Carotid intima media thickness in type 2 diabetes mellitus with ischemic cerebrovascular stroke and its utility as a marker for predicting cerebrovascular disease

Background:In India, the national prevalence of diabetes mellitus (DM) is estimated at 18.2%. More than half of all diabetic deaths are accounted for by atherosclerotic disease leading to cardiovascular or cerebral complications. Intima media thickness (IMT), a measure of atherosclerotic vascular disease. It can easily be measured especially at the carotids by B mode ultrasonography, a relatively simple way representing a safe, precise, and reproducible measure. It has therefore been proposed as a non-invasive measure of predicting chances of cerebrovascular disease burden in adults. Methods:A total of 60 subjects in the age group of 30-75 years (M:F=37:23) were selected and divided into three groups, group C: Patients of either sex in the age group of 30-75 years with type 2 DM (T2DM) with or without hypertension with ischemic stroke demonstrated on CT scan. Group B: Age-matched T2DM patients of either sex without any prior history of transient ischemic attack or stroke. Group A: Age-matched normal individuals of either sex. The following groups of diabetic patients with stroke were excluded from our study: cardioembolic stroke, patients with hemorrhagic stroke, and patients with stroke due to secondary causes like trauma, impaired coagulation or tumor.Results: Average mean common carotid artery IMT (CCA-IMT) ranged from 0.72 to 0.97 mm across cohorts in people with diabetes.Patients with T2DM with ischemic stroke were found to have significantly higher prevalence of increased CIMT and a value greater than 0.8 mm was found to be associated with the occurrence of stroke. The mean CIMT was significantly higher in diabetic subjects compared to healthy subjects.Conclusions: A high CIMT is a surrogate and reliable marker of higher risk of cerebrovascular accidents amongst type 2 diabetic patients. Our study demonstrates the utility of carotid IMT as a simple non-invasive screening test for the assessment of atherosclerosis risk/prognosis in T2DM.

Posttransplant epithelioid inflammatory myofibroblastic sarcoma: A case report

Epithelioid inflammatory myofibroblastic sarcoma (EIMS) is a rare entity and a novel variant of inflammatory myofibroblastic tumor (IMT), usually seen in children and nonsmoking young adults. Their occurrence in a posttransplant setting is still rare. These tumors are characterized by prominent epithelioid morphology, large histiocytoid “Reed Sternberg”-like cell, unique pattern of ALK immuno-reactivity, and aggressive clinical behavior. Their etiology and metastatic potential is controversial. In a post-transplant setting, many factors such as trauma, infections with EBV, HIV, Hepatitis C, mycobacteria, fungus, and chemotherapy-induced immunosuppression have been implicated in their etiology. We present the case of a 2-year-old female child who developed multiple omental and mesenteric tumor nodules, 8 months post liver transplant for progressive familial intrahepatic cholestasis (PFIC). Following a histopathological diagnosis of “mesenchymal neoplasm of possible malignant nature” on a trucut biopsy and frozen section, tumor debulking was performed. A final histological diagnosis of EMIS was made on the completely resected tumor. The patient remains in remission nearly 7 months after presentation, without any follow-up systemic chemotherapy. IMT after a solid organ transplant is rare, only 5 cases have been reported in the literature until now. Similar phenomenon has also been noted with hematopoietic stem cell transplant. However, to our knowledge, this case of EMIS in a post liver transplant patient is first of its kind.

Effect Of Threshold Inspiratory Muscle Training Versus Incentive Spirometry In Upper Abdominal Surgeries: A Comparative Study

Background: Surgical care has a role in treating a broad spectrum of diseases in the alleviation of human suffering. Upper abdominal surgery included gastrectomy, pancreatectomy, hepatic resection, cholecystectomy and splenectomy. Maximal inspiratory pressure (Pimax) is an important indicator for assessing the strength of inspiratory muscles. Respiratory muscle training devices enhance respiratory muscle strength, endurance and exercise capacity. Pressure Threshold IMT devices are usually handheld devices with a spring load that is impeded with different intensities. Incentive Spirometer is a form of ventilatory training that emphasis sustained maximum inspiration. Therefore, the present study aims to assess the effect of Threshold Inspiratory Muscle Training versus Incentive spirometry in participants with upper abdominal surgeries. Materials and Methods: A prospective cross-sectional comparative study was done with 30 participants with upper abdominal surgeries in the age group of 20 to 65. On Day 1 and after 2 weeks the maximal inspiratory pressure was measured using Hand Held Pressure Manometer Device (Pimax). Group A participants received Threshold Inspiratory Muscle Training (IMT) and Group B participants received Incentive spirometry. The intervention was given for 5 days in a week for 2 weeks. The duration for each session was of 15-30 minutes which also includes rest periods. Data was analyzed using student Paired ‘t’ test and Unpaired ‘t’ test. Result: There was extremely significant difference (p<0.0001) in Maximal Inspiratory Pressure (Pimax) in both the groups but Group A showed slightly more improvement were Threshold Inspiratory Muscle Training (IMT) was given as an intervention after 2 weeks. Conclusion: The study shows extremely significant improvement in Maximal Inspiratory Pressure (PImax) in both the groups. This study concluded that Threshold IMT has more effect than Incentive Spirometry in participants with upper abdominal surgeries.

Factors affecting carotid intimal medial thickness in patients with rheumatoid arthritis, an analytical cross-sectional study

Background: IMT assessment as a non-invasive imaging test is quite widely used especially among RA patients, the clinical applications of using such knowledge is scarce, hence study was conducted to compare the carotid artery intima-media thickness (CIMT) in patients with rheumatoid arthritis (RA) with healthy controls also to study the correlation between duration of rheumatoid arthritis, the activity of rheumatoid arthritis and other factors influencing (CIMT).Methods: In analytical cross-sectional study, of 80 participants of RA and 40 healthy controls, “DAS28” was used to assess disease activity. Carotid intima-media thickness assessed using carotid ultrasonography.Results: Mean age of the cases and controls was 43.9 and 44.38 years. Subjects with duration of disease <2 years, to 5 years and >5 years were 35%, 45% and 20%. The mean carotid intima-media thickness was 5.61mm in controls, and CIMT was 6.11mm in people below 2 years and 7.08 mm in people between 2 to 5 years and 8.00mm in people above 5 years which was statistically significant. The mean carotid intima-media thickness was 5.61mm controls and 6.86mm in people with low, 7.00mm in people with moderate and 6.95mm in people with high disease activity, which was statistically significant.Conclusions: Study findings revealed risk of increase in carotid intima-media thickness higher among RA patients in the later stages and can increase the patients’ susceptibility to cardiovascular events. The factors showing strong association with intimal medial thickness were the age and symptoms duration.

Effects of acupuncture on carotid intima-media thickness and cerebral blood flow velocity in patients with mild-to-moderate hypertension / 中国针灸

OBJECTIVE@#To observe the characteristics of carotid intima-media thickness (IMT) and cerebral blood flow velocity in patients with mild-to-moderate hypertension, and to evaluate the effects of acupuncture on carotid IMT and blood flow velocity of middle cerebral artery and vertebral-basilar artery.@*METHODS@#A total of 240 patients with mild-to-moderate hypertension who met the inclusion criteria were treated with acupuncture method proposed by academician . The acupoints of Renying (ST 9), Quchi (LI 11), Hegu (LI 4), Zusanli (ST 36) and Taichong (LR 3) were selected. The treatment was given once a day, five times a week for 3 months. The carotid ultrasonography and transcranial color Doppler were performed before treatment and 3 months after treatment to evaluate the improvements of carotid IMT and brain blood flow velocity.@*RESULTS@#Among 175 patients, 94.3% suffered from impaired carotid IMT. After acupuncture intervention, 7.7%-10.9% patients had improved IMT but 4.6%-6.3% had aggravated carotid IMT. There was no significant difference of carotid IMT before and after treatment (>0.05). About 50% patients had abnormal intracranial blood flow velocity; after acupuncture intervention, 27.4%-33.3% patients who had the abnormal blood flow velocity had normal one, but 27.0%-52.5% patients who had normal blood flow velocity had abnormal one. After acupuncture intervention, the low-speed blood flow of MCA, VA and BA in female patients aged 41-60 years and the low-speed blood flow of MCA and VA in female patients aged 61-70 years were significantly improved (all <0.05); the high-speed blood flow of MCA and VA in male patients aged 61-70 years and the high-speed blood flow of VA and BA in female patients aged 41-60 years were significantly decreased (all <0.05).@*CONCLUSION@#Nearly 95% of patients with mild-to-moderate hypertension had carotid IMT, and about 50% had abnormal blood flow velocity of intracranial artery. The present study failed to found significant effects of acupuncture on carotid IMT, but it shows acupuncture can generally improve the low blood flow velocity in women with mild-to-moderate hypertension.

Increased Carotid Intima-Media Thickness (IMT) in Hyperuricemic Individuals May Be Explained by Hyperhomocysteinemia Associated with Renal Dysfunction: a Cross-Sectional Study

BACKGROUND: Both hyperuricemia and hyperhomocysteinemia are known as main risk factors of cardiovascular diseases. There has been, however, no report on the relationship between carotid intima-media thickness (IMT) and homocysteine (Hcy) in hyperuricemic patients. This study aimed to investigate how hyperuricemia is associated with increased carotid IMT with a focus on hyperhomocysteinemia. METHODS: This cross-sectional study included 1,222 patients who visited the Chung-Ang University Hospital Health Promotion Center from January 2013 to December 2015. The serum Hcy levels were estimated with a competitive immunoassay using the direct chemiluminescence method. The carotid IMT was measured by B-mode carotid ultrasonography. The definition of hyperuricemia was a serum uric acid level > 7.0 mg/dL for men or > 5.6 mg/dL for women, and hyperhomocysteinemia was defined as serum levels > 15 μmol/L. RESULTS: The hyperuricemic patients showed significantly higher serum Hcy levels and lower estimated glomerular filtration rate (eGFR) than did normouricemic patients (13.39 ± 4.42 vs. 11.69 ± 3.65 μmol/L, P < 0.001; 85.16 ± 19.18 vs. 96.14 ± 16.63, P < 0.001, respectively). Serum Hcy level (odds ratio [OR], 1.050; 95% confidence interval [CI], 1.009–1.092) and fasting glucose level (OR, 1.018; 95% CI, 1.011–1.026) were independent risk factors for carotid plaque. In patients with hyperuricemia, the serum Hcy levels correlated with the eGFR (γ = −0.478, P < 0.001). The carotid IMT correlated with serum Hcy levels and eGFR (γ = 0.196, P = 0.008; γ = − 0.297, P < 0.001, respectively) but not with the serum lipid profile. CONCLUSION: These results suggest that renal function impairment in hyperuricemic patients may worsen carotid IMT by increasing serum Hcy levels.

Relationship between homocysteine in plasma and carotid atherosclerosis in the elderly patients / 上海交通大学学报（医学版）

Objective • To study the relationship between homocysteine (HCY) in plasma and carotid atherosclerosis in the elderly patients and its clinical significance. Methods • The intima-media thickness (IMT) of the common carotid arteries and the sclerotic lesions at the carotid arteries bulbs were evaluated by color Doppler ultrasonography in 99 elderly in-patients (65 years old or above). Fasting venous blood was drew from the patients for the determination of plasma HCY and other indexes. According to the plasma HCY concentration, the patients were divided into two groups, i.e., control group (HCY<15 μmol/L) and high HCY group (HCY ≥ 15 μmol/L). General clinical data, carotid plaque number, plaque thickness, plaque stability and carotid IMT were investigated in the two group of patients. Results • The numbers (P=0.015), stability (P=0.013) and thickness (P=0.001) of carotid plaques between the two groups were significantly different. After balancing the effects of age by the partial correlation analysis, plasma HCY concentration was positively correlated with the number (partial correlation coefficient=0.133, P=0.049), instability (partial correlation coefficient=0.046, P=0.023) and thickness (partial correlation coefficient=0.119, P=0.024) of carotid plaques. Nevertheless, the difference in the IMT of carotid arteries between the two groups was not significant (P=0.057). Conclusion • Plasma HCY concentration is correlated with the number, stability and thickness of carotid plaques.

Correlation between serum 25-hydroxyvitamin D levels and carotid intima-media thickness in a Brazilian population descended from African slaves

Hypovitaminosis D has been identified as a possible new cardiovascular risk factor. However, the results of studies correlating serum vitamin D levels with markers of subclinical atherosclerosis have been conflicting. The aim of this study was to correlate serum levels of 25-hydroxyvitamin D [25(OH)D] with carotid intima-media thickness (C-IMT) and conventional cardiovascular risk factors in Afro-descendants. A cross-sectional analysis was performed on a sample of 382 individuals from a cohort of descendants of African slaves, inhabitants of "Quilombola" communities, with a mean age of 57.79 ±15.3 years, 54.5% of whom were women. Socio-demographic and clinical data were collected and biochemical tests were performed, including serum levels of 25(OH)D by electrochemiluminescence and urinary albumin excretion, evaluated by the albumin/creatinine ratio (ACR) in a spot urine sample. All participants underwent high-resolution ultrasonography for C-IMT measurement. Hypovitaminosis D was defined as serum 25(OH)D levels <30 ng/mL. The mean serum 25(OH)D levels were 50.4±13.5 ng/mL, with a low prevalence of hypovitaminosis D (4.86%). By simple linear correlation, a significant inverse association between 25(OH)D levels and C-IMT (r=-0.174, P=0.001) was observed. However, after multiple linear regression analysis, the significance of the association between serum levels of 25(OH)D and C-IMT measurement was lost (β=-0.039, P=0.318) and only male gender, age, smoking, systolic blood pressure, glucose and low density lipoprotein (LDL)-cholesterol remained significantly associated with C-IMT. Levels of 25(OH)D were independently and positively associated with HDL-cholesterol and inversely associated with age and ACR. In conclusion, no independent association between 25(OH)D levels and C-IMT was observed in this population. On the other hand, there was an inverse association with albuminuria, a marker of endothelial lesion.

Evaluación de la adiponectina y su correlación con la íntima media carotidea en mujeres peri y post menopáusicas hospital de engativá, bogotá

El riesgo cardiovascular (RCV), se incrementa en las mujeres después de la menopausia. La adiponectina, se postula como un biomarcador de riesgo cardiovascular. La presente investigación buscó conocer si los niveles de adiponectina y la evaluación de a Intima Media Carotidea (IMT) se modifican durante el climaterio. Se evaluó el riesgo cardiovascular a diez años, en la escala de Framingham (FRS). Se tomaron 80 pacientes, entre 45 y 65 años, de la consulta de Climaterio en el Hospital de Engativá, Bogotá, entre el 15 de enero y 15 de diciembre de 2015. Las pacientes, se dividieron en dos grupos: 46 perimenopáusicas y 34 posmenopáusicas, todas las participantes firmaron el consentimiento informado. En formulario precodificado, se consignaron las variables sociodemográficas, examen físico, valores química sanguínea y resultados de ecografía doppler de carótida. La edad media entre los dos grupos fue: 50,95 años y 60,59 años. Se evidenció diferencia significativa en la presión arterial media. No hubo diferencia estadística en el perímetro abdominal ni en el Índice de Masa Corporal (IMC). La adiponectina presentó diferencia significativa intra grupos. No hubo diferencia en el perfil lipídico, el riesgo cardiovascular aumentó significativamente entre las mujeres pre y postmenopáusicas. La evaluación de la Íntima Media Carotidea (IMT) evidenció diferencias significativas en la placa anterior y posterior, tanto de carótida derecha como de carótida izquierda. El índice de pulsatilidad (IP) fue significativo en la carótida derecha y no en la izquierda. Se postula que la adiponectina es un marcador de riesgo cardiovascular y la IMT útil en la evaluación de arterioesclerosis.

The cardiovascular risk (CVR) increases in women after menopause. Adiponectin is postulated as a biomarker of cardiovascular risk. This study sought to determine whether adiponectin levels and assessment of Carotid Intima Media (IMT) are modified during the climacteric. cardiovascular risk ten years in the Framingham (FRS) was evaluated. 80 patients between 45 and 65 years of consulting Climaterio at the Hospital of Engativá, Bogota, between January 15 and December 15, 2015. The patients were divided into two groups, 46 perimenopausal and 34 postmenopausal, all participants signed informed consent. In pre-encoded form sociodemographic variables, physical examination, blood chemistry values and results of carotid doppler ultrasound were recorded. The average age between the two groups was: 50.95 years and 60.59 years. Significant difference was evidenced in mean arterial pressure. There was no statistical difference in waist circumference or the Body Mass Index (BMI). Adiponectin showed a significant difference intra groups. There was no difference in lipid profile, cardiovascular risk increased significantly between preand postmenopausal women. Evaluation of Carotid Intima Media showed significant differences in the anterior and posterior plates both right and left carotid carotid. The pulsatility index (PI) was significant in the right carotid artery and not in the left. We hypothesize that adiponectin is a marker of cardiovascular risk and IMT useful in assessing atherosclerosis.

Clinical & radiological evaluation of atherosclerotic changes in carotid & coronary arteries in asymptomatic & clinically symptomatic individuals as a tool for pre-symptomatic diagnosis of cardiovascular disease.

Background & objectives: An increase in prevalence of atherosclerosis has been noted worldwide with reports of higher incidence of atherosclerotic vascular changes in Asian Indians. There is a need to measure vascular atherosclerotic changes and provide objective parameter to predict cardiac and cerebrovascular adverse events. Atherosclerotic changes in carotids and coronaries are generally accepted as an association. We attempted in this study to relate intimal-luminal changes in carotid arteries to luminal changes in coronary arteries. Our study presents results of high resolution ultra sonographic (HRUS) evaluation of intimal-medial-thickness (IMT) in carotid with luminal changes in coronaries on multidetector-CT (MDCT) in clinically asymptomatic and symptomatic individuals. Methods: In this prospective study, HRUS examination of the carotid bifurcation was performed in 151 individuals to measure IMT in asymptomatic and symptomatic groups. Assessments of coronary arteries of the same group of patients were evaluated by MDCT within a week interval. IMT changes were associated with age, sex, predisposing factors, calcium burden of coronaries and structural atherosclerotic changes in coronary arteries. Results: A linear association of IMT was observed with increasing age. IMT of 0.5-0.69 mm was noted in 50 per cent of patients between 51-56 yr with higher number of symptomatic patients in this group. Linear increases in coronary vascular changes were noted with increasing IMT thickness. Changes were more prevalent in diabetic, hypertensive, treadmill test (TMT) positive and clinically symptomatic patients. Interpretation & conclusions: Age-related progression of atherosclerosis was evident in internal carotid arteries. Significant association was observed in the IMT thickness of right common carotid (RCC) and coronary disease in symptomatic group; whereas IMT of left common carotid and internal carotid arteries did not show any association. RCC IMT between 0.5-0.7mm showed maximal association with significant symptomatic narrowing of coronary arteries. Patients with IMT beyond 0.7mm had no association with symptoms.

Enfermedad de Hansen asociado a Síndrome de Reconstitución Inmune en Pacientes con VIH/SIDA

Introducción: El Instituto de Medicina Tropical es un centro de referencia para enfermedades tropicales e infecciosas de Paraguay. Se expone la coincidencia entre la infección por el Virus de la Inmunodeficiencia Humana (VIH) y su estado terminal el Síndrome de Inmunodeficiencia Adquirida (SIDA) con la lepra, pues ambas tienen en común un deterioro del sistema inmunitario y una misma ubicación geográfica. Se analiza esta coinfección en diferentes países y su evolución, no siendo más frecuente esta asociación que el VIH en los grupos control. Objetivo: El objetivo de este trabajo es comunicar nuestra experiencia del tratamiento de la lepra en pacientes con VIH/SIDA. Materiales y métodos. Mediante el análisis de las historias clínicas de los pacientes con diagnóstico de Lepra y VIH/SIDA, se evaluó el tratamiento y el estado inmunológico. Resultados. A lo largo del periodo de estudio se trataron 6 pacientes con lepra y VIH. De ellos el 66.6% eran hombres, con el 33.3% (2 pacientes) menores de 30 años, 50% de ellos Lepra Bordeline Lepromatosa y 50% LB Tuberculoide. Al momento del estudio, 5 pacientes habían terminado el tratamiento, quedando uno con tratamiento hasta febrero del 2014 cumpliendo de manera regular. Conclusión. Se concluye que existe una asociación entre el estado inmunológico de los pacientes y la del diagnóstico de Lepra. Pretendemos proseguir la vigilancia de ambas endemias en los próximos años.

Abstract Background: The Institute of Tropical Medicine is a reference center for tropical and infectious diseases of Paraguay. The coincidence between infection HIV (HIV) and terminally Acquired Immune Deficiency Syndrome (AIDS) is exposed to leprosy, as both have in common a deterioration of the immune system and a geographic location. We analyzed this coinfection in different countries and their evolution, being this association not more frequent than HIV association in the control groups. Objective: The objective of this study was to report our experience in treating leprosy patients with HIV / AIDS. Materials and methods. Through the analysis of medical records of patients diagnosed with leprosy and HIV / AIDS, treatment and immune status was assessed. Results. Throughout the study period, 6 patients with leprosy and HIV were discussed. Of these, 66.6% were men, 33.3% (2 patients) under 30, 50% of them Borderline lepromatous leprosy and 50% LB Tuberculoid. At the time of the study, 5 patients had completed the treatment, leaving one treatment until February 2014 meeting regularly. Conclution. We conclude that there is an association between the immune status of patients and the diagnosis of leprosy. We intend to continue monitoring both endemic in the coming years

<b>Efficacy of a Supplement Containing Freeze-dried Earthworm Powder for Atherosclerosis</b> / 日本東洋医学雑誌

We studied the effects of a supplement containing freeze-dried earthworm powder : “Protein Related compound Derived from Redworm (PR-DR)” for atherosclerosis in 19 patients (10 females, average age : 61.5 ± 6.9), whose vascular ages were estimated to be older than their actual ages based on the index of atherosclerosis ; Intima-Media Thickness (IMT) by carotid ultrasonography and Cardio-Ankle Vascular Index (CAVI). After we obtained informed consent, they took daily dose of 6 PR-DR capsules for 6 months. Each capsule contains 40 mg of powdered extract of <i>Lumbricus rubellus</i>, which is known to contain fibrin-degrading an enzyme and to increase the effect of t-PA.<br>Before and 6 months after intake, we found significant decrease in 3 indicators of atherosclerosis. The scores of difference between 2 time points (6 month-pre) were IMT-Cmax : -0.15 ± 0.16 mm, maxIMT : -0.22 ± 0.17 mm, plaque score : -1.57 ± 1.12 (all p < 0.01 by Wilcoxon signed-rank test). As statins and EPA also decrease atherosclerosis, we excluded 6 patients who were taking these medications. Even in the remaining 13 patients (7 females, average age : 61.2 ± 7.9), 3 indicators were still significantly lower (IMT-Cmax : -0.07 ± 0.07 mm, maxIMT : -0.19 ± 0.17 mm, plaque score : -1.39 ± 1.04 ; all p < 0.01) after 6 months of intake. Thus, the results showed that PR-DR has anti-atherosclerosis effect and can be used clinically for the prevention of atherosclerosis and diseases associated with it.

Clinical study on intermaxillary traction screws used in internal fixation in the treatment of jaw fracture / 实用口腔医学杂志

Objective:To analyse the methord and effects of intermaxillary traction(IMT)screws used in the treatment of jaw frac-ture.Methods:In the treatment of 1 68 cases of jaw fracture IMT screws were used for the restoration of normal and stable occlusion. The screw number,position,traction effect and postoperative complications of the treatment were analysed.Results:705 screws were used in 168 patients,4 screws were used in each of 147 cased (88%),6 in 12(7%),5 in 9(5%).336(47.7%)screws were fixed between the roots of first and second premolar,292(41 .4%)between the roots of canine and first premolar,50 (7.1%)be-tween the roots of second premolar and first molar,27(3.8%)between the other tooth roots.Normal postoperative occlusion relation was achived by the use of screws in 92 cases without traction.Occlusion disharmony or deviation was found in 76 cases by the used of screws and was restored to normlal by 1 4-day traction in 71 cases.The total efficiency of the treatment was 97%.Pain of the mucosa surrounding the screws was observed in 23 cases (1 3.7%).Root damage,traction screw loosening and adjacent tooth dislocation were observed in 1 3(1 .8%),1 1 (1 .6%)and 2(0.3%)cases respectively.Conclusion:For the fixation of IMT screws,the posi-tions between tooth root from canine to first molar were most common and safe.The fixation point should be in 5 ~8mm below the gin-gival margin.Use of 4-6 screws can meet treatment need.

Building human capacity through early childhood intervention: the Child Development Research programme at the Tropical Medicine Research Institute, The University of the West Indies, Kingston, Jamaica / Construcción de la capacidad humana mediante intervención en la primera infancia: Programa de Investigación del Desarrollo Infantil en el Instituto de Investigación de Medicina Tropical, Universidad de West Indies, Kingston, Jamaica

Research conducted by the Child Development Research Group in the Tropical Medicine Research Institute has made significant contributions to the understanding of the importance of early nutrition and the home environment for children's development and the impact of psychosocial stimulation for disadvantaged and/or undernourished children. The work has provided critical evidence that has contributed to the increasing attention given to early childhood development in the work and policies of agencies such as the World Bank, World Health Organization (WHO) and United Nations Children Fund (UNICEF). This review concerns research which documented the impact of malnutrition on children's development and for the first time demonstrated the benefits and necessity of psychosocial stimulation for improvement in development. Subsequent research was critical in establishing the importance of linear growth retardation (stunting) as a risk factor for poor child development. A twenty-two-year study of stunted children has demonstrated benefits through to adulthood in areas such as educational attainment, mental health and reduced violent behaviour, from an early childhood home visiting programme that works through mothers to promote their children's development. The group's research has also demonstrated that it is feasible and effective to integrate the stimulation intervention into primary care services with benefits to children's development and mothers' child rearing knowledge and practices. The group is currently conducting a study to provide information needed for scaling-up of parenting programmes through evaluation of a new approach to improving parenting through health centres and a modified home visit programme.

Una investigación dirigida por el Grupo de Investigación del Desarrollo Infantil en el Instituto de Investigación de Medicina Tropical, ha contribuido de manera significativa a comprender, por una parte, la importancia que tanto la nutrición temprana como el ambiente hogareño poseen para el desarrollo infantil de niños, y por otra parte, el impacto de la estimulación psicosocial para los niños desfavorecidos y/o desnutridos. La evidencia crítica ofrecida por este trabajo ha hecho que se le conceda mayor atención al desarrollo de la primera infancia en el trabajo y las políticas de agencias como el Banco Mundial, la Organización Mundial de la Salud (OMS) y el Fondo de las Naciones Unidas para la Infancia (UNICEF). Este estudio trata de una investigación que documenta el impacto de la desnutrición en el desarrollo de niños, y por primera vez demuestra los beneficios y la necesidad de la estimulación psicosocial para favorecer el desarrollo. La investigación subsiguiente fue decisiva para establecer la importancia del retraso del crecimiento linear (RCL) como un factor de riesgo para el desarrollo del niño pobre. Un estudio de veintidós años sobre niños con retraso en el crecimiento ha demostrado los beneficios hasta llegar a la adultez, en áreas como la educación, la salud mental y la reducción del comportamiento violento, a partir de un programa de visita a hogares de la primera infancia, que trabaja con las madres para promover el desarrollo de sus hijos.

Estudo das variações de pressão inspiratória máxima em tetraplégicos, tratados por meio de incentivador respiratório, em regime ambulatorial / Study of maximal inspiratory pressure variations in tetraplegics, treated by means of incentive spirometry, in outpatients

Introdução: O crescente número de vitimas de lesão medular nos tempos atuais, suas incapacidades e consequências físico-funcionais motivaram-nos a abordar no presente estudo a intervenção fisioterapêutica respiratória ambulatorial nesta população. Objetivos: Escolhemos pesquisar sujeitos com lesão adquirida traumática oriundos de uma associação na cidade de Curitiba, PR. Considerando-seque o prognóstico relaciona-se ao nível sensitivo e motor, selecionamos sujeitos com lesões cervicais,por se tratarem de quadros que estão acompanhados de disfunções respiratórias, estas decorrentes do acometimento dos músculos acessórios da respiração. Portanto, essa população é merecedora de uma abordagem preventiva, uma vez que as referidas disfunções podem produzir complicações e piora de prognóstico geral. Tivemos a preocupação de demonstrar as possíveis alterações da capacidade de força respiratória, em função da intervenção fisioterapêutica. Metodologia: Utilizamos, para tanto, o instrumento de medida, comparação e controle da força muscular inspiratória denominado manovacuometria.No tratamento, utilizamos o Threshold IMT, que é um incentivador respiratório. Para os critérios metodológicos, optamos por amostra conveniente, de corte longitudinal, em que foi realizada uma avaliação de força inspiratória inicial, objetivando-se alcançar os valores de pressão inspiratória máxima (PImáx), para comparar com a posterior reavaliação, pós intervenção. Os sujeitos foram submetidos a 30 atendimentos de 15 minutos cada, três vezes por semana. Após este período foram reavaliados sob os mesmos critérios técnicos, para as devidas comparações. Resultados: Os resultados permitiram constatar significativa melhora no condicionamento muscular respiratório, o qual atingiu o nível relevante do desvio padrão (p < 0,05). Conclusão: Concluímos, portanto, que a proposta de tratamento é eficaz.

Introduction: The growing number of victims of spinal cord injury, in modern times, with their disabilities and physical-functional consequences, motivated us to discuss in this study the respiratory physiotherapeutic intervention in outpatients. Objective: We choose to search individuals with traumatic injury acquired, from an association in the city of Curitiba, Paraná State. Considering that the prognosis is linked to the motor and sensory level, we selected persons with cervical lesions, by targeting frames that are accompanied by respiratory dysfunctions, those resulting from the involvement of accessories muscles of respiration. Therefore, this population deserves a preventive approach, because these dysfunctions can produce complications and reduced overall prognosis. We demonstrate the possible changes in respiratory force capacity, depending on the physiotherapeutic intervention. Methodology: We use, for that, the instrument of measurement, comparison and control of inspiratory muscle strength named manovacuometry. In treatment, we use the Threshold IMT, which is a respiratory supporter. For methodological criteria, we chose convenience sample, slitting, with an assessment of initial inspiratory force, aiming to achieve the values of maximal inspiratory pressure (MIP), to compare with subsequent reassessment after intervention. The subjects underwent 30 calls of 15 minutes each, three times a week. After this, they were re-evaluated under the same technical criteria for the appropriate comparisons. Results: Results show significant improvement in respiratory muscle conditioning, which reached the level of the relevant standard deviation (p < 0.05). Conclusion: We conclude, therefore, that the proposed treatment is effective.

Relationship between tooth loss and carotid intima-media thickness in Korean adults

PURPOSE: The aim of this study was to examine the relationship between tooth loss and sub-clinical atherosclerosis in Korean adults. MATERIALS AND METHODS: The subjects were part of a cohort study conducted in Ansan city by the Korea University medical school as part of the Korean Genome project. 749 subjects over than 40 years old were evaluated. After taking panoramic radiography, the amount of tooth loss was calculated. The intima-media thickness (IMT) was assessed by using ultrasonography at the common carotid artery. Traditional cardiovascular risk factors for atherosclerosis were also evaluated. The relationship between tooth loss and the IMT was evaluated using ANOVA with Scheffe's multiple comparison method in univariate analysis. Multiple regression analysis was also performed to determine the significance between the IMT and tooth loss. RESULTS: With age, tooth loss increased, but there was no significant increase in other traditional cardiovascular risk factors. Univariate analysis revealed the IMT to be positively related with the amount of tooth loss. Regression analysis of the IMT in the anterior and posterior tooth loss revealed that only the posterior tooth loss was significantly related with the IMT at all sites of the common carotid artery (right far wall, P = .015; left far wall, P = .008; right near wall, P < .001; left near wall, P = .001). CONCLUSION: This study verified the positive relationship between the increased tooth loss at the posterior area and the accumulation of atheroma in arteries.

The Effect of Latent Syphilis on Carotid Intima-Media Thickness in Acute Ischemic Stroke Patients

BACKGROUND: Neurosyphilis develops into ischemic stroke due to the occlusion of intracranial arteries, which has the histopathological change of intracranial syphilitic arteritis. There might be an association between a latent syphilis and arterial changes before the neurosyphilis develops. We evaluated the relationship between the latent syphilis and the carotid intima-media thickness (IMT) in acute ischemic stroke patients to study whether the latent syphilis affected pathological arterial changes. METHODS: Retrospectively consecutive 96 acute ischemic first ever stroke patients were selected from the Gachon stroke registration from January 2003 to May 2005. The latent syphilis group was made up of 44 patients and the non-syphilis group matched in the age and the sex and consisted of 52 patients. The stroke subtype was classified by TOAST classification. RESULTS: The mean carotid IMT of the latent syphilis group (3.06+/-3.78 mm right, 2.68+/-3.39 mm left) was thicker than that of the non-syphilis group (1.49 +/-2.37 mm right, 1.43+/-1.99 mm left)(p<0.05). The hs-CRP was more elevated in the latent syphilis group than the non-syphilis group (1.6+/-2.2 mg/dl, 1.0+/-2.3 mg/dl respectively) (p<0.05). There were no significant differences of in each of the risk factors between the two groups. CONCLUSIONS: Our results showed the patients with latent syphilis had thicker carotid IMT, and a higher level of hs-CRP than the non-syphilis patients. It could be possible that the latent syphilis attributed to the pathological changes by the inflammation in the extracranial carotid artery.

Research of the relationship between the level of SAA and carotid atery artherosclerosis in patient with type 2 diabetes / 中国实用内科杂志

Objective To study the relationship between serum amyloid A(SAA)and the common carotid intima-media thickness(IMT)in type 2 diabetic(T_2DM)patients.Methods Sixty-nine patients with type 2 diabetes,and 20 healthy subjects regarded as the normal controls(NC)were enrolled in the study from January to July of 2005.SAA levels were measured using ELISA.The carotid IMT were examined by hypersensitive color Doppler ultrasonography.Results SAA level was significantly elevated in type 2 diabetes group compared with that in the control3.08(2.1~5.06)mg/L vs 1.37(1.07~1.86)mg/L,P

Relationship between clinical course and measures of atherosclerosis in diabetic foot / 대한내과학회지

No abstract available.

Measurements of Carotid Intima, Media, and Intima-media Thickness and Their Clinical Importance / 의학물리

The severity of carotid intima-media thickness (IMT) is an independent predictor of atherosclerosis which causes transient cerebral ischemia, stroke, and coronary events such as myocardial infarction. The IMT consists of intima thickness (IT) and media thickness (MT). However, the Individual clinical significance of IT and MT has not been well studied. We devised a method of measuring IT, MT, and IMT using B-mode ultrasound image processing technique for the diagnosis of atherosclerosis. To inspect the clinical significance of IT, MT, and IMT, one hundred forty-four consecutive patients (mean age; 57 years old, 72 males) were underwent common carotid artery scanning using high-resolution ultrasound. Results showed that, the IT (p<0.05), MT (p<0.05) as well as IMT (p<0.01) of patients with atherosclerotic disease were significantly thicker than that of the patients without atherosclerotic disease. Patients with hypertension showed significantly thicker IT (p<0.01), MT (p<0.001), and IMT (p<0.001). However, only IT was thicker in patients with smoking (p<0.01). The IT (r=0.374, p=0.001), MT (r=0.433, p=0.000), and IMT (r=0.479, p=0.000) showed positive correlation with age. The coefficients of determination (r(2)) were estimated to be 92.4% for IMT and MT, 49.1% for IMT and IT, and 27.4% for IT and MT. This result suggests that the intima layer of the carotid artery has a different physiology with the media layer.