bluuebunny/crossref_metadata_2025_split huggingface dataset:
P205 HYPERTENSION AWARENESS, TREATMENT, AND CONTROL RATE IN NEPAL: AN EFFECTIVENESS OF WHO-PEN PACKAGE INTEGRATION THROUGH PRIMARY CARE TO ADDRESS THE NCDs
Authors: Mehata Suresh , Mehta Ranju Kumari , Thapa Astha 
Published: September 2024

WHO-PEN, the essential NCD services even in resource constraint settings through PHC approach has been implemented in Nepal since 2017. PEN approach consists of set of protocols for the management of listed major diseases and behavioral interventions to address the associated major modifiable risk factors. The major focused diseases in PEN includes cardiovascular diseases, diabetes, cancer and chronic respiratory diseases. By 2021 it has been expanded across all 77 districts of Nepal. The aim of this analysis is to assess the before and after PEN package changes in hypertension prevalence, awareness, treatment and control rate in Nepal.
This analysis used the 2016 Nepal demographic and health survey (NDHS) data as a baseline(N=14,823) and 2022 NDHS data as an Edline(N=10,022). Awareness, treatment and control rate was calculated from the population aged 15 years and above along with the concentration Index (CI) to assess the changes in magnitude and inequalities before and after the intervention. Cluster sampling design was considered for all the inferential statistics and sample weight was used to obtain the population estimates. P<0.05 were considered statistically significant.
The study revealed a non-significant change in the hypertension prevalence before and after the intervention (19.6% vs 20.1%;p>0.05). However, a significant change was observed in the awareness rate (40% vs 50.2%,p<0.05) and treatment rate (20.2% vs 31.7%,p<0.05). A significant wealth inequality was observed in awareness ((CI:0.12,p<0.001 in 2016) and (CI:0.13,p<0.001 in 2022)) and treatment rate ((CI:0.24,p<0.001 in 2016) and (CI:0.21,p<0.001 in 2022)) over the period of time. We did not find a significant change (51.7% vs 56.7%, p>0.05) and wealth inequalities in control rate (figure 1).
The improvement in awareness and treatment rate over the period entails the integration of WHO-PEN package through primary care is effective, however, the persistent wealth inequalities indicate next level community-based intervention should be instrumental to address the NCDs burden targeted to ultra-poor/poor and marginalized population of Nepal.
P208 MAY MEASURE MONTH 2023: AN ANALYSIS OF BLOOD PRESSURE SCREENING RESULTS FROM ULAANBAATAR, MONGOLIA
Authors: Myanganbayar Maral , Davaadamdin Orkhonselenge , Badamjargal Tuyajargal , Erdenebat Solongo , Beaney Thomas , Poulter Neil R , Dashtseren Myagmarsuren , Amartuvshin Tsolmontuya , Dashdorj Naranjargal 
Published: September 2024

Background and Objectives:
In Mongolia, 1 in 3 people have high blood pressure and mortalities due to ischaemic heart disease and haemorraghic stroke has hit record high in the past years. Since 2019, Mongolia has been participating in the world's largest hypertension screening campaign, May Measure Month. After skipping the screening campaign for 2 years, we aimed to screen people for hypertension after the COVID-19 pandemic.

Method
Screening sites were set up in 14 primary healthcare centers (PHC) of 4 districts in Ulaanbaatar, Mongolia between June and September 2023. Screenees came into the PHC and participated voluntarily and they were aged 18 and above. Questionnaire was completed with three sittings BP measured. Definition was hypertension was as a systolic BP at least 140 mmHg and/or a diastolic BP at least 90 mmHg (using the mean of the second and third readings) or taking antihypertensive medication. We used SPSS version 29.0.2.0 and RStudio for data analysis.

Result
Total of 5036 respondents were participated. Of which, 44.8% were male and female were 55.2% with mean age 46.8 (±15.8). Hypertensive adult proportion was 42.6% (2143), of whom 85.1% (1823) were aware and 84.0% (1800) were on hypertension treatment. Of those on medication, control rate 53.8% had controlled blood pressure (<140/90). Noncommunicable disease factors including smoking was 26.6%, current vaper 7.6%, alcohol consumption 28.8%, diabetes 7.2%, previously diagnosed heart attack was 3.7% while stroke was 3.5%. Overweight and obese were 36.8% and 14.6% respectively.

Conclusion
The high hypertension prevalence and inadequately treated hypertension demonstrates that hypertension treatment management is needed to be prioritized.
P209 A TEAM-BASED APPROACH TO MANAGE BLOOD PRESSURE BETWEEN COMMUNITY PHARMACISTS AND PRIMARY HEALTH CARE PHYSICIANS BY MEANS OF VASCULAR AGE (RIESCO/TOGETHER)
Authors: Rodilla Enrique , Aichberger Monika , Ardelt Florian , Baixauli Vicente , Cinza Sergio , Fernández María Soledad , García Luis , Mayer Christopher , Pereira Telmo , Santschi Valérie , Weber Thomas 
Published: September 2024

Background and Objective:
Estimating arterial stiffness in Community Farmacies (CPh) has been shown to improve hypertension (HTN) management in Portugal, Austria and Spain. TOGETHER aims to evaluate whether empowering hypertensive subjects by determining arterial stiffness in CPh increases HTN control, establishing paths of lasting cooperation between Primary Care (PC) doctors and CPh.

Methods:
TOGETHER is a cluster-randomized, prospective study in Portugal, Austria and Spain. All consecutive expected 1260 subjects entering CPh will be offered BP measurement and ambulatory BP monitoring (ABPM) for those with high values. CPh will be randomly grouped into a usual care arm (health education associated with HTN and communication of the results to PC). In the experimental care group, early vascular aging (EVA) will additionally be assessed estimating oscillometric pulse wave velocity. The therapeutic options of EVA will be explained to patients/PC. HTN will be treated by PC according to usual clinical practice. A second evaluation with ABPM will be performed after 6 months and HTN control will be compared between the arms. The degree of patient-doctor interaction will be determined through validated surveys.

Results
Five fundamental unmet needs will be addressed by TOGETHER: 1) lack of HTN screening programs; 2) Implementation of the simpler and more informative EVA concept (“Your arteries are 10 years older than you”); 3) understanding CV risk on an individual basis (individual EVA) should improve patient adherence and reduce physician inertia; 4) Implementation of health educational programs, combined with the concept of EVA; 5) Higher collaboration and development of a team-based approach to HTN care between CPh and PC.

Conclusions:
The complementary organizational settings and strengths of CPh and PC will allow TOGETHER to create new strategies for early identification and intervention in HTN, ranging from lifestyle to medical treatment, taking social, economic, and behavioral aspects into account.
P210 ASSOCIATION BETWEEN FOLLOW-UP BLOOD PRESSURE AND BLOOD PRESSURE CONTROL: A META-REGRESSION ANALYSIS
Authors: Salam Abdul , Dhurjati Rupasvi , Pant Rashmi , Rodgers Anthony , Satheesh Gautam , Rajaram Shwetha , Nandakumar Krishna 
Published: September 2024

Background:
Blood pressure (BP) control is typically defined as BP values under certain thresholds, most commonly <140/90 mmHg – but there is widespread uncertainty about how mean BP is related to BP control, and what mean BP is required to achieve BP control in 80% of patients.

Objective:
To assess the association between follow-up mean systolic BP (SBP) and BP control from randomised clinical trials (RCTs).

Methods:
We systematically searched multiple databases for relevant RCTs. We included double-blind individual RCTs (iRCTs) of adults with hypertension, randomised to BP-lowering drugs from five major antihypertensive classes for ≥2 to ≤ 26 weeks, and which reported data for follow-up mean SBP and BP control (clinic BP <140/90 mmHg) at the last follow-up visit. We also included cluster RCTs (cRCTs), of adults with hypertension, randomised to any BP-lowering intervention, for any duration. The association between follow-up mean SBP and BP control at the last follow-up visit was assessed using a linear regression model. The coefficient was interpreted as the increase in percentage of patients with BP control for every 1 mmHg decrease in follow-up mean SBP.

Results:
Seventy iRCTs (45,836 participants) and 36 cRCTs (28,154 participants) were included. Each 1 mmHg decrease in follow-up mean SBP was associated with about 2% improvement in BP control in both iRCTs and cRCTs (R2= 78% and 76%, respectively). This finding was broadly consistent in the subgroups of BP-lowering drug classes, baseline SBP categories, and pre-trial BP-lowering treatment status in iRCTs, and country income and baseline SBP categories in cRCTs. Mean SBP levels of 125, 130, and 135 mmHg were associated with BP control rates of 78%, 67%, and 55%, respectively, in iRCTs and 80%, 68%, and 56% in cRCTs.

Conclusion:
Mean SBP levels of 125 mmHg are required for achieving BP control of <140/90 mmHg in about 80% of the patients. These findings should inform clinical care, guideline recommendations and hypertension control programs.
P221 ANKLE BRACHIAL INDEX AND ASSOCIATION WITH CHRONIC KIDNEY DISEASE IN THE H3 AFRICA KIDNEY DISEASE RESEARCH NETWORK
Authors: Olanrewaju Timothy Olusegun , Osafo Charlotte , Raji Yemi R , Mamven Manmak , Ajayi Samuel O , Arogundade Fatiu A , Ulasi Ifeoma I , Gbadegesin Rasheed , Parekh Rulan S , Tayo Bamidele , Adeyemo Adebowale A , Salako Babatund L , Ojo Akololu O , Adu Dwomoa 
Published: September 2024

Background and Objective:
Abnormal ankle brachial index (ABI) is common in patients with chronic kidney disease (CKD). We evaluated the association of ABI, a non-invasive tool to evaluate peripheral arterial disease and arterial stiffness, with CKD among West Africans enrolled in the H3Africa Kidney Disease Research Network (H3AKDRN).

Methods:
We recruited 9206 participants (5356 with CKD), from Ghana and Nigeria in the H3AKDRN, a multinational case-control study. CKD was defined as estimated glomerular filtration rate of <60 ml/min/1.73m2 and/or albuminuria as albumin/creatinine ratio >3.0 mg/mmol (>30 mg/g) for ≥3months. ABI was divided into low (≤0.9), normal (0.91 – 1.3), and high (>1.3). We assessed low ABI, a marker of peripheral artery disease, and high ABI, the marker of arterial stiffness. We determined association of ABI with CKD by multivariate logistic regression.

Results:
The mean age of participants was 45.8±15.36 years and 56.3% were males. The prevalence of low ABI was higher in CKD group (32%% versus 16% (control), p=0.013). The prevalence of high ABI was also higher in CKD (15% versus 10.9% (control), p = 0.01). Patients with CKD and low ABI have reduced BMI, low haemoglobin, higher systolic BP and increased albuminuria. Male gender, history of hypertension and diabetes were independently associated with CKD. Higher BMI was associated with reduced odds of CKD (p = < 0.03). After adjustment for covariates, low ABI was associated with CKD, with 26% increased odd (aOR 1.26 (CI, 1.01 – 1.56; p = 0.037)), but high ABI was not associated with CKD (aOR 1.45 (0.88 – 2.38, p = 0.147)).

Conclusion:
The prevalence of abnormal ankle brachial index is high among adult populations of Ghana and Nigeria, with and without CKD. The Marker of peripheral arterial disease, but not marker of arterial stiffness was associated with CKD. A longitudinal study is required to determine the true relationship between ABI and CKD in West Africa.
P224 EFFECT OF SODIUM NITRITE ON RENAL DAMAGE FROM 2-KIDNEY, 1-CLIP (2K-1C) HYPERTENSION IN RATS
Authors: Ribeiro Jéssyca , Silva Alessandra , Almeida Carolina , Marques Fernanda , Victorino Thaís , Paula Fernanda , Tanus José Eduardo , Rizzi Elen , Torres Larissa , Ceron Carla 
Published: September 2024

Renovascular hypertension is characterized by oxidative stress and decreased availability of nitric oxide (NO). Nitrite is a physiologically recycled metabolite that generates NO. Treatment with sodium nitrite has antihypertensive effects due to its antioxidant capacity. However, the renal effects of this treatment are not known in 2K1C hypertension. This study aims to evaluate the effect of treatment with sodium nitrite on kidney damage caused by 2K1C hypertension. Hypertension was induced by cleavage of the left renal artery in Wistar rats. Two weeks after surgery, the animals were treated with two doses (1 mg/kg/day or 15 mg/kg/day) of sodium nitrite or vehicle for 4 weeks, by gavage. Blood pressure (BP) was checked weekly by tail plethysmography. To assess renal function, plasma urea and creatinine were determined. Kidney oxidative stress was evaluated through the activity of catalase (CAT), superoxide dismutase (SOD), levels of reduced glutathione (GSH), lipid peroxidation, and superoxide (O2-) levels. Treatment with 15 mg/kg/day of sodium nitrite reversed the increase in BP in 2K1C rats (p<0.05, 2K1C:170.5±6.542; 2K1C+Nitrite15:162.4±6.712 mmHg), and improved renal function previously impaired by hypertension (urea, p<0.05; 2K1C:76.37±24.53; 2K1C+Nitrite15:47.82±13.86; creatinine, p<0.05; 2K1C:0.540±0.105; 2K1C+Nitrite15:0.3550±0.117). SOD activity decreased in the kidneys of hypertensive animals (p<0.05, Control:0.7176±0.06426; 2K1C:0.636±0.0888; 2K1C+Nitrite1:0.703±0.0866; 2K1C+Nitrite15:0.648±0.173). As for CAT and GSH, there was a decrease in activity in hypertensive animals, with improvement in the group treated with nitrite 15 mg/kg/day (CAT p<0.05, Control:0.651±0.255; 2K1C:0.2772±0.1837; 2K1C+Nitrite15: 0.6654±0.1440 and GSH: p<0.05, Control:44.80±10.59; 2K1C: 29,62±7,253 2K1C+Nitrite15:44.25±10.07). Lipid peroxidation increased by hypertension was reduced with treatment at the highest dosage (p<0.05, Control:0.314±0.158; 2K1C:0.497±0.113; 2K1C+Nitrite15:0.278±0.084). O2- levels were decreased in all groups treated with nitrite (p<0.05, 2K1C:3.844±1.598; 2K1C+Nitrite1:0.9643±0.2063; 2K1C+Nitrite15:0.4431±0.1838). Our results suggest that sodium nitrite treatment improves 2K1C renal damage through its antioxidant activity.
Acknowledgments: FAPEMIG# APQ-00946-23, CNPq# 302076/2022-0
P227 MACROPHAGE TO MYOFIBROBLAST TRANSITION IN THE DEVELOPMENT OF DIASTOLIC DYSFUNCTION
Authors: Mora Christoph , Deck Katherine , Liu Yunmeng , Guo Yunping , Rafferty Tonya , Benson Lance , Mu Shengyu 
Published: September 2024

Diastolic dysfunction (DD) and heart failure (HF) ravage a significant portion of the world's population. These end-stage diseases are most often precluded by hypertension (HTN). Cardiac fibrosis is one of the major factors in the degradation of cardiac function. There are multiple cellular players involved in fibrosis—including, macrophages. Indeed, in the past decade these cells have been shown to differentiate into professional fibrotic cells, myofibroblasts, a process termed macrophage to myofibroblast transition (MMT), in models of kidney injury. Despite this, the role of MMT in fibrotic remodeling in HTN and DD remains unknown. As such, we seek to investigate this phenomenon in the HTN heart and determine the role it plays in the pathological progression of HTN to DD.
We utilized cardiac ultrasound and direct left ventricular (LV) pressure catheterization to gauge diastolic function. These gold-standard methods allowed us to assess cardiac function during HTN and investigate the heart at the transition to DD. Furthermore, flow cytometry was utilized to identify MMT cells (α-SMA+, CD68+) in the heart. These methods gave insight into the role that MMT plays in the degradation of heart function during HTN that inevitably leads to DD and HF.
Cardiac ultrasound revealed that E/A and deceleration time (DcT) were greatly decreased in DOCA mice 10 days after the start of HTN. Further, LV pressure catheterization revealed decreased cardiac function, as shown by decreased -dp/dt. Finally, HTN and normal hearts were harvested and leukocytes isolated. Indeed α-SMA and CD68 staining showed a significant increase in MMT cells in the HTN heart.
This study has shown a rapid onset of DD inside of DOCA + salt HTN mice. In addition, there was a significant increase of MMT cells in these same hearts, elucidating a novel mechanism of cardiac fibrosis. Future studies will aim to parse out the gravity of MMT in HTN to find new pharmaceutical targets against this debilitating disease.
Juvenile Behçet syndrome: a contemporary view and differential diagnosis in pediatric practice
Authors: Yildiz Mehmet , Koker Oya , Kasapcopur Ozgur 
Published: September 2024

Purpose of review
This review aims to provide a comprehensive and contemporary overview of juvenile Behçet syndrome (jBS), highlighting its clinical manifestations, diagnostic challenges, and treatment strategies.

Recent findings
Behçet syndrome, with its intricate etiopathogenesis and diverse clinical phenotypes, is more aptly classified as a syndrome than a single disease. Its heterogeneous nature requires a broad diagnostic approach and sophisticated differential diagnosis capabilities. The relatively rare occurrence of Behçet syndrome, combined with incomplete clinical presentations and overlapping differential diagnoses, presents significant diagnostic challenges, particularly in pediatric cases. Nevertheless, substantial progress has been made in treatment, especially in managing inflammatory components and preventing complications. Juvenile patients, given their developmental stage, require distinct therapeutic strategies compared to adults, with careful consideration of treatment side effects on growth and psychosocial development.

Summary
To ensure early identification of jBS, it is imperative to refine and develop diagnostic criteria specifically tailored to pediatric populations. With a deeper understanding of the disease mechanisms, treatment protocols should be designed to address the developmental, psychosocial, and individual needs of patients, aiming to minimize long-term side effects. Additionally, comprehensive studies considering age, sex, and ethnic differences are necessary to fill gaps in the literature and resolve existing inconsistencies.
Association Between Inability to Stand at ICU Discharge and Readmission: A Historical Cohort Study*
Authors: Brosseau Marc , Shahin Jason , Fan Eddy , Amaral Andre , Wang Han Ting 
Published: September 2024

OBJECTIVES:
The aim of this study was to determine if being unable to stand at ICU discharge was associated with an increased probability of ICU readmission.

DESIGN:
A multicenter retrospective cohort study was conducted using the Toronto Intensive Care Observational Registry (iCORE) project.

SETTING:
Nine tertiary academic ICUs in Toronto, Canada, affiliated with the University of Toronto.

PATIENTS:
All patients admitted to ICUs participating in iCORE from September 2014 to January 2020 were included. Patients had to be mechanically ventilated for more than 4 hours to be included in iCORE. Exclusion criteria were death during the initial ICU stay, transfer to another institution not included in iCORE at ICU discharge, and a short ICU stay defined as less than 2 days.

INTERVENTIONS:
None.

MEASUREMENTS AND MAIN RESULTS:
The main exposure in this study was the inability of the patient to stand at ICU discharge, documented daily in the database within the ICU Mobility Scale. The primary outcome of this study was readmission to the ICU. After adjusting for potential confounders, being unable to stand at ICU discharge was associated with increased odds of readmission (odds ratio, 1.85; 95% CI, 1.31–2.62; p < 0.001).

CONCLUSIONS:
In patients with an ICU stay of 2 days or more, being unable to stand at ICU discharge is associated with increased odds of readmission to the ICU.
Tranexamic acid in prevention of postpartum hemorrhage: a case-control study from Nepal
Authors: Pradhananga Smeena , Jha Meena , Shrestha Ashish , Karki Praju , Aryal Saurav 
Published: September 2024

Introduction:
Postpartum hemorrhage (PPH) is the leading cause of maternal mortality in low-income countries. WHO recommends the use of tranexamic acid in addition to oxytocin for the prevention and treatment of PPH. However, it is not yet standardized. Our study aims to assess the effectiveness of tranexamic acid in preventing PPH in low-risk patients.

Method:
This hospital-based case-control study included 60 patients, 30 undergoing vaginal delivery and 30 cesarean delivery. Fifteen cases undergoing vaginal delivery received 1 g tranexamic acid in addition to 10 units of oxytocin, while 15 controls received only oxytocin. 15 cases undergoing cesarean section received 1 g tranexamic acid followed by 6 units of oxytocin after delivery, while 15 controls received only oxytocin. Blood loss after placental delivery and hemoglobin were measured 12 h postpartum.

Results:
Mean volume of blood loss was lower in the case as compared to the control group in both vaginal delivery (134.05 ± 8.7.85 mL vs. 334.22 ± 280.57 mL, P = 0.01) and cesarean delivery (333.35 ± 139.18 mL vs. 553.74 ± 321.37 mL, P = 0.03). The incidence of PPH was lower in the case as compared to the control group in both vaginal delivery (0% vs 16.66%, P = 0.01) and cesarean delivery (3.33% vs 23.33%, P = 0.02). Mean change in hemoglobin was lower in the case as compared to the control group in both vaginal delivery (0.50 ± 0.65 g/dl vs. 1.77 ± 2.11, P = 0.03) and cesarean section (1.52 ± 1.15 g/dL vs. 2.69 ± 1.81 g/dL, P = 0.00). Blood transfusion was lower in the case as compared to the control group in both vaginal delivery (0% vs. 13.33%, P = 0.03) and cesarean delivery (0% vs. 16.66%, P = 0.01).

Conclusion:
Tranexamic acid, in addition to oxytocin, reduces the mean amount of blood loss during delivery and helps prevent PPH.
Combination of Cultured Epidermal Autograft and Meshed Skin Graft Enables Full-thickness Excision of Giant Congenital Nevus
Authors: Kobori Chie , Hikosaka Makoto , Tsugu Wataru , Sakurai Koki , Nakajima Yukari , Kono Hikaru , Kikuchi Akira , Nakajima Yuki , Sumi Miho , Kuwahara Kosuke , Kaneko Tsuyoshi 
Published: September 2024

Summary:
Giant congenital melanocytic nevus (GCMN) is a skin condition characterized by an abnormally dark, noncancerous skin patch. Two main issues with GCMN are aesthetics and malignant transformation. Various methods of treatment are reported, but each method has its own disadvantages, such as risk of recurrence or restriction in the treatable area. We report three cases of GCMN treated with full-thickness excision and immediately covered with cultured epidermal autograft (CEA) combined with split-thickness skin graft (STSG). This is a single-center, single-arm, retrospective report of three cases. The nevus was excised at full skin thickness. Meshed STSG taken from scalp was grafted to the defect, and CEA was grafted over simultaneously. Two weeks later, CEA was applied again as a booster. The same procedures were performed until all nevi were excised. In all cases, nearly complete epithelialization was achieved at several weeks after operation. The reconstructed skin was elastic, and there was no persistent joint contracture. Vancouver Scar Scale score was 4–8. Mesh-like appearance was observed. A hypertrophic scar appeared in the area without meshed STSG. An intractable keloid was observed in one patient. No recurrence of the nevus was observed during the follow-up period. The donor site scar on the scalp was well hidden by the hair. Our method enables full-thickness resection and reconstruction of a wider area in a single operation while improving the take rate of CEA, with reasonable degree of scarring compared with conventional methods.