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Review of Blood Pressure Lowering-Benefits of Physical Activity, Weight-Loss and Dietary Modifications in Blood Pressure Control among US Minority Communities
No full textBackground: Hypertension develops in individuals irrespective of age, gender, national origin or ethnic grouping. However, there are some differences regarding the extent to which each ethnic population distribution is involved. This review utilized the Health Belief Model (HBM) to design an approach to promote knowledge, beliefs, and modify health behavior of African-Americans with borderline high blood pressure risk factors toward hypertension.Methods: To meet the study objectives, we searched MEDLINE from January 2011 through December 2013, using the medical subject headings of physical activity and health, nutrition, exercise/leisure-time activity, hypertension, stroke, and cardiovascular disease. Twenty-five peer-reviewed scientific articles which met our research inclusion criteria were identified and reviewed.Results: On overweight, obesity and sedentary lifestyles, as comorbid factors for hypertension and other CVDs, many researchers concluded that the combination of excessive nutrient intake and sedentary lifestyle has been the major causes for the rapid acceleration of obesity in today’s US population. While hypertension is more prevalent and severer in African Americans than other US populations, these authors believe that the major process in high blood pressure control, therefore, lies in the concept of primary and secondary prevention interventions involving sustained efforts in behavior, lifestyle changes, and therapeutic compliance via the HBM at the pre-hypertension stage.Conclusion: The risk of hypertension in the US general population and its unabated disproportional representation in minority communities, especially African Americans, remains a major health challenge. Hence, reviewing and understanding research studies on hypertension, behavioral risk factors and lifestyle changes may prove useful and beneficial for high blood pressure and comorbid conditions intervention programs
Multidisciplinary Management of an Unusual Case of Vascular Dementia.
No full textCerebral Autosomal Dominant Arteriopathy with Subcortical Infarcts and Leucoencephalopathy, also known as CADASIL is a non-amyloid form of small vessel disease [1]. CADASIL is an autosomal dominant condition mainly affecting the vasculature of the deep matter within the brain, and is caused by a mutation in the NOTCH3 gene on chromosome 19 [2]. The NOTCH3 gene encodes a receptor that is important for the structure and functioning of vascular smooth muscle cells [3]. There are a wide variety of mutations that can take place within the NOTCH3 gene and cysteine is the amino acid involved in the majority of mutations. The addition or deletion of a cysteine molecule affects the Notch3 receptor function in the cells of the vascular smooth muscle, and can lead to apoptosis of the cells [4]. This degeneration along with mural fibrosis can result in stenosis of the arteries [3]. Consequently the blood supply is reduced to the areas supplied by those vessels which in turn causes the symptoms experienced in CADASIL [5]
Effects of a Prolonged Exercise Program on Exercise Tolerance in Individuals with History of Acute Coronary Syndrome: A Retrospective Study
No full textObjective: To verify the influence of a prolonged physical exercise program on physical fitness and cardiovascular parameters, as evaluated by exercise stress test (EST), in subjects with newly diagnosed acute coronary syndrome.Methods: The sample included 50 subjects distributed by an experimental group (EG; n = 25) and a control group (CG; n = 25). The EG was subject to a program of regular exercise during 52 weeks. All subjects performed two ESTs: one at the beginning and one at the end of the experimental protocol. The first test was performed 2-3 months after the cardiac event. During the EST fitness parameters (speed and incline of the treadmill and test time), cardiovascular parameters (maximum and resting heart rate, maximum and resting blood pressure, and maximum and resting double product), and metabolic equivalents were recorded.Results: Compared with the first test, in the second EST showed a significant increase (p <0.05) of the absolute values of metabolic equivalents and physical fitness indicators (testing time and maximum speed and incline of the treadmill) in the EG, with a percentage of variation of these parameters significantly higher than in CG. Despite the better physical performance demonstrated by the EG, there were no significant differences between the two groups with respect to cardiovascular parameters.Conclusion: In this study, the physical training program improved exercise tolerance in individuals with a history of acute coronary events, without an apparent increased cardiac work
Three Indications for Bovine Jugular Vein Grafts in a Single Tertiary Centre in Jeddah: A Retrospective Study
No full textIntroduction and Aim of the Work: Bovine jugular vein grafts(Contegra) can be used not only in the reconstruction of an abnormal right ventricular outflow tract (RVOT) but also for VSD repairs and as an extra-cardiac conduit for the Fontan circulation.(1-2-3-4-5). We aimed to present and review the preliminary results of contegra in the 3 different indications.Patients and Methods: We reviewed the available charts of 22 patients who needed contegra as an RVOT reconstive graft, 23 cases for Fontan extracardiac conduits and 8 cases of VSD in a single tertiary centre in Jeddah in more than 8 years between 2002 and 2011. The available demographic data, operative, ECHO findings, results, complications and the follow up data are presented and analysed.Results: Fifty three cases were included in this retrospective study from June 2002 to January 2011. The Median age at the time of operation was 3.5 years (range 1-26 years). The thirty days mortality was 7.5 % (four patients); one Fontan patient died because of arrhythmia & sepsis, the other Fontan one due to lately detected thrombosed Fontan connection. The 3rd patient was a case of Fallot tetralogy who died because of ventricular dysfunction and the 4th one was a repaired VSD died because of sepsis and DIC. Follow-up was available for 40 (75.4%) patients at a mean of 19.8 months (range 8-78 months) postoperatively.Conclusion: The Contegra xenograft is a good conduit for RVOT reconstruction, a potential acceptable alternative conduit for the extracardiac Fontan connections and can be used to close the VSD if it is associated with one of the previous 2 indication
Difficult Urethral Catheterization in Cardiovascular Surgery Patients: Do you have a Road Map?
No full textPurpose: To report our approach and findings of intraoperative difficult urethral catheterization in cardiovascular surgery patients.Materials and Methods: A total of 60 male patients who underwent intraoperative urologic consultation during anesthesia preparation for the insertion of Foley catheter where urology team failed to insert the latex Foley catheter by the normal procedure, were enrolled in the study. The kind of problems encountered and the methods employed were considered in this paper.Results: In 4 (6.6%) out of 60 patients 14 F and 12 F silicone Foley catheters and in 6 patients (10%) 16 F Tiemann Foley catheters were inserted. Fifty patients (83%), in whom various types and sizes of Foley catheter could not be inserted, underwent rigid or flexible cystoscopy under endo-camera guidance. Eight of these patients (16%) underwent flexible cystoscopy, and 42 patients (84%) underwent rigid cystoscopy. The distribution of different pathologies seen in 50 patients, who underwent cystoscopy, was as follows: urethral calculi (2 patients), false passage (12 patients), bladder neck contracture or high bladder neck (16 patients), prostatic hypertrophy (8 patients), urethral stricture (12 patients). No micturition problem was observed during the follow-up.Conclusion: We should strive to resolve the problem of urethral catheterization with the least possible trauma especially in patients with increased risk of bleeding who are scheduled for cardiovascular surgery. We think that performing this endoscopic procedure by cystoscopy helps to define the existing pathology and to relieve the problem successfully
A Follow-Up Study of Treated and Untreated Greek Adolescents with a History of Specific Developmental Language Disorder
No full textResearch has shown that specific developmental language disorders (SDLD) may develop over time into other impairments or disorders. For instance, children with these diagnoses often show learning, social adjustment or behaviour disorders in adolescence. On the other hand, many professionals claim that early intervention has a significant effect on these disorders. The question which arises is whether early intervention can forestall the development of these more serious consequences in adolescence. The aim of this study is to examine adolescents who had been diagnosed with SDLD in childhood and who had attended during their preschool years an Early Intervention Programme (EIP) within a Community Mental Health Centre. These adolescents’ outcomes are compared with those of adolescents who had also been diagnosed with SDLD, but who had not complied with therapy. The experimental group (N=44), now have a mean age of 13 years, whereas the control group (N=52), who had not accepted therapy, have a mean age of 14 years. The parameters which were investigated were school achievement, social and emotional adjustment, behaviour, language skills, and their parents’ attitudes. Statistical analysis shows that although some of the treated adolescents now exhibit learning difficulties, those who began their therapy before the age of 5 are presently showing significantly better concentration and behaviour than all the other groups. In conclusion, early intervention seems to be effective for children with SDLD and may restrict the appearance of more serious social adjustment and behavioural problems in adolescence
Classic Ductal Sonographic Criteria versus Real Time Elastography Criteria in Diagnosing Nodular Breast Lesions
No full textObjectives: Sonoelastography is a noninvasive, real time procedure, complementary diagnostic method that increases the diagnostic qualities of conventional ductal ultrasound. We want to evaluate the added diagnostic value of sonoelastography in cases of apparent benign lesions in conventional ultrasound.Method: Prospective Study: 1115 women, under 45 years of age, mean age 34.5±5.17 years, who came in in our Ultrasound Unit for a routine breast evaluation.Recruitment Period: January 2011-APRIL 2013. Ductal breast ultrasound and elastography was performed with a HITACHI EUB 7500 HV machine, with 6-13 MHz variable frequency linear probe, with water bag, Hitachi Medical System Tokyo, Japan. Ueno score and also strain ratio were measured for all described lesions. All cases with BIRADS-US 4 evaluation were operated. Extemporaneous and postsurgical histopathological exam was performed in all cases. Some BIRADS –US 3 lesions were also referred to the surgeons because of cosmetic, pre-pregnancy, need of hormonal contraception use reasons.Results: From the total of 1115 cases, we diagnosed 416 solid tumors, of which 273were referred to the surgeon, and only 174 did have surgery with histopathological result. Diagnostic value of classical ultrasound was medium, with a sensitivity of 48.61% and specificity of 66.66%. Doppler US had higher diagnostic value (51.38%, respectively 75.49), combined information being better in diagnostic (68.42% and 50.75%). Real time elastography had the highest diagnostic values, in both qualitative and quantitative technique, with a sensitivity of 90.41%, respectively 94.4%, with the same specificity of 94.4% and 94.11%.Conclusion: real time elastography should be considered as a useful diagnostic tool in preoperative evaluation of solid breast masses
Relevance of the Nutritional Care in Patients before Liver Transplantation
No full textAim: To define the body composition of patients awaiting liver transplantation and analyze the effect of the nutritional counseling.Methods: This retrospective study involved 335 patients in screening for liver transplantation. The evaluation of the nutritional status at the first access to the Center comprised: anthropometrical evaluations and Mini Nutritional Assessment. For cases that reached transplantation (N. 110), evaluated two times, the second control comprised also the Subjective Global Assessment.Results: The Body Max Index at the first observation showed a prevalence of overweight or obesity while the Mini Nutritional Assessment and anthropometric evaluation showed that a large number of patients were at risk of malnutrition or bad nourished with a decrease of fat and/or of muscular mass. Immediately before transplantation and after a nutritional follow up with a personalized diet fat mass has been normalized in 91% and muscular mass remained stable in 56% of cases.Conclusions: Malnutrition is largely diffused in patients undergoing liver transplantation. An evaluation by simple methods such as anthropometry and nutritional counseling is needed to ameliorate their conditions. Particular attention must be paid to counteract the decrease of fat mass and muscular mass in females. Â
Novel 1,2,3-Triazole Derivatives as Antimicrobial Agents
No full text2-Substituted benzimidazoles 3a-c was prepared via condensation of ethyl pyruvates 2a-c with 2-phenylenediamine in glacial acetic acid. Pyrrolo[1,2-a]benzimidazole derivatives 5 and 8 were prepared via cyclocondensation of compounds 3a,b with phosphorus oxychloride or acetic anhydride in presence of sodium acetate respectively. Reactivity of pyruvate 2 towards 2-aminophenol, hydroxylamine and cyanothioacetamide was also investigated. They exhibited potent antimicrobial activity comparable to clinical drugs such as ciprofloxacin and ketoconazole. Compounds 3a, 11 and 13 showed excellent antimicrobial activity against all the tested microbes, and Compound 11 showed lower MIC values against all the tested organisms
Psychotherapeutic Change in Mental Health: Narcissistic Personality Disorder and its Treatment
No full textThe aim of this study is to analyze if a specific type of metacognitive deficit is present in a patient with Narcissistic Personality Disorder, if a metacognitive improvement can be detected during the psychotherapy treatment and if this improvement can be indicative of the effectiveness of psychotherapy itself. A single case study has been conducted; metacognitive deficits have been measured with the Metacognition Assessment Scale (MAS). In line with the hypothesis, results show a global and progressive improvement of metacognitive functions. We conclude in agreement with the current literature, the existence of a major deficit in “Understanding of Others’ Mind/Decentration†function, if we compare it to “Self-reflexivity†(both belonging to Metacognitive monitoring)