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Normvarianten des oberen Labrum-Bizepssehnen-Komplexes und differentiadiagnostische Kriterien von SLAP-Lasionen in der Magnetresonanztomographie.
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Orthopedic Tests for Joint Pathology: Correlation with Imaging Findings, Diagnostic Accuracy and Review of the Differential Diagnoses. Objectives: To determine the frequency of metabolic syndrome in type 2 diabetes according to three commonly used operational definitions {World Health Organization(WHO), National Cholesterol Education Program Adult Treatment Panel( NCEP ATP III) and International Diabetes Federation( IDF)}.
Methods: Data was collected retrospectively of 210 patients with type 2 diabetes visiting outpatient clinics of one of the large tertiary care hospitals at Karachi, Pakistan between June 2008 to November 2008.
Conclusion: Our study results suggested that NCEP ATPIII and IDF are the most reliable criteria for diagnosing metabolic syndrome in type 2 diabetic patients, with NECP capturing more patients in comparison to IDF definition.
Five diagnostic criteria have been put forward since the inception of this syndrome MS which has created perplexity among practitioners.
Thereafter in 2001, NCEP ATP III National Cholesterol Education Program Adult Treatment Panel III (NCEP ATP III) proposed another definition for the diagnosis of metabolic syndrome MS with less focus on insulin resistance as compared to WHO criteria but not addressing separate cut off points of waist circumference for Asian population initially.10 In 2003, American Association of Clinical Endocrinologists (AACE) proposed another set of criteria for the diagnosis of MS metabolic syndrome. Considering that SA have a higher percentage of body fat mainly in the form of abdominal adiposity at a lower Body Mass Index (BMI) in comparison with other population,12 International Diabetes Federation (IDF) in 2005 suggested separate cutoff points of waist circumference for Asian population and defined central obesity as waist circumference of more than 80 cm for women and 90 cm in men based on local statistics from the corresponding area.13 The revised NCEP ATPIII modified for SA South Asian population incorporated the same cut off points for Asian population as given by IDF. Type 2 diabetes is also emerging as a global epidemic with increasing prevalence in developing countries.14 Pakistan is among top ten countries estimated to have the highest number of diabetics occupying sixth position on the diabetes prevalence listing currently15,16 and it is estimated that prevalence would be doubled by 2025. There are studies that have looked into the differences in most widely used definitions of metabolic syndrome MS in general,18-21 but only few studies have compared these definitions in the diabetic population.22-24 Therefore we decided to determine the frequency of MS metabolic syndrome in Type 2 diabetics according to NCEP ATPIII, IDF and WHO definitions and then to compare these traits within the Pakistani population.
This cross-sectional study was conducted in the out-patient clinics at a tertiary care hospital of Karachi, Pakistan. The sample size was calculated on an assumption that minimum 208 participants would be required to study the frequency of (MS) metabolic syndrome in type 2 diabetics of around 46-74% (2, 25) to achieve 80% power, 0.068 percentage point of true value and 5% significance level.
The laboratory tests which are routinely done for patients with type 2 diabetes including triglycerides and high density lipoprotein (HDL-C) were recorded. The data was analyzed separately according to NCEP ATP III, IDF and WHO definitions and the results were then compared. Description of baseline, anthropometric and laboratory parameters of type 2 diabetics comparing patients fulfilling any one of the three definitions of metabolic syndrome MS with those not having MS syndrome are provided in Table-2.
The frequency increased to 179 (85.2%) by WHO, using the new cut offs for defining overweight (BMI of 23 vs. Central obesity was present in 162 (77%) patients by WHO criteria followed by 197 (90.5%) based on IDF and NCEP ATP III. For prevalence of hypertriglyceridaemia, no statistically significant difference between both genders were found. Our study showed a considerably high frequency of MS in people with type 2 diabetes based on NECP (ATPIII) and IDF criteria.
One of the hospital based studies in Iran, showed the prevalence of MS in type 2 diabetics according to the NCEP (ATPIII) criteria, to be 65%.30 In this study instead of BMI, waist circumference was used highlighting the importance of abdominal adiposity, a better marker of MS as compared to BMI. The higher frequency of MS in women according to all criteria is also consistent with other studies from South Asian countries.33,34 This could be attributed to less physical activity in women due to ethnic and cultural restrictions. Regarding the selection of criteria for diagnosing MS the slightly higher prevalence of MS by ATP III definition in comparison to IDF (91.9% vs. Except for this difference the ATP III and IDF definitions are essentially identical as seen by the degree of agreement (kappa statistic= -0.728). On the basis of these findings NCEP (ATPIII) modified criteria should preferably be used in the Pakistani population. This journal is a member of and subscribes to the principles of the Committee on Publication Ethics.
ABCD sponsors treatment for those in need regardless of gender, race or creed, helping them to reach their full potential, to live life with dignity and to take their rightful place in their community.
ABCD works through local Palestinian partners, the Bethlehem Arab Society for Rehabilitation (BASR) based in Beit Jala, The Sheepfold in Beit Sahour and two UNWRA Refugee Camps in Jalazone and Nour Shams. Funding is constantly needed for new projects and to update and refurbish existing facilities. A separated shoulder is a common injury among contact athletes, especially hockey and football players, but it can happen to anyone who falls and lands on the tip of their shoulder or elbow. You may have a partial or complete tear of one or both of the main ligaments that connect your collarbone (clavicle) to your shoulder blade (scapula).


Grade 1: A mild shoulder separation involves a sprain of your AC ligament that does not move your clavicle and looks normal on X-rays.
Grade 2: A more serious injury tears the AC ligament and sprains or slightly tears the CC ligament, putting your clavicle out of alignment to some extent. Grade 3: The most severe shoulder separation completely tears both your AC and CC ligaments and puts your shoulder joint noticeably out of position. Since the severity of your injuries may vary greatly, all injuries are treated on a case-by-case basis. Surgical intervention when treating a separated shoulder is very rare and only performed in the most severe cases. The material contained on this site is for informational purposes only and is not intended to be a substitute for professional medical advice, diagnosis, or treatment. The alarmingly high frequency of metabolic syndrome in type 2 diabetes found in this study suggests that primary prevention strategies should be initiated earlier and early in this ethnic group and our health care system should be geared up to cope with this deadly quartet. This encompasses atherogenic dyslipidaemia, hypertension, dysglycaemia and visceral obesity and pro coagulant state.5 Apart from increasing prevalence, the age of onset is also declining among South Asian (SA) population6 due to genetic predisposition and consumption of easily available energy dense foods from an early age. Apart from the cut off differences, NCEP ATP III gives equal weight to each component of metabolic syndrome MS as compared to IDF for which abdominal obesity remains a prerequisite for the diagnosis.13 Moreover, microalbuminuria which is a controversial variable of WHO criteria is not included in other definitions. Data of 210 type 2 diabetes patients was collected retrospectively who were visiting the clinics between June and November 2008, by using a questionnaire which included demographic characteristics and individual components of MS i.e.
Patients already on anti-hypertensive and anti-lipid medications specifically in the form of fibric acid derivatives and niacin were taken as cases of hypertension and hypertriglyceridaemia respectively, irrespective of their blood pressure and lipid levels. Hypertension was found in 116 (55.2%) patients according to WHO in comparison to 147 (70%) by NCEP & IDF cut off of blood pressure. However, by all other criteria MS was significantly more common among females as compared to males, 95.9% vs. However, for low HDL cholesterol, prevalence was higher in males, 44 (57.14%) than in females 33 (43%) by WHO criteria (pTo find out the independent predictors of MS, a multivariable logistic regression was performed. The frequency was quite high in comparison to 46-76% found in other hospital based studies from Pakistan.25-27 This is very interesting keeping in view that all of these studies were done in the same region. A multicenter hospital based study in Brazil and Finland showed a close frequency of central obesity and MS (85 & 91.5%) was observed in type 2 diabetics[31] although the study population comprised of people of European descent.
This also highlights the importance of education of our women in terms of prevention of MS with life style changes which would indirectly influence the eating habits of the whole family. 86.7%) could be attributed to the relative flexibility of the ATP III in which abdominal obesity is not considered as a prerequisite for the diagnosis. According to this, NCEP (ATPIII) and IDF are the most reliable criteria's for diagnosing MS in type 2 diabetic patients, with NECP capturing more patients in comparison to IDF. Using waist circumference an obligatory criterion still missed out 5.2% cases of MS in our study.
Executive Summary of The Third Report of The National Cholesterol Education Program (NCEP) Expert Panel on Detection, Evaluation, And Treatment of High Blood Cholesterol In Adults (Adult Treatment Panel III). The result can be an injury to the muscles, tendons and ligaments that hold the bones in your shoulder together.
If your injury is a grade 1, 2, or 3 AC separation, you'll possibly wear a sling for a few days until the pain subsides. If you are a contact athlete, you will be allowed to return to your sport once you have full range of motion and good strength in your shoulder. This trend has got major health implications since South Asians constitute one fifth of world's population7 and the health care system in majority of these countries is not very primed to deal with these medical conditions. Among these definitions, WHO, NCEP ATPIII & IDF have been the main ones which are used most widely.
The data were presented as the mean ± SD and median [inter-quartile range (IQR)] for skewed variables, respectively. Female gender, low HDL cholesterol and high systolic blood pressure were found to be the most important predictors for MS (Table-4). The disparity could be attributed to lower frequency of obesity (30-74%) found in the above mentioned studies in comparison to our study (90.5%). Our data was also consistent with an Indian study showing prevalence of 91.1% MS20 using the same NCEP (ATPIII) definition.
In contrast WHO showed lower frequency of MS due to different cutoffs used for HDL levels and obesity.


To further validate these recommendations, more studies are required to estimate the predictive power for micro and macro vascular complications and to establish the most appropriate definition of MS for South Asian population with type 2 diabetes. Cardiovascular diseases in the developing countries: dimensions, determinants, dynamics and directions for public health action. The deadly quartet: upper-body obesity, glucose intolerance, hypertriglyceridemia, and hypertension.
Definition, Diagnosis and Classification of Diabetes Mellitus and its Complications [Internet]. International Day for the Evaluation of Abdominal Obesity (IDEA): a study of waist circumference, cardiovascular disease, and diabetes mellitus in 168,000 primary care patients in 63 countries. Early life origins of insulin resistance and type 2 diabetes in India and other Asian countries. The metabolic syndrome influences the risk of chronic complications in patients with type II diabetes.
Prevalence of metabolic syndrome in urban Pakistan (Karachi): comparison of newly proposed International Diabetes Federation and modified Adult Treatment Panel III criteria. Prevalence of metabolic syndrome using WHO, ATPIII and IDF definitions in Asian Indians: the Chennai Urban Rural Epidemiology Study (CURES-34). Diagnostic criteria for metabolic syndrome: a comparative analysis in an unselected sample of adult male population. An evaluation of the International Diabetes Federation definition of metabolic syndrome in Chinese patients older than 30 years and diagnosed with type 2 diabetes mellitus.
The metabolic syndrome is a risk indicator of microvascular and macrovascular complications in diabetes: results from Metascreen, a multicenter diabetes clinic-based survey. Frequency of metabolic syndrome in type 2 diabetes and its relationship with insulin resistance. High prevalence of multiple coronary risk factors in Punjabi Bhatia community: Jaipur Heart Watch-3.
Frequency of the metabolic syndrome in adult type2 diabetics presenting to Pakistan Institute of Medical Sciences. Metabolic syndrome in type 2 diabetes mellitus in Isfahan, Iran: prevalence and risk factors. Aggregation of features of the metabolic syndrome is associated with increased prevalence of chronic complications in Type 2 diabetes.
Methods for establishing a surveillance system for cardiovascular diseases in Indian industrial populations. Appropriate body-mass index for Asian populations and its implications for policy and intervention strategies. It is a very different injury than a shoulder dislocation, which is a separation of the large joint (glenohumeral) in the shoulder. X-rays may be taken to help diagnose the extent of your problem and exclude a fracture at the end of your clavicle.
It is recommended that you ice your shoulder for 20 minutes, 3-4 times a day during the first 48 hours.
Categorical variables were presented as numbers and percentages; Continuous variables were compared using Student t test for normally distributed variables and Wilcoxon rank-sum test for non-normally distributed variables and categorical variables were compared by chi-square or Fisher exact test. This difference remained significant even after adjusting it with BMI cutoffs for Asian population of 23 vs.30 endorsed by WHO expert consultation35 pointing towards the fact that waist circumference or central obesity is a more valuable tool for detection of MS in Asian population. The alarmingly high frequency of MS in type 2 diabetes found in our study, indicates that our health care system should to take emergent steps in implementing life style intervention programmes.
In most cases, your doctor will send you to physical therapy to restore and rebuild motion, strength, and flexibility. In univariate analysis, comparison between MS and without MS was done for each variable of interest. Multivariable logistic regression analysis was conducted to identify the factors associated with MS.



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