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As its socioeconomic situation is improving, Indonesia is now in epidemiological transition, having the double burden of infectious diseases and emerging noncommunicable, especially cardiovascular, diseases. A review of the data from recent community surveys indicates an increase in cardiovascular diseases, particularly ischaemic heart disease and hypertension and its sequelae, as causes of morbidity and mortality, most markedly among the elderly, while rheumatic heart disease and congenital heart disease continue to have much lower incidences. In response to this situation, Indonesia has joined the WHO MONICA Project as an associate member. The first population screening, completed in 1988 on 2,073 randomly selected subjects, disclosed important risk factors including hypertension, smoking and physical inactivity. Lipid values are low compared with Western figures but higher than Japanese values. The prevalence of hypertension ranged from 5 to 15% in all adults but reached over 20% in those aged 50 years and over. Primary and primordial prevention programmes are to receive higher priority, and health education is to be given special attention at all levels. It will be necessary for the government to work closely with nongovernmental organizations in order to accomplish the tasks in hand.
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PMID:The pattern of cardiovascular disease in Indonesia. 830 6

HIV infection has been associated with a variety of renal diseases, although the pathogenesis of such dysfunction is unknown. To determine whether HIV-infection is associated with glomerular permeability defects, and if so, the prevalence of the finding, we studied patients with various stages of HIV infection. Urine samples from 505 outpatients with HIV infection (without hypertension, azotemia, or dipstick proteinuria), 41 normal controls and 40 febrile non-HIV positive, hospitalized patients with infectious diseases were analyzed for the urinary microalbumin/creatinine ratio (U microA/Cr), a sensitive indicator of incipient renal disease in diabetes mellitus and hypertension, and the urinary beta 2-microglobulin/creatinine ratio (U beta 2/Cr), an indicator of renal tubular function. Microalbumin concentration was measured by ELISA. Beta 2-microglobulin concentration was measured by an enzyme immunoassay. HIV-infected outpatients had higher mean U microA/Cr than normal subjects, but not febrile hospitalized controls. The prevalence of an increased U microA/Cr was 29.8% in the HIV-infected outpatient population. There was no difference in the ratio between Black and White HIV-infected outpatients, HIV-infected outpatients treated or untreated with zidovudine (AZT), or HIV infected outpatients untreated with any drug. There was no difference between U microA/Cr in stage II, III or IV HIV-infected patients when assessed by analysis of variance. A similar pattern was noted with U beta 2/Cr. The prevalence of an increased U beta 2/Cr ratio was 37.7% in HIV-infected outpatients. Increased urinary albumin and beta 2-microglobulin excretion, not associated with drug therapy, is present in patients with early HIV infection.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Abnormal urinary protein excretion in HIV-infected patients. 813 71

Cocaine abuse has produced a major epidemic health problem in North America in the 1980s. The abuse of cocaine is maintained by the drug's effects on brain reward systems, mediated at least in part by its dopaminergic action. The patterns and consequences of use are best understood by considering the pharmacokinetics (rapid absorption and delivery to the brain, relatively short half-life) and the pharmacodynamics (intense central and peripheral neural stimulation). Cocaine is used therapeutically as a topical and local anaesthetic. Toxicity occurs primarily in cocaine abusers, but also occasionally after therapeutic dosing. Medical complications reflect primarily excessive central nervous system stimulation and excessive vasoconstriction, the latter resulting in severe hypertension and/or organ ischaemia with associated organ injury. Most deaths that result from medical complications of cocaine intoxication are sudden and occur before medical intervention is possible. Other complications of cocaine abuse with severe personal and social consequences include traumatic deaths and injuries, and reproductive disturbances, as well as transmission of infectious diseases, especially AIDS. Cocaine addiction is clearly a problem, although the number of addicts is unknown. Pharmacologic treatment of cocaine addiction has as yet been unsuccessful. Psychosocial approaches remain the mainstay of therapy.
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PMID:Clinical pharmacology and toxicology of cocaine. 844 38

We have reappraised studies on morbidity and mortality in continuous ambulatory peritoneal dialysis (CAPD), comparing it with hemodialysis (HD), the standard treatment for end-stage renal disease (ESRD). More hospitalization is required for CAPD, the difference being related to peritonitis, to the more frequent presence of some risk factors (such as diabetes and atherosclerosis) in the patients selected for CAPD, and to the lack of experience in the early years of CAPD practice. CAPD patients have less acute morbidity during treatment that not always requires hospitalization: hypotension, hypertension, arrhythmias, and myocardial ischemia. Cardiac performance is also better in CAPD patients, who develop less myocardial hypertrophy than HD patients. Hospitalization due to infectious disease not referable to technique, beta 2-microglobulin related morbidity, signs of uremic neuropathy, osteodystrophy, and malnutrition are similar in both groups. Method survival is better for HD, the difference being completely accounted for by peritonitis. Patient survival adjusted for pre-treatment differences is similar in CAPD and HD, and this is not an artifact of more drop-outs on CAPD. A high incidence of peritonitis is accompanied by an increased risk of death. Older patients have a lesser risk of death on CAPD than on HD. Diabetics have a worse survival than non-diabetics, with no difference between the two methods. Although patient survivals on CAPD and HD are the same, differences in the mode of blood purification have an interesting impact on particular aspects of morbidity.
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PMID:Morbidity and mortality of CAPD and hemodialysis. 844 38

Patients with sickle cell disease often develop acute chest syndrome (ACS). Signs of ACS include chest pain, fever, prostration, and pulmonary opacities. Pneumonia and infarction have been implicated in the pathogenesis of this syndrome. Infarction as a result of microvascular occlusion and pneumonia are not easily differentiated with chest radiography or ventilation-perfusion scintigraphy. The authors evaluated the ability of thin section (3-mm) chest computed tomography (CT) to help diagnose microvascular occlusion in ACS and thus help differentiate two of its most likely causes. CT scans of the chest of 10 patients with moderate to severe ACS were retrospectively reviewed by two observers, who listed the number of bronchopulmonary segments showing consolidation; areas of ground-glass attenuation due to early hemorrhagic edema; and paucity or absence of small vessels, arterioles, and venules. In all patients, the degree of hypoxia was out of proportion to the extent of consolidation evident at chest radiography. The CT scans showed microvascular occlusion and areas of ground-glass attenuation in nine patients. Infection was ruled out in eight patients. High-resolution CT may play an important role in the initial evaluation and timely selection of an appropriate treatment regimen aimed at improving tissue perfusion, thus forestalling irreversible organ damage and chronic pulmonary arterial hypertension in patients with sickle cell disease.
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PMID:Acute chest syndrome in sickle cell disease: CT evidence of microvascular occlusion. 845 35

Data was compiled from a wide variety sources in order to construct a demographic profile of elderly women in Latin America. Data was organized into a cross-classification matrix based on three age groups (midlife, young old, and old old) and three country types (highly rural, mixed, and highly urban). The macro-level overview takes into account such factors as education, family structure, and employment. Smaller reports and research project reports of micro conditions are used to help explain the macro trends. Women older than 40 represented 9-20% of the population of the region (of 21 Latin American and Caribbean countries). 6-14% of midlife women were widowed, with the highest concentrations in urban countries. Widows and single women comprised about 20-35% of midlife women and 50-65% of older women. Female household headship increased with age from 9-23% in midlife to 24-41% among women 60 years and older. In all countries with the exception of Uruguay, women had less primary schooling than men. Women's salaried employment in the formal sector decreased rapidly with increasing age. For example, in highly urban countries the range of employment was from 34% of women in midlife to only 4% among women 65 years and older. Women were working, but often in the informal sector or as prostitutes or beggars. Women's health conditions included 12-37% with chronic anemia and many with signs of premature aging (early onset of diabetes, hypertension, and osteoarthritic joint changes). Depression among older women may have been as high as 40%. The strain of maintaining a double work load of child care and housekeeping and employment is unmeasured. Regardless of the level of development, older women suffered primarily from heart disease. Breast cancer was more common in urban countries. Highly rural or mixed countries had greater incidence of cervical cancer. Chronic liver disease was appearing in some countries. In highly rural countries infectious diseases and malnutrition still contributed significantly to causes of death. Most women did not have social security coverage. Evidence points to women's remarkable responses (creativity, initiative, and persistence) to fulfilling survival needs.
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PMID:Older women in Latin America: the health and socioeconomic situation of this important subgroup. 857 13

A case of cranial hypertrophic pachymeningitis of unknown etiology in a patient with 15-year history of headaches, cranial nerve palsies, and gait disturbance is reported. A 77-year-old woman was brought to our institute in a coma. CT revealed intracerebral hemorrhage in the right temporal lobe and thickening of the falx and tentorium. Fifteen years previously the patient had undergone CT scanning because of headaches, cranial nerve palsies, and progressive gait disturbance and a thickened tentorium, mild hydrocephalus and edematous change in the right temporal lobe had been reported. Since the etiology of her symptoms was unclear at the time, she did not receive adequate treatment. Her symptoms gradually progressed thereafter, and her visual acuity and hearing deteriorated. MR imaging in 1994 showed the thickened tentorium as a hypointense area with hyperintense edges on Gd-DTPA enhanced images. Angiography revealed narrowing of posterior portion of the superior sagittal sinus. The patient's condition rapidly deteriorated due to the intracranial hypertension and she subsequently died. Autopsy revealed a thickened tentorium with xanthochromic surface. This hypertrophic change was also seen in the dura mater of the posterior and middle cranial fossa. Microscopic examination of the thickened tentorium revealed extensive fibrous tissue with a chronic inflammatory infiltrate, predominantly of lymphocytes. No specific lesions were revealed by staining with hematoxylin-eosin, PAS, Gram's or Ziehl-Neelsen stains. The patient had no inflammatory or infectious diseases of other organs, and a diagnosis of idiopathic cranial hypertrophic pachymeningitis of unknown etiology was made. Considering the above findings, the thickened tentorium depicted as a hypointense area on the T1- and T2-weighted images and the Gd-enhanced edges of the tentorium are thought to be represent fibrous tissue and inflammatory regions, respectively.
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PMID:[A case of cranial hypertrophic pachymeningitis with intracranial hemorrhage]. 867 7

A national survey was performed in France from May to June, 1993. The aim of this study was to evaluate general practitioners' attitudes and behaviors when diagnosing and managing patients with lower extremity arterial disease (LEAD). One thousand general practitioners, randomly drawn from an exhaustive list, were contacted to participate in a telephone interview concerning the last patient with intermittent claudication seen in their practice. Four hundred seventy-six general practitioners participated. Risk factors noted for these 476 patients with intermittent claudication were in agreement with the literature: 86% were men aged 64 +/- 10 years (mean +/- SD) and 14% were women aged 73 +/- 8 years. Sixty-two percent had a pain-free walking distance of between 100 and 500 meters at diagnosis. Forty-five percent were former smokers and 37% currently smoked; 55% had hypertension, 14% diabetes, and 56% disturbances of lipid metabolism. A majority of them were hypercholesterolemic. The diagnosis of the disease was based primarily on a clinical assessment, confirmed for 33% by Doppler or echo Doppler. The mean duration of diagnosis was 4.4 +/- 4.1 years. Management of the disease was mainly by prescription of vasodilators (91%), antiplatelet agents (59%), and anticoagulants (8%). Use of Doppler or echo Doppler was recommended once a year. Infection was observed in 27% of patients. Thirty-eight percent had had a cardiac incident (angina pectoris or myocardial infarction) and 10% a cerebrovascular accident. They differed significantly from those with LEAD alone for the following parameters: age (68.5 +/- 9.2 vs. 63.2 +/- 10.3 years; p < 0.001); duration of LEAD (5.6 +/- 4.6 vs. 3.6 +/- 3.5 years; p < 0.001); hypertension (65% vs. 50%; p < 0.01); and current smoking (29% vs. 43%; p < 0.01). This survey confirmed the feasibility of telephone interviewing, on a large sample of general practitioners in France. The high level of association with other cardiac incidents was, for these patients, a much higher risk of mortality and morbidity than LEAD alone. It would be interesting to validate the associations observed with a prospective study of comorbidity.
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PMID:National study of obliterative arterial disease of the lower limbs involving general practitioners in France: Artemio study. 869 62

In Japan, the spread of immunization and the development of antibiotics and antituberculosis drugs have dramatically decreased the mortality rate from infectious diseases since World War II. Alterations in health practices, such as decreasing the intake of salty foods and strict management of hypertension, have resulted in prominent decreases in the mortality rate from cerebrovascular diseases, especially from cerebral hemorrhage. However, we still have high death rates from malignant neoplasms and circulatory diseases, which may be partly prevented through improvement of health status. We discuss here about various health promotion activities recently reported in Japan, including prevention of smoking, promotion of exercise, improvement of nutrition, improvement of mental health status, and health risk appraisal. Finally we would like to stress the importance of comprehensive assessment of health status in order to encourage health promotion activities further.
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PMID:Health promotion activities in Japan. 880 Feb 90

The contribution of hypertension to adult mortality in Africa has not been well studied. Although cross-sectional surveys have provided data on the prevalence of this condition, the relative risk of death associated with hypertension has not been defined. In the face of high levels of competing mortality from infectious disease among the general population, and the virtual absence of atherosclerotic precursors, estimates of risk derived from industrialised countries may not be generalisable to this setting. We conducted a 2-year prospective study among 1344 mean and women in a rural community in south-western Nigeria. The prevalence of hypertension (140/90 mm Hg) at baseline was 9.3%. In the observational phase, 3.0% of the survey participants died each year. Among the 74 decedents, hypertension was nearly twice as common as among those who survived (14.9% vs 8.4%). In multivariate analysis the risk of death increased over 60% for a 20 mm Hg increase in diastolic blood pressure. The population attributable risk, or the reduction in mortality that would have been observed if hypertension were not present in this community, was estimated as 7%. These findings document an identifiable impact of hypertension on all-cause mortality in rural Africa and demonstrate that programs to evaluate potential treatment options are needed.
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PMID:The mortality risk associated with hypertension: preliminary results of a prospective study in rural Nigeria. 888 May 60


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