De novo partial 2p duplication with postmortem description

A new syndrome characterized by sensorineural hearing loss (beginning in early infancy), progressive optic nerve atrophy, and dementia (beginning in adult-hood) is described in 3 males in the same family. This is probably an X-linked recessive trait.     

The effect of chlor-iso-propamide on experimentally induced resistance to insulin

Summary A study was made of the effect produced by sulfanilamides on the insulin resistance, experimentally induced in depancreatized dogs. Experimental animals with extirpated pancreases received 150 grams of raw pancreas with food (daily), a certain dose of insulin, and contrainsular hormones with an always definite food regimen. As established, thyroidin, ACTH, adresone, and prednisone given in definite doses considerably increased the insulin requirement, whereas chlor-iso-propamide considerably decreased this requirement. Investigations demonstrated that, instead of increasing the insulin dose, one may intensify its effect by chlor-iso-propamide administration.(Presented by Active Member of the Akad. Med. Nauk SSSR A V. Lebedinskii) Translated from Byulleten' Éksperimental'noi Biologii i Meditsiny, Vol. 55, No. 4, pp. 56–61, August, 1963     

Predictive factors for masked hypertension within a population of controlled hypertensives

CONTEXT: Prevalence of masked hypertension (MH) is far from negligible reaching 40% in some studies. The SHEAF study (Self measurement of blood pressure at Home in the Elderly: Assessment and Follow-Up) and others clearly showed that masked hypertension (MH) as detected by home blood pressure measurement (HBPM) is associated with poor cardiovascular prognosis. OBJECTIVE: Systematic HBPM to detect MH is not yet routine. The aim of this work is to better define the clinical profile of masked hypertensives within a population with controlled office blood pressure (BP) and the factors associated with a higher prevalence of MH. MATERIALS AND METHODS: BP was measured at the clinic by the doctor and at home by the patient himself. Risk factors for MH were analysed in a cohort of 1150 treated hypertensive patients over the age of 60 (mean age 70 +/- 6.5, 48.9% men) with controlled office BP. (SBP < 140 mmHg and DBP < 90 mmHg). RESULTS: 463 patients (40%) were masked hypertensives (SBP > or = 135 mmHg or DBP > or = 85 mmHg at home). Three parameters were associated with MH (odds ratio OR): office SBP (OR = 1.110), male gender (OR = 2.214) and age (OR = 1.031). Decision trees showed a 130 mmHg SBP was an efficient threshold to propose HBPM with a higher probability to detect MH. Subsequent variables were male gender and age over 70 in males. CONCLUSION: To detect masked hypertension, it would be logical to first of all select patients whose office SBP is between 130 and 140 mmHg.     

High-Frequency Users of Emergency Department Care

Background

The heterogeneous group of patients who frequently use the Emergency Department (ED) have been of interest in public health care reform debate, but little is known about the subgroup of the highest frequency users.

Study Objectives

We sought to describe the demographic and utilization characteristics of patients who visit the ED 20 or more times per year.

Methods

We retrospectively studied patients who visited a large, urban ED over a 1-year period, identifying all patients using the department 20 or more times. Age, gender, insurance, psychosocial factors, chief complaint, and visit disposition were described for all visits. Inferential tests assessed associations between demographic variables, insurance status, and admission rates.

Results

Of the 59,172 unique patients to visit the ED between December 1, 2009 and November 30, 2010, 31 patients were identified as high-frequency ED users, contributing 1.1% of all visits. Patients were more likely to be 30–59 years of age (52%), stably insured (81%), and have at least one significant psychosocial cofactor (65%). Their admission rate was 15%, as compared to 21% for all other patients.

Conclusions

High-frequency users are patients with significant psychiatric and social comorbidities. Given their small proportion of visits, lower admission rates, and favorable insurance status, the impact of high-frequency users of the ED may be out of proportion to common perceptions.