Assuntos
Infecções Relacionadas a Cateter , Cardiopatias , Staphylococcus aureus Resistente à Meticilina/isolamento & purificação , Diálise Renal/efeitos adversos , Trombose , Ultrassonografia/métodos , Trombose Venosa , Adulto , Encéfalo/diagnóstico por imagem , Procedimentos Cirúrgicos Cardiovasculares/métodos , Infecções Relacionadas a Cateter/complicações , Infecções Relacionadas a Cateter/etiologia , Infecções Relacionadas a Cateter/microbiologia , Infarto Cerebral/diagnóstico por imagem , Drenagem/métodos , Feminino , Cardiopatias/diagnóstico , Cardiopatias/etiologia , Humanos , Falência Renal Crônica/terapia , Testes Imediatos , Diálise Renal/instrumentação , Supuração , Trombose/complicações , Trombose/diagnóstico por imagem , Trombose/fisiopatologia , Trombose/cirurgia , Resultado do Tratamento , Trombose Venosa/complicações , Trombose Venosa/etiologiaRESUMO
Purpose: Mouthwash is used by a large population. Short-term clinical trials have shown that antibacterial mouthwash deplete oral nitrate-reducing bacteria, and decrease systemic nitric oxide bioavailability. Our previous publication from the San Juan Overweight Adults Longitudinal Study (SOALS) was the first to show frequent over-the-counter mouthwash use was independently associated with increased risk of prediabetes/diabetes. This manuscript evaluates whether over-the-counter mouthwash was associated with increased risk of hypertension.Materials and methods: SOALS recruited 40-65 year old overweight/obese individuals; baseline evaluations started in 2011 and the 3-year follow-up exam was completed by 2016. From the 1028 participants (76%) who completed follow-up, we excluded people with reported physician diagnosis of hypertension or systolic or diastolic BP at or above the hypertension cut-offs (n = 481), missing smoking (n = 1), missing physical activity (n = 1) and missing alcohol intake (n = 5) at baseline; 540 participants were included. The primary exposure was mouthwash use twice daily or more. The primary outcome for this manuscript is self-reported physician-diagnosed hypertension over the follow-up. We used Poisson regression controlling for age, sex, smoking, physical activity, waist circumference, alcohol intake, systolic blood pressure, pre-diabetes/diabetes status and cardiac medication use. We additionally evaluated other mouthwash use categorizations.Results: Twelve percent (66/540) developed hypertension over follow-up. People who used mouthwash twice/day or more had higher incidence of hypertension compared to less frequent users (Incidence Rate Ratio = 1.85; 95% Confidence Interval: 1.17, 2.94), and compared to non-users (IRR = 2.17; 95% CI: 1.27, 3.71). Several additional potential confounders evaluated did not impact these associations. Associations persisted among never smokers. Additional outcomes including BP assessed at a single study visit did not show associations.Conclusion: In this study, frequent regular use of over-the-counter mouthwash was associated with increased risk of hypertension, independent of major risk factors for hypertension and several other potential confounders.
Assuntos
Bactérias/efeitos dos fármacos , Pressão Sanguínea , Hipertensão/epidemiologia , Boca/microbiologia , Antissépticos Bucais/efeitos adversos , Óxido Nítrico/metabolismo , Adulto , Idoso , Bactérias/metabolismo , Feminino , Humanos , Hipertensão/diagnóstico , Hipertensão/fisiopatologia , Incidência , Estudos Longitudinais , Masculino , Pessoa de Meia-Idade , Porto Rico , Medição de Risco , Fatores de Risco , Fatores de TempoRESUMO
The scope of hypertension (HTN) even for those involved in the field is staggering with numbers close to 60 million Americans and more than 1 billion individuals across the globe. It is the most common reason to seek medical attention and according to the World Health Organization, the number one cause of mortality in the world. Yet, we still don't know what is normal or abnormal. Even though the most recent 2017 Guideline for the Prevention, Detection, Evaluation, and Management of High Blood Pressure in Adults has created quite a commotion, new questions could be raised. The purpose of this Editorial not only to fuel more interest on this topic but also to create the notion that HTN needs to be considered a dynamic clinical entity rather than a static blood pressure reading.
Assuntos
Anti-Hipertensivos/uso terapêutico , Pressão Sanguínea/fisiologia , Hipertensão/tratamento farmacológico , Humanos , Fenótipo , Guias de Prática Clínica como Assunto , Estados UnidosRESUMO
BACKGROUND: Even though left atrial (LA) size and function are intimately related to left ventricular (LV) diastolic dysfunction, the role of LA with regard to LV systolic function is less clear. Consequently, we examined the potential association that might exist between measures of longitudinal LV systolic shortening and LA dilation using LA volume index (LAVI). METHODS: In this retrospective analysis, data from 75 echocardiograms (mean age 53 ± 14; range 24 - 89 years; mean body surface area (BSA) 2.0 ± 0.3) were analyzed. RESULTS: Peak global longitudinal (PGLS) correlated best with LV mass index (LVMI) followed by mitral annular systolic excursion (MAPSE), and age. Similar results were obtained when analyzing the best variables that correlated with LAVI. Finally, MAPSE correlated best with PGLS, then with MA tissue Doppler systolic velocity, BSA, and LAVI in that order. All patients had normal LV ejection fraction (LVEF) and normal sinus rhythm when studied. CONCLUSIONS: LAVI does not directly affect LV systolic function and longitudinal measures of LV shortening are mainly dependent on LV mass. Additional studies are now required to determine how these associations vary when different degrees of LV dilatation and systolic dysfunction are included in the analysis.
RESUMO
BACKGROUND: Antiplatelet therapy with clopidogrel is recommended to reduce cardiovascular events in patients with peripheral artery disease (PAD); however, clopidogrel efficacy has not been adequately studied in this patient population. Therefore, we aimed to determine the effects of cilostazol therapy on platelet reactivity among PAD patients on clopidogrel. METHODS: We performed a cross-sectional pilot study of 46 Puerto Rican patients diagnosed with PAD. The cohort was divided based on use of clopidogrel and cilostazol (n=24) or clopidogrel alone (n=22). Platelet function was measured ex vivo using the VerifyNow P2Y12 assay. Genomic DNA was extracted from peripheral blood samples using the QIAamp DNA Blood Midi Kit, which was subjected to candidate variant genotyping (CYP2C19, ABCB1, PON1 and P2RY12) using TaqMan quantitative polymerase chain reaction assays. All analyses were performed using SAS version 9.4 (SAS Institute). RESULTS: Among all enrolled patients, 18 (39%) had high on-treatment platelet reactivity (HTPR). The mean platelet reactivity was 207±53 (range, 78-325) with higher P2Y12 reaction units in the non-cilostazol group, 224±45 vs. 191±55 on the cilostazol group (p=0.03). No significant differences were observed in the clinical or genetic variables between the two groups. A multiple regression analysis determined that history of diabetes mellitus (p=0.03), use of cilostazol (p=0.03) and hematocrit (p=0.02) were independent predictors of platelet reactivity. CONCLUSIONS: In Puerto Rican PAD patients on clopidogrel therapy, history of diabetes mellitus, use of cilostazol and hematocrit are independent predictors of platelet reactivity. Adjunctive cilostazol therapy may enhance clopidogrel efficacy among PAD patients with HTPR.
Assuntos
Plaquetas/efeitos dos fármacos , Doença Arterial Periférica/complicações , Doença Arterial Periférica/tratamento farmacológico , Inibidores da Agregação Plaquetária/farmacologia , Inibidores da Agregação Plaquetária/uso terapêutico , Tetrazóis/farmacologia , Ticlopidina/análogos & derivados , Subfamília B de Transportador de Cassetes de Ligação de ATP/genética , Idoso , Arildialquilfosfatase/genética , Cilostazol , Clopidogrel , Estudos Transversais , Citocromo P-450 CYP2C19 , Sinergismo Farmacológico , Quimioterapia Combinada , Feminino , Humanos , Masculino , Projetos Piloto , Testes de Função Plaquetária , Receptores Purinérgicos P2Y12/genética , Tetrazóis/uso terapêutico , Ticlopidina/farmacologia , Ticlopidina/uso terapêuticoRESUMO
The destruction in Puerto Rico following Hurricane Maria brought an increased demand for health care services while severely limiting the health care system's ability to provide patient care. Immediately following the hurricane, countless patients found themselves in a situation without their medications for both acute and chronic conditions. Many of these patients turned first to community pharmacies for access to their medications. In this letter, we describe the response of pharmacists to the needs of their communities following the natural disaster, Hurricane Maria, and summarize some lessons learned from the experience that may be useful in future disaster planning.