Hospital or outpatient care when patients present with hypertensive urgency?

Do ambulatory patients who present in office settings with hypertensive urgency -- systolic blood pressure (BP) at least 180mm HG and diastolic BP at least 110 mm Hg -- do better when they are referred to the hospital or when they have their BP managed in an outpatient setting?

Krishna K. Patel, M.D., of the Cleveland Clinic, and coauthors examined that question in a new study published online by JAMA Internal Medicine.

Organ damage can result from increased blood pressure over time, so physicians may be concerned about the potential for organ damage after severely elevated BP, even for a short time. However, the management of hypertensive urgency is complicated by a lack of observational studies or randomized trials. Some patients with hypertensive urgency are evaluated and treated in emergency departments.

To help inform management of hypertensive urgency, the authors conducted a study of all patients presenting with hypertensive urgency to a Cleveland Clinic office from 2008 through 2013.

Of nearly 2.2 million patient visits, 59,836 (4.6 percent) met the definition of hypertensive urgency. The study's final sample included 58,535 patients. Almost 58 percent of those patients were women, most were white, they had an average body mass index of about 31, and they had an average systolic BP of 182.5 mm Hg and an average diastolic BP of 96.4 mm Hg.

The authors report only 426 patients (0.7 percent) were referred to the hospital for blood pressure management and the rest (n=58,109) were sent home.

In an analysis that matched the 426 patients referred to the hospital with 852 patients who were sent home, there was no significant difference in major adverse cardiovascular events in a week, in a month or in six months, the study showed.

Patients who were sent home were more likely to have uncontrolled blood pressure at one month but not at 6 months. However, about two-thirds of all patients still had uncontrolled blood pressure at six months. Patients who were sent home also had lower hospital admission rates at seven days, according to the results.

"Hypertensive urgency is common in the outpatient setting. In the absence of symptoms of target organ damage, most patients probably can be safely treated in the outpatient setting, because cardiovascular complications are rare in the short term. Furthermore, referral to the ED was associated with increased use of health care resources but not better outcomes. Finally, patients with hypertensive urgency are at high risk for uncontrolled hypertension as long as six months after the initial episode. Efforts to improve follow-up and intensify antihypertensive therapy should be pursued," the study concludes.

Source:

Michael B. Rothberg, MD, MPH et al. Characteristics and Outcomes of Patients Presenting With Hypertensive Urgency in the Office Setting. JAMA Intern Med, June 2016 DOI: 10.1001/jamainternmed.2016.1509

FDA approves vaccine to prevent cholera for travelers

The U.S. Food and Drug Administration today approved Vaxchora, a vaccine for the prevention of cholera caused by serogroup O1 in adults 18 through 64 years of age traveling to cholera-affected areas. Vaxchora is the only FDA-approved vaccine for the prevention of cholera.

Ulcerative Colitis: A new treatment strategy discovered

A new study discovers that Type I collagen and its daughter peptides is promising in targeting mucosal healing in ulcerative colitis.

Ulcerative colitis is a chronic relapsing form of inflammatory bowel disease that causes inflammation and ulcers in the colon. Symptoms can range from mild to severe with disease onset usually occurring in young adults.

The existing treatment protocol aims at only reducing intestinal inflammation, rather than targeting mucosal ulceration.

In the study, type I collagen and its daughter peptides called collagen hydrolysate, highly popular reconstructive materials for tissue engineering applications, are hypothesized as healing matrices to target the recuperation of internal mucosal ulceration.

The study concludes, Both collagen and collagen hydrolysate treatments showed significant reduction in mucosal damage score and facilitated faster regeneration of damaged mucosa.

Reference material gotten from:
ScienceDirect

ZIKA VIRUS UPDATE: Apart from microencephaly in foetus other complications discovered

Existing evidence and unpublished data shared with WHO highlight the wider range of congenital abnormalities probably associated with the acquisition of Zika virus infection in utero. In addition to microcephaly, other manifestations include craniofacial disproportion, spasticity, seizures, irritability and brainstem dysfunction including feeding difficulties, ocular abnormalities and findings on neuroimaging such as calcifications, cortical disorders and ventriculomegaly.3–6,8–10 Similar to other infections acquired in utero, cases range in severity; some babies have been reported to have neurological abnormalities with a normal head circumference. Preliminary data from Colombia and Panama also suggest that the genitourinary, cardiac and digestive systems can be affected (Pilar Ramon-Pardo, unpublished data).

FDA approves first buprenorphine implant for opioid dependence

The US Food and Drug Administration (FDA), which is responsible for evaluating the safety and efficacy of medicines in the United States, has approved the first buprenorphine implant for the maintenance treatment of opioid dependence in adults, a treatment that is being hailed as “a game changer”.

Probuphine, which is marketed by Titan Pharmaceuticals and Braeburn Pharmaceuticals, consists of four, one-inch-long rods that are implanted under the skin in the upper arm. The treatment has been approved for use in patients who are already stable on low-to-moderate doses of other forms of buprenorphine (8mg or less a day) as part of a complete treatment programme that includes counselling and psychosocial support.

Previous buprenorphine treatment for opioid dependence is approved only as a pill or film, which needs to be placed under the tongue or inside a person’s cheek until it dissolved, and therefore doses can be easily forgotten, lost or stolen. Taking the implant eliminates these risks because it provides a constant, low-level dose of buprenorphine for six months.

If further treatment is required after six months, the FDA says one additional course of Probuphine may be inserted in the patient’s opposite arm.

Only certified doctors trained through the Probuphine risk evaluation and mitigation strategy programme will be able to insert and remove the implants, which will come with a boxed warning that says its insertion and removal are associated with the risk of implant migration, protrusion, expulsion and nerve damage resulting from the procedure.

The implants contain a significant amount of drug that can potentially be expelled or removed, resulting in the potential for accidental exposure or intentional misuse and abuse if the implant comes out of the skin. As a result, the FDA recommends that patients are seen during the first week after insertion and at least once a month thereafter for continued counselling and support.

ENZYME WITH HIGH POTENTIAL FOR CANCER TREATMENT DISCOVERED!!

A team of researchers from the Biology department at the Technische Universität  Darmstadt has identified an enzyme that separates DNA replication from repair. This discovery could be of tremendous significance in the treatment of tumours. The scientists have now published the results of their research in the research journal Molecular Cell.

Several essential processes take place in separate compartments within a cell. The cell's most important asset, DNA, is packed inside the cell nucleus, and a veritable armada of proteins is responsible for the organisation, replication and protection of the DNA. Many of these proteins perform a number of tasks, for instance possessing functions at the replication fork and repairing damage to DNA. Most of the mechanisms for the individual functions of these proteins are understood, but there has as yet been little research into the coordination and regulation between the various processes.

Biologists at the TU Darmstadt under Prof. Dr. Markus Löbrich and Dr. Julian Spies have collaborated with their colleagues at the University of California in Davis and identified a protein kinase called Nek1 that promotes the repair of DNA double-strand breaks and separates this repair from replication. Nek1 switches on the motor protein Rad54 only after the completion of replication in order to finalize the repair process. This is of physiological relevance because during replication, Rad54 possesses additional functions at the replication fork, and premature activation of Rad54 results in a major disturbance of the replication process, report the Darmstadt-based researchers in the research journal Molecular Cell.
Technische Universität

USE IN CANCER TREATMENT

This discovery has a very high potential for use in the development of entirely new kinds of cancer treatments. Finding inhibitors that block the function of Nek1 would lead to a loss in the repair function. Tumour cells in particular would suffer from this loss of function in Nek1, since they experience a tremendous amount of DNA damage during their uncontrolled growth. The scientists suspect that the inhibition of Nek1 could be associated with an accumulation of unrepaired DNA damage in these cells that could cause the tumour cells to die. The team of researchers plans to continue to investigate these assumptions over the coming years.

Scientist develop new wearable device that can predict asthmatic attacks

Researchers have developed an integrated, wearable system that monitors a user's environment, heart rate and other physical attributes with the goal of predicting and preventing asthma attacks. The researchers plan to begin testing the system on a larger subject population this summer.

The system, called the Health and Environmental Tracker (HET), is composed of a suite of new sensor devices and was developed by researchers from the National Science Foundation's Nanosystems Engineering Research Center for Advanced Self-Powered Systems of Integrated Sensors and Technologies (ASSIST) at North Carolina State University.

According to the Centers for Disease Control and Prevention, asthma affects more than 24 million people in the United States. Asthma patients currently rely on inhalers to deal with their symptoms, which can include often-debilitating asthma attacks.

"Our goal was to design a wearable system that could track the wellness of the subjects and in particular provide the infrastructure to predict asthma attacks, so that the users could take steps to prevent them by changing their activities or environment," says Alper Bozkurt, the principal investigator of a paper describing the work and an assistant professor of electrical and computer engineering at NC State.

"Preventing an attack could be as simple as going indoors or taking a break from an exercise routine," says James Dieffenderfer, lead author of the paper and a Ph.D. student in the joint biomedical engineering program at NC State and the University of North Carolina at Chapel Hill.

The HET system incorporates a host of novel sensing devices, which are incorporated into a wristband and a patch that adheres to the chest.

The patch includes sensors that track a patient's movement, heart rate, respiratory rate, the amount of oxygen in the blood, skin impedance and wheezing in the lungs.

The wristband focuses largely on environmental factors, monitoring volatile organic compounds and ozone in the air, as well as ambient humidity and temperature. The wristband also includes additional sensors to monitor motion, heart rate and the amount of oxygen in the blood.

The system also has one nonwearable component: a spirometer, which patients breathe into several times a day to measure lung function.

"Right now, people with asthma are asked to use a peak flow meter to measure lung function on a day-to-day basis," Dieffenderfer says. "That information is used to inform the dosage of prescription drugs used in their inhalers.

"For HET, we developed a customized self-powered spirometer, which collects more accurate information on lung function and feeds that data into the system," Dieffenderfer adds.

Data from all of these sensors is transmitted wirelessly to a computer, where custom software collects and records the data.

"The uniqueness of this work is not simply the integration of various sensors in wearable form factors," says Veena Misra, co-author of the paper and a professor of electrical and computer engineering at NC State. "The impact here is that we have been able to demonstrate power consumption levels that are in the sub-milliwatt levels by using nano-enabled novel sensor technologies. Comparable, existing devices have power consumption levels in the hundreds of milliwatts.

"This ultra-low power consumption is important because it gives the devices a long battery life, and will make them compatible with the power generated by the body -- which is not a lot," says Misra, who is also the director of the ASSIST Center. "It enables a pathway to realize the ASSIST Center's vision of self-powered wearable sensors in the near future."

"We have tested the system in the benchtop and on a limited number of human subjects for proof of concept demonstration and have confirmed that all of the sensors work, and that the system accurately compiles the data," Misra says. "This summer, we plan to begin testing HET in a controlled environment with subjects suffering fro