Male Study Subjects Research Articles

The recognition and treatment of vertebral fractures in males with chronic obstructive pulmonary disease

Males with chronic obstructive pulmonary disease (COPD) are at increased risk for developing osteoporosis (OP) with subsequent vertebral compression fractures. Such fractures with resultant increased thoracic kyphotic angle (TKA) may interfere with these patients' already compromised pulmonary function. A retrospective cross-sectional study was performed to evaluate the recognition and treatment of vertebral fractures in male patients with COPD. The study population included male patients with COPD aged 55 years and older who had a lateral chest X-ray (index film) performed between January 1, 2001 and July 5, 2005. Vertebral fractures and the TKA were determined independently by two different radiologists. One radiologist (reviewer #1) used direct measurement including quantitative morphometric analysis to determine fractures and the TKA, whereas the second radiologist (reviewer #2) used visual inspection only. Inter-reader agreement for vertebral fractures and TKA was assessed. The computerized charts were reviewed to determine the initial recognition of vertebral fractures and the subsequent therapy. Logistic regression was employed to determine significant risk factors for vertebral fractures in this male population. Three hundred and fifty male study subjects and their index lateral chest X-rays were reviewed. Ages ranged from 52 to 90 and 9/350 (2.6%) of the study subjects had vertebral fractures identified on the initial radiology report. None of these nine patients were subsequently treated with anti-osteoporotic agents other than calcium and vitamin D, and two of them had a follow-up central bone density. Reviewer #1 measured 361 fractures in 181 subjects and determined the mean TKA to be 31.43 (+/-8.62) degrees. Reviewer #2 identified 27 fractures in 19 subjects and with an estimated mean TKA of 24.84 (+/-8.53) degrees. There was little inter-observer agreement with vertebral fractures (kappa=0.07), but there was a strong positive correlation with the TKA (r=0.79). There was a weak to moderate correlation with the TKA and the presence of vertebral fractures (r=0.26). Significant risk factors for vertebral fractures included smoking status (odds ratio 1.84 [1.08-3.15]) and age (odds ratio 1.06 [1.03-1.09] for each year increase in age). A large number of vertebral fractures in males with COPD goes undiagnosed. In those patients with diagnosed vertebral fractures, follow-up therapy is under-utilized. When analyzing lateral chest X-rays for vertebral fractures, visual inspection alone without direct measurement may not be an adequate technique for identifying fractures.

Areca nut use in rural Tamil Nadu: A growing threat

Areca nut is the fourth main psychoactive substance in the world. In India, tobacco is added to the quid and the commercially manufactured nonperishable forms of betel quid (pan masala or gutkha) are on the rise in the market. To find out the prevalence of areca nut among the rural residents of Sriperambudur Taluk. A community-based survey using pre-tested semi-structured questionnaire. The survey was conducted in 2 villages and their colonies, which were randomly selected out of 168 villages. Data was collected from 500 residents of the study population. The survey was conducted for a period of 2 months. SPSS version 10.0. The study participants were more likely to initiate areca nut use by 22 years of age. As many as 19.8% (n = 99) of the study participants chewed areca nut products, out of whom 11.2% (n = 56) indulged in chewing habit alone (areca nut products). Areca nut use was higher among male study subjects compared to females. The commercial forms of areca nut products (gutkha) were the most prevalent ones [47.5% (n = 47) of those who used areca nut] observed in the community. Compared to female participants, male participants were more likely to perceive areca nut use as the most harmful habit draining the community health and wealth. There seems to be an increase in the prevalence of areca nut use. The community also perceives it to be a harmful habit. Therefore, effective interventions should be targeted towards the high-risk subpopulation of the community to decrease the prevalence of areca nut use in rural Tamil Nadu.

Analysis of Effectiveness of Human U-500 Insulin in Patients Unresponsive to Conventional Insulin Therapy

To present a retrospective analysis of the effects of human U-500 insulin in 20 patients with type 2 diabetes and insulin resistance. Medical records of 20 patients with type 2 diabetes who had received U-500 insulin for at least 6 months were reviewed to determine glycemic control before and after this therapy. Human regular U-500 insulin therapy was initiated at a unit dosage equivalent to the previous standard insulin dosage. Comparisons of hemoglobin A1c levels, insulin doses, and body mass index at baseline and 6 months after changing to U-500 insulin therapy were analyzed. In the 10 female and 10 male study subjects, the mean (+/-SD) hemoglobin A1c level was 9.59 +/- 1.37% initially, and it decreased to 8.53 +/- 1.11% at 3 months and to 7.83 +/- 1.26% at 6 months after initiation of U-500 insulin therapy. In comparison with baseline, these decreases were statistically significant. The amount of insulin used and the body mass index did not change significantly from baseline to 6 months after initiation of U-500 insulin treatment. Analysis of data suggests that U-500 insulin therapy yields improved glycemic control in insulin-resistant patients who have poor control of blood glucose with use of standard insulin regimens. There is no proof, however, that improved glycemic control by this method decreases diabetes-related complications or improves survival. Further studies must be performed before U-500 insulin can be recommended as a standard therapy for patients with insulin resistance.

Paternal and maternal components of the predisposition to preeclampsia.

There is an inherited maternal predisposition to preeclampsia. Whether there is a paternal component, however, is not known. We used records of the Utah Population Database to identify 298 men and 237 women born in Utah between 1947 and 1957 whose mothers had had preeclampsia during their pregnancy. For each man and woman in the study group, we identified two matched, unrelated control subjects who were not the products of pregnancies complicated by preeclampsia. We then identified 947 children of the 298 male study subjects and 830 children of the 237 female study subjects who had been born between 1970 and 1992. These children were matched to offspring of the control subjects (1950 offspring of the male control group and 1658 offspring of the female control group). Factors associated with preeclampsia were identified, and odds ratios were calculated with the use of stepwise logistic-regression analysis. In the group whose mothers had had preeclampsia (the male study group), 2.7 percent of the offspring (26 of 947) were born of pregnancies complicated by preeclampsia, as compared with 1.3 percent of the offspring (26 of 1973) in the male control group. In the female study group, 4.7 percent of the pregnancies (39 of 830) were complicated by preeclampsia, as compared with 1.9 percent (32 of 1658) in the female control group. After adjustment for the offspring's year of birth, maternal parity, and the offspring's gestational age at delivery, the odds ratio for an adult whose mother had had preeclampsia having a child who was the product of a pregnancy complicated by preeclampsia was 2.1 (95 percent confidence interval, 1.0 to 4.3; P=0.04) in the male study group and 3.3 (95 percent confidence interval, 1.5 to 7.5; P=0.004) in the female study group. Both men and women who were the product of a pregnancy complicated by preeclampsia were significantly more likely than control men and women to have a child who was the product of a pregnancy complicated by preeclampsia.

Impact of Early HIV-1 RNA and T-Lymphocyte Dynamics During Primary HIV-1 Infection on the Subsequent Course of HIV-1 RNA Levels and CD4+ T-Lymphocyte Counts in the First Year of HIV-1 Infection

Summary: Plasma HIV-1 RNA and CD4+ T-cell counts after HIV-1 seroconversion are important independent markers that predict the clinical course of HIV-1 infection. The prognostic significance of these parameters during primary HIV-1 infection, however, remains largely unknown. In a cohort of 53 male study subjects (age, 33 ± 7 years), who consecutively presented with primary HIV-1 infection, we analyzed the relationship between early plasma HIV-1 RNA, CD4+ and CD8+ T-cell counts, β2microglobulin, and p24-antigen levels determined in the first 3 months and subsequent plasma HIV-1 RNA levels and CD4+ T-cell counts 6 to 12 months after onset of primary symptoms. Peak, nadir, and median HIV-1 RNA levels in the first 30 days were already significantly associated with HIV-1 RNA levels at 6 to 12 months (p = .02, p < .0001, and p = .01, respectively). Similarly, early nadir and median CD4+ T-lymphocyte counts in the first 30 days showed a significant relationship with CD4+ T-cell counts at 6 to 12 months (p = .009 and p = .0008, respectively). Study subjects with an early decline of CD4+ counts to <500 cells/μl had an eightfold higher risk that CD4+ counts were <500 cells/μl at 1 year. Of all evaluated virologic parameters, only nadir HIV-1 RNA at 76 days predicted CD4+ counts at 6 to 12 months (p = .006). Early HIV-1 RNA levels and CD4+ counts are already associated with the time course of those parameters 6 to 12 months after onset of symptoms. Nadir viral load was the strongest predictor of HIV-1 RNA levels as well as of CD4+ counts at 6 to 12 months. An early decline of CD4+ T lymphocytes may be a useful clinical prognostic marker for rapid disease progression.

Impact of early HIV-1 RNA and T-lymphocyte dynamics during primary HIV-1 infection on the subsequent course of HIV-1 RNA levels and CD4+ T-lymphocyte counts in the first year of HIV-1 infection. Sydney Primary HIV Infection Study Group.

Plasma HIV-1 RNA and CD4+ T-cell counts after HIV-1 seroconversion are important independent markers that predict the clinical course of HIV-1 infection. The prognostic significance of these parameters during primary HIV-1 infection, however, remains largely unknown. In a cohort of 53 male study subjects (age, 33 +/- 7 years), who consecutively presented with primary HIV-1 infection, we analyzed the relationship between early plasma HIV-1 RNA, CD4+ and CD8+ T-cell counts, beta2-microglobulin, and p24-antigen levels determined in the first 3 months and subsequent plasma HIV-1 RNA levels and CD4+ T-cell counts 6 to 12 months after onset of primary symptoms. Peak, nadir, and median HIV-1 RNA levels in the first 30 days were already significantly associated with HIV-1 RNA levels at 6 to 12 months (p = .02, p < .0001, and p = .01, respectively). Similarly, early nadir and median CD4+ T-lymphocyte counts in the first 30 days showed a significant relationship with CD4+ T-cell counts at 6 to 12 months (p = .009 and p = .0008, respectively). Study subjects with an early decline of CD4+ counts to <500 cells/microl had an eightfold higher risk that CD4+ counts were <500 cells/microl at 1 year. Of all evaluated virologic parameters, only nadir HIV-1 RNA at 76 days predicted CD4+ counts at 6 to 12 months (p = .006). Early HIV-1 RNA levels and CD4+ counts are already associated with the time course of those parameters 6 to 12 months after onset of symptoms. Nadir viral load was the strongest predictor of HIV-1 RNA levels as well as of CD4+ counts at 6 to 12 months. An early decline of CD4+ T lymphocytes may be a useful clinical prognostic marker for rapid disease progression.

Age‐Specific Analysis of Liver Dysfunction among Printing Plant Workers

Age‐Specific Analysis of Liver Dysfunction among Printing Plant Workers: Yasushi Honda, et al. Environmental Health Sciences Division, National Institute for Environmental Studies—This cross‐sectional survey investigated the age difference in the effect of two major causes of liver dysfunction, i.e., obesity and drinking. “Liver dysfunction” is defined here as an abnormal level of either serum aspartate aminotransferase (AST) or alanine aminotransferase (ALT). After eliminating subjects who are either hepatitis B antigen positive or hepatitis C antibody positive, we obtained 901 male study subjects aged 24 to 63 working at two printing plants, whose tasks did not entail exposure to materials that might cause liver dysfunction. The proportion of subjects with’ liver dysfunction was higher in the 40‐49 year age group than in any other age group. We consider this age pattern was mainly attributable to the following two factors: (1) Among non‐drinkers, the prevalence ratio (PR) for the moderately obese group was 3.4 (95% confidence interval = 1.1 1 0.4) and the PR for severely obese group was 8.2 (3.0‐22.9) compared with the non‐obese group in the 40‐49 year age group, whereas the corresponding Mantel‐Haenszel PRs controlled for age were 1.6 (0.97‐2.7) and 4.4 (2.8‐7.1), respectively. (2) The proportion of subjects with obesity or with a drinking habit is higher in the 40‐49 year age group. The effect of habitual drinking was not great : The Mantel‐Haenszel PR (controlled for age) for drinkers compared with “non‐habitual‐drinkers” was 1.2 (0.72‐2.0) for the non‐obese group, 1.8 (1.1‐2.8) for the moderately obese group, and 0.84 (0.48‐1.5) for the severely obese subjects.

Seroepidemiology of human T-lymphotropic virus type I infection among intravenous drug abusers in Taiwan.

In order to assess seroprevalence of human T-lymphotropic virus type I (HTLV-I) infection among intravenous drug abusers in Taiwan, serum samples were collected from 858 male study subjects. Antibodies against HTLV-I (anti-HTLV-I) in sera were tested by enzyme-linked immunosorbent assay and confirmed by Western blotting. The overall prevalence of anti-HTLV-I (2.3%) in drug abusers was significantly higher than that in the general population in Taiwan with a relative risk of 4.9, but it was only slightly higher than that in prostitutes (1.9%). There was a statistically significant increase in prevalence with age. Drug abusers engaged in prostitution had a significantly higher prevalence (18.2%) than those who were not (2.1%). No significant association with anti-HTLV-I positivity was observed with marital status and educational level. Tatooed abusers had an increased prevalence (2.7%) compared with the untattooed (1.4%). Drug abusers tattooed before 1980 had a significantly higher prevalence (3.5%) than those tattooed after 1980 (0.8%). Anti-HTLV-I prevalence was higher for those who had been blood transfused (4.5%) than untransfused abusers (2.0%).

Heterosexual transmission of viral hepatitis and cytomegalovirus infection among United States military personnel stationed in the western Pacific.

A serosurvey of United States military personnel presenting to a sexually transmitted diseases (STD) clinic or reporting for routine physical examination in the Philippines was conducted to determine the risk factors for hepatitis B (anti-HBc), hepatitis C (anti-HCV), and cytomegalovirus (anti-CMV) infection. Among 470 male study subjects, 74 (15.7%) were positive for anti-HBc, five (1.1%) were positive for anti-HCV, and 232 (49.4%) were positive for anti-CMV. A history of a STD (odds ratio [OR] = 7.7) and contact with a female prostitute (OR = 2.3) were significantly associated with anti-HBc seropositivity after adjusting for age, race/ethnicity, foreign birth, and classification as either a STD or routine examination patient. Anti-CMV seropositivity was significantly associated with a history of a STD (adjusted OR = 2.0). These data suggest that in this military population, heterosexual activity was a risk factor for acquiring hepatitis B and CMV infection. United States military personnel stationed in high-risk areas of the western Pacific, particularly patients presenting to STD clinics, may need to be targeted for hepatitis B vaccination.