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 277,896 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Hyperlipidemia is one of the major modifiable risk factors for coronary heart disease in men and women. There is substantial epidemiological data showing the relationship between elevations in total and low-density lipoprotein cholesterol, triglycerides and low high-density lipoprotein cholesterol, and coronary heart disease in women. Yet hyperlipidemia is undertreated in women. This may be due to limited data to support intervention for the primary prevention of coronary heart disease, confusion in national guidelines, and inadequate counseling on diet and exercise in clinical practice. Lipid levels should be evaluated in women with established coronary heart disease, cerebrovascular disease, peripheral vascular disease, and diabetes. These women should be targeted for aggressive lipid lowering with diet, exercise, and medication. Women with multiple risk factors and early family history of coronary heart disease should also be evaluated. Asymptomatic young women with elevated or borderline lipids should be counseled with regard to lifestyle and behavioral interventions such as diet and exercise. (c) 2000 by CHF, Inc.
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PMID:Lipid lowering strategies in women. 1183 11

Pakistan along with many other West and South Asian countries has a very high prevalence of consanguineous, especially close cousin, marriages. Although there is substantial empirical information on offspring morbidity and mortality attributable to parental consanguinity, population-based information on how communities in general, and women in particular, perceive the health risks associated with consanguineous unions is limited. This paper considers community perceptions of health effects associated with consanguineous marriages using qualitative data from 15 focus group discussions and 294 in-depth interviews. The study was conducted in four low-income, multi-ethnic, and multi-religious communities in Karachi, the principal commercial center of Pakistan. The results show a general lack of awareness of the possible adverse health effects of consanguineous marriage. In cases where a link between consanguinity and ill health was acknowledged, it often centered on the familial origins of non-communicable disorders such as diabetes and hypertension or infectious diseases such as tuberculosis. Belief in fate and the "evil eye" was widespread across all ethnic and religious groups. Many respondents did not agree with medical explanations of a genetic mode of disease inheritance, even in cases where there was an affected child in the family. The absence of a uniform manifestation of disease among all children of a couple who were identified as carriers of a specific mutation added to the confusion among participants. The study highlights the need for further quantification of risks associated with consanguinity and a need for provision of appropriate information to primary-care clinicians and also to communities. The likely impact of increasing morbidity attributable to inbreeding on the health care system in resource poor settings is also discussed.
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PMID:Lay perceptions of genetic risks attributable to inbreeding in Pakistan. 1189 38

Autoimmune diabetes recurrence is in part responsible for islet graft destruction in type 1 diabetic individuals. The aim of the present study was to design treatment modalities able to prevent autoimmune diabetes recurrence after islet transplantation in spontaneously diabetic NOD mice. In order to avoid confusion between autoimmune diabetes recurrence and allograft rejection, we performed syngeneic islet transplantations in spontaneously diabetic NOD mice. Mice were treated with mouse interferon-beta (IFN-beta, 1 x 105 IU/day), a new 14-epi-1,25-(OH)2D3-analogue (TX 527, 5 microg/kg/day) and cyclosporin A (CsA, 7.5 mg/kg/day) as single substances and in combinations. Treatment was stopped either 20 days (IFN-beta and CsA) or 30 days (TX 527) after transplantation. Autoimmune diabetes recurred in 100% of control mice (MST 11 days). None of the mono-therapies significantly prolonged islet graft survival. Combining CsA with TX 527 maintained graft function in 67% of recipients as long as treatment was given (MST 31 days, P < 0.01 versus controls). Interestingly, 100% of the IFN-beta plus TX 527-treated mice had normal blood glucose levels during treatment, and even had a more pronounced prolongation of graft survival (MST 62 days, P < 0.005 versus controls). Cytokine mRNA analysis of the grafts 6 days after transplantation revealed a significant decrease in IL-2, IFN-gamma and IL-12 messages in both IFN-beta plus TX 527- and CsA plus TX 527-treated mice, while only in the IFN-beta with TX 527 group were higher levels of IL-10 transcripts observed. Therefore, we conclude that a combination of IFN-beta and TX 527 delays autoimmune diabetes recurrence in islet grafts in spontaneously diabetic NOD mice.
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PMID:Treatment of autoimmune diabetes recurrence in non-obese diabetic mice by mouse interferon-beta in combination with an analogue of 1alpha,25-dihydroxyvitamin-D3. 1198 11

To choose the best possible dialysis technique for those patients with end-stage renal disease continues to be a matter of debate. Even after putting aside the evident influence that economic and geographic factors as well as the health politics may have in the selection of the technique, different studies comparing survival between hemodialysis (HD) and peritoneal dialysis (PD) have shown contradictory results which could be explained by the differing methodological and statistical methods used together with the different influence assigned to the comorbidity found when starting the treatment, a situation that has increased the confusion about this topic. Based on this we performed a retrospective analysis with a follow-up time of seven years including all those patients who started dialytic treatment in our area, with a final number of 3.106 hemodialysis patients and 542 peritoneal dialysis patients. Those patients who were transferred to another treatment technique during the time of the study were excluded. Age higher than 70 years, cardiovascular disease, liver disease, diabetes mellitus and the presence of dyslipidemia were included as comorbidity factors. Peritoneal dialysis patients were younger than those treated by hemodialysis (54.53 vs 60.1 years), but suffered from higher cardiovascular comorbidity and were more often diabetic. The global survival was the same in both groups up to 32 months of treatment. Although no differences were found when comparing those patients without comorbidity factors, those with comorbidity had better survival on hemodialysis. Age higher than 70 years was the only comorbidity factor with statistically significant difference for a better survival in hemodialysis.
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PMID:[Analysis of survival in dialysis: hemodialysis versus peritoneal dialysis and the significance of comorbidity]. 1212 25

The ageing process can bring with it an increased incidence of conditions which give rise to chronic pain. Persistent musculoskeletal and/or neuropathic pain due to conditions such as back pain, arthritis, osteoporosis and diabetes in elderly people can lead to a marked deterioration in their quality of life. Pain assessment can be complicated by concomitant disorientation, confusion and communication deficits, leading to the undertreatment of pain in this client group. Pain management can be difficult due to the existence of multiple medical problems and the increased incidence of side-effects related to the treatment. This article aims to update nurses on the assessment and management of pain in the older adult, and will provide a broad overview of pain management strategies suitable for elderly patients.
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PMID:Assessment and management of chronic pain in elderly people. 1217 Jun 72

There is a relationship between coping with chronic illness and a person's psychosocial development. The aim of this study was to describe dimensions of psychosocial development based on results of a previous factor analysis of the Modified Erikson Psychosocial Stage Inventory among people with type 2 diabetes. Interviews were carried out with 10 people with diabetes. The transcribed interviews were analysed by qualitative content analysis into main categories, categories and themes. The categories were trust, lack of trust, positive identity, identity confusion, integrity and lack of integrity. Themes that permeated the categories in a positive way were 'activity' and 'involvement', while themes that permeated the categories in a negative way were 'passivity' and 'alienation'. Our interpretation is that the category 'trust' is the basis for 'identity', and together 'trust' and 'identity' are the basis for maturity and 'integrity'. A conclusion is that positive psychosocial maturity has to do with attaining trust, identity and integrity through activity and involvement. Qualities important for maturation through trust, identity and integrity are understanding, capacity, purposefulness and fortitude. Our interpretation of maturity is considered as being an important and interesting focus in nursing, while the above related qualities are closely connected to coping with diabetes.
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PMID:Psychosocial maturity among people with diabetes mellitus. 1242 83

To evaluate and review the clinical spectrum of anterior cerebral artery (ACA) territory infarction, we studied 48 consecutive patients who admitted to our stroke unit over a 6-year period. We performed magnetic resonance imaging (MRI) and magnetic resonance angiography (MRA) in all patients, and diffusion magnetic resonance imaging (DWI) in 21. In our stroke registry, patients with ACA infarction represented 1.3% of 3705 patients with ischemic stroke. The main risk factors of ACA infarcts was hypertension in 58% of patients, diabetes mellitus in 29%, hypercholesterolemia in 25%, cigarette smoking in 19%, atrial fibrillation in 19%, and myocardial infarct in 6%. Presumed causes of ACA infarct were large-artery disease and cardioembolism in 13 patients each, small-artery disease (SAD) in the territory of Heubner's artery in two and atherosclerosis of large-arteries (<50% stenosis) in 16. On clinico-radiologic analysis there were three main clinical patterns depending on lesion side; left-side infarction (30 patients) consisting of mutism, transcortical motor aphasia, and hemiparesis with lower limb predominance; right side infarction (16 patients) accompanied by acute confusional state, motor hemineglect and hemiparesis; bilateral infarction (two patients) presented with akinetic mutism, severe sphincter dysfunction, and dependent functional outcome. Our findings suggest that clinical and etiologic spectrum of ACA infarction may present similar features as that of middle cerebral artery infarction, but frontal dysfunctions and callosal syndromes can help to make a clinical differential diagnosis. Moreover, at the early phase of stroke, DWI is useful imaging method to locate and delineate the boundary of lesion in the territory of ACA.
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PMID:Spectrum of anterior cerebral artery territory infarction: clinical and MRI findings. 1245 77

Diabetic mastopathy is a source of confusion with breast carcinoma. The association between mastopathy and Type I diabetes of long duration has been reported, but this clinical condition is poorly recognized since breast examination is not routinely performed in young diabetic patients. Radiologists' awareness of the constellation of findings in diabetic mastopathy may spare patients from undergoing unwarranted surgical biopsies.
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PMID:Case report: diabetic mastopathy. 1268 35

A 56-year-old black woman with diabetes mellitus was admitted for hypoglycemia and confusion. Her past medical history included breast cancer, for which she had undergone a left lumpectomy and then mastectomy for in-breast recurrence. Her oral intake had decreased during the past month because of increasing discomfort from left-sided chest pain. During this period, she continued to take pioglitazone for diabetes at her originally prescribed dose. The patient's mental status improved quickly after taking orange juice and intravenous glucose, but the chest pain persisted. The pain, which was described as an ache along the left costal margin, increased with palpation, deep inspiration, or coughing. She had recently presented with similar complaints at another hospital where she had been prescribed a muscle relaxant that provided no relief from the pain. She also reported a 14-lb weight loss during the previous 3 months, as well as fatigue, weakness, and aches in her legs and arms. She denied fevers, chills, sweats, abdominal pain, nausea, or recent trauma. Laboratory values at the time of admission were: calcium, 11.8 mg/dL; total protein, 11.1 mg/dL; albumin, 3.2 g/dL; creatinine, 1.0 mg/dL; and hematocrit, 29.3%, with a mean corpuscular volume of 89.3. Chest radiography revealed a lytic lesion in the left lateral fourth rib and left humerus (). Serum and urine protein electrophoresis revealed a monoclonal spike in the gamma region consistent with monoclonal gammopathy. The serum spike was quantified at 3.78 g/dL. A skeletal survey showed many small well-defined lytic lesions in the skull (with one 1.5-cm lytic lesion in the upper posterior parietal bone), arms, and legs. A bone scan showed multiple foci of increased uptake in the right and left ribs as well as the proximal portion of the left femur. The peripheral blood smear revealed rouleaux formation () and plasma cells (). What is the diagnosis?
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PMID:Cases from the Osler medical service at Johns Hopkins University. 1275 89

We report a case of autoimmune pancreatitis presenting as a mass in the head of the pancreas that was successfully diagnosed without pancreaticoduodenectomy. The patient was a 64-year-old man who had no complaint. A routine physical checkup unexpectedly revealed mild diabetes and a low-echoic mass in the pancreatic head. The diagnosis was made by noting irregular narrowing of the main pancreatic duct, hypergammaglobulinemia, and increased immunoglobulin G levels. An open wedge biopsy of the mass was performed; this showed a marked fibrosis with lymphocyte- or macrophage-predominant inflammatory infiltrates. Immunohistochemical study revealed that the remnant acinar cells expressed Fas (CD95) ligand and not Fas. We review some of the literature and discuss various features and diagnostic clues of autoimmune pancreatitis. Awareness of this pathologic condition may prevent confusion with pancreatic malignancy and unnecessary surgery.
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PMID:Autoimmune pancreatitis presenting as a mass in the head of the pancreas: a diagnosis to differentiate from cancer. 1276 4


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