Managing hypertension in African Americans with heart failure: A guide for the primary care clinician.

Hypertension is the predominant risk factor for cardiovascular disease related morbidity and mortality among Black adults in the United States. It contributes significantly to the development of heart failure and increases the risk of death following heart failure diagnosis. It is also a leading predisposing factor for hypertensive disorders of pregnancy and peripartum cardiomyopathy in Black women. As such, all stakeholders including health care providers, particularly primary care clinicians (including physicians and advanced practice providers), patients, and communities must be aware of the consequences of uncontrolled hypertension among Black adults. Appropriate treatment strategies should be identified and implemented to ensure timely and effective blood pressure management among Black individuals, particularly those with, and at risk for heart failure.

Trends and Outcomes of ST-Segment-Elevation Myocardial Infarction Among Young Women in the United States.

Background Although there has been a decrease in the incidence of ST-segment-elevation myocardial infarction (STEMI) in the United States, this trend might be stagnant or increasing in young women. We assessed the trends, characteristics, and outcomes of STEMI in women aged 18 to 55 years. Methods and Results We identified 177 602 women aged 18 to 55 with the primary diagnosis of STEMI from the National Inpatient Sample during years 2008 to 2019. We performed trend analyses to assess hospitalization rates, cardiovascular disease (CVD) risk factor profile, and in-hospital outcomes stratified by three age subgroups (18-34, 35-44, and 45-55 years). We found STEMI hospitalization rates were decreased in the overall study cohort from 52 per 100 000 hospitalizations in 2008 to 36 per 100 000 in 2019. This was driven by decreased proportion of hospitalizations in women aged 45 to 55 years (74.2% to-71.7%; P<0.001). Proportion of STEMI hospitalizationincreased in women aged 18-34 (4.7%-5.5%; P<0.001) and 35-44 years (21.2%-22.7%; P<0.001). The prevalence of traditional and non-traditional female-specific or female-predominant CVD risk factors increased in all age subgroups. The adjusted odds of in-hospital mortality in the overall study cohort and age subgroups were unchanged throughout the study period. Additionally, we observed an increase in the adjusted odds of cardiogenic shock, acute stroke, and acute kidney injury in the overall cohort over the study period. Conclusions STEMI hospitalizations are increasing among women aged <45 years, and in-hospital mortality has not changed over the past 12 years in women aged <55 years. Future studies on the optimization of risk assessment and management of STEMI in young women are urgently needed.

Nuclear spin Hall and Klein tunneling effects during oxidation with electric and magnetic field inductions in graphene.

The recent observation of the explosive oxidation of graphene with enhancement for decreasing temperature and the requirements for synchronizing oxidants for collective oxidation-reduction (redox) reactions presented a chemical scenario for the thermal harvesting by the magnetic spin Hall Effect. More experimental data are presented to demonstrate such spin Hall Effect by determining the influence of spins of so-called spectator fermionic cations. Furthermore, the so-called spectator bosonic cations are discovered to cause a Klein tunneling effect during the redox reaction of graphene. The Na(+) and K(+), fermionic cations and the Mg(2+) and Ca(2+), bosonic cations were observed and compared under a variety of experimental conditions: adiabatic reactions with initial temperatures (18-22 °C); reactions toward infinite dilution; isothermal reactions under nonadiabatic conditions at low temperature of 18 °C; reactions under paramagnetic O(2) or diamagnetic N(2) atmospheres of different permeabilities; reactions in applied and no applied external magnetic field; and reactions toward excess concentrations of common and uncommon Na(+) and Mg(2+) cations. The observed reaction kinetics and dynamics under these various, diverse conditions are consistent with the spin Hall mechanism, energy harvesting and short time violation of Second Law of Thermodynamics for redox reactions of graphene by the Na(+)K(+) mixture and are consistent with the Klein tunnel mechanism for the redox reactions of graphene by the Mg(2+)Ca(2+) mixture. Mixed spin Hall and Klein tunnel mechanisms are discovered to slow and modulate explosive redox reactions. Such spin Hall Effect also gives explanation of recent tunneling of electrons through boron nitride.

Can Automated Text Messaging Successfully Monitor Antibiotic Adherence for Urban Adolescents and Young Women Managed for Pelvic Inflammatory Disease in the Outpatient Setting.

Objective: This study evaluates patient responsiveness to an automated text messaging system for pelvic inflammatory disease (PID) self-care support, and measures the reliability of text-reported adherence. Design: Patients aged 13-25-years with mild to moderate PID were recruited from urban, academic outpatient settings. Enrolled patients received antibiotics and were randomized into a standard of care or intervention group. During a 14-day treatment period, participants in the intervention arm received a community-based nursing visit and daily text message medication reminders with evening prompts to report the number of doses taken. Result: Of the 97 participants randomized into the intervention arm, 91 (94%) were eligible for analysis. Most were African American and low income, with a mean age of 18.3 (SD=2.2) years. Participants responded to ~53% (SD=34%) of all dosage inquiry messages. Responsiveness attenuated at approximately 2.2% per day over the treatment period. Ninety-three percent (n=85) of the analyzed intervention arm returned for the two-week follow-up. Despite overall adherence and general responsiveness, text-reported and self-reported medication adherence were not well correlated (r=0.37, p<0.001). Conclusion: Our findings show that text messaging is a feasible strategy for reaching urban adolescents being managed for complicated sexually transmitted infections in outpatient settings. However, patient responsiveness to self-care text messages do vary, limiting the adherence monitoring capacity of this technology. Given the number of unanswered text messages and incomplete text-reported adherence data, additional measures to assess adolescents' adherence to PID medications are needed in clinical trials.

Survival and glycemic control in patients with coexisting lymphoma and diabetes: a case-control analysis.

AIM: We examined the effect of diabetes on survival in patients with lymphoma and the effect of lymphoma on glycemic control. PATIENTS & METHODS: Patients with lymphoma with and without diabetes (2005-2016) were retrospectively identified and matched 1:1. Overall survival and progression-free survival were estimated by the Kaplan-Meier method. Hemoglobin A1c (HbA1c) and glucose levels during the year after cancer diagnosis were compared by mixed models. RESULTS: For patients with diabetes, mean HbA1c during the year after lymphoma diagnosis was 6.7%. Estimated 5-year progression-free survival for patients with versus without diabetes was 63% (95% CI: 53-76%) versus 58% (95% CI: 46-71%) (p = 0.42). CONCLUSION: Lymphoma and its treatment did not affect glycemic control. Diabetes did not decrease lymphoma-specific survival.