Blood Pressure ; physiology ; Child ; Female ; Humans ; Hypotension, Orthostatic ; diagnosis ; epidemiology ; physiopathology ; therapy ; Male

BACKGROUND: Blood pressure (BP) varies considerably during general anesthesia. Accurate BP measurement is critical for appropriate treatment, especially during hypotension and hypertension. Here we evaluated whether the noninvasive oscillometric BP measurement technique accurately reflects BP measured by the direct intraarterial technique. METHODS: A total of 256 samples were extracted from 10 patients operated on under general anesthesia. Systolic, diastolic and mean BP were analyzed according to the level of BP; hypotension, normotension, and hypertension. Repeatability of the noninvasive BP measurement were analyzed with repeatability coefficients and percent errors. Agreement between the two BP measurements were analyzed with a Bland-Altman and Modified Bland-Altman analysis. RESULTS: The repeatability coefficient for mean BP of the noninvasive oscillometric BP measurement was 6.34. Percent errors of mean BP were smaller than those of systolic and diastolic BP. All biases were less than 5 mmHg at all BP levels. Most BP agreements were larger than 8 mmHg except all-range mean BP (7.7), hypotensive diastolic BP (6.7), and mean BP (6.2). During hypotension, only mean BP was within the 95% of confidence interval (CI) of bias and limit of agreement. During hypertension, only systolic BP could meet the criteria. CONCLUSIONS: Only mean BP during hypotension and systolic BP during hypertension accurately reflect the direct intraarterial BP. But, diastolic BP does not reflect the direct intraarterial BP over all BPs.
Anesthesia, General ; Arterial Pressure ; Bias (Epidemiology) ; Blood Pressure ; Humans ; Hypertension ; Hypotension

OBJECTIVETo study the clinical characteristics of orthostatic hypertension (OHT) in children.

METHODA total of 96 children with OHT who met the diagnostic criteria and clinical manifestations were recruited in the Department of Pediatrics, Peking University First Hospital. Age and sex distributions were observed. The duration of disease, the frequencies of symptoms and the predisposing factors were recorded. The hemodynamic changes from supine to up-right positions were also analyzed.

RESULTThere were 50 boys and 46 girls in the study group. The mean age was (11.8 ± 2.7) years. Thirty-two children were from 6 to 10 years old, accounting for 33.3% of all subjects, while 64 patients were from 11 to 17 years old, accounting for 66.7%. Durations of symptoms of OHT were less than 1 month in 22.9% children, from 1 month to 1 year in 51.1% children and longer than 1 year in 26.0% children. The most common clinical manifestations were syncope and dizziness. The incidence of them was 70.8% and 46.9%, respectively. Other clinical manifestations included transitional amaurosis, nausea and/or vomiting, pallor and so on. These clinical manifestations often occurred on position change (24.0%) and long-time standing (57.3%) in children. Other predisposing factors included exercise, emotion changes and fuggy environment. The baseline systolic and diastolic blood pressures were (103 ± 8) mm Hg (1 mm Hg = 0.133 kPa) and (59 ± 6) mm Hg, respectively, the up-right systolic and diastolic blood pressure at 3 min were (113 ± 8) mm Hg and (73 ± 6) mm Hg and the differences were significant (t = 27.674, P < 0.01; t = 17.936, P < 0.01). The baseline heart rate in supine position was (81 ± 11) bpm and the maximum heart rate in up-right position was (113 ± 12) bpm (t = 33.092, P < 0.01).

CONCLUSIONOHT is commonly seen in puberty of children. The chief complaints are syncope and dizziness. They were mostly induced by position change and long-time standing. Blood pressure was significantly increased from supine to up-right position.

Adolescent ; Blood Pressure ; physiology ; Child ; Dizziness ; epidemiology ; physiopathology ; Female ; Heart Rate ; Humans ; Hypotension, Orthostatic ; epidemiology ; etiology ; physiopathology ; Male ; Multivariate Analysis ; Posture ; Risk Factors ; Syncope ; epidemiology ; physiopathology

The clinical characteristics of painless aortic dissection were investigated in order to improve the awareness of diagnosis and treatment of atypical aortic dissection. The 482 cases of aortic dissection were divided into painless group and pain group, and the data of the two groups were retrospectively analyzed. The major clinical symptom was pain in 447 cases (92.74%), while 35 patients (7.26%) had no typical pain. The gender, age, hypertension, hyperlipidemia, diabetes, smoking and drinking history had no statistically significant differences between the two groups (P>0.05). The proportion of Stanford type A in painless group was significantly higher than that in pain group (48.57% vs. 21.03%, P=0.006). The incidence of unconsciousness in the painless group was significantly higher than that in the pain group (14.29% vs. 3.58%, P=0.011). The incidence of hypotension in painless group was significantly higher than that in pain group for 4.26 folds (P=0.01). Computed tomography angiography (CTA) examination revealed that the incidence of aortic arch involved in the painless group was significantly higher than that in the pain group (19.23% vs. 5.52%, P=0.019). It was concluded that the incidence of painless aortic dissection was higher in Stanford A type patients, commonly seen in the patients complicated with hypotension and unconsciousness. CTA examination revealed higher incidence of aortic arch involvement.
Adult ; Aged ; Angiography ; Aortic Rupture ; diagnostic imaging ; epidemiology ; physiopathology ; Female ; Humans ; Hypotension ; diagnostic imaging ; epidemiology ; physiopathology ; Incidence ; Male ; Middle Aged ; Pain ; diagnostic imaging ; epidemiology ; physiopathology ; Retrospective Studies ; Tomography, X-Ray Computed ; Unconsciousness ; diagnostic imaging ; epidemiology ; physiopathology

OBJECTIVES: The purpose of this study was to estimate the prevalence and correlated factors of high myopia in 19 year-old men in Southeast Korea. METHODS: This retrospective study was based on the medical checkup data of conscription during 2005. The study subjects were 19 years old men in Busan, Ulsan and Gyeongsangnam-do. The health checkup data of the conscripts consisted of noncycloplegic autorefraction test, the biometric data and social factors. To analyze the social and biometric effects, we classified the biometric factors into 4 or 5 groups and the social factors into 3 groups. High myopia was defined as a spherical equivalent of under -6.0 diopter. Data analysis was performed using the chi square test for trends and multiple logistic regression analysis. The SAS(version 9.1) program was used for all the analyses. RESULTS: The prevalence of high myopia was 12.39% (6256 / 50 508). The factors correlated with high myopia were the residence area (OR, 2.07; 95% CI, 1.77 to 2.4 for small city; OR, 2.01; 95% CI, 1.72 to 2.34 for metropolis; the reference group was rural area), academic achievement (OR, 1.43; 95% CI, 1.34 to 1.53 for students of 4-and 6-year-course university; the reference group was high school graduates & under) and blood pressure (OR, 1.54; 95% CI, 1.10 to 2.16 for hypertension; OR, 1.09; 95% CI, 1.02 to 1.17 for prehypertension; OR, 1.10; 95% CI, 1.01 to 1.20 for hypotension; the reference group was normal blood pressure). CONCLUSIONS: More than one tenth of the young men were high myopia as one of the risk factor for visual loss. Further studies on high myopia and its complications are needed to improve eye health in Southeast Korea.
Body Mass Index ; Cluster Analysis ; Comorbidity ; Humans ; Hypertension/*epidemiology ; Hypotension/*epidemiology ; Male ; Military Personnel/statistics & numerical data ; Myopia/classification/*epidemiology ; Prevalence ; Republic of Korea/epidemiology ; *Residence Characteristics ; Retrospective Studies ; Rural Population ; Severity of Illness Index ; Urban Population ; Young Adult

OBJECTIVE: To provide epidemiologic data of the pressure sores and to determine the most effective prevention and treatment methods. METHOD: Seventy patients with pressure sores who were admitted to the Rehabilitation Hospital, Yonsei University College of Medicine from 1991 to 1995 were included in this study. RESULTS: The average age of the patients was 36. Traffic accident was the most common(46 cases) cause of injury, followed by falling injury. Thirty-one patients developed pressure sores at home, while 39 patients in various hospitals. According to Frankel's classification, 51 cases were Frankel A, 13 cases were Frankel B, 5 cases were Frankel C and none was Frankel D. Sacrum was the most common site of the sore followed by buttock, ischial tuberosity, greater trochanter, and coccyx. Among many factors investigated, the anemia and hypotension had a significant correlation with the healing time. The treatment methods were variable among the patients depending on the size and severity of the sores. The severe and larger lesions required more surgical managements. CONCLUSION: The results support that an intensive prevention is necessary at homes as well as at the hospitals. More educational programs should be provided not only for the patients, but also for the hospital personnels.
Accidents, Traffic ; Anemia ; Buttocks ; Classification ; Coccyx ; Epidemiology* ; Femur ; Humans ; Hypotension ; Personnel, Hospital ; Pressure Ulcer* ; Rehabilitation ; Sacrum ; Spinal Cord Injuries ; Spinal Cord*

: Anaphylaxis is a predominantly childhood disease. Most of the literature on anaphylaxis has emerged from Western countries. This study aimed to describe the incidence, triggers and clinical presentation of anaphylaxis among children in Singapore, look for predictors for anaphylaxis with severe outcomes, and study the incidence of biphasic reactions.: We retrospectively reviewed records of children presenting with anaphylaxis to our paediatric emergency department from 1 January 2007 to 31 December 2014.: We identified 485 cases of anaphylaxis in 445 patients. Cutaneous symptoms (urticarial/angio-oedema) were the most common across all age groups (481 cases, 99%), followed by respiratory (412, 85%), gastrointestinal (118, 24%) and cardiovascular (35, 7.2%) symptoms. Central nervous system symptoms (drowsiness/ irritability) were rare across all age groups (11, 2.2%). Food was identified as the most common trigger across all age groups (45% to 63%). Seafood was the most common food trigger (57, 25%). A total of 420 (86.6%) children were treated with adrenaline, 451 (93%) received steroids and 411 (85%) received antihistamines. Sixty-three (13%) children fulfilled the criteria of severe anaphylaxis. There was no statistically significant association between severe anaphylaxis and the type of trigger (= 0.851), nor an overall past history of atopy (= 0.428). The only independent predictor for severe anaphylaxis was a previous drug allergy (= 0.016). A very low prevalence of biphasic reactions (0.6% of study population) was noted in our study.: We described the presentation and management of anaphylaxis in the Singapore population. A history of drug allergy is associated with severe presentation. Biphasic reactions are rare in our population.
Adolescent ; Adrenal Cortex Hormones ; therapeutic use ; Anaphylaxis ; drug therapy ; epidemiology ; etiology ; physiopathology ; Angioedema ; epidemiology ; etiology ; physiopathology ; Child ; Child, Preschool ; Drug Hypersensitivity ; epidemiology ; Emergency Service, Hospital ; Epinephrine ; therapeutic use ; Female ; Food Hypersensitivity ; complications ; epidemiology ; Gastrointestinal Diseases ; epidemiology ; etiology ; physiopathology ; Histamine Antagonists ; therapeutic use ; Humans ; Hypotension ; etiology ; physiopathology ; Incidence ; Infant ; Male ; Pediatrics ; Prevalence ; Respiratory Tract Diseases ; epidemiology ; etiology ; physiopathology ; Retrospective Studies ; Risk Factors ; Seafood ; Severity of Illness Index ; Singapore ; epidemiology ; Sympathomimetics ; therapeutic use ; Tertiary Care Centers ; Urticaria ; epidemiology ; etiology ; physiopathology

INTRODUCTIONThe prevalence of orthostatic hypotension (OH) among the elderly population in Singapore, as defined by a decline in blood pressure upon a change in position, is not well-established. Studies associate OH with clinically significant outcomes such as falls. This study aims to determine the prevalence of OH among elderly patients attending a public primary care clinic (polyclinic) for chronic disease management, and examine the relationships between postulated risk factors and OH.

METHODSPatients aged ≥ 65 years attending a typical polyclinic in Geylang were identified and targeted for recruitment at the study site. A questionnaire on symptoms and postulated risk factors was administered, followed by supine and standing blood pressure measurements. Cross-sectional analysis was performed with independent sample t-test for continuous data and chi-square test for categorical data. Prevalence rate ratios with 95% confidence interval were calculated for the latter.

RESULTSA total of 364 multiethnic patients participated in the study. The prevalence of OH was 11.0%. Older age, comorbidities such as cardiac failure and kidney disease, being physically inactive at work, fatigue, self-reported dizziness in the past year, and the use of loop diuretics were found to be significantly associated with OH.

CONCLUSIONAbout one in ten elderly patients at a local polyclinic was affected by OH, which was associated with multiple factors. Some of these factors are modifiable and can be addressed to reduce the incidence of OH.

Accidental Falls ; prevention & control ; Aged ; Aged, 80 and over ; Asian Continental Ancestry Group ; Blood Pressure ; Blood Pressure Determination ; Cross-Sectional Studies ; Female ; Geriatrics ; Humans ; Hypotension, Orthostatic ; diagnosis ; epidemiology ; therapy ; Male ; Middle Aged ; Models, Statistical ; Prevalence ; Primary Health Care ; Risk Factors ; Singapore

PURPOSE: The purposes of this study were to identify the prevalence of postprandial hypotension (PPH) and risk factors for PPH in Korean elderly people. METHODS: A cross-sectional descriptive study was conducted with community dwelling and nursing home residents. The blood pressure of 162 adults aged 65 yr or older was measured before meal as a baseline and then at 15 min intervals from immediately after the meal through 90 min after the meal. Descriptive statistics and logistic regression with the SPSS WIN 14.0 program were used to analyze the data. RESULTS: The prevalence of PPH was 29% and the PPH occurred immediately after the meal continuously through 90 min after the meal. The biggest drop in systolic blood pressure occurred at 45 min after the meal. Risk factors for PPH were age, base line systolic blood pressure, and presence of cardiovascular disease. CONCLUSION: To prevent side effects of PPH such as falls and syncope, nurses should provide careful management of PPH and prohibit activities until at least 90 min after a meal. We also recommend that risk of PPH should be included in fall prevention guidelines for elderly people.
Aged ; Aged, 80 and over ; Blood Pressure ; Cardiovascular Diseases/complications ; Cross-Sectional Studies ; Demography ; Female ; Humans ; Hypotension/*epidemiology/etiology ; Korea ; Male ; Nursing Homes ; Postprandial Period ; Prevalence ; Risk Factors ; Time Factors

BACKGROUND: Recently in Europe, some epidemiologic studies reported that various physical symptoms and social, psychological wellbeing are related to low blood pressure. But in Korea, none has been studied on symptoms related to low blood pressure yet. In this study, we would like to see if the somatic symptoms and social, psychological wellbeing shown t,o be related to low SBP is truly associated with it. METHODS: Questionnaire interview was done to the people who have visited Department of family practice in two university hospitals and two health promotion center from April, 1996 to August, 1996. Seven somatic symptoms and Psychosocial Wellbeing Index(PWI) for the evaluation of social, psychological health status were included in the questionnaire. SAS statistics packages was used in statistical precess. We used logistic regression to see the frequency of somatic symptoms related to the systolic blood pressure(SBP) group and the confirmation of confounding variables was done by ANOVA. RESULTS: Total of 304 completed the questionnaire. Average age was 44 years old and average SBP was 115.4+/-16.4. 84 of them (27.6%) felt that they had a low BP & 69 were women compared to 21 men, being meaningfully more common. 107(35.2%) people answered that they had heard that their blood pressure was low and 66% were from doctors. Only 32(38.1%) of the group who felt of having hypotensive symptoms and 38 of the group who heard of having hypotension actually had SBP of below 100 mmHg. Vocation, income, smoking & alcohol history, present illness, marital status were not significant as a confounding variable. SBP of 100 or below group had a less presentation of fatigue & significantly higher PWI than the group of above 100mmHg (p<0.05). The group who felt that they had a low BP had more complaints of fatigue, dizziness, palpitation, cold hands and feet and had significnatly higher PWI than the group who didnt. CONCLUSIONS: SBP of 100mmHg or below group has more frequent manifestion of fatigue and low level of sociopsycholgiacl health index than the above 100mmHg group. But most of the people who complained of hypotensive symptoms didnt have low blood pressure and a lot of them misunderstand of having low blood pressure and after checking blood pressure by doctors, so great deal of caution is called for when seeing patients.
Adult ; Blood Pressure* ; Confounding Factors (Epidemiology) ; Dizziness ; Epidemiologic Studies ; Europe ; Family Practice ; Fatigue ; Female ; Foot ; Hand ; Health Promotion ; Hospitals, University ; Humans ; Hypotension ; Korea ; Logistic Models ; Male ; Marital Status ; Occupations ; Smoke ; Smoking ; Surveys and Questionnaires