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1.
Medicine (Baltimore) ; 100(16): e25589, 2021 Apr 23.
Artículo en Inglés | MEDLINE | ID: mdl-33879719

RESUMEN

RATIONALE: Reversible posterior leukoencephalopathy syndrome (RPLS) is a clinicoradiological phenomenon first observed 2 decades ago. Reversibility is the hallmark of this rare clinical phenomenon once the triggering pathology is aptly and adequately treated. Tinnitus preceding bilateral hearing loss as a symptomatology of RPLS has not been reported in the literature. Furthermore, chronic obstructive ureteric calculus with superimposed infections as a cause of RPLS has not been reported in the literature. PATIENT CONCERNS: A 57-year-old female was admitted at our facility because of 2 days history of hearing loss in both ears. She experienced tinnitus in both ears 2 weeks prior to the hearing loss. She is a known hypertensive. She has also undergone multiple surgical treatments for urinary calculi. DIAGNOSIS: Computed tomography (CT) scan of the urinary system revealed a calculus at the right ureter. Magnetic resonance imaging (MRI) showed abnormal signals at both temporo-parieto-occipital (TPO) cortices, the subcortical area, as well as the left hippocampus which was consistent with the diagnosis of RPLS. INTERVENTIONS: While on antibiotics for treatment of infections, the patient went into hypertensive encephalopathy and pneumonia was also established necessitating intensive care. OUTCOMES: We observed a resolution of the patient's temperature and hypertension when the right ureteric stone finally descended into the bladder. Also, we observed disappearance of the abnormal signals at both TPO cortices, the subcortical area, as well as the left hippocampus. Two years follow-up revealed no recurrence of her symptomatology. LESIONS: Patients who present with hypertensive encephalopathy maybe more prone to developing RPLS. Renal insufficiency alone or hypertension alone may not be single predisposing entities to RPLS but rather multiple predisposing factors.


Asunto(s)
Pérdida Auditiva Bilateral/diagnóstico por imagen , Síndrome de Leucoencefalopatía Posterior/diagnóstico por imagen , Acúfeno/diagnóstico por imagen , Cálculos Urinarios/complicaciones , Infecciones Urinarias/complicaciones , Encéfalo/diagnóstico por imagen , Femenino , Pérdida Auditiva Bilateral/etiología , Humanos , Hipertensión/etiología , Imagen por Resonancia Magnética , Persona de Mediana Edad , Síndrome de Leucoencefalopatía Posterior/etiología , Acúfeno/etiología , Tomografía Computarizada por Rayos X , Uréter/diagnóstico por imagen , Cálculos Urinarios/diagnóstico por imagen , Infecciones Urinarias/diagnóstico por imagen
2.
Medicine (Baltimore) ; 100(16): e25629, 2021 Apr 23.
Artículo en Inglés | MEDLINE | ID: mdl-33879739

RESUMEN

ABSTRACT: Hypertension causes a substantial burden to society. Some studies found that hypertension was associated with the working type and working hours. The purpose of the current study is to assess the dose-response relationship between working hours and hypertension.Data of 12,080 adults aged 18 to 65 years who attended the China Health and Nutrition Survey (CHNS) between 1989 and 2011 were analyzed. Hypertension was determined based on systolic and/or diastolic blood pressure measures, or having doctor-diagnosed hypertension. Multivariable Cox regression and restricted cubic spline to assess the dose-response relationship between working hours and hypertension.A total of 12,080 participants including 5852 females and 6228 males. By the last follow-up (2011), a total of 830 participants were hypertensive, with an incidence of 6.9%. After adjusting socio-demographic, lifestyle factors, as well as occupation type, compared with those who worked 35 to 49 hours per week, participants who worked no more than 34 hours per week (HR: 1.21, 95%CI: 1.03-1.41) and at least 56 hours per week (HR: 1.38, 95%CI: 1.19-1.59) had a higher risk of hypertension. The significant association between long working hours (at least 56 hours per week) and hypertension was observed among females (HR: 1.38, 95%CI: 1.16-1.64) and males (HR: 1.36, 95%CI: 1.04-1.78). Among manual workers, the relationship between long working hours and hypertension was observed (HR: 1.49, 95%CI: 1.10-2.02). The relationship between long working hours (HR: 1.21, 95%CI: 1.01-1.44) and short working hours (HR: 1.37, 95%CI: 1.16-1.61) and hypertension was observed among nonmanual workers. The hazard ratio of hypertension and working time displayed U-shape non-linear relationship (Ptrend < .001, non-linear P < .001). The non-linear response-dose relationship was found in manual worker, nonmanual worker, and male (Ptrend < .001, non-linear P < .001).The association between working time and hypertension showed U-shape relationship. Specifically, overtime work was an important occupational risk factors for adults, and short work time was related to hazard ratio of hypertension in nonmanual workers.


Asunto(s)
Hipertensión/epidemiología , Hipertensión/etiología , Enfermedades Profesionales/epidemiología , Enfermedades Profesionales/etiología , Factores de Tiempo , Adolescente , Adulto , Anciano , Presión Sanguínea , China , Femenino , Estudios de Seguimiento , Encuestas Epidemiológicas , Humanos , Incidencia , Estilo de Vida , Estudios Longitudinales , Masculino , Persona de Mediana Edad , Encuestas Nutricionales , Ocupaciones/estadística & datos numéricos , Estudios Prospectivos , Tolerancia al Trabajo Programado/fisiología , Adulto Joven
3.
Wiad Lek ; 74(3 cz 1): 517-522, 2021.
Artículo en Inglés | MEDLINE | ID: mdl-33813461

RESUMEN

OBJECTIVE: The aim: Of our study was to identify the relationship between the main risk factors for heart disease and social factors among northern population. PATIENTS AND METHODS: Materials and methods: We polled 3092 native and non-native habitants of the Sakha Republic (Yakutia). The poll consists of several sections. It includes questions related to social, demographic and life record data, heredity, physical activity and unhealthy habits. RESULTS: Results: Among the people diagnosed with hypertension (HT), there are more smokers than among the people without this medical condition. On the contrary, in the group of people diagnosed with HT at the examination for taking blood pressure, there were fewer smokers than in the group, in which HT was not registered. Patients with CHD, Myocardial infarction (MI) in past medical history, cerebrovascular accident (CVA) and type 2 diabetes (T2D), are smokers to the same degree as the other group. This indicates that this category of the examined are exposed to the risk of cardiovascular aggravations. We determined a high spread of psychosocial risk factors for the examined respondents - the relationship between smoking, overweight, obesity, abdominal obesity and HT, and the level of education, marital status and labor specificity. The increase in the level of education is associated with fewer amounts of smokers among both non-native and native habitants. Overweight is more frequently observed for the people who are not single, have low level of education and are engaged in manual labor. In particular, it is applicable to native habitants. CONCLUSION: Conclusions: Abdominal obesity did not have any relationship with psychosocial factors for native habitants. However, in relation to non-native habitants, overweight, obesity, abdominal obesity and HT are associated with marital status (married) and with manual labor.


Asunto(s)
Diabetes Mellitus Tipo 2 , Hipertensión , Humanos , Hipertensión/epidemiología , Hipertensión/etiología , Obesidad/epidemiología , Factores de Riesgo , Fumar/epidemiología
4.
Harefuah ; 160(4): 215-220, 2021 Apr.
Artículo en Hebreo | MEDLINE | ID: mdl-33899369

RESUMEN

BACKGROUND: Hypertension in dialysis patients is common. In daily practice, it is not always clear whether adjustment of dry weight or vasodilatory medication should be administered and treatment strategy is often based on clinical impression. We used a whole-body bio-impedance based, non-invasive, hemodynamics monitoring technology to acquire hemodynamic data in order to evaluate the incidence and causes of hypertension in dialysis patients. METHODS: Novel noninvasive impedance based technique was used to collect hemodynamic data from patients undergoing chronic hemodialysis in four different dialysis units. Patients were defined as having hypertension if their predialysis systolic or diastolic BP results were >140mmHg or >90 respectively and as hypervolemic if their total body water (TBW) was greater than normal according to the Kushner formula+1SD. Vasoconstriction was defined as total peripheral resistance index (TPRI) greater than 3000 dyn*sec/cm5*m2. RESULTS: Of 144 hemodialysis patients, 81 (56%) were male; mean age was 67.3±12.1 years and 67 (47%) had hypertension. Among the hypertensive patients, only 18(27%) met hypervolemia criteria and thirty (45%) met vasoconstriction criteria (mean TPRI of 4474±1592dyn*sec/cm5*m2). Patients with hypertension due to vasoconstriction had higher vintage (50±45 vs 20±8 months 0=0.018), lower heart rate (71±11 vs 79±11 BPM p=0.002), lower stroke index (28±7 vs 44±8ml/m2 p<0.001) and cardiac index (2.1±0.5 vs 3.5±0.6 p=0<0.001) compared to patients without vasoconstriction. CONCLUSIONS: Vasoconstriction was the main etiology for pre-dialysis hypertension in chronic hemodialysis patients. This calls for individualized, hemodynamic-based therapeutic intervention.


Asunto(s)
Hipertensión , Hipotensión , Anciano , Presión Sanguínea , Femenino , Humanos , Hipertensión/epidemiología , Hipertensión/etiología , Masculino , Persona de Mediana Edad , Diálisis Renal/efectos adversos
5.
Harefuah ; 160(4): 221-225, 2021 Apr.
Artículo en Hebreo | MEDLINE | ID: mdl-33899370

RESUMEN

INTRODUCTION: This is a case study of a thirty-five year old woman with a past medical history of anxiety disorder and hypertension which has been elevated up to 180/100 mmHg during the previous year. She had no cardiovascular risk factors or family history of hypertension. Her high blood pressure was initially attributed to emotional stress, however, she was later referred for additional evaluation for secondary causes of hypertension. Her lab test results demonstrated significantly elevated plasma aldosterone levels and suppressed renin levels. A computed tomography scan demonstrated a left adrenal mass consistent with adrenal adenoma, with a normal adrenal gland on the right. Immediately after left adrenalectomy, plasma aldosterone level normalized and blood pressure was controlled with only minimal pharmacotherapy. Approximately 10 days post-surgery, her blood pressure values were measured in a range of 125/90 and anxiety significantly improved, under treatment only with 12.5mg Atenolol.


Asunto(s)
Neoplasias de las Glándulas Suprarrenales , Adenoma Corticosuprarrenal , Hiperaldosteronismo , Hipertensión , Neoplasias de las Glándulas Suprarrenales/cirugía , Adrenalectomía , Adenoma Corticosuprarrenal/cirugía , Adulto , Aldosterona , Trastornos de Ansiedad , Femenino , Humanos , Hiperaldosteronismo/complicaciones , Hiperaldosteronismo/diagnóstico , Hipertensión/diagnóstico , Hipertensión/etiología
6.
Harefuah ; 160(4): 242-244, 2021 Apr.
Artículo en Hebreo | MEDLINE | ID: mdl-33899374

RESUMEN

INTRODUCTION: A 35 year old patient, who had a successful surgical repair of coarctation of the aorta in early childhood, was referred for investigation regarding the cause for resistant hypertension. He underwent a full workup which was negative. Due to elevated renin levels his medications were altered with corresponding normalization of the renin levels. Symptomatic palpitations subsided after stopping treatment with a calcium channel blocker (lercanidipine), which implies reflex tachycardia secondary to lercanidipine. After all the investigations and interventions were performed, it appears that the etiology of resistant hypertension in his case is secondary to the coarctation, in spite of prior successful therapeutic interventions.


Asunto(s)
Coartación Aórtica , Hipertensión , Adulto , Coartación Aórtica/diagnóstico , Niño , Preescolar , Humanos , Hipertensión/etiología , Masculino
7.
Harefuah ; 160(4): 245-249, 2021 Apr.
Artículo en Hebreo | MEDLINE | ID: mdl-33899375

RESUMEN

INTRODUCTION: Pseudopheochromocytoma is an uncommon form of hypertension. In contrast to the more well-known pheochromocytoma, no unequivocal etiologic factor or a clear physiological abnormality can be identified. This disorder manifests in sudden, recurrent, episodes of significant, sometimes extreme, increase in blood pressure, both systolic and diastolic, lasting from minutes to hours, with no consistent trigger that the patient or the doctor is aware of, and is accompanied by typical symptoms. These symptoms include, but are not limited to, headaches, fever, flushing, weakness, with or without an accelerated heart rate. Patients with this disorder have increased sympathetic activity, from an adrenal source or sympathetic nerve endings, as well as hyper-responsiveness of the heart and blood vessels to this activation. There is an increased secretion of epinephrine and dopamine in the case of an adrenal source, and norepinephrine in the case of the sympathetic nerve endings. It is important to perform the differential diagnosis of this condition to rule out pheochromocytoma by testing plasma and urinary metanephrines. Additional diagnoses that need to be excluded are anxiety attacks, fluctuating-episodic hypertension, and baroreflex failure. The therapeutic approach of this disorder includes a combination of drugs to lower and control blood pressure, especially drugs that block alpha and beta-adrenergic receptors, along with antianxiety and antidepressants. Psychological intervention, as well as techniques that are aimed to reduce anxiety, have a place in therapy, especially among those patients who can relate the manifestations of the disorder to mental and emotional factors that contribute to the clinical manifestations.


Asunto(s)
Neoplasias de las Glándulas Suprarrenales , Hipertensión , Feocromocitoma , Neoplasias de las Glándulas Suprarrenales/diagnóstico , Neoplasias de las Glándulas Suprarrenales/terapia , Presión Sanguínea , Epinefrina , Humanos , Hipertensión/diagnóstico , Hipertensión/etiología , Feocromocitoma/diagnóstico , Feocromocitoma/terapia
8.
Harefuah ; 160(4): 256-259, 2021 Apr.
Artículo en Hebreo | MEDLINE | ID: mdl-33899377

RESUMEN

INTRODUCTION: The understanding that the immune system has a role in the pathogenesis of essential hypertension was established over the last few decades, with many different works showing that manipulating the immune system effects blood pressure. Pro-inflammatory cell activation can cause hypertension while anti-inflammatory cell activation restrains it. These activations involve different cell types, cytokine and chemokine secretions, and affect different target organs. Additionally, there is evidence that hypertension itself may affect the immune system. This article reviews the main findings in this area.


Asunto(s)
Hipertensión , Citocinas , Humanos , Hipertensión/etiología , Sistema Inmunológico
9.
Int J Mol Sci ; 22(5)2021 Mar 06.
Artículo en Inglés | MEDLINE | ID: mdl-33800916

RESUMEN

Gut microbiota-derived metabolites, in particular short chain fatty acids (SCFAs) and their receptors, are linked to hypertension. Fructose and antibiotics are commonly used worldwide, and they have a negative impact on the gut microbiota. Our previous study revealed that maternal high-fructose (HF) diet-induced hypertension in adult offspring is relevant to altered gut microbiome and its metabolites. We, therefore, intended to examine whether minocycline administration during pregnancy and lactation may further affect blood pressure (BP) programmed by maternal HF intake via mediating gut microbiota and SCFAs. Pregnant Sprague-Dawley rats received a normal diet or diet containing 60% fructose throughout pregnancy and lactation periods. Additionally, pregnant dams received minocycline (50 mg/kg/day) via oral gavage or a vehicle during pregnancy and lactation periods. Four groups of male offspring were studied (n = 8 per group): normal diet (ND), high-fructose diet (HF), normal diet + minocycline (NDM), and HF + minocycline (HFM). Male offspring were killed at 12 weeks of age. We observed that the HF diet and minocycline administration, both individually and together, causes the elevation of BP in adult male offspring, while there is no synergistic effect between them. Four groups displayed distinct enterotypes. Minocycline treatment leads to an increase in the F/B ratio, but decreased abundance of genera Lactobacillus, Ruminococcus, and Odoribacter. Additionally, minocycline treatment decreases plasma acetic acid and butyric acid levels. Hypertension programmed by maternal HF diet plus minocycline exposure is related to the increased expression of several SCFA receptors. Moreover, minocycline- and HF-induced hypertension, individually or together, is associated with the aberrant activation of the renin-angiotensin system (RAS). Conclusively, our results provide a new insight into the support of gut microbiota and its metabolite SCAFs in the developmental programming of hypertension and cast new light on the role of RAS in this process, which will help prevent hypertension programmed by maternal high-fructose and antibiotic exposure.


Asunto(s)
Antibacterianos/toxicidad , Fructosa/toxicidad , Microbioma Gastrointestinal/fisiología , Hipertensión/microbiología , Minociclina/toxicidad , Efectos Tardíos de la Exposición Prenatal , Animales , Antibacterianos/administración & dosificación , Ácidos Grasos Volátiles/metabolismo , Femenino , Microbioma Gastrointestinal/efectos de los fármacos , Bacterias Gramnegativas/efectos de los fármacos , Bacterias Gramnegativas/aislamiento & purificación , Bacterias Gramnegativas/metabolismo , Bacterias Grampositivas/efectos de los fármacos , Bacterias Grampositivas/aislamiento & purificación , Bacterias Grampositivas/metabolismo , Hipertensión/etiología , Riñón/efectos de los fármacos , Riñón/metabolismo , Lactancia , Masculino , Minociclina/administración & dosificación , Óxido Nítrico/metabolismo , Embarazo , Ratas , Ratas Sprague-Dawley , Receptores de Superficie Celular/biosíntesis , Receptores de Superficie Celular/genética , Sistema Renina-Angiotensina/fisiología
10.
Arq Gastroenterol ; 58(1): 77-81, 2021.
Artículo en Inglés | MEDLINE | ID: mdl-33909801

RESUMEN

BACKGROUND: The use of immunosuppressive drugs after liver transplantation (LT) is associated with the development of systemic arterial hypertension (SAH), in addition to other comorbidities of metabolic syndrome. OBJECTIVE: Therefore, the purpose of this study was to analyze the time after use immunosuppressive drugs the patient progresses to SAH, as well as to identify its prevalence and the factors that may be correlated to it. METHODS: A retrospective and longitudinal study was conducted, based on the analysis of medical records of 72 normotensive patients, attended in the transplant unit of a university hospital, between 2016 and 2019. RESULTS: It was observed, on average, 9±6.98 months after immunosuppressive use, the patients were diagnosed with hypertension, and the prevalence of transplanted patients who evolved to SAH in this study was 59.64% (41 patients). In addition, there was a correlation between serum dosage of tacrolimus and the development of SAH (P=0.0067), which shows that tacrolimus has a significant role in the development of SAH. Finally, it was noticed that the development of post-transplantation hypertension indicates a higher risk of the patient presenting the other parameters of metabolic syndrome, as well as a higher impairment in its renal function (P=0.0061). CONCLUSION: This study shows that the patients evolved to SAH in an average of 9±6.98 months after immunosuppressive drug use. We have also found high prevalence of systemic arterial hypertension (59.64%) in patients after liver transplantation, who used calcineurin inhibitors, especially when associated with the use of tacrolimus.


Asunto(s)
Hipertensión , Trasplante de Hígado , Humanos , Hipertensión/epidemiología , Hipertensión/etiología , Inmunosupresores/efectos adversos , Trasplante de Hígado/efectos adversos , Estudios Longitudinales , Prevalencia , Estudios Retrospectivos , Tacrolimus/efectos adversos
12.
Ann Afr Med ; 20(1): 37-41, 2021.
Artículo en Inglés | MEDLINE | ID: mdl-33727510

RESUMEN

Context: Some market populations in Nigeria have been shown to have high prevalence of hypertension. Current evidence includes environmental pollutants such as heavy metals as risk factors for hypertension. Aim: To study the heavy metal content of rice meals sold in a market population with a high prevalence of hypertension. Settings and Design: This was a descriptive, cross-sectional study conducted in Ogbete market in Enugu, Southeast Nigeria. Subjects and Methods: Five different cooked rice meals were obtained from 25 locations of the market. The rice meals included jollof rice, white rice and tomato stew, fried rice, white rice and vegetable sauce, and white rice and palm oil stew (ofeakwu). Accompanying protein (meat, fish, and egg) and vegetable salad were excluded. Similar rice meals were homogenized and analyzed in triplicates using spectrophotometric methods for mercury, copper, cadmium, lead, and arsenic determination. Statistical Analysis Used: The mean concentrations of the heavy metals were compared using analysis of variance, and P < 0.05 was considered statistically significant. Results: Twenty-five rice dishes were evaluated, five of each kind. Arsenic content ranged from 503 to 550 mg/kg and was comparable across the five rice dishes (P = 0.148). Copper was significantly highest (16767 mg/kg) in the white rice and tomato stew dish (P < 0.001), while mercury was significantly highest (33 mg/kg) in white rice and ofeakwu (P < 0.001). Jollof rice had the highest cadmium content (23 mg/kg), which was statistically significant (P = 0.021). Lead was not found in any of the rice dishes. Conclusions: Risk factors such as heavy metals may play a role in the high prevalence of hypertension observed in market populations, and rice meals may be a major source of these heavy metals.


Asunto(s)
Hipertensión/epidemiología , Metales Pesados/análisis , Oryza/química , Adulto , Arsénico/análisis , Arsénico/metabolismo , Cadmio/análisis , Cadmio/metabolismo , Estudios Transversales , Femenino , Humanos , Hipertensión/etiología , Masculino , Mercurio/análisis , Mercurio/metabolismo , Metales Pesados/metabolismo , Nigeria , Oryza/metabolismo , Prevalencia , Espectrofotometría
13.
Sci Rep ; 11(1): 7163, 2021 03 30.
Artículo en Inglés | MEDLINE | ID: mdl-33785784

RESUMEN

The spread of virus via the blood stream has been suggested to contribute to extra-pulmonary organ failure in Coronavirus disease 2019 (COVID-19). We assessed SARS-CoV-2 RNAemia (RNAemia) and the association between RNAemia and inflammation, organ failure and mortality in critically ill COVID-19 patients. We included all patients with PCR verified COVID-19 and consent admitted to ICU. SARS-CoV-2 RNA copies above 1000/ml measured by PCR in plasma was defined as RNAemia and used as surrogate for viremia. In this cohort of 92 patients 59 (64%) were invasively ventilated. RNAemia was found in 31 patients (34%). Hypertension and corticosteroid treatment was more common in patients with RNAemia. Extra-pulmonary organ failure biomarkers and the extent of organ failure were similar in patients with and without RNAemia, but the former group had more renal replacement therapy and higher mortality (26 vs 16%; 35 vs 16%, respectively, p = 0.04). RNAemia was not an independent predictor of death at 30 days after adjustment for age. SARS-CoV2 RNA copies in plasma is a common finding in ICU patients with COVID-19. Although viremia was not associated with extra pulmonary organ failure it was more common in patients who did not survive to 30 days after ICU admission.Trial registration: ClinicalTrials NCT04316884.


Asunto(s)
/etiología , Viremia/etiología , Anciano , Biomarcadores/sangre , Comorbilidad , Enfermedad Crítica , Femenino , Humanos , Hipertensión/epidemiología , Hipertensión/etiología , Interleucina-6/sangre , Masculino , Persona de Mediana Edad , Insuficiencia Multiorgánica/etiología , Insuficiencia Multiorgánica/virología , Estudios Prospectivos , ARN Viral/sangre , Terapia de Reemplazo Renal , Respiración Artificial , Suecia/epidemiología , Viremia/mortalidad , Viremia/terapia
16.
Environ Res ; 195: 110813, 2021 04.
Artículo en Inglés | MEDLINE | ID: mdl-33545125

RESUMEN

OBJECTIVE: We aimed to synthesize available cohorts about the relationship between various types of noise and hypertension, and to explore the potential dose-response relationship between them in an updated meta-analysis. METHODS: PubMed and Embase were searched through October 2019 to identify cohort studies that met predetermined inclusion criteria. A random-effects model was used to combine the results of included studies. Dose-response meta-analysis was conducted to examine the potential dose-response relationship. RESULTS: Eleven cohort studies involving 224,829 participants were included in this systematic review. Pooled result showed that living or working in environment with noise exposure was significantly associated with increased risk of hypertension (RR: 1.18; 95% CI: 1.06 to 1.32), with low heterogeneity (P = 0.098, I2 = 42.1%). We found no evidence of a nonlinear association of elevated noise with hypertension risk (P = 0.443). The summary risk ratio of hypertension for an increment of per 10 dB(A) of noise was 1.13 (95% CI: 0.99 to 1.28), with moderate heterogeneity (P = 0.003, I2 = 72.1%). CONCLUSIONS: Integrated evidence from cohort studies supports the hypothesis that exposure to noise may be a risk factor of hypertension.


Asunto(s)
Hipertensión , Estudios de Cohortes , Humanos , Hipertensión/epidemiología , Hipertensión/etiología , Ruido/efectos adversos , Oportunidad Relativa , Factores de Riesgo
17.
JAMA Netw Open ; 4(2): e2037209, 2021 02 01.
Artículo en Inglés | MEDLINE | ID: mdl-33576818

RESUMEN

Importance: Conducted electrical weapons (CEWs) are used broadly as a less-lethal force option for police officers. However, there is no clear picture of the possible health risks in humans on the basis of rigorously assessed scientific evidence from the international peer-reviewed literature. Objective: To synthesize and systematically evaluate the strength of published evidence for an association between exposure to different models of CEWs and adverse acute as well as chronic conditions. Evidence Review: Following a preregistered review protocol, the literature search strategy was based on a search of reviews published between January 1, 2000, and April 24, 2020, of PubMed, MEDLINE, EMBASE, Web of Science, PsycINFO, and Cochrane Library, as well as relevant online databases and bibliographic sources, such as reference sections of recent publications. The identified studies were independently assessed in terms of scope, relevance, methodologic bias, and quality. Peer-reviewed publications of human studies were included, using original data and with a focus on the use of taser CEWs in the context of law enforcement. Eligible studies examined clearly defined health outcomes as dependent variables following exposure to a CEW. The review followed the relevant sections of the Preferred Reporting Items for Systematic Reviews and Meta-analyses reporting guideline. A meta-analysis could not be conducted. Findings: Of the 1081 unique records screened, 33 relevant studies were identified, all of them of experimental design and conducted in the US. Eleven studies had a low risk of bias and 22 had a higher bias risk. Studies focused on outcomes such as physiologic stress responses, heart rate, blood pressure, arrhythmias, or cognitive performance. Independently of bias risk, the studies reported few or no acute health problems, apart from the wounds caused by the darts. Furthermore, no long-term outcomes were studied. Most of the studies were performed on healthy, physically fit individuals (eg, police officers) in a controlled setting, with short exposure duration (5 seconds). Half of the studies, mainly those with a higher risk of bias, were at least partly funded by the manufacturer. Conclusions and Relevance: Based on the findings of the reviewed studies, the risk for adverse health outcomes due to CEW exposure can be currently estimated as low. However, most of the reviewed studies had methodologic limitations. Considering that recruited participants were not representative of the population that usually encounters a CEW deployment, it is not possible to draw conclusions regarding exposure outcomes in potentially vulnerable populations or high-risk groups, such as those under the influence of substances.


Asunto(s)
Presión Sanguínea/fisiología , Cognición/fisiología , Lesiones por Armas Conductoras de Energía/fisiopatología , Frecuencia Cardíaca/fisiología , Armas , Acidosis Láctica/epidemiología , Acidosis Láctica/etiología , Arritmias Cardíacas/epidemiología , Arritmias Cardíacas/etiología , Enfermedad Crónica , Lesiones por Armas Conductoras de Energía/complicaciones , Voluntarios Sanos , Humanos , Hipertensión/epidemiología , Hipertensión/etiología , Policia , Apoyo a la Investigación como Asunto , Medición de Riesgo , Factores de Tiempo
18.
Internist (Berl) ; 62(3): 245-251, 2021 Mar.
Artículo en Alemán | MEDLINE | ID: mdl-33599784

RESUMEN

Aldosterone is produced in the adrenal cortex and governs volume and electrolyte homeostasis. Hyperaldosteronism can occur either as primary aldosteronism (renin-independent) or secondary aldosteronism (renin-dependent). As the commonest cause of secondary hypertension, primary aldosteronism is associated with increased cardiovascular risk. Its most prevalent subtypes are aldosterone-producing adenomas as the most frequent unilateral form and bilateral hyperaldosteronism. Unilateral hyperplasia, familial hyperaldosteronism and aldosterone-producing carcinoma are rare. The aldosterone/renin ratio serves as a screening parameter for primary aldosteronism. If this ratio is elevated, confirmatory testing and adrenal imaging are performed. Adrenal venous sampling is considered the gold standard for the distinction of unilateral from bilateral disease. Unilateral disease can potentially be cured by adrenalectomy, whereas patients that are not candidates for surgery or have bilateral disease are treated with mineralocorticoid receptor antagonists. Over the past 10 years, somatic mutations in ion channels or transporters have been identified as causes of aldosterone-producing adenomas and so-called aldosterone-producing cell clusters (potential precursors of adenomas and correlates of bilateral hyperplasia, but also of subclinical hyperaldosteronism). In addition, germline mutations in overlapping genes cause familial hyperaldosteronism. Secondary hyperaldosteronism can occur in patients with hypertension treated with diuretics or in renal artery stenosis.


Asunto(s)
Hiperaldosteronismo/complicaciones , Adrenalectomía , Adenoma Corticosuprarrenal/etiología , Adenoma Corticosuprarrenal/genética , Aldosterona , Humanos , Hiperaldosteronismo/genética , Hiperaldosteronismo/terapia , Hipertensión/etiología , Antagonistas de Receptores de Mineralocorticoides/uso terapéutico , Renina
19.
Environ Health Prev Med ; 26(1): 19, 2021 Feb 06.
Artículo en Inglés | MEDLINE | ID: mdl-33549053

RESUMEN

Recent studies have revealed an inverse association between height and cardiovascular disease. However, the background mechanism of this association has not yet been clarified. Height has also been reported to be positively associated with cancer. Therefore, well-known cardiovascular risk factors, such as increased oxidative stress and chronic inflammation, are not the best explanations for this inverse association because these risk factors are also related to cancer. However, impaired blood flow is the main pathological problem in cardiovascular disease, while glowing feeding vessels (angiogenesis) are the main characteristic of cancer pathologies. Therefore, endothelial maintenance activity, especially for the productivity of hematopoietic stem cells such as CD34-positive cells, could be associated with the height of an individual because this cell contributes not only to the progression of atherosclerosis but also to the development of angiogenesis. In addition, recent studies have also revealed a close connection between bone marrow activity and endothelial maintenance; bone marrow-derived hematopoietic stem cells contribute towards endothelial maintenance. Since the absolute volume of bone marrow is positively associated with height, height could influence endothelial maintenance activity. Based on these hypotheses, we performed several studies. The aim of this review is not only to discuss the association between height and bone marrow activity, but also to describe the potential mechanism underlying endothelial maintenance. In addition, this review also aims to explain some of the reasons that implicate hypertension as a major risk factor for stroke among the Japanese population. The review also aims to clarify the anthropological reasons behind the high risk of atherosclerosis progression in Japanese individuals with acquired genetic characteristics.


Asunto(s)
Aterosclerosis/epidemiología , Estatura/fisiología , Médula Ósea/fisiología , Endotelio/fisiología , Hipertensión/epidemiología , Accidente Cerebrovascular/epidemiología , Anciano , Aterosclerosis/etiología , Aterosclerosis/fisiopatología , Progresión de la Enfermedad , Humanos , Hipertensión/etiología , Hipertensión/fisiopatología , Japón/epidemiología , Masculino , Persona de Mediana Edad , Factores de Riesgo , Accidente Cerebrovascular/etiología , Accidente Cerebrovascular/fisiopatología
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