Department of Medicine, London Health Sciences Centre, University of Western Ontario, 339 Windermere Road, London, Ontario N6A 5A5, Canada. Kelly.Zarnke@lhsc.on.ca
To provide updated, evidence-based recommendations for the diagnosis and assessment of high blood pressure in adults.
For people with high blood pressure, the assignment of a diagnosis of hypertension depends on the appropriate measurement of blood pressure, the level of the blood pressure elevation, the duration of follow-up and the presence of concomitant vascular risk factors, target organ damage and established atherosclerotic diseases. For people diagnosed with hypertension, defining the overall risk of adverse cardiovascular outcomes requires laboratory testing, a search for target organ damage and an assessment of the modifiable causes of hypertension. Out-of-clinic blood pressure assessment and echocardiography are options for selected patients.
People at increased risk of adverse cardiovascular outcomes and were identified and quantified.
Medline searches were conducted from the period of the last revision of the Canadian recommendations for the management of hypertension (May 1998 to October 2000). Reference lists were scanned, experts were polled, and the personal files of the subgroup members and authors were used to identify other studies. All relevant articles were reviewed and appraised, using prespecified levels of evidence, by content experts and methodological experts.
A high value was placed on the identification of people at increased risk of cardiovascular morbidity and mortality.
The identification of people at higher risk of cardiovascular disease will permit counselling for lifestyle manoeuvres and the introduction of antihypertensive drugs to reduce blood pressure for patients with sustained hypertension. In certain settings, and for specific classes of drugs, blood pressure lowering has been associated with reduced cardiovascular morbidity and/or mortality.
The present document contains detailed recommendations pertaining to aspects of the diagnosis and assessment of patients with hypertension, including the accurate measurement of blood pressure, criteria for the diagnosis of hypertension and recommendations for follow-up, routine and optional laboratory testing, assessment for renovascular hypertension, home and ambulatory blood pressure monitoring, and the role of echocardiography in hypertension.
All recommendations were graded according to strength of the evidence and voted on by the Canadian Hypertension Recommendations Working Group. Only the recommendations achieving high levels of consensus are reported here. These guidelines will be updated annually.
These recommendations are endorsed by the Canadian Hypertension Society, The Canadian Coalition for High Blood Pressure Prevention and Control, The College of Family Physicians of Canada, The Heart and Stroke Foundation of Canada, The Adult Disease Division and Bureau of Cardio-Respiratory Diseases and Diabetes at the Centre for Chronic Disease Prevention and Control of Health Canada.
[About effectiveness and perspective of application of test of venereal disease research laboratory (VDRL) for diagnostic of neurosyphilis in the Russian Federation].
The comparative evaluation of effectiveness of different nontreponema tests in analysis of cerebrospinal fluid. The liquor from 100 patients with syphilis was analyzed using Bordet-Gengou test, VDRL test and micro-precipitation reaction with cardiolipin antigen. The Bordet-Gengou test and VDRL test made in Russia or abroad are equally effective in analysis of positive samples of liquor and twice surpass the same capacity of micro-precipitation reaction with cardiolipin antigen in case of neurosyphilis with symptoms and thrice surpass in case of asymptomatic neurosyphilis. VDRL test is a simple standardized nontreponema reaction which can substitute labor-consuming non-unified liquorologic complex in laboratory diagnostic of neurosyphilis. The testing of liquor on the basis of micro-precipitation reaction with cardiolipin antigen is non-effective and results in false negative results in Bordet-Gengou and VDRL positive tests determining high risk of erroneous clinical considerations.
Polyhexamethyleneguanidine hydrochloride (PHMG) is an antimicrobial biocide of the guanidine family. In the period from August 2006 to May 2007, more than 12500 patients were admitted to hospital with a history of drinking illegal cheap "vodka" in 44 different regions in Russia, of whom 9.4% died. In reality, the "vodka" was an antiseptic liquid composed of ethanol (˜93%), diethyl phthalate, and 0.1-0.14% PHMG (brand name "Extrasept-1").
We performed an analysis of the clinical features and outcome in four poisoning treatment centers in the cities of Perm, Ekaterinburg, Irkutsk, and Khabarovsk. A total of 579 patients (215 females and 364 males) with similar symptoms were included.
The main symptoms on admission included jaundice (99.7%), skin itch (78.4%), weakness (96%), anorexia (65.8%), dizziness (65.3%), nausea (54.8%), vomiting (22.6%), stomach ache (52.7%), diarrhea (32%), and fever (50%). Mild symptoms were found in 2.5% of cases, moderate in 63%, and severe in 34.5%. Laboratory results were (mean ± SD): total bilirubin 249 ± 158 µmol/L, direct bilirubin 166 ± 97 µmol/L, cholesterol 14 ± 8 mmol/L, alanine aminotransferase 207 ± 174 IU/L, aspartate aminotransferase 174 ± 230 IU/L, alkaline phosphatase 742 ± 751 IU/L, and gamma-glutamyltranspeptidase 1199 ± 1095 IU/L. Patients generally recovered over a period of 1-5 months, although high levels of alkaline phosphatase and gamma-glutamyltranspeptidase were still found in all patients examined after 6 months. Sixty-one patients (10.5%) died between 23 and 150 days after poisoning. Local cholestasis, inflammatory infiltration, and fibrosis developing into cirrhosis were found by liver biopsy.
Acute liver injury caused by PHMG-hydrochloride or PHMG in combination with either ethanol or diethyl phthalate can be characterized as cholestatic hepatitis with a severe inflammatory component causing high mortality.
The authors describe a clinical diagnosis center working in close cooperation with a chair of therapy. Analysis of the activities of the center demonstrated the usefulness of medical divisions of such kind for practical health service, for it is at such diagnostic centers that profound examinations of patients, making use of present-day diagnostic methods, is possible at the preclinical stage. Such a possibility was offered to the residents of a large region who previously had to be hospitalized for this purpose. A diagnostic center brings evident economic benefit and is a clinic where physicians of primary health centers upgrade their knowledge and skills.
The functioning of the present-day system of public health is largely determined by the extent and effectiveness of the use of resources. The saving of resources is reflected in the costs. The research was concerned with development of methods of calculating the costs of clinical laboratory tests. Due account of costs offers means for evolving new patterns of self-reliance accounting and paid medical services.
The etiological structure of influenza-like was analyzed in the population in cities and towns and in Russia as a whole in November 1998 to April 1999 by the findings of immunofluorescence and serological surveys of patients with acute respiratory viral infections (ARVI). By the results of both tests, the proportion of the incidence of influenza A (H3N2) was largest, the decreasing order in their significance was as follows: adenoviruses, type 3 parainfluenza virus, RSV, influenza B virus, influenza A(H1N1), types 2 and 1 parainfluenza virus. All influenza viruses A(H1N1) were isolated in Samara in February 1999. Three of them were similar to the reference strain A/Johannesburg/82/96 in antigenic properties, two strains appeared to be its drift variants. No A/Beijing/262/95 (H1N1)-like viruses recommended for incorporation as part of vaccines were detected. All influenza A(H3N2) viruses were drift variants of strain A/Sydney/05/97, and all influenza B viruses were similar to the reference strain B/Harbin/07/94 in antigenic structure.
The material is based on the autopsy findings collected over 15 years (1975-1989). Findings related to 748 fatal outcomes were subjected to analysis in which 90 (12%) cases were misdiagnosed regarding the principal disease. A percentage of diagnostic errors with respect to tuberculosis was 1.8 on the whole and in the diagnosis of clinical forms and phases it was considerably higher-15.9 and 19.4, respectively. Hyperdiagnosis was typical of disseminated tuberculosis and caseous pneumonia, while hypodiagnosis--of primary, fibrocavernous tuberculosis and post-tuberculous changes. A percentage of hypodiagnosis in nontuberculous pathology varied from 12.5 to 50. Dynamic observation by the five-year plans demonstrated an increase in the percentage of misdiagnosis of the concurrent pathology and its decrease when the phase of a specific process was established. Purely medical errors accounted for 75% of misdiagnosis.
The results of an evaluation of the Innotrac Aio! cardiac markers are presented. This system is based on dry-chemistry, time-resolved fluorometry. All assay-specific reagents are dry-coated into assay-specific cups, and only the generic assay buffer is required. The levels of precision attained with pooled serum samples and control materials were acceptable for cTnI and CK-MB. Myoglobin assay showed higher CV, 5.6-9.5%. The linearity studies were performed in concentration ranges of 0.1-76 microg/L for cTnI, 0.7-450 microg/L for CK-MB and 0.6-1500 microg/L for myoglobin. The markers were found to be linear within the ranges tested. The correlation coefficient between the Aio! and AxSYM cTnI assays was 0.960, and the slope was 0.07. The correlation coefficients between the Aio! and AxSYM CK-MB and myoglobin assays were 0.995 and 0.971, respectively. They involved some differences in the measured concentrations (Aio! CK-MB was about 9% higher than AxSYM CK-MB, and Aio! myoglobin was 19% higher than AxSYM). Comparative studies with all the markers, using EDTA whole blood and lithium heparin plasma specimens and lithium heparin whole blood and plasma, yielded the following results: the slopes were close to 1.0 for all correlations, with the exception of that between CK-MB EDTA whole blood and lithium heparin (0.83). High correlation coefficients were obtained (> or = 0.97). The carryover results for all the cardiac markers were good, 0.0%, 0.0%, and 0.3% for cTnI, CK-MB, and myoglobin, respectively. The analytical detection limits were 0.01 microg/L for cTnI, 0.8 microg/L for CK-MB and 0.5 microg/L for myoglobin. The stability of the analytes in the lithium heparin samples at room temperature was also studied and was found to be decreased by from 10% (myoglobin and CK-MB) to 17% (cTnI) in 8 h. Innotrac Aio! provides a rapid and easy quantitative measurement of cardiac TnI, CK-MB, and myoglobin within
