bluuebunny/crossref_metadata_2025_split huggingface dataset:
P182 AORTIC VASCULAR BIOMARKERS FOR THE EARLY DETECTION OF PLACENTAL SYNDROMES DURING PREGNANCY: A SYSTEMATIC REVIEW AND META-ANALYSIS
Authors: Bentley Gisele J. , Cox James R. , Liao Catherine , Avolio Alberto , Qasem Ahmad , Butlin Mark 
Published: September 2024

Background:
Placental syndromes (PS) cause over 14 million complications and the death of more than 350,000 women each year. Women with preeclampsia (PE) or gestational hypertension (GH) typically exhibit late gestational acute brachial hypertension, making early intervention difficult. Non-invasive aortic waveform assessments provide nuanced insight to global cardiovascular function. Our objective is to delineate cardiovascular differences between complicated and normotensive pregnancies (NP), to identify early vascular markers of at-risk women.

Methods:
A systematic search (March 2024) for studies reporting both NP and PS pregnancies was performed across five databases: PubMed; Medline; CINAHL Complete; Web of Science; and Scopus. Inclusion criteria required reporting before, during (trimester: T1; T2; T3), or after pregnancy (< 1 year post-delivery) of at least one of the following vascular biomarkers from aortic pulse pressure waveform: aortic systolic blood pressure (aSBP); aortic pulse pressure (aPP); augmentation index normalised to a heart rate of 75 bpm (AIx@75); or arterial stiffness measured by carotid femoral pulse wave velocity (cfPWV). A meta-analysis of continuous random-effects model calculated Hedges’ g with 95% confidence intervals.

Results:
The systematic search yielded 19 studies. Analysis depicted PS having significantly higher aggregated measures than NP throughout pregnancy (p <0.001) and a stronger effect size of AIx@75, aSBP, cfPWV in each trimester [T1, Hedges g 1.4(CI .64 - 2.0); T2, 1.1(CI .64 - 1.5); T3, 3.4(CI 2.1 – 4.6) p<0.001]. Overall, cfPWV had the highest effect size particularly during T1 and T3 [T1, 2.8(CI 2.5 – 3.1); T2, 1.7(CI 1.2 – 2.1); T3, 5.3(CI 4.6 – 5.9)]. Low aPP reporting allowed only analysis of T3 which showed similar effect sizes to other markers [3.14(CI 1.23 – 5.05)].

Conclusions:
Early indication of PS was quantifiable from vascular biomarkers, along with each trimester of pregnancy being elevated compared to NP. Pulse wave analysis and arterial stiffness assessment could enhance risk assessment from as early as the first trimester, improving and informing prenatal care.
P186 ASSESSMENT OF ECHOCARDIOGRAPHY INDICATORS AND ENDOTHELIAL DYSFUNCTION IN PREGNANT WOMEN WITH GESTATIONAL ARTERIAL HYPERTENSION
Authors: Sadulloeva Mokhinur , Zakirova Feruza 
Published: September 2024

Background and Objective:
Hypertensive disorders during pregnancy occur in 5–10% of pregnant women worldwide. In Central Asia, hypertension accounts for 14.5% of all maternal deaths. To identify the features of hemodynamic parameters in pregnant women with gestational arterial hypertension (GHTN).

Methods:
Study included 74 women, who were divided into 2 groups: Group I healthy pregnant women (n=44) and Group II pregnant women with HAG (n=30) according to 2018 ESC/ESH. All pregnant women underwent medical history collection, blood pressure measurement, ECG, B-mode echocardiography, 24-hour blood pressure monitoring, and endothelial function was determined based on an ultrasound cuff test. Statistical analysis of the obtained data was carried out using the STATISTICA 13 program. P <0.05 was considered statistically significant

Results:
The compared groups were comparable in age (27.24±5.79 years vs. 29.07±6.51 years, P = 0.2085), number of pregnancies (2.55±1.63 vs. 2.5±1.35 P = 0.8901), childbirth (2.11±1.13 vs. 2.13±1.02 P = 0.9378) and gestational age (28.4±3.89 vs. 29.6±4.86 P = 0.2632). The average BP level in II group corresponded to moderately elevated BP, amounting to SBP of 153.17±8.14 mmHg vs 102.72±10.42 mmHg (P<0.0001), according to DBP 96±4.62 mmHg. vs 64.77±5.9 mmHg. in group 1 (P <0.0001). Body mass index was normal in 37 women (84%) with normotension, while all pregnant women (100%) with GAG were overweight (n=14; 46.6%) and obese (n=16; 53.4%) respectively. Analysis of central hemodynamic parameters did not reveal any signs of cardiac remodeling (LVH, LVDD). Echocardiography did not reveal any statistically significant deviations. But in pregnant women with GHTN, signs of endothelial dysfunction were revealed according to the results of the cuff test ^D (%) was 7.93 ± 2.03 versus 10.97 ± 2.73 (P < 0.0001).

Conclusion:
According to the results of this study, initial manifestations of diastolic dysfunction were identified among pregnant women with GHTN who are overweight.
P206 ANALYZING ATTRITION POINTS IN INDONESIA'S HYPERTENSION CARE CASCADE: STUDY OF 200,000 POPULATION FROM 2013-2018
Authors: Muharram Farizal Rizky 
Published: September 2024

Background:
According to NCDRisC, Indonesia ranks as the worst performer globally in hypertension control, with control rates of 5.1% for females and 3.6% for males, despite having an income level with better potential outcomes. Hypertension is a leading risk factor for cardiovascular disease (CVD), and its management is critical for reducing major CVD risks. This study aims to identify the significant attrition points in the hypertension care cascade in Indonesia, focusing on identifying where the most significant drop-offs occur at each stage.

Methods:
The study utilizes data from the 2018 Indonesian Basic Health Research (RISKESDAS), a nationally representative health survey sample of ∼1 million individuals. The hypertension care cascade was divided into stages: prevalence, diagnosis, treatment, and control. Descriptive statistics and attrition analysis were used to analyze the data.

Results:
Indonesia managed to diagnose 29.6% of its hypertensive population and treat 23.4%, yet only 4.4% achieved control over their condition. Between 2013 and 2018, diagnosis rates slightly decreased from 33.5% to 29.6%, while treatment rates significantly improved, doubling from 10.7% to 23.4%. Control rates modestly improved by ∼60% from 2013 to 2018, from 2.6% to 4.4%. The diagnostic phase showed the highest attrition, with over 70% of the hypertensive population undiagnosed. Improvement in diagnosed-to-treated performance was observed, with conversion rates increasing from 32% in 2013 to 79% in 2018. However, the treatment-to-control conversion remained low at 18%, indicating that 19% of the treated hypertensive population did not achieve control. Huge care gaps are shown in males vs females (Figure 1). Overall, more than 95% of the hypertensive population remains uncontrolled.

Conclusion:
The most significant drop in the hypertension care cascade occurs at the diagnostic phase, where over 70% of the hypertensive population remains undiagnosed. Despite improvements in treatment rates, the conversion from treatment to control remains low. Addressing the diagnostic gap is critical for enhancing hypertension control and reducing CVD risks in Indonesia.
P207 MAY MEASURE MONTH 2022 AND 2019: AN ANALYSIS OF BLOOD PRESSURE SCREENING RESULTS PRE COVID-19 AND POST COVID-19 FROM ULAANBAATAR, MONGOLIA
Authors: Myanganbayar Maral , Davaadamdin Orkhonselenge , Badamsambuu Tuyajargal , Erdenebat Solongo , Beaney Thomas , Poulter Neil R , Dashtseren Myagmarsuren , Dashdorj Naranjargal 
Published: September 2024

Background:
Mongolia has experienced high mortality rates from ischaemic heart disease and haemorrhagic stroke, with hypertension as a major risk factor. Two separate hypertension screening campaigns were conducted: the May Measurement Month (MMM) campaign in May 2019 and a follow-up campaign after the COVID-19 pandemic between July and September 2022.

Methods:
The 2019 MMM campaign involved screening at 80 sites, primarily workplaces, using trained health volunteers. Blood pressure was measured using clinically verified digital devices. In contrast, the 2022 campaign was conducted at five primary healthcare centers in Ulaanbaatar, with participants voluntarily attending the screening, where blood pressure was measured over three sessions.

Results:
In 2019, 6522 individuals were screened, with a hypertension prevalence of 32.5%, where 62.2% were aware of their condition and 50.1% were on medication. The control rate among those treated was 27.1%. In 2022, 1774 individuals were screened, showing a higher prevalence of 56.1%, with 95.4% awareness and 52.7% receiving treatment. The control rate for treated individuals was significantly higher at 48.5%.

Conclusion:
Both campaigns highlight the critical public health issue of hypertension in Mongolia. The increase in hypertension awareness and control rates in 2022 may be due to smaller sample size and participants are already patients who came to visit primary healthcare centers.However, the persistent high prevalence of hypertension underscores the need for continued prioritization and enhanced strategies in hypertension management.
P216 STUDY OF BLOOD PRESSURE VARIABILITY DURING DIFFERENT PHASES OF MENSTRUAL CYCLE IN APPARENTLY HEALTHY FEMALES
Authors: Bajpai Manish , Singh Shweta 
Published: September 2024

Background and Objective:
Variability is an intrinsic property of blood pressure and is essential for physiological adaptability, blood pressure variability can be spontaneous and especially striking during physical activity and emotional and hormonal challenges like menstruation.

Methods
30 Females in the age group 18 to 35 years having regular ovulatory cycles, not undergoing any medication were included in the study.
Blood pressure variability was measured by Ambulatory blood pressure monitoring using ABPM machine (A&D Japan). for 24 hours at midpoint of menstrual, proliferative and luteal phases of menstrual cycle considering ovulation on (X-14) where X is the last day of menstrual cycle.

Observation:
In the menstrual phase, mean systolic B.P.is 103.8 mm of Hg SD +/- 15.25, proliferative phase mean is 105.41 mm Hg, SD +/- 7.33 luteal phase mean is 124.13 mm Hg, SD +/- 10.6.(P < 0.001).
Comparison of mean changes in diastolic blood pressure between menstrual, proliferative and luteal phase shows mean of 63.6 mm Hg SD +/- 15.75, 68.4 mm Hg SD+/- 5.66 and 76.32 mm Hg SD +/- 6.7. (P < 0.001) respectively.
Mean arterial pressure (MAP) in the menstrual phase of 78.03 mm Hg, SD +/- 10.95 proliferative phase 79.91 mm Hg SD +/- 6.34 and luteal phase mean is 89.58 mm Hg +/- 5.49(P < 0.001).
Results-: This study shows that the systolic B.P. tends to rise in the luteal phase, also the diastolic B.P. rises significantly in the luteal phase.
There is marked dipping in the night time blood pressure in all phases when compared to day time blood pressure and the daytime blood pressure is elevated in the luteal phase compared to menstrual and proliferative phases.

Conclusion
Therefore, we can conclude that in luteal phase, the systolic, diastolic blood pressure and mean arterial pressure was significantly higher than the other two phases. The daytime BP was also high in luteal phase compared to other two phases.
P218 MAY MEASUREMENT MONTH 2019: BLOOD PRESSURE VARIABILITY AND ITS RELATIONSHIP WITH HYPERTENSION AND COMORBIDITIES
Authors: Kerr Gabriele , Beaney Thomas , Schlaich Markus , Schutte Aletta , Stergiou George , Poulter Neil 
Published: September 2024

Background and Objective:
Within-visit blood pressure variability (BPV) is a predictor of cardiovascular events, independent of mean blood pressure (BP) levels. This study explored the associations of BPV with hypertension status and comorbidities in May Measurement Month (MMM) 2019 global survey participants.

Methods:
Adults (≥18 years) were surveyed via convenience sampling from 92 countries in May 2019. Each participant had up to three standardized seated BP readings. Participants with incomplete data on age or sex, or any missing BP readings were excluded. Hypertension was defined as having a BP ≥140 and/or 90 mmHg or being treated with BP-lowering medication. Participants were stratified into three groups: normotensive, untreated hypertensives, treated hypertensives, and normotensives. BPV was calculated as the variation independent of the mean (VIM) of the three BP readings. Associations between BPV and each of three conditions (previous stroke, previous myocardial infarction, or diabetes) were modelled using linear regression. Each model was adjusted for mean BP, age, sex, and an interaction term between age and sex.

Results:
Data from 1,128,889 participants were included. The mean age was 45.2 (SD 16.6) years and 51.4% were female. A third (33.6%) of participants were hypertensive, of whom 200,370 (53.2%) were treated. Of non-hypertensive and untreated hypertensive participants, those with a history of stroke, myocardial infarction, or diabetes had lower BPV relative to those without a history of these conditions (Figure). A stronger association was observed for diabetes within untreated hypertensive than non-hypertensive participants. However, amongst treated hypertensive participants, differences in BPV between those with comorbid conditions and those without were smaller than in the other two groups.

Conclusions:
Contrary to expectation, BPV was significantly lower in those with diabetes, or a history of stroke or myocardial infarction, amongst both untreated hypertensives and normotensives. However, among treated hypertensives, BPV was similar between those with or without each comorbidity, suggesting a modifying effect of BP-lowering medication.
P223 BENEFICIAL EFFECT OF ACEI/ARB, BETABLOCKER AND MINERALOCORTICOID RECEPTOR ANTAGONIST IN PATIENTS WITH RECURRENT FLASH PULMONARY EDEMA INITIATED ON HEMODIALYSIS FOR END STAGE RENAL FAILURE
Authors: Rajaratnam Krishnan 
Published: September 2024

Background and Objectives:
Recurrent flash pulmonary edema is a rare manifestation of ESRF commencing hemodialysis, necessitating more frequent dialysis. Recurrent flash pulmonary edema is seen in renal artery stenosis and rarely in chronic kidney disease. Objective of the study is look for any possible contributory factors for recurrent flash pulmonary edema in patients with ESRF initiated on hemodialysis; and the potential role of ACEI/ARB, β blockers and MRA in controlling episodes of flash pulmonary edema.

Methods:
All patients initiated on hemodialysis from January 2020 to December 2023 were studied in detail; including ECHO cardiography and renal ultrasound doppler. Patient were divided in to 2 groups based on absence or presence of recurrent flash pulmonary edema (Group A and Group B).Group B further divided in to Group C and D. Group C were treated with ACEI/ARB, β blocker and MRA in addition to nitroglycerine infusion and hemodialysis. Group D were given usual anti hypertensives nitroglycerine infusion and hemodialysis as per requirement. Group C and D were followed up for 2 months and evaluated for the final out come.

Results:
238 patients were initiated on hemodialysis during the period of 3 years. 18 patients (7.56%) presented with recurrent flash pulmonary edema (Group B) and 220 patients (92.44%) comprised Group A. Patients in Group B had more severe LVH, left ventricular diastolic dysfunction (LVDD) PAH and accelerated hypertension. None of the patients had renal artery stenosis. At the end of 2 months patients in Group C (9 patients) were free from recurrent flash pulmonary edema compared to Group D (9 patients)

Conclusions:
Recurrent flash pulmonary edema is a rare manifestation of ESRF. Renal artery stenosis was not seen in our patients. LVH, LVDD due to uremic cardiomyopathy and accelerated hypertension due to RAAS activation may be the contributory factors. Treatment with ACEI/ARB, β blockers and MRA may help in controlling episodes of flash pulmonary edema.
A Scalable Advising Model for Part-Time, Distant Learners in Graduate Health Professions Education Programs
Authors: Meyer Holly , Wildermuth Annie , Melton John , Durning Steven J. , Martin Paolo C. 
Published: September 2024

Abstract

Problem
There is a need within graduate health professions education (HPE) programs to align advising practices to support an increasing number of working adult learners, especially those studying part-time and from remote locations. Despite the recognized importance of the advisor–advisee relationship in graduate learner success, many advisors lack formal training and have to manage multiple completing priorities. Furthermore, a lack of established evidence-based practices for graduate HPE advising has left each program navigating advising independently.

Approach
The Department of Health Professions Education, Uniformed Services University, established a small cadre of faculty to serve as academic advisors (n = 7) in August 2018. This cadre uses an advising model based on 5 advising practices, called TOTAL Advising—train the advisors, onboard the learners, touch base frequently, annually review learners, and learner review. These advising practices are meant to provide a wrap-around support system to ensure learners feel empowered to fully engage in the program while managing the demands of their personal and professional lives. TOTAL Advising provides the framework needed to achieve 3 guiding beliefs: each learner is capable of completing the program, fostering community, and providing clear communication.

Outcomes
Between May 2020–May 2024, learners who completed a degree (n = 21) were interviewed about their advising experiences by a program evaluator after they graduated. The themes observed from these reflect the program’s 3 guiding beliefs. Additionally, from May 2018–May 2024, of the 574 learners who enrolled in the program, 568 (99%) graduated with a certificate or degree, only 6 (1%) were disenrolled.

Next Steps
The next steps for TOTAL Advising involve a comprehensive evaluation of the effectiveness of the training program for advisors and collaborating with other graduate HPE programs to share best practices in advising, discuss emerging challenges, and shape advising practices in the broader HPE community.
Mortality Risks and Causes in Previous Carbon Monoxide Poisoning: A Nationwide Population-Based Cohort Study*
Authors: Ahn Gyo J. , Lee Solam , Heo Yeon-Woo , Cha Yong S. 
Published: September 2024

OBJECTIVES:
Carbon monoxide (CO) poisoning can cause brain, heart, and kidney injuries. We aimed to determine the association of risks of all-cause and cause-specific mortality in patients with previous CO poisoning.

DESIGN, SETTING, AND PATIENTS:
This population-based cohort study used data from the National Health Insurance Service database and the National Death Registry of Korea. Adult patients diagnosed with CO poisoning and controls between 2002 and 2020 were included. Patients were matched with controls on a 1:1 ratio, considering age, sex, insurance type, income level, residential location, smoking status, alcohol consumption, obesity status, medical and psychiatric illness history, and Charlson Comorbidity Index at the index date. The cohort was monitored from 2002 to 2022 or until death or emigration in terms of all-cause and cause-specific mortality.

INTERVENTIONS:
None.

MEASUREMENTS AND MAIN RESULTS:
A total of 48,600 patients with CO poisoning and matched controls were included. The cohort included 41.30% females, and the mean age was 48.05 years. Patients with CO poisoning exhibited a substantially elevated risk of all-cause mortality compared with those in the control group, with an adjusted hazard ratio (aHR) of 15.67 (95% CI, 12.58–19.51). The mortality associated with infectious (aHR, 6.71; 95% CI, 1.51–29.72), neoplasm/oncologic (aHR, 5.20; 95% CI, 3.39–7.99), endocrine (aHR, 13.44; 95% CI, 1.76–102.70), neurologic (aHR, 7.42; 95% CI, 2.91–18.90), cardiovascular (aHR, 8.97; 95% CI, 5.05–15.93), respiratory (aHR, 17.54; 95% CI, 5.48–56.17), and gastrointestinal (aHR, 24.72; 95% CI, 3.34–182.69) disorders was significantly greater in the former. Deaths due to external causes, including suicide, were significantly higher in the CO poisoning group (aHR, 50.07; 95% CI, 30.98–80.90).

CONCLUSIONS:
Patients with CO poisoning exhibited a heightened risk of all-cause mortality compared with the matched controls. Additionally, the cause-specific mortality risk differed between the groups.
Epineurectomy of extracranial facial nerve trunk for non-flaccid sequelae following Bell’s palsy: a single-arm trial
Authors: Zhao Hua , Cai Xiaomin , Zhang Zhongding , Ying Tingting , Tang Yinda , Wang Haopeng , Wang Baimiao , Li Shiting 
Published: September 2024

Background:
Non-flaccid facial palsy sequelae manifest as sequelae following Bell’s palsy. Currently, there are no effective remedies for addressing this issue. In this study, the authors proposed a new surgical solution, epineurectomy of the extracranial facial nerve trunk, and assessed its safety and efficacy as a potential remedy.

Methods:
In this single-arm trial, adult patients with non-flaccid facial palsy sequelae were enrolled and subjected to epineurectomy of the extracranial facial nerve trunk. The primary efficacy endpoint was the Sunnybrook scores at months 12 postoperatively. The secondary endpoints included non-flaccid facial palsy sequelae symptom scores, such as facial tightness or facial stiffness, facial synkinesis, eye fissures narrowing or difficulty in opening the eyes, House-Brackmann grade scale, and Facial Disability Index.

Results:
A total of 22 patients were enrolled between July 2020 and January 2021. One patient was lost to follow-up. One year after surgery, the Sunnybrook score was 72.0 (63.0–75.0) at 12 months versus 68.0 (58.0–70.8) at baseline. The mean difference was −5.4 (−7.2 to −3.6). The scores of facial tightness or facial stiffness, synkinesis, eye fissures narrowing or difficulty in opening eyes were 0.0 (0.0–1.0), 1.0 (1.0–1.0), 1.0 (1.0–2.0) at 12 months versus 3.0 (1.3–3.0), 2.0 (1.0–2.8), 2.0 (2.0–3.0) at baseline, respectively. The median (IQR) values of the Facial Disability Index physical function were 92.0 (90.0–95.0) at months 12, and the mean difference (95% CI) was −32 (−38 to −26) compared to baseline. The mean difference (95% CI) in the Facial Disability Index social/well-being function between month 12 and baseline was −38 (−46 to −31).

Conclusions:
Epineurectomy of the extracranial facial nerve trunk can effectively and safely alleviate the sequelae of non-flaccid facial palsy.
Point-of-Care Ultrasound for Diagnosis of Mandibular Fracture in a Pediatric Patient
Authors: Venn April M.R. , Rizvi Munaza Batool , Rabiner Joni E. 
Published: September 2024

Abstract
Point-of-care ultrasound has been shown to be effective in diagnosing many types of fractures, including nasal fractures, but it is not commonly used in pediatrics to diagnose mandibular fractures. We describe a case of a mandibular fracture diagnosed by point-of-care ultrasound in the pediatric emergency department. Additional studies are needed in the pediatric population to determine if point-of-care ultrasound can diagnose mandibular fracture rapidly and accurately, expediting diagnosis and potentially minimizing exposure to ionizing radiation in patients with no point-of-care ultrasound evidence of mandibular fracture.