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evaluation and treatment of hypertensive emergencies in adults

Seema Kumar, Aaron S Kelly
Childhood obesity has emerged as an important public health problem in the United States and other countries in the world. Currently 1 in 3 children in the United States is afflicted with overweight or obesity. The increasing prevalence of childhood obesity is associated with emergence of comorbidities previously considered to be "adult" diseases including type 2 diabetes mellitus, hypertension, nonalcoholic fatty liver disease, obstructive sleep apnea, and dyslipidemia. The most common cause of obesity in children is a positive energy balance due to caloric intake in excess of caloric expenditure combined with a genetic predisposition for weight gain...
February 2017: Mayo Clinic Proceedings
Jason R Tatreau, Suzanne Harris, Brian Sheitman, Beat D Steiner
Background: Reverse colocation care models reduce lifestyle risk factors, emergency department visits, and readmissions. Persons with serious mental illness have higher than average rates of cardiovascular disease-related morbidity and mortality, with second-generation antipsychotics (SGAs) conferring added related risks. Little is written about reverse colocated medical care (RCL) in inpatient psychiatric settings. The objective of this study was to identify associations between screening, diagnosis, and treatment of chronic medical comorbidities and mode of medical care for patients discharged from 2 inpatient psychiatric units on SGAs...
December 22, 2016: Primary Care Companion to CNS Disorders
Edward B Garon, Jeffrey D Neidhart, Nashat Y Gabrail, Moacyr R de Oliveira, Jai Balkissoon, Fairooz Kabbinavar
INTRODUCTION: Combretastatin A4-phosphate, fosbretabulin tromethamine (CA4P) is a vascular disrupting agent that targets tumor vasculature. This study evaluated the safety of CA4P when combined with carboplatin, paclitaxel, and bevacizumab in chemotherapy-naïve subjects with advanced nonsquamous, non-small-cell lung cancer. METHODS: Adult subjects with confirmed American Joint Committee on Cancer six stage IIIB/IV non-small-cell lung cancer and an Eastern Cooperative Oncology Group performance score of 0 or 1 were randomized to receive six cycles (treatment phase) of paclitaxel (200 mg/m(2)), carboplatin (area under the concentration versus time curve 6), and bevacizumab (15 mg/kg) on day 1 and repeated every 21 days, or this regimen plus CA4P (60 mg/m(2)) on days 7, 14, and 21 of each cycle...
2016: OncoTargets and Therapy
Julie Brown, Tineke J Crawford, Jane Alsweiler, Caroline A Crowther
BACKGROUND: Gestational diabetes mellitus (GDM) is any degree of glucose intolerance that first presents and is recognised during pregnancy and usually resolves after the birth of the baby. GDM is associated with increased short- and long-term morbidity for the mother and her baby. Treatment usually includes lifestyle modification and/or pharmacological therapy (oral antidiabetic agents or insulin) with the aim to maintain treatment targets for blood glucose concentrations. Finding novel treatment agents which are effective, acceptable and safe for the mother and her baby are important...
September 7, 2016: Cochrane Database of Systematic Reviews
P Guimarães Cunha, J Cotter, P Oliveira, I Vila, P Boutouyrie, S Laurent, P M Nilsson, A Scuteri, N Sousa
OBJECTIVE: The value of central blood pressure (CBP) over peripheral blood pressure is under debate, i.e. concerning its independent predictive power for cardiovascular (CV) events / target organ damage (TOD) and its use as a therapeutic target. OBJECTIVES: To characterize the distribution of CBP values in a population residing in an area of high stroke incidence through comparison with published reference values for healthy subjects; to identify subjects at higher CV risk; to analyze the influence of salt intake on CBP, and to assess whether CBP plays a role in risk stratification and treatment...
September 2016: Journal of Hypertension
Felipe A Medeiros, Keith R Martin, James Peace, Baldo Scassellati Sforzolini, Jason L Vittitow, Robert N Weinreb
PURPOSE: To compare the intraocular pressure (IOP)-lowering effect of latanoprostene bunod (LBN) 0.024% with timolol maleate 0.5% in subjects with open-angle glaucoma (OAG) or ocular hypertension (OHT). DESIGN: Prospective, randomized, double-masked, parallel-group, noninferiority clinical trial. METHODS: Adults with OAG or OHT from 46 clinical sites (United States and European Union) were randomized 2:1 to LBN instilled once daily (QD) in the evening and vehicle in the morning or timolol instilled twice a day (BID) for 3 months...
August 2016: American Journal of Ophthalmology
A Sindone, J Erlich, C Lee, H Newman, M Suranyi, S D Roger
Previously, management of hypertension has concentrated on lowering elevated blood pressure. However, the target has shifted to reducing absolute cardiovascular (CV) risk. It is estimated that two in three Australian adults have three or more CV risk factors at the same time. Moderate reductions in several risk factors can, therefore, be more effective than major reductions in one. When managing hypertension, therapy should be focused on medications with the strongest evidence for CV event reduction, substituting alternatives only when a primary choice is not appropriate...
March 2016: Internal Medicine Journal
N Ali-Tatar Chentir, M Korabi, M T Chentir
OBJECTIFS: Irradiation of the heart in patients with breast cancer increases the risk of the so-called "radiation-induced heart disease" (RIHD). Among risk factors of RIHD, overweight, hypertension and diabetes mellitus take a major place. To describe a clinical case of an obese hypertensive diabetes mellitus woman with breast cancer since the begining of her radiotherapy until heart failure on the basis of the report from the European Association of Cardiovascular Imaging consensus for evaluation of cardiovascular complications of radiotherapy in adults...
December 2015: Annales de Cardiologie et D'angéiologie
Paul Oykhman, Harold L Kim, Anne K Ellis
BACKGROUND: Allergic diseases such as asthma and allergic rhinitis constitute a significant burden of disease among women of childbearing age and those who are pregnant. Adequately managing these conditions is paramount in reducing negative fetal outcomes as well as maternal complications during pregnancy. However, the potential for harm to both the mother and fetus demands carefully balancing efficacy and safety of treatment. Allergen immunotherapy (AIT) has emerged as a relatively safe and efficacious mode of therapy in both children and adults...
2015: Allergy, Asthma, and Clinical Immunology
Ronadip R Banerjee, Neyssa Marina, Laurence Katznelson, Brian J Feldman
Cushing's syndrome (CS) in the pediatric population is challenging to diagnose and treat. Although next-generation medical therapies are emerging for adults with CS, none are currently approved or used in children. Here we describe the first use of mifepristone, a glucocorticoid receptor antagonist, to treat CS in a pediatric subject. The patient, a 14-year-old girl with an 18-month history of metastatic neuroendocrine carcinoma, suffered from fatigue, profound myopathy, irritability, and depression. She was found to have hypertension, hypokalemia, and worsening control of her preexisting type 1 diabetes...
November 2015: Pediatrics
Rolf M F Berger, Sheila G Haworth, Damien Bonnet, Yves Dulac, Alain Fraisse, Nazzareno Galiè, D Dunbar Ivy, Xavier Jaïs, Oliver Miera, Erika B Rosenzweig, Michela Efficace, Andjela Kusic-Pajic, Maurice Beghetti
BACKGROUND: A novel formulation of bosentan was evaluated in children with pulmonary arterial hypertension (PAH) in FUTURE-1, which characterized its pharmacokinetic and clinical profile. The subsequent phase III, open-label, long-term extension study, FUTURE-2, aimed to provide long-term tolerability, safety and exploratory efficacy data. METHODS: Children (≥2 and <12 years) with idiopathic or heritable PAH, who completed 12-week treatment in FUTURE-1 and for whom bosentan was considered beneficial were enrolled, and continued to receive bosentan 4 mg/kg twice-daily, which could be down-titrated to 2mg/kg if not tolerated...
January 1, 2016: International Journal of Cardiology
Licia Polimeni, Maria Del Ben, Francesco Baratta, Ludovica Perri, Fabiana Albanese, Daniele Pastori, Francesco Violi, Francesco Angelico
Non-alcoholic fatty liver disease (NAFLD) represents the most common and emerging chronic liver disease worldwide. It includes a wide spectrum of liver diseases ranging from simple fatty liver to non-alcoholic steatohepatitis (NASH), which may progress to fibrosis and more severe liver complications such as cirrhosis, hepatocellular carcinoma and liver mortality. NAFLD is strongly associated with obesity, insulin resistance, hypertension, and dyslipidaemia, and is now regarded as the liver manifestation of the metabolic syndrome...
June 8, 2015: World Journal of Hepatology
M Ellen Tsay, Gabrielle Procopio, Bruce D Anderson, Wendy Klein-Schwartz
OBJECTIVE: Promethazine abuse has been reported. The objective was to investigate promethazine abuse/misuse in the United States. METHODS: An 11-year retrospective review was conducted of promethazine abuse and intentional misuse cases without co-ingestants in persons 10 years and older reported to the National Poison Data System. Data were stratified by product (promethazine-alone [PA] or co-formulation [PC]) and evaluated for demographics, toxicity, management sites, and outcomes...
May 2015: Journal of Addiction Medicine
Juliane Léger, Sophie dos Santos, Béatrice Larroque, Emmanuel Ecosse
CONTEXT: Untreated hypothyroidism is associated with a higher risk of adverse obstetric and neonatal outcomes. Pregnancy complications have yet to be evaluated in patients treated early for congenital hypothyroidism (CH). OBJECTIVE: This study aimed to investigate pregnancy outcomes and their determinants in a population-based registry of young adult women with CH. SETTING AND DESIGN: In total, 1748 subjects were diagnosed with CH in the first 10 years after the introduction of neonatal screening in France; 1158 of these subjects completed a questionnaire on fecundity at a mean age of 25...
March 2015: Journal of Clinical Endocrinology and Metabolism
Nancy Kerner, Kristina D'Antonio, Gregory H Pelton, Elianny Salcedo, Jennifer Ferrar, Steven P Roose, Dp Devanand
OBJECTIVE: We evaluated the efficacy and side effects of the selective serotonin and norepinephrine reuptake inhibitor antidepressant duloxetine in older adults with dysthymic disorder. METHODS: Patients ≥ 60 years old with dysthymic disorder received flexible dose duloxetine 20-120 mg daily in an open-label 12-week trial. The main outcomes were change from baseline to 12 weeks in 24-item Hamilton Depression Rating Scale scores and Treatment Emergent Symptoms Scale scores...
May 8, 2014: SAGE Open Medicine
Dominik Wiedemann, Marek Ehrlich, Philippe Amabile, Luigi Lovato, Hervé Rousseau, Arturo Evangelista-Masip, Patrick Moeller, Joseph Bavaria
OBJECTIVE: The objective of this study was to assess midterm results of emergency endovascular stent grafting for patients with life-threatening complications of acute type B aortic dissection. METHODS: Between March 1999 and November 2011, 110 patients (86 men, 24 women) with complications of acute type B aortic dissection (mean age, 61 years; range, 19-87 years) were treated with thoracic endovascular aortic repair for malperfusion (55.5%) or aortic rupture (53...
November 2014: Journal of Vascular Surgery
Robert W Schrier, Godela Brosnahan, Melissa A Cadnapaphornchai, Michel Chonchol, Keith Friend, Berenice Gitomer, Sandro Rossetti
Autosomal dominant polycystic kidney disease is a genetic disorder associated with substantial variability in its natural course within and between affected families. Understanding predictors for rapid progression of this disease has become increasingly important with the emergence of potential new treatments. This systematic review of the literature since 1988 evaluates factors that may predict and/or effect autosomal dominant polycystic kidney disease progression. Predicting factors associated with early adverse structural and/or functional outcomes are considered...
November 2014: Journal of the American Society of Nephrology: JASN
M Reitter, N Petitpain, C Latarche, J Cottin, N Massy, P Demoly, P Gillet, P M Mertes
BACKGROUND: Anaphylactic reactions to neuromuscular blocking agents (NMBAs) can be severe and even fatal. Our aim was to evaluate mortality rate in France from anaphylactic reactions to NMBAs, to identify risk factors for a fatal outcome, and to describe management of the cases that proved fatal. METHODS: The French National Pharmacovigilance Database was queried for reports of NMBA anaphylaxis that occurred between January 2000 and December 2011. A questionnaire was sent to regional pharmacovigilance centers to obtain further information on the management of cases with a fatal outcome...
July 2014: Allergy
Qing-Shan Wang, Jia-Feng Wang, Guang-Yan Zhang
OBJECTIVE: To evaluate the efficacy of the operation in the treatment of postoperative re-hemorrhage after splenectomy with periesophagogastric devascularization for advanced schistosomiasis. METHODS: Forty-three re-hemorrhage patients, who received varicose ligation combined with pericardial devascularization through left thoracic cavity with esophageal incision from October 2002 to October 2011, after splenectomy with periesophagogastric devascularization due to portal vein hypertension, were investigated retrospectively and followed up for 1 to 9 years...
February 2014: Zhongguo Xue Xi Chong Bing Fang Zhi za Zhi, Chinese Journal of Schistosomiasis Control
Kaberi Dasgupta, Robert R Quinn, Kelly B Zarnke, Doreen M Rabi, Pietro Ravani, Stella S Daskalopoulou, Simon W Rabkin, Luc Trudeau, Ross D Feldman, Lyne Cloutier, Ally Prebtani, Robert J Herman, Simon L Bacon, Richard E Gilbert, Marcel Ruzicka, Donald W McKay, Tavis S Campbell, Steven Grover, George Honos, Ernesto L Schiffrin, Peter Bolli, Thomas W Wilson, Patrice Lindsay, Michael D Hill, Shelagh B Coutts, Gord Gubitz, Mark Gelfer, Michel Vallée, G V Ramesh Prasad, Marcel Lebel, Donna McLean, J Malcolm O Arnold, Gordon W Moe, Jonathan G Howlett, Jean-Martin Boulanger, Pierre Larochelle, Lawrence A Leiter, Charlotte Jones, Richard I Ogilvie, Vincent Woo, Janusz Kaczorowski, Kevin D Burns, Robert J Petrella, Swapnil Hiremath, Alain Milot, James A Stone, Denis Drouin, Kim L Lavoie, Maxime Lamarre-Cliche, Guy Tremblay, Pavel Hamet, George Fodor, S George Carruthers, George B Pylypchuk, Ellen Burgess, Richard Lewanczuk, George K Dresser, S Brian Penner, Robert A Hegele, Philip A McFarlane, Milan Khara, Andrew Pipe, Paul Oh, Peter Selby, Mukul Sharma, Debra J Reid, Sheldon W Tobe, Raj S Padwal, Luc Poirier
Herein, updated evidence-based recommendations for the diagnosis, assessment, prevention, and treatment of hypertension in Canadian adults are detailed. For 2014, 3 existing recommendations were modified and 2 new recommendations were added. The following recommendations were modified: (1) the recommended sodium intake threshold was changed from ≤ 1500 mg (3.75 g of salt) to approximately 2000 mg (5 g of salt) per day; (2) a pharmacotherapy treatment initiation systolic blood pressure threshold of ≥ 160 mm Hg was added in very elderly (age ≥ 80 years) patients who do not have diabetes or target organ damage (systolic blood pressure target in this population remains at < 150 mm Hg); and (3) the target population recommended to receive low-dose acetylsalicylic acid therapy for primary prevention was narrowed from all patients with controlled hypertension to only those ≥ 50 years of age...
May 2014: Canadian Journal of Cardiology
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