Review of nifedipine GITS in the treatment of high risk patients with coronary artery disease and hypertension

Nifedipine is a dihydropyridine calcium-channel blocker (CCB) introduced approximately 30 years ago for the prophylaxis of angina symptoms, and then later utilized as an anti-hypertensive agent. In the 1990s, several meta-analyses and a case-control study were published which raised concern regarding increased mortality and increased risk for myocardial infarction with short-acting nifedipine. Further evaluation of these meta-analyses and case control study underscores some important limitations and the need to further elucidate the role of this class of medications in high-risk patients. Until 2000, there was a paucity of data on the long-term effects as well as the long-term outcomes of CCBs in the treatment of stable coronary disease or in patients with manifestations of the disease such as hypertension or angina. While it has been well established that nifedipine and other dihydropyridines lower blood pressure and improve symptoms of angina, several studies were designed to evaluate the effect of dihydropyridines on “hard” outcomes, specifically cardiovascular and cerebrovascular events. In this review, we describe the clinical studies evaluating the use of nifedipine when compared to placebo as well as other anti-hypertensive therapies in an attempt to identify the most appropriate place in therapy for this class of medications and to further clarify its utilization in high-risk patients

Association between racial discrimination and health‐related quality of life and the impact of social relationships

Purpose: Interpersonal racial discrimination is associated with poor health. Social relationships may moderate the impact of discrimination and represent modifiable behaviors that can be targeted by public health interventions. We described citywide associations between self-reported racial discrimination and health-related quality of life among the overall New York City (NYC) adult residential population and by four main race/ethnicity groups and explored whether social relationships moderated health effects of discrimination. Methods: We analyzed cross-sectional survey data from 2335 adults weighted to be representative of the NYC population. We measured exposures to lifetime interpersonal racial discrimination in nine domains using a modifed version of the Experiences of Discrimination scale. We performed unadjusted and adjusted regression analyses on four self-rated health-related quality of life outcomes including general health, physical health, mental health, and limitations from physical or mental health. Results: Overall, 47% [95% CI 44.5, 50.3] of respondents reported having experienced racial discrimination in at least one domain. In the overall population, significant associations with racial discrimination were noted in adjusted models for poor physical health, poor mental health, and limitations by poor physical and mental health. Among those exposed to racial discrimination, the risk of experiencing poor mental health was lower among those who had contact with family or friends outside their household at least once a week, compared with those who had less frequent social contact. Conclusion: This study provides evidence that social relationships may moderate the impact of racial discrimination on mental health and should be integrated into health promotion efforts

INt(he)erSECtion

An overview of transmedia experiments in which the body and experience is shown dematerialized through character play and reconfigured, into multiple consumable and interactive gestures of isolated fetishization or form. By questioning gender assumptions within secure networks of policy driven performative expectation, form is made. Investigating the values that drive fetishization and form significance in direct violation of accepted data sets, this work leverages intersectional data or generative power, towards solutions requested by the cyborg or humyn condition of bondage to technologized power

Association between racial discrimination and health-related quality of life and the impact of social relationships

Purpose: Interpersonal racial discrimination is associated with poor health. Social relationships may moderate the impact of discrimination and represent modifiable behaviors that can be targeted by public health interventions. We described city-wide associations between self-reported racial discrimination and health-related quality of life among the overall New York City (NYC) adult residential population and by four main race/ethnicity groups and explored whether social relationships moderated health effects of discrimination. Methods: We analyzed cross-sectional survey data from 2335 adults weighted to be representative of the NYC population. We measured exposures to lifetime interpersonal racial discrimination in nine domains using a modified version of the Experiences of Discrimination scale. We performed unadjusted and adjusted regression analyses on four self-rated health-related quality of life outcomes including general health, physical health, mental health, and limitations from physical or mental health. Results: Overall, 47% [95% CI 44.5, 50.3] of respondents reported having experienced racial discrimination in at least one domain. In the overall population, significant associations with racial discrimination were noted in adjusted models for poor physical health, poor mental health, and limitations by poor physical and mental health. Among those exposed to racial discrimination, the risk of experiencing poor mental health was lower among those who had contact with family or friends outside their household at least once a week, compared with those who had less frequent social contact. Conclusion: This study provides evidence that social relationships may moderate the impact of racial discrimination on mental health and should be integrated into health promotion effort

A Call to Arms: Emergency Hand and Upper-Extremity Operations During the COVID-19 Pandemic.

PurposeLimited data exist regarding volumetric trends and management of upper-extremity emergencies during periods of social restriction and duress, such as the coronavirus disease 2019 pandemic. We sought to study the effect of shelter-in-place orders on emergent operative upper-extremity surgery.MethodsAll patients undergoing emergent and time-sensitive operations to the finger(s), hand, wrist, and forearm were tracked over an equal number of days before and after shelter-in-place orders at 2 geographically distinct Level I trauma centers. Surgical volume and resources, patient demographics, and injury patterns were compared before and after official shelter-in-place orders.ResultsA total of 58 patients underwent time-sensitive or emergent operations. Mean patient age was 42 years; mean injury severity score was 9 and median American Society of Anesthesiologist score was 2. There was a 40% increase in volume after shelter-in-place orders, averaging 1.4 cases/d. Indications for surgery included high-energy closed fracture (60%), traumatic nerve injury (19%), severe soft tissue infection (15%), and revascularization of the arm, hand, or digit(s) (15%). High-risk behavior, defined as lawlessness, assault, and high-speed auto accidents, was associated with a significantly greater proportion of operations after shelter-in-place orders (40% vs 12.5%; P < .05). Each institution dedicated an average of 3 inpatient beds and one intensive care unit-capable bed to upper-extremity care daily. Resources used included an average of 115 minutes of daily operating room time and 8 operating room staff or personnel per case.ConclusionsHand and upper-extremity operative volume increased after shelter-in-place orders at 2 major Level I trauma centers across the country, demanding considerable hospital resources. The rise in volume was associated with an increase in high-risk behavior.Type of study/level of evidenceTherapeutic IV