Role of ambulatory blood pressure monitoring in hypertensive patients having controlled office blood pressure

Background and objectivesAmbulatory blood pressure (BP) monitoring has become useful in the diagnosis and management of hypertensive individuals. In this study we tried to know the role of office and ambulatory BP in treated hypertensive patients.Methods and patientsProspective cohort of 561 treated hypertensive patients were enrolled in the study. Hypertension definitions were according to JNC 8 classification. Office BP and ambulatory BP monitoring was done according to defined protocol.ResultsFrom a subgroup of 158 treated hypertensive patients, 91(16.2%) patients were having white coat hypertension (p value 0.00 by Pearson chi square test). In a subset of 403 patients who were having controlled BP on the day of enrolment as well as on the day of attaching ambulatory BP monitor; 98 (17.4%) patients were having masked uncontrolled hypertension (MUCH). In addition there was very significant percentage of non-dippers and reverse dippers. In our study we found that office BP has a moderate to low specificity and sensitivity and low negative predictive value for overall control in treated hypertensive patients.ConclusionAmbulatory BP monitoring should be included in the management protocol of treated hypertensive patients, for the optimal BP control.     

Cribado de cáncer de pulmón: Supervivencia en un amplio programa de detección precoz en España (I-ELCAP)

IntroductionLung cancer (LC) is usually diagnosed at advanced stages with only a 12% 5-year survival. Trials as NLST and NELSON show a mortality decrease, which justifies implementation of lung cancer screening in risk population. Our objective was to show survival results of the largest LC screening program in Spain with low dosage computed tomography (LDCT).MethodsClinical records from International Early Lung Cancer Detection Program (IELCAP) at Valencia, Spain were analysed. This program recruited volunteers, ever-smokers aged 40-80 years, since 2008. Results are compared to those from other similar sizeable programs.ResultsA total of 8278 participants were screened with at least two-rounds until November 2020. A mean of 6 annual screening rounds were performed. We detected 239 tumours along 12-year follow-up. Adenocarcinoma was the most common histology, being 61.3% at stage I. The lung cancer prevalence and incidence proportion was 1.5% and 1.4%, respectively with an annual detection rate of 0.17. One-year survival and 10-year survival were 90% and 80.1%, respectively. Adherence was 96.84%.ConclusionLargest lung cancer screening in Spain shows that survival is improved when is performed in multidisciplinary team experienced in management of LC, and is comparable to similar screening programs.     

Silver Diamine Fluoride Protocol for Reducing Preventable Dental Hospitalisations in Victorian Children

IntroductionThis study was designed to assess whether a dental caries management protocol combining a single application of 38% silver diamine fluoride (SDF) with comprehensive oral health education will successfully divert high-risk children from dental treatment under dental general anaesthesia (DGA), arrest active caries in primary teeth, and improve parent-reported child oral health–related quality of life (OHRQoL).MethodsChildren aged 2 to 10 years, who attended two public dental agencies in Victoria, Australia, and were unable to tolerate restorative treatments in the clinic setting, elected to participate in either a 38% SDF intervention protocol or, alternatively, referral for DGA. Follow-up examinations were completed at 6 months to assess caries progression, decayed missing filled tooth index, PUFA index (pulpal involvement, ulceration, fistula, abscess), DGA referral rates, and OHRQoL (Early Childhood Oral Health Impact Scale [ECOHIS]).ResultsOf the total sample, 89.5% of children (n = 102) [mean (SD) age, 4.1 (1.0) years] with 401 active carious lesions elected to participate in the 38% SDF protocol; 10.5% (n = 12) of parents opted for referral for treatment under DGA. The proportion of active caries subsequently arrested at follow-up (number of arrested lesions/number of lesions treated) was 0.78 (95% CI, 0.69 to 0.87). There was an 88% reduction in referrals for DGA in eligible children over the 6-month period. The 38% SDF intervention group showed a significant improvement in ECOHIS scores at follow-up (P < .001).DiscussionAdoption of the 38% SDF intervention protocol resulted in a significant reduction in the rate of preventable dental hospitalisations. Most parents opted against referral for DGA. Parent-reported OHRQoL for children improved significantly.     

Midterm Outcomes of Angioplasty for Pediatric Renovascular Hypertension

PurposeTo evaluate the midterm outcomes of percutaneous transluminal renal angioplasty (PTRA) for pediatric renovascular hypertension (RVH).Materials and MethodsThe clinical data of patients who underwent PTRA for RVH in the authors’ hospital from 2012 to 2019 were retrospectively analyzed. Postprocedural blood pressure, glomerular filtration rate (GFR) of the affected kidney, restenosis, and complications were closely monitored.ResultsPTRA was performed in a total of 30 children (20 boys and 10 girls), with a mean age of 7.3 years ± 0.7 (range, 40 days to 13.9 years) and a mean weight of 25.0 kg ± 2.3 (range, 3.4–53 kg). The median follow-up period was 26.5 months (range, 1 month to 7.5 years). Technical success was achieved in 26 (86.7%) of the 30 patients. Restenosis developed in 3 patients (10.0%). Only 1 patient underwent stent implantation, and the stent fractured 8 months later, requiring further intervention. There were no other complications. In terms of clinical benefit of blood pressure control after the initial PTRA procedure, 15 patients (50%) were cured and 7 patients (23.3%) showed improvement. There was no significant difference in the etiology, lesion location, and lesion length between patients with clinical benefit and failure (P = .06, P = .202, and P = .06, respectively). GFR of the affected kidney was significantly improved from 19.9 mL/min ± 11.2 to 38.1 mL/min ± 11.9 at the 6-month follow-up after PTRA (P < .001).ConclusionsThe overall results of PTRA for pediatric RVH caused by different etiologies are promising. PTRA not only provided a clinical benefit of blood pressure control in 73.3% of the patients but also significantly improved the function of the affected kidney.     

Outcomes of Prostatectomy versus Radiation Therapy in the Management of Clinically Localized Prostate Cancer Patients Within the PLCO Trial

Background

The objective of the study was to evaluate the outcomes of clinically localized prostate cancer treated with prostatectomy versus radiation therapy within the context of a prospective prostate cancer screening study.

妊娠早期阴道微环境变化及与阴道炎症的关系分析

目的分析妊娠早期阴道微环境变化及与阴道炎症的关系。方法回顾性分析2017年3月-2018年12月韶关市曲江区妇幼保健计划生育服务中心104例妊娠早期孕产妇临床资料。记录其非妊娠期及妊娠早期阴道微环境变化情况,包括酸碱度(pH)、菌群密集度、菌群多样性、阴道微生物功能正常率、乳杆菌阳性率、阴道微生态正常率,并比较妊娠早期阴道炎症发生情况及其阴道微环境。结果孕产妇非妊娠期pH、阴道微生物功能正常率、乳杆菌阳性率及阴道微生态正常率明显高于妊娠早期,菌群密集度、菌群多样性则低于妊娠早期,差异均有统计学意义(P<0.05)。孕产妇妊娠早期阴道炎症组pH、菌群密集度、菌群多样性明显高于无阴道炎症组,阴道微生物功能正常率及乳杆菌阳性率则低于无阴道炎症组,差异均有统计学意义(P<0.05)。结论妊娠早期阴道微环境出现一系列变化,造成阴道炎症发生率升高,对此临床应给予重视。     

探讨中西医护理改善老年高血压患者生活质量的效果

目的探讨中西医结合护理改善老年高血压患者心理状态及生活质量的效果。方法在医院2018年1月—2018年6月就诊的老年高血压患者中选出60例,按照随机数字法的原则,分成研究组(n=30)和参考组(n=30)。参考组采用单一西医护理,研究组在此之外联合中医护理,比较两组患者的临床疗效。结果入院时研究组与参考组SAS、SDS、SF-6评分差异不显著(P>0.05),护理后1月、3月与参考组相比,研究组SAS、SDS评分显著降低(P<0.05),SF-6评分显著升高(P<0.05);研究组患者对中西结合护理满意度为96.67%,参考组患者对西医护理满意度为73.33%,研究组满意度较参考组高,差异显著(P<0.05)。结论中西医结合护理能够有效改善老年高血压患者的心理状态,提高生活质量。