Initial antihypertensive agent effects on acute blood pressure after intracerebral haemorrhage

Introduction

Current guidelines recommend blood pressure (BP) lowering in patients after acute intracerebral haemorrhage (ICH) without guidance on initial choice of antihypertensive class. This study sought to determine if initial antihypertensive class differentially effects acute BP lowering in a large multiethnic ICH cohort.

Methods

Subjects enrolled in the Ethnic/Racial Variations in ICH study between August 2010 and August 2017 with elevated admission BP and who received labetalol, nicardipine or hydralazine monotherapy as initial antihypertensive were analysed. Primary outcomes were systolic and diastolic BP changes from baseline to first BP measurement after initial antihypertensive treatment. Secondary outcomes included haematoma expansion (HE), hospital length of stay (LOS) and modified Rankin Score (mRS) up to 12 months after ICH. Exploratory outcomes assessed effects of race/ethnicity. Linear and logistic regression analyses, adjusted for relevant covariates, were performed to determine associations of antihypertensive class with outcomes.

Results

In total, 1156 cases were used in analyses. Antihypertensive class was associated with diastolic BP change (p=0.003), but not systolic BP change (p=0.419). Initial dosing with nicardipine lowered acute diastolic BP than labetalol (least square mean difference (labetalol-nicardipine)=5.47 (2.37, 8.57), p<0.001). Initial antihypertensive class was also found to be associated with LOS (p=0.028), but not with HE (p=0.406), mortality (p=0.118), discharge disposition (p=0.083) or mRS score at discharge, 3, 6 and 12 months follow-up (p=0.262, 0.276, 0.152 and 0.36, respectively). Race/ethnicity variably affected multivariable models.

Conclusion

In this large acute ICH cohort, initial antihypertensive class was associated with acute diastolic, but not systolic, BP-lowering suggesting differential effects of antihypertensive agents.

Trial registration number

NCT01202864.

Plantago ovata in broiler chicken nutrition: Performance, carcass criteria, intestinal morphology, immunity, and intestinal bacterial population

In this experiment, the effect of dietary Plantago ovata (PO) on performance, carcass criteria, intestinal morphology, immunity, and intestinal bacterial population of broiler chickens was evaluated. A total of 250 one-day-old male broiler chicks (Ross 308) were randomly assigned to five treatments containing 0, 5, 10, 15, or 20 g/kg of PO with five replicate pens and 10 birds in each replicate. Dietary PO increased body weight gain and decreased feed conversion ratio in the finisher period, improving the performance index (p < .05). Dietary treatments had no effects on carcass criteria, but breast meat percentage showed an increasing trend with incremental levels of PO in the diet (p = .069). The length of small intestine, especially jejunum section, as well as the villus height, villus width, villus area, and goblet cell numbers were significantly increased with supplemental PO (p < .05). Humoral and cellular immunity parameters, and oxidation stability of meat were improved due to use of dietary PO (p < .05). Dietary PO decreased the CFU of Escherichia coli, whereas the Lactobacilli population was increased (p = .001). Broken-line regression revealed that dietary PO at the rate of 10 g/kg may results in the best performance in broiler chickens. This study showed that PO at the level of 10 g/kg could be considered as a beneficial feed additive in broiler diet.

Past, present, and future of anti-platelet therapy

INTRODUCTION

Anti-platelet drugs are useful in preventing unwanted clots, but the complexities of platelet activation and clot formation are challenging.

BACKGROUND

Platelets can be activated by a variety of agents, including natural biomolecules, foreign materials, and drugs. Calcium mediates a number of the intracellular processs Once activated, platelets release factors that act on other circulating cells and vascular endothelial cells to promote formation of a clot. The original anti-platelet drug, aspirin, inhibits cyclooxegenase, interfering with a crucial step in the biochemical cascade. Aspirin is cost-effective but limited in its application. Newer drugs, ticlopidine and clopidogrel, act on the activation pathway at different points, so they can supplement aspirin. NEW DIRECTIONS: Abciximab represents a new generation of antiplatelet drug, being an antibody that binds to platelet surface receptors, thus inhibiting growth of thrombus. Other potential sites for antibody intervention are extracellular matrix and endothelial surface components. As new drugs are developed it becomes more imperative to find assays of platelet function that are sensitive and cost-effective.

CONCLUSION

Although much progress has been made in anagement of clotting significant opportunities and challenges remain, both in treatment and in measurement of treatment effectiveness.

A 70-year-old woman with poor grade subarachnoid hemorrhage complicated by carotid stenosis, cerebral vasospasm, and cerebral rebleed

INTRODUCTION

Subarachnoid hemorrhage is one of the most common entities encountered in neurocritical care units. Knowledge of disease sequelae and their management is paramount for all neurointensivists.

MATERIALS AND METHODS

This study relates the case of a 70-year-old woman with poor grade subarachnoid hemorrhage who underwent endovascular detachable coil embolization of a right internal carotid artery aneurysm. Her hospital course was subsequently complicated by symptomatic carotid stenosis and cerebral vasospasm requiring intervention.

DISCUSSION

The discussants present their views regarding five main questions pertaining to management of the patient regarding the choice of endovascular versus surgical aneurysm occlusion, stent-supported angioplasty in a patient with a recent subarachnoid hemorrhage, and treatment options for vasospasm.