Hypertensive Encephalopathy Research Articles

Childhood Hypertension: An Observational Study from a Tertiary Care Centre, Gujarat, India

Introduction: Childhood hypertension is an underestimated problem in India and other developing countries. It often leads to Hypertension in adult. Hypertensive children, although usually asymptomatic, already manifest evidence of target organ damage. Many of hypertensive children have left ventricular hypertrophy and increased carotid intima-media thickness, a marker of early atherosclerosis. Hypertensive children are very prone to develop target organ damage like retinopathy, renal damage, cardiac complications if remains undiagnosed and untreated for long. Other risk factors like cardiovascular disease, diabetes mellitus and hyperlipidaemia must also be looked for in hypertensive children. Aim: To study the prevalence, clinical profile, aetiology and to analyse various management protocol, complications, and early outcomes of hypertension in hospitalised children aged between 5-10 years. Materials and Methods: This was a prospective, observational analytical study conducted in the Department of Paediatrics of a Tertiary Care Centre at Ahmedabad, Gujarat, India, from 1st October 2017 to 30th September 2019. Blood pressure was measured by mercury sphygmomanometer using auscultatory method in all admitted patients in Paediatrics Department between the age of 5-10 years as a part of vital monitoring. A total of 103 patients having average systolic blood pressure and/or diastolic blood pressure greater than or equal to 95th percentile for that age, sex and height on three or more occasions were included in the study and their comprehensive details were recorded in prestructured proforma. The outcome was recorded as data in excel sheet and arranged in tables. Results: The prevalence of hypertension was 0.96%. The mean age of the study population was 8 years, and the male:female ratio was 1.09:1. Vomiting was the most common presenting complaint followed by fever and puffiness of eyes. A higher incidence of fever on presentation was due to the associated infective pathology of Central Nervous System (CNS). Pallor was the most common finding on general examination. Neurological deficit was observed in patients with hypertensive encephalopathy and stroke. Overall, 21 (20.38%) patients were in stage 2 hypertension, amounting to hypertensive emergencies, 48 (46.6%) patients with hypertension had an underlying renal disorder, followed by CNS disorder in 47 (45.6%). Amlodipine (26.21%) was the most common drug used in hypertensive patients. Most common complication of the present study was hypertensive retinopathy seen in 14 patients (13.59%). Conclusion: In hospitalised patients, the prevalence of hypertension was 0.96% with a male preponderance. On admission, the most prevalent complaints were vomiting and fever; pallor and puffiness of eyes were the most common general examination findings, and ascites was the most common systemic examination result. The most common secondary cause of hypertension was renal disease, with acute glomerulonephritis as most prevalent

Posterior reversible encephalopathy syndrome in spotted fever group of rickettsial infection with brugada syndrome

Rickettsioses are one of the common causes of undifferentiated febrile illness. Patients present commonly with fever, rash, and eschar. Posterior Reversible Encephalopathy Syndrome (PRES) also known as reversible posterior encephalopathy syndrome is a rare condition, in which parts of the brain are affected by swelling as a result of an underlying cause such as infection. However, PRES caused by spotted fever group of rickettsiosis is rarely reported. We are here with reporting such a case. A 55-year-old male was admitted to MVJ Medical College and Research Hospital, Bengaluru, with complaints of fever for 3 days and one episode of Generalized Tonic Clonic Seizures (GTCS) following which he was in altered sensorium. On examination, there was hepatosplenomegaly. Weil-Felix OX19 and OX2 were 1:320. Lumbar puncture was done which showed 15 cells 98% lymphocytes and 2% neutrophils, proteins-119 mg/dl, and sugar- 153 mg/dl. Magnetic resonance imaging of the brain showed bilateral symmetric hyperintensities on T2-weighted imaging in the parietal and occipital lobes. The calcarine and occipital lobes were spared suggestive of posterior reversible encephalopathy syndrome. Electrocardiogram showed ST elevation in V1 and V2 along with T-wave inversion (Brugada sign). Posterior reversible encephalopathy syndrome is usually commonly seen in hypertensive encephalopathy and in infections such as dengue and few cases of scrub typhus. This is one of the rare cases where spotted fever group of rickettsia has caused posterior reversible encephalopathy syndrome and Brugada syndrome.

Young Psychiatrist Award

Background:The treatment in organic catatonia includes benzodiazepines, ECT and treatment of underlying condition. In a pilot study1, Lorazepam produced sedation, hypotension and respiratory depression. Tofisopam, (FDA approved for IBS2) was safe and effective which can be a treatment alternative. This study was designed to study the efficacy and adverse effects of Tofisopam in organic catatonia.Materials and Methods:This study included 60 patients irrespective of age and gender with diagnosis of Organic Catatonia (F061, ICD-10). Patients with Delirium, Psychiatric illness and SUD were excluded. Busch Francis Catatonia Rating Scale (BFCRS) was used to assess the features of catatonia at baseline and at 48 to 72 hours. Tofisopam 50-100mg/day was administered. Changes in BP, RR, spO2 and GCS was noted. Paired T test, Chi square test, Pearson’s correlation and SPSS 17 was used.Results and Discussion:The mean age was 54.27 ± 16.5 years with 46 males and 14 females. The mean baseline score in BFCRS was 11.73+-1.31. Out of 60 patients, 44 (71%) had response. Response was defined as reduction of catatonic signs to 1 or none on 14 item BFCRS3. Response occurred in CKD, Parkinsonism, Hypertensive encephalopathy, post-CABG and post-GI surgery patients. No response occurred in Septicemia, CKD with Multi-organ Failure. The domains with significant response were Stupor, Mutism, Staring, Posturing, Rigidity, Negativism and Withdrawal without significant side-effects. Tofisopam (mixed dopamine agonist- antagonist)4 modulates the hypo-dopaminergic state in catatonia. Its non-sedative, non-hypotensive5 property can explain the added advantage over lorazepam.Conclusion:Tofisopam can be a safe and effective alternative treatment in Organic Catatonia.

НЕЙРОПСИХОЛОГИЧЕСКИЙ ПРОФИЛЬ У ПАЦИЕНТОВ С ГИПЕРТОНИЧЕСКОЙ ЭНЦЕФАЛОПАТИЕЙ НА ФОНЕ РЕЗИСТЕНТНОЙ АРТЕРИАЛЬНОЙ ГИПЕРТОНИИ

Objective: To assess the severity of CI in relation to the level of RDR to antihypertensive therapy in patients with primary arterial hypertension (AH) and the features of CI on the background of RAH. Methods: A complex of modern clinical, hemodynamic and neuropsychological methods was used to assess RDR to treatment and the severity of CI in groups of patients with high and very high RDR to treatment: the group I – with controlled arterial hypertension (CAH; n=40), the group II – with RAH (n=35). Results: When screening for CI on the Montreal Cognitive Assessment (MoCA) scale, a decrease in the average number of various domains of cognitive function in patients with CAH was found against the background of increased RDR to treatment compared with RAH. The results of the neurodynamic analysis of cognitive function in the Trail Making Test (TMT) indicate the relative sustain of selective attention and information processing speed. However, the established increase in the difference between the part B and part A performance in patients with AH demonstrated a decline in flexible thinking, cognitive control, and programming. The results of the study of regulatory functions showed that frontal dysfunction was observed more often in patients of group II, although the difference was statistically insignificant (p>0.05). Based on the results of speech studies, along with the results of memory impairment testing in the Clock Drawing (CDT) and Free and Cued Selective Reminding – Immediate Recall (FCSRT-IR) tests, a more pronounced decline of semantic memory was found in patients with RAH, indicating the possibility of memory impairment not only due to secondary neurodynamic changes but also due to the neurodegenerative processes. Conclusion: A significant decrease in semantic memory in patients with RAH suggests the possibility of the transformation of cerebral vascular lesions into neurodegenerative ones or their combination. Keywords: Neuropsychological profile, cognitive impairment, hypertensive encephalopathy, risk of developing resistance to treatment, resistant arterial hypertension.

Thiamine-responsive, life-threatening, pulmonary hypertensive crisis with encephalopathy in young infants: A case series.

Thiamine (Vitamin B1) deficiency (TD), although reduced in incidence, is still seen in infants. We describe a rarely reported form of infantile TD with life-threatening pulmonary hypertensive crisis and severe encephalopathy, with dramatic response to thiamine supplementation. Study design: Descriptive case series. Six young infants with mean age 76 days (range 1-3 months), manifesting rapidly progressive encephalopathy and cardio-pulmonary arrest were included. All infants underwent cardiac, neuroimaging and metabolic evaluations. All six infants had similar presentation with severe pulmonary arterial hypertension (PAH), hypotensive shock, metabolic acidosis and severe encephalopathy. All infants were exclusively breast-fed. Thiamine treatmwnt resulted in dramatic improvement in haemodynamic and neurological function in all the infants. There were no major neurological deficits on follow up. A high index of suspicion is warranted for this rarely described form of TD, as early identification helps in preventing mortality and morbidity.

Clinical, imaging spectrum and outcome of PRES

Background: Posterior reversible encephalopathy syndrome (PRES), also called the acute hypertensive encephalopathy and reversible leukoencephalopathy syndrome (RPLS), is a clinico-radiological syndrome presents with rapid onset of headache, seizures, loss of consciousness, visual loss and characterized by white matter vasogenic edema affecting parietal and occipital lobes of the brain predominantly. However, the imaging findings are variable and may occur in other locations such as the frontal lobes, thalami, basal ganglia and brainstem. Objective: To study the clinical, imaging spectrum and final disease outcome of PRES Materials And Methods: The study was conducted on 52 patients who presented with clinical features and radiological diagnosis of PRES The clinical, imaging features and outcome of each patient were analyzed Results: The study was conducted on 52 patients with age range from below 10yrs to 65 yrs. Patients presented with various symptoms of which seizures(84.6%) is most common followed by headache(59.6%), vomiting (36.5%), visual disturbances(32.7%), altered sensorium(15.3%), thalamic aphasia (5.7%), hemiparesis(3.8%), paresthesia(3.8%), ataxia(3.8%), Quadriparesis (3.8%) and facial numbness (1.9%) is the least. On MR imaging typical parieto-occipital lobe involvement(98%)is seen in most of the cases, however other atypical regions involved were frontal lobe(52%),temporal lobe (17.3%), cerebellum (27%),thalamus (15.3%), brainstem (13.4%), basal ganglia (9.6%) and corpus callosum (1.9%) Lesions in atypical locations also had lesions in typical locations in all cases except in one case of central PRES. Dominant parieto-occipital pattern was seen in 32%,superior frontal sulcus pattern in 27%,holohemispheric pattern in 34.6%,Partial or asymmetric expression of primary patterns in 5.2% cases Diffusion restriction and postcontrast enhancement was seen in less than 25% cases. Complete resolution of symptoms was seen in 90.5% cases,3.8% of them succumbed to death. On follow up 5.7% of cases showed persistence of symptoms. Conclusion: PRES is a clinico-radiological syndrome with varied clinical and imaging spectrum. Involvement of atypical regions is not uncommon. However lesions in atypical locations often have lesions in typical locations also.Atypical imaging features like restricted diffusion and contrast enhancement are also not uncommon. Knowledge of atypical lesion location, atypical imaging features is necessary for the clinicians and radiologists not to misdiagnose PRES in the appropriate clinical setting

Porto-Sinusoidal Vascular Disease and Focal Nodular Hyperplasia-like Nodules in a Patient with Neurofibromatosis and Non-Cirrhotic Portal Hypertension

Abstract Introduction/Objective Non-cirrhotic portal hypertension (NCPH) is uncommon. The underlying pathophysiology appears to lie at the level of intrahepatic portal veins and sinusoids, hence the term “porto-sinusoidal vascular disease” (PSVD). We report a rare case of PSVD with focal nodular hyperplasia (FNH)-like nodules in a patient with neurofibromatosis type 2 (NF2). Methods/Case Report A 57-year-old male with NF2 and type 2 diabetes, presented with a large variceal bleed requiring blood transfusion and subsequent transjugular intrahepatic portosystemic shunt (TIPS). Imaging showed a nodular liver, presumed to be cirrhosis due to non-alcoholic liver disease. Liver biopsy was not done. Thereafter, he had several episodes of hepatic encephalopathy and TIPS was downsized to prevent recurrences. The patient required liver transplantation for intractable portal hypertension and severe hepatic encephalopathy; his liver synthetic function was near normal and MELD was 11. Portal vein was patent. The explanted liver was micronodular, soft and weighed 946 grams. Unencapsulated nodules, a few mm to 1 cm in size, were present. Microscopically, there was diffuse nodularity in the absence of bridging fibrosis. Thin, incomplete curvilinear fibrous septa were present. There were aberrant veins, hypervascular portal tracts, herniated portal veins and rare occluded portal veins. Trichrome and reticulin stains confirmed architectural abnormalities including nodularity, lack of bridging fibrosis and approximation of portal tracts. Immunohistochemistry for glutamine synthetase accentuated architectural distortion and revealed nodules with FNH-like geographic areas of staining. Results (if a Case Study enter NA) NA Conclusion This is a rare case of NCPH due to PSVD in a patient with NF2. Microscopy suggested incomplete septal cirrhosis (ISC), a pattern associated with both PSVD and regression of fibrosis in a cirrhotic liver. Isolated portal hypertension without loss of synthetic function favors primary PSVD over regression of fibrosis. FNH-like nodules are consistent with regenerative changes caused by localized abnormalities of blood flow.

50 Years Ago in TheJournalofPediatrics: The Search for Safe and Effective Treatment of Acute Severe Hypertension in Childhood

McLaine PN, Drummond KN. Intravenous diazoxide for severe hypertension in childhood. J Pediatr 1971;79:829-32. Children with acute presentations of severe hypertension require prompt therapy to avoid end-organ effects of uncontrolled hypertension such as hypertensive encephalopathy. Usually, an intravenous antihypertensive agent is preferred, given their more rapid onset of action compared with oral medications. No matter what agent is chosen, a major concern in treating such patients is to avoid rapid hypotension, which can lead to cerebral ischemia, especially in those with chronic hypertension. McLaine and Drummond provide one of the first descriptions of using an intravenously administered drug for children with acute severe hypertension. They gave bolus doses of diazoxide, a potassium channel activator, to 16 children aged 16 days to 16 years with severe hypertension, defined as blood pressure (BP) >140/90 mm Hg. The children all had hypertension secondary to kidney disease, and many were receiving other antihypertensive agents. Reduction of mean arterial pressure occurred within 10 minutes, with reductions of 25%-35% or more of pretreatment BP levels. Although this effect would be considered excessive according to current recommendations,1Seeman T. Hamdani G. Mitsnefes M. Hypertensive crisis in children and adolescents.Pediatr Nephrol. 2019; 34: 2523-2537Crossref PubMed Scopus (25) Google Scholar the authors reported no side effects, even though in 3 patients, the diastolic BP briefly dropped to zero! Today, intravenous diazoxide is no longer in use for the treatment of acute severe hypertension—clinicians have recognized that its use is riskier than other agents such as labetalol or hydralazine. However, even these agents have safety concerns. For example, in our analysis of the use of intravenous hydralazine in hospitalized children with acute hypertension,2Flynn J.T. Bradford M.C. Harvey E.M. Intravenous hydralazine in hospitalized children and adolescents with hypertension.J Pediatr. 2016; 168: 88-92Abstract Full Text Full Text PDF PubMed Scopus (9) Google Scholar approximately 30% of doses resulted in drops of mean arterial pressure that exceeded the current recommendation of no greater than a 25% reduction.1Seeman T. Hamdani G. Mitsnefes M. Hypertensive crisis in children and adolescents.Pediatr Nephrol. 2019; 34: 2523-2537Crossref PubMed Scopus (25) Google Scholar So, the search for safe and effective treatment of acute severe hypertension in childhood continues. In the absence of prospective clinical trials in this patient population, we can at least apply the findings of pioneers like McLaine and Drummond to improve patient safety and avoid untoward outcomes.

Pediatric adrenocortical tumors cohort characteristics and long-term follow-up at a single Argentinian tertiary center.

To report clinical, biochemical, and histological features, staging, and therapeutic interventions in a cohort of 28 patients treated at a single tertiary center. A retrospective review of medical records of children with PACT (diagnosed before <18 years of age) followed between 1987-2018 at Hospital de Pediatría Garrahan, Buenos Aires, Argentina. Mean age at diagnosis was 4.6 years (range, 0.3-17.3 years) and median follow-up was 4.17 years (range, 0-12 years). Female to male ratio was 2.5:1. Signs and symptoms that prompted medical intervention were hormonal overproduction (57%), abdominal complaints (36%), and hypertensive encephalopathy (7%). In patients with clinically virilizing tumors (n=16) mean height standard deviation score (SDS) and bone age advance were significantly higher while body mass index (BMI) SDS was significantly lower than in those with clinical Cushing's (n=10) (p<0.05). Serum dehydroepiandrosterone sulfate (DHEAS) levels were significantly higher in stage IV than in stage I (p=0.03). Total adrenalectomy was performed in 26 patients. Eight patients (stage III-IV) received adjuvant chemotherapy. Five-year overall and disease-free survival were 100% for ST I-II, and 51% (95%CI 21-82) and 33% (95% CI 1.2-65) for ST III-IV, respectively (p=0.002). No statistical difference was found when comparing 2-year parameters with and without adjuvant chemotherapy. Height SDS and BMI SDS seem to mirror hormonal secretion in pediatric adrenocortical tumors. Higher DHEAS levels were found in patients with more advanced disease. Further large-scale studies are needed to validate a possible role for DHEAS as a biochemical marker of tumor stage and to draw robust conclusions on the use of adjuvant chemotherapy.

O23 A series of catastrophic events

Case report - IntroductionCatastrophic antiphospholipid syndrome (CAPS) is a rare, life-threatening disease occurring in up to 1% of antiphospholipid syndrome (APS) cases. It was first defined in 1992 and remains a difficult to treat entity with a mortality rate of 37%. We describe a patient with systemic lupus erythematosus (SLE) and CAPS presenting with simultaneous multi-organ injuries who was successfully managed with ‘triple’ therapy including cyclophosphamide.Case report - Case descriptionA 42-year-old female presented to her local hospital with chest pain and worsening vision. She had a background of SLE, triple antibody-positive APS (previous DVT, pregnancy loss and strokes), hypertension, a metallic mitral valve, a previous myocardial infarction and pre-existing visual impairment due to a prior intra-cerebral bleed related to anticoagulation. Examination revealed a faint malar rash, cortical blindness and long tract neurological signs. Her ECG showed ischaemic changes and the admission troponin was significantly raised (3773ng/L). An echocardiogram showed new left ventricular dysfunction and a subsequent cardiac MRI was in keeping with coronary artery disease. Investigations showed an acute kidney injury, newly deranged liver function tests and a raised INR (>11, with no bleeding). Complement was normal with a low dsDNA titre. Urinalysis revealed proteinuria and a protein creatinine ratio measured 176mg/mmol. MRI diffusion weighted brain imaging showed acute bilateral occipital and left fronto-parietal infarcts. She had symptoms of a lupus flare with arthralgia and a butterfly facial rash. COVID-19 PCR tests were negative and she had not been recently vaccinated. She was diagnosed with CAPS and transferred to St Thomas’ hospital intensive care.On arrival, she received 1mg intravenous vitamin K followed by triple therapy for CAPS: an unfractionated heparin infusion, oral prednisolone 40mg daily, 5 days of plasma exchange and, given her background of SLE, she was treated with intravenous cyclophosphamide (according to the EUROLUPUS regimen). Intravenous methylprednisolone was avoided due to a previous hypertensive encephalopathy reaction. She responded rapidly. Her troponin fell from a peak of 5054 to 294ng/L, her creatinine settled at a new baseline (232umol/L) and her liver function normalised. She was switched back to warfarin due to her metallic valve and started on aspirin for cardiovascular secondary prevention. She required physical and occupational therapy due to her strokes but recovered well.Case report - DiscussionAccording to the 2003 criteria, CAPS can be classified as definite when there is evidence of: ≥3 organs involved, development of manifestations simultaneously or within a week, confirmation by imaging and/or histopathology of small vessel occlusion and positive antiphospholipid antibodies. Probable CAPS is when 3 out of the 4 criteria are present. In this case, three organs were confirmed to be involved with imaging showing cerebral and cardiac ischaemia. Her creatinine rose from a base of 190 to 289umol/L coupled with a high protein creatinine ratio confirming renal involvement. A Budd-Chiari syndrome was also suspected due to deranged liver function tests and INR, though imaging performed after therapy did not confirm this. A biopsy of any of these four organs was not feasible given the severity of her presentation and coagulopathy. There are no randomised controlled trials but data from the CAPS registry guides treatment and management follows a logical approach: anticoagulation to treat thrombosis, glucocorticoids for inflammation and plasma exchange (or IVIG) to remove the circulating autoantibodies. Triple therapy was associated with a reduced mortality compared to no treatment (28.6% versus 75%, respectively).Following analyses from the CAPS registry we also chose to treat with cyclophosphamide, which is associated with improved survival in patients with SLE. This decision was based on the clinical features of an SLE flare as opposed to serological grounds. There have been reports of rituximab and eculizumab being used successfully in CAPS, though generally as a last resort. As complement activation is seen in animal models of antiphospholipid syndrome thrombosis and rituximab is often used in refractory SLE, they may prove to be promising agents for refractory CAPS.Case report - Key learning pointsPrompt recognition and early treatment is vital in managing CAPSTriple therapy with anticoagulation, glucocorticoids and plasma exchange / IVIG is associated with better survival in CAPSCyclophosphamide is associated with better survival in patients with CAPS and concomitant SLE

Overview of Scleroderma Renal Crisis - A Review

Scleroderma renal crisis is a life-threatening condition. It usually starts with a sudden onset of severe hypertension, followed by renal failure, hypertensive encephalopathy, congestive heart failure, and/or microangiopathic hemolytic anemia. Renal ischemia, hyperplasia of the juxtaglomerular apparatus, activation of the renin-angiotensin-aldosterone system (RAAS), and an increase in blood pressure are caused by decreased blood flow caused by structural changes in the blood vessels as well as renal vasospasm ("Raynaud's phenomenon"). This overview discusses the evaluation, diagnosis, and treatment of scleroderma renal crisis, emphasizing the importance of early detection of disease, strong correlation of corticosteroids intake and the disease incidence, and best approach of such cases.

Posterior reversible encephalopathy syndrome with spinal cord involvement

Posterior reversible encephalopathy syndrome (PRES) is an heterogeneous syndrome with the neurologic symptoms of hypertensive encephalopathy. In the majority of cases has typical MRI radiological landmark corresponding to edema that is classically parieto-occipital. Rare are the form with spinal cord involvement (PRES-SCI).

Склеродермический почечный криз: вопросы патогенеза, клиника и современные подходы к лечению

Склеродермический почечный криз (СПК) является одним из самых тяжелых осложнений у пациентов с системной склеродермией (ССД). СПК возникает примерно у 5–25 % пациентов, страдающих склеродермией. Он характеризуется злокачественной гипертензией и олиго-/анурической острой почечной недостаточностью. Около 10 % случаев СПК могут сопровождаться нормальным артериальным давлением — это так называемый нормотензивный почечный кризис. Предполагается, что этиопатогенез СПК обусловлен повреждением почек, что приводит к поражению эндотелия, пролиферации интимы и сужению почечных артериол, вызывая снижение кровотока, гиперплазию юкстагломерулярного аппарата, гиперренинемию и развитие злокачественной артериальной гипертензии. Развитие СПК у пациентов с ССД часто провоцируется нефротоксичными препаратами или уменьшением внутрисосудистого объема крови. СПК наиболее часто встречается в первые годы развития склеродермии и при диффузной ее форме. Появление СПК чаще встречается у пациентов, получающих глюкокортикоиды, риск увеличивается с увеличением дозы. Характерные также такие клинические признаки, как левожелудочковая сердечная недостаточность и гипертоническая энцефалопатия. Тромботическая микроангиопатия появляется в 43 % случаев СПК. Антитела к РНК-полимеразе III присутствуют у одной трети больных, у которых развился СПК. При классическом течении СПК проведение нефробиопсии не рекомендуется. Однако этот метод исследования может помочь определить прогноз и методы лечения при нетипичных формах. Прогноз СПК резко улучшился с использованием ингибиторов ангиотензинпревращающего фермента. Однако выживаемость в течение 5 лет у пациентов с СПК остается низкой (65 %). Лечение СПК опирается на агрессивный контроль артериального давления с помощью ингибиторов ангиотензинпревращающего фермента, если необходимо сочетание с другими видами антигипертензивных препаратов. Довольно часто больные нуждаются в проведении гемодиализа, но при контроле артериального давления он может быть прекращен. Пациентам, которым необходим диализ более 2 лет, показана трансплантация почек. СПК остается важной причиной заболеваемости и смертности при склеродермии. Быстрая диагностика и лечение могут помочь предотвратить неблагоприятные последствия и улучшить выживание таких пациентов.

Хронічна ішемія мозку у хворих з артеріальною гіпертензією та гіпотиреозом

Розглядаються питання патогенезу хронічної ішемії мозку у хворих з артеріальною гіпертензією та гіпотиреозом. Наведено приклади деяких результатів власних досліджень авторів. За результатами досліджень, у пацієнтів із гіпертонічною дисциркуляторною енцефалопатією та гіпотиреозом відзначаються погіршення кровопостачання головного мозку за рахунок зменшення реактивності судинної стінки, зниження функціональної активності головного мозку, погіршення когнітивних функцій та підвищення рівня тривожності та депресії.

Posterior Reversible Encepalopathy Syndrome in A Child With Post Streptococcal Glomerulonephritis- A Rare Case Report

Posterior reversible encephalopathy syndrome is a condition occurring in majority of case of hypertensive encephalopathy mainly due to vasogenic edema in parieto occipital region in neuroimaging. It is reversible if timely treatment is done .Here we are reporting a 11 year old female child with acute post streptococal glomerulonephrtitis leading to typical clinical and radiological features of posterior reversible encephalopathy syndrome

Severity of neurological signs in feline hypertensive encephalopathy may be reflected through brain histopathological lesions

AbstractHypertensive encephalopathy (HE) was diagnosed in two aged cats with chronic kidney disease. The cause for admission was generalised epileptic seizures, with severe, interictal neurological dysfunction (dementia, locomotor dysfunction, cranial nerve deficits). Both cats had systolic hypertension (SH) (180‐220 mm Hg), bilateral retinal detachment, non‐regenerative anaemia and moderate renal azotaemia. Both cats died. Gross lesions were apparent in one cat consisting of white matter oedema in the parietal and temporal lobe and a focal area of malacia. Histopathological examination of brain tissue revealed bilateral severe oedema and astrocytic gliosis in the corona radiata, basal nuclei, thalamus and piriform lobe of both cats. Extensive hyaline and hyperplastic arteriolosclerosis, perivascular plasma exudation and haemorrhages were present throughout the meninges and neuroparenchyma. Histopathological findings reflected the severity of neurological deficits. This could indicate that the severity of the brain lesions is associated with the neurological manifestations of HE.

Clinical and neuroimaging signs of cerebral venous thrombosis in patients with hypertensive dyscirculatory encephalopathy

Clinical and neuroimaging signs of cerebral venous thrombosis in patients with hypertensive dyscirculatory encephalopathy

The Widow Maker: A National Inpatient Sample Study of Health Care Utilization Costs for Cardiovascular Complications Patients Diagnosed with Non-Hodgkin's Lymphoma from 2000-2014

Background:Combination chemotherapy has improved the prognosis of DLBCL but has the potential for cardiovascular toxicity that can contribute to long-term morbidity and mortality. There is limited literature assessing the health care utilization costs for cardiovascular outcomes in patients diagnosed with non Hodgkin Lymphoma (NHL). We conducted this study to evaluate trends in hospital cost, length of stay, complication rates, and in-hospital mortality in adult patients diagnosed with non-Hodgkin lymphomas admitted for cardiovascular complications.Methods:We conducted a population-based study from the Nationwide Inpatient Sample (NIS). All adult admissions with a diagnosis of NHL from 2000-2014 were identified using ICD-9 codes. A priori outcome measures were left heart failure, atrial or ventricular arrhythmias, malignant or accelerated hypertension, hypertensive encephalopathy, and aortic dissection. Total cost was adjusted for inflation using data from the U.S. Bureau of Labor Statistics. Logistic regression was used to compare rates of cardiovascular complications and mortality, cost, and length of stay between patients with NHL the general cardiovascular admissions (GCV), and between teaching and non-teaching hospitals.Results:Data were available for 9711761 hospitalized adults, of which 9711761 comprised the NHL group. The incidence of hospitalization for cardiovascular complications was 2.8 (OR = 2.78, 95% confidence interval [CI] 2.48+/-3.16) times higher in the NHL group than the general cardiovascular admissions (GCV) (58.7% versus 20.9%, P=0.005). Patients with Non Hodgkins lymphoma were 2.8 times more likely to be seen in the ED and admitted with cardiovascular complications than GCV patients (7,112,300 in the NHL group vs. 2,599,450 GCV group p< .005). Cardiovascular death was also twice as common in the NHL group (OR 2.2 95% confidence interval [CI] 1.9-3.6, 28.45% versus 19.54, P= 0.014). Risk factors for death included age ≥ 70 years (OR = 2.1, 95% confidence interval [CI] 1.4-3.0), male sex (OR=2.4, 95%CI 1.6-3.3) Caucasian race (OR=2.3, 95%CI 1.8-3.1), and admission at a teaching hospital (OR=1.67, 95%CI 1.2-2.4), average length of stay (4.8 days versus 2.3 days per 100 patients, p< 0.023) and total hospital cost ($960,554, 4206±45206 versus $479,167 ±19672, p = .002) were significantly higher in NHL patients than GCV patients. The leading cause of mortality was ventricular arrhythmias (88,350 death in the NHL group and 36,530 deaths in the GCV group). Rates for atrial arrhythmias, heart failure, acute myocardial infarction and accelerated hypertension were similar in both groups.Conclusions: There is a high rate of cardiovascular morbidity in NHL patients and survivors, which contributes hospitalization, cost, and increased morbidity and mortality. This large population based study identifies a need for cardiovascular screening and risk reduction strategies after treatment for NHL. DisclosuresNo relevant conflicts of interest to declare.

Influence of Hypothermia and Cell Therapy on Structural Changes in Brain Tissues of Rats with Dyscirculatory Encephalopathy of Mixed Genesis

The study examines the morphological changes that occur in brain of SHR rats on the background of developing hypertensive dyscirculatory encephalopathy (DE), complicated by chronic alcohol intoxication (CAI). CAI has been proven to potentiate the progressive aging of brain in rats with hypertensive DE by aggravating its course and to lead to the development of DE of mixed genesis. The effectiveness of a single and combined use of rhythmic craniocerebral hypothermia (rCCH) and the introduction of cryopreserved cord blood nucleated cells (cCBNCs) to reduce the progressive vascular lesions of brain and the effects of chronic ischemia in animals with DE of mixed genesis. It has been proven that the combined use of rCCH and cCBNCs in the rats with a mixed DE had a more pronounced positive effect on morphological structure of brain tissues and vessels than their single use. There was a further decrease in the signs of dystrophic, destructive and pathologically altered compensatory adaptive processes in brain on the background of a significant decrease in neuroglial index, stimulation of angiogenesis, complete or partial absence of signs of smooth muscle cell hyperplasia, acute hemorrhages and ischemic strokes, spasms of arterial vessels’ walls and plethory in veins, that contributed to restoration of brain microhemocirculation and cytoarchitectonics.

Development and Validation of a Prognostic Model for One-year Survival of Cirrhosis Patients with First-ever Spontaneous Bacterial Peritonitis.

Background and AimsSpontaneous bacterial peritonitis (SBP) is one of the leading causes of death in patients with liver cirrhosis. We aimed to establish a prognostic model to evaluate the 1-year survival of cirrhosis patients after the first episode of SBP.MethodsA prognostic model was developed based on a retrospective derivation cohort of 309 cirrhosis patients with first-ever SBP and was validated in a separate validation cohort of 141 patients. We used Uno’s concordance, calibration curve, and decision curve (DCA) analysis to evaluate the discrimination, calibration, and clinical net benefit of the model.ResultsA total of 59 (19.1%) patients in the derivation cohort and 42 (29.8%) patients in the validation cohort died over the course of 1 year. A prognostic model in nomogram form was developed with predictors including age [hazard ratio (HR): 1.25; 95% confidence interval (CI): 0.92–1.71], total serum bilirubin (HR: 1.66; 95% CI: 1.28–2.14), serum sodium (HR: 0.94; 95% CI: 0.90–0.98), history of hypertension (HR: 2.52; 95% CI: 1.44–4.41) and hepatic encephalopathy (HR: 2.06; 95% CI: 1.13–3.73). The nomogram had a higher concordance (0.79) compared with the model end-stage liver disease (0.67) or Child-Turcotte-Pugh (0.71) score. The nomogram also showed acceptable calibration (calibration slope, 1.12; Bier score, 0.15±0.21) and optimal clinical net benefit in the validation cohort.ConclusionsThis prediction model developed based on characteristics of first-ever SBP patients may benefit the prediction of patients’ 1-year survival.