Is it Practical to Search for Masked Hypertension?

Hypertension is an important public health challenge worldwide. It has been identified as the first cause of death worldwide being responsible for 9.4 million premature deaths. Moreover, it has been ranked third as a cause of disability adjusted life-years deteriorating health related quality of life. Hypertension is one of the most frequent reasons for adults to visit a physician´s office, and 33% of US adults ≥ 20 years of age have been reported to have hypertension. 

Hypertension is strongly associated with overall cardiovascular risk. Cardiovascular disease is the foremost cause of preventable deaths globally accounting for 30% of all deaths . However, approximately half of the disease burden attributable to office BP develops in individuals with hypertension; the remainder develops in those with BP values in the normal range . Masked hypertension, a condition with normal office and elevated out-of-office, is often missed in the office visit. . Read more>>>>>>>>>>>>

Transcatheter Embolisation with Onyx of a Persistent Type 1a Endoleak

Type 1endoleak is a manifestation of a sealing failure and is defined as a persistent blood flow within the aneurysm sac at the attachment site. It is associated with a significant pressure increase in the aneurysm sac and an increased risk of aneurysm rupture. 

Treatment always should be considered. Standard endovascular treatment includes the insertion of an aortic cuff, which gives additional coverage more proximally, or placement of a balloon-expandable stent inside the endograft to improve sealing. If it doesn’t exist any additional landing zone, chimney or periscope grafts or visceral artery bypass can be useful to extend landing zones. Transcatheter embolisation with coils, glue and thrombin, N-butyl cyanoacrylate (BCA) or Onyx is rarely performed to solve type I endoleaks. We describe a case of a patient who underwent Onyx embolisation of a type 1 endoleak after failure of a chimney graft. Read more>>>>>>>>>>>>>

Right Phrenic Nerve Palsy Post Coronary Artery Bypass Grafting (CABG) without Harvesting Right Internal Mammary Artery (RIMA)

Phrenic nerve palsy has many causes, and can be caused by lesions anywhere along its course, as it travels from the neck to pierce the diaphragm. The epidemiologywill therefore match that of the underlying etiology. Most of the cases are idiopathic or even thought to be post viral. 

Common causes include: tumors like bronchogenic carcinoma or neuroblastoma, trauma like post thoracic or neck surgeries or penetrating injuries, neuromuscular diseases, inflammation, direct compression from aortic aneurysm or cervical osteophytes, toxins like some spider or lizard toxins, alcoholic neuropathy, or endocrinal causes like hypothyroidism or diabetes mellitus (diabetic autonomic neuropathy) which enhances and exaggerates the effect of the other factors. Read more>>>>>>>>>>>

Faecal Incontinence in Gullain-Barre Syndrome with Bulbar Palsy

Guillain-Barre Syndrome (GBS) is explained under common causes of acute poly-neuropathy in adults. Acute Inflammatory Demyelinating Polyradiculoneuropathy is a common variant in Guillain-Barre Syndrome. It is slightly predominant in males than females. 

The disease generally starts as ascending neuropathy from the lower extremities, and involves upper extremities and respiratory muscles over a short period of time, with a history of upper respiratory or gastrointestinal infections in the 1-4 weeks prior to onset in majority of patients. However in Guillain-Barre syndrome variants, some patients have unusual distribution of muscle involvement. Autonomic dysfunction has been reported in association with Guillain-Barre Syndrome in as many as 66% of patients in a study by Singh NK et al..  Read more>>>>>>>>>>>>>

The Heart of Haiti: A Pure Soul from Tortured Soil

How do you speak about something that touches the soul so deeply, that enters one’s heart so completely? What are the words that can express the pain and the joy of working in a medical clinic in Haiti? A land branded by slavery, revolution,oppression, tyranny, earthquakes and blood and yet a land of some of the mostbeautiful people in the world.

Some of the strongest and best and brightest souls in the world live and work here, humbly giving all they have, every day, to help their people grow. Who among us could live this life and still work to give back? From extraordinary pain grows such extraordinary beauty. For this editorial I will draw from my own experience, but this editorial is meant to discuss and introduce the absolute joys and yet also terror and fears of working in a medical mission in a troubled country.  Read more>>>>>>>>>>>>>

Insights into Pathophysiology of Carotid Baroreceptor Stimulation as a Method for Treatment of Resistant Hypertension

Arterial hypertension (AH) is a major health problem worldwide, with a high prevalence in general population. It is also an important risk factor for cardiovascular (CVD) and renal (RD) diseases. 

According to WHO data, about 30-50% of the adult population suffer from AH. The prevalence of AH in 2025 is expected to rise by60% (29.2%-1.56 billion people) from the current 26.4% (972 million people inyear 2000). Hypertension remains a major risk factor for early renal failure, stroke, heart failure and heart attack. The risk of end-stage chronic kidney disease and myocardial infarction is four times higher in persons with systolic blood pressure above 160 mmHg than in those with normal blood pressure, and the risk of developing heart failure is two times higher in persons after the age of forty.  Read more>>>>>>>>>>>>>

Mycotic Aneurysm of the Abdominal Aorta Caused by Salmonella Non-Typhi Treated Surgically

The mycotic aortic aneurysm is a rare disease with an incidence of about 0.65% to 2%of all aortic aneurysms. Pathogens include infectious organisms, the most common of which are Staphylococcus aureus, Salmonella and Streptococcus. We report the case of a patient with a saccular aneurysm of the infra-renal aorta, due to a systemic infection with Salmonella Paratyphi B treated successfully with antibiotics and surgical resection.

Case Report : We report the case of a 65 year old man (a farmer), diabetic, admitted to the emergency department for fever and severe abdominal pain which started since 10 days. Biological tests have revealed leukocytosis 22,000/mm3, and blood cultures were positive for Salmonella paratyphi B. The transthoracic echocardiography excluded endocarditis Abdominal CT scan revealed a small aneurysm of the antero-lateral wall of the aorta measuring 15 mm in diameter. Read more>>>>>>>>>>>>>>

Treatment for sub-massive pulmonary embolism with intra cellular bi-arterial thrombus

The patient, who was presented with chest pain and dyspnea was diagnosed with sub-massive pulmonary embolism and also with intra-cardiac biatrial thrombus. This patient was treated with 100mgtissue activator and the echocardiography clinical reports, reported improvement in the ventricular function. Thus, finally they deduced that, sub-massive PE with intracellular bi-arterial thrombus can manage successfully without any side effect, with thrombolytic treatment.

46 years old male presented to the emergency department with chest pain and dyspnea that begun one day prior to his admission. The patient's medical history was notable for obesity, Kleinefelter's syndrome and two previous thromboembolic events. On arrival, the patient's blood pressure was 134/96 mmHg, tachycardia of 110 bpm, body temperature 36.7 Celsius, tachypnea of 26 breaths per minute and room air O2 saturation was 94%. Read more>>>>>>>>>>>

Transient Cortical Blindness Following Coronary Angiography

Coronary angiography (CA) is the headmost clinical tool for both diagnosis and intervention of coronary artery disease(CAD), and therefore, CA procedures occupy a huge space in modern healthcare practices. 

At the same time, the recurrent complications which accompany CA are extensively investigated. Such these complications are allergy to contrast, infection, nephropathy, embolism, local vascular injury, great vessel dissection, arrhythmia, myocardial infarction, and even death . Transient cortical blindness following coronary angiography (TCBCA) is scarcely documented in the literature, and poorly studied. TCBCA is rare and less frequent; however, it has a devastating effect on patients who have already finished their CA. In this paper, a thorough investigation of this phenomenon and a comparison review of the available published literatures that specifically discuss TCBCA. Read more>>>>>>>>>

Acenocoumarol in Geriatric Population

Thromboembolic disorders which are common across the globe have been associated with a high mortality rat. Prevention and treatment of recurrent thromboembolic disorders necessitates the use ofanticoagulants. 

Treatment with anticoagulants has been the mainstay to prevent/treat deep vein thrombosis, pulmonary embolism, acute coronary syndrome and stroke prevention in valvular and non - valvular heart disease. The elderly population is not only characterized by being at a higher thromboembolic risk but also with a higher bleeding risk, Hence physicians are prone to underuse anticoagulants either due to underestimation of thromboembolic risk or fear of bleeding or both within this geriatric population. Oral anticoagulation therapy is as effective in the elderly as in younger patients. Read more>>>>>>>>>>>>>

Mycotic Aneurysm of the Abdominal Aorta Caused by Salmonella Non-Typhi Treated Surgically

The mycotic aortic aneurysm is a rare disease with an incidence of about 0.65% to 2% of all aortic aneurysms . Pathogens include infectious organisms, the most common of which are Staphylococcus aureus, Salmonella and Streptococcus. We report the case of a patient with a saccular aneurysm of the infra-renal aorta, due to a systemic infection with Salmonella Paratyphi B treated successfully with antibiotics and surgical resection.  

Case Report: We report the case of a 65 year old man (a farmer), diabetic, admitted to the emergency department for fever and severe abdominal pain which started since 10 days. Biological tests have revealed leukocytosis 22,000/mm3, and blood cultures were positive for Salmonella paratyphi B. The transthoracic echocardiography excluded endocarditis Abdominal CT scan revealed a small aneurysm of the antero-lateral wall of the aorta measuring 15 mm in diameter.  Read more>>>>>>>>>>>>

The Relationship between Micro Albuminuria and Plasma Homocysteine Level in Chinese Patients with Hypertension

Chronic Kidney Disease (CKD) and its associated morbidity pose a worldwide health problem. Cardiovascular disease is the leading cause of premature death among the CKD population. Microalbuminuriais a marker of renal injury that can often be detected earlier than any tangible decline in glomerular filtration rate. 

As well as being a risk marker of renal dysfunction, micro albuminuria is now widely accepted as an independent risk factor for cardiovascular morbidity and mortality. The elevation of homocysteine (Hcy) level is now known as an independent risk factor for vascular diseases and hyperhomocysteinemia (Hcy) is more common in Chinese patients with hypertension due to their special genetic background. It can promote oxidant injury to the vascular endothelium, impairs endothelium-dependent vasomotor regulation, and may also alter the coagulant properties of the blood.  Read more>>>>>>>>>

Twelve Month Follow-Up Audit of Nigerian Hypertensives on Back Titration

The question of whether pharmacotherapy for systemic arterial hypertension should be life-long has continued to agitate the mind of care givers and patients alike. Whereas it is possible in some cases to reduce dose or discontinue drug(s) outright, relapse of high blood pressure is known to occur after some time. 

All the same, the attitude of step down or outright discontinuation of anti-hypertensive pharmacotherapy appears to be safe provided close monitoring continued. In an audit of hypertension care in a specialized care facility, the author observed that some patients remained controlled despite self-imposed drug holidays or physician initiated dose reduction following therapy induced hypotensive features. Some earlier workers had called for future studies to shed light on how long and intensively hypertensives could be treated before discontinuation of therapy can be embarked upon.  Read more>>>>>>>>>>>>

Surgery of Cardiac and Multi-Organ Hydatidosis Involvement

The prevalence of cardiac hydatidosis is less than 2% of all human body infestations. Predominantly registered locations are the left ventricle, followed by the right ventricle and the interventricular septum. Multi-visceral hydatidosis is exceptional. We present the case of a 37 year-old woman who underwent a successful surgery for multiple hydatidosis of the left ventricle, the left lung, and the two breasts in the same time.

 

Case Report:

We report a 37 year-old woman who had past history of surgical removal of four hydatid cysts of the right lung. Following surgery, she had been on antihelmintic treatment with albendazole for two years until Computerized Tomographic scan revealed well defined cystic lesions in the left atrium, the left lung, the liver, and the two breasts. So, surgery was planned. Preoperativetrans-thoracic echocardiography defined a cystic lesion of 50 * 40 mm originating from the apex of the heart and protruding into the pericardium. Coronary angiography was normal. Read more>>>>>>>>>>>>

Can the Intensive Blood Pressure Control in Diabetes Reduce Left Ventricular Hypertrophy ?

Left ventricular hypertrophy (LVH) is a common complication of hypertension and has been associated with higher risk for targetorgan damage. 

Insulin resistance and type2 diabetes mellitus (DM), myocardial infarction(MI), cardiomyopathy, coronaryartery disease( CAD) is reported to be associated LVH. LVH is a maladaptive response to chronic pressure overload and an important risk factor for atrial fibrillation, diastolic and systolic heart failure, and sudden death in patients with hypertension. Echocardiographic assessment of LVH has a high specificity and sensitivity (≥ 80%). The presence of LV hypertrophy is often considered when LV mass >116 g/m2 for men (M) and >104 g/m2 for women (W), or >125 g/m2 for M and W. Read more>>>>>>>>>>>