Consensus Bundle on Severe Hypertension During Pregnancy and the Postpartum Period

Complications arising from hypertensive disorders of pregnancy are among the leading causes of preventable severe maternal morbidity and mortality. Timely and appropriate treatment has the potential to significantly reduce hypertension‐related complications. To assist health care providers in achieving this goal, this patient safety bundle provides guidance to coordinate and standardize the care provided to women with severe hypertension during pregnancy and the postpartum period. This is one of several patient safety bundles developed by multidisciplinary work groups of the National Partnership for Maternal Safety under the guidance of the Council on Patient Safety in Women's Health Care. These safety bundles outline critical clinical practices that should be implemented in every maternity care setting. Similar to other bundles that have been developed and promoted by the Partnership, the hypertension safety bundle is organized into four domains: Readiness, Recognition and Prevention, Response, and Reporting and Systems Learning. Although the bundle components may be adapted to meet the resources available in individual facilities, standardization within an institution is strongly encouraged. This commentary provides information to assist with bundle implementation.     

Targeting mulitple dyslipidemias with fixed combinations – focus on extended release niacin and simvastatin

Dyslipidemia is a major risk factor in the initiation and progression of cardiovascular diseases such as atherosclerosis. Several pharmacological agents have been developed over the past 50 years which target various lipid components such as low density lipoprotein (LDL) cholesterol, triglyceride, and high density lipoprotein (HDL) cholesterol. Similar to other risk factors such as hypertension and diabetes mellitus, the management of dyslipidemia can be complicated and may require combination therapy for effective treatment. This review discusses the biochemical mechanisms of action and clinical uses for simvastatin (the most widely available and commercially prescribed statin) and niacin, and the combination of these agents in the management and treatment of dyslipidemia.     

Increased anxiety and altered responses to anxiolytics in mice deficient in the 65-kDa isoform of glutamic acid decarboxylase

The larger isoform of the enzyme glutamate decarboxylase, GAD67, synthesizes >90% of basal levels of γ-aminobutyric acid (GABA) in the brain. In contrast, the smaller isoform, GAD65, has been implicated in the fine-tuning of inhibitory neurotransmission. Mice deficient in GAD65 exhibit increased anxiety-like responses in both the open field and elevated zero maze assays. Additionally, GAD65-deficient mice have a diminished response to the anxiolytics diazepam and pentobarbital, both of which interact with GABA-A receptors in a GABA-dependent fashion to facilitate GABAergic neurotransmission. Loss of GAD65-generated GABA does not appear to result in compensatory postsynaptic GABA-A receptor changes based on radioligand receptor binding studies, which revealed no change in the postsynaptic GABA-A receptor density. Furthermore, mutant and wild-type animals do not differ in their behavioral response to muscimol, which acts independently of the presence of GABA. We propose that stress-induced GABA release is impaired in GAD65-deficient mice, resulting in increased anxiety-like responses and a diminished response to the acute effects of drugs that facilitate the actions of released GABA.     

Microleakage of glass ionomer/composite laminate Class V restorations

The aim of this investigation was to evaluate the effects on microleakage of pretreating dentin with polyacrylic acid (PAA), prior to placing a glass ionomer base/composite laminate restoration. Class V erosion-type lesions with the incisal margin on enamel and the cervical margin below the cemento-enamel junction (CEJ), were prepared in 50 sound extracted teeth. These teeth were divided into five dentin treatment groups: A) 10% PAA; B) 20% PAA; C) and D) 40% PAA; E) no dentin preconditioning. In groups A, B, C and E, a glass ionomer base was placed within 1 mm of the margins. In group D the glass ionomer base extended to the cervical margin. The glass ionomer base and the incisal enamel were etched with 37% phosphoric acid prior to placing a bonding agent and restoring with a composite. The restorations were finished and polished and the teeth were stored in distilled water at 37 degrees C for 7 days. They were thermocycled in 0.5% fuchsin dye for 500 cycles (5 degrees C to 60 degrees C), embedded in epoxy resin, and sectioned at 250 mu intervals through the restorations. The section of each tooth exhibiting the most severe dye penetration along the tooth/restoration interface was evaluated and scored both incisally and cervically: 0 = no leakage; 1 = leakage up to the glass ionomer base; 2 = leakage up to 1/2 the wall length; 3 = leakage exceeding 1/2 the wall length. Cervically, the median leakage for all groups was 3.0. Incisally, the median leakage for all the groups was 0.0.(ABSTRACT TRUNCATED AT 250 WORDS)