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Other Comorbidities (other + comorbidity)
Selected AbstractsA clinical pharmacological study of the potential beneficial effects of a propolis food product as an adjuvant in asthmatic patientsFUNDAMENTAL & CLINICAL PHARMACOLOGY, Issue 1 2003M. T. Khayyal Abstract The aqueous extract of propolis has been formulated as a nutritional food product and administered, as an adjuvant to therapy, to patients with mild to moderate asthma daily for 2 months in the framework of a comparative clinical study in parallel with a placebo preparation. The diagnosis of asthma was made according to the criteria of patient classification of the National Institutes of Health and Global Initiative for Asthma Management. At inclusion, the pulmonary forced expiratory volume in the first second (FEV1) as a percentage of the forced vital capacity (FVC) was more than 80% in mild persistent cases, and between 60 and 80% in moderate persistent cases, showing an increase in the degree of reversibility of >,15% in FEV1. All patients were on oral theophylline as controller therapy, none was receiving oral or inhaled corticosteroids, none had other comorbidities necessitating medical treatment, and all were from a middle-class community and had suffered from asthma for the last 2,5 years. Twenty-four patients received the placebo, with one drop-out during the study, while 22 received the propolis extract, with no drop-outs. The age range of the patients was 19,52 years; 36 were male and 10 female. The number of nocturnal attacks was recorded on a weekly basis, while pulmonary function tests were performed on all patients at the beginning of the trial, 1 month later and at the termination of the trial. Immunological parameters, including various cytokines and eicosanoids known to play a role in asthma, were measured in all patients at the beginning of the trial and 2 months later. Analysis of the results at the end of the clinical study revealed that patients receiving propolis showed a marked reduction in the incidence and severity of nocturnal attacks and improvement of ventilatory functions. The number of nocturnal attacks dropped from an average of 2.5 attacks per week to only 1. The improvement in pulmonary functions was manifested as a nearly 19% increase in FVC, a 29.5% increase in FEV1, a 30% increase in peak expiratory flow rate (PEFR), and a 41% increase in the forced expiratory flow rate between 25 and 75% of the vital capacity (FEF25-75). The clinical improvement was associated with decreases by 52, 65, 44 and 30%, respectively, of initial values for the pro-inflammatory cytokines tumor necrosis factor (TNF)-,, ICAM-1, interleukin (IL)-6 and IL-8, and a 3-fold increase in the ,protective' cytokine IL-10. The levels of prostaglandins E2 and F2, and leukotriene D4 were decreased significantly to 36, 39, and 28%, respectively, of initial values. Patients on the placebo preparation showed no significant improvement in ventilatory functions or in the levels of mediators. The findings suggest that the aqueous propolis extract tested is potentially effective as an adjuvant to therapy in asthmatic patients. The benefits may be related to the presence in the extract of caffeic acid derivatives and other active constituents. [source] Factors associated with treatment nonadherence among US bipolar disorder patients,HUMAN PSYCHOPHARMACOLOGY: CLINICAL AND EXPERIMENTAL, Issue 2 2008Ross J. Baldessarini Abstract Objective Since sustained treatment-adherence is often problematic and may limit clinical outcomes among bipolar disorder (BPD) patients, we sought risk factors to guide clinical prediction of nonadherence. Methods Data were from a 2005 US national sample providing questionnaire responses by 131 randomly selected prescribing psychiatrists and their adult BPD patients. We contrasted demographic and clinical factors in treatment-adherent versus nonadherent patients (strictly defined as missing ,1 dose within 10 days) in univariate analyses followed by multivariate logistic-regression modeling. Results Of 429 DSM-IV BPD patients (79% type-I; 62% women; 17% minorities), 34% reported missing,,,1 dose of psychotropic medication within 10 days, 20% missed entire daily doses at least once, and only 2.5% missed all doses for 10 days. However, their prescribing psychiatrists considered only 6% as treatment-nonadherent. Factors significantly associated with nonadherence in multivariate modeling ranked: alcohol-dependence,>,youth,>,greater affective morbidity,>,various side effects,,,comorbid obsessive-compulsive disorder,,,recovering from mania-hypomania. Unrelated were sex, diagnostic subtype, and other comorbidities. Since most patients received,,,2 psychotropics, potential relationships between treatment-complexity and adherence were obscured. Conclusions Prevalent treatment-nonadherence among American BPD patients, and striking underestimation of the problem by prescribing clinicians may encourage increasingly complex treatment-regimens of untested value, but added expense, risk of adverse effects, and uncertain impact on treatment-adherence itself. Copyright © 2007 John Wiley & Sons, Ltd. [source] Health Economics Perspective of the Components of the Cardiometabolic SyndromeJOURNAL OF CLINICAL HYPERTENSION, Issue 7 2010Leonardo Tamariz MD J ClinHypertens (Greenwich). 2010;12:549,555. © 2010 Wiley Periodicals, Inc. The components of the cardiometabolic syndrome (CMS) increase the risk of coronary artery disease (CAD). The authors compared 12-month costs of subjects with different number of components of the CMS. In claims data from a large health benefits company, 383,420 individuals with the first International Classification of Diseases, Ninth Revision codes for hypertension, diabetes, lipid abnormalities, and obesity were identified. Patients were stratified according to presence of CAD and the number of components of the CMS. Twelve-month costs were added after the identification of the risk factor. Mean annual costs increased with the number of components of CMS both in those with and without CAD, even after adjusting for age, sex, and comorbidities (P<.01). Similar trends were seen for medical and pharmacy costs. The adjusted total annual health care cost in those with an isolated component of the CMS was $5564 (95% confidence interval: $5491,$5631) while in those with 4 components was $12,287 (95% confidence interval: $11,987,$12,587). Individuals with accumulating components of the CMS have higher health care costs regardless of age, sex, and other comorbidities. [source] Managing Hypertension: State of the ScienceJOURNAL OF CLINICAL HYPERTENSION, Issue 2006Jerome D. Cohen MD Hypertension management is both routine and a challenge. Updated guidelines emphasize the need to achieve increasingly stringent blood pressure goals to reduce cardiovascular morbidity and mortality; however, the blood pressure of many patients who have been diagnosed with hypertension is not well controlled. Treating prehypertension nonpharmacologically may preempt the progression to hypertension, whereas early and aggressive management of hypertension with antihypertensive agents reduces short- and long-term cardiovascular risk. Treatment decisions should follow current guidelines while evaluating recently published clinical studies. When choosing between agents from different therapeutic classes or combining agents, physicians should consider current and targeted blood pressure levels, the patient's demographic profile, the presence or absence of compelling cardiovascular and metabolic indications, other comorbidities, and concurrent medication(s). [source] Increased Fibronectin Expression in Lung in the Setting of Chronic Alcohol AbuseALCOHOLISM, Issue 4 2007Ellen L. Burnham Rationale: The incidence and severity of the acute respiratory distress syndrome (ARDS) is increased in individuals who abuse alcohol. One possible mechanism by which alcohol increases susceptibility to acute lung injury is through alterations in alveolar macrophage function and induction of tissue remodeling activity. Our objective was to determine whether alcohol abuse, independent of other comorbidities, alters fibronectin and metalloproteinase gene expression in alveolar macrophages and in epithelial lining fluid (ELF) of the lung. Methods: Otherwise healthy subjects with alcohol abuse (n=21) and smoking-matched controls (n=17) underwent bronchoalveolar lavage. Alveolar macrophage fibronectin and matrix metalloproteinase (MMP) mRNA expression were measured via reverse transcription-polymerase chain reaction. The supernatant from cultured alveolar macrophages and lung ELF were tested for their ability to induce fibronectin and MMP-9 gene transcription in cell-based assays. Results: Alveolar macrophages from subjects with alcohol abuse demonstrated increased fibronectin mRNA expression (p<0.001), and their ELF also elicited more fibronectin gene transcription in lung fibroblasts compared with controls (p<0.001). In contrast, alveolar macrophages from subjects with alcohol abuse had decreased MMP-9 and MMP-2 mRNA expression (p<0.03 and p<0.005, respectively). Similarly, the supernatant (p<0.001) and ELF (p<0.01) from these subjects induced less MMP-9 gene transcription in THP-1 cells. Discussion: Alcohol abuse is associated with increased fibronectin mRNA expression in alveolar macrophages and increased fibronectin-inducing activity in the ELF. This appears to be a specific effect as other tissue remodeling genes, such as MMPs, were not equally affected. These findings suggest activation of tissue remodeling that may contribute to the increased susceptibility for the ARDS observed in alcoholism. [source] Impact of hepatitis C virus infection and other comorbidities on survival in patients on dialysisJOURNAL OF VIRAL HEPATITIS, Issue 10 2007A. A. Butt Summary., The impact of hepatitis C virus (HCV) and other comorbid conditions upon survival is not well quantified in patients on dialysis. We identified HCV-infected and uninfected persons in the USRDS using claims data in 1997,1998 and followed until September 22, 2002 or death. We used Gray's time-varying coefficients model to examine factors associated with survival. Subjects with a renal transplant were excluded. A total of 5737 HCV-infected and 11 228 HCV-uninfected persons were identified. HCV-infected subjects were younger (mean age 57.8 vs 65.3 years), more likely to be male (57.6%vs 49.6%) and black (54.0%vs 36.4%). They were more likely to have a diagnosis of drug (16.5%vs 4.6%) and alcohol use (14.0%vs 3.1%), and to be human immunodeficiency virus (HIV) co-infected (7.4%vs 1.8%) (all comparisons, P < 0.0005). In an adjusted Gray's time-varying coefficient model, HCV was associated with an increased risk of mortality (P < 0.0005). The hazards were highest at the time of HCV diagnosis and decreased to a stable level 2 years after diagnosis. Other factors associated with increased risk of mortality were (P < 0.0005 unless stated) HIV coinfection; diagnosis of drug use (P = 0.001); coronary artery disease (P = 0.006); stroke; diabetes as the primary cause for renal failure; peripheral vascular disease; depression and presence of anaemia. HCV was associated with higher risk of death in patients on dialysis, even after adjusting for concurrent comorbidities. The risk was highest at the time of HCV diagnosis and stabilized over time. Clinical trials of HCV screening and treatment to reduce mortality in this population are warranted. [source] Parkinson's disease, stroke, and related epidemiologyMOVEMENT DISORDERS, Issue 11 2005Andrew Nataraj MD Abstract We investigated the prevalence of cerebrovascular disease and other comorbidities in Parkinson's disease (PD) patients compared to the general population. Five hundred PD patients were chosen randomly from one author's (A.H.R.) database. Age- and sex-matched controls were derived from 270 patients with essential tremor from the same database and from 490 patients in a general practitioner's database. Age, hypertensive status, smoking status, coronary artery disease, orthostatic hypotension, diabetes mellitus, and symptomatic cerebrovascular disease (stroke or transient ischemic attack) were assessed. Statistical analysis was performed using Pearson ,2 testing and binary logistic regression analysis. The prevalence of coronary artery disease, hypertension, diabetes mellitus, and orthostatic hypotension was similar among groups. The PD group had more patients who never smoked and less current smokers than the other groups. While there were similar frequencies of symptomatic cerebrovascular disease among groups, the prevalence of stroke was lower in PD patients. This difference disappeared upon stratification into groups based on smoking status and in the addition of smoking as a covariate in the multivariate analysis. Diminished smoking in PD patients likely plays a role in our finding of decreased stroke in patients with PD. Increased access to appropriate neurological care and subsequent prevention of stroke after a warning transient ischemic attack may also play a role, as may diminished levels of excitotoxic neurotransmitters in PD patients. © 2005 Movement Disorder Society [source] Impaired working memory in children with attention deficit hyperactivity disorder and their siblingsASIA-PACIFIC PSYCHIATRY, Issue 3 2010Kok Wei Wee MD (USM) MMED (PSY) (USM) Abstract Introduction: Impairment of working memory in children with attention deficit hyperactivity disorder (ADHD) has been well described. If similar impairment in working memory can be demonstrated among their siblings, this could suggest impaired working memory is a genetic component of ADHD. Methods: Fifty-seven subjects were recruited: (1) ADHD group (n=21); (2) siblings of ADHD children group (n=15); and (3) non-ADHD children with chronic medical condition as the control group (n=21). All subjects were aged between 6 and 15 years, and ADHD was diagnosed according to DSM-IV-TR. Those with other comorbidity or IQ<70 were excluded. Digit Recall was used for assessment of the phonological loop component, Maze Memory test for the visuospatial sketch pad component and Backward Digit Recall for the central executive component of working memory. Results: ADHD children and their siblings showed similar impairment and both differed from the control group on the Maze Memory test. ADHD children also showed impairment in the Digit Recall test; however, the sibling group did not differ from the control group on this test. The Backward Digit Recall score did not show any significant difference between the three groups. Discussion: Impairment of the visuospatial sketch pad component of working memory seems to cluster in ADHD children and their siblings. Thus, impairment of the visuospatial sketch pad component of working memory may point towards a genetic predisposition of ADHD. 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