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  • ISSN: 2373-9258
    Current Issue
    Volume 5, Issue 2
    Mini Review
    Luis Dabul, Bishoy Goubran, Gerardo F. Ferrer, Juan D. Oms, Mohamed El Khashab, and Marcos A Sanchez-Gonzalez
    Patients with schizophrenia have twice higher mortality rate compared with the general population, a 20 year reduction in life expectancy, and increased risk of cardio metabolic diseases. The anatomical and physiological changes in heart structures are yet to be elucidated in hypertensive patients with schizophrenia. We have investigated echocardiographic parameters in two groups of hypertensive patients of different ages and compared them with the parameters of schizophrenic patients with hypertension. We retrospectively examined 250 patients with diagnoses of hypertension, and after excluding comorbid diabetes or metabolic syndrome allocated them to three groups: middle age (50-65 years; MN; n = 11), middle age with schizophrenia (MS; n = 9), and elderly (= 70; EN; n = 15). Non-parametric Jonckheere-Terpstra trend analysis was used for identifying linear trends across the three groups. Significant interaction effects (p < 0.05) were identified for ECHO variables LAD, LVDD, PWD, EF, and LVOT indicating a linear trend between the groups, such that there was an age and schizophrenia dependent linear decrease in PWD, EF, and LVOT (MN > MS >EN), but a linear increase of LVDD and LAD (MN< MS
    A Kaul*, MR Behera, S Bhat, and N Kumari
    American College of Obstetricians and Gynecologists’ (ACOG) Task Force on Hypertension in Pregnancy has modified the diagnosis of preeclampsia (PE) by eliminating the dependence of PE diagnosis on proteinuria. Proteinuria in PE may be a late marker of renal injury; and podoctyuria which appears much before proteinuria may serve as an early marker of renal injury. Thus biomarkers influencing endothelial dysfunction and renal damage in PE may need to be looked into and compared with internationally accepted risk stratification model. These women experience a 2-fold increased risk of long-term cardiovascular disease (CVD) and an approximate 5–12-fold increased risk of end-stage renal disease (ESRD). Hence, the objectives of screening tests for PE should be such that it can help in predicting and reducing the prevalence of the disease through early pharmacological intervention along with measures to minimize maternal and perinatal morbidity and mortality.
    Case Report
    Brandon E. Cave and Augustus R. Hough*
    In this case report, we describe the use of impedance cardiography (ICG) to guide antihypertensive therapy in a patient with difficult-to-treat hypertension illustrating the potential benefit of use in clinical practice. Through the identification of our patient’s hemodynamic phenotype, low cardiac index and elevated systemic vascular resistance index, and medication changes directed toward these patient-specific parameters therapy was streamlined to achieve target blood pressure with a net reduction in medications. Despite decades of research and guideline publications aiming to improve hypertensive control approximately half of hypertensive patients fail to reach BP targets using a stepped-care approach. Recent evidence advocates for more intensive BP goals in select patient populations, which would require therapy intensification for millions of hypertensive adults. Utilizing novel strategies, such as ICG, to personalize antihypertensive regimens has the potential to improve overall BP control without an increase in medications, or in certain cases, a reduction in medication. This case report illustrates the utilization of ICG as a method of providing more effective BP control while potentially decreasing burden on patients, and the healthcare system, through avoiding use of likely ineffective and potentially harmful therapies.
    Roger A. McMaster-Fay*
    This is a review of the roles of an abnormal uteroplacental circulation (UPC) and oxidative stress pathogenesis of preeclampsia (PE), as well as aspirin prophylaxis.
    Two models of the pathogenesis (PE); Redman and Sergeant’s (1991) and McMaster-Fay’s (2008) are used in this review and are analysed in relation to the results of recent publications.
    Both models agree on the primary importance of the development of an abnormal UPC or the failure to develop normal UPC. They also both agree on the importance of oxidative stress in the disease process but Redman and Sargent believe its importance is only in the clinical phase of the disease as McMaster-Fay believes it is important throughout the PE pregnancy. Recently published data would tend to confirm the later hypothesis.
    Aspirin is known to ameliorate PE, with recent studies showing a delay the onset of the disease. The mechanisms by which this occurs are probably due to both aspirins antiplatelet and antioxidant activities. Controversy exists around when the therapy should start.
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