Effects of calcium channel blockers on glucose tolerance, inflammatory state, and circulating progenitor cells in non-diabetic patients with essential hypertension: a comparative study between Azelnidipine and amlodipine on glucose tolerance and endothelial function - a crossover trial (AGENT)

<p>Abstract</p> <p>Background</p> <p>Hypertension is associated with impaired glucose tolerance and insulin resistance. Medical treatment that interferes with various steps in the renin-angiotensin system improves glucose tolerance and insulin resistance. However, it remains unclear if long-acting calcium channel blockers (CCBs) such as azelnidipine and amlodipine affect glucose tolerance and insulin resistance in clinical practice.</p> <p>Methods</p> <p>Seventeen non-diabetic patients with essential hypertension who had controlled blood pressure levels using amlodipine (5 mg/day) were enrolled in this study. After randomization, either azelnidipine (16 mg/day) or amlodipine (5 mg/day) was administered in a crossover design for 12-weeks. At baseline and the end of each CCB therapy, samples of blood and urine were collected and 75 g oral glucose tolerance test (OGTT) was performed. In addition, hematopoietic progenitor cells (HPCs) were measured at each point by flow cytometry and endothelial functions were measured by fingertip pulse amplitude tonometry using EndoPAT.</p> <p>Results</p> <p>Although blood pressure levels were identical after each CCB treatment, the heart rate significantly decreased after azelnidipine administration than that after amlodipine administration (<it>P </it>< 0.005). Compared with amlodipine administration, azelnidipine significantly decreased levels of glucose and insulin 120 min after the 75 g OGTT (both <it>P </it>< 0.05). Serum levels of high-sensitivity C-reactive protein (<it>P </it>= 0.067) and interleukin-6 (<it>P </it>= 0.035) were decreased. Although endothelial functions were not different between the two medication groups, the number of circulating HPCs was significantly increased after azelnidipine administration (<it>P </it>= 0.016).</p> <p>Conclusions</p> <p>These results suggest that azelnidipine treatment may have beneficial effects on glucose tolerance, insulin sensitivity, the inflammatory state, and number of circulating progenitor cells in non-diabetic patients with essential hypertension.</p

Fatal acute myocardial infarction after multiple blunt injuries involving the chest

The patient was a 60-year-old male fell whose head and left chest hit the ground after falling from a height of 2 m. He complained of the left shoulder and chest pain after regaining consciousness. On arrival, he showed left bloody otorrhea, left chest tenderness, and a limited range of motion due to the left shoulder pain. Emergency chest roentgenography revealed multiple left rib fractures, left clavicular fracture with decreased radiolucency in the left lung field, suggesting lung contusion. When the patient was being transported for computed tomography, he suddenly displayed ventricular tachycardia with pulse and subsequently became VF storm, which required percutaneous cardiopulmonary support. The coronary angiogram showed complete obstruction of the branch of the anterior descending artery. Coronary angioplasty resulted in recanalization; however, massive hemorrhage from the left ear was recognized. Computed tomography revealed traumatic subarachnoid hemorrhage and left massive hemothorax requiring thoracostomy. Massive hemorrhage from the left ear and left thoracic cavity continued after the patient was transported to the coronary care unit. He underwent massive transfusion; however, he died on the same day

Outcome in intoxicated patients transported by a physician‐staffed helicopter in Japan from 2015 to 2020

Abstract Aim We retrospectively investigated the current status of poisoned patients who had been transported by a physician‐staffed helicopter emergency medical service and their final outcomes using data from the JAPAN DOCTOR HELICOPTER REGISTRY SYSTEM. Methods The following details of dispatch activity were collected from the database of the JAPAN DOCTOR HELICOPTER REGISTRY SYSTEM: patient age and sex, timing of dispatch request, presence of cardiac arrest, vital signs, medical intervention, main etiology of intoxication, and final outcome. The patients were divided into two groups: those with a good outcome and those with a poor outcome. The variables were compared between the two groups. Results A total of 336 patients were intoxicated. Psychotropic drug overdose was the dominant cause, followed by carbon monoxide and ethanol. The median Glasgow Coma Scale score was significantly higher in the good outcome group than in the poor outcome group. The rates of cardiac arrest, interventions to secure an airway and/or assist with ventilation, and drug administration were significantly lower in the good outcome group than in the poor outcome group. There were no records concerning the decontamination of the intoxicating substance at the scene or during air evacuation. Conclusion The study suggests that various factors may influence the outcomes of patients with different types of intoxication. These findings offer valuable insights that could help to establish effective treatment strategies and the operation of doctor helicopters for intoxicated patients