Are We Aiming for Cure or Lifelong Treatment of Hypertension? All Doctors Need To Be Aware of Primary Aldosteronism. A Nationwide Study With Up To 8-Year Follow-Up

Purpose Long term follow-up studies on primary aldosteronism (PA) diagnosis, treatment response and comparison of the two major subgroups – unilateral (UD) and bilateral disease (BD) – are lacking. While adrenalectomy for UD is considered effective, less is known about long-term effects of specialized treatment for BD. We present the results from our nationwide observational study, executed at Landspitali University Hospital, tertiary referral center. We aim to review results of diagnostic procedures and histopathology for PA patients diagnosed in 2012-2016 in Iceland, compare UD and BD and assess treatment response. Methods A total of 32 PA patients aged 28-88 years were diagnosed and treated according to current guidelines. Adrenalectomy was used for AVS-confirmed UD and mineralocorticoid receptor antagonists for BD. Results The majority of patients had BD, roughly half of them had a unilateral nodule. With specialized treatment, a reduction was seen in UD and BD in systolic blood pressure (BP) (p<0,001, both groups), antihypertensive drug count (p=0,002 and p=0,04, respectively) and need for potassium supplementation (p<0,001, both groups). Diastolic BP decreased significantly in UD (p<0,001). Conclusion Our results show similarly good treatment response in both subgroups. Ratio of hypokalemia and number of cases indicates severe PA underdiagnosis in Iceland. Adrenal nodules diagnosed using CT can be misleading and AVS is mandatory in diagnosing unilateral vs bilateral PA.

Comparison of Domestic and Foreign Audiologist Education Status and Qualification System

Audiologists are experts in providing specialized treatment for evaluating and managing hearing loss through hearing technology. The purpose of this study is to review the education status of major foreign countries regarding the training of audiologists, their certification management systems, and the audiology education regulations according to international standards; this study compares these with the domestic (i.e., Republic of Korea) education status, certification management system, and audiology education regulations. The regulations, reports, and official documents related to domestic and overseas regarding audiology systems were reviewed and compared. The domestic audiologist education and qualification system is in fair conformity with foreign countries and international standards, but there are areas that need to be improved. If the domestic audiologist qualification system is improved to comply with advanced foreign national audiologist qualification systems and international standards, it will be possible to cultivate a more professional domestic audiologist workforce.

Time-trends and predictors of interhospital transfers and 30-day rehospitalizations after acute coronary syndrome from 2000-2015

Aims Assess trends and factors associated with interhospital transfers (IHT) and 30-day acute coronary syndrome (ACS) rehospitalizations in a national administrative database of patients admitted with an ACS between 2000–2015. Methods and results Cohort study of patients hospitalized with ACS from 2000 to 2015, using a validated linkage algorithm to identify and link patient-level sequential hospitalizations occurring within 30 days from first admission (considering all hospitalizations within the 30-day timeframe as belonging to the same ACS episode of care-ACS-EC). From 212,481 ACS-EC, 42,670 (20.1%) had more than one hospitalization. ACS-EC hospitalization rates decreased throughout the study period (2000: 207.7/100.000 person-years to 2015: 185,8/100,000 person-years, p for trend <0.05). Proportion of IHT increased from 10.5% in 2000 to 20.1% in 2015 compared to a reduction in both planned and unplanned 30-day ACS rehospitalization from 9.0% in 2000 to 2.7% in 2015. After adjusting for patient and first admission hospital’s characteristics, compared to 2000–2003, in 2012–2015 the odds of IHT increased by 3.81 (95%CI: 3.65–3.98); the odds of unplanned and planned 30-day ACS rehospitalization decreased by 0.36 (95%CI: 0.33; 0.39) and 0.47 (95%CI: 0.43; 0.53), respectively. Female sex, older age and the presence and severity of comorbidities were associated with lower likelihood of being transferred or having a planned 30-day ACS rehospitalization. Unplanned 30-day ACS rehospitalization was more likely in patients with higher comorbidity burden. Conclusion IHT and 30-day ACS rehospitalization reflect coronary referral network efficiency and access to specialized treatment. Identifying factors associated with higher likelihood of IHT and 30-day ACS rehospitalization may allow heightened surveillance and interventions to reduce rehospitalizations and inequities in access to specialized treatment.

Challenges affecting couples resorting to Assisted Reproductive Treatment (ART) in Romania

Objective: The aim of this paper is to illustrate the main points of interest regarding the way treatment of infertility impacts the life of couples who struggle with this condition in Romania. The unique aspects and specific challenges regarding social, financial and psychological implications that affect Romanian couples who access specialized treatment for infertility will be thoroughly discussed. Methods: This study is a descriptive cross-sectional research. The sample population included patients who attended specialized infertility treatment (Assisted Reproductive Techniques - ART) in Fertility Clinics from Romania. The study was conducted between 2017 and 2019 and data was gathered through two infertility questionnaires. Results: The questionnaire for women was filled in by 829 female participants who struggled with infertility and resorted to ART and the questionnaire for men was completed by 227 male participants, as partners of the women, some of them as well with fertility issues. We analysed the results regarding all aspects surrounding infertility and ART, such as: psychological implications, impact of stress, access to specialized treatment, costs for treatment. Conclusion: The results showed that couples who struggle with infertility have to deal with high costs for specialized infertility treatments, in addition to stress related to treatment, creating a combination which negatively impacts their future chances of getting a pregnancy.

Criteria of medical response to radiological emergencies in the Republic of Belarus

The Republican Research Center for Radiation Medicine and Human Ecology in the Internal and External Emergency Plans of the Belarusian nuclear power plant is specified as an institution that provides specialized treatment for personnel, as well as persons from the population living in the emergency zone of the station. The plant is the first facility in the Republic that used nuclear energy. There is no experience in treating radiation injuries in Belarus. This is the first time that the National Health Service has been assigned the task of ensuring readiness for the reception and specialized treatment of people who have been exposed to emergency or unplanned radiation. The purpose of the work is to establish criteria for radiation exposure for use in a Belarusian specialized medical institution in case of medical response to radiological accidents. As a result of the analysis of publications of international organizations, the criteria of radiation exposure that can be applied in the conditions of Belarusian specialized medical institutions were selected. Assessment of the criteria was made taking into account existing national technical regulations and the available capabilities of emergency response participants. To account for the quality of radiation in relation to deterministic effects “Gy-equivalent” is used. The criteria include both dosimetric values for cases of external and internal accidental and unplanned exposure, and levels of radioactive substances with unknown physical and chemical properties entering the body that require urgent medical intervention. Criteria for cases of surface contamination of skin and wounds require separate consideration.