International Journal of Chronic Diseases The latest articles from Hindawi Publishing Corporation © 2015 , Hindawi Publishing Corporation . 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. Activation of Natural Killer Cells in Patients with Chronic Bone and Joint Infection due to Staphylococci Expressing or Not the Small Colony Variant Phenotype Mon, 03 Mar 2014 11:25:06 +0000 Chronic bone and joint infections (BJI) are devastating diseases. Relapses are frequently observed, as some pathogens, especially staphylococci, can persist intracellularly by expressing a particular phenotype called small colony variant (SCV). As natural killer (NK) cells are lymphocytes specialized in the killing of host cells infected by intracellular pathogens, we studied NK cells of patients with chronic BJI due to staphylococci expressing or not SCVs (10 patients in both groups). Controls were patients infected with other bacteria without detectable expression of SCVs, and healthy volunteers. NK cell phenotype was evaluated from PBMCs by flow cytometry. Degranulation capacity was evaluated after stimulation with K562 cells in vitro. We found that NK cells were activated in terms of CD69 expression, loss of CD16 and perforin, in all infected patients in comparison with healthy volunteers, independently of the SCV phenotype. Peripheral NK cells in patients with chronic BJI display signs of recent activation and degranulation in vivo in response to CD16-mediated signals, regardless of the type of bacteria involved. This could involve a universal capacity of isolates responsible for chronic BJI to produce undetectable SCVs in vivo, which might be a target of future intervention. Sébastien Viel, Paul Rouzaire, Frédéric Laurent, Thierry Walzer, Jacques Bienvenu, Florent Valour, Christian Chidiac, Tristan Ferry, and The Lyon BJI Study Group Copyright © 2014 Sébastien Viel et al. All rights reserved. Comparison of Salivary TIMP-1 Levels in Periodontally Involved and Healthy Controls and the Response to Nonsurgical Periodontal Therapy Thu, 06 Feb 2014 13:52:22 +0000 Background. Periodontal disease is a chronic inflammatory condition affecting the supporting structures of the dentition. Periodontal destruction is an outcome of the imbalance between matrix metalloproteinases and tissue inhibitors of matrix metalloproteinases (TIMPs). We wanted to prove the hypothesis that salivary TIPM-1 level will vary in different people. A decrease in TIMP-1 level could make them more susceptible to periodontitis whereas a normal level could prevent increased tissue destruction thereby inhibiting the progression from gingivitis to periodontitis. This could probably pave the way for TIPM-1 to be a specific salivary biomarker and serve as a useful diagnostic and therapeutic tool in periodontitis. Methods. Whole unstimulated saliva of 2 ml was collected from twenty-five periodontally healthy and twenty-seven systemically healthy subjects with periodontitis. Clinical parameters recorded at baseline and reevaluated after four weeks in subjects with periodontitis following nonsurgical periodontal therapy were gingival index (GI), oral hygiene index-Simplified (OHI-S), probing pocket depth, and clinical attachment level (CAL). Salivary TIMP-1 levels in both were analyzed using a commercially available ELISA kit. Angel Fenol, Maya Rajan Peter, Jayachandran Perayil, Rajesh Vyloppillil, and Anuradha Bhaskar Copyright © 2014 Angel Fenol et al. All rights reserved. Feasibility of Development of a Cohort in a Rural Area of Sub-Himalayan Region of India to Assess the Emergence of Cardiovascular Diseases Risk Factors Wed, 22 Jan 2014 15:09:45 +0000 Introduction. Rural area of India is facing epidemiological transitions due to growth and development, warranting a longitudinal study to assess the development of CVDs risk factors. Objective. Feasibility of setting up a rural cohort for the assessment and development of biochemical risk factors for CVDs. Methodology. In Himachal Pradesh, house-to-house surveys were carried out in six villages for anthropometry and assessment of lipid profile. All the information was stored in specifically designed web-based software, which can be retrieved at any time. Results. A total of 2749 individuals of more than 20 years of age were recruited with a 14.3% refusal rate. According to Asian criteria, measured overweight and obesity (BMI > 27.5 kg/m2) were 44.9% and 10.5%, respectively. Obesity was significantly more () among females (11.7%) as compared to males (8.4%). The prevalence of prehypertension and hypertension was observed to be 16.3% and 37.4%, respectively. Eighty percent of individuals had borderline (46.5%) to high (35.4%) level of triglycerides (TGs). Elevated total cholesterol (TC) and low density lipoprotein (LDL) level were observed among 30.0% and 11.0% individuals only. Conclusion. A high prevalence of biochemical risk factors for CVDs in a rural area urges establishment of an effective surveillance system. Ashok Kumar Bhardwaj, Dinesh Kumar, Sunil Kumar Raina, Satya Bhushan, Vishav Chander, and Sushant Sharma Copyright © 2014 Ashok Kumar Bhardwaj et al. All rights reserved. A Comparison of the Effects of Aerobic and Intense Exercise on the Type 2 Diabetes Mellitus Risk Marker Adipokines, Adiponectin and Retinol Binding Protein-4 Sun, 12 Jan 2014 10:28:42 +0000 With a more sedentary population comes growing rates of obesity and increased type 2 diabetes mellitus (T2DM) risk. Exercise generally induces positive changes in traditional T2DM risk markers such as lipids, glucose tolerance, and insulin sensitivity; however alterations in concentrations of many circulating cytokines and their respective receptors are also becoming apparent. These cytokines may be early-response health risk factors otherwise overlooked in traditional T2DM risk marker analysis. Plasma levels of two adipocyte-originating cytokines, adiponectin and retinol binding protein 4 (RBP-4), alter following exercise. Adiponectin has anti-inflammatory, anti-atherosclerotic, and anti-insulin resistance roles and its secretion increases with physical activity, whilst elevated RBP-4 leads to increased insulin resistance, and secretion decreases with increasing physical activity; thus these plasma adipokine levels alter favourably following exercise. Although current data are limited, they do suggest that the more intense the exercise, the greater the positive effect on plasma RBP-4 levels, whilst lower intensity aerobic exercise may positively improve adiponectin concentrations. Therefore short-duration, high intensity training may provide a time-efficient alternative to the recommended 150 min moderate aerobic exercise per week in providing positive changes in RBP-4 and other traditional T2DM risk markers and due to increased compliance give greater health benefits over the longer term. Amy Phillips and Christian Cobbold Copyright © 2014 Amy Phillips and Christian Cobbold. All rights reserved. Social Determinants of Health, the Chronic Care Model, and Systemic Lupus Erythematosus Thu, 02 Jan 2014 14:11:43 +0000 Systemic lupus erythematosus (SLE) is a chronic inflammatory rheumatic disease that disproportionately affects African Americans and other minorities in the USA. Public health attention to SLE has been predominantly epidemiological. To better understand the effects of this cumulative disadvantage and ultimately improve the delivery of care, specifically in the context of SLE, we propose that more research attention to the social determinants of SLE is warranted and more transdisciplinary approaches are necessary to appropriately address identified social determinants of SLE. Further, we suggest drawing from the chronic care model (CCM) for an understanding of how community-level factors may exacerbate disparities explored within social determinant frameworks or facilitate better delivery of care for SLE patients. Grounded in social determinants of health (SDH) frameworks and the CCM, this paper presents issues relative to accessibility to suggest that more transdisciplinary research focused on the role of place could improve care for SLE patients, particularly the most vulnerable patients. It is our hope that this paper will serve as a springboard for future studies to more effectively connect social determinants of health with the chronic care model and thus more comprehensively address adverse health trajectories in SLE and other chronic conditions. Edith M. Williams, Kasim Ortiz, and Teri Browne Copyright © 2014 Edith M. Williams et al. All rights reserved. Migration Status and Prevalence of Chronic Diseases in Kerala State, India Tue, 10 Dec 2013 19:14:51 +0000 Aim. To study the relationship between a personal history of migration and prevalence of chronic diseases and risk factors in a rural population. Method. Cross sectional survey data from PROLIFE, a cohort study involving the long time follow-up of the residents of an administrative unit in Kerala, India, was used. Pre-tested questionnaire was administered to 78,173 adult residents. Information on physician diagnosed diabetes, hypertension, and cardiac diseases and lifestyle attributes like physical activity, habits, and migration was captured. Results. Subjects with a history of migration had a higher prevalence of chronic disease when compared with those with no history of migration. Diabetes (19.6% versus 4.1%), hypertension (18.8% versus 6.6%), and cardiac complaints (8.6% versus 4.1%) are more prevalent among those with history of migration of over 5 years. After adjustment for age, gender, and education, we found that chronic diseases are higher among persons with a history of migration (OR 2.2, 95% CI: 2.1–2.3). Age-specific increases in prevalence of chronic diseases are also substantially higher among migrants. Conclusion. People with a history of migration have a higher prevalence of chronic diseases and risk factors. Safraj Shahul Hameed, Vellapallil Raman Kutty, Krishnapillai Vijayakumar, and Ajayan Kamalasanan Copyright © 2013 Safraj Shahul Hameed et al. All rights reserved. A Review on the Management of Hip and Knee Osteoarthritis Sat, 28 Sep 2013 11:32:26 +0000 Arthritis is the most common chronic condition affecting patients over the age of 70. The prevalence of osteoarthritis increases with age, and with an aging population, the effect of this disease will represent an ever-increasing burden on health care. The knee is the most common joint affected in osteoarthritis, with up to 41% of limb arthritis being located in the knee, compared to 30% in hands and 19% in hips. We review the current concepts with regard to the disease process and risk factors for developing hip and knee osteoarthritis. We then explore the nonsurgical management of osteoarthritis as well as the operative management of hip and knee arthritis. We discuss the indications for surgical treatment of hip and knee arthritis, looking in particular at the controversies affecting young and obese patients in both hip and knee replacements. Patient and implant related outcomes along with survivorships are addressed as well as the experiences and controversies described in national joint registries. Alexander MacDonald Wood, Timothy M. Brock, Kieran Heil, Rachel Holmes, and Axel Weusten Copyright © 2013 Alexander MacDonald Wood et al. All rights reserved. Evaluation of Chronic Liver Disease: Does Ultrasound Scoring Criteria Help? Tue, 10 Sep 2013 11:31:07 +0000 Noninvasive approaches for assessment of liver histology include routine laboratory tests and radiological evaluation. The purpose of our study was to determine the utility of a simplified scoring system based on routinely evaluated ultrasound features for the evaluation of chronic liver disease and correlate it with the histological findings. For this cross-sectional analytical study the data was collected prospectively by nonprobability purposive sampling technique. The ultrasound variables/parameters and their assigned scoring system that was a modified version adopted from published literature were evaluated. Sensitivity, specificity, positive and negative predictive values of the liver morphological score and combined score of liver morphology and sizes was determined using stage and grade as reference standard. Our results show a high sensitivity and PPV of liver morphological sonographic evaluation for the staging and grading of CLD respectively thus supporting it as a screening diagnostic strategy. Of the three liver morphology variables, specificity of liver surface evaluation was highest for the stage of fibrosis and grade of inflammation. The simplified ultrasound scoring system evaluated in our study is clinically relevant and reproducible for differentiating patients with CLD with mild or no fibrosis from moderate to severe fibrosis. Shaista Afzal, Imrana Masroor, and Madiha Beg Copyright © 2013 Shaista Afzal et al. All rights reserved. Biomarkers in Exhaled Breath Condensate and Serum of Chronic Obstructive Pulmonary Disease and Non-Small-Cell Lung Cancer Sun, 04 Aug 2013 07:53:22 +0000 Chronic obstructive pulmonary disease (COPD) and lung cancer are leading causes of deaths worldwide which are associated with chronic inflammation and oxidative stress. Lung cancer, in particular, has a very high mortality rate due to the characteristically late diagnosis. As such, identification of novel biomarkers which allow for early diagnosis of these diseases could improve outcome and survival rate. Markers of oxidative stress in exhaled breath condensate (EBC) are examples of potential diagnostic markers for both COPD and non-small-cell lung cancer (NSCLC). They may even be useful in monitoring treatment response. In the serum, S100A8, S100A9, and S100A12 of the S100 proteins are proinflammatory markers. They have been indicated in several inflammatory diseases and cancers including secondary metastasis into the lung. It is highly likely that they not only have the potential to be diagnostic biomarkers for NSCLC but also prognostic indicators and therapeutic targets. Mann Ying Lim and Paul S. Thomas Copyright © 2013 Mann Ying Lim and Paul S. Thomas. All rights reserved. Sarcoidosis: Immunopathogenesis and Immunological Markers Thu, 25 Jul 2013 13:44:15 +0000 Sarcoidosis is a multisystem granulomatous disorder invariably affecting the lungs. It is a disease with noteworthy variations in clinical manifestation and disease outcome and has been described as an “immune paradox” with peripheral anergy despite exaggerated inflammation at disease sites. Despite extensive research, sarcoidosis remains a disease with undetermined aetiology. Current evidence supports the notion that the immune response in sarcoidosis is driven by a putative antigen in a genetically susceptible individual. Unfortunately, there currently exists no reliable biomarker to delineate the disease severity and prognosis. As such, the diagnosis of sarcoidosis remains a vexing clinical challenge. In this review, we outline the immunological features of sarcoidosis, discuss the evidence for and against various candidate etiological agents (infective and noninfective), describe the exhaled breath condensate, a novel method of identifying immunological biomarkers, and suggest other possible immunological biomarkers to better characterise the immunopathogenesis of sarcoidosis. Wei Sheng Joshua Loke, Cristan Herbert, and Paul S. Thomas Copyright © 2013 Wei Sheng Joshua Loke et al. All rights reserved. Quality of Life Assessment Using EuroQOL EQ-5D Questionnaire in Patients with Deep Infiltrating Endometriosis: The Relation with Symptoms and Locations Wed, 24 Jul 2013 09:54:25 +0000 The objective of this study was to evaluate the quality of life (QOL) of patients with deep infiltrating endometriosis (DIE) using EuroQOL (EQ-5D) and its correlation with symptoms and locations of endometriotic lesions. One hundred and fifty-nine patients referred for DIE from January 2011 to April 2011 were prospectively invited to complete questionnaires evaluating symptoms associated with endometriosis as well as the EQ-5D questionnaire and health state. Patients also had locations of DIE evaluated by clinical examination and magnetic resonance imaging (MRI). All 159 patients completed the questionnaires. Item response rate was 91.1%. The most intense symptoms were dysmenorrhea (7.1/10), painful defecation (6.3/10), and fatigue (6.0/10). Mean (SD) scores were 77 (14) for the EQ-5D questionnaire and 63.4 (21) for the health state. A relation was observed between the EQ-5D questionnaire and the presence of dysmenorrhea, dyspareunia, cyclic pelvic pain, painful defecation, and diarrhea or constipation. Vaginal and rectal infiltrations were significantly associated with altered EQ-5D and health state scores. The EQ-5D questionnaire is easy to complete and well related to symptoms of DIE. Rectal and vaginal infiltrations were found to be determinant factors of altered QOL by the EQ-5D questionnaire and health state. C. Touboul, P. Amate, M. Ballester, M. Bazot, A. Fauconnier, and E. Daraï Copyright © 2013 C. Touboul et al. All rights reserved.