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evaluation and treatment of hypertensive emergencies in adults

Michael H Pillinger, Sripal Bangalore, Alyssa B Klein, Scott Baumgartner, Robert Morlock
BACKGROUND: Gout, hyperuricemia, and cardiovascular disease (CVD) are prevalent conditions in the United States, and while they share common risk factors such as obesity, hypertension, hypercholesterolemia, and type 2 diabetes mellitus, relatively little is known about what patient and disease characteristics may link CVD with hyperuricemia and gout and how the presence of both diseases affects management decisions differently than for patients with gout alone. OBJECTIVE: To identify differences in patient characteristics, patterns of urate-lowering therapy (ULT) use, and gout control in gout patients with and without cardiovascular comorbidity...
June 2017: Journal of Managed Care & Specialty Pharmacy
Jeremy R Bonzo, Gregory E Tasian
PURPOSE OF REVIEW: The goal of this chapter is to review the recent epidemiologic trends of kidney stone disease and discuss the impact of the increasing incidence of nephrolithiasis among children on adults with respect to extra-renal manifestations, surgical management, and secondary prevention. RECENT FINDINGS: Among pediatric patients, kidney stone disease has been increasing at a rate of approximately 5-10% annually. Kidney stone disease has been associated with increased risks of coronary heart disease, chronic kidney disease, hypertension, and decreased bone mineral density, which is concerning for patients diagnosed at a young age...
June 2017: Current Urology Reports
G R Constantine, P Ranasinghe, P Weeratunga, C Weeraratne, P Galappatthy, S Rajapakse, U Senarath, P Katulanda
BACKGROUND: Resistant hypertension is defined as an uncontrolled blood pressure despite treatment at best-tolerated doses with at least three antihypertensive agents including a diuretic. It is an emerging public health problem. At present clinical trial data on management of resistant hypertension is limited. Management is largely based on observational studies and expert opinions. Propranolol is a nonselective beta blocker. Several studies have confirmed that propranolol has a significant hypotensive action, both when used alone and as an adjuvant therapy...
March 14, 2017: Trials
Danijela Milčić, Slavenka Janković, Sonja Vesić, Mirjana Milinković, Jelena Marinković, Andja Ćirković, Janko Janković
BACKGROUND: Emerging epidemiological evidence suggests independent associations between psoriasis and metabolic syndrome. Objectives: The aim of the study was to examine the prevalence of metabolic syndrome and its components in patients with psoriasis, and to assess which factors may predict metabolic syndrome in these patients. METHODS: A hospital-based, cross-sectional study with 244 psoriatic patients and 163 control subjects with skin diseases other than psoriasis was conducted at the Clinic of Dermatovenerology, Clinical Center of Serbia, Belgrade, from October 2011 to October 2012...
January 2017: Anais Brasileiros de Dermatologia
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
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