A case report of embolic retinal artery occlusion: the lost measurement of healthcare quality.

In this case, we report a 43-year-old African-American woman who presented with acute vision loss of the left eye. The patient was found to have central retinal artery occlusion (CRAO). Clinical examination showed characteristic physical findings of severe mitral stenosis. Echoardiographic findings confirmed the diagnosis. Laboratory testing was negative for hypercoagulability diseases. The patient suffered permanent vision loss in her left eye due to thromboembolic phenomenon secondary to mitral stenosis. Few case reports in literature, most of which date back to more than half a century ago, have reported CRAO secondary to embolic phenomenon due to mitral stenosis. The patient was born and had lived all of her life in the United States; she was admitted to hospitals on several occasions for delivery, cesarean section, and routine preventive healthcare. However, the distinctive physical examination findings were detected in none of her healthcare encounters, which would have prevented such a devastating complication of mitral stenosis. Rheumatic heart disease still exists in such a developed nation, and attentive and skilful physical examination during routine healthcare visits is important for optimum medical care.

Stair design in the United States and obesity: the need for a change.

BACKGROUND: Maintenance of healthy body weight is a function of total energy expenditure including household and workplace activity. Light to moderate physical activity has been found to be effective in motivating sedentary and obese individuals, and is at least as effective as structured exercise in lowering weight in some studies. DISCUSSION: Stair use offers a promising intervention for increasing physical activity, because it involves a lifestyle choice that must be made (people must get to their destination), and it requires no personal financial cost. Stairs in United States buildings are frequently hidden from entrances with small signs denoting their location, mainly in connection to fire exits. Using the stairs is usually seen as a way of escaping from fires rather than as a recommended daily activity. To comply with State Fire Marshal regulations, stairs are usually guarded by heavy, spring doors, without air conditioning, and are noncarpeted. In this article, several suggestions to change the architectural design in buildings to be more physical activity-friendly are discussed. Such changes would make stairs attractive, safe, and readily accessible. Local and state authorities may also allow incentives for such designs to compensate for their additional costs. Moreover, standard national building codes that incorporate health concerns should be devised. CONCLUSION: Stair use at work and in living places has the potential to increase physical activity and decrease obesity. Changing stair design to encourage their use requires a series of interventions both architecturally and legislatively to create physical environments that support active lifestyles.

Clinical Inquiry: Can calcium supplements cause serious adverse effects in healthy people?

Yes, according to studies with some limitations. Calcium supplements with or without vitamin D increase the risk of myocardial infarction, with numbers needed to harm (NNH) over 5 years of 69 to 240 (strength of recommendation: B, meta-analyses of randomized controlled trials that evaluated a predominantly older female population and were limited by study designs).