Research on Trypanosoma cruzi and Analysis of Inflammatory Infiltrate in Esophagus and Colon from Chronic Chagasic Patients with and without Mega

Directory of Open Access Journals (Sweden)

Eliângela de Castro Côbo

2012-01-01

Full Text Available To compare parasitism and inflammatory process in esophagus and colon from chronic chagasic patients, immunohistochemistry was carried out to research for T. cruzi and to evaluate the inflammatory infiltrate in the muscular and myenteric plexus in 39 esophagi (20 with and 19 without megaesophagus and 50 colons (25 with and 25 without megacolon. The frequency of T. cruzi in megaesophagus was 20%, and in megacolon it was 4%. No amastigotes were found in organs without mega; considering the total of esophagi (with and without mega, the frequency of T. cruzi would be 10% and 2% in the colon. Myositis and ganglionitis were more frequent and intense in organs with mega compared to those without mega, and in esophagus compared to colon. Qualitatively, inflammatory infiltration in esophagus and colon, with or without mega, was similar, consisting predominantly of T lymphocytes (CD3+, scarce macrophages (CD68+, and rare B lymphocytes (CD20+.

Research on Trypanosoma cruzi and Analysis of Inflammatory Infiltrate in Esophagus and Colon from Chronic Chagasic Patients with and without Mega

Science.gov (United States)

Côbo, Eliângela de Castro; Silveira, Thales Parenti; Micheletti, Adilha Misson; Crema, Eduardo; Adad, Sheila Jorge

2012-01-01

To compare parasitism and inflammatory process in esophagus and colon from chronic chagasic patients, immunohistochemistry was carried out to research for T. cruzi and to evaluate the inflammatory infiltrate in the muscular and myenteric plexus in 39 esophagi (20 with and 19 without megaesophagus) and 50 colons (25 with and 25 without megacolon). The frequency of T. cruzi in megaesophagus was 20%, and in megacolon it was 4%. No amastigotes were found in organs without mega; considering the total of esophagi (with and without mega), the frequency of T. cruzi would be 10% and 2% in the colon. Myositis and ganglionitis were more frequent and intense in organs with mega compared to those without mega, and in esophagus compared to colon. Qualitatively, inflammatory infiltration in esophagus and colon, with or without mega, was similar, consisting predominantly of T lymphocytes (CD3+), scarce macrophages (CD68+), and rare B lymphocytes (CD20+). PMID:22131997

Evolução clínica a longo prazo, correlacionando a presença de bloqueios da condução intraventricular em pacientes chagásicos e não chagásicos assintomáticos Long-term follow up of asymptomatic chagasic individuals with intraventricular conduction disturbances, correlating with non-chagasic patients

Directory of Open Access Journals (Sweden)

João Pimenta

1999-12-01

Full Text Available Estudo prospectivo para avaliar o potencial evolutivo, a longo prazo, dos transtornos da condução intraventricular em indivíduos chagásicos e não chagásicos assintomáticos. Foram submetidos a estudo eletrofisiológico, por metodologia convencional, 84 indivíduos portadores de bloqueio de ramo direito ou esquerdo, 55 chagásicos e 29 não chagásicos. A idade média foi de 45 anos nos chagásicos e 63 nos não chagásicos (pThis prospective study was designed to evaluate intraventricular conduction disturbances in asymptomatic patients with Chagas' disease, and patients with primary sclerosis of the conducting system of the heart (Lev-Lenègre's disease. Eighty-four asymptomatic individuals with right- or left-bundle branch block were submitted to electrophysiological evaluation and long-term follow-up. Fifty-five had positive serologic blood tests for Chagas' disease and 29 had Lev-Lenègre's disease. Mean-age of 45 years in chagasic and 63 in non-chagasic patients (p< 0.001. There were 54 (98.2% with right-bundle branch block in chagasic and 14 (48.3% among non-chagasic patients (p <0.001. Sinus nodal and atrioventricular nodal functions presented no differences in either group. However, mean HV interval was greater in the NCH than in the CH group (p< 0.01. After a mean follow-up of 121 ± 63.75 months among chagasic and 94.97 ± 67.55 months among non-chagasic patients, total mortality was 20 (36.6% patients in chagasic and 9 (31% among non-chagasic patients (NS. Cardiac death was recorded in 17 (85% individuals among chagasic and 3 (33.3% among non-chagasic patients(p <0.05. Sudden death occurred in 10 (50% among chagasic and was not observed in non-chagasic patients (p <0.01. In conclusion: 1. Asymptomatic chagasic individuals with intraventricular conduction disturbances showed higher cardiac mortality, sudden or non-sudden death in relation to non-chagasic individuals. 2. The evaluated electrophysiological parameters were of no

Immunoperoxidase technique in experimental chronic chagasic myocarditis

OpenAIRE

M.d. Maria Celina Morales; M.D. José Milei

1987-01-01

Chagas'disease has been described as the commonest form of chronic myocarditis. An immunologic pathogenesis has been discribed for this form of the disease. So far, no immunoperoxidase technique has been used for the detection of immunological deposits in chronic experimental Chagas'myocardiopathy. Forty-one Swiss mice, three months old were inoculated intraperitoneally with doses between 10 and 10(5) Tulahuen trypomastigotes. Mice were reinoculated one month after with doses between 10² and ...

Bone marrow cell migration to the heart in a chimeric mouse model of acute chagasic disease.

Science.gov (United States)

Irion, Camila Iansen; Paredes, Bruno Diaz; Brasil, Guilherme Visconde; Cunha, Sandro Torrentes da; Paula, Luis Felipe; Carvalho, Alysson Roncally; Carvalho, Antonio Carlos Campos de; Carvalho, Adriana Bastos; Goldenberg, Regina Coeli Dos Santos

2017-08-01

Chagas disease is a public health problem caused by infection with the protozoan Trypanosoma cruzi. There is currently no effective therapy for Chagas disease. Although there is some evidence for the beneficial effect of bone marrow-derived cells in chagasic disease, the mechanisms underlying their effects in the heart are unknown. Reports have suggested that bone marrow cells are recruited to the chagasic heart; however, studies using chimeric mouse models of chagasic cardiomyopathy are rare. The aim of this study was to investigate the migration of bone marrow cells to the heart after T. cruzi infection in a model of chagasic disease in chimeric mice. To obtain chimerical mice, wild-type (WT) C57BL6 mice were exposed to full body irradiation (7 Gy), causing bone marrow ablation. Then, bone marrow cells from green fluorescent protein (GFP)-transgenic mice were infused into the mice. Graft effectiveness was confirmed by flow cytometry. Experimental mice were divided into four groups: (i) infected chimeric (iChim) mice; (ii) infected WT (iWT) mice, both of which received 3 × 104 trypomastigotes of the Brazil strain; (iii) non-infected chimeric (Chim) mice; and (iv) non-infected WT mice. At one-month post-infection, iChim and iWT mice showed first degree atrioventricular block with decreased heart rate and treadmill exercise parameters compared to those in the non-infected groups. iChim mice showed an increase in parasitaemia, myocarditis, and the presence of amastigote nests in the heart tissue compared to iWT mice. Flow cytometry analysis did not detect haematopoietic progenitor cells in the hearts of infected mice. Furthermore, GFP+ cardiomyocytes were not detected in the tissues of chimeric mice.

[Megas and cancer. Cancer of the large intestine in chagasic patients with megacolon].

Science.gov (United States)

Meneses, A C; Lopes, M A; Rocha, A; Fatureto, M C; Lopes, G P; Lopes, E R; Chapadeiro, E

1989-01-01

This is a review of 4.690 necropsies and 24.209 surgical pathology specimens describing the association between megacolon chagasic and malignant tumors of the large bowel. The prevalence of malignant tumors of the large bowel was not higher in megacolon.

Four cases of acute chagasic myocarditis in French Guiana.

Science.gov (United States)

Carme, B; Aune, I; Nguyen, G; Aznar, C; Beaudet, B

2001-01-01

The authors report four cases of acute chagasic myocarditis which had been diagnosed and treated in Cayenne, French Guiana, in the past 6 years. This French territory, which has the highest standard of living in South America, should be considered an area of risk for sporadic Chagas disease with epidemiologic features similar to those of the disease found in dense Amazon forest areas. Appropriate measures must be taken to screen and promptly manage Chagas disease in the French Guiana population.

Leukoreduction by centrifugation does not eliminate Trypanosoma cruzi from infected blood units.

Science.gov (United States)

Dzib, Doris; Hernández, Virginia Peña; Ake, Baldemar Canche; López, Ruth Alacantara; Monteón, Victor Manuel

2009-06-01

Current strategies to prevent transfusion-associated Chagas disease include the identification of Trypanosoma cruzi-infected blood donors through questionnaires and serologic tests. There are other procedures such as leukoreduction that prevent the transmission of infectious agents associated to white cells. The objective of the present work was to estimate the seroprevalence, evaluate the efficacy of leukoreduction by centrifugation to eliminate T. cruzi in infected blood units, and the correlation of immunoglobulin G (IgG) subclasses of seropositive blood donors with chronic chagasic cardiopathy. Over a period of 14 months, 33 out of 6600 blood donors (0.5%) at Centro Estatal de la Transfusión Sanguínea in Campeche State, México were seropositive for T. cruzi. Twenty seropositive blood units were submitted through leukoreduction by centrifugation, and in the fractions generated (red cell fraction, platelets, and the buffy-coat), we searched for the presence of T. cruzi using specific polymerase chain reaction. We detected parasite DNA in 50% to 60% of the fractions tested, suggesting that leukoreduction by centrifugation does not eliminate the microorganisms in the infected blood unit. We also observed that the level of IgG2 and IgG4 subclasses specific for T. cruzi in seropositive blood donors was lower than in chronic cardiopathic chagasic patients. In conclusion, leukoreduction by centrifugation has a limited role in eliminating T. cruzi in infected blood supply, and the low level of specific IgG2 and IgG4 could be a marker in the indeterminate phase of infection.

[Prevalence of ischemic cardiopathy risk factors on the island of Lanzarote].

Science.gov (United States)

Rodríguez Pérez, J C; Calonge Ramírez, S; Bichara Antanios, G

1993-06-05

As a fruit of complex interaction of factors, coronary atherosclerosis constitutes the first cause of death in the developed countries. With the aim of studying the risk factors of ischemic cardiopathy in a natural adult population (30-64 years) from Lanzarote (Canary Islands) a representative sample of 600 individuals was studied with participation of 70% being obtained. The prevalences obtained were the following: established arterial hypertension (systolic: 160 mmHg and/or diastolic 95 mmHg) 24%; hypercholesterolemia (cholesterol: 6.5 mmol) 25%; diabetes (basal glucose: 7.8 mmol) 6.1%; hypertriglyceridemia (triglycerides 2.3 mmol) 12%; cholesterol (lipids and high density lipoproteinemia HDL) lower than 0.90 mmol in males 19% and lower than 1.16 mmol in females 36%; male smoking habit 53%; female smoking habit 15%; obesity (Quetelet index: 30) male 19%, females 35%, family history of ischemic cardiopathy (prior to 60 years of age) 14%; use of oral contraceptives in premenopausic females 13%; left ventricular growth in hypertensive individuals 7.4%. The prevalence of cardiovascular risk factors is high for arterial hypertension, diabetes, hypercholesterolemia, male smoking habit and female obesity. These results demonstrate an unfavorable profile for cardiovascular risk in the population of Lanzarote and it is reasonable to assume that this may be due to the great socioeconomic growth which has taken place on the island over the last decade.

Characterization of T cell clones from chagasic patients: predominance of CD8 surface phenotype in clones from patients with pathology

Directory of Open Access Journals (Sweden)

Washington R. Cuna

1995-08-01

Full Text Available Human Chagas' disease, caused by the protozoan Trypanosoma cruzi, is associated with pathological processes whose mechanisms are not known. To address this question, T cell lines were developed from chronic chagasic patients peripheral blood mononuclear cells (PBMC and cloned. These T cell clones (TCC were analyzed phenotypically with monoclonal antibodies by the use of a fluorescence microscope. The surface phenotype of the TCC from the asymptomatic patient were predominantly CD4 positive (86%. On the contrary, the surface phenotype CD8 was predominant in the TCC from the patients suffering from cardiomegaly with right bundle branch block (83%, bradycardia with megacolon (75 % and bradycardia (75%. Future studies will be developed in order to identify the antigens eliciting these T cell subpopulations.

Defects of mtDNA Replication Impaired Mitochondrial Biogenesis During Trypanosoma cruzi Infection in Human Cardiomyocytes and Chagasic Patients: The Role of Nrf1/2 and Antioxidant Response

Science.gov (United States)

Wan, Xianxiu; Gupta, Shivali; Zago, Maria P.; Davidson, Mercy M.; Dousset, Pierre; Amoroso, Alejandro; Garg, Nisha Jain

2012-01-01

Background Mitochondrial dysfunction is a key determinant in chagasic cardiomyopathy development in mice; however, its relevance in human Chagas disease is not known. We determined if defects in mitochondrial biogenesis and dysregulation of peroxisome proliferator-activated receptor gamma (PPARγ) coactivator-1 (PGC-1)–regulated transcriptional pathways constitute a mechanism or mechanisms underlying mitochondrial oxidative-phosphorylation (OXPHOS) deficiency in human Chagas disease. Methods and Results We utilized human cardiomyocytes and left-ventricular tissue from chagasic and other cardiomyopathy patients and healthy donors (n>6/group). We noted no change in citrate synthase activity, yet mRNA and/or protein levels of subunits of the respiratory complexes were significantly decreased in Trypanosoma cruzi–infected cardiomyocytes (0 to 24 hours) and chagasic hearts. We observed increased mRNA and decreased nuclear localization of PGC-1-coactivated transcription factors, yet the expression of genes for PPARγ-regulated fatty acid oxidation and nuclear respiratory factor (NRF1/2)–regulated mtDNA replication and transcription machinery was enhanced in infected cardiomyocytes and chagasic hearts. The D-loop formation was normal or higher, but mtDNA replication and mtDNA content were decreased by 83% and 40% to 65%, respectively. Subsequently, we noted that reactive oxygen species (ROS), oxidative stress, and mtDNA oxidation were significantly increased, yet NRF1/2-regulated antioxidant gene expression remained compromised in infected cardiomyocytes and chagasic hearts. Conclusions The replication of mtDNA was severely compromised, resulting in a significant loss of mtDNA and expression of OXPHOS genes in T cruzi–infected cardiomyocytes and chagasic hearts. Our data suggest increased ROS generation and selective functional incapacity of NRF2-mediated antioxidant gene expression played a role in the defects in mtDNA replication and unfitness of mtDNA for

Trasplante autólogo de células progenitoras derivadas de la médula ósea, por vía intramiocárdica, para revascularización en cardiopatía isquémica crónica Autologous intramyocardial transplant of bone marrow derived stem cells for revascularization in ischemic chronic cardiopathy

Directory of Open Access Journals (Sweden)

Óscar Velásquez

2005-08-01

Full Text Available Introducción: estudios experimentales y clínicos demuestran que la implantación intramiocárdica de células progenitoras derivadas de la médula ósea, produce angiogénesis y mejora la función cardiaca en pacientes con cardiopatía isquémica crónica. Metodología: este es el reporte del seguimiento a dos meses de un paciente con cardiopatía isquémica crónica no susceptible de revascularización quirúrgica o percutánea, a quien se le realizó ,por vía epicárdica, un implánte de células progenitoras derivadas de médula ósea movilizadas con factor de crecimiento granulocito-macrófago. Resultados: se demostró mejoría significativa en la sintomatología, en la capacidad funcional (1.8 MET a 10 MET, en el estado funcional (IV a I, en el tamaño del defecto de perfusión miocárdica por medicina nuclear, en la fracción de eyección y en la disminución del volumen sistólico final del ventrículo izquierdo, sin observar complicaciones relacionadas con el procedimiento. Conclusión: el trasplante de células progenitoras derivadas de la médula ósea es una terapia efectiva y segura para promover neovascularización y para mejorar la contractilidad y la perfusión miocárdica en los pacientes con cardiopatía isquémica crónica pobres candidatos a cirugía.Introduction: experimental and clinical studies have demonstrated that intramyocardial bone marrow derived stem cells implantation produce angiogenesis and improvement of cardiac function in patients with chronic ischemic cardiopathy. Methodology: this is a two months follow-up report of a patient with chronic ischemic cardiopathy not susceptible of surgical or percutaneous revascularization, to whom bone marrow stem cells mobilized with granulocyte - macrophage growth factor was implanted. Results: significant improvement was demonstrated in symptomatology, functional capacity (1.8 Mets to 10 Mets, functional state (IV to I, size of the myocardial perfusion defect by nuclear

Enteric Neuronal Damage, Intramuscular Denervation and Smooth Muscle Phenotype Changes as Mechanisms of Chagasic Megacolon: Evidence from a Long-Term Murine Model of Trypanosoma cruzi Infection.

Directory of Open Access Journals (Sweden)

Camila França Campos

Full Text Available We developed a novel murine model of long-term infection with Trypanosoma cruzi with the aim to elucidate the pathogenesis of megacolon and the associated adaptive and neuromuscular intestinal disorders. Our intent was to produce a chronic stage of the disease since the early treatment should avoid 100% mortality of untreated animals at acute phase. Treatment allowed animals to be kept infected and alive in order to develop the chronic phase of infection with low parasitism as in human disease. A group of Swiss mice was infected with the Y strain of T. cruzi. At the 11th day after infection, a sub-group was euthanized (acute-phase group and another sub-group was treated with benznidazole and euthanized 15 months after infection (chronic-phase group. Whole colon samples were harvested and used for studying the histopathology of the intestinal smooth muscle and the plasticity of the enteric nerves. In the acute phase, all animals presented inflammatory lesions associated with intense and diffuse parasitism of the muscular and submucosa layers, which were enlarged when compared with the controls. The occurrence of intense degenerative inflammatory changes and increased reticular fibers suggests inflammatory-induced necrosis of muscle cells. In the chronic phase, parasitism was insignificant; however, the architecture of Aüerbach plexuses was focally affected in the inflamed areas, and a significant decrease in the number of neurons and in the density of intramuscular nerve bundles was detected. Other changes observed included increased thickness of the colon wall, diffuse muscle cell hypertrophy, and increased collagen deposition, indicating early fibrosis in the damaged areas. Mast cell count significantly increased in the muscular layers. We propose a model for studying the long-term (15 months pathogenesis of Chagasic megacolon in mice that mimics the human disease, which persists for several years and has not been fully elucidated. We

Funções autonômica cardíaca e mecânica ventricular na cardiopatia chagásica crônica assintomática Cardiac autonomic and ventricular mechanical functions in asymptomatic chronic chagasic cardiomyopathy

Directory of Open Access Journals (Sweden)

Daniel França Vasconcelos

2012-02-01

ventricular systolic and diastolic functions is still controversial and little explored in chronic Chagas' disease. OBJECTIVE: To evaluate the extent to which cardiac autonomic and mechanical ventricular functions are altered and whether they are associated in asymptomatic chagasic cardiomyopathy. METHODS: A total of 13 patients with asymptomatic chagasic cardiomyopathy and 15 normal subjects (control group were evaluated and the autonomic modulation of heart rate variability for five minutes, in the temporal and spectral domains, in the supine and orthostatic positions, as well as ventricular function based on morphological-functional variables obtained by Doppler echocardiography were correlated. Statistical analysis used the Mann-Whitney test and Spearman's correlation. RESULTS: In both positions, the temporal index (p = 0.0004 to 0.01 and total (p = 0.0007-0.005 and absolute spectral areas, of low and high frequencies (p = 0.0001 to 0.002, were lower in the chagasic group. The vagal-sympathetic balance was similar in both positions (p = 0.43 to 0.89. The echocardiographic variables did not differ between groups (p = 0.13 to 0.82, except the left ventricular end-systolic diameter, which was larger (p = 0.04 and correlated directly with reduced rates of global (p = 0.01 to 0.04 and parasympathetic (p = 0.002 to 0.01 autonomic modulation in patients with Chagas disease in the orthostatic position. CONCLUSION: The sympathetic and parasympathetic depressions with preserved balance were associated with only one ventricular dysfunction indicator. This suggests that cardiac autonomic dysfunction may precede and be independently more severe than ventricular dysfunction, with no causal association between both disorders in chronic chagasic cardiomyopathy.

Cardiopathies congénitales: aspects épidémiologiques et échocardiographies à propos de 109 cas au centre hospitalier universitaire pédiatrique Charles de Gaulle (CHUP-CDG) de Ouagadougou, Burkina Faso

Science.gov (United States)

Kinda, Georges; Millogo, Georges Rosario Christian; Koueta, Fla; Dao, Lassina; Talbousouma, Sollimy; Cissé, Hassane; Djiguimdé, Aristide; Yé, Diarra; Sorgho, Claudine Lougue

2015-01-01

Notre travail avait pour objectif d’étudier les aspects épidémiologiques et écho-cardiographiques des cardiopathies congénitales au CHUP-CDG afin d'y faire l’état des lieux. Pour se faire, nous avons mené sur une période de 27 mois d'aout 2009 à mai 2010 et d'octobre 2011 à décembre 2011, une étude rétrospective des comptes rendus d’échocardiographies Doppler des patients admis dans le service d'imagerie médicale. Nous avons utilisé une sonde cardiaque de 5MHz sur appareil Aloka Prosound 4000 Plus. Durant la période d’étude, 380 examens écho-cardiographiques ont été réalisés et ont permis de mettre en évidence 109 cas de cardiopathies congénitales avec 138 entités nosologiques différentes. Les cardiopathies congénitales représentaient 0,98% des 11169 entrées. Les souffles étaient au premier rang des motifs de demande de l’échographie Doppler cardiaque (121 cas sur 380) soit 39,53%. Les CIV étaient au premier plan des cardiopathies congénitales (28,26%), suivies des CIA (23,19%), des sténoses pulmonaires (19,57%), des Tétralogie de Fallot (9,42%). Dans leur forme isolée, les CIA étaient les plus fréquentes avec 21,95% des cas, suivies des CIV avec 20,73%. Sur 138 cas de cardiopathies congénitales (chez 109 enfants), 53 cas ont été observés chez des enfants de sexe féminin et 56 cas chez des enfants de sexe masculin soit un sexe ration de 1,1. La tranche d’âge présentant une fréquence élevée de cardiopathie congénitale est celle de 1mois- 30 mois avec 55% des cas. Les cardiopathies congénitales de l'enfant sont une réalité en Afrique, leurs fréquences dans toutes les séries rapportées sont certainement sous estimées en raison de l'inaccessibilité de l’échocardiographie doppler. PMID:26090039

Characteristics and identification of sites of chagasic ventricular tachycardia by endocardial mapping

Directory of Open Access Journals (Sweden)

Távora Maria Zildany P.

1999-01-01

Full Text Available OBJECTIVE: To study electrophysiological characteristics that enable the identification and ablation of sites of chagasic tachycardia. METHODS: Thirty-one patients with chronic Chagas' heart disease and sustained ventricular tachycardia (SVT underwent electrophysiological study to map and ablate that arrhythmia. Fifteen patients had hemodinamically stable SVT reproducible by programmed ventricular stimulation, 9 men and 6 women with ages ranging from 37 to 67 years and ejection fraction varying from 0.17 to 0.64. Endocardial mapping was performed during SVT in all patients. Radiofrequency (RF current was applied to sites of presystolic activity of at least 30 ms. Entrainment was used to identify reentrant circuits. In both successful and unsuccessful sites of RF current application, electrogram and entrainment were analyzed. RESULTS: Entrainment was obtained during all mapped SVT. In 70.5% of the sites we observed concealed entrainment and ventricular tachycardia termination in the first 15 seconds of RF current application. In the unsuccessful sites, significantly earlier electrical activity was seen than in the successful ones. Concealed entrainment was significantly associated with ventricular tachycardia termination. Bystander areas were not observed. CONCLUSION: The reentrant mechanism was responsible for the genesis of all tachycardias. In 70.5% of the studied sites, the endocardial participation of the slow conducting zone of reentrant circuits was shown. Concealed entrainment was the main electrophysiological parameter associated with successful RF current application. There was no electrophysiological evidence of bystander regions in the mapped circuits of SVT.

Chagasic megacolon and large bowel neoplasms: case series and literature review

Directory of Open Access Journals (Sweden)

Maxwel Capsy Boga Ribeiro

2011-12-01

Full Text Available There is a clear association between chagasic megaesophagus and the esophageal cancer. On the other hand, the association between chagasic megacolon and intestinal neoplasm is uncommon. There are only a few cases described in literature. We selected two cases of colorectal adenocarcinoma associated with adenoma from 2000 to 2011, which are added to the four patients already described by this group. The mean age of the patients, was 68.5 years. Both had been submitted to surgical resection of the neoplasm. Survival rates ranged and were directly related to tumor staging at the time of diagnosis. In this context, we report our case series and reviwed the corresponding literature, especially the clinical and epidemiological aspects of this rare association.Há uma clara associação entre megaesôfago por doença de Chagas e o câncer esofágico. Ao contrário, tal relação, entre megacólon chagásico e neoplasias do intestino grosso é, reconhecidamente, incomum. Existem poucos casos relatados na literatura. Destacamos, entre 2000 e 2011, dois casos, sendo ambos adenocarcinomas colorretais e associados a adenomas, que se somam aos outros quatro já descritos por este grupo. A média de idade dos pacientes, foi de 68,5 anos. Todos foram submetidos à ressecção cirúrgica da neoplasia. A sobrevida foi variável e diretamente relacionada ao estádio do tumor no momento do diagnóstico. Dentro desse contexto, relatamos essa série de casos e revisamos a literatura correlata, com relação aos aspectos clínicos e epidemiológicos dessa rara associação.

Experimental Chagas' disease in dogs

Directory of Open Access Journals (Sweden)

Marta de Lana

1992-03-01

Full Text Available This paper describes the development of experimental Chagas' disease in 64 out-bred young dogs. Twenty-nine animals were inoculated with the Be-62 and 35 with Be-78 Trypanosoma cruzi strains. Twenty-six were infected with blood trypomastigotes by different inoculation routes and 38 with metacyclic trypomastigotes from the vector via the conjunctival route. Twenty of the 26 dogs infected with blood trypomastigotes were autopsied during the acute phase. Eleven died spontaneously and nine were sacrificed. Six remained alive until they died suddenly (two or were autopsied (four. Twelve of the 38 dogs infected with metacyclic trypomastigotes evolved naturally to the chronic phase and remained alive for 24-48 months. The parasitemia, clinical aspects and serology (IgM and IgG as well as electrocardiogram, hemogram and heart anatomo-histopathologic patterns of acute and chronic cardiac forms of Chagas' disease as seen in human infections, were reproduced. The most important finding is the reproductibility of diffuse fibrosing chronic chagasic cardiopathy in all dogs infected with Be-78 T. cruzi strain autopsied between the 90th and 864th days of infection. Thus, the dog can be considered as a suitable experimental model to study Chagas' disease according to the requisites of the World Health Organization (1984. Futhermore the animal is easily obtained and easy to handle and maintain in experimental laboratory conditions.

Electrocardiographic findings in Mexican chagasic subjects living in high and low endemic regions of Trypanosoma cruzi infection

Directory of Open Access Journals (Sweden)

Francisca Sosa-Jurado

2003-07-01

Full Text Available In México the first human chronic chagasic case was recognized in 1940. In spite of an increasing number of cases detected since that time, Chagas disease in México has been poorly documented. In the present work we studied 617 volunteers subjects living in high and low endemic regions of Trypanosoma cruzi infection with seroprevalence of 22% and 4% respectively. Hemoculture performed in those seropositive subjects failed to demonstrate circulating parasites, however polymerase chain reaction identified up to 60% of them as positives. A higher level of anti-T. cruzi antibodies was observed in seropositive residents in high endemic region, in spite of similar parasite persistence (p < 0.05. On standard 12 leads electrocardiogram (ECG 20% to 22% seropositive individuals from either region showed right bundle branch block or ventricular extrasystoles which were more prevalent in seropositive than in seronegative individuals (p < 0.05. In conclusion, the frequency or type of ECG abnormality was influenced by serologic status but not by endemicity or parasite persistence. Furthermore, Mexican indeterminate patients have a similar ECG pattern to those reported in South America.

Effect of low oral doses of disopyramide and amiodarone on ventricular and atrial arrhythmias of chagasic patients with advanced myocardial damage.

Science.gov (United States)

Carrasco, H A; Vicuña, A V; Molina, C; Landaeta, A; Reynosa, J; Vicuña, N; Fuenmayor, A; López, F

1985-12-01

Low-dose (7 mg/kg per day) disopyramide administration to arrhythmic chagasic patients decreased the frequency of ventricular extrasystoles in 4 of 17 patients (24%) and suppressed most complex ventricular arrhythmias in 12 of 15 patients (80%). This assessment was made from 72-h continuous Holter monitoring recorded during the course of this double blind, placebo-controlled randomized crossover study. Seven patients (41%) complained of anticholinergic side effects, but no contractile or conduction system depression was seen. Amiodarone (200 mg) given on a single blind, placebo-controlled basis to 9 of these patients reduced the frequency of ventricular extrasystoles in 6 of 9 patients (67%) and suppressed complex ventricular ectopy in 6 of 7 patients (85%). One patient was unable to tolerate this drug (11%). Both drugs seemed less effective in controlling supraventricular arrhythmias, although disopyramide eliminated paroxysms of supraventricular tachycardia in 9 of 13 (69%) and amiodarone in all 6 patients with this arrhythmia. Amiodarone appears to be a better antiarrhythmic drug for chagasic patients, due to its greater effectiveness and lower incidence of side effects.

Transplant of stem cells derived from bone marrow and granulocytic growth factor in acute and chronic ischemic myocardiopathy

International Nuclear Information System (INIS)

Senior Juan M; Cuellar Francisco; Velasquez Oscar; Velasquez Margarita; Navas Claudia M; Ortiz Sergio; Delgado Juan A; Guillerrno, Blanco; Londono Juan L; Coronado Manuel A; Gomez Francisco; Alzate, Fernando Leon; Zuluaga Alejandra

2007-01-01

Recent studies have shown the safety and efficacy of the stem cells derived from bone marrow (BMC) implant with concomitant administration of stimulating factor of granulocyte colonies in patients with acute myocardial infarction with ST segment elevation and in chronic ischemic cardiopathy. An open prospective (before and after) design was made to evaluate the safety and efficacy of cell therapy associated to growth factor administration. The first experience with this kind of therapy is reported. Methodology: this is a 6 months follow-up report of patients with acute and chronic ischemic cardiopathy to who transplant of stem cells derived from bone marrow mobilized with granulocyte colonies growth stimulating factor via coronary arteries or epicardium was realized. Two groups of patients were included: Ten patients with anterior wall infarct and 2. Five patients with chronic ischemic cardiopathy, all with extensive necrosis demonstrated by absence of myocardial viability through nuclear medicine and ejection fraction of less than 40%. Results: significant improvement of ejection fraction from 29.44 ± 3.36 to 37.6 ± 5.3 with p<0.001 and decrease of ventricular systolic and diastolic volume without statistical significance (p =0.31 and 0.4 respectively) were demonstrated. Exercise capacity evidenced by increment in the six minutes test, exercise time and the MET number achieved, increased in a significant way. There were significant changes in the perfusion defect from the second follow-up month and no complications directly related to the stem cells derived from bone marrow transplant or the use of stimulating granulocyte colony factor were presented. Conclusions: this is the first experience of stem cells derived from bone marrow transplant associated to the administration of stimulating granulocyte growth colony factor in which recovery of left ventricular function was demonstrated, as well as improvement in exercise capacity and in the perfusion defect

Increased osmotic sensitivity for antidiuretic response in chronic chagas' disease

Directory of Open Access Journals (Sweden)

Joel Paulo Russomano Veiga

1985-06-01

Full Text Available The osmotic threshold for attaining the antidiuretic response to hypertonic saline infusion and Progressive dehydration was studied in 31 patients with the chronic form of Chagas' disease and 16 control patients. The chagasic patients exhibited enhanced osmoticsensitivity to the antidiuretic response. This was demonstrated by lower values of the increments in plasma osmolarity sufficient to induce a significant fall in water clearance, without alterations in the osmolar clearance or creatinine excretion. The time needed to attain the antidiuretic response was shorterfor chagasics in relation to normal subjects. The results suggest the existence of a disturbance in the fine control of osmoregulation in the chagasic patients. They are interpreted to be a consequence of the denervation in hypothalamic or extrahypothalamic areas that regulate the secretion of vasopressin in chronic Chagas' disease.O limiar de sensibilidade osmótíca para obtenção de resposta antídiurética foi avaliado em 31 pacientes com a forma crônica da moléstia de Chagas, através de infusão de salina hipertônica ou desidratação. Os resultados, quando comparados com os obtidos em 16 pacientes-controle, mostram uma sensibilidade osmótíca aumentada para os chagásicos, dados os menores valores do incremento na osmolaridade plasmática, suficiente para induzir uma queda significativa na depuração de água livre, sem alterações na depuração osmolar ou na excreção de creatínina. Também, o tempo necessário para atingir a antídiurese foi mais curto para os chagásicos do que para os controles. Os resultados sugerem a existência de um distúrbio na osmorregulação, nos pacientes chagásicos, caracterizado por uma sensibilidade osmótíca aumentada dos osmorreceptores para liberação da vasopressina. Estes dados interpretam-se como conseqüente à desnervação em áreas hipotalâmicas ou extra-hipotalâmicas, relacionadas com a secreção do horm

Longitudinal study of the indirect immunofluorescence and complement fixation tests for diagnosis of chagas' disease in immunosuppressed patients submitted to renal transplantation

Directory of Open Access Journals (Sweden)

José Fernando de Castro Figueiredo

1993-12-01

Full Text Available Clinical and serological follow-up of 7 patients submitted to renal transplantation and presenting positive serological reactions to Chagas 'disease before immunossupression did not show significant changes in indirect immunofluorescence and complement fixation titres for Chagas ' disease, or signs and symptoms indicating exacerbation of the disease during follow- up. In addition, 18 of 66 recipients of renal transplants considered to be non-chagasic before immunosuppression showed at least one positive result to the indirect immunofluorescence test for Chagas ' disease during the study period. The results suggest that the immunosuppression State induced in chagasic patients submitted to renal transplant did notpromoted exacerbation of the chronic infection in these patients and not interfere with the serological response of chronic chagasics, thus permitting the use of these serologic reactions for diagnostic purposes in these cases. However, the positive results ofthe indirect immunofluorescence test in non- chagasic patients indicate the needforjudicious interpretation ofthe indirect immunofluorescence test for the diagnosis of Chagas' disease in renal transplanted patients.

Effects of water deprivation on renal hydroelectrolytic excretion in chronically Trypanosoma cruzi-infected rats

Directory of Open Access Journals (Sweden)

T.T. Rosa

1995-03-01

Full Text Available The effect of an 8 hour-period of water deprivation on fluid and electrolyte renal excretion was investigated in male Wistar rats infected with the strain São Felipe (12SF of Trypanosoma cruzi, in comparison with age and sex matched non-infected controls. The median percent reductions in the urinary flow (-40% v -63% and excretion ofsodium (-57% v-79% were smaller in chagasic than in control rats, respectively. So, chagasic rats excreted more than controls. On the other hand, the median percent decrement in the clearance of creatinine was higher in chagasic (-51% than in controls (-39%. Thus, chagasic rats showed some disturbed renal hydroelectrolytic responses to water deprivation, expressed by smaller conservation, or higher excretion of water and sodium in association with smaller glomerularfiltration rate. This fact denoted an elevation in the fractional excretion of sodium and water.

Genetic Polymorphism at CCL5 Is Associated With Protection in Chagas' Heart Disease: Antagonistic Participation of CCR1+ and CCR5+ Cells in Chronic Chagasic Cardiomyopathy.

Science.gov (United States)

Batista, Angelica Martins; Alvarado-Arnez, Lucia Elena; Alves, Silvia Marinho; Melo, Gloria; Pereira, Isabela Resende; Ruivo, Leonardo Alexandre de Souza; da Silva, Andrea Alice; Gibaldi, Daniel; da Silva, Thayse do E S Protásio; de Lorena, Virginia Maria Barros; de Melo, Adriene Siqueira; de Araújo Soares, Ana Karine; Barros, Michelle da Silva; Costa, Vláudia Maria Assis; Cardoso, Cynthia C; Pacheco, Antonio G; Carrazzone, Cristina; Oliveira, Wilson; Moraes, Milton Ozório; Lannes-Vieira, Joseli

2018-01-01

Chronic cardiomyopathy is the main clinical manifestation of Chagas disease (CD), a disease caused by Trypanosoma cruzi infection. A hallmark of chronic chagasic cardiomyopathy (CCC) is a fibrogenic inflammation mainly composed of CD8 + and CD4 + T cells and macrophages. CC-chemokine ligands and receptors have been proposed to drive cell migration toward the heart tissue of CD patients. Single nucleotide polymorphisms (SNPs) in CC-chemokine ligand and receptor genes may determine protein expression. Herein, we evaluated the association of SNPs in the CC-chemokines CCL2 (rs1024611) and CCL5 (rs2107538, rs2280788) and the CCL5/RANTES receptors CCR1 (rs3181077, rs1491961, rs3136672) and CCR5 (rs1799987) with risk and progression toward CCC. We performed a cross-sectional association study of 406 seropositive patients from endemic areas for CD in the State of Pernambuco, Northeast Brazil. The patients were classified as non-cardiopathic (A, n  = 110) or cardiopathic (mild, B1, n  = 163; severe, C, n  = 133). Serum levels of CCL5 and CCL2/MCP-1 were elevated in CD patients but were neither associated with risk/severity of CCC nor with SNP genotypes. After logistic regression analysis with adjustment for the covariates gender and ethnicity, CCL5 -403 (rs2107538) CT heterozygotes (OR = 0.5, P -value = 0.04) and T carriers (OR = 0.5, P -value = 0.01) were associated with protection against CCC. To gain insight into the participation of the CCL5-CCR5/CCR1 axis in CCC, mice were infected with the Colombian T. cruzi strain. Increased CCL5 concentrations were detected in cardiac tissue. In spleen, frequencies of CCR1 + CD8 + T cells and CD14 + macrophages were decreased, while frequencies of CCR5 + cells were increased. Importantly, CCR1 + CD14 + macrophages were mainly IL-10 + , while CCR5 + cells were mostly TNF + . CCR5-deficient infected mice presented reduced TNF concentrations and injury in heart tissue. Selective blockade of CCR1 (Met

Genetic Polymorphism at CCL5 Is Associated With Protection in Chagas’ Heart Disease: Antagonistic Participation of CCR1+ and CCR5+ Cells in Chronic Chagasic Cardiomyopathy

Science.gov (United States)

Batista, Angelica Martins; Alvarado-Arnez, Lucia Elena; Alves, Silvia Marinho; Melo, Gloria; Pereira, Isabela Resende; Ruivo, Leonardo Alexandre de Souza; da Silva, Andrea Alice; Gibaldi, Daniel; da Silva, Thayse do E. S. Protásio; de Lorena, Virginia Maria Barros; de Melo, Adriene Siqueira; de Araújo Soares, Ana Karine; Barros, Michelle da Silva; Costa, Vláudia Maria Assis; Cardoso, Cynthia C.; Pacheco, Antonio G.; Carrazzone, Cristina; Oliveira, Wilson; Moraes, Milton Ozório; Lannes-Vieira, Joseli

2018-01-01

Chronic cardiomyopathy is the main clinical manifestation of Chagas disease (CD), a disease caused by Trypanosoma cruzi infection. A hallmark of chronic chagasic cardiomyopathy (CCC) is a fibrogenic inflammation mainly composed of CD8+ and CD4+ T cells and macrophages. CC-chemokine ligands and receptors have been proposed to drive cell migration toward the heart tissue of CD patients. Single nucleotide polymorphisms (SNPs) in CC-chemokine ligand and receptor genes may determine protein expression. Herein, we evaluated the association of SNPs in the CC-chemokines CCL2 (rs1024611) and CCL5 (rs2107538, rs2280788) and the CCL5/RANTES receptors CCR1 (rs3181077, rs1491961, rs3136672) and CCR5 (rs1799987) with risk and progression toward CCC. We performed a cross-sectional association study of 406 seropositive patients from endemic areas for CD in the State of Pernambuco, Northeast Brazil. The patients were classified as non-cardiopathic (A, n = 110) or cardiopathic (mild, B1, n = 163; severe, C, n = 133). Serum levels of CCL5 and CCL2/MCP-1 were elevated in CD patients but were neither associated with risk/severity of CCC nor with SNP genotypes. After logistic regression analysis with adjustment for the covariates gender and ethnicity, CCL5 −403 (rs2107538) CT heterozygotes (OR = 0.5, P-value = 0.04) and T carriers (OR = 0.5, P-value = 0.01) were associated with protection against CCC. To gain insight into the participation of the CCL5–CCR5/CCR1 axis in CCC, mice were infected with the Colombian T. cruzi strain. Increased CCL5 concentrations were detected in cardiac tissue. In spleen, frequencies of CCR1+ CD8+ T cells and CD14+ macrophages were decreased, while frequencies of CCR5+ cells were increased. Importantly, CCR1+CD14+ macrophages were mainly IL-10+, while CCR5+ cells were mostly TNF+. CCR5-deficient infected mice presented reduced TNF concentrations and injury in heart tissue. Selective blockade of CCR1 (Met-RANTES therapy) in

Genetic Polymorphism at CCL5 Is Associated With Protection in Chagas’ Heart Disease: Antagonistic Participation of CCR1+ and CCR5+ Cells in Chronic Chagasic Cardiomyopathy

Directory of Open Access Journals (Sweden)

Angelica Martins Batista

2018-04-01

Full Text Available Chronic cardiomyopathy is the main clinical manifestation of Chagas disease (CD, a disease caused by Trypanosoma cruzi infection. A hallmark of chronic chagasic cardiomyopathy (CCC is a fibrogenic inflammation mainly composed of CD8+ and CD4+ T cells and macrophages. CC-chemokine ligands and receptors have been proposed to drive cell migration toward the heart tissue of CD patients. Single nucleotide polymorphisms (SNPs in CC-chemokine ligand and receptor genes may determine protein expression. Herein, we evaluated the association of SNPs in the CC-chemokines CCL2 (rs1024611 and CCL5 (rs2107538, rs2280788 and the CCL5/RANTES receptors CCR1 (rs3181077, rs1491961, rs3136672 and CCR5 (rs1799987 with risk and progression toward CCC. We performed a cross-sectional association study of 406 seropositive patients from endemic areas for CD in the State of Pernambuco, Northeast Brazil. The patients were classified as non-cardiopathic (A, n = 110 or cardiopathic (mild, B1, n = 163; severe, C, n = 133. Serum levels of CCL5 and CCL2/MCP-1 were elevated in CD patients but were neither associated with risk/severity of CCC nor with SNP genotypes. After logistic regression analysis with adjustment for the covariates gender and ethnicity, CCL5 −403 (rs2107538 CT heterozygotes (OR = 0.5, P-value = 0.04 and T carriers (OR = 0.5, P-value = 0.01 were associated with protection against CCC. To gain insight into the participation of the CCL5–CCR5/CCR1 axis in CCC, mice were infected with the Colombian T. cruzi strain. Increased CCL5 concentrations were detected in cardiac tissue. In spleen, frequencies of CCR1+ CD8+ T cells and CD14+ macrophages were decreased, while frequencies of CCR5+ cells were increased. Importantly, CCR1+CD14+ macrophages were mainly IL-10+, while CCR5+ cells were mostly TNF+. CCR5-deficient infected mice presented reduced TNF concentrations and injury in heart tissue. Selective blockade of CCR1 (Met-RANTES therapy

Biomarkers of Atrial Cardiopathy and Atrial Fibrillation Detection on Mobile Outpatient Continuous Telemetry After Embolic Stroke of Undetermined Source.

Science.gov (United States)

Sebasigari, Denise; Merkler, Alexander; Guo, Yang; Gialdini, Gino; Kummer, Benjamin; Hemendinger, Morgan; Song, Christopher; Chu, Antony; Cutting, Shawna; Silver, Brian; Elkind, Mitchell S V; Kamel, Hooman; Furie, Karen L; Yaghi, Shadi

2017-06-01

Biomarkers of atrial dysfunction or "cardiopathy" are associated with embolic stroke risk. However, it is unclear if this risk is mediated by undiagnosed paroxysmal atrial fibrillation or flutter (AF). We aim to determine whether atrial cardiopathy biomarkers predict AF on continuous heart-rhythm monitoring after embolic stroke of undetermined source (ESUS). This was a single-center retrospective study including all patients with ESUS undergoing 30 days of ambulatory heart-rhythm monitoring to look for AF between January 1, 2013 and December 31, 2015. We reviewed medical records for clinical, radiographic, and cardiac variables. The primary outcome was a new diagnosis of AF detected during heart-rhythm monitoring. The primary predictors were atrial biomarkers: left atrial diameter on echocardiography, P-wave terminal force in electrocardiogram (ECG) lead V1, and P wave - R wave (PR) interval on ECG. A multiple logistic regression model was used to assess the relationship between atrial biomarkers and AF detection. Among 196 eligible patients, 23 (11.7%) were diagnosed with AF. In unadjusted analyses, patients with AF were older (72.4 years versus 61.4 years, P atrial diameter (39.2 mm versus 35.7 mm, P = .03). In a multivariable model, the only predictor of AF was age ≥ 60 years (odds ratio, 3.0; 95% CI, 1.06-8.5; P = .04). Atrial biomarkers were weakly associated with AF after ESUS. This suggests that previously reported associations between these markers and stroke may reflect independent cardiac pathways leading to stroke. Prospective studies are needed to investigate these mechanisms. Copyright © 2017 National Stroke Association. Published by Elsevier Inc. All rights reserved.

Association of chagasic megacolon and cancer of the colon: case report and review of the literature Associação de megacólon chagásico e câncer de cólon: relato de caso e revisão da literatura

Directory of Open Access Journals (Sweden)

Sheila Jorge Adad

2002-02-01

Full Text Available There are few descriptions of association between chagasic megacolon and colon cancer. We report a case of obstructive abdomen caused by adenocarcinoma of the left colon in chagasic megacolon. A review of the literature revealed 8 cases of this association and, analyzing together the series of findings of cancer in chagasic organomegalies, we found a frequency of 4.8% in megaesophagus and 0.1% in megacolon.Há poucas descrições de associação entre megacólon chagásico e câncer de cólon. Relatamos caso de abdômen obstrutivo por adenocarcinoma do cólon esquerdo, em megacólon chagásico. A revisão da literatura indica 8 casos desta associação e, analisando-se em conjunto as séries de levantamentos de câncer em megas chagásicos, encontra-se freqüência de 4,8% em megaesôfago e 0,1% em megacólon.

Aggregatory behaviour of platelets incubated with subcellular fractions of normal and chagasic human syncytiotrophoblast Comportamento agregatório das plaquetas incubadas com frações subcelulares de sinciciotrofoblasto humano normal e chagásico

Directory of Open Access Journals (Sweden)

A.R. Eynard

1993-06-01

Full Text Available The surface of human syncytiotrophoblast does not induce maternal blood platelet aggregation even though it is not an endothelium. It can be surmised that as occurs in endothelial injury the subcellular components of the syncytiotrophoblast may have pro-or antiaggregatory activity. During congenital Chagas' disease which is associated to trophoblast lesions, platelets may play a role in the development of T. cruzi-induced placentitis. In the present work the aggregatory behaviour of normal human blood platelets was recorded after their challenging with subcellular fractions of syncytiotrophoblast isolated from normal and chagasic women. Nuclear, Mitochondrial, Microsomal and Supernatant fractions isolated from normal and chagasic syncytiotrophoblast failed to induce per se any aggregatory reaction on platelets. When samples of platelet-rich plasma (PRP were preincubated with normal and chagasic nuclear fractions and then stimulated with collagen at threshold level (CT-PRP an inhibition of the aggregatory response was observed. Treatment of CT-PRP with normal and chagasic mitochondrial fractions induced inhibition of platelet aggregation whereas only chagasic fraction reduced latency time. Microsornal fraction from normal placentas showed no significant effects on platelet aggregation. It is concluded that subcellular fractions of normal human syncytiotrophoblast do not exhibit any effect on platelet aggregation, whereas those subcellular fractions enriched in intracellular membrane components isolated from chagasic placentas inhibit platelet aggregation.A superficie do sinciciotrofoblasto humano não induz agregação das plaquetas maternas apesar de não ser um endotélio. Lesões endoteliais propiciam o aparecimento de agregados plaquetários, o que nos leva a questionar se os componentes subcelulares do sinciciotrofoblasto também poderiam propiciar eventos semelhantes. Na doença de Chagas congênita, que está associada a lesões a nivel de

Esophageal transit time in patients with chagasic megaesophagus

Science.gov (United States)

Martins, Paula; Ferreira, Cid Sergio; Cunha-Melo, José Renan

2018-01-01

Abstract The aim of this study was to determine the esophageal transit time in control individuals and in chagasic patients with or without megaesophagus. A total of 148 patients were allocated in 6 groups according to serological diagnostic of Chagas disease and the degree of esophageal dilatation: A, control healthy individuals (n = 34, 22.9%); B, indeterminate form (n = 23, 15.5%); C, megaesophagus I (n = 37, 25.0%); D, megaesophagus II (n = 19, 12.8%); E, megaesophagus III (n = 21, 14.2%); and F, megaesophagus IV (n = 14, 9.5%). After 8-hour fasting, patients were asked to swallow 75 mL of barium sulfate solution. x-Rays were obtained after 8, 30, 60, and 90 seconds, 5, 10, 30, 60, and 90 minutes, 2, 6, 12, 24 hours, and at every 12 hours until no more contrast was seen in the esophagus. This was the transit time. The transit time varied from 8 seconds to 36 hours (median = 90 seconds). A linear correlation was observed between transit time and megaesophagus grade: 8 seconds in groups A and B, 5 minutes in C, 30 minutes in D, 2 hours in E, and 9:15 hours in F. Dysphagia was not reported by 60 of 114 (52.6%) patients with positive serological tests for Chagas disease (37/91—40.7%—of patients with megaesophagus I–IV grades). The esophageal transit time increased with the grade of megaesophagus. The esophageal transit time has a direct correlation with the grade of megaesophagus; dysphagia complaint correlates with the grade of megaesophagus. However, many patients with megaesophagus do not report dysphagia. PMID:29517674

Enteropatia chagásica

OpenAIRE

Meneghelli, Ulysses G.

2004-01-01

Involvement of the hollow organs of the digestive apparatus can occur in patients in the chronic phase of Chagas' disease. The basic mechanism is destruction of neurons of the enteric nervous system. Whereas megaesophagus and megacolon are the most notable and most extensively studied expressions of the digestive form of Chagas' disease, involvement of the small intestine (Chagasic enteropathy) is less frequent and less known than involvement of the two above mentioned entities. Chagasic ente...

Accuracy of chimeric proteins in the serological diagnosis of chronic chagas disease - a Phase II study.

Directory of Open Access Journals (Sweden)

Fred Luciano Neves Santos

2017-03-01

Full Text Available The performance of current serologic tests for diagnosing chronic Chagas disease (CD is highly variable. The search for new diagnostic markers has been a constant challenge for improving accuracy and reducing the number of inconclusive results.Here, four chimeric proteins (IBMP-8.1 to -8.4 comprising immunodominant regions of different Trypanosoma cruzi antigens were tested by enzyme-linked immunosorbent assay. The proteins were used to detect specific anti-T. cruzi antibodies in the sera of 857 chagasic and 689 non-chagasic individuals to evaluate their accuracy for chronic CD diagnosis. The antigens were recombinantly expressed in Escherichia coli and purified by chromatographic methods. The sensitivity and specificity values ranged from 94.3% to 99.3% and 99.4% to 100%, respectively. The diagnostic odds ratio (DOR values were 6,462 for IBMP-8.1, 3,807 for IBMP-8.2, 32,095 for IBMP-8.3, and 283,714 for IBMP-8.4. These chimeric antigens presented DORs that were higher than the commercial test Pathozyme Chagas. The antigens IBMP-8.3 and -8.4 also showed DORs higher than the Gold ELISA Chagas test. Mixtures with equimolar concentrations were tested in order to improve the diagnosis accuracy of negative samples with high signal and positive samples with low signal. However, no gain in accuracy was observed relative to the individual antigens. A total of 1,079 additional sera were used to test cross-reactivity to unrelated diseases. The cross-reactivity rates ranged from 0.37% to 0.74% even for Leishmania spp., a pathogen showing relatively high genome sequence identity to T. cruzi. Imprecision analyses showed that IBMP chimeras are very stable and the results are highly reproducible.Our findings indicate that the IBMP-8.4 antigen can be safely used in serological tests for T. cruzi screening in blood banks and for chronic CD laboratory diagnosis.

Histological and endoscopic features of the stomachs of patients with Chagas disease in the era of Helicobacter pylori

Directory of Open Access Journals (Sweden)

Fernanda Machado Fonseca

2014-12-01

Full Text Available Introduction Most studies that have evaluated the stomachs of patients with Chagas disease were performed before the discovery of Helicobacter pylori and used no control groups. This study compared the gastric features of chagasic and non-chagasic patients and assessed whether gastritis could be associated with Chagas disease. Methods Gastric biopsy samples were taken from patients who underwent endoscopy for histological analysis according to the Updated Sydney System. H. pylori infection was assessed by histology, 16S ribosomal ribonucleic acid (rRNA polymerase chain reaction (PCR, serology and the 13C-urea breath test. Patients were considered H. pylori-negative when all of these diagnostic tests were negative. Clinical and socio-demographic data were obtained by reviewing medical records and using a questionnaire. Results The prevalence of H. pylori infection (70.3% versus 71.7% and chronic gastritis (92.2% versus 85% was similar in the chagasic and non-chagasic groups, respectively; such as peptic ulcer, atrophy and intestinal metaplasia. Gastritis was associated with H. pylori infection independent of Chagas disease in a log-binomial regression model. However, the chagasic H. pylori-negative patients showed a significantly higher grade of mononuclear (in the corpus and polymorphonuclear (PMN (in the antrum cell infiltration. Additionally, the patients with the digestive form of Chagas disease showed a significantly lower prevalence of corpus atrophy than those with other clinical forms. Conclusions The prevalence of H. pylori infection and of gastric histological and endoscopic features was similar among the chagasic and non-chagasic patients. Additionally, this is the first controlled study to demonstrate that H. pylori is the major cause of gastritis in patients with Chagas disease.

Estudo da infecção e morbidade da doença de Chagas no município de João Costa: Parque Nacional Serra da Capivara, Piauí, Brasil Study of the infection and morbidity of Chagas' disease in municipality of João Costa: National Park Serra da Capivara, Piauí, Brazil

Directory of Open Access Journals (Sweden)

José Borges-Pereira

2002-08-01

. The high proportion of the chagasic component on the cardiopathy prevalence is indicative of the high morbidity of Chagas' disease in the studied region.

Contribuição ao estudo da anatomia patológica do megaesôfago chagásico Contribution to the study of the pathology and pathogenesis of the chagasic megaesophagus

Directory of Open Access Journals (Sweden)

Sheila J. Adad

1991-12-01

Full Text Available Estudo anatomopatológico sistematizado foi feito em 56 esôfagos de chagásicos crônicos (17 com e 39 sem mega e em 26 de não chagásicos com as seguintes finalidades: 1 avaliar as variações de calibre e espessura da parede do órgão; 2 analisar qualitativa e quantitativamente o plexo mientérico, na tentativa de avaliar a eventual relação entre suas lesões e o aparecimento de megaesôfago (ME; 3 estudar as lesões das musculares procurando verificar sua contribuição na gênese da visceromegalia; 4 pesquisar formas amastigotas do T. cruzi e sua possível relação com o processo inflamatorio; 5 identificar as principais alterações da mucosa. Confirmou-se que as lesões mais intensas localizavam-se na muscular própria e no plexo de Auerbach. Na primeira, as principais alterações foram miosite e fibrose e nos gânglios mientéricos observou-se inflamação e despopulação neuronal, maior nos esôfagos dos chagásicos com dilatação em relação aos sem dilatação e destes em relação aos controles. Entretanto, foram vistos esôfagos de calibre normal, com intensa denervação. Conclui-se que parecem ser múltiplos os fatores que desencadeiam a esofagopatia, especialmente, o ME. A pesquisa de parasitas em oito esófagos com mega e em oito sem ME foi positiva somente em quatro casos, do primeiro grupo. As lesões da mucosa e submucosa não parecem participar do processo.Systematized study was made in 56 esophagi of chronic chagasics (17 with and 39 without megas aiming to: 1 to avaluate the esophageal caliber and thickness ranges; 2 analyse qualitative and quantitatively, the myenteric plexuses, trying to evaluate the relation of their lesions and the development of megaesophagus (ME; 3 study the lesions of the muscularis propria to verify if they contribute or not to the beginning of the process; 4 search for T. cruzi and its eventual relationship with the inflammation; 5 identify the principal mucosal alterations. It was

Gene expression changes associated with myocarditis and fibrosis in hearts of mice with chronic chagasic cardiomyopathy

DEFF Research Database (Denmark)

Soares, Milena Botelho Pereira; de Lima, Ricardo Santana; Rocha, Leonardo Lima

2010-01-01

histocompatibility complex molecules) and fibrosis (extracellular matrix components, lysyl oxidase, and tissue inhibitor of metalloproteinase 1). Our results indicate potentially relevant factors involved in the pathogenesis of the disease that may provide new therapeutic targets in chronic Chagas disease....

O perfil dos portadores de doença de Chagas, com ênfase na forma digestiva, em hospital terciário de Ribeirão Preto, SP Features of Chagas' disease patients with emphasis on digestive form, in a tertiary hospital of Ribeirão Preto, SP

Directory of Open Access Journals (Sweden)

Mayra Mayumi Kamiji

2005-08-01

Full Text Available Para caracterizar o perfil clínico e demográfico dos portadores da forma digestiva da doença de Chagas atualmente atendidos no Hospital das Clínicas da Faculdade de Medicina de Ribeirão Preto, foram revistos 377 prontuários de pacientes com resultado positivo para reação sorológica para a doença de Chagas atendidos entre janeiro de 2002 a março de 2003. A idade mediana dos pacientes era de 67 anos e 210 (56% eram mulheres. Megaesôfago e/ou megacólon chagásicos estavam presentes em 135 pacientes, dos quais, 59% apresentavam cardiopatia. Para 49% dos pacientes com doença digestiva, havia prescrição de pelo menos dois medicamentos para tratamento de doença cardiovascular. Em 66 pacientes, foram detectadas comorbidades crônicas. A população de portadores da forma digestiva da doença de Chagas do HCFMRP é majoritariamente geriátrica e apresenta freqüência elevada de doenças cardiovasculares, o que sugere risco elevado das modalidades de tratamento cirúrgico do megaesôfago e megacólon.In order to characterize the demographic and clinical profile of patients with digestive manifestations of Chagas' disease, the medical records were reviewed of patients (n = 377 currently attended at Hospital das Clinicas da Faculdade de Medicina de Ribeirão Preto with positive serologic reaction for Chagas' disease and admitted from January 2002 to March 2003. Median age was 67 years and 210 (56% were women. Megaesophagus and/or megacolon were present in 135 patients, 59% of these had cardiopathy. For 49% of patients with digestive disease, at least two medical prescriptions of medicines for the treatment of cardiovascular diseases were found. In 66 patients, chronic comorbidities were detected. The population with digestive manifestation of Chagas' disease referred to HCFMRP is mostly geriatric, with an elevated frequency of cardiopathy, which may indicate a high risk for surgical approach to the treatment of chagasic megaesophagus and

Chronic gastritis and Helicobacter pylori in digestive form of Chagas' disease Gastrite crônica e Helicobacter Pylori na forma digestiva da doença de Chagas

Directory of Open Access Journals (Sweden)

A. J. A. Barbosa

1993-04-01

Full Text Available Patients with the digestive form of Chagas'disease frequently present chronic gastritis. As the microorganism Helicobacter pylori is now accepted as the most common cause of human chronic gastritis, the present work was undertaken to verify a possible relationship between the presence of this bacterium and inflammatory changes of antral mucosa in chagasic patients. Seventeen chagasics, with megaesophagus and or megacolon were studied. Fragments from two different regions of antral mucosa were obtained by endoscopy, fixed in 4% neutral formaldehyde and embedded in paraffin. The sections were stained by haematoxylin and eosin for histology analysis, and by carbolfuchsin for H. pylori identification. H. pylori was found in 16 (94.1% chagasic patients, all of them presenting chronic gastritis. Superficial gastritis was seen in 9 (52.9% while atrophic gastritis was present in 8 (47.1% patients. H. pylori was present on gastric mucosa of 8 (100% patients with atrophic gastritis and of 8 (88.8% patients with superficial gastritis. We concluded that the microorganism H. pylori should be considered a possible factor connected with the etiopathogenesis of chronic superficial and atrophic gastritis frequently observed in patients with the digestive form of Chagas' disease.Pacientes com a forma digestiva da doença de Chagas frequentemente apresentam gastrite crônica. Tendo em vista que o microrganismo Helicobacter pylori é hoje considerado a causa mais comum de gastrite crônica no homem, propôs-se a realização deste trabalho para se verificar a possibilidade de esta bactéria estar também associada com as alterações inflamatórias da mucosa gástrica em pacientes com a forma digestiva da doença de Chagas. Fragmentos de duas regiões diferentes da mucosa antral foram obtidos endoscopicamente de 17 pacientes chagásicos com megaesôfago e ou megacolon. Os fragmentos foram processados rotineiramente para inclusão em parafina e cortes de 5 |im de

Development of peptide-based lineage-specific serology for chronic Chagas disease: geographical and clinical distribution of epitope recognition.

Directory of Open Access Journals (Sweden)

Tapan Bhattacharyya

2014-05-01

Full Text Available BACKGROUND: Chagas disease, caused by infection with the protozoan Trypanosoma cruzi, remains a serious public health issue in Latin America. Genetically diverse, the species is sub-divided into six lineages, known as TcI-TcVI, which have disparate geographical and ecological distributions. TcII, TcV, and TcVI are associated with severe human disease in the Southern Cone countries, whereas TcI is associated with cardiomyopathy north of the Amazon. T. cruzi persists as a chronic infection, with cardiac and/or gastrointestinal symptoms developing years or decades after initial infection. Identifying an individual's history of T. cruzi lineage infection directly by genotyping of the parasite is complicated by the low parasitaemia and sequestration in the host tissues. METHODOLOGY/PRINCIPAL FINDINGS: We have applied here serology against lineage-specific epitopes of the T. cruzi surface antigen TSSA, as an indirect approach to allow identification of infecting lineage. Chagasic sera from chronic patients from a range of endemic countries were tested by ELISA against synthetic peptides representing lineage-specific TSSA epitopes bound to avidin-coated ELISA plates via a biotin labelled polyethylene glycol-glycine spacer to increase rotation and ensure each amino acid side chain could freely interact with their antibodies. 79/113 (70% of samples from Brazil, Bolivia, and Argentina recognised the TSSA epitope common to lineages TcII/TcV/TcVI. Comparison with clinical information showed that a higher proportion of Brazilian TSSApep-II/V/VI responders had ECG abnormalities than non-responders (38% vs 17%; p<0.0001. Among northern chagasic sera 4/20 (20% from Ecuador reacted with this peptide; 1/12 Venezuelan and 1/34 Colombian samples reacted with TSSApep-IV. In addition, a proposed TcI-specific epitope, described elsewhere, was demonstrated here to be highly conserved across lineages and therefore not applicable to lineage-specific serology. CONCLUSIONS

Development of peptide-based lineage-specific serology for chronic Chagas disease: geographical and clinical distribution of epitope recognition.

Science.gov (United States)

Bhattacharyya, Tapan; Falconar, Andrew K; Luquetti, Alejandro O; Costales, Jaime A; Grijalva, Mario J; Lewis, Michael D; Messenger, Louisa A; Tran, Trang T; Ramirez, Juan-David; Guhl, Felipe; Carrasco, Hernan J; Diosque, Patricio; Garcia, Lineth; Litvinov, Sergey V; Miles, Michael A

2014-05-01

Chagas disease, caused by infection with the protozoan Trypanosoma cruzi, remains a serious public health issue in Latin America. Genetically diverse, the species is sub-divided into six lineages, known as TcI-TcVI, which have disparate geographical and ecological distributions. TcII, TcV, and TcVI are associated with severe human disease in the Southern Cone countries, whereas TcI is associated with cardiomyopathy north of the Amazon. T. cruzi persists as a chronic infection, with cardiac and/or gastrointestinal symptoms developing years or decades after initial infection. Identifying an individual's history of T. cruzi lineage infection directly by genotyping of the parasite is complicated by the low parasitaemia and sequestration in the host tissues. We have applied here serology against lineage-specific epitopes of the T. cruzi surface antigen TSSA, as an indirect approach to allow identification of infecting lineage. Chagasic sera from chronic patients from a range of endemic countries were tested by ELISA against synthetic peptides representing lineage-specific TSSA epitopes bound to avidin-coated ELISA plates via a biotin labelled polyethylene glycol-glycine spacer to increase rotation and ensure each amino acid side chain could freely interact with their antibodies. 79/113 (70%) of samples from Brazil, Bolivia, and Argentina recognised the TSSA epitope common to lineages TcII/TcV/TcVI. Comparison with clinical information showed that a higher proportion of Brazilian TSSApep-II/V/VI responders had ECG abnormalities than non-responders (38% vs 17%; p<0.0001). Among northern chagasic sera 4/20 (20%) from Ecuador reacted with this peptide; 1/12 Venezuelan and 1/34 Colombian samples reacted with TSSApep-IV. In addition, a proposed TcI-specific epitope, described elsewhere, was demonstrated here to be highly conserved across lineages and therefore not applicable to lineage-specific serology. These results demonstrate the considerable potential for synthetic

Neuronal counting and parasympathetic dysfunction in the hearts of chronically Trypanosoma cruzi - infected rats Contagem neuronal e disfunção cardíaca parassimpática em ratos cronicamente infectados pelo Trypanosoma cruzi

Directory of Open Access Journals (Sweden)

E. Chapadeiro

1991-10-01

Full Text Available Ten male Wistar rats, chronically infected with Colombian, São Felipe (12SF and Y strains of Trypanosoma cruzi and ten non-infected control animals were submitted to the bradycardia responsiveness test, an assessment of heart parasympathetic function, after phenylephrine injection. Six chagasic animals showed heart parasympathetic dysfuntion characterized by reduction in the index of bradycardia baroreflex responsiveness, as compared with the control group. Microscopic examination of the atrial heart ganglia of chagasic rats showed ganglionitis, but no statiscally significant reduction in the number of neurons.Dez ratos machos Wistar cronicamente infectados pelas cepas Colombiana, São Felipe (12SF, e Y do Trypanosoma cruzi, foram submetidos, após 8 meses de infecção, juntamente com dez animais controles, ao teste da resposta bradicárdica barorreflexa pela injeção endovenosa de fenilefrina. Seis ratos chagásicos exibiram disfunção cardíaca parassimpática, caracterizada pela depressão do índice da resposta bradicárdica barorreflexa. Embora o estudo histológico dos corações chagásicos mostrasse lesões dos gânglios atriais, a contagem dos neurônios em cortes seriados, não apresentou redução numérica significativa dos mesmos.

Anatomia patológica de corações de chagásicos assintomáticos falecidos de modo violento Anatomo-pathology of heart of asymptomatic chagas' patients who had a violent death

Directory of Open Access Journals (Sweden)

Edison Reis Lopes

1981-06-01

Full Text Available Com finalidade de melhor conhecimento da forma indeterminada da doença de Chagas os autores realizaram estudo anatomopatólogico sistematizado de trinta corações de chagásicos assintomáticos falecidos de modo violento. Demonstram que nos portadores da forma em questão da tripanossomiase cruzi o coração e acometido por lesões da mesma natureza, porém de intensidade muito menor do que as observadas em chagásicos crônicos que falecem subitamente ou após periodo variável de insuficiência cardíaca. Baseados em seus achados e em outros dados da literatura, concluem que a infecção chagásica, sem inflamação do coração, se ocorre, é rara. Tecem ainda considerações a respeito do significado das lesões observadas no sistema nervoso autônomo intracardíaco no sistema de condução e sobre a gênese formal da cardite chagásica crônica humana.With the purpose of better knowledge of the indeterminate form of Chagas's disease the authors carried out a systematized anatomopathological study of thirty hearts from symptomatic chagasics who had a violent death. In this specific form of the trypanosomiasis cruzi the hearts show lesions of the same nature but much less intense as those observed in chronic chagasics who had a sudden death or died after cardiac failure. Based on theses findings and on data from literature, we conclude that chagasic infection without a cardiac inflammatory process, if it occurs, is very rarely only. Also some comments are made upon the meaning of the lesions observed in the intra-cardiac autonomic nervous system, in the conduction system and on the formal origin of the human chronic chagasic carditis.

Prevailing of ischemia cardiopathy, demonstrated by gammagraphy in less than 40 years old persons and its association with risk factors

International Nuclear Information System (INIS)

Cano G, M.A.; Castillo M, L.; Orea T, A.

2005-01-01

The Coronary Arterial Illness (EAC) is the first cause of death of those Mexicans. Among their numerous risk factors it highlights the age with more bias starting from the 45 years. The objective of this investigation was to determine the prevailing of ischemic cardiopathy (Cl) and heart attack to the myocardium (IAM) in fellows smaller than 40 years and to identify risk factors. The study of myocardial perfusion (EPM) it is a non invasive study and of great sensibility and specificity that it allows to detect obstructive coronary lesions. The used method was retrospective-traverse Study in 125 patients smaller than 40 years. Files of patients to who EPM had been practiced with Technetium 99m-SESTAMlBI, protocol of one day, were revised, where its were analyzed the short and long axis (vertical and horizontal). General data, somatometry, emotional profile analysis, lipids and glucose profiles were gathered. Results. The population conformed it 53% women and 47% men with average of 31.9 year-old age of corporal mass index (IMC) 25.1 kg/cm 2 . 46% of abnormal studies was obtained, of which 35% was compatible with ischemic cardiopathy (Cl) and 11% with heart attack to the myocardium (IAM). The characteristics of these were: age 31.6±6 Vs 32.6±5.9 years; IMC 25.4±7.0 Vs 24.4±3.34 kg/cm 2 ; stature 161.6±9.8 Vs 165.5±9.7cm; TAS 139.1±29.2 Vs. 115±13.4 mm Hg, TAD 84.5±17.4 Vs. 75±9.4 mm Hg; civil state married 65.5% (p=0.005) Vs single 57%; bigger depression 32% Vs anxiety 28%, in the group of patients with Cl and IAM, respectively. In the IAM population it was found an additional IRC 21% (p=0.030), HAS 21% (p=0.025) and drug addiction 21% (p=0.002). The rest of the results didn't show significant differences. Conclusion: Only 6.5% of the patients that went to EPM- 99m Tc-SESTAMIBl in a 6 year-old lapse, were smaller than 40 years. 71% of them was referred by prechordal pain in who almost the half it was evidenced Cl or IAM. In this investigation besides the

Histological, biochemical and pharmacologycal characterization of the gastric muscular layer in Chagas disease Caracterização histológica, bioquímica e farmacológica da musculatura gástrica na doença de Chagas

Directory of Open Access Journals (Sweden)

Wagner Carlucci

2011-01-01

Full Text Available PURPOSE: To assess in vitro the correlation between the number of neurons and the sensitivity to cholinergic drugs and acetylcholinesterase activity in chagasic patients. METHODS: A 3x1 cm strip of the muscle layer of the anterior part of the stomach, always close to the angular incisure, was removed from 10 chronic chagasic patients (6 men submitted to megaesophagus or megacolon surgery and from 10 non-chagasic patients (4 men submitted to other types of surgery (control group, aged on average 52.3 and 50.1 years, respectively, for histological and pharmacological studies. The action of cholinergic drugs was investigated in isolated preparations according to the superfusion method of Ferreira and Costa, and acetylcholinesterase activity was determined by the method of Ellman. For neuron count, the strips were cut into 8 µm sections according to the method standardized by Alcântara. RESULTS: There was a difference in number of neurons between the chagasic (5,6 and control (7,3 groups. Acetylcholinesterase activity, in moles of hydrolyzed substrate per minute per gram tissue, was reduced in chagasic patients (4,32 compared to the controls (7,30. No hypersensitivity of the gastric musculature to cholinergic drugs was detected, with a reduced maximum response to carbachol and betanechol in the chagasic group. CONCLUSIONS: The reduction of neurons in the myenteric plexus of the stomach of chronic chagasic patients can be demonstrated even in the absence of clinical chagasic gastropathy. The hypersensitivity of the gastric musculature to cholinergic drugs probably depends on intense denervation. The reduced acetylcholinesterase activity demonstrates the involvement of the cholinergic innervation in the stomach of chronic chagasic patients. There was no correlation between number of neurons, sensitivity to cholinergic drugs and acetylcholinesterase activity in the gastric musculature of chagasic and non-chagasic patients.OBJETIVO: Avaliar in vitro a

Assessment and epidemiology of Chagas' disease in patients treated in Araguaina - Tocantins; Avaliacao e epidemiologia da cardiopatia chagasica em pacientes atendidos em Araguaina - Tocantins

Energy Technology Data Exchange (ETDEWEB)

Correa, Valeria Rita

2010-07-01

Chagas disease (AD) was described by Carlos Chagas in 1909. It is caused by a parasite T. cruzi, transmitted by bugs, by blood transfusion, vertical and orally. The DC has two phases: acute and chronic. The evolution to the cardiac form occurs in about 30% of chronic cases and is the largest cause of mortality in chronic Chagas disease. The aim of this study was to Chagas' disease in patients of Tocantins, compared with other heart patients and asymptomatic from the standpoint of non-invasive exams using radiant energies such as echocardiography and ECG and RX. The descriptive study included 80 patients, 20 chronic form of Chagas disease, 20 indeterminate, 20 with other heart diseases, and 20 controls. There was a prevalence of 9.5% of chagasic patients treated in outpatient cardiology at Araguaina Tocantins, and 7.3% in chronic and 2.21% in the indeterminate. Of the chronic patients in the study 50% had mega esophagus and megacolon 4 (20%). Most patients had no family history of AD, nor was a smoker or drinker. Major electrocardiographic abnormalities found refer to driving. The evaluation of ICT, the chronic chagasic showed that increased by 40% of patients, 40% had esophageal changes and 20% of patients had megacolon s. The echocardiogram was abnormal in 42%). 27% of patients had EF below 55% changed. Changes in segmental contractility and Asynchrony septum were found in 80% of chronic Chagas disease. In 80% of the patients was observed diastolic dysfunction. The valvular changes occurred in 75%. Electrocardiographic abnormalities occurred in 80% of patients with CCC, while the other heart had ECG changes. Arterial hypertension had an incidence of 45% in patients with CCC and 40% in FCI. The systolic and diastolic ventricular dysfunction was more prevalent in groups that had an abnormal ECG and arrhythmia. Observed that the group of chagasic decreased ejection fraction is correlated to a higher incidence of arrhythmias besides diastolic dysfunction and

Assessment and epidemiology of Chagas' disease in patients treated in Araguaina - Tocantins

International Nuclear Information System (INIS)

Correa, Valeria Rita

2010-01-01

Chagas disease (AD) was described by Carlos Chagas in 1909. It is caused by a parasite T. cruzi, transmitted by bugs, by blood transfusion, vertical and orally. The DC has two phases: acute and chronic. The evolution to the cardiac form occurs in about 30% of chronic cases and is the largest cause of mortality in chronic Chagas disease. The aim of this study was to Chagas' disease in patients of Tocantins, compared with other heart patients and asymptomatic from the standpoint of non-invasive exams using radiant energies such as echocardiography and ECG and RX. The descriptive study included 80 patients, 20 chronic form of Chagas disease, 20 indeterminate, 20 with other heart diseases, and 20 controls. There was a prevalence of 9.5% of chagasic patients treated in outpatient cardiology at Araguaina Tocantins, and 7.3% in chronic and 2.21% in the indeterminate. Of the chronic patients in the study 50% had mega esophagus and megacolon 4 (20%). Most patients had no family history of AD, nor was a smoker or drinker. Major electrocardiographic abnormalities found refer to driving. The evaluation of ICT, the chronic chagasic showed that increased by 40% of patients, 40% had esophageal changes and 20% of patients had megacolon s. The echocardiogram was abnormal in 42%). 27% of patients had EF below 55% changed. Changes in segmental contractility and Asynchrony septum were found in 80% of chronic Chagas disease. In 80% of the patients was observed diastolic dysfunction. The valvular changes occurred in 75%. Electrocardiographic abnormalities occurred in 80% of patients with CCC, while the other heart had ECG changes. Arterial hypertension had an incidence of 45% in patients with CCC and 40% in FCI. The systolic and diastolic ventricular dysfunction was more prevalent in groups that had an abnormal ECG and arrhythmia. Observed that the group of chagasic decreased ejection fraction is correlated to a higher incidence of arrhythmias besides diastolic dysfunction and related

Voltage-gated potassium channel (K(v) 1) autoantibodies in patients with chagasic gut dysmotility and distribution of K(v) 1 channels in human enteric neuromusculature (autoantibodies in GI dysmotility).

Science.gov (United States)

Hubball, A W; Lang, B; Souza, M A N; Curran, O D; Martin, J E; Knowles, C H

2012-08-01

Autoantibodies directed against specific neuronal antigens are found in a significant number of patients with gastrointestinal neuromuscular diseases (GINMDs) secondary to neoplasia. This study examined the presence of antineuronal antibodies in idiopathic GINMD and GINMD secondary to South American Trypanosomiasis. The GI distribution of voltage-gated potassium channels (VGKCs) was also investigated. Seventy-three patients were included in the study with diagnoses of primary achalasia, enteric dysmotility, chronic intestinal pseudo-obstruction, esophageal or colonic dysmotility secondary to Chagas' disease. Sera were screened for specific antibodies to glutamic acid decarboxylase, voltage-gated calcium channels (VGCCs; P/Q subtype), nicotinic acetylcholine receptors (nAChRs; α3 subtype), and voltage-gated potassium channels (VGKCs, K(V) 1 subtype) using validated immunoprecipitation assays. The distribution of six VGKC subunits (K(V) 1.1-1.6), including those known to be antigenic targets of anti-VGKC antibodies was immunohistochemically investigated in all main human GI tract regions. Three patients (14%) with chagasic GI dysmotility were found to have positive anti-VGKC antibody titers. No antibodies were detected in patients with idiopathic GINMD. The VGKCs were found in enteric neurons at every level of the gut in unique yet overlapping distributions. The VGKC expression in GI smooth muscle was found to be limited to the esophagus. A small proportion of patients with GI dysfunction secondary to Chagas' disease have antibodies against VGKCs. The presence of these channels in the human enteric nervous system may have pathological relevance to the growing number of GINMDs with which anti-VGKC antibodies have been associated. © 2012 Blackwell Publishing Ltd.

Associação entre acidentes vasculares encefálicos e doença de Chagas

Directory of Open Access Journals (Sweden)

Edison Reis Lopes

1991-06-01

Full Text Available Foi pesquisada a freqüência de acidentes vasculares encefálicos (A VE, isquêmicos e hemorrágicos, em chagásicos crônicos e em não chagásicos, maiores de 15 anos de idade, necropsiados em Uberaba, de 1979 a 1988, optando-se por estudo emparelhado por sexo e idade em 208 pares. Em 41 (19,7% dos chagásicos e em 55 (26,4% dos não chagásicos foram diagnosticados AVE, diferença não significante ao nível de 5%. Dos chagásicos 12 (75% tiveram infarto e 4 (25% hemorragia encefálica; dos não chagásicos 5 (31,3% tiveram infarto e 11 (68,7% hemorragia. As .diferenças são significantes ao nível de 5%. Os resultados demonstram menor freqüência de AVE hemorrágico em chagásicos que em não chagásicos e comprovam alta freqüência de AVE isqüêmico na doença de Chagas humana.The frequency of strokes was studied in chronic chagasic and years ofage, non-chagasicpatients, older than 15 coming to necropsy in Uberaba, from 1979 than 1988. The study consisted of paired sex and age matched controls. Two hundred and eight pairs were analysed. Either ischemic or hemorrhagic strokes were found in 41 (19,7% of the chagasics and in 55 (26.4% of the non-chagasic, a difference not significant at the level of 5%. Twelve (75% of the former had infarcts and 4(25% had brain hemorrhage; five (31,3% of the non-chagasics had ischemic strokes and 11 (68,7% had hemorrhagic strokes. The differences were significant to the level of 5%. The results indicate a high frequency of ischemic strokes in human Chagas'disease and demonstrate a lesser frequency of hemorrhagic stroke in chagasics when compared with non-chagasics.

Neoplasia no sítio da colostomia de paciente com megacólon chagásico: relato de caso Neoplasia at the site of the colostomy of patient with chagasic megacolon: case report

Directory of Open Access Journals (Sweden)

Thiago Agostini Braga

2011-06-01

Full Text Available A neoplasia no sítio da colostomia associada ao megacólon chagásico é uma entidade rara. Os autores relatam caso de um paciente com lesão avançada, o qual foi submetido a tratamento cirúrgico e discutem aspectos relacionados a esta afecção.Neoplasia at the site of the colostomy associated with chagasic megacolon is a rare clinical event. Here, the authors report the case of a patient with advanced lesion, who had to undergo surgical treatment, and discuss aspects related to this disease.

Omega-3 supplementation on inflammatory markers in patients with chronic Chagas cardiomyopathy: a randomized clinical study.

Science.gov (United States)

Silva, Paula Simplício da; Mediano, Mauro Felippe Felix; Silva, Gilberto Marcelo Sperandio da; Brito, Patricia Dias de; Cardoso, Claudia Santos de Aguiar; Almeida, Cristiane Fonseca de; Sangenis, Luiz Henrique Conde; Pinheiro, Roberta Olmo; Hasslocher-Moreno, Alejandro Marcel; Brasil, Pedro Emmanuel Alvarenga Americano do; Sousa, Andrea Silvestre de

2017-06-09

Several studies have been focusing on the effect of omega-3 polyunsaturated fatty acids on modulation of inflammatory markers in several cardiopathies. Although immunoregulatory dysfunction has been associated to the chronic cardiac involvement in Chagas disease, there is no study examining the effects of omega-3 supplementation in these patients. We investigated the effects of omega-3 PUFAs on markers of inflammation and lipid profile in chronic Chagas cardiomyopathy patients. The present study was a single-center double-blind clinical trial including patients with chronic Chagas cardiomyopathy. Patients were randomly assigned to receive omega-3 PUFAs capsules (1.8g EPA and 1.2g DHA) or placebo (corn oil) during an 8-week period. Cytokines, fasting glucose, lipid, and anthropometric profiles were evaluated. Forty-two patients (23 women and 19 men) were included in the study and there were only two losses to follow-up during the 8-week period. Most of sociodemographic and clinical characteristics were similar between the groups at baseline, except for the cytokines IL-1β, IL-6, IL-8, IL-10, IL-17α, and IFNγ. The omega-3 PUFAs group demonstrated greater improvements in serum triglycerides (-21.1 vs. -4.1; p = 0.05) and IL-10 levels (-10.6 vs. -35.7; p = 0.01) in comparison to controls after 8 weeks of intervention. No further differences were observed between groups. Omega-3 PUFAs supplementation may favorably affect lipid and inflammatory profile in chronic Chagas cardiomyopathy patients, demonstrated by a decrease in triglycerides and improvements on IL-10 concentration. Further studies examining the clinical effects of omega-3 fatty acids supplementation in chronic Chagas cardiomyopathy are necessary. NCT01863576.

[Intravenous nitroglycerin infusion suppresses exercise-induced arrhythmia in patients with ischemic cardiopathy: indications for chronic treatment ].

Science.gov (United States)

Bonetti, F; Margonato, A; Mailhac, A; Vicedomini, G; Cianflone, D; Scarpazza, P; Chierchia, S L

1990-05-01

In patients with ischemic heart disease and arrhythmias, selection of antiarrhythmic treatment is often difficult as it is hard to separate "primary" from ischemic arrhythmias. We studied 20 patients with ischemic heart disease, who developed ventricular arrhythmias consistently during exercise test. Exercise test was performed twice during infusion of placebo and then during intravenous administration of nitroglycerin, titrated to reduce systolic blood pressure by 10 mmHg. Exercise duration was 7.8 +/- 1.7 and 7.9 +/- 1.5 min, in the 2 placebo tests (NS). Angina developed in 5 patients and ischemic ST changes in 10. With nitroglycerin exercise duration increased to 8.4 +/- 20 min (p less than 0.05), diagnostic ST segment depression was observed in 2 patients and only 1 had angina. In all 20 patients, ventricular arrhythmias were consistently present during both tests on placebo, that were markedly reduced by nitroglycerin. In fact, ventricular ectopic beats were 455 (mean 35.8 +/- 16.8) and 418 (mean 34.4 +/- 11.1) in the 2 exercise tests with placebo, and 11 during nitroglycerin infusion (mean 0.6 +/- 0.1; p less than 0.001). Couplets were 28 and 29 during placebo (NS) and 0 during nitroglycerin (p less than 0.001). Ventricular tachycardia was present in 6 and 8 patients during placebo but in none during nitroglycerin (p less than 0.001). Reduction of exercise-induced arrhythmias was maintained during chronic treatment with oral vasodilators. Prevention of exercise-related arrhythmias by nitroglycerin infusion appears a good indicator of their ischemic origin and may provide valuable information for long-term profilaxis with oral vasodilators, then avoiding the use of antiarrhythmic agents and their potential side effects.

Chronic Chagas disease: PCR-xenodiagnosis without previous microscopic observation is a useful tool to detect viable Trypanosoma cruzi.

Science.gov (United States)

Saavedra, Miguel; Zulantay, Inés; Apt, Werner; Martínez, Gabriela; Rojas, Antonio; Rodríguez, Jorge

2013-01-01

We evaluate the elimination of the microscopic stage of conventional xenodiagnosis (XD) to optimize the parasitological diagnosis of Trypanosoma cruzi in chronic Chagas disease. To this purpose we applied under informed consent two XD cages to 150 Chilean chronic chagasic patients. The fecal samples (FS) of the triatomines at 30, 60 and 90 days post feeding were divided into two parts: in one a microscopic search for mobile trypomastigote and/or epimastigote forms was performed. In the other part, DNA extraction-purification for PCR directed to the conserved region of kDNA minicircles of trypanosomes (PCR-XD), without previous microscopic observation was done. An XD was considered positive when at least one mobile T. cruzi parasite in any one of three periods of incubation was observed, whereas PCR-XD was considered positive when the 330 bp band specific for T. cruzi was detected. 25 of 26 cases with positive conventional XD were PCR-XD positive (concordance 96.2%), whereas 85 of 124 cases with negative conventional XD were positive by PCR-XD (68.5%). Human chromosome 12 detected by Real-time PCR used as exogenous internal control of PCR-XD reaction allowed to discounting of PCR inhibition and false negative in 40 cases with negative PCR-XD. PCR-XD performed without previous microscopic observation is a useful tool for detection of viable parasites with higher efficiency then conventional XD.

Xenodiagnostico, hemocultura e teste de lise mediada pelo complemento, como critérios de seleção de pacientes chagásicos crônicos para quimioterapia Xenodiagnosis, hemoculture and complement mediated lysis tests as criteria for selection of chronic chagasic patients for chemotherapy

Directory of Open Access Journals (Sweden)

Vera Lúcia Pereira

1989-10-01

Full Text Available O tratamento etiológico da doença de Chagas é iniciado geralmente apenas quando se dispõe de um diagnóstico parasitológico positivo. Na tentativa de aumentar o número de candidatos assim selecionados para o tratamento específico, estudamos 36 pacientes chagásicos crônicos associando o xenodiagnóstico, a hemocultura e o teste de lise mediada pelo complemento, em duas séries sucessivas, intercaladas de um mínimo de 60 dias. A sensibilidade do xenodiagnóstico e da hemocultura foi respectivamente de 30,5% e de 8,3% na primeira série e de 36,1% e de 19,4% nas duas séries. Foram positivos, em pelo menos uma das duas provas, 17 (47,2% dos pacientes. Destes, entretanto, somente 9 (53,0% mostraram teste de lise constantemente positivo enquanto que em 5 (29,4% o teste foi negativo e 3 (17,6% apresentaram resultados ora positivos, ora negativos. Nos pacientes com provas parasitológicas negativas, o teste de lise foi positivo em 4 (15,8%, negativo em 9 (47,4% e discordante em 6 (31,5%. Assim, o teste de lise mediada pelo complemento não se constitue em bom método de triagem de candidatos ao tratamento. Apesar da baixa sensibilidade, as provas parasitológicas ainda constituem o instrumento mais seguro para o clínico.Normally specific treatment of chronic Chagas' disease begins only after a positive parasitological diagnosis has been established. Xenodiagnosis, hemoculture and complement mediated lysis were associated, and repeated, as an attempt to increase the number of selected candidates for specific treatment. Thirty six chronic chagasic patients were submitted to two series of the above tests, with a minimal interval of 60 days. In the first series of tests sensitivity of xenodiagnosis and hemoculture were 30.5% and 8.3% respectively. Processing of a second sample increased sensitivity to 36.1% (xenodiagnosis and 19.4% (hemoculture; 47.2% were shown to be positive by at least one of these tests. From the positive cases, 29.4% were

Alterações contráteis segmentares e sua associação com arritmias ventriculares complexas, em pacientes chagásicos com eletrocardiograma normal ou borderline Regional left ventricular dysfunction and its association with complex ventricular arrhythmia, in chagasic patients with normal or borderline electrocardiogram

Directory of Open Access Journals (Sweden)

Flavia Vernin de Oliveira Terzi

2010-10-01

Full Text Available INTRODUÇÃO: Morte súbita representa a principal causa de óbito em chagásicos. Eventos fatais em pacientes saudáveis, com anormalidades contráteis, foram documentados. O objetivo deste trabalho é determinar a associação entre alteração contrátil e arritmias ventriculares complexas em pacientes chagásicos, classe funcional I, eletrocardiograma normal ou borderline e função ventricular preservada. MÉTODOS: Quarenta e nove pacientes com doença de Chagas e eletrocardiograma normal ou borderline realizaram ecocardiograma, teste ergométrico e Holter. Avaliou-se a contratilidade global e segmentar dos ventrículos e a presença de arritmias ventriculares complexas induzidas no esforço e espontâneas, respectivamente. A análise estatística foi feita pelo modelo Log-Linear geral. RESULTADOS: Idade média de 56 anos; 55% mulheres. Alterações contráteis segmentares em 24,5% dos pacientes; 12% dos Holter e 18% dos testes ergométricos positivos. Houve associação entre arritmia e alteração segmentar condicionada à presença da disfunção sistólica leve do ventrículo esquerdo. CONCLUSÕES: Alterações contráteis, na presença de disfunção global leve, indicam pacientes sob maior risco de arritmias complexas.INTRODUCTION: Sudden death is the major cause of death among chagasic patients. A significant number of fatal events in patients without apparent heart disease and borderline electrocardiogram, but with contractile ventricular dysfunction, have been documented. This work aimed to determine the association between regional dysfunction and the presence of ventricular arrhythmia in chagasic patients without apparent heart disease. METHODS: Forty-nine patients with normal or borderline electrocardiogram were submitted to echocardiogram, exercise stress test and Holter. The presence of cardiac contractile alterations and complex ventricular arrhythmia was analyzed. Statistic analysis used the general Log-Linear model. RESULTS

Miocardite na forma aguda da doença de Chagas

Directory of Open Access Journals (Sweden)

Eitel Duarte

1948-12-01

Full Text Available The autopsy of a case of CHAGAS'S disease or American tryponosomiasis (a girl, 5 years old, dead in the 22nd day of illness is reported. The anatomic diagnosis was a follows: Acute diffuse chagasic nyocarditis. Chagasic encephalitis. Chagasic lymphadenitis of the right posterior auricular node. Tuberculosis of the bronchial and pulmonary nodes. Chronic passive hyperemia and atelectasia of the lungs. Chronic passive congestion and hemorrhages of the spleen. Serous hepatitis. Parotiditis. Edema of the right eyelids. Bilateral hydrothorax. Hydropericardium. Hydroperitoneum. The morphology of Schizotrypanum cruzi in the myocardium is considered. Besides agglomerates with typical small oval or round intracellular bodies, pre-flagellate and flagellate organisms, others are found in which the great amount of parasites and marked pressure exerted by them against each other render very difficult their identification; sometimes the similitude of such agglamerates to Toxoplasma is striking (Fig. 1 and 1 A. In such a case, the structure of the blepharoplast (Fig. 1 and IA, usually preserved, is profitable and allows the identification of the pre-flagellate and flagellate forms of Schizotrypanum cruzi. Most of the small sensitive nerves in the epicardium shows mononuclear infiltration of the perineurium (perineuritis, Figs. 12-14. Microscopically there is extensive Zenker's degeneration (Figs. 6-8 and parasitism of the heart muscle fibers, marked cellular infiltration of the interstitial connective tissue, which are found in the ordinary musculature of every chamber of the heart (Figs. 10-11 as well as in Tawara's node (Fig. 9, main bundle (Fig. 2 and right (Fig. 4 and left (Fig. 5 septal divisions of the bundle of His, and perineuritis. Those anatomic changes are associated to an abnormal electrocardiogram presenting some similitude to that of an anemic infarct of the anterior wall of the heart and which will be discussed elsewhere (unpublished paper by

Scintiscanning study of esophageal transit on the chronic chagasic esophagopaty

International Nuclear Information System (INIS)

Rezende Filho, J.

1985-01-01

The passage of a radionuclide labelled 10 ml liquid bolus through the esophagus was evaluated by a scintigraphic method in 13 normal subjects, 13 asymptomatic Chagas' disease patients, and 39 Chagas' disease patients with esophageal symptoms and/or radiological esophageal abnormalities. The manometric evaluation of esophagus was performed on 44 Chagas' disease patients by a standard manometric technique. (author)

Chronic Chagas disease: PCR-xenodiagnosis without previous microscopic observation is a useful tool to detect viable Trypanosoma cruzi

Directory of Open Access Journals (Sweden)

Miguel Saavedra

2013-01-01

Full Text Available We evaluate the elimination of the microscopic stage of conventional xenodiagnosis (XD to optimize the parasitological diagnosis of Trypanosoma cruzi in chronic Chagas disease. To this purpose we applied under informed consent two XD cages to 150 Chilean chronic chagasic patients. The fecal samples (FS of the triatomines at 30, 60 and 90 days post feeding were divided into two parts: in one a microscopic search for mobile trypomastigote and/or epimastigote forms was performed. In the other part, DNA extraction-purification for PCR directed to the conserved region of kDNA minicircles of trypanosomes (PCR-XD, without previous microscopic observation was done. An XD was considered positive when at least one mobile T. cruzi parasite in any one of three periods of incubation was observed, whereas PCR-XD was considered positive when the 330 bp band specific for T. cruzi was detected. 25 of 26 cases with positive conventional XD were PCR-XD positive (concordance 96.2%, whereas 85 of 124 cases with negative conventional XD were positive by PCR-XD (68.5%. Human chromosome 12 detected by Real-time PCR used as exogenous internal control of PCR-XD reaction allowed to discounting of PCR inhibition and false negative in 40 cases with negative PCR-XD. Conclusion: PCR-XD performed without previous microscopic observation is a useful tool for detection of viable parasites with higher efficiency then conventional XD.

Depopulation of interstitial cells of cajal in chagasic megacolon: towards tailored surgery? Depleção de células intersticiais de Cajal no megacólon chagásico: a caminho do tratamento cirúrgico individualizado?

Directory of Open Access Journals (Sweden)

Sergio Eduardo Alonso Araujo

2010-06-01

Full Text Available BACKGROUND: The mechanism of constipation in patients with Chagasic megacolon remains partially explained. In these patients, it was recently demonstrated a reduction in the population of interstitial cells of Cajal. AIM: To evaluate density of Cajal cells in the surgically resected colon of Chagasic patients in comparison to control patients, and to verify possible association between preoperative and postoperative bowel function of Chagasic patients and colonic cell count. METHOD: Sixteen patients with Chagasic megacolon were operated on. Clinical pre- and post-operative evaluation using the Cleveland Clinic Constipation Score was undertaken. Resected colons were examined. Cajal cells were identified by immunohistochemistry using anti-CD117 antibody. The mean cell number was compared to resected colons from 16 patients with non-obstructive sigmoid cancer. Association between pre-and post-operative constipation scores and cell count for megacolon patients was evaluated using the Pearson coefficient correlation test (r. RESULTS: A reduced number of Cajal cells [cells per field: 2.84 (0-6.6 vs. 9.68 (4.3-13 - pRACIONAL: A fisiopatologia da constipação intestinal nos pacientes portadores de megacólon chagásico permanece parcialmente esclarecida. Recentemente demontrou-se que nesses pacientes, o contingente de células intersticiais de Cajal está reduzido assim como ocorre em outros distúrbios funcionais gastrointestinais. OBJETIVO: Avaliar a densidade de células intersticiais de Cajal no intestino ressecado de pacientes submetidos a tratamento cirúrgico eletivo de megacólon chagásico em comparação com a observada no cólon de pacientes controles, e verificar possível associação entre o grau de constipação intestinal de pacientes com megacólon chagásico no pré e no pós-operatório e o grau de despopulação de células de Cajal. MÉTODO: Dezesseis pacientes com megacólon chagásico foram operados. A avaliação da fun

Human Leucocyte Antigen-G (HLA-G and Its Murine Functional Homolog Qa2 in the Trypanosoma cruzi Infection

Directory of Open Access Journals (Sweden)

Fabrício C. Dias

2015-01-01

Full Text Available Genetic susceptibility factors, parasite strain, and an adequate modulation of the immune system seem to be crucial for disease progression after Trypanosoma cruzi infection. HLA-G and its murine functional homolog Qa2 have well-recognized immunomodulatory properties. We evaluated the HLA-G 3′ untranslated region (3′UTR polymorphic sites (associated with mRNA stability and target for microRNA binding and HLA-G tissue expression (heart, colon, and esophagus in patients presenting Chagas disease, stratified according to the major clinical variants. Further, we investigated the transcriptional levels of Qa2 and other pro- and anti-inflammatory genes in affected mouse tissues during T. cruzi experimental acute and early chronic infection induced by the CL strain. Chagas disease patients exhibited differential HLA-G 3′UTR susceptibility allele/genotype/haplotype patterns, according to the major clinical variant (digestive/cardiac/mixed/indeterminate. HLA-G constitutive expression on cardiac muscle and colonic cells was decreased in Chagasic tissues; however, no difference was observed for Chagasic and non-Chagasic esophagus tissues. The transcriptional levels of Qa2 and other anti and proinflammatory (CTLA-4, PDCD1, IL-10, INF-γ, and NOS-2 genes were induced only during the acute T. cruzi infection in BALB/c and C57BL/6 mice. We present several lines of evidence indicating the role of immunomodulatory genes and molecules in human and experimental T. cruzi infection.

Esophageal transit time in patients with chagasic megaesophagus: Lack of linear correlation between dysphagia and grade of dilatation.

Science.gov (United States)

Martins, Paula; Ferreira, Cid Sergio; Cunha-Melo, José Renan

2018-03-01

The aim of this study was to determine the esophageal transit time in control individuals and in chagasic patients with or without megaesophagus.A total of 148 patients were allocated in 6 groups according to serological diagnostic of Chagas disease and the degree of esophageal dilatation: A, control healthy individuals (n = 34, 22.9%); B, indeterminate form (n = 23, 15.5%); C, megaesophagus I (n = 37, 25.0%); D, megaesophagus II (n = 19, 12.8%); E, megaesophagus III (n = 21, 14.2%); and F, megaesophagus IV (n = 14, 9.5%). After 8-hour fasting, patients were asked to swallow 75 mL of barium sulfate solution. x-Rays were obtained after 8, 30, 60, and 90 seconds, 5, 10, 30, 60, and 90 minutes, 2, 6, 12, 24 hours, and at every 12 hours until no more contrast was seen in the esophagus. This was the transit time.The transit time varied from 8 seconds to 36 hours (median = 90 seconds). A linear correlation was observed between transit time and megaesophagus grade: 8 seconds in groups A and B, 5 minutes in C, 30 minutes in D, 2 hours in E, and 9:15 hours in F. Dysphagia was not reported by 60 of 114 (52.6%) patients with positive serological tests for Chagas disease (37/91-40.7%-of patients with megaesophagus I-IV grades). The esophageal transit time increased with the grade of megaesophagus.The esophageal transit time has a direct correlation with the grade of megaesophagus; dysphagia complaint correlates with the grade of megaesophagus. However, many patients with megaesophagus do not report dysphagia.

[Esophageal motor disorders in asymptomatic subjects with Trypanosoma cruzi infection].

Science.gov (United States)

Torres-Aguilera, M; Remes-Troche, J M; Roesch-Dietlen, F; Vázquez-Jiménez, J G; De la Cruz-Patiño, E; Grube-Pagola, P; Ruiz-Juárez, I

2011-01-01

The indeterminate chronic or "asymptomatic" phase of Trypanosoma cruzi (Chagas' disease) infection is characterized by the absence of gastrointestinal symptoms, and has an estimated duration of 20 to 30 years. However, the intramural denervation that induces dysfunction of the gastrointestinal tract is progressive. Recently, epidemiological studies have shown that the seroprevalence for this infection in our area ranges between 2% and 3% of the population. To detect the presence of esophageal motor disorders in asymptomatic individuals chronically infected with Trypanosoma cruzi using standard esophageal manometry. A cross sectional study in 28 asymptomatic subjects (27 men, age 40.39 ± 10.79) with serological evidence of infection with Trypanosoma cruzi was performed. In all cases demographic characteristics, gastrointestinal symptoms and esophageal motility disorders using conventional manometry were analyzed. In this study 54% (n = 15) of asymptomatic subjects had an esophageal motor disorder: 5 (18%) had nutcracker esophagus, 5 (18%) nonspecific esophageal motor disorders, 3 (11%) hypertensive lower esophageal sphincter (LES), 1 (4%) an incomplete relaxation of the LES and 1 (4%) had chagasic achalasia. More than half of patients that course with Chagas' disease in the indeterminate phase and that are apparently asymptomatic have impaired esophageal motility. Presence of hypertensive LES raises the possibility that this alteration represents an early stage in the development of chagasic achalasia.

Chagas. From Exotic Tropical Disease to Pathology Globalized

Directory of Open Access Journals (Sweden)

Beatriz BASSO

2016-09-01

Full Text Available Chagas disease, whose aetiological agent is Trypanosoma cruzi, is one of the main endemic diseases in Latin America, ranking fourth regarding the number of lost life years due to death or disability in the area; nevertheless, it is among the so-called “neglected diseases”. Despite its rural origin, where it is transmitted through vector insects belonging to the Reduviidae family, it has nowadays also become a problem in urbanized areas and is becoming globalized through inter-human transmission, above all congenital, but also through transfusions and transplants. Chagas, a Hidden Affliction (Chagas, Un mal escondido, a documentary by Ricardo Preve, focuses on both aspects of the disease: the rural and the global one, including interviews with North American doctors and European researchers. A significant part of the film takes place in the USA, showing the worst consequence of the evolution of the disease, which is death by chagasic cardiopathy which, being a reality that takes place during filming, increases the sense of drama. In this paper we approach specific topics related to Chagas disease from a biomedical point of view, including comments related to the highlights of the film that are connected with such aspects. Towards the end, there is mention of the film Houses of Fire (Casas de fuego and of certain illustrative aspects concerning the life of Dr Salvador Mazza and the Argentine Mission of Regional Pathology Studies (MEPRA, topics that have already been dealt with in this. 

Trasplante de células progenitoras derivadas de la médula ósea y factor de crecimiento granulocítico en cardiopatía isquémica aguda y crónica Transplant of stem cells derived from bone marrow and granulocytic growth factor in acute and chronic ischemic myocardiopathy

Directory of Open Access Journals (Sweden)

Juan M Senior

2007-12-01

Full Text Available Introducción: estudios recientes demuestran la seguridad y eficacia de la implantación de células progenitoras derivadas de la médula ósea y de la administración del factor estimulante de colonias de granulocito en pacientes con infarto agudo del miocardio con elevación del segmento ST y en cardiopatía isquémica crónica. Se diseñó un estudio prospectivo, abierto de «antes y después» para evaluar la seguridad y eficacia de la terapia celular asociada a la administración del factor de crecimiento. Se reporta la primera experiencia con este tipo de terapia. Metodología: este es el reporte del seguimiento a seis meses, de los pacientes con cardiopatía isquémica aguda y crónica a quienes se les realizó trasplante de células progenitoras derivadas de la médula ósea, movilizadas con factor de crecimiento estimulante de colonias de granulocitos, por vía intracoronaria o epicárdica. Se incluyeron dos grupos de pacientes: 1. Diez pacientes con infarto de pared anterior y 2. Cinco pacientes con cardiopatía isquémica crónica, todos con necrosis extensa demostrada por ausencia de viabilidad miocárdica por medicina nuclear y fracción de eyección menor del 40%. Resultados: se demostró mejoría significativa de la fracción de eyección de 29,44 ± 3,36 a 37,6 ± 5,3 con pIntroduction: recent studies have shown the safety and efficacy of the stem cells derived from bone marrow (BMC implant with concomitant administration of stimulating factor of granulocyte colonies in patients with acute myocardial infarction with ST segment elevation and in chronic ischemic cardiopathy. An open prospective «before and after» design was made to evaluate the safety and efficacy of cell therapy associated to growth factor administration. The first experience with this kind of therapy is reported. Methodology; this is a 6 months follow-up report of patients with acute and chronic ischemic cardiopathy to whom transplant of stem cells derived from

Prevalência de megas em necrópsias realizadas no triângulo mineiro no período de 1954 a 1988

Directory of Open Access Journals (Sweden)

Edison Reis Lopes

1989-12-01

Full Text Available Dentre 1708 necrópsias de chagásicos crônicos, de um total de 4690, diagnosticamos 273 megas. Destes o mais freqüente foi o megacólon, seguido pelo megaesôfago, ocupando a associação megacólon e megaesôfago o terceiro lugar. Discutem-se e comparam-se os achados com outros de ordem clinico-epidemiológica e anatomopatológica. Confirmando dados da literatura, nossos achados atuais mostram, que a exemplo do que sucede na cardiopatia chagásica, o megacólon e o megaesôfago predominam no sexo masculino, discutindo-se os fatores que poderiam explicar a razão desse fato.One thousand seven hundred and eight chronic chagasic post-mortem examinations studied from a total of4690 autopsies perfomed at our Institution. Two hundred and seventy-three chagasic had megas. Megacolon was the most frequent, followed by megaesophagus. Megacolon associated with megaesophagus was, the third mostcommom finding. Our data are discussed and compared with the literature. Megacolon and megaesophagus were more prevalent in man, as shown by other workers. Higher parasitemia perhaps could explain this finding.

Diagnostic electrocardiography in epidemiological studies of Chagas' disease: multicenter evaluation of a standardized method

Directory of Open Access Journals (Sweden)

Lázzari Julio O.

1998-01-01

Full Text Available An electrocardiographic recording method with an associated reading guide, designed for epidemiological studies on Chagas' disease, was tested to assess its diagnostic reproducibility. Six cardiologists from five countries each read 100 electrocardiographic (ECG tracings, including 30 from chronic chagasic patients, then reread them after an interval of 6 months. The readings were blind, with the tracings numbered randomly for the first reading and renumbered randomly for the second reading. The physicians, all experienced in interpreting ECGs from chagasic patients, followed printed instructions for reading the tracings. Reproducibility of the readings was evaluated using the kappa (k index for concordance. The results showed a high degree of interobserver concordance with respect to the diagnosis of normal vs. abnormal tracings (k = 0.66; SE 0.02. While the interpretations of some categories of ECG abnormalities were highly reproducible, others, especially those having a low prevalence, showed lower levels of concordance. Intraobserver concordance was uniformly higher than interobserver concordance. The findings of this study justify the use by specialists of the recording of readings method proposed for epidemiological studies on Chagas' disease, but warrant caution in the interpretation of some categories of electrocardiographic alterations.

Diagnostic electrocardiography in epidemiological studies of Chagas' disease: multicenter evaluation of a standardized method

Directory of Open Access Journals (Sweden)

Julio O. Lázzari

1998-11-01

Full Text Available An electrocardiographic recording method with an associated reading guide, designed for epidemiological studies on Chagas' disease, was tested to assess its diagnostic reproducibility. Six cardiologists from five countries each read 100 electrocardiographic (ECG tracings, including 30 from chronic chagasic patients, then reread them after an interval of 6 months. The readings were blind, with the tracings numbered randomly for the first reading and renumbered randomly for the second reading. The physicians, all experienced in interpreting ECGs from chagasic patients, followed printed instructions for reading the tracings. Reproducibility of the readings was evaluated using the kappa (k index for concordance. The results showed a high degree of interobserver concordance with respect to the diagnosis of normal vs. abnormal tracings (k = 0.66; SE 0.02. While the interpretations of some categories of ECG abnormalities were highly reproducible, others, especially those having a low prevalence, showed lower levels of concordance. Intraobserver concordance was uniformly higher than interobserver concordance. The findings of this study justify the use by specialists of the recording of readings method proposed for epidemiological studies on Chagas' disease, but warrant caution in the interpretation of some categories of electrocardiographic alterations.

Chagas' disease: IgG isotypes against cytoplasmic (CRA) and flagellar (FRA) recombinant repetitive antigens of Trypanosoma cruzi in chronic Chagasic patients.

Science.gov (United States)

Verçosa, A F A; Lorena, V M B; Carvalho, C L; Melo, M F A D; Cavalcanti, M G A; Silva, E D; Ferreira, A G P; Pereira, V R A; Souza, W V; Gomes, Y M

2007-01-01

The wide range of clinical Chagas' disease manifestations, of which heart involvement is the most significant, because of its characteristics, frequency and consequences, and lack of treatment and cure, justify research in this area. Specific immunoglobulin G (IgG) antibody subclasses have been associated with human Chagas' disease. Thus, in this study, the profile of IgG subclasses against cytoplasmic (CRA) and flagellar (FRA) recombinant repetitive T. cruzi-specific antigens was correlated with cardiac (CARD, n=33), cardiodigestive (CD, n=7), and indeterminate (IND, n=20) forms of Chagas' disease by indirect enzyme-linked immunosorbent assay (ELISA). IgG subclasses were detected in almost all Chagas patients studied. Nevertheless, only specific IgG2 isotype FRA was found with a significant statistical difference in CARD patients when compared to IND patients. This result suggests the potential use of this isotype for prognostic purposes, for monitoring the progression of chronic Chagas' disease, and for predicting the risk of CARD damage. This is important information, as it could help physicians to evaluate and manage the treatment of their patients. However, a follow-up study is necessary to confirm our result. (c) 2007 Wiley-Liss, Inc.

Performance Assessment of Four Chimeric Trypanosoma cruzi Antigens Based on Antigen-Antibody Detection for Diagnosis of Chronic Chagas Disease.

Directory of Open Access Journals (Sweden)

Fred Luciano Neves Santos

Full Text Available The performance of serologic tests in chronic Chagas disease diagnosis largely depends on the type and quality of the antigen preparations that are used for detection of anti-Trypanosoma cruzi antibodies. Whole-cell T. cruzi extracts or recombinant proteins have shown variation in the performance and cross-reactivity. Synthetic chimeric proteins comprising fragments of repetitive amino acids of several different proteins have been shown to improve assay performances to detect Chagasic infections. Here, we describe the production of four chimeric T. cruzi proteins and the assessment of their performance for diagnostic purposes. Circular Dichroism spectra indicated the absence of well-defined secondary structures, while polydispersity evaluated by Dynamic Light Scattering revealed only minor aggregates in 50 mM carbonate-bicarbonate (pH 9.6, demonstrating that it is an appropriate buffering system for sensitizing microplates. Serum samples from T. cruzi-infected and non-infected individuals were used to assess the performance of these antigens for detecting antibodies against T. cruzi, using both enzyme-linked immunosorbent assay and a liquid bead array platform. Performance parameters (AUC, sensitivity, specificity, accuracy and J index showed high diagnostic accuracy for all chimeric proteins for detection of specific anti-T. cruzi antibodies and differentiated seropositive individuals from those who were seronegative. Our data suggest that these four chimeric proteins are eligible for phase II studies.

Retrospective Study (2009-2014): Perineal Hernias and Related Comorbidities in Bitches.

Science.gov (United States)

Hayashi, Ayne Murata; Rosner, Sandra Aparecida; de Assumpção, Thais Cristine Alves; Stopiglia, Angelo João; Matera, Julia Maria

2016-12-01

Retrospective study based on data extracted from medical records of dogs diagnosed with perineal hernia between 2009 and 2014; medical records of bitches were selected for further analysis to determine the prevalence of perineal hernias in bitches and to investigate potential comorbidities. Perineal hernia was diagnosed in 182 dogs (174 males and 8 females; 96% and 4%, respectively). Surgical correction was performed in 6 bitches. Surgical procedures corresponded to internal obturator muscle transposition with or without polypropylene mesh reinforcement (n = 5) and semitendinosus muscle transposition flap (n = 1). Major comorbidities associated with perineal hernias in adult bitches were trauma (n = 3; 7.3 ± 1.5 years; 7.1 ± 8.5kg) and persistent cough secondary to conditions such as bronchitis, tracheal collapse, and cardiopathy in aged, small-sized patients (n = 3; 13.6 ± 2.0 years; 2.3 ± 0.1kg). Perineal hernias are uncommon in bitches and tend to be associated with comorbidities in these patients. Aged female dogs suffering from uncontrolled chronic cough secondary to cardiopathy or bronchitis are at risk of developing perineal hernia. Previous trauma to the pelvis is another potential risk factor for perineal hernia development in female dogs. Copyright © 2016. Published by Elsevier Inc.

Prevailing of ischemia cardiopathy, demonstrated by gammagraphy in less than 40 years old persons and its association with risk factors; Prevalencia de cardiopatia isquemica, demostrada por gammagrafia en menores de 40 anos y su asociacion con factores de riesgo

Energy Technology Data Exchange (ETDEWEB)

Cano G, M.A.; Castillo M, L.; Orea T, A. [Departamento de Medicina Nuclear, Departamento de Cardioiogia del Insitituto Nacional de Ciencias Medicas y Nutricion Salvador Zubiran. Mexico Distrito Federal (Mexico)

2005-07-01

The Coronary Arterial Illness (EAC) is the first cause of death of those Mexicans. Among their numerous risk factors it highlights the age with more bias starting from the 45 years. The objective of this investigation was to determine the prevailing of ischemic cardiopathy (Cl) and heart attack to the myocardium (IAM) in fellows smaller than 40 years and to identify risk factors. The study of myocardial perfusion (EPM) it is a non invasive study and of great sensibility and specificity that it allows to detect obstructive coronary lesions. The used method was retrospective-traverse Study in 125 patients smaller than 40 years. Files of patients to who EPM had been practiced with Technetium 99m-SESTAMlBI, protocol of one day, were revised, where its were analyzed the short and long axis (vertical and horizontal). General data, somatometry, emotional profile analysis, lipids and glucose profiles were gathered. Results. The population conformed it 53% women and 47% men with average of 31.9 year-old age of corporal mass index (IMC) 25.1 kg/cm{sup 2}. 46% of abnormal studies was obtained, of which 35% was compatible with ischemic cardiopathy (Cl) and 11% with heart attack to the myocardium (IAM). The characteristics of these were: age 31.6{+-}6 Vs 32.6{+-}5.9 years; IMC 25.4{+-}7.0 Vs 24.4{+-}3.34 kg/cm{sup 2}; stature 161.6{+-}9.8 Vs 165.5{+-}9.7cm; TAS 139.1{+-}29.2 Vs. 115{+-}13.4 mm Hg, TAD 84.5{+-}17.4 Vs. 75{+-}9.4 mm Hg; civil state married 65.5% (p=0.005) Vs single 57%; bigger depression 32% Vs anxiety 28%, in the group of patients with Cl and IAM, respectively. In the IAM population it was found an additional IRC 21% (p=0.030), HAS 21% (p=0.025) and drug addiction 21% (p=0.002). The rest of the results didn't show significant differences. Conclusion: Only 6.5% of the patients that went to EPM-{sup 99m}Tc-SESTAMIBl in a 6 year-old lapse, were smaller than 40 years. 71% of them was referred by prechordal pain in who almost the half it was evidenced Cl or IAM

Prevailing of ischemia cardiopathy, demonstrated by gammagraphy in less than 40 years old persons and its association with risk factors; Prevalencia de cardiopatia isquemica, demostrada por gammagrafia en menores de 40 anos y su asociacion con factores de riesgo

Energy Technology Data Exchange (ETDEWEB)

Cano G, M A; Castillo M, L; Orea T, A [Departamento de Medicina Nuclear, Departamento de Cardioiogia del Insitituto Nacional de Ciencias Medicas y Nutricion Salvador Zubiran. Mexico Distrito Federal (Mexico)

2005-07-01

The Coronary Arterial Illness (EAC) is the first cause of death of those Mexicans. Among their numerous risk factors it highlights the age with more bias starting from the 45 years. The objective of this investigation was to determine the prevailing of ischemic cardiopathy (Cl) and heart attack to the myocardium (IAM) in fellows smaller than 40 years and to identify risk factors. The study of myocardial perfusion (EPM) it is a non invasive study and of great sensibility and specificity that it allows to detect obstructive coronary lesions. The used method was retrospective-traverse Study in 125 patients smaller than 40 years. Files of patients to who EPM had been practiced with Technetium 99m-SESTAMlBI, protocol of one day, were revised, where its were analyzed the short and long axis (vertical and horizontal). General data, somatometry, emotional profile analysis, lipids and glucose profiles were gathered. Results. The population conformed it 53% women and 47% men with average of 31.9 year-old age of corporal mass index (IMC) 25.1 kg/cm{sup 2}. 46% of abnormal studies was obtained, of which 35% was compatible with ischemic cardiopathy (Cl) and 11% with heart attack to the myocardium (IAM). The characteristics of these were: age 31.6{+-}6 Vs 32.6{+-}5.9 years; IMC 25.4{+-}7.0 Vs 24.4{+-}3.34 kg/cm{sup 2}; stature 161.6{+-}9.8 Vs 165.5{+-}9.7cm; TAS 139.1{+-}29.2 Vs. 115{+-}13.4 mm Hg, TAD 84.5{+-}17.4 Vs. 75{+-}9.4 mm Hg; civil state married 65.5% (p=0.005) Vs single 57%; bigger depression 32% Vs anxiety 28%, in the group of patients with Cl and IAM, respectively. In the IAM population it was found an additional IRC 21% (p=0.030), HAS 21% (p=0.025) and drug addiction 21% (p=0.002). The rest of the results didn't show significant differences. Conclusion: Only 6.5% of the patients that went to EPM-{sup 99m}Tc-SESTAMIBl in a 6 year-old lapse, were smaller than 40 years. 71% of them was referred by prechordal pain in who almost the half it was evidenced Cl or IAM. In

Standardization of micro-enzyme-linked immunosorbent assay (ELISA) and Western blot for detection of Trypanosoma cruzi antibodies using extracts from Mexican strains as antigens.

Science.gov (United States)

Sánchez, B; Monteón, V; Reyes, P A; Espinoza, B

2001-01-01

This report describes two assays for the detection of anti-Trypanosoma cruzi antibodies using Mexican strains of the parasite and the concordance with two assays previously evaluated at the Instituto Nacional de Cardiología Ignacio Chávez in Mexico City. Micro-enzyme-linked immunosorbent assay (ELISA) and Western blot were used for the detection of T. cruzi antibodies with a total extract of epimastigote from Ninoa and Queretaro, which are Mexican strains of T. cruzi. To standardize these methods, a total of 246 serum samples was used. In addition, sera from six confirmed Mexican chronic individuals in the asymptomatic phase were also used for comparison with the Argentinean antigen. ELISA was 100% specific in that no false positive results were found with sera of both healthy individuals and non-Chagasic cardiopaths. Sera from individuals infected with Leishmania sp. showed approximately 16% of cross-reaction with ELISA. The test showed a positive predictive value of 90% and a negative predictive value of 100%. Western blot was also a highly sensitive test for detecting chronic Chagasic symptomatic patients from Mexico because no false negative results were obtained. Furthermore, it was possible to use Western blot to detect seven immunodominant antigens of approximately 30, 32, 40, 42, 65, 70, and 83 kDa. Concordance with two previous standardized tests at the Instituto Nacional de Cardiología showed a Kappa index of 0.96, indicating high concordance between the results obtained at these two laboratories. Finally, ELISA using Ninoa antigen extract was more sensitive than ELISA with an Argentinean extract, which failed to detect individuals in the chronic asymptomatic phase (undetermined phase) of infection. This study indicates that ELISA and Western blot using Ninoa and/or Queretaro extracts of T. cruzi as antigens are useful tools in the detection of individuals who have been exposed to T. cruzi both in the undetermined/asymptomatic and symptomatic phases

ADENOSINE DEAMINASE ACTIVITY AND SERUM C-REACTIVE PROTEIN AS PROGNOSTIC MARKERS OF CHAGAS DISEASE SEVERITY

Directory of Open Access Journals (Sweden)

Iván Darío BRAVO-TOBAR

2015-10-01

Full Text Available SUMMARY Chagas disease is a public health problem worldwide. The availability of diagnostic tools to predict the development of chronic Chagas cardiomyopathy is crucial to reduce morbidity and mortality. Here we analyze the prognostic value of adenosine deaminase serum activity (ADA and C-reactive protein serum levels (CRP in chagasic individuals. One hundred and ten individuals, 28 healthy and 82 chagasic patients were divided according to disease severity in phase I (n = 35, II (n = 29, and III (n = 18. A complete medical history, 12-lead electrocardiogram, chest X-ray, and M-mode echocardiogram were performed on each individual. Diagnosis of Chagas disease was confirmed by ELISA and MABA using recombinant antigens; ADA was determined spectrophotometrically and CRP by ELISA. The results have shown that CRP and ADA increased linearly in relation to disease phase, CRP being significantly higher in phase III and ADA at all phases. Also, CRP and ADA were positively correlated with echocardiographic parameters of cardiac remodeling and with electrocardiographic abnormalities, and negatively with ejection fraction. CRP and ADA were higher in patients with cardiothoracic index ≥ 50%, while ADA was higher in patients with ventricular repolarization disturbances. Finally, CRP was positively correlated with ADA. In conclusion, ADA and CRP are prognostic markers of cardiac dysfunction and remodeling in Chagas disease.

Development and clinical application of human gastrin radioimmunoassay

International Nuclear Information System (INIS)

Ginabreda, M.G.P.; Borghi, V.C.; Bettarello, A.

1988-08-01

The determination of human gastrin levels in the blood is very important for diagnosis of gastrointestinal disorders. This work describes the radioimmunoassay of gastrin developed according to Russell et al. and its clinical application measuring fasting levels of this hormone in normal subjects, gastrectomized, chagasics, patients with chronic renal failure (CRF), pernicious anemia (PA) and Zollinger-Ellison syndrome (ZES). Synthetic human gastrin was used for radioiodination and as standard, while the specific antibody was raised in rabbits. Gastrin was radioiodinated by a modification of the chloramine T technique and purified by anion exchange chromatography in QAE-Sephadex A-25 to a specific activity around 200 uCi/ug. The assays were performed by incubation of 125 I-gastrin, standard gastrin (zero to 500 pmol/l) or unknown samples with the antiserum for 4 days at 4 0 C. The antibody bound and free 125 I-gastrin was separated by adsorption of the latter to the charcoal. The basal gastrin values of normal subjects ranged from 2 to 74 pmol/l, being these levels higher in the chagasics (from 6 to 261 pmol/l). Higher levels of gastrin were determined in patients with CRF (from 12 to 350 pmol/l), PA (from 160 to 680 pmol/l) and with ZES(1010 pmol/l), while very low levels were confirmed in gastrectomized (from 1 to 8 pmol/l). (author) [pt

Analysis of the relationship cost-effectiveness of the myocardial gammagraphy studies and the impact to the total expenditure by diagnostic of ischemic cardiopathy

International Nuclear Information System (INIS)

Valenzuela F, A.G.; Perez C, J.P.; Arreola O, H.; Valenzuela F, A.A.; Soto M, H.; Arguero S, R.

2005-01-01

Recent advances in pharmacology, diagnostic and invasive procedures provide a series of modalities that diminish the morbidity and increase the long term survival in the patients that have suffered a heart attack to myocardium. The stratification by risk is an essential element for the handling of the survivors of heart attack to myocardium. In their attention it is looked for to optimize the therapeutic benefit, to diminish the unnecessary diagnostic and therapeutic procedures and to improve the efficiency. For example, a coronariography in sick with heart attack to myocardium it is not cost-effective if not is clinically suitable. Of there that from the institutional point of view, this is, of the Mexican Institute of the Public Health, they are required of appropriate reference approaches and counter reference to grant to the sick person, the best service that is the one in this case the diagnostic and the handling of the ischemic cardiopathy with the smallest waste of resources. The estimation of the annual survival is the base of the stratification, it constitutes the angular stone of the early handling of the heart attack to myocardium. The goal for the clinical would be to identify patients with intermediate risk, since, this risk makes them candidates to therapy interventionist. As long as those with low risk won't require intervention. This would allow the decrease of rates by revenues of heart attack to myocardium, and therefore to diminish the hospital staying rates. The Nuclear Cardiology (myocardial gammagraphy) it is not the only invasive method available to evaluate the myocardial perfusion in sick in who coronary illness is suspected. When the myocardial gammagraphy is carried out in appropriate population, the cost it diminishes because it restricts the necessity of additional invasive evaluations. This because the nuclear cardiology has predictive value so much for the mortality like to detect myocardial viability. Based on these probabilities

Trypanosomiasis-induced megacolon illustrates how myenteric neurons modulate the risk for colon cancer in rats and humans.

Directory of Open Access Journals (Sweden)

Vinicius Kannen

2015-04-01

Full Text Available Trypanosomiasis induces a remarkable myenteric neuronal degeneration leading to megacolon. Very little is known about the risk for colon cancer in chagasic megacolon patients. To clarify whether chagasic megacolon impacts on colon carcinogenesis, we investigated the risk for colon cancer in Trypanosoma cruzi (T. cruzi infected patients and rats.Colon samples from T. cruzi-infected and uninfected patients and rats were histopathologically investigated with colon cancer biomarkers. An experimental model for chemical myenteric denervation was also performed to verify the myenteric neuronal effects on colon carcinogenesis. All experiments complied the guidelines and approval of ethical institutional review boards.No colon tumors were found in chagasic megacolon samples. A significant myenteric neuronal denervation was observed. Epithelial cell proliferation and hyperplasia were found increased in chagasic megacolon. Analyzing the argyrophilic nucleolar organiser regions within the cryptal bottom revealed reduced risk for colon cancer in Chagas' megacolon patients. T. cruzi-infected rats showed a significant myenteric neuronal denervation and decreased numbers of colon preneoplastic lesions. In chemical myenteric denervated rats preneoplastic lesions were reduced from the 2nd wk onward, which ensued having the colon myenteric denervation significantly induced.Our data suggest that the trypanosomiasis-related myenteric neuronal degeneration protects the colon tissue from carcinogenic events. Current findings highlight potential mechanisms in tropical diseases and cancer research.

A human type 5 adenovirus-based Trypanosoma cruzi therapeutic vaccine re-programs immune response and reverses chronic cardiomyopathy.

Directory of Open Access Journals (Sweden)

Isabela Resende Pereira

2015-01-01

Full Text Available Chagas disease (CD, caused by the protozoan Trypanosoma cruzi, is a prototypical neglected tropical disease. Specific immunity promotes acute phase survival. Nevertheless, one-third of CD patients develop chronic chagasic cardiomyopathy (CCC associated with parasite persistence and immunological unbalance. Currently, the therapeutic management of patients only mitigates CCC symptoms. Therefore, a vaccine arises as an alternative to stimulate protective immunity and thereby prevent, delay progression and even reverse CCC. We examined this hypothesis by vaccinating mice with replication-defective human Type 5 recombinant adenoviruses (rAd carrying sequences of amastigote surface protein-2 (rAdASP2 and trans-sialidase (rAdTS T. cruzi antigens. For prophylactic vaccination, naïve C57BL/6 mice were immunized with rAdASP2+rAdTS (rAdVax using a homologous prime/boost protocol before challenge with the Colombian strain. For therapeutic vaccination, rAdVax administration was initiated at 120 days post-infection (dpi, when mice were afflicted by CCC. Mice were analyzed for electrical abnormalities, immune response and cardiac parasitism and tissue damage. Prophylactic immunization with rAdVax induced antibodies and H-2Kb-restricted cytotoxic and interferon (IFNγ-producing CD8+ T-cells, reduced acute heart parasitism and electrical abnormalities in the chronic phase. Therapeutic vaccination increased survival and reduced electrical abnormalities after the prime (analysis at 160 dpi and the boost (analysis at 180 and 230 dpi. Post-therapy mice exhibited less heart injury and electrical abnormalities compared with pre-therapy mice. rAdVax therapeutic vaccination preserved specific IFNγ-mediated immunity but reduced the response to polyclonal stimuli (anti-CD3 plus anti-CD28, CD107a+ CD8+ T-cell frequency and plasma nitric oxide (NO levels. Moreover, therapeutic rAdVax reshaped immunity in the heart tissue as reduced the number of perforin+ cells

Sistema ABO e formas anatomoclínicas da doença de Chagas crônica

Directory of Open Access Journals (Sweden)

Vicente de Paula Antunes Teixeira

1987-09-01

Full Text Available Estudou-se a distribuição do sistema ABO em 222 controles e em 148 chagásicos crônicos, assintomáticos e sintomáticos, com diferentes formas anatomoclinicas (insuficiência cardíaca congestiva, visceromegalias e morte súbita. O foi calculado a partir de tabelas de contingência e pelo método de Woolf. OX², obtido por estes dois métodos, demonstra que a freqüência do grupo OX² foi significativamente menor nos chagásicos sintomáticos considerados como um todo e naqueles com "megas", em relação aos controles. Nos chagásicos falecidos subitamente observou-se maior freqüência de grupos B que nos controles, sendo o X² significativo apenas quando calculado por tabelas de contingência. A relativa proteção aparentemente conferida aos chagásicos do grupo O, no que se refere à evolução para formas sintomáticas da doença, se explicaria por antigenicidade cruzada entre populações do Trypanosoma cruzi e o sistema ABO ou por outros fatores que se deixam influenciar ou influenciam a distribuição dos grupos sangüíneos.ABO blood group distribution was studied in 222 Controls and in 148 symptomatic and symptomless patients with chronic Chagas' disease with different anatomo-clinics forms (congestive heart failure, visceromegalias and sudden death. The X² was estimated from contingency table and by Woolfs method. The X² obtained by these two methods showed that the group O frequency was significantly less in the symptomatic chagasic group as a whole and in those with "megas" when compared with the controls. B blood group was observed to be more frequent in chagasics with sudden death but the X² was only significant when calculated for contingency tables. The apparent relative protection confered by the O blood group to chagasics with respect to its evolution to symptomatic forms of the disease, could be explained by cross antigenicity among T. cruzi populations and ABO blood group or by other factors influencing or being

Myenteric plexus is differentially affected by infection with distinct Trypanosoma cruzi strains in Beagle dogs

Directory of Open Access Journals (Sweden)

Nívia Carolina Nogueira-Paiva

2014-02-01

Full Text Available Chagasic megaoesophagus and megacolon are characterised by motor abnormalities related to enteric nervous system lesions and their development seems to be related to geographic distribution of distinct Trypanosoma cruzi subpopulations. Beagle dogs were infected with Y or Berenice-78 (Be-78 T. cruzi strains and necropsied during the acute or chronic phase of experimental disease for post mortem histopathological evaluation of the oesophagus and colon. Both strains infected the oesophagus and colon and caused an inflammatory response during the acute phase. In the chronic phase, inflammatory process was observed exclusively in the Be-78 infected animals, possibly due to a parasitism persistent only in this group. Myenteric denervation occurred during the acute phase of infection for both strains, but persisted chronically only in Be-78 infected animals. Glial cell involvement occurred earlier in animals infected with the Y strain, while animals infected with the Be-78 strain showed reduced glial fibrillary acidic protein immunoreactive area of enteric glial cells in the chronic phase. These results suggest that although both strains cause lesions in the digestive tract, the Y strain is associated with early control of the lesion, while the Be-78 strain results in progressive gut lesions in this model.

Mast cell-nerve interaction in the colon of Trypanosoma cruzi-infected individuals with chagasic megacolon.

Science.gov (United States)

Martins, Patrícia Rocha; Nascimento, Rodolfo Duarte; Dos Santos, Aline Tomaz; de Oliveira, Enio Chaves; Martinelli, Patricia Massara; d'Avila Reis, Débora

2018-04-01

Chagas disease is an infection caused by the parasite Trypanosoma cruzi that affects millions of people worldwide and is endemic in Latin America. Megacolon is the most frequent complication of the digestive chronic form and happens due to lesions of the enteric nervous system. The neuronal lesions seem to initiate in the acute phase and persist during the chronic phase, albeit the mechanisms involved in this process are still debated. Among the cells of the immune system possibly involved in this pathological process is the mast cell (MC) due to its well-known role in the bi-directional communication between the immune and nervous systems. Using ultrastructural analysis, we found an increased number of degranulated MCs in close proximity to nerve fibers in infected patients when compared with uninfected controls. We also immunostained MCs for the two pro-inflammatory molecules tryptase and chymase, the first being also important in neuronal death. The number of MCs immunostained for tryptase or chymase was increased in patients with megacolon, whereas increased tryptase staining was additionally observed in patients without megacolon. Moreover, we detected the expression of the tryptase receptor PAR2 in neurons of the enteric nervous system, which correlated to the tryptase staining results. Altogether, the data presented herein point to the participation of MCs on the denervation process that occurs in the development of T. cruzi-induced megacolon.

Transplante de coração em pacientes com miocardiopatia chagásica Heart transplantation in patients with chagasic cardiomiopathy

Directory of Open Access Journals (Sweden)

Adib D Jatene

1987-04-01

Full Text Available Entre 27 pacientes submetidos a transplante cardíaco, no Instituto do Coração do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, 4 eram portadores de cardiomiopatia chagásica. As idades situaram-se entre 28 e 43 anos. Três pacientes estavam em grupo funcional IV e 1, na classe funcional II, mas apresentando taquiarritmia ventricular retrataria. A imunossupressão foi feita com ciclosporina mais corticóide, no 1º paciente, e ciclosporina, azatioprina e corticóide, nos outros três. Três pacientes tiveram episódios de rejeição, tratados com pulsoterapia. Um destes pacientes apresentou doença intestinal linfoproliferativa precoce. Os 3 pacientes tiveram reagudização da doença de Chagas no 59º, 81º e 420º de pós-operatório, respectivamente, caracterizada por febre, lesões cutâneas e miocardite. O Trypanosoma cruzi foi encontrado nas biópsias de pele dos 3 pacientes e nas biópsias do miocárdio em 2 pacientes. Um dos pacientes não teve reagudização. Todos os 4 doentes foram tratados com medicação específica, bem tolerada em todos. As alterações da reagudização da doença de Chagas reverteram em poucos dias. Um dos pacientes, que teve doença linfoproliferativa e cujas doses de imunossupressores foram reduzidas, faleceu no 197º dia, em crise de rejeição. Os demais estão bem e em seguimento por 107, 160 e 500 dias, respectivamente.Among 27 heart transplanted patients, 4 had chagasic cardiomiopathy. They were male, with ages from 28 to 43 years, 3 in the NYHA class IV and 1 in class II, but with refractory arrhythmias. The immunosuppressive protocol included cyclosporin and steroids in the first patient and cyclosporin, azathioprine and steroids in the last. Three patients had one or more rejection episodes and 1 had no episode. Usual complications were observed and in 1 patient a lymphoproliferative intestinal disease occurred. Three patients had a new acute phase of Chagas disease

[Congenital cardiopathy and cerebral abscess].

Science.gov (United States)

Paixão, A; de Andrade, F F; Sampayo, F

1989-01-01

During 1986 the authors came across two cases of brain abscess among children with congenital heart disease followed at the Pediatric Cardiology Service and decided to evaluate their global experience on the subject. In a retrospective study of 860 infants and children with cyanotic congenital heart disease and final diagnosis, there were four cases complicated with brain abscess. The following items were evaluated: prevalence of the complication, type of congenital heart disease, date and age at the diagnosis of brain abscess, diagnostic methods, neurosurgical treatment and results. The main findings were: all patients were above two years of age and had noncorrected cyanotic congenital heart disease belonging to the classic high risk group; the first two cases had been treated in other institutions and only scanty information was available; two recent cases had early diagnosis on CAT scan followed by neurosurgical treatment. All children survived. brain abscess is a rare but severe complication occurring in patients with noncorrected cyanotic congenital heart disease above two years of age; whenever prevention turns impossible, early diagnosis and treatment provide good short term and long term results. A multidisciplinar approach with full cooperation is advocated.

Initial validation of the Argentinean Spanish version of the PedsQL™ 4.0 Generic Core Scales in children and adolescents with chronic diseases: acceptability and comprehensibility in low-income settings

Directory of Open Access Journals (Sweden)

Bauer Gabriela

2008-08-01

Full Text Available Abstract Background To validate the Argentinean Spanish version of the PedsQL™ 4.0 Generic Core Scales in Argentinean children and adolescents with chronic conditions and to assess the impact of socio-demographic characteristics on the instrument's comprehensibility and acceptability. Reliability, and known-groups, and convergent validity were tested. Methods Consecutive sample of 287 children with chronic conditions and 105 healthy children, ages 2–18, and their parents. Chronically ill children were: (1 attending outpatient clinics and (2 had one of the following diagnoses: stem cell transplant, chronic obstructive pulmonary disease, HIV/AIDS, cancer, end stage renal disease, complex congenital cardiopathy. Patients and adult proxies completed the PedsQL™ 4.0 and an overall health status assessment. Physicians were asked to rate degree of health status impairment. Results The PedsQL™ 4.0 was feasible (only 9 children, all 5 to 7 year-olds, could not complete the instrument, easy to administer, completed without, or with minimal, help by most children and parents, and required a brief administration time (average 5–6 minutes. People living below the poverty line and/or low literacy needed more help to complete the instrument. Cronbach Alpha's internal consistency values for the total and subscale scores exceeded 0.70 for self-reports of children over 8 years-old and parent-reports of children over 5 years of age. Reliability of proxy-reports of 2–4 year-olds was low but improved when school items were excluded. Internal consistency for 5–7 year-olds was low (α range = 0.28–0.76. Construct validity was good. Child self-report and parent proxy-report PedsQL™ 4.0 scores were moderately but significantly correlated (ρ = 0.39, p Conclusion Results suggest that the Argentinean Spanish PedsQL™ 4.0 is suitable for research purposes in the public health setting for children over 8 years old and parents of children over 5 years old

Autoantibodies Enhance Agonist Action and Binding to Cardiac Muscarinic Receptors in Chronic Chagas’ Disease

Science.gov (United States)

Hernández, Ciria C.; Nascimento, José H.; Chaves, Elen A.; Costa, Patrícia C.; Masuda, Masako O.; Kurtenbach, Eleonora; Campos de Carvalho, Antônio C.; Giménez, Luis E.

2009-01-01

Chronic Chagasic patient immunoglobulins (CChP-IgGs) recognize an acidic amino acid cluster at the second extracellular loop (el2) of cardiac M2-muscarinic acetylcholine receptors (M2AChRs). These residues correspond to a common binding site for various allosteric agents. We characterized the nature of the M2AChR/CChP-IgG interaction in functional and radioligand binding experiments applying the same mainstream strategies previously used for the characterization of other allosteric agents. Dose-response curves of acetylcholine effect on heart rate were constructed with data from isolated heart experiments in the presence of CChP or normal blood donor (NBD) sera. In these experiments, CChP sera but not NBD sera increased the efficacy of agonist action by augmenting the onset of bradyarrhythmias and inducing a Hill slope of 2.5. This effect was blocked by gallamine, an M2AChR allosteric antagonist. Correspondingly, CChP-IgGs increased acetylcholine affinity twofold and showed negative cooperativity for [3H]-N-methyl scopolamine ([3H]-NMS) in allosterism binding assays. A peptide corresponding to the M2AChR-el2 blocked this effect. Furthermore, dissociation assays showed that the effect of gallamine on the [3H]-NMS off-rate was reverted by CChP-IgGs. Finally, concentration-effect curves for the allosteric delay of W84 on [3H]-NMS dissociation right shifted from an IC50 of 33 nmol/L to 78 nmol/L, 992 nmol/L, and 1670 nmol/L in the presence of 6.7 × 10−8, 1.33 × 10−7, and 2.0 × 10−7 mol/L of anti-el2 affinity-purified CChP-IgGs. Taken together, these findings confirmed a competitive interplay of these ligands at the common allosteric site and revealed the novel allosteric nature of the interaction of CChP-IgGs at the M2AChRs as a positive cooperativity effect on acetylcholine action. PMID:18702010

Antibody Maturation in Trypanosoma cruzi-Infected Rats

Science.gov (United States)

Marcipar, Iván S.; Risso, Marikena G.; Silber, Ariel M.; Revelli, Silvia; Marcipar, Alberto J.

2001-01-01

The study of antibody avidity changes during infection has improved the understanding of the pathologic processes involved in several infectious diseases. In some infections, like toxoplasmosis, this information is being used for diagnostic purposes. Results of the evolution of antibody avidity for different specific antigens in Trypanosome cruzi-infected rats are presented. A Western blotting technique, combined with avidity analysis to identify antigens that elicit high-avidity antibodies, is suggested. In this system, antibodies showed high avidity values only during the chronic phase of infection and only in relation to antibodies against 21-, 33-, 41-, 42-, 56-, 58-, 66-, and 72-kDa antigens. Finally, a 97-kDa T. cruzi antigen, which was recognized by high-avidity antibodies and occurred in noninfected rats, was identified. These results allow us to evaluate the different antigens in chagasic infection. Our results show that with the correct choice of antigen it is possible to detect differences in maturation of antibodies and to discriminate, in an experimental model, between recent (acute) and chronic infections. PMID:11427430

Chronic pancreatitis

Science.gov (United States)

Chronic pancreatitis - chronic; Pancreatitis - chronic - discharge; Pancreatic insufficiency - chronic; Acute pancreatitis - chronic ... abuse over many years. Repeated episodes of acute pancreatitis can lead to chronic pancreatitis. Genetics may be ...

Rastreamento de cardiopatias congênitas associadas ao diabetes mellitus por meio da concentração plasmática materna de frutosamina Congenital cardiopathies screening associated with diabetes mellitus using maternal fructosamine plasma concentration

Directory of Open Access Journals (Sweden)

Zilma Silveira Nogueira Reis

2010-02-01

Full Text Available OBJETIVO: avaliar a importância da concentração plasmática materna de frutosamina como indicador de cardiopatias congênitas fetais, em gestações complicadas pelo diabetes mellitus. MÉTODOS: o estudo retrospectivo incluiu 91 gestantes portadoras de diabetes mellitus, as quais foram submetidas à ecocardiografia fetal de rotina em centro universitário de referência em Medicina Fetal. Foram selecionadas 65 pacientes que apresentavam diabete pré-gestacional e registro em prontuário médico de frutosamina plasmática anterior ao exame ultrassonográfico. A primeira dosagem registrada foi confrontada com o resultado da ecocardiografia fetal de rotina, realizada por médico especialista do serviço. A presença ou ausência de achados ecográficos de cardiopatia congênita (AECC foi relacionada aos níveis plasmáticos de frutosamina, por meio de teste de médias, e sua acuidade para AECC verificada por curva ROC. Foram discutidos como pontos de corte os valores da concentração plasmática materna de frutosamina de 2,68, 2,9 e 2,23 mmol/L, que são, respectivamente, o valor de referência local do laboratório, o do kit de dosagem empregado e o de maior acurácia global. RESULTADOS: o AECC foi encontrado em 52,3% dos fetos. A primeira dosagem de frutosamina durante o pré-natal aconteceu em média com 20,4±8,0 semanas de gestação. A capacidade da concentração materna de frutosamina em identificar fetos com AECC foi significante (pPURPOSE: to evaluate the importance of maternal plasma concentration of fructosamine as an indicator of fetal congenital cardiopathies in pregnancies complicated by diabetes mellitus. METHODS: this was a retrospective study conducted on 91 pregnant women with diabetes mellitus who underwent routine fetal echocardiography at a university reference center in fetal medicine. Sixty-five patientes who presented pre-gestational diabetes mellitus and plasma fructosamine level were registered in the medical records

Obsessive-compulsive disorder; chronic versus non-chronic symptoms

NARCIS (Netherlands)

Visser, H.A.; van Oppen, P.C.; van Megen, H.J.; Eikelenboom, M.; van Balkom, A.J.L.M.

2014-01-01

Objective Understanding chronicity in OCD is hampered by contradictory findings arising from dissimilar definitions of chronic OCD. The purpose of this study was to investigate the magnitude of chronicity in OCD and to examine if chronic OCD is critically different from non-chronic OCD, using a

Resposta pressórica de pacientes com miocardiopatia chagásica ante o uso do sildenafil Pressure response in chagasic cardiomyopathy patients after using sildenafil

Directory of Open Access Journals (Sweden)

Rodrigo Abensur Athanazio

2007-03-01

Full Text Available OBJETIVO: Verificar o efeito do sildenafil na pressão arterial (PA e freqüência cardíaca (FC de indivíduos portadores de miocardiopata chagásica (MCC e de disfunção ventricular sistólica grave (FEOBJECTIVE: To accurately verify the effect of Sildenafil on blood pressure (BP and heart rate (HR in individuals with Chagasic myocardiopathy (CMC and severe systolic ventricular dysfunction (EF<40% submitted to physical activity. METHODS: Twelve men with ejection fractions <40% and CMC confirmed by a serological test were assessed. The six-minute walk test (6MWT was performed before and after administration of 50 mg of Sildenafil, with a 30 minute interval. Heart rate (HR, systolic blood pressure (SBP and diastolic blood pressure were taken and compared before and after each 6MWT. For statistical analysis purposes, the study was divided into four stages: before the 6MWT and administration of Sildenafil (S1; after the 6MWT but before the administration of Sildenafil (S2; after the administration of Sildenafil but before the 6MWT (S3; and after the administration of Sildenafil and the 6MWT (S4. RESULTS: Participant ages ranged from 47 to 68 years (57.6 ± 6.4. SBP and DBP after the 6MWT and the administration of Sildenafil (S4 were lower than before taking the drug (S2: 134.2 ± 15.1 versus 125.5 ± 14.0 and 88.4 ± 12.4 versus 83.0 ± 10.8, respectively. None of the patients reported any symptoms during the 6MWT. There were no differences in the distances walked during the 6MWT before or after taking Sildenafil (487.5±15.22 versus 505.3±18.45 meters, respectively-p=0.056, or in HR (before Sildenafil 75.5 ± 8.79 and 96.8 ± 10.36 bpm and after 77.1 ± 9.81 and 96.1 ± 12.97 bpm. CONCLUSION: Based on these results, it can be concluded that both prediction equations significantly overestimated HRmax measured during maximal GXT in Brazilian elderly women, a finding that may have important implications when prescribing exercise intensity for this

Resultados perinatológicos del servicio de Cardiopatía y Embarazo del Hospital Ginecobstétrico "Ramón González Coro" en el bienio 2000-2001, Habana Perinatologic results of Cardiopathy and Pregnancy's Service in 2000-2001, in "Ramón González Coro" Hospital, Havana

Directory of Open Access Journals (Sweden)

Roberto Viñas Oliva

2003-03-01

Full Text Available OBJETIVOS: establecer las bases para el tratamiento y atención de la mujer portadora de cardiopatía en edad fértil, caracterizando al grupo de gestantes atendidas en servicio. MÉTODOS: realizó un estudio descriptivo y las mujeres fueran clasificadas según cardiopatía y grado de afectación funcional en relación con los resultados, se decribiendo las complicaciones durante el embarazo, parto y puerperio y los resultados perinatales. Variables analizadas: tipo de cardiopatía y clasificación funcional de las mismas, complicaciones obstétricas y/o cardiovasculares, edad gestacional al parto, modo de nacimiento, peso y puntaje de Apgar en el recién nacido y mortalidad materna y del recién nacido. RESULTADOS: encontramos 129 valvulopatías adquiridas, 79 congénitas, 18 casos de trastornos del ritmo. Lesiones más frecuentes valvulopatías mitrales (92 y comunicaciones interauriculares (31. 21 pacientes presentaron empeoramiento funcional durante el embarazo. Aparecieron complicaciones cardiovasculares en 19 pacientes y obstétricas en 142. 14 requirieron ingreso en Servicios de Terapia Intensiva y tres fallecieron. CONCLUSIONES: Se confirmó la asociación entre clasificación funcional y complicaciones cardiovasculares durante el embarazo, parto y puerperio. Las complicaciones obstétricas se comportan igual que en las gestaciones de pacientes sanas y más de la mitad de los partos fueron eutócicos.OBJECTIVES: to establish the basis for treatment and care of cardiopath women in fertile age, following the criteria of evidence based Medicine, through the clinical and perinatal assessment of a group of pregnant women admitted in our service. METHODS: the women were classified according to their cardiopathy and degree of functional impairment related to the complications described during pregnancy, delivery and puerperal stage and perinatal results. The variables analysed were : type of cardiopathy and functional classification of the

High similarity of Trypanosoma cruzi kDNA genetic profiles detected by LSSP-PCR within family groups in an endemic area of Chagas disease in Brazil

Directory of Open Access Journals (Sweden)

Sandra Maria Alkmim-Oliveira

2014-10-01

Full Text Available Introduction Determining the genetic similarities among Trypanosoma cruzi populations isolated from different hosts and vectors is very important to clarify the epidemiology of Chagas disease. Methods An epidemiological study was conducted in a Brazilian endemic area for Chagas disease, including 76 chronic chagasic individuals (96.1% with an indeterminate form; 46.1% with positive hemoculture. Results T. cruzi I (TcI was isolated from one child and TcII was found in the remaining (97.1% subjects. Low-stringency single-specific-primer-polymerase chain reaction (LSSP-PCR showed high heterogeneity among TcII populations (46% of shared bands; however, high similarities (80-100% among pairs of mothers/children, siblings, or cousins were detected. Conclusions LSSP-PCR showed potential for identifying similar parasite populations among individuals with close kinship in epidemiological studies of Chagas disease.

Diverse inhibitor chemotypes targeting Trypanosoma cruzi CYP51.

Directory of Open Access Journals (Sweden)

Shamila S Gunatilleke

Full Text Available Chagas Disease, a WHO- and NIH-designated neglected tropical disease, is endemic in Latin America and an emerging infection in North America and Europe as a result of population moves. Although a major cause of morbidity and mortality due to heart failure, as well as inflicting a heavy economic burden in affected regions, Chagas Disease elicits scant notice from the pharmaceutical industry because of adverse economic incentives. The discovery and development of new routes to chemotherapy for Chagas Disease is a clear priority.The similarity between the membrane sterol requirements of pathogenic fungi and those of the parasitic protozoon Trypanosoma cruzi, the causative agent of Chagas human cardiopathy, has led to repurposing anti-fungal azole inhibitors of sterol 14α-demethylase (CYP51 for the treatment of Chagas Disease. To diversify the therapeutic pipeline of anti-Chagasic drug candidates we exploited an approach that included directly probing the T. cruzi CYP51 active site with a library of synthetic small molecules. Target-based high-throughput screening reduced the library of ∼104,000 small molecules to 185 hits with estimated nanomolar K(D values, while cross-validation against T. cruzi-infected skeletal myoblast cells yielded 57 active hits with EC(50 <10 µM. Two pools of hits partially overlapped. The top hit inhibited T. cruzi with EC(50 of 17 nM and was trypanocidal at 40 nM.The hits are structurally diverse, demonstrating that CYP51 is a rather permissive enzyme target for small molecules. Cheminformatic analysis of the hits suggests that CYP51 pharmacology is similar to that of other cytochromes P450 therapeutic targets, including thromboxane synthase (CYP5, fatty acid ω-hydroxylases (CYP4, 17α-hydroxylase/17,20-lyase (CYP17 and aromatase (CYP19. Surprisingly, strong similarity is suggested to glutaminyl-peptide cyclotransferase, which is unrelated to CYP51 by sequence or structure. Lead compounds developed by pharmaceutical

Chronic periodontitis, inflammatory cytokines, and interrelationship with other chronic diseases.

Science.gov (United States)

Cardoso, Elsa Maria; Reis, Cátia; Manzanares-Céspedes, Maria Cristina

2018-01-01

Periodontal diseases, such as chronic periodontitis, share common inflammatory risk factors with other systemic and chronic inflammatory disorders. Mucosal tissues, such as oral epithelia, are exposed to environmental stressors, such as tobacco and oral bacteria, that might be involved in promoting a systemic inflammatory state. Conversely, chronic disorders can also affect oral health. This review will summarize recent evidence for the interrelationship between chronic periodontitis and other prevalent chronic diseases such as cardiovascular diseases, diabetes, cancer and chronic respiratory diseases. The association with pregnancy is also included due to possible obstetric complications. We will focus on inflammatory cytokines such as TNF-alpha, IL-1, and IL-6, because they have been shown to be increased in patients with chronic periodontitis, in patients with chronic systemic diseases, and in patients with both chronic periodontitis and other chronic diseases. Therefore, an imbalance towards a proinflammatory immune response could underline a bidirectional link between chronic periodontitis and other chronic diseases. Finally, we highlight that a close coordination between dental and other health professionals could promote oral health and prevent or ameliorate other chronic diseases.

Follow-up of ischemic cardiopathy, an essential moment in the communication between in-patient and out-patient setting: problems and opportunities

Directory of Open Access Journals (Sweden)

Italo Paolini

2008-12-01

Full Text Available It is known that the transition from the inpatient to the outpatient setting is a critical time. Evidence suggests that contact between patients and providers (i.e., physicians, nurse practitioners, and physician assistants during this interval may be crucial for appropriate treatment modifications and recognition of errors in treatment. Ambulatory follow-up provides opportunities for clinical assessment, patient education, and medication review, which may in turn improve outcomes. However, little is known about the appropriate timing and type of follow-up that is necessary following hospitalization for AMI. In Italian System of Heath contact between general pratictioner and specialists, after dicharge, is critical moment for management of chronic pharmacological and non pharmacological therapy. If professional approaches are not integrated can reduce patients compliance and effectiveness of therapies themselves. Good management of chronic cardiovascular disease requires attention to stenghtening the continuity of information and management of patients.

Changes in Proteome Profile of Peripheral Blood Mononuclear Cells in Chronic Chagas Disease.

Directory of Open Access Journals (Sweden)

Nisha Jain Garg

2016-02-01

Full Text Available Trypanosoma cruzi (Tc infection causes chagasic cardiomyopathy; however, why 30-40% of the patients develop clinical disease is not known. To discover the pathomechanisms in disease progression, we obtained the proteome signature of peripheral blood mononuclear cells (PBMCs of normal healthy controls (N/H, n = 30 and subjects that were seropositive for Tc-specific antibodies, but were clinically asymptomatic (C/A, n = 25 or clinically symptomatic (C/S, n = 28 with cardiac involvement and left ventricular dysfunction. Protein samples were labeled with BODIPY FL-maleimide (dynamic range: > 4 orders of magnitude, detection limit: 5 f-mol and resolved by two-dimensional gel electrophoresis (2D-GE. After normalizing the gel images, protein spots that exhibited differential abundance in any of the two groups were analyzed by mass spectrometry, and searched against UniProt human database for protein identification. We found 213 and 199 protein spots (fold change: |≥ 1.5|, p93% prediction success in classifying infected individuals with no disease and those with cardiac involvement and LV dysfunction. In conclusion, we have identified molecular pathways and a panel of proteins that could aid in detecting seropositive individuals at risk of developing cardiomyopathy.

Examination of congenital cardiopathy of children

Energy Technology Data Exchange (ETDEWEB)

Ogawa, M; Miyagi, T; Yufune, K; Nakagawa, T; Otake, K [Kanagawa Children Medical Center (Japan)

1979-05-01

Several problems peculiar to children before and after operation are discussed putting stress on 800 cases of cardio-angiography of from newborn to school children. As the amount of contrast medium for children is very small, it makes the adjustment of injection speed difficult and sometimes makes diagnosis impossible because of poor contrast. Thin catheters require more strength, the curve and resistance must be reduced. Much attention peculiar to children should be paid to each device. Angiography of a child often requires an operator to attend near the child and sometimes requires several operators to attend. Consequently much attention must be paid to exposure prevention for operators as well as patients.

Chronic Pancreatitis.

Science.gov (United States)

Stram, Michelle; Liu, Shu; Singhi, Aatur D

2016-12-01

Chronic pancreatitis is a debilitating condition often associated with severe abdominal pain and exocrine and endocrine dysfunction. The underlying cause is multifactorial and involves complex interaction of environmental, genetic, and/or other risk factors. The pathology is dependent on the underlying pathogenesis of the disease. This review describes the clinical, gross, and microscopic findings of the main subtypes of chronic pancreatitis: alcoholic chronic pancreatitis, obstructive chronic pancreatitis, paraduodenal ("groove") pancreatitis, pancreatic divisum, autoimmune pancreatitis, and genetic factors associated with chronic pancreatitis. As pancreatic ductal adenocarcinoma may be confused with chronic pancreatitis, the main distinguishing features between these 2 diseases are discussed. Copyright © 2016 Elsevier Inc. All rights reserved.

Aspectos da miocardite em chagásicos crônicos com "megas" e sem "megas" com insuficiência cardíaca congestiva

Directory of Open Access Journals (Sweden)

Hipólito de Oliveira Almeida

1984-06-01

Full Text Available O estudo microscópico de 20 corações de chagásicos com "megas" e de outros 20 sem "megas" com insuficiência cardíaca congestiva (ICC revelou que tanto a Jibrose quanto o exsudato inflamatório no miocárdio são discretos nos casos de "megas" e geralmente acentuados nos casos de ICC. Considerando-se que nos "megas" a ICC, a hipertrofia do miocárdio e a lesão vorticilar são fenômenos raros, nossos achados (atuais e anteriores sugerem que estes estejam relacionados principalmente com a agressão inflamatória ao miocárdio ventricular, uma vez que a desnervação é, geralmente, mais acentuada nos casos de "megas" que nos de ICC.The study of 20 hearts from chagasic patients with "megas " and of others 20 from chagasics without "megas" with heart failure, shows that both, myocardial Jibrosis and inflammatory exudate are light in cases with "megas" and severe in group with heart failure. In chagasic with "megas" the myocardial hypertrophy, the apical lesion and the cardiac insufficiency are infrequent. Ourfindings suggest that they are related to the myocardial ventricular inflammation and not to the cardiac denervation. This latter is more severe in cases of "megas" than in cases of congestive heart failure without "megas".

O xenodiagnostico e os critérios para avaliar o nivel de parasitemia do paciente chagásico crônico

Directory of Open Access Journals (Sweden)

Elisabeth Bronfen

1991-03-01

Full Text Available A sensibilidade do xenodiagnóstico e sua relação com a parasitemia da fase crônica da doença de Chagas foi verificada em 104 pacientes crônicos. As ninfas das espécies de triatomineos, simultaneamente utilizadas nos xenodiagnósticos destes pacientes, divididos em dois grupos, foram examinadas de maneiras diferentes. Os índices depositividade totais obtidos nos dois grupos (40,0% e 42,4% e os percentuais de positividade porpaciente sugerem uma reavaliação do que se denomina a "quantificação da parasitemia do paciente chagásico crônico, considerando a metodologia de exame do xenodiagnóstico.Xenodiagnosis sensibility and its relation to Chagas' disease chronic phase parasitemia was verified in 104 patients. The nymphs of the triatomine species, simultaneously utilized in the xenodiagnosis of these patients, divided into two grupos, were examined in different ways. The positivity rates achieved in the two groups (40,0% and 42,4% and the individual positivity rates suggest a reavaliation in what is called "quantification of the chronic chagasic patient parasitemia", considering the methodology used in the xenodiagnosis examinations.

[Chronic otitis mediaChronic Otitis Media].

Science.gov (United States)

Kohles, N; Schulz, T; Eßer, D

2015-11-01

There are 2 different kinds of chronic otitis media: Otitis media chronica mesotympanalis and otitis media chronica epitympanalis (cholesteatoma). The incidence of chronic otitis media as reported in literature differs in a wide range. The incidence rates vary between 0.45 and 46%. Both, otitis media chronica mesotympanalis and cholesteatoma, lead to eardrum perforation due to lengthy and recurring inflammations. Furthermore, chronic otitis media is characterized by frequently recurring otorrhea and conductive hearing loss. Georg Thieme Verlag KG Stuttgart · New York.

Um modelo experimental de ablação do Sistema Nervoso Intrínseco Cardíaco reduz a contratilidade do coração de ratos A new experimental model of chemical ablation of the Intrinsic Cardiac Nervous System reduces heart contractility and causes a type of dilated cardiopathy in rats

Directory of Open Access Journals (Sweden)

Adilson Scorzoni Filho

2004-09-01

denervation of the viscera. Thus, our aim was to obtain an experimental model of cardiac intrinsic denervation by the application of BC. METHOD: Thirty male Wistar rats received intrapericardic injection of CB 0.3% (CB animals and thirty similar animals received saline (C animals. After 15 days the animals were divided in three groups, with 10 CB-treated and 10 saline-treated animals each. Group I was submitted to radiological and morphologic studies. The cardiac shadow area (CSA and cardiothoracic index were calculated in roentgenograms with a semi-automatic image analysis system (MINI-MOP. The day after the animals were weighted and sacrificed with heart, liver and lung collected for histopathologic analysis. The animals of group II were submitted to a hemodynamic study. Measurements of blood pressure, heart rate and cardiac output were performed using the Cardiomax II termodilution system and a Termistor sensor. With the animals of the group III, the integrity of extrinsic parassympatic cardiac innervartion was examined by measuring heart rate response to electrical stimulation of the right vagus. Electrical activity was assessed by ECG. RESULTS: CB animals presented increases in cardiothoracic index, CSA, body and liver weight. In these animals the histopathologic analysis showed passive chronic congestion and reduction of the number of atrial neurons. In the hemodynamic study, total peripheral resistance and heart rate were similar in both groups, but blood pressure and cardiac index were reduced in the CB group. The vagal stimulation and ECG were similar in both groups. CONCLUSION: The Intrinsic Cardiac Nervous System denervation caused dilated cardiopathy in rats with left and right heart failure. The etiology of some dilated cardiopathies in human is largely unknown. Thisunpublished experimental model should provide future studies with the objective of elucidating the relationship between neuronal injures and heart disease.

[Major tricuspid insufficiency and absence of systolic valvular coaptation. Echocardiographic study. Apropos of 6 cases].

Science.gov (United States)

Roudaut, R; Héraudeau, A; Gosse, P; Aouizerate, E; Dequecker, J L; Dallocchio, M

1986-09-01

In a retrospective series of 960 cases of tricuspid regurgitation studied by two-dimensional echocardiography 6 patients presented a systolic defect of valvular coaptation. The origin of this defect varied: one case was due to carcinoid, two to rheumatic cardiopathy, two to papyraceous right ventricle and one to sclerodermia associated with pulmonary arterial hypertension. The mechanism of the lacking coaptation varies according to the etiology: valvular retraction in carcinoid cardiopathy, right-ventricle dilatation, dilatation of the tricuspid ring and altered kinetics of the right ventricle in the other cases. Changed contractility of the right ventricle is the only element allowing to distinguish tricuspid regurgitation with and without a coaptation defect. Clinically this abnormality always points to an advanced stage of severe tricuspid regurgitation.

4-aminopyridyl-based lead compounds targeting CYP51 prevent spontaneous parasite relapse in a chronic model and improve cardiac pathology in an acute model of Trypanosoma cruzi infection.

Science.gov (United States)

Calvet, Claudia Magalhaes; Choi, Jun Yong; Thomas, Diane; Suzuki, Brian; Hirata, Ken; Lostracco-Johnson, Sharon; de Mesquita, Liliane Batista; Nogueira, Alanderson; Meuser-Batista, Marcelo; Silva, Tatiana Araujo; Siqueira-Neto, Jair Lage; Roush, William R; de Souza Pereira, Mirian Claudia; McKerrow, James H; Podust, Larissa M

2017-12-01

Chagas disease, caused by the protozoan Trypanosoma cruzi, is the leading cause of heart failure in Latin America. The clinical treatment of Chagas disease is limited to two 60 year-old drugs, nifurtimox and benznidazole, that have variable efficacy against different strains of the parasite and may lead to severe side effects. CYP51 is an enzyme in the sterol biosynthesis pathway that has been exploited for the development of therapeutics for fungal and parasitic infections. In a target-based drug discovery program guided by x-ray crystallography, we identified the 4-aminopyridyl-based series of CYP51 inhibitors as being efficacious versus T.cruzi in vitro; two of the most potent leads, 9 and 12, have now been evaluated for toxicity and efficacy in mice. Both acute and chronic animal models infected with wild type or transgenic T. cruzi strains were evaluated. There was no evidence of toxicity in the 28-day dosing study of uninfected animals, as judged by the monitoring of multiple serum and histological parameters. In two acute models of Chagas disease, 9 and 12 drastically reduced parasitemia, increased survival of mice, and prevented liver and heart injury. None of the compounds produced long term sterile cure. In the less severe acute model using the transgenic CL-Brenner strain of T.cruzi, parasitemia relapsed upon drug withdrawal. In the chronic model, parasitemia fell to a background level and, as evidenced by the bioluminescence detection of T. cruzi expressing the red-shifted luciferase marker, mice remained negative for 4 weeks after drug withdrawal. Two immunosuppression cycles with cyclophosphamide were required to re-activate the parasites. Although no sterile cure was achieved, the suppression of parasitemia in acutely infected mice resulted in drastically reduced inflammation in the heart. The positive outcomes achieved in the absence of sterile cure suggest that the target product profile in anti-Chagasic drug discovery should be revised in favor of

Chronic Myelogenous Leukemia

Science.gov (United States)

Chronic myelogenous leukemia Overview Chronic myelogenous leukemia (CML) is an uncommon type of cancer of the blood cells. The term "chronic" in chronic myelogenous leukemia indicates that this cancer ...

[Comparison of conventional and non-conventional serological tests for the diagnosis of imported Chagas disease in Spain].

Science.gov (United States)

Flores-Chávez, María; Cruz, Israel; Rodríguez, Mercedes; Nieto, Javier; Franco, Elena; Gárate, Teresa; Cañavate, Carmen

2010-05-01

Trypanosoma cruzi infection is a major imported parasitic disease in Spain, because of the increase of immigrants from endemic areas. Since the laboratory diagnosis during the chronic phase is based on detection of anti-T. cruzi IgG antibodies, our aims were to compare 10 tests for determining anti-T. cruzi antibodies, to assess their cross-reactivity with related diseases, and to evaluate the rk39-ELISA and IFAT-Leishmania tests as tools for the differential diagnosis of leishmaniasis due to Leishmania infantum. A total of 223 sera were tested: 40 had been previously characterized by Qpanel, and 183 were obtained from the serum library of the Parasitology Department, Centro Nacional de Microbiología (66 chagasic, 97 healthy, 30 visceral leishmaniasis, and 30 malaria). Samples were examined using in-house IFAT and ELISA, 5 commercial ELISAs (Certest/Abbot Laboratories/BiosChile; Ortho Clinical Diagnostics; BLK Diagnostic; bioMérieux; and Biokit), particle gel agglutination (ID-PaGIA), and two immunochromatographic assays (Operon and CTK Biotech). The last 4 tests are based in recombinant antigens (non-conventional tests). The IFAT and ELISAs showed a sensitivity of 97% to 100%. The immunochromatographic tests had somewhat lower sensitivity (92%-96%). All non-conventional tests presented a smaller number of cross-reactions. Leishmania-Rk39-ELISA did not show cross-reactivity with chagasic sera. In general, our results confirm the data obtained by other authors. The sensitivity of ELISA is higher than other tests; therefore, these techniques would be the most appropriate for screening of T. cruzi infection. A suitable approach is the combination of a test using total antigen with another based on either recombinant antigens or synthetic peptides. (c) 2009 Elsevier España, S.L. All rights reserved.

El estado periodontal y la higiene bucal en los pacientes cardiópatas del Policlínico “Plaza de la Revolución” The periodontal state and the oral hygiene in cardiopathy patients at “Plaza de la Revolución ” Polyclinic

Directory of Open Access Journals (Sweden)

María Elena Pueo Lazo

2006-09-01

Full Text Available La enfermedad periodontal se relaciona con las enfermedades cardiovasculares, ya que los microorganismos del surco gingival y de las bolsas periodontales pueden agravar el inicio y curso de estas afecciones cardiovasculares. Se efectuó un estudio descriptivo y transversal, a una muestra no probabilística de 210 cardiópatas del Policlínico "Plaza de la Revolución" en el mes de febrero del 2003, a los que se les aplicó el índice de higiene bucal revisado (IHB-R de Greene y Vermillion, y el índice periodontal revisado de Russell (IP-R. Las variables del estudio fueron: la edad, el sexo, el estado periodontal y el grado de higiene bucal. Se pudo constatar que el 91 % de estos pacientes presentó algún grado de afección periodontal, y fueron los adultos jóvenes los de mayor prevalencia en cuanto a enfermedad gingival crónica, con el 83,3 %. La gravedad de las periodontopatías aumentó con la edad; no hubo diferencias significativas en canto al sexo. Solo el 8 % de estos pacientes tuvo buena higiene bucal; en el grupo estudiado predominó la higiene deficiente. Se evidenció que a medida que la higiene bucal fue más deficiente, el grado de afección periodontal aumentó, por lo cual resulta importante aplicar medidas preventivo-curativas, para mejorar la salud periodontal y así disminuir los riesgos en este grupo de pacientes dispensarizados.The periodontal disease is related to the cardiovascular diseases, since the microorganisms of the gingival sulcus and of the periodontal pockets may aggravate the beginning and the course of these cardiovascular affections. A descriptive and cross-sectional study was conducted in a non-probabilistic sample of 210 cardiopathy patients of “Plaza de la Revolución ” Polyclinic in February 2003. They were applied the revised oral higiene index (R-OHI of Greene and Vermillion, and the revised periodontal index of Russell (R-PI.The following variables were studied: age, sex, periodontal state, and

An experimental and clinical assay with ketoconazole in the treatment of Chagas disease

Directory of Open Access Journals (Sweden)

Zigman Brener

1993-03-01

Full Text Available Ketoconazole an azole antifungic drug which is already in the market has also been demonstrated to be active against Trypanossoma cruzi experimental infections. In this paper we confirmed the drug effect and investigated its range of activity against different T. cruzi strains naturally resistant or susceptible to both standard drugs Nifurtimox and Benznidazole used clinically in Chagas disease. Moreover, we have shown that the association of Ketoconazole plus Lovastatin (an inhibitor of sterol synthesis, which has an antiproliferative effect against T. cruzi in vitro, failed to enhance the supressive effect of Ketoconazole displayed when administered alone to infected mice. Finally, administration in chronic chagasic patients of Ketoconazole at doses used in the treatment of deep mycosis also failed to induce cure as demonstrated by parasitological and serological tests. The strategy of identify and test drugs which are already in the market and fortuitously are active against T. cruzi has been discussed.

Prevalence of chronic cough, chronic phlegm & associated factors in Mysore, Karnataka, India.

Science.gov (United States)

Mahesh, P A; Jayaraj, B S; Prabhakar, A K; Chaya, S K; Vijayasimha, R

2011-07-01

Chronic cough and chronic phlegm are important indicators of respiratory morbidity, accelerated lung function decline, increased hospitalization and mortality. This study was planned to estimate the prevalence of chronic cough and phlegm in the absence of dyspneoa and wheezing and to study its associated factors in a representative population of Mysore district. A cross-sectional survey was planned in a representative population of Mysore taluk. Eight villages were randomly selected based on the list of villages from census 2001. Trained field workers using the Burden of Obstructive Diseases questionnaire carried out a house-to-house survey. A total of 4333 adult subjects were enrolled in the study with 2333 males and 2000 females. The prevalence of chronic cough in the community was 2.5 per cent and that of chronic phlegm was 1.2 per cent. A significant association was observed between chronic cough and age, gender, occupation and smoking and chronic phlegm with age, gender, occupation, indoor animals and smoking. A multivariate analysis confirmed independent association of age, occupation and smoking for chronic cough and age and smoking for chronic phlegm. On sub-group analysis of males, heavy smokers had higher prevalence of chronic cough and chronic phlegm as compared to light smokers and non smokers. The prevalence of chronic cough was 2.5 per cent and chronic phlegm was 1.2 per cent in the general population in Mysore which is lower than that observed in other studies. Heavy smoking was an important preventable risk factor identified in this study and efforts towards smoking cessation are crucial to achieve good respiratory health in the community.

Chronic motor tic disorder

Science.gov (United States)

Chronic vocal tic disorder; Tic - chronic motor tic disorder ... Chronic motor tic disorder is more common than Tourette syndrome . Chronic tics may be forms of Tourette syndrome. Tics usually start ...

On examination of congenital cardiopathy of children

International Nuclear Information System (INIS)

Ogawa, Masayasu; Miyagi, Tetsuo; Yufune, Kazuo; Nakagawa, Toshio; Otake, Kazuo

1979-01-01

Several problems peculiar to children before and after operation are discussed putting stress on 800 cases of cardio-angiography of from newborn to school children. As the amount of contrast medium for children is very small, it makes the adjustment of injection speed difficult and sometimes makes diagnosis impossible because of poor contrast. Thin catheters require more strength, the curve and resistance must be reduced. Much attention peculiar to children should be paid to each device. Angiography of a child often requires an operator to attend near the child and sometimes requires several operators to attend. Consequently much attention must be paid to exposure prevention for operators as well as patients. (Kobatake, H.)

Les cardiopathies congenitales (cc) au Togo aspects ...

African Journals Online (AJOL)

The petrology of the. Follot (16.96%) and the CIA (06.25%) 112 patients have been transferred to foreign countries of which 74.10% Suisse 107 CC have been operated. The evolution has been favourable in 89.18%. In Togo, the discovery of the CC has been done lately posing therefore a problem of therapeutic choice.

Clinical manifestations of peripheral nervous system involvement in human chronic chagas disease Manifestaciones clinicas de compromiso del sistema nervioso periférico en el estádio crônico de la enfermedad de Chagas

Directory of Open Access Journals (Sweden)

Osvaldo Genovese

1996-06-01

Full Text Available We conducted a clinical and electromyographical study in patients with Chagas' disease in the indeterminate or chronic stages of the illness. Altogether 841 patients were examined. Only 511 were admitted within the protocol; the remainder patients were rejected because they showed other causes able to damage the nervous system. Fifty two (10.17% out of the 511 patients showed signs and symptoms of peripheral nervous system involvement in the form of sensory impairment and diminished tendon jerks suggesting the presence of neuropathy. Forty five of them were submitted to a conventional electromyographical examination. Fifteen of mem showed normal results, while the remainder 30 disclosed a reduced interference pattern, being most of the remaining motor unit potentials fragmented or poliphasic, reduced sensory and motor conduction velocities and diminished amplitude of the sensory action potential. The findings suggest that some chagasic patients in the indeterminate or chronic stages of the disease may develop a clinical mild sensory-motor peripheral neuropathy.El estúdio presente fue diseftado con ei objeto de pesquizar Ia existência de manifestaciones clinicas en pacientes afectados por enfermedad de Chagas, en estádio indeterminado o crônico, que tuviesen, ai menos, 2 reacciones serologicas positivas. En total fueron examinados 841 enfermos. De ellos solo 511 fueron admitidos en ei protocolo; los restantes fueron rechazados por mostrar Ia presencia de otras causas que hubiesen podido danar su sistema nervioso. Dentro de los 511 pacientes admitidos, 52 (10.17% evidenciaron alteraciones objetivas y subjetivas de Ia sensibilidad y disminucion de los reflejos osteotendinosos. Estos signos y sintomas, que sugieren la presencia de neuropatia, podian combinarse de diferente manera. Como complemento dei examen clinico, se efectuo estúdio electromiografico convencional en 45 de estos pacientes. En 15 los hallazgos fueron normales, en tanto que en

Supporting Self-management of Chronic Pain

Science.gov (United States)

2018-04-04

Chronic Pain Syndrome; Chronic Pain; Chronic Pain Due to Injury; Chronic Pain Due to Trauma; Chronic Pain Due to Malignancy (Finding); Chronic Pain Post-Procedural; Chronic Pain Hip; Chronic Pain, Widespread

[Chronically ill--chronically forgotten?--communication/mobility/everyday life].

Science.gov (United States)

Mattern, R

2007-04-01

In the course of the recent years, the policy for the needs of disabled people has started a fundamental paradigm shift. Central elements of the current policy for the needs of disabled people are prevention, rehabilitation and integration. Self-determination instead of care forms the guiding principle. An indistinct definition of chronic disease makes it difficult to obtain a general idea of structures in the care and support for people with chronic diseases. The following compilation examines requirements in social legislation and questions the quality of life by means of the three exemplary aspects: communication, mobility and everyday life. Here the question remains whether the current focus on health neglects any relevant components of chronic diseases. It turns out that people with a chronic illness, although social legislation has improved, are neglected the more support they need. Care as an elementary social principle must be discussed on an interdisciplinary basis and in the context of the whole society.

Chronic obstructive pulmonary disease and chronic heart failure: two muscle diseases?

Science.gov (United States)

Troosters, Thierry; Gosselink, Rik; Decramer, Marc

2004-01-01

Chronic obstructive pulmonary disease and congestive heart failure are two increasingly prevalent chronic diseases. Although care for these patients often is provided by different clinical teams, both disease conditions have much in common. In recent decades, more knowledge about the systemic impact of both diseases has become available, highlighting remarkable similarities in terms of prognostic factors and disease management. Rehabilitation programs deal with the systemic consequences of both diseases. Although clinical research also is conducted by various researchers investigating chronic obstructive pulmonary disease and chronic heart failure, it is worthwhile to compare the progress in relation to these two diseases over recent decades. Such comparison, the purpose of the current review, may help clinicians and scientists to learn about progress made in different, yet related, fields. The current review focuses on the similarities observed in the clinical impact of muscle weakness, the mechanisms of muscle dysfunction, the strategies to improve muscle function, and the effects of exercise training on chronic obstructive pulmonary disease and chronic heart failure.

Chronic Pericarditis

Science.gov (United States)

... surgery) and is considered subacute. Causes Usually, the cause of chronic effusive pericarditis is unknown. However, it may be caused by cancer, tuberculosis , or an underactive thyroid gland ( hypothyroidism ), and it occasionally occurs in people with chronic ...

Chronic Pain

Science.gov (United States)

... pain. Psychotherapy, relaxation and medication therapies, biofeedback, and behavior modification may also be employed to treat chronic pain. × ... pain. Psychotherapy, relaxation and medication therapies, biofeedback, and behavior modification may also be employed to treat chronic pain. ...

E-submission Format for Sub-chronic and Chronic Studies

Science.gov (United States)

The purpose of this document is to suggest the format for final reports and to provide instructions for creation of Adobe PDF electronic submission documents for electronic submission of sub-chronic and chronic studies for pesticides.

Tendances de la prévalence, de l'incidence et de la mortalité des cardiopathies ischémiques diagnostiquées et silencieuses au Québec

Directory of Open Access Journals (Sweden)

C. Blais

2015-01-01

Full Text Available Introduction : Parmi toutes les causes de décès d'origine cardiovasculaire, les cardiopathies ischémiques (CI demeurent les plus importantes. Notre étude visait à définir les tendances de la prévalence et de l'incidence des CI au Québec ainsi qu'à déterminer la proportion de décès par CI qui n'avait aucun diagnostic antérieur de CI. Méthodologie : Les tendances de la prévalence, de l'incidence et de la mortalité ont été examinées avec une étude populationnelle utilisant le Système intégré de surveillance des maladies chroniques du Québec, qui jumelle plusieurs fichiers médico administratifs. Les données, recueillies auprès des Québécois de 20 ans et plus, sont présentées selon deux définitions de cas : 1 une définition validée et 2 une définition reposant sur l'addition des codes de décès liés aux CI afin d'estimer la proportion des décès sans diagnostic antérieur de CI comme indicateur de mort cardiaque subite (MCS. Résultats : En 2012-2013, la prévalence brute des CI selon la première définition était de 9,4 % (593 000 personnes. Entre 2000-2001 et 2012-2013, la prévalence ajustée selon l'âge a augmenté de 14 %, avec une légère diminution depuis 2009-2010. Les taux d'incidence et de mortalité ajustés selon l'âge ont diminué de respectivement 46 % et 26 %, les taux bruts s'établissant à 6,9 pour 1 000 et à 5,2 % en 2012-2013. La proportion de décès identifiés uniquement grâce au décès par CI, soit l'indicateur de MCS, n'était significative que pour les cas incidents (0,38 pour 1 000 en 2009-2010 et elle a diminué au cours de la période à l'étude. Conclusion: La prévalence des CI a eu tendance à diminuer au cours des dernières années et l'incidence comme la mortalité ont également diminué au Québec. La majorité des décès par CI touchent des patients ayant déjà reçu un diagnostic, seule une faible proportion des cas incidents n'ayant pas été pr

Terminalia mjuna (Roxb.ex DC) Wight & Am. of COl11bretaceae is a ...

Indian Academy of Sciences (India)

... inflorescences. Fruit is ovoid lrvith 5-7 angles or 'wings. Bark is astringent, sweet, acrid, cooling, aphrodisiac, demulcent, cardiotonic, antidysenteric, urinary astringent, expectorant, alexiteric and tollie. It is useful ill ulcers, urethrorrhea, leucorrhoea, diabetes, anaemia, cardiopathy, cirrhosis of the liver and hypertension.

Chronic myelogenous leukemia (CML)

Science.gov (United States)

CML; Chronic myeloid leukemia; Chronic granulocytic leukemia; Leukemia - chronic granulocytic ... nuclear disaster. It takes many years to develop leukemia from radiation exposure. Most people treated for cancer ...

[Chronic appendicitis. A case report].

Science.gov (United States)

Montiel-Jarquín, Alvaro José; Gómez-Conde, Eduardo; Reyes-Páramo, Pedro; Romero-Briones, Carlos; Mendoza-García, Aurelio Valentín; García-Ramírez, Ulises Noel

2008-01-01

The term chronic appendicitis has been used to describe any type of chronic pain that originates in the appendix, with or without inflammation. This broad category can be divided more specifically into: chronic or recurrent appendicitis and appendiceal colic pain. a 41-year-old female, suffering intestinal chronic constipation, abdominal pain, nausea, hiporexia and febricula, treated with antibiotics, vermifuges, analgesics and antispasmodics, showing a slight and partial improvement. She was suffering chronic pain in lower abdomen, mostly on the right side along a year. With these symptoms, she underwent an exploratory laparotomy, that showed chronic appendicitis. Appendix had been removed. The histopathological report corresponded to chronic appendicitis. the histopathological characteristics and the clinical manifestations of the chronic appendicitis are different from those of acute appendicitis. Criteria for chronic appendicitis include: symptoms lasting longer than 4 weeks, confirmation of chronic swelling through histopathological examination, improvement of symptoms after appendectomy. The ultrasonic images, the barium enema and the computerized helicoidal tomography could be suggestive for its diagnosis.

Chronic Pain and Chronic Stress: Two Sides of the Same Coin?

Science.gov (United States)

Abdallah, Chadi G; Geha, Paul

2017-02-01

Pain and stress share significant conceptual and physiological overlaps. Both phenomena challenge the body's homeostasis and necessitate decision-making to help animals adapt to their environment. In addition, chronic stress and chronic pain share a common behavioral model of failure to extinguish negative memories. Yet, they also have discrepancies such that the final brain endophenotype of posttraumatic stress disorder, depression, and chronic pain appears to be different among the three conditions, and the role of the hypothalamic-pituitary-adrenal axis remains unclear in the physiology of pain. Persistence of either stress or pain is maladaptive and could lead to compromised well-being. In this brief review, we highlight the commonalities and differences between chronic stress and chronic pain, while focusing particularly on the central role of the limbic brain. We assess the current attempts in the field to conceptualize and understand chronic pain, within the context of knowledge gained from the stress literature. The limbic brain-including hippocampus, amygdala, and ventromedial pre-frontal cortex-plays a critical role in learning. These brain areas integrate incoming nociceptive or stress signals with internal state, and generate learning signals necessary for decision-making. Therefore, the physiological and structural remodeling of this learning circuitry is observed in conditions such as chronic pain, depression, and posttraumatic stress disorder, and is also linked to the risk of onset of these conditions.

Atypical Chronic Myelogenous Leukemia

Science.gov (United States)

... myeloproliferative neoplasms, leukemia , and other conditions . Chronic Myelomonocytic Leukemia Key Points Chronic myelomonocytic leukemia is a disease ... chance of recovery) and treatment options. Chronic myelomonocytic leukemia is a disease in which too many myelocytes ...

Chronic Pancreatitis in Children

Science.gov (United States)

... E-News Sign-Up Home Patient Information Children/Pediatric Chronic Pancreatitis in Children Chronic Pancreatitis in Children What symptoms would my child have? Frequent or chronic abdominal pain is the most common symptom of pancreatitis. The ...

Genetic Basis for Correction of Very‐Long‐Chain Acyl-Coenzyme A Dehydrogenase Deficiency by Bezafibrate in Patient Fibroblasts: Toward a Genotype‐Based Therapy

DEFF Research Database (Denmark)

Gobin‐Limballe, S.; Djouadi, F.; Aubey, F.

2007-01-01

Very‐long‐chain acyl-coenzyme A dehydrogenase (VLCAD) deficiency is an inborn mitochondrial fatty‐acid β‐oxidation (FAO) defect associated with a broad mutational spectrum, with phenotypes ranging from fatal cardiopathy in infancy to adolescent‐onset myopathy, and for which there is no established...

Chronic daily headaches

Directory of Open Access Journals (Sweden)

Fayyaz Ahmed

2012-01-01

Full Text Available Chronic Daily Headache is a descriptive term that includes disorders with headaches on more days than not and affects 4% of the general population. The condition has a debilitating effect on individuals and society through direct cost to healthcare and indirectly to the economy in general. To successfully manage chronic daily headache syndromes it is important to exclude secondary causes with comprehensive history and relevant investigations; identify risk factors that predict its development and recognise its sub-types to appropriately manage the condition. Chronic migraine, chronic tension-type headache, new daily persistent headache and medication overuse headache accounts for the vast majority of chronic daily headaches. The scope of this article is to review the primary headache disorders. Secondary headaches are not discussed except medication overuse headache that often accompanies primary headache disorders. The article critically reviews the literature on the current understanding of daily headache disorders focusing in particular on recent developments in the treatment of frequent headaches.

Chronic Obstructive Pulmonary Disease (COPD) Includes: Chronic Bronchitis and Emphysema

Science.gov (United States)

... Submit Button NCHS Home Chronic Obstructive Pulmonary Disease (COPD) Includes: Chronic Bronchitis and Emphysema Recommend on Facebook ... Percent of visits to office-based physicians with COPD indicated on the medical record: 3.2% Source: ...

Chronic pancreatitis.

Science.gov (United States)

Kleeff, Jorg; Whitcomb, David C; Shimosegawa, Tooru; Esposito, Irene; Lerch, Markus M; Gress, Thomas; Mayerle, Julia; Drewes, Asbjørn Mohr; Rebours, Vinciane; Akisik, Fatih; Muñoz, J Enrique Domínguez; Neoptolemos, John P

2017-09-07

Chronic pancreatitis is defined as a pathological fibro-inflammatory syndrome of the pancreas in individuals with genetic, environmental and/or other risk factors who develop persistent pathological responses to parenchymal injury or stress. Potential causes can include toxic factors (such as alcohol or smoking), metabolic abnormalities, idiopathic mechanisms, genetics, autoimmune responses and obstructive mechanisms. The pathophysiology of chronic pancreatitis is fairly complex and includes acinar cell injury, acinar stress responses, duct dysfunction, persistent or altered inflammation, and/or neuro-immune crosstalk, but these mechanisms are not completely understood. Chronic pancreatitis is characterized by ongoing inflammation of the pancreas that results in progressive loss of the endocrine and exocrine compartment owing to atrophy and/or replacement with fibrotic tissue. Functional consequences include recurrent or constant abdominal pain, diabetes mellitus (endocrine insufficiency) and maldigestion (exocrine insufficiency). Diagnosing early-stage chronic pancreatitis is challenging as changes are subtle, ill-defined and overlap those of other disorders. Later stages are characterized by variable fibrosis and calcification of the pancreatic parenchyma; dilatation, distortion and stricturing of the pancreatic ducts; pseudocysts; intrapancreatic bile duct stricturing; narrowing of the duodenum; and superior mesenteric, portal and/or splenic vein thrombosis. Treatment options comprise medical, radiological, endoscopic and surgical interventions, but evidence-based approaches are limited. This Primer highlights the major progress that has been made in understanding the pathophysiology, presentation, prevalence and management of chronic pancreatitis and its complications.

Chronic Diseases Overview

Science.gov (United States)

... Plan Templates All Chronic Surveillance Systems Communications Center Social Media Press Room Press Release Archives Multimedia Communication Campaigns Publications Chronic Disease Overview 2016–2017 At A ...

Chronic lymphocytic leukemia (CLL)

Science.gov (United States)

... is used for painful and enlarged lymph nodes. Blood transfusions or platelet transfusions may be required if blood ... unexplained fatigue, bruising, excessive sweating, or weight loss. Alternative ... Leukemia - chronic lymphocytic (CLL); Blood cancer - chronic lymphocytic leukemia; Bone marrow cancer - chronic ...

Chronic subdural hematoma

Science.gov (United States)

Subdural hemorrhage - chronic; Subdural hematoma - chronic; Subdural hygroma ... A subdural hematoma develops when bridging veins tear and leak blood. These are the tiny veins that run between the ...

Plasma cytokine expression is associated with cardiac morbidity in chagas disease.

Directory of Open Access Journals (Sweden)

Giovane Rodrigo Sousa

Full Text Available The expression of immune response appears to be associated with morbidity in Chagas disease. However, the studies in this field have usually employed small samples of patients and statistical analyses that do not consider the wide dispersion of cytokine production observed in these patients. The aim of this study was to evaluate the plasma cytokine levels in well-defined clinical polar groups of chagasic patients divided into categories that better reflect the wide cytokine profile and its relationship with morbidity. Patients infected with Trypanosoma cruzi (T. cruzi were grouped as indeterminate (IND and cardiac (CARD forms ranging from 23 to 69 years of age (mean of 45.6±11.25. The IND group included 82 individuals, ranging from 24 to 66 years of age (mean of 39.6±10.3. The CARD group included 94 patients ranging from 23 to 69 years of age (mean of 48±12.52 presenting dilated cardiomyopathy. None of the patients have undergone chemotherapeutic treatment, nor had been previously treated for T. cruzi infection. Healthy non-chagasic individuals, ranging from 29 to 55 years of age (mean of 42.6±8.8 were included as a control group (NI. IND patients have a higher intensity of interleukin 10 (IL-10 expression when compared with individuals in the other groups. By contrast, inflammatory cytokine expression, such as interferon gamma (IFN-γ, tumor necrosis factor alpha (TNF-α, interleukin 6 (IL-6, and interleukin 1 beta (IL-1β, proved to be the highest in the CARD group. Correlation analysis showed that higher IL-10 expression was associated with better cardiac function, as determined by left ventricular ejection fraction and left ventricular diastolic diameter values. Altogether, these findings reinforce the concept that a fine balance between regulatory and inflammatory cytokines represents a key element in the establishment of distinct forms of chronic Chagas disease.

Alfuzosin and Symptoms of Chronic Prostatitis–Chronic Pelvic Pain Syndrome

Science.gov (United States)

Nickel, J. Curtis; Krieger, John N.; McNaughton-Collins, Mary; Anderson, Rodney U.; Pontari, Michel; Shoskes, Daniel A.; Litwin, Mark S.; Alexander, Richard B.; White, Paige C.; Berger, Richard; Nadler, Robert; O'Leary, Michael; Liong, Men Long; Zeitlin, Scott; Chuai, Shannon; Landis, J. Richard; Kusek, John W.; Nyberg, Leroy M.; Schaeffer, Anthony J.

2009-01-01

Background In men with chronic prostatitis–chronic pelvic pain syndrome, treatment with alpha-adrenergic receptor blockers early in the course of the disorder has been reported to be effective in some, but not all, relatively small randomized trials. Methods We conducted a multicenter, randomized, double-blind, placebo-controlled trial to evaluate the efficacy of alfuzosin, an alpha-adrenergic receptor blocker, in reducing symptoms in men with chronic prostatitis–chronic pelvic pain syndrome. Participation in the study required diagnosis of the condition within the preceding 2 years and no previous treatment with an alpha-adrenergic receptor blocker. Men were randomly assigned to treatment for 12 weeks with either 10 mg of alfuzosin per day or placebo. The primary outcome was a reduction of at least 4 points (from baseline to 12 weeks) in the score on the National Institutes of Health Chronic Prostatitis Symptom Index (NIH-CPSI) (range, 0 to 43; higher scores indicate more severe symptoms). A 4-point decrease is the minimal clinically significant difference in the score. Results A total of 272 eligible participants underwent randomization, and in both study groups, 49.3% of participants had a decrease of at least 4 points in their total NIH-CPSI score (rate difference associated with alfuzosin, 0.1%; 95% confidence interval, −11.2 to 11.0; P = 0.99). In addition, a global response assessment showed similar response rates at 12 weeks: 33.6% in the placebo group and 34.8% in the alfuzosin group (P = 0.90). The rates of adverse events in the two groups were also similar. Conclusions Our findings do not support the use of alfuzosin to reduce the symptoms of chronic prostatitis–chronic pelvic pain syndrome in men who have not received prior treatment with an alpha-blocker. PMID:19092152

SERUM IRON PARAMETERS IN ALCOHOLIC CIRRHOSIS, CRYPTOGENIC CIRRHOSIS, CHRONIC HEPATITIS B AND CHRONIC HEPATITIS C

Directory of Open Access Journals (Sweden)

Sajeevan K. C

2016-11-01

Full Text Available BACKGROUND Regular monitoring of serum iron parameters is helpful for assessing the severity of alcoholic liver disease. Assessment of serum iron parameters are used for screening hereditary haemochromatosis in chronic liver disease. Serum iron parameters in chronic liver disease have not been clearly described in most of the studies. The aim of this study was to assess the serum iron, Total Iron Binding Capacity (TIBC, transferrin saturation and ferritin levels in common chronic liver disease like alcoholic cirrhosis, cryptogenic cirrhosis, chronic hepatitis C and chronic hepatitis B. MATERIALS AND METHODS 110 consecutive patients with chronic liver disease admitted to the Gastroenterology Department, Government Medical College, Kozhikode were selected for the study. The categories of chronic liver disease included in our study were alcoholic cirrhosis (Group I, n = 40, cryptogenic cirrhosis (Group II, n = 30, chronic hepatitis C (Group III, n = 20 and chronic hepatitis B (Group IV, n = 20. Serum iron, ferritin, total iron binding capacity and transferrin saturation were estimated in the fasting sample. Statistical Analysis- Analysis was performed using nonparametric Kruskal-Wallis and Bonferroni test to assess statistical significance of difference of continuous variables among and between groups, respectively. The results were considered statistically significant at the level of p <0.05. RESULTS The serum iron level was normal and total iron binding capacity was low in all the four groups of chronic liver disease. Serum ferritin and transferrin saturation were significantly higher in alcoholic cirrhosis in comparison with cryptogenic cirrhosis and chronic hepatitis B, but was not statistically significant in comparison with chronic hepatitis C. CONCLUSION We observed irregularities in iron status in patients with alcoholic cirrhosis, cryptogenic cirrhosis, chronic hepatitis C and chronic hepatitis B.

Chronic tophaceous gout

Directory of Open Access Journals (Sweden)

Thappa D

1993-01-01

Full Text Available A rare case of chronic tophaceous gout, in a 27-year-old female on diuretics for chronic congestive cardiac failure with characteristic histopathological and radiological changes is reported.

Heredity of chronic bronchitis

DEFF Research Database (Denmark)

Meteran, Howraman; Backer, Vibeke; Kyvik, Kirsten Ohm

2014-01-01

BACKGROUND: Smoking is a major risk factor for lung diseases and lower respiratory symptoms, but since not all smokers develop chronic bronchitis and since chronic bronchitis is also diagnosed in never-smokers, it has been suggested that some individuals are more susceptible to develop chronic br...

Transesofagic echocardiography in the study of patient with cerebrovascular events in who origin cardiovascular embolic is suspected

International Nuclear Information System (INIS)

Escobar Q, Carlos I; Jaramillo U, Mario; Tenorio, Luis F; Molina V, Claudia; Saldarriaga A, Marcela; Arango, Angela M

2003-01-01

Cerebrovascular events have an enormous social and economic impact. Twenty percent are of cardiac embolic origin and thirty five percent are of unknown cause or cryptogenic. In the cryptogenic group some echocardiographic findings could explain a cardiovascular origin. Echocardiography helps to study 55% of patients with cerebrovascular accidents. We present our experience during ten years since December 1992 to May 2002 in the Santa Maria cardiovascular clinic with 866 patients, 416 women and 450 men, mean age of 62:1:15 years. The five most frequent diagnoses were: aortic atheromatosis (34%), dilated cardiopathy (8.2%), ischemic cardiopathy (8.2%), left atrial spontaneous contrast (8%), patent foramen ovale (7.7%) and atrial septal aneurysm (4.5%). thirty percent of this population had a normal study. echocardiography helped to guide most of the patient's treatment. there was one esophagus rupture and fifteen minor oropharinx hemorrhages. Trans esophageal echocardiography is a very useful diagnostic method in this patient's study

Hereditary chronic pancreatitis

Directory of Open Access Journals (Sweden)

Mössner Joachim

2007-01-01

Full Text Available Abstract Hereditary chronic pancreatitis (HCP is a very rare form of early onset chronic pancreatitis. With the exception of the young age at diagnosis and a slower progression, the clinical course, morphological features and laboratory findings of HCP do not differ from those of patients with alcoholic chronic pancreatitis. As well, diagnostic criteria and treatment of HCP resemble that of chronic pancreatitis of other causes. The clinical presentation is highly variable and includes chronic abdominal pain, impairment of endocrine and exocrine pancreatic function, nausea and vomiting, maldigestion, diabetes, pseudocysts, bile duct and duodenal obstruction, and rarely pancreatic cancer. Fortunately, most patients have a mild disease. Mutations in the PRSS1 gene, encoding cationic trypsinogen, play a causative role in chronic pancreatitis. It has been shown that the PRSS1 mutations increase autocatalytic conversion of trypsinogen to active trypsin, and thus probably cause premature, intrapancreatic trypsinogen activation disturbing the intrapancreatic balance of proteases and their inhibitors. Other genes, such as the anionic trypsinogen (PRSS2, the serine protease inhibitor, Kazal type 1 (SPINK1 and the cystic fibrosis transmembrane conductance regulator (CFTR have been found to be associated with chronic pancreatitis (idiopathic and hereditary as well. Genetic testing should only be performed in carefully selected patients by direct DNA sequencing and antenatal diagnosis should not be encouraged. Treatment focuses on enzyme and nutritional supplementation, pain management, pancreatic diabetes, and local organ complications, such as pseudocysts, bile duct or duodenal obstruction. The disease course and prognosis of patients with HCP is unpredictable. Pancreatic cancer risk is elevated. Therefore, HCP patients should strongly avoid environmental risk factors for pancreatic cancer.

Chronic gastritis - an update.

Science.gov (United States)

Varbanova, Mariya; Frauenschläger, Katrin; Malfertheiner, Peter

2014-12-01

Helicobacter pylori is the main aetiologic factor for chronic gastritis worldwide. The degree of inflammation and the evolution of this form of chronic gastritis can vary largely depending on bacterial virulence factors, host susceptibility factors and environmental conditions. Autoimmune gastritis is another cause of chronic inflammation in the stomach, which can occur in all age groups. This disease presents typically with vitamin B12 deficiency and pernicious anaemia. The presence of anti-parietal cell antibodies is highly specific for the diagnosis. The role of H. pylori as a trigger for autoimmune gastritis remains uncertain. Other rare conditions for chronic gastritis are chronic inflammatory conditions such as Crohn's disease or on the background of lymphocytic or collagenous gastroenteropathies. Copyright © 2014. Published by Elsevier Ltd.

The Chronic Illness Problem Inventory as a measure of dysfunction in chronic pain patients.

Science.gov (United States)

Romano, J M; Turner, J A; Jensen, M P

1992-04-01

Assessment of physical and psychosocial dysfunction is recognized as essential in chronic pain patient evaluation. One instrument, the Sickness Impact Profile (SIP), has demonstrated good reliability and validity as a measure of dysfunction among chronic pain patients. An alternate measure, the Chronic Illness Problem Inventory (CIPI), is shorter and more easily scored than the SIP, but as yet has not been applied widely to chronic pain problems. In the present study, 95 chronic low back pain patients completed the SIP, the CIPI, activity diaries, the McGill Pain Questionnaire (MPQ), and the Center for Epidemiologic Studies-Depression scale (CES-D), before participating in a chronic pain treatment study. Overt pain behaviors were also coded from videotapes of a standardized assessment protocol. Seventy-five subjects completed the measures post-treatment. The results indicate that although the SIP and the CIPI are significantly correlated and appear to be measuring similar constructs, there is also substantial unshared variance between them, suggesting that they may tap somewhat different aspects of dysfunction in chronic pain. The CIPI shows promise as a useful alternative measure of dysfunction in chronic low back pain patients, but requires further validation for this purpose.

Chronic bacterial prostatitis and chronic pelvic pain syndrome.

Science.gov (United States)

Bowen, Diana K; Dielubanza, Elodi; Schaeffer, Anthony J

2015-08-27

Chronic prostatitis can cause pain and urinary symptoms, and can occur either with an active infection (chronic bacterial prostatitis [CBP]) or with only pain and no evidence of bacterial causation (chronic pelvic pain syndrome [CPPS]). Bacterial prostatitis is characterised by recurrent urinary tract infections or infection in the prostate with the same bacterial strain, which often results from urinary tract instrumentation. However, the cause and natural history of CPPS are unknown and not associated with active infection. We conducted a systematic overview and aimed to answer the following clinical questions: What are the effects of treatments for chronic bacterial prostatitis? What are the effects of treatments for chronic pelvic pain syndrome? We searched: Medline, Embase, The Cochrane Library, and other important databases up to February 2014 (Clinical Evidence overviews are updated periodically; please check our website for the most up-to-date version of this overview). At this update, searching of electronic databases retrieved 131 studies. After deduplication and removal of conference abstracts, 67 records were screened for inclusion in the overview. Appraisal of titles and abstracts led to the exclusion of 51 studies and the further review of 16 full publications. Of the 16 full articles evaluated, three systematic reviews and one RCT were included at this update. We performed a GRADE evaluation for 14 PICO combinations. In this systematic overview, we categorised the efficacy for 12 interventions based on information relating to the effectiveness and safety of 5 alpha-reductase inhibitors, allopurinol, alpha-blockers, local injections of antimicrobial drugs, mepartricin, non-steroidal anti-inflammatory drugs (NSAIDs), oral antimicrobial drugs, pentosan polysulfate, quercetin, sitz baths, transurethral microwave thermotherapy (TUMT), and transurethral resection of the prostate (TURP).

Chronic mucus hypersecretion

DEFF Research Database (Denmark)

Ulrik, Charlotte Suppli; von Linstow, Marie-Louise; Nepper-Christensen, Steen

2005-01-01

To investigate if chronic mucus hypersecretion (CMH) can be used as a marker of asthma in young adults.......To investigate if chronic mucus hypersecretion (CMH) can be used as a marker of asthma in young adults....

Airway inflammation in nonobstructive and obstructive chronic bronchitis with chronic haemophilus influenzae airway infection. Comparison with noninfected patients with chronic obstructive pulmonary disease

NARCIS (Netherlands)

Bresser, P.; Out, T. A.; van Alphen, L.; Jansen, H. M.; Lutter, R.

2000-01-01

Nonencapsulated Haemophilus influenzae often causes chronic infections of the lower respiratory tract in both nonobstructive and obstructive chronic bronchitis. We assessed airway inflammation in clinically stable, chronically H. influenzae-infected patients with nonobstructive (CB-HI, n = 10) and

Chronic gastritis.

Science.gov (United States)

Sipponen, Pentti; Maaroos, Heidi-Ingrid

2015-06-01

Prevalence of chronic gastritis has markedly declined in developed populations during the past decades. However, chronic gastritis is still one of the most common serious pandemic infections with such severe killing sequelae as peptic ulcer or gastric cancer. Globally, on average, even more than half of people may have a chronic gastritis at present. Helicobacter pylori infection in childhood is the main cause of chronic gastritis, which microbial origin is the key for the understanding of the bizarre epidemiology and course of the disease. A life-long and aggressive inflammation in gastritis results in destruction (atrophic gastritis) of stomach mucosa with time (years and decades). The progressive worsening of atrophic gastritis results subsequently in dysfunctions of stomach mucosa. Atrophic gastritis will finally end up in a permanently acid-free stomach in the most extreme cases. Severe atrophic gastritis and acid-free stomach are the highest independent risk conditions for gastric cancer known so far. In addition to the risks of malignancy and peptic ulcer, acid-free stomach and severe forms of atrophic gastritis may associate with failures in absorption of essential vitamins, like vitamin B12, micronutrients (like iron, calcium, magnesium and zinc), diet and medicines.

Chronic Kidney Diseases

Science.gov (United States)

... Safe Videos for Educators Search English Español Chronic Kidney Diseases KidsHealth / For Kids / Chronic Kidney Diseases What's ... re talking about your kidneys. What Are the Kidneys? Your kidneys are tucked under your lower ribs ...

Chronic depression : Determinants and consequences of chronic major depression in the general population

NARCIS (Netherlands)

Spijker, Jan

2002-01-01

The subject of this thesis is chronicity of major depressive disorder (MDD). The main aims of the study are to examine: 1. the duration of a major depressive episode (MDE) and the rate of a chronic duration of MDE in the general population, 2. the determinants of (chronic) duration of

Surgical Management of Chronic Pancreatitis.

Science.gov (United States)

Parekh, Dilip; Natarajan, Sathima

2015-10-01

Advances over the past decade have indicated that a complex interplay between environmental factors, genetic predisposition, alcohol abuse, and smoking lead towards the development of chronic pancreatitis. Chronic pancreatitis is a complex disorder that causes significant and chronic incapacity in patients and a substantial burden on the society. Major advances have been made in the etiology and pathogenesis of this disease and the role of genetic predisposition is increasingly coming to the fore. Advances in noninvasive diagnostic modalities now allow for better diagnosis of chronic pancreatitis at an early stage of the disease. The impact of these advances on surgical treatment is beginning to emerge, for example, patients with certain genetic predispositions may be better treated with total pancreatectomy versus lesser procedures. Considerable controversy remains with respect to the surgical management of chronic pancreatitis. Modern understanding of the neurobiology of pain in chronic pancreatitis suggests that a window of opportunity exists for effective treatment of the intractable pain after which central sensitization can lead to an irreversible pain syndrome in patients with chronic pancreatitis. Effective surgical procedures exist for chronic pancreatitis; however, the timing of surgery is unclear. For optimal treatment of patients with chronic pancreatitis, close collaboration between a multidisciplinary team including gastroenterologists, surgeons, and pain management physicians is needed.

Clinicoroentgenological control in chronic pneumonia

International Nuclear Information System (INIS)

Mamilyaev, R.M.

1984-01-01

A comprehensive clinicoroentgenological study was used to examine 494 patients with chronic pneumonia. Morphological and functional changes observed in the pulmonary pare and functional changes observed in the pulmonary parenchyma and bronchial tree were studied. Types of pneumosclerosis, tigns of exacerbation of chronic pneumonia and abscess formation, morphological and functional disorders of bronchial penetrability in the pneumonic zone were described. Three forms of chronic pneumonia: bronchial, bronchiectatic and abscessing are signled out. The bronchial form is subdivided into chronic pneumonia with chronic bronchitis without deformity and wi.th deforming chronic bronchitis. In the bronchiectatic form pneumonia can be with cylindrical, saccular and cyst-like bronchiectasia. The general diagnosis of chronic pneumonia is established clinically depending on type and variants in 89-94% of cases, by X-ray and sonographic findings in all patients; types and variants of disease are most frequently defined after bronchography

Stages of Chronic Myelogenous Leukemia

Science.gov (United States)

... ALL Treatment Childhood AML Treatment Research Chronic Myelogenous Leukemia Treatment (PDQ®)–Patient Version General Information About Chronic Myelogenous Leukemia Go to Health Professional Version Key Points Chronic ...

Chagas disease in the State of Amazonas: history, epidemiological evolution, risks of endemicity and future perspectives

Directory of Open Access Journals (Sweden)

Maria das Graças Vale Barbosa

2015-06-01

Full Text Available Chagas disease (CD is a parasitic infection that originated in the Americas and is caused by Trypanosoma cruzi. In the last few years, the disease has spread to countries in North America, Asia and Europe due to the migration of Latin Americans. In the Brazilian Amazon, CD has an endemic transmission, especially in the Rio Negro region, where an occupational hazard was described for piaçaveiros (piassaba gatherers. In the State of Amazonas, the first chagasic infection was reported in 1977, and the first acute CD case was recorded in 1980. After initiatives to integrate acute CD diagnostics with the malaria laboratories network, reports of acute CD cases have increased. Most of these cases are associated with oral transmission by the consumption of contaminated food. Chronic cases have also been diagnosed, mostly in the indeterminate form. These cases were detected by serological surveys in cardiologic outpatient clinics and during blood donor screening. Considering that the control mechanisms adopted in Brazil's classic transmission areas are not fully applicable in the Amazon, it is important to understand the disease behavior in this region, both in the acute and chronic cases. Therefore, the pursuit of control measures for the Amazon region should be a priority given that CD represents a challenge to preserving the way of life of the Amazon's inhabitants.

Chronic neutrophilic leukemia.

Science.gov (United States)

Bredeweg, Arthur; Burch, Micah; Krause, John R

2018-01-01

Chronic neutrophilic leukemia is a rare myeloproliferative disorder characterized by a sustained peripheral blood neutrophilia, absence of the BCR/ABL oncoprotein, bone marrow hypercellularity with less than 5% myeloblasts and normal neutrophil maturation, and no dysplasia. This leukemia has been associated with mutations in the colony-stimulating factor 3 receptor (CSF3R) that may activate this receptor, leading to the proliferation of neutrophils that are the hallmark of chronic neutrophilic leukemia. We present a case of chronic neutrophilic leukemia and discuss the criteria for diagnosis and the significance of mutations found in this leukemia.

The burden of chronic pain

DEFF Research Database (Denmark)

Kurita, Geana Paula; Sjøgren, Per; Juel, Knud

2012-01-01

sample consisted of 25,000 individuals (≥16 years old) living in Denmark. In all, 60.7% completed a mailed or online questionnaire. Associations were examined with multiple logistic regression analysis. The study population consisted of 14,925 individuals in whom a high prevalence of chronic pain (26......Chronic pain is currently considered a public health problem with high costs to the individual and society. To improve prevention and treatment of chronic pain, epidemiologic studies are mandatory for assessing chronic pain. The aims of this study were to estimate the prevalence of chronic pain...

Are There Any Natural Remedies That Reduce Chronic Fatigue Associated with Chronic Fatigue Syndrome?

Science.gov (United States)

... natural remedies that reduce chronic fatigue associated with chronic fatigue syndrome? Answers from Brent A. Bauer, M.D. Researchers ... a variety of natural products for effectiveness against chronic fatigue syndrome. Most results have been disappointing. A few remedies — ...

PR Interval Prolongation and Cryptogenic Stroke: A Multicenter Retrospective Study.

Science.gov (United States)

Montalvo, Mayra; Tadi, Prasanna; Merkler, Alexander; Gialdini, Gino; Martin-Schild, Sheryl; Navalkele, Digvijaya; Samai, Alyana; Nouh, Amre; Hussain, Mohammad; Goldblatt, Steven; Hemendinger, Morgan; Chu, Antony; Song, Christopher; Kamel, Hooman; Furie, Karen L; Yaghi, Shadi

2017-10-01

Atrial dysfunction or "cardiopathy" has been recently proposed as a mechanism in cryptogenic stroke. A prolonged PR interval may reflect impaired atrial conduction and thus may be a biomarker of atrial cardiopathy. We aim to compare the prevalence of PR interval prolongation in patients with cryptogenic stroke (CS) when compared with known non-cryptogenic non-cardioembolic stroke (NCNCS) subtypes. We used prospective ischemic stroke databases of 3 comprehensive stroke centers to identify patients 18 years or older with a discharge diagnosis of ischemic non-cardioembolic stroke between December 1, 2013 and August 31, 2015. The main outcome was ischemic stroke subtype (CS versus NCNCS). We compared PR intervals as a continuous and categorical variable (PR interval prolongation and CS. We identified 644 patients with ischemic non-cardioembolic stroke (224 CS and 420 NCNCS). Patients with CS were more likely to have a PR of 200 milliseconds or greater when compared with those with NCNCS (23.2% versus 13.8%, P = .009). After adjusting for factors that were significant in univariate analyses, a PR of 200 milliseconds or greater was independently associated with CS (odds ratio [OR] 1.70, 95% CI 1.08-2.70). The association was more pronounced when excluding patients on atrioventricular nodal blocking agents (OR 2.64, 95% CI 1.44-4.83). A PR of 200 milliseconds or greater is associated with CS and may be a biomarker of atrial cardiopathy in the absence of atrial fibrillation. Prospective studies are needed to confirm this association. Copyright © 2017 National Stroke Association. Published by Elsevier Inc. All rights reserved.

Chronic thyroiditis (Hashimoto disease)

Science.gov (United States)

Hashimoto thyroiditis; Chronic lymphocytic thyroiditis; Autoimmune thyroiditis; Chronic autoimmune thyroiditis; Lymphadenoid goiter - Hashimoto; Hypothyroidism - Hashimoto; Type 2 polyglandular autoimmune ...

History of Chronic Subdural Hematoma

Science.gov (United States)

2015-01-01

Trephination or trepanation is an intentional surgical procedure performed from the Stone Age. It looks like escaping a black evil from the head. This technique is still used for treatment of chronic subdural hematoma (SDH). Now, we know the origin, pathogenesis and natural history of this lesion. The author try to explore the history of trephination and modern discovery of chronic SDH. The author performed a detailed electronic search of PubMed. By the key word of chronic SDH, 2,593 articles were found without language restriction in May 2015. The author reviewed the fact and way, discovering the present knowledge on the chronic SDH. The first authentic report of chronic SDH was that of Wepfer in 1657. Chronic SDH was regarded as a stroke in 17th century. It was changed as an inflammatory disease in 19th century by Virchow, and became a traumatic lesion in 20th century. However, trauma is not necessary in many cases of chronic SDHs. The more important prerequisite is sufficient potential subdural space, degeneration of the brain. Modifying Virchow's description, chronic SDH is sometimes traumatic, but most often caused by severe degeneration of the brain. From Wepfer's first description, nearly 350 years passed to explore the origin, pathogenesis, and fate of chronic SDH. The nature of the black evil in the head of the Stone Age is uncovering by many authors riding the giant's shoulder. Chronic SDH should be categorized as a degenerative lesion instead of a traumatic lesion. PMID:27169062

Abces cerebral associe a une cardiopathie congenitale cyanogene ...

African Journals Online (AJOL)

Case 1: This was a 3-year-old girl with a known Fallot tetralogy who was admitted for non-febrile intracranial hypertension syndrome, evolving for 2 months, associated with a functional impotence of the right hemicorp. The cerebral tomodensitometry had objectified a left hemispherical abscess. She had received a puncture ...

VDR activation and uremic cardiopathy: myths and paradoxes

Directory of Open Access Journals (Sweden)

Diego Brancaccio

2015-04-01

Full Text Available The role of vitamin D receptor (VDR activators for the control of secondary hyperparathyroidism has been clarified during the last few decades; however, their possible activity in conditioning cardiovascular comorbidity and mortality has become of interest more recently. On the basis of experimental studies showing that VDR activating therapy is associated with a reduction of cardiac hypertrophy, the PRIMO Study (an international randomized controlled trial [RCT] was carried out a few years ago, but the results were disappointing, as the group of uremic patients on dialysis treated for 48 weeks with paricalcitol showed no differences in comparison with controls in terms of regression of heart hypertrophy. The aim of this editorial is to analyze the possible reasons for such results, and to help understand the actual role of VDR activators in dialysis patients in controlling cardiovascular morbidity and mortality.

Case series

African Journals Online (AJOL)

abp

7 avr. 2016 ... Naima Bouznad1,&, Ghizlane El Mghari1, Nawal El Ansari1. 1Service ... des cas. L'HTA a été compliquée de cardiopathie dans 24% des cas et de néphropathie dans 20% des cas. ..... Maria Abad- Cardiel et al. ... 2004;27(3).

CARDIO-VASCULAR RISK FACTORS IN ELDERLY PATIENTS WITH DISEASES OF THE STOMATOGNATHIC SYSTEM

Directory of Open Access Journals (Sweden)

Botez C

2011-09-01

Full Text Available The association between dental and cardio-vascular diseases is essential as both are highly prevalent. Finding a possible causal relation between cardiovascular disease and chronic periodontal pathology, known to cause tooth loss, is therefore essential. The existence of some risk factors, such as smoking, bacterial infections, malnutrition and nutritional deficiencies, may explain the associations observed between cardio-vascular and oral pathologies. In the case of dental diseases, acceleration of atherosclerosis is supported by the role played by infections. The study – performed between 2008-2009 – analyzed 45 cases, selected from the patients hospitalized in the Medical Clinics of the Military Hospital of Ia[i. The patients included in the study suffered from arterial hypertension (HTA, cardiac insufficiency, ischemic cardiopathy, pectoral angina and subacute infectious endocarditis. All were subjected to a stomatological examination, for establishing their dental hygiene, the stomatological diseases they had had and the treatments performed. There are several ways in which infections of the oral cavity lead to cardiovascular disease. These include: transitory bacteriemia; inflammation and vascular lesions; diet and smoking.

EBV CHRONIC INFECTIONS

Directory of Open Access Journals (Sweden)

Eligio Pizzigallo

2010-08-01

Full Text Available The infection from Epstein-Barr virus (EBV or virus of infectious mononucleosis, together with other herpesviruses’ infections, represents a prototype of persistent viral infections characterized by the property of the latency. Although the reactivations of the latent infection are associated with the resumption of the viral replication and eventually with the “shedding”, it is still not clear if this virus can determine chronic infectious diseases, more or less evolutive. These diseases could include some pathological conditions actually defined as “idiopathic”and characterized by the “viral persistence” as the more credible pathogenetic factor. Among the so-called idiopathic syndromes, the “chronic fatigue syndrome” (CFS aroused a great interest around the eighties of the last century when, just for its relationship with EBV, it was called “chronic mononucleosis” or “chronic EBV infection”. Today CFS, as defined in 1994 by the CDC of Atlanta (USA, really represents a multifactorial syndrome characterized by a chronic course, where reactivation and remission phases alternate, and by a good prognosis. The etiopathogenetic role of EBV is demonstrated only in a well-examined subgroup of patients, while in most of the remaining cases this role should be played by other infectious agents - able to remain in a latent or persistent way in the host – or even by not infectious agents (toxic, neuroendocrine, methabolic, etc.. However, the pathogenetic substrate of the different etiologic forms seems to be the same, much probably represented by the oxidative damage due to the release of pro-inflammatory cytokines as a response to the triggering event (infectious or not infectious. Anyway, recently the scientists turned their’s attention to the genetic predisposition of the subjects affected by the syndrome, so that in the last years the genetic studies, together with those of molecular biology, received a great impulse

Defining and Measuring Chronic Conditions

Centers for Disease Control (CDC) Podcasts

2013-05-20

This podcast is an interview with Dr. Anand Parekh, U.S. Department of Health and Human Services Deputy Assistant Secretary for Health, and Dr. Samuel Posner, Preventing Chronic Disease Editor in Chief, about the definition and burden of multiple chronic conditions in the United States.  Created: 5/20/2013 by Preventing Chronic Disease (PCD), National Center for Chronic Disease Prevention and Health Promotion (NCCDPHP).   Date Released: 5/20/2013.

Testing for Chronic Diarrhea.

Science.gov (United States)

Raman, M

Chronic diarrhea is a frequently encountered symptom in clinical practice. The etiologies for chronic diarrhea are diverse and broad with varying clinical implications. A useful method of categorizing chronic diarrhea to guide a diagnostic work-up is a pathophysiology-based framework. Chronic diarrhea may be categorized as malabsorptive, secretory, osmotic, and inflammatory or motility related. Frequently, overlap between categories may exist for any given diarrhea etiology and diagnostic testing must occur with an understanding of the differential diagnosis. Investigations to achieve a diagnosis for chronic diarrhea range from screening blood and stool tests to more directed testing such as diagnostic imaging, and endoscopic and histological evaluation. The pathophysiology-based framework proposed in this chapter will allow the clinician to select screening tests followed by targeted tests to minimize cost and complications to the patient, while providing a highly effective method to achieve an accurate diagnosis. © 2017 Elsevier Inc. All rights reserved.

Anemia in Chronic Kidney Disease

Science.gov (United States)

... artérielle Heart Disease Mineral & Bone Disorder Anemia in Chronic Kidney Disease What is anemia? Anemia is a condition in ... as they should. How is anemia related to chronic kidney disease? Anemia commonly occurs in people with chronic kidney ...

Lifestyle and Risk of Chronic Prostatitis/Chronic Pelvic Pain Syndrome in a Cohort of United States Male Health Professionals.

Science.gov (United States)

Zhang, Ran; Sutcliffe, Siobhan; Giovannucci, Edward; Willett, Walter C; Platz, Elizabeth A; Rosner, Bernard A; Dimitrakoff, Jordan D; Wu, Kana

2015-11-01

Although chronic prostatitis/chronic pelvic pain syndrome is a prevalent urological disorder among men of all ages, its etiology remains unknown. Only a few previous studies have examined associations between lifestyle factors and chronic prostatitis/chronic pelvic pain syndrome, of which most were limited by the cross-sectional study design and lack of control for possible confounders. To address these limitations we performed a cohort study of major lifestyle factors (obesity, smoking and hypertension) and chronic prostatitis/chronic pelvic pain syndrome risk in the HPFS (Health Professionals Follow-up Study), a large ongoing cohort of United States based male health professionals. The HPFS includes 51,529 men who were 40 to 75 years old at baseline in 1986. At enrollment and every 2 years thereafter participants have completed questionnaires on lifestyle and health conditions. In 2008 participants completed an additional set of questions on recent chronic prostatitis/chronic pelvic pain syndrome pain symptoms modified from the NIH (National Institutes of Health)-CPSI (Chronic Prostatitis Symptom Index) as well as questions on approximate date of symptom onset. The 653 participants with NIH-CPSI pain scores 8 or greater who first experienced symptoms after 1986 were considered incident chronic prostatitis/chronic pelvic pain syndrome cases and the 19,138 who completed chronic prostatitis/chronic pelvic pain syndrome questions but did not report chronic prostatitis/chronic pelvic pain syndrome related pain were considered noncases. No associations were observed for baseline body mass index, waist circumference, waist-to-hip ratio, cigarette smoking and hypertension with chronic prostatitis/chronic pelvic pain syndrome risk (each OR ≤1.34). In this large cohort study none of the lifestyle factors examined was associated with chronic prostatitis/chronic pelvic pain syndrome risk. As the etiology of chronic prostatitis/chronic pelvic pain syndrome remains unknown

Chronic hypersensitivity pneumonitis.

Science.gov (United States)

Pereira, Carlos Ac; Gimenez, Andréa; Kuranishi, Lilian; Storrer, Karin

2016-01-01

Hypersensitivity pneumonitis (HSP) is a common interstitial lung disease resulting from inhalation of a large variety of antigens by susceptible individuals. The disease is best classified as acute and chronic. Chronic HSP can be fibrosing or not. Fibrotic HSP has a large differential diagnosis and has a worse prognosis. The most common etiologies for HSP are reviewed. Diagnostic criteria are proposed for both chronic forms based on exposure, lung auscultation, lung function tests, HRCT findings, bronchoalveolar lavage, and biopsies. Treatment options are limited, but lung transplantation results in greater survival in comparison to idiopathic pulmonary fibrosis. Randomized trials with new antifibrotic agents are necessary.

Chronic Pain: How Challenging Are DDIs in the Analgesic Treatment of Inpatients with Multiple Chronic Conditions?

Science.gov (United States)

Siebenhuener, Klarissa; Eschmann, Emmanuel; Kienast, Alexander; Schneider, Dominik; Minder, Christoph E.; Saller, Reinhard; Zimmerli, Lukas; Blaser, Jürg; Battegay, Edouard

2017-01-01

Background Chronic pain is common in multimorbid patients. However, little is known about the implications of chronic pain and analgesic treatment on multimorbid patients. This study aimed to assess chronic pain therapy with regard to the interaction potential in a sample of inpatients with multiple chronic conditions. Methods and Findings We conducted a retrospective study with all multimorbid inpatients aged ≥18 years admitted to the Department of Internal Medicine of University Hospital Zurich in 2011 (n = 1,039 patients). Data were extracted from the electronic health records and reviewed. We identified 433 hospitalizations of patients with chronic pain and analyzed their combinations of chronic conditions (multimorbidity). We then classified all analgesic prescriptions according to the World Health Organization (WHO) analgesic ladder. Furthermore, we used a Swiss drug-drug interactions knowledge base to identify potential interactions between opioids and other drug classes, in particular coanalgesics and other concomitant drugs. Chronic pain was present in 38% of patients with multimorbidity. On average, patients with chronic pain were aged 65.7 years and had a mean number of 6.6 diagnoses. Hypertension was the most common chronic condition. Chronic back pain was the most common painful condition. Almost 90% of patients were exposed to polypharmacotherapy. Of the chronic pain patients, 71.1% received opioids for moderate to severe pain, 43.4% received coanalgesics. We identified 3,186 potential drug-drug interactions, with 17% classified between analgesics (without coanalgesics). Conclusions Analgesic drugs-related DDIs, in particular opioids, in multimorbid patients are often complex and difficult to assess by using DDI knowledge bases alone. Drug-multimorbidity interactions are not sufficiently investigated and understood. Today, the scientific literature is scarce for chronic pain in combination with multiple coexisting medical conditions and medication

Diagnosis and management of chronic pancreatitis

OpenAIRE

Gupta, V; Toskes, P

2005-01-01

Chronic pancreatitis represents a condition that is challenging for clinicians secondary to the difficulty in making an accurate diagnosis and the less than satisfactory means of managing chronic pain. This review emphasises the various manifestations that patients with chronic pancreatitis may have and describes recent advances in medical and surgical therapy. It is probable that many patients with chronic abdominal pain are suffering from chronic pancreatitis that is not appreciated. As the...

Pregnancy follow-up in a patient with mechanical valve: possible in ...

African Journals Online (AJOL)

Pregnancy follow-up in a patient with mechanical valve: possible in sub-Saharan Africa? ... Background: In Africa in general and in Cameroon in particular, post rheumatic cardiopathies are a health care problem, one of the causes of infertility in the women population and a major cause of death among children and adults.

Cellular immune response from Chagasic patients to CRA or FRA recombinant antigens of Trypanosoma cruzi.

Science.gov (United States)

Lorena, Virginia M B; Verçosa, Alinne F A; Machado, Raquel C A; Moitinho-Silva, Lucas; Cavalcanti, Maria G A; Silva, Edimilson D; Ferreira, Antonio G P; Correa-Oliveira, Rodrigo; Pereira, Valéria R A; Gomes, Yara M

2008-01-01

We propose to analyze the relation between the cellular immune response of Chagas' disease patients after in vitro stimulation of peripheral blood mononuclear cells (PBMC) with recombinant antigens cytoplasmatic repetitive antigen (CRA) or flagellar repetitive antigen (FRA) of T. cruzi and the chronic clinical forms of disease. Cells were stimulated using phytohemagglutinin, CRA, FRA, or a soluble antigen of Epimastigota (Ag-Epi) for 24 hr, 72 hr, or 6 days. The proliferation of cells was evaluated after 6 days of culture by quantification of incorporated 3H-thymidine. Cytokines were measured in the supernatants obtained after 24 hr (tumor necrosis factor [TNF]-alpha and interleukin [IL]-4), 72 hr (IL-10), and 6 days (interferon [IFN]-gamma) using enzyme-linked immunosorbent assay (ELISA). Cells of the Chagas patients stimulated with the recombinant antigens exhibited higher proliferation responses compared with that of non-Chagas (NC) individuals. However, when proliferation was compared between patients with the cardiac form (CF) or indeterminate form (IF), it was not possible to establish a difference in the response. So far as the cytokines secreted in the culture supernatants after stimulation in vitro with T. cruzi antigens were concerned, the results showed that CRA, as well as Epi-Ag, were able to stimulate the production of TNF-alpha and IFN-gamma in Chagas patients as compared with NC individuals. However, the cytokine levels after stimulation with the T. cruzi antigens were not different between the patients with CF and IF. CRA was capable of inducing a T helper type 1 (Th1) immune response, with elevated production of TNF-alpha and IFN-gamma in Chagas patients that are carriers of CF and IF clinical forms. (Copyright ) 2008 Wiley-Liss, Inc.

[Chronic diarrhea: etiologies and diagnostic evaluation].

Science.gov (United States)

Schoepfer, A

2008-04-30

Chronic diarrhea is defined as a decrease in fecal consistency lasting for four or more weeks. A myriad of disorders are associated with chronic diarrhea. In developed countries, chronic diarrhea is mostly caused by non-infectious diseases. There are four pathogenic mechanisms leading to chronic diarrhea: osmotic diarrhea, secretory diarrhea, inflammatory diarrhea, and dysmotility. Overlaps between these mechanisms are possible. A 72-hour fecal collection as well as the fasting test are important diagnostic tools to identify the underlying pathomechanism. The identification of the pathomechanism narrows down the possible etiologies of chronic diarrhea and allows therefore a cost-saving diagnostic workup. The endoscopy is well established in the workup of chronic diarrhea. This article gives an overview about the main causes and mechanisms leading to chronic diarrhea and proposes an algorithm for the diagnostic evalution.

CHRONIC UNEXPLAINED OROFACIAL PAIN

Directory of Open Access Journals (Sweden)

Aleš Vesnaver

2002-04-01

Full Text Available Background. Chronic unexplained orofacial pain is frequently the cause of prolonged suffering for the patient and an unsolvable problem for the therapist. Pathophysiology of the onset of this type of pain is virtually unknown. Still, it is possible to divide chronic orofacial pain into several separate categories, according to its onset, symptoms and therapy. All forms of this type of pain have a strong psychological component.Methods. A retrograde review was conducted, in which patients’ records, treated in 1994 for chronic unexplained orofacial pain, were followed through a 5 year period. The modalities of treatment then and at present were compared.Conclusions. Except for trigeminal neuralgia, where carbamazepine remains the first choice drug, treatment of chronic facial pain has changed considerably.

Battling Chronic Absenteeism

Science.gov (United States)

Nauer, Kim

2016-01-01

While the principal of a New York elementary school (P.S. 48) took on chronic absenteeism from 2011 to 2013, a research team at the Center for New York City Affairs followed her efforts. The school drove down chronic absenteeism almost 10 percentage points. School staff routinely touched base with students, outside "success mentors"…

Chronic Pain, Chronic Opioid Addiction: a Complex Nexus.

Science.gov (United States)

Salsitz, Edwin A

2016-03-01

Over the past two decades, there has been a significant increase in the prescribing of opioids, with associated increases in opioid addiction and overdose deaths. This article reviews the evidence for the effectiveness and risk of developing an opioid use disorder (OUD) in those patients treated with chronic opioid therapy (COT) for chronic non-cancer pain (CNCP). Rates of development of OUD range from 0-50 %, and aberrant drug related behaviors (ADRBs) are reported to be 20 %. Health care providers must properly assess, screen, and carefully monitor patients on COT utilizing evidence-based tools.

Clinical management of chronic TMD pain.

Science.gov (United States)

Miller, D B

1998-01-01

Chronic Pain extracts a "penalty" on society now estimated to be well in excess of $100 million per year. The "penalty" that Chronic Pain extracts from its victims is incalculable. Chronic Pain is a major component of Temporomandibular Disorders. The current neurological theory of the mechanism of chronic TMD pain is explored along with the current modes of treatment. Pharmacological management of Chronic Pain in a clinical setting is outlined. Dentists are involved in pain management on a daily basis. Dentists treat pain both prophylacticly and in response to specific patient symptoms. Most dental treatment involves some type of pain management. We, dentists, have become very adept at managing acute pain. We have much greater difficulty managing chronic pain. The word "pain" derives from the Greek word for penalty, and appeared to them to be a "penalty" inflicted by the gods. In 1984, Bonica estimated that one-third of all Americans suffered from some kind of chronic pain at a "penalty" to society of $65 Billion annually in medical expenses and lost wages and productivity. This figure is certainly much greater now. Chronic pain can be a very complex problem that can require a multidisciplinary approach to treatment. Chronic pain in the dental setting is most frequetly caused by prolonged Temporomandibular Disorders.

Occurrence of chronic lymphocytic leukemia in patients with chronic myelogenous leukemia

Directory of Open Access Journals (Sweden)

Pritish K Bhattacharyya

2013-01-01

Full Text Available Chronic lymphocytic leukemia (CLL is the most common leukemia of adults in the western world and constitutes about 33% of all leukemia′s. The incidence of CLL increases with age and are more common in older population. Chronic myeloid leukemia (CML on the contrary occurs in both young adults and elderly and is a chronic myeloproliferative disease that originates from abnormal pluripotent stem cells and results in involvement of multiple hematopoietic lineages, but predominantly myeloid and less commonly lymphoid. Association between CLL and myeloid malignancies (CML, acute myeloid leukemia and MDS, myelodysplastic syndrome is rare. In literature documenting CLL and CML in same patients, occur either simultaneously or CML is preceded by CLL.

Treatment Option Overview (Chronic Myelogenous Leukemia)

Science.gov (United States)

... ALL Treatment Childhood AML Treatment Research Chronic Myelogenous Leukemia Treatment (PDQ®)–Patient Version General Information About Chronic Myelogenous Leukemia Go to Health Professional Version Key Points Chronic ...

General Information about Chronic Myelogenous Leukemia

Science.gov (United States)

... ALL Treatment Childhood AML Treatment Research Chronic Myelogenous Leukemia Treatment (PDQ®)–Patient Version General Information About Chronic Myelogenous Leukemia Go to Health Professional Version Key Points Chronic ...

Case report

African Journals Online (AJOL)

abp

Sténose pylorique, ulcère gastro-duodénal. Anastomoses intestinales, grêle court, court-circuit jéjuno-iléal. Entéropathie diabétique. Maladie cœliaque. Maladie de Hirschsprung. Autres. Gestes invasifs. Colonoscopie. Médicaments. AINS, corticoïdes, ciclosporine, neuroleptiques. BPCO, asthme et Cardiopathies. Toxiques.

Chronic Recurrent Multifocal Osteomyelitis

African Journals Online (AJOL)

Administrator

OBJECTIVE: To present a case and review the literature on chronic ... Successful treatment is difficult to achieve, though some ... named the syndrome “subacute and chronic ... An assessment of acute ... scans can cause a significant radiation.

Neurodegenerative properties of chronic pain: cognitive decline in patients with chronic pancreatitis.

Directory of Open Access Journals (Sweden)

Marijtje L A Jongsma

Full Text Available Chronic pain has been associated with impaired cognitive function. We examined cognitive performance in patients with severe chronic pancreatitis pain. We explored the following factors for their contribution to observed cognitive deficits: pain duration, comorbidity (depression, sleep disturbance, use of opioids, and premorbid alcohol abuse. The cognitive profiles of 16 patients with severe pain due to chronic pancreatitis were determined using an extensive neuropsychological test battery. Data from three cognitive domains (psychomotor performance, memory, executive functions were compared to data from healthy controls matched for age, gender and education. Multivariate multilevel analysis of the data showed decreased test scores in patients with chronic pancreatitis pain in different cognitive domains. Psychomotor performance and executive functions showed the most prominent decline. Interestingly, pain duration appeared to be the strongest predictor for observed cognitive decline. Depressive symptoms, sleep disturbance, opioid use and history of alcohol abuse provided additional explanations for the observed cognitive decline in some of the tests, but to a lesser extent than pain duration. The negative effect of pain duration on cognitive performance is compatible with the theory of neurodegenerative properties of chronic pain. Therefore, early and effective therapeutic interventions might reduce or prevent decline in cognitive performance, thereby improving outcomes and quality of life in these patients.

[Chronic diarrhea].

Science.gov (United States)

Stelzer, Teresa; Heuss, Ludwig Theodor

2014-09-01

Defined by lasting more than four weeks - is a common but often challenging clinical scenario. It is important to be aware that diarrhoea means different things to different patients. The evaluation of chronic diarrhoea depends on taking an excellent history and careful physical examination as well as planning investigations thoughtfully. Functional diarrhea ist the most common cause of chronic diarrhea in the developed countries and motility disorders are more common than inflammatory, osmotic or secretory causes. In some cases categorizing patients by their stool characteristics can be helpful in directing further evaluation.

[Medical transportation of Congolese children by the Foundation "Terre des hommes" Netherlands (1989--1998)].

Science.gov (United States)

Cardorelle, A Mbika; Okoko, A R; Perez, A Cosio; Moyen, G

2004-01-01

We report the 10 year assessment of collaboration with the Foundation "Terre des hommes" concerning the medical transfer in the Netherlands of 41 children carrying pathologies which couldn't be treated or operated on in Brazzaville. The average age was 3 years and 6 months old (extremes: 2 months - 15 years). 33 non-cyanotic cardiopathies dominated by ventricular septal defect (VSD) (n = 10) and 11 cyanotic cardiopathies among them the tetralogy of Fallot (n = 5) were admitted. The other pathologies were respectively: osseous (n = 3), vesical (n = 2), pulmonary tumoral, ophthalmic in 1 case. The surgery consisted in a complete repair in 19 cases, palliative in 9 cases. Two children proved to be inoperable. Eight other extra-cardiac pathologies had a specific surgery for each case. The average stay in the Netherlands was 1 month 13 days (extremes: 1 - 12 months). The evolution was favourable for 35 children all pathologies included. Four deaths occurred in the Netherlands and 2 in Congo. The organization of the technology transfer would be probably a better choice in the future.

Hostility and Anger in Chronic Pain

Directory of Open Access Journals (Sweden)

Sara Oliveira

2013-11-01

Full Text Available Introduction: The affective component of pain incorporates various emotions, primarily negative in quality. A great emphasis has been traditionally given to the role of depression and anxiety in chronic pain. More recently, the focus has been directed towards hostility and anger, as fundamental components of the emotional experience of chronic pain. Objective: The aim of this article is to present a literature’s review about the association between chronic pain, anger and hostility. Discussion: Patients with several chronic disorders are characterized by high levels of trait anger and hostility. On the other hand, the manner in which angry feelings are typically handled (anger management style, especially the marked tendency to suppress or express angry feelings, is a particularly important determinant of the chronic pain severity. Conclusion: Hostility and anger are involved in the development, maintenance and treatment of chronic pain. Further research is needed to clarify its relationship with chronic pain and to evaluate the effects of anger management on treatment outcomes.

Hostility and Anger in Chronic Pain

Directory of Open Access Journals (Sweden)

Lúcia Ribeiro

2012-06-01

Full Text Available Introduction: The affective component of pain incorporates various emotions, primarily negative in quality. A great emphasis has been traditionally given to the role of depression and anxiety in chronic pain. More recently, the focus has been directed towards hostility and anger, as fundamental components of the emotional experience of chronic pain. Objective: The aim of this article is to present a literature’s review about the association between chronic pain, anger and hostility. Discussion: Patients with several chronic disorders are characterized by high levels of trait anger and hostility. On the other hand, the manner in which angry feelings are typically handled (anger management style, especially the marked tendency to suppress or express angry feelings, is a particularly important determinant of the chronic pain severity. Conclusion: Hostility and anger are involved in the development, maintenance and treatment of chronic pain. Further research is needed to clarify its relationship with chronic pain and to evaluate the effects of anger management on treatment outcomes.

Autoantibodies in chronic pancreatitis

DEFF Research Database (Denmark)

Rumessen, J J; Marner, B; Pedersen, N T

1985-01-01

In 60 consecutive patients clinically suspected of having chronic pancreatitis the serum concentration of the immunoglobulins (IgA, IgG, IgM), the IgG- and IgA-type non-organ-specific autoantibodies against nuclear material (ANA), smooth and striated muscle, mitochondria, basal membrane, and reti......In 60 consecutive patients clinically suspected of having chronic pancreatitis the serum concentration of the immunoglobulins (IgA, IgG, IgM), the IgG- and IgA-type non-organ-specific autoantibodies against nuclear material (ANA), smooth and striated muscle, mitochondria, basal membrane......, and reticulin, and the IgG- and IgA-type pancreas-specific antibodies against islet cells, acinus cells, and ductal cells (DA) were estimated blindly. In 23 of the patients chronic pancreatitis was verified, whereas chronic pancreatitis was rejected in 37 patients (control group). IgG and IgA were found...... in significantly higher concentrations in the patients with chronic pancreatitis than in the control group but within the normal range. ANA and DA occurred very frequently in both groups but with no statistical difference. Other autoantibodies only occurred sporadically. The findings of this study do not support...

Omacetaxine Mepesuccinate for Chronic Myeloid Leukemia.

Science.gov (United States)

Rosshandler, Yasmin; Shen, Ann Q; Cortes, Jorge; Khoury, Hanna Jean

2016-05-01

Omacetaxine mepesuccinate is approved by the Food and Drug Administration in the United States for the treatment of chronic myeloid leukemia in chronic or accelerated phase resistant to two or more tyrosine kinase inhibitors. This review summarizes the mode of action, pharmacokinetics, efficacy and safety of omacetaxine mepesuccinate. Omacetaxine mepesuccinate has activity in chronic myeloid leukemia, especially in the chronic phase, regardless of the presence of ABL1 kinase domain mutations. Omacetaxine mepesuccinate has distinct but manageable adverse events profile. Omacetaxine mepesuccinate is a treatment option for a subset of patients with refractory chronic myeloid leukemia.

Vacuum therapy for chronic wounds

Directory of Open Access Journals (Sweden)

Ekaterina Leonidovna Zaytseva

2012-09-01

Full Text Available Chronic wound in patients with diabetes mellitus (DM is one of the most urgent problems of modern diabetology and surgery. Numberof patients suffering from different types of chronic wounds follows increase in DM incidence. Vacuum therapy is a novel perspectivemethod of topical treatment for non-healing chronic wounds of various etiology. Current review addresses experimental and clinicalevidence for this method.

Chronic pelvic pain.

Science.gov (United States)

Stein, Sharon L

2013-12-01

Chronic pelvic pain is pain lasting longer than 6 months and is estimated to occur in 15% of women. Causes of pelvic pain include disorders of gynecologic, urologic, gastroenterologic, and musculoskeletal systems. The multidisciplinary nature of chronic pelvic pain may complicate diagnosis and treatment. Treatments vary by cause but may include medicinal, neuroablative, and surgical treatments. Copyright © 2013 Elsevier Inc. All rights reserved.

Neurovascular Unit in Chronic Pain

Directory of Open Access Journals (Sweden)

Beatrice Mihaela Radu

2013-01-01

Full Text Available Chronic pain is a debilitating condition with major socioeconomic impact, whose neurobiological basis is still not clear. An involvement of the neurovascular unit (NVU has been recently proposed. In particular, the blood-brain barrier (BBB and blood-spinal cord barrier (BSCB, two NVU key players, may be affected during the development of chronic pain; in particular, transient permeabilization of the barrier is suggested by several inflammatory- and nerve-injury-based pain models, and we argue that the clarification of molecular BBB/BSCB permeabilization events will shed new light in understanding chronic pain mechanisms. Possible biases in experiments supporting this theory and its translational potentials are discussed. Moving beyond an exclusive focus on the role of the endothelium, we propose that our understanding of the mechanisms subserving chronic pain will benefit from the extension of research efforts to the NVU as a whole. In this view, the available evidence on the interaction between analgesic drugs and the NVU is here reviewed. Chronic pain comorbidities, such as neuroinflammatory and neurodegenerative diseases, are also discussed in view of NVU changes, together with innovative pharmacological solutions targeting NVU components in chronic pain treatment.

Lutter contre l'obésité en Afrique du Sud à l'aide des politiques fiscales

International Development Research Centre (IDRC) Digital Library (Canada)

17 nov. 2016 ... En 2008, le fardeau total des maladies non transmissibles en Afrique du Sud était estimé à 40 %, et ne cessait de croître. L'obésité est un facteur de risque de plusieurs maladies non transmissibles, dont les cardiopathies, l'hypertension, le diabète et le cancer.

Case series

African Journals Online (AJOL)

ebutamanya

22 juin 2015 ... grossesse et l'accouchement chez la femme cardiaque constituent un haut risque materno-foetal dépendant du type, mais surtout du stade de la cardiopathie, nécessitant ... Concernant l'accouchement, quarante patientes (71,42%) étaient .... femmes ont des enfants à un âge plus tardif et qu'elles sont plus.

Treatment Strategies for Chronic Cases

Directory of Open Access Journals (Sweden)

Susan M Lord

2003-01-01

Full Text Available The treatment of chronic somatic pain, including pain referred to the head, neck, shoulder girdle and upper limb from somatic structures, is addressed. Levels of evidence for the various treatments that have been prescribed for chronic whiplash associated disorders are considered. The challenge to find a treatment strategy for chronic pain after whiplash that completely relieves the condition and prevents its sequelae is reviewed.

Common Questions About Chronic Prostatitis.

Science.gov (United States)

Holt, James D; Garrett, W Allan; McCurry, Tyler K; Teichman, Joel M H

2016-02-15

Chronic prostatitis is relatively common, with a lifetime prevalence of 1.8% to 8.2%. Risk factors include conditions that facilitate introduction of bacteria into the urethra and prostate (which also predispose the patient to urinary tract infections) and conditions that can lead to chronic neuropathic pain. Chronic prostatitis must be differentiated from other causes of chronic pelvic pain, such as interstitial cystitis/bladder pain syndrome and pelvic floor dysfunction; prostate and bladder cancers; benign prostatic hyperplasia; urolithiasis; and other causes of dysuria, urinary frequency, and nocturia. The National Institutes of Health divides prostatitis into four syndromes: acute bacterial prostatitis, chronic bacterial prostatitis (CBP), chronic nonbacterial prostatitis (CNP)/chronic pelvic pain syndrome (CPPS), and asymptomatic inflammatory prostatitis. CBP and CNP/CPPS both lead to pelvic pain and lower urinary tract symptoms. CBP presents as recurrent urinary tract infections with the same organism identified on repeated cultures; it responds to a prolonged course of an antibiotic that adequately penetrates the prostate, if the urine culture suggests sensitivity. If four to six weeks of antibiotic therapy is effective but symptoms recur, another course may be prescribed, perhaps in combination with alpha blockers or nonopioid analgesics. CNP/CPPS, accounting for more than 90% of chronic prostatitis cases, presents as prostatic pain lasting at least three months without consistent culture results. Weak evidence supports the use of alpha blockers, pain medications, and a four- to six-week course of antibiotics for the treatment of CNP/CPPS. Patients may also be referred to a psychologist experienced in managing chronic pain. Experts on this condition recommend a combination of treatments tailored to the patient's phenotypic presentation. Urology referral should be considered when appropriate treatment is ineffective. Additional treatments include pelvic

HIV/AIDS, chronic diseases and globalisation.

Science.gov (United States)

Colvin, Christopher J

2011-08-26

HIV/AIDS has always been one of the most thoroughly global of diseases. In the era of widely available anti-retroviral therapy (ART), it is also commonly recognised as a chronic disease that can be successfully managed on a long-term basis. This article examines the chronic character of the HIV/AIDS pandemic and highlights some of the changes we might expect to see at the global level as HIV is increasingly normalised as "just another chronic disease". The article also addresses the use of this language of chronicity to interpret the HIV/AIDS pandemic and calls into question some of the consequences of an uncritical acceptance of concepts of chronicity.

Clinical significance of changes of serum gastrin levels in patients with chronic eczema or chronic urticaria

International Nuclear Information System (INIS)

Zheng Xianghong; Jiang Xiaoling; Chen Wei; Wang Jinglin

2005-01-01

Objective: To study the clinical significance of changes of serum levels of gastrin in patients with chronic eczema or chronic urticaria. Methods: Serum gastrin levels were, 37 patients with chromic urticaria and 43 controls. Results: Serum gastrin levels in patients with chronic exzema (102.95 ± 27.33 ng/L) and patients with chronic urticaria (109.87 ± 33.64 ng/L) were both significantly higher than those in controls (61.72 ± 20.38 ng/L, both P<0.01). Difference between the levels in the two patients groups was not significant. Conclusion: The high gastrin levels in those patients might reflect the presence of helicobacter pylori infections; eradication of which might be helpful for treatment of these chronic dermatologic disorders. (authors)

Eosinophilic Chronic Rhinosinusitis in Japan

Directory of Open Access Journals (Sweden)

Junichi Ishitoya

Full Text Available ABSTRACT: Chronic rhinosinusitis is a heterogeneous disease. In Europe and the United States, it has recently been divided into two subgroups: chronic rhinosinusitis with nasal polyps (CRSwNP and chronic rhinosinusitis without nasal polyps (CRSsNP. The majority of CRSwNP cases have a strong tendency to recur after surgery and show eosinophil-dominant inflammation. However, this definition has proved difficult to apply in Japan and East Asia, because more than half of the CRSwNP cases do not exhibit eosinophil-dominant inflammation in these areas of the world. In Japan in the 1990s, refractory CRSwNP to the standard treatment was focused on in clinical studies and the term ''eosinophilic chronic rhinosinusitis'' (ECRS was introduced to identify this subgroup of chronic rhinosinusitis in 2001.ECRS is different from non-ECRS in terms of many clinical features: symptom appearance, occurrence site of nasal polyps, CT scan findings, the histology of nasal polyps, blood examination findings, clinical course after surgery, and co-morbid asthma, etc. In this review, we describe these clinical features and mention how to make a clinical diagnosis of ECRS as well as how to treat it. Finally, we discuss the pathophysiology of ECRS. The concept of ECRS in Japan would be applicable for CRSwNP in other countries including Europe and the United States. KEY WORDS: chronic rhinosinusitis, clinical feature, diagnosis, eosinophilic chronic rhinosinusitis, eosinophils

Physical therapist management of chronic prostatitis/chronic pelvic pain syndrome.

Science.gov (United States)

Van Alstyne, Linda S; Harrington, Kendra L; Haskvitz, Esther M

2010-12-01

Chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS) negatively affects quality of life and sexual function in men of all ages. Typical treatment with antibiotic and antimicrobial drugs often is not successful. The purpose of this case report is to describe a multimodal physical therapy intervention that included manual therapy techniques applied to the pelvic floor in 2 patients who were unsuccessfully treated with the biomedical model of prescription drug therapies. Two men, aged 45 years and 53 years and diagnosed with chronic prostatitis, were referred for physical therapy following unsuccessful pharmacological treatment. The patients were treated with manual therapy techniques applied to the pelvic floor and instructed in progressive muscle relaxation, flexibility exercises, and aerobic exercises. Changes in the patients' National Institutes of Health Chronic Prostatitis Symptom Index revealed differences between preintervention and postintervention scores reflecting decreased pain and improved quality of life. One patient improved from a score of 25 (total possible score = 43) before treatment to a score of 0 after treatment, and the other patient improved from a score of 29 to a score of 21. Manual therapy techniques applied to the pelvic floor and performed by a physical therapist specially trained in these techniques, along with progressive muscle relaxation, flexibility exercises, and aerobic exercises, appeared to be beneficial to both patients in reducing pain and improving sexual function.

A histopathologic analysis of chronic inflammatory infiltrate in patients of h. pylori associated chronic gastritis

International Nuclear Information System (INIS)

Khalid, H.; Zubair, A.; Malik, T.M.

2015-01-01

To determine the relationship between H. pylori density with severity of chronic inflammatory infiltrate. Study Design: A cross-sectional study. Place and Duration of Study: The study was carried out in the Department of Pathology (Histopathology), Army Medical College, National University of Sciences and Technology (NUST) Islamabad, from Nov 2011 to Nov 2012. Methodology: Gastric antral biopsies of H. pylori associated chronic gastritis were included in the study. Demographic characteristics and relevant clinical information were collected. First hundred biopsies of H. pylori associated chronic gastritis were assessed for density of H. pylori and chronic inflammatory infiltrate. istopathological features like lymphoid aggregates, ulcer slough, superficial epithelial damage, dysplasia and nuclear reactive changes were simply assessed in case of their presence or absence. Results: A significant moderate positive correlation was found between grades of H. pylori and chronic inflammatory infiltrate (rs= 0.636). Insignificant correlation was found with lymphoid aggregates, superficial epithelial damage, dysplasia and nuclear reactive changes. Conclusion: In conclusion this study corroborated the determination of histopathological parameters and depicted that, the greater the density of H. pylori infection, the greater the degrees of chronic inflammatory infiltrate. (author)

Conservative treatment of chronic pancreatitis.

Science.gov (United States)

Löhr, J-Matthias; Haas, Stephen L; Lindgren, Fredrik; Enochsson, Lars; Hedström, Aleksandra; Swahn, Fredrik; Segersvärd, Ralf; Arnelo, Urban

2013-01-01

Chronic pancreatitis is a progressive inflammatory disease giving rise to several complications that need to be treated accordingly. Because pancreatic surgery has significant morbidity and mortality, less invasive therapy seems to be an attractive option. This paper reviews current state-of-the-art strategies to treat chronic pancreatitis without surgery and the current guidelines for the medical therapy of chronic pancreatitis. Endoscopic therapy of complications of chronic pancreatitis such as pain, main pancreatic duct strictures and stones as well as pseudocysts is technically feasible and safe. The long-term outcome, however, is inferior to definitive surgical procedures such as resection or drainage. On the other hand, the medical therapy of pancreatic endocrine and exocrine insufficiency is well established and evidence based. Endoscopic therapy may be an option to bridge for surgery and in children/young adolescents and those unfit for surgery. Pain in chronic pancreatitis as well as treatment of pancreatic exocrine insufficiency follows established guidelines. Copyright © 2013 S. Karger AG, Basel.

Chronic bacterial seminal vesiculitis as a potential disease entity in men with chronic prostatitis.

Science.gov (United States)

Park, Soo-Hwan; Ryu, Ji-Kan; Choo, Gwoan-Youb; Chung, Yeun-Goo; Seong, Do-Hwan; Kim, Chang-Ho; Choe, Won-Sik; Ryu, Dong-Soo; Hyun, In Young; Suh, Jun-Kyu

2015-05-01

To investigate bacterial infection in the seminal vesicles by bacteriological examination and radionuclide imaging in men with chronic prostatitis. The study included 50 patients with chronic prostatitis who showed hot uptake in seminal vesicles on Tc-99m ciprofloxacin imaging and eight patients who did not show hot uptake. The evaluation included the National Institutes of Health Chronic Prostatitis Symptom Index and four-glass test. In all participants, transperineal aspiration of seminal vesicle fluid under the guidance of transrectal ultrasonography and bacteriological examination was carried out. Of the 50 patients who showed hot uptake in the seminal vesicles on the isotope study, microorganisms were isolated from the seminal vesicle fluid in 17 patients (positive predictive value, 34%). The most common causative organisms were Escherichia coli in 13 patients (26%), followed by coagulase-negative Staphylococcus species in two patients (4%), Enterococcus faecalis in one patient (2%) and Chlamydia trachomatis in one patient (2%). No microorganisms were isolated in the eight patients who did not show hot uptake in the seminal vesicles (negative predictive value, 100%). However, there were no significant differences in National Institutes of Health Chronic Prostatitis Symptom Index total scores and subscores between the study groups. Chronic bacterial seminal vesiculitis might simultaneously affect a considerable portion of patients with chronic prostatitis, although the clinical implication of the disease remains to be further investigated. © 2015 The Japanese Urological Association.

Chronic heart failure

OpenAIRE

Hopper, Ingrid; Easton, Kellie

2017-01-01

1. The common symptoms and signs of chronic heart failure are dyspnoea, ankle swelling, raised jugular venous pressure and basal crepitations. Other conditions may be confused with chronic heart failure, including dependent oedema or oedema due to renal or hepatic disease. Shortness of breath may be due to respiratory disease or severe anaemia. Heart failure secondary to lung disease (cor pulmonale) should be distinguished from congestive cardiac failure. Heart failure may also present with l...

New Directions in Chronic Disease Management

Directory of Open Access Journals (Sweden)

Hun-Sung Kim

2015-06-01

Full Text Available A worldwide epidemic of chronic disease, and complications thereof, is underway, with no sign of abatement. Healthcare costs have increased tremendously, principally because of the need to treat chronic complications of non-communicable diseases including cardiovascular disease, blindness, end-stage renal disease, and amputation of extremities. Current healthcare systems fail to provide an appropriate quality of care to prevent the development of chronic complications without additional healthcare costs. A new paradigm for prevention and treatment of chronic disease and the complications thereof is urgently required. Several clinical studies have clearly shown that frequent communication between physicians and patients, based on electronic data transmission from medical devices, greatly assists in the management of chronic disease. However, for various reasons, these advantages have not translated effectively into real clinical practice. In the present review, we describe current relevant studies, and trends in the use of information technology for chronic disease management. We also discuss limitations and future directions.

Uso de pericardio bovino para la corrección de cardiopatías congénitas Use of bovine pericardium for correcting congenital cardiopathies

Directory of Open Access Journals (Sweden)

Juan C Rendón

2007-08-01

una herramienta útil para la corrección de cardiopatías congénitas. Las características del tejido ofrecen al cirujano ventajas como el fácil moldeamiento, lo que permite implantarlo en diferentes zonas anatómicas.Bovine pericardial patch has been utilized as an alternative for different surgical pathologies, including congenital heart malformations. Nevertheless, there are only few articles that report the experience with this kind of patch. The objective of this study is to evaluate the experience with the use of bovine pericardium for the reconstruction of cardiopathies in the Santa Maria Cardiovascular Clinic Medellín since 1994. Materials and methods: 520 patients underwent a corrective or palliative surgical procedure of a congenital heart disease in which the bovine pericardial patch was utilized. 163 of these patients had at least two years follow-up. The localization of the patch, as well as the kind of procedures, the survival, calcifications, aneurysms and leaks, were evaluated. The functional class was evaluated as well and the patients’ survival was compared according to the localization and the kind of patch. Results: 520 procedures were realized using the bovine pericardial patch. Prevalent malformations were septal defects (58% followed by the tetralogy of Fallot (16%.The patch was also used in total or partial anomalous venous connections, and pulmonary atresia among others. 50.9% was localized in a systemic way and 49.7% in the pulmonary circulation. According to the localization, 50.3% were intracardiac and 49.7% extracardiac. Two leaks, two bleedings and three re-interventions were reported during the implantation. During the follow-up only three leaks were reported. Global survival was 95%. There were no significant differences in survival with intra or extracardiac patches or in those that supported pulmonary or systemic circulation. No calcifications were reported. 95% of patients were in functional class I or II, and the rest in III

ChronicOnline: Implementing a mHealth solution for monitoring and early alerting in chronic obstructive pulmonary disease.

Science.gov (United States)

Bitsaki, Marina; Koutras, Christos; Koutras, George; Leymann, Frank; Steimle, Frank; Wagner, Sebastian; Wieland, Matthias

2017-09-01

Lack of time or economic difficulties prevent chronic obstructive pulmonary disease patients from communicating regularly with their physicians, thus inducing exacerbation of their chronic condition and possible hospitalization. Enhancing Chronic patients' Health Online proposes a new, sustainable and innovative business model that provides at low cost and at significant savings to the national health system, a preventive health service for chronic obstructive pulmonary disease patients, by combining human medical expertise with state-of-the-art online service delivery based on cloud computing, service-oriented architecture, data analytics, and mobile applications. In this article, we implement the frontend applications of the Enhancing Chronic patients' Health Online system and describe their functionality and the interfaces available to the users.

Personality disparity in chronic regional and widespread pain.

Science.gov (United States)

Chang, Mei-Chung; Chen, Po-Fei; Lung, For-Wey

2017-08-01

Chronic pain has high comorbidity with psychiatric disorders, therefore, better understanding of the relationship between chronic pain and mental illness is needed. This study aimed to investigate the pathway relationships among parental attachment, personality characteristics, alexithymic trait and mental health in patients with chronic widespread pain, those with chronic regional pain, and controls. Two hundred and thirty participants were recruited. The parental Bonding Inventory, Eysenck Personality Inventory (EPI), 20-item Toronto Alexithymia Scale (TAS-20), Chinese Health Questionnaire, and Short-Form 36 were filled out. The pathway relationships revealed that patients of mothers who were more protective were more neurotic, had more difficulty identifying feelings (DIF), worse mental health, and a higher association with chronic widespread pain. No differences were found between patients with chronic regional pain and the controls. The predisposing factors for chronic widespread pain, when compared with chronic regional pain, may be more closely related to psychiatric disorders. The pathways to chronic regional pain and chronic widespread pain differ, with neuroticism and the alexithymic DIF trait being the main factors defining chronic widespread pain. Therefore, besides therapies targeting pain symptoms, psychiatric consultation, medication and psychotherapy are also recommended for those with chronic widespread pain to alleviate their mental health conditions. Copyright © 2017 Elsevier Ireland Ltd. All rights reserved.

Contemporary Management of Chronic Prostatitis/Chronic Pelvic Pain Syndrome.

Science.gov (United States)

Magistro, Giuseppe; Wagenlehner, Florian M E; Grabe, Magnus; Weidner, Wolfgang; Stief, Christian G; Nickel, J Curtis

2016-02-01

Chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS) is a common condition that causes severe symptoms, bother, and quality-of-life impact in the 8.2% of men who are believed to be affected. Research suggests a complex pathophysiology underlying this syndrome that is mirrored by its heterogeneous clinical presentation. Management of patients diagnosed with CP/CPPS has always been a formidable task in clinical practice. Due to its enigmatic etiology, a plethora of clinical trials failed to identify an efficient monotherapy. A comprehensive review of published randomized controlled trials (RCTs) on the treatment of CP/CPPS and practical best evidence recommendations for management. Medline and the Cochrane database were screened for RCTs on the treatment of CP/CPPS from 1998 to December 2014, using the National Institutes of Health Chronic Prostatitis Symptom Index as an objective outcome measure. Published data in concert with expert opinion were used to formulate a practical best evidence statement for the management of CP/CPPS. Twenty-eight RCTs identified were eligible for this review and presented. Trials evaluating antibiotics, α-blockers, anti-inflammatory and immune-modulating substances, hormonal agents, phytotherapeutics, neuromodulatory drugs, agents that modify bladder function, and physical treatment options failed to reveal a clear therapeutic benefit. With its multifactorial pathophysiology and its various clinical presentations, the management of CP/CPPS demands a phenotypic-directed approach addressing the individual clinical profile of each patient. Different categorization algorithms have been proposed. First studies applying the UPOINTs classification system provided promising results. Introducing three index patients with CP/CPPS, we present practical best evidence recommendations for management. Our current understanding of the pathophysiology underlying CP/CPPS resulting in this highly variable syndrome does not speak in favor of a

Exercise-induced ventricular arrhythmias and vagal dysfunction in Chagas disease patients with no apparent cardiac involvement

Directory of Open Access Journals (Sweden)

Henrique Silveira Costa

2015-04-01

Full Text Available INTRODUCTION : Exercise-induced ventricular arrhythmia (EIVA and autonomic imbalance are considered as early markers of heart disease in Chagas disease (ChD patients. The objective of the present study was to verify the differences in the occurrence of EIVA and autonomic maneuver indexes between healthy individuals and ChD patients with no apparent cardiac involvement. METHODS : A total of 75 ChD patients with no apparent cardiac involvement, aged 44.7 (8.5 years, and 38 healthy individuals, aged 44.0 (9.2 years, were evaluated using echocardiography, symptom-limited treadmill exercise testing and autonomic function tests. RESULTS : The occurrence of EIVA was higher in the chagasic group (48% than in the control group (23.7% during both the effort and the recovery phases. Frequent ventricular contractions occurred only in the patient group. Additionally, the respiratory sinus arrhythmia index was significantly lower in the chagasic individuals compared with the control group. CONCLUSIONS : ChD patients with no apparent cardiac involvement had a higher frequency of EIVA as well as more vagal dysfunction by respiratory sinus arrhythmia. These results suggest that even when asymptomatic, ChD patients possess important arrhythmogenic substrates and subclinical disease.

[Chronic wounds as a public health problem].

Science.gov (United States)

Situm, Mirna; Kolić, Maja; Redzepi, Gzim; Antolić, Slavko

2014-10-01

Chronic wounds represent a significant burden to patients, health care professionals and the entire health care system. Regarding the healing process, wounds can be classified as acute or chronic wounds. A wound is considered chronic if healing does not occur within the expected period according to the wound etiology and localization. Chronic wounds can be classified as typical and atypical. The majority of wounds (95 percent) are typical ones, which include ischemic, neurotrophic and hypostatic ulcers and two separate entities: diabetic foot and decubital ulcers. Eighty percent of chronic wounds localized on lower leg are the result of chronic venous insufficiency, in 5-10 percent the cause is of arterial etiology, whereas the rest are mostly neuropathic ulcers. Chronic wounds significantly decrease the quality of life of patients by requiring continuous topical treatment, causing immobility and pain in a high percentage of patients. Chronic wounds affect elderly population. Chronic leg ulcers affect 0.6-3 percent of those aged over 60, increasing to over 5 percent of those aged over 80. Emergence of chronic wounds is a substantial socioeconomic problem as 1-2 percent of western population will suffer from it. This estimate is expected to rise due to the increasing proportion of elderly population along with the diabetic and obesity epidemic. It has been proved that chronic wounds account for the large proportion of costs in the health care system, even in rich societies. Socioeconomically, the management of chronic wounds reaches a total of 2-4 percent of the health budget in western countries. Treatment costs for some other diseases are not irrelevant, nor are the method and materials used for treating these wounds. Considering etiologic factors, a chronic wound demands a multidisciplinary approach with great efforts of health care professionals to treat it more efficiently, more simply and more painlessly for the patient, as well as more inexpensively for

Laparoscopic Cholecystectomy in Chronic Calculus Cholecystitis

Directory of Open Access Journals (Sweden)

Prakash Sapkota

2013-12-01

Full Text Available Introduction: Laparoscopic cholecystectomy has clearly become the choice over open cholecystectomy in the treatment of hepatobiliary disease since its introduction by Mouret in 1987. This study evaluates a series of patients with chronic calculus cholecystitis who were treated with laparoscopic and open cholecystectomy and assesses the outcomes of both techniques. Objective: To evaluate the efficacy of laparoscopic vs open cholecystectomy in chronic calculus cholecystitis and establish the out-comes of this treatment modality at Lumbini Medical College and Teaching Hospital. Methods: This was a retrospective analysis over a one-year period (January 1, 2012 to December 31, 2012, per-formed by single surgeon at Lumbini Medical College and Teaching Hospital located midwest of Nepal. 166 patients underwent surgical treatment for chronic calculus cholecystitis. Patients included were only chronic calculus cholecystitis proven histopathologocally and the rest were excluded. Data was collected which included patients demographics, medical history, presentation, complications, conversion rates from laparoscopic. cholecystectomy to open cholecystectomy, operative and postoperative time. Results: Patients treated with laparoscopic cholecystectomy for chronic calculus cholecystitis had shorter operating times and length of stay compared to patients treated with open cholecystectomy for chronic calculus cholecystitis. Conversion rates were 3.54% in chronic calculus cholecystitis during the study period. Complications were also lower in patients who underwent laparoscopic cholecystectomy versus open cholecystectomy for cholelithiasis. Conclusions: Laparoscopic cholecystectomy appears to be a reliable, safe, and cost-effective treatment modality for chronic calculus cholecystitis.

Altered resting state EEG in chronic pancreatitis patients: toward a marker for chronic pain

NARCIS (Netherlands)

Vries, M. de; Wilder-Smith, O.H.G.; Jongsma, M.L.A.; Broeke, E.N. van den; Arns, M.W.; Goor, H. van; Rijn, C.M. van

2013-01-01

OBJECTIVES: Electroencephalography (EEG) may be a promising source of physiological biomarkers accompanying chronic pain. Several studies in patients with chronic neuropathic pain have reported alterations in central pain processing, manifested as slowed EEG rhythmicity and increased EEG power in

Altered resting state EEG in chronic pancreatitis patients: toward a marker for chronic pain

NARCIS (Netherlands)

Vries, M. de; Wilder-Smith, O.H.G.; Jongsma, M.L.A.; Broeke, E.N. van den; Arns, M.W.; Goor, H. van; Rijn, C.M. van

2013-01-01

Objectives: Electroencephalography (EEG) may be a promising source of physiological biomarkers accompanying chronic pain. Several studies in patients with chronic neuropathic pain have reported alterations in central pain processing, manifested as slowed EEG rhythmicity and increased EEG power in

Chronic saponin treatment attenuates damage to the pancreas in chronic alcohol-treated diabetic rats

Directory of Open Access Journals (Sweden)

Mi Ran Choi

2017-10-01

Conclusion: Saponin may not only be helpful in alleviating the rapid progress of diabetes due to chronic alcohol consumption in diabetic patients, but may also show potential as an antidiabetic drug candidate for diabetic patients who chronically consume alcohol.

Screening for Chronic Kidney Disease

Science.gov (United States)

Understanding Task Force Recommendations Screening for Chronic Kidney Disease The U.S. Preventive Services Task Force (Task Force) has issued a final recommendation on Screening for Chronic Kidney Disease (CKD) . This recommendation ...

[Thermometric diagnostics of chronic ulcerous pulpitis].

Science.gov (United States)

Zvetkova, P; Mostrova, I

1989-01-01

Thermometric measurements were performed of 408 teeth of the upper and lower jaw with clinically confirmed initial and advanced stage of chronic ulcerous pulpitis in 398 subjects, aged from 18 to 30. Temperature elevation within the range from 1.4 to 3.2 degrees C was established in the initial form of chronic pulpitis and from 1 to 2.5 degrees C in advanced form of chronic pulpitis as compared with the norm. Significant difference in the temperature deviations exists in both forms of chronic pulpitis between the teeth of the upper and lower jaw.

Prevalence of maternal chronic diseases during pregnancy

DEFF Research Database (Denmark)

Jølving, Line Riis; Nielsen, Jan; Kesmodel, Ulrik Schiøler

2016-01-01

INTRODUCTION: There is substantial evidence of a negative impact of maternal chronic disease during pregnancy on reproductive outcomes. Knowledge of the prevalence of chronic diseases during pregnancy is limited, but essential for a focused preventive effort regarding optimal disease control during...... chronic diseases were chronic lung diseases/asthma (1.73%), thyroid disorders (1.50%) and anxiety and personality disorders (1.33%). Taking increasing maternal age at birth into account, the relative risk for women to have a chronic disease from 2009 to 2013 was 4.14 (95% CI 4.05-4.22), compared...

EBV CHRONIC INFECTIONS

Directory of Open Access Journals (Sweden)

Delia Racciatti

2010-02-01

Full Text Available

The infection from Epstein-Barr virus (EBV or virus of infectious mononucleosis, together with other herpesviruses’ infections, represents a prototype of persistent viral infections characterized by the property of the latency. Although the reactivations of the latent infection are associated with the resumption of the viral replication and eventually with the “shedding”, it is still not clear if this virus can determine chronic infectious diseases, more or less evolutive. These diseases could include some pathological conditions actually defined as “idiopathic”and characterized by the “viral persistence” as the more credible pathogenetic factor. Among the so-called idiopathic syndromes, the “chronic fatigue syndrome” (CFS aroused a great interest around the eighties of the last century when, just for its relationship with EBV, it was called “chronic mononucleosis” or “chronic EBV infection”.

Today CFS, as defined in 1994 by the CDC of Atlanta (USA, really represents a multifactorial syndrome characterized by a chronic course, where reactivation and remission phases alternate, and by a good prognosis

Omalizumab for chronic urticaria

DEFF Research Database (Denmark)

Ivyanskiy, Ilya; Sand, Carsten; Thomsen, Simon Francis

2012-01-01

Omalizumab is a recombinant humanized monoclonal antibody that blocks the high-affinity Fc receptor of IgE. Omalizumab has been approved for the treatment of moderate to severe asthma; however, there is currently more and more data showing promising results in the management also of chronic urtic...... with placebo. The collective evidence points to omalizumab as a safe and effective treatment option for patients with chronic urticaria who do not sufficiently respond to standard therapy as recommended by existing guidelines.......Omalizumab is a recombinant humanized monoclonal antibody that blocks the high-affinity Fc receptor of IgE. Omalizumab has been approved for the treatment of moderate to severe asthma; however, there is currently more and more data showing promising results in the management also of chronic...... urticaria. We present a case series of 19 patients with chronic urticaria treated in a university department with omalizumab and give an overview of the existing literature comprising an additional 59 cases as well as a total of 139 patients enrolled in two randomized controlled trials comparing omalizumab...

[Chronic pancreatitis: new definition and perspectives.

Science.gov (United States)

Conti Bellocchi, Maria Cristina; De Pretis, Nicolò; Amodio, Antonio; Zerbi, Alessandro; Frulloni, Luca

2018-01-01

Chronic pancreatitis has been considered over the past years as a single disease, alcohol-induced and different from acute pancreatitis, in terms of etiology and prognosis. Actually, the introduction of a new concept of chronic pancreatitis, now considered as a fibroinflammatory process caused by multiple factors (toxic-metabolic, genetic, immunologic, obstructive), allow to better understand the pathogenesis of this complex disease. Furthermore, the discover of peculiar forms of chronic pancreatitis (autoimmune, paraduodenal, associated to gene mutations), different in term of clinical aspects, findings at imaging, prognosis and therapy, radically changed the concept of the disease. In this brief review, we described the impact of this new concept in the comprehension of pathogenesis, in the definition of peculiar forms of chronic pancreatitis, and in the clinical and therapeutic approach of chronic pancreatitis.

Publications | Page 10 | CRDI - Centre de recherches pour le ...

International Development Research Centre (IDRC) Digital Library (Canada)

L'obésité est un facteur de risque de plusieurs maladies non transmissibles, dont les cardiopathies, l'hypertension, le diabète et le cancer. Conflit et développement dans les collines de Guwahati. Dans la ville de Guwahati, dans le nord-est de l'Inde, la croissance rapide a alimenté une explosion de développement non ...

Chronic pretrigeminal and cerveau isolé cats.

Science.gov (United States)

Slósarska, M; Zernicki, B

1973-01-01

Ten pretrigeminal and ten cerveau isole cats were observed chronically. During 24-36 h sessions EEG activity was continuously recorded and the EEG and ocular responses to visual and olfactory stimuli were studied. In the pretrigeminal cat acute and chronic stages were distinguished, and in the cerveau isole, acute, "early chronic" and "late chronic" stages. During the acute stage, the pretrigeminal cat is continuously awake, whereas the cerveau isole is comatose. During the "early chronic stage", which lasted at least about 3 weeks, the cerveau isole is semicomatose. During the chronic stage in the pretrigeminal cat and the "late chronic stage" in the cerveau isole, the sleep-waking cycle is present. In both preparations alert wakefulness, drowsiness, light .synchronized sleep and deep synchronized sleep occupy, respectively, about 30 percent, 45 percent, 15 percent and 10 percent of the time. Thus, synchronized sleep is strikingly reduced in comparison with an intact cat, while desynchronized sleep is absent.

Chronic hypersensitivity pneumonitis

Directory of Open Access Journals (Sweden)

Pereira CA

2016-09-01

Full Text Available Carlos AC Pereira,1 Andréa Gimenez,2 Lilian Kuranishi,2 Karin Storrer 2 1Interstitial Lung Diseases Program, 2Pulmonology Postgraduate, Federal University of São Paulo, São Paulo, Brazil Abstract: Hypersensitivity pneumonitis (HSP is a common interstitial lung disease resulting from inhalation of a large variety of antigens by susceptible individuals. The disease is best classified as acute and chronic. Chronic HSP can be fibrosing or not. Fibrotic HSP has a large differential diagnosis and has a worse prognosis. The most common etiologies for HSP are reviewed. Diagnostic criteria are proposed for both chronic forms based on exposure, lung auscultation, lung function tests, HRCT findings, bronchoalveolar lavage, and biopsies. Treatment options are limited, but lung transplantation results in greater survival in comparison to idiopathic pulmonary fibrosis. Randomized trials with new antifibrotic agents are necessary. Keywords: interstitial lung diseases, extrinsic allergic alveolitis, diffuse lung disease, lung immune response, HRCT, farmers lung

Chronic Bronchitis and Chronic Obstructive Pulmonary Disease (COPD) Among Textile Workers in Karachi, Pakistan

International Nuclear Information System (INIS)

Nafees, A. A.; Fatmi, Z.; Kadir, M. M.; Sathiakumar, N.

2016-01-01

Objective: To determine the frequency and predictors of chronic bronchitis and COPD among textile workers in Karachi, Pakistan. Study Design: Cross-sectional survey. Place and Duration of Study: Karachi, Pakistan, from October to December 2009. Methodology: Male textile workers from 15 mills of Karachi were inducted. Data was collected using American Thoracic Society respiratory questionnaire (ATS-DLD-78-a) and spirometry. Result: Out of 372 participants, 29 (7.8 percentage) workers had chronic bronchitis (4, 9.1 percentage aged =40 years) and 25 (6.7 percentage) had COPD (12, 27.2 percentage aged ≥40 years). Workers with chronic bronchitis had significantly decreased lung function compared to the healthy workers. Those reporting severe self-perceived dust exposure at work, ≥ 10 pack years of smoking, uneducated, longer duration of work (≥11 years), and ever smokers were more likely to have chronic bronchitis or COPD. In the multivariate analyses, severe self-perceived dust exposure at work (AOR = 7.4; 95 percentage CI: 1.9, 28.0), family history of respiratory illness/symptoms (AOR = 4.8; 95 percentage CI: 1.1, 20.9) and lack of education (AOR = 4.2; 95 percentage CI: 1.1, 16.9) were significant predictors of chronic bronchitis. Duration of work ≥11 years (AOR = 5.5; 95 percentage CI: 1.5, 19.7) and pack years of smoking ≥10 years (AOR = 3.5; 95 percentage CI: 1.1, 11.7) were strong predictors for COPD. Conclusion: There is a high frequency of chronic bronchitis and COPD among textile workers. Multiple important predictors for prevention are identified. (author)

Acute vs. chronic conditions (image)

Science.gov (United States)

... describe anything from a broken bone to an asthma attack. A chronic condition, by contrast is a long- ... a broken bone, an acute condition. An acute asthma attack occurs in the midst of the chronic disease ...

Chronic Inflammatory Demyelinating Polyneuropathy (CIDP)

Science.gov (United States)

... and abnormal sensations. CIDP is closely related to Guillain-Barre syndrome and it is considered the chronic counterpart ... and abnormal sensations. CIDP is closely related to Guillain-Barre syndrome and it is considered the chronic counterpart ...

Intraosseous anesthesia in hemodynamic studies in children with cardiopathy.

Science.gov (United States)

Aliman, Ana Cristina; Piccioni, Marilde de Albuquerque; Piccioni, João Luiz; Oliva, José Luiz; Auler Júnior, José Otávio Costa

2011-01-01

Intraosseous (IO) access has been used with good results in emergency situations, when venous access is not available for fluids and drugs infusion. The objective of this study was to evaluate IO a useful technique for anesthesia and fluids infusion during hemodynamic studies and when peripheral intravascular access is unobtainable. The setting was an university hospital hemodynamics unit, and the subjects were twenty one infants with congenital heart disease enrolled for elective hemodynamic study diagnosis. This study compared the effectiveness of IO access in relation to IV access for infusion of anesthetics agents (ketamine, midazolam, and fentanyl) and fluids during hemodynamic studies. The anesthetic induction time, procedure duration, anesthesia recovery time, adequate hydration, and IV and IO puncture complications were compared between groups. The puncture time was significantly smaller in IO group (3.6 min) that in IV group (9.6 min). The anesthetic onset time (56.3 second) for the IV group was faster than IO group (71.3 second). No significant difference between groups were found in relation to hydration (IV group, 315.5 mL vs IO group, 293.2 mL), and anesthesia recovery time (IO group, 65.2 min vs IV group, 55.0 min). The puncture site was reevaluated after 7 and 15 days without signs of infection or other complications. Results showed superiority for IO infusion when considering the puncture time of the procedure. Due to its easy manipulation and efficiency, hydration and anesthesia by IO access was satisfactory for hemodynamic studies without the necessity of other infusion access. Copyright © 2011 Elsevier Editora Ltda. All rights reserved.

Chronic inflammatory and suppurative processes in lungs

International Nuclear Information System (INIS)

Rozenshtraukh, L.C.; Rybakova, N.I.; Vinner, M.G.

1987-01-01

Roentgenologic methods of diagnosis of chronic bronchitis, bronchiectatic disease, lung abscess and gangrene, chronic non-specific pneumonia and cancer of lung and other pathalogical changes at chronic processes in lungs are discussed in detail

A novel model of chronic wounds: importance of redox imbalance and biofilm-forming bacteria for establishment of chronicity.

Directory of Open Access Journals (Sweden)

Sandeep Dhall

Full Text Available Chronic wounds have a large impact on health, affecting ∼6.5 M people and costing ∼$25B/year in the US alone. We previously discovered that a genetically modified mouse model displays impaired healing similar to problematic wounds in humans and that sometimes the wounds become chronic. Here we show how and why these impaired wounds become chronic, describe a way whereby we can drive impaired wounds to chronicity at will and propose that the same processes are involved in chronic wound development in humans. We hypothesize that exacerbated levels of oxidative stress are critical for initiation of chronicity. We show that, very early after injury, wounds with impaired healing contain elevated levels of reactive oxygen and nitrogen species and, much like in humans, these levels increase with age. Moreover, the activity of anti-oxidant enzymes is not elevated, leading to buildup of oxidative stress in the wound environment. To induce chronicity, we exacerbated the redox imbalance by further inhibiting the antioxidant enzymes and by infecting the wounds with biofilm-forming bacteria isolated from the chronic wounds that developed naturally in these mice. These wounds do not re-epithelialize, the granulation tissue lacks vascularization and interstitial collagen fibers, they contain an antibiotic-resistant mixed bioflora with biofilm-forming capacity, and they stay open for several weeks. These findings are highly significant because they show for the first time that chronic wounds can be generated in an animal model effectively and consistently. The availability of such a model will significantly propel the field forward because it can be used to develop strategies to regain redox balance that may result in inhibition of biofilm formation and result in restoration of healthy wound tissue. Furthermore, the model can lead to the understanding of other fundamental mechanisms of chronic wound development that can potentially lead to novel therapies.

[Tropical chronic pancreatitis in a young patient].

Science.gov (United States)

Reyes, J; Ginard, D; Barranco, L; Riera, J; Obrador, A

2001-11-01

Tropical chronic pancreatitis is a form of idiopathic chronic pancreatitis that has not previously been described in Spain. Typically it is related to dietary factors and malnutrition, although genetic factors may also play a significant role in the development of the disease. We report a case of chronic tropical pancreatitis in a 27-year-old woman from the Dominican Republic domiciled in Spain since 1992. The patient was admitted to our hospital for acute pancreatitis that fulfilled the diagnostic criteria (clinical and radiological) for chronic tropical pancreatitis. This case has led us to review this uncommon entity. Because of the increasing number of immigrants from tropical countries, chronic tropical pancreatitis will probably need to be taken into account in the differential diagnosis of chronic pancreatitis in our patients.

Complemento hemolítico total, C3 e taxa de conversão de C3 nas formas cardíaca e indeterminada da doença de Chagas Levels of hemolytic complement, total C3 and degree of conversion of native C3 in cardiac and indeterminate form of Chagas' disease

Directory of Open Access Journals (Sweden)

M. A. Shikanai-Yasuda

1984-02-01

Full Text Available Os valores de complemento hemolítico total, C3 total (nativo + produtos de degradação e o grau de conversão de C3 nativo foram estudados em dois subgrupos de pacientes chagásicos, nas formas cardíaca e indeterminada, e em um subgrupo de indivíduos não chagásicos, clinicamente sadios. Os níveis de C3 total e as taxas de conversão de C3 em seus produtos de degradação foram semelhantes nos três subgrupos. Os valores de complemento hemolítico total foram estatisticamente diferentes nos três subgrupos (nível de significância descritivo p = 0,0757, tendo sido observada média aritmética mais baixa no subgrupo de cardíacos e mais elevada no subgrupo de controles. Maior amplitude de variação dos níveis de complemento hemolítico total foi notada no subgrupo de cardíacos, no qual se encontraram os valores extremos (máximo e mínimo, considerando-se todos os subgrupos.The levels of hemolytic complement and total C3 (native C3 plus its degration products and the degree of conversion of native C3 into its breakdown products were studied in sera from two subgroups of chagasic patients (indeterminate and cardiac forms and from non chagasic individuals (control subgroup. The levels of total C3 and the degree of conversion of native C3 into its breakdown products were similar in the three subgroups. The levels of hemolytic complement were statistically different among the three subgroups. The lowest average was observed in the subgroup of cardiac patients and the highest average in the control subgroup of non chagasic individuals. The widest variation on levels of hemolytic complement was observed in the subgroup of cardiac patients in which we found the maximum and minimum values among all the subgroups.

Chronic Neck Pain and Whiplash: A Case-Control Study of the Relationship between Acute Whiplash Injuries and Chronic Neck Pain

OpenAIRE

Freeman, Michael D; Croft, Arthur C; Rossignol, Annette M; Centeno, Christopher J; Elkins, Whitney L

2006-01-01

The authors undertook a case-control study of chronic neck pain and whiplash injuries in nine states in the United States to determine whether whiplash injuries contributed significantly to the population of individuals with chronic neck and other spine pain.Four hundred nineteen patients and 246 controls were randomly enrolled. Patients were defined as individuals with chronic neck pain, and controls as those with chronic back pain. The two groups were surveyed for cause of chronic pain as w...

Physiotherapeutic methods in treating patients with chronic abacterial prostatitis / chronic pelvic pain syndrome: current and development perspectives

Directory of Open Access Journals (Sweden)

Popkov V.M.

2017-09-01

Full Text Available Chronic abacterial prostatitis / chronic pelvic pain syndrome is one of the most common diseases in urological practice. Physical factors are widely used in treatment of this pathology. This literature review is devoted to study of role of physiotherapeutic methods in treatment of chronic abacterial prostatitis and prospects for development of this therapeutic direction.

Impact of Iodinated Contrast on Renal Function and Hemodynamics in Rats with Chronic Hyperglycemia and Chronic Kidney Disease

Science.gov (United States)

Fernandes, Sheila Marques; Martins, Daniel Malisani; da Fonseca, Cassiane Dezoti; Watanabe, Mirian; Vattimo, Maria de Fátima Fernandes

2016-01-01

Iodinated contrast (IC) is clinically used in diagnostic and interventional procedures, but its use can result in contrast-induced acute kidney injury (CI-AKI). Chronic kidney disease (CKD) and chronic hyperglycemia (CH) are important predisposing factors to CI-AKI. The aim of this study was to investigate the impact of iodinated contrast on the renal function and hemodynamics in rats with chronic hyperglycemia and chronic kidney disease. A total of 30 rats were divided into six groups; Sham: control of chronic renal disease; Citrate: control of chronic hyperglycemia (CH); Nx5/6: rats with 5/6 nephrectomy; Chronic Hyperglycemia: rats receiving Streptozotocin 65 mg/kg; Nx5/6 + IC: rats Nx5/6 received 6 mL/kg of IC; CH + IC: Chronic hyperglycemia rats receiving 6 mL/kg of IC. Renal function (inulin clearance; urinary neutrophil gelatinase-associated lipocalin, NGAL) and hemodynamics (arterial blood pressure; renal blood flow; renal vascular resistance) were evaluated. Iodinated contrast significantly increased urinary NGAL and reduced inulin clearance, while the hemodynamics parameters showed changes in arterial blood pressure, renal blood flow, and renal vascular resistance in both CKD and CH groups. The results suggest that the iodinated contrast in risk factors models has important impact on renal function and hemodynamics. NGAL was confirmed to play a role of highlight in diagnosis of CI-AKI. PMID:27034930

Impact of Iodinated Contrast on Renal Function and Hemodynamics in Rats with Chronic Hyperglycemia and Chronic Kidney Disease

Directory of Open Access Journals (Sweden)

Sheila Marques Fernandes

2016-01-01

Full Text Available Iodinated contrast (IC is clinically used in diagnostic and interventional procedures, but its use can result in contrast-induced acute kidney injury (CI-AKI. Chronic kidney disease (CKD and chronic hyperglycemia (CH are important predisposing factors to CI-AKI. The aim of this study was to investigate the impact of iodinated contrast on the renal function and hemodynamics in rats with chronic hyperglycemia and chronic kidney disease. A total of 30 rats were divided into six groups; Sham: control of chronic renal disease; Citrate: control of chronic hyperglycemia (CH; Nx5/6: rats with 5/6 nephrectomy; Chronic Hyperglycemia: rats receiving Streptozotocin 65 mg/kg; Nx5/6 + IC: rats Nx5/6 received 6 mL/kg of IC; CH + IC: Chronic hyperglycemia rats receiving 6 mL/kg of IC. Renal function (inulin clearance; urinary neutrophil gelatinase-associated lipocalin, NGAL and hemodynamics (arterial blood pressure; renal blood flow; renal vascular resistance were evaluated. Iodinated contrast significantly increased urinary NGAL and reduced inulin clearance, while the hemodynamics parameters showed changes in arterial blood pressure, renal blood flow, and renal vascular resistance in both CKD and CH groups. The results suggest that the iodinated contrast in risk factors models has important impact on renal function and hemodynamics. NGAL was confirmed to play a role of highlight in diagnosis of CI-AKI.

Tai chi and chronic pain.

Science.gov (United States)

Peng, Philip W H

2012-01-01

In the last 2 decades, a growing body of research aimed at investigating the health benefits of Tai Chi in various chronic health conditions has been recognized in the literature. This article reviewed the history, the philosophy, and the evidence for the role of Tai Chi in a few selected chronic pain conditions. The ancient health art of Tai Chi contributes to chronic pain management in 3 major areas: adaptive exercise, mind-body interaction, and meditation. Trials examining the health benefit of Tai Chi in chronic pain conditions are mostly low quality. Only 5 pain conditions were reviewed: osteoarthritis, fibromyalgia, rheumatoid arthritis, low back pain, and headache. Of these, Tai Chi seems to be an effective intervention in osteoarthritis, low back pain, and fibromyalgia. The limitations of the Tai Chi study design and suggestions for the direction of future research are also discussed.

Empowering Patients with Chronic Diseases

DEFF Research Database (Denmark)

Bestek, Mate; Meglič, Matic; Kurent, Blaž

2012-01-01

Background: Chronic diseases require most of the resources in todays healthcare systems. Healthcare systems, as such, are thus not sustainable in the long term. Solutions to this problem are needed and a lot of research is focused on finding new approaches to more sustainable healthcare systems...... himself to become empowered. The patient needs to see data about his health in order to start thinking about new decisions in life that can lead to change in his behaviour. Objective: We have approached the problem of empowering patients with chronic diseases from a biological, psychological, sociological....... We want to develop extensible technology to support even more new interventions for different chronic diseases. We want the technology to enable semantic interoperability with other systems. Methods: We have collaborated with doctors in order to model the care plans for different chronic diseases...

Surgical Approaches to Chronic Pancreatitis

Directory of Open Access Journals (Sweden)

Daniel Hartmann

2015-01-01

Full Text Available Chronic pancreatitis is a progressive inflammatory disease resulting in permanent structural damage of the pancreas. It is mainly characterized by recurring epigastric pain and pancreatic insufficiency. In addition, progression of the disease might lead to additional complications, such as pseudocyst formation or development of pancreatic cancer. The medical and surgical treatment of chronic pancreatitis has changed significantly in the past decades. With regard to surgical management, pancreatic head resection has been shown to be a mainstay in the treatment of severe chronic pancreatitis because the pancreatic head mass is known to trigger the chronic inflammatory process. Over the years, organ-preserving procedures, such as the duodenum-preserving pancreatic head resection and the pylorus-preserving Whipple, have become the surgical standard and have led to major improvements in pain relief, preservation of pancreatic function, and quality of life of patients.

Nitazoxanide for chronic hepatitis C

DEFF Research Database (Denmark)

Nikolova, Kristiana; Gluud, Christian; Grevstad, Berit

2014-01-01

BACKGROUND: Hepatitis C infection is a disease of the liver caused by the hepatitis C virus. The estimated number of chronically infected people with hepatitis C virus worldwide is about 150 million people. Every year, another three to four million people acquire the infection. Chronic hepatitis C......) and ribavirin was the approved standard treatment for chronic hepatitis C. In 2011, first-generation direct-acting antivirals (DAAs) have been licensed, for use in combination with peginterferon and ribavirin for treating hepatitis C virus genotype 1 infection. Nitazoxanide is another antiviral drug with broad...... antiviral activity and may have potential as an effective alternative, or an addition to standard treatment for the treatment of the hepatitis C virus. OBJECTIVES: To assess the benefits and harms of nitazoxanide in people with chronic hepatitis C virus infection. SEARCH METHODS: We searched The Cochrane...

Chronic Fatigue Syndrome: Review of the Literature

OpenAIRE

Turgeon, Sue A.

1989-01-01

Chronic fatigue syndrome, previously known as chronic mononucleosis or post-infectious fatigue, is a poorly understood illness characterized by chronic debilitating fatigue, recurrent flu-like symptoms, and few clinical or laboratory abnormalities. Attention was briefly focused on the Epstein-Barr virus (EBV) as a causal agent, but that hypothesis is now in serious doubt. While a significant incidence of psychiatric illness has been demonstrated among patients with the chronic fatigue syndrom...

Omalizumab for chronic urticaria

DEFF Research Database (Denmark)

Ivyanskiy, Ilya; Sand, Carsten; Thomsen, Simon Francis

2012-01-01

Omalizumab is a recombinant humanized monoclonal antibody that blocks the high-affinity Fc receptor of IgE. Omalizumab has been approved for the treatment of moderate to severe asthma; however, there is currently more and more data showing promising results in the management also of chronic...... urticaria. We present a case series of 19 patients with chronic urticaria treated in a university department with omalizumab and give an overview of the existing literature comprising an additional 59 cases as well as a total of 139 patients enrolled in two randomized controlled trials comparing omalizumab...... with placebo. The collective evidence points to omalizumab as a safe and effective treatment option for patients with chronic urticaria who do not sufficiently respond to standard therapy as recommended by existing guidelines....

Epidemiology of chronic pain in Denmark: an update

DEFF Research Database (Denmark)

Sjøgren, Per; Ekholm, Ola; Peuckmann, Vera

2008-01-01

-administrated questionnaire. The same questions were included in the survey in 2000 and, hence, it was possible to evaluate the trends in the past five years. In all, 20.2% of the adult Danish population has chronic pain. From year 2000-2005 the prevalence of chronic pain has remained stable. Generally, chronic pain......The most recent Danish health survey of 2005 is based on a region-stratified random sample of 10.916 individuals. Data were collected via personal interviews and self-administrated questionnaires. Respondents suffering from chronic pain were identified through the question 'Do you have chronic...... was associated with female gender and increasing age. Higher prevalence of chronic pain were associated with being divorced, separated or widowed, having less than 10 years of education and high BMI. Musculoskeletal diseases (66.8%) were the most common cause for chronic pain and most persons with chronic pain...

Anemia in Chronic Kidney Disease

Science.gov (United States)

... Cysts Solitary Kidney Your Kidneys & How They Work Anemia in Chronic Kidney Disease What is anemia? Anemia is a condition in which the body ... function as well as they should. How is anemia related to chronic kidney disease? Anemia commonly occurs ...

Chronic and integrated care in Catalonia

Science.gov (United States)

Contel, Juan Carlos; Ledesma, Albert; Blay, Carles; Mestre, Assumpció González; Cabezas, Carmen; Puigdollers, Montse; Zara, Corine; Amil, Paloma; Sarquella, Ester; Constante, Carles

2015-01-01

Introduction The Chronicity Prevention and Care Programme set up by the Health Plan for Catalonia 2011–2015 has been an outstanding and excellent opportunity to create a new integrated care model in Catalonia. People with chronic conditions require major changes and transformation within the current health and social system. The new and gradual context of ageing, increase in the number of chronic diseases and the current fragmented system requires this transformation to be implemented. Method The Chronicity Prevention and Care Programme aims to implement actions which drive the current system towards a new scenario where organisations and professionals must work collaboratively. New tools should facilitate this new context- or work-like integrated health information systems, an integrative financing and commissioning scheme and provide a new approach to virtual care by substituting traditional face-to-face care with transfer and shared responsibilities between patients, citizens and health care professionals. Results It has been observed some impact reducing the rate of emergency admissions and readmission related to chronic conditions and better outcome related to better chronic disease control. Some initiative like the Catalan Expert Patient Program has obtained good results and an appropriate service utilization. Discussion The implementation of a Chronic Care Program show good results but it is expected that the new integrated health and social care agenda could provoke a real change and transformation. Some of the results related to better health outcomes and a decrease in avoidable hospital admissions related to chronic conditions confirm we are on the right track to make our health and social system more sustainable for the decades to come. PMID:26150763

Bacterial Contribution in Chronicity of Wounds.

Science.gov (United States)

Rahim, Kashif; Saleha, Shamim; Zhu, Xudong; Huo, Liang; Basit, Abdul; Franco, Octavio Luiz

2017-04-01

A wound is damage of a tissue usually caused by laceration of a membrane, generally the skin. Wound healing is accomplished in three stages in healthy individuals, including inflammatory, proliferative, and remodeling stages. Healing of wounds normally starts from the inflammatory phase and ends up in the remodeling phase, but chronic wounds remain in an inflammatory stage and do not show progression due to some specific reasons. Chronic wounds are classified in different categories, such as diabetic foot ulcer (DFU), venous leg ulcers (VLU) and pressure ulcer (PU), surgical site infection (SSI), abscess, or trauma ulcers. Globally, the incidence rate of DFU is 1-4 % and prevalence rate is 5.3-10.5 %. However, colonization of pathogenic bacteria at the wound site is associated with wound chronicity. Most chronic wounds contain more than one bacterial species and produce a synergetic effect that results in previously non-virulent bacterial species becoming virulent and causing damage to the host. While investigating bacterial diversity in chronic wounds, Staphylococcus, Pseudomonas, Peptoniphilus, Enterobacter, Stenotrophomonas, Finegoldia, and Serratia were found most frequently in chronic wounds. Recently, it has been observed that bacteria in chronic wounds develop biofilms that contribute to a delay in healing. In a mature biofilm, bacteria grow slowly due to deficiency of nutrients that results in the resistance of bacteria to antibiotics. The present review reflects the reasons why acute wounds become chronic. Interesting findings include the bacterial load, which forms biofilms and shows high-level resistance toward antibiotics, which is a threat to human health in general and particularly to some patients who have acute wounds.

Chronic and integrated care in Catalonia

Directory of Open Access Journals (Sweden)

Juan Carlos Contel

2015-06-01

Full Text Available Introduction: The Chronicity Prevention and Care Programme set up by the Health Plan for Catalonia 2011–2015 has been an outstanding and excellent opportunity to create a new integrated care model in Catalonia. People with chronic conditions require major changes and transformation within the current health and social system. The new and gradual context of ageing, increase in the number of chronic diseases and the current fragmented system requires this transformation to be implemented. Method: The Chronicity Prevention and Care Programme aims to implement actions which drive the current system towards a new scenario where organisations and professionals must work collaboratively. New tools should facilitate this new context- or work-like integrated health information systems, an integrative financing and commissioning scheme and provide a new approach to virtual care by substituting traditional face-to-face care with transfer and shared responsibilities between patients, citizens and health care professionals. Results: It has been observed some impact reducing the rate of emergency admissions and readmission related to chronic conditions and better outcome related to better chronic disease control. Some initiative like the Catalan Expert Patient Program has obtained good results and an appropriate service utilization. Discussion: The implementation of a Chronic Care Program show good results but it is expected that the new integrated health and social care agenda could provoke a real change and transformation. Some of the results related to better health outcomes and a decrease in avoidable hospital admissions related to chronic conditions confirm we are on the right track to make our health and social system more sustainable for the decades to come.

Diagnosis and treatment of chronic bacterial prostatitis and chronic prostatitis/chronic pelvic pain syndrome: a consensus guideline.

Science.gov (United States)

Rees, Jon; Abrahams, Mark; Doble, Andrew; Cooper, Alison

2015-10-01

To improve awareness and recognition of chronic bacterial prostatitis (CBP) and chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS) among non-specialists and patients. To provide guidance to healthcare professionals treating patients with CBP and CP/CPPS, in both non-specialist and specialist settings. To promote efficient referral of care between non-specialists and specialists and the involvement of the multidisciplinary team (MDT). The guideline population were men with CBP or CP/CPPS (persistent or recurrent symptoms and no other urogenital pathology for ≥3 of the previous 6 months). Consensus recommendations for the guidelines were based on a search to identify literature on the diagnosis and management of CBP and CP/CPPS (published between 1999 and February 2014). A Delphi panel process was used where high-quality, published evidence was lacking. CBP and CP/CPPS can present with a wide range of clinical manifestations. The four main symptom domains are urogenital pain, lower urinary tract symptoms (LUTS - voiding or storage symptoms), psychological issues and sexual dysfunction. Patients should be managed according to their individual symptom pattern. Options for first-line treatment include antibiotics, α-adrenergic antagonists (if voiding LUTS are present) and simple analgesics. Repeated use of antibiotics, such as quinolones, should be avoided if there is no obvious symptomatic benefit from infection control or cultures do not support an infectious cause. Early use of treatments targeting neuropathic pain and/or referral to specialist services should be considered for patients who do not respond to initial measures. An MDT approach (urologists, pain specialists, nurse specialists, specialist physiotherapists, general practitioners, cognitive behavioural therapists/psychologists, and sexual health specialists) is recommended. Patients should be fully informed about the possible underlying causes and treatment options, including an explanation of

Patient-reported outcomes (PROs) in chronic urticaria

DEFF Research Database (Denmark)

Moestrup, Kristian; Ghazanfar, Misbah N.; Thomsen, Simon F.

2017-01-01

Chronic urticaria is an itching skin disease which persists for more than 6 weeks. Chronic urticaria has great impact on the daily life of the patient, and the fluctuating nature of the symptoms complicates the monitoring and treatment of the disease. Currently, there are no reliable biomarkers...... to identify and measure disease activity in chronic spontaneous urticaria. Consequently, use of patient-reported outcomes (PROs) is crucial when evaluating and monitoring different aspects of chronic urticaria such as disease activity/severity, disease control, and quality of life. We present an overview...... of seven different PROs used in chronic urticaria and highlight their strengths, limitations, and use in clinical practice and research....

Chronic eosinophilic pneumonia: a case report

Energy Technology Data Exchange (ETDEWEB)

Heo, Tae Haeng; Park, Jeong Hee; Lim, Jong Nam; Shin, Hyun Jun; Jeon, Hae Jeong [College of Medicine, Kon-Kuk University, Seoul (Korea, Republic of)

1995-05-15

Chronic eosinophilic pneumonia is a rare disease characterized by chronic infiltration of the lung with eosinophils, usually associated with peripheral eosinophilia. In 65% of cases, the chest radiograph shows typical nonsegmental air-space consolidation confined to the outer third of the lung, and in 25% of cases, the 'photographic negative of pulmonary edema' Typical lung manifestations with peripheral eosinophilia are characteristic of chronic eosinophilic pneumonia. In the remaining cases, radiographic findings are nonspecific and require lung biopsy for confirmation. We report a case of chronic eosinophilic pneumonia in which chest radiograph and CT scans revealed bilateral patchy or diffuse opacity with nodules scattered throughout the lungs.

Treatment for Chronic Depression Using Schema Therapy

NARCIS (Netherlands)

Renner, F.; Arntz, A.; Leeuw, I.; Huibers, M.J.H.

2013-01-01

Schema therapy (ST) is an integrative treatment approach to chronic lifelong problems with an established effectiveness for treating personality disorders. This article describes the adaptation of ST to chronic depression by reviewing the literature on the underlying risk factors to chronic

Several submaximal exercise tests are reliable, valid and acceptable in people with chronic pain, fibromyalgia or chronic fatigue: a systematic review

OpenAIRE

Julia Ratter; Lorenz Radlinger; Cees Lucas

2014-01-01

Question: Are submaximal and maximal exercise tests reliable, valid and acceptable in people with chronic pain, fibromyalgia and fatigue disorders? Design: Systematic review of studies of the psychometric properties of exercise tests. Participants: People older than 18 years with chronic pain, fibromyalgia and chronic fatigue disorders. Intervention: Studies of the measurement properties of tests of physical capacity in people with chronic pain, fibromyalgia or chronic fatigue disorders were ...

Chronic diseases and mental disorder.

NARCIS (Netherlands)

Verhaak, P.F.M.; Heijmans, M.J.W.M.; Peters, L.; Rijken, M.

2005-01-01

The aim of this study was to achieve a better understanding of the relationship between chronic medical illness and mental distress. Therefore, the association between chronic medical illness and mental distress was analysed, taking into account the modifying effects of generic disease

Radiology of chronic diseases of the ankle joint

International Nuclear Information System (INIS)

Rand, T.; Trattnig, S.; Breitenseher, M.; Imhof, H.; Wagesreither, S.

1999-01-01

The etiology of chronic diseases of the ankle joint comprises a wide spectrum including chronic inflammatory processes and chronic degenerative, tumorous and neuropathic processes, as well as some specific syndromes based on chronic changes of the ankle joint. Of the inflammatory processes, chronic juvenile arthritis (JVC) is the most common disease. However, also Reiter disease, psoriasis or chronic monoarthritid diseases such as gout, as well as granulomatous diseases (tuberculosis, sarcoidosis) and fungal infections, may affect the ankle joint in a chronic course. Chronic degenerative changes are usually secondary due to abnormal positioning of the joint constituents or repetitive trauma. Neuropathic changes, as frequently seen in the course of diabetes, present with massive osseous destruction and malposition of the articular constituents. Chronic osseous as well as cartilaginous and synovial changes are seen in hemoplici patients. Chronic traumatic changes are represented by pigmented villonodular synovitis (PVNS), and chondromatosis, both with a predilection for the ankle joint. Due to the possibilities of magnetic resonance imaging (MRI), diagnosis of chronic ankle changes includes chronic ligamentous, tendinous and soft tissue changes. With the use MRI, specific syndromes can be defined which particularly affect the ankle joint in a chronic way, such as the os trigonum syndrome, the anterolateral impingement syndrome and the sinus tarsi syndrome. Nevertheless, plain film radiographs are still the basic element of any investigation. MRI, however, can be potentially used as a second investigation, saving an unnecessary cascade of investigations with ultrasound and CT. The latter investigations are used only with very specific indications, for instance CT for subtle bone structures and sonography for a limited investigation of tendons or evaluation of fluid. Particularly due to the possibilities of MRI and the development of special gradient-echo imaging or

Brain morphological signatures for chronic pain.

Directory of Open Access Journals (Sweden)

Marwan N Baliki

Full Text Available Chronic pain can be understood not only as an altered functional state, but also as a consequence of neuronal plasticity. Here we use in vivo structural MRI to compare global, local, and architectural changes in gray matter properties in patients suffering from chronic back pain (CBP, complex regional pain syndrome (CRPS and knee osteoarthritis (OA, relative to healthy controls. We find that different chronic pain types exhibit unique anatomical 'brain signatures'. Only the CBP group showed altered whole-brain gray matter volume, while regional gray matter density was distinct for each group. Voxel-wise comparison of gray matter density showed that the impact on the extent of chronicity of pain was localized to a common set of regions across all conditions. When gray matter density was examined for large regions approximating Brodmann areas, it exhibited unique large-scale distributed networks for each group. We derived a barcode, summarized by a single index of within-subject co-variation of gray matter density, which enabled classification of individual brains to their conditions with high accuracy. This index also enabled calculating time constants and asymptotic amplitudes for an exponential increase in brain re-organization with pain chronicity, and showed that brain reorganization with pain chronicity was 6 times slower and twice as large in CBP in comparison to CRPS. The results show an exuberance of brain anatomical reorganization peculiar to each condition and as such reflecting the unique maladaptive physiology of different types of chronic pain.

Shared genetic factors underlie chronic pain syndromes

NARCIS (Netherlands)

Vehof, Jelle; Zavos, Helena M. S.; Lachance, Genevieve; Hammond, Christopher J.; Williams, Frances M. K.

Chronic pain syndromes (CPS) are highly prevalent in the general population, and increasingly the evidence points to a common etiological pathway. Using a large cohort of twins (n = 8564) characterized for chronic widespread musculoskeletal pain (CWP), chronic pelvic pain (PP), migraine (MIG), dry

Chronic Cough in Otorhinolaryngologic Routine

Directory of Open Access Journals (Sweden)

Palheta Neto, Francisco Xavier

2011-04-01

Full Text Available Introduction: The chronic cough is sometimes manifested as an imprecise symptom, but of great importance for both the diagnosis and the prognosis. In an otorhinolaryngologic approach, several illnesses that can occur with it can be numbered, including 2 of the 3 main causes of chronic cough. Objective: To identify the main otorhinolaryngologic diseases showing the chronic cough as one of their manifestations. Method: A literature's revision was performed in several scientific articles, specialized books and consultation in Birene and Scielo databases. Literature's revision: cough production in the upper airways is usually associated with an inflammatory reaction by stimulating sensitive receptors of these areas or by mechanic stimulus. The main cause of the chronic cough in the otorhinolaryngology day-to-day is the post-nasal drip, gathering together by itself 02 of the most common diseases: rhinitis and sinusitis. Laryngitis as a result of gastroesophageal reflux (GER stands out in the index of chronic cough etiology, but it is not as severe as GER . Neoplasias are also somewhat frequent causes of cough, and the difficulty in diagnosing the cough cause is common in this disease group. Motility disorder, laryngeal irritation persistence, parasitic disease and injuries by inhalation of toxic products were also found as a cause of cough for longer than 03 months. Conclusion:Chronic cough is a frequent and important finding in otorhinolaryngology and cannot be underestimated, and a careful anamnesis is the best way to determine the etiology and perform a correct treatment for the patient's disease.

Chronic Pain Among Homeless Persons with Mental Illness.

Science.gov (United States)

Vogel, Marc; Frank, Anastasia; Choi, Fiona; Strehlau, Verena; Nikoo, Nooshin; Nikoo, Mohammadali; Hwang, Stephen W; Somers, Julian; Krausz, Michael R; Schütz, Christian G

2017-12-01

Chronic pain is an important public health issue. However, characteristics and needs of marginalized populations have received limited attention. Studies on prevalence and correlates of chronic pain among homeless persons are lacking. We assessed chronic pain among homeless persons with mental illness in the At Home/Chez Soi study. Cross-sectional data from a randomized controlled trial on homelessness and mental health. Data collected between 2009 and 2013 in three Canadian cities. One thousand two hundred eighty-seven homeless persons with mental illness. Data on chronic pain and utilization of prescribed and nonprescribed interventions was assessed using a chronic pain screening instrument. Mental illness was diagnosed with the Mini-International Neuropsychiatric Interview. Forty-three percent reported moderate to severe chronic pain, interfering with general daily activities (80%), sleep (78%), and social interactions (61%). Multivariate analysis indicated that increasing age and diagnoses of major depressive disorder, mood disorder with psychotic features, panic disorder, and post-traumatic stress disorder (PTSD) were independent predictors of chronic pain. Chronic pain was further associated with increased suicidality. Among participants reporting chronic pain, 64% had sought medical treatment and 56% treated pain with prescribed drugs, while 38% used illicit drugs for pain relief. Chronic pain is very common among homeless persons with mental illness and affects activities of daily living. Clinicians treating this population should be aware of the common connections between chronic pain, depression, panic disorder, PTSD, and substance use. While the data indicate the contribution of chronic pain to complex treatment needs, they also indicate a clear treatment gap. © 2017 American Academy of Pain Medicine. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com

Chronic sleep reduction in adolescents

NARCIS (Netherlands)

Dewald-Kaufmann, J.F.

2012-01-01

Based on the results of this thesis, it can be concluded that sleep problems and chronic sleep reduction have a high impact on adolescents’ daytime functioning. Additionally, this research shows that gradual sleep extension can improve adolescents’ sleep and especially their chronic sleep reduction.

Defining and Measuring Chronic Conditions

Centers for Disease Control (CDC) Podcasts

This podcast is an interview with Dr. Anand Parekh, U.S. Department of Health and Human Services Deputy Assistant Secretary for Health, and Dr. Samuel Posner, Preventing Chronic Disease Editor in Chief, about the definition and burden of multiple chronic conditions in the United States.

Chronic infections in hip arthroplasties

DEFF Research Database (Denmark)

Lange, Jeppe; Troelsen, Anders; Thomsen, Reimar W

2012-01-01

Two-stage revision is regarded by many as the best treatment of chronic infection in hip arthroplasties. Some international reports, however, have advocated one-stage revision. No systematic review or meta-analysis has ever compared the risk of reinfection following one-stage and two-stage revisi......Two-stage revision is regarded by many as the best treatment of chronic infection in hip arthroplasties. Some international reports, however, have advocated one-stage revision. No systematic review or meta-analysis has ever compared the risk of reinfection following one-stage and two......-stage revisions for chronic infection in hip arthroplasties....

Periodontitis in Chronic Heart Failure.

Science.gov (United States)

Fröhlich, Hanna; Herrmann, Kristina; Franke, Jennifer; Karimi, Alamara; Täger, Tobias; Cebola, Rita; Katus, Hugo A; Zugck, Christian; Frankenstein, Lutz

2016-08-01

Periodontal disease has been associated with an increased risk of cardiovascular events. The purpose of our study was to investigate whether a correlation between periodontitis and chronic heart failure exists, as well as the nature of the underlying cause. We enrolled 71 patients (mean age, 54 ± 13 yr; 56 men) who had stable chronic heart failure; all underwent complete cardiologic and dental evaluations. The periodontal screening index was used to quantify the degree of periodontal disease. We compared the findings to those in the general population with use of data from the 4th German Dental Health Survey. Gingivitis, moderate periodontitis, and severe periodontitis were present in 17 (24%), 17 (24%), and 37 (52%) patients, respectively. Severe periodontitis was more prevalent among chronic heart failure patients than in the general population. In contrast, moderate periodontitis was more prevalent in the general population (P periodontal disease was not associated with the cause of chronic heart failure or the severity of heart failure symptoms. Six-minute walking distance was the only independent predictor of severe periodontitis. Periodontal disease is highly prevalent in chronic heart failure patients regardless of the cause of heart failure. Prospective trials are warranted to clarify the causal relationship between both diseases.

Pharmacological challenges in chronic pancreatitis.

Science.gov (United States)

Olesen, Anne Estrup; Brokjaer, Anne; Fisher, Iben Wendelboe; Larsen, Isabelle Myriam

2013-11-14

Drug absorption in patients with chronic pancreatitis might be affected by the pathophysiology of the disease. The exocrine pancreatic insufficiency is associated with changes in gastrointestinal intraluminal pH, motility disorder, bacterial overgrowth and changed pancreatic gland secretion. Together these factors can result in malabsorption and may also affect the efficacy of pharmacological intervention. The lifestyle of chronic pancreatitis patients may also contribute to gastrointestinal changes. Many patients limit their food intake because of the pain caused by eating and in some cases food intake is more or less substituted with alcohol, tobacco and coffee. Alcohol and drug interaction are known to influence the pharmacokinetics by altering either drug absorption or by affecting liver metabolism. Since patients suffering from chronic pancreatitis experience severe pain, opioids are often prescribed as pain treatment. Opioids have intrinsic effects on gastrointestinal motility and hence can modify the absorption of other drugs taken at the same time. Furthermore, the increased fluid absorption caused by opioids will decrease water available for drug dissolution and may hereby affect absorption of the drug. As stated above many factors can influence drug absorption and metabolism in patients with chronic pancreatitis. The factors may not have clinical relevance, but may explain inter-individual variations in responses to a given drug, in patients with chronic pancreatitis.

Fisetin and Its Role in Chronic Diseases.

Science.gov (United States)

Pal, Harish C; Pearlman, Ross L; Afaq, Farrukh

2016-01-01

Chronic inflammation is a prolonged and dysregulated immune response leading to a wide variety of physiological and pathological conditions such as neurological abnormalities, cardiovascular diseases, diabetes, obesity, pulmonary diseases, immunological diseases, cancers, and other life-threatening conditions. Therefore, inhibition of persistent inflammation will reduce the risk of inflammation-associated chronic diseases. Inflammation-related chronic diseases require chronic treatment without side effects. Use of traditional medicines and restricted diet has been utilized by mankind for ages to prevent or treat several chronic diseases. Bioactive dietary agents or "Nutraceuticals" present in several fruits, vegetables, legumes, cereals, fibers, and certain spices have shown potential to inhibit or reverse the inflammatory responses and several chronic diseases related to chronic inflammation. Due to safe, nontoxic, and preventive benefits, the use of nutraceuticals as dietary supplements or functional foods has increased in the Western world. Fisetin (3,3',4',7-tetrahydroxyflavone) is a dietary flavonoid found in various fruits (strawberries, apples, mangoes, persimmons, kiwis, and grapes), vegetables (tomatoes, onions, and cucumbers), nuts, and wine that has shown strong anti-inflammatory, anti-oxidant, anti-tumorigenic, anti-invasive, anti-angiogenic, anti-diabetic, neuroprotective, and cardioprotective effects in cell culture and in animal models relevant to human diseases. In this chapter, we discuss the beneficial pharmacological effects of fisetin against different pathological conditions with special emphasis on diseases related to chronic inflammatory conditions.

Chronic disease as risk multiplier for disadvantage.

Science.gov (United States)

Stutzin Donoso, Francisca

2018-03-06

This paper starts by establishing a prima facie case that disadvantaged groups or individuals are more likely to get a chronic disease and are in a disadvantaged position to adhere to chronic treatment despite access through Universal Health Coverage. However, the main aim of this paper is to explore the normative implications of this claim by examining two different but intertwined argumentative lines that might contribute to a better understanding of the ethical challenges faced by chronic disease health policy. The paper develops the argument that certain disadvantages which may predispose to illness might overlap with disadvantages that may hinder self-management, potentially becoming disadvantageous in handling chronic disease. If so, chronic diseases may be seen as disadvantages in themselves, describing a reproduction of disadvantage among the chronically ill and a vicious circle of disadvantage that could both predict and shed light on the catastrophic health outcomes among disadvantaged groups-or individuals-dealing with chronic disease. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2018. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

Chinese medicinal herbs for chronic hepatitis B

DEFF Research Database (Denmark)

Liu, J; McIntosh, H; Lin, Haili

2001-01-01

Chronic hepatitis B is a serious health problem worldwide. Chinese medicinal herbs are widely used for treatment of chronic hepatitis B in China and many clinical trials have been conducted. This systematic review is to assess the efficacy and safety of Chinese medicinal herbs for chronic hepatitis...

Health-Related Quality of Life among Chronic Opioid Users, Nonchronic Opioid Users, and Nonopioid Users with Chronic Noncancer Pain.

Science.gov (United States)

Hayes, Corey J; Li, Xiaocong; Li, Chenghui; Shah, Anuj; Kathe, Niranjan; Bhandari, Naleen Raj; Payakachat, Nalin

2018-02-25

Evaluate the association between opioid therapy and health-related quality of life (HRQoL) in participants with chronic, noncancer pain (CNCP). Medical Expenditure Panel Survey Longitudinal, Medical Conditions, and Prescription Files. Using a retrospective cohort study design, the Mental Health Component (MCS12) and Physical Health Component (PCS12) scores of the Short Form-12 Version 2 were assessed to measure mental and physical HRQoL. Chronic, noncancer pain participants were classified as chronic, nonchronic, and nonopioid users. One-to-one propensity score matching was employed to match chronic opioid users to nonchronic opioid users plus nonchronic opioid users and chronic opioid users to nonopioid users. A total of 5,876 participants were identified. After matching, PCS12 was not significantly different between nonchronic versus nonopioid users (LSM Diff = -0.98, 95% CI: -2.07, 0.10), chronic versus nonopioid users (LSM Diff = -2.24, 95% CI: -4.58, 0.10), or chronic versus nonchronic opioid users (LSM Diff = -2.23, 95% CI: -4.53, 0.05). Similarly, MCS12 was not significantly different between nonchronic versus nonopioid users (LSM Diff = 0.76, 95% CI: -0.46, 1.98), chronic versus nonopioid users (LSM Diff = 1.08, 95% CI: -1.26, 3.42), or chronic versus nonchronic opioid users (LSM Diff = -0.57, 95% CI: -2.90, 1.77). Clinicians should evaluate opioid use in participants with CNCP as opioid use is not correlated with better HRQoL. © Health Research and Educational Trust.

The Key Genes of Chronic Pancreatitis which Bridge Chronic Pancreatitis and Pancreatic Cancer Can be Therapeutic Targets.

Science.gov (United States)

Li, Shuang; Li, Rui; Wang, Heping; Li, Lisha; Li, Huiyu; Li, Yulin

2018-04-01

An important question in systems biology is what role the underlying molecular mechanisms play in disease progression. The relationship between chronic pancreatitis and pancreatic cancer needs further exploration in a system view. We constructed the disease network based on gene expression data and protein-protein interaction. We proposed an approach to discover the underlying core network and molecular factors in the progression of pancreatic diseases, which contain stages of chronic pancreatitis and pancreatic cancer. The chronic pancreatitis and pancreatic cancer core network and key factors were revealed and then verified by gene set enrichment analysis of pathways and diseases. The key factors provide the microenvironment for tumor initiation and the change of gene expression level of key factors bridge chronic pancreatitis and pancreatic cancer. Some new candidate genes need further verification by experiments. Transcriptome profiling-based network analysis reveals the importance of chronic pancreatitis genes and pathways in pancreatic cancer development on a system level by computational method and they can be therapeutic targets.

Enteric hyperoxaluria in chronic pancreatitis.

Science.gov (United States)

Demoulin, Nathalie; Issa, Zaina; Crott, Ralph; Morelle, Johann; Danse, Etienne; Wallemacq, Pierre; Jadoul, Michel; Deprez, Pierre H

2017-05-01

Chronic pancreatitis may lead to steatorrhea, enteric hyperoxaluria, and kidney damage. However, the prevalence and determinants of hyperoxaluria in chronic pancreatitis patients as well as its association with renal function decline have not been investigated.We performed an observational study. Urine oxalate to creatinine ratio was assessed on 2 independent random urine samples in consecutive adult patients with chronic pancreatitis followed at the outpatient clinic from March 1 to October 31, 2012. Baseline characteristics and annual estimated glomerular filtration rate (eGFR) change during follow-up were compared between patients with hyper- and normo-oxaluria.A total of 48 patients with chronic pancreatitis were included. The etiology of the disease was toxic (52%), idiopathic (27%), obstructive (11%), autoimmune (6%), or genetic (4%). Hyperoxaluria (defined as urine oxalate to creatinine ratio >32 mg/g) was found in 23% of patients. Multivariate regression analysis identified clinical steatorrhea, high fecal acid steatocrit, and pancreatic atrophy as independent predictors of hyperoxaluria. Taken together, a combination of clinical steatorrhea, steatocrit level >31%, and pancreatic atrophy was associated with a positive predictive value of 100% for hyperoxaluria. On the contrary, none of the patients with a fecal elastase-1 level >100 μg/g had hyperoxaluria. Longitudinal evolution of eGFR was available in 71% of the patients, with a mean follow-up of 904 days. After adjustment for established determinants of renal function decline (gender, diabetes, bicarbonate level, baseline eGFR, and proteinuria), a urine oxalate to creatinine ratio >32 mg/g was associated with a higher risk of eGFR decline.Hyperoxaluria is highly prevalent in patients with chronic pancreatitis and associated with faster decline in renal function. A high urine oxalate to creatinine ratio in patients with chronic pancreatitis is best predicted by clinical steatorrhea, a high acid

Case series

African Journals Online (AJOL)

ebutamanya

2015-01-29

Jan 29, 2015 ... Doppler cardiaque (121 cas sur 380) soit 39,53%. Les CIV étaient au premier plan des cardiopathies congénitales (28,26%), suivies des CIA. (23,19%), des sténoses pulmonaires (19,57%), des Tétralogie de Fallot (9,42%). Dans leur forme isolée, les CIA étaient les plus fréquentes avec. 21,95% des cas, ...

Imaging in the diagnosis of chronic pancreatitis

Directory of Open Access Journals (Sweden)

Vasile D. Balaban

2014-12-01

Full Text Available Chronic pancreatitis is characterised by progressive and irreversible damage of the pancreatic parenchyma and ductal system, which leads to chronic pain, loss of endocrine and exocrine functions. Clinically, pancreatic exocrine insufficiency becomes apparent only after 90% of the parenchima has been lost. Despite the simple definition, diagnosing chronic pancreatitis remains a challenge, especially for early stage disease. Because pancreatic function tests can be normal until late stages and have significant limitations, there is an incresing interest in the role of imaging techniques for the diagnosis of chronic pancreatitis. In this article we review the utility and accuracy of different imaging methods in the diagnosis of chronic pancreatitis, focusing on the role of advanced imaging (magnetic resonance imaging, endoscopic retrograde cholangiopancreatography and endoscopic ultrasound.

A Customizable Model for Chronic Disease Coordination: Lessons Learned From the Coordinated Chronic Disease Program.

Science.gov (United States)

Voetsch, Karen; Sequeira, Sonia; Chavez, Amy Holmes

2016-03-31

In 2012, the Centers for Disease Control and Prevention provided funding and technical assistance to all states and territories to implement the Coordinated Chronic Disease Program, marking the first time that all state health departments had federal resources to coordinate chronic disease prevention and control programs. This article describes lessons learned from this initiative and identifies key elements of a coordinated approach. We analyzed 80 programmatic documents from 21 states and conducted semistructured interviews with 7 chronic disease directors. Six overarching themes emerged: 1) focused agenda, 2) identification of functions, 3) comprehensive planning, 4) collaborative leadership and expertise, 5) managed resources, and 6) relationship building. These elements supported 4 essential activities: 1) evidence-based interventions, 2) strategic use of staff, 3) consistent communication, and 4) strong program infrastructure. On the basis of these elements and activities, we propose a conceptual model that frames overarching concepts, skills, and strategies needed to coordinate state chronic disease prevention and control programs.

How Is Chronic Myeloid Leukemia Diagnosed?

Science.gov (United States)

... Myeloid Leukemia? More In Chronic Myeloid Leukemia About Chronic Myeloid Leukemia Causes, Risk Factors, and Prevention Early Detection, Diagnosis, and Staging Treatment After Treatment Back To Top Imagine a world ...

Multiple chronic conditions and life expectancy

DEFF Research Database (Denmark)

DuGoff, Eva H; Canudas-Romo, Vladimir; Buttorff, Christine

2014-01-01

BACKGROUND: The number of people living with multiple chronic conditions is increasing, but we know little about the impact of multimorbidity on life expectancy. OBJECTIVE: We analyze life expectancy in Medicare beneficiaries by number of chronic conditions. RESEARCH DESIGN: A retrospective cohort...... study using single-decrement period life tables. SUBJECTS: Medicare fee-for-service beneficiaries (N=1,372,272) aged 67 and older as of January 1, 2008. MEASURES: Our primary outcome measure is life expectancy. We categorize study subjects by sex, race, selected chronic conditions (heart disease, cancer...... and increasing numbers of comorbid conditions. CONCLUSIONS: Social Security and Medicare actuaries should account for the growing number of beneficiaries with multiple chronic conditions when determining population projections and trust fund solvency....

Gastric emptying in chronic dyspepsia

International Nuclear Information System (INIS)

Sielaff, F.; Jahnel, P.; Sest, C.; Sydow, K.; Sapia, C.; Hass, A.; Buchali, K.

1987-01-01

Gastric emptying of a semiliquid test meal with 5 MBq /sup 99m/Tc-sulfur colloid as a marker was measured in 97 chronic dyspeptic patients and 16 healthy subjects. A comparison of half emptying time between both showed that chronic dyspeptic patients empty semiliquid meal at a significantly (p < 0.005) slower rate (at 70 +- 33 min) than healthy controls (at 52 x 20 min). The studies indicate that gastric stasis in chronic dyspepsia is not caused by inflammatory changes in gastric or duodenal mucosa nor by different gastric acid secretion. The presence of stasis cannot be predicted sufficiently by anamnestic complaints or endoscopic findings. (author)

Oriental Medical Treatment of chronic Acalculous Cholecystitis

Directory of Open Access Journals (Sweden)

Hae-Yeon Lee

2004-12-01

Full Text Available Chronic acalculous cholecystitis gets possession of about 12 to 13 percent of patients with chronic cholecystitis. Pathologically it is characterised by chronic inflammation and thickening of the gallbladder wall but doesn't come across stones. Clinical symptoms are vague and include abdominal discomfort and distension, nausea, flatulence and intolerance of fatty foods. A patient on chronic acalculous cholecystitis diagnosed from his clinical symtoms and abdominal ultrasonogram was treated by Geonbihwan, acupuncture and herbal acupuncture. Satisfactory symptomatic improvement was achieved and findings of abdominal ultrasonogram came also normal.

Chronic obstructive pulmonary disease - adults - discharge

Science.gov (United States)

... coughing up dark mucus Your fingertips or the skin around your fingernails are blue Alternative Names COPD - adults - discharge; Chronic obstructive airways disease - adults - discharge; Chronic obstructive lung disease - adults - discharge; ...

Etiologies of chronic liver disease in children

Directory of Open Access Journals (Sweden)

Farahmand F

2001-11-01

Full Text Available Chronic Liver diseases in children is the result of many different diseases including: metabolic, genetic, infectious, toxic and idiopathic causes. This was a case series study on 133 infants and children with age range 6 month to 12 years old, who presented clinically with manifestation of chronic liver disease and were admitted to Children Hospital Medical Center from year 1999 to 2000. In this study, 32 (24.5 percent patients had autoimmune chronic hepatitis, 15 (11.3 percent Glycogen storage diseases, 12 (9 percent extrahepatic biliary atresia, 11 (8.2 percent willson disease, 10 (7.5 percent cryptogenic cirrhosis, 6 (4.5 percent chronic hepatitis C, 5 (3.8 percen chronic hepatitic B, 5 (3.8 percent galactosemia 3 (2.25 percent congenital hepatic fibrosis, 3 (3.8 percent histiocytosis X, 3 (2.25 percent sclerosing cholangitis, 2 (1.5 percent byler’s disease 2 (1.5 percent primary tuberculosis, 1 (0.75 percent choledocalcyst, 1 (0.75 percent Alagyle syndrome. According to our data, chronic liver disease should be considered in infants and children. In our study, the most common causes are found to be: metabolic and genetic diseases (37.5 percent, chronic autoimmune hepatitis (24 percent and biliary disorders (14 percent, that encompass 86 percent of the patients.

Integration of healthcare rehabilitation in chronic conditions

Directory of Open Access Journals (Sweden)

Anne Frølich

2010-02-01

Full Text Available Introduction: Quality of care provided to people with chronic conditions does not often fulfil standards of care in Denmark and in other countries. Inadequate organisation of healthcare systems has been identified as one of the most important causes for observed performance inadequacies, and providing integrated healthcare has been identified as an important organisational challenge for healthcare systems. Three entities—Bispebjerg University Hospital, the City of Copenhagen, and the GPs in Copenhagen—collaborated on a quality improvement project focusing on integration and implementation of rehabilitation programmes in four conditions. Description of care practice: Four multidisciplinary rehabilitation intervention programmes, one for each chronic condition: chronic obstructive pulmonary disease, type 2 diabetes, chronic heart failure, and falls in elderly people were developed and implemented during the project period. The chronic care model was used as a framework for support of implementing and integration of the four rehabilitation programmes. Conclusion and discussion: The chronic care model provided support for implementing rehabilitation programmes for four chronic conditions in Bispebjerg University Hospital, the City of Copenhagen, and GPs' offices. New management practices were developed, known practices were improved to support integration, and known practices were used for implementation purposes. Several barriers to integrated care were identified.

Expression of AQP3 gene in chronic atrophic and chronic superficial gastritis patients

Directory of Open Access Journals (Sweden)

Shijun Zhang

2007-12-01

Full Text Available BACKGROUND: Most studies about aquaporin 3 (AQP3 in the gastrointestinal tract were carried out on both in vivo and in vitro. The role of AQP3-mediated water transport in human gastrointestinal tract is still unclear. Our aim in this study was to explore the expression of AQP3 gene in chronic atrophic gastritis (CAG and chronic superficial gastritis (CSG atients and to determine its possible function in the development of gastritis.
METHODS: Twenty-two outpatients diagnosed as CSG and 12 outpatients diagnosed as CAG were selected randomly. Ten cases of healthy individuals were selected as normal control group. In all cases, AQP3 gene expression of gastric mucosa was detected by fluorescence quantitative polymerase chain reaction (FQ-PCR.
RESULTS: The AQP3 gene expression was significantly higher in gastric mucosa of CSG and healthy individuals than that in CAG (P<0.01. However, there was no significant difference in the AQP3 gene expression between helicobacter pylori positive patients and helicobacter pylori negative patients (P>0.05.
CONCLUSIONS: AQP3 expression might play certain role in the occurrence and development of gastritis.
KEY WORDS: Aquaporin 3, chronic superficial gastritis, chronic atrophic gastritis.

SECRETED KLOTHO AND CHRONIC KIDNEY DISEASE

Science.gov (United States)

Hu, Ming Chang; Kuro-o, Makoto; Moe, Orson W.

2013-01-01

Soluble Klotho (sKl) in the circulation can be generated directly by alterative splicing of the Klotho transcript or the extracellular domain of membrane Klotho can be released from membrane-anchored Klotho on the cell surface. Unlike membrane Klotho which functions as a coreceptor for fibroblast growth factor-23 (FGF23), sKl, acts as hormonal factor and plays important roles in anti-aging, anti-oxidation, modulation of ion transport, and Wnt signaling. Emerging evidence reveals that Klotho deficiency is an early biomarker for chronic kidney diseases as well as a pathogenic factor. Klotho deficiency is associated with progression and chronic complications in chronic kidney disease including vascular calcification, cardiac hypertrophy, and secondary hyperparathyroidism. In multiple experimental models, replacement of sKl, or manipulated up-regulation of endogenous Klotho protect the kidney from renal insults, preserve kidney function, and suppress renal fibrosis, in chronic kidney disease. Klotho is a highly promising candidate on the horizon as an early biomarker, and as a novel therapeutic agent for chronic kidney disease. PMID:22396167

Analysis of the relationship cost-effectiveness of the myocardial gammagraphy studies and the impact to the total expenditure by diagnostic of ischemic cardiopathy; Analisis de la relacion costo-efectividad de los estudios de gamagrafia miocardica e impacto al gasto total por diagnostico de cardiopatia isquemica

Energy Technology Data Exchange (ETDEWEB)

Valenzuela F, A.G.; Perez C, J.P. [Servicio de Cardiologia Nuclear, Hospital cardiologia CMN, IMSS, Mexico D.F. (Mexico); Arreola O, H. [Fundacion Mexicana para la Salud, Mexico D.F. (Mexico); Valenzuela F, A.A. [Unidad de Epidemiologia Hospitalaria, IMSS, Mexico D.F. (Mexico); Soto M, H. [UAEM, Toluca, Estado de Mexico (Mexico); Arguero S, R. [Director del Hospital de Cardiologia, IMSS, Mexico D.F. (Mexico)

2005-07-01

Recent advances in pharmacology, diagnostic and invasive procedures provide a series of modalities that diminish the morbidity and increase the long term survival in the patients that have suffered a heart attack to myocardium. The stratification by risk is an essential element for the handling of the survivors of heart attack to myocardium. In their attention it is looked for to optimize the therapeutic benefit, to diminish the unnecessary diagnostic and therapeutic procedures and to improve the efficiency. For example, a coronariography in sick with heart attack to myocardium it is not cost-effective if not is clinically suitable. Of there that from the institutional point of view, this is, of the Mexican Institute of the Public Health, they are required of appropriate reference approaches and counter reference to grant to the sick person, the best service that is the one in this case the diagnostic and the handling of the ischemic cardiopathy with the smallest waste of resources. The estimation of the annual survival is the base of the stratification, it constitutes the angular stone of the early handling of the heart attack to myocardium. The goal for the clinical would be to identify patients with intermediate risk, since, this risk makes them candidates to therapy interventionist. As long as those with low risk won't require intervention. This would allow the decrease of rates by revenues of heart attack to myocardium, and therefore to diminish the hospital staying rates. The Nuclear Cardiology (myocardial gammagraphy) it is not the only invasive method available to evaluate the myocardial perfusion in sick in who coronary illness is suspected. When the myocardial gammagraphy is carried out in appropriate population, the cost it diminishes because it restricts the necessity of additional invasive evaluations. This because the nuclear cardiology has predictive value so much for the mortality like to detect myocardial viability. Based on these

Neighborhood, Socioeconomic, and Racial Influence on Chronic Pain.

Science.gov (United States)

Maly, Angelika; Vallerand, April Hazard

2018-02-01

The purpose of this review is to highlight the neighborhood, socioeconomic, and racial influences on chronic pain. Negative influences on the experience of chronic pain are explored and defined as any adverse stressor common in low socioeconomic, urban neighborhoods that potentially contributes to health disparity in African Americans experiencing chronic pain. The multifactorial influences on chronic pain disparity in African Americans are explored and expounded upon in this review of existing evidence. Databases used for the search included CINAHL, PubMed, and PsycArticles. The experience of chronic pain is multifaceted, existing with multiple comorbidities and lasting consequences. To improve the burden of chronic pain requires a multifactorial assessment that considers neighborhood risk factors, emphasis on environmental stressors, limitations to support networks, barriers to physical activity, and access to primary care providers with whom communication is open and without bias. A comprehensive assessment of barriers will aid in the development of interventions that reach beyond the physical factors of chronic pain, also considering the psychosocial barriers to improving the burden of chronic pain in African Americans living in impoverished urban neighborhoods. Copyright © 2017 American Society for Pain Management Nursing. Published by Elsevier Inc. All rights reserved.

Chronic Condition Public Use File (PUF)

Data.gov (United States)

U.S. Department of Health & Human Services — This release contains the Chronic Conditions Public Use Files (PUF) with information from Medicare claims. The CMS Chronic Conditions PUF is an aggregated file in...

Prevalence of chronic conditions in Australia.

Directory of Open Access Journals (Sweden)

Christopher Harrison

Full Text Available OBJECTIVES: To estimate prevalence of chronic conditions among patients seeing a general practitioner (GP, patients attending general practice at least once in a year, and the Australian population. DESIGN SETTING AND PARTICIPANTS: A sub-study of the BEACH (Bettering the Evaluation and Care of Health program, a continuous national study of general practice activity conducted between July 2008 and May 2009. Each of 290 GPs provided data for about 30 consecutive patients (total 8,707 indicating diagnosed chronic conditions, using their knowledge of the patient, patient self-report, and patient's health record. MAIN OUTCOME MEASURES: Estimates of prevalence of chronic conditions among patients surveyed, adjusted prevalence in patients who attended general practice at least once that year, and national population prevalence. RESULTS: Two-thirds (66.3% of patients surveyed had at least one chronic condition: most prevalent being hypertension (26.6%, hyperlipidaemia (18.5%, osteoarthritis (17.8%, depression (13.7%, gastro-oesophageal reflux disease (11.6%, asthma (9.5% and Type 2 diabetes (8.3%. For patients who attended general practice at least once, we estimated 58.8% had at least one chronic condition. After further adjustment we estimated 50.8% of the Australian population had at least one chronic condition: hypertension (17.4%, hyperlipidaemia (12.7%, osteoarthritis (11.1%, depression (10.5% and asthma (8.0% being most prevalent. CONCLUSIONS: This study used GPs to gather information from their knowledge, the patient, and health records, to provide prevalence estimates that overcome weaknesses of studies using patient self-report or health record audit alone. Our results facilitate examination of primary care resource use in management of chronic conditions and measurement of prevalence of multimorbidity in Australia.

Alberta's systems approach to chronic disease management and prevention utilizing the expanded chronic care model.

Science.gov (United States)

Delon, Sandra; Mackinnon, Blair

2009-01-01

Alberta's integrated approach to chronic disease management programming embraces client-centred care, supports self-management and facilitates care across the continuum. This paper presents strategies implemented through collaboration with primary care to improve care of individuals with chronic conditions, evaluation evidence supporting success and lessons learned from the Alberta perspective.

Chronic fatigue syndrome after infectious mononucleosis in adolescents.

Science.gov (United States)

Katz, Ben Z; Shiraishi, Yukiko; Mears, Cynthia J; Binns, Helen J; Taylor, Renee

2009-07-01

The goal was to characterize prospectively the course and outcome of chronic fatigue syndrome in adolescents during a 2-year period after infectious mononucleosis. A total of 301 adolescents (12-18 years of age) with infectious mononucleosis were identified and screened for nonrecovery 6 months after infectious mononucleosis by using a telephone screening interview. Nonrecovered adolescents underwent a medical evaluation, with follow-up screening 12 and 24 months after infectious mononucleosis. After blind review, final diagnoses of chronic fatigue syndrome at 6, 12, and 24 months were made by using established pediatric criteria. Six, 12, and 24 months after infectious mononucleosis, 13%, 7%, and 4% of adolescents, respectively, met the criteria for chronic fatigue syndrome. Most individuals recovered with time; only 2 adolescents with chronic fatigue syndrome at 24 months seemed to have recovered or had an explanation for chronic fatigue at 12 months but then were reclassified as having chronic fatigue syndrome at 24 months. All 13 adolescents with chronic fatigue syndrome 24 months after infectious mononucleosis were female and, on average, they reported greater fatigue severity at 12 months. Reported use of steroid therapy during the acute phase of infectious mononucleosis did not increase the risk of developing chronic fatigue syndrome. Infectious mononucleosis may be a risk factor for chronic fatigue syndrome in adolescents. Female gender and greater fatigue severity, but not reported steroid use during the acute illness, were associated with the development of chronic fatigue syndrome in adolescents. Additional research is needed to determine other predictors of persistent fatigue after infectious mononucleosis.

Proteomics portrait of archival lesions of chronic pancreatitis.

Directory of Open Access Journals (Sweden)

Sheng Pan

Full Text Available Chronic pancreatitis is a chronic inflammatory disorder of the pancreas. The etiology is multi-fold, but all lead to progressive scarring and loss of pancreatic function. Early diagnosis is difficult; and the understanding of the molecular events that underlie this progressive disease is limited. In this study, we investigated differential proteins associated with mild and severe chronic pancreatitis in comparison with normal pancreas and pancreatic cancer. Paraffin-embedded formalin-fixed tissues from five well-characterized specimens each of normal pancreas (NL, mild chronic pancreatitis (MCP, severe chronic pancreatitis (SCP and pancreatic ductal adenocarcinoma (PDAC were subjected to proteomic analysis using a "label-free" comparative approach. Our results show that the numbers of differential proteins increase substantially with the disease severity, from mild to severe chronic pancreatitis, while the number of dysregulated proteins is highest in pancreatic adenocarcinoma. Important functional groups and biological processes associated with chronic pancreatitis and cancer include acinar cell secretory proteins, pancreatic fibrosis/stellate cell activation, glycoproteins, and inflammatory proteins. Three differential proteins were selected for verification by immunohistochemistry, including collagen 14A1, lumican and versican. Further canonical pathway analysis revealed that acute phase response signal, prothrombin activation pathway, and pancreatic fibrosis/pancreatic stellate cell activation pathway were the most significant pathways involved in chronic pancreatitis, while pathways relating to metabolism were the most significant pathways in pancreatic adenocarcinoma. Our study reveals a group of differentially expressed proteins and the related pathways that may shed light on the pathogenesis of chronic pancreatitis and the common molecular events associated with chronic pancreatitis and pancreatic adenocarcinoma.

Chronic pelvic floor dysfunction.

Science.gov (United States)

Hartmann, Dee; Sarton, Julie

2014-10-01

The successful treatment of women with vestibulodynia and its associated chronic pelvic floor dysfunctions requires interventions that address a broad field of possible pain contributors. Pelvic floor muscle hypertonicity was implicated in the mid-1990s as a trigger of major chronic vulvar pain. Painful bladder syndrome, irritable bowel syndrome, fibromyalgia, and temporomandibular jaw disorder are known common comorbidities that can cause a host of associated muscular, visceral, bony, and fascial dysfunctions. It appears that normalizing all of those disorders plays a pivotal role in reducing complaints of chronic vulvar pain and sexual dysfunction. Though the studies have yet to prove a specific protocol, physical therapists trained in pelvic dysfunction are reporting success with restoring tissue normalcy and reducing vulvar and sexual pain. A review of pelvic anatomy and common findings are presented along with suggested physical therapy management. Copyright © 2014 Elsevier Ltd. All rights reserved.

Chronic obstructive pulmonary disease

Directory of Open Access Journals (Sweden)

V K Vijayan

2013-01-01

Full Text Available The global prevalence of physiologically defined chronic obstructive pulmonary disease (COPD in adults aged >40 yr is approximately 9-10 per cent. Recently, the Indian Study on Epidemiology of Asthma, Respiratory Symptoms and Chronic Bronchitis in Adults had shown that the overall prevalence of chronic bronchitis in adults >35 yr is 3.49 per cent. The development of COPD is multifactorial and the risk factors of COPD include genetic and environmental factors. Pathological changes in COPD are observed in central airways, small airways and alveolar space. The proposed pathogenesis of COPD includes proteinase-antiproteinase hypothesis, immunological mechanisms, oxidant-antioxidant balance, systemic inflammation, apoptosis and ineffective repair. Airflow limitation in COPD is defined as a postbronchodilator FEV1 (forced expiratory volume in 1 sec to FVC (forced vital capacity ratio <0.70. COPD is characterized by an accelerated decline in FEV1. Co morbidities associated with COPD are cardiovascular disorders (coronary artery disease and chronic heart failure, hypertension, metabolic diseases (diabetes mellitus, metabolic syndrome and obesity, bone disease (osteoporosis and osteopenia, stroke, lung cancer, cachexia, skeletal muscle weakness, anaemia, depression and cognitive decline. The assessment of COPD is required to determine the severity of the disease, its impact on the health status and the risk of future events (e.g., exacerbations, hospital admissions or death and this is essential to guide therapy. COPD is treated with inhaled bronchodilators, inhaled corticosteroids, oral theophylline and oral phosphodiesterase-4 inhibitor. Non pharmacological treatment of COPD includes smoking cessation, pulmonary rehabilitation and nutritional support. Lung volume reduction surgery and lung transplantation are advised in selected severe patients. Global strategy for the diagnosis, management and prevention of Chronic Obstructive Pulmonary Disease

Genetics Home Reference: PDGFRB-associated chronic eosinophilic leukemia

Science.gov (United States)

... associated chronic eosinophilic leukemia PDGFRB-associated chronic eosinophilic leukemia Printable PDF Open All Close All Enable Javascript ... expand/collapse boxes. Description PDGFRB -associated chronic eosinophilic leukemia is a type of cancer of blood-forming ...

A randomized controlled trial of qigong exercise on fatigue symptoms, functioning, and telomerase activity in persons with chronic fatigue or chronic fatigue syndrome.

Science.gov (United States)

Ho, Rainbow T H; Chan, Jessie S M; Wang, Chong-Wen; Lau, Benson W M; So, Kwok Fai; Yuen, Li Ping; Sham, Jonathan S T; Chan, Cecilia L W

2012-10-01

Chronic fatigue is common in the general population. Complementary therapies are often used by patients with chronic fatigue or chronic fatigue syndrome to manage their symptoms. This study aimed to assess the effect of a 4-month qigong intervention program among patients with chronic fatigue or chronic fatigue syndrome. Sixty-four participants were randomly assigned to either an intervention group or a wait list control group. Outcome measures included fatigue symptoms, physical functioning, mental functioning, and telomerase activity. Fatigue symptoms and mental functioning were significantly improved in the qigong group compared to controls. Telomerase activity increased in the qigong group from 0.102 to 0.178 arbitrary units (p chronic fatigue and chronic fatigue syndrome.

Management of chronic unstable acromioclavicular joint injuries.

Science.gov (United States)

Cisneros, Luis Natera; Reiriz, Juan Sarasquete

2017-12-01

The acromioclavicular joint represents the link between the clavicle and the scapula, which is responsible for the synchronized dynamic of the shoulder girdle. Chronic acromioclavicular joint instability involves changes in the orientation of the scapula, which provokes cinematic alterations that might result in chronic pain. Several surgical strategies for the management of patients with chronic and symptomatic acromioclavicular joint instability have been described. The range of possibilities includes anatomical and non-anatomical techniques, open and arthroscopy-assisted procedures, and biological and synthetic grafts. Surgical management of chronic acromioclavicular joint instability should involve the reconstruction of the torn ligaments because it is accepted that from three weeks after the injury, these structures may lack healing potential. Here, we provide a review of the literature regarding the management of chronic acromioclavicular joint instability. Expert opinion, Level V.

Community-based exercise training for people with chronic respiratory and chronic cardiac disease: a mixed-methods evaluation

Directory of Open Access Journals (Sweden)

McNamara RJ

2016-11-01

Full Text Available Renae J McNamara,1,2 Zoe J McKeough,3 Laura R Mo,3 Jamie T Dallimore,4 Sarah M Dennis3 1Physiotherapy Department, 2Respiratory and Sleep Medicine Department, Prince of Wales Hospital, Randwick, 3Discipline of Physiotherapy, The University of Sydney, Lidcombe, 4Eastern Sydney Medicare Local, Rosebery, NSW, Australia Background: Poor uptake and adherence are problematic for hospital-based pulmonary and heart failure rehabilitation programs, often because of access difficulties. The aims of this mixed-methods study were to determine the feasibility of a supervised exercise training program in a community gymnasium in people with chronic respiratory and chronic cardiac disease, to explore the experiences of participants and physiotherapists and to determine if a community venue improved access and adherence to rehabilitation. Methods: Adults with chronic respiratory and/or chronic cardiac disease referred to a hospital-based pulmonary and heart failure rehabilitation program were screened to determine their suitability to exercise in a community venue. Eligible patients were offered the opportunity to attend supervised exercise training for 8 weeks in a community gymnasium. Semi-structured interviews were conducted with participants and physiotherapists at the completion of the program. Results: Thirty-one people with chronic respiratory and chronic cardiac disease (34% males, mean [standard deviation] age 72 [10] years commenced the community-based exercise training program. Twenty-two (71% completed the program. All participants who completed the program, and the physiotherapists delivering the program, were highly satisfied, with reports of the community venue being well-equipped, convenient, and easily accessible. Using a community gymnasium promoted a sense of normality and instilled confidence in some to continue exercising at a similar venue post rehabilitation. However, factors such as cost and lack of motivation continue to be barriers

Personalized Medicine for Chronic Respiratory Infectious Diseases: Tuberculosis, Nontuberculous Mycobacterial Pulmonary Diseases, and Chronic Pulmonary Aspergillosis.

Science.gov (United States)

Salzer, Helmut J F; Wassilew, Nasstasja; Köhler, Niklas; Olaru, Ioana D; Günther, Gunar; Herzmann, Christian; Kalsdorf, Barbara; Sanchez-Carballo, Patricia; Terhalle, Elena; Rolling, Thierry; Lange, Christoph; Heyckendorf, Jan

2016-01-01

Chronic respiratory infectious diseases are causing high rates of morbidity and mortality worldwide. Tuberculosis, a major cause of chronic pulmonary infection, is currently responsible for approximately 1.5 million deaths per year. Although important advances in the fight against tuberculosis have been made, the progress towards eradication of this disease is being challenged by the dramatic increase in multidrug-resistant bacilli. Nontuberculous mycobacteria causing pulmonary disease and chronic pulmonary aspergillosis are emerging infectious diseases. In contrast to other infectious diseases, chronic respiratory infections share the trait of having highly variable treatment outcomes despite longstanding antimicrobial therapy. Recent scientific progress indicates that medicine is presently at a transition stage from programmatic to personalized management. We explain current state-of-the-art management concepts of chronic pulmonary infectious diseases as well as the underlying methods for therapeutic decisions and their implications for personalized medicine. Furthermore, we describe promising biomarkers and techniques with the potential to serve future individual treatment concepts in this field of difficult-to-treat patients. These include candidate markers to improve individual risk assessment for disease development, the design of tailor-made drug therapy regimens, and individualized biomarker-guided therapy duration to achieve relapse-free cure. In addition, the use of therapeutic drug monitoring to reach optimal drug dosing with the smallest rate of adverse events as well as candidate agents for future host-directed therapies are described. Taken together, personalized medicine will provide opportunities to substantially improve the management and treatment outcome of difficult-to-treat patients with chronic respiratory infections. © 2016 S. Karger AG, Basel.

Comparative analysis of gingival crevicular fluid β-glucuronidase levels in health, chronic gingivitis and chronic periodontitis.

Science.gov (United States)

Sanara, P P; Shereef, Mohammed; Hegde, Shashikanth; Rajesh, K S; Arun Kumar, M S; Mohamed, Shabeer

2015-08-01

Current methods available for periodontal disease diagnosis are seriously deficient in terms of accuracy, in the ability to predict ongoing or future disease activity and indeed in determining whether previously diseased sites are in an arrested phase or still active. One area that is receiving a great deal of attention is the biochemical investigation of gingival crevicular fluid (GCF). β-glucuronidase (βG) is one of the enzymes found in GCF that is involved in degradation of the ground substance and fibrillar components of host connective tissue. GCF βG activity might be a good indicator or predictor of periodontal disease activity. This study was conducted to estimate and compare the GCF βG levels in patients with healthy periodontium, chronic gingivitis, and chronic periodontitis. Subjects were classified into three groups of 20 patients each; healthy individuals, chronic gingivitis, and chronic periodontitis. After recording the plaque index, gingival index and probing pocket depth, 1 μL GCF was collected by placing a calibrated microcapillary pipette extracrevicularly and transferred to sterile plastic vials containing 350 μL of normal saline with 1% bovine serum albumin. Analysis of βG was done by spectrophotometry. βG levels in GCF were significantly higher in chronic periodontitis group (mean value - 2.04743), followed by chronic gingivitis group (mean - 1.11510) and healthy group (0.53643). Increased βG levels were observed in patients with increased periodontal destruction, hence GCF βG levels can be used as biochemical marker for periodontal disease activity.

Curcumin, Inflammation, and Chronic Diseases: How Are They Linked?

Directory of Open Access Journals (Sweden)

Yan He

2015-05-01

Full Text Available It is extensively verified that continued oxidative stress and oxidative damage may lead to chronic inflammation, which in turn can mediate most chronic diseases including cancer, diabetes, cardiovascular, neurological, inflammatory bowel disease and pulmonary diseases. Curcumin, a yellow coloring agent extracted from turmeric, shows strong anti-oxidative and anti-inflammatory activities when used as a remedy for the prevention and treatment of chronic diseases. How oxidative stress activates inflammatory pathways leading to the progression of chronic diseases is the focus of this review. Thus, research to date suggests that chronic inflammation, oxidative stress, and most chronic diseases are closely linked, and the antioxidant properties of curcumin can play a key role in the prevention and treatment of chronic inflammation diseases.

Overgeneral autobiographical memory in patients with chronic pain.

Science.gov (United States)

Liu, Xianhua; Liu, Yanling; Li, Li; Hu, Yiqiu; Wu, Siwei; Yao, Shuqiao

2014-03-01

Overgenerality and delay of the retrieval of autobiographical memory (AM) are well documented in a range of clinical conditions, particularly in patients with emotional disorder. The present study extended the investigation to chronic pain, attempting to identify whether the retrieval of AM in patients with chronic pain tends to be overgeneral or delayed. With an observational cross-sectional design, we evaluated the AM both in patients with chronic pain and healthy controls by Autobiographical Memory Test. Pain conditions were assessed using the pain diagnostic protocol, the short-form McGill Pain Questionnaire (SF-MPQ), and the Pain Self-Efficacy Questionnaire (PSEQ). Emotion was assessed using the Beck Depression Inventory-II (BDI-II) and the Beck Anxiety Inventory. Subjects included 176 outpatients with chronic pain lasting for at least 6 months and 170 healthy controls. 1) Compared with the healthy group, the chronic pain group had more overgeneral memories (OGMs) (F = 29.061, P OGM were significant (P OGM scores could be predicted by the BDI score (9.7%), pain chronicity (4.3%), PSEQ score (7.1%), and Affective Index (of SF-MPQ) score (2.7%). 3) In the chronic pain group, the stepwise multiple regression models for variables predicting latency were significant (P < 0.05). Specifically, the variance in latency could be predicted by age (3.1%), pain chronicity (2.7%), pain duration (4.3%), and PSEQ score (2.0%). The retrieval of AM in patients with chronic pain tends to be overgeneral and delayed, and the retrieval style of AM may be contributed to negative emotions and chronic pain conditions. Wiley Periodicals, Inc.

Chronic radiodermatitis. A historical and actual diagnosis

International Nuclear Information System (INIS)

Tilsted, D.; Norup Lauridsen, K.; Otkjaer Nielsen, A.

1997-01-01

Chronic radiodermatitis was already diagnosed a few years after the discovery of X-rays. Despite the fact that protection should be known to be necessary to avoid radiodermatitis, cases of chronic radiodermatitis still occur. The present case report describes a nurse who endured years of direct hand exposure, leading to chronic radiodermatitis ten years after cessation of exposure. (au) 10 refs

Firstline treatment for chronic phase chronic myeloid leukemia patients should be based on a holistic approach.

Science.gov (United States)

Breccia, Massimo; Alimena, Giuliana

2015-02-01

New selective and more potent drugs for the cure of chronic phase chronic myeloid leukemia patients are now available: physicians in some countries must decide the best option, selecting one of the drugs available. What the main prognostic factors are in order to make this selection remains a matter of discussion. Introducing a 'holistic approach' for the first time in chronic myeloid leukemia, as practiced in other diseases, and looking at the patient in a complete picture, considering several variables, such as comorbidities, age, concomitant drugs, lifestyle and patient expectations, may be of help to understand, patient by patient, the best therapeutic strategy.

Adenoid ciliostimulation in children with chronic otitis media.

Science.gov (United States)

Andreoli, Steven M; Schlosser, Rodney J; Wang, Ling-Feng; Mulligan, Ryan M; Discolo, Christopher M; White, David R

2013-01-01

Adenoid hypertrophy and chronic adenoiditis are associated with an increased incidence of chronic otitis media. This study intends to determine the relationship between chronic otitis media and dynamic ciliary beat frequency in children undergoing adenoidectomy. Prospective, controlled study. Pediatric tertiary care hospital. Children undergoing adenoidectomy were enrolled. Patients were stratified according to their indication for surgery, including adenotonsillar hypertrophy with obstructive sleep apnea, chronic otitis media with effusion, or recurrent episodes of acute otitis media. Adenoids were harvested using the curette. Tissue was sectioned and allowed to equilibrate in basal media for 24 hours. Cilia-bearing tissue was then stimulated using isoproterenol or methacholine. Ciliary beat frequency was serially reordered and analyzed using the Sisson-Ammons Video Analysis software program. Baseline ciliary beat frequency was similar in all groups (N = 47, total). Using isoproterenol, children with chronic otitis media with effusion demonstrated a blunted dynamic ciliary response at 2 and 3 hours relative to control (P = .0176 and P = .0282). Methacholine-stimulated ciliary beat frequency was not different between each group. At 2 and 3 hours following isoproterenol stimulation, there was a significant blunting of dynamic ciliary beat frequency in children with chronic otitis media with effusion. This ciliary dysfunction may provide a physiological explanation related to chronic adenoiditis in children with chronic otitis media.

Chronic neck pain and whiplash: a case-control study of the relationship between acute whiplash injuries and chronic neck pain.

Science.gov (United States)

Freeman, M D; Croft, Arthur C; Rossignol, Annette M; Centeno, Christopher J; Elkins, Whitney L

2006-01-01

The authors undertook a case-control study of chronic neck pain and whiplash injuries in nine states in the United States to determine whether whiplash injuries contributed significantly to the population of individuals with chronic neck and other spine pain. Four hundred nineteen patients and 246 controls were randomly enrolled. Patients were defined as individuals with chronic neck pain, and controls as those with chronic back pain. The two groups were surveyed for cause of chronic pain as well as demographic information. The two groups were compared using an exposure-odds ratio. Forty-five per cent of the patients attributed their pain to a motor vehicle accident. An OR of 4.0 and 2.1 was calculated for men and women, respectively. Based on the results of the present study, it reasonable to infer that a significant proportion of individuals with chronic neck pain in the general population were originally injured in a motor vehicle accident.

Chronic neck pain and whiplash: A case-control study of the relationship between acute whiplash injuries and chronic neck pain

Science.gov (United States)

Freeman, Michael D; Croft, Arthur C; Rossignol, Annette M; Centeno, Christopher J; Elkins, Whitney L

2006-01-01

The authors undertook a case-control study of chronic neck pain and whiplash injuries in nine states in the United States to determine whether whiplash injuries contributed significantly to the population of individuals with chronic neck and other spine pain. Four hundred nineteen patients and 246 controls were randomly enrolled. Patients were defined as individuals with chronic neck pain, and controls as those with chronic back pain. The two groups were surveyed for cause of chronic pain as well as demographic information. The two groups were compared using an exposure-odds ratio. Forty-five per cent of the patients attributed their pain to a motor vehicle accident. An OR of 4.0 and 2.1 was calculated for men and women, respectively. Based on the results of the present study, it reasonable to infer that a significant proportion of individuals with chronic neck pain in the general population were originally injured in a motor vehicle accident. PMID:16770448

Combined Medical Treatment Of Chronic Pancreatitis

Directory of Open Access Journals (Sweden)

Umnova Larisa

2015-04-01

Full Text Available The aim of the study was to determine the most effective medical treatment of patients with chronic pancreatitis, by using either pancreatin alone or in combination with proton pump inhibitor (PPI or PPI and non-steroidal anti-inflammatory drug (NSAID. Patients with chronic pancreatitis, who did not require a surgical treatment, received medical treatment for a one–month period: 20 patients received pancreatin monotherapy; 48 patients were given a combination of pancreatin and PPI; 38 patients were treated with a combination of pancreatin, PPI and NSAID (PNP therapy group. In comparison with other groups, patients in the PNP therapy group showed improvement in body mass index, abdominal pain, bowel movements, chronic pancreatitis severity, as well as their quality of life assessment (p < 0.05. The combination of pancreatin, PPI and NSAID was the most effective among those applied in chronic pancreatitis patient treatment. A one–month long course of this therapy was safe and did not cause any significant adverse effects. The combination of pancreatin, PPI and NSAID for treatment of chronic pancreatitis can be recommended, as it is based on pathogenesis of the disease, effective, safe and economically advantageous.

Animal models for investigating chronic pancreatitis

Science.gov (United States)

2011-01-01

Chronic pancreatitis is defined as a continuous or recurrent inflammatory disease of the pancreas characterized by progressive and irreversible morphological changes. It typically causes pain and permanent impairment of pancreatic function. In chronic pancreatitis areas of focal necrosis are followed by perilobular and intralobular fibrosis of the parenchyma, by stone formation in the pancreatic duct, calcifications in the parenchyma as well as the formation of pseudocysts. Late in the course of the disease a progressive loss of endocrine and exocrine function occurs. Despite advances in understanding the pathogenesis no causal treatment for chronic pancreatitis is presently available. Thus, there is a need for well characterized animal models for further investigations that allow translation to the human situation. This review summarizes existing experimental models and distinguishes them according to the type of pathological stimulus used for induction of pancreatitis. There is a special focus on pancreatic duct ligation, repetitive overstimulation with caerulein and chronic alcohol feeding. Secondly, attention is drawn to genetic models that have recently been generated and which mimic features of chronic pancreatitis in man. Each technique will be supplemented with data on the pathophysiological background of the model and their limitations will be discussed. PMID:22133269

Expression of the SOCS family in human chronic wound tissues: Potential implications for SOCS in chronic wound healing

Science.gov (United States)

Feng, Yi; Sanders, Andrew J.; Ruge, Fiona; Morris, Ceri-Ann; Harding, Keith G.; Jiang, Wen G.

2016-01-01

Cytokines play important roles in the wound healing process through various signalling pathways. The JAK-STAT pathway is utilised by most cytokines for signal transduction and is regulated by a variety of molecules, including suppressor of cytokine signalling (SOCS) proteins. SOCS are associated with inflammatory diseases and have an impact on cytokines, growth factors and key cell types involved in the wound-healing process. SOCS, a negative regulator of cytokine signalling, may hold the potential to regulate cytokine-induced signalling in the chronic wound-healing process. Wound edge tissues were collected from chronic venous leg ulcer patients and classified as non-healing and healing wounds. The expression pattern of seven SOCSs members, at the transcript and protein level, were examined in these tissues using qPCR and immunohistochemistry. Significantly higher levels of SOCS3 (P=0.0284) and SOCS4 (P=0.0376) in non-healing chronic wounds compared to the healing/healed chronic wounds were observed at the transcript level. Relocalisation of SOCS3 protein in the non-healing wound environment was evident in the investigated chronic biopsies. Thus, the results show that the expression of SOCS transcript indicated that SOCS members may act as a prognostic biomarker of chronic wounds. PMID:27635428

The management of chronic pain in Switzerland: a comparative survey of Swiss medical specialists treating chronic pain.

NARCIS (Netherlands)

Wilder-Smith, O.H.G.; Mohrle, J.J.; Dolin, P.J.; Martin, N.C.

2001-01-01

Chronic pain management by Swiss specialist physicians with the primary hypothesis that pain clinic practitioners conform better to good practice (interdisciplinarity, diagnostic/therapeutic routines, quality control, education) than other specialists treating chronic pain was surveyed. Management

Percutaneous Nephrolithotomy and Chronic Kidney Disease

DEFF Research Database (Denmark)

Sairam, Krish; Scoffone, Cesare M; Alken, Peter

2012-01-01

by glomerular filtration rate, including chronic kidney disease stages 0/I/II-greater than 60, stage III-30 to 59 and stages IV/V-less than 30 ml/minute/1.73 m(2). Patient characteristics, operative characteristics, outcomes and morbidity were assessed. RESULTS: Estimated glomerular filtration rate data were...... available on 5,644 patients, including 4,436 with chronic kidney disease stages 0/I/II, 994 with stage III and 214 with stages IV/V. A clinically significant minority of patients with nephrolithiasis presented with severe chronic kidney disease. A greater number of patients with stages IV/V previously...... underwent percutaneous nephrolithotomy, ureteroscopy or nephrostomy and had positive urine cultures than less severely affected patients, consistent with the higher incidence of staghorn stones in these patients. Patients with chronic kidney disease stages IV/V had statistically significantly worse...

International recognition of the Chronic Otitis Media Questionnaire 12.

Science.gov (United States)

Kosyakov, S I; Minavnina, J V; Phillips, J S; Yung, M W

2017-06-01

The Chronic Otitis Media Questionnaire 12 was developed initially in the UK to assess patient-reported health-related quality of life associated with chronic otitis media. This study aimed to determine whether this tool is applicable to the Russian population, which has a materially different healthcare system. A total of 108 patients with different forms of chronic otitis media completed the Russian Chronic Otitis Media Questionnaire 12. The average Russian Chronic Otitis Media Questionnaire 12 score was 19.4 (standard deviation = 8.3). The internal consistency of the Russian Chronic Otitis Media Questionnaire 12 was high, with a Cronbach's alpha value of 0.860. The Russian version of the Chronic Otitis Media Questionnaire 12 was found to be a reliable tool for the assessment of health-related quality of life in patients with chronic otitis media. This sets the scene for international collaboration, using this tool to assess the effectiveness of surgical treatments even amongst countries with different healthcare systems.

Temperament vs. chronic fatigue in police officers

Directory of Open Access Journals (Sweden)

Ewa Stępka

2015-12-01

Full Text Available Background: Chronic fatigue is a problem affecting a still growing number of people. Among them there are representatives of different professions who are forced to cope not only with occupational stress, but also with the problem of fatigue. The police is one of such occupational groups, in which exposure to stressful and often traumatic situations, contact with those who violate the law, shift work and contact with superiors can play a key role in the development of chronic fatigue. However, chronic fatigue, induced by the above mentioned factors, does not affect all police officers since its occurrence also depends on many personal traits, including temperament. Material and methods: We studied a group of 61 police officers of the Kuyavian-Pomeranian garrison. The study was conducted using the Buss and Plomin EAS (emotionality, activity, sociability Temperament Questionnaire, CIS-20R (community, innovation, survey Questionnaire, developed by Vercoulen et al. and a questionnaire on socio-demographic data. Results: The results indicated the relationship between chronic fatigue and emotionality. Statistical analyses showed a negative correlation between the nature of emotional components, distress, fear, anger, and the general rate of chronic fatigue. There was no statistically significant correlation between age, and service experience and the level of chronic fatigue. Conclusions: The results indicate that the officers of the study group show dramatically high levels of chronic fatigue. The results also revealed that temperament characteristics, such as sociability and activity, reported in the literature as factors reducing fatigue and stress, did not show relevance to chronic fatigue in the study group. Med Pr 2015;66(6:793–801

Management of chronic pain after hernia repair

Directory of Open Access Journals (Sweden)

Andresen K

2018-04-01

Full Text Available Kristoffer Andresen, Jacob Rosenberg Department of Surgery, Herlev Hospital, University of Copenhagen, Copenhagen, Denmark Abstract: Chronic pain following inguinal hernia repair is a common problem and feared complication. Up to 16% of people experience chronic pain following the repair of a groin hernia. The aim of this review was to provide an overview of treatment strategies for patients with chronic pain following inguinal hernia repair based on best practice guidelines and current clinical routines. The optimal management of chronic pain following inguinal hernia surgery should begin with a thorough clinical examination to rule out other causes of chronic pain and to rule out a recurrence. A scaled approach to treatment is recommended. Initially, watchful waiting can be tried if it can be tolerated by the patient and then systemic painkillers, escalating to blocks, and surgery as the final option. Surgery should include mesh removal and triple neurectomy following anterior approaches or mesh and tack removal following a posterior approach. The diagnosis and treatment strategies should be performed by or discussed with experts in the field. Keywords: inguinal hernia, chronic pain, management, surgery, pharmacology, radio frequency

Myalgic Encephalomyelitis/Chronic Fatigue Syndrome: Diagnosis

Science.gov (United States)

... Controls Search Form Controls Cancel Submit Myalgic Encephalomyelitis/Chronic Fatigue Syndrome Note: Javascript is disabled or is not supported ... Facebook Tweet Share Compartir To diagnose myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS), a patient’s doctor or healthcare provider ...

Headache in patients with chronic obstructive pulmonary disease: effects of chronic hypoxaemia.

Science.gov (United States)

Ozge, Aynur; Ozge, Cengiz; Kaleagasi, Hakan; Yalin, Osman Ozgür; Unal, Ozgür; Ozgür, Eylem S

2006-02-01

The frequency and characteristics of headache in patients with chronic obstructive pulmonary disease (COPD) are not clear and there are only a few studies that have assessed the relationship between chronic hypoxaemia and headache. We performed this study in order to evaluate the frequency and characteristics of headache in COPD patients. A total of 119 patients, with a mean age of 63.4 +/- 8.2 years, diagnosed with moderate or severe stable COPD were included in the study. Overall 31.9% of the patients complained of headache and 45.4% were reported to have sleep disorders. There were significant effects of family history of COPD, having other systemic disorders or sleep disorders (snoring, bruxism, restless leg syndrome, etc.) and laboratory data of chronic hypoxaemia and airway obstruction on headache co-morbidity. In conclusion, possibly being a specific subtype of elderly headache, headache in patients with moderate or severe COPD is a common problem and future studies are needed to obtain more knowledge about its pathophysiological and clinical basis.

Gallstones in Patients with Chronic Liver Diseases

Directory of Open Access Journals (Sweden)

Xu Li

2017-01-01

Full Text Available With prevalence of 10–20% in adults in developed countries, gallstone disease (GSD is one of the most prevalent and costly gastrointestinal tract disorders in the world. In addition to gallstone disease, chronic liver disease (CLD is also an important global public health problem. The reported frequency of gallstone in chronic liver disease tends to be higher. The prevalence of gallstone disease might be related to age, gender, etiology, and severity of liver disease in patients with chronic liver disease. In this review, the aim was to identify the epidemiology, mechanisms, and treatment strategies of gallstone disease in chronic liver disease patients.

Chronic conditions, fluid states: chronicity and the anthropology of illness

National Research Council Canada - National Science Library

Manderson, Lenore; Smith-Morris, Carolyn

2010-01-01

.... Breaking new ground in medical anthropology by challenging the chronic/acute divide in illness and disease, the editors, along with a group of rising scholars and some of the most influential minds...

Peginterferon Treatment In Children: A Review Of Chronic Hepatitis B And Chronic Hepatitis C Treatment

Directory of Open Access Journals (Sweden)

Makbule EREN

2009-11-01

Full Text Available Despite of extensive blood product screening and national immunization programs, chronic hepatitis B and C infections continues to be a global problem with high mortality, morbidity and economic impact. Even though acquisition of these infections mostly occurs in childhood, major problems appear in adulthood. Cirrhosis and HCC are two major expected late events related to chronic hepatitis B and C infections. Rarely, children may also face these complications. To avoid these complications and increase the life expectancy in adults treatment of these two type infections should be started in childhood with appropriate patient selection. In contrast to children, adults are luckier in terms of treatment alternatives. They have the chance to use more potent antivirals with higher genetic barrier and pegylated form of interferons. Recently, the use of pegylated interferon and ribavirin combinations has been approved in children in Chronic HCV infection. However, chronic hepatitis B treatment in children is still dependent on the use of one type antiviral drug and conventional interferon. Treatment in early ages with an antiviral agent that has limited genetic barrier may block the chance of treatment or reduce the response rate in adulthood in chronic hepatitis B infection. This burden indicates the necessity of new therapeutic modalities in children. In this term pegylated interferons may be one of the optiones. In this article we aimed to reviewe the efficacy and safety of conventional and pegylated interferons, for the treatment of Hepatitis C and B infections in children.

Conformal radiotherapy of 450 localized prostate cancers (may 1999 - march 2007): impact of digestive disorders on the quality of life after dose escalation

International Nuclear Information System (INIS)

Guerif, S.; Lavigne, B.; Berger, A.

2007-01-01

The incidence of digestive toxicity and the impact of quality of life do not depend on dose escalation in our population selected out of the measurement at the end of the treatment. The incidence of rectum hemorrhages does not any impact on the quality of life of patients. The factors linked to digestive toxicity were the 'co morbidities' (cardiopathy, ischemia, diabetes) and a high initial digestive score. (N.C.)

Efeitos da aplicação da eletroestimulação nervosa transcutânea (TENS) sobre a dor e volumes pulmonares em indivíduos submetidos à cirurgia cardíaca

OpenAIRE

Machado, Caroline Lopes; Brito, Renata Mendes; Belmonte, Luana Meneghini

2017-01-01

Introduction: Cardiac surgery is the prognosis of many cardiopathies, but as a consequence of the invasiveness of this procedure, the occurrence of perinatal pain and, consequently, a decrease in pulmonary volumes and capacities in the postoperative is frequent, increasing the risk of complications and morbimortality rates. Objectives: To analyze the effects of TENS on pulmonary pain and volumes in individuals undergoing cardiac surgery. Materials and Methods: All subjects submitted to cardia...

Chronic diseases in elderly men

DEFF Research Database (Denmark)

Nielsen, Morten Frost Munk; Wraae, Kristian; Gudex, Claire

2012-01-01

OBJECTIVE: prevalence estimates for chronic diseases and associated risk factors are needed for priority setting and disease prevention strategies. The aim of this cross-sectional study was to estimate the self-reported and clinical prevalence of common chronic disorders in elderly men. STUDY......-reported data on risk factors and disease prevalence were compared with data from hospital medical records. RESULTS: physical inactivity, smoking and excessive alcohol intake were reported by 27, 22 and 17% of the study population, respectively. Except for diabetes, all the chronic diseases investigated......, including hypertension, musculoskeletal and respiratory diseases were underreported by study participants. Erectile dysfunction and hypogonadism were substantially underreported in the study population even though these diseases were found to affect 48 and 21% of the participants, respectively. CONCLUSIONS...

Pharmacological challenges in chronic pancreatitis

DEFF Research Database (Denmark)

Olesen, Anne Estrup; Brokjaer, Anne; Fischer, Iben Wendelboe Deleuran

2014-01-01

food intake is more or less substituted with alcohol, tobacco and coffee. Alcohol and drug interaction are known to influence the pharmacokinetics by altering either drug absorption or by affecting liver metabolism. Since patients suffering from chronic pancreatitis experience severe pain, opioids......Drug absorption in patients with chronic pancreatitis might be affected by the pathophysiology of the disease. The exocrine pancreatic insufficiency is associated with changes in gastrointestinal intraluminal pH, motility disorder, bacterial overgrowth and changed pancreatic gland secretion....... Together these factors can result in malabsorption and may also affect the efficacy of pharmacological intervention. The lifestyle of chronic pancreatitis patients may also contribute to gastrointestinal changes. Many patients limit their food intake because of the pain caused by eating and in some cases...

Pharmacological challenges in chronic pancreatitis

DEFF Research Database (Denmark)

Olesen, Anne Estrup; Brokjaer, Anne; Fischer, Iben Wendelboe Deleuran

2014-01-01

food intake is more or less substituted with alcohol, tobacco and coffee. Alcohol and drug interaction are known to influence the pharmacokinetics by altering either drug absorption or by affecting liver metabolism. Since patients suffering from chronic pancreatitis experience severe pain, opioids....... Together these factors can result in malabsorption and may also affect the efficacy of pharmacological intervention. The lifestyle of chronic pancreatitis patients may also contribute to gastrointestinal changes. Many patients limit their food intake because of the pain caused by eating and in some cases......Drug absorption in patients with chronic pancreatitis might be affected by the pathophysiology of the disease. The exocrine pancreatic insufficiency is associated with changes in gastrointestinal intraluminal pH, motility disorder, bacterial overgrowth and changed pancreatic gland secretion...

Chronic pain and mortality: a systematic review.

Directory of Open Access Journals (Sweden)

Diane Smith

Full Text Available Chronic pain is common, often widespread and has a substantial impact on health and quality of life. The relationship between chronic pain and mortality is unclear. This systematic review aimed to identify and evaluate evidence for a relationship between chronic pain and mortality.A search of ten electronic databases including EMBASE and MEDLINE was conducted in March 2012, and updated until March 2014. Observational studies investigating the association between chronic or widespread pain (including fibromyalgia and mortality were included. Risk of bias was assessed and a meta-analysis was undertaken to quantify heterogeneity and pool results. A narrative review was undertaken to explore similarities and differences between the included studies.Ten studies were included in the review. Three reported significant associations between chronic or widespread pain and mortality in unadjusted results. In adjusted analyses, four studies reported a significant association. The remaining studies reported no statistically significant association. A meta-analysis showed statistically significant heterogeneity of results from studies using comparable outcome measures (n = 7(I2 = 78.8% and a modest but non-significant pooled estimate (MRR1.14,95%CI 0.95-1.37 for the relationship between chronic pain and all-cause mortality. This association was stronger when analysis was restricted to studies of widespread pain (n = 5,I2 = 82.3% MRR1.22(95%CI 0.93-1.60. The same pattern was observed with deaths from cancer and cardiovascular diseases. Heterogeneity is likely to be due to differences in study populations, follow-up time, pain phenotype, methods of analysis and use of confounding factors.This review showed a mildly increased risk of death in people with chronic pain, particularly from cancer. However, the small number of studies and methodological differences prevented clear conclusions from being drawn. Consistently applied definitions of

Chronic Actinic Dermatitis

Directory of Open Access Journals (Sweden)

Bengü Çevirgen Cemil

2017-06-01

Full Text Available Chronic actinic dermatitis (CAD is characterized by persistent eczema-like lesions, mainly on sun-exposed sites, induced by ultraviolet B, sometimes ultraviolet A, and occasionally visible light. CAD is a rare photodermatitis. It is often associated with contact allergens including airborne allergens such as fragrances, plant antigens and topical medications. A 62 year old farmer is applied with eczematous lesions restricted to sun-exposed areas. Clinical findings and histopathologic features were consistent with the diagnosis of chronic actinic dermatitis. The patient also had contact allergy to multiple allergens. We present this case to emphasize the significance of patch test on CAD treatment and the success of topical tacrolimus and azathioprine.

Determinants of Chronic Respiratory Symptoms among Pharmaceutical Factory Workers

Directory of Open Access Journals (Sweden)

Sahle Asfaw

2018-01-01

Full Text Available Background. Chronic respiratory symptoms including chronic cough, chronic phlegm, wheezing, shortness of breath, and chest pain are manifestations of respiratory problems which are mainly evolved as a result of occupational exposures. This study aims to assess determinants of chronic respiratory symptoms among pharmaceutical factory workers. Methods. A case control study was carried out among 453 pharmaceutical factory workers with 151 cases and 302 controls. Data was collected using pretested and structured questionnaire. The data was analyzed using descriptive statistics and bivariate and multivariate analysis. Result. Previous history of chronic respiratory diseases (AOR = 3.36, 95% CI = 1.85–6.12, family history of chronic respiratory diseases (AOR = 2.55, 95% CI = 1.51–4.32, previous dusty working environment (AOR = 2.26, 95% CI = 1.07–4.78, ever smoking (AOR = 3.66, 95% CI = 1.05–12.72, and service years (AOR = 1.86, 95% CI = 1.16–2.99 showed statistically significant association with chronic respiratory symptoms. Conclusion. Previous history of respiratory diseases, family history of chronic respiratory diseases, previous dusty working environment, smoking, and service years were determinants of chronic respiratory symptoms. Public health endeavors to prevent the burden of chronic respiratory symptoms among pharmaceutical factory workers should target the reduction of adverse workplace exposures and discouragement of smoking.

Genetics Home Reference: chronic granulomatous disease

Science.gov (United States)

... Other common areas of infection in people with chronic granulomatous disease include the skin, liver , and lymph nodes . Inflammation can occur in ... Other common areas of inflammation in people with chronic granulomatous ... and skin. Additionally, granulomas within the gastrointestinal tract can lead ...

Tailoring Self-Management in Chronic Care

NARCIS (Netherlands)

Touwen, ID

2016-01-01

Self-management is nowadays seen as an important element in chronic care and therefore, self-management is increasingly embedded in chronic care guidelines; however, implementation in clinical practice is a slow and difficult process. Evidence, from research on self-management interventions, shows

[Chronic prostatitis and Bechterew's disease].

Science.gov (United States)

Kohlicek, J; Svec, V

1977-11-01

A group of patients between 35 and 65 years old with chronic prostatitis were examined for the presence of Becherew's disease. In this connection the New York and Roman criterions for morbus Bechterew were applied. There were found one ankyosing spondylarthritis, one ankylosis of the sacroiliac joint, and 11 times a tentative sacroileitis were stated. Altogether the proved and tentative findings were only 3.68 per cent of all examinations. In our countries the morbus Bechterew is found in 0,21 per cent of the normal population. So the protion of the Bechterew's disease in patients with chronic prostatitis is indeed a little higher than average, but not so frequent as often pretended in recent times. After a second series 58 patients being treated because of Bechterew's disease of different stages and different terms were examined for the possibility of a simultaneously elapsing chronic prostatitis. A chronic prostatitis was found in 38 per cent of these patients which correspondents to the incidence published in literature for the medium-age manhood. Nobody of the test persons had complaints on the part of the urologenital tract.

Several submaximal exercise tests are reliable, valid and acceptable in people with chronic pain, fibromyalgia or chronic fatigue: a systematic review

NARCIS (Netherlands)

Ratter, Julia; Radlinger, Lorenz; Lucas, Cees

2014-01-01

Are submaximal and maximal exercise tests reliable, valid and acceptable in people with chronic pain, fibromyalgia and fatigue disorders? Systematic review of studies of the psychometric properties of exercise tests. People older than 18 years with chronic pain, fibromyalgia and chronic fatigue

Chronic granulomatous mastitis: review of 26 cases with special reference to chronic lobular mastitis.

Science.gov (United States)

Bhaskaran, C S; Prasad, K R; Rao, G; Kameshwari, R; Saheb, D A; Aruna, C A

1992-01-01

Twenty six cases of chronic granulomatous mastitis are reported in a 5 year period and the slides are reviewed. They are sub-classified into Chronic lobular mastitis (CLM), Plasma cell mastitis and subareolar granuloma. There are 10 cases each of CLM and plasma cell mastitis and one of subareolar granuloma. All the three conditions are associated with duct ectasia. Fat necrosis and infective granulomas were 2 each and one of foreign body granuloma. These lesions can be easily differentiated by histology. While most of the CLM occurred in younger age group, plasma cell mastitis is seen in older women. Histologically, there is a florid inflammatory cell reaction of the stroma with dilatation and destruction of some ducts, with microabscess formation. In plasma cell mastitis, the lesion is more chronic with predominance of plasma cells and involutionary changes of the ducts are seen.

Chronic toxicology of cannabis.

Science.gov (United States)

Reece, Albert Stuart

2009-07-01

Cannabis is the most widely used illicit drug worldwide. As societies reconsider the legal status of cannabis, policy makers and clinicians require sound knowledge of the acute and chronic effects of cannabis. This review focuses on the latter. A systematic review of Medline, PubMed, PsychInfo, and Google Scholar using the search terms "cannabis," "marijuana," "marihuana," "toxicity," "complications," and "mechanisms" identified 5,198 papers. This list was screened by hand, and papers describing mechanisms and those published in more recent years were chosen preferentially for inclusion in this review. There is evidence of psychiatric, respiratory, cardiovascular, and bone toxicity associated with chronic cannabis use. Cannabis has now been implicated in the etiology of many major long-term psychiatric conditions including depression, anxiety, psychosis, bipolar disorder, and an amotivational state. Respiratory conditions linked with cannabis include reduced lung density, lung cysts, and chronic bronchitis. Cannabis has been linked in a dose-dependent manner with elevated rates of myocardial infarction and cardiac arrythmias. It is known to affect bone metabolism and also has teratogenic effects on the developing brain following perinatal exposure. Cannabis has been linked to cancers at eight sites, including children after in utero maternal exposure, and multiple molecular pathways to oncogenesis exist. Chronic cannabis use is associated with psychiatric, respiratory, cardiovascular, and bone effects. It also has oncogenic, teratogenic, and mutagenic effects all of which depend upon dose and duration of use.

The management of acute and chronic pancreatitis.

Science.gov (United States)

Banks, Peter A; Conwell, Darwin L; Toskes, Phillip P

2010-02-01

Pancreatitis, which is most generally described as any inflammation of the pancreas, is a serious condition that manifests in either acute or chronic forms. Chronic pancreatitis results from irreversible scarring of the pancreas, resulting from prolonged inflammation. Six major etiologies for chronic pancreatitis have been identified: toxic/ metabolic, idiopathic, genetic, autoimmune, recurrent and severe acute pancreatitis, and obstruction. The most common symptom associated with chronic pancreatitis is pain localized to the upper-to-middle abdomen, along with food malabsorption, and eventual development of diabetes. Treatment strategies for acute pancreatitis include fasting and short-term intravenous feeding, fluid therapy, and pain management with narcotics for severe pain or nonsteroidal anti-inflammatories for milder cases. Patients with chronic disease and symptoms require further care to address digestive issues and the possible development of diabetes. Dietary restrictions are recommended, along with enzyme replacement and vitamin supplementation. More definitive outcomes may be achieved with surgical or endoscopic methods, depending on the role of the pancreatic ducts in the manifestation of disease.

The Correlation between Chronic Periodontitis and Oral Cancer.

Science.gov (United States)

Krüger, Maximilian; Hansen, Torsten; Kasaj, Adrian; Moergel, Maximilian

2013-01-01

Infections are increasingly considered as potential trigger for carcinogenesis apart from risk factors like alcohol and tobacco. The discussion about human papilloma virus (HPV) in oral squamous cell carcinoma (OSCC) points at a general role of infection for the development of oral carcinomas. Furthermore, first studies describe a correlation between chronic periodontitis and OSCC, thus, characterizing chronic inflammation as being a possible trigger for OSCC. In front of this background, we present four well-documented clinical cases. All patients showed a significant anatomical relation between OSCC and clinical signs of chronic periodontitis. The interindividual differences of the clinical findings lead to different theoretical concepts: two with coincidental appearance of OSCC and chronic periodontitis and two with possible de novo development of OSCC triggered by chronic inflammation. We conclude that the activation of different inflammatory cascades by chronic periodontitis negatively affects mucosa and bone. Furthermore, the inflammatory response has the potential to activate carcinogenesis. Apart from a mere coincidental occurrence, two out of four patients give first clinical hints for a model wherein chronic periodontitis represents a potential risk factor for the development of OSCC.

The Correlation between Chronic Periodontitis and Oral Cancer

Directory of Open Access Journals (Sweden)

Maximilian Krüger

2013-01-01

Full Text Available Infections are increasingly considered as potential trigger for carcinogenesis apart from risk factors like alcohol and tobacco. The discussion about human papilloma virus (HPV in oral squamous cell carcinoma (OSCC points at a general role of infection for the development of oral carcinomas. Furthermore, first studies describe a correlation between chronic periodontitis and OSCC, thus, characterizing chronic inflammation as being a possible trigger for OSCC. In front of this background, we present four well-documented clinical cases. All patients showed a significant anatomical relation between OSCC and clinical signs of chronic periodontitis. The interindividual differences of the clinical findings lead to different theoretical concepts: two with coincidental appearance of OSCC and chronic periodontitis and two with possible de novo development of OSCC triggered by chronic inflammation. We conclude that the activation of different inflammatory cascades by chronic periodontitis negatively affects mucosa and bone. Furthermore, the inflammatory response has the potential to activate carcinogenesis. Apart from a mere coincidental occurrence, two out of four patients give first clinical hints for a model wherein chronic periodontitis represents a potential risk factor for the development of OSCC.

SEXUAL DYSFUNCTION ASSOCIATION WITH THE CHRONIC BACTERIAL PROSTATITIS

Directory of Open Access Journals (Sweden)

H. S. Ibishev

2013-01-01

Full Text Available The study involved 230 patients aged 20 to 45 years with a diagnosis of chronic bacterial prostatitis. The study found that in patients with chronic bacterial prostatitis clinical picture, in addition to pain, is a lower urinary tract symptoms, neuro-vegetative and sexual dysfunction. In patients with chronic bacterial prostatitis, recorded various sexual disorders, most of which are normalized after antibiotic therapy. Erectile dysfunction, which are recorded in patients with chronic bacterial prostatitis is psychogenic in nature dysfunction.

A vicious circle in chronic lymphoedema pathophysiology?

DEFF Research Database (Denmark)

Cucchi, F; Rossmeislova, L; Simonsen, L

2017-01-01

Chronic lymphoedema is a disease caused by a congenital or acquired damage to the lymphatic system and characterized by complex chains of pathophysiologic events such as lymphatic fluid stasis, chronic inflammation, lymphatic vessels impairment, adipose tissue deposition and fibrosis. These event....... Together, these observations indicate strong reciprocal relationship between lymphatics and adipose tissue and suggest a possible key role of the adipocyte in the pathophysiology of chronic lymphoedema's vicious circle....

Several submaximal exercise tests are reliable, valid and acceptable in people with chronic pain, fibromyalgia or chronic fatigue: a systematic review.

Science.gov (United States)

Ratter, Julia; Radlinger, Lorenz; Lucas, Cees

2014-09-01

Are submaximal and maximal exercise tests reliable, valid and acceptable in people with chronic pain, fibromyalgia and fatigue disorders? Systematic review of studies of the psychometric properties of exercise tests. People older than 18 years with chronic pain, fibromyalgia and chronic fatigue disorders. Studies of the measurement properties of tests of physical capacity in people with chronic pain, fibromyalgia or chronic fatigue disorders were included. Studies were required to report: reliability coefficients (intraclass correlation coefficient, alpha reliability coefficient, limits of agreements and Bland-Altman plots); validity coefficients (intraclass correlation coefficient, Spearman's correlation, Kendal T coefficient, Pearson's correlation); or dropout rates. Fourteen studies were eligible: none had low risk of bias, 10 had unclear risk of bias and four had high risk of bias. The included studies evaluated: Åstrand test; modified Åstrand test; Lean body mass-based Åstrand test; submaximal bicycle ergometer test following another protocol other than Åstrand test; 2-km walk test; 5-minute, 6-minute and 10-minute walk tests; shuttle walk test; and modified symptom-limited Bruce treadmill test. None of the studies assessed maximal exercise tests. Where they had been tested, reliability and validity were generally high. Dropout rates were generally acceptable. The 2-km walk test was not recommended in fibromyalgia. Moderate evidence was found for reliability, validity and acceptability of submaximal exercise tests in patients with chronic pain, fibromyalgia or chronic fatigue. There is no evidence about maximal exercise tests in patients with chronic pain, fibromyalgia and chronic fatigue. Copyright © 2014. Published by Elsevier B.V.

Risk of chronic anxiety in implantable defibrillator patients

DEFF Research Database (Denmark)

Pedersen, Susanne S.; den Broek, Krista C van; Theuns, Dominic A M J

2011-01-01

Little is known about the prevalence of chronic anxiety in patients with an implantable cardioverter defibrillator (ICD). In a multi-center, prospective study, we examined 1) the prevalence of chronic anxiety (i.e., patients anxious at implantation and 12 months), and 2) predictors of chronic...... anxiety....

Nephropathy and Neuropathy in Diabetic Patients with Chronic ...

African Journals Online (AJOL)

Introduction: Several reports described an association between type 2 diabetes mellitus (DM) and chronic hepatitis C virus (HCV) infection. Chronic HCV infection is prevalent in Egypt. The present work aimed to evaluate the prevalence of proteinuria and neuropathy among diabetic patients with and without chronic HCV ...

Spontaneous resolution of post-traumatic chronic subdural hematoma

African Journals Online (AJOL)

Here, we present a case of spontaneously resolved post-traumatic bilateral chronic subdural hematoma within a period of one month in a 55-year-old male and we discuss the probable mechanisms of pathophysiology in the spontaneous resolution of chronic subdural hematoma. Keywords: Antiaggregation therapy, chronic ...

The impact of chronic diseases - The partner's perspective

NARCIS (Netherlands)

Baanders, A.N.; Heijmans, M.J.W.M.

2007-01-01

A chronic physical disease not only has direct consequences for the chronically ill person but can also distort the life of the healthy partner. This study of a representative sample of chronically ill persons and their partners in the Netherlands presents quantitative information on the proportion

The impact of chronic diseases: the partner's perspective.

NARCIS (Netherlands)

Baanders, A.N.; Heijmans, M.

2007-01-01

A chronic physical disease not only has direct consequences for the chronically ill person but can also distort the life of the healthy partner. This study of a representative sample of chronically ill persons and their partners in the Netherlands presents quantitative information on the proportion

Medication Overuse in Chronic Pain.

Science.gov (United States)

Hsu, Eric S

2017-01-01

Chronic pain is usually managed by various pharmacotherapies after exhausting the conservative modalities such as over-the-counter choices. The goal of this review is to investigate current state of opioids and non-opioid medication overuse that includes NSAIDs, skeletal muscle relaxants, antidepressants, membrane stabilization agents, and benzodiazepine. How to minimize medication overuse and achieve better outcome in chronic pain management? Although antidepressants and membrane stabilization agents contribute to the crucial components for neuromodulation, opioids were frequently designated as a rescue remedy in chronic pain since adjunct analgesics usually do not provide instantaneous relief. The updated CDC guideline for prescribing opioids has gained widespread attention via media exposure. Both patients and prescribers are alerted to respond to the opioid epidemic and numerous complications. However, there has been overuse of non-opioid adjunct analgesics that caused significant adverse effects in addition to concurrent opioid consumption. It is a common practice to extrapolate the WHO three-step analgesic ladder for cancer pain to apply in non-cancer pain that emphasizes solely on pharmacologic therapy which may result in overuse and escalation of opioids in non-cancer pain. There has been promising progress in non-pharmacologic therapies such as biofeedback, complementary, and alternative medicine to facilitate pain control instead of dependency on pharmacologic therapies. This review article presents the current state of medication overuse in chronic pain and proposes precaution to balance the risk and benefit ratio. It may serve as a premier for future study on clinical pathway for comprehensive chronic pain management and reduce medication overuse.

Spinal dorsal horn astrocytes: New players in chronic itch

Directory of Open Access Journals (Sweden)

Makoto Tsuda

2017-01-01

Full Text Available Chronic itch is a debilitating symptom of inflammatory skin conditions, such as atopic dermatitis, and systemic diseases, for which existing treatment is largely ineffective. Recent studies have revealed the selective neuronal pathways that are involved in itch sensations; however, the mechanisms by which itch turns into a pathological chronic state are poorly understood. Recent advances in our understanding of the mechanisms producing chronic itch have been made by defining causal roles for astrocytes in the spinal dorsal horn in mouse models of chronic itch including atopic dermatitis. Understanding the key roles of astrocytes may provide us with exciting insights into the mechanisms for itch chronicity and lead to a previously unrecognized target for treating chronic itch.

Pharmacological challenges in chronic pancreatitis

OpenAIRE

Olesen, Anne Estrup; Brokjaer, Anne; Fisher, Iben Wendelboe; Larsen, Isabelle Myriam

2013-01-01

Drug absorption in patients with chronic pancreatitis might be affected by the pathophysiology of the disease. The exocrine pancreatic insufficiency is associated with changes in gastrointestinal intraluminal pH, motility disorder, bacterial overgrowth and changed pancreatic gland secretion. Together these factors can result in malabsorption and may also affect the efficacy of pharmacological intervention. The lifestyle of chronic pancreatitis patients may also contribute to gastrointestinal ...

Chronic Meningococcaemia

African Journals Online (AJOL)

clinical features, complications, laboratory findings and treatment of this condition are discussed. The resemblance, both clinically and histologically, to allergic vasculitis is stressed. S. Air. Med. J., 48, 2154 (1974). Chronic meningococcaemia is an uncommon condition today, but was well recognised in the early decades of.

Genetics Home Reference: chronic myeloid leukemia

Science.gov (United States)

... Central Quintás-Cardama A, Cortes JE. Chronic myeloid leukemia: diagnosis and treatment. Mayo Clin Proc. 2006 Jul;81(7):973-88. Review. Citation on PubMed Skorski T. Genetic mechanisms of chronic myeloid leukemia blastic transformation. Curr Hematol Malig Rep. 2012 Jun; ...

Management of chronic hepatitis Band C

African Journals Online (AJOL)

disorders must be excluded. Serum copper, urinary copper ... storage diseases and a,-antitrypsin deficiency. ... s absent, the specimen should be sent to a centre of excellence for .... Drug-induced chronic liver disease with emphasis on chronic active hepatitis. ..... interferon represent a difficult management problem. Lower.

Chronic Meningitis: Simplifying a Diagnostic Challenge.

Science.gov (United States)

Baldwin, Kelly; Whiting, Chris

2016-03-01

Chronic meningitis can be a diagnostic dilemma for even the most experienced clinician. Many times, the differential diagnosis is broad and encompasses autoimmune, neoplastic, and infectious etiologies. This review will focus on a general approach to chronic meningitis to simplify the diagnostic challenges many clinicians face. The article will also review the most common etiologies of chronic meningitis in some detail including clinical presentation, diagnostic testing, treatment, and outcomes. By using a case-based approach, we will focus on the key elements of clinical presentation and laboratory analysis that will yield the most rapid and accurate diagnosis in these complicated cases.

Chronic Conditions Dashboard

Data.gov (United States)

U.S. Department of Health & Human Services — The CMS Chronic Conditions Dashboard presents statistical views of information on the prevalence, utilization and Medicare spending for Medicare beneficiaries with...

Effects of Chronic Central Arginine Vasopressin (AVP) on Maternal Behavior in Chronically Stressed Rat Dams

Science.gov (United States)

Coverdill, Alexander J.; McCarthy, Megan; Bridges, Robert S.; Nephew, Benjamin C.

2012-01-01

Exposure of mothers to chronic stressors during pregnancy or the postpartum period often leads to the development of depression, anxiety, or other related mood disorders. The adverse effects of mood disorders are often mediated through maternal behavior and recent work has identified arginine vasopressin (AVP) as a key neuropeptide hormone in the expression of maternal behavior in both rats and humans. Using an established rodent model that elicits behavioral and physiological responses similar to human mood disorders, this study tested the effectiveness of chronic AVP infusion as a novel treatment for the adverse effects of exposure to chronic social stress during lactation in rats. During early (day 3) and mid (day 10) lactation, AVP treatment significantly decreased the latency to initiate nursing and time spent retrieving pups, and increased pup grooming and total maternal care (sum of pup grooming and nursing). AVP treatment was also effective in decreasing maternal aggression and the average duration of aggressive bouts on day 3 of lactation. Central AVP may be an effective target for the development of treatments for enhancing maternal behavior in individuals exposed to chronic social stress. PMID:24349762

Chronic administration of sildenafil improves erectile function in a rat model of chronic renal failure

Science.gov (United States)

Gurbuz, Nilgun; Kol, Arif; Ipekci, Tumay; Ates, Erhan; Baykal, Asli; Usta, Mustafa F

2015-01-01

The relationship between erectile dysfunction (ED) and chronic renal failure (CRF) has been reported in several studies. This study aimed to investigate whether the chronic use of sildenafil could enhance the erectile capacity in CRF-induced rats. In addition, we assessed the effect of that treatment on certain molecules, which have been suggested to play crucial roles in erectile physiology and CRF-related ED as well. Three groups of animals were utilized: (1) age-matched control rats, (2) CRF-induced rats, (3) CRF-induced rats treated with chronic administration of sildenafil (5 mg kg−1 p.o. for 6 weeks [treatment started after 6 weeks of CRF induction]). At 3 months, all animals underwent cavernosal nerve stimulation (CNS) to assess erectile function. Penile tissue advanced glycation end products (AGE's)/5-hydroxymethyl-2-furaldehyde, malondialdehyde (MDA), cGMP (ELISA), inducible nitric oxide synthase (iNOS) and neuronal NOS (nNOS) (Western blot) analyses were performed in all rat groups. CRF-induced rats had a significant decrease in erectile function when compared to control rats (P chronic sildenafil administration on erectile function in CRF-induced rats. PMID:25652632

Netherlands : employment opportunities for people with chronic diseases

NARCIS (Netherlands)

Hooftman, W.; Houtman, I.L.D.

2014-01-01

There is no clear national definition of a chronic disease in a work situation in the Netherlands. Questionnaire data shows that between 25% and 30% of all workers are affected by a chronic disease. Worker with a chronic disease have slightly different working conditions as compared to workers

Bacterial biofilm in chronic lesions of Hidradenitis Suppurativa

DEFF Research Database (Denmark)

Ring, H C; Bay, L; Nilsson, M

2017-01-01

BACKGROUND: Chronic non-healing or recurrent inflammatory lesions, reminiscent of infection but recalcitrant to antibiotic therapy generally characterize biofilm driven-diseases. Chronic lesions of Hidradenitis Suppurativa (HS) exhibit several aspects, which are compatible with well-known biofilm...... infections. OBJECTIVE: To determine and quantify the potential presence of bacterial aggregates in chronic HS lesions. METHODS: In 42 consecutive HS patients suffering from chronic lesions, biopsies were obtained from lesional as well as from perilesional skin. Samples were investigated using Peptide Nucleic...... Acid (PNA) - Fluorescence in situ Hybridization (FISH) in combination with Confocal Laser Scanning Microscopy (CLSM). In addition, corresponding histopathological analysis in hematoxylin and eosin slides were performed. RESULTS: Biofilms were seen in 67% of the samples of chronic lesions and in 75...

Aminoadamantanes for chronic hepatitis C

DEFF Research Database (Denmark)

Lamers, Mieke H; Broekman, Mark; Drenth, Joost Ph

2014-01-01

BACKGROUND: Around 3% of the world's population (approximately 160 million people) are chronically infected with hepatitis C virus. The proportion of infected people who develop clinical symptoms varies between 5% and 40%. Combination therapy with pegylated interferon-alpha plus ribavirin...... response in genotype 1 infected patients to at least 70%. There is therefore an unmet need for drugs that can achieve a higher proportion of sustained virological response. Aminoadamantanes are antiviral drugs used for treatment of patients with chronic hepatitis C. OBJECTIVES: To assess the beneficial...... and harmful effects of aminoadamantanes for patients with chronic hepatitis C infection by conducting a systematic review with meta-analyses of randomised clinical trials, as well as trial sequential analyses. SEARCH METHODS: We conducted electronic searches of the Cochrane Hepato-Biliary Group Controlled...

Health Technologies for the Improvement of Chronic Disease Management

Science.gov (United States)

Nikitovic, M; Brener, S

2013-01-01

Background As part of ongoing efforts to improve the Ontario health care system, a mega-analysis examining the optimization of chronic disease management in the community was conducted by Evidence Development and Standards, Health Quality Ontario (previously known as the Medical Advisory Secretariat [MAS]). Objective The purpose of this report was to identify health technologies previously evaluated by MAS that may be leveraged in efforts to optimize chronic disease management in the community. Data Sources The Ontario Health Technology Assessment Series and field evaluations conducted by MAS and its partners between January 1, 2006, and December 31, 2011. Review Methods Technologies related to at least 1 of 7 disease areas of interest (type 2 diabetes, coronary artery disease, atrial fibrillation, chronic obstructive pulmonary disease, congestive heart failure, stroke, and chronic wounds) or that may greatly impact health services utilization were reviewed. Only technologies with a moderate to high quality of evidence and associated with a clinically or statistically significant improvement in disease management were included. Technologies related to other topics in the mega-analysis on chronic disease management were excluded. Evidence-based analyses were reviewed, and outcomes of interest were extracted. Outcomes of interest included hospital utilization, mortality, health-related quality of life, disease-specific measures, and economic analysis measures. Results Eleven analyses were included and summarized. Technologies fell into 3 categories: those with evidence for the cure of chronic disease, those with evidence for the prevention of chronic disease, and those with evidence for the management of chronic disease. Conclusions The impact on patient outcomes and hospitalization rates of new health technologies in chronic disease management is often overlooked. This analysis demonstrates that health technologies can reduce the burden of illness; improve patient

Perceived stereotyping and seeking care for chronic vulvar pain.

Science.gov (United States)

Nguyen, Ruby H N; Turner, Rachael M; Rydell, Sarah A; Maclehose, Richard F; Harlow, Bernard L

2013-10-01

We examined stereotyping of chronic pain sufferers among women aged 18-40 years and determined whether perceived stereotyping affects seeking care for women with chronic vulvar pain. Cross-sectional study using a community-based survey of vulvodynia asking if "Doctors think that people with chronic pain exaggerate their pain," and if "People believe that vulvar pain is used as an excuse to avoid having sex". Twelve thousand eight hundred thirty-four women aged 18-40 years in metropolitan Minneapolis/St. Paul, Minnesota. Women were considered to have a history of chronic vulvar pain if they reported vulvar burning lasting more than 3 months or vulvar pain on contact. Four thousand nine hundred eighty-seven (38.9%) women reported a chronic pain condition; 1,651 had chronic vulvar pain. Women experiencing chronic pain were more likely than those without to perceive stereotyping from both doctors and others; a dose-response with the number of pain conditions existed. Women with chronic vulvar pain were more likely to believe that people think vulvar pain is an excuse to avoid intercourse. Half of the women with chronic vulvar pain did not seek medical care for it; of these, 40.4% perceived stereotyping from doctors. However, it was women who actually sought care (45.1%) who were more likely to feel stigmatized by doctors (adjusted relative risk = 1.11, 95% confidence interval: 1.01-1.23). Perceived negative stereotyping among chronic pain sufferers is common, particularly negative perceptions about physicians. In fact, chronic vulvar pain sufferers who felt stigmatized were more likely to have sought care than those who did not feel stigmatized. Wiley Periodicals, Inc.

Association between chronic urticaria and self-reported penicillin allergy.

Science.gov (United States)

Silverman, Susanna; Localio, Russell; Apter, Andrea J

2016-04-01

Penicillin allergy is the most commonly reported drug allergy and often presents with cutaneous symptoms. Other common diagnoses, such as chronic urticaria, may be falsely attributed to penicillin allergy. Because chronic urticaria is fairly common in the general population, evaluation of its prevalence in patients with self-reported penicillin allergy was of interest. Similarly, the prevalence of self-reported penicillin allergy in patients with chronic urticaria is not well known and also becomes interesting in light of the high prevalence of self-reported penicillin allergy in the general population. To determine the prevalence of self-reported penicillin allergy in patients with chronic urticaria and the prevalence of chronic urticaria in patients with self-reported penicillin allergy. This was a retrospective medical record review of 11,143 patients completed using the electronic health record of the University of Pennsylvania Allergy and Immunology clinic. The prevalence of self-reported penicillin allergy in patients with chronic urticaria was found to be approximately 3 times greater than in the general population. The prevalence of chronic urticaria in patients with self-reported penicillin allergy was also found to be approximately 3 times greater than in the population. This link between chronic urticaria and self-reported penicillin allergy highlights the need for clinicians to inquire about self-reported penicillin allergy in patients with chronic urticaria and to consider penicillin skin testing. Furthermore, patients who report penicillin allergy might actually have chronic urticaria, indicating the importance of inquiring about chronic urticaria symptoms in patients with self-reported penicillin allergy. Copyright © 2016 American College of Allergy, Asthma & Immunology. Published by Elsevier Inc. All rights reserved.

Conditioned pain modulation in patients with nonspecific chronic back pain with chronic local pain, chronic widespread pain, and fibromyalgia.

Science.gov (United States)

Gerhardt, Andreas; Eich, Wolfgang; Treede, Rolf-Detlef; Tesarz, Jonas

2017-03-01

Findings considering conditioned pain modulation (CPM) in chronic back pain (CBP) are contradictory. This might be because many patients with CBP report pain in further areas of the body, and altered CPM might influence spatial extent of pain rather than CBP per se. Therefore, we compared CPM in patients with CBP with different pain extent. Patients with fibromyalgia syndrome (FMS), for whom CPM impairment is reported most consistently, were measured for comparison. Based on clinical evaluation and pain drawings, patients were categorized into chronic local back pain (CLP; n = 53), chronic widespread back pain (CWP; n = 32), and FMS (n = 92). Conditioned pain modulation was measured by the difference in pressure pain threshold (test stimuli) at the lower back before and after tonic heat pain (conditioning stimulus). We also measured psychosocial variables. Pressure pain threshold was significantly increased in CLP patients after tonic heat pain (P pain modulation in CLP was significantly higher than that in CWP and FMS (P painful areas (0-10) were associated with lower CPM (r = 0.346, P = 0.001) in CBP but not in FMS (r = -0.013, P = 0.903). Anxiety and depression were more pronounced in FMS than in CLP or CWP (P values pain inhibition seem to be more indicated the higher the pain extent.

Radiofrequency Wire Recanalization of Chronically Thrombosed TIPS

Energy Technology Data Exchange (ETDEWEB)

Majdalany, Bill S., E-mail: bmajdala@med.umich.edu [University of Michigan Health System, Division of Interventional Radiology, Department of Radiology (United States); Elliott, Eric D., E-mail: eric.elliott@osumc.edu [The Ohio State University Wexner Medical Center, Division of Interventional Radiology, Department of Radiology (United States); Michaels, Anthony J., E-mail: Anthony.michaels@osumc.edu; Hanje, A. James, E-mail: James.Hanje@osumc.edu [The Ohio State University Wexner Medical Center, Division of Gastroenterology and Hepatology, Department of Medicine (United States); Saad, Wael E. A., E-mail: wsaad@med.umich.edu [University of Michigan Health System, Division of Interventional Radiology, Department of Radiology (United States)

2016-07-15

Radiofrequency (RF) guide wires have been applied to cardiac interventions, recanalization of central venous thromboses, and to cross biliary occlusions. Herein, the use of a RF wire technique to revise chronically occluded transjugular intrahepatic portosystemic shunts (TIPS) is described. In both cases, conventional TIPS revision techniques failed to revise the chronically thrombosed TIPS. RF wire recanalization was successfully performed through each of the chronically thrombosed TIPS, demonstrating initial safety and feasibility in this application.

Underlying causes of chronic bladder dysfunction

African Journals Online (AJOL)

It is often associated with other chronic pain conditions such as chronic functional ... a safe and effective option for treating IC/PBS.10 Proposed future research approaches include systemic treatment with anti-nerve growth factors .... polyethylene or arylamine derivatives) may contribute towards developing transitional cell ...

Cannabis and Cannabinoids for Chronic Pain.

Science.gov (United States)

Romero-Sandoval, E Alfonso; Kolano, Ashley L; Alvarado-Vázquez, P Abigail

2017-10-05

The purpose of this study was to provide the most up-to-date scientific evidence of the potential analgesic effects, or lack thereof, of the marijuana plant (cannabis) or cannabinoids, and of safety or tolerability of their long-term use. We found that inhaled (smoked or vaporized) cannabis is consistently effective in reducing chronic non-cancer pain. Oral cannabinoids seem to improve some aspects of chronic pain (sleep and general quality of life), or cancer chronic pain, but they do not seem effective in acute postoperative pain, abdominal chronic pain, or rheumatoid pain. The available literature shows that inhaled cannabis seems to be more tolerable and predictable than oral cannabinoids. Cannabis or cannabinoids are not universally effective for pain. Continued research on cannabis constituents and improving bioavailability for oral cannabinoids is needed. Other aspects of pain management in patients using cannabis require further open discussion: concomitant opioid use, medical vs. recreational cannabis, abuse potential, etc.

Chronic traumatic encephalopathy: The unknown disease.

Science.gov (United States)

Martínez-Pérez, R; Paredes, I; Munarriz, P M; Paredes, B; Alén, J F

2017-04-01

Chronic traumatic encephalopathy is a neurodegenerative disease produced by accumulated minor traumatic brain injuries; no definitive premortem diagnosis and no treatments are available for chronic traumatic encephalopathy. Risk factors associated with chronic traumatic encephalopathy include playing contact sports, presence of the apolipoprotein E4, and old age. Although it shares certain histopathological findings with Alzheimer disease, chronic traumatic encephalopathy has a more specific presentation (hyperphosphorylated tau protein deposited as neurofibrillary tangles, associated with neuropil threads and sometimes with beta-amyloid plaques). Its clinical presentation is insidious; patients show mild cognitive and emotional symptoms before progressing to parkinsonian motor signs and finally dementia. Results from new experimental diagnostic tools are promising, but these tools are not yet available. The mainstay of managing this disease is prevention and early detection of its first symptoms. Copyright © 2014 Sociedad Española de Neurología. Publicado por Elsevier España, S.L.U. All rights reserved.

Chronic pain, work performance and litigation.

Science.gov (United States)

Blyth, Fiona M; March, Lyn M; Nicholas, Michael K; Cousins, Michael J

2003-05-01

The overall population impact of chronic pain on work performance has been underestimated as it has often been described in terms of work-related absence, excluding more subtle effects that chronic pain may have on the ability to work effectively. Additionally, most studies have focussed on occupational and/or patient cohorts and treatment seeking, rather than sampling from the general population. We undertook a population-based random digit dialling computer-assisted telephone survey with participants randomly selected within households in order to measure the impact of chronic pain on work performance. In addition, we measured the association between pain-related disability and litigation. The study took place in Northern Sydney Health Area, a geographically defined urban area of New South Wales, Australia, and included 484 adults aged 18 or over with chronic pain. The response rate was 73.4%. Working with pain was more common (on an average 83.8 days in 6 months) than lost work days due to pain (4.5 days) among chronic pain participants in full-time or part-time employment. When both lost work days and reduced-effectiveness work days were summed, an average of 16.4 lost work day equivalents occurred in a 6-month period, approximately three times the average number of lost work days. In multiple logistic regression modelling with pain-related disability as the dependent variable, past or present pain-related litigation had the strongest association (odds ratio (OR)=3.59, P=0.001). In conclusion, chronic pain had a larger impact on work performance than has previously been recognised, related to reduced performance while working with pain. A significant proportion were able to work effectively with pain, suggesting that complete relief of pain may not be an essential therapeutic target. Litigation (principally work-related) for chronic pain was strongly associated with higher levels of pain-related disability, even after taking into account other factors

Chronic Kidney Disease and Lipid Disorders.

Science.gov (United States)

Zubovic, Sandra Vegar; Kristic, Spomenka; Prevljak, Sabina; Pasic, Irmina Sefic

2016-06-01

Chronic kidney disease (CKD) represents a serious public health problem due to the increase in incidence and prevalence of this disease worldwide. Given the significant morbidity and mortality from cardiovascular disease (CVD) in the population of patients with CKD, and the fact that dyslipidemia itself is a risk factor for CVD, increases the importance of lipid metabolism study in patients with CKD. Evaluate the lipid status of patients with chronic kidney disease. A one-year prospective study included 150 adult patients who were in various stages of chronic renal failure (stage I to IV). Estimate of creatinine clearance was performed using Cockroft-Goult formula. The classification of patients according to stages of chronic renal insufficiency was performed in accordance with the criteria of Kidney Disease Outcomes Quality Initiative (K/DOQI). Of the total number of patients (N=150) there was 71 males and 79 females. The mean age of patients was 55.43 years. Average values of serum cholesterol were highest in patients with stage II renal disease and the lowest in patients classified as stage IV (5.76±1.60 mmol/L vs. 5.07±1.88 mmol/L). Analysis of the average value of triglycerides in blood show a slight increase through the stages of CKD in a manner that patients classified into stage I have low serum triglyceride levels (1.73±1.17 mmol/L (range 0.61 to 5.5 mmol/L), and patients classified in stage III the highest value 2.13±1.11 mmol/L (range 0.62 to 4.66 mmol/L). Average cholesterol levels does not statistically significantly change with progression of chronic renal disease. There is an almost linear increase in average triglyceride levels in chronic renal disease. Triglyceride levels in serum begins to increase in the early stage of chronic renal disease and reach the peak in stage IV.

Damage of hippocampal neurons in rats with chronic alcoholism.

Science.gov (United States)

Du, Ailin; Jiang, Hongbo; Xu, Lei; An, Na; Liu, Hui; Li, Yinsheng; Zhang, Ruiling

2014-09-01

Chronic alcoholism can damage the cytoskeleton and aggravate neurological deficits. However, the effect of chronic alcoholism on hippocampal neurons remains unclear. In this study, a model of chronic alcoholism was established in rats that were fed with 6% alcohol for 42 days. Endogenous hydrogen sulfide content and cystathionine-beta-synthase activity in the hippocampus of rats with chronic alcoholism were significantly increased, while F-actin expression was decreased. Hippocampal neurons in rats with chronic alcoholism appeared to have a fuzzy nuclear membrane, mitochondrial edema, and ruptured mitochondrial crista. These findings suggest that chronic alcoholism can cause learning and memory decline in rats, which may be associated with the hydrogen sulfide/cystathionine-beta-synthase system, mitochondrial damage and reduced expression of F-actin.

Chronic conditions, fluid states: chronicity and the anthropology of illness

National Research Council Canada - National Science Library

Manderson, Lenore; Smith-Morris, Carolyn

2010-01-01

... in the field, address the concept of chronicity, an idea used to explain individual and local life-worlds, question public health discourse, and consider the relationship between health and the globalizing forces that shape it."--pub. desc.

Inducible nitric oxide synthase in heart tissue and nitric oxide in serum of Trypanosoma cruzi-infected rhesus monkeys: association with heart injury.

Directory of Open Access Journals (Sweden)

Cristiano Marcelo Espinola Carvalho

Full Text Available BACKGROUND: The factors contributing to chronic Chagas' heart disease remain unknown. High nitric oxide (NO levels have been shown to be associated with cardiomyopathy severity in patients. Further, NO produced via inducible nitric oxide synthase (iNOS/NOS2 is proposed to play a role in Trypanosoma cruzi control. However, the participation of iNOS/NOS2 and NO in T. cruzi control and heart injury has been questioned. Here, using chronically infected rhesus monkeys and iNOS/NOS2-deficient (Nos2(-/- mice we explored the participation of iNOS/NOS2-derived NO in heart injury in T. cruzi infection. METHODOLOGY: Rhesus monkeys and C57BL/6 and Nos2(-/- mice were infected with the Colombian T. cruzi strain. Parasite DNA was detected by polymerase chain reaction, T. cruzi antigens and iNOS/NOS2(+ cells were immunohistochemically detected in heart sections and NO levels in serum were determined by Griess reagent. Heart injury was assessed by electrocardiogram (ECG, echocardiogram (ECHO, creatine kinase heart isoenzyme (CK-MB activity levels in serum and connexin 43 (Cx43 expression in the cardiac tissue. RESULTS: Chronically infected monkeys presented conduction abnormalities, cardiac inflammation and fibrosis, which resembled the spectrum of human chronic chagasic cardiomyopathy (CCC. Importantly, chronic myocarditis was associated with parasite persistence. Moreover, Cx43 loss and increased CK-MB activity levels were primarily correlated with iNOS/NOS2(+ cells infiltrating the cardiac tissue and NO levels in serum. Studies in Nos2(-/- mice reinforced that the iNOS/NOS2-NO pathway plays a pivotal role in T. cruzi-elicited cardiomyocyte injury and in conduction abnormalities that were associated with Cx43 loss in the cardiac tissue. CONCLUSION: T. cruzi-infected rhesus monkeys reproduce features of CCC. Moreover, our data support that in T. cruzi infection persistent parasite-triggered iNOS/NOS2 in the cardiac tissue and NO overproduction might contribute

Clinical and pathological assessment of 82 patients with cardiovascular diseases undergoing autopsy at the Hospital das Clínicas of the Faculdade de Medicina de Botucatu from 1988 to 1993

Directory of Open Access Journals (Sweden)

Reinaldo Ayer de Oliveira

2000-10-01

Full Text Available OBJECTIVE: To evaluated the clinical diagnostic, efficiency for basic death causes in patients dying of circulatory disease and de relative frequency of those diseases. METHODS: Analysis of medical record data of 82 patients, ages from 16 to 84 years old (68 over 40 years old, whose died of circulatory disease and had undergone necropsy in the period from 1988 to 1993 years in the University Hospital of Medicine Faculty of Botucatu-UNESP, Br. RESULTS: The functional class of patients were III or IV, in 78%, and 81.7% needed urgent hospitalization. By the clinical judgment the death were by ischemic heart disease in 32 (21 acute myocardial infarction, Chagas'disease in 12, valvopathy in 11, cardiomyopathy in 7, heart failure with no specification of cardiopathy in 11 and other causes in 9. At the necropsy the death cause was ischemic heart disease in 34 patients, valvopathy in 10, Chagas'disease in 10, cardiomyopathy in 5, and heart failure with no specification of cardiopathy in 2.The concordance taxes were in thhe same order: 94,6%, 90,0%, 83.3%, 71.4% and 28.5%. CONCLUSION: There was a great efficiency of clinical diagnosis for death cause in a general university hospital. The ischemic heart disease were the main causes of death.

Evidence-based clinical practice guidelines for chronic pancreatitis 2015.

Science.gov (United States)

Ito, Tetsuhide; Ishiguro, Hiroshi; Ohara, Hirotaka; Kamisawa, Terumi; Sakagami, Junichi; Sata, Naohiro; Takeyama, Yoshifumi; Hirota, Morihisa; Miyakawa, Hiroyuki; Igarashi, Hisato; Lee, Lingaku; Fujiyama, Takashi; Hijioka, Masayuki; Ueda, Keijiro; Tachibana, Yuichi; Sogame, Yoshio; Yasuda, Hiroaki; Kato, Ryusuke; Kataoka, Keisho; Shiratori, Keiko; Sugiyama, Masanori; Okazaki, Kazuichi; Kawa, Shigeyuki; Tando, Yusuke; Kinoshita, Yoshikazu; Watanabe, Mamoru; Shimosegawa, Tooru

2016-02-01

Chronic pancreatitis is considered to be an irreversible progressive chronic inflammatory disease. The etiology and pathology of chronic pancreatitis are complex; therefore, it is important to correctly understand the stage and pathology and provide appropriate treatment accordingly. The newly revised Clinical Practice Guidelines of Chronic Pancreatitis 2015 consist of four chapters, i.e., diagnosis, staging, treatment, and prognosis, and includes a total of 65 clinical questions. These guidelines have aimed at providing certain directions and clinically practical contents for the management of chronic pancreatitis, preferentially adopting clinically useful articles. These revised guidelines also refer to early chronic pancreatitis based on the Criteria for the Diagnosis of Chronic Pancreatitis 2009. They include such items as health insurance coverage of high-titer lipase preparations and extracorporeal shock wave lithotripsy, new antidiabetic drugs, and the definition of and treatment approach to pancreatic pseudocyst. The accuracy of these guidelines has been improved by examining and adopting new evidence obtained after the publication of the first edition.

The computed tomography appearance of recurrent and chronic appendicitis.

Science.gov (United States)

Rao, P M; Rhea, J T; Novelline, R A; McCabe, C J

1998-01-01

The objective of this study was to determine computed tomography (CT) appearance of recurrent and chronic appendicitis. In 100 consecutive appendiceal CT examinations of proven appendicitis, 18 patients met criteria for recurrent (multiple discrete episodes) or chronic (continuous symptoms > 3 weeks, pathological findings) appendicitis. CT findings were reviewed. Ten patients had recurrent appendicitis, 3 had chronic appendicitis, 3 had both, and 2 had pathological chronic appendicitis. CT findings in 18 recurrent/chronic cases were identical to 82 acute appendicitis cases, including pericecal stranding (both 100%), dilated (> 6 mm) appendix (88.9% versus 93.9%), apical thickening (66.7% versus 69.5%), adenopathy (66.7% versus 61.0%), appendolith(s) (50% versus 42.7%), arrowhead (27.8% versus 22.0%), abscess (11.1% versus 11.0%), phlegmon (11.1% versus 6.1%), and fluid (5.6% versus 19.5%). CT findings in recurrent and chronic appendicitis are the same as those in acute appendicitis. Appendiceal CT can be beneficial for evaluating patients with suspected recurrent or chronic appendicitis.

Chronic pancreatitis: diagnosis, classification, and new genetic developments.

Science.gov (United States)

Etemad, B; Whitcomb, D C

2001-02-01

The utilization of recent advances in molecular and genomic technologies and progress in pancreatic imaging techniques provided remarkable insight into genetic, environmental, immunologic, and pathobiological factors leading to chronic pancreatitis. Translation of these advances into clinical practice demands a reassessment of current approaches to diagnosis, classification, and staging. We conclude that an adequate pancreatic biopsy must be the gold standard against which all diagnostic approaches are judged. Although computed tomography remains the initial test of choice for the diagnosis of chronic pancreatitis, the roles of endoscopic retrograde pancreatography, endoscopic ultrasonography, and magnetic resonance imaging are considered. Once chronic pancreatitis is diagnosed, proper classification becomes important. Major predisposing risk factors to chronic pancreatitis may be categorized as either (1) toxic-metabolic, (2) idiopathic, (3) genetic, (4) autoimmune, (5) recurrent and severe acute pancreatitis, or (6) obstructive (TIGAR-O system). After classification, staging of pancreatic function, injury, and fibrosis becomes the next major concern. Further research is needed to determine the clinical and natural history of chronic pancreatitis developing in the context of various risk factors. New methods are needed for early diagnosis of chronic pancreatitis, and new therapies are needed to determine whether interventions will delay or prevent the progression of the irreversible damage characterizing end-stage chronic pancreatitis.

Epidemiology of Chronic Pain in Denmark and Sweden

Directory of Open Access Journals (Sweden)

Julie Harker

2012-01-01

Full Text Available Introduction. Estimates on the epidemiology of chronic pain vary widely throughout Europe. It is unclear whether this variation reflects true differences between populations or methodological factors. Information on the epidemiology of chronic pain can support decision makers in allocating adequate health care resources. Methods. In order to obtain epidemiological data on chronic pain in Denmark and Sweden, we conducted a literature review of epidemiological data primarily on chronic noncancer pain, prioritising studies of highest quality, recency, and validity by conducting a systematic search for relevant studies. Following quality assessment, data were summarised and assigned to the research questions. Results. The prevalence of moderate to severe noncancer pain was estimated at 16% in Denmark and 18% in Sweden. Chronic pain impacts negatively on perceived health status, quality of life and is associated with increased cost. Despite using pain medications, a large proportion of chronic pain sufferers have inadequate pain control. There was a lack of high-quality and low-bias studies with clear inclusion criteria. Conclusions. In both Denmark and Sweden, chronic pain is a common health problem which is potentially undertreated and warrants attention of health care workers, policy makers and researchers. Future research should utilise clear reporting guidelines to assist decision and policy makers, in this important area.

Major and chronic diseases, report 2007.

NARCIS (Netherlands)

Giampaoli, S.; Oyen, H. van; Devillé, W.; Verschuuren, M.

2008-01-01

Blind spots in European health information On June 6th 2008 the European Commission has published the Major and Chronic Diseases Report 2007. This report describes the state of the art of health information in Europe on 13 prevalent chronic conditions. Large differences between the Member States of

New treatment of chronic hepatitis B

DEFF Research Database (Denmark)

Andersen, E.S.; Weis, Nina

2008-01-01

Worldwide, 350 million people are infected with chronic hepatitis B. Over the last few years, it has been possible to treat chronic hepatitis B. Treatment very often consists of nucleos(t)ide analogs and in a few cases of pegylated alpha-interferon. In 2007, a new nucleoside analog, Telbivudine...

38 CFR 4.88a - Chronic fatigue syndrome.

Science.gov (United States)

2010-07-01

... 38 Pensions, Bonuses, and Veterans' Relief 1 2010-07-01 2010-07-01 false Chronic fatigue syndrome. 4.88a Section 4.88a Pensions, Bonuses, and Veterans' Relief DEPARTMENT OF VETERANS AFFAIRS SCHEDULE... Deficiencies § 4.88a Chronic fatigue syndrome. (a) For VA purposes, the diagnosis of chronic fatigue syndrome...

Imatinib mesylate in chronic myelogenous leukemia: a Congolese ...

African Journals Online (AJOL)

Major cytogenetic response was noticed in 87.18%. After a median follow up of 12 months, chronic myeloid leukemia had not progressed to the accelerated or blastic phase in an estimated 91.8% of patients and 86.6% were alive. Conclusion: Imatinib is effective in newly chronic phase chronic myeloid leukemia patient ...

ETIOLOGICAL FACTORS OF CHRONIC GASTRITIS IN CHILDREN

Directory of Open Access Journals (Sweden)

G.V. Volynets

2006-01-01

Full Text Available In the article the data on the study of the etiological factors of various types of chronic gastritis in children are presented. Based on revealing of the auto antibodies to parietal gastric cells in 40,0% of children autoimmune gastritis (a type gastritis is diagnosed. Helicobacterr pylori infection is revealed in 44,8% of children. In 27,6% of children type c gastritis is diagnosed. Autoimmune gastritis in children has been linked to the active phase of chronic epsteinbbarr virus infection. the etiological factors of nonautoimmune gastritis are Helicobacter pylori infection (type b gastritis and multiple duodenogastric refluxes (type c gastritis.Key words: children, chronic gastritis, etiological factors, autoimmune gastritis, nonautoimmune gastritis, active phase of chronic Epstein-Barr virus infection, Helicobacter pylori infection.

Hypoglycemia, chronic kidney disease, and diabetes mellitus.

Science.gov (United States)

Alsahli, Mazen; Gerich, John E

2014-11-01

Hypoglycemia is a major problem associated with substantial morbidity and mortality in patients with diabetes and is often a major barrier to achieving optimal glycemic control. Chronic kidney disease not only is an independent risk factor for hypoglycemia but also augments the risk of hypoglycemia that is already present in people with diabetes. This article summarizes our current knowledge of the epidemiology, pathogenesis, and morbidity of hypoglycemia in patients with diabetes and chronic kidney disease and reviews therapeutic considerations in this situation. PubMed and MEDLINE were searched for literature published in English from January 1989 to May 2014 for diabetes mellitus, hypoglycemia, chronic kidney disease, and chronic renal insufficiency. Copyright © 2014 Mayo Foundation for Medical Education and Research. Published by Elsevier Inc. All rights reserved.

Chronic Pain and Neuropathy Following Adjuvant Chemotherapy

DEFF Research Database (Denmark)

Ventzel, Lise; Madsen, Caspar S; Karlsson, Páll

2017-01-01

Objective: To determine symptoms and characteristics of chronic sensory neuropathy in patients treated with oxaliplatin and docetaxel, including patterns of somatosensory abnormalities, pain descriptors, and psychological functioning. Design: A retrospective cross-sectional study. Setting: A chro...... mechanisms useful for future studies in the tailored treatment of prevention of chemotherapy-induced peripheral neuropathy and pain.......Objective: To determine symptoms and characteristics of chronic sensory neuropathy in patients treated with oxaliplatin and docetaxel, including patterns of somatosensory abnormalities, pain descriptors, and psychological functioning. Design: A retrospective cross-sectional study. Setting......: A chronic pain research center. Subjects: Thirty-eight patients with chronic peripheral pain and/or dysesthesia following chemotherapy. Methods:  Sensory profiles, psychological functioning, and quality of life were assessed using standardized questionnaires. In addition, standardized quantitative sensory...

[Occurrence of associated tumours in chronic lymphocytic leukemia].

Science.gov (United States)

Szerafin, László; Jakó, János; Varju, Lóránt

2016-10-01

Chronic lymphocytic leukemia is one of the most common hematologic malignancy. The aim of the authors was to investigate the characteristics of malignancies associated with chronic lymphocytic leukemia in patients diagnozed between 2000 and 2015. Data of patients with chronic lymphocytic leukemia who had other associated tumours were analysed using the Leukemia/Lymphoma Registry of the Szabolcs-Szatmár-Bereg County, Hungary and patient records. Between January 1, 2000 and December 31, 2015, 526 patients with chronic lymphocytic leukemia were diagnosed. 95 patients of the 526 patients (18.06%) were diagnosed as having associated other tumours. In 48/95 patients (50.5%) the first diagnosed tumour was chronic lymphocytic leukemia, in 23/95 patients (24.2%) the first recognized malignancy was the associated tumour, whereas in 24/95 patients (25.3%) synchron tumours were diagnosed. The number of patients with more than one associated tumour was 10/95 (10.5%). The total number of tumours was 107. The incidence of chronic lymphoid leukemia increased in the period between 2000 and 2015 as compared to the period between 1983 and 1999 (3.19 vs 5.65/100 000 person/year). The occurrence of associated malignancies increased as well (8.06% vs 18.06%). In addition to the most common tumours (colorectal, breast, lung, prostate), skin squamous cell carcinoma (17/95 patients; 17.9%) and melanoma (6/95 patients; 6.3%) also frequently occurred. The second malignancies were most frequently discovered after the diagnosis of chronic lymphocytic leukemia and synchron tumours accounting for 78.5% (84/107) of all associated tumours. The incidence of second malignancies decreased 10 years after the diagnosis of chronic lymphocytic leukemia. The possible reasons for the high frequency of other tumours associated with chronic lymphocytic leukemia are elderly age of patients, immunsuppressed state and, presumably, chemotherapy of patients with chronic lymphocytic leukemia. During the follow up

Use of a General Magnetotherapy for Correction of the Lipoperoxidation Values in Patients with a Chronic Cervicitis Combined with a Chronic Adnexitis

OpenAIRE

Fatalieva G.G.; Chandra D'Mello R.

2010-01-01

Aim of investigation is detection of the lipid peroxidation (LPO) state in patients with a chronic cervicitis combined with a chronic adnexitis and possibility of a general magnetotherapy use in its correction. Materials and Methods. 80 patients with a chronic nonspecific cervicitis combined with a chronic adnexitis are examined. A general magnetotherapy was used in one of the groups together with antibacterial therapy. Results. It is established, that a normalization of the disease c...

Does the Spiritual Well-Being of Chronic Hemodialysis Patients Differ from that of Pre-dialysis Chronic Kidney Disease Patients?

Directory of Open Access Journals (Sweden)

Areewan Cheawchanwattana

2014-12-01

Full Text Available Spiritual well-being is viewed as an essential component of health-related quality of life (HRQOL in the modernized biopsychosocial-spiritual model of health. Understanding spiritual well-being should lead to better treatment plans from the patients’ point of view, and improved patient adherence. There are numerous studies of traditional HRQOL, physical, mental, and social well-being; however, studies of spiritual well-being in chronic kidney disease (CKD patients are limited. Thus, this study compared spiritual well-being of chronic hemodialysis patients and pre-dialysis CKD patients. A total of 31 chronic hemodialysis and 63 pre-dialysis CKD patients were asked for consent and then interviewed for spiritual well-being using the Functional Assessment of Chronic Illness Therapy–Spiritual Well-Being (FACIT-Sp. Analysis of covariance was applied to compare FACIT-Sp scores between pre-dialysis CKD and chronic hemodialysis groups that were adjusted by patient characteristics. The FACIT-Sp scores of pre-dialysis CKD patients were non-significantly greater than those of chronic hemodialysis patients after adjustment for gender, age, and marital status. However, all FACIT-Sp scores of males were significantly lower than those of females [FACIT Meaning −1.59 (p = 0.024, FACIT Peace −2.37 (p = 0.004, FACIT Faith −2.87 (p = 0.001, FACIT Total Score −6.83 (p = 0.001]. The spiritual well-being did not significantly differ by stages of chronic kidney disease; however, patient gender was associated with spiritual well-being instead. To improve spiritual well-being, researchers should consider patient gender as a significant factor.

Chronic pain during pregnancy: a review of the literature.

Science.gov (United States)

Ray-Griffith, Shona L; Wendel, Michael P; Stowe, Zachary N; Magann, Everett F

2018-01-01

The majority of the reviews and studies on chronic pain in pregnancy have primarily focused on the pharmacological and non-pharmacological treatment options. The purpose of our review was to identify evidence-based clinical research for the evaluation and management of preexisting chronic pain in pregnancy, chronic pain associated with pregnancy, and chronic pain in relation to mode of delivery. A literature search was undertaken using the search engines PubMed, CINAHL, EBSCOhost, and Web of Science. Search terms used included "chronic pain" AND "pregnant OR pregnancy" OR "pregnancy complications" from inception through August 2016. The basis of this review was the 144 articles that met inclusion criteria for this review. Based on our review of the current literature, we recommend 7 guidelines for chronic pain management during and after pregnancy: 1) complete history and physical examination; 2) monitor patients for alcohol, nicotine, and substance use; 3) collaborate with patient to set treatment goals; 4) develop a management plan; 5) for opioids, use lowest effective dose; 6) formulate a pain management plan for labor and delivery; and 7) discuss reproductive health with women with chronic pain. The management of chronic pain associated with pregnancy is understudied. Obstetrical providers primarily manage chronic pain during pregnancy. Some general guidelines are provided for those health care providers until more information is available.

Chronic pain during pregnancy: a review of the literature

Directory of Open Access Journals (Sweden)

Ray-Griffith SL

2018-04-01

Full Text Available Shona L Ray-Griffith,1,2 Michael P Wendel,2 Zachary N Stowe,3 Everett F Magann2 1Department of Psychiatry, University of Arkansas for Medical Sciences, Little Rock, AR, USA; 2Department of Obstetrics and Gynecology, University of Arkansas for Medical Sciences, Little Rock, AR, USA; 3Department of Psychiatry, University of Wisconsin-Madison, Madison, WI, USA Background and purpose: The majority of the reviews and studies on chronic pain in pregnancy have primarily focused on the pharmacological and non-pharmacological treatment options. The purpose of our review was to identify evidence-based clinical research for the evaluation and management of preexisting chronic pain in pregnancy, chronic pain associated with pregnancy, and chronic pain in relation to mode of delivery. Methods: A literature search was undertaken using the search engines PubMed, CINAHL, EBSCOhost, and Web of Science. Search terms used included “chronic pain” AND “pregnant OR pregnancy” OR “pregnancy complications” from inception through August 2016. Results: The basis of this review was the 144 articles that met inclusion criteria for this review. Based on our review of the current literature, we recommend 7 guidelines for chronic pain management during and after pregnancy: 1 complete history and physical examination; 2 monitor patients for alcohol, nicotine, and substance use; 3 collaborate with patient to set treatment goals; 4 develop a management plan; 5 for opioids, use lowest effective dose; 6 formulate a pain management plan for labor and delivery; and 7 discuss reproductive health with women with chronic pain. Conclusion: The management of chronic pain associated with pregnancy is understudied. Obstetrical providers primarily manage chronic pain during pregnancy. Some general guidelines are provided for those health care providers until more information is available. Keywords: chronic pain, pregnancy, pregnancy complications, chronic pain in pregnancy

Pathogenesis of chronic subdural hematoma

International Nuclear Information System (INIS)

Taguchi, Yoshio; Nakamura, Norio; Sato, Jun; Hasegawa, Yoshio.

1982-01-01

Ten cases of chronic subdural hematoma that were followed by a sequential study with CT from an early posttraumatic period to evolution of chronic subdural hematoma were reported. In four of these 10 cases, the initial CT showed thin subdural collections of high density suggesting acute subdural hematoma. Two weeks later, the density of subdural collections reduced, but their volumes increased. Clinical symptoms such as headache and disorientation occurred three or four weeks later. Preoperative CT showed similar huge subdural collections of low density and marked mass effect. These cases underwent surgery from 24 to 44 days after injury, and development of neomenbranes was confirmed. In the remaining six cases, the initial CT showed thin subdural collections of low density suggesting subdural hygroma. In five of the six cases, the density of the subdural collections was slightly higher than that of cerebrospinal fluid, and in one case, an area of spotted high density was shown. It was suggested that these were mixtures with blood. Follow-up CT scans revealed that the subdural collections increased in size but remained at a uniformly low density for the first month after the head injury, and then the increase in density occurred. Operations were performed 55 to 76 days after injury, and operative findings were not different from those of common chronic subdural hematoma. From these investigations, it was suggested that there were two types of evolution of chronic subdural hematoma. One is the development from acute subdural hematomas, and the other from subdural hygromas. It is supposed that blood and cerebrospinal fluid are very important factors in the evolution of subdural collections into chronic subdural hematomas. (J.P.N.)

Old Yellow Enzyme from Trypanosoma cruzi Exhibits In Vivo Prostaglandin F2α Synthase Activity and Has a Key Role in Parasite Infection and Drug Susceptibility

Directory of Open Access Journals (Sweden)

Florencia Díaz-Viraqué

2018-03-01

Full Text Available The discovery that trypanosomatids, unicellular organisms of the order Kinetoplastida, are capable of synthesizing prostaglandins raised questions about the role of these molecules during parasitic infections. Multiple studies indicate that prostaglandins could be related to the infection processes and pathogenesis in trypanosomatids. This work aimed to unveil the role of the prostaglandin F2α synthase TcOYE in the establishment of Trypanosoma cruzi infection, the causative agent of Chagas disease. This chronic disease affects several million people in Latin America causing high morbidity and mortality. Here, we propose a prokaryotic evolutionary origin for TcOYE, and then we used in vitro and in vivo experiments to show that T. cruzi prostaglandin F2α synthase plays an important role in modulating the infection process. TcOYE overexpressing parasites were less able to complete the infective cycle in cell culture infections and increased cardiac tissue parasitic load in infected mice. Additionally, parasites overexpressing the enzyme increased PGF2α synthesis from arachidonic acid. Finally, an increase in benznidazole and nifurtimox susceptibility in TcOYE overexpressing parasites showed its participation in activating the currently anti-chagasic drugs, which added to its observed ability to confer resistance to hydrogen peroxide, highlights the relevance of this enzyme in multiple events including host–parasite interaction.

Malignant transformation in chronic osteomyelitis

Directory of Open Access Journals (Sweden)

Diogo Lino Moura

Full Text Available ABSTRACT INTRODUCTION: Carcinomatous degeneration is a rare and late complication developing decades after the diagnosis of chronic osteomyelitis. OBJECTIVES: To present the results from a retrospective study of six cases of squamous cell carcinoma arising from chronic osteomyelitis. METHODS: Six cases of chronic osteomyelitis related to cutaneous squamous cell carcinoma were identified. The cause and characteristics of the osteomyelitis were analyzed, as well as time up to malignancy, the suspicion signs for malignancy, the localization and histological type of the cancer, and the type and result of the treatment. RESULTS: The mean time between osteomyelitis onset and the diagnosis of malignant degeneration was 49.17 years (range: 32-65. The carcinoma resulted from tibia osteomyelitis in five cases and from femur osteomyelitis in one. The pathological examination indicated cutaneous squamous cell carcinoma in all cases. All the patients were staged as N0M0, except for one, whose lomboaortic lymph nodes were affected. The treatment consisted of amputation proximal to the tumor in all patients. No patient presented signs of local recurrence and only one had carcinoma metastasis. CONCLUSION: Early diagnosis and proximal amputation are essential for prognosis and final results in carcinomatous degeneration secondary to chronic osteomyelitis.

Pathophysiology of Pulmonary Hypertension in Chronic Parenchymal Lung Disease.

Science.gov (United States)

Singh, Inderjit; Ma, Kevin Cong; Berlin, David Adam

2016-04-01

Pulmonary hypertension commonly complicates chronic obstructive pulmonary disease and interstitial lung disease. The association of chronic lung disease and pulmonary hypertension portends a worse prognosis. The pathophysiology of pulmonary hypertension differs in the presence or absence of lung disease. We describe the physiological determinants of the normal pulmonary circulation to better understand the pathophysiological factors implicated in chronic parenchymal lung disease-associated pulmonary hypertension. This review will focus on the pathophysiology of 3 forms of chronic lung disease-associated pulmonary hypertension: idiopathic pulmonary fibrosis, chronic obstructive pulmonary disease, and sarcoidosis. Copyright © 2016 Elsevier Inc. All rights reserved.

Neurological Complications Of Chronic Myeloid Leukaemia: Any ...

African Journals Online (AJOL)

, of the neurological deficits complicating chronic myeloid leukaemia. Method: Using patients\\' case folders and haematological malignancy register all cases of chronic myeloid leukaemia seen in Jos University Teaching Hospital between July ...

The efficacy of adhesiolysis on chronic abdominal pain

DEFF Research Database (Denmark)

Gerner-Rasmussen, Jonas; Burcharth, Jakob; Gögenur, Ismail

2015-01-01

INTRODUCTION: Abdominal adhesions are a frequent reason for chronic abdominal pain. The purpose of this systematic review was to investigate the evidence of performing laparoscopic adhesiolysis as a treatment for patients with chronic abdominal pain. METHODS: Medline, Embase, and The Cochrane Cen...... Central Register of Controlled Trials were searched for trials performing lysis of adhesions on patients suffering from chronic abdominal pain. Clinical studies on patients being treated for chronic abdominal pain with surgical adhesiolysis were included. The main outcome of the study...... chronic abdominal pain. A total of 22 trials were identified as case-series and included no control group. Three studies were identified as randomized controlled trials (RCT). A benefit of the intervention varied from 16 to 88 % in the non-randomized studies, with the majority reporting pain relief...... no difference between the intervention and control group. CONCLUSION: The identified studies showed promising but preliminary results of laparoscopic adhesiolysis as a treatment of chronic abdominal pain. The evidence for laparoscopic adhesiolysis is not sufficient to make definitive conclusions....

Syndrome Analysis: Chronic Alcoholism in Adults.

Science.gov (United States)

Pendorf, James E.

1990-01-01

Provides outline narrative of most possible outcomes of regular heavy alcohol use, regular alcohol abuse, or chronic alcoholism. A systems analysis approach is used to expose conditions that may result when a human organism is subjected to excessive and chronic alcohol consumption. Such an approach illustrates the detrimental effects which alcohol…

Dependence and addiction during chronic opioid therapy.

Science.gov (United States)

Juurlink, David N; Dhalla, Irfan A

2012-12-01

The use of opioids for chronic noncancer pain has increased dramatically over the past 25 years in North America and has been accompanied by a major increase in opioid addiction and overdose deaths. The increase in opioid prescribing is multifactorial and partly reflects concerns about the effectiveness and safety of alternative medications, particularly the nonsteroidal anti-inflammatory drugs. However, much of the rise in opioid prescribing reflects the assertion, widely communicated to physicians in the 1990s, that the risks of dependence and addiction during chronic opioid therapy were low, predictable, and could be minimized by the use of controlled-release opioid formulations. In this narrative review, we offer a critical appraisal of the publications most frequently cited as evidence that the risk of addiction during chronic opioid therapy is low. We conclude that very few well-designed studies support the notion that opioid addiction is rare during chronic opioid therapy and that none can be readily generalized to present-day practice. Despite serious methodological limitations, these studies have been repeatedly mischaracterized as showing that the risk of addiction during chronic opioid therapy is rare. These studies are countered by a larger, more rigorous and contemporary body of evidence demonstrating that dependence and addiction are relatively common consequences of chronic opioid therapy, occurring in up to one-third of patients in some series.

Cardiopathies ischémiques et troubles psychoaffectifs chez le noir ...

African Journals Online (AJOL)

L'alcoolisme (34%), la prise de café (29,9%) et l'obésité (29,3% étaient les facteurs de risques prédominants ; 36,7% des patients étaient de père hypertendu et 31,3% de mère hypertendue. 73,5% de nos patients étaient au stade 2 de la classification JNCVII, 72,8% avaient une pression pulsée supérieure à 60 mmHg.

[Rheumatic cardiopathy in children younger than 6 years of age].

Science.gov (United States)

Vázquez-Antona, C; Calderón-Colmenero, J; Attié, F; Zabal, C; Buendía-Hernández, A; Díaz-Medina, L H; Bialkowski, J; García Arenal, F

1991-01-01

Most of the published papers on Rheumatic Fever (RF) have not included the younger population. We selected 211 cases of children with RF younger than 6 years of age from 9,471 clinical files from 1944 to 1982. These were followed retrospectively to identify the presence of rheumatic activity, subsequent attacks and penicillin profilaxis. From de 211 cases, 209 had carditis; 57% of them were girls and 43% boys. There were no previous infections of the upper respiratory tract in 36% of the patients. The number of cases with RF increased abruptly after 3 years of age and continued increasing until 5 years of age when 70.5% of the population had there first clinically recognized attack. Lesions were present in the mitral valve in 80% of the cases, in the aortic valve in 12%, in the tricuspid in 5% and in the pulmonary valve in 3%. The death rate during the first attack was 20% being refractory heart failure the main cause of death. Thirteen cases suffered rheumatic pneumonia, 9 of whom died (69.2%). 1) The incidence of acute rheumatic fever in children under 6 years of age has decreased with time. 2) The death rate as well as the valvular damage decreased with the parents cooperation with the treatment. 3) The changes in the clinical picture and the severity of valve sequelea may be due to penicillin profilaxis and the better understanding of the disease.

The Relationship Between Posttraumatic Stress Disorder and Chronic Pain in People Seeking Treatment for Chronic Pain: The Mediating Role of Psychological Flexibility.

Science.gov (United States)

Åkerblom, Sophia; Perrin, Sean; Rivano Fischer, Marcelo; McCracken, Lance M

2018-06-01

The symptoms of posttraumatic stress disorder (PTSD) and chronic pain are thought to interact to increase the severity and impact of both conditions, but the mechanisms by which they interact remain unclear. This study examines the relationship between PTSD and chronic pain and whether indices of Psychological Flexibility mediate the relationship between these 2 conditions. Standardized self-report measures of PTSD, pain severity, pain interference, depression, and psychological flexibility (pain-related acceptance, committed action, cognitive fusion, and values-based action) were obtained from 315 people seeking treatment for chronic pain who also reported at least 1 traumatic experience. People seeking treatment for chronic pain and reporting symptoms consistent with a current diagnosis of PTSD had significantly higher levels of pain severity, pain interference, depression, and cognitive fusion and lower levels of pain-related acceptance and committed action than those reporting symptoms below the diagnostic threshold for PTSD. Pain-related acceptance, committed action, cognitive fusion, and depression mediated the relationship between PTSD and pain severity/interference, with pain-related acceptance being the strongest mediator from the Psychological Flexibility model. Processes from the Psychological Flexibility model were identified as mediators of the relationship between PTSD and chronic pain in people seeking treatment for chronic pain. The Psychological Flexibility model may be useful as an overarching model to help understand the relationship between PTSD and chronic pain. It is possible that targeting pain-related acceptance, committed action, and cognitive fusion (among other processes) in the treatment of chronic pain may produce corresponding improvements in comorbid symptoms of PTSD when these are present and may reduce impacts of PTSD on outcomes of chronic pain. Conversely, targeting of these processes in the treatment of PTSD may produce similar

Staged anticonvulsant screening for chronic epilepsy.

Science.gov (United States)

Berdichevsky, Yevgeny; Saponjian, Yero; Park, Kyung-Il; Roach, Bonnie; Pouliot, Wendy; Lu, Kimberly; Swiercz, Waldemar; Dudek, F Edward; Staley, Kevin J

2016-12-01

Current anticonvulsant screening programs are based on seizures evoked in normal animals. One-third of epileptic patients do not respond to the anticonvulsants discovered with these models. We evaluated a tiered program based on chronic epilepsy and spontaneous seizures, with compounds advancing from high-throughput in vitro models to low-throughput in vivo models. Epileptogenesis in organotypic hippocampal slice cultures was quantified by lactate production and lactate dehydrogenase release into culture media as rapid assays for seizure-like activity and cell death, respectively. Compounds that reduced these biochemical measures were retested with in vitro electrophysiological confirmation (i.e., second stage). The third stage involved crossover testing in the kainate model of chronic epilepsy, with blinded analysis of spontaneous seizures after continuous electrographic recordings. We screened 407 compound-concentration combinations. The cyclooxygenase inhibitor, celecoxib, had no effect on seizures evoked in normal brain tissue but demonstrated robust antiseizure activity in all tested models of chronic epilepsy. The use of organotypic hippocampal cultures, where epileptogenesis occurs on a compressed time scale, and where seizure-like activity and seizure-induced cell death can be easily quantified with biomarker assays, allowed us to circumvent the throughput limitations of in vivo chronic epilepsy models. Ability to rapidly screen compounds in a chronic model of epilepsy allowed us to find an anticonvulsant that would be missed by screening in acute models.

Comportamento do peso do coração e do corpo em chagásicos crônicos com e sem "megas"

Directory of Open Access Journals (Sweden)

Hipólito de Oliveira Almeida

1980-12-01

Full Text Available O peso do coração é menor nos chagásicos com "megas" do que nos falecidos subitamente ou em I.C.C., sendo, porém, maior que nos controles. Já o peso corporal ésemelhante nos chagásicos falecidos subitamente e nos controles, havendo redução moderada no grupo com I.C.C., e rtiais acentuada nos chagásicos com "megas" (redução de 20% em relação aos controles. A relação percentual peso cardíaco/peso corporal é de 1,1% no grupo com I.C.C.; 0,71% no grupo de morte súbita; 0,77% no grupo com "megas"; 0,49% no grupo controle e 0,60% ne grupo de doenças caquetizantes. Com base nas médias dos pesos cardíacos e corporal dos grupos controle, de doenças caquetizantes e de megas, calculou-se que o emagrecimento ocorrido nos megas reduziria o peso cardíaco médio de apenas 6,8%.Heart weight is less in chagasic patients with "mega" syndromes than in those which have died suddenly or with congestive heart failure, it is, however, greater than in the Controls. Body weight is similar in chagasic patients who have died suddenly and in the Controls, there is a moderate body weight reduction in the group with congestive heart failure, and a more accentuated reduction in chagasic patients with "mega" syndromes (a reduction of 20% in comparíson with the Controls. The relationship between heart - weight and body - weight, expressed as a percentage is 1,1% in the group with congestive heart failure; 0,71% in the group which died suddenly; 0.77% in the group with "mega" syndromes, 0.49% in the Controls group and 0.60% in the group with cachexia producing diseases. On the basis of mean heart - weights and body - weights of the control group, group with cachexia producing diseases and group with "mega" syndromes it was calculated that the emaciation which occurred in those with "mega"syndromes could reduce mean heart - weight by at least 6.8%.

Chronic asymptomatic hyperamylasemia unrelated to pancreatic disease

Directory of Open Access Journals (Sweden)

Generoso Uomo

2013-05-01

Full Text Available BACKGROUND Almost all patients presenting with chronic hyperamylasemia undergo an expensive, long, difficult and often repeated diagnostic workup even if this occurrence is not associated with symptoms or with known pancreatotoxic factors. This is in relationship with the poor knowledge that, beside hyperenzymemia secondary to pancreatic diseases and systemic illnesses, various non-pathological forms of chronic hyperamylasemia can occur in clinical practice. AIM OF THE STUDY This study was addressed to assess the clinical characteristics of patients presenting with chronic hyperamylasemia unrelated to pancreatic diseases (CHUPD. PATIENTS AND METHODS Data of all patients with CHUPD were retrospectively reviewed (June 1997-March 2007. Forty patients were included in the study; median follow- up was 33 months (range 3-84 months. CHUPD was secondary to: a chronic benign pancreatic hyperamylasemia, 16 patients (40%; b macroamylasemia, 15 patients (37.5%; c salivary hyperamylasemia, 9 patients (22.5%. Gilbert’s syndrome was present in 13 patients (32.5%; 8 with macroamylasemia and hyperdyslipidemia in 8 patients (20%; 5 with chronic benign pancreatic hyperamylasemia. Diagnostic exams (all in the normal range performed before our observation were: Ca19-9 serum level in 37/40 (92.5%, ultrasonography and computed tomography-scan in all patients, endoscopic retrograde cholangiopancreatography in 21/40 (52.5%, abdominal magnetic resonance in 14/40 (35%. Previous diagnosis in these asymptomatic subjects were: chronic pancreatitis in 26 cases (65%; recurrent pancreatitis in 10 cases (25%; the remaining 4 patients (10% were addressed without a specific diagnosis. CONCLUSIONS In clinical practice, the occurrence of an unexplained chronic hyperamylasemia very often allows to an unappropriate diagnostic workup due to the poor familiarity with CHUPD conditions.

Psychological Characteristics of Chronic Depression : A Longitudinal Cohort Study

NARCIS (Netherlands)

Wiersma, Jenneke E.; van Oppen, Patricia; van Schaik, Digna J. F.; van der Does, A. J. Willem; Beekman, Aartjan T. E.; Penninx, Brenda W. J. H.

Background: Few studies have investigated the importance of psychological characteristics for chronicity of depression. Knowledge about psychological differences between chronically depressed persons and nonchronically depressed persons may help to improve treatment of chronic depression. This is

Influence of work-related psychosocial factors on the prevalence of chronic pain and quality of life in patients with chronic pain.

Science.gov (United States)

Yamada, Keiko; Matsudaira, Ko; Imano, Hironori; Kitamura, Akihiko; Iso, Hiroyasu

2016-04-25

Working is a common cause of chronic pain for workers. However, most of them need to continue working despite the pain in order to make a living unless they get a sick leave or retirement. We hypothesised that the therapeutic effect of vocational rehabilitation may depend on psychosocial factors related to the workplace. To test this hypothesis, we examined the association of work-related psychosocial factors with the prevalence of chronic pain or health-related quality of life (HRQoL) among workers with chronic pain. We examined 1764 workers aged 20-59 years in the pain-associated cross-sectional epidemiological survey in Japan. The outcomes were (1) chronic pain prevalence among all workers and (2) low Euro QoL (EQ-5D job satisfaction. Workplace social support and job satisfaction were measured using the Brief Job Stress Questionnaire. Multivariable-adjusted ORs were calculated using a logistic regression model including age, sex, smoking, exercise, sleep time, work hours, body mass index, personal consumption expenditure, intensity of pain and the presence of severe depressive symptoms. Chronic pain prevalence was higher among males reporting job dissatisfaction compared with those reporting job satisfaction. No difference was observed among women. Chronic pain prevalence did not differ between workers of either sex reporting poor workplace social support compared with those reporting sufficient support. Among workers with chronic pain, low HRQoL was more frequent in those reporting job dissatisfaction. Similarly, low HRQoL was more frequent in patients with chronic pain reporting poor social support from supervisors or co-workers compared with patients reporting sufficient support. Work-related psychosocial factors are critical for HRQoL in patients with chronic pain. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/

Damage of hippocampal neurons in rats with chronic alcoholism

OpenAIRE

Du, Ailin; Jiang, Hongbo; Xu, Lei; An, Na; Liu, Hui; Li, Yinsheng; Zhang, Ruiling

2014-01-01

Chronic alcoholism can damage the cytoskeleton and aggravate neurological deficits. However, the effect of chronic alcoholism on hippocampal neurons remains unclear. In this study, a model of chronic alcoholism was established in rats that were fed with 6% alcohol for 42 days. Endogenous hydrogen sulfide content and cystathionine-beta-synthase activity in the hippocampus of rats with chronic alcoholism were significantly increased, while F-actin expression was decreased. Hippocampal neurons i...

Global strategies to prevent chronic diseases1

African Journals Online (AJOL)

Nicky

leading global causes of death and disability, are ... global strategies for the prevention and control of chronic ... Preventing Chronic Diseases: A Vital Investment, will ..... Millennium Development Goals for Health In Europe and Central Asia.

Protein restriction in chronic renal failure

NARCIS (Netherlands)

ECHTEN, JEKT; NAUTA, J; HOP, WCJ; de Jong, MCJ; REITSMABIERENS, WCC; VANAMSTEL, SLBP; VANACKER, KJ; NOORDZIJ, CM; WOLFF, ED

The aim of the study was to investigate the effect of a protein restricted diet on renal function and growth of children with chronic renal failure. In a multicentre prospective study 56 children (aged 2-18 years) with chronic renal failure were randomly assigned to the protein restricted (0.8-1.1

Chronic Conditions PUF

Data.gov (United States)

U.S. Department of Health & Human Services — The Chronic Conditions PUFs are aggregated files in which each record is a profile or cell defined by the characteristics of Medicare beneficiaries. A profile is...

Chronic subordinate colony housing (CSC as a model of chronic psychosocial stress in male rats.

Directory of Open Access Journals (Sweden)

Kewir D Nyuyki

Full Text Available Chronic subordinate colony housing (CSC is an adequate and reliable mouse model of chronic psychosocial stress, resulting in reduced body weight gain, reduced thymus and increased adrenal weight, long-lasting anxiety-like behaviour, and spontaneous colitis. Furthermore, CSC mice show increased corticotrophin (ACTH responsiveness to acute heterotypic stressors, suggesting a general mechanism which allows a chronically-stressed organism to adequately respond to a novel threat. Therefore, the aim of the present study was to extend the CSC model to another rodent species, namely male Wistar rats, and to characterize relevant physiological, immunological, and behavioural consequences; placing particular emphasis on changes in hypothalamo-pituitary-adrenal (HPA axis responsiveness to an acute heterotypic stressor. In line with previous mouse data, exposure of Wistar rats to 19 days of CSC resulted in a decrease in body weight gain and absolute thymus mass, mild colonic barrier defects and intestinal immune activation. Moreover, no changes in stress-coping behaviour or social preference were seen; again in agreement with the mouse paradigm. Most importantly, CSC rats showed an increased plasma corticosterone response to an acute heterotypic stressor (open arm, 5 min despite displaying similar basal levels and similar basal and stressor-induced plasma ACTH levels. In contrast to CSC mice, anxiety-related behaviour and absolute, as well as relative adrenal weights remained unchanged in CSC rats. In summary, the CSC paradigm could be established as an adequate model of chronic psychosocial stress in male rats. Our data further support the initial hypothesis that adrenal hyper-responsiveness to ACTH during acute heterotypic stressors represents a general adaptation, which enables a chronically-stressed organism to adequately respond to novel challenges.

Airway distensibility in Chronic Obstructive Airway Disease

DEFF Research Database (Denmark)

Winkler Wille, Mathilde Marie; Pedersen, Jesper Holst; Dirksen, Asger

2013-01-01

Rationale – Chronic Obstructive Pulmonary Disease (COPD) is a combination of chronic bronchitis and emphysema, which both may lead to airway obstruction. Under normal circumstances, airway dimensions vary as a function of inspiration level. We aim to study the influence of COPD and emphysema......-20% (mild), 20%-30% (moderate) or >30% (severe). Spirometry was performed annually and participants were divided into severity groups according to the Global Initiative for Chronic Obstructive Lung Disease (GOLD). Data were analysed in a mixed effects regression model with log(airway lumen diameter...... and emphysema, respectively. Conclusions – Airway distensibility decreases significantly with increasing severity of both GOLD status and emphysema, indicating that in COPD the dynamic change in airway calibre during respiration is compromised. Chronic bronchitis and emphysema appear to be interacting...

Heart and radiation

Directory of Open Access Journals (Sweden)

Lauro Martins Júnior

2011-12-01

Full Text Available ABSTRATC The heart exposition to ionizing radiation may produce lesions in cardiac structures, acute (in most of cases benign and reversible, or months and even years later. There is a direct relationship of severity of lesions with radiation doses. The clinical picture receives a new denomination: radiation induced cardiopathy. The more frequent use of radiation in diagnosis and therapeutics increases the importance of their knowledge and especially their prevention.

Enhanced Gamma Oscillatory Activity in Rats with Chronic Inflammatory Pain

OpenAIRE

Wang, Jing; Wang, Jing; Xing, Guo-Gang; Li, Xiaoli; Wan, You

2016-01-01

It has been reported that oscillatory gamma activity participates in brief acute pain and tonic ongoing pain. It is of great interest to determine whether the gamma activity is involved in chronic pain since chronic pain is a more severe pathological condition characterized by pain persistency. To investigate the oscillatory gamma activity in chronic pain, in the present study, we recorded spontaneous electrocorticogram (ECoG) signals during chronic pain development in rats with chronic infla...

Gastric emptying in patients with chronic liver diseases

Energy Technology Data Exchange (ETDEWEB)

Ishizu, Hirotaka; Shiomi, Susumu; Kawamura, Etsushi; Iwata, Yoshinori; Nishiguchi, Shuhei; Kawabe, Joji; Ochi, Hironobu [Osaka City Univ. (Japan). Graduate School of Medicine

2002-05-01

There have been a number of reports of gastric emptying in cirrhosis, all with unconfirmed results. Moreover, the mechanism for delayed emptying in cirrhotic patients in unclear. We evaluated gastric emptying in patients with chronic hepatitis and cirrhosis by means of gastric emptying scintigraphy. The subjects were 18 normal controls and 75 patients with chronic viral hepatitis (50 patients had chronic hepatitis and 25 patients had cirrhosis). Tc-99m diethyltriamine pentaacetic acid labeled solid meals were used to evaluate gastric emptying; the half-time (T 1/2) of which was calculated. Digestive symptom scores were determined at the time of gastric emptying tests. Fourteen (28%) of 50 patients with chronic hepatitis and 16 (64%) of 25 patients with cirrhosis had delayed gastric emptying. T 1/2 in patients with cirrhosis was significantly higher than that in normal controls and patients with chronic hepatitis (p=0.0001 and 0.0003, respectively). The difference between T 1/2 in patients with chronic hepatitis and that in normal controls was not significant. On regression analysis, two indices, the serum albumin level and platelet count, were found to be significantly related to delayed gastric emptying. Gastric emptying was more delayed in cirrhotic patients than in those with chronic hepatitis and normal controls. Delayed gastric emptying may be related to liver function and portal hypertension. (author)

Screening markers for chronic atrophic gastritis in Chiapas, Mexico.

Science.gov (United States)

Ley, C; Mohar, A; Guarner, J; Herrera-Goepfert, R; Figueroa, L S; Halperin, D; Parsonnet, J

2001-02-01

Intestinal-type gastric adenocarcinomas usually are preceded by chronic atrophic gastritis. Studies of gastric cancer prevention often rely on identification of this condition. In a clinical trial, we sought to determine the best serological screening method for chronic atrophic gastritis and compared our findings to the published literature. Test characteristics of potential screening tests (antibodies to Helicobacter pyloni or CagA, elevated gastrin, low pepsinogen, increased age) alone or in combination were examined among consecutive subjects enrolled in a study of H. pylori and preneoplastic gastric lesions in Chiapas, Mexico; 70% had chronic atrophic gastritis. English-language articles concerning screening for chronic atrophic gastritis were also reviewed. Sensitivity for chronic atrophic gastritis was highest for antibodies to H. pylori (92%) or CagA, or gastrin levels >25 ng/l (both 83%). Specificity, however, was low for these tests (18, 41, and 22%, respectively). Pepsinogen levels were highly specific but insensitive markers of chronic atrophic gastritis (for pepsinogen I gastritis screening. However, no screening test was both highly sensitive and highly specific for chronic atrophic gastritis.

The contribution of rib fractures to chronic pain and disability.

Science.gov (United States)

Gordy, Stephanie; Fabricant, Loic; Ham, Bruce; Mullins, Richard; Mayberry, John

2014-05-01

The contribution of rib fractures to chronic pain and disability is not well described. Two hundred three patients with rib fractures were followed for 6 months. Chronic pain was assessed using the McGill Pain Questionnaire Pain Rating Index and Present Pain Intensity (PPI) scales. Disability was defined as a decrease in work or functional status. The prevalence of chronic pain was 22% and disability was 53%. Acute PPI predicted chronic pain. Associated injuries, bilateral rib fractures, injury severity score, and number of rib fractures were not predictive of chronic pain. No acute injury characteristics were predictive of disability. Among 89 patients with isolated rib fractures, the prevalence of chronic pain was 28% and of disability was 40%. No injury characteristics predicted chronic pain. Bilateral rib fractures and acute PPI predicted disability. The contribution of rib fractures to chronic pain and disability is significant but unpredictable with conventional injury descriptors. Copyright © 2014 Elsevier Inc. All rights reserved.

Chronic pain and difficulty in relaxing postural muscles in patients with fibromyalgia and chronic whiplash associated disorders.

Science.gov (United States)

Elert, J; Kendall, S A; Larsson, B; Månsson, B; Gerdle, B

2001-06-01

To investigate if muscle tension according to the surface electromyogram (EMG) of the shoulder flexors is increased in consecutive patients with fibromyalgia (FM) or chronic whiplash associated disorders (WAD). A total of 59 consecutive patients with FM (n = 36) or chronic WAD (n = 23) performed 100 maximal isokinetic contractions combined with surface electromyography of the trapezius and infraspinatus. A randomized group of pain-free female (n = 27) subjects served as control group. Peak torque initially (Pti) and absolute and relative peak torque at endurance level (PTe, PTer) were registered as output variables, together with the EMG level of unnecessary muscle tension, i.e., the signal amplitude ratio (SAR). The patient groups had a higher level of unnecessary tension initially and at the endurance level. The patients had lower absolute output (PTi and PTe), but the relative levels (PTer) did not differ comparing all 3 groups. Subjects with FM had significantly higher body mass index (BMI) than the other groups. BMI did not influence the SAR but correlated positively with PTi. The results confirmed earlier findings that groups of patients with chronic pain have increased muscle tension and decreased output during dynamic activity compared to pain-free controls. However, the results indicated there is heterogeneity within groups of patients with the same chronic pain disorder and that not all patients with chronic pain have increased muscle tension.

Review of occupational therapy for people with chronic pain.

LENUS (Irish Health Repository)

Robinson, Katie

2011-04-01

Chronic pain is a significant health-care problem. This review aims to critically analyse occupational therapy services for people with chronic pain and identify significant factors influencing the future development of occupational therapy services for people with chronic pain.

Chronic bronchitis in an elderly population

DEFF Research Database (Denmark)

Lange, Peter; Parner, Jan; Prescott, Eva

2003-01-01

in order to describe the prevalence and prognostic implications of chronic bronchitis in individuals 65 years or older we analysed data from The Copenhagen City Heart Study.......in order to describe the prevalence and prognostic implications of chronic bronchitis in individuals 65 years or older we analysed data from The Copenhagen City Heart Study....

Chronic arsenic poisoning following ayurvedic medication.

Science.gov (United States)

Pinto, Benzeeta; Goyal, Palvi; Flora, S J S; Gill, K D; Singh, Surjit

2014-12-01

Ayurveda, Indian traditional system of medicine, is practiced commonly in South East Asia and in many parts of the world. Many ayurvedic drugs contain heavy metals and may lead to metal toxicity. Of these, chronic lead poisoning is the most common. Chronic arsenic poisoning following the use of ayurvedic medication, though reported, is rare. We describe three patients who presented with features of chronic arsenic poisoning following prolonged ayurvedic medication use. The diagnosis of chronic arsenic poisoning was confirmed by high arsenic levels in the blood, urine, hair, and nails in all the three patients and in ayurvedic drug in two patients. The ayurvedic medication was discontinued and treatment with D-penicillamine started. At 6 months after treatment, blood arsenic levels returned to normal with clinical recovery in all of them. Arsenic poisoning following ayurvedic medication is much less common than lead poisoning, though mineral ayurvedic medicines may lead to it. We used D-penicillamine as chelator and all of them recovered. Whether withdrawal of medication alone or D-penicillamine also played a role in recovery is unclear and needs to be assessed.

Food Insecurity and Chronic Disease123

Science.gov (United States)

Laraia, Barbara A.

2013-01-01

Household food insecurity has been previously hypothesized to promote dependence on inexpensive, highly palatable foods that are energy dense. Such dependence, and the cyclical nature of having enough food in the beginning of the month followed by food scarcity at the end of the month, could lead to weight gain over a short period of time. Such dependence on energy-dense foods and weight gain may play a direct role in the development of chronic conditions. Other compounding factors that result from exposure to household food insecurity have been well described, including pathways by which stress promotes visceral fat accumulation and chronic disease. This symposium review paper summarizes the literature on the link between food insecurity and the following: 1) diet, 2) weight gain, and 3) chronic disease, especially among women. This paper also proposes a framework for considering how the lived experience of household food insecurity may potentiate the development of chronic disease by activating the stress response among individuals at critical developmental periods in a food-impoverished environment. PMID:23493536

Chronic pain, perceived stress, and cellular aging: an exploratory study

Directory of Open Access Journals (Sweden)

Sibille Kimberly T

2012-02-01

Full Text Available Abstract Background Chronic pain conditions are characterized by significant individual variability complicating the identification of pathophysiological markers. Leukocyte telomere length (TL, a measure of cellular aging, is associated with age-related disease onset, psychosocial stress, and health-related functional decline. Psychosocial stress has been associated with the onset of chronic pain and chronic pain is experienced as a physical and psychosocial stressor. However, the utility of TL as a biological marker reflecting the burden of chronic pain and psychosocial stress has not yet been explored. Findings The relationship between chronic pain, stress, and TL was analyzed in 36 ethnically diverse, older adults, half of whom reported no chronic pain and the other half had chronic knee osteoarthritis (OA pain. Subjects completed a physical exam, radiographs, health history, and psychosocial questionnaires. Blood samples were collected and TL was measured by quantitative polymerase chain reaction (qPCR. Four groups were identified characterized by pain status and the Perceived Stress Scale scores: 1 no pain/low stress, 2 no pain/high stress, chronic pain/low stress, and 4 chronic pain/high stress. TL differed between the pain/stress groups (p = 0.01, controlling for relevant covariates. Specifically, the chronic pain/high stress group had significantly shorter TL compared to the no pain/low stress group. Age was negatively correlated with TL, particularly in the chronic pain/high stress group (p = 0.03. Conclusions Although preliminary in nature and based on a modest sample size, these findings indicate that cellular aging may be more pronounced in older adults experiencing high levels of perceived stress and chronic pain.

Review series: Examples of chronic care model: the home-based chronic care model: redesigning home health for high quality care delivery.

Science.gov (United States)

Suter, Paula; Hennessey, Beth; Florez, Donna; Newton Suter, W

2011-01-01

Individuals with chronic obstructive pulmonary disease (COPD) face significant challenges due to frequent distressing dyspnea and deficits related to activities of daily living. Individuals with COPD are often hospitalized frequently for disease exacerbations, negatively impacting quality of life and healthcare expenditure burden. The home-based chronic care model (HBCCM) was designed to address the needs of patients with chronic diseases. This model facilitates the re-design of chronic care delivery within the home health sector by ensuring patient-centered evidence-based care. This HBCCM foundation is Dr. Edward Wagner s chronic care model and has four additional areas of focus: high touch delivery, theory-based self management, specialist oversight and the use of technology. This article will describe this model in detail and outline how model use for patients with COPD can bring value to stakeholders across the health care continuum.

Cytokine ratios in chronic periodontitis and type 2 diabetes mellitus.

Science.gov (United States)

Acharya, Anirudh B; Thakur, Srinath; Muddapur, M V; Kulkarni, Raghavendra D

Chronic periodontitis may influence systemic cytokines in type 2 diabetes. This study aimed to evaluate the cytokine ratios in type 2 diabetes with, and without chronic periodontitis. Gingival status, periodontal, glycemic parameters and serum cytokines were evaluated in participants grouped as healthy, chronic periodontitis, and type 2 diabetes with, and without chronic periodontitis. Cytokine ratios showed significant differences in type 2 diabetes and chronic periodontitis, were highest in participants having both type 2 diabetes and chronic periodontitis, with a statistically significant cut-off point and area under curve by receiver operating characteristic. Copyright © 2016 Diabetes India. Published by Elsevier Ltd. All rights reserved.

[Adaptation strategies faced with chronic pain].

Science.gov (United States)

Bioy, Antoine

2017-05-01

Chronic pain constitutes a challenge for patients. It makes them uneasy with regard to their personality, their corporality and their life balance, and leaves long-lasting effects on their experience as a patient. The development of adaptation strategies and resources to deal with chronic pain is therefore essential. Copyright © 2017 Elsevier Masson SAS. All rights reserved.

Chronic Abdominal Wall Pain.

Science.gov (United States)

Koop, Herbert; Koprdova, Simona; Schürmann, Christine

2016-01-29

Chronic abdominal wall pain is a poorly recognized clinical problem despite being an important element in the differential diagnosis of abdominal pain. This review is based on pertinent articles that were retrieved by a selective search in PubMed and EMBASE employing the terms "abdominal wall pain" and "cutaneous nerve entrapment syndrome," as well as on the authors' clinical experience. In 2% to 3% of patients with chronic abdominal pain, the pain arises from the abdominal wall; in patients with previously diagnosed chronic abdominal pain who have no demonstrable pathological abnormality, this likelihood can rise as high as 30% . There have only been a small number of clinical trials of treatment for this condition. The diagnosis is made on clinical grounds, with the aid of Carnett's test. The characteristic clinical feature is strictly localized pain in the anterior abdominal wall, which is often mischaracterized as a "functional" complaint. In one study, injection of local anesthesia combined with steroids into the painful area was found to relieve pain for 4 weeks in 95% of patients. The injection of lidocaine alone brought about improvement in 83-91% of patients. Long-term pain relief ensued after a single lidocaine injection in 20-30% of patients, after repeated injections in 40-50% , and after combined lidocaine and steroid injections in up to 80% . Pain that persists despite these treatments can be treated with surgery (neurectomy). Chronic abdominal wall pain is easily diagnosed on physical examination and can often be rapidly treated. Any physician treating patients with abdominal pain should be aware of this condition. Further comparative treatment trials will be needed before a validated treatment algorithm can be established.

Diagnosis and treatment of acute and chronic leukemia

International Nuclear Information System (INIS)

1978-01-01

The Cancergram covers both acute and chronic leukemia in all of its forms (acute lymphocytic, acute monocytic, acute or sub-acute granulocytic, chronic granulocytic, chronic lymphocytic, chronic monocytic, plasma cell, stem cell, and hairy cell). Other neoplastic conditions of the reticuloendothelial system, lymphatic system, spleen, multiple myeloma, macroglobulinemia and other monoclonal gammopathies are excluded, and will be coveted by other Cancergrams now under development. This Cancergram includes abstracts concerning all clinical aspects of the disease, such as diagnosis and staging, supportive care, evaluation, and therapy. Animal models, tissue culture experiments, carcinogenesis and other pre-clinical studies are generally excluded, except for those considered to have direct clinical relevance

Predisposing Factors in Acute-on-Chronic Liver Failure

DEFF Research Database (Denmark)

Trebicka, J.

2016-01-01

Acute-on-chronic liver failure (ACLF) is a syndrome with high short-term mortality in patients with chronic liver disease. The definition of ACLF has been addressed recently in many publications, and despite regional differences the number and severity of organ failures are decisive for the prese......Acute-on-chronic liver failure (ACLF) is a syndrome with high short-term mortality in patients with chronic liver disease. The definition of ACLF has been addressed recently in many publications, and despite regional differences the number and severity of organ failures are decisive...... hypertension might predispose for the development of ACLF after proper injury and response. © 2016 by Thieme Medical Publishers, Inc....

[Dexketoprofen trometamol in the treatment of chronic prostatitis/chronic pelvic pain syndrome].

Science.gov (United States)

Jiang, Ming-hua; Wu, Guan-cheng; Liu, Hong-liang

2009-09-01

To evaluate the clinical efficacy and safety of dexketoprofen trometamol in the treatment of patients with chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS). A total of 115 patients with CP/CPPS were divided into a dexketoprofen trometamol group (n = 40), treated with dexketoprofen trometamol (25 mg, tid) and terazosin (2 mg, qn), an indometacin group (n = 40) given indometacin (25 mg, tid) and terazosin (2 mg, qn), and a terazosin group (n = 35) administered terazosin (2 mg, qn) only, all treated for 4 weeks. Scores on the NIH-chronic prostatitis symptom index (NIH-CPSI) were obtained before and after the treatment, and the efficacy and adverse events were observed and compared. The NIH-CPSI scores were significantly improved after the treatment in all the three groups. The clinical efficacy was significantly better in the dexketoprofen trometamol and indometacin groups than in the terazosin group (P 0.05). The rates of adverse events were 10.00%, 18.57% and 27.50% in the dexketoprofen trometamol, terazosin and indometacin groups, significantly lower in the former two than in the latter one (P dexketoprofen trometamol with terazosin could effectively improve the clinical symptoms of CP/CPPS, better than terazosin in therapeutic efficacy and than indometacin in drug tolerance.

[Physical treatment modalities for chronic leg ulcers].

Science.gov (United States)

Dissemond, J

2010-05-01

An increasing numbers of physical treatment options are available for chronic leg ulcer. In this review article, compression therapy, therapeutic ultrasound, negative pressure therapy, extracorporeal shock wave therapy, electrostimulation therapy, electromagnetic therapy, photodynamic therapy, water-filtered infrared-A-radiation and hydrotherapy are discussed in terms of their practical applications and the underlying evidence. With the exception of compression therapy for most of these treatments, good scientific data are not available. However this is a widespread problem in the treatment of chronic wounds. Nevertheless, several of the described methods such as negative pressure therapy represent one of the gold standards in practical treatment of patients with chronic leg ulcers. Although the use of physical treatment modalities may improve healing in patients with chronic leg ulcers, the diagnosis and treatment of the underlying causes are essential for long-lasting success.

Hypnotherapy for the Management of Chronic Pain

Science.gov (United States)

Elkins, Gary; Jensen, Mark P.; Patterson, David R.

2009-01-01

This article reviews controlled prospective trials of hypnosis for the treatment of chronic pain. Thirteen studies, excluding studies of headaches, were identified that compared outcomes from hypnosis for the treatment of chronic pain to either baseline data or a control condition. The findings indicate that hypnosis interventions consistently produce significant decreases in pain associated with a variety of chronic-pain problems. Also, hypnosis was generally found to be more effective than nonhypnotic interventions such as attention, physical therapy, and education. Most of the hypnosis interventions for chronic pain include instructions in self-hypnosis. However, there is a lack of standardization of the hypnotic interventions examined in clinical trials, and the number of patients enrolled in the studies has tended to be low and lacking long-term follow-up. Implications of the findings for future clinical research and applications are discussed. PMID:17558718

Psychological characteristics of chronic depression: a longitudinal cohort study.

Science.gov (United States)

Wiersma, Jenneke E; van Oppen, Patricia; van Schaik, Digna J F; van der Does, A J Willem; Beekman, Aartjan T F; Penninx, Brenda W J H

2011-03-01

Few studies have investigated the importance of psychological characteristics for chronicity of depression. Knowledge about psychological differences between chronically depressed persons and nonchronically depressed persons may help to improve treatment of chronic depression. This is the first study to simultaneously compare in large samples various psychological characteristics between chronically depressed and nonchronically depressed adults. Baseline data were drawn from the Netherlands Study of Depression and Anxiety (NESDA), an ongoing longitudinal cohort study aimed at examining the long-term course of depressive and anxiety disorders in different health care settings and phases of illness. Participants were aged 18 to 65 years at the baseline assessment in 2004-2007 and had a current diagnosis of DSM-IV major depressive disorder (N = 1,002). Chronicity of depression was defined as being depressed for 24 months or more in the past 4 to 5 years. The chronicity criterion was fulfilled by 31% (n = 312). The NEO Five-Factor Inventory measured the 5 personality domains, the Leiden Index of Depression Sensitivity-Revised was used to measure cognitive reactivity (eg, hopelessness, rumination), and the Mastery Scale measured external locus of control. Compared to the nonchronically depressed persons, the chronically depressed persons reported significantly higher levels of neuroticism (OR = 1.81; 95% CI, 1.55-2.12; P testing these variables multivariably, the odds of chronic depression were significantly increased among those with low extraversion (OR = 0.73; 95% CI, 0.61-0.88; P = .001), high rumination (OR = 1.24; 95% CI, 1.01-1.53; P = .04), and high external locus of control (OR = 1.48; 95% CI, 1.21-1.80; P psychological characteristics for chronicity of depression. These findings provide suggestions for more specific interventions, focused on extraversion, rumination, and external locus of control, in the treatment of chronic depression. © Copyright 2011

Multiple chronic conditions and life expectancy: a life table analysis.

Science.gov (United States)

DuGoff, Eva H; Canudas-Romo, Vladimir; Buttorff, Christine; Leff, Bruce; Anderson, Gerard F

2014-08-01

The number of people living with multiple chronic conditions is increasing, but we know little about the impact of multimorbidity on life expectancy. We analyze life expectancy in Medicare beneficiaries by number of chronic conditions. A retrospective cohort study using single-decrement period life tables. Medicare fee-for-service beneficiaries (N=1,372,272) aged 67 and older as of January 1, 2008. Our primary outcome measure is life expectancy. We categorize study subjects by sex, race, selected chronic conditions (heart disease, cancer, chronic obstructive pulmonary disease, stroke, and Alzheimer disease), and number of comorbid conditions. Comorbidity was measured as a count of conditions collected by Chronic Conditions Warehouse and the Charlson Comorbidity Index. Life expectancy decreases with each additional chronic condition. A 67-year-old individual with no chronic conditions will live on average 22.6 additional years. A 67-year-old individual with 5 chronic conditions and ≥10 chronic conditions will live 7.7 fewer years and 17.6 fewer years, respectively. The average marginal decline in life expectancy is 1.8 years with each additional chronic condition-ranging from 0.4 fewer years with the first condition to 2.6 fewer years with the sixth condition. These results are consistent by sex and race. We observe differences in life expectancy by selected conditions at 67, but these differences diminish with age and increasing numbers of comorbid conditions. Social Security and Medicare actuaries should account for the growing number of beneficiaries with multiple chronic conditions when determining population projections and trust fund solvency.

[The French Chronic Kidney Disease-Renal Epidemiology and Information Network (CKD-REIN) cohort study: To better understand chronic kidney disease].

Science.gov (United States)

Stengel, Bénédicte; Combe, Christian; Jacquelinet, Christian; Briançon, Serge; Fouque, Denis; Laville, Maurice; Frimat, Luc; Pascal, Christophe; Herpe, Yves-Édouard; Morel, Pascal; Deleuze, Jean-François; Schanstra, Joost P; Pisoni, Ron L; Robinson, Bruce M; Massy, Ziad A

2016-04-01

Preserving kidney function and improving the transition from chronic kidney disease to end stage is a research and healthcare challenge. The national Chronic Kidney Disease-Renal Epidemiology and Information Network (CKD-REIN) cohort was established to identify the determinants, biomarkers and practice patterns associated with chronic kidney disease outcomes. The study will include more than 3000 adult patients with moderate to advanced chronic kidney disease from a representative sample of 40 nephrology clinics with respect to regions and legal status, public or private. Patients are recruited during a routine visit and followed for 5 years, before and after starting renal replacement therapy. Patient-level clinical, biological, and lifestyle data are collected annually, as well as provider-level data on clinical practices, coordinated with the International Chronic Kidney Disease Outcomes and Practice Pattern Study. Blood and urine samples are stored in a biobank. Major studied outcomes include survival, patient-reported outcomes, disease progression and hospitalizations. More than 13,000 eligible patients with chronic kidney disease were identified, 60% with stage 3 and 40% with stage 4. Their median age is 72 years [interquartile range, 62-80 years], 60% are men and 38% have diabetes. By the end of December 2015, 2885 patients were included. The CKD-REIN cohort will serve to improve our understanding of chronic kidney disease and provide evidence to improve patient survival and quality of life as well as health care system performances. Copyright © 2016 Association Société de néphrologie. All rights reserved.

Chronic Disease Management in Family Practice: Clinical Note.

Science.gov (United States)

1998-03-01

disease management in the family practice selling. This paper discusses chronic disease management in the family practice selling....Chronic disease management is the process of evaluating and treating a medical condition or disease state which can not be readily cured so as to...minimize it’s negative impact on the individual. Examples of chronic disease management include the treatment of hypertension, diabetes, osteoporosis

Aggregation of MBP in chronic demyelination.

Science.gov (United States)

Frid, Kati; Einstein, Ofira; Friedman-Levi, Yael; Binyamin, Orli; Ben-Hur, Tamir; Gabizon, Ruth

2015-07-01

Misfolding of key disease proteins to an insoluble state is associated with most neurodegenerative conditions, such as prion, Parkinson, and Alzheimer's diseases. In this work, and by studying animal models of multiple sclerosis, we asked whether this is also the case for myelin basic protein (MBP) in the late and neurodegenerative phases of demyelinating diseases. To this effect, we tested whether MBP, an essential myelin component, present prion-like properties in animal models of MS, as is the case for Cuprizone-induced chronic demyelination or chronic phases of Experimental Autoimmune Encephalomyelitis (EAE). We show here that while total levels of MBP were not reduced following extensive demyelination, part of these molecules accumulated thereafter as aggregates inside oligodendrocytes or around neuronal cells. In chronic EAE, MBP precipitated concomitantly with Tau, a marker of diverse neurodegenerative conditions, including MS. Most important, analysis of fractions from Triton X-100 floatation gradients suggest that the lipid composition of brain membranes in chronic EAE differs significantly from that of naïve mice, an effect which may relate to oxidative insults and subsequently prevent the appropriate insertion and compaction of new MBP in the myelin sheath, thereby causing its misfolding and aggregation. Prion-like aggregation of MBP following chronic demyelination may result from an aberrant lipid composition accompanying this pathological status. Such aggregation of MBP may contribute to neuronal damage that occurs in the progressive phase of MS.

Drug therapy for chronic idiopathic axonal polyneuropathy

NARCIS (Netherlands)

Vrancken, A. F. J. E.; van Schaik, I. N.; Hughes, R. A. C.; Notermans, N. C.

2004-01-01

BACKGROUND: Chronic idiopathic axonal polyneuropathy is an insidiously progressive sensory or sensorimotor polyneuropathy that affects elderly people. Although severe disability or handicap does not occur, it reduces quality of life. OBJECTIVES: To assess whether drug therapy for chronic idiopathic

Do Danes enjoy a high performing chronic care system?

DEFF Research Database (Denmark)

Hernández-Quevedo, Christina; Olejaz, Maria; Juul, Annegrete

2012-01-01

The trends in population health in Denmark are similar to those in most Western European countries. Major health issues include, among others, the high prevalence of chronic illnesses and lifestyle related risk factors such as obesity, tobacco, physical inactivity and alcohol. This has pressed...... the health system towards a model of provision of care based on the management of chronic care conditions. While the Chronic Care Model was introduced in 2005, the Danish health system does not fulfil the ten key preconditions that would characterise a high-performing chronic care system. As revealed...... in a recent report, the fragmented structure of the Danish health system poses challenges in providing effectively coordinated care to patients with chronic diseases....

Chronic care model and cost reduction in initial health: a new approach for satisfaction and improvement of chronicity

Directory of Open Access Journals (Sweden)

Stefano Marcelli

2017-10-01

Full Text Available Nowadays, the number of elderly is growing, with consequent increase of chronic diseases. An effective approach to reduce the costs incurred is required. The Chronic Care Model has proven to be a good starting point for a better management of economic and human resources.

Do illness perceptions of people with chronic low back pain differ from people without chronic low back pain?

NARCIS (Netherlands)

van Wilgen, C. Paul; van Ittersum, Miriam W.; Kaptein, Ad A.

Objectives To determine why some people develop chronic low back pain, and whether illness perceptions are an important risk factor in the transition from acute to chronic low back pain. Design Cross-sectional study. Participants Four hundred and two members of the general Dutch population, with and

Stage effect of chronic kidney disease in erectile function

Directory of Open Access Journals (Sweden)

Márcio Rodrigues Costa

Full Text Available ABSTRACT Purpose The study aims to assess the influence of the stage of chronic kidney disease and glomerular filtration rate on prevalence and degree of erectile dysfunction. Materials and Methods This transversal study, conducted from May 2013 to December 2015, included patients with chronic kidney disease in conservative treatment, stages III/IV/V. Erectile dysfunction was evaluated by the International Index of Erectile Function. Data classically associated with erectile dysfunction were obtained by medical record review. Erectile dysfunction, degree of erectile dysfunction, and other main variables associated with erectile dysfunction were compared between patients with chronic kidney disease on conservative treatment stages III versus IV/V using the Chi-square test. The relationship between score of the International Index of Erectile Dysfunction and glomerular filtration rate was established by Pearson correlation coefficient. Results Two hundred and forty five patients with chronic kidney disease in conservative treatment participated of the study. The prevalence of erectile dysfunction in patients with chronic kidney disease in stages IV/V was greater than in stage III. Glomerular filtration rate positively correlated with score of the International Index of Erectile Dysfunction. Conclusions The study suggests that chronic kidney disease progression (glomerular filtration rate decrease and advance in chronic kidney disease stages worsen erectile function. Hypothetically, diagnosis and treatment of erectile dysfunction may be anticipated with the analysis of chronic kidney disease progression.

Severity of chronic Lyme disease compared to other chronic conditions: a quality of life survey

Directory of Open Access Journals (Sweden)

Lorraine Johnson

2014-03-01

Full Text Available Overview. The Centers for Disease Control and Prevention (CDC health-related quality of life (HRQoL indicators are widely used in the general population to determine the burden of disease, identify health needs, and direct public health policy. These indicators also allow the burden of illness to be compared across different diseases. Although Lyme disease has recently been acknowledged as a major health threat in the USA with more than 300,000 new cases per year, no comprehensive assessment of the health burden of this tickborne disease is available. This study assesses the HRQoL of patients with chronic Lyme disease (CLD and compares the severity of CLD to other chronic conditions.Methods. Of 5,357 subjects who responded to an online survey, 3,090 were selected for the study. Respondents were characterized as having CLD if they were clinically diagnosed with Lyme disease and had persisting symptoms lasting more than 6 months following antibiotic treatment. HRQoL of CLD patients was assessed using the CDC 9-item metric. The HRQoL analysis for CLD was compared to published analyses for the general population and other chronic illnesses using standard statistical methods.Results. Compared to the general population and patients with other chronic diseases reviewed here, patients with CLD reported significantly lower health quality status, more bad mental and physical health days, a significant symptom disease burden, and greater activity limitations. They also reported impairment in their ability to work, increased utilization of healthcare services, and greater out of pocket medical costs.Conclusions. CLD patients have significantly impaired HRQoL and greater healthcare utilization compared to the general population and patients with other chronic diseases. The heavy burden of illness associated with CLD highlights the need for earlier diagnosis and innovative treatment approaches that may reduce the burden of illness and concomitant costs posed

Severity of chronic Lyme disease compared to other chronic conditions: a quality of life survey

Science.gov (United States)

Johnson, Lorraine; Wilcox, Spencer; Mankoff, Jennifer

2014-01-01

Overview. The Centers for Disease Control and Prevention (CDC) health-related quality of life (HRQoL) indicators are widely used in the general population to determine the burden of disease, identify health needs, and direct public health policy. These indicators also allow the burden of illness to be compared across different diseases. Although Lyme disease has recently been acknowledged as a major health threat in the USA with more than 300,000 new cases per year, no comprehensive assessment of the health burden of this tickborne disease is available. This study assesses the HRQoL of patients with chronic Lyme disease (CLD) and compares the severity of CLD to other chronic conditions. Methods. Of 5,357 subjects who responded to an online survey, 3,090 were selected for the study. Respondents were characterized as having CLD if they were clinically diagnosed with Lyme disease and had persisting symptoms lasting more than 6 months following antibiotic treatment. HRQoL of CLD patients was assessed using the CDC 9-item metric. The HRQoL analysis for CLD was compared to published analyses for the general population and other chronic illnesses using standard statistical methods. Results. Compared to the general population and patients with other chronic diseases reviewed here, patients with CLD reported significantly lower health quality status, more bad mental and physical health days, a significant symptom disease burden, and greater activity limitations. They also reported impairment in their ability to work, increased utilization of healthcare services, and greater out of pocket medical costs. Conclusions. CLD patients have significantly impaired HRQoL and greater healthcare utilization compared to the general population and patients with other chronic diseases. The heavy burden of illness associated with CLD highlights the need for earlier diagnosis and innovative treatment approaches that may reduce the burden of illness and concomitant costs posed by this

Siblings of children with a chronic illness: a meta-analysis.

Science.gov (United States)

Sharpe, Donald; Rossiter, Lucille

2002-12-01

To review the literature pertaining to the siblings of children with a chronic illness. Fifty-one published studies and 103 effect sizes were identified and examined through meta-analysis. We found (1) a modest, negative effect size statistic existed for siblings of children with a chronic illness relative to comparison participants or normative data; (2) heterogeneity existed for those effect sizes; (3) parent reports were more negative than child self-reports; (4) psychological functioning (i.e., depression, anxiety), peer activities, and cognitive development scores were lower for siblings of children with a chronic illness compared to controls; and (5) a cluster of chronic illnesses with daily treatment regimes was associated with negative effect statistics compared to chronic illnesses that did not affect daily functioning. More methodologically sound studies investigating the psychological functioning of siblings of children with a chronic illness are needed. Clinicians need to know that siblings of children with a chronic illness are at risk for negative psychological effects. Intervention programs for the siblings and families of children with a chronic illness should be developed.

Effective physical treatment for chronic low back pain.

Science.gov (United States)

Maher, C G

2004-01-01

It is now feasible to adopt an evidence-based approach when providing physical treatment for patients with chronic LBP. A summary of the efficacy of a range of physical treatments is provided in Table 1. The evidence-based primary care options are exercise, laser, massage, and spinal manipulation; however, the latter three have small or transient effects that limit their value as therapies for chronic LBP. In contrast, exercise produces large reductions in pain and disability, a feature that suggests that exercise should play a major role in the management of chronic LBP. Physical treatments, such as acupuncture, backschool, hydrotherapy, lumbar supports, magnets, TENS, traction, ultrasound, Pilates therapy, Feldenkrais therapy, Alexander technique, and craniosacral therapy are either of unknown value or ineffective and so should not be considered. Outside of primary care, multidisciplinary treatment or functional restoration is effective; however, the high cost probably means that these programs should be reserved for patients who do not respond to cheaper treatment options for chronic LBP. Although there are now effective treatment options for chronic LBP, it needs to be acknowledged that the problem of chronic LBP is far from solved. Though treatments can provide marked improvements in the patient's condition, the available evidence suggests that the typical chronic LBP patient is left with some residual pain and disability. Developing new, more powerful treatments and refining the current group of known effective treatments is the challenge for the future.

Pregabalin for Pain Treatment in Chronic Pancreatitis

DEFF Research Database (Denmark)

Olesen, Søren Schou; Bowense, S; Wilder-Smith, Oliver

2011-01-01

Intractable pain usually dominates the clinical presentation of chronic pancreatitis (CP). Slowing of electroencephalogram (EEG) rhythmicity has been associated with abnormal cortical pain processing in other chronic pain disorders. The aim of this study was to investigate the spectral distribution...

Reported barriers to evaluation in chronic care

DEFF Research Database (Denmark)

Knai, Cécile; Nolte, Ellen; Brunn, Matthias

2013-01-01

The growing movement of innovative approaches to chronic disease management in Europe has not been matched by a corresponding effort to evaluate them. This paper discusses challenges to evaluation of chronic disease management as reported by experts in six European countries....

Ribavirin monotherapy for chronic hepatitis C infection

DEFF Research Database (Denmark)

Brok, Jesper; Gluud, Lise L; Gluud, Christian

2006-01-01

Adding ribavirin to interferon improves treatment response for patients with chronic hepatitis C, but the effects of ribavirin monotherapy are unclear. We conducted a systematic review to assess the benefits and harms of ribavirin monotherapy for patients with chronic hepatitis C....

Chronic Pancreatitis: A Changing Etiology?

OpenAIRE

Raffaele Pezzilli; Andrea Lioce; Luca Frulloni

2008-01-01

In 1998, Lankisch and Banks reported that the prevalence of chronic pancreatitis appeared to be in the range of 3-10 per 100,000 people in many parts of the world [1]. They also emphasized that the most important medical problems associated with the disease included abdominal pain, steatorrhea, diabetes mellitus and the possibility that chronic pancreatitis may be considered a premalignant condition [2, 3]. In 2002, in a well-written review, Banks pointed out that the two important forms were...

FEATURES OF CHEMILUMINESCENT ACTIVITY OF NEUTROPHILIC GRANULOCYTES IN PATIENTS WITH CHRONIC GASTRITIS, CHRONIC ATROPHIC GASTRITIS AND GASTRIC CANCER

Directory of Open Access Journals (Sweden)

O. V. Smirnova

2017-01-01

Full Text Available Chronic gastritis is the most common disease of gastro-intestinal tract. Precancerous potential is among most important epidemiological features of chronic gastritis. Immune system plays a distinct role in transformation from precancerous state to malignancy. In this context, the aim of our work was a study of spontaneous and induced chemiluminescence activity of neutrophilic granulocytes in patients with chronic superficial gastritis, chronic atrophic gastritis and gastric cancer. The work presents results of comprehensive laboratory examination of patients with chronic gastritis (CG (a total of 85 persons. 25 patients with chronic atrophic gastritis (CAG, and 50 patients with gastric cancer (GC at the age of 19 to 70 years were enrolled. Control group included 115 healthy donors without gastrointestinal complaints at the age of 19 to 67 years. The study was performed with venous blood samples taken from cubital vein into Vacutainer tubes with sodium heparin (5 U/mL prior to starting any pathogenic treatment. Evaluation of spontaneous and induced chemiluminescence was performed for 90 minutes at a 36-channel “CL 3606” chemiluminescence analyzer (Russia. In our study, patients with gastric cancer showed clear unidirectional changes in chemiluminescent activity of neutrophilic granulocytes (NG. When measuring spontaneous and induced NG chemiluminescence, we diagnosed a decreased phagocytic activity characterized by prolonged time-to-peak and area under the curve for spontaneous and induced CL, thus presuming longer activation time required in cases of reduced phagocytic function. The NG activity in patients with chronic gastritis is not impaired, but, similar changes of time-to-peak and area under were detected. Chemiluminescent activity of NG is increased in the group of CAG patients, and, considering similar changes in activation time and area under the curve, NG also produce greater amount of reactive oxygen species. Thus, for all H

Coexistence of chronic myeloid leukemia and diffuse large B-cell lymphoma with antecedent chronic lymphocytic leukemia: a case report and review of the literature.

Science.gov (United States)

Abuelgasim, Khadega A; Rehan, Hinna; Alsubaie, Maha; Al Atwi, Nasser; Al Balwi, Mohammed; Alshieban, Saeed; Almughairi, Areej

2018-03-11

Chronic lymphocytic leukemia and chronic myeloid leukemia are the most common types of adult leukemia. However, it is rare for the same patient to suffer from both. Richter's transformation to diffuse large B-cell lymphoma is frequently observed in chronic lymphocytic leukemia. Purine analog therapy and the presence of trisomy 12, and CCND1 gene rearrangement have been linked to increased risk of Richter's transformation. The coexistence of chronic myeloid leukemia and diffuse large B-cell lymphoma in the same patient is extremely rare, with only nine reported cases. Here, we describe the first reported case of concurrent chronic myeloid leukemia and diffuse large B-cell lymphoma in a background of chronic lymphocytic leukemia. A 60-year-old Saudi man known to have diabetes, hypertension, and chronic active hepatitis B was diagnosed as having Rai stage II chronic lymphocytic leukemia, with trisomy 12 and rearrangement of the CCND1 gene in December 2012. He required no therapy until January 2016 when he developed significant anemia, thrombocytopenia, and constitutional symptoms. He received six cycles of fludarabine, cyclophosphamide, and rituximab, after which he achieved complete remission. One month later, he presented with progressive leukocytosis (mostly neutrophilia) and splenomegaly. Fluorescence in situ hybridization from bone marrow aspirate was positive for translocation (9;22) and reverse transcription polymerase chain reaction detected BCR-ABL fusion gene consistent with chronic myeloid leukemia. He had no morphologic or immunophenotypic evidence of chronic lymphocytic leukemia at the time. Imatinib, a first-line tyrosine kinase inhibitor, was started. Eight months later, a screening imaging revealed new liver lesions, which were confirmed to be diffuse large B-cell lymphoma. In chronic lymphocytic leukemia, progressive leukocytosis and splenomegaly caused by emerging chronic myeloid leukemia can be easily overlooked. It is unlikely that chronic myeloid

Patient-Centered Medical Home in chronic obstructive pulmonary disease

Directory of Open Access Journals (Sweden)

Ortiz G

2011-10-01

Full Text Available Gabriel Ortiz1, Len Fromer21Pediatric Pulmonary Services, El Paso, TX; 2Department of Family Medicine, David Geffen School of Medicine, UCLA, Los Angeles, CA, USAAbstract: Chronic obstructive pulmonary disease (COPD is a progressive and debilitating but preventable and treatable disease characterized by cough, phlegm, dyspnea, and fixed or incompletely reversible airway obstruction. Most patients with COPD rely on primary care practices for COPD management. Unfortunately, only about 55% of US outpatients with COPD receive all guideline-recommended care. Proactive and consistent primary care for COPD, as for many other chronic diseases, can reduce hospitalizations. Optimal chronic disease management requires focusing on maintenance rather than merely acute rescue. The Patient-Centered Medical Home (PCMH, which implements the chronic care model, is a promising framework for primary care transformation. This review presents core PCMH concepts and proposes multidisciplinary team-based PCMH care strategies for COPD.Keywords: Patient-Centered Medical Home, chronic care model, chronic obstructive pulmonary disease, patient education, physician assistants, nurse practitioners

Brain perfusion in acute and chronic hyperglycemia in rats

International Nuclear Information System (INIS)

Kikano, G.E.; LaManna, J.C.; Harik, S.I.

1989-01-01

Recent studies show that acute and chronic hyperglycemia cause a diffuse decrease in regional cerebral blood flow and that chronic hyperglycemia decreases the brain L-glucose space. Since these changes can be caused by a decreased density of perfused brain capillaries, we used 30 adult male Wistar rats to study the effect of acute and chronic hyperglycemia on (1) the brain intravascular space using radioiodinated albumin, (2) the anatomic density of brain capillaries using alkaline phosphatase histochemistry, and (3) the fraction of brain capillaries that are perfused using the fluorescein isothiocyanate-dextran method. Our results indicate that acute and chronic hyperglycemia do not affect the brain intravascular space nor the anatomic density of brain capillaries. Also, there were no differences in capillary recruitment among normoglycemic, acutely hyperglycemic, and chronically hyperglycemic rats. These results suggest that the shrinkage of the brain L-glucose space in chronic hyperglycemia is more likely due to changes in the blood-brain barrier permeability to L-glucose

Pathology and differential diagnosis of chronic, noninfectious gastritis.

Science.gov (United States)

Polydorides, Alexandros D

2014-03-01

The histologic finding of chronic inflammation in an endoscopic mucosal biopsy of the stomach (chronic gastritis) is very common and usually reflects the presence of Helicobacter pylori infection. However, infectious organisms are not always present in biopsy material, and some cases of chronic gastritis do not result from H. pylori infection. Thus, the differential diagnosis of this finding is an important one for pathologists to keep in mind. This review presents the three most common and clinically significant causes of chronic, noninfectious gastritis, namely, autoimmune atrophic gastritis, lymphocytic gastritis, and gastric involvement in the setting of inflammatory bowel disease, especially Crohn disease. For each entity, a brief discussion of its etiology and pathogenesis, a review of the clinical and endoscopic features, and a description of the microscopic findings are presented in the context of the differential diagnosis of chronic gastritis with emphasis on helpful histopathologic hints and long-term sequelae. Copyright © 2014 Elsevier Inc. All rights reserved.

[Reporting chronic hepatitis B and C in Denmark

DEFF Research Database (Denmark)

Hansen, N.; Cowan, S.; Christensen, P.B.

2008-01-01

INTRODUCTION: It became mandatory to report cases of chronic hepatitis B and C in Denmark in May 2002. The "treating doctor" is obliged to make the report. The purpose of this study is to find out how many patients with chronic hepatitis B or C who are monitored in the Danish health care system...... are reported to the State Serum Institute (SSI) and to find out who makes the report and from these numbers to estimate the total number of patients in Denmark with chronic hepatitis B and C. MATERIALS AND METHODS: Patients with chronic hepatitis B or C who were reported to the SSI before June 20th 2006 were...... cross-referenced with patients included in the Danish Database of Hepatitis B and C (DANHEP) on the basis of their social security number. RESULTS: The study found that only 50% of patients monitored at Danish hospitals with chronic hepatitis B or C are registered with the SSI. Respectively 47% and 38...

Acupuncture for chronic pelvic inflammatory disease: A systematic review protocol.

Science.gov (United States)

Cheng, Ying; Yuan, Youcai; Jin, Yuhao; Xu, Na; Guo, Taipin

2018-03-01

Chronic pelvic inflammation disease (PID) is a difficult-to-treat gynecological disorder with complex etiologies. Acupuncture has been applied widely for treating chronic pelvic inflammation or chronic pelvic pain symptoms in China. The aim of this review is to undertake a systematic review to estimate the effectiveness and safety of acupuncture on chronic PID. A literature search will be conducted electronically with date up to October 2018 in MEDLINE, Cochrane Library, EBASE, and CNKI databases, using combination subject terms of chronic pelvic pain (or chronic pelvic inflammation, and chronic pelvic pain symptoms, etc.) and acupuncture related treatment. Also duplicates will be removed. The primary outcomes consisted of improvement rate and pain relief. Secondary outcomes include the recurrence rate and side effects, such as pneumothorax, bleeding, serious discomfort, subcutaneous nodules, and infection. Systematic reviews and databases will be searched for randomized controlled trials on acupuncture for chronic PID with acupuncture treatment will be included. Cochrane RevMan V5.3.5 risk of bias assessment tool will be implemented for risk of bias evaluation, data synthesis, meta-analyses, and subgroup analysis while condition is met. Mean difference (MD), standard mean difference (SMD), and dichotomous data will be used to present continuous outcomes. This study will generate a comprehensive review of current evidence of acupuncture for chronic pelvic inflammation diseases. The study will provide updated evidence to evaluate the effectiveness and side effects of acupuncture for chronic pelvic inflammation disease. CRD42018087950.

[Treatment motivation in patients with chronic cardiorenal syndrome].

Science.gov (United States)

Efremova, E V; Shutov, A M; Borodulina, E O

2015-01-01

To study treatment motivation in patients with chronic heart failure (CHF) and in those with CHF concurrent with chronic kidney disease (CKD). A total of 203 patients (130 men and 73 women; mean age, 61.8±9.6 years) with CHF diagnosed and assessed in accordance with the National Guidelines of the All-Russian Research Society of Cardiology and the Heart Failure Society for the diagnosis and treatment of CHF (third edition, 2009) were examined. CKD was diagnosed according to the 2012 National Guidelines of the Research Nephrology Society of Russia. A group of patients with chronic cardiorenal syndrome (CRS) included those with CHF and CKD with a glomerular filtration rate (GFR) of motivation for non-drug and drug treatments were assessed in patients with chronic CRS. CFR was 67.7±17.2 ml/min/1.73 m2; chronic CRS was observed in 89 (44%) patients. Psychological functioning assessment showed that the patients with chronic CRS as compared with those with CHF without CKD had high anxiety and maladaptive disease attitudes. CHF treatment motivation (compliance with lifestyle modification and medication) was proved inadequate and detected only in 31 (15.3%) patients with CHF regardless of the presence of CKD. The specific features of psychological functioning, which affected treatment motivation, were seen in patients with chronic CRS: those who were lowly motivated had a euphoric attitude towards their disease (p=0.03); those who were satisfactorily motivated showed an emotive accentuation of character (p=0.002). The presence of CKD aggravates the clinical course of CHF and negatively affects the psychological functioning of patients with CHF. The patients with chronic CRS are characterized by a low level of motivation for both drug and non-drug treatments, which should be taken into account when managing this cohort of patients.

Moderate alcohol consumption and chronic disease

DEFF Research Database (Denmark)

Mukamal, Kenneth J; Clowry, Catherine M; Murray, Margaret M

2016-01-01

Drinking within recommended limits is highly prevalent in much of the world, and strong epidemiological associations exist between moderate alcohol consumption and risk of several major chronic diseases, including coronary heart disease, diabetes, and breast cancer. In many cases, plausible...... biological mediators for these associations have been identified in randomized trials, but gold standard evidence that moderate drinking causes or prevents any chronic disease remains elusive and important concerns about available evidence have been raised. Although long-term randomized trials to test...... suggests that objections to the execution of a full-scale, long-term clinical trial of moderate drinking on chronic disease are increasingly untenable. We present potential lessons learned for such a trial and discuss key features to maximize its feasibility and value....

Ribavirin monotherapy for chronic hepatitis C

DEFF Research Database (Denmark)

Brok, Jesper; Gluud, Lise Lotte; Gluud, Christian

2009-01-01

BACKGROUND: Hepatitis C is a major cause of liver-related morbidity and mortality. A high proportion of patients never experience symptoms. Peginterferon plus ribavirin is the recommended treatment for chronic hepatitis C. However, ribavirin monotherapy may be considered for some patients....... OBJECTIVES: To assess the beneficial and harmful effects of ribavirin monotherapy for patients with chronic hepatitis C. SEARCH STRATEGY: We identified trials through electronic databases, manual searches of bibliographies and journals, authors of trials, and pharmaceutical companies until March 2009....... SELECTION CRITERIA: We included all randomised trials irrespective of blinding, language, or publication status comparing ribavirin versus no intervention, placebo, or interferon for chronic hepatitis C. DATA COLLECTION AND ANALYSIS: The primary outcome measures were serum sustained virological response...

Natural histories of chronic obstructive pulmonary disease

DEFF Research Database (Denmark)

Rennard, Stephen I; Vestbo, Jørgen

2008-01-01

Concepts relating to the natural history of chronic obstructive pulmonary disease (COPD) arise most importantly from the classic study of Fletcher and colleagues (The Natural History of Chronic Bronchitis and Emphysema, Oxford University Press, New York, 1976). This study, which evaluated working...

Clinical monitoring of 'autoimmune' chronic active hepatitis

NARCIS (Netherlands)

Hoek, Bart van

1989-01-01

This thesis describes the outcome- survival of a large group of 186 consecutive patients with chronic active hepatitis of variouse tiologies, and describes in detail the progress of 21 patients from this group with 'autoimmunie' chronic active hepatitis maintained on standardized immunosuppressive

Use of isosorbide dinitrate for the symptomatic treatment of patients with Chagas' disease achalasia. A double-blind, crossover trial.

Science.gov (United States)

Ferreira-Filho, L P; Patto, R J; Troncon, L E; Oliveira, R B

1991-01-01

1. A randomized, double-blind, placebo-controlled trial was carried out to determine the efficacy of isosorbide dinitrate (ISD) on dysphagia in patients with Chagasic achalasia. 2. Twenty-three patients with Chagas' disease and dysphagia entered the study and 20 (87%) completed the two 7-day treatment periods. Subjects were given either 5 mg ISD (12 patients) or placebo (11 patients) by the sublingual route for the first 7 days. On the 8th day, patients crossed over and began another 7-day period during which they received the opposite, identical-appearing tablets. 3. Scores attributed by uninformed investigators for the frequency and severity of dysphagia were significantly lower (P less than 0.05) following ISD treatment than after the placebo period or for the pretreatment condition. A significantly higher degree of improvement of dysphagia was experienced by the patients during ISD treatment than during the placebo period. Fourteen patients experienced meal-related headaches during ISD, but not placebo treatment. The extent of improvement in general well-being due to ISD was the same when the drug was given in the first or second test period. 4. Our results indicate that ISD, 5 mg by the sublingual route, is effective in alleviating dysphagia in patients with Chagasic achalasia but its usefulness is limited by the high rate of headache as a side effect.

Antagonistic Effect of Atorvastatin on High Fat Diet Induced Survival during Acute Chagas Disease

Science.gov (United States)

Zhao, Dazhi; Lizardo, Kezia; Cui, Min Hui; Ambadipudi, Kamalakar; Lora, Jose; Jelicks, Linda A; Nagajyothi, Jyothi F

2016-01-01

Chagasic cardiomyopathy, which is seen in Chagas Disease, is the most severe and life-threatening manifestation of infection by the kinetoplastid Trypanosoma cruzi. Adipose tissue and diet play a major role in maintaining lipid homeostasis and regulating cardiac pathogenesis during the development of Chagas cardiomyopathy. We have previously reported that T. cruzi has a high affinity for lipoproteins and that the invasion rate of this parasite increases in the presence of cholesterol, suggesting that drugs that inhibit cholesterol synthesis, such as statins, could affect infection and the development of Chagasic cardiomyopathy. The dual epidemic of diabetes and obesity in Latin America, the endemic regions for Chagas Disease, has led to many patients in the endemic region of infection having hyperlipidemia that is being treated with statins such as atorvastatin. The current study was performed to examine using mice fed on either regular or high fat diet the effect of atorvastatin on T. cruzi infection-induced myocarditis and to evaluate the effect of this treatment during infection on adipose tissue physiology and cardiac pathology. Atorvastatin was found to regulate lipolysis and cardiac lipidopathy during acute T. cruzi infection in mice and to enhance tissue parasite load, cardiac LDL levels, inflammation, and mortality in during acute infection. Overall, these data suggest that statins, such as atorvastatin, have deleterious effects during acute Chagas disease. PMID:27416748

Chronic pain after childhood groin hernia repair

DEFF Research Database (Denmark)

Aasvang, Eske Kvanner; Kehlet, Henrik

2007-01-01

BACKGROUND: In contrast to the well-described 10% risk of chronic pain affecting daily activities after adult groin hernia repair, chronic pain after childhood groin hernia repair has never been investigated. Studies of other childhood surgery before the age of 3 months suggest a risk of increased...... pain responsiveness later in life, but its potential relationship to chronic pain in adult life is unknown. METHODS: This was a nationwide detailed questionnaire study of chronic groin pain in adults having surgery for a groin hernia repair before the age of 5 years (n = 1075). RESULTS: The response...... rate was 63.3%. In the 651 patients available for analysis, pain from the operated groin was reported by 88 (13.5%) patients whereof 13 (2.0%) patients reported frequent and moderate or severe pain. Pain occurred primarily when exercising sports or other leisure activities. Patients operated on before...

Chronic granulomatous disease

NARCIS (Netherlands)

Roos, Dirk

2016-01-01

Chronic granulomatous disease (CGD) is a primary immunodeficiency characterized by recurrent, life-threatening bacterial and fungal infections of the skin, the airways, the lymph nodes, the liver, the brain and the bones. Frequently found pathogens are Staphylococcus aureus, Aspergillus species,

Chronic, unexplained pain

NARCIS (Netherlands)

Snijders, T.J.

2012-01-01

Chronic, unexplained pain (CUP) is a common clinical problem. The core symptom in this heterogeneous group of patients is pain for which no medical explanation is found. Patients also have many other characteristics (symptoms and psychosocial features) in common. Pathophysiologically, increased

Chronic Kidney Disease

Science.gov (United States)

You have two kidneys, each about the size of your fist. Their main job is to filter your blood. They remove wastes and ... help control blood pressure, and make hormones. Chronic kidney disease (CKD) means that your kidneys are damaged ...

Chronic koro-like symptoms – two case reports

Directory of Open Access Journals (Sweden)

Kar Nilamadhab

2005-10-01

Full Text Available Abstract Background Koro is a culture bound syndrome, which has been reported usually from Asian countries. It has been described as an acute, brief lasting illness, which often occurs in epidemics. There is no description in literature of a chronic form of this syndrome. Case presentation Two sporadic cases with koro-like symptoms from East India are presented where the illness had a chronic course with durations spanning more than ten years. In contrast to acute, good prognosis, psycho-education responsive form that is usually seen in epidemics; the chronic form, appeared to be associated with greater morbidity and poorer response to interventions. Conclusion There is a possibility of a chronic form of koro syndrome.

Glucose counterregulation in diabetes secondary to chronic pancreatitis

DEFF Research Database (Denmark)

Larsen, S; Hilsted, J; Philipsen, E K

1990-01-01

Glucose counterregulation and hormonal responses after insulin-induced hypoglycemia were investigated in six patients with diabetes mellitus secondary to chronic pancreatitis, in seven with insulin-dependent (type I) diabetes mellitus, and in seven healthy subjects. Glucose counterregulation...... was identical in type I patients and in the patients with chronic pancreatitis, whereas both groups had impaired glucose recovery compared with the healthy subjects. The patients with chronic pancreatitis had no glucagon response to hypoglycemia, whereas epinephrine increased significantly. In an additional...... experiment, glucose recovery did not occur after hypoglycemia during concomitant beta-adrenoceptor blockade in these patients. In conclusion, glucose counterregulation is preserved but slightly impaired in patients with diabetes secondary to chronic pancreatitis, and the combination of total glucagon...

[Analysis of salivary protease spectrum in chronic periodontitis].

Science.gov (United States)

Qian, Li; Xuedong, Zhou; Yaping, Fan; Tengyu, Yang; Songtao, Wu; Yu, Yu; Jiao, Chen; Ping, Zhang; Yun, Feng

2017-02-01

This study aimed to investigate the difference in salivary protease expression in patients with chronic periodontitis and normal individuals. The stimulating saliva in patients with chronic periodontitis and normal individuals were collected. Protein chip technology was adapted to analyze salivary protease spectrum. Among the 34 proteases in the chip, disintegrin and metalloproteinase (ADAM)8, matrix metalloproteinase (MMP)-8, MMP-12, neprilysin/CD10, and uridylyl phosphate adenosine/urokinase showed a significantly increased concentration in the saliva of chronic periodontitis patients compared with those in the saliva of normal individuals (Pchronic periodontitis patients and normal individuals significantly differed. Analysis of salivary protease spectrum is a potential clinical method to examine, diagnose, and monitor chronic periodontitis.

Labour participation of the chronically ill: a profile sketch.

NARCIS (Netherlands)

Baanders, A.N.; Rijken, P.M.; Peters, L.

2002-01-01

To improve our understanding of the problematic labour market position of people with a chronic disease, this paper describes the participation rates of several subgroups of the chronically ill in the Netherlands, as well as the aspects by which the working chronically ill differ from those who are

Appearance and Disappearance of Chronic Myeloid Leukemia (CML) in Patient with Chronic Lymphocytic Leukemia (CLL)

OpenAIRE

Payandeh, Mehrdad; Sadeghi, Edris; Khodarahmi, Reza; Sadeghi, Masoud

2014-01-01