盐城市县乡级医院内科医生《中国高血压防治指南》知晓情况调查

[目的]了解内科医生对《中国高血压防治指南》的知晓情况，提高《中国高血压防治指南》实施效果。[方法]2004年，抽取盐城市各县（市、区）部分县乡级医院具有执业医师资格的内科医生，调查对《指南》的知晓情况。[结果]调查114家县级医院、27家乡级卫生院的165名内科医生，对高血压的诊断标准能全面正确了解的占58．18%，21．82％的知道测量血压的正确部位，只有43．64％的能正确读取血压值，33．33％的知道要对所有就诊的患者测量血压。20．61％的知晓奶油中含有较高的胆固醇，41．21％的知晓番茄、香蕉有降压作用，75．76％的知道每人每天食盐的标准摄入量。[结论]县乡级医疗机构内科医生对《中国高血压防治指南》的知晓率比较低。     

Assessing guideline adherence in patients with non-variceal upper gastrointestinal bleeding receiving antiplatelet and anticoagulant therapy

Abstract

Background & aims: Non-variceal upper gastrointestinal bleeding (NVUGIB) occurs frequently and is associated with a significant morbidity and mortality, especially in patients receiving antiplatelet or anticoagulant therapy (APT and ACT, respectively). We aimed to evaluate adherence to guideline recommendations published by European Society of Gastrointestinal Endoscopy (ESGE).

Methods: Retrospective analysis of patients with NVUGIB und prior exposition to APT or ACT at a single university hospital between 01 January 2016 and 31 December 2017.

Results: 270 patients were identified (70.4% male, median age 72?years). 6/17 (35.3%) patients receiving APT for primary cardiovascular prophylaxis, 39/71 (54.9%) and 35 (49.3%) patients receiving APT for secondary cardiovascular prophylaxis (using strict and liberal definition, respectively) and 13/25 (52%) patients receiving dual antiplatelet therapy (DAPT) were not managed according to current recommendations. Management of ACT for secondary thromboembolic prophylaxis did not follow guideline recommendations in 59/93 (63.4%) and 34/93 (36.6%) patients (using strict and liberal definition, respectively). 23.7% of patients with NVUGIB were exposed to combined APT and ACT for whom no guideline recommendations exist. Mortality for any reason was twice as high in patients who were not managed according to guideline recommendations (18.8% vs. 8% using strict definition, 20.5% vs. 10.2% using liberal definition), which did not remain significant after adjusting for comorbidities, whereas cardiovascular events were observed at similar rates.

Conclusion: A significant number of patients with NVUGIB receiving APT or ACT is not managed according to current ESGE guideline recommendations. Strategies to implement these guidelines into daily practice need to be developed.     

中国胰腺癌诊治指南（2021）

正胰腺癌的发病率在世界范围内呈持续上升态势。2021年统计数据显示,在美国所有恶性肿瘤中,胰腺癌新发病例男性居第10位,女性居第9位,占恶性肿瘤相关病死率的第4位~([1])。中国国家癌症中心2017年统计数据显示,胰腺癌位列我国男性恶性肿瘤发病率的第7位,女性第11位,占恶性肿瘤相关病死率的第6位~([2])。作为预后极差的消化道肿瘤,胰腺癌具有早期诊断困难、手术切除率低、术后易复发转移等临床特点,临床诊治极具挑战性。     

Guidelines on the Treatment of Chronic Coinfection by Trypanosoma cruzi and HIV Outside Endemic Areas

Abstract

As a result of population migration, Chagas disease is no longer limited to the North and South American continents. In HIV-infected patients, chronic infection by Try-panosoma cruzi behaves as an opportunistic infection in severely immunosuppressed patients and is responsible for high morbidity and mortality. Unlike other opportunistic infections, information on the natural history, diagnosis, treatment, and prevention of Chagas disease is scarce. Spain has the highest number of cases of Chagas disease outside the North and South American continents, and coinfection with HIV is increasingly prevalent. In this article, the Spanish Society for Tropical Medicine and International Health (Sociedad Española de Medicina Tropical y Salud Interna-cional) reviews the current situation of coinfection with HIV and T. cruzi infection and provides guidelines on the diagnosis, treatment, and prevention in areas where Cha-gas disease is not endemic. It also identifies areas of uncertainty where additional research is necessary.