bluuebunny/crossref_metadata_2025 huggingface dataset:
15. Role of Mineral Corticosteroid Receptor Antagonist (MRA) as a Therapeutic Approach for Hypertension Management
Authors: Aprillia Gunawan Cynthia Marcelly , Herijanto Billie Edgara , Winisa Effia
Published: July 2024

Introduction: Hypertension remains a pervasive global health challenge. Emerging research highlights the potential of Mineral Corticosteroid Receptor Antagonists (MRAs) in addressing hypertension’s complexities. This study aims to elucidate the potential of MRAs, offering new insights in comprehensive hypertension management strategies.

Methods: A systemic search was conducted on electronic databases, including PubMed and Google Scholar. Keywords related to MRA and hypertension were used to obtain data from the database. The systolic blood pressure (SBP) and diastolic blood pressure (DBP) mean change, ambulatory 24 hour SBP and DBP mean change, as well as treatment-related adverse event (TRAE) were analysed using Review Manager (Version 5.4, cochrane collaboration, UK).

Results: 7 low risk bias studies with 2670 patients were obtained and included in this study. Significant reduction is seen in SBP and DBP [-6.36/–2.63 mmHg CI 95% = -9.41 to -3.32 / -4.5 to -0.7 mmHg, p < 0.0001] mean change from baseline and 24 hr ambulatory [-5.57/-3.74 mmHg CI 95% = -15.73 to -4.59 / -7.67 to -0.2 mmHg, p < 0.0001] favouring in MRA therapy. However, TRAE is markedly increased in MRA therapy [OR 2.06, CI 95% =0.53 - 7.99, p = <0.0001].

Conclusion: MRAs are effective as a therapeutic approach for treating patients with hypertension. However, treatment should also focus on preventing TRAE to increase the efficacy of its treatment, and increasing patients’ quality of life. This finding should be used with caution, as results are limited to current studies, and further research should be done to confirm its effectiveness.
17. The Effects of Nighttime vs. Morning Dosing of Antihypertensive Medications on Blood Pressure Reduction: A Systematic Review and Meta-Analysis
Authors: Pinatih PTP , Vidyawati  , Wiryawan IN
Published: July 2024

Background: Hypertension remains the major preventable cause of cardiovascular and all-cause mortality. Studies of ambulatory blood pressure measurements (ABPM) found a higher risk of cardiovascular events in nocturnal hypertension and non-dipping pattern. Previous studies have shown beneficial effects of nighttime dosing of antihypertensive medications on blood pressure (BP) reduction, a concept known as chronotherapy.

Objective: To assess the effects of nighttime dosing of antihypertensive medications compared to morning dosing on BP reductions.

Methods: A literature search was performed on online databases of scientific articles. The resulting articles were screened and assessed for eligibility. Patient characteristics and ABPM data were extracted for statistical analysis using a random-effects model.

Results: Twelve randomized clinical trials were included in the final analysis, including a total of 25,266 patients. Nighttime dosing did not have an effect on diurnal systolic (SBP) nor diastolic BP (DBP) (p=0.55 and p=0.99, respectively), but have a significantly greater reduction of nocturnal and 24 h/48 h BP when compared to morning dosing. Mean difference between groups was 5.94 (95% CI 4.61–7.28, p<0.001) mmHg for nocturnal SBP, 3.15 (2.29–4.01, p<0.001) mmHg for nocturnal DBP, 1.48 (1.17–1.79, p<0.001) mmHg for 24 h/48 h mean SBP, and 1.02 (0.50–1.54, p<0.001) mmHg for 24 h/48 h mean DBP. There were significantly less non-dippers in the nighttime dosing group compared to the morning group (37.3% vs. 52.8%, p<0.001) after the treatment period.

Conclusion: Compared to morning dosing, nighttime dosing of antihypertensive medications reduced nocturnal and 24 h/48 h blood pressures, as well as the number of non-dippers.
23. Angiotensin Receptor Blocker Significantly Reducing Left Ventricular Mass Index, All-Cause and, Cardiovascular Mortality in Chronic Kidney Disease Patient with Hypertension Undergoing Maintenance Hemodialysis: A Network Meta-Analysis of Randomized Control Trial
Authors: Yunia Dewi Ni Luh Putu , Pamungkas Kadek Mercu Narapati , Virnando Ricky , Sindhughosa Dwijo Anargha
Published: July 2024

Background: Cardiovascular diseases contribute to half of mortality in patients undergoing dialysis for kidney failure. Over 80% of dialysis patients are affected by hypertension, a leading risk factor for cardiovascular disease. However, the cardiovascular outcome of antihypertensives for patients on maintenance dialysis remains unclear.

Objective: To assess the efficacy of antihypertensive drugs on cardiovascular outcomes in hypertensive patients undergoing maintenance dialysis.

Method: We conducted a frequentist random-effects network meta-analysis of randomized, controlled trials that assessed the efficacy of antihypertensive agents in adult patients with hypertension undergoing maintenance dialysis. We searched PubMed, ScienceDirect, Wiley Online, CENTRAL, and Clinicaltrial.gov from the database up to November 2023 for relevant trials. The main outcome was a left ventricular mass index (LVMI) reduction.

Result: Twenty-four trials (2386 participants) met our inclusion criteria. Angiotensin receptor blockers (ARB), mineralocorticoid receptor antagonists (MRA), ACE inhibitors, and calcium channel blockers reduced LVMI to a greater extent than placebo, although the result was not statistically significant. Subgroup analysis revealed that up to 6 months after treatment, ARB had a significant effect on reducing LVMI (MD -44.72, 95%CI -73.09 to -16.35). ARB (86.92%) was the top among all medical interventions, as determined by the SUCRA ranking. Additionally, ARB significantly decreased all-cause mortality (RR 0.45, 95%CI 0.29-0.70) and cardiovascular-related death (RR 0.56, 95%CI 0.36-0.88). Nevertheless, MRA also showed a substantial effect on all-cause mortality and cardiovascular-related death.

Conclusion: ARB significantly reduced LVMI until 6 months after treatment and lowered the risk of all-cause and cardiovascular-related death in hypertensive patients undergoing maintenance hemodialysis.
27. The Efficacy and Safety of Ultrasound Renal Denervation on Hypertensive Patients: A Systematic Review and Meta-Analysis of Clinical Cases
Authors: Ramadhan Roy Novri , Gunawan Felicia Angelica , Homenta Rampengan Derren David Christian , Nathania  , Willyanto Sebastian Emanuell , Prana Jagannatha Gusti Ngurah
Published: July 2024

Introduction: The World Health Organization (WHO) recorded hypertension as the leading non-communicable disease case (77%) by 2021. Since the Renin-Angiotensin-Aldosterone System (RAAS) is implicated in the pathogenesis of primary hypertension, ultrasound-based renal denervation (URD) has proven effective as a future approach to improving systolic and diastolic blood pressure conditions. URD technology utilizes acoustic energy for circumferential ablation patterns while incorporating endovascular cooling through an irrigated balloon.

Objectives: This study evaluates the efficacy and safety of URD in hypertension patients.

Methods: The literature search was carried out through PubMed, ScienceDirect, BMJ Journals, and Google Scholar with a total of 643 articles. A total of 427 articles were screened and selected, resulting in 6 included studies. Quality appraisal was done using RoB 2.0, while meta-analysis used RevMan 5.4.

Results: Our analysis included six studies assessing the efficacy and safety of a URD intervention for hypertension, results indicated significant improvements in 24-hour, daytime, and home ambulatory blood pressure measurements, favouring the URD over control. The mean difference (MD) for 24-hour measurements was -0.84 [95% CI -1.41; -0.55], for daytime measurements -1.27 [95% CI -1.59; -0.95], and for home measurements -1.87 [95% CI -2.21; -1.52], with moderate heterogeneity observed. Office ambulatory measurements also favoured the URD with a significant MD of -1.51 [95% CI -1.91; -1.10]. Funnel plots revealed some outliers, indicating true heterogeneity among the studies.

Conclusion: URD was associated with a significant reduction in blood pressure in hypertensive patients across several settings, albeit with some variability between studies.
28. The Impact of Mid Day Nap Duration on Blood Pressure: A Systematic Review and Meta-Analysis
Authors: Soesanto Septo A. , Maulana Chandra A. , Mulawarman Rido , Trifitriana Monica , Tondas Alexander E.
Published: July 2024

Background and Aim: Hypertension, a major public health concern, is associated with various health complications. Recently, the role of nap power, specifically nap duration, has gained attention as a potential factor influencing blood pressure levels. We aim to assess the relationship between nap duration and blood pressure, shedding light on the potential implications for hypertension risk.

Method: A comprehensive search was conducted across electronic databases for relevant studies published up to the knowledge cutoff date of January 2024. Inclusion criteria comprised studies investigating the effects of mid-day nap duration on blood pressure, with a focus on both short and prolonged nap periods. Two studies meeting these criteria were selected for analysis.

Result: There were a total of 16.007 patients from 2 studies [1-2]. The outcome of this systematic review reported that mid-day napping was significantly associated with blood pressure. Meta-analysis showed that Mid-day napping ≥ 90 minutes was associated with Sistolic Blood Pressure (SBP) (1.72 [0/77-2.67], p=0.06 ; I2: 71%, p<0.0004) and Diastolic Blood Pressure (DBP) (0.69 [0.09-1.29], p=0.96 ; I2: 0%, p<0.02). There was no association between Mid-day napping < 30 minutes was associated with Sistolic Blood Pressure (SBP) (0.44 [-0.451.33], p=0.42 ; I2: 0%, p<0.33) and Diastolic Blood Pressure (DBP) (-0.16 [-0.71-0.39], p=0.02 ; I2: 80%, p<0.56).

Conclusion: Our meta-analysis showed a midday napping of over 90 minutes increases the risk of high blood pressure.
30. Navigating Hypertensive Emergencies: Understanding the Choices Between Nicardipine and Nitroprusside from a Rigorous Systematic Review and Meta-Analysis
Authors: Maulana Chandra. A. , Soesanto Septo. A. , Mulawarman Rido , Trifitriana Monica , Nurmansyah Muhamad Ikhsan , Tondas Alexander E. , Zulkarnain Edrian
Published: July 2024

Background: Hypertensive emergency is an acute blood pressure elevation with possibility of target-organ damage such as heart, brain, kidneys, eyes and lungs. Nicardipine and Nitroprusside are two widely-used intravenous treatment for hypertensive emergency patients. Nicardipine, a dihydropyridine type calcium channel blocker has strong anti-hypertensive activity while Nitroprusside has been used as an arterial and venous vasodilator.

Objective: We aim to find a better choice between intravenous Nicardipin and Nitroprusside on hypertensive emergency patients.

Method: We performed a comprehensive study that assesses Nicardipine and Nitroprusside outcome in hypertensive emergency patients up to 2008.

Results: There were a total of 734 patients from 5 controlled studies. The pooled analyses showed that systolic blood pressure (SBP), diastolic blood pressure (DBP), and heart rate (HR) had similar baseline. Pooled SBP was lower in Nicardipine group (mean difference -2.21 (-4.09, -0.34), p = 0.02; I2: 86%, p < 0.0001). This study showed DBP was lower in Nicardipine group (mean difference -2.93 (-4.39, -1.47), p < 0.0001; I2: 0%, p = 0.84). Meta-analysis also showed HR was lower in Nicardipine group compared to control group (mean difference -4.11 (-6.52, -1.69), p = 0.0009; I2: 0%, p = 0.89).

Conclusion: The systematic review and meta-analysis conclusively establishes the preeminence of Nicardipine over Nitroprusside in efficiently elevated blood pressure during hypertensive emergencies.
31. Prognostic Significance of Ambulatory Pulse Pressure Parameters in Predicting Clinical Outcomes: A Systematic Review and Meta- Analysis
Authors: Wilbert  , Soemarno Harrivcha Wendio , Frederich Alvin , Zafira Nadia Alyya
Published: July 2024

Background: Ambulatory pulse pressure (PP) is a 24 hour pulsatile sum of arterial stiffness in diastole and stiffening pressure in systole. Independent parameters deriving from ambulatory PP may yield different prognostications.

Objective: Evaluate different ambulatory PP parameters in predicting clinical outcomes

Method: A systematic review is conducted from PubMed, CochraneLibrary and BioMedCentral where population with or without hypertension is included. Ambulatory PP parameters assessed are 24 h, elastic, stiffening, daytime, and nighttime PP whereas outcomes measured are all cause mortality, cardiovascular, cardiac, and cerebrovascular events. Data are pooled for random effects using generic invariance method of hazards ratio (HR).

Result: 35 observational studies with a total of 71623 patients averaging 57.3 years old are included. Increasing 24 h PP is associated with a significant risk of developing all measured outcomes except cerebrovascular events. (HR 1.2 – 1.22, 95% CI 1.12 – 1.33) Conversely, increasing elastic PP is not significantly associated with any outcomes while stiffening PP is only associated with cardiovascular and cardiac events but not cerebrovascular events. (HR 1.1 – 1.5, 95% CI 1.00 – 1.33). Increasing daytime and nighttime PP are associated with significant risk of all measured outcomes except cardiac events (not measured). In addition, a subgroup analysis is also conducted in which older and younger population either with lower or higher heart rate are both associated with increased risk of cardiovascular events based on 24 h and elastic PP parameters.

Conclusion: All ambulatory PP parameters except elastic PP are predictors of cardiovascular events while only daytime and nighttime PP are associated with cerebrovascular events.
42. Territorial MCA Infarction with Hemorrhagic Transformation as a Complication of Percutaneous Coronary Intervention
Authors: Beeh Azario Desmilyos , Hidayat Rakhmad , Harris Salim
Published: July 2024

Introduction: Ninety-one percent of stroke complications in percutaneous coronary intervention (PCI) are due to cardioembolic. Fourteen percent of these complications occur as a total middle cerebral artery (MCA) occlusion, there is no report about MCA territory infarction with hemorrhagic transformation.

Case Illustration: A 46-year-old Indonesian gentleman was diagnosed with left MCA occlusion with hemorrhagic transformation post-PCI. The patient was stable in hemodynamics but exhibited right-sided weakness and global aphasia.

Result: The patient was stable in hemodynamics and vital signs but had neurological complications, including right-sided weakness and global aphasia.

Discussion: Post-PCI complications can include ischemic (0,1%) or hemorrhagic stroke (0,03%). In this patient, both events occurred. The patient has myocardial infarction and left ventricular dysfunction, which are moderate risks for cardiogenic stroke. Hypertension led to left ventricular hypertrophy and clot formation, causing a territorial infarction. The extensive infarct and antithrombotic use increased the patient’s bleeding risk.

Conclusion: This report highlights that MCA territory infarction with hemorrhagic transformation can occur as a complication of PCI in ST-elevation myocardial infarction (STEMI) patients in Indonesia, where stroke accounts for 5.7% of major cardiovascular events.
54. The Association Between Preeclampsia and Chronic Kidney Disease: A Systematic Review
Authors: Sugiono Keshia Paramita , Hailianto Evelyn Natalie , Adeodatia Theodora Constantina Embun , Jesslyn Olivia , Litelnoni Kirei Christabel , Sustanto Riona
Published: July 2024

Background: Preeclampsia is characterized by hypertension and the co-occurrence of one or more of the following symptoms, such as renal insufficiency. Renal function may also be impacted by endothelial dysfunction in Preeclampsia; a correlation has been shown between Preeclampsia and Acute Renal Dysfunction.

Objective: This study aimed to examine the association, incidence rate, and risk of CKD in women who had Preeclampsia.

Method: Data generated from the period of 5 years from PMC, ScienceDirect, and PubMed databases using MesH keywords “Renal Insufficiency, Chronic” and “Pre-Eclampsia”. Newcastle Ottawa Scale (NOS) was used to assess the quality of these studies. Inclusion criteria are participants who have been exposed to Preeclampsia with an outcome of CKD, and studies such as cohort, cross-sectional, and clinical trials. The exclusion criteria are systematic reviews, meta-analysis, and animal studies.

Result: After reviewing 15 studies, 3 cohort studies and 1 cross sectional study were included in this study, with a total of 2,185,163 participants. All studies have demonstrated a good quality based on NOS. This study found that there was a higher chance of chronic renal disease in women who had a history of preeclampsia. The findings of research on CKD in women who have had PE are debatable due to several confounding factors.

Conclusion: Women with a history of PE showed a higher risk of subsequent CKD. To validate, more thorough prospective investigations with a clear description of the severity of PE and renal illness as well as longer, sufficient follow-ups are required.
55. Incidence and Sex-Specific Predictors of Progression from Prehypertension to Hypertension in Asian Population: A Systematic Review of Cohort Study
Authors: Nurhayati Senja , Putri Nabila Rosalina , Pondang Josafat , Iustitia Sigit Pratama
Published: July 2024

Background: Prehypertension was more likely to develop hypertension compared to normotension. However, the predictors of this progression remain poorly understood.

Objective: This study aimed to determine the incidence and predictor for progression from prehypertension to hypertension in Asian population according to sex.

Methods: Systematic review was conducted adhering to PRISMA 2020 guidelines using databases PubMed, ScienceDirect, Proquest, and Epistemonikos. Studies included were cohort studies published in 2013-2023 from Asian region with minimum follow-up duration of 2 years. We used Newcastle-Ottawa Scale to measure the quality of included studies.

Result: Nine cohort studies were included. The progression rate from prehypertension to hypertension ranged from 18.04-42.37%, with an average of 29.45%. Seven studies agreed that increasing age and BMI were independent predictive factors for progression from prehypertension to hypertension. Alcohol consumption, smoking, and hypertriglyceridemia were specific risk factors in men. Among women, progression to hypertension was associated with married status, nap time ≥30 minutes, income status, hemoglobin ≥15.5 g/dL, and family history of premature CVD. Irrespective of sex, hyperuricemia, history of chronic disease, total cholesterol ≥200 mg/dL, pulse pressure >60 mmHg, ALT ≥36 U/l, family history of hypertension, low HDL, baseline SBP and DBP, and waist-circumference gain significantly increased the risk of progression for both sexes.

Conclusion: High incidence of progression to hypertension from prehypertension should be warning for every health worker. We emphasize the need for an easy assessment system (e.g., prediction score model) to categorize the risk in order to prevent unnecessary treatment in low-risk group while providing the best prevention to high-risk group.
59. Is Cutting Down Sodium Intake is Best for Reduce Risk of Hypertension in Patient with T2DM?: A Systematic Review
Authors: Revaldo  , Effendi V. V. K. , Sabran M. Z. , Kurniawan A.
Published: July 2024

Background: Hypertension is commonly found in patients with t2DM. In general, there are complex relationships between t2DM and Hypertension. Various studies have been conducted to reduce the incidence of hypertension in t2DM patients, one of them is to reduce the absorption of sodium in the body. However, uncertainties remain and further research is needed.

Objective: Find out whether reducing sodium consumption is beneficial in reducing the risk of hypertension in t2DM patients.

Method: Included RCTs were extracted from PMC, PubMed, and Science Direct on 15-30 December 2023 within last 10 years published using keywords “sodium reduction” AND “hypertension” AND “diabetes mellitus”. BP after intervention was the endpoint. 20-90 years old patient with t2DM were included, while individuals with impaired renal function, previous stroke, heart disease, malignancy, pregnancy, breastfeeding, or taking contraceptive pill were excluded. JADAD were used to assessed the included RCTs.

Result: Five RCTs out of 51 were included in this study, each scoring were rigorous based on JADAD. Examining the samples of included studies found a total of 464 participants. 4 studies found primarily positive results, one study found negative results. Not all studies demonstrated change in fasting glucose, hemoglobin A1c, or insulin sensitivity.

Conclusion: Sodium intake in type 2 DM patients have correlated with hypertension that may risk heart attack. Further research with more detail of result such as fasting glucose, hemoglobin A1c, or insulin sensitivity and higher sample sizes may be needed to see more corelation sodium intake in type 2 DM patient and account for any instances of sampling error.
63. Reversibility of High Degree Av Block in Hypertensive and Diabetic Patient with Unstable Angina Pectoris. Should We Delay the Pacemaker?
Authors: Hanifah  , Puryani A. , Darkuthni F.R , Hasanuddin  , Chairiadi V.
Published: July 2024

Introduction: High degree atrioventricular block (HAVB) is a common and potentially life-threatening complication of coronary artery disease (CAD). Studies show that acute myocardial infarction (AMI) is a well-known cause of reversible AV block. Conversely, the study about reversibility of HAVB in patient with CAD other than AMI following revascularization remains limited, especially when the patient has some risk factors associated with AV block.

Case Illustration: A 70 year-old man with history of diabetic and hypertension came to emergency department with symptoms of chest pain and shortness of breath. Physical examination showed hypertension, bradycardia, and tachypnea. Electrocardiograms showed total AV block. Laboratory test showed normal troponin. The echocardiography showed positive regional wall motion abnormality with ejection fraction of 42%. Temporary pacemaker implantation was done prior revascularization. Coronary angiography revealed multiple stenosis at left anterior descending artery (LAD). Percutaneous balloon angioplasty was successfully performed. Despite the revascularization, total AV-block still persisted and due to limited facilitation, patient was referred to tertiary hospital to undergo permanent pacemaker (PPM)

Discussion: In this case, patient has risk factors that significantly associated both with AV block and CAD. Despite the revascularization, the HAVB in this patient was irreversible.

Result: This result is consistent with prior study stating that AVB in CAD without MI is hardly reversible. Thus, it is recommended to not delay the pacemaker implantation

Conclusion: HAVB in patients with CAD without MI is rarely reversible. It is also aggravated by the risk factors including hypertension and diabetes. Hence, it is rational to undergo pacemaker implantation earlier
74. The Role of Daily Betel Nut (Areca catechu L.) Consumption on Blood Pressure in Patients with Pre-Existing High Blood Pressure at Mebung Primary Health Center, Alor Regency, East Nusa Tenggara
Authors: Ivan Ignatius , Budiman Fanny , Sagala Desima M.A. , Ridjab Denio A.
Published: July 2024

Introduction: Previous studies indicate a hypertension risk in normotensive individuals consuming betel nut. The link between areca nut consumption and hypertension in individuals with pre-existing high blood pressure (BP) is inadequately explored, particularly in Indonesia. We evaluate betel nut effect on BP in individuals with pre-existing high BP at Mebung Primary Health Center, Alor Regency.

Methods: In a cross-sectional study at an outpatient clinic, adults with normal-high BP (≥130/85mmHg) were included from August to December 2023 (excluding pregnancy and patients with anti-hypertensive treatments). Data on age, gender, family history of hypertension, education, job, diabetes, obesity (BMI≥25), physical activity, habits (salt, coffee, alcohol, smoking), and BP were collected. Sample size was determined for 90% power and 5% type I error. Bivariate analysis employed Mann-Whitney tests, and multivariate analysis used multiple linear regression in IBM SPSS Statistics Version 26 (95%CI with significance at p<0.05).

Results: Involving 97 participants (43 daily betel nut consumers and 54 non-consumers), bivariate analysis showed no significant BP difference between consumers and non-consumers (SBP: 140(130–211) vs 140(130–200),p=0.066; DBP: 90(60–131) vs 80(60–123),p=0.108). However, multivariate analysis revealed that daily betel nut consumption was associated with a significantly higher SBP (9.27mmHg,95%CI,1.269–17.272,p=0.024) after adjusting all covariates. Age, family history of hypertension, and excessive salt intake (>5 grams daily) independently contributed to higher SBP, while obesity independently contributed to elevated DBP.

Conclusion: Daily betel nut consumption independently raises SBP in individuals with pre-existing high BP, even after covariates adjustment. Therefore, hypertensive patients are advised to refrain from betel nut consumption as a measure to regulate BP.
80. Severe Hypertension and Renal Limited Thrombotic Microangiopathy Associated with Lenvatinib Therapy
Authors: Nilasari Dina , Gaol Donnie Lumban
Published: July 2024

Introduction: Lenvatinib is a multikinase inhibitor (MKI) used in the treatment of locally advanced or metastatic differentiated thyroid carcinoma. One of the main target molecules of m-TKIs is vascular endothelial growth factor receptor (VEGF-R). Hypertension (HTN) and Kidney involvement are the most frequent adverse events during treatment with Lenvatinib (LEN).

Case illustration: A 64-year-old woman with thyroid cancer (TC) developed a progressive disease. The patient started systemic treatment with Lenvatinib at a dose of 16 mg per day, and the dose was escalated to 24 mg per day. One month after starting Lenvatinib, the patient experienced hypertension (170/90 mmHg). Creatinine increased to 1.23 mg/dl, Urine albumin-creatinine ratio (ACR) was 7340 mg/g. Kidney biopsy was performed and the result shown thrombus in two glomerulus; this is consistent with thrombotic microangiopathy (TMA). Hypertension was controlled with nebivolol 5 mg per day, clonidine 0.15 mg three times a day, irbesartan 300 mg per day, terazosin HCl 4 mg per day and Lercanidipine 20 mg. For three months, we adjusted the dose of lenvatinib to 8 mg per day, and the level of ACR was improved from 7340 mg/g to 2028 mg/g. Kidney function was gradually improved and showed partial recovery after discontinuing the drugs.

Discussion: Although lenvatinib showed promising benefits for advanced TC, severe hypertension was reported at a high frequency. Hypertension is the most common AE observed during treatment with MKIs. Drug-induced TMA is estimated to account for 10–13% of all causes of TMA.

Conclusion: Severe hypertension, massive proteinuria and TMA were important side effects of lenvatinib.
Intersecting Blood Cytokines With Cholesterol Parameters to Profile Patients With Advanced Solid Tumors Receiving Immune Checkpoint Inhibitors
Authors: Mazzaschi Giulia , Perrone Fabiana , Maglietta Giuseppe , Favari Elda , Verzè Michela , Pluchino Monica , Minari Roberta , Pecci Federica , Gnetti Letizia , Campanini Nicoletta , Silini Enrico Maria , De Filippo Massimo , Maffezzoli Michele , Giudice Giulia Claire , Testi Irene , Tiseo Marcello , Quaini Federico , Buti Sebastiano
Published: July 2024

The study investigated the relationship between serum proinflammatory cytokine levels, cholesterol metabolism, and clinical outcome in cancer patients undergoing immune checkpoint inhibitors (ICIs). Peripheral blood was collected before therapy from ICI-treated advanced cancer patients. We retrospectively assessed plasma total cholesterol (TC), ABCA1- and ABCG1-mediated cholesterol efflux (CE), passive diffusion (PD), cholesterol loading capacity (CLC), and serum IL-6, IL-10, and TNF-α. The association between blood cholesterol parameters and inflammatory cytokines and their effect on overall survival (OS), progression-free survival (PFS), and clinical benefit (CB) from ICIs were statistically assessed. Among 70 consecutively enrolled patients (nonsmall cell lung cancer: 94%; renal cell carcinoma: 6%), TC, CLC, and cholesterol PD resulted significantly higher in IL-6low and IL-10low cases (P<0.05), whereas ABCA1-mediated CE was increased in IL-10high patients (P=0.018). Uni- and multivariable analysis revealed meaningfully longer OS and PFS in IL-6low (HR 2.13 and 2.97, respectively) and IL-10low (HR 3.17 and 2.62) groups. At univariate analysis all cholesterol-related indices significantly correlated with OS and PFS, whereas at multivariate only high PD was validated as a protection factor (OS, HR 0.75; PFS, HR 0.84). Finally, uni- and multivariable showed a statistically significant inverse association of CB with ABCG1-CE (OR 0.62), as with IL-6 (OR 0.13) and IL-10 (OR 0.10). In-depth characterization of the interplay between blood cholesterol metabolism and immune-inflammatory cytokines might provide novel insights into the complex relationship among cancer, inflammation, lipids profile, and response to immunotherapy.
Sleep Disturbance in Children with Fetal Alcohol Spectrum Disorder and the Relationship to the Neurodevelopmental Profile
Authors: O'Rourke Claudia , Horne Rosemary S.C. , Nixon Gillian M. , Harris Katrina R. , Connelly Annette , Crichton Alison
Published: July 2024

Objective:

Sleep disturbance is an important feature of fetal alcohol spectrum disorder (FASD). We sought to describe sleep patterns in school-aged children with FASD, in comparison with a typically developing community group, and investigate the relationship between sleep and neurodevelopmental profiles.

Method:

The FASD cohort (N = 36) was recruited from a tertiary Australian FASD diagnostic center, and the typically developing group (N = 36) was previously recruited as a control cohort for a separate study. Sleep disturbance was assessed with the caregiver-completed Sleep Disturbance Scale for Children (SDSC) questionnaire. Neurodevelopmental assessment results for the 10 domains impaired in FASD were used for correlations with sleep disturbance.

Results:

In the FASD group, 80% of children scored above the SDSC cutoff, compared with 22% of the control group (p < 0.001). Statistically significant group differences were seen for all 6 subscales of the SDSC (p < 0.05). The most frequently affected domains in the FASD group related to difficulties with initiating and maintaining sleep (58%), sleep-wake transition disorders (44%), and disorders of arousal (42%). A statistically significant relationship was not found between sleep and the severity of neurodevelopmental impairment or impairment of a particular domain, acknowledging the limitations of our small sample size. Half of the FASD sample (52%) were taking a pharmaceutical agent to support sleep, which was not associated with lower SDSC scores.

Conclusion:

In this small study, sleep disturbances were frequently reported by carers of children with FASD, independent of the severity of their neurodevelopmental impairments. Persistent sleep disturbance despite the use of sleep medications highlights the need for prospective studies exploring sleep interventions in this population. Integration of behavioral sleep medicine into management is recommended for all children with FASD.
Proposal for a Mechanistic Disease Conceptualization in Clinical Neurosciences: The Neural Network Components (NNC) Model
Authors: Nassan Malik
Published: July 2024

Clinical neurosciences, and psychiatry specifically, have been challenged by the lack of a comprehensive and practical framework that explains the core mechanistic processes of variable psychiatric presentations. Current conceptualization and classification of psychiatric presentations are primarily centered on a non-biologically based clinical descriptive approach. Despite various attempts, advances in neuroscience research have not led to an improved conceptualization or mechanistic classification of psychiatric disorders. This perspective article proposes a new—work-in-progress—framework for conceptualizing psychiatric presentations based on neural network components (NNC). This framework could guide the development of mechanistic disease classification, improve understanding of underpinning pathology, and provide specific intervention targets. This model also has the potential to dissolve artificial barriers between the fields of psychiatry and neurology.
Why Do Veterans Not Respond as Well as Civilians to Trauma-Focused Therapies for PTSD?
Authors: Kitaj Max , Goff Donald C.
Published: July 2024

This column first reviews evidence that veterans have poorer response to trauma-focused therapies for PTSD compared to civilians. We then consider several explanations for this trend, starting with gender as a possible confounding variable. We also examine other hypotheses, including the effects of the military acculturation process, the unique influences of military traumas, such as combat and military sexual traumas, and the roles of traumatic brain injuries (TBIs) and moral injury. Future research, we conclude, must determine whether gender explains the differences in trauma-focused therapy response. If so, then the underlying reasons must be further explored. If not, then we must determine the unique characteristics of the veteran population that make it more resistant to treatment. Mining these elements will help us adapt our trauma-focused therapies to better help this population and close the response-rate gap.
How are agitated patients dealt with in internal medicine departments?
Authors: Ferraz-Gonçalves José António , Silva Ana Sofia , Reis Joana Silva , Assis José Guilherme , Matos Maria Inês , Matias Paula , Alves Sérgio
Published: July 2024

Background:

Studies on agitation in internal medicine departments are scarce, especially regarding how doctors and nurses act in these situations. The objective of this study was to clarify how agitation is dealt with in these departments.

Methods:

This prospective observational study was performed in the internal medicine departments of four Portuguese hospitals. The researchers at each hospital contacted the nursing team that identifies patients who were agitated in the previous shifts. The researcher reviewed these patients' files, recording the research protocol's parameters.

Results:

During the study period, 331 patients were observed; 177 (54%) were female, and the median age was 80 years (19–99). Episodes of agitation occurred in 69 patients (21%); of them, 44 (64%) were female, and the median age was 84 years (31–98). In the first episode of agitation, the doctor on duty was called in 49 times (71%). These doctors prescribed a new medication for the crisis in 30 cases (43%). After the crisis, the assistant doctor recorded the episode in the patient file in 41 cases (59%). According to the medical notes, after the acute phase, in only 21 patients (30%), there was an attempt to clarify the cause of agitation. The prescription after the crisis was regular medication in 32 cases (46%), rescue medication in 27 (39%), and physical restraint in 9 (13%), isolated or in various combinations.

Conclusion:

This study suggests that there is room to improve how agitated patients are managed in internal medicine departments.
Age of First Exposure to Contact Sports Is Not Associated With Worse Later-In-Life Brain Health in a Cohort of Community-Dwelling Older Men
Authors: Jo Jacob , Wong Gunther , Williams Kristen L. , Davis Philip J. , Rigney Grant H. , Zuckerman Scott L. , Terry Douglas P.
Published: July 2024

Objective:

To evaluate whether early age of first exposure to contact sports (AFE-CS) is associated with worse long-term brain health outcomes.

Design:

A cross-sectional, survey study of older men with a history of contact sport participation was completed.

Setting:

Tertiary care facility.

Participants:

A cohort of community-dwelling older men dichotomized by using AFE-CS (<12 years vs ≥12 years).

Interventions:

Independent variables included a dichotomized group of AFE-CS (<12 years vs ≥12 years).

Main Outcome Measures:

Brain health outcomes measured by depression, anxiety, cognitive difficulties, and neurobehavioral symptoms. Endorsements of general health problems, motor symptoms, and psychiatric history were also collected. Age of first exposure groups was compared using t tests, χ2 tests, and multivariable linear regressions, which included the following covariates: age, number of prior concussions, and total years of contact sport.

Results:

Of 69 men aged 70.5 ± 8.0 years, approximately one-third of the sample (34.8%) reported AFE-CS before age 12 years. That group had more years of contact sports (10.8 ± 9.2 years) compared with those with AFE-CS ≥12 (5.6 ± 4.5 years; P = 0.02). No differences were found after univariate testing between AFE-CS groups on all outcomes (P-values >0.05). Multivariable models suggest that AFE-CS is not a predictor of depression or anxiety. Those in the AFE-CS <12 group had fewer cognitive difficulties (P = 0.03) and fewer neurobehavioral symptoms (P = 0.03).

Conclusions:

Those with AFE-CS <12 to contact sports did not have worse long-term brain health outcomes compared with those with AFE-CS ≥12. Individuals with AFE-CS <12 had significantly lower British Columbia Cognitive Complaints Inventory and Neurobehavioral Symptom Inventory scores compared with those with AFE-CS ≥12.

Clinical Relevance:

The benefits of earlier AFE-CS may outweigh the risks of head strikes and result in comparable long-term brain health outcomes.
Nurse-Sensitive Indicators as Predictors of Trauma Patient Discharge Disposition
Authors: Silverstein Lily A. , Moser Debra K. , Rayens Mary Kay
Published: July 2024

BACKGROUND:

About 3.5 million trauma patients are hospitalized every year, but 35%–40% require further care after discharge. Nurses’ ability to affect discharge disposition by minimizing the occurrence of nurse-sensitive indicators (catheter-associated urinary tract infection [CAUTI], central line-associated bloodstream infection [CLABSI], and hospital-acquired pressure injury [HAPI]) is unknown. These indicators may serve as surrogate measures of quality nursing care.

OBJECTIVE:

The purpose of this study was to determine whether nursing care, as represented by three nurse-sensitive indicators (CAUTI, CLABSI, and HAPI), predicts discharge disposition in trauma patients.

METHODS:

This study was a secondary analysis of the 2021 National Trauma Data Bank. We performed logistic regression analyses to determine the predictive effects of CAUTI, CLABSI, and HAPI on discharge disposition, controlling for participant characteristics.

RESULTS:

A total of n = 29,642 patients were included, of which n = 21,469 (72%) were male, n = 16,404 (64%) were White, with a mean (SD) age of 44 (14.5) and mean (SD) Injury Severity Score of 23.2 (12.5). We created four models to test nurse-sensitive indicators, both individually and compositely, as predictors. While CAUTI and HAPI increased the odds of discharge to further care by 1.4–1.5 and 2.1 times, respectively, CLABSI was not a statistically significant predictor.

CONCLUSIONS:

Both CAUTI and HAPI are statistically significant predictors of discharge to further care for patients after traumatic injury. High-quality nursing care to prevent iatrogenic complications can improve trauma patients’ long-term outcomes.
Applications of artificial intelligence in computed tomography imaging for phenotyping pulmonary hypertension
Authors: Sharkey Michael J. , Checkley Elliot W. , Swift Andrew J.
Published: July 2024

Purpose of review

Pulmonary hypertension is a heterogeneous condition with significant morbidity and mortality. Computer tomography (CT) plays a central role in determining the phenotype of pulmonary hypertension, informing treatment strategies. Many artificial intelligence tools have been developed in this modality for the assessment of pulmonary hypertension. This article reviews the latest CT artificial intelligence applications in pulmonary hypertension and related diseases.

Recent findings

Multistructure segmentation tools have been developed in both pulmonary hypertension and nonpulmonary hypertension cohorts using state-of-the-art UNet architecture. These segmentations correspond well with those of trained radiologists, giving clinically valuable metrics in significantly less time. Artificial intelligence lung parenchymal assessment accurately identifies and quantifies lung disease patterns by integrating multiple radiomic techniques such as texture analysis and classification. This gives valuable information on disease burden and prognosis. There are many accurate artificial intelligence tools to detect acute pulmonary embolism. Detection of chronic pulmonary embolism proves more challenging with further research required.

There are numerous artificial intelligence tools being developed to identify and quantify many clinically relevant parameters in both pulmonary hypertension and related disease cohorts. These potentially provide accurate and efficient clinical information, impacting clinical decision-making.
Missed Opportunities for HIV Confirmatory Testing Using an Institutional Testing Algorithm Without Reflex to HIV Nucleic Acid Testing
Authors: Caster Lauryn , Paetz Olivia R. , Sayles Harlan , Fey Paul D. , Bares Sara H.
Published: July 2024

At our medical center, HIV nucleic acid tests are recommended when the HIV antigen-antibody screening immunoassay and antibody differentiation tests are discordant, but not done reflexively. A retrospective chart review found that 35% of discordant test results did not have HIV nucleic acid test completed as recommended.
The impact of vision loss on attitudes toward autonomous vehicles: A vision-centric analysis
Authors: Kuborn Abigail M. , Hassan Shirin E.
Published: July 2024

SIGNIFICANCE

Autonomous vehicles (AVs) have the promise to be an alternative transportation solution for those with vision loss. However, the impact of vision loss on the perceptions and concerns of AVs is unknown. This study therefore examined whether AVs are perceived differently by blind, visually impaired (VI), and normally sighted people.

PURPOSE

This study compared the perceptions of AVs among the blind, VI, and normally sighted.

METHODS

Participants' opinions on four perception measures (general opinion, trust, impact on quality of life, and intention to use AVs) and nine concerns regarding AVs were measured. The survey was administered to 51 normally sighted, 68 VI, and 65 blind participants. Analyses of covariance assessed whether the four perception measures and nine concerns varied by vision status (normal vision, VI, blind) and driving status (driver, nondriver). Univariate correlations and multiple regression analyses identified associations and predictors of AV perceptions and concerns from demographic, mood, cognition, travel behavior, and vision measures, which included visual acuity, contrast sensitivity, and visual field.

RESULTS

The blind (p<0.001), VI (p<0.001), and nondrivers (p<0.001) showed a greater intention to use AVs compared with those with normal vision and drivers. Similar findings were found for the other perception measures. As visual acuity, contrast sensitivity, and visual field extent declined, positivity toward AVs increased (p<0.001). Visual field extent best predicted general opinion and trust in AVs, whereas driving measures were the best predictors of impact on quality of life and intention to use AVs. Concerns about AVs showed no differences based on vision (p=0.94) or driving (p=0.63) status.

CONCLUSIONS

Individuals with vision loss expressed more acceptance of AVs despite their concerns. How positive someone is toward AVs appears to be dependent on their visual field extent and driving status.
The effect of illumination on the visibility of steps and ramps for people with low vision
Authors: Lei Quan , Gage Rachel , Kersten Daniel , Legge Gordon E.
Published: July 2024

SIGNIFICANCE

Poor visibility of indoor features such as steps and ramps can pose mobility hazards for people with low vision. For purposes of architectural design, it is important to understand how design parameters such as the illumination level of an indoor space affect the visibility of steps and ramps.

PURPOSE

This study was aimed to examine the effect of typical variation in photopic illumination level in an indoor space on the visibility of steps and ramps for individuals with low vision.

METHODS

Steps and ramps were constructed in a large windowless room illuminated by overhead lights. Subjects with low vision completed a 5-alternative forced choice task to recognize the targets at three levels of photopic illumination, i.e., 800, 80, and 8 lux, and gave confidence ratings about their judgments on a 5-point scale. Acuities and contrast sensitivities of the subjects were also measured at each illumination level. For comparison, a group of normally sighted subjects with simulated acuity reduction also completed the step-and-ramp recognition task.

RESULTS

For both groups of subjects, recognition accuracy was not affected by illumination level. For subjects with low vision, however, there was a significant effect of illumination level on confidence rating: subjects became more confident about their judgments with increasing illumination. There was also a weak effect of illumination level on acuity and contrast sensitivity, both worsening with decreasing illumination. Recognition performance was best predicted by contrast sensitivity, whereas confidence was best predicted by visual acuity.

CONCLUSIONS

Illumination variation over a typical photopic range in an indoor space had minimal effect on the objective visibility of steps and ramps for people with low vision. However, illumination level affected subjects' confidence in hazard recognition. Design decisions on parameters such as illumination should consider the consequences on both the objective and the subjective accessibility of a space.