Search Results (14,690)

Background: Thoracic surgery is associated with severe postoperative pain caused by chest wall manipulation and intercostal nerve injury. Multimodal analgesia with non-opioid agents such as lidocaine, ketamine and magnesium might be beneficial for pain control and reduce opioid consumption. Methods: In this prospective cohort study, we recruited 118 consecutive patients who underwent lung resection via thoracotomy from January 2019 to January 2021 at Hospital Universitari de Girona Doctor Josep Trueta. The primary outcome was total intravenous morphine consumption within the first 24 h postoperatively. Multivariable linear regression modeling was used to determine the adjusted association between lidocaine, ketamine and magnesium administration and morphine consumption in the first 24 h after surgery. Statistical analysis was performed using Wilcoxon’s rank-sum and Fisher’s exact tests. Results: In total, 71 patients received lidocaine, ketamine and magnesium intraoperatively (LKM group) while 47 patients did not receive this regimen (non-LKM group). The LKM group had a higher prevalence of hypertension and higher proportions of patients undergoing lobectomy and pneumonectomy. Morphine consumption within 24 h postoperatively was lower in the LKM group than in the non-LKM group (median (interquartile range), 2 (0–6) mg vs. 5 (3–8) mg; p = 0.001). No drug-related adverse events were observed. After multivariable risk adjustment, lidocaine, ketamine and magnesium use was associated with significantly decreased total intravenous morphine consumption within 24 h postoperatively (−1.76, 95% confidence interval = −3.40 to −0.12, p = 0.03). Conclusions: Lidocaine, ketamine and magnesium use was associated with lower 24 h morphine consumption in our prospective cohort. Full article

Background/Objectives: Pulmonary hypertension (PH) is an increasingly recognized complication in patients with end-stage renal disease (ESRD) undergoing hemodialysis, particularly those utilizing arteriovenous fistulas (AVF) or grafts (AVG) for vascular access. The prevalence and clinical impact of PH in this population remain unclear due to methodological heterogeneity and variable diagnostic criteria. This systematic review and meta-analysis aimed to quantify the association between AVF/AVG use and PH prevalence in ESRD patients and to explore sources of heterogeneity. Methods: A systematic search of PubMed, Embase, Scopus, and Web of Science was conducted for studies published through 31 December 2024, without language or date restrictions. Eligible studies included adults (≥18 years) with ESRD on dialysis, comparing those with AVF/AVG access to non-AVF/AVG controls (e.g., tunneled dialysis catheters or peritoneal dialysis), and reporting PH prevalence or mean pulmonary artery pressures. Study quality was assessed using the Newcastle–Ottawa Scale, and risk of bias was evaluated. A random-effects meta-analysis calculated pooled odds ratios (OR) for PH prevalence, with heterogeneity assessed by I² and Cochran’s Q. Sensitivity analyses and tests for publication bias (Egger’s and Begg’s) were performed. Secondary analysis compared pooled mean pulmonary artery pressures between groups. Results: Eleven observational studies (1299 dialysis patients) met the inclusion criteria; ten studies (1224 patients) contributed to the quantitative meta-analysis after exclusion of one study with a zero-event control arm. Most studies were small, predominantly cross-sectional, and of moderate methodological quality. The pooled analysis showed a statistically significant association between AVF/AVG use and PH (OR 2.06, 95% CI: 1.69–2.52), with low statistical heterogeneity (I² = 0%). This estimate was sensitive to individual studies: in leave-one-out analysis the association lost statistical significance when the single most influential study was removed indicating that the pooled result is driven in part by a small number of studies rather than being uniformly robust. No statistical evidence of publication bias was detected. Five studies reported continuous pulmonary artery pressures, which were directionally higher in AVF/AVG patients but were not pooled because of extreme heterogeneity (I² = 99.4%). Conclusions: In this synthesis of observational data, AVF/AVG use was associated with higher odds of pulmonary hypertension than non-AVF/AVG access. Because all included studies were observational and the pooled estimate is sensitive to individual influential studies, these findings indicate a possible association rather than a causal effect and should be interpreted with caution. They support the rationale for prospective hemodynamic studies and for evaluating—rather than presuming the benefit of—PH monitoring and individualized access strategies in higher-risk dialysis patients. Full article

Background and Objectives: Rheumatic diseases confer excess cardiovascular risk, yet prognosis after acute coronary syndrome (ACS) in contemporary angiography-treated care remains incompletely characterized, particularly when psychiatric multimorbidity is considered. We evaluated whether documented rheumatic disease was associated with psychiatric comorbidity and post-discharge mortality after ACS. Materials and Methods: We retrospectively analyzed a predefined two-center registry extract of 2950 consecutive patients who underwent coronary angiography for ACS. Documented rheumatic disease was identified from diagnoses recorded in admission history, prior medical records, or discharge documentation and was not re-adjudicated. The primary outcome was post-discharge all-cause mortality. Results: Documented rheumatic disease was present in 106 patients (3.6%). Compared with patients without documented rheumatic disease, exposed patients were older, more often women, more often hypertensive, and more likely to have a documented psychiatric disorder (25.5% vs. 14.1%). Short-term mortality was similar, whereas crude overall long-term mortality was higher (27.4% vs. 19.3%). Among hospital survivors with usable follow-up, post-discharge survival was worse (log-rank p = 0.013). Documented rheumatic disease was associated with higher post-discharge mortality in unadjusted analysis (hazard ratio 1.66, 95% confidence interval 1.11–2.48) and in a prespecified parsimonious model (adjusted hazard ratio 1.56, 95% confidence interval 1.04–2.34); the association attenuated and was no longer statistically significant in a broader exploratory model (adjusted hazard ratio 1.35, 95% confidence interval 0.87–2.07). Documented psychiatric disorder independently predicted mortality. Conclusions: In angiography-treated ACS, documented rheumatic disease was associated with greater psychiatric comorbidity and worse post-discharge survival in a small, documentation-defined, heterogeneous subgroup. Because the signal attenuated in broader exploratory adjustment and exposure ascertainment was documentation-based, the findings should be regarded as hypothesis-generating rather than disease-specific or causal. Full article

Background/Objectives: Dementia is a progressive, multifactorial neurodegenerative syndrome that poses a major public health challenge, with an increasing number of cases due to an aging population. Vitamin D (vitD) is crucial not only for bone and calcium homeostasis, but also as a neuroactive steroid that influences brain functions such as neurotransmission, neuroprotection and immunomodulation. Emerging evidence suggests that vitD deficiency may be a modifiable risk factor for the development of dementia. Thus, the aim of this review is to understand the possible role of vitD as a modifiable risk factor in the prevention of dementia. Methods: Research was conducted in the PubMed and Scopus databases using combinations of the MeSH terms ‘calcitriol’, ‘dementia’, ‘vitamin D receptors’, and ‘brain function’ for articles from 2014 until 2026. Results: The analysis of the 30 articles retrieved exhibited a significant association between vitD deficiency and an increased risk of dementia. Longitudinal studies and meta-analyses have indicated an increased risk of dementia and Alzheimer’s disease proportional to the severity of the deficit. A significant association with vascular dementia was also highlighted, with the risk increasing synergistically in the presence of hypertension. Conclusions: The evidence reviewed suggests that both vitD deficiency and insufficiency are strongly associated with increased risk of dementia, particularly Alzheimer’s disease and vascular dementia. Addressing vitD deficiency by maintaining adequate levels is proposed as a potentially effective preventive strategy against cognitive decline and dementia. Full article

Background: Cardiovascular diseases (CVDs) are the leading cause of death in Saudi Arabia, and public knowledge of risk factors and warning signs supports early detection and prevention. This study aimed to assess CVD knowledge and its demographic predictors among adults in the Jazan region. Methods: A cross-sectional study was conducted among 382 adults (≥18 years) between February and April 2025. A questionnaire adapted from prior validated instruments assessed CVD awareness, knowledge of 11 risk factors and 10 warning signs, perceptions, and practices. Total knowledge scores (0–21) were dichotomized as adequate (≥8) versus inadequate (<8). Mann–Whitney U and Kruskal–Wallis tests were used for bivariate analysis, followed by binary logistic regression. Results: Most participants (89.5%) had heard of CVD, yet 53.7% had inadequate knowledge, and only 9.9% demonstrated good knowledge (≥15). The median total knowledge score was 7 (IQR 2–11) out of 21, with warning-sign knowledge (2.96/10) lower than risk-factor knowledge (3.95/11). Overweight/obesity (52.6%), hypertension (51.3%), and smoking (49.5%) were the most recognized risk factors; chest pain (47.6%) and shortness of breath (46.1%) were the most recognized warning signs. University education (aOR = 2.44, 95% CI 1.23–4.85, p = 0.011) and family history of chronic disease (aOR = 2.26, 95% CI 1.32–3.85, p = 0.003) were the only independent predictors of adequate knowledge. Conclusions: More than half of the surveyed adults in the Jazan region had inadequate CVD knowledge despite high general awareness. These findings suggest that targeted education using digital platforms and primary care providers may help improve knowledge of risk factors and warning signs in the region. Full article

Background: Cardiac involvement in cryoglobulinemia (CG) is rare but potentially fatal, and its clinical spectrum remains poorly characterized. Methods: This retrospective study enrolled 11 patients with cardiac involvement among 885 patients with CG at Peking Union Medical College Hospital between January 2015 and March 2026. We analyzed its clinical characteristics, radiological features and management. Results: Among 885 CG patients, 11 (1.2%; 4 type I, 7 type II) had cardiac involvement. Cardiac symptoms included dyspnea (n = 6), chest tightness (n = 4), edema (n = 3), and orthopnea (n = 1). All patients had elevated N-terminal pro-B-type natriuretic peptide (median 29,799 pg/mL). Echocardiography, performed in all 11 patients, revealed left heart enlargement (n = 9), reduced left ventricular ejection fraction (n = 7), myocardial disease (n = 6), pericardial effusion (n = 4), and pulmonary hypertension (n = 3). Cardiac magnetic resonance in 5 of 11 patients showed non-ischemic late gadolinium enhancement in two cases. For first-line therapy, 6 of 11 patients received rituximab-based regimens, 3 of 11 received bortezomib-based regimens, and 1 of 11 received antiviral therapy with corticosteroids; 1 patient declined treatment. All 10 treated patients achieved initial cardiac improvement, with 5 relapsing and 2 dying during a median follow-up of 57 months (range 9–130 months). The estimated 4-year overall and progression-free survival rates were 77.9% (95% CI: 0.546–1.000) and 50.0% (95% CI: 0.269–0.929), respectively. Conclusions: Cardiac involvement in CG is rare and associated with diverse structural and functional abnormalities. Cardiac involvement should be considered in CG patients presenting with unexplained cardiac manifestations after excluding alternative causes. B-cell-targeted therapy induced an initial response, but relapse is common. Early intervention is essential given the substantial relapse burden and potential for severe morbidity. Full article

Background: Type 2 diabetes mellitus (T2DM) in pregnancy is increasingly recognized as a high-risk metabolic condition, frequently accompanied by overweight, obesity, insulin resistance, and adverse maternal and neonatal outcomes. This systematic review and meta-analysis aimed to evaluate body weight-related parameters in pregnancies complicated by T2DM compared with those in non-T2DM control groups. Methods: A systematic search of PubMed, Scopus, and Web of Science was conducted up to 19 August 2025. Original studies reporting body weight, body mass index (BMI), or gestational weight gain (GWG) in pregnant women with T2DM and different control groups were included. Data were synthesized using standardized mean differences (SMDs) with fixed or random-effects models. Maternal, metabolic, delivery, and neonatal outcomes were summarized descriptively. Results: Eighty-seven studies were included in the systematic review and seventy-two were included in the meta-analysis. Pregnant women with T2DM had significantly higher pre-pregnancy body weight and first-trimester body weight than normoglycemic and T1DM controls. Pre-pregnancy BMI was also significantly higher in T2DM pregnancies compared with normoglycemic, T1DM, and gestational diabetes controls. In contrast, GWG did not differ significantly between T2DM and normoglycemic or gestational diabetes pregnancies, while it was significantly lower in T2DM than in type 1 diabetes pregnancies. Adverse maternal and neonatal outcomes, including hypertensive disorders, preterm delivery, fetal growth abnormalities, macrosomia, congenital anomalies, and fetal/neonatal loss, were frequently reported across the included studies. Conclusions: Pregnancies complicated by T2DM are characterized by an unfavorable preconception anthropometric profile. The contrasting patterns across diabetes types suggest different periods for weight-related care: preconception weight optimization appears particularly relevant in T2DM, whereas the higher gestational weight gain observed in T1DM relative to T2DM supports individualized monitoring of gestational weight trajectories during pregnancy. These strategies should be incorporated into comprehensive preconception and antenatal care alongside glycemic optimization and assessment of diabetes-related complications. Full article

Background/Objectives: Catatonia is a severe transdiagnostic neuropsychiatric syndrome for which accessible biological correlates remain insufficiently characterized. This study explored whether complete blood count (CBC)-derived inflammatory indices differ between psychiatric inpatients with catatonia and matched psychiatric controls without catatonia. Methods: This retrospective matched case–control study included 46 patients with catatonia and 46 psychiatric controls selected from the same clinical setting and study period. Controls were frequency-matched by sex, age distribution, and broad psychiatric diagnosis. CBC parameters obtained within the first 24 h of admission were used to calculate the neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), monocyte-to-lymphocyte ratio (MLR), systemic immune–inflammation index (SII), and systemic inflammation response index (SIRI). Group comparisons, adjusted log–linear regression models, Spearman correlations with documented catatonic signs, and exploratory receiver operating characteristic analyses were performed. Results: SII was higher in patients with catatonia than in controls and remained significant after Bonferroni correction (median 584 [IQR 468–823] vs. 476 [IQR 339–619], Bonferroni-adjusted p = 0.032). In secondary adjusted models, catatonia was associated with higher SII and SIRI after adjustment for body mass index, smoking, antipsychotic exposure, diabetes mellitus, and arterial hypertension. No inflammatory index correlated significantly with the number of documented catatonic signs after correction. Exploratory discrimination was poor to fair, with SII showing the highest AUC (0.665, 95% CI 0.550–0.773). Conclusions: CBC-derived indices, particularly SII, may reflect systemic inflammatory or physiological stress burden in catatonia, but they should be interpreted as exploratory markers rather than diagnostic biomarkers. Full article

Hypertension or high blood pressure drives structural and functional cardiac remodelling through sustained pressure overload, oxidative stress, and chronic inflammation. Lifestyle modifications including regular exercise and a healthy diet including fruits and vegetables help in attenuating high blood pressure. Berries are small fruits abundant in polyphenols, vitamins and minerals which provide these fruits with antioxidant and anti-inflammatory properties. One such berry is the Saskatoon berry (Amelanchier alnifolia), which is rich in anthocyanins and procyanidins with demonstrated cardiometabolic activity, yet its effects on hypertension and cardiac remodelling have not been studied. This study evaluated the impact of 16-week Saskatoon berry supplementation on cardiovascular structure, function, inflammation, and oxidative stress in spontaneously hypertensive rats (SHRs). Age-matched Wistar Kyoto (WKY) rats served as normotensive controls. Saskatoon berry supplementation did not significantly lower systolic or diastolic blood pressure in SHRs; however, echocardiography results revealed trends towards attenuation of hypertensive cardiac remodelling. Saskatoon berry supplementation reduced interventricular septal and posterior wall thickness, decreased left ventricular (LV) mass, and partially preserved systolic function, as reflected by improved ejection fraction and fractional shortening. Diastolic relaxation (IVRT) remained impaired, indicating selective effects on systolic rather than lusitropic function. Serum TNF-α and TBARS were not significantly altered, whereas IL-10 was partially restored, suggesting a modest improvement in systemic inflammatory balance. Principal component analysis integrating all hemodynamic, echocardiographic, and biochemical variables revealed a dominant pathological remodelling axis that distinguished WKY from SHRs. Saskatoon berry supplementation shifted SHRs toward an intermediate multivariate phenotype, supporting a coordinated improvement across structural and functional domains despite persistent hypertension. Together, these findings indicate that Saskatoon berry exerts blood pressure-independent cardioprotective effects that mitigate hypertensive LV hypertrophy and preserve systolic performance. Saskatoon berry may represent a promising functional food ingredient for attenuating cardiac remodelling in hypertension. Full article

Background/Objectives: Interleukin-6 (IL-6) is a pro-inflammatory cytokine implicated in the pathogenesis of SLE. Beyond its role in disease activity, IL-6 has also been associated with increased cardiovascular risk, potentially promoting endothelial dysfunction, atherosclerosis, and thromboinflammation. Our study aimed to investigate the associations between IL-6 levels, disease manifestations, organ damage, cardiovascular comorbidities, and treatment regimens in a cohort of SLE patients. Methods: A total of 88 SLE patients were recruited from the Rheumatology Clinic of the Clinical Rehabilitation Hospital, Iași. Disease activity was assessed using the SLE Disease Activity Index (SLEDAI) and irreversible organ damage with the SLICC/ACR Damage Index. Serum IL-6 levels were measured by ELISA. Statistical analyses included Mann–Whitney U tests and Spearman correlation coefficients. Results: Among 88 SLE patients (89.8% female, mean age 51.9 ± 14.8 years), 68.2% presented irreversible organ damage, most frequently cardiovascular (26.1%). Regarding disease manifestations, IL-6 was non-significantly elevated in patients with arthritis, rash, and low complement levels. Serum concentrations also tended to increase with disease severity, being higher in severe compared to moderate activity, and in moderate versus mild activity. Significant associations were found between IL-6 and hypertension (p = 0.027), aortic atherosclerosis (p = 0.034), menopausal status (p = 0.015), and hypercholesterolemia (p = 0.034). No significant differences were observed across treatment subgroups. Conclusions: IL-6 showed limited correlation with SLE clinical activity but was significantly elevated in patients with selected cardiovascular comorbidities. These findings suggest a potential contribution of IL-6 to cardiovascular risk in SLE, warranting further investigation in larger cohorts. Full article

Background: Metabolic-dysfunction-associated steatotic liver disease (MASLD) is associated with adverse outcomes in sepsis, but risk stratification within MASLD remains insufficiently defined. We investigated whether an admission liver–metabolic phenotype framework combining cardiometabolic burden with liver injury/fibroinflammatory risk markers identifies clinically relevant organ-support vulnerability in community-acquired sepsis. Methods: This secondary analysis of the prospective SepsisFAT cohort (378 adults with community-acquired sepsis) classified patients into four phenotypes by cardiometabolic burden (≥2 of: diabetes, hypertension, dyslipidemia, BMI ≥ 30 kg/m²) and liver-risk positivity (FIB-4 ≥ 2.67, APRI ≥ 1.0, liver stiffness ≥ 10 kPa, or FAST ≥ 0.55). The primary outcome was acute kidney injury (AKI), while continuous renal replacement therapy (CRRT), other organ-support outcomes and in-hospital mortality were secondary endpoints. Results: Phenotype distribution was Low-risk 137 (36.2%), Cardiometabolic-only 84 (22.2%), Liver-dominant 88 (23.3%), and Mixed liver–cardiometabolic 69 (18.3%). AKI and CRRT increased across phenotypes (13.9% to 40.6% and 5.1% to 26.1%, respectively), and in-hospital mortality was highest in the Mixed phenotype (26.1%). After Firth-penalized adjustment for age, sex, and admission SOFA, the Mixed phenotype remained independently associated with AKI (aOR 2.82, 95% CI 1.37–5.90) and CRRT (aOR 3.87, 1.50–10.80), confirmed in non-renal SOFA and admission eGFR-adjusted sensitivity analyses. Cardiometabolic burden alone did not confer excess organ-support risk. The same gradient persisted within the MASLD subgroup. Conclusions: Admission liver–metabolic phenotyping identified a renal-vulnerable sepsis subgroup not captured by binary MASLD classification alone. These findings support prospective, multicenter external validation of liver–metabolic phenotyping as a pragmatic approach to renal risk stratification in community-acquired sepsis. Full article

Background: Coronary artery disease (CAD) arises from the convergence of genetic susceptibility, lipid dysregulation, and modifiable environmental exposures. The polymorphism rs4977574, located proximal to the CDKN2A/CDKN2B gene cluster, has been repeatedly implicated in CAD risk across several populations, yet its relationship to intermediate cardiometabolic phenotypes and pharmacological treatment patterns in Saudi individuals remains poorly characterized. Objective: This study aimed to evaluate the association of rs4977574 with CAD status, lipid-related phenotypes, smoking history, obesity, and atorvastatin exposure in a Saudi cardiovascular cohort, and to assess the robustness of observed associations through sensitivity-adjusted analyses excluding participants with major metabolic confounders. Methods: A case–control genetic association study was conducted in Saudi participants with clinically confirmed CAD and healthy controls. Genomic DNA was genotyped for rs4977574 using TaqMan^® allelic discrimination assays. Genotype–phenotype associations were examined using chi-square testing, binary logistic regression under additive and dominant inheritance models, and one-way ANOVA for continuous lipid traits. Hardy–Weinberg equilibrium (HWE) was assessed in controls. Sensitivity analyses were conducted by sequentially excluding participants with obesity, smoking, diabetes mellitus, hypertension, dyslipidaemia, and statin use. Results: After covariate adjustment, rs4977574 was not independently associated with CAD case–control status under any inheritance model. Genotype-stratified analyses identified significant differences in HDL-cholesterol and triglyceride concentrations among cases, with no equivalent effects on total cholesterol or LDL-cholesterol. A significant association was observed between rs4977574 genotype and atorvastatin prescribing patterns. Sensitivity-adjusted analyses were directionally consistent with primary findings. HWE deviation persisted in controls after sequential metabolic exclusions, implicating population stratification or regional genetic heterogeneity rather than sample selection bias. Conclusions: Although rs4977574 did not associate independently with CAD susceptibility, its relationship with HDL-cholesterol, triglycerides, and atorvastatin exposure indicates that this locus contributes to cardiometabolic phenotypic heterogeneity in this Saudi cohort. These findings support phenotype-oriented and pharmacogenetically informed approaches in regional cardiovascular genetics and highlight the need for larger, ancestry-stratified investigations across Middle Eastern populations. Full article