La hipertensión no controlada se asocia con hipotensión posprandial / Uncontrolled Hypertension is Associated with Postprandial Hypotension

Introducción: En un estudio previo que incorporó mediciones posalmuerzo al esquema convencional de monitoreo domiciliario de la presión arterial hemos detectado hipotensión posprandial en alrededor de la cuarta parte de nuestros pacientes hipertensos. Objetivos: Comparar el cambio posprandial de la presión arterial sistólica, y la correspondiente respuesta cronotrópica, en relación con el control de la hipertensión. Material y métodos: Se evaluaron prospectivamente con monitoreo domiciliario de la presión arterial 140 pacientes hipertensos tratados, mayores de 40 años. El control de la hipertensión se basó en el promedio de la presión arterial matinal y la vespertina, tomando como valor de corte 135/85 mm Hg. Se consideró hipotensión posprandial cuando la presión arterial sistólica disminuyó 20 mm Hg o más respecto del valor preprandial en al menos uno de tres almuerzos. Resultados: Se detectó hipotensión posprandial en el 13,2% (n = 10) de los hipertensos controlados y en el 42,2% (n = 27) de los no controlados (p < 0,001). Después de los almuerzos, la presión arterial sistólica disminuyó en promedio 9,5 ± 10,5 mm Hg (6,4% ± 7,8%) en los hipertensos no controlados y 3,2 ± 7,8 mm Hg (2,6% ± 6,5%) en los controlados (p < 0,001), sin diferencia significativa en la respuesta cronotrópica. Al estratificar a los pacientes por el control de la hipertensión se observó una correlación inversa entre la respuesta posprandial de la frecuencia cardíaca y de la presión arterial sistólica en los controlados (r = -0,24; p = 0,035), sin relación significativa en los no controlados. En el análisis de regresión lineal múltiple, la falta de control de la hipertensión (beta = -0,26; p = 0,002) y el sexo femenino (beta = 0,22; p < 0,001) fueron predictores significativos de la caída posprandial en la presión arterial sistólica, sin influencia significativa de la edad o del número de fármacos antihipertensivos. Conclusión: La falta de control de la hipertensión se asoció con una respuesta circulatoria posprandial anormal que favorece la hipotensión.

Background: In a previous study that incorporated post-lunch measurements to the conventional scheme of home-based blood pressure monitoring, we detected postprandial hypotension in about a quarter of hypertensive patients. Objectives: The aim of this study was to compare the postprandial change of systolic blood pressure, and the corresponding chronotropic response, associated to the control of hypertension. Methods: We prospectively evaluated 140 treated hypertensive patients, aged over 40 years, with home-based blood pressure monitoring. The control of hypertension was based on the average morning and evening blood pressure, considering 135/85 mmHg as cutoff value. Postprandial hypotension was defined as a drop in systolic blood pressure equal to or greater than 20 mmHg with respect to the preprandial value in at least one of three lunches. Results: Postprandial hypotension was found in 13.2% (n=10) of patients with controlled hypertension and in 42.2% (n=27) with uncontrolled hypertension (p<0.001). After lunch, the average decrease of systolic blood pressure was 9.5±10.5 mmHg (6.4%±7.8%) in patients with uncontrolled hypertension and 3.2±7.8 mmHg (2.6%±6.5%) in those with controlled hypertension (p<0.001), with no significant difference in the chronotropic response. After stratifying the patients by hypertension control, the postprandial response of heart rate and systolic blood pressure showed a significant inverse correlation in controlled hypertensive patients (r=-0.24; p=0.035), and a not significant correlation in uncontrolled patients. On the multiple linear regression analysis, lack of blood pressure control (beta=0.26, p=0.002) and female gender (beta=0.22; p<0.001) were significant predictors of a postprandial drop in systolic blood pressure, without a significant influence of age or number of antihypertensive drugs. Conclusion: Lack of blood pressure control was associated with an abnormal postprandial circulatory response that predisposes to hypotension.

Dosimetric and Clinical Influence of 3D Versus 2D Planning in Postoperative Radiation Therapy for Gastric Cancer / Journal of the Korean Cancer Association, 대한암학회지

PURPOSE: The purpose of this study is to investigate the dosimetric and clinical influence of computed tomography-based (3-dimensional [3D]) simulation versus conventional 2-dimensional (2D)-based simulation in postoperative chemoradiotherapy (CRT) for patients with advanced gastric cancer in terms of parallel opposed anteroposterior-posteroanterior field arrangement. MATERIALS AND METHODS: A retrospective stage-matched cohort study was conducted in 158 patients treated with adjuvant CRT following curative surgery and D2 dissection from 2006 to 2008 at Samsung Medical Center: 98 patients in the 3D group; and 60 patients in the 2D group. For comparison of the dosimetric parameters between 3D plan and 2D plan, second sets of radiation treatment plans were generated according to the same target delineation method used in the 2D group for each patient in the 3D group (V2D). Acute toxicity, recurrence, and survival were analyzed. The median follow-up period was 28 months (range, 5 to 51 months). RESULTS: The 3D group showed better dose-volume histogram (DVH) profiles than the V2D group for all dosimetric parameters, including the kidneys, liver, spinal cord, duodenum, pancreas, and bowel. However, no difference in acute gastrointestinal toxicity and survival outcomes was observed between the 3D group and the 2D group. CONCLUSION: The 3D plan enabled precise delineation of the target volume and organs at risk by visualization of geometric changes in the internal organs after surgery. The DVH of normal tissues in the 3D plan was superior to that of the V2D plan, but similar clinical features were observed between the 3D group and the 2D group.

Infectious aetiology of congenital cataract based on torchesTORCHES screening in a tertiary eye hospital in Chennai, Tamil Nadu, India.

Background & objectives: We undertook this study to determine the infectious aetiology of congenital cataract based on the presence of IgM antibodies to TORCHES [(Toxoplasma gondii (T. gondii), Rubella virus (RV), Cytomegalovirus (CMV), Herpes simplex virus (HSV) and Syphilis (caused by Treponema pallidum)] in the serum samples of congenital cataract patients. Methods: Serum samples collected from 593 infants and children (10 days to 12 months old) with clinically diagnosed congenital cataract at Sankara Nethralaya, a referral eye hospital in Chennai, were tested for the presence of specific IgG and IgM antibodies to T. gondii, RV, CMV, HSV by ELISA and specific treponemal antibodies by T. pallidum haemagglutination test (TPHA). Results: IgM antibodies were detected against T. gondii in 1.7 per cent, RV in 8.4 per cent, CMV in 17.8 per cent and HSV in 5.1 per cent, and that of specific IgG in 8.9, 25.0, 66.1 and 2.6 per cent respectively. Presence of IgM antibodies to T. Gondii in the study group was significantly lower when compared to IgM antibodies to RV, CMV and HSV. All serum samples were negative for the presence of anti treponemal antibodies by TPHA. Overall, IgM antibodies to one or more of the four infectious agents were detected in 20.2 per cent of the study population, and among these co-infections to more than one infectious agents were detected in 12.5 per cent. Interpretation & conclusion: The results of the present retrospective analysis showed association of RV, CMV, HSV and T. gondii with congenital cataract based on the presence of specific IgM antibodies.

Application of PCR based - RFLP for species identification of ocular isolates of methicillin resistant staphylococci (MRS).

Background & objectives: Early detection of methicillin resistant staphylococci (MRS) from clinical specimens enables institution of appropriate antimicrobial therapy. Limited information is available on speciation of MRS. This study was undertaken to compare results of conventional and molecular methods in detection of methicillin resistance (MR) and application of PCR-restriction fragment length polymorphism (RFLP) and DNA sequencing for speciation of ocular isolates of MRS. Methods: A total of 110 consecutive ocular staphylococcal isolates were screened for MR. MRS was speciated by PCR-RFLP of gap gene and results were confirmed by DNA sequencing. All isolates were processed within 48 h of isolation. A single colony of bacterium, stocked as stab cultures in Hyer’s and Johnson agar, was stored at 40C and sub-cultured at every 15 days interval. Results: Seventy (63.6%) of 110 isolates were identified as MRS and 40 (36.4%) were MSS by conventional and molecular method (100% correlation). Of the 70 MRS, 18 (25.7%) were Staphylococcus aureus, remaining 52 (74.3%) were CNS by conventional and molecular method (100% correlation). PCR-RFLP of gap gene identified 18 (25.71%) MRS as S. aureus, 11 (15.71%) S. epidermidis, 27 (38.57%) S. haemolyticus, 6 (8.57%) S. cohnii subsp. urealyticum, 6 (8.57%) S. equorum, 1 (1.42%) S. xylosus and 1 (1.42%) S. hominis. Interpretation & conclusions: Overall rate of isolation MRS was 63.6 per cent and were predominantly isolated from conjunctival swab (23.6%) and donor corneal scleral rim (23.6%) of non hospitalized patients indicating their community origin. Detection of MR by mecA gene was easier and less time consuming compared to conventional methods. Speciation of MRS was possible by gap gene PCR - RFLP and the predominant MRS in our study was S. haemolyticus.

Seroprevalence of human immunodeficiency virus, hepatitis B virus and hepatitis C virus among eye donors.

Blood specimens collected at the time of enucleation of the eyes from 483 consecutive eye donors were tested for sero-markers of Human Immunodeficiency Virus (HIV), Hepatitis B Virus (HBV) and Hepatitis C Virus (HCV). Antibodies to HIV1 were detected in 3 (0.62%), HBsAg in 17 (3.52%) and antibodies to HCV in 7 (1.45%).

Timing of nephrology referral: Its impact on mortality and morbidity

OBJECTIVES: To determine the effect of the timing of nephrology referral, whether early (ER) or late (LR), on morbidity and mortality of dialysis patients Study Design: Cohort, retrospectiveMATERIALS AND METHODS: We retrospectively reviewed all patients with CRF who were dialyzed for the first time in the Center for Kidney Diseases of the University of Santo Tomas Hospital from January 1 to December 31, 2000. Included cases were classified as either early referral or late referral patients. Excluded in this study were patients with severe acute renal failure (ARF), those who had undergone acute peritoneal dialysis for whatever cause, those with malignancies, those who transferred to another dialysis unit and those who were lost to follow-up.RESULTS: Among 104 patients, 45 (43.3 percent) were included in the study. Sixteen cases (35.6 percent) were timed as ER and 29 (64.4 percent) as LR. There was no difference in the age, sex, comorbid illness and type of renal diseases in both groups. The mean values of BUN, serum creatinine were higher in the LR group. Majority (50 percent) of the ER group had creation of AV fistula at the onset of the first dialysis. The initial morbity was longer in the LR group (mean, 20.48 +/- 11.55 days). The need for emergent dialysis was similar in both groups. There was no difference in the mortality rate in both groups (ER 75 percent, LR 62 percent). Likewise, survival analysis showed no difference in the two groups at twelve months.CONCLUSION: To our knowledge, this is the first study in the Philippines that focused on CRF patients early or late referral status, and its effects on morbidity and mortality. Further studies are needed to determine whether these results are linked with dialysis modalities, psychosocial conditions and socioeconomic factors. Widespread dissemination of clear guidelines for general practitioners and non-nephrologists, interventions to promote early diagnosis and adequate pre-dialysis follow-up and development of educational programs for the patients need to be evaluated since they appear to be important in improving the survival of CRF patients.