Medical Sciences

Background/Objectives: Although hypertension is linked to oxidative stress, it remains unclear whether this pro-oxidant state persists after achieving recommended blood pressure (BP) control. This pilot study aimed to explore the presence of residual oxidative stress in patients with well-controlled hypertension compared to normotensive individuals. Methods: In this cross-sectional pilot study, 34 adults were enrolled: 20 normotensive controls and 14 patients with well-controlled hypertension (office BP < 140/90 mmHg). Macrovascular status was assessed by ankle–brachial index (ABI), and plasma concentrations of malondialdehyde (MDA), superoxide dismutase (SOD), catalase, tumor necrosis factor-alpha (TNF-α), and interleukin-6 (IL-6) were measured. Hypertensive patients were further stratified by median MDA levels for subgroup analysis. Results: Baseline characteristics, including BP, were similar between groups. However, patients with well-controlled hypertension exhibited significantly higher plasma MDA concentrations compared to normotensive controls (9.91 ± 6.07 vs. 4.73 ± 2.34 µmol/L, p = 0.008). In subgroup analysis, hypertensive patients with high MDA were significantly older (p = 0.03) and showed a trend towards higher systolic BP (p = 0.05) compared to those with low MDA. No significant differences were observed in SOD or catalase activity, ABI, or inflammatory markers (all p > 0.05). Conclusions: Residual oxidative stress—as reflected by increased plasma MDA—persists in patients with well-controlled hypertension. While this oxidative state appears broadly independent of BP when viewed as a whole, it is notably more pronounced in older patients and in those with systolic BP approaching the upper limit of the controlled range. These findings support the need for comprehensive, biomarker-based risk assessment and further investigation into targeted strategies for mitigating persistent redox imbalance in hypertension.

Background/Objectives: Venous thromboembolism (VTE) is the third most common cardiovascular condition, with higher rates among hospitalized patients. The limited efficacy of universal prophylaxis strategies has led to individual VTE risk assessments approaches. The main objective of this study was to assess outcomes in high-risk patients for VTE who receive prophylactic vs. intermediate, weight-adjusted doses of tinzaparin for thromboprophylaxis. Methods: This was a retrospective study assessing adult patients hospitalized with acute medical disease in a tertiary university hospital from January 2022–2024. Patients were included if found to be at high risk for VTE—as this reflected in Padua Prediction Score (PPS) ≥ 4—and received prophylactic versus intermediate dosage of tinzaparin. Data were collected from patients’ files and analyzed using appropriate statistical methods. Results: In total, 286 patients were included, of whom 160 received prophylactic and 126 intermediate tinzaparin dosage. The groups were comparable, except for arterial thrombosis history, central venous catheter presence, and median PPS. Patients receiving prophylactic doses exhibited significantly higher mortality rates (20.62 vs. 7.14, p = 0.002), increased length of stay (LOS) (6 vs. 4, p < 0.001), and prolonged treatment durations (5 vs. 3, p = 0.003) compared to patients receiving intermediate dosages. Univariate analysis revealed significant associations between mortality and tinzaparin dose (OR = 3.38, p = 0.002), age (OR = 1.03, p = 0.017), LOS (OR = 1.07, p = 0.001), PPS (OR = 1.62, p < 0.001), Charlson Comorbidity Index (CCI) (OR = 1.27, p < 0.001), and prior thrombotic events (OR = 2.27, p = 0.028). In multivariate analysis, tinzaparin dose (OR = 2.58, p = 0.035), age (OR = 1.04, p = 0.033), LOS (OR = 1.10, p < 0.001), and PPS (OR = 1.33, p = 0.038) remained independent predictors of mortality. Conclusions: These findings reveal that intermediate tinzaparin dosing is a more effective and safe approach in high-risk for VTE hospitalized patients, emphasizing the need for personalized VTE management.

Background and objectives: Pain neuroscience education (PNE) is a therapeutic strategy aimed at reconceptualizing pain in patients with chronic low back pain (CLBP). This systematic review with a meta-analysis (SRMA) aimed to assess the effectiveness of PNE in reducing pain, disability, kinesiophobia, and catastrophizing in patients with CLBP at the end of the intervention, and at 1 and 3 months of follow-up. Materials and Methods: Following PRISMA guidelines, an SRMA was conducted after searching in PubMed Medline, Scopus, Web of Science, and PEDro databases from inception up to June 2025. The inclusion criteria agreed with the PICOS tool: population (patients with CLBP), intervention (PNE), comparator (physiotherapy or non-intervention), outcomes (pain, disability, kinesiophobia, and catastrophizing), and study design (randomized controlled trials (RCTs) and pilot RCTs). The PEDro scale was used to assess the methodological quality and risk of bias of the RCTs included. The pooled effect was assessed using the Cohen standardized mean difference (SMD) and its 95% confidence interval (95% CI) in a random-effects model. Results: Fifteen RCTs, including data from 810 patients (43.7 ± 5.2 years; 61% female) with CLBP were included. The mean methodological quality of the RCTs included was good (6.8 ± 1.1 on the PEDro scale). Selection, performance, and detection were the most important biases identified. Our meta-analysis demonstrated, at the end of the intervention, and at 1 and 3 months of follow-up, respectively, that PNE is effective in reducing pain intensity (SMD = −0.65, p = 0.005; SMD = −1.1, p < 0.001; SMD = −1; p < 0.001), disability (SMD = −0.6, p = 0.009; SMD = −0.78, p = 0.002; SMD = −0.84; p = 0.004), and kinesiophobia (SMD = −1.12, p < 0.001; SMD = −1.51, p < 0.001; SMD = −1.57; p = 0.001). In reducing catastrophizing, PNE was largely effective at the end of intervention (SMD = −0.9, p = 0.016) and at 1 month of follow-up (SMD = −1.36, p = 0.007). Conclusions: Our findings demonstrate that PNE is an effective therapeutic approach for the management of CLBP, reducing pain, disability, kinesiophobia, and catastrophizing in patients with CLBP.