Management of psoriasis and its comorbidities in primary care

Psoriasis is a common chronic disfiguring skin disease. Its management depends on the extent of disease, sites affected, comorbidities, and patient's background or lifestyle. In the UK, psoriasis treatment starts in the primary care with range of topical applications, including steroids, vitamin D analogues and coal tar. However, psoriasis is associated with physical, psychological and metabolic comorbidities which could not be improved by topical therapy. The aim of this review is to address the challenge in managing these comorbidities within primary care.     

Comprehensive management for the comorbidities and pulmonary complications in COPD

Chronic obstructive pulmonary disease (COPD) has been recently recognized not only as inflammatory airway disorders, but also as a chronic systemic inflammatory syndrome. The systemic inflammation causes a variety of abnormalities in the patients. In the end, systemic comorbidities including cardiovascular diseases, endocrine diseases, gastrointestinal diseases and psychological disorders are highly prevalent in patients with COPD. These disorders and those related pulmonary complications have a great impact on quality of life (QOL) and mortality in the patients. For the improving the QOL and the mortality, we have to diagnose these comorbidities early and to treat the complications properly. This review discusses pathogenic mechanisms of the comorbidities and implications for the comprehensive management in patients with COPD.     

纤溶系统活性检测在高血压病及其并发症中的应用

当今,威胁人类健康与生命的疾病排名表上心脑血管疾病占据首位,而心脑血管疾病中最为常见的就是高血压病。1991年在全国30个省、市、自治区进行的第三次大规模调查中,高血压人群抽样调查的设计、     

Health care expenditures for the elderly. Who pays for them?

The degree to which Medicare and Medicaid programs provide health coverage for the elderly still leaves a large financial burden on this population. Although the sale of supplementary health insurance to the elderly has been fraught with abuse, a policy purchased from a reputable organization can be advantageous. Knowledge of the large amount spent on personal health care will hopefully stimulate the search for alternative, less expensive ways to provide health care.     

Medical expenditures and insurance coverage for people with diabetes: estimates from the National Medical Care Expenditure Survey

Access to health insurance and protection against expenditures for medical care are of special concern to diabetic patients in the United States. This study examines some information on the extent and breadth of public and private health insurance for individuals with diabetes, as well as some estimates of their use of health-care services and their mean expenses for this care. About 12% of all diabetic patients less than 65 yr old (approximately 311,000 individuals) were uninsured throughout 1977, a rate not much different from that for the rest of the United States population. Those with diabetes who are uninsured tend to be younger, Black or Hispanic, in excellent or good health, and live outside of metropolitan areas and in the South or West. As expected, diabetic patients use more medical care than others of their age and sex, and their medical expenses are also much higher, particularly in younger age groups. In 1977, average total medical-care expenses for people with diabetes were $1514 compared with $548 for the rest of the population. They and their families paid approximately 20% out of pocket (approximately $355). Their health insurance premiums were not much different from those without diabetes, averaging approximately $1000 in 1977 for those under age 65. The private insurance coverage for diabetic patients was similar to that for others, although slightly fewer had major medical coverage than the general population.     

高血压患者康复治疗

为了探讨康复治疗效果,从2006年6月～2008年8月对64例老年高血压进行综合治疗,取得显著疗效,现报告如下.     

生物伤口护理膜用于包皮环切伤口:疼痛、愈合及并发症的比较

背景:近年来不同化学成分和生物学特性的伤口护理膜和敷料已被广泛应用于临床,选择合适的材料既能保持术后伤口的湿润,又能止血止痛、预防感染及促进伤口愈合.目的:观察生物伤口护理膜用于包皮环切后促进切口愈合的疗效.方法:90例包皮环切患者随机分为2组,伤口护理膜组于包皮环切后立即用济安舒能喷洒缝合伤口,包扎前将纱布的包扎面喷湿喷透后采取常规纱布包扎,术后2 d拆除纱布暴露,用济安舒能喷洒伤口,每天至少3次,患者尿后如尿湿应及时喷涂;对照组术后采用常规纱布包扎法处理伤口,每3 d换药1次.结果与结论:与对照组比较,伤口护理膜组术后伤口疼痛评分明显降低(P<0.05),伤口愈合情况明显改善(P<0.05).提示包皮环切后应用济安舒能生物伤口护理膜安全可靠,具有较好的止痛、抗感染、促进创面愈合、减少渗出、水肿及瘢痕发生的治疗效果,临床操作简单,值得临床推广应用.     

Current possibilities of ACE inhibitor and ARB combination in arterial hypertension and its complications

The renin-angiotensin-aldosterone system (RAAS) plays a crucial role in blood pressure regulation and hypertension-related complications. Angiotensin-converting enzyme inhibitors (ACEIs) were the first to be used to block the RAAS and now have many compelling indications in the treatment of hypertension and its cardiovascular and renal complications. Angiotensin II receptor blockers (ARBs), introduced 20 years later, have been shown to be equally as effective as antihypertensive treatment and are also associated with a lower number of side effects. Furthermore, in clinical trials ARBs and ACEIs were associated with comparable benefits for their most typical indications. This was confirmed in the 2007 New European Society of Hypertension/European Society of Cardiology (ESH/ESC) guidelines for the management of hypertension by comparable specific recommendations for ARB and ACEI treatment. There is sufficient theoretical background and, in some cases, also clinical evidence that combination therapy with ACEIs and ARBs may be more beneficial than monotherapy with either of the groups alone, both in uncomplicated hypertension and with concomitant heart failure or renal dysfunction. However, the combination of ACEI and ARB was not recommended in the ESH/ESC 2007 Guidelines. This may change after the publication of the Ongoing Telmisartan Alone and in Combination with Ramipril Global End point Trial (ONTARGET) study, the preliminary results of which have just been presented. In heart failure, recent studies have shown that the combination of ACEI and ARB decreases cardiovascular mortality and the number of hospitalizations due to aggravation of heart failure. These results have been reflected in the newest ESC guidelines of the heart failure treatment. Nephroprotective properties of the combination of ACEs and ARBs have been proved both in studies on nondiabetic and diabetic nephropathy. The potential benefits, indications in prespecified groups of patients, the most recent data from clinical trials and latest research regarding dual blockade of RAAS will be reviewed in this article.     

Current possibilities of ACE inhibitor and ARB combination in arterial hypertension and its complications

The renin–angiotensin–aldosterone system (RAAS) plays a crucial role in blood pressure regulation and hypertension-related complications. Angiotensin-converting enzyme inhibitors (ACEIs) were the first to be used to block the RAAS and now have many compelling indications in the treatment of hypertension and its cardiovascular and renal complications. Angiotensin II receptor blockers (ARBs), introduced 20 years later, have been shown to be equally as effective as antihypertensive treatment and are also associated with a lower number of side effects. Furthermore, in clinical trials ARBs and ACEIs were associated with comparable benefits for their most typical indications. This was confirmed in the 2007 New European Society of Hypertension/European Society of Cardiology (ESH/ESC) guidelines for the management of hypertension by comparable specific recommendations for ARB and ACEI treatment. There is sufficient theoretical background and, in some cases, also clinical evidence that combination therapy with ACEIs and ARBs may be more beneficial than monotherapy with either of the groups alone, both in uncomplicated hypertension and with concomitant heart failure or renal dysfunction. However, the combination of ACEI and ARB was not recommended in the ESH/ESC 2007 Guidelines. This may change after the publication of the Ongoing Telmisartan Alone and in Combination with Ramipril Global End point Trial (ONTARGET) study, the preliminary results of which have just been presented. In heart failure, recent studies have shown that the combination of ACEI and ARB decreases cardiovascular mortality and the number of hospitalizations due to aggravation of heart failure. These results have been reflected in the newest ESC guidelines of the heart failure treatment. Nephroprotective properties of the combination of ACEs and ARBs have been proved both in studies on nondiabetic and diabetic nephropathy. The potential benefits, indications in prespecified groups of patients, the most recent data from clinical trials and latest research regarding dual blockade of RAAS will be reviewed in this article.     

Contact lens care and complications

In the past 20 years, great strides have been made in contact lens technology, but this progress has been accompanied by a multitude of lens-related problems. Bacterial keratitis may be the most significant problem, but reports of Acanthamoeba keratitis, a parasitic corneal infection, are increasing. Infectious complications may be lessened by proper lens care. Thermal disinfection is recommended for soft lenses with a low water content; chemical decontamination is preferred for soft contact lenses with a high water content.