Gene/Protein Disease Symptom Drug Enzyme Compound
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Query: UMLS:C0020538 (hypertension)
 170,190 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

This case report deals with the very rare complication of an intraspinal haematoma: a 70 year old male underwent anticoagulation because of supraventricular dysrhythmias followed by two transient ischaemic attacks. He accidentally received an intramuscular injection for tetanus prophylaxis and developed a deep intramuscular haematoma, which was operated upon, after normalisation of coagulation parameters, under spinal anaesthesia. No primary complication was noted. Heparin therapy was started perioperatively, on the day of the operation. Sixteen days postoperatively, the patient resumed oral anticoagulation; 3 months later he developed a progressive cauda-equina-syndrome due to an epidural haematoma at the level of L2 to L4. This could be diagnosed by magnetic resonance imaging, but not by computed tomography. Acute surgical decompression was performed. The haematoma showed various ages as suspected by the intraoperative morphology and proven by histological examination. The neurological findings improved, and 6 months after rehabilitation only slight neurological deficits remained. Hypertension, anticoagulants, and spinal anaesthesia are discussed as risk factors for this complication.
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PMID:[Delayed lumbar epidural hematoma. Discussion of the risk factors: hypertension, anticoagulation and spinal anesthesia]. 989 22

Membrane metalloendopeptidase EC 3.4.24.11 (Enkephalinase, neutral endopeptidase, NEP) is a cellular ectoenzyme, immunophenotypically identified as the leukocyte cluster of differentiation CD10 or CALLA (common acute lymphoblastic leukemia antigen). Immunological, biochemical and molecular biology techniques have identified tis cell membrane feature in various organs: brain, cardiovascular system, lung, placenta, kidney etc. The CD10 immunophenotype is a common feature of lymphoblasts in acute lymphoid leukemia not expressing the T- or B-markers. The enzymatic activity of CD10/NEP possibly influences normal lymphocyte ontogeny by proteolytic cleavage of the regulatory peptides. The substrates of CD10/NEP in the kidneys are (see the list of abbreviations) ANP, adrenomedullin and PAMP; in the brain, the substrates are enkephalins and oxytocin; in the lung, bombesin, BLP, GRP, neuromedin C, substance P and neurokinin A; in the cardiovascular system, angiotenisin II, bradykinin and CGRP; in the gut, VIP; on the neutrophil membrane, fMLP etc. Some substrates are not strictly tissue-specific, e.g. substance P. Preclinical and clinical trials explore possibilities of therapeutic application of the inhibitors of neutral endopeptidase, such as thiorphan in the management of pain, diarrhoea, depression, arterial hypertension and asthma. Other possibilities of application include the treatment of hyalinomembranous disease and prevention of neurotoxicosis in tetanus and botulism.
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PMID:[Membrane metalloendopeptidase (CD10/CALLA): distribution, physiologic and pathophysiologic functions and its inhibitors]. 974 92

Tetanus is a preventable disease that continues to affect people in the United States due to poor immunization practices in our health care system. A 57-year-old man with type 2 diabetes mellitus, hypertension, and end-stage renal disease with many hospital admissions came to the hospital emergency department because of a blackened great toe. He denied pain in the toe or knowledge of foot injury. The patient also complained of temporomandibular tenderness accompanied by inability to open his mouth completely. The man's problems progressed to generalized tetanus and required a long hospitalization. Clostridium tetani can flourish in the anaerobic environment of a diabetic foot infection. Practitioners should be aware of tetanus as a rare but potentially serious complication of diabetic foot infections.
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PMID:Generalized tetanus in a patient with a diabetic foot infection. 1041 39

The occupational health nurse for the South Carolina Department of Transportation (SCDOT) collaborated with the Schools of Nursing within the state universities of South Carolina to coordinate individual health screenings for the employees of SCDOT. Personal Wellness Profiles (PWP) by Wellsource, Inc., were used to perform the health screenings and included family and personal histories, and assessment of blood pressure, vision, height, weight, total and high density lipoprotein cholesterol, and blood glucose levels. In addition, hepatitis and tetanus/diphtheria immunizations and influenza vaccines were provided. Each of the 48 county sites was visited twice during the semester by nursing faculty and nursing and public health students. The first visit was to collect assessment data for screening and provide immunizations. The second visit was to provide individualized analyzed data and health counseling. Of the 5,118 SCDOT employees, 3,141 were screened the first year and 2,315 were screened the second year. Of the original 3,141, only 1,549 elected to participate in the rescreening. Although the average population age was 41, 78.3% were rated at high coronary risk because of high blood pressure, high cholesterol and blood sugar levels, excessive weight and stress levels, and sedentary lifestyles.
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PMID:Providing worksite health promotion through university-community partnerships. The South Carolina DOT project. 1081 24

A patient with severe tetanus, who had a sympathetic crisis while sedated with 30 mg/h diazepam and 30 mg/h morphine, is described. Satisfactory control of the haemodynamic crisis was achieved with bolus doses of esmolol to a total of 180 mg. A disturbing finding was that although there was adequate control of the tachycardia and hypertension, arterial catecholamine levels remained markedly elevated. Adrenaline levels of 531 pg/ml (normal 10-110 pg/ml) and noradrenaline levels of 1,036 pg/ml (normal 100-500 pg/ml) were recorded when the patient had a systolic arterial pressure of 110 mmHg and a heart rate of 97/min. The implications of this finding are discussed.
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PMID:Esmolol in a case of severe tetanus. Adequate haemodynamic control achieved despite markedly elevated catecholamine levels. 1121 41

Altered sympathetic nervous system activity has been implicated often in hypertension. We examined short-term potentiation [posttetanic potentiation (PTP)] and long-term potentiation (LTP) in the isolated superior cervical ganglia (SCG) from Sprague-Dawley (SD) rats given vehicle, digoxin, or ouabain by subcutaneous implants as well as in animals with ouabain-induced hypertension (OHR), and inbred Baltimore ouabain-resistant (BOR) and Baltimore ouabain-sensitive (BOS) strains of rats. Postganglionic compound action potentials (CAP) were used to determine PTP and LTP following a tetanic stimulus (20 Hz, 20 s). Baseline CAP magnitude was greater in ganglia from OHR than in vehicle-treated SD rats before tetanus, but the decay time constant of PTP was significantly decreased in OHR and in rats infused with digoxin that were normotensive. In hypertensive BOS and OHR, the time constants for the decay of both PTP and LTP (t(L)) were increased and correlated with blood pressure (slope = 0.15 min/mmHg, r = 0.52, P < 0.047 and 6.7 min/mmHg, r = 0.906, P < 0.0001, respectively). In BOS and OHR, t(L) (minutes) was 492 +/- 40 (n = 7) and 539 +/- 41 (n = 5), respectively, and differed (P < 0.05) from BOR (257 +/- 48, n = 4), SD vehicle rats (240 +/- 18, n = 4), and captopril-treated OHR (370 +/- 52, n = 5). After the tetanus, the CAP at 90 min in BOS and OHR SCG declined less rapidly vs. SD vehicle rats or BOR. Captopril normalized blood pressure and t(L) in OHR. We conclude that the duration of ganglionic LTP and blood pressure are tightly linked in ouabain-dependent hypertension. Our results favor the possibility that enhanced duration of LTP in sympathetic neurons contributes to the increase in sympathetic nerve activity in ouabain-dependent hypertension and suggest that a captopril-sensitive step mediates the link of ouabain with LTP.
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PMID:Synaptic plasticity in sympathetic ganglia from acquired and inherited forms of ouabain-dependent hypertension. 1144 69

Prenatal care has been implemented in developing countries according to the same mode as applied in industrialized countries without considering its real effectiveness in reducing maternal and neonatal mortality. Several recent studies suggest that the goals should be revisited in order to implement a program of prenatal care based on real scientific evidence. Based on the current literature, we propose a potentially effective content for prenatal care adapted to the context of developing countries. Four antenatal consultations would be enough if appropriately timed at 12, 26, 32 and 36 weeks pregnancy. The purpose of these consultations would be: 1) to screen for three major risk factors, which, when recognized, lead to specific action: uterine, scare, malpresentation, premature rupture of the membranes; 2) to prevent and/or detect (and treat) specific complications of pregnancy: hypertension, infection (malaria, venereal disease, HIV, tetanus, urinary tract infection); anemia and trace element deficiencies, gestational diabetes mellitus; 3) to provide counseling, support and information for pregnant women and their families (including the partner) concerning: severe signs and symptoms of pregnancy and delivery, community organization of emergency transfer, delivery planning. These potentially effective actions can only have a real public health impact if implemented within an organized maternal health system with a functional network of delivery units, if truly quality care is given, and if the relationships between health care providers and the population are based on mutual respect. Sub-Saharan African women use prenatal care extensively when it is accessible; this opportunity must be used to implement evidence-based actions with appropriate and realistic goals.
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PMID:[Potential role of prenatal care in reducing maternal and perinatal mortality in sub-Saharan Africa]. 1197 82

In order for women to benefit from adequate community-based care during pregnancy, delivery, and the postpartum, health authorities must provide adequate local services with a sufficient number of trained agents to supervise all deliveries, and the communities themselves must strive to prevent maternal deaths. The community should monitor the health of women, assure access to family planning and prenatal care for all women, and make its members aware of warning signs during pregnancy and delivery. Communities need the assistance of a maternity center or hospital for high-risk pregnancies and difficult deliveries if morbidity and mortality are to be avoided. Each delivery should be attended by a trained person who knows when the delivery is excessively protracted and hospitalization is necessary, what to do in case of hemorrhage or poor presentation of the infant, what rules of hygiene to follow, and how to handle other situations that arise during delivery. Women who are healthy and well-nourished before pregnancy have fewer problems during pregnancy and delivery, and family planning allows high-risk pregnancies to be avoided. Regular prenatal care allows high-risk pregnancies to be identified so that the women can be sent to a hospital for delivery. The expectant mother can be given iron supplements, the 2 injections that will protect mother and infant against tetanus, and antimalarial drugs if necessary. Hypertensive women can be identified, and women can be given advice on child care and family planning. Warning signs before pregnancy include pregnancy within the past 2 years, being under 18 or over 35 years old, family size of 4 or more children, birth of a previous infant weighing under 2500 gm at birth, history of difficult delivery or cesarean, previous premature delivery or stillbirth, maternal weight under 38 kg or height under 145 cm, or chronic illness. Warning signs during pregnancy include failure to gain weight, pallor in the interior of the eyelids, and swelling of the legs, arms, or face. 6 signs requiring immediate attention are vaginal bleeding during pregnancy, intense headaches which may signal high blood pressure, significant vomiting, fever, convulsions, and labor of more than 24 hours. The community should try to ensure that each pregnant woman has a delivery kit in her home ready for use so that the delivery can be safely attended at home if necessary. Women and families should know where to seek further assistance if complications or warning signs occur. Communities can organize 2-way communications by telephone or radio with the referral hospital and can ensure that transportation is always available. Communities can also organize their own forms of insurance so that women can pay for emergency medical care.
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PMID:[Maternal care: what must it provide in the community for maternity without risks?]. 1228 31

In order to accelerate welfare and nutrition programs for women and children in tribal, hilly, and backward areas of India, the government of India has accepted the National Program of Integrated Services. Delivery of these services is coordinated by the Integrated Child Development Services (ICDS). The package of services for prenatal women include physical and obstetrical exams; serial recording of weight, blood pressure, hemoglobin, and urinalysis; tetanus immunization; iron (60 mg) and folic acid (.5 mg) tablets; food supplements; identification and referral of high-risk mothers; and health education on antenatal care, breast feeding, child rearing, and family planning. Postnatal women received 2 home visits within 10 days of delivery and make 1 visit after 1 month of delivery. These visits cover general health, breast feeding, delivery records, infant health, and birth control measures. Food supplementation continues for nursing mothers. All women 15-44 years of age receive health and nutrition education. Specially organized courses, campaigns, home visits by anganwadi workers, cooking demonstrations, and mass media emphasize simple messages regarding health and nutrition. Areas that are covered include family welfare; antenatal, intranatal, and postnatal care; breast feeding; immunization; prevention of such common communicable diseases as malaria, tuberculosis, and leprosy; weaning and supplementary feeding; improvement of children's nutritional status; balanced diet; food storage, preparation, cooking, and serving; eye and ear care; personal and environmental hygiene; sanitation; management of acute respiratory infections; management of diarrhea; and control and treatment of internal parasites. The mobile food and extension units of the Department of Food are utilized. Pregnant and nursing mothers belonging to families of landless agricultural laborers, of marginal farmers, of the scheduled caste, of the scheduled tribe, and of poorer sections of the community are chosen for this program. Special care is given to pregnant women who: are pregnant for the 1st, 3rd, or 4th time; have gained less than 6 kg; are younger than 18 or older than 35; have had frequent or twin pregnancies; have a history of miscarriage or preterm delivery; are anemic; or have a history of edema, hypertension, or seizure. Personnel, who are monitored, receive training supplemented by reorientation and continuing education.
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PMID:Health and development of mothers through system of ICDS. 1228 36

In India, maternal and child deaths account for 60% of total mortality. Reductions in maternal mortality require the identification of all pregnant women in the community, prenatal care, the early detection of medical problems and pregnancy-related complications, tetanus toxoid immunization, identification of the most appropriate setting for delivery, prevention of maternal malnutrition, and motivation to practice breastfeeding and birth spacing in the postpartum period. To reduce child mortality, infants should be breastfed, immunization against common infectious diseases should be provided, and growth should be monitored at regular check-ups. As part of the village health worker's regular household visits, pregnant women should be motivated to seek prenatal care. Ideally, there should be a prenatal visit monthly for the 1st 7 months of pregnancy, once every 2 weeks until 36 weeks, and weekly thereafter. If long distance from a medical facility or the loss of wages make this impossible, there should be at least 4-5 visits at the 10th, 20th, 30th, 35th, and 35th weeks of gestation. Care should be taken to identify the major factors in high-risk pregnancies: moderate to severe toxemia, chronic hypertension, significant rental or heart disease, hydramnios or oligohydramnios, and uterine rupture. In areas where financial and human resources in the primary health care sector are limited, inputs should be targeted to high-risk groups and activities of preventive and therapeutic value that are most cost- effective. All interventions should be based on a thorough analysis of the major determinants of mortality, the incidence of specific diseases, the responsiveness of diseases to available technologies, the community's nutritional status, and the cultural milieu. Rather than create new schemes and categories of workers, existing health facilities should be fully utilized.
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PMID:Strategies for promoting child health. 1231 87


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