Mean Arterial Pressure Levels Research Articles

Glucose metabolism disorders and changes in cardiovascular risk among adult Peruvian population

Background Rates of cardiovascular diseases are increasing annually, and glucose metabolism disorders play an important role in cardiovascular risk. This study aimed to assess changes in cardiovascular risk over time according to the levels of blood glucose, especially prediabetes and type 2 diabetes. Methods Prospective cohort study conducted in the northern Peru. Two were the outcomes of interest, evaluated at the cohort’s baseline and six years after: cardiovascular risk (in percentage), defined using the laboratory-free risk score (HEARTS from the World Health Organization), and the mean arterial pressure (in mmHg); whereas the exposure was glucose metabolism disorder, especially prediabetes and type 2 diabetes, compared to normoglycaemia. Associations were evaluated using mixed linear regression models, and coefficients (β) and 95% confidence intervals (95% CI) were reported. Results A total of 1607 subjects were recruited, with a mean age of 48.0 (standard deviation [SD]: 10.5) years, and 50.3% women. Baseline prevalence of prediabetes and type 2 diabetes was 16.9% (95%CI: 15.1%-18.9%) and 11.0% (95%CI: 9.5%-12.6%), respectively; whereas the average of the cardiovascular risk and mean arterial pressure was 3.0% (SD: 2.5%) and 93.1 (SD: 11.9) mmHg, respectively. At baseline, those with prediabetes and type 2 diabetes had a higher cardiovascular risk (0.31% and 0.33%, respectively) and a higher mean arterial pressure (3.3 and 4.2 mmHg, respectively) than those with normal glycaemia. No significant change was found in cardiovascular risk between baseline and follow-up; however, there was a reduction in mean arterial pressure levels, greater among those with normoglycaemia than in cases of prediabetes and type 2 diabetes. Conclusions Glucose metabolism disorders were associated with an increased cardiovascular risk and mean arterial pressure at baseline, but only with higher levels of mean arterial pressure at follow-up. These findings suggest the need for cardiovascular risk assessment in patients with prediabetes and type 2 diabetes.

Mode of cell death in the penile cavernous tissue of type 1 diabetes mellitus rats.

Diabetes mellitus commonly causes endothelial cell and smooth muscle cell death in penile cavernous tissue. The study sought to study the mode of cell death in the penile cavernous tissue in type 1 diabetic rats. A total of 36 Sprague Dawley rats 10 weeks of age were randomly divided into 2 groups: a normoglycemic group and type 1 diabetic group (intraperitoneal injection of Streptozotocin (STZ), 60mg/kg). We randomly selected 6 rats from each group for tests at the end of 11, 14, and 18weeks of age, respectively. All rats were able to eat and drink freely. The ratio of maximum intracavernous pressure to mean arterial pressure, concentration of serum testosterone, level of nitric oxide in the penile cavernosum, and expression of active caspase-1 (pyroptosis) and active caspase-3 (apoptosis) were determined. At the end of weeks 4 and 8 of type 1 diabetes, the proportions of endothelial cells and smooth muscle cells undergoing apoptosis and pyroptosis in penile cavernous tissue are different. The ratio of maximum intracavernous pressure to mean arterial pressure and nitric oxide levels were significantly lower in the 4- and 8-week diabetic groups than in the normoglycemic group (P < .01). Penile endothelial cell pyroptosis (5.67 ± 0.81%), smooth muscle cell apoptosis (23.72 ± 0.48%), total cell pyroptosis (9.67 ± 0.73%), and total apoptosis (10.52 ± 1.45%) were significantly greater in the 4-week diabetic group than in the normoglycemic group (P < .01). The proportion of endothelial cell pyroptosis (24.4 ± 3.69%), endothelial cell apoptosis (22.13 ± 2.43%), total cell pyroptosis (14.75 ± 0.93%), and total apoptosis (14.82 ± 1.08%) in the penile tissues of the 8-week diabetic group were significantly greater than those in the normoglycemic group (P < .01).The 8-week survival proportions of diabetic endothelial cells (38.86 ± 8.85%) and smooth muscle cells (44.46 ± 2.94%) was significantly lower than the 4-week survival proportions of endothelial cells (93.17 ± 8.07%) and smooth muscle cells (75.12 ± 4.76%) (P < .05). Inhibition of cell death by different methods at different stages may be the key to the treatment of type 1 diabetes-induced erectile dysfunction. The effect of type 1 diabetes on other types of cell death in penile cavernous tissue needs further study. The mode of death of endothelial cells in the cavernous tissue of the penis in the early stage in diabetic rats is dominated by pyroptosis, and the death of smooth muscle cells is dominated by apoptosis. Endothelial cell and smooth muscle cell death are not consistent at different stages of diabetes progression.

Risk factors and prognosis of postoperative spinal cord injury in type A aortic dissection.

To investigate the risk factors and prognosis of spinal cord injury (SCI) after surgical procedure in type A aortic dissection (AAD). Between January 2013 and December 2021, a total of 1647 patients with AAD underwent surgical procedure. Postoperative SCI occurred in 58 patients, including 24 patients with paraplegia and 34 patients with paraparesis. Factors associated with SCI were identified through comparison between patients with and without SCI. The mean age was 48.8 ± 10.8 years for patients with SCI and 50.1 ± 12.1 years for those without SCI (P = 0.43), with a comparable gender distribution. Median numbers of intercostal and lumbar arteries with involvement were significantly higher in the SCI group (both P < 0.001). The highest (P = 0.033) and lowest (P = 0.001) levels of intraoperative mean arterial pressure (MAP) were significantly lower in the SCI group. Multivariable analysis revealed the number of segmental arteries involved (odds ratio = 1.14, 95% CI 1.08-1.20, P = 0.000), and the duration of hypothermic circulatory arrest (HCA) (odds ratio = 1.04, 95% CI 1.01-1.08, P = 0.042) was positively associated with the occurrence of SCI. Conversely, the lowest level of MAP was negatively associated with SCI (odds ratio = 0.98, 95% CI 0.96-0.99, P = 0.031). During the long-term follow-up, 14 patients with paraplegia needed a wheel chair, while only 1 patient with paraparesis needed one (P < 0.001). The risk of postoperative SCI increases when AAD patients experience segmental arteries involved, longer HCA duration and decreased intraoperative MAP during operation.

Prevalence, Predictors, and Outcomes of Pulmonary Hypertension in Patients with Lupus Nephritis.

Background and Objectives: This study aimed to assess the prevalence, predictors, and outcomes of pulmonary hypertension (PH) in patients with lupus nephritis (LN). Materials and Methods: Baseline characteristics and clinical outcomes of 387 patients with LN were retrospectively collected from 2007 to 2017. PH was defined as pulmonary artery systolic pressure ≥40 mmHg assessed by resting transthoracic echocardiography. The primary endpoint was all-cause mortality. The secondary endpoint was renal events, defined as the doubling of baseline serum creatinine or end-stage renal disease. Associations between PH and outcomes were analyzed by Cox regression models. Results: A total of 15.3% (59/387) of patients with LN were diagnosed with PH, and the prevalence of PH was higher for patients with an estimated glomerular filtration rate (eGFR) < 30 mL/min/1.73 m2 compared to those with an eGFR ≥ 30 mL/min/1.73 m2 (31.5% vs. 12.6%). Higher mean arterial pressure, lower hemoglobin, and lower triglyceride levels were associated with greater odds of having PH. After adjusting for relevant confounding variables, PH was independently associated with a higher risk for death (HR: 2.01; 95% CI: 1.01-4.00; p = 0.047) and renal events (HR: 2.07; 95% CI: 1.04-4.12; p = 0.039). Conclusions: PH is an independent risk factor for all-cause mortality and adverse renal outcomes in patients with LN.

Mean Arterial Pressure and Neonatal Outcomes in Pregnancies Complicated by Mild Chronic Hypertension.

To estimate the association between mean arterial pressure during pregnancy and neonatal outcomes in participants with chronic hypertension using data from the CHAP (Chronic Hypertension and Pregnancy) trial. A secondary analysis of the CHAP trial, an open-label, multicenter randomized trial of antihypertensive treatment in pregnancy, was conducted. The CHAP trial enrolled participants with mild chronic hypertension (blood pressure [BP] 140-159/90-104 mm Hg) and singleton pregnancies less than 23 weeks of gestation, randomizing them to active treatment (maintained on antihypertensive therapy with a goal BP below 140/90 mm Hg) or standard treatment (control; antihypertensives withheld unless BP reached 160 mm Hg systolic BP or higher or 105 mm Hg diastolic BP or higher). We used logistic regression to measure the strength of association between mean arterial pressure (average and highest across study visits) and to select neonatal outcomes. Unadjusted and adjusted odds ratios (per 1-unit increase in millimeters of mercury) of the primary neonatal composite outcome (bronchopulmonary dysplasia, retinopathy of prematurity, necrotizing enterocolitis, or intraventricular hemorrhage grade 3 or 4) and individual secondary outcomes (neonatal intensive care unit admission [NICU], low birth weight [LBW] below 2,500 g, and small for gestational age [SGA]) were calculated. A total of 2,284 participants were included: 1,155 active and 1,129 control. Adjusted models controlling for randomization group demonstrated that increasing average mean arterial pressure per millimeter of mercury was associated with an increase in each neonatal outcome examined except NEC, specifically neonatal composite (adjusted odds ratio [aOR] 1.12, 95% CI, 1.09-1.16), NICU admission (aOR 1.07, 95% CI, 1.06-1.08), LBW (aOR 1.12, 95% CI, 1.11-1.14), SGA below the fifth percentile (aOR 1.03, 95% CI, 1.01-1.06), and SGA below the 10th percentile (aOR 1.02, 95% CI, 1.01-1.04). Models using the highest mean arterial pressure as opposed to average mean arterial pressure also demonstrated consistent associations. Increasing mean arterial pressure was positively associated with most adverse neonatal outcomes except NEC. Given that the relationship between mean arterial pressure and adverse pregnancy outcomes may not be consistent at all mean arterial pressure levels, future work should attempt to further elucidate whether there is an absolute threshold or relative change in mean arterial pressure at which fetal benefits are optimized along with maternal benefits. ClinicalTrials.gov , NCT02299414.

The impact of yoga in pregnancy on placental growth factor levels and mean arterial pressure in pre-eclampsia: A randomized controlled trial

Context: Pre-eclampsia is a pregnancy-related condition characterized by hypertension, proteinuria, and edema occurring after 20 weeks of pregnancy or during the postpartum period. Several markers are often assessed to determine the suitable option for confirming pre-eclampsia diagnosis, one of which is the examination of placental growth factor (PlGF) as a placental ischemia indicator. Aims: To evaluate the impact of prenatal yoga on PlGF and mean arterial pressure (MAP) levels in pre-eclampsia within the Madura region. Methods: A randomized controlled trial was conducted on fifty subjects that were randomly allocated to the experimental group with pre-post control groups consisting of 50 participants, namely 25 pregnant women with pre-eclampsia and 25 healthy individuals. The selection was conducted based on the following inclusion criteria: belonging to Madura ethnicity spanning three generations, exhibiting pregnancy duration &gt;20 weeks, maternal ages ranging from 20–35 years, pre-pregnancy body mass index (BMI) &gt;25, a history of hypertension, diabetes mellitus (DM), kidney disorders, pre-eclampsia, chronic hypertension, or family history of chronic high blood pressure and pre-eclampsia among those at risk. PlGF levels were estimated using an ELISA kit, while blood pressure was measured with an Omron brand sphygmomanometer. Results: Statistical analysis performed with the Wilcoxon sign test and T-test indicated significant differences (p&lt;0.005) in systolic blood pressure, diastolic blood pressure, and MAP between the groups. Furthermore, a significant difference was observed in PlGF levels before and after engaging in prenatal yoga practice (p&lt;0.05). Conclusions: The results showed that prenatal yoga contributed to the elevation of PlGF levels in women with pre-eclampsia, compared to their healthy counterparts.

Prognostic accuracy of mean arterial pressure and serum lactate level in patients with acute myocardial infarction.

Mean arterial pressure (MAP) can be used to evaluate macro-circulatory perfusion while serum lactate concentration is a marker of tissue perfusion. It is important to note that the primary objective of initial medical interventions is to restore microcirculatory perfusion rather than focusing solely on macro-hemodynamics. We aimed to investigate the prognostic value of the combination of MAP and serum lactate levels measured on admission to the hospital in relation to patients' 30-day survival rate in patients with acute myocardial infarction (MI). Data from 532 consecutive patients with acute MI treated with percutaneous coronary intervention were analyzed. The study endpoint was 30-day all-cause mortality. We found that both MAP and lactate levels were relevant predictors of the 30-day mortality in multivariable Cox regression analysis (HR, 0.83; 95% CI, 0.71-0.97; P = 0.02 and HR, 1.16; 95% CI, 1.06-1.16; P = 0.01, respectively). There was a significant increase in the prognostic performance in relation to 30-day mortality for the combination of both MAP and lactate levels in comparison to MAP alone (P = 0.03 for comparison between areas under the curve). Conversely, the combination of MAP and lactates did not add a significant prognostic value in comparison to lactates alone (P = 0.53 for comparison between areas under the curve). In patients with acute MI, serum lactate level seems to have a higher prognostic value in comparison to MAP. Our data suggest that on initial assessment of patients with acute myocardial infarction, we should move toward a tissue perfusion-based approach instead of focusing on a blood pressure-oriented strategy alone.

Characteristics and outcome of patients with malaria presented to a Hong Kong emergency department—A retrospective cohort analysis

AbstractBackgroundMalaria remains a significant cause of illness for return travellers in Hong Kong. However, the lack of experience of local healthcare providers in tropical medicine and non‐specific presenting symptoms may lead to underdiagnosis or delayed diagnosis of the disease. We evaluate patients presenting with malaria to a local emergency department to understand the disease presentation and outcome.MethodsA retrospective review of all patients diagnosed with malaria presenting to the emergency department from January 2009 to December 2019 was conducted. Information about patient demographics, travel history, presenting vital signs and blood results, how the diagnosis is made, clinical features and outcomes were analysed. Subgroup analysis was also performed for comparison.ResultsAmong the 70 patients diagnosed with malaria, most of them were imported cases (98.6%). Most were infected with Plasmodium Falciparum (50%) and Plasmodium vivax (45.7%). The common presenting symptoms included fever (100%), nausea or vomiting (42.9%) and headache (38.6%). 43 out of 70 cases had a diagnosis made in the emergency department, either by malarial blood smear (34.3%) or incidental haematological findings (27.1%). Most cases could be discharged uneventfully (90%), with six cases requiring Intensive Care Unit admission during the stay (8.6%). Patients with diagnoses not made in AED had a significantly lower mean arterial pressure (p = 0.009) and haemoglobin level (p = 0.004). Significantly lower platelet count (p = 0.002) and higher bilirubin level (p = 0.041) were found in patients who required ICU admission. For those who had AED reattendance before diagnosis was made, their creatinine levels were significantly higher (p = 0.022) and had a longer length of stay (p = 0.021).ConclusionsThe clinical presentation of imported malaria cases is non‐specific, and high suspicion of malaria should be raised when diagnosing febrile patients with a travel history. The history of taking malarial chemoprophylaxis is essential and should have been included in most cases. Malarial‐specific treatments were rarely given in the emergency department despite diagnosis.

Assessing the Impact of General Anesthesia and Bronchial Intubation in Conjunction with Thoracic Paravertebral Nerve Block on Cellular Immunity and Surgical Management in Tuberculous Pyothorax Patients

Objective: This study aims to investigate the impact of combining general anesthesia with bronchial intubation and thoracic paravertebral nerve block during surgery for patients with tuberculous pyothorax. Methods: Eighty patients diagnosed with tuberculous pyothorax, admitted to the hospital between January 2023 and September 2023, were randomly selected for this study. The patients were divided into control and study groups using a numerical table method. The control group underwent general anesthesia with bronchial intubation, while the study group received general anesthesia with bronchial intubation in conjunction with thoracic paravertebral nerve block. Subsequently, the patients were monitored to assess mean arterial pressure, heart rate variations, and adverse reactions to anesthesia. Results: The study group exhibited significantly lower mean arterial pressure and heart rate levels during the post-surgical incision, immediate end of surgery, and immediate extubation periods compared to the control group (P &lt; 0.05). Furthermore, the Ricker and Ramsay scores in the study group were significantly lower than those in the control group (P &lt; 0.05). Conclusion: The combined use of general anesthesia via bronchial intubation and thoracic paravertebral nerve block has been found to stabilize mean arterial pressure and heart rate while providing effective sedation for surgical treatment in patients with tuberculous septic thorax.

Effect of protocol-based family visitation on physiological indicators in ICU patients: a randomized controlled trial

BackgroundIntensive care unit (ICU) patients often experience significant physiological stress. This study evaluated the effect of a defined family visitation protocol on physiological responses in the ICU.MethodsA randomized, block-randomized clinical trial was conducted on 78 ICU patients at Imam Reza Hospital between February 8, 2017, and August 8, 2017. The intervention group received protocol-based visits, and the control group continued with standard visitation. Block randomization was utilized for group assignments. The primary outcome was the measurement of physiological signs using designated monitoring devices. Data were analyzed using SPSS version 22, employing independent t-tests, Mann-Whitney U test, repeated measures analysis, and Friedman’s test.ResultsThe results showed no significant differences in systolic blood pressure, diastolic blood pressure, mean arterial pressure, respiratory rate, and arterial blood oxygen levels between the two groups. However, heart rate in the intervention group was significantly lower in three stages before, during, and after the meaningful visiting (P = 0.008).ConclusionProtocol-based scheduled family visits in the ICU may reduce physiological stress, as evidenced by a decrease in patients’ heart rate. Implementing tailored visitation protocols sensitive to patient preferences and clinical contexts is advisable, suggesting the integration of family visits into standard care practices for enhanced patient outcomes.Trial RegistrationIRCT20161229031654N2; 25/01/2018; Iranian Registry of Clinical Trials (https://en.irct.ir).

Effect of Unexpected Prolonged Fasting on Patients Undergoing Elective Surgery under Spinal Anaesthesia: An Observational Study

Introduction: Preoperative fasting is a standard practice aimed at minimising the risk of pulmonary aspiration during surgery. However, patients often experience prolonged fasting periods beyond the recommended duration due to unanticipated delays in the operating theatre, communication failures between teams, inadequate preoperative planning and other factors. Aim: To investigate the effects of unexpectedly prolonged fasting on intraoperative and postoperative parameters in patients undergoing elective surgery under spinal anaesthesia. Materials and Methods: This prospective observational study was conducted from October 2023 to June 2024 at the Department of Anaesthesiology, Dr. D.Y. Patil Medical College, Hospital and Research Centre, Pimpri, Pune, Maharashtra, India. The study included 70 patients undergoing elective surgery under spinal anaesthesia. Patients were divided into two groups: Group A (AM group, n=35), scheduled for surgery between 8:00 AM and 12:00 PM and Group B (PM group, n=35), scheduled for surgery after 12:00 PM or with delayed surgeries. Intraoperative parameters, including Mean Arterial Pressure (MAP), Heart Rate (HR), oxygen saturation (SpO2 ) and random blood glucose levels, were recorded at specific time points. Postoperative outcomes, such as nausea, vomiting and random blood glucose levels, were also assessed. Continuous and discrete variables were summarised as mean±SD and median, while categorical variables were presented as frequencies and percentages. Associations between categorical variables were tested using Pearson’s Chi-square or Fisher’s-exact test, with p-values&lt;0.05 considered statistically significant. Results: The PM group exhibited higher preoperative random blood glucose levels (102.3±18.7 mg/dL) compared to the AM group (89.2±12.5 mg/dL). Postoperative nausea and vomiting were observed in 5 (14.3%) patients in the AM group and 11 (31.4%) patients in the PM group. Both groups showed a gradual decrease in MAP and HR from the preoperative period to 30 minutes after spinal anaesthesia administration, with slightly higher values noted in the PM group. No significant differences in SpO2 were observed between the groups. Conclusion: Unexpected prolonged fasting before elective surgery under spinal anaesthesia may contribute to higher preoperative blood glucose levels and an increased risk of postoperative nausea and vomiting. These findings underscore the importance of adhering to preoperative fasting guidelines and exploring potential strategies to minimise prolonged fasting periods, such as carbohydrate loading or allowing clear fluids closer to surgery

Gut microbiota alterations are associated with functional outcomes in patients of acute ischemic stroke with non-alcoholic fatty liver disease.

Patients with acute ischemic stroke (AIS) with non-alcoholic fatty liver disease (NAFLD) frequently have poor prognosis. Many evidences suggested that the changes in gut microbiota may play an important role in the occurrence and development of AIS patients with NAFLD. The purpose of this study was to explore microbial characteristics in patients of AIS with NAFLD, and the correlation between gut microbiota and functional outcomes. The patients of AIS were recruited and divided into NAFLD group and non-NAFLD group. The stool samples and clinical information were collected. 16 s rRNA sequencing was used to analyze the characteristics of gut microbiota. The patients of AIS with NAFLD were followed-up to evaluate the functional outcomes of disease. The adverse outcomes were determined by modified Rankin scale (mRS) scores at 3 months after stroke. The diagnostic performance of microbial marker in predicting adverse outcomes was assessed by recipient operating characteristic (ROC) curves. Our results showed that the composition of gut microbiota between non-NAFLD group and NAFLD group were different. The characteristic bacteria in the patients of AIS with NAFLD was that the relative abundance of Dorea, Dialister, Intestinibacter and Flavonifractor were decreased, while the relative abundance of Enorma was increased. Moreover, the characteristic microbiota was correlated with many clinical parameters, such as mRS scores, mean arterial pressure and fasting blood glucose level. In addition, ROC models based on the characteristic microbiota or the combination of characteristic microbiota with independent risk factors could distinguish functional dependence patients and functional independence patients in AIS with NAFLD (area under curve is 0.765 and 0.882 respectively). These findings revealed the microbial characteristics in patients of AIS with NAFLD, and further demonstrated the predictive capability of characteristic microbiota for adverse outcomes in patients of AIS with NAFLD.

Clinical value of arterial stiffness assessment on risk prediction of vascular stiffness in the octogenarian elderly

Objective: This study aimed to analyze clinical factors related to arterial stiffening and establish a risk prediction nomogram of arterial stiffening in the octogenarian(≥80 years). Methods: This study was a retrospective cross-sectional study, which enrolled the octogenarian elderly who underwent physical examination and secondary prevention intervention in the outpatient department of Chinese People's Liberation Army General Hospital from April 2022 to August 2022. Clinical data including demographics, biochemical indicators and medical history were collected. Brachial-ankle pulse wave velocity (baPWV) was detected during the clinical visit. Participants were divided into the control group (baPWV≤1 800 cm/s) and vascular sclerosis group (baPWV>1 800 cm/s). The risk factors of arterial stiffness were analyzed by univariate and logistic regression analysis, and the nomogram model was constructed by R programming language. The predictive effect of the nomogram model was evaluated by the receiver operating characteristic curve (ROC). Results: The median age of the 525 participants was 87.0 (82.0, 92.0) years, 504 (96.0%) were male, 82 in the control group, 443 in the vascular sclerosis group. The baPWV, age, systolic blood pressure, mean arterial pressure and diastolic blood pressure were significantly lower in the control group than those in the vascular sclerosis group (all P<0.05). Logistic regression analysis showed that high-density lipoprotein cholesterol, alanine aminotransferase and amylase were protective factors, and alkaline phosphatase and creatinine were risk factors of arterial stiffening (all P<0.05). The combined nomogram model scores including age, mean arterial pressure and the above five laboratory indicators indicated that mean arterial pressure and serum creatinine levels were strongly correlated with vascular sclerosis. The ROC curve suggested that the nomogram model had good prediction ability. Conclusions: Age, mean arterial pressure, high-density lipoprotein cholesterol, alanine aminotransferase, alkaline phosphatase, amylase and creatinine are independently determinants for increased vascular stiffness. The combined prediction model in this study can provide reference for individualized clinical risk prediction of vascular sclerosis in the octogenarian elderly.

Monitoring tissue perfusion during extracorporeal circulation with laser speckle contrast imaging

Objective: The laser speckle contrast imaging (LSCI) system is a method to evaluate microcirculation. The primary aim of our study&#x0D; is to evaluate the relationship between LSCI and perfusion markers in coronary artery bypass grafting (CABG). Our second aim is to&#x0D; investigate the relationship between LSCI and extubation time in the intensive care unit.&#x0D; Patients and Methods: Fifteen patients aged 43-80 years who will undergo on-pump CABG were included in the prospective study.&#x0D; Mean arterial pressure (mmHg), heart rate (min-1), PO2 (mmHg), PCO2 (mmHg) and lactate (mmol/L) levels were measured preinduction,&#x0D; post-induction, 10th minute of the extracorporeal circulation, post-crossclamp, and post-operatively. At the same time&#x0D; points, LSCI values from the skin were measured and recorded. The intubation times of the patients were also recorded.&#x0D; Results: There was no significant change in systemic tissue perfusion markers (P&gt;0.05). LSCI perfusion values decreased significantly&#x0D; from induction and remained low until the end of surgery (P

Effect of Vitamin E Supplemented with Calcium in the Treatment of Hypertension During Pregnancy on Maternal and Infant Outcomes

Objective: To investigate the effect of vitamin E supplemented with calcium in the treatment of hypertension during pregnancy on maternal and infant outcomes. Methods: 60 patients with gestational hypertension admitted from January 2020 to December 2022 were recruited and randomly divided into the control group and the observation group, each group including 30 patients. The control group was given routine treatment, whereas the observation group was given routine treatment combined with vitamin E-supplemented calcium therapy, and both groups received treatment until delivery. The clinical effects of the observation group and the control group after treatment, systolic and diastolic blood pressure, mean arterial pressure, urine protein, blood lipid levels at different time points (before and after treatment), and maternal and child outcomes during treatment were uniformly compared and analyzed. Results: After treatment, the total clinical effective rate (93.33%) of the observation group was significantly higher than that of the control group (70.00%); compared with before treatment, the systolic blood pressure, diastolic blood pressure, mean arterial pressure, urine protein, TC, and TG levels of the two groups were all lower after treatment, and the observation group was at a lower level; there was no significant difference in the incidence of hemorrhage (P &gt; 0.05). Conclusion: Vitamin E supplemented with calcium has a significant effect on the treatment of hypertension during pregnancy, which can help reduce blood pressure and blood lipid levels, reduce urinary protein content, improve maternal and child outcomes, and improve safety.

Redefining Hypotension in Older Adults: Implications for the Prevention of Age Related Cognitive Decline

Chronically low blood pressure in older adults is associated with significantly increased long-term risks of dementia and all-cause mortality risk. Yet low blood pressure is generally not treated until an individual begins to experience the acute symptoms arising from very low cerebral perfusion. However, these acute symptoms, such as dizziness, balance difficulty, syncope, increased fall occurrence, vision impairment, and nausea, begin to occur only at very low blood pressure levels, such that mean arterial pressure levels as low as 65mmHg are often considered to be of limited concern. If the long-term consequences of chronic low blood pressure are to be prevented, an alternative approach to defining what constitutes too low a blood pressure for older adults, i.e. hypotension, will be required. Cognitive aging is a significant health concern for many older adults as it has significant impact on quality of life, and is widely considered a precursor to dementia. Here, we utilize an FDA cleared computer aided cognitive assessment tool to identify the relationship between resting brachial blood pressure in the upright seated position, and cognitive function in a convenience sample of independently living older adult men and women. We observed that resting diastolic blood pressure is significantly and positively correlated with cognitive function in adults over the age of 60 years. Specifically, cognitive performance was found to be significantly impaired for diastolic blood pressure levels below approximately 80 mmHg. Diastolic blood pressures (DBP) below 80 mmHg in older adults have consistently been shown to increase the risk of dementia as well as all-cause mortality, but the influence of below normal DBP on quality of life (QoL) in older adults has not been extensively addressed. The present work shows that adults over age 60, with a DBP below 80 mmHg, are significantly more likely to demonstrate mild to moderate cognitive impairment, and correspondingly, the associated impacts on QoL. These results lead to the suggestion that maintenance of diastolic blood in older adults in the 80-90 mmHg range will not only improve quality of life in this population, but may also provide substantial clinical benefit in terms of preventing, or reversing, age-related cognitive decline.

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.

Effect of hematuria on the kidney disease progression in IgA nephropathy patients with mild proteinuria and well-preserved renal function

ObjectiveTo investigate whether hematuria is a risk factor in IgA nephropathy (IgAN) patients with mild proteinuria and well-preserved renal function. MethodsThis retrospective study included a total of 63 IgAN patients, with complete clinical data available for 50 patients. Hematuria assessment was conducted using two methods: 1) an automated method using a urine particle analyzer, and 2) a manual method performed by a skilled examiner to examine microscopic urine sediment. ResultsThe results of hematuria measurement using both automated and manual methods showed a strong linear correlation (r = 0.78, P < 0.001). In IgAN patients, those with high urinary red blood cell count (U-RBCs) exhibited higher serum IgA levels compared to patients with low U-RBCs. Additionally, patients with crescent formation had higher levels of proteinuria compared to those without crescents. Patients who received immunosuppressive treatment displayed higher levels of systolic blood pressure (SBP) and mean arterial pressure (MAP), as well as lower levels of serum hemoglobin and albumin. They also had a higher prevalence of T1 lesions compared to patients who did not undergo immunosuppression. Furthermore, among patients with crescent formation, those who received immunosuppressive agents exhibited higher levels of SBP, diastolic blood pressure (DBP), MAP, and U-RBCs, as well as lower levels of albumin and proteinuria at the time of renal biopsy. No composite kidney endpoint events were observed in these groups of patients. The U-RBCs level was not identified as a risk factor influencing the decline of estimated glomerular filtration rate (eGFR) in IgAN. ConclusionsThe presence of hematuria at the time of biopsy was not found to be associated with kidney disease progression in IgAN patients who had mild proteinuria and well-preserved renal function. This suggests that it is possible that these patients may not derive significant benefits from immunosuppressive therapy.

The prognostic value of rapid risk scores among patients with community-acquired pneumonia : Aretrospective cohort study.

Community-acquired pneumonia (CAP) is afrequent reason for emergency department (ED) presentations. Various risk scores have been validated in the management of CAP and are recommended for daily practice. The aim of the study was to evaluate the performance of the rapid risk scores (the rapid acute physiology score (RAPS), the rapid emergency medicine score (REMS), the Worthing physiological scoring system (WPS), CURB-65 and CRB-65) among patients with CAP. This retrospective cohort study was conducted in the ED of atertiary hospital between 1 January 2019 and 31 December 2019. Patients aged ≥ 18years and diagnosed with CAP were included. Patients who were transferred from another center or with missing records were excluded. Demographic information, vital signs, level of consciousness, laboratory results, and outcomes were recorded. Atotal of 2057 patients were included in the final analysis. The 30-day mortality of the patients was 15.2% (n = 312). The WPS achieved the most successful results for all three outcomes, 30-day mortality, intensive care unit (ICU) admission and mechanical ventilation (MV) needs (area under the curve, AUC 0.810, 0.918, and 0.910, respectively; p < 0.001). In the prediction of mortality, RAPS, REMS, CURB-65, and CRB-65 had a moderate overall performance (AUC 0.648, 0.752, 0.778, and 0.739, respectively). In the prediction of ICU admission and MV needs, RAPS, REMS, CURB-65, and CRB-65 had moderate to good overall performance (AUC at ICU admission 0.793, 0.873, 0.829, and 0.810; AUC for MV needs 0.759, 0.892, 0.754, and 0.738, respectively). Advanced age, lower levels of mean arterial pressure and peripheral oxygen saturation, presence of active malignancy and cerebrovascular disease, and ICU admission were associated with mortality (p < 0.05). The WPS outperformed other risk scores in patients with CAP and can be used safely. The CRB-65 can be used to discriminate critically ill patients with CAP due to its high specificity. The overall performances of the scores were satisfactory for all three outcomes.

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.