Ischemic Type Research Articles

A rare rosuvastatin-induced urticaria in a high-risk cardiovascular patient: A case report

Statins are widely used lipid-lowering agents essential for the prevention and management of cardiovascular diseases. Despite their proven efficacy and safety, rare adverse drug reactions (ADRs), such as allergic skin reactions, can occur. This case report describes a 54-year-old male with ischemic heart disease, hypertension, and type 2 diabetes mellitus, who developed pruritic, red-pigmented skin lesions characteristic of urticaria within 10 days of starting rosuvastatin 40 mg daily. The symptoms resolved after discontinuation of the drug and administration of symptomatic treatment with cetirizine and calamine lotion. The likelihood of rosuvastatin causing the urticaria was assessed using the Naranjo Adverse Drug Reaction Probability Scale, which indicated a probable relationship. Although statins are generally well-tolerated, rare hypersensitivity reactions may occur due to immune-mediated mechanisms or mast cell activation. Early recognition and withdrawal of the offending agent are crucial for swift symptom resolution and prevention of further complications. In patients requiring continued lipid-lowering therapy, alternative agents such as pravastatin may be considered. This case highlights the importance of post-marketing surveillance in identifying rare ADRs, ensuring pharmacovigilance, and improving patient care. Increased awareness among clinicians is essential for timely detection and management of uncommon drug-related reactions to enhance treatment outcomes.

Influence of nutritional status on rehabilitation efficacy of patients after stroke—a scoping review

Stroke patients are susceptible to malnutrition as a result of dysphagia, neurological impairments, and altered levels of consciousness. The nutritional status of individuals post-stroke is a critical determinant influencing the efficacy of rehabilitation outcomes. Therefore, there is great interest in the possible role of nutrients in promoting recovery after stroke. This article examines the enhancement of rehabilitation outcomes through the improvement of nutritional status. A comprehensive literature search was conducted using the PubMed, Cochrane, Web of Science, and Embase databases. Articles relevant to this topic, published from the inception of each database until November 2024, were identified. The selection was restricted to randomized controlled clinical trials, irrespective of language or publication date. The search specifically targeted studies involving stroke patients, encompassing both hemorrhagic and ischemic types, and interventions that combined nutritional supplementation with rehabilitation therapy. Studies with a focus on stroke prevention were excluded. Full-text articles that met the inclusion criteria were retrieved from the aforementioned sources. In instances where both a full report and a conference abstract were available for the same study, only the full report was considered. A total of 751 studies were considered for inclusion in this scoping review. Following a rigorous screening process, 13 studies were selected for detailed analysis. All selected studies were randomized controlled clinical trials. The findings indicate that supplementation with nutrients such as proteins, vitamins, essential amino acids, and antioxidants can enhance activities of daily living, improve balance function, and reduce neurological deficits in post-stroke patients. This review aims to synthesize current evidence regarding the effects of various nutrients and dietary regimens on limb rehabilitation in post-stroke patients, with the goal of providing new insights to facilitate the accelerated recovery of this population.

Age and Sex-Related Characteristics of Obesity-Associated Adult Mortality

Background. Obesity and associated diseases could substantially affect life expectancy by increasing the risks of premature mortality.Objective. To evaluate the changes in the age and sex distribution of adult mortality from obesity-associated causes in Moscow from 2011 to 2020 in comparison to the average national indicators.Materials and methods. The analysis focused on standardized death rates among the adult population, categorized by sex and age groups (aged 20–54, aged 55–59, aged 60 and older).Results. In Moscow, mortality from atherosclerotic cardiovascular disease significantly reduced, especially in persons aged 20–54. The reduction in mortality rate from cerebral infarction was higher in Moscow, especially in individuals aged 55 and older, across both sexes. Conversely, the incidence of ischemic heart disease mortality in Moscow has risen. The study showed an increase in mortality from endocrine diseases, including type 2 diabetes, which may be partly explained by the revised guidelines for coding primary causes of death. In addition, the dynamic in Moscow was more favorable. The mortality rates from malignant neoplasms in Moscow were 8% lower than in Russia, and mortality trends were rather favorable, both in Moscow and Russia. However, mortality rates and trends vary significantly depending on the type of malignancy.Conclusions. A favorable trend was observed in mortality from obesity-associated diseases, such as acute cerebrovascular accident (cerebral infarction) and some malignant neoplasms (colorectal cancer and breast cancer in women). The negative trends in mortality from such chronic diseases as ischemic heart disease and type 2 diabetes were observed. Men aged 55–59 have been identified as a risk group for these negative trends. Therefore, it is necessary to expand the preventive measures targeting these at-risk groups.

FEATURES OF THE PSYCHO-EMOTIONAL STATUS IN PATIENTS WITH COMORBID CORONARY HEART DISEASE, TYPE 2 DIABETES MELLITUS, AND OBESITY, ACCORDING TO THE FUNCTIONAL CLASS OF CHRONIC HEART FAILURE

The purpose of this study is to assess the presence and nature of changes in the components of emotional status in patients with comorbidity of coronary heart disease and type 2 diabetes mellitus or its combination with obesity, according to the functional class of chronic heart failure. Subjects and methods. This study involved 225 patients with chronic heart failure secondary to coronary heart disease, divided into groups based on the presence of metabolic disorders. Group 1 included patients with chronic heart failure, coronary heart disease, type 2 diabetes mellitus, and obesity (n = 75). Group 2 consisted of patients with chronic heart failure and coronary heart disease, along with type 2 diabetes mellitus (n = 50). Group 3 included patients with chronic heart failure and coronary heart disease, with concomitant obesity (n = 50). The comparison group, Group 4, consisted of patients with ischemic chronic heart failure without metabolic disorders (n = 50). All groups were comparable in age and sex. The Beck Depression Inventory scale was used to assess the presence and nature of depressive disorders. Results. In patients with chronic heart failure II functional class and a combination of type 2 diabetes mellitus and obesity, the cognitive-affective subscale scores were lower than in patients with chronic heart failure III functional class by 23.4% (p<0.01) and chronic heart failure IV functional class by 83.8% (p<0.01). Similar differences were noted for the somatic subscale scores in patients with chronic heart failure in coronary heart disease in combination with type 2 diabetes mellitus and obesity. The somatic subscale scores in patients with chronic heart failure II functional class were significantly reduced when compared with chronic heart failure III functional class by 40.7% (p<0.01) and chronic heart failure IV functional class by 105.7% (p<0.01). Analyzing the components of emotional status in patients with ischemic chronic heart failure and concomitant type 2 diabetes mellitus, an increase in cognitive-affective subscale scores in patients with chronic heart failure III functional class by 21% (p<0.01) was found, compared with chronic heart failure II functional class. In patients with chronic heart failure IV functional class, cognitive-affective subscale scores were higher than in patients with III functional class by 72.3% (p<0.01). Somatic subscale scores in patients with IV functional class of chronic heart failure significantly exceeded those in patients with III functional class by 63.8% (p<0.01). When comparing somatic subscale scores in patients with II and III functional class of chronic heart failure of ischemic origin against the background of concomitant type 2 diabetes mellitus, no significant differences were found (p>0.05). Conclusions. The deterioration of emotional status in patients with ischemic chronic heart failure and type 2 diabetes mellitus occurs in proportion to the worsening of symptoms, particularly on the cognitive-affective subscale. At the stage of pronounced cardiac decompensation, progressive somatic depressive manifestations emerge. In patients with coronary heart disease and combined metabolic pathology, changes in both the cognitive-affective and somatic subscales are observed, correlating with an increase in the functional class of heart failure.

Adipsin improves diabetic hindlimb ischemia through SERPINE1 dependent angiogenesis

BackgroundAdipsin (complement factor D, CFD), as the first described adipokine, is well-known for its regulatory effects in diabetic cardiovascular complications. However, its role in diabetic hind-limb ischemia was not clarified. This study aimed to evaluate the possible therapeutic effect of Adipsin in hind-limb ischemia in type 2 diabetic mice and to elucidate the molecular mechanisms involved.MethodsA high-fat diet and streptozotocin (HFD/STZ)-induced diabetic mouse model, and a transgenic mouse model with adipose tissue-specific overexpression of Adipsin (Adipsin-Tg) were employed. Hindlimb ischemia was established by femoral artery ligation, and blood flow recovery was monitored using Laser Doppler perfusion imaging. Molecular mechanisms underlying Adipsin-potentiated angiogenesis were examined using RNA sequencing and co-immunoprecipitation/mass spectrometry (Co-IP/MS) analyses.ResultsAdipsin expression was upregulated in non-diabetic mice following HLI, while suppressed in diabetic mice, indicating its potential role in ischemic recovery which is impaired in diabetes. Adipsin-Tg mice exhibited significantly improved blood flow recovery, increased capillary density, and enhanced muscle regeneration in comparison with non-transgenic (NTg) diabetic mice. Adipsin facilitated proliferation, migration, and tube formation of human umbilical vein endothelial cells (HUVECs) under hyperglycemic and hypoxic conditions. Additionally, it enhanced phosphorylation of AKT, ERK, and eNOS pathways both in vivo and in vitro. RNA sequencing and co-immunoprecipitation/mass spectrometry (Co-IP/MS) analyses identified that Adipsin promoted angiogenesis by interacting with SERBP1, which disrupted the binding of SERBP1 to SERPINE1 mRNA, resulting in reduced SERPINE1 expression and the subsequent activation of the VEGFR2 signaling cascade.ConclusionsAdipsin promotes angiogenesis and facilitates blood perfusion recovery in diabetic mice with HLI by downregulating SERPINE1 through interaction with SERBP1. These findings elucidate a novel therapeutic potential for Adipsin in the management of PAD in diabetic patients, highlighting its role in enhancing angiogenesis and tissue repair.

Pulmonary hypertension in Finland 2008-2020: a descriptive real-world cohort study (FINPAH)

ObjectivesTo assess characteristics, risk group distribution, and prognosis of patients with pulmonary arterial hypertension (PAH) or chronic thromboembolic pulmonary hypertension (CTEPH) in Finland. MethodsClinical chart review of patients with PAH or CTEPH recorded between 2008-19 and linkage to official mortality data. ResultsWe identified 627 patients, with 502 (80%) diagnosed after 2008, yielding an incidence of PAH and CTEPH of 4.0 and 2.9/million/year, respectively. The median time from symptoms to diagnosis was 1 year. Mean age at diagnosis of PAH patients (n=268) was 57 years, 73% were women, 40% had idiopathic PAH, 28% associated with connective tissue diseases, and 15% with congenital heart disease, 9% had ≥3 cardiovascular comorbidities. At 1 year, 34/34/24/8% were at the low/intermediate-low/intermediate-high/high Compera 2.0 risk classification groups. Survival was 91.3%, 74.8 %, and 62.6% at 1, 3, and 5 years, respectively, with an improving trend over calendar time. Ten PAH patients had a lung transplant. PAH subtype, cardiac output, and the presence of ischemic heart disease or type 2 diabetes predicted survival.CTEPH patients (n=189) were 63 years (mean) at diagnosis and 49% were women. 29% underwent pulmonary endarterectomy (PEA) and 22% were treated with balloon pulmonary angioplasty. Survival was 94.6%, 87.2%, and 79.4% at 1, 3, and 5 years, respectively. PEA patients were younger, had fewer comorbidities, and had longer survival than non-PEA patients. ConclusionsIncidence and survival of PAH and CTEPH patients in Finland were similar to previously presented data for other countries.

Hospitalization costs in patients with stroke in southeastern China: a retrospective population-based cohort study, 2019-2022.

Stroke remains a predominant cause of mortality and accounts for one-third of all stroke-related fatalities worldwide. Increasing expenses associated with stroke are a matter of significant concern; however, this aspect has been insufficiently examined. The purpose of this study was to analyze in-hospital stroke costs and explore potential factors influencing them across stroke subtypes. The records of stroke patients from 50 hospitals in southeastern China between 2019 and 2022 were reviewed using multistage stratified cluster random sampling. We focused on the cost patterns of four stroke types and used multivariate linear regression to identify cost determinants. A total of 417 (1.1%) patients had subarachnoid hemorrhage (SAH), 9309 (25.9%) had intracerebral hemorrhage (ICH), 22,248 (61.8%) had ischemic stroke (IS), and 4025 had transient ischemic attack (TIA). The number of stroke patients has sharply increased since the onset of COVID-19, with a majority of them being male (72.2%). Despite the fact that hospitalization costs are highest in tertiary hospitals (Chinese yuan [CNY] 30610.8/United States dollar [USD] 4551.0, interquartile range [IQR] 9944.9, 29668.4/1478.6, 4410.9), the majority of patients are admitted to tertiary hospitals (74.6%) or public hospitals (90.2%). Across all stroke subtypes, patients with SAH had the highest costs (CNY 93,454.9/USD13894.4, IQR 12273.2, 169920.0/1824.7, 25262.8), followed by those with ICH (CNY 48,724.2/USD 7244.0, IQR 16789.6, 57540.7/2496.2, 8554.8), IS (CNY 26,550.3/USD3947.4, IQR 8684.2, 28697.7/1291.1, 4266.6), and TIA (CNY 11,170.1/USD1660.7, IQR 6823.7, 12965.2/1014.5, 1927.6). Therapy fees comprised a significant portion of costs in ICH and IS cases (47.9% and 42.7%, respectively). Materials accounted for the highest proportion of expenses for SAH (56.1%), whereas patients with TIA spent more time on examinations (34.1%). Linear regression analysis revealed that length of stay (LOS), stroke subtype, hospital level, and stroke type were key factors influencing hospitalization costs. The visiting rate and charges were highest in tertiary public hospitals, and hospitalization costs were higher in hemorrhagic types of stroke than in ischemic types of stroke; the proportion of hospitalization cost categories varied among different types of stroke, with LOS, hospital type, and level substantially affecting hospitalization costs. Enhancing medical insurance reimbursement rates for hemorrhagic strokes, implementing a hierarchical medical system, tailoring cost categories to accommodate varying stroke subtypes, and shortening LOS may help alleviate the economic burden of stroke.

Pre-hospital Blood Pressure Lowering in Presumed Hyperacute Stroke: A Systematic Review and Meta-Analysis of Randomized Controlled Trials.

BackgroundHigh blood pressure (BP) is common in acute stroke and a predictor of poor outcomes. Treatment of acute stroke, before a distinction can be made between ischemic and hemorrhagic types, is challenging. We aimed to assess whether patients with presumed acute stroke benefit from pre-hospital BP lowering. MethodsWe conducted a comprehensive systematic review and meta-analysis of randomized controlled trials from PubMed, Web of Science, Scopus, and Cochrane searches until June 2024. Dichotomous data were pooled using risk ratio (RR), and continuous data were pooled using mean difference (MD), both with a 95% confidence interval (CI), using (R version 4.3). PROSPERO ID: CRD42024560200. ResultsOur analysis included five RCTs encompassing 3,933 patients. There was no difference between early BP control and usual care regarding National Institutes of Health Stroke Scale (NIHSS) after 24 hours (MD: 0.65 with 95% CI [0.01, 1.29], P = 0.05), excellent neurological recovery (Modified Rankin Score (mRS) 0–1) (RR: 1.00 with 95% CI [0.91, 1.11], P= 0.98), functional independence (mRS 0–2) (RR: 1.04 with 95% CI [0.96, 1.13], P= 0.30), and independent Ambulation (mRS 0–3) (RR: 1.01 with 95% CI [0.95, 1.06], P= 0.84). Also, there was no difference between both groups in poor neurological recovery (mRS 4–6) (RR: 0.98 with 95% CI [0.91, 1.07], P= 0.68), all-cause mortality (RR: 1.02 with 95% CI [0.90, 1.15], P= 0.79), and any serious adverse events (RR: 1.04 with 95% CI [0.95, 1.15], P= 0.40). However, early BP control significantly increased the incidence of hypotension (RR: 2.24 with 95% CI [1.14, 4.38], P= 0.02) and headache (RR: 1.51 with 95% CI [1.01, 2.26], P= 0.04). ConclusionIn patients with presumed hyperacute stroke and elevated blood pressure, the rapid initiation of blood pressure reduction in the ambulance very early after symptom onset had no significant benefit regarding functional outcomes in patients with undifferentiated stroke but with an increased incidence of hypotension and headaches.

Impact of dapagliflozin on supraventricular and ventricular arrhythmias, assessed by Holter ECG, in patients with heart failure with reduced ejection fraction

Abstract Background & Introduction Dapagliflozin has significantly reduced morbidity & mortality in patients with heart failure with reduced ejection fraction (HFrEF) (1). Some studies reported supraventricular & ventricular arrhythmia suppression, but Holter ECG was underused, hindering precise assessment of arrhythmia burden. Purpose We aim to assess the impact of dapagliflozin on reduction of arrhythmia in HFrEF at 1 year follow-up (FU) by Holter ECG. Methods This is a single center, prospective study. We have screened 219 HFrEF patients, but only 156 patients were enrolled with LVEF <40% in sinus rhythm from December 2021 to July 2023. All patients had dapagliflozin 10 mg once/day tablet with the standard HF therapy. Clinical evaluation, NYHA evaluation, 6-minute walking test (6MWT), echocardiogram, 24-hours Holter ECG and laboratory work-up were done at baseline, and FU at 6 months and 12 months. Results Males constituted 61.5% of study population; mean± SD participants’ age was 56.8 ± 8.6 years. The most common comorbidities were: ischemic etiology (63.3%), dilated cardiomyopathy (28.1%), hypertension (27.3%), smokers (14.7%), and type II diabetes (31.4%). LVEF was ≤ 35% in 85.9% of patients. We have reported (7.69%) deaths during 1-year FU, and 4 patients (2.56%) didn't complete 1-year FU. Main clinical and echocardiographic findings (baseline vs. 1-year FU): NYHA FC III& ambulant IV dropped from (42.9 to 32.9%), P value<0.05. Distance walked in 6MWT improved from 191.52 ± 75.37 to 219.35 ± 71.51 mean± SD meters, P value<0.05. E/e improved (9.4 to 8.3 cm/s, P value <0.01), LVEF improved (31.3 to 36.4%, P value<0.05). HF emergency: [HF visits dropped (23.7 to 19.2%) and HF hospitalization dropped (11.1 to 7.8%)], P value<0.05. Holter ECG (baseline vs. 1-year FU): Supraventricular Arrhythmia: [Paroxysmal AF reduced (56.2 to 47.6%), frequent PACs (≥ 10%) dropped (3.8 to 1.4%) & Intermittent 1st degree heart block dropped (12.5 to 7.3%)] P value <0.01. Ventricular Arrhythmia: [PVCs >5%-<10% dropped (16% to 9.3%), Frequent PVCs >10% dropped (3.2 to 1.4%), and NSVT dropped (7.8 to 3.1%)], P value <0.01. Stepwise logistic regression multivariable model aiming to predict the occurrence of ventricular and supraventricular arrhythmias has indicated a direct linear correlation with male gender, smoking, body mass index, left atrial volume, and a history of myocardial infarction. Conversely, there is an inverse relationship with systolic blood pressure, 6MWT distance, LVEF, and the administration of dapagliflozin (OR 0.72 [0.61 - 1.07], P value <0.01) concerning the likelihood of supraventricular and ventricular arrhythmias. Conclusions Dapagliflozin has demonstrated significant improvement in functional and echocardiographic parameters in HFrEF patients. Furthermore, it has effectively decreased the incidence of supraventricular and ventricular arrhythmias, identified through 24-hour Holter ECG monitoring during 1-year follow-up.

Effect of Treatment of Neuropathic and Ischemic Diabetic Foot Ulcers with the Use of Local Ozone Therapy Procedures-An Observational Single Center Study.

Background: Diabetes ranks high among worldwide global health problems, and diabetic foot ulcer syndrome (DFU) is considered as one of its most serious complications. The purpose of this study was to evaluate the impact of local ozone therapy procedures on the wound healing process in patients with two DFU types: neuropathic and ischemic. Material and Methods: In the retrospective study reported here, the treatment outcomes of 90 patients were analyzed: 44 males (48.8%) and 46 females (51.2%), in the age range between 38 and 87 years of age, with neuropathic (group 1) and ischemic (group 2) diabetic foot ulcers treated by means of local ozone therapy. The assessment of therapeutic effects in both groups of patients included an analysis of the rate of ulcer healing using planimetry and an analysis of the intensity of pain associated with ulcers performed using the VAS scale. Results: After the application of ozone therapy procedures, a statistically significant decrease in the surface area of the ulcers was obtained in both groups of patients, respectively: in group 1 from 7 (6-7.5) cm2 to 3 (2-3.5) cm2 and in group 2 from 7.5 (6.5-8) cm2 to 5 (4.5-5.5) cm2 (p < 0.001), with a complete healing of ulcers not observed in any patients from groups 1 and 2. After treatment, the surface area of the assessed ulcers was smaller in the neuropathic group. The intensity of pain experienced after treatment also decreased with statistical significance in both groups (p < 0.001). Conclusions: Short-term local ozone therapy was effective in promoting wound healing and alleviating pain in patients with DFUs of both neuropathic and ischemic etiology. The effectiveness of therapy in the neuropathic type of DFUs was significantly higher than in the ischemic type, in which patients had a higher incidence of risk factors and more advanced lesions, characterized by a larger initial ulcer area and greater intensity of pain.

TERAPIA DO ESPELHO (TE) PARA MEMBROS SUPERIORES EM PACIENTES PÓS-ACIDENTE VASCULAR ENCEFÁLICO: REVISÃO DE LITERATURA

Introduction: Stroke is a condition caused by changes in blood flow to the brain and can be of hemorrhagic, ischemic, or subarachnoid origin, with the ischemic type being the most prevalent and the most common. Additionally, it is considered the leading cause of death and disability in Brazil, and worldwide, it ranks as the second most prevalent neurological disease and similarly in terms of mortality. Moreover, it is the third leading cause of disability. Based on the activation of the Mirror Neuron System (MNS) and the corticospinal tract, Mirror Therapy (MT) accelerates the recovery of the hemiparetic limb and promotes cortical reorganization, leading to functional and motor gains. Method: A search of articles was conducted in the following databases: Scielo, Virtual Health Library (VHL), PubMed, and Google School, using the descriptors: Mirror Therapy, Rehabilitation, Stroke, and their English equivalents. The search focused on randomized controlled trials with control and intervention groups, published between 2014 and 2024. Results: Four relevant articles were selected for the research after excluding duplicates or those that did not meet the quality and inclusion criteria, with four articles being used for the systematic review. All articles scored 4 or higher on the PEDro scale. Conclusion: Despite the benefits of Mirror Therapy (MT), further research is still needed to confirm these findings, particularly regarding the best phase to start applying this therapy. However, MT is one of the most feasible low-cost resources with a scientific basis for motor improvement and sensory deficit recovery.

Association of Short-term Pain and Chronic Pain Intensity With Cardiometabolic Multimorbidity Progression: A Multistate Markov Model Analysis.

The impact of pain intensity on the progression trajectories of cardiometabolic multimorbidity (CMM) is not well understood. We attempted to dissect the relationship of short-term pain (STP) and chronic pain intensity with the temporal progression of CMM. We conducted a prospective cohort study based on the UK Biobank participants. Incident cases of cardiometabolic diseases (CMDs) were identified based on self-reported information and multiple health-related records in the UK Biobank. CMM was defined as the occurrence of at least 2 CMDs, including heart failure (HF), ischemic heart disease (IHD), stroke, and type 2 diabetes (T2D). The pain intensity was categorized into 5 levels based on pain duration and the number of sites involved, including chronic widespread pain (CWSP), chronic multilocation pain (CMLP), chronic single-location pain (CSLP), STP, and free-of-pain (FOP). Multistate models were used to assess the impact of pain intensity on the CMM trajectories from enrollment to initial cardiometabolic disease (ICMD), subsequently to CMM, and ultimately to death. A total of 429,145 participants were included. Over the course of a 12.8-year median follow-up, 13.1% (56,137/429,145) developed ICMD, 19.6% (10,979/56,137) further progressed to CMM, and a total of 5.3% (22,775/429,145) died. Compared with FOP, CMLP (hazard ratio [HR], 1.11; 95% confidence interval [CI], 1.06-1.17) and CWSP (HR, 1.26; 95% CI, 1.13-1.42) elevated the risk of transitioning from ICMD to CMM. STP (HR, 0.89; 95% CI, 0.82-0.96), CSLP (HR, 0.88; 95% CI, 0.82-0.95), and CMLP (HR, 0.87; 95% CI, 0.81-0.93) lowered the risk of transition from ICMD to mortality, and STP also reduced the risk of transition from enrollment to mortality (HR, 0.94; 95% CI, 0.89-0.98). The results of disease-specific transitions revealed that the influence of pain intensity varied across transitional stages. Specifically, CMLP and CWSP heightened the risk of conversion from T2D or IHD to CMM, whereas only CWSP substantially elevated the transition risk from HF to CMM. Our results highlighted reductions in chronic pain may mitigate both the onset and progression of CMM, potentially having an important impact on future revisions of cardiometabolic and pain-related guidelines.

VITAMIN D STATUS AMONG FEMALE STUDENTS IN FACULTY OF MEDICINE AND HEALTH SCIENCES UNIVERSITY OF ADEN- YEMEN

Vitamin D deficiency is not only associated with rickets and osteomalacia, but with several chronic diseases, such as cancer, ischemic heart disease and type 1 and 2 diabetes mellitus. Vitamin D deficiency is prevalent across all age groups in epidemic proportions. Worldwide, an estimated one billion people suffer from vitamin D deficiency. One of the major reasons for the worldwide spread of this disorder has been deficient awareness about the importance of vitamin D, its benefits on health, and prevention of deficiency state across different populations. This study aimed to investigate the prevalence of vitamin D deficiency among female medical students regarding the importance of vitamin D and to determine its correlates among female students in Aden, Yemen. A cross-sectional study was conducted with 70 adult female students aged 19-30 years enrolled in Faculty of Medicine and Health Sciences University of Aden in the period April to October 2019. A self-administered questionnaire was used to collect information for participants data such as age, place of residence (urban or rural), skin color (pigmentation) and applying of sun protection creams. Blood samples were taken to investigate serum 25-(OH)D3 level for all participants through laboratory examination using Roche Cobas e 411 Automatic Analyzer, after recruiting their sociodemographic, health and lifestyle. Serum 25-hydroxyvitamin D levels were classified as normal (&gt;30 ng/ml), insufficiency (10-30 ng/ml) and deficiency (&lt;10 ng/ml). The data statistically analyzed using SPSS version 24. The mean age (SD) of participants 22.4 ± 2.01years. The prevalence of vitamin D deficiency among all participants was 34.3% while 65.7% had vitamin D insufficiency. low concentrations of serum vitamin D is highly prevalent among female medical students. It is advisable to increase their consumption of foods rich in vitamin D. the incidence of VDD among growing girls is concerning and necessitates preventive intervention. Importantly, health strategy plan requires considerations of more promotion of safe sun exposure practice, sufficient vitamin D supplements and vitamin D fortification of foods.

The Adaptive Physical Activity Study for Stroke: A Feasibility Sequential Multiple Assignment Randomized Trial

Abstract Background Between 1990 and 2017, stroke cases nearly doubled, ranking as the second leading cause of death and disability globally. Inadequate physical activity (PA) is a leading risk factor. Recent guidelines advise stroke survivors to follow population-based PA guidelines. Given stroke heterogeneity personalised PA interventions are recommended. Therefore, this study used a Sequential Multiple-Assignment Randomized Trial (SMART) design to develop an adaptive mHealth intervention to improve PA post-stroke. Methods This SMART is in progress, with recruitment completed and follow-up data ending November 2024. A 12-week intervention programme was developed incorporating public patient involvement (PPI), empirical evidence and behavioural change theory to increase participation in Structured Exercise (SE), Lifestyle Physical Activity (LPA), or both. The study enrolled 54 ambulatory, community-dwelling people who were randomly assigned to either SE or LPA treatment groups. Participants used Fitbit Inspire 2 devices to monitor step counts and set personalized weekly step goals. At six weeks post-randomisation, participants were evaluated and classified as responders or non-responders based on their step count target achievement. Non-responders were re-randomized to switch treatments or augment their current regime with an additional intervention. Responders maintained their original treatment protocol. Primary outcomes address recruitment, retention and adherence rates. Secondary outcomes encompass overall health. Results Preliminary results include 54 participants (56% male) aged 51.58 (± 15.12) with Ischaemic (44%), Haemorrhagic (28%) or unknown (28%) stroke type at baseline. The mean weekly step was 7046 (±3797) while the mean Fatigue Severity Scale score was 38.02 (± 14.60). Participants had a mean Hospital Anxiety and Depression Scale score of 12.33 (± 6.98). Additionally, the mean Stroke Specific Quality of Life was 155.04 (58.84). Conclusion This is the first trial to use a SMART to design an adaptive intervention post-stroke internationally. Findings will inform the development of a PA intervention and subsequently will be evaluated against treatment as usual in a definitive trial.

The effect of exogenous mitochondria in enhancing the survival and volume retention of transplanted fat tissue in a nude mice model

BackgroundDespite the pivotal role of fat grafting in plastic, reconstructive, and aesthetic surgery, inconsistent survival rates of transplanted adipose tissue, primarily due to early ischemic and hypoxic insults, remain a significant challenge. The infusion of healthy mitochondria has emerged as a promising intervention to support tissue recovery from ischemic, hypoxic, and other types of damages across various organ systems.ObjectivesThis study aims to evaluate the impact of supplementing human adipose tissue grafts with healthy exogenous mitochondria on their volume and mass retention rates when transplanted into the subcutaneous layers of nude mice. This approach seeks to improve and optimize fat grafting techniques.MethodsHuman adipose tissues were preconditioned with exogenous mitochondria (10 µg/mL), a combination of exogenous mitochondria and the inhibitor Dyngo-4a, Dyngo-4a alone, or PBS, and then transplanted into the subcutaneous tissue of 24 nude mice. Samples were harvested at 1 and 3 months post-transplantation for analysis of mass and volume retention. The structural morphology and integrity of the adipose tissues were assessed using Hematoxylin and Eosin (H&E) staining.ResultsMitochondrial preconditioning significantly enhanced the retention of mass and volume in fat grafts, demonstrating superior structural morphology and integrity compared to the control group.ConclusionsThis study highlights the potential of exogenous mitochondrial augmentation in fat transplantation to significantly improve fat graft survival, thereby optimizing the success of fat grafting procedures.

A Review on Stroke’s Pathophysiology, Associated Risk Factors, and Management

Background: Stroke is a medical disorder defined by focal neurological deficits caused by vascular impairment (hemorrhage or infarction) in the CNS (Central Nervous System). Currently the second biggest cause of morbidity worldwide, strokes continue to be a deadly disease. Objective: This review aimed to elucidate the stroke’s pathophysiology, both changeable and unchangeable risk factors associated with stroke, including prevention of stroke, its diagnosis, as well as treatment. Methods: The articles were collected involving the research on stroke with the help of different sources, like PubMed, Science Direct, and Google. Many manuscripts were collected and analyzed, and the relevant ones were considered for the present manuscript. Results: A brain CT scan has been found to be the first step in the management of Cerebrovascular Accident (CVA) in order to distinguish between ischemic and hemorrhagic stroke types. Beyond stroke classification, imaging has been observed to serve as a powerful tool for ruling out alternative diagnoses, predicting stroke outcomes, and facilitating appropriate treatment planning. Conclusion: Stroke is the second foremost cause of death as well as disability worldwide, leading to substantial economic losses. Therefore, better treatment and improved management after stroke are a global health priority. Modifying risk factors can decrease the chances of occurrence of stroke. Also, correct diagnosis should be done to diagnose the presence of stroke and its type. Proper treatment should be provided, like perfusion, glucose management, antiplatelet therapy, antihypertensive therapy, stem cell therapy, neural response and rehabilitation, increased awareness, lifestyle changes, stress management, etc. Exercise can also help positively to reduce the chances of stroke.

Electrolytes Status in Acute Stroke Patient in Rajshahi Medical College Hospital

Background: Stroke is a major cause of mortality and morbidity worldwide, significantly impacting patients and healthcare systems. Electrolyte imbalances are common in acute stroke patients and can influence clinical outcomes. This study investigates the electrolyte status in acute stroke patients admitted to Rajshahi Medical College Hospital Objective: To evaluate the electrolyte status (sodium and potassium levels) in acute stroke patients and its association with stroke types (Ischaemic and haemorrhagic) and clinical outcomes. Method: A cross-sectional study was conducted over two years (July 2017 to June 2019) in the Medicine and Neuromedicine Department of Rajshahi Medical College Hospital. A total of 104 acute stroke patients were included. Serum sodium and potassium levels were measured upon admission. Sociodemographic data, stroke types, and electrolyte levels were analyzed. Results: Among the 104 stroke patients, 71 (68.27%) had ischaemic stroke, and 33 (31.73%) had haemorrhagic stroke. The age distribution was highest in the 50-60 years group (34.62%). Males comprised 58.65% of the patients. Sodium levels were normal in 61.54% of patients, high in 2.88%, and low in 35.58%. Potassium levels were normal in 68.27% of patients, high in 10.58%, and low in 21.15%. No significant difference was found in sodium (p&gt;0.05) and potassium (p&gt;0.05) levels between ischaemic and haemorrhagic stroke patients. Conclusions: Electrolyte imbalances are prevalent in acute stroke patients, but no significant differences were observed between ischaemic and haemorrhagic stroke types. Regular monitoring and correction of electrolytes are crucial in managing stroke patients to improve outcomes.

Possibilities of Azilsartan Medoxomil for Preparation for Planned Percutaneous Coronary Intervention in Patients With Type 2 Diabetes Mellitus.

To evaluate the efficacy and safety of azilsartan medoxomil for preoperative preparation and improving the long-term prognosis of elective percutaneous coronary intervention (PCI) in patients with ischemic heart disease (IHD), arterial hypertension (AH), and type 2 diabetes mellitus (DM). The study sample included patients with type 2 DM referred for elective PCI who had poor blood pressure (BP) control according to 24-hour BP monitoring (24-BPM) (mean daily systolic BP ≥130 mmHg, mean daily diastolic BP ≥80 mmHg). The data were collected from 2018 through 2020. A total of 75 patients was included and distributed by simple randomization into two groups: group 1 (main, n=37) received azilsartan medoxomil as an antihypertensive drug at a dose of 40 mg/day (previously prescribed angiotensin-converting enzyme inhibitors or angiotensin II receptor blockers (ARB) were discontinued); group 2 (control, n=38) continued on their previous antihypertensive therapy. The follow-up period was 6 months. During each of 5 consecutive follow-up visits, the patient was examined, 24-BPM was recorded, and urinary markers of renal dysfunction (glomerular filtration rate, GFR; neutrophil gelatinase-associated lipocalin, NGAL; urine albumin-creatinine ratio, UACR; kidney injury molecule, KIM-1; and interleukin-18, IL-18) were measured. During the azilsartan treatment, GFR decreased by 7.4%, while in the control group, it decreased by 18.9% (p&lt;0.001). For 6 months of follow-up, no changes in the NGAL concentration were found in the main group, while the NGAL concentration in the control group increased by 12.9%. With azilsartan, there was a decrease in the urinary concentration of IL-18 (16.9%), while in patients of the control group, IL-18 increased (7.14%). Proteinuria progressed in both groups, which was expectable given the presence of DM; however, in patients receiving azilsartan, the UACR value increased by 37.5%, while in patients of the control group, it increased by 96.15%. These differences were statistically significant. No statistically significant differences were found in the concentrations of cystatin C and KIM-1. This study demonstrated two important facts: the possibility for diagnosing contrast-induced acute kidney injury (CI-AKI) using new, more sensitive markers of kidney damage, which is important for assessing the effectiveness of prevention, and the possibility of using ARBs, in particular azilsartan, for the prevention of CI-AKI in patients with IHD in combination with AH and DM.

Acute ST elevation myocardial infarction (STEMI) in a patient with leptospirosis; a therapeutical dilemma – A case report

A 45-year-old previously healthy farmer was seen at the Emergency Department with ischemic type chest pain. He had a history of an acute febrile illness for four days. The ECG showed an acute anterior myocardial infarction. His laboratory investigations revealed thrombocytopenia, a raised serum creatinine level and significantly raised high-sensitive cardiac Troponin I. A provisional diagnosis of acute STEMI with co-existing leptospirosis was made. The patient was managed conservatively with antibiotics, statins, and aspirin. Neither thrombolysis nor primary coronary intervention was attempted due to high risk of bleeding. Diagnosis of leptospirosis was confirmed later by markedly elevated leptospira antibodies. After recovery, he underwent coronary angiogram which revealed a totally occluded left anterior descending artery and is awaiting myocardial viability assessment with dobutamine stress echocardiography before PCI. We report this uncommon presentation of acute myocardial infarction in a patient with leptospirosis, as it causes a considerable therapeutic dilemma especially in a resource-poor setting.

Functional capacity evaluation in acute isquemic patients

Abstract Background An acute ischemic event may cause a functional deterioration even in previously autonomous patients. The determination of functional capacity is relevant to determine health indicators for rehabilitation nursing care, allowing at the same time to determine the patient's functional status throughout their health-disease cycle and to prescribe exercise-based rehabilitation for home-based programs. The six-minute walking test is widely used in studies involving cardiac patients, however, reference values for ischemic population after immediate clinical stabilization are not known. Also the 6MWT has a prognostic value for cardiac patients, being of utmost importance to evaluate it, after clinical stabilization in order to properly determine goals for patient´s rehabilitation process. Aim Determine the functional capacity level of ischemic patients, by gender and type of event, after clinical stabilization using the 6-minute walking test. Methods Using the 6-minute walking test, the functional capacity of ischemic inpatients was evaluated at discharge, after clinical stabilization. Patients with acute coronary syndrome with and without ST-segment elevation were included. All patients were accompanied by the rehabilitation nursing team during the in-hospital stay period and performed phase 1 cardiac rehabilitation. The 6MWT was performed based on the 2016 ATS guidelines and the expected value of the distance covered was determined based on the Enright equation. The sample was divided by gender, taking into account their widely known differences in functional capacity and also by event, namely ST elevation and Non ST-segment elevation myocardial infraction. The profile of modifiable cardiovascular risk factors (CRF) was also evaluated, being considered the following: Hypertension, Dyslipidemia, obesity, tobacco, sedentary lifestyle and stress. Results A total of 303 patients were studied (229 male), with a mean age of 62 years (men) and 62 (women). About 36% of men and 7% of women were admitted with ST elevation Myocardial Infraction, with a mean number of cardiovascular risk factors (CVRF) of 3.2 in men and 3.9 in women. The most prevalent CVRF in females is dyslipidemia and sedentary lifestyle, while in males it is dyslipidemia. The sample was divided in two groups by type of event, namely ST-elevation (group A) and NonST-elevation (group B) and in each group, data was evaluated by gender. A statistically significant difference (p&amp;lt;0.01 for males and p&amp;lt;0.02 for female) was found between the value of the 6MWT performed (441.2 meters – males; 369.5 meters - females) compared to the value estimated by the equation (559.9 males; 482.8 female gender). There is a very significant difference between the expected value and the value actually covered in the walking test. It may be pertinent to define reference values for this typology of patients, so that their functional capacity can be properly measured.