Physician Examination Research Articles

Evaluation of the National Task Group-Early Detection Screen for Dementia: Sensitivity to 'mild cognitive impairment' in adults with Down syndrome.

The accuracy of the National Task Group-Early Detection Screen for Dementia (NTG-EDSD) was evaluated in a sample of 185 adults with Down syndrome (DS), emphasizing 'mild cognitive impairment (MCI-DS)'. Knowledgeable informants were interviewed with the NTG-EDSD, and findings were compared to an independent dementia status rating based on consensus review of detailed assessments of cognition, functional abilities and health status (including physician examination). Results indicated that sections of the NTG-EDSD were sensitive to MCI-DS, with one or more concerns within the 'Memory' or 'Language and Communication' domains being most informative. The NTG-EDSD is a useful tool for evaluating dementia status, including MCI-DS. However, estimates of sensitivity and specificity, even for detecting frank dementia, indicated that NTG-EDSD findings need to be supplemented by additional sources of relevant information to achieve an acceptable level of diagnostic/screening accuracy.

What does the structure of a medical consultation look like? A new method for visualising doctor-patient communication

ObjectiveThis project developed an innovative methodology for visualising consultation structure by categorising doctor-patient talk into the phases proposed by an established educational model of clinical communication. MethodConsultation phases were identified from verbatim transcripts using the tasks and process skills of the Calgary-Cambridge Guide to the Medical Interview. Seventy-eight simulated consultations from a ‘History-taking’ station of a postgraduate examination for physicians were analysed by two independent raters. Transcripts were converted into diagrams comprising up to six phases: Initiating, Gathering information, Summary, Explanation, Planning and Closing. ResultsThe dominant phases were Gathering information, Planning and Explanation (66 %, 10 % and 12 % of talk respectively). While consultations broadly followed the expected chronological sequence, less than a third (23/78) contained all six phases, with Closing and Summary most frequently absent. Half of consultations (40/78) did not include phases in the predicted order, with intertwined phases commonly observed. ConclusionsIn this standardised setting, doctors created variable consultation structures, typically omitting phases involving consolidation and agreement of plans going forward. Practice implicationsThe method enables visualisation and comparison of consultation structure. The findings pose questions about the alignment of practice with educational guidance and the opportunities afforded to patients to actively engage in consultations.

Multiple choice questions for Haematology and core medical traineesB. J. Bain

The transition from core medical training posts to higher specialist training in Haematology presents a challenge to junior doctors. In the UK they will have demonstrated competency in general medicine through the Membership of the Royal College of Physicians (MRCP) examination, but once embarked on a career in Haematology they are presented with patients with diseases that they have not previously encountered. Furthermore, they must learn essential laboratory-based diagnostic skills. Haematology is therefore perceived by some as a difficult specialty with a long and arduous training. This book by Professor Bain aims to offset that misconception. Directed at both core medical and junior haematology trainees it covers a broad range of topics in a quick-reference question book. There are single best answer questions and extended matching question formats similar to those used in MRCP and MRCPath part 1 examinations. The answers are supported by a comprehensive explanation, where necessary, and appropriate references to prompt further reading. A broad spectrum of clinical and laboratory topics are covered, many relevant to the practice of junior doctors working in medical specialties, in addition to those involved in higher specialist training. I hope that this publication stimulates more junior doctors to consider career opportunities and discover that Haematology is a fascinating subject built around and relevant to all branches of medicine and not just the domain of the specialist.

Augmenting physician examiner scoring in objective structured clinical examinations: including the standardized patient perspective.

In Canada, high stakes objective structured clinical examinations (OSCEs) administered by the Medical Council of Canada have relied exclusively on physician examiners (PEs) for scoring. Prior research has looked at using SPs to replace PEs. This paper reports on two studies that implement and evaluate a standardized patient (SP) scoring tool to augment PE scoring. The unique aspect of this study is that it explores the benefits of combining SP and PE scores. SP focus groups developed rating scales for four dimensions they labelled: Listening, Communication, Empathy/Rapport, and Global Impression. In Study I, 43 SPs from one site of a national PE-scored OSCE rated 60 examinees with the initial SP rating scales. In Study II, 137 SPs used slightly revised rating scales with optional narrative comments to score 275 examinees at two sites. Examinees were blinded to SP scoring and SP ratings did not count. Separate PE and SP scoring was examined using descriptive statistics and correlations. Combinations of SP and PE scoring were assessed using pass-rates, reliability, and decision consistency and accuracy indices. In Study II, SP and PE comments were examined. SPs showed greater variability in their scoring, and rated examinees lower than PEs on common elements, resulting in slightly lower pass rates when combined. There was a moderate tendency for both SPs and PEs to make negative comments for the same examinee but for different reasons. We argue that SPs and PE assess performance from different perspectives, and that combining scores from both augments overall reliability of scores and pass/fail decisions. There is potential to provide examinees with feedback comments from each group.

Improving the utilization of essential public health services by Chinese elderly migrants: strategies and policy implication.

BackgroundThe concept of healthy aging has become a global health strategy in response to the population aging. In China, old-aged migrants are facing serious health care challenges due to the obstacles in the utilization of health services, social integration and ignored public policies. We aimed to examine the old-aged migrants’ utilization of the essential public health services and its underlying factors on account of change of residence, and social support.MethodsData came from the senior sample (aged over 65 years, n = 11 161) of the 2015 National Migrant Dynamic Monitoring Survey in China that employed Probability Proportionate to Size method as a sampling strategy. χ2 tests and binary multilevel model were conducted to analyze the difference and the underlying factors of the utilization of essential health services among old-aged migrants.ResultsApproximately 66.2% of old-aged migrants did not receive free physician examination services from health institutions in the past year, and 34.6% of old-aged migrants with chronic disease have been followed up by doctors. There were significant differences in the utilization of essential public health services among old-aged migrants across different individuals and families. It showed that exercise time, migrating range, migrating reason, physical health condition, chronic disease, local friends, health insurance, household expenditure, and income were significantly associated with the elderly migrants’ utilization of essential public health services.ConclusionsThe utilization of essential public health services among old-aged migrants was insufficient in comparison with the general population. The government should launch targeted policies such as production and work-related injuries for the floating population. The supply side should promote the equalization of essential public health services for migrants. Social organizations and community should undertake the responsibility in social support for old-aged migrants.

Patient autonomy in the consultation: How signalling structure can facilitate patient-centred care

ObjectiveTo identify types and functions of doctors’ verbal signalling behaviours used to share consultation structure with patients. MethodDoctors’ verbal utterances signalling what would happen in the consultation were identified by two independent raters from transcripts of 78 simulated consultations from a postgraduate examination for physicians. In total, 974 behaviours were categorised as informing, inviting or instructing. Principles adopted from Speech Act Theory and Conversation Analysis were used to examine their function from their literal meaning and use in context. ResultsSignalling behaviours to inform were most frequent, particularly ‘signposts’, with less informative signalling behaviours also found (‘posts without signs’ and ‘signs without posts’). Behaviours to invite involvement offered limited choice. Doctors also instructed the patient in what to do (behaviour) or not to do (emotion). Behaviours signalled more ‘micro-level’ changes than broader consultation aims. Signalling behaviours carried roles beyond their literal meaning (‘hyperfunctions’) and were combined (‘stacked’), often seen deflecting the conversation away from patient concerns. ConclusionDoctors use a variety of verbal signalling behaviours with multiple functions. As well as sharing information, these behaviours regulate patient agency in the consultation. Practice implicationsDoctors’ signalling behaviours may play an important role in facilitating or inhibiting patient autonomy.

Telemedicine for Outpatient Neurosurgical Oncology Care: Lessons Learned for the Future During the COVID-19 Pandemic

BackgroundThe coronavirus 2019 (COVD-19) pandemic has drastically disrupted the delivery of neurosurgical care, especially for the already at-risk neuro-oncology population. The sudden change to clinic visits has rapidly spurned the implementation of telemedicine. A recommendation care paradigm of neuro-oncologic patients limited by telemedicine has not been reported.MethodsA summary of a multi-institution experience detailing the potential benefits, pitfalls, and the necessary considerations to outpatient care of neurosurgical oncology patients.ResultsThere are limitations and advantages to incorporating telemedicine into the outpatient care of neuro-oncology patients. Telemedicine-specific considerations for each step and stakeholder of the appointment (physician, patient, scheduling, previsit, imaging, and physical examination) are examined.ConclusionsTelemedicine, pushed to prominence during this COVID-19 pandemic, is a powerful and possibly preferential tool for the future of outpatient neuro-oncologic care.

Quality of Care for the Screening, Diagnosis, and Management of Lupus Nephritis Across Multiple Health Care Settings

We examined quality measures for screening, diagnosis, and treatment of lupus nephritis (LN) among participants of the California Lupus Epidemiology Study across 25 different clinical sites to identify gaps in quality of care. Data from 250 participants with lupus were analyzed across 3 sources (medical records, physician examination, and patient interviews). Overall performance on 8 quality measures was calculated separately for participants with and without LN. We used generalized estimating equations in which the outcome was performance on measures, adjusting for participant demographics, lupus disease severity, and practice characteristics. Of 148 patients without LN, 42% underwent screening laboratory tests for nephritis, 38% underwent lupus activity serum studies, and 81% had their blood pressure checked every 6 months. Of 102 LN patients, 67% had a timely kidney biopsy, at least 81% had appropriate treatment, and 78% achieved target blood pressure within 1 year of diagnosis. Overall performance in participants across quality measures was 54% (no LN) and 80% (LN). Significantly higher overall performance for screening measures for LN was seen at academic (63.4-73%) versus community clinics (37.9-38.4%). Similarly, among those with LN, higher performance in academic (84.1-85.2%) versus community clinics (54.8-60.2%) was observed for treatment measures. In this quality-of-care analysis across 25 diverse clinical settings, we found relatively high performance on measures for management of LN. However, future work should focus on bridging the gaps in lupus quality of care for patients without nephritis, particularly in community settings.

Which dermatology patients attend to Dermatology Outpatient Clinics during the SARS-CoV-2 outbreak in Turkey and what happened to them?

ABSTRACTCoronavirus disease, first emerged in Wuhan, rapidly spread all over the world since December 2019. There are concerns about elective dermatology appointments and its results. Herein, we aimed to find out which type of dermatologic patients attended to dermatology outpatient clinic. The patients visiting the clinics for elective dermatologic diseases between March 11 and 18, 2020, were included in this study. Their age, sex, diagnosis of disease, requirement for emergent intervention, and their medical records about COVID‐19 were obtained. There were 390 patients attending to the dermatology outpatient clinic in this period. The most common disease was acne (N: 94, 24%), only 19% of patients need emergent interventions or dose adjustment. There were 40 (10%) patients over the age of 65. After their visits, five patients were diagnosed as COVID‐19 in 2weeks. Dermatologic examinations may be a vector for severe acute respiratory syndrome coronavirus 2 (SARS‐CoV‐2) transmission since being closed to the patient. Five of our patients were diagnosed as COVID‐19 after their elective visit to hospital. Since the asymptomatic course of some young patients, most of our patients were not screened for COVID‐19. Our findings support the concerns of elective physician examinations.

Autonomic and Cognitive Function Response to Normobaric Hyperoxia Exposure in Healthy Subjects. Preliminary Study.

Background and objective: This is the first study to investigate the effect of high-flow oxygen therapy, using a normobaric chamber on cognitive, biochemical (oxidative stress parameters and the level of neurotrophins), cardiovascular and autonomic functioning. Materials and methods: 17 healthy volunteers, eight males and nine females, with a mean age of 37.5 years, were examined. The experimental study involved ten two-hour exposures in a normobaric chamber with a total pressure of 1500 hPa, in air adjusted to 37% oxygen, 1.079% carbon dioxide and 0.44% hydrogen. Cognitive function was assessed by using Trail Making Test parts A, B and difference in results of these tests (TMT A, TMT B and TMT B-A); California Verbal Learning Test (CVLT); Digit symbol substitution test (DSST); and Digit Span (DS). Fatigue (Fatigue Severity Scale (FSS)), cardiovascular, autonomic and baroreceptor functioning (Task Force Monitor) and biochemical parameters were measured before and after intervention. Results: After 10 sessions in the normobaric chamber, significant decreases in weight, caused mainly by body fat % decrease (24.86 vs. 23.93%, p = 0.04 were observed. TMT part A and B results improved (p = 0.0007 and p = 0.001, respectively). In contrast, there was no statistically significant influence on TMT B-A. Moreover, decrease in the number of symbols left after a one-minute test in DSST was noted (p = 0.0001). The mean number of words correctly recalled in the CVLT Long Delay Free Recall test improved (p = 0.002), and a reduction in fatigue was observed (p = 0.001). Biochemical tests showed a reduction in levels of malondialdehyde (p < 0.001), with increased levels of Cu Zn superoxide dismutase (p < 0.001), Neurotrophin 4 (p = 0.0001) and brain-derived neurotrophic factor (p = 0.001). A significant increase in nitric oxide synthase 2 (Z = 2.29, p = 0.02) and Club cell secretory protein (p = 0.015) was also noted. Baroreceptor function was significantly improved after normobaric exposures (p = 0.003). Significant effect of normobaric exposures and BDNF in CVLT Long Delay Free Recall was noted. Conclusions: This study demonstrates that 10 exposures in a normobaric chamber have a positive impact on visual information and set-shifting processing speed and increase auditory-verbal short-term memory, neurotrophic levels and baroreceptor function. A response of the respiratory tract to oxidative stress was also noted. There is a need to rigorously examine the safety of normobaric therapy. Further studies should be carried out with physician examination, both pre and post treatment.

The prevalence, epidemiology and screening results of breast cancer in women of Guilan province, north of Iran: A cross-sectional study during 2017–2018

ObjectiveBreast cancer is one of the most common types of cancer in women, affecting many women worldwide every year. Breast cancer screening is one of the best strategies to reduce the death rate caused by this cancer. The aim of this study was to evaluate the prevalence, epidemiology and screening results of breast cancer in women in Guilan province. MethodsThis cross-sectional study was carried out on 300 women who participated in the screening program in Guilan province during 2017–2018. The data were collected by a breast screening questionnaire. Finally, the data were analyzed using chi-square and independent t-tests. ResultsThe mean age of the patients was 49.96 ± 6.53 years old and the estimated prevalence of breast cancer was 1.7% (95% Confidence interval (CI): 0.6–3.6). Physicians examination were significantly associated with breast cancer status (P = 0.003). The results also showed that the percentage of malignancy and benignity in the center (69 patient, 52.3%), west and northwest of Guilan (69 patient, 54.8%) was more than descriptive in East Guilan (20 patient, 47.6%). But it was not statistically significant (P = 0.730). The accuracy of mammography results (BIRADS) and sonography were 69.76% and the kappa coefficient was 0.44 (p < 0.001). ConclusionImplementation of screening programs in women should be considered and breast screening using mammography is one of the valuable methods for early detection of breast lesions, which is associated with a better prognosis of cancer.

Hot Off the Press: Troponin Testing and Coronary Syndrome in Geriatric Patients With Nonspecific Complaints: Are We Overtesting?

Elderly patients frequently present to the emergency department with nonspecific complaints and it falls to the emergency physicians to determine whether a workup for acute coronary syndrome is warranted. We discuss a study by Wang et al published in Academic Emergency Medicine, January 2020, looking at the value of troponin testing in elderly patients presenting to the emergency department with nonspecific complaints. We provide critical analysis of the article, and summarize the social media discussion and a podcast in which the authors discuss their work.

Worse Quality of Life, Function, and Pain in Children With Enthesitis, Irrespective of Their Juvenile Arthritis Category.

To estimate the impact of enthesitis on patient-reported outcomes in children with juvenile idiopathic arthritis (JIA), irrespective of JIA category. Children enrolled in the Research in Arthritis in Canadian Children Emphasizing Outcomes cohort were studied. Entheseal tenderness by physician examination in 33 defined locations, Juvenile Arthritis Quality of Life Questionnaire (JAQQ), Quality of My Life (QoML) Questionnaire, Childhood Health Assessment Questionnaire (C-HAQ), and a pain visual analog scale were completed at enrollment, every 6 months for 2 years, and then yearly up to 5 years. Analyses consisted of descriptive statistics, linear mixed models for longitudinal data, and analysis of covariance. Among 1,371 patients followed for a median of 35.3 months (interquartile range 22.1, 49.2), 214 (16%) had enthesitis, of whom 137 (64%) were classified as having enthesitis-related arthritis. After adjusting for JIA category and covariates, children with enthesitis reported higher JAQQ (mean raw score 2.71 versus 2.16, adjusted difference 0.41 points; 95% confidence interval [95% CI] 0.22, 0.59), higher C-HAQ (0.47 versus 0.31, adjusted difference 0.14 points; 95% CI 0.07, 0.22), higher pain (3.01 versus 1.68, adjusted difference 0.94 points; 95% CI 0.64, 1.25), and lower QoML (7.02 versus 8.23, adjusted difference -0.80 points; 95% CI -1.09, -0.51) scores than children without enthesitis. These differences persisted up to 5 years. Children with enthesitis, regardless of JIA category, report worse patient-reported outcomes than those without enthesitis. Thus, enthesitis should be assessed in all children with JIA.

A comparative study on medical humanity evaluation in medical licensing examination between China and the United States

Medical licensing examination is a well-accepted form to authenticate physicians' qualification for practicing in most countries. Assessment of medical humanities is of great importance in medical licensing examination. In this study, the medical humanity evaluation, including contents, forms, scores and proportion of the scores of the examinations, in the medical licensing examination and the empirical research examination of segmental physician examination in China and the United States was compared by analyzing literatures and comparative approach, with the clinical examinations as examples. Results showed that contents and proportion of the scores of medical humanities in the two countries were basically the same, but there were fewer stations in current medical licensing examination in China and improvement should be made in the examination form. The feasibility of standard patients in China's medical licensing examination should be further explored, so as to make full use of the guiding role of medical licensing examination in medical education. Key words: Medical licensing examination; Medical humanities; Examination methods

Racial disparities in allergic outcomes persist to age 10 years in black and white children

BackgroundPrevious analyses in the WHEALS birth cohort demonstrated that black children are more likely to experience allergic outcomes than white children by age 2 years. The results could not be explained by a host of variables. ObjectiveAssess whether racial disparities persisted to age 10 years and determine whether any differences could be explained by a panel of variables related to early life exposures in WHEALS. MethodsAt age 10 years, WHEALS children (n = 481) completed skin prick testing, spirometry and methacholine challenge, and a physician examination for eczema and asthma. Allergen-specific immunoglobulin Es (sIgE) and total IgE were measured. Inverse probability weighting with logistic and linear regression models was used to assess associations between race (black or white) and the outcomes. ResultsBlack children fared worse than white children with respect to each outcome. Black children were more likely to have eczema, asthma, sensitization (≥1 sIgE ≥ 0.35 IU/L) and at least 1 positive skin pick test; however, some variability was present in the magnitudes of association within subgroups defined by delivery mode, sex of the child, prenatal indoor dog exposure, and firstborn status. In some subgroups, black children were also more likely to have higher total IgE and worse pulmonary function test measures (PC 20 ≤ 25 mg/mL, % predicted forced vital capacity [FVC], forced expiratory volume in 1 second [FEV1]/FVC, forced expiratory flow from 25% to 75% of vital capacity [FEF25-75]). Confounding did not explain these differences. ConclusionRacial differences persisted in this cohort through age 10 years. Future studies should include potentially important, but rarely studied factors such as segregation and structural racism, because these factors could explain the observed racial differences.

Examination of physicians' adherence to the 2013 ACC/AHA statin/cholesterol guidelines using a framework of awareness to adherence: A cross-sectional study.

BackgroundCurrently, limited data exists regarding primary care physicians’ awareness and implementation of the 2013 cholesterol guidelines.ObjectivesTo evaluate primary care physicians’ adherence to the 2013 ACC/AHA cholesterol management guidelines using the framework of the awareness-to-adherence model.MethodsThe study was a cross-sectional pre-post survey design based on the constructs of the awareness-to-adherence model to capture physicians’ awareness of, agreement with, adoption of, and adherence to the 2013 ACC/AHA guidelines for cholesterol treatment and statin and cholesterol management software applications. Physicians with a Medicare Advantage organization in Texas were surveyed before and after educational interventions.ResultsA total of 170 responses were considered usable (post-survey). A significant difference was observed when physicians were divided into 2 groups (any intervention vs no intervention) (P = .027). Physicians with a higher level of agreement were 4.8 times more likely to be adherent to the guidelines (P = .011), compared with those with a lower level of agreement. Also, physicians practicing in the Rio Grande Valley area were 4.7 times more likely to be adherent to the guidelines (P = .001) compared with those from the Greater Houston area.ConclusionA high level of awareness, but a lower level of adherence to the guidelines was reported among responding physicians. The awareness-to-adherence model was useful in examining physicians’ level of adherence to the cholesterol guidelines and the utilization of statin and cholesterol management cellular apps and online websites. Future studies are required to examine physicians’ adoption and adherence of new guidelines.

Research of hepatitis a virus antibodies in children 0-18 aged in the province of Erzurum, Turkey

Aim: The aim of the study was to compare the anti-HAV IgG and Anti-HAV IgM seropositivity in children aged 0-18 in Erzurum with studies in our country and other countries, and also to evaluate the effect of seasons on hepatitis A infection.Material and Methods: The study was conducted on the serum samples of 5086 patients aged 0-18 years, who were considered to have Hepatitis A or who applied with different complaints as a result of the examination of family physicians in Erzurum between 2015 and 2018. The results of these patients, obtained from Anti-HAV IgM and Anti-HAV IgG analysis by ELISA method in the Public Health Microbiology Laboratory, were evaluated retrospectively. Pearson chi-square test was used to analyze the categorical data such as gender, age and seasonal differences in anti-HAV IgM and Anti-HAV IgG positivity rates and p 0.05 was considered significant.Results: Anti-HAV IgG seropositivity was 69.0% (3510/5086) and Anti-HAV IgM positivity was 0.7% (33/5063). Anti-HAV IgM was positive in 1.1% of girls and 0.1% of boys. Anti-HAV IgG positivity was 89.9%, 83.3%, 62.5% 61.9% and 74.5% in the 0-3 age group, 4-7 age group, 8-11 age group, 12-15 age group and 16-18 age groups, respectively. Anti-HAV IgM positivity was 0, 0.2%, 0.2%, 1.0%, 0.9% in the 0-3 age group, 4-7 age group, 8-11 age group, 12-15 age group and 16-18 age groups, respectively. The highest anti-HAV IgM positivity was found in November (1.7%).Conclusion: Total anti-HAV IgG seropositivity rate in our province showed many similarities with studies in Turkey and developing countries. The prevalence of anti-HAV IgM was the highest in November.

Knowledge and confidence in managing obstructive sleep apnea patients in Canadian otolaryngology - head and neck surgery residents: a cross sectional survey

BackgroundObstructive sleep apnea is an expected competency for Otolaryngology - Head and Neck surgery residents and tested on the Royal College of Physicians and Surgeons examination. Our objective was to evaluate the knowledge, attitudes and confidence of Canadian Otolaryngology - Head and Neck surgery residents in managing Obstructive Sleep Apnea (OSA) patients.MethodsAn anonymous, online, cross-sectional survey was distributed to all current Canadian Otolaryngology-Head and Neck surgery residents according to the Dillman Tailored Design Method in English and French. The previously validated OSA Knowledge and Attitudes (OSAKA) questionnaire was administered, along with questions exploring resident confidence levels with performing OSA surgeries. Descriptive statistics, Wilcoxon Rank Sum and unpaired Student’s t tests were calculated in Excel.ResultsSixty-six (38.4%) out of 172 residents responded (60.6% male; 80.3% English-speaking). Median OSAKA knowledge score was 16/18 (88.9%; Interquartile range: 14–16). Although all respondents believed that OSA was an important clinical disorder, only 45.5% of residents felt confident in managing OSA patients, while only 15.2% were confident in managing continuous positive airway pressure therapy (CPAP). Senior residents were more confident than junior residents in identifying OSA patients (96.7% vs 69.4%; p < 0.005) and managing the disease (60.0% vs. 33.3%; p = 0.03), including CPAP (26.7% vs. 5.6%; p = 0.01).Residents had lowest confidence levels in performing tongue base suspension (1.5%), transpalatal advancement pharyngoplasty (3.0%), and laser assisted uvulopalatoplasty (6.1%). Highest confidence levels were described in performing septoplasty (56.1%), adult tonsillectomy (75.8%), and tracheotomy (77.3%).ConclusionsOtolaryngology - Head and Neck surgery residents’ knowledge of OSA was very good; however, confidence levels for managing OSA and performing OSA surgeries were varied. Several areas of perceived strengths and weaknesses in OSA training were identified by Canadian Otolaryngology - Head and Neck surgery residents.

24-hour blood pressure profile analysis and comorbid pathology in postmenopausal female ­patients not receiving antihypertensive therapy

Aim. Assessment of ambulatory blood pressure monitoring data depending on the Charlson comorbidity index in postmenopause.&#x0D; Methods. A cross-sectional study included 129 outpatients who did not receive medical treatment for hypertension. Median age was 58.5 (54.062.0) years, postmenopause duration 9 (4.012.0) years. Investigation included medical history registration, physician examination by an internist, anthropometry with measurement of body mass, height with further body mass index calculation. Comorbid conditions were diagnosed according to current clinical guidelines. All females had ambulatory 24-hour blood pressure monitoring. Based on Charlson comorbidity index, the subjects were divided into groups with moderate comorbidity (Charlson index 2, group 1) and high comorbidity (Charlson index 2, group 2).&#x0D; Results. Females from group 2 were significantly older, had a longer duration of postmenopause and the severity of menopausal symptoms, higher body mass index values, functional limitations due to osteoarthritis, higher maximum and average 24-hour, average daily and average night systolic blood pressure levels as well as time index. No differences were revealed in the prevalence of females with night increase or absence of sufficient decrease of blood pressure at night. The absence of antihypertensive treatment in multimorbid postmenopausal females was associated with significant menopausal symptoms persistence.&#x0D; Conclusion. Blood pressure monitoring in multimorbid females can reveal higher average daily values of systolic and diastolic blood pressure, higher variability during 24 hour of systolic blood pressure and greater index of time of systolic blood pressure, which can be considered as a cardiovascular disease progression predictor; uncontrolled hypertension and persistence of neurovegetative symptoms of menopausal syndrome may be the markers of a higher risk of premature death compared to the assessment by Charlson index score.

Is folate deficiency a common cause of distal symmetric polyneuropathy in Zambian clinics?

ObjectivesTo evaluate the odds of vitamin B12 and folate deficiencies among Zambian clinic attendees with distal symmetric polyneuropathy (DSP) and age, sex, and HIV matched controls. MethodsCases were adults from clinics in urban/peri-urban Zambia. Controls were enrolled among persons not seeking personal medical care, such as a caregiver or person collecting antiretrovirals without a medical complaint. Participants underwent structured interviews, physician examination, and assessments of complete blood count, renal and liver profiles, serum vitamin B12 and folate, erythrocyte folate, plasma total homocysteine and methylmalonic acid. HIV testing and CD4 counts were performed when appropriate. ResultsAmong 107 consenting matched case-control pairs, 65% were female, 52% HIV positive, with mean age of 47.6 (SD 13.5) years. Among HIV positive participants, mean CD4 count was 484 (SD 221) and 482 (SD 236) for cases and controls, respectively (p = .93). DSP symptoms and severity did not differ by HIV status (p's > 0.05). Height, history of tuberculosis treatment, alcohol use, education, asset index, dietary diversity, and nutritional supplement use did not differ between cases and controls (p's > 0.05). DSP cases had at least 3:1 odds of having low serum folate (p = .0001), severely low erythrocyte folate (p = .014), and elevated total homocysteine (p = .001) levels compared to controls. Markers of vitamin B12 deficiency were not associated with case status (p's > 0.05). ConclusionMarkers of folate deficiency are highly associated with DSP among Zambian clinic attendees. Future studies should consider a broader range of comorbid nutritional deficiencies, and strategies for interventions.