Your browser doesn't support javascript.
loading
Mostrar: 20 | 50 | 100
Resultados 1 - 12 de 12
Filtrar
Más filtros

Banco de datos
País/Región como asunto
Tipo del documento
Intervalo de año de publicación
1.
Am Heart J ; 267: 95-100, 2024 01.
Artículo en Inglés | MEDLINE | ID: mdl-38071003

RESUMEN

BACKGROUND: The association between cumulative burden of unfavorable social determinants of health (SDoH) and all-cause mortality has not been assessed by atherosclerotic cardiovascular disease (ASCVD) status on a population level in the United States. METHODS: We assessed the association between cumulative social disadvantage and all-cause mortality by ASCVD status in the National Health Interview Survey, linked to the National Death Index. RESULTS: In models adjusted for established clinical risk factors, individuals experiencing the highest level of social disadvantage (SDoH-Q4) had over 1.5 (aHR = 1.55; 95%CI = 1.22, 1.96) and 2-fold (aHR = 2.21; 95% CI = 1.91, 2.56) fold increased risk of mortality relative to those with the most favorable social profile (SDoH-Q1), respectively for adults with and without ASCVD; those experiencing co-occurring ASCVD and high social disadvantage had up to four-fold higher risk of mortality (aHR = 3.81; 95%CI = 3.36, 4.32). CONCLUSIONS: These findings emphasize the importance of a healthcare model that prioritizes efforts to identify and address key social and environmental barriers to health and wellbeing, particularly in individuals experiencing the double jeopardy of clinical and social risk.


Asunto(s)
Aterosclerosis , Enfermedades Cardiovasculares , Adulto , Humanos , Estados Unidos/epidemiología , Determinantes Sociales de la Salud , Factores de Riesgo , Recolección de Datos
2.
BMC Public Health ; 23(1): 900, 2023 05 16.
Artículo en Inglés | MEDLINE | ID: mdl-37193999

RESUMEN

INTRODUCTION: Educational attainment is an important social determinant of health (SDOH) for cardiovascular disease (CVD). However, the association between educational attainment and all-cause and CVD mortality has not been longitudinally evaluated on a population-level in the US, especially in individuals with atherosclerotic cardiovascular disease (ASCVD). In this nationally representative study, we assessed the association between educational attainment and the risk of all-cause and cardiovascular (CVD) mortality in the general adult population and in adults with ASCVD in the US. METHODS: We used data from the 2006-2014 National Death Index-linked National Health Interview Survey for adults ≥ 18 years. We generated age-adjusted mortality rates (AAMR) by levels of educational attainment (< high school (HS), HS/General Education Development (GED), some college, and ≥ College) in the overall population and in adults with ASCVD. Cox proportional hazards models were used to examine the multivariable-adjusted associations between educational attainment and all-cause and CVD mortality. RESULTS: The sample comprised 210,853 participants (mean age 46.3), representing ~ 189 million adults annually, of which 8% had ASCVD. Overall, 14.7%, 27%, 20.3%, and 38% of the population had educational attainment < HS, HS/GED, Some College, and ≥ College, respectively. During a median follow-up of 4.5 years, all-cause age-adjusted mortality rates were 400.6 vs. 208.6 and 1446.7 vs. 984.0 for the total and ASCVD populations for < HS vs ≥ College education, respectively. CVD age adjusted mortality rates were 82.1 vs. 38.7 and 456.4 vs 279.5 for the total and ASCVD populations for < HS vs ≥ College education, respectively. In models adjusting for demographics and SDOH, < HS (reference = ≥ College) was associated with 40-50% increased risk of mortality in the total population and 20-40% increased risk of mortality in the ASCVD population, for both all-cause and CVD mortality. Further adjustment for traditional risk factors attenuated the associations but remained statistically significant for < HS in the overall population. Similar trends were seen across sociodemographic subgroups including age, sex, race/ethnicity, income, and insurance status. CONCLUSIONS: Lower educational attainment is independently associated with increased risk of all-cause and CVD mortality in both the total and ASCVD populations, with the highest risk observed for individuals with < HS education. Future efforts to understand persistent disparities in CVD and all-cause mortality should pay close attention to the role of education, and include educational attainment as an independent predictor in mortality risk prediction algorithms.


Asunto(s)
Enfermedades Cardiovasculares , Humanos , Adulto , Estados Unidos/epidemiología , Persona de Mediana Edad , Enfermedades Cardiovasculares/epidemiología , Escolaridad , Factores de Riesgo , Etnicidad , Modelos de Riesgos Proporcionales
3.
J Pak Med Assoc ; 73(3): 547-551, 2023 Mar.
Artículo en Inglés | MEDLINE | ID: mdl-36932757

RESUMEN

OBJECTIVE: To identify the association between acute infection and acute coronary syndrome, and to evaluate the outcomes in such cases. METHODS: The cross-sectional, retrospective, analytical study was conducted at the Aga Khan University Hospital, Karachi, from July to December 2020, and comprised data from January to December 2019 of acute coronary syndrome patients aged >18 years. Data related to demographics, comorbidities, smoking status and history of dyslipidaemia. Binary logistic regression was used to explore the association of infections with acute coronary syndrome. Data was analysed using SPSS 26. RESULTS: Of the 1202 patients with acute coronary syndrome, 189(15.7%) had infection before the coronary event. The mean age of the patients was 68.5±12.4 years, and 97(51.3%) of them were females. Community-acquired pneumonia was found in 105(55.6%) patients, followed by urinary tract infection 64(33.9%) and cellulitis 8(4.2%). For pneumonia, the odds of having non-ST elevated myocardial infarction was 1.1 (95% confidence interval: 0.4-3.0). With urinary tract infections, unstable angina was associated with an odd ratio of 4.2 (95% confidence interval: 1-17.4), and ST elevated myocardial infarction was associated with odd ratio of 3.7 (95% confidence interval: 0.4-31). CONCLUSIONS: Bacterial infections were found to be associated with acute coronary syndrome. Bacterial infections with pneumonia and urinary tract infections showed a higher risk of myocardial ischaemia..


Asunto(s)
Síndrome Coronario Agudo , Infecciones Bacterianas , Infarto del Miocardio sin Elevación del ST , Neumonía , Infarto del Miocardio con Elevación del ST , Femenino , Humanos , Persona de Mediana Edad , Anciano , Anciano de 80 o más Años , Masculino , Síndrome Coronario Agudo/epidemiología , Estudios Transversales , Estudios Retrospectivos , Centros de Atención Terciaria , Pakistán/epidemiología , Neumonía/epidemiología , Factores de Riesgo
4.
J Environ Manage ; 211: 22-27, 2018 Apr 01.
Artículo en Inglés | MEDLINE | ID: mdl-29408070

RESUMEN

The present study investigates the optimization of HNO3 leaching of Cu from old AMD Athlon processors under the effect of nitric acid concentration (%), temperature (°C) and ultrasonic power (W). The optimization study is carried out using response surface methodology with central composite rotatable design (CCRD). The ANOVA study concludes that the second degree polynomial model is fitted well to the fifteen experimental runs based on p-value (0.003), R2 (0.97) and Adj-R2 (0.914). The study shows that the temperature is the most significant process variable to the leaching concentration of Cu followed by nitric acid concentration. However, ultrasound power shows no significant impact on the leaching concentration. The optimum conditions were found to be 20% nitric acid concentration, 48.89 °C temperature and 5.52 W ultrasound power for attaining maximum concentration of 97.916 mg/l for Cu leaching in solution.


Asunto(s)
Cobre/química , Ácido Nítrico/química , Contaminantes del Agua/química , Cobre/análisis , Minería , Modelos Estadísticos , Temperatura , Contaminantes del Agua/análisis
5.
BMJ Open Diabetes Res Care ; 12(1)2024 Jan 30.
Artículo en Inglés | MEDLINE | ID: mdl-38290988

RESUMEN

INTRODUCTION: Understanding the role of social determinants of health as predictors of mortality in adults with diabetes may help improve health outcomes in this high-risk population. Using population-based, nationally representative data, this study investigated the cumulative effect of unfavorable social determinants on all-cause mortality in adults with diabetes. RESEARCH DESIGN AND METHODS: We used data from the 2013-2018 National Health Interview Survey, linked to the National Death Index through 2019, for mortality ascertainment. A total of 47 individual social determinants of health were used to categorize participants in quartiles denoting increasing levels of social disadvantage. Poisson regression was used to report age-adjusted mortality rates across increasing social burden. Multivariable Cox proportional hazards models were used to assess the association between cumulative social disadvantage and all-cause mortality in adults with diabetes, adjusting for traditional risk factors. RESULTS: The final sample comprised 182 445 adults, of whom 20 079 had diabetes. In the diabetes population, mortality rate increased from 1052.7 per 100 000 person-years in the first quartile (Q1) to 2073.1 in the fourth quartile (Q4). In multivariable models, individuals in Q4 experienced up to twofold higher mortality risk relative to those in Q1. This effect was observed similarly across gender and racial/ethnic subgroups, although with a relatively stronger association for non-Hispanic white participants compared with non-Hispanic black and Hispanic subpopulations. CONCLUSIONS: Cumulative social disadvantage in individuals with diabetes is associated with over twofold higher risk of mortality, independent of established risk factors. Our findings call for action to screen for unfavorable social determinants and design novel interventions to mitigate the risk of mortality in this high-risk population.


Asunto(s)
Diabetes Mellitus , Determinantes Sociales de la Salud , Adulto , Humanos , Diabetes Mellitus/mortalidad , Etnicidad , Factores de Riesgo
6.
J Coll Physicians Surg Pak ; 32(4): S37-S38, 2022 Apr.
Artículo en Inglés | MEDLINE | ID: mdl-35633006

RESUMEN

Extensively drug-resistant (XDR) salmonella typhi is a gram-negative bacillus, transmitted by feco-oral route. Its systemic manifestations are protean. Untreated enteric fever carries high morbidity and mortality. Life-threatening complications are mainly extra-intestinal, and include involvement of central nervous system, lungs, liver, and genitourinary system. We report a case of a young girl presenting to a hospital in Karachi with a 1-week history of fever, rigors, abdominal pain, watery diarrhea, nausea, and anorexia. She developed toxic myocarditis, pulmonary edema, septic shock, and coagulopathy. Multi-drug-resistant (MDR) salmonella typhi was isolated from blood cultures. Her symptoms resolved after intravenous antibiotics and she completely recovered. Key Words: Myocarditis, Salmonella typhi, Coagulopathy.


Asunto(s)
Miocarditis , Fiebre Tifoidea , Antibacterianos/uso terapéutico , Cultivo de Sangre , Femenino , Humanos , Salmonella typhi , Fiebre Tifoidea/complicaciones , Fiebre Tifoidea/diagnóstico , Fiebre Tifoidea/tratamiento farmacológico
7.
J Coll Physicians Surg Pak ; 32(4): S49-S51, 2022 Apr.
Artículo en Inglés | MEDLINE | ID: mdl-35633011

RESUMEN

Cryptococcal meningitis (CM) is an uncommon opportunistic infection in immunocompetent hosts; and causes significant mortality and long-term morbidity. Cryptococci primarily cause disease in immunocompromised hosts, but rarely can lead to severe disease in immunocompetent individuals. A 64-year man, with no known immunosuppressive illnesses, presented in the Emergency Department with gait disturbances and lethargy for one year, which got worsened recently. After further deliberation on elevated intracranial pressure (ICP), a CT brain was performed, which showed hydrocephalus; and thus lumbar puncture (LP) was done. Fungal cultures grew cryptococcus neoformans. The patient was treated with anti-fungal medications. It is highly essential for emergency physicians and other clinicians to think of atypical neurological manifestations of meningitis in immunocompetent individuals. Key Words: Cryptococcus, Immunocompetent, Antifungal treatment, Meningitis.


Asunto(s)
Cryptococcus neoformans , Hidrocefalia , Meningitis Criptocócica , Meningoencefalitis , Antifúngicos/uso terapéutico , Humanos , Masculino , Meningitis Criptocócica/diagnóstico , Meningitis Criptocócica/tratamiento farmacológico , Meningitis Criptocócica/microbiología , Meningoencefalitis/diagnóstico , Meningoencefalitis/tratamiento farmacológico , Meningoencefalitis/microbiología
8.
Popul Health Manag ; 25(5): 669-676, 2022 10.
Artículo en Inglés | MEDLINE | ID: mdl-36067118

RESUMEN

Disparities in cardiovascular outcomes are persistent in our society. The objective was to track the trends before and after the passage of the Affordable Care Act in socioeconomic status (SES) disparities in utilization of cardiovascular disease (CVD) preventive services among nonelderly adults aged 18-64 years. This study used the National Health Interview Survey (2011-2017) to compare utilization of blood pressure, cholesterol, glycemic screening, and diet and smoking cessation advice over time between groups stratified by SES and race using difference-in-difference analysis. This study also measured the differences over time in specific vulnerable population subgroups (Hispanic, low-income and uninsured vs. White, middle-high-income, and insured). The study population included 176,961 surveyed individuals (mean age 40 [±13] years; 51% female; 67.7% non-Hispanic White) between 2011 and 2017, translating to 194.8 million nonelderly US adults per year. Most individuals were from high-income SES (40.0%), followed by middle-income (28.1%), low-income (13.6%), and lowest income SES (18.3%). The proportion of CVD preventive services increased over all SES categories through the study period. The biggest relative changes were seen among low-income individuals. The difference in blood pressure checks, cholesterol checks, and smoking cessation advise between high- and lowest income groups showed a statistically significant decrease at 5.2%, 4.8%, and 11.2%, respectively, between 2011 and 2017. The findings demonstrate a trend in reduction of CVD preventive care disparities between SES groups. However, a gap still exists, and this study highlights the need for continuous improvement to eliminate SES disparities.


Asunto(s)
Enfermedades Cardiovasculares , Patient Protection and Affordable Care Act , Adulto , Enfermedades Cardiovasculares/epidemiología , Enfermedades Cardiovasculares/prevención & control , Colesterol , Femenino , Hispánicos o Latinos , Humanos , Masculino , Clase Social , Factores Socioeconómicos , Estados Unidos/epidemiología
9.
J Coll Physicians Surg Pak ; 30(6): 732-734, 2021 Jun.
Artículo en Inglés | MEDLINE | ID: mdl-34102792

RESUMEN

Acute rhabdomyolysis and elevated transaminases during streptococcal pharyngitis are rare presentations. The proposed pathophysiological mechanisms include direct bacterial invasion and toxin generation. Physicians should be aware of the association between these infections and the above-mentioned complications to facilitate optimal treatment of these patients. We present the case of a 18-years-old gentleman with ß-haemolytic streptococcal pharyngitis complicated by rhabdomyolysis and elevated liver function tests. Such high levels of creatine phosphokinase of 111856 IU/L and elevated liver function tests with aspartate aminotransferase (AST) of 1862 U/L and alanine aminotransferase (ALT) of 1003 U/L in streptococcal pharyngitis is rare to find in the literature. He was treated with aggressive intravenous hydration, antibiotics and hemodialysis. Key Words: Rhabdomyolysis, ß-haemolytic Streptococci, Creatine phosphokinase, Liver function tests.


Asunto(s)
Faringitis , Infecciones Estreptocócicas , Adolescente , Antibacterianos/uso terapéutico , Humanos , Masculino , Faringe , Infecciones Estreptocócicas/diagnóstico , Infecciones Estreptocócicas/tratamiento farmacológico , Streptococcus pyogenes
10.
J Coll Physicians Surg Pak ; 30(7): 846-848, 2021 Jul.
Artículo en Inglés | MEDLINE | ID: mdl-34271789

RESUMEN

Acute urinary retention (AUR) is a fairly common presentation in the elderly; but interesting to be noted in a healthy young individual as a manifestation of acute appendicitis. We present a case of a 32-year gentleman with decreased urine output with mild tenderness at the supra-pubic region; which was later on, shifted to the right iliac fossa. Computed tomography of the abdomen showed acute appendicitis. Emergency physicians are challenged to recognize the uncommon presentation of acute appendicitis and need to be reminded of this common complaint as a rare presentation of it. This case also stresses on the repeated abdominal examinations to seek diagnostic clarity. Key Words: Appendicitis, Acute urinary retention, Repeat abdominal examination.


Asunto(s)
Apendicitis , Retención Urinaria , Enfermedad Aguda , Anciano , Apendicitis/diagnóstico , Apendicitis/diagnóstico por imagen , Humanos , Examen Físico , Tomografía Computarizada por Rayos X , Retención Urinaria/diagnóstico , Retención Urinaria/etiología
11.
J Coll Physicians Surg Pak ; 30(12): 1343-1344, 2020 Dec.
Artículo en Inglés | MEDLINE | ID: mdl-33397066

RESUMEN

Osteitis condensans ilii (OCI) remains an orthopedic diagnostic dilemma; moreover, such presentation in the emergency room (ER) is unique. Limited awareness about this topic compels emergency and internal medicine physicians to perform extensive investigations which often leads to misdiagnosis. A 23-year pregnant female presented in the Emergency Room with severe low back pain, who was treated conservatively with radiological evidence of OCI. The mainstay treatments are analgesics and physiotherapy. Key Words: Osteitis condensans ilii, Back pain, Pregnancy, Triangular sclerosis.


Asunto(s)
Enfermedades de los Cartílagos , Osteítis , Dolor de Espalda/etiología , Servicio de Urgencia en Hospital , Femenino , Humanos , Osteítis/diagnóstico por imagen , Embarazo , Radiografía
12.
Arch Pharm Res ; 37(7): 862-72, 2014 Jul.
Artículo en Inglés | MEDLINE | ID: mdl-24045884

RESUMEN

A series of 6-deoxymollugins were prepared five steps from benzaldehyde and its derivatives via phenylboronic acid-catalyzed chromenylation as a key step. Their inhibitory activities against tyrosinase from mushroom were evaluated to show that the parent, methyl 2,2-dimethyl-2H-benzo[h]chromene-5-carboxylate (9a) showed best and promising inhibitory activity at IC50 = 18.3 µM.


Asunto(s)
Medicamentos Herbarios Chinos/síntesis química , Inhibidores Enzimáticos/síntesis química , Monofenol Monooxigenasa/antagonistas & inhibidores , Piranos/síntesis química , Rubiaceae , Agaricales/enzimología , Línea Celular Tumoral , Medicamentos Herbarios Chinos/aislamiento & purificación , Medicamentos Herbarios Chinos/farmacología , Inhibidores Enzimáticos/aislamiento & purificación , Inhibidores Enzimáticos/farmacología , Humanos , Monofenol Monooxigenasa/metabolismo , Piranos/aislamiento & purificación , Piranos/farmacología
SELECCIÓN DE REFERENCIAS
DETALLE DE LA BÚSQUEDA