International Journal of Chronic Diseases The latest articles from Hindawi Publishing Corporation © 2016 , Hindawi Publishing Corporation . All rights reserved. Screening for Nephropathy in Diabetes Mellitus: Is Micral-Test Valid among All Diabetics? Wed, 18 May 2016 11:48:44 +0000 Background. Using Micral-test (MT) for screening microalbuminuria (MA) among type 2 diabetics (T2D) is helpful. We aimed at determining prevalence of MA and at describing the MT validity. Methods. We studied 182 T2D followed up in family medicine. Two 24-hour urinary quantitative assays of MA had been used as a gold standard. Results. Prevalence of MA was 23%, CI 95%: 16.9–29.1. MT validity was 77% for sensitivity, 88% for negative predictive value, and 0.2 for Kappa coefficient (). Among subjects having a blood pressure ≥130/80 mmHg, having a CHT/HDL ratio ≥ 3, being a T2D for more than 5 years, and being women, negative predictive values were, respectively, 91%, 89%, 95%, and 91%. The area under the ROC curve was 0.81 in men () and 0.80 when diabetes duration exceeds 5 years (). The MA value at 100% Sp for MT was 35 mg/L. Conclusion. The use of MT in primary healthcare for yearly screening for MA in T2D must be accentuated especially when diabetes duration exceeds 5 years or when associated with other cardiovascular risks. Koubaa Afifa, Sriha Belguith Asma, Harzallah Nabil, Bellaleh Ahlem, Sahtout Mounira, Younes Kawthar, Triki Sonia, Hellara Ilhem, Neffati Fadoua, Najjar Fadhel, and Soltani Mohamed Copyright © 2016 Koubaa Afifa et al. All rights reserved. Evolution of Experience of Care of Patients with and without Chronic Diseases following a Québec Primary Healthcare Reform Thu, 07 Apr 2016 07:58:07 +0000 Objectives. To assess the extent to which new primary healthcare (PHC) models implemented in two regions of Quebec have improved patient experience of care, unmet needs, and use of services for individuals with and without chronic diseases, compared with other forms of PHC practices. Methods. In 2005 and 2010, we carried out population and organization surveys. We divided PHC organizations into new model practices and other practices and followed the evolution over time of patient experience of care. Results. Patients with chronic diseases had better accessibility but worse continuity of care in the new model practices than in the other practices at both time periods. Through the reform, accessibility decreased evenly in both groups, but continuity and perceived outcomes improved more in the other practices. Use of primary care services decreased more in the new model practices. Among patients without chronic disease, accessibility decreased much less in the new models and responsiveness increased more. There was no significant change in ER attendance and hospitalization. Conclusion. The evolution of patient experience of care has been more favorable for patients without chronic diseases. These findings raise concerns about equity since the aim of the PHC reform was targeting in priority individuals with the greatest needs. Raynald Pineault, Roxane Borgès Da Silva, Sylvie Provost, Mylaine Breton, Pierre Tousignant, Michel Fournier, Alexandre Prud’homme, and Jean-Frédéric Levesque Copyright © 2016 Raynald Pineault et al. All rights reserved. Corrigendum to “A Systematic Review of Peripheral and Central Nervous System Involvement of Rheumatoid Arthritis, Systemic Lupus Erythematosus, Primary Sjögren’s Syndrome, and Associated Immunological Profiles” Thu, 07 Apr 2016 06:40:15 +0000 Anastasia Bougea, Evangelos Anagnostou, Konstantinos Giatas, George Paraskevas, Nikolaos Triantafyllou, and Evangelia Kararizou Copyright © 2016 Anastasia Bougea et al. All rights reserved. An Innovative Approach to Evaluate the Morphological Patterns of Soft Palate in Oral Submucous Fibrosis Patients: A Digital Cephalometric Study Sun, 13 Mar 2016 13:24:57 +0000 Oral submucous fibrosis (OSMF) is a chronic insidious disease affecting mucosa and submucosa of oral cavity and soft palate. The present study aimed to evaluate the morphology of soft palate in normal individuals and OSMF patients using lateral cephalometry and to compare and correlate these variants of soft palate with different stages of OSMF. 100 subjects were included in the study, who were divided into two groups. Group I included 50 subjects with clinical diagnosis of OSMF and Group II included 50 normal subjects (control group). Using digital lateral cephalometry, velar length and width were measured and soft palatal patterns were categorized based on You et al.’s classification. Leaf and rat-tail patterns of soft palate were predominant in control group, whereas butt and crook shaped variants were more in study group. Anteroposterior (A-P) length of soft palate was significantly greater in stage I OSMF, while superoinferior (S-I) width was greater in stage III OSMF. Interestingly, a negative correlation was observed in staging of OSMF and A-P dimensions. As the staging of OSMF advances, the A-P length of soft palate decreases, but S-I width increases. Chintamaneni Raja Lakshmi, Dharmavaram Ayesha Thabusum, and Sujana Mulk Bhavana Copyright © 2016 Chintamaneni Raja Lakshmi et al. All rights reserved. Age and Sex Specific Reference Intervals for Modifiable Risk Factors of Cardiovascular Diseases for Gujarati Asian Indians Mon, 28 Dec 2015 13:14:35 +0000 Objective. We aimed to establish age and sex specific percentile reference data for cardiovascular risk factors such as lipids, sugar, blood pressure, and BMI in apparently healthy and disease-free Gujarati population. Methods. In this cross-sectional study, we enrolled 3265 apparently healthy and disease-free individuals of both genders residing in Gujarat state. Fasting samples of blood were used for biochemical estimations of lipids and sugar. The measurement of BMI and blood pressure was also done according to the standard guidelines. Age and gender specific 5th, 25th, 50th, 75th, 90th, and 95th percentiles were obtained. Results. The mean values of lipids, sugar, blood pressure, and BMI were significantly () higher in males as compared to female population. Age-wise distribution trends showed increase in the risk factors from the 2nd decade until the 5th to 6th decade in most of the cases, where loss of premenopausal protection in females was also observed. Specific trends according to gender and age were observed in percentile values of various parameters. Conclusion. The outcome of current study will contribute significantly to proposing clinically important reference values of various lipids, sugar, blood pressure, and BMI that could be used to screen the asymptomatic Gujarati Indian population with a propensity of developing dyslipidemia, diabetes, blood pressure, and obesity. Sibasis Sahoo, Komal H. Shah, Ashwati R. Konat, Kamal H. Sharma, and Payal Tripathi Copyright © 2015 Sibasis Sahoo et al. All rights reserved. Exploring the Unmet Needs of the Patients in the Outpatient Respiratory Medical Clinic: Patients versus Clinicians Perspectives Wed, 09 Dec 2015 06:08:22 +0000 Aim. Developing a theoretical framework explaining patients’ behaviour and actions related to unmet needs during interactions with health care professionals in hospital-based outpatient respiratory medical clinics. Background. The outpatient respiratory medical clinic plays a prominent role in many patients’ lives regarding treatment and counselling increasing the need for a better understanding of patients’ perspective to the counselling of the health care professionals. Design. The study is exploratory and based on Charmaz’s interpretation of grounded theory. Methods. The study included 65 field observations with a sample of 43 patients, 11 doctors, and 11 nurses, as well as 30 interviews with patients, conducted through theoretical sampling from three outpatient respiratory medical clinics in Denmark. Findings. The patients’ efforts to share their significant stories triggered predominantly an adaptation or resistance behaviour, conceptualized as “fitting in” and “fighting back” behaviour, explaining the patients’ counterreactions to unrecognized needs during the medical encounter. Conclusion. Firstly this study allows for a better understanding of patients’ counterreactions in the time-pressured and, simultaneously, tight structured guidance program in the outpatient clinic. Secondly the study offers practical and ethical implications as to how health care professionals’ attitudes towards patients can increase their ability to support emotional suffering and increase patient participation and responsiveness to guidance in the lifestyle changes. Lone Birgitte Skov Jensen, Ulf Brinkjær, Kristian Larsen, and Hanne Konradsen Copyright © 2015 Lone Birgitte Skov Jensen et al. All rights reserved. Burden of Self-Reported Noncommunicable Diseases in 26 Villages of Anand District of Gujarat, India Mon, 30 Nov 2015 07:34:27 +0000 Introduction. Noncommunicable diseases (NCDs) account for 53% of deaths and 44% of disability adjusted life years lost in India. A survey was undertaken to measure the prevalence of tobacco and alcohol use and self-reported NCDs in a rural community in western part of India. Methodology. Trained Village Health Workers did the survey in the years 2012-13 under supervision. The data was collected for five NCDs, namely, hypertension, diabetes mellitus, cancer, heart disease, and mental illnesses. Results. 18,269 households with a population of 89755 were covered. Prevalence of any form of tobacco use in the age group of >20 years was 34.5 and 52.7% and 15.2% in males and females, respectively. Prevalence of any NCD was 5.3% with a slightly higher prevalence in females (5.4%) than males (5.2%) in the age group of 20–69 years. Prevalence of NCD multimorbidity (≥2 NCDs) was 0.7% in the age group of 20–69 years. 80.7% of hypertensives and 94.9% of diabetics were taking treatment. More females than males were taking antihypertensive treatment. Conclusion. Tobacco use was high. Prevalence of NCDs was less than that reported in other studies. Data generated from this study can be useful in planning a community based NCD programme. Dinesh Kumar, Shyamsundar J. Raithatha, Shanti Gupta, Ravi Raj, and Nikhil Kharod Copyright © 2015 Dinesh Kumar et al. All rights reserved. A Systematic Review of Peripheral and Central Nervous System Involvement of Rheumatoid Arthritis, Systemic Lupus Erythematosus, Primary Sjögren’s Syndrome, and Associated Immunological Profiles Wed, 25 Nov 2015 09:19:16 +0000 Both central (CNS) and peripheral nervous system (PNS) complications are frequent and varied in connective tissue diseases. A systematic review was conducted between 1989 and 2014 in the databases Medline, Scopus, and Cochrane Library using the search terms, peripheral and central nervous complications and immunological profiles, to identify studies in specific connective tissue disorders such as rheumatoid arthritis, systemic lupus erythematosus, and primary Sjögren’s syndrome. A total of 675 references were identified, of which 118 were selected for detailed analysis and 22 were included in the final review with a total of 2338 participants. Our search focused only on studies upon connective tissue disorders such as rheumatoid arthritis, systemic lupus erythematosus, and primary Sjögren’s syndrome associated with seroimmunological data. The reported prevalence of CNS involvement ranges from 9 to 92% across the reported studies. However, the association between CNS and PNS manifestations and seroimmunological profiles remains controversial. Τo date, no laboratory test has been shown as pathognomonic neither for CNS nor for PNS involvement. Anastasia Bougea, Evangelos Anagnostou, Giatas Konstantinos, Paraskevas George, Nikolaos Triantafyllou, and Evangelia Kararizou Copyright © 2015 Anastasia Bougea et al. All rights reserved. Genetic Evaluation of E. coli Strains Isolated from Asymptomatic Children with Neurogenic Bladders Sun, 01 Nov 2015 09:00:20 +0000 This study was conducted to describe the genetic profiles of E. coli that colonize asymptomatic pediatric neurogenic bladders. E. coli was isolated from 25 of 80 urine samples. Patients were excluded if they presented with symptomatic urinary tract infection or received treatment with antibiotics in the preceding three months. Multiplex PCR was performed to determine E. coli phylotype (A, B1, B2, and D) and the presence of seven pathogenicity islands (PAIs) and 10 virulence factors (VFs). E. coli strains were predominantly of the B1 and B2 phylotype, with few strains in the A or D phylotype. The PAIs IV536, , and had the highest prevalence: 76%, 64%, and 48%, respectively. The PAIs II536, , and were less prevalent: 28%, 20%, and 24%, respectively. The most prevalent VF was vat (40%), while the least prevalent VFs were sfa (8%) and iha (12%). None of the strains carried the VF fyuA, which is very common in uropathogenic E. coli (UPEC). The genetic profiles of E. coli in this cohort seem to be more similar to UPEC than to commensal E. coli. However, they appear to have reduced virulence potential that allows them to colonize asymptomatically. John Kryger, Alexandra Burleigh, Melissa Christensen, and Walter Hopkins Copyright © 2015 John Kryger et al. All rights reserved. Uric Acid Levels in Normotensive Children of Hypertensive Parents Mon, 24 Aug 2015 07:35:41 +0000 This study evaluated uric acid concentrations in normotensive children of parents with hypertension. Eighty normotensive children from families with and without a history of essential hypertension were included. Concentrations of lipid parameters and uric acid were compared. Demographic and anthropometric characteristics were similar in the groups. Systolic and diastolic blood pressure were higher in the normotensive children of parents with hypertension without statistically significant difference (). Uric acid concentrations were higher in the normotensive children of parents with hypertension (4.61 versus 3.57 mg/dL, ). Total cholesterol and triglyceride concentrations were similar in the two groups. Systolic and diastolic blood pressure were significantly higher in control children aged >10 years (). Uric acid levels were significantly higher in all children with more pronounced difference after age 10 of years (). Positive correlations were found between the level of serum uric acid and age, body weight, body mass index, and systolic and diastolic blood pressure in the normotensive children of parents. The higher uric acid levels in the normotensive children of hypertensive parents suggest that uric acid may be a predeterminant of hypertension. Monitoring of uric acid levels in these children may allow for prevention or earlier treatment of future hypertension. Ali Yildirim, Fatma Keles, Pelin Kosger, Gokmen Ozdemir, Birsen Ucar, and Zubeyir Kilic Copyright © 2015 Ali Yildirim et al. All rights reserved. Female Sex Hormones Pattern and Its Relation to Disease Severity and Treatment in Pre- and Postmenopausal Patients with Chronic Hepatitis C Virus (Genotype 4) Infection Mon, 17 Aug 2015 12:17:27 +0000 Chronic hepatitis C (CHC) course revealed differences between men and women. Male gender and postmenopausal women are thought to be of the critical factors affecting HCV infection progression. The study aimed to assess female sex hormones and their relation to disease severity and treatment in HCV infected females. Subjects were divided to 2 groups: 44 CHC female patients and 44 controls. Both groups were classified to premenopausal and postmenopausal females. Serum estradiol (E2), progesterone (PRG), and total testosterone (TT) were assessed using chemiluminescent immunoassay. Our results showed that menopausal patients had significantly higher levels of estradiol, total testosterone, and progesterone compared to controls (). Reproductive aged patients had lower level of total testosterone compared to menopausal patients (). HCV infected females of reproductive age had higher level of progesterone compared to menopausal HCV infected females (). Indicators of disease severity and treatment response were significantly worse in menopausal women compared to reproductive aged women (fibrosis: , activity: , and treatment: ). We observed that lower estradiol level may be related to fibrosis severity in CHC females. Higher total testosterone and progesterone levels may be related to fibrosis severity and poor response to treatment in CHC menopausal females only. Nora H. Ahmed, Taghrid B. El-Abaseri, Hesham F. El-Sayed, and Taher I. El-Serafi Copyright © 2015 Nora H. Ahmed et al. All rights reserved. Does Intensive Glucose Control Prevent Cognitive Decline in Diabetes? A Meta-Analysis Tue, 04 Aug 2015 13:08:24 +0000 Diabetes mellitus is associated with cognitive decline and impaired performance in cognitive function tests among type 1 and type 2 diabetics. Even though the use of tight glucose control has been limited by a reported higher mortality, few reports have assessed the impact of treatment intensity on cognitive function. We conducted a meta-analysis to evaluate if an intensive glucose control in diabetes improves cognitive function, in comparison to standard therapy. We included 7 studies that included type 1 or type 2 diabetics and used standardized tests to evaluate various cognitive function domains. Standardized mean differences (SMDs) were calculated for each domain. We found that type 1 diabetics get no cognitive benefit from a tight glucose control, whereas type 2 diabetics get some benefit on processing speed and executive domains but had worse performances in the memory and attention domains, along with a higher incidence of mortality when using intensive glucose control regimes. Carlos Peñaherrera-Oviedo, Daniel Moreno-Zambrano, Michael Palacios, María Carolina Duarte-Martinez, Carlos Cevallos, Ximena Gamboa, María Beatriz Jurado, Leonardo Tamariz, Ana Palacio, and Rocío Santibañez Copyright © 2015 Carlos Peñaherrera-Oviedo et al. All rights reserved. Prevalence and Predictors of Metabolic Syndrome in Young Asymptomatic Gujarati Population Thu, 30 Jul 2015 13:32:04 +0000 Background. Metabolic syndrome is a cluster of risk factors leading to the development of atherosclerotic cardiovascular diseases. We aimed to evaluate the prevalence of metabolic syndrome (MS) and its predictors in young and apparently healthy Gujarati individuals. Methods. This population based cross-sectional study involved a total of 1500 healthy adults of 20–40 years of age. Demographic details and clinical data such as body mass index (BMI), waist circumference (WC), and blood pressure were measured along with the estimations of lipoprotein (a), total cholesterol (TC), triglyceride (TG), total lipid, LDL/HDL ratio, TC/HDL ratio, and fasting blood glucose (FBS). Results. Overall in young Gujarati population (20–40 years) prevalence rates of MS were 16.0% (male: 21.5%; female: 10.8%) where the metabolic abnormalities increased with advanced age as 9.56% of the young population (20–30 years) had MS, in contrast to the 24.57% in the old (31–40 years). Odds ratio analysis had indicated BMI (1.120; 95% CI: 1.077–1.163; ) as the strongest risk factor for MS closely followed by advancing age (1.100; 95% CI: 1.061–1.139; ) levels. Conclusion. Prevalence of metabolic syndrome in young Gujarati population reinforces the need for early life style intervention and awareness programs in this ethnic group. Sharad R. Jain, Komal H. Shah, Himanshu N. Acharya, Kaushik Barot, and Kamal H. Sharma Copyright © 2015 Sharad R. Jain et al. All rights reserved. Mean Platelet Volume and Splenomegaly as Useful Markers of Subclinical Activity in Egyptian Children with Familial Mediterranean Fever: A Cross-Sectional Study Mon, 13 Jul 2015 05:56:21 +0000 Objective. To study whether mean platelet volume (MPV) and splenomegaly could be used as subclinical inflammatory markers in children with familial Mediterranean fever (FMF) at the attack-free period. Patients and Methods. The study included ninety-seven children with FMF. MPV was carried out within 4 hours of blood sampling according to standard laboratory practice. Splenomegaly was determined by abdominal ultrasound (USG). Results. High MPV was detected in 84.45% of our studied patients and was significantly higher in FMF patients with splenomegaly than in patients without splenomegaly. There was a statistically significant correlation between MPV and splenic span (). Conclusion. Elevated MPV and its significant correlation with splenic span in FMF children during the attack-free periods support the use of MPV and splenomegaly as useful markers of the subclinical inflammation in FMF patients at the attack-free period. Huda Marzouk, Hala M. Lotfy, Yomna Farag, L. A. Rashed, and Kamal El-Garf Copyright © 2015 Huda Marzouk et al. All rights reserved. Untreated Isolated Sytolic Hypertension among Middle-Aged and Old Adults in the United States: Trends in the Prevalence by Demographic Factors During 1999–2010 Mon, 23 Feb 2015 12:28:07 +0000 Isolated systolic hypertension (ISH) predominates hemodynamic hypertension subtypes and becomes a significant factor for cardiovascular and renal outcomes in middle-aged and old adults. The prevalence and changes of untreated ISH have not been fully investigated in this population. A total of 12,097 participants aged ≥40 years were selected from the National Health and Nutrition Examination Survey 1999–2010. The overall prevalence of untreated ISH was 15.2%. The prevalence decreased significantly from 16.8% in 1999–2004 to 13.5% in 2005–2010. Females, non-Hispanic blacks, and adults with low education had higher prevalence of untreated ISH than males, non-Hispanic whites, and adults with high education, respectively. Compared with 1999–2004, the prevalence of untreated ISH in 2005–2010 reduced in old adults (28.0% versus 37.7%), females (14.3% versus 19.5%), and non-Hispanic whites (12.7% versus 16.2%). The stratified prevalence of untreated ISH decreased in 2005–2010 in non-Hispanic white females (12.8% versus 18.6%) and females who did not attend college (16.9% versus 21.8%). Untreated ISH is more prevalent in old and female subjects, and significant improvements in these groups suggest that public health measures or changes are in the right direction. Xuefeng Liu, Van Minh Hoang, Yali Liu, and Rachel L.W. Brown Copyright © 2015 Xuefeng Liu et al. All rights reserved. Reduced Risk of Parkinson’s Disease in Users of Calcium Channel Blockers: A Meta-Analysis Tue, 03 Feb 2015 07:28:29 +0000 Aim. To pool the data currently available to determine the association between calcium channel blockers (CCBs) and risk of Parkinson’s disease (PD). Methods. Literature search in PubMed, EBSCO, and Cochrane library was undertaken through March 2014, looking for observational studies evaluating the association between CCBs use and PD. Pooled relative risk (RR) estimates and 95% confidence intervals (CIs) were calculated using random-effects model. Subgroup analyses, sensitivity Analysis, and cumulative meta-analysis were also performed. Results. Six studies were included in our meta-analysis according to the selection criteria, including three cohort studies and three case-control studies involving 27,67,990 subjects including 11,941 PD cases. We found CCBs use was associated with significant decreased risk of PD, compared with not using CCBs (random effects model pooled RR, 0.81 (95% CI, 0.69–0.95)); a significant heterogeneity was found between studies (; 54.6%). Both the classes of CCB, that is, dihydropyridine calcium channel blockers (DiCCB) (0.80 (95% CI, 0.65–0.98) ) and non-DiCCB (0.70 (95% CI, 0.53–0.92) ), were found to be reducing the risk of PD. Conclusion. In our analysis, we found that CCBs use was associated with a Significantly decreased risk of PD compared with non-CCB use. Kapil Gudala, Raju Kanukula, and Dipika Bansal Copyright © 2015 Kapil Gudala et al. All rights reserved. Relationship between Helicobacter pylori Infections in Diabetic Patients and Inflammations, Metabolic Syndrome, and Complications Thu, 22 Jan 2015 14:27:35 +0000 Helicobacter pylori infection and diabetes mellitus are two independent common diseases. It is showed that the worsening glycemic and metabolic control increases the rates of Helicobacter pylori infections and Helicobacter pylori is shown as one of the common problems in diabetic patients with complaints of gastrointestinal diseases. In this study, we aimed to investigate the prevalence and eradication rates of Helicobacter pylori in diabetic patients and the relationship of Helicobacter pylori with the risk factors and diabetic complications. In our study, in which we have included 133 patients, we have shown a significant relationship between Helicobacter pylori infections and metabolic syndrome, insulin resistance, inflammations, and diabetic complications. Yusuf Kayar, Özgül Pamukçu, Hatice Eroğlu, Kübra Kalkan Erol, Aysegul Ilhan, and Orhan Kocaman Copyright © 2015 Yusuf Kayar et al. All rights reserved. Association of Socioeconomic Position and Demographic Characteristics with Cardiovascular Disease Risk Factors and Healthcare Access among Adults Living in Pohnpei, Federated States of Micronesia Tue, 23 Dec 2014 00:10:01 +0000 Background. The burden of cardiovascular disease (CVD) is increasing in low-to-middle income countries. We examined how socioeconomic and demographic characteristics may be associated with CVD risk factors and healthcare access in such countries. Methods. We extracted data from the World Health Organization’s STEPwise approach to surveillance 2002 cross-sectional dataset from Pohnpei, Federated States of Micronesia (FSM). We used these data to estimate associations for socioeconomic position (education, income, and employment) and demographics (age, sex, and urban/rural) with CVD risk factors and with healthcare access, among a sample of 1638 adults (25–64 years). Results. In general, we found significantly higher proportions of daily tobacco use among men than women and respondents reporting primary-level education (<9 years) than among those with postsecondary education (>12 years). Results also revealed significant positive associations between paid employment and waist circumference and systolic blood pressure. Healthcare access did not differ significantly by socioeconomic position. Women reported significantly higher mean waist circumference than men. Conclusion. Our results suggest that socioeconomic position and demographic characteristics impact CVD risk factors and healthcare access in FSM. This understanding may help decision-makers tailor population-level policies and programs. The 2002 Pohnpei data provides a baseline; subsequent population health surveillance data might define trends. G. M. Hosey, M. Samo, E. W. Gregg, L. Barker, D. Padden, and S. G. Bibb Copyright © 2014 G. M. Hosey et al. All rights reserved. Microvascular Complications and Their Associated Risk Factors in Newly Diagnosed Type 2 Diabetes Mellitus Patients Sun, 30 Nov 2014 07:20:04 +0000 The study was aimed at assessing the prevalence of microvascular complications and associated risk factors in newly diagnosed type 2 diabetes mellitus patients. A cross-sectional study was conducted in a public tertiary care hospital. All the recruited patients underwent extensive examination for the presence of microvascular complications like neuropathy, retinopathy, and nephropathy. Prevalence of any complication was 18.04%. Prevalence of neuropathy, retinopathy, and nephropathy was found to be 8.2%, 9.5%, and 2.8%, respectively. Triglycerides (OR, 1.01; ) and old age (OR, 1.06; ) were significantly associated with any complication. Triglycerides were significantly associated with neuropathy (OR, 1.01; ) and retinopathy (OR, 1.01; ). Being male posed high risk for nephropathy (OR, 0.06; ). These results are suggesting need of regular screening for microvascular complications. Dipika Bansal, Kapil Gudala, Hari Prasad Esam, Ramya Nayakallu, Raja Vikram Vyamusani, and Anil Bhansali Copyright © 2014 Dipika Bansal et al. All rights reserved. The Lived Experience of Lupus Flares: Features, Triggers, and Management in an Australian Female Cohort Sun, 23 Nov 2014 00:00:00 +0000 Individuals living with lupus commonly experience daily backgrounds of symptoms managed to acceptable tolerance levels to prevent organ damage. Despite management, exacerbation periods (flares) still occur. Varied clinical presentations and unpredictable symptom exacerbation patterns provide management and assessment challenges. Patient perceptions of symptoms vary with perceived impact, lifestyles, available support, and self-management capacity. Therefore, to increase our understanding of lupus’ health impacts and management, it was important to explore lupus flare characteristics from the patient viewpoint. Lupus flares in 101 Australian female patients were retrospectively explored with the use of a novel flare definition. Qualitative methods were used to explore patient-perceived flare symptoms, triggers, and management strategies adopted to alleviate symptom exacerbations. A mean of 29.9 flare days, with 6.8 discrete flares, was experienced. The study confirmed that patients perceive stress, infection, and UV light as flare triggers and identified new potential triggers of temperature and weather changes, work, and chemical exposure from home cleaning. The majority of flares were self-managed with patients making considered management choices without medical input. Barriers to seeking medical support included appointment timings and past negative experiences reflecting incongruence between clinician and patient views of symptom impact, assessment, and ultimately flare occurrence. Marline L. Squance, Glenn E. M. Reeves, and Howard Bridgman Copyright © 2014 Marline L. Squance et al. All rights reserved. The Influence of Insulin Dependent Diabetes Mellitus on Dental Caries and Salivary Flow Tue, 14 Oct 2014 07:44:47 +0000 Objective. To assess whether or not there was any change in the dental caries and rate of salivary flow of patients with Insulin Dependent Diabetes Mellitus (IDDM) and the contribution of salivary flow to caries risk in IDDM. Setting. Department of Endocrinology, MS Ramaiah Hospital, Bangalore, India. Design. A comparative cross-sectional descriptive type. Materials and Methods. The sample consisted of two groups: 140 diabetic group (mean age 14.8 yr) and 140 nondiabetic group (mean age 13.7 yr). Dental caries by dmf(t) and dmf(s) indices for primary dentition and DMF(T) and DMF(S) indices was used in permanent dentition to assess the dental caries experience. Both stimulated and unstimulated salivary flow rate were assessed after collection of saliva. Results. In diabetic group 76% had carious lesion and in nondiabetic group 85.3% had carious lesion. Diabetics have lower mean DMFT, DMFS, dmft, and dmfs compared to the nondiabetic group. Diminished unstimulated and stimulated salivary flow rate in diabetic than nondiabetic group. Conclusions. The findings obtained conclude that even though there was reduced salivary flow rate in diabetic group the caries prevalence was low. V. K. Gupta, Seema Malhotra, Vasuda Sharma, and S. S. Hiremath Copyright © 2014 V. K. Gupta et al. All rights reserved. Association between Dietary Patterns and Chronic Diseases among Chinese Adults in Baoji Mon, 22 Sep 2014 00:00:00 +0000 Objective. This study was aimed to identify the dietary patterns among Chinese adults in Baoji and explore the association between these dietary patterns and chronic diseases. Methods. With multistage stratified random sampling and semiquantitative food frequency questionnaire, the prevalence of chronic disease and dietary intake was investigated in 2013. We used factor analysis to establish dietary patterns. Results. A total of 5020 participants over 15 years old were included in this study. Five dietary patterns were identified in Baoji named as protein, balanced, beans, prudent, and traditional patterns. There are many protective effects with protein, balanced, and beans dietary patterns on chronic diseases. Conclusions. We should encourage Baoji city residents to choose protein, balanced, and beans dietary patterns and abandon prudent and traditional patterns. Honglin Wang, Feng Deng, Meng Qu, Peirong Yang, and Biao Yang Copyright © 2014 Honglin Wang et al. All rights reserved. Evaluation of Rhubarb Supplementation in Stages 3 and 4 of Chronic Kidney Disease: A Randomized Clinical Trial Thu, 11 Sep 2014 06:29:22 +0000 Objective. To evaluate the efficacy and safety of Rhubarb supplementation in patients of chronic kidney disease. Material and Methods. This study was a prospective comparative study conducted in patients of chronic kidney disease (stages 3 & 4) attending Renal Clinic of Department of Medicine, JN Medical College & Hospital, AMU, Aligarh. Patients were randomly divided into two interventional groups. Group I (Control) was given conservative management while Group II (Rhubarb) received conservative management along with Rhubarb capsule (350 mg, thrice daily) for 12 weeks. Haemogram and renal function tests were measured at 0, 4, 8, and 12 weeks of treatment. Results. There was progressive improvement in clinical features in both the groups after 12 weeks of treatment but Rhubarb group showed more marked improvement as compared to control group. Both groups showed gradual improvement in the biochemical parameters as compared to their pretreated values which was more marked in Rhubarb supplemented group. There was reduction in blood glucose, blood urea, serum creatinine, and 24 hour total urine protein (TUP). There was increase in haemoglobin, 24 hour total urine volume (TUV), and glomerular filtration rate (GFR). There was no statistical difference in two groups with respect to side effects . Conclusion. Rhubarb supplementation improved the therapeutic effect of conservative management in stage 3 and stage 4 patients of chronic kidney disease. Irfan A. Khan, Mohammad Nasiruddin, Shahzad F. Haque, and Rahat A. Khan Copyright © 2014 Irfan A. Khan et al. All rights reserved. Hypertensive Crisis, Burden, Management, and Outcome at a Tertiary Care Center in Karachi Mon, 18 Aug 2014 06:28:11 +0000 Objectives. Hypertension, if uncontrolled, can lead to hypertensive crisis. We aim to determine the prevalence of hypertensive crisis, its management, and outcome in patients presenting to a tertiary care center in Karachi. Methods. This was a cross-sectional study conducted at the Aga Khan University, Karachi, Pakistan. Adult inpatients (>18 yrs) presenting to the ER who were known hypertensive and had uncontrolled hypertension were included. Results. Out of 1336 patients, 28.6% (387) had uncontrolled hypertension. The prevalence of hypertensive crisis among uncontrolled hypertensive was 56.3% (218). Per oral calcium channel blocker; 35.4% (137) and intravenous nitrate; 22.7% (88) were the most commonly administered medication in the ER. The mean (SD) drop in SBP in patients with hypertensive crisis on intravenous treatment was 53.1 (29) mm Hg and on per oral treatment was 43 (27) mm Hg. The maximum mean (SD) drop in blood pressure was seen by intravenous sodium nitroprusside; 80 (51) mm Hg in SBP. Acute renal failure was the most common complication with a prevalence of 11.5% (24). Conclusion. The prevalence of hypertensive crisis is high. Per oral calcium channel blocker and intravenous nitrate are the most commonly administered medications in our setup. Aysha Almas, Ayaz Ghouse, Ahmed Raza Iftikhar, and Munawwar Khursheed Copyright © 2014 Aysha Almas et al. All rights reserved. Prevalence of Diabetes Mellitus and Its Risk Factors among Permanently Settled Tribal Individuals in Tribal and Urban Areas in Northern State of Sub-Himalayan Region of India Tue, 06 May 2014 11:36:56 +0000 Background. Effect of urban environment on the development of DM and its risk factors is studied with an ecological fallacy due to their study designs that formulate the background for the present study. Objective. To study the prevalence of DM and associated lifestyle related risk factors in traditional tribal individuals residing in tribal area and migrating persons of the same tribe to urban area of sub-Himalayan northern state of India. Methodology. Population based cross-sectional study. Results. A total of 8000 individuals (tribal: 4000; urban: 4000) were recruited. Overall, among urban tribes the prevalence of central obesity (59.0%), overweight (29.3%), stage 1 (22.8%) and stage 2 (5.3%) hypertension, and DM (fasting: 7.8%; OGTT: 8.5%) was significantly higher than the tribes of tribal area. Based on OGTT, the prevalence of DM was found to be 9.2% among central obese tribes of urban area and 6.7% of tribal area . DM showed a significant high prevalence among urban tribes with prehypertension (urban: 8.3%; tribal: 2.9%; ), and stage 1 (urban: 14.1%; tribal: 8.7%; ) and stage 2 (urban: 17.5%; tribal: 13.9%; ) hypertension. Conclusion. Urban environment showed a changing lifestyle and high prevalence of DM among tribal migrating urban tribes as compared to traditional tribes. Dhiraj Kapoor, Ashok Kumar Bhardwaj, Dinesh Kumar, and Sunil Kumar Raina Copyright © 2014 Dhiraj Kapoor et al. All rights reserved. Obesity Disease and Surgery Mon, 28 Apr 2014 07:55:27 +0000 Obesity is a medical disease that is increasing significantly nowadays. Worldwide obesity prevalence doubled since 1980. Obese patients are at great risk for complications with physical and psychological burdens, thus affecting their quality of life. Obesity is well known to have higher risk for cardiovascular diseases, diabetes mellitus, musculoskeletal diseases and shorter life expectancy. In addition, obesity has a great impact on surgical diseases, and elective surgeries in comparison to general population. There is higher risk for wound infection, longer operative time, poorer outcome, and others. The higher the BMI (body mass index), the higher the risk for these complications. This literature review illustrates the prevalence of obesity as a diseases and complications of obesity in general as well as, in a surgical point of view, general surgery perioperative risks and complications among obese patients. It will review the evidence-based updates in these headlines. Abdulrahman Saleh Al-Mulhim, Hessah Abdulaziz Al-Hussaini, Bashaeer Abdullah Al-Jalal, Rehab Omar Al-Moagal, and Sara Abdullah Al-Najjar Copyright © 2014 Abdulrahman Saleh Al-Mulhim et al. All rights reserved. Beneficial Effect of Low-Fat Elemental Diet Therapy on Pain in Chronic Pancreatitis Mon, 14 Apr 2014 12:46:00 +0000 Background & Aims. Chronic pancreatitis (CP) is often associated with abdominal pain, which impairs quality of life. The aim of this prospective study was to clarify whether the use of a low-fat elemental diet (ED) is beneficial for managing pain in patients with CP. Methods. Seventeen CP patients with pain despite fat-restricted dietary and conventional medical treatments were enrolled in this prospective study. These patients received low-fat ED therapy in addition to restricting fat intake for 8 weeks. The change of pain severity was examined by interviewing the patient and status of analgesic use. Results. Mean serum levels of amylase and lipase at 8 weeks after the beginning of low-fat ED therapy decreased compared to those before the therapy. At 8 weeks, pain alleviation after low-fat ED therapy was reported in 15 out of 17 patients (88%). Of these 15 patients, 10 patients reported complete pain disappearance. One of 3 patients with severe or moderate pain requiring analgesic was relieved of analgesic use after low-fat ED therapy. Conclusion. Low-fat ED therapy is useful as means of pain control in CP. The therapy is recommended in outpatients with CP who present with pain despite conventional dietary and medical treatments. Tsukasa Ikeura, Makoto Takaoka, Kazushige Uchida, Hideaki Miyoshi, and Kazuichi Okazaki Copyright © 2014 Tsukasa Ikeura et al. All rights reserved. p21WAF1/CIP1 Expression is Differentially Regulated by Metformin and Rapamycin Tue, 25 Mar 2014 15:28:28 +0000 The mammalian target of rapamycin (mTOR) pathway plays an important role in the development of diabetic nephropathy and other age-related diseases. One of the features of DN is the elevated expression of p21WAF1/CIP1. However, the importance of the mTOR signalling pathway in p21 regulation is poorly understood. Here we investigated the effect of metformin and rapamycin on mTOR-related phenotypes in cell lines of epithelial origin. This study reports that metformin inhibits high glucose-induced p21 expression. High glucose opposed metformin in regulating cell size, proliferation, and protein synthesis. These effects were associated with reduced AMPK activation, affecting downstream mTOR signalling. However, the inhibition of the mTOR pathway by rapamycin did not have a negative effect on p21 expression, suggesting that metformin regulates p21 upstream of mTOR. These findings provide support for the hypothesis that AMPK activation may regulate p21 expression, which may have implications for diabetic nephropathy and other age-related pathologies. Zoltan Molnar, Ann B. Millward, Wai Tse, and Andrew G. Demaine Copyright © 2014 Zoltan Molnar et al. All rights reserved. Role of Theories in the Design of Web-Based Person-Centered Support: A Critical Analysis Wed, 19 Mar 2014 07:23:06 +0000 Objective. The aim of this study was to provide a critical understanding of the role of theories and their compatibility with a person-centered approach in the design and evaluation of web-based support for the management of chronic illness. Methods. Exploration of web-based support research projects focusing on four cases: (1) preschool children aged 4–6 with bladder dysfunction and urogenital malformation; (2) young adults aged 16–25 living with mental illness; (3) women with type 1 diabetes who are pregnant or in early motherhood; and (4) women who have undergone surgery for breast cancer. Data comprised interviews with research leaders and documented plans. Analysis was performed by means of a cross-case methodology. Results. The used theories concerned design, learning, health and well-being, or transition. All web support products had been developed using a participatory design (PD). Fundamental to the technology design and evaluation of outcomes were theories focusing on learning and on health and well-being. All theories were compatible with a person-centered approach. However, a notable exception was the relatively collective character of PD and Communities of Practice. Conclusion. Our results illustrate multifaceted ways for theories to be used in the design and evaluation of web-based support. Agneta Ranerup, Carina Sparud-Lundin, Ingalill Koinberg, Ingela Skärsäter, Margaretha Jenholt-Nolbris, and Marie Berg Copyright © 2014 Agneta Ranerup et al. All rights reserved. Evaluation of the Mean Platelet Volume and Red Cell Distribution Width in FMF: Are They Related to Subclinical Inflammation or Not? Wed, 12 Mar 2014 08:54:16 +0000 In this paper we want to demonstrate whether higher than normal levels of RDW, and lower than normal levels of MPV can be used as indicators of subclinical inflammation and tools for treatment decision in FMF or not. The participants in this study included 89 patients with FMF during attack-free periods and 30 healthy controls. The RDW and platelet counts were significantly higher, while the MPV was significantly lower in the patients with FMF group than healthy control group (; ; , resp.). In the attack-free FMF group, a negative correlation was found between the MPV and RDW values (, ). The positive correlation was found between the RDW and ESR (, ). And the negative correlation was found between the MPV and CRP (, ). Consequently, our results suggest that low MPV and high RDW levels may provide additional information about subclinical inflammation in FMF patients. But other strong predisposing factors affecting subclinical inflammation in FMF should be considered. Further studies with large numbers of patients are needed. Treatment of FMF should include not only prevention of acute attacks but also decreasing of the subclinical inflammation. Gozde Yildirim Cetin, Ozlem Gul, Fatma Kesici-Metin, İrem Gokalp, and Mehmet Sayarlıoglu Copyright © 2014 Gozde Yildirim Cetin et al. All rights reserved.