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Guidelines on the management of patients with multidrug-resistant tuberculosis in Hong Kong. Slideshare uses cookies to improve functionality and performance, and to provide you with relevant advertising. Although the infective dose required to cause IE in humans is unknownHowever, no data show that visible bleeding during a dental procedure is a reliable predictor for bacteremia.
The Council on Scientific Affairs of the American Dental Association has approved these guidelines as they relate todentistry. For patients with low gradient (LG) severe aortic stenosis (AS) with preserved ejection fraction (EF), treatment of hypertension with vasodilators, such as sodium nitroprusside, could help lower left ventricular (LV) afterload, leading to decreased LV filling pressures and pulmonary artery pressures.
In their study, the researchers compared a group of 18 symptomatic Mayo Clinic patients who presented with LG severe AS with preserved EF to a group of six symptomatic patients with low gradient severe AS and reduced EF. They then administered sodium nitroprusside (Nitropress, Abbott) to determine how the reduction in afterload affected the severity of AS.

Nitroprusside reduced afterload as well as average pulmonary artery pressure with a 40 percent decrease in LV end diastolic pressure compared to baseline. While the study yielded important clues about how nitroprusside can be used to determine AS severity, it is still unclear whether this use can be clinically beneficial to patients.
Despite the small study size, the authors argued that their findings have implications for managing elderly patients with hypertension and LG severe AS with preserved EF as well as managing paradoxical low-flow, LG severe AS. Hypertension can influence the determination of the severity of AS, which can impact decisions about valve replacements, they explained.
On the basis of these data, it is unlikely that topical antiseptics are effective to significantly reduce the frequency, magnitude and duration of bacteremia associated with a dental procedure. Patients had severe hypertension, pulmonary hypertension, elevated LV end diastolic pressure and diminished stroke volume at baseline.
This assessment, they explained, should include cardiac output, characteristics of the peripheral circulation and the morphology of the aortic pressure tracing in addition to the mean gradient and valve area information.

With valve replacements, systemic hypertension may develop due to increased flow resulting from diminished valvular afterload, which could minimize the benefits of LV unloading with valve replacement. Procedured Prophylaxis may prevent an exceedingly small number of cases of IE, if any, in people who undergo a dental, GI tract or GU tract procedure.
The risk of antibiotic-associated adverse events exceeds the benefit, if any, from prophylactic antibiotic therapy. Otto, MD, of the University of Washington School of Medicine in Seattle, wrote in an editorial that the study data could have clinical significance.

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