Occurrence Of Cardiovascular Complications Research Articles

Remdesivir-Related Cardiac Adverse Effects in COVID-19 Patients: A Case-Control Study.

There have been reports of serious side effects of Remdesivir, including cardiovascular complications. The present study aimed to determine the adverse cardiovascular effects of Remdesivir and the factors affecting them in COVID-19 patients. The patients were classified into two groups: those receiving Remdesivir without cardiac complications and those receiving Remdesivir with cardiovascular complications. After reviewing the patient's medical records, the relationship of some factors with the incidence of adverse cardiovascular effects was measured. Chi-square test showed that the distribution of complications in men was significantly higher than in women (P=0.001). The independent t-test revealed that the mean age in the group with complications was significantly higher than the group without complications (P=0.013). Fisher's exact test demonstrated a significant relationship between smoking and cardiovascular complications (P=0.05). According to the Mann-Whitney test, a significant difference was found in the mean changes of Bilirubin (P=0.02) and ALKP (P=0.01) before and after treatment in the groups with and without heart complications. Our findings indicated that most of the COVID-19 patients suffered from sinus bradycardia, and the distribution of complications was more pronounced in men than in women. The mean age in the group with complications was higher than the group without complications. Smoking was found to be associated with the occurrence of cardiovascular complications and the mean changes of Bilirubin and ALKP before and after treatment were significantly different in the groups with and without cardiovascular complications.

PerIoperative iNflammatory reSponse assessment In hiGH-risk patienTs undergoing non-cardiac surgery (INSIGHT): study protocol of a prospective non-interventional observational study

IntroductionIncreased inflammatory processes after non-cardiac surgery are very common. The association between postoperative inflammation and the occurrence of cardiovascular complications after non-cardiac surgery are still not entirely clear. Therefore, we...

Sarcopenia and echocardiographic parameters for prediction of cardiovascular events and mortality in patients undergoing maintenance hemodialysis.

Sarcopenia is prevalent and is associated with the occurrence of cardiovascular complications in patients undergoing maintenance hemodialysis (MHD). It is unknown how skeletal muscle may be associated with aspects of myocardial structure and function. This study aimed to evaluate the association between sarcopenia and cardiac structure and function in patients undergoing MHD. We also examined the prognostic role of sarcopenia for mortality and cardiovascular events (CVE) in this population. Participants from a single center underwent bioimpedance body composition analysis to measure skeletal muscle and echocardiography to assess myocardial structure and function. Sarcopenia was diagnosed based on the Asian Working Group for Sarcopenia criteria. The end points were all-cause mortality and CVE. Of the 158 participants, 46 (29.1%) had sarcopenia, 102 (64.6%) had left ventricular diastolic dysfunction (LVDD), and 106 (67.0%) had left ventricular hypertrophy (LVH). Participants with sarcopenia had smaller right ventricular sizes (2.54 ± 0.77 vs 2.76 ± 0.28; P < 0.01), inter-ventricular thickness (1.07 ± 0.19 vs 1.14 ± 0.20; P = 0.039), and left ventricular posterior wall thickness (0.96, 0.89-1.10 vs 1.06, 0.95-1.20; P = 0.018). Skeletal muscle mass was strongly correlated with left ventricular mass (LVM) (r = 0.577; P < 0.0001). Furthermore, the risk of LVDD (OR: 4.92, 95% confidence interval (CI) [1.73-13.95]) and LVH (OR: 4.88, 95% CI [1.08-21.96]) was much higher in the sarcopenic group than in the non-sarcopenic group. During a follow-up period of 18 months, 11 (6.9%) patients died, of which seven died (4.4%) of CVE, and 36 (22.8%) experienced CVE. The presence of sarcopenia (adjusted hazard ratio (HR), 6.59; 95% CI [1.08-39.91]; P = 0.041) and low skeletal muscle index (HR, 3.41; 95% CI [1.01-11.57]; P = 0.049) and handgrip strength (HR, 0.88; 95% CI [0.78-0.99]; P = 0.037) independently predicted death. Sarcopenia was a significant predictor of CVE (HR, 10.96; 95% CI [1.14-105.10]; P = 0.038). Our findings demonstrated that sarcopenia is associated with LVDD and LVH, and is associated with a higher probability of death and CVE.

Peri-procedural complications following endovascular revascularization for critical limb ischemia.

Revascularization procedures are considered the cornerstone of therapy in patients with critical limb ischemia (CLI) and multiple procedures are often required to attain limb salvage. The aim of the present study is to determine the prevalence of peri-procedural complications after endovascular procedure, and to determine the clinical and biological characteristics of patients associated to the risk of peri-procedural complications. From November 2013 to May 2021, 324 consecutive patients were retrospectively included, of whom 99 underwent more than one revascularization procedure for contralateral CLI or clinical recurrence of CLI. A total of 532 revascularizations were performed. Clinical and biological parameters were recorded at baseline before endovascular revascularization. The occurrence of a peri-procedural complication (local complications, fatal and non-fatal major bleeding or cardiovascular events) was recorded up to 30days after revascularization. Univariate and multivariate analyses were performed to study the parameters associated with per-procedural complications. A P<0.05 was considered as statistically significant. A total of 324 consecutive patients were included, 177 men and 147 women with CLI, with a mean age of 77.6±11.9years. Most of these patients had cardiovascular comorbidities (41% with a history of coronary heart disease, 78% treated hypertensive patients, 49% diabetic patients). Peri-procedural mortality occurred in 13 patients (4%) and 9 patients (2.8%) experienced major amputation at one-month following revascularization. Among the 532 revascularization procedures, 99 major bleeding events (22.8% of the cohort population) and 31 cardiovascular events (8.6% of the cohort population), were recorded in the peri-procedural period. Cardiovascular events were associated with peri-procedural mortality. Complications at the puncture site occurred during 38 of the 532 procedures (10.2% of the cohort population). Compared with patients undergoing a single revascularization procedure, patients with multiple procedures presented a higher risk of major bleeding events (48.5% vs. 11.6%, P<0.0001) and access site complications (20.2% vs. 5.78%, P<0.0001). In multivariate analysis, pulse pressure <60mmHg and hemoglobin level <10g/dl were correlated with the occurrence of major bleeding events; left ventricular ejection fraction<60% and the absence of statin treatment were correlated with the occurrence of cardiovascular complications; a high chronological rank of revascularization was correlated with the occurrence of local complication. Finally, age and gender were not associated with the occurrence of peri-procedural complication. The present results highlight that multiple revascularization procedures for limb salvage are required in almost one third of the population with critical limb ischemia and were associated with the risk of major bleeding events and access site complications. The most frequent complications of peripheral vascular interventions were major bleeding events. Adverse cardiovascular events were related with peri-procedural mortality. Anemia, blood pressure, left ventricular ejection fraction and statin treatment are important parameters to consider for peri-procedural outcomes, independently of age, gender and the chronological rank of revascularization procedure.

VLA4-Enhanced Allogeneic Endothelial Progenitor Cell-Based Therapy Preserves the Aortic Valve Function in a Mouse Model of Dyslipidemia and Diabetes

The number and function of endothelial progenitor cells (EPCs) are reduced in diabetes, contributing to deteriorated vascular repair and the occurrence of cardiovascular complications. Here, we present the results of treating early diabetic dyslipidemic mice or dyslipidemic with disease-matched EPCs modified to overexpress VLA4 (VLA4-EPCs) as compared with the treatment of EPCs transfected with GFP (GFP-EPCs) as well as EPCs from healthy animals. Organ imaging of injected PKH26-stained cells showed little pulmonary first-pass effects and distribution in highly vascularized organs, with splenic removal from circulation, mostly in non-diabetic animals. Plasma measurements showed pronounced dyslipidemia in all animals and glycaemia indicative of diabetes in streptozotocin-injected animals. Echocardiographic measurements performed 3 days after the treatment showed significantly improved aortic valve function in animals treated with VLA4-overexpressing EPCs compared with GFP-EPCs, and similar results in the groups treated with healthy EPCs and VLA4-EPCs. Immunohistochemical analyses revealed active inflammation and remodelling in all groups but different profiles, with higher MMP9 and lower P-selectin levels in GFP-EPCs, treated animals. In conclusion, our experiments show that genetically modified allogeneic EPCs might be a safe treatment option, with bioavailability in the desired target compartments and the ability to preserve aortic valve function in dyslipidemia and diabetes.

The antioxidant, anti‐inflammatory, and antiplatelet effects of Ribes rubrum L. fruit extract in the diabetic rats

The prothrombotic and inflammatory state plays a significant role in the occurrence of cardiovascular complications in type 2 diabetes mellitus. In this study, the antidiabetic, anti-inflammatory, and antiplatelet potentials of the extracts obtained from Ribes rubrum were investigated. The antidiabetic, anti-inflammatory, and antioxidant activities of the ethanol and water extracts of R. rubrum were evaluated by in vitro methods. The total phenolic and flavonoid contents were also determined. The experimental diabetes model in rats was induced with streptozotocin (STZ). After hyperglycemia occurred, the ethanol extracts of R. rubrum (RRE, at 100mg/kg and 500mg/kg doses) were administered to the treatment groups for 14days. Blood glucose, lipid profile, plasma, and pancreas tumor necrosis factor-α (TNF-α) levels were determined and compared at the end of the experiments. P-selectin levels and mitochondrial membrane polarization (MMP) of platelets were also measured. In vitro study, the RRE showed potent anti-inflammatory activity. Administration of RRE (at 100mg/kg doses) to diabetic rats lowered blood glucose level insignificantly. The results showed that there was an increment in levels of TNF-α in plasma and pancreas tissue of the diabetic group compared to the control group. R. rubrum extract regulated and normalized their levels in plasma and pancreatic tissue. RRE at both doses significantly decreased platelet P-selectin levels and prevented STZ-induced loss of MMP in platelets. The results of current research indicate that RRE extract has potent anti-platelet and anti-inflammatory effects and may be beneficial in preventing diabetic complications. PRACTICAL APPLICATIONS: Hyperglycemia causes dyslipidemia, advanced oxidative stress, platelet activation, and inflammation in diabetes mellitus. Plants with various medicinal properties are of worldwide interest for the treatment of diseases due to their biological activities. In this study, the antidiabetic, anti-inflammatory, and antioxidant effects of extracts of Ribes rubrum (%100 ethanol, 50% ethanol, water) were evaluated by in vitro and in vivo methods. The diabetes model was induced with streptozotocin (STZ). The rats were divided into control, diabetic control, R. rubrum-100mg/kg, and R. rubrum-500mg/kg doses groups. Blood glucose levels, tumor necrosis factor-α (TNF-α), platelet P-selectin levels, mitochondrial membrane polarization of platelets were examined. The present study has shown that R. rubrum has anti-inflammatory and antiplatelet activity. R. rubrum may be beneficial in the prevention and treatment of DM complications due to its anti-inflammatory and antithrombotic effects.

POS-253 THE RELATIONSHIP BETWEEN THE NEUTROPHILS / LYMPHOCYTES RATIO AND THE PLATELETS / LYMPHOCYTES RATIO WITH THE OCCURRENCE OF CARDIOVASCULAR COMPLICATIONS IN HEMODIALYSIS PATIENTS

Cardiovascular complications are the leading cause of death in end stage renal disease.The neutrophils / lymphocytes ratio (RNL) has been presented as a novel and a potential marker to assess the inflammatory status of HD patients.Our study aims to define the relationship between the occurrence of cardiovascular complications in hemodialysis(HD)patients with theratio of neutrophils to lymphocytes (RNL) and the ratio of platelets to lymphocytes (RPL).

NSAIDs and PPIs - review of new reports

The aim of this study is to systematise knowledge on non-steroidal anti-inflammatory drugs (NSAIDs) - cyclooxygenase (COX) enzyme inhibitors and proton pump inhibitors (PPIs) inhibiting potassium hydrogen ATPase. A review of recent reports on possible side effects and new therapeutic options will be presented.&#x0D; Results: Over the last few years, reports of PPI side effects have been published: drug-induced thrombocytopenia, severe hypomagnesemia, hyponatremia or rhabdomyolysis. In the case of NSAIDs, ancillary therapeutic effects in the supportive therapy of multiple myeloma or in the reduction of adenoma formation in the colon stand out, but also cases of acute kidney injury in children. On the basis of meta-analyses, attempts were made to demonstrate the effect of individual NSAIDs on the occurrence of cardiovascular complications, stroke or myocardial infarction&#x0D; Conclusions: Despite the fact that the indicated preparations were admitted to the list of drugs several decades ago, still their pharmacological potential (on the example of NSAIDs, which can be successfully used even in complementary therapy) has not been fully exploited. The aforementioned reports on side effects must not be forgotten. It is possible that the examples presented in the review will raise awareness in order to use these drugs with greater respect, in accordance with the recommendations in the leaflet.

Prognostic implications of longitudinal strain in hypertensive patients

Abstract Funding Acknowledgements Type of funding sources: Public hospital(s). Main funding source(s): University Hospital of Tlemcen Introduction Hypertension is a well-established risk factor for cardiovascular disease. It causes left ventricular (LV) pressure overload, and, in turn, changes in cardiac geometry and LV hypertrophy (LVH). Early impairment of LV function, detected by a reduced GLS, is associated with long-lasting, uncontrolled HBP, overweight, related metabolic changes, and is more pronounced in patients with LVH. This decline in longitudinal function may be a determining factor in the occurrence of cardiovascular complications and therefore an increase in cardiovascular morbidity and mortality. Purpose : This study sought to investigate the associations of left ventricular (LV) strain and its serial change with major adverse cardiac events in hypertensive patients. Methods We retrospectively studied 400 asymptomatic patients with hypertension of which, 182 patients had abnormal global longitudinal strain(GLS) and 218 patients had normal GLS, between 2016 and 2019. Global longitudinal strain (GLS) was measured using speckle tracking. Patients were followed for admission because of heart failure, myocardial infarction, atrial fibrillation and strokes, over median of 4 years. At the start of study, all patients had preserved LV ejection fraction. Résultats : The control of patients noted 25 cases (6.25%) of attacks of heart failure in the arm hypertension with low GLS against only 4 cases (1%) in the arm hypertension + normal GLS (P &amp;lt;0.001). The same, 19 ( 4.75%) hypertensive patients with low GLS had a stroke compared to only 5 (1.25%) hypertensive patients with normal GLS. A significant difference in the incidence of onset of acute coronary syndromes was also noted in the hypertension arm with abnormal GLS (P = 0.002). As for rhythmic complications, 26 (6.5%) hypertensive patients with abnormal GLS developed atrial fibrillation compared to only 9 (2.25%) hypertensive patients with normal GLS (P &amp;lt;0.0001). Conclusion : GLS and its deterioration are associated with cardiovascular complications in asymptomatic hypertensive heart disease. Although LVEF will remain a cornerstone of LV function assessment, the addition of GLS enables detailed phenotyping and improved risk assessment and is a tool for present and future therapeutic advancement. A risk score incorporating strain was useful for predicting risk of cardiac events.

Functional assessment in left ventricular non-compaction cardiomyopathy in multimodality imaging era might improve the definition

Abstract Left ventricular non-compaction (LVNC) is an increasingly recognized phenotype. The current definition of the LVNC does not mention LV dysfunction as an absolute criterion in addition to morphological criteria. LV dilatation and decreased LV ejection fraction (LVEF) are often late manifestations of the disease and correlate with the occurrence of cardiovascular complications. However, to define LVNC as a cardiomyopathy, functional criteria must be fulfilled, in addition to the morphological ones. Multimodality imaging, such as myocardial deformation and myocardial work analysis derived from speckle tracking echocardiography (STE), in combination with cardiac magnetic resonance (CMR) might improve diagnosis and characterization of non-compaction, exposing earlier signs of LV systolic dysfunction. We present two comparative cases of LVNC in order to highlight the idea of subclinical dysfunction even in apparently benign forms with preserved LVEF, and also the importance of multimodality imaging approach.

Inflammatory cardiovascular risk markers and silent myocardial ischemia in type 2 diabetic patients

Background/Aim. A special feature of coronary heart disease (CHD) in patients with type 2 diabetes mellitus (T2DM) is that it is often a symptomatic and occurs as a consequence of cardiovascular autonomic neuropathy. Dysregulation of the autonomic nervous system is associated with elevated values of inflammatory markers such as high-sensitivity C-reactive protein (hs-CRP) and interleukin- 6 (IL-6), which accelerate atherosclerosis and the occurrence of cardiovascular complications in patients with T2DM. The aim of the study was to evaluate the importance of determining inflammatory cardiovascular risk markers IL-6 and hs-CRP in screening for the presence of CHD in asymptomatic patients with T2DM. Methods. The study included 169 patients with T2DM without any symptoms and signs of CHD. Ergometric testing proved or ruled out the presence of silent CHD. The levels of hs- CRP and IL-6 were determined by ELISA. Results. IL-6 values were significantly higher in patients with a positive ergometric test (6.83 ? 1.99 pg/mL) compared to patients with a negative ergometric test (3.04 ? 1.39 pg/mL) (p &lt; 0.001). We also found that hs-CRP values in patients with a positive ergometric test were significantly higher compared to patients with a negative ergometric test (6.37 ? 2.25 vs 1.67 ? 1.41 mg/L; p &lt; 0.001). Combinations of IL-6 and hs-CRP with age, HbA1c values, and duration of diabetes, presented through three binary logistic regression models, are significant predictors of silent CHD proven by ergometric testing, ie, with their increase, the probability of a positive ergometric test also increases (p &lt; 0.01). The sensitivity of the associated finding of elevated IL-6 and hs-CRP values in the detection of silent CHD by ergometric testing was 90%, and the specificity was 86%. Conclusion. Hs-CRP and IL-6 are significant predictors of silent CHD, and their determination could be recommended for improving cardiovascular risk stratification in asymptomatic patients with T2DM.

Atrial Fibrillation: the Association with Physical Activity and the Effects of Cardiac Rehabilitation

The purpose of this review was to present modern studies that examine the relationship of physical activity and risk of atrial fibrillation (AF) development and the impact of cardiac rehabilitation programs in patients with all forms of AF. Data of 52 Russian and foreign scientific sources published in 1998- 2020 were presented. In our study, 48 patients with paroxysmal AF after radiofrequency ablation (RFA) were randomly assigned to a physical rehabilitation/standard therapy or control (standard therapy) group. Aerobic physical training was conducted for 6 months 3 times a week. AF is one of the most common cardiac arrhythmias. Despite modern advances, results of treatment of this disease are far from optimal. Many problems of patients with AF can be addressed through enrolment in multidisciplinary cardiac rehabilitation programs. But this question remains open. This is mainly due to the complexity of selection of physical rehabilitation program for patients with AF. It is known that physical activity can trigger an episode of AF. In the following review article, the approaches to functional capacity assessment of patient with AF are described, recommendations for prescribing safe exercise training to achieve a therapeutic effect are presented. Various aspects of the effects of physical rehabilitation are discussed, including its impact on cardiovascular risk factors, influence on atrial remodeling processes and associated biomarkers, prevention of AF progression and occurrence of cardiovascular complications. Results of our own research indicate effectiveness of physical training in patients with AF after RFA: increase in exercise duration by 18.6% (p&lt;0.001) and load by 24.8% (p&lt;0.01) during exercise test, increase in level of everyday physical activity by 23.8% (p=0.001); left atrium dimensions remain stable comparing with control group. That was combined with a decrease of post ablation atrial arrhythmias: after 6 months, they were registered in 4.5% of trained patients vs 17.4% of control group patients (p&lt;0.01). Steady growth in the number of patients with AF and catheter ablation procedures around the world dictates the need for organization of multi-purpose medical rehabilitation.

A study on occurrence of cardiovascular complications among adult patients with ST elevation anterior wall myocardial infarction in the presence or absence of reciprocal lead ECG changes

Acute anterior wall ST elevation MI with reciprocal lead changes are associated with more extensive ischemic area or larger infarction & more complications. The present research was thus conducted to study the occurrence of cardiovascular events in ST elevation anterior wall myocardial infarction in the presence or absence of reciprocal lead ECG changes.

Sarcopenia and inflammation in patients undergoing hemodialysis.

Introduction: in individuals with chronic kidney disease, sarcopenia is prevalent and is associated with increased morbidity and mortality, and the occurrence of cardiovascular complications. Objective: to verify the relationship between sarcopenia and inflammation in hemodialysis patients. Methods: a cross-sectional study with 209 patients in five hemodialysis units. Demographic, socioeconomic, body composition, clinical laboratory, and functional data were collected. Sarcopenia was diagnosed according to the European Working Group on Sarcopenia in Older People (grip strength < 27 kg for men and < 16 kg for women; DEXA muscle mass < 7.0 kg/m² for men and < 5.5 kg/m² for women). Inflammation was assessed by C-reactive protein. Results: mean age was 51.9 ± 15.0 years, with a predominance of males (59.3 %). The prevalence of sarcopenia was 29.1 % and that of inflammation was 50.2 %. A Poisson regression analysis showed that sarcopenia was associated with increased hsCRP values (PR: 1.06; 95 % CI: 1.01-1.10; p-value = 0.005); BMI (PR: 0.74; 95 % CI: 0.65-0.84; p-value < 0.001); age (PR: 1.02; 95 % CI: 1.00-1.03; p < 0.001); male (PR: 5.75; 95 % CI: 3.20-10.34; p-value < 0.001); presence of diabetes mellitus (DM) (PR: 1.87; 95 % CI: 1.27-2.74; p-value < 0.001); % body fat (PR: 1.07; 95 % CI: 1.04-1.09; p-value < 0.001). Conclusion: the prevalence of sarcopenia can be considered high in this study, as well as inflammation. Being inflamed, presence of DM, being male, increasing age, and % body fat were risk factors for sarcopenia. On the other hand, increased BMI had a protective role.

Cardiovascular Complications in Pre-eclampsia: Can they be Predicted Electrocardiographically?

Background: Pre-eclampsia is a common condition that causes significant morbidity and mortality in pregnant women; the occurrence of cardiovascular complications aggravates the disease. Efforts have been made to predict the complications of pre-eclampsia, but some modalities, such as echocardiography and biomarkers, are neither available nor widely feasible for use by healthcare providers, especially in developing countries. On the other hand, ECG is cheap, noninvasive, widely available, and already routinely performed for pre-eclampsia. The role of ECG in predicting cardiovascular complications in pre-eclampsia patients is not known. Objective: This study aimed to investigate the role of ECG in pre-eclampsia diagnostics and simple clinical parameters in pre-eclampsia patients with and without cardiovascular complications. Methods: This cross-sectional, analytical study used retrospective data from medical records of patients with pre-eclampsia from the Dr Kariadi General Hospital, Semarang, Indonesia, from January 2016–July 2017. Bivariate association between demographic, clinical, laboratory, and ECG results with the occurrence of cardiovascular complications was tested; this continued with logistic regression. Results: Sixty-eight pre-eclampsia patients were identified, with a mean age of 30.2 years. Cardiovascular complications occurred in 16 patients (23.5%), with 14 patients exhibiting pulmonary oedema. In univariate analysis, haemoglobin level and heart rate showed a significant association with the occurrence of cardiovascular complications (p=0.035 and 0.033, respectively). No significant independent predictor was found in multivariate analysis. Conclusion: This study showed that ECG parameters were not able to predict cardiovascular complications in pre-eclampsia patients. Nevertheless, there was a significant association between heart rate and haemoglobin level with cardiovascular complications in pre-eclampsia.

Correlation between the state of periodontal tissues and selected risk factors for periodontitis and myocardial infarction.

The current level of knowledge indicates a relationship between periodontitis and diabetes and/or cardiovascular diseases (CVD). Periodontitis can be not only a risk factor for these diseases, but also a condition modifying other primary risk factors associated with the occurrence of cardiovascular complications (lipid disorders, arterial hypertension, etc.) or diabetes. The aim of the study was an analysis of the correlation between the state of periodontal tissues and selected risk factors for myocardial infarction (MI) in patients after recent myocardial infarction. The study included 417 patients (92 women, 325 men) hospitalized due to recent MI. The inclusion criteria were MI history and age below 70 years. The state of periodontal tissues (plaque index, bleeding on probing, pocket depth and clinical attachment loss, CPI index) and selected risk factors for periodontitis and CVD were recorded. An analysis of the results showed no statistically significant correlation between the depth, the number, percentage of periodontal pockets and the average clinical attachment level on one hand and BMI on the other hand. Whereas a statistically significant correlation was observed between tobacco smoking and the degree of severity of periodontal diseases measured by the average pocket depth, the number and percentage of pockets above 4 mm and the average clinical attachment loss, as well as between hypertension and the state of oral hygiene and between diabetes and the number of preserved teeth and the number of pockets above 4 mm. The degree of severity of periodontal disease can impact hypertension and diabetes, which could potentially influence the occurrence and course of CVD.

Fibroblast Growth Factor-23-A Potential Uremic Toxin.

Fibroblast growth factor-23 (FGF23) is a circulating member of the FGF family produced mainly by the osteocytes and osteoblasts that can act as a hormone. The main action of FGF23 is to lower phosphatemia via the reduction of urinary phosphate reabsorption and the decrease of 1,25(OH)2-D generation in the kidney. In the course of chronic kidney disease (CKD), plasma FGF23 concentration rises early, most probably to compensate the inability of the deteriorating kidneys to excrete an adequate amount of phosphate. However, this comes at the cost of FGF23-related target organ toxicity. Results of clinical studies suggest that elevated plasma FGF23 concentration is independently associated with the increased risk of CKD progression, occurrence of cardio-vascular complications, and mortality in different stages of CKD. FGF23 also contributes to cardiomyocyte hypertrophy, vascular calcification, and endothelial dysfunction. The impact of FGF23 on heart muscle is not dependent on Klotho, but rather on the PLCγ–calcineurin–NFAT (nuclear factor of activated T-cells) pathway. Among the factors increasing plasma FGF23 concentration, active vitamin D analogues play a significant role. Additionally, inflammation and iron deficiency can contribute to the increase of plasma FGF23. Among the factors decreasing plasma FGF23, dietary phosphate restriction, some intestinal phosphate binders, cinacalcet (and other calcimimetics), and nicotinamide can be enumerated. Anti-FGF23 antibodies have also recently been developed to inhibit the action of FGF23 in target organs. Still, the best way to normalize plasma FGF23 in maintenance hemodialysis patients is restoring kidney function by successful kidney transplantation.

Determinants of therapeutic nonadherence to antihypertensive treatment: a hospital-based study on outpatients in Northern Cameroon

Background: Poor therapeutic adherence has disastrous consequences for the patient and the health-care system as a whole. In patients, poorly controlled blood pressure facilitates the occurrence of cardiovascular complications. Adherence to therapy is more central to good clinical outcomes than the improvement of treatment efficiency, reason why it is important to identify risk factors of poor therapeutic adherence to ameliorate current interventions; hence, enabling the health system attain its goals. Objective: To assess the level of therapeutic adherence to antihypertensive treatment and to identify factors associated to poor observance among patients with hypertension in Garoua city, North Cameroon. Materials and Methods: The patients were randomly and consecutively selected at the consultation services of the Medico-Social Centre of the National Social Insurance Fund in Garoua. Data were collected using self-administered semi-structured questionnaire that included the Girerd X compliance test. Result: In total 210 patients were enrolled into the study. Of them, 12.9% of patients followed up their treatment correctly, 52.9% had minor observance problems, and 34.3% had a poor therapeutic adherence to antihypertensive drugs. The determining factors of poor adherence were the presence of complications of high blood pressure (p = 0.002; odds ratio [OR] = 0.198), the presence of a handicap (p = 0.040; OR = 0.295), and a low level of education (p = 0.008). Conclusion: Adherence to antihypertensive drug treatment is poor within our population of study. It is therefore important to emphasize on therapeutic education initiatives in our environment to limit the progression of hypertension, thus, minimizing the occurrence of complications because of high blood pressure and consequently the associated economic burden.

Relationship S100 protein levels in blood plasma with a frequency of occurrence of cardiovascular complications in Parkinson's disease

Relationship S100 protein levels in blood plasma with a frequency of occurrence of cardiovascular complications in Parkinson's disease

The Importance of Novel Inflammatory Biomarkers in Renal Disease.

Kidney disease, whether acute or chronic, represents a major health hazard. Acute kidney injury (AKI) detection is based mainly on serum creatinine, which is considered to delay prompt diagnosis and management, thus increasing substantially patient morbidity and mortality and prolonged hospitalization. Several biomarkers have been evaluated as early prognostic markers of AKI. However, the vast majority of them are still far from being implicated into clinical practice. On the other hand, routine eGFR estimation and proteinuria monitoring have contributed to previous identification of chronic kidney disease (CKD). Hence, more sensitive and specific biomarkers are needed to enable us recognize individuals at increased risk for progression of CKD to end-stage renal disease (ESRD) and occurrence of cardiovascular complications. This review focuses on the most important novel inflammatory biomarkers that have emerged for early prediction, monitoring and management of kidney disease.