mmHg Research Articles

Status of Hypertension Control in Urban Slums of Central India: A community Health Worker-Based Two-Year Follow-Up.

Hypertension (HTN) is a leading cause of cardiovascular diseases and its control is poor. There is heterogeneity in levels of blood pressure control among various population subgroups. The present study was conducted within the framework of the National Program for Prevention and Control of Cancer, Diabetes, Cardiovascular Diseases, and Stroke (NPCDCS) in India. It aims to estimate the proportion of optimal blood pressure control and identify factors associated with uncontrolled HTN consequent to initial screening. We assembled a cohort of individuals with HTN confirmed in a baseline screening in sixteen urban slum clusters of Bhopal (2017-2018). Sixteen accredited social health activists were trained from within these slums. Individuals with HTN were linked to primary care providers and followed up for the next two years. Obtaining optimal blood pressure control (defined as SBP <140 and DBP <90 mm of Hg) was a key outcome. Of a total of 6174 individuals, 1571 (25.4%) had HTN, of which 813 were previously known and 758 were newly detected during the baseline survey. Two-year follow-up was completed for 1177 (74.9%). Blood pressure was optimally controlled in 301 (26%) at baseline and in 442 (38%) individuals at two years (an absolute increase of 12%; 95% CI 10.2-13.9). Older age, physical inactivity, higher body mass index, and newly diagnosed HTN were significantly associated with uncontrolled blood pressure. We found about six of every ten individuals with HTN were on treatment, and about four were optimally controlled. These findings provide a benchmark for NPCDCS, in terms of achievable goals within short periods of follow-up.

Branch retinal artery occlusion post-vitreo-retinal surgery – A case report

We report a case of 50 year old female patient who underwent vitreo-retina surgery in left eye for retinal detachment and presented with branch retinal artery occlusion (BRAO) one month post surgery. Surgical procedures included scleral buckling, pars plana vitrectomy and silicon oil injection. Her best corrected visual acuity (BCVA) was 1/60 and intraocular pressure was 46 mm of Hg. Partial SOR was done which resulted in reperfusion and improvement in visual acuity. Early intervention is the key in managing such complications.

The effect of systemic antihypertensive drugs on the risk of primary open-angle glaucoma

The goal of the present study was to test the effect of systemic antihypertensive drugs on the risk of POAG using cis-Mendelian randomization (cis-MR) approach. The study involved summary statistics from genome-wide association studies (GWAS) for POAG (15229 cases and 177 473 controls) and from GWAS for systolic blood pressure meta-analysis (757 601 individuals). Drug targets for beta-blockers and for calcium channel blockers and genes coding these targets were identified via DrugBank. Genetic variants within the regions of these genes were selected for the Mendelian randomization analysis. The effect of a 10-mm Hg decrease in systolic blood pressure caused by calcium channel blockers on the risk of POAG amounted to: odds ratio (OR) 0.90 (95% CI 0.63-1.30, p=0.59). For beta blockers the cis-MR estimated effect on the risk of POAG was OR=0.95 (95% CI 0.34-2.70, p=0.92). The results of the present study do not confirm the hypothesis of causal effect of antihypertensive drugs intake on the risk of developing POAG.

Comparison of Effects of Volume-Controlled and Pressure-Controlled Ventilation during Laparoscopic Surgeries in Birat Medical College Teaching Hospital

Introduction: The pneumoperitoneum created during laparoscopic surgery has numerous effects on the patient ranging from respiratory to hemodynamics. The two common methods of ventilator are volume control and pressure control. The volume control method has been commonly used during general anesthesia. Pressure control method has been used in intensive care unit for improving the respiratory mechanics.&#x0D; Objective: The study aims to compare the effects of pressure control to volume control ventilation in patients undergoing laparoscopic surgery. The hypothesis of the study is that pressure control method improves the respiratory mechanics by decreasing the peak airway pressure and increasing the lung compliance.&#x0D; Methodology: The total of 100 patients who underwent laparoscopic surgery were undertaken for this study. The 50 in each group (PCV and VCV) were allotted randomly. As per predicted body weight, the tidal volume was adjusted to 8 ml/kg, for both the modes of ventilation, peep 5 mm of Hg with fio2 of 100% and I:E-1:2,. The variations in peak airway pressure, mean airway pressure, lung compliance, SPO2 and hemodynamic parameters were observed at baseline (T1), at pneumoperitoneum (T2), after 10 minutes of pneumoperitonium (T3) and at 20 minutes after pneumoperitonium (T4).&#x0D; Results: The pressure control group on comparison to volume control mode group showed significant decrease in peak airway pressure while increase in mean airway pressure and increase in lung compliance at different points of pneumoperitoneum. However there was no significant change in hemodynamics between the two groups in patient undergoing laparoscopic surgery.&#x0D; Conclusion: We conclude that respiratory mechanics improve when the patient is on pressure control ventilation in compared to volume control method of ventilation. Whereas there is no difference in hemodynamic parameters between the two methods.&#x0D;

Factors related to mortality in patients with stage 5 chronic kidney disease on dialysis with COVID-19: An exploratory case series analysis.

Different studies describe the clinical profile and factors that could explain the evolution and outcome of patients with chronic kidney disease and COVID-19. This study aims to evaluate the factors related to the mortality of patients with stage-5 chronic kidney disease on chronic dialysis hospitalized for COVID-19 at the Hospital Nacional Arzobispo Loayza from April to December 2020. Retrospective case series and exploratory analysis were performed. Patients with stage-5 chronic kidney disease on dialysis, older than 18 years, and hospitalized for COVID-19 disease were included. Hospital medical records were the primary data source. A total of 105 medical records were reviewed. 57 were male (54.3%), with a mean age of 58.6 years (standard deviation: 14.3). Eighty-four patients survived (80%), and 21 died (20%). The main cause of hospital admission, present in 80 patients (76.2%), was respiratory failure; the mean hospital stay was of 11.8 days (SD: 7.8). In the bivariate analysis: patients with moderate to severe COVID-19, overweight and obesity, increased levels of leukocytes, D-dimer, ferritin, C-reactive protein, lactate dehydrogenase, as well as, decreased levels of lymphocytes, bicarbonate and arterial oxygen pressure/inspired oxygen fraction were related to mortality risk. In multivariate analysis, only severe COVID-19 disease (OR 1.48; 95% CI 2.24 to 7.77), C-reactive protein > 10 mg/dL (OR: 9.72; 95% CI: 1.41 to 18.58), and arterial oxygen pressure/inspired oxygen fraction ≤ 150 millimeters of mercury (OR: 10.23; 95% CI: 5.87 to 36.06) were factors associated with poor survival. In patients with stage-5 chronic kidney disease hospitalized for COVID-19, severe COVID-19 disease, C-protein reactive levels > 10 milligrams per deciliter, arterial oxygen pressure / inspired oxygen fraction ≤ 150 millimeters of mercury and severe COVID-19 disease were the main factors related to mortality.

Progression of metabolic syndrome and associated cardiometabolic risk factors from prepuberty to puberty in children: The PUBMEP study.

Metabolic syndrome (MetS) is a cluster of clinical and metabolic alterations related to the risk of cardiovascular diseases (CVD). Metabolic changes occurring during puberty, especially in children with overweight and obesity, can influence the risk of developing chronic diseases, especially CVD. Longitudinal study based on the follow-up until puberty of a cohort of 191 prepubertal Spanish boys and girls without congenital, chronic, or inflammatory diseases: undernutrition: or intake of any drug that could alter blood glucose, blood pressure, or lipid metabolism. The following parameters were used to determine the presence of MetS: obesity, hypertension, hyperglycemia, hypertriglyceridemia, and low HDL-c. A total of 75·5% of participants stayed in the same BMI category from prepuberty to puberty, whereas 6·3% increased by at least one category. The prevalence of MetS was 9·1% (prepubertal stage) and 11·9% (pubertal stage). The risk of presenting alterations in puberty for systolic blood pressure (SBP), plasma triacylglycerols, HDL cholesterol (HDL-c), and HOMA-IR was significantly higher in those participants who had the same alterations in prepuberty. MetS prevalence in puberty was predicted by sex and levels of HOMA-IR, BMI-z, and waist circumference in the prepubertal stage, in the whole sample: in puberty, the predictors were levels of HOMA-IR, BMI-z, and diastolic blood pressure in participants with obesity. Two fast-and-frugal decision trees were built to predict the risk of MetS in puberty based on prepuberty HOMA-IR (cutoff 2·5), SBP (cutoff 106 mm of Hg), and TAG (cutoff 53 mg/dl). Controlling obesity and cardiometabolic risk factors, especially HOMA-IR and blood pressure, in children during the prepubertal stage appears critical to preventing pubertal MetS effectively.

Partial vs Full Resuscitative Endovascular Balloon Occlusion of the Aorta (REBOA) in a Swine Model of Raised Intracranial Pressure and Hemorrhagic Shock.

Partial resuscitative endovascular balloon occlusion of the aorta (pREBOA) is a potential method to mitigate the ischemia observed in full REBOA (fREBOA). However, the effect of pREBOA on cerebral perfusion in the setting of raised intracranial pressure (rICP) is unknown. The aim was to evaluate the effects of no REBOA (nREBOA) vs pREBOA vs fREBOA on cerebral perfusion in a swine model of rICP and hemorrhagic shock. Anesthetized swine (n = 18) underwent instrumentation. Controlled hemorrhage was performed over 30 minutes. rICP was achieved using an intracranial Fogarty catheter inflated to achieve an ICP of 20 mmHg. Animals underwent intervention for 30 minutes, followed by resuscitation. The primary outcome was cerebral perfusion measured by ICP (millimeters of mercury), cerebral perfusion pressure (CPP; millimeters of mercury), and cerebral blood flow (CBF; milliliters per minute per 100 g) derived from CT perfusion. The secondary outcomes included hemodynamics and lactate (millimoles per liter). The peak ICP of pREBOA animals (22.7 ± 2.5) was significantly lower than nREBOA and fREBOA. pREBOA CPP was significantly higher compared with nREBOA and fREBOA during resuscitation. The pREBOA CBF was greater during intervention and resuscitation compared with nREBOA (p < 0.001). Systolic blood pressure was similar between pREBOA and fREBOA, and coronary perfusion was significantly greater in pREBOA. fREBOA had significantly higher lactate during the intervention (9.3 ± 1.3) and resuscitation (8.9 ± 3.5) compared with nREBOA and pREBOA. pREBOA produced greater cerebral perfusion, as demonstrated by more favorable CPP, CBF, and ICP values. fREBOA was associated with metabolic derangement and diminished pressure during resuscitation. pREBOA is superior to fREBOA in a swine model and should be considered over fREBOA for aortic occlusion.

EFFECTS OF RESISTANCE EXERCISE ON BLOOD PRESSURE IN HYPERTENSIVE PATIENTS OF CENTRAL INDIA: A PROSPECTIVE STUDY

Objectives: The objectives of this research were to see whether practicing resistance exercises alone can help to reduce the hypertension and can be considered as an adjunct to treat the hypertension. Methods: It is a prospective, cross-sectional, and descriptive study conducted in the Department of Physiology, Malwanchal University over a period of 3 years. This study was carried out with a sample of 60 participants who were explained the procedure of experiment and informed consent was taken from all the participants included in the study. Results: Systolic blood pressure, diastolic blood pressure, pulse pressure, and pulse rate were observed. Pre-test of resistance exercise group mean pulse rate is 79.52±4.14 beats/min (Mean±SD) reduced to 76.36±4.01 in post-test. Resistance exercise mean systolic blood pressure of pre-test 137.34±6.36 mmHg (Mean±SD) is reduced to post-test 134.65±6.35mm of Hg (Mean±SD). Pre-test of resistance exercise mean diastolic blood pressure 91.52±4.45 mmHg (Mean±SD) is reduced to post-test 88.45±4.31 mm of Hg. Conclusion: Resistance exercise alone lowers systolic and diastolic blood pressure in prehypertensive and stage-1 hypertensive patients. Hence, resistance training is advised as a technique for managing the systemic hypertension.

Acute Exacerbation of Chronic Obstructive Pulmonary Disease in Rural Area: Why, How, and What Next?

Background: Acute exacerbation of chronic obstructive pulmonary disease (AECOPD) leads to fall in lung function, quality of life, and ultimately disease progression. The present study is an effort to study in detail about COPD exacerbation in a rural tertiary hospital. Aim: To study demographic, clinical, and laboratory profile of hospitalized patients of AECOPD. Methodology: Retrospective data of 170 consecutive patients of AECOPD were collected from records, were divided into two groups based on severity, and were analyzed: Group 1 for admission in the wards and Group 2 for intensive care unit (ICU) admissions. Results: A total of 141 (82.9%) patients were hospitalized in the wards, whereas 29 (17.1%) were admitted in the ICU. The mean age was 62.36 years in the wards and 64.89 years in the ICU. Nearly 89.4% of patients were smokers. Dyspnea (100%) was the most common symptom followed by cough (99%) and expectoration (98%). The mean respiratory rate at the time of presentation was 26/min in the wards and 31.56/min in the ICU. The mean oxygen saturation was 93% in the wards and 88.62% in the ICU. The mean post forced expiratory volume in 1 s (FEV1) was 43.98% in ward patients and 29.28% among ICU patients. Arterial blood gas revealed mean PaCO2 of 44.25 mmHg in the wards and 63.24 mmHg in the ICU. The mean pH in the ward was 7.48 compared to 7.34 in the ICU. The mean pulmonary arterial pressure (PAP) was higher in the ICU (53.74 mmHg) than in the ward (38.87 mmHg). Conclusion: The ratio of hospitalization in ICU to ward was 1:5. The site of treatment depends on respiratory rate, oxygen saturation, post-FEV1%, PAP, pH, and PaCO2.

Group Medical Visits for Addressing Weight and Blood Pressure in an Underserved Population.

The effect of group medical visits (GMV) compared to individual medical visits (IMV), on weight and blood pressure in a large primary care practice serving a predominantly underserved population, was assessed. The records of 304 patients attending a weight-loss program were analyzed using mixed-effects regression models. Patients in GMV lost an average of 11.63 lbs, whereas patients in IMV lost an average of 3.99 lbs (p &lt; 0.001). A total of 55% of patients lost ≥7% in GMV compared to 11% of patients in IMV (p ≤ 0.001). Individuals who lost &gt;5% of their baseline weight had a higher reduction in overall blood pressure. For systolic and diastolic blood pressure, the differences between baseline and three months for GMV and IMV were -7.4 vs. 4.1 mm of Hg (p = 0.002) and -4.6 vs. 4.2 mm of Hg (p = 0.003), respectively. Results from this study demonstrate that GMV may be a potentially useful modality for addressing weight and blood pressure in an underserved population.

Retrospective Study of a Sustained-Release Intracanalicular Dexamethasone Insert for Treatment of Ocular Inflammation After Cataract and Corneal Surgery.

To evaluate the effectiveness and safety of a sustained-release intracanalicular dexamethasone insert (Dextenza, Ocular Therapeutix, Inc.) as an adjunctive therapy in patients undergoing cataract and corneal surgery. This retrospective case series contains 18 patients undergoing cataract surgery and 6 patients undergoing corneal surgery. All patients received the Dextenza intracanalicular insert. 6/18 of the patients in the cataract surgery arm were on the standard of care post-surgery topical steroid drop regimen, whereas 11/18 of the patients were on a reduced regimen. 1/18 of the patients was on a drop regimen that deviated from the aforementioned regimens. 2/6 of the patients in the corneal surgery arm were on the standard of care post-surgery topical steroid drop regimen, whereas 3/6 of the patients were on a reduced regimen. 1/6 of the patients were on a drop regimen that deviated from the aforementioned regimens. The primary outcome measures are intraocular pressure (IOP) levels and anterior chamber inflammation levels across the post-operative recovery period. 1/18 of the patients in the cataract surgery arm and 1/6 of the patients in the corneal surgery arm experienced a clinically significant IOP spike greater than 10 millimeters of mercury (mmHg) above baseline IOP. No patient in either of the study groups had significant inflammation after 1 week post-surgery. 1/18 of the patients in the cataract surgery arm and 1/6 of the patients in the corneal surgery arm experienced a canalicular obstruction. Dextenza with the lower drop protocol showed non-inferiority in terms of inflammation management and safety. As with any steroid delivery mechanism, monitoring IOP is paramount when using Dextenza. One of the patients with a canalicular obstruction had a history of punctal plug implantation, so care should be taken when choosing to implant Dextenza in such a patient.

Acute bilateral glaucoma related to uveal effusion syndrome associated with topiramate

AbstractPurpose: Drugs mostly sulfa‐related compounds, have produced uveal effusions, forward rotation of the iris‐lens diaphragm, transient myopia, and secondary angle closure. It has been recently encountered one case in which uveal effusions have occurred after administration of topiramate, a new anticonvulsant medication.Methods: A 54‐year‐old woman was seen in our emergency department with severe headaches, progressively blurry vision and photophobia in both eyes starting that morning. On examination, her visual acuity was hand movement in both eyes. Central corneal edema was observed, narrow chamber and anterior lens‐iris complex displacement with an unreactive middle pupil in both eyes. The funduscopic examination was difficult to assess due to the media opacity. Intraocular pressure measured with an applanation tonometer was 45 mm of mercury (mmHg) in the right eye and 50 mmHg in the left eye. Her medications included topiramate which she had started 2 weeks prior to initial examination due to headaches followed by neurology.Results: Topiramate‐induced angle closure has even been described as an idiosyncratic reaction in patients with normal depth of anterior chamber. The drug causes a prostaglandins increasement that trigger ciliary body edema at the local level but without acting at the systemic level. Ultrasound biomicroscopy shows the presence of a ciliochoroidal effusion syndrome, edema and the ciliary body anterolateral rotation, with zonular relaxation, changes that lead to iris‐lens diaphragm anterior displacement and, as a consequence, narrowing of the responsible anterior chamber with an acute glaucoma crisis.Conclusions: Topiramate is a sulfamate monosaccharide and belongs to a new generation of antiepileptic drugs, widely prescribed throughout the world as treatment of generalized tonic–clonic seizures and partial seizures. Prophylaxis of migraine, bipolar disorder, depression and neuropathic pain are other recent indications of its use. Bilateral acute glaucoma due to uveal effusion syndrome should be considered as an infrequent complication of topiramate use.References.1. Prithvi S. Sankar, MD; Louis R. Pasquale et al. Uveal Effusion and Secondary Angle‐Closure Glaucoma Associated With Topiramate Use. Arch Ophthalmol. 2001;119(8):1210–1211.

This Month in Pediatric Urology

You have accessJournal of UrologyThis Month in Pediatric Urology1 Dec 2022This Month in Pediatric Urology Julian Wan Julian WanJulian Wan More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003003AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail Improved Vesicoureteral Reflux Assessment With Simple and Machine Learning Approaches An important step to treating any disease is to accurately describe and classify its presentation. Reproducible designation of stage or severity allows for meaningful analysis. This is particularly true when pooling data and running multicenter trials. Superficially, one would expect this effort to be simple, robust, and easily portable. Methods based on an interval scale (eg, height in centimeters, blood pressure in millimeters of mercury), appear to be straightforward but require consistent mensuration. Categorical methods need clear, consistent descriptions and assignment (eg, egg sorting into small, medium, large, extra-large by a template). One might assume that the classification of vesicoureteral reflux (VUR) might be a simple matter given the widespread use of the International Reflux Study system and the ready availability of illustrations and examples.1 Despite these aids, the agreement of VUR has been low. One notion advanced to resolve this issue is to automate the process. Khondker et al (page 1314) describe a multi-institutional effort to assess the utility of a machine learning system (qVUR) to help improve VUR grading reliability.2 Using data gathered from 1,492 kidneys with over 8,000 independent grades the human inter-rater reliability was only 0.44 and there was low intra-rater reliability. The program was an improvement and achieved an accuracy of 62%. The program notably does not consider calyceal dilation or distortion because the finding was too easily confounded by contrast volume and kidney rotation. While this improvement may seem small, further testing after training showed a threefold improvement on grading reliability. While novel to medicine, the use of machines to perform measurements and improve quality assessment in commercial manufacturing is widespread. The mass manufacture of complex devices (eg, automobiles, airplanes, computers) while keeping high quality has been possible in part due to automated quality assessment and improvement. A key part of this effort is the automation of quality assurance. Once a human quality assurance worker would periodically take random samples of components and carefully record and track variations. Now, machine vision systems can assess every widget and software can track the variation and note when these variations cease being random and start trending towards being out of tolerance. These methods are applicable to not just wholly manufactured products but also to items and processes where there is inherent natural variation, such as potato chips.3 Whether such machine systems for VUR will supplant human grading remains to be demonstrated. Improvements would help increase reliability and help create uniformly classified pools of data for large-scale research.

Efficacy and Safety of Suprachoroidal Administration of Triamcinolone Acetonide in Patients of Refractory Diabetic Macular Edema

Background: To determine the efficacy and safety of suprachoroidal administration of triamcinolone acetonide in patients of refractory diabetic macular edema. Study setting: This study was conducted from September 2020 to April 2021 in the department of Ophthalmology FMU/Allied Hospital Faialabad. Study design was quasi experimental Materials and methods: sample size was 45, through non probability consecutive sampling. All 45 patients with refractory diabetic macular edema were enrolled and following parameters e.g Best corrected visual acuity (less than 20/40 on Snellen Visual acuity Chart),IOP &lt; 21 mm of Hg, Central macular thickness &gt;300 micrometers, were recorded as baseline at the start of study. Suprachoroidal triamcinolone acetonide injection 0.1 ml given to these 45 patients. Same parameters e.g Best Corrected visual acuity, Intraocular pressure, Central Macular Thickness were measured at each follow-up visit. First follow-up visit was conducted on next day then one week , one month and in third month. Results: In this study, mean of age was 50.71 ± 7.05 years. 23(51.1%) were males and 22(48.9%) were females. Pre-treatment Intra ocular pressure, best corrected visual acuity and macular thickness were 13.4± 1.9 mmHg ,0.72± 0.11 and 638.04 ± 133.9 micrometers respectively. After one-month Intra ocular pressure, Best corrected visual acuity and Central macular thickness were 13.71 ± 2.61 mmHg, 0.48± 0.11 and 314.11 ±53.8 micrometer and after three months 13.24±1.26mmHg, 0.46±0.12 and 306.9±49.52 micrometer respectively. Statistical significant difference was found for pre and post Best corrected visual acuity and Central macular thickness (p-value &lt;0.0001).In two (4.4%) patients, intra ocular pressure was raised. Practical implication: This study was highlighted safety and efficacy of suprachoroidal injection of triamcinolone acetonide in cases of refractory diabetic macular edema Conclusion: Suprachoroidal Triamcinolone acetonide injection is proved to be safe and effective treatment modality for the patients of refractory diabetic macular edema as it decreases central macular thickness and improves best corrected visual acuity. Keywords: Diabetic macular edema, Suprachoroidal, Triamcinolone acetonide, Intra ocular pressure, Optical coherence tomography, visual acuity.

TO STUDY THE VISUAL OUTCOME AND IOP CHANGES AFTER ND: YAG LASER CAPSULOTOMY

Aims and objectives : To study the Visual outcome and IOP changes after Nd YAG Laser Capsulotomy in patients with posterior capsular opacity. To study the age and sex distribution. To study intra and post laser complications of Nd YAG Laser Capsulotomy. Materials and Methods: This was a Prospective interventional study done on 100 eyes of 100 Post Cataract surgery patients who are having PCO attending to OPD of Ophthalmology department, Dr. R.S.P.R Government Regional eye hospital, Andhra Medical College, Visakhapatnam from August 2021 to August 2022. Relevant detailed History and Ocular examination was done. Results: Majority of the patients are in the age group of 51-60yrs(36%). Females (54%) are more than Males(46%). Fibrous type is seen in majority of cases(45%). The mean IOP is more at 2hrs post Laser treatment. 1- 5 mmHg rise is seen in majority of cases(70%). 85% of patients showed best corrected visual acuity better than 6/18. 15% patients showed visual acuity less than 6/24. Elevation of IOP (&gt;4 mm of hg) is the most common complication (46%) and Pitting of IOL (5%) after Nd: YAG Laser Capsulotomy. Conclusion: Visual improvement is excellent after Nd: YAG Laser Capsulotomy. Transient rise of IOP is the most common complication. Even though transient, it may be detrimental to the health of of the optic nerve head. So a careful monitoring of IOP before and after Nd:YAG Laser Capsulotomy is very much needed.

Chickpea Peptide: A Nutraceutical Molecule Corroborating Neurodegenerative and ACE-I Inhibition.

Chickpea seeds are the source of proteins in human nutrition and attribute some nutraceutical properties. Herein, we report the effects of chickpea seed bioactive peptide on albumin, insulin, lactoglobulin and lysozyme amyloid fibril formation. Employing thioflavin T (ThT) assays and circular dichroism (CD), amyloid structural binding transition was experimented to analyze the inhibition of amyloid fibril formation. The purified active peptide with a molecular mass of 934.53 Da was evaluated in vitro for its ACE-I inhibitory, antibacterial, antifungal and antidiabetic activities. Further, in vivo animal studies were carried out in wistar rats for blood pressure lowering action. In hypertensive rats, chickpea peptide decreased 131 ± 3.57 mm of Hg for systolic blood pressure and 86 ± 1.5 mm of Hg for diastolic blood pressure after 8 h intraperitoneal administration. Additionally, the peptide suppressed the fibrillation of amyloid and destabilized the preformed mature fibrils. Data emphasize efficacy of chickpea peptide vis-a-vis ACE-Inhibitory, antibacterial, antifungal, antidiabetic and anti-amyloidogenic activities, allowing us to propose this novel peptide as a suitable candidate for nutraceutical-based drugs and seems the first kind of its nature.

Abstract 14223: Lifetime Smoking Behaviors, Frequency of Worship and Systolic Blood Pressure in the Metabolic Syndrome Outcome (MetSO) Cohort Study

Introduction: Research has shown faith-based intervention can influence a net reduction of 5.8 millimeters of mercury in systolic blood pressure 1 . This study examined the relationships between lifetime smoking behaviors and systolic blood pressure (BP) in a diverse sample of Blacks residing in New York City and whether this relationship is moderated by frequency of visit to place of worship. Method: The present study utilized data from the MetSO study, an NIH-funded cohort study of blacks with metabolic syndrome (MetS). A total of 1035 were screened for MetS in the MetSO registry. The average age of the sample was 62±14 years (range: 20-97); 71% were female, and all were of the black race/ethnicity. Seventy-one percent reported finishing high school, and 43% reported annual income &lt;10K. Patients were diagnosed with MetS using standard criteria articulated in the joint interim statement for harmonizing the MetS. Data was gathered on demographics, health behaviors and religious practices. Participants were asked about their smoking habits and alcohol consumption, as well as their religious practices. Correlation matrix and multilinear regression analysis were conducted to explore associations between smoking behaviors and blood pressure level. Interaction effects between smoking behaviors and potential moderators (frequency of visits to place of worship) were conducted to examine which category was at greater risk of higher systolic blood pressure. Results: Surprisingly, lifetime smoking habits were positively correlated with frequency of visit to place of worship (r =.41; p=.000) and emerged as the strongest independent predictor of systolic BP [β =.084(SE=1.068); p&lt; 0.001], after adjustment for age, employment and daily alcohol consumption. The association between lifetime smoking habits and systolic BP was moderated by the frequency of visits to place of worship [B(SE)=.098 (.150); p&lt; 0.001]. Conclusions: Results of our study suggest that frequency of visit to place of worship is linked with lifetime smoking habits, which may have significant impact on systolic blood pressure among diverse older Blacks.

Effect of tracheal tube cuff inflation with alkalinized lidocaine versus air on hemodynamic responses during extubation and post-operative airway morbidities in children: prospective observational cohort study, Ethiopia

BackgroundEndotracheal tube with an inflated cuff was used to manage and maintain the airway during general anesthesia in children. When the lateral pressure exerted by an inflated Endotracheal tube cuff on tracheal mucosa exceeds capillary perfusion pressure, patients may complain of cough, sore throat, and hoarseness in the postoperative period. This study aimed to assess the effect of a tracheal tube cuff filled with alkalinized lidocaine versus air on hemodynamic parameter changes during extubation and post-operative airway morbidity in children.MethodsInstitutional based observational prospective cohort study was conducted among 56 elective children; aged 3–13 years, who underwent operation under general anesthesia with cuffed endotracheal intubation for greater than one hour by grouping into the air (group1) and alkalinized Lidocaine (group2) at Tikur Anbessa specialized Hospital. Hemodynamic parameters (Heart rate and Blood pressure) and other variables were measured starting from 5 min before extubation to 24th hours after extubation of the endotracheal tube. A Comparison of numerical variables between study group was done with an independent t-test. Data were expressed in terms of mean ± standard deviation. Categorical data were assessed by Chi-square tests.ResultsPostoperative Sore throat was lower in alkalinized lidocaine group compared to the air group. The mean heart rate at five minutes after extubation was significantly lower in alkalinized lidocaine group (107.29 ± 6.457 beat per minute (bpm)) compared to the air group (122.04 ± 8.809 bpm), with P ≤ 0.001. Systolic blood pressure was also significantly lower in alkalinized lidocaine group (99.64 ± 8.434 millimeters of mercury (mmHg)) compared to the air group (108.21 ± 11.902 mmHg), p = 0.016 at five minutes after extubation.ConclusionAlkalinized lidocaine inflated tracheal tubes have shown improved hemodynamic and laryngotracheal morbidities in children.

PMON265 First Ever Placebo-Controlled Randomised Study of Testosterone on Ambulatory Blood Pressure and Heart Rate in Hypogonadal Men With Uncontrolled Type 2 Diabetes – STRIDE Study

Abstract Background Testosterone has been historically believed to increase blood pressure(BP) and hence bad for heart despite no convincing evidence to prove this. Self-administered use of anabolic steroids has adverse cardiac effects including hypertension. Many RCTs that have looked at the effect of TRT have been BP measurements using mercury sphygmomanometer. Our study is the first RCT looking at the effect of testosterone on ambulatory BP in patients with type 2 diabetes and hypogonadism. Research design and methods: This is a randomised double blinded placebo-controlled add-on trial of intramuscular testosterone undecanoate (Nebido®) administered every 12 weeks in 65 hypogonadal men with poorly-controlled diabetes. Phase 1 patients were randomly assigned to either treatment or placebo arm for 6 months of TRT. Phase 2 was an open-labelled phase for 6 months and patients on placebo moved on to the treatment group wherein patients in the treatment group continued. Diurnal Ambulatory-BP measurements were performed with Spacelabs 90217 mounted on the non-dominant upper arm over 24-hours. Results Mean age of the cohort was 59(42-77)years. 55.4% of the patients had hypertension at baseline. Baseline characteristics were comparable between active/placebo groups apart from cardiovascular disease and hypertension which were significantly higher in the active group compared to placebo group (n=28 vs n=18, p=0.05), (n=23 vs n=13, p=0.008) respectively. There was no significant difference in 24-hours ambulatory average SBP or DBP before and after TRT for 6 months (SBP p=0.407, DBP p=0.649). There were no significant changes in average daytime or night-time SBP (p=0.291), (p=0.295) respectively or average daytime DBP (p=0.566) or night-time DBP (p=0.879) either. There was no significant difference in the total average heart rate and day time average heart rate however night time average heart rate showed a significant reduction of around 4 beats/minute (p=0.046) between the two groups at 6 months. There was no significant difference in the values for the above parameters in the normotensive group (average baseline ambulatory BP≤ 140/90 mm of Hg) and hypertensive group (≥ to 140/90 mm of Hg) either. There was no change in antihypertensive medications in the first 6 months. Mean 24-hour ambulatory BP components were compared at 0, 3, 6, 9 and 12 months for participants in the active group before and after treatment with testosterone undecanoate. There was no significant change in the total, day or night-time systolic or diastolic BP levels before and after the treatment. Conclusions Our study concludes that testosterone given as a replacement hormone in hypogonadal patients with type 2 diabetes does not increase 24-hour ambulatory systolic or diastolic BP. Our study also shows that testosterone causes a decrease in average night-time heart rate of 4 to 5 beats/minute and the cause and significance of such a decrease needs further detailed evaluation. Presentation: Monday, June 13, 2022 12:30 p.m. - 2:30 p.m.

7763 Hysteroscopic Morcellation (with Bigatti Shaver) Under Laparoscopic Guidance: A Novel Approach to Management of Caesarean Scar Pregnancy

<h3>Study Objective</h3> To present our experience in treating cases with caesarean scar pregnancy by hysteroscopic morcellation using Bigatti Shaver over a period of 1 year. <h3>Design</h3> Longitudinal prospective study for 1 year & follow up done till beta HCG level comes to normal. <h3>Setting</h3> Patients positioning in the OT table: Lithotomy position, 45-degree angle between OT table & patients elevated legs. 2 Endomat Select: one for irrigation & other for suction, RPM-2100, Irrigation: 200-250 ml/min, Pressure: 150mm of Hg <h3>Patients or Participants</h3> 10 women between age 22-35years presented to us in the OPD with caesarean scar pregnancy confirmed on their dating ultrasound. <h3>Interventions</h3> Pre operative investigations were done prior to surgery and under laparoscopy they were posted for surgical intervention - removal of scar pregnancy by Bigatti Shaver. <h3>Measurements and Main Results</h3> • No fertility desired by the patient further, so patient should be tubectomised • It should be done till 7 weeks of period of gestation • Myometrial thickness should be between 2 to 4 mm <h3>Results</h3> 1. None had any intra or post operative complications. 2. Average duration of procedure: less than half an hour & blood loss less than 100ml. 3. Serial Beta HCG from the day of discharge and weekly therefore done, which returned to non-pregnant levels by end of 4 weeks. <h3>Conclusion</h3> Hysteroscopic morcellation is a convenient and effective mode of management of caesarean scar pregnancy with excellent safety profile and patient satisfaction rates.