Concomitant Risk Factors Research Articles

Improvement of symptoms and quality of life in patients with coronary vasomotion disorders by endotype-based drug therapy

Abstract Introduction In patients with angina pectoris and/or signs of ischemia but no obstructive coronary artery disease (ANOCA) coronary vasomotion disorders are a frequent cause for their symptoms. However, the heterogeneous clinical presentation resulting from a wide spectrum of subtypes (so-called endotypes) poses a major therapeutic challenge. Many patients suffer from long-term refractory symptoms and severely reduced quality of life. Purpose The purpose of this study was to demonstrate that the quality of life of these patients can be improved by an endotype-based drug therapy. Methods A total of 50 patients (56% women, mean age 63±14 years) with a confirmed diagnosis of coronary vasomotion disorder were enrolled between April 2021 and February 2022. The endotypes were classified according to the diagnostically distinguishable subtypes (coronary spasm: n=30; vasodilatation disorder: n=3; combined vasomotion disorder: n=17). Based on the guideline recommendations of the European Society of Cardiology, an individual endotype-adapted medication was prescribed. The efficacy and tolerability of the medications were monitored over a period of 3 months. In addition, the quality of life was assessed quantitatively (score 0-100) using the Seattle Angina Questionnaire-7 (SAQ-7) at baseline and after 1, 2 and 3 months. The symptoms at home were documented weekly using a patient diary (PROM). Results Within the study population, arterial hypertension (74%) and dyslipidemia (80%) were among the most frequent concomitant cardiovascular risk factors. After 3 months of endotype-based antianginal therapy, a clinically relevant and significant improvement of 15 points on average in the SAQ7-score was achieved in 70% of the patients within the entire cohort (p<0.001), while no change (<5 points) was recorded in 14% of the study participants and 16% experienced an aggravation in the clinically relevant range (≥5 points). Accordingly, the PROM mood score (scale 1-5) also showed a significant improvement of 0.5 points (2.7±0.8 vs. 3.2±0.8; p<0.001) as well as a significant decrease in monthly number of chest pain attacks by 38% (11.7±13.6 vs. 7.3±15.4; p=0.041) and nitroglycerin intake by 67% (2.7±5.9 vs. 0.9±2.6; p=0.004). When comparing the initial and final medication, a significant increase (33%) in the intake of calcium channel antagonists (non-DHP) was recorded in patients with coronary spasm (p=0.004). Within the patient group with combined vasomotion disorders, statins, ezetimibe and ranolazine were taken significantly more often by 35% respectively at the end of the observation period (p=0.031). Conclusion Targeted endotype-based drug therapy can contribute decisively to a clinically relevant improvement of symptoms and quality of life in ANOCA patients.Outcome of the whole patient cohortSAQ improvement during follow-up

Impact of Non-Immune Factors on Platelet Transfusion Responses in an Allo-Immunized Cohort

Background: Patients with hematologic malignancies and/or hematopoietic stem cell transplantation (HSCT) recipients often require platelet transfusion support for extended periods. This can result in platelet transfusion refractoriness (PTR) from HLA alloimmunization in up to 30% of individuals. These medically complex patients may also have splenomegaly, fevers and other factors which contribute to PTR. Consequently, they may demonstrate variability in immediate platelet recovery (at 0-2 hours post-transfusion), and in subsequent platelet consumption (at 18-24 hours) despite receiving HLA-selected platelet products. We sought to examine patient and product related factors which impacted platelet transfusion response in a cohort of HLA-alloimmunized platelet transfusion refractory patients. Methods: From April 2021 to June 2023, HLA-alloimmunized (PRA >50%) subjects who required three or more HLA selected platelet units were identified at the Fred Hutchinson Cancer Center/University of Washington. Data were obtained on patient demographics, diagnoses, Panel Reactive Antibodies (PRA %) and factors shown to be associated with poor platelet responses (spleen size, disseminated intravascular coagulation (DIC), bleeding, selected medications, history of hematopoietic stem cell transplant (HSCT) and/or graft versus host disease (GVHD), ABO compatibility, and product age). Platelet corrected count increments (CCI) were calculated for each transfusion. Non-HLA factors potentially contributing to CCIs at 0-2 and 18-24 hours post-transfusion were compared among HLA-compatible (either 4/4 HLA matched without HLA antigen mismatches, or with permissive mismatches (defined as cumulative a mean fluorescent intensity (MFI) <10,000 on the Luminex donor specific HLA antibody testing platform)) and HLA incompatible transfusions (cumulative MFI >10,000 or random donor apheresis products). Results: Of the 420 patients screened, 75 had sufficient records for inclusion. These subjects received 2729 platelet transfusions, an average of 36 transfusions per patient over 5.2 (± 4.1) months. Post transfusion platelet counts were available for 1528 transfusions. All platelet products were leukoreduced, irradiated, single donor apheresis products. Patients were predominantly Caucasian (70.7%; n=53/75), female (82.7%; n=62/75), aged 57 (±14.9) years. The primary diagnosis was Acute myelogenous leukemia or myeloproliferative disorder in most cases (88%; n=66/75). 58.7% (n=44/75) of patients were HSCT recipients (3 auto-; 41 allo-HSCT). Average PRA among patients was 72.4%±22.2%. 25 patients had splenomegaly. Among HLA-compatible transfusions, average CCIs at 0-2 and 18-24 hours were 17,088 and 6,666. In HLA-mismatched/random donor transfusions, average CCIs at 0-2 and 18-24 hours were 11,489 and 2,786; HLA compatible products increased CCIs by 5,599 and 3880 at 0-2 and 18-24 hours. In both groups splenomegaly had the most consistent association with poor CCI at both time intervals (Figures A and B). Conclusions: In this cohort of individuals with HLA-alloimmunization mediated PTR, the administration of HLA-compatible products offset the impact of other detrimental factors generating adequate CCIs at 0-2 and 18-24 hours. Among patients with splenomegaly, CCIs were lower despite HLA compatible product administration. In the same individuals, HLA-incompatible/random donor products negatively impacted CCIs overall and the negative effect of other concomitant non-immune/product-related factors was additive.Our data highlights the need to account for non-HLA related conditions while evaluating CCI response following each HLA-selected product transfusion, and to further explore any interactions among such factors. Next steps include conducting a multivariate analysis and developing a predictive model for platelet transfusion response in HLA-alloimmunized recipients who have concomitant non-immune or product related risk factors.

Embolic stroke due to atrial myxoma: about a case

Cardiac myxoma is recognized as the most common primary cardiac tumor, typically benign, slow-growing, with a predilection for the left atrium, presenting as a mobile mass attached to the inner surface of the heart by a peduncle. Although its presentation through cerebrovascular events is quite common, it remains an exceedingly rare cause, representing approximately 0.5% of all cerebrovascular events. In this clinical case, we describe a 54-year-old woman with no significant medical history who presented with embolization in both cerebral hemispheres without specific neurological deficits. A left atrial mass was identified on echocardiography. Given the risk of further systemic embolization, the patient underwent surgical excision of the left atrial mass, which histopathology confirmed to be a cardiac myxoma. Due to the high recurrence of systemic embolic events, particularly in the form of cerebral ischemic embolisms, the diagnosis of cardiac myxoma should prompt immediate surgical intervention, as the tumor's friability is more closely related to the embolic risk than its size or the presence of concomitant cardiovascular risk factors. Surgical resection is generally curative and the recurrence of new cerebrovascular events is rare, with an excellent prognosis, although recurrence of tumor is possible in cases of inadequate resection. Treatment with antiplatelet agents or anticoagulants is not an alternative to surgery, as cerebrovascular events can occur even under such treatments.

A smoking cessation intervention for rural veterans tailored to individual risk factors: A multicenter randomized clinical trial

IntroductionRates of cigarette use remain elevated among those living in rural areas. Depressive symptoms, risky alcohol use, and weight concerns frequently accompany cigarette smoking and may adversely affect quitting. Whether treatment for tobacco use that simultaneously addresses these issues affects cessation outcomes is uncertain. MethodsThe study was a multicenter, two-group, randomized controlled trial involving mostly rural veterans who smoke (N = 358) receiving treatment at one of five Veterans Affairs Medical Centers. The study randomly assigned participants to a tailored telephone counseling intervention or referral to their state tobacco quitline. Both groups received guideline-recommended smoking cessation pharmacotherapy, selected using a shared decision-making approach. The primary outcome was self-reported seven-day point prevalence abstinence (PPA) at three and six months. The study used salivary cotinine to verify self-reported quitting at six months. ResultsSelf-reported PPA was significantly greater in participants assigned to Tailored Counseling at three (OR = 1.66; 95 % CI: 1.07–2.58) but not six (OR = 1.35; 95 % CI: 0.85–2.15) months. Post hoc subgroup analyses examining treatment group differences based on whether participants had a positive screen for elevated depressive symptoms, risky alcohol use, and/or concerns about weight gain indicated that the cessation benefit of Tailored Counseling at three months was limited to those with ≥1 accompanying concern (OR = 2.02, 95 % CI: 1.20–3.42). Biochemical verification suggested low rates of misreporting. ConclusionsA tailored smoking cessation intervention addressing concomitant risk factors enhanced short-term abstinence but did not significantly improve long-term quitting. Extending the duration of treatment may be necessary to sustain treatment effects.

Prognostic value of humoral markers in patients with anthracycline-related cardiac dysfunction

Aim. To carry out a 12-month study on the prognostic role of humoral markers responsible for the main mechanisms of initiation of cardiotoxic myocardial damage (endothelin-1, soluble Fas-L, N-terminal pro-brain natriuretic peptide (NT-proBNP), tumor necrosis factor-α, interleukin (IL)-1β, matrix metalloproteinase (MMP)-2 and MMP9, soluble form of the ST2 protein (sST2), a tissue inhibitor of metalloproteinase-1, and tetranectin) in assessing the risk of progression of anthracycline-related left ventricular dysfunction.Materials and methods. The study included a total of 114 women aged 48.0 (46.0; 52.0) years without concomitant cardiovascular diseases and risk factors who received chemotherapy with anthracyclines in the past. The levels of serum biomarkers were determined using the enzyme immunoassay. Transthoracic echocardiography was performed at baseline and at 12 months of follow-up.Results. After 12 months of follow-up, all patients were retrospectively divided into 2 groups: group 1 (n = 54) included patients with an unfavorable course of anthracycline-related cardiac dysfunction (ARCD), group 2 (n = 60) encompassed patients with a favorable course of the disease. According to the ROC analysis, MMP-2 ≥ ≥ 338.8 pg / ml (sensitivity 57%, specificity 78%; AUC = 0.629; p = 0.025), MMP-9 ≥ 22.18 pg / ml (sensitivity 89%, specificity 87%; AUC = 0.886; p < 0.001), sST2 ≥ 32.4 ng / ml (sensitivity 64%, specificity 70.5%; AUC = 0.691; p = 0.002), and tetranectin ≤ 15.4 pg / ml (sensitivity 69%, specificity 72%; AUC = 0.764; p < 0.001) were identified as predictors of an adverse course of ARCD. When comparing ROC curves, it was found that the concentration of MMP-9 (p = 0.002) was the most significant predictor of the progression of ARCD.Conclusion. MMP-2 and -9, soluble ST2, and tetranectin can be considered as non-invasive markers for assessing the risk of ARCD progression. At the same time, an increased level of MMP-9 is the most significant predictor of ARCD progression.

THE ACCURACY OF RISK SCORES IN PREDICTING PRETERM BIRTH : A SYSTEMATIC REVIEW

Introduction: Preterm birth (PTB) is a leading cause of infant illness and death. PTB is spontaneous in two-thirds of instances. SPTB is problematic because it has several causes. If SPTB has occurred before, it will likely happen again. PTB is hard to forecast because the scenario is varied and there are many causes and risk factors. Risk score accuracy in predicting premature birth is discussed. The aim: This study demonstrated the accurateness of risk score predictions for premature birth. Methods: This study demonstrated that it met all of the requirements by comparing itself to the Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) 2020 guidelines. As a result, the specialists were able to ensure that the study was as up to date as possible. Publications published between 2013 and 2023 were considered for this search strategy. This was accomplished using a variety of online reference sources, including Pubmed and SagePub. It was chosen not to include review pieces, previously published works, or works that were just partially completed. Result: In the PubMed database, the results of our search brought up 415 articles and SagePub 366 articles. The results of the search conducted for the last year of 2013 yielded a total 56 articles for PubMed and 49 articles from SagePub. In the end, we compiled a total of 10 papers. Conclusion: Preterm birth has been associated to a short cervix, a maternal age over 35, a maternal body mass index above 25, smoking, and concomitant risk factors like hypertension and diabetes.

Statins, commonly coprescribed drugs, and concomitant risk factors: A protective, neutral, or harmful association with common cancer types development: A 10-year multicentric retrospective lebanese study.

Elevated blood levels of low-density lipoprotein cholesterol are a major cardiovascular risk factor, and cholesterol-lowering drugs are among the most prescribed drugs worldwide. Cancer is the second leading cause of death after cardiovascular diseases. The relationship between cancer development and statins intake is controversial, and there are no clear studies in Lebanon and the Middle East concerning this topic. Hence, our study aimed to search for any possible association of statin intake as well as other medications (proton pump inhibitors [PPI], metformin, Aspirin, Angiotensin-Converting Enzyme inhibitors, and fenofibrate) with lung, colorectal cancer (CRC), and bladder cancer development in the Lebanese population. A retrospective study was performed on 709 subjects divided into 2 main groups: control (no cancer ± statin intake), and cases (either lung, or colorectal, or bladder cancer ± statin intake). Collected data included the age and gender of the patient, socioeconomic status, presence of cardiovascular disease and comorbidities, cancer risk factors, and the intake type, dose, and duration of statins. Bivariate, multivariate, and binary logistic analyses were enrolled. Out of 709 participants, 63.2% were males and 75% were cancer-positive (24.1%: lung cancer, 26.7%: CRC, 24.1%: bladder cancer). The overall intake of statins was not shown to significantly affect cancer development. However, a duration-response relationship was established between Simvastatin and lung cancer (odds ratio [OR]=1.208) as well as bladder cancer (OR=1.189). No significant association was found between each statin and CRC. Although PPIs intake was associated with a possibly harmful effect on lung cancer development (OR=3.42), it revealed a protective association with CRC development (OR=0.38). Other risk factors such as smoking and age were strongly associated (harmful) with lung and bladder cancer development. Physical inactivity and a family history of CRC were each associated with a harmful effect on CRC development. A harmful association with the development of lung and bladder cancer was found with the increasing duration of intake of Simvastatin. Other drugs such as PPIs and specific risk factors were also associated negatively or positively with the development of these 3 cancers. These findings should be validated by further investigations to guide clinicians on optimal treatment options for their patients.

Standardised Exercise Prescription for Patients with Chronic Coronary Syndrome and/or Heart Failure: A Consensus Statement from the EXPERT Working Group.

Whereas exercise training, as part of multidisciplinary rehabilitation, is a key component in the management of patients with chronic coronary syndrome (CCS) and/or congestive heart failure (CHF), physicians and exercise professionals disagree among themselves on the type and characteristics of the exercise to be prescribed to these patients, and the exercise prescriptions are not consistent with the international guidelines. This impacts the efficacy and quality of the intervention of rehabilitation. To overcome these barriers, a digital training and decision support system [i.e. EXercise Prescription in Everyday practice & Rehabilitative Training (EXPERT) tool], i.e. a stepwise aid to exercise prescription in patients with CCS and/or CHF, affected by concomitant risk factors and comorbidities, in the setting of multidisciplinary rehabilitation, was developed. The EXPERT working group members reviewed the literature and formulated exercise recommendations (exercise training intensity, frequency, volume, type, session and programme duration) and safety precautions for CCS and/or CHF (including heart transplantation). Also, highly prevalent comorbidities (e.g. peripheral arterial disease) or cardiac devices (e.g. pacemaker, implanted cardioverter defibrillator, left-ventricular assist device) were considered, as well as indications for the in-hospital phase (e.g. after coronary revascularisation or hospitalisation for CHF). The contributions of physical fitness, medications and adverse events during exercise testing were also considered. The EXPERT tool was developed on the basis of this evidence. In this paper, the exercise prescriptions for patients with CCS and/or CHF formulated for the EXPERT tool are presented. Finally, to demonstrate how the EXPERT tool proposes exercise prescriptions in patients with CCS and/or CHF with different combinations of CVD risk factors, three patient cases with solutions are presented.

Risk of Incident Venous Thromboembolism Among Patients With Bullous Pemphigoid or Pemphigus Vulgaris: A Nationwide Cohort Study With Meta-Analysis.

Background Bullous pemphigoid (BP) and pemphigus vulgaris (PV) share similar pathophysiology with venous thromboembolism (VTE) involving platelet activation, immune dysregulation, and systemic inflammation. Nevertheless, their associations have not been well established. Methods and Results To examine the risk of incident VTE among patients with BP or PV, we performed a nationwide cohort study using Taiwan's National Health Insurance Research Database and enrolled 12 162 adults with BP or PV and 12 162 controls. A Cox regression model considering stabilized inverse probability weighting was used to calculate the hazard ratios (HRs) for incident VTE associated with BP or PV. To consolidate the findings, a meta-analysis that incorporated results from the present cohort study with previous literature was also conducted. Compared with controls, patients with BP or PV had an increased risk for incident VTE (HR, 1.87 [95% CI, 1.55-2.26]; P<0.001). The incidence of VTE was 6.47 and 2.20 per 1000 person-years in the BP and PV cohorts, respectively. The risk for incident VTE significantly increased among patients with BP (HR, 1.85 [95% CI, 1.52-2.24]; P<0.001) and PV (HR, 1.99 [95% CI, 1.02-3.91]; P=0.04). In the meta-analysis of 8 studies including ours, BP and PV were associated with an increased risk for incident VTE (pooled relative risk, 2.17 [95% CI, 1.82-2.62]; P<0.001). Conclusions BP and PV are associated with an increased risk for VTE. Preventive approaches and cardiovascular evaluation should be considered particularly for patients with BP or PV with concomitant risk factors such as hospitalization or immobilization.

Risk factors and diagnostic markers for acute coronary syndrome in chronic kidney disease

Introduction. Acute coronary artery disease is the leading cause of death in patients with chronic kidney disease (CKD). In addition, CKD itself is the initiator of acute coronary syndrome (ACS), the prevalence of which is greater, the more pronounced the impairment of kidney function and the more concomitant risk factors in the patient.Aim. To study the predictive value of various laboratory and instrumental markers in identifying the risk of developing ACS in patients with CKD.Materials and methods. A search was made for articles for the last 10 years in the databases: PubMed, Medline, Google Scholar and eLIBRARY by keywords in Russian and English, the articles were selected in accordance with the purpose of the study.Results. ACS manifests itself in CKD patients with an atypical picture, and in 3 % of cases it is generally asymptomatic. The risk of death from cardiovascular complications increases in proportion to the deterioration of the glomerular filtration rate (GFR). This progression also increases the risk of coronary artery calcification. At the same time, it was found that cystatin C is a more universal marker of a decrease in GFR than creatinine. Other laboratory markers that indicate the risk of ACS are inflammatory markers, albuminuria, troponins, natriuretic peptide.Conclusion. So far as ACS is atypical or asymptomatic, in addition to troponins and traditional instrumental diagnostic methods, markers such as GFR, albuminuria, an increase in serum cystatin C, phosphate, fibroblast growth factor-23, interleukin-6, tumor necrosis factor-alpha, total parathyroid hormone, fibrinogen, natriuretic peptide can help in its prediction.

Pediatric Drug-Associated Pancreatitis Reveals Concomitant Risk Factors and Poor Reliability of Causality Scoring: Report From INSPPIRE.

Drug-associated acute pancreatitis (DAP) studies typically focus on single acute pancreatitis (AP) cases. We aimed to analyze the (1) characteristics, (2) co-risk factors, and (3) reliability of the Naranjo scoring system for DAP using INSPPIRE-2 (the INternational Study group of Pediatric Pancreatitis: In search for a cuRE-2) cohort study of acute recurrent pancreatitis (ARP) and chronic pancreatitis (CP) in children. Data were obtained from ARP group with ≥1 episode of DAP and CP group with medication exposure ± DAP. Physicians could report multiple risk factors. Pancreatitis associated with Medication (Med) (ARP+CP) was compared to Non-Medication cases, and ARP-Med vs CP-Med groups. Naranjo score was calculated for each DAP episode. Of 726 children, 392 had ARP and 334 had CP; 51 children (39 ARP and 12 CP) had ≥1 AP associated with a medication; 61% had ≥1 AP without concurrent medication exposure. The Med group had other risk factors present (where tested): 10 of 35 (28.6%) genetic, 1 of 48 (2.1%) autoimmune pancreatitis, 13 of 51 (25.5%) immune-mediated conditions, 11 of 50 (22.0%) obstructive/anatomic, and 28 of 51 (54.9%) systemic risk factors. In Med group, 24 of 51 (47%) had involvement of >1 medication, simultaneously or over different AP episodes. There were 20 ARP and 4 CP cases in "probable" category and 19 ARP and 7 CP in "possible" category by Naranjo scores. Medications were involved in 51 of 726 (7%) of ARP or CP patients in INSPPIRE-2 cohort; other pancreatitis risk factors were present in most, suggesting a potential additive role of different risks. The Naranjo scoring system failed to identify any cases as "definitive," raising questions about its reliability for DAP.

Sex Differences in Cardiovascular Risk Associated With Prediabetes and Undiagnosed Diabetes

Women with Type 2 diabetes (T2D) face up to 50% higher risk of cardiovascular disease than men. This study evaluated the extent to which prediabetes and undiagnosed T2D are associated with a greater excess risk of cardiovascular disease in women versus in men. Data were pooled from 18,745 cardiovascular disease-free individuals from the Atherosclerosis Risk in Communities Study, the Multi-Ethnic Study of Atherosclerosis, and the Jackson Heart Study. The risk of coronary heart disease, ischemic stroke, and atherosclerotic cardiovascular disease (coronary heart disease or stroke) associated with prediabetes or undiagnosed T2D was estimated using Cox models adjusting for sociodemographic factors, concomitant risk factors, medication use, and menopausal status. Data were collected in 2022, and the analysis was performed in 2023. During a median follow-up of 18.6 years, the associations between prediabetes and risk of atherosclerotic cardiovascular disease were only significant in women (hazard ratio=1.18, 95% CI=1.01, 1.34, p=0.03) but not in men (hazard ratio=1.08, 95% CI=1.00, 1.28, p=0.06) (p-interaction=0.18). The associations between undiagnosed T2D and cardiovascular disease outcomes were significant in both sexes, but the effect was more pronounced in women (coronary heart disease: hazard ratio=1.83, 95% CI=1.4, 2.41, p<0.0001 in women vs hazard ratio=1.6, 95% CI=1.38, 2.07, p=0.007 in men; stroke: hazard ratio=1.99, 95% CI=1.39, 2.72, p<0.0001 vs hazard ratio=1.81, 95% CI=1.36, 2.6, p<0.0001; atherosclerotic cardiovascular disease: hazard ratio=1.86, 95% CI=1.5, 2.28, p<0.0001 vs hazard ratio=1.65, 95% CI=1.4, 1.98, p<0.0001) (all p-interactions≤0.2). Both White and Black patients exhibit similar sex differences. Prediabetes or undiagnosed T2D was associated with a greater excess risk of cardiovascular disease in women than in men. The sex differential in cardiovascular disease risk among those without the T2D diagnosis suggests the need for sex-specific guidelines in T2D screening and treatment.

Prevalence of ventricular extrasystoles among smokers and individuals with risk factors for cardiovascular diseases

Abstract Funding Acknowledgements Type of funding sources: None. Main funding source(s): no. The purpose of the work to establish the prevalence of life-threatening arrhythmias and the risk of sudden death among people with a high and very high risk of cardiovascular diseases. Materials and methods During the period 2007-2013 years, we examined 4,214 patients, ages 35 to 85 years, who underwent Holter heart rhythm monitoring. Patients were divided into 4 groups. The 1st group: patients with coronary heart disease (stable angina), but without concomitant risk factors for cardiovascular diseases, such as smoking and obesity. The 2nd group - people who smoke 5 or more cigarettes per day for more than 2 years. The 3rd group - obese people without concomitant ischemic heart disease and arterial hypertension. The 4th group - people with obesity and hypertension. The control group included 149 practically healthy people. The groups were identical in age and sex. The highest prevalence of ventricular extrasystoles was recorded in group 2 (among smokers) and was 44,8% (p&amp;lt;0.01), and 9,02% of people from this group had class V ventricular extrasystoles according to V. Lown and M. Wolf classification, and the result was higher among people with stable angina, where this figure was 7,69%. The lowest prevalence of this arrhythmia was found among people with stable angina and was 30,34%. This can be explained by patients being more thoroughly supervised by doctors and medicine intake. Another reason was that groups 2-4 included people with only risk factors, and group 1 - people with the disease. Among obese people with and without hypertension, the prevalence of this arrhythmia was almost the same – 35,1% and 36,7%, respectively, and was not significantly different from the control group (33,6%). The next step was to determine the prevalence of polytopic (supraventricular + ventricular extrasystole) and ectopic foci among these individuals. And again, smokers had the highest prevalence of polytopic extrasystoles, which was 69,57%. Among people with stable angina, this figure was 55% (p&amp;lt;0.01). In people with obesity, which were included in the 3rd and 4th groups, polytopy was observed in less than half of the patients – 47,83% and 43,48%, respectively. Therefore, analyzing the data presented above, we can say that people who smoke tobacco have higher prevalence of both individual ventricular arrhythmia and ventricular and supraventricular extrasystoles than healthy individuals and people with obesity and hypertension. There is no significant difference in the prevalence of ventricular extrasystoles in individuals with only obesity or plus hypertension.

Predictive model of recurrent ischemic stroke: model development from real-world data.

There are established correlations between risk factors and ischemic stroke (IS) recurrence; however, does the hazard of recurrent IS change over time? What is the predicted baseline hazard of recurrent IS if there is no influence of variable predictors? This study aimed to quantify the hazard of recurrent IS when the variable predictors were set to zero and quantify the secondary prevention influence on the hazard of recurrent ischemic stroke. In the population cohort involved in this study, data were extracted from 7,697 patients with a history of first IS attack registered with the National Neurology Registry of Malaysia from 2009 to 2016. A time-to-recurrent IS model was developed using NONMEM version 7.5. Three baseline hazard models were fitted into the data. The best model was selected using maximum likelihood estimation, clinical plausibility, and visual predictive checks. Within the maximum 7.37 years of follow-up, 333 (4.32%) patients had at least one incident of recurrent IS. The data were well described by the Gompertz hazard model. Within the first 6 months after the index IS, the hazard of recurrent IS was predicted to be 0.238, and 6 months after the index attack, it reduced to 0.001. The presence of typical risk factors such as hyperlipidemia [HR, 2.22 (95%CI: 1.81-2.72)], hypertension [HR, 2.03 (95%CI: 1.52-2.71)], and ischemic heart disease [HR, 2.10 (95%CI: 1.64-2.69)] accelerated the hazard of recurrent IS, but receiving antiplatelets (APLTs) upon stroke decreased this hazard [HR, 0.59 (95%CI: 0.79-0.44)]. The hazard of recurrent IS magnitude differs during different time intervals based on the concomitant risk factors and secondary prevention.

Impact of coronary artery revascularization on long-term outcome in hypertrophic cardiomyopathy patients: a nationwide population-based cohort study

Limited data are available on the long-term outcomes in patients with hypertrophic cardiomyopathy (HCM) patients with significant coronary artery disease (CAD) requiring revascularization. We investigated the risk of cardiovascular outcomes in HCM patients who underwent coronary revascularization compared to the control group without HCM. HCM patients aged ≥ 20 years were enrolled from the Korean National Health Insurance Database. Information on the diagnosis and previous medical history was obtained from the claims data. Cardiovascular outcomes were identified during 8-year after coronary revascularization in HCM patients (HCM group) and matched controls without HCM (non-HCM control group). A total of 431 patients in the HCM group and 1968 in the non-HCM control group were analyzed. The risk of all-cause death, cardiovascular death, sudden cardiac death (SCD), ischemic stroke, and hospitalization due to heart failure was significantly higher in the HCM group than in the non-HCM group, with prominent risk increase of cardiovascular death (adjusted hazard ratio [HR] 2.27, 95% confidence interval [CI] 1.63–3.15, P < 0.001) and ischemic stroke (adjusted HR 2.38, 95% CI 1.55–3.64, P < 0.001). Beyond 1-year after revascularization, the HCM group still had a significantly higher risk of cardiovascular death, SCD, and ventricular fibrillation/tachycardia compared to the non-HCM group. Mortality and major cardiovascular outcomes occurred more frequently in HCM patients with significant CAD requiring revascularization, compared to the matched non-HCM control group. Active and regular surveillance for concomitant risk factors and relevant intervention are warranted in HCM patients at increased risk for CAD.

Hearing Outcomes in the Audiology Department of a Children Hospital.

The incidence of sensorineural hearing loss is between 1 and 3 per 1000 in healthy neonates and 2-4 per 100 in high-risk infants. In this study, we assessed the incidence of hearing impairment in normal term (≥ 37 wga) infants (control group), in children with suspicion and/or risk factors of hearing loss, included premature infants (< 37weeks gestational age (wga) and/or low birth weight < 2,5 Kgr), in children diagnosed with a specific syndrome and in children with speech disorder, candidate for speech therapy. Hearing impairment is a severe consequence of prematurity and its prevalence is inversely related to the maturity of the baby based on gestation age and /or birth weight. Both above parameters are of particular importance and it has not been found that one factor prevails over the other. Premature infants have many concomitant risk factors for hearing impairment. The most important other risk factors were ototoxic medications, very low birth weight and "treatment in the intensive care unit '' (low Apgar score and mechanical ventilation). Frequent risk factors such as congenital infections and family history of hearing loss, although frequently recorded, does not seem to be very significant. Children with speech disorder do not seem to suffer from hearing impairment more frequently than children in general population.

Dual Antiplatelet Therapy and Cancer; Balancing between Ischemic and Bleeding Risk: A Narrative Review.

Cardiovascular (CV) events in patients with cancer can be caused by concomitant CV risk factors, cancer itself, and anticancer therapy. Since malignancy can dysregulate the hemostatic system, predisposing cancer patients to both thrombosis and hemorrhage, the administration of dual antiplatelet therapy (DAPT) to patients with cancer who suffer from acute coronary syndrome (ACS) or undergo percutaneous coronary intervention (PCI) is a clinical challenge to cardiologists. Apart from PCI and ACS, other structural interventions, such as TAVR, PFO-ASD closure, and LAA occlusion, and non-cardiac diseases, such as PAD and CVAs, may require DAPT. The aim of the present review is to review the current literature on the optimal antiplatelet therapy and duration of DAPT for oncologic patients, in order to reduce both the ischemic and bleeding risk in this high-risk population.

Cerebral small-vessel disease at high altitude: A comparison of patients from plateau and plain.

Cerebral small-vessel disease (CSVD) is prevalent worldwide and one of the major causes of stroke and dementia. For patients with CSVD at high altitude, a special environmental status, limited information is known about their clinical phenotype and specific neuroimaging change. We investigated the clinical and neuroimaging features of patients residing at high altitude by comparing with those in the plain, trying to explore the impact of high altitude environment on CSVD. Two cohorts of CSVD patients from the Tibet Autonomous Region and Beijing were recruited retrospectively. In addition to the collection of clinical diagnoses, demographic information and traditional vascular risk factors, the presence, location, and severity of lacunes and white matter hyperintensities were assessed by manual counting and using age-related white matter changes (ARWMC) rating scale. Differences between the two groups and influence of long-term residing in the plateau were analyzed. A total of 169 patients in Tibet (high altitude) and 310 patients in Beijing (low altitude) were enrolled. Fewer patients in high altitude group were found with acute cerebrovascular events and concomitant traditional vascular risk factors. The median (quartiles) ARWMC score was 10 (4, 15) in high altitude group and 6 (3, 12) in low altitude group. Less lacunes were detected in high altitude group [0 (0, 4)] than in low altitude group [2 (0, 5)]. In both groups, most lesions located in the subcortical (especially frontal) and basal ganglia regions. Logistic regressions showed that age, hypertension, family history of stroke, and plateau resident were independently associated with severe white matter hyperintensities, while plateau resident was negatively correlated with lacunes. Patients of CSVD residing at high altitude showed more severe WMH but less acute cerebrovascular events and lacunes in neuroimaging, comparing to patients residing at low altitude. Our findings suggest potential biphasic effect of high altitude on the occurrence and progression of CSVD.

Real-World Racial Variation in Treatment and Outcomes Among Patients with Peripheral Artery Disease.

Prior studies have found considerable disparities in prevalence and outcomes for patients with peripheral arterial disease (PAD). This study compared rates of diagnostic testing, treatment patterns, and outcomes after diagnosis of PAD among commercially insured Black and White patients in the United States. Optum's de-identified Clinformatics® Data Mart Database (1/2016-6/2021) were used to identify Black and White patients with PAD; first PAD diagnosis was deemed study index date. Baseline demographics, markers of disease severity, and healthcare costs were compared between cohorts. Patterns of medical management and rates of major adverse limb events (MALE; including acute or chronic limb ischemia, lower-limb amputation) and cardiovascular (CV) events (stroke, myocardial infarction) during the available follow-up period were described. Outcomes were compared between cohorts using multinomial logistic regression models, Kaplan-Meier survival analysis, and Cox proportional hazards models. A total of 669,939 patients were identified, with 454,382 White patients and 96,162 Black patients. Black patients were younger on average (71.8years vs. 74.2years), but had higher comorbid burden, concomitant risk factors, and CV medication use at baseline. Prevalence of diagnostic testing, revascularization procedures, and medication use was numerically higher among Black patients. Black patients were also more likely than the White patients to receive medical therapy without a revascularization procedure [adjusted odds ratio with 95% confidence interval (CI)=1.47 (1.44-1.49)]. However, Black patients with PAD had higher incidence of MALE and CV events than White patients [adjusted hazard ratio for composite event (95% CI)=1.13, (1.11-1.15)]. Except myocardial infarction, the hazards of individual components of MALE and CV events were also significantly higher among Black patients with PAD. Results of this real-world study suggest that Black patients with PAD have higher disease severity at the time of diagnosis and are at increased risk of experiencing adverse outcomes following diagnosis.

Gastroparesis-Related Symptoms in Patients With Type 2 Diabetes Mellitus: Early Detection, Risk Factors, and Prevalence.

Background The symptoms of gastroparesis, such as bloating, postprandial fullness, early satiety, nausea, and abdominal discomfort, progressively worsen the quality of life of the affected individuals. The diagnosis is established on the assessment of gastric function that confirms delayed gastric emptying in the absence of structural etiologies. This study aimed to detect gastroparesis-related clinical symptoms early in patients with type 2 diabetes mellitus (T2DM), investigate the concomitant risk factors, and evaluate the prevalence. Methodology This study was conducted at the Department of Medicine and Diabetes Outdoor Clinic of Sheikh Zayed Hospital, Rahim Yar Khan from February 13, 2022, to February 11, 2023. The study involved 175 patients with T2DM who reported gastroparesis-related symptoms. The demographic and clinical characteristics, symptom severity, complications, related risk factors, duration of disease, medications, body mass index (BMI), fasting plasma glucose, and glycated hemoglobin (HbA1C) levels were assessed. The severity of diabetic gastroparesis was established using the disease-specific Patient Assessment of Gastrointestinal Disorders-Symptom Severity Index (PAGI-SYM) and the Gastroparesis Cardinal Symptom Index (GCSI). The five-point scale of the PAGI-SYM and the four-degree severity scores of GCSI were assessed. Neuropathy disability scores and motor evacuation functions were analyzed. Data were analyzed from these questionnaires, special proforma, and patient interviews. Results The clinical features of diabetic gastroparesis were observed in 44% of T2DM patients with mild-grade gastroparesis in 38 (21.7%), moderate in 30 (17.1%), and severe-grade gastroparesis-related symptoms in nine (5.2%) patients. The main manifestations were early satiety (45.1%), stomach fullness (44.5%), bloating (38.3%), and nausea (33.1%). Diabetic gastroparesis symptoms were considerably linked to disease duration of more than 10 years (p = 0.02), high HbA1c (p = 0.001), increased fasting blood glucose (p = 0.003), polyneuropathy, cigarette smoking, and history of comorbid conditions (p = 0.009). Obesity and the female gender were the forecasters of the manifestation of at least one cardinal gastroparesis symptom. Conclusions Gastric emptying is significant in the pathogenesis of gastroparesis-related symptoms. Disease duration of more than 10 years, poor glycemic control with hyperglycemia, high HbA1C, polyneuropathy, and cigarette smoking must be considered as predictors for early detection and risk factors for the advancement of gastroparesis in T2DM. Gastroparesis-related common symptoms of early satiety, bloating, and stomach fullness were considerably linked to the additional risk factors of hypercholesteremia, chronic microvascular complications, concomitant cardiovascular diseases, and a positive family history of diabetes mellitus. There was no relationship between BMI, age, types of treatment, and the degree of gastroparesis severity. The prevalence and severity of gastroparesis symptoms were particularly high among obese females with poor glycemic control and longer disease duration.