Pharmacy- and community-based screenings for diabetes and cardiovascular conditions in high-risk individuals.

OBJECTIVE: To assess a model to screen minority, elderly, and at-risk individuals for diabetes, hypertension, and dyslipidemia in pharmacy and non-health care settings. DESIGN: Multicenter, prospective, observational trial. SETTING: 26 pharmacies and 4 non-health care settings. PARTICIPANTS: 888 individuals with one or more of the following risk factors: first-degree relative with diabetes, age 55 years or older, obesity, previous diagnosis of hypertension, or a previous diagnosis of dyslipidemia. Intervention: Measurement of plasma glucose, total cholesterol, high-density lipoprotein cholesterol (HDL-C), and blood pressure; risk assessment using a risk factor tool; referral of participants with abnormalities to physicians. MAIN OUTCOME MEASURES: Adherence with follow-up, physician recommendations, and new diagnoses of diabetes, hypertension, and dyslipidemia. RESULTS: Pharmacists screened 888 participants in pharmacies and non-health care settings; 794 scored at least 10 on the risk factor tool and received further screenings. Of these, 81% were referred for follow-up for at least one abnormality: 15% glucose, 68% blood pressure, 66% total cholesterol, and 26% HDL-C. For those referred, the mean (+/- SD) fasting plasma glucose concentration was 179 +/- 87 mg/dL, and the random glucose concentration was 234 +/- 90 mg/dL. Of participants completing follow-up, 16% received one or more new diagnoses as follows: diabetes, 8; hypertension, 9; and dyslipidemia, 29. Therapy changed for 42% of participants. Participants who were elderly, of African American and Hispanic race/ethnicity, or those with elevated cholesterol values were at significantly greater risk for elevated glucose levels. Screenings in community pharmacy settings had improved follow-up rates with physicians compared with screenings conducted in non-health care settings. CONCLUSION: Pharmacists identified individuals with elevated glucose, cholesterol, and blood pressure values through community-based screenings. Pharmacists also identified individuals who could benefit from further control of previously diagnosed hypertension and hyperlipidemia.     

Role of mechanical factors in modulating cardiac fibroblast function and extracellular matrix synthesis

The cardiac fibroblast is the most abundant cell type present in the myocardium and is mainly responsible for the deposition of extracellular matrix (ECM). Important components of cardiac ECM include structural and adhesive proteins such as collagen and fibronectin. Excess deposition of cardiac ECM (fibrosis) has been associated with the pathophysiological mechanical overload of the heart. Therefore, the role of cardiac fibroblasts in "sensing", "integrating" and "responding" to mechanical stimuli is of great interest. The development of in vitro strain apparatuses has allowed scientists to investigate the effects of mechanical stimuli on cardiac fibroblast function. Cardiac fibroblasts express ECM receptors (integrins) which couple mechanical stimuli to functional responses. Mechanical stimulation of cardiac fibroblasts has been shown to result in activation of various signal transduction pathways. The application of defined mechanical stimuli to cultured cardiac fibroblasts has been associated with ECM gene expression, growth factor production, release and/or bioactivity as well as collagenase activity. Ultimately, for fibrosis to develop the overproduction of ECM must overcome any associated increases in collagenase activity. Mechanically induced upregulation of ECM production may follow direct or indirect pathways through the autocrine or paracrine action of growth factors. Given the complex nature of the interstitial milieu of the working heart, additional research is needed to further our understanding of the roles that mechanical stimuli play in excess deposition of myocardial ECM.     

Objective evaluation of vocal pathology in childhood

Voice disorders in children are often described as existing on a continuum with anatomic or physiologic causes at one end and functional or psychogenic causes at the other. In this study we report the objective evaluation of the voice disorders on 48 school children. The evaluation was made by means of laryngostroboscopy, acoustic analysis of the voice and narrow-band spectrography. The stroboscopic examination was performed on more than a half of the patients, resulting in the change of diagnose in six cases. The severity of the hoarseness was classified in four groups according Yanagihara method. A multivariate analysis was carried out using jitter, shimmer and harmonic-to-noise ratio as variables. Only the harmonic-to-noise ratio predicts the severity of the spectrographic record. Classification of degrees of hoarseness is found to be clinically useful in two respects: the degree of hoarseness can be numerically expressed and the objective acoustic degree of hoarseness based on this method closely agrees with subjective perceived degree of hoarseness.     

Gross hematuria associated with sickle cell trait and von Willebrand's disease.

A case of recurrent gross hematuria, sickle cell trait and von Willebrand's disease is reported. The gross hematuria abated promptly after the institution of cryoprecipitate therapy. The importance of considering von Willebrand's disease in the differential diagnosis in patients with sickle cell trait and hematuria is discussed.     

The ABCs of Health Literacy

A significant portion of the US population has serious problems with both literacy and understanding how to effectively use and understand health-related information. An understanding of the breadth and significance of this problem and its impact on health outcomes is now clear. Interventions and strategies for effectively working with patients with limited literacy must be developed and evaluated. An agenda for medical and public health workers, health educators, and researchers is suggested.     

Nonspecificity of the fat-sparing ring surrounding focal liver lesion at MR imaging

RATIONALE AND OBJECTIVES: The presence of a fat-sparing ring surrounding focal liver lesions in patients with steatosis has been described only in malignant lesions. Our purpose is to evaluate whether this fat-sparing ring peripheral to tumors is a specific marker of malignancy. MATERIALS AND METHODS: From 300 magnetic resonance examinations of focal liver lesions, 132 patients with a confirmed nature of the lesions were selected. There were 24 patients (18.2%) with lesions having a perilesional fat-sparing ring in the opposed-phase spoiled T1-weighted gradient echo images. All these livers had steatosis. RESULTS: Perilesional fat-sparing rings were observed in 19 (21.6%) malignant and 5 (11.4%) benign lesions. Size of the lesion was not related to the presence of the fat-sparing ring (P=.6), neither was type of lesion (malignant versus benign) statistically related to the presence of the perilesional fat-sparing ring in the opposed-phase gradient echo magnetic resonance images (chi-square, P=.15). Fat-sparing rings were mainly seen in metastases (51.4% of metastases), but seldom in primary malignant tumors (1.9% of hepatocellular carcinomas). Hemangiomas also presented this finding (18.5% of hemangiomas). CONCLUSIONS: We believe that the presence of this bright rim surrounding lesions on oppose-phase images in patients with steatosis mainly represent decrease portal flow, either because of compressed and atrophic hepatocyte cords with sinusoidal congestion in expanding metastatic lesions or the presence of arterioportal perfusion abnormalities in vascularized hemangiomas.