Journal of General Practice

Peripheral artery disease (PAD) has been associated with specific risk factors such as smoking, diabetes mellitus (DM) as well as previous coronary and cerebrovascular disease [1]. The prevalence of DM for all age groups worldwide was estimated to be 2.8% (171 million) in 2000, a figure that was predicted to double over the subsequent two decades [2]. Moreover, approximately 20% to 30% of patients with diabetes also have PAD. Diabetic patients are at high risk for PAD characterized by symptoms of intermittent claudication (IC) or critical limb ischaemia. Furthermore, the presence of PAD identifies those at increased risk of ulceration, failure to heal an ulcer, and amputation [3]. Finally, patients with IC and DM have more risk cardiovascular factors, cardiovascular conditions, disability and worse haemodynamic status and quality of life than claudicant patients without diabetes [4]. Therefore, proper diagnostic and therapeutic management of such patients in the general practice is a crucial matter in order to decrease morbidity and improve quality of life.

Background: The acute coronary syndromes encompass a spectrum of unstable angina to trans-mural myocardial infarction. The definition of acute coronary syndrome depends on the specific characteristics of each element of the triad of clinical presentation, electrocardiographic changes and biochemical cardiac markers.

Objectives: To assess Correlation between P wave dispersion, QRS duration and QT dispersion in hospital events in patients with Acute Coronary Syndrome [ACS].

Methods: This prospective study was conducted on 60 patients with acute coronary syndrome admitted to critical care units of Alexandria University Hospitals from first of January 2012 to end of August 2012. An informed consent was taken from relatives of every patient included in the study. This study was approved by ethical committee of Alexandria Faculty of Medicine.

Results: During the observation up to 5 days, 1 patient [1.6%] developed AF. There was no significant correlation between P wave Dispersion [PD] in the three studied groups and No significant relation between its and the whole complications developed in failed thrombolysis group [p>0.05]. PD alone couldn’t predict AF in this study, as the mean was 20.0 milliseconds, which was too small to predict AF alone.There was no significance difference between QRS duration in the three groups [unstable angina, successful thrombolysis and failed thrombolysis respectively with mean value [75.7 ± 14.02, 75.2 ± 10.88, 73.36 ± 8.81] [p>0.05] and the relationship between the QRS duration and the development of complications was non-significant in this study. This study showed that there was a significant relation among the three groups and highly significant correlation between QTD duration and prediction of complications. It was clear that ICU length of stay was longer in patients with failed thrombolysis in comparison with the other two groups [p<0.05]. Conclusions: Importance of measurements of QT Dispersion to patients with acute coronary syndrome especially at admission. Failed thrombolysis patients should be under close observation and Monitoring till another option is available like coronary intervention.

The likelihood of periprosthetic infection in high-risk patients (obesity and diabetes mellitus) after revisional arthroplasty is extremely high. The authors conducted a pilot prospective comparative study of clinical and economical efficacy of interactive absorbing dressings based on carboxymethyl cellulose impregnated with silver ions and single-use vacuum assisted dressings in prevention of surface surgical site infections in high-risk patients.

Statins competitively inhibit 3-hyroxy-3-methylglutaryl coenzyme A (HMG CoA) reductase, an enzyme involved in cholesterol synthesis, especially in the liver. Statins are considered for all patients with cardiovascular diseases such as coronary heart disease, peripheral vascular disease, non-haemorrhagic stroke, and transient ischemic attacks. Pleural and pericardial effusions may be caused by infectious diseases, malignancies and autoimmune disorders. However, unexplained effusions should raise the possibility of drugs as being the cause. Drug-induced anemia may be in the form of auto-immune or oxidative hemolysis, aplastic anemia, sideroblastic anemia or megaloblastic anemia. I report a case of lymphocytic pleural effusion, pericardial effusion and megaloblastic anemia in a patient known to have ischemic stroke, diabetes mellitus and hypertension. In the view of un-yielding clinical and laboratory evaluation, a drug-induced reaction was suspected. Because of the recent addition of simvastatin to the patient's regimen, the improvement of the patient's condition after discontinuation of simvastatin and recurrence of symptoms following it's re-administration, a conclusion was made that simvastatin may be the cause of the patient's clinical picture and should be further considered as a cause of unexplained pleural and pericardial effusions, and megaloblastic anemia.

There is no doubt that we face major problems both in health care quality and costs. The crucial question for the Employer (Buyer) is how to respond to these issues. There is a solution. Simply stated, the failure we are experiencing today is, basically, a failure in our primary care system. Therefore, any initiative that strives to improve the overall quality and cost of care must focus on primary care.