39 research outputs found
Documentation of body mass index and control of associated risk factors in a large primary care network
<p>Abstract</p> <p>Background</p> <p>Body mass index (BMI) will be a reportable health measure in the United States (US) through implementation of Healthcare Effectiveness Data and Information Set (HEDIS) guidelines. We evaluated current documentation of BMI, and documentation and control of associated risk factors by BMI category, based on electronic health records from a 12-clinic primary care network.</p> <p>Methods</p> <p>We conducted a cross-sectional analysis of 79,947 active network patients greater than 18 years of age seen between 7/05 - 12/06. We defined BMI category as normal weight (NW, 18-24.9 kg/m<sup>2</sup>), overweight (OW, 25-29.9), and obese (OB, ≥ 30). We measured documentation (yes/no) and control (above/below) of the following three risk factors: blood pressure (BP) ≤130/≤85 mmHg, low-density lipoprotein (LDL) ≤130 mg/dL (3.367 mmol/L), and fasting glucose <100 mg/dL (5.55 mmol/L) or casual glucose <200 mg/dL (11.1 mmol/L).</p> <p>Results</p> <p>BMI was documented in 48,376 patients (61%, range 34-94%), distributed as 30% OB, 34% OW, and 36% NW. Documentation of all three risk factors was higher in obesity (OB = 58%, OW = 54%, NW = 41%, p for trend <0.0001), but control of all three was lower (OB = 44%, OW = 49%, NW = 62%, p = 0.0001). The presence of cardiovascular disease (CVD) or diabetes modified some associations with obesity, and OB patients with CVD or diabetes had low rates of control of all three risk factors (CVD: OB = 49%, OW = 50%, NW = 56%; diabetes: OB = 42%, OW = 47%, NW = 48%, p < 0.0001 for adiposity-CVD or diabetes interaction).</p> <p>Conclusions</p> <p>In a large primary care network BMI documentation has been incomplete and for patients with BMI measured, risk factor control has been poorer in obese patients compared with NW, even in those with obesity and CVD or diabetes. Better knowledge of BMI could provide an opportunity for improved quality in obesity care.</p
Iron Behaving Badly: Inappropriate Iron Chelation as a Major Contributor to the Aetiology of Vascular and Other Progressive Inflammatory and Degenerative Diseases
The production of peroxide and superoxide is an inevitable consequence of
aerobic metabolism, and while these particular "reactive oxygen species" (ROSs)
can exhibit a number of biological effects, they are not of themselves
excessively reactive and thus they are not especially damaging at physiological
concentrations. However, their reactions with poorly liganded iron species can
lead to the catalytic production of the very reactive and dangerous hydroxyl
radical, which is exceptionally damaging, and a major cause of chronic
inflammation. We review the considerable and wide-ranging evidence for the
involvement of this combination of (su)peroxide and poorly liganded iron in a
large number of physiological and indeed pathological processes and
inflammatory disorders, especially those involving the progressive degradation
of cellular and organismal performance. These diseases share a great many
similarities and thus might be considered to have a common cause (i.e.
iron-catalysed free radical and especially hydroxyl radical generation). The
studies reviewed include those focused on a series of cardiovascular, metabolic
and neurological diseases, where iron can be found at the sites of plaques and
lesions, as well as studies showing the significance of iron to aging and
longevity. The effective chelation of iron by natural or synthetic ligands is
thus of major physiological (and potentially therapeutic) importance. As
systems properties, we need to recognise that physiological observables have
multiple molecular causes, and studying them in isolation leads to inconsistent
patterns of apparent causality when it is the simultaneous combination of
multiple factors that is responsible. This explains, for instance, the
decidedly mixed effects of antioxidants that have been observed, etc...Comment: 159 pages, including 9 Figs and 2184 reference
Recommended from our members
DEVELOPMENT AND REGRESSION OF NEO-INTESTINAL CYSTS IN A RAT MODEL
Recommended from our members
Trasplante renal mediante reconstrucción de conducto vascular en riñones de donantes fallecidos con arterias renales múltiples y venas renales cortas
El trasplante renal con variantes anatómicas vasculares sigue siendo un desafío. Debido a su éxito variable en lo que respecta a la función del injerto después del trasplante, estos órganos se descartan frecuentemente, asumiendo de antemano una tasa inasequible de complicaciones vasculares.Realizamos 3 trasplantes de riñón utilizando órganos de donantes fallecidos que presentaban variantes vasculares (arterias múltiples y venas cortas), incluyendo un riñón en herradura indivisible. Se utilizaron diferentes injertos extraídos de la aorta, la arteria ilíaca común y la vena cava inferior del mismo donante para reconstruir la configuración vascular inicial mediante la creación de conductos arteriales y venosos individuales, con el fin de simplificar la anastomosis vascular en el receptor.No se registraron complicaciones postoperatorias. Los tiempos de isquemia caliente fueron comparables con los de aloinjertos renales de una sola arteria. En ningún caso se observó un retraso en la función del injerto y todos los pacientes recuperaron la función renal normal después del trasplante.La reconstrucción vascular mediante injertos arteriales y venosos del mismo donante fallecido puede ser un recurso útil para simplificar la anastomosis vascular durante la cirugía de trasplante, evitando así su descarte de antemano, reduciendo al mínimo las complicaciones perioperatorias y permitiendo tasas normales de función de los injertos en el seguimiento a largo plazo. El resultado satisfactorio obtenido mediante la utilización de este enfoque ayudaría a ampliar los criterios de donantes para incluir órganos que presentan variantes anatómicas vasculares.Transplantation of kidneys with vascular anatomical variants remains a challenge. Due to its varying success in regard to graft function after transplantation, these organs have been frequently discarded assuming in advance an unaffordable rate of vascular complications.We performed three kidney transplants using organs from deceased donors harboring vascular variants (multiple arteries and short veins), including an unsplittable horseshoe kidney. Different grafts harvested from the same donor aorta, common iliac artery, and inferior vena cava, were used to reconstruct the initial vascular configuration by creating single arterial and venous conduits aimed to simplify the vascular anastomoses in the recipient.No post-operative complications were recorded. Warm ischemia times remained comparable to single artery renal allografts. No delayed graft function was noted in any case, and every patient regained normal renal function after transplantation.Vascular reconstruction using arterial and venous grafts harvested from the same deceased donor may result a helpful tool to simplify vascular anastomoses during transplantation surgery, thus avoiding their discard in advance, minimizing perioperative complications, and enabling normal graft function rates in the long-term follow-up. The successful outcome obtained by using this approach would help to expand the donor criteria for the inclusion of organs containing vascular anatomical variants
Recommended from our members
Renal transplantation using vascular conduit reconstruction in deceased kidneys with multiple renal arteries and short renal veins
Transplantation of kidneys with vascular anatomical variants remains a challenge. Due to its varying success in regard to graft function after transplantation, these organs have been frequently discarded assuming in advance an unaffordable rate of vascular complications.We performed three kidney transplants using organs from deceased donors harboring vascular variants (multiple arteries and short veins), including an unsplittable horseshoe kidney. Different grafts harvested from the same donor aorta, common iliac artery, and inferior vena cava, were used to reconstruct the initial vascular configuration by creating single arterial and venous conduits aimed to simplify the vascular anastomoses in the recipient.No post-operative complications were recorded. Warm ischemia times remained comparable to single artery renal allografts. No delayed graft function was noted in any case, and every patient regained normal renal function after transplantation.Vascular reconstruction using arterial and venous grafts harvested from the same deceased donor may result a helpful tool to simplify vascular anastomoses during transplantation surgery, thus avoiding their discard in advance, minimizing perioperative complications, and enabling normal graft function rates in the long-term follow-up. The successful outcome obtained by using this approach would help to expand the donor criteria for the inclusion of organs containing vascular anatomical variants.El trasplante renal con variantes anatómicas vasculares sigue siendo un desafío. Debido a su éxito variable en lo que respecta a la función del injerto después del trasplante, estos órganos se descartan frecuentemente, asumiendo de antemano una tasa inasequible de complicaciones vasculares.Realizamos 3 trasplantes de riñón utilizando órganos de donantes fallecidos que presentaban variantes vasculares (arterias múltiples y venas cortas), incluyendo un riñón en herradura indivisible. Se utilizaron diferentes injertos extraídos de la aorta, la arteria ilíaca común y la vena cava inferior del mismo donante para reconstruir la configuración vascular inicial mediante la creación de conductos arteriales y venosos individuales, con el fin de simplificar la anastomosis vascular en el receptor.No se registraron complicaciones postoperatorias. Los tiempos de isquemia caliente fueron comparables con los de aloinjertos renales de una sola arteria. En ningún caso se observó un retraso en la función del injerto y todos los pacientes recuperaron la función renal normal después del trasplante.La reconstrucción vascular mediante injertos arteriales y venosos del mismo donante fallecido puede ser un recurso útil para simplificar la anastomosis vascular durante la cirugía de trasplante, evitando así su descarte de antemano, reduciendo al mínimo las complicaciones perioperatorias y permitiendo tasas normales de función de los injertos en el seguimiento a largo plazo. El resultado satisfactorio obtenido mediante la utilización de este enfoque ayudaría a ampliar los criterios de donantes para incluir órganos que presentan variantes anatómicas vasculares
Recommended from our members