch, Dorothea; Brandstätter, Anita; Kollerits, Barbara; Kedenko, Lyudmyla; Mägi, Reedik; Stumvoll, Michael; Kovacs, Peter; Boban, Mladen; Campbell, Susan; Endlich, Karlhans; Völzke, Henry; Kroemer, Heyo K; Nauck, Matthias; Völker, Uwe; Polasek, Ozren; Vitart, Veronique; Badola, Sunita; Parker, Alexander N; Ridker, Paul M; Kardia, Sharon L R; Blankenberg, Stefan; Liu, Yongmei; Curhan, Gary C; Franke, Andre; Rochat, Thierry; Paulweber, Bernhard; Prokopenko, Inga; Wang, Wei; Gudnason, Vilmundur; Shuldiner, Alan R; Coresh, Josef; Schmidt, Reinhold; Ferrucci, Luigi; Shlipak, Michael G; van Duijn, Cornelia M; Borecki, Ingrid; Krämer, Bernhard K; Rudan, Igor; Gyllensten, Ulf; Wilson, James F; Witteman, Jacqueline C; Pramstaller, Peter P; Rettig, Rainer; Hastie, Nick; Chasman, Daniel I; Kao, W H; Heid, Iris M; Fox, Caroline S



Older Adults, Chronic Disease and Leisure-time Physical Activity  

PubMed Central

Background Participating in regular physical activity is an important part of healthy aging. There is an increased risk for inactivity associated with aging and the risk becomes greater for adults who have a chronic disease. However, there is limited information on current physical activity levels for older adults and even less for those with chronic diseases. Objective Our primary objective was to determine the proportion of older adults who achieved a recommended amount of weekly physical activity (?1000 kcal/week). The secondary objectives were to identify variables associated with meeting guideline leisure-time physical activity (LTPA), and to describe the type of physical activities that respondents reported across different chronic diseases. Methods In this study we used the Canadian Community Health Survey Cycle 1.1 (2000/2001) to report LTPA for adults aged 65 years and older. This was a population-based self-report telephone survey. We used univariate logistic regression to provide odds ratios to determine differences in activity and the likelihood of meeting guideline recommendations. Results For adults over 65 years of age with no chronic diseases, 30% reported meeting guideline LTPA, while only 23% met the recommendations if they had one or more chronic diseases. Factors associated with achieving the guideline amount of physical activity included a higher level of education, higher income and moderate alcohol consumption. Likelihood for not achieving the recommended level of LTPA included low BMI, pain and the presence of mobility and dexterity problems. Walking, gardening and home exercises were the three most frequent types of reported physical activities. Conclusion This study provides the most recent evidence to suggest that older Canadians are not active enough and this is accentuated if a chronic disease is present. It is important to develop community-based programs to facilitate LTPA, in particular for older people with a chronic disease.

Ashe, Maureen C.; Miller, William C.; Eng, Janice J.; Noreau, Luc



Inflammatory factors and exercise in chronic kidney disease.  


Patients with chronic kidney disease frequently present with chronic elevations in markers of inflammation, a condition that appears to be exacerbated by disease progression and onset of haemodialysis. Systemic inflammation is interlinked with malnutrition and muscle protein wasting and is implicated in a number of morbidities including cardiovascular disease: the most common cause of mortality in this population. Research in the general population and other chronic disease cohorts suggests that an increase in habitual activity levels over a prolonged period may help redress basal increases in systemic inflammation. Furthermore, those populations with the highest baseline levels of systemic inflammation appear to have the greatest improvements from training. On the whole, the activity levels of the chronic kidney disease population reflect a sedentary lifestyle, indicating the potential for increasing physical activity and observing health benefits. This review explores the current literature investigating exercise and inflammatory factors in the chronic kidney disease population and then attempts to explain the contradictory findings and suggests where future research is required. PMID:23737775

Dungey, Maurice; Hull, Katherine L; Smith, Alice C; Burton, James O; Bishop, Nicolette C



Anti-inflammatory treatments for chronic diseases: a review.  


Inflammation is viewed as one of the major causes for the development of different diseases like cancer, cardiovascular disease, diabetes, obesity, osteoporosis, rheumatoid arthritis, inflammatory bowel disease, asthma, and CNS related diseases such as depression and parkinson's disease; and this fervent phenomenon provides space for understanding different inflammatory markers. Increasing evidences have elucidated the outcome of inflammatory pathways dysregulation resulting in many symptoms of chronic diseases. The detection of transcription factors such as nuclear factor kappa-B (NF-?B), STAT and their gene products such as COX-2, cytokines, chemokines and chemokine receptors has laid molecular foundation for the important role of inflammation in chronic diseases in which the NF-?B is reported as a major mediator which makes a possible way for the development of new therapeutic approaches using synthetic and natural compounds that might eventually decrease the prevalence of these diseases. Even if many inflammatory markers like TNF-?, IL-1, IL-6, IL-8 and C-reactive protein (CRP) are reported to be the major key factors with proved role in several inflammatory diseases, IL-1 and TNF-? are the important cytokines that can induce the expression of NF-?B which is the potential target in these inflammatory diseases. This review aims to explore and summarize that how some drugs and natural compounds show their modulatory activity in inflammatory pathways and chronic inflammatory markers in these inflammatory diseases. PMID:23876224

Laveti, Durgaprasad; Kumar, Manoj; Hemalatha, R; Sistla, Ramakrishna; Naidu, V G M; Talla, Venu; Verma, Vinod; Kaur, Navrinder; Nagpal, Ravinder



Chronic kidney disease (CKD) in the elderly -- a geriatrician's perspective.  


Chronic kidney disease (CKD) is becoming increasingly prevalent among many different populations all over the world, including the US and Europe. Its multitude of complications with devastating outcomes leads to a significantly higher risk for cardio-vascular and all-cause mortality in an individual. However, it is clear now that early detection of CKD might not only delay some of the complications but also prevent them. Therefore, various important public health organizations all over the world have turned their focus and attention to CKD and its risk factors, early detection and early intervention. Nevertheless, the general goals in preventing the increase in CKD and its complications are far from being completely achieved. Why is this so? What is the magnitude and complexity of the problem? How is it affecting the population - are there differences in its affection by age, gender or frail elderly versus the robust? Are we modifying the risk factors appropriately and aggressively? Are there subtle differences in managing the risk factors in those on dialysis versus the non-dialysis CKD patients? Is it important to treat anaemia of CKD aggressively, will it make a difference in the disease progression, its complications or to quality of life? What do these unfortunate individuals commonly succumb to? What do we advise patients who refuse dialysis or those who desire dialysis or transplant? Are there useful non-dialytic treatment recommendations for those who refuse dialysis? What is the role of the physicians caring for the elderly with CKD? When should the primary care givers refer a CKD patient to a nephrologist? The key to eventually controlling incident and prevalent CKD and improve quality of life of affected individuals, lies in not only knowing these and many other vital aspects, but also in applying such knowledge compulsively in day-to-day practice by each and every one us. As CKD is increasingly a disease of the elderly with men being affected more, this review details fairly comprehensively the vital aspects of CKD, especially from a primary care geriatrician's practical standpoint. PMID:17701657

Munikrishnappa, Devaraj



Angiotensin1 Converting Enzyme Polymorphisms in Chronic Beryllium Disease  

Microsoft Academic Search

To test the hypothesis that the angiotensin converting enzyme (ACE) genotype is associated with chronic beryllium disease (CBD) and disease severity, we studied 50 cases of CBD and compared their ACE genotype to that of two different control groups, consisting of: ( 1 ) 50 participants from a beryl- lium machining facility; and ( 2 ) 50 participants from a




Vascular Calcification in Patients with Chronic Kidney Disease  

Microsoft Academic Search

Chronic kidney disease (CKD) represents an extremely common condition, and cardiovascular diseases are frequently reported in this patient population. Traditional risk factors are not accurate prognostic predictors in CKD patients, and new potential markers to predict the cardiovascular involvement in uremic patients need to be identified. Vascular calcification (VC) represents a hallmark of the atherosclerotic process in CKD. This review

Santo Dellegrottaglie; Javier Sanz; Sanjay Rajagopalan



Emerging risk factors and markers of chronic kidney disease progression  

Microsoft Academic Search

Chronic kidney disease (CKD) is a common condition with an increasing prevalence. A number of comorbidities are associated with CKD and prognosis is poor, with many patients experiencing disease progression. Recognizing the factors associated with CKD progression enables high-risk patients to be identified and given more intensive treatment if necessary. The identification of new predictive markers might improve our understanding

Florian Kronenberg



Chronic kidney disease in the United States: An underrecognized problem  

Microsoft Academic Search

The continued growth of the population with end-stage renal disease (ESRD) is partially related to the underrecognition of earlier stages of chronic kidney disease (CKD) and risk factors for the development of CKD. There are several published estimates of the prevalence of CKD in the United States. From Third National Health and Nutrition Examination Survey data it has been estimated

Gregorio T. Obrador; Brian J. G. Pereira; Annamaria T. Kausz



Nutrition and growth in children with chronic kidney disease  

Microsoft Academic Search

Poor growth in chronic kidney disease (CKD) is a marker of disease severity and of quality of care. Causes are multifactorial, and include malnutrition, cachexia, hematological factors, endocrine problems and metabolic abnormalities. In this Review, we focus on the impact of inadequate nutrition on growth disturbances in children with CKD, and discuss all aspects of the epidemiology, causes and potential

Robert H. Mak; Lesley Rees



Arterial Stiffness and Osteoporosis in Chronic Obstructive Pulmonary Disease  

Microsoft Academic Search

Rationale: Chronic obstructive pulmonary disease (COPD) is associ- ated with an increased risk of cardiovascular events and osteoporo- sis. Increasedarterialstiffnessis anindependentpredictorofcardio- vascular disease. Objectives: Wetested thehypothesisthat patientswithCOPD would have increased arterial stiffness, which would be associated with osteoporosis and systemic inflammation. Methods: We studied 75 clinically stable patients with a range of severity of airway obstruction and 42 healthy smoker

Ramsey Sabit; Charlotte E. Bolton; Peter H. Edwards; Rebecca J. Pettit; William D. Evans; Carmel M. McEniery; Ian B. Wilkinson; John R. Cockcroft; Dennis J. Shale



Nutritional and metabolic modulation in chronic obstructive pulmonary disease management  

Microsoft Academic Search

In this paper the perspective for nutritional modulation of systemic impairment in patients with chronic obstructive pulmonary disease (COPD) is discussed. Progressive weight loss is characterised by disease-specific elevated energy requirements unbalanced by dietary intake. Weight gain per se can be achieved by caloric supplementation while future studies may prove efficacy of amino acid modulation to stimulate protein synthesis and

A. M. W. J. Schols



Total burden of chronic diseases among older cancer patients  

Microsoft Academic Search

Introduction: Both chronic diseases and cancer are associated with ageing. As the population ages, also the number of older cancer patients with comorbidity will increase dramatically. In the future, general practitioners will be confronted with older patients with cancer and two, three or more concomitant diseases. Aim: We aim to assess the occurrence of comorbidity among older cancer patients as

L. D. Deckx; M. A. van der Akker; S. B. Bartholomeeusen; J. M. Metsemakers; A. K. Knottnerus; F. G. Schellevis; F. B. Buntinx



The unrecognized prevalence of chronic kidney disease in diabetes  

Microsoft Academic Search

Background. Diabetes mellitus and chronic kidney disease (CKD) are common and exhibit synergistic associations with premature mortality. Current diabetes guidelines in the UK recommend annual urinary albumin and serum creatinine determinations to screen for diabetic kidney disease. The aim of this study was to estimate the burden of CKD in patients with diabetes and examine the ability of serum creatinine

Rachel J. Middleton; Robert N. Foley; Janet Hegarty; Ching M. Cheung; Patrick McElduff; J. Martin Gibson; Philip A. Kalra; Donal J. O'Donoghue; John P. New



Sleep and Sleep Disorders in Chronic Obstructive Pulmonary Disease  

Microsoft Academic Search

Chronic obstructive pulmonary disease (COPD) is one of the leading causes of death in the US. Numerous studies have demonstrated that sleep disturbances are common in COPD patients, with more prominent complaints in patients with more severe disease and with increasing age. Sleep disturbances may occur due to the effects of breathing abnormalities on sleep and sleep disruption. However, other

Nancy Collop



Alterations in Serum Leptin in Chronic Liver Disease  

Microsoft Academic Search

The role of leptin in anorexia associated with liver cirrhosis remains controversial. The aim of this study was to quantify the serum leptin level in patients with hepatocellular or cholestatic liver disease and to assess its relationship with serum insulin, body mass index, and serum lipoproteins. The study population included 30 women, 15 with chronic hepatocellular liver disease and 15

Ziv Ben-Ari; Zahava Schafer; Jaqueline Sulkes; Varda Manhaim; Ran Tur-Kaspa; Menahem Fainaru



Atherosclerosis in chronic kidney disease: the role of macrophages  

Microsoft Academic Search

Patients with chronic kidney disease (CKD) are at increased risk of atherosclerotic cardiovascular disease and loss of renal parenchyma accelerates atherosclerosis in animal models. Macrophages are central to atherogenesis because they regulate cholesterol traffic and inflammation in the arterial wall. CKD influences macrophage behavior at multiple levels, rendering them proatherogenic. Even at normal creatinine levels, macrophages from uninephrectomized Apoe?\\/? mice

Valentina Kon; MacRae F. Linton; Sergio Fazio



Management of Pediatric Patients With Chronic Kidney Disease Deborah Miller  

Microsoft Academic Search

Chronic kidney disease in children is associated with complications that require nursing interventions in both the inpatient and outpatient settings. Given the progressive nature of the disease and the com- plexity of the treatment regimen, it is important that nurses be com- fortable implementing acute and preventive care strategies and facili- tating the coordination of care. In addition, the need

Dina MacDonald


Anticholinergics in the Treatment of Chronic Obstructive Pulmonary Disease  

Microsoft Academic Search

Chronic obstructive pulmonary disease (COPD) is one of the leading causes of morbidity and mortality in the world. In the majority of cases, the disease is the result of years of cigarette smoking. Contributing factors leading to bronchial obstruction in COPD include mucus hypersecretion and an increase in bronchial muscle tone, which is triggered mainly by cholinergic mechanisms. Anticholinergic bronchodilators

Kai-Michael Beeh; Tobias Welte; Roland Buhl



Histological diagnosis of chronic inflammatory bowel disease in childhood  

Microsoft Academic Search

One hundred and four children were initially assessed by clinical, radiological, and endoscopic criteria as chronic inflammatory bowel disease. All were assessed independently using precise histological diagnostic criteria. Fifty eight patients were diagnosed as Crohn's disease, 25 as ulcerative colitis, 15 remained provisionally categorised as indeterminate colitis and six proved to be normal. Diagnostic granulomas were found in 36% of

S K Chong; A J Blackshaw; S Boyle; C B Williams; J A Walker-Smith



Intergenerational transmission of non-communicable chronic diseases  

Microsoft Academic Search

We introduce a theoretical framework that contributes to the understanding of non-communicable chronic diseases' (NCDs) epidemics: even if NCDs are non-infectious diseases, they may spread due to the social transmission of unhealthy activities such as unhealthy diet, physical inactivity, and smoking. In particular, we study the intergener- ational dimension of this mechanism. We find that, due to the social transmission

Catarina Goulao; Agustin Pérez-Barahona



Racial and survival paradoxes in chronic kidney disease  

Microsoft Academic Search

Most of the 20 million people in the US with chronic kidney disease (CKD) die before commencing dialysis. One of every five dialysis patients dies each year in the US. Although cardiovascular disease is the most common cause of death among patients with CKD, conventional cardiovascular risk factors such as hypercholesterolemia, hypertension and obesity are paradoxically associated with better survival

Csaba P Kovesdy; Stephen F Derose; Tamara B Horwich; Gregg C Fonarow; Kamyar Kalantar-Zadeh



Direct Renin Inhibitor: Aliskiren in Chronic Kidney Disease  

PubMed Central

The renin-angiotensin-aldosterone system (RAAS) plays pivotal roles in the pathogenesis of chronic kidney disease (CKD) progression and its increased complications such as hypertension (HT) and cardiovascular diseases (CVD). Previous studies suggested that aliskiren a direct renin inhibitor, blocks RAAS and may be effective for the management of CKD and its complications. This review focuses on the effects of aliskiren on CKD.

Morishita, Yoshiyuki; Kusano, Eiji



Chronic Obstructive Pulmonary Disease Outcome Measurements: What's Important? What's Useful?  

Microsoft Academic Search

The severity of chronic obstructive pulmonary disease (COPD) and patients' response to therapy are difficult to assess. The traditional measure, spirometry, correlates poorly with important clinical fea- tures of the disease, such as survival and quality of life (QOL). Moreover, COPD has recently been recognized as a systemic dis- ease,anditssystemicmanifestations,suchasweightlossandmuscle weakness, are only poorly related to lung function. Therefore, al-

Nicholas J. Gross



Uremia-related cardiovascular risk factors in chronic kidney disease  

Microsoft Academic Search

Cardiovascular disease is the leading cause of mortality in the dialysis population and a major cause of morbidity and mortality in patients with chronic renal failure. The conventional Framingham cardiovascular (CV) risk factors (ie, hypertension, smoking, age, hyper- cholesterolemia, and a family history of CV disease) have typically been the focus of risk stratification and subse- quent primary and\\/or secondary

Caroline E. Stigant


Acute and Chronic Low Back Pain: Cognitive, Affective, and Behavioral Dimensions  

Microsoft Academic Search

Despite strong suppositions concerning differences between patients suffering acute and chronic low back pain, relatively few data-based comparisons have been made. In this study, affective, cognitive, behavioral, and demographic contrasts were conducted. Chronic patients were divided into those who demonstrated signs and symptoms that were either congruent or incongruent with underlying anatomical and physiological principles. Low socioeconomic status, compensation claims,

Heather D. Hadjistavropoulos; Kenneth D. Craig



Clinical application of ghrelin for chronic respiratory diseases.  


The discovery of ghrelin has resulted in the development of potential therapeutics for cachexia caused by multiple underlying diseases. When chronic respiratory diseases progress to their advanced stages, cachexia often occurs, thereby worsening the patient's prognosis. A small clinical trial that enrolled cachectic patients with chronic respiratory disease revealed that administration of ghrelin improved their nutritional status and exercise tolerance. Short-term administration of ghrelin was found to be safe and tolerated with adverse events, including suffusion, sleepiness, peristalsis, hunger, and sweating. Further large-scale and long-term clinical trials are needed. PMID:22975067

Matsumoto, Nobuhiro; Nakazato, Masamitsu



[Chronic disease management: mistaken approach in the elderly].  


Lifestyle changes, including unhealthy eating habits and high rates of physical inactivity and stress, along with an increase in life expectancy have been accompanied by increasing rates of chronic non-communicable diseases. Chronic diseases are the main causes of death and disability in Brazil. Chronic disease management is one of the most important challenges facing health managers who are constantly seeking interventions and strategies to reduce costs and hospital admissions and to prevent other conditions. However, most existing models of health care have focused exclusively on disease, but it is a mistaken approach. An integrated approach is required to effectively meet patient needs. The purpose of this article was to further discuss policies and strategies for the development of new models of care for the elderly with an emphasis on prevention and resolution actions. PMID:23503534

Veras, Renato Peixoto



Treatment of chronic graft-versus-host disease in 2011  

PubMed Central

Purpose of review This article summarizes recent reports on the risks, pathogenesis and treatment of chronic graft-versus-host disease (GVHD). Recent findings Chronic GVHD remains an elusive disorder to characterize and to treat. Recent evidence on tolerance induction by regulatory T cells and on B cells involvement shed some insights in the pathogenesis of chronic GVHD. In a recent large comparative study, the overall risk profiles for acute and for chronic GVHD were similar, but risks factors were not changed after adjustment for prior acute GVHD, supporting the concept that chronic GVHD is not an end stage of acute GVHD. Glucocorticoids remain the standard initial treatment of chronic GVHD, but the outcomes are not satisfactory, particularly for patients with high-risk features. Many treatments for chronic GVHD including extracorporeal photopheresis, rituximab, sirolimus, mycofenolate mofetil, imatinib, pentostatin and infusion of mesenchymal stem cells have been reported in several retrospective and relatively small phase I/II studies with a wide range of overall responses. Summary No current therapies used for chronic GVHD have been approved by the Food and Drug Administration. Large well-designed prospective studies are warranted to establish better treatments. Targeted therapies based on the pathogenesis of chronic GVHD may lead to better outcomes.

Inamoto, Yoshihiro; Flowers, Mary E.D.



Pathophysiology and management of abnormal growth in children with chronic inflammatory bowel disease.  


Many children with a variety of chronic diseases suffer from a variable component of chronic inflammation and often have co-existing growth retardation. The aetiology of this growth retardation may be multifactorial and in a condition such as inflammatory bowel disease it includes the effects of the disease on nutrition as well as the effect of drugs such as glucocorticoids. Growth is primarily regulated through the endocrine and paracrine component of the GH/IGF-1 axis which may be modulated by other factors such as sex steroids. There is increasing evidence that this axis may be affected in children with chronic inflammation. An improved understanding of the GH/IGF-1 axis and how it is affected in chronic inflammation will lead to an improved rationale for developing therapeutic regimens that can improve growth in those children whose growth does not improve despite optimal management of the disease. This review will illustrate these aspects by concentrating primarily on the pathophysiology of growth retardation in inflammatory bowel disease and possible interventions for improving growth. PMID:23428693

Ahmed, S F; Farquharson, C; McGrogan, P; Russell, R K



Chronic Recurrent Multifocal Osteomyelitis Associated with Chronic Inflammatory Bowel Disease in Children  

Microsoft Academic Search

Chronic recurrent multifocal osteomyelitis(CRMO) is a rare disease of children characterized byaseptic inflammation of the long bones and clavicles. Noinfectious etiology has been identified, and CRMO has been associated with a number of autoimmunediseases (including Wegener's granulomatosis andpsoriasis). The relationship between CRMO andinflammatory bowel disease is poorly described. Throughan internet bulletin board subscribed to by 500pediatric gastroenterologists, we identified sixinflammatory

Athos Bousvaros; Margaret Marcon; William Treem; Peter Waters; Robert Issenman; Richard Couper; Richard Burnell; Allan Rosenberg; Egla Rabinovich; Barbara S. Kirschner



[Chronic inflammation in patients with acute coronary syndrome and chronic kidney disease].  


Chronic kidney disease is a worldwide growing problem in public health. It is a risk factor for complications in patients with acute coronary syndrome (ACS). Diabetes, hypertension (hypertrophy and left ventricular failure), impaired fibrinolysis and coagulation processes, as well as the rapid development of atherosclerosis (partly associated with chronic inflammation) are responsible for higher prevalence of cardiovascular diseases in patients with chronic kidney disease. Inflammatory process of unknown aetiology belongs to the so-called non-traditional risk factors in development of cardiovascular system diseases. It is thought that this process is responsible for adverse remodelling of atherosclerosis plaque and its instability which causes plaque rupture and as a result a coronary syndrome occurrence. Important inflammatory mediators, which take part in pathogenesis of ACS, are acute phase proteins such as: C-reactive protein, adhesion molecules VCAM-1, ICAM-1, selectins, plasma amyloid A, metalloproteinases, interleukins-1 and -6, tumour necrosis factor-a and vascular endothelial growth factor. PMID:21523678

Owczarek, Aleksander; Babi?ska, Magdalena; Szygu?a-Jurkiewicz, Bo?ena; Chudek, Jerzy



Diarrhea in chronic inflammatory bowel diseases.  


Diarrhea is a common clinical feature of inflammatory bowel diseases and may be accompanied by abdominal pain, urgency, and fecal incontinence. The pathophysiology of diarrhea in these diseases is complex, but defective absorption of salt and water by the inflamed bowel is the most important mechanism involved. In addition to inflammation secondary to the disease, diarrhea may arise from a variety of other conditions. It is important to differentiate the pathophysiologic mechanisms involved in the diarrhea in the individual patient to provide the appropriate therapy. This article reviews microscopic colitis, ulcerative colitis, and Crohn's disease, focusing on diarrhea. PMID:22917170

Wenzl, Heimo H



Ultrasound in patients affected with Peyronie's disease.  


Peyronie's disease (PD, induratio penis plastica) is uncommon. Its etiology is unknown and the incidence is stated to be 1%, although more recent data suggest that it is higher. The symptoms are penile deviation and painful erection in association with penile plaques. The diagnosis is performed by palpation of the penis. X-ray diagnostics are only used to visualize the calcified plaques in soft tissue imaging, and the survey of plaque size and consistence is done by sonography with high reproduction. This enables the exact evaluation of treatment effects. By application of high frequency scanners (7-12 MHz) the extent and depth of the plaques can be estimated non-invasively in high resolution images. Furthermore, color coded duplex sonography and recording of Doppler spectra are used to assess hemo-perfusion in the penile vessels and the analysis of erectile dysfunction, often seen in combination with PD. Sonographic diagnosis appears as a valuable supplement and requirement for a successful therapy of PD. PMID:15672280

Fornara, P; Gerbershagen, H-P



Metabolic Syndrome, Components, and Cardiovascular Disease Prevalence in Chronic Kidney Disease: Findings from the Chronic Renal Insufficiency Cohort (CRIC) Study  

Microsoft Academic Search

Background\\/Aims: Metabolic syndrome may increase the risk for incident cardiovascular disease (CVD) and all-cause mortality in the general population. It is unclear whether, and to what degree, metabolic syndrome is associated with CVD in chronic kidney disease (CKD). We determined metabolic syndrome prevalence among individuals with a broad spectrum of kidney dysfunction, examining the role of the individual elements of

Raymond R. Townsend; Amanda H. Anderson; Jing Chen; Crystal A. Gadebegku; Harold I. Feldman; Jeffrey C. Fink; Alan S. Go; Marshall Joffe; Lisa A. Nessel; Akinlolu Ojo; Daniel J. Rader; Muredach P. Reilly; Valerie Teal; Karen Teff; Jackson T. Wright; Dawei Xie



Chronic colonization by Pseudomonas aeruginosa of patients with obstructive lung diseases: cystic fibrosis, bronchiectasis, and chronic obstructive pulmonary disease  

Microsoft Academic Search

Pseudomonas aeruginosa is isolated in sputum cultures from cystic fibrosis (CF) patients and adults with bronchiectasis (BS) and chronic obstructive pulmonary disease, but it is not well known if the characteristics of colonization in these latter patients are similar to those with CF. We examined 125 P. aeruginosa isolates obtained from 31 patients suffering from these diseases by pulsed field

Andrea D. Valderrey; María José Pozuelo; Pedro A. Jiménez; María D. Maciá; Antonio Oliver; Rafael Rotger



Chronic lyme disease: psychogenic fantasy or somatic infection?  

PubMed Central

Sigal and Hassett published an article about Lyme disease in the EHP Supplements (Sigal and Hassett 2002), suggesting that chronic Lyme disease is "psychogenic." I do not think that Sigal and Hassett, non-psychiatrists, are qualified to speak about psychiatric matters. I, however, actually have had the disease, which they characterize as "medically unexplained," for over 25 years and have 15 years of experience as a patient advocate and educator. I beg to differ.

Mervine, Phyllis



Quantitative sputum gram stains in chronic bronchial disease  

Microsoft Academic Search

The assessment of bacterial flora of the bronchial system can provide useful information for determining the presence of acute\\u000a bacterial infections in patients with chronic bronchial disease. The authors examined the value of quantitative sputum gram\\u000a stains performed in patients during acute bronchial exacerbations, recovery from such exacerbations, acute allergic exacerbations\\u000a of chronic extrinsic asthma, and a stable period. The

W. Baigelman; S. Chodosh; D. Pizzuto; T. Sadow



Extracorporeal photopheresis in chronic graft-versus-host disease  

Microsoft Academic Search

Despite significant advances in stem cell manipulation and post-transplant immunosuppression, chronic graft-versus-host disease (cGVHD) remains a cause of major long-term morbidity in survivors of allogeneic stem cell transplantation. Extracorporeal photopheresis (ECP) is a novel therapeutic intervention which has demonstrated efficacy in patients with refractory acute and chronic GVHD. Clinical responses have been reported in skin and visceral GVHD. While the

FM Foss; G Gorgun; KB Miller



The management of chronic diseases in rural Missouri practices.  


This qualitative study describes the challenges of managing chronic diseases in small, rural, health care practices in Missouri. Four recurrent themes were identified from each of the nine focus groups: the similarity of their patient population and community characteristics, their unfamiliarity with aspects of the chronic care model, the consistent problem of poverty as a barrier to health care access for patients, and the uncertainty about what health care reform will mean for rural practice settings. PMID:22860289

Enriquez, Maithe; Moormeier, Jill; Lafferty, William


Urinary Kallikrein Excretion in Chronic Pancreatic Diseases  

Microsoft Academic Search

Variations in urinary kallikrein in pancreatic diseases were ascertained, and possible influencing factors were investigated. Serum amylase and urinary excretion of glandular kallikrein, pancreatic ribonuclease (RNase),?-glutamyltransferase (GGT) and amylase were measured in 24 control subjects, 39 patients with pancreatic cancer, 49 with pancreatitis and 63 with extra-pancreatic diseases. Urinary kallikrein was found to be elevated in a substantial number of

Carlo Fabris; Maria Piera Panozzo; Daniela Basso; Giuseppe Del Favero; Mario Plebani; Martina Zaninotto; Paola Fogar; Tamara Meggiato; Paola Scalon; Chiara Ferrara; Remo Naccarato



Screening for Chronic Kidney Disease: Unresolved Issues  

Microsoft Academic Search

End-stage renal disease is epidemic in the United States. As a measure to control this epidemic, it has been recommended that individuals who are at risk for CKD be tested for undetected kidney disease during routine health care encounters. There are generally accepted criteria against which screening recommendations for CKD control and prevention programs should be judged. If detection strategies




What are the eating cognitions of children whose chronic diseases do and do not require attention to diet?  

Microsoft Academic Search

Nutrition therapy is essential to the management of several chronic diseases affecting adolescents. Unfortunately, dietary impositions may evoke pathological eating-related cognitions. This pilot study examined eating- and weight-related cognitions of 55 adolescents attending a summer camp for youngsters with a heterogeneous variety of chronic diseases.Campers completed the Eating Cognitions Questionnaire and the Situational Obstacles to Dietary Adherence questionnaire. Campers whose

David G Schlundt; Steven Rowe; James W Pichert; Dennis D Plant



Influence of dyslipidemia and diabetes mellitus on chronic periodontal disease.  


Background: Periodontal disease is closely related to certain systemic conditions, such as type 2 diabetes mellitus (DM2), and, as recently described, dyslipidemia, a condition with alterations in blood lipids levels. However, more than acting as disease modifiers, these conditions commonly occur as comorbidities, possibly synergically affecting periodontal tissues. The aim of the current study is to identify whether DM2 and dyslipidemia are related to the occurrence and severity of chronic periodontitis. Methods: A total of 254 individuals participated: 56 were patients with DM2, 67 had dyslipidemia, 74 had DM2 and dyslipidemia, and 57 were systemically healthy individuals. The clinical examination included a full-mouth evaluation of periodontal probing depth, plaque score, bleeding on probing, and clinical attachment level (CAL). Blood samples were taken to assess fasting plasma glucose, low-density lipoprotein, high-density lipoprotein, and triglyceride levels. These parameters, as well as other medical conditions (i.e., smoking habits and body mass index), were considered in multiple regression analyses for data analyses (? = 5%). Results: Dyslipidemia was not related to periodontal disease (P >0.05). At the same time, DM2, age, and smoking showed a statistical and positive association, an increase in percentage of sites with CAL ?3 and ?5 mm. Regarding the percentage of sites presenting severe destruction (CAL ?7 mm), only DM2 remained a significant risk factor (P <0.05). Conclusions: It could be concluded that dyslipidemia did not influence periodontal conditions in participants with normal health or those with DM2. However, age, smoking habits, and especially DM2 were significantly associated with loss of CAL. PMID:23136946

Almeida Abdo, Juliane; Cirano, Fabiano Ribeiro; Casati, Marcio Zaffalon; Ribeiro, Fernanda Vieira; Giampaoli, Viviana; Viana Casarin, Renato Corrêa; Pimentel, Suzana Peres



Osteoporosis and skeletal fractures in chronic liver disease.  

PubMed Central

In order to determine the prevalence and severity of hepatic osteodystrophy by non-invasive means we compared 115 consecutive ambulant patients with histologically proven chronic liver disease to 113 age and sex matched control subjects. Methods used included the assessment of fracture prevalence rates, spinal radiography, and measurements of bone mineral density in the spine and the forearm. Spinal and peripheral fractures were more prevalent in the patients than in the control subjects (p less than 0.03 and p less than 0.01 respectively). The type of the underlying liver disease did not significantly affect the fracture prevalence rates, but alcoholic patients sustained more peripheral fractures than patients with other hepatic disorders (p less than 0.05). The bone mineral densities of the spines and the forearms were significantly reduced in male patients of all age groups and in female patients aged 60 years or more (p less than 0.001 for men and p less than 0.01 for women for both measurements). The prevalence rates of spinal and forearm osteoporosis were twice as high among patients with liver disease than in control subjects regardless of the definitions used. The presence of cirrhosis and hypogonadism were major risk factors for development of both spinal (Beta coef = 0.190 and 0.176; SE = 0.079 and 0.086 respectively) and forearm osteoporosis (Beta coef = 0.20 and 0.29; SE = 0.073 and 0.80 respectively). Spinal bone density was the predominant determinant of spinal fractures (Beta coef = -0.007; SE = 0.001), while hypogonadism (Beta coef = 0.363; SE = 0.075) and cirrhosis (Beta coef = 0.185; SE = 0.068) were the major predictors of peripheral fractures. The concentrations of serum calcium and serum vitamin D metabolites and the use of corticosteroids were apparently without effect on the prevalence of skeletal fractures or bone density.

Diamond, T; Stiel, D; Lunzer, M; Wilkinson, M; Roche, J; Posen, S



Psychological impact of chronic hepatitis C: Comparison with other stressful life events and chronic diseases  

Microsoft Academic Search

AIM: To examine the psychological impact of chronic hepatitis C (CHC) diagnosis in a large cohort of CHC patients as compared with other stressful life events and chronic diseases carrying a risk of life-threatening complications. METHODS: One hundred and eighty-five outpatients with compensated CHC were asked to self-grade, using a 100-mm visual analogue scale (VAS), the degree of stress caused

Laurent Castera; Aymery Constant; Pierre-Henri Bernard; Victor de Ledinghen; Patrice Couzigou



In Search of a Germ Theory Equivalent for Chronic Disease  

PubMed Central

The fight against infectious disease advanced dramatically with the consolidation of the germ theory in the 19th century. This focus on a predominant cause of infections (ie, microbial pathogens) ultimately led to medical and public health advances (eg, immunization, pasteurization, antibiotics). However, the resulting declines in infections in the 20th century were matched by a rise in chronic, noncommunicable diseases, for which there is no single underlying etiology. The discovery of a form of low-grade systemic and chronic inflammation (“metaflammation”), linked to inducers (broadly termed “anthropogens”) associated with modern man-made environments and lifestyles, suggests an underlying basis for chronic disease that could provide a 21st-century equivalent of the germ theory.



Revisions to chronic disease surveillance indicators, United States, 2004.  


To allow public health officials to uniformly define, collect, and report chronic disease data, Indicators for Chronic Disease Surveillance was released by the Council of State and Territorial Epidemiologists in 1999. This publication provided standard definitions for 73 indicators developed by epidemiologists and chronic disease program directors at the state and federal levels. The indicators were selected because of their importance to public health and the availability of state-level data. This report describes the latest revisions to the chronic disease indicators published in 2004. The revised set of 92 indicators includes 24 for cancer; 15 for cardiovascular disease; 11 for diabetes; 7 for alcohol; 5 each for nutrition and tobacco; 3 each for oral health, physical activity, and renal disease; and 2 each for asthma, osteoporosis, and immunizations. The remaining 10 indicators cover such overarching conditions as poverty, education, and life expectancy. Although multiple states have used the indicators, wider adoption depends on increased epidemiology capacity at the state level and improved access to surveillance data. PMID:15963317

Pelletier, Andrew R; Siegel, Paul Z; Baptiste, Mark S; Maylahn, Christopher



Spectrum of anemia associated with chronic liver disease  

PubMed Central

Anemia of diverse etiology is a common complication of chronic liver diseases. The causes of anemia include acute or chronic gastrointestinal hemorrhage, and hypersplenism secondary to portal hypertension. Severe hepatocellular disease predisposes to hemorrhage because of impaired blood coagulation caused by deficiency of blood coagulation factors synthesized by hepatocytes, and/or thrombocytopenia. Aplastic anemia, which is characterized by pancytopenia and hypocellular bone marrow, may follow the development of hepatitis. Its presentation includes progressive anemia and hemorrhagic manifestations. Hematological complications of combination therapy for chronic viral hepatitis include clinically significant anemia, secondary to treatment with ribavirin and/or interferon. Ribavirin-induced hemolysis can be reversed by reducing the dose of the drug or discontinuing it altogether. Interferons may contribute to anemia by inducing bone marrow suppression. Alcohol ingestion is implicated in the pathogenesis of chronic liver disease and may contribute to associated anemia. In patients with chronic liver disease, anemia may be exacerbated by deficiency of folic acid and/or vitamin B12 that can occur secondary to inadequate dietary intake or malabsorption.

Gonzalez-Casas, Rosario; Jones, E Anthony; Moreno-Otero, Ricardo



Chronic Kidney Disease and Kidney Failure  


... suffered from disabling bone disease, dementia caused by aluminum intoxication, and severe fatigue from uncontrollable anemia. High ... life of dialysis patients. Dialysis dementia due to aluminum toxicity no longer occurs. Premature death due to ...


Chronic Venous Disease (Beyond the Basics)  


... Patient information: Doppler ultrasound (The Basics) Patient information: Pulmonary embolism (blood clot in the lungs) (The Basics) Patient ... disease in the legs (The Basics) Patient information: Pulmonary embolism (blood clot in the lungs) (The Basics) Patient ...


Older Adults Under a Mixed Regime of Infectious and Chronic Diseases  

PubMed Central

Objective Analyze the impact of a mixed regime of infectious and chronic conditions among older adults in Mexico on their health progression. Methods A total of 12,207 adults from the Mexican Health and Aging Study were included. Logistic regression analyses were conducted to assess the relationship between self-reported health (SRH) and covariates, including infectious and chronic diseases. Changes in SRH between 2001–2003 were analyzed using multinomial analysis. Results Older age, low SES, poor SRH and type of disease at baseline increase the odds of poor SRH at follow-up. Odds of poor SRH are highest for persons with both types of diseases (OR 2.63, SE 0.24), followed by only chronic (OR 1.86; SE 0.12) and finally only infectious (OR 1.55; SE 0.25). Discussion Mexico is experiencing a mixed regime of diseases that affects the health and wellbeing of older adults. Despite the rising importance of chronic diseases in countries like Mexico, it is premature to disregard the relevance of infectious diseases for public health.

Michaels-Obregon, Alejandra; Wong, Rebeca; Palloni, Alberto



69 FR 64057 - National Center for Chronic Disease Prevention and Health Promotion Conference Support Program  

Federal Register 2010, 2011, 2012, 2013

...Chronic Disease Prevention and Health Promotion Conference Support Program Announcement...Chronic Disease Prevention and Health Promotion Conference Support Program...conferences in the areas of health promotion and disease prevention...



Identity and psychological ownership in chronic illness and disease state  

PubMed Central

Psychological ownership is rarely considered in health discourse related to chronic illness or disease state. Construction of identity is an important consideration within this framework. This autoethnographic study explores psychological ownership and identity related to prostate cancer and chronic illness. Conclusions about the nature of psychological ownership and identity were gathered from the relevant literature and personal experience. Themes include the patient–healthcare professional relationship and that psychological ownership is personal and grounded in an individual's sense of identity, control and perceived capacity to control illness or disease. Personal reflection through autoethnography guides discussion of psychological ownership and identity.

Karnilowicz, W



Oxidative stress, anti-oxidant therapies and chronic kidney disease.  


Chronic kidney disease (CKD) is a common and serious problem that adversely affects human health, limits longevity and increases costs to health-care systems worldwide. Its increasing incidence cannot be fully explained by traditional risk factors. Oxidative stress is prevalent in CKD patients and is considered to be an important pathogenic mechanism. Oxidative stress develops from an imbalance between free radical production often increased through dysfunctional mitochondria formed with increasing age, type 2 diabetes mellitus, inflammation, and reduced anti-oxidant defences. Perturbations in cellular oxidant handling influence downstream cellular signalling and, in the kidney, promote renal cell apoptosis and senescence, decreased regenerative ability of cells, and fibrosis. These factors have a stochastic deleterious effect on kidney function. The majority of studies investigating anti-oxidant treatments in CKD patients show a reduction in oxidative stress and many show improved renal function. Despite heterogeneity in the oxidative stress levels in the CKD population, there has been little effort to measure patient oxidative stress levels before the use of any anti-oxidants therapies to optimize outcome. This review describes the development of oxidative stress, how it can be measured, the involvement of mitochondrial dysfunction and the molecular pathways that are altered, the role of oxidative stress in CKD pathogenesis and an update on the amelioration of CKD using anti-oxidant therapies. PMID:22288610

Small, David M; Coombes, Jeff S; Bennett, Nigel; Johnson, David W; Gobe, Glenda C



FGF-23 and secondary hyperparathyroidism in chronic kidney disease.  


The metabolic changes that occur in patients with chronic kidney disease (CKD) have a profound influence on mineral and bone metabolism. CKD results in altered levels of serum phosphate, vitamin D, calcium, parathyroid hormone (PTH) and fibroblast growth factor 23 (FGF-23); the increased levels of serum phosphate, PTH and FGF-23 contribute to the increased cardiovascular mortality in affected patients. FGF-23 is produced by osteocytes and osteoblasts and acts physiologically in the kidney to induce phosphaturia and inhibit the synthesis of 1,25-dihydroxyvitamin D3. PTH acts directly on osteocytes to increase FGF-23 expression. In addition, the high levels of PTH associated with CKD contribute to changes in bone remodelling that result in decreased levels of dentin matrix protein 1 and the release of low-molecular-weight fibroblast growth factors from the bone matrix, which stimulate FGF-23 transcription. A prolonged oral phosphorus load increases FGF-23 expression by a mechanism that includes local changes in the ratio of inorganic phosphate to pyrophosphate in bone. Other factors such as dietary vitamin D compounds, calcium, and metabolic acidosis all increase FGF-23 levels. This Review discusses the mechanisms by which secondary hyperparathyroidism associated with CKD stimulates bone cells to overexpress FGF-23 levels. PMID:23877588

Silver, Justin; Naveh-Many, Tally



Chronic inflammatory diseases and cardiovascular risk: a systematic review.  


Despite recent advancements in the treatment of coronary artery disease (CAD), it remains the number one cause of death in the world. While traditional risk factors partially account for the development of CAD, other novel risk factors have recently been implicated. Specifically, chronic inflammation has been postulated to play a role in the development and propagation of this disease. The purpose of this systematic review is to examine the available evidence to determine if patients with chronic inflammatory diseases have higher rates of cardiovascular disease. A MEDLINE search was conducted for articles published between 1980-2009. We focused on studies that assessed hard cardiovascular endpoints in subjects with chronic inflammatory conditions such as systemic lupus erythematosus, rheumatoid arthritis, ankylosing spondylitis, psoriatic arthritis, polymyositis/dermatomyositis, and inflammatory bowel disease. Although largely based on small studies, our review indicates that patients with chronic inflammatory conditions are likely at elevated risk for the development of CAD. Further research consisting of prospective cohort studies is needed to better quantify this risk. PMID:21459266

Roifman, Idan; Beck, Paul L; Anderson, Todd J; Eisenberg, Mark J; Genest, Jacques


The Economic Impacts of Chronic Wasting Disease and Bovine Spongiform Encephalopathy in Alberta and the Rest of Canada  

Microsoft Academic Search

Input–output analysis was used to calculate the economic impacts from potential prion diseases outbreaks in Alberta and the rest of Canada. Both chronic wasting disease (CWD) and bovine spongiform encephalopathy (BSE) have the capacity not only to affect the farmed cervid and cattle industries, but also to impact all industries with direct and indirect links to these sectors. Cervid sector

Milap Petigara; Chokri Dridi; Jim Unterschultz



CD46 Protects against Chronic Obstructive Pulmonary Disease  

PubMed Central

Background Chronic obstructive pulmonary disease and emphysema develops in 15% of ex-smokers despite sustained quitting, while 10% are free of emphysema or severe lung obstruction. The cause of the incapacity of the immune system to clear the inflammation in the first group remains unclear. Methods and Findings We searched genes that were protecting ex-smokers without emphysema, using microarrays on portions of human lungs surgically removed; we found that loss of lung function in patients with chronic obstructive pulmonary disease and emphysema was associated with a lower expression of CD46 and verified this finding by qRT-PCR and flow cytometry. Also, there was a significant association among decreased CD46+ cells with decreased CD4+T cells, apoptosis mediator CD95 and increased CD8+T cells that were protecting patients without emphysema or severe chronic obstructive pulmonary disease. CD46 not only regulates the production of T regulatory cells, which suppresses CD8+T cell proliferation, but also the complement cascade by degradation of C3b. These results were replicated in the murine smoking model, which showed increased C5a (produced by C3b) that suppressed IL12 mediated bias to T helper 1 cells and elastin co-precipitation with C3b, suggesting that elastin could be presented as an antigen. Thus, using ELISA from elastin peptides, we verified that 43% of the patients with severe early onset of chronic obstructive pulmonary disease tested positive for IgG to elastin in their serum compared to healthy controls. Conclusions These data suggest that higher expression of CD46 in the lungs of ex-smoker protects them from emphysema and chronic obstructive pulmonary disease by clearing the inflammation impeding the proliferation of CD8+ T cells and necrosis, achieved by production of T regulatory cells and degradation of C3b; restraining the complement cascade favors apoptosis over necrosis, protecting them from autoimmunity and chronic inflammation.

Grumelli, Sandra; Lu, Bao; Peterson, Leif; Maeno, Toshitaka; Gerard, Craig



CHRONIOUS: an open, ubiquitous and adaptive chronic disease management platform for chronic obstructive pulmonary disease (COPD), chronic kidney disease (CKD) and renal insufficiency.  


CHRONIOUS is an highly innovative Information and Communication Technologies (ICT) research Initiative that aspires to implement its vision for ubiquitous health and lifestyle monitoring. The 17 European project partners are strictly working together since February 2008 to realize and open platform to manage and monitor elderly patients with chronic diseases and many difficulties to reach hospital centers for routine controls. The testing activities will be done in Italy and Spain involving COPD (Chronic Obstructive Pulmonary Disease) and CKD (Chronic Kidney Disease) patients, these being widespread and highly expensive in terms of social and economic costs. Patients, equipped by wearable technologies and sensors and interacting with lifestyle interfaces, will be assisted by healthcare personnel able to check the health record and critical conditions through the Chronious platform data analysis and decision support system. Additionally, the new ontology based literature search engine will help the clinicians in the standardization of care delivery process. This paper is to present the main project objectives and its principal components from the intelligent system point of view. PMID:21096301

Rosso, R; Munaro, G; Salvetti, O; Colantonio, S; Ciancitto, F



Gut-bone interactions and implications for the child with chronic gastrointestinal disease.  


Bone is not simply a framework on which to hang viscera and connective tissue; it is also a dynamic interactive organ system with roles in immunoregulation, adipogenesis, and vascular calcification, among others. Bone is intimately affected by chronic disease, including gastrointestinal disease. The mechanisms for bone loss in conditions such as inflammatory bowel disease, celiac disease, and cystic fibrosis are discussed with regard to the role of the inflammatory response. Furthermore, we raise the issue of effects of inflammation on both intestinal and renal calcium and phosphate transport, although the ways in which these actions affect bone are not explained and require further research. The stress response, a prominent feature following burn injury, is also elucidated and its relation to gastrointestinal disease is examined. We then discuss the importance of knowing the mechanism of bone loss to determine proper prevention and treatment for the bone loss in specific gastrointestinal conditions. PMID:21613962

Klein, Gordon L



Chronic acalculous gallbladder disease: A clinical enigma  

Microsoft Academic Search

Patients with classic symptoms of gallbladder disease who have negative oral cholecystograms (OCG) or ultrasonography present perplexing management problems. The surgical literature attests to the fact that there is a marked difference of opinion as to the role of surgery in these patients. The high recurrence rate of symptoms in patients following surgery reported in some series has been a

Paul F. Nora; Robert P. Davis; Michael J. Fernandez



Neuropsychiatric complications of chronic kidney disease  

Microsoft Academic Search

Evidence is emerging that cognitive impairment, delirium and depression are very common in patients with renal disease. All of these conditions are associated with prolonged hospitalization and an increased risk of mortality. A good understanding of these conditions is key to their prevention, early intervention and management. This Review summarizes the clinical features of various forms of cognitive dysfunction that

Rory McQuillan; Sarbjit V. Jassal



Malnutrition in chronic obstructive pulmonary disease.  


Malnutrition in patients with COPD is associated with an impaired pulmonary status, reduced diaphragmatic mass, lower exercise capacity, and higher mortality rate when compared with adequately nourished individuals with COPD. Deterioration in patients with COPD may be the result of malnutrition. In addition, malnutrition could be a sign of other factors directly altered by the disease. PMID:17150429

Schwartz, Denise Baird



Chronic Liver Diseases as Liver Tumor Precursors  

Microsoft Academic Search

Liver cancer is a major global health problem and hepatocellular carcinoma (HCC) accounts for 75% of all liver carcinoma. HCC occurs more often in men than in women and mostly in people 50 to 60 years old. The disease is more common in parts of sub-Saharan Africa and Asia than in North and South America and Europe. Nevertheless its incidence

Jan Lata



Beneficial effect of salmon roe phosphatidylcholine in chronic liver disease.  


Phosphatidylcholine (PC), especially dilinoleoyl-PC, has been reported to be effective in preventing hepatic fibrosis in chronically alcohol-fed baboons. Continuous hepatic inflammation predisposes the structure of the liver to fibrosis. Since n-3 polyunsaturated fatty acids (PUFA) have been shown to exhibit an anti-inflammatory effect, we tested the hypothesis that n-3 PUFA PC as a dietary supplement has a beneficial effect on chronic liver disease susceptible to fibrosis. Salmon roe phospholipids, 90% of which are PC, were extracted and encapsulated. Almost a third of the PC fatty acids were docosahexaenoic acid (22:6 n3) and 10% were eicosapentanoic acid (20:5 n3). About 1600 mg/day of the phospholipids was administered for six months to six chronic liver disease patients, four with hepatitis B infection (three with cirrhosis, one with chronic hepatitis), one with hepatitis C virus cirrhosis and one with alcoholic cirrhosis. There was no change in the results of blood chemistry studies related to liver function, except in globulin, which decreased from 3.80 g/dl to 3.67 g/dl (p < 0.05). Among the lipid parameters, HDL-cholesterol, apolipoprotein A-I and apolipoprotein E increased significantly. Although this was a small trial, n-3 PUFA PC may be beneficial in the treatment of chronic liver diseases. PMID:10621924

Hayashi, H; Tanaka, Y; Hibino, H; Umeda, Y; Kawamitsu, H; Fujimoto, H; Amakawa, T



Definition and classification of chronic kidney disease: A position statement from Kidney Disease: Improving Global Outcomes (KDIGO)  

Microsoft Academic Search

Definition and classification of chronic kidney disease: A position statement from Kidney Disease: Improving Global Outcomes (KDIGO). Chronic kidney disease (CKD) is a worldwide public health problem, with adverse outcomes of kidney failure, cardiovascular disease (CVD), and premature death. A simple definition and classification of kidney disease is necessary for international development and implementation of clinical practice guidelines. Kidney Disease:




Selection in the social network: effects of chronic diseases  

Microsoft Academic Search

Background: this article deals with the consequences of disease for someone's personal social network. It is hypothesized that the duration of a socially severe disease will affect the social network in such a way that the proportions of women, kin, long-standing relationships and people living nearby are higher for people suffering from a disease longer. Contacts with colleagues will decline.




Chronic non-communicable diseases and the economy.  


There is no question that chronic non-communicable diseases (CNCDs) pose the single, greatest sustained threat to the stability of health systems worldwide. While undoubtedly the main dimension of the CNCDs challenge is in respect of the health and well-being of the population, it is becoming increasingly obvious that CNCDs are also posing a serious challenge to economies. Health system costs are increasing faster than national income in almost all nations and the main cause is the growing incidence of CNCDs and the diverse spill-over effects. The concern is that if this continues, there will come a time when the economic system will simply no longer be capable of coping with the burden of the CNCDs. In these circumstances the economist has two major concerns. The first is to understand and explain how CNCDs affect the functioning of the economic system. It is argued that while the analysis will necessarily begin on the qualitative level, for policy purposes it must also be taken to the quantitative level. The second major concern of the economist is to understand and explain how the working of the economy influences the incidence of CNCDs in particular countries. The author suggests that at a time when the prevention and management of CNCDs are high on the agenda of many nations, it is important to know whether the measures being taken to improve human development and economic well-being are themselves contributing to an increasing incidence of CNCDs particularly in small, vulnerable, open economies. In this regard, this paper briefly explains how CNCDs affect the economic system and presents some of the estimates of quantitative impact on the economy. PMID:22097669

Theodore, K



HIV and Chronic Methamphetamine Dependence Affect Cerebral Blood Flow  

PubMed Central

Human immunodeficiency virus (HIV) and methamphetamine (METH) dependence are independently associated with neuronal dysfunction. The coupling between cerebral blood flow (CBF) and neuronal activity is the basis of many task-based functional neuroimaging techniques. We examined the interaction between HIV infection and a previous history of METH dependence on CBF within the lenticular nuclei (LN). Twenty-four HIV?/METH?, eight HIV?/METH+, 24 HIV+/METH?, and 15 HIV+/METH+ participants performed a finger tapping paradigm. A multiple regression analysis of covariance assessed associations and two-way interactions between CBF and HIV serostatus and/or previous history of METH dependence. HIV+ individuals had a trend towards a lower baseline CBF (?10%, p=0.07) and greater CBF changes for the functional task (+32%, p=0.01) than HIV? subjects. Individuals with a previous history of METH dependence had a lower baseline CBF (–16%, p= 0.007) and greater CBF changes for a functional task (+33%, p=0.02). However, no interaction existed between HIV serostatus and previous history of METH dependence for either baseline CBF (p=0.53) or CBF changes for a functional task (p=0.10). In addition, CBF and volume in the LN were not correlated. A possible additive relationship could exist between HIV infection and a history of METH dependence on CBF with a previous history of METH dependence having a larger contribution. Abnormalities in CBF could serve as a surrogate measure for assessing the chronic effects of HIV and previous METH dependence on brain function.

Vaida, Florin; Cherner, Mariana; Yeh, Melinda J.; Liang, Christine L.; Gardner, Carly; Grant, Igor; Ellis, Ronald J.; Buxton, Richard B.



Factors affecting the decline of ventilatory function in chronic bronchitis.  

PubMed Central

Ninety six middle aged male patients with chronic bronchitis with relatively well preserved ventilatory function who were resident in Queensland, New South Wales, or Victoria took part in a prospective study to determine the relationship of various factors to the rate of decline of the FEV1. Thirty of the subjects withdrew, leaving 66 to be followed for four to six years. The mean rate of decline of the FEV1 was 58.6 (SD 51.4) ml/year. The subjects' ventilatory responses to bronchodilator and to methacholine (measures of bronchial lability) were significantly related to each other and to sputum eosinophilia. With a linear model for the data on 57 patients who had methacholine and skin tests the rate of decline of the FEV1 was found, after adjustment had been made for other variables, to be significantly related to State of residence, current smoking, response to bronchodilator, age, and occupational exposure to dust. Response to bronchodilator was interchangeable with response to methacholine. With the five variables in the model none of the following factors was related to the rate of decline of the FEV1:FEV1 on entry, FEV1% predicted normal, FEV1/VC%, skin test reaction, occupation on entry, history of sinusitis and rhinitis, and height. When data from all 66 subjects were introduced into the model, in addition to the five significant individual variables (FEV1/VC% X response to bronchodilator) was significantly related to the rate of decline of the FEV1. Of these prognostic indices, response to bronchodilator was independent of the initial FEV1, FEV/VC%, and FEV1% predicted. The difference between States, which was not explained by differences due to sampling or withdrawal of subjects, was due to a low rate of decline in Queensland.

Campbell, A H; Barter, C E; O'Connell, J M; Huggins, R



Health status of patients with self-reported chronic diseases in Jamaica  

PubMed Central

Background: Developing countries such as Jamaica suffer increasingly from high levels of public health problems related to chronic diseases. Aims: To examine the physical health status and use a model to determine the significant predictors of poor health status of Jamaicans who reported being diagnosed with a chronic non-communicable disease. Methods and Materials: The current study extracted a sub-sample of 714 people from a larger nationally representative cross-sectional survey of 6,783 Jamaicans. A self-administered questionnaire was used to collect the data from the sample. Statistical analysis was performed using chi-square to investigate non-metric variables, and logistic regression to determine predictors of poor health status. Results: Approximately one-quarter 25.3%) of the sample reported that they had poor health status. Thirty-three percent of the sample indicated unspecified chronic diseases: 7.8% arthritis, 28.9% hypertension, 17.2% diabetes mellitus and 13.3% asthma. Asthma affected 47.2% of children and 23.2% of young adults. S ignificant predictors of poor health status of Jamaicans who reported being diagnosed with chronic diseases were: age of respondents, area of residence and inability to work. Conclusion: Majority of the respondents in the sample had good health, and adults with poor health status were more likely to report having hypertension followed by diabetes mellitus and arthritis, while asthma was the most prevalent among children. Improvement in chronic disease control and health status can be achieved with improved patient education on the importance of compliance, access to more effective medication and development of support groups among chronic disease patients.

Boume, Paul A.; McGrowder, Donovan A.



Chronic Kidney Disease in an Adult with Propionic Acidemia.  


We report an adult male with classic propionic acidemia (PA) who developed chronic kidney disease in the third decade of his life. This diagnosis was recognized by an increasing serum creatinine and confirmed by reduced glomerular filtration on a (99m)Tc-diethylenetriamine pentaacetate (DTPA) scan. Histopathology of the kidney showed moderate glomerulo- and tubulointerstitial fibrosis with very segmental mesangial IgA deposits. This is the second reported case of kidney disease in an individual with propionic acidemia possibly indicating that chronic kidney disease may be a late-stage complication of propionic acidemia. Additionally, this is the first description of the histopathology of kidney disease in an individual with propionic acidemia. As more cases emerge, the clinical course and spectrum of renal pathology in this disorder will be better defined. PMID:23756992

Vernon, H J; Bagnasco, S; Hamosh, A; Sperati, C J



Chronic Granulomatous Disease: Lessons from a Rare Disorder  

PubMed Central

Chronic granulomatous disease (CGD) is a rare primary immunodeficiency with x-linked or autosomal recessive inheritance involving defects in genes encoding phox proteins which are the subunits of the phagocyte NADPH oxidase. This results in failure to produce superoxide anion and downstream antimicrobial oxidant metabolites and to activate antimicrobial proteases. Affected patients are susceptible to severe, life-threatening bacterial and fungal infections and excessive inflammation characterized by granulomatous enteritis resembling Crohn's disease and genitourinary obstruction. Early diagnosis of CGD and rapid treatment of infections are critical. Prophylaxis with antibacterial and mould-active antifungal agents and the administration of interferon-? has significantly improved the natural history of CGD. Currently, the only cure is allogeneic hematopoietic cell transplant (HCT) although there remains controversy as to which patients with CGD should get a transplant. Allele-based HLA typing of alternative donors, improved supportive care measures and use of reduced toxicity conditioning have resulted in EFS of at least 80% even with an unrelated donor and even better when the patient has no active infections/inflammation. Gene correction of CGD would eliminate the risks of GVHD and the immunoablative chemotherapy required for allogeneic HCT. Based on gene therapy trials in patients with SCID-X1, ADA-SCID and the early experience with CGD, it is clear that at least some degree of myeloablation will be necessary for CGD as there is no inherent selective growth advantage for gene-corrected cells. Current efforts for gene therapy focus on use of lentivector constructs which are thought to be safer from the standpoint of insertional mutagenesis and more efficient in transducing hematopoietic stem cells.

Segal, B H; Veys, P; Malech, H; Cowan, M J



Using information technology to improve the management of chronic disease.  


Information and communications technology (ICT) is increasingly being used in management of chronic illness to facilitate shared services (virtual health networks and electronic health records), knowledge management (care rules and protocols, scheduling, information directories), as well as consumer-based health education and evidence-based clinical protocols. Common applications of ICT include home monitoring of vital signs for patients with chronic disease, as well as replacing home visits by nurses in person with telemedicine videophone consultations. A patient-managed Home Telecare System with integrated clinical signs monitoring, automated scheduling and medication reminders, as well as access to health education and daily logs, is presented as an example of ICT use for chronic disease self-management. A clinical case study demonstrates how early identification of adverse trends in clinical signs recorded in the home can either avoid hospital readmission or reduce the length of hospital stay. PMID:12924970

Celler, Branko G; Lovell, Nigel H; Basilakis, Jim



Contribution of Chronic Disease to the Burden of Disability  

PubMed Central

Background Population ageing is expected to lead to strong increases in the number of persons with one or more disabilities, which may result in substantial declines in the quality of life. To reduce the burden of disability and to prevent concomitant declines in the quality of life, one of the first steps is to establish which diseases contribute most to the burden. Therefore, this paper aims to determine the contribution of specific diseases to the prevalence of disability and to years lived with disability, and to assess whether large contributions are due to a high disease prevalence or a high disabling impact. Methodology/Principal Findings Data from the Dutch POLS-survey (Permanent Onderzoek Leefsituatie, 2001–2007) were analyzed. Using additive regression and accounting for co-morbidity, the disabling impact of selected chronic diseases was calculated, and the prevalence and years lived with ADL and mobility disabilities were partitioned into contributions of specific disease. Musculoskeletal and cardiovascular disease contributed most to the burden of disability, but chronic non-specific lung disease (males) and diabetes (females) also contributed much. Within the musculoskeletal and cardiovascular disease groups, back pain, peripheral vascular disease and stroke contributed particularly by their high disabling impact. Arthritis and heart disease were less disabling but contributed substantially because of their high prevalence. The disabling impact of diseases was particularly high among persons older than 80. Conclusions/Significance To reduce the burden of disability, the extent diseases such as back pain, peripheral vascular disease and stroke lead to disability should be reduced, particularly among the oldest old. But also moderately disabling diseases with a high prevalence, such as arthritis and heart disease, should be targeted.

Klijs, Bart; Nusselder, Wilma J.; Looman, Caspar W.; Mackenbach, Johan P.



Treating Alcoholism as a Chronic Disease  

PubMed Central

For many patients, alcohol and other drug (AOD) use disorders are chronic, recurring conditions involving multiple cycles of treatment, abstinence, and relapse. To disrupt this cycle, treatment can include continuing care to reduce the risk of relapse. The most commonly used treatment approach is initial intensive inpatient or outpatient care based on 12-step principles, followed by continuing care involving self-help groups, 12-step group counseling, or individual therapy. Although these programs can be effective, many patients drop out of initial treatment or do not complete continuing care. Thus, researchers and clinicians have begun to develop alternative approaches to enhance treatment retention in both initial and continuing care. One focus of these efforts has been the design of extended treatment models. These approaches increasingly blur the distinction between initial and continuing care and aim to prolong treatment participation by providing a continuum of care. Other researchers have focused on developing alternative treatment strategies (e.g., telephone-based interventions) that go beyond traditional settings and adaptive treatment algorithms that may improve outcomes for clients who do not respond well to traditional approaches

McKay, James R.; Hiller-Sturmhoefel, Susanne



[Chronic peripheral arterial disease induced by cocaine].  


Cocaine induced acute peripheral thrombosis, though a rare complication, has been described in the literature. Although there are reports describing the chronic effects of cocaine on the peripheral arterial system, there are no published cases of this complication when other risk factors are lacking. We report on a 22 year old female patient, with intranasal consumption of 3 grams of cocaine per week for a year, who consulted for intermittent claudication at 200 meters, associated to left lower limb pain and paresthesiae for the last two months. Arterial Doppler ultrasonography showed a stenosis greater than 70% in the superficial left femoral artery. Other probable etiologies were excluded. Treatment was initiated with acetylsalicylic acid, cilostazol and graded physical exercise, associated to support therapy in order to maintain cocaine consumption avoidance, with good response. This case emphasizes the relevance of patients information, as most people ignore the cardiovascular complication of this addiction. It is also essential to inquire about cocaine consumption in young patients with peripheral arteriopathy and no apparent risk factors. PMID:22257455

Pankl, Sonia; Pellegrini, Débora; Bruetman, Julio E



Economic Modeling in Chronic Obstructive Pulmonary Disease  

Microsoft Academic Search

Calculating the cost-effectiveness of interventions is an important step in accurately assessing the health and financial burdens of a disease. Although clinical trials that include cost data can be used to compare the cost-effectiveness of specific interventions, they only deal with outcomes within the time frame of the trial. Health economic models can synthesize epidemiologic, clinical, economic, andquality-of-lifedatafrommanydifferentsourcesandextrapolate results to

Maureen Rutten-van Molken; Todd A. Lee



Sympatho-renal axis in chronic disease  

Microsoft Academic Search

Essential hypertension, insulin resistance, heart failure, congestion, diuretic resistance, and functional renal disease are\\u000a all characterized by excessive central sympathetic drive. The contribution of the kidney’s somatic afferent nerves, as an\\u000a underlying cause of elevated central sympathetic drive, and the consequences of excessive efferent sympathetic signals to\\u000a the kidney itself, as well as other organs, identify the renal sympathetic nerves

Paul A. Sobotka; Felix Mahfoud; Markus P. Schlaich; Uta C. Hoppe; Michael Böhm; Henry Krum



Microsoft Academic Search

Objectives: Osteoprotegerin (OPG) is a decoy receptor that binds RANK-ligand (RANKL) and prevents osteoclast activation. Oestrogens, androgens, corticosteroids, parathyroid hormone (PTH), vitamin D, and several cytokines exert their effects on bone modulating the OPG\\/RANKL system. Since these substances become altered in chronic alcoholic liver disease, we investigated the OPG\\/RANKL system in alcoholic liver disease, its relation with bone mineral density




Therapeutic strategies to slow chronic kidney disease progression  

Microsoft Academic Search

Childhood chronic kidney disease commonly progresses toward end-stage renal failure, largely independent of the underlying\\u000a disorder, once a critical impairment of renal function has occurred. Hypertension and proteinuria are the most important independent\\u000a risk factors for renal disease progression. Therefore, current therapeutic strategies to prevent progression aim at controlling\\u000a blood pressure and reducing urinary protein excretion. Renin-angiotensin-system (RAS) antagonists preserve

Elke Wühl; Franz Schaefer



Should prevention of chronic kidney disease start before pregnancy?  

Microsoft Academic Search

Objective  The objective was to evaluate whether there is a role for the prevention of future chronic kidney disease (CKD) in children\\u000a by improving maternal health at conception, this review addresses: the risk of childhood obesity in the development of CKD,\\u000a trends in childhood obesity and body composition in children with renal diseases, trends in pre-pregnancy BMI and its association\\u000a with

Guido Filler; Meera S. Rayar; Orlando da Silva; Ilan Buffo; Dion Pepelassis; Ajay P. Sharma



Elderly people at home disabled by chronic obstructive pulmonary disease  

Microsoft Academic Search

Background: we compared uptake of hospital and community-based support in elderly people disabled by chronic obstructive pulmonary disease (COPD), normal controls (NCs) and patients with Parkinsons disease, stroke, amputation, or arthritis (disabled controls; DCs). Methods: there were 65 subjects (35 men) aged 70-93 years (mean 78) with COPD, 55 NCs (23 men; age range 71-90 years (mean 78)) and 53




Factors Influencing Survival in Children with Chronic Interstitial Lung Disease  

Microsoft Academic Search

To investigate factors influencing survival in children with chronic interstitial lung disease (ILD), we extracted specific clinical information from a data base of 99 children with ILD who met entry criteria for our study. The effects of a weight below the fifth percentile for the patient's age, crackles, club- bing, family history of ILD, symptom duration, and severity-of-illness score on




Enhanced neutrophil response in chronic obstructive pulmonary disease  

Microsoft Academic Search

BACKGROUNDNeutrophils are likely to play a major role in the inflammatory response seen in chronic obstructive pulmonary disease (COPD). This study sought to address the hypothesis that an enhanced neutrophil response to proinflammatory agents in COPD may contribute to their recruitment and activation in the lungs.METHODSCirculating neutrophils were obtained from 10 patients with COPD, eight long term smokers with normal

A Noguera; S Batle; C Miralles; J Iglesias; X Busquets; W MacNee; A G N Agustí



Depression in elderly outpatients with disabling chronic obstructive pulmonary disease  

Microsoft Academic Search

Introduction: depression is common in both young adults and elderly people with chronic obstructive pulmonary disease (COPD). Methods: we compared the prevalence of depressive symptomatology in elderly outpatients with stable disabling COPD with that in healthy controls and age-matched patients with other disabilities, and also assessed the relation between degree of disability, quality of life and depressive symptoms. The subjects




Quality of sleep in patients with chronic kidney disease  

Microsoft Academic Search

Background. Sleep disorders are common in patients with renal failure on dialysis; however, the prevalence of 'poor sleep' in patients with chronic kidney disease (CKD) not yet on dialysis is not known. This study aimed to measure the prevalence of 'poor sleep' in CKD patients and to examine the association between quality of sleep and the degree of renal impairment

Eduard A. Iliescu; Karen E. Yeates; David C. Holland



Postnatal steroids and chronic lung disease in the newborn  

Microsoft Academic Search

Introduction: Chronic lung disease (CLD) represents a condition of persistent inflammation within the airways which may have its origin either in utero or after birth. Corticosteroids, because of their anti- inflammatory actions, have been used to modify the course of CLD. There have been almost 40 randomised controlled trials of postnatal dexamethasone and 12 of inhaled steroids. Methods: Systematic reviews

Henry L. Halliday



Abdominal muscle and quadriceps strength in chronic obstructive pulmonary disease  

Microsoft Academic Search

Background: Quadriceps muscle weakness is common in chronic obstructive pulmonary disease (COPD) but is not observed in a small hand muscle (adductor pollicis). Although this could be explained by reduced activity in the quadriceps, the observation could also be explained by anatomical location of the muscle or fibre type composition. However, the abdominal muscles are of a similar anatomical and

W D-C Man; N S Hopkinson; F Harraf; D Nikoletou; M I Polkey; J Moxham



Chronic hepatitis in childhood: the spectrum of the disease  

Microsoft Academic Search

During a multicentre study of chronic hepatitis in childhood diagnosed by biopsy, the spectrum of the disease has been evaluated in 196 consecutive patients, including 157 from Northern Italy and 39 from Southern Italy. Only 31% of patients in the former group and 27% in the latter were symptomatic when first seen: the majority of cases being seen after familial

F Bortolotti; R Calzia; A Vegnente; P Cadrobbi; M Rugge; M Armigliato; M G Marazzi; R Iorio; C Crivellaro; R Piscopo



Nitric Oxide Inhalation During Exercise in Chronic Obstructive Pulmonary Disease  

Microsoft Academic Search

Patients with chronic obstructive pulmonary disease (COPD) may develop hypoxemia and pulmonary hypertension when exercising. To investigate whether inhaled nitric oxide (NO), a selective pulmo- nary vasodilator, modifies the changes induced by exercise in pulmonary hemodynamics and gas ex- change in COPD, we studied nine patients (FEV 1 5 39 6 2% predicted), at rest and at submaximal ex- ercise,




Management of cardiovascular disease risk in chronic inflammatory disorders  

Microsoft Academic Search

Patients with chronic inflammatory disorders are at increased risk of developing premature cardiovascular disease. Despite significant advances in our understanding of the effects of inflammatory pathways on the vasculature, clear guidelines on the management of traditional and nontraditional cardiovascular risk factors in patients with systemic autoimmunity are lacking. Thus, rigorous studies assessing the individual contributions of the various treatments used

Mariana J. Kaplan



Air travel in patients with chronic obstructive pulmonary disease.  


Air travel exposes patients with chronic obstructive pulmonary disease to the risk of severe hypoxemia. We sought to determine the frequency and outcome of airline travel in patients with chronic obstructive pulmonary disease. A cohort of 100 patients (76 men and 24 women; age 67 +/- 7 years [mean +/- SD]) with severe chronic pulmonary obstructive disease examined by means of spirometry (forced expiratory volume in the first second, 0.04 +/- 0.35 L), all military retirees, or their dependents, comprised the study population. Forty-four patients traveled by commercial air carrier over a 28-month interval, giving an annual frequency of 18.9% of these patients per year. The group that did not travel by air (n = 56) had a lower mean value for forced expiratory volume in the first second and greater prevalence of home oxygen use than did the group that did travel by air. Twelve of the travelers (27.3%) consulted a physician beforehand. Flights reached foreign destinations for 22.7% of patients. The median duration of the longest flight segment was 3 hours. A minority of patients (34.3%) occupied seats in the smoking sections of aircraft. A majority (56.8%) ambulated aboard the aircraft during flights. Eight patients (18.2%) reported transient symptoms during air travel. We conclude that patients with chronic obstructive pulmonary disease travel with appreciable frequency, often without medical consultation, and develop symptoms in some cases. PMID:1888245

Dillard, T A; Beninati, W A; Berg, B W



Exercise in patients with chronic obstructive pulmonary disease  

Microsoft Academic Search

Sporadic visits to the local doctor followed sometimes by changes in oral and inhaled bronchodilators and occasionally by the addition of steroids frequently does little to significantly improve symptoms and function in the disabled patient with COPD. As in other chronic diseases, the management of these patients is facilitated by a team approach in conjunction with general rehabilitation principles. The

M J Belman




Microsoft Academic Search

In the past 12 years (1967-79) a syndrome we identify as chronic wasting disease has been observed in 53 mule deer (Odocoileus hemionus hemionus) and one black-tailed deer (Odocoileus hemionus columbianus) held in captivity in several wildlife facilities in Colorado and more recently in Wyoming. Clinical signs were seen in adultdeerand includedbehavioral alterations, progressive weight loss and death in 2



Dietary change, nutrition education and chronic obstructive pulmonary disease  

Microsoft Academic Search

Chronic obstructive pulmonary disease (COPD) is a prevalent and serious condition. Nutrition might play a role in COPD prevention and is definitely important in COPD management. There are some indications from epidemiological studies that dietary factors such as ample consumption of fruit and fish may decrease COPD risk. The available evidence is, however, not substantial enough to warrant dietary recommendations

Johannes Brug; Annemie Schols; Ilse Mesters



Evaluation of Continuing Medical Education for Chronic Obstructive Pulmonary Diseases.  

ERIC Educational Resources Information Center

A continuing medical education program is discussed that addresses chronic obstructive pulmonary disease and that links primary care physicians to a source of needed clinical knowledge at a relatively low cost. The educational methods, evaluation design, diagnosis of educational needs, selection of program content and behavioral outcomes are…

Li Wang, Virginia; And Others



Vascular calcification and cardiovascular function in chronic kidney disease  

Microsoft Academic Search

Background. Vascular calcification and arterial stiff- ening are independent predictors of all causes and cardiovascular mortality in chronic kidney disease (CKD). Few data are currently available comparing vascular calcification and its attendant functional cardiovascular consequences between CKD stage 4 patients and both peritoneal dialysis (PD) and haemodialysis (HD) (CKD stage 5) patients. Method. We studied 134 subjects (60 HD, 28

Mhairi Sigrist; Peter Bungay; Maarter W. Taal; Christopher W. McIntyre



Inhaled corticosteroids and mortality in chronic obstructive pulmonary disease  

Microsoft Academic Search

Background: Clinical studies suggest that inhaled corticosteroids reduce exacerbations and improve health status in chronic obstructive pulmonary disease (COPD). However, their effect on mortality is unknown.Methods: A pooled analysis, based on intention to treat, of individual patient data from seven randomised trials (involving 5085 patients) was performed in which the effects of inhaled corticosteroids and placebo were compared over at

D D Sin; L Wu; J A Anderson; N R Anthonisen; A S Buist; P S Burge; P M Calverley; J E Connett; B Lindmark; R A Pauwels; D S Postma; J B Soriano; W Szafranski; J Vestbo



Regulation of fibroblast growth factor-23 in chronic kidney disease  

Microsoft Academic Search

Background. Fibroblast growth factor-23 (FGF23) is a circulating factor that regulates the renal reabsorption of inorganic phosphate (Pi) and is increased in chronic kidney disease (CKD). The aim of the current investigation was to study the regulation of FGF23 in CKD subjects with various degree of renal function. As such, we analysed the relationship between FGF23, Pi, calcium, parathyriod hormone

Per-Anton Westerberg; Torbjorn Linde; Bjorn Wikstrom; Osten Ljunggren; Mats Stridsberg; Tobias E. Larsson



Chronic Wasting Disease and Potential Transmission to Humans  

Microsoft Academic Search

Chronic wasting disease (CWD) of deer and elk is endemic in a tri-corner area of Colorado, Wyoming, and Nebraska, and new foci of CWD have been detected in other parts of the United States. Although detection in some areas may be related to increased surveillance, introduction of CWD due to translocation or natural migration of animals may account for some

Ermias D. Belay; Ryan A. Maddox; Elizabeth S. Williams; Michael W. Miller; Pierluigi Gambetti; Lawrence B. Schonberger



Clinical Effects of Inhaled Corticosteroids in Chronic Obstructive Pulmonary Disease  

Microsoft Academic Search

Chronic obstructive pulmonary disease (COPD) has multiple patho- physiologic effects that are not confined to the lungs. Similarly, treatment for COPD may have a number of different beneficial effects, and although each of these may be small, their cumulative effect may add up to a worthwhile overall outcome. Many of the effects of COPD are only weakly related to FEV1,

Paul W. Jones



Proinflammatory effects of iron sucrose in chronic kidney disease  

Microsoft Academic Search

Inflammation is a central component of progressive chronic kidney disease (CKD). Iron promotes oxidative stress and inflammatory response in animals and promotes progressive CKD. Parenteral iron provokes oxidative stress in patients with CKD; however, its potential to provoke an inflammatory response is unknown. In 20 veterans with CKD, 100 mg iron sucrose was administered intravenously over 5 min and urinary

R Agarwal



Markers of exacerbation severity in chronic obstructive pulmonary disease  

Microsoft Academic Search

BACKGROUND: Patients with chronic obstructive pulmonary disease (COPD) can experience 'exacerbations' of their conditions. An exacerbation is an event defined in terms of subjective descriptors or symptoms, namely dyspnoea, cough and sputum that worsen sufficiently to warrant a change in medical management. There is a need for reliable markers that reflect the pathological mechanisms that underlie exacerbation severity and that

Luigi G Franciosi; Clive P Page; Bartolome R Celli; Mario Cazzola; Michael J Walker; Meindert Danhof; Klaus F Rabe; Oscar E Della Pasqua



Prevalence of celiac disease in patients with juvenile chronic arthritis  

Microsoft Academic Search

We estimated the prevalence of celiac disease in children with juvenile chronic arthritis (JCA), using antiendomysium antibodies as the screening test to select patients for intestinal biopsy. We studied 119 children with JCA and found four patients with antiendomysium antibodies. In three of these patients (2.5%), intestinal biopsy revealed villous atrophy; in the fourth the intestinal mucosa was normal. We

Loredana Lepore; Stefano Martelossi; Marco Pennesi; Fernanda Falcini; Maria Luisa Ermini; Roberto Ferrari; Sandra Perticarari; Gianni Presani; Ariella Lucchesi; Manuela Lapini; Alessandro Ventura



Animal models of obesity-associated chronic kidney disease.  


Dramatic advances in basic science have been made in the past 50 years on the basis of animal models of obesity and type II diabetes. Positional-cloning strategies in rodents with spontaneous obesity have enabled landmark scientific breakthroughs and defined the molecular scaffolding for the regulation of energy homeostasis. Recently, studies in the general population suggest that obesity is an independent risk factor for chronic kidney disease. To date, most of the animal studies that investigated chronic kidney disease associated with obesity and type II diabetes have largely been descriptive. We aim to provide an overview of animal models used to investigate the mechanisms of obesity-associated chronic kidney disease. Our overview is not meant to be an exhaustive list of all animal models in the literature on this subject, but rather to illustrate the experimental approaches. Because of space limitations, we have chosen to concentrate on rodent models. These animal models will provide excellent tools for in vivo testing of molecular mechanisms. Further hypothesis-driven research into the mechanism of chronic kidney disease and their progression by use of these models will provide important insights necessary to develop therapeutic strategies for this significant complication of the worldwide epidemic of obesity and type II diabetes. PMID:17045223

Mak, Robert H; Kuo, Huey-Ju; Cheung, Wai W



Combination Therapy for Chronic Obstructive Pulmonary Disease: Clinical Aspects  

Microsoft Academic Search

Anticholinergics and -agonists reduce bronchoconstriction through different mechanisms, and there is a long history of combination therapy with short-acting agents in these classes for chronic ob- structive pulmonary disease. Such combinations may allow lower doses and thereby improve safety. Oral theophylline has also been combined with short-acting bronchodilators for many years. Most studies, however, show only mild improvements in bronchodilation

James F. Donohue



Alpha 1-antitrypsin deficiency, complement activation, and chronic liver disease  

Microsoft Academic Search

Activation of the complement system, the main humoral mediator of inflammation, is restrained by the action of enzyme inhibitors including alpha 1-antitrypsin. Deficiency leads to chronic liver disease in about one in five children with this genetic defect. Complement activation was investigated in 34 children with alpha 1 AT deficiency (12 with minimal, 10 with moderate, and 12 with severe

E T Littleton; L Bevis; L J Hansen; M Peakman; A P Mowat; G Mieli-Vergani; D Vergani



Home hospitalisation of exacerbated chronic obstructive pulmonary disease patients  

Microsoft Academic Search

It was postulated that home hospitalisation (HH) of selected chronic obstructive pulmonary disease (COPD) exacerbations admitted at the emergency room (ER) could facilitate a better outcome than conventional hospitalisation. To this end, 222 COPD patients (3.2% female; 71 +10 yrs (mean+SD)) were randomly assigned to HH (n =121) or conventional care (n =101). During HH, integrated care was delivered by

C. Hernandez; A. Casas; J. Escarrabill; J. Alonso; J. Puig-Junoy; E. Farrero; G. Vilagut; B. Collvinent; R. Rodriguez-Roisin; J. Roca



Palliative care provision for patients with chronic obstructive pulmonary disease  

Microsoft Academic Search

Chronic obstructive pulmonary disease (COPD) is a major cause of disability, morbidity and mortality in old age. Patients with advanced stage COPD are most likely to be admitted three to four times per year with acute exacerbations of COPD (AECOPD) which are costly to manage. The adverse events of AECOPD are associated with poor quality of life, severe physical disability,

Abebaw Mengistu Yohannes



Calcimimetics in chronic kidney disease: evidence, opportunities and challenges  

Microsoft Academic Search

Secondary hyperparathyroidism (SHPT) remains a highly prevalent and important complication in patients with chronic kidney disease (CKD). Indeed, SHPT may compromise bone health and contribute to the increased cardiovascular risks of these patients. Calcimimetic agents may help to control SHPT and to achieve the stringent mineral metabolism targets in patients with CKD stage 5D. Whether this will translate in improved

Pieter Evenepoel



Frequency of Hypoglycemia and Its Significance in Chronic Kidney Disease  

Microsoft Academic Search

Background and objectives: This study set out to determine the incidence of hypoglycemia in patients with chronic kidney disease (CKD), with and without diabetes, and the association of hypoglycemia with mortality. Design, setting, participants, & measurements: This was a retrospective cohort analysis of 243,222 patients who had 2,040,206 glucose measurements and were cared for at the Veterans Health Administration. CKD

Maureen F. Moen; Lori D. Walker; Lisa M. Einhorn; Stephen L. Seliger; Jeffrey C. Fink


21st Century Perspective on Chronic Obstructive Pulmonary Disease  

Microsoft Academic Search

The prediction that chronic obstructive pulmonary disease (COPD) will be the third leading cause of death worldwide by 2020 has enormous economic repercussions. Yet many issues and questions remain unresolved. For example, how can population studies of morbidity and mortality be viewed as comparable, without a worldwide consensus on the definition of COPD? How can the early diagnosis of COPD

Susan A. Ward; Richard Casaburi




EPA Science Inventory

The potential role of ozone in the induction of chronic lung diseases remains unclear. sing an ambient profile adopted from aerometric data from the Southwest Air Basin, rats were exposed to O3 for up to 18 months before assessments of pulmonary structure, function and biochemist...


Chronic Obstructive Pulmonary Disease and Lung Cancer: New Molecular Insights  

Microsoft Academic Search

Both chronic obstructive pulmonary disease (COPD) and lung cancer are major causes of death worldwide. In most cases this reflects cigarette smoke exposure which is able to induce an inflammatory response in the airways of smokers. Indeed, COPD is characterized by lower airway inflammation, and importantly, the presence of COPD is by far the greatest risk factor for lung cancer

Ian M. Adcock; Gaetano Caramori; Peter J. Barnes



Chronic Granulomatous Disease and Other Disorders of Phagocyte Function  

Microsoft Academic Search

The analysis of specific gene defects in disorders of phagocyte function has shed light on important aspects of the innate immune response. Each disor- der has distinctive features in the clinical presentation and characteristic microbial pathogens. Chronic granulomatous disease has been extensively studied both in patient series and in mouse models. New insights continue to be obtained regarding the role

Mary C. Dinauer


Correlates of osteoporosis in chronic obstructive pulmonary disease  

Microsoft Academic Search

The aim of this study was to analyse the correlates of reduced bone mineral density in patients with chronic obstructive pulmonary disease (COPD), with special regard to a possible protective role of hypercapnia.One hundred and four consecutive COPD inpatients in stabilized respiratory conditions underwent a comprehensive assessment of their health status. Bone mineral density was measured by X-ray absorptiometry at




Chronic systemic pesticide exposure reproduces features of Parkinson's disease  

Microsoft Academic Search

The cause of Parkinson's disease (PD) is unknown, but epidemiological studies suggest an association with pesticides and other environmental toxins, and biochemical studies implicate a systemic defect in mitochondrial complex I. We report that chronic, systemic inhibition of complex I by the lipophilic pesticide, rotenone, causes highly selective nigrostriatal dopaminergic degeneration that is associated behaviorally with hypokinesia and rigidity. Nigral

Ranjita Betarbet; Todd B. Sherer; Gillian MacKenzie; Monica Garcia-Osuna; Alexander V. Panov; J. Timothy Greenamyre



Circulating Leptin in Patients with Chronic Obstructive Pulmonary Disease  

Microsoft Academic Search

Unexplained weight loss is common in patients with chronic obstructive pulmonary disease (COPD). Since leptin, an obesity gene product, is known to play important roles in the control of body weight and energy expenditure, we investigated serum leptin levels, along with circulating tumor necrosis factor- a (TNF- a ) and soluble TNF receptor (sTNF-R55 and -R75) levels, in 31 patients




The natural history of beryllium sensitization and chronic beryllium disease  

SciTech Connect

With the advent of in vitro immunologic testing, we can now detect exposed individuals who are sensitized to beryllium and those who have chronic beryllium disease (CBD) with lung pathology and impairment. Earlier detection and more accurate diagnostic tools raise new questions about the natural history of sensitization and granulomatous disease. Preliminary data suggest that early detection identifies people who are sensitized to beryllium and that these individuals are at risk for progressing into clinical disease. This article discusses the historical, recent, and ongoing studies germane to our understanding of CBD natural history, including the immunologic and inflammatory basis of the disease, the environmental and host risk factors for disease progression, biological markers of disease severity and activity that may help predict outcome, and the implications for broad-based workplace screening to identify patients at the earliest stages of beryllium sensitization and disease. 29 refs., 2 figs.

Newman, L.S. [National Jewish Center for Immunology and Respiratory Medicine, Denver, CO (United States)]|[Univ. of Colorado, Denver, CO (United States); Lloyd, J.; Daniloff, E. [National Jewish Center for Immunology and Respiratory Medicine, Denver, CO (United States)



Hunters' General Disease Risk Sensitivity and Behaviors Associated with Chronic Wasting Disease  

Microsoft Academic Search

This article examines deer hunters' general disease risk sensitivity relative to specific behaviors and beliefs about chronic wasting disease (CWD). Data were obtained from the 2003–04 Illinois Hunter Harvest Survey (n = 1521). Cluster analysis of perceived risks from CWD, Bovine Spongiform Encephalopathy (i.e., mad cow), Salmonella, Escheria coli (E. coli), West Nile Virus, and Lyme disease identified three hunter

Craig A. Miller; Lori B. Shelby



Chronic Obstructive Pulmonary Disease, Risk Factors, and Outcome Trials: Comparisons with Cardiovascular Disease  

Microsoft Academic Search

Chronic obstructive pulmonary disease (COPD) is a major health problem and now ranks fifth in terms of the global burden of disease. Although COPD is a disease that is characterized by pro- gressive respiratory symptoms and functional decline, exacerba- tions pose the greatest risk for morbidity and early mortality, have a dramatic effect on quality of life, and are the

Scott D. Ramsey; F. D. Richard Hobbs



Central Blood Pressure and Chronic Kidney Disease Progression  

PubMed Central

Hypertension, diabetes, and proteinuria are well-recognized risk factors for progressive kidney function loss. However, despite excellent antihypertensive and antidiabetic drug therapies, which also often lower urinary protein excretion, there remains a significant reservoir of patients with chronic kidney disease who are at high risk for progression to end-stage kidney disease. This has led to the search for less traditional cardiovascular risk factors that will help stratify patients at risk for more rapid kidney disease progression. Among these are noninvasive estimates of vascular structure and function. Arterial stiffness, manifested by the pulse wave velocity in the aorta, has been established in a number of studies as a significant risk factor for kidney disease progression and cardiovascular endpoints. Much less well studied in chronic kidney disease are measures of central arterial pressures. In this paper we cover the physiology behind the generation of the central pulse wave contour and the studies available using these approaches and conclude with some speculations on the rationale for why measurements of central pressure may be informative for the study of chronic kidney disease progression.

Cohen, Debbie L.; Townsend, Raymond R.



Autoimmune diseases, bipolar disorder, and non-affective psychosis  

PubMed Central

Objective Clinic-based studies of immune function, as well as comorbidity of autoimmune diseases, bipolar disorder, and schizophrenia, suggest a possible autoimmune etiology. Studies of non-affective psychosis and schizophrenia suggest common etiologies. The objective was to determine the degree to which 30 different autoimmune diseases are antecedent risk factors for bipolar disorder, schizophrenia, and non-affective psychosis. Methods A cohort of 3.57 million births in Denmark was linked to the Psychiatric Case Register and the National Hospital Register. There were 20,317 cases of schizophrenia, 39,076 cases of non-affective psychosis, and 9,920 cases of bipolar disorder. Results As in prior studies, there were a range of autoimmune diseases which predicted raised risk of schizophrenia in individuals who had a history of autoimmune diseases, and also raised risk in persons whose first-degree relatives had an onset of autoimmune disease prior to onset of schizophrenia in the case. These relationships also existed for the broader category of non-affective psychosis. Only pernicious anemia in the family was associated with raised risk for bipolar disorder (relative risk: 1.7), suggesting a small role for genetic linkage. A history of Guillain-Barré syndrome, Crohn’s disease, and autoimmune hepatitis in the individual was associated with raised risk of bipolar disorder. Conclusions The familial relationship of schizophrenia to a range of autoimmune diseases extends to non-affective psychosis, but not to bipolar disorder. The data suggest that autoimmune processes precede onset of schizophrenia, but also non-affective psychosis and bipolar disorder.

Eaton, William W; Pedersen, Marianne G; Nielsen, Philip R; Mortensen, Preben Bo



Annual lung function changes in young patients with chronic lung disease  

Microsoft Academic Search

Reference equations for ventilatory function that use different\\u000a statistical models may introduce artifacts that affect the estimated\\u000a change of lung function during growth in young subjects. The effect of\\u000a differently modelled reference equations on the estimated annual change of\\u000a forced expiratory volume in one second (FEV1) and forced vital capacity\\u000a (FVC) in young patients with chronic lung disease was assessed.

P. J. F. M. Merkus; H. A. W. M. Tiddens; Jongste de J. C



Chronic Kidney Disease: Novel Insights from Genome-Wide Association Studies  

Microsoft Academic Search

Chronic kidney disease (CKD) is common, affecting about 10% of the general population, and causing significant morbidity and mortality. Apart from the risk conferred by traditional cardiovascular risk factors, there is a strong genetic component. The method of a genome-wide association study (GWAS) is a powerful hypothesis-free approach to unravel this component by association analyses of CKD with several million

Carsten A. Böger; Iris M. Heid



Angiogenesis and vascular remodeling in chronic airway diseases.  


Asthma and chronic obstructive pulmonary disease remain a global health problem, with increasing morbidity and mortality. Despite differences in the causal agents, both diseases exhibit various degrees of inflammatory changes, structural alterations of the airways leading to airflow limitation. The existence of transient disease phenotypes which overlap both diseases and which progressively decline the lung function has complicated the search for an effective therapy. Important characteristics of chronic airway diseases include airway and vascular remodeling, of which the molecular mechanisms are complex and poorly understood. Recently, we and others have shown that airway smooth muscle (ASM) cells are not only structural and contractile components of airways, rather they bear capabilities of producing large number of pro-inflammatory and mitogenic factors. Increase in size and number of blood vessels both inside and outside the smooth muscle layer as well as hyperemia of bronchial vasculature are contributing factors in airway wall remodeling in patients with chronic airway diseases, proposing for the ongoing mechanisms like angiogenesis and vascular dilatation. We believe that vascular changes directly add to the airway narrowing and hyper-responsiveness by exudation and transudation of proinflammatory mediators, cytokines and growth factors; facilitating trafficking of inflammatory cells; causing oedema of the airway wall and promoting ASM accumulation. One of the key regulators of angiogenesis, vascular endothelial growth factor in concerted action with other endothelial mitogens play pivotal role in regulating bronchial angiogenesis. In this review article we address recent advances in pulmonary angiogenesis and remodelling that contribute in the pathogenesis of chronic airway diseases. PMID:23975597

Alagappan, Vijay K T; de Boer, Willem I; Misra, Virendra K; Mooi, Wolter J; Sharma, Hari S



Chronic lymphoproliferative disease of large granular lymphocytes.  


An 80-year-old patient has been followed for hepato- and splenomegaly, hemolytic anemia, neutropenia with lymphocytosis with large granular lymphocyte predominance in his peripheral blood, with infiltration of bone marrow, liver and probably also spleen. Determination of surface markers of proliferating lymphocytes in peripheral blood showed a mixed phenotype of T suppressor/cytotoxic and natural killer cells (SIg-, E+, T3+, T8+, EAC+, Leu7-, N901+, NK9+, VIB C5 and VIB E3-, Ia-). An in vitro cytotoxic test showed the functional inactivity of the cells tested also after human leukocyte interferon stimulation. Chromosomal analysis neither of peripheral blood lymphocytes nor of bone marrow cells proved the monoclonality marker. Following long-term prednisone therapy, the improvement of anemia, later also neutropenia accompanied by the decrease of lymphocytes has been achieved. As the disease present in our patient was distinguished only in recent years and in our country has not been reported yet, the details on its clinical, morphologic, hematologic, cytogenetic and mainly immunophenotypic characteristics are given in this paper. The problems concerning classification of the disease and determination of its biological nature are discussed. PMID:3352841

Vahancík, A; Babusíková, O; Ujházy, P; Klobusická, M; Jakubovský, J; Izakovic, V



Microbial Translocation in Chronic Liver Diseases  

PubMed Central

The intestinal microflora is not only involved in the digestion of nutrients, but also in local immunity, forming a barrier against pathogenic microorganisms. The derangement of the gut microflora may lead to microbial translocation, defined as the passage of viable microorganisms or bacterial products (i.e., LPS, lipopeptides) from the intestinal lumen to the mesenteric lymph nodes and other extraintestinal sites. The most recent evidence suggests that microbial translocation (MT) may occur not only in cirrhosis, but also in the early stage of several liver diseases, including alcoholic hepatopathy and nonalcoholic fatty liver disease. Different mechanisms, such as small intestinal bacterial overgrowth, increased permeability of intestinal mucosa, and impaired immunity, may favor MT. Furthermore, MT has been implicated in the pathogenesis of the complications of cirrhosis, which are a significant cause of morbidity and mortality in cirrhotic subjects. Therapeutic strategies aiming at modulating the gut microflora and reducing MT have focused on antibiotic-based options, such as selective intestinal decontamination, and nonantibiotic-based options, such as prokinetics and probiotics. In particular, probiotics may represent an attractive strategy, even though the promising results of experimental models and limited clinical studies need to be confirmed in larger randomized trials.

Pinzone, Marilia Rita; Celesia, Benedetto Maurizio; Di Rosa, Michele; Cacopardo, Bruno; Nunnari, Giuseppe



Chronic disease epidemiology, cancer and mobile global approaches to disease prevention.  


The focus of this symposium was worldwide prevention of chronic disease through the use of inexpensive Internet pathways, as demonstrated with the Supercourse project, and other initiatives, including promoting mobile phone technology (m-health). This symposium highlighted the need to use the Supercourse to prevent cancer and other chronic diseases. It also highlighted several components of the Supercourse library, including the former Soviet Union network, the Latin American network, and some other initiatives. PMID:22414605

Linkov, F; Shubnikov, E; Padilla, N; McCallum, A; LaPorte, R



Does chronic stress enhance the risk of diseases?  


In the everyday life, stress is deemed as something unfavorable that may enhance the risk for the development or worsen a disease. However, in its nature, stress is adaptive reaction of the body. Its main characteristic is the activation of the hypothalamic-pituitary-adrenocortical (HPA) axis. Previously, we have shown that activation of the HPA axis plays a gastroprotective role during acute stress. The aim of our study was to clarify the effects of chronic stress and chronically elevated basal corticosterone levels on the gastric ulceration and cardiovascular vulnerability in rats.Methods. Male Wistar rats were repeatedly restrained 60 min daily for 14 days and examined on day 15th. The gastric ulceration was induced by a s.c. injection of indomethacin (35 mg/kg). The cardiovascular vulnerability was examined in urethane-anaesthetized rats in an experimental angina pectoris model (epinephrine, 10 µg/kg, 30 s later phentolamine, 15 mg/kg, both i.v.).Results. We confirmed the development of chronic stress consequences by changes in several somatic parameters (body weight decrease, thymus involution, adrenal gland hypertrophy), and elevated resting corticosterone levels. However, the gastroprotective effect of chronic stress was not manifested and there was no aggravation of indomethacin-induced gastric ulceration, either. In the experimental angina pectoris model, previous chronic stress did not have any profound effect on the blood pressure, heart rate, and electrocardiogram changes.Conclusions. In contrast to the general view on the harmfulness nature of the stress, we were unable to find a harmful effect of chronic stress on the internal diseases (gastric ulceration and angina pectoris). However, its protective effect was also missing among present experimental conditions. Keywords: chronic stress, indomethacin-induced gastric ulceration, experimental angina pectoris. PMID:24156706

Filaretova, L; Morozova, O; Laszlo, F; Morschl, E; Zelena, D



[Surgical treatment of chronic obstructive pulmonary disease].  


Treatment of advanced emphysema is not limited to medical management. Surgical options can also be envisioned for some cases, and physicians must know about them. A bullectomy may be considered for giant bullae, defined by a volume greater than a third of a hemithorax. This option must be discussed even in cases of advanced obstructive disease. Lung volume reduction surgery is useful for emphysema that is heterogeneously distributed but without individual giant bullae. A large-scale controlled study helped to identify its indications and results. The third possible surgical option is lung transplantation. It offers the greatest functional benefits but also involves considerable risks. One of the key points is therefore to define the optimal moment in a patient's life when this option should be discussed. Recent guidelines developed by a panel of international experts provide clinicians with the criteria for considering transplantation. PMID:19150209

Mal, Hervé



Bisphenol A in Chronic Kidney Disease  

PubMed Central

Phenols are uremic toxins of intestinal origin formed by bacteria during protein metabolism. Of these molecules, p-cresol is the most studied and has been associated with renal function impairment and vascular damage. Bisphenol A (BPA) is a molecule with structural similarity with phenols found in plastic food and beverage containers as well as in some dialyzers. BPA is considered an environmental toxicant based on animal and cell culture studies. Japanese authorities recently banned BPA use in baby bottles based on observational association studies in newborns. BPA is excreted in urine and uremic patients present higher serum levels, but there is insufficient evidence to set cut-off levels or to link BPA to any harmful effect in CKD. However, the renal elimination and potential exposure during dialysis warrant the monitoring of BPA exposure and the design of observational studies in which the potential health risks of BPA for end-stage renal disease patients are evaluated.

Gonzalez-Parra, Emilio; Herrero, Jose Antonio; Elewa, Usama; Arduan, Alberto Ortiz; Egido, Jesus



Chronic Granulomatous Disease: The European Experience  

PubMed Central

CGD is an immunodeficiency caused by deletions or mutations in genes that encode subunits of the leukocyte NADPH oxidase complex. Normally, assembly of the NADPH oxidase complex in phagosomes of certain phagocytic cells leads to a “respiratory burst”, essential for the clearance of phagocytosed micro-organisms. CGD patients lack this mechanism, which leads to life-threatening infections and granuloma formation. However, a clear picture of the clinical course of CGD is hampered by its low prevalence (?1?250,000). Therefore, extensive clinical data from 429 European patients were collected and analyzed. Of these patients 351 were males and 78 were females. X-linked (XL) CGD (gp91phox deficient) accounted for 67% of the cases, autosomal recessive (AR) inheritance for 33%. AR-CGD was diagnosed later in life, and the mean survival time was significantly better in AR patients (49.6 years) than in XL CGD (37.8 years), suggesting a milder disease course in AR patients. The disease manifested itself most frequently in the lungs (66% of patients), skin (53%), lymph nodes (50%), gastrointestinal tract (48%) and liver (32%). The most frequently cultured micro-organisms per episode were Staphylococcus aureus (30%), Aspergillus spp. (26%), and Salmonella spp. (16%). Surprisingly, Pseudomonas spp. (2%) and Burkholderia cepacia (<1%) were found only sporadically. Lesions induced by inoculation with BCG occurred in 8% of the patients. Only 71% of the patients received antibiotic maintenance therapy, and 53% antifungal prophylaxis. 33% were treated with ?-interferon. 24 patients (6%) had received a stem cell transplantation. The most prominent reason of death was pneumonia and pulmonary abscess (18/84 cases), septicemia (16/84) and brain abscess (4/84). These data provide further insight in the clinical course of CGD in Europe and hopefully can help to increase awareness and optimize the treatment of these patients.

van den Berg, J. Merlijn; van Koppen, Elsbeth; Ahlin, Anders; Belohradsky, Bernd H.; Bernatowska, Ewa; Corbeel, Lucien; Espanol, Teresa; Fischer, Alain; Kurenko-Deptuch, Magdalena; Mouy, Richard; Petropoulou, Theoni; Roesler, Joachim; Seger, Reinhard; Stasia, Marie-Jose; Valerius, Niels H.; Weening, Ron S.; Wolach, Baruch; Roos, Dirk; Kuijpers, Taco W.



Lung disease with chronic obstruction in opium smokers in Singapore  

PubMed Central

Fifty-four opium smokers with chronic obstructive lung disease were studied for two-and-a-half years. Forty-eight patients had a cough for at least two years before the onset of inappropriate exertional dyspnoea. Fine, bubbling adventitious sounds suggesting small airway disease were heard on auscultation over the middle and lower lobes in 38 patients. The prevalence of inflammatory lung disease and chronic respiratory failure in this series is suggested as the main cause for the frequent finding of right ventricular hypertrophy and congestive heart failure. Physiological studies revealed moderate to severe airways obstruction with gross over-inflation and, in 32 patients, an additional restrictive defect probably due to peribronchiolar fibrosis. Radiological evidence of chronic bronchitis and bronchiolitis was observed in 45 patients, `pure' chronic bronchiolitis in six patients, and `widespread' emphysema in 25 patients respectively. Necropsy examinations in nine patients, however, showed destructive emphysema of variable severity in all. Chronic bronchiolitis often associated with striking bronchiolectasis was present in six cases. More severe bronchiolar rather than bronchial inflammation was noted. The heavy opium smokers had characteristic nodular shadows on chest radiography, sometimes associated with a striking reticular pattern not seen in `pure' cigarette smokers. This was due to gross pigmented dust (presumably carbon) deposition in relation to blood vessels, lymphatics, and bronchioles, and also within the alveoli. It is speculated that the initial lesion is an acquired bronchiolitis. Opium smoking induces an irritative bronchopathy favouring repeated attacks of acute bronchiolitis and eventually resulting in obliterative bronchiolitis, peribronchiolar fibrosis, chronic bronchitis, and destructive emphysema. Images

Da Costa, J. L.; Tock, E. P. C.; Boey, H. K.



Innate Immune Responses and Chronic Obstructive Pulmonary Disease  

PubMed Central

Innate immune responses appear to be partially responsible for maintaining inflammation and tissue destruction in chronic obstructive pulmonary disease. In the early stages of the disease in smokers, the airways are bombarded with large quantities of particulate material, and activation of phagocytic cells results in the release of many of the mediators believed to remodel the airways. Ironically, failure of the innate immune defense system, either by inherited deficiency or as a result of chronic smoke inhalation, is likely to result in increased susceptibility to infectious disease and exacerbations of chronic obstructive pulmonary disease. It is well known that deficiencies in the production of collectins, pentraxins, and complement can lead to increased infections, and several studies indicate that deficiency in one or another innate defense component is associated with increased exacerbations. Corticosteroids reduce exacerbations in part because of their ability to boost the production of innate host-defense molecules. Therapeutic approaches that stimulate the generation of antimicrobial molecules in the lungs might be able to reduce disease exacerbations.

Schleimer, Robert P.



Cancer screening in people who have chronic disease: the example of kidney disease.  


Cancer screening in people with chronic illness has been the subject of considerable debate recently. Despite the increased incidence of cancer and higher risk of cancer deaths in selected populations, such as those with kidney disease, the benefits-to-harms ratio of cancer screening is uncertain and is likely to be different to people without chronic illnesses because of the expected higher competing risk of death from disease other than cancer, and a higher risk of complications associated with the screening, the diagnostic, and the treatment processes. Using kidney disease as an example, the authors reviewed the current evidence for early cancer detection through screening in people with two or more coexistent chronic diseases, discussed the accepted principles underpinning cancer screening, and the applicability of these concepts to individuals with chronic disease. This review suggests that future research that evaluates the screening test accuracy, quality of life of having cancer, and cancer treatment effectiveness, targeting those with chronic illnesses are necessary for the development of an effective, safe, and acceptable cancer screening program among people with two or more chronic diseases. PMID:21338395

Wong, Germaine; Howard, Kirsten; Tong, Allison; Craig, Jonathan C


Pharmacogenetics of chronic obstructive pulmonary disease: challenges and opportunities  

PubMed Central

Similar to other common chronic diseases, chronic obstructive pulmonary disease (COPD) is a heterogeneous disorder with multiple disease subtypes. Candidate gene studies have found genetic associations for COPD-related phenotypes that may be relevant for pharmacogenetics studies, including lung function decline and COPD exacerbations. However, few COPD pharmacogenetics studies have been completed. Most studies have focused on the role of variants in the ?2-adrenergic receptor gene on bronchodilator response, but the findings have been inconclusive. Candidate gene studies highlight the concept that genes for COPD susceptibility may also be relevant in COPD pharmacogenetics. Currently, there are no clinical applications of pharmacogenetics to COPD therapy, but the use of pharmacogenetics to determine initial smoking cessation therapy may be closer to clinical application.

Hersh, Craig P



Factors promoting acute and chronic diseases caused by yersiniae.  

PubMed Central

The experimental system constructed with the medically significant yersiniae provides a powerful basic model for comparative study of factors required for expression of acute versus chronic disease. The system exploits the close genetic similarity between Yersinia pestis, the etiological agent of bubonic plague, and enteropathogenic Yersinia pseudotuberculosis and Yersinia enterocolitica. Y. pestis possesses three plasmids, of which one, shared by the enteropathogenic species, mediates a number of virulence factors that directly or indirectly promote survival within macrophages and immunosuppression. The two remaining plasmids are unique and encode functions that promote acute disease by enhancing bacterial dissemination in tissues and resistance to phagocytosis by neutrophils and monocytes. These properties are replaced in the enteropathogenic yersiniae by host cell invasins and an adhesin which promote chronic disease; the latter are cryptic in Y. pestis. Additional distinctions include specific mutational losses in Y. pestis which result in loss of fitness in natural environments plus gain of properties that facilitate transmission and infection via fleabite. Images

Brubaker, R R



Calorie restriction and prevention of age-associated chronic disease  

PubMed Central

Life expectancy in the world has increased dramatically during the last century; the number of older adults is expected to rise while the number of youths will decline in the near future. This demographic shift has considerable public health and economic implications since aging is associated with the development of serious chronic diseases. Calorie restriction (CR) is the most effective nutritional intervention for slowing aging and preventing chronic disease in rodents. In non-human and human primates, CR with adequate nutrition protects against abdominal obesity, diabetes, hypertension and cardiovascular diseases. Cancer morbidity and mortality are also diminished in CR monkeys, and data obtained from individuals practicing long-term CR show a reduction of metabolic and hormonal factors associated with increased cancer risk.

Omodei, Daniela; Fontana, Luigi



Chronic HIV disease and activation of the coagulation system.  


With current effective antiretroviral treatment, the spectrum of morbidity and mortality during chronic HIV disease has shifted away from AIDS defining clinical events. Persistent abnormalities in coagulation appear to contribute to excess risk for a broad spectrum of non-AIDS defining complications, including, but not limited to, venous and arterial thrombotic disease. Mechanisms specific to HIV disease, antiretroviral therapy, and lifestyle or behavioral factors contribute to a pro-coagulant state, in part, through increased tissue factor activity coupled with a paradoxical decline in the anti-coagulant response. Alterations in coagulation biology in the context of HIV disease appear to be largely a consequence of persistent systemic immune activation, micro- and macro-vascular disease, and, potentially, impaired hepatic synthesis of coagulation factors. The clinical consequences of HIV-related changes in coagulation biology, the degree to which they are unique to HIV disease, and whether they can be mitigated through adjunct treatments, remains a focus of current research. PMID:24034985

Baker, Jason V



Association Between Retinopathy and Cardiovascular Disease in Patients with Chronic Kidney Disease (From the Chronic Renal Insufficiency Cohort [CRIC] Study)  

PubMed Central

Patients with chronic kidney disease (CKD) experience co-morbid illneses including cardiovascular disease (CVD) and retinopathy. The purpose of this study was to assess the association between retinopathy and self reported CVD in a subgroup of the participants of the Chronic Renal Insufficiency Cohort (CRIC) study. In this observational, ancillary investigation, 2605 CRIC participants were invited to participate in this study, and non-mydriatic fundus photographs in both eyes were obtained in 1936 subjects. Photographs were reviewed in a masked fashion at a central photograph reading center. Presence and severity of retinopathy (diabetic, hypertensive or other) and vessel diameter caliber were assessed using standard protocols by trained graders masked to information about study participants. History of self-reported cardiovascular disease was obtained using a medical history questionnaire. Kidney function measurements, traditional and non-traditional risk factors for CVD were obtained from the CRIC study. Greater severity of retinopathy was associated with higher prevalence of any cardiovascular disease and this association persisted after adjustment for traditional risk factors for CVD. Presence of vascular abnormalities usually associated with hypertension was also associated with increased prevalence of CVD. We found a direct relationship between CVD prevalence and mean venular caliber. In conclusion, presence of retinopathy was associated with CVD, suggesting that retinovascular pathology may be indicative of macrovascular disease even after adjustment for renal dysfunction and traditional CVD risk factors. This would make assessment of retinal morphology a valuable tool in chronic kidney disease studies of CVD outcomes.

Grunwald, Juan E.; Ying, Gui-Shuang; Maguire, Maureen; Pistilli, Maxwell; Daniel, Ebenezer; Alexander, Judith; Whittock-Martin, Revell; Parker, Candace; Mohler, Emile; Chia-Mei Lo, Joan; Townsend, Raymond; Gadegbeku, Crystal Ann; Lash, James Phillip; Fink, Jeffrey Craig; Rahman, Mahboob; Feldman, Harold; Kusek, John Walter; Xie, Dawei; Coleman, Martha; Keane, Martin Gerard



[Clinical management of poor sleep quality in patients with chronic obstruction pulmonary disease].  


Sleep disturbance is the most common clinical problem for patients with chronic obstruction pulmonary disease (COPD). Potentially the result of changes in patient breathing patterns, symptoms of the disease, or pharmacological side effects, sleep disturbance can negatively affect COPD patients both physiologically and psychologically. It is therefore important for the medical community to acknowledge the problem through clear observation and suitable application of assessment tools in order to recommend therapies able to promote sleep quality. The article reviews the literature and analyzes clinical cases to discuss the effects of chronic obstruction pulmonary disease on sleep and potential management strategies. I hope this article will be a useful resource for the medical community to improve clinical nursing quality. PMID:22113639

Chen, Pei-Ju; Wang, Kwua-Yun



Women, Environments and Chronic Disease: Shifting the Gaze from Individual Level to Structural Factors  

PubMed Central

Introduction: Chronic heart and respiratory diseases are two of the leading causes of morbidity and mortality affecting women. Patterns of and disparities in chronic diseases between sub-populations of women suggest that there are social as well as individual level factors which enhance or impede the prevention or development of chronic respiratory and cardiovascular diseases. By examining the sex, gender and diversity based dimensions of women’s lung and heart health and how these overlap with environmental factors we extend analysis of preventive health beyond the individual level. We demonstrate how biological, environmental and social factors interact and operate in women’s lives, structuring their opportunities for health and abilities to prevent or manage chronic cardiovascular and respiratory diseases. Methods: This commentary is based on the findings from two evidence reviews, one conducted on women’s heart health, and another on women’s lung health. Additional literature was also reviewed which assessed the relationship between environmental factors and chronic heart and lung diseases. This paper explores how obesogenic environments, exposure to tobacco smoke, and the experience of living in deprived areas can affect women’s heart and respiratory health. We discuss the barriers which impede women’s ability to engage in physical activity, consume healthy foods, or avoid smoking, tobacco smoke, and other airborne contaminants. Results: Sex, gender and diversity clearly interact with environmental factors and shape women’s promotion of health and prevention of chronic respiratory and cardiovascular diseases. The environments women live in structure their opportunities for health, and women navigate these environments in unique ways based on gender, socioeconomic status, race/ethnicity and other social factors. Discussion: Future research, policy and programs relating to the prevention of chronic disease need to move beyond linear individually-oriented models and address these complexities by developing frameworks and interventions which improve environmental conditions for all groups of women. Indeed, in order to improve women’s health, broad social and economic policies and initiatives are required to eliminate negative environmental impacts on women’s opportunities for health.

Hemsing, Natalie; Greaves, Lorraine



Oxysterols in the pathogenesis of major chronic diseases?  

PubMed Central

Pathological accumulation of 27-carbon intermediates or end-products of cholesterol metabolism, named oxysterols, may contribute to the onset and especially to the development of major chronic diseases in which inflammation, but also oxidative damage and to a certain extent cell death, are hallmarks and primary mechanisms of progression. Indeed, certain oxysterols exercise strong pro-oxidant and pro-inflammatory effects at concentrations detectable in the lesions typical of atherosclerosis, neurodegenerative diseases, inflammatory bowel diseases, age-related macular degeneration, and other pathological conditions characterized by altered cholesterol uptake and/or metabolism.

Poli, Giuseppe; Biasi, Fiorella; Leonarduzzi, Gabriella



The strength to cope: spirituality and faith in chronic disease.  


The lifelong management of a chronic condition requires considerable mental fortitude and commitment in social adjustment and adherence to medical advice. In examining strategies of adaptation, we draw on ethnographic research, including interviews with 69 people with type 2 diabetes and/or cardiovascular disease. We explore how they incorporate spirituality into their self-management routines, with positive impact on their health and wellbeing, and highlight the role of spiritual practices in supporting people with chronic conditions mentally, physically and socially, so encouraging personal responsibility for one's health and wellbeing. PMID:22083464

Unantenne, Nalika; Warren, Narelle; Canaway, Rachel; Manderson, Lenore



Management of degenerative disk disease and chronic low back pain.  


Degenerative disk disease is a strong etiologic risk factor of chronic low back pain (LBP). A multidisciplinary approach to treatment is often warranted. Patient education, medication, and cognitive behavioral therapies are essential in the treatment of chronic LBP sufferers. Surgical intervention with a rehabilitation regime is sometimes advocated. Prognostic factors related to the outcome of different treatments include maladaptive pain coping and genetics. The identification of pain genes may assist in determining individuals susceptible to pain and in patient selection for appropriate therapy. Biologic therapies show promise, but clinical trials are needed before advocating their use in humans. PMID:21944588

Karppinen, Jaro; Shen, Francis H; Luk, Keith D K; Andersson, Gunnar B J; Cheung, Kenneth M C; Samartzis, Dino