Cardiovascular risk markers in premature canities.

BACKGROUND: An elevated cardiovascular risk has been demonstrated in middle-aged individuals with onset of hair greying before the age of 30 years. Increased serum levels of pro-inflammatory cytokines, interleukin-6 (IL-6) and tumour necrosis factor-alpha (TNF-α), indicate an ongoing state of chronic inflammation that is correlated with cardiovascular risk but have not been studied earlier in patients with early onset of hair greying. AIM/OBJECTIVE: To study various cardiovascular risk markers including pro-inflammatory cytokines interleukin-6 (IL-6) and tumour necrosis factor-alpha (TNF-α) in patients with premature canities. METHODS: This was a hospital-based case-control study of 40 patients with premature canities (age between 19 and 25 years; >5 grey hair) and an equal number of age and gender-matched healthy controls. The blood pressure, pulse rate and body mass index were recorded, and investigations including fasting blood sugar, serum insulin, fasting lipid profile, high sensitivity c-reactive protein (hs-CRP), IL-6 and TNF-α were performed. The homeostatic model assessment of insulin resistance (HOMA-IR) was calculated for all the participants. RESULTS: The mean blood pressure, fasting blood sugar, serum insulin, hs-CRP and HOMA-IR were all significantly elevated in patients with premature canities and the serum HDL levels were significantly lower. A greater number of patients with premature canities had significantly elevated IL-6 as compared with the controls. LIMITATIONS: The sample size was small. A subjective scale was used for grading the severity of premature canities. Trichoscopic evaluation of severity of greying or modified phototrichogram could not be used in this study. CONCLUSION: Abnormalities in cardiovascular risk markers were found in patients with premature canities. Screening and counselling of patients with premature greying of hair is recommended in order to prevent future cardiovascular disease.

Frontiers of cardiovascular polypills: From atherosclerosis and beyond.

Fixed-dose combination (FDC) therapies (also known as polypills) remain underutilized in clinical practice despite over two decades of evidence from randomized controlled trials demonstrating increased adherence to multidrug therapy, improved cardiovascular disease (CVD) risk factor control, and lower incidence of cardiovascular events. Evidence demonstrates that FDC-based implementation strategies can substantially complement and augment current strategies for CVD risk prevention globally. The next decade is likely to extend the frontier of cardiovascular FDC therapies, particularly given expected advances in FDC manufacturing technology and accessibility. FDC-based anti-hypertensive therapies are emerging as integral components of a pragmatic blood pressure lowering strategy. Cardiovascular FDCs are rapidly approaching its coming of age, transforming from heavily hyped research tools to pragmatic clinical instruments. This review evaluates the current evidence for cardiovascular FDCs, barriers to current use, and potential next generation advances.

Prognostic comparison of the FRIEND and Wasserman/Hansen peak VO2 equations applied to a submaximal walking test in outpatients with cardiovascular disease.

AIMS: The aim of this study was to determine the ability to predict all-cause mortality using established per cent-predicted (%PRED) equations for peak oxygen consumption (VO2peak) estimated by a submaximal walk test in outpatients with cardiovascular disease. METHODS: Male patients (N = 1491) aged 62 ± 10 years at baseline underwent a moderate and perceptually regulated (11-13 on the 6-20 Borg scale) 1-km treadmill-walking test to estimate VO2peak. %PRED was derived from the Fitness Registry and the Importance of Exercise: A National Data Base (FRIEND) and the Wasserman/Hansen equations. RESULTS: There were 215 deaths during a median 9.4-year follow-up. The FRIEND prediction equation provided better prognostic information with receiver operating curve analysis showing significantly different areas under the curve (0.72 and 0.69 for the FRIEND and the Wasserman/Hansen equations respectively, p = 0.001). Overall mortality rate was higher across decreasing tertiles of %PRED using FRIEND, with 26%, 11% and 5% for the least fit, intermediate and high fit tertiles, respectively (p for trend < 0.0001). Compared with the least fit tertile, the adjusted hazard ratios for the second and third tertiles were 0.54 (95% confidence interval 0.34-0.87, p = 0.01) and 0.45 (95% confidence interval 0.25-0.81, p = 0.008), respectively. Each 1% increase in %PRED conferred a 3% improvement in survival (p = 0.0004). CONCLUSION: Low %PRED VO2peak in cardiac outpatients determined by the FRIEND equation was associated with a high mortality rate independent of traditional cardiovascular risk factors and clinical history. The FRIEND equation may provide a suitable normal standard when applied to clinically stable outpatients with cardiovascular disease.

Evaluating the health effect of a Social Housing programme, Minha Casa Minha Vida, using the 100 million Brazilian Cohort: a natural experiment study protocol.

INTRODUCTION: Social housing programmes have been shown to influence health, but their effects on cardiovascular mortality and incidence of infectious diseases, such as leprosy and tuberculosis, are unknown. We will use individual administrative data to evaluate the effect of the Brazilian housing programme Minha Casa Minha Vida (MCMV) on cardiovascular disease (CVD) mortality and incidence of leprosy and tuberculosis. METHODS AND ANALYSIS: We will link the baseline of the 100 Million Brazilian Cohort (2001-2015), which includes information on socioeconomic and demographic variables, to the MCMV (2009-2015), CVD mortality (2007-2015), leprosy (2007-2015) and tuberculosis (2007-2015) registries. We will define our exposed population as individuals who signed the contract to receive a house from MCMV, and our non-exposed group will be comparable individuals within the cohort who have not signed a contract for a house at that time. We will estimate the effect of MCMV on health outcomes using different propensity score approaches to control for observed confounders. Follow-up time of individuals will begin at the date of exposure ascertainment and will end at the time a specific outcome occurs, date of death or end of follow-up (31 December 2015). In addition, we will conduct stratified analyses by the follow-up time, age group, race/ethnicity, gender and socioeconomic position. ETHICS AND DISSEMINATION: The study was approved by the ethic committees from Instituto Gonçalo Muniz-Oswaldo Cruz Foundation and University of Glasgow Medical, Veterinary and Life Sciences College. Data analysis will be carried out using an anonymised dataset, accessed by researchers in a secure computational environment according to the Centre for Integration of Data and Health Knowledge procedures. Study findings will be published in high quality peer-reviewed research journals and will also be disseminated to policy makers through stakeholder events and policy briefs.

Revealing the Therapeutic Uses of Garlic (Allium sativum) and Its Potential for Drug Discovery.

BACKGROUND: Garlic is a common bulb vegetable that is used to flavor and flavor food. The plant contains biologically active components that contribute to its pharmacological properties. This paper attempts to examine the therapeutic uses and potential role in the drug development of garlic for various human diseases. METHODS: To obtain crucial data and scientific knowledge about the therapeutic uses of garlic, systematic literature searches were conducted using key terms on well-known indexed platforms such as PubMed, Scopus, Web of Science, Medline, Embase, and popular search engines. RESULTS: Garlic, which is utilized as a spice and flavoring ingredient, is found to have fundamental nutritional components. Carbohydrates, protein, fat, minerals, water, and vitamins are all found in abundance in this plant. The plant also has a high medicinal value and is used to cure a variety of human diseases. It has anti-inflammatory, rheumatological, ulcer inhibiting, anticholinergic, analgesic, antimicrobial, antistress, antidiabetes, anticancer, liver protection, anthelmintics, antioxidants, antifungal, and wound healing properties, as well as properties that help with asthma, arthritis, chronic fever, tuberculosis, runny nose, malaria, leprosy, skin discoloration, and itching, indigestion, colic, enlarged spleen, hemorrhoids, fistula, bone fracture, gout, urinary tract disease, diabetes, kidney stones, anemia, jaundice, epilepsy, cataract, and night blindness. CONCLUSIONS: The nutritional content of the plant is significant, and it has incredible therapeutic potential. The findings of this study are needed to investigate the therapeutic potential, as it may be a promising option for drug development.

Cardiovascular disease risk factors and markers of oxidative stress and DNA damage in leprosy patients in Southern Nigeria.

Leprosy reduces quality of life of affected persons. Oxidative stress caused by reactive oxygen species may play a vital role in the pathogenesis of leprosy. This study evaluated anthropometric indices, fasting plasma glucose (FPG), lipid profile, total antioxidant capacity (TAC), total plasma peroxide (TPP), oxidative stress index (OSI), malondialdehyde (MDA), glutathione (GSH) and 8-hydroxy-2-deoxyguanosine (8-OHdg) in leprosy patients. Sixty test participants of both genders, aged 18-65years and diagnosed of multibacillary leprosy and 30 apparently healthy controls were consecutively recruited for this study. The test participants comprised of 30 patients on multidrug therapy (MDT) and 30 patients relieved from therapy (RFT). Body mass index (BMI), Waist-hip ratio (WHR), FPG, lipid profile, TAC, TPP, OSI, MDA, GSH and 8-OHdg were determined using appropriate methods. Data were analyzed using Analysis of variance; p<0.05 was considered statistically significant. The MDT group had significantly lower BMI (p = 0.0001), Total cholesterol (p = 0.001), HDL-C (p = 0.019), LDL-C (p = 0.005), TAC (p = 0.0001) and higher TPP (p = 0.001), MDA (p = 0.0001), OSI (p = 0.005) and 8-OHdg (p = 0.035) compared to the controls. The RFT group had significantly lower BMI (p = 0.001) Total cholesterol (0.0001), HDL-C (p = 0.006) LDL-C (p = 0.0001), TAC (p = 0.001) and higher WHR (p = 0.010), VLDL-C (p = 0.035), TG (p = 0.023) Atherogenic index of plasma (p = 0.0001) and TPP (p = 0.001), MDA (p = 0.0001) compared to the control group. GSH levels correlated negatively with duration of treatment (r = -0.401, p = 0.028). This study has shown that there is oxidative stress in multibacillary leprosy patients irrespective of drug treatment status. This study also shows that leprosy patients relieved from treatment may be susceptible to cardiovascular events. Antioxidants supplementation may be beneficial in the treatment of leprosy and clinical follow up on patients relieved from treatment may also be necessary to monitor health status and prevent development of cardiovascular events.

Determining the best percent-predicted equation for estimated VO2 peak by a 1-km moderate perceptually-regulated treadmill walk to predict mortality in outpatients with cardiovascular disease.

OBJECTIVES: To determine the prognostic ability of established percent-predicted equations of peak oxygen consumption (%PRED) estimated by a moderate submaximal walking test in a large cohort of outpatients with cardiovascular disease (CVD). DESIGN: Population-based prospective study. METHODS: A total of 1442 male patients aged 25-85 years at baseline, underwent a moderate perceptually-regulated (11-13 on the 6-20 Borg scale) treadmill walk (1k-TWT) for peak oxygen consumption estimation (VO2 peak). %PRED was derived from ACSM, Ades et al, Morris et al, and the Wasserman/Hansen equations, and their prognostic performance was assessed. Overall mortality was the end point. Participants were divided into quartiles of %PRED, and mortality risk was estimated using a Cox regression model. RESULTS: During a median 8.2year follow-up, 167 all-cause deaths occurred. The Wasserman/Hansen equation provided the highest prognostic value. Mortality rate was lower across increasing quartiles of %PRED. Compared to the first quartile, after adjustment for confounders, the mortality risk decreased for the second, third, and fourth quartiles, with HRs of 0.75 (95% CI 0.44-1.29, p=0.29), 0.67 (95% CI 0.38-1.18, p=0.17), and 0.37 (95% CI 0.10-0.78, p=0.009), respectively (p for trend <0.0001). Each 1% increase in %PRED conferred a 4% improvement in survival. CONCLUSIONS: The percent-predicted VO2 peak determined by Wasserman/Hansen equations applied to the 1k-TWT is inversely and significantly related to survival in cardiac outpatients. The 1k-TWT is a simple and useful tool for stratifying mortality risk in patients participating in secondary prevention programs.

Cardio-pulmonary involvement in systemic sclerosis: A study at a tertiary care center.

BACKGROUND: Systemic sclerosis is a multisystem disorder characterized by microangiopathy, dysregulation of the immune system and massive deposition of collagen in the connective tissue of the skin, blood vessels and various internal organs. Although the mortality from renal crises has dropped significantly due to the use of angiotensin-converting enzyme inhibitors, cardiac and pulmonary involvement accounts for significant morbidity and mortality. We studied 28 patients with systemic sclerosis at Gandhi Medical College and Hospital, Hyderabad, over a period of two years for cardiopulmonary involvement. AIM: The aim of this study was to analyze the cardiopulmonary involvement in systemic sclerosis. METHODS: All patients with systemic sclerosis attending the dermatology outpatient department were included in the study. The diagnosis of systemic sclerosis was made based on the American Rheumatology Association criteria, and was further confirmed by skin biopsy and serological investigations. X-ray chest, electrocardiogram, two-dimensional ECHO, high-resolution computed tomography chest, pulmonary function tests and bronchoalveolar lavage were done to evaluate cardiopulmonary involvement. OBSERVATIONS: Out of 28 patients, 17 had diffuse systemic sclerosis and 11 had limited systemic sclerosis. Mean duration of symptoms was 2.9 years. Abnormalities in chest X-ray were found in 16 patients. Pulmonary function tests showed a restrictive pattern in 23 patients. High-resolution computed tomography of the chest showed evidence of interstitial lung disease in 21 patients, while five patients each had pleural effusion and cardiomegaly. Bronchoalveolar lavage showed different cellular patterns such as neutrophilia, eosinophilia and lymphocytosis. Pulmonary arterial hypertension was observed in seven patients and isolated pulmonary arterial hypertension in two patients. Electrocardiogram abnormalities were found in twenty patients. Two-dimensional ECHO was abnormal in 17 patients with valvular abnormalities being the most common finding. Overall, pulmonary involvement was observed in 27 patients and cardiac involvement in 17 patients. LIMITATIONS: A small sample size was a limitation of this study. Diffusing capacity of lung for carbon monoxide, and right cardiac catheterization were not done, as these were not available at our centre. CONCLUSIONS: In our patients, pulmonary involvement was more common than cardiac involvement. Interstitial lung disease and cardiac involvement were more commonly seen in diffuse systemic sclerosis whereas pulmonary hypertension was more frequent in limited systemic sclerosis. Hence, it is important to screen the patients for cardiopulmonary involvement for early diagnosis and treatment and a better prognostic outcome.

Correlation between therapy and lipid profile of leprosy patients: is there a higher risk for developing cardiovascular diseases after treatment?

BACKGROUND: The impact of leprosy reduces health-related quality of life of affected patients, interfering with different factors such as nutrition. This study investigated the lipid profile, nutritional status, and risk for cardiovascular disease (CVD) in patients who underwent leprosy treatment in Brazil. METHODS: Eighty-four adult patients of both genders ranging in age from 20 to 60 years and diagnosed with paucibacillary (PB) or multibacillary (MB) leprosy were selected after undergoing multidrug treatment. The following data were collected: sociodemographic and clinical data; food intake; anthropometric measures (weight, height, and waist circumference); and lipid profile components (total cholesterol, high-density lipoprotein cholesterol [HDL-c], low-density lipoprotein cholesterol [LDL-c], and triglycerides). RESULTS: Among the study population, there was a predominance of males (65.48%) aged 50 to 60 years, patients with an income of 248-496 American dollars (63.10%), patients who completed elementary school (65.48%), inactive patients (76.19%), non-smokers (46.43%), and non-drinking patients (69.05%). The levels (mean ± standard deviation) of total cholesterol were 193.8 ± 29.4 mg/dL in the PB form and 203.5 ± 41.7 mg/dL in the MB form. The mean LDL-c was 116.9 ± 22.7 mg/dL in PB patients and 121 ± 31.3 mg/dL in MB patients. Mean triglyceride levels were 123.4 ± 45.2 mg/dL in the PB form and 147.4 ± 88.9 mg/dL in the MB form. The evaluation of nutritional status showed that 41.67% of the patients were eutrophic, while 55.96% had excess weight. Food intake was significantly associated with HDL-c in male patients (P = 0.0264) and with triglycerides in patients above the ideal weight (P = 0.0049). CONCLUSIONS: The risk of acquiring CVDs was observed to be high due to patients' excess weight and increased waist circumference. This study will guide clinicians in the adequate treatment of patients with leprosy in order to avoid adverse cardiovascular events.

A study of the association of acanthosis nigricans with subclinical atherosclerosis.

BACKGROUND: Hyperinsulinism is related to the presence of acanthosis nigricans and atherosclerosis; however, we were unable to find any study on the prevalence of atherosclerosis in acanthosis nigricans. AIMS: To evaluate the prevalence of carotid atherosclerosis and metabolic alterations in Mexican patients with acanthosis nigricans. METHODS: We carried out a cross-sectional study that included 45 patients with acanthosis nigricans, age- and gender-matched with 45 healthy participants. Volunteers with any comorbidity or taking weight reduction, glucose- and/or lipid-lowering medication or drugs capable of causing acanthosis nigricans were not included in the study. B-mode ultrasound tests were done to measure the carotid intima-media thickness. Body mass index, insulin, glucose and lipid blood serum levels were measured. Chi-square or Fisher's exact test and paired Student t-test were used for statistical analysis. RESULTS: Carotid intima-media thickness was greater in patients with acanthosis nigricans (mean 0.52 mm vs. 0.46 mm, P = 0.002). The prevalence of abnormal intima-media thickness was higher in patients with acanthosis nigricans versus healthy participants (62.2% vs. 35.5%, P = 0.02). The same occurred with hyperinsulinemia (73.3% vs. 13.3%, P< 0.001), insulin resistance (86.6% vs. 33.3%, P< 0.001), obesity (86.6% vs. 13.3%, P< 0.001) and dyslipidemia (95.5% vs. 77.7%, P = 0.01). LIMITATIONS: The sample size is small and serum markers of cardiovascular risk were not measured. CONCLUSION: Acanthosis nigricans is a skin marker for metabolic disturbances and is also associated with carotid atherosclerosis, a finding which is not well documented. We propose that individuals with acanthosis nigricans should be routinely evaluated for these cardiovascular risks.

Erectile Dysfunction in Male Adults With Atopic Dermatitis and Psoriasis.

INTRODUCTION: Patients with psoriasis have increased risk of cardiovascular disease, but data on atopic dermatitis (AD) are less clear-cut. However, it is well-established that erectile dysfunction (ED) can serve as a risk marker for coronary disease. AIM: To investigate the incidence, prevalence, and risk of ED in men with psoriasis and AD. METHODS: The sample included all Danish men at least 30 years old. In patients with AD and psoriasis, we determined disease severity based on use of systemic therapy. We performed a cross-sectional study (January 1, 2008) using logistic regression to estimate the prevalence and odds ratio of ED. Moreover, in a cohort study design, patients were followed from January 1, 2008 through December 31, 2012, and Cox regression models were used to estimate adjusted hazard ratios of new-onset ED. Models were adjusted for potential confounding factors, including age, socioeconomic status, health care consumption, smoking, alcohol abuse, diabetes, and cholesterol-lowering drug use. MAIN OUTCOME MEASURES: The outcome was initiation of pharmacotherapy used for treatment of ED. RESULTS: The sample consisted of 1,756,679 Danish men (age range = 30-100 years), of which 2,373 and 26,536 had adult AD (mild = 1,072; severe = 1,301) and psoriasis (mild = 21,775; severe = 4,761), respectively. Mean ages (SDs) were 53.0 (14.6), 46.7 (12.0), and 56.3 (13.8) years for the general population, patients with AD, and patients with psoriasis, respectively. Prevalences of ED were 8.7%, 6.7%, and 12.8% for the general population, patients with AD, and patients with psoriasis, respectively. Adjusted odds ratios (logistic regression) of ED were decreased in patients with AD (0.68; 0.57-0.80) but increased in those with psoriasis (1.15; 1.11-1.20). Adjusted odds ratios for mild and severe AD were 0.63 (0.48-0.82) and 0.72 (0.58-0.88), respectively, and those for psoriasis these were 1.16 (1.11-1.21) and 1.13 (1.03-1.23). Adjusted hazard ratios (Cox regression) were 0.92 (0.76-1.11) for AD and 1.14 (1.08-1.20) for psoriasis. The ED risk was not increased in men with mild AD (0.85; 0.63-1.14) or severe AD (0.97; 0.76-1.24) but was significantly increased in men with mild psoriasis (1.13; 1.09-1.20) and severe psoriasis (1.17; 1.04-1.32). CONCLUSION: We found an increased prevalence and risk of ED in men with psoriasis, whereas the risk was comparable to (and even slightly lower than) the general population for men with AD. Egeberg A, Hansen PR, Gislason GH, et al. Erectile Dysfunction in Male Adults With Atopic Dermatitis and Psoriasis. J Sex Med 2017;14:380-386.

Prevalence of metabolic syndrome and cardiovascular changes in patients with chronic plaque psoriasis and their correlation with disease severity: A hospital-based cross-sectional study.

BACKGROUND: Previous epidemiological studies suggest an association between psoriasis and metabolic syndrome and risk of subclinical atherosclerosis. However, there is a paucity of data in the Indian population on these associations. OBJECTIVES: To evaluate the prevalence of metabolic syndrome and subclinical atherosclerosis in patients with chronic plaque psoriasis compared to healthy controls and to correlate the prevalence of metabolic syndrome with severity of psoriasis. METHODS: A hospital-based cross-sectional study was performed on 140 patients with chronic plaque psoriasis and 140 controls. Psoriasis was categorized as mild, moderate and severe based on psoriasis area and severity index (<10, 10-14 and ≥15, respectively) and as disease of short (<1 year), intermediate (1-3 years) and long duration (>3 years). In all patients and controls, body mass index was calculated, blood pressure and waist circumference were measured and fasting bloaod sugar and lipid profile were estimated. Metabolic syndrome was diagnosed by the presence of 3 or more of the modified National Cholesterol Education Program's Adult Treatment Panel III criteria. A subset of 30 psoriatic patients and 30 healthy controls were selected by the systematic sampling method for cardiac evaluation including electrocardiography, echocardiography and carotid intima-media thickness measurement. RESULTS: The prevalence of metabolic syndrome was significantly more in psoriatic patients than in controls (39.3% vs. 17.1%, odds ratio = 3.13). Psoriatic patients also had a significantly higher prevalence of hypertension, abdominal obesity and diabetes. There was a significant trend to increase in prevalence of metabolic syndrome, hypertension and type 2 diabetes with increased severity and longer duration of the psoriasis. Patients with psoriasis had significantly higher carotid intima-media thickness (mean 0.61 mm ± 0.01 mm vs. 0.37 mm ± 0.01 mm) than controls. LIMITATION: This was a hospital-based cross-sectional study with a relatively small sample size. A prospective study with a larger sample would have validated the results further. CONCLUSION: There is a significantly higher prevalence of metabolic syndrome in psoriasis patients as compared to controls; the prevalence of metabolic syndrome and its components increases with severity and duration of psoriasis. There is a higher prevalence of subclinical atherosclerosis in patients with psoriasis thus increasing the risk of cardiovascular disease. We suggest that patients with moderate to severe psoriasis be screened routinely for metabolic syndrome and cardiovascular disease and encouraged to correct modifiable cardiovascular risk factors.

Comprehensive lipid tetrad index, atherogenic index and lipid peroxidation: Surrogate markers for increased cardiovascular risk in psoriasis.

BACKGROUND AND OBJECTIVES: Recently, the concept of "psoriatic march" has come to the fore, in which chronic cutaneous inflammation in psoriasis leads to systemic inflammation which, in conjunction with increased oxidative stress, triggers a cascade of events resulting in increased cardiovascular risk in patients with severe psoriasis. We, therefore, decided to study the levels of some biochemical cardiovascular risk markers: lipid peroxidation (malondialdehyde), lipoprotein (a), lipid indices and atherogenic index, in patients with psoriasis and their association with disease severity. METHODS: Forty five patients with psoriasis and 45 age and gender-matched healthy controls were included in this cross-sectional study. Disease severity was assessed by the Psoriasis Area Severity Index (PASI). Serum malondialdehyde, lipoprotein (a) and fasting lipid profile were estimated in all study subjects. Lipoprotein ratios were computed using standard formulae. Atherogenic index was calculated as ratio of lipoprotein (a)/high-density lipoprotein. RESULTS: In psoriasis, we observed significantly higher levels of malondialdehyde, total cholesterol, low-density lipoprotein cholesterol, non-high-density lipoprotein cholesterol, lipoprotein (a), lipid ratios, atherogenic index and comprehensive lipid tetrad index, compared to controls. These levels were directly proportional to disease severity. Serum levels of malondialdehyde correlated positively with serum lipoprotein (a), comprehensive lipid tetrad index and atherogenic index. LIMITATIONS: Different morphological types of psoriasis were not included and follow-up post-therapy was not done. A larger sample size would have validated the results further. CONCLUSION: Our results indicate that psoriasis, especially the severe variants, are associated with increased oxidative stress and dyslipidemia, which correlate positively with atherogenic index and hence, an increased cardiovascular risk.

Abordagem domiciliar de situações clínicas comuns em adultos

Curso da atenção domiciliar que apresenta as principais situações clínicas comuns em adultos, descrevendo o manejo dos pacientes na atenção domiciliar e reforçando o papel do cuidador como parte fundamental da equipe de cuidado. São apresentadas as seguintes situações clínicas: asma, doença pulmonar obstrutiva crônica, pneumonia, coronariopatia, doença vascular periférica, insuficiência cardíaca, hanseníase, SIDA, malária, tuberculose, infecção do trato urinário, osteomielite, pós-operatório em ortopedia, transtornos psiquiátricos, abordagem ao usuário de álcool e outras drogas, esclerose múltipla e esclerose lateral amiotrófica. Em cada uma das situações são tratados os aspectos conceituais, o diagnóstico, o manejo na atenção domiciliar, as orientações que devem ser fornecidas ao cuidador, o plano de alta na atenção domiciliar e quando referenciar para outros serviços.

Comorbidities in psoriasis.

Moderate to severe psoriasis is associated with concomitant diseases that may have a significant impact on patients. It is necessary for the treating physician to recognize these concomitant diseases, known as comorbidities, early as they influence the management options. Important comorbidities are psoriatic arthritis, metabolic syndrome, Crohn's disease, depression, and cancer. Patients with severe psoriasis may be at an increased risk for myocardial infarction and this subgroup of patients tends to have a reduced life expectancy. The presence of co-morbid diseases is associated with an increase in concomitant medication, some of which may worsen psoriasis; conversely, systemic treatment of psoriasis with certain drugs may impact the co-morbid conditions. As dermatologists are the primary health-care providers for psoriasis, adequate knowledge of comorbidities helps in choosing the appropriate therapy as well as timely intervention.

Measurement of vitamin D and cathelicidin (LL-37) levels in patients of psoriasis with co-morbidities.

BACKGROUND: During the last decade, a lot of co-morbidities (diabetes, obesity, heart disease, etc.) have been described to be associated with psoriasis, but the exact link at the molecular level is not well-known. Researchers have shown molecular level changes in vitamin D pathway and its relationship to cathelicidin. AIMS: To estimate the levels of cathelicidin (LL-37), and vitamin D in psoriasis patients with co-morbidities, and compare them with matched healthy controls. METHODS: One hundred consecutive patients with stable plaque psoriasis (psoriasis area and severity index ≥10) with no systemic treatment in the past 3 months were investigated for the serum levels of vitamin D and LL-37, and compared with equal number of matched healthy volunteers. RESULTS: The serum vitamin D levels were significantly lower in patients. Furthermore, the levels of serum LL-37 were significantly high. CONCLUSION: Our study showed that the low serum levels of vitamin D, and higher blood levels of cathelicidin could form a molecular level clue in the pathogenesis of psoriasis patients, who are more likely to develop co-morbidities.

A novel integrative network approach to understand the interplay between cardiovascular disease and other complex disorders.

There is accumulating evidence that the proteins encoded by the genes associated with a common disorder interact with each other, participate in similar pathways and share GO terms. It has been anticipated that the functional modules in a disease related functional linkage network can be integrated with bibliomics to reveal association with other complex disorders. In this study, the cardiovascular disease functional linkage network (CFN) containing 1536 nodes and 3345 interactions was constructed using proteins encoded by 234 genes associated with the disease. Integration of CFN with bibliomics showed that 227 out of 566 functional modules are significantly associated with one or more diseases. Analysis of functional modules revealed the possible regulatory roles of SP1 and CXCL12 in the pathogenesis of cardiovascular disease (CVD) and modulation of their activities may be considered as potential therapeutic tools. The integration of CFN with bibliomics also indicated significant relations of CVD with other complex disorders. In a stratified map the members of 227 functional modules and 58 diseases in 15 disease classes were combined. In this map, leprosy, listeria monocytogenes, myasthenia, hemorrhagic diathesis and Protein S deficiency, which were not previously reported to be associated with CVD, showed significant associations. Several cancers arising from epithelial cells were also found to be linked to other diseases through hub proteins, VEGFA and PTGS2.

Causes of death among active leprosy patients in China.

We analyzed the causes of death among active leprosy patients in China, to better understand the disease and improve the quality of services, by performing a retrospective study involving 24 provinces of China. Information about patients with active leprosy who were not clinically cured and died between January 1, 2000, and December 31, 2005, was collected by professionals at county levels. A total of 524 deaths were analyzed. The leading cause of death was suicide. There were 86 patients (16%) who died at a mean of 21 ± 19 months after starting multi-drug therapy (MDT). The second and third leading causes of death were cardiovascular disease and organ failure associated with advanced age, respectively. Two hundred and twenty-one patients (42%) died within one year of beginning MDT. The second month of MDT was the riskiest for newly treated patients; approximately 20% of patients succumbed to liver failure, 33% to dapsone (diaminodiphenylsulfone/DDS) allergy, and 27% to renal insufficiency during this period. Among 143 deaths related to leprosy, 37 (26%) occurred within three months of starting MDT. We recommend that newly diagnosed patients should be provided with no more than two months of MDT blister packs.

[Status report on public health in Mauritius in 2009]. / Situation et enjeux sanitaires à l'île Maurice en 2009.

Mauritius is an island nation off the coast of Africa in the southwestern Indian Ocean. Improved socio-sanitation conditions over the past years have dramatically decreased the incidence of tropical diseases to levels comparable with those observed in developed countries. Some tropical illnesses including malaria, schistosomiasis, cysticercosis and lymphatic filariasis have been eradicated. Others such as amibiasis, typhoid fever and leprosy have become rare. However, because of the island's geographical proximity to countries with uncontrolled and suboptimal socio-sanitation conditions and its humid subtropical climate, there is a continued risk for certain vector transmitted tropical diseases such as Chikungunya and dengue. In addition, the incidence of HIV infection and AIDS has been rising rapidly since 2004 and tuberculosis remains a public health problem. Better living conditions have also been accompanied by an increase in cardiovascular and metabolic diseases that, along with cancer, are now the main causes of morbidity and mortality.

Health status of the elderly population among four primitive tribes of Orissa, India: a clinico-epidemiological study.

Primitive tribal groups (PTGs) are the most marginalised and vulnerable communities in India. Clinico-epidemiological studies on morbidity patterns among the elderly primitive tribe members are essential to recommend special intervention programmes to improve the health of the elderly in these communities. A community-based cross-sectional study was carried out among the elderly populations of four different PTGs, namely Langia Saora (LS), Paudi Bhuiyan (PB), Kutia Kondh (KK) and Dongria Kondh (DK) living in the forests of Orissa, India. Clinical and anthropometric data were collected using standard methods and haemoglobin was estimated by the cyanomethaemoglobin method. The average number of illnesses per person was 3.0. Common disabilities like vision and hearing impairment and mobility-related problems were found in considerable numbers. Gastrointestinal problems like acid peptic disease were found among 2.6% to 20% of cases. Non-specific fever was marked in 10.2% to 24.2% of individuals. The iodine deficiency disorder, namely goitre, was found among 4.2% to 6.0% of individuals. Diseases of the respiratory tract, like upper and lower respiratory tract infection, asthma, tuberculosis and leprosy, were found in small numbers. The prevalence of hypertension among males and females was 31.8% and 42.2%, respectively. The LS had the highest prevalence of hypertension (63% among men and 68% among women). With regard to anaemia status, severe anaemia was marked in 70% of males and 76.7% of females in the LS, while in other groups the prevalence of severe anaemia ranged from 15% to 33%. Although the prevalence of severe anaemia in other tribal communities is lower than in the LS, mild to moderate anaemia was found to range from 60% to 80%. The present study revealed a high prevalence of physical disabilities with both non-communicable as well as communicable diseases among the elderly primitive tribal members. This warrants the implementation of a special health care strategy to reduce suffering at this crucial age and improve quality of life.