Day 1 :
Keynote: Assessment of Hypertension and Consistency of Blood Pressure Control in a Primary Care Clinic of a Safety Net Hospital
Time : 12:30-13:15
Anthi Katsouli completed her MD from National and Kapodistrian University of Athens and then moved to USA where she completed her residency in Internal Medicine at University of Pittsburgh Medical Center.
After her residency, she proceeded with fellowship in Preventive Medicine at John Stroger Hospital of Cook County and earned her Master of Public Health from University of Illinois at Chicago. Her main area of interest is Preventive Cardiology and she is focusing on Prevalence of Major Cardiovascular Risk Factors and Cardiovascular Disease among vulnerable population of a safety net hospital. Currently, she is an Assistant Professor of Medicine at Loyola University Medical Center and serves as an Internal Medicine ward attending.
Introduction: Hypertension is a powerful risk factor for fatal and nonfatal cardiovascular disease events and several lines of evidence support that these events are less in patients in whom on-treatment blood pressure (BP) is reduced <140/90 mm Hg. Nationally, in 2007-8, 69% of people with treated hypertension had BP at the target for control. However, analysis of BP control using mean BP over multiple times does not provide a complete picture of BP control, because BP may be in control at one visit and not in control at the next visit. We conducted a study to assess the BP control and consistency of blood pressure control in a primary care clinic of a safety net hospital that serves a vulnerable population and also to identify predictors of inconsistent BP control.
Methods: A retrospective chart review of established patients with hypertension was conducted in a primary care clinic at John Stroger Hospital of Cook County. Patients were selected using a random sampling method over two weeks and demographic, clinical and laboratory data was collected. An established primary care patient was defined as one who had 5 or more visits to the primary care clinic in the last 3 years. A diagnosis of hypertension was based upon the physician’s problem list. BP control was defined as <140/90 mmHg at the last visit. Consistent control was defined as BP <140/90 on 4 or 5 of the last 5 visits. Stage 2 HTN was defined as BP >160/100. The primary outcome measure was proportion with controlled and consistent BP. Using the definition of consistent BP control; subjects were divided into two groups: those with consistent BP and those with inconsistent BP control. The distribution of clinical predictors was compared between the two groups with chi square test. Independent predictors were identified using multivariate logistic regression.
Results: Of the 258 charts, 150 met inclusion criteria. The mean age was 63 (23-90 years); 58% were women, 69% were African American. The most common co-morbidities were dyslipidemia (79%) and diabetes (57%). 55% had controlled BP at the last visit and 43% had consistent control of BP. Among those with controlled BP at the last visit, 68% had consistent control. Among those with elevated BP at the last visit, only 18% had consistent control. Independent predictors of inconsistent BP control were African American race, Chronic Kidney Disease (CKD) and having visited a primary care physician less than 9 times in the last 3 years. After adjustment for age and sex, African American (OR 3.06; 95% CI 1.38-6.77), patients with CKD (OR 2.66; 95% CI 1.27-5.57) and number of visits to primary care clinic <9 (OR 2.58; 95% CI 1.11-5.98) were significantly associated with inconsistent BP control.
Conclusion: Among a largely minority population of hypertensive patients with regular access to primary care services and multiple co-morbidities we found deficits in control of BP. Just over half had controlled BP at the last visit, less than half had consistent control of their BP. We also noted that African American, patients with CKD and patients with fewer visits are more likely to have inconsistent BP control. To approach national rates of control of blood pressure and improve the consistency of control, we recommend a clinic based quality improvement effort and a better understanding of differences in hypertension control among minority groups.
Keynote: Influence of Helicobacter pylori infection on HbA1c (Glycated Haemoglobin) Levels: SYSTEMATIC REVIEW
Time : 12:30-13:15
Lakshman Manoranjan is from St. Elizabeth University, Bratislava. He have published last year a poster presentation in Paris conference. Doing his Masters in Diabetes in United Kingdom.
Aim: Influence of H. pylori infection on HbA1c levels, how importance to eradicate the Infection and control the glucose levels
Objectives: An early discovery of the changes in blood glucose help to prevent or delay the of development of type 2 diabetes and complications. H. Pylori treatment could have an important role in improving insulin resistance.
HypothesisWe performed a research literature of the PubMed, Cochrane Library, and Chinese BioMedicine. Web Base and Chinese Science and Technology Journals databases databases for studies of the Influence of H pylori infection on HbA1c levels from the last 10 years. This study focuses on.
The data from this study are taken from PubMed, Cochrane Library, and Chinese BioMedicine databases for studies of the Influence of H pylori infection on HbA1c levels from the last 10 years. We selected 5 studies that included 2456 Patients. Helicobacter pylori is a microaerophilic bacterium that is commonly found in patients with gastrointestinal disorders. It is present in approximately one half of the world's population. The most of the people who are infected have no symptoms however Helicobacter pylori is capable of causing some digestive problems such as Abdominal Pain (mild to severe), Belching and Gastric reflux, Mild nausea, Irritable Bowel Syndrome, Bloating and distension, Constant bad breath, Hypochlorhydria. Most commonly associated with Peptic Ulcer Disease (PUD) is responsible for the development of 70% of Gastric and 80 to 95% of Duodenal Ulcers, that can may lead to the development of Cancers (Traci L Testerman 2014). Helicobacter pylori were found high percentage in the polluted well water, contaminated food, faeces, Dental plaque/saliva (Popescu D et al. 2017). Transmission through unclean water person to person, faecal-oral by poor hygiene not properly washing hands after using the toilets, oral-oral by kissing or gastro-oral. This continues to cause inflammation in mononuclear cells that stimulate an initial inflammatory effect, which can lead to duodenal and stomach ulcer.
All patients infected with Helicobacter pylori should be monitored for glucose, HbA1c, lipid profile, BMI, blood pressure. Previous studies on the association between H. pylori and diabetes have had mixed results, however the results shows positive association between H. pylori status and HbA1c levels among adult participants free of diabetes. The increased levels of HbA1c associated with H. pylori were greater among those with higher BMI.
Type 2 Diabetes Mellitus (T2DM) patients are increasingly using herbal remedies due to the fact that sticking to the therapeutic regimens is becoming awkward. However, studies towards herbal medicine use by diabetic patients are scarce in Ethiopia. Therefore, the aim of the current study was to explore the prevalence and correlates of herbal medicine use with different sociodemographic variables among type 2 diabetes patients visiting the diabetic follow-up clinic of University of Gondar comprehensive specialized hospital (UOGCSH), Ethiopia.
A hospital-based cross sectional study was employed on 387 T2DM patients visiting the diabetes illness follow-up care clinic of UOGCSH from October 1 to November 30, 2016. An interviewer-administered questionnaire regarding the demographic and disease characteristics as well as herbal medicine use was completed by the study subjects. Descriptive, univariate and multivariate logistic regression statistics were performed to determine prevalence and come up with correlates of herbal medicine use.
From 387 participants, 62% were reported to be herbal medicine users. The most prevalent herbal preparations used were Garlic (Allium sativum L.) (41.7%), Giesilla (Caylusea abyssinica (fresen.) (39.6%), Tinjute (Otostegia integrifolia Benth) (27.2%), and Kosso (Hagenia abyssinicaa) (26.9%). Most of herbal medicine users (87.1%) didn’t consult their physicians about their herbal medicine use. Families and friends (51.9%) were the frontline sources of information about herbal medicine followed by other DM patients who used herbal medicines (28.9%).
The present study revealed a high rate of herbal medicine use along with a very low rate use disclosure to the health care professionals. Higher educational status, a family history of DM, duration of T2DM and presence of DM complications were identified to be strong predictors of herbal medicine use. From the stand point of high prevalence and low disclosure rate, it is imperative for health care providers to strongly consult patients regarding herbal medicine use.
Problem: As outlined by the NHS Five Year Forward View, rapid advancements in technology mean it is becoming a prodigious tool in healthcare management. It endeavors to support efforts for more effective demand and more personalized, user-centred care. One such example is e-health, digital health used to collect patient information on an electronic device instead of the traditional paper-based format; studies have shown that use of such technology can increase patient satisfaction, reduce costs and improve treatment adherence. However, the slow uptake of this technology in the NHS and lack of literature surrounding its use, particularly in pre-operative surgical care made exploring the views of major stakeholders in adoption vital.
Methodology: 16 semi-structured interviews (SSI) were used to interview healthcare professionals (HCPs) identified as key stakeholders in the pre-operative pathway for elective hip and knee surgery at ICHT. Key stakeholders were chosen based on a process map, created with the help of HCPs. These included General Practitioners, Orthopaedic Surgeons, Anaesthetists, Orthogeriatricians, Nurses, Occupational Therapists and Physiotherapists. Interviews were stopped once data saturation had been achieved. Once interviews were concluded, a thematic analysis was conducted to identify themes in the data. Findings and recommendations were then member-checked with the interviewees.
Ethical approval was received from Imperial College Research Ethics Committee on 05/02/2019.
Conclusion & Significance: The literature and SSIs showed that e-health within the pre-operative process for elective orthopaedic surgery was promising in being used for triaging pre-operatively via assessment forms and for obtaining consent to yield reductions in time and costs for the patients and improving accessibility and personalization. However, the lack of access to technology and the lack of digital literacy in the elderly and patient compliance did pose as some challenges in its widespread adoption.
Former Assistant Clinical Professor of Medicine, USA
Time : 10:30-11:15
William J. Rowe M.D. FBIS (Fellow British Interplanetary Society), FACN (Fellow American College of Nutrition, Retired Fellow Royal Society of Medicine), is a board certified specialist in Internal Medicine. He received his M.D. at the University of Cincinnati and was in private practice in Toledo, Ohio for 34 years. During that time he supervised over 5000 symptom - limited maximum hospital-based treadmill stress tests. He studied 3 world class extraordinary endurance athletes and published their exercise-related magnesium deficiencies. This triggered a 20 year pursuit of the cardiovascular complications of Space flight. All his publications are posted on his website William J. Rowe M.D. FBIS (Fellow British Interplanetary Society), FACN (Fellow American College of Nutrition, Retired Fellow Royal Society of Medicine), is a board certified specialist in Internal Medicine. He received his M.D. at the University of Cincinnati and was in private practice in Toledo, Ohio for 34 years. During that time he supervised over 5000 symptom - limited maximum hospital-based treadmill stress tests. He studied 3 world class extraordinary endurance athletes and published their exercise-related magnesium deficiencies. This triggered a 20 year pursuit of the cardiovascular complications of Space flight. All his publications are posted on his website.
With space flight (SF) significant reductions of serum Mg (P < 0.0001) despite poor serum sensitivity, shown in space shuttle crew members. Mg, a strong antioxidant and calcium blocker; with SF, there is oxidative stress, insulin resistance, inflammatory conditions; in experimental animals significant endothelial injuries to mitochondria, reductions in transferrin and in turn oxidative stress. Inhalation of Lunar iron (Ir) particulate matter contributes to stress test - hypertension on Earth return (ER): James Irwin’s blood pressure (BP) 275/125 after 3 minutes of exercise (ER); Neil Armstrong showed very high diastolic BP 160/135 on ER, consistent with impaired cardiac function. Magnet (M) studies of value on moon; similarly, M studies on Earth used to quantitate high indoor Ir levels. Since over 90 % of brakes made of Ir, combination Ir brake dust inhalation and Mg deficiencies in over 60% U.S. population, may be important factors intensifying worldwide hypertension.