Age and aging effects on blood pressure: 15 years follow‐up of Tehran lipid and glucose study

Age is a known predictor of blood pressure (BP); however, the literature mostly includes cross‐sectional investigations. This prospective cohort study aimed to decompose the cross‐sectional and longitudinal age effects on BP. The secondary data were obtained from the Tehran lipid and glucose study, which comprised six repeated measurements of participants, with median follow‐up of 15.8 (interquartile range of 14.2‐16.9) years. The sample is representative of the metropolitan area of Tehran, Iran, containing 7,460 participants aged 20‐70. The cross‐sectional and longitudinal effects of age (age at baseline and aging, respectively) were fitted in the mixed effects models, taking systolic, diastolic, and pulse BPs as response, adjusting for adiposity, smoking, diabetes, and antihypertensive medication, and stratifying for sex and 10‐year age‐groups. The mean age at baseline was 41.3 (SD = 12.9) years, and 41.7% of the participants were male. Age at baseline and aging were directly associated with BP, aging owned the weaker effect, and the largest distinction were for systolic blood pressure of men aged 40‐49 years (0.75 vs 0.10, p‐value < .001). Moreover, the aging effects on systolic and diastolic BPs were higher in men than women, in the age groups 40‐49 and 30‐39 years (0.35 vs 0.10 and 0.30 vs 0.07, p‐values < .001), respectively. Adjusting for adiposity remarkably declined the impact of aging on BP, among the < 50 years old.     

Low-dose preoperative pregabalin improves postoperative pain management in septorhinoplasty surgery: a double-blind randomized clinical trial

European Archives of Oto-Rhino-Laryngology - To evaluate the&nbsp;efficacy of single low&nbsp;dose (75&nbsp;mg) preoperative pregabalin in reducing post-operative pain of...     

Perceived benefits of the disease: A qualitative study of patients' experiences of heart failure

Heart failure may bring about positive outcomes, which have not been adequately addressed in the literature. Therefore, this qualitative study sought to scrutinize the experiences of patients and the perceived positive effects of heart failure. The opinions of 19 patients with heart failure in Mashhad city (Iran) were collected via semistructured interviews from December 2017 to November 2018. After analyzing the data, six themes were identified by framework analysis: healthy lifestyle, effective interactions, appreciation of life, spirituality, reappraisal of life and priorities, and endurance. Such positive effects may lead to empowerment and better coping of patients with the disease. Therefore, nurses should consider the patients' perception of illness in addition to the disease manifestations and offer training focusing on the possibilities instead of limitations.     

Impact of subcutaneous infiltration of 0.5% bupivacaine on post-operative C-reactive protein serum titer after craniotomy surgery

Background

Tissue injuries may provoke neuro-hormonal response which in turn may lead to release of inflammatory cytokines. We hypothesize that block of afferent sensory pathways by infiltration of 0.5% bupivacaine in the scalp may decrease neuro-hormonal response in the neurosurgical patient.

Methods

After obtaining informed consent, forty ASA physical statuses I, II, or III patients between the ages of 18 and 65 years were enrolled randomly into two equal groups to receive either 20 ml of 0.5% bupivacaine (group A) or 20 ml of 0.9% normal saline as a placebo (group B) in the site of pin insertion and scalp incision. As the primary outcome we checked serum C-reactive protein (CRP) levels before implementation of noxious stimulus, 24h, and 48h after the end of surgery to compare these values between groups. In addition, mean arterial pressure (MAP) and heart rate (HR) were checked at baseline (after the induction of anesthesia), one minute after pin fixation and 5, 10, and 15 minute after skin incision and the recorded values were compared between groups.

Results

No significant difference was found between serum CRP levels of the two groups. Comparison of mean HR between groups shows no significant difference. The mean of MAP was significantly lower in the group A in comparison with the group B (p< 0.001).

Conclusion

The results of this study confirm that 0.5% bupivacaine scalp infiltration before skull-pin holder fixation and skin incision could not decrease post-operative C-reactive protein level.     

Effect of dexamethasone on the frequency of postdural puncture headache after spinal anesthesia for cesarean section: a double-blind randomized clinical trial

In this study, we evaluated the effect of dexamethasone used as a prophylaxis for nausea and vomiting on the incidence of postdural puncture headache (PDPH) in pregnant women receiving spinal anesthesia for cesarean section. In a prospective, randomized, double-blind, placebo-controlled study, 372 women under spinal anesthesia received 8?mg of dexamethasone or placebo intravenously just after the umbilical cord was clamped. The rate of PDPH and correlated risk factors were evaluated. The prevalence of nausea and vomiting in the dexamethasone and placebo groups was 54.4 and 51.7?%, respectively. There was no statistically meaningful difference between the results (P value?=?0.673). The overall incidence rate of PDPH was 10.8?%, with 28 cases from the dexamethasone group compared with 11 subjects from the placebo group (P value?=?0.006). This effect was most prominent on the first day (P value?=?0.046) and disappeared on the second day after spinal anesthesia (P value?=?0.678). Prophylactic treatment with 8?mg of dexamethasone not only increases the severity and incidence of PDPH, but is also ineffective in decreasing the prevalence of intra-operative nausea and vomiting during cesarean section. The treatment is a significant risk factor for the development of PDPH.     

Estimation of LV End-Diastolic Pressure Using Color-TDI and Its Application to Noninvasive Quantification of Myocardial Wall Stress

Background: This study was undertaken to evaluate early-diastolic annular velocity (Ea) by color-TDI, combined with the early transmitral filling velocity (E) by pulsed Doppler echocardiography for estimation of left ventricular end diastolic pressure (LVEDP). We applied LVEDP to noninvasive quantification of myocardial wall stress in end-diastole. Forty-one coronary artery disease (CAD) patients with sinus rhythm underwent echocardiography and cardiac catheterization evaluated in the study. Methods: First linear regression analysis was performed to assess the relationships between E/Ea and LVEDP. Second LVEDP estimation with these two methods was tested prospectively in 59 additional CAD patients, and average end-diastolic wall stress was calculated at rest by measuring the principal radii, the thickness of the LV segments, and the estimated LVEDP. The results were compared to the wall stress that was calculated using catheter-measured LVEDP. Linear regression analysis was performed to assess the relationships between calculated wall stress using Doppler-estimated LVEDP (WSEP) and calculated wall stress using catheter-measured LVEDP (WSMP). Results: The results showed that LVEDP had a strong correlation to the lateral E/Ea (r = 0.85; P < 0.001) and medial E/Ea ratios (r = 0.73; P < 0.001). No significant differences were found between the WSEP and WSMP. There were highly significant correlations (at least r = 0.85, P < 0.001) between the WSMP and WSEP at all the myocardial sites. Conclusions: The current data demonstrate that the lateral E/Ea ratio obtained by Doppler echocardiography and color-TDI is a powerful estimator of LVEDP in CAD patients and provides pressure information required for noninvasive quantification of LV myocardial wall stress with reasonable accuracy in diastole.     

Can triggered electromyography monitoring throughout retraction predict postoperative symptomatic neuropraxia after XLIF? Results from a prospective multicenter trial

Purpose

This multicenter study aims to evaluate the utility of triggered electromyography (t-EMG) recorded throughout psoas retraction during lateral transpsoas interbody fusion to predict postoperative changes in motor function.

Methods

Three hundred and twenty-three patients undergoing L4–5 minimally invasive lateral interbody fusion from 21 sites were enrolled. Intraoperative data collection included initial t-EMG thresholds in response to posterior retractor blade stimulation and subsequent t-EMG threshold values collected every 5 min throughout retraction. Additional data collection included dimensions/duration of retraction as well as pre-and postoperative lower extremity neurologic exams.

Results

Prior to expanding the retractor, the lowestt-EMG threshold was identified posterior to the retractor in 94 % of cases. Postoperatively, 13 (4.5 %) patients had a new motor weakness that was consistent with symptomatic neuropraxia (SN) of lumbar plexus nerves on the approach side. There were no significant differences between patients with or without a corresponding postoperative SN with respect to initial posterior blade reading (p = 0.600), or retraction dimensions (p > 0.05). Retraction time was significantly longer in those patients with SN vs. those without (p = 0.031). Stepwise logistic regression showed a significant positive relationship between the presence of new postoperative SN and total retraction time (p < 0.001), as well as change in t-EMG thresholds over time (p < 0.001), although false positive rates (increased threshold in patients with no new SN) remained high regardless of the absolute increase in threshold used to define an alarm criteria.

Conclusions

Prolonged retraction time and coincident increases in t-EMG thresholds are predictors of declining nerve integrity. Increasing t-EMG thresholds, while predictive of injury, were also observed in a large number of patients without iatrogenic injury, with a greater predictive value in cases with extended duration. In addition to a careful approach with minimal muscle retraction and consistent lumbar plexus directional retraction, the incidence of postoperative motor neuropraxia may be reduced by limiting retraction time and utilizing t-EMG throughout retraction, while understanding that the specificity of this monitoring technique is low during initial retraction and increases with longer retraction duration.