bluuebunny/crossref_metadata_2025 huggingface dataset:
CHARACTERISING A NOVEL MODEL OF SUPER-IMPOSED PRE-ECLAMPSIA
Authors: Scott Kayley , Morgan Hannah , Graham Delyth , Delles Christian
Published: April 2021

Objective:

The stroke-prone spontaneously hypertensive (SHRSP) rat is a model of chronic hypertension and defective vascular remodelling during pregnancy that can be stressed by administration of angiotensin II (ANGII) to mimic super-imposed pre-eclampsia. This novel model has been tested with doses of 500 ng/kg/min and 1000 ng/kg/min ANGII.

The aim of this study was to characterise the pathology of this model with a dose of 750 ng/kg/min to enhance reproducibility and refine the model.

Design and method:

SHRSP and normotensive Wistar Kyoto (WKY) females were time mated with males of the relevant strain. On gestational day (GD) 10.5 mini osmotic pumps were implanted administering either 0.9% saline or 750 ng/kg/min of ANGII. SHRSPs were split into either SHAM (saline) or ANGII groups. WKY received saline only. At pre-pregnancy (PP), GD 6.5, 14.5 and 18.5 blood pressure, cardiac function and uteroplacental blood flow were measured by tail cuff plethysmography and ultrasound. Urine was collected by metabolic cage at PP, GD6.5 & 18.5 to assess proteinuria.

Results:

ANGII showed reduced pregnancy-related weight gain vs WKY and SHAM (168.3 ± 3.7 g vs 231.2 ± 3.0 g vs 183.3 ± 5.9 g, p < 0.001). ANGII showed an increased BP when compared to SHAM and WKY (180.9 ± 9.7mmHg vs 127.5 ± 6.5mmHg vs 139.8 ± 7.1 mmHg p < 0.001 GD18.5). ANGII dams showed signs of left ventricular cardiac dysfunction with an elevated relative wall thickness and reduced stroke volume and cardiac output vs WKY (p < 0.05). ANGII and SHAM exhibited impaired uteroplacental blood flow vs WKY at GD18.5 (0.57 ± 0.03au vs 0.62 ± 0.05au vs 0.38 ± 0.02au, p < 0.01). Infusion of ANGII successfully induced proteinuria, measured as urinary albumin:creatinine compared to SHAM and WKY (12.2 ± 8.28 μg/μmol/L vs 0.16 ± 0.01 μg/μmol/L vs 3.9 ± 0.40 μg/μmol/L, p < 0.001).

Conclusions:

The results presented here show this model has effectively captured the overall disease picture of pre-eclampsia with consistent disease characteristics such as proteinuria, hypertension, maternal cardiovascular impairment and dysregulated uterine artery remodelling. It may serve as a useful tool in the study of pre-eclampsia.
CARDIORENAL CONSEQUENCE IN A CHILD WITH LATENT HEPATITIS B
Authors: Rodoman Iulia , Ina Palii , Eva Gudumac , Tatiana Raba , Angela Ciuntu , Lucia Pirtu , Adrian Chiriac , Ilona Cucu , Diana Bujor
Published: April 2021

Objective:

Approximately 20% of patients with HBV infection have a wide range of extrahepatic damages that include renal and cardiovascular abnormalities. The purpose: is to highlight the cause of hypertension in a child with viral hepatitis B and multiorgan damage.

Design and method:

Describing a clinical case of a child with occult hepatitits.

Results:

A 1-year-old girl with toxic syndromes was hospitalized in Pediatric Department. Anamnestic data: the mother was diagnosed with HBsAg positive 4 years ago. The child was vaccinated with all 4 scheduled doses of anti-HBV vaccine. At first examination - increased BP values (160–220/100–120 mm/Hg), tachycardia, hepatomegaly. Laboratory tests: anemia gr. II, hypoproteinemia, hypoalbuminemia, hypocalcemia, slightly elevated transaminases. Ecocardiography - cardiac remodeling with dilated lef ventricle (LV); hypokinesia, and mild hypertrophy of interventricular septum; LV ejection fraction - 47%.

The secondary causes of arterial hypertension have been investigated: concentration of fractionated urinary and plasma metanephrines - N, direct plasma renin - > 5000 UI/mL, and serum aldosterone - 128 ng / dL. The aldosterone/renin ratio was 0.025 - suggestion of renal ischemia with secondary hyperaldosteronism. Cardiac and abdominal angioCT - severe hypoplasia of the common hepatic artery, moderate diffuse stenosis of the abdominal aorta at the renal and infrarenal levels, moderate diffuse stenosis of the bilateral renal arteries, more pronounced on the right, bilateral renal atrophy changes; cateterism cardiac - the aorta is permeable throughout, stenosis on the renal arteries, celiac trunk, and mesenteric artery was not determined, data that allowed the exclusion of the renovascular cause of hypertension. Abdominal MRI - focal areas 7x8 mm of diffusion restriction in the bilateral renal parenchymal.

The patient was suspected of an HBV infection with a risk of perinatal transmission, after in dynamics, there was identified hepatomegaly (+3.0 cm) and elevated ALAT and ASAT. Quantitative plasma HBV DNA -1 418 771 300 copies/ml or 834 571 352 IU/ml, which confirmed the diagnosis - Occult viral hepatitis B, gr. III of activity, seropositive form, with extrahepatic cardiorenal impairment.

Conclusions:

Cardiorenal impairment should be suspected in patients with HBV infection, especially in presence of clinical signs.
ENHANCED PRODUCTIONS OF INTRARENAL NLRP-3 INFLAMMASOME AND ANGIOTENSINOGEN IN ANGIOTENSIN II-DEPENDENT HYPERTENSION ARE PREVENTED BY IMMUNOSUPPRESSANT TREATMENT
Authors: Navar Luis Gabriel , Franco Martha , Katsurada Akemi , Dugas Courtney , Satou Ryousuke
Published: April 2021

Objective:

Activated inflammasomes enhance maturation of pro-inflammatory cytokines, which facilitates the development of kidney injury. NOD-, LRR- and pyrin domain-containing protein 3 (NLRP3), one of major subunits in the inflammasome complex, plays a crucial role in innate immunity and inflammation. NLRP3 inflammasome is activated by ATP-P2X7 axis and reactive oxygen species. Expression of pro-NLRP3 is promoted by activated NF-κB by cytokines or PAMPs/DAMPs. In angiotensin II (Ang II)-dependent hypertension, there is augmentation of renal immune cells leading to enhanced production of cytokines and consequent activation of NF-κB. Therefore, we hypothesized that intrarenal NLRP3 levels are increased in Ang II-dependent hypertension in association with the kidney injury, and treatment with mycophenolate mofetil (MMF), an immunosuppressant, prevents the augmentation of NLRP3 and attenuates the consequent progression of kidney injury.

Design and method:

Ang II (80 ng/min) was infused with/without daily MMF administration (50 ng/kg) to male rats for 2 weeks. mRNA levels of intrarenal NLRP3 and AIM2, which forms another type of inflammasome complex by viral or bacterial infections, were measured by droplet digital PCR. Furthermore, levels of intrarenal angiotensinogen (AGT), a critical contributor to activation of intrarenal renin-angiotensin system leading to the development of hypertension and associated kidney injury, were evaluated. Histological analyses of kidney injury were also performed.

Results:

MMF prevented increases in intrarenal macrophage/monocyte and IL-6 levels induced by Ang II infusion, confirming immunosuppression by the drug. Ang II infusion significantly increased intrarenal NLRP3 levels (control group: 4.12 ± 1.1 copies/ng RNA vs. Ang II-infused group: 9.96 ± 1.8 copies). The elevated NLRP3 expression was attenuated by MMF (6.24 ± 1.4 copies). In contrast, intrarenal AIM2 levels were not altered by Ang II infusion or MMF. Urinary protein and AGT levels were elevated in Ang II-infused rats, which were prevented by MMF. Histological analyses showed mesangial expansion and tubulointerstitial fibrosis observed in Ang II-infused group, but these injury markers were in normal ranges in the group receiving Ang II + MMF.

Conclusions:

These results demonstrate activation of the NLRP3 inflammasome in Ang II dependent hypertension and indicate that immunosuppression by MMF mitigates the inflammasome activation, which contributes to attenuation of the kidney injury.
CHANGE IN HEMODYNAMIC PARAMETERS AND CAROTID STIFFNESS INDICES AFTER VITAMIN K2 SUPPLEMENTATION IN PATIENTS WITH TYPE 2 DIABETES MELLITUS
Authors: Marinova Elena , Dimova-Mileva Maria , Kanazirev Branimir
Published: April 2021

Objective:

Vitamin K2 is a cofactor of gamma-carboxylase activating group of vitamin K-dependent proteins involved in vascular calcification and arterial stiffness. Data on the protective effects of vitamin K2 supplementation in the progression of vascular damage in patients with type 2 diabetes mellitus (T2DM) are scarce.

Aim:

to investigate the change in systolic (SAP), diastolic (DAP), pulse (PP), mean (MAP) blood pressure, central systolic aortic pressure (CASP), pulse wave velocity (PWV) and beta-stiffness index (BSI) in patients with T2DM after vitamin K2 supplementation.

Design and method:

We included 18 patients with T2DM (mean age 59.09 ± 8.5 men 38.8%) who received Vitamin K2 (Menaquinone-7) 75 μg once daily for a period of 4 weeks. Patients with overt cardio-vascular diseases, uncontrolled blood pressure and vitamin K-antagonists intake were excluded from the study. Hemodynamic parameters were measured using an A-pulse CASP-AL device. Carotid stiffness indices were measured by one-point echo-tracking method with Aloka Hitachi Prosound on the both common carotid arteries (CA).

Results:

All hemodynamic parameters showed increased values compared to the baseline: SAP (+5 mmHg) (p = 0.1), DAP (+2.9mmHg) (p = 0.19), PP (+1.4mmHg) (p = 1.4), MAP (+3.4 mmHg) (p = 0.08). CASP increased from 119.8 ± 12.1mmHg to 126.8 ± 11.4 mmHg (+5 mmHg), and this change was significant (p = 0.02). PWV on the right CA did not change significantly before (7.0 ± 1.48 m/s) and after (7.19 ± 1.28 m/s) supplementation (p = 0.47), similar to BSI 10.08 ± 3.41 and respectively 10.51 ± 3.99 (p = 0.61). PWV on the left CA before supplementation is 7.01 ± 1.22 m/c, respectively after 7.19 ± 1.56 m/c (p = 0.49). BSI on the left CA is 9.97 ± 2.79, resp. 10.69 ± 5.07 (p = 0.43).

Conclusions:

Vitamin K2 supplementation for four weeks showed significant increase in CASP in our cohort of patients with T2DM. The other hemodynamic parameters as well as the indicators of carotid stiffness do not change significantly. A limitation of our study is the small number of patients included and the short period of intake of vitamin K2, which may not lead to morphological changes in the vessel wall. More extensive research is needed in the field.
HYPERTENSION PHENOTYPES, TARGET ORGAN DAMAGE AND STIFF ARTERIES AND SEVERITY OF COVID-19
Authors: Mahmud Azra , Alhabdan Nawaf Abdulaziz , Alkhdiri Mohammad Hamad , Alahaideb Ruba , Rajendrum Rajkumar
Published: April 2021

Objective:

Since the Coronavirus Disease 2019 (COVID-19) pandemic began, conflicting reports have emerged regarding its association with hypertension (HTN) in various populations worldwide. However, there is paucity of data regarding the association between the severity of COVID-19 and HTN phenotypes and HTN mediated organ damage (HMOD).

Design and method:

In a cohort of patients (n = 501, mean age 53.5 ± 14.6) attending a specialist hypertension clinic at King Abdulaziz Cardiac Center, Riyadh, Saudi Arabia, we identified patients diagnosed with COVID-19 between January and November, 2020. We compared HTN phenotypes and HMOD in patients admitted with severe COVID-19 infection to those with mild disease and without disease. Data were analysed using JMP version 13 Pro (SAS for Windows).

Results:

Twenty-seven patients developed COVID-19 (5.38%), 8 of whom were admitted (29.6%), with one fatality (3.8%). Patients admitted with COVID-19 were more likely to have refractory HTN (43% vs. 15% vs. 8.9%, p < 0.01), body mass index > 30 (85.7% vs. 46% vs. 47%, p < 0.05), left ventricular hypertrophy (28.6% vs. 7.7% vs. 6.5%, p < 0.01), high hs-CRP (7.8 ± 1.1 vs. 2.1 ± 2 vs. 5 ± 1.5, p < 0.01) and greater central systolic pressure (132 ± 5 vs. 122 ± 7 vs. 110 ± 13, p < 0.01) with no difference in age and gender.

Conclusions:

In hypertensive patients, severe COVID-19 is associated with severe uncontrolled hypertension with HMOD and stiff arteries. While this is a small single center study, it does highlight aspects of COVID-19 in hypertensive patients which warrant further investigation.
THE EFFECTS OF CHANGING MEASUREMENT INTERVALS AND CUFFS ON BLOOD PRESSURE MONITOR VALIDATION
Authors: Lewis Philip , Smith Lara Jane , Budd Jayne , Curtis Janet , Wilkinson Helen , Adeyoju Joshua , Adeyoju Daniel Adedeji , Woodyatt Wiesia Krystyna , Rajai Azita
Published: April 2021

Objective:

We investigated whether intervals between automated BP measurements (AutoBPMs) and alternating manual BP measurements (ManBPMs) might affect validation protocol results and if cuff changes had independent affects.

Design and method:

The BP of 72 healthy volunteers (59 female, 13 male; age 36–58 years; BMI 23–29 Kg/m2), SBP 90–180 mmHg, was measured manually by trained observers using an Accoson mercury sphygmomanometer alternating with automated readings with an Omron M6 AC monitor in 2 phases. In Phase 1, participants were randomised to 9 BPMs (ManBPMs with a Standard Adult Accoson cuff alternating with AutoBPMs with an Omron RML31 D-ring cuff) at 30 second intervals followed by 9 BPMs at 60 second intervals or vice versa.

In Phase 2, participants were randomised to 9 alternating ManBPMs and AutoBPMs at 60 second intervals using an Omron RML31 cuff for all, followed by 9 alternating ManBPMs and AutoBPMs using an equivalent sized D-ring cuff made with Accoson Standard cuff materials for all or vice versa.

Statistical analyses were made using RStudio with Mixed Model Repeated Measure (MMRM) modelling.

Results:

Phase 1 ManSBPs were significantly greater than AutoSBPs especially at 30 second intervals (ManSBP – AutoSBP = 2.76 mmHg [CI1.5, 4.01]) than at 60 second intervals (-0.92 [-0.58, 2.42]). ManDBPs were lower than AutoDBPs at 60 second intervals (-3.25 [-4.53, -1.97]) than at 30 second intervals (-1.19 [-2.17, -0.21]) 1.5, 4.01]) In Phase 2, AutoDBPs were lower than ManDBPs but AutoSBPs were not significantly different from ManSBPs. These results were unaffected by using either cuff.

There was no significant difference if ABPMs were compared with the mean of the preceding and subsequent readings or with the value of the preceding or subsequent readings nearest to the ABPM value. Comparisons were unaffected by excluding the first 2 of the 9 alternating BPMs at each stage

Conclusions:

Intervals between alternating manual and automated BPMs used in validation protocols may significantly affect the outcome of a validation unrelated to the cuff used. SBP differences are greater at 30 second intervals than at 60 second intervals whilst DBP differences are greater at 60 seconds.
PATIENTS’ PERCEPTIONS ON THE USE OF RENIN-ANGIOTENSIN-ALDOSTERONE SYSTEM INHIBITORS: COMPARISON BETWEEN THE FIRST AND THE SECOND COVID-19 PANDEMIC WAVES
Authors: Ioannidis Antonios , Pechlevanis Apostolos , Fragkiskou Afroditi , Paraskelidou Maria
Published: April 2021

Objective:

Since the outbreak of the SARS-COV-2 pandemic, concerns have been raised that RAAS inhibitors (RAAS-i) may increase susceptibility to coronavirus and likelihood of severe COVID-19 illness. This study aims to assess the patients’ perceptions on the risk or benefit of RAAS-I use focusing on the differences between the two waves of the pandemic in Northern Greece.

Design and method:

Patients visiting the emergency (non-COVID) department or the outpatient clinics of a tertiary hospital were invited to participate by completing a short questionnaire. This observational study was conducted during the first (April to June 2020) and the much more forceful second wave (November 2020) of the COVID-19 pandemic.

Results:

In total 341 patients (183 women, 53.7%) taking angiotensin-converting enzyme inhibitors (ACEIs) or angiotensin II receptor type 1 blockers (ARBs) participated (mean age 64.7 ± 9.7 years). About half the patients (188, 55.1%) were taking RAAS-i for hypertension, while the rest for other indications (heart failure, coronary artery disease, etc.). The vast majority (319, 93.5%) were aware of the issue that some antihypertensive drugs might be harmful (mainly from TV reports). Several differences were noted between the participants of the first and the second wave (Table 1). In particular, more patients of the second wave, than of the first wave, knew if they were taking RAAS-I and had contacted their doctor with eventually 14 of them altering their therapeutic regimen. Moreover, the second wave patients, in contrast to the first wave participants, reported higher chances of getting COVID-19, with the majority of them believing they are more susceptible to SARS-COV-2 and expecting more severe disease course. Disturbingly, only few of the patients of the second wave and none of the first had been informed of the position of major scientific societies that patients should continue taking RAAS-i.

Conclusions:

Greek patients are aware of the issue relating the RAAS-i with the COVID-19 pandemic. Second wave participants seem more worried, seeking medical advice and inquiring drug substitution. Nevertheless they still lack information from scientific societies. Further research is warranted to assess whether patient oriented informative campaigns could comfort their concerns.
NUTRITIONAL STATUS IN OLDER HYPERTENSIVE PATIENTS DEPENDING ON COMORBIDITY
Authors: Efremova Elena , Shutov Alexander , Cheremnyh Anastasija , Hramova Anna , Samsonova Natal’ja , Bykova Alina , Antonova Elena
Published: April 2021

Objective:

Obesity and the type of obesity are an important prognostic factor in older patients with hypertension and comorbidity (including chronic heart failure (CHF)). The aim of this study was to investigate nutritional status in older hypertensive patients with CHF.

Design and method:

119 older hypertensive patients withCHF (89 males, mean age was 68.9 ± 6.7 years) were studied. Arterial hypertension was defined according to ESC Guidelines for the diagnosis and treatment of arterial hypertension, 2018. Charlson comorbidity index (CCI) was estimated. Comorbidity was regarded as high at index less or equal 6 scores. Nutritional status was assessed: the presence of obesity, type of obesity, body composition, including percentage of lean and fat tissue.

Results:

The CCI was 5.9 ± 1.9 scores. 67 (56.3%) older hypertensive patients with CHF had high comorbidity. Chronic kidney disease (CKD) was more common in the comorbidity structure (57; 47,9%). Obesity was observed in 59 (81.9%) patients, 56 (77.8%) with abdominal obesity, 116 (97%) - had a higher percentage of body fat. Lean body mass index, body fat index, percentage of lean body mass and percentage of body fat did not differ in patients depending on the level of comorbidity (p > 0.05). There was a direct relationship between the percentage of body fat and CCI (r = 0.30, p = 0.006). However, patients with CKD had lower total water volume (42.4 ± 6.9 and39,1 ± 6.7 liters resp., p = 0,009) and lean body mass (58.0 ± 9.4and53,7 ± 9.3 kg resp., p = 0,01) compared to older hypertensive patients with CHF without CKD.

Conclusions:

Older patients with arterial hypertension and CHF are characterized by obesity (abdominal obesity) and sarcopenic obesity. Body composition is independent on comorbidity. However, patients withCKD had lower total water volume and lean body mass, which also causes a poor prognosis.
10-YEAR STROKE RISK PREDICTION: A CENTRAL REGION OF VIETNAM COMMUNITY-BASED RESEARCH
Authors: Doan Long , Huynh Van Minh , Hoang Anh Tien , Doan Phuoc Thuoc , Nguyen Thi Huong , Nguyen Thi Thuy Hang , Nguyen Thi Phuong Thao , Nguyen Minh Tam , Le Chuyen , Tran Thi Thanh Nhan
Published: April 2021

Objective:

This study aim to predict the risk of cerebral stroke in the next 10 years with QStroke® tool in Thua Thien - Hue province, a central region province of Vietnam.

Design and method:

A cross-sectional study recruits 1,600 Vietnamese adults aged from 25 to 84 who were in 4 different eco-regions in many parts of Thua Thien Hue included city, delta, mountainous, and coastal region. We calculated the 10-year risk of stroke using QStroke® 2017.

Results:

According to data on clinical characteristics collected in 2018. By 2020, the risk prediction of stroke in all study subjects is <10%. In the following years, the proportion of below 10% risk subject group tends to decrease, and equal or more than 10% subject groups tend to increase. By 2028, 10-year of prediction, the risk of stroke is less than 10% in 84.2% of research subjects, 7.1% of subjects have stroke risk level of 10% to 14%, 4.6% of subjects have stroke risk of 15% to 19% and 4.1% of subjects have stroke risk level equal or more than 20%. Analysis of the next 10 years risk prediction by ecological region showed that there is a difference in the risk of stroke prediction in the next 10 years between the delta region and coastal region (p < 0.0125), the difference between delta region and city area (p < 0.0125). The delta region has the highest risk of stroke in the next 10 years compared to the rest. Thereby, it is necessary to study in-depth the risk factors for stroke in the delta region to have the next intervention programs to improve the health of the people generally.

Conclusions:

The proportion of people at risk of stroke increasing year-by-year if they do not have any effective prevention intervention. The delta region has the highest risk of suffering a stroke in the next 10 years compared to the rest. A comprehensive intervention strategy for risk factors is the answer in reducing the risk of stroke in the community.
THE LEFT VENTRICULAR FUNCTIONALITY IN ARTERIAL HYPERTENSION ASSESSED THROUGH THE PERFORMANCE MYOCARDIAL INDEX CALCULATED BY THE TISSULAR DOPPLER ECHOCARDIOGRAPHY
Authors: Caruso Giuseppe , Paoli Vera Delli , Ciarambino Tiziana , D’Avino Maria
Published: April 2021

Objective:

The aim of this study was to determine whether the TDE, which directly assesses the systo-diastolic movement of the cardiac wall rather than the hematic flow movement, would allow us to ascertain the IMP and the various cardiac cycle times that contribute to its assessment, such as: the Isovolumetric Contraction Time (ICT), the Isovolumetric Relaxation Time (IRT) and the Ejection Time (ET).

Design and method:

we selected 95 healthy voluntaries (61 M and 34 F –1st group) aged 36 - 65 and 94 patients (59 M and 35 F) aged 38–70 suffering from 1–2 grade AH for at least two years. 26 patients showed conventional echocardiographic signs of left ventricular hypertrophy (LVH) while the remaining 68 did not report any (2nd group). All patients underwent a TDE test with apical approach whereby the standard volume was placed onto the lateral portion of the mitral anulus in order to record the diastolic and systolic phase. IRT and ITC were also measured separately.

Results:

Table I below shows the results for the two groups including the statistical significance: 

Conclusions:

hypertensive patients with or without LVH reported a ventricular dysfunction shown by an increase in MPI. This increase was a consequence of an extension of IRT while ICT and TE did not change in comparison with normal values. This indicates that any ventricular functionality impairment exclusively regards the diastolic phase. These results demonstrate that the ventricular dysfunction in these patients was mainly of diastolic type whereas the systolic functionality appeared to be preserved.
RESISTENT ARTERIAL HYPERTENSION (RAH): FOLLOW UP
Authors: Caruso Giuseppe , Ciarambino Tiziana , Ciaburri Filippina , Paoli Venere Delli , Vitolo G , D’avino Maria
Published: April 2021

Objective:

Resistent arterial hypertension (RAH) shows a 3 times higher risk for cardiovascular events. We evaluated the occurrence of fatal and non-fatal cardiovascular events during a follow-up period of 2 years.

Design and method:

From January 2018 to January 2020, 139 patients (79 M; mean age 57 ± 7) with RAH were followed at the Cardiovascular Medicine Department, AORN Cardarelli, Naples. All were on low-sodium diet and drugs therapy. We subdivided patients in 4 groups: Group A with left ventricular hypertrophy (IVS); Group B with carotid mid-intimal thickening (IMT major 0.9 mm); Group C with both signs of IVS and IMT, and, Group D with no signs of organ damage. BP values were controlled by Home Ambulatory Monitoring/24 hours (MAPA) at T0, T1 (after 12 months) and T2 (after 24 months).

Results:

In Group D, during the follow-up, 2 patients presented a myocardial infarct, 3 a Stroke, 5 a TIA and 7 an Atrial Fibrillation. In group C, 3 patients, underwent coronary angiography and treated with angioplasty. Only at T2, a significant reduction in BP values was obtained (p < 0.05). Similarly, a reduction in the BP was also recorded, with the MAPA, both in the 24 hours and in the day and night hours, especially at T2 (p < 0.05).

Conclusions:

Group D experienced greater cardiovascular events. The reduction of PA plays a crucial role in the evolution of the damage itself. The identification of organ damage in patients with resistant hypertension must lead us to be particularly careful in optimizing therapy.
EFFECT OF BEETROOT JUICE INGESTION ON POST-EXERCISE HYPOTENSION AND HEART RATE VARIABILITY IN HYPERTENSIVE POSTMENOPAUSAL WOMEN
Authors: Carrijo Victor Hugo Vila , Amaral Ana Luiza , Mariano Igor Moraes , Souza Tállita Cristina Ferreira de , Batista Jaqueline Pontes , Oliveira Erick Prado de , Puga Guilherme Morais
Published: April 2021

Objective:

To compare the acute effects of a single dose of beet juice (BJ), with different nitrate concentration (NO3-) in post-exercise hypotension (HPE) and in heart rate variability (HRV) in postmenopausal hypertensive women.

Design and method:

Thirteen hypertensive postmenopausal women (58.1 ± 4.6 years and 27 ± 4 kg/m2) completed the protocol that consisted of three visits with different beverage ingestion in a randomized and crossover design: beetroot juice (BJ) with a high content of nitrate (high-NO3-), BJ with a low content of nitrate (low-NO3-), and an orange flavored non-caloric drink (OFD). After overnight fasting, women drank one of the beverage, rested in siting position for 120 min and then performed 40 min of aerobic exercise at 65–70% of the heat rate (HR) reserve on a treadmill. Blood Pressure (BP) and HR were measured in rest sitting position at 7:20 am (baseline) and during 90 min after exercise. HRV index were analyzed in time (RMSSD, SDNN, PNN50), frequency (HF, LF, LF/HF), and non-linear (SD2, SD1, and SD2/SD1) domains.

Two-way ANOVA were used to compare BP and HRV time and sessions responses.

Results:

No interaction effects (time∗sessions) in BP responses nor any of the HRV indexes after exercise in all among three sessions. However, after aerobic exercise, systolic BP and diastolic BP decreased (p < 0.05), and HRV indexes (LF, LF/HF, SDNN, SD1, SD2, and SD2/SD) increased (p < 0.05) similarly in all three sessions (high-NO3-, low-NO3-, OFD) when compared with the baseline time point.

Conclusions:

A single dose of BJ, independent of NO3- content, does not change acute aerobic exercise-mediated improvements responses in BP or HRV in hypertensive postmenopausal women.
ASSOCIATION BETWEEN SERUM URIC ACID LEVEL AND CARDIOVASCULAR RISK FACTORS AND THEIR CLUSTERING RISK IN CHILDREN AND ADOLESCENTS IN YINCHUAN CITY
Authors: Cai Rongrong , Dong Yangyang , Zhou Jinyu , Bai Ling , Jia Leina , Ding Wenqing
Published: April 2021

Objective:

To explore the relationship between serum uric acid (SUA) levels and cardiovascular risk factors and their clustering risk among children and adolescents in Yinchuan City, China, so as to provide scientific evidence for the prevention and treatment of cardiovascular diseases in children and adults.

Design and method:

The design of cross-sectional study was adopted, and 1486 children and adolescents aged 10–18 in Yinchuan City were selected as the research objects by convenient sampling methods. All the research objects completed questionnaire survey, physical measurement and biochemical examination.

Results:

The detection rate of hyperuricemia (HUA) was 29.8%, including 39.4% for boys and 20.5% for girls. The detection rate for boys was higher than girls (χ2 = 63.01, P < 0.001); SUA were positively correlated with BMI, WC, SBP, DBP, TC, TG and LDL-C (P < 0.01). Except for hyperglycemia in the general population, hyperuricemia increased general obesity (OR = 4.48,95%CI: 3.46–5.81), abdominal obesity (OR = 4.91, 95%CI: 3.76–6.42), hypertension (OR = 1.92,95%CI: 1.43–2.57), hyperlipidemia (OR = 2.72, 95%CI: 1.96–3.79) and dyslipidemia (OR = 1.67,95%CI: 1.30–2.14). The risk of cardiovascular clustering greater than or equal to 2 and 3 in children with high uric acid was 3.64 times (95%CI: 2.74–4.84) and 6.88 times (95%CI: 3.83–12.40) of children with normal uric acid, respectively, both P < 0.01, similar results were obtained in boys and girls.

Conclusions:

High uric acid in children and adolescents in Yinchuan City is significantly associated with cardiovascular risk factors and their clustering risk. The serum uric acid level of children and adolescents should be paid attention to in time.
ARTERIAL HYPERTENSION MAY INVOLVE SARCOPLASMIC RETICULUM CALCIUM ATPASE (SERCA) PROTEOLYSIS BY MATRIX METALLOPROTEINASE (MMP)-2
Authors: De Mello Marcela Maria Blascke , Parente Juliana Montenegro , Pernomian Laena , Silva Pedro Henrique Leite , Schulz Richard , De Castro Michele Mazzaron
Published: April 2021

Objective:

Aortic SERCA protein level and activity are reduced in hypertension. Increased MMP-2 activity may cleave SERCA in acute myocardial ischemia and reperfusion injury. Our objective was to verify whether increased vascular MMP-2 activity in hypertension proteolyzes SERCA to alter cytosolic calcium, thus causing enhanced vasoconstriction or maladaptive remodeling.

Design and method:

Male Sprague-Dawley rats were submitted to two kidney-one clip (2K-1C) or sham surgery and treated with doxycycline (Doxy, 30 mg/kg/day) by gavage from the third to seventh day post-surgery. Systolic blood pressure (SBP; tail-cuff plethysmography) was daily measured, and after seven days aortas were collected and processed for gelatin and in situ zymography, SERCA protein levels by Western blot and calcium immunofluorescence using Rhod-2AM. Aortas were isolated from normal rats were incubated at 37°C for 6 or 12 hours in DMEM with angiotensin (Ang) II (0.1 μM) +/- MMP inhibitors, ONO-4817 (10 μM) or Doxycycline (30 μM). Aorta segments were processed as above and used for co-immunoprecipitation of SERCA and MMP-2. Statistical analysis was done by two-way ANOVA followed by Tukey post-hoc test. The Ethics Committee for Animal Research of the Ribeirao Preto Medical School approved all protocols (122/2019).

Results:

MMP-2 activity in 2K-1C aorta was elevated 1.5-fold vs. controls and Doxy decreased it by 1.3-fold (n = 5–8; p < 0.05). SERCA proteolysis was 3-fold increase in 2K-1C aorta (n = 4–8; p < 0.05 vs. controls). Treatment with Doxy seemed to prevent this effect (0.49 ± 0.07 2K1C+Doxy vs 1.42 ± 0.42 2K1C). These effects were not associated with changes in SBP as Doxy did not alter it. Cytosolic calcium concentrations trended to increase in 2K1C aorta from 13 to 19 a.u. (n = 3; p = 0.08) and Doxy decreased it (n = 3; p < 0.05). In AngII treated aorta, MMP-2 activity also increased by 1.5-fold (n = 4-5; p < 0.05 vs. controls) and both ONO-4817 and Doxy reduced its activity by the half (n = 4-5; p < 0.05). MMP-2 was co-immunoprecipitated with SERCA in the incubated aortas, and AngII seemed to increase it.

Conclusions:

SERCA levels may be decreased by MMP-2 activity in the aortas of hypertensive rats which may contribute to calcium-induced vascular alterations in hypertension. These effects are currently being investigated.
NON-INVASIVE ASSESSMENT OF CENTRAL AORTIC PRESSURE, AORTIC FLOW AND VASCULAR LOAD IN PATIENTS WITH AORTIC STENOSIS BEFORE AND AFTER TRANSCATHETER AORTIC VALVE REPLACEMENT
Authors: Adji Audrey , Song Ning , Hungerford Sara , Namasivayam Mayooran , Hayward Christopher , Jabbour Andrew , Muller David
Published: April 2021

Objective:

The left ventricle (LV) faces a dual afterload in patients with aortic stenosis (AS), both from the narrowed valve and age-related arterial stiffening. Variability in indices of AS severity assessment suggests an inter-relationship of the valvular pressure gradient on systemic arterial pressure and flow. Our study aims to evaluate the dynamic vascular load (VL) non-invasively in AS patients before and after transcatheter aortic valve replacement (TAVR) using the approach of simultaneous cardiac magnetic resonance (CMR) and radial applanation tonometry (AT).

Design and method:

Ascending aortic pressure, flow and VL were measured in 3 patients at baseline and post-TAVR using a previously reported simultaneous CMR/AT technique. CMR provided aortic flow, and radial AT waves were converted offline to aortic pressure using SphygmoCor 8.1 (AtCor Medical) and calibrated using brachial cuff values. VL was determined as the relationship of derived aortic pressure to CMR aortic flow velocity, by calculating the average modulus of pressure divided by flow. Following the acquisition of post TAVR data, 300 micrograms of sublingual nitroglycerine (GTN) was introduced to investigate the effect on changing vascular load.

Results:

At 38 ± 3 days post TAVR, mean aortic pressure (MP) and mean systolic flow (MF) both increased (100 ± 17 pre, 109 ± 12 post, mmHg; 178 ± 44 pre, 230 ± 74 post, ml/s). Following GTN administration, MP (95 ± 3 mmHg) decreased but not MF (228 ± 57 ml/s) – see figure.

The steady state systemic vascular resistance (SVR) reduced post TAVR (22501 ± 5929 pre, 20484 ± 6232 post, dynes.s/cm3), but not VL (1082 ± 219 pre, 1111 ± 483 post, dynes.s/cm3). Conversely, GTN administration significantly reduced VL (838 ± 295 dynes.s/cm3) with little effect on SVR (19313 ± 5631 dynes.s/cm3).

Conclusions:

Our study demonstrates that our novel technique can be reliably replicated in patients to evaluate the changes to aortic pressure, flow and VL before and after TAVR. VL appears to be a dynamic measurement of vascular stiffness independent of AS and may prove to be a useful measure to predict haemodynamic responses and ventriculo-arterial coupling in AS patients post TAVR. Larger longitudinal cohort studies are warranted.
KNOWLEDGE, ATTITUDE AND PRACTICE TOWARDS THERAPEUTIC LIFESTYLE CHANGES IN THE MANAGEMENT OF HYPERTENSION IN KHARTOUM STATE (2020)
Authors: Abdalla Ahmed Ali , Mirghani Kamil
Published: April 2021

Objective:

Hypertension (HTN) has long been recognised as a major risk factor for coronary artery diseases, stroke and kidney disease. Despite a myriad of new pharmacological agents, a significant portion of hypertensive patients’ blood pressure remains uncontrolled in the Sudan, an important, often underutilised treatment approach is therapeutic lifestyle changes (TLC). This study aimed to assess the attitude, practice and barriers of patients to therapeutic lifestyle changes in the management of hypertension in a third world country in Khartoum locality in 2016.

Design and method:

The study was cross-sectional descriptive. Data was collected via structured interviews using a questionnaire, full coverage of patients attending Ahmed Gasim and Alshaab hospitals for follow up in a certain time period was carried out, this amounted to a sample of 112, Descriptive and inferential statistics were utilised for data analysis.

Results:

112 patients were identified for participation in this study, a slight female preponderance (54.5%), older age with 58% in the 55–70 years’ age group, when assessed for knowledge on lifestyles and habits that affect blood pressure, respondents were most familiar with the fact that salt consumption affects blood pressure, 93.8% answering correctly. After Knowledge scores were calculated, only 31.3% of participants had above average knowledge on blood pressure and TLC. The lifestyle change respondents were least adherent to was regular exercise with 59.8% of participants admitting to not exercising most days. Participants most frequent response to why they aren’t implementing a certain change was that they didn’t feel it mattered enough, the same answer being most frequent for each lifestyle change.

Conclusions:

In conclusion, this study demonstrated that hypertensive patients are generally knowledgeable on hypertension and the importance of therapeutic lifestyle changes in its management, particularly the importance of minimizing salt intake. The researcher believes that novel approaches are needed to help motivate patients in a third world country such as Sudan diagnosed with hypertension apply their knowledge regarding TLC.
Integration of Virtual Simulation Into a Web-Based Nursing Dosage Calculation Course
Authors: Donahue Nadine
Published: April 2021

This article describes an innovative approach to student learning using virtual simulation in a web-based dosage calculation nursing course. This new technology was implemented in a baccalaureate generic nursing program. The project was designed to improve student test scores and increase self-confidence. Using this technology allowed students to practice their skills and receive feedback in real time. Feedback from students was mostly favorable. Higher performing students found it repetitive; lower performing students showed improvement in their scores.
Efficacy of a Simulation Program to Improve Clinical Judgment and Clinical Competence Among Graduate Nurses
Authors: Cantrell Mary Ann , Mariani Bette , Lengetti Evelyn
Published: April 2021

AIM

This two-group feasibility study tested the efficacy of a four-scenario simulation program to improve clinical judgment and clinical competence among graduate nurses.

BACKGROUND

Clinical judgment and clinical competence are underdeveloped among new-to-practice nurses.

METHOD

Clinical judgment was compared between the intervention group (n = 17) and a control group (n = 26) in the practice setting at two time points.

RESULTS

The simulation program had a large effect on the intervention group’s clinical judgment (η2 = .143) and clinical competence (η2 = .153). There were no statistically significant differences for each outcome at baseline as compared to the final scenario for the intervention group. There was no statistical significance between the intervention and control groups in clinical judgment in the practice setting at each measurement time.

CONCLUSION

Replication of the study with a randomized controlled trial and large sample size is warranted.
Nursing Student Perceptions of Academic and Clinical Integrity
Authors: Devine Christine Ann , Chin Elizabeth Danells , Sethares Kristen A. , Asselin Marilyn E.
Published: April 2021

AIM

This study aimed to explore how nursing students define and describe academic and clinical integrity and to identify social and psychological influences on student decisions to act with integrity.

BACKGROUD

Nursing students are exhibiting a decline in academic and clinical integrity. Academic dishonesty often correlates to clinical dishonesty, subsequently impacting patient care quality and safety. Student perceptions and understanding of integrity are unknown.

METHOD

A qualitative descriptive approach guided this study. A purposive sample of 19 traditional baccalaureate nursing students was recruited to participate in one-hour face-to-face interviews.

RESULTS

All participants defined academic and clinical integrity as honest, ethical, and accountable behavior. Additional subthemes of characteristics, facilitators and barriers, and outcomes of acting with integrity emerged.

CONCLUSION

Students recognize the positive characteristics of integrity and their effects on personal growth and optimal patient outcomes. These findings can inform faculty in developing and supporting a culture of integrity.
Under the Skin: The Relationship Between Subcutaneous Injection and Skin Infections Among People Who Inject Drugs
Authors: Freibott Christina E. , Phillips Kristina T. , Anderson Bradley J. , Stewart Catherine , Liebschutz Jane M. , Stein Michael D.
Published: April 2021

Objectives:

People who inject drugs (PWID) are at increased risk for numerous negative health outcomes. Subcutaneous injections (aka skin popping) can result in greater risk of skin and soft tissue infections (SSTIs), but less is known about PWID who choose this route of administration. This study compares subcutaneous injectors to intravenous injectors, characterizes those who inject subcutaneously, and examines whether subcutaneous injection is associated with SSTIs in the past year.

Methods:

A cohort of hospitalized PWID (n = 252) were interviewed regarding injection-related behaviors, history of SSTI, and knowledge of subcutaneous injection risk. We examined differences between those who do and do not inject subcutaneously and used a negative binomial regression model to estimate adjusted odds associating subcutaneous injection and SSTI.

Results:

Participants averaged 38 years, with 58.3% male, 59.5% White, 20.6% Black, and 15.9% Latinx. PWID who performed subcutaneous injection were not demographically different from other PWID; however, the mean rate of past year SSTIs was higher for persons injecting subcutaneously than for those who did not (1.98 vs 0.96, P < 0.001). Persons injecting subcutaneously did not differ from those who injected intravenously in terms of their knowledge of subcutaneous injection risk (P = 0.112) and knowledge score was not associated with SSTIs (P = 0.457).

Conclusions:

PWID who perform subcutaneous injections are demographically similar to other PWID but had higher rates of past year SSTIs. Knowledge of subcutaneous injection risk was not associated with SSTI risk.
Inpatient Opioid Use Disorder Treatment by Generalists is Associated With Linkage to Opioid Treatment Programs After Discharge
Authors: Tierney Hannah R. , Rowe Christopher L. , Coffa Diana A. , Sarnaik Shashi , Coffin Phillip O. , Snyder Hannah R.
Published: April 2021

Objectives:

Describe clinical and demographic associations with inpatient medication for opioid use disorder (MOUD) initiation on general medicine services and to examine associations between inpatient MOUD initiation by generalists and subsequent patient healthcare utilization.

Methods:

This is a retrospective study using medical record data from general medicine services at an urban safety-net hospital before an inpatient addiction consultation service. The patients were adults hospitalized for acute medical illness who had an opioid-related ICD-10 code associated with the visit. Associations with MOUD initiation were assessed using multivariable logistic regression. Hospital readmission, emergency department use, linkage to opioid treatment programs (OTP), and mortality at 30- and 90-days postdischarge were compared between those with and without hospital MOUD initiation using χ
2 tests.

Results:

Of 1,284 hospitalized patients with an opioid-related code, 59.81% received MOUD and 31.38% of these were newly initiated in-hospital. In multivariable logistic regression, Black race, mood disorder, psychotic disorder, and alcohol use disorder were negatively associated with MOUD initiation, while being aged 25–34, having a moderate hospital severity of illness score, and experiencing homelessness were positively associated. There were no bivariate associations between MOUD initiation and postdischarge emergency department use, hospital readmission, or mortality at 30- and 90-days, but those initiated on MOUD were more likely to present to an OTP within 90 days (30.57% vs 12.80%, P < 0.001).

Conclusions:

MOUD prescribing by inpatient generalists may help to increase the number of patients on treatment for opioid use disorder after hospital discharge. More research is needed to understand the impact of inpatient MOUD treatment without addiction specialty consultation.
Pretreatment With Mifepristone Compared With Misoprostol Alone for Delivery After Fetal Death Between 14 and 28 Weeks of Gestation
Authors: Allanson Emma R. , Copson Sean , Spilsbury Katrina , Criddle Sonya , Jennings Belinda , Doherty Dorota A. , Wong Antonia M. , Dickinson Jan E.
Published: April 2021

OBJECTIVE:

To assess the efficacy of pretreatment with mifepristone before misoprostol, compared with misoprostol alone, for termination of pregnancy after a fetal death in the second trimester.

METHODS:

This prospective, double blind, placebo-controlled trial randomized women requiring a termination of pregnancy after fetal death between 14 and 28 weeks of gestation to placebo or 200 mg mifepristone orally 24–48 hours before the termination of pregnancy with misoprostol (400 micrograms every 6 hours vaginally for women at 24 weeks of gestation or less, and 200 micrograms every 4 hours vaginally for women at 24 weeks of gestation or more). Based on a median labor with misoprostol alone in the second trimester of 13 hours, a sample size of 116 women per group was planned to compare the primary outcome of time from administration of misoprostol to delivery. The trial was ceased after 66 women were enrolled secondary to prolonged time to achieve recruitment.

RESULTS:

From April 2013 to November 2016, 66 women were randomized (34 to placebo and 32 to mifepristone). There were no differences in the characteristics between the two groups. The median time for the primary outcome of administration of misoprostol to delivery in the placebo group was 10.5 hours, compared with 6.8 hours in the treatment group (hazard ratio 2.41 95% CI 1.39–4.17, P=.002). Women in the placebo group required more doses of misoprostol (3.4 vs 2.1, P=.002) and more misoprostol overall (1,181.8 micrograms, vs 767.7 micrograms, P=.003). There was no difference in maternal complications between the two groups. Women in the mifepristone group reported improved perception of the procedure.

CONCLUSION:

The sequential use of mifepristone and misoprostol for the termination of pregnancy after fetal deaths between 14 and 28 weeks of gestation reduces the time to delivery, compared with the use of misoprostol alone, with no worsening of maternal complications.

CLINICAL TRIAL REGISTRATION:

Australian New Zealand Clinical Trials Registry, ACTRN12612000884808.
Racial and Ethnic Disparities in Death Associated With Severe Maternal Morbidity in the United States
Authors: Guglielminotti Jean , Wong Cynthia A. , Friedman Alexander M. , Li Guohua
Published: April 2021

OBJECTIVE:

To analyze racial and ethnic disparities in failure to rescue (ie, death) associated with severe maternal morbidity and describe temporal trends.

METHODS:

This was a retrospective cohort study using administrative data. Data for delivery hospitalizations with severe maternal morbidity, as defined by the Centers for Disease Control and Prevention, were abstracted from the 1999–2017 National Inpatient Sample. Race and ethnicity were categorized into non-Hispanic White (reference), non-Hispanic Black, Hispanic, other, and missing. The outcome was failure to rescue from severe maternal morbidity. Disparities were assessed using the failure-to-rescue rate ratio (ratio of the failure-to-rescue rate in the racial and minority group to the failure-to-rescue rate in White women), adjusted for patient and hospital characteristics. Temporal trends in severe maternal morbidity and failure to rescue were assessed.

RESULTS:

During the study period, 73,934,559 delivery hospitalizations were identified, including 993,864 with severe maternal morbidity (13.4/1,000; 95% CI 13.3–13.5). Among women with severe maternal morbidity, 4,328 died (4.3/1,000; 95% CI 4.2–4.5). The adjusted failure-to-rescue rate ratio was 1.79 (95% CI 1.77–1.81) for Black women, 1.39 (95% CI 1.37–1.41) for women of other race and ethnicity, 1.43 (95% CI 1.42–1.45) for women with missing race and ethnicity data, and 1.08 (95% CI 1.06–1.09) for Hispanic women. During the study period, the severe maternal morbidity rate increased significantly in each of the five racial and ethnic groups but started declining in 2012. Meanwhile, the failure-to-rescue rate decreased significantly during the entire study period.

CONCLUSION:

Despite improvement over time, failure to rescue from severe maternal morbidity remains a major contributing factor to excess maternal mortality in racial and ethnic minority women.