Cardiovascular Complaints Research Articles

Does Patient Gender Impact Resident Physicians’ Approach to the Cardiac Exam?

Physical examination remains an important part of the initial evaluation of patients presenting with chest pain but little is known about the effect of patient gender on physician performance of the cardiovascular exam. To determine if resident physicians are less likely to perform five key components of the cardiovascular exam on female versus male standardized patients (SPs) presenting with acute chest pain. Videotape review of SP encounters during Objective Structured Clinical Examinations (OSCEs) administered by the Emory University Internal Medicine Residency Program in 2006 and 2007. Encounters were reviewed to assess residents' performance of five cardiac exam skills: auscultation of the aortic, pulmonic, tricuspid, and mitral valve areas and palpation for the apical impulse. One hundred forty-nine incoming residents. Residents' performance for each skill was classified as correct, incorrect, or unknown. One hundred ten of 149 (74 %) of encounters were available for review. Residents were less likely to correctly perform each of the five skills on female versus male SPs. This difference was statistically significant for auscultation of the tricuspid (p = 0.004, RR = 0.62, 95 % CI 0.46-0.83) and mitral (p = 0.007, RR = 0.58, 95 % CI = 0.41-0.83) valve regions and palpation for the apical impulse (p < 0.001, RR = 0.27, 95 % CI = 0.16-0.47). Male residents were less likely than female residents to correctly perform each maneuver on female versus male SPs. The interaction of SP gender and resident gender was statistically significant for auscultation of the mitral valve region (p = 0.006) and palpation for the apical impulse (p = 0.01). We observed significant differences in the performance of key elements of the cardiac exam for female versus male SPs presenting with chest pain. This observation represents a previously unidentified but potentially important source of gender bias in the evaluation of patients presenting with cardiovascular complaints.

Abstract 57: Reduction Of Cardiovascular Admissions From The Emergency Department: A Coordination Of Care Model Using Early Access To Specialists After Normal Working Hours

BACKGROUND: Despite the implementation of diagnostic and treatment algorithms for many common cardiovascular (CV) complaints, identifying low- and intermediate-risk patients presenting to the emergency department (ED) who could be managed without hospital admission remains difficult. We hypothesized that the presence of an attending cardiologist in the ED after normal working hours can help reduce the number of avoidable CV admissions by providing ED physicians with the support needed to identify, manage, and safely transition patients to the outpatient setting. METHODS: Beginning 08/22/2011, an attending cardiologist was available to consult on ED patients on weekdays between 6PM and midnight. The study population included all patients seen in the ED of an academic medical center on weekdays from 08/22/2011 to 11/30/2011 presenting in the afternoon/evening with a primary diagnosis of chest pain, atrial fibrillation (Afib), congestive heart failure (CHF), and syncope (based on ICD-9 diagnostic coding). Consultations were requested by the ED attending for patients where the intention was for inpatient admission, or where the disposition decision was complex. Rates of inpatient admission and 30-day return visit to the ED were compared to the same time period in the previous year using the Fisher’s exact test. RESULTS: Among patients presenting to the ED with one of the diagnoses of interest during the study period, there was a significant decrease in the inpatient admission rate compared to the same period in 2010 (52.0% vs. 38.6%; p&lt;0.001, see Figure). Baseline clinical characteristics of the 2 cohorts were similar. During the study period, 174 consults were performed by the evening attending cardiologist with the diagnoses of interest accounting for 53% (n=93) of these. The decrease in admission rate was largely driven by an increase in the proportion of patients with chest pain being managed with observation in the ED (36.9% vs. 51.1%; p&lt;0.001), and a decrease in the percentage of patients with Afib being admitted (61.1% vs. 45.0%; p=0.02). The incidence of return visits to the ED within 30-days following discharge did not increase (13.0%, 46/353 vs. 8.8%, 35/399; p=0.08). CONCLUSION: A program involving cardiology staff in the coordination of disposition decisions in the ED after normal working hours resulted in a reduction in the number of inpatient admissions for common CV conditions without increasing the incidence of return visits to the ED within 30 days.

Reversible Myocarditis after Black Widow Spider Envenomation

Black widow spiders can cause variable clinical scenarios from local damage to very serious conditions including death. Acute myocardial damage is rarely observed and its prognostic significance is not known. We report a rare case of a 35-year-old man who developed an acute myocarditis with cardiogenic pulmonary edema requiring mechanical ventilation caused by black widow spider's envenomation. The patient was previously healthy. The clinical course was associated with systemic and cardiovascular complaints. His electrocardiogram revealed ST-segment elevation with T-wave amplitude. The plasma concentrations of cardiac enzymes were elevated. His first echocardiography showed hypokinesis of the left ventricle (left ventricle ejection fraction 48%). Magnetic resonance imaging showed also focal myocardial injury of the LV. There was progressive improvement in cardiac traces, biochemical and echocardiographical values (second left ventricle ejection fraction increased to 50%). Myocardial involvement after a spider bite is rare and can cause death. The exact mechanism of this myocarditis is unknown. We report a rare case of acute myocarditis with cardiogenic pulmonary edema requiring mechanical ventilation caused by black widow spider's envenomation. We objectively documented progressive clinical and electrical improvement.

Pain in patients with multiple sclerosis: a complex assessment including quantitative and qualitative measurements provides for a disease-related biopsychosocial pain model

Background:Pain of various causes is a common phenomenon in patients with Multiple Sclerosis (MS). A biopsychosocial perspective has proven a useful theoretical construct in other chronic pain conditions and was also started in MS. To support such an approach, we aimed to investigate pain in MS with special emphasis on separating quantitative and qualitative aspects, and its interrelation to behavioral and physical aspects.Materials and methods:Pain intensity (NRS) and quality (SES) were measured in 38 consecutive outpatients with MS (mean age, 42.0 ± 11.5 years, 82% women). Pain-related behavior (FSR), health care utilization, bodily complaints (GBB-24) and fatigue (WEIMuS) were assessed by questionnaires, and MS-related neurological impairment by a standardized neurological examination (EDSS).Results:Mean pain intensity was 4.0 (range, 0–10) and mean EDSS 3.7 (range, 0–8) in the overall sample. Currently present pain was reported by 81.6% of all patients. Disease duration and EDSS did not differ between patients with and without pain and were not correlated to quality or intensity of pain. Patients with pain had significantly higher scores of musculoskeletal complaints, but equal scores of exhaustion, gastrointestinal and cardiovascular complaints. Pain intensity correlated only with physical aspects, whereas quality of pain was additionally associated with increased avoidance, resignation and cognitive fatigue.Conclusion:As in other conditions, pain in MS must be assessed in a multidimensional way. Further research should be devoted to adapt existing models to a MS-specific model of pain.

Reviews on Trichinellosis (III): Cardiovascular Involvement

Cardiovascular complaints represent the most important complications of trichinellosis and are particularly evident in the moderate and severe courses of the disease. An overview of 17 epidemiological studies on trichinellosis (including 5268 cases) indicated that cardiovascular events occurred in 26% of patients (range: 1.5%-75%). This narrative systematic review focuses exclusively on the cardiovascular involvement of trichinellosis and includes a brief overview and analysis of selected cases reported in the literature. Our primary goal was to increase the awareness of infectious diseases specialists, cardiologists, and general practitioners about these major complications and their possible fatal outcomes. To our knowledge, this is the first international review of this topic. Eighty-nine cases were detailed enough to allow pooled analysis (in terms of sex, age, source of infection, clinical characteristics, outcome, and routine laboratory parameters). The mean age of the analyzed group was 36.8±14.7 years (range: 3-80), with most cases in the age group of 18-29 years (25.8%, n=23). Males slightly predominated (53.9%), and pork was responsible for 91.2% of the infections. Electrocardiographic (ECG) changes represented the most common findings (80.9%). The mean eosinophil count was 25.9%±18.9% (range: 1-76). Heart failure significantly predominated in patients who died (p=0.047), whereas ECG abnormalities were reported more frequently in those who made complete recovery (p<0.0001). Because of their life-threatening character (our systematic analysis detected a case fatality ratio of 22.5%), we believe that cardiovascular complications must be considered in any patient suspected or diagnosed with trichinellosis. At the same time, practitioners should be able to establish the correct diagnosis in a timely manner and to make the best decision toward the management of these cases. Additionally, public health services located in endemic regions must be perpetually aware of this condition and must implement efficient prophylactic measures.

Symptomatic pectus excavatum in seniors (SPES): a cardiovascular problem?

There is no consensus among physicians as to whether or not pectus excavatum can produce symptoms sometimes even severe enough to justify a surgical procedure. The aim of this study was to assess the prevalence and severity of complaints and symptoms of senior patients with a pectus excavatum and to evaluate the results of surgical correction of the chest deformation. This is a prospective clinical study, case series. The participants are 42 senior patients with a pectus excavatum and somatic complaints. Cardiological screening included medical history taking, physical examination, electrocardiography, transthoracic echocardiography and treadmill cardiography. Complaints, symptoms and test results were arranged in a clinical score. Indication for a therapeutic surgical correction by a modified Ravitch operation was a high clinical score in combination with radiological evidence of cardiac compression on CT or MRI. The clinical picture of the 42 senior patients with a pectus excavatum showed complaints of fatigue and low exercise tolerance, shortness of breath, palpitations, inspiratory obstruction and sometimes chest discomfort or pain. The serious and sometimes invalidating complaints of 19 patients (45%) had started only in their fourth or fifth decade of life and were labelled in 12 patients (63%) as 'Unexplained cardiovascular complaints'. To date, 11 patients have undergone surgical procedures. Symptoms were reduced substantially or had disappeared completely. All patients indicated that their health-related quality of life was significantly improved. Recognising the clinical picture of SPES is relevant because surgical reconstruction of the chest can provide substantial relief of symptoms.

Self-perceived stress reactivity is an indicator of psychosocial impairment at the workplace

BackgroundWork related stress is associated with a range of debilitating health outcomes. However, no unanimously accepted assessment tool exists for the early identification of individuals suffering from chronic job stress. The psychological concept of self-perceived stress reactivity refers to the individual disposition of a person to answer stressors with immediate as well as long lasting stress reactions, and it could be a valid indicator of current as well as prospective adverse health outcomes. The aim of this study was to determine the extent to which perceived stress reactivity correlates with various parameters of psychosocial health, cardiovascular risk factors, and parameters of chronic stress and job stress in a sample of middle-aged industrial employees in a so-called "sandwich-position".MethodsIn this cross-sectional study, a total of 174 industrial employees were assessed for psychosocial and biological stress parameters. Differences between groups with high and low stress reactivity were analysed. Logistic regression models were applied to identify which parameters allow to predict perceived high versus low stress reactivity.ResultsIn our sample various parameters of psychosocial stress like chronic stress and effort-reward imbalance were significantly increased in comparison to the normal population. Compared to employees with perceived low stress reactivity, those with perceived high stress reactivity showed poorer results in health-related complaints, depression, anxiety, sports behaviour, chronic stress, and effort-reward imbalance. The educational status of employees with perceived low stress reactivity is higher. Education, cardiovascular complaints, chronic stress, and effort-reward imbalance were moderate predictors for perceived stress reactivity. However, no relationship was found between stress reactivity and cardiovascular risk factors in our sample.ConclusionsJob stress is a major burden in a relevant subgroup of industrial employees in a middle management position. Self-perceived stress reactivity seems to be an appropriate concept to identify employees who experience psychosocial stress and associated psychological problems at the workplace.

Echocardiographic study of paediatric patients with mucopolysaccharidosis

Mucopolysaccharidosis is an inborn error of metabolism causing glucosaminoglycans tissue storage. Cardiovascular involvement is variable but contributes significantly towards the morbidity and mortality of the patients. To characterise the echocardiographic abnormalities in children and adolescents with different types of mucopolysaccharidosis. Echocardiograms and medical records of 28 patients aged 2-14 years, seen from 2003 to 2005, were revised. At that time, the enzymatic replacement therapy was still not available in our institution. Echocardiographic alterations were detected in 26 patients (93%), whereas 16 (57%) had abnormal auscultation, and only 6 (21%) presented with cardiovascular complaint. Mitral valve thickening with dysfunction (regurgitation, stenosis, or double lesion) was diagnosed in 60.8%, left ventricular hypertrophy in 43% and aortic valve thickening with regurgitation in 35.8% of the patients. There was no systolic dysfunction and mild left diastolic dysfunction was shown in 21.5% of the patients. Pulmonary hypertension was present in 36% of the patients, causing the only two deaths recorded. There was a strong association between the accumulation of dermatan sulphate and the presence of mitral valve dysfunction (p = 0.0003), aortic valve dysfunction (p = 0.006), and pulmonary hypertension (p = 0.006). Among individuals with two or more examinations, 82% had a worsening evolution. Echocardiographic alterations in children with Mucopolysaccharidosis are frequent and have a progressive character. Left valve lesions, ventricular hypertrophy, and pulmonary hypertension were the most common findings and there was an association between the accumulation of dermatan sulphate and cardiovascular involvement. Unlike in adults, pulmonary hypertension was the main cause of death, not left ventricle systolic dysfunction.

Impact of 2‐week Oral Consumption of Gynostemma pentaphyllum (Jiaogulan)‐containing Liquid Dietary Supplement, JULE of the Orient™ on Various Subjective Symptoms, Blood Circulation, Blood Pressure and Other Anthropometric Parameters: A Randomized, Placebo‐controlled, Double‐blind Human Clinical Study

A randomized, double‐blind, placebo‐controlled human clinical trial has examined the general effects of orally consumed saponin‐standardized Gynostemma pentaphyllum (jiaogulan)‐containing herbal tonic named JULE of the Orient™ (JULE). JULE or a placebo was provided as a beverage to healthy adults for 14 days (120 ml/day). Subjective questionnaire ratings (0–5) were used to measure general feelings of well‐being, neurological/psychological traits, gastrointestinal, musculoskeletal and cardiovascular complaints and any adverse effects. Blood circulation in hands was measured using laser Doppler. Questionnaire data were analyzed between day 1 and day 15 with the nonparametric Wilcoxon matched pairs tests. Significant differences were found in the JULE group (N=12) and consisted of decreased ratings for tiredness, procrastination, stiff shoulder, heartburn, physical discomfort, vision issues, stress, memory loss, daydream and increased stamina. Blood circulation in JULE group tended to be increased by about 30% compared to the pre‐intervention. In contrast, the placebo group (N=12) showed no significant changes. All other parametric data, such as body weight, BMI, blood pressure were not significantly different. These results suggest that JULE intake may increase subjective feelings of general well‐being and neurological/psychological traits by enhancing blood circulation.

Doctors’ use of laboratory tests in the diagnosis and treatment of patients

The provincial health budgets in South Africa are under enormous pressure and, annually, budgets are exceeded by most hospitals and clinics. Laboratory tests requested by clinicians are contributing to the problem of over-expenditure. The aim of this study was to determine from patients’ fles whether doctors were using laboratory tests prudently during their treatment of patients in the outpatient department (OPD) of the National District Hospital in Bloemfontein. A descriptive study was carried out using all the fles of patients who visited the OPD in a three-month period (1 July to 30 September 2005) for whom laboratory tests were requested by the attending physician. The majority (31.3%) of patients for whom laboratory tests were requested presented to the OPD with cardiovascular complaints or diagnoses, followed by endocrine (27.8%) and musculoskeletal (16.3%) complaints or diagnoses. Between one and three tests were requested for most patients, i.e. 33% and 15%, respectively. The most frequently requ...

Short-Term Effects of Lisdexamfetamine Dimesylate on Cardiovascular Parameters in a 4-Week Clinical Trial in Adults With Attention-Deficit/Hyperactivity Disorder

To evaluate the short-term impact of lisdexamfetamine dimesylate on cardiovascular parameters in adults with attention-deficit/hyperactivity disorder (ADHD). Medically healthy adults (18-55 years of age) with DSM-IV-TR-defined ADHD were randomly assigned to placebo or 30, 50, or 70 mg/d of lisdexamfetamine dimesylate for 4 weeks between May and November 2006. Electrocardiograms, systolic and diastolic blood pressure, and pulse were assessed pretreatment and weekly thereafter. There were no significant differences for mean systolic or diastolic blood pressure in any lisdexamfetamine dimesylate dose group versus placebo. Changes in pulse from baseline to endpoint were 0.0, 2.8, 4.2, and 5.2 bpm in the placebo and lisdexamfetamine dimesylate 30, 50, and 70 mg/d groups, respectively (P < .05, all lisdexamfetamine dimesylate groups vs placebo). Post hoc pulse outliers (pulse > or = 100 bpm; any 1 event) ranged from 3.3% to 8.5% of subjects in the lisdexamfetamine dimesylate groups, and no subjects in the placebo group were pulse outliers (P < .05 for lisdexamfetamine dimesylate 50 mg vs placebo only). There were no clinically meaningful electrocardiogram abnormalities. Overall, 8.3% (35/420; safety population) of subjects had treatment-emergent cardiovascular adverse events, and 1.7% (7/420) withdrew from the study because of cardiovascular complaints. Cardiovascular adverse events with lisdexamfetamine dimesylate in these medically healthy adults were generally mild to moderate in severity. Lisdexamfetamine dimesylate had limited short-term effects on heart rate, blood pressure, and electrocardiogram parameters that were of minimal clinical concern. These findings support the relative safety of lisdexamfetamine dimesylate. However, considering the potential of outliers, it is advisable to monitor cardiovascular parameters in stimulant-treated patients. Interpretation of these findings is limited to patients with no preexisting cardiac conditions who are taking their medication as prescribed. clinicaltrials.gov Identifier: NCT00334880.

Differential Manifestation of Cardiovascular Complaints as a Function of Utilization of Ergogenic Supplements

The rate of use of dietary supplements among young adults is significant. While the military makes significant restrictions on the use of certain pharmacologic drugs and actively tests for illegal drugs in a deployed environment, there is a near-unlimited supply of body-enhancing supplements available at military exchanges to deployed personnel. By emphasizing physical performance and providing these for purchase, the military leadership, perhaps unknowingly, endorses the use of these products. Cardiovascular symptoms represent one of the leading nontraumatic causes of aeromedical evacuation from a combat zone. Whether the use of supplements is associated with a differential presentation to cardiovascular complaint is unknown. Retrospective review using the US Department of Defense Military Health System data, we identified patients evaluated for cardiovascular complaints of syncope or palpitations while deployed to Iraq and Afghanistan. There were 905 US military personnel who presented with complaint of syncope or palpitations (mean age 31 +/- 10 years, 77% male). There were 83 (9.2%) who self-reported taking an ergogenic supplement. The incidence of reported use of supplements among males was 10.8%, which was significantly higher than its use among females at 3.8% (P = 0.001). In those >30 years, those on supplements had a higher resting pulse (90 +/- 28 vs 79 +/- 24 beats/min, P = 0.032), and the incidence of resting tachycardia was three-fold higher (35.0% vs 11.4%, P = 0.008). Supplement use was seen in 12.3% of those who presented with palpitations, which was significantly higher than those who presented without palpitations (7.8%, P = 0.043). In those taking supplements, symptoms were more likely during exertion (26.5% vs 15.0%, P < 0.001), and immediately postexertional (13.2% vs 4.6%, P < 0.001). An electrocardiogram was suggestive of diagnosis in 103 (16.3%), while head computed tomography, treadmill, and echocardiogram had no diagnostic utility in this patient population. In a healthy population serving within a combat zone, there exists a differential expression of disease in those taking supplements. Further study of a prospective nature to determine the impact of supplement use in this environment may allow for a more refined policy toward use and medical evaluation.

Kwaliteit van leven en zingeving bij chronische lymfatische leukemie

Quality of life and existential fulfilment in chronic lymphocytic leukemia Despite the profound effects of chronic lymphocytic leukemia (CLL) on all aspects of the patient’s life, hardly any studies have been conducted that have objectively assessed the quality of life of these patients. The same is true of the patient’s existential fulfilment in relation to quality of life. The sample consisted of 138 CLL patients who were supporters of the Contact Group Leukemia Foundation. The patients filled out questionnaires assessing quality of life, fatigue and existential fulfilment. Standardized and validated survey instruments were used. The most common physical disorders were increased cholesterol, hypertension, arthritis and cardiovascular complaints. Female patients received less support from their immediate surroundings than male patients. Women experienced more negative emotions than men. Quite a lot of patients had high fatigue scores (66%). Regression analysis showed that self-acceptance was related to social/family well-being and functional well-being. Self-actualization was related to social/family well-being and emotional and functional well-being. Self-transcendence was not related to QOL.

Fracture and Embolization of an Inferior Vena Cava Filter Strut Leading to Cardiac Tamponade

A 56-year-old woman presented to the Emergency Department of Parkland Memorial Hospital complaining of chest pain. She had a remote history of a hemorrhagic cerebrovascular accident complicated by pulmonary embolism, for which a Gunther-Tulip inferior vena cava (IVC) filter had been placed 6 years previously. In the triage area, the patient collapsed and was found to be hypotensive. An ECG showed sinus bradycardia with nonspecific ST and T-wave changes …

Health Problems in Cold Work

Cold in- and outdoor work can result in different adverse effects on human health. Health problems decrease performance and work productivity and increase the occurrence of accidents and injuries. Serious health problems can also result in absence from work due to sick leave or hospitalization. At its worst, work in cold conditions could be associated with deaths due to cold-related accidents or a sudden health event. Musculoskeletal complaints, like pain, aches etc. are common in indoor cold work. Breathing cold air while working may lead to respiratory symptoms, which can decrease performance in cold. The symptoms are usually worsened by exercise and ageing, being more common in persons having a respiratory disease. Cardiovascular complaints and related performance decrements could be especially pronounced during work in cold weather and involving physical exercise, especially among those with an underlying cardiovascular disease. The article also reviews the current information related to diabetes, skin disorders and diseases, as well as cold injuries and accidents occurring in cold work. Increasing awareness and identifying workplace- and individual-related cold risks is the first step in proper cold risk management. Following this, the susceptible population groups need customized advice on proper prevention and protection in cold work.

Enterocolic lymphocytic phlebitis and lymphocytic colitis: drug-related coexistent pathology

Dear Editor: Enterocolic lymphocytic phlebitis (ELP), a term coined in 1989, is an entity of unknown etiology and pathogenesis. This term is synonymous with mesenteric veno-occlusive disease, granulomatous phlebitis, necrotizing phlebitis, and myointimal hyperplasia. It is a spectrum of disease with lymphocytic phlebitis at one end of the spectrum, and thrombosis and myointimal hyperplasia at the other. ELP is a rare type of venulitis involving only the submucosal, subserosal, and mesenteric veins and venules of bowel wall. The arteries and arterioles, as well as the systemic circulation, are typically spared. Whilst a definitive cause has not been isolated, specific drugs have been associated with ELP. The entity of lymphocytic colitis (LC) was first described as “microscopic colitis” in 1980. An infiltrate of T lymphocytes within the epithelium in excess of 20 lymphocytes per 100 epithelial cells, features of epithelial injury, chronic inflammatory infiltrate in lamina propria, and absence of a prominent subepithelial collagen band, characterize LC histologically. The patients typically present with chronic diarrhea but the colon has a normal appearance endoscopically. LC was considered idiopathic until recently when infectious agents and drugs were proposed to be the possible triggers. We wish to report a 73-year-old man with a mechanical aortic valve (replaced twice), grade III left ventricular function, and a history of triple artery bypass graft, who presented with iron-deficiency anemia. Colonoscopy was performed to investigate the cause of the anemia and a large sessile polyp was found in ascending colon. Endoscopic removal of the polyp was unsuccessful, as the centre of the polyp could not be raised by saline instillation. Following a histopathological diagnosis of tubulo-villous adenoma with high-grade dysplasia, a right hemicolectomy was performed. It is noteworthy that the patient did not have any history of abdominal pain, diarrhea, alteration of bowel habits, or mass in abdomen at the time of presentation. The patient had been taking warfarin, aspirin, betablockers, angiotensin-converting enzyme inhibitor, statins, lasix, amiodarone, levothyroxine, and ferrous gluconate for several months for his cardiovascular complaints and irondeficiency anemia. The right hemicolectomy resection specimen was examined after formalin fixation and comprised an 18-cm segment of colon, 3 cm of terminal ileum, and an appendix measuring 6.5 cm in length. A polypoid mass, 2.5×2.5× 0.4 cm was identified in the proximal ascending colon. The rest of the resection specimen were grossly unremarkable, especially the mucosa which did not show evidence of ulceration, hemorrhage, or congestion. Histological examination of the mass was in keeping with the previous biopsy and the final diagnosis was tubulo-villous adenoma with isolated high-grade foci, no invasion, and complete excision. The grossly “normal” colon revealed thickening of the submucosal venous walls due to edema and a concentric, dense lymphocytic infiltrate. The lymphocytes permeated the entire thickness of the vessel wall and they did not show atypia. Several eosinophils were seen but neutrophils and plasma cells Int J Colorectal Dis (2009) 24:473–474 DOI 10.1007/s00384-008-0573-2

A Randomized, Double-Blind, Placebo-Controlled, Clinical Study of the General Effects of a Standardized Lycium barbarum (Goji) Juice, GoChi™

This randomized, double-blind, placebo-controlled clinical trial is the first study reported from outside China that has examined the general effects of the orally consumed goji berry, Lycium barbarum, as a standardized juice (GoChi; FreeLife International LLC, Phoenix, AZ) to healthy adults for 14 days. Based upon the medicinal properties of Lycium barbarum in traditional Asian medicine, we examined by questionnaire subjective ratings (0-5) of general feelings of well-being, neurologic/psychologic traits, gastrointestinal, musculoskeletal, and cardiovascular complaints as well as any adverse effects. Also, measures of body weight, body-mass index, blood pressure, pulse rate, and visual acuity were assessed before and after consuming 120 mL of GoChi/day or placebo control solution. Data were statistically analyzed for changes between day 1 and day 15. Significant differences between day 1 and day 15 were found in the GoChi group (N = 16) in increased ratings for energy level, athletic performance, quality of sleep, ease of awakening, ability to focus on activities, mental acuity, calmness, and feelings of health, contentment, and happiness. GoChi also significantly reduced fatigue and stress, and improved regularity of gastrointestinal function. In contrast, the placebo group (N = 18) showed only two significant changes (heartburn and happiness). No significant changes in musculoskeletal or cardiovascular complaints were observed in either group. All parametric data (body weight, etc.) were not significantly different between groups or between day 1 and day 15 for either group. These results clearly indicate that daily consumption of GoChi for 14 days increases subjective feelings of general well-being, and improves neurologic/psychologic performance and gastrointestinal functions. The data strongly suggest that further research is indicated to confirm and extend knowledge of the potential effects of Lycium barbarum upon human health.

A Randomized, Double‐blind, Placebo‐controlled, Clinical Study of the General Effects of Himalayan Goji® Juice/Lycium barbarum

This first randomized, double‐blind, placebo‐controlled clinical trial has examined the general effects of orally consumed goji berry, Lycium barbarum. The goji or a placebo was provided as a beverage (Himalayan Goji® Juice, HGJ) to healthy adults for 14 days of consuming 120 ml of HGJ/day or placebo. Subjective questionnaire ratings (0–5) was used for general feelings of well‐being, neurological/psychological traits, gastrointestinal, musculoskeletal and cardiovascular complaints, and any adverse effects. Questionnaire data were analyzed between day 1 and day 15 with the nonparametric Wilcoxon matched pairs tests. Significant differences (p&lt;0.05) were found in the HGJ group (N = 16) and consisted of increased ratings for energy level, athletic performance, quality of sleep, ease of waking up, ability to focus on activities, mental acuity, calmness, and feelings of health, contentment and happiness. HGJ also significantly reduced feelings of fatigue and stress, and improved gastrointestinal regularity. In contrast, the placebo group (N = 18) showed only two significant changes (heartburn and happiness). No significant changes in musculoskeletal or cardiovascular complaints were observed in either group. All parametric data, such as body weight, BMI, blood pressure, etc. were not significantly different. These results clearly indicate that daily consumption of HGJ increases subjective feelings of general well‐being, neurological/psychological traits and gastrointestinal regularity. This study was supported financially by FreeLife International.

Prevalence of cocaine use in ED patients with severe hypertension

Study objective We prospectively evaluated the prevalence of cocaine use in emergency department patients with elevated diastolic blood pressure greater than 120 mm Hg. Design Urine was collected on adult patients with diastolic blood pressure greater than 120 mm Hg. The Institutional Review Board granted a waiver of informed consent based on complete deidentification of the data to prevent selection bias. Spontaneously voided urine specimens were analyzed for the presence of the benzoylecgonine. Results Of 107 eligible patients with a diastolic blood pressure equal to or greater than 120 mm Hg, 99 were tested. Of the 99, 13 (13%) tested positive, and of which, 6 (46%) presented with a request for medication refill. Five patients (39%) had cardiovascular and/or pulmonary complaints. Conclusion Emergency department patients with hypertension who have recently used cocaine may be difficult to differentiate from those who have not. Consideration should be given to the potential for cocaine use when making treatment decisions in patients with hypertension.

Measuring the Effects of Air pollution on the Morbidity, Mortality and Healthcare Consumption of the Population in the Southern Region of Israel

P-704 Introduction: In Israel, research of the health effects of air pollution, while still limited, is rapidly developing. The objectives of this study are: a) quantification of air pollution exposure through geo-mapping, b) correlation with hospital and community-based health outcomes, c) cost-benefit evaluation of treatment versus pollution abatement. Methods: Air quality data collected from 18 regional monitoring stations from January 2000 through May 2004 are being used to construct mathematical interpolation maps of SO2, NOx, PM2.5 and O3 concentrations. Health outcomes are being evaluated using a historical-prospective study design to describe the association between pollution episodes and diagnosis-specific emergency department admissions, community clinic visits and selected pharmacy purchases. A cost-benefit analysis will explore the cost of treating the short-term health effects of pollution episodes and the potential for cost savings through a strategy of pollution abatement. Results: Substantial regional variation was observed for all pollutants. A decreasing trend in SO2 concentrations, with a marked drop in 2004, coincides with the conversion of a regional power plant from crude oil to natural gas. NO2 concentrations were substantially lower on weekends than on weekdays. NO2 and SO2 concentrations were lower in the summer months than during other seasons. Exploratory case-control investigation yielded an association between NOx values and emergency department patient volume for cardiovascular complaints(OR 1.065, 95%CI 1.009–1.124). No effect was observed for PM2.5. Conclusion: These methods and initial results will provide the basis for further analyses of pollution-related health effects. The development of advanced analytical capabilities is crucial for future assessment of extensive health-related databases.