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Changes of Reactive Hyperemia Index (RHI) in Hypertensive Patients
Sunil Kumar Patel,
Liangdi Xie,
Gong Jin,
Xiaoqi Cai
Issue:
Volume 1, Issue 3, July 2017
Pages:
67-75
Received:
26 February 2017
Accepted:
4 May 2017
Published:
10 July 2017
DOI:
10.11648/j.ccr.20170103.11
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Abstract: Recent epidemiological evidences indicates a complex association of hypertension with vascular endothelial dysfunction which causes the development and progression of atherosclerosis leading to adverse cardiovascular and cerebrovascular events due to reduction in nitric oxide (NO) bioavailability. The aim of the study was to investigate the value on reactive hyperemia peripheral arterial tonometry (RH-PAT) as a noninvasive tool to assess and compare endothelial function in between hypertensive and normotensives. Although they do not measure vascular function in the coronary circulation directly, they have been shown to correlate reasonably with its more invasive counterparts. A total of 73 hypertensive patients and 48 normotensive patients were consecutively recruited from Cardiology outpatient department of first affiliated hospital of Fujian medical university. Peripheral endothelial function was measured by using EndoPAT device to assess reactive hyperemia induced vasodilation and expressed by the reactive hyperemia index (RHI) with age, sex, BMI, height with the control subjects and further the relationship between RHI and clinical characteristics laboratory cardiovascular risk factors were also investigated. Statistical analysis were performed using SPSS software version 19.0. The normality of the distribution of variables were performed by the Kolmogorov-Smirnov test and homogeneity test of variance. Continuous variables were expressed as mean ± SD and categorical variables were expressed as percentages. Comparison between two normal groups were made by t-test, for abnormal distributed variables Mann-Whitney U test was used and χ2 test was performed for comparison of categorical variables. Pearson’s correlation analysis was used to assess associations between measured parameters and a p-value < 0.05 was considered to be statistically significant. RHI was significantly lower in hypertensive subjects compared to normotensive subjects (1.69 ± 0.46 vs 2.27 ± 0.60, p < 0.001) and when both groups were divided into different subgroups according to (sex, age < or ≥ 55, smoking, high cholesterol, physical activity, BMI, alcohol habit), significantly low RHI was noted in the hypertensive subgroups, p < 0.05. In the both groups there was no significant difference in normal cholesterol category where as in hypertensive group, subjects with regular physical activity had significantly high RHI as compared to those with no physical activity at all. In a univariate analysis age (r = -0.482, P = 0.001), Systolic BP (r = -0.312, P = 0.001), GFR (r = 0.196, P = 0.031), physical activity (r = 0.536, P = 0.001) were found to significantly correlate with RHI. In a multivariate analysis, only age (β = 0.004, P = 0.001) and SBP (β = 0.003, P = 0.010) significantly and independently correlated with RHI. RHI was significantly attenuated in hypertensive subjects and showed significant correlation between age, SBP, GFR, and physical activity indicating endothelial dysfunction, suggesting RH-PAT may be used as a non-invasive test to identify hypertensive patients with an early endothelial dysfunction.
Abstract: Recent epidemiological evidences indicates a complex association of hypertension with vascular endothelial dysfunction which causes the development and progression of atherosclerosis leading to adverse cardiovascular and cerebrovascular events due to reduction in nitric oxide (NO) bioavailability. The aim of the study was to investigate the value o...
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A Cross-Sectional Study on the Evaluation of the Lipid Profile of Regular Blood Donors in the Buea Regional Hospital, Cameroon
Assob Nguedia Jules Clement,
Verla Sissy Vincent,
Nsagha Dickson Shey,
Bongkem Edward Afoni,
Ngowe Ngowe Marcelin
Issue:
Volume 1, Issue 3, July 2017
Pages:
76-83
Received:
29 May 2017
Accepted:
6 June 2017
Published:
21 July 2017
DOI:
10.11648/j.ccr.20170103.12
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Abstract: There is an acute shortage of blood in most blood banks worldwide to meet up with demands for several medical interventions. A few reports have associated regular blood donation to the lowering of lipid profile parameters. Estimating the lipid profile is a conventional method of assessing an individual’s risk for coronary heart disease. The purpose of this study was to evaluate the lipid profile of blood donors as a whole and to determine the effect of regular blood donation on lipid profile. This study was a cross sectional study that involved 146 consented blood donors, 90 of whom were regular blood donors (study group) and 56 irregular blood donors (control group). A volume of 5ml venous blood was drawn from each fasting participant into a dry biochemistry screw capped tube. This was allowed to clot and the serum was used to determine total cholesterol, Low-density lipoprotein, High-density lipoprotein and triglycerides. Their atherogenic indices were also calculated from the values of the lipid profile parameters. The student’s t test was use to compare means of the study group and control group, while linear regression analysis was used to measure amount of change. The mean total cholesterol (173.54 ± 46.28mg/dl), low-density lipoprotein (96.68 ± 39.37mg/dL), triglycerides (79.28 ± 42.95mg/dL) were comparatively lower in the regular blood donors than the irregular donors (174.61 ± 50.57, 98.16 ± 42.71, 79.82 ± 50.07) respectively, even though did not reach statistical significance (P > 0.05). The mean Low/High-density lipoprotein ratio was also lower in the regular donors than in the irregular donors, though not statistically significant (P > 0.05). 2.05% of the population of blood donors had a risky Low/High-density lipoprotein ratio (i.e. ratio ≥ 3.0). Blood donors as a whole may be said to have a reduced risk of developing coronary heart disease as reflected by the low prevalence of risky Low/High-density lipoprotein ratio and this benefit may be enhanced with regular blood donation as reflected by the lower total cholesterol, low-density lipoprotein, and triglyceride levels in regular blood donors.
Abstract: There is an acute shortage of blood in most blood banks worldwide to meet up with demands for several medical interventions. A few reports have associated regular blood donation to the lowering of lipid profile parameters. Estimating the lipid profile is a conventional method of assessing an individual’s risk for coronary heart disease. The purpose...
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Sex Differences in Characteristics and Management of Patients with Acute Heart Failure
Paolo Biagi,
Valerio Verdiani,
Grazia Panigada,
Vieri Vannucchi,
Luca Masotti,
Alberto Fortini
Issue:
Volume 1, Issue 3, July 2017
Pages:
84-90
Received:
21 May 2017
Accepted:
1 June 2017
Published:
24 July 2017
DOI:
10.11648/j.ccr.20170103.13
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Abstract: Burden of heart failure (HF) among females is growing. However, whether characteristics and management of acute HF differ according to sex is unknown. Therefore, the aim of the present study was to provide information about this concern from a real life perspective. Data from the Scompenso Cardiaco in Medicina Interna in Toscana (SMIT) Study, an observational, retrospective, multicenter 30-day cross-sectional study performed in thirty-two Internal Medicine wards of Tuscany, Italy, were analyzed. The present sub-analysis focused on the difference between female and male patients. Overall, seven hundred and seventy patients were enrolled in the SMIT Study. Of these, four hundred and twenty-nine (55.7%) were females. Females were significantly older than males. Seventy-two women (16.7%) and forty-eight men (14%) presented a new onset HF, whereas the majority of patients presented at least one previous hospital admission for HF in their history. No difference in length of hospital stay and mortality was found between sexes. Hypertensive (26.8% vs 19.8%, p = 0.02) and valvular (13.6% vs 8.6%, p = 0.03) were the more prevalent etiologies of HF in females, while ischemic heart disease was in males (25.8% vs 18.2%, p = 0.01). HF with a preserved left ventricle ejection fraction (LVEF) was significantly more prevalent in females compared to males (51.3% vs 32.6%, p = 0.0001). Chronic obstructive pulmonary disease (COPD), peripheral artery diseases (PAD) and severe anemia were more frequent in males, while cognitive impairment was in females. Mean creatinine clearance at hospital admission was lower in females than in males (44.4 ± 22.2 vs 49.4 ± 26.3 ml/min, p < 0.05). Females received more frequently non invasive ventilation compared to males (15.1% vs 9.1%, p = 0.011). No difference between sexes was registered in the use of diuretics, angiotensin converting enzyme (ACE) inhibitors, angiotensin II receptor blockers, beta blockers and digoxin, whereas the use of anti-aldosterone agents, ivabradine and statins were more frequently used in males. No difference between sexes was found in the median number of drugs prescribed at hospital discharge [8 (interquartile range, IQR, 6-11) vs 9 (IQR 7-11)]. Eighty-two percent of females and seventy-nine percent of males were discharged at home (p = ns). Fifty-six percent of females compared with forty percent of males were dependent in activities of daily living at hospital discharge (p = 0.0001). The present study demonstrates that demographic characteristics, etiology, co-morbidity and echocardiographic pattern of HF differ according to sex. Further prospective study are warranted.
Abstract: Burden of heart failure (HF) among females is growing. However, whether characteristics and management of acute HF differ according to sex is unknown. Therefore, the aim of the present study was to provide information about this concern from a real life perspective. Data from the Scompenso Cardiaco in Medicina Interna in Toscana (SMIT) Study, an ob...
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Antiphospholipid Syndrome Associated with Lupus Nephritis in a Resource-Poor Setting: A Case Report in Orlu, Nigeria
Issue:
Volume 1, Issue 3, July 2017
Pages:
91-93
Received:
24 May 2017
Accepted:
14 June 2017
Published:
24 July 2017
DOI:
10.11648/j.ccr.20170103.14
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Abstract: The incidence of antiphospholipid syndrome (APS) in Nigeria is not well-defined. Concomitant occurrence of APS and systemic lupus erythematosus (SLE) is rare in Nigeria. Documented here is a case of APS associated with SLE, complicated by lupus nephritis, in a young woman in Nigeria. Patient was a 31-year-old woman on evaluation for 2 consecutive mid-trimester pregnancy losses, each preceded by a history of leg swelling and passage of blood in urine. Two of her sisters, about her age, have a similar history of recurrent mid-trimester pregnancy losses. Her blood pressure was normal. She has proteinuria +++, 24-hour urine protein 2942mg, and positive serology results for ANA, dsDNA, antiphospholipid antibody, and lupus anticoagulant. She was placed on Aspirin and Prednisolone, among others. Repeat urine protein was 1242mg/day at 4 weeks and 419mg/day at 12 weeks on follow-up. This case report highlights the need for consideration of the possibility of APS in association with SLE in the evaluation of miscarriages and proteinuric diseases in pregnancy.
Abstract: The incidence of antiphospholipid syndrome (APS) in Nigeria is not well-defined. Concomitant occurrence of APS and systemic lupus erythematosus (SLE) is rare in Nigeria. Documented here is a case of APS associated with SLE, complicated by lupus nephritis, in a young woman in Nigeria. Patient was a 31-year-old woman on evaluation for 2 consecutive m...
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Before First Two Minutes: A Quality Improvement Project Aimed at Decreasing the Time to Defibrillation for In-patients at High Risk of Having a Cardiac Arrest
Joyce Akwe,
Penny Gunter,
Anne Cadet,
Joel Moorhead,
Leslie Bao,
Ancy Chemmalakuzhy
Issue:
Volume 1, Issue 3, July 2017
Pages:
94-97
Received:
31 May 2017
Accepted:
15 June 2017
Published:
24 July 2017
DOI:
10.11648/j.ccr.20170103.15
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Abstract: The time from cardiac arrest to the administration of Cardio Pulmonary Resuscitation (CPR) and defibrillation have been shown to influence the outcome of a cardiac arrest in the hospital setting. Both the time to defibrillation and the start of CPR could be influenced by several factors including patient’s physical environment, system based problems, promptness to calling for help, the availability of the code equipment and patient readiness for a CPR or Advance Cardiac Life Support (ACLS). In order to cut down on these barriers to a successful code, a pre-code readiness training was administered to hospital staff with various background and level of responsibilities. The goal of the program was to reduce the response time to in-hospital cardiac arrest by focusing on the factors which have been reported to increase the response time such as lack of a vascular access, equipment malfunction or even discrepancies in alerting hospital-wide resuscitation response. Twelve questions were prepared to address the main aspects that could reduce the time to defibrillation to below 2 minutes and contribute to the success of a code. A total of 125 volunteers were trained. First they completed a questionnaire with 12 questions on how to prepare both the patient and their environment to a possible emergent medical intervention or a cardiac arrest. Next, they received training on how they could assist in preparing a deteriorating patient or patient at a high risk of having a cardiac arrest during that admission. After the training, they were invited into the simulation center where there was a deteriorating virtual patient and a typical patient room environment was simulated, and a real life situation was simulated. There was a statistically significant difference in the before and after training response to each of the questions. Prior to the training, 968 answers to these questions were correct. After the training, 1484 answers were correct (Value is < 0.00001). The difference in the correct answers before and after the training was statistically significant for each of the questions. Most code situations are disorganized and the hypothesis is that recognizing a patient at a high risk of having a cardiac arrest and preparing the patient and his environment to a cardiac arrest may lead to a better outcome. This training program covered the most common patient related factors, environmental aspects and equipment related factors that could contribute to rapid intervention and consequently to a successful code.
Abstract: The time from cardiac arrest to the administration of Cardio Pulmonary Resuscitation (CPR) and defibrillation have been shown to influence the outcome of a cardiac arrest in the hospital setting. Both the time to defibrillation and the start of CPR could be influenced by several factors including patient’s physical environment, system based problem...
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