Lack Of Pharmacological Treatment Research Articles

Abstract 5956: Relationship between fatty acid intake and liver steatosis and fibrosis among overweight and obese Mexican-origin adults

Abstract Background: Mexican-origin (MO) Hispanic adults have the highest rates of non-alcoholic fatty liver disease (NAFLD) in the United States (US), which places them at high risk of hepatocellular carcinoma (HCC). Diet plays a significant role in the development and treatment of NAFLD given the lack of pharmacological treatment. Nutritional components hypothesized to influence NAFLD risk include an imbalance in the consumption of omega-6 (n-6) relative to omega-3 (n-3) polyunsaturated fatty acids (PUFAs). However, data on the relationship between dietary intake of fatty acids (FA) and liver steatosis and fibrosis is limited for MO adults. Purpose: This study examined FA intake among overweight and obese Mexican-origin (MO) Hispanic adults and evaluated its association to liver steatosis and fibrosis. Methods: Overweight and obese participants (n=285, MO Hispanic adults) completed three 24-hour dietary recalls on two week days and one weekend day, to estimate dietary FA intake. Liver steatosis was defined by continuous attenuation parameter (CAP) scores that can range from 100 to 400 dB/m. Fibrosis was defined by kilopascals (kPa) and can range from 2 to 75 kPa. Liver steatosis and fibrosis were quantified using non-invasive transient elastography (Fibroscan®). Multiple regression analyses tested relationships between FA intakes and liver steatosis or fibrosis, adjusting for sex, BMI, and total energy intake. Results: Among MO Hispanic adults, mean CAP score was 289.5 ± 48.9 dB/m, equivalent to approximately 67% hepatic steatosis, and a mean fibrosis of 5.67± 2.83 kPa. The mean intake of n-6 and n-3 was 12.0 ± 6.5 g/day and 1.50 ± 1.01 g/day, respectively, with a ratio of 8.9 (range: 2.46 - 19.8). The most commonly consumed n-6 and n-3 FAs were linoleic acid (LA) (12 ± 6.5 g/day) and alpha-linoleic acid (ALA) (1.50 g/day ± 1.01), respectively. Overall, no associations were observed between the ratio of n-6 to n-3 and liver steatosis. However, LA-to-ALA ratio and the n-6 to n-3 ratio were positively associated with liver fibrosis such that a one point increase in the LA-to-ALA ratio resulted in a 1.01-point increase in fibrosis (95% CI: [1.00, 1.03]; p=0.029), and a one point increase in the n-6 to n-3 resulted in a 1.02-point increase in fibrosis (95% CI: [1.01, 1.03]; p=0.005). Conclusion: Intake and ratios of n-6 and n-3 PUFAs were comparable to what is observed in general US populations and were not associated with liver steatosis. However, n-6 and n-3 ratios were associated with liver fibrosis. These findings highlight the need for a more rigorous examination of the association between n-PUFAS and liver fibrosis and their potential as a therapeutic strategy for more severe liver disease such as non-alcoholic steatohepatitis (NASH) and cirrhosis in this high-risk population. Citation Format: Melissa Lopez-Pentecost, Brian Hallmark, Cynthia Thomson, Floyd Chilton, David Garcia. Relationship between fatty acid intake and liver steatosis and fibrosis among overweight and obese Mexican-origin adults [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2022; 2022 Apr 8-13. Philadelphia (PA): AACR; Cancer Res 2022;82(12_Suppl):Abstract nr 5956.

Outcome assessment using estimation of left ventricular filling pressure in asymptomatic patients at risk for heart failure with preserved ejection fraction

AimsHigh prevalence and lack of pharmacological treatment are making heart failure with preserved ejection fraction (HFpEF) a growing public health problem. No algorithm for the screening of asymptomatic patients with risk for HFpEF exists to date. We assessed whether HFA/ESC 2007 diagnostic criteria for HFpEF are helpful to investigate the cardiovascular outcome in asymptomatic patients. Methods and resultsWe performed an analysis of the Diagnostic Trial on Prevalence and Clinical Course of Diastolic Dysfunction and Heart Failure (DIAST-CHF) that recruited patients with cardiovascular risk factors. All patients underwent a comprehensive diagnostic workup at baseline. Asymptomatic patients with preserved LVEF (>50%) were selected and classified according to HFA/ESC surrogate criteria for left ventricular elevated filling pressure (mean E/e’ >15 or E/e’ >8 and presence of either NT-proBNP > 220 ng/l, BNP > 200 ng/l or atrial fibrillation) into elevated filling pressure (FPe) or controls. Cardiovascular hospitalizations and all-cause death were assessed for both groups over a 10-year-follow-up.851 asymptomatic patients (age 65.5 ± 7.6 years, 44% female) were included in the analysis. FPe-patients were significantly older (p < 0.001), more often female (p = 0.003) and more often had a history of coronary artery disease, atrial fibrillation and renal dysfunction (p < 0.001, respectively) compared to controls. Incidence of death was significantly higher in the FPe group after a 10-year follow-up (p < 0.001), whereas cardiovascular hospitalization did not differ between groups. ConclusionAsymptomatic patients that fulfill HFA/ESC diagnostic criteria for HFpEF are at higher risk of symptomatic HFpEF and have a worse 10-year-outcome than those who do not fulfill criteria.

Analysis of Anxiety, Depression and Aggression in Patients Attending Pain Clinics.

The aim of the study was to measure the frequency of such emotional disturbances as anxiety, depression and aggression among patients treated in a pain clinic, as well as assess the factors contributing to such disorders. Research was conducted from January 2014 to April 2018 and involved patients treated in two pain clinics in the city of Warsaw, Poland. The study used the Hospital Anxiety and Depression Scale—Modified Version (HADS-M) and the Numerical Rating Scale (NSR). 1025 patients were recruited. The main reasons for their attending the pain clinic were osteoarticular pain (43.61%) and neuropathic pain (41.56%). Emotional disturbances in the form of anxiety were diagnosed in 32.39% of all the patients, depression in 17.85%, and aggression in 46.15%. The factors determining the level of anxiety in the study group were: sex, age, pain intensity and the lack of pharmacological treatment. Depression was determined by sex, pain intensity and the time of treatment in the clinic, while aggression by age and pain intensity.

In Vivo Articular Cartilage Regeneration Using Human Dental Pulp Stem Cells Cultured in an Alginate Scaffold: A Preliminary Study

Osteoarthritis is an inflammatory disease in which all joint-related elements, articular cartilage in particular, are affected. The poor regeneration capacity of this tissue together with the lack of pharmacological treatment has led to the development of regenerative medicine methodologies including microfracture and autologous chondrocyte implantation (ACI). The effectiveness of ACI has been shown in vitro and in vivo, but the use of other cell types, including bone marrow and adipose-derived mesenchymal stem cells, is necessary because of the poor proliferation rate of isolated articular chondrocytes. In this investigation, we assessed the chondrogenic ability of human dental pulp stem cells (hDPSCs) to regenerate cartilage in vitro and in vivo. hDPSCs and primary isolated rabbit chondrocytes were cultured in chondrogenic culture medium and found to express collagen II and aggrecan. Both cell types were cultured in 3% alginate hydrogels and implanted in a rabbit model of cartilage damage. Three months after surgery, significant cartilage regeneration was observed, particularly in the animals implanted with hDPSCs. Although the results presented here are preliminary, they suggest that hDPSCs may be useful for regeneration of articular cartilage.

Low prevalence of hypertension with pharmacological treatments and associated factors

OBJECTIVE: To assess the determinants of the lack of pharmacological treatment for hypertension. METHODS: In 2005, 3,323 Mozambicans aged 25-64 years old were evaluated. Blood pressure, weight, height and smoking status were assessed following the Stepwise Approach to Chronic Disease Risk Factor Surveillance. Hypertensives (systolic blood pressure ≥ 140 mmHg and/or diastolic blood pressure ≥ 90 mmHg and/or antihypertensive drug therapy) were evaluated for awareness of their condition, pharmacological and non-pharmacological management, as well as use of herbal or traditional remedies. Prevalence ratios (PR) were calculated, adjusted for sociodemographic characteristics, cardiovascular risk factors and non-pharmacological treatment. RESULTS: Most of the hypertensive subjects (92.3%), and nearly half of those aware of their condition were not treated pharmacologically. Among the aware, the prevalence of untreated hypertension was higher in men {PR = 1.61; 95% confidence interval (95%CI 1.10;2.36)} and was lower in subjects under non-pharmacological treatment (PR = 0.58; 95%CI 0.42;0.79); there was no significant association with traditional treatments (PR = 0.75; 95%CI 0.44;1.26). CONCLUSIONS: The lack of pharmacological treatment for hypertension was more frequent in men, and was not influenced by the presence of other cardiovascular risk factors; it could not be explained by the use of alternative treatments as herbal/traditional medicines or non-pharmacological management. It is important to understand the reasons behind the lack of management of diagnosed hypertension and to implement appropriate corrective actions to reduce the gap in the access to healthcare between developed and developing countries.

Crack/cocaine use in a rural county of England

Crack/cocaine use is an increasing problem in the UK. This study is the first to ascertain the magnitude of the crack/cocaine problem in a rural county of the UK and to determine users' needs for treatment services. A questionnaire on drug dependence and risk behaviour was completed by 306 users of drug treatment services, and focus groups were conducted with 45 self-selected crack/cocaine users. It is estimated that 31% (95% C.I., 26% to 37%) of drug users in treatment services have moderate/severe dependence on crack/cocaine. Factors associated with severe crack/cocaine dependence are severe dependence on benzodiazepines, increasing number of drugs used, engaging in sex work and non-white ethnicity. Those with severe dependence have a higher prevalence of hepatitis B and C compared with those with moderate or no dependence. All focus group participants describe a frenzied drug life so when entering treatment they require additional support to give structure to their lives to prevent relapse. Current service provision appears not to provide help to crack/cocaine users. Given the lack of pharmacological treatment, programmes should incorporate a wide range of activities and interventions to provide structure to clients' lives. Learning from ex-users was perceived as an important component of treatment.