Novosibirsk, Russia
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PubMed | University of the Republic of Uruguay, University of California at Irvine, Steno Diabetes Center, Copenhagen University and 12 more.
Type: Journal Article | Journal: Journal of the American College of Cardiology | Year: 2016

The role of white-coat hypertension (WCH) and the white-coat-effect (WCE) in development of cardiovascular disease (CVD) risk remains poorly understood.Using data from the population-based, 11-cohort IDACO (International Database on Ambulatory Blood Pressure Monitoring in Relation to Cardiovascular Outcomes), this study compared daytime ambulatory blood pressure monitoring with conventional blood pressure measurements in 653 untreated subjects with WCH and 653 normotensive control subjects.European Society Hypertension guidelines were used as a 5-stage risk score. Low risk was defined as 0 to 2 risk factors, and high risk was defined as3 to 5 risk factors, diabetes, and/or history of prior CVD events. Age- and cohort-matching was done between 653 untreated subjects with WCH and 653 normotensive control subjects.In a stepwise linear regression model, systolic WCE increased by 3.8 mmHg (95% confidence interval [CI]: 3.1to 4.6 mmHg) per 10-year increase in age, and was similar in low- and high-risk subjects with or without prior CVDevents. Over a median 10.6-year follow-up, incidence of new CVD events was higher in 159 high-risk subjects with WCH compared with 159 cohort- and age-matched high-risk normotensive subjects (adjusted hazard ratio [HR]: 2.06; 95% CI: 1.10 to 3.84; p= 0.023). The HR was not significant for 494 participants with low-risk WCH and age-matched low-risk normotensive subjects. Subgroup analysis by age showed that an association between WCH and incident CVD events is limited to older (age60 years) high-risk WCH subjects; the adjusted HR was 2.19 (95% CI: 1.09 to 4.37; p=0.027) in the older high-risk group and 0.88 (95% CI: 0.51 to 1.53; p= 0.66) in the older low-risk group (pforinteraction= 0.044).WCE size is related to aging, not to CVD risk. CVD risk in most persons with WCH is comparable to age-and risk-adjusted normotensive control subjects.


Linkov F.,University of Pittsburgh | Shubnikov E.,Institute of Internal Medicine | Padilla N.,University of Guanajuato | McCallum A.,NHS Lothian | LaPorte R.,University of Pittsburgh
Public Health | Year: 2012

The focus of this symposium was worldwide prevention of chronic disease through the use of inexpensive Internet pathways, as demonstrated with the Supercourse project, and other initiatives, including promoting mobile phone technology (m-health). This symposium highlighted the need to use the Supercourse to prevent cancer and other chronic diseases. It also highlighted several components of the Supercourse library, including the former Soviet Union network, the Latin American network, and some other initiatives. © 2011 The Royal Society for Public Health.


Stolarz-Skrzypek K.,Catholic University of Leuven | Stolarz-Skrzypek K.,Jagiellonian University | Kuznetsova T.,Catholic University of Leuven | Thijs L.,Catholic University of Leuven | And 13 more authors.
JAMA - Journal of the American Medical Association | Year: 2011

Context: Extrapolations from observational studies and short-term intervention trials suggest that population-wide moderation of salt intake might reduce cardiovascular events. Objective: To assess whether 24-hour urinary sodium excretion predicts blood pressure (BP) and health outcomes. Design, Setting, and Participants: Prospective population study, involving 3681 participants without cardiovascular disease (CVD) who are members of families that were randomly enrolled in the Flemish Study on Genes, Environment, and Health Outcomes (1985-2004) or in the European Project on Genes in Hypertension (1999-2001). Of 3681 participants without CVD, 2096 were normotensive at baseline and 1499 had BP and sodium excretion measured at baseline and last follow-up (2005-2008). Main Outcome Measures: Incidence of mortality and morbidity and association between changes in BP and sodium excretion. Multivariable-adjusted hazard ratios (HRs) express the risk in tertiles of sodium excretion relative to average risk in the whole study population. Results: Among 3681 participants followed up for a median 7.9 years, CVD deaths decreased across increasing tertiles of 24-hour sodium excretion, from 50 deaths in the low (mean, 107 mmol), 24 in the medium (mean, 168 mmol), and 10 in the high excretion group (mean, 260 mmol; P<.001), resulting in respective death rates of 4.1% (95% confidence interval [CI], 3.5%-4.7%), 1.9% (95% CI, 1.5%-2.3%), and 0.8% (95% CI, 0.5%-1.1%). In multivariable-adjusted analyses, this inverse association retained significance (P=.02): the HR in the low tertile was 1.56 (95% CI, 1.02-2.36; P=.04). Baseline sodium excretion predicted neither total mortality (P=.10) nor fatal combined with nonfatal CVD events (P=.55). Among 2096 participants followed up for 6.5 years, the risk of hypertension did not increase across increasing tertiles (P=.93). Incident hypertension was 187 (27.0%; HR, 1.00; 95% CI, 0.87-1.16) in the low, 190 (26.6%; HR, 1.02; 95% CI, 0.89-1.16) in the medium, and 175 (25.4%; HR , 0.98; 95% CI, 0.86-1.12) in the high sodium excretion group. In 1499 participants followed up for 6.1 years, systolic blood pressure increased by 0.37 mm Hg per year (P<.001), whereas sodium excretion did not change (-0.45 mmol per year, P=.15). However, in multivariable-adjusted analyses, a 100-mmol increase in sodium excretion was associated with 1.71 mm Hg increase in systolic blood pressure (P.<001) but no change in diastolic BP. Conclusions: In this population-based cohort, systolic blood pressure, but not diastolic pressure, changes over time aligned with change in sodium excretion, but this association did not translate into a higher risk of hypertension or CVD complications. Lower sodium excretion was associated with higher CVD mortality. ©2011 American Medical Association. All rights reserved.


PubMed | Prof. of Medicine., Post Graduate., Bernard Institute of Radiology and Institute of Internal Medicine
Type: Case Reports | Journal: The Journal of the Association of Physicians of India | Year: 2016

Ivemark syndrome or right atrial isomerism is a rare syndrome of asplenia / hyposplenia with malformation of heart and abnormal arrangement of internal organs of chest and abdomen and is classified under heterotaxy disorder. We describe here the case of a 14 year old boy diagnosed with asplenia, dextrocardia with double outlet right ventricle and midline liver.


Rajendiran C.,Institute of Internal Medicine
The Journal of the Association of Physicians of India | Year: 2012

Bee stings are commonly encountered worldwide. Various manifestations after bee sting have been described. Local reactions are common. Unusually, manifestations like vomiting, diarrhea, dyspnea, generalized edema, acute renal failure, hypotension and collapse may occur. Rarely vasculitis, serum sickness, neuritis and encephalitis have been described which generally develop days to weeks after a sting. We report a case of a 25-year-old male who developed left sided monoparesis and transient visual loss following multiple bee stings. Unlike the previous case reports, in our case there has been involvement of both the anterior circulation and posterior circulation territory to the brain. We report this case due to it's rarity.


Vancsa A.,Debrecen University | Gergely L.,Debrecen University | Ponyi A.,Semmelweis University | Lakos G.,Debrecen University | And 3 more authors.
Joint Bone Spine | Year: 2010

Objective: The current study was performed in order to determine the prevalence of different myositis-specific and myositis-associated antibodies, as well as their association with clinical characteristics, disease course and response to therapy in 169 Hungarian patients with idiopathic inflammatory myopathy. Methods: Sera of 130 primary and 39 overlap myositis including systemic sclerosis (13), rheumatoid arthritis (12), systemic lupus erythematosus (5) and Sjögren's syndrome (9) cases were analyzed. Antinuclear antibody, scleroderma-associated antibodies (anti-centromere, anti-topoisomerase I), anti-Jo-1, anti-PL-7, anti-PL-12, anti-Mi-2, anti-SRP and anti-PM-Scl, anti-Ku, anti-SS-A, anti-SS-B, anti-U1snRNP were tested. Autoantibody results were compared with clinical characteristics, disease course of overlap versus primary myositis patients, as well as with response to therapy. Results: Associated connective tissue disease occurred in 23.1% of the patients. Myositis-associated antibodies were found in 8.5% of primary myositis patients, indicating that 11 additional primary myositis patients (23% vs. 29.6%) can be classified as overlap in all cohort according to the newly proposed diagnostic criteria. Polymyositis was found to be the most common myositis form in overlap myositis (87.2%), while scleroderma was the most common disease associated (33.3%). ANA was positive in 25.4% of primary and in 61.5% of overlap myositis cases. Altogether 39.6% of myositis patients (n = 67) had autoantibodies, most commonly anti Jo-1 (18.3%) correlating with a polycyclic disease course. Conclusion: Inclusion of myositis-specific and associated antibodies into the newly proposed diagnostic criteria for inflammatory myopathies is of great importance in order to determine subclasses and to introduce adequate therapy in time. © 2010 Société française de rhumatologie.


Bazila Banu A.,Velammal College of Engineering and Technology | Appavu Alias Balamurugan S.,k-Technology | Thirumalaikolundu Subramanian P.,Institute of Internal Medicine
Journal of Biological Sciences | Year: 2013

In this study detection of association between drugs and Adverse Drug Reactions (ADRs), is carried out by using Naive Bayes method. Adverse event reports submitted to the United States Food and Drug Administration (FDA) were reviewed to find top 10 drugs causing frequent ADRs for a particular period. The main objective of this paper is to evaluate drugs associated with list of outcomes provided by FDA. For a particular category of disease, drugs creating outcomes are ranked using Naive Bayes method. FDA represents ADRs in Preferred Terms(PT) by referring Medical Dictionary for Regulatory Activities (MedDRA). To create conceptual hierarchy System Organ Class (SOC) present in MedDRA is mapped with low level Preferred Terms (PT) in FDA dataset. For each SOC the drugs are ranked based on posterior probability obtained by Naive Bayes method. Data mining model has been built to analyse drugs associated with outcome for a disease category in SOC level. The newly designed tool is user friendly and applicable to pharmaceutical industries, policy makers and practitioners. © 2013 Asian Network for Scientific Information.


Puvanalingam A.,Institute of Internal Medicine | Rajendiran C.,Institute of Internal Medicine | Sivasubramanian K.,Institute of Internal Medicine | Ragunanthanan S.,Institute of Internal Medicine | And 2 more authors.
Journal of Association of Physicians of India | Year: 2011

Objectives: To study the clinical profile of the H1N1 influenza cases attending government hospitals in South India and to study the impact of H1N1 infection on pregnancy ou tcome. Materials and Methods: A total number of 442 H1N1 positive patients (198 inpatients and 244 outpatients) from two government hospitals in Chennai, Madras Medical College & Government General Hospital and Institute of Child Health, Egmore were studied retrospectively during a period of 6 months from August 2009 to January 2010. Results: The rate of reported cases and hospitalization rates was highest among individuals aged 5 to 24 years. H1N1 cases were equally distributed in both the sexes in the adult population In our study 86.92% percent of patients with pandemic H1N1 influenza A met the case definition for influenza like illness (subjective fever plus cough and/or sorethroat). Similar to the western data bronchial asthma,pulmonary tuberculosis were found to risk factors for complications in H1N1 infection. The overall mortality rate was 1.8% and the most common cause of death in patients was due to pneumonia. Ventilator requirement was associated with poor prognosis in H1N1 patients. P value <0.01. The percentage of persons > 65 years who were affected was far less ie 0.67% which is quite unusual in the case of seasonal flu. H1N1 pnuemonia was found to involve predominantly the lower lobe of lung. (p value <0.01).The mortality rate among pregnant women with H1N1 infection was 25% and the fetal loss rate was 16.67%. There was an increased risk of H1N1 influenza infection during the third trimester of pregnancy. (p value-0.027) Conclusions: Individuals with comorbid conditions, pregnancy were found to be severely affected. Hence individuals with risk factors need to be protected by v accination. © JAPI.


Meenakshisundaram R.,Institute of Internal Medicine | Sweni S.,Debrecen University | Thirumalaikolundusubramanian P.,Chennai Medical College Hospital
Pediatric Cardiology | Year: 2010

Cardiac involvement in children with human immunodeficiency virus (HIV)/acquired immune deficiency syndrome (AIDS) is known but less often considered. Our objectives were to determine cardiac manifestations in pediatric HIV/AIDS and estimate the cardiac isoform of alpha-2 macroglobulin [CA2M] among them. We recruited 67 pediatric HIV/AIDS patients, 37 with cardiac involvement (group A) and 30 without (group B); 30 cardiac patients without HIV infection (group C); and 30 healthy control subjects without any comorbid illness (group D). Their sociodemographic and clinical information were collected along with echocardiogram and blood for CA2M. Patterns of cardiac involvement in HIV/AIDS (group A) were pericardial effusion, left ventricular dysfunction, pulmonary hypertension, and cardiomyopathy and observed in 43, 30, 16, and 11% of subjects, respectively. CA2M levels among groups A, B, C, and D were 132.67 ± 5.01, 41.25 ± 3.33, 65.99 ± 2.48 and 29.59 ± 2.76 lgm/ml, respectively. It was elevated significantly in group A (P = 0.001; 95% confidence interval [CI] 87.27-95.55) compared with group B and was independent of sex and CD4 count among HIV/AIDS subjects. Although CA2M was elevated in HIV-negative patients with cardiac involvement, it was much less than in HIV/AIDS subjects with cardiac involvement (P = 0.001; 95% CI 62.54-70.82). Because CA2M is a cardiac biomarker, further research with larger population is needed to ascertain the role of CA2M as a diagnostic/therapeutic/prognostic marker in cardiac patients with and without HIV infection. © Springer Science+Business Media, LLC 2009.


Chitra S.,Institute of Internal medicine | Latha K.V.S.,Institute of Internal medicine | Jubilee,Institute of Internal medicine
Journal of Association of Physicians of India | Year: 2012

Objective: We describe a case of Wernicke's encephalopathy associated with visual loss that was caused by hyperemesis gravidarum. Methods: A 25 year old lady in her 20th week of her pregnancy consulted us. She had history of nausea and vomiting for 3 months with resultant weight loss. She now presented with sub-acute onset of visual loss in both her eyes, and gait disturbance with unsteadiness. Upon ophthalmologic examination she was found to have a visual acuity of 6/60 in both eyes; abduction restriction, nystagmus and retinal hemorrhages and macular oedema in both eyes. She also had truncal, stance and gait ataxia. Results: She was treated with parenteral thiamine and her visual loss reversed and her ataxia improved dramatically. magnetic resonance imaging (mRI) brain with diffusion weighted imaging showed findings consistent with Wernicke's Encephalopathy. Conclusion: Wernicke's Encephalopathy can occur in many hitherto under-recognised clinical scenarios associated with inadequate oral intake like hyperemesis gravidarum, after gastric bypass surgeries and those on total parenteral nutrition. Visual loss is increasingly being recognized as the additional, reversible feature of Wernicke's Encephalopathy. The changes that occur on mRI brain, especially on the diffusion weighted images, are characteristic and considered diagnostic of Wernicke's Encephalopathy. © JAPI.

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