Association of Serum Magnesium with Blood Pressure in Patients with Hypertensive Crises: A Retrospective Cross-Sectional Study.

The role of magnesium in blood pressure has been studied among hypertensive patients; however, there is a dearth of studies exploring the role of magnesium in hypertensive crises. The primary objective of this study was to evaluate the relationship between serum magnesium and blood pressure in patients with hypertensive crises. This was a single-center, retrospective, chart review, cross-sectional study of patients with hypertensive crises. Patients were included if they were eighteen years of age or older, with an international classification disease ninth revision (ICD-9) code of 401.9 (hypertensive crises: emergency or urgency) and a documented magnesium level on their electronic medical record. The primary outcome of the study was the correlation between serum magnesium and blood pressure (systolic blood pressure and diastolic blood pressure) in patients with hypertensive crises. Two hundred and ninety-three patients were included in the study. The primary outcome result showed that serum magnesium was positively correlated with systolic blood pressure (r = 0.143, p = 0.014), but not diastolic blood pressure. Conclusion: This study found a significant positive association between magnesium and systolic blood pressure, but not diastolic blood pressure, among patients with hypertensive crises. This positive association of serum magnesium with systolic blood pressure was maintained after adjusting for covariates. This study's findings suggest a potential role of magnesium in blood pressure among patients with hypertensive crises.

Evaluation of serum calcium differences in hypertensive crises and control patients: A randomly matched case-control study.

The role of calcium in blood pressure has been widely studied among hypertensive patients; however, no study has explored the role of calcium in hypertensive crises. The primary objective of this study is to evaluate the differences in serum calcium levels between hypertensive crises patients and a 1:1 random matched controls (age-, sex-, race-, diabetes, and body mass index matched). This study is a single-center, retrospective, chart review, case-control study of patients with hypertensive crises (case group) and patients without hypertensive crises (control group). Patients were included in the case group if they were 18 years of age or older with hypertensive crises and have a documented calcium level. The control group patients were required to be 18 years of age or older, have a documented calcium level, and have no diagnosis of hypertensive crises. The primary outcome of the study was to compare the mean serum calcium in patients with hypertensive crises vs patients without hypertensive crises. Five hundred and sixty-six patients were included in the study: 283 patients in both the case group and control group. The primary outcome results showed that serum calcium concentration was not significantly different between the case group (8.99 ± 0.78 mg/dL) and control group (8.96 ± 0.75 mg/dL) (P = .606). This study found no significant difference in serum calcium levels in patients with hypertensive crises compared to a random matched control group. Larger observational or experimental studies may be useful to evaluate the effect of calcium on blood pressure in hypertensive crises.

Evaluation of serum magnesium differences in hypertensive crises and control patients: A randomly matched case-control study.

Although the role of magnesium in blood pressure has been well studied among hypertensive patients, no study has explored the role of magnesium in hypertensive crises. The primary objective of this study is to evaluate the differences in serum magnesium levels between hypertensive crises patients and matched controls (age-, sex-, race-, and diabetes-matched) in a 1:1 random match. This study is a single-center, retrospective, chart review, case-control study of patients with hypertensive crises (case group) and patients without hypertensive crises (control group). Patients were included in the case group if they were 18 years of age or older with hypertensive crises and have a documented magnesium level. The control group patients were required to be 18 years of age or older, have no diagnosis of hypertensive crises, and have a documented magnesium level. The primary outcome of the study was to compare the mean serum magnesium in patients with hypertensive crises versus patients without hypertensive crises. Three hundred and fifty-eight patients were included in the study: 179 patients in both the case group and control group. The primary outcome results showed that serum magnesium concentration was not significantly different between the case group (1.89 ± 0.29 mg/dl) and control group (1.90 ± 0.31 mg/dl) (p = .787). This study found no significant difference in serum magnesium levels in patients with hypertensive crises compared to a random matched control group. Larger observational or experimental studies may be useful to evaluate the effect of magnesium on blood pressure in hypertensive crises.

Is Ciprofloxacin in Combination With Beta-lactam Antibiotics a Recipe for Thrombocytosis?: A Case Report of Thrombocytosis in a Patient Receiving Ciprofloxacin and Ceftriaxone.

Thrombocytosis is defined as a platelet count greater than 400,000/mcL. We report the case of a patient who developed thrombocytosis after receiving ciprofloxacin and ceftriaxone therapy. A 73-year-old African-American female presented to the hospital with altered mental status attributed to sepsis and urinary tract infection. Patient was initiated on multiple empiric antibiotic therapy and was subsequently transitioned to ciprofloxacin and ceftriaxone at different times as definitive therapy for treatment of Escherichia coli bacteremia and Escherichia coli urinary tract infection. The patient developed thrombocytosis during and/or proximally to the administration of ciprofloxacin and ceftriaxone. A myeloproliferative source for the thrombocytosis was ruled out by the hematology/oncology team with a negative Janus kinase 2 V617F mutation assay result. In addition, other nondrug reactive sources of thrombocytosis (infection and anemia) were generally ruled out because the thrombocytosis was proximally linked with ciprofloxacin and ceftriaxone administration. The Naranjo Adverse Drug Reaction Probability Scale assigned a score of 5, indicating ciprofloxacin or ceftriaxone independently or in combination as a probable cause of thrombocytosis. This case report suggests that ciprofloxacin in combination with ceftriaxone (a beta-lactam antibiotic) may be a probable cause of thrombocytosis.

Supporting health system transformation through an interprofessional education experience focused on population health.

The purpose of the study was to determine the impact of an interprofessional education (IPE) experience on first year students across all schools of a health sciences center on the topic of pediatric immunizations. The authors conducted a pre-/post-test at Louisiana State University Health Sciences Center-New Orleans with 731 first year students from 25 academic programs encompassing all six schools (Allied Health, Dentistry, Graduate Studies, Medicine, Nursing and Public Health). In the four questions related to the Interprofessional Education Collaborative (IPEC) sub-competencies and the three questions related to professional role regarding immunizations, there was a statistically significant difference in the pre-/post-test survey results (P < 0.0001). Student learning related to the collaboration needed to make a larger impact on patient outcomes was demonstrated through assessment of an open-ended question. IPE experiences can improve first-year students' perceptions of IPEC sub-competencies regarding the importance of population health and teamwork. By utilizing a population health focus with IPE activities, novice learners are equipped to learn and apply collaborative practice skills along with recognizing the importance of promoting overall health and well-being instead of just health care.

Hemophagocytic lymphohistiocytosis in an HIV-positive patient with concomitant disseminated histoplasmosis.

A 46-year-old Dominican man, known to have HIV, presented with constitutional symptoms of two week's duration. The patient was found to have cytopenias, significantly elevated ferritin level and lymphadenopathy. Biopsies and laboratory studies met the criteria for hemophagocytic lymphohistiocytosis (HLH). A concomitant diagnosis of histoplasmosis was confirmed as the trigger for HLH and treatment resulted in clinical improvement and resolution of symptoms.

Clinical Case of the Month:A 54 Year-Old Woman With Fever and Chills of Four-Days Duration.

CASE REPORT: A 54 year-old woman with diabetes mellitus type two and end-stage renal disease on hemodialysis presented to the emergency department with a four day history of generalized malaise, fever, and chills. Her symptoms were also associated with occasional dyspnea without a cough. She reported intermittent chronic diarrhea with hemodialysis which was currently unchanged. On the day of admission, she could not tolerate hemodialysis due to her symptoms. Over the past year she admitted to night sweats and a 40 pound weight loss. She denied having palpitations, chest pain, hemoptysis, lymph node swelling, sick contacts, or recent travel. The remainder of the review of systems was negative.

Hypertension knowledge among patients from an urban clinic.

OBJECTIVE: To determine levels and correlates of hypertension knowledge. DESIGN: Cross-sectional telephone survey. SETTING: Urban, public hospital clinic. PARTICIPANTS: 296 adults with hypertension. MAIN OUTCOME MEASURE: Hypertension knowledge was assessed through a 10-item test; respondents received one point for each correct answer. RESULTS: Eighty-nine percent of respondents were Black, 79% were female, 75% had a monthly income < $1000, and 62% had completed high school. Items with the lowest percentage of correct responses included knowing that hypertension does not cause cancer (41.9% correct), a blood pressure of 130/80 mm Hg is normal (59.8% correct), hypertension lasts a lifetime (60.5% correct), and renal failure is a complication of hypertension (76.4% correct). Overall, 39% answered 9 or 10 questions correctly. Low hypertension knowledge (< or = 7 questions correct) was associated with age > or = 60 years, having less than a high school education, and reporting a first hypertension diagnosis within 9 years before being surveyed. CONCLUSIONS: Hypertension knowledge deficits in specific content areas and among certain subgroups were present in this urban population. Educational programs focusing on newly diagnosed hypertensive patients and aimed at filling targeted knowledge deficits may be a cost-effective approach to increase hypertension knowledge in similar populations.