Microcirculatory dysfunction in cardiac syndrome X: role of abnormal blood rheology

Objective: Cardiac syndrome X (CSX) is of clinical interest, yet the underlying pathophysiological mechanisms have not been fully elucidated. It is well known that elevated blood viscosity and red blood cell (RBC) aggregation can adversely affect microcirculatory blood flow. The present study was designed to explore whether CSX is associated with abnormalities of blood rheology. Methods: Blood samples were obtained from 152 adult angina patients undergoing diagnostic coronary angiography; geometric and flow‐velocity data were obtained. Rheologic measurements were performed in a blinded manner; 21 subjects were later identified with CSX. Hemorheologic and clinical laboratory data were compared to 21 age‐ and gender‐matched healthy controls. Results: CSX patients had markedly abnormal blood rheology: (1) higher RBC aggregation and aggregability as judged by erythrocyte sedimentation rate and Myrenne indices at stasis and low shear (p < 0.001) and (2) elevated hematocrit‐corrected blood viscosity, plasma viscosity (p < 0.001), and yield stress (p < 0.01). White blood cell counts and high‐sensitivity C‐reactive protein levels were significantly elevated in CSX; coronary‐flow velocities were below normal. Conclusions: Abnormal hemorheologic parameters exist in subjects with CSX and may contribute to the pathophysiology of the disease, presumably via adversely affecting blood flow in the coronary microcirculation. Therapeutic measures aimed at normalizing blood rheology and hence microcirculatory flow should be explored.     

Relationship issues of women with breast cancer

This in-depth, qualitative pilot study explored the impact of breast cancer on specific dimensions of the relationships and roles of women. It included interaction within the partner relationship as well as with family, friends, and colleagues. Data were obtained by individual and group interviews from 10 women with a diagnosis of breast cancer and 5 male partners. Both partnered and single women participated. There were four major findings seldom discussed in the literature, which have important implications for preventive intervention. First, partner relationships troubled before the diagnosis as well as those characterized by mutual caring faced challenges and negative changes. Second, in an effort to protect each other, communication within the partner dyad became less open, and there were changes in the usual manner of conflict resolution. Third, unpartnered women appeared to be more vulnerable to problems of negative adjustment, largely because of relationship issues. Fourth, participants confirmed the need for a comprehensive intervention to facilitate coping with issues relative to relationships, intimacy, and sexuality. Although the sample was small, in-depth data were obtained that provide a basis for specific areas in which further empirical investigation is needed, and they indicate that preventive intervention may well be warranted.     

Pattern of long-term fat intake and BMI during childhood and adolescence--results of the DONALD Study

OBJECTIVE: Adverse dietary habits have been discussed as being conducive to the increased prevalence of obesity in children and adolescents. No single dietary factor has been clearly identified so far. We analyzed long-term fat intake patterns during childhood and adolescence and their influence on body fatness. METHODS: Four clusters with different patterns of percent energy from fat were found in 228 individuals from the age of 2-18 y participating in the DONALD Study (Dortmund Nutritional Anthropometric Longitudinally Designed Study) with at least 10 yearly weighed dietary records between 1985 and 2002. Clusters were evaluated with regard to macronutrient and food group intakes and body mass index (BMI). RESULTS: The mean energy density and the ratio of energy intake to estimated basal metabolic rate per subject differed significantly between clusters. All calculated macronutrients (per energy intake) with the exception of dietary fiber differed significantly as well as intakes of Meat/Fish/Eggs, Fats/Oils and Fruit/Vegetables. Although these differences in dietary characteristics persisted during the study period, no differences of BMI (calculated as standard deviation score) were found either at the first or last examination per subject. The mean BMI during the study period differed significantly, with the highest BMI in the low fat intake cluster. CONCLUSION: BMI could not be explained by different dietary patterns during childhood and adolescence in this long-term evaluation of dietary records. Underreporting especially in obese subjects, the problem of detecting minor overconsumption of energy intake that favors the development of obesity over long periods, and the small study sample may explain these conflicting results.     

Prenatal factors and birth outcomes in the public health service: A rural/urban comparison

To determine whether predictors of birth outcomes differ for women in rural versus urban areas, data were obtained from the health records of women who received prenatal care through the Public Health Departments of a rural (N = 364) and urban (N = 415) setting. The rural group was more apt to be single, less educated, African-American, and have a lower income than the urban group. Rural women also had a higher incidence of low birth weight infants, which may be related to poor nutrition and low weight gain during pregnancy. Urban women had more maternal and neonatal complications, which may be related to a higher incidence of drug use and smoking. Membership in a rural or urban population did not predict low birth weight. Race, weeks gestation at first prenatal visit, number of total visits, and adequacy of diet and weight gain were significant predictors of birth weight. Neonatal complications were higher in the urban group and best predicted by poor diet, alcohol intake, and race. Both rural and urban women received inadequate prenatal care, as indicated by late entry into care and total number of visits. Alternative models of care which explore strategies to individualize care, while providing comprehensive care, should be investigated. © 1997 John Wiley & Sons, Inc. Res Nurs Health 20: 61–70, 1997     

Fruit juice consumption and the prevalence of obesity and short stature in german preschool children: results of the DONALD Study. Dortmund Nutritional and Anthropometrical Longitudinally Designed.

BACKGROUND: In recent years, a possible association between excessive consumption of fruit juice (> or =12 fl oz per day) and short stature and/or obesity has been discussed. The association among the consumption of fruit juice, anthropometric indices, and the overall diet was examined during a 3-year period in a sample of healthy preschool children participating in the Dortmund Nutritional and Anthropometrical Longitudinally Designed (DONALD) Study. METHODS: Two hundred five children were examined annually at the ages of 3, 4, and 5 years. Dietary intake was calculated from 3-day weighed diet records. Height was measured using a stadiometer. Weight was measured using an electronic scale. RESULTS: Five children consumed excessive fruit juice continually in all three records, 10 children in two records, and 23 children in one record. None of the five children with repeatedly excessive fruit juice consumption was obese or short. Growth velocity, body mass index, and height standard deviation score were not correlated with fruit juice consumption. Consumption of fruit juice was inversely correlated with the consumption of all other beverages and the total consumption of all other food. The intake of protein, fat, and carbohydrates of children consuming excessive fruit juice was closer to the international dietary preventive guidelines than the intake of children consuming low amounts of fruit juice. CONCLUSIONS: In the study sample, even repeatedly excessive fruit juice consumption had no influence on anthropometric indices. The results do not justify a general warning or a general promotion regarding high fruit juice consumption in preschool children's diets.     

Neurotoxicity in the Post-HAART Era: Caution for the Antiretroviral Therapeutics

Despite the advent of highly active antiretroviral therapy (HAART), HIV-associated neurological disorders (HAND) remain a major challenge in human immunodeficiency virus (HIV) treatment. The early implementation of HAART in the infected individuals helps suppress the viral replication in the plasma and other compartments. Several studies also report the beneficial effect of drugs that successfully penetrate central nervous system (CNS). However, recent data in both clinical setup and in in vitro studies indicate CNS toxicity of the antiretrovirals (ARVs). Although the evidence is limited, correlation between prolonged use of ARVs and neurotoxicity strongly suggests that it is essential to study the underlying mechanisms responsible for such toxicity. Furthermore, closer attention toward clinical outcomes is required to screen various ARV regimens for their association with HAND and other comorbidities. A growing body of literature also indicates a possible role of accelerated aging in the antiretroviral therapy-associated neurotoxicity. Lastly, owing to high pill burden, multiple drugs in the HIV treatment also invite a possible role of drug–drug interaction via various cytochrome P450 enzymes. The particular emphasis of this review is to highlight the need to identify alternative approaches in reducing the CNS toxicity of the ARV drugs in HIV-infected individuals.