Browsing by keyword "etiology"
Now showing items 1-4 of 4
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An update on immunopathogenesis, diagnosis, and treatment of multiple sclerosisBACKGROUND: Multiple sclerosis is an acquired demyelinating disease of the central nervous system. It is the second most common cause of disability in adults in United States after head trauma. DISCUSSION: The etiology of MS is probably multifactorial, related to genetic, environmental, and several other factors. The pathogenesis is not fully understood but is believed to involve T-cell-mediated inflammation directed against myelin and other related proteins with a possible role for B cells. The McDonald criteria have been proposed and revised over the years to guide the diagnosis of MS and are based on clinical presentation and magnetic resonance imaging (MRI) of the brain and spinal cord to establish dissemination in time and space. The treatment of MS includes disease modification with immunomodulator drugs and symptom management to address the specific symptoms such as fatigue, spasticity, and pain. CONCLUSION: An update on etiology, pathogenesis, diagnosis, and immunomodulatory treatment of MS is presented.
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Geographic disparities persist despite decline in mortality from IHD in California's Central Valley 1999-2014Background: Nationally, ischemic heart disease mortality has declined significantly due to advancements in managing traditional risk factors of hypertension, diabetes, hyperlipidemia, smoking, and obesity and acute intervention. However geographic disparities persist that may, in part, be attributed to environmental effects. Methods: Ischemic heart disease age-adjusted mortality were obtained from the CDC database for years 1999 through 2014 by county, gender, race, and Hispanic origin for the Central Valley of California. Results: There was an increase in mortality from north to south of 14.9 (95% CI: 8.0-21.9, p value < 0.0001) in time period 1, 7.9 (95% CI: 0.8-15, p value < 0.05) in time period 2, and 9.2 (95% CI: 4.0-14.3, p value < 0.001) in time period 3. In time period 1, the ambient particulate matter < /=2.5 micrometers (PM2.5) level increased from north to south by 0.84 microg/m(3) (95% CI: 0.71-0.96), in time period 2 there was a 0.87 microg/m(3) increase (95% CI: 0.74-1.0), and a 1.0 microg/m(3) increase in time period 3 (95% CI: 0.87-1.1). PM2.5 level was correlated to IHD mortality in all time periods (Period 1 r(2) = 0.46, p = 0.0001; Period 2, r(2) = 0.34, p = 0.008; Period 3 r(2) = 0.51, p value < 0.0001). Conclusion: Continued declines in ischemic heart disease mortality will depend on the concerted efforts of clinicians in continuing management of the traditional risk factors with appropriate medication use, acute interventions for coronary syndromes, the necessity of patient self-management of high risk behaviors associated with smoking and obesity, and the development of coordinated actions with policy makers to reduce environmental exposure in their respective communities.
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Red blood cell membrane trans fatty acid levels and risk of non-Hodgkin lymphoma: a prospective nested case-control studyBACKGROUND: Trans fatty acid (TFA) intake persists in much of the world, posing ongoing threats to public health that warrant further elucidation. Published evidence suggests a positive association of self-reported TFA intake with non-Hodgkin lymphoma (NHL) risk. OBJECTIVES: To confirm those reports, we conducted a prospective study of prediagnosis RBC membrane TFA levels and risk of NHL and common NHL histologic subtypes. METHODS: We conducted a nested case-control study in Nurses' Health Study and Health Professionals Follow-Up Study participants with archived RBC specimens and no history of cancer at blood draw (1989-1090 and 1994-1995, respectively). We confirmed 583 incident NHL cases (332 women and 251 men) and individually matched 583 controls on cohort (sex), age, race, and blood draw date/time. We analyzed RBC membrane TFA using GLC (in 2013-2014) and expressed individual TFA levels as a percentage of total fatty acids. We used unconditional logistic regression adjusted for the matching factors to estimate ORs and 95% CIs for overall NHL risk per 1 SD increase in TFA level and assessed histologic subtype-specific associations with multivariable polytomous logistic regression. RESULTS: Total and individual TFA levels were not associated with risk of all NHL or most subtypes. We observed a positive association of total TFA levels with diffuse large B cell lymphoma (DLBCL) risk [n = 98 cases; OR (95% CI) per 1 SD increase: 1.30 (1.05, 1.61); P = 0.015], driven by trans 18:1n-9(omega-9)/elaidic acid [OR (95% CI): 1.34 (1.08, 1.66); P = 0.007], trans 18:1n-7/vaccenic acid [OR (95% CI): 1.28 (1.04, 1.58); P = 0.023], and trans 18:2n-6t,t [OR (95% CI): 1.26 (1.01, 1.57); P = 0.037]. CONCLUSIONS: Our findings extended evidence for TFA intake and DLBCL risk but not for other NHL subtypes. Reduced TFA consumption through dietary choices or health policy measures may support prevention of DLBCL, an aggressive NHL subtype.
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Suicide prevention and COVID-19INTRODUCTION: Suicide prevention during Covid 19 has become a global priority because the current pandemic has led to societal difficulties threatening the fabric of our lifestyle with increased morbidity and mortality. Modelling studies published since the COVID 19 pandemic was declared in March 2020 estimate that suicide rates will increase by anywhere between 1% to 145% globally in response to the pandemic and action needs to be taken. METHODS: A narrative literature review on high quality evidence sources limited to human studies and publications written in English language only has been used to examine the relationship of COVID 19 and existing mental illness or history of mental illness, suicide prevention strategies and changes in overall suicide rates. RESULTS: A total of 39 papers are summarised and grouped using the headings aetiological factors, proposed interventions to increase access and national policies to provide a framework for suicide prevention during pandemics such as COVID 19. This review indicates that 1) investing in active labour market programmes will result in a decreased suicide rate during times of high unemployment 2) People in low paid and casual jobs require specific support because they are most financially vulnerable during a pandemic related crisis 3) Women require specific support during a pandemic because of the type of employment they have and because they often carry a greater proportion of the domestic burden and are at increased risk of domestic violence during lockdown and crisis 4) Mental health and substance misuse services need to be appropriately funded and prioritised during and post pandemic, due to the associated increase in substance misuse during a pandemic causing worsening mental health and increased risk of suicide 5) National Suicide Prevention Strategies should be developed by all countries and should anticipate response to a range of disasters, including a pandemic 6) Suicide prevention is everybody's business and National Suicide Prevention Strategies should adopt a whole-systems approach including mental health services, primary care, social care, NGO's and other community stakeholders 7) Suicide is preventable 8) It is essential to prioritise suicide prevention strategies in the COVID and post-COVID period to ensure that lives are saved. DISCUSSION: Increase in suicide is not inevitable and suicide prevention during pandemics and post COVID 19 pandemics requires a collaborative whole system approach. We require real time data to inform dynamic action planning.
