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Biomedical subjects

A Ansari

Publications and source records attributed to A Ansari.

209 records · Page 12Linked to original sources
PubMedDate not supplied

Efficacy and safety of combination therapy using high- or low-dose hydrochlorothiazide with valsartan or other Angiotensin-receptor blockers.

Only a minority of patients treated for hypertension achieve controlled blood pressure (BP) levels. Therapy with fixed-dose combinations of an angiotensinreceptor blocker (ARB) and low-dose hydrochlorothiazide (HCTZ) is commonly prescribed but not always sufficient to achieve the target BP. The efficacy and safety of the fixed-dose combination of valsartan 160 mg and HCTZ 25 mg was evaluated in patients in whom BP had not been controlled with a fixed-dose combination of another ARB and low-dose HCTZ (12.5 mg) in a multicenter trial. After a wash-out period for antihypertensive drugs, patients with a mean sitting diastolic BP (DBP) at trough (3)100 mm Hg but <110 mm Hg were treated with candesartan cilexetil 16 mg plus HCTZ 12.5 mg or telmisartan 80 mg plus HCTZ 12.5 mg for 4 weeks (phase 1). Patients whose BP was still uncontrolled (DBP (3)90 mm Hg) after 4 weeks of therapy were then given valsartan 160 mg plus HCTZ 25 mg for an additional 4 weeks (phase 2). The primary efficacy parameter was the reduction in DBP between week 4 and week 8 in the intention-to-treat (ITT) population. BP reduction during phase 1 was -14.3+/-11.3/-7.5+/-3.9 mm Hg. DBP was controlled in 26% of the patients after phase 1. In patients treated with valsartan 160 mg plus HCTZ 25 mg during phase 2, DBP decreased by an additional 10.3+/-6.5 mm Hg and the mean sitting systolic BP (SBP) by an additional 11.0+/-11.7 mm Hg. The additional decrease was significant (P<.0001) for both parameters and independent of the fixed-dose combination used during phase 1. Among patients whose BP remained uncontrolled during phase 1, 74% achieved a controlled DBP after phase 2. The incidence of adverse events during both phases was comparably low and the results of laboratory tests were unremarkable. Treatment with valsartan 160 mg/HCTZ 25 mg offered a substantial benefit for patients with hypertension not controlled with the combination of candesartan cilexetil 16 mg or telmisartan 80 mg and low dose HCTZ, while maintaining a comparable safety and tolerability profile.

Adult↗
PubMedDate not supplied

Cardiovascular manifestations of systemic lupus erythematosus: current perspective.

Cardiovascular manifestations develop in the majority of SLE patients at some time during the course of their illness, the most common being acute fibrinous pericarditis and pericardial effusion. Echocardiography has demonstrated an increased incidence of pericardial effusion, even in those who have minimal symptoms. Chronic adhesive pericarditis, pericardial tamponade, and constrictive pericarditis occur rarely. While myocarditis is commonly noted at autopsy, it is often silent clinically. Diagnosis during life can be confirmed only by endomyocardial biopsy. Electrocardiographic changes are often nonspecific. Endocarditis with superimposed nonbacterial verrucous vegetations (Libman-Sacks) is noted in more than 40% of hearts at autopsy, but is rarely diagnosed during life. Valve dysfunctions, such as aortic stenosis, aortic insufficiency, mitral stenosis, and mitral insufficiency, occasionally manifest during life and rarely may necessitate surgery. Atrial and ventricular arrhythmias, first degree AV block, and acquired CHB occur in association with pericarditis, myocarditis, vasculitis, and myocardial fibrosis, respectively. CCHB developing in newborns of mothers with SLE, particularly those who have an antibody to soluble tissue ribonuclear protein RO(SS-A), is increasingly being appreciated by both pediatric cardiologists and rheumatologists. Recently, severe coronary atherosclerosis resulting in angina pectoris and/or myocardial infarction in young adults has been noted, particularly in those who had developed risk factors such as hypertension and hyperlipidemia while receiving prolonged corticosteroid therapy. Rarely, coronary arteritis may produce similar symptoms. Congestive heart failure of either single or multiple etiologies carries an ominous prognosis. It remains a cause of high morbidity and mortality unless recognized early and treated properly. Extracardiac vascular manifestations of SLE include telangiectasia, vasculitis, livedo reticularis, Raynaud's phenomena, and thrombophlebitis, all of which may occur either alone or in different combinations. Evidence is now slowly accumulating that substantiates that immune complex deposition, complement activation and subsequent inflammatory reaction is responsible for the majority of the cardiovascular manifestations of SLE, for example, pericarditis, myocarditis, endocarditis, coronary arteritis, coronary atherosclerosis, and systemic and pulmonary vasculitis.(ABSTRACT TRUNCATED AT 400 WORDS)

Adrenal Cortex Hormones↗
PubMedDate not supplied

Isolated pulmonary valvular regurgitation: current perspectives.

IPVR is a rare clinical entity that was first diagnosed during life in 1955. In the past 35 years, only 69 patients have been reported. With increasing clinical awareness, as well as use of PDE, the confirmation of its clinical diagnosis has become easier and more accurate without having to take recourse to invasive cardiac studies as in the past. For this reason, it is becoming increasingly apparent that IPVR is not so rare as has been suggested in the past. IPVR is more common in men than in women, in whites than blacks, and in the young than the elderly. The mean age of IPVR patients is 27 years (range, 4 to 85). The majority of the patients are asymptomatic and the diagnosis is usually suspected upon the discovery of a crescendo-decrescendo, low-pitched, early to mid diastolic murmur in the second and third left intercostal space, which increases during inspiration, particularly in the presence of a hyperdynamic right ventricle and in the absence of peripheral circulatory phenomenon of aortic regurgitation. The ECG often shows right axis deviation, incomplete right bundle branch block, and rarely, right ventricular hypertrophy and strain. However, a normal ECG does not preclude its diagnosis. Approximately 30% of the IPVR patients have normal 12-lead ECGs. The diagnosis may be further suggested by the posteroanterior chest roentgenogram when dilated and large central pulmonary arteries are noted to pulsate vigorously (hilar dance) on chest fluoroscopy.(ABSTRACT TRUNCATED AT 250 WORDS)

Animals↗
PubMedDate not supplied

The efficacy of newer antidepressants in the treatment of chronic pain: a review of current literature.

Tricyclic antidepressants have been extensively studied and frequently used in the treatment of various chronic pain syndromes. Newer antidepressants, namely fluoxetine, sertraline, paroxetine, fluvoxamine, citalopram, trazodone, nefazodone, bupropion, mirtazapine, and venlafaxine, have also been considered for this indication, although they have been less extensively studied. This article reviews the available publications, including placebo-controlled trials, other outcome studies, and case reports, pertaining to the use of these medications for chronic pain. Although some of these newer compounds may be effective for specific types of pain, making generalizations regarding their use as analgesics is difficult, given the limitations of existing data. Additional observations based on the data are presented in the hope that they may help to guide further research and clinical use.

Adult↗
PubMedDate not supplied

Symptomatic fibroid uterus in a 15-year-old girl.

A 15 year-old gravida 1, abortus 1 black girl presented with chief complaints of menorrhagia, severe dysmenorrhea, and progressively worsening abdominal pain, which was caused by a very large uterine leiomyoma. The symptoms began 6 months earlier, shortly after a 10-week spontaneous abortion at age 14. A solitary 25-cm uterine leiomyoma was removed uneventfully with an abdominal laparotomy. In the English literature of the past 50 years, this case represents the sixth, and we believe, the largest, documented uterine fibroid among teenagers, which required corrective surgery.

Adolescent↗
PubMedDate not supplied

Transesophageal echocardiography.

TEE is the most recent and significant addition to the already existent array of cardiovascular ultrasound imaging techniques. Never before have cardiologists reaped so many benefits from their exploitation of the close anatomic relationship between the heart and esophagus, and never before has there been such a close co-operation and imparting of expertise between gastroenterologists and cardiologist. TEE consists of two-dimensional cardiac and vascular imaging via the esophagus by a flexible echoscope which contains a phased-array mono- or biplane transducer (5MHz) mounted on its distal end. It completely bypasses the transthoracic acoustic impedance and thereby provides superior resolution. TEE requires training of a cardiologist by a gastroenterologist in safe insertion and handling of the echoscope necessary for imaging. The indications and contraindications of TEE have been quickly defined in view of the past TTE and upper gastrointestinal endoscopic experience (ref. Tables 1 and 2). Our own and others experience indicate that only 8%-10% of the indicated TTE studies require supplementary TEE studies either because of inadequate or nondiagnostic TTE imaging for various technical reasons -- e.g., obesity, hyperinflation of lungs, thoracic age abnormalities such as severe pectus excavatum or kyphoscoliosis-or difficult areas of imaging such as left atrial appendage or interatrial septum in the sinus venosus region, aortic dissection, prosthetic valve dysfunction, valvular vegetation, complex congenital heart disease etc. One area in which TEE has made a significant impact is in the intraoperative and perioperative cardiac monitoring for left ventricular function during CABG, repair of intracardiac shunt, cardiac valve repair or replacement and complete removal of intracardiac air before discontinuation of cardiopulmonary bypass. In these contexts, TEE has also proved more practical, convenient and superior to TTE. TEE has also improved the imaging and problem solving in critical care units, particularly in those patients who have recently undergone cardiothoracic surgery and those who are on mechanical ventilation, traditionally the two clinical situations where TTE provides suboptimal results. TEE can safely be performed at the patient's bedside in these units. Refinement and miniaturizing of the transesophageal echoscope (5MHz, small, 6 to 8-mm circumference) has made it possible to perform TEE in infants and young children and improve the diagnosis and surgical management of both cyanotic and acyanotic congenital heart disease.(ABSTRACT TRUNCATED AT 400 WORDS)

Contraindications↗