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 15,891 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

We try to establish a new clinical laboratory system, so-called profiles for each diagnosis related group which have features as shown below. 1) The profiles are clinical manuals that are utilized by home doctors and show how to diagnose, follow up, observe complications and judge therapeutic effect. 2) The profiles are constructed on condition that they cover 60% of cases and cases that they cannot handle are supposed to be referred to the major hospitals or the specialized doctors. 3) The profiles are guaranteed to be reformed and maintained according to medical advancement. 4) The target diseases of the profiles are thyroid disease, liver diseases, diabetes mellitus, respiratory disease, infectious disease, renal disease, cardiac disease, hyperlipemia, collagen disease, hematological disease, osteoporosis and gynecological disease. We present the profiles for thyroid disease, hyperlipemia and collagen disease which have been accomplished.
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PMID:[The introduction of a new clinical laboratory system, so-called the profiles for each diagnosis related group]. 1176 68

Three categories of highly active antiretroviral therapy (HAART)-associated major toxic effects have been identified: nucleoside-related toxic effects (e.g., neuropathy, myopathy, pancreatitis, hepatic steatosis, lactic acidosis, and possibly lipoatrophy), metabolic complications (e.g., fat redistribution, insulin resistance, and hyperlipidemia), and bone disease (e.g., osteopenia and/or osteoporosis). The toxic effects caused by nucleosides are hypothesized to be a result of mitochondrial injury and include myopathy, pancreatitis, liver failure, and lactic acidosis. Alterations in lactic acid metabolism range from common instances of asymptomatic lactic acidemia to rare occurrences of life-threatening lactic acidosis with hepatic steatosis. A metabolic syndrome consisting of lipodystrophy (i.e., fat redistribution), hyperlipidemia and insulin resistance has been observed, particularly with protease inhibitor treatment. Some additive interaction between protease inhibitors and nucleosides has also been described. The potential relationship of these metabolic abnormalities to increased risk of cardiovascular disease and diabetes has broad implications on long-term patient management. Lipodystrophy associated with HAART is generally accompanied by potentially serious abnormalities, including dyslipidemia (i.e., hypercholesterolemia and hypertriglyceridemia) and altered glucose metabolism (i.e., insulin resistance). Regimens of HAART may have adverse effects on bone metabolism, as indicated by emerging reports of osteopenia, osteoporosis, and avascular necrosis.
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PMID:Long-term exposure to lifelong therapies. 1183 99

Lung transplantation has become an accepted treatment modality for end stage lung disease including emphysema, fibrosing alveolitis, cystic fibrosis, pulmonary hypertension and bronchiectasis. Despite the use of potent immunosuppressive drugs, acute rejection occurs frequently, especially in the first few weeks and months after transplantation. Bacterial, viral and fungal infections frequently occur in lung transplant recipients. Rapid diagnosis and adequate treatment of infections is needed. The side effects with the use of long term immunosuppressive agents includes renal toxicity, hypertension, neurotoxicity, hyperlipidemia, leucopoenia, hyperglycaemia, weight gain, osteoporosis and malignancy. However, obliterative bronchiolitis (OB) which is regarded as a chronic rejection process remains the dominant cause of morbidity and mortality in the long-term survivors of lung transplantation. This article focuses on the postoperative and long term management of lung transplant recipients.
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PMID:Lung transplantation: management and complications. 1184 31

3-Hydroxy-3-methylglutaryl coenzyme A (HMG-CoA) reductase inhibitors (statins) are greatly contributed to the treatment of hypercholesterolemia, and constitute an important part of comprehensive strategies for the treatment of cardiovascular disease in the 21st century. Particularly, a strategy for preventing acute coronary syndrome (ACS), the most important complication of hyperlipidemia, is urgently needed. Recent research has revealed a new mechanism of prevention of coronary heart disease by statins: they not only lowered cholesterol level as previously reported, but also contribute directly to plaque stabilization. Among many statins recently marketed, some act directly onto the blood vessel wall to stabilize plaques already formed (so-called vascular statins), while statins are originally classified as chemical or non-chemical. At the same time, reports on pleiotropic activities of statins, including improvement of osteoporosis, have accumulated to suggest an extended role of statins, not merely as a hypolipidemic agent but also possibly an anti-arteriosclerotic/anti-aging drug. This article reviews the direct action of statins on the blood vessel wall, with reference to classification of statins based on difference in action on the blood vessel wall (hepatic statins vs. vascular statins).
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PMID:HMG-Co A reductase inhibitors in the treatment of cardiovascular diseases: stabilization of coronary artery plaque. 1218 29

Nonhormonal contraceptives, include the condom that is safe and frequently used lately because of its ability to help in the prevention of sexually transmitted diseases. There is often psychological resistance to the use of diaphragm in the over 40 age group. The rhythm method is not reliable especially in irregular menstrual cycles, and its lack of reliability can cause anxiety. In the US 16% of women over 40 use spermicides. The IUD is recommended to women over 40 because of 1-time insertion, no requirement of care, efficacy, and the risk of pelvic inflammatory disease is modest at this age. IUDs with progesterone are particularly effective and seem to reduce the risk of inflammatory disease by making the cervical mucus more viscous. Surgical sterilization is not recommended at this age. Women over 40 who are not obese, do not smoke, and do not have a family history of cardiovascular disease have no contraindications to using modern oral contraceptives, (OCs). On the other hand, family history of diabetes and hyperlipidemia has to be assessed on an individual basis. Low dose contraceptives can have outright beneficial effects in vascular pathology by improving the hemostatic profile. Recently, animal research has suggested the possibility of a protective effect of OCs on the cardiovascular system. OCs also protect against osteoporosis. Although the debate is still unresolved, at the moment there is no proof whatsoever that OCs increase the risk of breast cancer in women over 40. The evaluation of patients for OC use has to include a diabetic history of mother or father, familial cardiovascular disease, overweight by more than 20%, smoking more than 10 cigarettes a day, and hypertension. If findings are negative, there is no appreciable risk for the patients. Mammography every 2 years for those with familial precedents, laboratory tests (lipid profile, coagulation, and hepatic function) and semiannual checkups are also be recommended.
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PMID:[Contraception in women over forty]. 1234 91

Approximately half of patients with schizophrenia have at least one comorbid psychiatric or medical condition, worsening prognosis and contributing to the high rate of morbidity and mortality. Depression is associated with suicide, the leading cause of premature death in patients with schizophrenia; obsessive-compulsive symptoms may worsen prognosis; alcohol and substance use disorders are associated with a poor outcome; and comorbid medical conditions, including cardiac and pulmonary disease, infectious diseases, diabetes, hyperlipidemia, hypogonadism, and osteoporosis, are often underrecognized and undertreated. The new generation of antipsychotic medications has improved the potential outcome of patients with schizophrenia. Providing optimal treatment for patients and fully realizing the potential of these new agents require focused attention on detection, recognition, and treatment of comorbid psychiatric and medical conditions in patients with schizophrenia.
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PMID:Detection and management of comorbidity in patients with schizophrenia. 1268 63

Endogenous thyroid receptor hormones 3,5,3',5'-tetraiodo-l-thyronine (T(4), 1) and 3,5,3'-triiodo-l-thyronine (T(3), 2) exert a significant effects on growth, development, and homeostasis in mammals. They regulate important genes in intestinal, skeletal, and cardiac muscles, the liver, and the central nervous system, influence overall metabolic rate, cholesterol and triglyceride levels, and heart rate, and affect mood and overall sense of well being. The literature suggests many or most effects of thyroid hormones on the heart, in particular on the heart rate and rhythm, are mediated through the TRalpha(1) isoform, while most actions of the hormones on the liver and other tissues are mediated more through the TRbeta(1) isoform of the receptor. Some effects of thyroid hormones may be therapeutically useful in nonthyroid disorders if adverse effects can be minimized or eliminated. These potentially useful features include weight reduction for the treatment of obesity, cholesterol lowering for treating hyperlipidemia, amelioration of depression, and stimulation of bone formation in osteoporosis. Prior attempts to utilize thyroid hormones pharmacologically to treat these disorders have been limited by manifestations of hyperthyroidism and, in particular, cardiovascular toxicity. Consequently, development of thyroid hormone receptor agonists that are selective for the beta-isoform could lead to safe therapies for these common disorders while avoiding cardiotoxicity. We describe here the synthesis and evaluation of a series of novel TR ligands, which are selective for TRbeta(1) over TRalpha(1). These ligands could potentially be useful for treatment of various disorders as outlined above. From a series of homologous R(1)-substituted carboxylic acid derivatives, increasing chain length was found to have a profound effect on affinity and selectivity in a radioreceptor binding assay for the human thyroid hormone receptors alpha(1) and beta(1) (TRalpha(1) and TRbeta(2)) as well as a reporter cell assay employing CHOK1-cells (Chinese hamster ovary cells) stably transfected with hTRalpha(1) or hTRbeta(1) and an alkaline phosphatase reporter-gene downstream thyroid response element (TRAFalpha(1) and TRAFbeta(1)). Affinity increases in the order formic, acetic, and propionic acid, while beta-selectivity is highest when the R(1) position is substituted with acetic acid. Within this series 3,5-dibromo-4-[(4-hydroxy-3-isopropylphenoxy)phenyl]acetic acid (11a) and 3,5-dichloro-4-[(4-hydroxy-3-isopropylphenoxy)phenyl]acetic acid (15) were found to reveal the most promising in vitro data based on isoform selectivity and were selected for further in vivo studies. The effect of 2, 11a, and 15 in a cholesterol-fed rat model was monitored including potencies for heart rate (ED(15)), cholesterol (ED(50)), and TSH (ED(50)). Potency for tachycardia was significantly reduced for the TRbeta selective compounds 11a and 15 compared with 2, while both 11a and 15 retained the cholesterol-lowering potency of 2. This left an approximately 10-fold therapeutic window between heart rate and cholesterol, which is consistent with the action of ligands that are approximately 10-fold more selective for TRbeta(1). We also report the X-ray crystallographic structures of the ligand binding domains of TRalpha and TRbeta in complex with 15. These structures reveal that the single amino acid difference in the ligand binding pocket (Ser277 in TRalpha or Asn331 in TRbeta) results in a slightly different hydrogen bonding pattern that may explain the increased beta-selectivity of 15.
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PMID:Thyroid receptor ligands. 1. Agonist ligands selective for the thyroid receptor beta1. 1269 76

Recent studies suggest that the mevalonate pathway plays an important role in skeletal metabolism. HMG CoA reductase inhibitors ("statins"), which inhibit a key enzyme in the mevalonate pathway, are widely used for the treatment of hyperlipidemia. In vitro and animal studies demonstrate that statins stimulate the production of BMP-2, a potent regulator of osteoblast differentiation and activity, suggesting that statins may have an anabolic effect on bone. Statin use in most, but not all observational studies is associated with a reduced risk of fracture, particularly hip fracture, even after adjustment for the confounding effects of age, weight and other medication use. This beneficial effect has not been observed in clinical trials designed to assess cardiovascular endpoints. The effects of statins on bone mass and bone turnover are controversial, but increased bone mass and reduced bone turnover have been observed in controlled studies. Further studies of the skeletal effects of statins are needed, particularly their effects on surrogate markers such as bone mass, bone turnover, and microarchitecture, to determine the optimal formulation, dosing and route of administration. Clinical trials with fracture endpoints are needed before statins can be recommended as therapeutic agents for osteoporosis.
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PMID:HMG CoA reductase inhibitors and the skeleton: a comprehensive review. 1273 72

Several years ago we hypothesized that products of lipid and lipoprotein oxidation may contribute to pathophysiology of osteoporosis (F. Parhami, Curr. Opin. Lipidol. 8 (1997) 312), and that their effects on artery wall and bone cells may explain the parallel development of osteoporosis and atherosclerosis in the same subjects (R. Boukhris, JAMA 219 (1972) 1307; M.A. Frye, Bone Miner. 19 (1992) 185). Since then, new evidence has accumulated in support of this hypothesis and its possibility is being further tested by investigators in both vascular and bone fields (A.D. Watson, J. Biol. Chem. 272 (1997) 13597). This review will summarize the evidence to date that support the role of oxidized lipids in osteoporosis, and will address some of the issues that need further examination in order to establish whether hyperlipidemia and susceptibility to lipid oxidation may serve as risk factors for osteoporosis.
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PMID:Possible role of oxidized lipids in osteoporosis: could hyperlipidemia be a risk factor? 1279 57

Extensive differences in the osteoporosis epidemiological pattern among geographic and ethnic groups have been reported. The evidence concerning association of multiple pregnancies, lactations, and other menstrual history factors with low bone mineral density (BMD) remains inconclusive. Previous local studies addressing these issues in Jordan are very restricted. We present a cross-sectional study of Jordanian women who visited outpatient clinics between August 2000 and August 2002 at two community hospitals in Amman City. BMD measurement was performed for all subjects, while comprehensive appraisal of clinical issues related to reproductive status and past medical history was carried out using a structured questionnaire administered to 50% of the subjects. We also attempted to examine the current hypothesis of possible influence of hyperlipidemia and thyroid abnormalities on decreased BMD. According to WHO criteria, 119 (29.6%) were identified as having osteoporosis, 176 (43.8%) were osteopenic, and 107 (26.6%) had normal BMD. The multiple-linear regression analyses at different bone sites revealed that age, years of menopause, low-density lipoprotein (LDL), and follicle-stimulating hormone (FSH) have strong independent associations with decreased BMD at all lumbar and femoral neck regions. The negative effect associated with number of children (live births) and frequency of lactations was only evident at femoral neck. Although years of menstruation, age at menopause, days of menstrual cycle, number of pregnancies, and duration of hormone replacement therapy (HRT) were positively correlated with BMD, they had weaker associations than previous variables. Moreover, in the final multivariable logistic regression model, variables which rendered significantly independent risk factors after adjustment for age and BMI were: current smokers of more that 25 cigarettes/day, postmenopausal women irrespective of HRT use, menopausal years of > or =5 year intervals, natural early menopause, gastrointestinal disease, rheumatoid arthritis, osteoarthritis, hypertension, and thyroid replacement therapy. Ever-lactation, frequent lactation of 4 or more times, duration of lactation interval of 1-6 months and clinical hyperthyroidism were significant protective factors. Hysterectomy with or without oophorectomy, premature ovarian failure, gravidity, menstrual flow pattern, family history of osteoporosis, clinical hypothyroidism, hyperlipidemia, HRT, and corticosteroids therapy were not independent predictors of osteoporosis among our population. It was concluded that the prevalence of this worldwide public health problem among the Jordanian female population is extremely high, and is even found in younger age categories compared to previous international surveys. Though, the number of pregnancies in our multiparous female population showed a negative impact on femoral neck BMD, no evidence of increased risk of osteoporosis among ever-pregnant women was noted. Conversely, the current data analysis highlight many potential risk factors including associated medical illnesses, and other hormonal alterations experienced during menopausal period. Therefore, increased health awareness and intensive screening programs are mandatory for early detection of low bone mass.
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PMID:Prevalence of osteoporosis and its reproductive risk factors among Jordanian women: a cross-sectional study. 1453 Sep 8


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