Journal of General Practice

Introduction: Empirically, the analyses of mortality have been on age, crude death rate, age-specific death rates and infant mortality, not mortality and inflation. Objectives: The present work 1) evaluates mortality and inflation patterns, 2) models mortality, inflation and crude death rates, and 3) assesses age-specific mortality. Methods: Using at least 20 years of data on Jamaica (1989-2009), inflation, mortality, and mortality and inflation were graphed, and models were created to fit the data. Results: Mortality pattern is best fitted by a 6 degree polynomial (R2 = 0.789). Less than 20% of the change in mortality can be accounted for by a 1% change in inflation, and about 60% of deaths occurred at 60+ years and 70% at 75+ years. Conclusion: This work offers insights into the insignificant influence that inflation has on mortality except age, and provides pertinent information for its inclusion in the economics of death, particularly at older ages.

Introduction: Diabetes care to the standard targets is an art need trained health care provider’s work in harmony. It is not an easy job; it is a continuous process of hard team works. Primary care practice is a busy practice where diabetes care is part of a complex daily care covering other health problems. In spite of this multiple daily care services, we raised the question if our care took our patients to meet target goals settled by the American diabetes association or not?. Assessing the current situation is the first step to catch the standards. Objectives: To determine the degree of glycemic control by using HbA1c and lipid profile control by measuring total cholesterol, low density lipo-protein, high density lipo-protein and triglycerides. To detect variations in HbA1c, lipid or Vit D control during the year 2013 Methodology: Cross sectional study was designed and conducted at Alwaha medical specialist center; one of the National Guard health affairs / WR primary care centers. Chronic disease registry was designed. A list of 1224 diabetic patients' records were reviewed and 302 patients' records were randomly selected. HbA1c values were detected with total cholesterol (T-Chol), low density lipoprotein (LDL) and vitamin D. HbA1c and lipid profiles were clustered into three groups; group A (1st Jan – 30st April 2013), group B (1st May – 31st August 2013). Group C (1st Sep – 31st Dec 2013). The American Diabetes Association 2014 target goals for diabetic patients were adopted. Data was collected and analyzed using SPSS software. Results: Three hundred and two, medical records were reviewed (110 males, 192 females) with mean age 57.31 ± 11.47. The overall means of HbA1c 8.73 ± 2.04 , total cholesterol (T-Chol) 4.6 ± 1.17 mmol/L, low density lipoprotein (LDL) 2.7 ± 0.85 mmol/L, high density lipoprotein (HDL) 1.02 ± 0.23 mmol/L, Triglyceride (TG) 1.68 ± 1.08 mmol/L and vitamin D 42.32 ± 22.56 nmol/l were calculated as shown. There were no statistical differences in HbA1c between groups A vs B or C (7.65 ± 3.49 vs 8.03 ± 2.85 and 7.69 ± 3.28), P values were 0.3 and 0.9. For Vit D means there were no statistical differences between groups (32.46 ± 26.12 nmol/l vs 31.83 ± nmol/l and 29.54 ± 29.68 nmol/l; P values were 0.8 and 0.36. There was no statistically difference between male and female in their overall mean HbA1c values (HbA1c 8.49 ± 1.86 vs 8.86 ± 2.14); P value was 0.13. Males showed better LDL means than females; 2.54 ± 0.88 vs 2.81 ± 0.83 (P value 0.0082). Interestedly, those who did there HbA1c once, twice and thrice were 42.4%, 31.8% and 25.8% respectively while 61.2% meet ADA HbA1c target goal. Conclusion: Targeted glycemic and lipid control was difficult to achieve in primary care setting. More studies were recommended to analyzed barriers to achieve control and how to overcome them.

Background: First described in 1760, Pott’s Puffy Tumor (PPT) is frontal bone osteomyelitis and sub-periosteal abscess complicated by frontal sinusitis. Currently, it’s a very rare complication due to the advent of Antibiotics and even more rare in adults than adolescents as developmental differences in cranial anatomy have been presumed to be the reason why more cases are seen in the younger age group. Only 32 adult cases are reported since 1990 to date. Most common organisms being streptococci, staphylococci, and anaerobes. The Case: 51 year old African American male patient presented with worsening frontal headache and a painful swelling on the forehead along with diplopia. Past history is positive for HIV, diagnosed 7 years earlier, not on antiretroviral therapy, in addition to surgery for head trauma 13 years prior. With appropriate medical and surgical management, the patient had significant improvement on examination and his diplopia resolved. Cultures from drainage grew Propioni bacterium sp. Discussion: We present a unique case of PPT on a patient with a history of head trauma and HIV, both acting as predisposing factors for his delayed presentation. This link may suggest a possible epidemiological transition in the trends of comorbidities predisposing to PPT since HIV prevalence has been in the rise. It is also a case with the longest documented latency period between head trauma and PPT presentation date. This, combined with unusual anaerobic bacterial isolates, make this new case report a pioneer in pointing out PPT’s association with novel risk factors.

Mondor's disease is superficial thrombophlebitis involving the chest wall, breast, abdomen and penis. It is an entity and unknown to many physicians and considered under diagnosed and under reported. In recent years the therapeutic approach to superficial venous thrombosis is changing. In this article we discuss the presentation of this condition in the chest wall, etiology, epidemiology, diagnosis and treatment. We believe that by familiarity of physicians with Mondor's disease will help them in the diagnosis and treatment of patients, and also with reporting and building a data base for further research.

Background: Impaired renal function is a strong prognostic factor in Chronic Heart Failure (CHF). Most studies ofit, however, have assessed single measurements of renal function. Thus, the purpose of the present study was todetermine the prognostic significance and importance of serial measurements of renal function before and afterhospital discharge.
Methods and results: A total of 542 consecutive patients admitted for worsening CHF (455 males, 60.6 ± 14.2years) were studied. Estimated glomerular filtration rate (eGFR) was evaluated before discharge and 6 months later.Patients were followed-up to register cardiac death and rehospitalization due to worsening heart failure. We dividedstudy subjects into four groups based on changes in renal function between before discharge and 6 months after.These were Group 1: normal to normal eGFR (≥60 mL/min/17.3m2), Group 2: reduced (<60 mL/min/17.3m2) tonormal eGFR, Group 3: normal to reduced eGFR, and Group 4: reduced to reduced eGFR. Compared to Group 1,Groups 2, 3 and 4 had relative risks of 2.265-fold (P<0.05), 4.055-fold (P<0.001) and 3.974-fold (P<0.001),respectively, for adverse cardiac events after discharge. The multivariate Cox proportional hazard regressionanalysis demonstrated that log BNP at 6 months after discharge (hazard ratio [HR]: 1.768, P<0.001), peak VO2 (HR:0.859, P<0.001) and eGFR <60 mL/min/1.73m2 at 6 months (HR: 1.854, P<0.05), but not eGFR at discharge, wereindependent predictors for cardiac events.
Conclusion: Changes in renal function by serial measurements after discharge are important for the assessmentof risk in CHF.

Two London Universities, University College London and Imperial College London, have established a biobank as a resource for investigating the four main complications of pregnancy (recurrent miscarriage, preterm birth, fetal growth restriction (FGR) and pre-eclampsia), that collectively affect about 20% of families trying to conceive. Samples are being taken from the three key members of the family, mother, father and baby, allowing hereditary factors from both parents to be tracked. Additional samples are being stored to allow parallel analysis of the functional mechanisms of pregnancy including the epigenetic, anatomical, physiological and even metabolic causes for the high loss of fecundity in man. http://www.ucl.ac.uk/babybiobank.

Background: Capnography is widely used as a non-invasive monitoring technique for intra-operative and postoperative mechanically ventilated patients. Aim: To study whether the EtCO2 values should be used to adjust mechanical ventilation during low cardiac output states such as off pump cardiac bypass surgery (OPCABG). Setting and design: Prospective study in 50 patients undergoing OPCABG. Material and Methods: The values of cardiac index (CI), EtCO2, PaCO2 and P(a-Et)CO2 gradient were compared at two time points during OPCABG: immediately before skin incision and during grafting of obtuse marginal artery, as usually OM grafting is considered to be associated with low cardiac output. Statistics: Data was analysed using student’s t-test. Results: There was a significant decrease in the value of CI from point A to point B (2.33 vs. 1.75 L/min/m2, p<0.001), significant decrease in EtCO2 from 25.28 to 21.88mmHg (p<0.001) and statistically significant increase in P(a-Et)CO2 gradient 4.39 at point A to 9.18 mmHg at point B (p<0.003). Conclusion: The decrease in EtCO2 had a positive correlation with the decrease in cardiac index. So during the low flow periods as found in OPCABG, EtCO2 cannot reliably estimate the adequacy of ventilation.