Blood Pressure Indices in Children with Sickle Cell Disease, of Age 8-18 Yrs. at a Tertiary Care Centre in Chhattisgarh- A Cross Sectional Study.

Sickle cell disease is the commonest haemoglobinopathy. Anaemia leads to a hyperdynamic circulation, decreased systemic resistance, and sickle polymerization causing hyperviscosity, natriuresis and hyposthenuria that blunt the maximal plasma volume expansion interplay to affect blood pressure indices. Asian and African continents have a high share of sickle cell population, being historically malaria endemic areas. These populations have previously witnessed early death due to complications from sickle cell disease. With the recent advanced therapeutic approaches, sickle cell patients are surviving beyond adulthood. Increased survival has resulted in a new subset of sickle cell patients which is exposed to the effects of persistent haemolytic anaemia and the haemodynamic alterations. These effects have not been studied in sickle cell patients in the state of Chhattisgarh. Most of the studies conclude that sickle subjects have lower systolic, diastolic and mean blood pressure and higher pulse pressure. METHODSParticipants were all sickle cell anaemia patients with SS pattern under the age group 8 to 18 yrs. from the Paediatric Department of the Pt J N M Medical College and associated Dr B R A M Hospital, Raipur and the controls were healthy age matched patients without any haemoglobinopathy. This study documented blood pressure indices - systolic blood pressure, diastolic blood pressure, mean blood pressure and pulse pressure in children with sickle cell disease and comparable controls presenting to a tertiary medical college hospital in Chhattisgarh. RESULTSThe present cross sectional study reveals no difference in these blood pressure indices of systolic blood pressure, diastolic blood pressure, mean blood pressure and pulse pressure between sickle and control subjects. Data was tabulated for 50 patients of sickle cell disease and 50 healthy controls without any haemoglobinopathy. The study concluded that the mean systolic blood pressure in sickle cell patients and control group was 119.46 ± 8.32 & 117.14 ± 8.10 (p=0.161), the diastolic blood pressure was 73.42 ± 7.88 & 72.60 ± 6.62 (p=0.575), mean blood pressure was 137.71 ± 11.44 & 135.85 ± 9.91 (p=0.385) and the pulse pressure was 46.04 ± 10.13 & 44.52 ± 9.00 (p=0.430) respectively. CONCLUSIONSThe blood pressure indices in sickle cell patients in India vary from those observed in other studies from other countries. It is possible that the sickle population in the present study may be having relative systemic hypertension that can be ascertained with future studies.

Presión arterial media: ¿importa el uso de escaleras? / Mean arterial pressure: does the use of stairs matter?

Objetivo: Determinar si el uso diario de escaleras se relaciona con valores de presión arterial media, en un grupo de habitantes de un conjunto residencial con edificios de 4 pisos. Materiales y métodos:Estudio descriptivo, transversal. Se tomó la presión arterial a 125 sujetos sanos (50,4% mujeres) residentes en los 4 pisos de cada uno de los 4 edificios de un conjunto residencial. Se compararon los valores de presión arterial media según el piso de residencia mediante ANOVA de un factor y prueba de Bonferroni, y se estratificó el análisis según edad, sexo, obesidad, fumar, beber alcohol con frecuencia y actividad física. Resultados: Se encontró relación significativa (p<0,05) entre el promedio de presión arterial media y el piso de residencia, siendo marcadas las diferencias especialmente entre el piso uno y el cuatro (p<0,05). Se encontró significancia estadística (p<0,05) al estratificar los valores de presión arterial media según sexo masculino, obesidad abdominal y fumar. Conclusión: En los adultos sanos, participantes en el estudio, hubo un efecto benéfico en el uso diario de escaleras con respecto a los valores de presión arterial media.Palabras clave: Actividad física, presión arterial media, escaleras, obesidad, fumar

Objective:To determine if the daily use of stairs is related to values of mean arterial pressure, in a group of inhabitants of a residential complex with buildings of 4 floors.Materials and methods:Descriptive, cross-sectional study. Blood pressure was taken to 125 healthy subjects (50.4% women) living in the 4 floors of each of the 4 buildings of a residential complex. The values of mean arterial pressure were compared according to the residence floor by means of one-way ANOVA and Bonferroni test, and the analysis was stratified according to age, sex, obesity, smoking, frequent alcohol drinking and physical activity.Results:A significant relationship was found (p <0.05) between the meanarterialpressure average and the residence floor, the differences being marked especially between floor one and four (p <0.05). Statistical significance was found (p <0.05) when stratifying mean arterialpressure values according to male sex, abdominal obesity and smoking.Conclusion: In healthy adults, participants in the study, there was a beneficial effect in the daily use of stairs with respect to the values of mean arterial pressure.

Factors affecting ambulatory blood pressures in treated hypertensive patients / 第二军医大学学报

Objective To explore the factors affecting the circadian rhythm of blood pressure in treated hypertensive patients. Methods Based on the clinical data, ambulatory blood pressure, 24-hour mean blood pressure (24hMBP) and circadian rhythm, 125 consecutive patients receiving antihypertensive treatment were divided into the following groups: normal 24hMBP and dipper type (type I), abnormal 24hMBP and dipper type(type E), abnormal 24hMBP and non-dipper type (type I), and normal 24hMBP and non-dipper type (type IT). The clinical data and ambulatory blood pressure of the latter three groups were compared. Non-conditional Logistic regression was used to analyze the factors for ambulatory blood pressure. Results Ninety patients had abnormal 24hMBP (72. 0%), and 106 (84. 8%) had abnormal circadian rhythm. Among these cases, 2 (1.6%) patients had type I, 17 (13.6%) had type TJ, 73 (58.4%) had type I, and 33 (26.4%) had type IT. The incidence of kidney disease in patients with abnormal 24hMBP was significantly higher than those with normal 24hMBP (P< 0. 05). The incidence of diabetes mellitus in patients with abnormal circadian rhythm (non-dipper type) was higher than those with normal circadian rhythm (dipper type), with the highest incidence seen in patients of type IT (P<0. 05); the rates of calcium channel blocker (CCB) use and a daily morning dose administration in type TV patients were higher than those in type II and type III patients (P<0. 05). Type IT group had the most severe abnormal ambulatory blood pressure among the latter three groups. Logistic regression analysis showed that complication with renal diseases (OR=0. 301, 95%CI:0. 124-0. 729, P = 0. 008), use of CCB (OR = 2. 191,95%CI: 0. 967-4. 966,P = 0. 048), and administration of a morning dose (OR = 2. 384,95% CI: 1. 017-5. 591,P = 0. 046) were the factors of ambulatory blood pressure. Conclusion Abnormal circadian rhythm of blood pressure is high in patients receiving antihypertensive treatment. Complication with kidney diseases, use of CCB, and a daily morning dose are the factors for ambulatory blood pressure, indicating it is be reasonable to analyze factors for circadian rhythm by combining the 24hMBP and the components of circadian rhythm.

Effect-site concentration of remifentanil to blunt the hemodynamic changes during rapid sequence intubation

BACKGROUND: This study was undertaken to evaluate the effect-site concentration of remifentanil to blunt the hemodynamic changes during rapid sequence intubation. METHODS: Eighty patients were enrolled and divided into four groups being assigned with different effect-site concentrations (Ce)of remifentanil of 0, 2, 3, or 4 ng/ml. Patients arrived at the operating room without premedication and their baseline vital signs were recorded. With preoxygenation of 100% O2, remifentanil was infused by target controlled infusion according to patient group. After achievement of a stable level of Ce, propofol 2 mg/kg and rocuronium 1.2 mg/kg were injected and the trachea was intubated one minute later. Hemodynamic changes were recorded at 1, 2, and 3 min after remifentanil infusion, immediately before and after endotracheal intubation, and 1 and 2 min after endotracheal intubation. RESULTS: The 50% effective Ce of remifentanil was 1.4 ng/ml (95% confidence interval, CI: 0.9-1.8) to blunt the increase of mean blood pressure and was 2.4 ng/ml (95% CI: 1.6-3.1) to blunt the increase of heart rate. The 50% Ce for the decrease of mean blood pressure was 2.8 ng/ml (95% CI: 2.2-3.4). CONCLUSIONS: During the rapid sequence intubation, the 50% effective effect site concentration of remifentanil to prevent hemodynamic changes is between 2.4 and 2.8 ng/ml.

Effect of Continuous Infusion of Remifentanil on Propofol Dose and Hemodynamics using Bispectral Index during Anesthetic Induction / 대한마취과학회지

BACKGROUND: Remifentanil combined with propofol is usually used to induce anesthesia. However, remifentanil and propofol depress the cardiovascular system. This study investigated the effects of a continuous infusion of remifentanil on the propofol dose and hemodynamics using the bispectral index (BIS) during anesthetic induction. METHODS: Sixty female ASA physical status class I or II patients, who were scheduled to undergo gynecologic surgery were randomly assigned to one of three groups (n = 20). Normal saline 20 ml/hr (Group S), remifentanil 0.25microgram/kg/min (Group 0.25), or remifentanil 0.5microgram/kg/min (Group 0.5) was infused intravenously. Propofol was administered slowly two minutes after administering remifentanil or normal saline. The heart rate, mean arterial pressure (MAP) and BIS were measured at baseline, preintubation and postintubation. RESULT: There were no significant differences in the changes in the BIS among the groups. The MAP and heart rate decreased at preintubation compared with baseline (P < 0.05). The MAP of Group 0.5 at postintubation was lower than that in the other groups (P < 0.05). The heart rate in all groups increased at postintubation compared with baseline (P < 0.05). The heart rate of Group 0.5 at postintubation was lower than that of Group S (P < 0.05). The propofol requirement for unconsciousness was lower in Groups 0.25 and 0.5 than in Group S. The propofol requirement in Groups S, 0.25 and 0.5 was 1.56+/-0.2 mg/kg, 1.07+/-0.2 mg/kg and 0.9+/-0.1 mg/kg, respectively. CONCLUSIONS: A combined injection of 0.5microgram/kg/min remifantanil with 0.9 mg/kg of propofol decreases the heart rate and MAP at preintubation without adverse effects and appropriately prevents the cardiovascular responses to tracheal intubation, and reduces the propofol dose needed for a loss of consciousness.

Effect of Continuous Infusion of Remifentanil on Propofol Dose and Hemodynamics using Bispectral Index during Anesthetic Induction / 대한마취과학회지

BACKGROUND: Remifentanil combined with propofol is usually used to induce anesthesia. However, remifentanil and propofol depress the cardiovascular system. This study investigated the effects of a continuous infusion of remifentanil on the propofol dose and hemodynamics using the bispectral index (BIS) during anesthetic induction. METHODS: Sixty female ASA physical status class I or II patients, who were scheduled to undergo gynecologic surgery were randomly assigned to one of three groups (n = 20). Normal saline 20 ml/hr (Group S), remifentanil 0.25microgram/kg/min (Group 0.25), or remifentanil 0.5microgram/kg/min (Group 0.5) was infused intravenously. Propofol was administered slowly two minutes after administering remifentanil or normal saline. The heart rate, mean arterial pressure (MAP) and BIS were measured at baseline, preintubation and postintubation. RESULT: There were no significant differences in the changes in the BIS among the groups. The MAP and heart rate decreased at preintubation compared with baseline (P < 0.05). The MAP of Group 0.5 at postintubation was lower than that in the other groups (P < 0.05). The heart rate in all groups increased at postintubation compared with baseline (P < 0.05). The heart rate of Group 0.5 at postintubation was lower than that of Group S (P < 0.05). The propofol requirement for unconsciousness was lower in Groups 0.25 and 0.5 than in Group S. The propofol requirement in Groups S, 0.25 and 0.5 was 1.56+/-0.2 mg/kg, 1.07+/-0.2 mg/kg and 0.9+/-0.1 mg/kg, respectively. CONCLUSIONS: A combined injection of 0.5microgram/kg/min remifantanil with 0.9 mg/kg of propofol decreases the heart rate and MAP at preintubation without adverse effects and appropriately prevents the cardiovascular responses to tracheal intubation, and reduces the propofol dose needed for a loss of consciousness.

Study of ambulatory blood pressure monitoring in diagnosis of early renal impairment by essential hypertension / 中国实用内科杂志

58 mm Hg and 24hDBP descend significantly.Diurnal blood pressure rhythm abnormality(blood pressure descending 10% at night)is a high risk factor for renal impairment in essential hypertension.

The Effect of Carbon Dioxide on Cardiovascular Functions and Peripheral Circulation Using a New System of Carbon Dioxide Bath / 日本温泉気候物理医学会雑誌

Effect of carbon dioxide bath on cardiovascular functions and peripheral circulation were studied using a new system of carbon dioxide bath. The subjects consisted of 13 males and 17 females, ranging from 50 to 84 years old, 67.4±8.3 in average, having the complaints resulting mainly from arteriosclerosis such as coldness on extremities or exertional pains of lower extremities. Each subject took a bath in plain water (PW) on the first experimental day and then a bath in carbon dioxide (CO₂) at the same time on the second experimental day. Both baths were done for 10min. at 39°C of water temperature. The results obtained were as follows.<br>1) Mean blood pressure (MBP) was elevating during bath and lowered below prebath level immediately after bath in both PW and CO₂ groups. However, MBP in CO₂ group was lower significantly (p<0.05) than in PW group 20 and 30min after bath.<br>2) Both body and skin temperatures were similarly elevated at all points to be measured directly after bath, and then lowerd gradually thereafter. There was no significance in changes between both groups.<br>4) An increase in cutaneous blood flow was observed at the same grade in both groups during and after bath, though no showing significant difference between both groups.<br>5) PO₂ in venous blood increased after bath, while PCO₂ decreased. However, no significant difference in these changes was observed between both groups.<br>6) Tendency to increase in CV R-R was observed during and after bath, though no significant difference was showed between both groups.<br>7) Relating to the feeling to bath, all subjects had the feeling of “warmness” at the beginning of bath and also of comfortableness during and after bath in both PW and CO₂ groups. However, there was no difference in the intensity of these feelings between both groups.<br>8) No side reaction due to an inhalation of carbon dioxide during bath was observed in all subjects.<br>From these results, it is expected that a new carbon dioxide bath results in benefit for patients with disturbance of peripheral circulation.

The Effect of Bathing with NY-008 on Skin Temperature / 日本温泉気候物理医学会雑誌

The effect of bathing with NY-008 (3-octylphthalide, a newly synthesized vasodilative compound) on skin temperature was examined. The subjects were 28 healthy male adults (22±4 years old). The group bathed for 10min in 40°C water containing 3ppm of NY-008. On alternate days, the group bathed similarly but without NY-008 (control bathing). Skin temperature (Ts), blood pressure, and heart rate (HR) were then measured in a room in which the ambient temperature was maintained at 24°C and relative humidity at 60%. To eliminate any effect of diurnal fluctuations in skin temperature, each subject bathed at the same hour each day. Measurements were performed in random order by the double-blind method. The mean values of Ts after bathing were slightly higher after NY-008 bathing than after control bathing, and a significant difference was noted 10min after bathing (p<0.01). There was no significant difference in systolic blood pressure between NY-008 bathing and control bathing. Diastolic blood pressure was slightly lower after NY-008 bathing. Mean blood pressure, measured 5 min after bathing, was significantly lower after NY-008 bathing than after control bathing (p<0.05). No significant difference was found in HR. These findings suggest that NY-008 bathing increases skin blood flow through vasodilation of skin vessels and lower peripheral resistance, and may have longer lasting warming effects than ordinary bathing.

3.0 mg/kg IV Lidocaine on the Catecholamine Response to Endotracheal Intubation / 대한마취과학회지

A previous study by us has demonstrated no beneficial clinical effect on the vital signs and catecholamine levels following laryngoscopy and oral endotracheal intubation, when normal saline or 1.5 mg/Kg iv lidocaine was administered prior to rapid sequence induction of general anesthesia. The present study used a dose of 3.0 mg/Kg i.v lidocaine to determine whether a beneficial clinical effect might ensue. The results were as follows; 1) The mean heart rate increased to ca. 30% at l, 3, and 5 minutes for both groups 2) The mean arterial pressures increased maximally to 19% and 7% at 1 minute in both groups 3) The mean epinephrine level increased 36% at 1 minute then decreased rapidly in the saline group, whereas the lidocaine group showed decreases of 43, 52, 50, 67 and 75% at I, 2, 3, 5 and 10 minutes, respectively. 4) The mean norepinephrine levels increased to 65, 8l, 70, 72 and 60% at l, 2, 3, 5 and 10 minutes, in the saline group, where as the increases were 71, 66, 71, 53 and 22% for the lidocaine group. Since these findinga are similar to those from our previous study, We believe there to be little justification for the use of i.v lidocaine at this dose.