Evidence Linking Obstructive Sleep Apnea to Hypertension

Obstructive sleep apnea (OSA) has been linked to hypertension in several experimental, epidemiological, and clinical studies. Animal modes of sleep apnea have provided strong evidence for a causal relationship with hypertension. Studies in humans have demonstrated that patients with sleep apnea have an increased blood pressure and a higher incidence of hypertension.  The most compelling evidence linking OSA and hypertension was provided by data from the Wisconsin Sleep Cohort Study. This study has demonstrated a dose-response association between sleep-disordered breathing at baseline and the presence of de novo hypertension 4 years later.  The odds ratios for the presence of hypertension at the 4-year follow-up study according to the apnea-hypopnea index (AHI) at base line were estimated after adjustment for baseline hypertension status, body mass index (BMI), neck and waist circumference, age, gender, and weekly use of alcohol and tobacco. Relative to the reference category of an AHI of 0 events per hour at baseline, the odds ratios for the presence of hypertension at follow-up were 1.42 (95% confidence intervals-CI 1.13-1.78) with an AHI of 0.1-4.9 events per hour at base line as compared with none, 2.03 (95% CI 1.29-3.17) with an AHI of 5.0-14.9 events per hour, and 2.89 (95% CI 1.46-5.64) with an AHI of 15.0 or more events per hour. These findings suggest two important concepts. First, sleep-disordered breathing is a risk factor for hypertension in the general population. Second, even sleep apnea that is considered mild may also contribute significantly to overall blood pressure levels...(excerpt

Cardiac Amyloidosis : Mini Review and a Case Report

Amyloidosis is a rare heterogeneous group of systemic disorders, which result due to extra cellular deposition of an insoluble, amorphous, eosinophilic, substance known as amyloid. The disease is often characterized by a restrictive cardiomyopathy with a poor prognosis and survival. The treatment of cardiac amyloidosis depends on the underlying etiology. However, the diagnosis of the type of cardiac amyloidosis is not always straightforward. We present here a case of cardiac amyloidosis and we discuss the different forms

First Diagnosed Heart Failure Due to Churg-Strauss Syndrome. A Case Report

Churg Strauss Syndrome (CSS)is an autoimmune condition that causes inflammation of small and medium-sized blood vessels. It is a non-infectious systemic vasculitis, which affects mainly the lungs but also other tissues and organs. CSS is considered a highly variable condition in terms of its presentation and its course. The most serious complication of the vasculitic stage is congestive heart failure with reduced ejection fraction. We present a case with first diagnosed heart failure because of CSS and review of the literature

Neurological and neurourological complications of electrical injuries

Electrical injury can affect any system and organ. Central nervous system (CNS) complications are especially well recognised, causing an increased risk of morbidity, while peripheral nervous system (PNS) complications, neurourological and cognitive and psychological abnormalities are less predictable after electrical injuries.PubMed was searched for English language clinical observational, retrospective, review and case studies published in the last 30 years using the key words: electrical injury, electrocution, complications, sequelae, neurological, cognitive, psychological, urological, neuropsychological, neurourological, neurogenic, and bladder.In this review, the broad spectrum of neurological, cognitive, psychological and neurourological consequences of electrical trauma are discussed, and clinical features characteristic of an underlying neurological, psychological or neurourological disorder are identified. The latest information about the most recently discovered forms of nervous system disorders secondary to electrical trauma, such as the presentation of neurological sequelae years after electrocution, in other words long-term sequelae, are presented. Unexpected central nervous system or muscular complications such as hydrocephalus, brain venous thrombosis, and amyotrophic lateral sclerosis are described. Common and uncommon neuropsychological syndromes after electrical trauma are defined. Neurourological sequelae secondary to spinal cord or brain trauma or as independent consequences of electrical shock are also highlighted

Correction to: Two years later: Is the SARS-CoV-2 pandemic still having an impact on emergency surgery? An international cross-sectional survey among WSES members

Background: The SARS-CoV-2 pandemic is still ongoing and a major challenge for health care services worldwide. In the first WSES COVID-19 emergency surgery survey, a strong negative impact on emergency surgery (ES) had been described already early in the pandemic situation. However, the knowledge is limited about current effects of the pandemic on patient flow through emergency rooms, daily routine and decision making in ES as well as their changes over time during the last two pandemic years. This second WSES COVID-19 emergency surgery survey investigates the impact of the SARS-CoV-2 pandemic on ES during the course of the pandemic. Methods: A web survey had been distributed to medical specialists in ES during a four-week period from January 2022, investigating the impact of the pandemic on patients and septic diseases both requiring ES, structural problems due to the pandemic and time-to-intervention in ES routine. Results: 367 collaborators from 59 countries responded to the survey. The majority indicated that the pandemic still significantly impacts on treatment and outcome of surgical emergency patients (83.1% and 78.5%, respectively). As reasons, the collaborators reported decreased case load in ES (44.7%), but patients presenting with more prolonged and severe diseases, especially concerning perforated appendicitis (62.1%) and diverticulitis (57.5%). Otherwise, approximately 50% of the participants still observe a delay in time-to-intervention in ES compared with the situation before the pandemic. Relevant causes leading to enlarged time-to-intervention in ES during the pandemic are persistent problems with in-hospital logistics, lacks in medical staff as well as operating room and intensive care capacities during the pandemic. This leads not only to the need for triage or transferring of ES patients to other hospitals, reported by 64.0% and 48.8% of the collaborators, respectively, but also to paradigm shifts in treatment modalities to non-operative approaches reported by 67.3% of the participants, especially in uncomplicated appendicitis, cholecystitis and multiple-recurrent diverticulitis. Conclusions: The SARS-CoV-2 pandemic still significantly impacts on care and outcome of patients in ES. Well-known problems with in-hospital logistics are not sufficiently resolved by now; however, medical staff shortages and reduced capacities have been dramatically aggravated over last two pandemic years

Reducing the environmental impact of surgery on a global scale: systematic review and co-prioritization with healthcare workers in 132 countries

Abstract Background Healthcare cannot achieve net-zero carbon without addressing operating theatres. The aim of this study was to prioritize feasible interventions to reduce the environmental impact of operating theatres. Methods This study adopted a four-phase Delphi consensus co-prioritization methodology. In phase 1, a systematic review of published interventions and global consultation of perioperative healthcare professionals were used to longlist interventions. In phase 2, iterative thematic analysis consolidated comparable interventions into a shortlist. In phase 3, the shortlist was co-prioritized based on patient and clinician views on acceptability, feasibility, and safety. In phase 4, ranked lists of interventions were presented by their relevance to high-income countries and low–middle-income countries. Results In phase 1, 43 interventions were identified, which had low uptake in practice according to 3042 professionals globally. In phase 2, a shortlist of 15 intervention domains was generated. In phase 3, interventions were deemed acceptable for more than 90 per cent of patients except for reducing general anaesthesia (84 per cent) and re-sterilization of ‘single-use’ consumables (86 per cent). In phase 4, the top three shortlisted interventions for high-income countries were: introducing recycling; reducing use of anaesthetic gases; and appropriate clinical waste processing. In phase 4, the top three shortlisted interventions for low–middle-income countries were: introducing reusable surgical devices; reducing use of consumables; and reducing the use of general anaesthesia. Conclusion This is a step toward environmentally sustainable operating environments with actionable interventions applicable to both high– and low–middle–income countries

Neurological and neurourological complications of electrical injuries

Electrical injury can affect any system and organ. Central nervous system (CNS) complications are especially well recognised, causing an increased risk of morbidity, while peripheral nervous system (PNS) complications, neurourological and cognitive and psychological abnormalities are less predictable after electrical injuries. PubMed was searched for English language clinical observational, retrospective, review and case studies published in the last 30 years using the key words: electrical injury, electrocution, complications, sequelae, neurological, cognitive, psychological, urological, neuropsychological, neurourological, neurogenic, and bladder. In this review, the broad spectrum of neurological, cognitive, psychological and neurourological consequences of electrical trauma are discussed, and clinical features characteristic of an underlying neurological, psychological or neurourological disorder are identified. The latest information about the most recently discovered forms of nervous system disorders secondary to electrical trauma, such as the presentation of neurological sequelae years after electrocution, in other words long-term sequelae, are presented. Unexpected central nervous system or muscular complications such as hydrocephalus, brain venous thrombosis, and amyotrophic lateral sclerosis are described. Common and uncommon neuropsychological syndromes after electrical trauma are defined. Neurourological sequelae secondary to spinal cord or brain trauma or as independent consequences of electrical shock are also highlighted

Impaired glucose homeostasis in non-diabetic Greek hypertensives with diabetes family history. Effect of the obesity status

Arterial hypertension (AH) and diabetes mellitus (DM) are established cardiovascular risk factors. Impaired glucose homeostasis (IGH; impaired fasting glucose or/and impaired glucose tolerance) or pre-diabetes, obesity, and DM family history identify individuals at risk for type 2 DM in whom preventive interventions are necessary. The aim of this study was to determine the glycemic profile in non-diabetic Greek adult hypertensive men and women according to DM family history and the obesity status. Diabetes family history, obesity markers (waist-to-hip ratio, WHR; body mass index, BMI), glycemic parameters (fasting and 2-hour post-load plasma glucose, if necessary; glycated hemoglobin, HbA(l)c; fasting insulin), insulin resistance indices (homeostasis model assessment, HOMA; quantitative insulin sensitivity check index, QUICKI; Bennett; McAuley), and IGH prevalence were determined in a large cohort of 11,540 Greek hypertensives referred to our institutions. Positive DM family history was associated with elevated fasting glucose (98.6 +/- 13.1 vs 96.5 +/- 12.3 mg/dL), HbA(l)c (5.58% +/- 0.49% vs 5.50% +/- 0.46%), fasting insulin (9.74 +/- 4.20 vs 9.21 +/- 3.63 mu U/mL) and HOMA (2.43 +/- 1.19 vs 2.24 +/- 1.01) values, lower QUICKI (0.342 +/- 0.025 vs 0.345 +/- 0.023), Bennett (0.285 +/- 0.081 vs 0.292 +/- 0.078) and McAuley (6.73 +/- 3.43 vs 6.95 +/- 3.44) values, and higher IGH prevalence (45.3% vs 38.7%); P < .01 for all comparisons. The difference in the prevalence of IGH according to DM family history was significant (P < .01) in both genders and every WHR and BMI subgroup (except for women with BMI <20 kg/m(2)). Non-diabetic hypertensives with positive DM family history present with higher IGH prevalence and worse glycemic indices levels compared with those with negative family history, especially in the higher WHR/BMI subgroups. (c) 2013 American Society of Hypertension. All rights reserved