Hypertension drugs benefit bypass patients

Until now, cardiologists have routinely instructed patients facing coronary artery bypass graft (CABG) surgery to stop taking blood pressure- reducing drugs, and not to resume taking them immediately afterwards, as it was thought that these drugs increased the risk to the patient.

But Prof. Benjamin Drenger, a senior physician at Hadassah University Medical Center’s department of anesthesiology and critical care medicine, has just published an article in the prestigious journal Circulation showing the opposite; on the basis of 4,200 patients who underwent CABG, taking ACE inhibitors actually reduced the risk associated with this type of surgery.

ACE (angiotensin-converting-enzyme) inhibitors – originally synthesized from compounds found in viper venom – have long been used to treat hypertension in patients who were either unresponsive to more basic medication or had a medical history of cardiac insufficiency and heart attacks.

But the new research shows that patients that resumed taking ACE inhibitors immediately after CABG surgery suffered many fewer cardiac complications.

Those patients who had not received ACE inhibitors just before and after the surgery suffered from many more complications in the kidneys, and were at greater risk for heart attacks and coronary insufficiency, Drenger and colleagues wrote.

“Publication of our research, meant for cardiologists, heart surgeons and internal medicine specialists, is meant to change the approach” on ACE inhibitors for bypass surgery patients, he continued.

It may be that renewal of ACE inhibitors immediately after surgery will become the policy of choice and that in the long term, “the recommendations in the article will be included in new clinical directives,” the Hadassah anesthesiologist said.

VITAMIN D FOR IN-HOSPITAL INFECTIONS

Hospital-acquired (nosocomial) infections are a significant threat around the world. These infections aren’t brought in by patients but are already present in hospitals, and spread easily among those already sick. In the US alone, there are an estimated 100,000 deaths a year from hospital-acquired infections, with some 1.7 million annual cases causing between $30 billion and $40 billion in excess healthcare costs.

A paper recently published in the journal Dermato-Endocrinology suggests that raising vitamin D concentrations among patients has the potential to greatly reduce the risk of nosocomial infections.

Patients are often vitamin D-deficient since many diseases such as cancer, cardiovascular disease and respiratory infections are linked to low vitamin D concentrations.

Pneumonia is the most likely result, followed by bacteremias, urinary tract infections, surgical site infections and sepsis.

Vitamin D plays an important antimicrobial role. It is known to strengthen people’s innate immune response, thus overcoming the antibiotic resistance of many bacteria encountered in hospitals.

Even in sunny Israel, where exposure to the sun produces the vitamin in the skin, a large percentage of people have been found to be vitamin D deficient because many cover themselves out of modesty or concern about skin cancer due to overexposure to ultraviolet rays.

The researchers, headed by infectious disease expert Dr. Dima Youssef of East Tennessee State University, advocated raising vitamin D concentrations in patients. Not only does the vitamin reduce the rate of diseases such as many types of cancer, cardiovascular disease, hip fractures and respiratory infections, but it would also cut the rate of nosocomial infections.

PRENATAL COUNSELING

Israeli women typically undergo several ultrasound scans and other tests during pregnancy. But what does one do if a problem is suspected in the fetus? A new clinic has now opened at Jerusalem’s Alyn Hospital, the national pediatric and adolescent rehabilitation center for children with serious physical disability due to genetic disease, accidents or other causes. The clinic will advise parents whose fetus is suspected of suffering from heart defects, spina bifida, skeletal defects, muscular disorders, cleft palate (which can easily be treated with plastic surgery) and other problems.

Such parents will be able to consult with hospital director-general Dr. Maurit Be’eri or Dr. Eliezer Be’eri, the deputy director-general, a social worker and Rabbi Zvi Porat, who specializes in matters of medicine and halacha.

Parents who want to have the baby despite suspected disorders will be told what capabilities the baby will have despite disabilities and what treatments can be offered. The Alyn director said she hoped the new clinic would relieve parents’ fears and worries and help them cope.

ELIMINATING QUEUE FOR CHILDREN

Parents of children in the Bnei Brak area who need help for urological problems have had to wait for three months or more to get a consultation with a specialist.

Now, the city’s hospital, Ma’ayanei Hayeshua, has announced the opening of a pediatric urology clinic that will eliminate the queue.

It is being run by Dr. Bezalel Sivan, an Orthodox specialist in the field who did his residency at Schneider Children’s Medical Center and then his subspecialty at Cinncinnati Children’s Hospital, one of the leading institutions of its kind in the world. Referrals from the health funds are accepted. The medical center in the largely ultra-Orthodox city began primarily as an obstetrical hospital but has expanded to including many other services and departments.