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Mesenchymal Stem Cells from Rats with Chronic Kidney Disease Exhibit Premature Senescence and Loss of Regenerative Potential
Mesenchymal stem cell (MSC) transplantation has the potential for organ repair. Nevertheless, some factors might lessen the regenerative potential of MSCs, e.g. donor age or systemic disease. It is thus important to carefully assess the patient's suitability for autologous MSC transplantation. Here we investigated the effects of chronic kidney disease (CKD) on MSC function. We isolated bone marrow MSCs from remnant kidney rats (RK) with CKD (CKD-RK-MSC) and found signs of premature senescence: spontaneous adipogenesis, reduced proliferation capacity, active senescence-associated-?-galactosidase, accumulation of actin and a modulated secretion profile. The functionality of CKD-RK-MSCs in vivo was tested in rats with acute anti-Thy1.1-nephritis, where healthy MSCs have been shown to be beneficial. Rats received healthy MSCs, CKD-RK-MSC or medium by injection into the left renal artery. Kidneys receiving healthy MSCs exhibited accelerated healing of glomerular lesions, whereas CKD-RK-MSC or medium exerted no benefit. The negative influence of advanced CKD/uremia on MSCs was confirmed in a second model of CKD, adenine nephropathy (AD). MSCs from rats with adenine nephropathy (CKD-AD-MSC) also exhibited cellular modifications and functional deficits in vivo. We conclude that CKD leads to a sustained loss of in vitro and in vivo functionality in MSCs, possibly due to premature cellular senescence. Considering autologous MSC therapy in human renal disease, studies identifying uremia-associated mechanisms that account for altered MSC function are urgently needed.
Mallau, Monika; Makowska, Anna; van Roeyen, Claudia Renate; Rong, Song; Buecher, Eva Bettina; Boor, Peter; Kovacova, Katarina; Zok, Stephanie; Denecke, Bernd; Stuettgen, Esther; Otten, Simon; Floege, Juergen; Kunter, Uta
Although diabetes mellitus, cardiovascular disease, and human immunodeficiency virus infection are three separate entities,\\u000a each has causal and non-causal risk factors that are common in the stage 5 chronic kidney disease population. The medical\\u000a nutrition therapies are similar, which emphasize adequate protein and energy intakes, fluid control, and possibly carbohydrate\\u000a and fat modifications. Each patient requires an individualized evaluation, taking
Sharon R. Schatz
GM-CSF Exhibits Anti-Inflammatory Activity on Endothelial Cells Derived from Chronic Venous Disease Patients
Twenty patients affected by chronic venous disease (CVD) in tertiary venous network and/or saphenous vein were analyzed before surgical ablation by echo-color-doppler for the hemodynamic parameters reflux time (RT) and resistance index (RI), a negative and a positive prognostic factor, respectively. RT and RI were next correlated with relevant in vitro parameters of venous endothelial cells (VEC) obtained from surgical specimens, such as cell migration in response to serum gradient, proliferation index, intercellular adhesion molecule (ICAM)-1 and vascular cell adhesion molecule (VCAM)-1 expression, as well as cytokines release. Of interest, ICAM-1 expression in patient-derived VEC cultures correlated positively with RT and negatively with RI. Moreover, RT showed a positive correlation with the baseline osteoprotegerin (OPG) expression by VEC and an inverse correlation with VEC proliferation index. On the other hand, RI correlated positively with TNF-related apoptosis inducing ligand (TRAIL) expression. Among the cytokines released by VEC, GM-CSF showed a positive correlation with VEC proliferation and TRAIL expression and a negative correlation with OPG, ICAM-1 and VCAM-1 expression. Since in vitro recombinant GM-CSF induced VEC proliferation and counteracted the induction of ICAM-1, VCAM-1 and OPG upon exposure to TNF-?, our data suggest an anti-inflammatory activity of GM-CSF on venous endothelial cells.
Tisato, Veronica; Secchiero, Paola; Rimondi, Erika; Gianesini, Sergio; Menegatti, Erica; Casciano, Fabio; Zamboni, Paolo; Zauli, Giorgio
NSDL National Science Digital Library
The Chronic Disease Indicators (CDI) is a cross-cutting set of 97 indicators that were developed by consensus and that allows states and territories and large metropolitan areas to uniformly define, collect, and report chronic disease data that are important to public health practice and available for states, territories and large metropolitan areas.
Control, Center F.
Chronic Obstructive Pulmonary Disease: A Chronic Systemic Inflammatory Disease
Chronic obstructive pulmonary disease (COPD) is characterized by chronic inflammation in both the airways causing airway obstruction and the lung tissues causing emphysema. The disease is induced by inhalation of noxious gasses and particulate matter resulting in a chronic persistent inflammatory response in the lung, and the extent of the inflammatory reaction correlates with the severity of the disease. This
Stephan F. van Eeden; Don D. Sin
Chronic wasting disease (CWD) is an always-fatal, neurological illness occurring in North American cervids (members of the deer family), including white-tailed deer, mule deer, elk and moose. Since its discovery in 1967, CWD has spread geographically and increased in prevalence locally. CWD is contagious; it can be transmitted freely within and among free-ranging populations. It is likely that diseased animals can transmit CWD to healthy animals long before they become clinically ill. Managing CWD in free-ranging populations is extremely difficult, therefore preventative measures designed to reduce the chance for disease spread are critically important.
Richards, Bryan
Chronic Diseases and Health Promotion
... of blindness among adults. 6 Top of page Health Risk Behaviors that Cause Chronic Diseases Health risk behaviors ... of page The Cost of Chronic Diseases and Health Risk Behaviors The majority of US health care and ...
Hyperphosphatemia of Chronic Kidney Disease
Observational studies have determined hyperphosphatemia to be a cardiovascular risk factor in chronic kidney disease. Mechanistic studies have elucidated that hyperphosphatemia is a direct stimulus to vascular calcification, which is one cause of morbid cardiovascular events contributing to the excess mortality of chronic kidney disease. This review describes the pathobiology of hyperphosphatemia that develops as a consequence of positive phosphate balance in chronic kidney disease and the mechanisms by which hyperphosphatemia acts on neointimal vascular cells that are stimulated to mineralize in chronic kidney disease. The characterization of hyperphosphatemia of chronic kidney disease as a distinct syndrome in clinical medicine with unique disordered skeletal remodeling, heterotopic mineralization and cardiovascular morbidity is presented.
Hruska, Keith A; Mathew, Suresh; Lund, Richard; Qiu, Ping; Pratt, Raymond
Chronic viral hepatitis and chronic kidney disease
Chronic kidney disease (CKD) has become a major public health problem worldwide over the past few decades because of the increasing prevalence of hypertension, diabetes mellitus, and elderly individuals in most countries. Chronic viral hepatitis (due to hepatitis B virus (HBV) and hepatitis C virus (HCV)) also poses significant morbidity and mortality globally. Both these viruses can cause CKD and
Elias C Chacko; Soondal Koomar Surrun; T. P. Mubarack Sani; Joseph M Pappachan
Chronic myeloproliferative diseases.
The chronic myeloproliferative disorders are a group of diseases in which there is an increased proliferation of one or more subtypes of myeloid cells; they include essential thrombocythemia (ET), polycythemia vera (PV), and primary myelofibrosis (PMF). In ET and PV the main neurologic manifestations are headaches, dizziness and macro- and microvascular, both venous and arterial, thrombosis and intracranial hemorrhages. Paresthesias and chorea also occur in PV. In PMF neurologic complications are very rare and consist predominantly of spinal cord compression by extramedullary hematopoiesis tissue. PMID:24365372
de Lacerda, Jo�o Forjaz; Oliveira, Sofia N; Ferro, Jos� M
Chronic Obstructive Pulmonary Disease (COPD)
... and Health Education Division using SPSS and SUDAAN software. 3. Centers for Disease Control and Prevention. Chronic ... and Health Education Division using SPSS and SUDAAN software. 5. Ibid. 6. Centers for Disease Control and ...
[Chronic liver diseases and diabetes].
The presence of chronic liver diseases may drastically limit the use of anti-diabetic drugs. Chronic liver diseases increase insulin resistance, and in some risk groups promote the development of diabetes. Therefore, antidiabetic treatment should be adapted to the severity of liver disease. However, diabetes, notably when associated with obesity and dyslipidemia, participates in the development of nonalcoholic fatty liver disease and to steato-hepatitis that may progress to cirrhosis and hepatocellular carcinoma. Other relations between diabetes and chronic liver disease will be discussed in this article. Finally, the indications and limits of each anti-diabetic therapy group will be discussed according to the degree of liver damage. PMID:25004772
Jaafar, Jaafar; de Kalbermatten, B�n�dicte; Philippe, Jacques; Scheen, Andr�; Jornayvaz, Fran�ois R
[Chronic inflammatory bowel disease].
Chronic inflammatory bowel disease (IBD) encompasses the disease entities, ulcerative colitis (UC) and Crohn's disease (CD). An aetiologic agent has not yet been defined and the diagnosis is based, therefore, on the sum of clinical, paraclinical, radiologic, endoscopic and histopathologic features. In recent years pathogenetic studies have focused on immune mechanisms, transmissible infectious agents, the potential role of the normal intestinal flora, dietary factors, enzymatic alterations and genetic features, in addition to vascular, neuromotor, allergic and psychologic factors. The corner stones in medical therapy of IBD are still corticosteroids and sulphasalazine (SAZ). The new oral salicylates, which are analogues of SAZ or "slow release" preparations of 5-aminosalicylic acid (mesalazine), have provided a therapeutic progress, because they are tolerated better than SAZ. Immunosuppressive agents, such as azathioprine and 6-mercaptopurine, reduce the requirement for corticosteroids and are effective in refractory CD, but the effect is delayed up to several months. The therapeutic action of cyclosporine A is not sustained, but often associated with side effects. Metronidazole has a beneficial effect on perineal disease. The efficacy of antimycobacterial drugs, sodium-cromoglycate, lidocaine, clonidine and sucralfate has been reported only in optimistic case stories and small open trials. A diet, rich in omega-3-fatty acids, modifies leukotriene (LT) production, but its clinical efficacy is insufficient. The first anti-leukotriene-drug, zileuton, has recently been evaluated and a significant, although insufficient, clinical response was obtained by a 70 per cent inhibition of rectal LTB4 synthesis. Dietary therapy may be useful as an adjunct to treatment of local complications in CD.(ABSTRACT TRUNCATED AT 250 WORDS) PMID:1408722
Madsen, J R; Laursen, L S; Lauritsen, K
Chronic Kidney Disease Prevention in Singapore
Singapore's Ministry of Health. The NKF Singapore program incorporates primary, secondary and tertiary approaches to the prevention of chronic kidney disease. These include the population-based screening for early chronic kidney disease and chronic diseases that are associated with kidney disease and the implementation of disease management programs that aim to improve the multi-faceted care of patients with chronic diseases that
Sylvia P. B. Ramirez
Autoantibodies in chronic liver diseases.
177 patients with chronic liver disease, among 115 with chronic hepatitis and 61 with liver cirrhosis were subjected to the autoantibodies examinations (ANA, AMA, ASMA, APCA, LKM, ATA) by means of immunofluorescent method (IFA). 25% of cases showed autoantibodies of autoimmunological disease index titre (1:80). Autoantibodies occurred more frequently in woman (75%), mainly in the age of 40-60. Patients with hepatic cirrhosis revealed autoantibodies as frequently as other patients. Among patients infected with hepatotropic viruses (HBV, HCV) with chronic liver diseases, autoantibodies were present in 23-28% of cases and in patients with chronic liver diseases of non-infectious etiology, autoantibodies were observed in 25% of cases. PMID:11780553
Panasiuk, A
... Disease About Beryllium Causes Symptoms Diagnosis Treatment Work Environment Management FAQ Make an Appointment Ask a Question Refer ... Beryllium Disease Information About Beryllium Causes Diagnosis Work Environment Management FAQ Symptoms Treatment Print Page Email Page Add ...
Treatment of chronic kidney disease
Treatment of chronic kidney disease (CKD) can slow its progression to end-stage renal disease (ESRD). However, the therapies remain limited. Blood pressure control using angiotensin-converting enzyme (ACE) inhibitors or angiotensin II receptor blockers (ARBs) has the greatest weight of evidence. Glycemic control in diabetes seems likely to retard progression. Several metabolic disturbances of CKD may prove to be useful therapeutic
Jeffrey M Turner; Carolyn Bauer; Matthew K Abramowitz; Michal L Melamed; Thomas H Hostetter
Chronic Disease and the Environment
NSDL National Science Digital Library
This site provides an overview of chronic diseases such as asthma, cancer and birth defects (with respect to infant mortality) and their environmental causes. Special topics include disease tracking, biomonitoring, Hispanic Americans and environmental health, public health infrastructure, and bioterrorism. The site also features links to current news and related resources.
Responsibility, Physicians F.; Envirohealthaction
Genetics of Chronic Kidney Disease
The current review collates what is already known of the genetics of chronic kidney disease (CKD), and focuses on new trends in genome-wide assessment of the inherited component of susceptibility to this condition. Early efforts to identify kidney disease susceptibility genetic loci using linkage and candidate gene strategies proved disappointing. More recently, genome-wide association studies have yielded highly promising results
Conall M. O�Seaghdha; Caroline S. Fox
[Chronic liver diseases in patients with chronic kidney disease].
The morphological and functional integrity of the liver is vital to human health in general as well as to patients with renal disease. Any chronic liver disease will eventually lead to liver insufficiency. Liver enzymes are routinely measured to assess liver function in patients with or without renal failure. The use of standard reference values of aminotransferases to help detect liver disease is less useful in patients on chronic dialysis therapy. Some investigators have suggested that, to increase the sensitivity of liver function tests among dialysis patients, lower "normal" values of aminotransferases should be adopted. Liver biopsy may be helpful for assessing the activity and severity of liver disease, especially in chronic viral liver diseases. The most widely used scores are Ishak (6-point scale) and METAVIR (4-point scale). The most important chronic liver diseases associated with chronic renal disease are hepatitis B and C. Several types of renal disease have been recognized: mixed cryoglobulinemia, membranoproliferative glomerulonephritis, membranous nephropathy and polyarteritis nodosa. In any patient first ever diagnosed with any of the mentioned features, serologic and molecular tests for hepatitis B and/or C should be done. There is limited information on the treatment of HBV-associated renal diseases. Nonrandomized studies suggest that antiviral therapy may be beneficial in patients with glomerular disease or vasculitis due to HBV. According to Croatian National Guidelines for Hepatitis B and C, treatment with antiviral drug is recommended for patients with chronic renal disease, especially those on the waiting list for kidney transplantation. Decision on the type and duration of treatment is based on the level of viremia and biochemical and histological activity of liver disease. Several antiviral drugs are currently used for hepatitis B: pegylated interferon alpha-2a and nucleot(z)id analogues. The choice of analogues is based on their genetic barrier and resistance. The probability to develop resistance is much higher in prolonged treatment, more than 1 year. To avoid it, regular check-ups are mandatory. First check-up is recommended after 12 weeks of treatment to detect the possible primary resistance to treatment. Similar approach is used in patients with hepatitis C. Today's standard of care is treatment with a combination of pegylated interferon alpha and ribavirin. Serum concentration of both drugs rises in patients with impaired renal function. The dosage should be corrected according to the glomerular filtration rate. Treatment with pegylated interferon alpha is not recommended in patients with glomerular filtration rate less than 15 mL/min and ribavirin less than 50 mL/min. Recent evidence suggest that nonalcoholic fatty liver disease is associated with an increased prevalence and incidence of chronic renal disease. Current treatment recommendations for nonalcoholic fatty liver disease are limited to weight reduction and treatment of any component of the metabolic syndrome. Liver cirrhosis is the terminal stage of any chronic liver disease. Mortality differs according to the stage of cirrhosis evaluated with Child-Turcotte-Pugh score. The worst prognosis have patients with grade C cirrhosis, which should be borne in mind when evaluating patients with terminal renal disease for treatment with kidney transplantation. PMID:22359907
Hrsti?, Irena; Ostoji?, Rajko
Klotho and Chronic Kidney Disease
Through alternative splicing, Klotho protein exists both as a secreted and a membrane form whose extracellular domain could be shed from the cell surface by secretases and released into the circulation to act as endocrine factor. Unlike membrane Klotho which functions as a coreceptor for fibroblast growth factor-23 (FGF23) to modulate FGF23 signal transduction, soluble Klotho is a multi-function protein present in the biological fluids including blood, urine, cerebrospinal fluid and plays important roles in anti-aging, energy metabolism, inhibition of Wnt signaling, anti-oxidation, modulation of ion transport, control of parathyroid hormone and 1,25(OH)2VD3 production, and antagonism of renin-angiotensin-aldosterone system. Emerging evidence from clinical and basic studies reveal that chronic kidney disease is a state of endocrine and renal Klotho deficiency, which may serve as an early biomarker and a pathogenic contributor to chronic progression and complications in chronic kidney disease including vascular calcification, cardiac hypertrophy, and secondary hyperparathyroidism. Supplementation of exogenous Klotho and/or up-regulation of endogenous Klotho production by using rennin angiotensin system inhibitors, HMG CoA reductase inhibitors, vitamin D analogues, peroxisome proliferator-activated receptors-gamma agonists, or anti-oxidants may confer renoprotection from oxidation and suppression of renal fibrosis, and also on prevention or alleviation of complications in chronic kidney disease. Therefore, Klotho is a highly promising candidate on the horizon as an early biomarker, and as a novel therapeutic agent for chronic kidney disease.
Hu, Ming Chang; Kuro-o, Makoto; Moe, Orson W.
Puberty in Chronically Diseased Patients
Delayed onset of puberty and a reduced pubertal growth spurt are often reported in patients suffering from chronic diseases. The basis of abnormal puberty in these patients is multifactorial. Nutritional deficiency may contribute to growth disorders and delayed puberty. Insufficient food supply and\\/or eating disorders and\\/or malabsorption of nutrients can be observed in these patients. Moreover, increased energy supplies are
Dominique Simon
Nutrition and chronic kidney disease
The incidence of malnutrition disorders in chronic kidney disease (CKD) appears unchanged over time, whereas patient-care and dialysis techniques continue to progress. Despite some evidence for cost-effective treatments, there are numerous caveats to applying these research findings on a daily care basis. There is a sustained generation of data confirming metabolic improvement when patients control their protein intake, even at
Denis Fouque; Solenne Pelletier; Denise Mafra; Philippe Chauveau
Comorbidity of chronic diseases in general practice
With the increasing number of elderly people in The Netherlands the prevalence of chronic diseases will rise in the next decades. It is recognized in general practice that many older patients suffer from more than one chronic disease (comorbidity). The aim of this study is to describe the extent of comorbidity for the following diseases: hypertension, chronic ischemic heart disease,
F. G. Schellevis; J. van der Velden; E. van de Lisdonk; J. T. M. van Eijk; C. van Weel
Glomerulonephritis, often accompanied by the nephrotic syndrome, developed in CAF1 mice following the administration of spleen cells from normal BALB/c mice. The renal lesion was membranous glomerulonephritis. When studied with fluorescein-conjugated antisera to either mouse gamma globulin or ?1C-globulin, the glomeruli contained beaded and irregular deposits of these immunoproteins. The ultrastructure of the lesion was characterized by thickening of the glomerular basement membranes and the presence of electron-dense subepithelial deposits. Acid eluates of the diseased kidneys contained gamma globulin that failed to bind to sections of normal kidneys. These findings conform to the type of nephritis provoked by immune complexes. They indicate that this type of immune injury can be based on the reaction of intolerant immunocytes to normal antigens.
Lewis, Robert M.; Armstrong, Martine Y. K.; Andre-Schwartz, Janine; Muftuoglu, Asuman; Beldotti, Lorraine; Schwartz, Robert S.
Management of chronic liver disease.
Childhood liver disorders have, in general, mode of presentations which are distinct from that in adult population. It is due to varying etiology and natural history of the liver diseases in childhood. Chronic hepatitis B and C can be managed with alpha interferon. Remission rates in children have been reported to be between 20-58%. Recently available lamuvidine has also been used in combination with interferon therapy. Oral chelation therapy and liver transplantation have radically affected the outcome of patients with Wilson's disease. Corticosteroids and immunosuppressive therapy are effective in reducing both morbidity and mortality due to auto-immune hepatitis. Offending carbohydrates are eliminated from the diet of patients with galactosemia and hereditary fructose intolerance. The most important and often neglected component of management of chronic liver diseases in childhood are nutritional management and prompt interventions for ascites, spontaneous bacterial peritonitis, portal hypertension and hepatic encephalopathy. With definitive etiological and histological assessment and institution of specific as well as supportive therapy, children with chronic liver disease can have a prolonged survival with improved quality of life. Several of them can potentially receive the liver transplant as and when it becomes available. PMID:11132457
Thapa, B R
Osteodystrophy in chronic liver diseases.
Osteoporosis and osteomalacia are, to date, among the most common metabolic diseases in the world. Lately, an association between metabolic bone diseases and chronic liver disease has been increasingly reported, inducing many authors to create a new nosographic entity known as 'hepatic osteodystrophy.' The importance of such a condition is further increased by the morbidity of these two diseases, which greatly reduce the quality of life because of frequent fractures, especially vertebral and femoral neck ones. For this reason, early identification of high-risk patients should be routinely performed by measuring bone mass density. The explanation for the association between bone diseases and chronic liver disease is still uncertain, and involves many factors: from hypogonadism to use of corticosteroid drugs, from genetic factors to interferon therapy. To date, few studies have been conducted, and all with a small number of patients to establish definitive conclusions about the possible treatment, but some evidence is beginning to emerge about the safety and efficacy of bisphosphonates. PMID:22241574
Mansueto, Pasquale; Carroccio, Antonio; Seidita, Aurelio; Di Fede, Gaetana; Crax�, Antonio
Ureaplasma urealyticum and chronic lung disease
Neonatal lower respiratory tract colonisation with mycoplasma organisms was examined for an association with chronic lung disease.Ureaplasma urealyticum colonised 9\\/70 (13%) infants less than 1500 g. Seven (78%) colonised and 33 (54%) non-colonised infants developed chronic lung disease. Logistic regression analyses revealed early gestation, but not mycoplasma colonisation, was independently associated with chronic lung disease.
A. R. Smyth; N. J. Shaw; B. C. Pratt; A. M. Weindling
Chronic inflammatory rheumatic diseases in black Zimbabweans
The pattern of chronic inflammatory rheumatic diseases seen in 52 black Zimbabweans was determined. These diseases constituted 2% of all treatable chronic endemic medical diseases registered around Gweru City. Rheumatoid arthritis (RA) and gout were the commonest, 38.8% and 28.8% of the total respectively. Systemic lupus erythematosus (SLE), polymyositis, progressive systemic sclerosis, mixed connective tissue disease, ankylosing spondylitis, and Reiter's
S K Lutalo
Is acute recurrent pancreatitis a chronic disease?
Whether acute recurrent pancreatitis is a chronic disease is still debated and a consensus is not still reached as demonstrated by differences in the classification of acute recurrent pancreatitis. There is major evidence for considering alcoholic pancreatitis as a chronic disease ab initio while chronic pancreatitis lesions detectable in biliary acute recurrent pancreatitis (ARP) seem a casual association. Cystic fibrosis
Alberto Mariani; Pier Alberto Testoni
Iron and anemia of chronic disease
Iron and anemia of chronic disease. Anemia of chronic disease (ACD) is the most frequent anemia found in hospitalized patients, often occurring in subjects suffering from chronic inflammatory disorders. The underlying diversion of iron traffic leads to a withdrawal of the metal from the sites of erythropoiesis and the circulation to the storage compartment in the reticuloendothelial system, thus resulting,
Kidneys in chronic liver diseases
Acute kidney injury (AKI), defined as an abrupt increase in the serum creatinine level by at least 0.3 mg/dL, occurs in about 20% of patients hospitalized for decompensating liver cirrhosis. Patients with cirrhosis are susceptible to developing AKI because of the progressive vasodilatory state, reduced effective blood volume and stimulation of vasoconstrictor hormones. The most common causes of AKI in cirrhosis are pre-renal azotemia, hepatorenal syndrome and acute tubular necrosis. Differential diagnosis is based on analysis of circumstances of AKI development, natriuresis, urine osmolality, response to withdrawal of diuretics and volume repletion, and rarely on renal biopsy. Chronic glomerulonephritis and obstructive uropathy are rare causes of azotemia in cirrhotic patients. AKI is one of the last events in the natural history of chronic liver disease, therefore, such patients should have an expedited referral for liver transplantation. Hepatorenal syndrome (HRS) is initiated by progressive portal hypertension, and may be prematurely triggered by bacterial infections, nonbacterial systemic inflammatory reactions, excessive diuresis, gastrointestinal hemorrhage, diarrhea or nephrotoxic agents. Each type of renal disease has a specific treatment approach ranging from repletion of the vascular system to renal replacement therapy. The treatment of choice in type 1 hepatorenal syndrome is a combination of vasoconstrictor with albumin infusion, which is effective in about 50% of patients. The second-line treatment of HRS involves a transjugular intrahepatic portosystemic shunt, renal vasoprotection or systems of artificial liver support.
Hartleb, Marek; Gutkowski, Krzysztof
Health literacy and knowledge of chronic disease
We sought to examine the relationship between health literacy and knowledge of disease among patients with a chronic disease. A total of 653 new Medicare enrollees aged 65 years or older who had at least one chronic disease (115 asthma, 266 diabetes, 166 congestive heart failure, 214 hypertension), completed both the in-person and telephone survey. Health literacy measured by the
Julie A Gazmararian; Mark V Williams; Jennifer Peel; David W Baker
Is chronic traumatic encephalopathy a real disease?
Chronic traumatic encephalopathy (CTE) has received widespread media attention and is treated in the lay press as an established disease, characterized by suicidality and progressive dementia. The extant literature on CTE is reviewed here. There currently are no controlled epidemiological data to suggest that retired athletes are at increased risk for dementia or that they exhibit any type of unique neuropathology. There remain no established clinical or pathological criteria for diagnosing CTE. Despite claims that CTE occurs frequently in retired National Football League (NFL) players, recent studies of NFL retirees report that they have an all-cause mortality rate that is approximately half of the expected rate, and even lower suicide rates. In addition, recent clinical studies of samples of cognitively impaired NFL retirees have failed to identify any unique clinical syndrome. Until further controlled studies are completed, it appears to be premature to consider CTE a verifiable disease. PMID:24412888
Randolph, Christopher
[Infection and chronic kidney disease].
Many pathogens are thought to be involved in the development and progression of chronic kidney disease (CKD). The mechanism of kidney damage due to infection includes direct invasion of pathogens and deposition of antigen-antibody complex by immunological reaction. As to renal dysfunction induced by bacterial infection, some cases of poststreptococcal glomerulonephritis present progressive decline of glomerular filtration rate (GFR). Methicillin resistant Staphylococcus aureus (MRSA)-related glomerulonephritis and infectious endocarditis are known to cause acute renal failure, which clinicians often find difficulty in the treatment. Chronic pyelonephritis by repetitive vesicoureteral reflux or nephrolithiasis also cannot be disregarded. Hepatitis B virus (HBV) and hepatitis C virus (HCV) infections are the most recognized etiology of virus associated nephropathy, and the representative histological changes are membranous nephropathy and membranoproliferative glomerulonephritis, respectively. Furthermore, morbidity of human immunodeficiency virus (HIV) associated nephropathy is increasing, reflecting the prolonged survival of HIV-infected patients. Thorough preventive/therapeutic strategies should be taken against these infections for improving clinical outcome. PMID:18788411
Akagi, Shigeru; Sugiyama, Hitoshi; Makino, Hirofumi
Chronic Venous Disease (Beyond the Basics)
... disease Pathophysiology of chronic venous disease Patient information: Deep vein thrombosis (blood clots in the legs) (The ... from the surface of the legs to the deep veins and back to the heart; the valves ...
Managing Anemia of Chronic Kidney Disease
Anemia begins early in the course of declining kidney function and is a frequent complication of chronic kidney disease. Both anemia and chronic kidney disease are underdiagnosed and undertreated. Anemia is associated with significantly increased risk of morbidity and mortality, including increased risks of left ventricular hypertrophy and heart failure. Although the detrimental effects of anemia are more common in
Susan A. Krikorian
The Chronic Gastrointestinal Manifestations of Chagas Disease
Chagas disease is an infectious disease caused by the protozoan Trypanosoma cruzi. The disease mainly affects the nervous system, digestive system and heart. The objective of this review is to revise the literature and summarize the main chronic gastrointestinal manifestations of Chagas disease. The chronic gastrointestinal manifestations of Chagas disease are mainly a result of enteric nervous system impairment caused by T. cruzi infection. The anatomical locations most commonly described to be affected by Chagas disease are salivary glands, esophagus, lower esophageal sphincter, stomach, small intestine, colon, gallbladder and biliary tree. Chagas disease has also been studied in association with Helicobacter pylori infection, interstitial cells of Cajal and the incidence of gastrointestinal cancer.
Matsuda, Nilce Mitiko; Miller, Steven M.; Evora, Paulo R. Barbosa
Autoantibodies in chronic liver disease.
Some hepatotropic viruses (HBV and HCV) are capable of triggering autoimmune phenomena and manifest the features of autoimmune hepatitis (AIH) in the course of the disease. Careful attention is required to differentiate between AIH and chronic viral hepatitis (CVH) before the selection of treatment. This study was performed to assess the prevalence of rheumatoid factor (RF), antinuclear antibodies (ANA), anti-smooth muscle antibodies (ASMA), anti-mitochondrial antibodies (AMA), anti-parietal cell antibodies (APCA), anti-liver/kidney microsomal antibodies type I (ALKMA1) and anti-neutrophil cytoplasmic antibodies (ANCA) among patients with chronic liver diseases (CLD), and to assess the diagnostic value of these autoantibodies and their relation to HCV viral load and genotype and treatment with interferon-alpha (IFN-alpha). Five groups of patients with CLD (HCV, HBV, HCC, AIH and schistosomal hepatic fibrosis {SHF}) as well as a group of age- and gender-matched healthy controls were enrolled in the study. All the studied persons were subjected to full clinical assessment and laboratory investigations, including liver function tests, hepatitis markers, and HCV RNA by PCR. Detection of ANA, ASMA, APCA, AMA and ALKMA-1 was done by indirect immunofluorescence technique, while ANCA and RF were detected by EIA and latex agglutination test respectively. Results showed a significantly higher prevalence of RF, ASMA and ANCA among patients with CHC, RF and ASMA among HCC patients and ASMA and ALKMA1, among AIH patients as compared to the control group. Patients with HBV and those with SHF had a non-significantly higher prevalence of RF, ASMA and ANCA compared to controls. However, AMA was not detected in this study, and APCA showed no significant difference between the studied groups. The occurrence of these autoantibodies was not significantly related to HCV viral load, HCV genotype or treatment with IFN-alpha. There was a significant association between the occurrence of RF, ANA, ASMA, and ALKMA1 and high ALT levels, and between the occurrence of ANA, ASMA and ALKMA-1 and high AST and ALP levels. In conclusion, autoantibodies are commonly found among patients with HCV infection. The co-existence of HCV infection and autoimmune hepatitis should be considered in patients who are positive for both viral markers and autoantibodies and thorough evaluation of patients must be performed before selection of treatment. Testing for RF, ASMA and ANCA may have a good diagnostic value, however, AMA is the least useful in diagnosis. PMID:17977215
Ghonaim, Mabrouk; Al-Ghamdi, Abdullah; El-Bana, Hassan; Bakr, Ahmed; Ghoneim, Enas; El-Edel, Rawhia; Hassona, Mona; Shoeib, Sabry; Allam, Heba
Nutrition and chronic kidney disease.
The incidence of malnutrition disorders in chronic kidney disease (CKD) appears unchanged over time, whereas patient-care and dialysis techniques continue to progress. Despite some evidence for cost-effective treatments, there are numerous caveats to applying these research findings on a daily care basis. There is a sustained generation of data confirming metabolic improvement when patients control their protein intake, even at early stages of CKD. A recent protein-energy wasting nomenclature allows a simpler approach to the diagnosis and causes of malnutrition. During maintenance dialysis, optimal protein and energy intakes have been recently challenged, and there is no longer an indication to control hyperphosphatemia through diet restriction. Recent measurements of energy expenditure in dialysis patients confirm very low physical activity, which affects energy requirements. Finally, inflammation, a common state during CKD, acts on both nutrient intake and catabolism, but is not a contraindication to a nutritional intervention, as patients do respond and improve their survival as well as do noninflamed patients. PMID:21562470
Fouque, Denis; Pelletier, Solenne; Mafra, Denise; Chauveau, Philippe
Chronic Kidney Disease in Primary Care
ney disease is established (by the presence of persistent kidney damage or a GFR <60 mL\\/min\\/1.73m 2 for at least 3 months), the etiology of chronic kidney disease needs to be elucidated. Often the etiology can be determined by history alone; however, reversible causes of chronic kidney disease should be considered in all patients. Regardless of the underlying etiology of
Duaine D. Murphree; Sarah M. Thelen
HIV/AIDS, chronic diseases and globalisation
HIV/AIDS has always been one of the most thoroughly global of diseases. In the era of widely available anti-retroviral therapy (ART), it is also commonly recognised as a chronic disease that can be successfully managed on a long-term basis. This article examines the chronic character of the HIV/AIDS pandemic and highlights some of the changes we might expect to see at the global level as HIV is increasingly normalised as "just another chronic disease". The article also addresses the use of this language of chronicity to interpret the HIV/AIDS pandemic and calls into question some of the consequences of an uncritical acceptance of concepts of chronicity.
Non-Hormonal Medications and Chronic Diseases
\\u000a This chapter explores the relation between breast cancer risk and the use of non-hormonal medications and chronic diseases.\\u000a Many drugs and diseases have been linked with breast cancer in case reports and epidemiologic studies. This chapter covers\\u000a those major medications and diseases where there is adequate epidemiologic evidence for evaluation.
Patricia F. Coogan
Pathogenesis of Chronic Obstructive Pulmonary Disease
The current paradigm for the pathogenesis of chronic obstructive pulmonary disease is that chronic airflow limitation results from an abnormal inflammatory response to inhaled particles and gases in the lung. Airspace inflammation appears to be different in suscepti- ble smokers and involves a predominance of CD8 T lymphocytes, neutrophils, and macrophages. Studies have characterized inflam- mation in the peripheral airspaces
William MacNee
[Comorbidity of chronic heart failure and chronic obstructive pulmonary disease].
Cardiovascular diseases most frequently coexist with the chronic obstructive pulmonary disease (COPD). The studies report on over 10 million patients of population suffering both chronic heart failure (CHF) and COPD. Similarity of the clinical symptoms and risk factors found in the medical history of patients with chronic heart failure and chronic obstructive pulmonary disease often causes diagnostic mistakes. At present, medicine has the wide range of diagnostic methods. Among them: well taken medical history, chest radiogram, determination of the serum concentration of natriuretic peptides, spirometry with bronchial reversibility test and many others should be mentioned. The skillfull interpretation of their results guarantee the possibility of more effective treatment. Pulmonary hypertension constitutes the link between the chronic obstructive pulmonary disease and CHF. Although its clinical manifestations are not specific and can be partially masked by the symptoms of COPD, the possibility of its existance should be taken under consideration in every patient with worsening effort toleration or intensification of dysponoea and stable spirometric values with the lack of other causes. It should be emphasized that, apart from the diagnostic leading to diagnosis of those two conditions in one patient, there are also the possible interactions of their concurrent treatment. PMID:24575642
Grzywa-Celi?ska, Anna; Szmygin-Milanowska, Katarzyna; Dyczko, Monika; Kwa?niewska, Katarzyna; Celi?ski, Rafa?; Mosiewicz, Jerzy
Financing of Chronic Kidney Disease Treatment Expense.
National Technical Information Service (NTIS)
The study's primary conclusion are relevant to financing of all catastrophically expensive health care; the study also includes details specific to financing treatment of chronic kidney disease. The study is based on a survey of (1) direct sources of fund...
Genetics Home Reference: Chronic granulomatous disease
... with this condition often have areas of inflammation (granulomas) in various tissues that can be damaging to ... in people with chronic granulomatous disease. Most commonly, granulomas occur in the gastrointestinal tract and the genitourinary ...
Population Studies on Chronic Obstructive Respiratory Disease.
National Technical Information Service (NTIS)
The prevalence of chronic obstructive respiratory disease (CORD) and respiratory impairment according to electronic spirometry, single breath nitrogen test (SBNT), plethysmography and questionnaire was determined in three demographically similar communiti...
R. Detels A. Coulson D. Tashkin S. Rokaw F. Massey
Dyslipidemia in children with chronic kidney disease
Dyslipidemia, a known risk factor for atherosclerosis, is frequent among both adults and children with chronic kidney disease. Here, we describe the prevalence and pattern of dyslipidemia from a cross-sectional analysis of 391 children aged 1�16 years, enrolled in the multicenter Chronic Kidney Disease in Children (CKiD) study, with a median glomerular filtration rate (GFR), measured by the plasma disappearance
Jeffrey M Saland; Christopher B Pierce; Mark M Mitsnefes; Joseph T Flynn; Jens Goebel; Juan C Kupferman; Bradley A Warady; Susan L Furth
Severe periodontitis associated with chronic kidney disease
The data on Indian population with regard to severity/prevalence of chronic periodontitis in association with chronic kidney disease (CKD) is scarce. We are describing an interesting case of severe periodontitis associated with CKD. The patient had unusual inflammatory gingival overgrowth which persisted even after treatment. By describing this case we want to highlight our current lack of understanding with regard to etiopathogenesis of periodontal disease in CKD patients and need for further research in this area.
Jain, Anurag; Kabi, Debipada
Idiopathic Chronic Urticaria and Celiac Disease
Idiopathic chronic urticaria (ICU) is a chronic relapsing cutaneous disease. Some case reports or studies on small series\\u000a of celiac disease (CD) patients have suggested a possible association between CD and ICU. The aim of this study was to assess\\u000a the prevalence of CD in a population of adults ICU patients with respect to healthy controls. We consecutively enrolled 80
Maurizio Gabrielli; Marcello Candelli; Filippo Cremonini; Veronica Ojetti; Luca Santarelli; Enrico C. Nista; Eleonora Nucera; Domenico Schiavino; Giampiero Patriarca; Giovanni Gasbarrini; Paolo Pola; Antonio Gasbarrini
Lung Compliance and Chronic Obstructive Pulmonary Disease
Chronic obstructive pulmonary disease, namely, pulmonary emphysema and chronic bronchitis, is a chronic inflammatory response of the airways to noxious particles or gases, with resulting pathological and pathophysiological changes in the lung. The main pathophysiological aspects of the disease are airflow obstruction and hyperinflation. The mechanical properties of the respiratory system and its component parts are studied by determining the corresponding volume-pressure (P-V) relationships. The consequences of the inflammatory response on the lung structure and function are depicted on the volume-pressure relationships.
Papandrinopoulou, D.; Tzouda, V.; Tsoukalas, G.
Adult Chronic Kidney Disease: Neurocognition in Chronic Renal Failure
In recent years there has been a keen interest in the neurocognitive sequelae of renal failure and subsequent end-stage renal\\u000a disease given its increasing prevalence and incidence. This review article summarizes the relevant information on cognitive\\u000a functioning in chronic kidney disease in adults before the initiation of dialysis, after the initiation of dialysis, and after\\u000a renal transplantation. In general, compared
Nikhil S. Koushik; Steven F. McArthur; Anne D. Baird
[Antioxidant therapy in chronic liver diseases].
In chronic liver diseases with inflammatory reactions (chronic viral hepatitis, alcoholic liver disease, non-alcoholic steatohepatitis, autoimmune hepatitis, chemicals and drug induced hepatitis, Wilson disease, haemochromatosis) the oxidative stress, the cell alteration induced by free radicals is an important part of the pathogeneis beside the aetiological factors. In this paper the development of free radicals and their physiological role are demonstrated. The factors, which are influenced by the free radicals and antioxidants, as well as the pathological effects caused by oxidative stress in biological systems are discussed in details. The authors demonstrate the free radical processes as key factors in alcoholic liver diseases and non-acoholic steatohepatitis, furthermore the possible treatment modalities in the inhibition of these alterations. Also the free radical processes in chronic viral hepatitis and autoimmune hepatitis are discussed as well. The oxidative stress is able to enhance the progression of chronic inflammatory liver disease independently from the aetiological factor or with it together. That is why the antioxidant drugs could be applied also in the treatment of chronic liver diseases beside the therapy based on the aetiological factors. PMID:16865855
Lengyel, Gabriella; Tulassay, Zsolt
Glycemic index in chronic disease: a review
Aim: The intent of this review is to critically analyze the scientific evidence on the role of the glycemic index in chronic Western disease and to discuss the utility of the glycemic index in the prevention and management of these disease states.Background: The glycemic index ranks foods based on their postprandial blood glucose response. Hyperinsulinemia and insulin resistance, as well
LS Augustin; S Franceschi; DJA Jenkins; CWC Kendall; C La Vecchia
Chronic Wasting Disease Agents in Nonhuman Primates
Chronic wasting disease is a prion disease of cervids. Assessment of its zoonotic potential is critical. To evaluate primate susceptibility, we tested monkeys from 2 genera. We found that 100% of intracerebrally inoculated and 92% of orally inoculated squirrel monkeys were susceptible, but cynomolgus macaques were not, suggesting possible low risk for humans.
Meade-White, Kimberly D.; Phillips, Katie; Striebel, James; Race, Richard; Chesebro, Bruce
Respiratory failure in chronic obstructive pulmonary disease
Respiratory failure is still an important complication of chronic obstructive pulmonary disease (COPD) and hospitalisation with an acute episode being a poor prognostic marker. However, other comorbid conditions, especially cardiovascular disease, are equally powerful predictors of mortality. The physiological basis of acute respiratory failure in COPD is now clear. Significant ventilation\\/perfusion mismatching with a relative increase in the physiolo- gical
P. M. A. Calverley
Multimorbidity and chronic disease: an emergent perspective.
The concept of emergence offers a new way of thinking about multimorbidity and chronic disease. Multimorbidity and chronic disease are the end result of ongoing perturbations and interconnected activities of simpler substructures that collectively constitute the complex adaptive superstructure known as us, the person or patient. Medical interventions cause perturbations of many different sub-systems within the patient, hence they are not limited to the person's bodily function, but also affect his general health perception and his interactions with his external environments. Changes in these domains inevitably have consequences on body function, and close the feedback loop of illness/disease, recovery and regained health. PMID:24702685
Sturmberg, Joachim P
Genetic polymorphisms in chronic obstructive pulmonary disease.
Etiology of chronic obstructive pulmonary disease remains unknown but, despite some inconsistencies in reports on inflammatory cells, mediators and proteases involved in the pathogenesis of chronic obstructive pulmonary disease, genetic risk factors were proposed as a cause of susceptibility to the disease. Results of many studies suggested polygenic inheritance, with the genetic component consisting of several genes of a small effect each, rather than of single major gene. We are going to review the clinical importance of alpha-1 antitrypsin, glutathione S-transferase, microsomal epoxide hydrolase, matrix metalloproteinase, tumor necrosis factor-a, alpha-1 antichymotrypsin, alpha 2-macroglobulin, cytochrome P4501A1, heme oxygenase-1 genes polymorphisms associated with susceptibility and progression of the chronic obstructive pulmonary disease. PMID:15687746
Ugenskiene, Rasa; Sanak, Marek; Sakalauskas, Raimundas; Szczeklik, Andrew
Chronic urticaria as a systemic disease.
Urticaria is one of the most common diseases seen in everyday dermatologic practice, characterized by the development of wheals, angioedema, or both. While acute urticaria is mostly related to allergic or pseudoallergic reaction to food, drugs, or infections, chronic urticaria is a more complex disease with different additional ethiopathologic mechanisms and evoking factors. While urticaria is an undisputed disease of the skin, growing evidence supports, like in other dermatologic diseases, the concept of urticaria as a systemic disease with clinical symptoms and signs predominantly presenting on the skin. In this review, we describe the evidence and association between chronic urticaria and a variety of disorders, such as autoimmune diseases, atopy, infections, metabolic conditions, and neoplastic disorders. Beyond the mechanistic association, the possible common underlying pathomechanisms, such as systemic immunologic processes, are discussed. PMID:24767190
Darlenski, Razvigor; Kazandjieva, Jana; Zuberbier, Torsten; Tsankov, Nikolai
Systemic effects of chronic obstructive pulmonary disease
ABSTRACT: Chronic obstructive pulmonary,disease (COPD) is characterised by an inappropriate\\/excessive inflammatory response of the lungs to respiratory pollutants, mainly tobacco smoking. Recently, besides the typical pulmonary pathology of COPD (i.e. chronic bronchitis and emphysema), several effects occurring outside the lungs have been described, the so- called systemic effects of COPD. These effects are clinically relevant because they modify,and can help
A. G. N. Agusti; A. Noguera; J. Sauleda; E. Sala; J. Pons; X. Busquets
Framing international trade and chronic disease
There is an emerging evidence base that global trade is linked with the rise of chronic disease in many low and middle-income countries (LMICs). This linkage is associated, in part, with the global diffusion of unhealthy lifestyles and health damaging products posing a particular challenge to countries still facing high burdens of communicable disease. We developed a generic framework which depicts the determinants and pathways connecting global trade with chronic disease. We then applied this framework to three key risk factors for chronic disease: unhealthy diets, alcohol, and tobacco. This led to specific 'product pathways', which can be further refined and used by health policy-makers to engage with their country's trade policy-makers around health impacts of ongoing trade treaty negotiations, and by researchers to continue refining an evidence base on how global trade is affecting patterns of chronic disease. The prevention and treatment of chronic diseases is now rising on global policy agendas, highlighted by the UN Summit on Noncommunicable Diseases (September 2011). Briefs and declarations leading up to this Summit reference the role of globalization and trade in the spread of risk factors for these diseases, but emphasis is placed on interventions to change health behaviours and on voluntary corporate responsibility. The findings summarized in this article imply the need for a more concerted approach to regulate trade-related risk factors and thus more engagement between health and trade policy sectors within and between nations. An explicit recognition of the role of trade policies in the spread of noncommunicable disease risk factors should be a minimum outcome of the September 2011 Summit, with a commitment to ensure that future trade treaties do not increase such risks.
Experimental modelling of chronic obstructive pulmonary disease.
A method for experimental reproduction of stages of chronic obstructive pulmonary disease formation (from acute inflammation to bronchopulmonary tissue restructuring characteristic of this disease) is presented. Lung injury and inflammation were induced by nitrogen dioxide. Hyperplasia and hypersecretion of goblet cells, squamous cell metaplasia of the ciliary epithelium, emphysema, and focal fibrosis served as the morphological substrate for the formation of bronchial obstruction. The adequacy of the model is confirmed by signs characteristic of chronic obstructive pulmonary disease: hyperexpression of CD3 lymphocytes in the bronchial wall and parenchyma, manifold increased production of TNF? and TGF?, high concentrations of circulating pathogenic immune complexes. Persistence of the structural and functional shifts throughout 6 months after exposure to nitrogen dioxide indicated a chronic course of the resultant pathological process. PMID:22803159
Lebedeva, E S; Kuzubova, N A; Danilov, L N; Titova, O N; Dvorakovskaya, I V; Kozlova, M Ya; Preobrazhenskaya, T N; Platonova, I S
Nationwide Framework for Surveillance of Cardiovascular and Chronic Lung Diseases.
National Technical Information Service (NTIS)
Chronic diseases are common and costly, yet they are also among the most preventable health problems (CDC, 2008). Comprehensive and accurate disease surveillance systems are needed to implement successful efforts to reduce the burden of chronic diseases o...
[Genetic features during chronic obstructive pulmonary disease].
Chronic obstructive pulmonary disease is one of the leading causes of mortality, which is caused by the interaction of genetic susceptibility with environmental factors (especially smoking); however, genetic features of chronic obstructive pulmonary disease still remain unknown. The only proven genetic risk factor is severe deficiency of plasma protease inhibitor, alpha-1 antitrypsin. A large number of candidate genes for chronic obstructive pulmonary disease have already been identified in many experimental and clinical studies; however, polygenic etiology of chronic obstructive pulmonary disease is the main reason for conflicting molecular and genetic findings. This review describes the correlation between single nucleotide polymorphism of alpha-1 antitrypsin, alpha-1 antichymotrypsin, microsomal epoxide hydrolase-1, matrix metalloproteinases-1,-9,-12, glutathione S-transferases, heme oxygenase-1, tumor necrosis factor-alpha, transforming growth factor-beta, interleukins-1,-4,-13, beta2-adrenergic receptor, G-globulin genes and chronic obstructive pulmonary disease. Regions on chromosomes 1, 2, 12, and 17 are indicated as candidate chromosomal regions influencing the decrease in spirometric parameters. Genome-wide scan shows direct evidence for linkage of decreased FEV1/FVC ratio to one or more genes on chromosome 2q influencing the development of airflow obstruction. Genetic markers on chromosome 12p suggest evidence for linkage of FEV1 to this region, and observations on chromosome 1p show the relationship between FVC and genes of this region. All these findings also need to be proven, and linkage analysis among combinations of gene candidates for chronic obstructive pulmonary disease has to be done. PMID:16861834
Babusyte, Agne; Sitkauskiene, Brigita; Sakalauskas, Raimundas
Sexuality and Chronic Kidney Disease
... with kidney disease or kidney failure still enjoy sex? It's important to remember that people with kidney ... healthcare professional. What if I lose interest in sex? Your interest in sex may change when you ...
[Pain management in chronic pancreatitis and chronic inflammatory bowel diseases].
Apart from local inflammation and defects in secretion, central mechanisms are important for pain etiology in chronic pancreatitis. Therefore, centrally acting co-analgetic agents can be used in addition to classical pain medications. Endoscopic interventions are preferred in patients with obvious dilation of the pancreatic duct. Surgical interventions are generally more effective although they are usually reserved for patients with prior failure of conservative treatment. Diverse surgical options with different efficacies and morbidities are used in individual patients.One of the main problems in chronic inflammatory bowel diseases is abdominal pain. Primarily the underlying disease needs to be adequately treated. Symptomatic pain management will most likely include treatment with acetaminophen and tramadol as well as occasionally principles of a multimodal pain regimen. For the treatment of arthralgia as well as enteropathy-associated arthritis the same treatment options are available as for other spondyloarthritic disorders. PMID:24903043
Prei�, J C; Hoffmann, J C
Animal models of chronic obstructive pulmonary disease.
Introduction: Chronic obstructive pulmonary disease (COPD) is a leading global cause of mortality and chronic morbidity. Inhalation of cigarette smoke is the principal risk factor for development of this disease. COPD is a progressive disease that is typically characterised by chronic pulmonary inflammation, mucus hypersecretion, airway remodelling and emphysema that collectively reduce lung function. There are currently no therapies that effectively halt or reverse disease progression. It is hoped that the development of animal models that develop the hallmark features of COPD, in a short time frame, will aid in the identifying and testing of new therapeutic approaches. Areas covered: The authors review the recent developments in mouse models of chronic cigarette smoke-induced COPD as well as the principal findings. Furthermore, the authors discuss the use of mouse models to understand the pathogenesis and the contribution of infectious exacerbations. They also discuss the investigations of the systemic co-morbidities of COPD (pulmonary hypertension, cachexia and osteoporosis). Expert opinion: Recent advances in the field mark a point where animal models recapitulate the pathologies of COPD patients in a short time frame. They also reveal novel insights into the pathogenesis and potential treatment of this debilitating disease. PMID:24754714
Fricker, Michael; Deane, Andrew; Hansbro, Philip M
Transgenic Mouse Model of Chronic Beryllium Disease
Animal models provide powerful tools for dissecting dose-response relationships and pathogenic mechanisms and for testing new treatment paradigms. Mechanistic research on beryllium exposure-disease relationships is severely limited by a general inability to develop a sufficient chronic beryllium disease animal model. Discovery of the Human Leukocyte Antigen (HLA) - DPB1Glu69 genetic susceptibility component of chronic beryllium disease permitted the addition of this human beryllium antigen presentation molecule to an animal genome which may permit development of a better animal model for chronic beryllium disease. Using FVB/N inbred mice, Drs. Rubin and Zhu, successfully produced three strains of HLA-DPB1 Glu 69 transgenic mice. Each mouse strain contains a haplotype of the HLA-DPB1 Glu 69 gene that confers a different magnitude of odds ratio (OR) of risk for chronic beryllium disease: HLA-DPB1*0401 (OR = 0.2), HLA-DPB1*0201 (OR = 15), HLA-DPB1*1701 (OR = 240). In addition, Drs. Rubin and Zhu developed transgenic mice with the human CD4 gene to permit better transmission of signals between T cells and antigen presenting cells. This project has maintained the colonies of these transgenic mice and tested the functionality of the human transgenes.
Gordon, Terry
Chronic Kidney Disease Is Associated with Angiographic Coronary Artery Disease
Background\\/Aims: Patients with chronic kidney disease (CKD) have a dramatically increased risk for cardiovascular mortality. Few prior studies have examined the independent association of CKD with coronary anatomy. Methods: We evaluated the relationship between CKD and severe coronary artery disease (CAD) in 261 male veterans with nuclear perfusion imaging tests suggesting coronary ischemia. We used chart review and patient and
Michel Chonchol; Jeff Whittle; Angela Desbien; Michelle B. Orner; Laura A. Petersen; Nancy R. Kressin
Illness experience in a chronic disease--ALS
The representative case study method was used in a 1-year longitudinal study of two individuals with a chronic, degenerative, terminal neurological disease, ALS (amyotrophic lateral sclerosis, also known as Lou Gehrig's Disease). Participants were interviewed in their homes every 2 months to examine the effects of the illness on relationships with family, friends and the health care system. Changing ideas
Ann Kuckelman Cobb; Edna Hamera
Cardiovascular disease and chronic renal disease: A new paradigm
Cardiovascular disease (CVD) is a major cause of morbidity and mortality among patients with chronic renal disease (CRD). Despite improvement in treatment for CVD over the past 30 years, CVD mortality is approximately 15 times higher in dialysis patients than in the general population. The high prevalence of CVD among incident dialysis patients suggests that CVD begins in earlier stages
Mark J. Sarnak; Andrew S. Levey
New Therapies for Chronic Obstructive Pulmonary Disease
Chronic obstructive pulmonary disease (COPD) is a major global health problem which is increasing throughout the world and a major cause of death. However, current therapies fail to prevent disease progression or mortality. The mainstay of current drug therapy are long-acting bronchodilators; several longer-acting inhaled ?2-agonists and muscarinic antagonists (and combinations) are now in development. No treatments have so far
Peter J. Barnes
Framing international trade and chronic disease
There is an emerging evidence base that global trade is linked with the rise of chronic disease in many low and middle-income\\u000a countries (LMICs). This linkage is associated, in part, with the global diffusion of unhealthy lifestyles and health damaging\\u000a products posing a particular challenge to countries still facing high burdens of communicable disease. We developed a generic\\u000a framework which
Ronald Labont�; Katia S Mohindra; Raphael Lencucha
Gene Therapy for Chronic Granulomatous Disease
Identification of gene mutations responsible for leukocyte dysfunction along with the application of gene transfer technology has made genetic correction of such disorders possible. Much of the research into molecular therapy for inherited disorders of phagocytes has been focused on chronic granulomatous disease (CGD). CGD results from mutations in any one of the four genes encoding essential subunits of respiratory
W. Scott Goebel; Mary C. Dinauer
Preventive Care in Chronic Liver Disease
OBJECTIVE To identify preventive care measures that are appropriate for and specific to patients with chronic liver disease and to provide recommendations and information that can be shared with patients. MEASUREMENTS A review of the literature was undertaken using medlinefrom 1970 to present. Priority was given to randomized controlled studies, but case reports, case-control studies, and reviews were included. MAIN RESULTS Evidence for the avoidance of alcohol and other toxic substances, immunizations, and dietary modifications for chronic liver disease is summarized. In addition, measures that are effective in the mitigation of the complications of cirrhosis are reviewed. CONCLUSIONS Preventive care can play an important role in patients with chronic liver diseases. Based on the existing data, the preventive strategies of alcohol avoidance, hepatitis vaccination, avoidance of NSAIDs nonsteroidal anti-inflammatory drugs, iron supplementation when appropriate, and a low-fat diet are prudent in patients with chronic liver disease. Once cirrhosis develops, screening for hepatocellular cancer with ?-fetoprotein testing and ultrasound, and screening for varices by endoscopy are justified.
Riley, Thomas R; Smith, Jill P
Antioxidants and Prevention of Chronic Disease
The generation of reactive oxygen species (ROS) and other free radicals (R�) during metabolism is a necessary and normal process that ideally is compensated for by an elaborate endogenous antioxidant system. However, due to many environmental, lifestyle, and pathological situations, excess radicals can accumulate, resulting in oxidative stress. Oxidative stress has been related to cardiovascular disease, cancer, and other chronic
Chronic Kidney Disease and Its Complications
Chronic kidney disease (CKD) is recognized as a major health problem affecting approximately 13% of the US population (1). Numbers of preva- lent CKD patients will continue to rise, reflecting the growing elderly pop- ulation and increasing numbers of patients with diabetes and hypertension. As numbers of CKD patients increase, primary care practitioners will be confronted with management of the
Robert Thomas; Abbas Kanso; John R. Sedor
Factor VIII Activity in Chronic Renal Disease
F VIII coagulant, F VHI-related antigen and F VIII ristocetin cofactor activity were significantly increased in 68 patients with various chronic renal diseases. All three F VIII functions correlated generally well with each other. A striking relationship between some F VIII activities and serum creatinine was detectable in patients with glomerulonephritis and kidney transplants, with mild or moderate renal insufficiency.
E. Wegm�ller; U. Gr�ninger; M. Furlan; E. A. Beck; J. Hodler; F. C. Reubi
Fluid homeostasis in chronic obstructive lung disease
Chronic obstructive pulmonary disease (COPD) often leads to massive oedema and the development of what is usually called cor pulmonale. The mechanisms by which patients with COPD retain salt and water are not completely understood. Several abnormalities have been found including reduced renal blood flow with relatively preserved glomerular filtration rate and elevated levels of renin, aldosterone, arginine vasopressin and
P. W. de Leeuw; A. Dees
Case Management of Adolescents with Chronic Disease.
ERIC Educational Resources Information Center
This training guide presents a model for optimum delivery of the primary duties, tasks, and steps required in the comprehensive case management of adolescents with chronic disease. Using a team approach to coordinated health care, the guide involves the patient and family as key members of the care team along with the physician, nurse, dietitian,�
Lankard, Bettina A.
Chronic Kidney Disease Mystery in Central America
NLM Director�s Comments Transcript Chronic Kidney Disease Mystery in Central America: 06/02/2014 To use the sharing features on this ... information is available in 43 other languages. Your comments about this or any of our podcasts are ...
Chronic kidney disease in postmenopausal women
Menopause is derived from the Greek words men (month) and pauses (cessation) and means permanent cessation of menstruation after the loss of ovarian activity. Chronic kidney disease (CKD) has recently been associated with cardiovascular events in several studies. CKD patients have a heavy burden of traditional cardiovascular risk factors in addition to a range of nontraditional risk factors such as
Hiromichi Suzuki; Kazuoki Kondo
Update on Pregnancy in Chronic Kidney Disease
The occurrence of pregnancy in patients with chronic kidney disease (CKD) has been considered a dangerous event both for the mother and for the fetus. However, increasing evidence shows that the stage of CKD is the leading factor that can predict possible acceleration in the declining of renal function and complications of pregnancy. This review summarizes recent data on pregnancy
Giuseppe Castellano; Vincenzo Losappio; Loreto Gesualdo
Magnesium in Chronic Kidney Disease: Unanswered Questions
Background: Magnesium ion is critical for life and is integrally involved in cellular function and a key component of normal bone mineral. In health, the kidneys, gastrointestinal tract and bone are responsible for maintaining serum magnesium concentrations in the normal range and magnesium balance. Most clinical disorders involving magnesium, other than chronic kidney disease (CKD), result in hypomagnesemia, either from
David M. Spiegel
Osteoporosis and cardiovascular disease: lessons from chronic kidney disease
Osteoporosis is a common complication of chronic kidney disease (CKD), and the latter is a major risk factor for cardiovascular mortality. Recent studies have elucidated some of the mechanisms by which CKD is a cardiovascular risk, and they relate to osteoporosis. Thus, the mechanisms of CKD induced cardiovascular risk provide valuable insight into the relationship between cardiovascular disease and osteoporosis, and they are reviewed here. Observational studies have determined hyperphosphatemia to be a cardiovascular risk factor in chronic kidney disease. Mechanistic studies have elucidated that hyperphosphatemia is a direct stimulus to vascular calcification, which is one cause of morbid cardiovascular events contributing to the excess mortality of chronic kidney disease. Hyperphosphatemia in chronic kidney is due to failure of excretion by the kidneys and excess bone resorption. It stimulates vascular cells to mineralize atherosclerotic plaques through osteoblastic processes. Hyperphosphatemia in chronic kidney disease is a distinct syndrome characterized by disordered skeletal remodeling, heterotopic mineralization and cardiovascular morbidity. The heterotopic mineralization stimulated by CKD is relevant to osteoporosis.
Hruska, Keith A; Mathew, Suresh; Lund, Richard
Endothelial dysfunction in chronic inflammatory diseases.
Chronic inflammatory diseases are associated with accelerated atherosclerosis and increased risk of cardiovascular diseases (CVD). As the pathogenesis of atherosclerosis is increasingly recognized as an inflammatory process, similarities between atherosclerosis and systemic inflammatory diseases such as rheumatoid arthritis, inflammatory bowel diseases, lupus, psoriasis, spondyloarthritis and others have become a topic of interest. Endothelial dysfunction represents a key step in the initiation and maintenance of atherosclerosis and may serve as a marker for future risk of cardiovascular events. Patients with chronic inflammatory diseases manifest endothelial dysfunction, often early in the course of the disease. Therefore, mechanisms linking systemic inflammatory diseases and atherosclerosis may be best understood at the level of the endothelium. Multiple factors, including circulating inflammatory cytokines, TNF-? (tumor necrosis factor-?), reactive oxygen species, oxidized LDL (low density lipoprotein), autoantibodies and traditional risk factors directly and indirectly activate endothelial cells, leading to impaired vascular relaxation, increased leukocyte adhesion, increased endothelial permeability and generation of a pro-thrombotic state. Pharmacologic agents directed against TNF-?-mediated inflammation may decrease the risk of endothelial dysfunction and cardiovascular disease in these patients. Understanding the precise mechanisms driving endothelial dysfunction in patients with systemic inflammatory diseases may help elucidate the pathogenesis of atherosclerosis in the general population. PMID:24968272
Steyers, Curtis M; Miller, Francis J
A Prediction Model for Chronic Kidney Disease Includes Periodontal Disease
Background An estimated 75% of the seven million Americans with moderate-to-severe chronic kidney disease are undiagnosed. Improved prediction models to identify high-risk subgroups for chronic kidney disease enhance the ability of health care providers to prevent or delay serious sequelae, including kidney failure, cardiovascular disease, and premature death. Methods We identified 11,955 adults ?18 years of age in the Third National Health and Nutrition Examination Survey. Chronic kidney disease was defined as an estimated glomerular filtration rate of 15 to 59 ml/minute/1.73 m2. High-risk subgroups for chronic kidney disease were identified by estimating the individual probability using ? coefficients from the model of traditional and non-traditional risk factors. To evaluate this model, we performed standard diagnostic analyses of sensitivity, specificity, positive predictive value, and negative predictive value using 5%, 10%, 15%, and 20% probability cutoff points. Results The estimated probability of chronic kidney disease ranged from virtually no probability (0%) for an individual with none of the 12 risk factors to very high probability (98%) for an older, non-Hispanic white edentulous former smoker, with diabetes ?10 years, hypertension, macroalbuminuria, high cholesterol, low high-density lipoprotein, high C-reactive protein, lower income, and who was hospitalized in the past year. Evaluation of this model using an estimated 5% probability cutoff point resulted in 86% sensitivity, 85% specificity, 18% positive predictive value, and 99% negative predictive value. Conclusion This United States population�based study suggested the importance of considering multiple risk factors, including periodontal status, because this improves the identification of individuals at high risk for chronic kidney disease and may ultimately reduce its burden.
Fisher, Monica A.; Taylor, George W.
Recognizing global burden of cardiovascular disease and related chronic diseases.
Cardiovascular disease is the leading cause of death worldwide, affecting not only high-income but also low- and middle-income countries. Nearly 80 percent of all estimated cardiovascular disease-related deaths worldwide now occur in low- and middle-income countries, where nearly 30 percent of all deaths are attributable to cardiovascular disease. The health burden of cardiovascular disease and other chronic diseases is also accompanied by a significant deleterious economic impact at the level of both national economies and households. The global trends in the health and economic burden of cardiovascular disease provide a compelling argument in support of prioritizing urgent yet carefully planned efforts to prevent and control cardiovascular disease worldwide-and especially in low- and middle-income countries. After decades of escalating efforts to draw attention to the high burden of cardiovascular disease and other chronic diseases, this critically important issue is now emerging as a more central part of the global health and development agenda. The breadth of behavioral, biological, social, environmental, and systems-level factors that contribute to cardiovascular disease necessitates multisectoral approaches across the lifecourse that promote healthful lifestyles, reduce risk, and reduce cardiovascular-disease morbidity and mortality through the delivery of quality health care services. Given that the complex interactions among the determinants of cardiovascular disease vary in different contexts, real progress in control efforts will come through approaches that are driven by a country's disease burden and risk profile, capacities, resources, and priorities-approaches that are led by a country's key decision-makers and stakeholders, including governments, civil society, the private sector, and communities. Many countries are already establishing efforts to address chronic diseases. In addition to these locally driven efforts, success will require active engagement and sustained action from a wide array of stakeholders operating at global and regional levels. PMID:23239202
Kelly, Bridget B; Narula, Jagat; Fuster, Valent�n
Early origins of chronic obstructive pulmonary disease.
Chronic obstructive pulmonary disease (COPD) is a major cause of morbidity and mortality worldwide and a significant challenge for adult physicians. However, there is a misconception that COPD is a disease of only adult smokers. There is a growing body of evidence to support the hypothesis that chronic respiratory diseases such as COPD have their origins in early life. In particular, adverse maternal factors will interact with the environment in a susceptible host promoting altered lung growth and development antenatally and in early childhood. Subsequent lung injury and further gene-environment interactions may result in permanent lung injury manifest by airway obstruction predisposing to COPD. This review will discuss the currently available data regarding risk factors in early life and their role in determining the COPD phenotype. PMID:22265926
Narang, Indra; Bush, Andrew
The systemic nature of chronic lung disease.
The systemic effects and comorbidities of chronic respiratory disease such as COPD contribute substantially to its burden. Symptoms in COPD do not solely arise from the degree of airflow obstruction as exercise limitation is compounded by the specific secondary manifestations of the disease including skeletal muscle impairment, osteoporosis, mood disturbance, anemia, and hormonal imbalance. Pulmonary rehabilitation targets the systemic manifestations of COPD, the causes of which include inactivity, systemic inflammation, hypoxia and corticosteroid treatment. Comorbidities are common, including cardiac disease, obesity, and metabolic syndrome and should not preclude pulmonary rehabilitation as they may also benefit from similar approaches. PMID:24874124
Evans, Rachael A; Morgan, Michael D L
Helping to Combat Chronic Wasting Disease
Chronic wasting disease (CWD) is a disease of the nervous system that results in distinctive brain lesions. CWD affects elk, white-tailed deer, and mule deer, but has not been documented in livestock or humans. The origins of the disease, as well as the modes of transmission, remain unknown. Infected deer and elk appear robust and healthy in the early stages of CWD; clinical signs might not show for years. Mortality typically occurs within months after the appearance of clinical signs. The route of transmission is unknown; likely routes include direct transmission between infected and noninfected animals and infected animals contaminating local environments.
Geological Survey (U.S)
Chronic Disease Modeling and Simulation Software
Computers allow describing the progress of a disease using computerized models. These models allow aggregating expert and clinical information to allow researchers and decision makers to forecast disease progression. To make this forecast reliable, good models and therefore good modeling tools are required. This paper will describe a new computer tool designed for chronic disease modeling. The modeling capabilities of this tool were used to model the Michigan model for diabetes. The modeling approach and its advantages such as simplicity, availability, and transparency are discussed.
Barhak, Jacob; Isaman, Deanna JM; Ye, Wen; Lee, Donghee
Pathogenesis of chronic obstructive pulmonary disease
The current epidemic of chronic obstructive pulmonary disease (COPD) has produced a worldwide health care burden, approaching that imposed by transmittable infectious diseases. COPD is a multidimensional disease, with varied intermediate and clinical phenotypes. This Review discusses the pathogenesis of COPD, with particular focus on emphysema, based on the concept that pulmonary injury involves stages of initiation (by exposure to cigarette smoke, pollutants, and infectious agents), progression, and consolidation. Tissue damage entails complex interactions among oxidative stress, inflammation, extracellular matrix proteolysis, and apoptotic and autophagic cell death. Lung damage by cigarette smoke ultimately leads to self-propagating processes, resulting in macromolecular and structural alterations � features similar to those seen in aging.
Tuder, Rubin M.; Petrache, Irina
Pathophysiology of Exacerbations of Chronic Obstructive Pulmonary Disease
Smokers with stable chronic obstructive pulmonary disease have a chronic inflammation of the entire tracheobronchial tree character- ized by an increased number of macrophages and CD8 T lympho- cytes in the airway wall and of neutrophils in the airway lumen. Exacerbations of chronic obstructive pulmonary disease are consid- ered to reflect worsening of the underlying chronic inflammation ofthe airways,causedmainlybyviralandbacterialinfections andair
Alberto Papi; Fabrizio Luppi; Francesca Franco; Leonardo M. Fabbri
Physical Therapy for Children with Chronic Lung Disease
Chronic lung disease is a major health problem among children. Estimates suggest that one child in six has a chronic respiratory condition. This article reviews three common chronic respiratory conditions occurring in childhood for which physical therapy is usually recommended. The cause, pathophysiology, and medical treatment are explained for asthma, respiratory complications of chronic neuromuscular disease, and cystic fibrosis. The
FastStats: Chronic Liver Disease/Cirrhosis
... Related Links Accessibility NCHS Home FastStats Home Chronic Liver Disease and Cirrhosis (Data are for the U.S.) ... Hospital Inpatient Care Number of discharges with chronic liver disease and cirrhosis as the first-listed diagnosis: ...
Caloric Restriction and Chronic Inflammatory Diseases
A reduction in calorie intake (Caloric restriction), appears to consistently decrease the biological rate of aging in a variety of organisms as well as protect against age-associated diseases including chronic inflammatory disorders such as cardiovascular disease and diabetes. Although the mechanisms behind this observation are not fully understood, identification of the main metabolic pathways affected by caloric restriction has generated interest in finding molecular targets that could be modulated by caloric restriction mimetics. This review describes the general concepts of caloric restriction and caloric restriction mimetics as well as discusses evidence related to their effects on inflammation and chronic inflammatory disorders. Additionally, emerging evidence related to the effects of caloric restriction on periodontal disease in non-human primates is presented. While the implementation of this type of dietary intervention appears to be challenging in our modern society where obesity is a major public health problem, caloric restriction mimetics could offer a promising alternative to control and perhaps prevent several chronic inflammatory disorders including periodontal disease.
Gonzalez, Octavio A.; Tobia, Christine; Ebersole, Jeffrey L.; Novak, M. John
Age-associated chronic diseases require age-old medicine: role of chronic inflammation.
Most chronic diseases--such as cancer, cardiovascular disease (CVD), Alzheimer disease, Parkinson disease, arthritis, diabetes and obesity--are becoming leading causes of disability and death all over the world. Some of the most common causes of these age-associated chronic diseases are lack of physical activity, poor nutrition, tobacco use, and excessive alcohol consumption. All the risk factors linked to these chronic diseases have been shown to up-regulate inflammation. Therefore, downregulation of inflammation-associated risk factors could prevent or delay these age-associated diseases. Although modern science has developed several drugs for treating chronic diseases, most of these drugs are enormously expensive and are associated with serious side effects and morbidity. In this review, we present evidence on how chronic inflammation leads to age-associated chronic disease. Furthermore, we discuss diet and lifestyle as solutions for age-associated chronic disease. PMID:22178471
Prasad, Sahdeo; Sung, Bokyung; Aggarwal, Bharat B
Age-Associated Chronic Diseases Require Age-Old Medicine: Role of Chronic Inflammation
Most chronic diseases - such as cancer, cardiovascular disease (CVD), Alzheimer disease, Parkinson disease, arthritis, diabetes and obesity - are becoming leading causes of disability and death all over the world. Some of the most common causes of these age-associated chronic diseases are lack of physical activity, poor nutrition, tobacco use, and excessive alcohol consumption. All the risk factors linked to these chronic diseases have been shown to up-regulate inflammation. Therefore, downregulation of inflammation-associated risk factors could prevent or delay these age-associated diseases. Although modern science has developed several drugs for treating chronic diseases, most of these drugs are enormously expensive and are associated with serious side effects and morbidity. In this review, we present evidence on how chronic inflammation leads to age-associated chronic disease. Furthermore, we discuss diet and lifestyle as solutions for age-associated chronic disease.
Prasad, Sahdeo; Sung, Bokyung; Aggarwal, Bharat B.
Nucleotide excision repair in chronic neurodegenerative diseases.
Impaired DNA repair involving the nucleotide excision repair (NER)/transcription-coupled repair (TCR) pathway cause human pathologies associated with severe neurological symptoms. These clinical observations suggest that defective NER/TCR might also play a critical role in chronic neurodegenerative disorders (ND), such as Alzheimer's and Parkinson's disease. Involvement of NER/TCR in these disorders is also substantiated by the evidence that aging constitutes the principal risk factor for chronic ND and that this DNA repair mechanism is very relevant for the aging process itself. Our understanding of the exact role of NER/TCR in chronic ND, however, is extremely rudimentary; while there is no doubt that defective NER/TCR can lead to neuronal death, evidence for its participation in the etiopathogenesis of ND is inconclusive thus far. Here we summarize the experimental observations supporting a role for NER/TCR in chronic ND and suggest questions and lines of investigation that might help in addressing this important issue. We also present a preliminary yet unprecedented meta-analysis on human brain microarray data to understand the expression levels of the various NER factors in the anatomical areas relevant for chronic ND pathogenesis. In summary, this review intends to highlight elements supporting a role of NER/TCR in these devastating disorders and to propose potential strategies of investigation. PMID:23726220
Sepe, Sara; Payan-Gomez, Cesar; Milanese, Chiara; Hoeijmakers, Jan H; Mastroberardino, Pier G
Optimizing Chronic Disease Management Mega-Analysis
Background As Ontario�s population ages, chronic diseases are becoming increasingly common. There is growing interest in services and care models designed to optimize the management of chronic disease. Objective To evaluate the cost-effectiveness and expected budget impact of interventions in chronic disease cohorts evaluated as part of the Optimizing Chronic Disease Management mega-analysis. Data Sources Sector-specific costs, disease incidence, and mortality were calculated for each condition using administrative databases from the Institute for Clinical Evaluative Sciences. Intervention outcomes were based on literature identified in the evidence-based analyses. Quality-of-life and disease prevalence data were obtained from the literature. Methods Analyses were restricted to interventions that showed significant benefit for resource use or mortality from the evidence-based analyses. An Ontario cohort of patients with each chronic disease was constructed and followed over 5 years (2006�2011). A phase-based approach was used to estimate costs across all sectors of the health care system. Utility values identified in the literature and effect estimates for resource use and mortality obtained from the evidence-based analyses were applied to calculate incremental costs and quality-adjusted life-years (QALYs). Given uncertainty about how many patients would benefit from each intervention, a system-wide budget impact was not determined. Instead, the difference in lifetime cost between an individual-administered intervention and no intervention was presented. Results Of 70 potential cost-effectiveness analyses, 8 met our inclusion criteria. All were found to result in QALY gains and cost savings compared with usual care. The models were robust to the majority of sensitivity analyses undertaken, but due to structural limitations and time constraints, few sensitivity analyses were conducted. Incremental cost savings per patient who received intervention ranged between $15 per diabetic patient with specialized nursing to $10,665 per patient wth congestive heart failure receiving in-home care. Limitations Evidence used to inform estimates of effect was often limited to a single trial with limited generalizability across populations, interventions, and health care systems. Because of the low clinical fidelity of health administrative data sets, intermediate clinical outcomes could not be included. Cohort costs included an average of all health care costs and were not restricted to costs associated with the disease. Intervention costs were based on resource use specified in clinical trials. Conclusions Applying estimates of effect from the evidence-based analyses to real-world resource use resulted in cost savings for all interventions. On the basis of quality-of-life data identified in the literature, all interventions were found to result in a greater QALY gain than usual care would. Implementation of all interventions could offer significant cost reductions. However, this analysis was subject to important limitations. Plain Language Summary Chronic diseases are the leading cause of death and disability in Ontario. They account for a third of direct health care costs across the province. This study aims to evaluate the cost-effectiveness of health care interventions that might improve the management of chronic diseases. The evaluated interventions led to lower costs and better quality of life than usual care. Offering these options could reduce costs per patient. However, the studies used in this analysis were of medium to very low quality, and the methods had many limitations.
PATH-THETA Collaboration
Osteoporosis in chronic obstructive pulmonary disease
ABSTRACT: Osteoporosis is one of the systemic,effects associated with chronic obstructive pulmonary,disease (COPD). Potential risk factors of osteoporosis may,be due to the lifestyle, genetics, treatment with corticosteroids, endocrine abnormalities or the impairment,of the body composition,and peripheral skeletal muscles. Evidence for the possible contribution of such factors is reviewed. The occurrence of fractures, as a consequence of osteoporosis, can contribute to
A. A. Ionescu; E. Schoon
[Emergency endoscopy in chronic liver diseases].
Emergency endoscopy has to be regarded as a method of high diagnostic value. Based on the resulting therapeutic consequences and with allowance for the prerequisites and contraindications, emergency endoscopy in chronic liver diseases is to be considered a purposeful method. If endoscopic treatment possibilities in bleedings of the gastrointestinal tract continue to improve, the demonstration of an improvement in prognosis by emergency endoscopy seems to be merely a question of time. PMID:3878773
Truckenbrodt, J; Bosseckert, H; Jorke, D; Eitner, K; Fritze, C; Koppe, P; Gross, V
Lactate metabolism in chronic liver disease.
Background. In the healthy liver there is a splanchnic net-uptake of lactate caused by gluconeogenesis. It has previously been shown that patients with acute liver failure in contrast have a splanchnic release of lactate caused by a combination of accelerated glycolysis in the splanchnic region and a reduction in hepatic gluconeogenesis. Aims. The aims of the present study were to investigate lactate metabolism and kinetics in patients with chronic liver disease compared with a control group with normal liver function. Methods. A total of 142 patients with chronic liver disease and 14 healthy controls underwent a liver vein catheterization. Blood samples from the femoral artery and the hepatic and renal veins were simultaneously collected before and after stimulation with galactose. Results. The fasting lactate levels, both in the hepatic vein and in the femoral artery, were higher in the patients than in the controls (P < 0.001) and there were a hepatic net-uptake of lactate in both groups. Fasting lactate concentrations correlated directly with the portal pressure, mean arterial blood pressure, and SaO2 and negatively with ICG clearance. Conclusions. Lactate levels are elevated in cirrhotic patients compared to controls relating to portal pressure and aspects of liver dysfunction and the lactate levels seem to increase with the severity of cirrhosis. This may not be caused by decreased gluconeogenesis but merely be due to accelerated glycolysis in the splanchnic region. Future studies should focus on the impact of chronic liver disease on lactate kinetics. PMID:23514017
Jeppesen, Johanne B; Mortensen, Christian; Bendtsen, Flemming; M�ller, S�ren
Educational session: managing chronic myeloid leukemia as a chronic disease.
Elucidation of the pathogenesis of chronic myeloid leukemia (CML) and the introduction of tyrosine kinase inhibitors (TKIs) has transformed this disease from being invariably fatal to being the type of leukemia with the best prognosis. Median survival associated with CML is estimated at > 20 years. Nevertheless, blast crisis occurs at an incidence of 1%-2% per year, and once this has occurred, treatment options are limited and survival is short. Due to the overall therapeutic success, the prevalence of CML is gradually increasing. The optimal management of this disease includes access to modern therapies and standardized surveillance methods for all patients, which will certainly create challenges. Furthermore, all available TKIs show mild but frequent side effects that may require symptomatic therapy. Adherence to therapy is the key prerequisite for efficacy of the drugs and for long-term success. Comprehensive information on the nature of the disease and the need for the continuous treatment using the appropriate dosages and timely information on efficacy data are key factors for optimal compliance. Standardized laboratory methods are required to provide optimal surveillance according to current recommendations. CML occurs in all age groups. Despite a median age of 55-60 years, particular challenges are the management of the disease in children, young women with the wish to get pregnant, and older patients. The main challenges in the long-term management of CML patients are discussed in this review. PMID:22160024
Hochhaus, Andreas
Chronic beryllium disease: diagnosis and management.
Chronic beryllium disease is predominantly a pulmonary granulomatosis that was originally described in 1946. Symptoms usually include dyspnea and cough. Fever, anorexia, and weight loss are common. Skin lesions are the most common extrathoracic manifestation. Granulomatous hepatitis, hypercalcemia, and kidney stones can also occur. Radiographic and physiologic abnormalities are similar to those in sarcoidosis. While traditionally the pathologic changes included granulomas and cellular interstitial changes, the hallmark of the disease today is the well-formed granuloma. Immunologic studies have demonstrated a cell-mediated response to beryllium that is due to an accumulation of CD4+ T cells at the site of disease activity. Diagnosis depends on the demonstration of pathologic changes (i.e., granuloma) and evidence that the granuloma was caused by a hypersensitivity to beryllium (i.e., positive lung proliferative response to beryllium). Using these criteria, the diagnosis of chronic beryllium disease can now be made before the onset of clinical symptoms. Whether, with early diagnosis, the natural course of this condition will be the same as when it was traditionally diagnosed is not known. Currently, corticosteroids are used to treat patients with significant symptoms or evidence of progressive disease.
Rossman, M D
Acne as a chronic systemic disease.
Acne is the most common skin disorder. In the majority of cases, acne is a disease that changes its skin distribution and severity over time; moreover, it can be a physically (scar development) and psychologically damaging condition that lasts for years. According to its clinical characteristics, it can be defined as a chronic disease according to the World Health Organization criteria. Acne is also a cardinal component of many systemic diseases or syndromes, such as congenital adrenal hyperplasia, seborrhea-acne-hirsutism-androgenetic alopecia syndrome, polycystic ovarian syndrome, hyperandrogenism-insulin resistance-acanthosis nigricans syndrome, Apert syndrome, synovitis-acne-pustulosis-hyperostosis-osteitis syndrome, and pyogenic arthritis-pyoderma gangrenosum-acne syndrome. Recent studies on the Ache hunter gatherers of Paraguay detected the lack of acne in association with markedly lower rates of obesity, diabetes mellitus, hyperlipidemia, and cardiovascular diseases, a finding that indicates either a nutritional or a genetic background of this impressive concomitance. PMID:24767186
Zouboulis, Christos C
Chronic liver disease in Aboriginal North Americans
A structured literature review was performed to detail the frequency and etiology of chronic liver disease (CLD) in Aboriginal North Americans. CLD affects Aboriginal North Americans disproportionately and is now one of the most common causes of death. Alcoholic liver disease is the leading etiology of CLD, but viral hepatitis, particularly hepatitis C, is an important and growing cause of CLD. High rates of autoimmune hepatitis and primary biliary cirrhosis (PBC) are reported in regions of coastal British Columbia and southeastern Alaska. Non-alcoholic liver disease is a common, but understudied, cause of CLD. Future research should monitor the incidence and etiology of CLD and should be geographically inclusive. In addition, more research is needed on the treatment of hepatitis C virus (HCV) infection and non-alcoholic fatty liver disease (NAFLD) in this population.
Scott, John D; Garland, Naomi
Chronic Granulomatous Disease as a Risk Factor for Autoimmune Disease
Chronic granulomatous disease (CGD) is characterized by recurrent infections and granuloma formation. In addition, we have observed a number of diverse autoimmune conditions in our CGD population, suggesting that patients with CGD are at an elevated risk for development of autoimmune (AI) disorders. In this report, we describe antiphospholipid syndrome (aPL), recurrent pericardial effusion, juvenile idiopathic arthritis (JIA), IgA nephropathy, cutaneous lupus erythematosus, and autoimmune pulmonary disease in the setting of CGD. The presence and type of autoimmune disease has important treatment implications for patients with CGD.
De Ravin, Suk See; Naumann, Nora; Cowen, Edward W.; Friend, Julia; Hilligoss, Dianne; Marquesen, Martha; Balow, James E.; Barron, Karyl S.; Turner, Maria L.; Gallin, John I.; Malech, Harry L.
Hospital Stays Involving Chronic Pulmonary Heart Disease, 2005. Statistical Brief No. 43.
National Technical Information Service (NTIS)
Chronic pulmonary heart disease, or pulmonary hypertension, is a serious cardiac disorder most often caused by lung disease. While almost any chronic lung disease can cause it, the most common cause is chronic obstructive pulmonary disease (COPD), chronic...
A. Elixhauser C. T. Merrill M. Nagamine
Chronic idiopathic urticaria and Graves' disease.
Chronic urticaria is a common condition characterized by recurrent episodes of mast cell-driven wheal and flare-type skin reactions lasting for more than 6 weeks. In about 75% of cases, the underlying causes remain unknown, and the term chronic idiopathic urticaria (CIU) is used to emphasize that wheals develop independently of identified external stimuli. Although CIU affects about 1.0% of the general population, its etiopathogenesis is not yet well understood. It is now widely accepted that in many cases CIU should be regarded as an autoimmune disorder caused by circulating and functionally active IgG autoantibodies specific for the IgE receptor (FceRI) present on mast cells and basophils or for IgE itself. The well-known association of CIU with other autoimmune processes/diseases represents further indirect evidence of its autoimmune origin. Autoimmune thyroid diseases, especially autoimmune thyroiditis, represent the most frequently investigated diseases in association with CIU. Here we review this topic with particular regard to the association between Graves' disease and CIU. The possible pathogenetic mechanisms and the clinical implications of such an association are discussed. PMID:23609949
Ruggeri, R M; Imbesi, S; Saitta, S; Campenn�, A; Cannav�, S; Trimarchi, F; Gangemi, S
Circulating Endothelial Cells and Chronic Kidney Disease
Endothelial dysfunction may play a crucial role in initiation of the pathogenesis of vascular disease and atherosclerosis. The identification and quantification of circulating endothelial cells (CEC) have been developed as a novel marker of endothelial function. We describe, in great detail, mechanisms of endothelial dysfunction and CEC detachment. We also review the relationship between numbers of CEC and disease severity and response to treatment. In addition, we describe the possible clinical use of CEC in chronic kidney disease (CKD) and kidney transplantation. In summary, CEC have been developed as a novel approach to assess the endothelial damage. Measurement of the CEC level would provide an important diagnostic and prognostic value on the endothelium status and the long-term outcome of vascular dysfunction.
Zhang, Kunying; Yin, Fang; Lin, Lin
Progress and promise in the management of chronic kidney disease
1 for the management of chronic kidney disease provide clear guidance for the co- operative care of patients with chronic kidney disease by all health care providers throughout the spectrum of disease. There are specific stages and recommendations for interven- tions to slow disease progression, prevent complications, and reduce morbidity and mortality. This is a major para- digm shift on
Garabed Eknoyan
Risks of chronic metabolic acidosis in patients with chronic kidney disease
Risks of chronic metabolic acidosis in patients with chronic kidney disease Metabolic acidosis is associated with chronic renal failure (CRF). Often, maintenance dialysis therapies are not able to reverse this condition. The major systemic consequences of chronic metabolic acidosis are increased protein catabolism, decreased protein synthesis, and a negative protein balance that improves after bicarbonate supplementation. Metabolic acidosis also induces
Joel D. Kopple; KAMYAR KALANTAR-ZADEH; RAJNISH MEHROTRA
The SLE Transcriptome Exhibits Evidence of Chronic Endotoxin Exposure and Has Widespread Dysregulation of Non-Coding and Coding RNAs
Background Gene expression studies of peripheral blood mononuclear cells from patients with systemic lupus erythematosus (SLE) have demonstrated a type I interferon signature and increased expression of inflammatory cytokine genes. Studies of patients with Aicardi Gouti�res syndrome, commonly cited as a single gene model for SLE, have suggested that accumulation of non-coding RNAs may drive some of the pathologic gene expression, however, no RNA sequencing studies of SLE patients have been performed. This study was designed to define altered expression of coding and non-coding RNAs and to detect globally altered RNA processing in SLE. Methods Purified monocytes from eight healthy age/gender matched controls and nine SLE patients (with low-moderate disease activity and lack of biologic drug use or immune suppressive treatment) were studied using RNA-seq. Quantitative RT-PCR was used to validate findings. Serum levels of endotoxin were measured by ELISA. Results We found that SLE patients had diminished expression of most endogenous retroviruses and small nucleolar RNAs, but exhibited increased expression of pri-miRNAs. Splicing patterns and polyadenylation were significantly altered. In addition, SLE monocytes expressed novel transcripts, an effect that was replicated by LPS treatment of control monocytes. We further identified increased circulating endotoxin in SLE patients. Conclusions Monocytes from SLE patients exhibit globally dysregulated gene expression. The transcriptome is not simply altered by the transcriptional activation of a set of genes, but is qualitatively different in SLE. The identification of novel loci, inducible by LPS, suggests that chronic microbial translocation could contribute to the immunologic dysregulation in SLE, a new potential disease mechanism.
Shi, Lihua; Zhang, Zhe; Yu, Angela M.; Wang, Wei; Wei, Zhi; Akhter, Ehtisham; Maurer, Kelly; Reis, Patricia Costa; Song, Li; Petri, Michelle; Sullivan, Kathleen E.
Pulmonary complications in chronic liver disease.
The association of chronic liver disease with respiratory symptoms and hypoxia is well recognized. Over the last century, three pulmonary complications specific to chronic liver disease have been characterized: hepatopulmonary syndrome (HPS), portopulmonary hypertension (POPH), and hepatic hydrothorax (HH). The development of portal hypertension is fundamental in the pathogenesis of each of these disorders. HPS is the most common condition, found in 5%-30% of cirrhosis patients, manifested by abnormal oxygenation due to the development of intrapulmonary vascular dilatations. The presence of HPS increases mortality and impairs quality of life, but is reversible with liver transplantation (LT). POPH is characterized by development of pulmonary arterial hypertension in the setting of portal hypertension, and is present in 5%-10% of cirrhosis patients evaluated for LT. Screening for POPH in cirrhosis patients eligible for LT is critical since severe POPH is a relative contraindication for LT. Patients with moderate POPH, who respond adequately to medical therapy, may benefit from LT, although sufficient controlled data are lacking. HH is a transudative pleural effusion seen in 5%-10% of cirrhosis patients, in the absence of cardiopulmonary disease. Diagnosis of HH should prompt consideration for LT, which is the ultimate treatment for HH. Conservative management includes salt restriction and diuretics, with thoracentesis and transjugular intrahepatic portosystemic shunt (TIPS) as second-line therapeutic options. PMID:24089295
Machicao, Victor I; Balakrishnan, Maya; Fallon, Michael B
Obesity, hypertension, and chronic kidney disease
Obesity is a major risk factor for essential hypertension, diabetes, and other comorbid conditions that contribute to development of chronic kidney disease. Obesity raises blood pressure by increasing renal tubular sodium reabsorption, impairing pressure natriuresis, and causing volume expansion via activation of the sympathetic nervous system and renin�angiotensin�aldosterone system and by physical compression of the kidneys, especially when there is increased visceral adiposity. Other factors such as inflammation, oxidative stress, and lipotoxicity may also contribute to obesity-mediated hypertension and renal dysfunction. Initially, obesity causes renal vasodilation and glomerular hyperfiltration, which act as compensatory mechanisms to maintain sodium balance despite increased tubular reabsorption. However, these compensations, along with increased arterial pressure and metabolic abnormalities, may ultimately lead to glomerular injury and initiate a slowly developing vicious cycle that exacerbates hypertension and worsens renal injury. Body weight reduction, via caloric restriction and increased physical activity, is an important first step for management of obesity, hypertension, and chronic kidney disease. However, this strategy may not be effective in producing long-term weight loss or in preventing cardiorenal and metabolic consequences in many obese patients. The majority of obese patients require medical therapy for obesity-associated hypertension, metabolic disorders, and renal disease, and morbidly obese patients may require surgical interventions to produce sustained weight loss.
Hall, Michael E; do Carmo, Jussara M; da Silva, Alexandre A; Juncos, Luis A; Wang, Zhen; Hall, John E
Time for chronic disease care and management.
To manage the future costs and quality of care, a health strategy must move beyond the individual, acute care model and address the care of older people with chronic, and often multiple, diseases. This strategy must address the issue of care gaps, ie, the differences between best care and usual care. It should also embrace broad partnerships in which providers may be a cross-disciplinary team of nurses, physicians and pharmacists; the patient partners may include all patients in the community with a disease or group of diseases; and the system managers should work with all to seek improved long-term care and share the governance of interventions and resources. This partnership is activated by repeated and widely communicated measurements of actual practices and outcomes, facilitating rapid knowledge gain and translation, including unmasking the invisible wait list of unmeasured care gaps. It drives continuous improvement in practices and outcomes. The time is right for such care models. There is increasing evidence of their clinical and financial benefits. There is a clear and immediate opportunity to evaluate them as part of a health strategy for effective chronic care in our aging society. Things can be better. PMID:17932573
Montague, Terrence J; Gogovor, Am�d�; Krelenbaum, Marilyn
Direct renin inhibition in chronic kidney disease.
For approximately 6 years, the only commercially available direct renin inhibitor, aliskiren, which inhibits the renin-angiotensin-aldosterone system at the initial rate limiting step, has been marketed for the treatment of hypertension. Concurrently, much attention has been given to the possibility that renin inhibition could hold potential for improved treatment in patients with chronic kidney disease, with diabetic nephropathy as an obvious group of patients to investigate, as the activity of the renin-angiotensin-aldosterone system is enhanced in these patients and as there is an unmet need for improved treatment and prognosis in these patients. Several short term studies have been performed in diabetic nephropathy, showing a consistent effect on the surrogate endpoint lowering of albuminuria, both as monotherapy and in combination with other blockers of the renin-angiotensin-aldosterone system. In addition, combination treatment also seemed safe and effective in patients with impaired kidney function. These initial findings formed the basis for the design of a large morbidity and mortality trial investigating aliskiren as add-on to standard treatment. The study has just concluded, but was terminated early as a beneficial effect was unlikely and there was an increased frequency of side effects. Also in non-diabetic kidney disease a few intervention studies have been carried out, but there is no ongoing hard outcome study. In this review we provide the current evidence for renin inhibition in chronic kidney disease by reporting the studies published so far as well as a perspective on the future possibilities. PMID:23278708
Persson, Frederik; Rossing, Peter; Parving, Hans-Henrik
Vitamin K status in chronic kidney disease.
The purpose of this review is to summarize the research to date on vitamin K status in chronic kidney disease (CKD). This review includes a summary of the data available on vitamin K status in patients across the spectrum of CKD as well as the link between vitamin K deficiency in CKD and bone dynamics, including mineralization and demineralization, as well as ectopic mineralization. It also describes two current clinical trials that are underway evaluating vitamin K treatment in CKD patients. These data may inform future clinical practice in this population. PMID:24212088
McCabe, Kristin M; Adams, Michael A; Holden, Rachel M
Illness experience in a chronic disease--ALS.
The representative case study method was used in a 1-year longitudinal study of two individuals with a chronic, degenerative, terminal neurological disease, ALS (amyotrophic lateral sclerosis, also known as Lou Gehrig's Disease). Participants were interviewed in their homes every 2 months to examine the effects of the illness on relationships with family, friends and the health care system. Changing ideas regarding causation, the use and evaluation of various therapies, use of illness role models, spiritual changes and symptom experience were also explored. Kleinman's concept of explanatory models guides the analysis of the data, although we argue for a greater emphasis on evaluation of therapies within this model. PMID:3775446
Cobb, A K; Hamera, E
Nutrition for Later Chronic Kidney Disease in Adults
... and adolescents with chronic kidney disease. Families of pediatric patients with CKD should seek age-appropriate nutritional counseling from a pediatric renal dietitian. [ Top ] About the Nutrition for Chronic ...
Epidemiology of Chronic Respiratory Disease: A Literature Review.
National Technical Information Service (NTIS)
The review focuses on three disorders--asthma, chronic bronchitis, and emphysema. Particular emphasis is directed toward the latter two maladies. Chronic lung diseases either cause or contribute to an increasing number of deaths throughout the world. Prac...
I. T. T. Higgins
Management of patients with chronic kidney disease.
Chronic kidney disease (CKD) is a silent disease which worsens gradually to end-stage kidney disease (ESKD). US kidney disease outcomes quality initiative (KDOQI) guidelines indicate five stages of CKD based on the severity of kidney function which is assessed by estimating the glomerular filtration rate (GFR) by the modification of diet in renal disease (MDRD) formula. The management of CKD patients with mild renal damage (stage 1-2 KDOQI) is articulated on the reduction of proteinuria (<500�mg/day), reduction of sitting systolic and diastolic blood pressure (<130/80�mmHg), salt restriction diet, diuretics (furosemide, spironolactone), antihypertensive agents (ACE inhibitors or ARBs (angiotensin II receptor blockers) or both as first-line therapy), additional other antihypertensives (aliskiren, non-dihydropyridine calcium channel blockers, beta blockers), body weight reduction, cigarette smoking stopping, allopurinol therapy and non-use of some drugs (non-steroidal anti-inflammatory agents, acetaminophen, bisphosphonates, oral estrogens) and herbals. The management of CKD patients with moderate-severe renal damage (stage 3-5 KDOQI) is based on the above recommendations plus low protein diet, correction of hyperkalaemia, metabolic acidosis, and administration of vitamin D derivates and erythropoietin for the correction of mineral metabolism disorders and anemia, respectively. In conclusion, patients with CKD (stage 1-2 KDOQI) may be correctly managed by primary care physicians, individuals in stage 3-5 KDOQI need the supervision of nephrologists to assess those patients who progress to ESKD and require renal replacement therapy. PMID:22009616
Schena, Francesco P
Epidemiology of Chronic Kidney Disease in Heart Failure
Synopsis Heart failure is common and is associated with poor prognosis. Chronic kidney disease is common in heart failure, and shares many risk factors with heart failure such as age, hypertension, diabetes, and coronary artery disease. Over half of all heart failure patients may have moderate to severe chronic kidney disease. The presence of chronic kidney disease is associated with increased morbidity and mortality, yet it is also associated with underutilization of evidence-based heart failure therapy that may reduce morbidity and mortality. Understanding the epidemiology and outcomes of chronic kidney disease in heart failure is essential to ensure proper management of these patients.
Ahmed, Ali; Campbell, Ruth C.
Pharmacological treatment of chronic obstructive pulmonary disease
None of the drugs currently available for chronic obstructive pulmonary disease (COPD) are able to reduce the progressive decline in lung function which is the hallmark of this disease. Smoking cessation is the only intervention that has proved effective. The current pharmacological treatment of COPD is symptomatic and is mainly based on bronchodilators, such as selective ?2-adrenergic agonists (short- and long-acting), anticholinergics, theophylline, or a combination of these drugs. Glucocorticoids are not generally recommended for patients with stable mild to moderate COPD due to their lack of efficacy, side effects, and high costs. However, glucocorticoids are recommended for severe COPD and frequent exacerbations of COPD. New pharmacological strategies for COPD need to be developed because the current treatment is inadequate.
Montuschi, Paolo
Achieving Salt Restriction in Chronic Kidney Disease
There is consistent evidence linking excessive dietary sodium intake to risk factors for cardiovascular disease and chronic kidney disease (CKD) progression in CKD patients; however, additional research is needed. In research trials and clinical practice, implementing and monitoring sodium intake present significant challenges. Epidemiological studies have shown that sodium intake remains high, and intervention studies have reported varied success with participant adherence to a sodium-restricted diet. Examining barriers to sodium restriction, as well as factors that predict adherence to a low sodium diet, can aid researchers and clinicians in implementing a sodium-restricted diet. In this paper, we critically review methods for measuring sodium intake with a specific focus on CKD patients, appraise dietary adherence, and factors that have optimized sodium restriction in key research trials and discuss barriers to sodium restriction and factors that must be considered when recommending a sodium-restricted diet.
McMahon, Emma J.; Campbell, Katrina L.; Mudge, David W.; Bauer, Judith D.
Interleukin-21 in chronic inflammatory diseases.
Interleukin-21 (IL-21), a cytokine produced by various subsets of activated CD4+ T cells, regulates multiple innate and adaptive immune responses. Indeed, IL-21 controls the proliferation and function of CD4+ and CD8+ T lymphocytes, drives the differentiation of B cells into memory cells and Ig-secreting plasma cells, enhances the activity of natural killer cells and negatively regulates the differentiation and activity of regulatory T cells. Moroever, IL-21 can stimulate nonimmune cells to synthesize various inflammatory molecules. Excessive production of IL-21 has been described in many human chronic inflammatory disorders and there is evidence that blockade of IL-21 helps attenuate detrimental responses in mouse models of immune-mediated diseases. In this article we briefly review data supporting the pathogenic role of IL-21 in immune-inflammatory pathologies and discuss the benefits and risks of IL-21 neutralization in patients with such diseases. PMID:23553807
Sarra, Massimiliano; Pallone, Francesco; Monteleone, Giovanni
Musculoskeletal Disorders in Chronic Obstructive Pulmonary Disease
Chronic obstructive pulmonary disease (COPD) is a lung disease characterized by airway obstruction and inflammation but also accompanied by several extrapulmonary consequences, such as skeletal muscle weakness and osteoporosis. Skeletal muscle weakness is of major concern, since it leads to poor functional capacity, impaired health status, increased healthcare utilization, and even mortality, independently of lung function. Osteoporosis leads to fractures and is associated with increased mortality, functional decline, loss of quality of life, and need for institutionalization. Therefore, the presence of the combination of these comorbidities will have a negative impact on daily life in patients with COPD. In this review, we will focus on these two comorbidities, their prevalence in COPD, combined risk factors, and pathogenesis. We will try to prove the clustering of these comorbidities and discuss possible preventive or therapeutic strategies.
Cielen, Nele; Maes, Karen
Chronic Kidney Disease Management: Comparison between Renal Transplant Recipients and Nontransplant Patients with Chronic Kidney Disease
Background\\/Aim: Renal transplant recipients (RTR) and patients with native chronic kidney disease (CKD) have similar complications. It is not known how the management of CKD in RTR differs from that of patients with native CKD. This study compares the management of complications related to CKD between RTR and patients with native CKD. Methods: Cross-sectional study of all RTR with stage
Ayub Akbari; Naser Hussain; Jolanta Karpinski; Greg A. Knoll
Models of chronic obstructive pulmonary disease
Chronic obstructive pulmonary disease (COPD) is a major global health problem and is predicted to become the third most common cause of death by 2020. Apart from the important preventive steps of smoking cessation, there are no other specific treatments for COPD that are as effective in reversing the condition, and therefore there is a need to understand the pathophysiological mechanisms that could lead to new therapeutic strategies. The development of experimental models will help to dissect these mechanisms at the cellular and molecular level. COPD is a disease characterized by progressive airflow obstruction of the peripheral airways, associated with lung inflammation, emphysema and mucus hypersecretion. Different approaches to mimic COPD have been developed but are limited in comparison to models of allergic asthma. COPD models usually do not mimic the major features of human COPD and are commonly based on the induction of COPD-like lesions in the lungs and airways using noxious inhalants such as tobacco smoke, nitrogen dioxide, or sulfur dioxide. Depending on the duration and intensity of exposure, these noxious stimuli induce signs of chronic inflammation and airway remodelling. Emphysema can be achieved by combining such exposure with instillation of tissue-degrading enzymes. Other approaches are based on genetically-targeted mice which develop COPD-like lesions with emphysema, and such mice provide deep insights into pathophysiological mechanisms. Future approaches should aim to mimic irreversible airflow obstruction, associated with cough and sputum production, with the possibility of inducing exacerbations.
Groneberg, David A; Chung, K Fan
Bidirectional Relationship between Chronic Kidney Disease & Periodontal Disease
Non communicable diseases (NCDs) affect the life of an individual in terms of mortality, morbidity and financial crises. Main NCDs are diabetes mellitus (DM), cardiovascular diseases (CVD), pulmonary diseases, osteoporosis and chronic kidney diseases (CKD). About 40% of the total deaths can be controlled by eliminating the risk factors for NCDs. Periodontitis have recently been labeled as an important potential risk factor for NCDs. CKD affect the oral health status of patients by inducing gingival hyperplasia, xerostomia, calcification of root canals and delayed eruption of teeth. Periodontitis increases systemic inflammatory burden leading to worsening of CKD which in turn has been has been found to negatively affect CKD of patients on hemodialysis therapy by altering their serum albumin and C-reactive protein levels. As hypoalbuminemia leads to increased mortality in CKD patients, it needs to be avoided by reducing systemic inflammatory burden in patients receiving HD therapy. Treating periodontal disease could be one factor that might decrease the systemic inflammatory burden and thereby improve quality of life of these patients. Sources of Data: Data from descriptive, cross sectional and longitudinal studies published between 2000 and 2012 were included. Data searches based on human studies only. Data Extraction: The key words, periodontitis, chronic kidney disease and hemodialysis, on MEDLINE, approximately 120 studies were identified. 35 of them were relevant to all three keywords. Most of them were cross sectional studies and total 7 clinical trials were identified regarding checking of serum levels after periodontal therapy with variable results. Conclusion: Patients with CKD have higher prevalence of periodontal disease while non-surgical periodontal therapy has been indicated to decrease the systemic inflammatory burden in patients with CKD specially those undergoing HD therapy.
Wahid, Arsalan; Chaudhry, Saima; Ehsan, Afifa; Butt, Sidra; Ali Khan, Ayyaz
Updated management of chronic kidney disease in patients with diabetes.
Chronic diseases, including chronic kidney disease (CKD), are the primary threat to global public health in the 21st century. Recently updated guidelines from the National Kidney Foundation's Kidney Disease Outcomes Quality Initiative provide patient care benchmarks that physician assistants can use when caring for patients with diabetes and CKD and developing clinical performance improvement plans. PMID:24819952
Hass, Virginia McCoy
Immunology of asthma and chronic obstructive pulmonary disease
Asthma and chronic obstructive pulmonary disease (COPD) are both obstructive airway diseases that involve chronic inflammation of the respiratory tract, but the type of inflammation is markedly different between these diseases, with different patterns of inflammatory cells and mediators being involved. As described in this Review, these inflammatory profiles are largely determined by the involvement of different immune cells, which
Peter J. Barnes
Early cardiovascular involvement in Chronic Obstructive Pulmonary Disease
Early cardiovascular involvement in Chronic Obstructive Pulmonary Disease. M. Malerba, G. Romanelli. Cardiovascular (CV) disease represents a consider- able risk factor in terms of both morbidity and mortality in elderly patients with chronic obstructive pulmonary disease (COPD). In fact, there is a considerable evidence of this association: for only 20 years forced expiratory vol- ume in 1 second (FEV1) has
M. Malerba; G. Romanelli
Chronic Disease Medication Administration Rates in a Public School System
ERIC Educational Resources Information Center
Anecdotal reports suggest school nurses and staff treat increasing numbers of public school students with chronic diseases. However, professionals know little about actual disease burden in schools. This study measured prevalence of chronic disease medication administration rates in a large, urban midwestern school district. Data from daily�
Weller, Lawrence; Fredrickson, Doren D.; Burbach, Cindy; Molgaard, Craig A.; Ngong, Lolem
Vitamin D and calcium deficits predispose for multiple chronic diseases
There is evidence from both observational studies and clinical trials that calcium malnutrition and hypovitaminosis D are predisposing conditions for various common chronic diseases. In addition to skeletal disorders, calcium and vitamin D deficits increase the risk of malignancies, particularly of colon, breast and prostate gland, of chronic inflammatory and autoimmune diseases (e.g. insulin-dependent diabetes mellitus, inflammatory bowel disease, multiple
M. Peterlik; H. S. Cross
Carnitine Levels in Patients with Chronic Rheumatic Heart Disease
Objective: Carnitine, a small aminoacid derivative plays a major role in fatty acid oxidation. Myocardial carnitine deficiency may cause malfunction of the heart. Rheumatic valvular heart disease can be associated with myocardial dysfunction. We have investigated myocardial and plasma-free carnitine levels in patients with chronic rheumatic heart disease.Material and Methods: Eleven patients with chronic rheumatic heart disease requiring valve replacement
Figen Narin; Nazmi Narin; Halit Anda�; Ali Ergin; Ali Co?kun; Muzaffer �stdal; Hakan Ceyran
Genomic Biomarkers for Chronic Kidney Disease
Chronic kidney disease (CKD) remains a major challenge in nephrology and for public health care, affecting 14�15% of the adult U.S. population and consuming significant health care resources. In the next 20 years, the number of patients with end stage renal disease is projected to increase by 50%. Ideal biomarkers that allow early identification of CKD patients at high risk of progression are urgently needed for early and targeted treatment to improve patient care. Recent success of integrating molecular approaches for personalized management of neoplastic diseases, including diagnosis, staging, prognosis, treatment selection and monitoring, has strongly encouraged kidney researchers to pursue molecular definitions of patients with kidney disease. Challenges for molecular marker identification in CKD are a high degree of cellular heterogeneity of the kidney and the paucity of human tissue availability for molecular studies. Despite these limitations potential molecular biomarker candidates have been uncovered at multiple levels along the genome � phenome continuum. Here we will review the identification and validation of potential genomic biomarker candidates of CKD and CKD progression in clinical studies. The challenges in predicting CKD progression, as well as the promises and opportunities resulting from a molecular definition of CKD will be discussed.
Ju, Wenjun; Smith, Shahaan; Kretzler, Matthias
Chronic obstructive pulmonary disease and its comorbidities.
Comorbidities of chronic obstructive pulmonary disease (COPD) include pneumonia, pulmonary embolism, lung cancer, musculoskeletal dysfunction, osteoporosis, gastroesophageal reflux disease, cardiac disease, diabetes, hyperlipidemia, anemia, and sleep dysfunction, amongst others. These medical conditions are commonly reported in COPD patients; however, the true prevalence of these conditions based on epidemiological studies is variable. Tobacco exposure is a common risk factor between COPD and many of its comorbidities but there is recent evidence that suggests that the harmful effects of these conditions on COPD is independent of their association with smoking. There has recently been an increasing focus on the impact that these health problems may have on the morbidity and mortality associated with COPD as these are now being recognized as part of the overall burden of the disease. It remains to be seen whether or not effective treatment of COPD reduces the risk of developing one of the comorbidities associated with it as well as if interventions that address specific comorbidities, such as improving anemia or preventing, will alter the natural course of COPD. Further investigation is required to gain a better understanding of the interrelationship between COPD and its comorbidities. PMID:19776712
Panetta, N L; Krachman, S; Chatila, W M
Genomic biomarkers for chronic kidney disease.
Chronic kidney disease (CKD) remains a major challenge in nephrology and for public health care, affecting 14% to 15% of the adult US population and consuming significant health care resources. In the next 20 years, the number of patients with end stage renal disease is projected to increase by 50%. Ideal biomarkers that allow early identification of CKD patients at high risk of progression are urgently needed for early and targeted treatment to improve patient care. Recent success of integrating molecular approaches for personalized management of neoplastic diseases, including diagnosis, staging, prognosis, treatment selection, and monitoring, has strongly encouraged kidney researchers to pursue molecular definitions of patients with kidney disease. Challenges for molecular marker identification in CKD are a high degree of cellular heterogeneity of the kidney and the paucity of human tissue availability for molecular studies. Despite these limitations, potential molecular biomarker candidates have been uncovered at multiple levels along the genome--phenome continuum. Here we will review the identification and validation of potential genomic biomarker candidates of CKD and CKD progression in clinical studies. The challenges in predicting CKD progression, as well as the promises and opportunities resulting from�a molecular definition of CKD will be discussed. PMID:22424432
Ju, Wenjun; Smith, Shahaan; Kretzler, Matthias
Abnormal joint torque patterns exhibited by chronic stroke subjects while walking with a prescribed physiological gait pattern
BACKGROUND: It is well documented that individuals with chronic stroke often exhibit considerable gait impairments that significantly impact their quality of life. While stroke subjects often walk asymmetrically, we sought to investigate whether prescribing near normal physiological gait patterns with the use of the Lokomat robotic gait-orthosis could help ameliorate asymmetries in gait, specifically, promote similar ankle, knee, and hip
Nathan D Neckel; Natalie Blonien; Diane Nichols; Joseph Hidler
Glycocholic acid in chronic active hepatitis and mild liver diseases
Serum levels of fasting glycocholic acid were measured in various noncirrhotic liver diseases. Forty-five patients were evaluated, 15 with chronic active hepatitis and 30 with mild liver diseases including chronic persistent hepatitis, steatosis, and minimal changes. There were increased levels of glycocholic acid in 53.3% of chronic active hepatitis cases and in 10% of mile liver disease cases (P=0.003), and
J. Collazos; Servicio de Medicina Interna
Application of Direct Renin Inhibition to Chronic Kidney Disease
Purpose��Chronic kidney disease has serious implications with a high risk for progressive loss of renal function, increased cardiovascular\\u000a events as well as a substantial financial burden. The renin-angiotensin-aldosterone system (RAAS) is activated in chronic\\u000a kidney disease, especially in diabetes and hypertension, which are the leading causes of chronic kidney disease. Angiotensin\\u000a converting enzyme (ACE) inhibitors and angiotensin receptor blockers (ARBs)
Christian W. Mende
Optimizing bone health in chronic kidney disease.
Phosphocalcic metabolism disorders often complicate chronic kidney disease (CKD) and worsen as kidney function declines, with a consequence on bone structural integrity. The risk of fracture exceeds that of the normal population in both patients with pre-dialysis CKD and end-stage renal disease (ESRD). The increasing incidence of CKD, the high mortality rate induced by hip fracture, the decreased quality of life and economic burden of fragility fracture make the renal bone disorders a major problem of public health around the world. Optimizing bone health in CKD patients should be a priority. Bone biopsy is invasive. Dual-energy X-ray absorptiometry, commonly used to screen individuals at risk of fragility fracture in the general population, is not adequate to assess advanced CKD because it does not discriminate fracture status in this population. New non-invasive three-dimensional high-resolution imaging techniques, distinguishing trabecular and cortical bone, appear to be promising in the assessment of bone strength and might improve bone fracture prediction in this population. Therapeutic intervention in the chronic kidney disease-mineral and bone disorders (CKD-MBD) should begin early in the course of CKD to maintain serum concentration of biological parameters involved in mineral metabolism in the normal recommended ranges, prevent the development of parathyroid hyperplasia, prevent extra-skeletal calcifications and preserve skeletal health. In this paper, we review studies of mineral and bone disorders in patients with CKD and ESRD, the utility of current techniques to assess bone health and the preventive and therapeutic strategies for managing CKD-MBD. PMID:20092971
Pelletier, Solenne; Chapurlat, Roland
Development and application of chronic disease risk prediction models.
Currently, non-communicable chronic diseases are a major cause of morbidity and mortality worldwide, and a large proportion of chronic diseases are preventable through risk factor management. However, the prevention efficacy at the individual level is not yet satisfactory. Chronic disease prediction models have been developed to assist physicians and individuals in clinical decision-making. A chronic disease prediction model assesses multiple risk factors together and estimates an absolute disease risk for the individual. Accurate prediction of an individual's future risk for a certain disease enables the comparison of benefits and risks of treatment, the costs of alternative prevention strategies, and selection of the most efficient strategy for the individual. A large number of chronic disease prediction models, especially targeting cardiovascular diseases and cancers, have been suggested, and some of them have been adopted in the clinical practice guidelines and recommendations of many countries. Although few chronic disease prediction tools have been suggested in the Korean population, their clinical utility is not as high as expected. This article reviews methodologies that are commonly used for developing and evaluating a chronic disease prediction model and discusses the current status of chronic disease prediction in Korea. PMID:24954311
Oh, Sun Min; Stefani, Katherine M; Kim, Hyeon Chang
Development and Application of Chronic Disease Risk Prediction Models
Currently, non-communicable chronic diseases are a major cause of morbidity and mortality worldwide, and a large proportion of chronic diseases are preventable through risk factor management. However, the prevention efficacy at the individual level is not yet satisfactory. Chronic disease prediction models have been developed to assist physicians and individuals in clinical decision-making. A chronic disease prediction model assesses multiple risk factors together and estimates an absolute disease risk for the individual. Accurate prediction of an individual's future risk for a certain disease enables the comparison of benefits and risks of treatment, the costs of alternative prevention strategies, and selection of the most efficient strategy for the individual. A large number of chronic disease prediction models, especially targeting cardiovascular diseases and cancers, have been suggested, and some of them have been adopted in the clinical practice guidelines and recommendations of many countries. Although few chronic disease prediction tools have been suggested in the Korean population, their clinical utility is not as high as expected. This article reviews methodologies that are commonly used for developing and evaluating a chronic disease prediction model and discusses the current status of chronic disease prediction in Korea.
Oh, Sun Min; Stefani, Katherine M.
Hypertension in Chronic Kidney Disease: Navigating the Evidence
Hypertension is both an important cause and consequence of chronic kidney disease. Evidence from numerous clinical trials has demonstrated the benefit of blood pressure control. However, it remains unclear whether available results could be extrapolated to patients with chronic kidney diseases because most studies on hypertension have excluded patients with kidney failure. In addition, chronic kidney disease encompasses a large group of clinical disorders with heterogeneous natural history and pathogenesis. In this paper, we review current evidence supporting treatment of hypertension in various forms of chronic kidney disease and highlight some of the gaps in the extant literature.
Tedla, F. M.; Brar, A.; Browne, R.; Brown, C.
[Chronic inflammatory bowel disease--current status].
Chronic inflammatory bowel disease (IBD) encompasses the disease entities, ulcerative colitis (UC) and Crohn's disease (CD). An aetiologic agent has not yet been defined and the diagnosis is based, therefore, on the sum of clinical, paraclinical, radiologic, endoscopic and histopathologic features. In recent years pathogenetic studies have focused on immune mechanisms, transmissible infectious agents, the potential role of the normal intestinal flora, dietary factors, enzymatic alterations and genetic features, in addition to vascular, neuromotor, allergic and psychologic factors. The prevalence of IBD is increased in first-degree relatives of patients and there is a high rate of disease concordance among monozygotic twins. Thus abnormal genes may encode for one or several immunoregulatory factors, while bacterial wall products seem to activate colonic inflammatory cells in a non-specific way, leading to increased production of cytokines, complement-derived peptides, eicosanoids, platelet activating factor, biogenic amines, kinins, chemotactic oligopeptides, and neuropeptides. The named soluble inflammatory mediators, in addition to free oxygen radicals, are considered responsible for the secondary amplification of the inflammatory process. The corner stones in medical therapy of IBD are still corticosteroids and sulphasalazine (SAZ). The new oral salicylates, which are analogues of SAZ or "slow release" preparations of 5-aminosalicylic acid (mesalazine), have provided a therapeutic progress, because they are tolerated better than SAZ. Immunosuppressive agents, such as azathioprine and 6-mercaptopurine, reduce the requirement for corticosteroids and are effective in refractory CD, but the effect is delayed up to several months. The therapeutic action of cyclosporine A is not sustained, but often associated with side effects. Metronidazole has a beneficial effect on perineal disease.(ABSTRACT TRUNCATED AT 250 WORDS) PMID:1413128
Madsen, J R; Laursen, L S; Lauritsen, K
Emerging drugs for chronic kidney disease.
Introduction: Chronic kidney disease (CKD) is a worldwide health problem. Despite remarkable headway in slowing the progression of kidney diseases, the incidence of end-stage renal disease (ESRD) is increasing in all countries with a severe impact on patients and society. The high incidence of diabetes and hypertension, along with the aging population, may partially explain this growth. Currently, the mainstay of pharmacological treatment for CKD, aiming to slow progression to ESRD are ACE inhibitors and angiotensin II receptor blockers for their hemodynamic/antihypertensive and anti-inflammatory/antifibrotic action. However, novel drugs would be highly desirable to effectively slow the progressive renal function loss. Areas covered: Through the search engines, PubMed and ClinicalTrial.gov, the scientific literature was reviewed in search of emerging drugs in Phase II or III trials, which appear to be the most promising for CKD treatment. Expert opinion: The great expectations for new drugs for the management of CKD over the last decade have unfortunately not been met. Encouraging results from preliminary studies with specific agents need to be tempered with caution, given the absence of consistent and adequate data. To date, several agents that showed great promise in animal studies have been less effective in humans. PMID:24836744
Stefoni, Sergio; Cianciolo, Giuseppe; Baraldi, Olga; Iorio, Mario; Angelini, Maria Laura
Dirty electricity, chronic stress, neurotransmitters and disease.
Dirty electricity, also called electrical pollution, is high-frequency voltage transients riding along the 50 or 60�Hz electricity provided by the electric utilities. It is generated by arcing, by sparking and by any device that interrupts current flow, especially switching power supplies. It has been associated with cancer, diabetes and attention deficit hyperactivity disorder in humans. Epidemiological evidence also links dirty electricity to most of the diseases of civilization including cancer, cardiovascular disease, diabetes and suicide, beginning at the turn of the twentieth century. The dirty electricity level in a public library was reduced from over 10�000 Graham/Stetzer (G/S) units to below 50�G/S units by installing plug-in capacitive filters. Before cleanup, the urinary dopamine level of only one of seven volunteers was within normal levels, while four of seven phenylethylamine levels were normal. After an initial decline, over the next 18�weeks the dopamine levels gradually increased to an average of over 215�?g/g creatinine, which is well above 170�?g/g creatinine, the high normal level for the lab. Average phenylethylamine levels also rose gradually to slightly above 70�?g/g creatinine, the high normal level for the lab. Neurotransmitters may be biomarkers for dirty electricity and other electromagnetic field exposures. We believe that dirty electricity is a chronic stressor of electrified populations and is responsible for many of their disease patterns. PMID:23323864
Milham, Samuel; Stetzer, David
Neuromotor control in chronic obstructive pulmonary disease.
Neuromotor control of skeletal muscles, including respiratory muscles, is ultimately dependent on the structure and function of the motor units (motoneurons and the muscle fibers they innervate) comprising the muscle. In most muscles, considerable diversity of contractile and fatigue properties exists across motor units, allowing a range of motor behaviors. In diseases such as chronic obstructive pulmonary disease (COPD), there may be disproportional primary (disease related) or secondary effects (related to treatment or other concomitant factors) on the size and contractility of specific muscle fiber types that would influence the relative contribution of different motor units. For example, with COPD there is a disproportionate atrophy of type IIx and/or IIb fibers that comprise more fatigable motor units. Thus fatigue resistance may appear to improve, while overall motor performance (e.g., 6-min walk test) and endurance (e.g., reduced aerobic exercise capacity) are diminished. There are many coexisting factors that might also influence motor performance. For example, in COPD patients, there may be concomitant hypoxia and/or hypercapnia, physical inactivity and unloading of muscles, and corticosteroid treatment, all of which may disproportionately affect specific muscle fiber types, thereby influencing neuromotor control. Future studies should address how plasticity in motor units can be harnessed to mitigate the functional impact of COPD-induced changes. PMID:23329816
Mantilla, Carlos B; Sieck, Gary C
Sputum myeloperoxidase in chronic obstructive pulmonary disease
Background Airway inflammation, especially neutrophilic airway inflammation, is a cardinal pathophysiologic feature in chronic obstructive pulmonary disease (COPD) patients. The ideal biomarkers characterizing the inflammation might have important potential clinical applications in disease assessment and therapeutic intervention. Sputum myeloperoxidase (MPO) is recognized as a marker of neutrophil activity. The purpose of this meta-analysis is to determine whether sputum MPO levels could reflect disease status or be regulated by regular medications for COPD. Methods Studies were identified by searching PubMed, Embase, the Cochrane Database, CINAHL and http://www.controlled-trials.com for relevant reports published before September 2012. Observational studies comparing sputum MPO in COPD patients and healthy subjects or asthmatics, or within the COPD group, and studies comparing sputum MPO before and after treatment were all included. Data were independently extracted by two investigators and analyzed using STATA 10.0 software. Results A total of 24 studies were included in the meta-analysis. Sputum MPO levels were increased in stable COPD patients when compared with normal controls, and this increase was especially pronounced during exacerbations as compared with MPO levels during the stable state. Theophylline treatment was able to reduce MPO levels in COPD patients, while glucocorticoid treatment failed to achieve the same result. Conclusion Sputum MPO might be a promising biomarker for guiding COPD management; however, further investigations are needed to confirm this.
Phosphorus and nutrition in chronic kidney disease.
Patients with renal impairment progressively lose the ability to excrete phosphorus. Decreased glomerular filtration of phosphorus is initially compensated by decreased tubular reabsorption, regulated by PTH and FGF23, maintaining normal serum phosphorus concentrations. There is a close relationship between protein and phosphorus intake. In chronic renal disease, a low dietary protein content slows the progression of kidney disease, especially in patients with proteinuria and decreases the supply of phosphorus, which has been directly related with progression of kidney disease and with patient survival. However, not all animal proteins and vegetables have the same proportion of phosphorus in their composition. Adequate labeling of food requires showing the phosphorus-to-protein ratio. The diet in patients with advanced-stage CKD has been controversial, because a diet with too low protein content can favor malnutrition and increase morbidity and mortality. Phosphorus binders lower serum phosphorus and also FGF23 levels, without decreasing diet protein content. But the interaction between intestinal dysbacteriosis in dialysis patients, phosphate binder efficacy, and patient tolerance to the binder could reduce their efficiency. PMID:22701173
Gonz�lez-Parra, Emilio; Gracia-Iguacel, Carolina; Egido, Jes�s; Ortiz, Alberto
Phosphorus and Nutrition in Chronic Kidney Disease
Patients with renal impairment progressively lose the ability to excrete phosphorus. Decreased glomerular filtration of phosphorus is initially compensated by decreased tubular reabsorption, regulated by PTH and FGF23, maintaining normal serum phosphorus concentrations. There is a close relationship between protein and phosphorus intake. In chronic renal disease, a low dietary protein content slows the progression of kidney disease, especially in patients with proteinuria and decreases the supply of phosphorus, which has been directly related with progression of kidney disease and with patient survival. However, not all animal proteins and vegetables have the same proportion of phosphorus in their composition. Adequate labeling of food requires showing the phosphorus-to-protein ratio. The diet in patients with advanced-stage CKD has been controversial, because a diet with too low protein content can favor malnutrition and increase morbidity and mortality. Phosphorus binders lower serum phosphorus and also FGF23 levels, without decreasing diet protein content. But the interaction between intestinal dysbacteriosis in dialysis patients, phosphate binder efficacy, and patient tolerance to the binder could reduce their efficiency.
Gonzalez-Parra, Emilio; Gracia-Iguacel, Carolina; Egido, Jesus; Ortiz, Alberto
Thyroid Disorders and Chronic Kidney Disease
Thyroid hormones play a very important role regulating metabolism, development, protein synthesis, and influencing other hormone functions. The two main hormones produced by the thyroid are triiodothyronine (T3) and thyroxine (T4). These hormones can also have significant impact on kidney disease so it is important to consider the physiological association of thyroid dysfunction in relation to chronic kidney disease (CKD). CKD has been known to affect the pituitary-thyroid axis and the peripheral metabolism of thyroid hormones. Low T3 levels are the most common laboratory finding followed by subclinical hypothyroidism in CKD patients. Hyperthyroidism is usually not associated with CKD but has been known to accelerate it. One of the most important links between thyroid disorders and CKD is uremia. Patients who are appropriately treated for thyroid disease have a less chance of developing renal dysfunction. Clinicians need to be very careful in treating patients with low T3 levels who also have an elevation in TSH, as this can lead to a negative nitrogen balance. Thus, clinicians should be well educated on the role of thyroid hormones in relation to CKD so that proper treatment can be delivered to the patient.
Reddy Maddika, Srikanth; Vyas, Anix; Iyer, Viswanathan; Cheriyath, Pramil
Immune Mechanisms Involved in Cardiovascular Complications of Chronic Kidney Disease
A sustained status of chronic inflammation is closely linked to several complications of chronic kidney disease (CKD), such as vascular degeneration, myocardial fibrosis, loss of appetite, insulin resistance, increased muscle catabolism and anemia. These consequences of a chronically activated immune system impact on the acceleration of atherosclerosis, vascular calcification and development of heart dysfunction. Recent evidence suggests that these immune-mediated
Andr�a E. M. Stinghen; Sergio Bucharles; Miguel C. Riella; R. Pecoits-Filho
Chronic Obstructive Pulmonary Disease: Evidence for an Autoimmune Component
Chronic obstructive pulmonary disease (COPD) is characterized by an irreversible limitation on pulmonary airflow associated with chronic inflammation and mucous hypersecretion (chronic bronchitis) and\\/or the pathological destruction of alveolar airspaces leading to emphysema. COPD, predominantly as a result of tobacco smoke exposure, represents the fourth leading cause of mortality worldwide and its prevalence is increasing. Despite this, much of the
Anna M. Stefanska; Patrick T. Walsh
Chronic Beryllium Disease Prevention Program Report
This document describes how Lawrence Livermore National Laboratory (LLNL) meets the requirements and management practices of federal regulation 10 CFR 850, 'Chronic Beryllium Disease Prevention Program (CBDPP).' This revision of the LLNL CBDPP incorporates clarification and editorial changes based on lessons learned from employee discussions, observations and reviews of Department of Energy (DOE) Complex and commercial industry beryllium (Be) safety programs. The information is used to strengthen beryllium safety practices at LLNL, particularly in the areas of: (1) Management of small parts and components; and (2) Communication of program status to employees. Future changes to LLNL beryllium activities and on-going operating experience will be incorporated into the program as described in Section S, 'Performance Feedback.'
Lee, S
Growth hormone in chronic renal disease
Severe growth retardation (below the third percentile for height) is seen in up to one-third children with chronic kidney disease. It is thought to be multifactorial and despite optimal medical therapy most children are unable to reach their normal height. Under-nutrition, anemia, vitamin D deficiency with secondary hyperparathyroidism, metabolic acidosis, hyperphosphatemia, renal osteodystrophy; abnormalities in the growth hormone/insulin like growth factor system and sex steroids, all have been implicated in the pathogenesis of growth failure. Therapy includes optimization of nutritional and metabolic abnormalities. Failure to achieve adequate height despite 3�6 months of optimal medical measures mandates the use of recombinant GH (rGH) therapy, which has shown to result in catch-up growth, anywhere from 2 cm to 10 cm with satisfactory liner, somatic and psychological development.
Gupta, Vishal; Lee, Marilyn
Autonomic dysfunction in chronic liver disease
It is becoming increasingly clear that quality of life (QOL) is impaired in those with chronic liver disease (CLD). One of the most important contributors to impaired QOL is the symptomatic burden which can range from slight to debilitating. Autonomic dysfunction accounts for a significant proportion of these symptoms, which can be common, non-specific and challenging to treat. Investigating the autonomic nervous system can be straight forward and can assist the clinician to diagnose and treat specific symptoms. Evidence-based treatment options for autonomic symptoms, specifically in CLD, can be lacking and must be extrapolated from other studies and expert opinion. For those with severely impaired quality of life, liver transplantation may offer an improvement; however, more research is needed to confirm this.
Frith, James; Newton, Julia L
[Iron, hepcidin and chronic kidney disease].
Iron deficiency is commonly observed in chronic kidney disease. Blood loss and iron consumption under erythropiesis activating agents (ESA) induce absolute deficiency whereas defect of iron intestinal absorption and storage release account for functional deficiency. High hepcidin plasma levels are probably induced by inflammatory process and can explain functional deficiency. However, hepcidin is negatively correlated with ESA needs and hepcidin expression is influenced by other factors as degree of renal insufficiency, iron pool, treatments (iron IV and ESA). IV iron is the common therapeutic approach of iron deficiency and only normalized iron marrow supply cannot account for his efficiency. New IV iron products allow us to conceive new therapeutic schemes. Hepcidin inhibition is another therapeutic alternative. PMID:21186144
Fievet, Patrick; Brazier, Fran�ois
Anemia of chronic disease and defective erythropoietin production in patients with celiac disease
Background Anemia due to hematinic deficiencies is common in patients with untreated celiac disease. Although celiac disease is a chronic condition characterized by an intense inflammator y response of the intestinal mucosa, scant data are available about the prevalence of anemia of chronic disease in celiac disease. Design and Methods One hundred and fifty-two patients with celiac disease at presentation
Gaetano Bergamaschi; Konstantinos Markopoulos; Riccardo Albertini; Federico Biagi; Rachele Ciccocioppo; Eloisa Arbustini; Gino Roberto Corazza
Cardiovascular disease in chronic kidney disease. A clinical update from Kidney Disease: Improving Global Outcomes (KDIGO)
Cardiovascular morbidity and mortality in patients with chronic kidney disease (CKD) is high, and the presence of CKD worsens outcomes of cardiovascular disease (CVD). CKD is associated with specific risk factors. Emerging evidence indicates that the pathology and manifestation of CVD differ in the presence of CKD. During a clinical update conference convened by the Kidney Disease: Improving Global Outcomes
Charles A Herzog; Richard W Asinger; Alan K Berger; David M Charytan; Javier D�ez; Robert G Hart; Kai-Uwe Eckardt; Bertram L Kasiske; Peter A McCullough; Rod S Passman; Stephanie S DeLoach; Patrick H Pun; Eberhard Ritz
Vitamin D and chronic kidney disease
Chronic kidney disease (CKD) has been recognized as a significant global health problem because of the increased risk of total and cardiovascular morbidity and mortality. Vitamin D deficiency or insufficiency is common in patients with CKD, and serum levels of vitamin D appear to have an inverse correlation with kidney function. Growing evidence has indicated that vitamin D deficiency may contribute to deteriorating renal function, as well as increased morbidity and mortality in patients with CKD. Recent studies have suggested that treatment with active vitamin D or its analogues can ameliorate renal injury by reducing fibrosis, apoptosis, and inflammation in animal models; this treatment also decreases proteinuria and mortality in patients with CKD. These renoprotective effects of vitamin D treatment are far beyond its classical role in the maintenance of bone and mineral metabolism, in addition to its pleiotropic effects on extra-mineral metabolism. In this review, we discuss the altered metabolism of vitamin D in kidney disease, and the potential renoprotective mechanisms of vitamin D in experimental and clinical studies. In addition, issues regarding the effects of vitamin D treatment on clinical outcomes are discussed.
Kim, Chang Seong
Molecular diagnosis of chronic granulomatous disease.
Patients with chronic granulomatous disease (CGD) suffer from recurrent, life-threatening bacterial and fungal infections of the skin, the airways, the lymph nodes, liver, brain and bones. Frequently found pathogens are Staphylococcus aureus, Aspergillus species, Klebsiella species, Burkholderia cepacia and Salmonella species. CGD is a rare (?1:250?000 births) disease caused by mutations in any one of the five components of the nicotinamide adenine dinucleotide phosphate (NADPH) oxidase in phagocytes. This enzyme generates superoxide and is essential for intracellular killing of pathogens by phagocytes. Molecular diagnosis of CGD involves measuring NADPH oxidase activity in phagocytes, measuring protein expression of NADPH oxidase components and mutation analysis of genes encoding these components. Residual oxidase activity is important to know for estimation of the clinical course and the chance of survival of the patient. Mutation analysis is mandatory for genetic counselling and prenatal diagnosis. This review summarizes the different assays available for the diagnosis of CGD, the precautions to be taken for correct measurements, the flow diagram to be followed, the assays for confirmation of the diagnosis and the determinations for carrier detection and prenatal diagnosis. PMID:24016250
Roos, D; de Boer, M
Chronic kidney disease in acute coronary syndromes
Chronic kidney disease (CKD) is associated with a high burden of coronary artery disease. In patients with acute coronary syndromes (ACS), CKD is highly prevalent and associated with poor short- and long-term outcomes. Management of patients with CKD presenting with ACS is more complex than in the general population because of the lack of well-designed randomized trials assessing therapeutic strategies in such patients. The almost uniform exclusion of patients with CKD from randomized studies evaluating new targeted therapies for ACS, coupled with concerns about further deterioration of renal function and therapy-related toxic effects, may explain the less frequent use of proven medical therapies in this subgroup of high-risk patients. However, these patients potentially have much to gain from conventional revascularization strategies used in the general population. The objective of this review is to summarize the current evidence regarding the epidemiology and the clinical and prognostic relevance of CKD in ACS patients, in particular with respect to unresolved issues and uncertainties regarding recommended medical therapies and coronary revascularization strategies.
Marenzi, Giancarlo; Cabiati, Angelo; Assanelli, Emilio
Chronic kidney disease alters intestinal microbial flora.
The population of microbes (microbiome) in the intestine is a symbiotic ecosystem conferring trophic and protective functions. Since the biochemical environment shapes the structure and function of the microbiome, we tested whether uremia and/or dietary and pharmacologic interventions in chronic kidney disease alters the microbiome. To identify different microbial populations, microbial DNA was isolated from the stools of 24 patients with end-stage renal disease (ESRD) and 12 healthy persons, and analyzed by phylogenetic microarray. There were marked differences in the abundance of 190 bacterial operational taxonomic units (OTUs) between the ESRD and control groups. OTUs from Brachybacterium, Catenibacterium, Enterobacteriaceae, Halomonadaceae, Moraxellaceae, Nesterenkonia, Polyangiaceae, Pseudomonadaceae, and Thiothrix families were markedly increased in patients with ESRD. To isolate the effect of uremia from inter-individual variations, comorbid conditions, and dietary and medicinal interventions, rats were studied 8 weeks post 5/6 nephrectomy or sham operation. This showed a significant difference in the abundance of 175 bacterial OTUs between the uremic and control animals, most notably as decreases in the Lactobacillaceae and Prevotellaceae families. Thus, uremia profoundly alters the composition of the gut microbiome. The biological impact of this phenomenon is unknown and awaits further investigation. PMID:22992469
Vaziri, Nosratola D; Wong, Jakk; Pahl, Madeleine; Piceno, Yvette M; Yuan, Jun; DeSantis, Todd Z; Ni, Zhenmin; Nguyen, Tien-Hung; Andersen, Gary L
Building the chronic kidney disease management team.
The need to be efficient and the demands for performance-based service are changing how nephrologists deliver care. Chronic kidney disease (CKD) occurs in patients with complex medical and social problems. CKD management requires that multidisciplinary professionals provide patient education, disease management, and psychosocial support. To remain cost-efficient, many physicians are training and supervising midlevel practitioners in the delivery of specialized health care. Specialized care that meets present CKD patient needs is best delivered in a CKD clinic. Three models of CKD clinic are identified: (1) anemia management CKD clinic, (2) the basic CKD clinic, and (3) the comprehensive CKD clinic. Each clinic model is based on critical elements of staffing, billable services, and patient-focused health care. Billable services are anemia-management services, physician services that may be provided by midlevel practitioners, and medical nutrition therapy. In some cases, social worker services may be billable. Building a patient-focused clinic that offers CKD management requires planning, familiarity with federal regulations and statutes, and skillful practitioners. Making services cost-efficient and outcome oriented requires careful physician leadership, talented midlevel practitioners, and billing professionals who understand the goals of the CKD clinic. As Medicare payment reforms evolve, a well-organized CKD program can be well poised to meet the requirements of payers and congressional mandates for performance-based purchasing. PMID:18155107
Spry, Leslie
Vegetarian diets, chronic diseases and longevity.
Vegetarians form a non-homogenous group consisting of semivegetarians (plant food, dairy products, eggs and fish), lacto-ovo vegetarians (plant food, dairy products, eggs) and vegans (plant food only). According to pure vegetarian ideologists, people consuming vegetarian diet have better health and live longer than nonvegetarians, because persons consuming milk, dairy products, meat, eggs and fish are at health risk. In fact the most healthy people in Europe are inhabitants of Iceland, Switzerland and Scandinavia, consuming great amounts of food of animal origin. Meta-analysis of several prospective studies showed no significant differences in the mortality caused by colorectal, stomach, lung, prostate or breast cancers and stroke between vegetarians and "health-conscious" nonvegetarians. In vegetarians, a decrease of ischemic heart disease mortality was observed probably due to lower total serum cholesterol levels, lower prevalence of obesity and higher consumption of antioxidants. Very probably, an ample consumption of fruits and vegetables and not the exclusion of meat make vegetarians healthful. Now, the largest cohort study of diet and health on more than half million of persons, the European Prospective Investigation into Cancer and Nutrition (EPIC) study, will bring new data on the relationships between diet, lifestyle and environmental factors and the incidence of cancer, cardiovascular and other chronic diseases. Vegetarianism is a form of food restriction; and in our overfed society, food restriction is a plus unless it results in a nutritional deficiency (Fig. 1, Tab. 2, Ref. 18). PMID:19166134
Ginter, E
Arterial stiffness in chronic kidney disease: causes and consequences
Chronic kidney disease is associated with elevated cardiovascular risk, and heart failure and arrhythmias are the biggest causes of cardiovascular death in this population. Increased arterial stiffness is a hallmark of chronic kidney disease and is associated with adverse alterations in cardiac structure and function that may predispose to an increased risk of cardiovascular death. These changes are already apparent
Colin D Chue; Jonathan N Townend; Richard P Steeds; Charles J Ferro
Bioecological control of chronic liver disease and encephalopathy
Minimal encephalopathy was originally associated with chronic liver disease but is increasingly associated with most other\\u000a chronic diseases and particularly with diabetes and also chronic disorders in other organs: kidneys, lungs, thyroid and with\\u000a obesity. It is increasingly with dramatically increased and more or less permanent increase in systemic inflammation, most\\u000a likely a result of Western lifestyle. Frequent physical exercise
Stig Bengmark
Treatment of hypertension in chronic kidney disease.
Chronic kidney disease (CKD) is a major public health problem in the United States. It is estimated that nearly 20 million Americans have some degree of chronic kidney disease defined as an estimated glomerular filtration rate of less than sixty milliliters per minute or evidence of kidney damage by imaging study, biopsy, biochemical testing or urine tests with an estimated glomerular filtration rate more than sixty milliliters per minute. Hypertension is present in more than 80% of patients with CKD and contributes to progression of kidney disease toward end stage (ESRD) as well as to cardiovascular events such as heart attack and stroke. In fact the risk for cardiovascular death in this patient population is greater than the risk for progression to ESRD. Proteinuria is an important co-morbidity in hypertensives with CKD and increase risk of disease progression and cardiovascular events. Treatment of hypertension is therefore imperative. The National Kidney Foundation clinical practice guidelines recommend a blood pressure goal of <130 mmHg systolic and <80 mmHg diastolic for all CKD patients. Recent post-hoc analyses of the Modification of Diet in Renal Disease study indicate that lower blood pressure may provide long-term kidney protection in patients with nondiabetic kidney disease. Specifically a mean arterial pressure <92 mmHg (e.g. 120/80 mmHg) as compared to 102-107 mmHg (e.g. 140/90 mmHg) is associated with reduced risk for ESRD. In most cases achieving this goal requires both non-pharmacologic and pharmacologic intervention. Dietary sodium restriction to no more than 2 grams daily is important. In addition, moderate alcohol intake, regular exercise, weight loss in those with a body mass index greater than 25 kg/M(2) and reduced amount of saturated fat help to reduce blood pressure. The first line pharmacologic intervention should be an angiotensin converting enzyme inhibitor or angiotensin II type 1 receptor blocker in those with diabetes or non-diabetics with more than 200 mg protein/gram creatinine on a random urine sample. For non-diabetics with less than 200 mg protein/gram creatinine on a random urine sample, no specific first-line drug class is recommended. After initial dosing with an ACEi, ARB or other drug, a diuretic should be added to the regimen. Thereafter, beta-blockers, calcium channel blockers, apha blockers and alpha 2 agonists (e.g. clonidine) and finally vasodilators (e.g. minoxidil) should be added to achieve blood pressure goal. Combinations of ACEi and ARB are helpful in reducing proteinuria and may also lower blood pressure further in some some cases. Blood pressure should be monitored closely in hypertensive patients with CKD and both clinic and home blood pressure measurements may help the clinician adjust treatment. PMID:16298269
Toto, Robert D
Vitamin D and chronic kidney disease.
Chronic kidney disease (CKD) is an emerging public health problem and one of the most powerful predictors of premature cardiovascular disease. Emerging evidence suggests that the progression of CKD and many of the cardiovascular complications may be linked to hypovitaminosis D. Patients with CKD have an exceptionally high rate of severe vitamin D deficiency that is further exacerbated by the reduced ability to convert 25-(OH)vitamin D into the active form, 1,25 dihydroxy-vitamin D. As new evidence has improved our understanding of classical, as well as the nonclassical, functions for vitamin D, it has become apparent that the autocrine role of vitamin D is an important modulator of several systems including the immune, renal and cardiovascular systems. In addition to the traditional supplementation of 1,25-vitamin D to CKD patients, by assessing and repleting 25-(OH)vitamin D deficiency, physicians will adequately fuel both the renal and extra-renal pathways of calcitriol synthesis maintaining the classical, as well as the non-classical, functions of vitamin D that ultimately influence clinical outcomes in this high-risk group of patients. Because of the high rates of hypovitaminosis D and progression of CKD to end-stage renal disease in minority populations, these findings are highly relevant to the national efforts to reduce health disparities. Healthcare providers are called to join the intensified efforts of public health officials to disseminate and implement updated guidelines and recommendations to halt the growing epidemic of vitamin D deficiency, particularly in high-risk populations. PMID:20077598
Williams, Sandra; Malatesta, Karla; Norris, Keith
Invasive Aspergillus infections in hospitalized patients with chronic lung disease
Background Although invasive pulmonary aspergillosis (IPA) is more prevalent in immunocompromised patients, critical care clinicians need to be aware of the occurrence of IPA in the nontraditional host, such as a patient with chronic lung disease. The purpose of this study was to describe the IPA patient with chronic lung disease and compare the data with that of immunocompromised patients. Methods The records of 351 patients with Aspergillus were evaluated in this single-center, retrospective study for evidence and outcomes of IPA. The outcomes of 57 patients with chronic lung disease and 56 immunocompromised patients were compared. Patients with chronic lung disease were defined by one of the following descriptive terms: emphysema, asthma, idiopathic lung disease, bronchitis, bronchiectasis, sarcoid, or pulmonary leukostasis. Results Baseline demographics were similar between the two groups. Patients with chronic lung disease were primarily defined by emphysema (61%) and asthma (18%), and immunocompromised patients primarily had malignancies (27%) and bone marrow transplants (14%). A higher proportion of patients with chronic lung disease had a diagnosis of IPA by bronchoalveolar lavage versus the immunocompromised group (P < 0.03). The major risk factors for IPA were found to be steroid use in the chronic lung disease group and neutropenia and prior surgical procedures in the immunocompromised group. Overall, 53% and 69% of chronic lung disease and immunocompromised patients were cured (P = 0.14); 55% of chronic lung patients and 47% of immunocompromised patients survived one month (P = 0.75). Conclusion Nontraditional patients with IPA, such as those with chronic lung disease, have outcomes and mortality similar to that in the more traditional immunocompromised population.
Wessolossky, Mireya; Welch, Verna L; Sen, Ajanta; Babu, Tara M; Luke, David R
Acute Exacerbation of Chronic Obstructive Pulmonary Disease: Cardiovascular Links
Chronic obstructive pulmonary disease (COPD) is a chronic, progressive lung disease resulting from exposure to cigarette smoke, noxious gases, particulate matter, and air pollutants. COPD is exacerbated by acute inflammatory insults such as lung infections (viral and bacterial) and air pollutants which further accelerate the steady decline in lung function. The chronic inflammatory process in the lung contributes to the extrapulmonary manifestations of COPD which are predominantly cardiovascular in nature. Here we review the significant burden of cardiovascular disease in COPD and discuss the clinical and pathological links between acute exacerbations of COPD and cardiovascular disease.
Laratta, Cheryl R.; van Eeden, Stephan
Hemoglobin Decline in Children with Chronic Kidney Disease: Baseline Results from the Chronic Kidney Disease in Children Prospective Cohort Study
Background and objectives: The level of glomerular filtration rate at which hemoglobin declines in chronic kidney disease is poorly described in the pediatric population. Design, setting, participants, & measurements: This cross-sectional study of North American children with chronic kidney disease examined the association of glomerular filtration rate, determined by the plasma disappearance of iohexol, and hemoglobin concentration. Results: Of the
Jeffrey J. Fadrowski; Christopher B. Pierce; Stephen R. Cole; Marva Moxey-Mims; Bradley A. Warady; Susan L. Furth
Disease progression and outcomes in chronic kidney disease and renal transplantation
Disease progression and outcomes in chronic kidney disease and renal transplantation.BackgroundIt is unknown whether renal transplant recipients (RTR) have better outcomes and disease progression rates compared to patients with chronic kidney disease (CKD) when matched for the level of kidney function.MethodsWe analyzed data on 1762 patients with CKD (N = 872) and RTR (N = 890) over 16 years, applying
Arjang Djamali; Christina Kendziorski; Peter C. Brazy; Bryan N. Becker
The spectrum of cardiovascular disease in children with predialysis chronic kidney disease
Cardiovascular disease is the major cause of mortality in adults and children on chronic dialysis and in adults after kidney transplantation. Cardiovascular disease burden and cardiovascular mortality are high in adults with chronic kidney disease. The early development of cardiovascular disease risk factors, some of which are modifiable, largely explain this phenomenon. Limited data are available on the prevalence of
Blanche M Chavers; Charles A Herzog
Prevalence of anemia in chronic obstructive pulmonary disease: comparison to other chronic diseases.
Chronic obstructive pulmonary disease (COPD) is a multisystemic inflammatory disease characterized by pulmonary and extrapulmonary symptoms. The impaired lung function has long-term implications on metabolism and homeostasis of many organ systems such as the skeleton, heart, brain and skeletal muscle. The occurrence and prevalence of anemia in COPD has rarely been studied. Anemia is such a common and simple clinical finding that we may underestimate its physiological relevance in COPD. The aim of the study was to retrospectively investigate the prevalence of anemia in a large population of COPD patients and to compare it to patients with chronic heart failure, renal insufficiency, cancer and asthma. A population of 7337 patients that was treated in the University Hospital Charit�, Berlin, Germany, from 1996 to 2003 was subsetted according to the ICD-9/10 code of the discharge diagnoses into the above-mentioned diagnoses groups. The overall prevalence of anemia in COPD patients was 23.1%. It was comparable to the prevalence of anemia we found in patients with chronic heart failure (23.3%). Patients with renal insufficiency and cancer presented the highest anemia frequencies. The high prevalence of anemia in hospitalised COPD patients that were treated mostly for exacerbations gives evidence that anemia is also a comorbidity in COPD and may contribute to exercise limitation and dyspnoea. PMID:16242192
John, Matthias; Lange, Andre; Hoernig, Soeren; Witt, Christian; Anker, Stefan D
The Microvasculature in Chronic Kidney Disease
Summary Background and objectives Individuals with chronic kidney disease (CKD) stages 3 to 5 have an increased risk of cardiac and other vascular disease. Here we examined the association of CKD 3 to 5 with small vessel caliber. Design, setting, participants, & measurements This was a cross-sectional observational study of 126 patients with CKD stages 3 to 5 (estimated GFR [eGFR] <60 ml/min per 1.73 m2) and 126 age- and gender-matched hospital patients with CKD 1 or 2. Retinal vessel diameters were measured from digital fundus images by a trained grader using a computer-assisted method and summarized as the central retinal artery equivalent (CRAE) and central retinal vein equivalent (CRVE). Results Patients with CKD 3 to 5 had a smaller mean CRAE and CRVE than hospital controls (139.4 � 17.8 ?m versus 148.5 � 16.0 ?m, P < 0.001; and 205.0 � 30.7 ?m versus 217.4 � 25.8 ?m, respectively; P = 0.001). CRAE and CRVE decreased progressively with each stage of renal failure CKD1�2 to 5 (P for trend = 0.08 and 0.04, respectively). CKD and hypertension were independent determinants of arteriolar narrowing after adjusting for age, gender, diabetes, dyslipidemia, and smoking history. Patients with CKD 5 and diabetes had a larger mean CRAE and CRVE than nondiabetics (141.4 � 14.9 ?m versus 132.9 � 14.2 ?m; 211.1 � 34.4 ?m versus 194.8 � 23.8 ?m). Conclusions The microvasculature is narrowed in patients with reduced eGFR.
Ooi, Qi Lun; Tow, Foong Kien Newk-Fon Hey; Deva, Raj; Alias, Mohamad Afzal; Kawasaki, Ryo; Wong, Tien Y.; Mohamad, Nor; Colville, Deb; Hutchinson, Anastasia
Cognitive Impairment in Chronic Obstructive Pulmonary Disease
Background/Purpose Chronic obstructive pulmonary disease (COPD), especially in severe forms, is commonly associated with multiple cognitive problems. Montreal Cognitive Assessment test (MoCA) is used to detect cognitive impairment evaluating several areas: visuospatial, memory, attention and fluency. Our study aim was to evaluate the impact of stable COPD and exacerbation (AECOPD) phases on cognitive status using MoCA questionnaire. Methods We enrolled 39 patients (pts), smokers with COPD group D (30 stable and 9 in AECOPD) and 13 healthy subjects (control group), having similar level of education and no significant differences regarding the anthropometric measurements. We analyzed the differences in MoCA score between these three groups and also the correlation between this score and inflammatory markers. Results Patients with AECOPD had a significant (p<0.001) decreased MoCA score (14.6�3.4) compared to stable COPD (20.2�2.4) and controls (24.2�5.8). The differences between groups were more accentuated for the language abstraction and attention (p<0.001) and delayed recall and orientation (p<0.001) sub-topics. No significant variance of score was observed between groups regarding visuospatial and naming score (p?=?0.095). The MoCA score was significantly correlated with forced expiratory volume (r?=?0.28) and reverse correlated with C-reactive protein (CRP) (r?=??0.57), fibrinogen (r?=??0.58), erythrocyte sedimentation rate (ESR) (r?=??0.55) and with the partial pressure of CO2 (r?=??0.47). Conclusions According to this study, COPD significantly decreases the cognitive status in advanced and acute stages of the disease.
Crisan, Alexandru F.; Oancea, Cristian; Timar, Bogdan; Fira-Mladinescu, Ovidiu; Crisan, Alexandru; Tudorache, Voicu
[Current trends in liver biopsy indications in chronic liver diseases].
Liver biopsy (LB) remains a major tool in chronic liver disease evaluation. Main current indications of LB in chronic liver disease are reviewed in this manuscript. Major development of non-invasive tools for evaluation of liver fibrosis led to decrease of LB indications in patients with chronic hepatitis C. LB is the only tool for exploration of necroinflammatory and fibrosis lesions in chronic hepatitis B as well as in autoimmune hepatitis. LB is the sole exam that can differentiate between bland steatosis and steatohepatitis in the setting of metabolic syndrome and to confirm the diagnosis of alcoholic hepatitis when corticosteroids are indicated. PMID:22425478
Cadranel, Jean-Fran�ois; Nousbaum, Jean-Baptiste
Venous disease and chronic oedema: treatment and patient concordance.
Compression therapy is the mainstay in the management of chronic venous disease, venous leg ulceration (VLU) and chronic oedema. The management of VLU alone is thought to cost a staggering �400 million per year and accounts for 13% of all district nursing visits. The predicted increase in elderly, obese and chronically ill patients will pose a further strain on already stretched resources. The impact of chronic venous and lymphovenous disease is also costly in terms of physical and psychological terms for patients. Adopting a preventive approach would reduce the financial, workload and symptomatic aspects of this condition. PMID:24820810
Todd, Marie
Neurological complications of chronic kidney disease.
Chronic kidney disease (CKD) is a critical and rapidly growing global health problem. Neurological complications occur in almost all patients with severe CKD, potentially affecting all levels of the nervous system, from the CNS through to the PNS. Cognitive impairment, manifesting typically as a vascular dementia, develops in a considerable proportion of patients on dialysis, and improves with renal transplantation. Patients on dialysis are generally weaker, less active and have reduced exercise capacity compared with healthy individuals. Peripheral neuropathy manifests in almost all such patients, leading to weakness and disability. Better dialysis strategies and dietary modification could improve outcomes of transplantation if implemented before surgery. For patients with autonomic neuropathy, specific treatments, including sildenafil for impotence and midodrine for intradialytic hypotension, are effective and well tolerated. Exercise training programs and carnitine supplementation might be beneficial for neuromuscular complications, and restless legs syndrome in CKD responds to dopaminergic agonists and levodopa treatment. The present Review dissects the pathophysiology of neurological complications related to CKD and highlights the spectrum of therapies currently available. PMID:19724248
Krishnan, Arun V; Kiernan, Matthew C
Resistant Hypertension in Nondialysis Chronic Kidney Disease
Resistant hypertension (RH) is defined as blood pressure (BP) that remains above the target of less than 140/90?mmHg in the general population and 130/80?mmHg in people with diabetes mellitus or chronic kidney disease (CKD) in spite of the use of at least three full-dose antihypertensive drugs including a diuretic or as BP that reaches the target by means of four or more drugs. In CKD, RH is a common condition due to a combination of factors including sodium retention, increased activity of the renin-angiotensin system, and enhanced activity of the sympathetic nervous system. Before defining the hypertensive patient as resistant it is mandatory to exclude the so-called �pseudoresistance.� This condition, which refers to the apparent failure to reach BP target in spite of an appropriate antihypertensive treatment, is mainly caused by white coat hypertension that is prevalent (30%) in CKD patients. Recently we have demonstrated that �true� RH represents an independent risk factor for renal and cardiovascular outcomes in CKD patients.
Stanzione, Giovanna; Conte, Giuseppe
Prevalence of chronic kidney disease in an urban Mexican population
Prevalence of chronic kidney disease in an urban Mexican population.BackgroundThe present study was primarily designed to assess the prevalence of chronic kidney disease in a Mexican urban population residing in Mexico and to evaluate certain biologic and socioeconomic conditions as risk factors for the development of renal disease.MethodsA population-based cross-sectional survey was conducted, which included 3564 patients of either gender
Atherosclerotic cardiovascular disease risks in chronic hemodialysis patients
Atherosclerotic cardiovascular disease risks in chronic hemodialysis patients.BackgroundCardiovascular diseases are the most common causes of death among chronic hemodialysis patients, yet the risk factors for these events have not been well established.MethodsIn this cross-sectional study, we examined the relationship between several traditional cardiovascular disease risk factors and the presence or history of cardiovascular events in 936 hemodialysis patients enrolled in
Alfred K. Cheung; Mark J. Sarnak; Guofen Yan; Johanna T. Dwyer; Robert J. Heyka; Michael V. Rocco; Brendan P. Teehan; Andrew S. Levey
Evidence for prescribing exercise as therapy in chronic disease.
Considerable knowledge has accumulated in recent decades concerning the significance of physical activity in the treatment of a number of diseases, including diseases that do not primarily manifest as disorders of the locomotive apparatus. In this review we present the evidence for prescribing exercise therapy in the treatment of metabolic syndrome-related disorders (insulin resistance, type 2 diabetes, dyslipidemia, hypertension, obesity), heart and pulmonary diseases (chronic obstructive pulmonary disease, coronary heart disease, chronic heart failure, intermittent claudication), muscle, bone and joint diseases (osteoarthritis, rheumatoid arthritis, osteoporosis, fibromyalgia, chronic fatigue syndrome) and cancer, depression, asthma and type 1 diabetes. For each disease, we review the effect of exercise therapy on disease pathogenesis, on symptoms specific to the diagnosis, on physical fitness or strength and on quality of life. The possible mechanisms of action are briefly examined and the principles for prescribing exercise therapy are discussed, focusing on the type and amount of exercise and possible contraindications. PMID:16451303
Pedersen, B K; Saltin, B
77 FR 43092 - Agency Information Collection Activities; Proposed Collection; Comment Request; Chronic Disease...
Federal Register 2010, 2011, 2012, 2013
...Chronic Disease Self-Management Education Program Standardized Data...the Chronic Disease Self-Management Education Program. DATES: Submit...through Chronic Disease Self-Management Education (CDSME) Programs''...
Pesticides and human chronic diseases: evidences, mechanisms, and perspectives.
Along with the wide use of pesticides in the world, the concerns over their health impacts are rapidly growing. There is a huge body of evidence on the relation between exposure to pesticides and elevated rate of chronic diseases such as different types of cancers, diabetes, neurodegenerative disorders like Parkinson, Alzheimer, and amyotrophic lateral sclerosis (ALS), birth defects, and reproductive disorders. There is also circumstantial evidence on the association of exposure to pesticides with some other chronic diseases like respiratory problems, particularly asthma and chronic obstructive pulmonary disease (COPD), cardiovascular disease such as atherosclerosis and coronary artery disease, chronic nephropathies, autoimmune diseases like systemic lupus erythematous and rheumatoid arthritis, chronic fatigue syndrome, and aging. The common feature of chronic disorders is a disturbance in cellular homeostasis, which can be induced via pesticides' primary action like perturbation of ion channels, enzymes, receptors, etc., or can as well be mediated via pathways other than the main mechanism. In this review, we present the highlighted evidence on the association of pesticide's exposure with the incidence of chronic diseases and introduce genetic damages, epigenetic modifications, endocrine disruption, mitochondrial dysfunction, oxidative stress, endoplasmic reticulum stress and unfolded protein response (UPR), impairment of ubiquitin proteasome system, and defective autophagy as the effective mechanisms of action. PMID:23402800
Mostafalou, Sara; Abdollahi, Mohammad
Chronic Lyme disease: the controversies and the science.
The diagnosis of chronic Lyme disease has been embroiled in controversy for many years. This is exacerbated by the lack of a clinical or microbiologic definition, and the commonality of chronic symptoms in the general population. An accumulating body of evidence suggests that Lyme disease is the appropriate diagnosis for only a minority of patients in whom it is suspected. In prospective studies of Lyme disease, very few patients go on to have a chronic syndrome dominated by subjective complaints. There is no systematic evidence that Borrelia burgdorferi, the etiology of Lyme disease, can be identified in patients with chronic symptoms following treated Lyme disease. Multiple prospective trials have revealed that prolonged courses of antibiotics neither prevent nor alleviate such post-Lyme syndromes. Extended courses of intravenous antibiotics have resulted in severe adverse events, which in light of their lack of efficacy, make them contraindicated. PMID:21810051
Lantos, Paul M
3xTgAD mice exhibit altered behavior and elevated A? after chronic mild social stress
Chronic stress may be a risk factor for developing Alzheimer�s disease (AD), but most studies of the effects of stress in models of AD utilize acute adverse stressors of questionable clinical relevance. The goal of this work was to determine how chronic psychosocial stress affects behavioral and pathological outcomes in an animal model of AD, and to elucidate underlying mechanisms. A triple-transgenic mouse model of AD (3xTgAD mice) and nontransgenic control mice were used to test for an affect of chronic mild social stress on blood glucose, plasma glucocorticoids, plasma insulin, anxiety and hippocampal A?, ptau and BDNF levels. Despite the fact that both control and 3xTgAD mice experienced rises in corticosterone during episodes of mild social stress, at the end of the 6 week stress period 3xTgAD mice displayed increased anxiety, elevated levels of A? oligomers and intraneuronal A?, and decreased BDNF levels, whereas control mice did not. Findings suggest 3xTgAD mice are more vulnerable than control mice to chronic psychosocial stress, and that such chronic stress exacerbates A? accumulation and impairs neurotrophic signaling.
Rothman, Sarah M.; Herdener, Nathan; Camandola, Simonetta; Texel, Sarah J.; Mughal, Mohamed R.; Cong, Wei-Na; Martin, Bronwen; Mattson, Mark P
Periodontal Disease in Chronic Kidney Disease and End-Stage Renal Disease Patients: A Review
Periodontal disease is a chronic inflammatory disorder and being so it has been associated with accelerated atherosclerosis and malnutrition. Cardiovascular diseases are the leading cause of mortality in chronic kidney disease (CKD) and end-stage renal disease (ESRD) patients [National Institutes of Health, National Institute of Diabetes and Digestive and Kidney Diseases: Annual Data Report, 2010]. A recent scientific statement released by the American Heart Association [Lockhart et al.: Circulation 2012;125:2520-2544] claims that, even though evidence exists to believe that periodontal interventions result in a reduction in systemic inflammation and endothelial dysfunction, there is little evidence that those interventions prevent atherosclerotic vascular disease or modify the outcomes. In this review, we discuss the periodontal findings and their association with an increased prevalence of inflammatory markers and cardiovascular mortality in ESRD patients and CKD.
Ariyamuthu, Venkatesh K.; Nolph, Karl D.; Ringdahl, Bruce E.
Periodontal disease in chronic kidney disease and end-stage renal disease patients: a review.
Periodontal disease is a chronic inflammatory disorder and being so it has been associated with accelerated atherosclerosis and malnutrition. Cardiovascular diseases are the leading cause of mortality in chronic kidney disease (CKD) and end-stage renal disease (ESRD) patients [National Institutes of Health, National Institute of Diabetes and Digestive and Kidney Diseases: Annual Data Report, 2010]. A recent scientific statement released by the American Heart Association [Lockhart et al.: Circulation 2012;125:2520-2544] claims that, even though evidence exists to believe that periodontal interventions result in a reduction in systemic inflammation and endothelial dysfunction, there is little evidence that those interventions prevent atherosclerotic vascular disease or modify the outcomes. In this review, we discuss the periodontal findings and their association with an increased prevalence of inflammatory markers and cardiovascular mortality in ESRD patients and CKD. PMID:23802000
Ariyamuthu, Venkatesh K; Nolph, Karl D; Ringdahl, Bruce E
[Autoimmunity in pathogenesis of chronic obstructive pulmonary disease].
For years, smoking induced inflammatory reaction, comprised mainly of neutrophils and macrophages, has been accepted to be the major component in pathogenesis of chronic obstructive pulmonary disease. New developments in molecular and cell biology have provided scientists with new knowledge and understanding of inflammatory processes in lung. Recent reports have underlined the role of autoimmunity and T lymphocytes as a potential important factor, which takes place in the pathogenesis of chronic obstructive pulmonary disease. This article reviews potential mechanism of T cell mediated immune response in chronic obstructive pulmonary disease. PMID:15827384
Urboniene, Daiva; Sakalauskas, Raimundas; Sitkauskiene, Brigita
Reporting of ethnicity in research on chronic disease: update
This paper examines the inclusion of ethnicity and race as variables in current, leading edge research on chronic disease and its risk factors. Of 100 randomly selected original research articles published in high?impact journals in 2005, 85% did not report either a definition of ethnicity or its conceptualisation in terms of theoretical reasoning, and 98% did not report an actual measurement item. Ethnicity and race remain non?standardised and largely underdescribed variables in research on chronic disease. This represents an important loss of opportunity to articulate and test hypotheses about the mechanisms underlying ethnic group differences in chronic disease.
O'Loughlin, J; Dugas, E; Maximova, K; Kishchuk, N
Chronic kidney disease: effects on the cardiovascular system.
Accelerated cardiovascular disease is a frequent complication of renal disease. Chronic kidney disease promotes hypertension and dyslipidemia, which in turn can contribute to the progression of renal failure. Furthermore, diabetic nephropathy is the leading cause of renal failure in developed countries. Together, hypertension, dyslipidemia, and diabetes are major risk factors for the development of endothelial dysfunction and progression of atherosclerosis. Inflammatory mediators are often elevated and the renin-angiotensin system is frequently activated in chronic kidney disease, which likely contributes through enhanced production of reactive oxygen species to the accelerated atherosclerosis observed in chronic kidney disease. Promoters of calcification are increased and inhibitors of calcification are reduced, which favors metastatic vascular calcification, an important participant in vascular injury associated with end-stage renal disease. Accelerated atherosclerosis will then lead to increased prevalence of coronary artery disease, heart failure, stroke, and peripheral arterial disease. Consequently, subjects with chronic renal failure are exposed to increased morbidity and mortality as a result of cardiovascular events. Prevention and treatment of cardiovascular disease are major considerations in the management of individuals with chronic kidney disease. PMID:17606856
Schiffrin, Ernesto L; Lipman, Mark L; Mann, Johannes F E
Marine Invertebrate Natural Products for Anti-Inflammatory and Chronic Diseases
The marine environment represents a relatively available source of functional ingredients that can be applied to various aspects of food processing, storage, and fortification. Moreover, numerous marine invertebrates based compounds have biological activities and also interfere with the pathogenesis of diseases. Isolated compounds from marine invertebrates have been shown to pharmacological activities and are helpful for the invention and discovery of bioactive compounds, primarily for deadly diseases like cancer, acquired immunodeficiency syndrome (AIDS), osteoporosis, and so forth. Extensive research within the last decade has revealed that most chronic illnesses such as cancer, neurological diseases, diabetes, and autoimmune diseases exhibit dysregulation of multiple cell signaling pathways that have been linked to inflammation. On the basis of their bioactive properties, this review focuses on the potential use of marine invertebrate derived compounds on anti-inflammatory and some chronic diseases such as cardiovascular disease, osteoporosis, diabetes, HIV, and cancer.
Senthilkumar, Kalimuthu; Kim, Se-Kwon
Comparison of chronic analgesic drugs prevalence in Parkinson's disease, other chronic diseases and the general population.
Patients with Parkinson's disease (PD) frequently experienced pain. Nevertheless, there are no epidemiological data about frequency of pain in PD. We compare pain prevalence using analgesic prescription in PD patients, in the general population and in two samples of painful patients: diabetics and osteoarthritis patients in France. Data were obtained from the French System of Health Insurance for the year 2005. Medications (antiparkinsonian, antidiabetics drugs and osteoarthritis drugs) were used for identification of PD, diabetic and osteoarthritis patients. We estimated the prevalence of analgesic drugs prescription (at least one analgesic drug) and the prevalence of chronic analgesic drugs prescription (more than 90 DDD of analgesic drug). The study included 11,466 PD patients. PD patients significantly received more prescription of analgesics than the general population (82% versus 77%,) and fewer than patients with osteoarthritis (82% versus 90%). No significant difference was found between PD and diabetic patients. The chronic prescription of analgesic drugs was more prevalent in PD patients (33%) than in the general population (20%) and in diabetic patients (26%) and similar to that in osteoarthritis patients. PD patients were more exposed than the general population and diabetics to opiates, acetaminophen, and adjuvant analgesics chronic use. PMID:19062167
Brefel-Courbon, Christine; Grolleau, Sabrina; Thalamas, Claire; Bourrel, Robert; Allaria-Lapierre, Val�rie; Lo�, Robert; Micallef-Roll, Joelle; Lapeyre-Mestre, Maryse
Patient Experiences of Depression and Anxiety with Chronic Disease
Background Depression and anxiety are highly prevalent in patients with chronic disease, but remain undertreated despite significant negative consequences on patient health. A number of clinical groups have developed recommendations for depression screening practices in the chronic disease population. Objectives The objective of this analysis was to review empirical qualitative research on the experiences of patients with chronic disease (e.g., COPD, diabetes, heart disease, stroke) and comorbid depression or anxiety, and to highlight the implications of the screening and management of anxiety and/or depression on chronic disease outcomes. Review Methods We performed literature searches for studies published from January 2002 to May 2012. We applied a qualitative mega-filter to nine condition-specific search filters. Titles and abstracts were reviewed by two reviewers and, for the studies that met the eligibility criteria, full-text articles were obtained. Qualitative meta-synthesis was used to integrate findings across relevant published primary research studies. Qualitative meta-synthesis produced a synthesis of evidence that both retained the original meaning of the authors and offered a new, integrative interpretation of the phenomenon through a process of comparing and contrasting findings across studies. Results The findings of 20 primary qualitative studies were synthesized. Patients tended to experience their chronic conditions and anxiety or depression as either independent or inter-related (i.e., the chronic disease lead to depression/anxiety, the depression/anxiety lead to the chronic disease, or the two conditions exacerbated each other). Potential barriers to screening for depression or anxiety were also identified. Limitations A wider array of issues might have been captured if the analysis had focused on broader psychological responses to the chronic disease experience. However, given the objective to highlight implications for screening for anxiety or depression, the more narrow focus seemed most relevant. Conclusions Chronic disease and anxiety or depression can be independent or inter-related. Patients may be reluctant to acknowledge depression or anxiety as a separate condition, or may not recognize that the conditions are separate because of overlapping physical symptoms. More qualitative research is needed to specifically address screening for depression or anxiety. Plain Language Summary Depression is a common complication of chronic disease. It may worsen the disease, and it may also affect the self-management of the disease. Screening for depression earlier, and then treating it, may reduce distress and improve symptoms of the chronic disease, leading to better quality of life.
DeJean, D; Giacomini, M; Vanstone, M; Brundisini, F
Patient Self-management of Chronic Disease in Primary Care
Patients with chronic conditions make day-to-day decisions about�self- manage�their illnesses. This reality introduces a new chronic disease para- digm: the patient-professional partnership, involving collaborative care and self-management education. Self-management education complements tra- ditional patient education in supporting patients to live the best possible quality of life with their chronic condition. Whereas traditional patient edu- cation offers information and technical skills,
Thomas Bodenheimer; Kate Lorig; Halsted Holman; Kevin Grumbach
Modulation of Lymphocyte Proliferation by Antioxidants in Chronic Beryllium Disease
Rationale: Occupational exposure to beryllium (Be) can result in chronic granulomatous inflammation characterized by the presence of Be-specific CD41 T cells. Studies show that oxidative stress plays a role in the pathogenesis of chronic inflammatory disorders. Objectives: We hypothesized that Be-induced oxidative stress mod- ulates the proliferation of Be-specific CD41 T cells. Methods: Thirty-three subjects with chronic beryllium disease (CBD),
Dave R. Dobis; Richard T. Sawyer; May M. Gillespie; Jie Huang; Lee S. Newman; Lisa A. Maier; Brian J. Day
[Disorders of the larynx and chronic inflammatory diseases].
Chronic inflammatory diseases including tuberculosis, rheumatic disorders (rheumatoid arthritis, sarcoidosis, systemic lupus erythematosus, Wegeners's granulomatosis, relapsing polychondritis) and reflux disease are considered as systemic diseases, and may affect the larynx. The clinical symptoms are often unspecific, leading to prolonged intervals to diagnosis. Solid and haematological tumours should be considered in differential diagnosis and may require bioptic sampling. Treatment may require interdisciplinary approach. PMID:23044789
Pickhard, A; Smith, E; Rottscholl, R; Brosch, S; Reiter, R
Management of Chronic Infectious Diseases in School Children.
ERIC Educational Resources Information Center
This document contains guidelines for developing policies and procedures related to chronic infectious diseases, as recommended by the Illinois Task Force on School Management of Infectious Disease. It is designed to help school personnel understand how infectious diseases can be transmitted, and to assist school districts in the development and�
Illinois State Board of Education, Springfield.
Urban air pollution and chronic obstructive pulmonary disease: a review
There is consistency in the findings that relate the acute increases in urban air pollution (mainly the particulate matter) and the short-term health effects (i.e. mortality and hospital admissions) on patients suffering from chronic obstructive pulmonary disease (COPD). Beyond the acute effects, a relevant public health and scientific question is to what extent chronic exposure to air pollution is related
J. Sunyer
Chronic obstructive pulmonary disease - quick-relief drugs
... al. Institute for Clinical Systems Improvement. Diagnosis and Management of Chronic Obstructive Pulmonary Disease (COPD). https://www.icsi.org/_asset/yw83gh/COPD.pdf. Accessed May 5, 2014. Balkissoon ...
Alpha-1-Antitrypsin Deficiency and Chronic Respiratory Disease.
National Technical Information Service (NTIS)
Samples of several general and select populations were studied to elucidate the relationship of severe and partial alpha-1-antitrypsin deficiency to chronic pulmonary disease. Methods used included respiratory questionnaire, pulmonary function tests and i...
R. H. Schwartz
Hyperuricemia and Urate Excretion in Chronic Renal Disease.
National Technical Information Service (NTIS)
Standard renal clearances were performed in 92 subjects, comparing uric acid excretion, glomerular filtration and renal plasma flow in normal people and people with proven chronic renal disease with normal and sub-normal glomerular filtration. Despite com...
J. J. McPhaul
[Phosphate binders in chronic kidney disease: the positions of sevelamer].
The paper shows the role of phosphate binders in the correction of phosphorus and calcium metabolic disturbances in chronic kidney disease. The results of clinical trials demonstrating the efficacy and safety of sevelamer are discussed. PMID:23875200
Fomin, V V; Shilov, E M; Svistunov, A A; Milovanov, Iu S
Pulmonary Rehabilitation for Patients With Chronic Pulmonary Disease (COPD)
Executive Summary In July 2010, the Medical Advisory Secretariat (MAS) began work on a Chronic Obstructive Pulmonary Disease (COPD) evidentiary framework, an evidence-based review of the literature surrounding treatment strategies for patients with COPD. This project emerged from a request by the Health System Strategy Division of the Ministry of Health and Long-Term Care that MAS provide them with an evidentiary platform on the effectiveness and cost-effectiveness of COPD interventions. After an initial review of health technology assessments and systematic reviews of COPD literature, and consultation with experts, MAS identified the following topics for analysis: vaccinations (influenza and pneumococcal), smoking cessation, multidisciplinary care, pulmonary rehabilitation, long-term oxygen therapy, noninvasive positive pressure ventilation for acute and chronic respiratory failure, hospital-at-home for acute exacerbations of COPD, and telehealth (including telemonitoring and telephone support). Evidence-based analyses were prepared for each of these topics. For each technology, an economic analysis was also completed where appropriate. In addition, a review of the qualitative literature on patient, caregiver, and provider perspectives on living and dying with COPD was conducted, as were reviews of the qualitative literature on each of the technologies included in these analyses. The Chronic Obstructive Pulmonary Disease Mega-Analysis series is made up of the following reports, which can be publicly accessed at the MAS website at: http://www.hqontario.ca/en/mas/mas_ohtas_mn.html. Chronic Obstructive Pulmonary Disease (COPD) Evidentiary Framework Influenza and Pneumococcal Vaccinations for Patients With Chronic Obstructive Pulmonary Disease (COPD): An Evidence-Based Analysis Smoking Cessation for Patients With Chronic Obstructive Pulmonary Disease (COPD): An Evidence-Based Analysis Community-Based Multidisciplinary Care for Patients With Stable Chronic Obstructive Pulmonary Disease (COPD): An Evidence-Based Analysis Pulmonary Rehabilitation for Patients With Chronic Obstructive Pulmonary Disease (COPD): An Evidence-Based Analysis Long-term Oxygen Therapy for Patients With Chronic Obstructive Pulmonary Disease (COPD): An Evidence-Based Analysis Noninvasive Positive Pressure Ventilation for Acute Respiratory Failure Patients With Chronic Obstructive Pulmonary Disease (COPD): An Evidence-Based Analysis Noninvasive Positive Pressure Ventilation for Chronic Respiratory Failure Patients With Stable Chronic Obstructive Pulmonary Disease (COPD): An Evidence-Based Analysis Hospital-at-Home Programs for Patients With Acute Exacerbations of Chronic Obstructive Pulmonary Disease (COPD): An Evidence-Based Analysis Home Telehealth for Patients With Chronic Obstructive Pulmonary Disease (COPD): An Evidence-Based Analysis Cost-Effectiveness of Interventions for Chronic Obstructive Pulmonary Disease Using an Ontario Policy Model Experiences of Living and Dying With COPD: A Systematic Review and Synthesis of the Qualitative Empirical Literature For more information on the qualitative review, please contact Mita Giacomini at: http://fhs.mcmaster.ca/ceb/faculty member_giacomini.htm. For more information on the economic analysis, please visit the PATH website: http://www.path-hta.ca/About-Us/Contact-Us.aspx. The Toronto Health Economics and Technology Assessment (THETA) collaborative has produced an associated report on patient preference for mechanical ventilation. For more information, please visit the THETA website: http://theta.utoronto.ca/static/contact. Objective The objective of this evidence-based review was to determine the effectiveness and cost-effectiveness of pulmonary rehabilitation in the management of chronic obstructive pulmonary disease (COPD). Technology Pulmonary rehabilitation refers to a multidisciplinary program of care for patients with chronic respiratory impairment that is individually tailored and designed to optimize physical and social performance and autonomy. Exercise training is the cornerstone of pulmonary re
Noninvasive Positive Pressure Ventilation for Chronic Respiratory Failure Patients With Stable Chronic Obstructive Pulmonary Disease (COPD)
Executive Summary In July 2010, the Medical Advisory Secretariat (MAS) began work on a Chronic Obstructive Pulmonary Disease (COPD) evidentiary framework, an evidence-based review of the literature surrounding treatment strategies for patients with COPD. This project emerged from a request by the Health System Strategy Division of the Ministry of Health and Long-Term Care that MAS provide them with an evidentiary platform on the effectiveness and cost-effectiveness of COPD interventions. After an initial review of health technology assessments and systematic reviews of COPD literature, and consultation with experts, MAS identified the following topics for analysis: vaccinations (influenza and pneumococcal), smoking cessation, multidisciplinary care, pulmonary rehabilitation, long-term oxygen therapy, noninvasive positive pressure ventilation for acute and chronic respiratory failure, hospital-at-home for acute exacerbations of COPD, and telehealth (including telemonitoring and telephone support). Evidence-based analyses were prepared for each of these topics. For each technology, an economic analysis was also completed where appropriate. In addition, a review of the qualitative literature on patient, caregiver, and provider perspectives on living and dying with COPD was conducted, as were reviews of the qualitative literature on each of the technologies included in these analyses. The Chronic Obstructive Pulmonary Disease Mega-Analysis series is made up of the following reports, which can be publicly accessed at the MAS website at: http://www.hqontario.ca/en/mas/mas_ohtas_mn.html. Chronic Obstructive Pulmonary Disease (COPD) Evidentiary Framework Influenza and Pneumococcal Vaccinations for Patients With Chronic Obstructive Pulmonary Disease (COPD): An Evidence-Based Analysis Smoking Cessation for Patients With Chronic Obstructive Pulmonary Disease (COPD): An Evidence-Based Analysis Community-Based Multidisciplinary Care for Patients With Stable Chronic Obstructive Pulmonary Disease (COPD): An Evidence-Based Analysis Pulmonary Rehabilitation for Patients With Chronic Obstructive Pulmonary Disease (COPD): An Evidence-Based Analysis Long-term Oxygen Therapy for Patients With Chronic Obstructive Pulmonary Disease (COPD): An Evidence-Based Analysis Noninvasive Positive Pressure Ventilation for Acute Respiratory Failure Patients With Chronic Obstructive Pulmonary Disease (COPD): An Evidence-Based Analysis Noninvasive Positive Pressure Ventilation for Chronic Respiratory Failure Patients With Stable Chronic Obstructive Pulmonary Disease (COPD): An Evidence-Based Analysis Hospital-at-Home Programs for Patients With Acute Exacerbations of Chronic Obstructive Pulmonary Disease (COPD): An Evidence-Based Analysis Home Telehealth for Patients With Chronic Obstructive Pulmonary Disease (COPD): An Evidence-Based Analysis Cost-Effectiveness of Interventions for Chronic Obstructive Pulmonary Disease Using an Ontario Policy Model Experiences of Living and Dying With COPD: A Systematic Review and Synthesis of the Qualitative Empirical Literature For more information on the qualitative review, please contact Mita Giacomini at: http://fhs.mcmaster.ca/ceb/faculty_member_giacomini.htm. For more information on the economic analysis, please visit the PATH website: http://www.path-hta.ca/About-Us/Contact-Us.aspx. The Toronto Health Economics and Technology Assessment (THETA) collaborative has produced an associated report on patient preference for mechanical ventilation. For more information, please visit the THETA website: http://theta.utoronto.ca/static/contact. Objective The objective of this health technology assessment was to determine the effectiveness and cost-effectiveness of noninvasive ventilation for stable chronic obstructive pulmonary disease (COPD). Clinical Need: Condition and Target Population Noninvasive ventilation is used for COPD patients with chronic respiratory failure. Chronic respiratory failure in COPD patients may be due to the inability of the pulmonary system to coordinate ventilation, leading to adverse arterial level
Chronic hypoxia as a mechanism of progression of chronic kidney diseases: from hypothesis to novel therapeutics
In chronic kidney disease, functional impairment correlates with tubulointerstitial fibrosis characterised by inflammation, accumulation of extracellular matrix, tubular atrophy and rarefaction of peritubular capillaries. Loss of the microvasculature implies a hypoxic milieu and suggested an important role for hypoxia when the �chronic hypoxia hypothesis� was proposed a decade ago as an explanation for the progressive nature of fibrosis. Recent data
Leon G Fine; Jill T Norman
Systematic Review of the Chronic Care Model in Chronic Obstructive Pulmonary Disease Prevention and Management
Background: Implementation of the chronic care model (CCM) has been shown to be an effective preventative strategy to improve outcomes in diabetes mellitus, de- pression, and congestive heart failure, but data are lack- ing regarding the effectiveness of this model in prevent- ing complications in patients with chronic obstructive pulmonary disease. Methods: We searched the MEDLINE, CINAHL, and Cochrane databases
Sandra G. Adams; Paulla K. Smith; Patrick F. Allan; Antonio Anzueto; Jacqueline A. Pugh; John E. Cornell
Chronic Disease Management: What Will It Take To Improve Care for Chronic Illness?
M eeting the complex needs of patients with chronic illness or impairment is the single greatest challenge facing organized medical practice. Usual care is not doing the job; dozens of surveys and audits have revealed that sizable proportions of chronically ill patients are not receiving effective therapy, have poor disease con- trol, and are unhappy with their care (1). Results
Edward H. Wagner
Biomarkers of inflammation and progression of chronic kidney disease
Biomarkers of inflammation and progression of chronic kidney disease.BackgroundChronic kidney disease is associated with higher levels of inflammatory biomarkers. Statins have anti-inflammatory properties and may attenuate loss of kidney function. Although inflammation may mediate progressive renal injury, the relation between statin use, markers of inflammation, and the rate of kidney function loss has not been elucidated. We examined the association
Prognosis and life expectancy in chronic liver disease
The aim of the present study was to define prognosis and life expectancy in patients with chronic liver disease of different etiologies and to relate them to an age- and sex-matched normal population. After a follow-up of 15 years, life expectancy of 620 patients with chronic liver disease was retrospectively calculated and compared with an age- and sex-matched normal population.
Albert Propst; Theresa Propst; G�nther Zangerl; Dietmar �fner; Gert Judmaier; Wolfgang Vogel
Physical activity, genes, and lifetime predisposition to chronic disease
This mini-review summarizes the main associations between physical activity and chronic diseases and discusses the basic concepts\\u000a related to the role of genetic factors in studies evaluating the effects of physical activity\\/exercise therapy on chronic\\u000a disease prevention\\/treatment during the life course. Many observational cohort studies have shown that high physical activity\\u000a during young adulthood or middle age is associated with
Urho M. Kujala
Increased Serum Angiotensin-Converting Enzyme in Chronic Renal Disease
Serum angiotensin-converting enzyme (SACE) was significantly elevated in 16 of 48 patients with various types of chronic renal disease not on hemodialysis [45.6 � (SD)16.7 nmol\\/min\\/ml, p < 0.001] and in 17 of 52 patients with chronic renal disease on maintenance hemodialysis (43.2 � 13.8, p < 0.001) in comparison with 58 healthy adult controls (32.2 � 9.8). There was
Emanuel Silverstein; John Brunswick; Sreepada Rao; Joan Friedland
Pulmonary vascular involvement in chronic obstructive pulmonary disease
Pulmonary vascular involvement in chronic obstructive pulmonary disease. N.F. Voelkel, C.D. Cool. #ERS Journals Ltd 2003. ABSTRACT: Chronic obstructive lung disease affects the entire lung, not just the airways. Although pulmonary hypertension (PH) has long been recognised in a subset of patients with COLD, the important pathophysiological questions remain unanswered. Oxygen supplementation, however, has been shown to blunt the exercise-induced
N. F. Voelkel; C. D. Cool
Cigarette smoke contains various carcinogens, reactive oxygen species (ROS) and reactive nitrogen species (RNS). It has been found that cigarette smoking causes several chronic lung diseases including chronic obstructive pulmonary diseases (COPD). There are mul- tiple markers used for oxidative damage\\/stress in smokers such as urinary 8- hydroxydeoxyguanosine (8-OHdG), serum hydrogen peroxide (H2O2), interleukin-8 (IL-8) and H2O2 in breath condensate.
Ratana Banjerdpongchai
Metagenomic Applications and the Potential for Understanding Chronic Liver Disease
\\u000a Liver fibrosis is characterized by an excessive deposition of extracellular matrix proteins that occurs in chronic liver disease\\u000a of any origin. Cirrhosis occurs with the development of regenerating nodules of hepatocytes. Patients with decompensated liver\\u000a cirrhosis have a poor prognosis, and liver transplantation is often necessary. There are no effective antifibrotic treatments\\u000a for patients with chronic liver diseases. Intestinal dysbiosis
Bernd Schnabl
Neutrophil adherence in chronic liver disease and fulminant hepatic failure
Abnormal adherence of neutrophils to nylon fibre in vitro was found in blood from 17 of 51 (33.3%) patients with chronic or acute liver disease of different aetiologies. Patients with chronic liver disease had a much wider range of values than the controls and the sub-group with alcoholic cirrhosis had significantly higher adherence (72.4 +\\/- SD 6.2%) than that of
M Altin; I A Rajkovic; R D Hughes; R Williams
Advanced MRI Methods for Assessment of Chronic Liver Disease
MRI plays an increasingly important role for assessment of patients with chronic liver disease. MRI has numerous advantages, including lack of ionizing radiation and the possibility of performing multiparametric imaging. With recent advances in technology, advanced MRI methods such as diffusion-, perfusion-weighted MRI, MR elastography, chemical shift based fat-water separation and MR spectroscopy can now be applied to liver imaging. We will review the respective roles of these techniques for assessment of chronic liver disease.
Taouli, Bachir; Ehman, Richard L.; Reeder, Scott B.
Chronic disease trends due to excess body weight in Australia
Summary Trends in chronic diseases provide insights into strategies required to improve population health. The authors determined prevalence and multiple-adjusted population attributable risk (PAR) estimates of chronic diseases because of life- style factors among Australian adults between 1989-90 and 2004-5, accounting for demographic factors. Between 1989-90 and 2004-5, prevalence increased for diabetes (3.8-6.0%, P < 0.001) and high cholesterol (11.3-13.9%,
E. Atlantis; K. Lange; G. A. Wittert
Chronic kidney disease in Mayer-Rokitansky-Kuster-Hauser Syndrome
Mayer-Rokitansky-Kuster-Hauser (MRKH) syndrome is characterized by either absence or abnormalities of the mullerian structures. It is a rare disorder, resulting in complete or partial agenesis of the uterus and cervix and primary amenorrhea. It may rarely be associated with anomalies of the urinary tract, ovaries and skeleton. Renal failure secondary to chronic tubulo-interstitial disease has been reported. We report a case of MRKH syndrome presenting late with chronic kidney disease.
Wani, M. M.; Mir, S. A.
Chronic kidney disease in Mayer-Rokitansky-Kuster-Hauser Syndrome.
Mayer-Rokitansky-Kuster-Hauser (MRKH) syndrome is characterized by either absence or abnormalities of the mullerian structures. It is a rare disorder, resulting in complete or partial agenesis of the uterus and cervix and primary amenorrhea. It may rarely be associated with anomalies of the urinary tract, ovaries and skeleton. Renal failure secondary to chronic tubulo-interstitial disease has been reported. We report a case of MRKH syndrome presenting late with chronic kidney disease. PMID:21206686
Wani, M M; Mir, S A
Decrease in Irisin in Patients with Chronic Kidney Disease
Patients with chronic kidney disease have abnormal energy expenditure and metabolism. The mechanisms underlying altered energy expenditure in uremia are unknown and remain to be elucidated. Irisin is a peroxisome proliferator-activated receptor ? coactivator 1-?�dependent myokine, and it increases energy expenditure in the absence of changes in food intake or activity. We hypothesize that chronic kidney disease patients have altered irisin levels. We measured resting irisin levels in 38 patients with stage 5 chronic kidney disease and in 19 age- and sex-matched normal subjects. Plasma irisin levels were significantly decreased in chronic kidney disease patients (58.59%; 95% CI 47.9%�69.2%, p<0.0001). The decrease in irisin levels was inversely correlated with the levels of blood urea nitrogen and creatinine. Further association analysis revealed that irisin level is independently associated with high-density lipoprotein cholesterol level. Our results suggest that chronic kidney disease patients have lower than normal irisin levels at rest. Furthermore, irisin may play a major role in affecting high-density lipoprotein cholesterol levels and abnormal energy expenditure in chronic kidney disease patients.
Wen, Ming-Shien; Wang, Chao-Yung; Lin, Shuei-Liong; Hung, Kuo-Chun
Home Telehealth for Patients With Chronic Obstructive Pulmonary Disease (COPD)
Executive Summary In July 2010, the Medical Advisory Secretariat (MAS) began work on a Chronic Obstructive Pulmonary Disease (COPD) evidentiary framework, an evidence-based review of the literature surrounding treatment strategies for patients with COPD. This project emerged from a request by the Health System Strategy Division of the Ministry of Health and Long-Term Care that MAS provide them with an evidentiary platform on the effectiveness and cost-effectiveness of COPD interventions. After an initial review of health technology assessments and systematic reviews of COPD literature, and consultation with experts, MAS identified the following topics for analysis: vaccinations (influenza and pneumococcal), smoking cessation, multidisciplinary care, pulmonary rehabilitation, long-term oxygen therapy, noninvasive positive pressure ventilation for acute and chronic respiratory failure, hospital-at-home for acute exacerbations of COPD, and telehealth (including telemonitoring and telephone support). Evidence-based analyses were prepared for each of these topics. For each technology, an economic analysis was also completed where appropriate. In addition, a review of the qualitative literature on patient, caregiver, and provider perspectives on living and dying with COPD was conducted, as were reviews of the qualitative literature on each of the technologies included in these analyses. The Chronic Obstructive Pulmonary Disease Mega-Analysis series is made up of the following reports, which can be publicly accessed at the MAS website at: http://www.hqontario.ca/en/mas/mas_ohtas_mn.html. Chronic Obstructive Pulmonary Disease (COPD) Evidentiary Framework Influenza and Pneumococcal Vaccinations for Patients With Chronic Obstructive Pulmonary Disease (COPD): An Evidence-Based Analysis Smoking Cessation for Patients With Chronic Obstructive Pulmonary Disease (COPD): An Evidence-Based Analysis Community-Based Multidisciplinary Care for Patients With Stable Chronic Obstructive Pulmonary Disease (COPD): An Evidence-Based Analysis Pulmonary Rehabilitation for Patients With Chronic Obstructive Pulmonary Disease (COPD): An Evidence-Based Analysis Long-term Oxygen Therapy for Patients With Chronic Obstructive Pulmonary Disease (COPD): An Evidence-Based Analysis Noninvasive Positive Pressure Ventilation for Acute Respiratory Failure Patients With Chronic Obstructive Pulmonary Disease (COPD): An Evidence-Based Analysis Noninvasive Positive Pressure Ventilation for Chronic Respiratory Failure Patients With Stable Chronic Obstructive Pulmonary Disease (COPD): An Evidence-Based Analysis Hospital-at-Home Programs for Patients With Acute Exacerbations of Chronic Obstructive Pulmonary Disease (COPD): An Evidence-Based Analysis Home Telehealth for Patients With Chronic Obstructive Pulmonary Disease (COPD): An Evidence-Based Analysis Cost-Effectiveness of Interventions for Chronic Obstructive Pulmonary Disease Using an Ontario Policy Model Experiences of Living and Dying With COPD: A Systematic Review and Synthesis of the Qualitative Empirical Literature For more information on the qualitative review, please contact Mita Giacomini at: http://fhs.mcmaster.ca/ceb/faculty_member_giacomini.htm. For more information on the economic analysis, please visit the PATH website: http://www.path-hta.ca/About-Us/Contact-Us.aspx. The Toronto Health Economics and Technology Assessment (THETA) collaborative has produced an associated report on patient preference for mechanical ventilation. For more information, please visit the THETA website: http://theta.utoronto.ca/static/contact. Objective The objective of this analysis was to conduct an evidence-based assessment of home telehealth technologies for patients with chronic obstructive pulmonary disease (COPD) in order to inform recommendations regarding the access and provision of these services in Ontario. This analysis was one of several analyses undertaken to evaluate interventions for COPD. The perspective of this assessment was that of the Ontario Ministry of Health and Long-Term Care, a provincial payer of me
Franek, J
Formoterol in the management of chronic obstructive pulmonary disease
Bronchodilators represent the hallmark of symptomatic treatment of Chronic Obstructive Pulmonary Disease (COPD). There are four categories of bronchodilators: anticholinergics, methylxanthines, short-acting ?2-agonists, and long-acting ?2-agonists such as formoterol. Significant research has been performed to investigate the efficacy, safety and tolerability of formoterol in the therapeutic field of COPD. Formoterol exhibits a rapid onset of bronchodilation similar to that observed with salbutamol, yet its long bronchodilatory duration is comparable to salmeterol. In addition, formoterol presents with a clear superiority in lung function improvement compared with either ipratropium bromide or oral theophylline, while its efficacy improves when administered in combination with ipratropium. Formoterol has been shown to better reduce dynamic hyperinflation, which is responsible for exercise intolerance and dyspnea in COPD patients, compared with other bronchodilators, whereas it exerts synergistic effect with tiotropium. Moreover, formoterol reduces exacerbations, increases days free of use of rescue medication and improves patients� quality of life and disease symptoms. Formoterol has a favorable safety profile and is better tolerated than theophylline. Collectively, data extracted from multicenter clinical trials support formoterol as a valid therapeutic option in the treatment of COPD.
Steiropoulos, Paschalis; Tzouvelekis, Argyris; Bouros, Demosthenes
Direct medical costs of chronic obstructive pulmonary disease: chronic bronchitis and emphysema
In this study we aimed to estimate direct medical costs of Chronic Obstructive Pulmonary Disease (COPD) by disease type; chronic bronchitis and emphysema.This study estimates direct costs in 1996 dollars using a prevalence approach and both aggregate and micro-costing.A societal perspective is taken using prevalence, and multiple national, state and local data sources are used to estimate health-care utilization and
Total inspiratory and expiratory impedance in patients with severe chronic obstructive pulmonary disease
OBJECTIVES: Several studies have confirmed the high potential of the forced oscillation technique for the assessment of respiratory modifications related to chronic obstructive pulmonary disease. However, most of these studies did not employ within-breath analyses of the respiratory system. The aim of this study is to analyze respiratory impedance alterations in different phases of the respiratory cycle of chronic obstructive pulmonary disease patients and to evaluate their clinical use. METHODS: 39 individuals were evaluated, including 20 controls and 19 individuals with chronic obstructive pulmonary disease who experienced severe airway obstruction. We evaluated the mean respiratory impedance (Zm) as well as values for inspiration (Zi) and expiration cycles (Ze), at the beginning of inspiration (Zbi) and expiration (Zbe). The peak-to-peak impedance (Zpp), and the impedance change (?Zrs) were also analyzed. The clinical usefulness was evaluated by investigating the sensibility, specificity and the area under the receiver operating characteristic curve. RESULTS: The respiratory impedance increased in individuals with chronic obstructive pulmonary disease in all of the studied parameters (Zm, Zi, Ze, Zbi, Zbe, ?Zrs and Zpp). These changes were inversely associated with spirometric parameters. Higher impedances were observed in the expiratory phase of individuals with chronic obstructive pulmonary disease. All of the studied parameters, except for ?Zrs (area under the receiver operating characteristic <0.8), exhibited high accuracy for clinical use (area under the receiver operating characteristic >0.90; Sensibility ? 0.85; Sp ? 0.85). CONCLUSIONS: The respiratory alterations in severe chronic obstructive pulmonary disease may be identified by the increase in respiratory system impedance, which is more evident in the expiratory phase. These results confirm the potential of within-breath analysis of respiratory impedance for the assessment of respiratory modifications related to chronic obstructive pulmonary disease.
Silva, Karla Kristine Dames; Lopes, Agnaldo Jose; Jansen, Jose Manoel; de Melo, Pedro Lopes
Cardiovascular risk factors in patients with chronic kidney disease
Patients with chronic kidney disease have a higher burden of cardiovascular disease, which increases in a dose-dependent fashion with worsening kidney function. Traditional cardiovascular risk factors, including advanced age, diabetes mellitus, hypertension and dyslipidemia, have an important role in the progression of cardiovascular disease in patients who have a reduced glomerular filtration rate, especially in those with mild-to-moderate kidney disease.
Sarina van der Zee; Usman Baber; Sammy Elmariah; Jonathan Winston; Valentin Fuster
Magnesium in Chronic Kidney Disease: Challenges and Opportunities
Cardiovascular disease is the leading cause of mortality and morbidity in patients with chronic kidney disease, which is partly explained by the fact that 40�70% of patients receiving dialysis have significant coronary artery disease. Recent clinical studies have shown that lower serum magnesium (Mg) levels are associated with vascular calcification and cardiovascular mortality among patients with end-stage renal disease (ESRD).
Mehmet Kanbay; David Goldsmith; Mehtap Erkmen Uyar; Faruk Turgut; Adrian Covic
Patients, populations and policy: patient outcomes in chronic kidney disease.
Chronic kidney disease represents an interesting illustration for evaluating an epidemic of chronic illness, the impact of care processes and technology on health outcomes, the impact of financial incentives and cost containment on health outcomes, and the choices society must consider in responding to a chronic illness. The evidence suggests that strong economic pressures exist in the care of chronic kidney disease and that cost containment is important. The results in large part reflect the impact of economic pressures on clinical decision making in the absence of good evidence on outcomes. To improve clinical decision making we need valid evidence linking specific processes of care to patient outcomes. Specific processes amenable to study include the provision of preventive services, physician and nurse technical and interpersonal care and adherence to clinical practice guidelines. The ESRD Quality Study (EQUAL) currently underway and supported by the National Institutes of Diabetes and Digestive and Kidney Diseases, may help to guide physicians and centers in caring for their patients with chronic kidney disease. This investigation examines the relation between process of care and outcomes and expands outcomes measure to include disease-specific quality-of-life measures and patient satisfaction and accounts for case mix using the Index of Co-Existent Disease, a measure of the extent of different comorbid diseases as well as their severity (18,19,20). Better data on how processes of care are linked to health outcomes can inform decision making and allow educated cost cutting and quality maintenance. PMID:11419454
Powe, N R
Mobile technologies and the holistic management of chronic diseases.
Ageing populations and unhealthy lifestyles have led to some chronic conditions such as diabetes and heart disease reaching epidemic proportions in many developed nations. This paper explores the potential of mobile technologies to improve this situation. The pervasive nature of these technologies can contribute holistically across the whole spectrum of chronic care ranging from public information access and awareness, through monitoring and treatment of chronic disease, to support for patient carers. A related study to determine the perceptions of healthcare providers to m-health confirmed the view that attitudes were likely to be more important barriers to progress than technology. A key finding concerned the importance of seamless and integrated m-health processes across the spectrum of chronic disease management. PMID:19008280
Mirza, Farhaan; Norris, Tony; Stockdale, Rosemary
Chronic liver inflammation: clinical implications beyond alcoholic liver disease.
Chronic alcohol exposure can lead to alcoholic liver disease, including hepatitis, cirrhosis and hepatocellular carcinoma, and chronic inflammation can simultaneously cause systemic medical illness. Recent evidence suggests that alcoholic liver disease is a predictor for liver-related diseases, cardiovascular disease, immunologic disease, and bone disease. Chronic inflammation in alcoholic liver disease is mediated by a direct inflammatory cascade from the alcohol detoxification process and an indirect inflammatory cascade in response to gut microflora-derived lipopolysaccharides (LPS). The pathophysiology of alcoholic liver disease and its related systemic illness is characterized by oxidative stress, activation of the immune cascade, and gut-liver interactions. Integrative therapeutic strategies for alcoholic liver disease include abstaining from alcohol consumption; general anti-inflammatories such as glucocorticoid, pentoxifylline, and tumour necrosis factor-? antagonist; antioxidants such as N- acetylcysteine; gut microflora and LPS modulators such as rifaximin and/or probiotics. This review focuses on the impact of chronic liver inflammation on systemic health problems and several potential therapeutic targets. PMID:24605015
Park, Byoung-Jin; Lee, Yong-Jae; Lee, Hye-Ree
Cost Analysis of Chronic Disease Self-Management Programmes Being Delivered in South Florida
ERIC Educational Resources Information Center
Background: Chronic disease accounts for the majority of healthcare costs. The Chronic Disease Self-Management Programme (CDSMP) has been shown to be effective in reducing the burden of chronic disease. Objectives: The objective of this study was to measure the cost of delivering the Chronic Disease Self-Management Programme (CDSMP) in order to�
Page, Timothy F.; Palmer, Richard C.
Lack of exercise is a major cause of chronic diseases.
Chronic diseases are major killers in the modern era. Physical inactivity is a primary cause of most chronic diseases. The initial third of the article considers: activity and prevention definitions; historical evidence showing physical inactivity is detrimental to health and normal organ functional capacities; cause versus treatment; physical activity and inactivity mechanisms differ; gene-environment interaction (including aerobic training adaptations, personalized medicine, and co-twin physical activity); and specificity of adaptations to type of training. Next, physical activity/exercise is examined as primary prevention against 35 chronic conditions [accelerated biological aging/premature death, low cardiorespiratory fitness (VO2max), sarcopenia, metabolic syndrome, obesity, insulin resistance, prediabetes, type 2 diabetes, nonalcoholic fatty liver disease, coronary heart disease, peripheral artery disease, hypertension, stroke, congestive heart failure, endothelial dysfunction, arterial dyslipidemia, hemostasis, deep vein thrombosis, cognitive dysfunction, depression and anxiety, osteoporosis, osteoarthritis, balance, bone fracture/falls, rheumatoid arthritis, colon cancer, breast cancer, endometrial cancer, gestational diabetes, pre-eclampsia, polycystic ovary syndrome, erectile dysfunction, pain, diverticulitis, constipation, and gallbladder diseases]. The article ends with consideration of deterioration of risk factors in longer-term sedentary groups; clinical consequences of inactive childhood/adolescence; and public policy. In summary, the body rapidly maladapts to insufficient physical activity, and if continued, results in substantial decreases in both total and quality years of life. Taken together, conclusive evidence exists that physical inactivity is one important cause of most chronic diseases. In addition, physical activity primarily prevents, or delays, chronic diseases, implying that chronic disease need not be an inevitable outcome during life. PMID:23798298
Booth, Frank W; Roberts, Christian K; Laye, Matthew J
Mouse exophthalmic chronic orbital inflammatory disease
Mollicutes are cell wall deficient bacteria which may be overlooked or confused with viruses because of indistinct light microscopic morphology, poor staining, difficulty in cultivation, and the ability to pass 0.450 micron filters. As they have a distinctive ultrastructural appearance they can be identified using transmission electron microscopy [TEM]. Using TEM vitreous leucocytes from chronic endogenous uveitis patients may demonstrate
Emil Wirostko; Lewis Johnson; William Wirostko
Anti-inflammatory treatments for chronic diseases: a review.
Inflammation is viewed as one of the major causes for the development of different diseases like cancer, cardiovascular disease, diabetes, obesity, osteoporosis, rheumatoid arthritis, inflammatory bowel disease, asthma, and CNS related diseases such as depression and parkinson's disease; and this fervent phenomenon provides space for understanding different inflammatory markers. Increasing evidences have elucidated the outcome of inflammatory pathways dysregulation resulting in many symptoms of chronic diseases. The detection of transcription factors such as nuclear factor kappa-B (NF-?B), STAT and their gene products such as COX-2, cytokines, chemokines and chemokine receptors has laid molecular foundation for the important role of inflammation in chronic diseases in which the NF-?B is reported as a major mediator which makes a possible way for the development of new therapeutic approaches using synthetic and natural compounds that might eventually decrease the prevalence of these diseases. Even if many inflammatory markers like TNF-?, IL-1, IL-6, IL-8 and C-reactive protein (CRP) are reported to be the major key factors with proved role in several inflammatory diseases, IL-1 and TNF-? are the important cytokines that can induce the expression of NF-?B which is the potential target in these inflammatory diseases. This review aims to explore and summarize that how some drugs and natural compounds show their modulatory activity in inflammatory pathways and chronic inflammatory markers in these inflammatory diseases. PMID:23876224
Laveti, Durgaprasad; Kumar, Manoj; Hemalatha, R; Sistla, Ramakrishna; Naidu, V G M; Talla, Venu; Verma, Vinod; Kaur, Navrinder; Nagpal, Ravinder
Bisphenol A in chronic kidney disease.
The estrogenic endocrine-disrupting substance bisphenol A (BPA) is extensively used as a starting material for a variety of consumer plastic products including dialyzer materials. The present study was performed to explore plasma BPA levels in patients with impaired renal function and to investigate if dialyzers differing in elutable BPA influence plasma levels in patients on maintenance hemodialysis. In vitro BPA was eluted from high-flux polyethersulfone (PUREMA H, referred as PUR-H), high-flux polysulfone (referred as HF-PSu), and low-flux polysulfone (referred as LF-PSu) dialyzers by recirculation with water for 180?min. In a cross-sectional clinical study, plasma BPA levels of outpatients with different stages of chronic kidney disease (CKD) from four different centers were determined. Furthermore, in a prospective, randomized, and crossover setting, 18 maintenance dialysis patients were subjected successively to 4 weeks of thrice-weekly hemodialysis with each LF-PSu, HF-PSu, and PUR-H. In addition, the fractions of protein-bound and free BPA were determined in a subset of dialysis patients. The mass of BPA eluted from the blood compartments in vitro under aqueous conditions varied for the three dialyzers being very low for PUR-H (6.2?�?2.5?ng; P?0.001), intermediate for HF-PSu (48.1?�?7.7?ng), and highest for LF-PSu (140.8?�?38.7?ng; P?0.01). In 152 prevalent patients with CKD enrolled in the cross-sectional trial, plasma BPA started to rise after stage 3. Maintenance hemodialysis patients had more than six times higher BPA concentrations than patients with CKD stage 5 not yet on dialysis (10.0?�?6.6 vs. 1.6?�?1.8?ng/mL; P?0.001). The BPA concentrations highly and inversely correlated with renal function. In the randomized controlled study, the plasma BPA concentrations were highly elevated compared with healthy controls (range 9.1?�?4.5-12.0?�?6.0?ng/mL vs. ?0.2?�?0.1?ng/mL; P?0.001), but no change of the plasma levels was observed during hemodialysis with any of the three dialyzers in the course of a single treatment and over a period of 4 weeks. The protein-bound fraction of plasma BPA in the dialysis patients was 74?�?5%. Renal function and, most likely, the total quantity of ingested BPA are essential parameters affecting plasma BPA concentrations. Dialyzers are one additional source of BPA, but differences in the elutable BPA content are not associated with a significant effect on BPA plasma levels in Western European maintenance dialysis patients. Due to high protein binding, the removal of BPA by hemodialysis is limited. PMID:23145999
Krieter, Detlef H; Canaud, Bernard; Lemke, Horst-Dieter; Rodriguez, Annie; Morgenroth, Andreas; von Appen, Kai; Dragoun, Gerd-Peter; Wanner, Christoph
Hodgkin's disease developing after spontaneous remission of chronic lymphocytic leukemia
We present a 71-year-old patient with chronic lymphocytic leukemia diagnosed 27 years ago. Initially, the disease was staged as Rai II and the patient suffered from secondary immunoglobulin deficiency. Nevertheless, no treatment was necessary at that time. Because of disease progression a single course of chemotherapy was given in 1984. During the following year there was a constant decline of
H. H. Schmidt; H. Sill; M. Eibl; C. Beham-Schmid; G. H�fler; O. A. Haas; G. J. Krejs; W. Linkesch
Surrogates of Mortality in Chronic Obstructive Pulmonary Disease
Chronic obstructive pulmonary disease (COPD) remains a leading cause of disability and death in the United States. The identification and amelioration of systemic manifestations of COPD may improve long-term outcomes, including survival. These systemic manifestations often correlate with increased risk of mortality and may be considered surrogates of disease severity. Several potential clinical surrogates are evaluated, including airflow obstruction, dyspnea,
Claudia G. Cote
Nutritional and metabolic modulation in chronic obstructive pulmonary disease management
In this paper the perspective for nutritional modulation of systemic impairment in patients with chronic obstructive pulmonary disease (COPD) is discussed. Progressive weight loss is characterised by disease-specific elevated energy requirements unbalanced by dietary intake. Weight gain per se can be achieved by caloric supplementation while future studies may prove efficacy of amino acid modulation to stimulate protein synthesis and
A. M. W. J. Schols
Direct Renin Inhibitor: Aliskiren in Chronic Kidney Disease
The renin-angiotensin-aldosterone system (RAAS) plays pivotal roles in the pathogenesis of chronic kidney disease (CKD) progression and its increased complications such as hypertension (HT) and cardiovascular diseases (CVD). Previous studies suggested that aliskiren a direct renin inhibitor, blocks RAAS and may be effective for the management of CKD and its complications. This review focuses on the effects of aliskiren on CKD.
Morishita, Yoshiyuki; Kusano, Eiji
Beta blockers in the management of chronic kidney disease
The sympathetic nervous system modulates renal function through its receptors namely ?1 (cardiac output and renin release), ?1 (systemic and renovascular constriction), and ?2 renovascular dilation. Sympathetic overactivity is commonly seen in chronic kidney disease (CKD) and is an important contributor to increasing the risk of cardiovascular events as well as increasing renal disease progression. Recent evaluations of drug use
G L Bakris; P Hart; E Ritz
Anticholinergics in the Treatment of Chronic Obstructive Pulmonary Disease
Chronic obstructive pulmonary disease (COPD) is one of the leading causes of morbidity and mortality in the world. In the majority of cases, the disease is the result of years of cigarette smoking. Contributing factors leading to bronchial obstruction in COPD include mucus hypersecretion and an increase in bronchial muscle tone, which is triggered mainly by cholinergic mechanisms. Anticholinergic bronchodilators
Kai-Michael Beeh; Tobias Welte; Roland Buhl
Racial and survival paradoxes in chronic kidney disease
Most of the 20 million people in the US with chronic kidney disease (CKD) die before commencing dialysis. One of every five dialysis patients dies each year in the US. Although cardiovascular disease is the most common cause of death among patients with CKD, conventional cardiovascular risk factors such as hypercholesterolemia, hypertension and obesity are paradoxically associated with better survival
Csaba P Kovesdy; Stephen F Derose; Tamara B Horwich; Gregg C Fonarow; Kamyar Kalantar-Zadeh
Management of Pediatric Patients With Chronic Kidney Disease Deborah Miller
Chronic kidney disease in children is associated with complications that require nursing interventions in both the inpatient and outpatient settings. Given the progressive nature of the disease and the com- plexity of the treatment regimen, it is important that nurses be com- fortable implementing acute and preventive care strategies and facili- tating the coordination of care. In addition, the need
Dina MacDonald
Physical Activity in the Prevention of Chronic Kidney Disease
Chronic kidney disease (CKD) is an important risk factor for cardiovascular disease (CVD) and mortality. The increase in CKD in recent decades has paralleled increases in obesity, diabetes, and the metabolic syndrome. Physical inactivity is a modifiable risk factor that may affect the development and course of CKD. It is well established that exercise training improves a number of metabolic
Craig S. Stump
Cardiovascular Imaging in Patients with Chronic Kidney Disease
Cardiovascular disease is highly prevalent in chronic kidney disease and has been associated with increased morbidity and mortality. Several morphological and functional tests are available to assess the cardiovascular system. Since structural and functional cardiovascular abnormalities have prognostic implications, their identification may become crucial for the implementation of effective preventive and therapeutic strategies. We review the most frequently used imaging
Cristina Karohl; Paolo Raggi
VNI cures acute and chronic experimental Chagas disease.
Chagas disease is a deadly infection caused by the protozoan parasite Trypanosoma cruzi. Afflicting approximately 8 million people in Latin America, Chagas disease is now becoming a serious global health problem proliferating beyond the traditional geographical borders, mainly because of human and vector migration. Because the disease is endemic in low-resource areas, industrial drug development has been lethargic. The chronic form remains incurable, there are no vaccines, and 2 existing drugs for the acute form are toxic and have low efficacy. Here we report the efficacy of a small molecule, VNI, including evidence of its effectiveness against chronic Chagas disease. VNI is a potent experimental inhibitor of T. cruzi sterol 14?-demethylase. Nontoxic and highly selective, VNI displays promising pharmacokinetics and administered orally to mice at 25 mg/kg for 30 days cures, with 100% cure rate and 100% survival, the acute and chronic T. cruzi infection. PMID:23372180
Villalta, Fernando; Dobish, Mark C; Nde, Pius N; Kleshchenko, Yulia Y; Hargrove, Tatiana Y; Johnson, Candice A; Waterman, Michael R; Johnston, Jeffrey N; Lepesheva, Galina I
Patients with chronic urticaria exhibit increased rates of sensitisation to Candida albicans, but not to common moulds.
Patients with chronic spontaneous urticaria (CU) frequently exhibit increased levels of total IgE (tIgE). However, sensitisations to relevant allergens are rarely detected in CU patients by standard prick testing suggesting that CU symptoms, at least in some patients, may represent hypersensitivity reactions to less common allergens. The objective of this study was to characterise skin reactivity and serum levels of IgE to Candida albicans (CA) and mould allergens in CU patients. A total of 112 CU patients and 35 healthy control subjects were subjected to intracutaneous skin testing for CA and seven ubiquitous moulds. Allergen specific and tIgE were determined using the Pharmacia CAP System. CU patients exhibited higher levels of tIgE than healthy subjects, but comparable rates of skin reactivity to CA and moulds and similar levels of specific IgE to mould allergens. However, increased IgE-anti-CA could only be detected in CU patients (13%). Almost all IgE-anti-CA positive CU patients showed high levels of tIgE. These data suggest that IgE-anti-CA expression contributes, at least in part, to increased tIgE levels in CU patients. Our findings call for further studies to characterise the relevance of CA hypersensitivity in CU, particularly in IgE-anti-CA positive CU patients that exhibit colonisation with Candida albicans. PMID:18793264
Staubach, Petra; Vonend, Anneke; Burow, Gerhard; Metz, Martin; Magerl, Markus; Maurer, Marcus
Treatment of chronic graft-versus-host disease in 2011
Purpose of review This article summarizes recent reports on the risks, pathogenesis and treatment of chronic graft-versus-host disease (GVHD). Recent findings Chronic GVHD remains an elusive disorder to characterize and to treat. Recent evidence on tolerance induction by regulatory T cells and on B cells involvement shed some insights in the pathogenesis of chronic GVHD. In a recent large comparative study, the overall risk profiles for acute and for chronic GVHD were similar, but risks factors were not changed after adjustment for prior acute GVHD, supporting the concept that chronic GVHD is not an end stage of acute GVHD. Glucocorticoids remain the standard initial treatment of chronic GVHD, but the outcomes are not satisfactory, particularly for patients with high-risk features. Many treatments for chronic GVHD including extracorporeal photopheresis, rituximab, sirolimus, mycofenolate mofetil, imatinib, pentostatin and infusion of mesenchymal stem cells have been reported in several retrospective and relatively small phase I/II studies with a wide range of overall responses. Summary No current therapies used for chronic GVHD have been approved by the Food and Drug Administration. Large well-designed prospective studies are warranted to establish better treatments. Targeted therapies based on the pathogenesis of chronic GVHD may lead to better outcomes.
Inamoto, Yoshihiro; Flowers, Mary E.D.
Chronic granulomatous disease mimicking early-onset Crohn's disease with cutaneous manifestations
Background Chronic granulomatous disease is a rare inherited disorder of the innate immune system. In patients with a clinical history of recurrent or persistent infections, especially infections caused by uncommon species, chronic granulomatous disease should be considered. Case presentation We report the case of a 5-year-old boy with a presumptive diagnosis of Crohn�s disease with extraintestinal manifestations. Chronic granulomatous disease was suspected in this case after Serratia marcescens was isolated from a skin ulcer culture. Granulomas were confirmed on histology and chronic granulomatous disease was diagnosed. Conclusion This case emphasizes the importance of high clinical suspicion of an alternative diagnosis of immune deficiency in patients with presumed inflammatory bowel disease and opportunistic infections, especially when disease occurs in early life.
Anaemia in chronic obstructive pulmonary disease. Does it really matter?
Chronic obstructive pulmonary disease (COPD) is one of the most prevalent chronic diseases, with an increasing rate in morbidity and mortality. In recent years, there has been a greater awareness about the clinical importance of systemic effects and other chronic conditions associated with COPD, as these significantly impact on the course of disease. The most studied extrapulmonary manifestations in COPD include the presence of concomitant cardiovascular disease, skeletal muscle wasting, osteoporosis and lung cancer. Anaemia is a recognised independent marker of mortality in several chronic diseases. Recent studies have shown that anaemia in patients with COPD may be more frequent than expected, with a prevalence ranging from 5% to 33%. Some evidence suggests that systemic inflammation may play an important pathogenic role, but anaemia in COPD is probably multifactorial and may be caused by others factors, such as concealed chronic renal failure, decreased androgenic levels, iron depletion, angiotensin-converting enzyme inhibitor treatment and exacerbations. Low levels of haemoglobin and haematocrit in COPD patients have been associated with poor clinical and functional outcomes as well as with mortality and increased healthcare costs. Despite the potential clinical benefit of successfully treating anaemia in these patients, evidence supporting the importance of its correction on the prognosis of COPD is uncertain. PMID:23679907
Portillo, K; Martinez-Rivera, C; Ruiz-Manzano, J
Childhood social disadvantage, cardiometabolic risk, and chronic disease in adulthood.
Adverse social environments in early life are hypothesized to become biologically embedded during the first few years of life, with potentially far-reaching implications for health across the life course. Using prospective data from a subset of a US birth cohort, the Collaborative Perinatal Project, started in 1959-1966 (n = 566), we examined associations of social disadvantage assessed in childhood with cardiometabolic function and chronic disease status more than 40 years later (in 2005-2007). Social disadvantage was measured with an index that combined information on adverse socioeconomic and family stability factors experienced between birth and age 7 years. Cardiometabolic risk (CMR) was assessed by combining information from 8 CMR biomarkers; an index of chronic disease status was derived by assessing 8 chronic diseases. Poisson models were used to investigate associations between social disadvantage and CMR or chronic disease scores while adjusting for childhood covariates and potential pathway variables. A high level of social disadvantage was significantly associated with both higher CMR (incident rate ratio = 1.69, 95% confidence interval: 1.19, 2.39) and with a higher number of chronic diseases (incident rate ratio = 1.39, 95% confidence interval: 1.00, 1.92) in minimally adjusted models. Associations with CMR persisted even after accounting for childhood and adult covariates. PMID:24970845
Non, Amy L; Rewak, Marissa; Kawachi, Ichiro; Gilman, Stephen E; Loucks, Eric B; Appleton, Allison A; Rom�n, Jorge C; Buka, Stephen L; Kubzansky, Laura D
[Chronic diseases and complexity: new roles in nursing. Advanced practice nurses and chronic patient].
The increase in chronic diseases and the progressive ageing of the population is a source of concern for the different agencies with responsibility for health care. This has led to the creation of many documents focused on the analysis of the current situation and care of chronic diseases, including the WHO recommendations intended to assist countries and health services design and implement strategies that will address the existing demand, control and prevention of chronic diseases. In addition, there is a need to respond to the demand generated by chronic diseases in every sense, and from the different systems it is becoming more difficult to get enough support from multidisciplinary teams where the nurse has a central importance. While chronic diseases are becoming a threat due to the costs they generate, it is also an opportunity for nursing to be at the forefront for advanced care requirements, performed by professionals with recognized advanced clinical skills and ability for case management while monitoring and controlling complex chronic patients. The different services of the National Health System have introduced nurses that play different roles (cases managers, liaison nurses, advanced practice nurses and so on). However, it could be argued that they are not being trained to a desirable development level. It is therefore time for health care authorities to determine the role of the advanced practice nurse in relation to functional positions, and allow them to make an advance in the development of unified skills for the whole National Health System. From our experience we have learned that the advanced practice nurse is a resource that helps in the sustainability of services, thanks to the efficiency shown in the results obtained from the care given to both chronic and complex chronic patients. PMID:24468495
S�nchez-Mart�n, C Inmaculada
Chronic lyme disease: psychogenic fantasy or somatic infection?
Sigal and Hassett published an article about Lyme disease in the EHP Supplements (Sigal and Hassett 2002), suggesting that chronic Lyme disease is "psychogenic." I do not think that Sigal and Hassett, non-psychiatrists, are qualified to speak about psychiatric matters. I, however, actually have had the disease, which they characterize as "medically unexplained," for over 25 years and have 15 years of experience as a patient advocate and educator. I beg to differ.
Mervine, Phyllis
Managing advanced chronic kidney disease: A primary care guide.
Chronic kidney disease (CKD) is a common disorder that requires close collaboration between the primary care physician and nephrologist. Most aspects of early CKD can be managed in the primary care setting with nephrology input. As the disease progresses, many aspects of care should be transitioned to the nephrologist, especially as the patient nears end-stage renal disease, when dialysis and transplantation must be addressed. PMID:24789588
Sakhuja, Ankit; Hyland, Jennifer; Simon, James F
Hypertension, left ventricular hypertrophy and chronic kidney disease
Left ventricular hypertrophy (LVH) is a cardiovascular complication highly prevalent in patients with chronic kidney disease\\u000a (CKD) and end-stage renal disease. LVH in CKD patients has generally a negative prognostic value, because it represents an\\u000a independent risk factor for the development of arrhythmias, sudden death, heart failure and ischemic heart disease. LVH in\\u000a CKD patients is secondary to both pressure
Stefano Taddei; Renato Nami; Rosa Maria Bruno; Ilaria Quatrini; Ranuccio Nuti
Pulmonary Hypertension Associated with Chronic Obstructive Pulmonary Diseases
\\u000a Chronic obstructive lung diseases and so-called cor pulmonale have traditionally been connected by the link of pulmonary hypertension\\u000a (PH). The concept that right ventricular hypertrophy is attributed to the afterload of the right ventricle, i.e., attributable\\u000a to PH, has not been challenged and clinicians continue to attempt to explain cor pulmonale as a consequence of chronic PH.\\u000a Both pulmonary parenchyma
Norbert F. Voelkel; Catherine Grossman; Herman J. Bogaard
Chronic calcium pyrophosphate crystal deposition disease arthropathy associated with hypomagnesemia.
We describe a case of a young woman with a magnesium renal wasting syndrome leading to severe hypomagnesemia and a chronic pseudo-osteoaritis calcium pyrophosphate crystal deposition disease (CPDD) arthropathy. A chronic CPDD arthropathy secondary to hypomagnesemia has not been previously reported. The identification of CPDD, particularly in the young, can be a clue to the presence of a potentially treatable underlying metabolic disorder, such as hypomagnesemia. PMID:19078120
Erickson, A R; Yeun, J Y; Enzenauer, R J
Macrophage migration inhibitory factor deficiency in chronic obstructive pulmonary disease.
The pathogenesis of chronic obstructive pulmonary disease (COPD) remains poorly understood. Cellular senescence and apoptosis contribute to the development of COPD; however, crucial regulators of these underlying mechanisms remain unknown. Macrophage migration inhibitory factor (MIF) is a pleiotropic cytokine that antagonizes both apoptosis and premature senescence and may be important in the pathogenesis of COPD. This study examines the role of MIF in the pathogenesis of COPD. Mice deficient in MIF (Mif(-/-)) or the MIF receptor CD74 (Cd74(-/-)) and wild-type (WT) controls were aged for 6 mo. Both Mif(-/-) and Cd74(-/-) mice developed spontaneous emphysema by 6 mo of age compared with WT mice as measured by lung volume and chord length. This was associated with activation of the senescent pathway markers p53/21 and p16. Following exposure to cigarette smoke, Mif(-/-) mice were more susceptible to the development of COPD and apoptosis compared with WT mice. MIF plasma concentrations were measured in a cohort of 224 human participants. Within a subgroup of older current and former smokers (n = 72), MIF concentrations were significantly lower in those with COPD [8.8, 95%CI (6.7-11.0)] compared with those who did not exhibit COPD [12.7 ng/ml, 95%CI (10.6-14.8)]. Our results suggest that both MIF and the MIF receptor CD74 are required for maintenance of normal alveolar structure in mice and that decreases in MIF are associated with COPD in human subjects. PMID:24441872
Sauler, Maor; Leng, Lin; Trentalange, Mark; Haslip, Maria; Shan, Peiying; Piecychna, Marta; Zhang, Yi; Andrews, Nathaniel; Mannam, Praveen; Allore, Heather; Fried, Terri; Bucala, Richard; Lee, Patty J
Cardiovascular disease in patients with chronic kidney disease: Getting to the heart of the matter
The high prevalence of cardiovascular disease (CVD) in patients with kidney disease is well described. This Canadian, multicenter, observational cohort study reports the prevalence and risk factors of CVD associated with kidney disease, in a cohort of patients with established chronic kidney disease (CKD), who are followed-up by nephrologists. This analysis sought to answer 2 questions: (1) in patients with
Adeera Levin; Ognjenka Djurdjev; Brendan Barrett; Ellen Burgess; Euan Carlisle; Jean Ethier; Kailash Jindal; David Mendelssohn; Sheldon Tobe; Joel Singer; Christopher Thompson
Severity of chronic Lyme disease compared to other chronic conditions: a quality of life survey
Overview. The Centers for Disease Control and Prevention (CDC) health-related quality of life (HRQoL) indicators are widely used in the general population to determine the burden of disease, identify health needs, and direct public health policy. These indicators also allow the burden of illness to be compared across different diseases. Although Lyme disease has recently been acknowledged as a major health threat in the USA with more than 300,000 new cases per year, no comprehensive assessment of the health burden of this tickborne disease is available. This study assesses the HRQoL of patients with chronic Lyme disease (CLD) and compares the severity of CLD to other chronic conditions. Methods. Of 5,357 subjects who responded to an online survey, 3,090 were selected for the study. Respondents were characterized as having CLD if they were clinically diagnosed with Lyme disease and had persisting symptoms lasting more than 6 months following antibiotic treatment. HRQoL of CLD patients was assessed using the CDC 9-item metric. The HRQoL analysis for CLD was compared to published analyses for the general population and other chronic illnesses using standard statistical methods. Results. Compared to the general population and patients with other chronic diseases reviewed here, patients with CLD reported significantly lower health quality status, more bad mental and physical health days, a significant symptom disease burden, and greater activity limitations. They also reported impairment in their ability to work, increased utilization of healthcare services, and greater out of pocket medical costs. Conclusions. CLD patients have significantly impaired HRQoL and greater healthcare utilization compared to the general population and patients with other chronic diseases. The heavy burden of illness associated with CLD highlights the need for earlier diagnosis and innovative treatment approaches that may reduce the burden of illness and concomitant costs posed by this illness.
Johnson, Lorraine; Wilcox, Spencer; Mankoff, Jennifer
Identification of Arabidopsis mutants exhibiting an altered hypersensitive response in gene-for-gene disease resistance.
A mutational study was carried out to isolate Arabidopsis thaliana plants that exhibit full or partial disruption of the RPS2-mediated hypersensitive response (HR) to Pseudomonas syringae that express avrRpt2. Five classes of mutants were identified including mutations at RPS2, dnd mutations causing a "defense, no death" loss-of-HR phenotype, a lesion-mimic mutant that also exhibited an HR- phenotype, and a number of intermediate or partial-loss-of-HR mutants. Surprisingly, many of these mutants displayed elevated resistance to virulent P. syringae and, in some cases, to Peronospora parasitica. Constitutively elevated levels of pathogenesis-related (PR) gene expression and salicylic acid were also observed. In the lesion-mimic mutant, appearance of elevated resistance was temporally correlated with appearance of lesions. For one of the intermediate lines, resistance was shown to be dependent on elevated levels of salicylic acid. A new locus was identified and named IHR1, after the mutant phenotype of "intermediate HR." Genetic analysis of the intermediate-HR plant lines was difficult due to uncertainties in distinguishing the partial/intermediate mutant phenotypes from wild type. Despite this difficulty, the intermediate-HR mutants remain of interest because they reveal potential new defense-related loci and because many of these lines exhibit partially elevated disease resistance without dwarfing or other apparent growth defects. PMID:10707353
Yu, I; Fengler, K A; Clough, S J; Bent, A F
In Search of a Germ Theory Equivalent for Chronic Disease
The fight against infectious disease advanced dramatically with the consolidation of the germ theory in the 19th century. This focus on a predominant cause of infections (ie, microbial pathogens) ultimately led to medical and public health advances (eg, immunization, pasteurization, antibiotics). However, the resulting declines in infections in the 20th century were matched by a rise in chronic, noncommunicable diseases, for which there is no single underlying etiology. The discovery of a form of low-grade systemic and chronic inflammation (�metaflammation�), linked to inducers (broadly termed �anthropogens�) associated with modern man-made environments and lifestyles, suggests an underlying basis for chronic disease that could provide a 21st-century equivalent of the germ theory.
Fibromyalgia and chronic widespread pain in autoimmune thyroid disease.
Fibromyalgia and chronic widespread pain syndromes are among the commonest diseases seen in rheumatology practice. Despite advances in the management of these conditions, they remain significant causes of morbidity and disability. Autoimmune thyroid disease is the most prevalent autoimmune disorder, affecting about 10�% of the population, and is a recognized cause of fibromyalgia and chronic widespread pain. Recent reports are shedding light on the mechanisms of pain generation in autoimmune thyroid disease-associated pain syndromes including the role of inflammatory mediators, small-fiber polyneuropathy, and central sensitization. The gradual elucidation of these pain pathways is allowing the rational use of pharmacotherapy in the management of chronic widespread pain in autoimmune thyroid disease. This review looks at the current understanding of the prevalence of pain syndromes in autoimmune thyroid disease, their likely causes, present appreciation of the pathogenesis of chronic widespread pain, and how our knowledge can be used to find lasting and effective treatments for the pain syndromes associated with autoimmune thyroid disease. PMID:24435355
Ahmad, Jowairiyya; Tagoe, Clement E
Activated protein C based therapeutic strategies in chronic diseases.
Activated protein C (aPC) is a natural anticoagulant and a potent anti-inflammatory and cytoprotective agent. At the expense of increased bleeding risk aPC has been used - with some success - in sepsis. The design of cytoprotective-selective aPC variants circumvents this limitation of increased bleeding, reviving the interest in aPC as a therapeutic agent. Emerging studies suggest that aPC`s beneficial effects are not restricted to acute illness, but likewise relevant in chronic diseases, such as diabetic nephropathy, neurodegeneration or wound healing. Epigenetic regulation of gene expression, reduction of oxidative stress, and regulation of ROS-dependent transcription factors are potential mechanisms of sustained cytoprotective effects of aPC in chronic diseases. Given the available data it seems questionable whether a unifying mechanism of aPC dependent cytoprotection in acute and chronic diseases exists. In addition, the signalling pathways employed by aPC are tissue and cell specific. The mechanistic insights gained from studies exploring aPC`s effects in various diseases may hence lay ground for tissue and disease specific therapeutic approaches. This review outlines recent investigations into the mechanisms and consequences of long-term modulation of aPC-signalling in models of chronic diseases. PMID:24652581
Bock, Fabian; Shahzad, Khurrum; Vergnolle, Nathalie; Isermann, Berend
Distress Screening in Chronic Disease: Essential for Cancer Survivors
Distress is a psychological state that is often observed in patients with chronic disease. Many cancers are considered chronic in nature, with patients experiencing long, disease-free states and intervals of metastatic disease. Distress can negatively affect the biopsychosocial balance in cancer survivors and impede their progress along the cancer trajectory. Distress can also affect medical and psychological outcomes and hinder advancement into long-term survivorship. Distress may contribute to disease progression, although despite research findings, health-care providers seldom screen for indications of persistent or unresolved distress. This article discusses research findings related to the prevalence of distress in multiple chronic diseases. Validated instruments used to screen for distress in cancer survivors, such as the Distress Thermometer and symptom checklist from the National Comprehensive Cancer Network, are reviewed. With the availability of brief and concise instruments to screen for distress, providers have the ability to provide holistic and comprehensive care for cancer survivors. The overall financial impact of cancer-related distress is understudied, although similar psychological studies indicate that prevention or elimination of distress is beneficial. Cancer is a lifelong, chronic disease; patients have ongoing needs and varied sources of distress. As the number of cancer survivors exponentially increases, their psychosocial needs will likewise expand.
Petty, Lorie; Lester, Joanne
[Behavior of the aminophenazone breath test in chronic liver diseases].
In 230 patients with histologically ascertained chronic hepathopathies the aminophenazone breathing test in the modification after Haustein and Schenker was carried out. In contrast to a control group consisting of 16 test persons with healthy liver (14CO2 exhalation 1019 +/- 175 DPM/mmol-CO2/70 kg body weight) the hepatic elimination of the [14C]-aminophenazone in chronic liver diseases (626 +/- 203 DPM/mmol CO2/70 kg body weight) was significantly restricted (p less than 0.001). The values of the aminophenazone breathing test showed a dependence on the degree of severity of the liver disease. Hepatoses with partly questionable or slight value of the disease did not differ in their results (841 +/- 230 DPM/mmol CO2/70 kg body weight) from those of persons with healthy liver. Chronic inflammatory liver diseases (668 +/- 185 DPM/mmol CO2/70 kg body weight) occupied an average position (p less than 0.001). The lowest values were to be seen in patients with chronic fibrosing liver diseases, mainly with liver cirrhosis (403 +/- 218 DPM/mmol CO2/70 kg body weight). Compared with the control group the difference was significant (p less than 0.001). Broad regions of overlapping of the individual values of various chronic liver diseases do not allow an unequivocal coordination of regions of the breathing test values to certain morphologically defined chronic hepatopathies. For the determination of size and degree of severity of the damage of liver parenchyma the aminophenazone breathing test, however, may be a valuable help in the framework of a special programme of diagnostics. PMID:3245251
Treutler, J; Sensing, H; Haustein, K O; H�ller, G
Chronic Diseases in Captive Geriatric Female Chimpanzees (Pan troglodytes)
The current aging population of captive chimpanzees is expected to develop age-related diseases and present new challenges to providing their veterinary care. Spontaneous heart disease and sudden cardiac death are the main causes of death in chimpanzees (especially of male animals), but little is known about the relative frequency of other chronic diseases. Furthermore, female chimpanzees appear to outlive the males and scant literature addresses clinical conditions that affect female chimpanzees. Here we characterize the types and prevalence of chronic disease seen in geriatric (older than 35 y) female chimpanzees in the colony at Alamogordo Primate Facility. Of the 16 female chimpanzees that fit the age category, 87.5% had some form of chronic age-related disease. Cardiovascular-related disease was the most common (81.25%) followed by metabolic syndrome (43.75%) and renal disease (31.25%). These data show the incidence of disease in geriatric female chimpanzees and predict likely medical management challenges associated with maintaining an aging chimpanzee population.
Nunamaker, Elizabeth A; Lee, D Rick; Lammey, Michael L
Diagnosis and management of chronic graft-versus-host disease.
A joint working group established by the Haemato-oncology subgroup of the British Committee for Standards in Haematology (BCSH) and the British Society for Bone Marrow Transplantation (BSBMT) has reviewed the available literature and made recommendations for the diagnosis and management of chronic graft-versus-host disease (GvHD). This guideline includes recommendations for the diagnosis and staging of chronic GvHD as well as primary treatment and options for patients with steroid-refractory disease. The goal of treatment should be the effective control of GvHD while minimizing the risk of toxicity and relapse. PMID:22533811
Dignan, Fiona L; Amrolia, Persis; Clark, Andrew; Cornish, Jacqueline; Jackson, Graham; Mahendra, Prem; Scarisbrick, Julia J; Taylor, Peter C; Shaw, Bronwen E; Potter, Michael N
Identity and psychological ownership in chronic illness and disease state
Psychological ownership is rarely considered in health discourse related to chronic illness or disease state. Construction of identity is an important consideration within this framework. This autoethnographic study explores psychological ownership and identity related to prostate cancer and chronic illness. Conclusions about the nature of psychological ownership and identity were gathered from the relevant literature and personal experience. Themes include the patient�healthcare professional relationship and that psychological ownership is personal and grounded in an individual's sense of identity, control and perceived capacity to control illness or disease. Personal reflection through autoethnography guides discussion of psychological ownership and identity.
Karnilowicz, W
Central pulse pressure in chronic kidney disease: a chronic renal insufficiency cohort ancillary study.
Central pulse pressure (PP) can be noninvasively derived using the radial artery tonometric methods. Knowledge of central pressure profiles has predicted cardiovascular morbidity and mortality in several populations of patients, particularly those with known coronary artery disease and those receiving dialysis. Few data exist characterizing central pressure profiles in patients with mild-moderate chronic kidney disease who are not on dialysis. We measured central PP cross-sectionally in 2531 participants in the Chronic Renal Insufficiency Cohort Study to determine correlates of the magnitude of central PP in the setting of chronic kidney disease. Tertiles of central PP were <36 mm Hg, 36 to 51 mm Hg, and >51 mm Hg with an overall mean (+/-SD) of 46+/-19 mm Hg. Multivariable regression identified the following independent correlates of central PP: age, sex, diabetes mellitus, heart rate (negatively correlated), glycosylated hemoglobin, hemoglobin, glucose, and parathyroid hormone parathyroid hormone concentrations. Additional adjustment for brachial mean arterial pressure and brachial PP showed associations for age, sex, diabetes mellitus, weight, and heart rate. Discrete intervals of brachial PP stratification showed substantial overlap within the associated central PP values. The large size of this unique chronic kidney disease cohort provides an ideal situation to study the role of brachial and central pressure measurements in kidney disease progression and cardiovascular disease incidence. PMID:20660819
Townsend, Raymond R; Chirinos, Julio A; Parsa, Afshin; Weir, Matthew A; Sozio, Stephen M; Lash, James P; Chen, Jing; Steigerwalt, Susan P; Go, Alan S; Hsu, Chi-Yuan; Rafey, Mohammed; Wright, Jackson T; Duckworth, Mark J; Gadegbeku, Crystal A; Joffe, Marshall P
A novel BACHD transgenic rat exhibits characteristic neuropathological features of Huntington disease.
Huntington disease (HD) is an inherited progressive neurodegenerative disorder, characterized by motor, cognitive, and psychiatric deficits as well as neurodegeneration and brain atrophy beginning in the striatum and the cortex and extending to other subcortical brain regions. The genetic cause is an expansion of the CAG repeat stretch in the HTT gene encoding huntingtin protein (htt). Here, we generated an HD transgenic rat model using a human bacterial artificial chromosome (BAC), which contains the full-length HTT genomic sequence with 97 CAG/CAA repeats and all regulatory elements. BACHD transgenic rats display a robust, early onset and progressive HD-like phenotype including motor deficits and anxiety-related symptoms. In contrast to BAC and yeast artificial chromosome HD mouse models that express full-length mutant huntingtin, BACHD rats do not exhibit an increased body weight. Neuropathologically, the distribution of neuropil aggregates and nuclear accumulation of N-terminal mutant huntingtin in BACHD rats is similar to the observations in human HD brains. Aggregates occur more frequently in the cortex than in the striatum and neuropil aggregates appear earlier than mutant htt accumulation in the nucleus. Furthermore, we found an imbalance in the striatal striosome and matrix compartments in early stages of the disease. In addition, reduced dopamine receptor binding was detectable by in vivo imaging. Our data demonstrate that this transgenic BACHD rat line may be a valuable model for further understanding the disease mechanisms and for preclinical pharmacological studies. PMID:23115180
Yu-Taeger, Libo; Petrasch-Parwez, Elisabeth; Osmand, Alexander P; Redensek, Adriana; Metzger, Silke; Clemens, Laura E; Park, Larry; Howland, David; Calaminus, Carsten; Gu, Xiaofeng; Pichler, Bernd; Yang, X William; Riess, Olaf; Nguyen, Huu Phuc
A humidity-sensitive Arabidopsis copine mutant exhibits precocious cell death and increased disease resistance.
The copines are a newly identified class of calcium-dependent, phospholipid binding proteins that are present in a wide range of organisms, including Paramecium, plants, Caenorhabditis elegans, mouse, and human. However, the biological functions of the copines are unknown. Here, we describe a humidity-sensitive copine mutant in Arabidopsis. Under nonpermissive, low-humidity conditions, the cpn1-1 mutant displayed aberrant regulation of cell death that included a lesion mimic phenotype and an accelerated hypersensitive response (HR). However, the HR in cpn1-1 showed no increase in sensitivity to low pathogen titers. Low-humidity-grown cpn1-1 mutants also exhibited morphological abnormalities, increased resistance to virulent strains of Pseudomonas syringae and Peronospora parasitica, and constitutive expression of pathogenesis-related (PR) genes. Growth of cpn1-1 under permissive, high-humidity conditions abolished the increased disease resistance, lesion mimic, and morphological mutant phenotypes but only partially alleviated the accelerated HR and constitutive PR gene expression phenotypes. The disease resistance phenotype of cpn1-1 suggests that the CPN1 gene regulates defense responses. Alternatively, the primary function of CPN1 may be the regulation of plant responses to low humidity, and the effect of the cpn1-1 mutation on disease resistance may be indirect. PMID:11595798
Jambunathan, N; Siani, J M; McNellis, T W
Blocking Interleukin-1? in Acute and Chronic Autoinflammatory Diseases
An expanding spectrum of acute and chronic inflammatory diseases are considered �autoinflammatory� diseases. This review considers autoinflammatory diseases as being distinct from �autoimmune� diseases. Autoimmune diseases are associated with dysfunctional T-cells and treated with �biologicals� including anti-TNF?, CTLA-Ig, anti-IL-12/23, anti-CD20, anti-IL-17 and anti-IL-6 receptor. In contrast, autoinflammatory diseases are uniquely due to a dysfunctional monocyte caspase-1 activity and secretion of IL-1?; indeed, blocking IL-1? results in a rapid and sustained reduction in the severity of most autoinflammatory diseases. Flares of gout, Type-2 diabetes, heart failure and smoldering multiple myeloma are examples of seemingly unrelated diseases, which are uniquely responsive to IL-1? neutralization.
Dinarello, Charles A.
CD46 Protects against Chronic Obstructive Pulmonary Disease
Background Chronic obstructive pulmonary disease and emphysema develops in 15% of ex-smokers despite sustained quitting, while 10% are free of emphysema or severe lung obstruction. The cause of the incapacity of the immune system to clear the inflammation in the first group remains unclear. Methods and Findings We searched genes that were protecting ex-smokers without emphysema, using microarrays on portions of human lungs surgically removed; we found that loss of lung function in patients with chronic obstructive pulmonary disease and emphysema was associated with a lower expression of CD46 and verified this finding by qRT-PCR and flow cytometry. Also, there was a significant association among decreased CD46+ cells with decreased CD4+T cells, apoptosis mediator CD95 and increased CD8+T cells that were protecting patients without emphysema or severe chronic obstructive pulmonary disease. CD46 not only regulates the production of T regulatory cells, which suppresses CD8+T cell proliferation, but also the complement cascade by degradation of C3b. These results were replicated in the murine smoking model, which showed increased C5a (produced by C3b) that suppressed IL12 mediated bias to T helper 1 cells and elastin co-precipitation with C3b, suggesting that elastin could be presented as an antigen. Thus, using ELISA from elastin peptides, we verified that 43% of the patients with severe early onset of chronic obstructive pulmonary disease tested positive for IgG to elastin in their serum compared to healthy controls. Conclusions These data suggest that higher expression of CD46 in the lungs of ex-smoker protects them from emphysema and chronic obstructive pulmonary disease by clearing the inflammation impeding the proliferation of CD8+ T cells and necrosis, achieved by production of T regulatory cells and degradation of C3b; restraining the complement cascade favors apoptosis over necrosis, protecting them from autoimmunity and chronic inflammation.
Grumelli, Sandra; Lu, Bao; Peterson, Leif; Maeno, Toshitaka; Gerard, Craig
Therapeutic vaccination to treat chronic infectious diseases
A famous milestone in the vaccine field has been the first successful vaccination against smallpox, in 1798, by Edward Jenner. Using the vaccinia cowpox virus, Jenner was able to protect vaccinees from variola or smallpox. The Modified Virus Ankara (MVA) poxvirus strain has been one of the vaccines subsequently developed to prevent smallpox infection and was selected by the US government in their Biodefense strategy. Progress in molecular biology and immunology associated with MVA infection has led to the development of MVA as vaccine platform, both in the field of preventive and therapeutic vaccines. This later class of therapeutics has witnessed growing interest that has translated into an increasing number of vaccine candidates reaching the clinics. Among those, MVA-based therapeutic vaccines have addressed four major chronic infections including viral hepatitis, AIDS, human papillomavirus-linked pathologies and tuberculosis. Clinical trials encompass phase 1 and 2 and have started to show significant results and promises.
Boukhebza, Houda; Bellon, Nadine; Limacher, Jean Marc; Inchauspe, Genevieve
CHRONIOUS: an open, ubiquitous and adaptive chronic disease management platform for chronic obstructive pulmonary disease (COPD), chronic kidney disease (CKD) and renal insufficiency.
CHRONIOUS is an highly innovative Information and Communication Technologies (ICT) research Initiative that aspires to implement its vision for ubiquitous health and lifestyle monitoring. The 17 European project partners are strictly working together since February 2008 to realize and open platform to manage and monitor elderly patients with chronic diseases and many difficulties to reach hospital centers for routine controls. The testing activities will be done in Italy and Spain involving COPD (Chronic Obstructive Pulmonary Disease) and CKD (Chronic Kidney Disease) patients, these being widespread and highly expensive in terms of social and economic costs. Patients, equipped by wearable technologies and sensors and interacting with lifestyle interfaces, will be assisted by healthcare personnel able to check the health record and critical conditions through the Chronious platform data analysis and decision support system. Additionally, the new ontology based literature search engine will help the clinicians in the standardization of care delivery process. This paper is to present the main project objectives and its principal components from the intelligent system point of view. PMID:21096301
Rosso, R; Munaro, G; Salvetti, O; Colantonio, S; Ciancitto, F
MicroRNAs: New Insights into Chronic Childhood Diseases
Chronic diseases are the major cause of morbidity and mortality worldwide and have shown increasing incidence rates among children in the last decades. Chronic illnesses in the pediatric population, even if well managed, affect social, psychological, and physical development and often limit education and active participation and increase the risk for health complications. The significant pediatric morbidity and mortality rates caused by chronic illnesses call for serious efforts toward better understanding of the pathogenesis of these disorders. Recent studies have shown the involvement of microRNAs (miRNAs) in various aspects of major pediatric chronic non-neoplastic diseases. This review focuses on the role of miRNAs in four major pediatric chronic diseases including bronchial asthma, diabetes mellitus, epilepsy and cystic fibrosis. We intend to emphasize the importance of miRNA-based research in combating these major disorders, as we believe this approach will result in novel therapies to aid securing normal development and to prevent disabilities in the pediatric population.
Omran, Ahmed; Elimam, Dalia; Yin, Fei
CD137 in Chronic Graft-Versus-Host Disease.
Chronic graft-versus-host disease (GVHD) occurs in recipients of allogeneic hematopoietic stem cell transplantation with a high frequency. Preclinical animal chronic GVHD models outlined in this chapter allow for the delineation of events that occur during chronic GVHD development. The DBA/2 ? (C56BL/6 � DBA/2)F1 (BDF1) model is characterized by systemic lupus erythematosus (SLE)-like phenotype. The B10.D2 ? Balb/c model presents many features of autoimmune scleroderma. The former model is useful in defining how alloreactive donor CD4(+) T cells break B-cell tolerance, whereas the latter model is suitable for dissecting the pathogenesis of organ fibrosis. Our laboratory has demonstrated that injection of a single dose of strong CD137 agonists can prevent or cure chronic GVHD in these two models. In general, these models are particularly suited to screening the immunomodulatory therapeutics. PMID:24788176
Kim, Juyang; Cho, Hong R; Kwon, Byungsuk
Chronic pancreatitis: A surgical disease? Role of the Frey procedure
Although medical treatment and endoscopic interventions are primarily offered to patients with chronic pancreatitis, approximately 40% to 75% will ultimately require surgery during the course of their disease. Although pancreaticoduodenectomy has been considered the standard surgical procedure because of its favorable results on pain control, its high postoperative complication and pancreatic exocrine or/and endocrine dysfunction rates have led to a growing enthusiasm for duodenal preserving pancreatic head resection. The aim of this review is to better understand the rationale underlying of the Frey procedure in chronic pancreatitis and to analyze its outcome. Because of its hybrid nature, combining both resection and drainage, the Frey procedure has been conceptualized based on the pathophysiology of chronic pancreatitis. The short and long-term outcome, especially pain relief and quality of life, are better after the Frey procedure than after any other surgical procedure performed for chronic pancreatitis.
Roch, Alexandra; Teyssedou, Jerome; Mutter, Didier; Marescaux, Jacques; Pessaux, Patrick
Proteomics and chronic inflammatory bowel diseases
Inflammatory bowel diseases (IBD) are relatively frequent in developed countries. Physiopathological events involved in the etiology of IBDs include activation of immune, mesenchymal and epithelial cells. This review gives an overview of the currently applied proteomics technologies. It describes metabolic changes and goes into the approaches using this methodology to understand the molecular mechanisms implicated in the development of the
Emanuela Felley-Bosco; Muriel Andr�
Chronic interstitial nephritis in Whipple's disease
Summary Report is given on a 68-year-old man who suffered primarily from progressive weight loss and repeated episodes of fever and arthralgia. Later, liver dysfunction and renal insufficiency developed. Liver and kidney biopsics disclosed granulomatous hepatitis and nephritis. Because of the morphologic and clinical findings, the diagnosis of Boeck's disease was made. Shortly before death, diarrhea developed. Autopsy revealed a
A. Schlumpf; U. A. Marbet; E. St�cklin; W. Wegmann; B. L�mmle; M. Mujagic; W. J�sch; G. Thiel; H. Th�len; W. Olivieri; F. Gudat; J. Torhorst; H. U. Zollinger; M. J. Mihatsch
Chronic Liver Diseases as Liver Tumor Precursors
Liver cancer is a major global health problem and hepatocellular carcinoma (HCC) accounts for 75% of all liver carcinoma. HCC occurs more often in men than in women and mostly in people 50 to 60 years old. The disease is more common in parts of sub-Saharan Africa and Asia than in North and South America and Europe. Nevertheless its incidence
Jan Lata
Animal models in chronic obstructive pulmonary disease-an overview.
ABSTRACT Chronic obstructive pulmonary disease (COPD) is characterized by progressive airway obstruction resultant from an augmented inflammatory response of the respiratory tract to noxious particles and gases. Previous reports present a number of different hypotheses about the etiology and pathophysiology of COPD. The generating mechanisms of the disease are subject of much speculation, and a series of questions and controversies among experts still remain. In this context, several experimental models have been proposed in order to broaden the knowledge on the pathophysiological characteristics of the disease, as well as the search for new therapeutic approaches for acute or chronically injured lung tissue. This review aims to present the main experimental models of COPD, more specifically emphysema, as well as to describe the main characteristics, advantages, disadvantages, possibilities of application, and potential contribution of each of these models for the knowledge on the pathophysiological aspects and to test new treatment options for obstructive lung diseases. PMID:24785359
Marcelino, Monica Yonashiro; Fuoco, Natalia Langenfeld; Faria, Carolina Arruda de; Kozma, Rodrigo de Las Heras; Marques, Lais Fernanda; Ribeiro-Paes, Jo�o Tadeu
Chronic kidney disease in an adult with propionic acidemia.
We report an adult male with classic propionic acidemia (PA) who developed chronic kidney disease in the third decade of his life. This diagnosis was recognized by an increasing serum creatinine and confirmed by reduced glomerular filtration on a (99m)Tc-diethylenetriamine pentaacetate (DTPA) scan. Histopathology of the kidney showed moderate glomerulo- and tubulointerstitial fibrosis with very segmental mesangial IgA deposits. This is the second reported case of kidney disease in an individual with propionic acidemia possibly indicating that chronic kidney disease may be a late-stage complication of propionic acidemia. Additionally, this is the first description of the histopathology of kidney disease in an individual with propionic acidemia. As more cases emerge, the clinical course and spectrum of renal pathology in this disorder will be better defined. PMID:23756992
Vernon, H J; Bagnasco, S; Hamosh, A; Sperati, C J
Anti-Inflammatory Therapy in Chronic Disease: Challenges and Opportunities
A number of widespread and devastating chronic diseases, including atherosclerosis, type 2 diabetes, and Alzheimer�s disease, have a pathophysiologically important inflammatory component. In these diseases, the precise identity of the inflammatory stimulus is often unknown and, if known, is difficult to remove. Thus, there is interest in therapeutically targeting the inflammatory response. Although there has been success with anti-inflammatory therapy in chronic diseases triggered by primary inflammation dysregulation or autoimmunity, there are considerable limitations. In particular, the inflammatory response is critical for survival. As a result, redundancy, compensatory pathways, and necessity narrow the risk:benefit ratio of anti-inflammatory drugs. However, new advances in understanding inflammatory signaling and its links to resolution pathways, together with new drug development, offer promise in this area of translational biomedical research.
Tabas, Ira; Glass, Christopher K.
Therapeutic strategies to slow chronic kidney disease progression
Childhood chronic kidney disease commonly progresses toward end-stage renal failure, largely independent of the underlying\\u000a disorder, once a critical impairment of renal function has occurred. Hypertension and proteinuria are the most important independent\\u000a risk factors for renal disease progression. Therefore, current therapeutic strategies to prevent progression aim at controlling\\u000a blood pressure and reducing urinary protein excretion. Renin-angiotensin-system (RAS) antagonists preserve
Elke W�hl; Franz Schaefer
Expression of DNA topoisomerases in chronic proliferative kidney disease
Expression of DNA topoisomerases in chronic proliferative kidney disease.BackgroundCirculating autoantibodies to human topoisomerases have been reported in glomerular kidney disease associated with scleroderma and systemic lupus erythematosus. However, limited information is available about the expression of topoisomerases in the kidney under normal and pathological conditions.MethodsThe expression of DNA topoisomerases I and II? was studied by immunohistochemistry on archival biopsies from
Lilija V. Ivanova; Pierre Rudolph; Udo Kellner; Anja J�rgensen; Irina E. Tareeva; Per Alm; Dietfrid Proppe
Emerging therapies for chronic kidney disease: what is their role?
The prevalence of chronic kidney disease (CKD) is increasing worldwide. The best therapies currently available focus on the control of blood pressure and optimization of renin�angiotensin�aldosterone system blockade. Currently available agents are only partially effective against hard end points such as the development of end-stage renal disease and are not discussed in this Review. Many other agents have been shown
David C. H. Harris; Eswari Vilayur
Self-Management Support Interventions for Persons With Chronic Disease
Background Self-management support interventions such as the Stanford Chronic Disease Self-Management Program (CDSMP) are becoming more widespread in attempt to help individuals better self-manage chronic disease. Objective To systematically assess the clinical effectiveness of self-management support interventions for persons with chronic diseases. Data Sources A literature search was performed on January 15, 2012, using OVID MEDLINE, OVID MEDLINE In-Process and Other Non-Indexed Citations, OVID EMBASE, EBSCO Cumulative Index to Nursing & Allied Health Literature (CINAHL), the Wiley Cochrane Library, and the Centre for Reviews and Dissemination database for studies published between January 1, 2000, and January 15, 2012. A January 1, 2000, start date was used because the concept of non-disease-specific/general chronic disease self-management was first published only in 1999. Reference lists were examined for any additional relevant studies not identified through the search. Review Methods Randomized controlled trials (RCTs) comparing self-management support interventions for general chronic disease against usual care were included for analysis. Results of RCTs were pooled using a random-effects model with standardized mean difference as the summary statistic. Results Ten primary RCTs met the inclusion criteria (n = 6,074). Nine of these evaluated the Stanford CDSMP across various populations; results, therefore, focus on the CDSMP. Health status outcomes: There was a small, statistically significant improvement in favour of CDSMP across most health status measures, including pain, disability, fatigue, depression, health distress, and self-rated health (GRADE quality low). There was no significant difference between modalities for dyspnea (GRADE quality very low). There was significant improvement in health-related quality of life according to the EuroQol 5-D in favour of CDSMP, but inconsistent findings across other quality-of-life measures. Healthy behaviour outcomes: There was a small, statistically significant improvement in favour of CDSMP across all healthy behaviours, including aerobic exercise, cognitive symptom management, and communication with health care professionals (GRADE quality low). Self-efficacy: There was a small, statistically significant improvement in self-efficacy in favour of CDSMP (GRADE quality low). Health care utilization outcomes: There were no statistically significant differences between modalities with respect to visits with general practitioners, visits to the emergency department, days in hospital, or hospitalizations (GRADE quality very low). All results were measured over the short term (median 6 months of follow-up). Limitations Trials generally did not appropriately report data according to intention-to-treat principles. Results therefore reflect �available case analyses,� including only those participants whose outcome status was recorded. For this reason, there is high uncertainty around point estimates. Conclusions The Stanford CDSMP led to statistically significant, albeit clinically minimal, short-term improvements across a number of health status measures (including some measures of health-related quality of life), healthy behaviours, and self-efficacy compared to usual care. However, there was no evidence to suggest that the CDSMP improved health care utilization. More research is needed to explore longer-term outcomes, the impact of self-management on clinical outcomes, and to better identify responders and non-responders. Plain Language Summary Self-management support interventions are becoming more common as a structured way of helping patients learn to better manage their chronic disease. To assess the effects of these support interventions, we looked at the results of 10 studies involving a total of 6,074 people with various chronic diseases, such as arthritis and chronic pain, chronic respiratory diseases, depression, diabetes, heart disease, and stroke. Most trials focused on a program called the Stanford Chronic Disease Self-Management Program (CDSMP). W
Franek, J
Chronic Kidney Disease, Mortality, and Treatment Strategies among Patients with Clinically Significant Coronary Artery Disease
Cardiovascular disease is an important cause of mortal- ity among patients with chronic kidney disease (CKD). This study describes associations between CKD, cardiac revascularization strategies, and mortality among patients with CKD and cardio- vascular disease. All patients undergoing cardiac catheterization at Duke University Medical Center (1995 to 2000) with documented stenosis 75% of at least one coronary artery and available
Moraxella catarrhalis in Chronic Obstructive Pulmonary Disease Burden of Disease and Immune Response
Rationale: Moraxella catarrhalis is frequently present in the sputum of adults with chronic obstructive pulmonary disease (COPD). Little is known about the role of M. catarrhalis in this common disease. Objective: To elucidate the burden of disease, the dynamics of car- riage, and immune responses to M. catarrhalis in COPD. Methods: Prospective cohort study of 104 adults with COPD in
Timothy F. Murphy; Aimee L. Brauer; Brydon J. B. Grant; Sanjay Sethi
Chronic Kidney Disease Is Often Unrecognized among Patients with Coronary Heart Disease: The REGARDS Cohort Study
Introduction: Individuals with kidney disease are at increased risk for coronary heart disease (CHD) and CHD is associated with an increased prevalence of chronic kidney disease (CKD). Awareness of CKD may potentially influence diagnostic decisions, life-style changes and pharmacologic interventions targeted at modifiable CHD risk factors. We describe here the degree to which persons with CHD are aware of their
William M. McClellan; Britt B. Newsome; Leslie A. McClure; Mary Cushman; George Howard; Paul Audhya; Jerome L. Abramson; David G. Warnock
The natural history of beryllium sensitization and chronic beryllium disease.
With the advent of in vitro immunologic testing, we can now detect exposed individuals who are sensitized to beryllium and those who have chronic beryllium disease (CBD) with lung pathology and impairment. Earlier detection and more accurate diagnostic tools raise new questions about the natural history of sensitization and granulomatous disease. Preliminary data suggest that early detection identifies people who are sensitized to beryllium and that these individuals are at risk for progressing into clinical disease. This article discusses the historical, recent, and ongoing studies germane to our understanding of CBD natural history, including the immunologic and inflammatory basis of the disease, the environmental and host risk factors for disease progression, biological markers of disease severity and activity that may help predict outcome, and the implications for broad-based workplace screening to identify patients at the earliest stages of beryllium sensitization and disease. Images Figure 1. A Figure 1. B Figure 1. C Figure 1. D
Newman, L S; Lloyd, J; Daniloff, E
Mechanisms and treatment of extraosseous calcification in chronic kidney disease
Strong and unidirectional associations exist between the severity of cardiovascular calcifications and mortality in patients with advanced chronic kidney disease. In the past 10 years, a wealth of experimental and clinical information has been published on the key pathophysiological events that contribute to the development and progression of vascular and soft-tissue calcifications. These processes involve a sensitive balance of calcification
Hansj�rg Rothe; Thilo Kr�ger; Patrick H. Biggar; Georg Schlieper; Markus Ketteler
Circulating Leptin in Patients with Chronic Obstructive Pulmonary Disease
Unexplained weight loss is common in patients with chronic obstructive pulmonary disease (COPD). Since leptin, an obesity gene product, is known to play important roles in the control of body weight and energy expenditure, we investigated serum leptin levels, along with circulating tumor necrosis factor- a (TNF- a ) and soluble TNF receptor (sTNF-R55 and -R75) levels, in 31 patients
Pharmacotherapy for Mortality Reduction in Chronic Obstructive Pulmonary Disease
Despite rapid advances in our understanding of its pathophysiol- ogy, chronic obstructive pulmonary disease (COPD) remains incur- able. Although bronchodilators and theophyllines are commonly used to treat symptoms of dyspnea and cough and to acutely im- prove lung function, they do not modify the long-term decline in FEV1. The principal goals of current COPD pharmacotherapy are to reduce exacerbations, improve
Don D. Sin; S. F. Paul Man
Drugs in Clinical Development for Chronic Obstructive Pulmonary Disease
Many drugs may be potentially useful in the treatment of chronic obstructive pulmonary disease (COPD), but relatively few become available for human use due to lack of safety, lack of efficacy, or both. This is an inherent risk in the drug development process, which coupled with the limited understanding of the molecular pathogenesis of COPD, has produced a trend toward
N�stor A. Molfino
Chronic pancreatitis as presentation of Crohn's disease in a child
It is reported that a pancreatic disease may precede the diagnosis of inflammatory bowel disease (IBD) both in children and in adults. Idiopathic chronic pancreatitis, however, occasionally co-exists with the IBD, mainly at pediatric age. We report a case of a patient who progressively developed the features of a chronic pancreatitis, before the diagnosis of Crohn�s Disease (CD). Ten months after the onset of the first episode of pancreatitis the patient developed bloody diarrhea, mucus stools and biochemical findings of inflammation. The colonoscopy revealed a diffuse colitis without involvement of the last loop and the gastroscopy showed inflammation of the iuxta-papillary area. The histological findings confirmed the diagnosis of CD that involved the colon and the duodenum. In conclusion, in children the idiopathic chronic pancreatitis may be an unusual presentation of CD. Thus, if other known cause of chronic pancreatitis are not found, a not invasive work up to exclude the IBD should be warranted. An early coincidental diagnosis of the IBD may delay the progression of the pancreatic disease.
Knafelz, Daniela; Panetta, Fabio; Monti, Lidia; Bracci, Fiammetta; Papadatou, Bronislava; Torre, Giuliano; Dall'Oglio, Luigi; Diamanti, Antonella
Hepatitis E virus superinfection in patients with chronic liver disease
Infection with hepatitis A virus (HAV) can cause severe illness in adult patients with chronic liver disease (CLD) caused by hepatitis C. In endemic areas such as South Asia, however, most adult patients already have been exposed to HAV but could still be susceptible to hepatitis E virus (HEV) infection. We document that HEV superinfection in 4 of our CLD
Saeed S. Hamid; Muslim Atiq; Farooq Shehzad; Aneela Yasmeen; Tayyabun Nissa; Abdul Salam; Anwar Siddiqui; Wasim Jafri
Anxiety and Chronic Obstructive Pulmonary Disease: Prevalence, Impact, and Treatment
Objective: This article reviews the prevalence of anxiety disorders in patients with chronic obstructive pulmonary disease (COPD) as well as the impact of comorbid anxiety on quality of life in patients with COPD. Published studies on three types of treatments for anxiety are then reviewed: psychopharmacology, psychotherapy, and pulmonary rehabilitation programs. Materials and Methods: A PubMed search was conducted of
Medication dosing in patients with chronic kidney disease.
Appropriate dosage adjustments for patients with chronic kidney disease (CKD) are critical for patient safety. This article reviews adjustments for common antidiabetic, antibiotic, analgesic, and antithrombotic medications, as well as important patient teaching information for over-the-counter (OTC) medications. PMID:24201917
Zuber, Kim; Liles, Anne Marie; Davis, Jane
A Quantitative Approach to Drug Dosing in Chronic Kidney Disease
Chronic kidney disease (CKD) is increasing at an alarming rate. Medication prescribing in this growing population is especially difficult. Many pharmacological agents or their metabolites are eliminated unchanged through the kidney. Drug dosing in CKD is challenging as most patients have a number of comorbid conditions. Patients with CKD take pharmacological agents with potential for drug interactions. Most patients also
Ali J. Olyaei; Jessica L. Steffl
Corticosteroid Therapy for Liver Abscess in Chronic Granulomatous Disease
Liver abscesses in chronic granulomatous disease (CGD) are typically difficult to treat and often require surgery. We describe 9 X-linked CGD patients with staphylococcal liver abscesses refractory to conventional therapy successfully treated with corticosteroids and antibiotics. Corticosteroids may have a role in treatment of Staphylococcus aureus liver abscesses in CGD.
Leiding, Jennifer W.; Freeman, Alexandra F.; Marciano, Beatriz E.; Anderson, Victoria L.; Uzel, Gulbu; Malech, Harry L.; DeRavin, SukSee; Wilks, David; Venkatesan, Aradhana M.; Zerbe, Christa S.; Heller, Theo
Vitamin D and Vascular Calcification in Chronic Kidney Disease
Vascular calcification is common in patients with chronic kidney disease (CKD) and contributes to the increased rate of cardiovascular morbidity and mortality. The mechanisms regulating vascular calcification are under investigation; it is accepted that vascular calcification is an active and complex process involving many factors that promote or inhibit calcification. Vascular smooth muscle cells undergo transformation into osteogenic cells. This
Mariano Rodriguez; Julio Manuel Martinez-Moreno; M. Encarnaci�n Rodr�guez-Ortiz; Juan R. Mu�oz-Casta�eda; Yolanda Almaden
The clinical use of HVPG measurements in chronic liver disease
Portal hypertension is a severe, almost unavoidable complication of chronic liver diseases and is responsible for the main clinical consequences of cirrhosis. Measurement of the hepatic venous pressure gradient (HVPG) is currently the best available method to evaluate the presence and severity of portal hypertension. Clinically significant portal hypertension is defined as an increase in HVPG to ?10 mmHg; above
Juan G. Abraldes; Annalisa Berzigotti; Juan Carlos Garc�a-Pagan; Jaime Bosch
Arterial Compliance in Elderly Men with Chronic Kidney Disease
Background\\/Aim: Chronic kidney disease (CKD) is associated with decreased arterial compliance (AC). The stage of development of impaired arterial function in CKD in relation to loss of glomerular filtration rate (GFR) is not known. This study�s aim was to evaluate the relationship between GFR and AC in patients with CKD. Methods: We recruited 91 men aged ?60 years with GFR
Sri G. Yarlagadda; Ambreen Hussain; Dawn M. Bravata; Shaheen Motiwala; Aldo J. Peixoto
Participatory Research for Chronic Disease Prevention in Inuit Communities
ERIC Educational Resources Information Center
Objective: To develop a community-based chronic disease prevention program for Inuit in Nunavut, Canada. Methods: Stakeholders contributed to intervention development through formative research [in-depth interviews (n = 45), dietary recalls (n = 42)], community workshops, group feedback and implementation training. Results: Key cultural themes�
Gittelsohn, Joel; Roache, Cindy; Kratzmann, Meredith; Reid, Rhonda; Ogina, Julia; Sharma, Sangita
Regulation of fibroblast growth factor-23 in chronic kidney disease
Background. Fibroblast growth factor-23 (FGF23) is a circulating factor that regulates the renal reabsorption of inorganic phosphate (Pi) and is increased in chronic kidney disease (CKD). The aim of the current investigation was to study the regulation of FGF23 in CKD subjects with various degree of renal function. As such, we analysed the relationship between FGF23, Pi, calcium, parathyriod hormone
Per-Anton Westerberg; Torbjorn Linde; Bjorn Wikstrom; Osten Ljunggren; Mats Stridsberg; Tobias E. Larsson
[In silico pharmacology of Chinese herbs for chronic kidney diseases].
Tonifying herbs and evil expelling herbs of traditional Chinese medicine (TCM) for chronic kidney diseases in molecular level were studied by computer aided drug design, including analysis of molecular similarity, predictive ADME simulation and predictive toxic simulation. It was found that this technology could distinguish the structure diversity of compounds from TCM, and screen the lead compounds rapidly. PMID:21355252
Zhu, Wei; Wu, Dinghong; Qiu, Xiaohui; Xu, Wen
Postmortem diagnosis of chronic granulomatous disease: how worthwhile is it?
A previously healthy 11 year old boy died unexpectedly after a rapid course of progressive pneumonia. Postmortem microbiology and histopathology suggested an underlying diagnosis of chronic granulomatous disease. This was confirmed by neutrophil oxidative burst and gene mutation analysis of other family members, one of whom benefited from early bone marrow transplantation.
Lakshman, R; Bruce, S; Spencer, D A; Crawford, D; Galloway, A; Cooper, P N; Barge, D; Roos, D; Flood, T J; Abinun, M
Persistent Colonization by Haemophilus influenzae in Chronic Obstructive Pulmonary Disease
Nontypeable Haemophilus influenzae colonizes the respiratory tract of adults with chronic obstructive pulmonary disease (COPD) and causes intermittent exacerbations. Isolates of H. influenzae collected monthly in a prospective study were subjected to molecular typing. During a 7-year study spanning 345 patient-months of observation, 122 episodes of negative cultures lasting 1 month or more, and that were preceded and followed by
Timothy F. Murphy; Aimee L. Brauer; Andrew T. Schiffmacher; Sanjay Sethi
Sudden cardiac death in chronic kidney disease: epidemiology and prevention
Annual cardiovascular mortality in patients with chronic kidney disease (CKD) is much higher than in the general population. The rate of sudden cardiac death increases as the stage of CKD increases and could be responsible for 60% of cardiac deaths in patients undergoing dialysis. In hemodialysis units treating patients with CKD, cardiac arrest occurs at a rate of seven arrests
M. Khaled Shamseddin; Patrick S. Parfrey
Use of nitric oxide inhalation in chronic obstructive pulmonary disease
BACKGROUNDInhalation of nitric oxide with oxygen could be a promising treatment in patients with chronic obstructive pulmonary disease (COPD) and pulmonary hypertension. However, the current methods of delivery of NO are cumbersome and unsuitable for long term use. The present study was undertaken to investigate the safety and efficacy of a mixture of nitric oxide (NO) and oxygen administered via
Kumar Ashutosh; Kishor Phadke; Jody Fragale Jackson; David Steele
Cough threshold in patients with chronic obstructive pulmonary disease
BACKGROUNDCough is an important symptom of patients with chronic obstructive pulmonary disease (COPD). The cough threshold to citric acid and capsaicin in patients with COPD and in normal volunteers was measured, as well as bronchial hyperresponsiveness to methacholine.METHODSNineteen patients with COPD and 22 controls were recruited. Subjects underwent a methacholine bronchoprovocation test and a cough challenge to citric acid and
C H Wong; A H Morice
Chronic Obstructive Pulmonary Disease and Lung Cancer: New Molecular Insights
Both chronic obstructive pulmonary disease (COPD) and lung cancer are major causes of death worldwide. In most cases this reflects cigarette smoke exposure which is able to induce an inflammatory response in the airways of smokers. Indeed, COPD is characterized by lower airway inflammation, and importantly, the presence of COPD is by far the greatest risk factor for lung cancer
Ian M. Adcock; Gaetano Caramori; Peter J. Barnes
Actinomyces in Chronic Granulomatous Disease: An Emerging and Unanticipated Pathogen
Background Chronic granulomatous disease (CGD) is a rare inherited disease of the phagocyte NADPH oxidase system that causes defective production of toxic oxygen metabolites, impaired bacterial and fungal killing, and recurrent life-threatening infections, mostly by catalase-producing organisms. We report for the first time, to our knowledge, chronic infections with Actinomyces species in 10 patients with CGD. Actinomycosis is a chronic granulomatous condition that commonly manifests as cervicofacial, pulmonary, or abdominal disease, caused by slowly progressive infection with oral and gastrointestinal commensal Actinomyces species. Treatment of actinomycosis is usually simple in immunocompetent individuals, requiring long-term, high-dose intravenous penicillin, but is more complicated in those with CGD because of delayed diagnosis and an increased risk of chronic invasive or debilitating disease. Methods Actinomyces was identified by culture, staining, 16S ribosomal DNA polymerase chain reaction, and/ or a complement fixation test in 10 patients with CGD. Results All 10 patients presented with a history of fever and elevated inflammatory signs without evident focus. Diagnosis was delayed and clinical course severe and protracted despite high-dose intravenous antibiotic therapy and/or surgery. These results suggest an unrecognized and unanticipated susceptibility to weakly pathogenic Actinomyces species in patients with CGD because these are catalase-negative organisms previously thought to be nonpathogenic in CGD. Conclusions Actinomycosis should be vigorously sought and promptly treated in patients with CGD presenting with uncommon and prolonged clinical signs of infection. Actinomycosis is a catalase-negative infection important to consider in CGD.
Reichenbach, Janine; Lopatin, Uri; Mahlaoui, Nizar; Beovic, Bojana; Siler, Ulrich; Zbinden, Reinhard; Seger, Reinhard A.; Galmiche, Louise; Brousse, Nicole; Kayal, Samer; Gungor, Tayfun; Blanche, Stephane; Holland, Steven M.
The potential role of ozone in the induction of chronic lung diseases remains unclear. sing an ambient profile adopted from aerometric data from the Southwest Air Basin, rats were exposed to O3 for up to 18 months before assessments of pulmonary structure, function and biochemist...
Chronic Disease and Adherence to a Regimen of Care
Background: Maintenance of health and well being for patients with a chronic, progressive condition often requires pharmaceutical management and adherence to a regimen of physician visits, screening tests and laboratory tests to manage health and slow disease progression. We investigate adherence to a regimen of diabetes care services and its implications by first examining extent of covariation in adherence to
Teresa Gibson
Medicament contact dermatitis in patients with chronic inflammatory ear disease.
Patch testing of 40 patients with chronic inflammatory ear disease demonstrated medicament allergic contact dermatitis in 35%. The most frequent sensitizers were neomycin, framycetin, clioquinol and gentamicin. Although allergic contact dermatitis to dewaxing ear drops was unusual, irritant reactions were common.
Holmes, R C; Johns, A N; Wilkinson, J D; Black, M M; Rycroft, R J
Chronic systemic pesticide exposure reproduces features of Parkinson's disease
The cause of Parkinson's disease (PD) is unknown, but epidemiological studies suggest an association with pesticides and other environmental toxins, and biochemical studies implicate a systemic defect in mitochondrial complex I. We report that chronic, systemic inhibition of complex I by the lipophilic pesticide, rotenone, causes highly selective nigrostriatal dopaminergic degeneration that is associated behaviorally with hypokinesia and rigidity. Nigral
Ranjita Betarbet; Todd B. Sherer; Gillian MacKenzie; Monica Garcia-Osuna; Alexander V. Panov; J. Timothy Greenamyre
The importance of early detection of chronic kidney disease
Despite the absence of precise epidemiological data, we know there are a great many patients in the conservative phase of chronic kidney disease (CKD). The incidence and prevalence of renal replacement therapy (RRT) is increasing worldwide. As well as being a large and growing clinical problem, CKD is of an economic and organizational concern, since RRT consumes a considerable proportion
Francesco Locatelli; Lucia Del Vecchio; Pietro Pozzoni
Evaluation and treatment of gout as a chronic disease.
Gout is a disease caused by deposition of monosodium urate crystals in tissues. One of the limitations for successful treatment of gout is to consider it as an intermittent disease rather than a chronic inflammatory disease which, if improperly treated, leads to chronic clinical manifestations. In addition, gout is linked to increased cardiovascular morbidity and mortality.Urate-lowering therapy comprises both nonpharmacologic and pharmacologic interventions, but most patients will need urate-lowering drugs to achieve target therapeutic serum urate levels. Reaching target serum urate levels is associated with improvement in clinical outcomes, including a reduction of acute inflammation episodes, resolution of tophi, and improvement in health-related quality of life perception.A number of urate-lowering drugs are available but a number of patients fail to achieve or maintain therapeutic serum urate levels and go on to develop refractory chronic gout. For such patients, efforts have been made to develop new treatments (e.g., febuxostat or pegloticase).This review intends to increase the awareness of gout as a chronic deposition disease, and show that efforts should be made to properly control serum urate levels in order to achieve complete disappearance of urate crystal deposition. PMID:23104464
Perez-Ruiz, Fernando; Herrero-Beites, Ana Maria
Bilateral pneumectomy (volume reduction) for chronic obstructive pulmonary disease
We undertook surgical bilateral lung volume reduction in 20 patients with severe chronic obstructive pulmonary disease to relieve thoracic distention and improve respiratory mechanics. The operation, done through median sternotomy, involves excision of 20% to 30% of the volume of each lung. The most affected portions are excised with the use of a linear stapling device fitted with strips of
J. D. Cooper; E. P. Trulock; A. N. Triantafillou; G. A. Patterson; M. S. Pohl; P. A. Deloney; R. S. Sundaresan; C. L. Roper
Anaesthesia for Chronic Renal Disease and Renal Transplantation
The aim of this article is to present the features of chronic renal disease (CRD) that influence the conduct of anaesthesia and to introduce some of the anaesthetic techniques used for this challenging group of patients, including anaesthesia for renal transplantation.
Simon T. Rang; Nigel L. West; Jeremy Howard; Jonathan Cousins
Chronic Kidney Disease after Myeloablative Allogeneic Hematopoietic Stem Cell Transplantation
Because survival of recipients of allogeneic hematopoietic stem cell transplantation (HSCT) has improved, long-term complications become more important. We studied the incidence and risk factors of chronic kidney disease in these patients and evaluated associated posttransplant complications and mortality. We performed a retrospective cohort study of 266 adults who received myeloablative allogeneic HSCT and who survived for >6 months in
Sabina Kersting; Ronald J. Hen�; Hein A. Koomans; Leo F. Verdonck
Effects of calcimimetics on extraskeletal calcifications in chronic kidney disease
While the precise mechanisms of vascular calcification (VC) in chronic kidney disease (CKD) remain to be elucidated, there is a close association between VC and secondary hyperparathyroidism (HPT). The elevations in calcium, phosphorus, the Ca � P product, and parathyroid hormone (PTH) observed in patients with CKD and secondary HPT have been associated with VC and increased risk of cardiovascular
Mariano Rodr�guez; Escol�stico Aguilera-Tejero; F Javier Mendoza; F�tima Guerrero; Ignacio L�pez
Results: Twelve patients, seven males, and five females were identified. They aged between 13-84 months with a mean age of 29 months at the time of diagnosis. The median duration of follow-up was 33 months. Eight patients were alive and four had died. Family history of Chronic granulomatous disease was positive in 10 patients. The median duration of delay in
Adel M. Al-Wahadneh; Omar A. Al-Khaldi; Mohammed Al-Raqad
Endothelin System in Chronic Kidney Disease
Since its discovery in 1988,1 endothelin (ET) has been widely implicated in the pathophysiology of renal disease. Endothelins are a family of three 21-amino-acid\\u000a peptides, each with distinct genes and tissue distributions, with powerful vasoconstrictor and pressor properties.1�3 Of the three peptides, ET-1 is the major endothelial isoform and, in the human kidney, the only one so far shown to
Neeraj Dhaun; David J. Webb; Jane Goddard
Chronic-treated HIV: A neurologic disease
The concept of slow virus diseases was developed by Sigurdsson in the 1950s in studies of infections of Icelandic sheep, including\\u000a Visna, a slow (lenti) viral infection of the central nervous system. Human immunodeficiency virus (HIV) belongs to the same\\u000a lentivirus subfamily of retroviruses and causes significant dysfunction of all levels of the nervous system. Highly active\\u000a antiretroviral therapy should
John Booss
Treating Alcoholism As a Chronic Disease
For many patients, alcohol and other drug (AOD) use disorders are chronic, recurring conditions involving multiple cycles of treatment, abstinence, and relapse. To disrupt this cycle, treatment can include continuing care to reduce the risk of relapse. The most commonly used treatment approach is initial intensive inpatient or outpatient care based on 12-step principles, followed by continuing care involving self-help groups, 12-step group counseling, or individual therapy. Although these programs can be effective, many patients drop out of initial treatment or do not complete continuing care. Thus, researchers and clinicians have begun to develop alternative approaches to enhance treatment retention in both initial and continuing care. One focus of these efforts has been the design of extended treatment models. These approaches increasingly blur the distinction between initial and continuing care and aim to prolong treatment participation by providing a continuum of care. Other researchers have focused on developing alternative treatment strategies (e.g., telephone-based interventions) that go beyond traditional settings and adaptive treatment algorithms that may improve outcomes for clients who do not respond well to traditional approaches.
McKay, James R.; Hiller-Sturmhofel, Susanne
Celiac disease and chronic liver disease: is there a relationship?
Celiac disease is a multisystem disease, and the liver is affected in a subset of patients. We herein present a case series of 25 patients with celiac disease who had evidence of cirrhosis of the liver. We retrospectively reviewed the case records of patients with celiac disease having concomitant cirrhosis. The diagnosis of celiac disease was made on the basis of the modified European Society of Pediatric Gastroenterology, Hepatology, and Nutrition criteria. Of 25 patients (nine males; mean age 28.8?�?16.6�years) with celiac disease and cirrhosis, 17 patients presented predominantly with cirrhosis, while 8 presented primarily with celiac disease. Five patients had known cause of cirrhosis (autoimmune hepatitis, three; PBC, one; hepatic venous outflow tract obstruction, one); the remaining 20 were cryptogenic. Gluten-free diet led to improvement in diarrhea and anemia and to a better control of ascites and other features of liver failure. Some patients with cryptogenic cirrhosis have coexistent celiac disease, and they show response to gluten-free diet. Patients with cryptogenic cirrhosis should be screened for celiac disease. PMID:23918040
Singh, Prashant; Agnihotri, Abhishek; Jindal, Gaurav; Sharma, Piyush Kumar; Sharma, Minakshi; Das, Prasenjit; Gupta, Datta; Makharia, Govind K
Frailty and Chronic Kidney Disease: The Third National Health and Nutrition Evaluation Survey
BACKGROUND Frailty is common in the elderly and in persons with chronic diseases. Few studies have examined the association of frailty with chronic kidney disease. METHODS We used data from the Third National Health and Nutrition Examination Survey to estimate the prevalence of frailty among persons with chronic kidney disease. We created a definition of frailty based on established validated criteria, modified to accommodate available data. We used logistic regression to determine whether and to what degree stages of chronic kidney disease were associated with frailty. We also examined factors that might mediate the association between frailty and chronic kidney disease. RESULTS The overall prevalence of frailty was 2.8%. However, among persons with moderate to severe chronic kidney disease (estimated glomerular filtration rate <45 mL/min/1.73 m2), 20.9% were frail. The odds of frailty were significantly increased among all stages of chronic kidney disease, even after adjustment for the residual effects of age, sex, race, and prevalent chronic diseases. The odds of frailty associated with chronic kidney disease were only marginally attenuated with additional adjustment for sarcopenia, anemia, acidosis, inflammation, vitamin D deficiency, hypertension, and cardiovascular disease. Frailty and chronic kidney disease were independently associated with mortality. CONCLUSION Frailty is significantly associated with all stages of chronic kidney disease and particularly with moderate to severe chronic kidney disease. Potential mechanisms underlying the chronic kidney disease and frailty connection remain elusive.
Wilhelm-Leen, Emilee R.; Hall, Yoshio N.; Tamura, Manjula K.; Chertow, Glenn M.
Utility of screening for chronic granulomatous disease in patients with inflammatory bowel disease.
Chronic granulomatous disease (CGD), a genetically heterogeneous primary X-linked or autosomal recessive immunodeficiency, can manifest with gastrointestinal symptoms, including colitis or Crohn's disease. The frequency of CGD carriers among those with chronic colitis/inflammatory bowel disease is unknown. We underwent a pilot study examining the value of prospectively screening patients with chronic colitis/inflammatory bowel disease (IBD) for either CGD or the carrier state of CGD. No carriers of CGD or patients with CGD were detected among 120 patients. Three patients had inconclusive results and the assay was normal on repeat testing. We conclude that routine screening for CGD was not instructive in this cohort of chronic colitis or IBD patients. PMID:22089701
Jaggi, Preeti; Scherzer, Rebecca; Knieper, Rose; Mousa, Hayat; Prasad, Vinay
Informed Consent and Prevention of Disease Progression in Veterans with Chronic Kidney Disease. Healthcare Inspection.
National Technical Information Service (NTIS)
The VA Office of Inspector General Office of Healthcare Inspections assessed the extent to which informed consent was documented for veterans with chronic kidney disease who underwent procedures that involved intravascular injection of contrast media, and...
Cardiopulmonary complications in chronic liver disease
Patients with cirrhosis and portal hypertension exhibit characteristic cardiovascular and pulmonary hemodynamic changes. A vasodilatatory state and a hyperdynamic circulation affecting the cardiac and pulmonary functions dominate the circulation. The recently defined cirrhotic cardiomyopathy may affect systolic and diastolic functions, and imply electromechanical abnormalities. In addition, the baroreceptor function and regulation of the circulatory homoeostasis is impaired. Pulmonary dysfunction involves diffusing abnormalities with the development of the hepatopulmonary syndrome and portopulmonary hypertension in some patients. Recent research has focused on the assertion that the hemodynamic and neurohumoral dysregulation are of major importance for the development of the cardiovascular and pulmonary complications in cirrhosis. This aspect is important to take into account in the management of these patients.
M?ller, S?ren; Henriksen, Jens H
Recombinant Human Epo Treatment: Beneficial in Chronic Kidney Disease, Chronic Heart Failure, or Both?
For over two decades now, the recombinant form of erythropoietin (RhEPO) is used for the treatment of anemia in end-stage renal disease patients. Initial studies indicated an improvement in quality of life [1]. However, neutral\\/ negative data from two randomized controlled trials testing RhEPO to correct anemia in chronic kidney disease (CKD) were recently reported [2, 3]. The CHOIR study
A. M. S. Belonje; R. A. de Boer; A. A. Voors
[Probiotics in chronic inflammatory bowel disease].
Current data show that probiotics are more effective in preventing the recrudescence of an inflammatory process than in suppressing active disease. This is reflected in the solid evidence for the effect of E. coli Nissle 1917 (Mutaflor) in the maintenance of remission of ulcerative colitis, and of VSL#3 in preventing the recurrence of pouchitis. These indications have since been incorporated in valid guidelines. Initial clinical studies have also provided promising results regarding the efficacy of VSL#3 in preventing pouchitis immediately following proctocolectomy. PMID:16995360
B�hm, S; Kruis, W
Pruritus in chronic cholestatic liver disease.
Pruritus is a troublesome complication in patients with cholestatic liver disease. Several links to its pathogenesis have been proposed, including the role of bile acids, endogenous opioid and serotonins, and lysophosphatidic acid. The management of pruritus in cholestasis is challenging. Medical treatment of the underlying cholestatic condition may provide benefit. Extracorporeal albumin dialysis can be pursued for those who have a poor quality of life and failed the various therapeutic interventions, while awaiting liver transplantation. Experimental interventions, and the management of pruritus in certain conditions such as intrahepatic cholestasis of pregnancy and benign recurrent intrahepatic cholestasis, are also briefly reviewed. PMID:22541702
Bunchorntavakul, Chalermrat; Reddy, K Rajender
Different patterns of chronic tissue wasting among patients with chronic obstructive pulmonary disease
Background & aims:Nutritional depletion is frequently present in patients with chronicobstructive pulmonary disease, but it is unknown whether a difference exists between the two subtypes. The aim of this study was to determine whether patterns of tissue depletion were different between emphysema and chronic bronchitis patients and whether these were related to pulmonary function.
M. P. K. J. Engelen; A. M. W. J. Schols; R. J. S. Lamers; E. F. M. Wouters
Association of inflammation with anaemia in patients with chronic kidney disease not requiring chronic dialysis
Background. Anaemia associated with chronic kidney disease (CKD) has substantial public health importance. However, the association of haemoglobin concentrations with inflammation in the setting of decreased kidney func- tion is not well established. Methods. We analysed cross-sectional data from 7389 out- patient adults, who were referred by general practition- ers for routine blood testing between June 2006 and June 2007.
Michel Chonchol; Giuseppe Lippi; Martina Montagnana; Michele Muggeo; Giovanni Targher
Inflammation in chronic kidney disease: role in the progression of renal and cardiovascular disease
Inflammation is the response of the vasculature or tissues to various stimuli. An acute and chronic pro-inflammatory state\\u000a exists in patients with chronic kidney disease (CKD), contributing substantially to morbidity and mortality. There are many\\u000a mediators of inflammation in adults with CKD and end-stage kidney disease (ESKD), including hypoalbuminemia\\/malnutrition,\\u000a atherosclerosis, advanced oxidation protein products, the peroxisome proliferators-activated receptor, leptin, the
Douglas M. Silverstein
[Self-help for a rare, chronic disease].
The existence of support groups is of great interest, especially for individuals affected by a rare, chronic disease. The few affected people means a shortage of specialized physicians. As a result, affected individuals suffer from a great lack of information about their disease. Self-help organizations fill this gap and complement the work of physicians by informing patients, leading them through the health system and offering a partner to talk to. The support group "Society for von Hippel-Lindau (VHL) disease effected families" (Verein f�r von der von Hippel-Lindau (VHL) Erkrankung betroffene Familien e.V.) puts its main emphasis on general information about the disease. In addition, the association supports the exchange of experience and helps to explain psychologically or socially determined problems associated with the VHL-disease. The foundation of ACHSE (Allianz Chronischer Seltener Erkrankungen, Alliance for Rare, Chronic Diseases)), as the parent organization for the German support groups for individuals affected by a rare disease, has been an important step towards communicating the specific needs of individuals affected by such diseases to the public. PMID:17235572
Alsmeier, G; Rath, D
Renal Function Trajectory Is More Important than Chronic Kidney Disease Stage for Managing Patients with Chronic Kidney Disease
Management of patients with chronic kidney disease (CKD) emphasizes a current level of function as calculated from the modification of diet in renal disease glomerulofiltration rate equations (eGFR) and proteinuria for staging of CKD. Change in a patient�s eGFR over time (renal function trajectory) is an additional and potentially more important consideration in deciding which patients will progress to the
Steven J. Rosansky
Chronic fatigue is associated with increased disease-related worries and concerns in inflammatory bowel disease
AIM: To investigate the impact of chronic fatigue on disease-related worries in inflammatory bowel disease (IBD) and the potential multicolinearity between subjective questionnaires. METHODS: Patients in remission or with mild-to-moderate disease activity completed the fatigue questionnaire (FQ), the rating form of IBD patient concerns (RFIPC), the Short-Form 36 (SF-36), and IBD questionnaire (N-IBDQ). In addition, clinical and epidemiological data were obtained. RESULTS: In total, 140 patients were included; of which 92 were diagnosed with ulcerative colitis and 48 with Crohn�s disease. The mean age of patients with chronic fatigue was 44.2 years (SD = 15.8) and for non-fatigued patients was 44.7 years (SD = 16.0). Chronic fatigued patients had clinically significantly increased levels of disease-related worries, as measured by Cohen�s d effect size. Worries about having an ostomy bag, loss of bowel control, and energy levels were most prominent in both chronic fatigued and non-chronic fatigued IBD patients. Variance inflation factor (VIF) and tolerance indicated that there were no problematic multicolinearity among the FQ, RFIPC, SF-36 and N-IBDQ responses (VIF < 5 and tolerance > 2). CONCLUSION: Chronic fatigue is associated with increased levels of disease-related worries and concerns in IBD. Increased levels of worries were also associated with impaired health-related quality of life.
Jelsness-J?rgensen, Lars-Petter; Bernklev, Tomm; Henriksen, Magne; Torp, Roald; Moum, Bj?rn
Innate Immune Responses and Chronic Obstructive Pulmonary Disease
Innate immune responses appear to be partially responsible for maintaining inflammation and tissue destruction in chronic obstructive pulmonary disease. In the early stages of the disease in smokers, the airways are bombarded with large quantities of particulate material, and activation of phagocytic cells results in the release of many of the mediators believed to remodel the airways. Ironically, failure of the innate immune defense system, either by inherited deficiency or as a result of chronic smoke inhalation, is likely to result in increased susceptibility to infectious disease and exacerbations of chronic obstructive pulmonary disease. It is well known that deficiencies in the production of collectins, pentraxins, and complement can lead to increased infections, and several studies indicate that deficiency in one or another innate defense component is associated with increased exacerbations. Corticosteroids reduce exacerbations in part because of their ability to boost the production of innate host-defense molecules. Therapeutic approaches that stimulate the generation of antimicrobial molecules in the lungs might be able to reduce disease exacerbations.
Schleimer, Robert P.
Lung disease with chronic obstruction in opium smokers in Singapore
Fifty-four opium smokers with chronic obstructive lung disease were studied for two-and-a-half years. Forty-eight patients had a cough for at least two years before the onset of inappropriate exertional dyspnoea. Fine, bubbling adventitious sounds suggesting small airway disease were heard on auscultation over the middle and lower lobes in 38 patients. The prevalence of inflammatory lung disease and chronic respiratory failure in this series is suggested as the main cause for the frequent finding of right ventricular hypertrophy and congestive heart failure. Physiological studies revealed moderate to severe airways obstruction with gross over-inflation and, in 32 patients, an additional restrictive defect probably due to peribronchiolar fibrosis. Radiological evidence of chronic bronchitis and bronchiolitis was observed in 45 patients, `pure' chronic bronchiolitis in six patients, and `widespread' emphysema in 25 patients respectively. Necropsy examinations in nine patients, however, showed destructive emphysema of variable severity in all. Chronic bronchiolitis often associated with striking bronchiolectasis was present in six cases. More severe bronchiolar rather than bronchial inflammation was noted. The heavy opium smokers had characteristic nodular shadows on chest radiography, sometimes associated with a striking reticular pattern not seen in `pure' cigarette smokers. This was due to gross pigmented dust (presumably carbon) deposition in relation to blood vessels, lymphatics, and bronchioles, and also within the alveoli. It is speculated that the initial lesion is an acquired bronchiolitis. Opium smoking induces an irritative bronchopathy favouring repeated attacks of acute bronchiolitis and eventually resulting in obliterative bronchiolitis, peribronchiolar fibrosis, chronic bronchitis, and destructive emphysema. Images
Da Costa, J. L.; Tock, E. P. C.; Boey, H. K.
Chronic unremitting headache associated with Lyme disease-like illness.
The Brazilian Lyme-disease-like illness (BLDLI) or Baggio-Yoshinari syndrome is a unique zoonosis found in Brazil. It reproduces all the clinical symptoms of Lyme disease except for the high frequencies of relapse and the presence of autoimmune manifestations. Two cases of borreliosis manifesting with unremitting headache, which is a symptom associated with late-stage BLDLI, were presented. Clinical, therapeutic, and prognostic aspects of the BLDLI and its associated headaches were showed and discussed in this article. BLDLI diagnosis requires additional attention by physicians, since the disease has a tendency to progress to the late, recurrent stage or the chronic form, and the associated headache can be confused with chronic primary headache or with analgesic-overuse one. Special attention should be paid to patients with headaches who have traveled to endemic areas. PMID:23857618
Kowacs, Pedro Andr�; Martins, Rodrigo Tomazini; Piovesan, Elcio Juliato; Pinto, Maria Cristina Araujo; Yoshinari, Natalino Hagime
Chemokine receptors as therapeutic targets in chronic obstructive pulmonary disease.
Chronic obstructive pulmonary disease (COPD) is an increasing global health problem for which there are no effective disease-modifying therapies. COPD involves chronic inflammation of small airways and lung parenchyma, with the recruitment of inflammatory cells. This inflammatory-cell trafficking is orchestrated by multiple chemokines, so the blockade of chemokine receptors with selective antagonists might be an effective anti-inflammatory strategy in this disease. Several studies support the implication of several chemokines and their receptors in COPD, including chemokine receptors CXCR2 and CXCR3, with small-molecule receptor antagonists that are in development being potential anti-inflammatory therapies. Such a pharmacological strategy would provide a mechanism with which to inhibit leukocyte recruitment and, hence, reduce the inflammatory profile in COPD, which is currently unaffected by pharmacotherapy. PMID:16911834
Donnelly, Louise E; Barnes, Peter J
Calorie restriction and prevention of age-associated chronic disease
Life expectancy in the world has increased dramatically during the last century; the number of older adults is expected to rise while the number of youths will decline in the near future. This demographic shift has considerable public health and economic implications since aging is associated with the development of serious chronic diseases. Calorie restriction (CR) is the most effective nutritional intervention for slowing aging and preventing chronic disease in rodents. In non-human and human primates, CR with adequate nutrition protects against abdominal obesity, diabetes, hypertension and cardiovascular diseases. Cancer morbidity and mortality are also diminished in CR monkeys, and data obtained from individuals practicing long-term CR show a reduction of metabolic and hormonal factors associated with increased cancer risk.
Omodei, Daniela; Fontana, Luigi
Landscape genetics and the spatial distribution of chronic wasting disease
Predicting the spread of wildlife disease is critical for identifying populations at risk, targeting surveillance and designing proactive management programmes. We used a landscape genetics approach to identify landscape features that influenced gene flow and the distribution of chronic wasting disease (CWD) in Wisconsin white-tailed deer. CWD prevalence was negatively correlated with genetic differentiation of study area deer from deer in the area of disease origin (core-area). Genetic differentiation was greatest, and CWD prevalence lowest, in areas separated from the core-area by the Wisconsin River, indicating that this river reduced deer gene flow and probably disease spread. Features of the landscape that influence host dispersal and spatial patterns of disease can be identified based on host spatial genetic structure. Landscape genetics may be used to predict high-risk populations based on their genetic connection to infected populations and to target disease surveillance, control and preventative activities. ?? 2007 The Royal Society.
Blanchong, J. A.; Samuel, M. D.; Scribner, K. T.; Weckworth, B. V.; Langenberg, J. A.; Filcek, K. B.
Hereditary causes of kidney stones and chronic kidney disease.
Adenine phosphoribosyltransferase (APRT) deficiency, cystinuria, Dent disease, familial hypomagnesemia with hypercalciuria and nephrocalcinosis (FHHNC), and primary hyperoxaluria (PH) are rare but important causes of severe kidney stone disease and/or chronic kidney disease in children. Recurrent kidney stone disease and nephrocalcinosis, particularly in pre-pubertal children, should alert the physician to the possibility of an inborn error of metabolism as the underlying cause. Unfortunately, the lack of recognition and knowledge of the five disorders has frequently resulted in an unacceptable delay in diagnosis and treatment, sometimes with grave consequences. A high index of suspicion coupled with early diagnosis may reduce or even prevent the serious long-term complications of these diseases. In this paper, we review the epidemiology, clinical features, diagnosis, treatment, and outcome of patients with APRT deficiency, cystinuria, Dent disease, FHHNC, and PH, with an emphasis on childhood manifestations. PMID:23334384
Edvardsson, Vidar O; Goldfarb, David S; Lieske, John C; Beara-Lasic, Lada; Anglani, Franca; Milliner, Dawn S; Palsson, Runolfur
Polycystic kidney disease and chronic renal failure in tuberous sclerosis.
Tuberous sclerosis is a rare genetic disease which leads to formation of benign tumours in the brain and other organs of the body. It is a multisystem disease with various clinical manifestations. Renal angiomyolipomas are the most common renal manifestations whereas renal cell carcinoma is the least. Renal cysts are found in around 20% of the patients but polycystic kidney disease is present in less than 2% cases and is relatively rare manifestation of the disease. We present a case of tuberous sclerosis in a 60-year-old man who presented to the medicine outpatient department for routine evaluation of his hypertension. He was diagnosed as tuberous sclerosis. His ultrasound and CT scan of abdomen revealed polycystic kidney disease. His kidney function test and urine analysis were suggestive of chronic kidney disease. PMID:24092520
Dhakal, Mona; Dhakal, O P; Bhandari, Dhurba
Association Between Retinopathy and Cardiovascular Disease in Patients with Chronic Kidney Disease (From the Chronic Renal Insufficiency Cohort [CRIC] Study)
Patients with chronic kidney disease (CKD) experience co-morbid illneses including cardiovascular disease (CVD) and retinopathy. The purpose of this study was to assess the association between retinopathy and self reported CVD in a subgroup of the participants of the Chronic Renal Insufficiency Cohort (CRIC) study. In this observational, ancillary investigation, 2605 CRIC participants were invited to participate in this study, and non-mydriatic fundus photographs in both eyes were obtained in 1936 subjects. Photographs were reviewed in a masked fashion at a central photograph reading center. Presence and severity of retinopathy (diabetic, hypertensive or other) and vessel diameter caliber were assessed using standard protocols by trained graders masked to information about study participants. History of self-reported cardiovascular disease was obtained using a medical history questionnaire. Kidney function measurements, traditional and non-traditional risk factors for CVD were obtained from the CRIC study. Greater severity of retinopathy was associated with higher prevalence of any cardiovascular disease and this association persisted after adjustment for traditional risk factors for CVD. Presence of vascular abnormalities usually associated with hypertension was also associated with increased prevalence of CVD. We found a direct relationship between CVD prevalence and mean venular caliber. In conclusion, presence of retinopathy was associated with CVD, suggesting that retinovascular pathology may be indicative of macrovascular disease even after adjustment for renal dysfunction and traditional CVD risk factors. This would make assessment of retinal morphology a valuable tool in chronic kidney disease studies of CVD outcomes.
Grunwald, Juan E.; Ying, Gui-Shuang; Maguire, Maureen; Pistilli, Maxwell; Daniel, Ebenezer; Alexander, Judith; Whittock-Martin, Revell; Parker, Candace; Mohler, Emile; Chia-Mei Lo, Joan; Townsend, Raymond; Gadegbeku, Crystal Ann; Lash, James Phillip; Fink, Jeffrey Craig; Rahman, Mahboob; Feldman, Harold; Kusek, John Walter; Xie, Dawei; Coleman, Martha; Keane, Martin Gerard
The spectrum of disease in chronic traumatic encephalopathy
Chronic traumatic encephalopathy is a progressive tauopathy that occurs as a consequence of repetitive mild traumatic brain injury. We analysed post-mortem brains obtained from a cohort of 85 subjects with histories of repetitive mild traumatic brain injury and found evidence of chronic traumatic encephalopathy in 68 subjects: all males, ranging in age from 17 to 98 years (mean 59.5 years), including 64 athletes, 21 military veterans (86% of whom were also athletes) and one individual who engaged in self-injurious head banging behaviour. Eighteen age- and gender-matched individuals without a history of repetitive mild traumatic brain injury served as control subjects. In chronic traumatic encephalopathy, the spectrum of hyperphosphorylated tau pathology ranged in severity from focal perivascular epicentres of neurofibrillary tangles in the frontal neocortex to severe tauopathy affecting widespread brain regions, including the medial temporal lobe, thereby allowing a progressive staging of pathology from stages I�IV. Multifocal axonal varicosities and axonal loss were found in deep cortex and subcortical white matter at all stages of chronic traumatic encephalopathy. TAR DNA-binding protein 43 immunoreactive inclusions and neurites were also found in 85% of cases, ranging from focal pathology in stages I�III to widespread inclusions and neurites in stage IV. Symptoms in stage I chronic traumatic encephalopathy included headache and loss of attention and concentration. Additional symptoms in stage II included depression, explosivity and short-term memory loss. In stage III, executive dysfunction and cognitive impairment were found, and in stage IV, dementia, word-finding difficulty and aggression were characteristic. Data on athletic exposure were available for 34 American football players; the stage of chronic traumatic encephalopathy correlated with increased duration of football play, survival after football and age at death. Chronic traumatic encephalopathy was the sole diagnosis in 43 cases (63%); eight were also diagnosed with motor neuron disease (12%), seven with Alzheimer�s disease (11%), 11 with Lewy body disease (16%) and four with frontotemporal lobar degeneration (6%). There is an ordered and predictable progression of hyperphosphorylated tau abnormalities through the nervous system in chronic traumatic encephalopathy that occurs in conjunction with widespread axonal disruption and loss. The frequent association of chronic traumatic encephalopathy with other neurodegenerative disorders suggests that repetitive brain trauma and hyperphosphorylated tau protein deposition promote the accumulation of other abnormally aggregated proteins including TAR DNA-binding protein 43, amyloid beta protein and alpha-synuclein.
McKee, Ann C.; Stein, Thor D.; Nowinski, Christopher J.; Stern, Robert A.; Daneshvar, Daniel H.; Alvarez, Victor E.; Lee, Hyo-Soon; Hall, Garth; Wojtowicz, Sydney M.; Baugh, Christine M.; Riley, David O.; Kubilus, Caroline A.; Cormier, Kerry A.; Jacobs, Matthew A.; Martin, Brett R.; Abraham, Carmela R.; Ikezu, Tsuneya; Reichard, Robert Ross; Wolozin, Benjamin L.; Budson, Andrew E.; Goldstein, Lee E.; Kowall, Neil W.; Cantu, Robert C.
[Can we influence the progression of chronic kidney disease?].
Chronic renal failure does not only involve the risk for the patient of becoming dependent on hemodialysis, but also increases the risk of premature death due to cardiovascular events. In most renal diseases, progressive chronic loss of renal function develops once a critical extent of renal damage has occurred, independent of the course of the underlying renal disease. The key factors driving the progressive loss of renal function are, apart from the underlying nephrological disease, arterial hypertension and diabetes mellitus. The loss of renal function is also promoted by other factors, such as increased intake of dietary proteins, chronic inflammation, smoking, and anemia. With the help of a multimodal therapeutic concept, the progression of chronic renal failure can be delayed effectively. This approach comprises strict blood pressure control with a target blood pressure of 130/80 mmHg in patients with micro-albuminuria and of 120/75 mmHg in patients with proteinuria of >1 g/d. The preferred drugs for the treatment of hypertension are ACE inhibitors and angiotensin receptor blockers. In diabetics with renal insufficiency, target HbA1c levels below 7% are to be aimed for. Dietary protein intake should be restricted to 0.8-1 g/kg body weight/d. Additional therapeutic targets include nicotine abstinence, early treatment of renal anemia, weight reduction, and, if indicated, lipid-lowering therapy. PMID:19590915
Kuhlmann, U; Hoyer, J
Oxysterols in the pathogenesis of major chronic diseases?
Pathological accumulation of 27-carbon intermediates or end-products of cholesterol metabolism, named oxysterols, may contribute to the onset and especially to the development of major chronic diseases in which inflammation, but also oxidative damage and to a certain extent cell death, are hallmarks and primary mechanisms of progression. Indeed, certain oxysterols exercise strong pro-oxidant and pro-inflammatory effects at concentrations detectable in the lesions typical of atherosclerosis, neurodegenerative diseases, inflammatory bowel diseases, age-related macular degeneration, and other pathological conditions characterized by altered cholesterol uptake and/or metabolism.
Poli, Giuseppe; Biasi, Fiorella; Leonarduzzi, Gabriella
Subjects harboring presenilin familial Alzheimer's disease mutations exhibit diverse white matter biochemistry alterations
Alzheimer�s disease (AD) dementia impacts all facets of higher order cognitive function and is characterized by the presence of distinctive pathological lesions in the gray matter (GM). The profound alterations in GM structure and function have fostered the view that AD impacts are primarily a consequence of GM damage. However, the white matter (WM) represents about 50% of the cerebrum and this area of the brain is substantially atrophied and profoundly abnormal in both sporadic AD (SAD) and familial AD (FAD). We examined the WM biochemistry by ELISA and Western blot analyses of key proteins in 10 FAD cases harboring mutations in the presenilin genes PSEN1 and PSEN2 as well as in 4 non-demented control (NDC) individuals and 4 subjects with SAD. The molecules examined were direct substrates of PSEN1 such as Notch-1 and amyloid precursor protein (APP). In addition, apolipoproteins, axonal transport molecules, cytoskeletal and structural proteins, neurotrophic factors and synaptic proteins were examined. PSEN-FAD subjects had, on average, higher amounts of WM amyloid-beta (A?) peptides compared to SAD, which may play a role in the devastating dysfunction of the brain. However, the PSEN-FAD mutations we examined did not produce uniform increases in the relative proportions of A?42 and exhibited substantial variability in total A? levels. These observations suggest that neurodegeneration and dementia do not depend solely on enhanced A?42 levels. Our data revealed additional complexities in PSEN-FAD individuals. Some direct substrates of ?-secretase, such as Notch, N-cadherin, Erb-B4 and APP, deviated substantially from the NDC group baseline for some, but not all, mutation types. Proteins that were not direct ?-secretase substrates, but play key structural and functional roles in the WM, likewise exhibited varied concentrations in the distinct PSEN mutation backgrounds. Detailing the diverse biochemical pathology spectrum of PSEN mutations may offer valuable insights into dementia progression and the design of effective therapeutic interventions for both SAD and FAD.
Roher, Alex E; Maarouf, Chera L; Malek-Ahmadi, Michael; Wilson, Jeffrey; Kokjohn, Tyler A; Daugs, Ian D; Whiteside, Charisse M; Kalback, Walter M; Macias, MiMi P; Jacobson, Sandra A; Sabbagh, Marwan N; Ghetti, Bernardino; Beach, Thomas G
Chronic inflammatory diseases and the Acute Respiratory Distress Syndrome (ARDS).
The Acute Respiratory Distress Syndrome (ARDS) is a highly fatal pro-inflammatory oxidative respiratory disease. Relatively recently, the modulating effects of chronic inflammatory processes on ARDS susceptibility have been recognized in a number of clinical studies. Herein, we briefly review some of the chronic conditions that have been reported to increase (cigarette smoking and alcohol abuse) or decrease (diabetes and obesity) susceptibility to ARDS. We also propose some potential pathways that may hold clues regarding the pathogenesis and/or therapy for ARDS. PMID:23978096
Fernandez-Bustamante, Ana; Repine, John E
[Cognitive impairment and chronic kidney disease: which links?].
Ageing of the population leads to an increase of cognitive disorders and chronic renal failure incidence. Compared to the general population, prevalence of cognitive impairment is more important in renal failure patients, especially in dialyzed patients. No direct link has been established between renal failure and cognitive impairment. The care of older and older patients and the high frequency of vascular risk factors, in particular hypertension and diabetes, partially explain the prevalence of vascular dementia and Alzheimer disease in this population. Other factors as the anemia, phosphocalcic metabolism disorders facilitate the cognitive impairment. The present work reviews the links existing between chronic renal failure and cognitive impairment. PMID:21050832
Gaxatte, C�dric; Daroux, Ma�t�; Bloch, Jennifer; Puisieux, Fran�ois; Deramecourt, Vincent; Boulanger, Eric
Glycemic control and cardiovascular disease in chronic kidney disease
Diabetes increases cardiovascular (CV) risk to a similar extent as myocardial infarction. Epidemiologic data support the same\\u000a concept for the presence of Stage 3 (ie, glomerular filtration rate of < 60 mL\\/min) or higher nephropathy without diabetes.\\u000a The most common cause of end-stage kidney disease requiring dialysis is diabetes. Hence, CV risk is highest among those with\\u000a kidney disease and
Suma Dronovalli; Basil O. Burney; George L. Bakris
[Ultrasound and color Doppler applications in chronic kidney disease].
Chronic kidney disease (CKD) encompasses all clinical features and complications during the progression of various kidney conditions towards end-stage renal disease. These conditions include immune and inflammatory diseases such as primary and HCV-related glomerulonephritis; infectious diseases such as pyelonephritis with or without reflux and tuberculosis; vascular diseases such as chronic ischemic nephropathy; hereditary and congenital diseases such as polycystic disease and congenital cystic dysplasia; metabolic diseases including diabetes and hyperuricemia; and systemic diseases (collagen disease, vasculitis, myeloma). During the progression of CKD, ultrasound imaging can differentiate the nature of the renal damage in only 50-70% of cases. Infact, the end-stage kidney appears shrunken, reduced in volume (� <9 cm), unstructured, amorphous, with acquired cystic degeneration (small and multiple cysts involving the cortex and medulla) or nephrocalcinosis, but there are rare exceptions, such as polycystic kidney disease, diabetic nephropathy, and secondary inflammatory nephropathies. The main difficulties in the differential diagnosis are encountered in multifactorial CKD, which is commonly presented to the nephrologist at stage 4-5, when the kidney is shrunken, unstructured and amorphous. As in acute renal injury and despite the lack of sensitivity, ultrasonography is essential for assessing the progression of the renal damage and related complications, and for evaluating all conditions that increase the risk of CKD, such as lithiasis, recurrent urinary tract infections, vesicoureteral reflux, polycystic kidney disease and obstructive nephropathy. The timing and frequency of ultrasound scans in CKD patients should be evaluated case by case. In this review we will consider the morphofunctional features of the kidney in all nephropathies that may lead to progressive CKD. PMID:23229668
Meola, Mario; Petrucci, Ilaria
Etiology of hyperparathyroidism and bone disease during chronic hemodialysis
The present study was prompted by the observation that, in patients with chronic renal failure being followed at this center, renal osteodystrophy developed almost exclusively in those who were treated by chronic hemodialysis at home rather than in our center. A systematic comparison was made between the 10 patients with roentgenographic evidence of the bone disease and 18 patients without demonstrable bone disease. The two groups were similar in age, sex, nature of renal disease, and duration of dialysis. The mean duration of kidney disease was almost 2 yr longer in the patients without bone disease than in those with bone disease. Other significant differences related to where the hemodialysis was performed and to the calcium concentration in the dialysate (6.0-7.4 mg/100 ml in the hospital and 4.9-5.6 mg/100 ml at home). If the unknown factors related to where the dialysis was performed were of no consequence, the major factor contributing to the production of bone disease observed in these patients was the use of a dialysate with a calcium concentration less than 5.7 mg/100 ml.
Fournier, Albert E.; Johnson, William J.; Taves, Donald R.; Beabout, John W.; Arnaud, Claude D.; Goldsmith, Ralph S.
Antioxidants in food and chronic degenerative diseases.
Both preventive and chain breaking antioxidants have a role in the limitation of free radical damage. Some of these may be regarded as "classical", like vitamins E and C but others are more recently discovered, such as the flavonoids, widespread in plant tissues, and the muscle constituents anserine and carnosine. The major conditions in which the role of antioxidants is under intense investigation include coronary artery disease, cancer and diabetes. There are theoretical underpinnings for the efficacy of antioxidants in each of these, with the protection of low density lipoprotein (in respect of the first) being exceptionally persuasive. Much attention is now being focussed on the flavonoids, which are surprisingly pleiotropic in their effects. For one of them, quercetin, over a dozen seemingly independent biological effects can be listed, including the inhibition of low density lipoprotein oxidation. Flavonoids also inhibit peroxidation in foodstuffs, as opposed to tissues. There is much controversy over antioxidant supplementation policies, some authorities recommending a massive programme of supplementation for all ages and classes, others stressing the value of the traditional mixed diet. This matter is unlikely to be resolved soon, but in the meantime sensible supplementation policies should be continued for those most vulnerable, that is, babies and the aged. PMID:8886321
Candlish, J K; Das, N P
Persistent activation of an innate immune axis translates respiratory viral infection into chronic lung disease
To understand the pathogenesis of chronic inflammatory disease, we analyzed an experimental mouse model of a chronic lung disease that resembles asthma and chronic obstructive pulmonary disease (COPD) in humans. In this model, chronic lung disease develops after infection with a common type of respiratory virus is cleared to trace levels of noninfectious virus. Unexpectedly, the chronic inflammatory disease arises independently of an adaptive immune response and is driven by IL-13 produced by macrophages stimulated by CD1d-dependent TCR-invariant NKT cells. This innate immune axis is also activated in the lungs of humans with chronic airway disease due to asthma or COPD. These findings provide new insight into the pathogenesis of chronic inflammatory disease with the discovery that the transition from respiratory viral infection into chronic lung disease requires persistent activation of a novel NKT cell-macrophage innate immune axis.
Kim, Edy Y.; Battaile, John T.; Patel, Anand C.; You, Yingjian; Agapov, Eugene; Grayson, Mitchell H.; Benoit, Loralyn A.; Byers, Derek E.; Alevy, Yael; Tucker, Jennifer; Swanson, Suzanne; Tidwell, Rose; Tyner, Jeffrey W.; Morton, Jeffrey D.; Castro, Mario; Polineni, Deepika; Patterson, G. Alexander; Schwendener, Reto A.; Allard, John D.; Peltz, Gary; Holtzman, Michael J.
78 FR 17214 - Agency Information Collection Activities; Proposed Collection; Comment Request; Chronic Disease...
Federal Register 2010, 2011, 2012, 2013
...Request; Chronic Disease Self-Management Education Program Standardized Data...submitted to the Office of Management and Budget (OMB) for review...through Chronic Disease Self-Management Education (CDSME) Programs''...
Utilization of Telehealth Technology to Develop and Implement a Comprehensive Management Initiative for Chronic Diseases.
National Technical Information Service (NTIS)
Chronic diseases affect over 90 million Americans and result in high health care costs and tremendous personal and societal burden. Diabetes is, arguably, among the most pervasive and researched chronic diseases. Research shows that much of the costs and ...
R. A. Vigersky
Abnormal joint torque patterns exhibited by chronic stroke subjects while walking with a prescribed physiological gait pattern
Background It is well documented that individuals with chronic stroke often exhibit considerable gait impairments that significantly impact their quality of life. While stroke subjects often walk asymmetrically, we sought to investigate whether prescribing near normal physiological gait patterns with the use of the Lokomat robotic gait-orthosis could help ameliorate asymmetries in gait, specifically, promote similar ankle, knee, and hip joint torques in both lower extremities. We hypothesized that hemiparetic stroke subjects would demonstrate significant differences in total joint torques in both the frontal and sagittal planes compared to non-disabled subjects despite walking under normal gait kinematic trajectories. Methods A motion analysis system was used to track the kinematic patterns of the pelvis and legs of 10 chronic hemiparetic stroke subjects and 5 age matched controls as they walked in the Lokomat. The subject's legs were attached to the Lokomat using instrumented shank and thigh cuffs while instrumented footlifters were applied to the impaired foot of stroke subjects to aid with foot clearance during swing. With minimal body-weight support, subjects walked at 2.5 km/hr on an instrumented treadmill capable of measuring ground reaction forces. Through a custom inverse dynamics model, the ankle, knee, and hip joint torques were calculated in both the frontal and sagittal planes. A single factor ANOVA was used to investigate differences in joint torques between control, unimpaired, and impaired legs at various points in the gait cycle. Results While the kinematic patterns of the stroke subjects were quite similar to those of the control subjects, the kinetic patterns were very different. During stance phase, the unimpaired limb of stroke subjects produced greater hip extension and knee flexion torques than the control group. At pre-swing, stroke subjects inappropriately extended their impaired knee, while during swing they tended to abduct their impaired leg, both being typical abnormal torque synergy patterns common to stroke gait. Conclusion Despite the Lokomat guiding stroke subjects through physiologically symmetric kinematic gait patterns, abnormal asymmetric joint torque patterns are still generated. These differences from the control group are characteristic of the hip hike and circumduction strategy employed by stroke subjects.
Neckel, Nathan D; Blonien, Natalie; Nichols, Diane; Hidler, Joseph
The End of AIDS: HIV Infection as a Chronic Disease
Antiretroviral therapy has been a spectacular success. People are now asking if the end of AIDS is possible. For those who are motivated to take therapy and who have access to lifelong treatment, AIDS-related illnesses are no longer the primary threat, but a new set of HIV-associated complications have emerged, resulting in a novel chronic disease that for many will span several decades of life. Treatment does not fully restore immune health; as a consequence, a number of inflammation-associated and/or immunodeficiency complications such as cardiovascular disease and cancer are increasing in importance. Cumulative toxicities from exposure to antiretroviral drugs for decades cause clinically-relevant metabolic disturbances and end-organ damage. There are growing concerns that the multi-morbidity associated with HIV disease may impact healthy aging and could overwhelm some health care systems, particularly those in resource-limited regions that have yet to fully develop a chronic care model. Given the problems inherent in treating and caring for a chronic disease that might persist for several decades, a global effort to identify a cure is now underway.
Deeks, Steven G.; Lewin, Sharon R.; Havlir, Diane V.
Advances in geroscience: impact on healthspan and chronic disease.
Population aging is unprecedented, without parallel in human history, and the 21st century will witness even more rapid aging than did the century just past. Improvements in public health and medicine are having a profound effect on population demographics worldwide. By 2017, there will be more people over the age of 65 than under age 5, and by 2050, two billion of the estimated nine billion people on Earth will be older than 60 (http://unfpa.org/ageingreport/). Although we can reasonably expect to live longer today than past generations did, the age-related disease burden we will have to confront has not changed. With the proportion of older people among the global population being now higher than at any time in history and still expanding, maintaining health into old age (or healthspan) has become a new and urgent frontier for modern medicine. Geroscience is a cross-disciplinary field focused on understanding the relationships between the processes of aging and age-related chronic diseases. On October 30-31, 2013, the trans-National Institutes of Health GeroScience Interest Group hosted a Summit to promote collaborations between the aging and chronic disease research communities with the goal of developing innovative strategies to improve healthspan and reduce the burden of chronic disease. PMID:24833579
Burch, John B; Augustine, Alison Deckhut; Frieden, Leslie A; Hadley, Evan; Howcroft, T Kevin; Johnson, Ron; Khalsa, Partap S; Kohanski, Ronald A; Li, Xiao Ling; Macchiarini, Francesca; Niederehe, George; Oh, Young S; Pawlyk, Aaron C; Rodriguez, Henry; Rowland, Julia H; Shen, Grace L; Sierra, Felipe; Wise, Bradley C
Effects of iron overload on chronic metabolic diseases.
Iron can affect the clinical course of several chronic metabolic diseases such as type 2 diabetes, obesity, non-alcoholic fatty liver disease, and atherosclerosis. Iron overload can affect major tissues involved in glucose and lipid metabolism (pancreatic ? cells, liver, muscle, and adipose tissue) and organs affected by chronic diabetic complications. Because iron is a potent pro-oxidant, fine-tuned control mechanisms have evolved to regulate entry, recycling, and loss of body iron. These mechanisms include the interplay of iron with transferrin, ferritin, insulin, and hepcidin, as well as with adipokines and proinflammatory molecules. An imbalance of these homoeostatic mechanisms results in systemic and parenchymal siderosis that contributes to organ damage (such as ?-cell dysfunction, fibrosis in liver diseases, and atherosclerotic plaque growth and instability). Conversely, iron depletion can exert beneficial effects in patients with iron overload and even in healthy frequent blood donors. Regular assessment of iron balance should be recommended for patients with chronic metabolic diseases, and further research is needed to produce guidelines for the identification of patients who would benefit from iron depletion. PMID:24731656
Fern�ndez-Real, Jos� Manuel; Manco, Melania
Surveillance for the prevention of chronic diseases through information association
Background Research on Genomic medicine has suggested that the exposure of patients to early life risk factors may induce the development of chronic diseases in adulthood, as the presence of premature risk factors can influence gene expression. The large number of scientific papers published in this research area makes it difficult for the healthcare professional to keep up with individual results and to establish association between them. Therefore, in our work we aim at building a computational system that will offer an innovative approach that alerts health professionals about human development problems such as cardiovascular disease, obesity and type 2 diabetes. Methods We built a computational system called Chronic Illness Surveillance System (CISS), which retrieves scientific studies that establish associations (conceptual relationships) between chronic diseases (cardiovascular diseases, diabetes and obesity) and the risk factors described on clinical records. To evaluate our approach, we submitted ten queries to CISS as well as to three other search engines (Google�, Google Scholar� and Pubmed�;) � the queries were composed of terms and expressions from a list of risk factors provided by specialists. Results CISS retrieved a higher number of closely related (+) and somewhat related (+/-) documents, and a smaller number of unrelated (-) and almost unrelated (-/+) documents, in comparison with the three other systems. The results from the Friedman�s test carried out with the post-hoc Holm procedure (95% confidence) for our system (control) versus the results for the three other engines indicate that our system had the best performance in three of the categories (+), (-) and (+/-). This is an important result, since these are the most relevant categories for our users. Conclusion Our system should be able to assist researchers and health professionals in finding out relationships between potential risk factors and chronic diseases in scientific papers.
Radiological investigation of chronic inflammatory bowel disease in childhood.
The radiological investigations relevant to chronic IBD are described briefly with emphasis placed on compression techniques in small bowel studies. A classification for reporting small bowel Crohn's disease is proposed, where the disease is staged as early, advanced or complicated, and the extent of involvement measured directly from the film. The terminal ileum may be normal in 20% of children with proximal Crohn's disease, so that ileoscopy should not be used to exclude small bowel disease. Radiological assessment of the small bowel is important in management. Surgical referral was based on the radiological changes in 6% of patients, and in 24% the presence of extensive uncomplicated small bowel Crohn's disease led to treatment with elemental diet. The use of some specialized examinations, such as the instant and ileostomy enema, are discussed. PMID:8003738
Bartram, C I; Halligan, S
The glomerular proteome in a model of chronic kidney disease.
Adequate kidney function is crucial in sustaining vertebrate homeostasis. Certain diseases can diminish renal function and lead to end-stage renal disease. Diabetes mellitus and hypertension are the main causes of glomerulosclerosis and albuminuria in adults. The molecular mechanisms that trigger these maladaptive changes are still unsatisfyingly described. We previously introduced 2-D DIGE in combination with focused tissue isolation methods to analyze protein expression in glomeruli. Glomeruli, the crucial compartments in albuminuric renal diseases, were extracted using magnetic particles from subtotally nephrectomized FVB mice (n?=?6); this 5/6 nephrectomy in FVB mice is a model of chronic kidney disease. Analysis of protein expression levels from glomerular protein lysates was performed using 2-D DIGE and compared with glomerular protein lysates from mice that underwent sham surgery. The comparison of about 2100 detectable spots between both groups revealed 48 protein spots that showed significant differential expression. Of those, 33 proteins could be identified using nanoLC-ESI MS. The metalloproteinase meprin 1 alpha, the beta galactoside-binding-lectin galectin-1 and dimethylarginine dimethylaminohydrolase 1, a key enzyme in NO metabolism, were found to be differentially regulated, thus implying a role in the pathogenesis and pathophysiology of progressive kidney disease. In conclusion, 2-D DIGE protein analysis of smallest sample sizes from specific organ compartments provides focused protein expression results, which help in gaining an understanding of the molecular mechanisms of chronic kidney disease. PMID:21136910
Potthoff, Sebastian A; Sitek, Barbara; Stegbauer, Johannes; Schulenborg, Thomas; Marcus, Katrin; Quack, Ivo; Rump, Lars C; Meyer, Helmut E; St�hler, Kai; Vonend, Oliver
Association of anemia and erythropoiesis stimulating agents with inflammatory biomarkers in chronic kidney disease
Inflammatory cytokines are important predictors of cardiovascular mortality especially in patients with chronic kidney disease. Here we explored the relationship of anemia and epoetin treatment to inflammatory cytokine levels in patients with chronic kidney disease. One hundred non-dialysis patients with chronic kidney disease over 18 years of age were evenly split into anemic and non-anemic cohorts. Of the 50 anemic
Sai Ram Keithi-Reddy; Francesco Addabbo; Tejas V Patel; Bharati V Mittal; Michael S Goligorsky; Ajay K Singh
Relationship between disease severity and quality of life in patients with chronic obstructive pulmonary disease
Few studies have evaluated the relationship between Airways Questionnaire 20 (AQ20), a measure of the quality of life, scores and physiological outcomes or with systemic markers of disease in patients with chronic obstructive pulmonary disease (COPD). The aim of the present study was to investigate the relationship of forced expiratory volume in 1 s (FEV1), body mass index, fat- free
F. F. Sanchez; M. M. Faganello; S. E. Tanni; P. A. Lucheta; C. R. Padovani; I. Godoy
Oxidative stress and inflammation, a link between chronic kidney disease and cardiovascular disease
Patients with chronic kidney disease (CKD) show a high cardiovascular morbidity and mortality. This seems to be consequence of the cardiovascular risk factor clustering in CKD patients. Non traditional risk factors such as oxidative stress and inflammation are also far more prevalent in this population than in normal subjects. Renal disease is associated with a graded increase in oxidative stress
Victoria Cachofeiro; Marian Goicochea; Soledad Garc�a de Vinuesa; Pilar Oubi�a; Vicente Lahera; Jos� Lu�o
Nontraditional risk factors for cardiovascular disease in patients with chronic kidney disease
Patients with chronic kidney disease (CKD) have a reduced lifespan, and a substantial proportion of these individuals die from cardiovascular disease. Although a large percentage of patients with CKD have traditional cardiac risk factors such as diabetes, hypertension and abnormalities in cholesterol, interventions to address these factors�which have significantly decreased cardiovascular mortality in the general population�have not shown such benefit
Jessica Kendrick; Michel B Chonchol
Sexual and gonadal dysfunction in chronic kidney disease: Pathophysiology.
Sexual and gonadal dysfunction/infertility are quite common in patients with chronic kidney disease. Forty percent of male and 55% of female dialysis patients do not achieve orgasm. The pathophysiology of gonadal dysfunction is multifactorial. It is usually a combination of psychological, physiological, and other comorbid factors. Erectile dysfunction in males is mainly due to arterial factors, venous leakage, psychological factors, neurogenic factors, endocrine factors, and drugs. Sexual dysfunction in females is mainly due to hormonal factors and manifests mainly as menstrual irregularities, amenorrhea, lack of vaginal lubrication, and failure to conceive. Treatment of gonadal dysfunction in chronic kidney disease is multipronged and an exact understanding of underlying pathology is essential in proper management of these patients. PMID:22470857
Rathi, Manish; Ramachandran, Raja
Sexual and gonadal dysfunction in chronic kidney disease: Pathophysiology
Sexual and gonadal dysfunction/infertility are quite common in patients with chronic kidney disease. Forty percent of male and 55% of female dialysis patients do not achieve orgasm. The pathophysiology of gonadal dysfunction is multifactorial. It is usually a combination of psychological, physiological, and other comorbid factors. Erectile dysfunction in males is mainly due to arterial factors, venous leakage, psychological factors, neurogenic factors, endocrine factors, and drugs. Sexual dysfunction in females is mainly due to hormonal factors and manifests mainly as menstrual irregularities, amenorrhea, lack of vaginal lubrication, and failure to conceive. Treatment of gonadal dysfunction in chronic kidney disease is multipronged and an exact understanding of underlying pathology is essential in proper management of these patients.
Rathi, Manish; Ramachandran, Raja
Sympathoexcitation by brain oxidative stress mediates arterial pressure elevation in salt-induced chronic kidney disease.
Hypertension is very prevalent in chronic kidney disease and critical for its prognosis. Sympathoexcitation and oxidative stress have been demonstrated to be involved in chronic kidney disease. We have shown previously that sympathoexcitation by brain oxidative stress mediates arterial pressure elevation in the salt-sensitive hypertension model, Dahl salt-sensitive rats. Thus, we investigated whether sympathoexcitation by excessive brain oxidative stress could contribute to arterial pressure elevation in salt-induced chronic kidney disease model rats. Young (3-week-old) male Sprague-Dawley rats were randomly assigned to a uninephrectomy or sham operation and then subjected to either a normal salt (0.5%) or high-salt (8.0%) diet for 4 weeks. The young salt-loaded uninephrectomized rats exhibited sympathoexcitation, hypertension, and renal injury, proteinuria and global glomerulosclerosis together with tubulointerstitial damage. Under urethane anesthesia and artificial ventilation, renal sympathetic nerve activity, arterial pressure, and heart rate decreased to a greater degree in the salt-loaded uninephrectomized rats than in the nonsalt-loaded uninephrectomized rats and the salt-loaded or nonsalt-loaded sham-operated rats, when Tempol, a membrane-permeable superoxide dismutase mimetic, was infused acutely into the lateral cerebral ventricle. Oxidative stress in the hypothalamus, measured by lucigenin chemiluminescence, was also significantly greater. Furthermore, in the salt-loaded uninephrectomized rats, antioxidant treatment with chronic intracerebroventricular Tempol decreased sympathetic nerve activity and arterial pressure, which, in turn, led to a decrease in renal damage. Similar effects were elicited by treatment with oral moxonidine, the central sympatholytic agent. In conclusion, sympathoexcitation by brain oxidative stress may mediate arterial pressure elevation in salt-induced chronic kidney disease. PMID:22083162
Fujita, Megumi; Ando, Katsuyuki; Kawarazaki, Hiroo; Kawarasaki, Chiaki; Muraoka, Kazuhiko; Ohtsu, Hiroshi; Shimizu, Hideki; Fujita, Toshiro
Skeletal muscle dysfunction in chronic obstructive pulmonary disease
It has become increasingly recognized that skeletal muscle dysfunction is common in patients with chronic obstructive pulmonary\\u000a disease (COPD). Muscle strength and endurance are decreased, whereas muscle fatigability is increased. There is a reduced\\u000a proportion of type I fibers and an increase in type II fibers. Muscle atrophy occurs with a reduction in fiber cross-sectional\\u000a area. Oxidative enzyme activity is
M Jeffery Mador; Erkan Bozkanat
Positive Association between Plasma Homocysteine Level and Chronic Kidney Disease
Background: Increasing experimental evidence, including recently developed animal models, supports a role for homocysteine in the development of chronic kidney disease (CKD). However, relatively few clinical\\/epidemiological studies have examined this hypothesis in humans. We examined the relationship between plasma homocysteine level and CKD in a population-based study of older Australians. Methods: Community-based study (1992�1994) among 2,609 individuals (58.6% women), aged
Anoop Shankar; Jie Jin Wang; Brian Chua; Elena Rochtchina; Vicki Flood; Paul Mitchell
Docosahexaenoic Acid and Smoking-Related Chronic Obstructive Pulmonary Disease
If the inflammatory response to inhalation of cigarette smoke causes chronic obstructive pulmonary disease (COPD), suppression of that natural response might be beneficial. We hypothesized that a smoker's risk of developing COPD is inversely related to physiologic levels of two fatty acids that have antiinflammatory properties: eicosapentaenoic acid (EPA, C20:5) and docosahexaenoic acid (DHA, C22:6). The proportion of each fatty
Smoking and inflammation: Their synergistic roles in chronic disease
Cigarette smoking is a major risk factor for the development and progression of cardiovascular and other chronic diseases.\\u000a Cigarette smoke increases inflammatory mediators in the circulation and generates high amounts of reactive oxygen species,\\u000a which are potent triggers of the inflammatory response and thought to play a central role in the development of atherosclerosis.\\u000a Low-grade inflammation, atherogenic lipoprotein profile, and
Bente Halvorsen; Kari Otterdal; Serena Tonstad; P�l Aukrust
CD46 Protects against Chronic Obstructive Pulmonary Disease
BackgroundChronic obstructive pulmonary disease and emphysema develops in 15% of ex-smokers despite sustained quitting, while 10% are free of emphysema or severe lung obstruction. The cause of the incapacity of the immune system to clear the inflammation in the first group remains unclear.Methods and FindingsWe searched genes that were protecting ex-smokers without emphysema, using microarrays on portions of human lungs
Sandra Grumelli; Bao Lu; Leif Peterson; Toshitaka Maeno; Craig Gerard
Seronegative conversion after incomplete benznidazole treatment in chronic Chagas disease.
In 12-18% of adult patients, treatment with benznidazole for chronic Chagas disease has to be discontinued because of side-effects. We identified and analysed a cohort of 81 adult patients with three positive tests for Trypanosoma cruzi infection and serological monitoring following incomplete treatment with benznidazole for a median of 10 days. Twenty percent of these patients (16/81) met the criteria of cure, showing that the optimal schedule of benznidazole administration remains to be determined. PMID:22898619
Alvarez, M G; Vigliano, C; Lococo, B; Petti, M; Bertocchi, G; Viotti, R
Non-erythropoietin-based anaemia management in chronic kidney disease
Renal anaemia starts earlier in the progression of chronic kidney disease (CKD) than was previously thought and is often inadequately monitored and treated. Current treatment guidelines recommend giving recombinant erythropoietin (rHuEPO) as soon as haemoglobin (Hb) concentration falls below 11 gudl and alternative causes of anaemia have been ruled out. Recent studies show that, in practice, few patients receive rHuEPO
Walter H. Hor
Hyperuricemia and metabolic syndrome: associations with chronic kidney disease
The effects of serum uric acid (SUA) and metabolic syndrome on chronic kidney disease (CKD) remain controversial. This study\\u000a grouped subjects according to a combination of their uric acid and metabolic syndrome status and investigated the association\\u000a between these groups and CKD to clarify the relationships of SUA and metabolic syndrome to CKD. This survey analyzed data\\u000a from 81,799 adults
Lai-Chu See; Chang-Fu Kuo; Fang-Hsiu Chuang; Yu-Ming Shen; Yu-Shien Ko; Yu-Ming Chen; Kuang-Hui Yu
Abnormalities of megakaryocytes in myelitis and chronic myeloproliferative diseases
Summary��A planimetric study of megakaryopoiesis in various chronic myeloproliferative diseases (CMPD) was performed and the results\\u000a compared with those from controls and myelitis of rheumatic origin. Morphometric measurements included at least 200 megakaryocytes\\u000a in each case observed in Giemsa-stained semithin sections of resin-embedded core biopsies. Twenty specimens were evaluated\\u000a from the controls and inflammatory disorders and from each of the
J. Thiele; S. Holgado; H. Choritz; A. Georgii
Prophylactic antibiotic therapy in chronic obstructive pulmonary disease.
CLINICAL QUESTION Is prophylactic antibiotic treatment associated with fewer exacerbations or improved health-related quality of life (HRQOL) in patients with chronic obstructive pulmonary disease (COPD)? BOTTOM LINE Continuous macrolide antibiotic use for prophylaxis was associated with a clinically significant reduction in COPD exacerbations. Pulsed antibiotic use was not associated with benefit. Continuous and pulsed antibiotics were associated with improved HRQOL, but this was not clinically significant. PMID:24893090
Herath, Samantha C; Poole, Phillippa
Sibling cases of chronic recurrent hepatocerebral disease with hypercitrullinemia
Summary��Two sibling cases with chronic recurrent hepato-cerebral syndrome which correspond to the nutritional form of hepato-cerebral\\u000a disease entitled by Shikata et al. and the data of plasma free aminoacids analyses of these cases were reported. The one case\\u000a is 27 years old male and the other case is 36 years old female. Their parents were cousins. Both cases have had
Tadasu Tsujii; Tomofumi Morita; Yoshinori Matsuyama; Tsutomu Matsui; Masahiro Tamura; Yoichi Matsuoka
Managing ascites in patients with chronic liver disease.
This article discusses the pathophysiology of ascites, a complication associated with chronic liver disease. The diagnosis and grading of ascites and assessment of patients with the condition are explored. In addition, the nursing and medical management of ascites is discussed, and recommendations for interdisciplinary working and education are suggested. Nursing knowledge of this complication is essential to ensure that patients with ascites are cared for effectively and that their comfort is maximised. PMID:24494916
Fullwood, D; Purushothaman, A
Chronic graft-versus-host disease complicated by nephrotic syndrome
Chronic graft-versus-host disease (cGVHD) is one of the most frequent and serious complications of allogeneic hematopoietic stem cell transplantation (HSCT). Nephrotic syndrome (NS) is an uncommon and underrecognized manifestation of cGVHD. We report a patient who developed NS 18 months after allogeneic bone marrow transplantation. The onset of NS was accompanied by active manifestations of cGVHD, and immunosuppressants had not
Hsin-Hui Wang; An-Hang Yang; Ling-Yu Yang; Giun-Yi Hung; Jei-Wen Chang; Chun-Kai Wang; Tzong-Yann Lee; Ren-Bin Tang
An introduction to biomarkers: applications to chronic kidney disease
Diagnosis and management of chronic kidney disease (CKD) will be characterized in the future by an increasing use of biomarkers�quantitative\\u000a indicators of biologic or pathologic processes that vary continuously with progression of the process. �Classical� biomarkers\\u000a of CKD progression include quantitative proteinuria, the percentage of sclerotic glomeruli or fractional interstitial fibrosis.\\u000a New candidate biomarkers (e.g., urinary proteomic patterns) are being
Kevin V. Lemley
Role of chronic stress and depression in periodontal diseases.
An extensive body of experimental and clinical evidence documents the negative impact of chronic psychological stress and depression on the immune system and health. Chronic stress and depression can result in general dysregulation of the immune system, of both cellular and humoral pathways, which may contribute to pathogenic infection and concomitant periodontal tissue destruction. In general, the evidence is consistent with the hypothesis that stress can modify the host defense and progression of periodontal infections in patients susceptible to periodontitis. However, substantial evidence also indicates that these conditions can mediate risk for disease, including periodontitis, through changes in health-related behaviors, such as oral hygiene, smoking and diet. The unequivocal interpretation of studies has also been hampered, in part, by issues related to conceptualization of stress and depression, as well as commonly associated comorbidities, such as diabetes, that can modify the onset and progression of periodontal disease. In addition, stress and depression appear to fall into a spectrum, ranging from mild to severe, involving a complex interaction of genetic background, coping strategies and environment. Differences in the conceptualization of stress and depression are probably important in assessing associations with other biologic and clinical measures. Future studies are necessary to clarify the complex interactions of chronic stress and depression in periodontal diseases. PMID:24320960
Warren, Kimberly R; Postolache, Teodor T; Groer, Maureen E; Pinjari, Omar; Kelly, Deanna L; Reynolds, Mark A
The nervous system and chronic kidney disease in children
This paper provides a review of the literature on the nervous system involvement incurred by children and adolescents with chronic kidney disease (CKD), with a particular focus on neuropsychological functioning. In addition to an historical overview of earlier literature, published studies from the past 14�years that address both central and peripheral nervous system function in children with CKD are reviewed (1990�2003). These studies span work in neuroimaging, electrophysiology, and neuropsychology. A key focus for this review is on variables that might affect neurodevelopmental status in these children. The paper concludes with suggestions for achieving progress in the understanding of this complication of kidney disease in children.
Wetherington, Crista E.; Duquette, Peter J.; Hooper, Stephen R.
Prevalence of Vitamin�D Deficiency in Chronic Liver Disease
\\u000a Abstract��Vitamin�D deficiency has been associated with cholestatic liver disease such as primary biliary cirrhosis. Some studies have\\u000a suggested that cirrhosis can predispose patients to development of osteoporosis because of altered calcium and vitamin�D homeostasis.\\u000a The aim of this study was to determine the prevalence of vitamin�D deficiency in patients with chronic liver disease.\\u000a \\u000a \\u000a \\u000a \\u000a Methods��One hundred and eighteen consecutive patients (43
J. Arteh; S. Narra; S. Nair
Nongranulomatous chronic idiopathic enterocolitis: a primary histologically defined disease.
Nongranulomatous chronic idiopathic enterocolitis is characterized by sudden onset of severe watery diarrhea, malabsorption, exudative enteropathy, frequent appearance of shallow ulcerations, and variable degrees of villus atrophy. In the absence of infectious and pharmacologic causes, the presence of a predominantly acute inflammatory infiltrate limited to the lamina propria establishes the diagnosis. No underlying disease appears during prolonged follow-up. The etiology remains unknown. The disease is generally corticosteroid-responsive; low-dose maintenance therapy is frequently required. The long-term prognosis is guarded. Three of 11 patients died of opportunistic infections or resistance to therapy. PMID:11215720
Soergel, K H
An Unusual Cause of Anaemia of Chronic Disease: Lisinopril-Induced Chronic Inflammatory State
We report the case of a patient with severe systemic symptoms (weight loss, malaise, and anorexia), eosinophilic oesophagitis, and raised inflammatory markers coinciding with the use of lisinopril. The onset of symptoms occurred after the administration of lisinopril and resolved shortly after cessation of the medication. Despite thorough investigation, no other cause of the systemic inflammation and anaemia of chronic disease was found. �Drug rash with eosinophilia and systemic symptoms� (DRESSs) syndrome describes a potentially serious multiorgan inflammatory response to certain classes of drugs; this includes the use of ACE inhibitors. Although this patient did not meet strict criteria for DRESSs, the subacute inflammatory syndrome with eosinophilic organ infiltration bears similar features. ACE inhibitors should be considered in the differential diagnosis in patients with nonspecific systemic inflammation and anaemia of chronic disease where no other cause is found.
Eyre, Toby; Van-Hamel-Parsons, Victoria; Wang, Lai Mun; Hughes, Kathryn A.; Littlewood, Timothy J.
Parabiosis for the study of age-related chronic disease
Summary Modern medicine wields the power to treat large numbers of diseases and injuries most of us would have died from just a hundred years ago. In view of this tremendous achievement, it can seem as if progress has slowed, and we have been unable to impact the most devastating diseases of our time. Chronic diseases of age such as cardiovascular disease, diabetes, osteoarthritis, or Alzheimer�s disease turn out to be of a complexity that may require transformative ideas and paradigms to understand and treat them. Parabiosis, which mimics aspects of the naturally occurring shared blood supply in conjoined twins in humans and certain animals, may just have the power to be such a transformative experimental paradigm. Forgotten and now shunned in many countries, it has contributed to major breakthroughs in tumor biology, endocrinology, and transplantation research in the past century, and a set of new studies in the US and Britain report stunning advances in stem cell biology and tissue regeneration using parabiosis between young and old mice. We review here briefly the history of parabiosis and discuss its utility to study physiological and pathophysiological processes. We argue that parabiosis is a technique that should enjoy wider acceptance and application, and that policies should be revisited especially if one is to study complex age-related, chronic disorders.
Eggel, Alexander; Wyss-Coray, Tony
Asthma and Chronic Obstructive Pulmonary Disease (COPD) - Differences and Similarities
Bronchial asthma and COPD (chronic obstructive pulmonary disease) are obstructive pulmonary diseases that affected millions of people all over the world. Asthma is a serious global health problem with an estimated 300 million affected individuals. COPD is one of the major causes of chronic morbidity and mortality and one of the major public health problems worldwide. COPD is the fourth leading cause of death in the world and further increases in its prevalence and mortality can be predicted. Although asthma and COPD have many similarities, they also have many differences. They are two different diseases with differences in etiology, symptoms, type of airway inflammation, inflammatory cells, mediators, consequences of inflammation, response to therapy, course. Some similarities in airway inflammation in severe asthma and COPD and good response to combined therapy in both of these diseases suggest that they have some similar patophysiologic characteristics. The aim of this article is to show similarities and differences between these two diseases. Today asthma and COPD are not fully curable, not identified enough and not treated enough and the therapy is still developing. But in future better understanding of pathology, adequate identifying and treatment, may be and new drugs, will provide a much better quality of life, reduced morbidity and mortality of these patients.
Cukic, Vesna; Lovre, Vladimir; Dragisic, Dejan; Ustamujic, Aida
Epigenetics refers to a heritable change in the pattern of gene expression that is mediated by a mechanism specifically not due to alterations in the primary nucleotide sequence. Well known epigenetic mechanisms encompass DNA methylation, chromatin remodeling (histone modifications) and RNA interference. Functionally, epigenetics provides an extra layer of transcriptional control and plays a crucial role in normal physiological development, as well as in pathological conditions. Aberrant DNA methylation is implicated in immune dysfunction, inflammation and insulin resistance. Epigenetic changes may be responsible for �metabolic memory� and development of micro- and macrovascular complications of diabetes. MicroRNAs are critical in the maintenance of glomerular homeostasis and hence RNA interference may be important in the progression of renal disease. Recent studies have shown that epigenetic modifications orchestrate the epithelial-mesenchymal transition and eventually fibrosis of the renal tissue. Oxidative stress, inflammation, hyperhomocysteinemia and uremic toxins could induce epimutations in chronic kidney disease. Epigenetic alterations are associated with inflammation and cardiovascular disease in patients with chronic kidney disease. Reversible nature of the epigenetic changes gives an unique opportunity to halt or even reverse the disease process through targeted therapeutic strategies.
Dwivedi, Rama S.; Herman, James G.; McCaffrey, Timothy; Raj, Dominic SC
Celiac disease in patients with chronic psychiatric disorders
Aim The aim of this study was to determine the prevalence of celiac disease in Iranian patients suffering from chronic depression or schizophrenia. Background Psychiatric disorders are common in untreated celiac disease. Patients and methods Two hundred Iranian inpatient men with in chronic phase of depressive disorders or schizophrenia, and 200 age-matched healthy male subjects were screened for celiac disease by anti-tissue transglutaminase IgA antibodies. The mean age of the study patients was 37 years. Results One (1%) schizophrenic and two (2%) depressive patients were positive for anti-tissue transglutaminase IgA antibodies; duodenal biopsy was not possible in these subjects. In the control group one (0.5%) individual was positive for anti-tissue transglutaminase IgA antibodies, but had normal duodenal histology. The difference between patients and controls was not statistically significant. Conclusion The frequency of celiac disease serology in schizophrenic and depressive inpatients was not significantly higher than that in the general population. We would therefore not advocate systematic serologic screening in these patients, but alertness to celiac disease should be kept in mind.
Khoshbaten, Manouchehr; Sharifi, Nasrin; Fakhari, Ali; Golamnejad, Mahdyar; Hashemi, Sayed Hassan; Rostami, Kamran
Familial benign chronic pemphigus (Hailey-Hailey disease).
We present an atypical case of familial benign chronic pemphigus (Hailey-Hailey disease) that manifested with relapsing, flaccid vesicles and erosions, which were limited to the upper chest, anterior aspect of the neck, and anterior aspects of the upper arms without intertriginous involvement. Although individual eruptions in this patient demonstrated asymmetry, relapses did not obey a segmental distribution. To the best of our knowledge, no other patient has been described with symmetric lesions that were localized solely to the anterior upper body without a prior history of lesions at commonly affected disease sites, which include skin folds, the back, and the posterior and lateral aspects of the neck. This unusual presentation of Hailey-Hailey disease highlights the variable nature of the disease. PMID:21163165
Hunt, Raegan; O'Reilly, Kathryn; Ralston, Jonathan; Kamino, Hideko; Shupack, Jerome L
Statins in patients with chronic kidney disease: new evidence.
Dyslipidemia represents a common metabolic alteration in chronic kidney disease (CKD). Alterations can be different depending on the stage of the disease and the extent of proteinuria. Despite the high cardiovascular risk in patients with renal impairment, only a small percentage of patients receive adequate cholesterol-lowering therapy. The use of statins, inhibitors of the endogenous synthesis of cholesterol in patients with CKD, represents an efficient therapeutic instrument for reducing cardiovascular risk, at least in the early stage of the disease. Such evidence is currently lacking in dialysis, that is a setting where cardiovascular mortality is not consistently due to classical atherosclerosis. In addition to their efficacy, statins are proved as safe drugs with a high tolerability profile in CKD. In the case of intolerant patients, a new therapeutic perspective is represented by ezetimibe, inhibitor of intestinal absorption of cholesterol, whose effectiveness and tolerability allow its use throughout all stages of the renal disease. PMID:23872633
Savino, M; Garofalo, C; De Paris, V; Michini, C; Pirro, L; Palmisano, R; Provenzano, M; Minutolo, R; Conte, G; De Nicola, L
Chronic Lyme disease and the 'Axis of Evil'.
Lyme disease is a controversial illness, and the existence of chronic Lyme disease induced by persistent infection with the Lyme spirochete, Borrelia burgdorferi, is the subject of continued debate. A recent publication defined the 'Axis of Evil' in this controversy as physicians who treat patients with needlessly prolonged courses of antibiotics, 'specialty laboratories' that perform 'inaccurate' Lyme testing and the internet, which promotes 'Lyme hysteria'. We examine the 'Axis of Evil' components in the context of diagnostic and therapeutic challenges for Lyme disease patients and their physicians, and we present an evidence-based refutation to this misguided view. Despite its virulent nature, the 'Axis of Evil' perspective is a useful starting point to resolve the controversy over Lyme disease. PMID:19072179
Stricker, Raphael B; Johnson, Lorraine
[Influence of early stage of chronic renal disease on risk of cardiac diseases and stroke].
Cardiovascular diseases are the main cause of death among people with kidney diseases. The early stage of chronic kidney disease, with mild decrease of glomerular filtration rate (GFR) and small increase of creatinine concentration in serum and/or occurrence of microalbuminuria, is related to the increase of cardiovascular morbidity and mortality. Kidney insufficiency is also independently connected with the risk of stroke. Patients with early stage of kidney insufficiency should be qualified as those in a cardiovascular high risk group. PMID:16969907
Szk�?ka, Tomasz; My?liwiec, Michal
A retrospective study of clinical signs and epidemiology of chronic valve disease in a group of 207 Dachshunds in Poland
Background Chronic mitral valve disease is frequently seen in the Dachshund. Dachshunds (n=207) made up 11.73% of the dogs admitted to the Cardiology Service at the Small Animal Clinic, Warsaw University of Life Sciences, Poland (first visits only). Results Of these, 35 dogs had no clinically detectable heart disease while 172 had chronic valve disease with the mitral valve affected most often (130 dogs), both mitral and tricuspid valves infrequently (39 dogs) and rarely the tricuspid valve (3 dogs). Males were affected more frequently than females and the average age of dogs with chronic valve disease was 11.9 years for females and 11.3 years for males. A majority of the diseased Dachshunds were classified as ISACHC 2 (79), followed by ISACHC 1 (60). Most frequent clinical signs noted by owners included coughing, exercise intolerance, dyspnea and tachypnea. Heart murmurs were generally louder with increased disease severity; however there were 20 dogs in the ISACHC 1 group with no audible heart murmurs. The most frequent electrocardiographic abnormalities included an increased P wave and QRS complex duration, increased R wave amplitude and tachycardia. With increased disease severity, echocardiography revealed an increase in heart size. A higher ISACHC class was related to increased heart size (based on echocardiography) and increased percentage of patients exhibiting enlargement of both left atrium and left ventricle (based on radiography). Conclusions The Dachshund is often affected by chronic mitral valvular disease with a late onset of associated clinical signs and few cardiac complications.
Pathophysiological basis for antioxidant therapy in chronic liver disease.
Oxidative stress is a common pathogenetic mechanism contributing to initiation and progression of hepatic damage in a variety of liver disorders. Cell damage occurs when there is an excess of reactive species derived from oxygen and nitrogen, or a defect of antioxidant molecules. Experimental research on the delicately regulated molecular strategies whereby cells control the balance between oxidant and antioxidant molecules has progressed in recent years. On the basis of this evidence, antioxidants represent a logical therapeutic strategy for the treatment of chronic liver disease. Clinical studies with large numbers of patients have not yet been performed. However, results from several pilot trials support this concept and indicate that it may be worth performing multicentre studies, particularly combining antioxidants with anti-inflammatory and/or antiviral therapy. Oxidative stress plays a pathogenetic role in liver diseases such as alcoholic liver disease, chronic viral hepatitis, autoimmune liver diseases and non-alcoholic steatohepatitis. The use of antioxidants (e.g. S-adenosylmethionine [SAMe; ademetionine], tocopherol [vitamin E], polyenylphosphatidylcholine or silymarin) has already shown promising results in some of these pathologies. PMID:16296871
Medina, Jes�s; Moreno-Otero, Ricardo
[Regulatory T cells in chronic obstructive pulmonary disease].
Exposition to tobacco smoke has been established as the main risk factor to develop chronic obstructive pulmonary disease (COPD), by inducing inflammation of the airways. Several cell populations participate in this inflammatory process. It has been accepted that a maladaptive modulation of inflammatory responses plays a critical role in the development of the disease. Regulatory T cells (Treg) are a subset of T CD4(+) lymphocytes that modulate the immune response through secretion of cytokines. The role of the Treg cells in chronic obstructive pulmonary disease is not clearly known, that is why it is important to focus in understanding their participation in the pathogenesis of the disease. To elaborate a systematic review of original articles in which we could describe Treg cells (their ontogeny, mechanisms of action) and their role in COPD, we made a systematic literature search in some data bases (MEDLINE, AMED, PubMed and Scielo) looking through the next keywords: "COPD and Regulatory T cells/EPOC y c�lulas T reguladoras", �Inflammation and COPD/Inflamaci�n y EPOC�, �Regulatory T cells/C�lulas T reguladoras�. We included basic science articles, controlled and non-controlled clinical trials, meta-analysis and guides. From this search we conclude that Treg cells are a subpopulation of T CD4(+) lymphocytes and their major functions are the suppression of immune responses and the maintenance of tolerance to self-antigens. A disruption in the regulatory mechanisms of the Treg cells leads to the development and perpetuation of inflammation in COPD. PMID:23474149
Lim�n-Camacho, Leonardo; Solleiro-Villavicencio, Helena; Pupko-Sissa, Ilana; Lascurain, Ricardo; Vargas-Rojas, Mar�a In�s
Periodontitis associated with Chronic Kidney Disease among Mexican Americans
Objective In comparison to non-Hispanic whites, a number of healthcare disparities, including poor oral health, have been identified among Hispanics in general and Mexican-Americans in particular. We hypothesized that Mexican-Americans with Chronic Kidney disease (CKD) would have higher prevalence of chronic periodontitis compared to Mexican Americans with normal kidney function, and that the level of kidney function would be inversely related to the prevalence of periodontal disease. Method We examined this hypothesis using the National Health and Nutrition Examination Survey 1988�1994 (NHANES III) dataset. We followed the American Academy of Periodontology (AAP)/Center for Disease Control and Prevention (CDC) case definition for periodontitis. Glomerular filtration rate was estimated using the CKD-Epidemiology (EPI) equation for Hispanic populations. The classification to CKD stages was based on the National Kidney Foundation Kidney Disease Outcomes Quality Initiative. Results Periodontitis prevalence increased across the kidney function groups showing a statistically significant dose-response association (p<0.001). Mexican Americans with reduced kidney function were 2-fold more likely to have periodontitis compared to Mexican Americans with normal kidney function after adjusting for potential confounders such as smoking, diabetes and socioeconomic status. Multivariate adjusted Odds Ratio for periodontitis significantly increased with 1, 5 and 10 mL/minute eGFR reduction from the mean. Conclusion This is the first report, to the best our knowledge, that showed an increase of periodontitis prevalence with decreased kidney function in this population.
Ioannidou, Effie; Hall, Yoshio; Swede, Helen; Himmelfarb, Jonathan
Inhaled nitric oxide in chronic obstructive lung disease
During an investigation of the effect of nitric oxide on the pulmonary circulation the authors had the opportunity to give nitric oxide to a patient with longstanding obstructive airway disease, with successful results. A 72-year-old man with chronic obstructive pulmonary disease was referred to the institution for assessment of pulmonary vascular reactivity to acetylcholine and nitric oxide. Acetylcholine was infused into the main pulmonary artery followed 15 min later by an inhalation of 80 parts per million (ppm) nitric oxide. Heart rate and systemic arterial and pulmonary arterial pressures were continuously monitored. Throughout the study the inspired oxygen concentration was kept constant at 98%. Nitrogen dioxide and nitric oxide concentrations were monitored while nitric oxide was delivered. The infusion of acetylcholine resulted in a small increase in pulmonary artery pressure and pulmonary vascular resistance. Nitric oxide produced a substantial fall in pulmonary artery pressure and pulmonary vascular resistance with a concomitant increase in systemic arterial oxygen tension. These results suggest that endothelium-dependent relaxation of the pulmonary vasculature was impaired in the patient and that exogenous nitric oxide was an effective pulmonary vasodilator. In-vitro investigation of explanted airways disease suggests not only that endothelium-dependent pulmonary artery relaxation is impaired but also that the dysfunction is related to pre-existing hypoxemia and hypercapnia. Nitric oxide inhibits proliferation of cultured vascular smooth muscle cells and might alter the pulmonary vascular remodeling characteristic of patients with chronic obstructive airways disease.
Tiihonen, J.; Hakola, P.; Paanila, J.; Turtiainen (Univ. of Kuopio (Finland). Dept. of Forensic Psychiatry)
Telomere and telomerase in chronic liver disease and hepatocarcinoma
The pathogenesis of liver cirrhosis is not completely elucidated. Although in the majority of patients, the risk factors may be identified in B and C viral hepatitis, alcohol intake, drugs or fatty liver disease, there is a small percentage of patients with no apparent risk factors. In addition, the evolution of chronic liver disease is highly heterogeneous from one patient to another. Among patient with identical risk factors, some rapidly progress to cirrhosis and hepatocellular carcinoma (HCC) whereas others have a benign course. Therefore, a genetic predisposition may contribute to the development of cirrhosis and HCC. Evidence supporting the role of genetic factors as a risk for cirrhosis has been accumulating during the past years. In addition to the results from epidemiological studies, polymorphisms studies and data on twins, the concept of telomere shortening as a genetic risk factor for chronic liver disease and HCC has been proposed. Here we review the literature on telomerase mutations, telomere shortening and liver disease including hepatocellular carcinoma.
Carulli, Lucia; Anzivino, Claudia
Chromium exhibits adverse effects at environmental relevant concentrations in chronic toxicity assay system of nematode Caenorhabditis elegans.
Here we investigated whether the assay system (10-d) in Caenorhabditis elegans can be used to evaluate chronic toxicity of chromium (Cr(VI)) at environmental relevant concentrations ranging from 5.2 ?g L(-1) to 260 ?g L(-1). The results indicated that lethality, locomotion behavior as revealed by head thrash, body bend, and forward turn, metabolism as revealed by pumping rate and mean defecation cycle length, intestinal autofluorescence, and ROS production were severely altered in Cr chronically exposed nematodes at environmental relevant concentrations. The most surprising observations were that head thrash, body bend, intestinal autofluorescence, and ROS production in 13 ?g L(-1) Cr exposed nematodes were significantly influenced. The observed adverse effects of Cr on survival, locomotion behavior, and metabolism were largely due to forming severe intestinal autofluorescence and ROS production. Therefore, our findings demonstrate the usefulness of chronic toxicity assay system in C. elegans in evaluating the chronic toxicity of toxicants at environmental relevant concentrations. PMID:22336735
Wu, Quili; Qu, Yangyang; Li, Xing; Wang, Dayong
Multiple Associations Between a Broad Spectrum of Autoimmune Diseases, Chronic Inflammatory Diseases and Cancer
Background Many recent studies suggest the immune system plays a significant role in the pathogenesis of autoimmune diseases, chronic inflammatory diseases, and cancer. Materials and Methods Literature published between 2001 and 2011 was reviewed for risk of cancer development in patients with autoimmune and chronic inflammatory diseases. Mode of risk assessment employed did not limit inclusion of studies. Autoimmune conditions developing after diagnosis of a pre-existing cancer were also considered. Results We report a pervasive, largely positive association between 23 autoimmune and inflammatory diseases and subsequent cancer development. We discuss associations for celiac disease, inflammatory bowel disease rheumatoid arthritis, systemic lupus erythematosus, and multiple sclerosis in detail. We also address the less frequently reported development of some autoimmune conditions within the course of some malignancies, such as vitiligo developing in the course of melanoma. Conclusion Evidence demonstrates that chronic inflammation and autoimmunity are associated with the development of malignancy. Additionally, patients with a primary malignancy may develop autoimmune like disease. These relationships imply a need for surveillance of patients on immunomodulatory therapies for potential secondary disease processes.
Thalamic Glutamatergic Afferents into the Rat Basolateral Amygdala Exhibit Increased Presynaptic Glutamate Function Following Withdrawal from Chronic Intermittent Ethanol
Amygdala glutamatergic neurotransmission regulates withdrawal induced anxiety-like behaviors following chronic ethanol exposure. The lateral/basolateral amygdala receives multiple glutamatergic projections that contribute to overall amygdala function. Our lab has previously shown that rat cortical (external capsule) afferents express postsynaptic alterations during chronic intermittent ethanol exposure and withdrawal. However, thalamic (internal capsule) afferents also provide crucial glutamatergic input during behavioral conditioning, and they have not been studied in the context of chronic drug exposure. We report here that these thalamic inputs express altered presynaptic function during withdrawal from chronic ethanol exposure. This is characterized by enhanced release probability, as exemplified by altered paired-pulse ratios and decreased failure rates of unitary events, and increased concentrations of synaptic glutamate. Quantal analysis further implicates a withdrawal-dependent enhancement of the readily-releasable pool of vesicles as a probable mechanism. These functional alterations are accompanied by increased expression of vesicle associated protein markers. These data demonstrate that chronic ethanol modulation of glutamate neurotransmission in the rat lateral/basolateral amygdala is afferent-specific. Further, presynaptic regulation of lateral/basolateral amygdala thalamic inputs by chronic ethanol may be a novel neurobiological mechanism contributing to the increased anxiety-like behaviors that characterize withdrawal.
Christian, Daniel T; Alexander, Nancy J; Diaz, Marvin R; McCool, Brian A
The Chronic Kidney Disease Model: A General Purpose Model of Disease Progression and Treatment
Background��Chronic kidney disease (CKD) is the focus of recent national policy efforts; however, decision makers must account for multiple\\u000a therapeutic options, comorbidities and complications. The objective of the Chronic Kidney Disease model is to provide guidance\\u000a to decision makers. We describe this model and give an example of how it can inform clinical and policy decisions.\\u000a \\u000a \\u000a \\u000a \\u000a Methods��Monte Carlo simulation of
Lori A Orlando; Eric J Belasco; Uptal D Patel; David B Matchar
Life values and mental health: A longitudinal study comparing chronically ill women to women without chronic disease.
We tested the hypothesis that among women who are chronically ill, a re-ordering of life values maintains mental health. A community-based prospective longitudinal study was conducted in which data were obtained from 601 women in 1986, when the women were with mean age 42 and again in 2003, when the women were with mean age 58. There was a significant change in life values as women aged with more change among women with chronic disease (n = 476) than those without chronic disease (n = 125). Increased valuation of intrinsic life values (health and love) and decreased valuation of extrinsic life values (power, fame and attractiveness) were associated with subsequent better mental health for women with chronic disease, but not for those without chronic disease. PMID:20205001
Chen, Henian; Kasen, Stephanie; Cohen, Patricia
[Diagnosis and management of chronic obstructive pulmonary disease].
Chronic obstructive pulmonary disease (COPD) is an increasing health problem and one of the leading causes of morbidity and mortality worldwide. Cigarette smoking remains the main risk factor. COPD is preventable, readily diagnosable and treatable disease. The appropriate and early use of spirometry for diagnosis is of importance. A comprehensive treatment plan for managing patients with COPD involves the use of pharmacological as well as nonpharmacologic interventions. Smoking cessation can substantially reduce the risk for the development or rate of progression of COPD. Bronchodilator therapy is a basis in symptomatic treatment. Inhaled steroids might reduce frequency and severity of exacerbation and can be effectively combined with long acting beta2 agonists. Pulmonary rehabilitation benefits most patients. Patients with hypoxemia suffering from more severe disease may require a long-term oxygen therapy. Surgical intervention may help a limited number of patients. PMID:15758585
Malakauskas, Kestutis; Sakalauskas, Raimundas
[Educational activities for people with chronic disease: grants for nursing].
This is an intervention study conducted in a Unidade B�sica de Sa�de (Basic Health Unit) in Colombo, Parana, Brazil from March to November 2009, with 35 carriers of chronic diseases aged between 18 and 60 years, and enrolled in the Hypertension and Diabetes Program. The objectives were to identify their knowledge about arterial hypertension and act through educational group activities. Data were collected though semistructured interviews and four group meetings, and the following categories emerged from the analysis: "Understanding of the disease" and "Ways of caring". It was found that users knew the disease, its risk factors and possible complications, and that educational activities favored the sharing of experiences,provided reflection and the possibility of treatment management. This is a strategy that should be used and promoted by nurses. PMID:23155577
Ulbrich, Elis Martins; Maftum, Mariluci Alves; Labronici, Liliana Maria; Mantovani, Maria de F�tima
Association between retinopathy and cardiovascular disease in patients with chronic kidney disease (from the Chronic Renal Insufficiency Cohort [CRIC] Study).
Patients with chronic kidney disease experience co-morbid illnesses, including cardiovascular disease (CVD) and retinopathy. The purpose of the present study was to assess the association between retinopathy and self-reported CVD in a subgroup of the participants in the Chronic Renal Insufficiency Cohort study. For this observational, ancillary investigation, 2,605 Chronic Renal Insufficiency Cohort participants were invited to participate in the present study, and nonmydriatic fundus photographs in both eyes were obtained for 1,936 subjects. The photographs were reviewed in a masked fashion at a central photograph reading center. The presence and severity of retinopathy (diabetic, hypertensive, or other) and vessel diameter caliber were assessed using standard protocols by trained graders who were masked to the information about the study participants. A history of self-reported CVD was obtained using a medical history questionnaire. Kidney function measurements and traditional and nontraditional risk factors for CVD were obtained from the Chronic Renal Insufficiency Cohort study. A greater severity of retinopathy was associated with a greater prevalence of any CVD, and this association persisted after adjustment for the traditional risk factors for CVD. The presence of vascular abnormalities usually associated with hypertension was also associated with increased prevalence of CVD. We found a direct relation between CVD prevalence and mean venular caliber. In conclusion, the presence of retinopathy was associated with CVD, suggesting that retinovascular pathology might indicate macrovascular disease, even after adjustment for renal dysfunction and traditional CVD risk factors. This would make the assessment of retinal morphology a valuable tool in CKD studies of CVD outcomes. PMID:22516527
Grunwald, Juan E; Ying, Gui-Shuang; Maguire, Maureen; Pistilli, Maxwell; Daniel, Ebenezer; Alexander, Judith; Whittock-Martin, Revell; Parker, Candace; Mohler, Emile; Lo, Joan Chia-Mei; Townsend, Raymond; Gadegbeku, Crystal Ann; Lash, James Phillip; Fink, Jeffrey Craig; Rahman, Mahboob; Feldman, Harold; Kusek, John Walter; Xie, Dawei; Coleman, Martha; Keane, Martin Gerard
Hepatic inflammation and progressive liver fibrosis in chronic liver disease
Chronic liver inflammation drives hepatic fibrosis, and current immunosuppressive, anti-inflammatory, and anti-viral therapies can weaken this driver. Hepatic fibrosis is reversed, stabilized, or prevented in 57%-79% of patients by conventional treatment regimens, mainly by their anti-inflammatory actions. Responses, however, are commonly incomplete and inconsistently achieved. The fibrotic mechanisms associated with liver inflammation have been clarified, and anti-fibrotic agents promise to improve outcomes as adjunctive therapies. Hepatitis C virus and immune-mediated responses can activate hepatic stellate cells by increasing oxidative stress within hepatocytes. Angiotensin can be synthesized by activated hepatic stellate cells and promote the production of reactive oxygen species. Anti-oxidants (N-acetylcysteine, S-adenosyl-L-methionine, and vitamin E) and angiotensin inhibitors (losartin) have had anti-fibrotic actions in preliminary human studies, and they may emerge as supplemental therapies. Anti-fibrotic agents presage a new era of supplemental treatment for chronic liver disease.
Czaja, Albert J
The definition, classification, and prognosis of chronic kidney disease: a KDIGO Controversies Conference report
The definition and classification for chronic kidney disease was proposed by the National Kidney Foundation Kidney Disease Outcomes Quality Initiative (NKF-KDOQI) in 2002 and endorsed by the Kidney Disease: Improving Global Outcomes (KDIGO) in 2004. This framework promoted increased attention to chronic kidney disease in clinical practice, research and public health, but has also generated debate. It was the position
Andrew S Levey; Paul E de Jong; Josef Coresh; Meguid El Nahas; Brad C Astor; Kunihiro Matsushita; Ron T Gansevoort; Bertram L Kasiske; Kai-Uwe Eckardt
Gene Expression Profiling in Patients with Chronic Obstructive Pulmonary Disease and Lung Cancer
Rationale: Chronic obstructive lung disease (COPD) is a common and disabling lung disease for which there are few therapeutic options. Objectives: We reasoned that gene expression profiling of COPD lungs could reveal previously unidentified disease pathways. Methods: Forty-eight human lung samples were obtained from tis- sue resected from five nonsmokers, 21 GOLD (Global Initiative for Chronic Obstructive Lung Disease) stage
I-Ming Wang; Sergey Stepaniants; Yves Boie; James R. Mortimer; Brian Kennedy; Mark Elliott; Shizu Hayashi; Leanna Loy; Silvija Coulter; Sandra Cervino; Jennifer Harris; Michele Thornton; Richard Raubertas; Chris Roberts; Jim C. Hogg; Michael Crackower; Gary O'Neill; Peter D. Pare
Selenium, glutathione and glutathione peroxidases in blood of patients with chronic liver diseases
Disturbances in the antioxidant system could play a role in pathogenesis of chronic liver disease. The aim of our study was to evaluat