Melatonin and Human Cardiovascular Disease

The possible therapeutic role of melatonin in the pathophysiology of coronary artery disorder (CAD) is increasingly being recognized. In humans, exogenous melatonin has been shown to decrease nocturnal hypertension, improve systolic and diastolic blood pressure, reduce the pulsatility index in the internal carotid artery, decrease platelet aggregation, and reduce serum catecholamine levels. Low circulating levels of melatonin are reported in individuals with CAD, arterial hypertension, and congestive heart failure. This review assesses current literature on the cardiovascular effects of melatonin in humans. It can be concluded that melatonin deserves to be considered in clinical trials evaluating novel therapeutic interventions for cardiovascular disorders.Fil: Pandi Perumal, Seithikurippu R.. King Saud University; Arabia SauditaFil: BaHammam, Ahmed S.. King Saud University; Arabia SauditaFil: Ojike, Nwakile I.. King Saud University; Arabia SauditaFil: Akinseye, Oluwaseun A.. University of New York; Estados UnidosFil: Kendzerska, Tetyana. Sunnybrook Health Sciences Center; CanadáFil: Buttoo, Kenneth. Sleep Disorders Center; CanadáFil: Dhandapany, Perundurai S.. Oregon Health And Science University; Estados UnidosFil: Brown, Gregory M.. University of Toronto; CanadáFil: Cardinali, Daniel Pedro. Pontificia Universidad Católica Argentina ; Argentin

Abstract TP188: Black-White Differences in Susceptibility to Stroke Secondary to Abnormal Sleep Duration

Introduction: A strong predictor of stroke is abnormal sleep duration with both short and long sleep associated with increased stroke risk. Hypothesis: We tested the hypothesis that the stroke-sleep association differs based on race and age. Methods: Using a hypertensive subset from the NHIS dataset (2004-2013), we assessed the association between stroke prevalence and self-reported sleep duration, stratifying for race and age. Diagnosis of hypertension and stroke was based on self-report. Sleep duration was also self-reported and categorized as short (6 or fewer hours), normal/referent (7-8 h) or long (9 or more hours per day). Race was self-reported and categorized as White or Black. Age at screening was grouped into categories of 18-34, 45-64, and those 65 years and older. Results: Of the 403, 621 patients in the NHIS dataset (2004-2013), 50.5 % (n=203794) had a diagnosis of hypertension. The average age of the cohort was 58.1 years (95% CI=57.8-58.4), 50.2% female; 15.4 % of the cohort was Black. The prevalence of abnormally short and long sleep duration was 31.3 % and 11%, respectively. The age-standardized prevalence of stroke amongst the hypertensive population for normal, short and long sleep duration was 3.5%, 4.9%, and 7.6%, respectively. Both short and long sleep duration were significant predictors of stroke (1.17; 95% confidence interval (CI) 1.06 - 1.31 and 2.51; 95% CI 2.44-2.58, respectively). An interaction term added to the model suggested that race and age modified the relationship between sleep duration and stroke (p=0.01). Long sleep was a significant predictor of stroke in all age groups, regardless of race. Short sleep was not a significant predictor of stroke in Whites. Short sleep predicted stroke in the youngest age group of Blacks (1.95; 95% CI 1.01 - 3.74). Conversely, short sleep duration was associated with a lower risk of stroke in the oldest age group of Blacks (0.78; 95% CI 0.58- 1.05). Conclusions: Risk of stroke is predicted by abnormal sleep duration. The novel finding is that in this hypertensive cohort, the association between stroke and abnormal sleep duration differs by race and age. </jats:p

Anterolateral and Medial Locking Plate Stiffness in Distal Tibial Fracture Model

Background: The purpose of this study was to compare the axial and torsional stiffness between anterolateral and medial distal tibial locking plates in a pilon fracture model. Materials and Methods: The biomechanical stiffness of anterolateral or medial plated pilon fracture models was evaluated. Six Sawbones Composite Tibiae with a simulated pilon fracture representing varus or valgus comminution (OTA 43-A2.2) were plated with a Synthes 3.5-mm contoured LCP anterolateral or medial locking distal tibia plate. Load as a function of axial displacement and torque as a function of angular displacement were recorded. Each tibia was tested with a fracture wedge in place and removed with a medial and then anterolateral plate. Results: Loading the tibial plateau medial to the central axis, no significant difference in mean stiffness between the anteroateral and medial plates was demonstrated with the fracture wedge in place. A significant difference was demonstrated with the wedge removed. Loading the plateau posterior to the central axis, no significant difference in mean stiffness between plates was demonstrated with the wedge in place or removed. With the wedge in place, there was a significant difference in mean torsional stiffness for clockwise rotation, but not counterclockwise rotation. With the wedge removed, no significant difference appeared in mean stiffness for clockwise and counterclockwise rotation. Conclusion: Distal tibia extra-articular fractures stabilized with anterolateral or medial locking plate constructs demonstrated no statistically significant difference in biomechanical stiffness in compression and torsion testing. Clinical Relevance: We believe this study indicates the primary concern when treating a pilon fracture may be soft-tissue considerations. Further clinical studies are required before definitive changes can be recommended regarding pilon fracture fixation. </jats:sec

Hepatitis B Vaccination Rate in Patients with Diabetes: Assessment of Racial and Socioeconomic Disparity

Introduction: Less hygienic use of blood glucose monitoring equipment such as blood glucose meters, lancets, finger stick devices or other diabetes-care equipment such as syringes or insulin pens by self-administration often exposes the diabetic patient to Hepatitis B infection. This study evaluateshepatitis B vaccination among individuals with diabetes. Methods: The study used data from the 2000-2013 National Health Interview Survey (NHIS). Vaccination rates among adult individuals with diabetes of various ethnic backgrounds was accessed and compared using chis-square tests. Multivariable logistic regression model was used to compare factors affecting hepatitis B vaccination among individuals with diabetes.Results: The crude rate of diabetes in this population was 5.4%. The rate of vaccination among individuals with diabetes differed across racial groups (Asians 31.8% vs. blacks 30.7%; and whites 26.5%; p&lt;0.01). After multivariate regression, the leading factors affecting hepatitis B vaccination included Age (40-60 years) (OR=0.51, 95% CI=0.47-0.57, p&lt;0.01), lack of college education (OR=0.71,95% CI=0.64-0.79, p&lt;0.01), foreign birth (OR=0.83, 95% CI=0.72-0.95, p&lt;0.01) , and Hispanic ethnicity (OR=0.88, 95% CI=0.78-1.00, P&lt;0.05).Conclusion: Social and economic factors- education, insurance status, age, poverty level, and place of birth affect rates of vaccination among individuals with diabetes.Pubmed link: https://www.ncbi.nlm.nih.gov/pubmed/28638894 </p