History Of High Blood Pressure Research Articles

Screening for risk factors for type 2 diabetes mellitus using the Canadian Diabetes Risk Questionnaire (CANRISK) in the East Java Provincial Health Service, Indonesia

Diabetes Mellitus remains a serious and growing global challenge for public health. Early identification of cases prevents delays in treating diabetes mellitus, which often causes various complications in the body. Diabetes Mellitus screening includes anamnesis for family and personal history of the disease, measurement of height, weight, abdominal circumference, blood pressure examination, and examination of sugar levels. One instrument that can be used to assess the risk of developing type 2 diabetes mellitus is the Canadian Diabetes Risk Questionnaire (CANRISK). The aim of this research is to find out the characteristics of respondents and the risk categories of respondents suffering from type 2 diabetes mellitus in the next 10 years using CANRISK. This research uses quantitative methods. Based on the type of research, this research uses descriptive observational research. The research design used was cross sectional. The results showed that 78% of respondents had a low-moderate risk of developing type 2 DM, 6% had a high risk of developing type 2 DM, and 16% had a very high risk of developing type 2 DM. The conclusion of this study was that the risk factors for developing Type 2 DM 2 are age, BMI, waist circumference, physical activity habits, vegetable and fruit consumption habits, history of high blood pressure and high blood sugar, history of giving birth to a baby more than 4.1 kg, family history of diabetes, parents' ethnic group, and level of education.

Prevalence of Diabetic Retinopathy in Diabetic Patients Referred to Mashhad Parsian Diabetes Center, Iran

Background: Diabetes is a common disease that leads to chronic complications such as neuropathy, nephropathy, vascular diseases, and retinopathy. Diabetic retinopathy is an eye condition that can cause vision loss and blindness in diabetic patients. The aim of this study is to describe the prevalence of diabetic retinopathy in diabetic patients.
 Method: In this descriptive-cross-sectional study, 550 patients with diabetes referring to the diabetes centers in Mashhad Parsian Diabetes Center, Iran were enrolled. All patients were assessed for the presence of diabetic retinopathy by direct or indirect ophthalmoscopy. A standardized protocol was used to grade diabetic retinopathy. Two groups of diabetic patients with and without retinopathy were compared in terms of body mass index (BMI), gender, disease duration and type of diabetes, history of blood pressure, history of blood lipids, hemoglobin AIC and albumin.
 Results: The prevalence of diabetic retinopathy among 550 diabetic patients was 23.4% (129 patients). Age, duration of diabetic disease, history of high blood pressure, history of high blood lipids, type 2 diabetes and urine albumin were significantly different between the diabetic patients with and without retinopathy, while no significant difference was observed between the two groups in terms of gender, BMI, smoking, and hemoglobin A1C level.
 Conclusion: Due to the high prevalence of DR in diabetic patients, it is recommended that retinal examination should always be considered in the evaluation of diabetic patients.

Tekanan Darah Terkontrol dengan Rutin Pemeriksaan pada Program International Partnership Real Work College di Kampung Pandan Malaysia

Hypertension or high blood pressure is a severe global health problem and is often a significant risk factor for cardiovascular disease. Monitoring blood pressure regularly can help identify potential health problems quickly, enabling better treatment and preventive measures to avoid more severe problems, especially in cases of hypertension. Community service was conducted on Sunday, July 30, 2023, using a direct examination approach to residents who attended the PRIM & PRIA Kampung Pandan Malaysia branch deliberation event. The results of the examination showed that 20 residents were suffering from hypertension, or 46% of participants were suffering from hypertension. Twenty-three residents do not suffer from hypertension, 54%. Hypertension is characterized by increased blood pressure in the body's arteries, which can cause severe complications if not treated properly. Adults should check their blood pressure regularly as part of preventive health care. We encourage people to check their blood pressure regularly, especially if they are at high risk or have a family history of high blood pressure. Routine examinations allow for early detection and good management.

Granulomatous Acute Interstitial Nephritis Revealing Multisystem Sarcoidosis Associated with Thyroiditis and Cushingoid Syndrome: Report of a Case and Review of the Literature

Introduction: Sarcoidosis can present with acute renal failure (ARF) due to granulomatous interstitial nephritis (GIN). We report the case of granulomatous acute renal failure (ARF) revealing multisystemic sarcoidosis in the nephrology department of the Aristide Le Dantec hospital in Dakar. Observation: Mrs. kD aged 54 with a past history of high blood pressure for 22 years, a multi nodular euthyroid goiter, referred to the nephrology department for impaired renal function. The clinical examination revealed at entry, deterioration in the general condition with weight loss and non-selective anorexia. Clinical anemia was also noted. The clinical examination also revealed Cushingoid syndrome and dry mouth syndrome. On biology, the blood count showed bicytopenia with anemia at 10.9 g/dl and leukopenia at 2620/mm3. There was an impairment of renal function with creatinine at 139.2 mg/l and blood urea at 1.76 g/l. The renal ultrasound became normal. Cervical ultrasound showed an aspect of abscessed thyroiditis of the right lobe. Chest computed tomography (CT) showed bilateral hilar adenomegaly and a band of bilateral basal linear atelectasis. The renal biopsy showed glomeruli of subnormal structure, the interstitium is riddled with tuberculoid follicles formed of epithelioid and multinucleated histiocytes of the Langhans type. The diagnosis of granulomatous acute interstitial nephritis revealing multisystemic sarcoidosis was kept. The evolution was favorable after 1 month of treatment with corticosteroid therapy with a clear improvement in renal function. Conclusion: Renal manifestations during sarcoidosis are rare. They can be indicative of the disease as in our patient. Renal biopsy is essential in any patient presenting with impaired renal function with extra-renal signs.

Improving residential care amid COVID-19: The link between risk factors and hospitalization.

This study was conducted to investigate the relationship between the hospitalizations and backgrounds of patients with coronavirus disease 2019 to identify specific risk factors. This retrospective study used health observation records to analyze the relationship between certain risk factors and the subsequent hospitalization of 321 patients who were discharged from a residential care facility between January 16 and February 8, 2021. The usefulness of a hospitalization prediction score, created based on the presence of comorbidities and sex, was examined. Being older, male, and having a history of high blood pressure or vascular disease were all risk factors. A multivariate analysis with age and hospitalization predictive score as independent variables and hospitalization as the dependent variable showed that age (odds ratio: 1.07, 95 percent confidence interval: 1.03-1.11, p < 0.01) significantly increased hospitalization risk by 7 percent for every 1-year age increase. The median time from illness onset to hospitalization for all patients was 9 days (interquartile range: 8-10). Hypoxia was the most common cause of hospitalization. However, hypoxia and other symptoms, such as cough and dyspnea, were not correlated. Given the pandemic, there may come another time when hospitals are not able to accommodate all patients who require care. In such instances, age, sex, the presence of comorbidities, and checking oxygen saturation regularly using a pulse oximeter around 9 days after the onset of the disease should all be considered important, as it may lead to improved and safer operation of overnight care facilities.

A Rare Complication of Chronic Otitis Media: Septic Thrombosis of the Transverse Sinus and Meningoencephalitis due to a Parameningeal Infection. A Case Report

BACKGROUND: Septic cerebral venous sinus thrombosis or septic cavernous thrombosis is an extremely rare disorder, with 2 to 13 cases per million per year, following the introduction of antibiotics and advances in diagnostic imaging. It is a complex pathology, difficult to diagnose and life threatening. It has a high risk of otoneurologic sequelae, and it requires follow-up by various specialties, as treatment is medical and surgical, including neurology, internal medicine, intensive care, otorhinolaryngology, and infectiology, among others. Due to the low occurrence of septic cavernous thrombosis, the diagnosis may be erroneous or delayed, increasing complications and mortality. It is essential to perform a complete physical examination with emphasis on the ophthalmological, otological, rhinosinusal and neurological examinations, which is why this case is described. THE CASE: We describe a 77-year-old male patient, with history of high blood pressure, nasopharyngeal carcinoma in remission, bilateral hearing loss, prostatic hyperplasia, otitis media, and chronic mastoiditis. He was admitted due sudden onset of difficulty standing, gait instability, mutism, unquantified fever spikes, headache, and vertigo. The initial laboratory tests only revealed a complete blood count with leukocytosis. A simple brain computed tomography (CT) scan did not show relevant findings; therefore, a lumbar puncture (LP) was carried out due to suspicion of bacterial meningoencephalitis. Analysis of cerebrospinal fluid (CSF) showed pleocytosis with a predominance of polymorphonuclear cells, hypoglycorrhachia and hyperproteinorrachia. Empirical antibiotic therapy was started with Vancomycin and Cefepime. At day five since onset of symptoms, he did not have improvements of his symptoms, so a new LP was carried out and antibiotic therapy was escalated. In the CSF it was found an increased cellularity with greater hypoglycorrhachia, persistent hyperproteinorrachia, and cellular shift to lymphocyte predominance. A contrast-enhanced magnetic resonance imaging (MRI) of the brain was requested, showing pyogenic ventriculitis and decreased flow at the left transverse sinus, suggesting possible thrombosis, which was later confirmed with a contrast-enhanced brain angio-MRI. Furthermore, due to the otological involvement, a CT scan of the ears was performed, which showed severe bilateral otomastoiditis with bilateral mastoid cholesteatomas, bilateral otitis externa, and osteomyelitis of the left petrous apex. A diagnosis of a septic thrombosis of the left transverse sinus, in the context of meningoencephalitis secondary to a parameningeal focus, was made. Treatment with Meropenem 1 gr intravenously every 8 hours and Vancomycin 1 gr every 8 hours was continued up to 28 days. During the hospitalization, otorhinolaryngology did a mastoidectomy and continued outpatient antibiotic management with Ciprofloxacin for seven more days. The patient did not require anticoagulation, and at follow-up he was notably recovered, and in control studies the recanalization of the thrombosis was confirmed. CONCLUSION: Septic cerebral venous sinus thrombosis is a rare pathology, but with a high associated morbidity and mortality, which requires multidisciplinary management. It is vital to know its pathophysiology and predisposing factors to include it in differential diagnoses when managing a patient with meningeal symptoms.

Recurrent ACPA-positive pericarditis, would it be a pre-clinical manifestation of RA?

Abstract Introduction Rheumatoid arthritis (RA) is a chronic inflammatory rheumatic disease with an autoimmune component that preferentially affects the small joints of the hands and feet. Extra-articular manifestations may be associated with it. These are rather long-term complications compared to the inaugural forms of the disease. Observation We report the observation of a 62-year-old female patient with a history of high blood pressure under monotherapy by a conversion enzyme inhibitor, followed for recurrent pericarditis for three years, who was initially treated with anti-bacillary drugs without improvement. She presented two years ago an episode of pericarditis of great abundance requiring a pericardial drainage. The pericardial biopsy was non-specific. The etiological work-up revealed the presence of anti-citrullinated peptide antibodies (ACPA) and a rheumatoid factor (RF) at very high levels. The patient did not present any other systemic signs, especially articular ones. Joint imaging was normal. The evolution was marked by the persistence of a pericardial effusion of a small to medium size. RA could not be retained according to the American College of Rheumatology/ European League Against Rheumatism’s (ACR/EULAR) 2010 criteria. Glucocorticoids therapy at a dose of 0.5 mg/kg/day allowed the resolution of the pericarditis without recurrence, with a six-month follow-up period. Conclusion This is an extra-articular manifestation that would be inaugural of RA. It is an atypical presentation in the usual history of the disease. The inclusion of extra-articular involvement in the classification criteria and in the groups at risk of developing RA would be useful in these cases.

Exploring the impact of cognitive impairments on treatment compliance and quality of life in patients with Continuous Ambulatory Peritoneal Dialysis (CAPD).

The aim of this study is to investigate the impact of cognitive impairments on treatment compliance and quality of life in patients with Continuous Ambulatory Peritoneal Dialysis (CAPD). A cross-sectional study was conducted among patients with CAPD at the Department of Nephrology, Lianshui People's Hospital from October 2021 to May 2022. Cognitive function was assessed using the Montreal Cognitive Assessment (MoCA), and the End-Stage Renal Disease Adherence Questionnaire was used to evaluate treatment compliance. Quality of life was assessed using the SF-36 questionnaire. Scores from all the questionnaires and demographic data were recorded. A total of 98 patients were enrolled, and the prevalence of cognitive impairment among CAPD patients was 69.39% (MoCA score < 26). Patients were divided into 2 groups: one group with normal cognitive function (MoCA score ≥ 26) and the other with cognitive impairments. There were statistically significant differences in age, dialysis age, education, urea clearance index, history of high blood pressure, and diabetes between the 2 groups (all P < .05). Patients with cognitive impairments had lower compliance levels in terms of diet fluid restriction, medication therapeutic regimens, and dialysis regimen (all P < .05). Patients with cognitive impairments also had lower quality of life scores in the dimensions of physical function, general health, social function, emotional function, and mental health (all P < .05). Cognitive impairment appears to be common among CAPD patients and may adversely affect both their treatment adherence and overall quality of life. A more comprehensive understanding of the underlying mechanisms necessitates further study.

FRI665 Hirata's Syndrome: Autoimmune Hypoglycemia Diagnostic Pathway, A Mexican Case Report

Abstract Disclosure: G. Gonzalez De La Cruz: None. D. Porras Farret: None. Introduction: Autoimmune hypoglycemia or Hirata syndrome is a very rare cause of hypoglycemia in western populations, as an example, in Mexico until 2015, there was only a single case reported with these characteristics. Diagnosis is based on episodes of spontaneous, fasting or postprandial hypoglycemia, with endogenous hyperinsulinism, without pancreatic lesions on imaging and positive tests. Objective: To describe the approach to a patient with hypoglycemia, specifically to those with characteristics of autoimmune hypoglycemia syndrome, as well as the general approach to hypoglycemia of endogenous origin and the differential approach in those with a history of type 2 diabetes or drug use with secondary effects. Case description: An 86-year-old woman with a history of high blood pressure, prediabetes, and osteoporosis, presented episodes of dizziness, palpitations, diaphoresis, and syncope, documenting plasma glucose of 40 mg/dl. She was attended by paramedics responding adequately to oral glucose. She was evaluated by Cardiology, Holter was performed with predominant sinus rhythm, frequent atrial extrasystoles (2%) and infrequent ventricular extrasystoles. Next, she was referred to Endocrinology for evaluation and treatment, she was taken empagliflozin as prediabetes medication, and it was suspender. Laboratory studies are requested to address hypoglycemia, with serum insulin levels greater than 600 mU/l, c-peptide 3.9 ng/ml, TSH 6.1, T4T 7.5, T3T 67.8, T4L 1.1, ALT 26 U/L, AST 18 U/L, DHL 247 U/L, GGT 26 U/L, Cortisol 13.8 mcg/dl. An MRI of the upper abdomen was performed where there is no evidence of pancreatic injury. A profile of serum hypoglycemic agents (sulfonylureas in blood) was requested, which were not detected. Subsequently, anti-insulin studies were requested, which were reported in amounts greater than 100 U/ml. The diagnosis of autoimmune hypoglycemia syndrome was made, starting management with prednisone 70 mg every 24 hours, in addition to dietary changes. Conclusion: The approach to hypoglycemia in patients without clear evidence of exogenous administration of hypoglycemic agents must be ordered, taking into account differential diagnoses such as autoimmune causes. In the case of autoimmune hypoglycemia, remission is expected at 6 months, with constant monitoring and adjustment of drugs for underlying pathologies. Presentation: Friday, June 16, 2023

Relationship Between Diet Quality and Statin Use Among Adults With Metabolic Syndrome From the CARTaGENE Cohort

BackgroundIn metabolic syndrome (MetS), cardiovascular disease (CVD) risk reduction relies on the complementary use of diet and lipid-lowering medication. Evidence suggests that initiating such medication may impede diet quality. The objective of this study was to evaluate the relationship between diet quality and statin use among adults with MetS and free of CVD from the Province of Québec. MethodsThis cross-sectional study included 2481 adults with MetS (40-69 years of age) from the CARTaGENE Québec population-based cohort, of whom 463 self-reported using statin monotherapy. Diet was assessed using the Canadian Dietary History Questionnaire II, a food- frequency questionnaire, and diet quality was assessed using the Alternative Healthy Eating Index (AHEI). ResultsIn multivariable-adjusted linear regression models, statin users had lower AHEI (%) compared with nonusers (users: 40.0; 95% confidence interval [CI], 38.9, 41.2 vs nonusers: 41.2; 95% CI, 40.4, 42.0; P = 0.03] because of a lower consumption of vegetables and whole grains. Stratified interaction analyses showed that the lower diet quality among statin users was mostly prevalent among men aged ≥ 50 years and women aged ≥ 60 years, among individuals with annual household incomes of < $50,000 and persons who self-reported history of high blood pressure. ConclusionsIn this cohort of adults with MetS from Quebéc, the use of statin monotherapy in primary prevention of CVD was associated with a slightly lower diet quality. These data suggest suboptimal complementarity between diet quality and use of cholesterol-lowering medication in primary prevention of CVD in MetS.

Health education for elderly with hypertension in RW 17 Mojosongo Jebres Surakarta

Hypertension in the elderly has a high prevalence, which is due to the decline in organ function in the elderly. Based on the previous research, it was found that blood pressure was originally high, but after being given the intervention of slow deep breathing, stretching, and brisk walking exercise, it obtained relevant depreciation. With this counseling, it is hoped that all people, especially the elderly who have a history of high blood pressure, can increase their knowledge about exercises that can be done to reduce high blood pressure. This program included counseling about hypertension and exercises that could be done by the elderly to reduce high blood pressure. The evaluation result shows that there is an increase in the knowledge of the elderly about a healthy lifestyle by 8% for a good level of knowledge.

Flare-ups After Nonsurgical Retreatments: Incidence, Associated Factors, and Prediction

IntroductionThe aims of this study were to determine the incidence, associated factors, and predictability of flare-ups after nonsurgical retreatments (NSRetx). MethodsAll patients (n = 3,666) who received NSRetx by 3 endodontists in 2 endodontic offices during a period of 6 years (2016–2022) were included. Demographic, diagnostic, and procedural data were collected. A flare-up was defined as moderate-severe pain with/without swelling that took place within 14 days of initiation of NSRetx and resulted in an unscheduled appointment. Bivariate analyses on the entire cohort and multivariable analyses on cases with complete dataset (n = 2,846) were performed to identify significant associations. A Random Forest algorithm was used to make a prediction model. ResultsIncidence of flare-ups was 3.95% (n = 145). Increased risk of flare-ups was associated with diabetes (adjusted odds ratio [AOR] = 2.01; 95% confidence interval [CI], 1.01–3.97), mandibular teeth (AOR = 1.67; 95% CI, 1.11–2.52), moderate-severe preoperative pain on percussion (AOR = 2.13; 95% CI, 1.31–3.50), and pain on palpation (AOR = 1.63; 95% CI, 1.01–2.64). Lower risk of flare-up was associated with high blood pressure (AOR = 0.44; 95% CI, 0.21–0.82) (P < .05). The prediction model was not able to predict flare-ups with sufficient confidence (precision = 0.13). ConclusionsIncidence of flare-ups following NSRetx was low (∼4%) and had a weak but significant association with the history of diabetes. Moderate-severe pain on percussion, pain on palpation (any intensity), and mandibular teeth had a significant association with flare-ups. The history of high blood pressure was associated with lower risk of flare-ups. Flare-ups were difficult to predict in this clinical setting.

#5009 GESTATIONAL COUNSELING DURING PREGNANCY IN PATIENTS WITH KIDNEY DISEASE: EXPERIENCE OF A MULTIDISCIPLINARY TEAM

Abstract Background and Aims Chronic kidney disease increases morbidity and mortality in pregnancy, being more prone to complications. Because it confers a risk to the fetus, this group of patients should be evaluated by a multidisciplinary unit, including nephrologists, rheumatologists, and obstetricians. Our study's objective is to describe the clinical/analytical characteristics of patients with kidney disease (KD), assessed in a multidisciplinary consultation, to inform them of the risks and to be able to prepare them to reach pregnancy optimally. At the same time, detect patients with increased risk of complications and perform close follow-ups during pregnancy and postpartum. Method Demographic, clinical, analytical, and obstetric variables were collected in a retrospective study that included women with kidney disease (inflammatory/autoimmune) between May 2020 to March 2022. In our hospital, the hereditary kidney disease unit offers reproductive advice to its patients, which was not considered in this study. Results A total of 24 patients with a median age of 35 years (18-39) were evaluated, classifying them into two independent groups: 1-pre-pregnancy (N=12) and 2-during pregnancy (N=12) and postpartum (N=10). All patients from group 1 have kidney disease (100%). Lupus nephropathy (LN) was the most frequent (64%), followed by minimal change disease (17%) and IgA nephropathy (9%). Maternal-fetal risks were evaluated according to clinical and analytical parameters (age, blood pressure, renal function, proteinuria, and disease activity, among others). 17% of patients had a history of high blood pressure. Treatment modification was made in 25%. Renal biopsy was performed in 4/7 LN patients, and pregnancy was not recommended for one of them (class III LN). In group 2, 14% of the patients presented onset KD (one patient presented de novo nephrotic syndrome and another one, an atypical hemolytic uremic syndrome in the immediate postpartum), the rest of them had previous KD: IgA Nephropathy (25%), and minimal change disease (17%), were the most frequent. 8% of the patients had a history of high blood pressure, 25% of them received ACE/ARBs that were discontinued. There were no cases of preeclampsia/eclampsia. The average gestation time was 38.5 weeks, 6.7% &amp;lt;37 weeks, and none &amp;lt;34 weeks. All newborns weigh greater than 2.5 Kg (mean birth weight 3.42 Kg). There were three inductions (two due to diabetes and one due to an altered topographic record). One peri-gestational complication (premature rupture of membranes) and one perinatal complication (respiratory distress) were observed. No other recorded/evidenced complications. Conclusion The gestational counselling and monitoring during pregnancy provide adequate support for patients with KD, being able to carry out a "guided" pregnancy with fewer complications. The strategies of our unit include modification of pre-conception treatment, activity control of underlying pathologies, and monitoring of kidney disease during pregnancy to reduce the risk of miscarriages, premature births, and low birth weight, among other complications.

ACUTE PANCREATITIS REVEALING MAJOR HYPERTRIGLYCERIDEMIA

Objective: Severe hypertriglyceridemia is a common risk factor for acute pancreatitis and atherosclerotic vascular disease. Our aim was to report a rare case of acute pancreatitis due to major hypertriglyceridemia. Design and method: We report a case of acute pancreatitis revealing major hypertriglyceridemia. Results: A 53-year-old man, was hospitalized in May 2022 in endocrinology departement with abdominal pain, nausea,vomiting and alteration of general condition. History: high blood pressure, type 2 diabetes, alcohol consumption and family history of high blood pressure, type 2 diabetes, dyslipidemia. Clinical examination showed defense on palapation in epigastrium and right flank. Biochemical analyses were as follows: hypertriglyceridemia at 76.42 mmol/L associated with hypercholesterolemia at 17.58 mmol/L, LDL-C = 2.25 mmol/L, HDL-C = 2.12 mmol/L, hyperglycemia = 10.62 mmol/L, HBA1C = 8.1%, Lipasemia = 281 UI/L. Abdominal ultrasound did not show lithiasis, abdominal CT scan revealed pancreatitis. The diagnosis of acute pancreatitis due to major hypertriglyceridemia was made. The patient was treated by plasmapheresis and triglyceride level was reduced to 2.5 mmol/L. The lipidogram showed an isolated elevation of VLDL and defined hypertriglyceridemia as Familial hyperlipoproteinemia type 4. Conclusions: Familial hyperlipoproteinemia type 4 syndrome is an uncommon condition. Acute pancreatitis secondary to severe hypertriglyceridemia is a condition with a high risk of mortality which requires prompt clinical suspicion and treatment.

AB1523 CLINICAL SIGNS AND ACTIVITY LIMITATIONS ASSOCIATED WITH DURAL SAC ECTASIA IN INDIVIDUALS WITH MARFAN DISEASE: A CROSS-SECTIONAL CASE-CONTROL STUDY

BackgroundDural ectasia often occurs in individuals with Marfan disease. Fibrillin-1, a matrix component of microfibrils, has been hypothesized to play a role in the circulation of cerebrospinal fluid [1]. Modifications to the circulation of cerebrospinal fluid in individuals with Marfan disease may lead to an increased pressure in the lumbosacral spine and a decreased pressure in the cephalic extremity.ObjectivesWe hypothesized that individuals with Marfan disease and dural ectasia, as compared to individuals with Marfan disease without dural ectasia, may display a specific pattern of painful symptoms and spine-specific activity limitations [2]. The aim of our study was to compare: the frequencies and characteristics of painful symptoms, and the intensity of back and leg pain, spine-specific activity limitations and health-related quality of life, between individuals with Marfan disease with and without dural ectasia.MethodsWe conducted a single-centred cross-sectional comparative study. All individuals with Marfan disease followed in the department of cardiology of Bichat hospital (Paris, France) and recorded in the computerized database of the department from inception to January 2022 were systematically screened. Inclusion criteria were: adults ≥ 18 and ≤ 55 years; fulfilling Ghent nosology; FBN1 mutations confirmed by genetic testing; and CT-scan or magnetic resonance imaging available. Non-inclusion criteria were: history of lumbar surgery &lt; 1 year; specific back pain (i.e. tumor, infection, traumatism, fracture, inflammatory rheumatic disease); individuals unable to speak, read and write French. Individuals were considered to have dural ectasia or not to have dural ectasia based on CT-scan or magnetic resonance imaging, according to Ahn and colleagues’ criteria [3]. All self-administered questionnaires collected between 1/28/2022 and 9/12/2022 were included in the analysis.Results247 individuals were eligible to participate and were contacted by mail. 90 (36%) individuals accepted to participate and were included: 55 (61%) had dural ectasia and 45 (39%) did not(Figure 1). Mean participants’ age was 39.3 (9.4) years and 45 (50%) were women. 80 (89%) participants had back pain, most often located in the lower back, 65 (71%) a history of scoliosis and 8 (9%) a history of spine surgery. 15 (17%) participants had a history of high blood pressure, 84 (93%) a dilation and/or dissection of the ascending aorta, and 52 (58%) an aortic surgery. The 3 most often reported painful symptoms were increased pain in the lower back with upright posture in 53 (58%) participants, increased headache with upright posture in 36 (40%) and increased pain in the lower back when walking in 31 (34%). The frequencies of increased headache with upright posture and of increased pain in the lower back when coughing, laughing and/or sneezing were numerically higher in participants with than without dural ectasia (49% vs 26% and 13% vs 0%, respectively), without reaching statistical significance (p-value=0.030 and p-value=0.021, respectively)(Table 1).ConclusionIndividuals with Marfan disease and dural ectasia, as compared to those without dural ectasia, display a specific pattern of painful symptoms, including lower back pain and headache with upright posture. We detected too a difference in favor of a link between ectasia of the dural sac and abundance in ascending aortic surgery (64% vs 49%).

History of high blood pressure: narrative review

Introducción: la medición de la presión arterial es uno de los procedimientos más realizados en la práctica clínica. La presente revisión narrativa pretende sintetizar los aspectos relevantes que rodearon la definición de la hipertensión arterial, el recorrido histórico del tratamiento de esta y el aporte de los estudios a la disminución de la mortalidad por enfermedad cardiovascular en el tiempo. Metodología: revisión narrativa de la historia de la hipertensión arterial, desde el reconocimiento de la presión arterial alta como un factor asociado al riesgo cardiovascular y la evolución histórica del tratamiento hasta los hallazgos significativos del estudio SPRINT, publicado en 2015. Resultados: hasta hace aproximadamente 50 años la hipertensión arterial era conocida como una patología esencial, es decir, esta condición no siempre fue considerada como una enfermedad. El descubrimiento de la presión sanguínea ha sido atribuido a Stephen Hales, poeta, orador y sacerdote nacido en Inglaterra. La primera medición de la presión sanguínea e incidentalmente de la presión del pulso la realizó en 1733 en animales. Se describe el origen de la presión arterial, la hipertensión arterial, el camino recorrido para el reconocimiento de esta condición como enfermedad y posteriormente su tratamiento, hasta llegar al estudio SPRINT en 2015, el cual fue contundente en demostrar el beneficio de reducir la cifra de presión arterial sistólica objetivo en una población no diabética. Conclusión: los resultados de esta revisión narrativa exponen cómo el reconocimiento de la presión arterial alta como un factor de riesgo cardiovascular permitió el avance en la investigación científica para determinar el tratamiento y las cifras de presión arterial que favorecen la reducción de la mortalidad y morbilidad por esta causa.

Risk factors associated with acute kidney injury in a cohort of hospitalized patients with COVID-19

BackgroundPatients with COVID-19 have a high incidence of acute kidney injury (AKI), which is associated with mortality. The objective of the study was to determine the factors associated with AKI in patients with COVID-19.MethodologyA retrospective cohort was established in two university hospitals in Bogotá, Colombia. Adults hospitalized for more than 48 h from March 6, 2020, to March 31, 2021, with confirmed COVID-19 were included. The main outcome was to determine the factors associated with AKI in patients with COVID-19 and the secondary outcome was estimate the incidence of AKI during the 28 days following hospital admission.ResultsA total of 1584 patients were included: 60.4% were men, 738 (46.5%) developed AKI, 23.6% were classified as KDIGO 3, and 11.1% had renal replacement therapy. The risk factors for developing AKI during hospitalization were male sex (OR 2.28, 95% CI 1.73–2.99), age (OR 1.02, 95% CI 1.01–1.03), history of chronic kidney disease (CKD) (OR 3.61, 95% CI 2.03–6.42), High Blood Pressure (HBP) (OR 6.51, 95% CI 2.10–20.2), higher qSOFA score to the admission (OR 1.4, 95% CI 1.14–1.71), the use of vancomycin (OR 1.57, 95% CI 1.05–2.37), piperacillin/tazobactam (OR 1.67, 95% CI 1.2–2.31), and vasopressor support (CI 2.39, 95% CI 1.53–3.74). The gross hospital mortality for AKI was 45.5% versus 11.7% without AKI.ConclusionsThis cohort showed that male sex, age, history of HBP and CKD, presentation with elevated qSOFA, in-hospital use of nephrotoxic drugs and the requirement for vasopressor support were the main risk factors for developing AKI in patients hospitalized for COVID-19.

Cardiovascular disease incidence prediction by machine learning and statistical techniques: a 16-year cohort study from eastern Mediterranean region

BackgroundCardiovascular diseases (CVD) are the predominant cause of early death worldwide. Identification of people with a high risk of being affected by CVD is consequential in CVD prevention. This study adopts Machine Learning (ML) and statistical techniques to develop classification models for predicting the future occurrence of CVD events in a large sample of Iranians.MethodsWe used multiple prediction models and ML techniques with different abilities to analyze the large dataset of 5432 healthy people at the beginning of entrance into the Isfahan Cohort Study (ICS) (1990–2017). Bayesian additive regression trees enhanced with “missingness incorporated in attributes” (BARTm) was run on the dataset with 515 variables (336 variables without and the remaining with up to 90% missing values). In the other used classification algorithms, variables with more than 10% missing values were excluded, and MissForest imputes the missing values of the remaining 49 variables. We used Recursive Feature Elimination (RFE) to select the most contributing variables. Random oversampling technique, recommended cut-point by precision-recall curve, and relevant evaluation metrics were used for handling unbalancing in the binary response variable.ResultsThis study revealed that age, systolic blood pressure, fasting blood sugar, two-hour postprandial glucose, diabetes mellitus, history of heart disease, history of high blood pressure, and history of diabetes are the most contributing factors for predicting CVD incidence in the future. The main differences between the results of classification algorithms are due to the trade-off between sensitivity and specificity. Quadratic Discriminant Analysis (QDA) algorithm presents the highest accuracy (75.50 ± 0.08) but the minimum sensitivity (49.84 ± 0.25); In contrast, decision trees provide the lowest accuracy (51.95 ± 0.69) but the top sensitivity (82.52 ± 1.22). BARTm.90% resulted in 69.48 ± 0.28 accuracy and 54.00 ± 1.66 sensitivity without any preprocessing step.ConclusionsThis study confirmed that building a prediction model for CVD in each region is valuable for screening and primary prevention strategies in that specific region. Also, results showed that using conventional statistical models alongside ML algorithms makes it possible to take advantage of both techniques. Generally, QDA can accurately predict the future occurrence of CVD events with a fast (inference speed) and stable (confidence values) procedure. The combined ML and statistical algorithm of BARTm provide a flexible approach without any need for technical knowledge about assumptions and preprocessing steps of the prediction procedure.

Frequency of Factors Leading to Oligohydramnios in Patients Presenting to Women and Children Hospital, Dera Ismail Khan

Objective: To determine the frequency of factors leading to oligohydramnios in patients presenting to women and children hospital, Dera Ismail Khan. Materials and methods: This cross sectional study was conducted in obstetrics and gynecology department, Women and children teaching hospital Dera Ismail khan from 1 August, 2020 to 31 January, 2021, comprising 185 patients. Sampling technique used was convenient non-probability sampling. Factors leading to oligohydramnios (Primigravida, history of abortion, gestational age &gt; 40 weeks, history of UTI and history of high blood pressure) were noted as per operational definition and recorded on especially designed proforma. Result: A total of 185 pregnant women with oligohydramnios were included in the study. Factors leading to oligohydramnios (Primigravida, history of abortion, gestational age &gt; 40 weeks, history of UTI and history of high blood pressure) were noted. Age range in this study was from 18 to 35 years with mean age of 27.178±2.39 years and mean weight was 68.908±3.82 Kg. Factors leading to oligohydramnios were, primigravida 34.1%, History of Abortion 27%, gestational age &gt; 40 weeks 45.4%, history of UTI 15.7% and history of high blood pressure was 21.1%. Practical implication: This study will help the gynecologists in diagnosis and analysis of the oligohydramnios based on the risk factors discussed in this research. Conclusion: It can be concluded from our study that most common associated factors were primigravida, history of abortion, gestational age &gt; 40 weeks, history of UTI and history of high blood pressure. Keywords: Amniotic fluid, Gestation, Hypertension, Pregnancy, Oligohydramnios, Primigravida.

Risk factors of sudden cardiac death in women: A 10 years study in Tunisia

BackgroundSudden cardiac death (SCD) represents a frequent etiology of sudden death. It represents a major public health issue. Few data about SCD in women are available from the Arab world. Our work aimed to analyze the risk factors of sudden cardiac death in Tunisian women in comparison with men. MethodsA cross-sectional retrospective study including all sudden cardiac death cases, conducted in the Forensic Medicine Department of the main teaching hospital of Tunis, between January 2010 and December 2019. ResultsWe counted 417 cases of sudden cardiac death in women representing 17.5% of the total number of sudden cardiac deaths recorded during the study period. The average age was 60.03 ± 15.01 years with a predominance of urban married women. The most frequent cardiac risk factors were high blood pressure (50%), diabetes (36.2%), and cardiac disease history (34.2%). Predominately married women with a history of High blood pressure and diabetes, had a high predictive of sudden cardiac death. ConclusionCardiac sudden death is no longer a male focused issue. As a matter of facts Rates of SCD in women are rising with a different pattern. We will highlight the importance of adopting specific preventive measures of SCD in female.