Hypertensive crises in emergency medical services: analytical retrospective study

Clinica Universitară de Medicină de Urgentă, Institutul de Medicină Urgentă, Chişinău, Republica Moldova, Clinica Universitară, Centrul Naţional de Asistenţă Medicală de Urgenţă Prespitalicească, Chişinău, Republica Moldova, Catedra Urgenţe medicale, Universitatea de Stat de Medicină şi Farmacie ,,Nicolae Testemiţanu”, Chişinău, Republica MoldovaIntroducere. Criza hipertensivă (CH) este definită ca având niveluri ale tensiunii arteriale sistolice ≥180 mmHg și/ sau niveluri ale tensiunii arteriale diastolice ≥120 mmHg și este de obicei observată la pacienţii cu hipertensiune arterială esenţială și poate duce la afectarea vasculară acută a organelor vitale. Obiectivul studiului reprezintă evaluarea incidenţei factorilor de risc și a prezentării clinice a crizelor hipertensive în serviciile medicale de urgenţă în raport cu vârsta, sexul, durata și severitatea hipertensiunii, precum și prevalenţa simptomelor însoţitoare și a manifestărilor clinic. Material și metode. Studiul a fost realizat în perioada ianuarie și mai 2020 și a inclus 630 de subiecţi de ambele sexe, cu vârste cuprinse între 29-92 și diagnosticaţi cu crize hipertensive. Toţi subiecţii au fost împărţiţi în două loturi: urgenţe hipertensive comune (UHT-C) – 492 subiecţi și urgenţe hipertensive extreme (UHT-E) − 138 subiecţi. Rezultate. Subiecţii de sex feminin au fost supra-reprezentaţi semnificativ comparativ cu subiecţii de sex masculin (365– 57,9% faţă de 265–42,1%, p = 0,001). Vârsta medie a subiecţilor de sex masculin a fost de 56,6 ± 16,6 ani, în timp ce vârsta medie a subiecţilor de sex feminin a fost de 68,4±12,6 ani. Majoritatea subiecţilor aparţineau grupei de vârstă de 46-69 (86,2%) ani, inclusiv – 88,4% cu UHT-C și 78,3% cu UHT-E. Urgenţele hipertensive comune au fost semnificativ mai frecvente comparative cu urgenţele hipertensive extreme (78,1% faţă de 21,9%, p <0,0001). Presiunea arterială medie la subiecţii cu criză hipertensivă a fost de 216,86 ± 24,7 / 122,16 ± 17,6 mmHg. Concluzii. UHT-C au fost semnificativ mai frecvente decât UHT-E (78,1% vs. 21,9%, p <0,0001). Manifestările clinice ale UHT-E au fost; dificultăţi de respiraţie (45,0%), dureri toracice (37,6%), dispnee (35,5%), deficit neurologic (29,4%), cefalee (28,8%), palpitaţie (27,9%), aritmii (21,1%) și vederea înceţoșată (19,7%). Din totalul de 138 de pacienţi cu UHT-E, 21,1% au avut un singur organ ţintă implicat, 42,8% au avut două organe implicate, în timp ce 16,7% au avut trei organe ţintă implicate sub formă de ISNC, ISCV și IR și 19,6% au avut implicarea a mai mult de trei organe ţintă.Introduction. Hypertensive crisis (HC) is defined as having levels of systolic blood pressure ≥180 mmHg and / or levels of diastolic blood pressure ≥ 120 mmHg and is usually seen in patients with essential hypertension and can lead to acute vascular damage of vital organs. Obj ective of the study is to evaluate the incidence of risk factors and clinical presentation of hypertensive crises in emergency medical services in relation to age, sex, durat ion and severity of hypertension, as well as the prevalence of accompanying symptoms and clinical manifestations. Material and methods. The study was conducted between January and May 2020 and included 630 subjects of both sexes, aged 29-92, and diagnosed with hypertensive crisis. All subjects were divided into two groups: hypertensive urgencies (HTN-U) – 492 subjects and hypertensive emer gencies (HTN-E) -138 subjects. Resu lts. Female subjects were significantly over-represented compared to male subjects (365–57.9% vs. 265–42.1%, p=0.001). The average age of the male subjects was 56,6±16,6 years, while the female subjects’ average age was 68,4±12.6 years. The majority of subjects belonged to the age group of 46-69 (86.2%) years of age − 88.4% HTN-U and 78.3% HTNE. Hypertens ive urgencies were significantly more common than emergencies (78,1% vs. 21,9%, p<0.0001). The average blood pressure in subjects with hypertensive crisis was 216.86±24.7/122.16±17.6 mmHg. Conclusions. HTN-U were significantly more common than HTN-E (78,1% vs. 21,9%, p<0.0001). Clinical manifestations of HTN-E was shortness of breath (45.0%), chest pain (37.6%), dyspnea (35.5%), neurological deficit (29.4%), headache (28.8%), palpitation (27.9%), arrhythmias (21.1%) and blurring of vision (19.7%). Out of the total 138 patients with HTN-E, 21.1% had only one target organ involved, 42.8% had two organs involved, whereas 16.7% had three target organs involved in the form of CNSI, CVI and RI and 19.6% had more than three target organ involvement

Crizele hipertensive în asistența medicală de urgență prespitalicească

Department of Emergency Medicine, Nicolae Testemitanu SUMPhBackground. Hypertensive crisis is defined as levels of systolic blood pressure >180 mmHg and/or levels of diastolic blood pressure >120 mmHg and is usually seen in patients with essential hypertension and can lead to acute vascular damage of vital organs. Objective of the study. To evaluate the incidence and clinical presentation of hypertensive crises in the Emergency medical services in relation to age, sex, duration and severity of hypertension, as well as the prevalence of accompanying symptoms and clinical manifestation. Material and Methods. The study was conducted between January and May 2020 and included 630 subjects of both sexes, aged 28-92 with a diagnosis of hypertensive crises. All subjects were divided into two groups: hypertensive urgencies (492 subjects) and hypertensive emergencies ( 138 subjects). Results. Female subjects were significantly over- represented compared to men (365-57.9% vs. 265 – 42.1%, p=0.007). The average age of the male subjects was 56,6 ±16,6 years, while the female subjects’ average age was 68,4±12.6 years. The majority of subjects belonged to the age group of 60-69 (36.4%) years of age: 28.8% urgency and 38.6% emergency. Hypertensive urgencies were significantly more common than emergencies (78,1% vs. 21,9%, p<0.0001). The average blood pressure in subjects with hypertensive crisis was 216.46/122.16 mmHg. Conclusion. Hypertensive urgencies were significantly more common than emergencies (78,1% vs. 21,9%, p<0.0001) with clinical manifestations of hypertensive emergency being cerebral infarction (26.4%), acute pulmonary edema (24.8%), hypertensive encephalopathy (20.6%),acute coronary syndromes (20.4%).Introducere. Criza hipertensivă este definită ca nivel al tensiunii arteriale sistolice >180 mmHg și/ sau nivel al tensiunii arteriale diastolice > 120 mmHg, și este de obicei observată la pacienții cu hipertensiune arterială esențială, ce poate duce la afectarea vasculară acută a organelor. Scopul lucrării. Evaluarea incidenței și a manifestărilor clinice în cazul crizelor hypertensive, în asistența medicală de urgență, în raport cu vârsta, sexul, durata și severitatea hipertensiunii arteriale, precum și prevalența manifestărilor clinice. Material și Metode. Studiul a fost realizat în perioada lunilor ianuarie - mai 2020 și a inclus 630 de subiecți de ambele sexe, cu vârste cuprinse între 28 și 92 de ani, cu un diagnostic de urgență hipertensivă. Toți subiecții au fost repatizaţi în două grupuri: urgențe hipertensive comune (492 subiecți) și urgențe hipertensive extreme (138 subiecți). Rezultate. Subiecții de sex feminin au prevalat, în comparație cu subiecții de sex masculin (365-57,9% față de 265 - 42,1%, p = 0,007). Vârsta medie a subiecților de sex masculin a fost de 56,6 ± 16,6 ani, în timp ce vârsta medie a subiecților de sex feminin a fost de 68,4 ± 12,6 ani. Majoritatea subiecților aparțin grupei de vârstă de 60-69 ani (36,4%). După structură: 28,8% reprezintă urgența hipertensivă comună și 38,6% - urgența hipertensivă extremă. Urgențele hipertensive comune au fost semnificativ mai frecvente decât urgențele hipertensive extreme (78,1% față de 21,9%, p <0,0001). Presiunea arterială medie la subiecții cu criză hipertensivă a fost de 216,46 / 122,16 mmHg. Concluzii. Urgențele hipertensive comune au fost mai frecvente ca urgențele hipertensive extreme (78,1% și 21,9%, p <0,0001), manifestările clinice ale acestora fiind infarctul cerebral (26,4%), edemul pulmonar acut (24,8%), encefalopatia hipertensivă (20,6%) și sindromul coronarian acut (20,4%)

Evolution of E. coli in a mouse model of inflammatory bowel disease leads to a disease-specific bacterial genotype and trade-offs with clinical relevance

ABSTRACTInflammatory bowel disease (IBD) is a persistent inflammatory condition that affects the gastrointestinal tract and presents significant challenges in its management and treatment. Despite the knowledge that within-host bacterial evolution occurs in the intestine, the disease has rarely been studied from an evolutionary perspective. In this study, we aimed to investigate the evolution of resident bacteria during intestinal inflammation and whether- and how disease-related bacterial genetic changes may present trade-offs with potential therapeutic importance. Here, we perform an in vivo evolution experiment of E. coli in a gnotobiotic mouse model of IBD, followed by multiomic analyses to identify disease-specific genetic and phenotypic changes in bacteria that evolved in an inflamed versus a non-inflamed control environment. Our results demonstrate distinct evolutionary changes in E. coli specific to inflammation, including a single nucleotide variant that independently reached high frequency in all inflamed mice. Using ex vivo fitness assays, we find that these changes are associated with a higher fitness in an inflamed environment compared to isolates derived from non-inflamed mice. Further, using large-scale phenotypic assays, we show that bacterial adaptation to inflammation results in clinically relevant phenotypes, which intriguingly include collateral sensitivity to antibiotics. Bacterial evolution in an inflamed gut yields specific genetic and phenotypic signatures. These results may serve as a basis for developing novel evolution-informed treatment approaches for patients with intestinal inflammation

Rehabilitation and outcomes after complicated vs uncomplicated mild TBI: results from the CENTER-TBI study

International audienceBackground: Despite existing guidelines for managing mild traumatic brain injury (mTBI), evidence-based treatments are still scarce and large-scale studies on the provision and impact of specific rehabilitation services are needed. This study aimed to describe the provision of rehabilitation to patients after complicated and uncomplicated mTBI and investigate factors associated with functional outcome, symptom burden, and TBI-specific health-related quality of life (HRQOL) up to six months after injury. Methods: Patients (n = 1379) with mTBI from the Collaborative European NeuroTrauma Effectiveness Research in TBI (CENTER-TBI) study who reported whether they received rehabilitation services during the first six months post-injury and who participated in outcome assessments were included. Functional outcome was measured with the Glasgow Outcome Scale – Extended (GOSE), symptom burden with the Rivermead Post Concussion Symptoms Questionnaire (RPQ), and HRQOL with the Quality of Life after Brain Injury – Overall Scale (QOLIBRI-OS). We examined whether transition of care (TOC) pathways, receiving rehabilitation services, sociodemographic (incl. geographic), premorbid, and injury-related factors were associated with outcomes using regression models. For easy comparison, we estimated ordinal regression models for all outcomes where the scores were classified based on quantiles. Results: Overall, 43% of patients with complicated and 20% with uncomplicated mTBI reported receiving rehabilitation services, primarily in physical and cognitive domains. Patients with complicated mTBI had lower functional level, higher symptom burden, and lower HRQOL compared to uncomplicated mTBI. Rehabilitation services at three or six months and a higher number of TOC were associated with unfavorable outcomes in all models, in addition to pre-morbid psychiatric problems. Being male and having more than 13 years of education was associated with more favorable outcomes. Sustaining major trauma was associated with unfavorable GOSE outcome, whereas living in Southern and Eastern European regions was associated with lower HRQOL. Conclusions: Patients with complicated mTBI reported more unfavorable outcomes and received rehabilitation services more frequently. Receiving rehabilitation services and higher number of care transitions were indicators of injury severity and associated with unfavorable outcomes. The findings should be interpreted carefully and validated in future studies as we applied a novel analytic approach. Trial registration: ClinicalTrials.gov NCT02210221