M21 – When to Consider and How to Perform Case Detection Testing for Endocrine Hypertension

2013 ◽  
pp. 15-28
Author(s):  
Jacques Lenders
Keyword(s):  
Case Detection ◽  
Endocrine Hypertension

scholarly journals SUN-LB92 The Importance of Early Diagnosis and Treatment of Primary Aldosteronism on the Progression of Chronic Kidney Disease, Compared With Essential Hypertension: A Retrospective Cohort Study

2020 ◽  
Vol 4 (Supplement_1) ◽  
Author(s):  
Jayoung Lim
Keyword(s):  
Essential Hypertension ◽  
Surgical Treatment ◽  
Primary Aldosteronism ◽  
Medical Center ◽  
Case Detection ◽  
Renal Protection ◽  
Treatment Groups ◽  
Endocrine Hypertension ◽  
Study Support ◽  
Better Than

Abstract <META NAME=“author” CONTENT=“Windows 사용자”>Introduction: Primary aldosteronism(PA) has few clinical phenotypes and features, compared with other endocrine hypertension(HTN). Even though hypokalemia is a typical sign of PA, most of PA reveals normal potassium concentration. For that reason, PA is likely to undetected and underestimated and it may account for larger proportion of total HTN than we expected. However, it has known that PA has higher risk of renal complications than essential hypertension(EH) and has been controversy which treatment between medication and operation is better for renal protection of PA. Methods: We retrospectively reviewed the medial records of patients with PA and EH of a single medical center from January, 2009 to December, 2019. PA patients were divided into medical and surgical treatment groups. EH patients were distinguished from one that satisfied with case detection test, called non-confirmed PA. We excluded cases with other secondary HTN and baseline eGFR < 60 mL/min/1.73m2. Results: Patients with PA(N=66) and patients with EH(N=514) were selected for analysis. Each baseline mean eGFR of patients with PA and EH indicated 91.2 ± 74.5 and 87.1 ± 19.7 mL/min/1.73m2 and statistically insignificant differences(P = 0.1688) as well as baseline SBP(P = 0.5403) and DBP(P = 0.8691). However, in spite of treatment of PA and controlled BP, mean eGFR of PA patients was lower than one of EH patients and its difference was statistically significant showing 66.5 ± 14.2 and 94.6 ± 195.9 mL/min/1.73m2 (P < .0001) at 2~ 5 years, 52.4 ± 17.9 and 77.6 ± 20.6 mL/min/1.73m2 (P < 0.0004) at 6~10 years. Baseline mean eGFR of PA with normokalemia and hypokalemia respectively were 77.7 ± 11.6 and 98.9 ± 92.5 mL/min/1.73m2 (P = 0.0269). Baseline mean eGFR of non-confirmed PA and EH were 82.5 ± 13.2 and 88.4 ± 21.1 mL/min/1.73m2 (P = 0.0240). Although baseline mean eGFR of PA with surgical treatment was better than one with medical treatment, it was reversal after 2~5 years indicating mean eGFR of PA patients treated with operation, 62.9 ± 16.1 mL/min/1.73m2 and one treated with spironolactone, 70.5 ± 12.6 mL/min/1.73m2 (P = 0.0010). Conclusions: This study support PA has worse effects on renal function than EH. PA is frequently unsuspected and undiagnosed because it hardly shows symptoms and signs. Many cases do not reveal main characteristics such as uncontrolled HTN and hypokalemia, so that patients with PA maybe have longstanding exposure to risk of CKD. Therefore it is necessary to do case detection test and rule out PA in initial hypertensive patients. In addition, more longitudinal study and research should be performed to decide personalized and adequate treatments for PA patients.

Endocrine hypertension: before and after treatment of the endocrinopathy

2019 ◽  
Author(s):  
Marwa Khiari ◽  
Ibtissem Ben Nacef ◽  
Imene Rojbi ◽  
Karima Khiari ◽  
M Jerbi ◽  
...  
Keyword(s):  
Endocrine Hypertension ◽  
Before And After

Why is the Coverage of Pneumonia Case Detection on Children under Five Years-Old Still Considered as Low in Sleman?

2017 ◽  
Vol 1 (1) ◽  
pp. 26
Author(s):  
Ade Kartikasari Sebba ◽  
Baning Rahayujati ◽  
Isa Dharmawidjaja
Keyword(s):  
Community Health ◽  
Community Health Centers ◽  
Sampling Technique ◽  
Health Centers ◽  
Case Detection ◽  
Upper Respiratory Infection ◽  
Children Under Five ◽  
Under Five ◽  
Pneumonia Case ◽  
Case Investigation

Pneumonia is one of the deadliest diseases for children under five years-old throughout the world. In Indonesia, pneumonia is the second deadliest disease after diarrhea. In 2015-2016, the Coverage of pneumonia case detection on children under five years-old increased from 22.33% to 36.06% but it had not achieved the detection target (-85%). A program evaluation needs to conduct, consequently. The evaluation aims to observe the implementation of pneumonia investigation program on children under five years-old in Sleman in 2016. The evaluation used a descriptive design performed in June-July 2017. The research subject was the program of Upper Respiratory Infection (ISPA, Infeksi Saluran Pernapasan Akut) implemented in community health centers (puskesmas, pusat kesehatan masyarakat). Twenty respondents as the sample were chosen by using the purposive sampling technique. The surveillance evaluation employed the input, activities, and output. The instruments were structural questionnaires and checklist sheets. The analysis result was presented in forms of tabulation and narration. From the input facet, 100% respondents have not had any special trainings related to pneumonia. 55% respondents have interlocking jobs with the longest service time of three years or more (75%). 70% respondents are able to show ARI Soundtimer. There are only 10% respondents holding the media of communication, information, and education (KIE, Komunikasi, Informasi, dan Edukasi) in forms of flipchart and leaflet; while 100% respondents admit that they have no stamp seal of URI. The proses facet displays that 100% respondents do not arrange any plan. The case investigation is only passive (100%). 80% respondents do socialization of case management and only 15% respondents perform a home visit. 100% respondents have not held trainings for responsible people, alert villages, and private midwives. From the output facet, the scope of case investigation is still low (36.06%).The implementation of pneumonia case investigation program on children under five years-old has been well executed but there are still weaknesses. Hence, public health offices (dinas kesehatan) should improve their human resources by arran ging a training program, equalize the use of breath counting tool and make MoU with all health services to report pneumonia cases. Community health centers are recommended to arrange plans, actively attempt to discover pneumonia cases, and train the responsible people, centers for pre-and postnatal health care (posyandu, pos pelayanan terpadu), or midwives related to the subject of pneumonia.

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