European journal of internal medicine
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Eur. J. Intern. Med. · May 2009
Not all obese subjects of multiethnic origin are at similar risk for developing hypertension and type 2 diabetes.
Whether insulin resistance and not obesity per se is the major contributor to clinical outcomes associated with obesity has not been fully established. This study evaluated in a group of obese Brazilians of multiethnic origin to what extent the prevalence of hypertension and other cardiometabolic risk factors varies as a function of the degree of insulin sensitivity. ⋯ In conclusion, our findings have shown that the risk of developing essential hypertension, type 2 diabetes, and cardiovascular disease is accentuated in obese individuals who are also more insulin resistant.
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Eur. J. Intern. Med. · Mar 2009
Post-traumatic stress disorder is not over-represented in a sample population of migraine patients.
Exposure to extreme stress can result in a variety of clinical sequelae, in terms of severity and type, of which post-traumatic stress disorder (PTSD) is the prototype. PTSD was previously associated with chronic pain and primary pain disorders. ⋯ Migraine patients do not suffer from PTSD more than the general population. When they do suffer from PTSD they report high levels of disability.
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Hyperuricemia is a prevalent condition in chronic heart failure (CHF), describing increased oxidative stress and inflammation. Although there is evidence that serum uric acid (UA) predicts mortality in CHF, its role as a prognostic biomarker in acute heart failure (AHF) has not yet been well assessed. The aim of this study was to determine if UA levels predict all-cause mortality. Additionally, as a secondary endpoint we sought the clinical predictors of UA serum level in this population. ⋯ UA serum levels is an independent predictor of all-cause mortality in an unselected patients admitted with AHF.
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Eur. J. Intern. Med. · Jan 2009
Comparative StudyWhat diagnoses may make patients more seriously ill than they first appear? Mortality according to the Simple Clinical Score Risk Class at the time of admission compared to the observed mortality of different ICD9 codes identified on death or discharge.
The Simple Clinical Score (SCS) determined at the time of admission places acutely ill general medical patients into one of five risk classes associated with an increasing risk of death within 30 days. The cohort of acute medical patient that the SCS was derived from had, on average, four combinations of 74 groupings of ICD9 codes. This paper reports the ICD9 codes associated with the different SCS risk classes and identifies those ICD9 codes with a greater observed mortality than that of other patients in the same SCS risk class. ⋯ The Simple Clinical Score (SCS) determined at the time of admission identifies patients at very low risk of death regardless of what diagnoses are subsequently made during their hospitalisation. Nevertheless, patients with a very low risk of death according to their SCS risk class may still have a life-threatening condition that requires treatment in hospital. For higher risk patients only 14 ICD9 code groupings were associated with an observed mortality greater than that of others in the same SCS risk group.
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Syphilis is a complex disease, which is sexually transmitted. The incidence of syphilis is rising all over the world, partly due to the increased transmission in HIV patients and other high risk groups such as men who have sex with men. ⋯ Great importance exists in recognition of both diseases and their complex interactions. This article will review the manifestations of syphilis in the context of HIV infected patients, and the challenging diagnosis and management of these patients.