Introduction: The importance of the admission blood pressure (BP) for intracerebral
hemorrhage (ICH) outcome is not completely clear. Our objective was to
analyze the clinical impact of BP at hospital arrival in patients with primary ICH.
Material and methods: We studied 316 patients (50% women, mean age:
64 years, 75% with hypertension history) with acute primary ICH. The first BP reading
at admission was evaluated for its association with neuroimaging findings
and outcome. A Cox proportional hazards model and Kaplan-Meier analyses
were constructed to evaluate factors associated with in-hospital mortality.
Results: Intraventricular irruption occurred in 52% of cases. A high frequency
of third ventricle extension was observed in patients with BP readings in the
upper quartiles of the distribution (systolic, diastolic, or mean arterial pressure).
Blood pressure readings did not correlate with hematoma volumes. In-hospital
case fatality rate was 46% (63% among those with ventricular irruption). Systolic
BP (SBP) > 190 mm Hg was independently associated with in-hospital mortality
in supratentorial (n = 285) ICH (hazard ratio: 1.19, 95% confidence interval:
1.02-1.38, for the highest vs. the lowest quartile) even after adjustment for
known strong predictors (age, ICH volume, Glasgow coma scale and ventricular
extension). Blood pressure was not significantly associated with ventricular
extension or outcome in patients with infratentorial ICH.
Conclusions: A high BP on admission is associated with an increased risk of
intraventricular extension and early mortality in patients with supratentorial
ICH. However, a significant proportion of patients with high BP readings without
ventricular irruption still have an increased risk of death.
To study the variations of autonomic nervous system in hypertensive patients using a set of autonomic function tests
and to correlate cardiac autonomic function with Heart rate variability in hypertensives. Background: The pathophysiological mechanism for the development of hypertension is the lack of balance between sympathetic and parasympathetic nervous system. Both Heart rate variability (HRV) and Autonomic function tests provide a tool to know the concept of autonomic modulation of heart. They also forms an index of cardiac autonomic regulation. Methods: The study included 50 hypertensive patients and 50 normotensive
subjects. All the subjects underwent for the analysis of heart rate variability in time domain (TD) and frequency domain and a set of autonomic function tests were done to assess the autonomic functions. These results were compared with age and sex matched controls (normotensives). The subjects were selected based on exclusion-inclusion criteria. Results: Results showed that S: L ratio, Valsalva ratio & Heart rate response to deep breathing test values were decreased in Hypertensives as compared to Normotensives (p<0.05).><0.05). Both the time domain and frequency domain values of HRV reduced significantly in hypertensives indicated that there is increased sympathetic activity and decreased parasympathetic activity. Conclusion: From this study, it is evident that Hypertension can alter the normal autonomic functions of the body and predisposes to autonomic neuropathy. Early and regular screening of these individuals is necessary to prevent any future complications.
To study the variations of autonomic nervous system in hypertensive patients using a set of autonomic function tests
and to correlate cardiac autonomic function with Heart rate variability in hypertensives. Background: The pathophysiological mechanism for the development of hypertension is the lack of balance between sympathetic and parasympathetic nervous system. Both Heart rate variability (HRV) and Autonomic function tests provide a tool to know the concept of autonomic modulation of heart. They also forms an index of cardiac autonomic regulation. Methods: The study included 50 hypertensive patients and 50 normotensive
subjects. All the subjects underwent for the analysis of heart rate variability in time domain (TD) and frequency domain and a set of autonomic function tests were done to assess the autonomic functions. These results were compared with age and sex matched controls (normotensives). The subjects were selected based on exclusion-inclusion criteria. Results: Results showed that S: L ratio, Valsalva ratio & Heart rate response to deep breathing test values were decreased in Hypertensives as compared to Normotensives (p<0.05).><0.05). Both the time domain and frequency domain values of HRV reduced significantly in hypertensives indicated that there is increased sympathetic activity and decreased parasympathetic activity. Conclusion: From this study, it is evident that Hypertension can alter the normal autonomic functions of the body and predisposes to autonomic neuropathy. Early and regular screening of these individuals is necessary to prevent any future complications.
Blood-Pressure Management in Patients with Acute Cerebral Hemorrhage
Kontroversi hasil studi ATACH-2 dan dampaknya dalam manajemen hipertensi pada stroke perdarahan intraserebral akut.
The IOSR Journal of Pharmacy (IOSRPHR) is an open access online & offline peer reviewed international journal, which publishes innovative research papers, reviews, mini-reviews, short communications and notes dealing with Pharmaceutical Sciences( Pharmaceutical Technology, Pharmaceutics, Biopharmaceutics, Pharmacokinetics, Pharmaceutical/Medicinal Chemistry, Computational Chemistry and Molecular Drug Design, Pharmacognosy & Phytochemistry, Pharmacology, Pharmaceutical Analysis, Pharmacy Practice, Clinical and Hospital Pharmacy, Cell Biology, Genomics and Proteomics, Pharmacogenomics, Bioinformatics and Biotechnology of Pharmaceutical Interest........more details on Aim & Scope).
All manuscripts are subject to rapid peer review. Those of high quality (not previously published and not under consideration for publication in another journal) will be published without delay.
This Journal publishes original research work that contributes significantly to further the scientific knowledge in pharmacy.
Blood-Pressure Management in Patients with Acute Cerebral Hemorrhage
Kontroversi hasil studi ATACH-2 dan dampaknya dalam manajemen hipertensi pada stroke perdarahan intraserebral akut.
The IOSR Journal of Pharmacy (IOSRPHR) is an open access online & offline peer reviewed international journal, which publishes innovative research papers, reviews, mini-reviews, short communications and notes dealing with Pharmaceutical Sciences( Pharmaceutical Technology, Pharmaceutics, Biopharmaceutics, Pharmacokinetics, Pharmaceutical/Medicinal Chemistry, Computational Chemistry and Molecular Drug Design, Pharmacognosy & Phytochemistry, Pharmacology, Pharmaceutical Analysis, Pharmacy Practice, Clinical and Hospital Pharmacy, Cell Biology, Genomics and Proteomics, Pharmacogenomics, Bioinformatics and Biotechnology of Pharmaceutical Interest........more details on Aim & Scope).
All manuscripts are subject to rapid peer review. Those of high quality (not previously published and not under consideration for publication in another journal) will be published without delay.
This Journal publishes original research work that contributes significantly to further the scientific knowledge in pharmacy.
Using the library and referencing in a digital agekevinwilsongold
This is a presentation that I ran with postgraduate Media students in Autumn 2013 to give an overview of the resources available to them - this was coupled with a hands-on demo of these resources.
Associations B/W early blood pressure (BP) variability and clinical outcomes with ICH after antihypertensive therapy clarified by a post hoc analysis of Intensive Blood Pressure Reduction in Acute Cerebral Hemorrhage Trial 2 (INTERACT2)
Confirmed in Stroke Acute Management with Urgent Risk-factor Assessment and Improvement (SAMURAI)-intracerebral hemorrhage study cohort
Clinical Outcomes of Intensive Inpatient Blood Pressure.pdfSHINTU5
OBJECTIVE To examine the association of intensive treatment of elevated inpatient BPs
with in-hospital clinical outcomes of older adults hospitalized for noncardiac conditions.
DESIGN, SETTING, AND PARTICIPANTS This retrospective cohort study examined Veterans
Health Administration data between October 1, 2015, and December 31, 2017, for patients
aged 65 years or older hospitalized for noncardiovascular diagnoses and who experienced
elevated BPs in the first 48 hours of hospitalization.
INTERVENTIONS Intensive BP treatment following the first 48 hours of hospitalization,
defined as receipt of intravenous antihypertensives or oral classes not used prior to
admission.
MAIN OUTCOME AND MEASURES The primary outcomewas a composite of inpatient mortality,
intensive care unit transfer, stroke, acute kidney injury, B-type natriuretic peptide elevation,
and troponin elevation. Data were analyzed between October 1, 2021, and January 10, 2023,
with propensity score overlap weighting used to adjust for confounding between those who
did and did not receive early intensive treatment.
RESULTS Among 66 140 included patients (mean [SD] age, 74.4 [8.1] years; 97.5%male
and 2.6%female; 17.4%Black, 1.7%Hispanic, and 75.9%White), 14 084 (21.3%) received
intensive BP treatment in the first 48 hours of hospitalization. Patients who received early
intensive treatment vs those who did not continued to receive a greater number of additional
antihypertensives during the remainder of their hospitalization (mean additional doses, 6.1
[95%CI, 5.8-6.4] vs 1.6 [95%CI, 1.5-1.8], respectively). Intensive treatment was associated
with a greater risk of the primary composite outcome (1220 [8.7%] vs 3570 [6.9%]; weighted
odds ratio [OR], 1.28; 95%CI, 1.18-1.39), with the highest risk among patients receiving
intravenous antihypertensives (weighted OR, 1.90; 95%CI, 1.65-2.19). Intensively treated
patients were more likely to experience each component of the composite outcome except
for stroke and mortality. Findings were consistent across subgroups stratified by age, frailty,
preadmission BP, early hospitalization BP, and cardiovascular disease history.
CONCLUSIONS AND RELEVANCE The study’s findings indicate that among hospitalized
older adults with elevated BPs, intensive pharmacologic antihypertensive treatment
was associated with a greater risk of adverse events. These findings do not support
the treatment of elevated inpatient BPs without evidence of end organ damage,
and they highlight the need for randomized clinical trials of inpatient BP treatment targets
A brief review of traumatic brain injury. Slides made specifically for medical professionals and student (trauma and surgery). We will review some of the important caveats, a review of the literature and discuss some management treatment options.
Compliance of pharmacological treatment for non-ST-elevation acute coronary syndromes with contemporary guidelines: influence on outcomes
Authors: Hélder Dores, Carlos Aguiar, Jorge Ferreira, Jorge Mimoso, Sílvia Monteiro, Filipe Seixo, José Ferreira Santos, On behalf of Portuguese Registry on Acute Coronary Syndromes (ProACS) Investigators
Predictors of Ischaemia and Outcomes in Egyptian Patients with Diabetes Mellitus Referred for Perfusion Imaging. Samir Rafla*, Ahmed Abdel-Aaty, Mohamed Ahmed Sadaka, Aly Ahmed Abo Elhoda and Ahmed Mohamed Shams
Hemorheological indexes, living habits, medical history and genetics factor are primary risk factors in Coronary Heart Disease (CHD). In the present study the relation of all factors to the severity of CHD was examined. The data of 282 patients (mean age: 60±9 years) diagnosed with CHD and 229 healthy controls (mean age: 59±7 years) from Wenzhou Medical University were analyzed.
Mortalidad asociada al diagnóstico de síndrome de Guillain-Barré en adultos i...Erwin Chiquete, MD, PhD
Mortality associated with a diagnosis of Guillain-Barré syndrome in adults of Mexican health institutions
Introduction. Guillain-Barré syndrome (GBS) is a neurological emergency representing the main cause of flaccid paralysis
around the world, affecting all age groups. Little is known about the essential epidemiology of GBS in most Latin American
countries.
Aim. To determine the mortality associated with the diagnosis of GBS in hospital discharges during 2010 in hospitals of
the Ministry of Health, Mexico.
Patients and methods. We analyzed the database of hospital discharges of institutions pertaining to the Ministry of
Health. Study cases were identified by the code G61.0 of the International Classification of Diseases, 10th revision (ICD-10).
We excluded records of patients younger than 18 years and patients without complete demographic information.
Results. During the year 2010 there were 2,634,339 discharges from hospitals of the Ministry of Health. We identified a
total of 467 hospitalizations due to GBS in adults (median age: 41 years; 62.1% male) from 121 health institutions of the
32 Republic States. The highest frequency of GBS hospitalizations occurred during summer and fall. The median hospital
stay was 8 days. The hospital mortality rate was 10.5%. The probability of death was directly associated with age, without
a particular trend regarding gender, hospital care or state.
Conclusions. In 2010 GBS hospital mortality in this part of the Mexican health system was higher than that reported in
contemporary studies. A seasonal association was observed regarding the frequency of hospitalizations for GBS.
Key words. Climate. Epidemiology. Guillain-Barré syndrome. Mortality. Mexico.
Rogelio Domínguez-Moreno, Paulina Tolosa-Tort, Anais Patiño-Tamez, Alejandra Quintero-Bauman,
Deisy K. Collado-Frías, María G. Miranda-Rodríguez, Obet J. Canela-Calderón, Pablo Hurtado-Valadez,
Raúl de Gante-Castro, Karoll M. Ortiz-Guillén, Bruno Estañol-Vidal, Horacio Sentíes-Madrid,
Guillermo García-Ramos, Carlos Cantú-Brito, José Luis Ruiz-Sandoval, Erwin Chiquete
Seroepidemiology of Toxoplasma gondii infection in drivers involved in road t...Erwin Chiquete, MD, PhD
Background: The prevalence of toxoplasmosis in the general population of Guadalajara, Mexico, is around 32%.
Toxoplasmosis can cause ocular lesions and slowing of reaction reflexes. Latent toxoplasmosis has been related
with traffic accidents. We aimed to assess the prevalence of anti-Toxoplasma gondii antibodies and visual
impairments related with traffic accidents in drivers from the metropolitan Guadalajara.
Methods: We prospectively evaluated the prevalence of IgG and IgM anti-T. gondii antibodies in 159 individuals
involved in traffic accidents, and in 164 control drivers never involved in accidents. Cases of toxoplasmosis
reactivation or acute infection were detected by PCR in a subset of 71 drivers studied for the presence of T. gondii
DNA in blood samples. Ophthalmologic examinations were performed in drivers with IgG anti-T. gondii antibodies
in search of ocular toxoplasmosis.
Results: Fifty-four (34%) traffic accident drivers and 59 (36%) controls were positive to IgG anti-T. gondii antibodies
(p = 0.70). Among the 113 seropositive participants, mean anti-T. gondii IgG antibodies titers were higher in traffic
accident drivers than in controls (237.9 ± 308.5 IU/ml vs. 122.9 ± 112.7 IU/ml, respectively; p = 0.01 by Student’s t
test, p = 0.037 by Mann–Whitney U test). In multivariate analyses, anti-T. gondii IgG antibody titers were consistently
associated with an increased risk of traffic accidents, whereas age showed an inverse association. The presence of
IgM-anti-T. gondii antibodies was found in three (1.9%) subjects among traffic accident drives, and in two (1.2%)
controls. Three (4.2%) samples were positive for the presence of T. gondii DNA, all among seropositive individuals.
No signs of ocular toxoplasmosis were found in the entire cohort. Moreover, no other ocular conditions were found
to be associated with the risk of traffic accidents in a multivariate analysis.
Conclusions: Anti-T. gondii antibody titers are associated with the risk of traffic accidents. We could not determine
any association of ocular toxoplasmosis with traffic accidents. Our results warrant further analyses in order to clarify
the link between toxoplasmosis and traffic accidents.
Tiempo de llegada hospitalaria y pronóstico funcional después deun infarto ce...Erwin Chiquete, MD, PhD
Introducción: La información sobre el tiempo de llegada hospitalaria después de un infartocerebral (IC) se ha originado en países con unidades especializadas en ictus. Existe poca infor-mación en naciones emergentes. Nos propusimos identificar los factores que influyen en eltiempo de llegada hospitalaria a 1, 3 y 6 h y su relación con el pronóstico funcional después delictus.Métodos: Se analizó la información de pacientes con IC incluidos en el estudio Primer RegistroMexicano de Isquemia Cerebral (PREMIER) que tuvieran tiempo definido desde el inicio de lossíntomas hasta la llegada hospitalaria. El desenlace funcional se evaluó mediante la escalamodificada de Rankin a los 30 días, 3, 6 y 12 meses.Resultados: De 1.096 pacientes con IC, 61 (6%) llegaron en < 1 h, 250 (23%) en < 3 h y 464 (42%)en < 6 h. Favorecieron la llegada temprana en < 1 h: el antecedente familiar de cardiopatíaisquémica y ser migra˜noso; en < 3 h: edad 40-69 a˜nos, antecedente familiar de hipertensión,antecedente personal de dislipidemia y cardiopatía isquémica, así como la atención en hospitalprivado; en < 6 h: antecedente familiar de hipertensión, ser migra˜noso, ictus previo, cardiopatíaisquémica y atención en hospital privado. La llegada hospitalaria tardía se asoció a ictus lacunary alcoholismo. Solo el 2,4% recibió trombólisis. Independientemente de la trombólisis, la llegadaen < 3 h se asoció a menor mortalidad a los 3 y 6 meses, además de menos complicacionesintrahospitalarias.
Comportamiento del barorreflejo en pacientes con síncope vasovagal durante el...Erwin Chiquete, MD, PhD
Caroline Malamud-Kessler, Bruno Estañol-Vidal, Óscar Infante-Vázquez, Miguel Campos-Sánchez,
Erwin Chiquete
Introducción. El síncope mediado neuralmente, también conocido como síncope vasovagal, se define como la pérdida
súbita y transitoria del estado de alerta como consecuencia de un descenso brusco y profundo de la presión arterial.
Objetivo. Conocer las diferencias de los parámetros hemodinámicos que median el barorreflejo durante el ortostatismo
activo en pacientes con diagnóstico clínico de síncope vasovagal y sujetos sanos.
Sujetos y métodos. Estudio transversal, observacional y comparativo. Se incluyeron 20 pacientes con diagnóstico de síncope
neuralmente mediado y 30 controles, a los que se les practicó la prueba de ortostatismo activo y se les registró por
finometría la presión arterial sistólica (PAS) y la frecuencia cardíaca (intervalo entre latidos) de manera continua (latido a
latido) y no invasiva.
Resultados. Los pacientes con síncope presentaron una PAS basal con una media significativamente mayor que la de los
sanos. Las magnitudes medidas desde la PAS basal demostraron una diferencia significativa, que era de menor valor en el
grupo de los controles. No se demostraron diferencias entre grupos en la caída de la PAS desde el primer pico, recuperación
de la PAS desde la sima o en las latencias medidas en la frecuencia cardíaca.
Conclusiones. La PAS basal y la caída de la PAS medida desde la basal en posición supina fue mayor en los pacientes con
síncope mediado neuralmente que en los sujetos sanos. La magnitud de la elevación de la frecuencia cardíaca tuvo una
tendencia a ser mayor en el grupo de pacientes en comparación con el grupo control. Esto sugiere una hiperactividad
simpática en los pacientes con síncope
Delírium en adultos que reciben cuidados paliativos: revisión de laliteratura...Erwin Chiquete, MD, PhD
Delírium en adultos que reciben cuidados paliativos: revisión de laliteratura con un enfoque sistemáticoSofía Sánchez-Romána, Cristina Beltrán Zavalab, Argelia Lara Solaresby ErwinChiquetea,∗
El delírium en pacientes que reciben cuidados paliativos es frecuente y constituyeun importante reto de diagnóstico y tratamiento. Nuestro objetivo fue realizar en 2 fases unanálisis bibliométrico de la evidencia científica reciente (2007 a 2012) sobre diagnóstico y tra-tamiento del delírium en adultos en cuidados paliativos. En la fase 1 (estudios descriptivos yrevisiones narrativas) se identificaron 133 artículos relevantes: 73 trataron el tema del delíriumde forma secundaria y en 60 artículos como tema principal. Sin embargo, solo se identificaron4 estudios observacionales prospectivos en los que el delírium fue central. De 135 artículos iden-tificados en la fase 2 (ensayos clínicos o estudios descriptivos sobre tratamiento del delírium enpacientes paliativos), solo 3 fueron sobre prevención o tratamiento: 2 estudios retrospectivosy un ensayo clínico sobre prevención multicomponente en pacientes con cáncer. Gran parte dela literatura reciente corresponde a revisiones que hablan de estudios realizados hace másde una década en pacientes diferentes a los que reciben cuidados paliativos. En conclusión, laevidencia científica reciente sobre el delírium en cuidados paliativos es escasa y subóptima.Urgen estudios prospectivos que se enfoquen específicamente en esta población altamentevulnerable.
Central Adiposity and Mortality after First-Ever Acute Ischemic StrokeErwin Chiquete, MD, PhD
Erwin Chiquete a José L. Ruiz-Sandoval c Luis Murillo-Bonilla e
Carolina León-Jiménez g Bertha Ruiz-Madrigal d, f Erika Martínez-López d, f
Sonia Román d, f Arturo Panduro d, f Alma Ramos b Carlos Cantú-Brito
Background: The waist-to-height ratio (WHtR) may be a better
adiposity measure than the body mass index (BMI). We
evaluated the prognostic performance of WHtR in patients
with acute ischemic stroke (AIS). Methods: First, we compared
WHtR and BMI as adiposity measures in 712 healthy
adults by tetrapolar bioimpedance analysis. Thereafter,
baseline WHtR was analyzed as predictor of 12-month allcause
mortality in 821 Mexican mestizo adults with first-ever
AIS by a Cox proportional hazards model adjusted for baseline
predictors. Results: In healthy individuals, WHtR correlated
higher than BMI with total fat mass and showed a higher
accuracy in identifying a high percentage of body fat (p <
0.01). In AIS patients a U-shaped relationship was observed
between baseline WHtR and mortality (fatality rate 29.1%).
On multivariate analysis, baseline WHtR ≤ 0.300 or >0.800 independently
predicted 12-month all-cause mortality (h
José L. Ruiz-Sandoval, Guadalupe Ramírez-Guzmán,
Erwin Chiquete and Ángel Vargas-Sánchez
A 45-year-old garbage collector was referred to our department
with a history of tonic-clonic seizures and risky
sexual behavior (anilingus). A neurological examination was
normal. Contrast-enhanced cranial CT showed calcified lesions
and viable parasites compatible with a diagnosis of
massive non-encephalitic neurocysticercosis. Oral metallic
implants impeded performing brain MRI. Hepatitis and HIV
serologies were negative. The patient was discharged with
steroids and an anticonvulsant. Delayed cysticidal therapy
was planned; however, albendazole therapy was immediately
initiated in another hospital, which led to brain edema, uncontrolled
seizures, rostrocaudal deterioration and death.
Cestoda infections are rare in developed countries (1). In
contrast, neurocysticercosis is a leading cause of adult-onset
epilepsy in Latin America. Massive infections are classified
as encephalitic or non-encephalitic (2). In patients with the
encephalitic presentation, cysticidal drugs can cause extensive
parasite lysis and aggravate brain inflammation (2). In
patients with non-encephalitic massive neurocysticercosis,
cysticidal therapy is usually considered; (2) however, rapid
initiation of antiparasitic medications can launch an encephalitic
process.
Cost of care according to disease-modifying therapy in Mexicans with relapsin...Erwin Chiquete, MD, PhD
Miguel A. Macı´as-Islas • Isaac F. Soria-Cedillo • Merced Velazquez-Quintana •
Victor M. Rivera • Vero´nica I. Baca-Muro • Edith A. Lemus-Carmona • Erwin Chiquete
Limited data exist on the costs of care of
patients with multiple sclerosis (MS) in low- to middleincome
nations. The purpose of this study was to describe
the economic burden associated with care of Mexican
patients with relapsing-remitting MS in a representative
sample of the largest institution of the Mexican public
healthcare system. We analysed individual data of 492
patients (67 % women) with relapsing-remitting MS registered
from January 2009 to February 2011 at the Mexican
Social Security Institute. Direct costs were measured about
the use of diagnostic tests, disease-modifying therapies
(DMTs), symptoms control, medical consultations,
relapses, intensive care and rehabilitation. Four groups
were defined according to DMT alternatives: (1) interferon
beta (IFNb)-1a, 6 million units (MU); (2) IFNb-1a, 12MU;
(3) IFNb-1b, 8MU; and (4) glatiramer acetate. All patients
received DMTs for at least 1 year. The most frequently
used DMT was glatiramer acetate (45.5 %), followed by
IFNb-1a 12MU (22.6 %), IFNb-1b 8MU (20.7 %), and
IFNb-1a 6MU (11.2 %). The mean cost of a specialised
medical consultation was €74.90 (US $107.00). A single
relapse had a mean total cost of €2,505.97 (US $3,579.96).
No differences were found in annualised relapse rates and
costs of relapses according to DMT. However, a significant
difference was observed in total annual costs according to
treatment groups (glatiramer acetate being the most
expensive), mainly due to differences in unitary costs of
alternatives. From the public institutional perspective,
when equipotent DMTs are used in patients with comparable
characteristics, the costs of DMTs largely determine
the total expenses associated with care of patients with
relapsing-remitting MS in a middle-income country.
Serum Uric Acid and Outcome after Acute Ischemic Stroke: PREMIER StudyErwin Chiquete, MD, PhD
Background: Current evidence shows that uric acid is a potent
antioxidant whose serum concentration increases rapidly
after acute ischemic stroke (AIS). Nevertheless, the relationship
between serum uric acid (SUA) levels and AIS
outcome remains debatable. We aimed to describe the
prognostic significance of SUA in AIS. Methods: We studied
463 patients (52% men, mean age 68 years, 13% with glomerular
filtration rate <60 />2) at 30 days, or with
any outcome measure at 3, 6 or 12 months poststroke. After
adjustment for age, gender, stroke type and severity (NIHSS
<9),><24 h. Conclusions: A low SUA
concentration is modestly associated with a very good
short-term outcome. Our findings support the hypothesis
that SUA is more a marker of the magnitude of the cerebral
infarction than an independent predictor of stroke outcome.
Hepatitis C virus infection and type 2 diabetes mellitus in Mexican patients. Erwin Chiquete, MD, PhD
34. Chiquete E, Ochoa-Guzmán A, García-Lamas L, Anaya-Gómez F, Gutiérrez-Manjarrez JI, Sánchez-Orozco LV, Godínez-Gutiérrez SA, Maldonado M, Román S, Panduro A. Hepatitis C virus infection and type 2 diabetes mellitus in Mexican patients. Rev Med Inst Mex Seguro Soc. 2012;50(5):481-6. [PMID: 23282259]
Atherothrombotic Disease, Traditional Risk Factors, and 4-Year Mortality in a...Erwin Chiquete, MD, PhD
Erwin Chiquete, MD, PhD
Background: Atherothrombosis is becoming the leading cause of chronic morbidity in developing countries. This
epidemiological transition will represent an unbearable socioeconomic burden in the near future. We investigated
factors associated with 4-year all-cause mortality in a Latin American population at high risk.
Hypothesis: Largely modifiable risk factors as well as polyvascular disease are the main predictors of 4-year all-cause and
cardiovascular mortality in this Latin American cohort.
Methods: We analyzed 1816 Latin American stable outpatients (62.3% men, mean age 67 years) with symptomatic
atherothrombosis (87.1%) or with multiple risk factors only (12.9%), in the Reduction of Atherothrombosis for Continued
Health registry.
Results: Of patients with symptomatic atherothrombosis, 57.3% had coronary artery disease, 32% cerebrovascular disease,
and 11.7% peripheral artery disease at baseline (9.1% polyvascular). The main risk factors were hypertension (76%),
hypercholesterolemia (60%), and smoking (52.3%) in patients with established atherothrombosis; and hypertension
(89.7%), diabetes (80.8%), and hypercholesterolemia (73.9%) in those with risk factors only. Four-year all-cause mortality
steeply increased with none (6.8%), 1 (9.2%), 2 (15.5%), and 3 (29.2%) symptomatic arterial disease locations. In patients
with only 1 location, cardiovascular mortality was significantly higher with peripheral artery disease (11.3%) than with
cerebrovascular disease (6%) or coronary artery disease (5.1%). Significant baseline predictors of 4-year all-cause mortality
were congestive heart failure (hazard ratio [HR]: 3.81), body mass index<20 (HR: 2.32), hypertension (HR: 1.84), polyvascular
disease (HR: 1.69), and age ≥65 years (HR: 1.47), whereas statin use (HR: 0.49) and body mass index ≥30 (HR: 0.58) were
associated with a reduced risk.
Conclusions: Hypertension was the main modifiable risk factor for atherothrombosis and all-cause mortality in this Latin
José L. Ruiz-Sandoval, Erwin Chiquete,
Lucía E. Álvarez-Palazuelos, Miguel
A. Andrade-Ramos & Luis R. Rodríguez-
Rubio
Osmotic demyelination syndrome (ODS) is the
damage over the central nervous system caused by several
electrolytes, metabolic and toxic disorders. We aimed to
describe cases of unusual forms of ODS. In a 9-year period,
25 consecutive patients with ODS (15 men; mean age
42 years) were registered in our referral institution, among
them, four (16 %) with atypical neuroimaging findings
were abstracted for this communication. None of them
presented cardiorespiratory arrest, head trauma, seizures,
neuromyelitis optica spectrum or contact with toxic
chemicals. Case 1 was a 33-year-old alcoholic man without
hypertension or electrolyte imbalance, who presented a
classic central pontine myelinolysis (CPM) and a hemorrhage
within the pons. Case 2 was a 34-year-old alcoholic
man with hypoglycemia and hyponatremia who presented
CPM and diffuse bihemispheric extrapontine myelinolysis
(EPM) after correction of serum sodium. Case 3 was a
52-year-old woman with mild hypokalemia and hyponatremia
(inadequately corrected), who presented a peduncular
and cerebellar EPM. Case 4 was a 67-year-old
woman who had a suicidal attempt with antidepressants
and carbamazepine without impaired consciousness, who
complicated with mild hyponatremia associated with a
classical CPM and a spinal cord EPM. Case 2 died and the
rest remained with variable neurological impairments at
last follow-up visit. With modern neuroimaging, the
so-called atypical forms of ODS may not be as rare as
previously thought; however, they could have a more
adverse outcome than the classical ODS.
Spontaneous intracerebral hemorrhage in Mexico: results from a Multicenter Na...Erwin Chiquete, MD, PhD
Introduction. Scarce information exists on intracerebral hemorrhage (ICH) in Latin America, and the existent is derived
from single-center registries with non-generalizable conclusions. The aim of this study is to describe the frequency, etiology,
management and outcome of ICH in Mexico.
Patients and methods. We studied consecutive patients with ICH pertaining to the National Multicenter Registry on Cerebrovascular
Disease (RENAMEVASC), conducted in 25 centers from 14 states of Mexico. The Intracerebral Hemorrhage Grading
Scale (ICH-GS) at admission was used to assess prognosis at 30 days follow-up.
Results. Of 2,000 patients with acute cerebrovascular disease registered in RENAMEVASC, 564 (28%) had primary ICH
(53% women; median age: 63 years; interquartile range: 50-75 years). Hypertension (70%), vascular malformations (7%)
and amyloid angiopathy (4%) were the main etiologies. In 10% of cases etiology could not be determined. Main ICH
locations were basal ganglia (50%), lobar (35%) and cerebellum (5%). Irruption into the ventricular system occurred in
43%. Median score of ICH-GS was 8 points: 49% had 5-7 points, 37% had 8-10 points and 15% had 11-13 points. The 30-day
case fatality rate was 30%, and 31% presented severe disability. The 30-day survival was 92% for patients with ICH-GS 5-7
points, whereas it decreased to 27% in patients with ICH-GS 11-13 points.
Conclusions. In Mexico, ICH represents about a third of the forms of acute cerebrovascular disease, and the majority of
patients present severe disability or death at 30 days of follow-up. Hypertension is the main cause; hence, control of this
important cardiovascular risk factor should reduce the health burden of ICH.
An Expandable Prosthesis with Dual Cage-and-Plate Function in a Single Device...Erwin Chiquete, MD, PhD
Juan J. Ramı´rez, Erwin Chiquete, Juan J. Ramı´rez, Jr., Ernesto Go´mez-Limo´n, and Juan M. Ramı´rez
An expandable vertebral body prosthesis with dual cage-and-plate function in a single
device (JR prosthesis) was designed to test the hypothesis that this modular system can
provide the biomechanical requirements for immediate and durable spine stabilization
after corpectomy. Cadaver assays were performed with a stainless steal device to test fixation
and adequacy to the human spine anatomy. Then, 14 patients with vertebral tumors
(eight metastatic) underwent corpectomy and vertebral body replacement with a titaniummade
JR prosthesis. All patients had neurological deficit, severe pain and spine instability
prior to surgery. Mean pain score before surgery on a visual analog scale decreased from
7.6e3.0 points after operation ( p 5 0.002). All patients achieved at least one grade of
improvement in the Frankel score ( p 5 0.003), excepting the three patients with Frankel
grade A before surgery. Two patients with renal cell carcinoma died during the following
4 days after surgery. The remaining patients attained a painless and stable spine immediately,
which was maintained for long periods (mean follow-up: 25.4 months). No significant
infections or implant failures were registered. A nonfatal case of inferior vena cava
surgical injury was observed (repaired during surgery without further complications). In
conclusion, the JR prosthesis stabilizes the spine immediately after surgery and for the
rest of the patients’ life. To our knowledge, this is the first report on the clinical experience
of any expandable vertebral body prosthesis with dual cage-and-plate function in
a single device.
Expression profile of BRCA1 and BRCA2 genes in premenopausal Mexican women wi...Erwin Chiquete, MD, PhD
Gloria Loredo-Pozos, Erwin Chiquete,
Antonio Oceguera-Villanueva, Arturo Panduro,
Fernando Siller-Lo´pez, Martha E. Ramos-Márquez
Low BRCA1 gene expression is associated with
increased invasiveness and influences the response of
breast carcinoma (BC) to chemotherapeutics. However,
expression of BRCA1 and BRCA2 genes has not been
completely characterized in premenopausal BC. We analyzed
the clinical and immunohistochemical correlates of
BRCA1 and BRCA2 expression in young BC women. We
studied 62 women (mean age 38.8 years) who developed
BC before the age of 45 years. BRCA1 and BRCA2 mRNA
expression was assessed by reverse transcriptase-polymerase
chain reaction (RT-PCR) and that of HER-2 and
p53 proteins by immunohistochemistry. Body mass index
(BMI) C27 (52%) and a declared family history of BC
(26%) were the main risk factors. Ductal infiltrative adenocarcinoma
was found in 86% of the cases (tumor size
[5 cm in 48%). Disease stages I–IV occurred in 2, 40, 55,
and 3%, respectively (73% implicating lymph nodes).
Women aged B35 years (24%) had more family history of
cervical cancer, stage III/IV disease, HER-2 positivity, and
lower BRCA1 expression than older women (P-.05).
BRCA1 and BRCA2 expression correlated in healthy, but
not in tumor tissues (TT). Neither BRCA1 nor BRCA2
expression was associated with tumor histology, differentiation,
nodal metastasis or p53 and HER-2 expression.
After multivariate analysis, only disease stage explained
BRCA1 mRNA levels in the lowest quartile. Premenopausal
BC has aggressive clinical and molecular
characteristics. Low BRCA1 mRNA expression is associated
mainly with younger ages and advanced clinical stage
of premenopausal BC. BRCA2 expression is not associated
with disease severity in young BC women.
En conclusión, la neurotoxicidad por exposición
crónica a PDCB es rara y ha sido poco descrita
en la bibliografía. Las propiedades lipofílicas de
este compuesto producen desmielinización central,
y dan lugar a leucoencefalopatía difusa,
supra e infratentorial. Las manifestaciones más
frecuentemente descritas son agudas, y son de
interés particular, en nuestro paciente, las manifestaciones
cognitivas de tipo demenciales en
un seguimiento a largo plazo. Las recomendaciones
domésticas deben dirigirse a evitar el
contacto por parte de los menores de edad con
este compuesto, así como a su eventual sustitución
por productos menos tóxicos.
Spontaneous intracerebral hemorrhage in Mexico: results from a Multicenter Na...Erwin Chiquete, MD, PhD
José L. Ruiz-Sandoval, Erwin Chiquete, Alejandra Gárate-Carrillo, Ana Ochoa-Guzmán, Antonio Arauz,
Carolina León-Jiménez, Karina Carrillo-Loza, Luis M. Murillo-Bonilla, Jorge Villarreal-Careaga,
Fernando Barinagarrementería, Carlos Cantú-Brito, and the RENAMEVASC investigators
Introduction. Scarce information exists on intracerebral hemorrhage (ICH) in Latin America, and the existent is derived
from single-center registries with non-generalizable conclusions. The aim of this study is to describe the frequency, etiology,
management and outcome of ICH in Mexico.
Patients and methods. We studied consecutive patients with ICH pertaining to the National Multicenter Registry on Cerebrovascular
Disease (RENAMEVASC), conducted in 25 centers from 14 states of Mexico. The Intracerebral Hemorrhage Grading
Scale (ICH-GS) at admission was used to assess prognosis at 30 days follow-up.
Results. Of 2,000 patients with acute cerebrovascular disease registered in RENAMEVASC, 564 (28%) had primary ICH
(53% women; median age: 63 years; interquartile range: 50-75 years). Hypertension (70%), vascular malformations (7%)
and amyloid angiopathy (4%) were the main etiologies. In 10% of cases etiology could not be determined. Main ICH
locations were basal ganglia (50%), lobar (35%) and cerebellum (5%). Irruption into the ventricular system occurred in
43%. Median score of ICH-GS was 8 points: 49% had 5-7 points, 37% had 8-10 points and 15% had 11-13 points. The 30-day
case fatality rate was 30%, and 31% presented severe disability. The 30-day survival was 92% for patients with ICH-GS 5-7
points, whereas it decreased to 27% in patients with ICH-GS 11-13 points.
Conclusions. In Mexico, ICH represents about a third of the forms of acute cerebrovascular disease, and the majority of
patients present severe disability or death at 30 days of follow-up. Hypertension is the main cause; hence, control of this important cardiovascular risk factor should reduce the health burden of ICH.
Hemorragia intracerebral espontánea en México: resultados del Registro Hospit...Erwin Chiquete, MD, PhD
José L. Ruiz-Sandoval, Erwin Chiquete, Alejandra Gárate-Carrillo, Ana Ochoa-Guzmán, Antonio Arauz,
Carolina León-Jiménez, Karina Carrillo-Loza, Luis M. Murillo-Bonilla, Jorge Villarreal-Careaga,
Fernando Barinagarrementería, Carlos Cantú-Brito, investigadores RENAMEVASC
Introducción. Existe poca información respecto a la hemorragia intracerebral (HIC) en América Latina, y la existente ha
sido derivada de registros hospitalarios de un solo centro con conclusiones no generalizables. El objetivo de este estudio
es describir la frecuencia, etiología, manejo y desenlace clínico de la HIC en México.
Pacientes y métodos. Se estudiaron pacientes consecutivos con HIC incluidos en el Registro Nacional Mexicano de Enfermedad
Vascular Cerebral (RENAMEVASC), conducido en 25 centros de 14 estados de la República Mexicana. Se usó la
Intracerebral Hemorrhage Grading Scale (ICH-GS) para estimar el pronóstico a 30 días.
Resultados. De 2.000 pacientes con ictus agudo en el RENAMEVASC, 564 (28%) presentaron HIC espontánea (53% mujeres;
edad media: 63 años; rango intercuartílico: 50-75 años). La hipertensión arterial (70%), las malformaciones vasculares
(7%) y la angiopatía amiloidea (4%) fueron las causas más frecuentes. No se determinó la etiología en el 10% de
los casos. Las localizaciones más frecuentes fueron ganglionar (50%), lobar (35%) y cerebelosa (5%). La irrupción hacia
el sistema ventricular ocurrió en el 43%. La mediana en la escala ICH-GS al ingreso hospitalario fue de 8 puntos: el 49%
presentó 5-7 puntos; el 37%, 8-10 puntos, y el 15%, 11-13 puntos. La tasa de mortalidad a 30 días fue del 30%, y el 31%
mostró discapacidad grave. La sobrevida a 30 días fue del 92% en pacientes con 5-7 puntos en la escala ICH-GS, mientras
que se redujo al 27% en aquellos con 11-13 puntos.
Conclusiones. En México, la HIC representa casi un tercio de las formas de enfermedad vascular cerebral aguda, y la mayoría de los pacientes que la padecen presentan discapacidad funcional grave o muerte a 30 días. La hipertensión es la principal causa, por lo que el control de este importante factor de riesgo debería reducir la carga sanitaria de la HIC.
Presión arterial sistólica y pronóstico funcional en pacientes con enfermedad...Erwin Chiquete, MD, PhD
Manuel Baños-González, Carlos Cantú-Brito, Erwin Chiquete, Antonio Arauz, José Luís Ruiz-Sandoval, Jorge Villarreal-Careaga, Fernando Barinagarrementeria, José Juan Lozano y los investigadores RENAMEVASC
Objetivo: Analizar la asociación de la presión arterial sistólica (PAS) al ingreso hospitalario
y la evolución clínica a 30 días en pacientes con enfermedad vascular cerebral (EVC) aguda.
Métodos: El REgistro NAcional Mexicano de Enfermedad VAScular Cerebral (RENAMEVASC) es un registro
hospitalario multicéntrico realizado de noviembre de 2002 a octubre de 2004. Se registraron
2000 pacientes con distintos síndromes clínicos de EVC aguda confirmados por neuroimagen. La
estratificación de la evolución clínica se realizó mediante la escala de Rankin modificada.
Resultados: Se analizaron 1721 pacientes con registro de la PAS: 78 (4.5%) con isquemia cerebral
transitoria, 894 (51.9%) con infarto cerebral, 534 (30.9%) con hemorragia intracerebral,
165 (9.6%) con hemorragia subaracnoidea y 50 (2.9%) con trombosis venosa cerebral. De los
1036 (60.2%) pacientes con el antecedente de hipertensión, sólo 32.4% tenía un tratamiento
regular. La tasa de mortalidad a 30 días presentó un patrón en J con respecto a la PAS, de
tal manera que el riesgo de muerte fue máximo en <100><100>65 años (RR: 2.16, IC 95%: 1.74 - 2.67).
Conclusión: Tanto la hipotensión como la hipertensión arterial significativa al ingreso hospitalario
se asocian a un pronóstico adverso en la EVC aguda. No obstante, un buen pronóstico
funcional se puede lograr en un amplio rango de cifras de PAS.
Title: Sense of Taste
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the structure and function of taste buds.
Describe the relationship between the taste threshold and taste index of common substances.
Explain the chemical basis and signal transduction of taste perception for each type of primary taste sensation.
Recognize different abnormalities of taste perception and their causes.
Key Topics:
Significance of Taste Sensation:
Differentiation between pleasant and harmful food
Influence on behavior
Selection of food based on metabolic needs
Receptors of Taste:
Taste buds on the tongue
Influence of sense of smell, texture of food, and pain stimulation (e.g., by pepper)
Primary and Secondary Taste Sensations:
Primary taste sensations: Sweet, Sour, Salty, Bitter, Umami
Chemical basis and signal transduction mechanisms for each taste
Taste Threshold and Index:
Taste threshold values for Sweet (sucrose), Salty (NaCl), Sour (HCl), and Bitter (Quinine)
Taste index relationship: Inversely proportional to taste threshold
Taste Blindness:
Inability to taste certain substances, particularly thiourea compounds
Example: Phenylthiocarbamide
Structure and Function of Taste Buds:
Composition: Epithelial cells, Sustentacular/Supporting cells, Taste cells, Basal cells
Features: Taste pores, Taste hairs/microvilli, and Taste nerve fibers
Location of Taste Buds:
Found in papillae of the tongue (Fungiform, Circumvallate, Foliate)
Also present on the palate, tonsillar pillars, epiglottis, and proximal esophagus
Mechanism of Taste Stimulation:
Interaction of taste substances with receptors on microvilli
Signal transduction pathways for Umami, Sweet, Bitter, Sour, and Salty tastes
Taste Sensitivity and Adaptation:
Decrease in sensitivity with age
Rapid adaptation of taste sensation
Role of Saliva in Taste:
Dissolution of tastants to reach receptors
Washing away the stimulus
Taste Preferences and Aversions:
Mechanisms behind taste preference and aversion
Influence of receptors and neural pathways
Impact of Sensory Nerve Damage:
Degeneration of taste buds if the sensory nerve fiber is cut
Abnormalities of Taste Detection:
Conditions: Ageusia, Hypogeusia, Dysgeusia (parageusia)
Causes: Nerve damage, neurological disorders, infections, poor oral hygiene, adverse drug effects, deficiencies, aging, tobacco use, altered neurotransmitter levels
Neurotransmitters and Taste Threshold:
Effects of serotonin (5-HT) and norepinephrine (NE) on taste sensitivity
Supertasters:
25% of the population with heightened sensitivity to taste, especially bitterness
Increased number of fungiform papillae
Anti ulcer drugs and their Advance pharmacology ||
Anti-ulcer drugs are medications used to prevent and treat ulcers in the stomach and upper part of the small intestine (duodenal ulcers). These ulcers are often caused by an imbalance between stomach acid and the mucosal lining, which protects the stomach lining.
||Scope: Overview of various classes of anti-ulcer drugs, their mechanisms of action, indications, side effects, and clinical considerations.
Factory Supply Best Quality Pmk Oil CAS 28578–16–7 PMK Powder in Stockrebeccabio
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TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Ve...kevinkariuki227
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
These simplified slides by Dr. Sidra Arshad present an overview of the non-respiratory functions of the respiratory tract.
Learning objectives:
1. Enlist the non-respiratory functions of the respiratory tract
2. Briefly explain how these functions are carried out
3. Discuss the significance of dead space
4. Differentiate between minute ventilation and alveolar ventilation
5. Describe the cough and sneeze reflexes
Study Resources:
1. Chapter 39, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 34, Ganong’s Review of Medical Physiology, 26th edition
3. Chapter 17, Human Physiology by Lauralee Sherwood, 9th edition
4. Non-respiratory functions of the lungs https://academic.oup.com/bjaed/article/13/3/98/278874
micro teaching on communication m.sc nursing.pdfAnurag Sharma
Microteaching is a unique model of practice teaching. It is a viable instrument for the. desired change in the teaching behavior or the behavior potential which, in specified types of real. classroom situations, tends to facilitate the achievement of specified types of objectives.
Flu Vaccine Alert in Bangalore Karnatakaaddon Scans
As flu season approaches, health officials in Bangalore, Karnataka, are urging residents to get their flu vaccinations. The seasonal flu, while common, can lead to severe health complications, particularly for vulnerable populations such as young children, the elderly, and those with underlying health conditions.
Dr. Vidisha Kumari, a leading epidemiologist in Bangalore, emphasizes the importance of getting vaccinated. "The flu vaccine is our best defense against the influenza virus. It not only protects individuals but also helps prevent the spread of the virus in our communities," he says.
This year, the flu season is expected to coincide with a potential increase in other respiratory illnesses. The Karnataka Health Department has launched an awareness campaign highlighting the significance of flu vaccinations. They have set up multiple vaccination centers across Bangalore, making it convenient for residents to receive their shots.
To encourage widespread vaccination, the government is also collaborating with local schools, workplaces, and community centers to facilitate vaccination drives. Special attention is being given to ensuring that the vaccine is accessible to all, including marginalized communities who may have limited access to healthcare.
Residents are reminded that the flu vaccine is safe and effective. Common side effects are mild and may include soreness at the injection site, mild fever, or muscle aches. These side effects are generally short-lived and far less severe than the flu itself.
Healthcare providers are also stressing the importance of continuing COVID-19 precautions. Wearing masks, practicing good hand hygiene, and maintaining social distancing are still crucial, especially in crowded places.
Protect yourself and your loved ones by getting vaccinated. Together, we can help keep Bangalore healthy and safe this flu season. For more information on vaccination centers and schedules, residents can visit the Karnataka Health Department’s official website or follow their social media pages.
Stay informed, stay safe, and get your flu shot today!
ARTIFICIAL INTELLIGENCE IN HEALTHCARE.pdfAnujkumaranit
Artificial intelligence (AI) refers to the simulation of human intelligence processes by machines, especially computer systems. It encompasses tasks such as learning, reasoning, problem-solving, perception, and language understanding. AI technologies are revolutionizing various fields, from healthcare to finance, by enabling machines to perform tasks that typically require human intelligence.
Couples presenting to the infertility clinic- Do they really have infertility...Sujoy Dasgupta
Dr Sujoy Dasgupta presented the study on "Couples presenting to the infertility clinic- Do they really have infertility? – The unexplored stories of non-consummation" in the 13th Congress of the Asia Pacific Initiative on Reproduction (ASPIRE 2024) at Manila on 24 May, 2024.
Ozempic: Preoperative Management of Patients on GLP-1 Receptor Agonists Saeid Safari
Preoperative Management of Patients on GLP-1 Receptor Agonists like Ozempic and Semiglutide
ASA GUIDELINE
NYSORA Guideline
2 Case Reports of Gastric Ultrasound
Tom Selleck Health: A Comprehensive Look at the Iconic Actor’s Wellness Journeygreendigital
Tom Selleck, an enduring figure in Hollywood. has captivated audiences for decades with his rugged charm, iconic moustache. and memorable roles in television and film. From his breakout role as Thomas Magnum in Magnum P.I. to his current portrayal of Frank Reagan in Blue Bloods. Selleck's career has spanned over 50 years. But beyond his professional achievements. fans have often been curious about Tom Selleck Health. especially as he has aged in the public eye.
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Introduction
Many have been interested in Tom Selleck health. not only because of his enduring presence on screen but also because of the challenges. and lifestyle choices he has faced and made over the years. This article delves into the various aspects of Tom Selleck health. exploring his fitness regimen, diet, mental health. and the challenges he has encountered as he ages. We'll look at how he maintains his well-being. the health issues he has faced, and his approach to ageing .
Early Life and Career
Childhood and Athletic Beginnings
Tom Selleck was born on January 29, 1945, in Detroit, Michigan, and grew up in Sherman Oaks, California. From an early age, he was involved in sports, particularly basketball. which played a significant role in his physical development. His athletic pursuits continued into college. where he attended the University of Southern California (USC) on a basketball scholarship. This early involvement in sports laid a strong foundation for his physical health and disciplined lifestyle.
Transition to Acting
Selleck's transition from an athlete to an actor came with its physical demands. His first significant role in "Magnum P.I." required him to perform various stunts and maintain a fit appearance. This role, which he played from 1980 to 1988. necessitated a rigorous fitness routine to meet the show's demands. setting the stage for his long-term commitment to health and wellness.
Fitness Regimen
Workout Routine
Tom Selleck health and fitness regimen has evolved. adapting to his changing roles and age. During his "Magnum, P.I." days. Selleck's workouts were intense and focused on building and maintaining muscle mass. His routine included weightlifting, cardiovascular exercises. and specific training for the stunts he performed on the show.
Selleck adjusted his fitness routine as he aged to suit his body's needs. Today, his workouts focus on maintaining flexibility, strength, and cardiovascular health. He incorporates low-impact exercises such as swimming, walking, and light weightlifting. This balanced approach helps him stay fit without putting undue strain on his joints and muscles.
Importance of Flexibility and Mobility
In recent years, Selleck has emphasized the importance of flexibility and mobility in his fitness regimen. Understanding the natural decline in muscle mass and joint flexibility with age. he includes stretching and yoga in his routine. These practices help prevent injuries, improve posture, and maintain mobilit
MANAGEMENT OF ATRIOVENTRICULAR CONDUCTION BLOCK.pdfJim Jacob Roy
Cardiac conduction defects can occur due to various causes.
Atrioventricular conduction blocks ( AV blocks ) are classified into 3 types.
This document describes the acute management of AV block.
2. Blood pressure at hospital admission and outcome after primary intracerebral hemorrhage
acute cerebrovascular disease, as compared with
the basal state [7], so a high BP in the acute state
can be both the cause and the consequence of
a non-traumatic brain hematoma [2, 8]. Nevertheless, the clinical relevance of BP readings upon
arrival at the Emergency Department for radiological characteristics and outcome after ICH is
not completely clear [8-11].
The purpose of this study was to analyze the
clinical significance of the first BP reading performed at hospital admission in patients with acute
primary ICH, in relation to neuroimaging characteristics and short-term outcome. Our hypothesis
was that a high BP is associated with short-term
mortality, mainly through extension into the ventricular system. This may help to define adequate
patient selection for acute tight BP control after ICH.
Our findings are relevant in view of the recent clinical trials on acute control of BP in patients with primary cerebral hematomas.
Material and methods
Patient characteristics
This is a descriptive study on patients prospectively included in a single-center research database
[10]. The internal Committee of Ethics of our hospital approved the present study. Informed consent
was obtained from the patients or their closest relative. We reviewed 316 consecutive adult patients
hospitalized in the general wards of our institution
with acute primary ICH. Inclusion criteria were: 1)
ICH was defined as a sudden focal neurological
deficit explained by a brain hematoma demonstrated in head computed tomography (CT) or magnetic resonance imaging (MRI) performed in the
first 48 h after arrival; 2) supratentorial or infratentorial parenchymal hematomas; and 3) having available the first BP readings at hospital admission to
the Emergency Department registered within the
first 24 h after symptoms onset. The exclusion
criteria were: 1) hematomas secondary to head
trauma, arteriovenous malformations, aneurysms,
vasculitis, cerebral vein and sinus thrombosis, neoplasms, hemorrhagic diathesis, anti-coagulant therapy or illicit drug abuse; 2) time from symptoms
onset, neuroimaging or outcome information not
available. Blood pressure readings were performed
immediately following arrival at the Emergency
Department, and before exposure to any anti-hypertensive therapy [12]. After a systolic BP (SBP) > 200
mm Hg or a mean arterial pressure (MAP) > 150
mm Hg was identified, aggressive BP control was
applied, as recommended [7]. A standardized structured questionnaire was used to collect information on risk factors, neuroimaging characteristics,
acute management, in-hospital complications and
outcome at discharge.
Arch Med Sci 1, February / 2013
A hypertensive etiology was defined as the
patient having a history of hypertension or SBP
> 140 mm Hg or diastolic BP (DBP) > 90 mm Hg
maintained throughout one week or more after the
hospital admission, in the absence of other potential causes [3, 4]. Intracerebral hemorrhage volume
was calculated by analysis of the head CT scans
according to the ABC/2 method. The first SBP and
DBP reading taken on arrival at the Emergency
Department, before anti-hypertensive intervention,
was used to calculate MAP, as MAP = DBP + 0.412
(SBP – DBP) [3, 4]. This MAP formula corrects for
the spurious variance of calculated MAP seen in
individuals with hypertension; thus, it is the ideal
method in cases with hypertensive ICH.
Statistical analysis
Pearson χ2 and Fisher exact test were used to
assess nominal variables in bivariate analyses. Pearson correlation was used in continuous variables.
The SBP, DBP and MAP were evaluated for their
association with relevant neuroimaging findings
and short-term outcome. The distributions of SBP,
DBP and MAP values were divided into quartiles
to compare the highest (Q4: > 190, 110, 135 and
85 mm Hg; respectively) vs. lower (Q1-Q3) or the lowest (Q1) quartiles for their clinical correlates. To test
the association of BP values with short-term mortality, multivariate Cox proportional hazards models were constructed for the entire cohort and for
the cases with supratentorial ICH (n = 285) separately. Input variables were those significantly associated with mortality in bivariate analyses. Actuarial analyses by Kaplan-Meier survival curves were
constructed to evaluate the prognostic association
of SBP with mortality observed after hospital admission. Log-rank tests were used to compare Q4 and
Q1 in actuarial curves. All p values are two-sided
and considered significant when p < 0.05. Except
for the multivariable analysis, which implies adjustments for relevant confounders, a Bonferroni correction (multiple-comparison adjustment) was
applied to all significant associations in bivariate
analyses, with a correction factor derived from the
number of independent variables tested for each
outcome of interest (ICH location, BP estimate and
mortality). SPSS (SPSS Inc., Chicago, IL.) v17.0 statistical package was used for all calculations.
Results
We studied 316 patients (mean age: 64 years,
range: 18 to 99 years) with primary ICH: 159 (50.3%)
women (mean age: 65 years, range: 18 to 99 years)
and 157 (49.7%) men (mean age: 63 years, range:
18 to 95 years). No relevant differences were observed according to gender, except for more cases
with the antecedent of hypertension in women,
35
3. .
E. Chiquete, A. Ochoa-Guzmán, Á. Vargas-Sánchez, J. Navarro-Bonnet, M.A. Andrade-Ramos, P Gutiérrez-Plascencia, J.L. Ruiz-Sandoval
as compared with men (74% vs. 60%, respectively;
p = 0.009).
Systolic BP > 190 mm Hg was more frequently
found among older patients than those aged < 45
years, but not significantly after Bonferroni correction (Table I). Irruption into the third ventricle was
more common among patients with the highest
(i.e., Q4) BP estimates (Table I) than those with
a lower BP. Patients with SBP > 190 mm Hg and
DBP > 110 mm Hg (BP > 190/110 mm Hg) had more
extension into the third ventricle, as compared
with patients with SBP > 190 mm Hg but with DBP
≤ 110 mm Hg (56% vs. 30%, respectively; Bonferroni p = 0.04). No significant correlation was found
between BP (either as quartiles or crude values)
and hematoma volume. In cases with supratentorial ICH (n = 285), intraventricular extension
occurred more frequently in those with deep rather
than lobar hematomas (59% vs. 38%, respectively;
Bonferroni p = 0.01).
In patients with supratentorial ICH, 46% with
lobar and 26% with deep hematomas underwent
surgical evacuation (p = 0.04). Conversely, ven-
triculostomy was significantly more common
among patients with deep ICH than in lobar ICH
cases (11% vs. 1%, p = 0.005). High BP estimates
were not associated with the probability of receiving any surgical intervention. Median hospital stay
was 9 days (range: 1 to 82 days). Ten (3.2%) patients were discharged with total recovery,
45 (14.2%) with moderate disability, 110 (34.8%)
with severe disability and 7 (2.2%) in vegetative
state. The in-hospital case fatality rate was 45.6%
(n = 144), with 4.4% of in-hospital deaths occurring
within the first 48 h after admission. In-hospital
mortality was higher among patients with SBP
> 190 mm Hg (Table I), and in cases with any extension into the ventricular system, in bivariate analyses. Moreover, BP measures were not significantly
associated with acute case fatality or with extensions into the ventricles in patients with infratentorial ICH. On the other hand, in a Cox proportional
hazards model applied to patients with supratentorial ICH, the highest quartile of SBP was independently associated with a high frequency of
acute case fatalities, after adjusting for known pre-
Table I. Clinical characteristics of 316 patients with ICH, according to blood pressure readings
Variables
GCS at arrival ≤ 8, n (%)
SBP
DB P
> 190 mm Hg
(Q4)
(n = 77)
≤ 190 mm Hg
(Q1-Q3)
(n = 239)
> 110 mm Hg
(Q4)
(n = 54)
MA P
≤ 110 mm Hg
(Q1-Q3)
(n = 262)
> 135 mm Hg ≤ 135 mm Hg
(Q4)
(Q1-Q3)
(n = 75)
(n = 241)
29 (37.7)
63 (26.4)
20 (37.0)
72 (27.5)
26 (34.7)
66 (27.4)
ICH volume > 70 ml, n (%) 13 (16.9)
25 (10.5)
8 (14.8)
30 (11.5)
12 (16.0)
26 (10.8)
Supratentorial, n (%)
220 (92.1)
46 (85.2)
239 (91.2)
62 (82.7)
223 (92.5)
5 (8.1)
81 (36.3)a
65 (84.4)
9 (13.8)
Deep
56 (86.2)
143 (65.0)
43 (93.5)
156 (65.3)a
57 (91.9)
142 (63.7)a
12 (15.6)
19 (7.9)
8 (14.8)
23 (8.8)
13 (17.3)
18 (7.5)
119 (49.8)
32 (59.3)
131 (50.0)
41 (54.7)
122 (50.6)
25 (46.3)
(27.5)a
30 (40.0)
67 (27.8)a
Ventricular irruption, n (%) 44 (57.1)
65
(27.2)a
3 (6.5)
83
(34.7)a
Lobar
Infratentorial ICH, n (%)
77
(35.0)a
Third ventricle
32 (41.6)
72
Fourth ventricle
23 (29.9)
55 (23.0)
19 (35.2)
59 (22.5)
22 (29.3)
56 (23.2)
Lateral ventricles
40 (51.9)
110 (46.0)
29 (53.7)
121 (46.2)
38 (50.7)
112 (46.5)
In-hospital mortality, n (%) 43 (55.8)
101 (42.3)
26 (48.1)
118 (45.0)
37 (49.3)
107 (44.4)
DBP – diastolic blood pressure, GCS – Glasgow coma scale, ICH – intracerebral hemorrhage, MAP – mean arterial pressure, SBP – systolic blood
pressure. ap < 0.05, after Bonferroni correction; for comparison of upper vs. lower quartiles
Table II. Multivariate analysis of factors independently associated with in-hospital mortality in patients with supratentorial hemorrhage (n = 285): a Cox proportional hazards modela
Hazard ratio (95% confidence interval)
Value of p
GCS < 8 at admission
3.27 (2.08-5.14)
< 0.001
Hematoma volume > 70 ml
2.09 (1.24-3.54)
0.006
The highest vs. the lowest SBP quartile
1.19 (1.02-1.38)
0.03
Age, per one year increment
1.02 (1.00-1.03)
0.01
Variables
GCS – Glasgow coma scale, SBP, systolic blood pressure. aAdjusted for gender, age, extension into the ventricles (any or separate), diastolic and
mean blood pressure at hospital admission, ICH location (supratentorial vs. infratentorial; deep vs. lobar; and cerebellar vs. brainstem) and surgical interventions (surgical evacuation and ventriculostomy). Only significant predictors are shown
36
Arch Med Sci 1, February / 2013
4. Blood pressure at hospital admission and outcome after primary intracerebral hemorrhage
A
B
Log-rank test, p = 0.001
100
80
Survival rate [%]
80
Survival rate [%]
Log-rank test, p = 0.520
100
60
SBP < 140 mm Hg
(lowest quartile)
40
SBP < 140 mm Hg
(lowest quartile)
60
40
20
20
SBP > 190 mm Hg
(highest quartile)
0
0
20
40
60
SBP > 190 mm Hg
(highest quartile)
0
80
0
20
Days after hospital admission
C
D
Log-rank test, p = 0.002
100
60
80
Log-rank test, p = 0.119
100
80
Survival rate [%]
80
Survival rate [%]
40
Days after hospital admission
60
SBP < 140 mm Hg
(lowest quartile)
40
20
60
SBP < 140 mm Hg
(lowest quartile)
40
20
SBP > 190 mm Hg
(highest quartile)
0
SBP > 190 mm Hg
(highest quartile)
0
0
20
40
60
80
0
20
Days after hospital admission
40
60
80
Days after hospital admission
Figure 1. Kaplan-Meier estimates of short-term survival after primary intracerebral hemorrhage (ICH), according
A
to the first systolic blood pressure (SBP) reading at hospital admission, in patients with (n = 163) (A) and without
B
C
(n = 153) (B) intraventricular hematoma extension, as well as with supratentorial (n = 285) (C) and infratentorial
D
(n = 31) (D) ICH
Discussion
We found that a high BP at hospital admission
is associated with an increased probability of ICH
extension into the ventricular system and with
Arch Med Sci 1, February / 2013
60
Case fatality rate [%]
dictors of short-term outcome (Table II). The association of a high SBP with mortality remained significant only for supratentorial ICH and in cases
with hematoma extension into the ventricular system at first brain imaging (Figure 1). We also explored the possibility that low BP levels would be
associated with a high mortality, together with very
high BP readings (i.e., a “J-pattern relationship”
between BP levels and mortality frequency) either
as quartiles, quintiles or intuitive BP cutoffs (Figure 2) in the whole cohort (n = 316). A J-shaped relationship was observed for SBP intervals and case
fatality rate, but not for DBP or MAP (Figure 2).
50
40
30
20
10
SBP ≤ 110
111-130
131-150
151-170
171-190
> 190
DBP ≤ 60
61-80
81-100
101-120
121-140
> 140
MAP ≤ 80
81-100
101-120
121-140
141-160
> 160
Blood pressure intervals [mm Hg]
Figure 2. Case fatality rate according to blood pressure intervals (as 20 mm Hg increments)
DBP – diastolic blood pressure, SBP – systolic blood pressure,
MAP – mean arterial pressure
37
5. .
E. Chiquete, A. Ochoa-Guzmán, Á. Vargas-Sánchez, J. Navarro-Bonnet, M.A. Andrade-Ramos, P Gutiérrez-Plascencia, J.L. Ruiz-Sandoval
a high short-term mortality in patients with supratentorial ICH. The effect of a high BP is possibly
mediated by a high frequency of extension into the
ventricular system, especially the third ventricle.
We observed a high acute case fatality rate, possibly due to the fact that all patients analyzed in this
study were managed in the general wards.
Several autonomic responses have been described after acute cerebrovascular disease, including ICH [2, 6, 13]. The association of a high BP at
hospital admission and early outcome after ICH has
been discussed previously [2, 8-11], but the nature
of this relationship is difficult to explain. It has been
suggested that acute hypertension after ICH may
facilitate hematoma enlargement, perihematoma
edema or rebleeding, all dynamic factors associated with outcome [7]. Hematoma expansion is
a strong predictor of short-term outcome [14, 15],
but this factor has not been consistently associated with a high BP at hospital admission [16-19].
Alternatively, an elevated BP could be an epiphenomenal marker of early deterioration and not the
cause of the neurologic impairment [20].
Clinical and experimental studies have shown
that SBP increases acutely after ICH or cerebral
infarction, with a natural tendency to decrease in
the following days [2, 6, 21-24]. Impaired cerebrovascular reactivity [25] and baroreflex dysfunction [26] can result from ICH or cerebral infarction,
which could mediate in part the acute BP response
after brain injury and intracranial hypertension.
Recent trials [27, 28] have failed to demonstrate
a reduction in mortality with strict BP control in the
acute state after ICH. This suggests that there is
a tight balance that needs to be maintained
between adequate cerebral perfusion after ICH [6]
and the risk of hematoma expansion imposed by
a high systemic blood pressure [16], which highlights the importance of adequate patient selection
for strict blood pressure control in the acute management of ICH. Our results confirm the notion that
patients with supratentorial ICH experience more
benefit from tight BP control, as compared with
those with brainstem or cerebellar hematomas.
In the mid and long term, a J-shaped relationship
has been described for BP levels (below 110/70
mm Hg and above 140/90 mm Hg) with cardiovascular outcomes [1, 29]. This has challenged the
“lower the better” concept in BP management.
Moreover, in the acute presentation of the different
forms of cerebrovascular disease (ischemic stroke,
ICH, subarachnoid hemorrhage and cerebral venous
thrombosis) the first SBP readings (but not DBP or
MAP) at hospital admission also show a J-shaped
relationship with short-term mortality, so that the risk
of death is highest for SBP < 100 mm Hg, decreases between 100 mm Hg and 139 mm Hg, and gradually reaches a new zenith at SBP > 220 mm Hg [2].
38
In the present report we confirm this pattern in an
independent population; however, here we observed very few (n = 3) cases with SBP < 100 mm Hg,
and therefore Kaplan-Meier and Cox analyses did
not show a significant association for low SBP levels and short-term outcome. On the other hand,
the present study was about the first BP readings
at hospital admittance and not about BP control in
relation to outcome. A better understanding of BP
and organ perfusion dynamics will help to define
patient-centered cut-offs for effectively reducing
cardiovascular outcomes and mortality [30-32].
This study has several limitations that should be
acknowledged. First, no information could be
obtained about other relevant prognostic variables,
such as blood glucose levels, central temperature,
premorbid brain parenchymal characteristics, withdrawal of care and timing of neuroimaging or surgery [7, 14, 19]. Also, no sequential information from
brain imaging could be obtained to evaluate
hematoma expansion, secondary intraventricular
extension, or perihematoma edema, and the
dynamic changes of BP throughout the first week
after ICH were not registered. More importantly, we
could not eliminate the possibility of hematoma
enlargement before the first CT or MRI was performed, because neuroimaging was undertaken at
different time points for each patient. Nevertheless,
these findings may help to identify patients more
suitable to experience benefit from strict BP control in the acute phase of ICH. Whether aggressive
reduction of BP will result in better outcomes is yet
to be established [27, 28].
In conclusion, a high BP is associated with an
adverse short-term outcome. High BP readings are
more related to irruption into the ventricular system than with hematoma volume, therefore influencing mortality risk. However, a significant proportion of deaths could not be explained by
ventricular irruptions, which highlights the need for
more studies to define adequate BP cutoffs to positively affect cardiovascular outcomes in patients
with hypertension [30-32].
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