Background:Hypertension is a common medical disease, occurring in about one third of young adults and almost two thirds of individuals over the age of 60. With the release of the Eighth Joint National Committee on Prevention, Detection, Evaluation, and Treatment (JNC-8) guidelines, there have been major changes in blood pressure management in the various subgroups.Aim:Optimal blood pressure management and markers of end-organ damage in African-American adult patients were compared between patients who were managed according to the JNC-8 hypertension management guidelines and those who were treated with other regimens.Materials and Methods:African-American patients aged 18 years or older with an established diagnosis of hypertension were included in the study who were followed up in our internal medicine clinic between January 1, 2013 and December 31, 2103; the data on their systolic and diastolic blood pressure readings, heart rate, body mass index (BMI), age, gender, comorbidities, and medications were recorded. Patients were divided into four groups based on the antihypertensive therapy as follows — Group 1: Diuretic only; Group 2: Calcium channel blocker (CCB) only; Group 3: Diuretic and CCB; Group 4: Other antihypertensive agent. Their blood pressure control, comorbidities, and associated target organ damage were analyzed.Results:In all 323 patients, blood pressures were optimally controlled. The majority of the patients (79.6%) were treated with either a diuretic, a CCB, or both. Intergroup comparison analysis showed no statistically significant difference in the mean systolic blood pressure, mean diastolic blood pressure, associated comorbidities, or frequency of target organ damage.Conclusion:Although diuretics or CCBs are recommended as first-line agents in African-American patients, we found no significant difference in the optimal control of blood pressure and frequency of end-organ damage compared to management with other agents.

The knowledge of neural interconnections between adjacent nerves of the upper limb is important to the surgeon as such variations may lead to issues with surgical identification and thus iatrogenic injury. Trauma or entrapment of these nerves may cause functional losses different from those expected and thus result in misdiagnosis. The authors review the literature regarding such nervous system derangements.

The lymphatic system, a network of vessels carrying clear interstitial fluid called lymph, is found throughout the human body. The system maintains homeostasis, receiving proteins and excess fluid from the interstitial tissues, and returning them to the venous system. Understanding of lymphatic drainage remains important in the diagnosis, prognosis, and treatment of diseases, including the metastasis of malignant diseases. Information specific to the cardiac lymphatics is scarce. Indeed, quite often the topic is not even mentioned in many medical textbooks. The goal of our review is to compile and analyze the information currently available concerning the cardiac lymphatics, hoping further to demonstrate the clinical importance of this neglected system.

Abbreviations & Acronyms BICU = burn intensive care unit LOS = length of stay STSG = split thickness skin graft/debridement TBSA = total body surface area UTI = urinary tract infection Correspondence: Ronald S

Study Objective-The purpose of this study was to determine if intermittent hypoxia that mimics obstructive sleep apnea would upregulate myocardial and hepatic p-glycoprotein protein and Abcb1a/ Abcb1b mRNA expression.Design-Prospective, randomized, blinded, parallel designed animal study Setting-University Research LaboratoryParticipants-Thirty adult, male Sprague-Dawley rats Intervention-We assigned rats to either two weeks of intermittent hypoxia similar to sleep apnea (N=12) or control treatment (N=18) (no hypoxia).Measurements and Main Results-After intermittent hypoxia or normoxia exposure, rats were anesthetized and the heart and liver were harvested and small samples were taken from the left ventricle (heart) and the liver for analysis. P-glycoprotein protein expression was measured by Western blotting, while Abcb1a/Abcb1b mRNA expression (genes that code for P-glycoprotein) was assessed by real-time polymerase chain reaction. Band density of myocardial (but not hepatic) pglycoprotein protein expression (standardized by β-actin) was higher in hypoxic compared to control rats (p=0.03). Quantitative polymerase chain reaction revealed that myocardial and hepatic Abcb1a and myocardial Abcb1b mRNA expression were increased in hypoxic rats compared to controls.Conclusions-Myocardial P-glycoprotein expression and myocardial and hepatic Abcb1a mRNA expression are significantly increased by two weeks of intermittent hypoxia. Hypoxia-induced increases in p-glycoprotein expression may partially explain drug resistant cardiovascular disease in OSA.

Introduction: Octogenarians are often denied complex surgical intervention. We evaluated the rationality of this bias by comparing the outcomes of octogenarians undergoing aortic valve replacement (AVR) with or without coronary artery bypass grafting (CABG), to those of younger patients. Methods: Data on 476 patients (≥80 years) who underwent AVR or AVR/CABG were compared to the Society of Thoracic Surgeons (STS) database. Results: One hundred and seventeen octogenarians underwent AVR and 263 underwent AVR/CABG. Preoperative comorbidity rates were similar between these 2 respective groups, except for diabetes mellitus (18.8 vs. 30.4%, p = 0.02), previous cardiac stent placement (5.1 vs. 17.9%, p = 0.0006) and prior CABG (8.5 vs. 0.8%, p = 0.0002) and mortality did not differ significantly (5.1 vs. 7.6%, p = 0.51). Multivariate analysis identified preoperative chronic renal failure [odds ratio (OR) = 0.09, p < 0.048], postoperative arrhythmia (OR = 0.29, p < 0.022), sepsis (OR = 37.38, p < 0.000), pneumonia (OR = 8.29, p < 0.038) and renal failure (OR = 10.16, p < 0.000) with increased rates of inhospital mortality in AVR alone and AVR/CABG. Conclusion: AVR alone or AVR/CABG can be safely performed in patients ≥80 years with acceptable morbidity/mortality rates. An age of ≥80 years is not an independent risk factor predictive of increased inhospital mortality.

LSG is a safe and effective tool for morbid obesity with clinical and serological improvements for individuals who are unable to lose weight with medical management alone.

Background. Lung cancer screening with low-dose computed tomography for high-risk populations is being implemented in the UK. However, inclusive identification and invitation of the high-risk population is a major challenge for equitable lung screening implementation. Primary care electronic health records (EHRs) can be used to identify lung screening-eligible individuals based on age and smoking history, but the quality of EHR smoking data is limited. This study piloted a novel strategy for ascertaining smoking status in primary care and tested EHR search combinations to identify the lung screening-eligible population. Methods. Seven primary care General Practices in South Wales, UK were included. Practice-level data on missing tobacco codes in EHRs were obtained. To update patient EHRs with no tobacco code, we developed and tested an algorithm that sent a text message request to patients via their GP practice to update their smoking status. The patient’s response automatically updated their EHR with the relevant tobacco code. Four search strategies using different combinations of tobacco codes for the age range 55-74+364 were tested to estimate likely impact on the total lung screening-eligible population in Wales. Search strategies included: BROAD (wide range of ever-smoking codes); VOLUME (wide range of ever-smoking codes excluding “trivial” former smoking); FOCUSED (cigarette-related tobacco codes only), and RECENT (current smoking within the last 20 years). Results. Tobacco codes were not recorded for 3.3% of patients (n=724/21,956). Of those with no tobacco code and a validated mobile telephone number (n=333), 55% (n=183) responded via text message with their smoking status. Of the 183 patients who responded, 43.2% (n=79) had a history of smoking and were potentially eligible for lung cancer screening. Applying the BROAD search strategy resulted in an additional 148,522 patients eligible to receive an invitation for lung cancer screening when compared to the RECENT strategy. Conclusion. An automated text message system could be used to improve the completeness of primary care EHR smoking data in preparation for rolling out a national lung cancer screening programme. Varying the search strategy for tobacco codes may have profound implications for the size of the lung screening-eligible population.