Eosinophilia and Skin Rash in a Patient with Uncontrolled Hypertension and AKI

It is well known that hypertension is an independent cardiovascular risk factor. Treatment of hypertension frequently includes administration of three or more drugs. Resistant hypertension is defined when blood pressure remains above target value despite full doses (the patient’s maximum tolerated dose) of antihypertensive medication consisting of at least three different classes of drugs including a diuretic. Pharmacological treatment of hypertension is often unsuccessful despite the increasing number of drug combinations. Uncontrolled hypertension, however, increases the cardiovascular risk. Device treatment of resistant hypertension is currently testing two major fields. One of them the stimulation of baroreceptors in the carotid sinus and the other is radiofrequency ablation of sympathetic nerve fibers around renal arteries to reduce blood pressure in drug resistant hypertension. Orv. Hetil., 2013, 154, 203–208.

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Blue Skin Rash And Swelling Of The Orbits After Injection Of Patent Blue V Dye During Sentinel Lymph Node Biopsy - A Case Report

Polish Journal of Surgery ◽

10.2478/v10035-010-0085-y ◽

2010 ◽

Vol 82 (10) ◽

Author(s):

Łukasz Strzępek ◽

Wojciech Wysocki ◽

Piotr Skotnicki ◽

Jerzy Mituś

Keyword(s):

Case Report ◽

Lymph Node ◽

Sentinel Lymph Node ◽

Sentinel Lymph Node Biopsy ◽

Skin Rash ◽

Lymph Node Biopsy ◽

Patent Blue ◽

Node Biopsy ◽

Patent Blue V

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Faculty Opinions recommendation of Practical solutions to the challenges of uncontrolled hypertension: a white paper.

Faculty Opinions – Post-Publication Peer Review of the Biomedical Literature ◽

10.3410/f.1158661.618507 ◽

2009 ◽

Author(s):

Carl Erik Mogensen

Keyword(s):

White Paper ◽

Uncontrolled Hypertension

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Biochemical Markers in Patients with Readmission for Congestive Heart Failure

Revista de Chimie ◽

10.37358/rc.18.7.6395 ◽

2018 ◽

Vol 69 (7) ◽

pp. 1687-1691

Author(s):

Razan Al Namat ◽

Mihai Constantin ◽

Ionela Larisa Miftode ◽

Andrei Manta ◽

Antoniu Petris ◽

...

Keyword(s):

Heart Failure ◽

Congestive Heart Failure ◽

Rural Areas ◽

Discharge Planning ◽

Difficult Problem ◽

Uncontrolled Hypertension ◽

Medical Attention ◽

Family Doctors ◽

Increased Risk ◽

Risk Patients

Repetitive or recurrent hospitalizations are a general major health issue in patients with chronic disease. Congestive heart failure, is associated with a high incidence and presence of early rehospitalization, but variables in order to identify patients at increased risk and also an analysis of potentially remediable factors contributing to readmission have not been previously reported and it remains still a difficult problem. We retrospectively assessed 100 patients aged between 48-85 years old, of which 75% were men, who had been hospitalized with documentation of congestive heart failure in St. Spiridon County Emergency Hospital. They were hospitalized between 2010-2017. Even if recurrent heart failure was the most common cause for readmission or rehospitalization, other cardiac disorders and noncardiac illnesses were also accounted for readmission. Predictive factors of an increased probability of readmission included prior patient�s medical heart failure history, heart failure decompensation precipitated or accelerated by an ischaemic episode, atrial fibrillation or uncontrolled hypertension. Factors contributing to preventable readmissions included noncompliance with medications or diet, inadequate discharge planning or follow-up, failure of both social support system and the seek of a promp medical attention when symptoms reappeared. We also identified an inappropriate colaboration with family doctors especially for the patients from rural areas. Patients were more likely to cite side effects of prescribed medications rather than nonadherence as a precipitating factor for readmission. Thus, we can appreciate that early rehospitalization in patients with congestive heart failure may be avoidable in up to 50% of cases. Identification of high risk patients is possible and also necessary shortly after admission in order to identify nonpharmacological interventions designed to decrease readmission frequency.

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High prevalence of non-dipping patterns among Black Africans with uncontrolled hypertension: a secondary analysis of the CREOLE trial

BMC Cardiovascular Disorders ◽

10.1186/s12872-021-02074-7 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Prossie Merab Ingabire ◽

◽

Dike B. Ojji ◽

Brian Rayner ◽

Elijah Ogola ◽

...

Keyword(s):

Blood Pressure ◽

Blood Pressure Monitoring ◽

Secondary Analysis ◽

Uncontrolled Hypertension ◽

African Countries ◽

Night Time ◽

Black Africans ◽

Long Term Outcome ◽

Black African ◽

High Prevalence

Abstract Background Dipping of blood pressure (BP) at night is a normal physiological phenomenon. However, a non-dipping pattern is associated with hypertension mediated organ damage, secondary forms of hypertension and poorer long-term outcome. Identifying a non-dipping pattern may be useful in assessing risk, aiding the decision to investigate for secondary causes, initiating treatment, assisting decisions on choice and timing of antihypertensive therapy, and intensifying salt restriction. Objectives To estimate the prevalence and factors associated with non-dipping pattern and determine the effect of 6 months of three antihypertensive regimens on the dipping pattern among Black African hypertensive patients. Methods This was a secondary analysis of the CREOLE Study which was a randomized, single blind, three-group trial conducted in 10 sites in 6 Sub-Saharan African countries. The participants were 721 Black African patients, aged between 30 and 79 years, with uncontrolled hypertension and a baseline 24-h ambulatory blood pressure monitoring (ABPM). Dipping was calculated from the average day and average night systolic blood pressure measures. Results The prevalence of non-dipping pattern was 78% (564 of 721). Factors that were independently associated with non-dipping were: serum sodium > 140 mmol/l (OR = 1.72, 95% CI 1.17–2.51, p-value 0.005), a higher office systolic BP (OR = 1.03, 95% CI 1.01–1.05, p-value 0.003) and a lower office diastolic BP (OR = 0.97, 95% CI 0.95–0.99, p-value 0.03). Treatment allocation did not change dipping status at 6 months (McNemar’s Chi2 0.71, p-value 0.40). Conclusion There was a high prevalence of non-dipping among Black Africans with uncontrolled hypertension. ABPM should be considered more routinely in Black Africans with uncontrolled hypertension, if resources permit, to help personalise therapy. Further research is needed to understand the mechanisms and causes of non-dipping pattern and if targeting night-time BP improves clinical outcomes. Trial registration ClinicalTrials.gov (NCT02742467).

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Summertime skin rash

Journal of Paediatrics and Child Health ◽

10.1111/jpc.2_15251 ◽

2021 ◽

Vol 57 (6) ◽

pp. 963-963

Keyword(s):

Skin Rash

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Investigating the Mechanism of Trimethoprim-Induced Skin Rash and Liver Injury

Toxicological Sciences ◽

10.1093/toxsci/kfaa182 ◽

2021 ◽

Author(s):

Yanshan Cao ◽

Ahsan Bairam ◽

Alison Jee ◽

Ming Liu ◽

Jack Uetrecht

Keyword(s):

Liver Injury ◽

Skin Rash ◽

Covalent Binding ◽

Reactive Metabolites ◽

Important Data ◽

Drug Induced ◽

Interindividual Differences ◽

Immune Mediated ◽

Sulfate Conjugate

Abstract Trimethoprim (TMP)-induced skin rash and liver injury are likely to involve the formation of reactive metabolites. Analogous to nevirapine-induced skin rash, one possible reactive metabolite is the sulfate conjugate of α-hydroxyTMP, a metabolite of TMP. We synthesized this sulfate and found that it reacts with proteins in vitro. We produced a TMP-antiserum and found covalent binding of TMP in the liver of TMP-treated rats. However, we found that α-hydroxyTMP is not a substrate for human sulfotransferases, and we did not detect covalent binding in the skin of TMP-treated rats. Although less reactive than the sulfate, α-hydroxyTMP was found to covalently bind to liver and skin proteins in vitro. Even though there was covalent binding to liver proteins, TMP did not cause liver injury in rats or in our impaired immune tolerance mouse model that has been able to unmask the ability of other drugs to cause immune-mediated liver injury. This is likely because there was much less covalent binding of TMP in the livers of TMP-treated mice than TMP-treated rats. It is possible that some patients have a sulfotransferase that can produce the reactive benzylic sulfate; however, α-hydroxyTMP, itself, has sufficient reactivity to covalently bind to proteins in the skin and may be responsible for TMP-induced skin rash. Interspecies and interindividual differences in TMP metabolism may be one factor that determines the risk of TMP-induced skin rash. This study provides important data required to understand the mechanism of TMP-induced skin rash and drug-induced skin rash in general.

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Disease activity index is associated with subclinical atherosclerosis in childhood-onset systemic lupus erythematosus

Pediatric Rheumatology ◽

10.1186/s12969-021-00513-5 ◽

2021 ◽

Vol 19 (1) ◽

Author(s):

Priscila B. S. Medeiros ◽

Roberta G. Salomão ◽

Sara R. Teixeira ◽

Diane M. Rassi ◽

Luciana Rodrigues ◽

...

Keyword(s):

Risk Factors ◽

Systemic Lupus Erythematosus ◽

Disease Activity ◽

Lupus Erythematosus ◽

Activity Index ◽

Subclinical Atherosclerosis ◽

Disease Activity Index ◽

Uncontrolled Hypertension ◽

Childhood Onset ◽

Systemic Lupus

Abstract Background Systemic lupus erythematosus (SLE) is an independent risk factor for cardiovascular events. The present study determined the prevalence of subclinical atherosclerosis in childhood-onset SLE using the carotid intima-media thickness (CIMT) measurement and investigated associations between traditional and nontraditional risk factors for atherosclerosis, such as medications, SLE Disease Activity Index - SLEDAI-2 K and SLICC-ACR damage index and CIMT. Methods Cross-sectional prospective study between 2017 and 2018. CIMT was assessed by ultrasonography. Data were collected by chart review, nutritional evaluation and laboratory tests and analyzed by Fisher, Wilcoxon-Mann-Whitney tests, multiple linear and log binomial regression. Results Twenty-eight patients (mean age 13.9 years, SD 3) were enrolled. The prevalence of subclinical atherosclerosis was 32% (95% CI 14.8, 49.4). The mean CIMT was 0.43 ± 0.035 mm. The most common traditional risk factors observed were dyslipidemia (82.1%), uncontrolled hypertension (14.2%), obesity (14.3%), and poor diet (78.6%). Uncontrolled hypertension (p = 0.04), proteinuria (p = 0.02), estimated glomerular filtration rate < 75 ml /min/1.73 m2 (p = 0.02) and SLEDAI-2 K > 5 (P = 0.04) were associated with subclinical atherosclerosis. SLEDAI-2 K > 5 maintained association with CIMT after adjusting for control variables. Conclusion Subclinical atherosclerosis is frequently observed in cSLE, mainly in patients with moderate to severe disease activity.

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