INTRODUCTION

Several million patients suffer from nonhealing wounds in a variety of anatomical sites, costing the health system millions of dollars. The cost and management of these wounds varies in different centers. For example, the cost of managing a diabetic foot infection for approximately two weeks in one center is between $20,000-$25,000 but may be quite different in another center. Prior to the advent of the wound VAC, the treatment of nonhealing wounds consisted of traditional modalities, such as wet-to-dry dressings, debridement, and topical antibiotics, with closure of these wounds taking several weeks or months. The process of wound healing is a complex one, consisting of cell migration leading to repair and closure of wounds. The process also needs removal of debris, control of infection, clearance of inflammation, angiogenesis, deposition of granulation tissue, contraction, remodeling of the connective tissue matrix, and maturation. If any of these steps fail, a chronic open wound without anatomical or functional integrity results. Chronic wounds may be associated with pressure, trauma, venous insufficiency, diabetes, arterial disease, or prolonged immobilization. These wounds result in prolonged hospitalization, high risk of infection, and result in billions of dollars in healthcare costs. The advent of the wound VAC has substantially increased wound closure rates and reduced morbidity and health costs for many patients. …Read the rest of this article

The assessment of LVF was initially accomplished using cardiac catheterization and radionuclide angiography. These earlier techniques have the disadvantage of being invasive and therefore not suitable for very ill patients. There is also the risk of radiation exposure with the radionuclide method. However, with the emergence of Doppler echocardiography, a noninvasive assessment of LVF can now readily be done. It is easy to perform, results are reproducible, and the technique compares favorably with other techniques of cardiac function assessment.

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Ninety-five patients studied were made up of 60 males and 35 females. Ninety-two controls, made up of 54 males and 38 females, were also studied. The majority of the patients were in the fifth decade, followed by the fourth and sixth decades (Table 1). Fourteen patients, made up of four with peripartum cardiac failure, three with moderate anemia in association to cardiac failure, and four with severe renal failure in association to the cardiac failure and three with rheumatic valvular heart disease, were excluded because of its effect on LVF measurement.

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After approval by the Medical Ethical Committee of Ahmadu Bello University Zaria, 95 consecutive patients with hypertensive heart failure and 92 age-/sex-matched normotensive apparently healthy controls were recruited into the study. The demographic and clinical characteristics of these subjects were taken from history, physical examination, and routine laboratory investigations. Also included were patients who at the time of examination were in heart failure and had normal blood pressure but had a clear-cut history of hypertension. The WHO/ISH criteria for defining hypertension and Framingham clinical definition of cardiac failure were used to select patients. A patient with blood pressure equal or greater than 140/90 mmHg or definitive past history of hypertension and had exertional dyspnea, paroxysmal nocturnal dyspnea, raised jugular venous pressure, and S3 or S4 were included in the study.

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INTRODUCTION

There is a growing awareness that congestive heart failure (CHF) caused by a predominant abnormality in diastolic function causes significant morbidity and mortality. In the natural course of hypertensive heart disease progression, diastolic dysfunction appears before systolic dysfunction in hypertensive heart failure. However, there are still some patients who come up with symptoms and signs of heart failure while transiting from diastolic dysfunction to systolic dysfunction. These patients often have combined diastolic and systolic dysfunctions.

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Numerous published reports have documented ethnic differences in the receipt and outcomes of care between African-American and Caucasian patients in a variety of settings. Many of these studies have been based upon administrative data relating to hospitalization. This analysis represents one of the few attempts to investigate the existence of such differences in the primary care setting using data collected directly from patients. We found that African Americans with ischemic heart disease had higher levels of self-reported risk factors for ischemic heart disease, such as smoking, diabetes and hypertension but reported having received fewer cardiac procedures. Surprisingly, however, African Americans reported better physical function, vitality, and angina stability than Caucasians—a difference that persisted after adjustment for socioeconomic covariates and stratification by site. We also observed lower scores on the mental health scales of the SF-36 among African Americans compared with Caucasians, but these differences did not persist consistently across sites after adjustment. Notably, African Americans reported significantly lower satisfaction with the care for their IHD compared to Caucasian patients, and these differences persisted at half of our sites after adjustment.

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At enrollment into ACQUIP, the health-screening questionnaire was sent to 55,222 patients, of whom 32,149 were Caucasian and 12,816 were African-American. A total of 31,360 were returned, including 10,385 Caucasian and African-American patients, who reported ischemic heart disease and were sent the SAQ. Responses were received from 7,985 of these patients, of whom 6,704 (84.0%) were Caucasian and 1,281 (16.0%) were African-American. The percentage of African-American respondents at sites А, В, C, D, E, and F was 18% (of 1,377), 10% (of 2,429), 27% (of 1,289), 17% (of 548), 7% (of 1,715) and 37% (of 627), respectively.

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