Clinical consequences of Hypotension in patient with organophosphate poisoning

Objective: Aim of study is to describe the clinical consequences of hypotension in patient with organophosphate poisoning. Method: In the retrospective cohort study, we analyzed data of 66 patients with organophosphate poisoning who were treated at Bir Hospital, Nams Kathmandu. Data from those with hypotension and normal blood pressure were compared to identify significant clinical consequences. Results: All together 66 patients were enrolled in this study out of which 44(66.7%) were female and 22(33.3%) were male. After analyzing data, we found 18.2% of case with severe poisoning (ACHE < 700 U/L). Among all, 41(62%) were found to have normal blood pressure and 25(37.9%) were found to have low blood pressure. Among those with hypotension, around 56% were found to have prolonged QTc interval, p < 0.003 and there was statistically significant association between QTc prolongation and vasopressor requirement, X2(1) = 22.98, P < 0.001. Patients requiring higher dose to reach atropinization had statistically significant hypotension, P < 0.001. Those with low blood pressure were found to require more days of hospital admission, P < 0.001. Patients with hypotension were found to have severe poisoning both on the basis of POP Score severity grading, 16(64%) P <0.002 and ACHE Severity scale, 7(28%) P < 0.05. In comparison with normal blood pressure group, low blood pressure group had significantly more chance of developing complications like septic shock (2), aspiration pneumonia (5), ARDS (1) and bed sore, P = 0.002. Vasopressor requirement was significantly more among those with low blood pressure, P < 0.001. Most of hypotensive patients were needing ICU care, found to have higher WBC count P = 0.002 and lower GCS Score at admission P < 0.001. There was positive correlation between hypotension and POP Score at admission P < 0.001. Conclusion: Hypotension is a common complication in patient with organophosphate poisoning and is associated with higher POP Score, lower ACHE level, lower GCS Score, increased vasopressor requirement, more hospital stays, increasing ICU admission, more chance of developing septic shock and aspiration pneumonia.

Patients with Dipper and Nondipper High-Normal Blood Pressure Were Associated with Left Ventricular Mass

Purpose. High-normal blood pressure has been suggested to associate with target organ damage and higher left ventricular mass index (LVMI). Our aim is to find the association between people with high-normal blood pressure and their left ventricular mass index. Materials and Methods. Given a total of 181 people with office blood pressure, 24-hour ambulatory blood pressure monitoring, 35 of them are normotensive (BP < 130/85 mm Hg), and 146 people with high-normal blood pressure (BP 130–139/85–89 mm Hg), divide the high-normal blood pressure group into dipper and nondipper according to their ABPM in 24 hours. All of them were performed with echocardiography to calculate LVMI. Results. After adjusting for potential confounding factors, mean systolic blood pressure (BP) of the nondipper group is (119 + 9) mmHg in 24 h, which is significantly higher ( p < 0.05) than in the dipper group (116 + 11) mmHg, indicating the mean systolic BP is associated with the dipper type ( p < 0.05); furthermore, the higher nocturnal blood pressure is associated with the nondipper group significantly ( p < 0.05), and LVMI ((121 ± 11) g/m2) of the nondipper group is also significantly higher than in the dipper group’s LVMI ((108 ± 12) g/m2) ( p < 0.05). The multivariate linear regression analyses revealed significant and independent associations of LVMI with these factors: triglyceride (TG), total cholesterol (TC), low-density lipoprotein (LDL-C), and coefficient of variation of systolic and diastolic blood pressure in 24 hours. Conclusion. After multiple relevant clinical confounding factors were adjusted, patients with dipper and nondipper high-normal blood pressure had higher LVMI. Abnormalities in circadian blood pressure variability may be associated with the left ventricular hypertrophy.

Improving the Effectiveness of Therapeutic Measures for Generalized Periodontitis in Patients with Hypertension

The program of standard therapeutic measures in 45 patients with Generalized Chronic Periodontitis (GCP) and background hypertension, group I(a), included hirudotherapy, for comparison, the effectiveness of traditional treatment was evaluated in 40 patients, group I(b), who refused to use medical leeches. In the second comparison group (35 patients), patients with GCP, but normal blood pressure, also received only a set of traditional methods of treatment. The inclusion of hirudotherapy in the program of therapeutic measures in patients with GCP and hypertension makes it possible to optimize the onset of a persistent therapeutic effect, lengthen the period of remission of the pathological process in periodontal disease and significantly improves the quality of life of patients.

The Relationships Between Lipid Accumulation Product Levels and Cognitive Decline Over 4 Years in a Rural Area of Xi’an, China

Background and Aims: The relationships between blood lipid levels and obesity and cognitive impairment have not been fully determined. Considering that the lipid accumulation product (LAP) is a composite index of blood lipid levels and obesity, we investigated the relationships between LAP levels at baseline and cognitive decline over 4 years.Methods: A total of 983 subjects (≥40 years) from a longitudinal cohort in a village of Xi’an, China, who completed the baseline survey were followed-up for 4 years. All participants underwent face-to-face interviews and cognitive assessments at baseline and at the 4-year follow-up. The Mini-Mental State Examination (MMSE) was used to assess cognitive function, and an MMSE score dropping ≥ 2 points from baseline was defined as cognitive decline. The relationships between LAP and cognitive decline were analyzed by linear regression models.Results: During the 4-year follow-up, 172 patients exhibited cognitive decline (17.5%). Univariate analysis showed that the rate of change in MMSE score was significantly different between the low-LAP group and the high-LAP group (t = −2.26, p = 0.024). Multiple linear regression indicated that a high LAP was positively associated with cognitive decline (β = 0.564, p = 0.012). Stratified multivariate analysis showed that LAP was positively associated with cognitive decline in the normal blood pressure female subgroup (β = 1.29, p = 0.002) but not in the high blood pressure group or the male group.Conclusions: High LAP is associated with cognitive decline in females with normal blood pressure but not in those with high blood pressure or males. This indicates that the relationships between blood lipid levels and obesity and cognitive impairment may be affected by blood pressure and sex.

The role of insulin-like growth factor-1 in prognostication metabolic disorders in patients with arterial hypertension

The article reviews the sources of scientific literature on the role of somatomedin - insulin-like growth factor-1 (IGF-1) in predicting the development of metabolic disorders in patients with hypertension, the depth of the search for a period of 10 years. It is noted that this scientific problem has been studied in different countries, the connection between IGF-1 deficiency and the occurrence of metabolic disorders in patients with hypertension (AH) is considered to be one of the predictors of cardiovascular disease. It was experimentally established that the study of the content of IGF-1 in the blood revealed a significant decrease in the level of somatomedin in groups of patients with varying degrees of hypertension. Studies have confirmed the pathogenetic role of IGF-1 deficiency in the development of left ventricular hypertrophy and heart failure in patients with hypertension in combination with type 2 diabetes mellitus (DM). It is the deficiency of IGF-1 in the blood was associated with the development of degenerative processes. Immune-modulating ability of IGF-1 has been established, antithrombotic and antiremodeling properties of somatomedin have been proved. It was found that people with normal blood pressure and people without signs of impaired glucose tolerance had significantly higher levels of IGF-1 in the blood. It is established that the study of the role of IGF-1 in the prediction of metabolic disorders in patients with hypertension is a promising scientific problem.

Left Frontal Lobe Tumor-Induced Intraoperative Premature Ventricular Beats

In the absence of cardiac pathology, premature ventricular contractions (PVCs) in neurosurgical patients frequently accompany subarachnoid hemorrhage, intracerebral hemorrhage, traumatic brain injury, or raised intracranial pressure. PVCs detected during preanesthesia assessment prompts detailed cardiac evaluation. Our 57-year-old patient, a case of left frontal meningioma, with controlled hypertension, diabetes and hypothyroidism, had normal preoperative ECG and potassium. However, immediately on anesthesia induction, she developed multiple refractory to treatment PVCs but with normal blood pressure. Anesthesia, which was maintained with sevoflurane and fentanyl, was deepened to exclude light anesthesia as the cause, without useful outcome. Two lignocaine boluses (100 mg each), followed by its infusion, also proved ineffective. Her blood gases and potassium, checked twice, were normal. Throughout, her hemodynamics remained stable. As soon as tumor was removed, the PVCs disappeared not to return. Her postoperative recovery was uneventful with normal ECG.

Double Product as a Predictor of Coronary Artery Disease in Males with Normal Blood Pressure

Aim: This study investigates whether in males with normal blood pressure that underwent exercise stress test Double Product (DB) or Double Product Ratios to workload (DPR) are self-sufficient in predicting the presence of coronary artery disease (CAD). Method: 78 male patients with normal blood pressure went through bicycle exercise stress test (EST) and within four weeks they underwent coronary angiography. 34 of them resulted with normal coronary arteries and 44 of them were diagnosed with one or multiple vessel CAD. Pressure rate double product was calculated in rest, in the first stage of the exercise test, in the peak of exercise, and also in the second, fourth, and sixth minutes of recovery of the stress test. Also, the ratios of pressure rate double product with the workload, which reflects the relative growth of double product to the workload, were calculated. The results were compared between the two groups, the one with normal coronary arteries, and those with abnormal coronary angiography. Results: DP in rest and in the first stage of the exercise are not significantly different for normotensive males with or without CAD, while the peak DB value of the exercise, as well as the econd and sixth minutes of the recovery are significantly lower for the group of patients with CAD. The starting peak workloads were significantly lower in the patients' group with CAD (p=0.0002 and p 0.0001). On the other hand, the double product to workload ratio at the first stage was significantly lower in males with normal blood pressure and CAD. Significant lower DPR are detected also in the fourth and sixth minutes of recovery. Conclusion: The values of DP in the peak exercise and at the second and sixth minutes of the recovery phase are significantly lower in normotensive males with abnormal coronary angiography compared to those with normal coronary arteries, and these findings can be used to detect the presence of CAD despite the ECG changes and they are not affected by the baseline characteristics of the patients. The ratios between DP and workload at the first stage, and in the fourth and sixth minutes of recovery are significantly lower in normotensive male patients with coronary artery disease compared to those without CAD and can be independent predictive parameters for the disease.

Vitamin D in pediatric patients with obesity and arterial hypertension

The purpose of this study was to find potential differences in vitamin D levels between different groups: overweight children with hypertension, normal-weight children with hypertension, overweight children with normal blood pressure and normal-weight children without hypertension, representing the control group. We also wanted to determine whether there are correlations between vitamin D levels and other clinical laboratory parameters, to evaluate the potential need for substitution. We measured vitamin D, homocysteine, total cholesterol, HDL, LDL, triglycerides, uric acid, glucose, apolipoprotein A1, apolipoprotein B, alkaline phosphatase, calcium, phosphate and magnesium serum levels in all groups. We also took anthropometric measurements (body weight, height, body mass index (BMI)) and observed patients’ blood pressure. The results were analyzed with SPSS statistic tool with basic statistical methods. The study included 175 children between 5 and 18 years of age. Fiftyseven were healthy (group A—control group), 41 normal-weight with hypertension (group B), 44 overweight with hypertension (group C) and 33 overweight with normal blood pressure (group D). The results showed statistically significant differences in values of vitamin D between all groups—A and B (p = 0.003), A and C (p < 0.001), A and D (p < 0.001), B and D (p = 0.043), B and C (0.030), except for groups C and D (p = 0.830). There were statistically significant correlations between vitamin D and BMI (r = − 0.196, p = 0.010), systolic pressure (r = − 0.190, p = 0.002), diastolic pressure (r = − 0.149, p = 0.050), homocysteine (r = − 0.208, p = 0.007), triglycerides (r = − 0.196, p = 0.011) and apolipoprotein A1 (r = 0.222, p = 0.007), confirmed in multivariate model. For the blood pressure, the higher the systolic blood pressure, the lower the average vitamin D was. The pilot study shows significant differences in serum vitamin D levels between all groups of children, apart from groups C and D. These results, combined with statistically significant correlations between vitamin D and systolic and diastolic blood pressure suggest the need for monitoring and potential substitution of vitamin D in in pediatric patients with hypertension.

High-normal blood pressure (prehypertension) is associated with PM2.5 exposure in young adults

We aimed to examine PM2.5 exposure, blood pressure (SBP and DBP) measurement, hypertension risk factors and to assess the association between PM2.5 exposure and hypertension among young adults. The mean SBP was 117.78 mmHg, with 11.22% high-normal blood pressure (prehypertension) and 2.51% hypertension (≥ 140 mmHg). DBP was 75.48 mmHg with 26.37% prehypertension and 4.53% hypertension (≥ 90 mmHg). The median PM2.5 in the past year was 31.79 µg/m3, with highest in winter (49.33 µg/m3), followed by spring (37.34 µg/m3), autumn (29.64 µg/m3) and summer (24.33 µg/m3). Blood pressure was positively correlated with age, height, weight, BMI, daily smoking, alcohol consumption, mental stress and stay-up in the past 1 year. After adjustment for the covariates, each 10 µg/m3 increase in PM2.5 was associated with SBP (Day 1 = 1.07 mmHg, Day 3 = 1.25 mmHg, Day 5 = 1.01 mmHg) and DBP (Day 1 = 1.06 mmHg, Day 3 = 1.28 mmHg, Day 5 = 1.29 mmHg, Day 15 = 0.87 mmHg, Day 30 = 0.56 mmHg). Exposure in winter was associated with 1.17 mmHg increase in SBP. Logistic models showed for every 1 µg/m3 increase of PM2.5, SBP in Day 1 and Day 5 was increased by 6% and 4%, and DPB by 3% and 16%, respectively. SBP was increased by 13% in spring and 7% in winter, and DBP was increased by 12% in winter. Our data suggest a certain prevalence of pre- or hypertension among young population, which is associated with short-term fluctuation and season-specific exposure of PM2.5.