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OBJECTIVE: To investigate the spectrum of diagnoses made by general practitioners (GPs) seeing patients with acute abdominal pain, as well as GPs' handling of these patients. To investigate factors predictive of acute admission to hospital. DESIGN: Descriptive study. SETTING: General practices in southern Norway, autumn 2007 and spring 2008. Subjects. A total of 134 patients who were offered an acute appointment with a GP because of abdominal pain. MAIN OUTCOME MEASURES: Tentative diagnosis made and handling of the patient by the GP. Explanatory factors: pain duration, findings on clinical examination. RESULTS: The most frequent diagnosis was non-specific pain (20%), followed by gastroenteritis (13%), appendicitis (12%), ulcer disease (11%), gynaecological disease (9%), and urinary tract problems (7%). One-quarter of patients were sent home after clinical examination without any specific action taken. One-quarter were acutely admitted to hospital, and one-quarter were treated with medication. The rest was either referred for further investigations on a non-acute basis (14%) or given a follow-up appointment with the GP (10%). Suspected appendicitis was the strongest predictor for acute admission. Rebound tenderness on clinical examination as well as pain duration for 24 hours or less also independently predicted acute hospital admission. CONCLUSION: GPs face the challenge of meeting a wide and inhomogeneous spectre of complaints when dealing with patients with acute abdominal pain. Three-quarters of patients are taken care of in primary care. [ABSTRACT FROM AUTHOR]

Background: Progressive arterial stiffening may increase the risk of recurrent cardiovascular events in ischemic stroke survivors. Information about factors associated with progressive arterial stiffening during the follow-up of young patients with ischemic stroke is lacking., Methods: Arterial stiffness by carotid-femoral pulse wave velocity (cf-PWV) and ambulatory 24-hour blood pressure (24hBP) were assessed in 81 women and 190 men ≤60 years of age included in the Norwegian Stroke in the Young (NOR-SYS) study 3 months and 5.5 years after the incident ischemic stroke, representing baseline and follow-up. Covariables of change in cf-PWV were identified using linear regression analysis., Results: At baseline, women had less prevalent hypertension (53% vs. 69%, p < 0.05), and lower clinic and 24hBP than men, whereas age, obesity, and prevalence of smoking and antihypertensive drug treatment did not differ. During follow-up, systolic 24hBP remained unchanged, while diastolic 24hBP fell significantly (p < 0.01). Cf-PWV was lower in women both at baseline (7.3 m/s vs. 8.1 m/s) and at follow-up (7.3 m/s vs. 8.0 m/s, both p < 0.001), but the average change during follow-up did not differ between genders. In linear regression analysis, an increase in cf-PWV at the 5-year follow-up was associated with the presence of hypertension and lower cf-PWV at baseline, and higher systolic 24hBP and lack of use of antihypertensive treatment at follow-up (all p < 0.05)., Conclusion: In ischemic stroke survivors participating in the NOR-SYS study, the 5-year increase in cf-PWV did not differ between genders and was associated with higher systolic 24hBP and lack of antihypertensive treatment.

Background: Rheumatoid arthritis (RA) predominantly affects women and is associated with hypertension and arterial stiffness. We explored factors associated with change in arterial stiffness in patients with RA treated with disease-modifying antirheumatic drug (DMARD) therapy., Methods: Seventy-seven outpatients with RA (age 55 ± 11, 69% women), with indication for treatment with biological or targeted synthetic DMARDs, were included. Pulse wave velocity (PWV), augmentation pressure (AP), augmentation index (AIx) and Disease Activity Score in 28 joints (DAS28) were measured at baseline and after a mean of 22 months of follow-up., Results: At follow-up, 83% used DMARDs and 73% had achieved remission or low disease activity. DAS28 decreased from 3.8 ± 1.3 to 2.8 ± 1.2 ( p  < 0.001). Mean PWV increased from 7.8 ± 1.6 m/s at baseline to 8.5 ± 1.8 m/s at follow-up ( p  < 0.001), while AP and AIx were stable. Increase in PWV during follow-up was associated with increase in systolic blood pressure (BP), diabetes, higher DAS28 and body mass index (BMI) at baseline, independent of achieved remission/low disease activity and use of DMARDs at follow-up. In multivariable analyses at follow-up, female sex was associated with higher AP and AIx, but with lower PWV, after adjusting for possible confounders., Conclusion: In patients with RA, higher disease activity, BMI and diabetes at baseline, together with increase in office systolic BP were associated with an increase in arterial stiffness during follow-up, despite DMARD therapy. This highlights the need for management of cardiovascular risk factors in addition to reducing the inflammatory load in patients with RA to preserve arterial function.

Background: Incidence of cryptogenic ischemic stroke (CIS) in young adults is increasing. Early left atrial (LA) myopathy might be 1 of the underlying mechanisms, but this has only been scarcely explored., Objectives: The purpose of this study was to assess the association between increased LA stiffness and CIS in young adults., Methods: In the multicenter SECRETO (Searching for Explanations for Cryptogenic Stroke in the Young: Revealing the Etiology, Triggers, and Outcome) study, LA function was analyzed by speckle tracking echocardiography in 150 CIS patients (aged 18-49 years) and 150 age- and sex-matched controls. Minimum and maximum LA volumes, LA reservoir and contractile strain were measured. LA stiffness was calculated by the ratio: mitral peak E-wave velocity divided by mitral annular e' velocity (E/e')/LA reservoir strain and considered increased if ≥0.22. Increased LA volumes, LA stiffness, and/or reduced LA strain indicated LA myopathy. Logistic regression was used to determine the relation between LA stiffness and CIS and the clinical variables associated with LA stiffness., Results: Increased LA stiffness was found in 36% of patients and in 18% of controls ( P  < 0.001). Increased LA stiffness was associated with a 2.4-fold (95% CI: 1.1-5.3) higher risk of CIS after adjustment for age, sex, comorbidities, and echocardiographic confounders ( P  = 0.03). In patients, obesity, pre-CIS antihypertensive treatment, older age, and lower LA contractile strain were all related to increased LA stiffness (all P  < 0.05)., Conclusions: LA myopathy with increased LA stiffness and impaired LA mechanics more than doubles the risk of CIS in patients under the age of 50 years. This provides new insights into the link between LA dysfunction and CIS at young ages. (Searching for Explanations for Cryptogenic Stroke in the Young: Revealing the Etiology, Triggers, and Outcome [SECRETO]; NCT01934725)., Competing Interests: The SECRETO study has been funded by the 10.13039/501100002341Academy of Finland under grant numbers 318075 and 322656, Helsinki and Uusimaa Hospital District (TYH2018318), and 10.13039/501100006306Sigrid Juselius Foundation. Dr Cramariuc has received clinical researcher funds and open project support from the Regional Health Authorities in Western Norway (project numbers F-12557 and F-12615). Dr Sarkanen has received grant number 322663 from the Academy of Finland. The authors have reported that they have no relationships relevant to the contents of this paper to disclose.PERSPECTIVESCOMPETENCY IN MEDICAL KNOWLEDGE: Young adults with increased LA stiffness have significantly higher risk of CIS independent of LA size and in the absence of atrial fibrillation. TRANSLATIONAL OUTLOOK: Patients with premature LA disease may benefit from early intervention, like antithrombotic therapy. This should be further investigated in clinical studies addressing preventive and therapeutic interventions in young patients at high risk of ischemic stroke., (© 2024 The Authors.)