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High blood pressure [keywords]
- A comparative study of folate and vitamin B12 serum levels in preeclamptic versus normotensive pregnant women in correlation with uterine and umbilical artery Doppler findings and pregnancy outcome. [Journal Article]
- J Turk Ger Gynecol Assoc 2009; 10(3):152-7.
To detect the serum levels of folate and B12 in both preclamptic and normotensive pregnant women and to determine whether there is any relation between these levels with the uterine and umbilical artery Doppler indices as well as the pregnancy outcome.This case controlled study comprised 79 pregnant patients with preeclampsia and 113 healthy, normotensive pregnant women with singleton pregnancies at gestational ages ranging from 34-40 weeks. Patients were not obese (BMI<30) and did not suffer from chronic hypertension, chronic renal or liver disease nor diabetes mellitus. Serum folate and B12 were detected in all cases. They were also subjected to a Doppler study of both the uterine and umbilical arteries. Serum folate and B12 blood levels as well as the Doppler study indices (RI and PI) were compared in both groups.The serum folate level was significantly lower in preeclamptic patients than normal pregnant women (p<0.001). It was significantly correlated to uterine artery Doppler indices (RI and PI) and negatively correlated to umbilical artery Doppler indices (RI and PI). Low serum folate was significantly correlated to poor maternal outcome. Low serum folate was also significantly correlated to poor perinatal outcome. Serum B12 level was not significantly different in preeclamptic patients from the control group (P value=0.14).Serum folate was significantly lower in preeclamptic pregnant women with a significant correlation to increased uterine and umbilical RI, PI and poor maternal and neonatal outcome.
- Prevalence of hypertension and associated factors in bedele town, southwest ethiopia. [Journal Article]
- Ethiop J Health Sci 2014 Jan; 24(1):21-6.
Hypertension is the leading cause of death in the world and is the commonest cause for outpatient visits to physicians. The objective of this study was to assess the prevalence of hypertension and its risk factors among adults in Bedele Town, South-west Ethiopia.A community-based cross-sectional survey was conducted by interviewing participants regarding their socio-demographic characteristics, history of hypertension, its risk factors and knowledge of its complications and treatment. Measurements of their blood pressure, body weight, height, and waist circumferences were also done on the same day. The data were analyzed using SPSS Version 16 statistical software. Chi-square test and odds ratio with 95% CI were used to assess the association between dependent and independent variables. Logistic regression model was used to determine the independent risk factors for hypertension. P-values of < 0.05 were considered statistically significant.A total of 396 adults of whom 67.4% were males participated in the study. Prevalence of hypertension, defined as systolic blood pressure ≥140 mmHg or diastolic blood pressure ≥ 90 mmHg or reported use of anti-hypertensive medication, was 16.9%. However, only 44.8% of those with hypertension were aware of their status, and the overall control rate of hypertension was only 22.4%. Only age and waist circumference were found to be independent predictors of hypertension in the community.Hypertension was found to be prevalent in the community. However, the respondents' awareness about the problem and the overall control rates were very low. Activities targeted at increasing awareness of hypertension in the community and its risk reduction are very important for intervention. There should also be a national strategy for early detection and treatment of hypertension and related cardiovascular diseases.
- Pulmonary arterial hypertension preceding idiopathic pulmonary fibrosis in a BMPR2 mutation positive patient. [Journal Article]
- Eur Respir Rev 2014 Mar 1; 23(131):147-9.
- Influence of a positive family history of both type 2 diabetes and PCOS on metabolic and endocrine parameters in a large cohort of PCOS women. [JOURNAL ARTICLE]
- Eur J Endocrinol 2014 Mar 3.
There is evidence suggesting a strong genetic background of polycystic ovary syndrome (PCOS). We aim to study the metabolic and endocrine characteristics of PCOS women with and without a family history (FHx) of type 2 diabetes (T2DM) and PCOS.Cross-sectional study METHODS: We analysed the association of T2DM FHx and PCOS FHx with metabolic and endocrine parameters in 714 PCOS women.A positive FHx of T2DM and PCOS were prevalent in 36.8% and 21.4% of PCOS women, respectively. We found an independent association of T2DM FHx with central fat accumulation, obesity, prediabetes, metabolic syndrome (MS), insulin resistance, low HDL and elevated blood pressure (p<0.05 for all). PCOS FHx was independently associated with prediabetes (p<0.05). We observed an independent association of PCOS FHx with clinical and biochemical hyperandrogenism (p<0.05 for all), whereas there was no independent association of T2DM FHx with hyperandrogenism. PCOS women with a positive FHx of both T2DM and PCOS had an adverse metabolic and endocrine profile including a linear increase in risk of obesity, central fat accumulation, MS, prediabetes and low HDL (p<0.05 for all).Our findings suggest that the assessment of FHx might allow risk stratification of PCOS women which is important considering the high prevalence of PCOS.
- Inhibition of cellular transdifferentiation by losartan minimizes but does not reverse type 2 diabetes-induced renal fibrosis. [JOURNAL ARTICLE]
- J Renin Angiotensin Aldosterone Syst 2014 Mar 3.
Hypothesis/ INTRODUCTION: Transformer Growth Factor (TGF-β1) and angiotensin II (AngII) induce epithelial mesenchymal transition (EMT) and myofibroblastic transdifferentiation (MFT) contributing to renal fibrosis. The present study evaluated the capacity of an AT1 receptor blocker (losartan) to induce the regression of pre-existing fibrosis via interference with MFT and EMT in a rat model of type 2 diabetes, and in cultured mesangial cells (MCs) stimulated with high glucose and AngII.After 12 weeks of diabetes induction (D12 group), animals showing evidence of nephropathy, were divided in groups untreated for additional 8 weeks (D20 group) and treated for additional 8 weeks with losartan (D20+los group).D12 animals presented hyperglycemia, insulin resistance, hypertension, proteinuria, increased levels of TGF-β1 and MFT/EMT markers. Losartan stabilized all of these parameters and hindered the progression of fibrosis, but it did not reverse the pre-existing fibrotic manifestations. Losartan reduced TGF-β1 in the tubules, but not in the glomeruli. Stimulated MC exhibited myofibroblast phenotype and capacity for migration, which were completely reversed by losartan.Cellular transition may play a role in diabetes-inducing renal fibrogenesis in both AngII-TGF-β1 axis-dependent and independent manners. Losartan was efficient in preventing cells from undergoing further transdifferentiation, but this strategy was not sufficient to induce regression of the pre-existing tissue fibrosis.
- Radionuclides in Nephrourology, Part 2: Pitfalls and Diagnostic Applications. [JOURNAL ARTICLE]
- J Nucl Med 2014 Mar 3.
Radionuclide renal scintigraphy provides important functional data to assist in the diagnosis and management of patients with a variety of suspected genitourinary tract problems, but the procedures are underutilized. Maximizing the utility of the available studies (as well as the perception of utility by referring physicians) requires a clear understanding of the clinical question, attention to quality control, acquisition of the essential elements necessary to produce an informed interpretation, and production of a report that presents a coherent impression based on data contained in the report and that specifically addresses the clinical question. To help achieve these goals, part 1 of this review addressed the available radiopharmaceuticals, quality control, and quantitative indices, including the measurement of absolute and relative renal function. Part 2 assumes familiarity with part 1 and focuses on the common clinical indications of suspected obstruction and renovascular hypertension; part 2 also summarizes the status of radionuclide renal imaging in the evaluation of the transplanted kidney and the detection of infection, discusses potential pitfalls, and concludes with suggestions for future research. The series of SAM questions accompanying parts 1 and 2 has been designed to reinforce and extend points made in the review. Although the primary focus is the adult patient, aspects of the review also apply to the pediatric population.
- Prediction of pulmonary complications and long term survival in systemic sclerosis. [JOURNAL ARTICLE]
- Arthritis Rheumatol 2014 Mar 3.
Objective: We assess survival and incidence of organ-based complications in a large single-centre cohort of unselected systemic sclerosis (SSc) patients. We explore predictors of survival and clinically significant pulmonary fibrosis (csPF) and pulmonary hypertension (PH). Methods: The study cohort consisted of 398 consecutive SSc patients, followed for up to 15 years. Results: Overall survival estimate at the end of follow-up was 57% among limited and 50% among diffuse subset patients (p=0.017). We found that greater age at disease onset, diffuse subset, lower DLCO, lower haemoglobin, higher creatinine and presence of PH or cardiac involvement are independent predictors of worse survival. Over the entire follow-up, 42% of the dcSSc and 22% of the lcSSc patients developed csPF (p<0.001). The variables that predicted csPF development were dcSSc, greater age at onset, lower FVC and DLCO, presence of anti-topoisomerase I antibody (ATA), while presence of anti-centromere antibody was protective. There was no difference in PH cumulative incidence between the two subsets - 24% in lcSSc and 18% in dcSSc (p=0.558). Incidence rates were 1-2%/year. The PH prediction model demonstrated that older age at SSc onset, increase in serum creatinine and presence of anti-RNA polymerase or anti-U3RNP antibodies are associated with increased risk of PH, while ATA positivity reduced the hazard. Conclusion: Our study provides data on long-term outcome of SSc and the timing and frequency of major organ complications. The predictive models we present could be used as clinical tools for patient risk stratification and could facilitate cohort enrichment for event driven studies. © 2014 American College of Rheumatology.
- New hypertension guidelines: One size fits most? [Journal Article]
- Cleve Clin J Med 2014 Mar; 81(3):178-88.
The report of the panel appointed to the eighth Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure (JNC 8) is more evidence-based and focused than its predecessors, outlining a management strategy that is simpler and, in some instances, less aggressive. It has both strengths and weaknesses.
- Pregnancy-Induced Hypertension is Associated With Altered Anatomical Patterns of Hyrtl's Anastomosis. [JOURNAL ARTICLE]
- Anat Rec (Hoboken) 2014 Feb 12.
Umbilical arteries carry the blood from the fetus to the placenta and are typically connected by Hyrtl's anastomosis, a connection that is located near where the umbilical cord meets the placenta. The investigation of the anastomosis in pathological conditions, including pregnancy-induced hypertension is limited. Hence, 200 placenta and umbilical cords, 100 from normotensive and 100 from pregnancy-induced hypertensive subjects, were dissected and measurements were recorded. A single anastomosis between the umbilical arteries was observed in167 specimens. In 16 cases, the two umbilical arteries were fused, in 15 cases there was no anastomosis, and in two cases there was a single umbilical artery. In one specimen from a normotensive case, a double anastomosis was observed. To our knowledge this is only the second report of this rare anatomical variant. When an anastomosis is present, the connecting vessel can be transverse to or form an oblique angle with the umbilical arteries. We observed a striking increase in the number of artery pairs connected by a transverse vessel in specimens from hypertensive subjects relative to those from normotensive subjects. Moreover, placentas from hypertensive donors were small if the umbilical arteries were connected by an oblique anastomosis. In addition, the length of the anastomosis and its distance from the cord insertion was shorter in specimens from hypertensive compared to normotensive subjects. We conclude that pregnancy-induced hypertension alters the anatomy of Hyrtl's anastomosis, and in some circumstances, the placenta. Anat Rec, 2014. © 2014 Wiley Periodicals, Inc.