A Comparison of Web Sites Used to Manage and Present Home Blood Pressure Readings

J Clin Hypertens (Greenwich). 2010;12:389–395. ^©2010 Wiley Periodicals, Inc. Home blood pressure (HBP) monitoring is now recommended as a routine component of blood pressure management in patients with known or suspected hypertension. Over the last few years, a large number of Web sites, commonly termed Personal Health Records, have been developed so that patients can manage and present HBP readings. The objective of this report is to describe and compare these Web sites. A list of 33 desirable Web site features, organized into 4 categories, was developed. Between June and August of 2009, a total of 60 Web sites was identified, of which 20 were free or free to try. Each of the 20 Web sites displayed HBP readings in tabular and graphical formats, most offered an option to print results in tabular (70%) and graphical (70%) form, and many (47%) could download HBP data from Microsoft HealthVault. In contrast, none of the Web sites directly linked with common electronic medical records. Overall, Web sites offered between 41% and 77% of the 33 features considered desirable. In conclusion, there is considerable variation in available features on Web sites used to manage HBP data. Information presented in this report should be useful to physicians and patients in selecting a Web site for managing and presenting HBP readings and ultimately improving blood pressure control.     

Epidemic scabies in four Caribbean islands, 1981-1988

Scabies infestation has been reported to the PAHO/WHO Caribbean Epidemiology Centre (CAREC) from Trinidad and Tobago (T&T), Grenada, Dominica, the Turks and Caicos Islands (T&CI) and, more recently, St Lucia. Epidemic scabies was being reported from T&CI in 1981 (1200/100,000 population), but there were no reports from T&T until 1982 (8/100,000). The first phase of the bimodal epidemic in Grenada occurred between 1982 and 1984 (132/100,000) and the explosive second phase from 1985 to 1987 (474-699/100,000). In T&T there was a low incidence of scabies until 1985 (0-59/100,000) and in Dominica the rate fluctuated (67-14/100,000) during the same period. From 1986 to 1988, scabies infestation reached epidemic proportions in T&T (410-709/100,000) and fluctuated in Dominica (108-117/100,000). In Tobago alone, scabies was not reported until March 1986, and by December the incidence rate was 105/100,000; by 1988 it had increased to 1124/100,000 population. Although no secondary infections have been reported from Grenada, Dominica, T&CI or St Lucia, T&T has reported increased streptococcal skin infections and epidemic post-streptococcal acute glomerulonephritis (PSAGN). The observed trend of increasing scabies infestation, increasing streptococcal isolates from skin lesions, and increasing PSAGN in T&T is noteworthy.     

Esophago-pleural fistula with pulmonary tuberculosis

A patient with clinical diagnosis of pulmonary tuberculosis and right sided hydropneumothorax found to have fistulous connection of pleura with oesophagus as evidenced by upper GI endoscopy and intrapleural instillation of radio-opaque dye. He was managed with intercostal chest tube drainage, antibiotics, antitubercular regimen and nasogastric tube feeding, resulting in eventless recovery subsequently.     

Normal thoracic aorta diameter on cardiac computed tomography in healthy asymptomatic adults: impact of age and gender

RATIONALE AND OBJECTIVES: To establish the normal criterion of ascending aortic diameter (AAOD) measured by 64 multidetector computed tomography (MDCT) and electron beam computed tomography (EBT) based on gender and age. MATERIALS AND METHODS: A total of 1442 consecutive subjects who were referred for evaluation of possible coronary artery disease underwent coronary computed tomographic (CT) angiography (CTA) and coronary artery calcium scanning (CACS) (55 + 11 years, 65% male) without known coronary heart disease, hypertension, chronic pulmonary and renal disease, diabetes, and severe aortic calcification. The AAOD aortic diameter, descending aortic diameter (DAOD), pulmonary artery (PAD), and chest anteroposterior diameter (CAPD), posterior border of the sternal bone to the anterior border of the spine, were measured at the slice level of mid-right pulmonary artery using end systolic trigger imaging. The volume of four chambers, ejection fraction of left ventricle, and cardiac output were measured in 56% of the patients. Patients' demographic information, age, gender, weight, height, and body surface area were recorded. The mean value and age-specific and gender-adjusted upper normal limits (mean +/- 2 standard deviation) were calculated. The linear correlation analysis was done between AAOD and all parameters. The reproducibility, wall thickness, and difference between end-systole and end-diastole were calculated. RESULTS: AAOD has significant linear association with age, gender, DAOD, and pulmonary artery diameter (P < .05). There is no significant correlation between AAOD and body surface area, four-chamber volume, left ventricular ejection fraction, cardiac output, and CAPD. The mean intraluminal AAOD was 31.1 +/- 3.9 and 33.6 +/- 4.1 mm in females and males, respectively. The upper normal limits (mean +/- 2 standard deviations) of intraluminal AAOD, were 35.6, 38.3, and 40 mm for females and 37.8, 40.5, and 42.6 mm for males in age groups 20-40, 41-60, and older than 60 years, respectively. Intraluminal aortic diameters should parallel echocardiography and invasive angiography. Traditional cross-sectional imaging (with CT and magnetic resonance imaging) includes the vessel wall. The mean total AAOD was 33.5 and 36.0 mm in females and males, respectively. The upper normal limits (mean +/- 2 standard deviations) of intraluminal AAOD were 38.0, 40.7 and 42.4 mm for females and 40.2, 42.9, and 45.0 mm for males in age group 20 to 40, 41 to 60, and older than 60 years, respectively. The inter- and intraobserver, scanner, and repeated measurement variabilities were low (r value >0.91, P < .001, coefficient variation <3.2%). AAOD was 1.7 mm smaller in end-diastole than end-systole (P < .001). CONCLUSIONS: The AAOD increases with age and male gender. Gender-specific and age-adjusted normal values for aortic diameters are necessary to differentiate pathologic atherosclerotic changes in the ascending aorta. Use of intraluminal or total aortic diameter values depends on the comparison study employed.     

Open segmental fracture of both bone forearm and dislocation of ipsilateral elbow with extruded middle segment radius

Extruded middle segment of radius with open segmental fracture both bone forearm and dislocation of ipsilateral elbow is a rare injury. A 12-year-old child presented to us within 4 hours following fall from tree. The child''s mother was carrying a 12-cm-long extruded soiled segment of radius. The extruded bone was thoroughly washed. The medullary cavity was properly syringed with antiseptic solution. The bone was autoclaved and put in the muscle plane of the distal forearm after debridement of the wound. After 5 days, a 2.5-mm K-wire was introduced by retrograde method into the proximal radius by passing through the extruded segment. Another 2.5-mm K-wire was passed in ulna. The limb was evaluated clinicoradiologically every 2 weeks. The wound was healed by primary intention. At 4 months, the reposed bone appeared less dense radiologically and K-wire seemed to be out of the bone. In the subsequent months, the roentgenograms show remodeling of the extruded fragment. After 20 weeks, the K-wires were removed (first ulnar and then radial). Complete union was achieved with full range of movement except loss of few degrees of extension of elbow and thumb. This case is reported to show a good outcome following successful incorporation of an extruded segment of radius in an open fracture.