Presence Of Arterial Hypertension Research Articles

Evaluating Thrombolysis Rates and Emergency Department Time Targets in Acute Ischemic Stroke: Need for Personalized Medicine

Background and objectives: In the era of personalized medicine, standard protocols regarding the management of acute ischemic stroke (AIS) focus on time targets alone without tailoring the protocol to the specific patient and hospital characteristics to increase IV thrombolysis rates and improve outcomes for these patients by considering organizational differences and patient-related factors that influence adherence to target times at the emergency department level. With this in mind, we evaluate the effect of achieving ED time targets from standard protocol and patient-related risk factors on the intravenous (IV) thrombolysis rate in patients with AIS in the therapeutic window. Materials and Methods: For our research, we enrolled people who arrived at the ED with signs of recent AIS with an onset of less than 4.5 h. Initially, 355 patients were included in the study, but through careful screening, only 258 were considered eligible to participate. Of the final group of 258 patients, only 46 received intravenous thrombolysis treatment. Results: In our study, when we are analyzing ED times in patients admitted with stroke symptoms in the therapeutic window, we found statistically significantly decreased ED times for patients that performed IV thrombolysis compared to patients not performing as follows: a median of 100 min in onset-to-ED door time (p < 0.001), a door-to-physician time (ED doctor) of 4 min (p = 0.009), door-to-blood-samples of 5 min (p = 0.026), a door-to-CT time of 15.5 min (p = 0.009), and door-to-CT results of 37 min (p < 0.001). In addition, patients who received intravenous thrombolysis were found to be significantly older (p < 0.001), with lower height and weight (p < 0.001 for both) and lower Glasgow Coma Scale (GCS) scores (9 ± 4.94 vs. 13.85 ± 2.41, p < 0.001). The logistic regression analysis indicated that the onset-to-ED time (p < 0.001) and the door-to-physician time (p = 0.014) for emergency medicine physicians are significant predictors of the likelihood of administering thrombolysis. By analyzing the impact of comorbidities, we observed that dyslipidemia, chronic arterial hypertension, and diabetes mellitus are significant predictive factors for performing IV thrombolysis (the presence of dyslipidemia and diabetes mellitus are predictive factors for performing IV thrombolysis, while the presence of arterial hypertension is not). Conclusions: The ED time targets that significantly influenced IV thrombolysis in our study were the onset-to-ED door time and the time it takes for the ED doctor to assess the AIS patient (door-to-physician time). The IV thrombolysis rate for these patients was 17.83%, lower than expected despite achieving most ED time targets, with the presence of chronic arterial hypertension as a significant predictive patient-related factor for not performing it. Even though our reported hospital’s thrombolysis rate is favorable compared to international reports, there is always room for improvement. Based on our study results, it is necessary that new protocols to customized standard protocols and ED time targets for increasing IV thrombolysis rate in patients with AIS in the therapeutic window, focusing more on patient-related factors and type of hospitals, granting personalized medicine its right. Based on our study results, it is necessary that new protocols customize standard protocols and ED time targets for increasing IV thrombolysis rate in patients with AIS in the therapeutic window, focusing more on patient-related factors and type of hospitals, granting personalized medicine its right.

Diagnostic accuracy of a machine learning algorithm using point-of-care high-sensitivity cardiac troponin I for rapid rule-out of myocardial infarction: a retrospective study

Point-of-care (POC) high-sensitivity cardiac troponin (hs-cTn) assays have been shown to provide similar analytical precision despite substantially shorter turnaround times compared with laboratory-based hs-cTn assays. We applied the previously developed machine learning based personalised Artificial Intelligence in Suspected Myocardial Infarction Study (ARTEMIS) algorithm, which can predict the individual probability of myocardial infarction, with a single POC hs-cTn measurement, and compared its diagnostic performance with standard-of-care pathways for rapid rule-out of myocardial infarction. We retrospectively analysed pooled data from consecutive patients of two prospective observational cohorts in geographically distinct regions (the Safe Emergency Department Discharge Rate cohort from the USA and the Suspected Acute Myocardial Infarction in Emergency cohort from Australia) who presented to the emergency department with suspected myocardial infarction. Patients with ST-segment elevation myocardial infarction were excluded. Safety and efficacy of direct rule-out of myocardial infarction by the ARTEMIS algorithm (at a pre-specified probability threshold of <0·5%) were compared with the European Society of Cardiology (ESC)-recommended and the American College of Cardiology (ACC)-recommended 0 h pathways using a single POC high-sensitivity cardiac troponin I (hs-cTnI) measurement (Siemens Atellica VTLi as investigational assay). The primary diagnostic outcome was an adjudicated index diagnosis of type 1 or type 2 myocardial infarction according to the Fourth Universal Definition of Myocardial Infarction. The safety outcome was a composite of incident myocardial infarction and cardiovascular death (follow-up events) at 30 days. Additional analyses were performed for type I myocardial infarction only (secondary diagnostic outcome), and for each cohort separately. Subgroup analyses were performed for age (<65 years vs ≥65 years), sex, symptom onset (≤3 h vs >3 h), estimated glomerular filtration rate (<60 mL/min per 1·73 m2vs ≥60 mL/min per 1·73 m2), and absence or presence of arterial hypertension, diabetes, a history of coronary artery disease, myocardial infarction, or heart failure, smoking, and ischaemic electrocardiogram signs. Among 2560 patients (1075 [42%] women, median age 58 years [IQR 48·0-69·0]), prevalence of myocardial infarction was 6·5% (166/2560). The ARTEMIS-POC algorithm classified 899 patients (35·1%) as suitable for rapid rule-out with a negative predictive value of 99·96% (95% CI 99·64-99·96) and a sensitivity of 99·68% (97·21-99·70). For type I myocardial infarction only, negative predictive value and sensitivity were both 100%. Proportions of missed index myocardial infarction (0·05% [0·04-0·42]) and follow-up events at 30 days (0·07% [95% CI 0·06-0·59]) were low. While maintaining high safety, the ARTEMIS-POC algorithm identified more than twice as many patients as eligible for direct rule-out compared with guideline-recommended ESC 0 h (15·2%) and ACC 0 h (13·8%) pathways. Superior efficacy persisted across all clinically relevant subgroups. The patient-tailored, medical decision support ARTEMIS-POC algorithm applied with a single POC hs-cTnI measurement allows for very rapid, safe, and more efficient direct rule-out of myocardial infarction than guideline-recommended pathways. It has the potential to expedite the safe discharge of low-risk patients from the emergency department including early presenters with symptom onset less than 3 h at the time of admission and might open new opportunities for the triage of patients with suspected myocardial infarction even in ambulatory, preclinical, or geographically isolated care settings. The German Center for Cardiovascular Research (DZHK).

The challenges in diagnosing hypertrophic cardiomyopathy in the presence of arterial hypertension: a clinical case

Aim. To describe a clinical case and analyze the challenges in diagnosing hypertrophic cardiomyopathy (HCM) in a patient with concomitant arterial hypertension (AH). Materials and methods. The article presents the clinical case of HCM in the patient with concomitant AH that was observed in an ambulatory setting in the Municipal Enterprise “Dnipropetrovsk Regional Clinical Center for Diagnostics and Treatment” of Dnipropetrovsk Regional Council. Results. A 66-year-old woman N., diagnosed by her family physician with coronary artery disease (CAD): stable angina FC II, grade 2 AH, chronic heart failure FC II NYHA, was referred to a cardiologist because of experiencing exertional dyspnea, chest pain, and uncontrolled blood pressure despite treatment compliance. Echocardiography identified concentric left ventricular hypertrophy with the left ventricular outflow tract (LVOT) obstruction (a mean gradient of 35 mmHg as per catheterization). Cardiac MRI confirmed the diagnosis and coronary angiography ruled out CAD. Adjustments to the treatment regimen, taking into account HCM with LVOT obstruction, effectively alleviated the patient’s symptoms and stabilized her blood pressure. Conclusions. It is especially important to follow the guidelines of AH management and perform echocardiography in all patients with high blood pressure, so as not to miss the signs of concomitant HCM, particularly with LVOT obstruction. In addition, in the case of HCM, it is necessary to timely detect, provide prevention and manage patients at risk for sudden cardiac death. Since HCM encompasses various diagnoses with different pathogenesis and distinct management, cardiac MRI, enzymatic or genetic testing may be needed according to guidelines. As HCM is a relatively common inherited cardiac disease, general practitioners could often encounter such patients in everyday clinical practice. Hence, they should have a certain suspicion of this diagnosis in persons with AH whose left ventricular mass meets the criteria for HCM.

Relationship between obesity and hypertrophic or dilated cardiomyopathy: The role of sex.

Evidence suggests an association between obesity and the risk for cardiomyopathy development; however, robust evidence is still lacking. In this study we sought to explore the relationship of obesity with hypertrophic cardiomyopathy (HCM) and dilated cardiomyopathy (DCM) and possible interactions with sex using large-scale epidemiological real-world data. We analysed data from the Nationwide Inpatient Sample of US hospitalisations for the years 2015-2019. There were a total of 46 934 admissions with diagnosis of HCM and 170 924 with DCM. There was a significant interaction between cardiomyopathies' diagnosis with sex and age subgroups; the rates of both DCM and HCM increased with age (p < .001 for both); DCM diagnosis was significantly higher in males compared with females (0.85% vs. 0.35%, p < .001). After adjustment for age, sex, race and presence of arterial hypertension there was a significant stepwise positive association between obesity and the population rates of both cardiomyopathy subtypes. For hospitalised patients with a body mass index (BMI) ≥30 kg/m2 there was an odds ratio (OR) of 1.68 (95% CI: 1.55-1.81, p < .001) for HCM and OR = 1.82 (95% CI: 1.79-1.84, p < .001) for DCM. More importantly, the positive relationship between a cardiomyopathy diagnosis (HCM or DCM) with increasing BMI was driven by the male sex (p < .001 for both) and it was non-significant in females. The findings from this nationwide observational analysis support a sexual dimorphism in the relationship between obesity and HCM or DCM, which should be further investigated.

Are There Differences in Skin Autofluorescence-Measured Advanced Glycation End-Product Levels between Chronic Kidney Disease and Kidney Transplant Recipients?

The aim of this cross-sectional study was to evaluate the differences in the levels of advanced glycation end products (AGE) between patients with chronic kidney disease (CKD) and kidney transplant recipients (KTRs) and to investigate the risk factors for the AGE levels in each group of these patients. There were 217 participants total, of which 99 (45.6%) were KTRs and 118 (54.4%) had CKD. Data on the levels of AGE, body mass composition, anthropometric parameters, central and peripheral blood pressure, and clinical and laboratory parameters were gathered for each study participant. The AGE values of the CKD and KTRs groups did not differ from one another. In both groups, a lower estimated glomerular filtration rate, male sex, and older age were positive predictors for increased AGE values. Furthermore, higher levels of AGE were linked to lower central systolic blood pressure (cSBP) in the CKD group, whilst, in the KTRs group, higher levels of AGE were linked to a shorter time since kidney transplantation (KTx), more years of dialysis prior to KTx, lower levels of trunk visceral fat, the presence of arterial hypertension, and the absence of prescriptions for the antihypertensive medications urapidil and angiotensin II receptor blockers. Further studies are needed to better understand the above associations. Consequently, a personalised multidisciplinary approach to assess the cardiovascular as well as dietary and lifestyle risk factors to reduce the AGE levels in both KTRs and CKD patients may be implemented.

The prognostic potential of the pulmonary function tests parameters in determining the risks of comorbid pathology development

The aim is to study the prognostic potential of the parameters of the pulmonary function tests parameters in determining the risks of developing comorbid pathology. Material and methods. The study included 102 people, with an average age of 47 [43-52.7] years. Questionnaires, anthropometry, blood sampling for biochemical analysis, and spirometry were conducted. Cardiovascular risk (CVR) was calculated on the SCORE2 scale, stratification of the subjects by risk groups was carried out in accordance with the gradation on the scale used. Statistical processing was performed using nonparametric methods. Results. According to the calculation of the SSR on the SCORE2 scale, all the subjects were in the range of moderate (58.7 %) and high risk (41.3 %). The obtained data from the study of the respiratory function of the general sample were slightly lower in women than in men, with significant differences in the obtained FVC, FEV1, FEF2575. Depending on the presence of arterial hypertension (AH) it was found that the median values of both the actual and calculated lower limits of the norm (LLN) of spirometry indicators among people with AH were lower than those studied without hypertension. At the same time, significant differences depending on the presence of AH were revealed only in the case of LLN for FEV1, FEV1/FVC, FEF2575. In individuals with hypertension, the LLN-FEV1/FVC index was significantly lower than 70 %. In the group of subjects with hypertension, an inverse reliable relationship was found (p = −0.4; p &lt; 0.001) between LLN-FEV1/FVC and the level of uricemia – a decrease in the index by 0.008 % will lead to an increase in uric acid by 1 mmol/l. A decrease in LLN-FEV1/FVC by 0.2 l and LLN-FEF2575 by 0.03 l/sec will increase the CVR on the SCORE2 scale by 1 % ((p = −0.5; p &lt; 0.001) (p=−0.3; p=0.002), respectively). Conclusion. An assessment of the prognostic potential of the pulmonary function tests parameters in determining the risks of comorbid pathology, namely a combination of cardiovascular diseases and respiratory pathology, was carried out. A combined approach to the examination of the able-bodied population, taking into account spirometry data, will help to personify and in-depth assess the risks of developing significant diseases that affect the quality and life expectancy of the patient, his ability to work.

Bariatric surgery modulates plasma levels of antibodies against angiotensin II type 1 and endothelin 1 type A receptor in severe obesity.

The contribution of endothelial-targeted autoantibodies against the angiotensin II type 1 receptor (anti-AT1R) and the anti-endothelin 1 type A receptor (anti-ETAR1) has been proposed in the development of cardiovascular diseases. However, no data have been reported yet in obesity. In this observational study we evaluated the relationship between anthropometric and metabolic parameters and anti-AT1R and anti-ETAR1 concentrations in a cohort of patients with severe obesity and associated comorbidities undergoing bariatric surgery. Clinical evaluation and metabolic assessment were performed in 36 subjects referring to our Center for the Study and Integrated Treatment of Obesity at the University Hospital of Padova. Circulating inflammatory adipocytokines and the endothelial dysfunction marker asymmetric dimethylarginine (ADMA) were evaluated; plasma levels of anti-AT1R and anti-ETAR1 were also determined. 10 normal-weight subjects were considered as a control group. 29 patients out of 36 were re-evaluated after surgery. With respect to normal-weight controls patients showed significantly higher plasma levels of anti-AT1R (28 ± 20.4 vs 13.5 ± 2.8 U/mL, p < 0.005) and ADMA (0.8 ± 0.1 vs 0.54 ± 0.08 uM/L, p < 0.0001) but not anti-ETAR1 (14.2 ± 1.3 vs 13.3 ± 2 U/mL, p = 0.1). Anti-AT1R concentration showed an increasing trend with the worsening of glycemic status, while the presence of arterial hypertension among the patients did not affect autoantibodies levels. One year after surgery, a significant improvement in body weight and metabolic and inflammatory parameters was observed, along with a significant reduction of anti-AT1R (28.1 ± 20.4 U/mL vs 22.6 ± 16 U/mL, p < 0.05) and anti-ETAR1 (14.2 ± 1.3 U/L vs 13 ± 1.6 U/L, p < 0.01). Subjects with obesity present higher plasma levels of anti-AT1R which are more related to glycemic profile than blood pressure levels, and are reduced by bariatric surgery. Considering the detrimental effects of these autoantibodies on vascular health, they should be assessed as potential biomarkers in obesity and metabolic diseases.

Possibilities of noninvasive diagnostics of cardiovascular diseases associated with atherosclerosis

Background. Despite the global trend towards a decrease in mortality from cardiovascular pathology of atherosclerotic genesis, this group of diseases continues to occupy a leading position in the structure of disability and mortality among the population of many countries. Aim. Identification of noninvasive markers of arterial wall lesions associated with the presence of arterial hypertension (AH) and coronary heart disease (CHD) in persons younger than 55 years. Materials and methods. The study included 81 people. Three groups were distinguished from them: 1st (n=31) – a control group of practically healthy individuals, average age – 43 (40; 48) years; 2nd group (n=21) – patients with coronary heart disease without a history of cardiovascular diseases (CVD), average age – 45,5±6,1; group 3 (n=29) – patients with AH without CHD, average age – 47 (35; 50) years. The parameters of a biochemical blood test were determined, volumetric sphygmography and a sample with post-occlusive reactive hyperemia were performed. Results. In groups of patients with CHD and AH, negative changes in the lipid profile and higher glucose levels were recorded compared to healthy individuals. According to the results of volumetric sphygmography, the pulse wave velocity in arteries of predominantly elastic type (R/L-PWV) in group 1 was 10.1±1.7 m/s, in group 2 – 12.9±1.8 m/s, in group 3 – 13.1 (12; 14) m/s (р1–2=0.029; р1–30.001); cardio-ankle vascular index (CAVI) – 6.5±0.7, 7.7 (7; 8.7) and 7.8 (7.3; 8.4), respectively (р1–20.001; р1–30.001). According to the data of the test with post-occlusive reactive hyperemia, a comparably high frequency of pathological values of flow-dependent vasodilation (FDV) and reactivity index (RI) was demonstrated in patients with CHD and AH (р1–20.05; р1–30.05). A multifactorial model of noninvasive diagnosis of CHD in individuals without a history of CVD, including non-high-density lipoprotein cholesterol, R/L-PWV, and FDV, has been developed. For patients with AH, glucose, lipid metabolism, R/L-PWV, pulse wave velocity in muscle-type arteries (B-PWV), augmentation index (AI), biological age, CAVI, FDV, RI were the risk factors for the presence of the disease in the anamnesis. Conclusion. The results obtained confirm the importance of an integrated approach in the screening diagnosis of CVD.

Associations of ECG Signs of Ischemic and Non-Specific Signs of Metabolic Changes in the Myocardium With Unfavorable Cardiovascular Prognosis in a 7-Year Prospective Follow-Up of Young People Under 45 Years.

To study ischemic and/or nonspecific ECG signs of metabolic changes in the myocardium and to determine their relationship with unfavorable cardiovascular prognosis in a 7-year prospective observation of young people under 45 years of age. A cross-sectional population survey of a random sample aged 25-44 years (n=1363) was conducted in Novosibirsk. The survey program used the standardized epidemiological Rose questionnaire. Biochemical tests were used to measure blood concentrations of total cholesterol (C), triglycerides (TG), low- and high-density lipoprotein cholesterol (LDL-C, HDL-C), and fasting blood plasma glucose. Systolic and diastolic BP (SBP, DBP), the presence of arterial hypertension (AH), body mass index (BMI), waist circumference (WC), and smoking status were assessed. ECG was recorded at rest in 12 standard leads followed by interpretation according to the Minnesota Code. The presence of ischemic and/or nonspecific ECG signs of metabolic changes in the myocardium was determined. Subjects with ECG signs of ischemic changes in the myocardium were selected for long-term follow-up and additional examination by cardiologists. Then the whole cohort was monitored for 7 years, and cardiovascular events were recorded, including using data from the WHO Myocardial Infarction Registry in Novosibirsk. For statistical analysis of the results, cardiovascular events were combined into a composite endpoint. During 7 years, 40 people (27 men and 13 women) had an unfavorable cardiovascular prognosis. Multivariate regression analysis showed that a 7-year unfavorable cardiovascular prognosis in people younger than 45 years was associated with signs of ischemic myocardial alterations identified on the background ECG (OR 5.319, 95% CI: 1.543-18.342, p=0.008) and nonspecific ECG signs of metabolic changes in the myocardium (OR 2.978, 95% CI: 1.216-7.216, p=0.017) regardless of age, gender, the presence of arterial hypertension (AH) and type 2 diabetes mellitus (DM2). In young people under 45 years of age, not only ECG signs of ischemic changes in the myocardium, but also nonspecific ECG signs of metabolic changes in the myocardium are associated with an unfavorable cardiovascular prognosis, directly and independently on age and gender, in a long-term, 7-year period.

От неалкогольной к метаболически ассоциированной жировой болезни печени. Стеатометрия и кардиометаболические факторы как предикторы развития стеатогепатита

Non-alcoholic metabolic dysfunction-associated fatty liver disease is the most common liver sickness linked with the high risk of hepatic and extrahepatic complications. The article provides an overview of changes in the nomenclature of this disease, analysis of risk factors for its development and the results of own research. The aim of the study was to estimate the clinical significance of steatometry (CAP function) by Fibroscan and cardiometabolic factors in assessing the risk of steatohepatitis development. Material and methods. Patients with hepatic steatosis accompanied by metabolic disorders were examined. Steatometry as well as routine physical and laboratory examination, including biochemical blood tests and abdominal ultrasound were provided. Statistical analysis included χ2 test, Spearman's rank correlation test, Student's t-test, Mann–Whitney test, multiple linear regression analysis. Results. 74 patients were included. Main characteristics of the cohort: 62.2% male, mean age – 48.8 years, cases of steatohepatitis – 41.9%. It was revealed that the number of metabolic factors in an individual patient correlated with the presence of steatohepatitis (χ2 = 3.29; p &lt; 0.05) and the severity of steatosis by steatometry (rs = 0.37; p &lt; 0.05). Individual clinical and laboratory parameters influenced the severity of steatosis with varying degrees. The most significant parameters were: abdominal circumference, concentration of HDL, insulin, activity of ALT, GGTP, and the presence of arterial hypertension. Using these indicators, a formula for assessing the risk of severe liver steatosis was created. Conclusion. Steatometry is to be considered as an important diagnostic method for the prognosis assessment in patients who have risk factors for the development and progression of non-alcoholic metabolic dysfunction-associated fatty liver disease. Severe steatosis is a predictor of steatohepatitis. The number of metabolic factors present in an individual patient is important in assessing the risk of severe liver steatosis and steatohepatitis.

Niveles de Vitamina D en pacientes con y sin Enfermedad Renal Crónica, perfil clínico y epidemiológico: un análisis preeliminiar en un hospital de segundo nivel en quito, Ecuador.

Vitamin D has been associated with different effects unrelated to bone-mineral metabolism, such as its association with arterial hypertension. This study determines the prevalence profile of vitamin D deficiency and insufficiency in Ecuadorian patients, its epidemiological profile, and its relationship with other diseases such as arterial hypertension, diabetes mellitus, and chronic kidney disease. This is a pioneering study in Ecuador of a retrospective type, carried out at the Pablo Arturo Suarez Hospital over 6 months, in which it was found that the prevalence of vitamin D insufficiency was 28.5% (levels between 21 to 30 ng/ml) and deficiency was 57% (levels less than 20 ng/ml); Likewise, we ratify the inverse relationship between vitamin D levels and age, as well as finding a certain association between vitamin D levels and the presence of arterial hypertension; while no significant differences were found in its relationship with diabetes mellitus, chronic kidney disease without the use of renal replacement therapy and the general population. Keywords: vitamin D, chronic kidney disease, metabolism.

Niveles de Vitamina D en pacientes con y sin Enfermedad Renal Crónica, perfil clínico y epidemiológico: un análisis preeliminiar en un hospital de segundo nivel en Quito, Ecuador.

Vitamin D has been associated with different effects unrelated to bone-mineral metabolism, such as its association with arterial hypertension. This study determines the prevalence profile of vitamin D deficiency and insufficiency in Ecuadorian patients, its epidemiological profile, and its relationship with other diseases such as arterial hypertension, diabetes mellitus, and chronic kidney disease. This is a pioneering study in Ecuador of a retrospective type, carried out at the Pablo Arturo Suarez Hospital over 6 months, in which it was found that the prevalence of vitamin D insufficiency was 28.5% (levels between 21 to 30 ng/ml) and deficiency was 57% (levels less than 20 ng/ml); Likewise, we ratify the inverse relationship between vitamin D levels and age, as well as finding a certain association between vitamin D levels and the presence of arterial hypertension; while no significant differences were found in its relationship with diabetes mellitus, chronic kidney disease without the use of renal replacement therapy and the general population. Keywords: vitamin D, chronic kidney disease, metabolism.

Biofeedback Endurance Training for Gait Rehabilitation in Parkinson’s Disease: a Non-Randomized Controlled Study

INTRODUCTION. Parkinson’s disease is a disease with the highest rates of disability growth in the neurodegenerative pathology group, with the leading motor symptom — impaired walking and an increased risk of falling. There is evidence that Parkinson’s disease preserves stability for cycling. The issue of extending the effects of cycling training to daily activity, including walking, remains unclear.&#x0D; AIM. To evaluate the effect of a course of endurance training on a cycle ergometer with biofeedback (BFB) on a walking ability of a patient with Parkinson’s disease.&#x0D; MATERIALS AND METHODS. A total of 69 patients with stages 2–3 Parkinson’s disease according to the Hoehn and Yahr Rating Scale were included in the study, group 1: 34 people (60.05 ± 7.07 years) and group 2: 35 patients (61.75 ± 7.53 years). The patients were examined — anamnesis collection: duration of Parkinson disease, presence of arterial hypertension (AH), sports history, medication, assessment of systolic and diastolic blood pressure (SBP and DBP), body mass index (BMI), “6-minute walk” test (6MWT), motor function according to the MDS UPDRS scale — part III. The patients of group 1 had daily exercises on a digital bicycle ergometer with BOS for 10 days, the patients of group 2 — therapeutic gymnastics. The therapy was assessed by repeated 6MWT.&#x0D; RESULTS AND DISCUSSION. The Parkinson’s disease duration was longer in the patients of group 1. Concomitant hypertension was in 20 (57 %) patients of group 1 and 16 (47 %) patients of group 2 (p 0.05). 11 people of group 1 and 5 of group 2 had a sports history (p = 0.07). The indicators of SBP and DBP of groups 1 and 2 had normal values during the examination. BMI in both groups corresponded to excess body weight. Patients had risk factors of the modern world: hypertension and overweight. Motor disorders according to the MDS UPDRS — Part III scale were greater in group 1. Despite having serious motor impairments in group 1, after the therapy, the patients demonstrated an increase in the distance traveled in 6 minutes (392.18 ± 96.3 m vs. 476.43 ± 108.08 m; p 0.05), while no changes were found in group 2.&#x0D; CONCLUSION. BOS endurance training on a cycle ergometer is effective for walking rehabilitation of Parkinson’s disease patients.

Follistatin-like 1 (FSTL1) levels as potential early biomarker of cardiovascular disease in a Mexican population.

Cardiovascular diseases (CVD) are the leading cause of death globally. In recent years, follistatin-like protein 1 (FSTL1) has been proposed as an emerging potential clinical biomarker of CVD, since its concentration is upregulated in heart failure. The aim of the present study was to evaluate the association of FSTL1 levels and classic biomarkers with the risk of CVD in Mexican population. A case-control study was carried out in patients with cardiovascular diseases (CVD), arterial hypertension, but not CVD (cardiovascular risk factor-CRF), and healthy controls (control group) from the Mexican Institute of Social Security. Lipid profile, homocysteine (Hcys), serum amyloid A (SAA), FSTL1 concentration, PON1 concentration and activities [Arylesterase (ARE), and Lactonase (LAC)] were evaluated. High levels of FSTL1 were found in the CRF group and a positive association of FSTL1 (OR = 4.55; 95% CI 1.29-16.04, p = 0.02) with the presence of arterial hypertension, as well as Hcys (OR, 3.09; 95% CI 1.23-7.76, p = 0.02) and SAA (OR, 1.03; 95% CI 1.01-1.05, p < 0.01) with the presence of CVD. LAC activity (OR, 0.26; 95% CI 0.07-0.94, p = 0.04) and PON1 concentration (OR, 0.17; 95% CI 0.05-0.62, p = 0.01) were associated with a decrease in OR belonging to the group with CVD. Our results suggest that FSTL1 may be a useful biomarker for monitoring cardiovascular risk in clinical settings. However, longitudinal studies are needed to evaluate how FSTL1 could influence the association of PON1activity and Hcys with CVD.

Association Between Endothelial Cell Density and Corneal Thickness in Medium, Short, and Long Eyes of Han Chinese Cataract Patients

To evaluate the association between the endothelial cell density (ECD) and central corneal thickness (CCT) in medium, short, and long eyes of preoperative Han Chinese cataract patients. Retrospective cross-sectional study. We consecutively enrolled 410 eyes, namely, 50 short eyes (axial length [AL]<22.0 mm), 150 medium eyes (22.0≤AL<24.0 mm), 120 medium-long eyes (24.0≤AL<26.0 mm), and 90 long eyes (AL≥26.0 mm), of 410 adult patients scheduled for cataract surgery. The ECD and CCT were determined preoperatively with a noncontact specular microscope. The association between the CCT and ECD was identified by using a multivariable regression analysis. A thin cornea was defined as having a CCT less than 500 µm. After adjusting for age, the presence of arterial hypertension, the presence of diabetes mellitus, intraocular pressure, and AL, a positive association between the CCT and ECD was identified in short eyes (linear regression coefficient [B]=3.40; standardized B [β]=0.52; P = .03), medium eyes (B = 2.33; β=0.28; P = .002), medium-long eyes (B = 1.84; β=0.25; P = .02), and long eyes (B = 2.69; β=0.41; P = .04). In the total group, the multivariable logistic analysis showed a significant link between the presence of a thin cornea and a lower ECD (odds ratio [OR]=0.80 per 100 cells/mm2 increase; P = .001). For cataract patients of Han ethnicity, a significant association between a thin CCT and a lower ECD was shown across the AL spectrum and was most prominent in short eyes. Eyes with a thin cornea are more likely to have a lower ECD.

Risk factors associated with glomerular filtration rate in Mexican adults with type 2 diabetes mellitus

IntroductionType 2 diabetes mellitus (T2DM) is related to glomerular filtration rate (GFR) impairment, which is one of the main causes of chronic kidney disease. The objective of this study was to identify the risk factors related to GFR in Mexican adults with T2DM, using a validated multiple linear regression model (MLRM), with emphasis in body adiposity, glycemic control, duration of the diabetes and other relevant risk factors. Materials and methodsA cross-sectional, analytical, and observational study was carried out in 252 adults with a previous diagnosis of T2DM. Body mass index (BMI) and waist circumference (WC) were determined and a fasting blood sample was collected for glucose, creatinine and HbA1c determinations. GFR was calculated with the Cockcroft–Gault equation adjusted for body surface area. Four MLRM were performed to determine the factors related to the GFR; it was evaluated whether these models complied with the statistical assumptions of the linear regression model. ResultsThe average age of the participants was 60 ± 12 years, 62.3% of them were women. GFR correlated with BMI and WC; age and duration of the diabetes were associated inversely. Model 4 of the MLRM reported a coefficient of determination of 53.5% where the variables BMI (β = 1.31), male sex (β = −6.01), duration of T2DM (β = −0.57), arterial hypertension (β = −6.53) and age (β = −1.45) were simultaneously and significantly related to the GFR. ConclusionsOlder age, male sex, longer duration of T2DM and the presence of arterial hypertension were associated with a decrease in the GFR; BMI and WC were directly associated. No effect of glucose and HbA1c on GFR was observed.

Aneurysm Wall Contrast on Magnetic Resonance Imaging: A New Predictor of Rupture of Saccular Intracranial Aneurysms

Background. Recent studies suggest that accumulation of contrast agent in the aneurysm’s wall may predict a high risk of aneurysm growth or rupture.Objective. To compare the enhancement of the aneurysm wall with other characteristics that affect at the risk of rupture.Materials and Methods. The study included 95 patients with 132 previously identified saccular aneurysms, who underwent magnetic resonance imaging (MRI) according to a specialized protocol using 3.0 Tesla MRI scanner. The presence or absence of aneurysm’s wall enhancement compared with the following characteristics: gender and age of the patient, the size and shape of the aneurysm, the presence of arterial hypertension, and the PHASES score.Results. Accumulation of contrast agent by the aneurysm’s wall was associated with the aneurysm dome size (p &lt; 0,001, Sp = 78,1 %, Se = 72,1 %) and PHASES score (p &lt; 0,001, Sp = 64,1 %, Se =57,1 %). No relationship between age, gender, arterial hypertension, shape, and aneurysm location and contrast enhancement was found (p &gt; 0,05).Conclusion. Contrast enhancement of the aneurysm wall on MRI can be considered an additional risk marker of its rupture.

Factores de riesgo asociados con la tasa de filtración glomerular en adultos mexicanos con diabetes mellitus tipo 2

IntroductionType 2 diabetes mellitus (T2DM) is related to glomerular filtration rate (GFR) impairment, which is one of the main causes of chronic kidney disease. The objective of this study was to identify the risk factors related to GFR in Mexican adults with T2DM, using a validated multiple linear regression model (MLRM), with emphasis in body adiposity, glycemic control, duration of the diabetes and other relevant risk factors. Materials and methodsA cross-sectional, analytical, and observational study was carried out in 252 adults with a previous diagnosis of T2DM. Body mass index (BMI) and waist circumference (WC) were determined and a fasting blood sample was collected for glucose, creatinine and HbA1c determinations. GFR was calculated with the Cockcroft-Gault equation adjusted for body surface area. Four MLRM were performed to determine the factors related to the GFR; it was evaluated whether these models complied with the statistical assumptionsof the linear regression model. ResultsThe average age of the participants was 60±12 years, 62.3% of them were women. GFR correlated with BMI and WC; age and duration of the diabetes were associated inversely. Model 4 of the MLRM reported a coefficient of determination of 53.5% where the variables BMI (β=1.31), male sex (β=-6.01), duration of T2DM (β=-0.57), arterial hypertension (β=-6.53) and age (β=-1.45) were simultaneously and significantly related to the GFR. ConclusionsOlder age, male sex, longer duration of T2DM and the presence of arterial hypertension were associated with a decrease in the GFR; BMI and WC were directly associated. No effect of glucose and HbA1c on GFR was observed.

Independência funcional, aspectos clínicos e fatores sociodemográficos em pacientes na fase aguda do Acidente Vascular Cerebral: uma análise de associação

ABSTRACT Purpose To analyze the association of functional independence with clinical aspects of neurological impairment, the location and extent of neuronal damage and sociodemographic factors in patients in the acute phase of stroke. Methods Analytical cross-sectional study in 90 adult and older patients affected by ischemic stroke, admitted to the hospital within 24 hours of the vascular event. Sociodemographic factors and clinical aspects data were collected from electronic medical records and/or interviews in order to depict the patients'profile, Oxfordshire Community Stroke Project, Alberta Stroke Programme Early CT Score, National Institute of Health Stroke Scale, and Functional Independence Measure. Results Neurological impairment, according to the National Institute of Health Stroke Scale, was associated with functioning in the first 24 hours after the stroke. Furthermore, the presence of arterial hypertension, age, inactive work, smoking and extent of neuronal damage were associated with functional dependence, but did not remain in the final model of this study. Conclusion Functional dependence is associated with arterial hypertension, age, inactive work, smoking, extent of neuronal damage, and degree of neurological impairment in the first 24 hours after the vascular event. Furthermore, a higher level of neurological impairment was independently associated with increased levels of functional dependence.

Improving the management of morbidly obese patients with postoperative bleeding undergoing Roux-en-Y gastric bypass.

Aim: To improve the management of morbidly obese patients who undergo gastric bypass surgery to reduce the number of postoperative complications, in particular, bleeding. Materials and Methods: From 2011 to 2022, a total of 348 patients with morbid obesity (MO) underwent laparoscopic gastric bypass treatment at the clinical base of the Department of General Surgery №2 of Bogomolets National Medical University. The retrospective group included 178 patients who received treatment between 2011 and 2019. 170 patients were enrolled in the prospective group for the period from 2019 to 2022. Results: Retrospective group had 8 episodes of postoperative bleeding, representing a rate of 4.49%, prospective group - 3 episodes of postoperative bleeding, representing a rate of 1.76% Four factor characteristics associated with the probability of bleeding were identified: "number of comorbid conditions", "arterial hypertension", "chronic liver diseases" and "chronic obstructive pulmonary disease". Conclusions: The factors responsible for the occurrence of postoperative bleeding in morbidly obese patients after laparoscopic gastric bypass surgery were the number of comorbid conditions, the presence of arterial hypertension, the presence of chronic liver diseases, and chronic obstructive pulmonary disease. A new strategy for the management of morbidly obese patients after laparoscopic gastric bypass was developed. This strategy involves changing cassettes to create gastroentero- and enteroenteroanastomoses, reducing the period of use of the nasogastric tube, drains, and urinary catheter from 3-4 days to 1 day, and resuming the drinking regimen 6 hours after extubation.