bluuebunny/crossref_metadata_2025_split huggingface dataset:
CHANGES IN BLOOD COUNT INDUCED BY DOXAZOSIN TREATMENT IN SUBJECTS WITH PHEOCHROMOCYTOMA
Authors: Zelinka Tomas , Petrak Ondrej , Waldauf Pavel , Michalsky David , Novak Kvetoslav , Widimsky Jiri 
Published: June 2023

Objective:
Not only pre-treatment with with alfa-receptor antagonists and high-sodium diet, but also intravenous fluid administration immediately before surgery are recommended to minimalize per- and postoperative complications in subjects with pheochromocytoma or paraganglioma (PPGL). Aim of this study was to search for changes in blood count induced by doxazosin.

Design and method:
We studied PPGL subjects treated with doxazosin before operation and approximately one year after tumor removal. We measured count of blood elements – leukocytes, erythrocytes, thrombocytes, and hemoglobin level before initiation of treatment with doxazosin, during the treatment, and after tumor removal. Diagnosis of PPGL was based on elevated levels of plasma metanephrines preoperatively and was confirmed by histopathology.

Results:
In this retrospective study, we included 40 subjects with PPGL (15 males and 25 females, 51.8±14 years). Average doxazosin dose was 3.4±1.6 mg and median of duration of doxazosin treatment was 41 (25; 55) days. Leukocyte count decreased from 8.5±2.8 G/L to 7±2 G/L (P<0.001) after doxazosin treatment and to 6.5±1.6 G/L/l (P<0.001 vs. preoperatively) after surgery. Erythrocyte count decreased from 4.7±0.5 T/L to 4.3±0.5 T/L after doxazosin treatment (P = 0.01) and returned back after surgery: 4.6±0.3 T/L (P = 0.04 vs. after doxazosin). Similar results were found for hemoglobin levels: decrease from 140±15 g/L to 130±16 g/L (P<0.001) after doxazosin and increase after surgery to 140±14 g/L (P<0.001 vs. after doxazosin), and for hematocrit values: decrease from 0.42±0.04 to 0.39±0.04 (P<0.001) after doxazosin and increase after surgery to 0.41±0.05 (P<0.001). Platelets decreased significantly from 296±75 G/L to 263±78 G/L (P<0.001) after doxazosin and to 239±63 G/L after tumor removal (P = 0.02 vs. after doxazosin).

Conclusions:
These data show that doxazosin pretreatment before surgery was accompanied with a significant decrease in red blood cell count, and hemoglobin level and hematocrit compared to values before initiation of doxazosin treatment and after surgery (the highest decrease of hemoglobin value after doxazosin was almost 30 g/l). We conclude that routine fluid administration before PPGL surgery is not supported by presented data.
WHEN HYPERTENSION IS RESISTANT WE THINK IT OVER!
Authors: Torin Gioia , Cuppini Stefano , Zattoni Luca , Ricciardi Costantino , Camerotto Alessandro , Shafiei Vennus , Mazza Alberto 
Published: June 2023

Objective:
Hypertension is defined as resistant when the treatment strategy fails to lower office SBP and DBP values to <140 mmHg and/or <90 mmHg, respectively, and the inadequate control of blood pressure is confirmed by ABPM or HBPM in patients whose adherent to therapy. We report a case of resistant hypertension of a 64-year-old woman who referred to our Center in August 2021 for uncontrolled BP (160/94 mmHg) despite anti-hypertensive treatment with ramipril/hydrochlorothiazide 5/25 mg, atenolol 50 mg, ramipril 5 mg and lacidipine 4 mg daily and mild hypokalaemia (3.3 mmol/L).

Design and method:
Clinical history revealed dyslipidemia in treatment with simvastatin 20 mg/daily, osteoporosis in treatment with calcium and vitamin D supplements, parathyroid nodules in follow-up,family history of CAD.
Laboratory tests confirmed hypokalaemia (3.1 mmol/L). Blood glucose, creatinine,lipids thyroid function were normal; no proteinuria was observed. The echocardiogram showed left ventricular hypertrophy with EF 60% and grade-1 diastolic dysfunction.

Results:
After wash-out of anti-hypertensive drugs, the screening tests revealed high aldosterone plasma levels (1166 pg/mL) and low renin level (1.6 microu/mL) with an ARR of 729. Other adrenal hormone levels were within normal limits. The saline infusion test confirmed the hyper-aldosteronism and an abdominal CT scan revealed a left adrenal neoformation of 17 x 15 mm in seize (Figure 1A).
The patient underwent adrenal venous sampling which did not show lateralization and patients refuse to repeat the procedure. Anti-hypertensive therapy with spironolactone, eplerenone, canrenone and amiloride was stopped due to diarrhoea and rectal tenesmus (colonscopy excluded microscopic colitis). A 131I-norcholesterol adrenal scintigraphy with dexamethasone suppression documented early uptake only in the left adrenal gland (Figure 1B).
After surgical evaluation, the patient underwent a video-laparoscopic left adrenalectomy and the histological examination revealed an adrenal cortical adenoma. The post-operative course was complicated by a syncopal episode due to hypotension (80/50 mmHg) with head injury for which antihypertensive therapy was revised and at the discharged she takes valsartan 80 mg, verapamil 40 mg twice.

Conclusions:
Primary aldosteronism intolerant to potassium-sparing diuretics and aldosterone antagonists is a rare condition and the establishment of a multidisciplinary team can improve its management.
A 120-MINUTE SALINE INFUSION TEST FOR THE CONFIRMATION OF PRIMARY ALDOSTERONISM
Authors: Golani Tiran , Bleier Jonathan , Kaplan Alon , Hod Tamar , Sharabi Yehonatan , Leibowitz Avshalom , Grossman Ehud , Shlomai Gadi 
Published: June 2023

Objective:
Saline infusion test (SIT) for confirmation of primary aldosteronism (PA) traditionally requires two liters of normal saline and is 240 minutes long. Previous studies have raised concerns regarding increased blood pressure (BP) and worsening hypokalemia during and after SIT. Therefore, we aim to evaluate the diagnostic applicability of a shorter, one liter 120-minute-long SIT.

Design and method:
A cross-sectional study, including all consecutive patients with suspected PA who underwent SIT from 1st January 2015 to 31st December 2022 in a large, tertiary medical center in Israel. Blood samples were drawn for renin and aldosterone at baseline (t = 0), after 2 hours (t = 120 min), and after 4 hours (t = 240 min) of saline infusion. Receiver-operator curve (ROC) analysis was used to evaluate the sensitivity and specificity of various aldosterone cutoff values at t = 120 for the confirmation of PA. Logistic regression was performed to analyze the association of baseline variables and aldosterone levels after 120 minutes and after 240 minutes.

Results:
The final analysis included 55 patients. ROC analysis with an area under the curve (AUC) of 0.97 (95% CI [0.93, 1.00], P < 0.001) demonstrated 90% specificity and 92% sensitivity for an aldosterone cutoff value of 342 pmol/L at t = 120 to confirm PA. 45% (25/55) of patients did not suppress aldosterone levels after 240 minutes, of them 92% (23/25) did not suppress aldosterone at t = 120 according to the 342 pmol/L cutoff. Univariate analysis showed that male sex, hypokalemia, and elevated systolic BP were all associated with failure to suppress aldosterone levels below the traditional threshold for PA confirmation at t = 240 (i.e. <276 pmol/L), as well as below 342 pmol/L at t = 120. Mean systolic BP (SBP) at t = 0 was 139.9±21.2 mm/Hg and increased to 146.2±14.1 mm/Hg (p = 0.016) during the SIT.

Conclusions:
We present data showing that an aldosterone cutoff of 342 pmol/l at t = 120 has both high sensitivity and specificity for PA diagnosis confirmation.
HYPERTENSION AND HYPERALDOSTERONISM
Authors: Oliveira Monica Amorim de , Amaral Antonio , Tamiozzo Joao Felipe , Cleto Bernardo , Pedroso Ana Carolina , Figueiredo Caio , Pedro Flavia Moises , Buchsbaum Diana , Garcia Thaisa , Godomiczer Alessandra , Vieira Claudio , Marcondes Andre , Lamback Elisa , Ferraz Cristiane , Haddad Andrea 
Published: June 2023

Objective:
describe the importance of investigating secondary hypertension in cases of hypertension that is difficult to control through clinical signs

Design and method:
Case Report: Patient R.A., female, 47 years old, hypertensive for seventeen years appears in the emergency department with a report of a hypertensive peak in a periodic consultation. At the time she was asymptomatic with a blood pressure of 260 x 120 mmHg. The electrocardiogram showed sinus rhythm with reduced T wave amplitude, increased U wave amplitude, and increased QT interval. The laboratory test showed hypokalemia associated with metabolic alkalosis, and slight elevation of renal slag.

Results:
The investigation of arterial hypertension secondary to primary hyperaldosteronism was initiated with plasma aldosterone dosage and plasma renin activity, showing an AP/ARP ratio > 100 ng/mL/h. Computed tomography of the abdomen and pelvis showed adenoma in the right adrenal, which was resected laparoscopically.
One month after hospital discharge, the patient returns to the emergency room with nausea, vomiting and general malaise. Laboratory with hyperkalemia and worsening of renal function. At this moment, the patient was using a potassium-sparing diuretic, considered as a possible cause of the disorder, since other tests performed did not show any alteration. The diuretic was discontinued, with clinical and laboratory evolutionary improvement. The patient is discharged from hospital, with adequate blood pressure control and stable renal function.

Conclusions:
Primary hyperaldosteronism is a clinical condition determined by excessive production of aldosterone, caused by bilateral adrenal hyperplasia or unilateral adenoma.
Hyperaldosteronism is suspected when we observe hypertension associated with difficult control, hypokalemia, adrenal incidentaloma. The investigation continues through serum levels of aldosterone and renin activity, as well as imaging tests, such as computed tomography.
Laparoscopic surgery is indicated, with a success rate between 30-60%. It is important to emphasize that regular follow-up after the surgical procedure is essential to control blood pressure, with the aim of preventing the progression of renal hypertensive disease.
DELAYED DIAGNOSIS OF PRIMARY ALDOSTERONISM IN PATIENTS WITH HYPOKALEMIA: CLINICAL COURSE AND ASSOCIATED FACTORS
Authors: Gupta Gaytri , Teo Ada , Loh Lih Ming , Seyed Ehsan Saffari , Kek Peng Chin , Puar Troy 
Published: June 2023

Objective:
PA is a common and curable cause of hypertension. However, diagnosis is often delayed, leading to poorer clinical outcomes. Presence of hypokalemia, with hypertension, is characteristic of PA, and is an indication for screening. We evaluated if patients with PA had prolonged hypokalaemia before PA screening, the subsequent clinical course, and factors associated with delayed diagnosis.

Design and method:
Our retrospective study included all PA patients with hypokalemia diagnosed between 2001 to 2022. Delayed diagnosis was defined as duration of hypokalemia of >1 year from first occurrence, to first evaluation by a PA specialist. Patients who underwent unilateral adrenalectomy were assessed using the Primary Aldosteronism Surgery Outcomes criteria. We performed multivariable analysis to assess for factors associated with delayed diagnosis.

Results:
Of 240 newly diagnosed PA patients with hypokalemia, 122 (51%) patients had prolonged hypokalemia, with a median duration 4.5 (2.3 – 7.5) years. Patients with delayed diagnosis were older, had longer duration of hypertension, poorer renal function and more frequent cardiovascular disease. A lower proportion of patients with delayed diagnosis underwent adrenal vein sampling (58% vs 73%), P<0.05, adrenalectomy (32% vs 51%), P<0.05, and eventually achieved partial/complete clinical success post-adrenalectomy (21% vs 37%), P<0.05, compared to those with early diagnosis. Factors associated with delayed diagnosis included older age, presence of hyperlipidemia, and less severe hypokalemia (serum potassium >3mmol/L).

Conclusions:
Despite manifestation of hypokalaemia, many patients with PA fail to be promptly screened. Greater emphasis in hypertension guidelines, and efforts to improve awareness amongst primary care physicians are urgently needed.
MICROVASCULAR ENDOTHELIUM FUNCTION RESPONSE TO N-3 POLYUNSATURATED FATTY ACIDS, VITAMIN E, SELENIUM AND LUTEIN ENRICHED FUNCTIONAL FOOD IN PATIENTS WITH CHRONIC CORONARY SYNDROME
Authors: Stupin Ana , Curic Zeljka Breskic , Masle Ana Marija , Susnjara Petar , Kolobaric Nikolina , Mihaljevic Zrinka , Jukic Ivana , Kibel Aleksandar , Selthofer-Relatic Kristina , Juranic Brankica , Drenjancevic Ines 
Published: June 2023

Objective:
Ischemic heart disease is the leading cause of death at a global level. A healthy lifestyle, and especially a healthy diet, can have the effect of reducing the risk of subsequent cardiovascular events and mortality. The aim of this study was to examine the effect of hen eggs enriched with n-3 polyunsaturated fatty acids (n-3 PUFAs), vitamin E, selenium and lutein consumption on oxidative stress level and microvascular endothelium function in patients with existing chronic coronary syndrome (CCS).

Design and method:
A total of 30 patients (9 women and 21 men) with existing CCS participated in this study. The participants were divided in two groups; Control group (N = 15) who ate three regular hen eggs per day (n-3 PUFAs 146 mg, vitamin E 0.595 mg, selenium 0.0183 mg, lutein 0.11mg/per egg), and Nutri4 group (N = 15) who ate three enriched hen eggs per day (n-3 PUFAs 432 mg, vitamin E 1.098 mg, selenium 0.0191 mg, lutein 0.616 mg/per egg) for three weeks. Peripheral microvascular reactivity in response to vascular occlusion (PORH), and iontophoresis of acetylcholine (AChID) and sodium nitroprusside (SNPID), as well as serum lipid and fatty acids profile, pro- and anti-inflammatory cytokines level, as well as biomarkers of oxidative stress and antioxidant capacity were measured before and after the respective diet protocol.

Results:
Consumption of Nutri4 eggs significantly decreased serum triglycerides levels and n6/n3 PUFAs ratio, decreased levels of cytokines IL-17A and TGF-1beta, and improved endothelium-dependent microvascular PORH and AChID, but not endothelium-independent response in patients with CCS. Consumption of both Nutri4 and regular hen eggs did not affect biomarkers of oxidative stress and antioxidant capacity in CCS patients.

Conclusions:
Consumption of hen eggs enriched with n-3 PUFAs, vitamin E, selenium and lutein for three weeks induced an anti-inflammatory response, a favorable effect on lipid and fatty acids profile, especially on triglycerides levels and n6/n3 PUFAs ratio, as well as an improved endothelium-dependent peripheral microvascular reactivity in patients with CCS.
SOCIAL DEPRIVATION AND PRE-ECLAMPSIA RECURRENCE: THE NATIONWIDE CONCEPTION STUDY
Authors: Lailler Gregory , Grave Clémence , Gabet Amélie , Regnault Nolwenn , Deneux-Tharaux Catherine , Kretz Sandrine , Tsatsaris Vassilis , Plu-Bureau Geneviève , Blacher Jacques , Olié Valérie 
Published: June 2023

Objective:
The recurrence rate of pre-eclampsia in a subsequent pregnancy ranges between 10 and 20% in the literature. We aimed to study the association between social deprivation and the prevention and recurrence of preeclampsia.

Design and method:
All women of the nationwide Conception study (elaborated from French National Health Insurance Information System) who gave birth for the first time in France in 2010-2018, and who subsequently gave birth in the same period were included. Pre-eclampsia was identified through hospital diagnoses. Aspirin deliveries during the second pregnancy were collected to assess the rate and timing of initiation, and the treatment adherence. All medical consultations in the year before the beginning of their second pregnancy and until 20 weeks of gestation were identified. Women who benefitted from Universal Medical Coverage providing free access to health care for people with an annual income less than 60% of the poverty threshold were defined as living in social deprivation. The adjusted incidence rate ratios (aIRR) of preeclampsia during the second pregnancy were estimated using Poisson models adjusted for confounding

Results:
Of the 2,829,274 women included, 31,956 (1.9%) were diagnosed with a pre-eclampsia during their first pregnancy. From those, 4,697 (14.7%) had recurrent pre-eclampsia during the second pregnancy. Women living in social deprivation had more cardiovascular risk factors, were less likely to consult a physician in the year before and until 20 weeks of gestation (90.3% vs 97.5%), to receive prescribed aspirin at least once during their second pregnancy (33.7 vs 45.7%), to begin the treatment before 16 week of gestation (81.4 vs 90.7% among those receiving at least one delivery of aspirin during pregnancy), and to be adherent to therapy throughout the pregnancy (44.6 vs 55.9%). In multivariate analyses, women living in social deprivation were less likely to initiate aspirin during the second pregnancy (aIRR = 0.74 [0.70-0.78] and had a higher risk of pre-eclampsia recurrence (aIRR = 1.31 [1.28-1.33]).

Conclusions:
Greater efforts should be made to improve the medical monitoring and prevention strategies of socially deprived women with pre-eclampsia because of their high risk of recurrence.
HYPERTENSION AND SOCIAL STATUS
Authors: Oliveira Monica Amorim De , Rey Helena Cramer Veiga 
Published: June 2023

Objective:
To describe socioeconomic data in patients treated at a basic health unit in developing countries and their relationship with arterial hypertension

Design and method:
Prospective cohort of 1000 patients over 18 years selected in 21 primary care units in the city of Rio de Janeiro. At the initial consultation, the clinical form was filled out, in which medical history, socioeconomic variables, data on life habits and functional assessment were documented. Weight and height were measured at the initial visit, and, from these data, the Body Mass Index (BMI) was calculated in Kg/m2. The definition of hypertension was based on data from medical records.

Results:
The higher the level of education, the lower the proportion of SAH. Most patients had, as shown in table attached, primary education (53.83%). It was more frequent to find non-literate individuals among hypertensives (3.9%) than non-hypertensives (2.6%), with statistical significance. A higher proportion, also with a statistically significant difference, of patients with secondary education (40.44%) and higher education (15.1%) was found among non-hypertensive patients than among hypertensive patients (31.1% and 6.1% respectively). .
The vast majority of the sample receives even less than two minimum wages. This can be seen in table attached. It was found that the higher the family income, the lower the proportion of hypertensive individuals.

Conclusions:
It was verified in the current project that about 60% of the hypertensive population had an income of up to two minimum wages and also an inverse relationship between the level of education and the prevalence of SAH. Low educational level and low economic power, mainly in middle and low-income countries, are even associated with a higher risk of cardiovascular disease.
PRACTICES OF HOME BLOOD PRESSURE MEASUREMENT AND E-HEALTH: REAL-LIFE DATA GENERATED BY THE HY-RESULT APP
Authors: Postel-Vinay Nicolas , Gebara Nicole , Freminville Jean Baptiste , Bobrie Guillaume , Lorthioir Aurelien , Amar Laurence 
Published: June 2023

Objective:
To evaluate quality of Home Blood Pressure Measurement (HPBM) data generated in real-life circumstances by Hy-Result software, a validated App designed to help patients to: perform HBPM according to a standardized protocol; understand their results; share their readings in a PDF format report.

Design and method:
We analyzed 19,176 HBPM reports collected in real-life. Each report was generated by patients who self-measured BP (3 morning, 3 evening) for 1 to 7 consecutive days. Reports totaled over 51,000 BP (SBP)/Diastolic (DBP) readings. Data was generated through App used in-home, by patients following a self-management protocol. Reports are grouped according to two criteria: i) whether generated by “PRIMARY care users” (who find the app on internet or following the recommendation of their practitioner) and “TERTIARY patients” using the app per recommendation of ESH hypertension center; ii) whether patients were receiving antihypertensive drugs or not. The patient reported outcomes are saved in a secured database.

Results:
Mean age of users was 62 years (62.1 (+/- 13.1), and 63 % of reports (12,117) declared receiving hypertension drugs (Tab 1). PRIMARY were younger, less severely hypertensive, were receiving less treatment and suffered from fewer comorbidities (diabetes, stroke, kidney disease) than TERTIARY (Tab 2).
HBPM schedule: Tab. 3, show compliance with monitoring schedule. Reports are considered adequate for medical analysis if patients proceed to a minimum of 15 consecutive measurements for at least 3 days.
HBPM oscillometric devices: Upper arm cuff devices are declared by 81 % of PRIMARY reports and 93 % of ESH CENTER. Treated patients used more frequently the recommended monitor than untreated. Furthermore, Therapeutic education in the ESH Center promoted better compliance with the measurement schedule and greater use of humeral devices.

Conclusions:
Through generating 90% of HBPM reports of sufficient quality for medical interpretation in real-life conditions, the Hy-Result app has significant potential for triage in the care pathway of hypertensive patients in primary care settings or in ESH center for hypertension. Out of 19,000 reports, 43% presented PAS and/or PAD > 135/85 and the users were automatically prompted to seek medical advice by the software.
VASCULAR COMPLICATIONS IN LYMPHOCYTIC THYROIDITIS – SONOGRAPHIC FINDINGS
Authors: João Isabel , Almeida Paula , Mateus Sónia , Pós-De-Mina Vanda , Mendes Irene 
Published: June 2023

Objective:
Alert to the ultrasonographic findings of cervical vascular involvement in the context of lymphocytic thyroiditis, since it is a rare situation.

Design and method:
CASE DESCRIPTION: Male patient, 87 years old, caucasian, diagnosed with lymphocytic thyroiditis since 2004, euthyroid, stable until 2019, presenting an enlarged thyroid volume on that date. He has a history of ischemic stroke in 2003. In 2019, he underwent a thyroid ultrasound where the hypothesis of intraluminal thrombus of the right internal carotid artery was raised. The evaluation with cervical vascular ultrasonography revealed an iso-hypoechogenic, heterogeneous image, lining the arterial wall, in the proximal segment of the internal carotid arteries, without hemodynamic repercussions, compatible with a probable inflammatory/fibrous infiltrate, in the context of lymphocytic thyroiditis. Computed Tomography scan of the thyroid and soft tissue confirmed the progression of the adjacent soft tissue infiltrate.

Results:
DISCUSSION: Taking into account the size of the inflammatory changes and the fact that the patient remains euthyroid, it is important to question about a the possibility of an evolution/adjustment of the disease previously diagnosed in 2004 to a new one: Riedel's thyroiditis, also known as an invasive fibrous or sclerosing thyroiditis. Riedel's thyroiditis is a pathological condition with an unknown etiology that causes a fibro-inflammatory infiltrative stated in the 2019 examination. Considering the low prevalence of the pathology, it is important to alert sonographers to the possible vascular complications observed in a supposed Riedel's thyroiditis, in order to make a reliable evaluation and diagnosis of the cervical vascular ultrasonographic findings.

Conclusions:
Regarding the monitoring of lymphocytic thyroiditis, it is just as important to do a periodic evaluation of the dimensions, characteristics of the gland and analytical evaluation of the thyroid function, as it is to monitor the infiltrate of adjacent tissues, namely vascular, to prevent possible serious complications.