Peleska J

Circulating intercellular cell adhesion molecule-1, endothelin-1 and von Willebrand factor-markers of endothelial dysfunction in uncomplicated essential hypertension: the effect of treatment with ACE inhibitors.

The aim of the study was to examine whether the circulating cell adhesion molecules, von Willebrand factor (vWf) and endothelin-1, are elevated in patients with essential hypertension with no other risk factors for atherosclerosis and thus may serve as a markers of endothelial dysfunction in uncomplicated hypertension. Furthermore, the effect of treatment with the ACE inhibitor, quinapril, on levels of endothelial dysfunction markers were studied. The levels of adhesion molecules (intercellular cell adhesion molecule-1 [ICAM-1], E-selectin, P-selectin), von Wilebrand factor (vWf) and endothelin-1 were measured in patients with hypertension without any other risk factors of atherosclerosis before and after treatment with quinapril (nu2009=u200922) and in normotensive controls (nu2009=u200922). Compared with normotensive subjects, the hypertensive patients had significantly higher levels of ICAM-1 (238 vs 208u2009ng/ml, Pu2009=u20090.02), vWf (119 vs 105u2009IU/dl, Pu2009<u20090.05) and endothelin-1 (5.76 vs 5.14u2009fmol/ml, Pu2009<u20090.05). Three-month treatment of hypertensive patients with quinapril led to a significant decrease in the levels of endothelin-1 (5.76 vs 5.28u2009fmol/ml, Pu2009<u20090.01). We did not observe significant changes in the levels of adhesion molecules and vWf after ACE inhibitor treatment, although a trend toward a decrease was apparent with all these parameters. Patients with uncomplicated hypertension with no other risk factors of atherosclerosis had significantly elevated levels of ICAM-1, vWf, and endothelin-1. Our data suggest that these factors may serve as markers of endothelial damage even in uncomplicated hypertension. In hypertensive patients, treatment with the ACE inhibitor quinapril resulted in a significant decrease in endothelin-1 levels. These findings indicate a beneficial effect of ACE inhibitors on endothelial dysfunction in hypertensive patients.

Medical guidelines presentation and comparing with Electronic Health Record.

Electronic Health Record (EHR) systems are now being developed in many places. More advanced systems provide also reminder facilities, usually based on if-then rules. In this paper we propose a method how to build the reminder facility directly upon the guideline interchange format (GLIF) model of medical guidelines. The method compares data items on the input of EHR system with medical guidelines GLIF model and is able to reveal if the input data item, that represents patient diagnosis or proposed patient treatment, contradicts with medical guidelines or not. The reminder facility can be part of EHR system itself or it can be realized by a stand-alone reminder system (SRS). The possible architecture of stand-alone reminder system is described in this paper and the advantages of stand-alone solution are discussed. The part of the EHR system could be also a browser that would present graphical GLIF model in easy to understand manner on the user screen. This browser can be data driven and focus attention of user to the relevant part of medical guidelines GLIF model.

Association Analysis of Arg16Gly Polymorphism of the β 2 -Adrenergic Receptor Gene in Offspring from Hypertensive and Normotensive Families

Objective: Since g 2 -adrenergic receptors ( g 2 AR) can influence blood pressure not only by vasodilation, but also participate in noradrenaline release from sympathetic nerve endings, we have studied whether Arg16Gly polymorphism of the g 2 AR gene is associated with predisposition to essential hypertension and increased plasma noradrenaline concentration in offspring from normotensive (SN) and hypertensive parents (SH). Design and methods: The study population consisted of 105 young SN and 101 SH subjects matched for age and body mass index. Arg16Gly polymorphism of the g 2 AR gene was determined by polymerase chain reaction (PCR) technique and subsequent incubation with NcoI restriction enzyme. Resulting fragments were separated using electrophoresis on a 4.2% Metaphor agarose gel. Results: SH already had significantly higher systolic BP, and a tendency to higher diastolic BP than the SN group. The frequency of Arg/Arg homozygotes was significantly increased in SH when compared to SN (25% vs 15%). Results of logistic regression analysis showed the highest relative risk for the Arg/Arg genotype and suggested a recessive action of the Arg16 variant. There was an increased diastolic BP in Arg/Arg homozygotes of the SN group ( p = 0.029). This genotype also had a tendency to increased heart rate in both groups ( p = 0.049). There was no relationship of this polymorphism with plasma noradrenaline concentration. Conclusion: Our findings suggest that genetic variability of the g 2 AR gene is implicated in predisposition to essential hypertension. However, the contradictory results between individual studies indicate that the action of the g 2 AR gene is indirect, through multiple intermediate phenotypes and gene interactions.

Enhanced care of hypertensive patients using the Internet

Background : Medical guidelines provide recommendations that ought to help physicians in medical decision-making under different circumstances. To develop electronic medical guidelines and to make them available for physicians using the Internet can further enhance the quality and efficiency of health care, especially with the simultaneous use of electronic health records. Objectives : This study aims to outline the needs for web-based systems that support the use of medical guidelines in practice; and to focus on the development of web-based electronic medical guidelines for treatment of arterial hypertension. Methods : The importance of electronic health record in cardiology for data acquisition, data storage and data mining is considered. The anonymized database of approximately 1800 hypertensive patients has been created to compare medical practice with guidelines and discover features of diseases that can help with their management. Using this database we evaluated several web-based electronic guidelines systems. Results : The 1999 WHO/ISH Guidelines for the Management of Hypertension were formalized and interpreted using the Guide-X methodology, using the Apollo system and web-based electronic guidelines. The web-based electronic guidelines were tested on the smaller anonymous recent data set of 840 hypertensive patients. Conclusions : An easy transfer of knowledge from medical guidelines to structured electronic guidelines opens new possibilities for easy reusability of medical knowledge by general practitioners and clinicians.

Computer supported decision making in therapy of arterial hypertension

Therapy of hypertension is still more or less empirical. Several classes of antihypertensive medications are known, the effect of which is based on different mechanisms. The efficacy of the treatment is not always a reliable indication of the appropriate selection as a good therapeutical response can sometimes be achieved at the expense of humoral simulation. This can lead to harmful increased synthesis of trophic hormones. The program for PC called HYPERTENZE supports decision making in therapy of arterial hypertension. It gives a sequence of decisions based on clinical experience using a series of parameters. The program is using the Microsoft Access language of the Access database system and due to the Access Developers Toolkit it does not require Access to be installed on the users computer. The program HYPERTENZE offers the user essential information and explanation of the decisions in a graded form. The price list of equivalent medications can be updated by the user himself. It seems that this program might be very useful for Czech general practitioners.

Tool-supported Interactive Correction and Semantic Annotation of Narrative Clinical Reports

OBJECTIVESnOur main objective is to design a method of, and supporting software for, interactive correction and semantic annotation of narrative clinical reports, which would allow for their easier and less erroneous processing outside their original context: first, by physicians unfamiliar with the original language (and possibly also the source specialty), and second, by tools requiring structured information, such as decision-support systems. Our additional goal is to gain insights into the process of narrative report creation, including the errors and ambiguities arising therein, and also into the process of report annotation by clinical terms. Finally, we also aim to provide a dataset of ground-truth transformations (specific for Czech as the source language), set up by expert physicians, which can be reused in the future for subsequent analytical studies and for training automated transformation procedures.nnnMETHODSnA three-phase preprocessing method has been developed to support secondary use of narrative clinical reports in electronic health record. Narrative clinical reports are narrative texts of healthcare documentation often stored in electronic health records. In the first phase a narrative clinical report is tokenized. In the second phase the tokenized clinical report is normalized. The normalized clinical report is easily readable for health professionals with the knowledge of the language used in the narrative clinical report. In the third phase the normalized clinical report is enriched with extracted structured information. The final result of the third phase is a semi-structured normalized clinical report where the extracted clinical terms are matched to codebook terms. Software tools for interactive correction, expansion and semantic annotation of narrative clinical reports has been developed and the three-phase preprocessing method validated in the cardiology area.nnnRESULTSnThe three-phase preprocessing method was validated on 49 anonymous Czech narrative clinical reports in the field of cardiology. Descriptive statistics from the database of accomplished transformations has been calculated. Two cardiologists participated in the annotation phase. The first cardiologist annotated 1500 clinical terms found in 49 narrative clinical reports to codebook terms using the classification systems ICD 10, SNOMED CT, LOINC and LEKY. The second cardiologist validated annotations ofxa0the first cardiologist. The correct clinical terms and the codebook terms have been stored in a database.nnnCONCLUSIONSnWe extracted structured information from Czech narrative clinical reports by the proposed three-phase preprocessing method and linked it to electronic health records. The software tool, although generic, is tailored for Czech as the specific language of electronic health record pool under study. This will provide a potential etalon for porting this approach to dozens of other less-spoken languages. Structured information can support medical decision making, quality assurance tasks and further medical research.

Computer supported decision making in therapy of essential hypertension

In order to improve anti-hypertensive therapy in the Czech population, a new version of the predominantly educational program for PCs called Hypertenze was prepared. The program offers a user essential information and explanation of decisions taken step-by-step in a graded form from basic to detailed information which is easily accessible by browsing. Information concerns both the properties of drugs (contra-indications, adverse events, dosing and drug interactions) and the economy of treatment (price of the package, defined daily dose and its price). It seems that this program might be useful for Czech physicians to improve their therapy of hypertension. The program could also be used to a great extent for other populations.