Chronic Arterial Hypertension Research Articles

Hyperuricemia in Patients with Chronic Renal Failure: A Single Center Study, Pakistan

Introduction: a level of serum uric acid more than or equal to 70 mg/l (420 mol/l) in males and 60 mg/l (360 mol/l) in women is considered hyperuricemia. It has been established in many studies to be a risk factor or a factor in the progression of chronic renal disease. Recent experimental and epidemiological studies link hyperuricemia to chronic kidney disease (ckd), arterial hypertension, and cardiovascular disease, raising the issue of whether medicines are effective in the prevention of renal illness. The goal of this study is to discover whether there is a relationship between chronic renal disease and hyperuricemia. Methodology: From january 1st to december 1st, 2015, this single-center study was done at the department of nephrology at marcy teaching hospital in peshawar, pakistan (12 months). We included all chronic renal disease patients with associated hyperuricemia who were admitted to a hemodialysis unit. Results: A total of 72 individuals were included in the study. The prevalence of hyperuricemia was 15.20 percent. The average age of the patients was 35.5 years. The age group of 40 to 60 years old accounted for 54.6 percent of the total. Patients with hypertension accounted for 49% of the total, with diabetes and hypertension being linked in 11% of the cases. In 42.3 percent of patients, renal insufficiency was moderate. In more than 90% of the patients, hyperuricemia was found. Hyperuricemia was statistically linked to profession, age, hematuria, proteinuria, and hypertension. In 85 percent of patients, allopurinol was prescribed as a treatment. More than 12% of patients had an unsatisfactory course of treatment. Conclusion: Several recent investigations have shown the role of hyperuricemia in chronic renal disease. To determine its true influence on the prevention and treatment of chronic renal disease, randomised study on large sizes must be conducted. Keyword: A Single Center Study, Hyperuricemia, Chronic Renal Failure

Right Ventricular Dyssynchrony in Patients With Chronic Thromboembolic Pulmonary Hypertension and Pulmonary Arterial Hypertension.

Chronic thromboembolic pulmonary hypertension (CTEPH) and pulmonary arterial hypertension (PAH) are characterized by elevated pulmonary arterial pressure resulting in right heart failure. Right ventricular (RV) dyssynchrony may be associated with early-stage RV dysfunction; however, the differences in RV dyssynchrony between CTEPH and PAH and the factors contributing to RV dyssynchrony remain unclear.Methods and Results: Forty-four patients (CTEPH, 26; PAH, 18) were enrolled in this study. RV dyssynchrony was assessed by determining the standard deviation of the intervals from the peak QRS to peak systolic strain for 6 segments of the RV free and septal wall by using 2-dimensional speckle-tracking echocardiography (RV-6SD). The RV-6SD, pulmonary hemodynamics, echocardiographic findings, and patient demographics in CTEPH and PAH patients were compared and their correlations with RV-6SD were investigated. CTEPH patients were older and had significantly higher pulse pressure of the pulmonary artery (PP), tricuspid valve regurgitation pressure gradient, and RV-6SD, and lower pulmonary arterial compliance (PAC), despite showing comparable pulmonary arterial pressures. Age-adjusted multiple logistic analysis showed that RV-6SD and PAC were predictors of CTEPH rather than PAH. RV-SD6 was positively correlated with PP and RV dimension and negatively correlated with PAC. CTEPH patients showed more evident RV dyssynchrony than PAH patients. Low PAC and a widened PP may delay RV free wall motion and cause RV dyssynchrony.

A RELEVÂNCIA DO TREINAMENTO FUNCIONAL PARA AS CAPACIDADES FÍSICAS, FUNCIONAIS E ASPECTOS DA SAÚDE DE IDOSOS

There is evidence that Functional training (FT) improves the functional, physical, and health capacities of older adults. However, no review study has grouped this information. The objective was to describe the importance of FT for maintaining and improving functional, physical, and health capacities in older adults. Our study was a narrative review. FT improves the functional (mobility, balance, and basic and instrumental activities of daily living) and physical (increase in strength and muscle mass, decrease in body fat) capacities of older adults. In older adults with chronic diseases, e.g., arterial hypertension, diabetes, and cancer, FT helps as a complementary therapy to improve hemodynamic parameters, metabolic control, and quality of life. This type of physical exercise also acts as a preventive therapy for cardiovascular problems. The FT provides improvements in the physical, functional, and health capacities of older adults. Therefore, FT is an alternative to physical exercise with proven efficiency for health aspects that can be used by Physical Education Professionals.

Use of orthodontic treatment protocols in patients with chronic periodontitis and arterial hypertension

BACKGROUND: The wide prevalence and mutual influence of periodontitis and arterial hypertension determine the importance of choosing a rational approach to denture prosthetics in this patients.
 AIM: The study was to choose a rational tactics of dental prosthetics in patients with chronic periodontitis and arterial hypertension based on a clinical and instrumental assessment of the periodontal condition and morphofunctional characteristics of neuroendocrine gum cells.
 MATERIALS AND METHODS: The results of the examination of 120 patients with periodontitis and hypertension are presented, of which 90 patients had denture defects, 30 patients intact dentition. Clinical examination, immunohistochemical, and morphometric studies were performed. 90 patients underwent prosthetics of dentition defects, of which: 32 patients were fitted with metal dentures, 30-metal-ceramic dentures, 28 patients were fitted with thermoplastic resin removable partial dentures.
 RESULTS: Periodontitis in patients with hypertension is characterized by more significant changes in the expression of endothelin-1-, melatonin- and endothelial NO-synthase-like cells of gum, than periodontitis in patients without somatic pathology. After periodontal treatment, the use of metal-ceramic dentures and thermoplastic resin removable partial dentures by a year-long persistent remission of periodontitis in 85.786.7% of patients is accompanied. Remission is achieved against the background of satisfactory hygiene indicators and restoring the neurotransmitter balance of the oral cavity. After a year of metal dentures, 43.7% of patients report an exacerbation of periodontitis, which by poor hygiene and local neuroendocrine imbalance is facilitated.
 CONCLUSION: The use of metal-ceramic dentures and thermoplastic resin removable partial dentures is the preferred option for prosthetics of dentition defects in patients with periodontitis and hypertension.

Chronic arterial hypertension and nocturnal non-dipping predict postinduction and intraoperative hypotension: A secondary analysis of a prospective study

Study objectivePostinduction and intraoperative hypotension are associated with organ injury in non-cardiac surgery patients. Automated ambulatory blood pressure monitoring can identify chronic arterial hypertension and nocturnal blood pressure non-dipping. We tested the hypotheses that: a) chronic arterial hypertension and nocturnal non-dipping are independent risk factors for postinduction and intraoperative hypotension; and b) adding information on chronic arterial hypertension and nocturnal non-dipping improves hypotension prediction models based on readily available preoperative clinical information. DesignPrediction model development based on a secondary analysis of a prospective observational study. SettingGerman university medical center. Patients366 non-cardiac surgery patients who had preoperative automated ambulatory blood pressure monitoring. MeasurementsMultivariable analyses to identify risk factors for postinduction and intraoperative hypotension. Area under receiver operating characteristics curves (AUROC) and likelihood-ratio tests to test whether adding information on chronic arterial hypertension and nocturnal non-dipping improves hypotension prediction models based on readily available preoperative clinical information. Main resultsRisk factors for postinduction hypotension were age in years (odds ratio: 1.06 (95% confidence interval: 1.03 to 1.10), P = 0.001), American Society of Anesthesiologists physical status class (1.85 (1.02 to 3.35), P = 0.043), preoperative use of angiotensin-converting enzyme inhibitors or angiotensin II receptor blockers (15.19 (1.76 to 131.46), P = 0.013), chronic arterial hypertension (2.54 (1.49 to 4.34), P = 0.001), and nocturnal non-dipping (3.61 (2.09 to 6.23), P < 0.001). The model's AUROC was 0.76 (95% confidence interval: 0.71 to 0.81) with and 0.67 (0.62 to 0.73) without information on chronic arterial hypertension and nocturnal non-dipping (P < 0.001). Risk factors for intraoperative hypotension were male sex (1.73 (1.07 to 2.80), P = 0.025), chronic arterial hypertension (4.35 (2.33 to 8.14), P < 0.001), and nocturnal non-dipping (3.56 (2.07 to 6.11), P < 0.001). The model's AUROC was 0.76 (0.70 to 0.81) with and 0.63 (0.57 to 0.69) without information on chronic arterial hypertension and nocturnal non-dipping (P < 0.001). ConclusionsChronic arterial hypertension and nocturnal non-dipping are independent risk factors for postinduction and intraoperative hypotension in non-cardiac surgery patients. Adding information on chronic arterial hypertension and nocturnal non-dipping moderately improved hypotension prediction models based on preoperative clinical information.

Microcirculatory changes in patients with chronic obstructive pulmonary disease and arterial hypertension

Objective: to study the dynamics of microcirculation indices in patients with arterial hypertension, chronic obstructive pulmonary disease, and in their combination. Material and methods: the study included 226 people, of which 66 people were patients with chronic obstructive pulmonary disease, 54 patients with arterial hypertension, 74 people with a combination of chronic obstructive pulmonary disease and arterial hypertension, 32 relatively healthy volunteers. To assess the circulatory bed, we used a computerized ultrasonic Doppler instrument Minimax-Doppler-K, LLC JV «Minimax». Results: in patients with COPD and AH, microcirculation maladjustment is observed, manifested by a paradoxical reaction to stimuli in the form of an indirect occlusive effect. When studying the correlations between the indicators of the microvasculature and clinical and instrumental data, it was found that there is a relationship between the linear velocities of the microvasculature and the age, the smoking index, systolic blood pressure, pulse blood pressure. A correlation relationship was established between the FEV1 and the maximum linear systolic velocity along the maximum velocity curve in patients with COPD and COPD and AH. Conclusion: COPD and hypertension are comorbid conditions that lead to more pronounced microcirculatory changes, which can have a mutual effect on the course of these diseases.

Efficacy of interatrial shunt devices: an opening window to acute pulmonary hypertensive crisis and chronic pulmonary arterial hypertension.

The current study aimed to elucidate the efficacy of interatrial shunt device (IASD) for the treatment of acute pulmonary hypertensive crisis (PHC) and chronic pulmonary arterial hypertension (PAH). After establishing chronic PAH models using dehydrogenized monocrotaline (DHMCT), PAH dogs were implanted with IASDs (group A) or received no intervention (group B). One month later, DHMCT was injected again to establish an acute PHC. The prognosis, hemodynamics, ultrasound cardiography, electrocardiogram, and lung pathology of the dogs were observed. The baseline mean pulmonary arterial pressure increased from 12.70 ± 1.03 to 19.95 ± 1.75mmHg and established a chronic PAH model 2 months after DHMCT injection (1.50mg/kg). After an additional injection of DHMCT (1.50mg/kg) in the chronic PAH model, acute PHC occurred. Mean PAP, sPAP, and pulmonary vascular resistance increased to 22.67 ± 1.80mmHg, 35.70 ± 1.66mmHg, and 12.50 ± 3.50 WOOD U, respectively. Cardiac output (CO) decreased to 1.31 ± 0.26 L/min, and the right-to-left shunt caused hypoxemia. The survival rates of the dogs with and those without IASD were 70.0% and 22.2% (P = 0.037), respectively. Six months after PHC, the CO between the dogs with and those without IASD were 1.44 ± 0.11 L/min and 1.18 ± 0.04 L/min (P = 0.028). The long-term survival rates were 50.0% and 22.2%, respectively (P = 0.21). IASD might be efficacious and beneficial for treating acute PHC and chronic PAH, as well as improving prognosis.

Cardiac Phenotypes of Pregnant Women with Hypertensive Disorders in Different Ethnic Groups

The objective of this study was to conduct a comparative analysis of the features of LV myocardial remodeling in pregnant women with chronic arterial hypertension (CAH) and preeclampsia (PE) on the background of CAH. Methods and Results: The study cohort included pregnant women (n=547) with hypertensive disorders. All women were divided into two groups: Group 1 included 376 Caucasian patients living in the Republic of Dagestan; Group 2 included 171 patients living in the Republic of Sakha (Yakutia) (indigenous residents [Yakuts and Evenks). Later on, all patients were divided into the following subgroups: Sub1A (n=134), and Sub2A (n=69) – pregnant women with CAH; Sub1B (n=242) and Sub2B (n=102) – pregnant women with PE on the background of CAH. The diagnosis of pregnant women with CAH was made on the basis of existing national and foreign recommendations that an increase in SBP ≥140 mmHg and/or DBP ≥90 mmHg indicates CAH. Different patterns of left ventricular (LV) geometry were defined based on left ventricular mass index (LVMI) and relative wall thickness (RWT), as recommended by the American Society of Echocardiography. The observed/predicted LVM ratio was calculated as 100×(oLVM/pLVM). Participants with an oLVM/pLVM ratio of &gt;128% were categorized as having “inappropriate” LVM (iLVM). iLVM was found in Subgroups 1B and 2B in the third trimester. The frequency of LV remodeling in pregnant women of Subgroups 1 A and 2A in the second and third trimesters did not differ significantly. In Subgroup 1B, the frequency of concentric left ventricular hypertrophy (cLVH) was higher in the third trimester (42.6%) than in the second trimester (26.9%) (P=0.000). Moreover, in the third trimester, the frequency of cLVH was significantly higher in Subgroup 1B than in Subgroup 2B (42.6% and 29.4%, respectively, P=0.022). At the same time, in the third trimester, the frequency of left ventricular concentric remodeling (LVCR) was significantly higher in Subgroup 2B than in Subgroup 1B (56.9% and 44.2%, respectively, P=0.032). In the second trimester in Subgroup 1B, the frequency of LVCR was higher than in Subgroup 1A: 50% and 38.1%, respectively, P=0.026). By the third trimester, the severity of LV remodeling has increased significantly in Subgroup 1B. Thus, in Subgroup 1B, the frequency of c LVH reached 42.6% compared to 31.3% in Subgroup 1A (P=0.03). In Subgroup 2B, in the third trimester, the frequency of LVCR was slightly higher than in Subgroup 2A (56.9% and 43.5%. respectively, P=0.08). Conclusion: Living conditions predetermine the prevalence of iLVM and LVCR in pregnant northerners with CAH. A more common type of LV remodeling in pregnant women with CAH in conditions of high-altitude hypoxia is also LVCR, which transforms into cLVH by the third trimester in pregnant women with PE on the background of CAH. The study of the type of LV geometry and the appropriateness of LVM allows us to clarify the degree of LV damage in hypertension-related pregnancy. iLVM in pregnant women with CAH appears to be a predictor of the development of PE. The revealed changes in the LV structure—LVCR and cLVH—are more significant in PE on the background of CAH.

Valores extremos del IMC materno: factores determinantes de peores resultados obstétricos y perinatales

ObjectiveTo study the influence of maternal body mass index (BMI) at the beginning of pregnancy on obstetric-perinatal outcomes. Material and methodsObservational-ambispective study. We recruited 1407 patients with singleton gestations and deliveries of foetuses>24 weeks between 01/12/2017 and 31/07/2019. The sample was stratified according to their BMI following the WHO classification. Variables on pre-pregnancy, gestational disease, obstetric care, and maternal-perinatal outcomes were analysed and compared between the studied groups. The statistical program has been R Core Team 2020, version 3.6.3. P≤.05 was considered significant. ResultsClass II-III (BMI 35-39 and BMI≥40 respectively) obese women have a higher risk of chronic arterial hypertension (OR 53.54, 95% CI 18.21-229.02), gestational diabetes (OR 5.24, 95% CI 2.87-9.51) and preeclampsia (OR 2.38, 95% CI 0.95-5.51 with P=.049). The underweight women had more intrauterine growth restriction diagnoses (OR 3.09, 95% CI 1.46-6.17). Inductions of labour and caesarean sections increase as BMI increases (P=.006). Low weight patients also had a higher risk of caesarean section (OR 2.46, 95% CI 1.06-5.20). Neonatal admissions were more frequent in obese and underweight women (OR 2.68, 95% CI 1.39-5.00 and OR 2.56, 95% CI 1.10-5.44 respectively). Obese women had a higher risk of neonatal weight>4000g (OR 3.06, 95% CI 1.57-5.77) and low weight pregnant women had a higher risk of neonatal weight<2500g (OR 2.94, 95% CI 1.54-5.41). ConclusionExtreme values of maternal BMI at the beginning of gestation are determining factors for an adverse obstetric-perinatal outcome.

Emerging Therapeutic Potential of Mesenchymal Stem Cell-Derived Extracellular Vesicles in Chronic Respiratory Diseases: An Overview of Recent Progress.

Mesenchymal stem cell-derived extracellular vesicles (MSC-EVs) are able to carry genetic and protein goods to mediate the interaction between MSCs and target cells. Recently, more and more researches have focused on the therapeutic role of MSC-EVs in chronic respiratory diseases. In this review, we summarize the cumulative strategies and mechanisms of MSC-EVs in treating chronic respiratory diseases. This review suggests that MSC-EVs may serve as a novel cell-free-based therapy for chronic respiratory diseases, including COPD, asthma, pulmonary fibrosis, and pulmonary arterial hypertension. In current studies of chronic respiratory diseases, umbilical cord and bone marrow are main sources of MSC-EVs, while adipose tissue, lung, and induced pluripotent stem cells are also applied. Isolation methods of MSC-EVs in treating chronic respiratory diseases involve ultracentrifugation, exosome extraction kits and anion-exchange chromatography. Intratracheal delivery and intravenous administration are the most widely used routes of MSC-EVs. MSC-EVs are able to transfer microRNAs and protein to target cells and further magnify the therapeutic effects.

High intraoperative pulse pressure is a risk factor for postoperative acute kidney injury in a cohort of abdominal surgery patients: An exploratory study.

Both intraoperative hypotension and hypertension have been reported to increase the occurrence of acute kidney injury (AKI). However, the impact of the intraoperative pulse pressure (PP) on the latter complications remains relatively unknown. To explore whether high intraoperative PP values are associated with postoperative AKI. The data for this study come from a prospective cohort study in which patients who underwent abdominal surgery between October 1, 2018 and July 15, 2019 in university hospital in Katowice, Poland were included in the analysis. Preand intraoperative data, including blood pressure measurements, were acquired from medical charts. Several PP thresholds were applied: >50, >55, >60, >65, >70, >75, >80, >85, and >90 mm Hg. Additionally, by analyzing the maximal PP during the procedures, the cutoff point for the occurrence of outcomes was estimated. Postoperative AKI was considered as the outcome of the study. Univariable and multivariable analyses were performed to assess PP relationship with AKI. Four hundred and ninety-four patients were included in the analysis. The AKI was present in 32 (6.5%) cases. The receiver operating characteristic (ROC) curve analysis estimated a cutoff point of >84 mm Hg of maximal PP to be associated with the outcome. The PP values above 80 mm Hg and onward were successfully included in the multivariable statistical models. A model in which PP > 90 mm Hg (odds ratio (OR) = 4.03; 95% confidence interval (95% CI): [1.53; 10.62]) was included, had the best predicting value in predicting hypoperfusion injury (area under the receiver operating characteristics (AUROC) = 0.88). Apart from PP, intraoperative hypotension, presence of chronic arterial hypertension, chronic kidney disease, and procedure duration were independently associated with AKI. High intraoperative PP may be associated with the occurrence of postoperative AKI. However, the effect of high PP should be confirmed in other noncardiac populations to prove the generalizability of our results.

Metabolic profile in endothelial cells of chronic thromboembolic pulmonary hypertension and pulmonary arterial hypertension

Chronic thromboembolic pulmonary hypertension (CTEPH) and pulmonary arterial hypertension (PAH) are two forms of pulmonary hypertension (PH) characterized by obstructive vasculopathy. Endothelial dysfunction along with metabolic changes towards increased glycolysis are important in PAH pathophysiology. Less is known about such abnormalities in endothelial cells (ECs) from CTEPH patients. This study provides a systematic metabolic comparison of ECs derived from CTEPH and PAH patients. Metabolic gene expression was studied using qPCR in cultured CTEPH-EC and PAH-EC. Western blot analyses were done for HK2, LDHA, PDHA1, PDK and G6PD. Basal viability of CTEPH-EC and PAH-EC with the incubation with metabolic inhibitors was measured using colorimetric viability assays. Human pulmonary artery endothelial cells (HPAEC) were used as healthy controls. Whereas PAH-EC showed significant higher mRNA levels of GLUT1, HK2, LDHA, PDHA1 and GLUD1 metabolic enzymes compared to HPAEC, CTEPH-EC did not. Oxidative phosphorylation associated proteins had an increased expression in PAH-EC compared to CTEPH-EC and HPAEC. PAH-EC, CTEPH-EC and HPAEC presented similar HOXD macrovascular gene expression. Metabolic inhibitors showed a dose-dependent reduction in viability in all three groups, predominantly in PAH-EC. A different metabolic profile is present in CTEPH-EC compared to PAH-EC and suggests differences in molecular mechanisms important in the disease pathology and treatment.

ОСОБЕННОСТИ СТОМАТОЛОГИЧЕСКИХ ЗАБОЛЕВАНИЙ ПРИ НАРУШЕНИИ В АКУШЕРСКО-ГИНЕКОЛОГИЧЕСКОМ СТАТУСЕ У ЖЕНЩИН С ОТЕКАМИ, ВЫЗВАННЫМИ БЕРЕМЕННОСТЬЮ

Introduction. The course of dental diseases in pregnant women is significantly affected by extragenital pathology, recorded in 95% of pregnant women and 40% of non-pregnant women of reproductive age.&#x0D; Objectives: to identify the relationship between changes in obstetric and gynecological status in women with edema caused by pregnancy and the frequency of dental diseases.&#x0D; Materials and methods. The study groups included 127 pregnant women, including 79 women with edema caused by pregnancy, which made up the 1st group and 48 women with the physiological course of pregnancy, who were included in the 2nd group. The dental status (indices of the CPU, PMA, IZN, the structure of gingivitis), anthropometric data, somatic complications, the results of a general blood test, analysis of coagulogram indicators, analysis of biochemical parameters of the blood of pregnant women, and a general analysis of urine were studied.&#x0D; Conclusion. When studying the relationship between dental status and somatic obstetric and gynecological pathology in pregnant women with diagnosed edema caused by pregnancy, gingivitis is often recorded in the oral cavity, the prevalence of diseases of the urinary system, which were detected in 36.7%, was diagnosed in second place, chronic arterial hypertension 15.2%, in the third – iron deficiency anemia 13.9%. Our data indicate that the complication of the course of the third trimester of pregnancy with edema is accompanied by a deterioration in periodontal status, oral hygiene, and a 100% prevalence of gingivitis.

Pharmacogene Variants Associated with Liver Transplant in a Twelve-Year Clinical Follow-Up.

Some gene polymorphisms have been previously associated individually with tacrolimus efficacy and toxicity, but no long-term study to determine the role of pharmacogene variants in the clinical evolution of liver-transplanted patients has been addressed so far. In the present work, we analyzed the relation between highly-evidenced genetic polymorphisms located in relevant pharmacogenes and the risk of suffering premature death and other comorbidities such as cancer, diabetes mellitus, arterial hypertension, graft rejection, infections and nephrotoxicities in a cohort of 87 patients (8 were excluded due to early loss of follow-up) transplanted at Hospital La Fe in Valencia (Spain) during a 12-year follow-up. Employing a logistic regression model with false discovery rate penalization and Kaplan–Meier analyses, we observed significant association between survival rates and metabolizer genes. In this sense, our results show an association between MTHFR gene variants in donor rs1801133 (HR: 7.90; p-value: 0.032) and recipient rs1801131 (HR: 7.34; p-value: 0.036) and the group of patients who died during the follow-up period, supporting the interest of confirming these results with larger patient cohorts. In addition, donor polymorphisms in UGT1A9 metabolizer gene rs6714486 (OR: 0.13; p-value: 0.032) were associated with a lower risk of suffering from de novo cancer. Genetic variants in CYP2B6 metabolizer gene rs2279343 demonstrated an association with a risk of infection. Other variants in different locations of SLCO1A2, ABCC2 and ABCB1 transporter genes were associated with a lower risk of suffering from type 2 diabetes mellitus, chronic and acute nephrotoxicities and arterial hypertension. Results suggest that pharmacogenetics-derived information may be an important support for personalized drug prescription, clinical follow-up and the evolution of liver-transplanted patients.

Vasomotor menopausal disorders as a possible result of dysfunction of the microbiota-intestine-brain axis.

The study involved clinical and laboratory examination of 54 women with vasomotor menopausal disorders divided into 3 subgroups depending on the duration of symptoms (not more than 12 months, about 3 years, from 5 to 7 years). The control group included 21 patients without vasomotor disorders during the menopausal period. Data from the general and obstetric-gynecological anamnesis and the results of objective and general clinical examinations were analyzed. To assess the state of intestinal microbiocenosis in patients, a bacteriological study of feces was used according to modern methods. In women with menopausal vasomotor disorders, chronic arterial hypertension, overweight, diabetes mellitus, chronic enterocolitis, and chronic pyelonephritis prevailed among somatic diseases. The study also revealed that these patients had a pronounced imbalance of the intensive microbiota, which was characterized by a significant decrease in the main representatives of the obligate microflora (Bifidobacterium, Lactobacillus) and an increase in the number of opportunistic strains (Klebsiella and Clostridiodes difficile). Considering modern concepts, a change in the microbial composition of the intestine may be one of the possible trigger factors for the occurrence of vasomotor menopausal disorders. Further research will clarify the influence of the microbiome on the formation of the pathological menopausal symptom complex and improve the preventive and therapeutic measures in this category of women.

Diabetes gestacional: factores de riesgo y complicaciones perinatales

Objective: To determine the risk factors and perinatal complications in pregnant women with diabetes mellitus who attended the Concepción Palacios Maternity between 2010 and 2015. Methods: Retrospective, descriptive and cross-sectional study involving 108 gestational diabetic patients and 108 without diabetes.Risk factors were compared, complications and their risk factors were assessed. Results: Among gestational diabetics, 76.8% were 35 years of age or older (p-0.013), there were 18.5% primigestas (p-0.031), 86.9% obese (p-0.000), 75% increased by more than 10 kg (p-0,000), 83.3% had a history of gestational diabetes (p-0.000), 31.5% family history of chronic arterial hypertension (p-0.000) and 41 % diabetes mellitus (p-0.001). Maternal complications were hypertensive pregnancy disorder (p-0.004), hyperglycemies (p-0.000) and prolonged hospital stay (p-0.000). Neonatal complications were low (p-0.003), hypoglycemia (p-0.000), macrosomia (p-0.000) and admission to intensive therapy (p-0.001). Risk factors for hypertensive pregnancy disorder were 35 years or more (p-0.0049), a family history of hypertension and diabetes (p-0.000) and personal history of gestational diabetes (p-0.0135). For hyperglycemia, age 35 years lower than 35 years (p-0.005). For neonatal complications, age less than 35 years (p-0.0001), primigestas (p-0.0002), history of gestational diabetes (p-0.000) and relatives of chronic hypertension and diabetes mellitus (p-0.0019). Conclusions: A body mass index greater than 25 kg/m2, a personal history of gestational diabetes, family members of diabetes and hypertension, and excessive weight gain during pregnancy are risk factors for gestational diabetes. Associated complications were hypertensive pregnancy disorder and hyperglycemia. Keywords: Gestational diabetes, Risk factors, Perinatal complications.

Preoperative plasma D-dimer level may be predictive for success of cerebral reperfusion and outcome after emergency mechanical thrombectomy for intracranial large vessel occlusion

Presented retrospective analysis evaluated whether preoperative plasma D-dimer level may predict the success of cerebral reperfusion and outcome after emergency mechanical thrombectomy (MT) for intracranial large vessel occlusion (ILVO). Study cohort comprised 121 patients (mean age, 76 ± 12 years) from two participating centers. ILVO mostly affected the M1 segment (48 cases) and internal carotid artery (ICA; 37 cases). Mean preoperative National Institutes of Health Stroke Scale (NIHSS) score was 18 ± 8. Mean preoperative plasma D-dimer level was 4.4 ± 6.6 μg/ml. In 88 patients (73%) MT resulted in successful cerebral reperfusion. Multivariate analysis revealed independent associations of non-successful cerebral reperfusion with preoperative plasma D-dimer level > 6.7 μg/ml (P = 0.0021), location of ILVO other than ICA (P = 0.0056), and prolonged antiplatelet or anticoagulant therapy before stroke onset (P = 0.0172). Plasma D-dimer level ≤ 6.7 μg/ml predicted successful cerebral reperfusion with 0.91 sensitivity and 0.36 specificity. In 39 patients (32%) treatment resulted in favorable outcome. Multivariate analysis revealed independent associations of the unfavorable outcome with non-successful cerebral reperfusion after MT (P = 0.0005), preoperative plasma D-dimer level > 1.9 μg/ml (P = 0.0131), higher preoperative NIHSS score (P = 0.0171), and chronic arterial hypertension before stroke onset (P = 0.0254). Plasma D-dimer level ≤ 1.9 μg/ml predicted favorable outcome with 0.64 sensitivity and 0.62 specificity. In conclusion, preoperative plasma D-dimer level may be predictive for success of cerebral reperfusion and outcome after emergency MT for ILVO, which may be potentially helpful for prediction of prognosis in selected treatment candidates.

Technology for early differential diagnosis of hypertensive disorders during pregnancy

BACKGROUND: To date, no test provides sufficient sensitivity and specificity for the early diagnosis of severe preeclampsia. Meanwhile, severe preeclampsia is a condition that threatens the life of not only the mother, but also the fetus, and requires a solution to the issue of delivery. Therefore, the search for markers of severe preeclampsia is still relevant today.&#x0D; AIM: The aim of this study was to create a technology that allows for early differential diagnosis of hypertensive disorders during pregnancy based on a comprehensive analysis of echocardiographic data.&#x0D; MATERIALS AND METHODS: Based on the data collected in the Regional Clinical Hospital Perinatal Center, Chita, Russia in 2018-2021, the retrospective analysis of 112 cases of labor was carried out. The total sample was divided into five study groups: 30 relatively healthy women (group 1); 25 patients with chronic arterial hypertension (group 2); 21 patients with gestational arterial hypertension (group 3); 13 patients with moderate preeclampsia (group 4); and 23 patients with severe preeclampsia (group 5). The groups were formed in accordance with current clinical guidelines. Echocardiographic examination in all cases was carried out upon admission to the hospital. Statistical processing of the results was performed using the IBM SPSS Statistics Version 25.0 program.&#x0D; RESULTS: The technology for early differential diagnosis of hypertensive disorders during pregnancy is implemented based on a multilayer perceptron, the percentage of incorrect predictions being 20.5 %. The structure of the trained neural network included six input neurons: gestational age, left atrium size in the parasternal position, right ventricular size, interventricular septal thickness, systolic blood flow velocity, and pressure gradient in the pulmonary artery.&#x0D; CONCLUSIONS: Comprehensive analysis of echocardiographic data allows for early differential diagnosis of hypertensive disorders during pregnancy, while considering the result of neural network analysis as an additional criterion for severe preeclampsia. In the future, the use of this technology in clinical practice will not only optimize the tactics of managing patients with hypertensive disorders at admission to the hospital, but also reduce the incidence of adverse obstetric and perinatal outcomes.

The Roles of S100A4 and the EGF/EGFR Signaling Axis in Pulmonary Hypertension with Right Ventricular Hypertrophy.

Simple SummaryPulmonary hypertension (PH) is a condition characterized by increased pulmonary arterial pressure. PH can further lead to right ventricular hypertrophy (RVH) and, consequently, heart failure. Endothelial-to-mesenchymal transition (EndMT) was identified as a key process in PH pathology. Nonetheless, the exact systemic and local levels of EndMT factors have not been comprehensively studied so far. Here, we quantified S100A4, epidermal growth factor (EGF), and EGF receptor (EGFR) in serum and tissue samples of two classes of PH with RVH. Patients with left heart disease and healthy volunteers served as controls. Serum S100A4 was decreased in the PH groups investigated, while EGF levels were increased in one PH cohort. EGFR was diminished in all groups compared to healthy controls. Surgical treatment of PH showed no effect on systemic EndMT marker levels. Furthermore, we observed a positive correlation between advanced PH stages and S100A4. Together, these findings help to deepen our understanding of the complex molecular events contributing to PH pathology and disease progression.Pulmonary hypertension (PH) is characterized by increased pulmonary arterial pressure caused by the accumulation of mesenchymal-like cells in the pulmonary vasculature. PH can lead to right ventricular hypertrophy (RVH) and, ultimately, heart failure and death. In PH etiology, endothelial-to-mesenchymal transition (EndMT) has emerged as a critical process governing the conversion of endothelial cells into mesenchymal cells, and S100A4, EGF, and EGFR are implicated in EndMT. However, a potential role of S100A4, EGF, and EGFR in PH has to date not been elucidated. We therefore quantified S100A4, EGF, and EGFR in patients suffering from chronic thromboembolic pulmonary hypertension (CTEPH) and idiopathic pulmonary arterial hypertension (iPAH). To determine specificity for unilateral heart disease, the EndMT biomarker signature was further compared between PH patients presenting with RVH and patients suffering from aortic valve stenosis (AVS) with left ventricular hypertrophy. Reduced S100A4 concentrations were found in CTEPH and iPAH patients with RVH. Systemic EGF was increased in CTEPH but not in iPAH, while AVS patients displayed slightly diminished EGF levels. EGFR was downregulated in all patient groups when compared to healthy controls. Longitudinal data analysis revealed no effect of surgical therapies on EndMT markers. Pulmonary thrombo-endarterectomized samples were devoid of S100A4, while S100A4 tissue expression positively correlated with higher grades of Heath–Edwards histopathological lesions of iPAH-derived lung tissue. Histologically, EGFR was not detectable in CTEPH lungs or in iPAH lesions. Together, our data suggest an intricate role for S100A4 and EGF/EGFR in PH with right heart pathology.

Features of structural and microvascular changes of the choroid in angioretinopathy of various etiologies

To study structural and microvascular changes in the choroid in patients with chronic kidney disease (CKD), diabetic retinopathy (DR) and arterial hypertension (AH), and their relationship with the level of renal function, carbohydrate metabolism and blood pressure. The study involved 172 patients (325 eyes): 56 patients with CKD (109 eyes); 66 patients with DR (121 eyes); 50 patients with AH (95 eyes). All patients underwent comprehensive ophthalmological examination including visometry, biomicroscopy, ophthalmoscopy, optical coherence tomography (OCT) and OCT angiography. In patients with DR and CKD, a decrease in the thickness of the ganglion cell complex and the inner plexiform layer (GCL+IPL) was noted: in proliferative DR (PDR) - 62.45±4.25 µm, in stage 4-5 CKD - 75.23±6.43 µm; a decrease in choroidal thickness (CT) of minimal values in stage 4-5 CKD (179.9±37.72 µm) and PDR (211.0±40.7 µm). The decrease in choroidal vascularity index (CVI) depended on the stage of CKD and PDR (in PDR - 63.47±1.37, in stage 4-5 CKD - 65.93±2.01). Maximum decrease in perfusion density and vascular density was found in patients with DR (37.22±9.00% and 15.11±3.39 mm, respectively). An increase in the area, perimeter of the foveolar avascular zone (FAZ), and a decrease in the circularity index were noted in all groups, with most pronounced changes in PDR and stage 4-5 CKD. Patients with CKD were found to have strong correlations of CT and CVI with creatinine, urea, proteinuria and glomerular filtration rate (GFR). Patients with diabetes mellitus and PDR were revealed to have strong relations of CT, CVI, GCL+IPL, the area and perimeter of FAZ with creatinine levels and the duration of diabetes mellitus. Choroidal thickness and choroidal vascularity index are important diagnostic markers of disorders of chorioretinal microcirculation that allow stratifying individual assessment of risk factors for progression of both chronic kidney disease and diabetic retinopathy.