Lessons born of tragedy.
J Fam Pract. 2016 Jul;65(7):436
Authors: Hickner J
Violence and discrimination, like chronic disease, seem to be permanent fixtures on the human landscape. What can we do to prevent and mitigate these evils?
PMID: 27565093 [PubMed - indexed for MEDLINE]
Non-alcoholic fatty liver disease: What's in our arsenal?
J Fam Pract. 2016 Apr;65(4):239-44
Authors: Dasarathy J, Allampati S, Alexander C, McCullough A
Lifestyle changes and metabolic syndrome management are the best interventions for NAFLD. Less clear is which agents to use for liver-directed pharmacotherapy.
PMID: 27262247 [PubMed - indexed for MEDLINE]
Dietary Approaches to Stop Hypertension (DASH) Dietary Pattern Is Associated with Reduced Incidence of Metabolic Syndrome in Children and Adolescents.
J Pediatr. 2016 Jul;174:178-184.e1
Authors: Asghari G, Yuzbashian E, Mirmiran P, Hooshmand F, Najafi R, Azizi F
OBJECTIVE: To assess the association of adherence to Dietary Approaches to Stop Hypertension (DASH)-style diet with development of metabolic syndrome (MetS) in children and adolescents.
STUDY DESIGN: Dietary data were collected using a valid and reliable food frequency questionnaire among 425 healthy subjects, aged 6-18 years. MetS was defined as the presence of at least 3 of the following according to the Cook criteria: waist circumference ≥90th percentile for sex and age according to national reference curves; systolic blood pressure and/or diastolic blood pressure ≥90th percentile for sex, age, and height; fasting plasma glucose ≥100 mg/dL; triglycerides ≥110 mg/dL; and high-density lipoprotein cholesterol <40 mg/dL. The DASH-style diet score was assessed based on 8 components: high intakes of whole grain, vegetables, fruits, nuts, legumes; moderate amounts of low-fat dairy products; and low intake of red and processed meat, sweetened beverages, and sodium. Multivariable logistic regression models were used to estimate the OR and 95% CI after 3.6 years of follow-up for developing MetS in each quartile of DASH score after adjustment for baseline confounders.
RESULTS: Mean ± SD for age and DASH score were 13.6 ± 3.7 years and 24.1 ± 4.3, respectively, at baseline. The OR (95% CI) of developing MetS in the highest, compared with the lowest, quartile of DASH score was 0.36 (0.14-0.94) with a linear decreasing trend (P for trend = .023). Also, incidence of hypertension, high fasting plasma glucose, and abdominal obesity decreased with higher adherence to DASH diet (P < .05 for all).
CONCLUSIONS: Our findings indicate the relationship of adherence to DASH-style diet with MetS and some of its components in both children and adolescents.
PMID: 27156186 [PubMed - indexed for MEDLINE]
Serum levels of vascular dysfunction markers reflect disease severity and stage in systemic sclerosis patients.
Rheumatology (Oxford). 2016 Jun;55(6):1112-6
Authors: Cossu M, Andracco R, Santaniello A, Marchini M, Severino A, Caronni M, Radstake T, Beretta L
OBJECTIVE: To improve knowledge of vasculopathy in SSc through the assessment of serum levels of circulating angiogenetic and endothelial dysfunction markers in patients at different stages of the disease.
METHODS: Sera from 224 subjects were obtained and concentrations of angiopoietin-2, chemokine (C-X-C motif) ligand (CXCL)-16 (CXCL16), E-selectin, soluble intercellular adhesion molecule-1, IL-8 (CXCL8), soluble vascular adhesion molecule-1 and VEGF were determined by a Luminex assay. Subjects included 43 healthy controls, 47 early SSc patients according to LeRoy and Medsger without other signs and symptoms of evolutive disease, 48 definitive SSc (defSSc) patients according to the 2013 ACR/EULAR criteria without skin or lung fibrosis, 51 lcSSc subjects and 35 dcSSc subjects.
RESULTS: The four groups of patients showed well-distinct clinical and laboratory characteristics, with a linear decreasing trend in forced vital capacity and diffusing capacity for carbon monoxide % predicted values from early SSc to defSSc to lcSSc and to dcSSc, and a linear increasing trend in ESR, and in the prevalence of abnormal CRP, serum gamma globulins and lung fibrosis (all P < 0.0001). Highly significant linear trends pointing to an increase in angiopoietin-2 (P < 0.0001), CXCL16 (P < 0.0001), E-selectin (P = 0.001) and soluble intercellular adhesion molecule-1 (P = 0.002) in relation to the different disease subsets were observed.
CONCLUSION: Markers characterizing vascular activation are found to be increased in SSc patients from the earliest stages of disease when clinical and laboratory findings of advanced disease cannot yet be detected. These abnormalities progress with the appraisal of the first sclerodermatous manifestation in defSSc and further increase with the onset of fibrotic manifestations.
PMID: 26989111 [PubMed - indexed for MEDLINE]
Subcutaneous Immunoglobulin in Refractory Juvenile Dermatomyositis.
Pediatrics. 2016 Apr;137(4):
Authors: de Inocencio J, Enríquez-Merayo E, Casado R, González-Granado LI
Juvenile dermatomyositis (JDM) is the most common form of juvenile idiopathic inflammatory myopathy. We report a child with steroid-dependent JDM refractory to hydroxychloroquine and subcutaneous methotrexate who experienced systemic reactions to intravenous immunoglobulin and was successfully treated with subcutaneous immunoglobulin. This form of therapy has been shown to be safe, has a very low rate of adverse effects, does not require hospital admission, reduces the number of missed school days, and decreases the costs associated with treatment.
PMID: 26966131 [PubMed - indexed for MEDLINE]