OBJECTIVES: Multiple sclerosis (MS) is a chronic inflammatory disease with 12,000 new diagnoses per year in the United States. Higher latitude is associated with higher MS prevalence rates, and the female-to-male ratio in MS incidence has been estimated at 2:3 in 2000. This study aims to estimate the prevalence and incidence rate of MS in the United States. METHODS: Patients with an MS diagnosis (International Classification of Diseases Ninth Revision Clinical Modification [ICD-9-CM] code: 340.XX) between January 2006 and December 2010 were identified from a large U.S. claims database. Prevalence rates from 2006 to 2010 were calculated by dividing the number of MS patients by the total number of health plan enrollees in each year. The 2010 incidence rate was calculated by dividing the number of patients with a new MS diagnosis in 2010 by the total number of enrollees in 2010.
RESULTS:The prevalence rate remained stable at 0.16% from 2006 to 2008, and then increased in 2009 (0.17%) and again in 2010 (0.19%). In 2010, MS prevalence in women (0.26%) was more than twice the rate than that of the male population (0.09%). To examine regional differences, prevalence rate was also calculated for each U.S. state. Regional prevalence rates ranged from 0.11% (Arkansas) to 0.29% (Rhode Island). The estimated incidence rate for 2010 was 0.03% for the overall population, 0.05% for female, and 0.02% for male patients. Incident cases had an average age of 49 years, and were more likely to suffer from comorbid conditions, such as disturbance of skin sensation, fatigue, and hypertension. Incidence rates by state ranged from 0.01% (Maine) to 0.08% (Michigan). CONCLUSIONS: This study confirms that MS prevalence and incidence rates are higher in female patients, and in regions farther away from the equator.
Background and Aims
The prevalence of pulmonary hypertension HTP in patients receiving dialysis therapy is not completely clear, it is an independent risk factor for cardiovascular mortality, which indicates the serious need to sensitize the clinic with this comorbidity and maintain an active search for it.
Objective: Raise awareness about the prevalence of HTP in a hemodialysis population and identify the associated risk factors.
Method
Descriptive, retrospective study, in which echocardiograms of the patient (peritoneal dialysis PD and hemodialysis HD) in renal facility were reviewed, at least 12 months in therapy, Nice 2013 classification were used for the diagnosis of HTP, multivariate analysis (echocardiograHTPic, demograHTPic, clinical and biochemical variables) was performed and the statistical significance of P <0.05 with the X2 method was searched for the associated risk factors.
Results
24 male patients (45%), 75% with systemic hypertension, 34% with diabetes mellitus T2, on average 5 years on dialysis (+/- 2.7), age of 64 years (+/- 13.6) and 3 very elderly patients (> 85y); 35 patients (66%) on hd and 18 (34%) on PD. 51% had fistula ArterioVenosa (FAV). 100% of patients in hd with KtVe> 1.25 and 73% in pd with KtV> 1.7.
Regarding the HTP, 27 positive patients were found (51%), the significant (p <0.05), were: hd 54% vs 44% PD, having a 76% central catheter with HTP vs 33% with fav, and patients with severe vs mild Hiperparatiroidism
The severity of HTP, in hd vs pd was more severe, PSP average of pressures in the positive 43mmHg vs 34.3mmHg respectively (p <0.033)
Conclusion
HTP is a comorbidity that impoverishes the cardiovascular prognosis and its management must be specific, especially due to the preference of calcium antagonists over the use of renin angiotensin system blockers. The prevalence of PHT in the hemodialysis population is very high, which makes the clinician an active search and effective treatment, especially in patients with catheters. Hyperparathyroidism plays a role within the remodeling mechanisms of the pulmonary arterial endothelium, aggravating this situation and increasing mortality
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