Self-measurement of blood pressure at home reduces the need for antihypertensive drugs: a randomized, controlled trial

It is still uncertain whether one can safely base treatment decisions on self-measurement of blood pressure. In the present study, we investigated whether antihypertensive treatment based on self-measurement of blood pressure leads to the use of less medication without the loss of blood pressure control. We randomly assigned 430 hypertensive patients to receive treatment either on the basis of self-measured pressures (n=216) or office pressures (OPs; n=214). During 1-year follow-up, blood pressure was measured by office measurement (10 visits), ambulatory monitoring (start and end), and self-measurement (8 times, self-pressure group only). In addition, drug use, associated costs, and degree of target organ damage (echocardiography and microalbuminuria) were assessed. The self-pressure group used less medication than the OP group (1.47 versus 2.48 drug steps; P<0.001) with lower costs ($3222 versus $4420 per 100 patients per month; P<0.001) but without significant differences in systolic and diastolic OP values (1.6/1.0 mm Hg; P=0.25/0.20), in changes in left ventricular mass index (-6.5 g/m(2) versus -5.6 g/m(2); P=0.72), or in median urinary microalbumin concentration (-1.7 versus -1.5 mg per 24 hours; P=0.87). Nevertheless, 24-hour ambulatory blood pressure values at the end of the trial were higher in the self-pressure than in the OP group: 125.9 versus 123.8 mm Hg (P<0.05) for systolic and 77.2 versus 76.1 mm Hg (P<0.05) for diastolic blood pressure. These data show that self-measurement leads to less medication use than office blood pressure measurement without leading to significant differences in OP values or target organ damage. Ambulatory values, however, remain slightly elevated for the self-pressure group.     

Risk indicators and psychopathology in traumatised children and adolescents with a history of sexual abuse

PURPOSE: Childhood sexual abuse (CSA) is widespread amongst South African (SA) children, yet data on risk factors and psychiatric consequences are limited and mixed. METHODS: Traumatised children and adolescents referred to our Youth Stress Clinic were interviewed to obtain demographic, sexual abuse, lifetime trauma and psychiatric histories. RESULTS: Data for 94 participants (59 female, 35 male; mean age 14.25 [8.25-19] years) exposed to at least one lifetime trauma were analysed. Sexual abuse was reported in 53% of participants (42.56% females, 10.63% males) with 64% of violations committed by perpetrators known to them. Multinomial logistic regression analysis revealed female gender (P=0.002) and single-parent families (P=0.01) to be significant predictors of CSA (62.5%). CSA did not predict exposure to other traumas. Sexually abused children had significantly higher physical and emotional abuse subscale scores and total CTQ scores than non-abused children. Depression (33%, X(2)=10.89, P=0.001) and PTSD (63.8%, X(2)=4.79, P=0.034) were the most prevalent psychological consequences of trauma and both were significantly associated with CSA. CONCLUSIONS: High rates of CSA predicted high rates of PTSD in this traumatised sample. Associations we found appear consistent with international studies of CSA and, should be used to focus future social awareness, prevention and treatment strategies in developing countries.     

Case series: pedicled vertical rectus myocutaneous flaps for cover of breast and perineal defects��a 2-year review in our centre

Colorectal carcinoma is the most common cancer afflicting both Singaporean men and women; whereas, breast carcinoma is the most frequent female-specific cancer according to the report published by the Singapore Cancer Registry on cancer trends from 2003 to 2007. As such, breast and perineal defects requiring soft tissue cover is a challenging occurrence after initial tumour surgery by the breast and colorectal surgeons, especially for fungating breast tumours and very low colorectal carcinomas, respectively. In Tan Tock Seng Hospital prior to 2007, many of these patients may have had their wounds skin-grafted or allowed to heal by secondary intention. This often involved prolonged hospital stay, difficult wound care and significant morbidity as well as a negative impact on the quality of life for these patients. Pedicled vertical rectus myocutaneous (VRAM) flaps were then introduced for cover of these defects as an effective method of reducing these negative aspects of patient care. This case series aims to review the efficacy of the VRAM flap in achieving this within a 2-year period. Over this period, the VRAM flap has shown to decrease length of hospital stay, reduction of the duration to commencement of adjuvant therapy, and also decrease in the difficulty of wound care as well as the complication rate.     

Flow and Particle Deposition Patterns in a Realistic Human Double Bifurcation Airway Model

Velocity profiles, local deposition efficiencies (DE), and deposition patterns of aerosol particles in the first three generations (i.e., double bifurcations) of an airway model have been simulated numerically, in which the airway model was constructed from computed tomography (CT) scan data of real human tracheobronchial airways. Three steady inhalation conditions, 15, 30, and 60 L/min, were simulated and a range of micrometer particle sizes (1–20 μm diameter) were injected into the model. Results were then compared with experimental and other numerical results which had employed either similar model geometry or test conditions. The effects of inhalation conditions on velocity profiles and particle deposition were studied. The data indicated that the local deposition efficiencies in the first bifurcation increased with a rise in the Stokes number (St) within St range from 0.0004 to 0.7. Within the same St range, DE in the second bifurcations (both left and right) was dropped dramatically after St increased to 0.17. Also, the second bifurcation in the right side (B2.1, closer to first bifurcation than left side, B2.2) was found to show a much higher (almost double) DE than the left side. This may be due to the fact that the left main bronchus is longer and has greater angulation than the right main bronchus. Generally, the present simulation using a computational fluid dynamic (CFD) technique obtained concurrent results with subtle differences compared to other works. However, due to omission of larynx in the model, which is known to significantly modify airflow and hence particle deposition, the present model may only serve as the “stepping stone” to simulating and analyzing dose-response or inhalation risk assessment visually for clinical researchers.     

Molecular Typing of Environmental and Patient Isolates of Aspergillus fumigatus from Various Hospital Settings

Fingerprinting of more than 700 clinical and environmental isolates of Aspergillus fumigatus from four differential hospital settings was undertaken with a dispersed repeated DNA sequence. The analysis of the environmental isolates showed that the airborne A. fumigatus population is extremely diverse, with 85% of the strains being represented as a single genotype isolated once. The remaining 15% of the strains were isolated several times and were able to persist for several months in the same hospital environment. No strains were found to be associated with a specific location inside the hospital, and identical strains were isolated from different buildings of the hospital and outdoors. Isolation of the same strain both from patients and from the environment of the same hospital is highly suggestive of a nosocomial infection. The characteristics of the environmental fungal population explains the two main results obtained from the typing of the clinical isolates: (i) the absence of a common strain responsible for an invasive aspergillosis outbreak results from the extreme diversity of the environmental population of A. fumigatus in contact with the patients, and (ii) patients hospitalized in different wards of the same hospital can be infected with the same strain since every patient might inhale the same spore population.     

β-锗代-α-氨基酸衍生物的合成及抗肿瘤活性

自六十年代初期发现羧乙基锗倍半氧化物(Ge—132)广泛的生物活性以来,已有许多相应的有机锗化合物被发现,在抗肿瘤活性方面,因有毒性较低、抗瘤谱广等一系列优点而引起人们广泛的兴趣,但由于活性较低影响了应用及发展,据文献报道,有机锗倍半氧     

A cost-analysis of two approaches to infection control in a lung function laboratory

Background: The Thoracic Society of Australia and New Zealand (TSANZ) guidelines for infection control in respiratory laboratories are based on a ‘Universal Precautions’ approach to patient care. This requires that one-way breathing valves, flow sensors, and other items, be cleaned and disinfected between patient use. However, this is impractical in a busy laboratory. The recent introduction of disposable barrier filters may provide a practical solution to this problem, although most consider this approach to be an expensive option. Aim: To compare the cost of implementing the TSANZ infection control guidelines with the cost of using disposable barrier filters. Methods: Costs were based on the standard tests and equipment currently used in the lung function laboratory at The Alfred Hospital. We have assumed that a barrier filter offers the same degree of protection against cross-infection between patients as the TSANZ infection control guidelines. Time and motion studies were performed on the dismantling, cleaning, disinfecting, reassembling and re-calibrating of equipment. Conservative estimates were made as to the frequency of replacing pneumotachographs and rubber mouthpieces based on previous equipment turnover. Labour costs for a scientist to reprocess the equipment was based on $20.86/hour. The cost of employing a casual cleaner at an hourly rate of $14.07 to assist in reprocessing equipment was also investigated. The new high efficiency HyperFilter^TM disposable barrier filter, costing $2.95 was used in this cost-analysis. Results: The cost of reprocessing equipment required for spirometry alone was $17.58 per test if a scientist reprocesses the equipment, and $15.56 per test if a casual cleaner is employed to assist the scientist in performing these duties. In contrast, using a disposable filter would cost only $2.95 per test. Using a filter was considerably less expensive than following the TSANZ guidelines for all tests and equipment used in this cost-analysis. Conclusions: The TSANZ infection control guidelines are expensive and impractical to implement. However, disposable barrier filters provide a practical and inexpensive method of infection control.     

Field Survey and Comparative Study of Pteris Vittata and Pityrogramma Calomelanos Grown on Arsenic Contaminated Lands with Different Soil pH

Bulletin of Environmental Contamination and Toxicology - In field survey, Pteris vittata and Pityrogramma calomelanos were only found in arsenic (As) contaminated areas with soil pH 7.2–8.8...