Effect of multimorbidity on quality of life in adult with cardiovascular disease: a cross-sectional study

Background

The aim of present study was to describe the effect of multimorbidity on Health-Related Quality of Life (HRQoL) in patients with coronary artery disease (CAD).

Methods

A cross-sectional study with a simple sampling method of 296 patients undergoing coronary artery bypass surgery in a referral hospital of the northern part of Iran was conducted between April, 2015 and September, 2016. Multimorbidity was defined as the presence of at least two chronic diseases based on self-reporting and medical records. HRQoL was measured using the 36-item short form (SF-36) health status survey. We used analysis of variance (ANOVA) to assess the effect of multimorbidity on mental and physical component of HRQoL.

Results

Approximately, 69% of CAD patients had at least one other disease like diabetes or hypertension. Patients without multimorbidity compared with patients with multimorbidity were significantly older (p?=?0.012) and more educated (p?=?0.002). Both physical and mental component score of HRQoL was better in patients without any morbidity (48.82 vs. 43.93 with 95%CI of mean difference: 3.37–6.42 and 54.85 vs. 50.44 with 95% CI of mean difference: 1.68–7.15, respectively). Both physical and mental component score was significantly lower in female and lower educated patients (physical mean score 43.07 vs. 46.54 with P?=?.001 and 42.53 vs. 46.82 with P?<?.001 and mental mean score 49.98 vs. 52.65 with P?=?.055 and 49.80 vs. 52.75 with P?=?.022 for sex and education, respectively). Also, two-way ANOVA showed that regards to morbidity, physical component score was greater in patients with lower education level than higher education level (P?<?.001).

Conclusion

The findings of this study suggest that women, lower education level and overweight patients reported lower quality of life. HRQoL is affected by multimorbidity among CAD patients specially in less educated.

     

Source Apportionment of Volatile Organic Compounds in Tehran, Iran

Identifying the sources of volatile organic compounds (VOCs) is key issue to reducing ground-level ozone and PAN. A multivariate receptor model (Unmix) was used for the determination of the contributions of VOCs sources in Tehran-Iran. Concentrations of ambient C₂–C₁₀ VOCs were measured continuously and online at the center of Tehran city during the winter of 2012. A high correlation coefficient existed between measured and predicted values (R ² = 0.99), indicating that the data were well modeled. Five possible VOCs source categories were identified and mobile sources such as vehicle exhaust (61 %) and fuel evaporation (12 %) more than half of the total VOC concentration. City gas and CNG sources, biogenic source, and industrial solvent source categories accounted for 17 %, 8 % and 2 % of the total VOC, respectively. Result showed Unmix for VOCs source apportionment can be used to analyze and generate air pollution control strategies and policies.     

Agreement rate of skin prick test with tissue eosinophil count in patients with nasal polyps

The pathogenetic mechanism of nasal polyps remains unknown, although allergy has been cited as an important factor in the etiology of nasal polyposis. Currently there is no definite histological criterion for differentiation of allergic from inflammatory nasal polyp. However, in a few studies, tissue eosinophil count has been used for this. This study aimed to find out the agreement rate of skin prick test and tissue eosinophil count in patients with nasal polyposis. Twenty five patients (18 males, 7 females) with nasal polyp were enrolled in this study. For each patient tissue sample from polyp material was taken for histopathological investigation. Moreover, skin prick test was performed for each patient using eleven common aeroallergens. Skin prick test was positive in 48% of the patients. Tissue eosinophil count of more than 50% was found in 75% of skin prick positive and in 69.2% of skin prick negative patients. Also tissue eosinophil count of more than 50% was found in 69.2% of patients with typical allergic symptoms as well as 75% of patients without allergic symptoms. No agreement was found between skin prick tests and tissue eosinophil counts in patients with nasal polyp. Also no difference was found between the tissue eosinophil counts in allergic and non allergic patients. Considering these results, it can be concluded that having a high tissue eosinophil count in patients with nasal polyp does not indicate that the polyp is allergic.     

A referent bone mineral density database for Chinese American women

Introduction While osteoporosis is common among women of Chinese descent, a readily available bone mineral density (BMD) referent database for Chinese American women does not exist. Fracture risk among this population is currently assessed using a Caucasian reference as well as diagnostic criteria for osteoporosis developed for postmenopausal Caucasian women. Many studies indicate that there are important racial differences in skeletal health and fracture risk, an observation that makes the application of Caucasian data to all groups problematical. This study was undertaken to establish a BMD referent database in Chinese American women and to compare it with a Caucasian female database. It is expected that a race-specific database will be useful in the assessment of bone health for Chinese American women. Methods Healthy Chinese American women (n=359), ages 20–90, were recruited. Along with dual-energy X-ray absorptiometry (DXA) of the total hip and lumbar spine, demographic, medical, familial, nutritional, and behavioral data were obtained. The mean and standard deviation for BMD at each site was calculated for each 10-year age group and compared to mean BMD values for Caucasian women supplied as found in the Hologic DXA instrument. Osteoporosis diagnosis rates for this cohort, calculated with the Caucasian and newly established Chinese American BMD referent values, were compared with each other. Results Compared with Caucasian women, Chinese American women have significantly lower BMD at the lumbar spine, total hip, and femoral neck across a wide spectrum of age groups. As a consequence, more than one-half of Chinese American women ≥50 years of age, who would be characterized as osteoporotic using a Caucasian referent, would not be diagnosed as such if a Chinese American referent were utilized. Conclusion Chinese American reference BMD values are significantly lower than those for Caucasian women. Future studies relating Chinese American BMD values to fracture risk are necessary in order to determine if ethnic database-derived T-scores would be more predictive of fracture risk and to develop meaningful diagnostic criteria for this population.     

Reliability and failure modes of narrow implant systems

Objectives

Narrow implants are indicated in areas of limited bone width or when grafting is nonviable. However, the reduction of implant diameter may compromise their performance. This study evaluated the reliability of several narrow implant systems under fatigue, after restored with single-unit crowns.

Materials and methods

Narrow implant systems were divided (n = 18 each), as follows: Astra (ASC); BioHorizons (BSC); Straumann Roxolid (SNC), Intra-Lock (IMC), and Intra-Lock one-piece abutment (ILO). Maxillary central incisor crowns were cemented and subjected to step-stress accelerated life testing in water. Use level probability Weibull curves and reliability for a mission of 100,000 cycles at 130- and 180-N loads (90 % two-sided confidence intervals) were calculated. Scanning electron microscopy was used for fractography.

Results

Reliability for 100,000 cycles at 130 N was ～99 % in group ASC, ～99 % in BSC, ～96 % in SNC, ～99 % in IMC, and ～100 % in ILO. At 180 N, reliability of ～34 % resulted for the ASC group, ～91 % for BSC, ～53 % for SNC, ～70 % for IMC, and ～99 % for ILO. Abutment screw fracture was the main failure mode for all groups.

Conclusions

Reliability was not different between systems for 100,000 cycles at the 130-N load. A significant decrease was observed at the 180-N load for ASC, SNC, and IMC, whereas it was maintained for BSC and ILO.

Clinical relevance

The investigated narrow implants presented mechanical performance under fatigue that suggests their safe use as single crowns in the anterior region.

     

Pharmacological properties of a potent and selective nonpeptide substance P antagonist.

We describe here the pharmacological properties of RP 67580 [(3aR,7aR)-7,7-diphenyl-2-[1-imino-2-(2-methoxyphenyl)ethyl] perhydroisoindol-4-one], a nonpeptide antagonist of substance P (SP). In vitro, the compound was found to inhibit in a competitive manner (Ki = 4.16 +/- 0.59 nM) [3H]SP binding to neurokinin receptors type 1 (NK1 receptors) in rat brain membranes. Contractions induced by SP and septide (a selective NK1 agonist) in guinea pig ileum were competitively inhibited by RP 67580 (pA2 = 7.16 and 7.59, respectively). Moreover, RP 67580 displayed the profile of a specific antagonist of NK1 receptors: it was not active on NK2 and NK3 receptors as seen in binding assays and in isolated preparations of rabbit pulmonary artery and rat portal vein. In the rat, low intravenous doses of RP 67580 totally inhibited the plasma extravasation induced by SP in the urinary bladder (ED50 = 0.04 mg/kg i.v.) and by antidromic electrical stimulation of the saphenous nerve in the hind paw skin (ED50 = 0.15 mg/kg i.v.). This compound was also active in two classical analgesic tests in mice: phenylbenzoquinone-induced writhing (ED50 = 0.07 mg/kg s.c.) and the formalin test (ED50 = 3.7 mg/kg s.c.). Its potency was of the same order as that of morphine. Thus we conclude that RP 67580, a SP antagonist, belongs to a class of drugs that may be useful in the management of various clinical pathologies where pain and neurogenic inflammation are involved.     

Variations in plasma levels of substance P and effects of a specific substance P antagonist of the NK(1) receptor on preovulatory LH and FSH surges and progesterone secretion in the cycling cynomolgus monkey

These studies investigated the role of substance P (SP) in the regulation of the hypothalamic-pituitary-ovarian axis in cynomolgus monkeys with normal menstrual cycles. Plasma concentrations of SP were determined in blood samples taken every morning in normally menstruating cynomolgus monkeys throughout the menstrual cycle. There was a significant decreasing linear trend of SP during the follicular phase (cycle day -13 to day 0) and a significant inverse relationship between SP plasma values and plasma 17beta-estradiol (E(2)) values from day -13 to day 0 of the adjusted cycle. Correspondingly, SP area under the curve was significantly greater during the follicular phase than the luteal phase. In a second experiment, plasma concentrations of E(2), luteinizing hormone (LH), follicle-stimulating hormone (FSH) and progesterone and length of cycles were measured after five daily intragastric administrations (10 mg/kg) of an NK(1) receptor (SP receptor) antagonist (RPR 100893; 10 mg/kg) initiated after serum E(2) concentrations had exceeded 125 pg/ml. There was a statistically significant reduction in the amplitude (41% of control) and the area under the curve (37% of control) of the preovulatory LH surge. In addition, there was a reduction of the duration of the LH surge (3 +/- 0.1 days in controls vs. 2.1 +/- 0.2 days in treated animals). The present results show for the first time that there are significant variations in plasma levels of SP, with a strong negative correlation with serum levels of E(2) during the follicular phase of the cynomolgus monkey, and that endogenous SP has a potentiating role in the interactive hypothalamo-anterior-pituitary mechanisms which lead to the preovulatory LH and FSH surges during the menstrual cycle in the monkey.