16,336 research outputs found

    A Study on Estimation of Serum Uric Acid in Essential Hypertension

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    INTRODUCTION: Cardiovascular disease is an important epidemic of the public health. SHT is one of important vascular diseases, prevalence is about twenty five percent of individuals and increases with older age individuals. The various investigations have proved that SUA has been associated with cardiovascular morbidity and cardiovascular diseases. an attempt has been made to revise the estimation of elevated uric acid levels in essential hypertension and the correlation and association between elevated uric acid levels and hypertensive target organ damage. AIMS AND OBJECTIVE: 1. To study the level of uric acid in patients with essential hypertension. 2. To identify whether any association exists between ages, sex, body mass index, smoking, and target organ damage and the presence of elevated serum uric acid. STUDY DESIGN: Cross sectional study. METHODOLOGY: This study group included total number of 165 subjects. Among these 165 subjects, 110 were cases (hypertensives) and 55 were controls (normotensives). Study was conducted from January 2016 to June 2016. Patients diagnosed with ESSENTIAL HYPERTENSION coming to Thanjavur medical college & hospital , who satisfy the inclusion criteria are subjected to detailed history, clinical examination, and investigations. OBSERVATION AND RESULTS: In our study Among the 110 cases of hypertension, hyperuricemia was seen in 16 cases, which is account for 14% of cases. In study groups, The mean serum uric acid level in cases is 5.442mg/dl while in the control it is 4.084mg/dl. The mean serum uric acid level in cases with CAD is 6.024±0.02 while it is 5.023±0.01 among the cases without CAD. This is consistent with other studies, which has shown serum uric acid is elevated in hypertension. that uric acid level in patients with TOD is significantly elevated compared with those without TOD. CONCLUSION: Hyperuricemia (>7mg/dl in males and >6mg/dl in females) is found in 14% of hypertensives while none of the normotensives had hyperuricemia. Serum uric acid level is significantly elevated in Essential hypertension. There is no correlation between serum uric acid with gender, body mass index, smoking. Serum uric acid level is significantly elevated in cases with coronary artery disease as compared to those with other target organ damage

    Study on Serum Uric Acid levels in Essential Hypertension

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    BACKGROUND AND OBJECTIVES: Hypertension is one of the leading causes of death and disability among adults all over the world. It remains the major risk factor for coronary, cerebral and peripheral vascular disease. Essential hypertension comprises more than 90% of hypertension. Hypertension is an emerging health problem in India. Raised serum uric acid has been reported to be associated with an increased risk of coronary heart disease and is commonly encountered with essential hypertension, even untreated hypertension, and type 2 diabetes, which are in turn associated with coronary heart disease. In our study, an attempt has been made to study the prevalence of elevated uricacid levels in essential hypertension and the correlation between elevated uric acid levels and hypertensive target organ damage. METHODS AND RESULTS: In this Hospital based study for the CORRELATION OF SERUM URIC ACID LEVELS IN ESSENTIAL HYPERTENSION 300 patients who attended the out-patient and in-patient at the Institute of Internal Medicine, Madras Medical College, Chennai were evaluated for Serum Uric Acid levels of which 150 were cases and 100 Were controls. The method of Caraway was used for the estimation of creatinine based on Jaffe’s reaction. INTERPRETATION: The mean age for cases in this study is 52.74 years. The mean serum uric acid level in male is 5.5+1.26 while in female it is 5.4+1.15. They have shown that the serum UA level was more in males when related to females. In this study, serum uric acid does not correlate with Body Mass Index. The average serum UA level in hypertensive with BMI 25 are 5.38 mg/dl and 5.4 mg/dl and the difference is not statistically significant. The serum uric acid level is significantly higher in hypertensives when compared to normotensives. The average serum uric acid level in cases is 5.44mg/dl while in the control it is 3.96mg/dl. In this study, 87% of hypertensives has serum uric acid level >4mg/dl, while in controls 47% of subjects have serum uric acid level >4mg/dl. There is no significant correlation between diabetes and serum uric acid level in this study. Smoking which is also a cardiovascular risk factor does not significantly influence serum uric acid level in this study. Serum uric acid levels are significantly and independently related to increased risk of cardio-vascular mortlity. In our study coronary arterial disease is seen in 44 hypertensive individuals. The mean serum uric acid level in cases with CAD is 6+1.17.There is significant difference noticed among the cases with and without CAD. CONCLUSION: In conclusion, we decided that there can be a direct relation between hypertension and hyperuricemia based on the results of our study. Hyperuricemia is found in 15.5% of hypertensives while none of the normotensives had hyperuricemia. Serum uric acid level is significantly elevated in cases with coronary artery disease. Serum uric acid is significantly elevated in essential hypertension. There is no correlation between serum uric acid with age, sex, BMI, diabetes and smoking

    Concordance of gout management with European League against Rheumatism recommendations in hospital practice

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    Aim: To assess the concordance of gout management with the European League Against Rheumatism (EULAR) gout recommendations in hospital practice. Methods: This was a retrospective review of case notes of patients presenting to rheumatology outpatients between June and December 2009 under the care of 2 consultant rheumatologists. Data collected consisted of demographics, time lag to specialist referral, comorbidities, details about acute and recurrent attacks, lifestyle advice and use of urate lowering therapies. Documented management was assessed for concordance with the EULAR recommendations. Results: Thirty consecutive patients (27 males, 3 females) attending Rheumatology clinic at Mater Dei Hospital were recruited. Mean age at the time of survey was 59.4 ± 10.7 years, while mean age at diagnosis was 51.1 ± 14 years. Documentation of lifestyle advice was recorded for alcohol reduction (83%), weight loss (43%), diet (13%), and exercise (13%). Adequate control of comorbidities was attained in hyperlipidaemia (71%), diabetes mellitus (55%) and hypertension (30%). Advice about smoking cessation was given to 37%. Uric acid levels below target were achieved in 47%. The mean uric acid level at time of survey was 379 ± 146 μmol/l. This was significantly less than that at presentation (p=0.001). Conclusions: Current treatment of gout is poorly concordant with many of the EULAR recommendations. Documentation of lifestyle modifications advice is infrequent except for alcohol reduction. A significant number of patents on allopurinol still have hyperuricaemia implying that more aggressive management is required to improve standard of care. A proforma has been developed to make and help sustain the necessary improvements.peer-reviewe

    Uric acid is more strongly associated with impaired glucose regulation in women than in men from the general population: the KORA F4-Study.

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    High serum uric acid (UA) levels are associated with the metabolic syndrome, type 2 diabetes and cardiovascular disease. It is largely unknown whether there are gender-specific differences regarding the association between UA and prediabetic states. We examined the possible association between UA levels and known as well as newly diagnosed diabetes (NDD), isolated impaired fasting glucose (i-IFG), isolated impaired glucose tolerance (i-IGT), and combined IFG/IGT in a population-based sample of 32-to-81-year-old men and women. An oral glucose tolerance test was carried out in all 2,740 participants without known diabetes of the Cooperative Health Research in the Region of Augsburg (KORA) F4 Study conducted between 2006 and 2008 in Southern Germany. Serum UA was analysed by the uricase method. In women after multivariable adjustment the associations between UA and i-IFG (OR 1.57, 95% CI 1.15-2.14), IFG/IGT (OR 1.52, 1.07-2.16), NDD (OR 1.67, 95% CI 1.28-2.17), and known diabetes (OR 1.47, 95% CI 1.18-1.82) remained significant, but the association with i-IGT (OR 1.14, 95% CI 0.95-1.36) lost significance. In contrast in men, after multivariable adjustment there was only a significant association between UA levels and i-IFG (OR 1.49, 95% CI 1.21-1.84), all other associations were non-significant (i-IGT: OR 1.09, IFG/IGT: OR 1.06, NDD: OR 0.91, known diabetes: OR 1.04; all p-values>0.05). Serum UA concentrations were associated with different categories of impaired glucose regulation in individuals from the general population, particularly in women. Further studies investigating the role of UA in the development of derangements in glucose metabolism are needed

    Lesinurad, a novel, oral compound for gout, acts to decrease serum uric acid through inhibition of urate transporters in the kidney.

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    BackgroundExcess body burden of uric acid promotes gout. Diminished renal clearance of uric acid causes hyperuricemia in most patients with gout, and the renal urate transporter (URAT)1 is important for regulation of serum uric acid (sUA) levels. The URAT1 inhibitors probenecid and benzbromarone are used as gout therapies; however, their use is limited by drug-drug interactions and off-target toxicity, respectively. Here, we define the mechanism of action of lesinurad (Zurampic®; RDEA594), a novel URAT1 inhibitor, recently approved in the USA and Europe for treatment of chronic gout.MethodssUA levels, fractional excretion of uric acid (FEUA), lesinurad plasma levels, and urinary excretion of lesinurad were measured in healthy volunteers treated with lesinurad. In addition, lesinurad, probenecid, and benzbromarone were compared in vitro for effects on urate transporters and the organic anion transporters (OAT)1 and OAT3, changes in mitochondrial membrane potential, and human peroxisome proliferator-activated receptor gamma (PPARγ) activity.ResultsAfter 6 hours, a single 200-mg dose of lesinurad elevated FEUA 3.6-fold (p < 0.001) and reduced sUA levels by 33 % (p < 0.001). At concentrations achieved in the clinic, lesinurad inhibited activity of URAT1 and OAT4 in vitro, did not inhibit GLUT9, and had no effect on ABCG2. Lesinurad also showed a low risk for mitochondrial toxicity and PPARγ induction compared to benzbromarone. Unlike probenecid, lesinurad did not inhibit OAT1 or OAT3 in the clinical setting.ConclusionThe pharmacodynamic effects and in vitro activity of lesinurad are consistent with inhibition of URAT1 and OAT4, major apical transporters for uric acid. Lesinurad also has a favorable selectivity and safety profile, consistent with an important role in sUA-lowering therapy for patients with gout

    Gouty arthritis of the spine in a renal transplant patient : a clinical case report: an unusual presentation of a common disease

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    Axial gout is a well-documented but uncommon manifestation of gout. Its mimicking nature and the impracticality of axial joint aspiration might considerably delay its diagnosis. We report a case in a normouricemic renal transplant recipient, whereby the primary symptom of severe neck pain suggested pyogenic spondylodiscitis as an initial tentative diagnosis. Clinical findings included a high C-reactive protein concentration and elevated body temperature. The patient did not respond to empiric antibiotic treatment and suffered consecutive attacks of severe wrist and ankle pain in conjunction with a persistent fever. Blood and joint cultures were negative, but analysis of aspirated ankle joint fluid revealed monosodium urate crystals. A dual-energy computed tomography scan confirmed the presence of monosodium urate crystals in the costovertebral joints. Colchicine treatment dramatically improved the patient's clinical condition. Axial gout should be considered in transplant recipients with severe neck or back pain, fever, and increased inflammatory parameters with a high likelihood of an infectious etiology, despite the presence of paradoxically normal or even decreased serum urate concentrations. Dual-energy computed tomography is a noninvasive technique of possible benefit in the detection of axial gout when joint fluid aspiration is not deemed safe

    Sacubitril/valsartan reduces serum uric acid concentration, an independent predictor of adverse outcomes in PARADIGM-HF

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    Aims: Elevated serum uric acid concentration (SUA) has been associated with an increased risk of cardiovascular disease, but this may be due to unmeasured confounders. We examined the association between SUA and outcomes as well as the effect of sacubitril/valsartan on SUA in patients with heart failure with reduced ejection fraction (HFrEF) in PARADIGM-HF. Methods and results: The association between SUA and the primary composite outcome of cardiovascular death or heart failure (HF) hospitalization, its components, and all-cause mortality was examined using Cox regression analyses among 8213 patients using quintiles (Q1–Q5) of SUA adjusted for baseline prognostic variables including estimated glomerular filtration rate (eGFR), diuretic dose, and log N-terminal pro-brain natriuretic peptide. Change in SUA from baseline over 12 months was also evaluated in each treatment group. Patients in Q5 (SUA ≥8.6 mg/dL) compared with Q1 (<5.4 mg/dL) were younger (62.8 vs. 64.2 years), more often male (88.7% vs. 63.1%), had lower systolic blood pressure (119 vs. 123 mmHg), lower eGFR (57.4 vs. 76.6 mL/min/1.73 m2), and greater diuretic use. Higher SUA was associated with a higher risk of the primary outcome (adjusted hazard ratios) Q5 vs. Q1 = 1.28 [95% confidence intervals (1.09–1.50), P = 0.003], cardiovascular death [1.44 (1.11–1.77), P = 0.001], HF hospitalization [1.37 (1.11–1.70), P = 0.004], and all-cause mortality [1.36 (1.13–1.64), P = 0.001]. Compared with enalapril, sacubitril/valsartan reduced SUA by 0.24 (0.17–0.32) mg/dL over 12 months (P < 0.0001). Sacubitril/valsartan improved outcomes, irrespective of SUA concentration. Conclusion: Serum uric acid concentration was an independent predictor of worse outcomes after multivariable adjustment in patients with HFrEF. Compared with enalapril, sacubitril/valsartan reduced SUA and improved outcomes irrespective of SUA
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