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Journal of General Practice

ISSN: 2329-9126

Open Access

Articles in press and Articles in process

    Research Article Pages: 1 - 7

    Statins in Primary Prevention of Cardiovascular Disease: Incidence of Potentially Inappropriate Prescriptions in Very Low Risk Primary Care Patients and Associated Factors

    Usue Elizondo-Alzola, Alvaro Sanchez, Jose I. Pijoan, Marta M. Mediavilla, Rita Sainz De Rozas, Itxasne Lekue, Arturo Garcia-Alvarez and Gonzalo Grandes

    Objective: To quantify and characterize the initiation of Potentially Inappropriate Prescription (PIP) of statins in primary prevention of Cardiovascular Disease (CVD) in patients with low cardiovascular risk in the Basque Health Service (Osakidetza) by estimating the annual incidence rate and identifying the associated clinical and socio-demographic factors.
    Methods: Analytical retrospective observational study on the incidence of PIP of statins and provision of advice for changing lifestyles in 2018. Patients aged 40 to 75 years with cardiovascular risk <5% (REGICOR) and LDL-cholesterol levels between 70 and 189 mg/dl and/or Total Cholesterol (TC) between 200 and 289 mg/dl. Sociodemographic and clinical characteristics and deprivation index were evaluated. Global incidence, factors associated with PIP and the variability between Integrated Health Organizations (IHOs) were analyzed.
    Results: 70,526 people met the selection criteria. Of them, 741 started a PIP for statins with an overall incidence of 10.5 prescriptions per 1,000 person-years (ranging in IHOs from 2.3 to 18.0). Less than 40% of these people received preventive advice on physical activity and diet and approximately 50% received advice on cessation of smoking. PIPs were higher in men (RR 1.36), people with arterial hypertension (RR 1.86) and other comorbidities (RR 3.93 if ≥ 5 comorbidities); PIPs also increased with age (RR 1.02 per year) and TC levels (RR 1.21 per 10mg/of the increase).
    Conclusion: This study shows that practice in primary CVD prevention in low-risk primary care patients does not seem to follow the recommendations of current guidelines. It is necessary to identify determinants associated with this low-value practice in order to inform the design and implementation of strategies to favor its abandonment.

      Short Communication Pages: 1 - 2

      A Cutting Edge Therapy: Tonsillectomy for the Treatment of Probable Sleep Apnea Associated Chronic Migraine

      Roni Sharon*, Krithi Nathan and Paul G. Mathew

      Objective: Case report of chronic migraine with comorbid sleep apnea that regressed to low-frequency migraine after tonsillectomy

      Background: According to the International Classification of Headache Disorders III (ICHD-3), sleep apnea can be a cause of headache or a trigger for the chronification of migraine. Large tonsils that obstruct airways contribute to tonsillolith formation, halitosis, periodic tonsillitis and occasionally cause sleep apnea. Adequate treatment of sleep apnea can result in the improvement of migraine frequency and intensity, and reduce the risk of cardiovascular and cerebrovascular comorbidities.

      Results: The patient‏‎ is a 24 years old woman with a past medical history of obesity and asthma, with a chief complaint of ICHD-3 chronic migraine without aura. She experienced a frequency of 15-20 headache days per month, frequently with morning headaches and 3-5 sleep interruptions per night. She noted a history of snoring, feeling poorly rested and having daytime drowsiness. After tonsillectomy, the patient experienced significant improvement of her migraines and her sleep apnea associated symptoms, including spontaneous arousals, feeling poorly rested and daytime drowsiness.

      Conclusions: In patients complaining of chronic migraine and sleep dysfunction, visualizing the posterior pharynx should be incorporated into the physical examination. Tonsillectomy is a well-tolerated, same day surgical procedure, which can be an effective treatment for reducing airway resistance in patients diagnosed obstructive sleep apnea, and can improve the frequency and intensity of co-morbid migraine.

        Review Article Pages: 1 - 8

        Stillbirth and its Association with Early Rupture of Membranes in Sub-Saharan Africa: Systematic Review and Meta-Analysis

        Telksew Yelma Yezengaw*, Tariku Dingeta Amante, Tesfaye Assebe Yadeta and Biruk Shalmeno Tusa

        Background: Stillbirth rate is an important indicator of access to quality antenatal and delivery care services. Many previous pocket studies were conducted to assess the magnitude of stillbirth and its association with premature rupture of membrane. However, the level of stillbirth, as well as its relationship with Premature Rupture of Membrane (PROM) varies from study to study. Objectives: This systematic review and meta-analysis was conducted to estimate the pooled prevalence of stillbirth and its association with the early rupture of membranes in sub-Saharan Africa. Search strategy: Electronic databases such as PubMed Central PMC, Cochrane library, Medline via Virtual Health Library (VHL), HINARI (Health Inter Network Access to Research Initiative) portal, and Google scholar were used for searching for original articles. Selection criteria: All Published and unpublished observational studies (prospective and retrospective cohort studies, case-control studies, and cross-sectional studies) that deal with stillbirth and their association with early rupture of membranes in sub-Saharan African women were included. Data collection and analysis: The extracted data analyses were done using STATA (version.16.0) software. Texts, figures, and tables were used to describe the included original articles. The heterogeneity of the studies was checked by I-squared statistics. A Random-effects method was applied to estimate the pooled prevalence of stillbirth and the effect size of the early rupture of membranes in sub-Saharan Africa. Subgroup analysis was performed based on region (East, West, Central, and Southern Africa) and year of study (before 2015 and after 2015). A funnel plot and Egger’s regression test was used to see publication bias. Main result: Pooled prevalence of stillbirth in sub-Saharan Africa was 6.4% (95% CI: 5.5-7.3). In sub-group analysis, Southern African regions had a higher stillbirth prevalence and the western African regions had a lower than East and Southern Africa. The prevalence of stillbirth in the region is increased from 4.1% (95% CI: 2.2–6.0) before 2015 to 7.1%(95% CI: 5.8-8.3) after 2015. The pooled odds ratio results from seven studies showed the non-significant effect of early rupture of membrane on stillbirth (pooled OR=1.54, 95% CI: 0.26-2.82). According to the regression test (Egger test), there was no small study effects or publication bias (P=0.108). Conclusions: The pooled prevalence of stillbirth in sub-Saharan Africa was relativity high. The analysis establishes the minimal effects of early rupture of membrane on stillbirth. Therefore, we recommend that strengthening the testing intervention is crucial to reduce the still relatively high stillbirths. Funding: No fund was received for this work.

          Editorial Pages: 1 - 1

          Diagnostic Strategies are the Specific Tools

          H. Innesu

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          Prognosis is the identity of the character and reason of a sure
          phenomenon. Analysis is used in lots of exclusive disciplines, with
          versions in the use of good judgment, analytics, and revel in, to
          determine "motive and impact". In systems engineering and computer
          science, it's far usually used to determine the reasons of symptoms,
          mitigations, and answers. Analysis is frequently tough, because many
          signs and symptoms and symptoms are nonspecific, and can best be
          undertaken with the aid of registered and licensed health experts. As
          an instance, redness of the skin (erythema), through itself, is an
          indication of many disorders and for this reason does not tell the
          healthcare expert what is incorrect. Accordingly differential analysis,
          wherein several feasible reasons are compared and contrasted, need
          to be achieved. This entails the correlation of numerous pieces of
          records observed by using the popularity and differentiation of
          patterns. Occasionally the procedure is made clean by a sign or
          symptom (or a set of several) this is pathognomonic. The method of
          differential analysis is based totally on locating as many candidate
          illnesses or situations as viable which can in all likelihood purpose
          the symptoms or symptoms, observed via a process of removal or as
          a minimum of rendering the entries greater or much less likely by
          means of similarly medical assessments and other processing,
          aiming to attain the point wherein handiest one candidate disorder or
          condition stays as likely. The final end result may additionally remain
          a list of feasible conditions, ranked so as of possibility or severity.
          One of these lists is frequently generated by means of computeraided
          analysis systems. In a pattern reputation approach the
          company makes use of experience to apprehend a sample of
          scientific characteristics. Its miles specifically primarily based on sure
          symptoms or signs being related to certain diseases or situations,
          now not necessarily related to the extra cognitive processing
          concerned in a differential analysis. This will be the number one
          method utilized in cases where illnesses are "apparent", or the
          issuer's revel in may additionally allow her or him to understand the
          circumstance quick. Theoretically, a certain pattern of symptoms or
          signs and symptoms can be at once associated with a sure therapy,
          even without an exact decision concerning what's the actual disease,
          but this type of compromise contains a full-size hazard of missing a
          analysis which simply has a distinctive therapy so it can be
          restrained to instances wherein no diagnosis may be made. Over
          diagnosis is the diagnosis of "ailment" so one can by no means
          purpose signs and symptoms or loss of life at some stage in a
          affected person's lifetime. It’s far a problem as it turns people into
          patients unnecessarily and due to the fact it could cause monetary
          waste (overutilization) and remedies which could reason harm. Over
          diagnosis takes place whilst a disorder is diagnosed effectively, but
          the analysis is inappropriate. A correct prognosis can be beside the
          point because treatment for the sickness is not to be had, now not
          needed, or now not desired. Clinical diagnosis or the actual
          procedure of creating a analysis is a cognitive manner. A clinician
          uses several assets of information and puts the portions of the puzzle
          together to make a diagnostic impression. The preliminary diagnostic
          affect can be a broad time period describing a category of sicknesses
          in place of a selected ailment or circumstance. After the initial
          diagnostic influence, the clinician obtains comply with up
          assessments and processes to get extra facts to assist or reject the
          authentic prognosis and could try to narrow it all the way down to an
          extra unique stage. Diagnostic strategies are the specific tools that
          the clinicians use to slender the diagnostic opportunities.

          Editorial Pages: 1 - 1

          Anesthesiologists are Predicted to Have Knowledge of Human Physiology

          Bingxi Zhao

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          Anesthesiology is the medical uniqueness involved with the overall
          perioperative care of patients earlier than, throughout and after
          surgery. It encompasses anesthesia, intensive care medicine,
          important emergency medicinal drug, and pain medicinal drug. A
          medical doctor specialized in anesthesiology is known as an
          anesthesiologist. There are special approaches of referring to the
          sector of anesthesiology and physicians who specialize in it relying
          on the area of the world. As a strong point, the core element of
          anesthesiology is the exercise of anesthesia. This comprises using
          diverse injected and inhaled medications to provide a loss of
          sensation in patients, making it feasible to carry out approaches that
          might in any other case motive intolerable ache or be technically
          unfeasible. Safe anesthesia calls for in-depth understanding of
          diverse invasive and non-invasive organ aid techniques which might
          be used to control sufferers' critical capabilities while under the
          results of anesthetic pills; those include superior airway management,
          invasive and non-invasive hemodynamic video display units, and
          diagnostic strategies like ultrasonography and echocardiography.
          Anesthesiologists are predicted to have professional knowledge of
          human physiology, medical physics, and pharmacology, as well as a
          large general understanding of all regions of medication and surgical
          procedure in every age of patients, with a particular cognizance on
          the ones components which might also effect on a surgery. In latest
          decades, the function of anesthesiologists has broadened to attention
          now not just on administering anesthetics all through the surgical
          operation itself, however additionally ahead so as to pick out highrisk
          patients and optimize their fitness, in the course of the process to
          keep situational awareness of the surgical procedure itself to be able
          to improve protection, in addition to afterwards so as to sell and
          enhance healing. This has been termed "perioperative medicine". In
          the 19th century, the beginnings of preferred anesthesia began with
          the advent of ether in Boston and chloroform inside the UK to bring
          about a state of unawareness and unresponsiveness to the ache of
          surgical insult. With the isolation of cocaine in the mid-nineteenth
          century there started out to be tablets available for neighborhood
          anesthesia. Through the stop of the nineteenth century, the quantity
          of pharmacological alternatives multiplied and that they commenced
          to be implemented both peripherally and neuraxially. Then within the
          20th century neuromuscular blockade allowed the anesthesiologist to
          completely paralyze the affected person pharmacologically and
          breathe for him or her through mechanical air flow. With those new
          tools, the anesthetist may want to intensively manage the affected
          person's body structure bringing about vital care remedy, which, in
          many nations, is in detail related to anesthesiology. Anesthesiologists
          have key roles in primary trauma, resuscitation, airway management,
          and worrying for other patients outside the operating theatre who
          have critical emergencies that pose an instantaneous danger to
          existence, again reflecting transferable competencies from the
          operating room, and allowing continuity of care whilst patients are
          brought for surgical operation or in depth care. This branch of
          anesthesiology is together termed critical emergency remedy, and
          includes provision of pre-medical institution emergency medication
          as a part of air ambulance or emergency scientific offerings, as well
          as safe switch of significantly ill sufferers from one part of a clinic to
          another, or among healthcare facilities. Anesthesiologists typically
          shape part of cardiac arrest groups and speedy reaction teams
          composed of senior clinicians that are without delay summoned while
          a affected person's coronary heart stops beating, or after they
          deteriorate acutely whilst in sanatorium. Exclusive models for
          emergency medicine exist internationally: inside the Anglo-American
          version, the patient is hastily transported by means of non-health
          practitioner vendors to definitive care along with an emergency
          department in a health center. Conversely, the Franco-German
          technique has a health practitioner, often an anesthesiologist, come
          to the patient and offer stabilizing care inside the area. The patient is
          then triaged at once to the appropriate branch of a health facility.

          Commentry Pages: 1 - 1

          Psychology is the Science of Thoughts and Conduct

          Fengqi You

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          Psychology is the science of thoughts and conduct. Psychology
          includes the look at of aware and unconscious phenomena, such as
          feelings and mind. it is an academic discipline of great scope,
          crossing the boundaries between the natural and social sciences.
          Psychologists are seeking an expertise of the emergent houses of
          brains, linking the field to neuroscience. As a social technology,
          psychologists goal to understand the behavior of people and
          companies. At the same time as psychological information is often
          applied to the evaluation and remedy of mental fitness problems, it is
          also directed toward knowledge and solving problems in several
          spheres of human interest. Through much money owed psychology in
          the long run objectives to advantage society. Many psychologists are
          involved in some type of therapeutic position, practicing in clinical,
          counseling, or college settings. Different psychologists conduct
          clinical studies on a wide variety of topics related to intellectual
          approaches and conduct. Usually the latter organization of
          psychologists works in educational settings (e.g., universities,
          scientific faculties, hospitals). Any other organization of psychologists
          is employed in industrial and organizational settings. But others are
          worried in paintings on human development, getting older, sports
          activities, fitness, forensics, and the media. In China, mental
          information grew from the philosophical works of Laozi and
          Confucius, and later from the doctrines of Buddhism. This body of
          understanding includes insights drawn from introspection and
          statement, as well as strategies for focused thinking and appearing. It
          frames the universe in term of a department of physical truth and
          intellectual reality as well as the interaction among the physical and
          the intellectual. Chinese language philosophy additionally
          emphasized purifying the thoughts a good way to growth virtue and
          strength. An historical text known as The Yellow Emperor's
          conventional of inner medicine identifies the brain as the nexus of
          know-how and sensation, includes theories of personality based on
          yin–yang stability, and analyzes intellectual ailment in terms of
          physiological and social disequilibria. Chinese scholarship that
          targeted on the mind superior in the course of the Qing Dynasty with
          the paintings of Western-educated Fang Yizhi (1611–1671), Liu Zhi
          (1660–1730), and Wang Qingren (1768–1831). Wang Qingren
          emphasized the significance of the mind as the center of the
          apprehensive machine, connected intellectual sickness with brain
          sicknesses, investigated the causes of dreams and insomnia, and
          advanced a concept of hemispheric lateralization in mind feature.
          Psychology turned into of hobby to Enlightenment thinkers in Europe.
          In Germany, Gottfried Wilhelm Leibniz (1646–1716) implemented his
          principles of calculus to the mind, arguing that mental pastime befell
          on an indivisible continuum. He suggested that the distinction
          between aware and subconscious focus is only a remember of
          degree. Christian Wolff identified psychology as its own technology,
          writing Psychology Empirical in 1732 and Psychologia Rationalism in
          1734. Immanuel Kant superior the concept of anthropology as an
          area, with psychology an essential subdivision. Kant, but, explicitly
          rejected the concept of an experimental psychology, writing that "the
          empirical doctrine of the soul also can in no way approach chemistry
          at the same time as a scientific artwork of evaluation or experimental
          doctrine, for in it the manifold of inner observation may be separated
          simplest by using mere division in notion, and cannot then be held
          separate and recombined at will (however nonetheless less does any
          other thinking concern suffer himself to be experimented upon to
          healthy our cause), or even commentary by using itself already
          modifications and displaces the kingdom of the determined item.

          Commentary Pages: 1 - 1

          Neuroscience is the Medical Study of Apprehensive Machine

          Lei Wang

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          Neuroscience is the medical study of the apprehensive machine.
          It’s far a multidisciplinary technological know-how that combines
          physiology, anatomy, molecular biology, developmental biology,
          cytology, pc technology and mathematical modeling to apprehend the
          fundamental and emergent residences of neurons, glia and neural
          circuits. The expertise of the biological basis of gaining knowledge of,
          reminiscence, conduct, belief, and attention has been defined by
          using Eric Kandel because the "remaining assignment" of the
          biological sciences. The view that the heart became the supply of
          awareness becomes no longer challenged till the time of the Greek
          physician Hippocrates. He believed that the mind turned into now not
          simplest concerned with sensation—due to the fact that most
          specialized organs (e.g., eyes, ears, tongue) are located in the head
          close to the mind—however becomes also the seat of intelligence.
          Plato additionally speculated that the mind become the seat of the
          rational a part of the soul. Aristotle, but, believed the coronary heart
          become the middle of intelligence and that the mind regulated the
          quantity of warmth from the coronary heart. This view became
          normally normal until the Roman health practitioner Galen, a follower
          of Hippocrates and doctor to Roman gladiators, determined that his
          sufferers misplaced their mental faculties after they had sustained
          harm to their brains. In parallel with these studies, paintings with
          brain-damaged sufferers by Paul Broca cautioned that positive
          regions of the mind had been answerable for certain functions. On
          the time, Broca's findings had been visible as a affirmation of Franz
          Joseph Gall's idea that language turned into localized and that sure
          mental functions have been localized in unique areas of the cerebral
          cortex. The localization of function hypothesis became supported via
          observations of epileptic patients performed by way of John Hugh
          lings Jackson, who effectively inferred the organization of the motor
          cortex by looking the progression of seizures via the frame. Carl
          Wernicke further advanced the concept of the specialization of
          particular brain systems in language comprehension and production.
          present day studies through neuroimaging techniques, still makes
          use of the Bradman cerebral cytoarchitectonic map (relating to study
          of cell structure) anatomical definitions from this period in continuing
          to show that distinct areas of the cortex are activated inside the
          execution of unique obligations. The medical take a look at of the
          anxious machine extended considerably for the duration of the
          second one half of the 20 th century, basically due to advances in
          molecular biology, electrophysiology, and computational
          neuroscience. This has allowed neuroscientists to have a look at the
          anxious gadget in all its factors: how it's far structured, the way it
          works, how it develops, the way it malfunctions, and how it could be
          modified. Neuroscience is also allied with the social and behavioral
          sciences, as well as with nascent interdisciplinary fields. Examples of
          such alliances encompass neuroeconomics, choice theory, social
          neuroscience, and neuromarketing to address complex questions
          about interactions of the brain with its environment. A observe into
          purchaser responses for instance uses EEG to research neural
          correlates related to narrative transportation into testimonies
          approximately strength performance. As an example, it has emerged
          as viable to apprehend, in a good deal detail, the complicated
          strategies occurring within a single neuron. Neurons are cells
          specialized for conversation. They’re capable of talk with neurons and
          other mobile kinds through specialized junctions called synapses, at
          which electrical or electrochemical indicators can be transmitted from
          one mobile to some other. Many neurons extrude an extended skinny
          filament of axoplasm known as an axon, which may expand to distant
          parts of the body and are able to swiftly wearing electric alerts,
          influencing the activity of other neurons, muscle tissues, or glands at
          their termination points. An anxious device emerges from the
          assemblage of neurons which might be connected to each other.

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