Blood Pressure sBP Research Articles

Cardiometabolic Profile in Young Adults With Diverse Cigarette Smoking Histories: A Longitudinal Study From Adolescence.

For the first time, the present study investigated smoking trajectory and cardiometabolic profile from adolescence to young adulthood in a middle-income developing country facing a high prevalence of smoking and cardiovascular disease-related outcomes. Data on 1082 adolescents (12-18 years of age) who participated in the TLGS (Tehran Lipid and Glucose Study) were gathered,and participants were followed for a median of 12.5 years (baseline: 1999-2002, last follow-up: 2014-2017). Participants were categorized as non/rare smokers, experimenters, and escalators using group-based trajectory models. Statistical analysis was used to compare the trajectory groups' cardiometabolic components, clinical characteristics, and cardiometabolic changes due to the individuals' placement in experimenter and escalator groups compared with non/rare smokers. The smoking trajectory groups in young adulthood differ significantly in blood pressure, triglycerides, high-density lipoprotein cholesterol, waist circumference, and body mass index, with the escalator group having the highest risk values for each component. Significant differences were observed in blood pressure (P=0.014), triglycerides (P<0.001), and waist circumference (P<0.001) status after using clinical cut points. The adjusted linear regression revealed that the escalator group had 3.16 mm Hg-lower systolic blood pressure SBP (P=0.016), 2.69 mm Hg-lower diastolic blood pressure (P=0.011), and 4.42 mg/dL-lower high-density lipoprotein cholesterol (P=0.002), compared with the non/rare smoker group. Despite elevated risks in unadjusted analyses for all cardiometabolic components among smokers, our study identified a modest protective link between early smoking and blood pressure in addition to a remarkable harmful association with high-density lipoprotein cholesterol levels exclusively in the escalator group during the developmental stage to young adulthood, using adjusted analyses.

A 3-Month Modified Basketball Exercise Program as a Health-Enhancing Sport Activity for Middle-Aged Individuals.

Recreational team sports have received great acceptance lately, in different populations, indicating encouraging results in health-related quality of life. This study examined the efficacy of a 3-month basketball exercise program on selected indices of health (body mass-BM, body fat-BF, blood pressure-BP), functional capacity (flexibility of lower and upper limbs, balance), and physical fitness (maximum strength of lower limbs, trunk and handgrip, aerobic capacity) in middle-aged individuals. Forty middle-aged individuals (males and females; 40-55 years old) were randomly divided into (a) exercise (EG; n = 20) and (b) control groups (CG; n = 20). The EG followed a 3-month modified basketball exercise program (2 times/week; 24 training units), including different basketball drills with and without the ball (dribbling, passing, pivot, stops, etc.), to improve participants' health and physical fitness. Repeated measures ANOVA showed that the EG significantly increased their flexibility (17.23-74.88%; p < 0.001), static balance (44.76-54.69%; p < 0.001), and strength of lower limbs and trunk (11.67-13.13%; p < 0.001), while reducing BP (7.31-12%; p < 0.001), heart rate and RPE (5.30-34.37%; p < 0.001), and time during time-up-and-go test (-10.91%; p < 0.001). Handgrip strength, BM, and BF did not change following the program in the EG (p > 0.05). In the CG, the above variables remained stable. In conclusion, this program may be used to eliminate the detrimental effects of aging on health, functional capacity, and physical fitness parameters.

PEAK NOCTURNAL HOME BLOOD PRESSURE AS AN EARLY AND STRONG NOVEL RISK FACTOR FOR STROKE: THE PRACTITIONER-BASED NATIONWIDE J-HOP NOCTURNAL BP STUDY

Objective: Recent evidence suggests a correlation between nighttime blood pressure BP) measured through ambulatory BP monitoring (ABPM), the nocturnal BP dipping phenotype, and cardiovascular risk. However, the clinical implications of elevated peak nighttime home BP are currently unknown. This analysis investigated the association between peak nighttime home systolic BP (SBP) and cardiovascular events in outpatients with one or more cardiovascular risk factors. Design and method: In the Japan Morning Surge-Home Blood Pressure (J-HOP) study, nighttime home BP was automatically measured three times every night for 14 days using a nighttime home BP monitoring device (HEM-5001, Omron Healthcare) at baseline. Peak nighttime home SBP was defined as average of the highest three values recoded during the 14-night measurement period. Cardiovascular events (stroke, coronary artery disease, heart failure, aortic dissection) were tracked over a mean 7.1 years’ follow-up period. Results: This analysis included 2545 individuals (mean age 63.3±10.3 years, 49% male) with their nighttime home BPs. After adjustment for covariates (including age, sex, and average office, morning, evening, and nighttime home SBP), individuals with peak nighttime home systolic blood pressure (SBP) in the highest quintile (Q5, &gt;=149.0 mmHg) demonstrated a significantly elevated risk of stroke compared to those in the lowest quintile (Q1, &lt;119.3 mmHg) (hazard ratio [HR] 4.24, 95% confidence interval [CI] 1.07–16.77; p=0.039 overall and 8.92, 1.49–53.43; p=0.017 in the subgroup with &gt;=6 nighttime home SBP measurements). Even when controlling for average real variability of nighttime BP, peak nighttime home SBP remained an independent predictor of stroke risk. On spline regression analysis, the average peak nighttime home SBP cut-off value for predicting an increased risk of incident stroke was 136 mmHg. Conclusions: We propose exaggerated peak nighttime home SBP determined from &gt;=6 measurements as a novel risk factor for stroke, independent of conventional office and home BP values.

Eight weeks of high-intensity interval vs. sprint interval training effects on overweight and obese adolescents carried out during the cool-down period of physical education classes: randomized controlled trial.

The aim of this study was to evaluate the effect of sprint interval training (SIT) and [high intensive interval training (HIIT)] carried out during the cool-down period of the physical education classes on body composition, blood pressure variables (BP) and pulse rate (PR), and cardiorespiratory fitness of adolescents who are overweight and obese, and to compare the differences in enjoyment in response to SIT vs. HIIT. For this randomized controlled trial, forty-five adolescents were recruited from a high school and were randomly placed into three groups. SIT and HIIT trained for 8 weeks, twice a week, for 12 min/session. Experimental group (EG) 3 was the control, and they maintained their regular physical education class schedule. The SIT group performed 6 sets of 60 s of work (90-95%HRmax) / 60 s of rest (50-55%HRmax), and the HIIT group performed 3 sets of 2 min of work (80-85%HRmax) / 2 min of rest (50-55%HRmax). Both experimental groups showed a significant improvement in fat mass (FM) (%) and trunk FM (kg). In addition, EG2 reported a significance improvement in lean mass (kg), blood pressure BP (mmHG), systolic blood pressure (SBP) (mmHg), diastolic blood pressure (DBP) (mmHg), PR (bpm), and VO2max (ml/kg/min). The present study found that a HIIT protocol performed during the cool-down period of the physical education classes generated adaptations such as improvement in body composition, BP variables and PR, and cardiorespiratory fitness, in overweight and obese adolescents. In contrast, the group of overweight and obese adolescents who performed SIT showed limited benefits, with changes in fat mass only.

Identification of Some Specific Hematological Indicators as Bladder Cancer Risk Factors

Background: Our study’s objectives were measuring the levels of blood glucose BG, blood pressure BP, glomerular filtration rate GFR, body mass index BMI and creatinine in the blood of patients with bladder cancer in order to control the development of a relationship between those hematological parameters in the case of bladder cancer BC.&#x0D; Methods and Results: Blood samples were collected during the application of this work on 155 participants diagnosed with BC were admitted to medical –Baghdad city and Al-Kindey teaching hospital. All the participants were with the age ranged (25-70 years).There are many people who have been excluded because of their young age under 20 years old and those who have any type of common cancer, which was outlined as any malignant neoplasm, including those with hematological or lymphoid origin and other tissues associated with them. All the participants wearing light clothing and no shoes in order to measure their height and weight. BP was recorded using a standard mercury sphygmomanometer after an average of 2 readings taken with a 10 min interval. Creatinine and GFR and DM also were measured meanwhile.&#x0D; It was noticed through the results that there is a high percentage of patients who are of advanced ages about 67(43.2%) with age ≥65 years, and those with high weights BMI ≥ 30 were 64(41.3%). After conducting pathological analyzes of blood samples, it was found that patients were having high levels of sugar, especially those with long duration of diabetics type 2, as well as high blood pressure, creatinine levels, and low GFR levels, and it was clear that males outperformed females in the height of all measurements, which is the dominant characteristic in this research.&#x0D;

Abstract 16096: Systolic Blood Pressure, Preeclampsia, and Leiomyoma Genes - A Multivariable Mendelian Randomization and Mediation Analysis

Introduction: Preeclampsia (PE) (sudden-onset hypertension (&gt;20 weeks gestation) with proteinuria, maternal organ/uteroplacental dysfunction or angiogenic imbalance) affects ~4 million women annually, causing death of &gt;70,000 women and 500,000 babies, and sequelae like heart failure. Hypothesis: We hypothesize that among the known genetic associations of PE is an independent risk factor (IRF). Methods: Data Publicly available European ancestry genome-wide association study (GWAS) summary statistics (SS) derived single nucleotide polymorphism (SNP) based genetic instruments ( P- value≤5x10 -08 , r 2 &lt;0.001) for known associations of PE [body mass index (BMI, kg/m 2 ) (339,224 subjects), high density lipoprotein (HDL, mg/dl) (188,577), blood pressure BP (mm Hg) - systolic (S) and diastolic (D) (458,577)] with SS for PE or eclampsia (7212 cases, 194266 controls) (outcome). Analyses 1) univariate two-sample Mendelian randomization (MR) [inverse variance weighted method (IVWM) for results; MR-Egger, and weighted-median methods for sensitivity analyses]; 2) multivariable (MV) MR to identify IRF after MV adjustment, 3) quantify change in effect size of IRF after adjustment (results reported as odds of PE per 10 unit change in SBP/DBP/HDL, and per standard deviation (SD) change in BMI); and 4) FUMA based analysis of IRF SNPs to annotate uterine genes using GTEx v8. Results: In 1) IVWM analysis, SBP (OR= 2.23 [95% CI= 1.82, 2.72]), DBP (3.32 [2.46,4.48], HDL (0.22 [0.09,0.55]), and BMI (1.58 [1.34,1.86]) associated with the odds of a diagnosis of PE; 2) MVMR analysis, only SBP (1.82 [1.11, 3.00] remained significant, after adjustment for BMI, DBP, and HDL; 3) proportion-explained analysis, ~18% reduction in the OR of SBP, after adjustment for BMI, DBP, and HDL; and 4) in FUMA based analyses, out of 7 gene associations, the top 2 uterine genes for SBP SNPs were ZNF859 , and CDC25A . Conclusions: Genetic predisposition to elevated SBP associated with increased odds of PE, independent of BMI, DBP, and HDL. Adjustment attenuated risk, suggesting shared genetic mechanisms. SBP is an independent risk factor for PE. SBP SNPs map to uterine ZNF859 and CDC25A, known leiomyoma associated genes, suggesting a pleiotropic role in PE development.

Promoting students’ well-being indicators through adapting biophilic design attributes in Salahaddin University dormitories

Due to its positive impact on human psychophysiological indicators, biophilic design can be implemented in various built environments. This design approach can be used when the connection to natural elements is limited and when the occupants feel stressed and uncomfortable in a specific space. Purposes: This research aims to investigate promoting Students’ well-being indicators through adapting biophilic design attributes in Salahaddin University dormitories Subjects: a cross-sectional field experiment conducted with 39 University students. Design: the participants experienced one of the two simulated rooms by using a virtual reality headset (VR). The first was a biophilic design room BDR based on the adopted BDAs, and the second was a non-biophilic design room NBDR. Besides, all participants performed a stress induction task SIT. Measures: Participants‘ physiological indicators were measured twice, one before and the other after the experiment. Measures included heart rate HR, Systolic blood pressure SBP and diastolic blood pressure DBP. Result: Paired-Samples T-Test was used to compare the mean of physiological indicators. The P-values of physiological indicators were statistically significant (P&lt;0.05). Conclusion: This study provided statistical evidence that BDAs can provide a restorative environment that positively affects human psychophysiology indicators, and NBDR provide a more stressful environment. VR is a powerful research tool if an empirical experiment and time/cost limit is now allowed.

Improving Knowledge of Healthy Lifestyle Using WhatsApp Application and Health Screening of Productive Age Population in Pajimatan Hamlet, Imogiri, Bantul

The prevalence of obesity continuously increase, as are associated comorbidities and healthcare expenses. Early detection, intervention, and effective treatment of obesity are important to improve quality of life and to reduce costs. This Community Practice Program aimed to evaluate health status and provide education about healthy life style of people at productive age in Pajimatan Hamlet, Imogiri, Bantul, Yogyakarta. Participants were 66 adults (26 men, 40 women) aged 19-64 years living in Pajimatan Hamlet. The program was held on November 2021. Education on healthy life style was done using WhatsApp group. Pre- and post-test were given to the participant before and after the education. Health screening was done by measuring height, weight, waist circumference (WC), blood pressure BP), and fasting blood glucose level. Obesity was determined using body mass index (BMI) and WC. There were significant increase scores before and after education in men (p= 0.017) and women (p&lt; 0.001). Health screening indicated that men were significantly taller (p&lt; 0.001) and heavier (p= 0.009) than women, however, there was no difference in BMI, WC, BP, and fasting blood glucose level (p&gt; 0.05). There were no differences in the distribution of BMI obesity between men and women, however, women with central obesity were higher than men (70% women, 30% women, p= 0.021). Men having prehypertension were higher than women (46.2 vs. 15%), on the other hand, women with hypertension I and II seemed to be higher than men (p= 0.043). The prevalence of type-2 diabetes was slightly greater in women (12.5%) compared with 7.7% in men. In conclusion, the Community Service Program found high prevalence of obesity and hypertension in the population. Education on healthy life style program can help to improve knowledge of the target population.

Safety of dapagliflozin initiation in acute decompensated heart failure patients with reduced left ventricular ejection fraction

Background. Chronic heart failure (CHF) is an immediate cardiological problem. At the same time, acute decompensated heart failure (ADHF) is associated with an extremely unfavorable prognosis and low survival of patients.&#x0D; Aim. To evaluate the safety of sodium-glucose cotransporter-2 inhibitor dapagliflozin early administration in patients with ADHF with a reduced left ventricular ejection fraction (LVEF) regardless of type 2 diabetes mellitus (diabetes).&#x0D; Materials and methods. We used standard CHF therapy and intravenous diuretic therapy in combination with 10 mg dapagliflozin in 43 patients with NYHA class IIIV ADHF. The study mainly included 39 (90.7%) male patients, the mean age was 6012 years (5663), diabetes was in 14 (32.6%) patients. Dapagliflozin was prescribed by a mean of 2 days (13) from admission to the hospital. The parameters were analyzed at the time of inclusion in the study and when CHF compensation was achieved.&#x0D; Results. The median of the length of hospital stay was 7 days (610). LVEF significantly increased during hospitalization from 276 to 307% (p0.001) and the level of NT-proBNP decreased: from 3700 pg/ml (17455331) to 1366 pg/ml (10252878); p=0.007. A decrease in the marker was observed in 90% of patients. Hypotension (decrease in systolic blood pressure BP less than 90 mmHg) was observed in 10 (23.3%) patients. A statistically significant decrease in BP was found: systolic and diastolic BP on admission was 114 mmHg (100126) and 70 mmHg (7080), respectively, when CHF compensation was achieved 110 mmHg (98120) and 70 mmHg (6178); p=0.047 and p=0.013, respectively. The increase in hematocrit during hospitalization was also statistically significant from 43.53.6 to 46.14.9% (p0.001) and this was found in 67% of patients. A total of 4 (9.3%) patients had acute renal injury (decrease in estimated glomerular filtration rate GFR by 25% or more). At the same time, there was no decrease in GFR of less than 15 ml/min/1.73 m2. There was no statistically significant decrease in GFR and an increase in creatinine levels during hospitalization (p=0.214 and 0.173, respectively). Urinary tract infections were observed in 1 (2.3%) patient, transient hypoglycemia in 2 (4.7%) patients, which did not lead to the discontinuation of dapagliflozin. Diabetic ketoacidosis, allergic reactions, syncope, lower extremity amputations were not observed in patients taking dapagliflozin.&#x0D; Conclusion. It can be concluded that dapagliflozin has a favorable safety profile when used in patients with ADHF, regardless of the presence or absence of diabetes.

Cardiorespiratory Response to Six-Minute Step Test in Post COVID-19 Patients-A Cross Sectional Study.

New coronavirus disease 2019 (COVID-19) can cause persistent symptoms and physical weakness that can lead to a limitation in activities of daily living (ADL). There is a lack of evidence about the performance in the six-minute step test (6MST) of post-COVID-19 patients and healthy subjects. The aim of this study is to investigate the cardiorespiratory response induced by the 6MST in post-COVID-19 patients and compare it with the response of the six-minute walk test (6MWT). This cross-sectional study was conducted on 34 post-COVID-19 patients and 33 healthy subjects. The assessment was performed at one month from a non-severe SARS-CoV-2 infection. Both groups were assessed by using the 6MST, 6MWT, and the pulmonary function test (PFT). Post COVID functional status (PCFS) scale was used for the post-COVID-19 group to assess functional status. Physiological responses; heart rate (HR), respiratory rate (RR), oxygen saturation (SpO2), blood pressure (BP), and Borg scale for fatigue and dyspnea were recorded before and after the 6MST and 6MWT. the performance of the post-COVID-19 group was worse than the healthy group in both tests. In 6MWT, the distance walked by the post-COVID-19 group (423 ± 7) was 94 m less than the healthy group, and the number of climbed steps in the 6MST (121 ± 4) was 34 steps less than the healthy group. Both results were statistically significant (p < 0.001). There was a moderate positive correlation between the 6MST and 6MWT in walked distance versus steps number (r = 0.5, p < 0.001). In addition, there was a moderate correlation between the two tests in the post (HR, RR, SpO2, systolic blood pressure SBP, diastolic blood pressure DBP, dyspnea, and fatigue) with p < 0.001. Six-minute step tests produced similar cardiorespiratory responses when compared to a 6MWT. The 6MST can be used as an assessment tool for COVID-19 patients to evaluate their functional capacity and ADL.

The Frequency of Ischemic Stroke Associated with Atrial Fibrillation at a Tertiary Care Hospital

Acute ischemic stroke is most commonly associated with atrial fibrillation. However, its prognostic impact on patients with acute cerebrovascular accidents is not fully clarified. Stroke associated with AF is associated with the worst outcome as compared to without atrial fibrillation. Atrial fibrillation is present in 20–30% of patients affected by stroke. Also, in Pakistan the prevalence of atrial fibrillation with ischemic stroke patients is still unknown. Objective: To determine the association of atrial fibrillation with acute ischemic stroke. Material &amp; methods: This cross-sectional analytical study was conducted at Neurology ward of Aga Khan University Hospital, Karachi, over eight months from 19th May 2020 to 18th December 2020. A total of two hundred sixteen patients who were admitted with the diagnosis of ischemic stroke were included in the study. Results: The 216 patients with first-ever acute ischemic stroke for more than 24 hours, age range between 30 and 80 years, both male and female were included in the study. The mean systolic blood pressure SBP and diastolic blood pressure DBP was 132.64±17.68 &amp; 84.45±15.01 &amp; mean duration of diabetes mellitus in new onset ischemic stroke patients was 11.1±6.61years male outnumbered females, with 78(36%) women and 138(64%) men. Conclusion: In summary, it was found that incidence of atrial fibrillation with ischemic stroke is most common among Pakistani population. Bangladesh Journal of Medical Science Vol. 22 No. 01 January’23 Page : 91-96

PS-C06-11: IRISIN ASSOCIATION WITH NON DIPPER HYPERTENSION DEVELOPMENT IN OBESE PATIENTS WITH CORONARY ARTERY DISEASE

Objective: Recent investigations showed that irisin, as a possible inflammatory marker, can be closely related to heart function, vessels tone regulation and possible development of arterial hypertension HTN. The purpose of the work was to study the relationship between irisin and the development of non dipper hypertension in obese patients with coronary artery disease CAD. Design and method: 97 obese hypertensive patients with CAD were enrolled into the study. CAD was presented as chronic coronary syndrome CCS according to 2019 ESC Guidelines, essential HTN as systolic blood pressure SBP ≧ 140 mmHg and or diastolic blood pressure DBP ≧ 90mmgHg. Obesity was assessed as body mass index BMI ≧ 30 kg per m2 according to WHO criteria. The mean age of participants was 53.61 ± 4.88 years. Patients were divided into 2 groups. The first one was with dipper HTN, n 46, and the second one with non dipper HTN, n 51. Dippers were established by Holter monitoring. Serum irisin levels were measured by ELISA. Results: It was found that irisin levels were significantly lower in non dipper hypertensive subjects compared with dippers 125.72 ± 15.09 vs 141.53 ± 21.84 ng per mL, p &lt; 0.001. Irisin has a negative correlation with SPR r = 0.29, p &lt; 0.01, and after adjusted for age, sex and BMI it remained a significant link between irisin and SBP, r = 0.21, p = 0.044. In multivariate logistic regression analysis of the irisin odds ratio OR 0.859, 95 per cent Confidence Interval 0.471 to 0.993, p &lt; 0.001 was found to be independent predictors for non dipper hypertension in obese patients with CCS. Conclusions: This study shows that decreased irisin levels are significantly associated with the development of non dipper hypertension in obese patients with coronary artery disease.

PS-C15-11: HYPERTENSION AND ITS CORRELATES AMONG SCHOOL ADOLESCENTS IN DELHI

Background: Hypertension is fast emerging as a major health problem amongst all school adolescents, particularly in urban areas. Regular screening of the students for this is required for preventing the emergence of complications later in life. Therefore the present study was undertaken with the objective to determine the prevalence of hypertension amongst urban school adolescents and its correlation with anthropometric measurements. Methods: A cross sectional study was conducted in a school in Central Delhi involving all 315 students of 9th and 11th standard. A proforma was filled by the students and anthropometric measurements along with blood pressure BP measurements were taken for each student. Data were analyzed using Epi info 2005 and SPSS 16.0. Results: Out of the total 315 students, 208 or 66% were boys and 107 or 34% were girls and the mean age was 14.31 SD 0.96 years. The overall prevalence of malnutrition was 24% and boys were found to be more obese as compared to girls. There were 5 students 1.6% who were found to have systolic hypertension while 17 or 5.4% were found to have diastolic hypertension while 4.1% n = 13 of the participants were systolic pre hypertensive and 26% n = 82 were in the stage of diastolic pre hypertension. Body mass index and gender were found to be independent predictors of systolic hypertension. Conclusions: Prevalence of hypertension and pre hypertension was high amongst the school children. BP check ups for children and adolescents are thus recommended to take remedial action on time

Human thermal sensation algorithm modelization via physiological thermoregulatory responses based on dynamic thermal environment tests on males

Background and Objectives: Thermal conditions are changeable in cabin space, where occupants could suffer consecutive self-thermoregulation to such changing thermal stresses. Thermal environment management is expected to be purposefully auto-adjustable for the environment by recognizing individual real-time thermal sensations. Current thermal sensation evaluation models are developed for virtual simulations rather than for realistic scenarios, challenging to evaluate human thermal sensation in the field surveys.Methods: The study constructs a human thermal sensation model via human physiological responses to evaluate the human thermal sensation in the actual vehicle environment. The thermal sensation model forms with exponential functions to clarify the relationship between thermal sensation and pulse rate and blood pressure, which successfully expresses the approximately linear trend around neutral sensation and compensates for the end-points bias. The study set up experimental cases to determine the parameter states in the thermal sensation model. Firstly, subjective thermal sensation scoring was performed by combing with an established seven-point-scale questionnaire survey system for human thermal sensation. Wearable sensors are then applied to measure the human physiological response, including blood pressure BP, pulse rate PR and blood oxygen saturation SpO2.Results: The subjects revealed significantly higher pulse rates (positively correlated) and lower blood pressure (negatively correlated) in the warm chamber than in the cool chamber. The defined parameter change rate effectively reveals the trend of human thermal sensation and avoids the inconsistency of raw physiological response levels. The change rate in PR and MAP between the thermal sensation in cold -3 and hot +3 is about a 10% difference.Conclusions: Based on the thermal sensation model algorithm, model parameters were fitted by the subjects’ thermal sensation voting and the change rate of their physiological responses. With the coefficient of determination (R2) of the regression over 0.8, the proposed thermal sensation model can be employed for human thermal sensation evaluation. The physiological thermoregulatory responses effectively indicate the thermal state of the human body and can be used in thermal environments in conjunction with human smart wearable devices.

Inadequate response to adenosine infusion during cardiac stress magnetic resonance imaging.

ABSTRACTAim:To determine the factors associated with an inadequate response to adenosine infusion during cardiac stress magnetic resonance imaging (MRI).Study Design:It is a retrospective cohort study.Introduction:Stress cardiac MRI is a highly accurate and non-invasive method to diagnose coronary artery disease (CAD). Stress MRI is performed by inducing stress with adenosine infusion. There is an increase in systemic and myocardial blood flow (MBF) with vasodilator agents. Capillaries are maximally dilated in a diseased artery and cannot sustain increased myocardial oxygen demand. It results in delayed delivery of contrast, which leads to an area of perfusion defect in the myocardium. These perfusion defects can be accurately seen by cardiovascular magnetic resonance (CMR) and help in the prognosis of patients.Methods:A retrospective study on patients subjected to cardiac stress MRI was conducted in a Tertiary Care Cardiac Center from January 2019 to January 2022. In total, 99 patients underwent adenosine stress perfusion cardiac MRI. All patients received an adenosine infusion of 140 mcg/kg/min for 2 min. Subsequently, the dosage was increased by 20 mcg/kg/min every 2 min to a maximum of 210 mcg/kg/min until an adequate stress response was achieved. Adequate stress was defined as two or more of the following criteria: 1) Increase in heart rate >/= 10 beats per minute. 2) Decrease in systolic blood pressure SBP by >/= 10 mm Hg Symptoms like chest discomfort, breathlessness, and headache. Patients who satisfied two or more of the above criteria were labeled as responders and the patients who did not satisfy the above criteria with the maximum dose of 210 mcg/kg/min of adenosine infusion were labeled as non-responders. Multivariable logistic regression analysis with forward and backward stepwise selection was used to identify predictors in non-responders. Basic demographic variables with P value </= 0.2 were examined for inclusion in the model. A P value </= 0.05 was considered significant.Results:Nine patients (9.1%) showed inadequate stress response to adenosine infusion even with a maximum dose of 210 mcg/kg/min. Multivariate logistic regression analysis showed that left ventricular end-diastolic volume (LVEDV) was a predictor of inadequate response to adenosine infusion.Conclusion:Inadequate stress response to adenosine occurred in 9.1% of subjects with an infusion of 140–210 ug/kg/min. LVEDV is an independent and strong predictor in non-responders.

AMBULATORY BLOOD PRESSURE VARIABILITY IN YOUNG ADULTS WITH LONG-COVID SYNDROME.

The aim: To perform an overall assessment of BP and BP variability using ambulatory measurements in young adults with long COVID syndrome. Materials and methods: We enrolled young patients with diagnosed long-COVID syndrome (n = 58, mean age 23.07 ± 1.54 years), compared with an age-matched healthy subjects who had not suffered from COVID-19 (n = 57, mean age 22.9 ± 1.83 years). Patients with long-COVID syndrome had recovered from mild/moderate illness and none had required hospitalization. Ambulatory 24 hours blood pressure (AMBP) parameters (mean BP, daytime BP, nighttime BP, pulse pressure, nocturnal systolic BP dipping, dipper status) were measured in all participants. The variability of systolic BP (SBP) and diastolic BP (DBP) values was assessed by the following common metrics, including the average real variability (ARV), the coefficient of variation (CV), the standard deviation (SD), and the weighed SD of SBP and DBP. Results: The average values of 24-hour ambulatory blood pressure, mean BP, daytime and nighttime systolic BP, diastolic BP and pulse pressure were found to be significantly different among patients with long COVID syndrome and control group. Group analyses showed that this difference was in SBP mean values (127.1 ± 6.65 mmHg and 115.93 ± 6.24 mmHg respectively) and DBP mean values (73.31 ± 5.30 mmHg and 68.79 ± 5.5 mmHg respectively) mainly at night. PP values at daytime were almost similar among groups, but PP values at nighttime were higher in patients with long-COVID syndrome (53.8 (52.44- 55.14) mmHg and 47.14 (46.45 - 47.88) mmHg respectively). Nocturnal SBP dipping was better in control group than in patients with long-COVID syndrome ( 5.3 ± 5.68 and 3.1 ± 3.79 mmHg respectively). Only 13 (22.4%) patients with long-COVID syndrome had normal dip-per status while more than half - 38 (66.7%) in healthy subjects. The values of ARV of SBP and DBP over 24-hour, awake, and asleep time frames were found to be greater in patients with long COVID syndrome than healthy controls (p < 0.05). Conclusions: Patients with long- COVID syndrome have higher BP mean values of 24-hour ABPM particularly at nightime, significant blood pressure BP variability, which increases the risk of cardiovascular events in future. Nevertheless, the further prospective investigations is warranted to investigate the potential mechanisms and causality associations.

The Immediate Effect of Steam Bath and Sauna Bath on Heart Rate Variability and Body Composition in Obese Individuals: A Comparative Study

Aim: The present study was designed to evaluate and compare the immediate effects of steam bath and sauna bath on body composition and Heart Rate Variabilities in individuals with obesity.&#x0D; Study Design: Prospective randomised comparative trial.&#x0D; Materials and Methods: Participants visiting Shantivana Nature cure hospital with age ranging from 18 to 32, without any comorbidities and Body Mass Index (BMI) more than 31 kg/m2 were appraised about the study protocol and after getting informed consent were divided into Steam bath group (n = 50) and Sauna bath group (n = 50) and were administered one sitting of Steam bath and sauna bath for 15 minutes. The Heart Rate Variability (HRV) and Body Fat Analyser data was recorded before and after one sitting of treatment. The data was analysed using JASP (version 0.14.1.0) software and parametric and non-parametric tests were employed based on the normal distribution. &#x0D; Results: Marked changes were observed in BMI (p= 0.022), Total Body Water (TBW; p&lt;0.0001), Heart Rate (HR; p= 0.002), RR Interval (p&lt; 0.001), NN50 (p=0.013), pNN50 (p=0.0001), variables in the Steam bath group after comparing with the baseline. In the Sauna bath group significant changes (in %) were seen in Body weight (BW; p&lt;0.001), BMI (p&lt;0.001), Free-Fat Mass (FFM; p= 0.004), Basal Metabolic Rate (BMR; p&lt; 0.001), Systolic Blood Pressure SBP; p= 0.008), HR (p&lt;0.001), Mean RR (p&lt;0.0001), RMSSD (p=0.005), pNN50 (p&lt;0.0001), Very low frequency (VLF; p&lt;0.0001), Low Frequency (LF; p&lt;0.001), High Frequency (HF; p&lt;0.001), LF/HF (p&lt;0.001). When comparing steam bath with sauna bath group, the variables Diastolic Blood Pressure (DBP; p=0.002), HR (p= 0.021), RMSSD (p&lt;0.001), RMSSD (p&lt;0.001), NN50 (p&lt;0.001), pNN50 (p&lt;0.001), VLF (p&lt;0.001) showed significant changes.&#x0D; Conclusion: The present study concludes that single dose of steam bath and sauna bath reduces the body weight by acting on the total body water percentage, reduces diastolic blood pressure, and causes vagal dominance. Sauna bath also increases basal metabolic rate which further helps in improving metabolism in the body and further helps in reducing body weight.

Is Hypertension Despite Use of Two or More Anti-hypertensive Medications for Patients with a BMI < 40 kg/m2 Justified for Eligibility for Bariatric Surgery?

Several insurance policies require the presence of hypertension, defined as blood pressure > 140 mmHg systolic (SBP), or 90 mmHg diastolic (DBP), despite concurrent use of >1 anti-hypertensive agents for patients with a BMI <40 kg/m2 to qualify for bariatric surgery (BS). The scientific validity of this requirement is assessed. A total of 461 patients who underwent BS in a community hospital were included. Systolic (SBP) and diastolic (DBP) blood pressure BP (in mmHg) was assessed by an automated manometer at each office visit until 3 years postoperatively and recorded in a prospectively maintained database. Thirty-six (7.8%) patients with BMI <40 Kg/m2, treated by 1, 2, or three anti-hypertensive medications and BP below 140/90, would have been denied BS under such policies. Number of anti-hypertensive medications had no impact on SBP/DBP control preoperatively. Patients being treated preoperatively with < 3 anti-hypertensive medications had a significantly higher percentage of hypertension resolution at 1 (one-med: 66.2%, two-med: 50.9% vs. three-med: 12.5%, p<.0001), 2 (one-med: 63.9%, two-med: 52.8% vs. three-med: 15.4%, p=.0068), and 3 (one-med: 76.9%, two-med: 52.9% vs. three-med: 20%, p=.005) years postoperatively. Multivariate regression demonstrated a significant correlation between the number of preoperative anti-hypertensive medications, preoperative SBP or DBP, and %TBWL. Patients treated with fewer than 3 anti-hypertensive medications did not have a better BP control preoperatively but were more likely to resolve their hypertension postoperatively. Restricting access to BS of patients with hypertension treated by fewer than 3 anti-hypertensive medications is not supported by this study.

English

BACKGROUND Laryngoscopy and endotracheal intubation, a painful procedure, frequently used in airway management is commonly associated with undesired haemodynamic changes like hypertension, tachycardia and arrythmias. Thus, this study was designed to compare haemodynamic stability to laryngoscopy and intubation using single drug induction with etomidate and combined drug induction with propofol and ketamine. METHODS This was a double blind randomised controlled trial, a total of 90 patients of both sexes, aged between 18 - 60 years, who were scheduled for elective surgeries under general anaesthesia in regional institute of medical sciences (RIMS) operation theatre (OT) were divided into two groups. Group PK received propofol (1.5 mg / kg) + ketamine (0.5 mg / kg) and Group E received etomidate (0.3 mg / kg) as induction agents. The haemodynamic parameters (systolic blood pressureSBP, diastolic blood pressure-DBP, mean arterial pressure-MAP, heart rate-HR) were recorded before induction, immediately after induction, 1, 3 and 5 mins after intubation. Side effects like myoclonus and post-operative nausea and vomiting were also noted. RESULTS SBP, DBP, MAP which were recorded, before induction considered as the baseline, and after induction, were comparable between the two groups. SBP, DBP and MAP compared at 1, 3 and 5 mins after intubation showed statistically significant difference between the two groups with propofol-ketamine group showing better haemodynamic stability. The HR between both the groups at various time intervals were comparable and not considered statistically significant. The side effect associated after induction was myoclonus in 14 patients in Group E i.e. 31 % and post-operative nausea vomiting was observed in 8 patients in Group E i.e. 18 %. CONCLUSIONS Thus, in view of haemodynamic stability during laryngoscopy, intubation and side effect profile; propofol and ketamine combination proves to be a better alternative compared to etomidate according to our study. KEYWORDS Propofol, Ketamine, Etomidate, Haemodynamic Stability

Drinking water salinity is associated with hypertension and hyperdilute urine among Daasanach pastoralists in Northern Kenya

Water salinity is a growing global environmental health concern. However, little is known about the relation between water salinity and chronic health outcomes in non-coastal, lean populations. Daasanach pastoralists living in northern Kenya traditionally rely on milk, yet are experiencing socioecological changes and have expressed concerns about the saltiness of their drinking water. Therefore, this cross-sectional study conducted water quality analyses to examine how water salinity, along with lifestyle factors like milk intake, was associated with hypertension (blood pressure BP ≥140 mm Hg systolic or ≥90 mm Hg diastolic) and hyperdilute urine (urine specific gravity <1.003 g/mL, indicative of altered kidney function). We collected health biomarkers and survey data from 226 non-pregnant adults (46.9% male) aged 18+ from 134 households in 2019 along with participant observations in 2020. The salinity (total concentration of all dissolved salts) of reported drinking water from hand-dug wells in dry river beds, boreholes, and a pond ranged from 120 to 520 mg/L. Water from Lake Turkana and standpipes, which was only periodically used for consumption when no other drinking sources are available, ranged from 1100 to 2300 mg/L. Multiple logistic regression models with standard errors clustered on households indicate that each additional 100 mg/L of drinking water salinity was associated with 45% (95% CI: 1.09–1.93, P = 0.010) increased odds of hypertension and 33% (95% CI: 0.97–1.83, P = 0.075) increased odds of hyperdilute urine adjusted for confounders. Results were robust to multiple specifications of the models and sensitivity analyses. Daily milk consumption was associated with 61–63% (P < 0.01) lower odds of both outcomes. This considerable protective effect of milk intake may be due to the high potassium, magnesium, and calcium contents or the protective lifestyle considerations of moving with livestock. Our study results demonstrate that drinking water salinity may have critical health implications for blood pressure and kidney function even among lean, active pastoralists.