bluuebunny/crossref_metadata_2025 huggingface dataset:
49. The Relationship of Metabolic Syndrome with Degrees Stenosis Based on Significant Non Significant
Authors: Danang Firzan , Abduh Saugi
Published: July 2024

Background: Based on reports from the World Health Organization (WHO), Coronary Heart Disease (CHD) is the number one cause of death in the world. The severity of CHD suffered by a patient can be seen from the degree of stenosis. Controlling risk factors and carrying out early diagnosis can help prevent CHD. This study aims to determine the relationship between metabolic syndrome and the degree of stenosis and which risk factors are associated with the degree of stenosis based on non-significant significant scores in CHD patients.

Objective: To determine the relationship between metabolic syndrome and the degree of stenosis based on significant non-significant in CHD patients at RSI Sultan Agung Semarang for the 2018 - 2021 period.

Methods: This research uses observational methods and cross sectional design. Data was taken from medical records at RSI Sultan Agung Semarang for the 2018 – 2021 period, totaling 765 samples. Sampling was carried out by total sampling. Data were analyzed univariately, bivariately using the chi square test and multivariately using multiple logistic regression.

Result: In patients with metabolic syndrome, significant and non-significant stenosis was found, and in patients without metabolic syndrome, significant and non-significant stenosis was found too. In the Spearman correlation analysis, the p value was obtained = 0.024. In the multivariate analysis, risk factors had the most influence on the incidence stenosis in CHD patients is age, OR = 3.222.

Conclusion: This study concluded that there was a relationship between metabolic syndrome and the degree of stenosis based on scores in CHD patients and the most influencing factor was smoking.
50. Amlodipine-Induced Mandibular Fibrous Overgrowth in Hypertension Patients with Chronic Kidney Disease
Authors: Satria Budi , Kuswadi Iri , Prasanto R Heru , Puspitasari Metalia , Wardhani Yulia , Pratama K Danny
Published: July 2024

Introduction: Amlodipine is a CCB that is often used to treat hypertension. One of the long-term effects of Amlodipine is excessive growth of gingiva. The clinical manifestation can be fibrous overgrowth in the mandibular arch.

Case Illustration: A 46 year old woman was treated for swelling in her right lower jaw for 1 year and become bigger in the last 6 months. The patient had hypertension since 2011, kidney failure since 9 years ago and has undergone routine dialysis twice a week. For hypertension, the patient received Amlodipine 2x10 mg, Clonidine 3x150 mcg, Bisoprolol 1x5 mg, Candesartan 2x16 mg. On physical examination, blood pressure was 169/95, right mandibular mass 8x6 cm. Histopathological examination showed fibrous dysplasia without signs of malignancy.

Discussion: The type of CCB drug that most frequently prescribed is amlodipine at 37%. Changes in the gingiva began to occur after 3 months of Amlodipine administration. The prevalence of gingival overgrowth was 31.4% of patients receiving treatment with Amlodipine. The pathophysiology goes through inflammatory and non-inflammatory pathways. Management of this condition is by discontinuing or replacing CCB drugs, periodontal treatment and surgery. With combined management of these 3 modalities, patients who were followed for up to 18 months did not experience recurrence.

Conclusion: This case report presents an incident of excessive fibrous tissue growth in the mandible of a patient who received amlodipine therapy for 11 years for hypertension. With surgical and non-surgical treatment, it is hoped that the patient will experience improvement and not recur.
52. Aortic Dissection: A Case Report
Authors: Lydia  , Dewi Ratih Tri Kusuma , Putranto Wachid
Published: July 2024

Introduction: Aortic dissection (AD) is an emergency, rarely found and have many clinical manifestations. The diagnosis can be delayed or undiagnosed. This must be fast and precise in order to determine the appropriate management and avoid complications/ death.

Case Illustration: A 76 years old man, came to ER due to weakness after fainting, stabbed chest and stomach pain radiating to the back. He suffering hypertension uncontrolled, heavy smoker. Three months ago, he experienced a similar complaint, and underwent TEVAR surgery. On examination BP was 210/125mmHg, HR 95x/m, BMI 15.5 kg/m2, VAS 6/10, throbbing lump in the hypogastric region, creatinine 2.2 mg/dl, D-Dimer 8500 Ng/ml, and abdominal aortic aneurysm, mural thrombus lumen patency 64% on MSCT.

Discussion: He was diagnosed type B AD post TEVAR and given conservative management. Typical symptoms fainting, acute stabbed chest and stomach pain radiating to the back, male, uncontrolled hypertension, smoking, pulsating lump in the hypogastric region, minimal pleural effusion caused by inflammatory processes, acute kidney disorders, and aortic aneurysm with high dimer and thrombus. Given acetaminophen due to advanced age and kidney problems, ARB have been proven to slow down aortic enlargement; BB reduce aneurysmal degeneration, progression to chronic AD and improve survival; CCB improve survival. Complications of hypotension may occur so rehydration, reevaluation, monitoring vitals and fluid balance are important.

Result: Patient experienced clinical and supportive improvement after 5 days with BP reaching the target <130/80 mmHg.

Conclusion: By knowing the clinical picture, investigation and management of these rare emergency cases, patients can be treated well.
57. Profile of hypertension-mediated organ damage (HMOD) in the heart, who visited the cardiology clinic at the Indonesian Christian University Hospital, Jakarta in 2020-2022.
Authors: Suling FRW , Ririhena KKJ , Rantung NOH , Simanjuntak TSB , Puspitasari F , Lumban Gaol D , Pangaribuan A , Kurniyanto  , Watupongoh HHV , Salutondok W , Manalu E
Published: July 2024

Background: Hypertension-mediated organ damage(HMOD) to the heart, the heart is directly exposed, which are asymptomatic at an early stage but represent a potent risk factor for subsequent Cardiovascular events. Preclinical or asymptomatic hypertensive heart disease includes Left ventricle hypertrophy (LVH). In clinical practice, most or all parameters indicating hypertensive heart disease should be evaluated in a comprehensive examination, using the Elecytro cardiography (ECG) and available imaging techniques.

Objective: This study was conducted to look at the profile of 100 patients with hypertensive heart disease who visited the cardiology clinic at the Indonesian Christian University General Hospital in 2020 - 2022

Method: This type of research is retrospective from medical records. All patients with hypertension with left ventricular hypertrophy, left ventricular hypertrophy were evaluated by a cardiologist using electrocardiography and echocardiography.

Results: Age 65 - 74 years is highest (39%), age 25-34 years is lowest (3%). men (46%), women (54%). Based on body mass index, obesity category 1, which has the highest prevalence rate (40%), based on the degree of hypertension, patients with hypertensive heart disease most often suffer from isolated systolic hypertension, namely (35%), the main complaint, shortness of breath was (47%). Based on the results of chest x-ray examination, (77%) had cardiomegaly.

Conclusion: Characteristics of hypertensive heart disease patients in our hospital, chest x-ray, cardiomegaly, age 65 years and over, isolated systolic hypertension, obesity category 1.
61. Interventions to Improve Adherence among Indonesian Patients with Hypertension: A Review
Authors: Rahmawati Riana
Published: July 2024

Background: Ensuring adherence to prescribed medication is crucial for hypertension treatment success, yet evidence highlights widespread non-compliance.

Objective: This review summarizes recent interventions in Indonesia to improve adherence to antihypertensive medication.

Methods: Using a scoping review method, we conducted article searches on Garuda and PubMed, focusing on publications from 2017 to July 2023.

Results: Among the 39 articles that met the criteria, only 2 were published in international journals. Studies mainly occurred in primary health centers, involving chronic disease care programs (prolanis), outpatient, and inpatient settings. Pharmacy as well as community setting were also explored, with interventions taking place in the Posyandu or Posbindu programs. Education, delivered through various methods and media, was the most reported intervention, often in conjunction with other methods, primarily provided by pharmacists. Pharmacy home care services, such as home visits, were found to effectively improve medication adherence. Alongside traditional educational tools like posters and leaflets, the use of videos and interactive digital media was also reported. Medication reminder systems, including self-reminder cards, daily pill boxes, functional calendars, and text messaging services, were implemented. Targeted and tailored interventions by pharmacists were recognized as effective in enhancing adherence, with some studies indicating additional outcomes such as reduced blood pressure or increased patient knowledge post-intervention. Notably, two articles reported the limited effectiveness of education-only interventions.

Conclusion: Interventions to improve medication adherence predominantly employed educational methods, with pharmacists playing a pivotal role. Future studies should explore the integration of technology and a combination of tailored intervention methods to better meet patients’ needs.
62. A Patient with Severe Hypertension Caused by Rarely Found Condition (Conn’s Syndrome)
Authors: Haryati Mutiara Rizki , Tjempakasari Artaria , Thaha Mochammad , Widodo
Published: July 2024

Background: Conn’s Syndrome is a primary aldosteronism (PA) caused by adrenal adenoma(s) and characterized by increased aldosterone secretion from the adrenal glands, suppressed plasma renin, hypertension, and hypokalemia. In Indonesia, it is considered rare because of the low reported case. World widely, it is estimated that more than 98% of all Conn’s syndrome patients are never detected or treated, resulting in unnecessary strokes, heart attacks, and heart failure.

Case presentation: We reported a 52-year-old male with chief complaint of headache and severe hypertension (225/143 mmHg). He had hypertension for more than five years with 3-4 antihypertension medications and histories of hypokalemia. The patient had been prescribed oral potassium supplements for years from different doctors and never been really told to work up on his disease. He had low potassium level (2.1 mmol/L) and metabolic alkalosis. His examination showed that he had high plasma aldosterone concentration (PAC), 46.7 ng/dL, and low plasma renin activity (PRA), 0.1 ng/mL/h. A unilateral nodule was found on his right adrenal gland from MRI. The patient then went for primary aldosteronism treatment and being planned for surgery.

Dicussion: The triad for Conn’s syndrome is hypertension, hypokalemia, and metabolic alkalosis. Because of the high aldosterone/renin ratio (467 ng/dL per ng/mL/h), PA diagnosis was made. While this patient was a good candidate for surgery as only having a single adrenal adenoma, by giving spironolactone 100 mg/day his blood pressure and hypokalemia could be controlled.

Conclusion: Primary aldosteronism are quite common in the general population, yet they go mostly unnoticed.
64. Renovascular Hypertension: An Etiology of Secondary Hypertension
Authors: Firman Fauzan Hertrisno , Panggabean Steven David , Hasiholan Marbun Maruhum Bonar
Published: July 2024

Hypertension is still becoming major concern in health issues, regarding complication toward cerebral-cardiovascular. Secondary hypertension is type of hypertension with identifiable cause, one of aetiologies is renovascular hypertension caused by stenosis of renal artery. We report a case of 32-years-old women who was diagnosed renovascular hypertension. Our patient had hypertension before age of 30-years. She was referred to nephrology clinic because of having blood-pressure 230/120 mmHg although she didn’t complaint anything and found incidentally due to routine physical examination. For the last 4 years, she had been treated with amlodipine 10 mg, ramipril 10 mg, and hydrochlorothiazide 25 mg, but her lowest blood pressure examinations were 160/90 mmHg. Based on her history, she never had stroke, heart diseases, hyperthyroid, glomerulonephritis, and other diseases. Both of her parents had hypertension that developed after 50 years. Physical examination revealed normal finding except body mass index was 25.34 kg/m2. Laboratory examination finding was normal kidney function (e-GFR 115 mL/min/1.73 m2), uACR 87.3 mg/g-creatinine, normal potassium (3.5 meq/L), and no hematuria. Electrocardiogram revealed PVC bigeminy, but abdominal doppler ultrasound showed tardus-parvus renal artery suspected bilateral stenosis. Further examination test of CT angiography of the abdomen confirmed stenosis in left renal artery (76%) and right renal artery (50%). Thus, she was consulted to vascular surgeon to undergo stenting in arteries, proceed to biopsy because of suspected Takayasu arteritis as underlying of that stenosis. Ramipril was stopped, bisoprolol 5 mg od was given as part of drugs combination. Further progress is still observed until this moment.
65. A Case Report of Misdiagnosed Visual Loss with Hypertension in Rural Area: Wider Perspective on Ophthalmological, Neurological, and Obstetrical View.
Authors: Paladan Triadi Putra , Tandipayuk Anggia Dwi Stephanie , Powatu Febriyanto , Kartika Ika , Arista Nurkamilawati
Published: July 2024

Introduction: Sudden visual loss presented with hypertension is an ophthalmologic emergency that correspond with vascular etiology. This phenomenon needs a sharp analysis considering that the pathophysiological process could be risen from various organ system.

Case Illustration: A 46-year-old woman with unknown pregnancy experienced sudden visual loss accompanied with mild headache within more than 24 hours before being admitted to the emergency room. Her blood pressure was 240/160 mmHg with visual acuity was light perception. There were no other visual or neurological related complaints. There were no problems found in ocular or neurological examination. Due to facilities limitation in rural setting, fundus examination couldn’t be performed. The patient was suspected as a sudden visual loss caused by an acute stroke, whereas the pregnancy wasn’t expected in this case. Dual anti-platelet and antihypertensive therapy were started immediately. Visual improvement was showed in 12 hours after initial therapy. Unexpectedly, two days after the treatment, the patient experienced abdominal pain with vaginal bleeding, followed by abrupt fetal release.

Discussion: The following incident implied that the actual etiology was a severe pre-eclampsia. Pre-eclampsia-induced visual loss is still a rare phenomenon, contributing to the lack of physician’s concern about pregnancy-induced hypertension as the actual etiology.

Result: Identification of an acute stroke from its mimics or chameleons have been a serious challenge for physicians to bear a prompt decision-making.

Conclusion: Comprehensive analysis is crucial in patient assessment to identify the right etiology and generate prompt treatment. Ophthalmological, neurological, and obstetrical approach in patient care should be elaborated to bring out an optimum outcome.
66. Blood Pressure’s Odyssey: A Systematic Exploration of long-term Renal Denervation’s Safety, Efficacy and Enduring Impact.
Authors: Rahman Andi Lestari , Samudera Nurrobi Yusuf Aji , Aristya Meutia Putri
Published: July 2024

Background: Resistant hypertension poses a formidable challenge in contemporary cardiovascular care. Renal denervation, an evolving therapeutic strategy, offering a potential avenue for blood pressure modulation.

Objective: This systematic review and meta-analysis focusing to unravel the enduring impact of renal denervation in the treatment of hypertension, particularly in cases of resistance.

Method: PubMed, Cochrane, and Biomed Central databases were searched from inception to January 2024. Randomised control trial and prospective cohort that evaluate the long-term efficacy and safety in resistant hypertension were included. Risk of Bias was assessed using the Cochrane Risk odd Bias tool. Study population, method and results data were extracted and tabulated by 3 authors.

Result: Five studies with total of 610 patients were included in this systematic review. All studies consistently reported significant improvements in long term blood pressure measurement. The duration of follow up varies between 6 months to 9 years. Mean change from baseline after 9 years -30.0 ± 12.7. Some studies highlight procedural complications such us 1 patient required femoral pseudoaneurysm repair, 1 haematoma at the femoral access and 1 renal artery dissection before energy delivery. Others studies highlight cardiac event such as 2 hypotensive events requiring hospitalization and 2 subjects were hospitalized with atrial fibrillation, 1 of whom underwent cardioversion.

Conclusion: Synthesizing the efficacy and safety outcomes, renal denervation holds promise as a long-term strategy for blood pressure management. The consistent improvement in systolic blood pressure aligns with the goal of sustained efficacy. However, the safety considerations introduce a layer of complexity.
69. Cardiogenic Shock Mimicking as Hypertensive Emergency: A Case Report from Rural Area
Authors: Rachmanadi Muhammad Berian , Carolina Arisita , Luqman Landy Bilal Ibn
Published: July 2024

Introduction: Cardiogenic Shock (CS) is a clinical syndrome resulting from cardiac dysfunction that leads to abnormal tissue perfusion and circulatory failure. Recognizing CS can be challenging, particularly in rural areas.

Case illustration: A 55-year-old female patient presented to the ER with severe headache and vomiting about 8 hours before admission. On examination, BP 226/198 mmHg, SpO2 82%, and other findings were normal. After oxygenation and sublingual captopril 25 mg, the patient’s BP dropped to 52/32 mmHg. We do a fluid challenge and then start vasopressors. In the ICU, the patient developed angina symptoms. ECG showed ST-Elevation in V1-V6, I, aVL, and Troponin I (>15ng/mL). The patient was diagnosed with CS and Extensive Anterior STEMI. The patient was treated with aspirin 160 mg, clopidogrel 300 mg, and fondaparinux before being referred to another hospital.

Discussion: Diagnosis of CS requires high suspicion of clinical and laboratory criteria of hypoperfusion. Initial evaluation of AMI in patients with suspected CS is crucial for treatment. Patients with a hypertensive emergency are diagnosed with marked elevation in BP that is associated with signs of target-organ damage.

Results: In this case, we treated the hypertensive emergency as the patient did not report any cardiac symptoms. After the drop in blood pressure, we stabilized the patient using the ACLS algorithm. The patients were reassessed in the ICU, where the diagnosis of STEMI was established as the cause of CS.

Conclusion: In rural areas, diagnosis and treatment of CS must be improvised with limited equipment. Early recognition and prompt treatment are crucial in managing CS.
72. A Systematic Review and Meta-Analysis of Probiotics Shielding the Kidneys: A Tertiary Prevention Approach to CKD
Authors: Tandi Yosi , Khairunnisa Anindyta , Flindy Samuel
Published: July 2024

Background: Gut dysbiosis and CKD are bidirectional. Probiotics have been reported to have beneficial effect on renal profile among patients with CKD.

Objective: We aimed to conduct reviews regarding probiotics’ effect on renal profile of CKD patients.

Method: RCTs on CKD patients given probiotics to determine the effect of probiotics on CKD progression and published within the past 10 years were included and were taken from Pubmed, ScienceDirect, and Cochrane Library databases. Articles with Antibiotic or Immunosuppressant drug therapy, pre- and pro-biotic treatment prior to recruitment, and Gastrointestinal chronic disease/syndrome were excluded. We use eGFR, creatinine, and albumin as the primary endpoint. We also assessed the risk of biases using the RoB2 tool.

Result: This study included 9 eligible studies (389 participants) enrolled. Probiotic intervention caused a significant change in eGFR MD 2.65 (95%CI -1.73 to 7.02; P < 0.005). Several studies stated that the probiotic intervention generally ameliorates eGFR compared to baseline (≥8 weeks after treatment), while placebo was induced CKD progressivity. Multilevel analysis at week 8 found eGFR changes MD 8.4 (95% CI 0.87 to 15.93; P<0.05), followed by 12 weeks MD 8.10 (95%CI 5.78 to 10.42; p<0.005). Participants who received probiotics also had a reduction of creatinine MD -0.40 (95%CI -0.92 to 0.13; p>0.05), hs-CRP MD -1.00 (95%CI -1.64 to -0.35; p<0.005), and BUN MD -0.10 (95%CI -1.43 to 1.23; p>0.05). Probiotics also significantly increased the albumin MD 0.18 (95%CI 0.01 to 0.35; p<0.05).

Conclusion: Probiotic intervention improves the renal biomarkers, waste product clearance, and inflammation of CKD patients.
73. Hypertension Prediction Models Using Machine Learning with Easy-to-Collect Risk Factors: A Systematic Review
Authors: Estiko Reza Ishak , Rijanto Estiko , Juwana Yahya Berkahanto , Juzar Dafsah Arifa , Widyantoro Bambang
Published: July 2024

Background: Most guidelines have used traditional methods (TM), such as regression, to analyze hypertension risk factors and predict high-risk populations. Many studies have developed hypertension prediction models using TM and machine learning (ML), but the risk factors and prediction accuracy vary.

Objective: This work reviews articles that predict hypertension using ML. It aims to find the risk factors that contribute the most and evaluate ML performance utilizing the area under the receiver operating characteristic curve (AUC) indicator.

Method: We conducted a systematic review using Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) for articles published from 2010 – 2023 through PubMed, Google Scholar, Science Direct, and Taylor & Francis. The keywords used were “hypertension,” “risk factor,” “prediction,” and “machine learning.” We used “AUC” as the inclusion criteria and filtered the articles with easy-to-collect risk factors, with 500 minimum subjects.

Results: After applying the inclusion criteria, we obtained 38 articles. Only eight articles use easy-to-collect risk factors, including age, gender, family history of hypertension, alcohol consumption, fruit and vegetable consumption, physical activity, smoking, and body mass index. Compared to TM, ML algorithms such as Random Forest (RF), Gradient Boosting, Extreme Gradient Boosting, and Support Vector Machine have more significant values in predicting hypertension risk. For a large general population, the highest AUC for ML was 0.92 using RF, and for TM, it was 0.829 using logistic regression.

Conclusion: ML can become an alternative method for predicting hypertension, providing better performance than TM.
75. The Association of Intravenous Nitrates Dosing Regimens on Blood Pressure Reduction and ICU Admission Rates among Acute Hypertensive Heart Failure Patients in Emergency Settings: A Systematic Review, Meta Analysis, and Meta-Regression
Authors: Ivan Ignatius , Budiman Fanny , Ananta Muammar Emir , Virnardo Ricky
Published: July 2024

Background: In acute hypertensive heart failure (AHHF), optimizing preload and afterload is vital. Higher doses of intermittent intravenous bolus (IVB) nitrates have shown promise in reducing cardiac afterload.

Objective: We evaluate impact of varying IV nitrate dosing regimens on MAP reduction and ICU admission rates in emergency AHHF.

Methods: We followed PRISMA 2020 guidelines, searching 8 databases. We included experimental or observational studies from inception to December 8, 2023, focusing on intravenous nitrates in emergency AHHF patients, in which studies documenting MAP reduction and ICU admission rates. Random effects meta-analyses and meta-regression for age, MAP, dosing regimens were employed. Studies qualities were evaluated using ROBINS-I and Newcastle-Ottawa-Scale.

Results: The search yielded 595 articles, including 2 single-arm trials and 5 cohorts. Meta-analysis revealed that a combined IVB and CIV regimen led to a significant MAP reduction (-48.27mmHg), compared to intermittent IVB alone (-23.113mmHg). MAP difference favored the combined regimen, with a significant value of -25.16mmHg(95%CI, -35.86 to -14.45, p=0.00001). Meta-analysis revealed a 39.6% ICU admission rate for combined IVB and CIV, compared to 11.8% for intermittent IVB, resulting in a risk difference of 37%(95%CI, 29%-45%, p=0.00001). Meta-regression analyses found no significant associations between covariates and ICU admission rates. No publication bias was detected (rank correlation p=0.23, regression p=0.17).

Conclusion: Our study revealed lower MAP reduction with combined regimens, and AHHF patients receiving intermittent IVB nitrates alone showed lower ICU admission rates. Meta-regression found no significant association between dose amounts and ICU admissions, indicating comparable impacts for both regimens. Larger-scale, double-arm studies are needed for further clarification.
78. Chronicles of Risk: Unveiling the Significance Cardiovascular, Renal, and Metabolic Diseases - A Systematic Review and Meta-analysis
Authors: Willyanto Sebastian Emmanuel , Homenta Rampengan Derren David Christian , Pramana Giri Nyoman Deva , Adilazuardini Latifa Gustina , Kamila Putri Annisa , Amirah Shakira , Ramadhan Roy Novri
Published: July 2024

Introduction: Individuals with a reduction of over 10% in nocturnal blood pressure (BP) are classified as “dippers”, while those with a lower decrease are ”non-dippers”. Numerous studies suggest a connection between a non-dipper BP profile and an increased risk of target-organ damage.

Objectives: The purpose of this study was to evaluate the association of non-dipping hypertension with the risk of cardiovascular, renal, and metabolic diseases.

Methods: The outcome of interest included laboratory parameters such as total triglycerides (TG), low-density lipoprotein (LDL), serum creatinine, glomerular filtration rate (GFR), and fasting plasma glucose (FPG) levels, along with occurrences of cardiovascular disease (CVD) and type 2 diabetes mellitus (DMT2). Quality appraisal was done using Newcastle-Ottawa scale (NOS), while meta-analysis was done using RevMan 5.4.

Results: A thorough search of five databases identified 20 articles, with quality assessment indicating 15 low-risk and five intermediate-risk studies. Laboratory analysis revealed that non-dipping hypertension is linked to increased total TG (2.52 mg/dl) and LDL (3.96 mg/dl), decreased GFR (3.54 ml/min), and elevated FPG (0.62 mg/dl) compared to dipping hypertension. No significant difference in serum creatinine was observed. Disease event analysis based on available studies indicated higher DMT2 occurrences in non-dipping hypertension, while CVD events were lower compared to dipping hypertension, noting high heterogeneity.

Conclusion: Non-dipping hypertension is associated with more adverse values of laboratory measures, thereby elevating the risk of cardiovascular, renal, and metabolic diseases. Further research is needed to thoroughly investigate the specific interrelationship between non-dipping hypertension and those diseases.
81. The Intersection of Tuberculosis Treatment and Blood Pressure Control: Insights from Primary Healthcare - A Case Report
Authors: Nugroho Muhammad Nurhazim , Eri Rifqi Rizkani
Published: July 2024

Introduction: Tuberculosis and hypertension often coexist, necessitating concurrent management. However, the interaction between antituberculosis and antihypertensive medications, particularly calcium channel blockers (CCBs), remains underexplored. This case highlights the impact of antituberculosis therapy on hypertension management.

Case Presentation: A 53-year-old female diagnosed with pulmonary tuberculosis also had a history of chronic essential hypertension managed with amlodipine 10 mg daily, maintaining blood pressure (BP) between 120-141/74-83 mmHg for the last 4 months at our primary healthcare center. Upon initiating antituberculosis treatment, her BP gradually rose to 146-168/78-90 mmHg. A gradual augmentation of her antihypertensive therapy a three-drug regimen of amlodipine 10 mg daily, captopril 25 mg twice daily, and hydrochlorothiazide 25 mg daily effectively controlled her BP within 1.5 months, maintaining stability at 128-145/77-82 mmHg throughout tuberculosis therapy. Following the completion of antituberculosis treatment, her BP gradually declined to 110-133/70-78 mmHg. Sequential de-escalation to a two-drug regimen of amlodipine 10 mg and captopril 12.5 mg twice daily sustained the BP at 114-136/72-81 mmHg for several months thereafter.

Discussion: The rise in BP during antituberculosis treatment, particularly rifampicin, prompts an exploration into its impact on antihypertensive drug metabolism and efficacy. Rifampicin’s induction of hepatic and intestinal cytochrome P450 (CYP) 3A4 enhances the first-pass metabolism of CCBs, diminishing their bioavailability and efficacy. There’s also potential for diminished effectiveness of beta-blockers (BBs) due to CYP2D6 induction by rifampicin.

Conclusion: This case highlights the importance of managing hypertension carefully during antituberculosis treatment, as rifampicin may reduce the efficacy of CCBs and BBs. Further studies are needed to develop optimal hypertension treatment strategies for patients undergoing antituberculosis therapy.
Characteristics Associated with Successful Residency Match in General Surgery
Authors: Collins Reagan A. , Nimmer Kaitlyn , Sheriff Salma A. , Arora Tania K. , Kothari Anai N. , Cunningham Carrie , Clarke Callisia N.
Published: July 2024

Objective:

To evaluate characteristics of matched and unmatched general surgery residency (GSR) applicants.

Background:

Given the recent change of the United States Medical Licensing Exam Step 1 grading to pass/fail, understanding the factors that influence GSR match success is integral to identifying potential interventions to improve match rates for diverse medical students.

Methods:

Retrospective review of GSR National Residency Matching Program (NRMP) applicant and Accreditation Council for Graduate Medical Education (ACGME) active resident data between 2011 and 2022. Data included application characteristics for United States (“US”) and “independent” applicants, factors cited by program directors in the interview and ranking process, paths pursued if applicants went unmatched, and racial/ethnic representation.

Results:

A total of 9149 US and 3985 independent applicants applied to GSR between 2011 and 2021. Matched versus unmatched applicants had higher step 1 scores (US: 236 vs 218, P = 0.005; independent: 237 vs 228, P = 0.001), higher step 2 scores (US: 248 vs 232, P = 0.006; independent: 245 vs 234, P < 0.001), more likely to belong to alpha omega alpha (US: 17.1% vs 1.6%, P = 0.002) or to attend a top 40 National Institutes of Health-funded school (US: 31.0% vs 19.4%, P = 0.002) compared to unmatched applicants. Program directors heavily factored step 1 and step 2 scores, letters of recommendation, interactions with faculty and trainees, and interpersonal skills when interviewing and ranking applicants. The proportion of active general surgery residents versus applicants was lower for Asians (12.3% vs 20.9%, P < 0.001), Black/African American (5.0% vs 8.8%, P < 0.001), Hispanic/Latino (5.0% vs 9.4%, P = 0.001), and underrepresented in medicine students (10.3% vs 19.1%, P < 0.001).

Conclusions:

In the pass/fail step 1 era, factors including step 2 score and other subjective metrics may be more heavily weighted in the GSR match process.
A Derotational Corrective Osteotomy in a Torsional Malaligned Femoral Shaft Fracture Around a Prior Stuck Intramedullary Nail
Authors: Melvin Patricia R. , O’Neill Conor , Laubach Logan K. , Satpathy Jibanananda
Published: July 2024

Background:

Femoral torsional malunion following trauma fixed with intramedullary (IM) nailing can necessitate femoral derotational osteotomy based on the symptomatic limitations of the patient. There is a paucity of studies discussing the utility and methods of femoral derotational osteotomy following post-traumatic femoral torsional malunion fixed with IM nailing that is not removable.

Methods:

We report a surgical technique in a patient treated with a femoral derotational osteotomy who sustained significant rotational deformity after a femoral shaft fracture initially treated with antegrade IM nailing. A standard inferior patellar approach was performed. The distal interlocking screws of the nail were removed, and a trephine was placed up through the distal femoral canal around the nail to free the nail from the surrounding bone to allow for mobility of the distal femur following osteotomy. Parallel K-wires were placed above and below the cut level for rotational control. A dynamic compression plate was then placed in compression mode on the lateral aspect of the femur, and the distal interlocking screws were placed to lock the IM nail.

Conclusions:

We recommend this technique only be used in cases where the nail is centric in the intramedullary canal and in line with the trochlea to be able to pass the trephine through the knee. We believe this technique to be an effective surgical option to treat post-traumatic torsional deformities of the femur where hardware cannot be removed.
Acute presentation of a canal of Nuck cyst complicated by strangulated inguinal hernia in an adult female patient: Case report and a review of literature
Authors: Guida Francesco , Marte Gianpaolo , Tufo Andrea , Rosato Andrea , D’Avino Raffaele , Sodano Loredana , Armellino Mariano Fortunato
Published: July 2024

A canal of Nuck cyst is a rare surgical condition in females, and is usually detected and repaired in young girls. It is caused by the patent canal of Nuck (a peritoneal fold along the round ligament). It is often diagnosed by clinical examination, ultrasound, computed tomography scan, and magnetic resonance imaging. However, definitive diagnosis is made by surgical excision and histopathological analysis. We report an unusual case of a canal of Nuck cyst with a strangulated left inguinal hernia. In addition, we present a literature review.
Preimplantation genetic testing: A narrative review
Authors: Fernandes Sofia L. E. , de Carvalho Filipa A. G.
Published: July 2024

Preimplantation genetic testing (PGT) is a diagnostic procedure that has become a powerful complement to assisted reproduction techniques. PGT has numerous indications, and there is a wide range of techniques that can be used, each with advantages and limitations that should be considered before choosing the more adequate one. In this article, it is reviewed the indications for PGT, biopsy and diagnostic technologies, along with their evolution, while also broaching new emerging methods.
Human head–neck model and its application thresholds: a narrative review
Authors: Liang Ziyang , Wu Ke , Tian Tengfei , Mo Fuhao
Published: July 2024

There have been many studies on human head–neck biomechanical models in the last two decades, and the associated modelling techniques were constantly evolving at the same time. Computational approaches have been widely leveraged, in parallel to conventional physical tests, to investigate biomechanics and injuries of the head–neck system in fields like the automotive industry, orthopedic, sports medicine, etc. The purpose of this manuscript is to provide a global review of the existing knowledge related to the modelling approaches, structural and biomechanical characteristics, validation, and application of the present head–neck models. This endeavor aims to support further enhancements and validations in modelling practices, particularly addressing the lack of data for model validation, as well as to prospect future advances in terms of the topics. Seventy-four models subject to the proposed selection criteria are considered. Based on previously established and validated head–neck computational models, most of the studies performed in-depth investigations of included cases, which revolved around four specific subjects: physiopathology, treatment evaluation, collision condition, and sports injury. Through the review of the recent 20 years of research, the summarized modelling information indicated existing deficiencies and future research topics, as well as provided references for subsequent head–neck model development and application.
Healthcare Professionals and Extreme Risk Protection Orders: A Concise Review
Authors: Lindley Lisa C. , Beebe Lora Humphrey , Davis Heather A. , Policastro Christina N. , Svynarenko Radion
Published: July 2024

Background:

Extreme risk protection orders (ERPOs) are one policy mechanism to address the critical public health problem of gun violence. The inclusion of healthcare professionals with ERPOs is a promising approach to expanding ERPO utilization, yet early evidence has not been examined.

Objective:

The purpose of this study was to synthesize the current research on healthcare professionals and ERPOs.

Data Sources:

Cumulative Index of Nursing and Allied Health Literature (CINAHL), PubMed, Academic Search Complete, and Web of Science were searched.

Study Selection:

Studies examined healthcare professionals’ role and function within the context of ERPOs.

Data Extraction:

Relevant studies were reviewed and included through consensus of the authors. Data extracted included authors, objective, design, states, healthcare professional type, mental health professional type, healthcare professional roles/involvement and key outcomes.

Data Synthesis:

There is unfamiliarity with ERPOs among healthcare professionals. Healthcare professionals lack ERPO knowledge and are unclear about ethical and legal ERPO liability.

Conclusion:

The available evidence suggests that healthcare professionals have an important role in ERPOs, but critical gaps in ERPO knowledge, training/resources, and liability will limit use and effectiveness of healthcare professionals, including nurses, in the role of ERPO petitioner.
Myocardial infarction with nonobstructive coronary arteries: a single-center retrospective study by sex and race
Authors: Hsueh Christine , Esin Ghenekaro , Breen Thomas , Gitto Mauro , Katz Miriam , Gulati Martha , Capers IV Quinn , Reynolds Harmony R. , Volgman Annabelle S. , Wenger Nanette , Altin S. Elissa
Published: July 2024

Background

In myocardial infarction with nonobstructive coronary arteries (MINOCA), there are limited patient-level data on outcomes by sex and race.

Objective

The aim of this study was to assess baseline demographics and 3-year outcomes by sex and race for MINOCA patients.

Methods

Patients admitted to a single center with acute myocardial infarction (MI) between 1 January 2012 and 31 December 2018, were identified by chart and angiographic review. The primary outcome was nonfatal MI with secondary outcomes including nonfatal cerebrovascular accident (CVA), chest pain readmission, and repeat coronary angiography.

Results

During the study period, 304 patients were admitted with MINOCA. The cohort was predominantly female (66.4%), and women were significantly older (64.6 vs. 59.2). One-sixth of the total population were Black patients, and nearly half of Black patients (47.2%) were male. Prior CVA (19.7%) and comorbid anxiety, depression, or post-traumatic stress disorder (41.1%) were common. Rates of nonfatal MI were 6.3% without difference by sex or race. For secondary outcomes, rates of CVA were 1.7%, chest pain readmission was 22.4%, and repeat angiography was 8.9%. Men were significantly more likely to have repeat angiography (13.7 vs. 6.4%), and Black patients were more likely to be readmitted for angina (34.0 vs. 19.1%). Over one-quarter of patients underwent repeat stress testing, with 8.9% ultimately undergoing repeat angiograms and low numbers (0.7%) undergoing revascularization. Men were more likely to be referred for a repeat angiogram (13.7 vs. 6.4%, P = 0.035). In multivariate analysis, Black race [odds ratio (OR), 2.31; 95% confidence interval (CI), 1.06–5.03] was associated with an increased risk of readmission for angina, while female sex was associated with decreased odds of repeat angiography (OR, 0.36; 95% CI, 0.14–0.90) and current smoking was associated with increased odds of repeat angiography (OR, 4.07; 95% CI, 1.02–16.29)] along with hyperlipidemia (OR, 4.65; 95% CI, 1.22–17.7).

Conclusion

White women presented more frequently with MINOCA than White men, however, Black men are equally as affected as Black women. Rates of nonfatal MI were low without statistical differences by sex or race.
Does using a bioptic telescope improve visual recognition of the on-road environment?
Authors: Oberstein Sharon L. , Boon Mei Ying , Chu Byoung Sun , Wood Joanne M.
Published: July 2024

SIGNIFICANCE

Individuals with reduced visual acuity (VA) may drive with bioptic telescopes in some jurisdictions. The effect of bioptic telescope use on on-road recognition distances is important for driving safety, as increased recognition distances increase the time available to react to road signs or driving events.

PURPOSE

This study aimed to investigate the impact of bioptic telescope use on visual recognition of road signs, traffic lights, and hazards in an on-road driving environment in individuals with reduced VA.

METHODS

Ten individuals (mean ± standard deviation age, 39.1 ± 19.1 years) with reduced VA (trained to use bioptic telescopes) participated in a repeated-measures on-road experiment for two viewing conditions, with and without a bioptic telescope (randomized order). Participants underwent a clinical low vision assessment, including high-contrast VA with and without the bioptic telescope aligned, visual fields, and contrast sensitivity testing. For the driving component, participants seated in the front passenger seat of a moving car reported all road signs, traffic lights, and hazards (unpredictable road events that represent a risk to driving safety including other vehicles, cyclists, pedestrians) seen along a route that included suburban roads and highways. Video cameras captured participants' viewing behavior, verbal commentary, and the distance at which three pre-selected road signs were reported.

RESULTS

In the eye with the bioptic telescope, high-contrast VA improved from 0.75 ± 0.17 (without) to 0.25 ± 0.1 logMAR with the bioptic telescope. Bioptic telescope use did not affect the percentage of road signs, traffic lights, or hazards correctly recognized but did result in 2.6 times longer recognition distances (49 ± 23 vs. 19 ± 11 m, t
9 = 5.02, p<0.001).

CONCLUSIONS

Road signs were recognized at significantly longer distances when using a bioptic telescope, confirming their positive impact on timely visual recognition of objects within the driving scene. Future work should explore whether this effect generalizes to individuals using bioptic telescopes when driving a vehicle.
Life space limitations in visually impaired older adults
Authors: Bittner Ava K. , Gobeille Micaela , Malkin Alexis G. , Ho Jeffrey , Idman-Rait Cecilia , Estabrook Max , Ross Nicole C. ,   for the CARE Study Team
Published: July 2024

SIGNIFICANCE

Future work should develop and evaluate interventional strategies to help overcome visual and health-related barriers to travel in visually impaired seniors and mitigate adverse impacts of loneliness for those who do not leave town.

PURPOSE

Life space refers to the area in which a person travels within a given time period. We explored whether demographics, vision, and/or health characteristics were related to restrictions in self-reported life space for visually impaired seniors.

METHODS

Visually impaired (n = 114) clinical trial participants aged ≥55 years learned visual assistive iPhone apps and completed the following baseline questionnaires: Life Space, 36-Item Short-Form Health Survey, University of California, Los Angeles Loneliness Scale, and New-General Self-efficacy Scale. Multiple logistic regressions evaluated associations between life space and patient factors after accounting for their distance to the next county or state.

RESULTS

During 2021 to 2023, 17%, 43%, and 70% of participants had not left their town, county, or state, respectively, in the past 3 months, or planned to in the next 3 months. Those with reduced distance best-corrected visual acuity had greater odds of not leaving the county in these time frames (odds ratio [OR] = 3.5; p=0.04). Minority race was associated with greater odds of not leaving town or the county in the past 2 weeks or future 3 months (OR = 4.3 to 6.4; p=0.009 to 0.049). Increased self-efficacy was associated with reduced odds of not leaving the state in the past 3 months, next 3 months, or past and/or future 3 months (OR = 0.54 to 0.55; p=0.02 to 0.03). Better physical function was associated with reduced odds of not leaving the state in the past 2 weeks or 3 months (OR = 0.96 to 0.98; p=0.01 to 0.04). Increased loneliness was related to greater odds of not leaving town in the past and/or future 3 months (OR = 1.8 to 2.0; p=0.007 to 0.009).

CONCLUSIONS

Minority race, reduced vision, self-efficacy, and physical health were related to life space restrictions in this cohort of visually impaired seniors, whereas loneliness was greater among those who were not leaving town.
Efficacy of perceptual learning in low vision: A systematic review and meta-analysis
Authors: Park Adela S. Y. , Wong Ginny H. T , Tan Ken W. S. , Cheung Blossom W. S. , Oremus Mark , Cheong Allen M. Y. , Thompson Benjamin
Published: July 2024

BACKGROUND

Visual perceptual learning (PL) shows promise for enhancing visual functions in individuals with visual impairment.

OBJECTIVE

This systematic review aimed to evaluate the effectiveness of PL in improving visual function.

STUDY ELIGIBILITY

Eligible studies were those examining the efficacy of PL in individuals with low vision.

STUDY APPRAISAL AND SYNTHESIS METHODS

The review protocol was registered with the international Prospective Register of Systematic Reviews (ID CRD42022327545) and adhered to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Screened studies were synthesized using random-effects meta-analysis and narrative synthesis following Synthesis Without Meta-analysis guidelines. The quality of the evidence was assessed using the Cochrane risk-of-bias tool and the JBI Critical Appraisal Tool for Quasi-Experimental studies.

RESULTS

Fifty studies were included, covering various visual impairments and employing different PL interventions. Most studies had low risk of bias. Meta-analysis showed significant improvement in visual search for individuals with cortical blindness (Hedges'g= 0.71; 95% confidence interval, 0.48 to 0.93; p=0.002); all other analyses did not show significant improvements—reading in central vision loss and cortical blindness, and visual field in peripheral vision loss and cortical blindness. However, the narrative synthesis provided evidence showing effectiveness, particularly in individuals with central vision loss and cortical blindness, demonstrating positive effects on reading, contrast sensitivity, visual field, and motion perception.

LIMITATIONS

Variations in study design, PL protocols, outcome measures, and measurement methods introduced heterogeneity, limiting the analysis.

CONCLUSIONS

The efficacy of PL in vision rehabilitation remains uncertain. Although meta-analysis results were mostly inconclusive, the narrative synthesis indicated improved visual functions following PL, consistent with individual study findings.

IMPLICATIONS OF KEY FINDINGS

Future research should optimize intervention parameters, explore long-term effects, and assess generalizability across diverse populations and visual impairment etiologies. Larger randomized controlled trials using standardized outcome measures are needed to advance the field.