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9 results

  • 7 - Apolipoprotein-4 (APOE-4)

  • Daniel Gibbs, Emeritus of Oregon Health and Science University
  • Book:
    Dispatches from the Land of Alzheimer's
    Published online:
    19 January 2024
    Print publication:
    22 February 2024, pp 30-33

  • Summary

    At some point while I was a medical student in the 1970s, I had my cholesterol checked. I think it was part of a pedagogical exercise, and as I recall, only the total cholesterol was measured. Surprisingly, the cholesterol level was near the upper limit of normal. Too many burgers and fries said Lois. I laughed it off. There wasn’t much heart disease in the family. One of my grandfathers died of a heart attack, a myocardial infarction, but he was in his mid-70s. I was in my 20s and invincible. As I grew older, my cholesterol levels, especially the LDL cholesterol, crept higher, and the upper limits of normal were revised down so that by the time I was in my 40s, my cholesterol was unambiguously elevated. By the time I was in my 50s, I was taking medications to keep my cholesterol levels and blood pressure under control. As the years went by, the doses of these medications continued to climb. My hyperlipidemia and hypertension have always been a bit of a puzzle to me, but they have both been manageable with medications and diet.

  • Determinants of poor sleep quality in elderly patients with diabetes mellitus, hyperlipidemia and hypertension in Singapore

  • Part of
  • Grace S. H. Chiang, Brenda L. H. Sim, Jeannette J. M. Lee, Joanne H. M. Quah
  • Journal:
    Primary Health Care Research & Development / Volume 19 / Issue 6 / November 2018
    Published online by Cambridge University Press:
    27 March 2018, pp. 610-615
    • Article
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  • Aim

    The objective of this study was to assess determinants of poor sleep quality which is an under-diagnosed and under-treated problem in elderly patients with diabetes mellitus, hyperlipidemia and hypertension.

    Background

    Poor sleep quality is linked to decreased quality of life, increased morbidity and mortality. Poor sleep quality is common in the elderly population with associated cardiometabolic risk factors such as diabetes, hyperlipidemia and hypertension.

    Methods

    This is a cross-sectional study undertaken in the primary healthcare setting (Singhealth Polyclinics-Outram) in Singapore. Singaporeans aged 65 years and above who had at least one of the three cardiometabolic risk factors (diabetes, hypertension and hyperlipidemia) were identified. Responders’ sleep quality was assessed using the Pittsburgh Sleep Quality Index (PSQI) questionnaire and were divided into those with good quality sleep and those with poor quality sleep, based on the PSQI score. Information on demographics, co-morbidities and lifestyle practices were collected. Descriptive and multivariate analyses of determinants of poor sleep were determined.

    Findings

    There were 199 responders (response rate 88.1%). Nocturia (adjusted prevalence rate ratio 1.54, 95% confidence interval 1.06–2.26) was found to be associated with an increased risk of poor sleep quality in elderly patients with diabetes mellitus, hypertension and hyperlipidaemia. Nocturia, a prevalent problem in the Asian elderly population, has been found to be associated with poor sleep quality in our study. Hence, it is imperative to identify and treat patients with nocturia to improve sleep quality among them.

  • Evaluation of cardiovascular risks and recovery of idiopathic sudden sensorineural hearing loss in hospitalised patients: comparison between complete and partial sudden sensorineural hearing loss

  • C Haremza, N Klopp-Dutote, V Strunski, C Page
  • Journal:
    The Journal of Laryngology & Otology / Volume 131 / Issue 10 / October 2017
    Published online by Cambridge University Press:
    15 August 2017, pp. 919-924
    Print publication:
    October 2017
  • Objective:

    To evaluate the presence of cardiovascular risk factors and recovery of idiopathic sudden sensorineural hearing loss in hospitalised patients.

    Methods:

    A single-centre retrospective study of 80 patients hospitalised for idiopathic sudden sensorineural hearing loss was conducted over a 6-year period. Mean pure tone hearing thresholds were assessed by pure tone audiometry.

    Results:

    Twenty-three of 80 patients (28.75 per cent) initially had no cardiovascular risk factors. Forty-five patients had hyperlipidaemia, 22 patients had hypertension, 7 patients had diabetes mellitus and 7 patients were obese. No statistically significant difference was observed between patients with complete versus partial sudden sensorineural hearing loss (p = 0.0708) concerning the cardiovascular risk factors. At long-term follow up, the hearing recovery rate was not significantly different between the two groups of patients (p = 0.7541).

    Conclusion:

    The lack of a clear relationship between idiopathic sudden sensorineural hearing loss and cardiovascular risk factors suggests that sudden sensorineural hearing loss has a predominantly multifactorial disease profile regardless of hearing impairment severity.

  • Chapter 21 - Recipient selection

  • from Section 4 - Liver
  • Edited by Andrew A. Klein, Clive J. Lewis, Joren C. Madsen
  • Book:
    Organ Transplantation
    Published online:
    07 September 2011
    Print publication:
    11 August 2011, pp 173-181

  • Summary

    Heart transplantation has excellent long-term survival, with 50% of patients living 10 years, and significant improvement in quality of life. Various factors contribute to increased early graft failure and morality, including changing donor and recipient profiles in recent years. Changes in recent years that have improved very long-term survival include modern immunosuppression, statin use, systematic post-transplant care/surveillance, and better management of renal dysfunction. The long-term complications following heart transplantation are similar to those of other organ transplants and include vasculopathy and complications of immunosuppressants. Coronary artery vasculopathy (CAV) is a leading cause of graft failure. The incidences of various metabolic syndrome risk factors including hypertension, obesity, diabetes mellitus, and hyperlipidemia are increasingly seen after heart transplantation. Acute and chronic renal failures are common after heart transplantation. Malignancy is a major cause of late morbidity and mortality after heart transplantation. Involvement of psychological and psychiatric support is important following heart transplantation.

  • Case 30 - Elderly lady with right-sided visual hallucinations

  • Edited by Serge Gauthier, McGill University, Montréal, Pedro Rosa-Neto, McGill University, Montréal
  • Book:
    Case Studies in Dementia
    Published online:
    16 May 2011
    Print publication:
    21 April 2011, pp 222-228

  • Summary

    This chapter talks about a 39-year-old woman who was reported to the "German National Reference Center for the Surveillance of Transmissible Spongiform Encephalopathies" (NRC). The patient's medical history comprised allergic asthma, hyperlipidemia, nasal sinus surgery, and pulmonary embolism. The family's medical history comprised allergies, asthma, and psoriasis, cerebrovascular disease, colon cancer, but no early onset dementia. The combination of rapidly progressive dementia, psychosyndrome, ataxia, visual disturbances, and the Pulvinar Sign revealed by MRI as well as the exclusion of encephalitis or many other possible causes of that symptom constellation made the involved physicians consider a prion disease, namely variant Creutzfeldt-Jakob disease, as a differential diagnosis. Rapidly progressive dementia, the "Hockey Sticks" and the exclusion of encephalitis led to the diagnosis of variant Creutzfeldt-Jakob disease (vCJD) in the first place. Wernicke's disease was not as strongly considered initially since the patient was non-alcoholic.

  • Case 43 - Neurofibromatosistype 1 and spinal deformity

  • from Section I - Neuroanesthesia
  • Edited by George A. Mashour, Ehab Farag
  • Book:
    Case Studies in Neuroanesthesia and Neurocritical Care
    Published online:
    03 May 2011
    Print publication:
    03 February 2011, pp 140-142

  • Summary

    Deep brain stimulation (DBS) is the ultimate therapy for motor disease disorders like Parkinson's disease (PD) and dystonia. This chapter presents a case study of a 70-year-old male with a past medical history of hypertension, hyperlipidemia, obstructive sleep apnea, and PD. The patient was scheduled for unilateral DBS electrode insertion in the subthalamic nucleus under sedation. The DBS procedure requires fixation of the patient's head to the stereotactic apparatus for accurate electrode placement. Patient selection and preparation for the procedure are very important in order to minimize the perioperative complications. Propofol can induce respiratory depression and airway obstruction, as was seen in the case. Placement of a laryngeal mask airway (LMA) is the ideal method for managing the upper airway in emergency situations during DBS procedures. Dexmedetomidine creates an environment in which the patient feels comfortable and relaxed during the procedure.

  • Case 56 - Acromegalyand gigantism

  • from Section I - Neuroanesthesia
  • Edited by George A. Mashour, Ehab Farag
  • Book:
    Case Studies in Neuroanesthesia and Neurocritical Care
    Published online:
    03 May 2011
    Print publication:
    03 February 2011, pp 182-183

  • Summary

    Jehovah's Witness (JW) is an evangelical Christian denomination best known to physicians for beliefs regarding the refusal of all blood product transfusions. This chapter presents a case study of a 54-year-old female with a history of obstructive sleep apnea, hyperlipidemia, and scoliosis who presented for T10-L5 posterior spinal fusion. The arterial blood gas analysis was used not only to assess respiratory and metabolic state but also the hematocrit. The antifibrinolytic drug aminocaproic acid was infused during the case to reduce blood loss. Erythropoietin is a blood-stimulating hormone normally synthesized in the kidney that stimulates red blood cell production in the bone marrow. While complex spine procedures in the JW patient may be challenging, successful outcomes can be achieved. With active preoperative assessment, communication, blood conservation strategies, proper positioning and meticulous surgical and anesthetic technique, complex spine surgeries are possible in the JW population.

  • 65 - FIBROMUSCULAR DYSPLASIA

  • from PART VI: - NONINFLAMMATORY DISORDERS OF THE ARTERIAL WALL
  • Edited by Louis R. Caplan, Julien Bogousslavsky
  • Book:
    Uncommon Causes of Stroke
    Published online:
    06 January 2010
    Print publication:
    09 October 2008, pp 491-496

  • Summary

    Minimal change disease (MCD) is the most common cause of nephrotic syndrome in children, although it is not uncommon among adults. Endothelial cell injury, platelet hyperreactivity and hyperaggregability secondary to increased activity of adenosine biphosphate lead to thrombosis. Microalbuminuria is an index of generalized vascular endothelial dysfunction, especially in hypertension and diabetes and a well-recognized risk factor for stroke in men and women, independent of other vascular risk factors and regardless of stroke mechanism. Hyperlipidemia may also contribute to the increased risk for thrombosis seen in nephrotic syndrome. Cerebral arterial infarction is an uncommon yet treatable cause of stroke in patients with nephrotic syndrome, predominantly in patients with membranous glomerulo nephropathy (MGN) followed by focal segmental glomerulosclerosis and immunoglobulin A (IgA) nephropathy, and rarely minimal change nephropathy. Magnetic resonance angiography and magnetic resonance venography are helpful to confirm the diagnosis, and dye contrast catheter cerebral angiography is rarely necessary.

  • Risk Factor Variability and Coronary Heart Disease

  • K. Berg
  • Journal:
    Acta geneticae medicae et gemellologiae: twin research / Volume 39 / Issue 1 / January 1990
    Published online by Cambridge University Press:
    01 August 2014, pp. 15-24
    Print publication:
    January 1990
    • Article
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  • Present attempts to identify genes contributing to coronary heart disease (CHD) risk focus on “candidate genes”. With respect to CHD this could be any gene whose protein product is directly or indirectly involved in atherogenesis, thrombogenesis or thrombolysis/fibrinolysis. Genes that exhibit associations with absolute risk factor levels may be referred to as “level genes” to distinguish them from “variability genes”, which are genes involved in establishing the framework within which environmental influences may cause risk factor variation. In a series of persons recruited from the Norwegian Twin Panel, confirmatory evidence for level gene effect with respect to apolipoprotein B (apoB) concentration was found with an XbaI polymorphism in DNA at the apoB locus corresponding to residue 2,488 in the mature protein. Evidence for variability gene effect with respect to apoB as well as body mass index emerged with DNA variants in the 3′ part of the apoB gene. Level gene effect with respect to apolipoprotein A-I (apoA-I) and high density lipoprotein (HDL) cholesterol as well as apparent variability gene effect with respect to total and LDL cholesterol were detected with a DNA polymorphism at the cholesteryl ester transfer protein (CETP) locus. The first example of interaction between normal genes in determining risk factor level was uncovered in analysis of the apolipoprotein E (apoE) polymorphism and a restriction fragment length polymorphism (RFLP) at the low density lipoprotein receptor (LDLR) locus. An LDLR gene identified by presence of a PvuII restriction site eliminated completely the well known effect of the apoE4 allele on cholesterol level. Finally, in families where high Lp(a) lipoprotein level (a well established risk factor for CHD) segregated as a Mendelian trait, very close linkage with an RFLP at the plasminogen locus was established and DNA variation at the LPA locus reflecting varying numbers of a structure homologous to the “kringle IV” region of plasminogen was uncovered.