Hypertension in pregnancy: classification, diagnosis and treatment

Hypertension in Pregnancy (HTNP) is defined as systolic blood pressure ≥ 140mmHg or diastolic blood pres­sure ≥ 90mmHg in at least two different measurements during pregnancy. According to guidelines, HTNP is classified into four or more individual categories. These categories include chronic hypertension, gestational hypertension, pre-existing hypertension plus superimposed gestational hypertension with proteinuria, antenatally unclassified hypertension and preec­lampsia. Although the exact causes and pathogenetic mechanisms of HTNP are not fully elucidated, the severity of the pos­sible complications, including eclampsia and HELLP syndrome, require the maximum alertness. Physicians should consider HTNP as a crucial maternal, fetal and neonatal morbidity and mortality factor. Early detection and treatment are of major importance and should be provided in every case. In the present review the potential pathogenetic mechanisms, categories and therapeutic interventions for HTNP are discussed, according to up-to-date data

Effects of Lifestyle Measures, Antiobesity Agents, and Bariatric Surgery on Serological Markers of Inflammation in Obese Patients

Overweight and obesity are highly prevalent in developed countries and are also becoming more frequent in the developing world. Overweight and obese patients have elevated levels of several inflammatory markers and this inflammatory state might contribute to their increased vascular risk. We summarize the effects of lifestyle changes, antiobesity agents, and bariatric surgery on serological inflammatory markers in overweight and obese patients. Most studies showed a decrease in inflammation with all 3 interventions. However, it remains to be established whether the decrease in inflammatory markers induced by lifestyle changes or (where indicated) with antiobesity agents or bariatric surgery will translate into reduced vascular morbidity and mortality in overweight and obese patients

Rectus Sheath Hematoma: A Simplified Emergency Surgical Approach

Rectus sheath hematoma (RSH) is an uncommon clinical event usually associated with trauma or coagulation disorders. It can also occur spontaneously. RSH usually runs a benign course but it can present with hypovolemic shock. When conservative management fails, surgical exploration becomes mandatory. We propose a technique of emergency ligation of the inferior epigastric artery. This is a simple approach as this artery originates at the posterior rectus sheath above the inguinal ligament. This safe technique provides immediate hemodynamic stabilization

The association between serum uric acid levels and 10-year cardiovascular disease incidence:Results from the ATTICA prospective study

Limited data suggests possible gender-specific association between serum uric acid (SUA) and cardiovascular disease (CVD) incidence. The aim of the present analysis was to evaluate the association between SUA levels and 10-year CVD incidence (2002–2012) in the ATTICA study participants. Overall, 1687 apparently healthy volunteers, with SUA measurements, residing in the greater metropolitan Athens area (Greece), were included. Multivariable Cox-regression models were used to estimate the hazard ratios for SUA in relation to 10-year CVD incidence. Receiver operating curve analysis was conducted to detect optimal SUA cut-off values. Participants in the 2nd and 3rd SUA tertile had 29 and 73% higher 10-year CVD incidence compared with those in the 1st tertile (p < 0.001). In gender-specific analysis, only in women SUA was independently associated with CVD incidence; women in the 3rd SUA tertile had 79% greater 10-year CVD event risk compared to their 1st tertile counterparts. Obese in the 3rd SUA tertile had 2-times higher CVD incidence compared to those in the 1st tertile. Similar findings were observed in metabolically healthy (vs. unhealthy) and metabolically healthy obese. SUA thresholds best predicting 10-year CVD incidence was 5.05 and 4.15 mg/dL (0.30 and 0.25 mmol/L) in men and women, respectively. In conclusion, increased SUA levels were independently related to 10-year CVD event rate in women, obese and metabolically healthy individuals. SUA could predict 10-year CVD incidence even at low levels. Further studies are warranted to identify SUA cut-off values that may improve the detection of individuals at higher CVD risk in clinical practice

Sleep Duration May Not Have Any Effect on The Risk of Stroke: Insights from Mendelian Randomization and Prospective Cohort Studies

Introduction: Due to contentious associations between sleep and stroke risk we performed a meta-analysis of cohort studies and utilized Mendelian randomization (MR). Material and methods: For the meta-analysis we pooled prospective studies and then reviewed the largest genome-wide association studies regarding self-reported or accelerometer-derived sleep duration with stroke [ischemic (IS), cardioembolic (CES), large artery (LAS), small vessel (SVS)]. Inverse variance weighted method (IVW), weighted median (WM)-based method, MR-Egger and MR-Pleiotropy RESidual Sum and Outlier (PRESSO) were performed. To determine the impact of single nucleotide polymorphisms (SNPs) leave-one-out method was applied. Results: Pooled prospective studies demonstrated shorter (8h) [n=16 studies, I2 = 53.6, p 0.126). Estimated associations had no significant heterogeneity and MR-PRESSO revealed no outliers. There was low likelihood of pleiotropy (all estimations p >0.539) and associations were not driven by single SNPs. Conclusions: Meta-analysis revealed shorter and longer sleep increased total stroke risk, but with high heterogeneity. MR analysis showed no causal associations between sleep duration and stroke risk