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Fulltext Prevalence of falls and its associated factors among elderly diabetes in a tertiary center, Malaysia

Azidah AK, Hasniza H, Zunaina E

Curr Gerontol Geriatr Res, 2012;2012:539073.
PMID: 22693496 DOI: 10.1155/2012/539073

The purpose of this study is to determine the prevalence of falls and its associated factors among elderly diabetes type 2 patients attending a tertiary center in Malaysia. We conducted a cross-sectional study among 288 elderly diabetes type 2. The data collected includes data on sociodemographic, diabetes history, comorbid diseases, drug use, and activity of daily living (Barthel's index). The patient also was examined physically, and balance and gait assessment was carried out. Prevalence of falls among elderly diabetes was 18.8%. Female gender (OR: 2.54, P < 0.05), age group more than 75 (OR: 2.97, P < 0.05), retinopathy (OR: 2.19, P < 0.05), and orthostatic hypotension (OR: 2.87, P < 0.05) were associated with higher risk for falls. High balance and gait score was associated with reduced risk of fall in elderly diabetes (OR: 0.89, P < 0.05). In conclusion, the factors that are associated with higher risk for falls among elderly diabetes were female sex, age group more than 75, presence of retinopathy, and orthostatic hypotension. Those who had higher balance and gait score were found to be less likely to fall compared with those with lower score.
Study site: Hospital Universiti Sains Malaysia, Kelantan, Malaysia
Questionnaires, Scales, Device: Tinetti Balance and Gait Assessment; 5.07 Semmes- Weinstein monofilament; Barthel’s index
Study site: Diabetic clinic, Hospital Universiti Sains Malaysia (HUSM), Kelantan, Malaysia

Matched MeSH terms: Hypotension, Orthostatic
The effect of prophylactic metaraminol on systemic hypotension caused by induction of anaesthesia with propofol in patients over 55 years old

Chiu CL, Tew GP, Wang CY

Anaesthesia, 2001 Sep;56(9):893-7.
PMID: 11531679

We conducted a double-blind, randomised, placebo-controlled study evaluating the efficacy of prophylactic metaraminol for preventing propofol-induced hypotension. Thirty patients aged 55-75 years undergoing general anaesthesia were randomly allocated to receive either metaraminol 0.5 mg or saline before administration of fentanyl 1 microg.kg(-1) and propofol 2 mg.kg(-1). Induction of anaesthesia was associated with a decrease in mean and systolic arterial pressure in both groups (p = 0.0001). However, there was no significant difference between the two groups. These results show that prophylactic use of metaraminol 0.5 mg does not prevent the decrease in blood pressure following fentanyl and propofol induction in older patients.

Matched MeSH terms: Hypotension/chemically induced; Hypotension/prevention & control*
Fulltext Autonomic Nervous System Mediates the Hypotensive Effects of Aqueous and Residual Methanolic Extracts of Syzygium polyanthum (Wight) Walp. var. polyanthum Leaves in Anaesthetized Rats

Ismail A, Mohamed M, Sulaiman SA, Wan Ahmad WA

Evid Based Complement Alternat Med, 2013;2013:716532.
PMID: 24454508 DOI: 10.1155/2013/716532

Syzygium polyanthum (Wight) Walp. var. polyanthum leaves are consumed as a traditional Malay treatment of hypertension. This study investigates hypotensive potential of aqueous (AESP) and residual methanolic (met-AESP) extracts of S. polyanthum leaves and possible involvement of autonomic receptors. AESP and met-AESP (20 to 100 mg/kg) were intravenously administered into anaesthetized Wistar-Kyoto (WKY) and spontaneously hypertensive (SHR) rats. Blood pressure and heart were monitored for 20 min. AESP and met-AESP induced significant dose-dependent hypotension, but only 100 mg/kg AESP caused mild bradycardia (n = 5). AESP-induced hypotension was more potent than that of met-AESP in WKY. AESP has a faster onset time than that of met-AESP in both WKY and SHR. However, met-AESP-induced hypotension was more sustained than that of AESP in SHR. Blockages of autonomic ganglion and α -adrenergic receptors using hexamethonium and phentolamine (n = 5 for each group) partially attenuated AESP-induced hypotension, suggesting involvement of α -adrenergic receptors. Blockages of autonomic ganglion, β -adrenergic, cholinergic receptors, and nitric oxide production using hexamethonium, propranolol, atropine, and N- ω -nitro-l arginine methyl ester (L-NAME) (n = 5 for each group) partially attenuated met-AESP-induced hypotension, suggesting involvement of β -adrenergic and cholinergic receptors via nitric oxide production.

Matched MeSH terms: Hypotension, Controlled
Fulltext The effect of prophylactic phenylephrine on systemic hypotension during induction of anaesthesia with propofol in patients over 55 years old

Kwok FY, Venugobal S

Med J Malaysia, 2016 Aug;71(4):166-170.
PMID: 27770114 MyJurnal

Induction of anaesthesia with propofol is often associated with a significant decrease in arterial pressure, especially in the older population. The aim of this study is to determine the efficacy of phenylephrine in two different doses i.e. 100mcg and 200mcg, given during induction to counteract the anticipated hypotensive effect of propofol in older patients aged over 55 years.

Matched MeSH terms: Hypotension*
Influence of a kinin antagonist on acute hypotensive responses induced by bradykinin and captopril in spontaneously hypertensive rats

Sharma JN, Stewart JM, Mohsin SS, Katori M, Vavrek R

Agents Actions Suppl., 1992;38 ( Pt 3):258-69.
PMID: 1334354

We have evaluated the effects of a B2 receptor antagonist (B5630) of kinins on BK and captopril-induced acute hypotensive responses in anaesthetized SHR. Intravenous treatment of BK (1.0 microgram) and captopril (0.3 mg/kg) caused significant (p < 0.05) fall in the SBP and DBP. Whereas BK caused greater fall in the SBP (p < 0.05), DBP (p < 0.01) and duration of hypotension (p < 0.05) when administered after captopril (Fig 1 and 2). All the hypotensive effects of BK and captopril were significantly antagonised (p < 0.05) in the presence of B5630 (2.0 mg/kg). Further, the duration of hypotensive responses of BK and captopril were blocked (p < 0.05) by B5630. The agonists and BK-antagonist did not cause significant (p > 0.05) alterations in HR during the entire investigation. These findings provide evidence to support the suggestion that B2 receptor might be involved in the regulation of the hypotensive actions of BK and captopril. Kinins should also have valuable functions in the antihypertensive property of captopril-like drugs.

Matched MeSH terms: Hypotension/chemically induced
Isolated hypotension after the induction of general anesthesia refractory to fluids and vasopressors: An indicator of anaphylaxis

Mok CS, Vanessa L

Med J Malaysia, 2021 03;76(2):267-269.
PMID: 33742644

Differentiating between anaphylaxis and hypotension during general anaesthesia is difficult, especially when patients present with only hypotension and without any of the other classical features of anaphylaxis. We report the successful management of an anaphylactic reaction to rocuronium that presented as isolated hypotension in a 45-year-old Indonesian man presented with lacerations on the scalp and right pinna caused by an assault to the head after the induction of general anaesthesia, refractory to fluids and high doses of vasopressors. This case highlights that a possible indicator of anaphylaxis can be the presence of isolated hypotension during.

Matched MeSH terms: Hypotension
Fulltext Intracranial Subdural Hematoma after Lumbar Spine Surgery: A Case Report

Zakaria AF, Tsuji M

Malays Orthop J, 2019 Nov;13(3):85-87.
PMID: 31890118 DOI: 10.5704/MOJ.1911.016

Intracranial subdural hematoma following lumbar surgery is a devastating but rare complication. It has been implicated due to intracranial hypotension secondary to persistent cerebrospinal fluid leakage. The resultant drop in intracranial pressure presumably causes traction and tearing of venous structures. Patients typically present with postural headaches. However, other symptoms of subdural hematoma, intracranial hypotension and cerebrospinal fluid leak must also be cautioned.

Matched MeSH terms: Hypotension; Intracranial Hypotension
Fulltext Purpura Fulminans: A rare presentation of Streptococcus Pneumoniae infection

Teo HG, Wong JY, Ting TLL

BMJ Case Rep, 2017 Oct 20;2017.
PMID: 29054893 DOI: 10.1136/bcr-2017-221150

A previously healthy man presented with fever for 2 days and rapidly progressive purpuric rash for 1 day. He progressed into hypotension, disseminated intravascular coagulation and refractory shock despite resuscitation and early antibiotic commencement. Blood culture grew Streptococcus pneumoniae This case report highlights the fact that purpura fulminans can be a rare presentation of S. pneumoniae infection as well.

Matched MeSH terms: Hypotension/etiology; Hypotension/microbiology*
Fulltext Maternal death and isolated left ventricular non-compaction cardiomyopathy

Razuin, R., Shahidan, M.N., Thanikasalam K.

International Medical Journal Malaysia, 2017;16(2):125-127.
MyJurnal

Left ventricular non-compaction cardiomyopathy (LVNC) is a rare congenital cardiomyopathy, which is
characterized by hypertrabeculations and deep recesses of the left ventricle. A patient could be
asymptomatic or presented with common manifestations, including reduced systolic function, arrhythmia,
thromboembolic events and heart failure. The rarity of the condition as well as lack of proper assessment
has probably led to this condition to be largely underdiagnosed or unrecognized. A 23-year-old lady had
collapsed at home thirty one days after delivering her first child. She had a history of goitre diagnosed a
year ago and noted to be fairly well throughout the pregnancy. Post mortem findings showed increased
trabeculations of the left ventricle. Further history was obtained after the procedure, revealing symptoms
such as syncopal attacks and bilateral lower limb weakness dated back as far as five years prior to her
sudden demise. These features were in keeping with hypotension hypoperfusion effects resulted from
reduced systolic function and decreased ejection fraction, as a result of left ventricular dysfunction. While
LVNC remains a rare type of disease, we would like to highlight the importance of a good anamnesis. It may
help to uncover some uncommon pathology such as this heart disease, thus warranting an appropriate
cardiac imaging to be engaged to clinch the primary diagnosis.

Matched MeSH terms: Hypotension
Blood pressure lowering therapy in older people: Does it really cause postural hypotension or falls?

Zia A, Kamaruzzaman SB, Tan MP

Postgrad Med, 2015 Mar;127(2):186-93.
PMID: 25622817 DOI: 10.1080/00325481.2015.996505

Hypertension is a highly prevalent condition among older people, but many physicians avoid aggressive treatment in this age group due to concerns about adverse effects such as orthostatic hypotension and falls. Orthostatic hypotension, which also increases in prevalence with increasing age, has been considered to be associated with antihypertensive therapy. Both orthostatic hypotension and antihypertensive medications are considered independent yet closely related predictors for falls among older people. The prescription of antihypertensive therapy among the elderly remains a long-standing controversy in geriatric medicine due to ongoing concerns about potential complications such as falls, despite conclusive evidence supporting the treatment of hypertension even among the very elderly. However, recent evidence suggests a dose-dependent relationship between blood pressure lowering therapy and falls among older individuals with preexisting risk factors for falls. In response to the spate of revisions in hypertension treatment targets for older patients in international guidelines and the recent evidence on antihypertensive therapy and falls, this review article examines the complex relationship between hypertension, antihypertensives, orthostatic hypotension, and falls among older patients.

Matched MeSH terms: Hypotension, Orthostatic/chemically induced*
Fulltext Evaluation of Two New Indices of Blood Pressure Variability Using Postural Change in Older Fallers

Goh CH, Ng SC, Kamaruzzaman SB, Chin AV, Poi PJ, Chee KH, et al.

Medicine (Baltimore), 2016 May;95(19):e3614.
PMID: 27175670 DOI: 10.1097/MD.0000000000003614

To evaluate the utility of blood pressure variability (BPV) calculated using previously published and newly introduced indices using the variables falls and age as comparators.While postural hypotension has long been considered a risk factor for falls, there is currently no documented evidence on the relationship between BPV and falls.A case-controlled study involving 25 fallers and 25 nonfallers was conducted. Systolic (SBPV) and diastolic blood pressure variability (DBPV) were assessed using 5 indices: standard deviation (SD), standard deviation of most stable continuous 120 beats (staSD), average real variability (ARV), root mean square of real variability (RMSRV), and standard deviation of real variability (SDRV). Continuous beat-to-beat blood pressure was recorded during 10 minutes' supine rest and 3 minutes' standing.Standing SBPV was significantly higher than supine SBPV using 4 indices in both groups. The standing-to-supine-BPV ratio (SSR) was then computed for each subject (staSD, ARV, RMSRV, and SDRV). Standing-to-supine ratio for SBPV was significantly higher among fallers compared to nonfallers using RMSRV and SDRV (P = 0.034 and P = 0.025). Using linear discriminant analysis (LDA), 3 indices (ARV, RMSRV, and SDRV) of SSR SBPV provided accuracies of 61.6%, 61.2%, and 60.0% for the prediction of falls which is comparable with timed-up and go (TUG), 64.4%.This study suggests that SSR SBPV using RMSRV and SDRV is a potential predictor for falls among older patients, and deserves further evaluation in larger prospective studies.

Matched MeSH terms: Hypotension, Orthostatic/complications; Hypotension, Orthostatic/physiopathology*
Postural blood pressure electrocardiographic changes are associated with falls in older people

Saedon NI, Zainal-Abidin I, Chee KH, Khor HM, Tan KM, Kamaruzzaman SK, et al.

Clin Auton Res, 2016 Feb;26(1):41-8.
PMID: 26695401 DOI: 10.1007/s10286-015-0327-5

To determine the magnitude of postural blood pressure change, differences in ECG between fallers and non-fallers were measured. Postural blood pressure change is associated with symptoms of dizziness, presyncope, and syncope.

Matched MeSH terms: Hypotension, Orthostatic/complications; Hypotension, Orthostatic/physiopathology*
Fulltext Shock in children

Sinniah, Davendralingam

International e-Journal of Science, Medicine & Education, 2012;6(10):0-0.
MyJurnal

Shock, a major cause of morbidity and mortality in children, is the the most anxiety-provoking emergency that needs to be addressed urgently and effectively by the attending paediatrician. It is a state where the metabolic demands of the tissue are not met due to circulatory dysfunction. Unlike adults, hypotension is a very late feature of shock in children. As the child’s condition worsens, the clinical presentation of the different causes of shock become similar, and nullify any aetiological differences. Regardless of the type of shock, the final common pathway is inadequate tissue perfusion and oxygen supply to meet cellular demands. Delayed recognition and treatment result in progression from compensated reversible shock to uncompensated irreversible shock with widespread multiple system
organ failure to death. This paper reviews the physiological basis, and pathophysiological classification of the various types of shock and their respective aetiologies. The clinical features of the different types of shock are described, and current diagnostic and therapeutic strategies are applied for the most effective and appropriate treatment for resuscitating the child in shock. A strong index of suspicion, early recognition, timely intervention and transfer to an intensive care unit are critical for successful outcomes in the management of paediatric shock.

Matched MeSH terms: Hypotension
Fulltext Massive, spontaneous ruptured renal subcapsular haematoma following thrombolytic therapy in acute ST-elevation myocardial infarction

Raja Ezman Faridz Raja Shariff, Sazzli Shahlan Kasim

Journal of Clinical and Health Sciences, 2019;4(2):82-85.
MyJurnal

Thrombolytic therapy remains widely used in majority of developing countries, where delivery
of primary percutaneous coronary intervention (PCI) remains a challenge. Unfortunately,
complications following such therapy remains prominent, predominantly bleeding-related
problems. We present a rare case of massive renal subcapsular haemorrhage and hematoma
following thrombolytic therapy. A 61-year old gentleman presented following an episode of
chest pain due to acute ST-elevation myocardial infarction. Due to potential delays in obtaining
PCI, the patient was counselled for thrombolysis using streptokinase which he had consented
to. Unfortunately, within 36 hours of admission, he developed abdominal pain, haematuria,
hypotension and altered mental status, associated with acute drops in haemoglobin levels.
Following initial resuscitation efforts, a Computed Tomography scan of the abdomen was
performed revealing a massive renal subcapsular hematoma, likely secondary to previous
thrombolysis. Renal subcapsular hematoma can either be spontaneous or iatrogenic, the latter
often due to coexisting renal-based neoplasm or vasculitidies. Iatrogenic causes include
trauma, following renal biopsies or anticoagulation therapy amongst a few others. Iatrogenic
renal subcapsular haemorrhage and hematoma formation are rare following thrombolysis. Our
literature search revealed only one other similar case, although this was following
administration of recombinant Tissue Plasminogen Activator in a case of acute ischaemic
cerebrovascular accident. This case highlights the complexity in management, following the
findings in terms of need for cessation of dual antiplatelet therapy and timing for PCI and stent
selection.

Matched MeSH terms: Hypotension
Fulltext Accidental self-injection of Xylazine during work: a rare case

Ganapathy, Ganesh Kumar, Dharmalingam, T. Kumaravadivel, Sathival, Mugunthan M.

Borneo Journal of Medical Sciences, 2018;12(2):47-49.
MyJurnal

Xylazine is an alpha-2agonist often used as a sedative, analgesic and muscle relaxant agent
in animals. Xylazine was not accepted by Food and Drug Administration (FDA) for human use
due to hazardous side effect such as hypotension, bradycardia, respiratory depression and coma.
This is a rare case report of a 64-year-old farmer who accidentally injected himself with Xylazine
which was supposed to be given to a fractious cow. He developed altered conscious level, hypotension, bradycardia and respiratory failure requiring mechanical ventilation. Fortunately, he
recovered and was discharged home after three days. This occurred due to improper handling of
Xylazine without standard operating procedures. Xylazine is regulated for animal use only. Therefore, effects of Xylazine toxicity in human must be emphasized for awareness on proper handling as well as for right management of its poisoning incident in future.

Matched MeSH terms: Hypotension
Fulltext Amitraz poisoning: a case report

Choor, C.K., Santha, K.N.

Medicine & Health, 2011;6(2):123-125.
MyJurnal

Amitraz poisoning is rare and there has been no reported cases in the Malaysian literature. Ingestion of this compound carries many life threatening side effects. We describe a case of Amitraz poisoning in an 18 years old young adult. He developed hypotension, required ventilatory support and a day of intensive care unit stay. He had a quick recovery after he was treated symptomatically and was discharged well after 3 days.

Matched MeSH terms: Hypotension
Fulltext Assessment of medication adherence and the costs associated with a calendar blister pack intervention among hypertensive patients in Malaysia: A randomized controlled trial

Tan BY, Shafie AA, Hassali MAA, Saleem F

SAGE Open Med, 2017;5:2050312117709189.
PMID: 28839933 DOI: 10.1177/2050312117709189

OBJECTIVES: To assess the efficacy and costs of a calendar blister packaging intervention used to improve medication adherence.
METHOD: A parallel randomized controlled trial was conducted with 73 hypertensive patients (intervention group = 35, control group = 38) at Hospital Kulim, Malaysia, for 7 months.
RESULTS: The intervention group demonstrated a significant improvement in medication possession ratio (p

Matched MeSH terms: Hypotension
Prophylactic low dose dopamine infusion on renal function in ventilated preterm newborns with respiratory distress syndrome

Hassan, H., Quah, B.S., Haider, D., Rostenberghe, H.V.

Malaysian Journal of Paediatrics and Child Health, 1998;10(2):24-33.
MyJurnal

The aim of the study was to determine the effect of pro-phylactic low dose dopamine infusion on renal function in ventilated premature newborns with respiratory dis-tress syndrome (RDS). A prospective, randomised con-trolled trial was conducted, using low dose dopamine [2.5μg/kg/min] in the treatment of preterm babies with gestational age 28-36 weeks requiring mechanical ventilation for RDS within six hours of age. Thirty-six babies were enrolled and 19 babies were randomly assigned to the treatment groups. The renal function after 72 hours for the treatment and control groups respectively were: urine output (ml/kg/hour) 3.3±0.4 and 3.0±0.3 [p=0.55], urine specific gravity 1006±0.6 and 1006±1.0 [p=0.68], fractional excretion of sodium 4.1±0.8 and 2.6±0.4 [p=0.10], fractional excretion of potassium 37.44 ± 5.6 and 16.49 ± 2.2 [p=0.001], glomerular filtration rate (ml/day/1.72m2) 16±2.6 and 25.6±4.5 [p=0.06]. There were no significant differ-ences in the frequency of hypotension, oliguria and sep-sis between the two groups. There were seven deaths (36.8%) in the treatment group (six due to sepsis and one due to prematurity) and two deaths (11.8%) in the control group (both due to sepsis) (p = 0.13). In con-clusion prophylactic low-dose dopamine infusion did not improve the renal function in ventilated premature babies with respiratory distress syndrome. The results of this study do not support the routine use of prophylac-tic low-dose dopamine in ventilated preterm babies with respiratory distress syndrome.

Matched MeSH terms: Hypotension
Fulltext Role of endothelium-dependent hyperpolarisation and prostacyclin in diabetes

Mokhtar SS, Rasool AH

Malays J Med Sci, 2015 Mar-Apr;22(2):8-17.
PMID: 26023290 MyJurnal

The endothelium plays a crucial role in maintaining vascular homeostasis by producing several vasodilating factors, including nitric oxide (NO), prostacyclin (PGI2), and endothelium-dependent hyperpolarisation (EDH); however, the balance between endothelial relaxing and contracting factors is disrupted in disease states such as diabetes mellitus and hypertension. Most reported studies of endothelial dysfunction in diabetes focused on the actions of NO; however, there is accumulating evidence demonstrating that in addition to NO, PGI2 and EDH are likely to contribute to the vasodilatation of blood vessels. EDH plays an important role as a regulator of vascular tone and reactivity in resistance and conduit arteries of animal models and humans. PGI2 only plays a minimal role in endothelium-dependent vasodilatation but may serve as an important compensatory mechanism in conditions in which NO and EDH activities are decreased. Further studies are needed to determine the exact roles of EDH and PGI2 in the development of endothelial dysfunction and clinical vasculopathy in humans with type 1 and type 2 diabetes.

Matched MeSH terms: Hypotension
Comparing the efficacy and safety between propofol and dexmedetomidine for sedation in claustrophobic adults undergoing magnetic resonance imaging (PADAM trial)

Loh PS, Ariffin MA, Rai V, Lai LL, Chan L, Ramli N

J Clin Anesth, 2016 Nov;34:216-22.
PMID: 27687378 DOI: 10.1016/j.jclinane.2016.03.074

STUDY OBJECTIVE: To determine the efficacy of sedation with dexmedetomidine compared to propofol for claustrophobic adults undergoing magnetic resonance imaging (MRI) in our institution.
DESIGN: Randomized, prospective, double-blinded study.
SETTING: University-based tertiary referral center.
PATIENTS: Thirty claustrophobic adults with American Society of Anesthesiologists physical status I and II who were planned for MRI.
INTERVENTIONS: Patients were randomly assigned to target-controlled infusion propofol or dexmedetomidine loading followed by maintenance dose for procedural sedation.
MEASUREMENTS AND MAIN RESULTS: The primary end point was adequate reduction in patient anxiety levels to allow successful completion of the MRI sequence. Both methods of sedation adequately reduced anxiety levels in visual analog scale scores and Spielberger Strait Test Anxiety Inventory (P

Matched MeSH terms: Hypotension/chemically induced

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