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1.
Headache ; 2019 Nov 25.
Artículo en Inglés | MEDLINE | ID: mdl-31769041

RESUMEN

OBJECTIVE: We aimed to examine arterial stiffness and vitamin K2 status in migraine subjects by comparison to controls. BACKGROUND: Migraine is a primary headache disorder that has been associated with an increased risk of cardiovascular events. Mechanisms underlying this increased risk, however, remain unclear. Vitamin K2 deficiency emerged as a cardiovascular risk factor, but vitamin K2 status has never been explored in migraine subjects. DESIGN AND METHODS: This is a case-control, single-center, observational study that includes a cohort of subjects with migraine and their age- and sex-matched controls. Arterial stiffness was measured using carotid-femoral pulse wave velocity (cfPWV). Dephosphorylated-uncarboxylated matrix-Gla-protein (dp-ucMGP) was used as a marker for vitamin K2 status. A propensity-matched scoring method was used. RESULTS: A total of 146 patients (73 matched pairs) were included in this study, of whom 89% were women with a mean age of 31.9 ± 8.4 years. Compared with controls, migraine patients had statistically significantly higher mean cfPWV (7.2 ± 1.1 vs 6.4 ± 0.8 m/s, 95% confidence interval (CI) of mean difference [0.45, 1.08], P < .001), as well as higher dp-ucMGP (454.3 ± 116.7 pmol/L vs 379.8 ± 126.6 pmol/L, 95% CI of mean difference [34.63, 114.31], P < .001). Higher cfPWV was associated with higher dp-ucMGP concentrations only in the migraine with aura (MWA) group. Moreover, migraine subjects had a higher frequency of vitamin K2 deficiency (dp-ucMGP ≥ 500 pmol/L) compared to controls, but this association was not statistically significant (23/73 [31.5%] vs 16/73 [21.9%], P = .193). CONCLUSIONS: Individuals with migraine have worse indices of arterial stiffness as compared with their age- and sex-matched control subjects. This increase in arterial stiffness is associated with an increase in markers of vitamin K2 deficiency in the MWA group.

2.
Int Urol Nephrol ; 50(6): 1075-1083, 2018 Jun.
Artículo en Inglés | MEDLINE | ID: mdl-29383580

RESUMEN

Sickle cell nephropathy is a major complication of sickle cell disease. It manifests in different forms, including glomerulopathy, proteinuria, hematuria, and tubular defects, and frequently results in end-stage renal disease (ESRD). Different pathophysiologic mechanisms have been proposed to explain the development of nephropathy in SCD, where hemolysis and vascular occlusion are the main contributors in the manifestations of this disease. Markers of renal injury, such as proteinuria and tubular dysfunction, have been associated with outcomes among patients with sickle cell nephropathy and provide means for early detection of nephropathy and screening prior to progression to renal failure. In small-sized clinical trials, hydroxyurea has demonstrated to be effective in slowing the progression to ESRD. Dialysis and renal transplantation represent the last resort for patients with sickle cell nephropathy. Nevertheless, despite the availability of diagnostic and therapeutic strategies, sickle cell nephropathy remains a challenging and under-recognized complication for patients with sickle cell disease.


Asunto(s)
Anemia de Células Falciformes/complicaciones , Enfermedades Renales/fisiopatología , Enfermedades Renales/terapia , Glomérulos Renales/fisiopatología , Túbulos Renales/fisiopatología , Analgésicos/uso terapéutico , Biomarcadores/sangre , Biomarcadores/orina , Tasa de Filtración Glomerular , Hematuria/etiología , Humanos , Hidroxiurea/uso terapéutico , Enfermedades Renales/diagnóstico , Enfermedades Renales/etiología , Fallo Renal Crónico/etiología , Inhibidores de la Síntesis del Ácido Nucleico/uso terapéutico , Terapia de Reemplazo Renal
3.
BMC Med Educ ; 18(1): 9, 2018 Jan 05.
Artículo en Inglés | MEDLINE | ID: mdl-29304800

RESUMEN

BACKGROUND: Students evaluations of their learning experiences can provide a useful source of information about clerkship effectiveness in undergraduate medical education. However, low response rates in clerkship evaluation surveys remain an important limitation. This study examined the impact of increasing response rates using a compulsory approach on validity evidence. METHODS: Data included 192 responses obtained voluntarily from 49 third-year students in 2014-2015, and 171 responses obtained compulsorily from 49 students in the first six months of the consecutive year at one medical school in Lebanon. Evidence supporting internal structure and response process validity was compared between the two administration modalities. The authors also tested for potential bias introduced by the use of the compulsory approach by examining students' responses to a sham item that was added to the last survey administration. RESULTS: Response rates increased from 56% in the voluntary group to 100% in the compulsory group (P < 0.001). Students in both groups provided comparable clerkship rating except for one clerkship that received higher rating in the voluntary group (P = 0.02). Respondents in the voluntary group had higher academic performance compared to the compulsory group but this difference diminished when whole class grades were compared. Reliability of ratings was adequately high and comparable between the two consecutive years. Testing for non-response bias in the voluntary group showed that females were more frequent responders in two clerkships. Testing for authority-induced bias revealed that students might complete the evaluation randomly without attention to content. CONCLUSIONS: While increasing response rates is often a policy requirement aimed to improve the credibility of ratings, using authority to enforce responses may not increase reliability and can raise concerns over the meaningfulness of the evaluation. Administrators are urged to consider not only response rates, but also representativeness and quality of responses in administering evaluation surveys.


Asunto(s)
Prácticas Clínicas , Educación de Pregrado en Medicina , Evaluación de Programas y Proyectos de Salud/métodos , Estudiantes de Medicina , Encuestas y Cuestionarios , Adulto , Análisis de Varianza , Sesgo , Análisis Factorial , Femenino , Humanos , Líbano , Masculino , Reproducibilidad de los Resultados , Facultades de Medicina
4.
Biomed Res Int ; 2017: 2543262, 2017.
Artículo en Inglés | MEDLINE | ID: mdl-28299320

RESUMEN

Background. Prior studies have demonstrated that conventional and emerging CV risk factors are associated with worsening arterial stiffness among end-stage renal disease (ESRD) patients on hemodialysis. The present cross-sectional study evaluates the association between the etiology of ESRD and arterial stiffness among a cohort of hemodialysis patients. Methods. Etiology of ESRD was identified from patients' medical records and classified as either vascular renal disease, diabetic nephropathy, nondiabetic glomerulopathy, tubular interstitial nephropathy, hereditary nephropathy, or ESRD of unconfirmed etiology. Results. A total of 82 subjects were enrolled. cfPWV was independently associated with the composite of either diabetic nephropathy or vascular renal disease (p = 0.022), pulse pressure (p = 0.001), and a history of CV events (p = 0.025), but not history of hypertension or diabetes mellitus alone. The median cfPWVs in diabetic nephropathy and vascular renal disease were comparable and significantly higher than median cfPWVs in other etiologies of ESRD. Conclusion. The study suggests that the etiology of ESRD is independently associated with arterial stiffness among hemodialysis patients. Furthermore, arterial stiffness was higher among patients who developed renal sequelae of either diabetes mellitus or hypertension as compared with those who have a history of either diabetes mellitus or hypertension alone.


Asunto(s)
Enfermedades Cardiovasculares/complicaciones , Nefropatías Diabéticas/complicaciones , Fallo Renal Crónico/etiología , Diálisis Renal , Enfermedades Vasculares/complicaciones , Rigidez Vascular , Adulto , Anciano , Presión Sanguínea , Estudios de Cohortes , Estudios Transversales , Femenino , Humanos , Hipertensión/complicaciones , Masculino , Registros Médicos , Persona de Mediana Edad , Factores de Riesgo
5.
BMC Med Educ ; 16(1): 298, 2016 Nov 22.
Artículo en Inglés | MEDLINE | ID: mdl-27876043

RESUMEN

BACKGROUND: With the adoption of the English language in medical education, a gap in clinical communication may develop in countries where the native language is different from the language of medical education. This study investigates the association between medical education in a foreign language and students' confidence in their history-taking skills in their native language. METHODS: This cross-sectional study consisted of a 17-question survey among medical students in clinical clerkships of Lebanese medical schools. The relationship between the language of medical education and confidence in conducting a medical history in Arabic (the native language) was evaluated (n = 457). RESULTS: The majority (88.5%) of students whose native language was Arabic were confident they could conduct a medical history in Arabic. Among participants enrolled in the first clinical year, high confidence in Arabic history-taking was independently associated with Arabic being the native language and with conducting medical history in Arabic either in the pre-clinical years or during extracurricular activities. Among students in their second clinical year, however, these factors were not associated with confidence levels. CONCLUSIONS: Despite having their medical education in a foreign language, the majority of students in Lebanese medical schools are confident in conducting a medical history in their native language.


Asunto(s)
Educación de Pregrado en Medicina , Anamnesis , Multilingüismo , Estudiantes de Medicina , Prácticas Clínicas , Comprensión , Estudios Transversales , Femenino , Humanos , Líbano , Masculino , Facultades de Medicina , Estudiantes de Medicina/psicología , Encuestas y Cuestionarios , Mundo Occidental
6.
Front Physiol ; 6: 248, 2015.
Artículo en Inglés | MEDLINE | ID: mdl-26388785

RESUMEN

In a population of 56,242 individuals living in France, we showed that individuals born in France have significantly different levels of blood pressure (BP) and cardiovascular (CV) risk factors than African and Asian populations born in their own country but living long-term in France (average duration of stay, 5-10 years). The objective of our study was to investigate the impact of country of birth on BP and CV risk factors in a subpopulation of 9245 patients selected solely on the diagnosis of hypertension, either alone or with simultaneous type 2 diabetes. In the subgroup of individuals with hypertension alone, brachial systolic, diastolic, mean and pulse pressure (PP), heart rate (HR), augmentation index and PP amplification were significantly higher in African-born than French- and Asian-born populations. In the subgroup of individuals with both hypertension and diabetes, only augmentation index, PP amplification and brachial and central PP, but not brachial systolic, diastolic, mean BP, and HR, were elevated when the African-born subgroup was compared to the French- and Asian-born populations. Increased body mass index (BMI), waist-hip ratio (WHR), and deprivation scores, but not increased plasma lipids or glycemia, were consistently associated with the African-born population. The combination of diabetes and hypertension in African populations was associated with increased aortic stiffness and PP, together with greater body weight and WHR. In individuals with increased PP and hence systolic hypertension, increased PP requires systolic BP to be reduced whereas notable reductions in diastolic BP may have deleterious consequences.

7.
Exp Clin Transplant ; 13 Suppl 1: 55-8, 2015 Apr.
Artículo en Inglés | MEDLINE | ID: mdl-25894128

RESUMEN

Organ procurement and transplant improve health outcomes among patients with organ failure. Although many strategies have been developed to overcome the organ shortage, the worldwide rates of organ donation remain suboptimal. The lack of commitment to the health care mission of organ donation and the limited expertise of health care professionals reflect 2 major barriers to organ procurement and raise the need to teach organ procurement to health care professionals early during their undergraduate education. To accommodate the various available curricular models and to develop a homogeneous and equitable teaching methodology irrespective of the adopted design, an early step is to set clear goals and objectives for an organ procurement program. Outcomes should be matched to different academic levels and tailored to the duration of each medical and nursing curriculum. In all cases, hands-on experience leads to a better understanding of the topic, especially with the advent of simulation techniques that may be useful for training as well as testing purposes. An effective program finally requires that attainment of objectives and outcomes are systematically tested using proper evaluation tools that adequately pair with the curricular design. In conclusion, organ procurement teaching should adopt a systematic evidence-based approach that simultaneously contributes to medical and nursing education and improves organ donation rates.


Asunto(s)
Actitud del Personal de Salud , Educación de Pregrado en Medicina/métodos , Educación en Enfermería/métodos , Medicina Basada en la Evidencia/educación , Conocimientos, Actitudes y Práctica en Salud , Estudiantes de Medicina/psicología , Estudiantes de Enfermería/psicología , Enseñanza/métodos , Obtención de Tejidos y Órganos , Curriculum , Humanos , Rol de la Enfermera , Rol del Médico
8.
Med Teach ; 36(3): 240-4, 2014 Mar.
Artículo en Inglés | MEDLINE | ID: mdl-24289251

RESUMEN

PURPOSE: Previous studies have shown that the standardized patient's (SP) gender may affect student performance in an Objective Structured Clinical Examination (OSCE). The aim of this study is to investigate the influence of the SPs' body habitus on students' performance in an OSCE counseling station. METHODS: Four equally trained female SPs, with either a normal or an obese BMI participated in an OSCE counseling station for cardiovascular risk factors. Ninety-two, second year medical students were randomly assigned to one of the SPs. Station scores were compared and student behavior and opinion regarding the influence of their SP's body habitus on their performance was assessed. RESULTS: There was no difference in mean exam scores for students interacting with SPs with a normal BMI versus increased BMI (14.9 ± 2.2 versus 14.01 ± 2.2/20 respectively, p = 0.06). Additionally, almost all students gave advice about healthy diets (93.5% versus 95.7%) with no specificity regarding the BMI of the SP. CONCLUSIONS: The body habitus of the SP did not significantly affect students' performance in an undergraduate OSCE about cardiovascular risk factors, suggesting that students at that level may primarily focus on gaining points the diagnostic checklist without considering SPs as real patients.


Asunto(s)
Competencia Clínica , Obesidad/diagnóstico , Obesidad/terapia , Examen Físico/psicología , Estudiantes de Medicina/psicología , Adulto , Índice de Masa Corporal , Comunicación , Dieta , Evaluación Educacional , Femenino , Humanos , Masculino , Simulación de Paciente , Relaciones Médico-Paciente , Pérdida de Peso
9.
Am J Hypertens ; 26(10): 1205-9, 2013 Oct.
Artículo en Inglés | MEDLINE | ID: mdl-23727841

RESUMEN

BACKGROUND: Masked hypertension has been associated with obesity. However, because most studies do not mention the specific cuff size used for home measurements, masked hypertension prevalence may have been overestimated in obese patients because of undersized cuffs. In this prospective, observational study, the effect of miscuffing on hypertension status was evaluated in patients with large arms. METHODS: Fifty-three patients with an upper-arm circumference >33cm, undergoing treatment for mild-to-moderate hypertension, took 2 sets of home blood pressure (BP) measurements (standard vs. large cuff) using the validated Microlife BP A100 Plus automated device. RESULTS: Mean BP was 143/85mm Hg at the office using a large cuff, 141/84mm Hg at home using a standard cuff, and 134/80mm Hg at home using a large cuff. Standard vs. large cuff home BP mean differences were 6.9mm Hg (95% confidence interval (CI) = 4.7-9.2; P < 0.0001) for systolic BP and 4.0mm Hg (95% CI = 2.4-5.5; P < 0.0001) for diastolic BP. Hypertension status differed significantly between standard vs. large cuffs: sustained hypertension (56.6% vs. 41.5%, respectively; P = 0.002), controlled hypertension (20.8% vs. 28.3%, respectively; P = 0.04), white coat hypertension (7.5% vs. 22.6%, respectively; P = 0.002), masked hypertension (15.1% vs. 7.5%, respectively; P = 0.04). CONCLUSIONS: In patients with large arms, use of an appropriately sized large cuff for home BP measurements led to a 2-fold reduction in masked hypertension. Regarding clinical and epidemiological implications, future studies investigating masked hypertension should specify cuff size for home BP measurements. The low market availability and increased cost of large cuffs should also be addressed.


Asunto(s)
Monitoreo Ambulatorio de la Presión Arterial/instrumentación , Hipertensión Enmascarada/diagnóstico , Anciano , Brazo/anatomía & histología , Presión Sanguínea/fisiología , Determinación de la Presión Sanguínea , Femenino , Humanos , Masculino , Hipertensión Enmascarada/epidemiología , Persona de Mediana Edad , Obesidad/fisiopatología , Prevalencia , Pronóstico , Estudios Prospectivos , Hipertensión de la Bata Blanca/diagnóstico
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