Daily Medical Practice Research Articles

Evaluation of the reliability of preoperative descriptive airway assessment tests in prediction of the Cormack-Lehane score: A prospective randomized clinical study

Study objectiveIn this study we investigated and compared the predictive values of different airway assessments tests including thyromental height measurement test, which has been recently suggested, in difficult laryngoscopy (Cormack and Lehane [C-L] scores 3 and 4). In addition, we compared the effectiveness of methods and C-L scores, by IDS, in terms of predicting difficult intubation. DesignProspective, blinded study. SettingMaltepe University. PatientsFour hundred fifty-one patients selected randomly who underwent general anesthesia. InterventionsIn this study we compared predictive value of thyromental height measurement test (TMH), which has been recently suggested, modified Mallampati test (MMT), upper lip bite test (ULBT), and thyromental distance measurement test (TMD) in difficult laryngoscopy. Final C-L scores were compared with intubation difficulty scale (IDS) in terms of predicting difficult intubation. MeasurementsPatient's American Society of Anesthesiology score, age and weight were recorded. TMH, TMD, MMT, ULBT, IDS and C-L scores were measured and determined. Main resultsThe optimal cut-off point for TMH for predicting difficult laryngoscopy was 43.5 mm and for TMD was 82.06 mm. Use of TMH <43.5 with MMT has the highest sensitivity for predicting difficult intubation (78.38) with 75.36% specificity and 97.50% negative predictive value. TMH showed sensitivity of 91.89% and specificity 52.17% at 50 mm cut-off value. In the comparison of the area under the receiver operating characteristic curve values, none of the tests came forth individually or in combination with MMT test. ConclusionsThe present study demonstrates the practicality of TMH as a digitalized test however the clinical benefits of TMH in daily medical practice are drawn into question. The additional variable of race may have had some bearing on this and further studies, larger in patient sample size, may need to use different methodology concerning age-, sex-, and race-dependent variables in evaluating these tests.

The principle of autonomy in pediatrics under the new Civil and Commercial Code of the Nation: a communication of the Subcommittee on Clinical Ethics

Autonomy, understood as the power of self-decision by having full acknowledgement and free will, has been one of the pillars of Bioethics since its beginnings. The new National Civil and Commercial Code brings major changes and updates as well as additions, all of which have great implications in the practice of health rights. This whole makes a strong mark in the participation of children and adolescents as subjects of law. It is important to bring this new understanding to our attention as pediatricians, as it will involve the resolution of the daily medical practice.

Observational Cohort Study of Patients With Metastatic Colorectal Cancer Initiating Chemotherapy in Combination With Bevacizumab (CONCERT)

BackgroundThe CONCERT study (observational cohort study of patients with metastatic colorectal cancer initiating chemotherapy in combination with bevacizumab) aimed to describe patient characteristics, bevacizumab use, its efficacy in terms of progression-free survival (PFS) and overall survival (OS), and its safety in patients with metastatic colorectal cancer (mCRC) treated in daily medical practice. Patients and MethodsCONCERT was an observational, prospective, multicenter, cohort study conducted in France. Patients with mCRC initiating bevacizumab combined with chemotherapy were included and followed up for ≤ 36 months. ResultsOverall, 737 evaluable patients were assessed, and 71%, 21%, and 8% initiated bevacizumab as first-, second-, or third-line therapy or more, respectively. Their mean age was 64.5 years (range, 25-88 years), and 60% were men. Bevacizumab was mainly started at 5 mg/kg every 2 weeks (95%) and mostly combined with FOLFIRI (leucovorin, 5-fluorouracil, irinotecan; 68.0%) or FOLFOX (leucovorin, 5-fluorouracil, oxaliplatin; 22.0%). The median PFS was 10.4 months (95% confidence interval [CI], 9.6-11.3) in first-line, 8.5 months (95% CI, 7.0-9.2) in second-line, and 6.3 months (95% CI, 4.5-8.9) in third-line or beyond. The corresponding median OS was 25.3 months (95% CI, 21.5-28.6), 19.1 months (95% CI, 15.7-22.6), and 14.9 months (95% CI, 11.6-20.4). In first-line treatment, primary tumor resection and oxaliplatin-based chemotherapy were prognostic of a longer PFS. Eastern Cooperative Oncology Group performance status ≥ 2, > 1 metastatic sites, and intermediate or high risk using the Köhne prognostic index were associated with shorter PFS. The safety profile of bevacizumab combined with chemotherapy was comparable to that found by other observational studies of mCRC. ConclusionThe efficacy and safety results of bevacizumab plus chemotherapy as first- and second-line treatment of mCRC in daily practice in the CONCERT observational, prospective study were in line with those from randomized clinical studies.

Why do family doctors prescribe potentially inappropriate medication to elderly patients?

BackgroundBased on changes in pharmacokinetics and –dynamics in elderly patients, there are potentially inappropriate medications (PIM) that should be avoided in patients aged ≥ 65 years. Current studies showed prescription rates of PIM between 22.5 and 28.4 % in the primary care setting. The evidence concerning reasons for PIM prescription by FPs is limited.MethodsThis mixed method study consisted of three research parts: 1) semi-standardized content analysis of patients’ records, 2) qualitative interviews with FPs using a) open questions and b) selected patient-specific case vignettes and 3) qualitative interviews with FPs’ medical assistants. The integration of qualitative interviews was used to explain the quantitative results (triangulation design). PIM were identified according to the German PRISCUS list. Descriptive and multivariate statistical analysis was done using SPSS 22.0. Qualitative content analysis of interviews was used to classify the content of the interviews for indicating pertinent categories. All data were pseudonymously recorded and analyzed.ResultsContent analysis of 1846 patients’ records and interviews with 7 related FPs were conducted. Elderly patients [n = 1241, mean age: 76, females: 56.6 %] were characterized in average by 8.3 documented chronic diagnosis. 23.9 % of elderly patients received at least one PIM prescription. Sedatives/hypnotics were the most frequent prescribed PIM-drugs (13.7 %). Mental disorders, gender and number of long-term medication were detected as predictors for the probability of a PIM prescription. Common reported reasons for PIM prescription by FPs concerned limited knowledge regarding PIM, limited applicability of PIM lists in daily practice, lack of time, having no alternatives in medication, stronger patient-related factors than age that influence prescription, own bad experiences regarding changes of medication or refusal of following prescriptions of sedative/hypnotics.ConclusionsIt is essential to see FPs in a complex decision making situation with several influencing factors on their prescribing, including: patient-oriented prioritization, FPs’ experiences in daily practice, FPs’ knowledge regarding existing recommendations and their trust in it and organizational characteristics of FPs’ daily medical practice. These pros and cons of PIM prescription in elderly patients should be considered in FPs’ advanced training.

Fall risk screening in the elderly: A comparison of the minimal chair height standing ability test and 5-repetition sit-to-stand test

BackgroundSuccessfully identifying older adults with a high risk of falling can be complicated, time consuming and not feasible in daily medical practice. This study compared the effectiveness of the Minimal Chair Height Standing Ability Test (MCHSAT) and 5-repetition sit-to-stand tst (5R-STS) as fall risk-screening instruments for the elderly. Methods167 community-dwelling older adults (mean age=83.6±7.3years) were interviewed for demographics, fall history, cognition, and mobility status. MCHSAT performance was assessed using a chair whose seat height was modifiable by increments of 5cm, starting at 47cm and lowering after each successful attempt. 5R-STS performance was assessed by recording the time it took to rise and sit back down five consecutive times from a chair of 47cm high. Operating Receiving Characteristic (ROC) curves and Area under the Curve (AUC) were calculated for each test as well as for sub-groups of participants classified based on medical comorbidities (e.g. cardiac disease/stroke, lower limb arthritis). ResultsThe MCHSAT and 5R-STS were equally effective fall-risk screening instruments for the overall population (AUC (95% CI)=0.72 (0.63–0.82) and 0.73(0.64–0.81) respectively). The 5R-STS was more effective than the MCHSAT for participants suffering from lower limb arthritis (AUC (95% CI)=0.81(0.70–0.92) and 0.71(0.58–0.85) respectively) while the opposite was true for participants with a history of cardiac disease or stroke (AUC (95% CI)=0.59 (0.44–0.80) and 0.65 (0.47–0.84) respectively). ConclusionDue to their simplicity and quick administration time, the MCHSAT and 5R-STS are equally suitable for implementation in clinical settings.

EHealth and the need for education in biomedical and health informatics for the physicians in Bulgaria

Introduction . eHealth applications are numerous: electronic health records, evidence-based practice, delivering care from a distance, patient self-care, epidemiological research, healthcare management activities etc. However, the effective provision of healthcare as appropriate to the eHealth environment, needs not only suitable buildings and modern medical equipment, it needs adequately trained healthcare staff. The aim of this study is to assess the readiness and the willingness of the Bulgarian physicians to work in eHealth environment and to give reason for their still actual necessity of education in biomedical and health informatics. Material and methods . An enquiry was carried out in 2013 among the physicians in Bulgaria aiming at the assessment of their knowledge of using computers in their daily medical practice, their attitude to eHealth and their readiness to work in eHealth environment. Results. The results of the study showed the positive attitude of the Bulgarian physicians to information technologies (97%) and their recognized need of using computers in medicine (91.9%). Although 77.49% declared that they have the necessary skills and knowledge to use computers, the study proved that this is just a basic computer literacy (word-processing and Internet). About half of the respondents recognize the need of additional education: databases and medical information systems (37.64%), graphical software (40.59%), statistical software (47.98%), specialized medical software (48.34%). The majority of the participants (86%) wish to personally use computers in their daily medical practice, yet only 38.4% of them wish to enter patient data in a computer by themselves. In fact, only 17.7% are aware of the principles of eHealth. Conclusions . Тhe adequate education in biomedical and health informatics is one of the most important prerequisites for the successful implementation of eHealth in Bulgaria. Keywords : Biomedical and health Informatics, eHealth, computer literacy, ICT

Safety and effectiveness of sorafenib in Japanese patients with hepatocellular carcinoma in daily medical practice: interim analysis of a prospective postmarketing all-patient surveillance study.

BackgroundSorafenib was approved for treatment of unresectable hepatocellular carcinoma (HCC) in Japan in 2009. A prospective postmarketing all-patient surveillance (PMS) study was requested by Japanese authorities to confirm safety and effectiveness of sorafenib in Japanese HCC population.MethodsPatients with unresectable HCC treated with sorafenib were followed up for 12 months. Data on patient demographic characteristics, treatment status, clinical outcome, and adverse events (AEs) were collected.ResultsThis interim analysis included 1109 and 1065 patients evaluable for safety and effectiveness, respectively. Most patients (83.4 %) received the recommended initial dose of 400 mg twice daily. After a follow-up of 12-months, 89.8 % had discontinued treatment, most because of AEs (44.5 %) or progression (33.8 %). The most common drug-related adverse events (DRAE) were hand-foot skin reaction (51.4 %), liver dysfunction (26.4 %), diarrhea (25.1 %), and hypertension (21.6 %). The median overall survival (OS) was 348 days [95 % confidence interval (CI) 299–389 days], and the median duration of treatment was 87 days (95 % CI 78–98 days). Multivariate analyses identified baseline prognostic factors for longer OS, including female sex, low Child-Pugh score, Eastern Cooperative Oncology Group performance status 0, tumor stage I/II/III, low aspartate aminotransferase level, high hemoglobin level, hepatitis C and history of surgical resection.ConclusionsIn general, the safety and effectiveness findings in this PMS were consistent with findings from previous clinical studies. Sorafenib was well tolerated and clinically useful for Japanese patients.Clinical trial registration number: NCT01411436Electronic supplementary materialThe online version of this article (doi:10.1007/s00535-016-1173-5) contains supplementary material, which is available to authorized users.

Adverse Drug Reaction Monitoring and Reporting at H.S.K Hospital and Research Center-Bagalkot

Adverse drug reactions (ADRs) are considered as one among the leading causes of morbidity and mortality. Around 10% of hospital admissions are estimated to be due to ADRs and about 5-20% of hospitalised patients experience a serious ADR [1-3]. Reporting of ADRs has become an important component of monitoring and evaluation activities performed in hospitals [4]. Such ADR reporting programs encourage surveillance for ADRs, promote the reporting of ADRs and stimulate the education of health professionals regarding potential ADRs [5]. A productive hospital-based reporting program can be instrumental in providing valuable information regarding potential problems of drug usage in an institution. Through these efforts, problems are identified and resolved, which results in continuous improvement in patient care [6]. Spontaneous reporting program, a common method of drug surveillance is capable of recognizing ADRs in the daily medical practice, even though under reporting and absence of information on number of people actually exposed to the drug are its disadvantages [7,8].

Hemoglobin as a possible biochemical index of hypertension-induced vascular damage.

BackgroundWe previously reported on the positive association of hemoglobin with hypertension and atherosclerosis. On the other hand, hepatocyte growth factor (HGF) has been evaluated as a possible biochemical index of hypertension-induced vascular damage. However, no studies have reported on a correlation between hemoglobin and HGF accounting for hypertension status.MethodsA cross-sectional study of 1108 subjects (392 men and 716 women, 40–93 years old) who were undergoing a general checkup in 2014 was conducted.ResultsMultiple linear regression analysis adjustment for known cardiovascular risk factors showed no significant correlation between hemoglobin and HGF in non-hypertensive subjects, but a significant positive correlation in hypertensive subjects; β (parameter estimate) = 0.3 (p = 0.975) for non-hypertensive men, β = 0.4 (p = 0.925) for non-hypertensive women, β = 32.7 (p < 0.001) for hypertensive men, and β = 18.7 (p = 0.002) for hypertensive women.ConclusionWe found a significant positive correlation between hemoglobin and HGF among hypertensive men and women. Like HGF, hemoglobin may be a useful indicator to evaluate hypertension-induced vascular damage. Since hemoglobin can easily be measured, these results support hemoglobin as an efficient tool to evaluate vascular damage induced by hypertension in daily medical practice.

Heart and Lungs in COPD. Close friends in real life - separate in daily medical practice?

Chronic obstructive pulmonary disease (COPD) is associated with a 2-3 times higher rate of cardiovascular disorders (CVD) which is independent of other risk factors. A low FEV1 is a specific predictor of mortality as a result of cardiac causes, even stronger than increased cholesterol: for each 10% reduction of FEV1, cardiovascular mortality increases by 28%. The main causes of death among COPD patients are of cardiovascular origin. COPD and CVD have two major risk factors in common - advanced age and tobacco smoking. The search for a pathogenetic link between the two conditions focuses mainly on systemic extension of pulmonary inflammation. Despite such a frequent association, pulmonologists and cardiologists in both the clinical and the research settings often underestimate the importance of a correct diagnosis and severity stratification of the two combined conditions. Spirometry, in particular, is largely underprescribed. Missed diagnosis and severity stratification, incomplete knowledge of adverse drug events and lack of resources lead to undertreatment of patients combining COPD and CVD, and in particular, the underuse of beta-blockers, inhaled bronchodilators and rehabilitation. Clinical studies focusing on this group of patients should be promoted in the future to test therapies and manage options. Furthermore, efforts must be made to improve the present standards of care, which falls short of recommended levels, starting from the often-neglected use of spirometry to confirm a diagnosis of COPD.

Renal function in advanced renal cell carcinoma patients treated with sorafenib: Subset analyses of post-marketing surveillance in Japan with over 3,200 consecutive cases.

518 Background: Patients with advanced renal cell carcinoma (RCC) are predisposed to impaired renal function due to prior nephrectomy and existing renal mass. Moreover, treatment with molecular targeted agents may also affect renal function. We retrospectively analyzed post marketing all-patients surveillance to assess the effect of sorafenib on the renal function of advanced renal cell carcinoma (RCC) in real-world use. Methods: We have collected safety/efficacy data of over 3,200 consecutive Japanese patients with advanced RCC treated with sorafenib under daily medical practice (1). Using this database, the effect of sorafenib on renal function was analyzed in a post-hoc manner, by calculating estimated glomerular filtration rate (eGFR) from age, gender, and serum creatinine at each time point. Results: The eGFRs at baseline (n=2,943), 12 months after sorafenib treatment (n=636, and the time of discontinuation (n=1712) of all patients were 54 ± 21, 57 ± 24, and 59.6 ± 31.8 mL/min/1.73 mm2, respectively, and showed no significant differences. The mean eGFRs of each segment at baseline and 12 months were 110 ± 26 and 96 ± 39 in G1(eGFR ≥90), 70 ± 8 and 73 ± 23 in G2 (eGFR ≥60 and &lt;90), 52 ± 4 and 57 ± 15 in G3a (eGFR ≥45 and &lt;60), 39 ± 4 and 43 ± 11 in G3b (eGFR ≥30 and &lt;45), 24 ± 4 and 30 ± 10 in G4 (eGFR ≥15 and &lt;30), 7 ± 3 and 11 ± 12 in G5 (eGFR &lt;15), respectively. The median daily dose were 726mg (G1), 522mg (G2), 524mg (G3a), 517mg (G3b), 483mg (G4), and 400mg (G5). The incidence of renal AEs seemed to be higher in G4 and G5 (14% and 6%, respectively) than the other groups. The objective response rate ranged from 29.2% in G3a to 18.3% in G5, and the overall survival were higher in G3a and G3b (1 year survival rate: 81.5% and 78.4%, respectively), and lower in G1 (1 year survival rate: 50.2%). Conclusions: This study demonstrated that little impact on renal function of advanced RCC patients treated with sorafenib during observational period with sufficient clinical response and safety irrespective of the baseline eGFR value.

EDTA: Ethylene Diamine Tetra Acetic Acid – A Review

Chelation therapists around the world incorporate chelation therapies into their daily medical practice, frequently using EDTA (ethylene diamine tetra acetic acid) compounds, unaware of the chemical difference of the various EDTA chelating agents. With this information, we aim to clarify the different mode of action of the EDTAs, including their appropriate medical use. In the USA, medical practitioners promote EDTA chelation, often as an alternative to conventional treatments for a variety of chronic diseases, including vascular problems. German nonmedical professionals use the ‘CaEDTA push’ as promoted by US web pages, although this is against standard protocol. CaEDTA has been FDA- approved for lead intoxication only, and Na2EDTA has not been approved for the treatment of cardiovascular disease. These facts are often overlooked. Misunderstandings increase the risk of iatrogenic accidents. This information aims to prevent this.

Telemedicine inside the Pocket: The Impact of Smartphones on Daily Patients’ Evaluations

ABSTRACT Objective To evaluate the perception of doctors, residents, and medical students of smartphone use on daily medical practice. Materials and methods Cross-sectional study with data collected online by questionnaire on Google Docs®, with closed multiple-choice questions regarding smartphones use in medical practice and its impact on decision-making and patients' privacy. Results There were 118 questionnaires, mostly from students (61%), followed by medical residents (31%) and medical preceptors (8%). All preceptors confirmed eventual use of smartphones on clinical cases discussions, 77.8% of whom use it in less than half of the time. Among the residents, 94.6% use theirs smartphones, 77% of them in more than half of the time. On the contrary, 12.5% of the students do not use this kind of resource, and among those that do use it, 50% do so more than half of the time. All preceptors, 94.6% residents and 80.6% of the students believe its use does not expose the patients' privacy. Conclusion Preceptors and residents use smartphones more often than medical students. Most agree its use helps on daily decision-making and does not jeopardize the patients' privacy. How to cite this article Abreu-Reis P, Bassani T, Collaco IA, Pereira GD, Faggion HZ, Sawczyn GV, Uchida EP, Nasr A, Tomasich FS, Lopes JA. Telemedicine inside the Pocket: The Impact of Smartphones on Daily Patients' Evaluations. Panam J Trauma Crit Care Emerg Surg 2016;5(2):88-92.

Effectiveness of Simple Individual Psychoeducation for Bipolar II Disorder.

Several studies have proven the effectiveness of psychoeducation in bipolar II disorder patients; however, simpler psychoeducation is needed in daily medical practice. Therefore, we devised a simple individual psychoeducation program, which involved 20-minute sessions spent reading a textbook aloud in the waiting time before examination. Here, we report a successful case of simple individual psychoeducation with a patient with bipolar II disorder, a 64-year-old woman who had misconceptions surrounding her mood due to 24 years of treatment for depression. Her perception of mood state, particularly mixed state, was dramatically changed, and her quality of life was improved after the simple individual psychoeducation. This case suggests that the simple individual psychoeducation could be effective for bipolar II disorder by improving understanding of the disease and by meeting different individual needs.

Training in Systems Approaches for the Next Generation of Life Scientists and Medical Doctors.

The last decades have challenged us with novel technologies and abilities to look deep into the human genome of each individual, to screen for numerous metabolites in the blood, to search organs by imaging techniques, and much more. We can collect data from all these measurements from humans with different (usually multifactorial) diseases and, in accordance with ethical rules, store the data safely, locally, or remotely. The human data is growing exponentially, from giga- (10(9)), tera- (10(12)) to peta- (10(15)) and zettabytes (10(21)), both in public and restricted access settings. However, everyone agrees that the technological and information booms have not yet sufficiently reached medicine and have so far only barely influenced the clinical settings. In this chapter, we discuss the opinion that without topping up the education system, it will be difficult to catch up. We propose that in addition to the classical medical education, which is traditionally good and highly respected in European countries, we must find ways on how to introduce into the medical curricula mathematical and big data aspects and insights. Only a global (systems) view on physiology and pathophysiology can break the Gordian knot of many multifactorial diseases where we still don't understand the complexity of disease causes nor we can predict or cure the disease. We believe that the breakthrough is in the systems and interdisciplinary education and training, as early as possible in professional careers. If medical and related students and professionals would be formally educated in such interdisciplinary manner, they could take this knowledge further towards applications in their daily medical practice. We describe the current challenges and scattered best practices of introducing the wider systems medicine topics into the medical education as well as possibilities for systems medicine training at the doctoral and lifelong levels.

Cinnarizine and dimenhydrinate in the treatment of vertigo in medical practice.

SummaryThe efficacy and safety of the fixed combination of cinnarizine 20 mg and dimenhydrinate 40 mg in the treatment of vertigo of various origins have been investigated in a prospective, noninterventional study involving private practices throughout Germany. A total of 1275 patients with an average age of 61.2 years participated in the study. The vertigo symptoms, measured by a validated mean vertigo score (primary efficacy endpoint) improved by 61 % in the course of the observational period (median: 6 weeks). Concomitant symptoms frequently associated with vertigo such as nausea, vomiting and tinnitus were also markedly reduced by 84, 85 and 51 %, respectively. Overall efficacy has been rated by the physicians as ‘very much improved’ or ‘much improved’ in 95 % of the patients. A total of 47 patients (3.7 %) reported 51 adverse drug reactions (all nonserious). The results indicate a good tolerability and efficacy of the fixed combination of cinnarizine and dimenhydrinate in the treatment of vertigo in daily medical practice, which is in line with previous findings of numerous interventional, randomised, double-blind, controlled clinical trials.

Variable Support Towards ASCO Recommendations for Venous Thromboembolism (VTE) Prophylaxis and Treatment in Patients with Cancer

Objectives: To determine the support of physicians for the recently published ASCO evidence-based clinical practice guidelines for venous thromboembolism (VTE) prophylaxis and treatment in patients with cancer (J Clin Oncol. 2015;33:654-6).Methods: ASCO key recommendations were presented as part of three CME seminars to physicians not specialized in hem/onc or hemostasis. In addition two specialists in the field discussed a list of arguments for and against each of the recommendations considering (1) quality of scientific evidence underlying each recommendation, (2) feasibility in daily practice including sensitivity to patients preferences, and (3) medicolegal implications and reimbursement aspects. After each presentation attendees were asked to fill out a questionnaire on how much they supported the ASCO recommendations and each of the pro&con arguments.Results: A total of 89 physicians attended the three meetings. 56 questionnaires were returned. The ASCO recommendations with the highest degree of support were:‒ Patients undergoing major cancer surgery should receive prophylaxis for 7-10 days and even 4 weeks after major abdominal or pelvic surgery with high-risk features (84% pro)‒ LMWH should be given for the initial treatment as well as for long-term secondary prophylaxis (80% pro).The recommendations with the lowest degree of support were:‒ Patients with cancer should be educated about signs and symptoms of VTE. They should be periodically assessed for VTE (59% pro).‒ Anticoagulation should not be used to extend survival of patients with cancer in the absence of other indications (56% pro).Conclusion: After presenting ASCO recommendations as part of CME training the degree of physicians' support was still at best moderate and sometimes even close to neutrality. In daily medical practice scientific evidence has no priority to clinical practicability, patients preferences, medicolegal aspects and cost-restrictions. Guideline authors should complement their recommendations with advice from their own practice on how to implement guidelines in daily care and how they manage financial and medicolegal restrictions. In addition there is an unmet need for more education on VTE prophylaxis and treatment among physicians not specialized in hem/onc or hemostasis who are caring for cancer patients. DisclosuresMatzdorff:AMGEN - e. Honoraria: Honoraria; Aspen Germany: Honoraria; Bayer: Equity Ownership; Boehringer Ingelheim: Honoraria; Behring: Honoraria; Bristol Myers Squibb: Honoraria; GlaxoSmithKline: Honoraria; LEO Pharma: Consultancy, Honoraria, Research Funding; Roche: Consultancy, Equity Ownership, Honoraria. Schwindel:LEO Pharma GmbH: Honoraria, Membership on an entity's Board of Directors or advisory committees; Roche: Honoraria; Amgen: Honoraria; Nordic Pharma: Honoraria. Hutt:LEO Pharma GmbH: Employment.

CO-31: Prevalence of asymmetrical blood pressure in uncontrolled hypertensive patients is high and highly related with cardiovascular diseases prevalence

Background A meta-analyse published in the Lancet has shown that an asymetry of the blood Pressure between arm of more than 15 mmHg and perhaps of 10 mmHg and more is associated with an increase of cardiovascular diseases and that a greater attention should be paid to it (Clark CE et al. Lancet 2012;379:905–14). These data need to be confirmed in daily practice. Objectives To describe the prevalence of the asymmetrical blood pressure (ABP) in patients presenting an uncontrolled blood pressure (BP) under treatment. Secondary objectives: To identify factors influencing its prevalence and evaluate its relation with the frequency of the cardiovascular diseases presented by the patients. Methods Observational cross sectional study conducted in daily community medical practice. Inclusion criteria: patients presenting uncontrolled BP according ESC criteria by a previous antihypertensive therapy. Measurements: ABP was measured at each arm according ESH/ESC Clinical Practice Guideline. Statistical analysis: multiple regression analysis (MRA) adjusted on cardiovascular risk factors (CVRF). Results Among 2417 hypertensive patients, 63,3 ± 11,0 years old, 36,8% (IC95% [34,9; 38,7]) were presenting a between-arm difference in systolic blood pressure > = 10mmHg, and 17,1% (IC95% [15,6; 18,6]) > = 15mmHg. MRA shows ABP (> = 10mmHg) prevalence was influenced by dyslipidemia (OR: 1,5 [1,2; 1,7] p = 10mmHg influences the frequency of sub clinical impairment of target organ (OR: 1.6 [1.3; 1.9] p = 15mmHg (OR: 1.6 [1.1; 2.4] p Conclusions In uncontrolled hypertensive patients, a greater intention should be paid to the screening of an asymmetrical blood pressure that should help to identify clinically high risk cardiovascular patients or patients with subclinical organs damages.

Anatomical variation in bifurcation and trifurcations of sciatic nerve and its clinical implications: in selected university in Ethiopia.

BackgroundThe Sciatic nerve is the widest nerve of the body. It consists of two components, namely: the tibia and the common peroneal components derived from the ventral rami of L4 to S3 spinal nerves of the lumbosacral plexus. It exits the pelvis through the greater sciatic foramen below the Piriformis muscle and descends between the greater trochanter of the femur and ischial tuberosity of the pelvis to the knee. The purpose of this study is to identify the course and variations in branching pattern of the sciatic nerve which may lead to various clinical manifestations.MethodsTwenty-eight formalin fixed cadavers comprising of 56 lower limbs are used for this study, of which six specimens were female cadavers. Dissection of gluteal region and posterior compartment of the thigh was done to expose the sciatic nerve. Variations in the sciatic nerve anatomy; their relationship to Piriformis muscle and a point of bifurcation and trifurcation were noted and recorded.ResultsForty-two lower limbs (75 %) showed normal anatomy of sciatic nerve. Fourteen regions (25 %) showed variations in the sciatic nerve, of which six regions (11 %) showed a variation of the sciatic nerve in relation to Piriformis muscle, three regions (5 %) showed trifurcation of the sciatic nerve and five regions (9 %) showed variation in the origin of the sural nerve.ConclusionThe knowledge regarding the level of division and distribution of the sciatic nerve and its location is of great importance. The sciatic nerve is frequently involved in daily medical practice of neurology, orthopedics, rehabilitation and anesthesia. Its long course makes it vulnerable to nerve injury. Even in this era the cadaver is the best means to study anatomy. It emphasizes proper clinical implications, for the surgeons to practice efficient surgical recombination and avoid errors.

Remedial theology: An exploration into the factors-Religious conviction, mysticism and wellbeing.

Spirituality and religion have been seen as beneficial, harmful, and irrelevant to health. An effort was made to examine the recent research on this topic. The focus was on: defining spirituality and religion both conceptually and operationally. The rapidly accumulating evidence on spirituality further confirmed that personal spirituality has important influences on healthcare outcomes however it is difficult to integrate into daily medical practice. However medical spirituality was studied as a distinct interdisciplinary with its own well-developed body of clinical evidence, clinical skill and with well-defined clinical boundaries. An effort was made to integrate the new knowledge, and help anticipate developing "turf issues."