Blood pressure variability and cerebrovascular disease

Variability is an aspect of blood pressure (BP) relatively unknown and poorly evaluated systematically in clinical practice. Although the introduction of intensive BP measurement methods, such as ambulatory blood pressure monitoring provided evidence of the importance of BP variability in the short-term, more recently, however, emphasis has been placed on the relevance of variability of BP in the medium- and long-term. The adverse cardiovascular consequences of high BP not only depend on absolute BP values, but also on BP variability. Independently of mean BP levels, BP variations in the short- and long-term are associated an increased risk of cardiovascular events and mortality. Also, it has been suggested that modulation of such variability may explain the different level protection exerted by different antihypertensive-drug classes.     

Oral graft vs host disease: An immune system disorder in hematopoietic cell transplantation

Graft vs host disease (GVHD) is a complication of patients who are treated by hematopoietic cell transplantation. National Institutes of Health in 2005 by Working Group on Diagnosis and Staging Consensus Development Project on Criteria for Clinical Trials in Chronic GVHD (cGVHD) established 2 principal categories of oral GVHD, acute and chronic. The oral mucosa may be the first site of manifestation of the disease. Clinical diagnosis needs to be confirmed by a biopsy of oral mucosa and minor salivary glands. Microscopic results have played a major role in the diagnosis and management of acute and chronic oral GVHD. Development of second malignancies is the greatest risk of oral cGVHD patients, mostly regarding squamous cell carcinoma. The focus of oral GVHD therapy is to improve symptoms and maintain oral function. The aim of this review article is to update the information on the oral GVHD in its clinical, microscopic features and their complications.     

Myasthenia gravis as a form of clinical presentation of thymic carcinoma

Thymic carcinomas are rare tumors of the thymus arising in the thymic epithelium. They represent less than 1% of thymic malignancies. They often present with an advanced disease and metastasize to regional lymph nodes and distant sites. They have a worse prognosis with a 5-year survival rate of 30%-50%, while thymomas are much less invasive and have a 5-year survival of approximately 78%. We report a rare form of clinical presentation of a thymic carcinoma in which the diagnosis of myasthenia gravis was the cornerstone of the diagnosis of cancer. Surgery is considered the salvage treatment when possible. Radiotherapy is a second choice of salvage treatment, when possible depending on its localization and relation to nearby structures such as vascular structures. Molecular target therapy is a more directed, more expensive but less toxic treatment. Further studies need to be carried out for its approval worldwide, outside clinical trials.     

Regression of cardiovascular remodeling in hypertension: Novel relevant mechanisms

Asymptomatic organ damage due to progressive kidney damage, cardiac hypertrophy and remodeling put hypertensive patients at high risk for developing heart and renal failure, myocardial infarction and stroke. Current antihypertensive treatment normalizes high blood pressure, partially reverses organ damage, and reduces the incidence of heart and renal failure. Activation of the renin-angiotensin system (RAS) is a primary mechanism of progressive organ damage and, specifically, a major cause of both renal and cardiovascular fibrosis. Currently, inhibition of the RAS system [mainly with angiotensin I converting enzyme inhibitors or angiotensin II (Ang II) receptor antagonists] is the most effective antihypertensive strategy for normalizing blood pressure and preventing target organ damage. However, residual organ damage and consequently high risk for cardiovascular events and renal failure still persist. Accordingly, in hypertension, it is relevant to develop new therapeutic perspectives, beyond reducing blood pressure to further prevent/reduce target organ damage by acting on pathways that trigger and maintain cardiovascular and renal remodeling. We review here relevant novel mechanisms of target organ damage in hypertension, their role and evidence in prevention/regression of cardiovascular remodeling and their possible clinical impact as well. Specifically, we focus on the signaling pathway RhoA/Rho kinase, on the impact of the vasodilatory peptides from the RAS and some insights on the role of estrogens and myocardial chymase in cardiovascular hypertensive remodeling.     

Unraveling oral psoriasis and its relationship with geographic tongue: A literature review

Differentiating between oral psoriasis and geographic tongue is difficult and controversial because some patients with geographic tongue do not necessarily have psoriasis. Furthermore, the number of clinical studies, reporting histopathological and genetic evidence for the definitive diagnosis of oral psoriasis, is limited. The aim of this literature review was to obtain data for supporting the diagnosis of oral psoriasis with particular emphasis on the relationship between psoriasis and geographic tongue. Based on the current data, it can be concluded that geographic tongue is the most common oral lesion in psoriasis, and histopathological, immunohistochemical, and genetic similarities have been observed between the two diseases. This review also emphasizes the importance of conducting oral examinations in patients with psoriasis and skin examinations in patients with geographic tongue.     

Improvised technique for measuring tracheal tube cuff pressure

We agree with the editorial published by Feng et al concerning the insufficient routine monitoring of tracheal tube cuff pressure (TTCP) by anesthesiologists, and propose an improvised technique that can facilitate and promote such routine monitoring by intensive care staff who attend to patients receiving mechanical ventilation. Insufficient monitoring of tracheal cuff pressure has also been documented for intensive care unit nurses. Measurements of cuff pressure are beneficial when used in management of air leakage around an endotracheal tube, and can be easily obtained with the aid of a personalized and simple technique performed using materials that are readily available in all hospitals. Other investigators have previously demonstrated the usefulness of employing an improvised technique. We considered that possible disadvantages are similar to those encountered when using standardized equipment. With our improvised technique, we seek to promote among the nursing staff the determination of the TTCP in intubated patients to reduce the risk of related medical complications.     

Understanding the paranoid psychosis of James: Use of the repertory grid technique for case conceptualization

In this paper we illustrate the potential of the repertory grid technique as an instrument for case formulation and understanding of the personal perception and meanings of people with a diagnosis of psychotic disorders. For this purpose, the case of James is presented: A young man diagnosed with schizophrenia and personality disorder, with severe persecutory delusions and other positive symptoms that have not responded to antipsychotic medication, as well with depressive symptomatology. His case was selected because of the way his symptoms are reflected in his personal perception of self and others, including his main persecutory figure, in the different measures that result from the analysis of his repertory grid. Some key clinical hypotheses and possible targets for therapy are discussed.     

Effectiveness of an intervention for reducing social stigma towards mental illness in adolescents

AIM: To evaluate the effectiveness of an intervention for reducing social stigma towards mental illness in adolescents. The effect of gender and knowledge of someone with mental illness was measured. METHODS: Two hundred and eighty secondary school students were evaluated using the Community Attitudes towards Mental Illness (CAMI) questionnaire. The schools were randomized and some received the intervention and others acted as the control group. The programme consisted of providing information via a documentary film and of contact with healthcare staff in order to reduce the social stigma within the school environment. RESULTS: The intervention was effective in reducing the CAMI authoritarianism and social restrictiveness subscales. The intervention showed significant changes in girls in terms of authoritarianism and social restrictiveness, while boys only showed significant changes in authoritarianism. Following the intervention, a significant reduction was found in authoritarianism and social restrictiveness in those who knew someone with mental illness, and only in authoritarianism in those who did not know anyone with mental illness. CONCLUSION: The intervention was effective to reduce social stigma towards people with mental illness, especially in the area of authoritarianism. Some differences were found depending on gender and whether or not the subjects knew someone with mental illness.