History Of Hypertension Research Articles

Exploring the epidemiology and awareness of metabolic dysfunction-associated steatotic liver disease (MASLD) among health sciences students in an academic health care institute in India

BackgroundMetabolic dysfunction-associated steatotic liver disease (MASLD) affects over 25 % of the global population, presenting a significant health challenge. It is often asymptomatic but linked to severe conditions like cirrhosis and liver cancer. Previous research indicates that people often underestimate MASLD risks. This study examines MASLD prevalence and awareness among medical students in an academic health care institute in India. Material and methodsThis cross-sectional study at SRM Medical College Hospital, Chennai, involved 80 medical and paramedical students aged 18–25. Exclusion criteria included history of alcohol use, neurological disorders, thyroid issues, diabetes, and hypertension. After obtaining informed consent, anthropometric data and blood samples were collected. Biochemical parameters including fasting plasma glucose, triglycerides, HDL-C, and GGT were measured. The Fatty Liver Index (FLI) was used to assess liver steatosis, with an FLI ≥60 indicating NAFLD. Data were analysed using SPSS Version 22.0, with statistical significance set at p < 0.05. ResultsAmong 80 participants, the mean age and BMI were 20.2 ± 1.03 years and 23.16 ± 4.55 kg/m2. The mean Fatty Liver Index (FLI) score was 15.11 ± 19.68. MASLD prevalence was 7.5 % (n = 6). Significant positive correlations were found between FLI and BMI, waist circumference, fasting plasma glucose, triglycerides, and GGT, while HDL-C showed a non-significant negative correlation. Most participants were aware of MASLD and its risk factors but showed varied adherence to preventive measures. ConclusionHealth Sciences undergraduates had a 7.5 % MASLD prevalence, highlighting a gap in understanding and testing. Addressing this requires better guidelines, awareness, and healthcare system enhancements.

DESIGN AND DEVELOPMENT OF A DAILY BOOK FOR PROLANIS PATIENTS TO INCREASE KNOWLEDGE AND MOTIVATION IN MAINTAINING DENTAL AND ORAL HEALTH

Background: The prevalence of hypertension has increased by 8.3%. The measurement results for the population aged ? 18 years in 2013 were 25.8% and in 2018 it was 34.1%. As much as 8.8% is the prevalence of hypertension in all provinces in Indonesia1. Oral health plays an important role in achieving general health and quality of life in old age. Poor oral conditions disrupt the function and activities of the oral cavity. Elderly people with a history of hypertension and Type 2 DM often seek treatment with loose or cavities in their teeth. Oral hygiene plays an important role in cases of caries in individuals, especially in the elderly who do not maintain oral and dental hygiene. This program aims to ensure that chronic disease sufferers can achieve an optimal quality of life with cost-effective and efficient health services so as to prevent disease complications. One effort to improve prolanis' quality of life is to maintain healthy teeth and mouth. Objective: Create and develop a dental and oral health daily book for prolanis sufferers. The research method: is R &amp; D research and pre-experiment with a one group pretest posttest design to measure knowledge and motivation in prolanis patients. Sampling using purposive sampling technique on prolanis patients amounted to 34 people (Small Group) and 85 people (Big Group). Results: The average value of expert va;idation of 90,55 shows that the interpretation is very high, which means that the media is suitable foe use. Wilxocon test shows an increase in knowledge of prolanis patients with significance (p-value 0.000). Conclusion: Promotional and Preventive Daily Books are effective in increasing knowledge and motivation in Prolanis patients.

Three-dimensional characterization of sex differences in abdominal aortic aneurysm progression via vascular deformation mapping

Although abdominal aortic aneurysms (AAA) are more common in men, women are at greater risk for AAA growth/rupture. Vascular deformation mapping (VDM) utilizes deformable image registration to qualify and quantify 3D-AAA growth using computed tomography angiograms (CTA). In this study we leveraged VDM to investigate sex differences in AAA growth patterns. Patients with infra-renal AAA and ≥ 2 CTA were identified. Males and females were matched for age, hypertension, and smoking history. Patient characteristics, maximum diameter (Dmax), and AAA volume were obtained. CTA images were segmented, and VDM was conducted to quantify 3D AAA growth rate per year (GR, cm/year). Statistical shape modeling was utilized to compute mean aneurysm shapes and 3D GR. Average GR was evaluated at specific regions of the aortic surface for males and females. Seventeen males and 17 females were matched. At the individual level, there were no sex differences in changes in Dmax or AAA volume. However, females had larger GR across the anterior and right lateral AAA (1.33 vs 0.89 and 1.56 vs 0.74 cm/year, respectively), despite no difference in posterior or left lateral AAA GR. Despite comparable changes in Dmax, AAA volume, and GR magnitude, women demonstrated a more eccentric, anterior-predominant, AAA growth pattern.

Prediabetes and Associated Risk Factors among Undergraduate Medical Students in Bangladesh

Background: Early detection and timely intervention of prediabetes is an important first step in preventing the disease. Objectives: To assess the prediabetes and associated risk factors in medical students of Bangladesh. Materials and Methods: A cross-sectional study was done among 252 medical students of Shaheed Ziaur Rahman Medical College, Bogura. Data related to demography with some behavioral factors, anthropometry, blood pressure, fasting plasma glucose, family history of hypertension (HTN) and diabetes mellitus (DM) were collected. Prediabetes was assessed by the American Diabetes Association (ADA) and World Health Organization (WHO) criteria. Results: The proportion of prediabetes was 13% according to ADA and 1.6% according to WHO respectively. Students with a positive family history of hypertension (HTN) had more prediabetes compared to those who didn’t have. None of the demographic factors, family history of DM or HTN, exercise and obesity were related between prediabetic and normal students, though prediabetic students had more proportion of family history of HTN. Conclusion: Prediabetes is proportionately high among students with positive family history of HTN. We recommend a regular checking of fasting plasma glucose of medical students with special attention to those who have a strong positive family history of DM and HTN. KYAMC Journal Volume: 15, No: 01, April 2024: 20-24.

Case Report: Aspirated Airway Foreign Body Mimicking Endobronchial Mass: A Diagnostic Challenge

Abstract Introduction/Objective Despite advancements in imaging modalities, identifying retained foreign bodies within the lung remains arduous. Detecting small foreign bodies is crucial as they can serve as a focal point for subsequent infections. Initial assessments may mimic malignancy. Herein, we present a case of a retained foreign body masquerading as an endobronchial mass, accompanied by unilateral pleural effusion and persistent hypoxia. Subsequent bronchoscopy showed a pearly white endobronchial mass partially obstructing the segmental bronchus at the posterior basal segment of the right lower lobe of lung with accompanying right pleural effusion and atelectasis. Methods/Case Report This is a 58-year-old male with history of hypertension, deep vein thrombosis, transient ischemic attack, and a recent motor vehicle accident with blunt chest trauma. He had a thoracic spinal cord transection with grade III blunt thoracic aortic injury, developed anasarca, hypoxia, right pleural fluid requiring multiple thoracentesis, and right sided hemothorax requiring massive transfusion protocol. Subsequent evaluations, including bronchoscopic transbronchial forceps biopsies and bronchial wash and pleural fluid cytologic examinations showed no malignant cells. Repeat bronchoscopy was concerning for enlarging mass and obstruction. Bronchoscopy almost 2 months after MVA revealed an endobronchial foreign body (tooth) lodged in the left lower lobe of lung posterior segment. Results (if a Case Study enter NA) N/A Conclusion While aspiration of foreign bodies into the tracheobronchial tree is not uncommon especially in children, foreign bodies, particularly teeth, are rare in adults. Bronchial foreign body aspiration may occur in trauma, with diagnosis typically relying on history and physical examination. Detection remains challenging despite imaging advancements, with implications including infection nidus formation. In our case, delayed diagnosis highlights the importance of considering unusual etiologies in persistent pulmonary pathology. Retrospective imaging analysis and CT findings suggested a foreign body, emphasizing the utility of imaging in suspected cases. Prompt surgical intervention is crucial to prevent complications such as recurrent infections.

Unveiling the Unusual: Mediastinal Rhabdomyosarcoma in an Adult Patient

Abstract Introduction/Objective We present a case of a 55-year-old female with a history of hypertension, diabetes, hyperlipidemia, chronic kidney disease (CKD), and asthma, who presented with a mediastinal mass. Methods/Case Report A needle core biopsy of the mediastinal mass was performed. Microscopic examination showed a proliferation of primitive appearing, moderately pleomorphic cells with features suggestive of rare strap cells of rhabdomyosarcoma. Immunohistochemical staining was positive for desmin and myogenin, consistent with rhabdomyosarcoma. Further cytogenetic analysis for FOXO1 translocation, was performed. Results (if a Case Study enter NA) Cytogenetic analysis was negative for FOXO1 translocation by FISH, ruling out alveolar rhabdomyosarcoma. Despite negative cytogenetic findings, the morphology and immunoprofile were consistent with rhabdomyosarcoma. However, the possibility of rhabdomyosarcoma occurring within a mediastinal teratoma, germ cell tumor, or carcinosarcoma was noted. Conclusion This case highlights the challenge of diagnosing rhabdomyosarcoma in adults, especially when presenting as a mediastinal mass. The histologic and immunophenotype supported the diagnosis of rhabdomyosarcoma. However understanding the primary of the lesion in the hilum is more diffecult. physical examination releave no lesion on the extremities. CT scan of the abdomen and pelvis reveals no other lesion. making the metastasis unlikely.This case underscores the importance of thorough diagnostic evaluation, including histopathology and immunohistochemistry, in the assessment of unusual neoplasms, which can impact treatment decisions and prognosis. Further studies are warranted to elucidate the molecular mechanisms underlying rhabdomyosarcoma in adults and its association with other mediastinal tumors. This case report contributes to the evolving understanding of rare malignancies and their implications for pathology and laboratory medicine practice.

Clinical spectrum and prevalence of temporomandibular joint disorder: A hospital-basedanalysis

Objective: The objective of this study was to determine frequency of temporomandibular joint disorders and its severity among patients presenting with complaints of pain at tempo mandibular joint. Materials and methods: A total of 205 patients were selected in this study, the research has been done in unit of oral and maxillofacial surgery at darul-sehat hospital, Karachi. Patients, age 18 to 40 years, with history of diabetes, hypertension, habits of pan/chalia and smoking presented with complain of pain at temporomandibular joint for a period of two weeks were recruited in study. Patients with history of bone &amp; neurological disorder, taking immunosuppressant drug, trauma or surgery of temporomandibular joint were excluded from study. Examinations were carried out by single researcher to ensure the continuity and reliability of answers and interpretation of results. This will also help to eliminate inter-observer biases. Data gathered using a questionnaire and analyzed using SPSS software version 20. Results: A total of 205 patients which fulfilled the inclusion criteria were included in the study, including 99(48.3%) males and 106(51.7%) females. The age ranged from 18-40 years were included, belonging to age 15-20 years n=73(35.3%), 21-25 years n=65(31.4%), 26-30 years n=2(1%), 31-35 years n=60 (29%), and 36-40% years n=5 (2.4%). Around 42 (20.5%) patients had history of hypertension while 40 (19.5%) had diabetes, for which they were taking their medicines. History of smoking was seen among 38 (18.5%) patients.Disease was categorized as mild in 98 (47.8%) patients, moderate in 88 (42.9%) patients and severe in 19 (9.3%) patients. Around 158 (77.1%) had unilateral and 47 (22.9%) had bilateral disorder. Out of 205 patients most of them had temporomandibular joint disorder 192(93.7%). Conclusion: temporomandibular joint disorder is most common cause of orofacial pain and requires thorough knowledge and adequate examination to diagnose the disorder.

Childhood exposure to air pollution, noise, and surrounding greenness and incident hypertension in early adulthood in a US nationwide cohort–the Growing Up Today Study (GUTS)

Exposure to increased air pollution, noise, and reduced surrounding greenness have been suggested as potential environmental risk factors for hypertension in adults, but limited evidence exists regarding early-life exposure, particularly from prospective studies. We investigated independent and joint associations of childhood exposure to these factors with incident hypertension in early adulthood in a US nationwide cohort. Study participants were from the Growing Up Today Study (GUTS) established in 1996 (GUTSI) and 2004 (GUTSII), who were ages 9−14 (GUTSI) or 10−17 (GUTSII) at enrollment. Incident hypertension was identified by self-report on questionnaires from 2010 to 2021. We estimated residential exposures to air pollution (from spatiotemporal models), noise, and surrounding greenness throughout childhood (10-18y). We applied Cox proportional hazards models adjusted for potential confounders to assess hazard ratios (HRs) and 95% confidence intervals (CIs) associated with each interquartile range (IQR) change in exposure. We performed a quantile g-computation to assess the joint association of simultaneous exposure to the mixture. We considered potential effect modification by sex, maternal history of hypertension, overweight/obese status at age 18, urbanicity, and neighborhood socioeconomic status. Among 17,762 participants, 1530 hypertensive cases occurred during an average follow-up of 12.8 years. HRs for all exposures were small with CIs including unity. A joint HR of 1.03 (95% CI: 0.95, 1.11) was associated with a one-quartile increase across simultaneous exposure to the environmental mixture. The joint associations were stronger among non-obese participants or participants living in less advantaged neighborhoods: HRs of 1.07 (95% CI: 0.97, 1.18) and 1.08 (95% CI: 0.98, 1.18), respectively. In conclusion, we did not identify an independent or joint association between childhood exposure to air pollution, noise, and surrounding greenness and early adulthood hypertension. However, a positive joint association was suggested among non-obese participants or those living in less advantaged neighborhoods.

Nonimmune Hemolytic Anemia in Myelodysplastic Neoplasms (MDS) with U2AF1 Gene Mutation at S34 Hotspot: A Rare and Challenging Case Presentation

Abstract Introduction/Objective Hemolysis is recognized but not well understood in a subset of patients with myelodysplastic Neoplasms (MDS), largely through non-immune-mediated mechanisms. Lower survival rates are observed in MDS patients experiencing hemolysis. It is important to investigate the underlying mechanism including the molecular features of these cases. We hereby present a rare and challenging case of nonimmune hemolytic anemia in MDS with U2AF1 gene mutation at S34 hotspot. Methods/Case Report The patient is a 75-year-old male with past medical history of hypertension that presented with two weeks of 20 pounds weight loss, dyspnea on exertion and a syncopal event complicated with a parietal subarachnoid hemorrhage. Patient was found to have pancytopenia with severe anemia (hemoglobin 3.6 g/dl), reticulocytosis (reticulocyte 13.29%), decreased haptoglobin, while increased indirect bilirubin and lactate dehydrogenase. Spherocytes were detected in peripheral blood smear. With Coombs test being negative, all above are consistent with nonimmune hemolytic anemia. There is no evidence of paroxysmal nocturnal hemoglobinuria. Bone marrow biopsy revealed trilineage hematopoiesis, many hypo-or mono-lobated dysplastic megakaryocytes and less than 5% blasts. Cytogenetics/FISH unveiled 5q deletion, 20q deletion and trisomy 8. Mutation in the U2AF1 gene at S34 hotpot is detected by next-generation sequencing. The overall findings are consistent with MDS with nonimmune mediated hemolysis. Results (if a Case Study enter NA) NA Conclusion Hemolysis, although uncommon in MDS, has a substantial impact on prognosis, treatment approaches and response. U2AF1 gene mutation is associated with poor outcomes in MDS patients. U2AF1 gene mutation at S34 hotpot is observed in 30% MDS patients with hemolysis in one recent report. Responses to erythropoiesis-stimulating agents and hypomethylating agents vary depending on different mutations, including U2AF1, SF3B1 and EZH2, with discrepancies across studies. Further investigation is warranted to elucidate the relationship between the molecular abnormalities and treatment response as well as prognosis in MDS patients with hemolysis.

Impact of hypertension on mortality in patients with ST-elevation myocardial infarction undergoing primary angioplasty: insights from the international multicenter ISACS-STEMI registry.

Hypertension is the most prevalent cardiovascular risk factor, with several detrimental effects on the cardiovascular system. Contrasting results have been reported so far on its prognostic role in patients admitted for ST-segment elevation myocardial infarction (STEMI). Therefore, we investigated the impact of hypertension on short-term mortality in a large multicenter contemporary registry of STEMI patients, including patients treated during COVID-19 pandemic. The ISACS-STEMI COVID-19 was a retrospective registry that included STEMI patients treated with primary percutaneous coronary intervention (PCI) between March and June of 2019 and 2020 in 109 high-volume primary PCI centers from 4 continents. We collected data on baseline, clinical and procedural characteristics, in-hospital outcome and 30-day mortality. For this analysis patients were grouped according to history of hypertension at admission. A total of 16083 patients were assessed, including 8813 (54.8%) with history of hypertension. These patients were more often elderly, with a worse cardiovascular risk profile, but were less frequently active smoker. Some procedural differences were observed between the two groups, including lower rate of thrombectomy and use of glycoprotein IIb/IIIa inhibitors or cangrelor but more extensive coronary disease in patients with hypertension. Between patients with and without hypertension, there was no significant difference in SARS-CoV-2 positivity. Hypertensive patients had a significantly higher in-hospital and 30-day mortality, similarly observed in both pre-COVID-19 and COVID-19 era, and confirmed after adjustment for main baseline differences and propensity score (in-hospital mortality: adjusted odds ratio (OR) [95% confidence interval (CI)] =1.673 [1.389-2.014], P < 0.001; 30-day mortality: adjusted hazard ratio (HR) [95% CI] = 1.418 [1.230-1.636], P < 0.001). This is one of the largest and contemporary study assessing the impact of hypertension in STEMI patients undergoing primary angioplasty, including also the COVID-19 pandemic period. Hypertension was independently associated with significantly higher rates of in-hospital and 30-day mortality.

Predictive diagnostic value of mean platelet volume to platelet count and neutrophil to lymphocyte ratios in the gray zone of prostate cancer with tPSA between 4 to 10 ng/mL.

Exploration of the Predictive Diagnostic Value of Mean Platelet Volume to Platelet Count Ratio (MPV/PLT,PVI) and Neutrophil-to-Lymphocyte Ratio (NLR) in the tPSA Gray Zone of Prostate Cancer. A retrospective study was conducted on 65 prostate cancer (Pca) patients and 52 benign prostatic hyperplasia (BPH) patients who underwent transperineal prostate biopsy at Xiangtan Central Hospital from December 2021 to December 2023. Descriptive statistics and logistic regression models were used to investigate the predictive diagnostic value of PVI and NLR in the tPSA gray zone of prostate cancer. Receiver operating characteristic (ROC) curves were constructed based on PVI and NLR values to determine the classification thresholds. A total of 117 patients were enrolled, including 65 cases of prostate cancer (PCa) and 52 cases of benign prostatic hyperplasia (BPH). There were no statistically significant differences in age, BMI, history of hypertension, history of diabetes, history of coronary heart disease, pre-biopsy white blood cell count, history of drinking, history of smoking, and tPSA between the PCa and BPH patients. The results of logistic regression analysis showed that PVI (OR=2.03, 95%CI: 1.34~3.07, P<0.00) and NLR (OR=0.32, 95%CI: 0.18~0.58, P<0.00) were independent predictors for diagnosing prostate cancer in the tPSA gray zone (VIF=1.04).The maximum area under the curve (AUC) for PVI was 0.70, with an optimal cut-off value of 0.05 (P ≤ 0.01). The maximum AUC for NLR was 0.76, with an optimal cut-off value of 2.86 (P ≤ 0.01).The calibration curve showed good consistency between the predicted and actual outcomes in both the PCa and BPH groups, indicating that the nomogram model had good predictive performance.When using PVI and NLR to plot the receiver operating characteristic (ROC) curves to predict the assessment of PCa in the tpsa gray zone, the area under the curve (AUC) for PVI was the largest at 0.70, with an optimal cutoff value of 0.05 (P ≤ 0.01). The AUC for NLR was the largest at 0.76, with an optimal cutoff value of 2.86 (P ≤ 0.01). PVI and NLR have certain predictive diagnostic value for Pca in the tPSA gray zone, and appropriate use of PVI and NLR can improve the positive rate of early screening for Pca in the gray zone.

Accelerated Takedown of Melolabial Interpolation Flaps at 1 to 2 weeks, Indications and Safety for Improved Patient Experience

BACKGROUND The melolabial interpolation flap is an effective surgical technique for reconstructing defects in the nasal ala and tip regions. Traditionally, this technique involves waiting for the standard 3-week period before pedicle division. OBJECTIVE To evaluate whether accelerated takedown at 1- or 2-week postflap creation is possible while maintaining the flap's viability and functionality. METHODS Retrospective cohort study at Oregon Health and Science University from 2018 to 2023. RESULTS The authors examined 67 patients who underwent reconstruction with a melolabial interpolation flap surgery, of which 50 had their flap takedown at &lt;21 days and 17 had their takedown at 21 or more days. This analysis revealed similar complication rates for both groups. There were no increased rates of infection, necrosis, or hematoma formation in the earlier takedown group. Those undergoing earlier takedown were more likely to have a history of hypertension but less likely to have a history of diabetes, immunosuppression, and smoking, though the differences were not statistically significant. CONCLUSION This study provides valuable insights into the safety and feasibility of early melolabial interpolation flap takedown. This approach has the potential to enhance the quality of life for patients undergoing this flap by decreasing the amount of time with a pedicle.

HYPERTENSIVE CRISES: HYPERTENSIVE EMERGENCY AND CRISIS MANAGEMENT DURING ANESTHESIA

Introduction: hypertensive crisis is characterized by an acute and massive increase in blood pressure. Hypertensive crises encompass several clinical situations with different severity and prognosis, including hypertensive urgency and hypertensive emergency. The difference between the latter depends on whether the situation is life-threatening for the affected individual. Objective: to detail current information related to hypertensive crises, especially hypertensive emergency, definition, differentiation, etiology, epidemiology, pathophysiology, histology, clinical history, physical examination, management, differential diagnosis, prognosis and complications. Methodology: a total of 28 articles were analyzed in this review, including review and original articles, as well as clinical cases, of which 15 bibliographies were used because the other articles were not relevant to this study. The sources of information were PubMed, Google Scholar and Cochrane; the terms used to search for information in Spanish, Portuguese and English were: hypertensive crises, hypertensive emergencies, hypertensive emergencies, arterial hypertension. Results: approximately 1-2% of adults with hypertension suffer hypertensive crises. Multiple case series show that short-term treatment of hypertensive emergencies has good results; however, long-term results are unknown. The main drawback is that follow-up of individuals is lost and the medication regimen is frequently modified. Untreated hypertensive emergencies have very high morbidity and mortality and if the patient does not receive adequate education about the severity of hypertension, this trend is likely to continue. Conclusions: given the high prevalence of hypertension, it is crucial that health care professionals are able to differentiate between hypertensive emergencies and hypertensive emergencies to provide appropriate and timely treatment. Rapid blood pressure reduction is critical in the treatment of hypertensive emergencies. The choice of medications should consider both efficacy and safety to avoid further complications. A detailed clinical evaluation can help identify the underlying cause and guide treatment, highlighting the importance of an individualized approach. Lack of timely treatment can lead to severe consequences, emphasizing the need for proper management in critical situations. Constant training in the management of hypertensive emergencies is essential to reduce the morbidity and mortality associated with this condition.The management of hypertension during anesthesia is critical, as its prompt detection and control are fundamental to prevent serious complications. Despite the lack of specific criteria to suspend surgery in hypertensive patients, it is essential to evaluate each case individually, prioritizing target organ damage over blood pressure levels. KEY WORDS: crisis, emergency, urgency, hypertension.

Effect of glycemic gap on prognosis and complications in vulnerable period of acute heart failure

Background: To investigate the effect of glycemic gap on the prognosis and complications of heart failure in patients with acute heart failure. Methods: 100 patients with acute heart failure treated in our hospital from January 2022 to August 2023 were divided into two groups according to the prognosis: good prognosis group (n = 58) and poor prognosis group (n = 42). Univariate analysis of the prognostic factors of acute heart failure patients in vulnerable period, multivariate Logistics regression analysis of the prognostic factors of acute heart failure patients. ROC analysis of the value of glycemic gap in predicting the prognosis of patients with acute heart failure in the vulnerable period of heart failure, and compare the occurrence of complications between the two groups. Including: arrhythmia, angina pectoris, cardiogenic shock, thrombosis. Results: There was no significant difference in age, sex, history of hypertension, BMI, TG, history of diabetes and serum potassium between the two groups. The glycemic gap, BNP, Ang II, cTnI and SCR in the good prognosis group were lower than those in the poor prognosis group, while LVEF and hemoglobin were higher than those in the poor prognosis group. Binary Logistics regression analysis showed that. Glycemic gap, BNP, Ang II, cTnI, SCR, LVEF and hemoglobin were independent prognostic factors in patients with acute heart failure. The area under the glycemic gap value curve was determined to be 0.8071. The sensitivity of the assessment was 72.8, while the specificity was 70.5, . The incidence of complications in the good prognosis group (1.72%) was significantly lower than that in the poor prognosis group (16.67%). Conclusions: Glycemic gap is related to the prognosis and complications of heart failure in patients with acute heart failure. Hyperglycemia gap will affect the prognosis of heart failure in patients with acute heart failure, resulting in poor prognosis and increasing the incidence of complications.

Serum albumin level is associated with mortality and hospital stays: A real-world data analysis

Background & AimsThe value of serum albumin might be underestimated, especially in cancer patients. We thus aimed to evaluate the association between serum albumin level at hospital admission and clinical outcomes in hospitalized patients with cancer. MethodsThis is a retrospective, cross-sectional, and real-world data analysis. Hospitalized adult patients with malignant cancer were recruited from two tertiary hospitals. Serum level of albumin, which was measured within 24 hours after hospital admission, was the exposure. Length of hospital stays (LOS) was the primary and all-cause in-hospital mortality was the secondary outcomes. Other information, including age, sex, types of cancer, history of hypertension and diabetes, surgery, blood routine test, liver and renal function, and dietary intake, were also abstracted from medical records. ResultsA total number of 5,187 adult patients with cancer (2,949 were men and 2,238 women; average age 61.6±12.4 years and average albumin 40.3±5.2 g/L) were included. The prevalence of hypoalbuminemia was 12.2% (634/5,187). Older patients, patients with liver injury, anemia, and with high level of WBC were positively, while those with overweight and high level of total triglycerides, were negatively associated with hypoalbuminemia. After adjustment of covariates, hypoalbuminemia was significantly associated with longer LOS in the current study. The increase of 5 g/L in serum level of albumin could result in 1.09 days (95%CI: -1.38, -0.80 days) shorter in LOS. The increase of 5 g/L in serum level of albumin was also associated with 45% lower in risk of mortality (OR=0.55; 95% CI: 0.43, 0.7) after fully adjustment. ConclusionsSerum albumin level at admission was associated with both LOS and mortality in patients with malignant cancer.

Major Adverse Cardiovascular Events Following Coronary Artery Stenting by History of Hypertensive Disorder of Pregnancy.

A history of hypertensive disorders of pregnancy is associated with at least twice the risk of incident ischemic heart disease. Whether the long-term outcome following treatment with coronary artery stenting is associated to the history of hypertensive disorders of pregnancy is unknown. We included 8364 women (age ≤65 years) undergoing first coronary artery stenting 2006 to 2022 following their first delivery in 1973 or later, linking nationwide data on percutaneous coronary intervention and delivery history. In total, 1122 women (13.4%) had a history of hypertensive disorders of pregnancy. The main outcome, a major adverse cardiovascular event, was defined as any incident myocardial infarction, ischemic heart disease, cardiac arrest, arrhythmias, angina pectoris, heart failure, cerebral infarction, or sudden death. During a median follow-up time of 5 years, 258 women with a history of hypertensive disorders of pregnancy had a major adverse cardiovascular event, compared with 1465 women without a history of hypertensive disorders of pregnancy (23% versus 20.2%, P=0.028 for log-rank test). Estimates adjusted for patient- and procedural characteristics in proportional hazards regression models suggested that the hazard rate increased only after 4-8 years of follow-up (hazard ratio [HR], 1.36 [95% CI, 1.05-1.78]) and was primarily driven by women with history of gestational hypertension (HR, 2.15 [95% CI, 1.49-3.11]). Women with a history of hypertensive disorders of pregnancy have an increased risk of a major adverse cardiovascular event following coronary artery stenting compared with other parous women. A history of hypertensive disorders of pregnancy warrants further attention in the secondary prevention setting of coronary artery disease.

Subsequent high blood pressure and hypertension by hypertensive disorders of pregnancy: the Tohoku Medical Megabank Project Birth and Three-Generation Cohort Study.

Hypertensive disorders of pregnancy can cause hypertension in the future. Understanding how the blood pressure values of women with and without hypertensive disorders of pregnancy differ will facilitate follow-up blood pressure monitoring in clinical settings. This study investigated the association between hypertensive disorders of pregnancy and subsequent high blood pressure and hypertension. This study used Japanese data from the Tohoku Medical Megabank Project Birth and Three-Generation Cohort Study. Follow-up systolic and diastolic blood pressures in normotensive women during pregnancy and those with hypertensive disorders of pregnancy were estimated using analysis of covariance adjusted for women with low birthweight, history of gestational diabetes mellitus, age, body mass index, pulse rate, smoking and drinking at the follow-up assessment, paternal hypertension history, and maternal hypertension or hypertensive disorders of pregnancy history. Finally, we performed a multiple logistic regression analysis. In total, 7343 women were included in the analysis. Women with a history of hypertensive disorders of pregnancy had higher blood pressure approximately three years postpartum compared with normotensive women. Hypertensive disorders of pregnancy in the most recent pregnancy in different subgroups, such as nulliparous women, multiparous women without a history of hypertensive disorders of pregnancy, and multiparous women with a history of hypertensive disorders of pregnancy, were associated with an increased risk of subsequent hypertension. Women's birthweight was also weakly associated with hypertension. Even one experience of hypertensive disorders of pregnancy may contribute to elevated blood pressure and hypertension approximately three years postpartum. In addition, women's birthweights may have a weak relationship with increasing blood pressure.

Liver damage in patients hospitalized with acute decompensated heart failure, depending on the degree of glucose metabolism disorder

Aim. To study the frequency of cardiohepatic syndrome and steatosis by the value of controlled attenuation parameter (CAP), fibrosis, and their combination, depending on the degree of glucose metabolism disorder in patients with acute decompensated heart failure (ADHF).Materials and methods. The study included 280 patients (53% men, average age 70.1 ± 10.8 years) with ADHF: 72.5% of patients had a history of arterial hypertension, 60% of patients had coronary heart disease. The HbA1c test was performed in all patients to assess the status of glucose metabolism. The patients were divided into groups depending on the results obtained: at HbA1c values &lt; 5.7%, patients were included in the group without glucose metabolism disorders, at HbA1c 5.7–6.4% – in the prediabetes group, at HbA1c ≥ 6.5% – in the type 2 diabetes group. All patients underwent a standard physical examination at admission and at discharge. Clinical and comprehensive assessments of congestion were performed – NT-proBNP, lung ultrasound, liver fibroscan with CAP, and bioelectrical impedance analysis of body composition.Results. The frequency of glucose metabolism disorders in patients hospitalized with ADHF was 57.5% (n = 161), while prediabetes was detected in 17.1% (n = 48) and type 2 diabetes – in 40.4% (n = 113) of patients. We revealed significantly higher incidence of steatosis by CAP value (69 vs. 42%, p &lt; 0.001), fibrosis (80 vs. 64%, p &lt; 0.001), and their combination (59 vs. 30%, p &lt; 0.001), as well as cardiohepatic syndrome (87 vs. 61%, p &lt; 0.001) in patients with ADHF and glucose metabolism disorders compared to individuals with ADHF without glucose metabolism disorders, respectively. The group of ADHF patients with glucose metabolism disorders and a combination of steatosis / fibrosis was characterized by more pronounced manifestations of metabolic syndrome, impaired kidney and liver function, and more pronounced manifestations (both clinical and laboratory) of congestion.Conclusion. In patients with ADHF with glucose metabolism disorders, liver function test and liver fibroscan with CAP allow for identifying the most severe group of patients with a combination of steatosis/fibrosis and pronounced congestion.

A case of convexity non-aneurysmal subarachnoid hemorrhage caused by cerebral sinus thrombosis

BackgroundConvexity subarachnoid hemorrhage (cSAH) is an uncommon presentation of subarachnoid bleeding, referring to bleeding more localized to the convexities of the brain. The diagnosis of cerebral venous sinus thrombosis (CVST) can be difficult especially when patients initially present with cSAH. The authors present a case and then discuss the pathophysiology and management.Case presentationA 56-year-old woman with a previous history of hypertension and ischemic heart disease presented to the emergency department after experiencing it. Two seizures following a severe headache. The patient’s history was negative for recent illnesses, head trauma, history of migraines, smoking, alcohol consumption, or intravenous drug use. The patient was diagnosed with CVST based on magnetic resonance venography (MRV). Genetic studies further identified homozygous mutations in the Prothrombin and MTHFR genes. Anticoagulant therapy was initiated with 60 mg of Enoxaparin twice daily and subsequently transitioned to Warfarin after 48 h continued for 3 months, and then replaced by rivaroxaban.ConclusionsThis study highlights the importance of considering CVST as a cause of SAH, emphasizes the role of advanced imaging in diagnosis, and demonstrates a successful treatment approach using both traditional and direct oral anticoagulants. The insights provided in this article can contribute to improving the management of patients with CVST-related SAH.

Predictive significance of hypertension in the incidence of complications in critically ill patients with COVID‑19: A retrospective cohort study.

The association between hypertension as a pre-existing comorbidity and the severe form of coronavirus disease 2019 (COVID-19) remains unclear due to the contradictory results of previously published studies. The present study evaluated the predictive significance of hypertension in the incidence of complications among critically ill patients with COVID-19. The present study included 372 critically ill adults with COVID-19 pneumonia, hospitalized between January 1 and December 31, 2021. The study cohort was divided into the hypertension group (HTA group), which included 245 patients with a history of hypertension, or a non-HTA group (control group), which included 127 patients without hypertension. The incidence of complications was retrospectively extracted from medical records and compared between groups. Multivariate regression analysis (adjusted for potential confounders) and receiver operating characteristic (ROC) curve analysis determined the predictive significance of hypertension on the incidence of complications. The patients in the HTA group were more likely to receive invasive mechanical ventilation [odds ratio (OR), 1.696; P<0.02], develop sepsis (OR, 1.807; P<0.01) and develop complications (OR, 3.101; P<0.001). Hypertension was an independent positive predictor for invasive mechanical ventilation [area under the curve (AUC), 0.67; positive predictive value (PPV), 71.7%; P<0.05], sepsis (AUC, 0.69; PPV, 77.5%; P<0.026) and total complications per patient (AUC, 0.71; PPV, 81.4%; P<0.001). On the whole, the data of the present study indicate that a history of hypertension should be considered as an independent clinical predictor of a higher incidence of complications in critically ill patients with COVID-19. Patients with pre-existing hypertension and a diagnosis of COVID-19 require timely identification, additional attention and treatment to avoid a critical course and help improve outcomes.