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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

The status of dialytic therapy in Korea at the end of 2001 was reported by the end-stage renal disease (ESRD) registry committee of Korean Society of Nephrology, where data were collected through an internet on-line registry program. The number of dialysis centres was 335 and the number of haemodialysis machines was 5529. The total number of patients with dialysis was 23,057 (haemodialysis 17,568, peritoneal dialysis 5489). Prevalence and incidence of dialysis patients were 477.5 and 96.4 patients per million population. The most common primary cause of end-stage renal diseases was diabetic nephropathy (41.5%), hypertensive nephrosclerosis (15.4%), and chronic glomerulonephritis (13.6%). Eighty-six percent of haemodialysis patients were on dialysis therapy three times a week, the mean urea reduction ratio was 66.7 +/- 8.68% and mean Kt/V was 1.250 +/- 0.292 in male patients; 1.526 +/- 0.361 in female patients. The technical survival of haemodialysis in 5 years was 30.2% and peritoneal dialysis was 13.8%. The common complication of haemodialysis patients was hypertension (43.3%), gastrointestinal disease other than peptic ulcer (8.0%), congestive heart failure (7.6%), and of peritoneal dialysis patients were also hypertension (28.8%), congestive heart failure (5.0%), and peritonitis (4.8%). The most common causes of death were cardiac diseases (26.9%), vascular diseases, including cerebrovascular accidents (22.7%), and infection (17.8%).
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PMID:Current status of dialytic therapy in Korea. 1501 84

The objective of this study is to clarify the difference of health-related quality of life (HRQoL) profiles by disease category with the SF-36 questionnaires, and to examine the possibility of application for a longitudinal study. A number of subjects was 536, specifically 127 men and 409 women. For all of the eight domains, Cronbach's alpha exceeded 0.7. Categories in which all of the domains were approximately equal to the national standard included hypertension, neck and shoulders syndrome, diabetes, hyperlipidemia and cardiac disease. Bodily pain was especially lower in gastrointestinal disorder, spondylopathy and hemopathy. Patients with mental disorder had lower scores in all domains. Categories in which 5-7 of the eight domains had lower scores included arthropathy, asthma, chronic hepatitis, autonomic imbalance, 'ovariopathy and hysteropathy' and chronic rheumatism. No significant change was found between the first and second scores in hypertension as a representative of the high HRQoL categories. In mental disorder as a representative of the low HRQoL categories, however, five of the eight domains increased significantly. We concluded that a target disease should be chosen among subjects with low HRQoL scores before an intervention to assess its effectiveness. Or subjects with high HRQoL scores can be examined to determine whether they keep the same level of HRQoL.
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PMID:Health-related quality of life in outpatients of a psychosomatic medicine clinic: a pilot survey in Japan. 1571 82

During 2002 and 2003, 1438 patients underwent a complete medical history and physical by the same hospital-based prescreening program before elective total joint arthroplasty to determine the benefits of this preoperative examination. Sixty percent of patients were female. Mean age was 67.5 years. New diagnoses established as a result of this prescreening program included coronary artery disease (0.12%), congestive heart failure (0.6%), valvular heart disease (3.2%), cardiac dysrhythmia (4.4%), chronic obstructive pulmonary disease (7.2%), cancer (9.6%), hypertension (55.8%), gastrointestinal disorder (37.1%), diabetes mellitus (12.1%), and urinary tract infection (2.2%). Forty-five (2.5%) patients were deemed unacceptable surgical candidates. Patients identified with an increased risk of perioperative cardiac problems were those with a preoperative diagnosis of valvular heart disease (P = .0077), congestive heart failure (P = .0093), or diabetes mellitus (P = .0187).
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PMID:The prescreening history and physical in elective total joint arthroplasty. 1782 9

The objective of the present study was to assess the risk factors for stroke in patients undergoing coronary artery bypass grafting (CABG) surgery. We conducted a nested case-control study from a 9-year, prospective hospitalization cohort (n = 6245). Inclusion in the cohort included CABG between October 1993 and June 2002. Exclusion criteria included any other simultaneously performed surgery. Cases were defined as patients who underwent CABG and experienced a stroke (171 cases, 2.7% of the total), and controls were patients who underwent CABG without a stroke. Cases were matched to controls at a ratio of 1:3 (513 controls). The 39 predictor variables were pump time, body surface area, creatinine, previous percutaneous transcoronary angioplasty (PTCA), clamp time, coronary perfusion time, previous cardiac surgeries, hypertension, race, sex, previous myocardial infarction, family history of coronary disease, history of cerebrovascular disease, preoperative neurologic disease, pulmonary hypertension, aortic disease, previous intervention within 30 days, angina history, bleeding history, previous vascular surgery, diabetes, age, myocardial findings, chronic obstructive pulmonary disease, New York Heart Association class, previous gastrointestinal disease, current vascular disease, systemic diseases, vessels at last PTCA, PTCA result, current smoking, tobacco history, dialysis, current anticoagulant therapy, character of operation, left ventricular hypertrophy, hypercholesterolemia, and chronic corticosteroid therapy. There were 13 significant predictors of stroke. Regression analysis revealed 3 independent predictors of stroke: age >70 years (odds ratio [OR], 4.61; 95% confidence interval [CI], 2.84-6.07), poor preoperative neurologic status (OR, 4.24; 95% CI, 2.02-5.79), and previous cardiac surgery (OR, 1.75; 95% CI, 1.05-2.91). We conclude that in patients undergoing CABG surgery, the independent predictors for stroke, in order of risk, are age >70 years, poor preoperative neurologic status, and previous cardiac surgery.
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PMID:Predictors of stroke in patients undergoing coronary artery bypass grafting surgery: a prospective, nested, case-control study. 1790 72

Angina bullosa hemorrhagica (ABH) is an oral mucosal blood blister that develops without blood dyscrasia or vesiculobullous disorder. Although a minor mucosal trauma has been suggested as a triggering factor for ABH, its etiopathogenesis, especially the causative role of systemic conditions, is largely unknown. We investigated the presence or absence of local factors as well as systemic background disease in 16 patients with ABH arising in the soft palate. All the lesions were solitary, and 75% of them (n = 12) appeared during the ingestion of hard or crispy food. With regard to underlying systemic conditions, hypertension was the most common (n = 6), and asthma, insomnia, diabetes mellitus, rheumatoid arthritis, gastrointestinal disorder and hyperuricemia were also recorded (n = 1 each). Five patients had no significant background disease. There were no recalcitrant or recurrent cases. In conclusion, the present study has revealed that scratching of the oral mucosa during eating plays an important role in the formation of ABH. Hypertension appears to be the most frequent background condition, but its pathogenic relationship with ABH remains speculative, as hypertension is fairly common in adults.
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PMID:Angina bullosa hemorrhagica of the soft palate: a clinical study of 16 cases. 1840 81

Gout is a commonly occurring medical condition that can lead to significant morbidity. Therapies available for the treatment of both acute and chronic gouty arthritis have not changed significantly since the 1960s. Although these treatments are well established, they are often contraindicated in the presence of various different comorbidities, including diabetes, renal insufficiency, hypertension and gastrointestinal disease, all of which can occur frequently in patients with gout. Therefore, new treatments are needed. This review describes recent advances in therapeutics for gout, including drugs designed to reduce levels of urate and to inhibit acute or chronic inflammation. While some of these strategies are currently available, others are undergoing regulatory evaluation or are at earlier stages of development.
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PMID:New treatments for gout. 2041 95

The prevalence of a necklace of telangiectases increases with the quantity and duration of regular alcohol intake. The necklace was present in 7%, 61.4%, 88.6%, and 98.5% of four groups of patients acknowledging less than 27 grams of ethanol intake per day for ten years, 77 grams per day for seven years, 112 grams per day for 11 years, and 113 grams per day for 15 years, respectively. The necklace first appeared after three to eight years of drinking 77 grams of ethanol (five to six drinks) per day, seems to be permanent and to appear before other skin changes associated with alcohol abuse such as `gooseflesh', palmar erythema, and spider nevi. Recognition of the necklace indicates the need for further assessment, to determine if alcohol abuse is contributing significantly to any other symptoms or signs (e.g., hypertension, intellectual impairment, or gastrointestinal disease). If the patient is taught to recognize the necklace, he or she may be able to differentiate `social drinking' from `alcohol abuse', and be motivated to seek treatment early.
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PMID:A necklace of telangiectases: an early clinical sign of alcohol abuse. 2127 22

Analysis of the effect of psychosocial factors and co-morbidities on the health status of patients with chronic nonspecific low back pain and patients with surgical intervention because of disk herniation was performed. One hundred and two nonselected consecutive inpatients with chronic nonspecific low back pain were included in the study. Their average age was 56.7 (SD = 10.9) years. The control group consisted of 199 subjects matched according to age and sex, chosen from the database of the national representative health survey Hungarostudy 2006, which involved 4,527 subjects. We measured quality of life including mental health with the SF-36 questionnaire validated for use in Hungary, the short 9-item version of the Beck Depression Inventory, the WHO-Five Well-Being Index, and the Hospital Anxiety-Depression Scale. We characterized the socio-demographic status with variables on age, sex, marital status, and education. Data on symptoms and signs of low back pain, other musculoskeletal diseases, and their treatments including spinal surgery were recorded. Co-morbidity and body mass index were considered as independent indicators of health. Depression as measured by Beck Depression Inventory and severity of depression did not vary significantly according to marital status, education, hypertension, diabetes, and gastrointestinal disease. Only half of the patients (52 %) were in the normal range of the scale; 22 % suffered from mild, 16 % from moderate, and 12 % from severe depression. Average values for anxiety and depression as measured by Hospital Anxiety-Depression Scale and Beck Depression Inventory were both significantly higher in the patient than in the control group (Hospital Anxiety Scale: p = 0.0001; Beck Depression Inventory: p = 0.0001). According to the WHO Well-Being Index-5 scale, the difference between patients and the control group was significant (p = 0.0001). Furthermore, correlation was found between the incidence of depression and surgery. Depression was demonstrated in 47.4 % of those patients who had no surgery, in 50 % of patients who had one round of surgery, and in 62.5 % of those who had undergone surgery more than once; the contingence coefficient was 0.211. According to different measurements, the psychological state of patients with chronic nonspecific low back pain was significantly altered as compared to the matched Hungarian population. Higher anxiety and depression markers occurred in 48 % of the patients. There was no correlation between the depression of patients with low back pain and variables such as marital status, education, and co-morbidities. Our study is the first to demonstrate that depression runs parallel with the number of surgical procedures. Therefore, if there is a relative indication for surgery, depression and severity of depression should be assessed and considered when deciding on the intervention.
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PMID:Psychosocial, educational, and somatic factors in chronic nonspecific low back pain. 2247 43

Following the discovery of the calcium-sensing receptor (CaSR) in 1993, its pivotal role in disorders of calcium homeostasis such as Familial Hypocalciuric Hypercalcemia (FHH) was quickly demonstrated. Since then, it has become clear that the CaSR has immense functional versatility largely through its ability to activate many different signaling pathways in a ligand- and tissue-specific manner. This allows the receptor to play diverse and crucial roles in human physiology and pathophysiology, both in calcium homeostasis and in tissues and biological processes unrelated to calcium balance. This review covers current knowledge of the role of the CaSR in disorders of calcium homeostasis (FHH, neonatal severe hyperparathyroidism, autosomal dominant hypocalcemia, primary and secondary hyperparathyroidism, hypercalcemia of malignancy) as well as unrelated diseases such as breast and colorectal cancer (where the receptor appears to play a tumor suppressor role), Alzheimer's disease, pancreatitis, diabetes mellitus, hypertension and bone and gastrointestinal disorders. In addition, it examines the use or potential use of CaSR agonists or antagonists (calcimimetics and calcilytics) and other drugs mediated through the CaSR, in the management of disorders as diverse as hyperparathyroidism, osteoporosis and gastrointestinal disease.
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PMID:The role of the calcium-sensing receptor in human disease. 2250 56


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