Several causes of eosinophilic pleural effusions have been described with malignancy being the commonest cause. Hypereosinophilic syndrome (HES) is a rare disease and very few cases have been reported of HES presenting as eosinophilic pleural effusion (EPE). We report a case of a 26-year-old male who presented with shortness of breath. He had bilateral pleural effusions, generalized lymphadenopathy, splenomegaly, and leukocytosis with marked peripheral blood eosinophilia. The pleural fluid was exudative, with 25%–30% eosinophilis, and absence of neoplastic cells. Hypereosinophilic syndrome was diagnosed after other causes of eosinophilia were excluded. He continued to be dyspneic with persistent accumulation of eosinophilic pleural fluid, even after his peripheral eosinophil count had normalized in response to treatment. This patient represents a very unusual presentation of HES with dyspnea and pleural effusions and demonstrates that treatment based on response of peripheral eosinophil counts, as is currently recommended, may not always be clinically adequate.
Objectives: Hypertension is a worldwide disorder that contributes significantly to morbidity, mortality, and healthcare costs in both developed and developing communities. No previous US study has evaluated the factors associated with blood pressure (BP) control when easy access to health care is available to hypertensive patients. Methods: A retrospective cohort study of hypertensive patients attending the Internal Medicine continuity clinic at Nashville General Hospital (NGH) between January and December 2007 was conducted. Given the easy access to health care at NGH and affordable BP medications with a cost of about $4 for a 30 day supply, we explored the ability to achieve optimal guideline directed BP control and evaluated which factors are associated with achieving adequate blood pressure control. Results: Of the 199 study participants, 59% of the study population achieved optimal guideline directed BP goal < 140/90mmHg similar to the national average. The mean (95% CI) systolic BP (SBP) was 139 mmHg (136 - 141)mmHg while the mean (95% CI) diastolic BP (DBP) was 80 mmHg (79-82)mmHg. Health insurance status was associated with SBP and DBP (All P < 0.046). Patients with health insurance had a 2.2 fold increased odds of achieving optimal BP control to less than 140/90mmHg compared to patients without health insurance (P=0.025). Furthermore, the number of blood pressure medications used was significantly associated with SBP and DBP (All P < 0.003). Patients taking more than three BP medications had a 58% reduced odds of achieving adequate BP control less than 140/90mmHg compared to patients taking one medication (P = 0.039). Ethnicity was not associated with achieving BP control in this study. Conclusion: Our study revealed optimal guideline directed BP control can be achieved when easy access to health care is provided and with use of affordable medications. The number of BP medications used and health insurance status, are factors associated with achieving optimal BP control.
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.
hi@scite.ai
10624 S. Eastern Ave., Ste. A-614
Henderson, NV 89052, USA
Copyright © 2024 scite LLC. All rights reserved.
Made with 💙 for researchers
Part of the Research Solutions Family.