bluuebunny/crossref_metadata_2025_split huggingface dataset:
ATHEROSCLEROSIS AND INCIPIENT NEPHROPATHY IN DIABETIC PATIENTS
Authors: Nelaj Ergita , Kecaj Irida , Gjata Margarita , Tase Mihal 
Published: June 2022

Objective:
The association between nephropathy, particularly microalbuminuria, and cardiovascular disease, is becoming increasingly apparent. Atherosclerotic process is a combination of fatty degeneration (atherosis) and of vessel stiffening (sclerosis) of the arterial wall. The aim of the study was to assess relationship between diabetic nephropathy and structural changes in arteries, such as carotid intima – media thickness (IMT).

Design and method:
We selected 80 adults with type 2 diabetes. 47 were women and 33 were men, mean age 51 ± 14. They were divided into three groups based on albuminuria status: Group I = no albuminuria (<30 mg albumin/g creatinine), numbers of patients 27; Group II = microalbuminuria (30 to 300 mg/g) numbers of patients 26; and Group III = macroalbuminuria (>300 mg/g) numbers of patients 27. Albuminuria was measured by collection of fasting random urine specimen on arrival to the clinic, usually in the morning. The IMT was measured by a B-mode ultrasound, 10 MHz transducer.
Each group was evaluated for body mass index (BMI), glycosylated hemoglobin (HbA1C), lipid profile, blood pressure.

Results:
Systolic blood pressure in the II-group was 143.3 ± 15.2mmHg and significantly higher (p < 0.01) than in the I-group (132.5 ± 18.1mmHg) and III-group (139.8 ± 18.9mmHg). No significant differences in age, smoking and kind of antihypertensive agent used were found between three groups. IMT level in the II-group was 1.28 ± 0.35 mm and significantly higher than in the I and III group (1.09 ± 0.28 mm; 1.19 ± 0.44 mm, respectively). There were no significant differences in HbA1C, lipid or serum creatinine between three groups

Conclusions:
The carotid IMT was significantly higher in the patients with microalbuminuria and so, the last one is associated with structural changes in arteries.
SUBCLINICAL VASCULAR DAMAGE IN YOUNG ADULTS WITH TYPE 1 DIABETES MELLITUS
Authors: Marcon Denise , Tagetti Angela , Giontella Alice , Bortolotti Stefano , Bonafini Sara , Piona Claudia Anita , Carletti Lorenza , Trombetta Maddalena , Maffeis Claudio , Fava Cristiano 
Published: June 2022

Objective:
Type 1 Diabetes (T1DM) is a chronic disease, whose prevalence is increasing, especially during childhood. Patients are affected by several complications, including macrovascular complications, that can be diagnosed early as subclinical vascular damage. The aim of our study was to assess possible associations between markers of subclinical arterial damage and traditional cardiovascular risk factors with a special focus on peripheral (pBP) and central blood pressure (cBP).

Design and method:
The study included 172 adolescents (100 male and 72 female) whose mean age was 24,72 ± 8,66 years, mean duration of the disease was 13,45 ± 9,58 years and mean BMI was 23,32 ± 3,22 kg/m2. 40 of the subjects (23,5%) had a BMI > or = 25 kg/m2. Peripheral blood pressure was assessed using a mercury sphygmomanometer. Central blood pressure, PWV and PWA were evaluated with a tonometer (SphygmoCor Xcel). CIMT and carotid distensibility (DC) were measured by a high-resolution echo-doppler analysis, using a 5–13 MHz probe, and then further elaborated with a dedicated hardware (Cardiovascular Suite, Quipu, Pisa, Italia). Finally, several metabolic parameters were measured in plasma.

Results:
In our sample, 17 patients (10,1%) could be classified as hypertensive by sphygmomanometer (systolic and diastolic pBP: pSBP and/or pDBP > or = 140/90mmHg) and 48 patients (27,9%) as hypertensive (cSBP and/or cDBP > or = 130/80mmHg) by central BP estimate. 116 patients (68,8%) had DC under the range of normality and 1 patient PWV (0,6%) above 10 m/sec. Glycaemic control was relatively poor (glycated haemoglobin 7,83 ± 0,98%). In multivariable models, cSBP was associated with markers of subclinical arterial damage [cIMT (beta = 0,288 ± 0,001, p < 0,001), AIx75 (beta = 0,257 ± 0,071, p = 0,001), PWV (beta = 0,374 ± 0,007, p < 0,001), DC (beta = -0,149 ± 0,055, p = 0,029)].

Conclusions:
Among subclinical vascular damage indices, carotid distensibility was the most altered in this sample of young adults with T1DM. But all the investigated markers showed a close association with BP values rather than with the other traditional cardiovascular risk factors. Further studies are warranted to better define the role of BP, especially cBP, in the stratification of cardiovascular risk in T1DM patients.
THE ASSOCIATION OF EGFR AND ALBUMINURIA WITH SYSTOLIC HYPERTENSION IN PATIENTS WITH DIABETES
Authors: Georgianou E. , Markakis K. , Georgianos P. , Zografou I. , Sachinidis A. , Sabanis C. , Doumas M. 
Published: June 2022

Objective:
Large epidemiological studies have shown that the prevalence of hypertension increases in parallel with the staging of chronic kidney disease. However, it remains unclear whether the decline in estimated-glomerular-filtration-rate (eGFR) or the severity of albuminuria is a stronger determinant of systolic hypertension.

Design and method:
In 483 outpatients with diabetes, the eGFR was determined using the CKD-EPI equation and albuminuria was assessed by measuring the albumin-to-creatinine ratio (ACR) in a random urine specimen. Triplicate automated office blood pressure (BP) recordings were obtained with the validated device HEM-705 (Omron, HealthCare) under standardized conditions requiring an at least 5-minute seated rest period in a quiet room.

Results:
The average office systolic BP was 138.3 ± 19.4 mmHg, whereas 69.6% of the patients were being treated with an average of 2.2 ± 1.1 antihypertensive medications daily. In univariate linear regression analysis, office systolic BP was associated with age, body mass index (BMI), antihypertensive drug use, the number of prescribed antihypertensive medications, severity of albuminuria and decline in eGFR. In multivariate analysis, however, it was logUACR (P = 0.022) and not eGFR (P > 0.05) the factor that remained a significant determinant of office systolic BP. Other parameters associated with office systolic BP in the multivariate model were higher age (P = 0.014), BMI (P = 0.012) and the number of prescribed antihypertensive medications (P = 0.045).

Conclusions:
The present study suggests that the severity of albuminuria and not the decline in eGFR is possibly a stronger determinant of systolic hypertension in patients with diabetes.
SGLT2I - A POTENTIAL ANTIHYPERTENSIVE AGENT IN HYPERTENSION PATIENTS WITH TYPE 2 DIABETES MELLITUS
Authors: Doan Long 
Published: June 2022

Objective:
Sodium Glucose cotransporter 2 inhibitor is a class of treatment type 2 diabetes mellitus (T2DM) recently recommended in treatment patient with heart failure. We evaluated the effect of BP lowering of this agent in patients with T2DM.

Design and method:
A prospective study in all hypertensive patients with T2DM admitted to Cardiology Department of Hue Central Hospital between 12/2020 and 05/2021 who had not been treated with SGLT2i. There were 236 patients don’t meet exclusion criterias, in which 110 patients received Dapagliflozin 10 mg daily with OMT and 126 patients received OTM. The patients were followed up at the hospital and 2 months after discharge. Measurement of upper arm blood pressure (BP) with Omron HEM-7121.

Results:
The mean age was 66.77 ± 15.53. The patient had 9 (0–40) year history of hypertension and 5 (0–37) year history of T2DM. The baseline BP was 146.29 ± 19.17 / 83.78 ± 13.1 mmHg, no significant difference in baseline BP in the 2 groups of patients. The results after 2 months showed, in the group of patients in with SGLT2i, there was a significant decrease in the mean SBP value compared with the group of patients with OTM of 5.95 mmHg (95%CI: 2.08 - 9.82, p = 0.003) but the decrease in DBP was not significantly different (95% CI: -0.09 - 5.40, p = 0.058). Subgroup analysis showed that in the group of patients with resistant hypertension, the group of patients using SGLT2i reduced DBP more than the group of patients with OTM by 2.77 mmHg (95%CI: 1.89 - 4.24, p = 0.005) but was not significant for SBP. In contrast, in the group of patients with isolated systolic hypertension, the SBP in the group of patients using SGLT2i decreased more than the group of patients without using SGLT2i about 8.91 mmHg (95%CI: 6.20 - 11.24, p = 0.035). These results were not observed in patients with heart failure and CKD.

Conclusions:
SGLT2i has shown potential to be used as an antihypertensive agent in patients with heart failure and chronic kidney disease and shows dominant efficacy in patients with isolated systolic pressure and resistant hypertension.
DIGITAL INTERVENTIONS TO DRIVE SELF-MANAGEMENT IN PEOPLE WITH HYPERTENSION IN NIGERIA
Authors: Ogboye Ayoposi , Rahman K. M. Jawadur , Odukwe Adaora , Mobisson Nneka 
Published: June 2022

Objective:
To examine whether a higher number of virtual interactions with health coaches through a digital health platform would lead to a greater reduction in blood pressure than people with a lower number of interactions.

Design and method:
The participants were 447 people with hypertension or a baseline blood pressure value of 140/90 mmHg or higher (female, 77.6%. male, 20.8%. Average age 43.9 years) enrolled on the CompleteHealthô platform between April 2018 and April 2021 who had entered a subsequent blood pressure value after 6 months of enrollment. The change in blood pressure was calculated as the difference between their blood pressure after 6 months and their first blood pressure value entered on CompleteHealthô. Engagement after 6 months was defined across two levels: minimally engaged members who had at most 1 interaction with a health coach and highly engaged members who had more than 1 interaction with a health coach. Given that the members are generally low-income people, we determined more than 1 interaction as a significant threshold for engagement.
By enrolling on mDoc Healthcare’s digital platform, CompleteHealthô, people were given access to self-care support via a virtual coach. They tracked their health metrics via the app, were given access to tele-education classes and community forums, and the coach provided health education and digital nudges on healthy behaviours to take, including regular blood pressure checks.

Results:
After 6 months, of the 447 people, 374 (83.7%) were highly engaged while 73 (16.3%) were minimally engaged. Highly engaged members saw an average reduction in their systolic and diastolic blood pressures of 13.6 mmHg and 10.4 mmHg respectively, while minimally engaged members saw reductions of 5.8 mmHg and 4.9 mmHg in their systolic and diastolic blood pressures. Limitations were that this did not take into account asynchronous engagement on the platform e.g. self-tracking, review of education messages etc.

Conclusions:
The results of the retrospective study show that increased engagement with a digital self-care intervention drives a higher reduction in blood pressure for people living with hypertension or an elevated blood pressure level.
PERSON-CENTREDNESS IN HYPERTENSION MANAGEMENT USING INFORMATION TECHNOLOGY (PERHIT): A RANDOMISED CONTROLLED TRIAL IN PRIMARY HEALTH CARE
Authors: Andersson Ulrika , Kjellgren Karin , Hoffmann Mikael , Wennersten André , Nilsson Peter , Midlöv Patrik 
Published: June 2022

Objective:
Few studies address results from use of new technology and patient participation in hypertension management. The PERHIT Study is a multicentre randomised controlled trial with the aim to evaluate the effects of a person-centred approach using a web-based, interactive self-management system through the patient´s own mobile phone on blood-pressure and well-being. Primary aim is the degree of achieved blood pressure (BP) control after eight weeks and one year. In addition, person-centeredness, usefulness, daily life activities in relation to BP values, awareness of risk and health care costs are studied.

Design and method:
The PERHIT study was performed in four regions in southern Sweden. Following inclusion, more than 900 patients from 31 primary health care centres were randomised to two groups. In the intervention group (INT), patients were provided with a web-based self-management support system including a home-BP monitor. For eight consecutive weeks, they measured BP and performed self-reports regarding well-being, symptoms, lifestyle, medication intake and side effects every evening via their mobile phone. They could also receive motivational messages and reminders throughout the intervention period. Both patients and professionals had access to graphic feedback of reported values through a secure web portal. Patients in the control (CON) group received standard treatment as usual.

Results:
The primary outcome (BP < 140/90 mmHg) was achieved by 48.5% and 47.1% in the INT, and by 40.4% and 40.9% in the CON group after 8 weeks (p = 0.016) and 12 months (p = 0.067), respectively. Both patients and professionals experienced the system as a useful resource for communication regarding BP and lifestyle. They described that it could be used to support a constructive and person-centred partnership between patients and professionals.

Conclusions:
Blood pressure control was significantly better after eight weeks, but not after one year, following an intervention based on use of mobile phones, feedback and interaction between patients and primary care professionals compared to standard care. The system can be a tool toward a new way of working and help patients reach a controlled BP and play a role in a more person-centred and individually adapted hypertension management.
TELEMEDICINE AND HEALTH POLICY CHANGES IN RESPONSE TO RESTRICTIONS RELATED TO COVID-19 PANDEMICS IN LATVIA
Authors: Sen Sevinc Elif , Sokolova Emma , Jeniceka Aleksandra , Bikava Ieva 
Published: June 2022

Objective:
Remote consultations are quickly emerging to give more access to real-time, high-quality, efficient, and cost-effective healthcare in the current COVID-19 pandemic.
Objective is to investigate the changing experiences of remote consulting for patients in Latvia and plan effective health policies, to provide a full analysis of the policy for telemedicine applications and solutions based on the current conditions.

Design and method:
Materials and approaches include an examination of normative documents as well as a variety of informational sources. The information offered is mostly based on national strategy papers, official reports, and scientefic publications on Tele-medicine implementation.

Results:
Telemedicine’s range will continue to expand, connecting patients and providers internationally as providers look to expand globally. This will not only help improve the long-term policies about health but may also provide patients with rare diseases alternative avenues to seek highly specialized care. Telemedicine strategy must react faster than ever during the COVID-19 epidemic. Latvia has reacted to Covid pandemics and have noticable implemented new possibilities to provide new approaches provided by telemedicine: providing remote consutlations to patients in different sectors, using E-referrals that were implemented but not sufficiently used before, providing more possibilites to provide remote services also for consiliums, physician-physiscan online consultations. New ICT tools were used for patient remote monitoring. The normative regulation, stategical decisions and changes in long-term policy documents haven’t been changed, so there are limitations to provide the telemedice expansion or stable use after the emengency situation ends. Health policies about telemedicine have another key role with to pursuing that.

Conclusions:
Telemedicine is fast expanding, demand for this service is rising. Although not a replacement for face-to-face consultations, this study illustrates that remote consulting can be an acceptable adjunct to traditional face-to-face consultations. More research is required to identify overall safety and applicability. Digital Health Strategy in Latvia is still on developing stage. Changes or legislation to clarify Telemedicine are still in the process. It is important to provide a good environment for Telemedicine to expand, setting strategies and visions on how those new approaches will be regulating normatively and administratively.
MULTIPLE ENDOCRINE NEOPLASIA TYPE 2A IN A FAMILY WITH RET C.1901G>A AND NOVEL SLC12A3 MUTATIONS
Authors: Zhao Lin , Yang Kun-Qi , Fan Peng , Meng Xu , Zhou Xian-Liang 
Published: June 2022

Objective:
In recent years, there has been a lot of controversy about the factors affecting the penetrance of multiple endocrine neoplasia type 2A(MEN2A). Some studies considered it may be related to gene mutations. In the present study, we aimed to support the hypothesis that RET gene mutation affect the penetrance of MEN2A and study the effects of novel SLC12A3 variants in MEN2A.

Design and method:
Peripheral blood samples were collected from the proband and his relatives. Whole-exome sequencing and Sanger sequencing were performed to identify the gene mutations. The protein structure prediction with comparative modelling was used to predict the effects of novel gene variants on protein function. We also used the clinical examinations to evaluate the phenotypes of patients comprehensively.

Results:
Genetic analysis identified RET c.1901G>A and novel variants in SLC12A3 c.3070_3079delinsCAG in the proband and his mother. The patients carrying the novel SLC12A3 variants didn’t show the typical clinical manifestations of Gitelman syndrome because of heterozygosity. But it is theoretically explained that the novel variants of SLC12A3 may affect the function of protein. We also found SLC12A3 gene was not expressed in typical target organs of MEN2A.We are the first to describe compound RET c.1901G>A and SLC12A3 mutations in one family with MEN2A. Our study supports the hypothesis that RET gene mutations affect the penetrance of MEN2A. The novel variants in SLC12A3 may be disease causing, but it is not significantly related to the clinical phenotype of MEN2A in our study.

Conclusions:
RET gene mutation affect the penetrance of MEN2A. The novel variants in SLC12A3 may affect the function of protein, but it is not significantly related to the clinical phenotype of MEN2A.We need more studies about the phenotypes and related mechanisms of gene mutations to guide individual treatment.
A CASE OF GIANT PHEOCHROMOCYTOMA
Authors: Nelaj Ergita , Kecaj Irida , Gjermeni Ilir , Gjata Margarita , Tase Mihal 
Published: June 2022

Objective:
Pheochromocytomas are rare tumours originating in chromaffin cells which predominantly are located in adrenal glands They are a representation of 0.1%-1% of all cases of secondary hypertension. Pheochromocytoma is the most typical cause of hypertension by promoting hypertension remission in the majority of patients after surgical procedure. Sustained or paroxysmal hypertension is the most frequent sign of pheochromocytoma, possibly associated with the classic triad: episodic headaches, sudoresis and tachycardia. We present a case of giant right adrenal pheochromocytoma.

Design and method:
A 52-year-old female patient presented with nausea, vomiting, mild discomfort at right flank, headache and resistant hypertension. She had unexplained orthostatic hypotension, and could not even get out of bed

Results:
Her ABPM shows an optimal hypertension in 65% of measurements, and a peak of hypertension about 204/110mmHg. The CT scan of head was normal and the CT scan of the abdomen showed a heterogeneous mass lesion between the right hepatic lobe and the right kidney, with central necrosis, dimensions 90x94x93 mm, probable with the origin of the right adrenal gland. Urine catecholamines levels were high, and urine metanephrines were 3-fold higher than the normal ranges.

Conclusions:
After surgery, the patient discharge home with controlled BP without need for antihypertensive medication. At 1-year follow-up, she remained asymptomatic and with normal serum metanephrine values.
CARDIOVASCULAR AND GLUCO-METABOLIC COMPLICATIONS IN PATIENTS WITH PRIMARY HYPERALDOSTERONISM
Authors: Nelaj Ergita , Koci Julinda , Kecaj Irida , Tase Mihal 
Published: June 2022

Objective:
Primary hyperaldosteronism (PA) is an under-diagnosed cause of hypertension. The presentation is classically known to occur in a patient with hypertension and hypokalemia. However, in reality, most patients will present without hyperkalemia. PA is characterized by the development of cardiovascular, renal and metabolic complications, including left ventricular hypertrophy, myocardial infarction, atrial fibrillation and stroke, microalbuminuria, as well as metabolic syndrome. The aim of our study was to assess the metabolic, renal, and cardiovascular alterations, in patients with primary hyperaldosteronism.

Design and method:
It’s a retrospective study with 50 patients with a primary hyperaldosteronism (aldosterone-producing adenoma: n = 34; adrenal hyperplasia: n = 16). In all patients were collected clinical and biological data, as well as electrocardiogram and cardiac ultrasound. Cardiovascular risk was assessed using the ASCVD risk score.

Results:
There were 34 (68 %) women and 16 (32%) men, with a mean age at the diagnosis of hypertension of 41.7 ± 10.9 years. Overweight, obesity, diabetes mellitus, dyslipidemia, and metabolic syndrome were diagnosed in 34, 48, 31, 44, and 71% of cases, respectively. Hypokalemia was present in 30 patients (60 %). Kalaemia was negatively correlated with plasma aldosterone level (P = 0.013). Albuminuria and chronic renal failure were found in 57 and 18% of cases, respectively. The average 10-year ASCVD risk was 18.6 ± 12.4%. It was significantly correlated with age, fasting glucose (P = 0.013), glycated hemoglobin (P = 0.008), triglycerides level (P = 0.005), and creatinine level (P = 0.001). 26% of patients had a low risk, 21% had a moderate risk and 53 % had a high risk. 31% had subepicardial ischemia, 59% had left ventricular hypertrophy and 10% had a low left ventricular ejection fraction. A history of stroke was found in 18% of patients.

Conclusions:
Aldosterone is a key mediator of the cardiometabolic syndrome in primary aldosteronism. PA is associated with a high prevalence of metabolic disorders and renal disease. These complications are significantly associated with cardiovascular risk.