Description of antihypertensive use in patients with resistant hypertension prescribed four or more agents

Data describing the use of recommended antihypertensive agents in the resistant hypertension population are limited. Treatment recommendations for resistant hypertension include maximizing diuretic therapy by using chlorthalidone and/or adding an aldosterone antagonist. Additional recommendations include combining antihypertensive agents from different drug classes. This retrospective cohort study describes antihypertensive use in patients with resistant hypertension defined as the concurrent use of ≥4 antihypertensive agents. Claims data from the Medstat MarketScan Commercial Claims and Encounter database were used to identify patients with resistant hypertension based on International Classification of Diseases, 9th Revision, Clinical Modification (ICD-9-CM) diagnosis codes and National Drug Codes between May 1, 2008 and June 30, 2009. Of the 5 442 410 patients with hypertension in the database, 140 126 met study criteria. The most frequently prescribed antihypertensive classes were angiotensin-converting enzyme inhibitors and/or angiotensin receptor blockers (96.2%), diuretics (93.2%), calcium channel blockers (83.6%), and β-blockers (80.0%). Only 3.0% and 5.9% of patients were on chlorthalidone or an aldosterone antagonist, respectively. A total of 15.6% of patients were treated with angiotensin-converting enzyme inhibitor plus angiotensin receptor blocker. Our findings demonstrate that frequently prescribed antihypertensive agents for the treatment of resistant hypertension included guideline-recommended first-line agents. However, evidence-based and recommended agents, such as chlorthalidone and aldosterone antagonists, were underused. Moreover, minimally efficacious combinations, such as an angiotensin-converting enzyme inhibitor with an angiotensin receptor blocker, were prescribed at higher rates than evidence-based and recommended agents.     

Psychological stress and wound healing in humans: A systematic review and meta-analysis

Objective

The current review aims to synthesize existing knowledge about the relationship between psychological stress and wound healing.

Methods

A systematic search strategy was conducted using electronic databases to search for published articles up to the end of October 2007. The reference lists of retrieved articles were inspected for further studies and citation searches were conducted. In addition, a meta-analysis of a subset of studies was conducted to provide a quantitative estimation of the influence of stress on wound healing.

Results

Twenty-two papers met the inclusion criteria of the systematic review and a subsample of 11 was included in a meta-analysis. The studies assessed the impact of stress on the healing of a variety of wound types in different contexts, including acute and chronic clinical wounds, experimentally created punch biopsy and blister wounds, and minor damage to the skin caused by tape stripping. Seventeen studies in the systematic review reported that stress was associated with impaired healing or dysregulation of a biomarker related to wound healing. The relationship between stress and wound healing estimated by the meta-analysis was r=−0.42 (95% CI=−0.51 to −0.32) (P<.01).

Conclusion

Attention now needs to be directed towards investigating potential moderators of the relationship, mediating mechanisms underpinning the association, as well as the demonstration of a causal link by the development of experimental interventions in healthy populations.     

Inherited metabolic disorders and cerebral infarction

The association of genetic factors and cerebral infarction (CI) has long been established. A positive family history alone is a recognized risk factor for CI and vascular events in general. However, there are certain inherited conditions that further increase the risk of stroke. These conditions are generally metabolic and mitochondrial genetic defects that have variable modes of inheritance. This article reviews major inherited metabolic disorders that predispose an individual to CI. Ten main conditions will be discussed: Fabry's disease, cerebrotendinous xanthomatosis, tangier disease, familial hypercholesterolemia, homocystinuria, methylmalonic acidemia, glutaric aciduria type I, propionic acidemia, ornithine transcarbamylase deficiency and mitochondrial encephalopathy, lactic acidosis and stroke-like phenomenon.     

Psychological impact of the tsunami on children and adolescents from the andaman and nicobar islands

Objective: The aim of this article is to present the assessment of the presentation of symptoms and psychiatric morbidity of children and adolescents from the Andaman and Nicobar islands during the first 3 months following the December 2004 earthquake and tsunami.Method: According to predefined criteria, a primary survivor is one who was exposed directly to the earthquake and tsunami, a secondary survivor is one with close family and personal ties to primary survivors, and tertiary survivors are individuals from the communities beyond the impact area, a majority of which were exposed to the earthquake only. This study included 37 primary and secondary survivors (aged 相似文献   

Sporadic midbrain dopamine neuron abnormalities in laboratory mice

We report an anatomical abnormality of dopaminergic neurons in the substantia nigra pars compacta (SNpc) and ventral tegmental area (VTA) in different strains of inbred and outbred mice, one mouse strain (C57BL/6, B6) from different commercial suppliers, and in B6J mice bred internally. The abnormality consisted of a sporadic and unpredictable decrease in the number of dopaminergic neurons and/or a reduction or complete loss of tyrosine hydroxylase (TH) staining in a focal subset of neurons of the SNpc and/or VTA. This abnormality had a preference for a unilateral right side location, but could affect one or both sides of each subregion independently or together. The frequency and severity were variable between and within strains and colonies. The neuronal abnormality was found in mice from the five commercial suppliers examined, 5/15 inbred strains from a single supplier, and the one outbred strain (CD1) examined. The striatal content of catecholamines was not affected by this abnormality even when there was significant asymmetric TH neuronal loss, but did vary significantly between commercial suppliers. Manipulations in housing conditions did not affect the abnormalities. The mechanism and cause of this abnormality could not be determined in this study although several potential factors were eliminated. The frequent, but not universal, occurrence of this abnormality has significant implications for the use of laboratory mice in studying the midbrain dopamine system and warrants its recognition, knowledge of their frequency, and exploration of a mechanism to address or eliminate them.     

Intraspecific Variation in Gloriosa Superba (L.) Population from Western Himalayas (India) and Evaluation of in vitro Antigout Potential

Proceedings of the National Academy of Sciences, India Section B: Biological Sciences - The natural population(s) of Gloriosa superba L. was mapped from 19 different locations of Western Himalayas,...     

Saliva and esophageal protection

There has been much interest in recent years in the potential protective role of saliva in the esophagus. Variables such as salivary volume and neutralizing capacity have been studied both during basal conditions and in response to esophageal acid exposure, in healthy subjects and in patients with esophagitis. In addition to its known neutralizing capacity, saliva also contains growth factors. These polypeptides (of which epidermal growth factor has been studied most) have cytoprotective and healing properties in various segments of the gastrointestinal tract. Therefore, a deficiency in one or more of these growth factors might be a contributing factor in the development of gastroesophageal reflux disease (GERD) or its complication, such as Barrett's metaplasia. However, human studies have produced contradictory results regarding salivary growth factor deficiency in such patients. Current methods of investigation make it difficult to assess the importance of saliva in GERD. This may be due in part to the multifactorial nature of the disease and the difficulty in long-term, selective manipulation of salivary function in humans. Given the present data in the literature, it is therefore unknown if saliva plays an important role in esophageal protection.     

Relationship of early childhood illness with adult cortisol in the Barry Caerphilly Growth (BCG) cohort

BACKGROUND: The developmental origins hypothesis suggests that pre- and postnatal exposures may influence vulnerability to later disease. The hypothalamic-pituitary-adrenal (HPA) axis is one pathway by which this may occur. Analyses were conducted in the Barry Caerphilly Growth (BCG) cohort to explore whether the postnatal exposure of childhood infections was related to HPA axis activity in adulthood. METHODS: Detailed data on type and frequency of illnesses were collected in the first 5 years of life. At the recent follow-up of this cohort (N=566; mean age of participants=25 years) three salivary cortisol samples were taken: two fasting samples in the morning (within 30 min of arrival at the study site and after venesection and cognitive test procedures) and one evening sample (2200 h). These data were transformed to provide AUCi and AUCg (indices reflecting axis reactivity and total hormonal output, respectively). FINDINGS: Negative associations were evident between number of upper respiratory illnesses and adult cortisol (as captured by the second morning sample, evening sample and AUCg). These relationships remained after controlling for other potential prenatal, postnatal and adult determinants. These associations were not observed for gastrointestinal illnesses suggesting that confounding by socioeconomic factors is unlikely to be the explanation. CONCLUSIONS: Childhood respiratory illnesses were associated with reduced HPA axis activity in adulthood. Further follow-ups will determine whether this pattern of activity influences vulnerability to diseases associated with HPA regulation.