Assessing Utility of 24-Hour Ambulatory Blood Pressure Monitoring to Distinguish Pediatric Populations Presenting with Elevated Blood Pressure in Rhode Island

This retrospective study aimed to assess the value of 24-hour ambulatory blood pressure monitoring (ABPM) in distinguishing primary from secondary hypertension in pediatric patients. Our study was conducted on 293 patients referred to a pediatric nephrology clinic over 11 years. Various ABPM parameters were analyzed, including daytime and nighttime systolic and diastolic blood pressures, heart rate, and blood pressure load. Among the participants, 74% were normotensive (white-coat hypertension), 21.5% had primary hypertension, and 4.4% had secondary hypertension. There were no significant differences in the analyzed variables between primary and secondary hypertension groups. Our findings suggest that ABPM might not reliably differentiate between the two in this cohort. As white-coat hypertension becomes more prevalent, ABPM remains a valuable tool in preventing unnecessary workups in children without sustained hypertension. However, our study did not identify specific endpoints for distinguishing primary from secondary hypertension.

Association of Metformin With the Development of Age-Related Macular Degeneration

Importance

Age-related macular degeneration (AMD) is a leading cause of blindness with no treatment available for early stages. Retrospective studies have shown an association between metformin and reduced risk of AMD.

Objective

To investigate the association between metformin use and age-related macular degeneration (AMD).

Design, Setting, and Participants

The Diabetes Prevention Program Outcomes Study is a cross-sectional follow-up phase of a large multicenter randomized clinical trial, Diabetes Prevention Program (1996-2001), to investigate the association of treatment with metformin or an intensive lifestyle modification vs placebo with preventing the onset of type 2 diabetes in a population at high risk for developing diabetes. Participants with retinal imaging at a follow-up visit 16 years posttrial (2017-2019) were included. Analysis took place between October 2019 and May 2022.

Interventions

Participants were randomly distributed between 3 interventional arms: lifestyle, metformin, and placebo.

Main Outcomes and Measures

Prevalence of AMD in the treatment arms.

Results

Of 1592 participants, 514 (32.3%) were in the lifestyle arm, 549 (34.5%) were in the metformin arm, and 529 (33.2%) were in the placebo arm. All 3 arms were balanced for baseline characteristics including age (mean [SD] age at randomization, 49 [9] years), sex (1128 [71%] male), race and ethnicity (784 [49%] White), smoking habits, body mass index, and education level. AMD was identified in 479 participants (30.1%); 229 (14.4%) had early AMD, 218 (13.7%) had intermediate AMD, and 32 (2.0%) had advanced AMD. There was no significant difference in the presence of AMD between the 3 groups: 152 (29.6%) in the lifestyle arm, 165 (30.2%) in the metformin arm, and 162 (30.7%) in the placebo arm. There was also no difference in the distribution of early, intermediate, and advanced AMD between the intervention groups. Mean duration of metformin use was similar for those with and without AMD (mean [SD], 8.0 [9.3] vs 8.5 [9.3] years; P = .69). In the multivariate models, history of smoking was associated with increased risks of AMD (odds ratio, 1.30; 95% CI, 1.05-1.61; P = .02).

Conclusions and Relevance

These data suggest neither metformin nor lifestyle changes initiated for diabetes prevention were associated with the risk of any AMD, with similar results for AMD severity. Duration of metformin use was also not associated with AMD. This analysis does not address the association of metformin with incidence or progression of AMD.

Assessment and treatment of psychosocial problems in cancer patients: an exploratory study of a course for nurses

A course in psychosocial oncology for nurses was developed and evaluated within the framework of a prospective randomised study. Six nurses participated. Areas covered were basic techniques for assessment of psychosocial problems, for relieving anxiety and depression, solving problems in conjunction with treatment and disease, and improving communication. Participants met for four 3h weekly lessons. Between meetings, they met to train assessment and techniques. Follow-up discussions were held at termination and 5 months later. Participants reported that the new knowledge and skills had made them feel more confident when handling patients' psychosocial situation. However, treatment of psychological problems did not prove to be a predominant aspect of their patient work. The evaluation of the course suggests that participants improved their skills for assessment of patient problems and, therefore, felt more confident when handling psychosocial issues.

Public health in the new millennium II: Social exclusion

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Public health in the new millennium III: global health and the economy

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Truisms or truth?

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Treatment of renal allograft rejection by exchange plasma-lymphocytapheresis

Therapy for acute renal allograft rejection generally consists of administration of high doses of corticosteroids along with cytotoxic drugs. Failure of this treatment usually dictates removal of the graft. We describe a patient who was rejecting a renal transplant from his HLA-identical, mixed lymphocyte culture-compatible brother. This acute rejection episode was unresponsive to three days of therapy with high doses of steroids, azathioprine and coumadin. The patient rapidly improved following intensive exchange plasmapheresis and lymphocytapheresis. This therapy produced depletion of immunoglobulins, complement components, coagulation factors and circulating lymphocytes, and resulted in dramatic improvement in renal function and reversal of the rejection crisis. We suggest that intensive pheresis may represent an important adjunct to currently available therapy for the treatment of acute renal allograft rejection.