Antihypertensive drug treatment changes in the general population: the CoLaus study.

BACKGROUND: Changes in antihypertensive drug treatment are paramount in the adequate management of patients with hypertension, still, there is little information regarding changes in antihypertensive drug treatment in Switzerland. Our aim was to assess those changes and associated factors in a population-based, prospective study. METHODS: Data from the population-based, CoLaus study, conducted among subjects initially aged 35-75 years and living in Lausanne, Switzerland. 772 hypertensive subjects (371 women) were followed for a median of 5.4 years. Data Subjects were defined as continuers (no change), switchers (one antihypertensive class replaced by another), combiners (one antihypertensive class added) and discontinuers (stopped treatment). The distribution and the factors associated with changes in antihypertensive drug treatment were assessed. RESULTS: During the study period, the prescription of diuretics decreased and of ARBs increased: at baseline, diuretics were taken by 46.9% of patients; angiotensin receptor blockers (ARB) by 44.7%, angiotensin converting enzyme inhibitors (ACEI) by 28.8%, beta-blockers (BB) by 28.0%, calcium channel blockers (CCB) by 18.9% and other antihypertensive drugs by 0.3%. At follow-up (approximately 5 years later), their corresponding percentages were 42.8%, 51.7%, 25.5%, 33.0% 20.7% and 1.0%. Among all participants, 54.4% (95% confidence interval: 50.8-58.0) were continuers, 26.9% (23.8-30.2) combiners, 12.7% (10.4-15.3) switchers and 6.0% (4.4-7.9) discontinuers. Combiners had higher systolic blood pressure values at baseline than the other groups (p < 0.05). Almost one third (30.6%) of switchers and 29.3% of combiners improved their blood pressure status at follow-up, versus 18.8% of continuers and 8.7% of discontinuers (p < 0.001). Conversely, almost one third (28.3%) of discontinuers became hypertensive (systolic ≥140 mm Hg or diastolic ≥90 mm Hg), vs. 22.1% of continuers, 16.3% of switchers and 11.5% of combiners (p < 0.001). Multivariate analysis showed baseline uncontrolled hypertension, ARBs, drug regimen (monotherapy/polytherapy) and overweight/obesity to be associated with changes in antihypertensive therapy. CONCLUSION: In Switzerland, ARBs have replaced diuretics as the most commonly prescribed antihypertensive drug. Uncontrolled hypertension, ARBs, drug regimen (monotherapy or polytherapy) and overweight/obesity are associated with changes in antihypertensive treatment

Delivery by repeat caesarean section today: an overview

Background: To find out the maternal and neonatal outcome and background characteristics of women delivering by repeat caesarean section in a tertiary care centre in Chennai, South India.Methods: Parturition records for the year 2017, were accessed and case records, for the calculated sample size were selected. Demographic features, obstetric history, gestational age and antenatal complications were recorded. Maternal outcome and baby details including sex of the baby, birth weight, APGAR and admission to New born Intensive Care Unit (NICU) data and acceptance of postpartum contraception was noted.Results: In the study group, 156 women delivered by repeat caesarean section.  The age group of women ranged from 20 years to 38 years.  Majority of 83.4% of women were Para one.  Threatening rupture was recorded in 2.6% of women. The risk of previous two CS scars was noted in 3.2% of women. More than 41% of women had other complications. Most often observed complications were Gestational hypertension, Gestational diabetes, preeclampsia and eclampsia. Pregnancy complications of oligohydramnios, twins, breech and abnormal presentation, were significant. 1% of women had associated medical complications of anaemia and hypothyroidism.  Maternal and Fetal causes were the most important indication for caesarean section in 74% of women. There were no maternal deaths in present study group. Postpartum contraception was accepted by 55 % of women.Conclusions: Majority of repeat caesarean section was observed most commonly in para one women in the age group of 26-30 years More than 41% of women had associated medical and obstetric complications. There were no maternal deaths in this study. Neonatal deaths were 2.5%

Finite-Size Scaling and Universality in the Spin 1 Quantum XY Chain

The spin-1 XY chain in a transverse field is studied using finite-size scaling. The ground state phase diagram displays a paramagnetic, an ordered ferromagnetic and an ordered oscillatory phase. The paramagnetic-ferromagnetic transition line belongs to the universality class of the 2D Ising model. Along this line, universality is confirmed for the finite-size scaling functions of several correlation lengths and for the conformal operator content.Comment: Latex 8 pages, 2 uucompressed figure

Kronecker's Double Series and Exact Asymptotic Expansion for Free Models of Statistical Mechanics on Torus

For the free models of statistical mechanics on torus, exact asymptotic expansions of the free energy, the internal energy and the specific heat in the vicinity of the critical point are found. It is shown that there is direct relation between the terms of the expansion and the Kronecker's double series. The latter can be expressed in terms of the elliptic theta-functions in all orders of the asymptotic expansion.Comment: REVTeX, 22 pages, this is expanded version which includes exact asymptotic expansions of the free energy, the internal energy and the specific hea

Pathological processing of sentinel lymph nodes in endometrial carcinoma - routine aspects of grossing, ultra-staging, and surgico-pathological parameters in a series of 833 lymph nodes.

Sentinel lymph nodes are widely accepted in the treatment of endometrial carcinoma. Whereas surgical aspects are well studied, the pathological work-up in terms of grossing, frozen section, and the so-called ultra-staging is still a matter of debate. This results in conflicting national or center-based recommendations. In a series of consecutive 833 sentinel lymph nodes from 206 patients in endometrial carcinomas, we compared three different grossing techniques and the use of frozen section in terms of anatomy, detection rates, and survival. In total, 42 macro-metastases, 6 micro-metastases, and 25 nodes with isolated tumor cells were found. Lymph nodes affected at least with micro-metastasis were about 0.5cm enlarged. Detection rates in lamellation technique increased with a step of 5.9% to 8.3% in comparison to bi-valved or complete embedding. The lamellation technique presented with a slight beneficial prognosis in pN0 subgroup (OS, p=0.05), which besides size effects might be attributed to trimming loss. In frozen section, this effect was less pronounced than expected (OS, p=0.56). Ultra-staging only revealed additional micro-metastases and isolated tumor cells. Exclusively, macro-metastases showed poor survival (p<0.001). In multivariate analysis, T-stage, subtype, and lympho-vascular invasion status outperformed this staging parameter significantly. Grossing of sentinel lymph nodes is the most essential step with evidence to prefer lamellation in 2 mm steps. Step sectioning should consider widely spaced protocols to exclude macro-metastases. Frozen sections might add value to the intra-operative assessment of endometrial carcinoma in selected cases. The excellent biological behavior of cases with isolated tumor cells might question the routine application of pan-cytokeratin as ultra-staging method

Low-Temperature Expansions and Correlation Functions of the Z_3-Chiral Potts Model

Using perturbative methods we derive new results for the spectrum and correlation functions of the general Z_3-chiral Potts quantum chain in the massive low-temperature phase. Explicit calculations of the ground state energy and the first excitations in the zero momentum sector give excellent approximations and confirm the general statement that the spectrum in the low-temperature phase of general Z_n-spin quantum chains is identical to one in the high-temperature phase where the role of charge and boundary conditions are interchanged. Using a perturbative expansion of the ground state for the Z_3 model we are able to gain some insight in correlation functions. We argue that they might be oscillating and give estimates for the oscillation length as well as the correlation length.Comment: 17 pages (Plain TeX), BONN-HE-93-1

Duality symmetry, strong coupling expansion and universal critical amplitudes in two-dimensional \Phi^{4} field models

We show that the exact beta-function \beta(g) in the continuous 2D g\Phi^{4} model possesses the Kramers-Wannier duality symmetry. The duality symmetry transformation \tilde{g}=d(g) such that \beta(d(g))=d'(g)\beta(g) is constructed and the approximate values of g^{*} computed from the duality equation d(g^{*})=g^{*} are shown to agree with the available numerical results. The calculation of the beta-function \beta(g) for the 2D scalar g\Phi^{4} field theory based on the strong coupling expansion is developed and the expansion of \beta(g) in powers of g^{-1} is obtained up to order g^{-8}. The numerical values calculated for the renormalized coupling constant g_{+}^{*} are in reasonable good agreement with the best modern estimates recently obtained from the high-temperature series expansion and with those known from the perturbative four-loop renormalization-group calculations. The application of Cardy's theorem for calculating the renormalized isothermal coupling constant g_{c} of the 2D Ising model and the related universal critical amplitudes is also discussed.Comment: 16 pages, REVTeX, to be published in J.Phys.A:Math.Ge

Fermionic representations for characters of M(3,t), M(4,5), M(5,6) and M(6,7) minimal models and related Rogers-Ramanujan type and dilogarithm identities

Characters and linear combinations of characters that admit a fermionic sum representation as well as a factorized form are considered for some minimal Virasoro models. As a consequence, various Rogers-Ramanujan type identities are obtained. Dilogarithm identities producing corresponding effective central charges and secondary effective central charges are derived. Several ways of constructing more general fermionic representations are discussed.Comment: 14 pages, LaTex; minor correction