Family History Of Disease Research Articles

Conservative management of left ventricle cardiac fibroma in an adult asymptomatic patient

Primary cardiac tumours are rare with an autopsy frequency of 0.001–0.03% and approximately 90% of them are benign. Among these, cardiac fibromas represent a minority and, together with rhabdomyomas, are themost common benign cardiac tumours in paediatric patients. However, their occurrence in the adult patient is uncommon. Most originate from the left ventricle (LV) or interventricular septum. Patients with cardiac fibroma usually present with chest discomfort or pain, syncope, heart failure, cyanosis, arrhythmias or even sudden death but approximately one third of patients diagnosed with cardiac fibroma are asymptomatic and the tumour is discovered incidentally [1]. There is a general agreement that surgical treatment should be performed whenever the cardiac fibroma is causing symptoms. In these patients, surgical options include complete surgical excision, partial resection or orthotopic heart transplantation. Indication for surgical treatment remains controversial in patients who are strictly asymptomatic. We report the case of an asymptomatic adult patient presenting with a giant LV cardiac fibroma and for whom we have opted for a conservative management. A 39-year-oldwomanwas referred to our institution for a LV cardiac mass discovered incidentally during transthoracic echocardiography performed for an unrelated reason. The patient had no personal or familial history of cardiovascular disease and presented no risk factors.

Prevalence and Determinants of Metabolic Syndrome among Women in Chinese Rural Areas

Background and AimsMetabolic syndrome (MS) is prevalent in recent years but few data is reported in the rural areas in China. The aim of this study was to examine MS prevalence and its risk factors among women in rural China.Methods and ResultsThe Nantong Metabolic Syndrome Study (NMSS), a population based cross-sectional study, was conducted during 2007–2008 in Nantong, China. In person interviews, blood glucose and lipid measurements were completed for 13,505 female participants aged 18–74 years. The International Diabetes Federation (IDF), the US Third Report of the National Cholesterol Education Program, the Adult Treatment Panel (ATPIII) and modified ATPIII for Asian population has determined three criteria of MS. These criteria for MS were used and compared in this study. The prevalence of MS was 22.0%, 16.9% and 23.3% according to IDF, ATPIII and ATPIII-modified criteria, respectively. Levels of agreement of these criteria for MS were above 0.75. We found that vigorous-intensity of occupational physical activity was associated with a low prevalence of MS with OR of 0.76 (95% confidence interval (CI): 0.63–0.91). Rice wine drinkers (alcohol >12.8 g/day) had about 34% low risks of developing MS with OR of 0.66 (95% CI: 0.48–0.91), compared with non-drinkers. Odds ratio of MS was 1.81 (95% CI: 1.15–2.84) in women who smoked more than 20 pack-years, compared to non-smokers. Odds ratio of MS was 1.56 (95% CI: 1.25–1.95) in women who had familial history of diseases, including hypertension, diabetes and stroke, compared to women without familial history of those diseases.ConclusionMS is highly prevalent among women in rural China. Both physical activity and rice wine consumption play a protective role, while family history and smoking are risk factors in MS development. Educational programs should be established for promoting healthy lifestyles and appropriate interventions in rural China.

Non-alcoholic fatty liver disease in children

Non-alcoholic fatty liver disease is increasingly prevalent in children, together with obesity. Transaminases, tests for insulin resistance, ultrasonography and MRI are variably used as surrogates markers of steatosis. Other liver diseases, such as Wilson disease, should be excluded. A liver biopsy is performed in selected cases: young children, familial history of severe disease, inconclusive tests for other pathologies, suspected advanced fibrosis, hypertransaminasemia despite weight loss and in clinical trials. Weight reduction, and changes in lifestyle, are the front-line treatment. Drug therapy is under evaluation.

Recommendations on prenatal screening and the connections to other diseases such as thyroid dysfunction

The aim of general maternal-foetal care is to ensure an uncomplicated birth of a healthy baby to a healthy mother. There is a large range of screening tests used during pregnancy: for gestational diabetes, infection, rhesus-D status, thyroid dysfunction, as well as other tests. An important part of prenatal care is the screening of major aneuploidies, primarily for Down's syndrome. This screening is possible in either the first or second trimester, or in both. Management of this type of screening is very similar around the world. Hypothyroidism can affect the psychomotor development of the child. Thyroid-stimulating hormone (TSH), autoantibodies against thyroperoxidase (TPOAb), and free thyroxin (FT4) were determined within our group of 7530 pregnant women. Elevated concentrations of TSH were found in 5.1%, suppression was found in 2.9% and 11.5% were TPOAb positive. Either a familial or personal history of thyroid or autoimmune diseases was present in 58.3% of those women who tested positive on any thyroid test. At minimum, 40% of women TPOAb positive during pregnancy have some kind of thyroid disorders after delivery. These results support the efficacy of general thyroid function screening in early pregnancy, as well as the follow-up after delivery of those women who are positive.

Being at risk for cardiovascular disease: Perceptions and preventive behavior in people with and without a known genetic predisposition

This study compares and explains differences in perceptions of cardiovascular disease (CVD) risk and preventive behaviors in people with and without a known genetic predisposition to CVD. A cross-sectional study using two samples was performed. The first sample (genetic predisposition; n = 51) consisted of individuals recently diagnosed with familial hypercholesterolemia (FH) through DNA testing. The second sample (no genetic predisposition; n = 49) was recruited among patients with CVD-risk profiles based on family history of CVD, cholesterol levels, and blood pressure, registered at general practices. Participants filled out a postal questionnaire asking about their perceived risk, causal attributions (i.e. genetic and lifestyle), and about perceived efficacy and adoption of preventive behavior (i.e. medication adherence and adoption of a healthy diet and being sufficiently active). Perceived comparative risk, genetic attributions of CVD, and perceived efficacy of medication were higher in the “genetic predisposition” sample than in the “no genetic predisposition” sample. The samples did not differ on lifestyle attributions, efficacy of a healthy lifestyle, or preventive behavior. Individual differences in perceived risk, genetic attributions, perceived efficacy of medication, and adoption of a healthy lifestyle were best explained by family history of CVD. Our findings suggest that in people diagnosed with a single gene disorder characterized by a family disease history such as FH, family disease history may be more important than DNA information in explaining perceptions of and responses to risk.

Serum thyroglobulin reference values according to NACB criteria in healthy subjects with normal thyroid ultrasound

The present study was undertaken to establish serum thyroglobulin (Tg) normal reference values in a large group of healthy subjects. Four hundred and thirty-eight non-smoking healthy subjects were selected to assess the Tg reference values (209 males, 229 non-pregnant females, age 34.7±13.1 years). Inclusion criteria were: no personal or familial history of thyroid disease, thyrotropin levels from 0.5 to 2.00 mUI/L, negative thyroperoxidase and thyroglobulin antibodies. In addition, the patients had a normal size thyroid (females ≤18 mL, males ≤25 mL) without nodules on the thyroid ultrasound (TUS). According to National Academy of Clinical Biochemistry (NACB) criteria the Tg results were transformed to a logarithmic scale and reference ranges were calculated as mean±2 SD. Serum Tg was measured on the Beckman Coulter UniCel DxI 800 automated platform by the simultaneous 1-step immunoenzymatic Access Thyroglobulin assay (Beckmann-Coulter SA, Nyon, Switzerland). Serum Tg levels were higher in females than in males (p=0.0022). Accordingly, gender-specific reference values were calculated (i.e., males: 1.40-29.2 ng/mL; females: 1.50-38.5 ng/mL). To the best of the authors' knowledge, the first reference interval study for Tg that integrates NACB criteria and TUS assessment for the selection of the reference population is provided here.

The Relationship between the Time of First Respiratory Syncytial Virus Bronchiolitis and Later Wheezing and Asthma Development

Purpose : Respiratory syncytial virus(RSV) bronchiolitis is believed to be associated with later development of asthma and wheezing. This study was conducted to determine the relationship between the age of the first RSV bronchiolitis episode, the development of later wheezing and asthma, and the related other factors. Methods : We studied 255 infants admitted with their first episode of RSV bronchiolitis. Epidemiological and clinical data were collected retrospectively from medical records and through telephone interviews. The patients were divided into ≤3 months, 4 to 12 months, and 13 to 24 months. Results : Eighty-one infants were ≤3 months, 115 were 4 to 12 months, and 59 were 13 to 24 months old. The gender ratios (Male:Female) were 1:1, 1.6:1, and 3.2:1. Familial and personal history of allergic diseases and disease severity did not significantly differ according to the age of the first RSV bronchiolitis episode. The occurrence of wheezing was associated with the presence of a familial and personal history of allergic diseases, but not with gender (male) or disease severity. The risk for asthma increased when the infants had their first RSV bronchiolitis episode at an older age. A personal history of allergic diseases was associated with an increased risk for asthma. Conclusion : Asthma was more frequently diagnosed in older infants. The most important risk factors for recurrent wheezing and asthma were a familial and personal history of allergic diseases. Therefore, it was thought that RSV bronchiolitis is not the cause of recurrent wheezing and asthma, but that infants with a genetic predisposition to asthma have an increased risk for RSV bronchiolitis. [Pediatr Allergy Respir Dis(Korea) 2012;22:54-63]

Coil Embolization of a Ruptured Basilar Tip Aneurysm Associated with Bilateral Cervical Internal Carotid Artery Occlusion: A Case Report and Literature Review

We report here on a rare case of a ruptured basilar tip aneurysm that was successfully treated with coil embolization in the bilateral cervical internal carotid artery (ICA) occlusions with abnormal vascular networks from the posterior circulation. A 43-year old man with a familial history of moyamoya disease presented with subarachnoid hemorrhage. Digital subtraction angiography demonstrated complete occlusion of the bilateral ICAs at the proximal portion and a ruptured aneurysm at the basilar artery bifurcation. Each meningeal artery supplied the anterior cranial base, but most of both hemispheres were supplied with blood from the basilar artery and the posterior cerebral arteries through a large number of collateral vessels to the ICA bifurcation as well as the anterior cerebral and middle cerebral arteries. The perfusion computed tomography (CT) scans with acetazolamide (ACZ) injection revealed no reduction of cerebral blood flow and normal cerebrovascular reactivity to ACZ. An abdominal CT aortogram showed no other extracranial vessel abnormalities. A ruptured basilar tip aneurysm was successfully treated with coil embolization without complications. Endovascular embolization may be a good treatment option with excellent safety for a ruptured basilar tip aneurysm that accompanies proximal ICA occlusion with vulnerable collateral flow.

Heart Failure in Pediatric and Adolescent Hyperthyroidism

Introduction. Life threatening heart disorders secondary to paediatric and adolescent hyperthyroidism are exceptional. Aim. We aimed to study cardiothyreosis frequency and outcome in children and adolescents with hyperthyroidism diagnosed between 1980 and 2010. Material and methods. In this retrospective study we observed 160 clinical and biological hyperthyroidisms in children (≤ 16 years) and adolescents (16-20 years). Results. Among them four girls aged 3, 16, 17 and 18, without previous familial history of heart diseases, had congestive heart failure (2.5%) without rhythmic troubles. Symptoms of cardiac insufficiency were resistant to digitalis and diuretics, but after anti thyroid drugs, there was an integral restitution of heart function in three cases and a persistent mitral, aortic and tricuspid regurgitation in one case arguing for heart rheumatic disease prior to hyperthyroidism. Conclusion. Heart failure secondary to thyroid hormones excess is extremely rare before age of 20. Among 160 paediatric and adolescent hyperthyroidisms seen in 30 years, four girls had life threatening congestive cardiac insufficiency (2.5%), but after euthyroidism, heart insufficiency disappeared totally in all cases which pleaded for a direct action of thyroid hormones excess on heart function.

Safety and Observations in a Pilot Study of Lenalidomide for Treatment in Autism

Autism affects 1 : 88 children in the United States. Familial history of autoimmune disease, autoantibodies in the serum of mothers when there is more than one autistic offspring, and neuroglial response in CSF and brain tissue in autistic patients suggest an immunological variable may be associated with this condition. Lenalidomide has the potential to invoke changes in TNF-α with less toxicity than thalidomide. This pilot study evaluated lenalidomide at reduction of TNF-α and improvement of behavior and language in children with autism with elevated TNF-α. Subjects with elevated TNF-α were given 2.5 mgs lenalidomide daily for 12-weeks. Pharmacodynamics and safety was evaluated. Changes in language and autistic behaviors after six and twelve weeks were measured. Although statistical significance was not achieved for most measures, there were trends toward improvement. After 6-weeks, mean receptive language increased: 60.67 ± 12.06 to 65.00 ± 15.10 (P = 0.11) and symptoms of autism decreased (40.75 ± 5.96 versus 38.67 ± 7.90, P = 0.068). After 12-weeks, CSF-TNF-α declined 57% ± 25% from 80.5 ± 41.03 to 38.0 ± 31.27 (P = 0.068). Serum TNF-α declined 57% (92.50 ± 68.92 to 40.25 ± 44.53 (P = 0.048). This study suggests that lenalidomide is tolerated as a treatment by children with autism and should be further studied as a potential agent for cytockine inflammation.

Postpartum Onset of Adult Celiac Disease in Identical Twin Sisters

Different risk factors for the onset of celiac disease have been enumerated, with the single most important factor being a known familial history of biopsy-defined disease (1). However, estimated rates of familial celiac disease have been difficult to determine due to the important phenomenon of clinical discordance, even in genetically identical twin pairs (2). In addition, nongenetic factors have been suspected to play a role in the clinical onset of adult celiac disease, including pregnancy and the puerperium (3,4).

Echo time에 따른 MR spectrum의 SNR: 1.5T와 3.0T비교

TE를 변화시킨 정상인 대뇌의 MR spectrum에서 주요 대사물질의 면적과 SNR을 측정하여 PRESS 펄스파형과 STEAM 펄스파형 그리고 1.5T와 3.0T간의 자장세기에 따른 spectrum 간의 차이를 알아보고자 하였다. Phantom 실험을 통하여 적절한 TR을 정한 후, 정상인 지원자 10명(3.0T 5명, 1.5T 5명 ; 남 22~30세 : 평균 26세)을 대상으로 단일용적기법의 STEAM과 PRESS 기법을 시행하였다. 사용된 장비는 3.0T MR scanner(Magnetom Trio, SIEMENS, Germany)와 1.5T MR scanner(Signa Twinspeed GE, USA)이였다. 영상변수는 TR은 2000ms, TE는 30ms, 40ms, 50ms, 60ms, 90ms, 144ms, 288ms, NA는 96, 용적 크기는 <TEX>$20{\times}20{\times}20mm3$</TEX>로 하였으며, spectrum 획득시간은 3분 20초였다. 획득한 데이터는 후처리과정을 통하여 PRESS와 STEAM, 그리고 1.5T와 3.0T system 간의 NAA, Cho, Cr 등의 단순면적값과 SNR을 비교하였다. 또한 육안적 관찰을 통하여 각 대사물질들의 관찰정도를 비교하였다. 1.5T와 3.0T MR spectrum을 분석한 결과, STEAM과 PRESS의 주요 대사물질의 단순 면적값과 SNR은 TE가 증가함에 따라 감소하는 경향을 보였으며, PRESS는 STEAM보다 1.5T에서 1.4배, 3.0T에서 1.3배 높은 SNR을 보였다. 자장의 세기에 따른 SNR 비교에서는 TE가 30ms에서 3.0T가 1.5T보다 약 2배 정도 높은 SNR을 보였으나 TE값이 증가함에 따라 3.0T에서의 SNR 감소율이 1.5T에서의 SNR 감소율보다 커서 TE가 90ms 이상부터는 큰 차이가 없었다. 반면 3.0T의 spectrum에서는 1.5T에서 구분할 수 없었던 <TEX>${\alpha}$</TEX>-Glx, <TEX>${\beta}{\cdot}{\gamma}$</TEX>-Glx, NAA complex등 작은 대사물질들을 보다 정확히 감별 할 수 있었고 short TE의 PRESS일 때 short TE의 STEAM보다 작은 대사물질들이 잘 관찰 되었다. 3.0T spectrum의 해상도와 SNR이 1.5T spectrum에 비하여 우수함을 알 수 있었다. 그러나 90ms이상의 long TE에서는 3.0T와 1.5T spectrum간의 SNR은 차이가 없었다. 따라서 고자장하에서의 자기공명분광법은 30ms 이하의 짧은 TE를 이용한 PRESS 펄스 파형을 사용하는 것이 임상적으로 유용하게 사용될 수 있을 것이라 사료된다. The purpose of this study is to know the differences of MR spectra, obtained from normal volunteers by variable TE value, through the quantitative analysis of brain metabolites by peak integral and SNR between 1.5T and 3.0T, together with PRESS and STEAM pulse sequence. Single-voxel MR proton spectra of the human brain obtained from normal volunteers at both 3.0T MR system (Magnetom Trio, SIEMENS, Germany) and 1.5T MR system (Signa Twinspeed, GE, USA) using the STEAM and PRESS pulse sequence. 10 healthy volunteers (3.0T:3 males, 2 females; 1.5T : 3 males, 2 females) with the range from 22 to 30 years old (mean 26 years) participated in our study. They had no personal or familial history of neurological diseases and had a normal neurological examination. Data acquisition parameters were closely matched between the two field strengths. Spectra were recorded in the white matter of the occipital lobe. Spectra were compared in terms of resolution and signal-to-noise ratio(SNR), and echo time(TE) were estimated at both field strengths. Imaging parameters was used for acquisition of the proton spectrum were as follow : TR 2000msec, TE 30ms, 40ms, 50ms, 60ms, 90ms, 144ms, 288ms, NA=96, VOI=<TEX>$20{\times}20{\times}20mm3$</TEX>. As the echo times were increased, the spectra obtained from 3.0T and 1.5T show decreased peak integral and SNR at both pulse sequence. PRESS pulse sequence shows higher SNR and signal intensity than those of STEAM. Especially, Spectra in normal volunteers at 3.0T demonstrated significantly improved overall SNR and spectral resolution compared to 1.5T(Fig1). The spectra acquired at short echo time, 3T MR system shows a twice improvement in SNR compared to 1.5T MR system(Table. 1). But, there was no significant difference between 3.0Tand 1.5T at long TE It is concluded that PRESS and short TE is useful for quantification of the brain metabolites at 3.0T MRS, our standardized protocol for quantification of the brain metabolites at 3.0T MRS is useful to evaluate the brain diseases by monitoring the systematic changes of biochemical metabolites concentration in vivo.

Cultural Competence: How Qualified Are You?

Cultural Competence: How Qualified Are You?

Combination of Allergic Factors Can Worsen Diarrheic Irritable Bowel Syndrome: Role of Barrier Defects and Mast Cells

Recent evidence suggests a role for increased colonic permeability and mucosal mast cell (MC) mediators on symptoms related to the irritable bowel syndrome (IBS). Whether allergic factors (AFs) are involved in the pathophysiology of IBS is unclear. We addressed the question of the possible influence of an allergic background on IBS symptoms. We assessed paracellular permeability, mucosal MCs counts, and spontaneous release of tryptase of colonic biopsy specimens in 34 IBS patients and 15 healthy subjects. The severity of IBS was assessed through self-reported questionnaires. All individuals were tested for the presence of AF, including self-perception of adverse reaction to food, personal and familial history of atopic disease, elevated total or specific immunoglobulin E against food/inhalant antigens, blood eosinophilia, and skin tests. IBS patients had significant enhanced colonic permeability, higher number of MCs, and spontaneous release of tryptase than healthy subjects. The severity of IBS was significantly correlated with colonic permeability (r=0.48, P=0.004), MCs counts (r=0.36, P=0.03), and tryptase (r=0.48, P=0.01). In 13 IBS patients (38.2%) having at least three AFs, symptoms scores, colonic permeability, MCs counts, and tryptase release by colonic biopsies were significantly higher than in those with less than three AFs. IBS patients with at least three AFs were more prone to diarrhea or alternating symptoms. None AF was found to be predictive of IBS severity. In IBS patients, the presence of an allergic background correlates with a more severe disease and diarrhea predominance, possibly by enhancing mucosal MC activation and paracellular permeability.

Family history of coronary heart disease, health care and health behaviors

IntroductionPrevious studies on health care and health behaviors in individuals with a family history of coronary heart disease (CHD) have produced contradictory results, and there is still no evidence that these individuals are more aware of their risk and have improved health behaviors and heath care. This study aims to evaluate health care and health behaviors according to family history of CHD. MethodsIndividuals randomly selected from the general population living in Porto, Portugal, aged ≥18 years (evaluation period: 1999–2003), and without prior history of chronic diseases (n=764), were evaluated by questionnaires on family and personal disease history, health care and health behaviors. A family history of CHD was defined as the occurrence of acute myocardial infarction or sudden death in at least one first-degree relative. Odds ratios and 95% confidence intervals (OR, 95% CI) were calculated using unconditional logistic regression after stratification for age (18–39 vs. ≥40 years) and education (≤6 vs. >6 years schooling). ResultsAmong men, 20% reported a family history of CHD, approximately the same proportion as in women (19.4%) (p=0.900). The proportion of subjects with a family history of CHD was significantly higher in older (≥40 vs. 18–39 years: 25.0% vs. 12.0%, p<0.001) and less educated individuals (>6 vs. ≤6 years: 27.0% vs. 17.1%, p=0.004). Overall, no significant associations were found between health care and behaviors and CHD family history. Only in younger individuals, after adjustment for education, was a significant positive association found between 1–2 dental visits and CHD family history (OR=2.92; 95% CI: 1.27–6.70). Younger subjects who smoked and consumed alcohol and caffeine also presented a higher probability of having CHD family history, but the associations were not statistically significant. Discussion and conclusionsIn this population without disease requiring regular medical care, individuals with CHD family history had similar care-seeking patterns and health behaviors to those without. These results suggest a lack of awareness of their increased risk and highlight the importance of developing measures to promote sustained and effective changes in risk factors in individuals with genetic susceptibility to CHD.

Family history of coronary heart disease, health care and health behaviors

Introduction Previous studies on health care and health behaviors in individuals with a family history of coronary heart disease (CHD) have produced contradictory results, and there is still no evidence that these individuals are more aware of their risk and have improved health behaviors and heath care. This study aims to evaluate health care and health behaviors according to family history of CHD. Methods Individuals randomly selected from the general population living in Porto, Portugal, aged ≥18 years (evaluation period: 1999–2003), and without prior history of chronic diseases (n = 764), were evaluated by questionnaires on family and personal disease history, health care and health behaviors. A family history of CHD was defined as the occurrence of acute myocardial infarction or sudden death in at least one first-degree relative. Odds ratios and 95% confidence intervals (OR, 95% CI) were calculated using unconditional logistic regression after stratification for age (18–39 vs. ≥40 years) and education (≤6 vs. >6 years schooling). Results Among men, 20% reported a family history of CHD, approximately the same proportion as in women (19.4%) (p = 0.900). The proportion of subjects with a family history of CHD was significantly higher in older (≥40 vs. 18–39 years: 25.0% vs. 12.0%, p < 0.001) and less educated individuals (>6 vs. ≤6 years: 27.0% vs. 17.1%, p = 0.004). Overall, no significant associations were found between health care and behaviors and CHD family history. Only in younger individuals, after adjustment for education, was a significant positive association found between 1–2 dental visits and CHD family history (OR=2.92; 95% CI: 1.27–6.70). Younger subjects who smoked and consumed alcohol and caffeine also presented a higher probability of having CHD family history, but the associations were not statistically significant. Discussion and conclusions In this population without disease requiring regular medical care, individuals with CHD family history had similar care-seeking patterns and health behaviors to those without. These results suggest a lack of awareness of their increased risk and highlight the importance of developing measures to promote sustained and effective changes in risk factors in individuals with genetic susceptibility to CHD.

Contemporary evidence of coronary atherosclerotic disease and myocardial bridge on left anterior descending artery in a patient with a nonobstructive hypertrophic cardiomyopathy

To the Editor. We report the case of patient P.R., a 46-year-old man with an echocardiographic diagnosis of nonobstructive hypertrophic cardiomyopathy since 2001. The patient’s major cardiovascular risk factors were a familial history of coronary artery disease and mild hypertension. In the previous 6 months, the patient complained of dyspnea on exertion (NYHA II), tachycardia and typical angina. An exercise stress test and subsequent physical stress echocardiography were completely negative. Due to the worsening of the symptoms at rest, we decided to perform selective coronary angiography. An 80% stenosis was detected in the proximal tract of the left anterior descending artery (LAD), at the level of the origin of the first diagonal branch. Three centimeters distal to this lesion, in the middle segment of the LAD, a clear dynamic (systolic) narrowing of the coronary arterial lumen was detected, suggesting a myocardial bridge (Fig. 1). This finding was confirmed by performing an intravascular ultrasound (IVUS) examination (Fig. 2).

Association Between Family History and Disease Risk in Persons Entering Supervised Exercise: a Pilot Study

Genetics is known to play an important role in many pathologies. Positive family history is often predictive of future diseases including heart disease, diabetes and obesity. This may be a reason why some individuals choose to enter monitored, medically supervised exercise programs. PURPOSE: To determine the association between family disease history and demographics collected from individuals entering a supervised exercise program. METHODS: Measurements were collected from 139 individuals, including estimated max VO2, body weight, BMI, waist/hip ratio, percent body fat, systolic and diastolic blood pressure, and cholesterol. Family history of heart attack, hypertension, hyperlipidemia, obesity, stroke, diabetes, and other heart disease was recorded upon program entry. RESULTS:TableCONCLUSIONS: Multiple associations may exist between family history and disease risk factors in individuals entering a supervised exercise program. Future research should examine the clinical significance and magnitude of these relationships.

Gender-Based Differences in the Management and Prognosis of Acute Coronary Syndrome in Korea

PurposeGender-based differences exist in the characteristics, management, and prognosis of acute coronary syndrome (ACS). However, their impact on prognosis remains unclear. We aimed to identify factors causing these differences in Koreans.Materials and MethodsWe examined 6,636 ACS patients (66.2% males) visiting 72 Korean hospitals between April-2007 and December-2008. Gender-based differences in clinical demographics, therapy, and outcomes were analyzed over 6 months.ResultsWomen were older than men [mean (standard deviation, SD) age, 67.6 (9.8) vs. 60.6 (11.2) years; p<0.001]; had higher rates of hypertension, diabetes mellitus, and lack of exercise (p<0.001 for all); and lower rates of obesity, familial history of cardiovascular disease (CVD), and smoking (p<0.05 for all). Atypical symptoms were more common in women (20.5% vs. 15.1% in men, p<0.001), whereas myocardial infarction with ST-segment elevation was less common (17.1% vs. 27.8%, p<0.001). Mean (SD) time lapse from symptom onset to arrival at hospital was longer in women [11.44 (18.19) vs. 8.26 (14.89) hours in men, p<0.001], as was the duration of hospitalization [7.58 (7.61) vs. 7.04 (7.72) days, p=0.007]. Fewer women underwent revascularization procedures, including thrombolytic therapy, balloon angioplasty, stent implantation, and coronary artery bypass grafting (79.4% vs. 83.3% men, p<0.001). No significant differences were observed in CVD-related death, recurrent ACS, stroke, refractory angina, or rehospitalization for angina.ConclusionFemale ACS patients were older than male subjects and had more atypical presentation. They arrived at the hospital later than men and had longer hospital stays, but less often required revascularization therapy. However, no gender-based differences were noted in ACS-related mortality and morbidity.

Early onset of allergic rhinitis and asthma in recent extra-European immigrants to Milan, Italy: the perspective of a non-governmental organisation

Background Allergy is determined by genetic and environmental factors. People immigrating from under-developed to industrialised countries are at higher risk of developing allergic diseases and immigration is as a good epidemiological model to quantify the influence of the environment. We performed the allergological assessment of 32,555 recent immigrants from different areas of the world to a polluted metropolitan area of Northern Italy. Methods We evaluated time of onset of allergic rhinitis and/or asthma, sensitisations and clinical characteristics of 395 subjects (3.74 ± 2.94 yrs, mean ± SD) from four macro-areas (Asia, Africa, East-Europe, South America) arriving to Milan, Italy from June 2005 to June 2009. Data were compared with immigrants having access to the same medical facility for any medical problem and with resident Italians living in the same area. Results Immigrants with allergic rhinitis and/or asthma days since arrival in Italy correlated with number of sensitisations (p=0.0030). Moreover, personal (2.02%) or familial (2.78%) history of allergic diseases was lower in allergic immigrants as compared to allergic residents (37.77 and 29.39%, respectively; p<0.0001 for both comparisons). Finally, the frequency of allergic immigrants from South America (63.3%) was higher than expected from the overall proportion of individuals from this macro-area who sought medical help at the same facility (40.4%; p<0.0001, OR 2.289, CI 2.1670–3.255). Conclusions Environmental factors play a relevant role in the induction of allergies in immigrants to Northern Italy. Genetics appears as a further promoting factor in the case of immigrants from South America.