Arterial Blood Pressure Levels Research Articles

Effects of Pharmacist-Led Interventions Regarding Adult Patients with Type 2 Diabetes Mellitus in Mexico: A Systematic Review.

In Mexico, type 2 diabetes mellitus (T2DM) is a serious public health concern. As experts in drug therapy, pharmacists are essential additions to multidisciplinary diabetes patient care teams. There have been no systematic reviews or meta-analyses performed on pharmacist-led interventions (PIs) in Mexico; therefore, the impact of PIs on patients remains poorly explored. An electronic search of the PubMed, SciELO and BVS databases and certain institutional repositories was conducted in English and Spanish through 24 August 2021 with a subsequent update through June 2024. A total of 1302 potentially relevant studies were identified in the initial search, of which nine met the eligibility criteria and were included in this systematic review. The results suggest that PIs, such as pharmacotherapeutic follow-up and patient education, may have positive effects on outcomes in Mexican patients with T2DM. PIs led to significant reductions in glycosylated hemoglobin, fasting blood glucose, triglycerides, total cholesterol, LDL cholesterol and arterial blood pressure levels, general reductions in body mass index and negative outcomes associated with medication, as well as significant improvements in therapeutic adherence and patient knowledge in the intervention group during follow-up periods of 3-12 months. Further well-designed research, including controlled studies with adequate sample sizes and standardized tools, is essential to fully understand the effects of PIs regarding patients with T2DM in Mexico.

Lack of Acute Agomelatine Effect in a Model of Social Anxiety in Healthy Volunteers: A Double-Blind, Placebo-Controlled Trial.

Agomelatine is an antidepressant drug that acts as an agonist of melatoninergic MT1/2 receptors and an antagonist of serotonergic 5-HT2C receptors. Studies suggest that agomelatine has anxiolytic properties in social anxiety, but there are no studies that assessed the effects of this compound in human experimental anxiety induced by a public speaking test. The objective of our investigation was to assess the effects of agomelatine on human experimental anxiety using the Simulation Public Speaking Test (SPST). Agomelatine (25 mg, n = 14), citalopram (20 mg, n = 14), venlafaxine (75 mg, n = 14), or placebo (n = 14) were administered in single doses to healthy volunteers in a double-blind study. Subjective anxiety was assessed with the Visual Analogue Mood Scale. Arterial blood pressure, heart rate, and blood levels of prolactin and cortisol were also recorded, as well as plasma levels of the 3 drugs. The SPST induced significant subjective, physiological, and hormonal effects in all groups. The SPST also increased the anxiety and decreased mental sedation Visual Analogue Mood Scale factors during the anticipatory and performance phases of the test. Citalopram increased anxiety during the test in females, whereas agomelatine and venlafaxine were not different from placebo. Confirming previous results, a serotonin selective reuptake inhibitor, citalopram, caused an anxiogenic effect in the SPST only in females. Acute administration of a low dose of agomelatine failed to modify the behavioral and physiological changes caused by this test. Future studies using higher doses and repeated administration should investigate if agomelatine behavioral and physiological effects could be detected in human experimental anxiety models.

The Impact of Intraoperative Hyperlactatemia on Weaning from Cardiopulmonary Bypass in Patients Undergoing on-Pump Coronary Artery Bypass Grafting Surgery: An Observational Study

Abstract Background: Hyperlactatemia after cardiac surgery is common. However, the association and the implications of hyperlactatemia on the prognosis after cardiopulmonary bypass (CPB) remains controversial. This study investigated the associations between early-onset hyperlactatemia and the need for doses of inotropes and vasopressors during weaning from CPB, hemodynamic stability after weaning from CPB, and the duration of postoperative mechanical ventilation. Patients and Methods: This prospective cohort study included 300 patients who underwent elective on-pump coronary artery bypass grafting (CABG) surgery and had normal systolic function >55%. Serum lactate levels were measured 1 h before induction, upon initiation of CPB, after removal of aortic cannula and on admission to the intensive care unit (ICU). Patients were divided into two groups: patients with lactate levels <4 mmol/L (Group N) and those with lactate levels ≥4 mmol/L (Group H). Results: Patients with hyperlactatemia constituted 20.7% of the study population. The number of patients who required adrenaline and noradrenaline administration upon weaning from CPB, as well as the doses of these drugs, were significantly higher in Group H (P < 0.001). Arterial blood pressure levels after weaning from CPB and upon admission to the ICU were significantly lower in Group H patients (P < 0.001). The duration of post-operative mechanical ventilation was longer in Group H patients (P < 0.001). Conclusion: Early-onset hyperlactatemia was associated with worse outcomes after CABG surgery. There was difficult weaning from CPB with increased inotrope and vasopressor drug support, early post-operative hemodynamic instability, and a prolonged duration of post-operative mechanical ventilation.

An Update on Pharmacologic Management of Neonatal Hypotension: When, Why, and Which Medication.

Anti-hypotensive treatment, which includes dopamine, dobutamine, epinephrine, norepinephrine, milrinone, vasopressin, terlipressin, levosimendan, and glucocorticoids, is a long-established intervention in neonates with arterial hypotension (AH). However, there are still gaps in knowledge and issues that need clarification. The main questions and challenges that neonatologists face relate to the reference ranges of arterial blood pressure in presumably healthy neonates in relation to gestational and postnatal age; the arterial blood pressure level that potentially affects perfusion of critical organs; the incorporation of targeted echocardiography and near-infrared spectroscopy for assessing heart function and cerebral perfusion in clinical practice; the indication, timing, and choice of medication for each individual patient; the limited randomized clinical trials in neonates with sometimes conflicting results; and the sparse data regarding the potential effect of early hypotension or anti-hypotensive medications on long-term neurodevelopment. In this review, after a short review of AH definitions used in neonates and existing data on pathophysiology of AH, we discuss currently available data on pharmacokinetic and hemodynamic effects, as well as the effectiveness and safety of anti-hypotensive medications in neonates. In addition, data on the comparisons between anti-hypotensive medications and current suggestions for the main indications of each medication are discussed.

Predictors of cardiovascular and renal complications in patients with resistant arterial hypertension during long-term follow-up

The aim – to evaluate the incidence of cardiovascular and renal complications and its predictors in resistant hypertensive (RH) patients during the long-term follow-up.Materials and methods. The frequency of cardiovascular and renal events was studied in 240 true resistant hypertensive patients. The duration of observation was 5.1±0.1 years. The comparison group consisted of 228 patients with controlled arterial hypertension (CAH) on a triple combination antihypertensive therapy. Cardiovascular endpoints included stroke/transient ischemic attack, myocardial infarction, cardiovascular death, myocardial revascularization, development of atrial fibrillation, hospitalization due to heart failure, and lower limb arterial disease. Kidney outcomes included dialysis or GFR decline by 40 % or greater. All the endpoints formed a composite primary endpoint. New cases of type 2 diabetes mellitus were also estimated.Results and discussion. The patients with resistant hypertension on multi-component antihypertensive therapy and significant reduction in arterial blood pressure (BP) levels (achievement of controlled office BP in 49.6 % of patients, office and ambulatory BP in 34.2 % of patients), maintained a higher risk of cardiovascular and renal events compared to patients with controlled arterial hypertension. It was found that the frequency of occurrence of the composite primary endpoint in resistant hypertensive patients was four times higher than in the group of patients with controlled hypertension – 30.0 % (72/240) versus 7.0 % (16/228) (p=0.001). The frequency of new cases of type 2 diabetes mellitus in patients with RH exceeded compared to CAH patients by 3.7 times (p=0.03).Conclusions. Independent predictors of the risk of cardiovascular and renal complications in patients with RH were the initial indicators of circulating endothelial progenitor cells if their concentration in the blood was ≤ 1818 cells/ml (HR 0.41; 95 % CI (0.21–0.79); p=0.007), the content of citrulline in the blood is more than 68 μmol/l (HR 1.13; 95 % CI (1.07–1.20); p<0.001); value of initial average daily systolic BP > 163 mm Hg (HR 1.10; 95 % CI (1.03–1.18); p=0.008).

Ruptura pankreasne pseudoaneurizme kao posledice hroničnog pankreatitisa - prikaz slučaja

Abstract: Introduction: Pseudoaneurysms of the pancreaticoduodenal arcade are rare, accounting for approximately 2% of all visceral artery aneurysms. They typically arise as complications of chronic pancreatitis, peptic ulcer disease, trauma, pancreatic and biliary surgery, or pancreas transplantation. Diagnosis often occurs only after rupture, leading to life-threatening internal bleeding. Bleeding may occur within a pseudocyst, with blood passing through the Vater's papilla into the digestive tract, or may result in the formation of a retroperitoneal hematoma that can rupture into the abdominal cavity, causing hemoperitoneum. The cell-saver is a tool that can be utilized for intraoperative blood cell salvage and autologous transfusions. Case Report: Our patient, a 54-year-old male, an untreated alcoholic with no prior medical history or documented treatment, presented to the Clinic for Emergency Surgery at the University Clinical Center of Serbia with a sudden onset of upper abdominal pain. A quick ultrasound of the abdomen was performed, followed by an urgent CT scan of the chest and abdomen, revealing a hematoma extending from the right retroperitoneum and mesentery of the intestine, measuring 150x109x180mm in diameter, with signs of active bleeding in the region beneath the pancreas, indicative of hemoperitoneum. Due to hemodynamic instability, accompanied by a drop in arterial blood pressure and hemoglobin levels, an urgent laparotomy was performed. Active bleeding was identified from a ruptured pseudoaneurysm originating from the pancreaticoduodenal arcade. Hemostasis was achieved followed by tamponade, and the tampons were removed 30 hours post-surgery. The patient remained hemodynamically stable thereafter, recovered well from the surgery, and was discharged home in good general condition. Intraoperatively, we utilized the Cell-saver to collect the patient's blood and subsequently administered autologous transfusion. Conclusion: In patients with chronic pancreatitis presenting with sudden abdominal pain and hemodynamic instability accompanied by a drop in arterial pressure, hemoglobin, and hematocrit levels, the possibility of a ruptured pseudoaneurysm in the pancreatic or peripancreatic region should be considered. Timely diagnosis and prompt surgical intervention are crucial for a successful outcome. Effective collaboration among radiologists, anesthesiologists, and surgeons is essential. The utilization of the Cell-saver system significantly aids in maintaining cardiac output and hemodynamic stability in these patients.

Comparative Study between Restrictive versus Liberal Intravenous Fluid Administration in Severe Sepsis and Septic Shock; A Randomized Clinical Trial

Abstract Background Sepsis is an inflammatory response to severe infection characterized by hypovolemia and vasodilation and treated with early antibiotics and fluid resuscitation. In-hospital mortality rates have decreased from 80% in the early years of intensive care to 20-30% in the modern era through improved surveillance, early treatment of underlying infection, and advances in support for failing organs. Despite the central role intravenous (IV) fluid administration has played in sepsis management for the last 15 years, fundamental questions regarding “which fluid” and “in what amount” remain unanswered. Objective To compare between the outcomes of fluid administration strategies in the form of restricted or usual fluid administration in patient with severe sepsis and septic shock, and to detect the optimal strategy of fluid administration which decreases morbidity and mortality. Patients and Methods This was a Prospective controlled; randomized, comparative study was conducted in the intensive care units at Ain-Shams University Hospitals and Gamal Abdelnaser Hospital. This study was conducted on 80 adult patients divided into two groups: Group A: 40 adult patients taking the Usual Care, and Group B: 40 adult patients taking the Restrictive Care. Results The restrictive fluid group received significantly less resuscitative IV fluid than the usual care group prior to randomization, over 24 hours, over 48 hours, over 72 hours and total, Moreover; the restrictive fluid group also received a lower fraction of non-resuscitative IV fluid than the usual care group. In addition, the restrictive fluid group also received less amount of total forms IV fluid than the usual care group. There were no statistically significant differences between the two groups in adjunct resuscitative measures administered including albumin, blood transfusion, or stress dose steroids. By day 30, 9 participants (22.5%) in the restrictive fluid group and 7 participants (17.5%) in the usual care had died with no statistical significant difference between the both groups (p = 0.29). Conclusion A restrictive resuscitation strategy that significantly limited the amount of IV fluid administered to patients with severe sepsis and septic shock show slight improvement as regard mean arterial blood pressure, urine output and lactate level. at the same time did not appear to increase mortality, organ dysfunction, or adverse events. Our data contribute to the current state of clinical equipoise surrounding the use of IV fluids in sepsis, support a larger multicenter trial addressing this topic, and inform future study design. This study demonstrates that a restrictive resuscitation strategy can successfully reduce the amount of IV fluid administered to patients with severe sepsis and septic shock compared with usual care. Although limited by the sample size, we observed no increase in mortality, organ failure, or adverse events.

Resuscitation goals in septic shock: fluid therapy and vasoactive drugs, an integrative review

Severe sepsis and septic shock are complex syndromes with high mortality that frequently affect ICU patients. Contributions such as the Surviving Sepsis campaign have led to the issuing of guidelines for managing these patients. This manuscript aims to provide a review of state of the art using a systematic review of resuscitation and the use of vasopressors in patients with septic shock. Using MESH terms and Boolean operators, systematic research for information was carried out in PubMed in February 2023. We included 28 articles of which 18 were selected using the prism algorithm that met the inclusion criteria (analysis of septic shock, fluid resuscitation, or the use of vasopressors in septic shock in humans). In conclusion, the management of septic shock should be performed based on clear objectives to improve outcomes, for which maintenance of physiological levels of oxygenation, serum lactate, and mean arterial blood pressure are crucial.

Immuno-inflammatory markers of syntropic cardiovascular diseases

Objective: To study the immuno-inflammatory markers of coronary heart disease, arterial hypertension and their combined course. The research work included 116 patients with cardiovascular disease of middle and old age. The average age of patients is 62.4±1.27. All patients were examined at the Bukhara branch of the Republican scientific and practical Center for emergency medical care. During the analysis, it was found that the level of systolic arterial blood pressure directly depends on the concentration of fibrinogen – r = 0.30 and oppositely depends on the concentration of procalcitonin (PCT) – r = -0.3 and IL-6 – r = -0.26. At the same time, a noticeable positive association of heart rate with creatinine in the blood – r = 0.35 was also revealed. The established connections show the contribution of inflammation syndrome (immune) in the progression of hypertension, or rather, indicators of the progression of hypertension in coronary heart disease are creatinine, fibrinogen, PCT and IL-6. Due to the high and noticeable correlation with the studied immuno-biochemical parameters of blood and functional parameters of the heart, IL-6 is a more informative indicator of the progression of coronary heart disease with the risk of complications and multiple organ failure. Thus, the established connections in our studies allow us to include the conclusion that, along with the above, risk factors for the development of rupture and/ or aneurysm of the aorta in CHD are an increase in the blood level of complement C3, IL-17 and PCT. Consequently, with an increase in the level of VEGF in the blood in CHD AS, the risk of an increase in the thickness of the LV in the diastole increases, and an increase in IL-6, IL-17A and urea in the blood shows a decrease in the thickness of the LV in the diastole, which makes it possible to differentiate the restrictive variant from the hypertrophic form in atypical angina. Due to the high and noticeable correlation with the studied immuno-biochemical parameters of blood and functional parameters of the heart, IL-6 is a more informative indicator of the progression of coronary artery disease with the risk of complications and multiple organ failure.

Associations between modifiable and non‐modifiable risk factors and domain‐specific cognitive decline over a 17‐year period

AbstractBackgroundModifiable risk factors account for 40% of worldwide dementias. However, to what extent different risk factors are associated with different types of cognitive decline remains unclear. The aim of this study was to investigate how different risk factors contribute to future decline in memory and attention/executive function, respectively.MethodBaseline examination of individuals without dementia in the prospective Swedish population‐based Malmö Diet and Cancer Study (MDCS) took place in 1991‐1996. In 2007‐2012, a randomly selected subsample was invited to a re‐examination using cognitive assessments (the Mini‐Mental State Examination [MMSE], A Quick Test of cognitive speed (AQT) and, for a sub‐population, The Montreal Cognitive Assessment (MoCA). Participants with complete data on cognitive assessments, body measurements, education and APOE genotype were included in the study (n = 2,881; n = 720 with MoCA). Linear regression models were used to examine the modifiable risk factors (hypertension, body mass index [BMI], long‐term glucose levels [HbA1c], lipid levels, physical activity and alcohol consumption) and non‐modifiable risk factor (APOE‐genotype). Follow‐up outcomes were 1) AQT‐color/form (processing speed and executive function, higher scores indicating worse function), 2) delayed recall and orientation scores from MMSE (memory function), and 3) subscores from MoCA. All models were adjusted for age, sex, education and time between baseline and cognitive assessments.ResultMedian follow‐up time was 17.3 (inter‐quartile range [IQR] 2.2) years. APOE‐e4 and higher HbA1c levels were independently associated with worse future memory function in a multivariable model (Table 1). Mean arterial blood pressure, obesity, lower HDL‐C, and higher HbA1c levels were independently associated with worse future processing speed/executive function (Table 2). Higher alcohol consumption was associated better performance in executive function (Table 2). Similar results were found using corresponding MoCA subscores (delayed recall and orientation subscores; visuospatial/executive and attention subscores).ConclusionIn this prospective, population‐based, 17‐years follow‐up study, cardiovascular risk factors in mid‐life were associated with future decline in processing speed and executive functions, while an APOE‐e4 genotype was associated with worse memory function. Alcohol consumption in mid‐life was associated with better performance in both cognitive domains. These results suggest that targeting cardiovascular risk factors in interventions may have a greater effect on future executive function than memory.

Central Versus Peripheral Arterial Pressure Monitoring in Patients Undergoing Cardiac Surgery: A Prospective Observational Study

The aortic-to-radial arterial pressure gradient is described during and after cardiopulmonary bypass (CPB), and can lead to underestimating arterial blood pressure. The authors hypothesized that central arterial pressure monitoring would be associated with lower norepinephrine requirements than radial arterial pressure monitoring during cardiac surgery. An observational prospective cohort with propensity score analysis. At a tertiary academic hospital's operating room and intensive care unit (ICU). A total of 286 consecutive adult patients undergoing cardiac surgery with CPB (central group: 109; radial group: 177) were enrolled and analyzed. To explore the hemodynamic effect of the measurement site, the authors divided the cohort into 2 groups according to a femoral/axillary (central group) or radial (radial group) site of arterial pressure monitoring. The primary outcome was the intraoperative amount of norepinephrine administered. Secondary outcomes included norepinephrine-free hours and ICU-free hours at postoperative day 2 (POD2). A logistic model with propensity score analysis was built to predict central arterial pressure monitoring use. The authors compared demographic, hemodynamic, and outcomes data before and after adjustment. Central group patients had a higher European System for Cardiac Operative Risk Evaluation. (EuroSCORE) compared to the radial group-7.9 ± 14.0 versus 3.8 ± 7.0, p < 0.001. After adjustment, both groups had similar patient EuroSCORE and arterial blood pressure levels. Intraoperative norepinephrine dose regimens were 0.10 ± 0.10 µg/kg/min in the central group and 0.11 ± 0.11 µg/kg/min in the radial group (p=0.519). Norepinephrine-free hours at POD2 were 38 ± 17 hours versus 33 ± 19 hours in central and radial groups, respectively (p=0.034). The ICU-free hours at POD2 were greater in the central group: 18 ± 13 hours versus 13 ± 13 hours, p=0.008. Adverse events were less frequent in the central group than in the radial group-67% versus 50%, p=0.007. No differences in the norepinephrine dose regimen were found according to the arterial measurement site during cardiac surgery. However, norepinephrine use and length of stay in the ICU were shorter, and adverse events were decreased when central arterial pressure monitoring was used.

Effects of dexmedetomidine combined with ropivacaine on the treatment of lumbar plexus sciatic nerve block in elderly patients with lower limb fractures

To further explore the effects of dexmedetomidine combined with ropivacaine in the treatment of lumbar plexus sciatic nerve block in elderly patients with lower limb fractures. 98 patients with lower limb fractures enrolled from January 2020 to January 2022 were randomly divided into the study and control groups, with 49 cases in each group. The study group received dexmedetomidine combined with ropivacaine for nerve block; while the control group received ropivacaine for nerve block. The anesthesia effect (duration time of onset and duration time of sensory block and motor block), heart rate, blood pressure, pain score, and adverse effects were compared between the study and control groups. Patients in the study group given dexmedetomidine combined with ropivacaine for lumbar plexus sciatic nerve block had a longer duration time of sensory block and motor block than the control group, showing a better anesthetic effect. The levels of mean arterial blood pressure (MAP) and heart rate (HR) in the study group at T1, T2, T3, T4, and T5 were significantly lower than that in the control group. The pain scores of the study group was lower than that of the control group, indicating the effects of dexmedetomidine combined with ropivacaine on reducing pain. Besides, the study group showed an adverse reaction incidence of 4.08%, which was slightly higher than that of the control group, with an index of 2.04%, without statistically significant difference. Dexmedetomidine combined with ropivacaine can enhance the effect of ropivacaine block, improve the heart rate index, and reduce patients’ pain, which is one of the reliable schemes in clinical practice for lumbar plexus sciatic nerve block.

Potentials for patients with severe arterial hypertension, by using antihypertensive pharmacotherapy combined with ozone therapy and nasal laser therapy.

Background: More people die each year from cardiovascular diseases than from any other cause. Arterial hypertension (AH) is a particularly important public health issue in Mongolia which has one of the highest mortality rates from hemorrhagic stroke in the world. Antihypertensive pharmacological therapy combined by other non-medication therapy is well-studied in patients with mild and moderate AH. However, studies that have investigated combination of low intensity laser irradiation and ozone therapy in patients with severe AH are lacking. The objective of the present work was to develop methods using low intensity laser irradiation therapy (LLLT) combined with major autohemotherapy (MAH) for the patients presenting with AH. &#x0D; Studies have shown that LLLT is capable of inducing a photobiological response within the cells which modifies the micro and macrovascular response; this accompanies evidence showing the systemic effects even using in nasal laser irradiation (NLI). &#x0D; Oxygen-ozone therapy exerts a positive effect on the platelet aggregation, cell remodeling, cytoskeletal elements organization and mitochondria structure. Due to O2-O3 therapy is an effective method in hypertension, and it diminishes the hypoxia state of various tissues. &#x0D; In recent years, scientists have made great progress in the area of pharmacotherapy for patients with AH. Drugs help to achieve the target level of arterial blood pressure, particularly in patients with mild and moderate AH. With a higher degree of AH (severe arterial hypertension – the 3rd degree of arterial hypertension) the effectiveness of pharmacological therapy decreases and to achieve the target level of arterial blood pressure it is necessary to use a combination of all major groups of antihypertensive medicines.&#x0D; &#x0D; Method and Result: The study was held at Wellness Med Hospital Mongolia since the beginning of 2021 until the end of year. The study included a total of 60 patients of any age (63% of men and 37% of women) having AH associated with coronary heart disease and abnormal blood lipid spectrum. Initially, clinical-instrumental and laboratory examination, blood pressure registration and daily arterial blood pressure monitoring were carried out. Suitable drugs were selected for all the patients. 3 months after starting drug treatment the patients were divided in 2 groups each comprising 30 patients matched for age, sex, severity of clinical conditions, and character. The patients of the first group were prescribed combination with NLI and ozone therapy (MAH) in addition to drugs. For ozone therapy used Ozomed smartline ozone generator by Hansler Medical, Germany. The total dose of ozone to be given at each session will vary according to the general condition of the patient. Intervals from daily to weekly and twice a week. Ten to twelve treatments are considered as one course of treatment. Also, as cycles to be given once or more times per year. It may vary from less than 1000 µg to 3000 µg. This procedure is in line with the Madrid Declaration (ISCO3/QAU/01/03). The ozone concentration in the O2-O3 gas mixture were between 20 µg/ml to 35 µg/ml. The volume of blood to use varies between 50 mL and 100 ml. For NLI therapy we used Semiconductor laser Therapeutic apparatus Model W-001 by Fithope, China. The laser watch with nasal laser irradiation with 650nm (5mW) of lights. Used this equipment same day with Ozone therapy for about 30-40 minutes each time. If AH was higher used the laser therapy longer time. &#x0D; The second group of patients continued receiving drugs alone. 3 months later, average daily blood pressure (BP), systolic BP and diastolic BP were compared in both groups. Three months after both groups demonstrated a significant decrease in SBP and DBP, but these indicators remained higher than normal and did not reach the target level. Three months after the inclusion of MAH+NLI in the comprehensive treatment, the first group demonstrated a significant decrease in BP (systolic and diastolic), not only in comparison with the initial data, but also with the data observed three months after PT. After 6 months SBP and DBP in the first group were significantly lower compared with those of patients in the second group. The inclusion of MAH+NLI in addition to multicomponent antihypertensive drugs is a promising treatment option for severe AH. &#x0D; &#x0D; Discussion: Drug therapy is not sufficient for the elimination of cellular-tissue and microcirculatory disorders in case of severe AH, it should be advisable to include MAH+NLI into the multicomponent treatment, and positive changes in the indicators of the 1st group of patients after the inclusion of MAH+NLI are suggestive of it. &#x0D; The oxygen-ozone therapy and LLLT seem to have no adverse events or side effects. Moreover, it is very cost-effective, as standard treatment costs can be reduced by 25% also.

Higherintraoperative mean arterial blood pressure does not reduce postoperative delirium in elderly patients following gastrointestinal surgery: A prospective randomized controlled trial.

This study aimed to describe the relationship between the different levels of intraoperative mean arterial blood pressure (MAP) and postoperative delirium in elderly patients undergoing gastrointestinal laparoscopic surgery. This prospective controlled clinical trial enrolled 116 patients aged 65 to 85 years who underwent gastrointestinal laparoscopic surgery. These patients were randomized 1:1 to a MAP goal of 65 to 85 mmHg (L group) or an 86 to 100 mmHg (H group). The primary endpoint was the incidence of postoperative delirium, assessed twice daily with the Confusion Assessment Method (CAM) and Richmond Agitation-Sedation Scale (RASS) during the first five postoperative days. Delirium severity was evaluated with the Delirium-O-Meter (D-O-M). 108 patients (L group n = 55, H group n = 53) were eventually included in intention-to-treat analyses. Postoperative delirium occurred in 18 (32.7%) of 55 cases of L group and in 15 (28.3%) of 53 cases of H group. The incidence of delirium subtypes between the two groups: hypoactive delirium 14.5% (8/55) vs 11.3% (6/53); hyperactive delirium 7.3% (4/55) vs 3.8% (2/53); mixed delirium 10.9% (6/55) vs 13.2% (7/53). However, the L group showed higher D-O-M scores of the first episode of delirium: 14.5 (Q1 = 12, Q3 = 18.5) vs 12 (Q1 = 10, Q3 = 14), which means the delirium is more severe. Compared with 65 to 85 mmHg, maintaining intraoperative MAP at 86-100 mmHg did not reduce the incidence of postoperative delirium in elderly patients undergoing gastrointestinal laparoscopic surgery. However, the severity of delirium could be reduced and blood loss is a risk factor for postoperative delirium.

Continuous Glucose Monitoring for Patients with COVID-19 Pneumonia: Initial Experience at a Tertiary Care Center

ObjectivePatients hospitalized with COVID-19 and hyperglycemia require frequent glucose monitoring, usually performed with glucometers. Continuous glucose monitors (CGMs) are common in the outpatient setting but not yet approved for hospital use. We evaluated CGM accuracy, safety for insulin dosing, and CGM clinical reliability in 20 adult patients hospitalized with COVID-19 and hyperglycemia. MethodsStudy patients were fitted with a remotely monitored CGM. CGM values were evaluated against glucometer readings. The CGM sensor calibration was performed if necessary. CGM values were used to dose insulin, without glucometer confirmation. ResultsCGM accuracy against glucometer, expressed as mean absolute relative difference (MARD), was calculated using 812 paired glucometer-CGM values. The aggregate MARD was 10.4%. For time in range and grades 1 and 2 hyperglycemia, MARD was 11.4%, 9.4%, and 9.1%, respectively, with a small variation between medical floors and intensive care units. There was no MARD correlation with mean arterial blood pressure levels, oxygen saturation, daily hemoglobin levels, and glomerular filtration rates. CGM clinical reliability was high, with 99.7% of the CGM values falling within the “safe” zones of Clarke error grid. After CGM placement, the frequency of glucometer measurements decreased from 5 to 3 and then 2 per day, reducing nurse presence in patient rooms and limiting viral exposure. ConclusionWith twice daily, on-demand calibration, the inpatient CGM use was safe for insulin dosing, decreasing the frequency of glucometer fingersticks. For glucose levels >70 mg/dL, CGMs showed adequate accuracy, without interference from vital and laboratory values.

Blood pressure alterations in recently COVID-19 vaccinated patients

Abstract Background A non-immediate hypertensive response short after COVID-19 vaccination has been reported. Mild to moderate elevated arterial blood pressure (BP) levels have been documented few days after a single or two-doses vaccine. This study sought to investigate this observation as a potential side effect in patients with known hypertension and healthy controls. Methods A total of 100 vaccinated patients between the age of 50 to 70 years old were studied. They were randomly assigned to one of the approved and available vaccines (Pfizer, Astra Zeneca, Moderna, Johnson &amp; Johnson). Half of them were hypertensives under medical treatment and half of them were not. All participants had systolic BP &amp;lt;140mmHg and diastolic BP &amp;lt;90mmHg before vaccination and volunteered for standard daily home BP measurements (HBPM) and ambulatory BP measurements (ABPM) between the 1st and the 21st day after considered fully COVID-19 vaccinated. Results All patients, hypertensives or not, had at some point a recorded hypertensive response for both systolic (SBP) and diastolic (DBP) BP after considered fully vaccinated. Hypertensives were older and with higher body mass index (BMI). Some of the hypertensive patients received additional medication whereas some of the non-hypertensive patients started life modification changes and systematic BP measurements for a possible diagnosis of hypertension. Conclusions Vaccination for COVID-19 seems to be related with a short period of hypertensive response. This phenomenon was partial and mostly observed in older overweight hypertensives. Funding Acknowledgement Type of funding sources: None.

Daily consumption of monosodium glutamate pronounced hypertension and altered renal excretory function in normotensive and hypertensive rats

This study aimed to investigate the effects of monosodium glutamate (MSG) on the levels of arterial blood pressure (ABP) and renal excretory function. Male Wistar rats were divided into 2 groups (n = 24 each) namely sham operation (SO) and 2-kidneys-1-clip (2K1C) to develop the normotensive and hypertensive model, respectively. Four weeks after the operation, each group of rats were further divided into 4 subgroups (n = 6 each) which were orally administered of either distilled water or MSG at the doses of 80, 160, or 320 mg/kg BW/day once a day for 8 weeks. The body weight, the 24-hour water intake, and the 24-hour urine output were recorded weekly. Then, each rat was anesthetized and the ABP was measured via carotid artery. The renal excretory function was examined by using the clearance technique to measure the levels of the glomerular filtration rate and the renal blood flow. The levels of serum malondialdehyde (MDA) as a marker of oxidative stress were analyzed. The expression of tumor necrosis factor alpha (TNF-α) in the kidneys was also investigated using immunohistochemistry. It was found that all doses of MSG significantly increased the ABP in both SO and 2K1C groups. All doses of MSG significantly increased the serum MDA levels and the expression of TNF-α in the kidneys of the SO groups. Long-term intake of 320 mg/kg BW MSG significantly decreased the renal excretion of salt and water in both SO and 2K1C groups. As a whole, this study demonstrated that MSG consumption contributed to an increase in oxidative stress which could lead to alterations in the cardiovascular and renal function.

Gut microbiota mediate vascular dysfunction in a murine model of sleep apnoea: effect of probiotics.

Obstructive sleep apnoea (OSA) is a chronic prevalent condition characterised by intermittent hypoxia (IH), and is associated with endothelial dysfunction and coronary artery disease (CAD). OSA can induce major changes in gut microbiome diversity and composition, which in turn may induce the emergence of OSA-associated morbidities. However, the causal effects of IH-induced gut microbiome changes on the vasculature remain unexplored. Our objective was to assess if vascular dysfunction induced by IH is mediated through gut microbiome changes. Faecal microbiota transplantation (FMT) was conducted on C57BL/6J naïve mice for 6 weeks to receive either IH or room air (RA) faecal slurry with or without probiotics (VSL#3). In addition to 16S rRNA amplicon sequencing of their gut microbiome, FMT recipients underwent arterial blood pressure and coronary artery and aorta function testing, and their trimethylamine N-oxide (TMAO) and plasma acetate levels were determined. Finally, C57BL/6J mice were exposed to IH, IH treated with VSL#3 or RA for 6 weeks, and arterial blood pressure and coronary artery function assessed. Gut microbiome taxonomic profiles correctly segregated IH from RA in FMT mice and the normalising effect of probiotics emerged. Furthermore, IH-FMT mice exhibited increased arterial blood pressure and TMAO levels, and impairments in aortic and coronary artery function (p<0.05) that were abrogated by probiotic administration. Lastly, treatment with VSL#3 under IH conditions did not attenuate elevations in arterial blood pressure or CAD. Gut microbiome alterations induced by chronic IH underlie, at least partially, the typical cardiovascular disturbances of sleep apnoea and can be mitigated by concurrent administration of probiotics.

Physical rehabilitation of patients with occupational diseases of the knee joints and industrial injuries

Introduction. The results of the use of therapeutic exercises in the form of Nordic walking in the patients with industrial injuries and occupational diseases of the knee joints are submitted. Studies have shown that Nordic walking helps to restore the range of motion in the affected joints, reduces the severity of pain syndrome, and has a positive effect on the cardiovascular and respiratory systems. Materials and methods. During the rehabilitation of the patients with industrial injuries and occupational diseases of the knee joints, therapeutic exercises were prescribed in the form of Nordic walking in the conditions of terrenkur against the background of high aeronization of the air environment. A control group of the patients with a similar pathology underwent rehabilitation using training devices for Continuous Passive Motion (CPM)-therapy in the hall for therapeutic exercises of the rehabilitation center. Upon admission and before discharge from the center, the volume of movements in the knee joints was examined, muscle strength, respiratory rate and heart rate, arterial blood pressure level were determined, pulse oximetry was performed, and the adaptive response was evaluated according to L.Kh. Garkavi. Results. The use of therapeutic exercises in the form of Nordic walking in the open air in the patients with industrial injuries and occupational diseases of the knee joints showed similar results with rehabilitation in closed halls, which makes it possible to use this technique instead of indoor activities. Limitations. The study did not include patients with other occupational pathology, as well as those who did not give informed consent to this study. Conclusions. The method of therapeutic exercises in the form of Nordic walking in the open air has shown similar effectiveness with the CPM-method in closed halls, which allows it to be preferred in rehabilitation programs for the patients with industrial injuries and occupational diseases of the knee joints in the conditions of the COVID-19 pandemic.

Comparison of Cardiac Risk Factors in Patients with Nephrotic Syndrome and Secondary Amyloidosis

Proteinuria is an independent risk factor for cardiovascular diseases and for the increment of atherosclerotic mortality. Atherosclerotic risk factors are well known in the various types of nephrotic syndrome but there are only few studies comparing the same risk factors between the secondary amyloidosis and nephrotic syndrome patients those have exactly same 24- hour protein levels in the urine. According to theliterature, recent comparative studies have not shown the etiological differences of atherosclerotic risk factors in these two disease groups. The aim of this study was to investigate the risk factors caused byproteinuria on development of atherosclerosis and to determine the differences in these disease groups those were well- matched in age, gender, arterial blood pressure levels, glomerular filtration rate (GFR) and body mass index. These patients groups were chosen to have exactly the same 24- hour protein levels in urine. 29 patients with nephrotic syndrome, 30 patients with secondary amyloidosis and 30 people of control group were taken to the trial. C- reactive protein (CRP), fibrinogen, cholesterol, triglyceride, low density lipoprotein (LDL-C), high density lipoprotein (HDL-C), lipoprotein -a [Lp(a)], apo- lipoprotein Al (apo Al), apolipoprotein B (apo B), apo- lipoprotein E (apo E), GFR and 24- hour protein in urine were compared between the patients and control groups.&#x0D; In the patients groups; cholesterol, triglyceride, LDL-C, Lp(a), apo A, apo B, apo E and fibrinogen levels were &#x0D; found much higher than the control group whereas HDL-C levels were lower (p