Hypertension as a risk factor for diabetic neuropathy: a prospective study

The pathogeneses of diabetic neuropathy is still unclear. This study prospectively investigated the risk factors for distal symmetrical polyneuropathy (DSP) in a cohort of childhood-onset IDDM patients. Subjects from the Epidemiology of Diabetes Complications (EDC) Study were clinically examined at baseline and then biennially. DSP was diagnosed by a combination of clinical criteria, symptoms and signs (Diabetes Control and Complications Trial [DCCT] exam), and quantitative sensory threshold (QST). Among the 463 (70.4%) subjects who were free of DSP at baseline, 453 (97.8%) participated in at least one biennial reexamination during the first 6 years of follow-up and were included in the current analysis. A total of 68 (15.0%) subjects developed DSP in 6 years, giving a cumulative probability of 0.29. The Cox proportional hazards model shows that longer IDDM duration, hypertension, poor glycemic control, height, and smoking were all independent predictors of the incidence of DSP (all P < 0.0001, except for smoking for which P = 0.03). Hypertension showed the greatest impact on the development of DSP for individuals with either short or long IDDM duration. This study confirms some risk factors for DSP found in cross-sectional studies and suggests a strong relationship between hypertension and DSP. The results indicate that in addition to good glycemic control, avoidance of smoking and good blood pressure control may be helpful in preventing or delaying the onset of DSP in IDDM patients.     

Ultraviolet radiation as a risk factor on the Earth and outer space]

During 1996, representatives from two professional organizations, the American School Health Association and the National Association of School Nurses, met collaboratively to identify and rank order key questions regarding contemporary research needs about school nursing services. This article summarizes existing literature and proposes areas for research. Recommendations are offered for nurses, school health program administrators, educators of school nurses, professional organizations, and others who plan and provide health care for children and school-aged youth.     

Diabetes mellitus as a risk factor for atherosclerosis--a reminder of the facts]

Diabetes mellitus in all its forms is the pathological state, which includes the atherogenic mechanisms of intensive action. This results in a very significant increase of the incidence, morbidity and mortality due to atherosclerotic complications. Such negative relationship is observed since decades and everywhere. Atherosclerosis is the main case of death in the subpopulation of diabetics in the degree much higher than in the general population. Therefore the studies of the mechanisms of the atherogenic influence of diabetes mellitus also of the possibility of preventive and therapeutic interventions are of utmost importance. Many of such studies are documenting, that such interventions are effective in practice. Active prevention and early individual diagnosis of atherosclerotic risk appears as the affective approach. The bare fact of such possibility was reminded in the paper.     

Obesity as a metabolic risk factor

On the basis of the results of clinico-experimental examinations and of animal experiments the importance of obesity as metabolic factor of risk is confirmed and hereby the diabetes mellitus as well as cardiovascular effects are particularly taken into consideration. Conclusions are made relevant to practice and it is particularly referred to the central position of the B-cells for the pathogenesis of diabetes as well as to prophylactic and early therapeutic measures.     

Working hours as a risk factor for acute myocardial infarction in Japan: case-control study

OBJECTIVE: To clarify the extent to which working hours affect the risk of acute myocardial infarction, independent of established risk factors and occupational conditions. DESIGN: Case-control study. SETTING: University and general hospitals and routine medical examinations at workplaces in Japan. SUBJECTS: Cases were 195 men aged 30-69 years admitted to hospital with acute myocardial infarction during 1990-3. Controls were 331 men matched at group level for age and occupation who were judged to be free of coronary heart diseases at routine medical examinations in the workplace. MAIN OUTCOME MEASURES: Odds ratios for myocardial infarction in relation to previous mean daily working hours in a month and changes in mean working hours during previous year. RESULTS: Compared with men with mean working hours of >7-9 hours, the odds ratio of acute myocardial infarction (adjusted for age and occupation) for men with working hours of >11 hours was 2.44 (95% confidence interval 1.26 to 4.73) and for men with working hours of <=7 hours was 3.07 (1.77 to 5.32). Compared with men who experienced an increase of <=1 hour in mean working hours, the adjusted odds ratio of myocardial infarction for men who experienced an increase of >3 hours was 2.53 (1.34 to 4. 77). No appreciable change was observed when odds ratios were adjusted for established and psychosocial risk factors for myocardial infarction. CONCLUSION: There was a U shaped relation between the mean working hours and the risk of acute myocardial infarction. There also seemed to be a trend for the risk of infarction to increase with greater increases in mean working hours.     

Thrombolytic treatment of acute myocardial infarct. 3]

In a population of close to 2.5 million infants born from 1983 to 1993 registered in the California Birth Defects Monitoring Program, we compared the prevalence of structural birth defects among 2,894 infants with Down syndrome (DS) with that of infants without DS. Among 61 defects uniformly ascertained in affected and unaffected infants, 45 were significantly more common in DS, with atrioventricular canal (risk ratio = 1,009), duodenal atresia (risk ratio = 265), and annular pancreas (risk ratio = 430) being the most common. Most defects of blastogenesis and most midline defects were either nonsignificantly associated or not observed in infants with DS. Theories on the pathogenesis of defects in trisomies must account for the lack of and for the presence of specific defects.     

Anticardiolopin antibodies as a risk factor in stroke

The level of anticardiolipin antibodies (aCL) in sera of 53 patients with ischemic cerebrovascular disease aged 35-55 years with mean age 48.4 +/- 5.03, was studied using a solid phase enzyme immunosorbent assay (ELISA). The investigation was done half year after the ischemic stroke. The control group consisted of 21 healthy participants matched for age and sex. The presence of aCL was found in sera of 17 persons (32.1%), in 9 it was IgG class antibodies. It was indicated that the risk of repeated cerebral ischemic events was relatively higher in aCL positive patients than in aCL negative. Relapses were found in 6 aCL positive patients (35.3%) (in 5 cases from the group of 9 IgG positive) and in 2 persons (5.6%) aCL negative patients. The existence of aCL can be helpful to determine pathogenesis of the disease and its prognosis.     

Identifying acute pulpalgia as a factor in TMD pain

An acute pulpalgia and temporomandibular disorders can produce many of the same symptoms. To illustrate identification of an acute pulpalgia as a component in TMD, the authors review the evaluation of 11 patients at a clinic that specializes in TMD treatment. During the evaluation, thermal testing and periodontal ligament anesthesia were used to identify the offending tooth. After receiving endodontic treatment or having the tooth extracted, patients reported either complete or partial relief of TMD symptoms. The authors provide questions that may help practitioners identify a tooth with an acute pulpalgia as a contributing factor to TMD symptoms and suggest a technique to confirm this diagnosis.     

The surgical treatment of acute myocardial infarct in the 90s]

At present, the treatment for acute myocardial infarction is revascularization during the critical initial period of six hours after the beginning of coronary occlusion. Despite the fact that surgery performed within this time period presents a hospital of mortality around 2%, and with excellent results in the long term, it is seldom used due to logistic limitations and capabilities of hospital infrastructures, high costs and the possibility of the surgical team initiating surgery inside the useful time period. Surgery is thus limited to the patients with suitable anatomy, who are not candidates or had failure of thrombolytic/angioplasty therapy and are in the six-hour period after initiation of symptoms. Surgery performed at a later stage has good results if performed in a non emergency situation, specially after the first 72 hours. Surgery continues to be the only treatment for the mechanical complications of infarction, and good results have recently been shown in ventricular septal ruptures, with hospital mortality of 14%, due to the use of an endoventricular patch in patients operated early, before the consequences of low cardiac output develop at systemic level. In the surgical treatment of mitral regurgitation, the tendency has been to use repair techniques whenever possible, but still with hospital mortality up to 15%. The recent advances of the techniques and tactics of myocardial preservation during surgery have made a very significant contribution to the better results we see today.     

Radon as a risk factor for extra-pulmonary tumours

Most divers and diving medicine specialists know that application of normobaric oxygen as first aid after a bubble disease incident is highly effective. However, as yet technical difficulties acted as a deterrent to using normobaric oxygen at the diving site. This can now be overcome by a newer technique. To be efficient, any therapy of bubble disease should follow three main principles: maximal partial pressure of inhaled oxygen (i.e. 100 kpa in normobaric, and 280 kpa in hyperbaric conditions); minimal partial pressure of inhaled nitrogen, which should ideally be near zero; immediate start of therapy, if possible at the diving site, but not later than 2 hours after the onset of the first symptoms. However, it has to be borne in mind that for an efficient normobaric oxygenation (100%), the standard apparatus design without oxygen reservoir is obsolete, for it offers at most 40% oxygen to the lungs. Currently the following technical approaches for an efficient normobaric oxygenation are available: open one-way systems with tightly fitting mask and oxygen reservoir bag (type Ambu or Leardal, etc.); open systems with on-demand regulation and tightly fitting mouth piece (type SCUBA, or Bird-respirator); closed systems with CO2 absorber (type oxygen rebreathing diving gear). The closed system is a genuine technical advance, because it needs 15 times less oxygen than open systems (about 90 liters oxygen for a 3-hours oxygenation run). Such an apparatus is thus of light weight, far less cumbersome, and nevertheless highly efficient. The therapy should start immediately at the site of the mishap and be maintained during the transport to the next HBO-unit (usually 3 to 6 hours).(ABSTRACT TRUNCATED AT 250 WORDS)     

Parity as a risk factor for cancer cervix

PURPOSE: To analyze the likelihood of perioperative transfusion using the data of the abstracted patient discharge records. MATERIAL AND METHODS: It was studied the data of the records of the pediatric patients in whom were done surgical procedures for 1996. The abstracted patient discharge records are codified according the ICD-9-CM codes. RESULTS: 1,166 pediatric patients were operated, of whom were transfused 25 (2.1%). The transfusion rate was higher in patients less than 3 years old, who were operated with three o more surgical procedures simultaneously, who were admitted newly after the admittance here studied, and patients operated of spine, dorsolumbar spine, pharynx, thorax and mediastinum, central nervous system, colon, vessels and hip. CONCLUSIONS: Given the variability of the transfusion rate, to know it will allow a better planning of the surgical transfusions, the policy of the hospital blood bank and to increase the information to patient about the risk of the elective surgery.