Visiting and Communication Policy in Intensive Care Units during COVID-19 Pandemic: A Cross-sectional Survey from South Asia and the Middle East

PURPOSE

The coronavirus disease-2019 (COVID-19) pandemic had affected the visiting or communicating policies for family members. We surveyed the intensive care units (ICUs) in South Asia and the Middle East to assess the impact of the COVID-19 pandemic on visiting and communication policies.

MATERIALS AND METHOD

A web-based cross-sectional survey was used to collect data between March 22, 2021, and April 7, 2021, from healthcare professionals (HCP) working in COVID and non-COVID ICUs (one response per ICU). The topics of the questionnaire included current and pre-pandemic policies on visiting, communication, informed consent, and end-of-life care in ICUs.

RESULTS

A total of 292 ICUs (73% of COVID ICUs) from 18 countries were included in the final analysis. Most (92%) of ICUs restricted their visiting hours, and nearly one-third (32.3%) followed a "no-visitor" policy. There was a significant change in the daily visiting duration in COVID ICUs compared to the pre-pandemic times (p = 0.011). There was also a significant change (p <0.001) in the process of informed consent and end-of-life discussions during the ongoing pandemic compared to pre-pandemic times.

CONCLUSION

Visiting and communication policies of the ICUs had significantly changed during the COVID-19 pandemic. Future studies are needed to understand the sociopsychological and medicolegal implications of revised policies.

HOW TO CITE THIS ARTICLE

Chanchalani G, Arora N, Nasa P, Sodhi K, Al Bahrani MJ, Al Tayar A, et al. Visiting and Communication Policy in Intensive Care Units during COVID-19 Pandemic: A Cross-sectional Survey from South Asia and the Middle East. Indian J Crit Care Med 2022;26(3):268-275.

Posterior Reversible Leukoencephalopathy Syndrome (PRES) in Intensive Care Unit - Case series

Introduction:

Posterior reversible encephalopathy syndrome (PRES) is characterized by a range of clinico neuro radiological manifestation along with hypertension due to varied etiology. Contrary to its name, a small number of patients have residual neurological deficits. Patients with severe manifestation of PRES may get admitted to the Intensive Care Unit (ICU) due to coma or status epilepticus. Small case series and large multicenter studies have been reported.

Materials and Methods:

We report a single center series of ten cases admitted to ICU over a 5 year period in a tertiary care centre. We retrospectively analyzed patients, admitted to adult ICU with different etiologies, and diagnosed to have PRES. Outcome at discharge and at 90 days after ICU admission was noted.

Result:

The most common etiologies were medications. ICU admissions were mainly for uncontrolled hypertension, seizures, and low level of consciousness. All except one patient were ventilated. Four patients had residual neurological damage.

Conclusion:

Irrespective of the etiology, early control of blood pressure, and removal of precipitating factors is of paramount importance to prevent morbidity and mortality. Awareness about PRES among the intensivist is necessary to ensure early recognition and treatment.

Wernicke's encephalopathy following hyperemesis gravidarum

Wernicke's encephalopathy (WE) is a potentially reversible yet serious neurological manifestation caused by vitamin B₁(thiamine) deficiency. It is commonly associated with heavy alcohol consumption. Other clinical associations are with hyperemesis gravidarum (HG), starvation, and prolonged intravenous feeding. Most patients present with the triad of ocular signs, ataxia, and confusion. It can be associated with life-threatening complication like central pontine myelinolysis (CPM). We report two cases of WE following HG, with two different outcomes.

Gastric emptying of a non-digestible solid: assessment with simultaneous SmartPill pH and pressure capsule, antroduodenal manometry, gastric emptying scintigraphy

Gastric emptying of digestible solids occurs after trituration of food particles. Non-digestible solids are thought to empty with phase III of the migrating motor complex (MMC). The aim of this study was to determine if a non-digestible capsule given with a meal empties from the stomach with return of the fasting phase III MMC or during the fed pattern with the solid meal. Fifteen normal subjects underwent antroduodenal manometry and ingestion of a radiolabelled meal and SmartPill wireless pH and pressure capsule. In five subjects, emptying of the SmartPill was studied in the fasting period by ingesting the SmartPill with radiolabelled water. The SmartPill emptied from the stomach within 6 h in 14 of 15 subjects. SmartPill pressure recordings showed high amplitude phasic contractions prior to emptying. SmartPill gastric residence time (261 +/- 22 min) correlated strongly with time to the first phase III MMC (239 +/- 23 min; r = 0.813; P < 0.01) and correlated moderately with solid-phase gastric emptying (r = 0.606 with T-50% and r = 0.565 with T-90%). Nine of 14 subjects emptied the capsule with a phase III MMC. In five subjects, the SmartPill emptied with isolated distal antral contractions. In five subjects ingesting only water, SmartPill gastric residence time (92 +/- 44 min) correlated with the time to the first phase III MMC (87 +/- 30 min; r = 0.979; P < 0.01). The non-digestible SmartPill given with a meal primarily empties from the stomach with the return of phase III MMCs occurring after emptying the solid-phase meal. However, in some subjects, the SmartPill emptied with isolated antral contractions, an unappreciated mechanism for emptying of a non-digestible solid.

Gastric emptying of a non-digestible solid: assessment with simultaneous SmartPill pH and pressure capsule, antroduodenal manometry, gastric emptying scintigraphy

Gastric emptying of digestible solids occurs after trituration of food particles. Non-digestible solids are thought to empty with phase III of the migrating motor complex (MMC). The aim of this study was to determine if a non-digestible capsule given with a meal empties from the stomach with return of the fasting phase III MMC or during the fed pattern with the solid meal. Fifteen normal subjects underwent antroduodenal manometry and ingestion of a radiolabelled meal and SmartPill wireless pH and pressure capsule. In five subjects, emptying of the SmartPill was studied in the fasting period by ingesting the SmartPill with radiolabelled water. The SmartPill emptied from the stomach within 6 h in 14 of 15 subjects. SmartPill pressure recordings showed high amplitude phasic contractions prior to emptying. SmartPill gastric residence time (261 +/- 22 min) correlated strongly with time to the first phase III MMC (239 +/- 23 min; r = 0.813; P < 0.01) and correlated moderately with solid-phase gastric emptying (r = 0.606 with T-50% and r = 0.565 with T-90%). Nine of 14 subjects emptied the capsule with a phase III MMC. In five subjects, the SmartPill emptied with isolated distal antral contractions. In five subjects ingesting only water, SmartPill gastric residence time (92 +/- 44 min) correlated with the time to the first phase III MMC (87 +/- 30 min; r = 0.979; P < 0.01). The non-digestible SmartPill given with a meal primarily empties from the stomach with the return of phase III MMCs occurring after emptying the solid-phase meal. However, in some subjects, the SmartPill emptied with isolated antral contractions, an unappreciated mechanism for emptying of a non-digestible solid.

RelA is required for IL-1beta stimulation of Matrix Metalloproteinase-1 expression in chondrocytes

OBJECTIVE

Interleukin-1beta (IL-1beta) stimulates collagenase-1 (Matrix Metalloproteinase-1 (MMP-1)) expression in articular chondrocytes, leading to cleavage of type II collagen and irreversible cartilage degradation. The nuclear factor-kappa B (NF-kappaB) pathway is potently activated in IL-1beta-stimulated cells and has been implicated as an intermediate in MMP-1 gene expression. However, the roles of individual NF-kappaB family members during IL-1beta-induced MMP-1 gene expression have not been defined.

RESULTS

To address the relationship between the NF-kappaB pathway and MMP-1 gene activation in chondrocytes, primary cultured human articular chondrocyte cultures (HAC) and SW-1353 cells were stimulated with IL-1beta over a 24-h time course and MMP-1, NF-kappaB1, NF-kappaB2 and RelA gene expression was assayed. IL-1beta-induced MMP-1 expression was comparable in HAC and SW-1353 cells both temporally and quantitatively. MMP-1 gene expression was mirrored by increases in NF-kappaB gene expression, and inhibition of NF-kappaB nuclear translocation with dominant-negative IkappaBalpha reduced IL-1beta-dependent MMP-1 gene expression. IL-1beta activated the NF-kappaB pathway in chondrocytes, both through phosphorylation and transient degradation of IkappaBalpha, as well as through sustained phosphorylation of RelA. Small inhibitory RNAs (siRNA) specific for RelA resulted in significant reduction of MMP-1 mRNA, whereas siRNA for NF-kappaB1 and NF-kappaB2 augmented IL-1beta-induced MMP-1 expression.

CONCLUSIONS

Our data demonstrate that IL-1beta activation of the NF-kappaB pathway is required for IL-1beta induction of MMP-1 in chondrocytes and that RelA can work independently of NF-kappaB1 or NF-kappaB2 to activate this gene expression program.

Anxiety-like effects induced by acute fluoxetine, sertraline or m-CPP treatment are reversed by pretreatment with the 5-HT2C receptor antagonist SB-242084 but not the 5-HT1A receptor antagonist WAY-100635

The possible role of 5-HT1A and 5-HT2C receptors in the anxiety induced by fear, acute treatment with SSRI antidepressants or the 5-HT receptor agonist m-CPP were tested in the social interaction anxiety test in male Sprague-Dawley rats. Fluoxetine (2.5-10 mg/kg, i.p.), sertraline (15 mg/kg, i.p.) and m-CPP (0.5-2.0 mg/kg, i.p.) all had an anxiogenic-like profile (decrease in time of total social interaction and increase in self-grooming compared to vehicle) under low-light, familiar arena test conditions. All these effects were reversed by pretreatment with the highly subtype-selective 5-HT2C receptor antagonist, SB-242084 at doses of either 0.05 or 0.2 mg/kg, i.p. In contrast, the selective 5-HT1A receptor antagonist WAY-100635 (0.05 and 0.2 mg/kg, s.c.) failed to reverse SSRI-induced decrease in time of total social interaction, further, it augmented self-grooming response. SB-242084 (0.2 mg/kg) and WAY-100635 (0.05 and 0.2 mg/kg) reversed hypolocomotion caused by the SSRI antidepressants. SB-242084, tested alone against vehicle under high-light, unfamiliar arena test conditions associated with fear, caused significant anxiolysis at 0.2 mg/kg and higher doses. These results suggest that increased anxiety in rodents, and possibly, also in humans (e.g. agitation or jitteriness after SSRIs and panic after m-CPP), caused by acute administration of SSRI antidepressants or m-CPP, are mediated by activation of 5-HT2C receptors. Blockade of 5-HT1A autoreceptors may exacerbate certain acute adverse effects of SSRI antidepressants. Both 5-HT1A and 5-HT2C receptors are involved in the SSRI-induced decrease in locomotor activity. In addition, our studies confirm data that subtype-selective 5-HT2C receptor antagonists have strong anxiolytic actions.

Femoral remodeling after porous-coated total hip arthroplasty with and without hydroxyapatite-tricalcium phosphate coating: a prospective randomized trial

We prospectively assessed femoral bone remodeling using dual-energy x-ray absorptiometry for 2 years after total hip arthroplasty. Thirty-nine hips were randomized to receive a titanium proximally porous-coated femoral component with or without hydroxyapatite-tricalcium phosphate coating. Although both stems resulted in alterations in the periprosthetic bone mineral density, the hydroxyapatite-tricalcium phosphate coated stems had significantly less femoral bone loss than the uncoated stems at 2-year follow-up. This reduced femoral bone loss may provide short-term and long-term advantages over noncoated stems.

8-OH-DPAT and MK-801 affect epileptic activity independently of vigilance

Vigilance and parallel occurrence of epileptic activity after administration of the 5-HT(1A) agonist 8-OH-DPAT and the NMDA receptor antagonist MK-801 were studied in the genetic absence epilepsy model WAG/Rij rats. Spike-wave discharges (SWD) were present predominantly in passive awake and light slow wave sleep (SWS1) either in control animals or after treatments. Injection of 8-OH-DPAT (20.0 microg/rat i.c.v.) caused marked increase and MK-801 (10.0 microg/rat i.c.v.) decrease in SWD densities, thus the ratios of SWD in passive awake and in SWS1. SWD densities of MK-801 plus 8-OH-DPAT in combination were similar to those of CSF+CSF treated control rats. Both 8-OH-DPAT and MK-801 transiently increased the duration of active awake, increased latency and decreased duration of rapid eye movement (REM) sleep. 8-OH-DPAT increased the amount of SWD despite the decrease in the duration of SWS1. MK-801 decreased the amount of SWD despite the lack of significant change in duration of passive awake or SWS1. Pre-treatment with MK-801 reversed 8-OH-DPAT- induced increase in duration of SWD without any effect on 8-OH-DPAT-induced changes in sleep parameters. Our studies provide evidence that 8-OH-DPAT-induced epileptic activity is independent of its effect on sleep, and that interaction of serotonergic and glutamatergic systems plays a role in the generation of SWD, but not in the regulation of vigilance and sleep.

Cervical osteophytes presenting as unilateral vocal fold paralysis and dysphagia

Any process involving either the vagus nerve, its recurrent laryngeal branch or the external branch of the superior laryngeal nerve may cause paralysis of the vocal fold. The most common cause is neoplasm. Clinically, the patients often present with a hoarse, breathy voice as well as symptoms of aspiration. The following represents a unique case of unilateral vocal fold paralysis and dysphagia caused by a degenerative disease of the cervical spine, resluting in extrinsic compression of the recurrent laryngeal nerve.

Enhancement of bone growth into porous intramedullary implants using non-invasive low intensity ultrasound

An in vivo study was designed to determine if non-invasive low intensity ultrasound could enhance bone growth into porous intramedullary implants. Fully porous intramedullary rods were implanted bilaterally into the ulnae of six dogs. In each dog, one ulna served as a control and the other was treated with 20 min of daily ultrasound stimulation for 6 consecutive weeks. Analysis of serial transverse sections indicated an average of 119% more bone growth into the ultrasound-treated implants compared with the contralateral controls (P < 0.001). In each of the 6 dogs, there was a significantly greater amount of bone ingrowth on the ultrasound-stimulated side. These data indicate a clear potential for externally applied ultrasound therapy to augment biological fixation.

Rapid desensitization of 5-HT(1A) receptors in Fawn-Hooded rats after chronic fluoxetine treatment

Anxiety, platelet serotonin (5-HT) content and functions of the 5-HT(1A) receptor agonist 8-hydroxy-2-(di-n-propylamino)tetralin (8-OH-DPAT) were measured in Sprague--Dawley (SD) and Fawn-Hooded (FH) rats, a strain with genetically impaired 5-HT storage and reuptake system and a putative model of depression and anxiety. In addition, the effects of 7 and 16 days treatment with the selective serotonin reuptake inhibitor (SSRI) fluoxetine on 8-OH-DPAT-induced responses were studied. FH rats showed significantly higher anxiety in the social interaction test, and much lower platelet 5-HT content compared to SD rats. The efficacy of 8-OH-DPAT (15-120 microg/kg, i.v.) to induce lower lip retraction (an effect mediated by median raphe receptors) was increased in FH rats. In most FH but only a few SD rats a special neurological syndrome, clonic movement of the masseters and in-and-out movement of the eyeballs, was induced by 8-OH-DPAT, and this behaviour like other effects of 8-OH-DPAT, was completely blocked by pretreatment with the 5-HT(1A) receptor antagonist WAY-100635. In SD rats fluoxetine (10 mg/kg/day, i.p.) caused a moderate inhibition of 8-OH-DPAT-induced hypothermia, an effect mediated most likely by hypothalamic 5-HT(1A) receptors, (-19% and -40% after 7 and 16 days of fluoxetine, 24 h after the last injection, respectively). In FH rats fluoxetine caused a rapid and complete reduction in the 8-OH-DPAT-induced hypothermia (-65% and -91% after 7 and 16 days of fluoxetine, respectively). Fluoxetine caused no change in lower lip retraction but a reduction in the masseter-eyeball syndrome in both SD and FH rats. Our data provide evidence that in FH rats, median raphe 5-HT(1A) receptors are hypersensitive, and the hypothalamic 5-HT(1A) receptor desensitization, caused by SSRI antidepressants, is faster and more complete. These data support the notion that chronic treatment with SSRIs induces a desensitization of some 5-HT(1A) receptor populations, and impaired 5-HT storage and reuptake may accelerate this process.

High social anxiety and low aggression in Fawn-Hooded rats

The Fawn-Hooded (FH) rat strain, with well-documented changes in their serotonergic and noradrenergic systems, is a putative genetic model for some neuropsychiatric disorders like depression, alcohol abuse, and anxiety. Because social phobia frequently occurs in combination with these disorders and there are no social anxiety-related data in FH rats in the literature, we measured the behavior of FH rats in the social interaction test. In addition, the effects of the anxiogenic Serotonin-2C (5-HT2C) receptor agonist, m-chlorophenylpiperazine (m-CPP), were studied. Male FH, Wistar (W), and Sprague-Dawley (SD) rats were used in two different test conditions of the social interaction test: the high light, unfamiliar arena, associated with high anxiety, and the low light, familiar arena, associated with low anxiety-like behavior. All social behaviors were markedly diminished in FH rats that suggested higher anxiety in these animals. Total social interaction time was reduced by 60-70% in FH rats compared either to W or SD rats under high light, unfamiliar or low light, familiar conditions, respectively. Aggressive behavior was reduced at least by 85% in FH rats. Locomotor activity and exploratory behavior were only minimally, in most comparisons, not significantly affected in FH rats. Total social interaction time, aggression, and locomotor activity were decreased, and self-grooming increased by m-CPP (0.5 mg/kg, ip) in all three strains. m-CPP decreased total social interaction time thus, caused anxiety most efficiently in FH rats (reduced by 69%, 50%, and 55% in FH, W, and SD rats, respectively), but other effects of the drug were similar in the three strains. Our studies provide evidence that the FH rat strain may be a genetic model of social phobia or other anxiety disorders with impaired social behavior.

Simaomicin (LL-D42067), a novel antibiotic from Actinomadura madurae. I. Taxonomy, fermentation and biological activity

A new antibacterial antibiotic, designated simaomicin alpha (LL-D42067 alpha) was isolated from the fermentation broth of an actinomycete strain. Based on cultural, physiological, morphological and chemical characteristics, culture LL-D42067 was identified as a new subspecies of Actinomadura madurae. Simaomicin alpha demonstrated potent activity against Gram-positive bacteria and was active in vivo against a variety of Eimeria species causing coccidiosis in chickens.

The effect of 13-cis retinoic acid on hematopoiesis in human long-term bone marrow culture

The modulatory effect of 13-cis retinoic acid (RA) on the growth, differentiation and function of hematopoietic cells in human long-term cultures was studied. RA (5 X 10(-8) M) induced enhancement of myeloid progenitor cell growth in the non-adherent layer throughout 6 weeks of incubation while it did not affect the number of myeloid progenitors in the adherent layer. The vitamin did not alter the differentiation pattern of colony forming unit-culture (CFU-C). The addition of RA to cultures for 5 weeks did not alter the cellular composition of the adherent layer. Prolonged exposure of hematopoietic cells to RA did not affect the functional activity of neutrophils and macrophages, i.e. the cells were active in phagocytosing Candida albicans (CA).

Efficacy of maduramicin against ionophore-tolerant field isolates of coccidia in broilers

Maduramicin ammonium was given at 2.5-8 ppm in the feed to broilers experimentally infected with coccidia recently isolated from broiler farms where ionophores had been used for several years. Infection pressure varied from mild to severe in five trials: mortality in unmedicated controls ranged from 0 to 59%, intestinal lesion scores were high, and weight gain was depressed by the infections. The cultures of Eimeria were partly resistant to ionophores: birds medicated with monensin at 100-121 ppm had only modest reductions in lesion scores and incomplete protection against weight loss or mortality. Control of infections by maduramicin was significant at 4 ppm but best at 5-7 ppm. Maduramicin was more effective than monensin or narasin, but about the same as salinomycin, in reducing lesions and mortality and in protecting performance. Maduramicin was well tolerated within the dose range of 5-7 ppm.

CL 259,971: a potent new polyether anticoccidial. 1. Battery efficacy and safety

The anticoccidial activity of CL 259,971, a new polyether ionophore produced by Actinomadura yumaense sp. nov, has been demonstrated against six species of poultry Eimeria, tested individually or in mixed species infections. Statistically significant activity was obtained against some species with as little as 2.5 ppm of drug. The optimal treatment level, however, was determined to be 5 ppm. At this level, performance was comparable to 100 or 120 ppm of monensin. CL 259,971 is coccidiocidal and affects the early asexual stages of the life cycle of E. tenella. Fed to uninoculated cockerels in batteries at 10 ppm for 7 weeks, CL 259,971 permitted numerically superior weight gains when compared with 200 ppm of monensin.

CL 259,971: a potent new polyether anticoccidial. 2. Floor-pen trials

Three floor-pen trials have confirmed the high anticoccidial activity of CL 259,971 as first reported in batteries. The optimal dosage level was shown to be 5 ppm in the diet. At this level, excellent anticoccidial activity was observed with no adverse effect on weight or performance. The results indicated that 5 ppm of CL 259,971 provided efficacy and performance comparable to arprinocid or monensin, which were used for comparison in these trials.

Percutaneous absorption, blood levels, and urinary excretion of resorcinol applied topically in humans

The absorption and metabolic disposition of 2% resorcinol applied topically in a hydroalcoholic vehicle was determined in three human subjects. The drug penetrated the skin at a rate of 0.37 micrograms/cm2/hour. After 2 weeks of bid application of 800 mg resorcinol to about 30% of body surface of each subject, an average of 1.64% of the dosage was being excreted in 24-hour urine specimens as the glucuronide or as the sulfate conjugate. There was no resorcinol in blood drawn at weeks 1, 2, 3, and 4, or nor were there any abnormalities in thyroid function or blood chemistries at weeks 2, 3, and 4. Resorcinol (2%) appears safe for topical use in humans.

Very low doses of radio-iodine for hyperthyroidism. Failure to prevent a high incidence of early hypothyroidism

One hundred and fifty-one patients with hyperthyroidism were treated with varying doses of radio-iodine (131I), and the results were analysed 1 year later. Of the patients with Graves' disease who received the lowest 131I doses (mean 2,8 mCi) 39% had persistent thyrotoxicosis and 25% were hypothyroid 12 months after therapy. Moderate doses of 131I (mean 5,9 mCi) reduced the rate of persistent disease to 19% and increased the rate of hypothyroidism by only 4% (P less than 0,05). When 131I dosages were calculated according to thyroid weight (microCi/g), patients who received the lowest doses (mean 115 microCi/g) again had significant rates of both persistent hyperthyroidism (38%) and hypothyroidism (24%). These data indicate that very low doses of 131I in the treatment of Graves's disease may result in a high incidence of persistent disease, but do not necessarily result in a very low incidence of early hypothyroidism. Low-dose 131I regimens are unsuitable for treatment of thyrotoxicosis unless very good facilities for patient follow-up are available.

Post-thyroidectomy thyrotoxicosis

94 patients with postoperative recurrent hyperthyroidism were evaluated for duration of remission, goitre size, and response to radio-iodine (131I). 6 patients required 131I therapy within twelve months of operation--5 had large remnants because of inadequate surgery. 57% of patients relapsed within 5 years, but 16% relapsed after 20 years and 8% after more than 30 years. Estimated goitre weights ranged from 4 g to 65 g, and goitre size was unrelated to the duration of remission. All patients were treated with 131I. 23% of the patients became hypothyroid in the first postoperative year and 10% in the second year. The results indicate that postoperative thyrotoxicosis can recur decades after operation. Operation seems to sensitise the thyroid to the early effects of radiation by 131I.

Relationship of pasture rotation to acquisition of gastrointestinal nematodes by sheep

In a study of the relationship between pasture rotation in Illinois and acquisition of nematodes (mostly Haemonchus contortus) and body weight gains by lambs grazing with their ewes, 2 pasture rotation systems were tested. (1) Lambs and ewes were rotated through a series of 12 alfalfa-bromegrass-lespedeza pastures, each pasture being grazed for 3 to 4 days and rested for 5.5 weeks; 4 complete rotations were done during a 168-day grazing season. (2) Lambs and ewes were moved every 2 days, and 3 complete rotations of 50, 42, and 54 days, respectively, were done during the 146-day grazing season. The lambs under rotation had more nematodes and gained less weight than nonrotated control lambs, although rotation increased the amount of pasturage. Rotation is not recommended to control nematode parasitism of sheep in Illinois.

1,3-Bis(p-chlorobenzylideneamino)guanidine hydrochloride (robenzidene): new poultry anticoccidial agent

At 66 parts per million in the feed, robenzidene is highly effective in preventing chicken coccidiosis caused by any one of eight Eimeria species. Three times this dose is safe for broiler chickens. In dogs and rats, the toxicity was relatively low over a period of 90 days. In laboratory trials, the drug completely prevents oocyst production by seven species and greatly reduces oocyst production by Eimeria maxima.

Familial aggregation of blood pressure. Preliminary report

Familial aggregation of blood pressure levels has been under study in a random sample of Buffalo families. Spouse aggregation has been demonstrated for couples married more than 15 years. Parent-child aggregation was limited to families in which father and mother had the same systolic blood pressure level in a five-response scale. Aggregation was further limited to parents and sons. In all comparisons in which aggregation was present, it was manifested most strongly in the lower range of systolic blood pressure values.