Gene/Protein Disease Symptom Drug Enzyme Compound
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Query: UMLS:C0018801 (heart failure)
 72,216 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

The purposes of this study were to describe the quality of life (QOL) of terminally ill patients in a home-based hospice program and to examine the relationship between QOL data and patients' symptom distress, ability to function, interpersonal communication (support from family and friends), well-being (their affairs in order), and transcendence (religious comfort/support) as recorded in their charts. QOL was measured by the Missoula-Vitas Quality of Life Index (MVQOLI), an instrument designed specifically for use with terminally ill patients. The study was conducted over a three-year period with 129 terminally ill patients enrolled in a home-based hospice program of care. The MVQOLI was administered to patients within 20 days of their admission to hospice. A retrospective chart review was conducted to determine patients' levels of symptom distress, ability to function, social support, whether or not their affairs were in order, and religious comfort/support. The mean age of participants in this study was 67, with 54.3 percent male and 45.7 percent female. Cancer was the primary diagnosis for 92.2 percent of the sample, and 35 percent of these patients had a diagnosis of lung cancer. Of the 7.8 percent non-cancer diagnoses, five were diagnosed with AIDS, four with chronic obstructive pulmonary disease, and one with chronic heart failure. The results of this study revealed positive scores on the five dimensions of the MVQOLI QOL scale, indicating that within 20 days of admission to hospice, patients rated their QOL as good to very good. Data obtained from the chart review also indicated that patients did not experience a great deal of symptom distress (e.g., pain, nausea, shortness of breath, and restlessness). A significant correlation existed between age and QOL; number of interventions and pain levels; and marital status, well-being, interpersonal relationships, and transcendence. Shortness of breath and well-being were significantly correlated with QOL. There was no significant correlation between gender, race, or closeness to death and the five dimensions of the MVQOLI and chart review assessments.
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PMID:The quality of life of hospice patients: patient and provider perceptions. 1585 87

Apoptosis, the major form of cellular suicide, is central to various physiological processes and the maintenance of homeostasis in multicellular organisms. Presumably, even more important is a causative or contributing role of apoptosis to various human diseases. These include situations with unwanted cell accumulation (cancer) and failure to eradicate aberrant cells (autoimmune diseases) or disorders with an inappropriate loss of cells (heart failure, stroke, AIDS, neurodegenerative diseases, and liver injury). The past decade has witnessed a tremendous progress in the knowledge of the molecular mechanisms that regulate apoptosis and the mediators that either prevent or trigger cell death. Consequently, apoptosis regulators have emerged as key targets for the design of therapeutic strategies aimed at modulating cellular life-and-death decisions. Numerous novel approaches are currently being followed employing gene therapy and antisense strategies, recombinant biologics, or classical organic and combinatorial chemistry to target specific apoptotic regulators. Convincing proof-of-principle evidence obtained in several animal models confirms the validity of strategies targeting apoptosis and revealed an enormous potential for therapeutic intervention in a variety of illnesses. Although numerous apoptotic drugs are currently being developed, several therapeutics have progressed to clinical testing or are already approved and marketed. Here we review the recent progress of apoptosis-based therapies and survey some highlights in a very promising field of drug development.
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PMID:New approaches and therapeutics targeting apoptosis in disease. 1591 67

Cachexia, usually defined as the loss of >5% of an individual's baseline bodyweight over 2-6 months, occurs with a number of diseases that includes not only AIDS and advanced cancer but also chronic heart failure, rheumatoid arthritis, chronic obstructive pulmonary disease, Crohn disease, and renal failure. Anorexia is considered a key component of the anorexia-cachexia syndrome. Progestogens, particularly megestrol acetate, are commonly used to treat anorexia-cachexia. The mechanism of action of megestrol is believed to involve stimulation of appetite by both direct and indirect pathways and antagonism of the metabolic effects of the principal catabolic cytokines. Because the bioavailability of megestrol acetate directly affects its efficacy and safety, the formulation was refined to enhance its pharmacokinetics. Such efforts yielded megestrol acetate in a tablet form, followed by a concentrated oral suspension form, and an oral suspension form developed using nanocrystal technology. Nanocrystal technology was designed specifically to optimize drug delivery and enhance the bioavailability of drugs that have poor solubility in water. Megestrol acetate nanocrystal oral suspension is currently under review by the US FDA for the treatment of cachexia in patients with AIDS. Preclinical pharmacokinetic data suggest that the new megestrol acetate formulation has the potential to significantly shorten the time to clinical response and thus may improve outcomes in patients with anorexia-cachexia.
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PMID:The science of megestrol acetate delivery: potential to improve outcomes in cachexia. 1598 2

Dilated cardiomyopathy (DCMP) is a non-coronary heart disease, which leads to the severe degenerative changes and destruction of cardiomyocytes, heart chamber dilatation, systolic and diastolic myocardial dysfunction, steady heart failure progression, disability, and high mortality. HIV is considered to be one of the possible causes of DCMP. Heart involvement in AIDS influences prognosis by lowering survival rate. The number of HIV-infected patients grows in our country; thus, the number of patients with various AIDS manifestations is going to grow, too. In this article the authors adduce the observation of DCMP development in a HIV-infected patient.
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PMID:[HIV-associated cardiomyopathy]. 1675 60

The HIV/AIDS pandemic is creating a strain on health care services in the developing world, with knock-on consequences for HIV negative patients. We looked for possible changes over time in the patterns of illness and outcomes of admission to an adult medical unit in Zimbabwe. We performed a prospective descriptive study of discharge diagnoses and causes of in-hospital ;mortality for all medical patients under the care of one consultant at Mpilo Central Hospital, Bulawayo, Zimbabwe. Two similar 7-month periods were compared in 1992 and 2000. Data recorded included: initials, sex, alive or dead status, diagnosis and HIV/AIDS status. Similar numbers of patients were admitted in 1992 and 2000 (1305 and 1369), but in-hospital mortality increased from 13.3% to 28.6% (P < 0.001), especially in male patients (13.1% to 33.9% P < 0.001). Mortality rates increased for both infectious and non-communicable diseases such as cardiac failure, stroke and diabetes. The 10 most common diagnoses were similar, apart from Pneumocystis carinii pneumonia (PCP) cases, which increased from 18 to 90. The proportion of patients clinically or serologically positive for HIV/AIDS rose from 13.9% to 51.1% (P < 0.001), but the number of cases of the HIV wasting syndrome (SLIM)/chronic gastroenteritis did not change significantly. In 1992 there happened to be a large number of cases of malaria transmission. Mortality related to both communicable and non-communicable diseases increased, confirming that HIV negative patients are also being affected by the strain on health services. Although based on clinical and radiological diagnosis, PCP pneumonia appears to be increasingly common in this area.
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PMID:Increase in hospital mortality from non-communicable disease and HIV-related conditions in Bulawayo, Zimbabwe, between 1992 and 2000. 1688 12

Overweight (body mass index [BMI]=25-30 kg/m2) and obesity (BMI>30 kg/m2) have become mass phenomena with a pronounced upward trend in prevalence in most countries throughout the world and are associated with increased cardiovascular risk and poor survival. In patients with chronic kidney disease (CKD) undergoing maintenance hemodialysis an 'obesity paradox' has been consistently reported, i.e., a high BMI is incrementally associated with better survival. While this 'reverse epidemiology' of obesity is relatively consistent in maintenance hemodialysis patients, studies in peritoneal dialysis patients have yielded mixed results. A similar obesity paradox has been described in patients with chronic heart failure as well as in 20 million members of other distinct medically 'at risk' populations in the USA. Possible causes of the reverse epidemiology of obesity include: (1) time-discrepancies between the competing risks for the adverse events that are associated with overnutrition and undernutrition; (2) sequestration of uremic toxins in adipose tissue; (3) selection of a gene pool favorable to longer survival in dialysis patients during the course of CKD progression, which eliminates over 95% of the CKD population before they commence maintenance dialysis therapy; (4) a more stable hemodynamic status; (5) alterations in circulating cytokines; (6) unique neurohormonal constellations; (7) endotoxin-lipoprotein interactions; and (8) reverse causation. Examining the causes and consequences of the obesity paradox in dialysis patients can improve our understanding of similar paradoxes observed both for other conventional risk factors in chronic dialysis patients, such as blood pressure and serum cholesterol, and in other populations, such as patients with heart failure, cancer or AIDS or geriatric populations.
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PMID:Obesity paradox in patients on maintenance dialysis. 1692 33

The 350,000 maintenance hemodialysis (MHD) patients in the United States have an unacceptably high mortality rate of >20%/year. Almost half of all deaths are assumed to be cardiovascular. Markers of kidney disease wasting (KDW) such as hypoalbuminemia, anorexia, body weight and fat loss, rather than traditional cardiovascular risk factors, appear to be the strongest predictors of early death in these patients. The KDW is closely related to oxidative stress (SOX). Such SOX markers as serum myeloperoxidase are associated with pro-inflammatory cytokines and poor survival in MHD patients. Identifying the conditions that modulate the KDW/SOX-axis may be the key to improving outcomes in MHD patients. Dysfunctional lipoproteins such as a higher ratio of the high-density lipoprotein inflammatory index (HII) may engender or aggravate the KDW, whereas functionally intact or larger lipoprotein pools, as in hypercholesterolemia and obesity, may mitigate the KDW in MHD patients. Hence, a reverse epidemiology or "bad-gone-good" phenomenon may be observed. Diet and gene and their complex interaction may lead to higher proportions of pro-inflammatory or oxidative lipoproteins such as HII, resulting in the aggravation of the SOX and inflammatory processes, endothelial dysfunction, and subsequent atherosclerotic cardiovascular disease and death in MHD patients. Understanding the factors that modulate the KDW/SOX complex and their associations with genetic polymorphism, nutrition, and outcomes in MHD patients may lead to developing more effective strategies to improve outcomes in this and the 20 to 30 million Americans with chronic disease states such as individuals with chronic heart failure, advanced age, malignancies, AIDS, or cachexia.
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PMID:The kidney disease wasting: inflammation, oxidative stress, and diet-gene interaction. 1701 6

Cardiovascular disease has been well documented in patients with Human Immunodeficiency Virus infection, especially after the introduction of highly active antiretroviral therapy. At present, HIV infection is one of the leading causes of acquired cardiovascular disease including heart failure. Some of the changes observed in these patients include left ventricular systolic dysfunction, dilated cardiomyopathy, congestive heart failure, myocarditis, lipodystrophy, dyslipidemia, insulin resistance, accelerated atherosclerosis including myocardial infarction, prothrombotic state, pericardial effusion, pulmonary hypertension, autonomic dysfunction, and malignancy. This article summarizes the main findings in the principal HIV-associated cardiovascular manifestations in order to stimulate its early recognition so helping in early intervention and therapy.
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PMID:Cardiovascular disease in HIV infection. 1720 95

Muscle wasting and weakness are common in many disease states and conditions including aging, cancer cachexia, sepsis, denervation, disuse, inactivity, burns, HIV-acquired immunodeficiency syndrome (AIDS), chronic kidney or heart failure, unloading/microgravity, and muscular dystrophies. Although the maintenance of muscle mass is generally regarded as a simple balance between protein synthesis and protein degradation, these mechanisms are not strictly independent, but in fact they are coordinated by a number of different and sometimes complementary signaling pathways. Clearer details are now emerging about these different molecular pathways and the extent to which these pathways contribute to the etiology of various muscle wasting disorders. Therapeutic strategies for attenuating muscle wasting and improving muscle function vary in efficacy. Exercise and nutritional interventions have merit for slowing the rate of muscle atrophy in some muscle wasting conditions, but in most cases they cannot halt or reverse the wasting process. Hormonal and/or other drug strategies that can target key steps in the molecular pathways that regulate protein synthesis and protein degradation are needed. This review describes the signaling pathways that maintain muscle mass and provides an overview of some of the major conditions where muscle wasting and weakness are indicated. The review provides details on some therapeutic strategies that could potentially attenuate muscle atrophy, promote muscle growth, and ultimately improve muscle function. The emphasis is on therapies that can increase muscle mass and improve functional outcomes that will ultimately lead to improvement in the quality of life for affected patients.
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PMID:Therapeutic approaches for muscle wasting disorders. 1725 13

Pharmacological agents used to treat patients with AIDS have been associated with QT prolongation and result in delayed repolarization. New evidence suggests that delayed repolarization can occur independently of pharmacological therapy. However, the effect of HIV on ventricular repolarization has not been investigated. Therefore, the objective of this study was to characterize cardiac repolarization in a mouse model of human HIV disease. All experiments were conducted on HIV transgenic mice (CD4C/HIV). These mice express the human HIV gene nef in cells of immune system and develop a severe AIDS-like disease that is similar to that observed in humans. ECG was recorded in conscious free moving mice and patch-clamp techniques were used to record action potentials and K+ current densities in single ventricular myocytes. Results showed that the QT interval and action potential duration were significantly prolonged in CD4C/HIV mice compared to wild-type littermates. This delay in repolarization was associated with a significant reduction in outward K+ currents. Echocardiography showed that cardiac structure and function were similar in CD4C/HIV and littermate control mice. This suggests that the changes in ventricular repolarization were not the result of heart failure or cardiac hypertrophy. Overall, this study shows that repolarization was delayed in CD4C/HIV mice and that this phenotype occurred in the absence of any pharmacological intervention. Thus, it appears that HIV may be responsible for the delayed ventricular repolarization phenotype observed in CD4C/HIV mice.
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PMID:Cardiac repolarization is prolonged in CD4C/HIV transgenic mice. 1759 46


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