scholarly journals The plasma peptides of Alzheimer’s disease

2021 ◽  
Vol 18 (1) ◽  
Author(s):  
Angelique Florentinus-Mefailoski ◽  
Peter Bowden ◽  
Philip Scheltens ◽  
Joep Killestein ◽  
Charlotte Teunissen ◽  
...  

Abstract Background A practical strategy to discover proteins specific to Alzheimer’s dementia (AD) may be to compare the plasma peptides and proteins from patients with dementia to normal controls and patients with neurological conditions like multiple sclerosis or other diseases. The aim was a proof of principle for a method to discover proteins and/or peptides of plasma that show greater observation frequency and/or precursor intensity in AD. The endogenous tryptic peptides of Alzheimer’s were compared to normals, multiple sclerosis, ovarian cancer, breast cancer, female normal, sepsis, ICU Control, heart attack, along with their institution-matched controls, and normal samples collected directly onto ice. Methods Endogenous tryptic peptides were extracted from blinded, individual AD and control EDTA plasma samples in a step gradient of acetonitrile for random and independent sampling by LC–ESI–MS/MS with a set of robust and sensitive linear quadrupole ion traps. The MS/MS spectra were fit to fully tryptic peptides within proteins identified using the X!TANDEM algorithm. Observation frequency of the identified proteins was counted using SEQUEST algorithm. The proteins with apparently increased observation frequency in AD versus AD Control were revealed graphically and subsequently tested by Chi Square analysis. The proteins specific to AD plasma by Chi Square with FDR correction were analyzed by the STRING algorithm. The average protein or peptide log10 precursor intensity was compared across disease and control treatments by ANOVA in the R statistical system. Results Peptides and/or phosphopeptides of common plasma proteins such as complement C2, C7, and C1QBP among others showed increased observation frequency by Chi Square and/or precursor intensity in AD. Cellular gene symbols with large Chi Square values (χ2 ≥ 25, p ≤ 0.001) from tryptic peptides included KIF12, DISC1, OR8B12, ZC3H12A, TNF, TBC1D8B, GALNT3, EME2, CD1B, BAG1, CPSF2, MMP15, DNAJC2, PHACTR4, OR8B3, GCK, EXOSC7, HMGA1 and NT5C3A among others. Similarly, increased frequency of tryptic phosphopeptides were observed from MOK, SMIM19, NXNL1, SLC24A2, Nbla10317, AHRR, C10orf90, MAEA, SRSF8, TBATA, TNIK, UBE2G1, PDE4C, PCGF2, KIR3DP1, TJP2, CPNE8, and NGF amongst others. STRING analysis showed an increase in cytoplasmic proteins and proteins associated with alternate splicing, exocytosis of luminal proteins, and proteins involved in the regulation of the cell cycle, mitochondrial functions or metabolism and apoptosis. Increases in mean precursor intensity of peptides from common plasma proteins such as DISC1, EXOSC5, UBE2G1, SMIM19, NXNL1, PANO, EIF4G1, KIR3DP1, MED25, MGRN1, OR8B3, MGC24039, POLR1A, SYTL4, RNF111, IREB2, ANKMY2, SGKL, SLC25A5, CHMP3 among others were associated with AD. Tryptic peptides from the highly conserved C-terminus of DISC1 within the sequence MPGGGPQGAPAAAGGGGVSHRAGSRDCLPPAACFR and ARQCGLDSR showed a higher frequency and highest intensity in AD compared to all other disease and controls. Conclusion Proteins apparently expressed in the brain that were directly related to Alzheimer’s including Nerve Growth Factor (NFG), Sphingomyelin Phosphodiesterase, Disrupted in Schizophrenia 1 (DISC1), the cell death regulator retinitis pigmentosa (NXNl1) that governs the loss of nerve cells in the retina and the cell death regulator ZC3H12A showed much higher observation frequency in AD plasma vs the matched control. There was a striking agreement between the proteins known to be mutated or dis-regulated in the brains of AD patients with the proteins observed in the plasma of AD patients from endogenous peptides including NBN, BAG1, NOX1, PDCD5, SGK3, UBE2G1, SMPD3 neuronal proteins associated with synapse function such as KSYTL4, VTI1B and brain specific proteins such as TBATA.

2021 ◽  
Author(s):  
Angelique Florentinus-Mefailoski ◽  
Peter Bowden ◽  
Philip Scheltens ◽  
Joep Killestein ◽  
Charlotte Teunissen ◽  
...  

Abstract BackgroundA practical strategy to discover proteins specific to Alzheimer’s dementia (AD) may be to compare the plasma peptides and proteins from patients with dementia to normal controls and patients with neurological conditions like multiple sclerosis or other diseases. The aim was a proof of principle for a method to discover proteins and/or peptides of plasma that show greater observation frequency and/or precursor intensity in AD. The endogenous tryptic peptides of Alzheimer’s were compared to normals, multiple sclerosis, ovarian cancer, breast cancer, female normal, sepsis, ICU Control, heart attack, along with their institution-matched controls, and normal samples collected directly onto ice.MethodsEndogenous tryptic peptides were extracted from blinded, individual AD and control EDTA plasma samples in a step gradient of acetonitrile for random and independent sampling by LC-ESI-MS/MS with a set of robust and sensitive linear quadrupole ion traps. The MS/MS spectra were fit to fully tryptic peptides within proteins identified using the X!TANDEM algorithm. Observation frequency of the identified proteins was counted using SEQUEST algorithm. The proteins with apparently increased observation frequency in AD versus AD Control were revealed graphically and subsequently tested by Chi Square analysis. The proteins specific to AD plasma by Chi Square with FDR correction were analyzed by the STRING algorithm. The average protein or peptide log10 precursor intensity was compared across disease and control treatments by ANOVA in the R statistical system. ResultsPeptides and/or phosphopeptides of common plasma proteins such as complement C2, C7, and C1QBP among others showed increased observation frequency by Chi Square and/or precursor intensity in AD. Cellular gene symbols with large Chi Square values (χ2 ≥ 25, p ≤ 0.001) from tryptic peptides included KIF12, DISC1, OR8B12, ZC3H12A, TNF, TBC1D8B, GALNT3, EME2, CD1B, BAG1, CPSF2, MMP15, DNAJC2, PHACTR4, OR8B3, GCK, EXOSC7, HMGA1 and NT5C3A among others. Similarly, increased frequency of tryptic phosphopeptides were observed from MOK, SMIM19, NXNL1, SLC24A2, Nbla10317, AHRR, C10orf90, MAEA, SRSF8, TBATA, TNIK, UBE2G1, PDE4C, PCGF2, KIR3DP1, TJP2, CPNE8, and NGF amongst others. STRING analysis showed an increase in cytoplasmic proteins and proteins associated with alternate splicing, exocytosis of luminal proteins, and proteins involved in the regulation of the cell cycle, mitochondrial functions or metabolism and apoptosis. Increases in mean precursor intensity of peptides from common plasma proteins such as DISC1, EXOSC5, UBE2G1, SMIM19, NXNL1, PANO, EIF4G1, KIR3DP1, MED25, MGRN1, OR8B3, MGC24039, POLR1A, SYTL4, RNF111, IREB2, ANKMY2, SGKL, SLC25A5, CHMP3 among others were associated with AD. Tryptic peptides from the highly conserved C-terminus of DISC1 within the sequence MPGGGPQGAPAAAGGGGVSHRAGSRDCLPPAACFR and ARQCGLDSR showed a higher frequency and highest intensity in AD compared to all other disease and controls. ConclusionProteins apparently from the brain that were directly related to Alzheimer’s including Nerve Growth Factor (NFG), Sphingomyelin Phosphodiesterase, Disrupted in Schizophrenia 1 (DISC1), the cell death regulator retinitis pigmentosa (NXNl1) that governs the loss of nerve cells in the retina and the cell death regulator ZC3H12A showed much higher observation frequency in AD plasma. There was a striking agreement between the proteins known to be mutated or dis-regulated in the brains of AD patients with the proteins observed in the plasma of AD patients from endogenous peptides including NBN, BAG1, NOX1, PDCD5, SGK3, UBE2G1, SMPD3 neuronal proteins associated with synapse function such as KSYTL4, VTI1B and brain specific proteins such as TBATA.


2019 ◽  
Vol 16 (1) ◽  
Author(s):  
Jaimie Dufresne ◽  
Pete Bowden ◽  
Thanusi Thavarajah ◽  
Angelique Florentinus-Mefailoski ◽  
Zhuo Zhen Chen ◽  
...  

Abstract Background There is a need to demonstrate a proof of principle that proteomics has the capacity to analyze plasma from breast cancer versus other diseases and controls in a multisite clinical trial design. The peptides or proteins that show a high observation frequency, and/or precursor intensity, specific to breast cancer plasma might be discovered by comparison to other diseases and matched controls. The endogenous tryptic peptides of breast cancer plasma were compared to ovarian cancer, female normal, sepsis, heart attack, Alzheimer’s and multiple sclerosis along with the institution-matched normal and control samples collected directly onto ice. Methods Endogenous tryptic peptides were extracted from individual breast cancer and control EDTA plasma samples in a step gradient of acetonitrile, and collected over preparative C18 for LC–ESI–MS/MS with a set of LTQ XL linear quadrupole ion traps working together in parallel to randomly and independently sample clinical populations. The MS/MS spectra were fit to fully tryptic peptides or phosphopeptides within proteins using the X!TANDEM algorithm. The protein observation frequency was counted using the SEQUEST algorithm after selecting the single best charge state and peptide sequence for each MS/MS spectra. The observation frequency was subsequently tested by Chi Square analysis. The log10 precursor intensity was compared by ANOVA in the R statistical system. Results Peptides and/or phosphopeptides of common plasma proteins such as APOE, C4A, C4B, C3, APOA1, APOC2, APOC4, ITIH3 and ITIH4 showed increased observation frequency and/or precursor intensity in breast cancer. Many cellular proteins also showed large changes in frequency by Chi Square (χ2 > 100, p < 0.0001) in the breast cancer samples such as CPEB1, LTBP4, HIF-1A, IGHE, RAB44, NEFM, C19orf82, SLC35B1, 1D12A, C8orf34, HIF1A, OCLN, EYA1, HLA-DRB1, LARS, PTPDC1, WWC1, ZNF562, PTMA, MGAT1, NDUFA1, NOGOC, OR1E1, OR1E2, CFI, HSA12, GCSH, ELTD1, TBX15, NR2C2, FLJ00045, PDLIM1, GALNT9, ASH2L, PPFIBP1, LRRC4B, SLCO3A1, BHMT2, CS, FAM188B2, LGALS7, SAT2, SFRS8, SLC22A12, WNT9B, SLC2A4, ZNF101, WT1, CCDC47, ERLIN1, SPFH1, EID2, THOC1, DDX47, MREG, PTPRE, EMILIN1, DKFZp779G1236 and MAP3K8 among others. The protein gene symbols with large Chi Square values were significantly enriched in proteins that showed a complex set of previously established functional and structural relationships by STRING analysis. An increase in mean precursor intensity of peptides was observed for QSER1 as well as SLC35B1, IQCJ-SCHIP1, MREG, BHMT2, LGALS7, THOC1, ANXA4, DHDDS, SAT2, PTMA and FYCO1 among others. In contrast, the QSER1 peptide QPKVKAEPPPK was apparently specific to ovarian cancer. Conclusion There was striking agreement between the breast cancer plasma peptides and proteins discovered by LC–ESI–MS/MS with previous biomarkers from tumors, cells lines or body fluids by genetic or biochemical methods. The results indicate that variation in plasma peptides from breast cancer versus ovarian cancer may be directly discovered by LC–ESI–MS/MS that will be a powerful tool for clinical research. It may be possible to use a battery of sensitive and robust linear quadrupole ion traps for random and independent sampling of plasma from a multisite clinical trial.


2020 ◽  
Vol 8 (7_suppl6) ◽  
pp. 2325967120S0043
Author(s):  
Benjamin Kivlan ◽  
Shane Nho ◽  
Andrew Wolff ◽  
John Salvo ◽  
John Christoforetti ◽  
...  

Objectives: The radiographic crossover sign (COS) is an indicator of acetabular retroversion, classically representing anterosuperior overcoverage often treated with acetabuloplasty which could exacerbate acetabular hypovolemia in dysplasia. No prior study has investigated the prevalence of acetabular retroversion in patients with dysplasia undergoing hip arthroscopy, acetabuloplasty rates, and outcomes in this setting. Study objectives are to report the prevalence of acetabular retroversion in dysplasia, the influence of the COS on arthroscopic acetabuloplasty rates, and relative outcomes compared with control groups. Methods: A retrospective cohort study was performed from a prospectively collected multi-center database. Patients undergoing isolated hip arthroscopic surgery were assigned to dysplasia (lateral center-edge angle (LCEA) ≤ 25°) or one of two control groups: normal(LCEA 26-38°), or pincer femoroacetabular impingement (FAI)(LCEA ≥ 39°). The prevalence of COS and acetabuloplasty rates between and within study and control groups were compared (Chi square analysis). Minimum 2 year outcomes utilizing iHOT-12 were compared (analysis of variance). Results: Of 401 study patients, 64 (16%) comprised the dysplasia group, 273 (68%) normal group, and 64 (16%) pincer group. Mean LCEAs were 22.3°, 31.5°, and 42.4°, respectively (p<0.001). COS prevalence was similar between groups at 31%, 26%, and 33%, respectively (p=0.873). Acetabuloplasty rates were dependent on the amount of acetabular coverage with lowered rate in the dysplasia group(40%) and increasing rates in the normal(52%) and the pincer(90%) groups (p=0.013). Post-operative iHOT-12 scores improved in all groups (68, 74, and 77, respectively, p=0.222). Patients with a COS plus rendered acetabuloplasty reported similar scores that improved to 77, 74, and 79, respectively,(p=0.949). Patients with dysplasia with COS averaged 73.1(SD 23.3) iHOT-12 score compared to 67.1(SD: 28.7) for the patients with dysplasia without COS (p=0.466). Within the dysplasia with COS subgroup, there was no significant difference in iHOT-12 scores between the group with acetabuloplasty (77.0;SD:17.1) and without acetabuloplasty (70.4;SD:27.4,p=0.580). Conclusion: Acetabular retroversion occurs with similar prevalence in borderline dysplasia compared with non-dysplastic hips undergoing hip arthroscopy but with lower acetabuloplasty rates not influenced by the COS. Arthroscopic outcomes of dysplasia with retroversion are similarly successful and comparable with those of dysplasia and non-dysplastic hips. Although infrequently performed, acetabuloplasty did not compromise outcomes in dysplasia with retroversion.


2009 ◽  
Vol 46 (3) ◽  
pp. 237-244 ◽  
Author(s):  
Albert K. Oh ◽  
John B. Mulliken ◽  
Richard A. LaBrie ◽  
Gary F. Rogers

Objective: Left-handedness reportedly has been more common in persons with neurological afflictions (e.g., stroke) and malformations (e.g., cleft lip with or without cleft palate) that demonstrate marked unilateral involvement. Coronal synostosis is also more frequently unilateral, affecting the right side more commonly than the left. We sought to compare left-handedness in patients with unilateral coronal synostosis versus healthy controls. Subjects: All patients aged 3 years or older with nonsyndromic unilateral coronal synostosis and healthy controls recruited by pediatricians blinded to the study. Main Outcome Measures: Prospective data obtained for all participants included age, gender, and handedness. In patients with unilateral coronal synostosis, the side of synostosis and age at surgery were documented. Left-handedness in the study and control groups was compared using chi-square analysis. Left-handedness also was analyzed in the study group according to side of fusion. Results: Eighty-six patients with nonsyndromic unilateral coronal synostosis comprised the study group; there were 96 controls. The mean ages of the study (8.8 years) and control groups (9.8 years) were not statistically different (p > .05). There were more girls in the study group (67%) than in the control group (56%), but this difference was not statistically significant (p > .05). Left-handedness was documented in 30.2% of the study group and 11.4% of the control group (p < .005). Left-handedness was twice as common in patients with left versus right unilateral coronal synostosis (44.4% versus 20.4%; p < .05). Conclusions: Left-handedness is nearly three times more common in patients with unilateral coronal synostosis than in controls and four times more likely in patients with left-sided fusion.


Author(s):  
Wi-Young So ◽  
Alon Kalron

(1) Purpose: Conflicting information exists regarding the relationship between obesity, leisure-time physical activity (PA), and disability in people with multiple sclerosis (PwMS). We aimed to investigate the association between leisure-time PA and weight status in a relatively large cohort of PwMS. Furthermore, we examined this relationship according to the level of neurological disability. (2) Methods: The study included 238 PwMS (138 women) with a mean Expanded Disability Status Scale (EDSS) score of 2.5 (standard deviation [SD] = 1.7), mean disease duration of 6.4 (SD = 8.2) years, and mean age of 40.5 (SD = 12.9) years. Obesity was defined using two different metrics, each based on body mass index (BMI). Leisure-time PA was determined by the Godin–Shephard leisure-time PA questionnaire. Statistical analyses included multivariate logistic regression, the chi-square test, and Pearson coefficient correlations. (3) Results: The unadjusted odds ratio (OR) between leisure-time PA and BMI based on the World Health Organization’s (WHO) definition was 1.070 (p = 0.844) for overweight and 1.648 (p = 0.254) for obesity. The adjusted OR was 1.126 (p = 0.763) for overweight and 1.093 (p = 0.847) for obesity after adjustment for age, gender, and disability status. Chi-square analysis revealed no significant correlation between leisure-time PA and obesity (p = 0.564) according to the BMI threshold for PwMS. The unadjusted OR (95% confidence interval [CI]) between disability level and BMI based on the WHO definition was 1.674 (p = 0.220) for overweight and 0.618 (p = 0.460) for obesity. The adjusted OR was 1.130 (p = 0.787) for overweight and 0.447 (p = 0.234) for obesity after adjustment for age, gender, and leisure-time PA. Similarly, chi-square analysis revealed no significant correlation between disability level and obesity (p = 0.701) per the BMI threshold for PwMS. (4) Conclusions: No association was found between leisure-time PA and BMI in PwMS. An additional finding was the absence of any association between obesity and neurological disability level in the multiple sclerosis cohort.


Author(s):  
Reza Abbasian ◽  
Morteza Mojahedi ◽  
Mostafa Alizadeh ◽  
Soraya Khafri ◽  
Mohammad Ansaripour ◽  
...  

Abstract Objectives Increased incidence of Multiple Sclerosis (MS) calls for supporting complementary therapies in this field. Persian Medicine (PM) specialists present various assumptions to help patients through Mizaj (temperament) modification, but its confirmation requires scientific evidence. This study aimed at identifying the Mizaj of MS patients, and comparing it with their Mizaj before the onset of the disease, and with that of healthy people. Methods Forty-two MS and fifty-four healthy subjects participated in the study as case and control groups. General and brain Mizaj in patients were identified by five PM specialists before and after the onset of the disease. Mojahedi Mizaj Questionnaire (MMQ) was completed by the two groups. The validity of MMQ was assessed using Mizaj diagnosis by PM specialists as the gold standard. T-test, McNemar-Bowker, Wilcoxon, and Chi-square (χ 2) tests were used to compare the Mizaj of patients before and after the onset of the disease, and between the two groups (p<0.05). Results The sensitivity and specificity of MMQ for Hotness (75, 81%) and Coldness (75, 65%) were acceptable. There were no significant differences between patients and healthy subjects in terms of general Mizaj. But general and brain Mizaj of patients after developing MS inclined to coldness and dryness, although merely inclination of general Mizaj to coldness was significant (p=0.03). Conclusions According to our results, the Mizaj of MS patients has an inclination toward coldness and dryness; Also, MMQ can be used as a validated scale for identifying the Mizaj of MS patients in future studies.


2015 ◽  
Vol 3 (2) ◽  
pp. 57
Author(s):  
Ulil Meisal

The research method used is a quasi-experimental method which consists of experimental class and class II controlkelas SDN 79 Pekanbaru, which illustrates a significant difference in the ability to calistung between the two. Research on the data pretest seen from arithmetic average of the experimental 70.66 and control 65.9, experimental writing skills 77, and controls 71.6, experimental ability to read 76, and controls 77.5. To find significant differences in the ability of the chi square analysis was used to calculate the ability Xhitung <Xtabel (1.67 <3.841), there was no significant difference, the ability to write with Xhitung <Xtabel (0.6 <3.841), there was no significant difference on writing skills, and the ability to read with Xhitung <Xtabel (1.12 <3.841), there was no significant difference in reading ability. Posttest data seen from the average value of the experimental class numeracy 75.6 and 71.7 control, the ability to write an experimental class 81.9 and control 74.6, literacy class experimental 82.1 and control 78.5. To determine differences in the ability to use the chi square analysis on numeracy Xhitung <Xtabel (3.51 <3.841), there was no significant difference in the experimental class and the control class numeracy skills. The ability to write with Xhitung <Xtabel (3.51 <3.841), there was no significant difference, while the ability to read Xhitung <Xtabel (0.71 <3.841), there was no significant difference. Improved results in the experimental class capabilities calistung numeracy skills of 0.15, and control 0.16, the ability to write of 0.26, and control 0.11, the ability to read the experimental class of 0.31, and controls 0.07, it is seen larger in capacity building calistung the experimental class.Key words: calistung, scientific thematics, numeracy skills, reading skills, and writing skills


2017 ◽  
Vol 8 (3) ◽  
pp. 389
Author(s):  
Siti Amallia ◽  
Rahmalia Afriyani ◽  
Siska Putri Utami

The appearance of anemia during the maternity caused the death of mothers indirectly. Based on the data from BARI hospital Palembang in 2015, it was found for about 29 (13 %) of 2218 maternity mothers affected by anemia. The objectives of this study were to discover the influential factors on the appearance of anemia on maternity women in the BARI Hospital Palembang in 2015. The cross-sectional approach was applied in this study. The population of the study was all the maternity women who checked their pregnancy in the BARI hospital in 2015. There were 236 respondents taken by using simple random sampling. Data were analyzed by using frequency analysis, chi-square analysis, and logistic regression analysis. The result of study showed that 31 (13.1%) respondents got anemia during their pregnancy, there was the correlation between the age (p-value=0.032)  and parity of maternity women (p-value=0.005) on anemia, and there was no correlation between the education and occupation of maternity women who affected by anemia. The regression logistic test showed that age and parity influenced the affection of anemia on maternity women and the most influential factor was the parity with OR = 4.012. Suggested to health officer will improve the counseling for maternity women about the importance of family planning after childbirth and control the number of children, so anemia cases in pregnancy will be decreased.


2018 ◽  
Vol 13 (1) ◽  
pp. 71
Author(s):  
Amima Fajriana ◽  
Annas Buanasita

Low Birth Weight (LBW) is one of the biggest causes of neonatal mortality in Indonesia. The prevalence of LBW at Semampir District in Surabaya tended to increase from 5.74% in 2013 to 13.65% in 2015. LBW caused by multi-factors including internal factors such as fetal, placental and maternal, and also external factors such as lifestyle and environment. This study aimed to analyze the association between maternal age, gestational age, Mid Upper-Arm Circumference (MUAC), Hemoglobin (Hb) levels, environmental tobacco exposure and LBW at Semampir District, Surabaya. The respondents were mothers at Semampir District who gave birth in 2016.  The design of this study was case control. The sample consisted of 22 mothers from the control group and 22 mothers from the case group. The result of descriptive analysis respectively showed that in case group (40.6%) and control group (13.6%) were not pregnant in healthy reproductive age. 59.1% and 18.1% gave birth when the gestational age <37 weeks. 41% and 9.1% were suffered of chronic energy malnutrition (MUAC <23.5). 40.9% and 22.7% were anemic. Moreover, 90,9% and 77,2% were exposed to tobacco smoke (secondhand smoke exposure). Chi square analysis with α=0,05 showed that there were significance associations between gestational age (p=0,006) (OR=6,198; CI 95%=1,61-27,88) and MUAC (p=0,018) (OR=6,623; CI 95%=1,327-51,2) with LBW. It is concluded that mother who gave birth to a premature baby were 6,2 times more likely to have LBW, whereas mother who suffered from chronic energy malnutrition were 6,6 times more likely to have LBW baby.


2020 ◽  
pp. 019394592094480
Author(s):  
Sherylyn M. Watson ◽  
Heather Ferrillo

A retrospective chart review study was conducted to evaluate health outcomes after a nurse-led short-term medical mission group provided free health care in four communities in Kingston, Jamaica over a four-year period. Participants were adult patients who had visited short-term medical mission clinics at least twice and were diagnosed with hypertension and/or diabetes. Blood pressure (BP) and blood sugar (BS) results along with factors including adherence and control per guidelines were analyzed using descriptive, t-tests and chi-square analysis. The data revealed that overall BP and BS measurements trended down, and there was a significant decrease in BP in patients with uncontrolled hypertension at the first visit. Medication adherence between the visits and gender had a statistically significant impact on BP and BS control. Outcomes suggest short-term medical missions are an effective model to address hypertension and diabetes in developing countries when using a sustainable approach.


Sign in / Sign up

Export Citation Format

Share Document