Top PDF Prevalence and risk factors of asymptomatic peripheral arterial disease in patients with COPD in Taiwan.

Body mass index (BMI) was calculated as weight (kg) divided by the square of the height (m). A BMI,25 was defined as normal weight, from 25 to 30 as overweight, and .30 as obese. The subjects self-reported their medical history including previous hypertension, hyperlipidemia and diabetes mellitus. The partici- pants were considered to be hypertensive if they had a previous diagnosis of hypertension, or if they were on treatment or had a systolic BP (SBP) .140 mmHg or a diastolic BP (DBP) .90 mmHg. The participants were considered to have hyperlip- idemia if they had a previous diagnosis of hypercholesterolemia or hypertriglyceridemia, or if they were under treatment or had a fasting cholesterol level of .240 mg/dL or triglycerides .150 mg/dL. Diabetes was defined as a history of diabetes, diabetes treatment, or fasting glucose level .126 mg/dL. Smoking status was evaluated by a self-reported questionnaire. The nursing staff confirmed the medical history by reviewing the participants’ medical charts. The severity of COPD was based on the Global Initiative for Chronic Obstructive Pulmonary Disease (GOLD) guidelines [20].

Prevalence of PAD was known diverse by ethnicity, with black people having the highest age-adjusted prevalence of low ABI [10,11]. Prevalence of low ABI is known to increase with age. In one study, prevalence of low ABI was 1.9% in the age group of 40 to 59 years, 8.1% in the group of 60 to 74 years, and 17.5% in the group of ≥75 years [11]. Although PAD is pre- sumed to be more common in men, the prevalence of low ABI does not estimated to vary signiicantly by gender [12,13]. he PAD prevalence in T2DM subjects is unclear, but in the Framingham heart study, 20% of symptomatic PAD subjects also exhibited diabetes [14]. According to the the prevention of progression of arterial disease and diabetes (POPADAD) study, 20.1% of ≥40-year-old patients with diabetes were associated symptoms exhibited PAD [15]. However, given that a large number of PAD patients are asymptomatic, it is assumed that more subjects with diabetes exhibit PAD. In the study conduct- ed with 6,880 German people whose age ≥65 years, the preva- lence of PAD by low ABI in diabetes subjects was 26.3%; where- as, prevalence of PAD in non-diabetic subjects was 15.3% [16]. Similar indings also have been reported [17,18].

NAFLD to be 24% and 14.8%, respectively, in non-alcoholic North Indian men. In a study by Mohan et al the prevalence of NAFLD (54.5%) was significantly higher in patients with diabetes compared to those with pre-diabetes (IGT or IFG) (33%), isolated IGT (32.4%), isolated IFG (27.3%) and normal glucose tolerance (NGT) (22.5%). Also in this study, it was found the prevalence of most cardio- metabolic risk factors was significantly higher in NAFLD patients. Gupta et al found that mild, moderate, and severe NAFLD was present in 65.5%, 12.5%, and 9.35% of otherwise asymptomatic type 2 diabetics, respectively. Prashanth et al found a high prevalence of NAFLD and NASH in type 2 diabetics which increased with multiple components of the metabolic syndrome. Banerjee et al observed that, on histology, only fatty change was present in 43%, NASH in 40% and more advanced disease in 23%. [25-26]

Objective: To estimate the prevalence of undiagnosed COPD among individuals with risk factors for the disease treated at primary health care clinics (PHCCs) in the city of Aparecida de Goiânia, Brazil. Methods: Inclusion criteria were being ≥ 40 years of age, having a > 20 pack-year history of smoking or a > 80 hour-year history of exposure to biomass smoke, and seeking medical attention at one of the selected PHCCs. All subjects included in the study underwent spirometry for the diagnosis of COPD. Results: We successfully evaluated 200 individuals, mostly males. The mean age was 65.9 ± 10.5 years. The diagnosis of COPD was confirmed in 63 individuals, only 18 of whom had been previously diagnosed with COPD (underdiagnosis rate, 71.4%). There were no significant differences between the subgroups with and without a previous diagnosis of COPD in relation to demographics and risk factors. However, there were significant differences between these subgroups for the presence of expectoration, wheezing, and dyspnea (p = 0.047; p = 0.005; and p = 0.047, respectively). The FEV 1 and FEV 1 /FVC ratio, expressed as percentages of the predicted values, were significantly lower in the subjects with a previous diagnosis of COPD, which was predominantly mild or moderate in both subgroups. Conclusions: The rate of underdiagnosis of COPD was high at the PHCCs studied. One third of the patients with risk factors for COPD met the clinical and functional criteria for the disease. It seems that spirometry is underutilized at such facilities.

Objective: To estimate the prevalence of undiagnosed COPD among individuals with risk factors for the disease treated at primary health care clinics (PHCCs) in the city of Aparecida de Goiânia, Brazil. Methods: Inclusion criteria were being ≥ 40 years of age, having a > 20 pack-year history of smoking or a > 80 hour-year history of exposure to biomass smoke, and seeking medical attention at one of the selected PHCCs. All subjects included in the study underwent spirometry for the diagnosis of COPD. Results: We successfully evaluated 200 individuals, mostly males. The mean age was 65.9 ± 10.5 years. The diagnosis of COPD was confirmed in 63 individuals, only 18 of whom had been previously diagnosed with COPD (underdiagnosis rate, 71.4%). There were no significant differences between the subgroups with and without a previous diagnosis of COPD in relation to demographics and risk factors. However, there were significant differences between these subgroups for the presence of expectoration, wheezing, and dyspnea (p = 0.047; p = 0.005; and p = 0.047, respectively). The FEV 1 and FEV 1 /FVC ratio, expressed as percentages of the predicted values, were significantly lower in the subjects with a previous diagnosis of COPD, which was predominantly mild or moderate in both subgroups. Conclusions: The rate of underdiagnosis of COPD was high at the PHCCs studied. One third of the patients with risk factors for COPD met the clinical and functional criteria for the disease. It seems that spirometry is underutilized at such facilities.

Objective: To study the stenosis of the carotid arteries in patients with symptomatic peripheral arterial disease. Methods Methods Methods Methods Methods: we assessed 100 consecutive patients with symptomatic peripheral arterial disease in stages of intermittent claudication, rest pain or ulceration. Carotid stenosis was studied by echo-color-doppler, and considered significant when greater than or equal to 50%. We used univariate analysis to select potential predictors of carotid stenosis, later taken to multivariate analysis. Results Results Results Results: The Results prevalence of carotid stenosis was 84%, being significant in 40% and severe in 17%. The age range was 43-89 years (mean 69.78). Regarding gender, 61% were male and 39% female. Half of the patients had claudication and half had critical ischemia. Regarding risk factors, 86% of patients had hypertension, 66% exposure to smoke, 47% diabetes, 65% dyslipidemia, 24% coronary artery disease, 16% renal failure and 60% had family history of cardiovascular disease. In seven patients, there was a history of ischemic cerebrovascular symptoms in the carotid territory. The presence of cerebrovascular symptoms was statistically significant in influencing the degree of stenosis in the carotid arteries (p = 0.02 at overall assessment and p = 0.05 in the subgroups of significant and non-significant stenoses). Conclusion Conclusion Conclusion Conclusion: the study of the carotid arteries by duplex scan examination is of Conclusion paramount importance in the evaluation of patients with symptomatic peripheral arterial disease, and should be systematically conducted in the study of such patients.

Our present study had some limitations. First, the small sample size, which leaded to wide confidence interval, was the major limitation of current study. However, if we took CS as continuous variable into regression model, the CS was still associated with amputation outcome with narrow confidence interval (1.000002– 1.000004) and significant p value (p = 0.03). Besides, the Kaplan- Meier survival curves for both outcomes were also widely separated. Therefore, we believed that the significant association between CS and outcomes could not be neglected, although the risk ratio might not be precisely estimated. Second, the soft tissue calcification, especially in patients with ESRD, might interfere with our interpretation of arterial calcification on MDCT. Third, our study population was a group of patients with advanced PAD; more than half of the patients were Fontaine stage IV. We need to be careful to extend the conclusion to non-selective PAD patients. Finally, no blood samples were collected at the time of CT scan. We therefore could not analyze several important circulating mineralization factors in our current study.

In the present study, the frequency of risk factors for atherosclerotic disease was high and similar to that found in other studies (31,39,40). Possible explanations for the broad variation in the prevalence of these risk factors among different ethnic groups are economic and sociocultural fac- tors, which may be responsible for the high frequency of cardiovascular disease in developing countries (35). The cardiovascular risk profile of the population was critical in the city where this study was conducted, which has more than 2,500,000 inhabitants, 70% of whom have mixed ethnic backgrounds, and most have little education and a low income. Improvements in educational levels and socioeco- nomic status may decrease the high frequency of risk factors (39).

18. Ferreira SR, Almeida-Pittito B, Japanese-Brazilian Diabetes Study Group (JBDS Group). Reflexão sobre a imigração japonesa no Brasil sob o ângulo da adiposidade corporal. Arq Bras Endocrinol Metab. 2009;53(2):175-82. 19. Hirsch AT, Criqui MH, Treat-Jacobson D. Peripheral arterial disease detection, awareness, and treatment in primary care. JAMA. 2001;286(11):1317-24. 20. Elhadd TA, Robb R, Jung RT, Stonebrigde PA, Belch JJ. Pilot study of prevalence of asymptomatic peripheral arterial occlusive disease in patients with diabetes attending a hospital clinic. Practical Diabetes Int. 1999;16(6):163-6. 21. Makdisse M, Pereira AC, Brasil DP, Borges JL, Machado-Coelho JL, Krieger JE,

Abstract COPD is one of the major public health problems in people aged 40 years or above. It is currently the 4th leading cause of death in the world and projected to be the 3rd leading cause of death by 2020. COPD and cardiac comorbidities are frequently associated. They share com- mon risk factors, pathophysiological processes, signs and symptoms, and act synergistically as negative prognostic factors. Cardiac disease includes a broad spectrum of entities with distinct pathophysiology, treatment and prognosis. From an epidemiological point of view, patients with COPD are particularly vulnerable to cardiac disease. Indeed, mortality due to cardiac disease in patients with moderate COPD is higher than mortality related to respiratory failure. Guidelines reinforce that the control of comorbidities in COPD has a clear benefit over the potential risk associated with the majority of the drugs utilized. On the other hand, the true survival benefits of aggressive treatment of cardiac disease and COPD in patients with both conditions have still not been clarified. Given their relevance in terms of prevalence and prognosis, we will focus in this paper on the management of COPD patients with ischemic coronary disease, heart failure and dysrhythmia.

12. Hirsch AT, Haskal ZJ, Hertzer NR, Bakal CW, Creager MA, Halperin JL, et al; American Association for Vascular Surgery; Society for Vascular Surgery; Society for Cardiovascular Angiography and Interventions; Society for Vascular Medicine and Biology; Society of Interventional Radiology; ACC/AHA Task Force on Practice Guidelines; American Association of Cardiovascular and Pulmonary Rehabilitation; National Heart, Lung, and Blood Institute; Society for Vascular Nursing; TransAtlantic Inter-Society Consensus; Vascular Disease Foundation. ACC/AHA 2005 guidelines for the management of patients with peripheral arterial disease (lower extremity, renal, mesenteric, and abdominal aortic): executive summary a collaborative report from the American Association for Vascular Surgery/Society for Vascular Surgery, Society for Cardiovascular Angiography and Interventions, Society for Vascular Medicine and Biology, Society of Interventional Radiology, and the ACC/AHA Task Force on Practice Guidelines (Writing Committee to Develop Guidelines for the Management of Patients With Peripheral Arterial Disease) endorsed by the American Association of Cardiovascular and Pulmonary Rehabilitation; National Heart, Lung, and Blood Institute; Society for Vascular Nursing; TransAtlantic Inter- Society Consensus; and Vascular Disease Foundation. J Am Coll Cardiol. 2006;47(6):1239-312.

14. Rooke TW, Hirsch AT, Misra S, Sidawy AN, Beckman JA, Findeiss LK, et al; American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines; Society for Cardiovascular Angiography and Interventions; Society of Interventional Radiology; Society for Vascular Medicine; Society for Vascular Surgery. 2011 ACCF/ AHA focused update of the guideline for the management of patients with peripheral artery disease (updating the 2005 guideline): a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines: developed in collaboration with the Society for Cardiovascular Angiography and Interventions, Society of

Background: Atherosclerosis is a multifactorial disease with an inlammatory pathophysiological basis. Cytokines released during the atherosclerotic process induce production of C-reactive protein (CRP) in the liver, which is an important marker of inlammation. Objective: We tested whether inlammatory biomarkers were associated with deterioration of peripheral arterial occlusive disease (PAOD) in a population at high cardiovascular risk. Methods: 1,330 subjects ≥30 years of age underwent clinical and laboratory examinations as part of a population-based study of the prevalence of diabetes. PAOD was deined as an ankle-brachial index (ABI) ≤0.90. After application of exclusion criteria, the sample comprised 1,038 subjects. Traditional risk factors, CRP and interleukin 6 (IL-6) were also compared across three ABI categories (≤0.70; 0.71-0.90; ≥0.90). Mean values for these variables were compared by presence/absence of DAOP (Student’s t test) and by ABI categories (ANOVA). Poisson regression and logistic regression models were used to test for associations between risk factors and DAOP and between risk factors and the ABI categories. Pearson’s linear correlation coeicients were calculated for the relationship between CRP and IL-6 levels. Results: Mean age was 56.8±12.9 years, 54% of the sample were women and the prevalence of DAOP was 21.0% (95%CI 18.4-24.1). Individuals with ABI ≤0.70 had higher concentrations of CRP-us (2.1 vs. 1.8) and of IL-6 (1.25 vs. 1.17). Concentrations of CRP and IL-6 were only correlated in patients with DAOP, (p=0.004). Conclusions: he inding that CRP and IL-6 levels were only elevated among people with advanced DAOP may suggest that these biomarkers have a role to play as indicators of more severe disease. Prospective studies are needed to test this hypothesis.

Crohn’s disease (CD) is a granulomatous chronic inflammatory disease that can affect any region of the gastrointestinal tract, although it is usually localized to the small intestine and colon [1]. First described by Crohn et al. [2], the diagnosis of CD is based on clinical signs, endoscopy, histology, radiographic and/or biochem- ical findings [3]. CD shows episodes of disease activity, so called flares and asymptomatic intervals, or remissions [4]. This often leads to recurrent episodes of illness during which treatment with drugs and sometimes surgery is required to achieve symptomatic remission [5]. The aetiology of CD is unknown, however, studies have linked a possible genetic association [6]. In addition, a link between the microbiota and the lining of the gut mucosa has also been proposed as possible aetiological environmental factors [1,7]. The incidences of CD differ depending on geographical region. North America and the northern part of Europe have the highest incidence [8,9]. The prevalence of CD in adults in the US is 201 per 10 5 people [8].

os limites clínicos estabelecidos na maioria das medidas. O risco cardiovascular global era baixo em 94% dessas mulheres. Os grupos FR e pDMG mostraram, como esperado, níveis mais elevados de pressão arterial, glicemia, colesterol total, cLDL, triglicérides e níveis mais baixos de cHDL do que o GC. Obesidade e cintura aumentada foram mais frequentes nos grupos pDMG e gFR, mas significativamente mais elevados no gFR em relação ao pDMG. A EMI média de quase todos os segmentos avaliados foi maior no grupo pDMG quando comparado com o GC, exceto na bifurcação carotídea e carótida comum direitas. O gFR só mostrou maior EMI do que o controle na medida composta; e menor do que o grupo pDMG na bifurcação carotídea esquerda. Após regressão linear univariada foi desenvolvido modelo de regressão múltipla tomando- se a EMI composta como a variável dependente e os grupos de estudo glicemia, colesterol total, cHDL, triglicérides, idade, cintura, SM e hipertensão como covariáveis. No modelo final, a idade, o colesterol e pertencer ao grupo pDMG foram independentemente associados à EMI composta. Esse modelo final explica 36,6% da variabilidade de EMI pelas variáveis incluídas. Conclusão: o passado de DMG está associado a aumento da EMI carotídea como fator de risco independente, juntamente com colesterol total e idade. O aumento da EMI nessas mulheres com passado de diabetes gestacional, semelhante àquelas sabidamente com dois ou mais fatores de risco cardiovascular, deve estimular cuidados de prevenção primária precoce.

of social commitments and values such as social justice and equity, which are stated in their constitutions, signed treaties and conventions. Ministries of health oversee the overall development of health systems using their governance function, which includes policy analysis and formulation, regulating service delivery between partners, developing norms and standards for quality assurance and ensuring the implementation of agreed upon policies and strategies. The importance of ICTs in development process was long recognized and access to ICTs has even been made one of the targets of the Millennium Development Goal No. 8 (MDG 8),which emphasizes the benefits of new technologies, especially ICTs in the fight against poverty [26]. In the implementation of mHealth, ICT is a key component therefore policies on penetration, adoption and utilization of ICT in the health sector play a key role in enhancing mHealth adoption. The telecommunications sector of some countries such as Ghana, Kenya, Nigeria and Senegal, are very dynamic. Yet, as shown in the introductory section, Africa as a whole continues to lag behind other regions of the world. This is primarily as a result of the high cost of services [27]. Based on a review conducted across 17 Sub-Saharan African countries, Calandroet. al. argue that the national objectives of achieving universal and affordable access to the full range of communications services have been undermined either by poor policies constraining market entry and the competitive allocation of available resources; weak institutional arrangements with a dearth of technical capacity and competencies; and, in some instances, regressive taxes on usage. Gillwald [28] argues that in addition to competition and open access regimes, effective regulation of other factors such as spectrum and interconnection and tariffs are required to stimulate market growth, improve access, and lower prices. This is because: many competitive markets with several players have experienced spectrum allocation problems high cost of services as a result of retrogressive tax on mobile communications despite having an open market with several operators such as Uganda and expensive leased lines generally available from incumbent operators which hare mostly unregulated contributed to the high cost of doing business and inhibited growth and employment opportunities [28].

Study subjects: The convenience sample consisted of individuals consecutively recruited during the period from September 2001 to December 2003. The healthy individuals were recruited at the Blood Bank of the University Hospital of Londrina, north of Paraná State, southern region of Brazil. The HIV-1-exposed but uninfected and HIV- 1-infected individuals were enrolled in various specialized, public, and nonprofit centers of STDs such as the University Hospital of State University of Londrina; Outpatient Clinic Hospital of the State University of Londrina; Integrated Center of Infectious Diseases of Londrina, and the State Health Services of various cities from the northern region of Paraná State, Brazil. The protocol was approved by the institutional Research Ethics Committees of Londrina State University, the Health State Secretary of Paraná State and the Brazilian National Program of STDs/AIDS of the Ministry of Health. The individuals were invited to participate and informed in detail about the research, and voluntary written consent was obtained from the subjects enrolled. Socio-demographic and epidemiological data associated with HIV-1 infection, and the stage of the disease were obtained at the time of enrollment from September 2001 to December 2003, using a Brazilian government standardized interview questionnaire. The economic level was based on the Criteria for Economic Classification in Brazil 8 . After the inclusion, blood samples were collected for

Only preoperative characterization data were used in this study. herefore, it is conigured up as a cross-sectional study. Hypertension, deined as a history of hypertension, registered in medical records, and categorized as yes or no, was considered as a dependent variable. he independent variables were divided into sociodemographic variables (gender, age, race, and source of funding for hospital ad- mission) cardiovascular risk factors (diabetes, dyslipidemia, smoking, obesity, and family history of coronary artery dis- ease), and other diseases (chronic obstructive pulmonary disease, chronic kidney disease, peripheral arterial disease, and cerebrovascular disease). For characterization of pa- tient race, similarly to what was used in population cen- suses by the Instituto Brasileiro de Geograia e Estatística (IBGE), we used self-deined skin color as informed by the individual for his/her identiication with the hospitaliza- tion service. he sources for funding hospitalization were dichotomized in SUS, for resources of the Uniied Health System, or non-SUS, for resources of either health insur- ance or private resources. We considered as current smok- ers individuals who reported smoking in the last month before surgery and former smokers those who have stopped smoking for 30 or more days before surgery. he body mass index (BMI) was calculated by the equation BMI = w/h 2

The deprivation index was developed by Caranci et al. using variables from the 2001 Gen- eral Census of Population and Housing [13]. Five traits that represented the multidimensional- ity of the social and material deprivation concept were considered: low level of education, unemployment, non-home ownership, one-parent family and household overcrowding. The index is calculated by summing standardized indicators [13]. The fragility index, developed by the Local Health Authority of Bologna represents the probability of acute hospitalization or death in the following year and ranges from 0 to 100. The index was derived from a predictive model following the experience of the Combined Predictive Model [14] which aims to identify individuals at high-risk of re-hospitalization or death. The predictive model included demo- graphic variables (age, gender), clinical variables such as heart failure, diabetes, cancer, lung disease, hospitalizations and access to emergency care during the previous year and social vari- ables (deprivation index).

Congenital anomaly and cancer may have some shared genetic and/or environmental fac- tors that may influence the risk of occurrence. A malformation may also cause physiologic or lifestyle changes that may impact on cancer risk [13,14]. Dysregulation of human development probably plays a vital role in the etiology of cancer among patients with birth defects [15–17]. Previous studies have shown that patients with congenital anomalies have increased risk of de- veloping cancer, such as leukemia, lymphoma, brain tumor, neuroblastoma, germ cell tumor, retinoblastoma, and soft tissue sarcoma [14–16,18–25]. Most of these studies have focused on the association of all categories of congenital anomalies with cancer. Congenital cardiovascular anomaly, a major subgroup of congenital anomalies, is the most frequent type of birth defects that also have a cancer diagnosis [20]. A few studies discuss the individual association of CHD with cancer occurrence, but not all categories of congenital anomalies are included and the re- sults have been conflicting [14,20,26–29]. Furthermore, previous studies do not explore the as- sociation between age at CHD diagnosis, gender, duration of follow-up, co-morbidities, and medical radiation examination among CHD patients, and cancer risk.