Alendronate reduces pain, improves function and retards AVN progression. Early surgical intervention can be avoided in most patients.
Summary Turner syndrome (TS), the result of a structurally abnormal or absent X chromosome, occurs in one in 2 000 live born females. The phenotype is highly variable, but short stature and gonadal dysgenesis are usually present. The main objective in adults with TS is health surveillance, but TS still causes a reduction in life expectancy of up to 13 years, with cardiovascular disease, congenital or acquired, as the major cause of an early death. While it has been established that all women with TS should undergo in-depth cardiovascular examination at diagnosis, advice on the cardiovascular management of women with TS is limited. Here, we provide a summary of our current practice within a multidisciplinary team, supported by our expertise in various aspects of cardiovascular risk management, and the evidence from research where it is available, with the aim of providing optimal support to our patients with TS.Background A dedicated Adult Turner Clinic was established in South East Scotland in 2002. This gynaecology-led clinic serves a population of roughly 1Á2 million and, currently, reviews around 50 women with TS annually. Referrals for adult care come from paediatrics or general practice. Following a series of individual case discussions regarding the management of more complex cardiovascular problems, we have assembled a dedicated multidisciplinary group to determine a timely cardiovascular screening strategy, a basis for specialist referral, and appropriate hypertension management. This team now includes a paediatric endocrinologist, gynaecologist, cardiologist (with an interest in inherited disorders), vascular radiologist and hypertension specialist. Here, we review the literature on cardiovascular disease in women with TS and, make recommendations, based on relatively limited high-quality evidence, together with our experience, on the optimal timing of cardiovascular screening.
Alendronate in the treatment of avascular necrosis of the hip SIR, Avascular necrosis (AVN) of the bone results from decreased blood supply to the bone, resulting in bone death. The most common site is the head of the femur. AVN is characterized by persistent, often nagging and disabling pain associated with significant reduction in joint movement and mobility. The condition tends to run a progressively downhill course. Medical and surgical management generally aims to improve the blood supply by vasodilators and antiplatelet drugs or by physically drilling holes and bone grafting to restore the blood supply to the avascular area. Eighty-five per cent of patients with symptomatic AVN progress to endstage disease over a 2-yr period [1]. So far, there is no universally accepted treatment that relieves pain and halts its progression. In this communication we report our early experience with the use of alendronate, a bisphosphonate, in AVN of the hip. All cases of proven AVN seen by us between February and October 2000 were assessed. All grades of AVN were considered eligible. Patients were excluded if they had one or more of the following: inability to be followed up regularly, symptoms of oesophagitis or gastritis, age below 18 yr, lactation, and abnormal renal, liver or bone profile. Besides routine physical examination, parameters specifically studied were range of motion, standing and walking time in minutes, pain on visual analogue scale of 0-10 (0, no pain; 10, maximum possible pain) and disability on a scale of 0-10 (0, no disability; 10, totally handicapped). Baseline investigations included complete blood count, liver, renal and bone profiles, Serum 25 (hydroxy) vit D 3 and magnetic resonance imaging (MRI) of both hips. MRI was staged according to the classification of Mitchell et al. [2]. If both hips were affected, for MRI staging the stage of the maximally affected hip was used for analysis. All patients received alendronate 10 mguday plus a calcium supplement of 1 guday. Oral vitamin D 3 was administered to patients
Distal DVT may not require treatment with anticoagulation. If leg symptoms worsen, or if there is an extension of distal DVT on the follow-up scan, treatment with anticoagulation is recommended.
The second edition of the MOH clinical practice guidelines on hypertension for Singapore was published in 2005. Since then, more facts about this important condition have emerged, particularly those recommending home blood pressure monitoring (HBPM) and 24-hour ambulatory blood pressure monitoring (ABPM) as key procedures in diagnosing suspected hypertension. Target groupThe main aim of these guidelines is to help physicians make sound clinical decisions about hypertension by presenting up-to-date information about diagnosis, classification, treatment, outcomes and follow-up. These guidelines are developed for all healthcare professionals in Singapore. Guideline developmentThese guidelines have been produced by an MOH-appointed committee of cardiologists, internists, general medicine practitioners, renal physicians, family physicians, and a neurologist. They were developed by adaptation of existing guidelines, critical review of relevant literature and expert clinical consensus taking local practice into consideration. The guidance does not override the individual responsibility of healthcare professionals to make decisions appropriate to the circumstances of the individual patient, in consultation with the patient and/or his guardian or carer. Review of guidelinesEvidence-based clinical practice guidelines are only as current as the evidence that supports them. Users must keep in mind that new evidence could supersede recommendations in these guidelines. The workgroup advises that these guidelines be scheduled for review five years after publication, or earlier if new evidence appears that requires substantive changes to the recommendations. EXECUTIVE SUMMARY OF RECOMMENDATIONS IntroductionThis is the executive summary of the MOH Clinical Practice Guidelines (CPG) on Hypertension. It is intended to be used with reference to the full version of the CPG, which is freely available on the MOH website at this link: https://www.moh.gov.sg/ content/moh_web/healthprofessionalsportal/doctors/guidelines/ cpg_medical.html.Hypertension is the leading associated risk factor for cardiovascular disease. It is prevalent and increasing in many developing and developed countries. The Singapore National Health Survey (NHS) 2010 showed that the crude prevalence of hypertension (defined as BP of ≥ 140/90 mmHg) among Singapore residents aged 30 to 69 years was 23.5%, compared to 24.9% in 2004 and 27.3% in 1998. However, the age-specific prevalence for hypertension rises markedly from age 40 years onward and, with our ageing population, we continue to face challenges in the prevention and control of hypertension. Target audienceThese guidelines are developed for all healthcare professionals in Singapore as an evidence-based resource to provide up-to date information and guidance on diagnosis, classification, treatment, outcomes and follow-up. CMEArticle Ministry of Health Clinical Practice Guidelines: HypertensionJam Chin Tay, Ashish Anil Sule, Daniel Chew, Jeannie Tey, Titus Lau, Simon Lee, Sze Haur Lee, Choon Kit Leong, Soo Teik L...
Background: Acetaminophen is widely used as first-line therapy for chronic pain because of its perceived safety and the assumption that, unlike nonsteroidal anti-inflammatory drugs, it has little or no effect on blood pressure (BP). Although observational studies suggest that acetaminophen may increase BP, clinical trials are lacking. We, therefore, studied the effects of regular acetaminophen dosing on BP in individuals with hypertension. Methods: In this double-blind, placebo-controlled, crossover study, 110 individuals were randomized to receive 1 g acetaminophen 4× daily or matched placebo for 2 weeks followed by a 2-week washout period before crossing over to the alternate treatment. At the beginning and end of each treatment period, 24-hour ambulatory BPs were measured. The primary outcome was a comparison of the change in mean daytime systolic BP from baseline to end of treatment between the placebo and acetaminophen arms. Results: One-hundred three patients completed both arms of the study. Regular acetaminophen, compared with placebo, resulted in a significant increase in mean daytime systolic BP (132.8±10.5 to 136.5±10.1 mm Hg [acetaminophen] vs 133.9±10.3 to 132.5±9.9 mm Hg [placebo]; P <0.0001) with a placebo-corrected increase of 4.7 mm Hg (95% CI, 2.9–6.6) and mean daytime diastolic BP (81.2±8.0 to 82.1±7.8 mm Hg [acetaminophen] vs 81.7±7.9 to 80.9±7.8 mm Hg [placebo]; P =0.005) with a placebo-corrected increase of 1.6 mm Hg (95% CI, 0.5–2.7). Similar findings were seen for 24-hour ambulatory and clinic BPs. Conclusions: Regular daily intake of 4 g acetaminophen increases systolic BP in individuals with hypertension by ≈5 mm Hg when compared with placebo; this increases cardiovascular risk and calls into question the safety of regular acetaminophen use in this situation. Registration: URL: https://www.clinicaltrials.gov ; Unique identifier: NCT01997112. URL: https://www.clinicaltrialsregister.eu ; Unique identifier: 2013-003204-40.
There is a general lack of awareness of the risk of aortic dissection in Turner syndrome (TS) from both patients with TS and their physicians. Patients often ignore symptoms for up to 24 h before seeking medical advice, significantly increasing their risk of death. A clinical profile of those at risk of dissection is emerging and includes the presence of congenital heart defects, aortic dilatation and hypertension. MRI has revolutionised the visualisation of cardiovascular anatomy in TS but remains underutilised, especially in children and adolescents, and there is currently little guidance on blood pressure (BP) assessment or hypertension management. Children and adolescents with TS at risk of dissection could be easily identified by timely imaging and BP assessment. This would allow medical management or surgical intervention to be put in place to reduce the risk of this major, and often fatal, complication. Since guidance is lacking, we have reviewed the literature on the risk factors for dissection in TS during childhood and adolescence, and make recommendations on the assessment and management of these patients.
Hyperhomocysteinemia is a rare condition which predisposes to atherothrombosis. Recurrent venous thromboembolism (VTE) with hyperhomocysteinemia is known but extremely uncommon. Homocysteine levels of more than 22 umol/L can predispose to VTE in a middle-aged women. We describe a case of a middle-aged woman, community ambulant with recurrent VTE with intermediately high homocysteine levels. She had no other risk factors for recurrent venous thrombosis. In our article, we also discuss hyperhomocysteinemia and its link to VTE.
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.
hi@scite.ai
10624 S. Eastern Ave., Ste. A-614
Henderson, NV 89052, USA
Copyright © 2024 scite LLC. All rights reserved.
Made with 💙 for researchers
Part of the Research Solutions Family.