Treatment of mild hypertension in low–risk patients

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There is no convincing data to show the benefit from antihypertensive therapy in patients with mild hypertension and no preexisting cardiovascular disease. A meta–analysis combined four placebo–controlled trials totaling 8912 patients with mild hypertension and no preexisting cardiovascular disease (1). During 4 to 5 years of follow–up, antihypertensive therapy resulted in lower rates of mortality and stroke but higher rates of myocardial infarction. Low–risk patients with mild hypertension and no preexisting cardiovascular disease who fail to reduce their blood pressure with lifestyle modification should receive antihypertensive therapy.

Treatment of hypertension in frail older adults

Older adults who are frail may not benefit from antihypertensive therapy. In an observational study of 2340 adults older than 65 years, the association between blood pressure and mortality was examined according to whether or not individuals were frail (2). Frail is defined as an inability to walk 6 meters in less than 8 seconds. Among frail adults, there was no association between blood pressure and mortality. In addition, a higher blood pressure was associated with a lower risk of death among the most frail (i.e., those who could not walk the distance at all).

References

  1. Diao D, Wright JM, Cundiff DK, Gueyffier F. Pharmacotherapy for mild hypertension. Cochrane Database Syst Rev 2012;8:CD006742.
  2. Odden MC, Peralta CA, Haan MN, Covinsky KE. Rethinking the association of high blood pressure with mortality in elderly adults: the impact of frailty. Arch Intern Med 2012;172:1162.

Wound Hygiene

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It is a common occurrence that one faces simple wounds at home which can be as a result of fall, animal bite etc. Following are the ways to manage them:

  1. Irrigation is the most important thing for reducing bacterial impact.
  2. Irrigation should be urgently done in every wound. It can be done by warm normal saline or simple running tap water.
  3. One can add dilute iodine or any asthetic solution if required.
  4. Irrigation can be low pressure or high pressure. At home low pressure injection is sufficient which can be done using any of the infant milk bottle system.
  5. If there is a burn, irrigation should be done continuously till the burning disappears.
  6. In case there is a foreign body with irritation, continuous irrigation should be done till burning disappears.
  7. Do not forget to wash your hands with soap and water before cleaning the wound and wear medical gloves, if available.
  8. It is good idea to let the injured person clear his or her own wounds, if possible.
  9. Rinsing of the wounds should be done for at least 5–10 minutes.
  10. Cool water may feel better than warm water on the wound.
  11. If there is a mild bleeding, clean the wound first and then stop the bleeding.
  12. Moderate scrubbing can be done if the wound is very dirty.
  13. If there are foreign bodies or objects, remove them using a clear tweezers, Do not push the tweezers, deeply into the wound.
  14. Apply the dressing and bandage to the wound as the need may be.

Fetus is a patient

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Recognizing the fetus as a patient, the American Heart Association (AHA) has released a scientific statement that addresses the diagnosis and treatment of fetal cardiac disease.

For diagnosis, the statement covers the timing of referral for evaluation, indications for referrals, and the level of experience needed to perform and interpret various diagnostic studies. That includes a detailed discussion of the fetal echocardiogram –– the main tool for evaluating fetal cardiac disease –– and reviews of other tests, including advanced ultrasound, fetal magnetic resonance imaging, and fetal magnetocardiography and electrocardiography.

Although the most common trigger for a referral is an obstetric ultrasound that raises the suspicion of a fetal structural heart abnormality, numerous other factors increase the chances of congenital heart disease in the fetus, such as:

  • Maternal pregestational diabetes and diabetes diagnosed in the first trimester
  • Maternal uncontrolled phenylketonuria
  • Exposure to nonsteroidal anti–inflammatory drugs in the third trimester
  • The presence of congenital heart disease in the mother or a close relative
  • The use of assisted reproductive technology to conceive

Once the diagnosis is made, it is important to manage parental stress and anxiety and discuss treatment options, according to the statement. Although there is no proven best way to do that, the authors provide guidance on counseling parents.

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