Sample records for chronic disease exhibit

  1. Endothelial Cells Obtained from Patients Affected by Chronic Venous Disease Exhibit a Pro-Inflammatory Phenotype

    PubMed Central

    Tisato, Veronica; Zauli, Giorgio; Voltan, Rebecca; Gianesini, Sergio; di Iasio, Maria Grazia; Volpi, Ilaria; Fiorentini, Guido; Zamboni, Paolo; Secchiero, Paola

    2012-01-01

    Background The inflammatory properties of vein endothelium in relation to chronic venous disease (CVD) have been poorly investigated. Therefore, new insights on the characteristics of large vein endothelium would increase our knowledge of large vessel physiopathology. Methodology/Principal Findings Surgical specimens of veins were obtained from the tertiary venous network (R3) and/or saphenous vein (SF) of patients affected by CVD and from control individuals. Highly purified venous endothelial cell (VEC) cultures obtained from CVD patients were characterized for morphological, phenotypic and functional properties compared to control VEC. An increase of CD31/PECAM-1, CD146 and ICAM-1 surface levels was documented at flow cytometry in pathological VEC with respect to normal controls. Of note, the strongest expression of these pro-inflammatory markers was observed in VEC obtained from patients with more advanced disease. Similarly, spontaneous cell proliferation and resistance to starvation was higher in pathological than in normal VEC, while the migratory response of VEC showed an opposite trend, being significantly lower in VEC obtained from pathological specimens. In addition, in keeping with a higher baseline transcriptional activity of NF-kB, the release of the pro-inflammatory cytokines osteoprotegerin (OPG) and vascular endothelial growth factor (VEGF) was higher in pathological VEC cultures with respect to control VEC. Interestingly, there was a systemic correlation to these in vitro data, as demonstrated by higher serum OPG and VEGF levels in CVD patients with respect to normal healthy controls. Conclusion/Significance Taken together, these data indicate that large vein endothelial cells obtained from CVD patients exhibit a pro-inflammatory phenotype, which might significantly contribute to systemic inflammation in CVD patients. PMID:22737245

  2. Chronic Diseases

    Microsoft Academic Search

    Sharon R. Schatz

    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

  3. Chronic Kidney Disease (CKD)

    MedlinePLUS

    ... www.kidneyfund.org > Kidney Disease > Chronic Kidney Disease Chronic Kidney Disease (CKD) An estimated 31 million people in the United ... living with chronic kidney disease (CKD). What is CKD? The term “chronic kidney disease” (CKD) means lasting ...

  4. Chronic obstructive pulmonary disease

    MedlinePLUS

    ... airways disease; Chronic obstructive lung disease; Chronic bronchitis; Emphysema; Bronchitis - chronic ... a protein called alpha-1 antitrypsin can develop emphysema. Other risk factors for COPD are: Exposure to ...

  5. GM-CSF Exhibits Anti-Inflammatory Activity on Endothelial Cells Derived from Chronic Venous Disease Patients

    PubMed Central

    Tisato, Veronica; Secchiero, Paola; Rimondi, Erika; Gianesini, Sergio; Menegatti, Erica; Casciano, Fabio; Zamboni, Paolo; Zauli, Giorgio

    2013-01-01

    Twenty patients affected by chronic venous disease (CVD) in tertiary venous network and/or saphenous vein were analyzed before surgical ablation by echo-color-doppler for the hemodynamic parameters reflux time (RT) and resistance index (RI), a negative and a positive prognostic factor, respectively. RT and RI were next correlated with relevant in vitro parameters of venous endothelial cells (VEC) obtained from surgical specimens, such as cell migration in response to serum gradient, proliferation index, intercellular adhesion molecule (ICAM)-1 and vascular cell adhesion molecule (VCAM)-1 expression, as well as cytokines release. Of interest, ICAM-1 expression in patient-derived VEC cultures correlated positively with RT and negatively with RI. Moreover, RT showed a positive correlation with the baseline osteoprotegerin (OPG) expression by VEC and an inverse correlation with VEC proliferation index. On the other hand, RI correlated positively with TNF-related apoptosis inducing ligand (TRAIL) expression. Among the cytokines released by VEC, GM-CSF showed a positive correlation with VEC proliferation and TRAIL expression and a negative correlation with OPG, ICAM-1 and VCAM-1 expression. Since in vitro recombinant GM-CSF induced VEC proliferation and counteracted the induction of ICAM-1, VCAM-1 and OPG upon exposure to TNF-?, our data suggest an anti-inflammatory activity of GM-CSF on venous endothelial cells. PMID:24327798

  6. Chronic thyroiditis (Hashimoto disease)

    MedlinePLUS

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

  7. Chronic Disease Indicators

    NSDL National Science Digital Library

    Center for Disease Control

    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. 

  8. Chronic Kidney Disease

    MedlinePLUS

    ... well as they should. Normal, healthy kidneys remove waste from the blood. The waste then leaves your body in your urine. The ... have chronic kidney disease, your kidneys cannot remove waste from the blood as well as they should. ...

  9. Anemia of chronic disease

    MedlinePLUS

    Anemia of inflammation; AOCD; ACD ... Anemia is a lower-than-normal number of red blood cells in the blood. Some conditions can lead to anemia of chronic disease include: Autoimmune disorders , such as ...

  10. Chronic wasting disease

    Microsoft Academic Search

    Christina J. Sigurdson; Adriano Aguzzi

    2007-01-01

    Until recently, chronic wasting disease of cervids, the only prion disease affecting wildlife, 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

  11. Chronic viral diseases.

    PubMed Central

    Berris, B

    1986-01-01

    Until 20 years ago the only chronic viral diseases known were those considered to be confined to the nervous system. As a result of recent advances in epidemiology, molecular biology and immunology, new viral diseases have been recognized and their clinical features and pathogenesis elucidated. Chronic disease may result from infection with the hepatitis B and D viruses and whatever agent or agents cause hepatitis non-A, non-B, the herpesviruses, Epstein-Barr virus, cytomegalovirus and human T-lymphotropic virus type III. These diseases have common features, including long-term or even lifetime asymptomatic carriage, viremia, with virus free in the plasma or attached to circulating mononuclear cells, presence of virus in body secretions, irreversible tissue injury in target organs and oncogenic potential. New information on these diseases is reviewed. Other chronic diseases for which the cause is currently unknown may eventually prove to be due to viral infection. In addition, vaccines may be developed for prophylaxis of some chronic viral diseases and associated malignant diseases. PMID:3022903

  12. Chronic Wasting Disease

    Microsoft Academic Search

    E. S. Williams

    2005-01-01

    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

  13. Chronic granulomatous disease

    Microsoft Academic Search

    Paul G Heyworth; Andrew R Cross; John T Curnutte

    2003-01-01

    Chronic granulomatous disease (CGD) is a primary immunodeficiency that affects phagocytes of the innate immune system and is characterized by a greatly increased susceptibility to severe bacterial and fungal infections. CGD is caused by mutations in any one of four genes that encode the subunits of phagocyte NADPH oxidase, the enzyme that generates microbicidal (and pro-inflammatory) oxygen radicals. Of the

  14. Chronic obstructive pulmonary disease

    Microsoft Academic Search

    S Singh

    2003-01-01

    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

  15. Chronic Obstructive Pulmonary Disease: A Chronic Systemic Inflammatory Disease

    Microsoft Academic Search

    Stephan F. van Eeden; Don D. Sin

    2008-01-01

    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

  16. Chronic Wasting Disease

    USGS Publications Warehouse

    Richards, Bryan

    2007-01-01

    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.

  17. Epidemic! The World of Infectious Disease - Exhibit

    NSDL National Science Digital Library

    This Web site, created to complement the museum's Epidemic! exhibit, provides an in-depth look at the world of infectious disease. It includes information on how environmental changes can affect the spread of disease, the three major groups of microbes and how disease is spread, and the factors that determine whether an outbreak will become an epidemic or a pandemic. There is a list, organized by topic and specific disease, of more than 250 Web sites and a glossary.

  18. Preventing Chronic Disease

    NSDL National Science Digital Library

    Persons with an interest in public health will want to make a beeline for this rather helpful and well-done journal offered by the Center for Disease Control (CDC). This online-only publication was started in January 2004, and contains a healthy mix of peer-reviewed articles, CDC announcements, and general interest pieces. The journal's interests are quite broad and include reproductive health, oral health, health risk behavior, and the value of policy and legislation in preventing chronic disease. Some of the recent articles in the journal have included pieces on childhood obesity prevention legislation, diabetes and tooth loss, and more specifically, "The Cradle to Prison Pipeline: An American Health Crisis". The site also contains an online archive and information for potential authors, peer reviewers, and information about email updates about new issues.

  19. Chronic Kidney Disease and Medicines

    MedlinePLUS

    ... Disease and Medicines (Brochure) Chronic Kidney Disease and Medicines (Brochure) What You Need to Know Because you ... pharmacist and provider need to know about your medicine and supplement use Your kidneys do not filter ...

  20. Chronic kidney disease.

    PubMed

    Drawz, Paul; Rahman, Mahboob

    2015-06-01

    This issue provides a clinical overview of chronic kidney disease, focusing on prevention, diagnosis, treatment, and patient information. The content of In the Clinic is drawn from the clinical information and education resources of the American College of Physicians (ACP), including ACP Smart Medicine and MKSAP (Medical Knowledge and Self-Assessment Program). Annals of Internal Medicine editors develop In the Clinic from these primary sources in collaboration with the ACP's Medical Education and Publishing divisions and with the assistance of science writers and physician writers. Editorial consultants from ACP Smart Medicine and MKSAP provide expert review of the content. Readers who are interested in these primary resources for more detail can consult http://smartmedicine.acponline.org, http://mksap.acponline.org, and other resources referenced in each issue of In the Clinic. PMID:26030647

  1. Chronic Liver Disease and Hispanic Americans

    MedlinePLUS

    ... Population Profiles > Hispanic/Latino > Chronic Liver Disease Chronic Liver Disease and Hispanic Americans Among the Hispanic/Latino population, chronic liver disease is a leading cause of death. While the ...

  2. Telenursing in Chronic Respiratory Diseases

    Microsoft Academic Search

    Carlos Zamarrón; Emilio Morete; Francisco Gonzalez

    \\u000a Patients with long-term conditions such as chronic pulmonary diseases represent a major health-care problem for the public\\u000a health-care systems. Among these conditions are the sleep apnea syndrome (SAS), neuromuscular diseases with respiratory involvement,\\u000a and chronic obstructive pulmonary disease (COPD). A recent study showed that over 27,000 people died from COPD in 2004 in\\u000a the UK, and that caring for these

  3. Chronic Granulomatous Disease.

    PubMed

    Agarwal, Shreya

    2015-05-01

    Chronic Granulomatous Disease (CGD) is an inherited immunodeficiency disorder characterized by defective functioning of NADPH oxidase enzyme in the phagocytes. This leads to recurrent infections by catalase positive organisms and later, granuloma formation in multiple organs. This condition usually presents in the age group of 2-5 y and is uncommon in neonates. In this case report, we describe a rare case of CGD in a 40-day-old male child who initially presented with a history of erythematous pustular rash on left forearm and refusal to feeds. He remained unresponsive to regular antibiotics. CT chest and abdomen revealed multiple ill-defined lesions suggestive of granulomas or developing abscesses. Immunodeficiency workup showed negative Nitroblue Tetrazolium test and positive Dihydrorhodamine test (flow cytometry). A diagnosis of CGD was then made and treated accordingly. The aim of this report is to highlight the fact that although it is rare for CGD to present at such an early age, but in a neonate with multiple granulomas or abscesses, it should be considered as a differential and worked up accordingly. Early diagnosis and treatment can significantly improve the prognosis. PMID:26155526

  4. Chronic Venous Disease and Comorbidities.

    PubMed

    Matic, P; Jolic, S; Tanaskovic, S; Soldatovic, I; Katsiki, N; Isenovic, E; Radak, Dj

    2015-07-01

    We report the relations between comorbidities and chronic venous disease. In this cross-sectional study, information was gathered from 1679 Serbian patients. The majority (65.0%) of patients were women. Mild forms of chronic venous disease (clinical, etiologic, anatomic and pathophysiologic [CEAP] classification; C0s-C1) were more frequent in women (11.6%), while severe forms (CEAP C4-C6) were more commonly encountered in men (42.1%). The most frequent comorbidity was emphysema/chronic obstructive pulmonary disease in both groups (74.3% in males and 70.6% in females). For females, diabetes mellitus (P < .005), arterial hypertension (P < .000), and skeletal/joint diseases (P < .042) were more commonly found in the C4 to C6 category. Both males and females, with severe form of chronic venous disease, may benefit from additional screening for comorbidities. Further studies are needed to clarify the nature of association among comorbidities and chronic venous disease. PMID:25005764

  5. Cost Estimates for Chronic Diseases

    Microsoft Academic Search

    Jean Woo; Clive Cockram

    2000-01-01

    With increasing chronic disease and disability burden as a result of the aging of populations worldwide, cost estimates of disease and disability are important in determining: 1. the most cost-effective methods in delivering healthcare in order to maximise resources; and 2. health policies and resource allocation. Cost may be divided into direct, indirect and intangible costs. Economic evaluations include cost-benefit,

  6. Children, Sports, and Chronic Disease.

    ERIC Educational Resources Information Center

    Goldberg, Barry

    1990-01-01

    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…

  7. Chronic Disease and the Environment

    NSDL National Science Digital Library

    Physicians for Social Responsibility

    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.

  8. Genetics of Chronic Kidney Disease

    Microsoft Academic Search

    Conall M. O’Seaghdha; Caroline S. Fox

    2011-01-01

    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

  9. The chronic enteropathogenic disease schistosomiasis.

    PubMed

    Olveda, David U; Olveda, Remigio M; McManus, Donald P; Cai, Pengfei; Chau, Thao N P; Lam, Alfred K; Li, Yuesheng; Harn, Donald A; Vinluan, Marilyn L; Ross, Allen G P

    2014-11-01

    Schistosomiasis is a chronic enteropathogenic disease caused by blood flukes of the genus Schistosoma. The disease afflicts approximately 240 million individuals globally, causing approximately 70 million disability-adjusted life years lost. Chronic infections with morbidity and mortality occur as a result of granuloma formation in the intestine, liver, or in the case of Schistosoma haematobium, the bladder. Various methods are utilized to diagnose and evaluate liver fibrosis due to schistosomiasis. Liver biopsy is still considered the gold standard, but it is invasive. Diagnostic imaging has proven to be an invaluable method in assessing hepatic morbidity in the hospital setting, but has practical limitations in the field. The potential of non-invasive biological markers, serum antibodies, cytokines, and circulating host microRNAs to diagnose hepatic fibrosis is presently undergoing evaluation. This review provides an update on the recent advances made with respect to gastrointestinal disease associated with chronic schistosomiasis. PMID:25250908

  10. Diet and Chronic Disease

    Technology Transfer Automated Retrieval System (TEKTRAN)

    Factors that improve insulin sensitivity usually lead to improvements in risk factors associated with the metabolic syndrome, diabetes and cardiovascular diseases. Naturally occurring bioactive compounds that have been shown to improve insulin sensitivity include chromium and polyphenols found in c...

  11. Comorbidity of chronic diseases in general practice

    Microsoft Academic Search

    F. G. Schellevis; J. van der Velden; E. van de Lisdonk; J. T. M. van Eijk; C. van Weel

    1993-01-01

    With the increasing number of elderly people in The Netherlands the prevalence of chronic diseases will rise in the next decades. It is recognized in general practice that many older patients suffer from more than one chronic disease (comorbidity). The aim of this study is to describe the extent of comorbidity for the following diseases: hypertension, chronic ischemic heart disease,

  12. Colitis in chronic granulomatous disease

    Microsoft Academic Search

    M G Schäppi; V V Smith; D Goldblatt; K J Lindley; P J Milla

    2001-01-01

    BACKGROUNDInvolvement of the gut in chronic granulomatous disease (CGD) has been previously described and colitis highlighted. However, the nature and histopathology of the colitis are unclear and have been thought to be non-specific or similar to Crohn's disease.METHODSSeven patients with CGD, suffering from gastrointestinal symptoms were prospectively studied.RESULTSAll patients had anaemia; other symptoms were failure to thrive (5\\/7) and diarrhoea

  13. Nutrition and chronic kidney disease

    Microsoft Academic Search

    Denis Fouque; Solenne Pelletier; Denise Mafra; Philippe Chauveau

    2011-01-01

    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

  14. Prognosis of chronic granulomatous disease

    Microsoft Academic Search

    A Finn; N Hadzi?; G Morgan; S Strobel; R J Levinsky

    1990-01-01

    The records of 28 patients with chronic granulomatous disease born over a 32 year period were reviewed. The characteristics of the group, and the frequency with which various clinical and laboratory features had been recorded, was assessed. Nine patients were known to have died, in most cases of progressive suppurative infection. Actuarial analysis showed 50% survival through the third decade

  15. Disease Management for Chronic Obstructive Pulmonary Disease: A Clinical Strategy

    Microsoft Academic Search

    Brian L. Tiep; Mary C. Barnett

    2008-01-01

    Chronic obstructive pulmonary disease (COPD) is a progressive chronic disease that is subject to acute exacerbations. Ideally, a patient with such a chronic disease should be provided with medical care that addresses these issues while empowering the patient to initiate rapid and definitive treatments to counter exacerbations. To do this, disease management for COPD must recognize that, as this disease

  16. Epidemiology of chronic venous disease.

    PubMed

    Robertson, L; Evans, C; Fowkes, F G R

    2008-01-01

    Chronic venous disease of the legs occurs commonly in the general population in the Western world. Estimates of the prevalence of varicose veins vary widely from 2-56% in men and from 1-60% in women. These variations reflect differences in variability of study populations including age, race and gender, methods of measurement and disease definition. Definitions of chronic venous disease may rely on reports of varicose veins by study participants, based on self-diagnosis or recall of a diagnosis, or on a standardized physical examination. Venous ulceration is less common, affecting approximately 0.3% of the adult population. Age and pregnancy have been established as risk factors for developing varicose veins. Evidence on other risk factors for venous disease is inconclusive. Prolonged standing has been proposed, but results of studies should be interpreted with caution given the difficulty in measuring levels of posture. Obesity has been suggested as a risk factor in women, but appears to be an aggravating factor rather than a primary cause. Other postulated risk factors include dietary intake and smoking, but evidence is lacking. Longitudinal studies using standardized methods of evaluation are required before the true incidence of chronic venous disease and associated risk factors can be determined. PMID:18467617

  17. Chronic Obstructive Pulmonary Disease (COPD)

    NSDL National Science Digital Library

    Patient Education Institute

    This patient education program explains chronic obstructive pulmonary disease (COPD) and emphysema including the causes, symptoms, diagnosis, and treatment options for these diseases. It also reviews the anatomy of the respiratory system. This resource is a MedlinePlus Interactive Health Tutorial from the National Library of Medicine, designed and developed by the Patient Education Institute. NOTE: This tutorial requires a special Flash plug-in, version 4 or above. If you do not have Flash, you will be prompted to obtain a free download of the software before you start the tutorial. You will also need an Acrobat Reader, available as a free download, in order to view the Reference Summary.

  18. Significant Improvement from Chronic Beryllium Disease Following Corticosteroid Pulse Therapy

    Microsoft Academic Search

    Kaoru NAGAOKA; Tsutomu YOSHIDA; Hiroki SAKAKIBARA; Hideki KURITA; Hiroshige TANIWAKI; Yuichiro ONO

    2006-01-01

    Chronic beryllium disease (CBD) is a rare disease characterized by diffuse interstitial pulmonary granulomatosis. We report a case of CBD which exhibited marked improvement both subjectively and objectively following pulse therapy. The patient was a 36-year-old man whose chief complaint was dyspnea and a dry cough. Since July 1990, the patient had been working in the development of an automatic

  19. The unrecognized prevalence of chronic kidney disease in diabetes

    Microsoft Academic Search

    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

    2005-01-01

    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

  20. [Skin and chronic kidney disease].

    PubMed

    Rizzo, Raffaella; Mancini, Elena; Santoro, Antonio

    2014-01-01

    Kidneys and skin are seldom considered associated, but their relationship is more closer than generally believed. In some immunological diseases (SLE...) and genetic syndromes (tuberous sclerosis, Fabrys disease...) the cutaneous manifestations are integral parts of the clinical picture. In advanced uremia, besides the well-known itching skin lesions, calciphylaxis may appear, a typical example of cutaneous involvement secondary to the metabolic complications (calcium-phosphate imbalance) of the renal disease. Nephrogenic systemic fibrosis appears only in patients with renal failure and it has a very severe prognosis due to the systemic organ involvement. Moreover, there is a heterogeneous group of metabolic diseases, with renal involvement, that may be accompanied by skin lesions, either related to the disease itself or to its complications (diabetes mellitus, porphyrias). In systemic amyloidosis, fibrils may deposit even in dermis leading to different skin lesions. In some heroin abusers, in the presence of suppurative lesions in the sites of needle insertion, renal amyloidosis should be suspected, secondary to the chronic inflammation. Atheroembolic disease is nowadays frequently observed, as a consequence of the increasing number of invasive intravascular manoeuvres. Skin manifestations like livedo reticularis or the blue toe syndrome are the most typical signs, but often renal dysfunction is also present. In all these conditions, the skin lesion may be a first sign, a warning, that should arouse the suspicion of a more complex pathology, even with renal involvement. Being aware of this relationship is fundamental to accelerate the diagnostic process. PMID:25315722

  1. New Directions in Chronic Disease Management

    PubMed Central

    Kim, Hun-Sung; Cho, Jae-Hyoung

    2015-01-01

    A worldwide epidemic of chronic disease, and complications thereof, is underway, with no sign of abatement. Healthcare costs have increased tremendously, principally because of the need to treat chronic complications of non-communicable diseases including cardiovascular disease, blindness, end-stage renal disease, and amputation of extremities. Current healthcare systems fail to provide an appropriate quality of care to prevent the development of chronic complications without additional healthcare costs. A new paradigm for prevention and treatment of chronic disease and the complications thereof is urgently required. Several clinical studies have clearly shown that frequent communication between physicians and patients, based on electronic data transmission from medical devices, greatly assists in the management of chronic disease. However, for various reasons, these advantages have not translated effectively into real clinical practice. In the present review, we describe current relevant studies, and trends in the use of information technology for chronic disease management. We also discuss limitations and future directions. PMID:26194075

  2. Hypertrophic osteoarthropathy of chronic inflammatory bowel disease

    SciTech Connect

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

    1982-12-01

    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.

  3. The management of chronic granulomatous disease

    Microsoft Academic Search

    A. Fischer; A. W. Segal; R. Seger; R. S. Weening

    1993-01-01

    Chronic granulomatous disease (CGD) is a primary immunodeficiency disease which results from absence of the NADPH oxidase in the professional phagocytic cells [13] neutrophils, monocytes, macrophages and eosinophils. Deficiency of this oxidase renders the patient liable to infection by bacteria and fungi, and, as the name of the disease suggests, to chronic granulomatous inflammation. These patients present with a great

  4. Management of chronic obstructive pulmonary disease (COPD)

    Microsoft Academic Search

    Peter G. Gibson

    2001-01-01

    SYNOPSIS The expiratory airflow obstruction that characterises chronic obstructive pulmonary disease is usually progressive over time and caused by emphysema, obliterative bronchiolitis, and mucus hypersecretion. Stopping smoking is the only measure that slows the progression of chronic obstructive pulmonary disease, and smokers should be encouraged to stop at all stages of the disease. The effects of medication are limited, and

  5. Is chronic traumatic encephalopathy a real disease?

    PubMed

    Randolph, Christopher

    2014-01-01

    Chronic traumatic encephalopathy (CTE) has received widespread media attention and is treated in the lay press as an established disease, characterized by suicidality and progressive dementia. The extant literature on CTE is reviewed here. There currently are no controlled epidemiological data to suggest that retired athletes are at increased risk for dementia or that they exhibit any type of unique neuropathology. There remain no established clinical or pathological criteria for diagnosing CTE. Despite claims that CTE occurs frequently in retired National Football League (NFL) players, recent studies of NFL retirees report that they have an all-cause mortality rate that is approximately half of the expected rate, and even lower suicide rates. In addition, recent clinical studies of samples of cognitively impaired NFL retirees have failed to identify any unique clinical syndrome. Until further controlled studies are completed, it appears to be premature to consider CTE a verifiable disease. PMID:24412888

  6. Chronic kidney disease and cardiovascular disease in the Medicare population

    Microsoft Academic Search

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

    2003-01-01

    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

  7. Nutrition and Chronic Kidney Disease

    Microsoft Academic Search

    Srinivasan Beddhu

    \\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

  8. The anemia of chronic disease.

    PubMed

    Lee, G R

    1983-04-01

    The anemia of chronic disease (ACD) is defined as a mild anemia associated with a chronic inflammatory, infectious or neoplastic illness and with a characteristic disturbance of iron metabolism. Many of the findings in ACD can be accounted for by release of a monokine called leukocyte endogenous mediator (LEM), endogenous pyrogen, or interleukin-1. This substance is released from "activated" monocytes. Bacterial endotoxins, certain lymphokines and phagocytic challenges are among the factors stimulating its biosynthesis. LEM induces fever, leukocytosis, biosynthesis. LEM induces fever, leukocytosis, and a variety of biochemical changes, including hypoferremia and alterations in plasma protein synthesis, collectively known as the "acute phase response." It is proposed that ACD results from the long-term elaboration of LEM and that release of this material is the common pathogenetic factor found in the illnesses that are associated with ACD. Some suggestions are made for testing the hypothesis. The hypoferremia associated with ACD is probably caused by defective release of iron from cells--particularly from macrophages, but also from hepatocytes and intestinal epithelium. Two possible mechanisms for this abnormality have been proposed: liberation of lactoferrin from neutrophilic leukocytes and induction of apoferritin synthesis. Neither mechanism has been established. Erythrokinetic studies in ACD have detected a modest reduction of erythrocyte survival without an adequate compensatory increase in the rate of red cell production. The reduced erythrocyte survival is probably related to an increase in phagocytic activity by activated macrophages. Impaired bone marrow response is partly related to the restricted iron supply, but there is substantial evidence for an additional defect in erythropoietin secretion. In some malignant diseases, there is evidence of an additional abnormality: impaired marrow response to a normal amount of erythropoietin. The nature of the erythropoietic defects and the relation of LEM to them remain to be established. PMID:6348957

  9. Right Ventricular Dysfunction in Chronic Lung Disease

    PubMed Central

    Kolb, Todd M.; Hassoun, Paul M.

    2012-01-01

    Right ventricular dysfunction arises in chronic lung disease when chronic hypoxemia and disruption of pulmonary vascular beds contribute to increase ventricular afterload, and is generally defined by hypertrophy with preserved myocardial contractility and cardiac output. Although the exact prevalence is unknown, right ventricular hypertrophy appears to be a common complication of chronic lung disease, and more frequently complicates advanced lung disease. Right ventricular failure is rare, except during acute exacerbations of chronic lung disease or when multiple co-morbidities are present. Treatment is targeted at correcting hypoxia and improving pulmonary gas exchange and mechanics. There are presently no convincing data to support the use of pulmonary hypertension-specific therapies in patients with right ventricular dysfunction secondary to chronic lung disease. PMID:22548815

  10. Disability in brisbane caused by chronic disease.

    PubMed

    Smithurst, B A

    1973-12-01

    Chronic diseases and the disabilities which they cause are the most important problem in Public Health. Ischaemic Heart Disease with its clinical manifestations of myocardial infarction and angina pectoris is a prime example of a chronic disease with acute complications which may lead either to death (ischaemic heart disease being the most common cause of death in Australia) or to permanent or semi-permanent invalidism. In the study of the epidemiology of chronic (disease there are certain problems encountered which are not faced in acute disease epidemiology. These include varying criteria for diagnosis (for example, what levels constitute normal blood pressure), the absence of an "incubation period" for the disease - when, for example, does arteriosclerosis begin in an individual - and a dearth of accurate incidence figures because most data on chronic disease are mortality data which, because of under reporting and incorrect diagnosis, may not give a true picture of the fatal effects of chronic disease. Death from cerebrovascular disease accounted for 1254 deaths per 10(6) population in Australia in 1970 yet hypertension only caused 139 deaths per 10(6). It is obvious that many death certificates recording stroke deaths do not mention hypertension which is a common cause of stroke. It can be seen that academic research into chronic disease epidemiology is fraught with many serious difficulties. PMID:25026021

  11. Chronic Liver Disease and Asian Americans/Pacific Islanders

    MedlinePLUS

    ... Population Profiles > Asian American > Chronic Liver Disease Chronic Liver Disease and Asian Americans/Pacific Islanders Among Asian Americans, chronic liver disease is a leading cause of death. While the ...

  12. Chronic Liver Disease and Native Hawaiian/Pacific Islanders

    MedlinePLUS

    ... Hawaiian/Other Pacific Islander > Chronic Liver Disease Chronic Liver Disease and Native Hawaiian/Pacific Islander Native Hawaiian/Pacific ... times more likely to be diagnosed with chronic liver disease in 2006. American Samoans were 8 times more ...

  13. Chronic opioid pain management for chronic kidney disease.

    PubMed

    Nagar, Vittal R; Birthi, Pravardhan

    2015-03-01

    Questions from patients about pain conditions, pain treatment, and responses from authors are presented to help educate patients and make them effective self-advocates. The topics addressed in this issue are renal or kidney failure and chronic pain management with opioids, morphine, and oxycodone effect in the body over a period of time. This includes process of absorption, distribution, localization in tissues, biotransformation and excretion in chronic kidney disease, expected side effects and recommendations. PMID:25558925

  14. Chronic kidney disease post-liver transplantation

    Microsoft Academic Search

    Aisling O'Riordan; Vincent Wong; P. Aiden McCormick; John E. Hegarty; Alan J. Watson

    Background. Renal disease is a recognized complica- tion of orthotopic liver transplantation (OLT). We aimed to determine the incidence of all stages of chronic kidney disease (CKD), as defined in the Kidney Disease Outcomes Quality Initiative Guidelines. We also wanted to determine the risk factors for development of CKD and its impact on patient survival. Methods. All patients who underwent

  15. Cardiovascular complications of pediatric chronic kidney disease

    PubMed Central

    2006-01-01

    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. PMID:17120060

  16. Singing the Chronic Obstructive Pulmonary Disease Blues

    Microsoft Academic Search

    Neil S. Cherniack

    2002-01-01

    Because little progress has been made in devising interventions that reverse or slow the progressive destruction of lung tissue in chronic obstructive pulmonary disease (COPD) we can treat only its secondary effects such as hypoxemia. Long-term oxygen therapy directed at overcoming chronic hypoxemia in COPD (the COPD blues) prolongs the life of patients whose arterial PO2 is less than 55

  17. WILDLIFE DISEASES SURVEILLANCE TO DETECT CHRONIC WASTING DISEASE IN

    E-print Network

    Mladenoff, David

    Chronic wasting disease (CWD) is a fatal neurodegenerative disease of mule deer (Odocoileus hemionus of 2002 and 2003 to determine the distribution of CWD in white-tailed deer (Odocoileus virginianus). Deer wasting disease, disease surveillance, Odocoileus virginianus, white- tailed deer, Wisconsin. INTRODUCTION

  18. The genetics of chronic obstructive pulmonary disease

    E-print Network

    2001-01-11

    Abstract 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...

  19. Anemia of Inflammation and Chronic Disease

    MedlinePLUS

    ... of life for people with chronic illnesses. To learn more about clinical trials, why they matter, and ... the NIDDK has established information services to increase knowledge and understanding about health and disease among patients, ...

  20. Inflammation and cachexia in chronic kidney disease

    Microsoft Academic Search

    Wai W. Cheung; Kyung Hoon Paik; Robert H. Mak

    2010-01-01

    Chronic inflammation is associated with cachexia and increased mortality risk in patients with chronic kidney disease (CKD)\\u000a and end-stage renal disease (ESRD). Inflammation suppresses appetite and causes the loss of protein stores. In CKD patients,\\u000a increased serum levels of pro-inflammatory cytokines may be caused by reduced renal function, volume overload, oxidative or\\u000a carbonyl stress, decreased levels of antioxidants, increased susceptibility

  1. Glycemic index in chronic disease: a review

    Microsoft Academic Search

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

    2002-01-01

    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

  2. Glycemic index in chronic disease: a review

    Microsoft Academic Search

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

    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

  3. Drinking water quality and chronic disease

    Microsoft Academic Search

    Ernest Angino; Bobby G. Wixson; Ivan Smith

    1977-01-01

    A series of drinking water samples from several major U.S. cities was analyzed last year and found to contain possible disease-causing agents. With the discovery of these potentially dangerous substances came the question of the relationship between many chronic diseases and the chemical composition of treated water. This question was discussed at a workshop held under the auspices of the

  4. Understanding Variation in Chronic Disease Outcomes

    Microsoft Academic Search

    Paul E. Johnson; Peter J. Veazie; Laura Kochevar; Patrick J. O'Connor; Sandra J. Potthoff; Devesh Verma; Pradyumna Dutta

    2002-01-01

    We propose an explanation for variation in disease outcomes based on patient adaptation to the conditions of chronic disease. We develop a model of patient adaptation using the example of Type 2 diabetes mellitus and assumptions about the process entailed in transforming self-care behaviors of compliance with treatment, compliance with glucose monitoring, and patient's knowledge seeking behavior into health outcomes

  5. Systemic manifestations of chronic obstructive pulmonary disease.

    PubMed

    Warwick, Eleanor; Scourfield, Andrew; Quint, Jennifer

    2015-06-01

    Chronic obstructive pulmonary disease is a complex multisystem disease with comorbidities and systemic manifestations that affect respiratory symptoms, exacerbation frequency and mortality. This article gives an overview of these systemic manifestations and their importance, and offers strategies for managing them. PMID:26053902

  6. Dermatological diseases in patients with chronic kidney disease

    PubMed Central

    Gagnon1, Amy L.; Desai, Tejas

    2013-01-01

    Context: There are a variety of dermatological diseases that are more commonly seen in patients with chronic kidney disease (CKD) and renal transplants than the general population. Evidence Acquisitions: Directory of Open Access Journals (DOAJ), Google Scholar, Pubmed (NLM), LISTA (EBSCO) and Web of Science has been searched. Results: Some cutaneous diseases are clearly unique to this population. Of them, Lindsay’s Nails, xerosis cutis, dryness of the skin, nephrogenic systemic fibrosis and acquired perforating dermatosis have been described in chronic kidney disease patients. The most common malignancy found in all transplant recipients is non-melanoma skin cancer. Conclusions: It is important for patients and physicians to recognize the manifestations of skin disease in patients suffering from chronic kidney disease to mitigate the morbidity associated with these conditions. PMID:24475435

  7. Chronic sequelae of foodborne disease.

    PubMed Central

    Lindsay, J. A.

    1997-01-01

    In the past decade the complexity of foodborne pathogens, as well as their adaptability and ability to cause acute illness, and in some cases chronic (secondary) complications, have been newly appreciated. This overview examines long-term consequences of foodborne infections and intoxications to emphasize the need for more research and education. PMID:9366595

  8. Cardiovascular complications of pediatric chronic kidney disease

    Microsoft Academic Search

    Mark M. Mitsnefes

    2008-01-01

    Cardiovascular disease (CVD) mortality is a leading cause of death in adult chronic kidney disease (CKD), with exceptionally\\u000a high rates in young adults, according to the Task Force on Cardiovascular Disease. Recent data indicate that cardiovascular\\u000a complications are already present in children with CKD. This review summarizes the current literature on cardiac risk factors,\\u000a mortality and morbidity in children with

  9. Epidemiology of chronic obstructive pulmonary disease

    Microsoft Academic Search

    J. M. Antó; P. Vermeire; J. Vestbo; J. Sunyer

    2001-01-01

    ABSTRACT: Chronic obstructive pulmonary,disease (COPD) is a leading cause of world-wide mortality and disability. On average y5–15% of adults in industrialized countries have COPD defined by spirometry. In 1990, COPD was considered to be at the twelfth position world-wide as a cause of combined,mortality and disability but is expected,to become,the fifth cause by the year 2020. COPD has a chronic

  10. Systemic effects of chronic obstructive pulmonary disease

    Microsoft Academic Search

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

    2003-01-01

    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

  11. Framing international trade and chronic disease

    PubMed Central

    2011-01-01

    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

  12. Framing international trade and chronic disease.

    PubMed

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

    2011-01-01

    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

  13. Systemic Diseases and Chronic Rhinosinusitis

    Microsoft Academic Search

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

    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

  14. Pathological mimics of chronic inflammatory bowel disease.

    PubMed Central

    Shepherd, N A

    1991-01-01

    When all of the macroscopic and microscopic features of Crohn's disease and ulcerative colitis are present, the correct diagnosis is usually made without difficulty. When some of the changes are absent, the accuracy of diagnosis is reduced. This review has outlined those diseases which feature some of these pathological changes and may masquerade as idiopathic chronic inflammatory bowel disease. Some of the pathological mimics are iatrogenic while other common diseases, such as bacterial infection, ischaemia, and diverticulosis may produce confusing histological appearances. The picture is complicated by the fact that many of these pathological imitators may themselves cause or predispose to chronic inflammatory bowel disease, or may complicate chronic inflammatory bowel disease. For example, drugs and infectious agents are recognisable causes of relapse in ulcerative colitis; Crohn's disease may cause diverticulitis in patients with diverticulosis; and lymphoma may complicate ulcerative colitis. It behooves all practising histopathologists to recognise these mimics of ulcerative colitis and Crohn's disease to ensure appropriate management for patients with inflammatory pathology of the intestines. Images PMID:1918397

  15. Sexuality and Chronic Kidney Disease

    MedlinePLUS

    ... with kidney disease or kidney failure still enjoy sex? It's important to remember that people with kidney ... healthcare professional. What if I lose interest in sex? Your interest in sex may change when you ...

  16. Transgenic Mouse Model of Chronic Beryllium Disease

    SciTech Connect

    Gordon, Terry

    2009-05-26

    Animal models provide powerful tools for dissecting dose-response relationships and pathogenic mechanisms and for testing new treatment paradigms. Mechanistic research on beryllium exposure-disease relationships is severely limited by a general inability to develop a sufficient chronic beryllium disease animal model. Discovery of the Human Leukocyte Antigen (HLA) - DPB1Glu69 genetic susceptibility component of chronic beryllium disease permitted the addition of this human beryllium antigen presentation molecule to an animal genome which may permit development of a better animal model for chronic beryllium disease. Using FVB/N inbred mice, Drs. Rubin and Zhu, successfully produced three strains of HLA-DPB1 Glu 69 transgenic mice. Each mouse strain contains a haplotype of the HLA-DPB1 Glu 69 gene that confers a different magnitude of odds ratio (OR) of risk for chronic beryllium disease: HLA-DPB1*0401 (OR = 0.2), HLA-DPB1*0201 (OR = 15), HLA-DPB1*1701 (OR = 240). In addition, Drs. Rubin and Zhu developed transgenic mice with the human CD4 gene to permit better transmission of signals between T cells and antigen presenting cells. This project has maintained the colonies of these transgenic mice and tested the functionality of the human transgenes.

  17. Cardiovascular disease in patients with chronic kidney disease

    PubMed Central

    Wright, Julian; Hutchison, Alastair

    2009-01-01

    Patients with chronic kidney disease have a high burden of cardiovascular morbidity and mortality. The vast majority of patients with chronic kidney disease do not progress to end stage renal failure, but do have a significantly higher incidence of all cardiovascular co-morbidities. Traditional cardiovascular risk factors only partially account for this increased incidence of cardiovascular disease. In patients with kidney disease the basic biology underlying cardiovascular disease may be similar to that in patients without kidney disease, but it would seem many more risk factors are involved as a consequence of renal dysfunction. Although emphasis is placed on delaying the progression of chronic kidney disease, it must be appreciated that for many patients it is vital to address their cardiovascular risk factors at an early stage to prevent premature cardiovascular death. This review examines available epidemiological evidence, discusses common cardiovascular risk factors in patients with chronic kidney disease, and suggests possible treatment strategies. Potential areas for important research are also described. PMID:19756163

  18. Defining exacerbations in chronic obstructive pulmonary disease.

    PubMed

    Hawkins, Padraig E; Alam, Jamshed; McDonnell, Timothy J; Kelly, Emer

    2015-06-01

    Chronic obstructive pulmonary disease is a very common disease often punctuated by intermittent episodes of exacerbation. These exacerbations affect the natural history of the disease, accelerating a decline in lung function. They affect the individual in many ways and affect the health service caring for these patients. The definition of exacerbation varies and lacks clarity. The definitions used most are either symptom based, for example, breathlessness, sputum production and sputum purulence, or event driven, for example, an event causing a patient to seek healthcare input or change to medications. In this article, we discuss the importance of exacerbations, the clinical definitions, clinical trial definitions, physiological and biomarker evidence of exacerbations and the challenges associated with each of these. Application of a practical definition would aid in our clinical management of patients with chronic obstructive pulmonary disease and facilitate developments in future therapeutic advances through clinical trials. PMID:26013261

  19. Ethical considerations in chronic musculoskeletal disease.

    PubMed

    MacKenzie, C Ronald; de Melo-Martin, Inmaculada

    2015-06-01

    Chronic diseases compromise the life of the sufferer, encumber their families, and exert intractable burdens on the health-care system. With the aging of the population, such conditions have become the primary determinants of morbidity and mortality and the leading cause of disability in our society. Despite the serious challenges they impose, the ethical discourse engendered by them has lagged behind that of acute care medicine. Of particular relevance are the challenges to individual autonomy, as the dilemmas arising in the chronic care setting have not only medical but personal and societal dimensions, may require the input of multiple participants, and resolve over longer periods of time. As such, the conventional model of autonomy is often inadequate to address problems in the chronic care setting. This paper deals with this dilemma through an examination of a clinical scenario. A framework for the exploration of ethical problems in the chronic care setting is thus presented. PMID:25864103

  20. New Therapies for Chronic Obstructive Pulmonary Disease

    Microsoft Academic Search

    Peter J. Barnes

    2010-01-01

    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

  1. Framing international trade and chronic disease

    Microsoft Academic Search

    Ronald Labonté; Katia S Mohindra; Raphael Lencucha

    2011-01-01

    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

  2. Platelet function in chronic liver disease

    Microsoft Academic Search

    M. H. Rubin; M. J. Weston; P. G. Langley; Yvette White; Roger Williams

    1979-01-01

    Abnormalities of platelet aggregation in response to adenosine diphosphate in 56 patients with chronic liver disease correlated with impairment of hepatocellular function but not with the etiology of the liver disease. Platelet-poor plasma from some patients appeared to contain an inhibitor since, in cross-over studies, it reduced the degree of aggregation of control subjects. However, platelet-poor plasma from some other

  3. Pancreatic function in chronic inflammatory bowel disease

    Microsoft Academic Search

    G. Angelini; G. Cavallini; P. Bovo; G. Brocco; A. Castagnini; E. Lavarini; F. Merigo; N. Tallon; L. A. Scuro

    1988-01-01

    Summary  This study was prospectively carried out to evaluate the frequency and clinical significance of pancreatic impairment in the\\u000a course of chronic inflammatory bowel disease (CIBD). Twenty-seven patients affected by ulcerative colitis or Crohn's disease\\u000a were submitted to a secretin-cerulein test, oral glucose test (OGT) and to indirect immunofluorescence (IFL) for detection\\u000a of autoantibodies against exocrine and endocrine tissue. A bicarbonate

  4. Chronically Injured Supraspinal Neurons Exhibit Only Modest Axonal Dieback in Response to a Cervical Hemisection Lesion

    Microsoft Academic Search

    John D. Houle; Ying Jin

    2001-01-01

    This study examined the extent of axon retraction (dieback) exhibited by injured brain stem neurons in a chronic spinal cord injury (SCI) condition. Adult female rats subjected to a cervical (C3) hemisection lesion were sacrificed 1, 4, 8, or 14 weeks after injury and the spinal cord from C1 to the lesion cavity was removed. One week prior to sacrifice,

  5. Endothelial Dysfunction in Chronic Inflammatory Diseases

    PubMed Central

    Steyers, Curtis M.; Miller, Francis J.

    2014-01-01

    Chronic inflammatory diseases are associated with accelerated atherosclerosis and increased risk of cardiovascular diseases (CVD). As the pathogenesis of atherosclerosis is increasingly recognized as an inflammatory process, similarities between atherosclerosis and systemic inflammatory diseases such as rheumatoid arthritis, inflammatory bowel diseases, lupus, psoriasis, spondyloarthritis and others have become a topic of interest. Endothelial dysfunction represents a key step in the initiation and maintenance of atherosclerosis and may serve as a marker for future risk of cardiovascular events. Patients with chronic inflammatory diseases manifest endothelial dysfunction, often early in the course of the disease. Therefore, mechanisms linking systemic inflammatory diseases and atherosclerosis may be best understood at the level of the endothelium. Multiple factors, including circulating inflammatory cytokines, TNF-? (tumor necrosis factor-?), reactive oxygen species, oxidized LDL (low density lipoprotein), autoantibodies and traditional risk factors directly and indirectly activate endothelial cells, leading to impaired vascular relaxation, increased leukocyte adhesion, increased endothelial permeability and generation of a pro-thrombotic state. Pharmacologic agents directed against TNF-?-mediated inflammation may decrease the risk of endothelial dysfunction and cardiovascular disease in these patients. Understanding the precise mechanisms driving endothelial dysfunction in patients with systemic inflammatory diseases may help elucidate the pathogenesis of atherosclerosis in the general population. PMID:24968272

  6. Chronic granulomatous disease, a heterogeneous syndrome

    Microsoft Academic Search

    W. H. Hitzig; R. A. Seger

    1983-01-01

    Chronic granulomatous disease (CGD) is a clinical syndrome, the unifying characteristics of which are a severe predisposition to bacterial and fungal infections, an impaired ability of phagocytic leukocytes to kill certain microorganisms and the failure of these cells to produce microbicidal oxygen metabolites. In CGD the causal biochemical defect and the mechanism of genetic transmission vary from family to family.

  7. Case Management of Adolescents with Chronic Disease.

    ERIC Educational Resources Information Center

    Lankard, Bettina A.

    This training guide presents a model for optimum delivery of the primary duties, tasks, and steps required in the comprehensive case management of adolescents with chronic disease. Using a team approach to coordinated health care, the guide involves the patient and family as key members of the care team along with the physician, nurse, dietitian,…

  8. Antioxidants and Prevention of Chronic Disease

    Microsoft Academic Search

    JOYE K. WILLCOX; SARAH L. ASH; GEORGE L. CATIGNANI

    2004-01-01

    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

  9. Gene therapy for chronic granulomatous disease

    Microsoft Academic Search

    Akihiro Kume; Mary C Dinauer

    2000-01-01

    Recent progress in the development of gene therapy for chronic granulomatous disease (CGD), an inherited immunodeficiency syndrome, is reviewed. This disorder results from defects in any of the four genes encoding essential subunits of respiratory burst oxidase, the superoxide-generating enzyme complex in phagocytic leukocytes. The absence of respiratory burst oxidants results in recurrent bacterial and fungal infections and can also

  10. Modern management of chronic granulomatous disease

    Microsoft Academic Search

    Reinhard A. Seger

    2008-01-01

    Summary Chronic granulomatous disease (CGD) is a rare primary immunodeficiency disorder of phagocytic cells resulting in failure to kill a characteristic spectrum of bacteria and fungi and in defective degradation of inflammatory mediators with concomitant granuloma formation. Current prophylaxis with trimethoprim-sulfamethoxazole, itraconazole and in selected cases additional interferon gamma is efficient, but imperfect. A significant recent progress towards new antibiotic

  11. Mucin overproduction in chronic inflammatory lung disease

    PubMed Central

    Hauber, Hans-Peter; Foley, Susan C; Hamid, Qutayba

    2006-01-01

    Mucus overproduction and hypersecretion are commonly observed in chronic inflammatory lung disease. Mucins are gel-forming glycoproteins that can be stimulated by a variety of mediators. The present review addresses the mechanisms involved in the upregulation of secreted mucins. Mucin induction by neutrophil elastase, bacteria, cytokines, growth factors, smoke and cystic fibrosis transmembrane conductance regulator malfunction are also discussed. PMID:16983448

  12. Physical Therapy for Children with Chronic Lung Disease

    Microsoft Academic Search

    JAN STEPHEN TECKLIN

    Chronic lung disease is a major health problem among children. Estimates suggest that one child in six has a chronic respiratory condition. This article reviews three common chronic respiratory conditions occurring in childhood for which physical therapy is usually recommended. The cause, pathophysiology, and medical treatment are explained for asthma, respiratory complications of chronic neuromuscular disease, and cystic fibrosis. The

  13. Osteoporosis in Chronic Obstructive Pulmonary Disease

    PubMed Central

    Sarkar, Malay; Bhardwaj, Rajeev; Madabhavi, Irappa; Khatana, Jasmin

    2015-01-01

    Chronic obstructive pulmonary disease (COPD) is a lifestyle-related chronic inflammatory pulmonary disease associated with significant morbidity and mortality worldwide. COPD is associated with various comorbidities found in all stages of COPD. The comorbidities have significant impact in terms of morbidity, mortality, and economic burden in COPD. Management of comorbidities should be incorporated into the comprehensive management of COPD as this will also have an effect on the outcome in COPD patients. Various comorbidities reported in COPD include cardiovascular disease, skeletal muscle dysfunction, anemia, metabolic syndrome, and osteoporosis. Osteoporosis is a significant comorbidity in COPD patients. Various risk factors, such as tobacco smoking, systemic inflammation, vitamin D deficiency, and the use of oral or inhaled corticosteroids (ICSs) are responsible for its occurrence in patients with COPD. This review will focus on the prevalence, pathogenesis, risk factors, diagnosis, and treatment of osteoporosis in COPD patients. PMID:25788838

  14. Chronic Kidney Disease-Mineral and Bone Disorder

    MedlinePLUS

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

  15. Chronic Liver Disease and American Indians/Alaska Natives

    MedlinePLUS

    ... Chronic Liver Disease Chronic Liver Disease and American Indians/Alaska Natives Among American Indians and Alaska Natives, ... 1 At a glance – Cancer Rates for American Indian/Alaska Natives (2008-2012) Cancer Incidence Rates per ...

  16. Helping to Combat Chronic Wasting Disease

    USGS Publications Warehouse

    U.S. Geological Survey

    2003-01-01

    Chronic wasting disease (CWD) is a disease of the nervous system that results in distinctive brain lesions. CWD affects elk, white-tailed deer, and mule deer, but has not been documented in livestock or humans. The origins of the disease, as well as the modes of transmission, remain unknown. Infected deer and elk appear robust and healthy in the early stages of CWD; clinical signs might not show for years. Mortality typically occurs within months after the appearance of clinical signs. The route of transmission is unknown; likely routes include direct transmission between infected and noninfected animals and infected animals contaminating local environments.

  17. Exacerbation of chronic obstructive pulmonary disease.

    PubMed

    Ismail, T S

    2009-09-01

    Acute exacerbations of chronic obstructive pulmonary disease (COPD) are important events in COPD patients and place a large burden on healthcare resources. COPD patients with frequent exacerbations have accelerated decline in lung function, poorer health status and are at higher risk of mortality. The mainstay of treatment includes increasing short acting bronchodilator therapy and systemic glucocorticosteroids with or without antibiotics. Non invasive ventilation is indicated in those with respiratory failure with acidosis or hypercapnia. Preventive strategies to reduce exacerbations include smoking cessation, immunisation against influenza and S. pneumonia, chronic maintenance inhaled pharmacotherapy, pulmonary rehabilitation and self management education. PMID:20527283

  18. Age-Associated Chronic Diseases Require Age-Old Medicine: Role of Chronic Inflammation

    PubMed Central

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

    2012-01-01

    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

  19. Ursodeoxycholic acid in chronic liver disease.

    PubMed Central

    de Caestecker, J S; Jazrawi, R P; Petroni, M L; Northfield, T C

    1991-01-01

    The hydrophilic bile acid ursodeoxycholic acid has recently been shown to reduce biochemical markers of both cholestasis and hepatocellular damage in patients with chronic liver diseases. The most compelling evidence available is for chronic cholestatic liver diseases, in particular primary biliary cirrhosis, primary sclerosing cholangitis, and cholestasis associated with cystic fibrosis. The effects may be less beneficial in patients with advanced liver disease from these conditions. Data from placebo controlled trials are now available in support of earlier uncontrolled observations, but it is not yet clear whether short term benefit results in an improvement in longterm prognosis. The mechanism of action of the compound seems to reside in its displacement of toxic hydrophobic bile acids from both the bile acid pool and hepatocellular membranes. There may be an independent effect on bile flow, which could be of particular importance in cystic fibrosis, and possibly an effect on the immune system. Ursodeoxycholic acid should now be regarded as occupying a central place in the medical management of chronic cholestatic liver diseases, in particular primary biliary cirrhosis, because it improves cholestasis and reduces hepatocellular damage and it is not toxic. Research should now be targeted on whether treatment with ursodeoxycholic acid, initiated early in cholestatic liver conditions, improves the long-term outcome. PMID:1916492

  20. Hypertension and chronic kidney disease in Turkey.

    PubMed

    Sengul, Sule; Erdem, Yunus; Batuman, Vecihi; Erturk, Sehsuvar

    2013-12-01

    Worldwide, both hypertension and chronic kidney disease are major public health problems, due to their epidemic proportions and their association with high cardiovascular mortality. In 2003, the first Prevalence, awareness, treatment, and control of hypertension in Turkey (the PatenT) study was conducted in a nationally representative population (n=4910) by the Turkish Society of Hypertension and Renal Diseases, and showed that overall age- and sex-adjusted prevalence of hypertension in Turkey was 31.8%. The PatenT study also reported that overall awareness (40.7%), treatment (31.1%), and control rates (8.1%) of hypertension were strikingly low. Only 20.7% of the patients who were aware of their hypertension and receiving treatment had their blood pressure controlled to <140/90?mm?Hg. In the Chronic Renal Disease in Turkey (CREDIT) study (n=10,748), the overall prevalence of chronic kidney (including all stages) disease was 15.7% and increased with advancing age. In the same population, the prevalence of hypertension, diabetes mellitus, dyslipidemia, obesity, and metabolic syndrome were reported as 32.7%, 12.7%, 76.3%, 20.1%, and 31.3%, respectively. The prevalence and awareness of hypertension in CREDIT population was 32.7% and 48.6%, respectively. According to the data obtained from national surveys, the prevalence of hypertension and chronic kidney disease in Turkey is alarmingly high. To improve prevention, early diagnosis, and treatment of these major public health problems, appropriate health strategies should be implemented by the government, together with medical societies, non-governmental organizations, industry, health-care providers, and academia. PMID:25019009

  1. Chronic wasting disease in Canada: Part 1

    PubMed Central

    2004-01-01

    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. PMID:15206588

  2. [Pneumococcal vaccine recommendations in chronic respiratory diseases].

    PubMed

    Casas Maldonado, F; Alfageme Michavila, I; Barchilón Cohen, V S; Peis Redondo, J I; Vargas Ortega, D A

    2014-09-01

    Community-acquired pneumonia is an acute respiratory infectious disease which has an incidence of 3-8 cases/1,000 inhabitants, and increases with age and comorbidities. The pneumococcus is the organism most frequently involved in community-acquired pneumonia in the adult (30-35%). Around 40% of patients with community-acquired pneumonia require hospital admission, and around 10% need to be admitted to an intensive care unit. The most serious forms of pneumococcal infection include invasive pneumococcal disease (IPD), which covers cases of bacteremia (associated or not to pneumonia), meningitis, pleuritis, arthritis, primary peritonitis and pericarditis. Currently, the biggest problem with the pneumococcus is the emergence of resistance to antimicrobial agents, and its high morbimortality, despite the use of appropriate antibiotics and proper medical treatment. Certain underlying medical conditions increase the risk of IPD and its complications, especially, from the respiratory diseases point of view, smoking and chronic respiratory diseases. Pneumococcal disease, according to the WHO, is the first preventable cause of death worldwide in children and adults. Among the strategies to prevent IPD is vaccination. WHO considers that its universal introduction and implementation against pneumococcus is essential and a priority in all countries. There are currently 2 pneumococcal vaccines for adults: the 23 serotypes polysaccharide and conjugate 13 serotypes. The scientific societies represented here have worked to develop some recommendations, based on the current scientific evidence, regarding the pneumococcal vaccination in the immunocompetent adult with chronic respiratory disease and smokers at risk of suffering from IPD. PMID:25107494

  3. Management of hepatitis C in patients with chronic kidney disease

    PubMed Central

    Carvalho-Filho, Roberto J; Feldner, Ana Cristina CA; Silva, Antonio Eduardo B; Ferraz, Maria Lucia G

    2015-01-01

    Hepatitis C virus (HCV) infection is highly prevalent among chronic kidney disease (CKD) subjects under hemodialysis and in kidney transplantation (KT) recipients, being an important cause of morbidity and mortality in these patients. The vast majority of HCV chronic infections in the hemodialysis setting are currently attributable to nosocomial transmission. Acute and chronic hepatitis C exhibits distinct clinical and laboratorial features, which can impact on management and treatment decisions. In hemodialysis subjects, acute infections are usually asymptomatic and anicteric; since spontaneous viral clearance is very uncommon in this context, acute infections should be treated as soon as possible. In KT recipients, the occurrence of acute hepatitis C can have a more severe course, with a rapid progression of liver fibrosis. In these patients, it is recommended to use pegylated interferon (PEG-IFN) in combination with ribavirin, with doses adjusted according to estimated glomerular filtration rate. There is no evidence suggesting that chronic hepatitis C exhibits a more aggressive course in CKD subjects under conservative management. In these subjects, indication of treatment with PEG-IFN plus ribavirin relies on the CKD stage, rate of progression of renal dysfunction and the possibility of a preemptive transplant. HCV infection has been associated with both liver disease-related deaths and cardiovascular mortality in hemodialysis patients. Among those individuals, low HCV viral loads and the phenomenon of intermittent HCV viremia are often observed, and sequential HCV RNA monitoring is needed. Despite the poor tolerability and suboptimal efficacy of antiviral therapy in CKD patients, many patients can achieve sustained virological response, which improve patient and graft outcomes. Hepatitis C eradication before KT theoretically improves survival and reduces the occurrence of chronic graft nephropathy, de novo glomerulonephritis and post-transplant diabetes mellitus. PMID:25593456

  4. The Pathogenesis of Chronic Myeloproliferative Diseases

    Microsoft Academic Search

    Ayalew Tefferi

    2001-01-01

    Chronic myeloproliferative disorders are operationally classified to include essential thrombocythemia, polycythemia vera,\\u000a and agnogenic myeloid metaplasia. In most cases, clonal hematopoiesis, involving all 3 myeloid lineages, can be demonstrated.\\u000a However, the underlying molecular lesions that are responsible for disease initiation and progression remain elusive. There\\u000a are ongoing efforts to clarify the pathogenetic role of cytokines, bone marrow stromal cells and

  5. Management of chronic obstructive pulmonary disease

    Microsoft Academic Search

    Dipak Chandy; Wilbert S. Aronow

    2006-01-01

    Original Article  Chronic obstructive pulmonary disease (COPD) is a major cause of mortality and morbidity throughout the world. It is the only\\u000a cause of death among the top 10 causes that is increasing and is expected to become the third leading cause of death in the\\u000a world by 2020. A diagnosis of COPD should be considered in any patient with previous

  6. Growth hormone axis in chronic kidney disease

    Microsoft Academic Search

    Shefali Mahesh; Frederick Kaskel

    2008-01-01

    Chronic kidney disease (CKD) in children is associated with dramatic changes in the growth hormone (GH) and insulin-like growth\\u000a factor (IGF-1) axis, resulting in growth retardation. Moderate-to-severe growth retardation in CKD is associated with increased\\u000a morbidity and mortality. Renal failure is a state of GH resistance and not GH deficiency. Some mechanisms of GH resistance\\u000a are: reduced density of GH

  7. Gene therapy of chronic granulomatous disease

    Microsoft Academic Search

    M Grez; S Becker; S Saulnier; H Knö?; MG Ott; A Maurer; MC Dinauer; D Hoelzer; R Seger; JP Hossle

    2000-01-01

    Chronic granulomatous disease (CGD) is a primary immunodeficiency disorder which results from absence or malfunction of the respiratory burst oxidase normally expressed in neutrophils and other phagocytic leukocytes. Two-thirds of the patients are males hemizygous for mutations in the X-linked gene coding for gp91-phox. As a therapeutic approach towards the X-linked form of CGD bicistronic retroviral vectors containing the gp91-phox

  8. Chronic Granulomatous Disease: Quantitative Clinicopathological Relationships

    Microsoft Academic Search

    Eileen N. Thompson; J. F. Soothill

    1970-01-01

    10 children with chronic granulomatous disease are described. Though the clinical features were typical, a wide range of clinical severity was noted. A significant correlation between the severity of the syndrome and the qualitative nitro-blue tetrazolium results was found.Facial rashes (4) and polyarthritis (1) were noted in female presumed heterozygotes, the incidence of which was also related to the nitro-blue

  9. Management of chronic obstructive pulmonary disease (COPD)

    Microsoft Academic Search

    Peter Martin

    2003-01-01

    Summary The management of chronic obstructive pulmonary disease (COPD) aims to optimise function. Although drugs have a place in achieving this, non-pharma- cological interventions are important. Smoking cessation, long-term oxygen therapy, rehabilitation, and non-inva- sive ventilation are well supported by the evidence. Preventive measures in- clude the use of influenza and pneumo- coccal vaccines and the treatment of nicotine addiction.

  10. Chronic kidney disease: Statins in chronic kidney disease: time to move on?

    PubMed

    Haynes, Richard; Wanner, Christoph

    2015-05-01

    Statins reduce the risk of atherosclerotic vascular disease in healthy individuals and those with chronic kidney disease (CKD); however, clinical trials have suggested a minimal effect of statins on CKD progression. The PLANET trials compared the renal effects of rosuvastatin and atorvastatin, but the findings leave many questions unanswered. PMID:25802077

  11. Chronic kidney disease: fluid in chronic kidney disease-how much is too much?

    PubMed

    Hebert, Lee A; Parikh, Samir

    2013-11-01

    A new study provides cogent evidence that fluid overload—measured using bioimpedance spectroscopy—promotes progression of chronic kidney disease (CKD). A prospective randomized trial is warranted to assess the effect of interventions to reduce fluid overload on disease progression in patients with CKD. PMID:24042464

  12. Chronic Coronary Artery Disease: Diagnosis and Management

    PubMed Central

    Cassar, Andrew; Holmes, David R.; Rihal, Charanjit S.; Gersh, Bernard J.

    2009-01-01

    Coronary artery disease (CAD) is the single most common cause of death in the developed world, responsible for about 1 in every 5 deaths. The morbidity, mortality, and socioeconomic importance of this disease make timely accurate diagnosis and cost-effective management of CAD of the utmost importance. This comprehensive review of the literature highlights key elements in the diagnosis, risk stratification, and management strategies of patients with chronic CAD. Relevant articles were identified by searching the PubMed database for the following terms: chronic coronary artery disease or stable angina. Novel imaging modalities, pharmacological treatment, and invasive (percutaneous and surgical) interventions have revolutionized the current treatment of patients with chronic CAD. Medical treatment remains the cornerstone of management, but revascularization continues to play an important role. In the current economic climate and with health care reform very much on the horizon, the issue of appropriate use of revascularization is important, and the indications for revascularization, in addition to the relative benefits and risks of a percutaneous vs a surgical approach, are discussed. PMID:19955250

  13. Chronic obstructive pulmonary disease: a concise review.

    PubMed

    Balkissoon, Ron; Lommatzsch, Steve; Carolan, Brendan; Make, Barry

    2011-11-01

    Globally, chronic obstructive pulmonary disease (COPD) is a major cause of significant morbidity and mortality, and is now the third leading cause of death in the United States. Over the past 15 years there has been a surge of bench and translational research regarding the genetics and pathogenesis of COPD, and several large-scale clinical trials have introduced new treatment paradigms for COPD. Current research also demonstrates that COPD is not just a lung disease and that there are several potential extrapulmonary manifestations and comorbidities that should be evaluated and treated when one identifies an individual as having COPD. PMID:22032431

  14. [Nutritional depletion in chronic obstructive pulmonary disease].

    PubMed

    Chen, Yan; Yao, Wan-zhen

    2004-10-01

    Chronic obstructive pulmonary disease (COPD) is one of the major diseases worldwide. Nutritional depletion is a common problem in COPD patients and also an independant predictor of survival in these patients. Many data are helpful for determining nutritional depletion, including anthropometric measurement, laboratory markers, body composition analysis (fat-free mass and lean mass), and body weight. The mechanism of nutritional depletion in patients with COPD is still uncertain. It may be associated with energy/metabolism imbalance, tissue hypoxia, systemic inflammation, and leptin/orexin disorders. In patients with nutritional depletion, growth hormone and testosterone can be used for nutritional therapy in addition to nutrition supplementation. PMID:15562780

  15. Educational session: managing chronic myeloid leukemia as a chronic disease.

    PubMed

    Hochhaus, Andreas

    2011-01-01

    Elucidation of the pathogenesis of chronic myeloid leukemia (CML) and the introduction of tyrosine kinase inhibitors (TKIs) has transformed this disease from being invariably fatal to being the type of leukemia with the best prognosis. Median survival associated with CML is estimated at > 20 years. Nevertheless, blast crisis occurs at an incidence of 1%-2% per year, and once this has occurred, treatment options are limited and survival is short. Due to the overall therapeutic success, the prevalence of CML is gradually increasing. The optimal management of this disease includes access to modern therapies and standardized surveillance methods for all patients, which will certainly create challenges. Furthermore, all available TKIs show mild but frequent side effects that may require symptomatic therapy. Adherence to therapy is the key prerequisite for efficacy of the drugs and for long-term success. Comprehensive information on the nature of the disease and the need for the continuous treatment using the appropriate dosages and timely information on efficacy data are key factors for optimal compliance. Standardized laboratory methods are required to provide optimal surveillance according to current recommendations. CML occurs in all age groups. Despite a median age of 55-60 years, particular challenges are the management of the disease in children, young women with the wish to get pregnant, and older patients. The main challenges in the long-term management of CML patients are discussed in this review. PMID:22160024

  16. Chronic beryllium disease: diagnosis and management.

    PubMed Central

    Rossman, M D

    1996-01-01

    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+ 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. PMID:8933039

  17. Chronic beryllium disease: Diagnosis and management

    SciTech Connect

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

    1996-10-01

    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.

  18. Acne as a chronic systemic disease.

    PubMed

    Zouboulis, Christos C

    2014-01-01

    Acne is the most common skin disorder. In the majority of cases, acne is a disease that changes its skin distribution and severity over time; moreover, it can be a physically (scar development) and psychologically damaging condition that lasts for years. According to its clinical characteristics, it can be defined as a chronic disease according to the World Health Organization criteria. Acne is also a cardinal component of many systemic diseases or syndromes, such as congenital adrenal hyperplasia, seborrhea-acne-hirsutism-androgenetic alopecia syndrome, polycystic ovarian syndrome, hyperandrogenism-insulin resistance-acanthosis nigricans syndrome, Apert syndrome, synovitis-acne-pustulosis-hyperostosis-osteitis syndrome, and pyogenic arthritis-pyoderma gangrenosum-acne syndrome. Recent studies on the Ache hunter gatherers of Paraguay detected the lack of acne in association with markedly lower rates of obesity, diabetes mellitus, hyperlipidemia, and cardiovascular diseases, a finding that indicates either a nutritional or a genetic background of this impressive concomitance. PMID:24767186

  19. Chronic kidney disease (CKD) in disadvantaged populations

    PubMed Central

    Garcia-Garcia, Guillermo; Jha, Vivekanand

    2015-01-01

    Twelve March 2015 will mark the 10th anniversary of World Kidney Day (WKD), an initiative of the International Society of Nephrology and the International Federation of Kidney Foundations. Since its inception in 2006, WKD has become the most successful effort ever mounted to raise awareness among decision-makers and the general public about the importance of kidney disease. Each year WKD reminds us that kidney disease is common, harmful and treatable. The focus of WKD 2015 is on chronic kidney disease (CKD) in disadvantaged populations. This article reviews the key links between poverty and CKD and the consequent implications for the prevention of kidney disease and the care of kidney patients in these populations. PMID:25713703

  20. Chronic Granulomatous Disease as a Risk Factor for Autoimmune Disease

    PubMed Central

    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.

    2009-01-01

    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 (AI) disorders. In this report, we describe antiphospholipid syndrome (aPL), recurrent pericardial effusion, juvenile idiopathic arthritis (JIA), IgA nephropathy, cutaneous lupus erythematosus, and autoimmune pulmonary disease in the setting of CGD. The presence and type of autoimmune disease has important treatment implications for patients with CGD. PMID:18823651

  1. Neprilysin inhibition in chronic kidney disease

    PubMed Central

    Judge, Parminder; Haynes, Richard; Landray, Martin J.; Baigent, Colin

    2015-01-01

    Despite current practice, patients with chronic kidney disease (CKD) are at increased risk of progression to end-stage renal disease and cardiovascular events. Neprilysin inhibition (NEPi) is a new therapeutic strategy with potential to improve outcomes for patients with CKD. NEPi enhances the activity of natriuretic peptide systems leading to natriuresis, diuresis and inhibition of the renin–angiotensin system (RAS), which could act as a potentially beneficial counter-regulatory system in states of RAS activation such as chronic heart failure (HF) and CKD. Early NEPi drugs were combined with angiotensin-converting enzyme inhibitors but were associated with unacceptable rates of angioedema and, therefore, withdrawn. However, one such agent (omapatrilat) showed promise of NEP/RAS inhibition in treating CKD in animal models, producing greater reductions in proteinuria, glomerulosclerosis and tubulointerstitial fibrosis compared with isolated RAS inhibition. A new class of drug called angiotensin receptor neprilysin inhibitor (ARNi) has been developed. One such drug, LCZ696, has shown substantial benefits in trials in hypertension and HF. In CKD, HF is common due to a range of mechanisms including hypertension and structural heart disease (including left ventricular hypertrophy), suggesting that ARNi could benefit patients with CKD by both retarding the progression of CKD (hence delaying the need for renal replacement therapy) and reducing the risk of cardiovascular disease. LCZ696 is now being studied in a CKD population. PMID:25140014

  2. [Tolerance of +Gz accelerations in chronic compensated cardiac muscle disease].

    PubMed

    Suvorov, P M; Bykova, Iu I

    1975-01-01

    The functional potentialities of the cardiovascular system were investigated during an exposure of people with compensated chronic diseases of the cardiac muscle to acceleration (+Gz). The test subjects were exposed to acceleration of 3 and 5 g for 30 sec with an interval of 5 min. The parameters of hemodynamics, ECG and visual perception were recorded. The systolic blood volume, cardiac output and specific peripheral resistance were derived from the Bremser-Ranke formula. Seventy one subjects with heart diseases and 23 healthy subjects were examined. The subjects with myocardiodystrophy and myocarditic cardiosclerosis (12+/-16) showed a reduced tolerance to accelerations. During an exposure the subjects with atherosclerotic cardiosclerosis showed a higher pressure in vessels of ear conch than the healthy subjects. The myocardiodystrophic subjects frequently (20%) exhibited an inversion of electrocardiographic T2. The subjects with heart diseases (27-33%) showed extrasystolic disturbances. The results may be used in medical expertise of pilots. PMID:1214489

  3. Peripheral blood lymphocytes DNA in patients with chronic liver diseases

    Microsoft Academic Search

    Vasiliy I Reshetnyak; Tatyana I Sharafanova; Ludmila U Ilchenko; Elena V Golovanova; Gennadiy G Poroshenko; Reshetnyak VI; Sharafanova TI; Ilchenko LU; Golovanova EV

    AIM Of this investigation is to reveal the damage to peripheral blood lymphocytes (PBL) DNA in the patients with chronic liver diseases. MATERIALS AND METHODS Sixteen-nine patients with chronic liver diseases (37 patients with chronic viral hepatitis, 2 patients with liver cirrhosis of mixed etiology (alcohol + virus G), 30 women with primary biliary cirrhosis-PBC) were examined. The condition of

  4. Prevalence of chronic obstructive pulmonary disease in rural women of

    E-print Network

    Silver, Whendee

    Prevalence of chronic obstructive pulmonary disease in rural women of Tamilnadu: implications Ramachandra University, Chennai, India Background: Chronic obstructive pulmonary disease (COPD) is the 13th Citation: Global Health Action 2011, 4: 7226 - DOI: 10.3402/gha.v4i0.7226 #12;Keywords: chronic obstructive

  5. Chronic kidney disease in disadvantaged populations

    PubMed Central

    Garcia-Garcia, G.; Jha, V.

    2015-01-01

    The increased burden of chronic kidney disease (CKD) in disadvantaged populations is due to both global factors and population-specific issues. Low socioeconomic status and poor access to care contribute to health care disparities and exacerbate the negative effects of genetic or biological predisposition. Provision of appropriate renal care to these populations requires a two-pronged approach: expanding the reach of dialysis through development of low-cost alternatives that can be practiced in remote locations, and implementation and evaluation of cost-effective prevention strategies. Kidney transplantation should be promoted by expansion of deceased donor transplant programs and use of inexpensive, generic immunosuppressive drugs. The message of World Kidney Day 2015 is that a concerted attack against the diseases that lead to end-stage renal disease, by increasing community outreach, better education, improved economic opportunity, and access to preventive medicine for those at highest risk, could end the unacceptable relationship between CKD and disadvantage in these communities. PMID:25760025

  6. Pharmacogenetics of chronic obstructive pulmonary disease.

    PubMed

    Hizawa, Nobuyuki

    2013-07-01

    Chronic obstructive pulmonary disease (COPD) is a complex genetic disease that develops as a result of the interaction of multiple susceptibility genes and environmental factors. Major therapeutic approaches include smoking cessation, treatment with bronchodilators and corticosteroid therapy. The goal of understanding the genetic defects in patients with COPD will be not only to redefine the disease phenotypes based on the genetic information, but also to alternatively approach patients based on the understanding of COPD pathogenesis, which will lead to improved clinical outcomes. Although there is no single ideal phenotype for COPD pharmacogenetic studies, thus far, most pharmacogenetics studies have focused on the role of variants in the ?2-adrenergic receptor gene on bronchodilator response. The inconclusive results yielded by these studies highlight many of the difficulties researchers face in assessing the influence of genetic variants and in translating this to clinically relevant outcomes. PMID:23859575

  7. Chronic kidney disease: considerations for nutrition interventions.

    PubMed

    Steiber, Alison L

    2014-05-01

    Chronic kidney disease (CKD) is highly prevalent and has major health consequences for patients. Caring for patients with CKD requires knowledge of the food supply, renal pathophysiology, and nutrition-related medications used to work synergistically with diet to control the signs and symptoms of the disease. The nutrition care process and International Dietetic and Nutrition Terminology allow for systematic, holistic, quality care of patients with this complex, progressive disease. Nutrition interventions must be designed with the individual patients needs in mind while prioritizing factors with the largest negative impact on health outcomes and mortality risk. New areas of nutrition treatment are emerging that involve a greater focus on micronutrient needs, the microbiome, and vegetarian-style diets. These interventions may improve outcomes by decreasing inflammation, improving energy and protein delivery, and lowering phosphorus, electrolytes, and fluid retention. PMID:24637245

  8. Chronic kidney disease and bone metabolism.

    PubMed

    Kazama, Junichiro James; Matsuo, Koji; Iwasaki, Yoshiko; Fukagawa, Masafumi

    2015-05-01

    Chronic kidney disease-related mineral and bone disease (CKD-MBD) is a syndrome defined as a systemic mineral metabolic disorder associated with CKD, and the term renal osteodystrophy indicates a pathomorphological concept of bone lesions associated with CKD-MBD. Cortical bone thinning, abnormalities in bone turnover and primary/secondary mineralization, elevated levels of circulating sclerostin, increased apoptosis in osteoblasts and osteocytes, disturbance of the coupling phenomenon, iatrogenic factors, accumulated micro-crackles, crystal/collagen disorientation, and chemical modification of collagen crosslinks are all possible candidates found in CKD that could promote osteopenia and/or bone fragility. Some of above factors are the consequences of abnormal systemic mineral metabolism but for others it seem unlikely. We have used the term uremic osteoporosis to describe the uremia-induced bone fragility which is not derived from abnormal systemic mineral metabolism. Interestingly, the disease aspect of uremic osteoporosis appears to be similar to that of senile osteoporosis. PMID:25653092

  9. [Biologic therapies in chronic inflammatory bowel diseases].

    PubMed

    Reenaers, C; Louis, E; Belaiche, J

    2009-01-01

    Crohn's disease and ulcerative colitis are chronic inflammatory bowel diseases which can be difficult to control with conventional therapies. Thanks to a better knowledge of their physiopathology, new therapies aimed at specific targets of the inflammatory cascade were developed. Three monoclonal anti-TNF antibodies were produced. Infliximab and adalimumab, currently widely used, can induce sustained remission in Crohn's disease. Infliximab is also efficacious in UC. Certolizumab pegol provides good short term results; its long term efficacy, however, remains to be assessed by further clinical trials. Therapies targeting leucocyte trafficking (anti-integrine) have also been provided and are associated with good clinical responses in Crohn's disease. Natalizumab (anti-alpha4) is responsible for significant side effects and is no longer in use in gasrtoenterology in Europe whereas MLN02 (anti-alpha417) has a good profile in terms of efficacy and safety. Monoclonal anti bodies targeting other cytokines are under development, mainly ustekinumab which inhibits IL12 and IL23. Ustekinumab generates favourable clinical responses in Crohn's disease. The development of biologic therapies in inflammatory bowel disease has dramatically altered the course and management of these disorders. PMID:19642463

  10. Chronic Obstructive Pulmonary Disease in the elderly.

    PubMed

    Incalzi, Raffaele Antonelli; Scarlata, Simone; Pennazza, Giorgio; Santonico, Marco; Pedone, Claudio

    2014-04-01

    The prevalence of Chronic Obstructive Pulmonary Disease (COPD) dramatically increases with age, and COPD complicated by chronic respiratory failure may be considered a geriatric condition. Unfortunately, most cases remain undiagnosed because of atypical clinical presentation and difficulty with current respiratory function diagnostic standards. Accordingly, the disease is under-recognized and undertreated. This is expected to impact noticeably the health status of unrecognized COPD patients because a timely therapy could mitigate the distinctive and important effects of COPD on the health status. Comorbidity also plays a pivotal role in conditioning both the health status and the therapy of COPD besides having major prognostic implication. Several problems affect the overall quality of the therapy for the elderly with COPD, and current guidelines as well as results from pharmacological trials only to some extent apply to this patient. Finally, physicians of different specialties care for the elderly COPD patient: physician's specialty largely determines the kind of approach. In conclusion, COPD, in itself a complex disease, becomes difficult to identify and to manage in the elderly. Interdisciplinary efforts are desirable to provide the practicing physician with a multidisciplinary guide to the identification and treatment of COPD. PMID:24183233

  11. HIV and Chronic Obstructive Pulmonary Disease

    PubMed Central

    Morris, Alison; George, M. Patricia; Crothers, Kristina; Huang, Laurence; Lucht, Lorrie; Kessinger, Cathy; Kleerup, Eric C.

    2011-01-01

    Smoking-related diseases, such as chronic obstructive pulmonary disease (COPD), are of particular concern in the HIV-infected population. Smoking rates are high in this population, and long-term exposure to cigarette smoke in the setting of HIV infection may increase the number of complications seen. Before the era of combination antiretroviral therapy, HIV-infected persons were noted to have an accelerated form of COPD, with significant emphysematous disease seen in individuals less than 40 years old. Unlike many of the AIDS-defining opportunistic infections, HIV-associated COPD may be more common in the current era of HIV because it is frequently reported in patients without a history of AIDS-related pulmonary complications and because many aging HIV-infected individuals have had a longer exposure to smoking and HIV. In this review, we document the epidemiology of HIV-associated COPD before and after the institution of combination antiretroviral therapy, review data suggesting that COPD is accelerated in those with HIV, and discuss possible mechanisms of HIV-associated COPD, including an increased susceptibility to chronic, latent infections; an aberrant inflammatory response; altered oxidant-antioxidant balance; increased apoptosis associated with HIV; and the effects of antiretroviral therapy. PMID:21653535

  12. Hepatitis G virus infection in chronic liver disease

    PubMed Central

    Guilera, M; Saiz, J; Lopez-Labrador, F; Olmedo, E; Ampurdanes, S; Forns, X; Bruix, J; Pares, A; Sanchez-Tapias, J; de Anta, M T J.; Rodes, J

    1998-01-01

    Background—The hepatitis G virus (HGV), a recently identified member of the Flaviviridae family, can cause chronic infection in man but the role of this agent in chronic liver disease is poorly understood. ?Aims—To evaluate the prevalence and meaning of HGV infection in a large series of patients with chronic liver disease. ?Subjects—Two hundred volunteer blood donors, 179 patients with chronic hepatitis C, 111 with chronic hepatitis B, 104 with alcoholic liver disease, 136 with hepatocellular carcinoma, and 24 with cryptogenic chronic liver disease were studied. ?Methods—HGV RNA was investigated in serum samples by reverse transcription and polymerase chain reaction amplification of the 5' non-coding region of HCV and hybridisation to a specific probe. The main features of HGV RNA seropositive and seronegative patients were compared. ?Results—The prevalence of HGV infection was 3% in blood donors, 7% in chronic hepatitis C, 8% in chronic hepatitis B, 2% in alcoholic liver disease, 4% in hepatocellular carcinoma, and 8% in cryptogenic chronic liver disease. HGV infected patients tended to be younger than non-infected patients but no differences concerning sex, possible source of infection, clinical manifestations, biochemical and virological parameters, or severity of liver lesions were found. ?Conclusions—The prevalence of HGV infection in chronic liver disease seems to be relatively low in our area. Infection with HGV does not seem to play a significant pathogenic role in patients with chronic liver disease related to chronic HBV or HCV infection or to increased alcohol consumption, or in those with cryptogenic chronic liver disease. ?? Keywords: chronic liver disease; hepatitis G virus PMID:9505895

  13. [Chronic obstructive pulmonary disease in women].

    PubMed

    de Torres Tajes, Juan Pablo; Macario, Ciro Casanova

    2010-01-01

    The prevalence of chronic obstructive pulmonary disease (COPD) is increasing worldwide, mainly due to the increase in women. In developed countries, COPD in women is mainly a result of exposure to tobacco smoke and in developing countries to inhalation of biomass combustion products. Underdiagnosis of COPD is more common in women since this disease has classically been associated with men. Moreover, COPD in women shows certain differential features, such as a greater expression of aspects related to perception (dyspnea and health-related quality of life), a high prevalence of malnutrition, anxiety and depression, and a distinct distribution of emphysema from that in men. Better phenotypical characterization of COPD in women would allow its impact on the health system to be more accurately evaluated and more individualized therapeutic strategies to be designed. PMID:20620689

  14. Immunology of asthma and chronic obstructive pulmonary disease

    Microsoft Academic Search

    Peter J. Barnes

    2008-01-01

    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

  15. Increased serum iron and iron saturation without liver iron accumulation distinguish chronic hepatitis C from other chronic liver diseases

    Microsoft Academic Search

    N. Arber; F. M. Konikoff; M. Moshkowitz; M. Baratz; A. Hallak; M. Santo; Z. Halpern; H. Weiss; T. Gilat

    1994-01-01

    One hundred twenty-three patients with chronic liver diseases of various etiologies were evaluated for their iron status. The patients were divided into four distinct groups: chronic hepatitis C (63), chronic hepatitis B (14), B + C (3) and nonviral chronic liver diseases (43). In 107 patients (87%) the chronic liver disease was confirmed by biopsy. Mean serum iron (±sd) levels

  16. Chronic Wasting Disease: The Disease and its Management in Wisconsin

    NSDL National Science Digital Library

    2002-01-01

    The discovery of chronic wasting disease (CWD) in Wisconsin's deer population earlier this year received national attention in the news, but basic information about CWD is harder to find. This Web site from the University of Wisconsin (UW) provides a reliable resource for CWD news and information, and is a product of a UW panel of experts assembled to independently assess the state's effort for control of the disease. The site includes comprehensive information on the biology of the disease and the issues involved in its eradication. Other features of this site include downloadable fact sheets on deer processing and the safety of venison. While geared toward a Wisconsin audience, this site should prove useful for anyone looking for more information on CWD.

  17. Modeling Routes of Chronic Wasting Disease Transmission: Environmental Prion Persistence Promotes

    E-print Network

    Lazzaro, Brian

    , United States of America Abstract Chronic wasting disease (CWD) is a fatal disease of deer, elk) Modeling Routes of Chronic Wasting Disease Transmission: Environmental Prion Persistence Promotes DeerModeling Routes of Chronic Wasting Disease Transmission: Environmental Prion Persistence Promotes

  18. MARKOV CELLULAR AUTOMATA AS MODELS FOR CHRONIC DISEASE PROGRESSION

    E-print Network

    Hawkins, Jane M.

    to model chronic illness 9 3.1. Adding the probability measure to a topological Markov CA 11 3.2. MedicalMARKOV CELLULAR AUTOMATA AS MODELS FOR CHRONIC DISEASE PROGRESSION JANE HAWKINS AND DONNA MOLINEK to a chronic condi- tion, such as human immunodeficiency virus (HIV) or hepatitis C virus (HCV). We show

  19. Collaborative Help in Chronic Disease Management: Supporting Individualized Problems

    E-print Network

    Anderson, Richard

    Coping with chronic illness disease is a long and lonely journey, because the burden of managing for supporting chronic illness patients in online community settings. Author Keywords Individualized, diabetes, chronic illness, support groups, online health community, collaborative help ACM Classification Keywords H

  20. Immune Mechanisms Involved in Cardiovascular Complications of Chronic Kidney Disease

    Microsoft Academic Search

    Andréa E. M. Stinghen; Sergio Bucharles; Miguel C. Riella; R. Pecoits-Filho

    2010-01-01

    A sustained status of chronic inflammation is closely linked to several complications of chronic kidney disease (CKD), such as vascular degeneration, myocardial fibrosis, loss of appetite, insulin resistance, increased muscle catabolism and anemia. These consequences of a chronically activated immune system impact on the acceleration of atherosclerosis, vascular calcification and development of heart dysfunction. Recent evidence suggests that these immune-mediated

  1. Comorbidity in chronic obstructive pulmonary disease. Related to disease severity?

    PubMed Central

    Echave-Sustaeta, Jose M; Comeche Casanova, Lorena; Cosio, Borja G; Soler-Cataluña, Juan Jose; Garcia-Lujan, Ricardo; Ribera, Xavier

    2014-01-01

    Background and objective Several diseases commonly co-exist with chronic obstructive pulmonary disease (COPD), especially in elderly patients. This study aimed to investigate whether there is an association between COPD severity and the frequency of comorbidities in stable COPD patients. Patients and methods In this multicenter, cross-sectional study, patients with spirometric diagnosis of COPD attended to by internal medicine departments throughout Spain were consecutively recruited by 225 internal medicine specialists. The severity of airflow obstruction was graded using the Global Initiative for Chronic Obstructive Lung Disease (GOLD) and data on demographics, smoking history, comorbidities, and dyspnea were collected. The Charlson comorbidity score was calculated. Results Eight hundred and sixty-six patients were analyzed: male 93%, mean age 69.8 (standard deviation [SD] 9.7) years and forced vital capacity in 1 second 42.1 (SD 17.7)%. Even, the mean (SD) Charlson score was 2.2 (2.2) for stage I, 2.3 (1.5) for stage II, 2.5 (1.6) for stage III, and 2.7 (1.8) for stage IV (P=0.013 between stage I and IV groups), independent predictors of Charlson score in the multivariate analysis were age, smoking history (pack-years), the hemoglobin level, and dyspnea, but not GOLD stage. Conclusion COPD patients attended to in internal medicine departments show high scores of comorbidity. However, GOLD stage was not an independent predictor of comorbidity. PMID:25429213

  2. Phosphorus and nutrition in chronic kidney disease.

    PubMed

    González-Parra, Emilio; Gracia-Iguacel, Carolina; Egido, Jesús; Ortiz, Alberto

    2012-01-01

    Patients with renal impairment progressively lose the ability to excrete phosphorus. Decreased glomerular filtration of phosphorus is initially compensated by decreased tubular reabsorption, regulated by PTH and FGF23, maintaining normal serum phosphorus concentrations. There is a close relationship between protein and phosphorus intake. In chronic renal disease, a low dietary protein content slows the progression of kidney disease, especially in patients with proteinuria and decreases the supply of phosphorus, which has been directly related with progression of kidney disease and with patient survival. However, not all animal proteins and vegetables have the same proportion of phosphorus in their composition. Adequate labeling of food requires showing the phosphorus-to-protein ratio. The diet in patients with advanced-stage CKD has been controversial, because a diet with too low protein content can favor malnutrition and increase morbidity and mortality. Phosphorus binders lower serum phosphorus and also FGF23 levels, without decreasing diet protein content. But the interaction between intestinal dysbacteriosis in dialysis patients, phosphate binder efficacy, and patient tolerance to the binder could reduce their efficiency. PMID:22701173

  3. Dirty electricity, chronic stress, neurotransmitters and disease.

    PubMed

    Milham, Samuel; Stetzer, David

    2013-12-01

    Dirty electricity, also called electrical pollution, is high-frequency voltage transients riding along the 50 or 60 Hz electricity provided by the electric utilities. It is generated by arcing, by sparking and by any device that interrupts current flow, especially switching power supplies. It has been associated with cancer, diabetes and attention deficit hyperactivity disorder in humans. Epidemiological evidence also links dirty electricity to most of the diseases of civilization including cancer, cardiovascular disease, diabetes and suicide, beginning at the turn of the twentieth century. The dirty electricity level in a public library was reduced from over 10 000 Graham/Stetzer (G/S) units to below 50 G/S units by installing plug-in capacitive filters. Before cleanup, the urinary dopamine level of only one of seven volunteers was within normal levels, while four of seven phenylethylamine levels were normal. After an initial decline, over the next 18 weeks the dopamine levels gradually increased to an average of over 215 ?g/g creatinine, which is well above 170 ?g/g creatinine, the high normal level for the lab. Average phenylethylamine levels also rose gradually to slightly above 70 ?g/g creatinine, the high normal level for the lab. Neurotransmitters may be biomarkers for dirty electricity and other electromagnetic field exposures. We believe that dirty electricity is a chronic stressor of electrified populations and is responsible for many of their disease patterns. PMID:23323864

  4. Skin problems in chronic kidney disease.

    PubMed

    Kuypers, Dirk R J

    2009-03-01

    Skin disorders associated with chronic kidney disease (CKD) can markedly affect a patient's quality of life and can negatively impact their mental and physical health. Uremic pruritus, which is frequently encountered in patients with CKD, is considered to be an inflammatory systemic disease rather than a local skin disorder. Biomarkers of inflammation are increased in patients with uremic pruritus and an imbalance of the endogenous opioidergic system might be involved in the complex pathogenesis of the disease. Treatment options for uremic pruritus include emollients, topical capsaicin cream, ultraviolet B phototherapy, gabapentin, oral activated charcoal and nalfurafine, a kappa-opioid-receptor agonist. Calcific uremic arteriolopathy is triggered by an imbalance of promoters and inhibitors of vascular calcification, caused by the inflammatory changes that occur in uremia. Promising therapeutic strategies for calcific uremic arteriolopathy include bisphosphonates and intravenous sodium thiosulfate. Nephrogenic systemic fibrosis is a devastating condition associated with the use of gadolinium-based contrast agents in patients with CKD. At present, no therapies are available for this complication. Preventive measures include use of iodine-based contrast agents, particularly in patients with CKD stage 4 and 5. If gadolinium contrast is necessary, administration of low volumes of the more stable macrocyclic ionic types of gadolinium-based contrast agent is advocated. Hemodialysis following gadolinium exposure might offer benefits but evidence is lacking. PMID:19190625

  5. Addressing Health Disparities in Chronic Kidney Disease

    PubMed Central

    Chan, Ta-Chien; Fan, I.-Chun; Liu, Michael Shi-Yung; Su, Ming-Daw; Chiang, Po-Huang

    2014-01-01

    According to the official health statistics, Taiwan has the highest prevalence of end stage renal disease (ESRD) in the world. Each year, around 60,000 ESRD patients in Taiwan consume 6% of the national insurance budget for dialysis treatment. The prevalence of chronic kidney disease (CKD) has been climbing during 2008–2012. However, the spatial disparities and clustering of CKD at the public health level have rarely been discussed. The aims of this study are to explore the possible population level risk factors and identify any clusters of CKD, using the national health insurance database. The results show that the ESRD prevalence in females is higher than that in males. ESRD medical expenditure constitutes 87% of total CKD medical expenditure. Pre-CKD and pre-ESRD disease management might slow the progression from CKD to ESRD. After applying ordinary least-squares regression, the percentages of high education status and the elderly in the townships are positively correlated with CKD prevalence. Geographically weighted regression and Local Moran’s I are used for identifying the clusters in southern Taiwan. The findings can be important evidence for earlier and targeted community interventions and reducing the health disparities of CKD. PMID:25514144

  6. Thyroid disorders and chronic kidney disease.

    PubMed

    Mohamedali, Mohamed; Reddy Maddika, Srikanth; Vyas, Anix; Iyer, Viswanathan; Cheriyath, Pramil

    2014-01-01

    Thyroid hormones play a very important role regulating metabolism, development, protein synthesis, and influencing other hormone functions. The two main hormones produced by the thyroid are triiodothyronine (T3) and thyroxine (T4). These hormones can also have significant impact on kidney disease so it is important to consider the physiological association of thyroid dysfunction in relation to chronic kidney disease (CKD). CKD has been known to affect the pituitary-thyroid axis and the peripheral metabolism of thyroid hormones. Low T3 levels are the most common laboratory finding followed by subclinical hypothyroidism in CKD patients. Hyperthyroidism is usually not associated with CKD but has been known to accelerate it. One of the most important links between thyroid disorders and CKD is uremia. Patients who are appropriately treated for thyroid disease have a less chance of developing renal dysfunction. Clinicians need to be very careful in treating patients with low T3 levels who also have an elevation in TSH, as this can lead to a negative nitrogen balance. Thus, clinicians should be well educated on the role of thyroid hormones in relation to CKD so that proper treatment can be delivered to the patient. PMID:24829799

  7. Immunological aspects of chronic venous disease pathogenesis

    PubMed Central

    Grudzi?ska, Ewa

    2014-01-01

    Chronic venous disease (CVD) is a very common health problem concerning up to 1/3 of the society. Although venous hypertension and valvular incompetence have been long known to be crucial for development of the illness, its exact aetiology remains unclear. Recent findings indicate that inflammatory processes may be crucial for development of incompetent valves and vein wall remodelling. One of the most interesting theories describes “leucocyte trapping” as the mechanism responsible for elevated vein wall permeability and oxidative stress in the veins. At the same time, the cytokine profile of the blood in incompetent veins has not been thoroughly examined. Popular anti-inflammatory drugs relieve some symptoms but do not have much proved effects in prevention and treatment. We intend to summarize the existing knowledge of the immunological aspects of CVD in order to emphasize its importance for understanding the aetiology of this illness. We also wish to indicate some aspects that remain to be studied in more detail.

  8. Chronic Beryllium Disease Prevention Program Report

    SciTech Connect

    Lee, S

    2012-03-29

    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.'

  9. [Airway biomarkers in chronic obstructive pulmonary disease].

    PubMed

    Tohda, Yuji; Higashimoto, Yuji

    2011-10-01

    Inflammation plays a central role in the pathogenesis of chronic obstructive pulmonary disease (COPD). Monitoring of inflammation of the airways has, therefore, become a growing are of research and there is particular interest in noninvasive approaches which allow frequent monitoring. Induced sputum has provided important insights into airway inflammation in COPD. However, induced sputum is relatively invasive. This has focused attention on other noninvasive methods. Exhaled breath condensate has the potential to measure semi-volatile lipid mediators. However, a major problem limiting the usefulness of this technique is variable dilution with water vapor and low concentrations of mediators. Many volatile organic compounds have been detected in the breath and the pattern of molecules can now be characterized with various electronic noses. PMID:22073577

  10. Pharmacokinetics of quinine in chronic liver disease.

    PubMed Central

    Auprayoon, P; Sukontason, K; Na-Bangchang, K; Banmairuroi, V; Molunto, P; Karbwang, J

    1995-01-01

    The pharmacokinetics of quinine were investigated in a) six healthy male Thai subjects, and b) nine male Thai patients with a moderate degree of chronic liver disease, after a single oral dose of 600 mg quinine sulphate. tmax and t1/2.2 were significantly prolonged in patients (median [range] tmax 2 [1-5] vs 1.6 [0.8-2] h; t1/2,z 23.4 [17.4-41.7] vs 9.7 [7.8-17.2] h), and Vz/F was significantly larger (median [range] 4.21 [2.33-15.87] vs 2.78 [1.49-3.38] 1 kg-1). Median (range) concentration of the plasma unbound Qn fraction collected from the patients at 4 h after drug administration was 17 (8.4-17.8)% of total drug concentration. PMID:8703656

  11. Gene polymorphisms and chronic obstructive pulmonary disease

    PubMed Central

    Wu, Xiaodan; Yuan, Bowei; López, Elena; Bai, Chunxue; Wang, Xiangdong

    2014-01-01

    The genetic component was suggested to contribute to the development of chronic obstructive pulmonary disease (COPD), a major and growing public health burden. The present review aims to characterize the evidence that gene polymorphisms contribute to the aetiology of COPD and related traits, and explore the potential relationship between certain gene polymorphisms and COPD susceptibility, severity, lung function, phenotypes, or drug effects, even though limited results from related studies lacked consistency. Most of these studies were association studies, rather than confirmatory studies. More large-sized and strictly controlled studies are needed to prove the relationship between gene polymorphisms and the reviewed traits. More importantly, prospective confirmatory studies beyond initial association studies will be necessary to evaluate true relationships between gene polymorphisms and COPD and help individualized treatment for patients with COPD. PMID:24256364

  12. Neurologic Complications of Chronic Kidney Disease.

    PubMed

    Vellanki, Kavitha; Bansal, Vinod K

    2015-08-01

    Chronic kidney disease (CKD) is an increasing problem worldwide and is now being recognized as a global health burden particularly for cardiovascular and cerebrovascular events. The incidence of stroke increases in the presence of CKD with a 3-fold increased rate reported in ESRD. Atrial fibrillation (AF) increases the risk of stroke in CKD. There is conflicting observational evidence regarding benefit of anticoagulation in CKD for prevention of stroke in AF as risk of bleeding is high. Overall, anticoagulant in CKD may be beneficial in appropriate patients with meticulous monitoring of international normalized ratio (INR). Neurological manifestations related to electrolyte disorders, drug toxicity, and uremia are common in CKD. Appropriate drug dosing, awareness of potential side effects of medications, prompt diagnosis, and treatment are essential in preventing long-term morbidity and mortality. PMID:26081561

  13. Chronic diseases and labour force participation in Australia.

    PubMed

    Zhang, Xiaohui; Zhao, Xueyan; Harris, Anthony

    2009-01-01

    We examine the impact of several chronic diseases on the probability of labour force participation using data from the Australian National Health Surveys. An endogenous multivariate probit model is used to account for the potential endogeneity of the incidence of chronic conditions such as diabetes, cardiovascular diseases and mental illnesses. The cross-equation correlations are significant, rejecting the exogeneity of the chronic illnesses. Marginal effects of exogenous socio-demographic and lifestyle variables are estimated through their direct effects on labour market participation and indirect effects via the chronic diseases. The treatment effects of chronic diseases on labour force participation are estimated via conditional probabilities using five-dimensional normal distributions. The estimated effects differ by gender and age groups. Although computationally more demanding, these treatment effects are compared with results from a univariate model treating the chronic conditions exogenous and the structural effects from the multivariate probit model; both significantly overestimate the effects. PMID:18945504

  14. Prevalence of Chronic Diseases in Adolescents with Intellectual Disability

    ERIC Educational Resources Information Center

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

    2010-01-01

    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…

  15. Flavonoid intake and risk of chronic diseases1,2

    Microsoft Academic Search

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

    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

  16. Pesticides and human chronic diseases: Evidences, mechanisms, and perspectives

    SciTech Connect

    Mostafalou, Sara; Abdollahi, Mohammad, E-mail: Mohammad.Abdollahi@UToronto.Ca

    2013-04-15

    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. - Highlights: ? There is a link between exposure to pesticides and incidence of chronic diseases. ? Genotoxicity and proteotoxicity are two main involved mechanisms. ? Epigenetic knowledge may help diagnose the relationships. ? Efficient policies on safe use of pesticides should be set up.

  17. Older Adults, Chronic Disease and Leisure-Time Physical Activity

    Microsoft Academic Search

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

    2009-01-01

    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

  18. [Left ventricular hypertrophy in chronic kidney disease].

    PubMed

    Paoletti, E; Cannella, G

    2006-01-01

    Chronic kidney disease (CKD) is associated with increased cardiovascular (CV) risk. Left ventricular (LV) hypertrophy (LVH), together with coronary artery disease, has been considered the main target of intervention. LVH is highly prevalent in CKD even in early stages, as compared to general non-selected population. This is mainly due to the multifactorial pathogenesis of LVH in renal patients where both haemodynamic and non-haemodynamic stimuli synergically act inducing either an increase in left ventricular mass or an LV dilation. Anaemia and arterial hypertension seem to be the most important factors. Interventional studies have shown that partial correction of anaemia through epoetin, together with an arterial hypertension successful therapy through renin-angiotensin system acting drugs, such as ACE-inhibitors, were able to induce a LVH regression in CKD. Indeed, the unfavourable outcome in patients with both CKD and LVH, whose survival is reduced and incidence of fatal and non-fatal CV events increased, can be reversed if LVH is regressed by therapy. The most promising strategy in CKD seems to be LVH early diagnosis through echocardiography, the correct screening of risk factors, a LVM longitudinal monitoring through echo, as well as starting treatment in the early stages of CKD, with the aim of improving general and CV prognosis for these patients. PMID:17173262

  19. Invasive Aspergillus infections in hospitalized patients with chronic lung disease

    PubMed Central

    Wessolossky, Mireya; Welch, Verna L; Sen, Ajanta; Babu, Tara M; Luke, David R

    2013-01-01

    Background Although invasive pulmonary aspergillosis (IPA) is more prevalent in immunocompromised patients, critical care clinicians need to be aware of the occurrence of IPA in the nontraditional host, such as a patient with chronic lung disease. The purpose of this study was to describe the IPA patient with chronic lung disease and compare the data with that of immunocompromised patients. Methods The records of 351 patients with Aspergillus were evaluated in this single-center, retrospective study for evidence and outcomes of IPA. The outcomes of 57 patients with chronic lung disease and 56 immunocompromised patients were compared. Patients with chronic lung disease were defined by one of the following descriptive terms: emphysema, asthma, idiopathic lung disease, bronchitis, bronchiectasis, sarcoid, or pulmonary leukostasis. Results Baseline demographics were similar between the two groups. Patients with chronic lung disease were primarily defined by emphysema (61%) and asthma (18%), and immunocompromised patients primarily had malignancies (27%) and bone marrow transplants (14%). A higher proportion of patients with chronic lung disease had a diagnosis of IPA by bronchoalveolar lavage versus the immunocompromised group (P < 0.03). The major risk factors for IPA were found to be steroid use in the chronic lung disease group and neutropenia and prior surgical procedures in the immunocompromised group. Overall, 53% and 69% of chronic lung disease and immunocompromised patients were cured (P = 0.14); 55% of chronic lung patients and 47% of immunocompromised patients survived one month (P = 0.75). Conclusion Nontraditional patients with IPA, such as those with chronic lung disease, have outcomes and mortality similar to that in the more traditional immunocompromised population. PMID:23761976

  20. Acute Exacerbation of Chronic Obstructive Pulmonary Disease: Cardiovascular Links

    PubMed Central

    Laratta, Cheryl R.; van Eeden, Stephan

    2014-01-01

    Chronic obstructive pulmonary disease (COPD) is a chronic, progressive lung disease resulting from exposure to cigarette smoke, noxious gases, particulate matter, and air pollutants. COPD is exacerbated by acute inflammatory insults such as lung infections (viral and bacterial) and air pollutants which further accelerate the steady decline in lung function. The chronic inflammatory process in the lung contributes to the extrapulmonary manifestations of COPD which are predominantly cardiovascular in nature. Here we review the significant burden of cardiovascular disease in COPD and discuss the clinical and pathological links between acute exacerbations of COPD and cardiovascular disease. PMID:24724085

  1. Moraxella catarrhalis in Chronic Obstructive Pulmonary Disease

    PubMed Central

    Murphy, Timothy F.; Brauer, Aimee L.; Grant, Brydon J. B.; Sethi, Sanjay

    2005-01-01

    Rationale: Moraxella catarrhalis is frequently present in the sputum of adults with chronic obstructive pulmonary disease (COPD). Little is known about the role of M. catarrhalis in this common disease. Objective: To elucidate the burden of disease, the dynamics of carriage, and immune responses to M. catarrhalis in COPD. Methods: Prospective cohort study of 104 adults with COPD in an outpatient clinic at the Buffalo Veterans Affairs Medical Center. Measurements: Clinical information, sputum cultures, molecular typing of isolates, and immunoassays to measure antibodies to M. catarrhalis. Main Results: Over 81 months, 104 patients made 3,009 clinic visits, 560 during exacerbations. Molecular typing identified 120 episodes of acquisition and clearance of M. catarrhalis in 50 patients; 57 (47.5%) of the acquisitions were associated with clinical exacerbations. No instances of simultaneous acquisition of a new strain of another pathogen were observed. The duration of carriage of M. catarrhalis was shorter with exacerbations compared with asymptomatic colonization (median, 31.0 vs. 40.4 days; p = 0.01). Reacquisition of the same strain was rare. The intensity of the serum IgG response was greater after exacerbations than asymptomatic colonization (p = 0.009). Asymptomatic colonization was associated with a greater frequency of a sputum IgA response than exacerbation (p = 0.009). Conclusions: M. catarrhalis likely causes approximately 10% of exacerbations of COPD, accounting for approximately 2 to 4 million episodes annually. The organism is cleared efficiently after a short duration of carriage. Patients develop strain-specific protection after clearance of M. catarrhalis from the respiratory tract. PMID:15805178

  2. Fatigue and multidimensional disease severity in chronic obstructive pulmonary disease

    PubMed Central

    2010-01-01

    Background and aims Fatigue is associated with longitudinal ratings of health in patients with chronic obstructive pulmonary disease (COPD). Although the degree of airflow obstruction is often used to grade disease severity in patients with COPD, multidimensional grading systems have recently been developed. The aim of this study was to investigate the relationship between perceived and actual fatigue level and multidimensional disease severity in patients with COPD. Materials and methods Twenty-two patients with COPD (aged 52-74 years) took part in the study. Multidimensional disease severity was measured using the SAFE and BODE indices. Perceived fatigue was assessed using the Fatigue Severity Scale (FSS) and the Fatigue Impact Scale (FIS). Peripheral muscle endurance was evaluated using the number of sit-ups, squats, and modified push-ups that each patient could do. Results Thirteen patients (59%) had severe fatigue, and their St George's Respiratory Questionnaire scores were significantly higher (p < 0.05). The SAFE index score was significantly correlated with the number of sit-ups, number of squats, FSS score and FIS score (p < 0.05). The BODE index was significantly associated with the numbers of sit-ups, squats and modified push-ups, and with the FSS and FIS scores (p < 0.05). Conclusions Peripheral muscle endurance and fatigue perception in patients with COPD was related to multidimensional disease severity measured with both the SAFE and BODE indices. Improvements in perceived and actual fatigue levels may positively affect multidimensional disease severity and health status in COPD patients. Further research is needed to investigate the effects of fatigue perception and exercise training on patients with different stages of multidimensional COPD severity. PMID:22958301

  3. Occupational causes of chronic obstructive pulmonary disease.

    PubMed

    Rushton, Lesley

    2007-01-01

    The relation between Chronic Obstructive Pulmonary Disease (COPD, including chronic bronchitis and emphysema (CBE), and exposure to coal dust is well established. This paper reviews the evidence relating to other occupational causes of COPD, including industries associated with exposure to fumes, chemical substances, and dusts. A review of key literature has been carried out with a focus on the magnitude of risks and levels of exposure causing disabling health effects. The literature suggests that elevated risks of developing COPD are clearly associated with several occupations, with risk estimates being high in some, even after taking into account the effect of confounders, such as smoking. Of particular concern are agricultural workers who can be exposed to a variety of gases and organic dusts, among whom CBE is clearly elevated, particularly for pig farmers and exposure to endotoxins, with an increased annual decline in lung function. Similarly, cotton textile workers are exposed to a mixture of substances affecting development of atopy, byssinosis, and CBE, and across-shift and long-term decline in lung function. Atopy also has an important role in the development of COPD in flour mill workers and bakers, with those sensitized to bakery allergens having a greater lung function decline than non-sensitized individuals. Welding processes involve a range of potential chemical, physical and radiation hazards. The average reduction in FEV1 associated with welding fumes is similar to that associated with smoking. Challenges in assessing the evidence include variation in diagnostic methods; concurrent exposure to cigarette smoke (direct or second-hand) and multiple work-place irritants; healthy worker selection/survivor effects; poor exposure definition. Raising awareness of occupational causes of COPD among employers, employees, and health service professionals is important. PMID:18078004

  4. 10 CFR Appendix A to Part 850 - Chronic Beryllium Disease Prevention Program Informed Consent Form

    Code of Federal Regulations, 2010 CFR

    2010-01-01

    ...2010-01-01 false Chronic Beryllium Disease Prevention Program Informed Consent Form...DEPARTMENT OF ENERGY CHRONIC BERYLLIUM DISEASE PREVENTION PROGRAM Pt. 850, App. A Appendix A to Part 850—Chronic Beryllium Disease Prevention Program Informed Consent...

  5. CHRONIC WASTING DISEASE: IMPLICATIONS AND CHALLENGES FOR WILDLIFE MANAGERS

    Microsoft Academic Search

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

    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

  6. Parathyroid hormone and growth in chronic kidney disease

    Microsoft Academic Search

    Simon Waller

    2011-01-01

    Growth failure is common in children with chronic kidney disease, and successful treatment is a major challenge in the management\\u000a of these children. The aetiology is multi-factorial with “chronic kidney disease–metabolic bone disorder” being a key component\\u000a that is particularly difficult to manage. Parathyroid hormone is at the centre of this mineral imbalance, consequent skeletal\\u000a disease and, ultimately, growth failure.

  7. Venous disease and chronic oedema: treatment and patient concordance.

    PubMed

    Todd, Marie

    Compression therapy is the mainstay in the management of chronic venous disease, venous leg ulceration (VLU) and chronic oedema. The management of VLU alone is thought to cost a staggering £400 million per year and accounts for 13% of all district nursing visits. The predicted increase in elderly, obese and chronically ill patients will pose a further strain on already stretched resources. The impact of chronic venous and lymphovenous disease is also costly in terms of physical and psychological terms for patients. Adopting a preventive approach would reduce the financial, workload and symptomatic aspects of this condition. PMID:24820810

  8. Exhibitions Exhibitions

    E-print Network

    Tennessee, University of

    in collaboration with Kevin Robinson and Eugene Moon for The Kentifrica Is: An Ethnomusicoloy Concert photo: Thom creeping out of the global recession.The German economy is predicted to exhibit modest growth in 2013

  9. Exercise training in chronic obstructive pulmonary disease.

    PubMed

    Rochester, Carolyn L

    2003-01-01

    Exercise and activity limitation are characteristic features of chronic obstructive pulmonary disease (COPD). Exercise intolerance may result from ventilatory limitation, cardiovascular impairment, and/or skeletal muscle dysfunction. Exercise training, a core component of pulmonary rehabilitation, improves the exercise capacity (endurance and, to a lesser degree, maximal work capacity) of patients with COPD in spite of the irreversible abnormalities in lung function. Dyspnea and health-related quality of life also improve following pulmonary rehabilitation. The clinical benefits of exercise rehabilitation last up to 2 years following 8 to 12 weeks of training. Existing evidence-based guidelines recommend that exercise training/pulmonary rehabilitation be included routinely in the management of patients with moderate to severe COPD. Exercise training/ pulmonary rehabilitation may be undertaken in an inpatient, outpatient, or home-based setting, depending on the individual needs of the patient and available resources. The type and intensity of training and muscle groups trained determine the expected outcomes of exercise training. Both high- and low-intensity exercise lead to increased exercise endurance, but only high-intensity training also leads to physiologic gains in aerobic fitness. The rationale for and outcomes of lower- and upper-limb training, as well as ventilatory muscle training, are reviewed, and the potential for anabolic hormone supplementation to optimize the benefits of exercise training is discussed. PMID:15074454

  10. Residual NADPH Oxidase and Survival in Chronic Granulomatous Disease

    PubMed Central

    Kuhns, Douglas B.; Alvord, W. Gregory; Heller, Theo; Feld, Jordan J.; Pike, Kristen M.; Marciano, Beatriz E.; Uzel, Gulbu; DeRavin, Suk See; Long Priel, Debra A.; Soule, Benjamin P.; Zarember, Kol A.; Malech, Harry L.; Holland, Steven M.; Gallin, John I.

    2011-01-01

    Background Failure to generate phagocyte-derived superoxide and related reactive oxygen intermediates (ROIs) is the major defect in chronic granulomatous disease, causing recurrent infections and granulomatous complications. Chronic granulomatous disease is caused by missense, nonsense, frameshift, splice, or deletion mutations in the genes for p22phox, p40phox, p47phox, p67phox (autosomal chronic granulomatous disease), or gp91phox (X-linked chronic granulomatous disease), which result in variable production of neutrophil-derived ROIs. We hypothesized that residual ROI production might be linked to survival in patients with chronic granulomatous disease. Methods We assessed the risks of illness and death among 287 patients with chronic granulomatous disease from 244 kindreds. Residual ROI production was measured with the use of superoxide-dependent ferricytochrome c reduction and flow cytometry with dihydrorhodamine oxidation assays. Expression of NADPH oxidase component protein was detected by means of immunoblotting, and the affected genes were sequenced to identify causal mutations. Results Survival of patients with chronic granulomatous disease was strongly associated with residual ROI production as a continuous variable, independently of the specific gene affected. Patients with mutations in p47phox and most missense mutations in gp91phox (with the exception of missense mutations in the nucleotide-binding and heme-binding domains) had more residual ROI production than patients with nonsense, frameshift, splice, or deletion mutations in gp91phox. After adolescence, mortality curves diverged according to the extent of residual ROI production. Conclusions Patients with chronic granulomatous disease and modest residual production of ROI have significantly less severe illness and a greater likelihood of long-term survival than patients with little residual ROI production. The production of residual ROI is predicted by the specific NADPH oxidase mutation, regardless of the specific gene affected, and it is a predictor of survival in patients with chronic granulomatous disease. (Funded by the National Institutes of Health.) PMID:21190454

  11. The SLE Transcriptome Exhibits Evidence of Chronic Endotoxin Exposure and Has Widespread Dysregulation of Non-Coding and Coding RNAs

    PubMed Central

    Shi, Lihua; Zhang, Zhe; Yu, Angela M.; Wang, Wei; Wei, Zhi; Akhter, Ehtisham; Maurer, Kelly; Reis, Patrícia Costa; Song, Li; Petri, Michelle; Sullivan, Kathleen E.

    2014-01-01

    Background Gene expression studies of peripheral blood mononuclear cells from patients with systemic lupus erythematosus (SLE) have demonstrated a type I interferon signature and increased expression of inflammatory cytokine genes. Studies of patients with Aicardi Goutières syndrome, commonly cited as a single gene model for SLE, have suggested that accumulation of non-coding RNAs may drive some of the pathologic gene expression, however, no RNA sequencing studies of SLE patients have been performed. This study was designed to define altered expression of coding and non-coding RNAs and to detect globally altered RNA processing in SLE. Methods Purified monocytes from eight healthy age/gender matched controls and nine SLE patients (with low-moderate disease activity and lack of biologic drug use or immune suppressive treatment) were studied using RNA-seq. Quantitative RT-PCR was used to validate findings. Serum levels of endotoxin were measured by ELISA. Results We found that SLE patients had diminished expression of most endogenous retroviruses and small nucleolar RNAs, but exhibited increased expression of pri-miRNAs. Splicing patterns and polyadenylation were significantly altered. In addition, SLE monocytes expressed novel transcripts, an effect that was replicated by LPS treatment of control monocytes. We further identified increased circulating endotoxin in SLE patients. Conclusions Monocytes from SLE patients exhibit globally dysregulated gene expression. The transcriptome is not simply altered by the transcriptional activation of a set of genes, but is qualitatively different in SLE. The identification of novel loci, inducible by LPS, suggests that chronic microbial translocation could contribute to the immunologic dysregulation in SLE, a new potential disease mechanism. PMID:24796678

  12. [Chronic obstructive pulmonary disease: The golden decade. Implications for the diagnosis, prevention and treatment of chronic obstructive pulmonary disease].

    PubMed

    López-Giraldo, Alejandra; Rodríguez-Roisin, Robert; Agustí, Alvar

    2015-06-01

    Chronic obstructive pulmonary disease (COPD) is a complex and heterogeneous illness, which causes an important socio-economic burden. The last decade has witnessed significant advances in the understanding and knowledge of COPD with a paradigm shift in both the assessment and management of the disease. The article here reviews these changes with a particular focus on the last revision (2013) of the Global Strategy for the Diagnosis, Management, and Prevention of chronic obstructive pulmonary disease. PMID:24820902

  13. Marine Invertebrate Natural Products for Anti-Inflammatory and Chronic Diseases

    PubMed Central

    Senthilkumar, Kalimuthu; Kim, Se-Kwon

    2013-01-01

    The marine environment represents a relatively available source of functional ingredients that can be applied to various aspects of food processing, storage, and fortification. Moreover, numerous marine invertebrates based compounds have biological activities and also interfere with the pathogenesis of diseases. Isolated compounds from marine invertebrates have been shown to pharmacological activities and are helpful for the invention and discovery of bioactive compounds, primarily for deadly diseases like cancer, acquired immunodeficiency syndrome (AIDS), osteoporosis, and so forth. Extensive research within the last decade has revealed that most chronic illnesses such as cancer, neurological diseases, diabetes, and autoimmune diseases exhibit dysregulation of multiple cell signaling pathways that have been linked to inflammation. On the basis of their bioactive properties, this review focuses on the potential use of marine invertebrate derived compounds on anti-inflammatory and some chronic diseases such as cardiovascular disease, osteoporosis, diabetes, HIV, and cancer. PMID:24489586

  14. Effects of exercise and diet on chronic disease.

    PubMed

    Roberts, Christian K; Barnard, R James

    2005-01-01

    Currently, modern chronic diseases, including cardiovascular diseases, Type 2 diabetes, metabolic syndrome, and cancer, are the leading killers in Westernized society and are increasing rampantly in developing nations. In fact, obesity, diabetes, and hypertension are now even commonplace in children. Clearly, however, there is a solution to this epidemic of metabolic disease that is inundating today's societies worldwide: exercise and diet. Overwhelming evidence from a variety of sources, including epidemiological, prospective cohort, and intervention studies, links most chronic diseases seen in the world today to physical inactivity and inappropriate diet consumption. The purpose of this review is to 1) discuss the effects of exercise and diet in the prevention of chronic disease, 2) highlight the effects of lifestyle modification for both mitigating disease progression and reversing existing disease, and 3) suggest potential mechanisms for beneficial effects. PMID:15591300

  15. Periodontal Disease in Chronic Kidney Disease and End-Stage Renal Disease Patients: A Review

    PubMed Central

    Ariyamuthu, Venkatesh K.; Nolph, Karl D.; Ringdahl, Bruce E.

    2013-01-01

    Periodontal disease is a chronic inflammatory disorder and being so it has been associated with accelerated atherosclerosis and malnutrition. Cardiovascular diseases are the leading cause of mortality in chronic kidney disease (CKD) and end-stage renal disease (ESRD) patients [National Institutes of Health, National Institute of Diabetes and Digestive and Kidney Diseases: Annual Data Report, 2010]. A recent scientific statement released by the American Heart Association [Lockhart et al.: Circulation 2012;125:2520-2544] claims that, even though evidence exists to believe that periodontal interventions result in a reduction in systemic inflammation and endothelial dysfunction, there is little evidence that those interventions prevent atherosclerotic vascular disease or modify the outcomes. In this review, we discuss the periodontal findings and their association with an increased prevalence of inflammatory markers and cardiovascular mortality in ESRD patients and CKD. PMID:23802000

  16. Exacerbations of chronic obstructive pulmonary disease.

    PubMed

    Wedzicha, Jadwiga A; Donaldson, Gavin C

    2003-12-01

    Exacerbations of chronic obstructive pulmonary disease (COPD) cause morbidity, hospital admissions, and mortality, and strongly influence health-related quality of life. Some patients are prone to frequent exacerbations, which are associated with considerable physiologic deterioration and increased airway inflammation. About half of COPD exacerbations are caused or triggered primarily by bacterial and viral infections (colds, especially from rhinovirus), but air pollution can contribute to the beginning of an exacerbation. Type 1 exacerbations involve increased dyspnea, sputum volume, and sputum purulence; Type 2 exacerbations involve any two of the latter symptoms, and Type 3 exacerbations involve one of those symptoms combined with cough, wheeze, or symptoms of an upper respiratory tract infection. Exacerbations are more common than previously believed (2.5-3 exacerbations per year); many exacerbations are treated in the community and not associated with hospital admission. We found that about half of exacerbations were unreported by the patients, despite considerable encouragement to do so, and, instead, were only diagnosed from patients' diary cards. COPD patients are accustomed to frequent symptom changes, and this may explain their tendency to underreport exacerbations. COPD patients tend to be anxious and depressed about the disease and some might not seek treatment. At the beginning of an exacerbation physiologic changes such as decreases in peak flow and forced expiratory volume in the first second (FEV(1)) are usually small and therefore are not useful in predicting exacerbations, but larger decreases in peak flow are associated with dyspnea and the presence of symptomatic upper-respiratory viral infection. More pronounced physiologic changes during exacerbation are related to longer exacerbation recovery time. Dyspnea, common colds, sore throat, and cough increase significantly during prodrome, indicating that respiratory viruses are important exacerbation triggers. However, the prodrome is relatively short and not useful in predicting onset. As colds are associated with longer and more severe exacerbations, a COPD patient who develops a cold should be considered for early therapy. Physiologic recovery after an exacerbation is often incomplete, which decreases health-related quality of life and resistance to future exacerbations, so it is important to identify COPD patients who suffer frequent exacerbations and to convince them to take precautions to minimize the risk of colds and other exacerbation triggers. Exacerbation frequency may vary with the severity of the COPD. Exacerbation frequency may or may not increase with the severity of the COPD. As the COPD progresses, exacerbations tend to have more symptoms and take longer to recover from. Twenty-five to fifty percent of COPD patients suffer lower airway bacteria colonization, which is related to the severity of COPD and cigarette smoking and which begins a cycle of epithelial cell damage, impaired mucociliary clearance, mucus hypersecretion, increased submucosal vascular leakage, and inflammatory cell infiltration. Elevated sputum interleukin-8 levels are associated with higher bacterial load and faster FEV(1) decline; the bacteria increase airway inflammation in the stable patient, which may accelerate disease progression. A 2-week course of oral corticosteroids is as beneficial as an 8-week course, with fewer adverse effects, and might extend the time until the next exacerbation. Antibiotics have some efficacy in treating exacerbations. Exacerbation frequency increases with progressive airflow obstruction; so patients with chronic respiratory failure are particularly susceptible to exacerbation. PMID:14651761

  17. Patient Experiences of Depression and Anxiety with Chronic Disease

    PubMed Central

    DeJean, D; Giacomini, M; Vanstone, M; Brundisini, F

    2013-01-01

    Background Depression and anxiety are highly prevalent in patients with chronic disease, but remain undertreated despite significant negative consequences on patient health. A number of clinical groups have developed recommendations for depression screening practices in the chronic disease population. Objectives The objective of this analysis was to review empirical qualitative research on the experiences of patients with chronic disease (e.g., COPD, diabetes, heart disease, stroke) and comorbid depression or anxiety, and to highlight the implications of the screening and management of anxiety and/or depression on chronic disease outcomes. Review Methods We performed literature searches for studies published from January 2002 to May 2012. We applied a qualitative mega-filter to nine condition-specific search filters. Titles and abstracts were reviewed by two reviewers and, for the studies that met the eligibility criteria, full-text articles were obtained. Qualitative meta-synthesis was used to integrate findings across relevant published primary research studies. Qualitative meta-synthesis produced a synthesis of evidence that both retained the original meaning of the authors and offered a new, integrative interpretation of the phenomenon through a process of comparing and contrasting findings across studies. Results The findings of 20 primary qualitative studies were synthesized. Patients tended to experience their chronic conditions and anxiety or depression as either independent or inter-related (i.e., the chronic disease lead to depression/anxiety, the depression/anxiety lead to the chronic disease, or the two conditions exacerbated each other). Potential barriers to screening for depression or anxiety were also identified. Limitations A wider array of issues might have been captured if the analysis had focused on broader psychological responses to the chronic disease experience. However, given the objective to highlight implications for screening for anxiety or depression, the more narrow focus seemed most relevant. Conclusions Chronic disease and anxiety or depression can be independent or inter-related. Patients may be reluctant to acknowledge depression or anxiety as a separate condition, or may not recognize that the conditions are separate because of overlapping physical symptoms. More qualitative research is needed to specifically address screening for depression or anxiety. Plain Language Summary Depression is a common complication of chronic disease. It may worsen the disease, and it may also affect the self-management of the disease. Screening for depression earlier, and then treating it, may reduce distress and improve symptoms of the chronic disease, leading to better quality of life. PMID:24228079

  18. Is hepatitis A more severe in patients with chronic hepatitis B and other chronic liver diseases?

    PubMed

    Keeffe, E B

    1995-02-01

    There are several published case series of acute hepatitis A, with coverage ranging from epidemics to case reports, that provide information regarding the clinical course and outcome of hepatitis A in patients with underlying chronic hepatitis B virus (HBV) infection (1-12). Only a few reports have addressed the outcome of hepatitis A in patients with other chronic liver diseases (2, 13). Some, but not all, of these reports suggest that hepatitis A superimposed on chronic hepatitis B or other chronic liver diseases is associated with higher peak laboratory abnormalities, more severe disease, including fulminant hepatic failure, and a higher case fatality rate. In addition, analysis of HBsAg titer and serum markers of HBV replication, including HBeAg, HBV DNA, and DNA polymerase, reveals suppression of HBV replication. With the availability of hepatitis A virus (HAV) vaccine in many countries and its imminent approval for use in the United States, the issue of whether or not patients with chronic liver diseases, including chronic HBV infection, should be a target group for vaccination to prevent hepatitis A warrants consideration. The purpose of this review is to analyze the published literature addressing the clinical course and outcome of acute hepatitis A in patients with chronic HBV infection and other chronic liver diseases to determine if hepatitis A is more severe in these patients. PMID:7847285

  19. Patient Self-management of Chronic Disease in Primary Care

    Microsoft Academic Search

    Thomas Bodenheimer; Kate Lorig; Halsted Holman; Kevin Grumbach

    2005-01-01

    Patients with chronic conditions make day-to-day decisions about—self- manage—their illnesses. This reality introduces a new chronic disease para- digm: the patient-professional partnership, involving collaborative care and self-management education. Self-management education complements tra- ditional patient education in supporting patients to live the best possible quality of life with their chronic condition. Whereas traditional patient edu- cation offers information and technical skills,

  20. Deer density and disease prevalence influence transmission of chronic wasting disease in white-tailed deer

    E-print Network

    Deer density and disease prevalence influence transmission of chronic wasting disease in white-tailed deer DANIEL J. STORM,1,7, MICHAEL D. SAMUEL,2 ROBERT E. ROLLEY,3 PAUL SHELTON,4 NICHOLAS S. KEULER,5. Richards, and T. R. Van Deelen. 2013. Deer density and disease prevalence influence transmission of chronic

  1. Psychological status among elderly people with chronic diseases: Does type of disease play a part?

    Microsoft Academic Search

    Brenda W. J. H. Penninx; Aartjan T. F. Beekman; Johan Ormel; Didi M. W. Kriegsman; A. Joan P. Boeke; Jacques Th. M. Van Eijk; Dorly J. H. Deeg

    1996-01-01

    Psychological status, including depressive symptoms, anxiety, and mastery, was measured in a community-based sample of 3,076 persons aged 55 to 85 with various chronic diseases. Strong, linear associations were found between the number of chronic diseases and depressive symptoms and anxiety, indicating that psychological distress among elderly people is more apparent in the presence of (more) diseases. Furthermore, in contrast

  2. Strain Fidelity of Chronic Wasting Disease upon Murine Adaptation

    Microsoft Academic Search

    Christina J. Sigurdson; Giuseppe Manco; Petra Schwarz; Pawel Liberski; Edward A. Hoover; Simone Hornemann; Magdalini Polymenidou; Michael W. Miller; Markus Glatzel; Adriano Aguzzi

    2006-01-01

    Chronic wasting disease (CWD), a prion disease of deer and elk, is highly prevalent in some regions of North America. The establishment of mouse-adapted CWD prions has proven difficult due to the strong species barrier between mice and deer. Here we report the efficient transmission of CWD to transgenic mice overex- pressing murine PrP. All mice developed disease 500 62

  3. [Disorders of the larynx and chronic inflammatory diseases].

    PubMed

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

    2012-12-01

    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

  4. Chronic Disease and Disability of the Poor: Tackling the challenge

    Microsoft Academic Search

    Derek Yach

    2001-01-01

    Derek Yach examines the range of factors that drive the increase in chronic disease incidence, disability and death among the poor: from social and demographic changes and patterns of consumption, to infectious disease, under-nutrition, trauma and the structure and focus of health services. He shows how the burden of disease is exacerbated by material deprivation and low levels of education.

  5. Chronic Wasting Disease Prions in Elk Antler Velvet

    Technology Transfer Automated Retrieval System (TEKTRAN)

    Chronic wasting disease (CWD) is a transmissible spongiform encephalopathy or prion disease of captive and free ranging white tailed deer, mule deer, Rocky Mountain elk and moose in the some parts of the United States and Canada. The presence of the disease has sharply curtailed movement of captive...

  6. Management of Chronic Infectious Diseases in School Children.

    ERIC Educational Resources Information Center

    Illinois State Board of Education, Springfield.

    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…

  7. Epidemiology of cardiovascular risk in patients with chronic kidney disease

    Microsoft Academic Search

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

    2003-01-01

    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

  8. Prevalence of Subclinical Hypothyroidism in Patients with Chronic Kidney Disease

    Microsoft Academic Search

    Michel Chonchol; Giuseppe Lippi; Gianluca Salvagno; Giacomo Zoppini; Michele Muggeo; Giovanni Targher

    Background and objectives: Subclinical primary hypothyroidism is highly prevalent in the general population, especially in the elderly. However, the prevalence of subclinical primary hypothyroidism in persons with chronic kidney disease (CKD) not requiring chronic dialysis is not well defined. Design, setting, participants, and measurements: Cross-sectional data from 3089 adult outpatients, who were consecutively referred by general practitioners for routine blood

  9. Tailored implementation for chronic diseases (TICD): A project protocol

    Microsoft Academic Search

    M. J. P. Wensing; A. Oxman; R. Baker; M. Godycki-Cwirko; S. Flottorp; J. Szecsenyi; J. Grimshaw; M. Eccles

    2011-01-01

    ABSTRACT\\\\BACKGROUND:The assumption underlying tailoring is that implementation interventions are most helpful if these effectively address the most important determinants of practice for improvement in the targeted setting. The aim of the Tailored Implementation For Chronic Diseases (TICD) project is to develop valid and efficient methods of tailoring implementation interventions to determinants of practice for knowledge implementation in chronic illness care.

  10. Chronic unexplained hypertransaminasemia may be caused by occult celiac disease

    Microsoft Academic Search

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

    1999-01-01

    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

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

    ERIC Educational Resources Information Center

    Katz, Michael

    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

  12. Management of Dyspnea in Severe Chronic Obstructive Pulmonary Disease

    Microsoft Academic Search

    Jean-Paul Janssens; Véronique Titelion

    2000-01-01

    Progression of chronic obstructive pulmonary disease (COPD) is frequently associated with increasing dyspnea; indeed, patients with severe COPD constitute the largest group of patients with chronic respiratory insufficiency. The sensation of dyspnea in these patients is mostly related to increased work of breathing, a consequence of an increased resistive load, of hyperinflation, and of the deleterious effect of intrinsic positive

  13. Chronic disease management in primary care: from evidence to policy

    Microsoft Academic Search

    Sarah M Dennis; Nicholas Zwar; Rhonda Griffiths; Martin Roland; Iqbal Hasan; Gawaine Powell Davies; Mark Harris

    Objectives: To review the effectiveness of chronic disease management interventions for physical health problems in the primary care setting, and to identify policy options for implementing successful interventions in Australian primary care. Methods: We conducted a systematic review with qualitative data synthesis, using the Chronic Care Model as a framework for analysis between January 1990 and February 2006. Interventions were

  14. Challenges and opportunities in late-stage chronic kidney disease*

    PubMed Central

    Fishbane, Steven; Hazzan, Azzour D.; Halinski, Candice; Mathew, Anna T.

    2015-01-01

    There is increasing recognition that chronic diseases are a major challenge for health delivery systems and treasuries. These are highly prevalent and costly diseases and frequency is expected to increase greatly as the population of many countries ages. Chronic kidney disease (CKD) has not received the same attention as other chronic diseases such as congestive heart failure; yet, the prevalence and costs of CKD are substantial. Greater recognition and support for CKD may require that the disease no longer be viewed as one continuous disease state. Early CKD stages require less complex care and generate lower costs. In contrast, late-stage CKD is every bit as complex and costly as other major chronic diseases. Health authorities may not recognize and fund CKD care appropriately until late-stage CKD is defined clearly as separate and distinct from earlier stages of disease. In this review, we describe the burden of chronic diseases, consider the challenges and barriers and propose processes to improve late-stage CKD care. In particular, we recommend the need for improved continuity of care, enhanced use of information technology, multidisciplinary care, timely referral to nephrologists, protocol use and improved patient engagement. PMID:25713711

  15. Drug-induced chronic hepatic disease.

    PubMed

    Zimmerman, H J

    1979-05-01

    A number of chronic hepatic lesions can result from adverse reactions to medicinal agents. Such lesions include a form of chronic active hepatitis; hepatic steatosis, phoepholipidosis and granulomatosis; several vascular lesions; two types of noncirrhotic portal hypertension; several types of cirrhosis and several neoplasms. PMID:221760

  16. Patient-Centered Medical Home in chronic obstructive pulmonary disease.

    PubMed

    Ortiz, Gabriel; Fromer, Len

    2011-01-01

    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. PMID:22096340

  17. Mentorship and competencies for applied chronic disease epidemiology.

    PubMed

    Lengerich, Eugene J; Siedlecki, Jennifer C; Brownson, Ross; Aldrich, Tim E; Hedberg, Katrina; Remington, Patrick; Siegel, Paul Z

    2003-01-01

    To understand the potential and establish a framework for mentoring as a method to develop professional competencies of state-level applied chronic disease epidemiologists, model mentorship programs were reviewed, specific competencies were identified, and competencies were then matched to essential public health services. Although few existing mentorship programs in public health were identified, common themes in other professional mentorship programs support the potential of mentoring as an effective means to develop capacity for applied chronic disease epidemiology. Proposed competencies for chronic disease epidemiologists in a mentorship program include planning, analysis, communication, basic public health, informatics and computer knowledge, and cultural diversity. Mentoring may constitute a viable strategy to build chronic disease epidemiology capacity, especially in public health agencies where resource and personnel system constraints limit opportunities to recruit and hire new staff. PMID:12836509

  18. Technology-supported apprenticeship in the management of chronic disease

    E-print Network

    Moore, John Oliver

    2013-01-01

    Chronic disease is the most important cause of morbidity and mortality worldwide, but the current standard of care is woefully ineffective. It is paternalistic, episodic, and perversely incentivized based on volume, resulting ...

  19. Health promotion or pharmacological treatment for chronic diseases?

    PubMed

    Allam, M F; Arjona, Ortiz

    2013-03-01

    Over the last years medicine has progressed very rapidly. Communicable diseases, which were the leading causes of mortalities, are not anymore, especially in developed countries. Currently, non-communicable diseases are more prevalent, and most of them are related to changes in our daily habits and degenerative processes. Most of these diseases are chronic, need continuous care and treatment with limited improvement and high costs. The General Assembly of the United Nations in its resolution 65/238 recognized the primary role and responsibility of Governments in responding to the challenge of non-communicable diseases and the essential need for the efforts and engagement of all sectors of society to generate an effective response. Special emphasis has been concentrated on pharmacological treatments for most of chronic non-communicable diseases with the challenge to discover new drugs for treating, in most cases, chronic irreversible degenerative diseases associated with aging. Little care was given to non-pharmacological lines of treatment. PMID:24396999

  20. Oral disease profiles in chronic graft versus host disease.

    PubMed

    Bassim, C W; Fassil, H; Mays, J W; Edwards, D; Baird, K; Steinberg, S M; Cowen, E W; Naik, H; Datiles, M; Stratton, P; Gress, R E; Pavletic, S Z

    2015-04-01

    At least half of patients with chronic graft-versus-host-disease (cGVHD), the leading cause of morbidity and non-relapse mortality after allogeneic stem cell transplantation, have oral manifestations: mucosal lesions, salivary dysfunction, and limited mouth-opening. cGVHD may manifest in a single organ or affect multiple organ systems, including the mouth, eyes, and the skin. The interrelationship of the 3 oral manifestations of cGVHD with each other and with the specific manifestations of extraoral cGVHD has not been studied. In this analysis, we explored, in a large group of patients with cGVHD, the potential associations between: (1) oral mucosal disease and erythematous skin disease, (2) salivary gland dysfunction and lacrimal gland dysfunction, and (3) limited mouth-opening and sclerotic skin cGVHD. Study participants, enrolled in a cGVHD Natural History Protocol (NCT00331968, n = 212), underwent an oral examination evaluating: (1) mucosal cGVHD [NIH Oral Mucosal Score (OMS)], (2) salivary dysfunction (saliva flow and xerostomia), and (3) maximum mouth-opening measurement. Parameters for dysfunction (OMS > 2, saliva flow ? 1 mL/5 min, mouth-opening ? 35 mm) were analyzed for association with skin cGVHD involvement (erythema and sclerosis, skin symptoms), lacrimal dysfunction (Schirmer's tear test, xerophthalmia), Lee cGVHD Symptom Scores, and NIH organ scores. Oral mucosal disease (31% prevalence) was associated with skin erythema (P < 0.001); salivary dysfunction (11% prevalence) was associated with lacrimal dysfunction (P = 0.010) and xerostomia with xerophthalmia (r = 0.32, P = 0.001); and limited mouth-opening (17% prevalence) was associated with skin sclerosis (P = 0.008) and skin symptoms (P = 0.001). There was no association found among these 3 oral cGVHD manifestations. This analysis supports the understanding of oral cGVHD as 3 distinct diseases: mucosal lesions, salivary gland dysfunction, and mouth sclerosis. Clear classification of oral cGVHD as 3 separate manifestations will improve clinical diagnosis, observational research data collection, and the definitions of outcome measures in clinical trials. PMID:25740857

  1. Chronic Disease Management: What Will It Take To Improve Care for Chronic Illness?

    Microsoft Academic Search

    Edward H. Wagner

    1998-01-01

    M eeting the complex needs of patients with chronic illness or impairment is the single greatest challenge facing organized medical practice. Usual care is not doing the job; dozens of surveys and audits have revealed that sizable proportions of chronically ill patients are not receiving effective therapy, have poor disease con- trol, and are unhappy with their care (1). Results

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

    PubMed

    Balkissoon, R C; Newman, L S

    1999-04-01

    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

  3. Home Telehealth for Patients With Chronic Obstructive Pulmonary Disease (COPD)

    PubMed Central

    Franek, J

    2012-01-01

    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: http://www.hqontario.ca/en/mas/mas_ohtas_mn.html. 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: http://fhs.mcmaster.ca/ceb/faculty_member_giacomini.htm. For more information on the economic analysis, please visit the PATH website: http://www.path-hta.ca/About-Us/Contact-Us.aspx. 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: http://theta.utoronto.ca/static/contact. Objective The objective of this analysis was to conduct an evidence-based assessment of home telehealth technologies for patients with chronic obstructive pulmonary disease (COPD) in order to inform recommendations regarding the access and provision of these services in Ontario. This analysis was one of several analyses undertaken to evaluate interventions for COPD. The perspective of this assessment was that of the Ontario Ministry of Health and Long-Term Care, a provincial payer of me

  4. Smoking Cessation for Patients With Chronic Obstructive Pulmonary Disease (COPD)

    PubMed Central

    2012-01-01

    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: http://www.hqontario.ca/en/mas/mas_ohtas_mn.html. 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: http://fhs.mcmaster.ca/ceb/faculty member_giacomini.htm. For more information on the economic analysis, please visit the PATH website: http://www.path-hta.ca/About-Us/Contact-Us.aspx. 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: http://theta.utoronto.ca/static/contact. Objective The objective of this evidence-based analysis was to determine the effectiveness and cost-effectiveness of smoking cessation interventions in the management of chronic obstructive pulmonary disease (COPD). Clinical Need: Condition and Target Population Tobacco smoking is the main risk factor for COPD. It is estimated that 50% of older smokers develop COPD and more than 80% of COPD-associated morbidity is attributed to tobacco smoking. According to the Canadian Community Health

  5. Risk factors for chronic kidney disease: an update

    PubMed Central

    Kazancio?lu, Rumeyza

    2013-01-01

    Chronic kidney disease has become a serious public health issue. There are currently over 1.4 million patients receiving renal replacement therapy worldwide. One way to reduce the economic burden of chronic kidney disease would be early intervention. In order to achieve this, we should be able to identify individuals with increased risk of renal disease. An individual's genetic and phenotypic make-up puts him/her at risk for kidney disease. Factors such as race, gender, age, and family history are highly important. For instance, being of African-American decent, older age, low birth weight and family history of kidney disease are considered to be strong risk factors for chronic kidney disease. Moreover, smoking, obesity, hypertension, and diabetes mellitus can also lead to kidney disease. An uncontrolled diabetic and/or hypertensive patient can easily and quickly progress to an end-stage kidney disease patient. Exposure to heavy metals, excessive alcohol consumption, smoking, and the use of analgesic medications also constitute risks. Experiencing acute kidney injury, a history of cardiovascular disease, hyperlipidemia, metabolic syndrome, hepatitis C virus, HIV infection, and malignancy are further risk factors. Determination of serum creatinine levels and urinalysis in patients with chronic kidney disease risk will usually be sufficient for initial screening. PMID:25019021

  6. Chronic Venous Disease (Beyond the Basics)

    MedlinePLUS

    ... from the surface of the legs to the deep leg veins, from which calf muscles pump blood ... is located in the superficial veins or the deep veins. (See "Diagnostic evaluation of chronic venous insufficiency" .) ...

  7. 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

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

    2009-01-01

    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

  8. Magnesium in Chronic Kidney Disease: Challenges and Opportunities

    Microsoft Academic Search

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

    2010-01-01

    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).

  9. Chronic obstructive pulmonary disease--a treatable disease.

    PubMed

    Osthoff, Mirjam; Jenkins, Christine; Leuppi, Jörg D

    2013-01-01

    Chronic obstructive pulmonary disease (COPD) is a global health challenge and a leading cause of death worldwide. Several risk factors have been identified, with cigarette smoking being the most important. Diagnostic assessment is based on symptoms, risk of exacerbations and results of lung function testing. A fixed post-bronchodilator ratio for forced expiratory volume in one second to forced expiratory volume (FEV1/FVC) of <0.7 is required to make the diagnosis, and the severity of airflow obstruction defines the grade according to GOLD (Global Strategy for the Diagnosis, Management, and Prevention of COPD). The GOLD strategy makes therapeutic recommendations taking into account the grade, symptomatic assessment and future risk of exacerbations. This review focuses on the therapeutic options for COPD, in accordance with the GOLD strategy. Smoking cessation is the most effective treatment option in all COPD stages. Bronchodilators, namely long-acting antimuscarinic drugs and long-acting beta-agonists, form the mainstay of treatment in COPD. Patients with frequent exacerbations also benefited from the addition of inhaled corticosteroids. Roflumilast is an add-on option for patients with severe COPD. Several controversies are the subject of discussion: (1.) whether pharmacotherapy can modify the natural history of COPD; (2.) whether pharmacotherapy should be started in the early stages of COPD; (3.) the impact of therapy on comorbidities; (4.) whether patients benefit from a combination therapy with a long-acting beta-agonist, a long-acting antimuscarinic drug and an inhaled corticosteroid; (5.) step-down therapy. This overview also reviews the evidence for recommended vaccines in COPD, as well as nonpharmacological therapies. Rehabilitation is an essential part of COPD treatment. Oxygen therapy, noninvasive nocturnal ventilation and surgical treatment options only apply to a highly selected group of patients. Disease management programmes and guideline adherence are briefly discussed. In conclusion, although there is debate as to the extent with which pharmacological therapies influence mortality, adherence to the GOLD strategy is recommended. PMID:23592218

  10. Severity of chronic Chagas disease is associated with cytokine/antioxidant imbalance in chronically infected individuals.

    PubMed

    Pérez-Fuentes, Ricardo; Guégan, Jean-François; Barnabé, Christian; López-Colombo, Aurelio; Salgado-Rosas, Hilda; Torres-Rasgado, Enrique; Briones, Bernardo; Romero-Díaz, Mónica; Ramos-Jiménez, Judith; Sánchez-Guillén, María del Carmen

    2003-03-01

    Understanding the pathogenic mechanisms in chronic Chagas disease, a major cause of morbidity and mortality in Latin America, is essential for the design of rational therapeutic strategies. In this paper we show that the development of Chagas disease is a consequence of a long-term and complex relationship between parasite persistence and maladapted homeostatic mechanisms in the host which leads to pathologic changes. We performed a retrospective study on 50 patients with chronic Chagas disease and 50 healthy control individuals. The specific immune response was detected by ELISA and IHA tests using autochthonous antigens, inflammatory process with the cytokine tumour necrosis factor (TNF)-alpha and nitric oxide (NO), and antioxidant protection with glutathione peroxidase and superoxide dismutase (SOD) levels. We developed generalised linear modelling procedures to assess simultaneously which explanatory variables and/or their interactions better explained disease severity in patients. Our results show the existence of a strong relationship between anti-Trypanosoma cruzi levels and chronic Chagas disease (P<0.0001). Taken together, the statistical data indicate both cumulative and complementary effects, where the increase in TNF-alpha (P=0.004) and NO (P=0.005) levels correlated with a reduction in glutathione peroxidase (P=0.0001) and SOD (P=0.01) levels drives the disease pathology in chronically infected patients. Our findings may have important implications for understanding host susceptibility to develop severe chronic infectious disease. In addition we show putative targets for the design of new therapeutic strategies to prevent disease progression, considering both specific treatment against the aetiological agent and modulation of the different immunopathological reactions in chronically infected individuals with chronic Chagas disease. PMID:12670514

  11. Cost Analysis of Chronic Disease Self-Management Programmes Being Delivered in South Florida

    ERIC Educational Resources Information Center

    Page, Timothy F.; Palmer, Richard C.

    2014-01-01

    Background: Chronic disease accounts for the majority of healthcare costs. The Chronic Disease Self-Management Programme (CDSMP) has been shown to be effective in reducing the burden of chronic disease. Objectives: The objective of this study was to measure the cost of delivering the Chronic Disease Self-Management Programme (CDSMP) in order to…

  12. Chronic liver inflammation: Clinical implications beyond alcoholic liver disease

    PubMed Central

    Park, Byoung-Jin; Lee, Yong-Jae; Lee, Hye-Ree

    2014-01-01

    Chronic alcohol exposure can lead to alcoholic liver disease, including hepatitis, cirrhosis and hepatocellular carcinoma, and chronic inflammation can simultaneously cause systemic medical illness. Recent evidence suggests that alcoholic liver disease is a predictor for liver-related diseases, cardiovascular disease, immunologic disease, and bone disease. Chronic inflammation in alcoholic liver disease is mediated by a direct inflammatory cascade from the alcohol detoxification process and an indirect inflammatory cascade in response to gut microflora-derived lipopolysaccharides (LPS). The pathophysiology of alcoholic liver disease and its related systemic illness is characterized by oxidative stress, activation of the immune cascade, and gut-liver interactions. Integrative therapeutic strategies for alcoholic liver disease include abstaining from alcohol consumption; general anti-inflammatories such as glucocorticoid, pentoxifylline, and tumour necrosis factor-? antagonist; antioxidants such as N- acetylcysteine; gut microflora and LPS modulators such as rifaximin and/or probiotics. This review focuses on the impact of chronic liver inflammation on systemic health problems and several potential therapeutic targets. PMID:24605015

  13. Chronic liver inflammation: clinical implications beyond alcoholic liver disease.

    PubMed

    Park, Byoung-Jin; Lee, Yong-Jae; Lee, Hye-Ree

    2014-03-01

    Chronic alcohol exposure can lead to alcoholic liver disease, including hepatitis, cirrhosis and hepatocellular carcinoma, and chronic inflammation can simultaneously cause systemic medical illness. Recent evidence suggests that alcoholic liver disease is a predictor for liver-related diseases, cardiovascular disease, immunologic disease, and bone disease. Chronic inflammation in alcoholic liver disease is mediated by a direct inflammatory cascade from the alcohol detoxification process and an indirect inflammatory cascade in response to gut microflora-derived lipopolysaccharides (LPS). The pathophysiology of alcoholic liver disease and its related systemic illness is characterized by oxidative stress, activation of the immune cascade, and gut-liver interactions. Integrative therapeutic strategies for alcoholic liver disease include abstaining from alcohol consumption; general anti-inflammatories such as glucocorticoid, pentoxifylline, and tumour necrosis factor-? antagonist; antioxidants such as N- acetylcysteine; gut microflora and LPS modulators such as rifaximin and/or probiotics. This review focuses on the impact of chronic liver inflammation on systemic health problems and several potential therapeutic targets. PMID:24605015

  14. Pattern and profile of chronic liver disease in acute on chronic liver failure.

    PubMed

    Abbas, Zaigham; Shazi, Lubna

    2015-07-01

    The etiology of the chronic liver disease (CLD) in patients with acute on chronic liver failure (ACLF) may vary from region to region. The major cause of underlying CLD is viral (hepatitis B and C) in the East, while it is alcohol related in the West and in some parts of the Indian subcontinent. Autoimmune liver disease and Wilson's disease are the major underlying etiologies in the pediatric age group. The patients with CLD without cirrhosis should be included when defining ACLF. Non-alcoholic fatty liver disease related chronic liver insult in patients with known risk factors for progressive disease should be taken as a chronic liver disease in the setting of ACLF, whereas fatty liver with normal aminotransferases in low risk patients should not. The patients with CLD and previous decompensation should be excluded. Diagnosis of chronic liver disease in the setting of ACLF is made by history, physical examination and previously available or recent laboratory, endoscopic or radiological investigations. A liver biopsy through the transjugular route may help in cases where the presence of underlying CLD or its cause is not clear. The need of liver biopsy in ACLF should, however, be individualized. Standardization of liver biopsy assessment is essential for a uniform approach to the diagnosis and treatment of CLD and acute insult. Tools to measure liver stiffness may aid in identifying patients with advanced fibrosis. Studies are needed to validate the performance of these tests in the setting of ACLF. PMID:26016461

  15. Lack of exercise is a major cause of chronic diseases.

    PubMed

    Booth, Frank W; Roberts, Christian K; Laye, Matthew J

    2012-04-01

    Chronic diseases are major killers in the modern era. Physical inactivity is a primary cause of most chronic diseases. The initial third of the article considers: activity and prevention definitions; historical evidence showing physical inactivity is detrimental to health and normal organ functional capacities; cause versus treatment; physical activity and inactivity mechanisms differ; gene-environment interaction (including aerobic training adaptations, personalized medicine, and co-twin physical activity); and specificity of adaptations to type of training. Next, physical activity/exercise is examined as primary prevention against 35 chronic conditions [accelerated biological aging/premature death, low cardiorespiratory fitness (VO2max), sarcopenia, metabolic syndrome, obesity, insulin resistance, prediabetes, type 2 diabetes, nonalcoholic fatty liver disease, coronary heart disease, peripheral artery disease, hypertension, stroke, congestive heart failure, endothelial dysfunction, arterial dyslipidemia, hemostasis, deep vein thrombosis, cognitive dysfunction, depression and anxiety, osteoporosis, osteoarthritis, balance, bone fracture/falls, rheumatoid arthritis, colon cancer, breast cancer, endometrial cancer, gestational diabetes, pre-eclampsia, polycystic ovary syndrome, erectile dysfunction, pain, diverticulitis, constipation, and gallbladder diseases]. The article ends with consideration of deterioration of risk factors in longer-term sedentary groups; clinical consequences of inactive childhood/adolescence; and public policy. In summary, the body rapidly maladapts to insufficient physical activity, and if continued, results in substantial decreases in both total and quality years of life. Taken together, conclusive evidence exists that physical inactivity is one important cause of most chronic diseases. In addition, physical activity primarily prevents, or delays, chronic diseases, implying that chronic disease need not be an inevitable outcome during life. PMID:23798298

  16. Atherosclerosis in chronic kidney disease: the role of macrophages

    Microsoft Academic Search

    Valentina Kon; MacRae F. Linton; Sergio Fazio

    2010-01-01

    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

  17. Vitamin D prophylaxis and osteomalacia in chronic cholestatic liver disease

    Microsoft Academic Search

    Juliet E. Compston; John P. Crowe; Irving P. Wells; L. W. L. Horton; D. Hirst; A. L. Merrett; J. S. Woodhead; Roger Williams

    1980-01-01

    Bone histology was examined in 32 patients with chronic cholestatic liver disease, of whom just over one half were receiving high-dose parenteral vitamin D therapy. Four patients had histological evidence of osteomalacia; two of these were receiving vitamin D therapy, and showed only very mild osteomalacia, while the remaining two untreated patients had more severe bone disease. Plasma 25-hydroxyvitamin D

  18. HDL metabolism and activity in chronic kidney disease

    Microsoft Academic Search

    Mohamad Navab; Alan M. Fogelman; Nosratola D. Vaziri

    2010-01-01

    Chronic kidney disease (CKD) is associated with development of atherosclerosis and premature death from cardiovascular disease. The predisposition of patients with CKD to atherosclerosis is driven by inflammation, oxidative stress and dyslipidemia, all of which are common features of this condition. Markers of dyslipidemia in patients with advanced CKD are impaired clearance and heightened oxidation of apolipoprotein-B-containing lipoproteins and their

  19. Intergenerational transmission of non-communicable chronic diseases

    Microsoft Academic Search

    Catarina Goulao; Agustin Pérez-Barahona

    2012-01-01

    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

  20. Landscape genetics and the spatial distribution of chronic wasting disease

    Microsoft Academic Search

    Julie A. Blanchong; Michael D. Samuel; Kim T. Scribner; Byron V. Weckworth; Julia A. Langenberg; Kristine B. Filcek

    2007-01-01

    Predicting the spread of wildlife disease is critical for identifying populations at risk, tar- geting surveillance and designing proactive management programmes. We used a landscape genetics approach to identify landscape features that influenced gene flow and the distribution of chronic wasting disease (CWD) in Wisconsin white-tailed deer. CWD prevalence was nega- tively correlated with genetic differentiation of study area deer

  1. Diabetes Group Visits: An Alternative to Managing Chronic Disease Outcomes

    Microsoft Academic Search

    Chris Simmons; Jane Faith Kapustin

    2011-01-01

    Diabetes mellitus is a chronic disease with an ever-expanding prevalence and financial burden for our health care system. Because patients with diabetes often require similar education and disease management, group visits or shared medical appointments have been piloted as an alternative to standard office visits. This article reviews the evidence from clinical trials involving the group visit model. Specific outcomes

  2. Defective tryptophan catabolism underlies inflammation in mouse chronic granulomatous disease

    Microsoft Academic Search

    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

    2008-01-01

    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

  3. Health status measurement in chronic obstructive pulmonary disease

    Microsoft Academic Search

    P W Jones

    2001-01-01

    Health status measurement is a common feature of studies in chronic obstructive pulmonary disease (COPD). This review assesses recent evidence for the validity of these measurements and their role as measures of the overall impact of the disease on the patient's daily life and wellbeing. It reviews the mostly widely used COPD specific questionnaires and examines the contribution that they

  4. Bronchodilator reversibility testing in chronic obstructive pulmonary disease

    Microsoft Academic Search

    P M A Calverley; P S Burge; S Spencer; J A Anderson; P W Jones

    2003-01-01

    Background: A limited or absent bronchodilator response is used to classify chronic obstructive pulmonary disease (COPD) and can determine the treatment offered. The reliability of the recommended response criteria and their relationship to disease progression has not been established.Methods: 660 patients meeting European Respiratory Society (ERS) diagnostic criteria for irreversible COPD were studied. Spirometric parameters were measured on three occasions

  5. Ventilation of patients with asthma and chronic obstructive pulmonary disease

    Microsoft Academic Search

    Yin Peigang; John J. Marini

    2002-01-01

    Ventilatory intervention is often life-saving when patients with asthma or chronic obstructive pulmonary disease (COPD) experience acute respiratory compromise. Although both noninvasive and invasive ventilation methods may be viable initial choices, which is better depends upon the severity of illness, the rapidity of response, coexisting disease, and capacity of the medical environment. In addition, noninvasive ventilation often relieves dyspnea and

  6. Role of psychiatric comorbidity in chronic Lyme disease

    Microsoft Academic Search

    Afton L. Hassett; Diane C. Radvanski; Steven Buyske; Shantal V. Savage; Michael Gara; Javier I. Escobar; Leonard H. Sigal

    2008-01-01

    Objective. To evaluate the prevalence and role of psychiatric comorbidity and other psychological factors in patients with chronic Lyme disease (CLD). Methods. We assessed 159 patients drawn from a cohort of 240 patients evaluated at an academic Lyme disease referral center. Patients were screened for common axis I psychiatric disorders (e.g., depressive and anxiety disorders); structured clinical interviews confirmed diagnoses.

  7. Underlying chronic granulomatous disease in a patient with bronchocentric granulomatosis

    PubMed Central

    Moltyaner, Y; Geerts, W; Chamberlain, D; Heyworth, P; Noack, D; Rae, J; Doyle, J; Downey, G

    2003-01-01

    We present a case of bronchocentric granulomatosis in a woman with no history of asthma who was colonised with Aspergillusfumigatus. A family history of chronic granulomatous disease prompted further testing that demonstrated severely depressed neutrophil oxidant production and gp91phox deficiency compatible with the X linked carrier state of chronic granulomatous disease. Only one report of the association of these two rare diseases has previously appeared in the literature. We postulate that an ineffective immune response led to the prolonged colonisation of Afumigatus resulting in a hypersensitivity reaction that was manifest clinically as bronchocentric granulomatosis. PMID:14645984

  8. VNI cures acute and chronic experimental Chagas disease.

    PubMed

    Villalta, Fernando; Dobish, Mark C; Nde, Pius N; Kleshchenko, Yulia Y; Hargrove, Tatiana Y; Johnson, Candice A; Waterman, Michael R; Johnston, Jeffrey N; Lepesheva, Galina I

    2013-08-01

    Chagas disease is a deadly infection caused by the protozoan parasite Trypanosoma cruzi. Afflicting approximately 8 million people in Latin America, Chagas disease is now becoming a serious global health problem proliferating beyond the traditional geographical borders, mainly because of human and vector migration. Because the disease is endemic in low-resource areas, industrial drug development has been lethargic. The chronic form remains incurable, there are no vaccines, and 2 existing drugs for the acute form are toxic and have low efficacy. Here we report the efficacy of a small molecule, VNI, including evidence of its effectiveness against chronic Chagas disease. VNI is a potent experimental inhibitor of T. cruzi sterol 14?-demethylase. Nontoxic and highly selective, VNI displays promising pharmacokinetics and administered orally to mice at 25 mg/kg for 30 days cures, with 100% cure rate and 100% survival, the acute and chronic T. cruzi infection. PMID:23372180

  9. Study on Assessment of Renal Function in Chronic Liver Disease

    PubMed Central

    Das, Nupur; Paria, Baishakhi; Sarkar, Sujoy

    2015-01-01

    Introduction: Renal dysfunction is common in chronic liver disease. The cause of this renal dysfunction is either multi-organ involvement in acute conditions or secondary to advanced liver disease. Objectives: The study was undertaken to assess the renal function in chronic liver diseases and find out the association of alteration of renal function with gradation of liver disease. (assessed by child-pugh criteria) and to find out the association of alteration of renal function among the cases of chronic liver disease of different aetiology. Materials and Methods: This cross-sectional, observational study was undertaken in Department of General Medicine, Calcutta National Medical College & Hospital, Kolkata during March 2012 to July 2013 with 50 admitted patients of chronic liver disease after considering the exclusion criteria. The patients were interviewed with a pre-designed and pre-tested schedule, examined clinically, followed by some laboratory investigations relevant to diagnose the aetiology of chronic liver disease, and to assess the severity of liver and renal dysfunction. Data was analysed by standard statistical method. Results: Eighty six percent of the patients were male and the mean age of study population was 43.58 y, 68% patients suffered from alcoholic liver disease, followed by 14% patients had chronic Hepatitis-B, 10% patients developed acute kidney injury, 20% had hepato renal syndrome and 14% had IgA deposition. The distribution of serum urea and creatinine across the categories of Child Pugh classification tested by Mann-Whitney test and the distribution was statistically significant. Conclusion: The present study has found significant association between severity of liver dysfunction and certain parameters of renal dysfunction. PMID:25954647

  10. Hydrocarbon exposure and chronic renal disease

    Microsoft Academic Search

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

    1996-01-01

    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

  11. Gastrointestinal Involvement in Chronic Granulomatous Disease

    Microsoft Academic Search

    Beatriz E. Marciano; Sergio D. Rosenzweig; David E. Kleiner; Victoria L. Anderson; Dirk N. Darnell; Sandra Anaya-O; Dianne M. Hilligoss; Harry L. Malech; John I. Gallin; Steven M. Holland

    Objective. Chronic granulomatous dis- ease (CGD) is a rare disorder of phagocyte oxidative metabolism. In addition to infectious complications, granulomatous lesions often involve hollow viscera, es- pecially the gastrointestinal (GI) tract. The objective of this study was to evaluate the clinical presentation, prev- alence, and consequences of GI involvement in patients with CGD. Methods. The medical records of 140 patients

  12. Bisphenol A in chronic kidney disease.

    PubMed

    Krieter, Detlef H; Canaud, Bernard; Lemke, Horst-Dieter; Rodriguez, Annie; Morgenroth, Andreas; von Appen, Kai; Dragoun, Gerd-Peter; Wanner, Christoph

    2013-03-01

    The estrogenic endocrine-disrupting substance bisphenol A (BPA) is extensively used as a starting material for a variety of consumer plastic products including dialyzer materials. The present study was performed to explore plasma BPA levels in patients with impaired renal function and to investigate if dialyzers differing in elutable BPA influence plasma levels in patients on maintenance hemodialysis. In vitro BPA was eluted from high-flux polyethersulfone (PUREMA H, referred as PUR-H), high-flux polysulfone (referred as HF-PSu), and low-flux polysulfone (referred as LF-PSu) dialyzers by recirculation with water for 180?min. In a cross-sectional clinical study, plasma BPA levels of outpatients with different stages of chronic kidney disease (CKD) from four different centers were determined. Furthermore, in a prospective, randomized, and crossover setting, 18 maintenance dialysis patients were subjected successively to 4 weeks of thrice-weekly hemodialysis with each LF-PSu, HF-PSu, and PUR-H. In addition, the fractions of protein-bound and free BPA were determined in a subset of dialysis patients. The mass of BPA eluted from the blood compartments in vitro under aqueous conditions varied for the three dialyzers being very low for PUR-H (6.2?±?2.5?ng; P?

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

    PubMed

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

    2013-01-01

    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

  14. Presymptomatic risk assessment for chronic non-communicable diseases

    Microsoft Academic Search

    Badri Padhukasahasram; Eran Halperin; Jennifer Wessel; Daryl J. Thomas; Elana Silver; Heather Trumbower; Michele Cargill; Dietrich A. Stephan

    2010-01-01

    The prevalence of common chronic non-communicable diseases (CNCDs) far overshadows the prevalence of both monogenic and infectious diseases combined. All CNCDs, also called complex genetic diseases, have a heritable genetic component that can be used for pre-symptomatic risk assessment. Common single nucleotide polymorphisms (SNPs) that tag risk haplotypes across the genome currently account for a non-trivial portion of the germ-line

  15. Relevance of Chronic Lyme Disease to Family Medicine as a Complex Multidimensional Chronic Disease Construct: A Systematic Review

    PubMed Central

    Goderis, Geert

    2014-01-01

    Lyme disease has become a global public health problem and a prototype of an emerging infection. Both treatment-refractory infection and symptoms that are related to Borrelia burgdorferi infection remain subject to controversy. Because of the absence of solid evidence on prevalence, causes, diagnostic criteria, tools and treatment options, the role of autoimmunity to residual or persisting antigens, and the role of a toxin or other bacterial-associated products that are responsible for the symptoms and signs, chronic Lyme disease (CLD) remains a relatively poorly understood chronic disease construct. The role and performance of family medicine in the detection, integrative treatment, and follow-up of CLD are not well studied either. The purpose of this paper is to describe insights into the complexity of CLD as a multidimensional chronic disease construct and its relevance to family medicine by means of a systematic literature review. PMID:25506429

  16. 77 FR 3434 - Notice of Request for Reinstatement of an Information Collection; Chronic Wasting Disease Herd...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2012-01-24

    ...Information Collection; Chronic Wasting Disease Herd Certification Program AGENCY: Animal and...wasting disease from farmed or captive cervid herds in the United States. DATES: We will...INFORMATION: Title: Chronic Wasting Disease Herd Certification Program. OMB Number:...

  17. Activated protein C based therapeutic strategies in chronic diseases.

    PubMed

    Bock, Fabian; Shahzad, Khurrum; Vergnolle, Nathalie; Isermann, Berend

    2014-04-01

    Activated protein C (aPC) is a natural anticoagulant and a potent anti-inflammatory and cytoprotective agent. At the expense of increased bleeding risk aPC has been used - with some success - in sepsis. The design of cytoprotective-selective aPC variants circumvents this limitation of increased bleeding, reviving the interest in aPC as a therapeutic agent. Emerging studies suggest that aPC`s beneficial effects are not restricted to acute illness, but likewise relevant in chronic diseases, such as diabetic nephropathy, neurodegeneration or wound healing. Epigenetic regulation of gene expression, reduction of oxidative stress, and regulation of ROS-dependent transcription factors are potential mechanisms of sustained cytoprotective effects of aPC in chronic diseases. Given the available data it seems questionable whether a unifying mechanism of aPC dependent cytoprotection in acute and chronic diseases exists. In addition, the signalling pathways employed by aPC are tissue and cell specific. The mechanistic insights gained from studies exploring aPC`s effects in various diseases may hence lay ground for tissue and disease specific therapeutic approaches. This review outlines recent investigations into the mechanisms and consequences of long-term modulation of aPC-signalling in models of chronic diseases. PMID:24652581

  18. Fibromyalgia and chronic widespread pain in autoimmune thyroid disease.

    PubMed

    Ahmad, Jowairiyya; Tagoe, Clement E

    2014-07-01

    Fibromyalgia and chronic widespread pain syndromes are among the commonest diseases seen in rheumatology practice. Despite advances in the management of these conditions, they remain significant causes of morbidity and disability. Autoimmune thyroid disease is the most prevalent autoimmune disorder, affecting about 10 % of the population, and is a recognized cause of fibromyalgia and chronic widespread pain. Recent reports are shedding light on the mechanisms of pain generation in autoimmune thyroid disease-associated pain syndromes including the role of inflammatory mediators, small-fiber polyneuropathy, and central sensitization. The gradual elucidation of these pain pathways is allowing the rational use of pharmacotherapy in the management of chronic widespread pain in autoimmune thyroid disease. This review looks at the current understanding of the prevalence of pain syndromes in autoimmune thyroid disease, their likely causes, present appreciation of the pathogenesis of chronic widespread pain, and how our knowledge can be used to find lasting and effective treatments for the pain syndromes associated with autoimmune thyroid disease. PMID:24435355

  19. Animal models of chronic obstructive pulmonary disease.

    PubMed

    Pérez-Rial, Sandra; Girón-Martínez, Álvaro; Peces-Barba, Germán

    2015-03-01

    Animal models of disease have always been welcomed by the scientific community because they provide an approach to the investigation of certain aspects of the disease in question. Animal models of COPD cannot reproduce the heterogeneity of the disease and usually only manage to represent the disease in its milder stages. Moreover, airflow obstruction, the variable that determines patient diagnosis, not always taken into account in the models. For this reason, models have focused on the development of emphysema, easily detectable by lung morphometry, and have disregarded other components of the disease, such as airway injury or associated vascular changes. Continuous, long-term exposure to cigarette smoke is considered the main risk factor for this disease, justifying the fact that the cigarette smoke exposure model is the most widely used. Some variations on this basic model, related to exposure time, the association of other inducers or inhibitors, exacerbations or the use of transgenic animals to facilitate the identification of pathogenic pathways have been developed. Some variations or heterogeneity of this disease, then, can be reproduced and models can be designed for resolving researchers' questions on disease identification or treatment responses. PMID:25201221

  20. Screening for Chronic Kidney Disease: Unresolved Issues

    Microsoft Academic Search

    WILLIAM M. MCCLELLAN; SYLVIA P. B. RAMIREZ; CLAUDINE JURKOVITZ

    2003-01-01

    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

  1. Why do young people with chronic kidney disease die early?

    PubMed Central

    Kumar, Shankar; Bogle, Richard; Banerjee, Debasish

    2014-01-01

    Cardiovascular disease poses the greatest risk of premature death seen among patients with chronic kidney disease (CKD). Up to 50% of mortality risk in the dialysis population is attributable to cardiovascular disease and the largest relative excess mortality is observed in younger patients. In early CKD, occlusive thrombotic coronary disease is common, but those who survive to reach end-stage renal failure requiring dialysis are more prone to sudden death attributable mostly to sudden arrhythmic events and heart failure related to left ventricular hypertrophy, coronary vascular calcification and electrolyte disturbances. In this review, we discuss the basis of the interaction of traditional risk factors for cardiovascular disease with various pathological processes such as endothelial dysfunction, oxidative stress, low grade chronic inflammation, neurohormonal changes and vascular calcification and stiffness which account for the structural and functional cardiac changes that predispose to excess morbidity and mortality in young people with CKD. PMID:25374808

  2. Oral protein calorie supplementation for children with chronic disease

    PubMed Central

    Francis, Damian K; Smith, Joanne; Saljuqi, Tawab; Watling, Ruth M

    2015-01-01

    Background Poor growth and nutritional status are common in children with chronic diseases. Oral protein calorie supplements are used to improve nutritional status in these children. These expensive products may be associated with some adverse effects, e.g. the development of inappropriate eating behaviour patterns. This is a new update of a Cochrane review last updated in 2009. Objectives To examine evidence that in children with chronic disease, oral protein calorie supplements alter daily nutrient intake, nutritional indices, survival and quality of life and are associated with adverse effects, e.g. diarrhoea, vomiting, reduced appetite, glucose intolerance, bloating and eating behaviour problems. Search methods Trials of oral protein calorie supplements in children with chronic diseases were identified through comprehensive electronic database searches, handsearching relevant journals and abstract books of conference proceedings. Companies marketing these products were also contacted. Most recent search of the Group's Trials Register: 24 February 2015. Selection criteria Randomised or quasi-randomised controlled trials comparing oral protein calorie supplements for at least one month to increase calorie intake with existing conventional therapy (including advice on improving nutritional intake from food or no specific intervention) in children with chronic disease. Data collection and analysis We independently assessed the outcomes: indices of nutrition and growth; anthropometric measures of body composition; calorie and nutrient intake (total from oral protein calorie supplements and food); eating behaviour; compliance; quality of life; specific adverse effects; disease severity scores; and mortality; we also assessed the risk of bias in the included trials. Main results Four studies (187 children) met the inclusion criteria. Three studies were carried out in children with cystic fibrosis and one study included children with paediatric malignant disease. Overall there was a low risk of bias for blinding and incomplete outcome data.Two studies had a high risk of bias for allocation concealment. Few statistical differences were found in the outcomes we assessed between treatment and control groups, except change in total energy intake at six and 12 months, mean difference 304.86 kcal per day (95% confidence interval 5.62 to 604.10) and mean difference 265.70 kcal per day (95% confidence interval 42.94 to 485.46), respectively. However, these were based on the analysis of just 58 children in only one study. Only two chronic diseases were included in these analyses, cystic fibrosis and paediatric malignant disease. No other studies were identified which assessed the effectiveness of oral protein calorie supplements in children with other chronic diseases. Authors' conclusions Oral protein calorie supplements are widely used to improve the nutritional status of children with a number of chronic diseases. We identified a small number of studies assessing these products in children with cystic fibrosis and paediatric malignant disease, but were unable to draw any conclusions based on the limited data extracted. We recommend a series of large, randomised controlled trials be undertaken investigating the use of these products in children with different chronic diseases. Until further data are available, we suggest these products are used with caution. PLAIN LANGUAGE SUMMARY The use of oral protein calorie supplements in children with chronic disease Background A lack of growth and poor nutrition are common in children with chronic diseases like cystic fibrosis and paediatric cancer. This may be due to reduced appetite, poor absorption and the need for extra calories due to the disease. Oral protein calorie supplements, either as milk or juices, may improve nutritional status and help children gain weight. Side effects of taking these supplements include the risk that the protein and calories in the supplement end up replacing those from normal food and have a negative effect on eating behaviour and physical side effects (e.g

  3. Identity and psychological ownership in chronic illness and disease state

    PubMed Central

    Karnilowicz, W

    2011-01-01

    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. PMID:20738388

  4. Cutaneous Miliary Tuberculosis in a Chronic Kidney Disease Patient

    PubMed Central

    Suraprasit, Pudit; Silpa-archa, Narumol; Triwongwaranat, Daranporn

    2014-01-01

    A 79-year-old Thai woman with advanced renal failure, dyslipidemia and anemia of chronic disease was admitted to hospital with prolonged fever, productive cough and multiple discrete small pustules on her face, trunk and extremities. A chest X-ray revealed diffuse miliary infiltration. Mycobacterium tuberculosis complex DNA was detected by polymerase chain reaction in sputum and scrapings of pustules from her skin. Blood culture identified M. tuberculosis complex. Pulmonary and cutaneous miliary tuberculosis was diagnosed. The patient's symptoms improved after 3 weeks of treatment with isoniazid, rifampicin, ethambutol and pyrazinamide. This report details a case of cutaneous miliary tuberculosis in a non-dialysis chronic kidney disease patient. PMID:25493081

  5. Underrecognized comorbidities of chronic obstructive pulmonary disease

    PubMed Central

    Mi?kowska-Dymanowska, Joanna; Bia?as, Adam J; Zalewska-Janowska, Anna; Górski, Pawe?; Piotrowski, Wojciech J

    2015-01-01

    COPD is associated with different comorbid diseases, and their frequency increases with age. Comorbidities severely impact costs of health care, intensity of symptoms, quality of life and, most importantly, may contribute to life span shortening. Some comorbidities are well acknowledged and established in doctors’ awareness. However, both everyday practice and literature searches provide evidence of other, less recognized diseases, which are frequently associated with COPD. We call them underrecognized comorbidities, and the reason why this is so may be related to their relatively low clinical significance, inefficient literature data, or data ambiguity. In this review, we describe rhinosinusitis, skin abnormalities, eye diseases, different endocrinological disorders, and gastroesophageal reflux disease. Possible links to COPD pathogenesis have been discussed, if the data were available.

  6. Carbon Nanotubes and Chronic Granulomatous Disease

    PubMed Central

    Barna, Barbara P.; Judson, Marc A.; Thomassen, Mary Jane

    2014-01-01

    Use of nanomaterials in manufactured consumer products is a rapidly expanding industry and potential toxicities are just beginning to be explored. Combustion-generated multiwall carbon nanotubes (MWCNT) or nanoparticles are ubiquitous in non-manufacturing environments and detectable in vapors from diesel fuel, methane, propane, and natural gas. In experimental animal models, carbon nanotubes have been shown to induce granulomas or other inflammatory changes. Evidence suggesting potential involvement of carbon nanomaterials in human granulomatous disease, has been gathered from analyses of dusts generated in the World Trade Center disaster combined with epidemiological data showing a subsequent increase in granulomatous disease of first responders. In this review we will discuss evidence for similarities in the pathophysiology of carbon nanotube-induced pulmonary disease in experimental animals with that of the human granulomatous disease, sarcoidosis. PMID:25525507

  7. Sulodexide in the treatment of chronic venous disease.

    PubMed

    Andreozzi, Giuseppe Maria

    2012-04-01

    Chronic venous disease encompasses a range of venous disorders, including those involving the lower limbs resulting from venous hypertension. The spectrum of chronic venous disease signs and symptoms shows variable severity, ranging from mild (aching, pain, and varicose veins) to severe (venous ulcers). The pathophysiology of chronic venous disease is characterized by venous hypertension, which triggers endothelial dysfunction and inflammation leading to microcirculatory and tissue damage, and eventually to varicose veins and venous ulcers. Sulodexide is an orally active mixture of glycosaminoglycan (GAG) polysaccharides with established antithrombotic and profibrinolytic activity. The agent is used in the treatment of a number of vascular disorders with increased risk of thrombosis, including intermittent claudication, peripheral arterial occlusive disease and post-myocardial infarction. Sulodexide differs from heparin because it is orally bioavailable and has a longer half-life and a smaller effect on systemic clotting and bleeding. An increasing body of preclinical evidence shows that sulodexide also exerts anti-inflammatory, endothelial-protective, and pleiotropic effects, supporting its potential efficacy in the treatment of chronic venous disease. Clinical studies of sulodexide have shown that the agent is associated with significant improvements in the clinical signs and symptoms of venous ulcers, and is therefore a recommended therapy in combination with local wound care and bandages for patients with persistent venous leg ulcers. Preliminary evidence supports the use of sulodexide in the prevention of recurrent deep venous thrombosis. Sulodexide was generally safe and well tolerated in clinical trials, without hemorrhagic complications. Sulodexide therefore appears to be a favorable option for the treatment of all stages of chronic venous disease and for the prevention of disease progression. PMID:22329592

  8. Chronic kidney disease of unknown etiology in agricultural communities.

    PubMed

    Almaguer, Miguel; Herrera, Raúl; Orantes, Carlos M

    2014-04-01

    In recent years, Central America, Egypt, India and Sri Lanka have reported a high prevalence of chronic kidney disease of unknown etiology in agricultural communities, predominantly among male farmworkers. This essay examines the disease's case definitions, epidemiology (disease burden, demographics, associated risk factors) and causal hypotheses, by reviewing published findings from El Salvador, Nicaragua, Costa Rica, Sri Lanka, Egypt and India. The range of confirmed chronic kidney disease prevalence was 17.9%-21.1%. Prevalence of reduced glomerular filtration (<60 mL/min/1.73 m2 body surface area) based on a single serum creatinine measurement was 0%-67% men and 0%-57% women. Prevalence was generally higher in male farmworkers aged 20-50 years, and varied by community economic activity and altitude. Cause was unknown in 57.4%-66.7% of patients. The dominant histopathological diagnosis was chronic tubulointerstitial nephritis. Associations were reported with agricultural work, agrochemical exposure, dehydration, hypertension, homemade alcohol use and family history of chronic kidney disease. There is no strong evidence for a single cause, and multiple environmental, occupational and social factors are probably involved. Further etiological research is needed, plus interventions to reduce preventable risk factors. PMID:24878644

  9. Left ventricular function in patients with chronic obstructive pulmonary disease

    PubMed Central

    Williams, John F.; Childress, Richard H.; Boyd, Daniel L.; Higgs, Lawrence M.; Behnke, Roy H.

    1968-01-01

    Left ventricular function was assessed in six patients with essentially normal cardiopulmonary function, in five patients with primary myocardial disease, and in 16 patients with chronic obstructive pulmonary disease by determining the response of the ventricle to an increased resistance to ejection. Studies were performed at the time of cardiac catheterization and increased resistance to left ventricular ejection was produced by the intravenous infusion of methoxamine. In the control patients, methoxamine produced an increase in stroke volume index (SVI), in stroke work index (SWI), and stroke power index (SPI), whereas left ventricular end-diastolic pressure (LVEDP) increased only moderately. In contrast SVI, SWI, and SPI fell, whereas LVEDP increased inordinately in the patients with myocardiopathy. The patients with chronic obstructive pulmonary disease responded to the infusion with an increase in SVI, SWI, SPI, and LVEDP comparable to the control patients. Furthermore, in this latter group of patients, a quantitatively similar response was observed in those with essentially normal resting hemodynamics, in those with resting pulmonary hypertension, and in those whose disease had progressed to the stage of right ventricular failure. This study provides no evidence that chronic obstructive pulmonary disease results in chronic impairment of left ventricular function, but on the contrary, has demonstrated that the left ventricle responds normally to an increased pressure load in these patients. PMID:5645859

  10. Chronic Lyme disease: misconceptions and challenges for patient management.

    PubMed

    Halperin, John J

    2015-01-01

    Lyme disease, infection with the tick-borne spirochete Borrelia burgdorferi, causes both specific and nonspecific symptoms. In untreated chronic infection, specific manifestations such as a relapsing large-joint oligoarthritis can persist for years, yet subside with appropriate antimicrobial therapy. Nervous system involvement occurs in 10%-15% of untreated patients and typically involves lymphocytic meningitis, cranial neuritis, and/or mononeuritis multiplex; in some rare cases, patients have parenchymal inflammation in the brain or spinal cord. Nervous system infection is similarly highly responsive to antimicrobial therapy, including oral doxycycline. Nonspecific symptoms such as fatigue, perceived cognitive slowing, headache, and others occur in patients with Lyme disease and are indistinguishable from comparable symptoms occurring in innumerable other inflammatory states. There is no evidence that these nonspecific symptoms reflect nervous system infection or damage, or that they are in any way specific to or diagnostic of this or other tick-borne infections. When these symptoms occur in patients with Lyme disease, they typically also subside after antimicrobial treatment, although this may take time. Chronic fatigue states have been reported to occur following any number of infections, including Lyme disease. The mechanism underlying this association is unclear, although there is no evidence in any of these infections that these chronic posttreatment symptoms are attributable to ongoing infection with B. burgdorferi or any other identified organism. Available appropriately controlled studies indicate that additional or prolonged courses of antimicrobial therapy do not benefit patients with a chronic fatigue-like state after appropriately treated Lyme disease. PMID:26028977

  11. Chronic Lyme disease: misconceptions and challenges for patient management

    PubMed Central

    Halperin, John J

    2015-01-01

    Lyme disease, infection with the tick-borne spirochete Borrelia burgdorferi, causes both specific and nonspecific symptoms. In untreated chronic infection, specific manifestations such as a relapsing large-joint oligoarthritis can persist for years, yet subside with appropriate antimicrobial therapy. Nervous system involvement occurs in 10%–15% of untreated patients and typically involves lymphocytic meningitis, cranial neuritis, and/or mononeuritis multiplex; in some rare cases, patients have parenchymal inflammation in the brain or spinal cord. Nervous system infection is similarly highly responsive to antimicrobial therapy, including oral doxycycline. Nonspecific symptoms such as fatigue, perceived cognitive slowing, headache, and others occur in patients with Lyme disease and are indistinguishable from comparable symptoms occurring in innumerable other inflammatory states. There is no evidence that these nonspecific symptoms reflect nervous system infection or damage, or that they are in any way specific to or diagnostic of this or other tick-borne infections. When these symptoms occur in patients with Lyme disease, they typically also subside after antimicrobial treatment, although this may take time. Chronic fatigue states have been reported to occur following any number of infections, including Lyme disease. The mechanism underlying this association is unclear, although there is no evidence in any of these infections that these chronic posttreatment symptoms are attributable to ongoing infection with B. burgdorferi or any other identified organism. Available appropriately controlled studies indicate that additional or prolonged courses of antimicrobial therapy do not benefit patients with a chronic fatigue-like state after appropriately treated Lyme disease. PMID:26028977

  12. VASCULAR DYSFUNCTION AND CHRONIC OBSTRUCTIVE PULMONARY DISEASE: THE ROLE OF REDOX BALANCE

    PubMed Central

    Ives, Stephen J.; Harris, Ryan A.; Witman, Melissa A.H.; Fjeldstad, Anette S.; Garten, Ryan S.; McDaniel, John; Wray, D. Walter; Richardson, Russell S.

    2015-01-01

    Chronic obstructive pulmonary disease is characterized by low pulmonary function, inflammation, free-radical production, vascular dysfunction and subsequently a greater incidence of cardiovascular disease. By administering an acute oral antioxidant cocktail to patients with chronic obstructive pulmonary disease (n=30) and controls (n=30), we sought to determine the role of redox balance in the vascular dysfunction of these patients. Using a double blind, randomized, placebo controlled, crossover design, patients with chronic obstructive pulmonary disease and controls ingested placebo or the antioxidant cocktail (Vitamin-C, Vitamin-E, ?-lipoic acid) after which brachial artery flow mediated dilation and carotid-radial pulse wave velocity were assessed using ultrasound Doppler. The patients exhibited lower baseline antioxidant levels (Vitamin-C and superoxide dismutase activity) and higher levels of oxidative stress (Thiobarbituic acid reactive species) in comparison to controls. The patients also displayed lower basal flow mediated dilation (p<0.05), which was significantly improved with antioxidant cocktail (3.1±0.5 vs. 4.7±0.6 %, p<0.05, placebo vs. antioxidant cocktail), but not controls (6.7±0.6 vs. 6.9±0.7 %, p>0.05, placebo vs. antioxidant cocktail). The antioxidant cocktail also improved pulse wave velocity in the patients (14±1 vs. 11±1 m·s?1, p<0.05, placebo vs. antioxidant cocktail), while not affecting controls (11±2 vs. 10±1 m·s?1, p>0.05, placebo vs. antioxidant). Patients with chronic obstructive pulmonary disease exhibit vascular dysfunction, likely mediated by an altered redox balance, which can be acutely mitigated by an oral antioxidant. Therefore, free radically-mediated vascular dysfunction may be an important mechanism contributing to this population’s greater risk and incidence of cardiovascular disease. PMID:24324045

  13. Lysozyme in chronic liver disease: a biochemical and histological study.

    PubMed Central

    Manifold, I H; Bishop, F M; Cloke, P; Triger, D R; Underwood, J C

    1982-01-01

    Serum lysozyme activities and semiquantitative analysis of tissue lysozyme distribution were studied in patients with primary biliary cirrhosis (PBC), chronic hepatitis (CH), miscellaneous liver diseases, and normal subjects. Serum lysozyme was significantly raised in PBC and CH. Portal venous blood has similar lysozyme activities to peripheral venous blood in a group of various liver diseases. Lysozyme-containing intralobular cells were decreased in all liver diseases studied but portal tract lysozyme was increased only in PBC and CH. Thus the increase in serum lysozyme in PBC and CH appears to originate from the portal inflammatory infiltrate, seen in these diseases. Images PMID:7050185

  14. [Psychological intervention for treatment compliance in chronic pediatric diseases].

    PubMed

    Benedito Monleón, M C

    2001-10-01

    This paper analyses the problems of treatment adherence in chronic pediatric diseases from a psychological point of view. We describe the repercussions of adherence on the course of the disease, the physician in charge, patients, and their relatives and place special emphasis on the complexity of the problem among adolescents. Factors impeding adherence are reviewed and factors related to disease and treatment, as well as cognitive, emotional, behavioral, familial, social, cultural, organizational and economic variables, are identified. The author proposes a psychological intervention that includes the assessment, prevention and management of problems of treatment adherence. The indications and implementation of each technique are outlined, distinguishing among educational, motivational and behavioral strategies. In summary, a psychological treatment program is proposed that may be easily applied to a large number of pediatric patients with chronic diseases and suspected or confirmed problems of treatment adherence. PMID:11578540

  15. Selenium and selenium-dependent antioxidants in chronic kidney disease.

    PubMed

    Zachara, Bronislaw A

    2015-01-01

    Oxidative stress plays a key role in numerous disease processes including chronic kidney disease (CKD). In general, oxygen metabolism leads to the formation of reactive oxygen species (ROS) dangerous to cells. Although enzymes and low-molecular-weight antioxidants protect against ROS, chronic imbalances of formation and elimination can eventually overwhelm endogenous defenses leading to deleterious consequences. In CKD, glutathione peroxidases (GSH-Px) play an important role in ROS metabolism. Plasma GSH-Px is synthesized in the kidney and requires selenium (Se) as a cofactor. Interestingly, Se and plasma GSH-Px are both significantly reduced in CKD, especially for those patients on hemodialysis. Supplementation of Se in these patients results in modest increases of GSH-Px, presumably from residual renal tissue. Kidney transplantation rapidly restores plasma GSH-Px. In this chapter, the relevance of these findings to CKD is explored with emphasis on renal disease processes and impact on attendant disorders including cancer and cardiovascular disease. PMID:25858871

  16. Evaluating Spatial Overlap and Relatedness of White-tailed Deer in a Chronic Wasting Disease Management

    E-print Network

    Evaluating Spatial Overlap and Relatedness of White- tailed Deer in a Chronic Wasting Disease Overlap and Relatedness of White-tailed Deer in a Chronic Wasting Disease Management Zone. PLoS ONE 8 and indirect transmission of infectious diseases such chronic wasting disease (CWD) or bovine tuberculosis. We

  17. Telehealth technologies for managing chronic disease - experiences from Australia and the UK

    Microsoft Academic Search

    Nigel H. Lovell; Stephen J. Redmond; Jim Basilakis; Tal Shany; Branko G. Celler

    2010-01-01

    In developed countries, chronic disease now accounts for more than 75% of health care expenditure and nearly an equivalent percentage of disease-related deaths. The burden of chronic disease (often, but not exclusively, associated with ageing) includes congestive heart failure (CHF), chronic obstructive pulmonary disease (COPD), hypertension and diabetes. Over the past several decades there has been an epidemiological shift in

  18. Nontraditional risk factors predict coronary calcification in chronic kidney disease in a population-based cohort

    Microsoft Academic Search

    U Baber; J A de Lemos; A Khera; D K McGuire; T Omland; R D Toto; S S Hedayati

    2008-01-01

    The increased burden of cardiovascular disease in chronic kidney disease cannot be explained by traditional risk factors alone. Here, we evaluated the impact of non-traditional factors on the association of chronic kidney disease with coronary artery calcification using logistic regression among 2672 Dallas Heart Study patients of whom 220 had chronic kidney disease. The prevalence of coronary calcification significantly increased

  19. Chronic pancreatitis: A surgical disease? Role of the Frey procedure

    PubMed Central

    Roch, Alexandra; Teyssedou, Jérome; Mutter, Didier; Marescaux, Jacques; Pessaux, Patrick

    2014-01-01

    Although medical treatment and endoscopic interventions are primarily offered to patients with chronic pancreatitis, approximately 40% to 75% will ultimately require surgery during the course of their disease. Although pancreaticoduodenectomy has been considered the standard surgical procedure because of its favorable results on pain control, its high postoperative complication and pancreatic exocrine or/and endocrine dysfunction rates have led to a growing enthusiasm for duodenal preserving pancreatic head resection. The aim of this review is to better understand the rationale underlying of the Frey procedure in chronic pancreatitis and to analyze its outcome. Because of its hybrid nature, combining both resection and drainage, the Frey procedure has been conceptualized based on the pathophysiology of chronic pancreatitis. The short and long-term outcome, especially pain relief and quality of life, are better after the Frey procedure than after any other surgical procedure performed for chronic pancreatitis. PMID:25068010

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

    Microsoft Academic Search

    Craig A. Miller; Lori B. Shelby

    2009-01-01

    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

  1. Human Prion Disease and Relative Risk Associated with Chronic Wasting Disease

    Microsoft Academic Search

    Samantha MaWhinney; W. John Pape; Jeri E. Forster; C. Alan Anderson; Patrick Bosque; Michael W. Miller

    2006-01-01

    The transmission of the prion disease bovine spongi- form encephalopathy (BSE) to humans raises concern about chronic wasting disease (CWD), a prion disease of deer and elk. In 7 Colorado counties with high CWD preva- lence, 75% of state hunting licenses are issued locally, which suggests that residents consume most regionally harvested game. We used Colorado death certificate data from

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

    Microsoft Academic Search

    Scott D. Ramsey; F. D. Richard Hobbs

    2006-01-01

    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

  3. Relationship between coronary artery disease and pulmonary arterial pressure in patients with chronic obstructive pulmonary disease

    PubMed Central

    Asker, Muntecep; Asker, Selvi; Kucuk, Ugur; Kucuk, Hilal Olgun; Ozbay, Bulent

    2014-01-01

    The aim of the present study was to determine whether there is a relationship between coronary artery disease and pulmonary hypertension and whether pulmonary hypertension is an additional risk factor for the presence and extent of coronary artery disease in patients with chronic obstructive pulmonary disease. Patients diagnosed with chronic obstructive pulmonary disease and pulmonary hypertension, and undergone diagnostic coronary angiography for evaluation of suspected coronary artery disease constituted the study group. Patients were divided into two groups according to the presence or absence of coronary artery disease and compared for age, gender, accompanying chronic disease, and pulmonary function tests. A total of 95 patients were recruited in the study. Comparison of the groups revealed that two groups were significantly different on gender (p=0.029), presence of hypertension (p=0.027), and biomass (p=0.040). Correlation analysis of variables revealed that male gender (rs=0.224, p=0.029), hypertension (rs=0.227, p=0.07) were positively correlated with the presence of coronary artery disease. FEV1/FVC ratio (rs=-0.253, p=0.013) and sPAP (rs=-0.215, p=0.037) were negatively correlated with the presence of coronary artery disease. High prevalence of coronary artery disease in patients with pulmonary hypertension secondary to chronic obstructive pulmonary disease was found. However, no correlation between the presence and severity of coronary artery disease and pulmonary hypertension was detected. PMID:25664116

  4. Therapeutic vaccination to treat chronic infectious diseases

    PubMed Central

    Boukhebza, Houda; Bellon, Nadine; Limacher, Jean Marc; Inchauspé, Geneviève

    2012-01-01

    A famous milestone in the vaccine field has been the first successful vaccination against smallpox, in 1798, by Edward Jenner. Using the vaccinia cowpox virus, Jenner was able to protect vaccinees from variola or smallpox. The Modified Virus Ankara (MVA) poxvirus strain has been one of the vaccines subsequently developed to prevent smallpox infection and was selected by the US government in their Biodefense strategy. Progress in molecular biology and immunology associated with MVA infection has led to the development of MVA as vaccine platform, both in the field of preventive and therapeutic vaccines. This later class of therapeutics has witnessed growing interest that has translated into an increasing number of vaccine candidates reaching the clinics. Among those, MVA-based therapeutic vaccines have addressed four major chronic infections including viral hepatitis, AIDS, human papillomavirus-linked pathologies and tuberculosis. Clinical trials encompass phase 1 and 2 and have started to show significant results and promises. PMID:22894957

  5. [Systemic therapy of chronic venous diseases].

    PubMed

    Reich, S; Altmeyer, P; Stücker, M

    2006-01-01

    The therapy of chronic venous insufficiency is multifactorial. Compression, interventional and operative approaches are available along with the possibility of systemic treatment. The efficacy of systemic venotonic medications, mostly phytotherapeutic agents, is controversial. Nonetheless in a number of clinical and laboratory studies, an effect was seen after use for 8-12 weeks. When administered appropriately, venotonic agents can show anti-edematous, anti-inflammatory, anti-oxidative, proteolytic effects as well as reducing capillary leakage. Furthermore they increase vein tone and lymph flow. Venotonic agents should be used if compression therapy alone is either not sufficient, contraindicated or not tolerable. They can be useful as a temporizing measure until surgical intervention is performed. Some of them can even be used in pregnancy, but the indications are very strict. PMID:16365774

  6. Understanding the role of genetic polymorphisms in chronic kidney disease

    Microsoft Academic Search

    Karin Luttropp; Peter Stenvinkel; Juan Jesús Carrero; Roberto Pecoits-Filho; Bengt Lindholm; Louise Nordfors

    2008-01-01

    Although no valid studies clearly indicate increasing or decreasing numbers of incident paediatric patients, the prevalence\\u000a of chronic kidney disease (CKD) and end-stage renal disease (ESRD) is growing worldwide. This is mainly due to improved access\\u000a to renal replacement therapy (RRT), increased survival after dialysis and kidney transplantation and an increase in diagnosis\\u000a and referral of these patients. Although the

  7. Early chronic obstructive pulmonary disease: definition, assessment, and prevention.

    PubMed

    Rennard, Stephen I; Drummond, M Bradley

    2015-05-01

    Chronic obstructive pulmonary disease (COPD) is the third leading cause of death worldwide. COPD, however, is a heterogeneous collection of diseases with differing causes, pathogenic mechanisms, and physiological effects. Therefore a comprehensive approach to COPD prevention will need to address the complexity of COPD. Advances in the understanding of the natural history of COPD and the development of strategies to assess COPD in its early stages make prevention a reasonable, if ambitious, goal. PMID:25943942

  8. The natural history of beryllium sensitization and chronic beryllium disease

    SciTech Connect

    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)

    1996-10-01

    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.

  9. Self-Management Support Interventions for Persons With Chronic Disease

    PubMed Central

    Franek, J

    2013-01-01

    Background Self-management support interventions such as the Stanford Chronic Disease Self-Management Program (CDSMP) are becoming more widespread in attempt to help individuals better self-manage chronic disease. Objective To systematically assess the clinical effectiveness of self-management support interventions for persons with chronic diseases. Data Sources A literature search was performed on January 15, 2012, using OVID MEDLINE, OVID MEDLINE In-Process and Other Non-Indexed Citations, OVID EMBASE, EBSCO Cumulative Index to Nursing & Allied Health Literature (CINAHL), the Wiley Cochrane Library, and the Centre for Reviews and Dissemination database for studies published between January 1, 2000, and January 15, 2012. A January 1, 2000, start date was used because the concept of non-disease-specific/general chronic disease self-management was first published only in 1999. Reference lists were examined for any additional relevant studies not identified through the search. Review Methods Randomized controlled trials (RCTs) comparing self-management support interventions for general chronic disease against usual care were included for analysis. Results of RCTs were pooled using a random-effects model with standardized mean difference as the summary statistic. Results Ten primary RCTs met the inclusion criteria (n = 6,074). Nine of these evaluated the Stanford CDSMP across various populations; results, therefore, focus on the CDSMP. Health status outcomes: There was a small, statistically significant improvement in favour of CDSMP across most health status measures, including pain, disability, fatigue, depression, health distress, and self-rated health (GRADE quality low). There was no significant difference between modalities for dyspnea (GRADE quality very low). There was significant improvement in health-related quality of life according to the EuroQol 5-D in favour of CDSMP, but inconsistent findings across other quality-of-life measures. Healthy behaviour outcomes: There was a small, statistically significant improvement in favour of CDSMP across all healthy behaviours, including aerobic exercise, cognitive symptom management, and communication with health care professionals (GRADE quality low). Self-efficacy: There was a small, statistically significant improvement in self-efficacy in favour of CDSMP (GRADE quality low). Health care utilization outcomes: There were no statistically significant differences between modalities with respect to visits with general practitioners, visits to the emergency department, days in hospital, or hospitalizations (GRADE quality very low). All results were measured over the short term (median 6 months of follow-up). Limitations Trials generally did not appropriately report data according to intention-to-treat principles. Results therefore reflect “available case analyses,” including only those participants whose outcome status was recorded. For this reason, there is high uncertainty around point estimates. Conclusions The Stanford CDSMP led to statistically significant, albeit clinically minimal, short-term improvements across a number of health status measures (including some measures of health-related quality of life), healthy behaviours, and self-efficacy compared to usual care. However, there was no evidence to suggest that the CDSMP improved health care utilization. More research is needed to explore longer-term outcomes, the impact of self-management on clinical outcomes, and to better identify responders and non-responders. Plain Language Summary Self-management support interventions are becoming more common as a structured way of helping patients learn to better manage their chronic disease. To assess the effects of these support interventions, we looked at the results of 10 studies involving a total of 6,074 people with various chronic diseases, such as arthritis and chronic pain, chronic respiratory diseases, depression, diabetes, heart disease, and stroke. Most trials focused on a program called the Stanford Chronic Disease Self-Management Program (CDSMP). W

  10. Hepatitis A and B Superimposed on Chronic Liver Disease: Vaccine-Preventable Diseases

    PubMed Central

    Keeffe, Emmet B

    2006-01-01

    A number of studies have demonstrated that the acquisition of hepatitis A or hepatitis B in patients with chronic liver disease is associated with high rates of morbidity and mortality. Superimposition of acute hepatitis A in patients with chronic hepatitis C has been associated with a particularly high mortality rate, and chronic hepatitis B virus coinfection with hepatitis C virus is associated with an accelerated progression of chronic liver disease to cirrhosis, decompensated liver disease and hepatocellular carcinoma. With the availability of vaccines against hepatitis B and hepatitis A since 1981 and 1995, respectively, these are vaccine-preventable diseases. Studies have confirmed that hepatitis A and hepatitis B vaccines are safe and immunogenic in patients with mild to moderate chronic liver disease. However, hepatitis A and B vaccination is less effective in patients with advanced liver disease and after liver transplantation. These observations have led to the recommendation that patients undergo hepatitis A and B vaccination early in the natural history of their chronic liver disease. Vaccination rates are low in clinical practice, and public health and educational programs are needed to overcome barriers to facilitate timely implementation of these recommendations. PMID:18528476

  11. Ulcerative colitis with chronic liver disease, eosinophilia and auto-immune thyroid disease

    Microsoft Academic Search

    S. P. Kane

    1977-01-01

    A patient with chronic mild ulcerative colitis is described. Her illness was characterized by fluctuating blood eosinophilia, chronic persistent hepatitis and hypersensitivity to sulphasalazine. She subsequently developed auto-immune thyroid disease. The inter-relationships of these various disorders are discussed.

  12. Gastrointestinal Manifestations of Patients with Chronic Granulomatous Disease

    Microsoft Academic Search

    Masoud Movahedi; Asghar Aghamohammadi; Nima Rezaei; Abolhasan Farhoudi; Mostafa Moin; Mohammad Gharagozlou; Davoud Mansouri; Saba Arshi; Lida Atarod; Bahram MirSaeid Ghazi; Nikrad Shahnavaz; Ali Babaei Jandaghi; Kamran Abolmaali; Maryam Mahmoudi; Nasrin Bazargan; Akefeh Ahmadi Afshar; Mohammad Nabavi

    Chronic Granulomatous Disease (CGD) represents a group of inherited disorders of phagocytic system, manifesting recurrent infections at different sites. The present study was accomplished in order to determine the gastrointestinal manifestations of CGD patients. Fifty-seven patients (38 males and 19 females) with CGD, who had been referred to three immunodeficiency referral centers in Iran, were studied during a 24-year period

  13. Chronic Kidney Disease Stages Are Appropriate at All Ages

    Microsoft Academic Search

    Beatrice Goilav; Frederick J. Kaskel

    2011-01-01

    Chronic kidney disease (CKD) is associated with multiple detrimental consequences to the cardiovascular and musculoskeletal systems. The effects of CKD are even more significant when they begin in childhood as they affect growth and (neuro-) development as well. The division into stages of CKD serves as a guideline for the physician to better anticipate and treat early and later manifestations

  14. Hepatitis E virus superinfection in patients with chronic liver disease

    Microsoft Academic Search

    Saeed S. Hamid; Muslim Atiq; Farooq Shehzad; Aneela Yasmeen; Tayyabun Nissa; Abdul Salam; Anwar Siddiqui; Wasim Jafri

    2002-01-01

    Infection with hepatitis A virus (HAV) can cause severe illness in adult patients with chronic liver disease (CLD) caused by hepatitis C. In endemic areas such as South Asia, however, most adult patients already have been exposed to HAV but could still be susceptible to hepatitis E virus (HEV) infection. We document that HEV superinfection in 4 of our CLD

  15. Pharmacotherapy for Mortality Reduction in Chronic Obstructive Pulmonary Disease

    Microsoft Academic Search

    Don D. Sin; S. F. Paul Man

    2006-01-01

    Despite rapid advances in our understanding of its pathophysiol- ogy, chronic obstructive pulmonary disease (COPD) remains incur- able. Although bronchodilators and theophyllines are commonly used to treat symptoms of dyspnea and cough and to acutely im- prove lung function, they do not modify the long-term decline in FEV1. The principal goals of current COPD pharmacotherapy are to reduce exacerbations, improve

  16. Drugs in Clinical Development for Chronic Obstructive Pulmonary Disease

    Microsoft Academic Search

    Néstor A. Molfino

    2005-01-01

    Many drugs may be potentially useful in the treatment of chronic obstructive pulmonary disease (COPD), but relatively few become available for human use due to lack of safety, lack of efficacy, or both. This is an inherent risk in the drug development process, which coupled with the limited understanding of the molecular pathogenesis of COPD, has produced a trend toward

  17. Children with Rare Chronic Skin Diseases: Hemangiomas and Epidermolysis Bullosa.

    ERIC Educational Resources Information Center

    Jones, Sheila Dove; Miller, Cynthia Dieterich

    The paper reports on studies involving children having the rare chronic skin diseases of hemangiomas and epidermolysis bullosa (characterized by easy blistering). One study compared the self-concept and psychosocial development of young (mean age 46 months) children (N=19) with hemangiomas with 19 children without hemangiomas. Findings indicated…

  18. Experimental chronic wasting disease (CWD) in fallow deer

    Technology Transfer Automated Retrieval System (TEKTRAN)

    To determine the transmissibility of chronic wasting disease (CWD) to fallow deer (Cervus dama) and to provide information about clinical course, lesions and suitability of currently used diagnostic procedures for detection of CWD in this species, 13 fawns were inoculated intracerebrally with CWD br...

  19. Surveillance of chronic wasting disease (CWD) in Japan

    Microsoft Academic Search

    Kimi Shimada; Yoshifumi Iwamaru; Hiroko Hayashi; Morikazu Imamura; Masuhiro Takata; Yuko Ushiki; Kumiko Kimura; Yuichi Tagawa; Motohiro Horiuchi; Morikazu Shinagawa; Takashi Yokoyama

    Chronic wasting disease (CWD) in cervids including elk, mule deer, and white-tailed deer, is a member of the transmissible spongiform encephalopathies (TSEs). CWD is a serious problem in North America. The detection of abnormal isoforms of prion protein (PrPSc) is a key factor for the diagnosis of CWD, similar to other TSEs. The surveillance program for TSEs in animals is

  20. Oral Transmission of Chronic Wasting Disease in Captive Shira's Moose

    Microsoft Academic Search

    Terry J. Kreeger; D. L. Montgomery; Jean E. Jewell; Will Schultz; Elizabeth S. Williams

    2006-01-01

    Three captive Shira's moose (Alces alces shirasi) were orally inoculated with a single dose (5 g) of whole-brain homogenate pre- pared from chronic wasting disease (CWD)- affected mule deer (Odocoileus hemionus). All moose died of causes thought to be other than CWD. Histologic examination of one female moose dying 465 days postinoculation revealed spongiform change in the neuropil, typical of

  1. Ultrastructural neuropathology of chronic wasting disease in captive mule deer

    Microsoft Academic Search

    Don C. Guiroy; Elizabeth S. Williams; Pawel P. Liberski; Ikuro Wakayama; D. Carleton Gajdusek

    1993-01-01

    Chronic wasting disease (CWD), a progressive and uniformly fatal neurological disorder, is characterized neuropathologically by intraneuronal vacuolation, spongiform change of the neuropil and astrocytic hyperplasia and hypertrophy. Ultrastructural neuropathological findings consist of (1) extensive vacuolation in neuronal processes, within myelin sheaths, formed by splitting at the major dense lines or within axons; (2) dystrophic neurites (dendrites, axonal preterminals and myelinated

  2. Chronic Wasting Disease and Potential Transmission to Humans

    Microsoft Academic Search

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

    2004-01-01

    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

  3. Lessons Learned from Human Dimensions of Chronic Wasting Disease Research

    Microsoft Academic Search

    Jerry J. Vaske

    2010-01-01

    Although the human dimensions (HD) of chronic wasting disease (CWD) research is relatively new, at least 38 journal articles have been published in the last seven years. This article synthesizes seven lessons learned from HD of CWD research (e.g., hunters vary in their behavioral response to CWD and perceived human health risks; agency trust can influence behavior and acceptance of

  4. Severe Pulmonary Hypertension and Chronic Obstructive Pulmonary Disease

    Microsoft Academic Search

    Ari Chaouat; Anne-Sophie Bugnet; Nabila Kadaoui; Roland Schott; Irina Enache; Alain Ducolone; May Ehrhart; Romain Kessler; Emmanuel Weitzenblum

    Rationale: Severe pulmonary hypertension occurs occasionally in patients with chronic obstructive pulmonary disease (COPD), but no detailed description of these patients is available. Objectives: To identifyandcharacterizepatientswithCOPDandseverepulmonary hypertension. Methods: Retrospective study of 27 patients with COPD with severe pulmonary hypertension (pulmonary artery mean pressure (Ppa), 40 mm Hg) among 998 patients who underwent right heart catheterization between 1990 and 2002 as

  5. Prevalence of Comorbidities in Patients with Chronic Obstructive Pulmonary Disease

    Microsoft Academic Search

    Mario Cazzola; Germano Bettoncelli; Emiliano Sessa; Claudio Cricelli; Gianluca Biscione

    2010-01-01

    Background: Chronic obstructive pulmonary disease (COPD) is associated with many comorbidities, but the percentage of COPD patients who develop comorbidities has not been clearly defined. Objectives: We aimed to examine the relationship between COPD and comorbidities using information obtained from the Health Search Database (HSD) owned by the Italian College of General Practitioners (SIMG), which stores information on about 1.5%

  6. Palliative care provision for patients with chronic obstructive pulmonary disease

    Microsoft Academic Search

    Abebaw Mengistu Yohannes

    2007-01-01

    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,

  7. CHRONIC WASTING DISEASE OF CAPTIVE MULE DEER: A SPONGIFORM ENCEPHALOPATHY

    Microsoft Academic Search

    E. S. WILLIAMS; S. YOUNG

    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

  8. The clinical use of HVPG measurements in chronic liver disease

    Microsoft Academic Search

    Juan G. Abraldes; Annalisa Berzigotti; Juan Carlos García-Pagan; Jaime Bosch

    2009-01-01

    Portal hypertension is a severe, almost unavoidable complication of chronic liver diseases and is responsible for the main clinical consequences of cirrhosis. Measurement of the hepatic venous pressure gradient (HVPG) is currently the best available method to evaluate the presence and severity of portal hypertension. Clinically significant portal hypertension is defined as an increase in HVPG to ?10 mmHg; above

  9. Chronic multifocal demyelinating neuropathy simulating motor neuron disease

    Microsoft Academic Search

    P. Di Bella; F. Logullo; L. Dionisi; M. Danni; M. Scarpelli; F. Angeleri

    1991-01-01

    We describe a patient with a chronic acquired predominantly motor polyneuropathy. His clinical picture initially led to a diagnosis of lower motor neuron form of amyotrophic lateral sclerosis. However electrophysiological examination revealed multifocal, prevalently proximal, conduction blocks at sites not prone to compression. Distinguishing this unusual polyneuropathy from motor neuron diseases is critical, since the former is a potentially, treatable

  10. Itraconazole to Prevent Fungal Infections in Chronic Granulomatous Disease

    Microsoft Academic Search

    John I. Gallin; David W. Alling; Harry L. Malech; Robert Wesley; Deloris Koziol; Beatriz Marciano; Eli M. Eisenstein; Maria L. Turner; Ellen S. DeCarlo; Judith M. Starling; Steven M. Holland

    2003-01-01

    background Chronic granulomatous disease is a rare disorder in which the phagocytes fail to pro- duce hydrogen peroxide. The patients are predisposed to bacterial and fungal infec- tions. Prophylactic antibiotics and interferon gamma have reduced bacterial infec- tions, but there is also the danger of life-threatening fungal infections. We assessed the efficacy of itraconazole as prophylaxis against serious fungal infections

  11. Chorioretinal lesions in patients and carriers of chronic granulomatous disease

    Microsoft Academic Search

    David Goldblatt; Jeremy Butcher; Adrian J. Thrasher; Isabelle Russell-Eggitt

    1999-01-01

    Objective: To investigate the frequency of retinal lesions in patients with chronic granulomatous disease (CGD) and to seek such lesions in carriers. Study design: Seventy-four individuals from 33 families were recruited; 38 had CGD (30 X-linked and 8 autosomal recessive inheritance). All participants (including 33 control subjects) underwent measurement of visual acuity, anterior segment examination by slit lamp, and dilated

  12. Evaluation of Continuing Medical Education for Chronic Obstructive Pulmonary Diseases.

    ERIC Educational Resources Information Center

    Li Wang, Virginia; And Others

    1979-01-01

    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…

  13. Bilateral pneumectomy (volume reduction) for chronic obstructive pulmonary disease

    Microsoft Academic Search

    J. D. Cooper; E. P. Trulock; A. N. Triantafillou; G. A. Patterson; M. S. Pohl; P. A. Deloney; R. S. Sundaresan; C. L. Roper

    1995-01-01

    We undertook surgical bilateral lung volume reduction in 20 patients with severe chronic obstructive pulmonary disease to relieve thoracic distention and improve respiratory mechanics. The operation, done through median sternotomy, involves excision of 20% to 30% of the volume of each lung. The most affected portions are excised with the use of a linear stapling device fitted with strips of

  14. Regulation of fibroblast growth factor-23 in chronic kidney disease

    Microsoft Academic Search

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

    2007-01-01

    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

  15. Helping the Child with Chronic Disease: Themes and Directions

    Microsoft Academic Search

    Christine Eiser

    1996-01-01

    Chronic childhood diseases affect some 10 percent of the population, with 1-2 percent being seriously affected. These conditions involve regular, often daily treatment and can be a potential threat to the quality of life of children and their families. In recent years, there has been much progress in documenting the extent of practical difficulties experienced at specific stress points (diagnosis,

  16. Exercise in patients with chronic obstructive pulmonary disease

    Microsoft Academic Search

    M J Belman

    1993-01-01

    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

  17. The costs of exacerbations in chronic obstructive pulmonary disease (COPD)

    Microsoft Academic Search

    FREDRIK ANDERSSON; SIXTEN BORG; SVEN-ARNE JANSSON; ANN-CHRISTIN JONSSON; ÅSA ERICSSON; CHRISTIN PRÜTZ; EVA RÖNMARK; BO LUNDBÄCK

    2002-01-01

    Exacerbations are the key drivers in the costs of chronic obstructive pulmonary disease (COPD). The objective was to examine the costs of COPD exacerbations in relation to differing degrees of severity of exacerbations and of COPD. We identified 202 subjects with COPD, defined according to the BTS and ERS criteria. Exacerbations were divided into mild (self-managed), mild\\/moderate (telephone contact with

  18. The radiology of chronic lung disease in children

    Microsoft Academic Search

    U G Rossi; C M Owens

    2005-01-01

    Chronic lung disease (CLD) in children represents a heterogeneous group of many distinct clinicopathological entities. The prevalence of CLD has increased in the past decade because of the more advanced and intensive respiratory support provided for compromised children and additionally the overall improved survival of preterm babies. The disorders which constitute CLD generally have a slow tempo of progression over

  19. DNA vaccination as a treatment for chronic kidney disease.

    PubMed

    Wang, Yuan Min; Alexander, Stephen I

    2014-01-01

    Chronic kidney disease is one of the major health problems worldwide. DNA vaccination delivers plasmid DNA encoding the target gene to induce both humoral and cellular immune responses. Here, we describe the methods of CD40 DNA vaccine enhanced by dendritic cell (DC) targeting on the development of Heymann nephritis (HN), a rat model of human membranous nephropathy. PMID:24715295

  20. Participatory Research for Chronic Disease Prevention in Inuit Communities

    ERIC Educational Resources Information Center

    Gittelsohn, Joel; Roache, Cindy; Kratzmann, Meredith; Reid, Rhonda; Ogina, Julia; Sharma, Sangita

    2010-01-01

    Objective: To develop a community-based chronic disease prevention program for Inuit in Nunavut, Canada. Methods: Stakeholders contributed to intervention development through formative research [in-depth interviews (n = 45), dietary recalls (n = 42)], community workshops, group feedback and implementation training. Results: Key cultural themes…

  1. Brown Nail-bed Arcs and Chronic Renal Disease

    Microsoft Academic Search

    W. K. Stewart; E. J. Raffle

    1972-01-01

    A brown arc affecting the distal part of the fingernail-bed, just proximal to the point of separation of the nail from its bed, has been found in 12 out of 34 patients with chronic renal disease (35%) compared with an incidence of less than 2% in a series of unselected patients. It represents a distinctive form of pigmentation, possibly due

  2. Students with Chronic Diseases: Nature of School Physician Support

    ERIC Educational Resources Information Center

    Taras, Howard; Brennan, Jesse J.

    2008-01-01

    Background: To educate children with chronic diseases in the least restrictive environment, schools must prevent, recognize, and react appropriately to symptom exacerbations. Schools are often pushed to their limits of knowledge, resources, and comfort level. This study determined the health conditions of students for whom districts seek school…

  3. Clinical Research Databases and Clinical Decision Making in Chronic Diseases

    Microsoft Academic Search

    Michael G. Kahn

    1999-01-01

    Chronic diseases are the major source of morbidity, mortality, and resource utilization. Large-scale longitudinal databases are rapidly proliferating in both single- and multi-institutional settings, providing clinical data on a broad range of patients who receive ‘real world’ management. Although bias and changing medical management may limit the types of questions that can be addressed using the data contained in longitudinal

  4. Chronic Obstructive Pulmonary Disease and Lung Cancer: New Molecular Insights

    Microsoft Academic Search

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

    2011-01-01

    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

  5. MRI of diffuse liver disease: characteristics of acute and chronic diseases

    PubMed Central

    Chundru, Surya; Kalb, Bobby; Arif-Tiwari, Hina; Sharma, Puneet; Costello, James; Martin, Diego R.

    2014-01-01

    Diffuse liver disease, including chronic liver disease, affects tens of millions of people worldwide, and there is a growing need for diagnostic evaluation as treatments become more readily available, particularly for viral liver diseases. Magnetic resonance imaging (MRI) provides unique capabilities for noninvasive characterization of the liver tissue that rival or surpass the diagnostic utility of liver biopsies. There has been incremental improvement in the use of standardized MRI sequences, acquired before and after administration of a contrast agent, for the evaluation of diffuse liver disease and the study of the liver parenchyma and blood supply. More recent developments have led to methods for quantifying important liver metabolites, including lipids and iron, and liver fibrosis, the hallmark of chronic liver disease. Here, we review the MRI techniques and diagnostic features associated with acute and chronic liver disease. PMID:24808418

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

    PubMed

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

    2012-03-01

    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

  7. Different patterns of chronic tissue wasting among patients with chronic obstructive pulmonary disease

    Microsoft Academic Search

    M. P. K. J. Engelen; A. M. W. J. Schols; R. J. S. Lamers; E. F. M. Wouters

    1999-01-01

    Background & aims:Nutritional depletion is frequently present in patients with chronicobstructive pulmonary disease, but it is unknown whether a difference exists between the two subtypes. The aim of this study was to determine whether patterns of tissue depletion were different between emphysema and chronic bronchitis patients and whether these were related to pulmonary function.

  8. Economic Modeling in Chronic Obstructive Pulmonary Disease

    Microsoft Academic Search

    Maureen Rutten-van Molken; Todd A. Lee

    2006-01-01

    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

  9. Asian Leadership in Chronic Kidney Disease

    PubMed Central

    2009-01-01

    Asian Pacific countries include those with the highest incidence of renal failure in the world, the richest and poorest economies and unparalleled diversity of economy, culture and geography. From this come many challenges, but also a strong basis for the introduction of strategies to combat renal diseases. With a rapidly developing scientific community, Asia needs to accept the challenge of becoming a global leader in nephrology in the near future. PMID:19194558

  10. Evidence of Skeletal Muscle Metabolic Reserve During Whole Body Exercise in Patients with Chronic Obstructive Pulmonary Disease

    Microsoft Academic Search

    R. S. RICHARDSON; J. SHELDON; D. C. POOLE; S. R. HOPKINS; A. L. RIES; P. D. WAGNER

    When freed from central cardiorespiratory limitations, healthy human skeletal muscle has exhibited a significant metabolic reserve. We studied the existence of this reserve in 10 severely compromised (FEV 1 5 0.97 6 SE 0.01) patients with chronic obstructive pulmonary disease (COPD). To manipulate O 2 supply and O 2 demand in locomotor and respiratory muscles, subjects performed both maximal conventional

  11. Hereditary Causes of Kidney Stones and Chronic Kidney Disease

    PubMed Central

    Edvardsson, Vidar O.; Goldfarb, David S.; Lieske, John C.; Beara-Lasic, Lada; Anglani, Franca; Milliner, Dawn S.; Palsson, Runolfur

    2013-01-01

    Adenine phosphoribosyltransferase (APRT) deficiency, cystinuria, Dent disease, familial hypomagnesemia with hypercalciuria and nephrocalcinosis (FHHNC) and primary hyperoxaluria (PH) are rare but important causes of severe kidney stone disease and/or chronic kidney disease in children. Recurrent kidney stone disease and nephrocalcinosis, particularly in pre-pubertal children, should alert the physician to the possibility of an inborn error of metabolism as the underlying cause. Unfortunately, the lack of recognition and knowledge of the five disorders has frequently resulted in an unacceptable delay in diagnosis and treatment, sometimes with grave consequences. A high index of suspicion coupled with early diagnosis may reduce or even prevent the serious long-term complications of these diseases. In this paper, we review the epidemiology, clinical features, diagnosis, treatment and outcome of patients with APRT deficiency, cystinuria, Dent disease, FHHNC and PH with emphasis on childhood manifestations. PMID:23334384

  12. Selenium and Chronic Diseases: A Nutritional Genomics Perspective

    PubMed Central

    Méplan, Catherine

    2015-01-01

    Mechanistic data have revealed a key role for selenium (Se) and selenoproteins in biological pathways known to be altered in multifactorial diseases, such as cellular maintenance, response to oxidative stress and correct protein folding. Although epidemiological studies indicate that low Se intake is linked to increased risk for various chronic diseases, supplementation trials have given confusing outcomes, suggesting that additional genetic factors could affect the relationship between Se and health. Genetic data support this hypothesis, as risk for several chronic diseases, in particular cancer, was linked to a number of single nucleotide polymorphisms (SNP) altering Se metabolism, selenoprotein synthesis or activity. Interactions between SNPs in selenoprotein genes, SNPs in related molecular pathways and biomarkers of Se status were found to further modulate the genetic risk carried by the SNPs. Taken together, nutritional genomics approaches uncovered the potential implication of some selenoproteins as well as the influence of complex interactions between genetic variants and Se status in the aetiology of several chronic diseases. This review discusses the results from these genetic associations in the context of selenoprotein functions and epidemiological investigations and emphasises the need to assess in future studies the combined contribution of Se status, environmental stress, and multiple or individual SNPs to disease risk. PMID:25988760

  13. Chronic Obstructive Pulmonary Disease: Respiratory Review of 2014

    PubMed Central

    2014-01-01

    Chronic obstructive pulmonary disease (COPD) is characterized by a diverse array of pulmonary and nonpulmonary manifestations, but our understanding of COPD pathogenesis and the factors that influence its heterogeneity in disease presentation is poor. Despite this heterogeneity, treatment algorithms are primarily driven by a single measurement, forced expiratory volume in 1 second (FEV1) as a percentage of its predicted value (FEV1%). In 2011, a major shift in Global Initiative for Chronic Obstructive Lung Disease (GOLD) treatment recommendations was proposed that stratifies patients with COPD on the basis of symptoms and exacerbation history. This article reviews the work reported in 2013 that enlightens our understanding of COPD with respect to COPD classification systems, phenotype, biomarker, exacerbation, and management for patients with COPD. PMID:25368660

  14. Lung disease with chronic obstruction in opium smokers in Singapore

    PubMed Central

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

    1971-01-01

    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 PMID:5134057

  15. Oxysterols in the pathogenesis of major chronic diseases?

    PubMed Central

    Poli, Giuseppe; Biasi, Fiorella; Leonarduzzi, Gabriella

    2013-01-01

    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. PMID:24024145

  16. Chronic Obstructive Pulmonary Disease: Respiratory Review of 2013

    PubMed Central

    2014-01-01

    Chronic obstructive pulmonary disease (COPD) is a common airway disease that has considerable impact on disease burdens and mortality rates. A large number of articles on COPD are published within the last few years. Many aspects on COPD ranging from risk factors to management have continued to be fertile fields of investigation. This review summarizes 6 clinical articles with regards to the risk factors, phenotype, assessment, exacerbation, management and prognosis of patients with COPD which were being published last year in major medical journals. PMID:24624213

  17. Chronic obstructive lung disease: perioperative management.

    PubMed

    Maddali, Madan Mohan

    2008-10-01

    Inflammatory mediators play a major role in pulmonary and extra pulmonary manifestations of COPD. In the preoperative risk evaluation, composite scoring systems like ASA physical status are more efficacious than any single risk factor. Intraoperative ventilator graphics help in managing respiratory mechanics and reducing dynamic hyperinflation. Preoperative optimization of respiratory status and use of postoperative lung expansion maneuvers are effective measures for prevention of PPCs. Lastly, anesthesiologists need to evolve strategies based on the pathophysiology of the disease to ensure that their patients receive optimal perioperative care. PMID:18942241

  18. The spectrum of disease in chronic traumatic encephalopathy

    PubMed Central

    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.

    2013-01-01

    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

  19. The spectrum of disease in chronic traumatic encephalopathy.

    PubMed

    McKee, Ann C; Stern, Robert A; Nowinski, Christopher J; Stein, Thor D; Alvarez, Victor E; Daneshvar, Daniel H; Lee, Hyo-Soon; Wojtowicz, Sydney M; Hall, Garth; 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

    2013-01-01

    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

  20. Renal Resistive Index and Mortality in Chronic Kidney Disease.

    PubMed

    Toledo, Clarisse; Thomas, George; Schold, Jesse D; Arrigain, Susana; Gornik, Heather L; Nally, Joseph V; Navaneethan, Sankar D

    2015-08-01

    Renal resistive index (RRI) measured by Doppler ultrasonography is associated with cardiovascular events and mortality in hypertensive, diabetic, and elderly patients. We studied the factors associated with high RRI (?0.70) and its associations with mortality in chronic kidney disease patients without renal artery stenosis. We included 1962 patients with an estimated glomerular filtration rate of 15 to 59 mL/min per 1.73 m(2) who also had RRI measured (January 1, 2005, to October 2011) from an existing chronic kidney disease registry. Participants with renal artery stenosis (60%-99% or renal artery occlusion) were excluded. Multivariable logistic regression model was used to study factors associated with high RRI (?0.70), and its association with mortality was studied using Kaplan-Meier plots and Cox proportional hazards model. Hypertension was prevalent in >90% of the patients. In the multivariable logistic regression, older age, female sex, diabetes mellitus, coronary artery disease, peripheral vascular disease, higher systolic blood pressure, and the use of ? blockers were associated with higher odds of having RRI?0.70. During a median follow-up of 2.2 years, 428 patients died. After adjusting for covariates, RRI?0.70 was associated with increased mortality (adjusted hazard ratio, 1.29; 95% confidence interval, 1.02-1.65; P<0.05). This association was more pronounced among younger patients and those with stage 3 chronic kidney disease. Noncardiovascular/non-malignancy-related deaths were higher in those with RRI?0.70. RRI?0.70 is associated with higher mortality in hypertensive chronic kidney disease patients without clinically significant renal artery stenosis after accounting for other significant risk factors. Its evaluation may allow early identification of those who are at risk thereby potentially preventing or delaying adverse outcomes. PMID:26077569

  1. Patients receiving maintenance dialysis have more severe functionally significant skeletal muscle wasting than patients with dialysis-independent chronic kidney disease

    Microsoft Academic Search

    Christopher W. McIntyre; Nicholas M. Selby; Mhairi Sigrist; Lyndsay E. Pearce; Thomas H. Mercer; Patrick F. Naish

    2006-01-01

    Background. Chronic renal replacement therapy patients exhibit reduction in skeletal muscle function as a result of a combination of metabolic effects and muscle fibre size reduction. The aim of this study was to compare muscle mass with function in patients with chronic kidney disease (CKD) at stages 4 and 5 on haemodialysis (HD) and peritoneal dialysis (PD), and investigate the

  2. [Chronic hepatitis C: patients with mild disease].

    PubMed

    Albillos, Agustín; Luis Calleja, José; Molina, Esther; Planas, Ramon; Romero-Gómez, Manuel; Turnes, Juan; Hernández-Guerra, Manuel

    2014-07-01

    The first-line option in the treatment of patients with advanced fibrosis and cirrhosis due to genotype 1 hepatitis C virus is currently triple therapy with boceprevir/telaprevir and pegylated interferon-ribavirin. However, certain limitations could constitute a barrier to starting treatment or achieving sustained viral response in these patients. These limitations include the patient's or physician's perception of treatment effectiveness in routine clinical practice-which can weight against the decision to start treatment-, the advanced stage of the disease with portal hypertension and comorbidity, treatment interruption due to poor adherence, and adverse effects, mainly anemia. In addition, it is now possible to identify patients who could benefit from a shorter therapeutic regimen with a similar cure rate. This review discusses these issues and their possible effect on the use of triple therapy. PMID:25907434

  3. Chronic kidney disease in disadvantaged populations.

    PubMed

    Garcia-Garcia, Guillermo; Jha, Vivekanand

    2015-01-01

    The increased burden of CKD in disadavantaged populations is due to both global factors and population-specific issues. Low socioeconomic status and poor access to care contribute to health care disparities, and exacerbate the negative effects of genetic or biologic predisposition. Provision of appropriate renal care to these populations requires a two-pronged approach: expanding the reach of dialysis through development of low-cost alternatives that can be practiced in remote locations, and implementation and evaluation of cost-effective prevention strategies. Kidney transplantation should be promoted by expanding deceased donor transplant programs and use of inexpensive, generic immunosuppressive drugs. The message of WKD 2015 is that a concerted attack against the diseases that lead to ESRD, by increasing community outreach, better education, improved economic opportunity, and access to preventive medicine for those at highest risk, could end the unacceptable relationship between CKD and disadvantage in these communities. PMID:25525919

  4. Patients with chronic obstructive pulmonary disease and chronically colonized with Haemophilus influenzae during stable disease phase have increased airway inflammation

    PubMed Central

    Tufvesson, Ellen; Bjermer, Leif; Ekberg, Marie

    2015-01-01

    Background Some patients with chronic obstructive pulmonary disease (COPD) show increased airway inflammation and bacterial colonization during stable phase. The aim of this study was to follow COPD patients and investigate chronic colonization with pathogenic bacteria during stable disease phase, and relate these findings to clinical parameters, inflammatory pattern, lung function, and exacerbations. Methods Forty-three patients with COPD were included while in a stable state and followed up monthly until exacerbation or for a maximum of 6 months. The patients completed the Clinical COPD Questionnaire and Medical Research Council dyspnea scale questionnaires, and exhaled breath condensate was collected, followed by spirometry, impulse oscillometry, and sputum induction. Results Ten patients were chronically colonized (ie, colonized at all visits) with Haemophilus influenzae during stable phase. These patients had higher sputum levels of leukotriene B4 (P<0.001), 8-isoprostane (P=0.002), myeloperoxidase activity (P=0.028), and interleukin-8 (P=0.02) during stable phase when compared with other patients. In addition, they had lower forced vital capacity (P=0.035) and reactance at 5 Hz (P=0.034), but there was no difference in forced expiratory volume in 1 second (FEV1), FEV1 % predicted, forced vital capacity % predicted, exhaled breath condensate biomarkers, C-reactive protein, or Clinical COPD Questionnaire and Medical Research Council dyspnea scale results. Three patients had intermittent colonization (colonized at only some visits) of H. influenzae during stable phase, and had lower levels of inflammatory biomarkers in sputum when compared with the chronically colonized patients. The difference in airway inflammation seen during stable phase in patients chronically colonized with H. influenzae was not observed during exacerbations. Conclusion Some COPD patients who were chronically colonized with H. influenzae during stable phase showed increased airway inflammation and reduced lung volumes when compared with non-chronically colonized patients. PMID:26005341

  5. Healthcare Decision Support System for Administration of Chronic Diseases

    PubMed Central

    Woo, Ji-In; Yang, Jung-Gi; Lee, Young-Ho

    2014-01-01

    Objectives A healthcare decision-making support model and rule management system is proposed based on a personalized rule-based intelligent concept, to effectively manage chronic diseases. Methods A Web service was built using a standard message transfer protocol for interoperability of personal health records among healthcare institutions. An intelligent decision service is provided that analyzes data using a service-oriented healthcare rule inference function and machine-learning platform; the rules are extensively compiled by physicians through a developmental user interface that enables knowledge base construction, modification, and integration. Further, screening results are visualized for the self-intuitive understanding of personal health status by patients. Results A recommendation message is output through the Web service by receiving patient information from the hospital information recording system and object attribute values as input factors. The proposed system can verify patient behavior by acting as an intellectualized backbone of chronic diseases management; further, it supports self-management and scheduling of screening. Conclusions Chronic patients can continuously receive active recommendations related to their healthcare through the rule management system, and they can model the system by acting as decision makers in diseases management; secondary diseases can be prevented and health management can be performed by reference to patient-specific lifestyle guidelines. PMID:25152830

  6. Anticoagulation in chronic kidney disease patients—the practical aspects

    PubMed Central

    Hughes, Stephen; Szeki, Iren; Nash, Michael J.; Thachil, Jecko

    2014-01-01

    There is an increasing awareness about the risks of arterial and venous thromboembolism (TE) in hospital patients and general public which has led to consideration of thrombosis prevention measures in earnest. Early recognition of the symptoms of TE disease has led to timely administration of antiplatelet and anticoagulant drugs, translating to better outcome in many of these patients. In this respect, patients with chronic kidney disease (CKD) represent a special group. They indeed represent a high-risk group for thrombosis both in the cardiovascular territory and also in the venous circulation. At the same time, abnormalities in the platelet membranes put them at risk of bleeding which is significantly more than other patients with chronic diseases. Anticoagulation may be ideal to prevent the former, but the co-existing bleeding risk and also that the commonly used drugs for inhibiting coagulation are eliminated by renal pathways pose additional problems. In this review, we try to explain the complex thrombotic-haemorrhagic state of chronic kidney disease patients, and practical considerations for the management of anticoagulation in them with a focus on heparins. PMID:25878775

  7. Surveillance for the prevention of chronic diseases through information association

    PubMed Central

    2014-01-01

    Background Research on Genomic medicine has suggested that the exposure of patients to early life risk factors may induce the development of chronic diseases in adulthood, as the presence of premature risk factors can influence gene expression. The large number of scientific papers published in this research area makes it difficult for the healthcare professional to keep up with individual results and to establish association between them. Therefore, in our work we aim at building a computational system that will offer an innovative approach that alerts health professionals about human development problems such as cardiovascular disease, obesity and type 2 diabetes. Methods We built a computational system called Chronic Illness Surveillance System (CISS), which retrieves scientific studies that establish associations (conceptual relationships) between chronic diseases (cardiovascular diseases, diabetes and obesity) and the risk factors described on clinical records. To evaluate our approach, we submitted ten queries to CISS as well as to three other search engines (Google™, Google Scholar™ and Pubmed®;) — the queries were composed of terms and expressions from a list of risk factors provided by specialists. Results CISS retrieved a higher number of closely related (+) and somewhat related (+/-) documents, and a smaller number of unrelated (-) and almost unrelated (-/+) documents, in comparison with the three other systems. The results from the Friedman’s test carried out with the post-hoc Holm procedure (95% confidence) for our system (control) versus the results for the three other engines indicate that our system had the best performance in three of the categories (+), (-) and (+/-). This is an important result, since these are the most relevant categories for our users. Conclusion Our system should be able to assist researchers and health professionals in finding out relationships between potential risk factors and chronic diseases in scientific papers. PMID:24479447

  8. [Clinicopathological study of chronic kidney diseases (CKD)].

    PubMed

    Yoshida, Haruyoshi

    2012-02-01

    I started my life as a medical doctor at Amagasaki Prefectural Hospital after graduation from the Faculty of Medicine, Kyoto University in September 1971. I joined the newly established section of nephrology in the second year. The chief was Dr. Kazuro Kanatsu who had just moved from Kyoto University at the time of the campus disturbances. Dr. Kanatsu not only oriented me in clinical nephrology, but also guided me in medical research. I used to go to the laboratory of Dr. Tadao Tamura, Kyoto University once a week to learn renal biopsy study. In 1977, I entered the Department of Pathology, Postgraduate School of my university to learn immunopathology from Prof. Yoshihiro Hamashima. In the second year, I was willingly involved in the research group on murine SLE organized by the newly invited associate professor, Dr. Toshikazu Shirai, who taught young researchers such as myself how to consider, practice and enjoy experiments. In 1982, I went abroad to Prof. Peter Miescher, University of Geneva, who was a friend of Prof. Hamashima and organized immunopathology research groups. In the laboratory of Prof. Shozo Izui, I performed an isoelectric focused study on anti-DNA antibodies in lupus-prone mice and identified the pathogenetic role of the clonal expansion of autoantibodies. After 3 years, I came back to the 3rd Division of Internal Medicine of my university. Meanwhile, Prof. Chuichi Kawai guided me to go back to Prof. Hamashima's Pathology Department, where I helped young doctors publish a series of papers, including studies on SLE and a murine model of IgA glomerulonephritis. Later, I was obliged to leave the Pathology Department, and moved to Himeji National Hospital in 1992 as a clinical nephrologist by the invitation of the Director, Dr. Tamura. At that time I was very much encouraged by Prof. Shirai at Juntendo University, who gave me a letter with an old saying "Jinkan itarutokoro seizan ari". After 3 years, I moved to Kitano Hospital, Osaka, where I learned up-to-date information and techniques in clinical nephrology. From this hospital, I published a paper in Kidney International entitled, "Mesangiolytic glomerulopathy in severe congestive heart failure", based on the autopsy cases collected at the Pathology Department. This paper became a milestone in starting to study the role of chronic hypoxia in CKD. In 1999, I was elected as a professor of the Department of Clinical Laboratories, Faculty of Medicine, University of Fukui. In Fukui, I could extend my hypoxia study to cellular levels and diabetic mouse experiments in collaboration with Dr. Kimura, Dr. Li, Dr. Takahashi and many other doctors and technicians. When overviewing my research history, I realize that I was fortunate to be involved at the starting point of every laboratory with energetic mood and that I was supported and helped by many people. PMID:22568096

  9. The macrobiotic diet in chronic disease.

    PubMed

    Lerman, Robert H

    2010-12-01

    The macrobiotic diet is a low-fat, high-fiber, high-complex carbohydrate, mainly vegetarian diet. It is associated with a lifestyle system and a spiritual philosophy of life. Unlike many diets, the composition is not fixed and may be altered depending on a person's health status, among other considerations. Studies indicating lower serum lipid levels and blood pressure in people following a macrobiotic diet than in the general population suggest it to be an effective preventive strategy for cardiovascular disease. Many of its components suggest macrobiotics would be a valuable approach to cancer prevention. On the other hand, it has been the subject of controversy, especially with respect to its use in patients suffering from malignancies. Several remarkable anecdotal case reports have supported a therapeutic effect in patients with advanced cancers. However, to date, the few studies attempted have been inadequate to prove effectiveness and further research is warranted. Concerns include potential delay in conventional treatment for cancer, risks associated with nutrition deficiencies, and social limitations related to the complexities of strict adherence to this diet. Many aspects of currently popular dietary recommendations such as eating locally grown, in-season, fresh, organic foods are legacies of the macrobiotic lifestyle and diet. PMID:21139126

  10. Oxidative stress and inflammation, a link between chronic kidney disease and cardiovascular disease

    Microsoft Academic Search

    Victoria Cachofeiro; Marian Goicochea; Soledad García de Vinuesa; Pilar Oubiña; Vicente Lahera; José Luño

    2008-01-01

    Patients with chronic kidney disease (CKD) show a high cardiovascular morbidity and mortality. This seems to be consequence of the cardiovascular risk factor clustering in CKD patients. Non traditional risk factors such as oxidative stress and inflammation are also far more prevalent in this population than in normal subjects. Renal disease is associated with a graded increase in oxidative stress

  11. Chronic kidney disease and dialysis access in women.

    PubMed

    Pounds, Lori L; Teodorescu, Victoria J

    2013-04-01

    Chronic kidney disease currently affects one in nine Americans and over 500,000 have progressed to failure requiring kidney replacement therapy, with nearly 45% being women. Clinical Practice Guidelines have been developed in an effort to synthesize the latest literature, particularly randomized controlled trials, to assist clinical decision making. Women have different levels of kidney function than men at the same level of serum creatinine and may also lose kidney function over time more slowly than men. Although the arteriovenous fistulae have long been recognized as the preferred access for hemodialysis, women are less likely to initiate dialysis with an arteriovenous fistula in place. In addition, the female sex is regarded as a risk factor for access failure as well for complications such as steal. This article reviews treatment of women with chronic kidney disease, focusing on the difficulties they are perceived to have with dialysis access. PMID:23522719

  12. Gut microbiota and inflammation in chronic kidney disease patients

    PubMed Central

    Mafra, Denise; Fouque, Denis

    2015-01-01

    Inflammation is a multifactorial phenotype that in chronic kidney disease is associated with adverse patient outcomes. Recently, alterations in gut microbiota composition and intestinal barrier have been associated with inflammation and oxidative stress in CKD patients. Vanholder and Glorieux recently critically reviewed [Clin Kidney J (2015) 8 (2): 168-179] the current understanding of the role of gut microbiota in the production of uraemic toxins and the therapeutic implications. Where do we stand now? The basic mechanisms of the gut-kidney crosstalk must still be clarified. In addition, the efficacy and safety of therapeutic strategies to modulate the gut microbiota in order to decrease uraemic toxin production and inflammation in chronic kidney disease should be evaluated. Finally, an impact of such strategies on hard outcomes should be demonstrated before incorporation into routine clinical practice.

  13. Multidisciplinary Care of the Patient with Chronic Obstructive Pulmonary Disease

    PubMed Central

    Kuzma, Anne Marie; Meli, Yvonne; Meldrum, Catherine; Jellen, Patricia; Butler-Lebair, Marianne; Koczen-Doyle, Debra; Rising, Peter; Stavrolakes, Kim; Brogan, Frances

    2008-01-01

    The National Emphysema Treatment Trial used a multidisciplinary team approach to implement the maximum medical care protocol, including adjustment of medications and outpatient pulmonary rehabilitation for all patients and nutritional and psychological counseling as needed. This article discusses the benefits of such an approach in the care of the patient with chronic obstructive pulmonary disease. Team member roles complement each other and contribute to the goal of providing the highest-quality medical care. The primary focus of the team is to reinforce the medical plan and to provide patient education and support. This article reviews the elements of the initial patient assessment and the functional and nutritional assessment. Patient education focuses on medication use, recognition and management of chronic obstructive pulmonary disease exacerbation symptoms, smoking cessation, advance directives, and travel. PMID:18453373

  14. Chronic obstructive pulmonary disease secondary to household air pollution.

    PubMed

    Assad, Nour A; Balmes, John; Mehta, Sumi; Cheema, Umar; Sood, Akshay

    2015-06-01

    Approximately 3 billion people around the world cook and heat their homes using solid fuels in open fires and rudimentary stoves, resulting in household air pollution. Household air pollution secondary to indoor combustion of solid fuel is associated with multiple chronic obstructive pulmonary disease (COPD) outcomes. The exposure is associated with both chronic bronchitis and emphysema phenotypes of COPD as well as a distinct form of obstructive airway disease called bronchial anthracofibrosis. COPD from household air pollution differs from COPD from tobacco smoke with respect to its disproportionately greater bronchial involvement, lesser emphysematous change, greater impact on quality of life, and possibly greater oxygen desaturation and pulmonary hypertensive changes. Interventions that decrease exposure to biomass smoke may decrease the risk for incident COPD and attenuate the longitudinal decline in lung function, but more data on exposure-response relationships from well-designed longitudinal studies are needed. PMID:26024348

  15. Gut microbiota and inflammation in chronic kidney disease patients.

    PubMed

    Mafra, Denise; Fouque, Denis

    2015-06-01

    Inflammation is a multifactorial phenotype that in chronic kidney disease is associated with adverse patient outcomes. Recently, alterations in gut microbiota composition and intestinal barrier have been associated with inflammation and oxidative stress in CKD patients. Vanholder and Glorieux recently critically reviewed [Clin Kidney J (2015) 8 (2): 168-179] the current understanding of the role of gut microbiota in the production of uraemic toxins and the therapeutic implications. Where do we stand now? The basic mechanisms of the gut-kidney crosstalk must still be clarified. In addition, the efficacy and safety of therapeutic strategies to modulate the gut microbiota in order to decrease uraemic toxin production and inflammation in chronic kidney disease should be evaluated. Finally, an impact of such strategies on hard outcomes should be demonstrated before incorporation into routine clinical practice. PMID:26034597

  16. Future Treatments for Chronic Obstructive Pulmonary Disease and Its Comorbidities

    Microsoft Academic Search

    Peter J. Barnes

    2008-01-01

    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

  17. Calcium balance in chronic kidney disease: walking the tightrope.

    PubMed

    Evenepoel, Pieter; Viaene, Liesbeth; Meijers, Bjorn

    2012-06-01

    Calcium supplements for prevention and treatment of mineral and bone disorders in chronic kidney disease (CKD) have been alternately praised and damned. Clinical evidence in favor of either attitude has been lacking. The calcium balance study by Spiegel and Brady in patients with late stage 3 and stage 4 CKD suggests that CKD subjects ingesting 2000 mg of elemental calcium per day are in marked positive balance. Methodological limitations such as unproven steady state warrant caution and confirmatory studies. PMID:22584593

  18. How to Best Define Patients with Moderate Chronic Kidney Disease

    Microsoft Academic Search

    Mahmoud Emara; Ahmed Zahran; Hassan Abd El Hady; Ahmed Shoker

    2008-01-01

    Background: The objective of this study was to identify which formula may best identify moderate chronic kidney disease (CKD) (glomerular filtration rate (GFR) cut-off of 60 ml\\/min\\/1.73 m2). Methods: We compared the performances of 14 serum creatinine (Scr) and 11 cystatin C (Cys C) estimated GFR equations using inulin clearance (Clin) as the reference test in a stable CKD population

  19. Moderators of chronic disease self-management programs: who benefits?

    Microsoft Academic Search

    Philip L Ritter; Jonathan Lee; Kate Lorig

    2011-01-01

    Background: The Stanford University Chronic Disease Self-Management Program (CDSMP) has resulted in moderate beneficial outcomes in randomized controlled trials. A study of a modified CDSMP in England suggested that younger participants, those with lower initial self-efficacy and those with greater depression benefited most from the program.Design: Using data from previous CDSMP programs in English and Spanish, we examined whether there

  20. Chronic Wasting Disease in Free-Ranging North American Cervids

    Microsoft Academic Search

    Michael D. Samuel

    2006-01-01

    Chronic Wasting Disease (CWD) was first described in captive mule deer in a Colorado research facility in 1967 and subsequently c~sified as a tr~rnissible SP?ngiform encephalopathY,in 1?78.. The first ~tection of CWD. in ~ free-ranging population was III Colorado elk III 1981. During the 1990s, CWD was ldentified III free-rangmg mule deer, white-tailed deer, and elk in Colorado and Wyoming.

  1. PreClinical Myocardial Metabolic Alterations in Chronic Kidney Disease

    Microsoft Academic Search

    Jeffrey C. Fink; Martin A. Lodge; Mark F. Smith; Anish Hinduja; Jeanine Brown; Mara Y. Dinits-Pensy; Vasken Dilsizian

    2010-01-01

    The risk for cardiovascular events conferred by decreased renal function is curvilinear with exponentially greater increases in risk as estimated glomerular filtration rate (eGFR) declines. In 13 non-diabetic pre-dialysis chronic kidney disease (CKD) patients, we employed quantitative F-18 fluorodeoxyglucose (FDG) positron emission tomography (PET) as a means to measure myocardial metabolic changes. Methods: Dynamic cardiac FDG PET images were acquired

  2. Aortic PWV in Chronic Kidney Disease: A CRIC Ancillary Study

    PubMed Central

    Townsend, Raymond R.; Wimmer, Neil J.; Chirinos, Julio A.; Parsa, Afshin; Weir, Matthew; Perumal, Kalyani; Lash, James P.; Chen, Jing; Steigerwalt, Susan P.; Flack, John; Go, Alan S.; Rafey, Mohammed; Rahman, Mahboob; Sheridan, Angela; Gadegbeku, Crystal A.; Robinson, Nancy A.; Joffe, Marshall

    2009-01-01

    Background Aortic PWV is a measure of arterial stiffness and has proved useful in predicting cardiovascular morbidity and mortality in several populations of patients, including the healthy elderly, hypertensives and those with end stage renal disease receiving hemodialysis. Little data exist characterizing aortic stiffness in patients with chronic kidney disease who are not receiving dialysis, and in particular the effect of reduced kidney function on aortic PWV. Methods We performed measurements of aortic PWV in a cross-sectional cohort of participants enrolled in the Chronic Renal Insufficiency Cohort (CRIC) study to determine factors which predict increased aortic PWV in chronic kidney disease. Results PWV measurements were obtained in 2564 participants. The tertiles of aortic PWV (adjusted for waist circumference) were < 7.7 m/sec, 7.7–10.2 m/sec and > 10.2 m/sec with an overall mean (± S.D.) value of 9.48 ± 3.03 m/sec [95% CI = 9.35–9.61 m/sec]. Multivariable regression identified significant independent positive associations of age, blood glucose concentrations, race, waist circumference, mean arterial blood pressure, gender, and presence of diabetes with aortic PWV and a significant negative association with the level of kidney function. Conclusions The large size of this unique cohort, and the targeted enrollment of chronic kidney disease participants provides an ideal situation to study the role of reduced kidney function as a determinant of arterial stiffness. Arterial stiffness may be a significant component of the enhanced cardiovascular risk associated with kidney failure. PMID:20019670

  3. Personal Health Records for Patients with Chronic Disease

    PubMed Central

    Rozenblum, R.; Park, A.; Dunn, M.; Bates, D.W.

    2014-01-01

    Summary Background Personal health records (PHRs) connected to a physician’s electronic health record system hold substantial promise for supporting and engaging patients with chronic disease. Objectives: To explore how U.S. health care organizations are currently utilizing PHRs for chronic disease populations. Methods A mixed methods study including semi-structured interviews and a questionnaire was conducted. A purposive sample was developed of health care organizations which were recognized as exemplars for PHRs and were high performers in national patient satisfaction surveys (H-CAHPS or CAHPS). Within each organization, participants were health IT leaders or those managing high-risk or chronic disease populations. Results Interviews were conducted with 30 informants and completed questionnaires were received from 16 organizations (84% response rate). Most PHRs allowed patients to access health records and educational material, message their provider, renew prescriptions and request appointments. Patient generated data was increasingly being sought and combined with messaging, resulted in greater understanding of patient health and functioning outside of the clinic visit. However for chronic disease populations, there was little targeted involvement in PHR design and few tools to help interpret and manage their conditions beyond those offered for all. The PHR was largely uncoupled from high risk population management interventions and no clear framework for future PHR development emerged. Conclusion This technology is currently underutilized and represents a major opportunity given the potential benefits of patient engagement and shared decision making. A coherent patient-centric PHR design and evaluation strategy is required to realize its potential and maximize this natural hub for multidisciplinary care co-ordination. PMID:25024758

  4. E-health System for Monitoring of Chronic Diseases

    Microsoft Academic Search

    R. Ciorap; D. Andritoi; V. Pomazan; L. Petcu; F. Ungureanu; D. Zaharia

    \\u000a The actual status of technological development impose the improvement of quality of life through health services, information\\u000a and communication systems and environment control more efficient in hospitals. This study want to develop a medical device\\u000a for monitoring some vital parameters on patients with chronically diseases that alongside a software application, it provides\\u000a an integrated solution of monitoring the evolution of

  5. New loci associated with kidney function and chronic kidney disease

    Microsoft Academic Search

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

    2010-01-01

    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

  6. Investigating mechanisms of chronic kidney disease in mouse models

    Microsoft Academic Search

    Allison A. Eddy; Jesús M. López-Guisa; Daryl M. Okamura; Ikuyo Yamaguchi

    Animal models of chronic kidney disease (CKD) are important experimental tools that are used to investigate novel mechanistic\\u000a pathways and to validate potential new therapeutic interventions prior to pre-clinical testing in humans. Over the past several\\u000a years, mouse CKD models have been extensively used for these purposes. Despite significant limitations, the model of unilateral\\u000a ureteral obstruction (UUO) has essentially become

  7. Occupation in chronic obstructive pulmonary disease and chronic bronchitis: an update.

    PubMed

    Blanc, P D; Torén, K

    2007-03-01

    This review critically evaluates the recent scientific literature relevant to occupational risk factors for chronic obstructive pulmonary disease (COPD) and chronic bronchitis. The 2003 American Thoracic Society statement on the occupational contribution to the burden of airway disease synthesized relevant data on this topic through 1999. Since 2000, 14 separate studies have published values or provide data that allow estimation of the population attributable risk per cent (PAR%) for the proportion of chronic bronchitis or COPD due to work-related factors. Based on data since 2000, the median PAR% value for both chronic bronchitis and COPD is 15%. A number of additional studies have been published that underscore the association between specific occupational exposures and airflow obstruction. In addition, data are emerging that indicate the extent to which COPD is a cause of work disability; limited data raise the possibility that among those with occupational COPD, disability may be even more prominent. This review supports previous analyses concluding that there is a causal association between work-related exposures and COPD. PMID:17352088

  8. Predictors of weaning outcome in chronic obstructive pulmonary disease patients.

    PubMed

    Alvisi, R; Volta, C A; Righini, E R; Capuzzo, M; Ragazzi, R; Verri, M; Candini, G; Gritti, G; Milic-Emili, J

    2000-04-01

    Several threshold values for predicting weaning outcome from mechanical ventilation have been proposed. These values, however, have been obtained in nonhomogeneous patient populations. The aim of the present study was to determine the threshold values in chronic obstructive pulmonary disease (COPD) patients and compare them to those reported for nonhomogeneous patient populations. The initial weaning trial included 81 COPD patients. Fifty-three of them underwent a successful weaning trial, whereas 28 failed it. The latter were enrolled into the present investigation, and were restudied during a subsequent successful trial. The weaning indices used were those reported in the literature. The threshold values obtained were within 10% of those reported for a nonhomogeneous patients population only for tidal volume and effective compliance. The classification error was <20% for maximal inspiratory pressure (MIP), occluded inspiratory pressure swing (deltaPI)/MIP, rapid and shallow breathing (respiratory frequency/tidal volume), and compliance, rate, oxygenation, pressure index (CROP), whereas the area under the receiver operating characteristic curves was >0.9 only for deltaPI/MIP and CROP. In conclusion, the threshold values obtained in chronic obstructive pulmonary disease patients who failed the first weaning attempt differed from those previously reported. Although a gold standard weaning index is not available for chronic obstructive pulmonary disease patients, the occluded inspiratory pressure swing/ maximal inspiratory pressure and compliance, rate, oxygenation, pressure index may be candidates for such a role. PMID:10780755

  9. [Peripheral muscle dysfunction in chronic obstructive pulmonary disease].

    PubMed

    Maltais, F; Leblanc, P; Jobin, J; Casaburi, R

    2002-09-01

    Patients with chronic obstructive pulmonary disease (COPD) often develop systemic complications of their disease. Peripheral muscle dysfunction is one such complication and is characterised by atrophy, weakness, and low oxidative capacity. These muscle changes influence exercise tolerance and quality of life independent of the impairment in lung function. In the following article, the evidence for peripheral muscle dysfunction in patients with COPD and the possible clinical implications of this problem will be discussed. Lastly, the available therapeutic options to improve peripheral muscle function in COPD will be reviewed. PMID:12417861

  10. Rhinosporidiosis: A Chronic Tropical Disease in Lateral Pharyngeal Wall

    PubMed Central

    Shenoy, Vijendra S; Rao, Raghavendra A; Kamath, Panduranga M.; Rao, Kanishka S.

    2015-01-01

    Rhinosporidiosis is a chronic granulomatous disease caused by Rhinosporidium seeberi. It predominantly affects the mucous membranes of the nose and the nasopharynx. Clinically the lesion presents as a pink or red pedunculated polyp in one or both nostrils. Diagnosis can be made by aspiration cytology and examination with May-Grunwald-Giemsa, hematoxylin and eosin, Periodic acid-Schiff and mucicarmine staining. Definitive diagnosis is by histopathology of the specimen. We report a case of Rhinosporidiosis at the lateral pharyngeal wall which is a very rare site for Rhinosporidiosis to occur; was treated by diathermy excision of the mass and cauterization of the base and oral Dapsone to prevent recurrence of the disease.

  11. Chronic recurrent multifocal osteomyelitis and inflammatory bowel disease.

    PubMed

    Audu, Grace K; Nikaki, Kornilia; Crespi, Daniel; Spray, Christine; Epstein, Jenny

    2015-05-01

    Chronic recurrent multifocal osteomyelitis (CRMO) has been reported in association with inflammatory bowel disease (IBD), mostly in children. We describe the UK paediatric experience of CRMO and IBD and review the global literature. Three cases of CRMO and IBD were identified in UK children during the last 10 years. This adds to the previously published 24 cases worldwide (15 children). We provide further evidence for the true association of CRMO and IBD, and a greater understanding of disease course. CRMO may be considered a rare extraintestinal complication of IBD. PMID:25493348

  12. Chronic Wasting Disease of Elk and Deer and Creutzfeldt-Jakob Disease

    PubMed Central

    Xie, Zhiliang; O’Rourke, Katherine I.; Dong, Zhiqian; Jenny, Allen L.; Langenberg, Julie A.; Belay, Ermias D.; Schonberger, Lawrence B.; Petersen, Robert B.; Zou, Wenquan; Kong, Qingzhong; Gambetti, Pierluigi; Chen, Shu G.

    2015-01-01

    Chronic wasting disease (CWD), a transmissible prion disease that affects elk and deer, poses new challenges to animal and human health. Although the transmission of CWD to humans has not been proven, it remains a possibility. If this were to occur, it is important to know whether the “acquired” human prion disease would show a phenotype including the scrapie prion protein (PrPSc) features that differ from those associated with human sporadic prion disease. In this study, we have compared the pathological profiles and PrPSc characteristics in brains of CWD-affected elk and deer with those in subjects with sporadic Creutzfeldt-Jakob disease (CJD), as well as CJD-affected subjects who might have been exposed to CWD, using histopathology, immunohistochemistry, immunoblotting, conformation stability assay, and N-terminal protein sequencing. Spongiform changes and intense PrPSc staining were present in several brain regions of CWD-affected animals. Immunoblotting revealed three proteinase K (PK)-resistant bands in CWD, representing different glycoforms of PrPSc. The unglycosylated PK-resistant PrPSc of CWD migrated at 21 kDa with an electrophoretic mobility similar to that of type 1 human PrPSc present in sporadic CJD affecting subjects homozygous for methionine at codon 129 (sCJDMM1). N-terminal sequencing showed that the PK cleavage site of PrPSc in CWD occurred at residues 82 and 78, similar to that of PrPSc in sCJDMM1. Conformation stability assay also showed no significant difference between elk CWD PrPSc and the PrPSc species associated with sCJDMM1. However, there was a major difference in glycoform ratio of PrPSc between CWD and sCJDMM1 affecting both subjects potentially exposed to CWD and non-exposed subjects. Moreover, PrPSc of CWD exhibited a distinct constellation of glycoforms distinguishable from that of sCJDMM1 in two-dimensional immunoblots. These findings underline the importance of detailed PrPSc characterization in trying to detect novel forms of acquired prion disease. PMID:16338930

  13. Prospective study of ultrasonography in chronic pancreatic disease.

    PubMed Central

    Lees, W R; Vallon, A G; Denyer, M E; Vahl, S P; Cotton, P B

    1979-01-01

    Grey-scale ultrasonography was used in 212 unselected patients in whom the presence or absence of pancreatic disease was subsequently confirmed by other means. Ultrasonographic criteria were established in the first 92 patients and by reference to previous experience. The remaining 120 patients were studied prospectively. The accuracy and clinical impact of the ultrasonographic diagnosis were judged alongside a standard clinical assessment. Clinical diagnoses were tentative and inaccurate. Ultrasound failed in three cases; otherwise it detected all the 33 patients with chronic pancreatic disease and correctly distinguished cancer from chronic pancreatitis. The ultrasonographic diagnosis of a normal pancreas was always correct, but four false-positive diagnoses were made in patients subsequently judged to have no pancreatic disease. Ultrasonography gave more accurate or more confident and accurate information than the clinical assessment in 57 of the 98 patients studied as problems in diagnosis. With this degree of accuracy ultrasonography should be the first imaging investigation in patients suspected of suffering from pancreatic disease. In our gastrointestinal unit the combination of grey-scale ultrasonography with techniques designed to outline the duct systems (such as endoscopic pancreatography) provides precise diagnosis and documentation of pancreatic disease. PMID:420999

  14. Management of Pulmonary Hypertension in Patients with Chronic Lung Disease.

    PubMed

    Barberà, Joan Albert; Blanco, Isabel

    2015-08-01

    Pulmonary hypertension (PH) is a common complication of chronic pulmonary diseases, especially in advanced disease, and is associated with greater mortality and worse clinical course. Patients with symptoms that exceed those expected by their pulmonary disease should be further evaluated by echocardiography. Confirmatory right heart catheterization is indicated in those conditions where the results of the hemodynamic assessment will determine treatment options. The treatment of choice for patients who are hypoxemic and have pulmonary hypertension associated with chronic lung disease is long-term oxygen therapy. Conventional vasodilators or drugs approved for pulmonary arterial hypertension are not recommended in patients with mild-to-moderate PH because they may impair gas exchange and because there is a lack of evidence supporting their efficacy. Patients with severe PH should be considered for referral to a center with expertise in PH and lung diseases. Ideally, these patients should be included in randomized controlled trials to determine which patients are more likely to derive benefit and which therapies are most likely to be successful. PMID:26115628

  15. Shift work and chronic disease: the epidemiological evidence

    PubMed Central

    Armstrong, M. E. G.; Cairns, B. J.; Key, T. J.; Travis, R. C.

    2011-01-01

    Background Shift work, including night work, has been hypothesized to increase the risk of chronic diseases, including cancer, cardiovascular disease (CVD), metabolic syndrome and diabetes. Recent reviews of evidence relating to these hypotheses have focussed on specific diseases or potential mechanisms, but no general summary of the current data on shift work and chronic disease has been published. Methods Systematic and critical reviews and recent original studies indexed in PubMed prior to 31 December 2009 were retrieved, aided by manual searches of reference lists. The main conclusions from reviews and principle results from recent studies are presented in text and tables. Results Published evidence is suggestive but not conclusive for an adverse association between night work and breast cancer but limited and inconsistent for cancers at other sites and all cancers combined. Findings on shift work, in relation to risks of CVD, metabolic syndrome and diabetes are also suggestive but not conclusive for an adverse relationship. Conclusions Heterogeneity of study exposures and outcomes and emphasis on positive but non-significant results make it difficult to draw general conclusions. Further data are needed for additional disease endpoints and study populations. PMID:21355031

  16. Preclinical murine models of Chronic Obstructive Pulmonary Disease.

    PubMed

    Vlahos, Ross; Bozinovski, Steven

    2015-07-15

    Chronic Obstructive Pulmonary Disease (COPD) is a major incurable global health burden and is the 4th leading cause of death worldwide. It is believed that an exaggerated inflammatory response to cigarette smoke causes progressive airflow limitation. This inflammation, where macrophages, neutrophils and T lymphocytes are prominent, leads to oxidative stress, emphysema, small airway fibrosis and mucus hypersecretion. Much of the disease burden and health care utilisation in COPD is associated with the management of its comorbidities and infectious (viral and bacterial) exacerbations (AECOPD). Comorbidities, defined as other chronic medical conditions, in particular skeletal muscle wasting and cardiovascular disease markedly impact on disease morbidity, progression and mortality. The mechanisms and mediators underlying COPD and its comorbidities are poorly understood and current COPD therapy is relatively ineffective. Thus, there is an obvious need for new therapies that can prevent the induction and progression of COPD and effectively treat AECOPD and comorbidities of COPD. Given that access to COPD patients can be difficult and that clinical samples often represent a "snapshot" at a particular time in the disease process, many researchers have used animal modelling systems to explore the mechanisms underlying COPD, AECOPD and comorbidities of COPD with the goal of identifying novel therapeutic targets. This review highlights the mouse models used to define the cellular, molecular and pathological consequences of cigarette smoke exposure and the recent advances in modelling infectious exacerbations and comorbidities of COPD. PMID:25818750

  17. Personality change in Parkinson's disease patients: chronic disease and aging.

    PubMed

    Mendelsohn, G A; Dakof, G A; Skaff, M

    1995-06-01

    Parkinson's disease patients (N = 41, mean age = 65 years) were described by themselves and their spouses as they were presently and before their illness using the Adjective Check List. Equivalent self- and spouse descriptions were obtained from the members of a matched community sample (N = 96). Descriptions of patients and their spouses converged, both reporting sharp, pervasive (e.g., on all of the Big Five dimensions), and uniformly negative change in personality. Similar, but much less marked change was found in the community sample. The data as a set suggest that the reported changes in the patients were veridical and that their magnitude was primarily the result of the disease rather than aging. Evidence of continuities in personality (for example, differential stability) was also noted. We argued that the illness accelerated and intensified changes normally expected in later life. PMID:7782993

  18. Occurrence, transmission, and zoonotic potential of chronic wasting disease.

    PubMed

    Saunders, Samuel E; Bartelt-Hunt, Shannon L; Bartz, Jason C

    2012-03-01

    Chronic wasting disease (CWD) is a fatal, transmissible prion disease that affects captive and free-ranging deer, elk, and moose. Although the zoonotic potential of CWD is considered low, identification of multiple CWD strains and the potential for agent evolution upon serial passage hinders a definitive conclusion. Surveillance for CWD in free-ranging populations has documented a continual geographic spread of the disease throughout North America. CWD prions are shed from clinically and preclinically affected hosts, and CWD transmission is mediated at least in part by the environment, perhaps by soil. Much remains unknown, including the sites and mechanisms of prion uptake in the naive host. There are no therapeutics or effective eradication measures for CWD-endemic populations. Continued surveillance and research of CWD and its effects on cervid ecosystems is vital for controlling the long-term consequences of this emerging disease. PMID:22377159

  19. IL6 in autoimmune disease and chronic inflammatory proliferative disease

    Microsoft Academic Search

    Katsuhiko Ishihara; Toshio Hirano

    2002-01-01

    Interleukin 6 (IL-6), which was originally identified as a B-cell differentiation factor, is now known to be a multifunctional cytokine that regulates the immune response, hematopoiesis, the acute phase response, and inflammation. Deregulation of IL-6 production is implicated in the pathology of several disease processes. The expression of constitutively high levels of IL-6 in transgenic mice results in fatal plasmacytosis,

  20. Chronic kidney disease and its prevention in India.

    PubMed

    Agarwal, Sanjay K

    2005-09-01

    Chronic kidney disease (CKD) is an important, chronic, noncommunicable disease epidemic that affects the world, including India. Because of the absence of a renal registry in India, the true magnitude of CKD/end-stage renal disease (ESRD) is unknown. Two community-based studies, although methodologically different, have shown a prevalence of chronic renal failure of 0.16% and 0.79%. The cost of maintenance hemodialysis for a single session varies between 10 US dollars to 40 between government-run and private hospitals. The average cost of erythropoetin is approximately 150 US dollars to 200 per month. The cost of chronic ambulatory peritoneal dialysis with "Y" set at 3 exchanges per week, which most patients in India do, is US 400 US dollars per month. The cost of a renal transplant (RT) procedure is approximately US 700 US dollars to 800 in the government sector and 6000 US dollars in the private sector. The cost of immunosuppression with basic triple immunosuppression drugs (cyclosporine, steroid, and azathioprin) is US 250 US dollars per month. There are hardly any state-funded medical treatment and medical insurance facilities for CKD and ESRD patients in India. India has nearly 700 nephrologists and approximately 400 dialysis units with 1000 dialysis stations, with the majority being in the private sector. A maximum of 2% of patients can be subjected to maintenance hemodialysis. Until now, approximately 3000 patients have been initiated on chronic ambulatory peritoneal dialysis. India has approximately 100 RT centers, mostly in private setup, and not more than 3000 to 4000 RTs are performed annually. Thus, only 3% to 5% of all patients with ESRD in India get some form of renal replacement therapy. Thus, planning for prevention of CKD on a long-term basis is the only practical solution for India. It appears that even in India, diabetes and hypertension are responsible for 40% to 50% of all cases of chronic renal failure. Screening for these 2 diseases and CKD is simple and easy to perform. The best approach will be to start screening for CKD in a high-risk group, like first-degree relatives of patients with diabetes, hypertension, and CKD, and simultaneously making a platform to run the program through the existing health care system of the country. The key issue of funding the program needs to be explored. Initial funding may come from international agencies like the World Health Organization, World Bank, and International Society of Nephrology, along with support from the country itself. Ultimately, funding has to be sustained from our own existing health care system. PMID:16108970

  1. Combination of ACE inhibitor with nicorandil provides further protection in chronic kidney disease.

    PubMed

    Shiraishi, Takeshi; Tamura, Yoshifuru; Taniguchi, Kei; Higaki, Masato; Ueda, Shuko; Shima, Tomoko; Nagura, Michito; Nakagawa, Takahiko; Johnson, Richard J; Uchida, Shunya

    2014-12-15

    An inhibition in the renin-angiotensin system (RAS) is one of the most widely used therapies to treat chronic kidney disease. However, its effect is occasionally not sufficient and additional treatments may be required. Recently, we reported that nicorandil exhibited renoprotective effects in a mouse model of diabetic nephropathy. Here we examined if nicorandil can provide an additive protection on enalapril in chronic kidney disease. Single treatment with either enalapril or nicorandil significantly ameliorated glomerular and tubulointerstitial injury in the rat remnant kidney while the combination of these two compounds provided additive effects. In addition, an increase in oxidative stress in remnant kidney was also blocked by either enalapril or nicorandil while the combination of the drugs was more potent. A mechanism was likely due for nicorandil to preventing manganase superoxide dismutase (MnSOD) and sirtuin (Sirt)3 from being reduced in injured kidneys. A study with cultured podocytes indicated that the antioxidative effect could be mediated through sulfonylurea receptor (SUR) in the mitochondrial KATP channel since blocking SUR with glibenclamide reduced MnSOD and Sirt3 expression in podocytes. In conclusion, nicorandil may synergize with enalapril to provide superior protection in chronic kidney disease. PMID:25320353

  2. ADVANCE: Study to Evaluate Cinacalcet Plus Low Dose Vitamin D on Vascular Calcification in Subjects With Chronic Kidney Disease Receiving Hemodialysis

    ClinicalTrials.gov

    2014-07-14

    Chronic Kidney Disease; End Stage Renal Disease; Coronary Artery Calcification; Vascular Calcification; Calcification; Cardiovascular Disease; Chronic Renal Failure; Hyperparathyroidism; Kidney Disease; Nephrology; Secondary Hyperparathyroidism

  3. Highly Efficient Amplification of Chronic Wasting Disease Agent by Protein Misfolding Cyclic Amplification with

    E-print Network

    Highly Efficient Amplification of Chronic Wasting Disease Agent by Protein Misfolding Cyclic of Chronic Wasting Disease Agent by Protein Misfolding Cyclic Amplification with Beads (PMCAb). PLoS ONE 7 wasting disease (CWD) in deer, elk and moose, and Creutzfeldt-Jakob disease in humans. The etiological

  4. Influences on Hunter Support for Deer Herd Reduction as a Chronic Wasting Disease (CWD) Management Strategy

    Microsoft Academic Search

    Erin E. Cooney; Robert H. Holsman

    2010-01-01

    The extent to which wildlife diseases like chronic wasting disease (CWD) are density dependent creates opportunities to manage them by implementing population reduction to disrupt disease spread and lower its prevalence. We tested a model to investigate the influence of risk perceptions and other salient beliefs on deer hunter support for deer density reduction as chronic wasting disease strategy in

  5. An NMR Metabolomics Study of Elk Inoculated with Chronic Wasting Disease

    Microsoft Academic Search

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

    2011-01-01

    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

  6. Clinical Implication of the Renin-angiotensin-aldosterone Blockers in Chronic Kidney Disease Undergoing Hemodialysis

    PubMed Central

    Morishita, Yoshiyuki; Kusano, Eiji; Nagata, Daisuke

    2014-01-01

    The renin-angiotensin-aldosterone system (RAAS) blockers have been widely used in chronic kidney disease patients undergoing hemodialysis; however, whether RAAS blockers have beneficial effects for cardiovascular disease in those patients has not been fully defined. This review focuses on the effects of RAAS blockers in chronic kidney disease undergoing hemodialysis for cardiovascular disease. PMID:24611082

  7. Treatment of intractable gastrointestinal manifestations of chronic granulomatous disease with cyclosporine

    Microsoft Academic Search

    Joel R. Rosh; Hope B. Tang; Lloyd Mayer; Gabriel Groisman; Sheeja K. Abraham; Alice Prince

    1995-01-01

    Gastrointestinal manifestations of chronic granulomatous disease of childhood include granulomatous inflammatory bowel disease. Severe colitis and perirectal disease developed in a 12-year-old boy with chronic granulomatous disease while he was receiving interferon gamma therapy. The boy had a deficiency of the 22 kd light chain of the cytochrome b heterodimer. After conventional medical therapy proved to be ineffective, a rapid

  8. Dyslipidemia and the progression of renal disease in chronic renal failure patients

    Microsoft Academic Search

    ALEIX CASES; ELISABET COLL

    2005-01-01

    Dyslipidemia and the progression of renal disease in chronic renal failure patients Dyslipidemia is a common complication of progressive kidney disease and contributes to the high cardiovascular morbidity and mortality of chronic kidney disease (CKD) patients. Recent evidence also suggests a role for dyslipidemia in the development and progression of renal disease. Experimental studies have demonstrated that lipids may induce

  9. Gene Expression Profiling in Patients with Chronic Obstructive Pulmonary Disease and Lung Cancer

    Microsoft Academic Search

    I-Ming Wang; Sergey Stepaniants; Yves Boie; James R. Mortimer; Brian Kennedy; Mark Elliott; Shizu Hayashi; Leanna Loy; Silvija Coulter; Sandra Cervino; Jennifer Harris; Michele Thornton; Richard Raubertas; Chris Roberts; Jim C. Hogg; Michael Crackower; Gary O'Neill; Peter D. Pare

    Rationale: Chronic obstructive lung disease (COPD) is a common and disabling lung disease for which there are few therapeutic options. Objectives: We reasoned that gene expression profiling of COPD lungs could reveal previously unidentified disease pathways. Methods: Forty-eight human lung samples were obtained from tis- sue resected from five nonsmokers, 21 GOLD (Global Initiative for Chronic Obstructive Lung Disease) stage

  10. Periodontitis associated with Chronic Kidney Disease among Mexican Americans

    PubMed Central

    Ioannidou, Effie; Hall, Yoshio; Swede, Helen; Himmelfarb, Jonathan

    2012-01-01

    Objective In comparison to non-Hispanic whites, a number of healthcare disparities, including poor oral health, have been identified among Hispanics in general and Mexican-Americans in particular. We hypothesized that Mexican-Americans with Chronic Kidney disease (CKD) would have higher prevalence of chronic periodontitis compared to Mexican Americans with normal kidney function, and that the level of kidney function would be inversely related to the prevalence of periodontal disease. Method We examined this hypothesis using the National Health and Nutrition Examination Survey 1988–1994 (NHANES III) dataset. We followed the American Academy of Periodontology (AAP)/Center for Disease Control and Prevention (CDC) case definition for periodontitis. Glomerular filtration rate was estimated using the CKD-Epidemiology (EPI) equation for Hispanic populations. The classification to CKD stages was based on the National Kidney Foundation Kidney Disease Outcomes Quality Initiative. Results Periodontitis prevalence increased across the kidney function groups showing a statistically significant dose-response association (p<0.001). Mexican Americans with reduced kidney function were 2-fold more likely to have periodontitis compared to Mexican Americans with normal kidney function after adjusting for potential confounders such as smoking, diabetes and socioeconomic status. Multivariate adjusted Odds Ratio for periodontitis significantly increased with 1, 5 and 10 mL/minute eGFR reduction from the mean. Conclusion This is the first report, to the best our knowledge, that showed an increase of periodontitis prevalence with decreased kidney function in this population. PMID:22775287

  11. Inhaled nitric oxide in chronic obstructive lung disease

    SciTech Connect

    Tiihonen, J.; Hakola, P.; Paanila, J.; Turtiainen (Univ. of Kuopio (Finland). Dept. of Forensic Psychiatry)

    1993-01-30

    During an investigation of the effect of nitric oxide on the pulmonary circulation the authors had the opportunity to give nitric oxide to a patient with longstanding obstructive airway disease, with successful results. A 72-year-old man with chronic obstructive pulmonary disease was referred to the institution for assessment of pulmonary vascular reactivity to acetylcholine and nitric oxide. Acetylcholine was infused into the main pulmonary artery followed 15 min later by an inhalation of 80 parts per million (ppm) nitric oxide. Heart rate and systemic arterial and pulmonary arterial pressures were continuously monitored. Throughout the study the inspired oxygen concentration was kept constant at 98%. Nitrogen dioxide and nitric oxide concentrations were monitored while nitric oxide was delivered. The infusion of acetylcholine resulted in a small increase in pulmonary artery pressure and pulmonary vascular resistance. Nitric oxide produced a substantial fall in pulmonary artery pressure and pulmonary vascular resistance with a concomitant increase in systemic arterial oxygen tension. These results suggest that endothelium-dependent relaxation of the pulmonary vasculature was impaired in the patient and that exogenous nitric oxide was an effective pulmonary vasodilator. In-vitro investigation of explanted airways disease suggests not only that endothelium-dependent pulmonary artery relaxation is impaired but also that the dysfunction is related to pre-existing hypoxemia and hypercapnia. Nitric oxide inhibits proliferation of cultured vascular smooth muscle cells and might alter the pulmonary vascular remodeling characteristic of patients with chronic obstructive airways disease.

  12. The chronic obstructive pulmonary disease-asthma overlap syndrome.

    PubMed

    Braman, Sidney S

    2015-01-01

    When asthma and chronic obstructive pulmonary disease (COPD) occur together the term COPD-asthma overlap syndrome has been applied. To date, there is no universally accepted definition of this overlap syndrome, just as there is no blood test or other technologic assessment that provides a simple way to distinguish asthma from COPD. One practical approach to the overlap diagnosis has been to include patients with a diagnosis of COPD by Global Initiative for Chronic Obstructive Lung Disease criteria and asthma defined by subject report of a physician diagnosis of asthma before the age of 40 years. Alternatively, it includes patients who meet criteria for COPD (fixed airflow obstruction) and who also have typical features of asthma (wheezing, atopy, eosinophilia, and positive bronchodilator response on spirometry). Compared with patients with COPD alone, the overlap patients are younger with less smoking intensity, have higher health-care utilization, have a worse disease-related quality of life, and have a higher mortality. Treatment with corticosteroids earlier in the course of the disease compared with the patient with only COPD has been recommended. PMID:25562551

  13. Chronic cutaneous graft-versus-host disease in man.

    PubMed Central

    Shulman, H. M.; Sale, G. E.; Lerner, K. G.; Barker, E. A.; Weiden, P. L.; Sullivan, K.; Gallucci, B.; Thomas, E. D.; Storb, R.

    1978-01-01

    This clinicopathologic study of patients with chronic graft-versus-host disease (GVHD) after allogeneic marrow transplantation emphasizes the most prominent feature of the syndrome, the cutaneous aspects, and describes the ophthalmic-oral sicca syndrome with sialoadenitis and the neurologic findings. Chronic cutaneous GVHD affected 19 of 92 recipients surviving 150 days or more. In 6 patients chronic GVHD presented as a continuation of acute GVHD; in 8 it occurred after the resolution of acute GVHD; and in 5 it arose without preceding acute GVHD, ie, de novo late onset. Two cutaneous types were distinguished. The generalized type affected 16 patients and ran a progressive course resulting in late complications of poikiloderma, diffuse dermal and subcutaneous fibrosis, and contractures. Microscopically, it resembled generalized morphea and lupus erythermatosus hypertrophicus et profundus. The local type affected 3 patients with a more variable picture of poikiloderma, dermal sclerosis, and contractures. Microscopically, it resembled lupus of erythematosus profundus and scleroderma. Guidelines for defining and subclassifying chronic cutaneous GVHD are proposed. Images Figure 5 Figure 6 Figure 7 Figure 8 Figure 9 Figure 10 Figure 11 Figure 12 Figure 13 Figure 14 Figure 15 Figure 16 Figure 17 Figure 18 Figure 19 Figure 20 Figure 1 Figure 2 Figure 3 Figure 4 PMID:26221

  14. Postoperative pain management in patients with chronic kidney disease

    PubMed Central

    Tawfic, Qutaiba A.; Bellingham, Geoff

    2015-01-01

    Chronic kidney disease (CKD) is a health care problem with increasing prevalence worldwide. Pain management represents one of the challenges in providing perioperative care for this group of patients. Physicians from different specialties may be involved in pain management of CKD patients, especially in advanced stages. It is important to understand the clinical staging of kidney function in CKD patients as the pharmacotherapeutic pain management strategies change as kidney function becomes progressively impaired. Special emphasis should be placed on dose adjustment of certain analgesics as well as prevention of further deterioration of renal function that could be induced by certain classes of analgesics. Chronic pain is a common finding in CKD patients which may be caused by the primary disease that led to kidney damage or can be a direct result of CKD and hemodialysis. The presence of chronic pain in some of the CKD patients makes postoperative pain management in these patients more challenging. This review focuses on the plans and challenges of postoperative pain management for patient at different stages of CKD undergoing surgical intervention to provide optimum pain control for this patient population. Further clinical studies are required to address the optimal medication regimen for postoperative pain management in the different stages of CKD. PMID:25788766

  15. Integrated management strategies for chronic obstructive pulmonary disease

    PubMed Central

    Sonetti, David A; Hospenthal, Angela C; Adams, Sandra G

    2010-01-01

    Chronic obstructive pulmonary disease (COPD) remains the fourth leading cause of death, is associated with significant morbidity and places a substantial time and cost burden on the health care system. Unfortunately, treatment for COPD remains underutilized and continues to focus on the acute care of complications. The chronic care model (CCM) shifts this focus from the acute management of symptoms and complications to the prevention and optimal management of the chronic disease. This model utilizes resources from the community and the health care system and emphasizes self-management, provides comprehensive clinic support, and implements evidence-based guidelines and technology into clinical practice to ensure delivery of the highest quality of care. The goal of this review is to use a case-based approach to provide practical information about how integrated care using the CCM can be applied to the clinical care of a complex patient with COPD, shifting the management goals for COPD from reactive to proactive and ultimately improving outcomes. PMID:21197367

  16. The role for S-carboxymethylcysteine (carbocisteine) in the management of chronic obstructive pulmonary disease

    PubMed Central

    Hooper, C; Calvert, J

    2008-01-01

    Prescription of mucoactive drugs for chronic obstructive pulmonary disease (COPD) is increasing. This development in clinical practice arises, at least in part, from a growing understanding of the important role that exacerbation frequency, systemic inflammation and oxidative stress play in the pathogenesis of respiratory disease. S-carboxymethylcysteine (carbocisteine) is the most frequently prescribed mucoactive agent for long-term COPD use in the UK. In addition to its mucoregulatory activity, carbocisteine exhibits free-radical scavenging and anti-inflammatory properties. These characteristics have stimulated interest in the potential that this and other mucoactive drugs may offer for modification of the disease processes present in COPD. This article reviews the pharmacology, in vivo and in vitro properties, and clinical trial evidence for carbocisteine in the context of guidelines for its use and the current understanding of the pathogenic processes that underlie COPD. PMID:19281081

  17. Vaccinations in juvenile chronic inflammatory diseases: an update.

    PubMed

    Silva, Clovis A; Aikawa, Nadia E; Bonfa, Eloisa

    2013-09-01

    Vaccination is a powerful tool to reduce the burden of infectious diseases in paediatric patients with chronic rheumatic diseases. Live attenuated vaccines are not recommended for profoundly immunosuppressed patients, but nonlive vaccines have adequate safety and efficacy profiles in the few (admittedly underpowered) studies published to date. No severe vaccine-specific or disease-specific adverse events have been observed in patients with juvenile idiopathic arthritis (JIA) or childhood-onset systemic lupus erythematosus (SLE) who have been vaccinated with live or nonlive agents. The immune response to live vaccines is variable in these patients but generally adequate, despite concomitant use of immunosuppressive and biologic agents. The proposal that onset of autoimmune rheumatic diseases could be induced by vaccination is controversial and primarily based on case reports; however, patients with mevalonate kinase deficiency can experience febrile attacks after immunizations. Adequately powered studies of live and nonlive vaccination in patients with paediatric rheumatic diseases are necessary to clarify safety and efficacy issues. This narrative Review discusses vaccination in patients with JIA, childhood-onset SLE, juvenile dermatomyositis, juvenile systemic sclerosis, primary vasculitis and autoinflammatory syndromes. Vaccine safety, short-term and long-term changes in disease parameters, and the immunogenicity and influence of immunosuppressive agents are outlined for each combination of disease and vaccine. PMID:23820860

  18. The Western Africa Ebola Virus Disease Epidemic Exhibits Both Global Exponential and Local Polynomial Growth Rates

    PubMed Central

    Chowell, Gerardo; Viboud, Cécile; Hyman, James M; Simonsen, Lone

    2015-01-01

    Background: While many infectious disease epidemics are initially characterized by an exponential growth in time, we show that district-level Ebola virus disease (EVD) outbreaks in West Africa follow slower polynomial-based growth kinetics over several generations of the disease. Methods: We analyzed epidemic growth patterns at three different spatial scales (regional, national, and subnational) of the Ebola virus disease epidemic in Guinea, Sierra Leone and Liberia by compiling publicly available weekly time series of reported EVD case numbers from the patient database available from the World Health Organization website for the period 05-Jan to 17-Dec 2014. Results: We found significant differences in the growth patterns of EVD cases at the scale of the country, district, and other subnational administrative divisions. The national cumulative curves of EVD cases in Guinea, Sierra Leone, and Liberia show periods of approximate exponential growth. In contrast, local epidemics are asynchronous and exhibit slow growth patterns during 3 or more EVD generations, which can be better approximated by a polynomial than an exponential function. Conclusions: The slower than expected growth pattern of local EVD outbreaks could result from a variety of factors, including behavior changes, success of control interventions, or intrinsic features of the disease such as a high level of clustering. Quantifying the contribution of each of these factors could help refine estimates of final epidemic size and the relative impact of different mitigation efforts in current and future EVD outbreaks. PMID:25685633

  19. Influence of genetic relatedness and spatial proximity on chronic wasting disease infection among female

    E-print Network

    Mladenoff, David

    Influence of genetic relatedness and spatial proximity on chronic wasting disease infection among. We evaluated the hypothesis of socially facilitated transmission of chronic wasting disease (CWD of the effects of this strategy on deer social behaviour and contact is needed. Key-words: chronic wasting

  20. MRI-based Three dimensional shape analysis of thigh muscles: people with Chronic Obstructive Pulmonary Disease versus healthy older adults.

    E-print Network

    Hamarneh, Ghassan

    MRI-based Three dimensional shape analysis of thigh muscles: people with Chronic Obstructive in Chronic Obstructive Pulmonary Disease (COPD). However, the distribution of the atrophy among individual and affected muscle regions in chronic diseases such as COPD. #12;

  1. Behavioral Medicine Approaches to Chronic Obstructive Pulmonary Disease

    PubMed Central

    Fritzsche, Anja; Trueba, Ana F.; Meuret, Alicia E.; Ritz, Thomas

    2013-01-01

    Background Chronic obstructive pulmonary disease (COPD) is a prevalent respiratory disease and associated with considerable individual and socioeconomic burden. Recent research started examining the role of psychosocial factors for course and management of the disease. Purpose This review provides an overview on recent findings on psychosocial factors and behavioral medicine approaches in COPD. Results Research has identified several important psychosocial factors and effective behavioral medicine interventions in COPD. However, there is considerable need for future research in this field. Conclusions Although beneficial effects of some behavioral medicine interventions have been demonstrated in COPD, future research efforts are necessary to study the effects of distinct components of these interventions, to thoroughly examine promising but yet not sufficiently proven interventions, and to develop new creative interventions. PMID:22351032

  2. Erectile dysfunction in chronic kidney disease: From pathophysiology to management

    PubMed Central

    Papadopoulou, Eirini; Varouktsi, Anna; Lazaridis, Antonios; Boutari, Chrysoula; Doumas, Michael

    2015-01-01

    Chronic kidney disease (CKD) is encountered in millions of people worldwide, with continuously rising incidence during the past decades, affecting their quality of life despite the increase of life expectancy in these patients. Disturbance of sexual function is common among men with CKD, as both conditions share common pathophysiological causes, such as vascular or hormonal abnormalities and are both affected by similar coexisting comorbid conditions such as cardiovascular disease, hypertension and diabetes mellitus. The estimated prevalence of erectile dysfunction reaches 70% in end stage renal disease patients. Nevertheless, sexual dysfunction remains under-recognized and under-treated in a high proportion of these patients, a fact which should raise awareness among clinicians. A multifactorial approach in management and treatment is undoubtedly required in order to improve patients’ quality of life and cardiovascular outcomes. PMID:26167462

  3. Chronic wasting disease of cervids: current knowledge and future perspectives.

    PubMed

    Haley, Nicholas J; Hoover, Edward A

    2015-01-01

    A naturally occurring transmissible spongiform encephalopathy (TSE) of mule deer was first reported in Colorado and Wyoming in 1967 and has since spread to other members of the cervid family in 22 states, 2 Canadian provinces, and the Republic of Korea. Chronic wasting disease (CWD), caused by exposure to an abnormally folded isoform of the cellular prion protein, is characterized by progressive neurological disease in susceptible natural and experimental hosts and is ultimately fatal. CWD is thought to be transmitted horizontally in excreta and through contaminated environments, features common to scrapie of sheep, though rare among TSEs. Evolving detection methods have revealed multiple strains of CWD and with continued development may lead to an effective antemortem test. Managing the spread of CWD, through the development of a vaccine or environmental cleanup strategies, is an active area of interest. As such, CWD represents a unique challenge in the study of prion diseases. PMID:25387112

  4. Experimental chronic wasting disease in wild type VM mice.

    PubMed

    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

    2013-01-01

    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

  5. Phenotype of asthma-chronic obstructive pulmonary disease overlap syndrome

    PubMed Central

    2015-01-01

    Many patients with asthma or chronic obstructive pulmonary disease (COPD) have overlapping characteristics of both diseases. By spirometric definition, patients with both fixed airflow obstruction (AO) and bronchodilator reversibility or fixed AO and bronchial hyperresponsiveness can be considered to have asthma-COPD overlap syndrome (ACOS). However, patients regarded to have ACOS by spirometric criteria alone are heterogeneous and can be classified by phenotype. Eosinophilic inflammation, a history of allergic disease, and smoke exposure are important components in the classification of ACOS. Each phenotype has a different underlying pathophysiology, set of characteristics, and prognosis. Medical treatment for ACOS should be tailored according to phenotype. A narrower definition of ACOS that includes both spirometric and clinical criteria is needed.

  6. Erectile dysfunction in chronic kidney disease: From pathophysiology to management.

    PubMed

    Papadopoulou, Eirini; Varouktsi, Anna; Lazaridis, Antonios; Boutari, Chrysoula; Doumas, Michael

    2015-07-01

    Chronic kidney disease (CKD) is encountered in millions of people worldwide, with continuously rising incidence during the past decades, affecting their quality of life despite the increase of life expectancy in these patients. Disturbance of sexual function is common among men with CKD, as both conditions share common pathophysiological causes, such as vascular or hormonal abnormalities and are both affected by similar coexisting comorbid conditions such as cardiovascular disease, hypertension and diabetes mellitus. The estimated prevalence of erectile dysfunction reaches 70% in end stage renal disease patients. Nevertheless, sexual dysfunction remains under-recognized and under-treated in a high proportion of these patients, a fact which should raise awareness among clinicians. A multifactorial approach in management and treatment is undoubtedly required in order to improve patients' quality of life and cardiovascular outcomes. PMID:26167462

  7. Biomarkers in chronic obstructive pulmonary disease: confusing or useful?

    PubMed Central

    Stockley, Robert A

    2014-01-01

    The field of biomarker research has almost reached unmanageable proportions in chronic obstructive pulmonary disease (COPD). The developments of new technology platforms have generated a huge information data base, both cross sectionally and increasingly, longitudinally. The knowledge emerging provides an enormous potential for understanding the disease pathophysiology, for developing markers specific for long-term outcomes, and for developing new therapeutic strategies. However, the excitement must be tempered with an understanding of the limitations of the data collection techniques, and of the variations in disease state, activity, impact, and progression. Nevertheless, the most crucial aspect in interpreting the current literature is the recognition of the relatively superficial characterization of what is a complex group of pathological processes with a common end point of airflow limitation. The current review explores some of these issues together with those areas where real progress appears to have been made, and provides caution on interpretation. PMID:24532968

  8. Engineering for reliability in at-home chronic disease management

    PubMed Central

    Kendall, Logan; Eschler, Jordan; Lozano, Paula; McClure, Jennifer B.; Vizer, Lisa M.; Ralston, James D.; Pratt, Wanda

    2014-01-01

    Individuals with chronic conditions face challenges with maintaining lifelong adherence to self-management activities. Although reminders can help support the cognitive demands of managing daily and future health tasks, we understand little of how they fit into people’s daily lives. Utilizing a maximum variation sampling method, we interviewed and compared the experiences of 20 older adults with diabetes and 19 mothers of children with asthma to understand reminder use for at-home chronic disease management. Based on our participants’ experiences, we contend that many self-management failures should be viewed as systems failures, rather than individual failures and non-compliance. Furthermore, we identify key principles from reliability engineering that both explain current behavior and suggest strategies to improve patient reminder systems. PMID:25954384

  9. Blood vitamin levels in dogs with chronic kidney disease.

    PubMed

    Galler, A; Tran, J L; Krammer-Lukas, S; Höller, U; Thalhammer, J G; Zentek, J; Willmann, M

    2012-05-01

    Chronic kidney disease (CKD) may affect excretion and metabolism of vitamins but data for dogs are limited. In this study, blood vitamin levels were investigated in 19 dogs with chronic renal failure. High performance liquid chromatography was used to quantify retinol, retinyl esters, tocopherol, thiamine, riboflavin, pyridoxal-5'-phosphate, ascorbic acid and 25-hydroxycholecalciferol concentrations, whereas cobalamin, folate, biotin and pantothenic acid were measured by microbiological methods. Levels of retinol, retinyl palmitate, ascorbic acid, and vitamins B1, B2 and B6 were increased compared to healthy dogs. Dogs with CKD showed decreased concentrations of 25-hydroxycholecalciferol and folate. Alpha-tocopherol, biotin, pantothenate and cobalamin levels were not significantly different between controls and dogs with CKD. Whether lower vitamin D and folate concentrations in dogs with CKD justify supplementation has to be evaluated in future studies. PMID:21767966

  10. Using intervention mapping (IM) to develop a self-management programme for employees with a chronic disease in the Netherlands

    Microsoft Academic Search

    Sarah I Detaille; Joost WJ van der Gulden; Josephine A Engels; Yvonne F Heerkens; Frank JH van Dijk

    2010-01-01

    BACKGROUND: Employees with a chronic disease often encounter problems at work because of their chronic disease. The current paper describes the development of a self-management programme based on the Chronic Disease Self-Management programme (CDSMP) of Stanford University to help employees with a chronic somatic disease cope with these problems at work. The objective of this article is to present the

  11. 65 FR 57816 - National Center for Chronic Disease Prevention and Health Promotion, Division of Reproductive...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2000-09-26

    ...OF HEALTH AND HUMAN SERVICES Centers for Disease Control and Prevention National Center for Chronic Disease Prevention and Health Promotion, Division...Services Development Branch, Centers for Disease Control and Prevention, (CDC)...

  12. Trisomy 12 chronic lymphocytic leukemia cells exhibit upregulation of integrin signaling that is modulated by NOTCH1 mutations

    PubMed Central

    Riches, John C.; O’Donovan, Conor J.; Kingdon, Sarah J.; McClanahan, Fabienne; Clear, Andrew J.; Neuberg, Donna S.; Werner, Lillian; Croce, Carlo M.; Ramsay, Alan G.; Rassenti, Laura Z.; Kipps, Thomas J.; Gribben, John G.

    2014-01-01

    The leukocyte adhesion cascade is important in chronic lymphocytic leukemia (CLL), as it controls migration of malignant cells into the pro-survival lymph node microenvironment. Circulating trisomy 12 CLL cells have increased expression of the integrins CD11a and CD49d, as well as CD38, but the tissue expression of these and other molecules, and the functional and clinical sequelae of these changes have not been described. Here, we demonstrate that circulating trisomy 12 CLL cells also have increased expression of the integrins CD11b, CD18, CD29, and ITGB7, and the adhesion molecule CD323. Notably, there was reduced expression of CD11a, CD11b, and CD18 in trisomy 12 cases with NOTCH1 mutations compared with wild type. Trisomy 12 cells also exhibit upregulation of intracellular integrin signaling molecules CALDAG-GEFI, RAP1B, and Ras-related protein ligand, resulting in enhanced very late antigen-4 [VLA-4] directed adhesion and motility. CD38 expression in CLL has prognostic significance, but the increased CD38 expression in trisomy 12 CLL cells must be taken into account in this subgroup, and the threshold of CD38 positivity should be raised to 40% for this marker to retain its prognostic value. In conclusion, trisomy 12 CLL cells exhibit functional upregulation of integrin signaling, with ?2-integrin expression being modulated by NOTCH1 mutation status. PMID:24829201

  13. Trisomy 12 chronic lymphocytic leukemia cells exhibit upregulation of integrin signaling that is modulated by NOTCH1 mutations.

    PubMed

    Riches, John C; O'Donovan, Conor J; Kingdon, Sarah J; McClanahan, Fabienne; Clear, Andrew J; Neuberg, Donna S; Werner, Lillian; Croce, Carlo M; Ramsay, Alan G; Rassenti, Laura Z; Kipps, Thomas J; Gribben, John G

    2014-06-26

    The leukocyte adhesion cascade is important in chronic lymphocytic leukemia (CLL), as it controls migration of malignant cells into the pro-survival lymph node microenvironment. Circulating trisomy 12 CLL cells have increased expression of the integrins CD11a and CD49d, as well as CD38, but the tissue expression of these and other molecules, and the functional and clinical sequelae of these changes have not been described. Here, we demonstrate that circulating trisomy 12 CLL cells also have increased expression of the integrins CD11b, CD18, CD29, and ITGB7, and the adhesion molecule CD323. Notably, there was reduced expression of CD11a, CD11b, and CD18 in trisomy 12 cases with NOTCH1 mutations compared with wild type. Trisomy 12 cells also exhibit upregulation of intracellular integrin signaling molecules CALDAG-GEFI, RAP1B, and Ras-related protein ligand, resulting in enhanced very late antigen-4 [VLA-4] directed adhesion and motility. CD38 expression in CLL has prognostic significance, but the increased CD38 expression in trisomy 12 CLL cells must be taken into account in this subgroup, and the threshold of CD38 positivity should be raised to 40% for this marker to retain its prognostic value. In conclusion, trisomy 12 CLL cells exhibit functional upregulation of integrin signaling, with ?2-integrin expression being modulated by NOTCH1 mutation status. PMID:24829201

  14. Arsenic and Chronic Kidney Disease: A Systematic Review.

    PubMed

    Zheng, Laura; Kuo, Chin-Chi; Fadrowski, Jeffrey; Agnew, Jackie; Weaver, Virginia M; Navas-Acien, Ana

    2014-09-01

    In epidemiologic studies, high arsenic exposure has been associated with adverse kidney disease outcomes. We performed a systematic review of the epidemiologic evidence of the association between arsenic and various kidney disease outcomes. The search period was January 1966 through January 2014. Twenty-five papers (comprising 24 studies) meeting the search criteria were identified and included in this review. In most studies, arsenic exposure was assessed by measurement of urine concentrations or with an ecological indicator. There was a generally positive association between arsenic and albuminuria and proteinuria outcomes. There was mixed evidence of an association between arsenic exposure and chronic kidney disease (CKD), ?-2 microglobulin (?2MG), and N-acetyl-?-D-glucosaminidase (NAG) outcomes. There was evidence of a positive association between arsenic exposure and kidney disease mortality. Assessment of a small number of studies with three or more categories showed a clear dose-response association between arsenic and prevalent albuminuria and proteinuria, but not with CKD outcomes. Eight studies lacked adjustment for possible confounders, and two had small study populations. The evaluation of the causality of the association between arsenic exposure and kidney disease outcomes is limited by the small number of studies, lack of study quality, and limited prospective evidence. Because of the high prevalence of arsenic exposure worldwide, there is a need for additional well-designed epidemiologic and mechanistic studies of arsenic and kidney disease outcomes. PMID:25221743

  15. Role of Nrf2 in chronic liver disease.

    PubMed

    Tang, Wei; Jiang, Yong-Fang; Ponnusamy, Murugavel; Diallo, Mamadou

    2014-09-28

    Nuclear erythroid 2-related factor 2 (Nrf2) is a central regulator of antioxidative response elements-mediated gene expression. It has a significant role in adaptive responses to oxidative stress by interacting with the antioxidant response element, which induces the expression of a variety of downstream targets aimed at cytoprotection. Previous studies suggested oxidative stress and associated damage could represent a common link between different forms of diseases. Oxidative stress has been implicated in various liver diseases, including viral hepatitis, nonalcoholic fatty liver disease/steatohepatitis, alcoholic liver disease and drug-induced liver injury. Nrf2 activation is initiated by oxidative or electrophilic stress, and aids in the detoxification and elimination of potentially harmful exogenous chemicals and their metabolites. The expression of Nrf2 has been observed throughout human tissue, with high expression in detoxification organs, especially the liver. Thus, Nrf2 may serve as a major regulator of several cellular defense associated pathways by which hepatic cells combat oxidative stress. We review the relevant literature concerning the crucial role of Nrf2 and its signaling pathways against oxidative stress to protect hepatic cell from oxidative damage during development of common chronic liver diseases. We also review the use of Nrf2 as a therapeutic target to prevent and treat liver diseases. PMID:25278702

  16. Primary prevention of chronic obstructive pulmonary disease in primary care.

    PubMed

    van der Molen, Thys; Schokker, Siebrig

    2009-12-01

    Chronic obstructive pulmonary disease (COPD) is a prevalent disease, with cigarette smoking being the main risk factor. Prevention is crucial in the fight against COPD. Whereas primary prevention is targeted on whole populations, patient populations are the focus of primary care; therefore, prevention in this setting is mainly aimed at preventing further deterioration of the disease in patients who present with the first signs of disease (secondary prevention). Prevention of COPD in primary care requires detection of COPD at an early stage. An accurate definition of COPD is crucial in this identification process. The benefits of detecting new patients with COPD should be determined before recommending screening and case-finding programs in primary care. No evidence is available that screening by spirometry results in significant health gains. Effective treatment options in patients with mild disease are lacking. Smoking cessation is the cornerstone of COPD prevention. Because cigarette smoking is not only a major cause of COPD but is also a major cause of many other diseases, a decline in tobacco smoking would result in substantial health benefits. PMID:20008880

  17. Pathogenesis of hyperinflation in chronic obstructive pulmonary disease

    PubMed Central

    Gagnon, Philippe; Guenette, Jordan A; Langer, Daniel; Laviolette, Louis; Mainguy, Vincent; Maltais, François; Ribeiro, Fernanda; Saey, Didier

    2014-01-01

    Chronic obstructive pulmonary disease (COPD) is a preventable and treatable lung disease characterized by airflow limitation that is not fully reversible. In a significant proportion of patients with COPD, reduced lung elastic recoil combined with expiratory flow limitation leads to lung hyperinflation during the course of the disease. Development of hyperinflation during the course of COPD is insidious. Dynamic hyperinflation is highly prevalent in the advanced stages of COPD, and new evidence suggests that it also occurs in many patients with mild disease, independently of the presence of resting hyperinflation. Hyperinflation is clinically relevant for patients with COPD mainly because it contributes to dyspnea, exercise intolerance, skeletal muscle limitations, morbidity, and reduced physical activity levels associated with the disease. Various pharmacological and nonpharmacological interventions have been shown to reduce hyperinflation and delay the onset of ventilatory limitation in patients with COPD. The aim of this review is to address the more recent literature regarding the pathogenesis, assessment, and management of both static and dynamic lung hyperinflation in patients with COPD. We also address the influence of biological sex and obesity and new developments in our understanding of hyperinflation in patients with mild COPD and its evolution during progression of the disease. PMID:24600216

  18. Comparative efficacy of indacaterol in chronic obstructive pulmonary disease.

    PubMed

    Ribeiro, Marcos; Chapman, Kenneth R

    2012-01-01

    Long-acting bronchodilators have been shown to improve multiple clinical outcomes in chronic obstructive pulmonary disease (COPD) including lung function, symptoms, dyspnea, quality of life, and exacerbations. Indacaterol is a novel, inhaled, long-acting ?2-agonist providing 24-hour bronchodilation with once-daily dosing. It is currently approved for the maintenance treatment of COPD to be administered as 150 or 300 ?g once-daily doses as licensed in many countries and 75 ?g as licensed in the US by means of a single-dose dry powder inhaler. The data from clinical development support a favorable safety and tolerability profile within the ?2-agonist drug class, with no relevant issues identified. Current evidence indicates that indacaterol is suitable for use as first-line monotherapy in COPD patients with moderate disease (Global Initiative for Chronic Obstructive Lung Disease [GOLD] stage II) and beyond that do not require an inhaled corticosteroid (ICS) as per GOLD guidelines, or in combination with an ICS in severe or very severe patients with repeated exacerbations. Data from trials with the novel once-daily ?2-agonist, indacaterol, indicate superior bronchodilation and clinical efficacy over twice-daily long-acting ?2-agonists and at least equipotent bronchodilation as once-daily tiotropium. Bronchodilators are central in the symptomatic management of COPD. It is likely that once-daily dosing of a bronchodilator would be a significant convenience and probably a compliance-enhancing advantage, leading to improved overall clinical outcomes in patients with COPD. PMID:22419862

  19. Diagnoses of chronic beryllium disease within cohorts of sarcoidosis patients.

    PubMed

    Müller-Quernheim, J; Gaede, K I; Fireman, E; Zissel, G

    2006-06-01

    An increase in chronic beryllium disease (CBD) has been suggested due to higher industrial use of beryllium alloys. Since occupational CBD is a perfect phenocopy of sarcoidosis, it might be misdiagnosed as sarcoidosis. In the current it was hypothesised that CBD exists in cohorts of sarcoidosis patients. In a prospective case study, sarcoidosis patients were evaluated for potential beryllium exposure. In those patients in whom beryllium exposure was confirmed and beryllium hypersensitivity demonstrated, the diagnosis of sarcoidosis was rejected and corrected to CBD. In 84 patients seen for re-evaluation or making a diagnosis of sarcoidosis, beryllium exposure was recognised and a diagnosis of CBD was made in 34 out of 84 patients. The time lag between clinical diagnosis of sarcoidosis and the final diagnosis of CBD ranged 0-18 yrs (median 3 yrs) and the mean (range) age at time of diagnosis of CBD was 43.9(25-80) yrs. Beryllium-contaminated workplaces causing disease encompassed a wide spectrum of industries and technical trades in which beryllium-exposure is generally not perceived as a health hazard. In conclusion, chronic beryllium disease still belongs to the spectrum of differential diagnoses of granulomatous disorders. PMID:16540500

  20. Biliary lipid secretion in chronic cholestatic liver disease.

    PubMed Central

    Kesäniemi, Y A; Salaspuro, M P; Vuoristo, M; Miettinen, T A

    1982-01-01

    Biliary lipid secretion rates, faecal steroids, and serum lipids were studied in patients with chronic cholestatic liver disease mainly primary biliary cirrhosis. The biliary secretion of cholesterol, bile acids, and phospholipids was markedly decreased as compared with those in the control group and in general correlated negatively with the serum cholesterol and triglyceride values. The molar percentage of cholesterol was increased in the hepatic bile. This suggests that, in cholestatic liver disease, in contrast with the normal state, the hapatic bile may be supersaturated postprandially. Faecal bile acids and neutral sterols of cholesterol origin were decreased proportionately to the corresponding biliary lipid secretion rates. In fact, both biliary and faecal steroid outputs were only about a half or less than those in the controls, indicating that the fractional absorption was not changed but absolute absorption and faecal steroid excretion were low in patients with chronic cholestatic liver disease. Thus, despite low cholesterol and bile acid absorption, cholesterol and bile acid synthesis is low. A negative correlation between faecal steroids and serum cholesterol suggests that the high serum cholesterol level contributed to regulation of cholesterol synthesis. PMID:7129204

  1. Chronic kidney disease alters vascular smooth muscle cell phenotype

    PubMed Central

    Monroy, M. Alexandra; Fang, Jianhua; Li, Shan; Ferrer, Lucas; Birkenbach, Mark P.; Lee, Iris J.; Wang, Hong; Yang, Xiao-Feng; Choi, Eric T.

    2015-01-01

    Vascular access dysfunction associated with arteriovenous grafts and fistulas contributes to the morbidity and mortality of chronic kidney disease (CKD) patients receiving hemodialysis. We hypothesized that the uremic conditions associated with CKD promote a pathophysiological vascular smooth muscle cell (VSMC) phenotype that contributes to neointimal hyperplasia. We analyzed the effect of culturing human VSMC with uremic serum. Expression of VSMC contractile marker genes was reduced 50-80% in cells exposed to uremic serum and the decreased expression was accompanied by changes in histone marks. There was an increase in proliferation in cells exposed to uremic conditions, with no change in the levels of apoptosis. Interestingly, we found that uremic serum inhibited PDGF-induced migration of VSMC. Histomorphometric analysis revealed venous neointimal hyperplasia in veins from chronic kidney disease (CKD) patients prior to any surgical manipulation as compared to veins from patients with no kidney disease. We conclude that uremia associated with CKD alters VSMC phenotype in vitro and contributes to neointimal hyperplasia formation in vivo contributing to the pathogenesis of vascular access dysfunction in CKD patients. PMID:25553479

  2. Targeting inflammation: new therapeutic approaches in chronic kidney disease (CKD).

    PubMed

    Impellizzeri, Daniela; Esposito, Emanuela; Attley, James; Cuzzocrea, Salvatore

    2014-03-01

    Chronic inflammation and oxidative stress, features that are closely associated with nuclear factor (NF-?B) activation, play a key role in the development and progression of chronic kidney disease (CKD). Several animal models and clinical trials have clearly demonstrated the effectiveness of angiotensin-converting enzyme inhibitor (ACEI) or angiotensin receptor blocker (ARB) therapy to improve glomerular/tubulointerstitial damage, reduce proteinuria, and decrease CKD progression, but CKD treatment still represents a clinical challenge. Bardoxolone methyl, a first-in-class oral Nrf-2 (nuclear factor erythroid 2-related factor 2) agonist that until recently showed considerable potential for the management of a range of chronic diseases, had been shown to improve kidney function in patients with advanced diabetic nephropathy (DN) with few adverse events in a phase 2 trial, but a large phase 3 study in patients with diabetes and CKD was halted due to emerging toxicity and death in a number of patients. Instead, palmitoylethanolamide (PEA) a member of the fatty acid ethanolamine family, is a novel non-steroidal, kidney friendly anti-inflammatory and anti-fibrotic agent with a well-documented safety profile, that may represent a potential candidate in treating CKD probably by a combination of pharmacological properties, including some activity at the peroxisome proliferator activated receptor alpha (PPAR-?). The aim of this review is to discuss new therapeutic approaches for the treatment of CKD, with particular reference to the outcome of two therapies, bardoxolone methyl and PEA, to improve our understanding of which pharmacological properties are responsible for the anti-inflammatory effects necessary for the effective treatment of renal disease. PMID:24602801

  3. Bisphenol A and Chronic Disease Risk Factors in US Children

    PubMed Central

    Eng, Donna S.; Gebremariam, Achamyeleh; Meeker, John D.; Peterson, Karen; Padmanabhan, Vasantha; Lee, Joyce M.

    2013-01-01

    OBJECTIVE: To evaluate the relationship between urinary bisphenol A (BPA) levels and measures of adiposity and chronic disease risk factors for a nationally representative US pediatric sample. METHODS: We used the NHANES 2003–2010 to evaluate cross-sectional associations between urinary BPA and multiple measures of adiposity, cholesterol, insulin, and glucose for children aged 6 to 18 years, adjusting for relevant covariates (eg, demographics, urine creatinine, tobacco exposure, and soda consumption). RESULTS: We found a higher odds of obesity (BMI ?95th percentile) with increasing quartiles of BPA for quartiles 2 vs 1 (odds ratio [OR] 1.74, 95% confidence interval [CI] 1.17–2.60, P = .008), 3 vs 1 (OR 1.64, 95% CI 1.09–2.47, P = .02), and 4 vs 1 (OR 2.01, 95% CI 1.36–2.98, P = .001). We also found a higher odds of having an abnormal waist circumference–to–height ratio (quartiles 2 vs 1 [OR 1.37, 95% CI 0.98–1.93, P = .07], 3 vs 1 [OR 1.41, 95% CI 1.07–1.87, P = .02], and 4 vs 1 [OR 1.55, 95% CI 1.12–2.15, P = .01]). We did not find significant associations of BPA with any other chronic disease risk factors. CONCLUSIONS: Higher levels of urinary BPA were associated with a higher odds of obesity (BMI >95%) and abnormal waist circumference–to–height ratio. Longitudinal analyses are needed to elucidate temporal relationships between BPA exposure and the development of obesity and chronic disease risk factors in children. PMID:23958765

  4. A study of neurological diseases in farmed deer in Switzerland, with emphasis on chronic wasting disease

    Microsoft Academic Search

    Veronika Sieber; Marie-Pierre Ryser-Degiorgis; Catherine Botteron

    2008-01-01

    A study of neurological diseases in farmed deer, with emphasis on chronic wasting disease, was conducted during 2 years in\\u000a Switzerland. Deer breeders were asked to submit the heads of all deer at least 2 years of age, found dead or slaughtered,\\u000a for examination. A complete histological examination of the brain and immunohistochemical detection of the prion protein on\\u000a selected regions of

  5. Bovine spongiform encephalopathy, chronic wasting disease, scrapie, and the threat to humans from prion disease epizootics

    Microsoft Academic Search

    Patrick J. Bosque

    2002-01-01

    Ongoing endemics and epidemics of prion disease afflict several species of ruminants regularly consumed by humans. Bovine\\u000a spongiform encephalopathy (BSE) is epidemic in British cattle, and is now found in the cattle of more than 20 countries. A\\u000a large, and apparently growing, epidemic of chronic wasting disease plagues deer and elk in North America. Finally, scrapie\\u000a has been endemic in

  6. Antecedents of chronic lung disease following three patterns of early respiratory disease in preterm infants

    Microsoft Academic Search

    Matthew Laughon; Carl Bose; Elizabeth N Allred; T Michael OShea; Richard A Ehrenkranz; Linda J Van Marter; Alan Leviton

    2011-01-01

    IntroductionThe incidence of chronic lung disease (CLD) varies among groups defined by their early pattern of respiratory disease.MethodsThe study examined data collected prospectively on 1204 of the 1506 infants born in 2002–2004 at 23–27 weeks gestation who survived to 36 weeks post-menstrual age. Based on their initial respiratory presentation and need for supplemental oxygen during the first 2 weeks, infants

  7. Chronic graft versus host disease and nephrotic syndrome.

    PubMed

    Barbouch, Samia; Gaied, Hanene; Abdelghani, Khaoula Ben; Goucha, Rim; Lakhal, Amel; Torjemen, Lamia; Hamida, Fethi Ben; Abderrahim, Ezzedine; Maiz, Hedi Ben; Adel, Khedher

    2014-09-01

    Disturbed kidney function is a common complication after bone marrow transplantation. Recently, attention has been given to immune-mediated glomerular damage related to graft versus host disease (GVHD). We describe a 19-year-old woman who developed membranous glomerulonephritis after bone marrow transplantation (BMT). Six months later, she developed soft palate, skin and liver lesions considered to be chronic GVHD. Fifteen months after undergoing BMT, this patient presented with nephrotic syndrome. A renal biopsy showed membranous glomerulonephritis associated with a focal segmental glomerulosclerosis. She was started on corticosteroid treatment with good outcome. PMID:25193909

  8. Systems medicine and integrated care to combat chronic noncommunicable diseases

    Microsoft Academic Search

    Jean Bousquet; Josep M Anto; Peter J Sterk; Ian M Adcock; Kian Fan Chung; Josep Roca; Alvar Agusti; Chris Brightling; Anne Cambon-Thomsen; Alfredo Cesario; Sonia Abdelhak; Stylianos E Antonarakis; Antoine Avignon; Andrea Ballabio; Eugenio Baraldi; Alexander Baranov; Thomas Bieber; Joël Bockaert; Samir Brahmachari; Christian Brambilla; Jacques Bringer; Michel Dauzat; Ingemar Ernberg; Leonardo Fabbri; Philippe Froguel; David Galas; Takashi Gojobori; Peter Hunter; Christian Jorgensen; Francine Kauffmann; Philippe Kourilsky; Marek L Kowalski; Doron Lancet; Claude Le Pen; Jacques Mallet; Bongani Mayosi; Jacques Mercier; Andres Metspalu; Joseph H Nadeau; Grégory Ninot; Denis Noble; Mehmet Öztürk; Susanna Palkonen; Christian Préfaut; Klaus Rabe; Eric Renard; Richard G Roberts; Boleslav Samolinski; Holger J Schünemann; Hans-Uwe Simon; Marcelo Bento Soares; Giulio Superti-Furga; Jesper Tegner; Sergio Verjovski-Almeida; Peter Wellstead; Olaf Wolkenhauer; Emiel Wouters; Rudi Balling; Anthony J Brookes; Dominique Charron; Christophe Pison; Zhu Chen; Leroy Hood; Charles Auffray

    2011-01-01

    We propose an innovative, integrated, cost-effective health system to combat major non-communicable diseases (NCDs), including\\u000a cardiovascular, chronic respiratory, metabolic, rheumatologic and neurologic disorders and cancers, which together are the\\u000a predominant health problem of the 21st century. This proposed holistic strategy involves comprehensive patient-centered integrated\\u000a care and multi-scale, multi-modal and multi-level systems approaches to tackle NCDs as a common group of

  9. Chronic kidney disease in the elderly: evaluation and management

    PubMed Central

    Mallappallil, Mary; Friedman, Eli A; Delano, Barbara G; McFarlane, Samy I; Salifu, Moro O

    2014-01-01

    Chronic kidney disease (CKD) is a very common clinical problem in elderly patients and is associated with increased morbidity and mortality. As life expectancy continues to improve worldwide, there is a rising prevalence of comorbidities and risk factors such as hypertension and diabetes predisposing to a high burden of CKD in this population. The body of knowledge on the approach to elderly patient with CKD is still evolving. Thus, this review seeks to explore the epidemiology and to discuss current understanding of challenges in the diagnosis and management of elderly patients CKD. PMID:25589951

  10. Epidemiology of chronic non-specific respiratory diseases*

    PubMed Central

    1975-01-01

    The current state of research into the epidemiology of chronic non-specific respiratory diseases (CNSRD) is reviewed. Recommendations are made on the definitions of CNSRD for use in epidemiological studies, and various aspects of the etiology and natural history of CNSRD are identified as requiring further investigation. The need for standardization of investigative methods is emphasized. Since smoking is such an important factor in the etiology of CNSRD, it is recommended that efforts be made to discourage children from taking up the habit. PMID:1084795

  11. The Emerging Chronic Obstructive Pulmonary Disease Epidemic: Clinical Impact, Economic Burden, and Opportunities for Disease Management

    Microsoft Academic Search

    Rick Carter; Brian L. Tiep; Rebecca E. Tiep

    2008-01-01

    The incidence and economic impact of chronic obstructive pulmonary disease (COPD) is escalating worldwide and is projected to remain on a positive trajectory for many years to come. At some point in this escalation, COPD may be regarded as a true epidemic. Unfortunately, the incidence among women is escalating more rapidly than in men, reflecting the social anthropology of changing

  12. Chronic wasting disease in bank voles: characterisation of the shortest incubation time model for prion diseases

    Technology Transfer Automated Retrieval System (TEKTRAN)

    In order to assess the susceptibility of bank voles to chronic wasting disease (CWD), we inoculated voles carrying isoleucine or methionine at codon 109 (Bv109I and Bv109M, respectively) with CWD isolates from elk, mule deer and white-tailed deer. Efficient transmission rate (100%) was observed with...

  13. Relationship between chronic kidney disease and metabolic syndrome: current perspectives

    PubMed Central

    Nashar, Khaled; Egan, Brent M

    2014-01-01

    Both metabolic syndrome (MetS) and chronic kidney disease (CKD) are increasing in incidence and lead to significant cardiovascular morbidity and mortality. The relationship between these two entities is complex. Individual components of the MetS are known risk factors for incident kidney disease, but it is not clear how the clustering of these components is linked to the development and progression of kidney disease. Cross-sectional studies show an association of the MetS and prevalent CKD; however, one cannot draw conclusions as to which came first – the MetS or the kidney disease. Observational studies suggest a relationship between MetS and incident CKD, but they also demonstrate the development of MetS in patients with established CKD. These observations suggest a bidirectional relationship. A better understanding of the relationship between components of the MetS and whether and how these components contribute to progression of CKD and incident cardiovascular disease could inform more effective prevention strategies. PMID:25258547

  14. Relationship between chronic kidney disease and metabolic syndrome: current perspectives.

    PubMed

    Nashar, Khaled; Egan, Brent M

    2014-01-01

    Both metabolic syndrome (MetS) and chronic kidney disease (CKD) are increasing in incidence and lead to significant cardiovascular morbidity and mortality. The relationship between these two entities is complex. Individual components of the MetS are known risk factors for incident kidney disease, but it is not clear how the clustering of these components is linked to the development and progression of kidney disease. Cross-sectional studies show an association of the MetS and prevalent CKD; however, one cannot draw conclusions as to which came first - the MetS or the kidney disease. Observational studies suggest a relationship between MetS and incident CKD, but they also demonstrate the development of MetS in patients with established CKD. These observations suggest a bidirectional relationship. A better understanding of the relationship between components of the MetS and whether and how these components contribute to progression of CKD and incident cardiovascular disease could inform more effective prevention strategies. PMID:25258547

  15. Disease severity, self-reported experience of workplace discrimination and employment loss during the course of chronic HIV disease: differences

    E-print Network

    Paris-Sud XI, Université de

    provided. Although this effect of chronic illness on employment has been reported to be higher among,18] This harmful effect of chronic illness on employment has been shown to be higher among the groups the course of chronic HIV disease: differences according to gender and education Rosemary Dray-Spira, MD, Ph

  16. Treatment of chronic kidney diseases with histone deacetylase inhibitors

    PubMed Central

    Liu, Na; Zhuang, Shougang

    2015-01-01

    Histone deacetylases (HDACs) induce deacetylation of both histone and non-histone proteins and play a critical role in the modulation of physiological and pathological gene expression. Pharmacological inhibition of HDAC has been reported to attenuate progression of renal fibrogenesis in obstructed kidney and reduce cyst formation in polycystic kidney disease. HDAC inhibitors (HDACis) are also able to ameliorate renal lesions in diabetes nephropathy, lupus nephritis, aristolochic acid nephropathy, and transplant nephropathy. The beneficial effects of HDACis are associated with their anti-fibrosis, anti-inflammation, and immunosuppressant effects. In this review, we summarize recent advances on the treatment of various chronic kidney diseases with HDACis in pre-clinical models. PMID:25972812

  17. Bioactive Nutritional Supplements for Chronic Kidney Disease: Potential Cost Benefits

    Microsoft Academic Search

    Glenda C. Gobe; Robert G. Fassett; Jeff S. Coombes

    \\u000a \\u000a \\u000a \\u000a \\u000a 1. \\u000a \\u000a \\u000a Chronic kidney disease (CKD) affects approximately 10–15% of the adult population in industrialized countries and the incidence\\u000a of CKD, and its associated end stage kidney disease, are increasing each year.\\u000a \\u000a \\u000a \\u000a \\u000a \\u000a 2. \\u000a \\u000a \\u000a Renal replacement therapies are already a significant cost to health systems internationally, and this is expected to increase.\\u000a \\u000a \\u000a \\u000a \\u000a 3. \\u000a \\u000a \\u000a There could be significant benefits through sensible use of

  18. Endoscopic sedation of patients with chronic liver disease.

    PubMed

    Bamji, Neville; Cohen, Lawrence B

    2010-05-01

    Endoscopic procedures are often necessary in patients with chronic liver disease. The preprocedure evaluation of such patients should include an assessment of hepatic synthetic function and identification of neuropsychiatric findings suggestive of hepatic encephalopathy. It may be possible, in some cases, to perform diagnostic esophagogastroduodenoscopy without administration of sedation; this is desirable to eliminate the risks of sedation, especially encephalopathy. Nonetheless, most patients undergoing upper and lower endoscopy require sedation. Currently, the use of propofol is preferred to benzodiazepines and opioids for endoscopic sedation of patients with advanced liver disease due to its short biologic half-life and low risk of provoking hepatic encephalopathy. In appropriately selected patients, gastroenterologist-directed propofol administration seems safe. PMID:20682228

  19. Chronic kidney disease: a clinical model of premature aging.

    PubMed

    Stenvinkel, Peter; Larsson, Tobias E

    2013-08-01

    Premature aging is a process associated with a progressive accumulation of deleterious changes over time, an impairment of physiologic functions, and an increase in the risk of disease and death. Regardless of genetic background, aging can be accelerated by the lifestyle choices and environmental conditions to which our genes are exposed. Chronic kidney disease is a common condition that promotes cellular senescence and premature aging through toxic alterations in the internal milieu. This occurs through several mechanisms, including DNA and mitochondria damage, increased reactive oxygen species generation, persistent inflammation, stem cell exhaustion, phosphate toxicity, decreased klotho expression, and telomere attrition. Because recent evidence suggests that both increased local signaling of growth factors (through the nutrient-sensing mammalian target of rapamycin) and decreased klotho expression are important modulators of aging, interventions that target these should be tested in this prematurely aged population. PMID:23357108

  20. Rhinosporidiosis: A Chronic Tropical Disease in Lateral Pharyngeal Wall.

    PubMed

    Prasad, Vishnu; Shenoy, Vijendra S; Rao, Raghavendra A; Kamath, Panduranga M; Rao, Kanishka S

    2015-05-01

    Rhinosporidiosis is a chronic granulomatous disease caused by Rhinosporidium seeberi. It predominantly affects the mucous membranes of the nose and the nasopharynx. Clinically the lesion presents as a pink or red pedunculated polyp in one or both nostrils. Diagnosis can be made by aspiration cytology and examination with May-Grunwald-Giemsa, hematoxylin and eosin, Periodic acid-Schiff and mucicarmine staining. Definitive diagnosis is by histopathology of the specimen. We report a case of Rhinosporidiosis at the lateral pharyngeal wall which is a very rare site for Rhinosporidiosis to occur; was treated by diathermy excision of the mass and cauterization of the base and oral Dapsone to prevent recurrence of the disease. PMID:26155503

  1. Aggressive blood pressure control for chronic kidney disease unmasks moyamoya!

    PubMed Central

    Davis, T. Keefe; Halabi, Carmen M.; Siefken, Philp; Karmarkar, Swati; Leonard, Jeffrey

    2013-01-01

    Hypertensive crises in children or adolescents are rare, but chronic kidney disease (CKD) is a major risk factor for occurrence. Vesicoureteral reflux nephropathy is a common cause of pediatric renal failure and is associated with hypertension. Aggressive blood pressure (BP) control has been shown to delay progression of CKD and treatment is targeted for the 50th percentile for height when compared with a target below the 90th percentile for the general pediatric hypertensive patient. We present a case of an adolescent presenting with seizures and renal failure due to a hypertensive crisis. Hypertension was thought to be secondary to CKD as she had scarred echogenic kidneys due to known reflux nephropathy. However, aggressive BP treatment improved kidney function which is inconsistent with CKD from reflux nephropathy. Secondly, aggressive BP control caused transient neurological symptoms. Further imaging identified moyamoya disease. We present this case to highlight the consideration of moyamoya as a diagnosis in the setting of renal failure and hypertensive crisis.

  2. An Integrated Healthcare System for Personalized Chronic Disease Care in Home–Hospital Environments

    Microsoft Academic Search

    Sangjin Jeong; Chan-Hyun Youn; Eun Bo Shim; Moonjung Kim; Young Min Cho; Limei Peng

    2012-01-01

    Facing the increasing demands and challenges in the area of chronic disease care, various studies on the healthcare system which can, whenever and wherever, extract and process patient data have been conducted. Chronic diseases are the long-term diseases and require the processes of the real-time monitoring, multidimensional quantitative analysis, and the classification of patients’ diagnostic information. A healthcare system for

  3. Outcome of anthroposophic medication therapy in chronic disease: A 12-month prospective cohort study

    Microsoft Academic Search

    Harald J Hamre; Claudia M Witt; Anja Glockmann; Renatus Ziegler; Gunver S Kienle; Stefan N Willich; Helmut Kiene

    2008-01-01

    Background: Anthroposophic medications (AMED) are prescribed in 56 countries. Objective: To study clinical outcomes in patients prescribed AMED for chronic disease. Design: Prospective cohort study. Setting: 110 medical practices in Germany. Participants: 665 consecutive outpatients aged 1-71 years, prescribed AMED for mental, respiratory, musculoskeletal, neurological, genitourinary, and other chronic diseases. Main outcomes: Disease and Symptom Scores (physicians' and patients' assessment,

  4. [Prevalence of chronic somatic diseases in workers engaged into luminescent lamps production].

    PubMed

    Leskina, L M; Golovkova, N P; Chebotarev, A G; Pasekov, A N

    2014-01-01

    The article presents results of epidemiologic study concerning occupational risk of chronic general somatic diseases in workers engaged into luminescent lamps production. Evidences are that hazardous work conditions affecting workers in main workshops of luminescent lamps production increase prevalence of chronic locomotory and connective tissue diseases, skin and cellular tissue disorders, respiratory diseases. PMID:25335422

  5. Asthma and chronic obstructive pulmonary disease (COPD) are both very common and their incidence

    E-print Network

    Cai, Long

    Asthma and chronic obstructive pulmonary disease (COPD) are both very common and their incidence in asthma but is progressive and largely irreversible in COPD. In both diseases, there is chronic increases. The similarity between these airway diseases prompted the suggestion in the 1960s that asthma

  6. Passage of chronic wasting disease prion into transgenic mice expressing Rocky Mountain elk

    E-print Network

    Accepted 1 August 2006 Chronic wasting disease (CWD) of elk (Cervus elaphus nelsoni) and mule deerPassage of chronic wasting disease prion into transgenic mice expressing Rocky Mountain elk (Cervus. Intracerebral injection of one mule deer and three elk CWD isolates into TgElk mice led to disease

  7. Chronic wasting disease in free-ranging Wisconsin white-tailed deer

    USGS Publications Warehouse

    Joly, D.O.; Ribic, C.A.; Langenberg, J.A.; Beheler, K.; Batha, C.A.; Dhuey, B.J.; Rolley, R.E.; Bartelt, G.; VanDeelen, T.R.; Samuel, M.D.

    2003-01-01

    Three White-tailed Deer shot within 5 km during the 2001 hunting season in Wisconsin tested positive for chronic wasting disease, a prion disease of cervids. Subsequent sampling within 18 km showed a 3% prevalence (n=476). This discovery represents an important range extension for chronic wasting disease into the eastern United States.

  8. Chronic kidney disease with three cases of oxalate-like nephrosis in Ragdoll cats

    Microsoft Academic Search

    Reidun Heiene; Gill Rumsby; Martine Ziener; Stein A. Dahl; Christopher Tims; Jon Teige; Nina Ottesen

    2009-01-01

    Two unrelated Ragdoll cat mothers in Norway were found dead from renal disease. The histopathology was consistent with oxalate nephrosis with chronic or acute-on-chronic underlying kidney disease. Both cats had offspring and relatives with signs of urinary tract disease, including a kitten dead with urethral gravel. Eleven living Ragdoll cats, including nine relatives of the dead cats and the male

  9. Ultrastructural Examination of a Case of Pagetoid Bowen Disease Exhibiting Immunohistochemical Features in Common With Extramammary Paget Disease.

    PubMed

    Baldovini, Chiara; Betts, Christine M; Reggiani, Camilla; Reggiani, Maurizio; Foschini, Maria P

    2015-07-01

    A panel of immunohistochemical markers may be used to differentiate between pagetoid Bowen disease (PBD) and primary extramammary Paget disease (EMPD) in selected cases. Although diffuse staining with cytokeratin 7 (CK7), CAM5.2, carcinoembryonic antigen, epithelial membrane antigen (EMA), and gross cystic disease fluid protein 15 generally supports diagnosis of EMPD, cases have been reported where PBD also expressed CK7, EMA, and CAM5.2. Based on these findings, some authors suggested that the 2 entities may arise from the same multipotent stem cell, capable of further differentiation toward squamous and secretory lines. To the best of our knowledge, this issue has never been investigated by comparing PBD and EMPD at the ultrastructural level. We performed the first ultrastructural study of a case of PBD exhibiting common immunohistochemical features with EMPD. The lesion displayed some ultrastructural features often observed in Bowen disease and some that are typically found in EMPD. These findings indicate the presence of a bidirectional differentiation-secretory and squamous-within the same lesion, thus supporting the hypothesis that PBD and primary EMPD may arise from a common progenitor cell. PMID:24786579

  10. Why are patients with chronic obstructive pulmonary disease at increased risk of cardiovascular diseases? The potential role of systemic inflammation in chronic obstructive pulmonary disease

    Microsoft Academic Search

    Don D. Sin; S. F. Paul Man

    2003-01-01

    Background—Chronic obstructive pulmonary disease (COPD) increases the risk of cardiovascular disease 2- to 3- fold. The factors responsible for this association remain largely unknown. Methods and Results—We analyzed data from participants, 50 years of age, of the Third National Health and Nutrition Examination Survey (n6629) to determine whether C-reactive protein (CRP) and other systemic inflammatory markers are present in participants

  11. Medicines for Early Stage Chronic Kidney Disease: A Review of the Research for Adults with Kidney Disease and Diabetes ....

    MedlinePLUS

    ... Blood Pressure" /> Consumer Summary – Oct. 11, 2012 Medicines for Early Stage Chronic Kidney Disease: A Review ... and blood vessel diseases. About Your Options What medicines may help? There are four types of medicine ...

  12. Gastrointestinal manifestations of patients with chronic granulomatous disease.

    PubMed

    Movahedi, Masoud; Aghamohammadi, Asghar; Rezaei, Nima; Farhoudi, Abolhasan; Pourpak, Zahra; Moin, Mostafa; Gharagozlou, Mohammad; Mansouri, Davoud; Arshi, Saba; Atarod, Lida; Mirsaeid Ghazi, Bahram; Shahnavaz, Nikrad; Babaei Jandaghi, Ali; Abolmaali, Kamran; Mahmoudi, Maryam; Bazargan, Nasrin; Ahmadi Afshar, Akefeh; Nabavi, Mohammad

    2004-06-01

    Chronic Granulomatous Disease (CGD) represents a group of inherited disorders of phagocytic system, manifesting recurrent infections at different sites. The present study was accomplished in order to determine the gastrointestinal manifestations of CGD patients. Fifty-seven patients (38 males and 19 females) with CGD, who had been referred to three immunodeficiency referral centers in Iran, were studied during a 24-year period (1980-2004). The median age at the time of study was 14.5 years old (1-56 years). The median onset age of symptoms was 5 months (1 month- 13.75 years), and that of diagnostic age was 5 years (2 months- 54.1 years), with a diagnostic delay of 33 months, on average. Seven patients were presented with acute diarrhea, 3 with oral candidiasis, and 2 with liver abscesses as the first chief complaints. Twenty-four cases (42.1%) had been complicated by gastrointestinal manifestations during their course of the disease. Of those, 12 cases (21.1%) had diarrhea, 7 (12.3%) oral candidiasis, 5 (8.8%) hepatitis, 4 (7.0%) hepatic abscess, and 2 cases (3.5%) gastric outlet obstruction. Also, failure to thrive was detected in 6 patients (10.5%). Four patients died (7%). CGD should be excluded in any patient with gastrointestinal manifestations especially chronic diarrhea, hepatic abscess, and gastric outlet obstruction. PMID:17301397

  13. Correlation between optic nerve involvement and chronic obstructive pulmonary disease

    PubMed Central

    Mikaeili, Haleh; Yazdchi, Mohammad; Solahaye Kahnamouii, Shiva; Sadeghi-Hokmabadi, Elyar; Mirnour, Reshad

    2015-01-01

    Background Chronic obstructive pulmonary disease (COPD) is a major public health problem worldwide. The aim of this study was to evaluate the rate of optic neuropathy in COPD patients. Methods Forty patients diagnosed with COPD and 60 healthy subjects as control group enrolled. After examination by a pulmonary subspecialist, patients were ranked by Global initiative for chronic Obstructive Lung Disease (GOLD) criteria, and patients with zero grades on GOLD criteria were excluded. Visual evoked potential by checkerboard (raster background) method with a frequency of 2 Hz were done for all participants. P-values less than 0.05 were considered as significant. Results Fifty-five percent of COPD patients had visual evoked potential abnormalities. Mean P100 latency in both eyes was significantly longer in COPD patients. Average P100/N140 amplitude in both eyes were insignificantly higher in COPD. Conclusion Higher P100 latency in COPD patients shows demyelinating type of optic nerve involvement; however, further investigation in this area is needed. PMID:25709388

  14. Oxygen therapy in acute exacerbations of chronic obstructive pulmonary disease.

    PubMed

    Pilcher, Janine; Weatherall, Mark; Perrin, Kyle; Beasley, Richard

    2015-06-01

    During the last decade, there have been major advances in knowledge of the effects of oxygen therapy in patients with acute exacerbations of chronic obstructive pulmonary disease. This includes a randomised controlled trial of oxygen therapy in the pre-hospital setting, which showed that high concentration oxygen therapy leads to a 2.4-fold increased risk of mortality compared with titrated oxygen therapy to maintain oxygen saturations (SpO2) within a target range of 88-92%. Professional guidelines now recommend the use of supplementary oxygen in acute exacerbations of chronic obstructive pulmonary disease only if the SpO2 is less than 88%, with titration to achieve an SpO2 of 88-92%, and the delivery of bronchodilators by air-driven nebulisation or metered dose inhaler with a spacer. The aim of this review is to provide an overview of the evidence base that underpins these recommendations. We suggest that their implementation will require important changes to current clinical practice in which there is an entrenched culture of the use of high concentration oxygen therapy. PMID:25979080

  15. Role of Oxidative RNA Damage in Chronic-Degenerative Diseases

    PubMed Central

    2015-01-01

    Normal cellular metabolism and exposure to ionizing and ultraviolet radiations and exogenous agents produce reactive oxygen species (ROS). Due to their reactivity, they can interact with many critical biomolecules and induce cell damage. The reaction of ROS with free nucleobases, nucleosides, nucleotides, or oligonucleotides can generate numerous distinct modifications in nucleic acids. Oxidative damage to DNA has been widely investigated and is strongly implicated in the development of many chronic-degenerative diseases. In contrast, RNA damage is a poorly examined field in biomedical research. In this review, I discuss the importance of RNA as a target of oxidative damage and the role of oxidative damage to RNA in the pathogenesis of some chronic-degenerative diseases, such as neurological disorders, atherosclerosis, and cancer. Furthermore, I review recent evidence suggesting that RNA may be the target for toxic agents and indicating RNA degradation as a powerful tool to treat any pathology in which there is an aberrant expression of mRNA and/or its gene products.

  16. Cardiovascular Autonomic Dysfunction in Chronic Kidney Disease: a Comprehensive Review.

    PubMed

    Salman, Ibrahim M

    2015-08-01

    Cardiovascular autonomic dysfunction is a major complication of chronic kidney disease (CKD), likely contributing to the high incidence of cardiovascular mortality in this patient population. In addition to adrenergic overdrive in affected individuals, clinical and experimental evidence now strongly indicates the presence of impaired reflex control of both sympathetic and parasympathetic outflow to the heart and vasculature. Although the principal underlying mechanisms are not completely understood, potential involvements of altered baroreceptor, cardiopulmonary, and chemoreceptor reflex function, along with factors including but not limited to increased renin-angiotensin-aldosterone system activity, activation of the renal afferents and cardiovascular structural remodeling have been suggested. This review therefore analyzes potential mechanisms underpinning autonomic imbalance in CKD, covers results accumulated thus far on cardiovascular autonomic function studies in clinical and experimental renal failure, discusses the role of current interventional and therapeutic strategies in ameliorating autonomic deficits associated with chronic renal dysfunction, and identifies gaps in our knowledge of neural mechanisms driving cardiovascular disease in CKD. PMID:26071764

  17. [Concept analysis of medication adherence in patients with chronic disease].

    PubMed

    Huang, Jen-Ying; Chen, Hsing-Mei

    2014-06-01

    Pharmacotherapy plays an important role in the management of chronic diseases. However, many patients with chronic disease do not adhere to their medication regimen. This results in worsening symptoms and frequent re-hospitalizations. As a result, healthcare providers may view these patients as bad. Medication adherence is a complex concept. Analyzing this concept may assist nurses to improve patient-centered care. This paper uses Walker & Avant's method to conduct a concept analysis of medication adherence. Results show the defining attributes of medication adherence as: (1) knowing and agreeing to the medication; (2) communicating and negotiating the regimen; and (3) active, continuous involvement in and appraisal of the treatment effect. Identified antecedents of medication adherence included the patient having: (1) a prescribed medication regimen; (2) cognitive and action abilities in her / his role as a patient; and (3) level of preparation for medication treatment. Identified consequences of medication adherence include: (1) improving symptom control; (2) decreasing re-hospitalizations and mortality; (3) reducing medical care costs; (4) restoring self-esteem; and (5) diminishing depression. It is hoped that this concept analysis provides a reference for nurses to achieve a better understanding of medication adherence and further improve nursing practice. PMID:24899565

  18. [Special surgical complications in chronic inflammatory bowel diseases].

    PubMed

    Kroesen, A J

    2015-04-01

    After colorectal and anorectal interventions for chronic inflammatory bowel diseases, specific complications can occur.In Crohn's disease these complications mainly occur after proctocolectomy. Pelvic sepsis can be prevented by omentoplasty with fixation inside the pelvis. A persisting sepsis of the sacral cavity can be treated primarily by dissection of the anal sphincter which ensures better drainage. In cases of chronic sacral sepsis, transposition of the gracilis muscle is a further effective option. Early recurrence of a transsphincteric anal fistula should be treated by reinsertion of a silicon seton drainage.Complications after restorative proctocolectomy are frequent and manifold (35%). The main acute complications are anastomotic leakage and pelvic sepsis. Therapy consists of transperineal drainage of the abscess with simultaneous transanal drainage. Late complications due to technical and septic reasons are still a relevant problem even 36 years after introduction of this operative technique. A consistent approach with detailed diagnostic and surgical therapy results in a 75% rescue rate of ileoanal pouches. PMID:25693779

  19. Signal Transduction Pathways in Chronic Inflammatory Autoimmune Disease: Small GTPases

    PubMed Central

    Reedquist, Kris A; Tak, Paul P

    2012-01-01

    Ras superfamily small GTPases represent a wide and diverse class of intracellular signaling proteins that are highly conserved during evolution. These enzymes serve as key checkpoints in coupling antigen receptor, growth factor, cytokine and chemokine stimulation to cellular responses. Once activated, via their ability to regulate multiple downstream signaling pathways, small GTPases amplify and diversify signaling cascades which regulate cellular proliferation, survival, cytokine expression, trafficking and retention. Small GTPases, particularly members of the Ras, Rap, and Rho family, critically coordinate the function and interplay of immune and stromal cells during inflammatory respones, and increasing evidence indicates that alterations in small GTPase signaling contribute to the pathological behavior of these cell populations in human chronic inflammatory diseases such as rheumatoid arthritis (RA) and systemic lupus erythematosus (SLE). Here, we review how Ras, Rap, and Rho family GTPases contribute to the biology of cell populations relevant to human chronic inflammatory disease, highlight recent advances in understanding how alterations in these pathways contribute to pathology in RA and SLE, and discuss new therapeutic strategies that may allow specific targeting of small GTPases in the clinic. PMID:23028410

  20. Pneumococci Can Persistently Colonize Adult Patients with Chronic Respiratory Disease

    PubMed Central

    Domenech, A.; Balsalobre, L.; Marti, S.; Calatayud, L.; De la Campa, A. G.; Brueggemann, A. B.; Liñares, J.

    2012-01-01

    Streptococcus pneumoniae plays an important role in causing acute exacerbations in patients with chronic respiratory disease. However, few data are available regarding pneumococcal persistence in adult patients with chronic respiratory diseases. Fifty pneumococci recovered from sputum samples (1995 to 2010) from 13 adult patients with ?3 episodes of acute exacerbation or pneumonia, with the same serotype and pulsed-field gel electrophoresis (PFGE) pattern, were studied. Multilocus sequence typing (MLST) loci, penicillin-binding protein (PBP) genes (pbp2x, pbp1a, pbp2b), and the quinolone-resistant determining regions (QRDRs) of parC, parE, and gyrA were PCR amplified and sequenced. The average time between the first and last episode was 582 days (standard deviation [SD], ±362). All but two patients received multiple courses of ?-lactam treatment, and all persistent strains were resistant to penicillin; however, the PBP sequences were stable over time apart from one variable nucleotide in pbp2x, observed among pneumococci isolated from three patients. In contrast, 7/11 patients treated with fluoroquinolones had fluoroquinolone-resistant pneumococci. In three patients, the initially fluoroquinolone-susceptible strain developed resistance after fluoroquinolone therapy, and in the remaining four patients, the persistent strain was fluoroquinolone resistant from the first episode. QRDR changes involved in fluoroquinolone resistance were frequently observed in persistent strains after fluoroquinolone treatment; however, the PBP sequences and MLST genotypes of these strains were stable over time. PMID:23052300

  1. Towards a vaccine for chronic obstructive pulmonary disease.

    PubMed

    Clancy, R L

    2012-06-01

    This review discusses chronic obstructive pulmonary disease as an outcome of two pathogenic pathways: the first resulting from inhalation of toxins and the second a consequence of bacterial colonisation of damaged airways. Earlier assessment of the role played by bacteria in acute exacerbations was compromised by a deficiency of quality data and the use of parameters more relevant to invasive infection. Data are reviewed to support a hypothesis that states intrabronchial inflammation reflects an excessive and inappropriate host response (largely mediated by Th17 cells derived from gut-associated lymphoid tissues) to colonising bacteria acting as an 'antigen sump' (in essence, a hypersensitivity reaction). It is proposed that both viral and bacterial infections exacerbate inflammation through a common pathway that involves colonising bacteria. An oral vaccine containing inactivated non-typeable Haemophilus influenzae augments a protective loop that involves the aspiration of bronchus content into the gut and reduces the severity of acute exacerbations including the need for hospital admission by reducing the 'load' of bacteria comprising this final common path. The positive clinical results from trials using oral NTHi support both the concept that bacterial colonisation of damaged airways is a potent second pathogenic pathway and that oral immunotherapy provides a significant therapeutic advance in limiting damage in chronic obstructive pulmonary disease. PMID:22372964

  2. Chronic Obstructive Pulmonary Disease in Never-Smoking Dairy Farmers

    PubMed Central

    Stoleski, Saso; Minov, Jordan; Karadzinska-Bislimovska, Jovanka; Mijakoski, Dragan

    2015-01-01

    Introduction : Work-related chronic obstructive pulmonary disease (COPD) represents a considerable part of the disease burden globally. Objective : To assess the COPD prevalence and characteristics in never-smoking dairy farmers. Materials and Methodology : We have conducted a cross-sectional study with 75 male dairy farmers aged 26 to 59 years, and compared them with equivalent number of male office workers similar by age, and duration of employment. Data on chronic respiratory symptoms, job history and daily activities were obtained by questionnaire. Lung functional testing of the examined subjects included baseline spirometry, and bronchodilator reversibility measurement. Results : Dairy farmers showed higher prevalence of overall respiratory symptoms, but significant difference was noticed for cough, phlegm, and dyspnea. Dairy farmers had more prevalent work-related respiratory symptoms, being significant for overall symptoms, cough, and phlegm. The mean baseline values of spirometric parameters were lower in dairy farmers, but significance was reported for FEV1/FVC%, MEF50, MEF75, and MEF25-75. Dairy farmers had significantly higher COPD prevalence than office controls (10.7% vs 2.7%, P = 0,049). Dairy farmers and office controls showed significant association between COPD and age over 45 years. Dairy farmers had a significant association between COPD and employment duration of over 20 years (P = 0.023), but also between COPD and work-related chronic respiratory symptoms (P = 0.041). Conclusion : The study findings favor the cause-effect association between job exposure to respiratory hazards, and development of persistent airway obstruction among dairy farmers. PMID:25893027

  3. [Frequency and structure of chronic diseases of ear, throat and nose among population and their dynamics].

    PubMed

    Tarasov, D I; Morozov, A B

    1991-01-01

    Medical examinations of children and adults have shown that ENT diseases amount to 230 and 190 per 1000, respectively. In terms of types of ENT diseases, chronic tonsilitis (38.4%) and adenoids (23.3%) are most prevalent among children and neurosensory hypoacusis (31.1%) and chronic pharyngitis (19.3%)--among the adult population. Trends in the prevalence and types of chronic ENT diseases have been identified. PMID:1828641

  4. Metabolic Syndrome, Chronic Kidney Disease, and Cardiovascular Disease: A Dynamic and Life-Threatening Triad

    PubMed Central

    Raimundo, Mário; Lopes, José António

    2011-01-01

    The metabolic syndrome (MS) and chronic kidney disease (CKD) have both become global public health problems, with increasing social and economic impact due to their high prevalence and remarkable impact on morbidity and mortality. The causality between MS and CKD, and its clinical implications, still does remain not completely understood. Moreover, prophylactic and therapeutic interventions do need to be properly investigated in this field. Herein, we critically review the existing clinical evidence that associates MS with renal disease and cardiovascular disease, as well as the associated pathophysiologic mechanisms and actual treatment options. PMID:21403897

  5. Australian health policy and end of life care for people with chronic disease: an analysis.

    PubMed

    Burgess, Teresa; Braunack-Mayer, Annette; Crawford, Gregory B; Beilby, Justin

    2014-03-01

    End of life care for people with advanced chronic disease is a growing international imperative, with the majority of deaths in the world now related to chronic disease. The provision of care that meets the needs of people with advanced chronic disease must be guided by appropriate policy. The key policy areas impacting directly on end of life care are related to chronic disease, palliative care and, increasingly, aged care. This paper describes the outcomes of an audit of Australian chronic disease and end of life/palliative care policies. We identified that chronic disease health policies/strategies demonstrate a focus on prevention, early intervention and management, with scant recognition of end of life care needs. The majority assume that a referral to palliative care will address end of life care needs for people with chronic disease. By contrast, palliative care policies recognise the need for the incorporation of a palliative approach into advanced chronic disease care, but there are few connections between these two policy areas. Whilst palliative care policies intersect with carer and advance care planning policies, chronic disease policy does not. Key concerns requiring consideration when developing policy in this area are discussed and possible policy options identified. PMID:23992757

  6. Health care 2020: reengineering health care delivery to combat chronic disease.

    PubMed

    Milani, Richard V; Lavie, Carl J

    2015-04-01

    Chronic disease has become the great epidemic of our times, responsible for 75% of total health care costs and the majority of deaths in the US. Our current delivery model is poorly constructed to manage chronic disease, as evidenced by low adherence to quality indicators and poor control of treatable conditions. New technologies have emerged that can engage patients and offer additional modalities in the treatment of chronic disease. Modifying our delivery model to include team-based care in concert with patient-centered technologies offers great promise in managing the chronic disease epidemic. PMID:25460529

  7. Chronic Diseases, Lack of Medications, and Depression Among Syrian Refugees in Jordan, 2013–2014

    PubMed Central

    Al-Smadi, Ahmed Mohammad; Tawalbeh, Loai Issa; Khoury, Laurice Sami

    2015-01-01

    Introduction Studying mental and physical health problems in refugees facilitates providing suitable health care, thus improving their quality of life. We studied depression tendency in Syrian refugees in Jordan in the light of chronic diseases and medication availability. Also, depression prevalence and depression comorbidity with chronic diseases were identified. Methods In this multicenter cross-sectional survey, data from Syrian refugees attending Caritas centers in 6 Jordanian cities from November 2013 through June 2014 were analyzed. Participants’ demographics, depression, previously diagnosed chronic diseases, and newly diagnosed chronic diseases and the availability of medications were studied. Logistic regression was used to examine predictors for depression. Results Of 765 refugees who participated, about one-third demonstrated significant depression as measured by the Beck Depression Inventory. Descriptive analyses showed that depression was comorbid in 35% of participants with previously diagnosed chronic diseases and in 40% of participants with newly diagnosed chronic diseases. Newly diagnosed chronic diseases and lack of medications significantly contributed to depression, but the regression model as a whole explained less than 5% of the variance. Conclusion Because the regression model showed low effect size, we concluded that newly diagnosed chronic diseases and medication shortages could not predict depression in Syrian refugees residing in Jordan. Therefore, further studies of additional factors are recommended. Prompt measures have to be taken to prevent the spread of chronic diseases and improve mental health in this fragile population. PMID:25633485

  8. Relationship between Helicobacter pylori infection and chronic obstructive pulmonary disease.

    PubMed

    Hashemi, Seyyed Hamid; Nadi, Ebrahim; Hajilooi, Mehrdad; Seif-Rabiei, Mohammad-Ali; Roustaei, Uldoz

    2011-01-01

    There is some evidence indicating the role of Helicobacter pylori infection in pathogenesis of extragastrointestinal diseases including skin, vascular, and autoimmune disorders, as well as some respiratory diseases. The aim of this study was to investigate the association between H. pylori and chronic obstructive pulmonary disease (COPD). In a case-control study, 90 patients with COPD and 90 age- and sex- matched control subjects were included. Serum samples were tested for anti-H. pylori and anti-CagA IgG by ELISA. A physician completed a questionnaire including demographic characteristics, habitual history, and spirometric findings for each patient. Of 90 patients with COPD 66 (51%) had mild, 31 (34.4%) moderate, and 13 (14.4%) sever disease. There was no significant association between H. pylori IgG seropositivity and COPD. Serum levels of anti-CagA IgG were significantly higher in patients with COPD than in the control subjects (P < 0.001). No association was observed between H. pylori infection and severity of COPD. The results suggest that there is an association between CagA-positive H. pylori infections and COPD. Further studies should be planned to investigate the potential pathogenic mechanisms that might underlie these associations. PMID:22131241

  9. Chronic wasting disease: fingerprinting the culprit in risk assessments.

    PubMed

    Daus, Martin L; Beekes, Michael

    2012-01-01

    Transmissible spongiform encephalopathies (prion diseases) in animals may be associated with a zoonotic risk potential for humans as shown by the occurrence of variant Creutzfeldt-Jakob disease in the wake of the bovine spongiform encephalopathy epidemic. Thus, the increasing exposure of humans in North America to cervid prions of chronic wasting disease (CWD) in elk and deer has prompted comprehensive risk assessments. The susceptibility of humans to CWD infections is currently under investigation in different studies using macaques as primate models. The necessity for such studies was recently reinforced when disease-associated prion protein and its seeding activity were detected in muscles of clinically inconspicuous CWD-infected white-tailed deer. Increasing evidence points to the existence of different CWD strains, and CWD prions may also change or newly emerge over time. Therefore, CWD isolates examined in macaques should be characterized as precisely as possible for their molecular identity. On this basis other CWD field samples collected in the past, present or future could be systematically compared with macaque-tested inocula in order to assess whether they are covered by the ongoing risk assessments in primates. CWD typing by Fourier transform-infrared spectroscopy of pathological prion protein may provide a method of choice for this purpose. PMID:22453172

  10. Acute exacerbations and respiratory failure in chronic obstructive pulmonary disease.

    PubMed

    MacIntyre, Neil; Huang, Yuh Chin

    2008-05-01

    Acute exacerbations of chronic obstructive pulmonary disease (AECOPD) describe the phenomenon of sudden worsening in airway function and respiratory symptoms in patients with COPD. These exacerbations can range from self-limited diseases to episodes of florid respiratory failure requiring mechanical ventilation. The average patient with COPD experiences two such episodes annually, and they account for significant consumption of health care resources. Although bacterial infections are the most common causes of AECOPD, viral infections and environmental stresses are also implicated. AECOPD episodes can be triggered or complicated by other comorbidities, such as heart disease, other lung diseases (e.g., pulmonary emboli, aspiration, pneumothorax), or systemic processes. Pharmacologic management includes bronchodilators, corticosteroids, and antibiotics in most patients. Oxygen, physical therapy, mucolytics, and airway clearance devices may be useful in selected patients. In hypercapneic respiratory failure, noninvasive positive pressure ventilation may allow time for other therapies to work and thus avoid endotracheal intubation. If the patient requires invasive mechanical ventilation, the focus should be on avoiding ventilator-induced lung injury and minimizing intrinsic positive end-expiratory pressure. These may require limiting ventilation and "permissive hypercapnia." Although mild episodes of AECOPD are generally reversible, more severe forms of respiratory failure are associated with a substantial mortality and a prolonged period of disability in survivors. PMID:18453367

  11. Management of chronic kidney disease and dialysis in homeless persons

    PubMed Central

    Podymow, Tiina; Turnbull, Jeff

    2013-01-01

    End-stage renal disease and dialysis are complicated illnesses to manage in homeless persons, who often suffer medical comorbidities, psychiatric disease, cognitive impairment and addictions; descriptions of this population and management strategies are lacking. A retrospective review of dialysis patients who were homeless or unstably housed was undertaken at an urban academic Canadian center from 2001 to 2011. Electronic hospital records were analyzed for demographic, housing, medical, and psychiatric history, dialysis history, adherence to treatment, and outcomes. Two detailed cases of homeless patients with chronic kidney disease are presented. Eleven homeless dialysis patients with a mean age of 52.7±12.3 years, mostly men and mostly from minority groups were dialyzed for 41.1±29.2 months. Most resided permanently in shelters, eventually obtained fistula access, and were adherent to dialysis schedules. Patients were often nonadherent to pre-dialysis management, resulting in emergency starts. Many barriers to care for homeless persons with end-stage kidney disease and on dialysis are identified, and management strategies are highlighted. Adherence is optimized with shelter-based health care and intensive team-oriented case management. PMID:25018988

  12. Population Causes and Consequences of Leading Chronic Diseases: A Comparative Analysis of Prevailing Explanations

    PubMed Central

    Stuckler, David

    2008-01-01

    Context The mortality numbers and rates of chronic disease are rising faster in developing than in developed countries. This article compares prevailing explanations of population chronic disease trends with theoretical and empirical models of population chronic disease epidemiology and assesses some economic consequences of the growth of chronic diseases in developing countries based on the experiences of developed countries. Methods Four decades of male mortality rates of cardiovascular and chronic noncommunicable diseases were regressed on changes in and levels of country income per capita, market integration, foreign direct investment, urbanization rates, and population aging in fifty-six countries for which comparative data were available. Neoclassical economic growth models were used to estimate the effect of the mortality rates of chronic noncommunicable diseases on economic growth in high-income OECD countries. Findings Processes of economic growth, market integration, foreign direct investment, and urbanization were significant determinants of long-term changes in mortality rates of heart disease and chronic noncommunicable disease, and the observed relationships with these social and economic factors were roughly three times stronger than the relationships with the population's aging. In low-income countries, higher levels of country income per capita, population urbanization, foreign direct investment, and market integration were associated with greater mortality rates of heart disease and chronic noncommunicable disease, less increased or sometimes reduced rates in middle-income countries, and decreased rates in high-income countries. Each 10 percent increase in the working-age mortality rates of chronic noncommunicable disease decreased economic growth rates by close to a half percent. Conclusions Macrosocial and macroeconomic forces are major determinants of population rises in chronic disease mortality, and some prevailing demographic explanations, such as population aging, are incomplete on methodological, empirical, and policy grounds. Rising chronic disease mortality rates will significantly reduce economic growth in developing countries and further widen the health and economic gap between the developed and developing world. PMID:18522614

  13. Cardiovascular disease relates to intestinal uptake of p-cresol in patients with chronic kidney disease

    PubMed Central

    2014-01-01

    Background Serum p-cresyl sulfate (PCS) associates with cardiovascular disease in patients with chronic kidney disease. PCS concentrations are determined by intestinal uptake of p-cresol, human metabolism to PCS and renal clearance. Whether intestinal uptake of p-cresol itself is directly associated with cardiovascular disease in patients with renal dysfunction has not been studied to date. Methods We performed a prospective study in patients with chronic kidney disease stage 1 – 5 (NCT00441623). Intestinal uptake of p-cresol, under steady state conditions, was estimated from 24 h urinary excretion of PCS. Primary endpoint was time to first cardiovascular event, i.e., cardiac death, myocardial infarction/ischemia, ventricular arrhythmia, cardiovascular surgery, ischemic stroke or symptomatic peripheral arterial disease. Statistical analysis was done using Kaplan-Meier estimates and Cox proportional hazard analyses. Results In a cohort of 200 patients, median 24 h urinary excretion of PCS amounted to 457.47 ?mol (IQR 252.68 – 697.17). After a median follow-up of 52 months, 25 patients reached the primary endpoint (tertile 1/2/3: 5/6/14 events, log rank P 0.037). Higher urinary excretion of PCS was directly associated with cardiovascular events (univariate hazard ratio per 100 ?mol increase: 1.112, P 0.002). In multivariate analysis, urinary excretion of PCS remained a predictor of cardiovascular events, independent of eGFR (hazard ratio 1.120, P 0.002). Conclusions In patients with chronic kidney disease, intestinal uptake of p-cresol associates with cardiovascular disease independent of renal function. The intestinal generation and absorption of p-cresol may be therapeutic targets to reduce cardiovascular disease risk in patients with renal dysfunction. PMID:24912660

  14. [Psychopathology of chronic diseases in children and adolescents. Congenital cardiopathies].

    PubMed

    Masi, G; Brovedani, P

    1996-10-01

    A most significant life event in the first years of life is a disease, especially if it is of early onset, severe, life threatening, with an uncertain prognosis, and with the necessity of frequent diagnostic and therapeutic interventions. Psychological implications are a significant parts of the illness, not a marginal component; they can affect prognosis and outcome. The authors describe the different psychological implications of an experience of chronic disease in children and adolescents and their families (parents and siblings). Congenital disease (for example congenital heart failure) has a peculiar significance: since it is diagnosed early, it influences mother-infant interactions from the beginning, in a crucial moment of the infant's psychological development; diagnostic and therapeutical interventions are early and frequent; congenital defects determine the strongest guilt feelings in the parents. Some specific psychological aspects can be described: the weakening of the Bodily self, the inhibition of thinking, the theories the child and the family formulates on the disease, the death feelings. Emotional features in children and adolescents with congenital cardiopathy are described: inhibition of emotions, marked anxiety, depressive reaction, with loneliness, low self-esteem and inadequacy, emotional lability, with oscillation between omnipotence and inadequacy; impulsiveness; weakness of self identity; especially in bodily Self. Some psychopathological aspects in children and adolescents with heart transplant and their families are also described. Intellectual level of patients with congenital heart disease is in the normal range, although significantly lower than normal controls. There is a positive correlation between worsening of intellectual functioning and clinical severity of the heart disease; this clinical severity is related both to restrictions in normal daily life activities, and blood oxygen saturation. It is hard to tease apart the role of early physical limitations versus the role of chronic hypoxia, in affecting intellectual development. Some methodological considerations are described, relating to the role of the physician, the psychological support to the children and adolescents and their families, the problem of the shared-cares between main centres and local hospitals, where primary health-care team operates. PMID:9091831

  15. Aggregated proteins in schizophrenia and other chronic mental diseases

    PubMed Central

    Korth, Carsten

    2012-01-01

    Chronic mental diseases (CMD) like the schizophrenias are progressive diseases of heterogenous but poorly understood biological origin. An imbalance in proteostasis is a hallmark of dysfunctional neurons, leading to impaired clearance and abnormal deposition of protein aggregates. Thus, it can be hypothesized that unbalanced proteostasis in such neurons may also lead to protein aggregates in schizophrenia. These protein aggregates, however, would be more subtle then in the classical neurodegenerative diseases and as such have not yet been detected. The DISC1 (Disrupted-in-schizophrenia 1) gene is considered among the most promising candidate genes for CMD having been identified as linked to CMD in a Scottish pedigree and having since been found to associate to various phenotypes of CMD. We have recently demonstrated increased insoluble DISC1 protein in the cingular cortex in approximately 20% of cases of CMD within the widely used Stanley Medical Research Institute Consortium Collection. Surprisingly, in vitro, DISC1 aggregates were cell-invasive, i.e., purified aggresomes or recombinant DISC1 fragments where internalized at an efficiency comparable to that of ?-synuclein. Intracellular DISC1 aggresomes acquired gain-of-function properties in recruiting otherwise soluble proteins such as the candidate schizophrenia protein dysbindin. Disease-associated DISC1 polymorphism S704C led to a higher oligomerization tendency of DISC1. These findings justify classification of DISC1-dependent brain disorders as protein conformational disorders which we have tentatively termed DISC1opathies. The notion of disturbed proteostasis and protein aggregation as a mechanism of mental diseases is thus emerging. The yet unidentified form of neuronal impairment in CMD is more subtle than in the classical neurodegenerative diseases without leading to massive cell death and as such present a different kind of neuronal dysfunctionality, eventually confined to highly selective CNS subpopulations. PMID:22421208

  16. Obesity, oxidative stress, and fibrosis in chronic kidney disease.

    PubMed

    Sharma, Kumar

    2014-11-01

    Obesity in combination with diabetes and hypertension likely is contributing to the increasing incidence of chronic kidney disease (CKD) in the 21st century worldwide and requires novel insights and strategies for treatment. There is an increasing recognition that the kidney has an important role in the complex inter-organ communication that occurs with the development of inflammation and fibrosis with obesity. Inhibition of the adiponectin-AMPK pathway has now become established as a critical pathway regulating both inflammation and pro-fibrotic pathways for both obesity-related kidney disease and diabetic kidney disease. AMPK regulates NF?B activation and is a potent regulator of NADPH oxidases. Nox4 in particular has emerged as a key contribtor to the early inflammation of diabetic kidney disease. AMPK also regulates several transcription factors that contribute to stimulation of the transforming growth factor-beta (TGF-?) system. Another key aspect of AMPK regulation is its control of mammalian target of rapamycin (mTOR) and mitochondrial biogenesis. Inhibition of PGC-1?, the transcriptional co-activator of mitochondrial biogenesis is being recognized as a key pathway that is inhibited in diabetic kidney disease and may be linked to inhibition of mitochondrial function. Translation of this concept is emerging via the field of urine metabolomics, as several metabolites linked to mitochondria are consistently downregulated in human diabetic kidney disease. Further studies to explore the role of AMPK and related energy-sensing pathways will likely lead to a more comprehensive understanding of why the kidney is affected early on and in a progressive manner with obesity and diabetes. PMID:25401040

  17. Vascular calcification in chronic kidney disease: Pathogenesis and clinical implication

    PubMed Central

    Disthabanchong, Sinee

    2012-01-01

    Cardiovascular disease is the leading cause of death among patients with chronic kidney disease (CKD). Vascular calcification (VC) is one of the independent risk factors associated with cardiovascular disease and cardiovascular mortality in both the general population and CKD patients. Earlier evidence revealed substantially higher prevalence of VC in young adults on chronic hemodialysis compared to the general population in the same age range, indicating the influence of CKD-related risk factors on the development of VC. Pathogenesis of VC involves an active, highly organized cellular transformation of vascular smooth muscle cells to bone forming cells evidenced by the presence of bone matrix proteins in the calcified arterial wall. VC occurs in both the intima and the media of arterial wall with medial calcification being more prevalent in CKD. In addition to traditional cardiovascular risks, risk factors specific to CKD such as phosphate retention, excess of calcium, history of dialysis, active vitamin D therapy in high doses and deficiency of calcification inhibitors play important roles in promoting the development of VC. Non-contrast multi-slice computed tomography has often been used to detect coronary artery calcification. Simple plain radiographs of the lateral lumbar spine and pelvis can also detect VC in the abdominal aorta and femoral and iliac arteries. Currently, there is no specific therapy to reverse VC. Reduction of calcium load, lowering phosphate retention using non-calcium containing phosphate binders, and moderate doses of active vitamin D may attenuate progression. Parenteral sodium thiosulfate has also been shown to delay VC progression. PMID:24175241

  18. Functional Performance in Chronic Obstructive Pulmonary Disease Declines with Time

    PubMed Central

    Kapella, Mary C.; Larson, Janet L.; Covey, Margaret K.; Alex, Charles G.

    2010-01-01

    Purpose It is well known that people with chronic obstructive pulmonary disease (COPD) experience declines in functional performance, but little is known about the rate of decline. The purpose of this research was to describe the rate of decline in functional performance and to examine the contribution of disease severity, body composition, symptoms and functional capacity. Functional performance was defined as the activities that people choose to engage in on a day-to-day basis. Methods People (N=108) with COPD were enrolled and followed yearly for three years with: self-reported functional performance (Functional Performance Inventory), spirometry, lung volumes, diffusion capacity, body composition (dual energy x-ray absorptiometry), dyspnea and fatigue (Chronic Respiratory Disease Questionnaire) and functional capacity (six-minute walk distance (6MWD), isokinetic strength of knee flexors and extensors, handgrip strength and maximal inspiratory pressure). A total of 88 subjects completed a (mean ± SD) of 2.7 ± 0.9 years of follow-up. Results Significant negative slopes were observed for functional performance (P=0.001), spirometry (the ratio of forced expiratory volume in one second to forced vital capacity ((FEV1/FVC), P<0.0001), diffusion capacity (P<0.0001) and muscle strength (P<0.0001). The slopes for dyspnea, fatigue and functional capacity were not significantly different from zero, but there was wide individual variation. Hierarchical regression demonstrated that 31% of the variance in the slope of functional performance was accounted for by the hierarchical model and the primary predictors were the slopes of the FEV1/FVC, 6MWD and muscle strength (knee flexors/extensor and handgrip). Conclusions Subjects experienced a slow decline in functional performance, associated with declines in functional capacity and increases in body fat. Symptoms were relatively stable and not associated with declines in functional performance. PMID:20543752

  19. John K. Rose, PhD Chronic viral disease often leads to cancer.

    E-print Network

    Lee, Daeyeol

    John K. Rose, PhD Chronic viral disease often leads to cancer. People with chronic hepatitis B on the idea seven years ago. The results look very promising. The current vaccine for hepatitis B prevents chronic HBV, noted Dr. Robek,"they don't cure the infection, and if you stop using them, the virus comes

  20. Radioimmunoprecipitation and immunoblot studies of antibodies to rubella virus in patients with chronic liver disease

    Microsoft Academic Search

    M. B. Kalvenes; K-H Kalland; G. Haukenes

    1994-01-01

    Summary Patients with autoimmune chronic active hepatitis (AICAH) and some other chronic liver disorders often have very high titres of rubella HI antibodies. In the present study sera from 46 patients with chronic liver disease and controls were examined for rubella antibodies using radioimmunoprecipitation assay (RIPA) and Western blot. RIPA appeared to be more suitable than Western blot for the

  1. Technology-enabled Chronic Disease Management in Under-resourced Environments

    E-print Network

    Knightly, Edward W.

    of chronic illness requires a partnership of the person with the illness and the healthcare establishment, populations are living to an older age and therefore becoming susceptible to chronic illness. In factTechnology-enabled Chronic Disease Management in Under-resourced Environments Clifford C. Dacso, MD

  2. Overweight, obesity, central adiposity and associated chronic diseases in cuban adults.

    PubMed

    Díaz, María Elena; Jiménez, Santa; García, René Guillermo; Bonet, Mariano; Wong, Iraida

    2009-10-01

    Introduction Prevalence of overweight and obesity is increasing worldwide in parallel with the growing burden of noncommunicable chronic diseases. According to the World Health Organization, in 2005 approximately 1.6 billion individuals aged ?15 years were overweight and at least 400 million were obese; by 2015 these figures will almost double. Central distribution of adiposity has also been associated with higher rates of cardiovascular diseases and other conditions. Objective Determine the prevalence of overweight, obesity and central adiposity, and their association with noncommunicable chronic diseases and related lifestyle risk factors in Cuban adults. Methods The Second National Survey on Risk Factors and Chronic Diseases (ENFRENT II), conducted in 2000-2001, surveyed a representative sample of males and females aged ?15 years using a stratified, multi-stage cluster sampling design. Data from a sub-sample of 19,519 individuals aged ?20 years were analyzed and prevalence calculated for diabetes, hypertension, cardiovascular and cerebrovascular diseases, and for each of these variables in association with overweight, obesity and central distribution of adiposity, and with the presence of sedentary lifestyle, smoking, alcohol consumption, eating regular daily meals and daily breakfast. Results Estimated prevalence of overweight and obesity in the adult population was 30.8% (CI: 30.1-31.5) and 11.8% (CI: 11.2-12.4), respectively. Obesity prevalence was twice as high in women (15.4%; CI: 14.5-16.3) as in men (7.9%; CI: 7.3-8.6). Obesity was significantly more frequent in diabetics, hypertensives and people with heart disease, while central adiposity was significantly associated with a higher prevalence of diabetes mellitus, cardiovascular and cerebrovascular diseases, hypertension, obesity and overweight. Smoking and alcohol consumption were low among overweight and obese subjects, who exhibited a higher prevalence of irregular and inadequate eating patterns. Conclusions Prevalence of overweight, obesity and central adiposity, and comorbidity with diabetes mellitus, hypertension and heart disease, are growing public health problems in Cuba. A multi-sector strategy is needed to develop comprehensive food and nutrition policies and programs aimed at halting these trends, including interventions that encourage healthy eating patterns and regular physical activity in adults and children. PMID:21483295

  3. Genetics of Sputum Gene Expression in Chronic Obstructive Pulmonary Disease

    PubMed Central

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

    2011-01-01

    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. By combining gene expression profiling on induced sputum samples from 131 COPD cases from the ECLIPSE Study with genomewide single nucleotide polymorphism (SNP) data, we found 4315 significant cis-eQTL SNP-probe set associations (3309 unique SNPs). The 3309 SNPs were tested for association with COPD in a genomewide association study (GWAS) dataset, which included 2940 COPD cases and 1380 controls. Adjusting for 3309 tests (p<1.5e-5), the two SNPs which were significantly associated with COPD were located in two separate genes in a known COPD locus on chromosome 15: CHRNA5 and IREB2. Detailed analysis of chromosome 15 demonstrated additional eQTLs for IREB2 mapping to that gene. eQTL SNPs for CHRNA5 mapped to multiple linkage disequilibrium (LD) bins. The eQTLs for IREB2 and CHRNA5 were not in LD. Seventy-four additional eQTL SNPs were associated with COPD at p<0.01. These were genotyped in two COPD populations, finding replicated associations with a SNP in PSORS1C1, in the HLA-C region on chromosome 6. Integrative analysis of GWAS and gene expression data from relevant tissue from diseased subjects has located potential functional variants in two known COPD genes and has identified a novel COPD susceptibility locus. PMID:21949713

  4. Crohn's disease and ulcerative colitis, the two main sub-types of inflammatory bowel disease (IBD), are chronic,

    E-print Network

    Cai, Long

    Crohn's disease and ulcerative colitis, the two main sub- types of inflammatory bowel disease (IBD with Crohn's disease is transmural and often discontinu- ous (TABLE 1). By contrast, the inflammatory changes other chronic inflammatory diseases, particularly primary sclerosing cholangitis, ankylosing spondylitis

  5. The dormant blood microbiome in chronic, inflammatory diseases

    PubMed Central

    Potgieter, Marnie; Bester, Janette; Kell, Douglas B.; Pretorius, Etheresia

    2015-01-01

    Blood in healthy organisms is seen as a ‘sterile’ environment: it lacks proliferating microbes. Dormant or not-immediately-culturable forms are not absent, however, as intracellular dormancy is well established. We highlight here that a great many pathogens can survive in blood and inside erythrocytes. ‘Non-culturability’, reflected by discrepancies between plate counts and total counts, is commonplace in environmental microbiology. It is overcome by improved culturing methods, and we asked how common this would be in blood. A number of recent, sequence-based and ultramicroscopic studies have uncovered an authentic blood microbiome in a number of non-communicable diseases. The chief origin of these microbes is the gut microbiome (especially when it shifts composition to a pathogenic state, known as ‘dysbiosis’). Another source is microbes translocated from the oral cavity. ‘Dysbiosis’ is also used to describe translocation of cells into blood or other tissues. To avoid ambiguity, we here use the term ‘atopobiosis’ for microbes that appear in places other than their normal location. Atopobiosis may contribute to the dynamics of a variety of inflammatory diseases. Overall, it seems that many more chronic, non-communicable, inflammatory diseases may have a microbial component than are presently considered, and may be treatable using bactericidal antibiotics or vaccines. PMID:25940667

  6. Disparities in periodontitis prevalence among chronic kidney disease patients.

    PubMed

    Ioannidou, E; Swede, H

    2011-06-01

    Because of adverse effects of uremia in the innate and adaptive immune systems, we hypothesized that chronic kidney disease (CKD) patients would have higher prevalence of moderate periodontitis compared with individuals without CKD. We examined this hypothesis using the NHANES III dataset, including 12,081 adults stratified by Race-Ethnicity. We followed the American Academy of Periodontology/Centers for Disease Control and Prevention definition for moderate periodontitis. Estimated glomerular filtration rate (GFR) was calculated based on calibrated serum creatinine levels according to the Modification of Diet in Renal Disease Study formula. Analyses incorporated NHANES sampling weights. Overall, 14.6% of individuals with CKD were classified as having moderate periodontitis, compared with 8.7% in the non-CKD group (p = 0.001). A significant dose-response association (p = 0.001) was observed between prevalence of moderate periodontitis and CKD stages among non-Hispanic Blacks and Mexican-Americans, but not so for non-Hispanic Whites. Prevalence of periodontitis among participants with CKD was substantially higher among non-Hispanic Blacks (38.9%) and Mexican-Americans (37.3%) compared with non-Hispanic Whites (12.9%). Multivariate logistic regression models showed that Mexican-Americans and non-Hispanic Blacks with CKD were approximately 30% to 60% more likely to have moderate periodontitis compared with those without CKD, after adjustment for diabetes status and other potential confounders. PMID:21422478

  7. Disparities in Periodontitis Prevalence among Chronic Kidney Disease Patients

    PubMed Central

    Ioannidou, E.; Swede, H.

    2011-01-01

    Because of adverse effects of uremia in the innate and adaptive immune systems, we hypothesized that chronic kidney disease (CKD) patients would have higher prevalence of moderate periodontitis compared with individuals without CKD. We examined this hypothesis using the NHANES III dataset, including 12,081 adults stratified by Race-Ethnicity. We followed the American Academy of Periodontology/Centers for Disease Control and Prevention definition for moderate periodontitis. Estimated glomerular filtration rate (GFR) was calculated based on calibrated serum creatinine levels according to the Modification of Diet in Renal Disease Study formula. Analyses incorporated NHANES sampling weights. Overall, 14.6% of individuals with CKD were classified as having moderate periodontitis, compared with 8.7% in the non-CKD group (p = 0.001). A significant dose-response association (p = 0.001) was observed between prevalence of moderate periodontitis and CKD stages among non-Hispanic Blacks and Mexican-Americans, but not so for non-Hispanic Whites. Prevalence of periodontitis among participants with CKD was substantially higher among non-Hispanic Blacks (38.9%) and Mexican-Americans (37.3%) compared with non-Hispanic Whites (12.9%). Multivariate logistic regression models showed that Mexican-Americans and non-Hispanic Blacks with CKD were approximately 30% to 60% more likely to have moderate periodontitis compared with those without CKD, after adjustment for diabetes status and other potential confounders. PMID:21422478

  8. Chronic wasting disease prion trafficking via the autonomic nervous system.

    PubMed

    Seelig, Davis M; Mason, Gary L; Telling, Glenn C; Hoover, Edward A

    2011-09-01

    Chronic wasting disease (CWD) is a fatal spongiform encephalopathy that is efficiently transmitted among members of the mammalian family Cervidae, including deer, elk, and moose. Typical of prion diseases, CWD is characterized by the conversion of the native protease-sensitive protein PrP(C) to a protease-resistant isoform, denoted PrP(RES). In native species, spread of the disease likely results from the ingestion of prion-containing excreta, including urine, saliva, or feces. Although cervid prion protein-expressing transgenic [Tg(CerPrP)] mice have been shown to be effective surrogates of natural CWD, uncertainties remain regarding the mechanisms by which CWD prions traffic in vivo, including the manner by which CWD prions traffic from the gastrointestinal tract to the central nervous system. We used elk prion protein-expressing transgenic [Tg(CerPrP-E)] mice, infected by three different routes of inoculation, and tissue-based IHC to elucidate that centripetal and centrifugal CWD prion transit pathways involve cells and fibers of the autonomic nervous systems, including the enteric nervous system and central autonomic network. Moreover, we identified CWD PrP(RES) associated with the cell bodies and processes of enteric glial cells within the enteric nervous system of CWD-infected Tg(CerPrP-E) mice. The present findings demonstrate the importance of the peripheral and central autonomic networks in CWD neuroinvasion and neuropathogenesis and suggest that enteroglial cells may facilitate the shedding of prions via the intestinal tract. PMID:21777560

  9. Early life obesity and chronic kidney disease in later life.

    PubMed

    Yim, Hyung Eun; Yoo, Kee Hwan

    2015-08-01

    The prevalence of chronic kidney disease (CKD) has increased considerably with a parallel rise in the prevalence of obesity. It is now recognized that early life nutrition has life-long effects on the susceptibility of an individual to develop obesity, diabetes, cardiovascular disease and CKD. The kidney can be programmed by a number of intrauterine and neonatal insults. Low birth weight (LBW) is one of the most identifiable markers of a suboptimal prenatal environment, and the important intrarenal factors sensitive to programming events include decreased nephron number and altered control of the renin-angiotensin system (RAS). LBW complicated by accelerated catch-up growth is associated with an increased risk of obesity, hypertension and CKD in later life. High birth weight and exposure to maternal diabetes or obesity can enhance the risk for developing CKD in later life. Rapid postnatal growth per se may also contribute to the subsequent development of obesity and CKD regardless of birth weight and prenatal nutrition. Although the mechanisms of renal risks due to early life nutritional programming remain largely unknown, experimental and clinical studies suggest the burdening role of early life obesity in longstanding cardiovascular and renal diseases. PMID:25145270

  10. The dormant blood microbiome in chronic, inflammatory diseases.

    PubMed

    Potgieter, Marnie; Bester, Janette; Kell, Douglas B; Pretorius, Etheresia

    2015-07-01

    Blood in healthy organisms is seen as a 'sterile' environment: it lacks proliferating microbes. Dormant or not-immediately-culturable forms are not absent, however, as intracellular dormancy is well established. We highlight here that a great many pathogens can survive in blood and inside erythrocytes. 'Non-culturability', reflected by discrepancies between plate counts and total counts, is commonplace in environmental microbiology. It is overcome by improved culturing methods, and we asked how common this would be in blood. A number of recent, sequence-based and ultramicroscopic studies have uncovered an authentic blood microbiome in a number of non-communicable diseases. The chief origin of these microbes is the gut microbiome (especially when it shifts composition to a pathogenic state, known as 'dysbiosis'). Another source is microbes translocated from the oral cavity. 'Dysbiosis' is also used to describe translocation of cells into blood or other tissues. To avoid ambiguity, we here use the term 'atopobiosis' for microbes that appear in places other than their normal location. Atopobiosis may contribute to the dynamics of a variety of inflammatory diseases. Overall, it seems that many more chronic, non-communicable, inflammatory diseases may have a microbial component than are presently considered, and may be treatable using bactericidal antibiotics or vaccines. PMID:25940667

  11. Assessment of Vascular Function in Patients With Chronic Kidney Disease

    PubMed Central

    Jablonski, Kristen L.; Decker, Emily; Perrenoud, Loni; Kendrick, Jessica; Chonchol, Michel; Seals, Douglas R.; Jalal, Diana

    2015-01-01

    Patients with chronic kidney disease (CKD) have significantly increased risk of cardiovascular disease (CVD) compared to the general population, and this is only partially explained by traditional CVD risk factors. Vascular dysfunction is an important non-traditional risk factor, characterized by vascular endothelial dysfunction (most commonly assessed as impaired endothelium-dependent dilation [EDD]) and stiffening of the large elastic arteries. While various techniques exist to assess EDD and large elastic artery stiffness, the most commonly used are brachial artery flow-mediated dilation (FMDBA) and aortic pulse-wave velocity (aPWV), respectively. Both of these noninvasive measures of vascular dysfunction are independent predictors of future cardiovascular events in patients with and without kidney disease. Patients with CKD demonstrate both impaired FMDBA, and increased aPWV. While the exact mechanisms by which vascular dysfunction develops in CKD are incompletely understood, increased oxidative stress and a subsequent reduction in nitric oxide (NO) bioavailability are important contributors. Cellular changes in oxidative stress can be assessed by collecting vascular endothelial cells from the antecubital vein and measuring protein expression of markers of oxidative stress using immunofluorescence. We provide here a discussion of these methods to measure FMDBA, aPWV, and vascular endothelial cell protein expression. PMID:24962357

  12. Ventilation of patients with asthma and chronic obstructive pulmonary disease.

    PubMed

    Peigang, Yin; Marini, John J

    2002-02-01

    Ventilatory intervention is often life-saving when patients with asthma or chronic obstructive pulmonary disease (COPD) experience acute respiratory compromise. Although both noninvasive and invasive ventilation methods may be viable initial choices, which is better depends upon the severity of illness, the rapidity of response, coexisting disease, and capacity of the medical environment. In addition, noninvasive ventilation often relieves dyspnea and hypoxemia in patients with stable severe COPD. On the basis of current evidence, the general principles of ventilatory management common to patients with acutely exacerbated asthma/COPD are these: noninvasive ventilation is suitable for a relatively simple condition, but invasive ventilation is usually required in patients with more complex or more severe disease. It is crucial to provide controlled hypoventilation, longer expiratory time, and titrated extrinsic positive end-expiratory pressure to avoid dynamic hyperinflation and its attendant consequences. Controlled sedation helps achieve synchrony of triggering, power, and breath timing between patient and ventilator. When feasible, noninvasive ventilation often facilitates the weaning of ventilator-dependent patients with COPD and shortens the patient's stay in the intensive care unit. PMID:12205409

  13. The Increasing Financial Impact of Chronic Kidney Disease in Australia

    PubMed Central

    Tucker, Patrick S.; Kingsley, Michael I.; Morton, R. Hugh; Scanlan, Aaron T.; Dalbo, Vincent J.

    2014-01-01

    The aim of this investigation was to determine and compare current and projected expenditure associated with chronic kidney disease (CKD), renal replacement therapy (RRT), and cardiovascular disease (CVD) in Australia. Data published by Australia and New Zealand Dialysis and Transplant Registry, Australian Institute of Health and Welfare, and World Bank were used to compare CKD-, RRT-, and CVD-related expenditure and prevalence rates. Prevalence and expenditure predictions were made using a linear regression model. Direct statistical comparisons of rates of annual increase utilised indicator variables in combined regressions. Statistical significance was set at P < 0.05. Dollar amounts were adjusted for inflation prior to analysis. Between 2012 and 2020, prevalence, per-patient expenditure, and total disease expenditure associated with CKD and RRT are estimated to increase significantly more rapidly than CVD. RRT prevalence is estimated to increase by 29%, compared to 7% in CVD. Average annual RRT per-patient expenditure is estimated to increase by 16%, compared to 8% in CVD. Total CKD- and RRT-related expenditure had been estimated to increase by 37%, compared to 14% in CVD. Per-patient, CKD produces a considerably greater financial impact on Australia's healthcare system, compared to CVD. Research focusing on novel preventative/therapeutic interventions is warranted. PMID:24800075

  14. [Epidemiology of chronic obstructive pulmonary disease in France].

    PubMed

    Fuhrman, C; Delmas, M-C

    2010-02-01

    This paper aims to summarize the most recent data on the descriptive epidemiology of chronic obstructive pulmonary disease (COPD) in France. Data are presented concerning the prevalence, mortality and hospital admissions. The prevalence of COPD is difficult to estimate due to the large degree of under-diagnosis and the difficulty of performing spirometry in population-based epidemiological surveys. The prevalence of chronic bronchitis was estimated at 4%, and the prevalence of COPD was estimated at 5-10%, among adults aged 45 years and older. Data from death certificates, although limited by the accuracy of certification, showed that the annual age-standardised mortality rates from COPD increased between 1979 and 2000 among women but remained stable among men. In 2006, about 16,500 death certificates mentioned COPD, of which 7400 identified it as the underlying cause of death. According to the French national hospital discharge database, the number of admissions related to an exacerbation of COPD ranged from 69,000 to 112,000 in 2006 according to the definition used. The admission rates have increased between 1998 and 2006 and this increase was more pronounced among women than among men. Large regional differences in COPD mortality and hospital admission rates were evident, with the highest rates in Northern and Eastern France and in Brittany. PMID:20206064

  15. Canakinumab for the treatment of chronic obstructive pulmonary disease.

    PubMed

    Rogliani, Paola; Calzetta, Luigino; Ora, Josuel; Matera, Maria Gabriella

    2015-04-01

    COPD is a preventable and treatable disease associated with an enhanced chronic inflammatory response. In addition to chronic inflammation other mechanisms have been proposed that is likely to be involved in the development and progression of COPD. Recent evidence in the literature suggests a role for the inflammasome in the airway inflammation observed in COPD. Inflammasomes are intracellular multiprotein complexes that facilitate the autoactivation of the proinflammatory caspase-1 that in response to specific signals induces ultimately the release of the mature form of the inflammatory cytokines IL-1? and IL-18. In stable COPD was observed a higher production of IL-1, with levels further increases during exacerbations. IL-1 is strongly expressed by macrophage-monocyte. It seems that the activity of IL-1? in the lung induces a phenotype with typical characteristics of COPD consisting of lung inflammation, emphysema, and airway fibrosis. COPD could benefit from a targeted approach to the suppression of the inflammatory response, although an effective anti-inflammatory treatment is not yet available. Canakinumab, an anti-IL-1? monoclonal antibody, that binds to human IL-1? with high specificity and neutralizes its signaling, resulting in suppression of inflammation in patients with disorders of autoimmune origin, has been recently evaluated in inflammatory conditions such as COPD. PMID:25660162

  16. Does chronic nicotine alter neurotransmitter receptors involved in Parkinson's disease

    SciTech Connect

    Reilly, M.A.; Lapin, E.P.; Lajtha, A.; Maker, H.S.

    1986-03-05

    Cigarette smokers are fewer in number among Parkinson's Disease (PD) patients than among groups of persons who do not have PD. Several hypotheses have been proposed to explain this observation. One which must be tested is the possibility that some pharmacologic agent present in cigarette smoke may interact with some central nervous system component involved in PD. To this end, they have investigated the effect of chronic nicotine administration on receptors for some of the neurotransmitters that are affected in PD. Rats were injected for six weeks with saline or nicotine 0.8 mg/kg S.C., then killed and brains removed and dissected. The binding of (/sup 3/H)-ketanserin to serotonin receptors in frontal cortex and of (/sup 3/H)-domperidone to dopamine receptors in caudate was not affected. However, the binding of (/sup 3/H)-domperidone in nucleus accumbens was altered: the K/sub d/ increased from 0.16 +/- 0.02 nM to 0.61 +/- 0.07 nM, and the B/sub max/ increased from 507 +/- 47 fmol/mg protein to 910 +/- 43 fmol/mg (p < 0.001 for both comparisons). These values are based on three ligand concentrations. Additional studies are in progress to substantiate the data. It is concluded that chronic nicotine administration may alter dopamine receptors in nucleus accumbens.

  17. Obesity as a Risk and Severity Factor in Rheumatic Diseases (Autoimmune Chronic Inflammatory Diseases)

    PubMed Central

    Gremese, Elisa; Tolusso, Barbara; Gigante, Maria Rita; Ferraccioli, Gianfranco

    2014-01-01

    The growing body of evidence recognizing the adipose tissue (AT) as an active endocrine organ secreting bioactive mediators involved in metabolic and inflammatory disorders, together with the global epidemic of overweight and obesity, rise obesity as a hot topic of current research. The chronic state of low-grade inflammation present in the obese condition and the multiple pleiotropic effects of adipokines on the immune system has been implicated in the pathogenesis of several inflammatory conditions including rheumatic autoimmune and inflammatory diseases. We will discuss the main relevant evidences on the role of the AT on immune and inflammatory networks and the more recent evidences regarding the effects of obesity on the incidence and outcomes of the major autoimmune chronic inflammatory diseases. PMID:25426122

  18. Urology and nephrology update: anemia of chronic kidney disease.

    PubMed

    Fiore, David C; Fox, Cara-Louise

    2014-01-01

    Anemia is associated with chronic kidney disease (CKD) at all stages, and it is nearly universal among patients with stage 5 CKD. Nonetheless, anemia of CKD is a diagnosis of exclusion. When anemia is detected in a patient with CKD, etiologies other than CKD must be considered and ruled out. Iron deficiency also is common among patients with CKD, and iron replenishment improves the anemia and the response to erythropoiesis-stimulating agents. Current guidelines for managing anemia of CKD recommend a hemoglobin goal of 11 to 12 g/dL, but lower hemoglobin may be acceptable for asymptomatic patients. Some patients do not benefit from erythropoiesis-stimulating agents, or they lose their responsiveness to treatment and transfusions must be considered. Other agents are being investigated as management for anemia of CKD, with vitamin C (ascorbic acid) showing some promise. PMID:24432707

  19. Oxygen therapy in acute exacerbations of chronic obstructive pulmonary disease

    PubMed Central

    Brill, Simon E; Wedzicha, Jadwiga A

    2014-01-01

    Acute exacerbations of chronic obstructive pulmonary disease (COPD) are important events in the history of this debilitating lung condition. Associated health care utilization and morbidity are high, and many patients require supplemental oxygen or ventilatory support. The last 2 decades have seen a substantial increase in our understanding of the best way to manage the respiratory failure suffered by many patients during this high-risk period. This review article examines the evidence underlying supplemental oxygen therapy during exacerbations of COPD. We first discuss the epidemiology and pathophysiology of respiratory failure in COPD during exacerbations. The rationale and evidence underlying oxygen therapy, including the risks when administered inappropriately, are then discussed, along with further strategies for ventilatory support. We also review current recommendations for best practice, including methods for improving oxygen provision in the future. PMID:25404854

  20. Chronic Lyme disease: in defense of the scientific enterprise.

    PubMed

    Baker, Phillip J

    2010-11-01

    There is no better example of a relentless attack on evidence-based biomedical research and the integrity of outstanding scientists than that associated with the treatment of a poorly defined condition called "chronic Lyme disease." Here, a scientifically naive general population, the lay press, and legislators, who in most instances are unable to evaluate and judge scientific evidence properly, have been misled by patient advocate groups to believe that extended antibiotic therapy is the best and only solution to this condition. This has resulted in the unprecedented intrusion of government and the legal systems into the practice of medicine and scientific research. Because there is no clinical evidence that this condition is due to a persistent infection, advocating extended antibiotic therapy is not justified and has been shown to be harmful and of no benefit. PMID:20631327

  1. Vegetarianism: advantages and drawbacks in patients with chronic kidney diseases.

    PubMed

    Chauveau, Philippe; Combe, Christian; Fouque, Denis; Aparicio, Michel

    2013-11-01

    Vegetarian diet is a very old practice that is liable to confer some health benefits. Recent studies have demonstrated that modification of the dietary pattern with a reduction of animal protein intake and increased consumption of plant-based foods could influence cardiovascular risk profile and mortality rate. Moreover, phosphate bioavailability from plant proteins is reduced. These statements could lead to some benefits for chronic kidney disease (CKD) patients. This review summarizes the characteristics and benefits of vegetarian diets in the general population and the potential beneficial effects of such a diet on phosphate balance, insulin sensitivity, and the control of metabolic acidosis in CKD patients. Potential drawbacks exist when a vegetarian diet is associated with protein intake that is too restrictive and/or insufficient energy intake, justifying an early and regular nutritional follow-up jointly assumed by a nephrologist and a renal dietitian. PMID:24070587

  2. Pneumocystis infection and the pathogenesis of chronic obstructive pulmonary disease

    PubMed Central

    Morris, Alison

    2011-01-01

    With increases in the immunocompromised patient population and aging of the HIV+ population, the risk of serious fungal infections and their complications will continue to rise. In these populations, infection with the fungal opportunistic pathogen Pneumocystis jirovecii remains a leading cause of morbidity and mortality. Infection with Pneumocystis (Pc) has been shown to be associated with the development of chronic obstructive pulmonary disease (COPD) in human subjects with and without HIV infection and in non-human primate models of HIV infection. In human studies and in a primate model of HIV/Pc co-infection, we have shown that antibody response to the Pc protein, kexin (KEX1), correlates with protection from colonization, Pc pneumonia, and COPD. These findings support the hypothesis that immunity to KEX1 may be critical to controlling Pc colonization and preventing or slowing development of COPD. PMID:21717077

  3. A distributed approach to alarm management in chronic kidney disease.

    PubMed

    Estudillo-Valderrama, Miguel A; Talaminos-Barroso, Alejandro; Roa, Laura M; Naranjo-Hernández, David; Reina-Tosina, Javier; Aresté-Fosalba, Nuria; Milán-Martín, José A

    2014-11-01

    This paper presents the feasibility study of using a distributed approach for the management of alarms from chronic kidney disease patients. In a first place, the key issues regarding alarm definition, classification, and prioritization according to available normalization efforts are analyzed for the main scenarios addressed in hemodialysis. Then, the middleware proposed for alarm management is described, which follows the publish/subscribe pattern, and supports the Object Management Group data distribution service (DDS) standard. This standard facilitates the real-time monitoring of the exchanged information, as well as the scalability and interoperability of the solution developed regarding the different stakeholders and resources involved. Finally, the results section shows, through the proof of concept studied, the viability of DDS for the activation of emergency protocols in terms of alarm prioritization and personalization, as well as some remarks about security, privacy, and real-time communication performance. PMID:25014977

  4. Chronic granulomatous disease presenting as refractory pneumonia in late adulthood

    PubMed Central

    Sarwar, Ghulam; de Malmanche, Theo; Rassam, Loui; Grainge, Christopher; Williams, Andrew; Arnold, David

    2015-01-01

    We present a case of refractory pneumonia in an adult patient with underlying chronic granulomatous disease (CGD). Her lobectomy tissue grew Burkholderia cepacia and histopathology revealed diffuse severe pneumonic consolidation with suppurative/necrotizing granulomata. An initial attempt to find an underlying immune deficiency was unsuccessful. Following recurrent invasive infections, repeat immunological assessment revealed reduced neutrophil function, demonstrating skewed carrier status (lyonization) for X-linked CGD (only 3% normal cells). A pathogenic mutation in the CYBB gene was found on sequencing. CYBB gene encodes the gp91phox, a catalytic subunit of nicotinamide adenine dinucleotide phosphate-oxidase that produces reactive oxygen species in phagocytes. Lyonization increases with age, explaining the delayed clinical CGD. CGD is a rare neutrophil disorder that usually presents in early life with recurrent infections due to bacteria and fungi primarily involving lungs and skin. It is secondary to a defective NADPH oxidase system needed to kill intracellular organisms and activate the formation of neutrophil extracellular traps.

  5. Recurrent Granulibacter bethesdensis infections and chronic granulomatous disease.

    PubMed

    Greenberg, David E; Shoffner, Adam R; Zelazny, Adrian M; Fenster, Michael E; Zarember, Kol A; Stock, Frida; Ding, Li; Marshall-Batty, Kimberly R; Wasserman, Richard L; Welch, David F; Kanakabandi, Kishore; Sturdevant, Dan E; Virtaneva, Kimmo; Porcella, Stephen F; Murray, Patrick R; Malech, Harry L; Holland, Steven M

    2010-09-01

    Chronic granulomatous disease (CGD) is characterized by frequent infections, most of which are curable. Granulibacter bethesdensis is an emerging pathogen in patients with CGD that causes fever and necrotizing lymphadenitis. However, unlike typical CGD organisms, this organism can cause relapse after clinical quiescence. To better define whether infections were newly acquired or recrudesced, we use comparative bacterial genomic hybridization to characterize 11 isolates obtained from 5 patients with CGD from North and Central America. Genomic typing showed that 3 patients had recurrent infection months to years after apparent clinical cure. Two patients were infected with the same strain as previously isolated, and 1 was infected with a genetically distinct strain. This organism is multidrug resistant, and therapy required surgery and combination antimicrobial drugs, including long-term ceftriaxone. G. bethesdensis causes necrotizing lymphadenitis in CGD, which may recur or relapse. PMID:20735916

  6. Chronic kidney disease associated with environmental toxins and exposures.

    PubMed

    Soderland, Peter; Lovekar, Shachi; Weiner, Daniel E; Brooks, Daniel R; Kaufman, James S

    2010-05-01

    People are exposed to various potentially toxic agents and conditions in their natural and occupational environments. These agents may be physical or chemical, may enter the human body through oral, inhalational, or transdermal routes, and may exert effects on all organ systems. Several well-known as well as lesser known associations exist between chronic kidney disease (CKD) and both environmental agents and conditions, such as heavy metals, industrial chemicals, elevated ambient temperatures, and infections. The effects of these agents may be modulated by genetic susceptibility and other comorbid conditions and may lead to the development of acute and CKD. In this article, we present environmental factors that are associated with CKD. PMID:20439094

  7. Bronchopulmonary dysplasia. Chronic pulmonary disease following neonatal respiratory failure.

    PubMed

    Nickerson, B G

    1985-04-01

    Infants with respiratory failure in the first weeks of life may develop a chronic pulmonary condition called bronchopulmonary dysplasia. Their lungs have areas of atelectasis and areas of air trapping from variable obstruction of the airways. These infants may be dependent on supplemental oxygen or a ventilator and may require hospitalization for months, and have symptoms of airway obstruction which last for years. They require meticulous medical management to avoid a number of common complications such as patent ductus arteriosus, cor pulmonale, tracheal stenosis, recurrent aspiration, and death. The condition of most infants improves over the first two years. Preliminary studies suggest that their exercise and pulmonary function is usually close to normal by school-age. The long-term implications for the increasing number of children with this disease who will soon reach adulthood are still unknown. PMID:3884289

  8. Noninvasive ventilation in patients with chronic obstructive airway disease.

    PubMed

    Khilnani, Gopi C; Banga, Amit

    2008-01-01

    Recent years have seen the emergence of noninvasive ventilation (NIV) as an important tool for management of patients with acute exacerbation of chronic obstructive pulmonary disease (COPD). Several well conducted studies in the recent years have established its role in the initial, as well as later management of these patients. However, some grey areas remain. Moreover, data is emerging on the role of long term nocturnal NIV use in patients with very severe stable COPD. This review summarizes the evidence supporting the use of NIV in various stages of COPD, discuss the merits as well as demerits of this novel ventilatory strategy and highlight the grey areas in the current body of knowledge. PMID:18990962

  9. Remnant nephron physiology and the progression of chronic kidney disease

    PubMed Central

    Schnaper, H. William

    2013-01-01

    In chronic kidney disease, ongoing failure of individual nephrons leads to the progressive loss of renal function. This process results in part from a cellular and molecular response to injury that represents an attempt to maintain homeostasis but instead initiates a program that damages the nephron. As nephrons are lost, compensation by the remaining nephrons exacerbates glomerular pathophysiology. Delivery of excessive amounts of biologically active molecules to the distal nephron and tubulointerstitium generates inflammation and cellular dedifferentiation. Energy requirements of hyperfunctioning nephrons exceed the metabolic substrate available to the renal tubule, and inadequacy of the local vascular supply promotes hypoxia/ischemia and consequent acidosis and reactive oxygen species generation. In this way, mechanisms activated to maintain biological balance ultimately lead to demise of the nephron. PMID:23715783

  10. Exercise as an Adjunct Therapy In Chronic Kidney Disease

    PubMed Central

    Kirkman, Danielle L.; Edwards, David G.; Lennon-Edwards, Shannon

    2015-01-01

    Physical activity levels are low in patients with chronic kidney disease (CKD). Evidence indicates that a sedentary lifestyle contributes to increased morbidity and mortality risk; thus, increasing physical activity is an undeniable aspect of a healthy lifestyle. Despite the myriad of health benefits associated with exercise, as well as clinical guidelines in its favor, exercise is still not prescribed as part of routine care in the CKD patient population. This article briefly discusses the benefits of regular exercise implemented across all stages of CKD on independent predictors of survival such as cardiorespiratory fitness, cardiovascular health and protein-energy wasting. Health care providers of the multidisciplinary nephrology team play a pivotal role in the encouragement and implementation of increasing physical activity levels. In order to increase physical activity counseling and enhance healthcare providers’ confidence in prescribing exercise for CKD patients, general recommendations for physical activity in these patients are provided.

  11. Intestinal parasitic infection among Egyptian children with chronic liver diseases.

    PubMed

    El-Shazly, Lerine Bahy El-Dine; El-Faramawy, Amel Abdel Magid; El-Sayed, Nagwa Mostafa; Ismail, Khadiga Ahmed; Fouad, Sally Mohammed

    2015-03-01

    Patients with chronic liver diseases (CLD) are often highly susceptible to parasitic infection due to a depressed immune system. The objective of this study was to detect the most commonly intestinal parasites found among Egyptian children with CLD. The present study was conducted on 50 children with CLD of different etiology (25 were having different intestinal symptoms, 25 without intestinal symptoms) and 50 non-CLD children with gastrointestinal complaints served as controls. All cases were subjected to stool examination and investigated by liver function tests. Also, anthropometric measurements were taken for all children including weight and height. It was found that the most commonly intestinal protozoa identified in the patients with CLD in order of frequency were: Entamoeba histolytica/Entamoeba dispar (16 %), Giardia lamblia (14 %), Blastocystis hominis (14 %), Cryptosporidium parvum (10 %), E. histolytica and G. lamblia (2 %), E. histolytica and B. hominis (2 %), G. lamblia and B. hominis (2 %), B. hominis and Entamoeba coli (2 %), Microsporidium (2 %) and no cases were found infected with Strongyloides stercoralis. As compared to the controls, the observed incidence of these organisms in CLD patients was significantly higher (p < 0.045) as regards stool examination by unstained techniques while, there was no significant difference between both groups as regards stool examination by stained techniques (p < 0.478). In addition, this study showed that the weight and height of studied patients were affected by parasitic infection while, there was no significant correlation between parasitic infection and liver function tests. In conclusion, chronic liver diseases affect the immunity of the patients as shown in significant increase in the incidence of intestinal parasites in cases compared to controls. PMID:25698851

  12. Variability of Spirometry in Chronic Obstructive Pulmonary Disease

    PubMed Central

    Herpel, Laura B.; Kanner, Richard E.; Lee, Shing M.; Fessler, Henry E.; Sciurba, Frank C.; Connett, John E.; Wise, Robert A.

    2006-01-01

    Objective: Our goal is to determine short-term intraindividual biologic and measurement variability in spirometry of patients with a wide range of stable chronic obstructive pulmonary disease severity, using datasets from the National Emphysema Treatment Trial (NETT) and the Lung Health Study (LHS). This may be applied to determine criteria that can be used to assess a clinically meaningful change in spirometry. Methods: A total of 5,886 participants from the LHS and 1,215 participants from the NETT performed prebronchodilator spirometry during two baseline sessions. We analyzed varying criteria for absolute and percent change of FEV1 and FVC to determine which criterion was met by 90% of the participants. Results: The mean ± SD FEV1 for the initial session was 2.64 ± 0.60 L (75.1 ± 8.8% predicted) for the LHS and 0.68 ± 0.22 L (23.7 ± 6.5% predicted) for the NETT. The mean ± SD number of days between test sessions was 24.9 ± 17.1 for the LHS and 85.7 ± 21.7 for the NETT. As the degree of obstruction increased, the intersession percent difference of FEV1 increased. However, the absolute difference between tests remained relatively constant despite the severity of obstruction (0.106 ± 0.10 L). Over 90% of participants had an intersession FEV1 difference of less than 225 ml irrespective of the severity of obstruction. Conclusions: Absolute changes in FEV1 rather than percent change should be used to determine whether patients with chronic obstructive pulmonary disease have improved or worsened between test sessions. PMID:16497996

  13. Ceramides and cardiac function in children with chronic kidney disease

    PubMed Central

    Scherer, Philipp E.; Friedman, Lisa Aronson; Gordillo, Ruth; Furth, Susan; Warady, Bradley A

    2014-01-01

    Background Chronic kidney disease (CKD) is associated with increased incidence of cardiac dysfunction. Recent animal studies have demonstrated that elevated levels of ceramides cause dilated lipotoxic cardiomyopathy. We hypothesized ceramides are increased in children with CKD and associated with abnormal cardiac structure and function. Methods Ceramide levels were determined in 93 children aged 1–16 years enrolled in the Chronic Kidney Disease in Children (CKiD) study and compared to levels from 24 healthy controls. Complete demographic, clinical, and laboratory information, and ceramide measurements were analyzed cross-sectionally. Echocardiography was performed to determine cardiac structure and function. Results Very long-chain C24:0 ceramides were the most abundant species in both control (56 %) and CKD subjects (55 %), followed by C24:1 (controls 19 %, CKD 23 %) and C22:0 (controls 19 %, CKD 13 %). Total serum ceramide levels were significantly higher in CKD children versus controls (p <0.001). Ceramide metabolites lactosylceramide, C24:0L, and C16:0L were significantly higher in CKD subjects than controls (p <0.001). The proportion of C24:0L was dramatically higher in CKD (59 %) versus control (17 %) subjects (p <0.001). In adjusted multivariate analyses, higher log10C24:0L and log10C16:0L were significant predictors of lower shortening fraction and mid-wall shortening. Conclusions Ceramide levels are increased in children with CKD. Our study identified lactosylceramides as an independent predictor of lower systolic function in these children. PMID:24389650

  14. Pharmacological and non pharmacological strategies in the management of coronary artery disease and chronic kidney disease.

    PubMed

    Agrawal, Harsh; Aggarwal, Kul; Littrell, Rachel; Velagapudi, Poonam; Turagam, Mohit K; Mittal, Mayank; Alpert, Martin A

    2015-01-01

    Patients with advanced chronic kidney disease (CKD), including those treated with dialysis, are at high risk for the development of cardiovascular disease (CVD). CVD accounts for 45-50% of deaths among dialysis patients. Therapy of acute and chronic coronary heart disease (CHD) that is effective in the general population is frequently less effective in patients with advanced CKD. Drug therapy in such patients may require dose modification in some cases. Oral anti-platelet drugs are less effective in those with advanced CKD than in persons with normal or near normal renal function. The intravenous antiplatelet drugs eptifibatide and tirofiban both require dose reductions in patients with advanced CKD. Enoxaparin requires dose reduction in early stage CKD and is contraindicated in hemodialysis patients. Unfractionated heparin and warfarin maybe used without dose adjustment in CKD patients. Atenolol, acetbutolol and nadolol may require dose adjustments in CKD. Metoprolol and carvedilol do not. Calcium channel blockers and nitrates do not require dose adjustment, whereas ranolazine does. Angiotensin converting enzyme inhibitors and angiotensin receptor blockers may safely be used in CKD patients with close observation for hyperkalemia. The safety of spironolactone in such patients is questionable. Statins are less effective in reducing cardiovascular complication in CKD patients and their initiation is not recommended in dialysis patients. Coronary artery bypass grafting is associated with higher shortterm mortality, but better long-term morbidity and mortality than percutaneous coronary interventions in patients with advanced CKD with non-ST segment ACS and chronic CHD. PMID:25981315

  15. Putting Chronic Disease on the Map: Building GIS Capacity in State and Local Health Departments

    PubMed Central

    Casper, Michele; Tootoo, Joshua; Schieb, Linda

    2013-01-01

    Techniques based on geographic information systems (GIS) have been widely adopted and applied in the fields of infectious disease and environmental epidemiology; their use in chronic disease programs is relatively new. The Centers for Disease Control and Prevention’s Division for Heart Disease and Stroke Prevention is collaborating with the National Association of Chronic Disease Directors and the University of Michigan to provide health departments with capacity to integrate GIS into daily operations, which support priorities for surveillance and prevention of chronic diseases. So far, 19 state and 7 local health departments participated in this project. On the basis of these participants’ experiences, we describe our training strategy and identify high-impact GIS skills that can be mastered and applied over a short time in support of chronic disease surveillance. We also describe the web-based resources in the Chronic Disease GIS Exchange that were produced on the basis of this training and are available to anyone interested in GIS and chronic disease (www.cdc.gov/DHDSP/maps/GISX). GIS offers diverse sets of tools that promise increased productivity for chronic disease staff of state and local health departments. PMID:23786907

  16. Nitric Oxide Levels in Patients with Chronic Renal Disease

    PubMed Central

    Meenakshi, S. R.; Agarwal, Rajni

    2013-01-01

    Background and Objectives: Nitric Oxide (NO), the L-arginine derivative, is tonically synthesised by the endothelium within the kidney and it plays a crucial role in the regulation of the blood pressure and the renal blood flow. NO regulates the renal function through the modulation of the vascular tone and sodium handling. With the progressive development of the renal insufficiency, it remains unclear whether the endogenous NO production is increased or decreased in the kidney. This study was carried out to determine whether there were any changes in the levels of NO and teir correlation with the routine parameters of the renal dysfunction in the patients of Chronic Renal Failure (CRF), as the disease progresses in conjunction with poor renal functions. Methods: Thirty patients with chronic renal disease which was caused by chronic glomerulonephritis and hypertension, who were on Maintenance Haemodialysis (MHD) with serum creatinine levels of > 2.5 mg/dl, were included in this study. Thirty healthy voluntary blood donors were taken as the controls. NO was estimated by a spectrophotometric method by using cadmium reduction. The routine renal function tests, BUN and Creatinine were performed by the standard clinical chemistry procedures. Results: The serum NO levels were found to be significantly increased (p < 0.01) in the CRF on MHD (98.77 ± 35.40 ?mol/l) as compared to the controls (22.03 ± 7.23 ?mol/l). The NO output correlated with the serum creatinine (r = 0.8123, p < 0.01) and the urea concentration (r = 0.5166, p = <0.01) in the CRF group. Conclusion: The NO levels were markedly enhanced in the CRF patients who were on MHD. This was due to the dialysis procedure itself, which led to the stimulation of cytokine induced NO synthase and also due to the platelets which generated more NO due to uraemia. At high concentrations, NO is a cytotoxic molecule which is responsible for the complications of dialysis and it results in Nitrosative Stress in these patients, as it is a highly reactive free radical. Since the no output correlated with the serum creatinine and urea concentrations, a higher no production probably indicated insufficient blood purification, due to the common effect on their elimination pathways via the renal tract. Therefore, the alterations of the renal function, that are reflected in the changes of the creatinine concentration, will be accompanied by the changes in the serum NO. Thus, the determination of the NO levels in the peripheral blood may be useful in the assessment of the dialysis and they can also be used as markers in the follow up and the prognosis in these type of patients. PMID:23998047

  17. Endothelial dysfunction and cardiovascular disease in early-stage chronic kidney disease: cause or association?

    PubMed

    Moody, William E; Edwards, Nicola C; Madhani, Melanie; Chue, Colin D; Steeds, Richard P; Ferro, Charles J; Townend, Jonathan N

    2012-07-01

    Chronic kidney disease (CKD) is strongly associated with cardiovascular disease (CVD); a graded inverse relationship between estimated glomerular filtration rate (eGFR) and cardiovascular event rates has emerged from large-scale observational studies. Chronic kidney disease is also associated with endothelial dysfunction (ED) although the precise relationship with GFR and the "threshold" at which ED begins are contentious. Abnormal endothelial function is certainly present in late-stage CKD but data in early-stage CKD appear confounded by disease states such as diabetes and hypertension which themselves promote ED. Thus, the direct effect of a reduction in GFR on endothelial function and, therefore, cardiovascular (CV) risk is far from completely established. In human studies, the precise duration of kidney impairment is seldom known and the onset of CVD often insidious, making it difficult to determine exactly when CVD first appears in the context of CKD. Kidney donors provide a near-ideal experimental model of CKD; subjects undergo an acute change from normal to modestly impaired renal function at the time of nephrectomy and lack the confounding co-morbidity that has made observational studies of CKD patients so challenging to interpret. By examining changes in endothelial function in living kidney donors before and after nephrectomy, useful insight might be gained into the pathophysiology of CVD in CKD and help determine whether targeting ED or the renal disease itself has the potential to reduce CV risk. PMID:22349087

  18. Chronic liver disease in the Alexandria governorate, Egypt: contribution of schistosomiasis and hepatitis virus infections

    Microsoft Academic Search

    Mario Angelico; Elil Renganathan; Claudia Gandin; Moustafa Fathy; M. Cristina Profili; Wael Rafai; Adriano De Santis; Ali Nagi; Gamal Amin; Livio Capocaccia; Fracesco Callea; Maria Rapicetta; Gamal Badr; Giovanni Rocchi

    1997-01-01

    Background\\/Aims: In Egypt chronic liver disease is customarily attributed to Schistosoma mansoni infection. Anti-HCV antibodies are highly prevalent among Egyptian blood donors, yet little is known about the risk factors, pathogenicity and virological features of HCV and its association with schistosomiasis. We studied 135 adult patients with chronic liver disease living in the Alexandria governorate, mostly in rural areas of

  19. Predictors of Declining Glomerular Filtration Rate in a Population-Based Chronic Kidney Disease Cohort

    Microsoft Academic Search

    Bjørn O. Eriksen; Janne Tomtum; Ole C. Ingebretsen

    2010-01-01

    Background\\/Aim: A high percentage of patients with chronic kidney disease has nonprogressive disease. Classification with respect to rate of change in glomerular filtration rate (GFR) would permit a more targeted approach to these patients. The aim of this study was to study predictors of rate of change in GFR in a population-based cohort. Methods: All prevalent patients with chronic kidney

  20. Disparity between Physical Capacity and Participation in Seniors with Chronic Disease

    Microsoft Academic Search

    MAUREEN C. ASHE; JANICE J. ENG; WILLIAM C. MILLER; JUDITH A. SOON

    2007-01-01

    ASHE, M. C., J. J. ENG, W. C. MILLER, and J. A. SOON, Disparity between Physical Capacity and Participation in Seniors with Chronic Disease. Med. Sci. Sports Exerc., Vol. 39, No. 7, pp. 1139-1146, 2007. Consistently low rates of physical activity are reported for older adults, and there is even lower participation if a chronic disease is present. Purpose: To