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1.
Medicine (Baltimore) ; 99(27): e21140, 2020 Jul 02.
Artigo em Inglês | MEDLINE | ID: mdl-32629750

RESUMO

INTRODUCTION: Treating blood stasis is effective in treating obesity and metabolic diseases in traditional Korean medicine. The aim of this prospective observational study is to determine the effectiveness of the diagnosis index for metabolic diseases with blood stasis by analyzing clinical data and blood samples. METHODS AND ANALYSIS: We will perform a prospective observational study. Participants who meet the inclusion criteria will be recruited from the Dongguk university Ilsan Oriental hospital. The outcomes are resistin, serum amyloid P component, C-reactive protein, D-dimer, and blood stasis scores. In addition, the blood pressure, ankle-brachial pressure index, brachial-ankle pulse wave velocity, body mass index, waist circumference, and levels of blood lipid will be assessed. DISCUSSION: Through this study, we could collect specific data for diagnosing metabolic diseases with blood stasis. Therefore, the findings of this study will provide a summary of the current state of evidence regarding the effectiveness of the diagnosis index in managing metabolic disease with blood stasis. ETHICS AND DISSEMINATION: The study was approved by the Institutional Review Board of the Dongguk University Ilsan Oriental Hospital (DUIOH-2018-09-001-007). The results will be published in a peer-reviewed journal and will be disseminated electronically and in print. TRIAL REGISTRATION NUMBER: Clinical Research Information Service: KCT0003548.


Assuntos
Medicina Tradicional Coreana/métodos , Doenças Metabólicas/diagnóstico , Doenças Metabólicas/terapia , Língua/irrigação sanguínea , Adulto , Idoso , Índice Tornozelo-Braço/métodos , Pressão Sanguínea/fisiologia , Índice de Massa Corporal , Feminino , Humanos , Lipídeos/sangue , Masculino , Doenças Metabólicas/complicações , Doenças Metabólicas/metabolismo , Pessoa de Meia-Idade , Estudos Prospectivos , Análise de Onda de Pulso/métodos , República da Coreia/epidemiologia , Língua/patologia , Circunferência da Cintura/fisiologia
2.
Cell ; 181(6): 1189-1193, 2020 06 11.
Artigo em Inglês | MEDLINE | ID: mdl-32442404
3.
PLoS Med ; 17(4): e1003100, 2020 04.
Artigo em Inglês | MEDLINE | ID: mdl-32353039

RESUMO

BACKGROUND: Non-alcoholic fatty liver disease (NAFLD) is a leading cause of chronic liver disease worldwide. Many individuals have risk factors associated with NAFLD, but the majority do not develop advanced liver disease: cirrhosis, hepatic decompensation, or hepatocellular carcinoma. Identifying people at high risk of experiencing these complications is important in order to prevent disease progression. This review synthesises the evidence on metabolic risk factors and their potential to predict liver disease outcomes in the general population at risk of NAFLD or with diagnosed NAFLD. METHODS AND FINDINGS: We conducted a systematic review and meta-analysis of population-based cohort studies. Databases (including MEDLINE, EMBASE, the Cochrane Library, and ClinicalTrials.gov) were searched up to 9 January 2020. Studies were included that reported severe liver disease outcomes (defined as liver cirrhosis, complications of cirrhosis, or liver-related death) or advanced fibrosis/non-alcoholic steatohepatitis (NASH) in adult individuals with metabolic risk factors, compared with individuals with no metabolic risk factors. Cohorts selected on the basis of a clinically indicated liver biopsy were excluded to better reflect general population risk. Risk of bias was assessed using the QUIPS tool. The results of similar studies were pooled, and overall estimates of hazard ratio (HR) were obtained using random-effects meta-analyses. Of 7,300 unique citations, 22 studies met the inclusion criteria and were of sufficient quality, with 18 studies contributing data suitable for pooling in 2 random-effects meta-analyses. Type 2 diabetes mellitus (T2DM) was associated with an increased risk of incident severe liver disease events (adjusted HR 2.25, 95% CI 1.83-2.76, p < 0.001, I2 99%). T2DM data were from 12 studies, with 22.8 million individuals followed up for a median of 10 years (IQR 6.4 to 16.9) experiencing 72,792 liver events. Fourteen studies were included in the meta-analysis of obesity (BMI > 30 kg/m2) as a prognostic factor, providing data on 19.3 million individuals followed up for a median of 13.8 years (IQR 9.0 to 19.8) experiencing 49,541 liver events. Obesity was associated with a modest increase in risk of incident severe liver disease outcomes (adjusted HR 1.20, 95% CI 1.12-1.28, p < 0.001, I2 87%). There was also evidence to suggest that lipid abnormalities (low high-density lipoprotein and high triglycerides) and hypertension were both independently associated with incident severe liver disease. Significant study heterogeneity observed in the meta-analyses and possible under-publishing of smaller negative studies are acknowledged to be limitations, as well as the potential effect of competing risks on outcome. CONCLUSIONS: In this review, we observed that T2DM is associated with a greater than 2-fold increase in the risk of developing severe liver disease. As the incidence of diabetes and obesity continue to rise, using these findings to improve case finding for people at high risk of liver disease will allow for effective management to help address the increasing morbidity and mortality from liver disease. TRIAL REGISTRATION: PROSPERO CRD42018115459.


Assuntos
Doenças Metabólicas/epidemiologia , Hepatopatia Gordurosa não Alcoólica/epidemiologia , Estudos Observacionais como Assunto/métodos , Vigilância da População , Humanos , Incidência , Hepatopatias/sangue , Hepatopatias/diagnóstico , Hepatopatias/epidemiologia , Doenças Metabólicas/sangue , Doenças Metabólicas/diagnóstico , Hepatopatia Gordurosa não Alcoólica/sangue , Hepatopatia Gordurosa não Alcoólica/diagnóstico , Vigilância da População/métodos , Fatores de Risco
4.
Nat Med ; 26(4): 549-557, 2020 04.
Artigo em Inglês | MEDLINE | ID: mdl-32273609

RESUMO

Polygenic risk scores (PRSs) have shown promise in predicting susceptibility to common diseases1-3. We estimated their added value in clinical risk prediction of five common diseases, using large-scale biobank data (FinnGen; n = 135,300) and the FINRISK study with clinical risk factors to test genome-wide PRSs for coronary heart disease, type 2 diabetes, atrial fibrillation, breast cancer and prostate cancer. We evaluated the lifetime risk at different PRS levels, and the impact on disease onset and on prediction together with clinical risk scores. Compared to having an average PRS, having a high PRS contributed 21% to 38% higher lifetime risk, and 4 to 9 years earlier disease onset. PRSs improved model discrimination over age and sex in type 2 diabetes, atrial fibrillation, breast cancer and prostate cancer, and over clinical risk in type 2 diabetes, breast cancer and prostate cancer. In all diseases, PRSs improved reclassification over clinical thresholds, with the largest net reclassification improvements for early-onset coronary heart disease, atrial fibrillation and prostate cancer. This study provides evidence for the additional value of PRSs in clinical disease prediction. The practical applications of polygenic risk information for stratified screening or for guiding lifestyle and medical interventions in the clinical setting remain to be defined in further studies.


Assuntos
Doenças Cardiovasculares , Predisposição Genética para Doença , Doenças Metabólicas , Herança Multifatorial , Neoplasias , Adulto , Idade de Início , Biomarcadores/análise , Neoplasias da Mama/diagnóstico , Neoplasias da Mama/epidemiologia , Neoplasias da Mama/genética , Doenças Cardiovasculares/diagnóstico , Doenças Cardiovasculares/epidemiologia , Doenças Cardiovasculares/genética , Estudos de Casos e Controles , Diabetes Mellitus Tipo 2/diagnóstico , Diabetes Mellitus Tipo 2/epidemiologia , Diabetes Mellitus Tipo 2/genética , Feminino , Finlândia/epidemiologia , Marcadores Genéticos/genética , Predisposição Genética para Doença/epidemiologia , Estudo de Associação Genômica Ampla , Humanos , Masculino , Doenças Metabólicas/diagnóstico , Doenças Metabólicas/epidemiologia , Doenças Metabólicas/genética , Pessoa de Meia-Idade , Neoplasias/diagnóstico , Neoplasias/epidemiologia , Neoplasias/genética , Polimorfismo de Nucleotídeo Único , Valor Preditivo dos Testes , Prognóstico , Neoplasias da Próstata/diagnóstico , Neoplasias da Próstata/epidemiologia , Neoplasias da Próstata/genética , Medição de Risco , Fatores de Risco , Adulto Jovem
5.
Zhonghua Yi Xue Yi Chuan Xue Za Zhi ; 37(4): 367-372, 2020 Apr 10.
Artigo em Chinês | MEDLINE | ID: mdl-32219815

RESUMO

Follow-up is a crucial step for the screening of neonatal genetic and metabolic diseases, which can directly influence the detection, diagnosis, efficacy of treatment, as well as the quality of neonatal screening. In view of the lack of follow-up, full understanding, and inconsistent requirement between various agencies and personnel in China, there is an urgent need for standardization. The Committee for Proficiency Testing of the Neonatal Genetic Metabolic Disease Screening Center of the National Health Committee of China has organized the writing of expert consensus for follow-up of neonatal genetic and metabolic disease screening after thorough discussion, so as to guide the follow-up work and improve its quality.


Assuntos
Doenças Genéticas Inatas/diagnóstico , Doenças Metabólicas , Triagem Neonatal , China , Consenso , Seguimentos , Humanos , Recém-Nascido , Doenças Metabólicas/diagnóstico , Doenças Metabólicas/genética
6.
Klin Lab Diagn ; 65(3): 155-162, 2020.
Artigo em Russo | MEDLINE | ID: mdl-32163689

RESUMO

The complete laboratory and clinical instrumental examination was conducted, it included serum COMP test, circadian excretion of type II collagen C-terminal telopeptides Urine CartiLaps (СТХ II) and Т2 relaxometry in 29 patients of both sexes of the main group with early (0-I) X-ray osteoarthrosis stages, 30 subjects of comparison group with no X-ray osteoarthrosis evidences aged 44.7±5.9 years and 25 healthy subjects aged 26.3±2.6 years of the control group. The increase (р<0,05) of COMP and Urine CartiLaps levels as well as the increase of Т2 relaxation signal was found at early osteoarthrosis evidences. It was proven that there was (р<0.01) a connection (R=0.8) between COMP and Urine CTX II levels as well as (р<0.05) results of Т2 relaxometry (R=0.8). It was proven that collagen anisotropy and formation of chondromalacia areas as Т2 relaxometry showed in patients with early OA evidences were connected with accumulation of serum COMP and increase of type II collagen circadian renal excretion. The combination of laboratory and radiological methods of articular hyaline cartilage assessment may be used for finding early osteoarthrosis stages.


Assuntos
Doenças Metabólicas/diagnóstico , Osteoartrite/diagnóstico , Adulto , Proteína de Matriz Oligomérica de Cartilagem/sangue , Estudos de Casos e Controles , Colágeno Tipo II/urina , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Fragmentos de Peptídeos/urina , Adulto Jovem
7.
Nutr Metab Cardiovasc Dis ; 30(5): 810-821, 2020 05 07.
Artigo em Inglês | MEDLINE | ID: mdl-32143895

RESUMO

BACKGROUND AND AIMS: Atherosclerosis begins early in life, thus optimal cardiovascular health needs to be promoted early. We investigated whether appetitive behaviors among 7 year olds are associated with their cardiometabolic health years later. METHODS AND RESULTS: A sample of 2951 children from a Portuguese birth cohort was analyzed. The Children's Eating Behavior Questionnaire assessed eating behaviors, and a measure of cardiometabolic risk (higher risk group: those in the upper quartile of triglycerides, homeostatic model assessment-insulin resistance, waist circumference and systolic blood pressure and in the lower quartile of high-density lipoprotein cholesterol z-scores) was created. Linear and logistic regressions were run. Children with more food avoidant behaviors had lower cardiometabolic risk (Satiety Responsiveness - boys: OR = 0.39, 95% CI 0.16; 0.93, girls: OR=0.37, 95% CI 0.17; 0.82 and Slowness in eating - boys: OR = 0.49, 95% CI 0.25; 0.95, girls: OR = 0.49, 95% CI 0.27; 0.91). Food approach behaviors (Food responsiveness (CEBQ-FR), Enjoyment of food (CEBQ-EF) and Emotional overeating (CEBQ-EOE)) increased cardiometabolic risks (e.g. CEBQ-FR: boys: OR = 2.50, 95% CI 1.45; 4.32, girls: OR = 2.33, 95% CI 1.46; 3.71). CEBQ-EF had stronger effects in boys, while CEBQ-EOE was positively associated with cardiometabolic risk among girls. When adjusting for BMIz at 7y, associations did not remain significant. Appetitive behaviors were also associated with isolated cardiometabolic parameters; the strongest association being with waist circumference. CONCLUSIONS: Appetitive behaviors at 7-years are associated with cardiometabolic risk at age 10. While 'food avoidant' behaviors protect against cardiometabolic risk and 'food approach' behaviors increase cardiometabolic risk, these associations are largely dependent of child's adiposity.


Assuntos
Regulação do Apetite , Doenças Cardiovasculares/epidemiologia , Comportamento Infantil , Comportamento Alimentar , Doenças Metabólicas/epidemiologia , Obesidade Pediátrica/epidemiologia , Fatores Etários , Doenças Cardiovasculares/diagnóstico , Doenças Cardiovasculares/prevenção & controle , Criança , Emoções , Feminino , Seletividade Alimentar , Preferências Alimentares , Humanos , Masculino , Doenças Metabólicas/diagnóstico , Doenças Metabólicas/prevenção & controle , Obesidade Pediátrica/diagnóstico , Obesidade Pediátrica/prevenção & controle , Portugal/epidemiologia , Estudos Prospectivos , Fatores de Proteção , Medição de Risco , Fatores de Risco , Comportamento de Redução do Risco , Fatores Sexuais
8.
Int. j. morphol ; 38(1): 120-125, Feb. 2020. tab, graf
Artigo em Espanhol | LILACS | ID: biblio-1056408

RESUMO

En el mundo la obesidad es considerada una pandemia que provoca grandes cambios metabólicos, responsables de las llamadas enfermedades crónicas no transmisibles (ECNT), las cuales presentan un 60 % de mortalidad, según la Organización Mundial de la Salud (2016). En Chile el 75 % de la población adulta y el 50,9 % de la población estudiantil, muestran índices de masa corporal de sobrepeso y obesidad, con un nivel de sedentarismo general de 66,2 %. Los objetivos de este trabajo fueron determinar los perfiles antropométricos, riesgo metabólico y niveles de actividad física en profesores de enseñanza básica en un colegio particular subvencionado de Arica-Chile. El total de los profesores, 12 varones y 29 mujeres, fueron evaluados según: peso, talla, perímetro de cintura, índice cintura-talla (ICT), índice de masa corporal (IMC), masa grasa (MG), masa grasa visceral (MGV) y masa muscular (MM). A todos ellos se les calculó el riesgo metabólico según protocolos de Ashwell & Gibson (2016) y el IMC según fórmula de Quetelet. Para determinar los porcentajes de MG, MM y MGV, se utilizó instrumento de bioimpedancia eléctrica, Omron HBF-514C. Posteriormente se les aplicó una encuesta sobre nivel de actividad física (IPAQ). Los datos fueron analizados en estadístico IBM SPSS para tendencia central, dispersión, conteos y porcentajes. Para correlación se usó test de Pearson (r>0,5). Los resultados muestran que un 68,3 % de los profesores presenta sobrepeso y obesidad. El IMC y porcentaje de MGV son significativamente más alto en varones que en mujeres (30,6 ±7,0 / 26,9±4,6 y 11,2±5,6 / 7,6±2,5 respectivamente). El riesgo metabólico general de la población en estudio fue de 58,5 % (75 % y 51,7 % varones y mujeres respectivamente). Se observa una alta correlación entre IMC-MGV (0,84), IMC-ICT (0,84) y MM-MG (0,85). Respecto al nivel de actividad física, solo el 19,5 % de los profesores muestra un nivel de actividad física alto. Se concluye que los profesores presentan valores antropométricos alterados que indican altos índices de riesgos metabólicos y con bajos niveles de actividad física. Independientemente, las mujeres presentan mejores índices morfométricos en todos los parámetros en estudio respecto a los profesores varones. Existe una alta correlación (r) entre el índice de masa corporal y los porcentajes de masa de grasa visceral y el índice de de cintura talla. Se sugiere enfocar las intervenciones educativas según sello de vida saludable, incentivando la actividad física y mejorar los hábitos alimenticios en los profesores.


Obesity is considered a global pandemic that causes major metabolic changes. It is responsible for the so-called noncommunicable chronic diseases (NCDs), which report a 60 % mortality rate (WHO, 2017). In Chile, 63 % of the population shows body mass indexes (BMI) of overweight and obesity, with a sedentary level of 86.7 %. The objectives of this work were to determine the anthropometric profiles, metabolic risk, and physical activity levels in primary school teachers, in a subsidized school in Arica, Chile. The teachers (n=41), 12 men, and 29 women were evaluated according to weight, height, waist circumference (WC), waist-to-height index (WHI), BMI, Fat Mass (FM), Visceral Fat Mass (VFM) and Muscle Mass (MM). All of them were calculated for metabolic risk, according to Ashwell & Gibson protocols and BMI according to Quetelet's formula. To determine the percentages of FM, MM, and VFM, an electric bioimpedance instrument, Omron HBF-514C, was used. Subsequently, a survey of physical activity level (IPAQ) was applied. The data were analyzed in the IBM SPSS statistic for central tendency, dispersion, counts, and percentages. For correlation, Pearson's test (r> 0.5) was used. The results show that 68.3 % of teachers are overweight and obese. BMI and percentage of VFM are significantly higher in men than in women (30.6 ± 7.0 / 26.9 ± 4.6 and 11.2 ± 5.6 / 7.6 ± 2.5 respectively). The overall metabolic risk of the study population was 58.5 % (75 % and 51.7 % men and women, respectively). There is a high correlation between BMIVFM (0.84), BMI-WHI (0.84), MM-FM (0.85). Regarding the level of physical activity, only 19.5 % of teachers show a high level of physical activity. It is concluded that teachers have altered anthropometric values that indicate high rates of metabolic risks and low levels of physical activity. Regardless, women have better morphometric indexes in all parameters under study, compared to male teachers. There is a high correlation (r) between body mass index and percentages of visceral fat mass and waist height index. It is suggested to focus on educational interventions according to the healthy life seal, promoting physical activity, and improving eating habits in teachers.


Assuntos
Humanos , Masculino , Feminino , Adulto , Composição Corporal , Medição de Risco , Professores Escolares , Doenças Metabólicas/diagnóstico , Índice de Massa Corporal , Chile , Tecido Adiposo , Razão Cintura-Estatura
9.
Prog Cardiovasc Dis ; 63(2): 170-177, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32059838

RESUMO

Despite its potential to improve metabolic health outcomes, longitudinal physical activity (PA) patterns and their association with cardiometabolic disease among people living with HIV (PLWH) have not been well characterized. We investigated this relationship among PLWH in the Centers for AIDS Research Network of Integrated Clinical Systems with at least one PA self-report between 2008 and 2015. The 4-item Lipid Research Clinics PA instrument was used to categorize habitual PA levels as: Very Low, Low, Moderate, or High. We analyzed demographic differences in PA patterns. Multivariable generalized estimating equation regression models were fit to assess longitudinal associations of PA with blood pressure, lipid, and glucose levels. Logistic regression modeling was used to assess the odds of being diagnosed with obesity, cardiovascular disease (CVD), cerebrovascular disease, hypertension, diabetes, or multimorbidity. A total of 40,462 unique PA assessments were provided by 11,719 participants. Only 13% of PLWH reported High PA, while 68% reported Very Low/Low PA at baseline and did not increase PA levels during the study period. Compared to those reporting High PA, participants with Very Low PA had almost 2-fold increased risk for CVD. Very Low PA was also associated with several risk factors associated with CVD, most notably elevated triglycerides (odds ratio 25.4), obesity (odds ratio 1.9), hypertension (odds ratio 1.4), and diabetes (odds ratio 2.3; all p < 0.01). Low levels of PA over time among PLWH are associated with increased cardiometabolic disease risk.


Assuntos
Fármacos Anti-HIV/uso terapêutico , Doenças Cardiovasculares/epidemiologia , Metabolismo Energético , Exercício Físico , Infecções por HIV/tratamento farmacológico , Sobreviventes de Longo Prazo ao HIV , Doenças Metabólicas/epidemiologia , Fármacos Anti-HIV/efeitos adversos , Biomarcadores/sangue , Doenças Cardiovasculares/diagnóstico , Doenças Cardiovasculares/fisiopatologia , Doenças Cardiovasculares/prevenção & controle , Feminino , Infecções por HIV/diagnóstico , Infecções por HIV/epidemiologia , Nível de Saúde , Humanos , Masculino , Doenças Metabólicas/diagnóstico , Doenças Metabólicas/fisiopatologia , Doenças Metabólicas/prevenção & controle , Fatores de Proteção , Estudos Retrospectivos , Medição de Risco , Fatores de Risco , Comportamento de Redução do Risco , Comportamento Sedentário , Fatores de Tempo , Estados Unidos/epidemiologia , Carga Viral
10.
Dan Med J ; 67(1)2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31908255

RESUMO

INTRODUCTION: Newborn screening is a public health programme for early diagnosis of treatable diseases. METHODS: The subjects included were newborns born 2002-2019. Expanded newborn screening (eNBS) for metabolic diseases was introduced as a pilot project from 2002 to 2009, followed by routine screening with informed dissent. A total of 967,780 newborns were screened; 82,930 were unscreened. Furthermore, a historic cohort of clinically diagnosed children born in the 1992-2001 period was included. Children in the unscreened and historic cohorts were evaluated for the same diseases as were the screened children. Dried blood spot samples were collected locally and sent for screening analyses. We recorded newborns with true and false positive results as well as false negative results and their clinical signs at screening and at the last follow-up. RESULTS: A total of 603 samples were screen positive: 354 false positives and 249 true positives (222 newborns and 27 mothers). The positive predictive value (PPV) was 41% for the entire screening period; 62% for 2018. The false positive rate (FPR) was 0.036% overall; 0.024% for 2018. The overall prevalence of diseases was 1:3,900; in the historic cohort, the prevalence of the same diseases was 1:8,300; 7.3% had symptoms at the time of screening. At follow-up, 93% of the children had no clinically significant sequelae. Among 82,930 unscreened newborns, 27 (1:3,000) had eNBS panel diseases, some with severe manifestations. CONCLUSIONS: This update of eNBS in Denmark confirms that eNBS is a successful preventive public health programme. Early treatment in a latent phase of disease is effective and screening should be extended to other diseases not currently in the programme. FUNDING: The work was supported by grants from The Ronald McDonald Børnefond, Danmarks Sundhedsfond, Direktør Ib Henriksens Fond, Ragnhild Ibsens Legat til Medicinsk Forskning, Gerda og Aage Haenschs Fond, Dronning Louises Børnehospitals Forskningsfond, Læge Sofus Carl Emil Friis og Hustru Olga Doris Friis's Legat, Aase and Ejnar Danielsens Fond, Oda og Hans Svenningsens Fond, Fonden af 1870, Vanførefonden, Fonden til Lægevidenskabens Fremme and Danish Medical Research Council. TRIAL REGISTRATION: not relevant.


Assuntos
Doenças Metabólicas/prevenção & controle , Triagem Neonatal , Serviços Preventivos de Saúde/estatística & dados numéricos , Dinamarca/epidemiologia , Diagnóstico Precoce , Feminino , Humanos , Recém-Nascido , Masculino , Doenças Metabólicas/diagnóstico , Doenças Metabólicas/epidemiologia , Projetos Piloto , Serviços Preventivos de Saúde/métodos , Avaliação de Programas e Projetos de Saúde
11.
Respir Res ; 20(1): 276, 2019 Dec 04.
Artigo em Inglês | MEDLINE | ID: mdl-31801522

RESUMO

BACKGROUND: Obstructive sleep apnea (OSA) and excessive daytime sleepiness (EDS) were considered to contribute to MetS. This study was performed to assess the association between MetS and EDS in two independent large-scale populations, and in subjects who underwent upper-airway surgery. METHODS: A total of 6312 patients without self-reported depression and 3578 suspected OSA patients were consecutively recruited, during health screening examinations and from our sleep center, respectively. A total of 57 subjects with OSA who underwent upper-airway surgery were also included. Demographic, anthropometric, biochemical, and polysomnographic data were obtained. RESULTS: In the health screening examination group, 233 (9.23%) women and 350 (10.93%) men had complaints of EDS. A total of 229 (7.04%) women and 1182 (36.88%) men met the criteria for MetS. In the OSA group, 147 (21.18%) women and 1058 (36.69%) men reported EDS. In addition, 93 (13.4%) women and 1368 (47.43%) men reported MetS. In the health screening examination group, EDS did not contribute significantly to MetS (OR = 1.125, 95% CI: 0.907-1.395; p = 0.283). In the OSA group, EDS significantly contributed to MetS (OR = 1.249, 95% CI: 1.063-1.468; p = 0.007); however, the results were not significant after adjusting for sleep variables (OR = 1.071, 95% CI: 0.905-1.268; p = 0.423). Upper-airway surgery did not affect cardio-metabolic variables in OSA patients with or without EDS. CONCLUSIONS: EDS was not associated with MetS in two independent large-scale cohorts. In addition, upper-airway surgery did not affect components of MetS in OSA patients with and without EDS.


Assuntos
Distúrbios do Sono por Sonolência Excessiva/diagnóstico , Distúrbios do Sono por Sonolência Excessiva/epidemiologia , Doenças Metabólicas/diagnóstico , Doenças Metabólicas/epidemiologia , Apneia Obstrutiva do Sono/diagnóstico , Apneia Obstrutiva do Sono/epidemiologia , Adulto , Fatores Etários , Índice de Massa Corporal , China , Estudos de Coortes , Comorbidade , Estudos Transversais , Análise Fatorial , Feminino , Humanos , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Análise Multivariada , Polissonografia/métodos , Prevalência , Prognóstico , Medição de Risco , Índice de Gravidade de Doença , Fatores Sexuais , Apneia Obstrutiva do Sono/cirurgia
12.
Int J Mol Sci ; 20(23)2019 Nov 29.
Artigo em Inglês | MEDLINE | ID: mdl-31795333

RESUMO

The need to facilitate the complex management of cardiometabolic diseases (CMD) has led to the detection of many biomarkers, however, there are no clear explanations of their role in the prevention, diagnosis or prognosis of these diseases. Molecules associated with disease pathways represent valid disease surrogates and well-fitted CMD biomarkers. To address this challenge, data from multi-omics types (genomics, epigenomics, transcriptomics, proteomics, metabolomics, microbiomics, and nutrigenomics), from human and animal models, have become available. However, individual omics types only provide data on a small part of molecules involved in the complex CMD mechanisms, whereas, here, we propose that their integration leads to multidimensional data. Such data provide a better understanding of molecules related to CMD mechanisms and, consequently, increase the possibility of identifying well-fitted biomarkers. In addition, the application of gender medicine also helps to identify accurate biomarkers according to gender, facilitating a differential CMD management. Accordingly, the impact of gender differences in CMD pathophysiology has been widely demonstrated, where gender is referred to the complex interrelation and integration of sex (as a biological and functional marker of the human body) and psychological and cultural behavior (due to ethnical, social, and religious background). In this review, all these aspects are described and discussed, as well as potential limitations and future directions in this incipient field.


Assuntos
Doenças Cardiovasculares/diagnóstico , Biologia Computacional/métodos , Doenças Metabólicas/diagnóstico , Medicina de Precisão/métodos , Animais , Biomarcadores/análise , Feminino , Humanos , Masculino
13.
Handb Clin Neurol ; 165: 191-205, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31727212

RESUMO

Wilson disease (WD) is a hereditary metabolic disorder (HMD) caused by a mutation in the copper-transporting gene ATP7B affecting the liver and central nervous system. About 30% of patients with WD may initially present with psychiatric symptoms, and management can be difficult. More generally, HMDs are a rare but important cause of psychiatric disorders in adolescents and adults. Main signs of HMDs may remain isolated for years before the appearance of hepatic or neurologic signs. The incidence of HMDs has been estimated at approximately 40 cases per 100,000 live births. Some of them are treatable and new diagnostic methods and therapies have become available. HMDs that present purely with psychiatric symptoms are very difficult to diagnose due to low awareness of these rare diseases among psychiatrists and neurologists. However, it is important to identify HMDs in order to provide disease-specific treatment and possible prevention of irreversible physical and neurologic complications. Genetic counseling can also be provided. Psychotropic medications should be prescribed carefully in that indication. This chapter focuses on three HMD categories: chronic, treatable HMDs (e.g., WD); acute, treatable HMDs; and chronic HMDs that are difficult to treat. In this review we focus on the psychopharmacology of WD and other chronic and difficult-to-treat HMDs. We provide some keys to take into account the main side effects associated with common psychotropic medications.


Assuntos
Degeneração Hepatolenticular/metabolismo , Degeneração Hepatolenticular/terapia , Doenças Metabólicas/metabolismo , Doenças Metabólicas/terapia , Psicotrópicos/uso terapêutico , Aconselhamento Genético/métodos , Degeneração Hepatolenticular/diagnóstico , Humanos , Doenças Metabólicas/diagnóstico , Psicofarmacologia
14.
Public Health Rep ; 134(2_suppl): 58S-63S, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31682555

RESUMO

The Plain community is the fastest-growing religious minority in Wisconsin. This community has a high incidence of genetic disorders, many of which are identifiable through newborn screening. We describe efforts by the Wisconsin Newborn Screening Program (WNSP) to improve health care in the Plain community by targeting early identification of, and intervention for, patients with inherited metabolic disorders. WNSP formed partnerships with families and health care providers to increase awareness of screening procedures and the intended benefits of screening, modify testing algorithms to enhance detection, and establish medical homes for patients with confirmed disorders. The estimated number of Plain newborns screened increased by 25.5% during the study period, from 547 in 2011 to 736 in 2017; 122 persons underwent carrier testing, and 143 newborns received second-tier testing. From 2014 to 2017, affected patients received 71 metabolic evaluations in their community medical home without travel to major health centers. This article demonstrates how a comprehensive public health program can help increase screening rates, enhance detection, and establish follow-up care in a hard-to-reach religious community. A key lesson learned was the importance of communication among all stakeholders to develop an effective public health program.


Assuntos
Comunicação , Assistência de Longa Duração , Doenças Metabólicas/diagnóstico , Doenças Metabólicas/epidemiologia , Triagem Neonatal , Religião , Feminino , Humanos , Incidência , Recém-Nascido , Masculino , Doenças Metabólicas/genética , Aceitação pelo Paciente de Cuidados de Saúde/psicologia , Wisconsin/epidemiologia
15.
BMC Res Notes ; 12(1): 747, 2019 Nov 15.
Artigo em Inglês | MEDLINE | ID: mdl-31730479

RESUMO

OBJECTIVES: The association between post-traumatic stress disorder (PTSD) and medical comorbidities is controversial since most studies focused on specific comorbidity and victim types. In Italy, data on this issue are scarce. A comprehensive evaluation of all the ICD medical categories co-occurring in PTSD may orient assessment and treatment during clinical and forensic practice. This is the first study evaluating all the ICD physical comorbidities and gender-related differences in Italian PTSD patients. Eighty-four PTSD patients (36 females, 48 males) were included. The Clinician-Administered PTSD Scale, Mini International Neuropsychiatric Interview and Davidson Trauma Scale were administered. RESULTS: Most patients had a PTSD consequent to an accident and half of them presented extreme symptom severity. No gender differences emerged on symptom severity/duration and age at the event. Metabolic (39.29%), circulatory (20.24%) and musculoskeletal systems/connective tissue diseases (17.86%) were the most frequent comorbidities. Metabolic/circulatory diseases were more frequent among males (p = 0.019 and p = 0.027, respectively) while females more frequently showed neoplasms (p = 0.039). Physical comorbidities represent a serious complication in PTSD patients and are more prevalent than in the Italian population. While gender is not associated with symptom presentation, it seems to play a key role in specific comorbidities including metabolic, circulatory and neoplastic diseases.


Assuntos
Doenças Cardiovasculares/epidemiologia , Doenças do Tecido Conjuntivo/epidemiologia , Doenças Metabólicas/epidemiologia , Doenças Musculoesqueléticas/epidemiologia , Transtornos de Estresse Pós-Traumáticos/epidemiologia , Adulto , Idoso , Doenças Cardiovasculares/diagnóstico , Doenças Cardiovasculares/fisiopatologia , Comorbidade , Doenças do Tecido Conjuntivo/diagnóstico , Doenças do Tecido Conjuntivo/fisiopatologia , Feminino , Humanos , Classificação Internacional de Doenças , Itália/epidemiologia , Masculino , Doenças Metabólicas/diagnóstico , Doenças Metabólicas/fisiopatologia , Pessoa de Meia-Idade , Doenças Musculoesqueléticas/diagnóstico , Doenças Musculoesqueléticas/fisiopatologia , Prevalência , Escalas de Graduação Psiquiátrica , Índice de Gravidade de Doença , Fatores Sexuais , Transtornos de Estresse Pós-Traumáticos/diagnóstico , Transtornos de Estresse Pós-Traumáticos/fisiopatologia
17.
BMC Med ; 17(1): 186, 2019 10 17.
Artigo em Inglês | MEDLINE | ID: mdl-31619225

RESUMO

BACKGROUND: Customized birth weight charts take into account physiological maternal characteristics that are known to influence fetal growth to differentiate between physiological and pathological abnormal size at birth. It is unknown whether customized birth weight charts better identify newborns at risk of long-term adverse outcomes than population birth weight charts. We aimed to examine whether birth weight classification according to customized charts is superior to population charts at identification of newborns at risk of adverse cardio-metabolic and respiratory health outcomes. METHODS: In a population-based prospective cohort study among 6052 pregnant women and their children, we measured infant catch-up growth, overweight, high blood pressure, hyperlipidemia, liver steatosis, clustering of cardio-metabolic risk factors, and asthma at age 10. Small size and large size for gestational age at birth was defined as birth weight in the lowest or highest decile, respectively, of population or customized charts. Association with birth weight classification was assessed using logistic regression models. RESULTS: Of the total of 605 newborns classified as small size for gestational age by population charts, 150 (24.8%) were reclassified as appropriate size for gestational age by customized charts, whereas of the total of 605 newborns classified as large size for gestational age by population charts, 129 (21.3%) cases were reclassified as appropriate size for gestational age by customized charts. Compared to newborns born appropriate size for gestational age, newborns born small size for gestational age according to customized charts had increased risks of infant catch-up growth (odds ratio (OR) 5.15 (95% confidence interval (CI) 4.22 to 6.29)), high blood pressure (OR 2.05 (95% CI 1.55 to 2.72)), and clustering of cardio-metabolic risk factors at 10 years (OR 1.66 (95% CI 1.18 to 2.34)). No associations were observed for overweight, hyperlipidemia, liver steatosis, or asthma. Newborns born large-size for gestational age according to customized charts had higher risk of catch-down-growth only (OR 3.84 (95% CI 3.22 to 4.59)). The direction and strength of the observed associations were largely similar when we used classification according to population charts. CONCLUSIONS: Small-size-for-gestational-age newborns seem to be at risk of long-term adverse cardio-metabolic health outcomes, irrespective of the use of customized or population birth weight charts.


Assuntos
Peso ao Nascer , Doenças Cardiovasculares/diagnóstico , Gráficos de Crescimento , Recém-Nascido Pequeno para a Idade Gestacional/crescimento & desenvolvimento , Transtornos Respiratórios/diagnóstico , Adulto , Doenças Cardiovasculares/epidemiologia , Doenças Cardiovasculares/etiologia , Criança , Pré-Escolar , Estudos de Coortes , Feminino , Desenvolvimento Fetal/fisiologia , Previsões/métodos , Idade Gestacional , Humanos , Individualidade , Lactente , Recém-Nascido , Masculino , Doenças Metabólicas/diagnóstico , Doenças Metabólicas/epidemiologia , Doenças Metabólicas/etiologia , Países Baixos/epidemiologia , Valor Preditivo dos Testes , Gravidez , Estudos Prospectivos , Transtornos Respiratórios/epidemiologia , Transtornos Respiratórios/etiologia , Fatores de Risco , Adulto Jovem
18.
Ulster Med J ; 88(3): 157-161, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31619849

RESUMO

Introduction: Patient portals are online electronic medical record applications that allow patients greater control of their own health and encourage meaningful interaction with their healthcare providers. The uptake of this technology is commonplace throughout developed healthcare economies and is on the Northern Ireland Electronic Healthcare Record (NIECR) roadmap. Aim: To assess patients' perceptions and proposed provision of a patient portal in endocrinology outpatients. Methods: Patients (n=75) attending three endocrinology outpatient clinics were eligible to participate. After discussion at clinic, invited patients were contacted via e-mail to complete a confidential and anonymised online survey. There were a total of 23 questions in the survey which included a mix of free text and categorical responses. The survey duration was conducted over a 6-month period. Results: The survey response rate was 51/75 (68%), M33:F18. 46/51 (90%) had access to smart phones, 45/51 (88%) used the internet daily. 31/51 (60%) of respondents were aged between 18-45, 20/51 (40%) were aged ≥ 45 years. 50/51 (98%) reported they would use the technology if available. 47/51 (92%) felt engaging with a patient portal would enhance communication with their doctor and improve understanding of their medical issues. Reported perceived applications of use included; remote access and advice for test results and medical questions, arranging appointments, requesting prescriptions and health promotion. 90% of respondents said they would be content to access results even if abnormal. Possible barriers to adoption of this technology included data protection and understanding medical terminology. Conclusions: The overall response to the provision of this technology was positive, although concerns regarding data protection remain prevalent. Perceived benefits included enhanced doctor-patient communication, optimizing workflow and improving patient engagement.


Assuntos
Registros Eletrônicos de Saúde/organização & administração , Doenças Metabólicas/terapia , Portais do Paciente/estatística & dados numéricos , Segurança do Paciente , Relações Médico-Paciente , Inquéritos e Questionários , Adolescente , Adulto , Assistência Ambulatorial/organização & administração , Comunicação , Humanos , Doenças Metabólicas/diagnóstico , Pessoa de Meia-Idade , Irlanda do Norte , Avaliação de Resultados em Cuidados de Saúde , Pacientes Ambulatoriais/estatística & dados numéricos , Aceitação pelo Paciente de Cuidados de Saúde/estatística & dados numéricos , Percepção , Adulto Jovem
19.
Int J Mol Sci ; 20(19)2019 Oct 08.
Artigo em Inglês | MEDLINE | ID: mdl-31597283

RESUMO

A balanced metabolic profile is essential for normal human physiological activities. Disproportions in nutrition give rise to imbalances in metabolism that are associated with aberrant immune function and an elevated risk for inflammatory-associated disorders. Inflammation is a complex process, and numerous mediators affect inflammation-mediated disorders. The available clinical modalities do not effectively address the underlying diseases but rather relieve the symptoms. Therefore, novel targeted agents have the potential to normalize the metabolic system and, thus, provide meaningful therapy to the underlying disorder. In this connection, polyphenols, the well-known and extensively studied phytochemical moieties, were evaluated for their effective role in the restoration of metabolism via various mechanistic signaling pathways. The various flavonoids that we observed in this comprehensive review interfere with the metabolic events that induce inflammation. The mechanisms via which the polyphenols, in particular flavonoids, act provide a promising treatment option for inflammatory disorders. However, detailed clinical studies of such molecules are required to decide their clinical fate.


Assuntos
Anti-Inflamatórios/farmacologia , Flavonoides/farmacologia , Inflamação/metabolismo , Doenças Metabólicas/metabolismo , Animais , Anti-Inflamatórios/química , Anti-Inflamatórios/uso terapêutico , Biomarcadores , Ensaios Clínicos como Assunto , Suscetibilidade a Doenças , Avaliação Pré-Clínica de Medicamentos , Flavonoides/química , Flavonoides/uso terapêutico , Humanos , Inflamação/complicações , Inflamação/diagnóstico , Mediadores da Inflamação/metabolismo , Doenças Metabólicas/diagnóstico , Doenças Metabólicas/tratamento farmacológico , Doenças Metabólicas/etiologia , Estresse Oxidativo/efeitos dos fármacos , Transdução de Sinais/efeitos dos fármacos , Resultado do Tratamento
20.
Vet Clin North Am Equine Pract ; 35(3): 399-417, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31587976

RESUMO

The donkey evolved under harsh and arid environmental conditions, developing unique energy-efficiency traits, with an efficiency to rapidly mobilize fat in situations of increased energy demands or when food is scarce. This evolution has led to an inherent predisposition of donkeys to obesity, dyslipidemias, insulin dysregulation/metabolic syndrome, pituitary pars intermedia dysfunction, and endocrinopathic laminitis. Marked differences have been described in hormone dynamics and testing protocols for the diagnosis of these endocrine and metabolic diseases in donkeys compared with horses, underlining the necessity of a species-specific approach in order to avoid misdiagnosis, unnecessary or inadequate treatments, and additional costs.


Assuntos
Doenças do Sistema Endócrino/veterinária , Equidae , Doenças dos Cavalos/diagnóstico , Doenças Metabólicas/veterinária , Animais , Doenças do Sistema Endócrino/diagnóstico , Doenças do Sistema Endócrino/metabolismo , Doenças do Sistema Endócrino/terapia , Doenças dos Cavalos/metabolismo , Doenças dos Cavalos/terapia , Cavalos , Doenças Metabólicas/diagnóstico , Doenças Metabólicas/metabolismo , Doenças Metabólicas/terapia
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