São Paulo medical journal = Revista paulista de medicina
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Acquired fetal hemoglobin (HbF) elevation has been implicated as a prognostic factor in dyserythropoietic disorders. Our objectives were to examine acquired HbF increases in aplastic anemia (AA) and paroxysmal nocturnal hemoglobinuria (PNH) patients, and to evaluate whether there is an association between the presence of XmnI and 5' hypersensitive site locus control region (LCR-HS2) polymorphisms and the HbF levels. ⋯ XmnI polymorphism absence reduction is associated with acquired HbF elevation. Further studies are required to confirm these observations and make treatment, prognosis and survival comparisons.
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Hypertension management and risk prediction based on diastolic blood pressure may be of little value for older people and people with isolated systolic hyper-tension (ISH). This study investigated primary care practice patterns in ISH management in a Nigerian high-risk subpopulation. ⋯ Aggressive ISH management needs to be further emphasized at primary care levels, which for many low-income patients may be the first and last orthodox port of call.
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Overall ratings (ORs) of competence, given by expert physicians, are increasingly used in clinical skills assessments. Nevertheless, the influence of specific components of competence on ORs is incompletely understood. The aim here was to investigate whether ORs for medical student history-taking competence are influenced by performance relating to communication skills, completeness of questioning and asking contentdriven key questions. ⋯ Experts overall ratings for medical student competence regarding history-taking is likely to encompass a particular dimension, since ratings were only weakly influenced by specific components of performance.
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Despite the development of tertiary care facilities, intensive care and advanced blood banking techniques, pregnancy-related hypertensive disorders are the main cause of maternal mortality in most countries. Our purpose was to determine maternal outcome in pregnancies complicated by HELLP syndrome (hemolysis, elevated liver enzymes and low platelet count) that required intensive care management. ⋯ Because of high maternal mortality and morbidity found among patients with HELLP syndrome, standard antenatal follow-up protocols should be applied, so as to obtain early diagnosis and improve the speed of transfer to obstetric departments with expertise in this field.
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There have been dramatic increases in very low birth weight infant survival. However, respiratory morbidity remains problematic. The aim here was to verify associations between pulmonary mechanics, pulmonary structural abnormalities and respiratory morbidity during the first year of life. ⋯ Upon discharge, there were high rates of lung mechanism and tomography abnormalities. More than 50% presented respiratory morbidity during the first year. Neonatal pneumonia and mechanical ventilation use were statistically significant risk factors.