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PubMed2002

Von Willebrand factor, fibrinogen and other risk factors of thrombosis in patients with a history of cerebrovascular ischemic stroke and their children.

BACKGROUND AND AIM: Von Willebrand factor (vWF) and fibrinogen (Fb) have recently emerged as plausible familial determinants of atherothrombosis. We investigated whether the vWF and Fb levels in patients with ischemic cerebrovascular stroke (ICS) correlate with those in their children. METHODS AND RESULTS: The study group consisted of 28 families (56 parents and 34 children) with one parent who had suffered an ICS at least three months before the study. All of the ICS patients had hyperlipoproteinemia and most arterial hypertension. The control group consisted of 15 families (30 parents and 20 children). The age of the parents and children did not exceed 55 and 16 years. The ICS parents had significantly higher vWF, Fb and protein C (PC) levels than the controls (vWF--fathers: 121.0 +/- 42.5% vs 79.2 +/- 23.4%; vWF--mothers: 110.7 +/- 40.1% vs 82.4 +/- 20.9%; Fb--fathers: 4.12 +/- 0.74 g/L vs 3.01 +/- 0.54 g/L; Fb--mothers: 3.64 +/- 0.84 gL vs 2.98 +/- 0.35 g/L; PC--fathers: 116.0 +/- 12.3% vs 105.6 +/- 13.7%; PC--mothers: 114.4 +/- 15.8% vs 105.0 +/- 12.2%). The children of the ICS parents had significantly higher PC and body mass index (BMI) values than the controls (PC: 102.6 +/- 13.7% vs 92.7 +/- 10.7%; BMI: 20.6 +/- 3.8 vs 17.8 +/- 3.5 Kg/m2), as well as an atherogenic lipid profile, higher blood pressure (BP) and a tendency toward higher vWF levels. Correlations between the ICS parents and their children were found for vWF, factor VIIc, low-density lipoprotein cholesterol, high-density lipoprotein cholesterol and BP, which were closer in the case of fathers. CONCLUSION: Regardless of gender, the parents with a history of ICS had a procoagulant state, with high levels of vWF, Fb and PC. In terms of inheritance, the most adverse risk factor profile was found in the children of ICS fathers.

Adult↗
PubMed1984

Geographic distribution of undocumented immigrants: estimates of undocumented aliens counted in the 1980 census by state.

"This article presents estimates of the number of undocumented aliens counted in the 1980 [U.S.] census for each state and the District of Columbia. The estimates, which indicate that 2.06 million undocumented aliens were counted in the 1980 census, are not based on individual records, but are aggregate estimates derived by a residual technique. The census count of aliens (modified somewhat to account for deficiencies in the data) is compared with estimates of the legally resident alien population based on data collected by the Immigration and Naturalization Service in January 1980." Estimates are provided "for each of the states for selected countries of birth and for age, sex, and period of entry categories.... The origins of the undocumented alien population [are described], as well as some of their demographic characteristics. Some of the implications of the numbers and distribution of undocumented aliens are also discussed." This paper was originally presented at the 1984 Annual Meeting of the Population Association of America (see Population Index, Vol. 50, No. 3, Fall 1984, p. 435).

Age Distribution↗
PubMedDate not supplied

Treatment of the collapsed femoral head by containment in Legg-Calve-Perthes disease.

One hundred ninety-seven patients with unilateral Legg-Calve-Perthes disease (LCPD) were followed-up to skeletal maturity. According to the lateral pillar classification, 142 hips were classified as group B and 55 hips as group C. Radiographs were evaluated for percent of collapse of the femoral head, Waldenstrom stage of disease at diagnosis, Mose sphericity, hinge abduction, lateral acetabular shape, and limb-length discrepancy. The hips were treated either by bedrest and traction in abduction (76), Petrie cast (21), abduction brace (74), or by pelvic or femoral osteotomy (26). One hundred twenty-five hips had less than a 2-mm difference in Mose sphericity at followup. According to the classification of Stulberg et al., 89 hips (45%) were class I, 57 (29%) were class II, 35 (18%) were class III, 12 (6%) were class IV, and 4 (2%) were class V. Analyses revealed statistically significant differences between group B versus group C with regard to the classifications of Stulberg et al. and Mose, lateral acetabular shape, age at onset, and limb-length discrepancy. There was no significant statistical difference with regard to the types of treatment. Containment treatment of a deformed femoral head from LCPD improves the sphericity of the hip and gives 63% satisfactory results according to the Mose classification and 74% satisfactory results according to the Stulberg et al. classification.

Age Distribution↗
PubMed2003

[High mortality due to infectious diseases and unnatural causes of death among asylum seekers in the Netherlands, 1998-1999].

OBJECTIVE: Description of causes of death among asylum seekers in the Netherlands compared to the Dutch standard population and identification of preventive measures to avoid preventable death. METHODS: An analysis of the causes of death of asylum seekers accommodated in housing facilities of the Central Organ Asylum seekers (COA) for the period 1998-1999 was performed. The primary cause of death was attributed using the International Classification of Diseases (ICD-10) and grouped according to the most important causes of death list issued by Statistics Netherlands. After stratification for gender and age standardised mortality ratios (SMR) were computed. RESULTS: In 82% of the observed deaths amongst asylum seekers a description of the cause and circumstances of death could be obtained. During the 2-year study period 156 asylum seekers died (of which 49 due to an unnatural cause of death and 15 due to infectious diseases). Fourteen stillbirths were registered in an index population of 37,688 in 1998 and 54,110 in 1999. The crude mortality rate was 1.95 per 1000 for male asylum seekers and 1.25 per 1000 for female asylum seekers. Compared to the Dutch standard population, the SMR was 1.23 (95%-CI: 1.01-1.42) for male asylum seekers and 0.85 (0.59-1.11) for female asylum seekers. The elevated mortality in male asylum seekers was due to the high mortality for infectious diseases with an SMR of 4.1 (1.3-6.9) and unnatural death with an SMR of 2.5 (1.7-3.2). More specifically, drowning had an SMR of 11.1 (2.3-20.7), murder and manslaughter 7.3 (2.5-12.0) and suicide 2.8 (1.5-4.1). AIDS accounted for half of the mortality due to infectious diseases. CONCLUSION: In 1998-1999, drowning, murder, manslaughter and suicide contributed significantly to an elevated mortality rate amongst male asylum seekers in the Netherlands. Some of these unnatural deaths could be avoided by implementing preventive measures.

Adolescent↗
PubMed2003

Risk index for predicting complications and prognosis in Thai patients with neutropenia and fever.

BACKGROUND: New strategies in the treatment of febrile neutropenic patients have been proposed during the past decade. It is more and more widely accepted that febrile neutropenic patients are a heterogeneous population and they have varying risks for complications and death. However, most of the data have been collected from patients in Western countries. The purpose of the study was to identify types of infection and etiologic organisms in febrile neutropenic patients at Siriraj Hospital, Thailand, and also to develop a prediction model in order to identify patients who are expected to have a favorable outcome or a low-risk subset. METHOD: The medical records of chemotherapy-induced neutropenic patients with fever hospitalized at Siriraj Hospital, Thailand, from January 1999 to December 2000 were analyzed. Data included patient characteristics, epidemiological data and the potential factors at the onset of fever for predicting patient outcome. A scoring system for predicting patients with favorable outcome was developed. The scoring system developed from this study was compared with a previously used scoring system. RESULTS: Of 220 patients with 267 febrile neutropenic episodes, 71.8 per cent had hematologic malignancies and 28.2 per cent had solid tumors. Bacteremia was found in 61 episodes (22.8%) and gram negative bacilli were the most common causative organism in bacteremia (88.6%). Overall mortality was 17.7 per cent. Multivariate analysis revealed that the factors predicting outcome were burden of illness, control of cancer, duration of neutropenia and dehydration. The scoring system developed from this set of data revealed that a score > or = 16 identified patients with a favorable outcome with a specificity of 90.2 per cent, sensitivity of 76.6 per cent and positive predictive value of 85.4 per cent. CONCLUSION: The causative organisms of bacterial infections in febrile neutropenic patients in Thailand are still gram negative bacteria. The locally developed risk index has a fair accuracy to identify patients with favorable outcome and may be used to identify patients suitable for less aggressive treatment strategies.

Adolescent↗
PubMedDate not supplied

Inflammation, infection and cardiovascular events in chronic hemodialysis patients: a prospective study.

BACKGROUND: Cardiovascular (CV) disease is the leading cause of morbidity and mortality in chronic hemodialysis (HD) patients. Inflammation is a potent risk factor for CV disease in the general population. Recent evidence suggests infection, particularly with agents such as Chlamydia pneumoniae (C.pneumoniae) and Helicobacter pylori (H.pylori), as a source of sustained inflammation. Our study tested the hypothesis that C-reactive protein (CRP) and positive serology for antibodies to C.pneumoniae and H.pylori can be associated with the occurrence of new CV events in chronic HD patients. METHODS: We evaluated 76 chronic HD patients (33 women and 43 men, aged 60.5+/-17.3 years) by measuring baseline CRP levels as well as the titres of antibodies (IgG and IgA) to C.pneumoniae and(IgG) to H.pylori. In addition, risk factors such as hypertension, smoking, diabetes, cholesterol levels and albumin were assessed at baseline. The incidence of new CV events (myocardial infarction and ischemic stroke) was recorded during a 36-month follow-up period. The effect of prognostic factors was evaluated by logistic regression analysis. RESULTS: The incidence of CV events was significantly higher in patients seropositive for C.pneumoniae antibodies than in those seronegative (16.1 vs. 4.3 events/100 patient-years, p=0.017, risk ratio 3.76), whereas it did not differ for H.pylori (12.2 vs. 11.7 events/100 patient-years,p=0.91, risk ratio 1.04). Logistic regression analysis showed C.pneumoniae seropositivity (odds ratio 10.11, p=0.04) and CRP levels (odds ratio 1.78, p=0.03) to be independent predictors of the occurrence of CV events. CONCLUSIONS: CRP levels and C.pneumoniae antibodies, but not H.pylori antibodies, were predictors of CV morbidity in the chronic HD patients studied.

Adult↗
PubMed2003

The changing trends of adult Hodgkin's disease in Saudi Arabia.

OBJECTIVE: Hodgkin's disease is one of the most common malignant lymphomas affecting the younger population. This disease has diversified pathologies and clinical stages that necessitate a well optimized clinical management. Regular updating of epidemiological behavior of Hodgkin's disease is obvious from various parts of the world; however, studies from the Kingdom of Saudi Arabia (KSA) in this field are scanty and more than a decade old. The aim of this study was to investigate the current trends in presentation and distribution of Hodgkin's disease with special reference to gender, age, histopathological subtypes, and clinical stages of this disease in Saudi patients. METHODS: A total of 142 Hodgkin's disease patients attending 2 referral hospitals (King Khalid University Hospital and Security Forces Hospital) in Riyadh, KSA, were included in this study. The records from the questionnaires were analyzed retrospectively for determining the trends of Hodgkin's disease in Saudi adults, over a period of 15 years (1985-2000). RESULTS: There were 86 males and 56 females, with a male to female ratio of 1.53:1. The mean age of the patients was 28.63 years, while most of the patients were <40 years (80.3%). Nodular sclerosis was the most frequent pathology. Presence of B symptoms had a significant correlation with histology type as well as clinical stage of Hodgkin's disease. Time course analysis showed the increasing trend of Hodgkin's disease frequency, especially in younger adults. The rate of nodular sclerosis continued to increase during the entire course of study whereas the frequency of other histology types showed a decreasing trend during 1992-2000. CONCLUSION: To the author's knowledge, this is the largest case series of adult Hodgkin's disease from KSA. The results of this study revealed a different pattern of Hodgkin's disease as compared to earlier studies reported from this region. These findings provide valuable insights in the understanding of current epidemiological features of Hodgkin's disease in KSA.

Adolescent↗
PubMedDate not supplied

Th2-mediated atopic disease protection in Th1-mediated rheumatoid arthritis.

OBJECTIVE: The balance between CD4+ T-helper (h) cell subsets (Th1 and Th2) plays an important role in the pathogenesis of rheumatoid arthritis (RA) and atopy. While RA is believed to be a Th1 mediated disease, Th2 cells predominate in atopic disorders. The purpose of this study was to investigate differences in the occurrence of allergy, hay fever, house dust mite sensitivity and asthma, as well as total serum IgE levels in RA patients and controls. METHODS: The case history of atopic disorders was assessed in 134 RA patients and compared to those found in 305 healthy blood donors. RA patients also answered clinical questions concerning disease activity and severity. Total serum IgE levels were measured in both groups, taking into consideration disease modifying therapy. RESULTS: A significantly lower occurrence of medical history of hay fever (2.3%) and house dust mite sensitivity (3.1%) was found among RA patients compared to controls (24.2% and 12.2%, respectively; p < 0.0001 and p < 0.003 respectively). Moreover, RA patients had significantly lower total serum IgE levels than control subjects (p < 0.0001). RA was less severe in patients with atopy compared to non-atopic RA patients. CONCLUSION: These results support the concept that RA and atopy antagonize each other and that a change in the cytokine patterns of Th1 and Th2 cells could provide an indication for curative effects on RA.

Age Distribution↗
PubMed2003

Prevalence of cryoglobulinemia and serological markers of autoimmunity in human immunodeficiency virus infected individuals: a cross-sectional study of 97 patients.

OBJECTIVE: Autommune diseases could constitute one emerging cause of morbidity in patients infected with human immunodeficiency virus (HIV) due to the chronicity of the infection and to the high level of B cell stimulation induced by HIV. We conducted a cross-sectional study investigating the clinical and biological signs of autoimmunity in HIV infected patients. METHODS: We studied the following plasma immunological variables: antinuclear antibodies (ANA) and antibodies to extractable nuclear antigens, antiphospholipids, anticardiolipins (aCL), antineutrophil cytoplasmic antibodies (ANCA), rheumatoid factor (RF), cryoglobulinemia, total complement, and C4 factor. HIV-RNA, CD4+ cell count, and serological status for hepatitis B (HBV) and C virus (HCV) were also studied. Clinical signs of autoimmune diseases were noted. RESULTS: In total, 97 patients were investigated (men 74%). Median age was 38 years (range 20-64). Median CD4+ count and HIV-RNA were 333/mm3 and 1662 copies/ml, respectively. Coinfection by HBV and HCV was present in 7% and 64% of the patients. In patients with HIV only, we detected cryoglobulinemia in 17% of patients, a positive RF in 19%, ANA > 1/100 in 21%, aCL in 51%, and ANCA > 1/20 in 17% (most of them type C by ELISA). There was a trend for a higher level of cryoglobulinemia and aCL in patients having CD4 lymphocyte counts > 350/mm3 than in others (25% vs 11%, p = 0.26, and 63% vs 42%, p = 0.23, respectively). Patients coinfected with HCV had a higher prevalence of cryoglobulinemia than HCV-free patients (42% vs 17%; p = 0.01). Prevalence of other immunological abnormalities was not different between patients with HIV only and HCV coinfected patients. Thirty patients expressed at least one clinical sign compatible with autoimmune disease. Patients with cryoglobulinemia more often had coinfection with HCV (OR 6.64, 95% CI 1.87-23.57) and IgM > 1.9 g/l (OR 6.16, 95% CI 2.15-17.67). CONCLUSION: Humoral immunological abnormalities are frequent in patients with HIV, but are rarely associated with severe clinical signs.

Adult↗
PubMed1995

[Spontaneous intracerebral hemorrhage: case histories].

Spontaneous intracerebral hemorrhage is a significant cause of morbidity and mortality. The disease primarily affects men between the age of 45 to 75 years. Arterial hypertension is the most frequent etiologic factor. Here is presented a case-record of 148 intracerebral hemorrhages observed during a five years period. Several clinical and radiological features have been correlated and analyzed from a statistical point of view. The most important prognostic factor is the state of consciousness. Either deep coma and a normal state of consciousness do not represent surgical indications.

Adult↗
PubMed1995

Modulation of occlusal plane during puberty.

The biological significance of the occlusal plane is of tremendous importance in the study of the etiology, diagnosis and treatment of malocclusion. The purpose of this investigation was to correlate the changes on the occlusal plane of patients in treatment with functional appliances and the subjects with no need of treatment during the prepubertal and pubertal period. Data on the space between the upper and lower occlusal lines-Interocclusal Distance (IOD) was obtained periodically. Some remarks about which changes are naturally provoked or not are very useful in the treatment of malocclusions and the evaluation of the occlusal plane in cases that do not need treatment.

Adolescent↗
PubMed1995

Periodontal findings in cases of incisor cross-bite.

The effect of cross-bite on periodontal health in the anterior teeth was investigated in 40 teenage subjects. The results have shown a relationship between the cross-bite in the anterior teeth and periodontal health as assessed by Plaque Index, Gingival index and pocket depth measurements. The periodontal status of the teeth in cross-bite revealed a more unfavorable condition compared to the well-aligned teeth. This was observed in both males and females. However, pocket depth on the lingual site for both sexes does not reach a significant difference between the cross-bite and the control teeth.

Child↗