International Journal of Chronic Diseases The latest articles from Hindawi © 2017 , Hindawi Limited . All rights reserved. Prevalence of Anemia, Overweight/Obesity, and Undiagnosed Hypertension and Diabetes among Residents of Selected Communities in Ghana Tue, 15 Aug 2017 07:46:58 +0000 The increasing numbers of lifestyle related chronic diseases in developing countries call for awareness, early detection, and effective management. The objective of this paper is to report the prevalence of undiagnosed hypertension, diabetes, overweight/obesity, and anemia among residents of selected communities in Ghana. The data comes from a community screening conducted in Ghana as part of the University of Georgia Summer Service Learning Program. Descriptive statistics were used to summarize the data while chi-square and independent -test compared groups. A total of 976 participants (37.9% males and 62.1% females), 18 years and older, were screened. Mean age was years, BMI was  kgm−2, and hemoglobin was  g/dL. 3.1% and 12.6% reported existing diagnosis for diabetes and hypertension, respectively. Almost half (47.8%) were overweight/obese; 27.0% were hypertensive while 34.0% had diabetes. Also, 28.8% males compared to 37.8% females had diabetes (), while 28.2% males compared to 26.2% females were hypertensive (). There were differences in BMI (), anemia (), and undiagnosed diabetes () and hypertension () by community (Takoradi versus Cape Coast) where the screening took place. Findings from the screening exercise call for improved public health education with a focus on lifestyle habits and health seeking behaviors among Ghanaians. Alex Kojo Anderson Copyright © 2017 Alex Kojo Anderson. All rights reserved. The Prevalence of Metabolic Syndrome and Its Components among People with Type 2 Diabetes in the Ho Municipality, Ghana: A Cross-Sectional Study Sun, 12 Feb 2017 00:00:00 +0000 The cooccurrence of diabetes mellitus and metabolic syndrome potentiates the cardiovascular risk associated with each of the conditions; therefore characterizing metabolic syndrome among people with type 2 diabetes is beneficial for the purpose of cardiovascular disease prevention. This study aims at evaluating the prevalence of metabolic syndrome and its components among 162 patients with type 2 diabetes attending the diabetic clinic of the Ho Municipal Hospital, Ghana. Data obtained included anthropometric indices, blood pressure, serum lipids, glucose, and sociodemographics and clinical information. The overall prevalence of metabolic syndrome among the study population was 43.83%, 63.58%, and 69.14% using the NCEP-ATP III, the WHO, and the IDF criteria, respectively. The most predominant component among the study population was high blood pressure using the NCEP-ATP III (108 (66.67%)) and WHO (102 (62.96)) criteria and abdominal obesity (112 (69.14%)) for IDF criteria. High blood pressure was the most prevalent component among the males while abdominal obesity was the principal component among the females. In this population with type 2 diabetes, high prevalence of metabolic syndrome exists. Gender vulnerability to metabolic syndrome and multiple cluster components were skewed towards the female subpopulation with type 2 diabetes. James Osei-Yeboah, William K. B. A. Owiredu, Gameli Kwame Norgbe, Sylvester Yao Lokpo, Jones Gyamfi, Emmanuel Alote Allotey, Romeo Asumbasiya Aduko, Mark Noagbe, and Florence A. Attah Copyright © 2017 James Osei-Yeboah et al. All rights reserved. COPD in a Population-Based Sample of Never-Smokers: Interactions among Sex, Gender, and Race Wed, 07 Dec 2016 07:56:39 +0000 This observational epidemiological study investigates sex/gender and racial differences in prevalence of COPD among never-smokers. Data were derived from the 2012 Center for Disease Control’s Behavioral Risk Factor Surveillance System. The sample consisted of 129,535 non-Hispanic whites and blacks 50 years of age and older who had never smoked. Descriptive and multivariable analyses were conducted, with the latter using a series of logistic regression models predicting COPD status by sex/gender and race, adjusting for age, height, socioeconomic position (SEP), number of household members, marital status, and health insurance coverage. Black women have the highest prevalence of COPD (7.0%), followed by white women (5.2%), white men (2.9%), and black men (2.4%). Women have significantly higher odds of COPD than men. When adjusting for SEP, black and white women have comparably higher odds of COPD than white men (black women OR = 1.66; 99% CI = 1.46, 1.88; white women OR = 1.49; 99% CI = 1.37, 1.63), while black men have significantly lower odds (OR = 0.62; 99% CI = 0.49, 0.79). This research provides evidence that racial inequalities in COPD (or lack thereof) may be related to SEP. Esme Fuller-Thomson, Rachel S. Chisholm, and Sarah Brennenstuhl Copyright © 2016 Esme Fuller-Thomson et al. All rights reserved. The Microbial Hypothesis: Contributions of Adenovirus Infection and Metabolic Endotoxaemia to the Pathogenesis of Obesity Thu, 24 Nov 2016 14:47:20 +0000 The global obesity epidemic, dubbed “globesity” by the World Health Organisation, is a pressing public health issue. The aetiology of obesity is multifactorial incorporating both genetic and environmental factors. Recently, epidemiological studies have observed an association between microbes and obesity. Obesity-promoting microbiome and resultant gut barrier disintegration have been implicated as key factors facilitating metabolic endotoxaemia. This is an influx of bacterial endotoxins into the systemic circulation, believed to underpin obesity pathogenesis. Adipocyte dysfunction and subsequent adipokine secretion characterised by low grade inflammation, were conventionally attributed to persistent hyperlipidaemia. They were thought of as pivotal in perpetuating obesity. It is now debated whether infection and endotoxaemia are also implicated in initiating and perpetuating low grade inflammation. The fact that obesity has a prevalence of over 600 million and serves as a risk factor for chronic diseases including cardiovascular disease and type 2 diabetes mellitus is testament to the importance of exploring the role of microbes in obesity pathobiology. It is on this basis that Massachusetts General Hospital is sponsoring the Faecal Microbiota Transplant for Obesity and Metabolism clinical trial, to study the impact of microbiome composition on weight. The association of microbes with obesity, namely, adenovirus infection and metabolic endotoxaemia, is reviewed. Amos Tambo, Mohsin H. K. Roshan, and Nikolai P. Pace Copyright © 2016 Amos Tambo et al. All rights reserved. Diabetes Mellitus as Hub for Tuberculosis Infection: A Snapshot Wed, 12 Oct 2016 13:44:29 +0000 Tuberculosis (TB) still remains the thorn in the flesh of efficient therapeutics affecting one-third of global population annually. There are several factors that enhance the susceptibility to TB infections including malnutrition, smoking, and immunocompromised conditions such as AIDS. In the recent years, growing body of evidence has gained considerable prominence which suggests that Diabetes Mellitus (DM) is individual risk factor leading to complicated TB infections. In this article the authors have attempted to summarize the link of type 2 DM with TB, the mechanistic action of how DM sensitizes for developing the active TB infection from the latent infection, and problems faced during treatment followed by possible preventive measures. We have tried to give account of the alterations that occurred in DM making a person more prone to develop TB. Rahul Pal, Moiz A. Ansari, Saif Hameed, and Zeeshan Fatima Copyright © 2016 Rahul Pal et al. All rights reserved. Prevalence of Osteoporosis and Its Risk Factors in Men with COPD in Qazvin Tue, 27 Sep 2016 13:12:47 +0000 Introduction. Chronic obstructive pulmonary disease (COPD) is a major cause of morbidity and mortality worldwide. Proper diagnosis of osteoporosis as a systemic adverse effect of COPD is of significant importance. The present study aimed at evaluating the prevalence of osteoporosis and its risk factors in men suffering from COPD in Qazvin (2014). Methods. This descriptive-analytical study was conducted on 90 patients with COPD using random sampling. Anthropometric data and results from physical examination were collected. Pulmonary function test and bone mineral densitometry were done for all participants as well. Results. The prevalence of osteopenia and osteoporosis in COPD patients was 31.5 and 52.8 percent, respectively. Bone mineral density (BMD) at the femoral neck was associated significantly with body mass index (BMI), increased severity of COPD, and use of oral corticosteroid (). Conclusion. The results showed that patients’ BMI and severity of COPD are two valuable risk factors for osteoporosis screening in COPD patients. Mahnaz Abbasi, Mohammadali Zohal, Banafsheh Atapour, and Zohreh Yazdi Copyright © 2016 Mahnaz Abbasi et al. All rights reserved. Behavioral Problems in Juvenile Idiopathic Arthritis: A Controlled Study to Examine the Risk of Psychopathology in a Chronic Pediatric Disorder Tue, 30 Aug 2016 12:52:09 +0000 Children with juvenile idiopathic arthritis (JIA) are prone to the problems that can delay their psychosocial development; however, the existing literature has not reached a consensus on the psychological problems related to JIA. A total of 51 children and adolescents with JIA and 75 healthy controls aged 6 to 18 years were examined using the Child Behavioral Checklist (CBCL). Our results represented that 70 percent of JIA group reached “borderline clinical” range or “clinical” range in internalizing problems, while this percentage in the control group was 18 percent. In addition, our results indicated that JIA group has gotten significantly higher scores (more than twofold) in externalizing behaviors compared to control group. Furthermore, children with JIA showed higher rate of anxiety/depression, withdrawal/depression, somatic complaints, rule breaking behaviors, and aggressive behaviors as well as thought and social problems compared to control group (). As a conclusion, children and adolescents with JIA compared to healthy controls may show higher rate of both internalizing and externalizing problems. Furthermore, our novel findings on externalizing, social, and thought problems in JIA warrant further investigation on affected children who may be at greater risk of future psychopathologies. Amir Hossein Memari, Elham Chamanara, Vahid Ziaee, Ramin Kordi, and Seyed-Reza Raeeskarami Copyright © 2016 Amir Hossein Memari et al. All rights reserved. Revealing Maximal Diameter of Upper Limb Superficial Vein with an Elevated Environmental Temperature Mon, 15 Aug 2016 14:58:47 +0000 Ultrasonography is the primary tool for preoperative analysis of vein morphology for fistula creation in patients with end-stage renal disease. This study examines the effect of environmental temperature on the superficial vein size. Superficial veins of thirteen healthy volunteers were marked at three sites: cephalic vein in left lateral arm near cubital fossa, cephalic vein in left forearm at wrist, and basilic vein in left medial arm near cubital fossa. Mean diameters were recorded using ultrasound probe at 26°C and 43°C. Body temperature was increased using a Bair Hugger blanket. Mean values from the two temperatures were analyzed using paired sample -test. All three superficial vein sites displayed statistically significant increase in diameter when the temperature was increased from 26°C to 43°C. Paired -test showed values of 0.001 for cephalic vein at wrist, 0.01 for cephalic vein near cubital fossa, and 0.01 for basilic vein near cubital fossa. This study proved that environmental temperature exerts a statistically significant effect on vein size measured by ultrasound during preoperative assessment for vascular access. Not to the extent of 43°C, the authors would recommend setting the room temperature higher during ultrasound vascular assessment to avoid underestimating the superficial vein size. Hira Irfan, Guo Shen Ooi, May M. Kyin, and Pei Ho Copyright © 2016 Hira Irfan et al. All rights reserved. Effectiveness of a Pharmacist-Led Cardiovascular Risk Reduction Clinic in Rural Perry County, Alabama Mon, 25 Jul 2016 07:36:08 +0000 Background. The Cardiovascular Risk Reduction Clinic (CRRC) in Perry County, Alabama, provides free pharmacist-led services. Clinic goals include improving health outcomes and reducing cardiovascular risk factors. Objective. To investigate the effectiveness of the CRRC in rural Perry County, Alabama. The reduction of the modifiable cardiovascular risk factors, blood pressure and body mass index, was evaluated to measure a decrease from baseline to last clinic date. Methods. This retrospective chart review identified 130 patients with at least two blood pressure and BMI measurements from baseline to June 30, 2010. The patients’ paper files were used to collect baseline data and most recent measurements, which were recorded on a data collection sheet. Results. There was a statistically significant reduction in systolic blood pressure of 4.08 mmHg, 3.25 mmHg reduction in diastolic blood pressure, and 0.42 kg/m2 reduction in mean BMI. At their last visit prior to June 30, 2010, 59% of hypertensive patients and 35% of diabetic patients were meeting their blood pressure goals. Conclusion. Pharmacist-led management of patients with cardiovascular risk factors significantly reduced blood pressure and allowed more patients to meet their hypertension treatment goals. Despite being modest, reductions in blood pressure and BMI help reduce overall cardiovascular risks. Pilar Z. Murphy, Charles Sands, and Frances Ford Copyright © 2016 Pilar Z. Murphy et al. All rights reserved. Effect of Aerobic Exercise Training on Blood Pressure in Indians: Systematic Review Sun, 17 Jul 2016 13:45:00 +0000 Introduction. High blood pressure (BP) is one of the most important modifiable risk factors for cardiovascular diseases, which accounts for one in every eight deaths worldwide. It has been predicted that, by 2020, there would be 111% increase in cardiovascular deaths in India. Aerobic exercise in the form of brisk walking, jogging, running, and cycling would result in reduction in BP. Many meta-analytical studies from western world confirm this. However, there is no such review from Indian subcontinent. Objective. Our objective is to systematically review and report the articles from India in aerobic exercise on blood pressure. Methodology. Study was done in March 2016 in Google Scholar using search terms “Aerobic exercise” AND “Training” AND “Blood pressure” AND “India.” This search produced 3210 titles. Results. 24 articles were identified for this review based on inclusion and exclusion criteria. Total of 1107 subjects participated with median of 25 subjects. Studies vary in duration from +3 weeks to 12 months with each session lasting 15–60 minutes and frequency varies from 3 to 8 times/week. The results suggest that there was mean reduction of −05.00 mmHg in SBP and −03.09 mmHg in DBP after aerobic training. Conclusion. Aerobic training reduces the blood pressure in Indians. Sonu Punia, Sivachidambaram Kulandaivelan, Varun Singh, and Vandana Punia Copyright © 2016 Sonu Punia et al. All rights reserved. Musculoskeletal Disorders and Perceived Work Demands among Female Nurses at a Tertiary Care Hospital in India Thu, 14 Jul 2016 13:57:33 +0000 Introduction. Musculoskeletal disorders (MSD) are common among nurses and can affect patient outcomes. There is a dearth of literature on MSD among Indian nurses. The study objective was to measure prevalence of MSD and their association with perceived work demands and sociodemographic variables among female nurses at a tertiary care hospital in rural India. Methods. A cross-sectional study was undertaken in 2013 through interviewer administered questionnaires which comprised three parts: sociodemographic data, modified Nordic questionnaire, and perceived physical and psychological work demands. Results. 296 nurses with a mean age of 30.4 years participated. Prevalence of any MSD in the last seven days was 60.5% with low back pain being the most common and elbow pain the least common. Occurrence of any MSD was associated with age, number of children, working hours at home, BMI, and total work experience. High perceived physical demands score was associated with lower back (OR: 3.06) and knee pain (OR: 7.73). Conclusion. Prevalence of MSD was high and occurrence of lower back and knee MSD was associated with perceived physical demands. This information should be used as a benchmark and guiding tool for designing work place interventions to improve working conditions and health of nurses. Apexa S. Raithatha and Daxa G. Mishra Copyright © 2016 Apexa S. Raithatha and Daxa G. Mishra. All rights reserved. The Negligible Influence of Chronic Obesity on Hospitalization, Clinical Status, and Complications in Elective Posterior Lumbar Interbody Fusion Sun, 10 Jul 2016 09:59:56 +0000 Background. Posterior lumbar interbody fusion (PLIF) is a common surgical treatment for degenerative spinal instability, but many surgeons consider obesity a contraindication for elective spinal fusion. The aim of this study was to analyze whether obesity has any influence on hospitalization parameters, change in clinical status, or complications. Methods. In this prospective study, regression analysis was used to analyze the influence of the body mass index (BMI) on operating time, postoperative care, hospitalization time, type of postdischarge care, change in paresis or sensory deficits, pain level, wound complications, cerebrospinal fluid leakage, and implant complications. Results. Operating time increased only 2.5 minutes for each increase of BMI by 1. The probability of having a wound complication increased statistically with rising BMI. Nonetheless, BMI accounted for very little of the variation in the data, meaning that other factors or random chances play a much larger role. Conclusions. Obesity has to be considered a risk factor for wound complications in patients undergoing elective PLIF for degenerative instability. However, BMI showed no significant influence on other kinds of peri- or postoperative complications, nor clinical outcomes. So obesity cannot be considered a contraindication for elective PLIF. Olaf Suess, Theodoros Kombos, and Frank Bode Copyright © 2016 Olaf Suess et al. 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.