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https://www.readbyqxmd.com/read/28323673/clinical-pearls-of-maternal-critical-care-part-2-sickle-cell-disease-in-pregnancy
#1
Vinod Patil, Gamunu Ratnayake, Galina Fastovets
PURPOSE OF REVIEW: The current review outlines the challenges in managing pregnant women with sickle-cell anemia, who are at risk of becoming critically ill during pregnancy. RECENT FINDINGS: Sickle obstetric patients pose unique challenges to the anesthetist and intensivist. We discuss the role of prophylactic transfusions for specific indications like acute anemia and twin pregnancies. The management and prevention of vaso-occlusive crises and chest crisis are also outlined...
March 18, 2017: Current Opinion in Anaesthesiology
https://www.readbyqxmd.com/read/28318686/probiotic-supplementation-for-management-of-cardiovascular-risk-factors-in-adults-with-type-ii-diabetes-a-systematic-review-and-meta-analysis
#2
Fatemeh Hendijani, Vajihe Akbari
BACKGROUND & AIMS: The effectiveness of probiotics in control of hypertension and dyslipidemia in diabetic patients remains unclear. Therefore, we systematically reviewed relevant data to elucidate the effects of probiotics on blood pressure and lipid profile of type 2 diabetic patients. METHODS: We searched PubMed, ISI Web of Knowledge, Scopus, The Cochrane Library, ClinicalTrials.gov, ProQuest Dissertations and Theses databases until May 2016. The primary outcomes were systolic blood pressure (SBP) and diastolic blood pressure (DBP), total cholesterol (TC), low-density lipoprotein cholesterol (LDL-C), high-density lipoprotein cholesterol (HDL-C) and triglycerides (TG)...
February 24, 2017: Clinical Nutrition: Official Journal of the European Society of Parenteral and Enteral Nutrition
https://www.readbyqxmd.com/read/28316323/a-rare-cause-of-upper-gastrointestinal-hemorrhage-chronic-thrombosis-of-the-splenic-artery
#3
Sevtap Arslan, Mehmet Ruhi Onur, Erhan Akpınar
Upper gastrointestinal bleeding (UGIB) represents one of the most serious conditions of the gastrointestinal tract with a mortality rate of 10%. The main cause of UGIB is peptic ulcer, accounting for 28%-59% of cases. A rare cause of UGIB is submucosal arterial collaterals, which develop after splenic artery thrombosis. UGIB secondary to gastric submucosal collateral arteries should be considered in patients with endoscopic appearance of varicose veins in the absence of portal hypertension. Computed tomography angiography (CTA) is the only fast and noninvasive definitive imaging technique for such patients...
March 17, 2017: Turkish Journal of Gastroenterology: the Official Journal of Turkish Society of Gastroenterology
https://www.readbyqxmd.com/read/28315287/elective-primary-or-secondary-delayed-sternal-closure-improves-outcome-in-severely-compromised-patients
#4
Antonio M Calafiore, Azmat A Sheikh, Juan J Alfonso, Tarek Tantawi, Belgeit Maklouf, Ahmed Shawki, Ahmed Allam, Mohammed O Awadi, Ahmed A Osman, Aly M Habib, Michele Di Mauro
Background Delayed sternal closure (DSC) in patients with severely compromised preoperative hemodynamics can be helpful as the chest sometimes cannot be able to contain both lungs and heart. We report our experience to evaluate the midterm results of this strategy in an adult population. Materials and Methods From May 2009 till July 2015, 33 patients had DSC as first treatment of severe hemodynamic deterioration after cardiac surgery. Surgical procedures were valvular (9.27%) or coronary artery bypass grafting + others (24...
March 17, 2017: Thoracic and Cardiovascular Surgeon
https://www.readbyqxmd.com/read/28306673/hypertensive-crisis-an-update-on-clinical-approach-and-management
#5
Emrah Ipek, Ahmet Afşin Oktay, Selim R Krim
PURPOSE OF REVIEW: Here, we review current concepts on hypertensive crisis (HTN-C) with a focus on epidemiology, causes, pathophysiology and prognosis. We also offer a practical approach to the management of HTN-C. RECENT FINDINGS: HTN-C is characterized by a severe and abrupt increase in blood pressure (BP) with impending or progressive acute end-organ damage (EOD). HTN-C can be divided into hypertensive emergency (HTN-E) and hypertensive urgency (HTN-U) based on the presence or absence of acute EOD, respectively...
March 16, 2017: Current Opinion in Cardiology
https://www.readbyqxmd.com/read/28302739/changing-landscape-of-congenital-heart-disease
#6
Berto J Bouma, Barbara J M Mulder
Congenital heart disease is the most frequently occurring congenital disorder affecting ≈0.8% of live births. Thanks to great efforts and technical improvements, including the development of cardiopulmonary bypass in the 1950s, large-scale repair in these patients became possible, with subsequent dramatic reduction in morbidity and mortality. The ongoing search for progress and the growing understanding of the cardiovascular system and its pathophysiology refined all aspects of care for these patients. As a consequence, survival further increased over the past decades, and a new group of patients, those who survived congenital heart disease into adulthood, emerged...
March 17, 2017: Circulation Research
https://www.readbyqxmd.com/read/28302660/rhabdomyolysis-induced-compartment-syndrome-secondary-to-atorvastatin-and-strenuous-exercise
#7
Louise Dunphy, Rossel Morhij, Sarah Tucker
A 50-year-old male UK resident with a history of hypertension and hypercholesterolaemia presented to the emergency department with a 48-hour history of sudden onset bilateral thigh swelling and pain unrelieved by regular analgesia. 3 days prior to presentation, he performed a vigorous workout in the gym. His medications included ramipril 5 mg once daily and atorvastatin 20 mg at night time. He was a non-smoker and did not consume alcohol. He reported no known drug allergies. Physical examination confirmed bilateral swollen thighs, with no overlying skin changes, clinically suggestive of compartment syndrome...
March 16, 2017: BMJ Case Reports
https://www.readbyqxmd.com/read/28300569/obesity-as-an-effect-modifier-in-sleep-disordered-breathing-and-post-cardiac-surgery-atrial-fibrillation
#8
Roop Kaw, Samer El Zarif, Lu Wang, James Bena, Eugene Blackstone, Reena Mehra
INTRODUCTION: As the inter-relationships of objectively-ascertained sleep disordered breathing (SDB), post-cardiac surgery atrial fibrillation (PCSAF) and obesity remain unclear; we aimed to further investigate in a clinic-based cohort. METHODS: Patients with polysomnography (PSG) and cardiac surgery (coronary artery bypass surgery and/or valvular surgery) within 3 years, from January 2009 to January 2014 were identified excluding those with pre-existing AF. Logistic models were used to determine the association of SDB (apnea hypopnea index (AHI) per 5 unit increase) and secondary predictors [central sleep apnea (CSA) (central apnea index>5) and oxygen desaturation index (ODI)] with PCSAF...
March 11, 2017: Chest
https://www.readbyqxmd.com/read/28299638/the-impact-of-aging-on-cardiac-extracellular-matrix
#9
REVIEW
Cesar A Meschiari, Osasere Kelvin Ero, Haihui Pan, Toren Finkel, Merry L Lindsey
Age-related changes in cardiac homeostasis can be observed at the cellular, extracellular, and tissue levels. Progressive cardiomyocyte hypertrophy, inflammation, and the gradual development of cardiac fibrosis are hallmarks of cardiac aging. In the absence of a secondary insult such as hypertension, these changes are subtle and result in slight to moderate impaired myocardial function, particularly diastolic function. While collagen deposition and cross-linking increase during aging, extracellular matrix (ECM) degradation capacity also increases due to increased expression of matrix metalloproteinases (MMPs)...
February 2017: Geroscience
https://www.readbyqxmd.com/read/28299608/dissipative-energy-loss-within-the-left-ventricle-detected-by-vector-flow-mapping-in-diabetic-patients-with-controlled-and-uncontrolled-blood-glucose-levels
#10
Chun-Mei Li, Wen-Juan Bai, Yan-Ting Liu, Hong Tang, Li Rao
Diabetes mellitus (DM) is related to increased risks of cardiovascular diseases, such as myocardial infarction, diabetic cardiomyopathy and secondary hypertension. Dissipative energy loss (EL) derived from vector flow mapping (VFM) is thought to reflect the efficiency of blood flow and has been deemed to be an index for the evaluation of left ventricular function. Our study aimed to investigate the value of dissipative EL in diabetic patients with controlled and uncontrolled blood glucose by VFM. Eighty-eight patients with DM and 58 age-matched healthy controls were recruited...
March 15, 2017: International Journal of Cardiovascular Imaging
https://www.readbyqxmd.com/read/28299283/lenvatinib-for-anaplastic-thyroid-cancer
#11
Makoto Tahara, Naomi Kiyota, Tomoko Yamazaki, Naoko Chayahara, Kenji Nakano, Lina Inagaki, Kazuhisa Toda, Tomohiro Enokida, Hironobu Minami, Yoshinori Imamura, Tatsuya Sasaki, Takuya Suzuki, Katsuki Fujino, Corina E Dutcus, Shunji Takahashi
BACKGROUND: Lenvatinib has been approved by regulatory agencies in Japan, the United States, and the European Union for treatment of radioiodine-refractory differentiated thyroid cancer (RR-DTC). Thyroid cancer, however, is a clinically diverse disease that includes anaplastic thyroid cancer (ATC), the subtype associated with the highest lethality. Effective therapy for ATC is an unmet need. PATIENTS AND METHODS: This phase 2, single-arm, open-label study in patients with thyroid cancer, including ATC, RR-DTC, and medullary thyroid cancer was conducted from 3 September 2012 to 9 July 2015...
2017: Frontiers in Oncology
https://www.readbyqxmd.com/read/28297825/-the-clinical-application-of-retractorless-surgery-in-patients-with-hypertensive-basal-ganglia-hemorrhage
#12
Z H Zhao, X M Zhong, Y Q Wang, J G Yang, Y Cai, Z H Fei, L Zhang
Objective: To discuss the clinical feasibility and practical application of retractorless surgical for patients with hypertensive basal ganglia hemorrhage. Methods: A total of 84 patients underwentretractorless surgery in The First People's Hospital of Huzhou from Jun 2014 to Jun 2016 were retrospectively reviewed.There were 53 male and 31 female of the 84 patients. Their mean age were 58.7 years with range: 29-74 years.Glasgow coma scale score(GCS) at admissionwereas follow: GCS 4-5 points 10 cases(including 3 cases companied dilated pupils), GCS 6-8 points 25 cases, GCS 9-12 points 32 cases, and GCS 13-14 points 17 cases...
March 7, 2017: Zhonghua Yi Xue za Zhi [Chinese medical journal]
https://www.readbyqxmd.com/read/28296786/association-between-macular-degeneration-and-mild-to-moderate-chronic-kidney-disease-a-nationwide-population-based-study
#13
Chun-Yu Chen, Ciou-Sia Dai, Chin-Chan Lee, Yu-Chiau Shyu, Ting-Shuo Huang, Ling Yeung, Chi-Chin Sun, Huang-Yu Yang, I-Wen Wu
Chronic kidney disease (CKD) and macular degeneration (MD) are 2 grave diseases leading to significant disability secondary to renal failure and blindness. The 2 diseases share not only common risk factors but also similar pathogenic mechanisms to renal and retinal injuries. Previous epidemiological studies indicated association between these 2 diseases. However, this concept is challenged by recent investigations. Patients with mild to moderate CKD (n = 30,696) between January 1, 1995 and December 31, 2005 were selected from the Taiwan National Health Insurance Database...
March 2017: Medicine (Baltimore)
https://www.readbyqxmd.com/read/28296731/clinical-outcomes-of-iga-nephropathy-patients-with-different-proportions-of-crescents
#14
Wang Zhang, Qian Zhou, Lingyao Hong, Wenfang Chen, Shicong Yang, Qiongqiong Yang, Wei Chen, Xueqing Yu
Crescents involving more than 50% of glomeruli in IgA nephropathy (IgAN) signify a rapid deterioration of renal function. However, little is known about the prognosis of IgAN patients presenting crescents in less than 50% of glomeruli. We aimed to investigate the clinicopathological characteristics and outcomes of IgAN patients with different proportions of crescents.From January 2000 to December 2011, biopsy-proven primary IgAN patients with histological crescents formation were enrolled in this retrospective cohort study...
March 2017: Medicine (Baltimore)
https://www.readbyqxmd.com/read/28295923/effect-of-viral-suppression-on-hepatic-venous-pressure-gradient-in-hepatitis-c-with-cirrhosis-and-portal-hypertension
#15
Nezam Afdhal, Gregory T Everson, Jose Luis Calleja, Geoffrey W McCaughan, Jaime Bosch, Diana M Brainard, John G McHutchison, Shampa De-Oertel, Di An, Michael Charlton, Rajender K Reddy, Tarik Asselah, Edward Gane, Michael P Curry, Xavier Forns
BACKGROUND&AIMS: Portal hypertension is a predictor of liver-related clinical events and mortality in patients with hepatitis C and cirrhosis. The effect of interferon-free hepatitis C treatment on portal pressure is unknown. METHODS: Fifty patients with Child-Pugh-Turcotte (CPT) A and B cirrhosis and portal hypertension (hepatic venous pressure gradient [HVPG] >6 mmHg) were randomized to receive 48 weeks of open-label sofosbuvir plus ribavirin at Day 1 or after a 24-week observation period...
March 10, 2017: Journal of Viral Hepatitis
https://www.readbyqxmd.com/read/28295182/a-phase-1-trial-of-temsirolimus-and-intensive-re-induction-chemotherapy-for-2nd-or-greater-relapse-of-acute-lymphoblastic-leukaemia-a-children-s-oncology-group-study-advl1114
#16
Susan R Rheingold, Sarah J Tasian, James A Whitlock, David T Teachey, Michael J Borowitz, Xiaowei Liu, Charles G Minard, Elizabeth Fox, Brenda J Weigel, Susan M Blaney
The phosphatidylinositol 3-kinase (PI3K)/mammalian (or mechanistic) target of rapamycin (mTOR) signalling pathway is commonly dysregulated in acute lymphoblastic leukaemia (ALL). A phase 1 trial of the mTOR inhibitor temsirolimus in combination with UKALL R3 re-induction chemotherapy was conducted in children and adolescents with second or greater relapse of ALL. The initial temsirolimus dose level (DL1) was 10 mg/m(2) weekly × 3 doses. Subsequent patient cohorts received temsirolimus 7·5 mg/m(2) weekly × 3 doses (DL0) or, secondary to toxicity, 7·5 mg/m(2) weekly × 2 doses (DL-1)...
March 14, 2017: British Journal of Haematology
https://www.readbyqxmd.com/read/28293914/a-late-diagnosis-of-primary-aldosteronism
#17
Francesco Zorzi, Oliviero Olivieri, Paolo Brazzarola, Francesca Pizzolo
We report the case of a 41-year-old male patient with juvenile onset refractory hypertension while taking four drugs including a diuretic. Fourteen years before he underwent a complete investigation for secondary hypertension (including the aldosterone to renin ratio-ARR) that was negative. Since that, hypertension control gradually worsened, hypertensive organ damage aggravated and hypokalemia developed in spite of ACE inhibitor treatment. At the re-evaluation ARR was elevated, and the further workup for primary aldosteronism demonstrated an unilateral aldosterone producing adenoma that was surgically removed, with subsequent optimal blood pressure control with two anti-hypertensive drugs...
March 14, 2017: High Blood Pressure & Cardiovascular Prevention: the Official Journal of the Italian Society of Hypertension
https://www.readbyqxmd.com/read/28290006/exercise-testing-and-stress-imaging-in-mitral-valve-disease
#18
REVIEW
Damien Voilliot, Patrizio Lancellotti
Mitral valve disease represented by mitral stenosis and mitral regurgitation is the second most frequent valvulopathy. Mitral stenosis leads to an increased left atrial pressure whereas mitral regurgitation leads to an increased left atrial pressure associated with a volume overload. Secondary to an upstream transmission of this overpressure, both mitral stenosis and regurgitation lead to pulmonary hypertension and right heart failure. In addition, mitral regurgitation also leads to left ventricular dilatation and dysfunction with left heart failure...
March 2017: Current Treatment Options in Cardiovascular Medicine
https://www.readbyqxmd.com/read/28289495/treatment-of-chronic-thromboembolic-pulmonary-hypertension-the-role-of-medical-therapy-and-balloon-pulmonary-angioplasty
#19
Timothy M Fernandes, David S Poch, William R Auger
Chronic thromboembolic pulmonary hypertension (CTEPH) is a potentially curable disease when treated with pulmonary thromboendarterectomy (PTE). However, even at experienced surgical centers, nearly one-third of patients with CTEPH will be deemed inoperable for reasons including distal disease, comorbidities, or out-of-proportion pulmonary hypertension. It is in these patients with inoperable CTEPH that pulmonary hypertension (PH)-targeted medical therapy and balloon pulmonary angioplasty have potential therapeutic value...
October 2016: Methodist DeBakey Cardiovascular Journal
https://www.readbyqxmd.com/read/28289041/coadministration-of-canagliflozin-and-phentermine-for-weight-management-in-overweight-and-obese-individuals-without-diabetes-a-randomized-clinical-trial
#20
Priscilla Hollander, Harold E Bays, Julio Rosenstock, Mary Ellen Frustaci, Albert Fung, Frank Vercruysse, Ngozi Erondu
OBJECTIVE: To assess the efficacy and safety of coadministration of canagliflozin (CANA) and phentermine (PHEN) compared with placebo (PBO) and CANA or PHEN monotherapies in individuals who were overweight and obese without type 2 diabetes. RESEARCH DESIGN AND METHODS: This 26-week, phase 2a, randomized, double-blind, PBO-controlled, multicenter, parallel-group study enrolled individuals who were obese or overweight without type 2 diabetes (N = 335, age 18-65 years, BMI ≥30 to <50 kg/m(2) or BMI ≥27 to <50 kg/m(2) with hypertension and/or dyslipidemia)...
March 13, 2017: Diabetes Care
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