Hypertension Research Articles

Mechanism of vitamin D deficiency involvement in the development of pulmonary arterial hypertension related to monocrotaline-induced connective tissue disease in rats

Objective: To investigating the impact of vitamin D (VitD) deficiency on the jagged 1 protein (Jagged1)/Notch3 signaling pathway in the pulmonary arteries of rats with monocrotaline (MCT)-induced connective tissue disease (CTD)-related pulmonary arterial hypertension (PAH) and to explore the pathological and molecular mechanisms of VitD involvement in the development of CTD-PAH. Methods: Twenty-four 7-week-old male Wistar rats were divided into a normal diet group and a VitD-free diet group using random number table, with 12 rats in each group. After 5 weeks of feeding, the rats were further randomly divided into saline and MCT groups, forming group A (normal diet+saline), group B (normal diet+MCT), group C (VitD-free+saline), and group D (VitD-free+MCT), with 6 rats in each group, and the rats were continued to be fed for another 4 weeks. The MCT group was injected with MCT solution subcutaneously on the back of the neck to construct the CTD-PAH model, and the saline group was injected with an equal amount of saline as a control. At the end of the experiment, blood samples were collected from all rats, and the serum 1, 25-dihydroxy vitamin D levels were determined by enzyme-linked immunosorbent assay. Hemodynamic measurements were performed on all rats, recording and calculating the mean values of right ventricular pressure and pulmonary artery pressure. Lung tissues and pulmonary arteries of all rats were stained with hematoxylin-eosin staining, the inner and outer diameters of pulmonary vessels were measured, and the percentage of pulmonary artery medial layer thickness was calculated. The right ventricular hypertrophy index was determined by weighing the parts of the heart and calculating the ratio. The apoptosis of pulmonary artery smooth muscle cells was assessed by terminal deoxynucleotidyl transferase-mediated deoxyuridine triphosphate nick-end labeling. The expression levels of Jagged1, Notch3, and hairy and enhancer of split-1 (Hes1) mRNA and protein in the pulmonary arteries were analyzed by reverse transcription quantitative polymerase chain reaction and Western blotting. Results: The serum 1, 25-dihydroxy vitamin D levels in group D were significantly lower than those in groups A, B, and C [(51.01±0.96) μg/L, (65.15±1.83), (57.49±0.28), (54.52±2.87) μg/L, respectively, all P<0.05]. The right ventricular pressure, pulmonary artery systolic pressure, pulmonary artery diastolic pressure, and mean pulmonary artery pressure in Group D rats were significantly higher than those in groups A, B and C (all P<0.05). The percentage of pulmonary artery medial layer thickness in group D (56.28%±9.51%) was significantly higher than that in Groups A (21.28%±1.89%), B [22.72% (22.16%, 30.10%)], and C (38.73%±7.34%) (all P<0.05); the right ventricular hypertrophy index in group D (45.74%±12.68%) was significantly higher than that in groups A (21.78%±2.80%), B (40.93%±9.10%), and C (23.71%±1.22%) (all P<0.05). The apoptosis of pulmonary artery smooth muscle cells in group D (0.07±0.01) was significantly lower than that in groups A (1.00±0.08), B (0.17±0.02), and C (0.49±0.07) (all P<0.05). The levels of Jagged1, Notch3, and Hes1 mRNA and protein in Group D were all significantly higher than those in Groups A, B, and C (all P<0.05). Conclusions: VitD deficiency is involved in the pathophysiological mechanisms of CTD-PAH development. This occurs by upregulating the expression of the Jagged1/Notch3/Hes1 pathway in the pulmonary arteries of rats with MCT-induced PAH. The consequences include pulmonary artery thickening, increased pulmonary artery pressure, increased right ventricular pressure, right ventricular hypertrophy, and decreased apoptosis of pulmonary artery cells.

Prevalence of Chronic Kidney Disease among diagnosed and undiagnosed hypertensive individuals in the general population of the northern region of Senegal

Introduction: Chronic kidney disease (CKD) is closely linked to high blood pressure (HBP) which is its leading cause in developing countries. Hypertension affect 1.2 billion people worldwide. However, a significant portion of individuals with HBP are undiagnosed and their kidney function is even less known. The objective of this study was to determine the prevalence and associated factors of chronic kidney disease among three sub-groups of blood pressure status (normotensive, diagnosed hypertension and undiagnosed hypertension) individuals. Patients and Methods: We conducted a cross-sectional study in the general population of three northern regions in Senegal using a two-level cluster sampling method. The sample was constituted with a precision of 5% and a power of 80%, with an additional 10% attrition margin. Individuals aged 18 – 80 years were included in the study after consent. Pregnant women, hospitalized persons within the past three months, patients with general or urinary symptoms within the past seven days and individuals undergoing renal replacement therapy were excluded. Investigators collected Clinical and biological data at participants' homes using a modified version of the WHO's STEPwise questionnaire. Samples were collected for biochemical analysis (serum creatinine, lipid profile and blood sugar). Estimated GFR was calculated using the CKD-EPI 2021 formula. Results: A total of 2441 participants were included in the study with a mean age of 45.4 +/- 16.0 years and a sex ratio M/F of 0.4. The Overall prevalence of HBP and CKD were respectively 52.0% and 17.8%. Three out of every five hypertensive patients were undiagnosed. Chronic kidney disease was more frequent among known hypertensive patients (30.5%) compared to individuals with undiagnosed hypertension (19.1%) and normotensive individuals (10.9%). Multivariate analysis showed that CKD was associated with older age and female sex. Conclusion: Undiagnosed hypertension is common among populations in northern Senegal. A high prevalence of CKD was found among both diagnosed and undiagnosed individuals with hypertension. Extending strategies for early detection and management in the general population could help prevent or reduce morbidity and mortality associated with CKD.

Relationship between perceived stress and levels of blood pressure: single center study

&amp;lt;p&amp;gt;&amp;lt;strong&amp;gt;Introduction. &amp;lt;/strong&amp;gt;High blood pressure (HBP) is a significant cardiovascular risk factor, with hypertension recognized as a leading cause of global mortality. This study aims to investigate the correlation between perceived stress and&amp;amp;nbsp;&amp;lt;br /&amp;gt;blood pressure levels among patients diagnosed with hypertension.&amp;amp;nbsp;&amp;lt;br /&amp;gt;&amp;lt;strong&amp;gt;Methods.&amp;lt;/strong&amp;gt; A cross-sectional study was conducted involving 80 hypertensive patients at the Institute for Cardiovascular Diseases &amp;amp;ldquo;Dedinje&amp;amp;rdquo;. Comprehensive clinical examinations, including 24-hour ambulatory blood pressure monitoring (ABPM) and Perceived Stress Scale (PSS) assessments were performed.&amp;amp;nbsp;&amp;lt;br /&amp;gt;&amp;lt;strong&amp;gt;Results.&amp;lt;/strong&amp;gt; The results revealed a significant positive correlation between PSS scores and blood pressure levels (r = 0.65, p &amp;amp;lt; 0.001), indicating that higher perceived stress is associated with elevated blood pressure. Furthermore, no statistically significant difference was found between stress levels and sex or smoking status.&amp;amp;nbsp;&amp;lt;br /&amp;gt;&amp;lt;strong&amp;gt;Conclusion.&amp;lt;/strong&amp;gt; These findings underscore the importance of stress management interventions in hypertension treatment, suggesting that addressing perceived stress could enhance therapeutic outcomes for patients.&amp;lt;/p&amp;gt;

Impact of a Physical Exercise and Health Education Program on Metabolic Syndrome and Quality of Life in Postmenopausal Breast Cancer Women Undergoing Adjuvant Treatment with Aromatase Inhibitors

Background and Objectives: Adjuvant treatment with aromatase inhibitors (AIs) in breast cancer (BC) survivors can cause adverse effects such as metabolic syndrome (MS) (insulin resistance, central obesity, atherogenic dyslipidemia, and hypertension) associated with morbidity and premature mortality. We evaluate the effect of a multimodal program based on physical exercise and health education on MS and health-related quality of life (QoL) in postmenopausal women with BC under AIs. Methods: A total of 56 postmenopausal women, diagnosed with BC, aged 60 years or older (mean age 67.2 years) and on hormonal treatment with AIs, were included in the multimodal physical exercise and health education program, and evaluated before and after their participation. The assessment of the five criteria of the MS included the following: waist circumference, high blood pressure, fasting glucose, triglycerides, and high-density lipoprotein cholesterol. Two main instruments were used to evaluate the impact of the intervention on QoL: the EORTC QLQ C30 (questionnaire for cancers in general) and the EORTC QLQ BR23 (specifically for breast cancer patients). The EuroQol 5D (EQ-5D) was also used to compare these results. Results: The percentage of women meeting the MS criteria was 37.7% at baseline and fell to 15.1% at 3 months after the intervention (p = 0.02). The intervention significantly reduced hypertension (p &lt; 0.001), central obesity (p &lt; 0.001), and the concentration of triglycerides (p = 0.016). No significant changes were observed in fasting glucose and HDL concentration. A statistically significant improvement was found in QoL (on both the QLQ30 and BR23 scales). A multivariate regression model analysis identified marital status (being married) (95% CI: 1.728–131.615, p = 0.014), and percentage of attendance at health education sessions (95% CI: 1.010–1.211, p = 0.029) as positive predictive variables of improvement in MS. Conclusions: The implementation of multimodal, community-based programs of physical exercise and health education improve the prevalence of MS and specific criteria of MS and QoL in postmenopausal women with breast cancer receiving AI treatment.

Bacteriemias por anaerobios estrictos

Introduction. Anaerobic bacteremia represents 0.5-12% of all bacteremias and its mortality is high, ranging from 25-44%. The aim was to know our data to compare them with existing data and demonstrate the importance of actively searching for these microorganisms in blood culture samples. Material and methods. A retrospective descriptive study in which the medical records of patients with significant episodes of anaerobic bacteremia were reviewed over a period of 8 years (2014-2022). Results. A total of 59,898 blood cultures were processed, of which 10,451 were positive (17%). An anaerobic microorganism was identified in 209 patients. Anaerobic bacteremia accounted for 2.11% of the total number of positive blood cultures. The mean age was 63.55 years (17-96), 66% of whom were men. The origin was community in 63.64%, of nosocomial origin in 15.31% and associated with health care in 17.70%. The focus of infection was the abdominal (39.23%), followed by the respiratory (13.88%) and skin and soft tissues (13.39%). The most frequent comorbidities were: arterial hypertension (49.76%), dyslipidemia (29.67%), neoplasia (26.32%) and diabetes (26.32%). The main species isolated were the group Bacteroides spp. (44.50%) (n=93) highlighting Bacteroides group fragilis (n=65), followed by Clostridium spp. (20%) (n=42) highlighting Clostridium perfringens (n=30). The clinical evolution was good in 67.46%. The mean length of stay was 27.8 days and was associated with 20% mortality. Conclusions. Bacteremias due to anaerobes represented 2.11% of the total number of true bacteremias, so we consider the active search for these microorganisms to be appropriate.

ARF6 as a Novel Activator of HIF-2α in Pulmonary Arterial Hypertension

ARF6 as a Novel Activator of HIF-2α in Pulmonary Arterial Hypertension

C-C motif chemokine receptor-2 blockade ameliorates pulmonary hypertension in rats and synergizes with a pulmonary vasodilator

Abstract Aims We investigated whether the disruption of C-C motif chemokine receptor (CCR) 2 may attenuate the development of pulmonary arterial hypertension (PAH) in any rat models with the reversal of the associated pro-inflammatory state and vascular dysfunction, and synergize with a conventional pulmonary vasodilator. Methods and Results Using Ccr2(-/-) rats generated by CRISPR/Cas9, we investigated pulmonary hypertension (PH) in Ccr2(+/+) or Ccr2(-/-) rats treated with monocrotaline (MCT), SU5416/hypoxia (SuHx) and chronic hypoxia (CH). Ccr2(-/-) decreased the right ventricular systolic pressure, an index of right ventricular hypertrophy and mortality rate, and reversed increased expression of inflammatory cytokines/chemokines (interleukin-6, tumor necrosis factor-α, C-C motif chemokine receptor (CCL)-2, interleukin-1β, transforming growth factor-β) in rats 3weeks after MCT injection, but not in SuHx or CH models. Consistently, Ccr2(-/-) decreased indices of pulmonary vascular diseases (PVD) and perivascular macrophage infiltration, as well as reversed impaired bone morphogenetic protein receptor type 2 signaling, increased endothelial apoptosis and impaired nitric oxide signaling and decreased phosphodiesterase-5 (PDE5) expression in lungs in MCT-treated rats. Gene expression of receptors for prostaglandin I2 and endothelin was not changed by Ccr2(-/-) in MCT-treated rats. In cultured pulmonary arterial smooth muscle cells (PASMCs), Ccr2(-/-) suppressed CCL2-induced hyperproliferation and dedifferentiation as well as reversed CCL2-induced decrease in PDE5 expression. The whole-genome RNA sequencing analysis identified differentially expressed genes in CCL2-stimulated Ccr2(-/-) PASMCs, which are related to regulation of cellular differentiation and contraction. Based on studies in rats and cultured PASMCs, we investigated whether a PDE5 inhibitor, tadalafil, synergizes with Ccr2(-/-). Tadalafil administration ameliorated PH and PVDs in MCT-treated Ccr2(-/-) rats but not in Ccr2(+/+) rats. Tadalafil further improved survival in MCT-treated Ccr2(-/-) rats. Conclusion The present findings demonstrated that CCR2 disruption ameliorated PAH in MCT-treated rats, which was associated with the reversal of dysregulated inflammatory pathways and vascular dysfunction and synergized with tadalafil. These findings suggest that CCR2 may be a therapeutic target in intractable PAH patients with a certain CCR2-related inflammatory phenotype and refractory to conventional pulmonary vasodilators.

A IMPORTÂNCIA DOS CURATIVOS ESPECIAIS EM FERIDAS DE DÍFICIL CICATRIZAÇÃO EM PACIENTES DE UMA CLÍNICA EM VITÓRIA DA CONQUISTA– BA

Wounds that are difficult to heal are those associated with diseases such as DM, SAH, leprosy, neoplasm, neurological and vascular problems, and others. Special dressings are suitable for the treatment of these injuries and, therefore, appropriate care is recommended. This research aims to: evaluate the relationship between the evolution of the healing process and the use of special dressings. This is a cross-sectional, quantitative and exploratory field research conducted in a clinic that specializes in wound prevention and treatment. The study included adults aged 60 to 70 years (50%), with lower limb injury (91.7%) over 1 year (58.3%), pathogenic history of Diabetes Mellitus and Systemic Arterial Hypertension (58.3%). %), adequate nutrition (91.7%), move independently (66.7%), diabetic foot and chronic wound (58.3%), deep wound involvement (83.3%), injured tissue granulated (75%), wounds with exudates and fibrosis (58.3%), moderate (50%) and mild (50%) pain, wound skin / edema (66.7%), macerated (91, 7%) and desquamative (66.7%). The lesions contain serous (41.7%), turbid (41.7%) and moderate (66.7%) exudates and characteristic odor (58.3%). The treatment is done with calcium alginate (66.7%), dressing up to 2 days (58.3%), with evolution in its entirety (100%). In view of the above, it is necessary to use these types of special covers to treat chronic injuries, but also the importance of comprehensive patient care, including the means of prevention, monitoring and treatment of existing co morbidities in order to obtain expected results.

The Glu86 Residue in TBX4 Proves Critical for Human Lung Development

ABSTRACTT‐box transcription factors are a group of evolutionarily conserved T‐box‐containing regulators of mesoderm specification and development. Heterozygous single nucleotide variants (SNVs) or copy‐number variant (CNV) deletions involving dosage‐sensitive TBX4 have been associated with pulmonary arterial hypertension (PAH), ischiocoxopodopatellar syndrome with or without PAH, and lethal lung developmental disorders (LLDDs), including acinar dysplasia (AcDys), congenital alveolar dysplasia (CAD), and other unspecified primary pulmonary hypoplasias. Loss‐ and gain‐of‐function variants have been proposed to cause pediatric PAH and LLDDs, and adult forms of PAH, respectively. Of more than 50 missense SNVs scattered across the entire TBX4, only three have been reported in patients with LLDDs, all mapping to the T‐box domain. Here, we report a recurrence of a pathogenic substitution Glu86Lys identified in an unrelated patient with AcDys. In silico predictions of the conformational changes of TBX4 resulting from this and another substitution, Glu86Gln, suggest the loss of most intermolecular hydrogen bonds involving residue 86, including those with Tyr230 that directly interact with DNA. Functional assays on the TBX4 variants in fetal lung fibroblasts confirmed their deleterious character. We propose that Glu86 is critically involved in maintaining TBX4 structure and function essential for airway branching during early stages of human lung development. Substitutions of this residue may act in a dominant negative manner, leading to AcDys and CAD.

Dependent censoring bias assessment using inverse probability of censoring weights: Type 2 diabetes mellitus risk in patients initiating bisoprolol versus other antihypertensives in a Clinical Practice Research Datalink cohort study.

Dependent censoring involves a preferential attrition of a subgroup of interest; occurring in survival analysis, it may impact interpretation by introducing a selection bias. To assess the potential bias in a comparison of bisoprolol to other antihypertensives in terms of Type 2 diabetes mellitus (T2DM) incidence, inverse probability of censoring weights (IPCW) was used. It was further used to contextualize results obtained through competing risks analysis. Two estimands were considered to assess T2DM incidence while accounting for deviations from the initial antihypertensive monotherapy (DFM). A hypothetical estimand using IPCW, treating DFM as censoring, was interpreted together with a 'while-on-treatment' estimand, treating DFM as a competing risk. We illustrated our application with a cohort study based on Clinical Practice Research Datalink (CPRD) including 267,352 patients with newly diagnosed arterial hypertension between 2000 and 2017, initiating antihypertensive monotherapy among bisoprolol, other beta-blockers, renin-angiotensin system drugs (ACEi/ARB), diuretics and calcium-channel blockers. A mild dependent censoring process was hypothesized, leading to slight overestimation of T2DM incidence. Although subject to some limitations, a nonsignificant trend toward an excess of risk associated with ACEi/ARB was yielded consistently by IPCW and competing risks analyses. Conversely, in comparisons of bisoprolol versus either diuretics, other beta-blockers or calcium channel blockers, no significant differences or critical dependent censoring impact were found. Concurrent use of complementary estimands allowed formulating a refined interpretation of our findings: though not significant, the trend toward an excess of T2DM risk associated with a ACEi/ARB monotherapy compared with bisoprolol is likely not originating only from the minor dependent censoring. Reassessing identical estimands in other cohorts would provide insights to corroborate or refute this result.

High blood pressure in the emergency department as an opportunistic screening tool for detection of hypertension.

Hypertension is the most preventable cause of morbidity and mortality, but many individuals are underdiagnosed and lack treatment control. High blood pressure (BP) in the emergency department (ED) is commonly observed, but mostly used for short-term evaluation. We aimed to study the usefulness of high BP in the ED as a screening tool for undiagnosed hypertension. We used the electronic medical record system to identify all patients that had attended the ED at a university hospital from 2018-01-01 to 2018-03-31 and from 2018-07-01 to 2018-09-30 with an obtained systolic BP ≥ 160 and/or diastolic BP ≥ 100 mmHg measured at the ED. We excluded patients with previously diagnosed hypertension and patients on BP-lowering medication. All patients identified where contacted two years after attending the ED, with a letter of consent and a questionnaire regarding diagnosis of hypertension and current medication. 5424 patients attended the ED during the 6-months-period. 271 patients met the inclusion criteria and were asked to participate. 167 individuals (62%) agreed to participate and responded to the questionnaire. Mean age of participants were 63.1 years and 51% were women. 134 patients (80%) had measured their BP after the ED-visit, and 48 (36%) of those had been diagnosed with hypertension. 96% of patients diagnosed with hypertension were on BP-lowering medication. To follow-up BP ≥ 160/100 mmHg after an ED visit can reveal undiagnosed hypertension in one third of the patients. Given the amount of undiagnosed hypertension, an ED-measured BP might provide an important tool to detect and start treatment of hypertension.

Mediatization of medicine and health: dysfunctional aspects

In this article, based on the results of empirical research conducted by employees of the Faculty of Sociology, Doctor of Sociological Sciences, Associate Professor T.V. Semina and graduate student A.A. Belov, the destructive influence of electronic and digital media on the health of Russian citizens is considered. In fact, we are talking about the “mediatization of medicine”, which is understood as “the process caused by the emergence of digital communication tools, as a result of which the masses have free access to medical information, and all issues related to human and social health are somehow mediated by electronic media”. The author emphasizes that quite often the media practices uncontrolled submission of quasi-medical information, signs of economic bias present in the media are expressed in the fact that the main source of income for the media is advertising, especially medicines and pharmaceuticals. At the same time, commercials advertising medicines on television are the most effective in influencing the audience. In 2019, T.V. Semina, Doctor of Sociology, Associate Professor of the Faculty of Sociology at Lomonosov Moscow State University, proved the destructive role of the media in the genesis of social conflict in the doctor–patient system. In April–July 2024, the author also undertook an empirical sociological study on the problems of constructing public health in the Russian Federation, in particular, the effectiveness of the impact of advertising materials placed in the media on the health-saving attitudes of Russians, he results of which are presented in the article. In general, the results of empirical studies conducted by T.V. Semina and confirmed by the author’s research convincingly prove the dysfunctionality of the media in relation to the health of Russian citizens, their negative impact on the consciousness of both healthy and sick people. The author emphasizes that it is not so difficult to protect health, but, unfortunately, many people do not even try to do this, guided by certain stereotypes imposed by the media. For example, that after a certain age, absolutely everyone has high blood pressure, overweight, hormonal and other disorders and should regularly take appropriate (widely advertised) medications or dietary supplements, the benefits of which have not been scientifically proven. Most importantly, the author notes, changes are needed in the development of self-preservation behavior among the population. The main task of the state is not only to develop an effective health care system, but also to promote a responsible attitude of citizens to their own health, which implies regular medical examinations, giving up bad habits, leading a healthy lifestyle involving “life on the move”, full sleep and cognitive activity.

Exploring the Endothelin-1 pathway in chronic thromboembolic pulmonary hypertension microvasculopathy.

Targeted vasopeptide therapies have significantly advanced the management of pulmonary arterial hypertension (PAH). However, due to insufficient preclinical evidence regarding the involvement of the endothelin-1 (ET-1) pathway in chronic thromboembolic pulmonary hypertension (CTEPH) pathophysiology, the potential of ET-1 receptor antagonism in treating CTEPH remains uncertain. In this study, we investigated the role of the ET-1 pathway in CTEPH microvasculopathy using a multifaceted approach. Plasma ET-1 levels were measured in a cohort of 59 CTEPH patients and 41 healthy controls. Additionally, we evaluated the expression of key ET-1 pathway members in pulmonary explants from CTEPH, idiopathic PAH, and control patients. We used an in vitro system to test the hypothesis that the turbulent flow, observed near the vascular obstructions pathognomonic of CTEPH, enhances ET-1 expression. Our findings were further validated in vivo using a CTEPH piglet model that contains distinct regions representing pre- and post-thrombus lung territories. We found a twofold increase in circulating ET-1 levels in CTEPH patients compared to healthy subjects. Pulmonary explants from CTEPH patients exhibited pronounced overexpression of ET-1, endothelin receptor A (ETA), and phosphorylated myosin light chain (p-MLC) in muscularized pulmonary microvessels, suggesting heightened vascular contraction. In vitro experiments showed that turbulent flow facilitates ET-1 secretion compared to laminar flow regions. Additionally, in the CTEPH piglet model, elevated plasma ET-1 levels were observed compared to controls. Immunofluorescence and confocal microscopy analyses confirmed increased ETA and p-MLC in remodeled arteries from both pulmonary territories. However, ET-1 protein elevation was exclusively observed in the obstructed territory. These findings collectively indicate impaired vascular tone in microvessels of CTEPH patients and the CTEPH piglet model. Furthermore, our data implicates the ET-1 pathway in microvasculopathy, with turbulent flow playing a pathological role. These insights underscore the potential utility of ET-1 receptor antagonists as a promising therapeutic approach for CTEPH treatment.

Results After Surgical Correction of Coarctation of the Aorta in Adults

Aim: This retrospective study aimed to determine the impact of coarctation surgical repair on arterial blood pressure in adults over 18 years of age. Materials and methods: This retrospective study included 17 patients with aortic coarctation in QSUT, Cardiac Surgery Service, from January 2007 to March 2024. Results: 22 patients with coarctation of the aorta included in this study were mostly male12(70%) versus 5 (30%) females. All patients had preoperative hypertension. Main systolic blood pressure was 160 ± 28mm Hg (range, 120 to 220 mm Hg). All patients had preoperative CT Angiography (the mean gradient across the coarctation was 62 ± 27 mm Hg). After surgical repair, the mean gradient was 24 ±4.3 mmHg. The operative technique was an extra-anatomic bypass for 22 patients. Of the 22 patients with preoperative hypertension, 5 were normotensive (systolic blood pressure ≤ 140 mm Hg, diastolic blood pressure ≤ 90 mm Hg) with no medication. 4 patients were receiving medication: 1 required single-drug therapy, and 3 patients required two drugs. There were no repeat operations. No patient had evidence of a cerebrovascular accident. There were no hospital deaths and no late morbidity. Conclusions: Surgical repair of coarctation in adults has proved to be an effective procedure and significantly reduces arterial hypertension. However, long-term surveillance is mandatory and should include exercise testing to identify patients with potential hypertension. Echocardiography is the most patient’s friendly method to evaluate CoA.

Prevalence and predictors of Sickle Cell Nephropathy A single-center experience.

Sickle cell disease (SCD) is the most common monogenic disorder in Saudi Arabia, which associates with an increased risk of organs damage, including the kidney. The aim of this study is to investigate the prevalence and predictors of sickle cell nephropathy (SCN) in the Saudi population. A retrospective study was conducted from April to October 2023, and included 343 adult patients with SCD who were recruited from the hereditary blood diseases center (HBDC), Al-Ahsa, Saudi Arabia. Spot protein-to-creatinine ratio was measured and glomerular filtration rate (GFR) was estimated from serum creatinine using the Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) equation. As per KIDGO guidelines, CKD was diagnosed in 93 (27.1%) patients. Based on the CKD-EPI equation, 2% of patients had low GFR (eGFR < 60mL/min), 28.3% had high GFR (eGFR > 140 mL/min), and 69.7% had normal GFR. Among SCD patients, proteinuria was observed in 26.5% of the patients. SCD patients with CKD were significantly older than non-CKD patients (p < 0.001) and had higher prevalence of diabetes mellitus (DM) and hypertension (HTN) (p = 0.045 and 0.001 respectively). The multivariate analysis showed that age (P = 0.001; OR 1.035; 95% CI 1.014-1.056) and low hemoglobin level (p = 0.034; OR -0.851; 95% CI 0.721-0.980) were independent risk factors for the development of SCN. Nephropathy is a common complication among patients with SCD as early as the third decade of life, although they remain asymptomatic. Advances in age and low hemoglobin levels are the main predictors of nephropathy. In addition, SCD patients with coexistent comorbidities, particularly DM and HTN, were at increased risk of developing kidney disease.

Diabetes mellitus and comorbidities in elderly people from the Lugu community: A critical-reflective analysis

Ageing has a close relationship with chronic non-communicable diseases, such as diabetes mellitus and high blood pressure. These pathologies are often associated with changes in eating habits and promote crucial physiological changes which act silently in the long term in the elderly population. Due to the speed of urban development and technological advances, there has been an increase in the population's life expectancy. However, it is essential to know the socio-demographic profile and prevalent comorbidities of the elderly population, which can provide a reliable and broad database to enable the outline of strategies and the promotion of efficient health policies. In this sense, the purpose of this editorial is to contribute to the debate surrounding the article that analysed epidemiological data from the Lugu community. Diabetes mellitus, hypertension and cardiovascular pathologies and their comorbidities were the most prevalent conditions in this community. Such data could contribute to develop public policies constructively and assertively, allowing investments in the prevention and treatment of these pathologies.

Lactate dehydrogenase as a biochemical marker for prediction of maternal and perinatal outcomes in hypertensive disorders in pregnancy

Hypertensive disorder of pregnancy includes new onset hypertension in pregnancy that is gestational hypertension and already existing hypertension that is chronic hypertension and gestational hypertension sometimes worsened by preeclampsia. Preeclampsia can cause complications such as eclampsia, HELLP syndrome, renal failure, pulmonary edema, stroke, and left ventricular failure. We aim to assessthe predictive role ofLactate Dehydrogenase value in Hypertensive disorders in pregnancy.After obtaining the informed consent, pregnant patients who were visiting Tertiary care centre and who were more than 28 weeks period of gestation were enrolled. Patients from both antenatal OPD clinics and from those who were presenting in emergency were included in this study. Serum levels of LDH were tested. Patients were monitored till delivery and 6 weeks following childbirth.The Mean serum levels of lactate dehydrogenase (LDH) in eclamptic group was 1495.000±859.1230, 804.569±224.5519 in severely preeclamptic group and in mild preeclamptic group ,mean LDH levels were 520.062±110.3944. The difference between both the groups was statistically significant (p &amp;#60; 0.001).Women with serum LDH levels &amp;#62; 800 IU/L and LDH levels between 601-800 IU/L, experienced considerably greater complications in preeclamptic-eclamptic group as compared to those with serum LDH levels &amp;#60; 600 IU/L.Thepreeclamptic-eclamptic group of women had increased serum LDH levels. Greater LDH levels were linked to worse outcomes for mothers including placental abruption, hemolysis elevated liver enzymes low platelet count (HELLP syndrome), pulmonary edema and maternal death and they were also linked to fetal complications including intrauterine fetal death (IUFD), intrauterine growth restriction and neonatal intensive care unit (NICU) admission.

Disability and Patient-Reported Satisfaction in Women with Idiopathic Intracranial Hypertension: A Comparative Study of Venous Sinus Stenting and Medical Management

Objective: Patients with chronic idiopathic intracranial hypertension (IIH) commonly experience a high level of disability and low satisfaction with medical treatment. We aim to evaluate long-term functional improvement and patient satisfaction in IIH patients with similar symptoms by comparing venous sinus stenting (VSS) to standard medical therapy. Methods: We conducted a cross-sectional questionnaire study of 111 IIH patients, comparing 37 adult female patients who underwent venous sinus stenting with 74 patients treated medically. Propensity score matching was used to balance age and presence of papilledema at presentation between groups. Headache-related disability was evaluated using the Migraine Disability Assessment Scale (MIDAS), while general function and treatment satisfaction were assessed using custom questionnaires. Electronic medical records and the results of imaging upon diagnosis were reviewed retrospectively. Results: The stented group reported significantly better outcomes in physical well-being (median 4.0 vs. 1.0, p &lt; 0.001), task completion (4.0 vs. 1.0, p &lt; 0.001), work/school persistence (5.0 vs. 1.0, p &lt; 0.001), and mental well-being (4.0 vs. 1.0, p &lt; 0.001). Additionally, the stented group had a lower proportion of patients with severe MIDAS (MIDAS &gt; 4, 24.3% vs. 47.9%, p = 0.017). Logistic regression suggested venous stenting as a protective factor against severe MIDAS scores (OR = 0.174, p = 0.004). Conclusion: Cerebral venous stenting in patients with IIH is associated with lower disability and higher patient satisfaction from medical treatment compared to those treated with medications only. These findings suggest that venous sinus stenting may be a valuable treatment option for selected IIH patients. However, larger prospective studies are needed to further validate our results.

Pulmonary manifestations of juvenile vs. adult systemic sclerosis: insights into pathophysiological and clinical features.

Juvenile systemic sclerosis (jSSc), the pediatric counterpart of systemic sclerosis (SSc), is a rare autoimmune disorder characterized by vasculopathy and fibrotic disorders. It ranks among the rheumatologic diseases with the highest rates of morbidity and mortality, predominantly impacting females. Although a universally accepted classification for jSSc remains elusive, a provisional classification proposed in 2007 integrates major and minor criteria, reflecting the involvement of diverse organs and tissues. Pulmonary manifestations are relatively common in jSSc, occurring in 36% to 55% of cases. Particularly lung complications include children s interstitial lung disease (chILD), pulmonary arterial hypertension (PAH) and nodules. The aim of this paper is to describe the main pulmonary manifestations of patients with jSSc in relation to SSc, highlighting fundamental pathophysiological, and clinical features based on the latest literature data.

Insights into fetomaternal outcomes in pre-eclampsia: A tertiary care center descriptive study

Preeclampsia and eclampsia remain significant challenges in both maternal and perinatal health worldwide, with a pronounced impact in regions such as India, where access to comprehensive maternal care can be limited. The objective of this study was to examine the outcomes for both mothers and babies, along with the complications linked to severe cases of preeclampsia and eclampsia, within a tertiary healthcare facility situated in South India. : Sixty-five pregnant women diagnosed with severe preeclampsia or eclampsia were enrolled in this descriptive observational study conducted at a tertiary care teaching hospital, Chennai, spanning from March 2023 to December 2023. Inclusion criteria comprised women with singleton pregnancies exhibiting severe preeclampsia (defined by blood pressure ≥160/110 mmHg and 1+ or more albuminuria) or eclampsia. Exclusion criteria included chronic hypertension, multiple pregnancies, chronic renal disease, connective tissue disorder, neurological complications, and refusal of consent. Data on sociodemographic variables, obstetric characteristics, maternal symptoms, and complications were collected using a structured questionnaire. Maternal and fetal well-being were assessed through biochemical, radiological, and nonstress tests.: The results revealed that 80% of the study population with severe preeclampsia or eclampsia fell within the age group of 21-30 years, with 49.2% aged between 26-30 years. Majority (60%) were primigravida. Common maternal symptoms included headache (60%), oedema (76.9%), with fewer experiencing epigastric pain (3.1%) and vaginal bleeding (15.4%). Complications observed were HELLP syndrome (12.35%), placental abruption (7.7%), and eclampsia (10.8%). Perinatal outcomes included intrauterine fetal death (4.6%), fetal growth retardation (23.1%), low birth weight (30.8%), respiratory distress syndrome (4.6%), and stillbirth (1.5%), with 35.4% being normal births.This study emphasises the substantial impact of severe preeclampsia and eclampsia on the health of both mothers and fetuses, underscoring the importance of thorough antenatal care, prompt identification of risk factors, and timely interventions to minimise negative consequences. There is a clear call for additional research to investigate and implement effective strategies for prevention and management, aiming to decrease the morbidity and mortality rates associated with these hypertensive disorders during pregnancy.