Comportamiento epidemiológico de la hipertensión arterial en países en vía de desarrollo y recomendaciones de la Sociedad Internacional de Hipertensión en el año 2020 / Epidemiological behavior of hypertension in developing countries and recommendations of the International Society of Hypertension in 2020

Resumen La hipertensión arterial se considera como una de las principales causas de morbimortalidad en todo el mundo. Asimismo, su elevada prevalencia en los países en vías de desarrollo se relaciona directamente con el desconocimiento de la enfermedad, e inversamente con la prevalencia del tratamiento y el control de la hipertensión arterial. El objetivo de esta revisión es compilar la evidencia sobre los factores que influencian la prevalencia de conocimiento del diagnóstico de hipertensión arterial, el tratamiento y el control óptimo de la enfermedad dependiendo del contexto epidemiológico. Por ello, se enfatiza que gran parte del desafío en los países en vías de desarrollo consiste en evaluar la escasa evidencia epidemiológica de base poblacional para realizar recomendaciones que se adapten a los recursos disponibles en las diferentes regiones. Para este propósito se realizó una breve revisión sobre las recomendaciones de las guías de práctica clínica propuestas por la Sociedad Internacional de Hipertensión en el año 2020.

Abstract High blood pressure is one of the leading causes of morbidity and mortality worldwide. In addition, its high prevalence in developing countries is directly related to the lack of awareness of the diagnosis and conversely to the prevalence of treatment and control of high blood pressure. This literature review aims to compile evidence on the factors that influence the prevalence of knowledge of the diagnosis of high blood pressure, the treatment and optimal control of the disease depending on the epidemiological context. In this review, we emphasize that much of the challenge in developing countries is to assess the limited population-based epidemiological evidence to make recommendations that are tailored to the resources available in the different regions. For this purpose, a brief review is carried out on the recommendations of the clinical practice guides proposed by the International Hypertension Society in 2020.

The Indigenous Cultural Ways of Diagnosis in the Ashanti Region of Ghana

The primary aim of this study is to make the indigenous cultural ways of identifying diseases known in order to promote and remove the mystery and superstition associated to them.Due to the nature of the study, the purposive sampling technique was largely employed.Interviews and observations were the main datacollecting instruments used. The four study areas which are Bongari Shrine at Adumakasekese, Asuo Abresua Shrine of Ahwirewam, Bokankye Akua Gyabon Shrine (currently situated at Mankranso Peposo), and Apomasu Kwao Shrine of Ntenserewere purposively selected.The study revealed that the traditional healers use items ranging from natural to artificial such as eggs, talismans, cowries, money and other objects to diagnose various diseases. In diagnosing of diseases, the traditional healers take a holistic approach which are the social, natural, spiritual and the cosmic environment which are not in the case of the orthodox medication.It is therefore importantfor government and stakeholders to give recognition to these diviners and spiritual healers by putting up nice buildings (clinics and hospitals) and providing them the necessary needs like what they have been doing for the orthodox health centres and if possible integrate the traditional medication into the orthodox ones.

The risk factors for predicting or diagnosing bone metastases from urinary bladder neoplasms / 解放军医学杂志

Objective To explore the clinical significance of some risk factor,such as blood calcium serum alkaline phosphatase (ALP) and hemoglobin (Hb) for predicting or diagnosing bone metastases from urinary bladder neoplasms.Methods A total of 35 patients diagnosed as urinary bladder neoplasms and bone metastasis based on the histopathologic analysis (bone metastasis group,BM),and 105 cases of age-,sex-and follow-up time matched urinary bladder neoplasms patients without bone metastasis (non bone metastasis group,NBM) were included in present study.The correlations between clinical-pathological parameters (blood calcium,ALP,Hb) and bone metastases from urinary bladder neoplasms were analyzed and the risk factors for predicting or diagnosing bone metastases were identified.Results The levels of blood calcium,ALP and Hb were significantly higher at first diagnosis and follow-up period in BM group than in NBM group (P＜0.05).Multivariate logistic regression analysis indicated that the levels of calcium,ALP and Hb at first diagnosis were the independent risk factors for predicting the later incidence of bone metastases (P＜0.05).The levels of calcium,ALP and Hb in follow-up period were the independent risk factors for diagnosing bone metastases (P＜0.05).Receiver operating characteristic (ROC) curves analysis showed that the levels of calcium,ALP,Hb may give a more accurate prediction on bone metastases (AUC:0.615,0.704,0.692;cut-off:2.55mmol/L,97.0U/L,101.5g/L,respectively) or diagnosing bone metastases (AUC:0.706,0.776,0.829;cut-off:2.46mmol/L,112.5U/L,103.5g/L,respectively).Conclusion The levels of blood calcium,ALP and Hb may be used to predict the risk of bone metastases for patients firstly diagnosed as urinary bladder neoplasms,and predict whether the patients will be complicated with bone metastases during follow-up period.

Application of HbA1C for diagnosing diabetes in Harbin / 中华内分泌代谢杂志

Objective To evaluate the sensitivity and specificity of different HbA1C cutoff points for diabetes diagnosis in high risk outpatients in Harbin.Methods A total of 2 122 high risk outpatients(male 1 032 and female 1 090)for diabetes screening in the Fourth affiliated Hospital of Harbin Medical University from April 2013 to February 2015 were included in this study, with the average age of(49.26±13.00)year. Oral glucose tolerance tests(OGTT)were conducted and HbA1C levels were examined in these patients. The sensitivity and specificity of different HbA1C cutoff points were calculated and a receiver operator characteristic(ROC)curve was then built.Results The average level of HbA1C in these subjects was(6.45±1.72)%. The prevalence of diabetes was 41.85%. The area under ROC curve(AUC)was 0.89 with the optimal cutoff point of HbA1C 6.0% and 0.68 for the highest Yonden index. The sensitivity and specificity of HbA1C 6.0% were 84.01% and 83.67% respectively. The sensitivity and specificity of HbA1C 6.5% were 62.84% and 95.92%, respectively. The AUC of HbA1C≥6.5% was 0.732. Conclusion HbA1C works well as the diagnostic standard for diabetes in high risk outpatients of Harbin city. The cutoff point of HbA1C 6.0% is suitable for screening diabetes in high risk population, and HbA1C 6.5% is appropriate for diabetes diagnosis, with high sensitivity and specificity.

A Potential Issue with Screening Prediabetes or Diabetes Using Serum Glucose: A Delay in Diagnosis

The aim of this study was to compare the fasting serum glucose level with the fasting plasma glucose level for diagnosing hyperglycemic states in real-life clinical situations. Additionally, we investigated a usual delay in sample processing and how such delays can impact the diagnosis of hyperglycemic states. Among 1,254 participants who had normoglycemia or impaired fasting glucose (IFG) assessed by the fasting serum glucose level, 20.9% were newly diagnosed with diabetes based on the plasma fasting glucose level. Of the participants with normoglycemia, 62.1% and 14.2% were newly diagnosed with IFG and diabetes, respectively, according to the plasma fasting glucose level. In our clinical laboratory for performing health examinations, the time delay from blood sampling to glycemic testing averaged 78±52 minutes. These findings show that the ordinary time delay for sample processing of the serum glucose for screening hyperglycemic states may be an important reason for these diagnoses to be underestimated in Korea.

The methods of exploring obesity cutoffs for screening/diagnosing diabetes / 中华流行病学杂志

It is important to establish an appropriate obesity-cutoff method to identify people with diabetes or at high risk of the disease.Aside from restricted cubic splines and fractional polynomial model,the receiver operating characteristic curve is the most frequently one used to define these cutoffs.In this study,we explored the obesity cutoffs across different ethnic populations and evaluated the merits/demerits of different Methods by reviewing the currently used obesity cutoffs.

Ethical Dilemma and Countermeasure of the Vagrant Mental Patients / 中国医学伦理学

Through investigating the hospital admission and hospital discharge of vagrant mental patients in Xi-aoshan Hospital from January 2011 to December 2015 , the present study found that there existed some ethical di-lemmas including the risk ofdiagnosing mental disorder but actually not, lack of the guarantee of patients' rights and interests and supervision mechanism without guardian, long-term retention in the wards, and so on. It is sug-gested to establish right protection and supervision committee for vagrant mental patients, reduce the misdiagnosis ofdiagnosing mental disorder but actually not through the error correction mechanism, ensure proper treatment and care, create retention way, protect the basic rights of the vagrant mental patients, reduce mental disability, avoid to stray again, so as to perfect the social management system.

Design and Application of the Multi-mode Diagnosing Distribution System / 医学信息学杂志

〔Abstract〕 The paper analyzes problems existing in the traditional outpatient diagnosing distribution process of hospitals , redesigns and optimizes the triage process .It designs a unified diagnosing distribution system , introduces the advantages , system composition , queuing rules and treatment priority strategies of the optimized process , and illustrates the application effects of the diagnosing distribution system with the outpatient of obstetrics and gynecology department of a large grade -III level-a hospital as an example .

Ethical and Legal Issues in the Compulsory Medical Service of Mental Patient from“Diagnosing Mental Disorder but Actually Not” / 中国医学伦理学

The event of “diagnosing mental disorder but actually not” violates patients′right of informed con-sent and refused to health , showing some problems of “diagnosing mental disorder but actually not” and mandatory admission process and psychiatric judicial authentication , and also have some ethical problems .Therefore, relevant departments should perfect the laws and regulation , establish a hospitalized psychiatric patients appeal , the appeal channels , at the same time , physicians should follow a correct understanding , respect patients rights , disinterest-ed, the ethical principles of self -supervision and also use constraints should be regulated .

Clinical Practice and Knowledge of Primary Health Care Physicians Toward Adverse Drug Reactions: Can We Recognize Adverse Drug Reactions and What Should We do to Maximize Patient Safety and to Improve Self-confidence of Doctors When Prescribing Medicines.

Aim: A suspicion about adverse drug reactions is sufficient for adverse drug reactions reporting. However, assessing the causal drug-disturbance(s) relation is the primary issue in physicians’ clinical practice, due to their principal responsibility among health care workers for patients' health, including patients' safety, while the far more studied adverse drug reactions reporting is the secondary one. Thus, adverse drug reactions, and the need for introducing activities for physicians toward adverse drug reactions. Study Design: It was a prospective, multicentric, questionnaire based, self-administered, and anonymous study, conducted during two months among physicians employed in five public (state) primary health care centers in the Republic of Serbia settled in Sombor, Mladenovac, Pozarevac, Cacak and Pirot. Results: It was questionnaired 238 out of 461 employed physicians. Doctors declared to diagnose adverse drug reactions (n = 213) but rarely report them (n = 49). They usually withdrew the drug suspected for adverse drug reactions (n = 212) and seldom introduce it to the same patient in the future (n = 5). They claimed to have difficulties in both the adverse drug reactions diagnosing (n = 146) and treating (n = 113). Almost all considered the improvement of the knowledge about adverse drug reactions beneficial for their clinical practice, adverse drug reactions diagnosing and treating (P < .001 for all the statements). With a very few exceptions, answers were not influenced by physicians’ ages and medical education. Conclusion: Physicians recognized the dimension of their problems in the field of adverse drug reactions, especially diagnosing, which is crucial for patient health. Better education and training are the most important strategies for improving existing weaknesses, which have to be translated into routine clinical practice.

Hemangioma cavernoso del mesosigmoide: informe de un caso y revisión de la bibliografía / Cavernous hemangioma of the mesosigmoid: a case report and literature review

Se informa un caso de hemangioma cavernoso del mesosigmoide, su presentación clínica, diagnóstico y tratamiento, y se ofrece una revisión de la literatura asequible sobre el tema, para lo cual se realizó una búsqueda en las bases de datos de Medigraphic, Cochrane, Medline y PubMed. El paciente es un hombre de 72 años de edad, que se presentó con dolor abdominal, estreñimiento, pérdida de peso y masa tumoral en la fosa ilíaca izquierda. A pesar de las investigaciones imaginológicas y endoscópica, no se pudo hacer el diagnóstico preoperatorio. Se trató por laparotomía y resección del tumor, y el diagnóstico se confirmó por estudio histopatológico. El hemangioma cavernoso del mesosigmoide es un tumor raro, difícil de diagnosticar preoperatoriamente, a pesar de las avanzadas técnicas imaginológicas. La escisión quirúrgica y el examen histológico pueden ser los únicos medios para el diagnóstico.

This article reported a case of cavernous hemangioma of the mesosigmoid, its clinical presentation, diagnosis and treatment. It also offered literature review on this topic for which search into the Medigraphic, Cochrane, Medline and Pubmed databases was made. The patient was a 72 years-old man that went to the hospital with abdominal pain, constipation, loss of weight and tumor mass in the left iliac cavity. Despite imaging and endoscopic research, it was not possible to reach diagnosis preoperatively. He underwent laparotomy and tumor resection and the final diagnosis was confirmed in the histopathological study. The cavernous hemangioma of the mesosigmoid is a rare tumor difficult to preoperatively diagnose despite the advanced imaging techniques. Surgical excision and histological exam are the only means to reach diagnosis.

The role of computed tomography in the diagnosing bladder cancer

A study on 41 patients with bladder cancer diagnosis in Viet Duc hospital from 3/1999 - 3/2002. The result showed that: Large tumor: 58.5%, hardening patch infiltration: 41.5%. The size of tumor changes. The density of tumor before injection taken from 35-50 HU, after injection, increase in 10-15 HU is not matched, with large mass and relative uniform in small tumors and hardening patch infiltration. Invasive operation of fatty layer around bladder: 78%; invasive sperm, prostate gland: 14.6%; ureter: 14.6%; gland: 9.8%; invasive rectum: 4.9%... Bladder cancer often occurs in male and elderly. Further diagnosis such as bladder endoscopy, UIV, ultrasound, computed tomography has value in the diagnosing and helps the physician to foresee and plan for treatment: diagnosis of operation capacity.

Cognitive Function of the Elderly in a Rural Community / 신경정신의학

OBJECTIVE: This study was conducted in order to evaluate the cognitive function of the elderly and to delineate the effects of sex, age and education on cognitive function. METHODS: The Cognitive Impairment Diagnosing Instrument(CIDI) was administered to the residents aged 70 years or more in Jookjang-Myun, Pohang City, Kyungpook. RESULTS: Mean percent decline were different among the CIDI subtests: concentration/calculation showed the greatest deterioration, performances on abstract thinking, higher cortical functions, and orientation in time declined by 20.3 to 29.5%, and long-term memory, memory registration, judgement object naming, and orientation in place showed modest decline. Performances on all the CIDI subtests were significantly correlated with age with correlation coefficients between -0.262 and -0.477. All subtest, but for short-term memory, scores were shown to be affected by education. Men scored better than women on all the CIDI subtests except for short-term memory and memory registration. CONCLUSION: All total and subtest performances of the CIDI were shown to be affected by sex, age, and education. However, memory registration and short-term memory revealed different pattern of decline according to the demographic factors.

A Discussion of the Patient's Subjectivity in Diagnosing and Curing Activities / 中国医学伦理学

Based on the main body's definition of philosophy,the article points out that patients are the main body of clinic activities.It also analyzes patients'main status in the performance of clinic activities and in the medical countermeasure.The concluson is that a harmonious relationship between doctors and patients should be composed from bi-main bodies characteristic of the clinic activities.