bluuebunny/crossref_metadata_2025_split huggingface dataset:
Use of beta‐blockers in obesity hypertension: potential role of weight gain
Authors: Pischon T. , Sharma A. M. 
Published: March 2003

AbstractBeta‐blockers are the most frequently used drugs for the treatment of hypertension. Apart from concerns regarding potential adverse metabolic effects on lipids or insulin sensitivity, beta‐blockers can also cause weight gain in some patients. This fact appears little known to clinical practitioners and trialists. Thus, only a minority of clinical trials with beta‐blockers report weight changes during treatment. In trials that do report weight changes, beta‐blockers are associated with a weight gain of 1.2 (range −0.4–3.5) kg. This may be attributable to the fact that beta blockade can decrease metabolic rate by 10%. Beta‐blockers may also have other negative effects on energy metabolism. Obesity management in overweight hypertensive patients may therefore be more difficult in the presence of beta‐blocker treatment. We therefore question the use of beta‐blockers as first‐line therapy for overweight or obese patients with uncomplicated hypertension.
Effects of free fatty acids on insulin secretion in obesity
Authors: Zraika S. , Dunlop M. , Proietto J. , Andrikopoulos S. 
Published: March 2003

SummaryThe prevalence of obesity in Western society has reached epidemic proportions and its aetiological role in the development of type 2 diabetes has made finding an effective treatment for the condition of crucial importance. Of the many consequences of obesity, derangements in glucose metabolism present one of the greatest problems to health. While the role of obesity in causing insulin resistance has received much attention, the effect of obesity on β‐cell failure and the consequent development of type 2 diabetes requires re‐emphasis. In this review, the current understanding of the effects of elevated free‐fatty acids on β‐cell function will be examined, including a discussion of potential mechanisms. In particular, dysregulation of biochemical pathways and alterations in key enzymes, proteins and hormones will be considered as grounds for the progression to a diabetic phenotype.
Obesity, coronary heart disease risk factors and diabetes in Chinese: an approach to the criteria of obesity in the Chinese population
Authors: Li G. , Chen X. , Jang Y. , Wang J. , Xing X. , Yang W. , Hu Y. 
Published: March 2003

SummaryThe aim of this work was to study the relationship between excess body weight and the risks of hypertension and diabetes in the population of northeastern China. Subsections of a cross‐sectional survey in Da Qing City were used to assess the relationship of excess weight to risk factors for coronary heart disease (CHD). A 6‐year prospective study also assessed the probability of developing Type 2 diabetes. A total of 2856 adults (25–70 years of age) were assessed cross‐sectionally and 629 non‐diabetic subjects of similar age were followed‐up for 6 years. Blood pressure, plasma fasting glucose, triglycerides, high‐density lipoporotein (HDL) cholesterol and fibrinogen levels were measured as well as weight, height and waist and hip circumferences. About 45% of adults had a body mass index (BMI) of ≥25.0. Risk factors increased with increasing BMI from a baseline value of 21.0: at a BMI of 23.0–24.9, the risk of hypertension and hypertriglyceridaemia doubled; the risk increased threefold at a BMI of 25.0–26.9. The prevalence of Type 2 diabetes increased progressively in women within the normal BMI range and in men from a BMI of 25.0. Type 2 diabetes was four times as common if the BMI was >27.0. Increasing waist measurements predicted 10‐fold increases in hypertension and a three‐to‐five times increased risk of diabetes. Suitable waist cut‐off points were 85 cm for men and 80 cm for women, with statistical analysis showing waist as the more dominant predictor of risk than age, waist‐to‐hip ratios or BMIs. Hence, small increases in BMI, and particularly in waist circumference, predict a substantial increase in the risk of diabetes and risk for CHD, especially hypertension, in Chinese adults.
Differences in body mass index and waist : hip ratios in North Indian rural and urban populations
Authors: Reddy K. S. , Prabhakaran D. , Shah P. , Shah B. 
Published: March 2003

SummaryOverweight could be a major factor in determining the increasing rates of coronary heart disease in the Indian population, by its influence on blood pressure, diabetes and insulin resistance. We studied the prevalence of overweight in north Indian urban and rural population samples. The urban sample population (n = 3050) was selected using a multistage sampling with stratification for geographical zone and the type of residential colony and cluster sampling of urban blocks in each stratum. The rural sample (n = 2487) was selected by random sampling of villages stratified for population size followed by coverage of all eligible persons in the village. All participating individuals were 35–64 years of age. Women constituted 52.2% (n = 1594) and 57% (n = 1417) of urban and rural samples, respectively. The study reveals that overweight is widely prevalent in the adult urban Delhi population, whereas underweight is a significant problem in the rural population. This was noted across all the age groups in both men and women. We estimated ‘comprehensive coronary risk estimates’ based on the New Zealand Heart foundation guidelines and noted that the proportion of high and very high risk subjects increased in a continuous manner even within the ‘normal’ ranges of BMI. This difference in prevalence in the urban population could represent the demographic transition in the Indian population.
Preventive strategies against weight gain and obesity
Authors: Swinburn B. , Egger G. 
Published: March 2003

SummaryA well‐resourced, comprehensive, population‐based set of strategiesis needed to attenuate and eventually reverse the current trendsof increasing obesity prevalence now apparent in most countries.The Epidemiological Triad (host, vector, environment) has provento be a robust model for other epidemics and is applied to obesity. Host‐based strategies are primarily educational and these tend to bemost effective among people with higher incomes and higher educational attainment.The main vectors for a high‐energy intake are energy‐dense foodsand drinks and large portion sizes and, for low energy expenditure,machines that promote physical inactivity. Vector‐based strategiesthat alter food formulation can have a significant impact, particularlythrough influencing common, high‐volume foods. The increasingly ‘obesogenic’ environmentsare probably the main driving forces for the obesity epidemic. Thereare many environmental strategies that can influence the physical,economic, policy or socio‐cultural environments, but the evidencebase for these potentially powerful interventions is small. ­Childrenshould be the priority population for interventions, and improvingthe general socio‐economic conditions for disadvantaged, marginalizedor poor population sectors is also a central strategy for obesityprevention. The key settings for interventions are schools, homes,neighbourhoods, primary health care services and communities. Thekey macroenvironments for interventions are the transport and infrastructuresector, the media and the food sector.
Treatment of obesity: an update on anti‐obesity medications
Authors: Halpern A. , Mancini M. C. 
Published: March 2003

SummaryThe information presented in this article provides an overview of physiological agents, therapeutics in current use, and medications that have been extensively used in the past but are no longer available, or are not classically considered as anti‐obesity drugs. The authors present an extensive review on the criteria for anti‐obesity management efficacy, on physiological mechanisms that regulate central and/or peripheral action energetic homeostasis (nutrients, monoamines and peptides), and on β‐phenethylamine pharmacological‐derivative agents (fenfluramine, dexfenfluramine, phentermine, diethylpropion, fenproporex and sibutramine), tricyclic derivatives (mazindol), phenylpropanolamine derivatives (ephedrine, phenylpropanolamine), a phenylpropanolamine oxy‐tri‐fluor‐phenyl derivative (fluoxetine), a naftilamine derivative (sertraline) and a lipstatine derivative (orlistat). An analysis of all clinical trials longer than 10 weeks in duration is also presented for medications used in the management of obesity.
Weight loss causes increased mortality: pros
Authors: Sørensen T. I. A. 
Published: March 2003

SummaryThere are many good reasons to expect that weight loss in overweight and obese subjects should lead to reduced mortality, not least because the general risk factor profile of several diseases responsible for the excess mortality associated with overweight and obesity improves with weight loss. However, observational long‐term population studies have shown that weight loss in overweight subjects leads to increased long‐term mortality, even if the studies are well controlled with regard to known confounding factors, including hazardous behaviour and underlying diseases that may lead to both weight loss and increased mortality. It seems unfeasible to wait for the multiple randomized clinical trials of sufficient quality, size and duration that may resolve this question. Therefore, the recommendations about weight loss must be based on the weaker evidence that can be obtained in short‐term clinical trials and the observational population studies. Several studies have tried to address the problem by distinguishing intentional from unintentional weight loss, but only few do so by gathering information about the intention to lose weight before weight loss is observed. These studies suggest that intentional weight loss is associated with increased mortality. Recommendations to healthy overweight and obese subjects to lose weight must be based on an explicit weighing of the short‐term well‐documented benefits of weight loss, including improvement of quality of life, against the possible risk of an increased mortality in the long term
Childhood obesity: a societal problem to solve
Authors: Schwartz M. B. , Puhl R. 
Published: March 2003

SummaryIn contrast to other threats to American children's health, the treatment and prevention of childhood obesity are considered the responsibility of individual children and their parents. This pressure exists in the context of the societal stigmatization of overweight children and the powerful environmental inducements aimed directly at children to eat nutritionally poor foods. Parents of overweight children are left in the difficult position of fearing the social and health consequences of their child's obesity, and fighting a losing battle against the omnipotent presence of the media and constant exposure to unhealthy foods. This paper brings together several literatures to provide a comprehensive examination of the major challenges facing obese children and their families. In particular, this paper documents the extent of stigmatization towards overweight children and reviews evidence of the conflicting advice given to parents about how to help children develop healthful eating in the face of biological and learned food preferences. We conclude with a call for a shift in thinking about the role of our society in the aetiology, treatment and prevention of childhood obesity.
Receiving a positive HIV test result: the experience of patients in Europe
Authors: Schrooten W , Dreezen C , Fleerackers Y , Andraghetti R , Finazzi R , Caldeira L , Platteau T , Colebunders R ,   the Eurosupport Group
Published: March 2003

Objective To describe HIV‐infected people's experience of the HIV test procedure in Europe.Methods Between August 1996 and September 1997, anonymous self‐administered questionnaires were distributed to HIV‐infected people in 11 European countries.Results A total of 1366 people completed the questionnaire (50% response rate). Of these, 194 (16%) had more than five negative HIV tests before being diagnosed as HIV positive, 179 (14%) were tested without consent and 192 (15%) were informed about the HIV positive test result by mail or by telephone. Of the 963 people who received a positive test result during a consultation, 247 (26%) reported that this visit lasted less than 10 min, 336 (35%) between 10 and 20 min, and 289 (30%) more than 20 min. Over half the total respondents (591, 54%) felt they did not receive adequate support when they were informed about being HIV positive, with 249 (19%) experiencing feelings of rejection. People who were diagnosed as HIV positive after 1994 reported more frequently receiving adequate support, information and understanding when the positive test result was revealed compared with those diagnosed before 1990.Conclusion A large number of our study participants did not endorse the way HIV tests were conducted and positive test results revealed. Although there was an improvement over time in the way HIV tests were conducted, they often did not conform to international guidelines.
Clinical lipoatrophy in HIV‐1 patients on HAART is not associated with increased abdominal girth, hyperlipidaemia or glucose intolerance
Authors: Worm D , Kirk O , Andersen O , Vinten J , Gerstoft J , Katzenstein TL , Nielsen H , Pedersen C 
Published: March 2003

ObjectiveTo compare information on body fat changes from questionnaire and clinical examination and to study lipoatrophy in HIV‐1 patients on highly active antiretroviral therapy (HAART).MethodsThe study was cross‐sectional within a randomized trial. One hundred and sixty‐eight male HIV‐1 patients were examined by questionnaire and clinical examination. Clinical lipoatrophy was studied and defined as fat wasting in the face, legs and/or arms. Fasting blood samples reflecting lipid and glucose metabolism were taken and the role of indinavir, ritonavir (RTV) and RTV/saquinavir (SQV) on lipoatrophy was investigated.ResultsAfter a median of 17 months on HAART, concordance rates between information on changes in body fat from questionnaire and clinical examination were significant and varied from 70 to 96%. With a positive criteria of lipoatrophy in both assessments, 14% of patients had lipoatrophy. These patients had lower weight (P = 0.0007), weight loss from baseline (P = 0.003), lower circumferences at all measurements (P < 0.01), lower plasma triglycerides and low‐density lipoprotein (LDL) (P < 0.05) and longer treatment with stavudine (P = 0.0009). Homeostasis model assessment (HOMA) estimates for insulin resistance and β‐cell function were comparable. Plasma cholesterol, triglycerides and very low‐density lipoprotein (VLDL) were higher in patients receiving RTV or RTV/SQV (P < 0.03).ConclusionQuestionnaire and clinical assessment provide concordant information on changes in body fat. Lipoatrophic patients on HAART with neither increase in abdominal circumference, nor hyperlipidaemia nor glucose intolerance may have side‐effects to protease inhibitor treatment, to nucleoside reverse transcriptase inhibitor treatment (stavudine) or suffer from a drug‐independent condition.
Patterns of antiretroviral use in the United States of America: analysis of three observational databases
Authors: Ghani AC , Donnelly CA , Anderson RM 
Published: March 2003

ObjectiveTo characterize patterns of antiretroviral use in HIV‐infected patients and explore variation by patient characteristics and disease stage.MethodsThree large patient databases recording information derived from routine clinical attendance were analyzed: HIV Insight (n = 10 873), Target Management Services (n = 2226) and Clinical Partners (n = 1505). Each database records the dates of starting and stopping individual antiretroviral agents over time, measurements of CD4 T‐cell counts and HIV‐RNA levels at approximately 6‐monthly intervals, and the demographic characteristics of patients. The number, frequency and duration of different antiretroviral combinations over time and their relationship to stage of HIV‐disease and demographic characteristics were explored.ResultsOver 2000 different combinations of antiretroviral agents are recorded. From 1987 onwards, the use of zidovudine increased, with 23% of patients receiving monotherapy by 1990. The majority of treated patients remained on monotherapy until the introduction of highly active antiretroviral therapy (HAART) in 1996. By 1999, the standard of care was HAART, with 84% of patients beginning antiretroviral therapy with HAART. Those of African American race (odds ratio 0.59) and funded by Medicaid (odds ratio 0.72) were significantly less likely to begin antiretroviral therapy on HAART. Until 1995, there was a significant decrease in CD4 T‐cell count when starting antiretroviral therapy. No significant trend was observed in either CD4 T‐cell count or viral load after this time. Those starting on HAART therapies were significantly less likely to stop or switch regimens than those on nucleoside reverse transcriptase inhibitor (NRTI)‐only therapies (P < 0.001).ConclusionsComplex patterns of antiretroviral treatment are observed in this large population. Changes over time mirror the introduction of the new antiretroviral agents.
Treatment of recalcitrant ulcers in pyoderma gangrenosum with mycophenolate mofetil and autologous keratinocyte transplantation on a hyaluronic acid matrix
Authors: Wollina Uwe , Karamfilov Theodor 
Published: March 2003

AbstractPyoderma gangrenosum sometimes takes a recalcitrant course that is unresponsive to standard immunosuppression with corticosteroids and/or cyclosporin A. In these cases improvement of painful ulcerations is a therapeutic challenge. We report a 17‐year‐old boy with severe pyoderma gangrenosum treated successfully with mycophenolate mofetil and autologous keratinocyte transplantation using an esterified hyluronic acid delivery system.
Granulomatous mycosis fungoides. Report of two cases and review of the literature
Authors: Fischer M , Wohlrab J , Audring H , Sterry W , Marsch Wc 
Published: March 2003

AbstractBackground Granulomatous mycosis fungoides is an extremely rare type of cutaneous T‐cell lymphoma. Two cases are described and checked for clinical, histological and therapeutic differences to other variants of mycosis fungoides.Case reports Case 1: a 52‐year‐old patient with livid plaques covering the whole integument. Histological findings showed granulomas with multinuclear giant cells in addition to a malignant lymphohistiocytic infiltrate (monoclonal T‐cell receptor (TCR) ‐γ rearrangement). Despite various chemotherapeutic regimens, progression to tumour stage was observed. Case 2: an 88‐year‐old man with plaques and ulcerating tumours on the trunk and head. Histological findings showed malignant T‐lymphocyte infiltrate (monoclonal TCR‐γ rearrangement) and granulomas with multinuclear foreign‐body giant cells. Complete regression of all lesions was achieved using both local psoralen‐ultraviolet A and electron radiotherapy.Conclusions The diagnosis of a granulomatous mycosis fungoides depends exclusively on the histological demonstration of granulomas. Distinct clinical characteristics are not present. Apart from granuloma formation, no other noticeable histological features are evident. The presence of granulomas in mycosis fungoides does not have prognostic implications, as cases with aggressive, but also with a prolonged course have been described.
Methotrexate in psoriasis: 26 years’ experience with low‐dose long‐term treatment
Authors: Haustein U‐F. , Rytter M. 
Published: March 2003

Abstract Objective To evaluate the efficacy, safety and side‐effects of methotrexate (MTX) in psoriasis. Design A 26‐year retrospective study. Setting Department of Dermatology, Leipzig University, Leipzig, Germany. Patients One hundred and fifty‐seven patients with extensive plaque psoriasis, erythrodermic, pustular and arthropathic forms, were treated with low‐dose methotrexate (15–20 mg maximum weekly dosage [Weinstein schedule]), the majority for long‐term periods. The mean cumulative dose was 3394 mg, the mean duration 237 weeks. Results The effect of MTX treatment was good in 76%, moderate in 18% and poor in 6% of subjects; 61% experienced side‐effects, most frequently due to liver function abnormalities, bone marrow suppression, nausea, gastric complaints and hair loss. In 20% of cases the subjects were forced to discontinue therapy; 9% refused therapy due to physical and psychological discomfort, 2% wanted to become pregnant, 16% were lost to follow‐up, 6% died from multimorbidity and old age. Three subjects (2%) developed cancer of the lung, breast or cervix uteri, possibly in relation to long‐term MTX treatment. Altogether there were no deaths or life‐threatening side‐effects attributable to MTX treatment, and no cases of progressive liver cirrhosis apart from two extensive skin necroses due to overdosage (misunderstanding, suicidal attempt) that were treated successfully with citrovorum factor. Conclusion Low‐dose MTX (<15–20 mg/week) is an effective therapy for extensive and severe forms of psoriasis if patients are selected carefully and monitored regularly, particularly with respect to liver and bone marrow toxicity. This helps to reduce severe side‐effects even during long‐term treatment. Drug interactions must be avoided. MTX therapy according to the guidelines is relatively safe and still has a place in the systemic treatment of psoriasis with 40 years of experience and an acceptable safety record.
The epidemiology of onychomycosis: possible role of smoking and peripheral arterial disease
Authors: Gupta Aditya K. , Gupta Madhulika A. , Summerbell Richard C. , Cooper Elizabeth A. , Konnikov Nellie , Albreski Douglas , MacDonald Paul , Harris Kenneth A. 
Published: March 2003

ABSTRACTBackgroundOnychomycosis is a relatively common condition the aetiology of which appears to be multifactorial, with both genetic and acquired factors being responsible. In our clinical practice we have observed that smokers and individuals with peripheral arterial disease may have an increased prevalence of onychomycosis compared to normal individuals.Patients and methodsPatients attending a vascular clinic in a hospital were asked about a history of smoking and peripheral arterial disease. The lower extremity was assessed for peripheral arterial disease. Material was obtained from toenails for mycological evaluation.ResultsTwo hundred and fifty‐four patients (male 146, female 108; age, mean ± standard error, 66.6 ± 0.8 years) were enrolled. Abnormal‐appearing nails and onychomycosis were present in 49.2% and 22.4% of patients, respectively. Factors associated with onychomycosis included, increasing age (risk odds ratio [ROR] 1.05, P = 0.002), male gender (ROR 1.7, P = 0.09), smoking (packs per day) (ROR 1.9, P = 0.02) and peripheral arterial disease (ROR 4.8, P = 0.02).ConclusionsThe factors predisposing to the development of onychomycosis are multifactorial. Both smoking (number of packs of cigarettes consumed per day) and peripheral arterial disease are independent predictors of onychomycosis. Awareness of these factors may help in the prevention of onychomycosis and the optimal management of this disease.
Burn‐induced linear IgA dermatosis
Authors: Girão L , Fiadeiro T , Rodrigues Jc 
Published: March 2003

AbstractThere have been several reports of linear IgA dermatosis (LAD) associated with drug exposure and lymphoproliferative malignancy, but trauma and burns have been suggested only in patients with bullous pemphigoid. We present a case of burn‐induced LAD in a 48‐year‐old caucasian male presenting with a recent history of blistering eruption on the periphery of a cicatricial area caused by boiling methyl alcohol. Clinically, he presented a widespread bullous eruption. The direct immunofluorescence examination of a perilesional biopsy revealed an intense homogeneous linear pattern of IgA deposition consistent with the diagnosis of LAD. The patient responded to therapy with systemic steroids.