Sex Differences in Hypertension and Its Management Throughout Life.

BACKGROUND: The prevalence of hypertension and uncontrolled hypertension may differ by age and sex. METHODS: We included participants in the Atherosclerosis Risk in Communities study at seven study visits over 33 years (visit 1: 15 636 participants; mean age, 54 years; 55% women), estimating sex differences in prevalence of hypertension (systolic blood pressure ≥130 mm Hg; diastolic blood pressure ≥80 mm Hg; or self-reported antihypertension medication use) and uncontrolled hypertension (systolic blood pressure ≥140 mm Hg or diastolic blood pressure ≥90 mm Hg) using unadjusted and comorbidity-adjusted models. RESULTS: The prevalence of hypertension increased from 40% (ages, 43-46 years) to 93% (ages, 91-94 years). Within hypertensive individuals, the prevalence of uncontrolled hypertension was higher in men (33%) than women (23%) at ages 43 to 46 years but became higher in women than men starting at ages 61 to 64, with 56% of women and 40% men having uncontrolled hypertension at ages 91 to 94. This sex difference was not explained by differences in coronary heart disease, diabetes, body mass index, estimated glomerular filtration rate, number of antihypertension medications, classes of medications, or adherence to medications. In both sexes, uncontrolled hypertension was associated with a higher risk for chronic kidney disease progression (hazard ratio, 1.5 [1.2-1.9]; P=4.5×10-4), heart failure (hazard ratio, 1.6 [1.4-2.0]; P=8.1×10-7), stroke (hazard ratio, 2.1 [1.6-2.8]; P=1.8×10-8), and mortality (hazard ratio, 1.5 [1.3-1.6]; P=6.2×10-19). CONCLUSIONS: Sex differences in the prevalence of hypertension and uncontrolled hypertension vary by age, with the latter having implications for health throughout the life course.

Evaluation of gender trends in first authorship in nephrology publications in four major US journals in the last decade.

BACKGROUND: To date, no data exist on gender-related publication biases in nephrology. This study was conducted to determine whether gender differences exist in the current literature published in high-ranking US nephrology journals, and how they may have changed over time. METHODS: The PubMed search was performed using the easyPubMed package in R, which extracted all articles indexed in PubMed from 2011 to 2021 from the US nephrology journals with the highest impact factors, i.e., Journal of the American Society of Nephrology (JASN), American Journal of Nephrology (AJN), American Journal of Kidney diseases (AJKD), and the Clinical Journal of the American Society of Nephrology (CJASN). Gender with predictions > 90% were accepted and the remaining were manually identified. Descriptive statistical analysis was carried out on the data. RESULTS: We identified 11,608 articles. On average, the ratio of male to female first authors decreased from 1.9 to 1.5 (p < 0.05). Additionally, in 2011, women accounted for 32% of first authors, a number that rose to 40% in 2021. All but the American Journal of Nephrology showed a variation in the ratio of men to women first authors. For the JASN, the ratio changed from 1.81 to 1.58, p = 0.001, for CJASN, the ratio declined from 1.91 to 1.15, p = 0.005 and for AJKD, the ratio declined from 2.19 to 1.19, p = 0.002. DISCUSSION AND CONCLUSIONS: Our study shows that gender biases in publications continue to exist in first-author publications in high-ranking Nephrology journals published in the US; the gap is however closing. We hope this study lays the groundwork to continue following and evaluating gender trends in publication.

An Atypical Presentation of West Nile Virus With Successful Treatment After Plasma Exchange and Intravenous Immunoglobulin.

West Nile (WN) disease is a relatively rare arboviral virus. Neuroinvasive cases of WN account for less than 1% of the total cases. The case described had difficult symptomatology and radical presentation, which included ascending paralysis. To date, there have been very few reports of West Nile cases that present with ascending paralysis. We describe the case of a 63-year-old white male who presented with a fever and proximal muscle weakness in the thighs and legs that rapidly worsened and ascended, eventually resulting in diaphragmatic paralysis. He was intubated after respiratory failure and given intravenous immunoglobulin and plasma exchange. The patient remained ventilated with persistent weakness. However, this improved after intravenous immunoglobulin and plasma exchange therapy. This case serves as a reminder to keep the diagnosis of WN on the differential, a primer on advanced treatments in the setting of aggressive atypical WN, and a lesson on similarly presenting diseases and distinguishing characteristics that may help rule out these diseases from WN.

Motivators and barriers to research among doctors in the Indian medical scenario: A cross-sectional study from Karnataka, India.

BACKGROUND: The fundamental principles of healthcare practices and policies are derived from good quality research. Doctors collectively are a source of vast sums of invaluable information. This information if effectively utilized can improve and strengthen the healthcare system. Our study provides a comprehensive overview of the ecosystem of an Indian medical researcher. OBJECTIVES: To understand (1) the obstacles faced by medical professionals (2) the challenges encountered at various steps (3) the gaps in research knowledge and (4) the means to rectify them. METHOD: Doctors from medical schools, hospitals, and in private practices were approached. Data were collected through online and physical questionnaire. Data were analyzed and studied. RESULTS: The total number of participants in this study is 212. Case reports (51.9%) and case-control studies (51.14%) are the most frequently conducted types of research. Lack of access to research journals (43.9%) and absence of proper guidance or mentorship (37.39%) are the commonly faced challenges among individuals who have pursued research, whereas busy schedule is the top-cited reason for not pursuing research (34.24%) and discontinuing research (57.4%). Coordinating time schedule with mentees is a challenge for mentors (49.2%). Doctors also face the greatest difficulty (48.12%) and delay (47.4%) in the publication process. On the other hand, personal interest (60.15%) and job requirement (46.61%) are the top facilitators for research. A small percentage has or knows someone that has plagiarized (21.32%) or falsified data (33.49%). Most of the doctors agree that research experience should be a mandatory part of undergrad training (81.6%). CONCLUSION: We believe interest, impact and importance of research can be the best developed and emphasized in the training years. Institutional support, adequate mentorship and an uplifting research environment can go a long way in motivating the doctors and tackling the challenges they face.

What influences adherence among HIV patients presenting with first-line antiretroviral therapy failure (ART failure)? A retrospective, cross-sectional study from a private clinic in Nagpur, India.

BACKGROUND: Multiple reports show increasing occurrences of ART failure in India. Despite the fact that a significant volume of outpatient and on-going healthcare occurs in private clinics, there are very few studies on adherence from private clinics in India. OBJECTIVE: To evaluate the factors influencing adherence to ART in patients with first-line ART failure. MATERIALS AND METHODS: Data were collected from a convenience sample of 139 individuals diagnosed with clinical, immunological or virologic failure from a private HIV clinic in Nagpur, India. A retrospective cross-sectional study was undertaken and data were statistically analysed. RESULTS: Of the 139 patients, 118 (84.9%) were male and 21 (15.1%) were female. 64 (46%) had received pre-treatment and adherence counselling. 81 (58.3%) were not told about the side effects of ART medications and 65 (46.8%) avoided friends and family. Most common reasons for suboptimal adherence by stopping treatment were high cost, alcoholism, choosing non-allopathic medications and depression. Reasons cited for suboptimal adherence due to missed doses included feeling healthy, depression, forgetfulness and busy schedule. A significant association was found between pre-treatment counselling, adherence counselling and being told the importance of lifelong treatment and decreased occurrence of complete stoppage of treatment. CONCLUSION: This study brings to light some of the predictors of ART failure. Counselling, having a strong support system as well as early identification and tackling of reasons for suboptimal adherence plays an important role in preventing ART failure.

A 38-year-old HIV elite controller from Bengaluru, Karnataka, India.

Elite controllers (ECs) constitute a rare subset of HIV-infected individuals who possess the remarkable ability to suppress viral replication (defined as an undetectable viral load or viral load <50 copies/ml for >12 months) in the absence of antiretroviral therapy (ART). Studies show that immunological parameters and indicators of long-term complications demonstrate the benefits of initiation of ART even in patients with undetectable viral loads or normal CD4 levels. We describe one such HIV EC from Bengaluru, Karnataka, India. This HIV-positive patient has been asymptomatic for several years in the absence of treatment. Multiple tests on viral load were undetectable. The patient was initiated on ART in view of falling CD4 counts, to ameliorate the high CD8 levels and to prevent future cardiovascular events.

Does this HIV-positive patient have progressive multifocal leukoencephalopathy or PML-immune reconstitution inflammatory syndrome?

We describe the case of an HIV/AIDS patient with progressive multifocal leukoencephalopathy (PML) associated with immune reconstitution inflammatory syndrome (IRIS) and the diagnostic and management dilemmas in distinguishing between PML and PML-IRIS. This case is relevant to physicians including family physicians who manage immunocompromised patients in their practice.

Hyperglycaemia induced by isoniazid preventive therapy.

We report the case of a HIV-positive patient with type 2 diabetes mellitus who presented with uncontrolled blood sugars after the initiation of prophylactic isoniazid (INH) therapy. INH is widely used for prophylaxis and treatment of tuberculosis (TB) around the world and INH-induced hyperglycaemia could be overlooked.