Today’s Audio. Sodium intake might be killing the future. It will get your attention.

500188374_XS

Now our blog supports audio. Today you can listen to Dr. Bonita Falkner, chair of the International Pediatric Hypertension Association giving insigtful comments about this topic.

Thanks to Sheila Kay McIntyre on LinkedIn: “Today’s ShoutOutThursday Winners are 1 Guillermo Alberto Perez Fernandez…

2017-08-31 09_12_55-Start

Today’s ShoutOutThursday Winners are 1 Guillermo Alberto Perez Fernandez  Cardiologist, Ph.D (read more about his fascinating Cardiovascular Health Article > https://lnkd.in/en4Ws2f  & under my latest comment! & 2 Melton McClanahan thank you for being such a valuable member of S.O.T, supporting so many with your positive comments, likes, re-posts & helpful articles! I want to Thank you 2 Great Men for all that you do for this Community!

Source: Sheila Kay McIntyre on LinkedIn: “Today’s ShoutOutThursday Winners are 1 Guillermo…

1.0 K views in less than one month. We strive for more.

Slide1

“It’s always further than it looks. It’s always taller than it looks. And it’s always harder than it looks.” – The 3 rules of mountaineering.

I must add, however, it’s possible.

Keep going through this blog further below.

Thanks,

Dr. Guillermo Alberto Perez Fernandez

 

(1-minute read) “Emotional” hypertension. Do not get mixed up. There is more on the table.

17762357-hombre-de-negocios-joven-confundido-Foto-de-archivo

The diagnosis of arterial hypertension has made it increasingly complex over time. It is no longer just to tell a patient “you suffer from arterial hypertension”. Nowadays, there are more abnormal blood pressure categories added to the list as prehypertension, “white-coat” hypertension and “masked” hypertension. No doubts, the complexity of the human been plays its role in all this (1)

Many patients have been said over years that they had “emotional hypertension” since her or his blood pressure (BP) at the medical office was elevated even after several BP readings at prudent intervals during the consultation, whereas at home blood pressure remained normal.

The abovementioned situation was overlooked by the medical community for a long time and there was a long-standing thinking that it was simply the result of patient’s stress arising from the patient-doctor encounter at the clinic. However, as time went by, the so-called white-coat effect was study in-depth and as a result, the “white-coat” hypertension term emerged (2)

Is it dangerous?  Yes indeed, several investigations have shown that: Continue reading “(1-minute read) “Emotional” hypertension. Do not get mixed up. There is more on the table.”

Poor buccal hygiene might lead to an acute myocardial infarction. Time to make the difference.

red_man_leader_332136

Dedicated to Dental Department at the Cuban Hospital in Qatar.

After several years studying the subject of cardiovascular disease early in life and with some papers published recently about it (1-5) I can say that nowadays, as health care providers, we are facing several cardiovascular disease contributing risk factors (hypertension, obesity, smoking, unhealthy diet, etc.) which prompts a large burden on our shoulders as they keep leading to a long-lasting and quite steady worldwide prevalence of heart conditions, stroke, kidney failure, premature death and disability for the last 20 years. (6)

Even, children and adolescents are not spared from this. For instance, according to the latest European (7) and North American Guidelines about the subject (8), the prevalence of high blood pressure in children and adolescents ranges between 3 to 11 % and rises up to 40 % when obesity is in place as well.

The above mentioned is a known fact that unfortunately is ongoing with some ups and downs but continue to be a pending endeavor yet to be solved by the medical community. Thus, I do not want to dwell on it on this post.

At the moment, I am more interested on reflecting how these spotlighted main risk factors might be blindfolding us from seeing “little facts” that are having also an impact on the complex setting related with the development of cardiovascular disease and sadly are often overlooked.

In this light, there is one fact which is not as publicized as the main risk factors mentioned above which is critical my opinion. I am referring to the buccal hygiene and its links to cardiovascular disease.

To get started, it is worth mentioning that the surfaces of the human body are heavily colonized by a varied microbial ecosystem called the microbiota, in other words, this is a mixed community of microorganisms composed of bacteria, viruses, archaea, and eukaryotic microbes that coinhabit in our body . The gathering of those microbes and their genes is named the human microbiome  and each person has a unique microbiome which varies along with our genetic background, age and life style (9)

As per the aim of this paper, I will point out at the oral microbiome, which is considered one of the most highly dynamic ecosystems in the human body.

According to the latest investigations, the estimated number of bacteria in the mouth is up to 100 billion and comprised nearly 700 identified bacterial species being the most prevalent Firmicutes and Proteobacteria, along with Bacteroidetes, Actinobacteria, and Fusobacteria (10)

Though, the oral microbiome is dynamic in terms of functioning, as ecosystem must be stable in its composition and structure. Any disruption in it leads to a state called dysbiosis.

Recently, multiple animal and human studies have examined the relationship between the oral microbiome disruption (dysbiosis) and blood pressure and have reported important insights explaining such links.

The most important proposed links to hypertension would be the following:

  • Increasing sympathetic nervous system activity.
  • Inflammation and endothelial dysfunction with vascular remodeling (11)

The above links, in turn are known triggering factors for high blood pressure through complex mechanisms beyond the scope of this article.

Now, I will lay out a question: How many time have you been asked by a doctor (no a dentist) in a clinic when feeling some cardiac-like symptoms about your buccal hygiene habits?

The response to this question will come later… Continue reading “Poor buccal hygiene might lead to an acute myocardial infarction. Time to make the difference.”

Just published. Dates, the World’s #1 food for Hypertension, Heart Attack and Stroke. Watch the video and think….

As we are settled in the Middle East now. I feel it is important to know about how good are dates for cardiovascular disease.

Never fall into the “Bandwagon” fallacy. The autochthonous is and always will be the most reliable.

7ixapa9hkqoxwj4pqfx9sagh

The concept of “predisease” arose in 1914 when Dr. William Rodman came up with the idea of intervening early on those patients having signs of a precancerous state. However, Rodman acknowledged that his thesis would be controversial when noted:  “I am aware that the term precancerous can be objected by at least two reasons: first, not always there will be a precancerous state; second, if this state existed, it does not mean that cancer will develop”.

Nevertheless, with the goal in preventing the appearance of morbid events, predisease as category makes sense if the following three conditions are met: 1) individuals who fall into this category should be more likely to develop disease; 2) There must be a an intervention that when directed towards this individuals at risk be effective in reducing the risk of evolution to disease, and 3) the benefits of intervening on the pre-disease must exceed the risks. Currently, the state of predisease applies for various conditions: pre-diabetes, pre-hypertension, subclinical thyroid dysfunction or even individuals tested positive for human immunodeficiency virus. All these clinical situations involve an increased risk of developing the disease. Although the lapse of time for this to happen might be uncertain in most cases, lots of studies have shown that there can be several damages at molecular and cellular levels that might be impairing tissues and at the same time fueling the occurrence of the disease.

Then, I wonder, are the current and most used cut-off points in medical practice really reliable to advise a patient on whether he or she has an unhealthy condition?

In the author’s opinion, a fundamental limitation of the cut-off points is that their use on biological variables might be biased since there is not any reliable foundation to do so. However, we keep labeling individuals as healthy or sick based on them and it has been this way since a long time and probably will be until we consider the problem more comprehensibly and stop staying on shallow waters instead of going into the deep end.

I acknowledge that currently the decision-making process would be very weak without cut-off point to make decisions but we must be very cautious when giving an opinion based on them.

In addition, it is valid to say that most of the cut-off points we use in our day to day practice with patient are not autochthonous but they have been taken from guidelines, pathways, etc that have nothing to do with the population of patient we deal with.

Can you imagine what would it be like to use a cut-off points to determine if one individual living in the middle east had any health condition using cut-off points offered by health institutions based in Canada, USA or Asia? It sounds like nonsense, however we do it every day. Why? because we have never thought on it. Some time we simply use what we have been given or taught as the best evidence, but this evidence is far away from us in terms of ethnicity, genetics or socioeconomic status and these factors indeed could have been a significant statistical impact in the countries they were used when where pooled to yield certain cut-off figures, but it does not mean that can be widely used across regions and continents.

Accordingly, I think that each country’s medical society must dig deep and pull out its own cut-off points, otherwise we will continue to miss key elements when it comes to diagnosing in medicine.

In the end my dear colleagues, the autochthonous is and always will be the most consistent and reliable. To be enticed by names of medical associations with a well gained fame in terms of taking all they offered as the absolute truth can be deceptive. So, never fall into the “Band Wagon“ fallacy (if most people like them, then they must be okay)

On one next post, I will expose some examples of some steps taken on this.

Thanks.

Note. This editorial has been written by Dr. Guillermo Alberto Perez Fernandez, author of this blog, and reflects his personal opinion about the topic.

Por favor “rate” esta entrada/Please rate this post