Postprandial hypotension in older Australians: Relationship to glycaemia and habitual food intake

The aim of the present study is to document the phenomenon of postprandial hypotension (PPH) in older Australians, and examine whether glycaemia and/or habitual nutrient intake could explain its occurrence. Twenty‐three subjects (8 male, 15 female) aged 69 ± 9.7 years and with body mass index of 29.7 ± 5.2 kg/m² participated in the study. Systolic blood pressure (SBP), diastolic blood pressure (DBP), heart rate (HR) and capillary blood glucose were measured at fasting and at regular intervals for two hours following a high‐carbohydrate breakfast meal. Postprandial symptoms of dizziness and nausea were recorded. Habitual food intake was assessed by a food frequency questionnaire. Twelve of 23 subjects had clinical PPH. These subjects also had higher resting SBP (P < 0.005), a trend for a greater fall in DBP (P < 0.08), and showed no change in HR following the test meal in comparison with those without PPH. Only three subjects in each group reported symptoms of nausea. Adjusted for age, body mass index and medication use, change (Δ) in glycaemia was inversely related to ΔDBP (r = ?0.53, P = 0.017) and ΔHR (r = ?0.52, P = 0.019). Differences in the habitual food intake were not statistically significant, and did not predict any postprandial outcomes. In conclusion, PPH appears to be a relatively common and symptomless condition. The lack of a compensatory increase in HR may underscore the phenomenon. Glycaemia inversely influenced the changes in HR and DBP. The role of habitual dietary composition needs to be further explored.     

Linear Morhpea,Nevus Comedonicus,and Lichen Striatus in a 5‐Year‐Old Girl

Abstract: Linear morphea, lichen striatus, and nevus comedonicus are rare conditions. We describe a five‐year‐old girl in whom all three of these dermatoses are present.     

Safety and Feasibility of Transcatheter Closure of Large Patent Ductus Arteriosus Measuring ≥4 mm in Patients Weighing ≤6 kg

Objectives: The study aims to find safety of transcatheter closure of large patent ductus arteriosus (PDA) ≥4 mm in patients weighing ≤6 kg.
Background: Large PDA ≥4 mm in patients ≤6 kg challenge the interventionist due to need for large delivery sheath, kink of delivery sheath, and encroachment of aorta or pulmonary artery (PA) by the device. Many institutions refer them for surgery.
Methods: Preterm neonates and ducts with coarctation were excluded. All other patients were taken for catheter closure. Ducts with roomy ampulla were closed with multiple coils aided by bioptome, and others with Amplatzer duct occluders.
Results: Twenty-eight patients aged 2–18 months (median 5.5 months) and weighing 3.8–6 kg (median 4.7 kg) had large PDA (mean diameter 6.3 ± 2 mm) with hyperkinetic pulmonary hypertension. Four patients had bioptome-aided coil closure. Twenty-two other ducts were closed with devices. Two procedures failed due to sheath kink in one patient and device pulling through a duct in the other patient. Four infants needed blood transfusions. The mean procedural time was 42 ± 20 minutes. On a mean follow-up of 25.5 ± 14.8 months, there were no residual flows and no gradients across aorta or pulmonary artery.
Conclusions: Transcatheter closure of large ducts ≥4 mm might be considered safe and effective in infants weighing ≤6 kg also. Decision on coils versus devices depends on ductal morphology. On midterm follow-up with somatic growth, there was no occurrence of aortic or PA gradients.