Prognosis of adequately treated hypertensive patients.

Adequate antihypertensive therapy will lower blood pressure to normotensive or near normotensive levels in 80-85% of patients. Long-term treatment results in a marked decrease in strokes and stroke recurrence, heart failure, renal failure, and progression to accelerated hypertension. The effects of long-term therapy on the occurrence of coronary artery disease are unclear.     

Recurrent thromboembolism in cancer patients: incidence and risk factors

In contrast with the paucity of data on the risk of a first episode of thrombosis in cancer patients, the frequency of recurrent thromboembolism in patients with malignancy has been extensively investigated, both during anticoagulation and after its cessation. Cancer patients are more likely to develop recurrent thromboembolism and major bleeding during anticoagulation than patients without malignancies. These events are more pronounced during the first weeks of treatment and increase with cancer severity. Since they are not associated with anticoagulant intensities outside the therapeutic range, possibilities for improvement using the current paradigms of anticoagulation seem limited and new treatment strategies should be developed. In this regard, the use of low-molecular-weight heparins for initial treatment and long-term anticoagulation in cancer patients with venous thrombosis seems promising. Furthermore, patients with active cancers exhibit a particularly high risk of recurrent venous thromboembolism after the cessation of anticoagulation. In view of the persisting high risk for recurrent thrombotic events in cancer patients, and the acceptable risk of bleeding, prolonged warfarin treatment should be considered in such patients for as long as the cancer is active.     

Thalassemic patients are at high risk for transfusion-transmitted cytomegalovirus infections

The prevalence of total as well as IgM antibodies against cytomegalovirus (CMV) was determined by enzyme immunoassay in a group of 287 multitransfused thalassemia major patients aged 5-39 years and in another group of 1,220 healthy controls. A significantly higher prevalence of CMV antibodies was observed in thalassemic patients of all age-groups compared with controls. The prevalence among splenectomized thalassemia patients was higher than among nonsplenectomized thalassemics. It is concluded concluded that patients with thalassemia, especially if splenectomized, are at high risk for transfusion-transmitted CMV infections. The high prevalence of CMV infections might be responsible, at least in part, for the immunological disturbances and the susceptibility to other infections observed in thalassemic patients. On the basis of these results, it is suggested that safe blood should be provided for anti-CMV-negative thalassemics, with priority to anti-HIV-positives and those who are to receive bone marrow transplantation.     

Pneumoconiosis and liver cirrhosis are not risk factors for tuberculosis in patients with pulmonary infection

BACKGROUND AND OBJECTIVE: It is unclear whether patients with liver cirrhosis and coal miners with pneumoconiosis are at increased risk of developing pulmonary tuberculosis (TB). Furthermore, little is known of the likelihood of pneumonia in patients with bronchiectasis, haemodialysis, diabetes mellitus or advanced lung cancer being due to TB. To answer these questions, patients with these clinical comorbidities were analysed. METHODS: The study was retrospective and included 264 TB patients, 478 non-TB pneumonia patients, and as negative controls, 438 subjects without pneumonia. The parameters analysed were age, gender and the presence of pneumoconiosis, bronchiectasis, liver cirrhosis, haemodialysis, diabetes mellitus and advanced lung cancer. RESULTS: Male gender was the only significant factor increasing the risk of pulmonary TB. When compared with non-TB pneumonia and control patients, the odds ratios were 1.862 and 2.182, respectively. Patients with liver cirrhosis did not show an increased risk of pulmonary TB after regression analysis. Pneumoconiosis resulted in a 2.260 (P = 0.003) odds ratio for pulmonary TB, compared with the controls. However, there was no difference in pneumoconiosis between TB and non-TB pneumonia patients. Patients with bronchiectasis, lung cancer and those receiving haemodialysis had a lower risk for pulmonary TB in lower respiratory tract infection, with odds ratios of 0.342, 0.311 and 0.182, respectively. CONCLUSION: Physicians should first consider non-TB bacterial infection rather than Mycobacterium tuberculosis infection in pneumonia in patients with bronchiectasis, lung cancer or those receiving haemodialysis.     

社区老年脑卒中高危人群抑郁状态筛查及危险因素分析

目的调查社区老年脑卒中高危人群中抑郁状态的发生情况,探讨抑郁的危险因素及对抑郁早期发生的影响机制。方法采用分层随机整群抽样的方法,对天津市河西区4个社区年龄≥45岁的居民进行脑卒中高危人群的横断面筛查,登记人口基本情况及脑卒中危险因素,最终选择年龄≥60岁者469例,分为抑郁组146例,非抑郁组323例。应用汉密尔顿抑郁量表(HAMD,17项版本)对其抑郁状态进行评估。结果 469例社区脑卒中高危者中,合并抑郁状态者146例,发生率为31.1%。与非抑郁组比较,抑郁组女性、单身、既往有抑郁病史、心脏病、缺乏体育锻炼或体力劳动及有脑卒中家族史比例明显升高,差异有统计学意义(P<0.05)。多因素logistic回归分析显示,女性(OR=2.542,95%CI:1.373⁴.707,P=0.003)、单身(OR=4.272,95%CI:1.7064.707,P=0.003)、单身(OR=4.272,95%CI:1.706¹0.696,P=0.002)、心脏病史(OR=2.734,95%CI:1.72810.696,P=0.002)、心脏病史(OR=2.734,95%CI:1.728⁴.325,P=0.000)和脑卒中家族史(OR=1.583,95%CI:1.0134.325,P=0.000)和脑卒中家族史(OR=1.583,95%CI:1.013².474,P=0.044)是社区老年脑卒中高危人群抑郁发生的独立危险因素。结论社区脑卒中高危人群以轻度抑郁状态多见,应对脑卒中高危人群进行抑郁量表筛查,早期诊断和早期干预抑郁状态。     

Recurrent pneumococcal bacteremia: risk factors and outcomes

BACKGROUND: Recurrent pneumococcal bacteremia receives infrequent mention in the literature, usually in association with patients who are immunocompromised. OBJECTIVE: To examine recurrent cases of pneumococcal bacteremia to determine risk factors and outcomes (mortality rates and emergence of resistance) associated with recurrences. METHODS: We retrospectively reviewed all cases of pneumococcal bacteremia identified by our microbiology laboratory from January 1, 1992, through December 31, 1996. Demographic, clinical, and laboratory data were abstracted. RESULTS: There were 462 bacteremic episodes in 432 patients; 23 of these patients had 30 recurrent episodes. The 5.3% recurrence rate (23/432) is greater than that previously described. The median time to recurrence was 200 days. The mean age of patients with recurrences was 34 years, 70% were women, all were black or Hispanic (in near equal numbers), and 87% were infected with the human immunodeficiency virus (HIV). Human immunodeficiency virus infection, coexistent cancer, and female sex were independent predictors of recurrence. Only patients who were HIV-infected had multiple recurrences. Isolates from recurrent bacteremias were more likely to be penicillin-resistant than were initial bacteremic isolates (relative risk, 2.0; P =.16). Patients with recurrences had a higher (although not statistically significant) mortality rate than those without recurrences (22% vs 16%; P =.33). There was an inverse relationship between severity of illness and likelihood of recurrence. CONCLUSIONS: Rates of recurrent pneumococcal bacteremia may be higher than previously reported. In patients with recurrent pneumococcal bacteremia, the presence of an underlying immunodeficiency should be investigated.     

Extensively drug-resistant tuberculosis in South Korea: risk factors and treatment outcomes among patients at a tertiary referral hospital.

BACKGROUND: Extensively drug-resistant (XDR) tuberculosis (TB) is a major public health threat in South Korea. METHODS: We analyzed baseline epidemiological data for 250 patients enrolled in an ongoing prospective observational study of TB at a large tertiary referral hospital in South Korea. RESULTS: Twenty-six subjects with XDR TB were identified; all were patients who had previously received TB therapy. Cumulative previous treatment duration (range, 18-34 months; odds ratio [OR], 5.6; 95% confidence interval [CI], 1.0-59), number of previously received second-line anti-TB drugs (OR, 1.3; 95% CI, 1.1-1.5), and female sex (OR, 3.2; 95% CI, 1.1-8.3) were significantly associated with XDR TB in crude analyses. After controlling for other factors in a multivariable model, cumulative previous treatment duration remained significantly associated with XDR TB (OR, 5.8; 95% CI, 1.0-61). Subjects with XDR TB were more likely to produce culture-positive sputum at 6 months, compared with patients with non-multidrug resistant TB (risk ratio, 13; 95% CI, 5.1-53). Kanamycin resistance was found to be predictive of 6-month culture positivity after adjustment for ofloxacin and streptomycin resistance (risk ratio, 3.9; 95% CI, 1.9-11). CONCLUSIONS: XDR TB was found to be associated with the cumulative duration of previous treatment with second-line TB drugs among subjects in a tertiary care TB hospital. Patients with XDR TB were more likely to not respond to therapy, and successful conversion of sputum culture results to negative was correlated with initial susceptibility to both fluoroquinolones and kanamycin but not to streptomycin.     

结核病在矽尘暴露人群中的流行情况及危险因素分析

目的：了解矽尘暴露者包括硅沉着病患者的结核病患病情况,并分析该人群中结核病发病的危险因素。方法对浙江温岭地区1227例矽尘暴露者进行现场调查,采集基本信息,行胸部 X 线片检查,收集痰标本行结核分枝杆菌培养及鉴定。在单因素分析中,连续变量比较采用两样本 t 检验;分类变量组间两两比较采用χ2检验。多因素分析采用二元 Logistic 回归计算优势比（OR）及95％可信区间（CI ）。结果共获得1204例矽尘暴露者完整的基本信息,其中男1201例（99．8％）,平均年龄（59．4±6．8）岁。其中硅沉着病0＋期（疑似患者）、Ⅰ、Ⅱ、Ⅲ期的患者分别为172例（14．3％）、255例（21．2％）、160例（13．3％）和617例（51．2％）。该人群中结核病患病率约为7300／10万,发病危险因素有硅沉着病Ⅱ期（OR＝2．96,95％CI ：1．05～8．32,P ＝0．04）、硅沉着病Ⅲ期（OR ＝3．88,95％CI ：1．58～9．56,P ＜0．01）、接触结核病患者（OR＝4．14,95％CI ：1．91～8．98,P ＜0．01）。硅沉着病合并肺结核患者缺乏特异性症状,发热、体质量减轻较非肺结核患者多见。结论矽尘暴露者包括硅沉着病患者是结核病的高发人群,尤其是硅沉着病Ⅱ期及Ⅲ期、有结核病患者接触史的患者。     

Prevalence, awareness and treatment of cardiovascular risk factors in patients at high risk of atherothrombosis in Japan.

BACKGROUND: The REduction of Atherothrombosis for Continued Health (REACH) Registry is an international observational study of patients with, or at risk of, atherothrombotic disease. Japanese patients were analyzed to clarify national prevalence and treatment. METHODS AND RESULTS: Almost 68,000 outpatients were recruited worldwide with 5,193 in Japan. Among the Japanese patients, 83.7% had established vascular disease (symptomatic) and 16.3% had risk factors only (asymptomatic). Of the symptomatic patients, 14.0% had atherothrombotic lesions in more than 1 vascular bed, with 0.8% having lesions in 3 areas: brain, heart, and peripheral arteries. The prevalence of additional atherothrombotic risk factors among symptomatic patients was independent of the vascular lesion. Obesity was recorded in 10.6% and 42.1% of patients according to the National Cholesterol Education Program and Japanese guidelines, respectively. Pharmacologic intervention for risk factors was inadequate: only 37.7% of diabetic patients received antidiabetic medication, 79.6% of hypertensive patients used antihypertensives, and 74.0% received antiplatelet agents. The use of statins (44.1%) and aspirin (54.7%) was less common than seen in REACH globally. CONCLUSIONS: Japanese patients enrolled in REACH share many similarities with the global population, but with some important differences. Long-term follow-up will determine the impact of these factors on the development of atherothrombotic events.     

沈阳市205例住院肺结核患者就诊延迟及影响因素分析

目的分析沈阳市肺结核患者就诊延迟的现状及其影响因素,为制定改善措施提供依据。方法采用前瞻性资料收集的方法对2017-2018年沈阳市第十人民医院(沈阳市胸科医院)结核病二科收治的确诊为肺结核且≥15岁的205例住院患者进行问卷调查和临床资料收集,包括患者一般人口学特征[年龄、性别、体质量指数(BMI)、婚姻状况、文化程度、是否为流动人口、是否饮酒、是否吸烟和有无医疗保险及类型(费别)等],临床特征[包括疾病严重程度、治疗类型(初、复治)、是否耐药、首诊机构、是否因症就诊、有无空洞、痰涂片检查结果],以及对结核病防治知识知晓情况(包括对8条结核病防治核心知识的基本认知,如对结核病的传播途径、可疑症状、结核病防治相关免费政策及对防治专业机构是否了解等情况)等。以患者自出现肺结核症状之日起至首次到医疗机构就诊之日止的时间间隔天数≥14d作为就诊延迟的判断标准,采用χ2检验和多因素logistic回归法对就诊延迟患者的影响因素进行分析。结果205例调查患者中,就诊延迟110例,就诊延迟率为53.7%。多因素logistic回归结果显示,就诊距离较远[OR(95%CI)=3.405(1.102~10.518)]、病情一般[OR(95%CI)=12.384(3.558~43.109)]、治疗类型为初治[OR(95%CI)=2.099(1.109~3.974)],以及饮酒[OR(95%CI)=2.283(1.212~4.299)]是就诊延迟的危险因素。结论沈阳市住院肺结核患者就诊延迟现象明显,就诊距离较远、临床症状一般、初治患者,以及有饮酒史的肺结核患者易出现就诊延迟,应加强对社会人群的结核病相关知识的宣传教育。     

Hyposelenaemia: patients with gastrointestinal diseases are at risk

A retrospective study of serum selenium determinations performed in a hospital laboratory revealed 47 cases of hyposelenaemia (defined as a serum selenium level below 0.74 mumol l-1). Moderate hyposelenaemia (serum selenium 0.30-0.55 mumol l-1) was found in 11 patients and seven of these suffered from gastrointestinal diseases. Furthermore severe hyposelenaemia (serum selenium below 0.30 mumol l-1) was detected in three patients, who were all affected by gastrointestinal disease. We concluded that patients with gastrointestinal diseases are especially at risk of developing selenium deficiency and should be monitored by repeated determinations of serum selenium. Patients with moderate or severe hyposelenaemia should receive selenium treatment.     

Cardiac risk factors: still important in the elderly

Shown to be associated with new coronary events in elderly men and women are cigarette smoking, systolic or diastolic hypertension, hypercholesterolemia, low serum HDL cholesterol, increased ratio of serum total cholesterol to serum HDL cholesterol, hypertriglyceridemia, diabetes mellitus, obesity, physical inactivity, increased age, prior coronary artery disease, and electrocardiographic and echocardiographic left ventricular hypertrophy. The greater the number of major coronary risk factors, the higher the incidence of new coronary events. Risk factor modification should therefore be considered in elderly persons.     

Prognosis and its risk factors in ANCA-associated glomerulonephritis patients treated with initial renal replacement therapy

正Objective To explore the prognosis and its risk factors in anti-neutrophil cytoplasmic antibodies(ANCA)-associated glomerulonephritis(AAGN)patients who needed initial renal replacement therapy(RRT).Methods One hundred patients[54 females,46 males,with a median age of 54(41,60)years]with biopsyproven AAGN and requiring initial RRT between January     

Alcoholic pancreatitis: patients at high risk of acute zinc deficiency.

The important role of zinc as an essential nutrient and therapeutic agent has been increasingly recognized in the last two decades. Abnormalities in physical growth and sexual maturation are caused by zinc deficiency. More recently, several clinical observations have suggested an association between zinc deficiency and poor healing of wounds, anorexia, hypogeusia and behavioral disorders. Furthermore, zinc-responsive vesiculobullous dermatitis has been well described.Within a seven-month period, we have seen two patients with alcoholic pancreatitis in whom acute zinc deficiency developed in the course of their treatment with parenteral hyperalimentation. Clinically, the zinc deficiency was manifested by the appearance of an erythematous, desquamative rash on the face. Serum zinc levels were remarkably low in each patient at the time the skin rash appeared: 18 and 11 μg/dl. Upon treatment with one or two tablets of zinc sulfate per day (220 mg each), the skin rashes rapidly and completely resolved within one to two weeks. Serum zinc levels were 49 and 50 μg/dl at the time the rash disappeared.Alcoholics, when subjected to stress, appear to be a high-risk group for the development of severe zinc deficiency while undergoing parenteral nutrition. Several factors which contribute to the development of zinc deficiency in alcoholics include diminished dietary intake, enhanced urinary excretion of zinc and, probably, marked diminution in zinc absorption. It is recommended that zinc supplementation be included as a standard part of total parenteral nutrition in this patient group.     

Recurrent tuberculosis: definitions and treatment regimens.

Within the National Tuberculosis Control Programme of Malawi, misunderstandings sometimes occur about the diagnosis and management of recurrent tuberculosis (TB). Patients with smear-positive pulmonary tuberculosis (PTB) who have had a previous, treated episode of smear-negative TB may be registered as 'new cases' rather than relapse cases, and thus denied the benefits of a retreatment regimen. Patients with a recurrent episode of smear-negative PTB or extra-pulmonary TB (EPTB) may also be wrongly registered as 'new cases' rather than recurrent cases. International guidelines about the treatment of recurrent smear-negative PTB and EPTB are not explicit, resulting in confusion about how best to manage these cases. It is suggested that all such cases be considered for re-treatment regimen because of concerns about acquired drug resistance. WHO and IUATLD guidelines on the diagnosis and management of recurrent and relapse TB need to be improved, and operational research studies should be conducted to provide answers to some outstanding questions.     

Telehome monitoring in patients with cardiac disease who are at high risk of readmission

Patients with chronic conditions are heavy users of the health care system. There are opportunities for significant savings and improvements to patient care if patients can be maintained in their homes. A randomized control trial tested the impact of 3 months of telehome monitoring on hospital readmission, quality of life, and functional status in patients with heart failure or angina. The intervention consisted of video conferencing and phone line transmission of weight, blood pressure, and electrocardiograms. Telehome monitoring significantly reduced the number of hospital readmissions and days spent in the hospital for patients with angina and improved quality of life and functional status in patients with heart failure or angina. Patients found the technology easy to use and expressed high levels of satisfaction. Telehealth technologies are a viable means of providing home monitoring to patients with heart disease at high risk of hospital readmission to improve their self-care abilities.     

Why patients with familial hypercholesterolemia are at high cardiovascular risk? Beyond LDL-C levels

Familial hypercholesterolemia (FH) is a common genetic cause of elevated low-density lipoprotein cholesterol (LDL-C) due to defective clearance of circulating LDL particles. All FH patients are at high risk for premature cardiovascular disease (CVD) events due to their genetically determined lifelong exposure to high LDL-C levels. However, different rates of CVD events have been reported in FH patients, even among those with the same genetic mutations and comparable LDL-C levels. Hence, additional CVD risk modifiers, beyond LDL-C, may contribute to increase CVD risk in the FH population. In this review, we discuss the overall CVD risk burden of the FH population. Additionally, we revise the prognostic impact of several traditional and emerging predictors of CVD risk and we provide an overview of the role of specific tools to stratify CVD risk in FH patients in order to ensure them a more personalized treatment approach.